diff --git "a/Text_summarization/task84_mimic_ct_head_and_neck_summarization.json" "b/Text_summarization/task84_mimic_ct_head_and_neck_summarization.json" new file mode 100644--- /dev/null +++ "b/Text_summarization/task84_mimic_ct_head_and_neck_summarization.json" @@ -0,0 +1,30367 @@ +{ + "Contributors": "MIMIC", + "Source": "MIMIC-IV", + "URL": "https://www.physionet.org/content/mimic-iv-note/2.2/", + "Categories": [ + "Summarization" + ], + "Definition": [ + "Summarize the CT imaging diagnostics' detailed findings for the Head_and_neck into a concise conclusion." + ], + "Reasoning": [], + "Input_language": [ + "English" + ], + "Output_language": [ + "English" + ], + "Instruction_language": [ + "English" + ], + "Domains": [ + "Medicine", + "Clinical Reports", + "CT", + "Head_and_neck" + ], + "Positive Examples": [], + "Negative Examples": [], + "Instances": [ + { + "input": "The patient is status post partial left temporoparietal craniotomy and partial\nleft temporal lobectomy. There is moderate amount of fluid and air within the\nsurgical bed. Large amount of pneumocephalus overlying the left frontal and\ntemporal lobe is similar to prior study. There is 5 mm of rightward midline\nshift, unchanged. There is unchanged effacement of the left sided sulci and\nleft lateral ventricle. No definite evidence of intracranial hemorrhage. No\nacute large territorial infarction. Encephalomalacia in the left cerebral\nhemisphere and right cerebral peduncle is unchanged.\n\nA partially visualized right nasoenteric tube is noted. There is atelectasis\nof the right maxillary sinus, which is likely secondary to chronic sinus\ndisease. The visualized portion of the remaining paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are normal.", + "output": "1. Status post left temporoparietal craniotomy and partial left temporal\nlobectomy with expected postsurgical changes. No evidence of intracranial\nhemorrhage.\n2. Stable mass effect with approximately 5 mm of rightward midline shift." + }, + { + "input": "The patient is status post left-sided craniotomy and partial left temporal\nlobectomy and hippocampectomy. There is expected evolving postsurgical\nchange, with a small amount of residual hyperdense material near the surgical\nbed, and improving pneumocephalus. Left convexity subdural fluid measures up\nto 6 mm, not substantially changed. Mostly low attenuating\nextracranial/subgaleal collection measures up to 8 mm. Minimal 3 mm rightward\nmidline shift is improved from ___. There is stable to slightly\nimproved effacement of the left-sided sulci and left lateral ventricle. No\nnew or expanding intracranial hemorrhage. Left cerebral encephalomalacia is\nunchanged.\n\nAgain noted is atelectasis of the right maxillary sinus, likely secondary to\nchronic sinus disease. Partial opacification of the mastoid air cells is\nunchanged. The middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. Status post left-sided craniotomy and partial left temporal lobectomy with\nexpected evolution of postsurgical change, as above.\n2. Slightly improved mass effect from ___ with 3 mm rightward midline\nshift.\n3. No evidence of an acute intracranial complication." + }, + { + "input": "There is 1.6 cm x 1.4 cm acute parenchymal hematoma centered on the upper left\nthalamus and caudate body, extending into adjacent corona radiata, internal\ncapsule and posterior left putamen, mild surrounding edema. Compared with\nhead CT ___ at 00:42 parenchyma hematoma is stable surrounding\nmild edema slightly more prominent. Mild volume intraventricular extension of\nhemorrhage, more prominent, with blood in the left greater than right lateral\nventricles, including left temporal horn. No hydrocephalus. In ___, there\nacute was hemorrhage centered in the left thalamus.\n\nModerate sized chronic infarct right parietal lobe, stable. Probably moderate\nchronic small vessel ischemic changes, similar to prior. Mild generalized\nbrain parenchymal atrophy. No evidence of midline shift or on uncus\nherniation. Patent foramina magnum, suprasellar and prepontine cisterns.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Stable parenchymal hemorrhage centered on left thalamus. Mild\nintraventricular extension of hemorrhage, mildly worsened since prior. No\nhydrocephalus.\n\nChronic moderate size right parietal lobe infarct. Moderate chronic small\nvessel ischemic changes. Mild brain parenchymal atrophy.\n\nRECOMMENDATION(S): Follow-up to resolution." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territorial infarct. Prominence of the\nventricles and sulci is consistent with involutional changes. Punctate\nthalamic lacunar infarcts are again seen. Previously seen right pons lacunar\ninfarct is subtly seen, better seen on the prior study. Old left occipital\ninfarct is also again demonstrated.. The visualized paranasal sinuses\ndemonstrate opacification of a right sided ethmoid air cell. Otherwise, the\npartially imaged paranasal sinuses are grossly clear. The mastoid air cells\nare clear. No acute fracture is seen.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute fracture, infarction,hemorrhage,edema, or mass. \nLeft occipital encephalomalacia and lacunar right thalamic infarct are again\nnoted, also seen on prior. Periventricular and subcortical white matter\nhypodensities, nonspecific but probably reflect sequela of chronic\nmicroangiopathy There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear.", + "output": "No acute intracranial process." + }, + { + "input": "Hyperdense sulci involving the right frontal, as well as bilateral temporal\nand parietallobes is consistent with subarachnoid hemorrhage. There is a\nsmall subdural hematoma layering along the right frontal convexity (series 2,\nimage 18). Hemorrhage all seen layering within the interpeduncular cistern. \nThickening of the bilateral leaflets of the tentorium also suggestive of small\nsubdural hematomas. There are small bilateral temporal lobe contusions with\nsurrounding vasogenic edema (series 2, image 15). There is no significant\nshift of midline structures. The basilar cisterns are patent. The ventricles\nand sulci normal in size and configuration. Small calcific extra-axial\ndensity overlying the left parietal lobe may represent calcifications of the\nfalx or potentially calcified meningioma.\n\nThere is an acute fracture in the left temporal bone extending into the left\nexternal auditory canal and also likely into the left middle ear (series 3,\nimage 25). There is a possible associated extra-axial hematoma which in the\nsetting of the left temporal bone fracture is concerning for an epidural\nhematoma. Nondisplaced fracture seen extending superiorly to involve the\nparietal bone as well.\n\nIncreased density material in the sphenoid and ethmoidal air cells is\nconsistent with hemorrhage. No other fracture identified. There is mild\nmucosal thickening of the bilateral maxillary sinuses. There is a small\nsubgaleal hematoma overlying the left parietal bone.", + "output": "1. Left temporal bone fracture extending into the left external auditory\ncanal and likely the middle ear. Possible associated small extra-axial\nhematoma, possibly an epidural hematoma, is noted just adjacent to the left\ntemporal bone fracture.\n2. Subarachnoid hemorrhage involving the right frontal as well as bilateral\ntemporal and parietal sulci.\n3. Small subdural hematoma extending into the right frontal convexity\n4. Probable extension of the subdural hematomas along the tentorium.\n5. Small bitemporal cerebral contusions.\n\nRECOMMENDATION(S): Findings 1 through 3 discussed in person with the surgical\nteam on ___ at 21:40, 5 minutes after discovery. Final impression\ndiscussed with Dr. ___ by NSR via telephone on ___ at 23:15." + }, + { + "input": "Evolving left temporoparietal scalp soft tissue swelling and subgaleal\nhematoma are again seen.\n\nAgain seen is diffuse subarachnoid hemorrhage, not significantly changed from\nthe prior study. The right frontal subdural hematoma is also unchanged, now\nmeasuring 4 mm in maximal diameter (see 02:16). Bitemporal hemorrhagic\ncontusions are again seen. There is unchanged sizing configuration of the\nventricles and sulci. There is no shift of normally midline structures and\nthe basal cisterns appear patent.\n\nThe left temporal bone fracture is again visualized extending into the left\nexternal auditory canal and the left middle ear with complete opacification of\nthe left middle ear. Nasogastric and endotracheal tubes are partially\nvisualized. Nonspecific opacification of the paranasal sinuses and\nnasopharynx are again seen, which may be related to intubation status.", + "output": "1. Evolving left temporoparietal scalp soft tissue swelling and subgaleal\nhematoma.\n2. Stable diffuse subarachnoid hemorrhage, right subdural hematoma, measuring\nup to 4 mm in maximum diameter and bike temporal parenchymal hemorrhagic\ncontusions.\n3. Stable nondisplaced left temporal bone fracture." + }, + { + "input": "There is stable to minimal decrease of diffuse subarachnoid hemorrhage. The\nright frontal subdural hematoma is also unchanged from prior measuring 4 mm in\nthe inner table. Hemorrhagic contusion in the right temporal lobe appears\nstable. There is no evidence of acute hemorrhage. The ventricles and sulci\nare unchanged in size and configuration. No evidence of midline shift. The\nbasal cisterns appear patent.\n\nThe left temporal bone fracture is is better visualized on prior examination\n(see 4:9 on current study and 03:17 on ___ prior exam).\n\nSoft tissue swelling overlying the left parietal bone is unchanged. Mild\nmucosal thickening of bilateral maxillary sinuses noted. Near complete\nopacification of the ethmoid air cells and near complete opacification of the\nright sphenoid sinus likely secondary to endotracheal intubation. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Stable to minimal decrease in diffuse subarachnoid hemorrhage.\n2. Stable subdural hematoma and bilateral temporal lobe hemorrhagic\ncontusions.\n3. Stable appearance of the ventricles and sulci without evidence of midline\nshift.\n4. Stable nondisplaced left temporal bone fracture." + }, + { + "input": "CT head: There is hyperdense subarachnoid hemorrhage at the at the bilateral\ntemporal lobe sulci, bilateral sylvian fissures, and bilateral cerebral\nconvexities, right greater than left, which has decreased in comparison to\nprior study. There are evolving hypodense cortical contusions involving the\nbilateral anterior temporal lobes, right greater than left, with mild amount\nof parenchymal hemorrhage. There is a small amount of hyperdense blood\nlayering within the bilateral occipital horn lateral ventricles and within the\ninterpeduncular cistern. There is mild prominence of the ventricles and\ncortical sulci consistent with volume loss. There is no midline shift or\ndownward herniation. There is a 2 mm left parietal convexity dural\ncalcification versus calcified meningioma (5:294).\n\nThe orbits are unremarkable. There is a small subgaleal hematoma. There is a\nminimally displaced fracture of the left parietal and squamous temporal\ncalvarium. There is a nondisplaced longitudinal fracture of the left mastoid\ntemporal bone extending into the middle ear with associated hemotympanum. \nThere is opacification of the right middle ear. There is mild mucosal\nthickening within the bilateral maxillary sinuses. There is near complete\nopacification of the bilateral ethmoid sinuses and partial opacification of\nthe frontal sinuses, left greater than right. There is complete opacification\nof sphenoid sinus with central hyperdensity.\n\nCTA head: There is motion artifact at the skullbase which limits spatial\nresolution. There is calcification of the bilateral intracranial internal\ncarotid arteries, which are patent. The bilateral posterior communicating\narteries are visualized. The anterior communicating artery is not\ndefinitively seen. There is a left fetal origin posterior cerebral artery. \nThere are codominant vertebral arteries. The anterior and posterior arterial\ncirculations are patent without occlusion, dissection, significant stenosis,\nor aneurysm. There is normal dural venous sinus enhancement. There is no\nevidence of vascular malformation.\n\nCTA neck: There is a 3 vessel aortic arch. No the carotid arteries are\npatent without significant stenosis by NASCET criteria. There is motion\nartifact at the thoracic inlet which limits spatial resolution. The vertebral\narteries are patent and demonstrate codominance.\n\nThere is a nasoenteric and endotracheal catheters in place with fluid layering\nwithin the nasopharynx. The thyroid and salivary glands are unremarkable. \nThe masticator and parapharyngeal spaces are unremarkable. There are no\nsuspicious lymph nodes by size or morphology. There are multilevel\ndegenerative changes of the cervical spine. There is a comminuted fracture of\nthe distal right clavicle with inferiorly displaced fracture fragment measured\n1.8 cm with adjacent hematoma (5:99). There is multifocal airspace disease\nwithin the lung apices. There are small bilateral pleural effusions, right\ngreater than left.", + "output": "1. Patent intracranial and neck vasculature without occlusion, dissection,\nsignificant stenosis, or aneurysm.\n2. Hyperdense subarachnoid hemorrhage at the bilateral temporal lobe sulci and\ncerebral convexities, right greater than left, which have decreased in\ncomparison to prior study. Small amount of subarachnoid blood layering within\nthe bilateral occipital horn lateral ventricles and interpeduncular cistern.\n3. Evolving bilateral anterior temporal lobe hemorrhagic contusions, right\ngreater than left.\n4. Re- demonstration of a left parietal temporal calvarial fracture and\nlongitudinal mastoid temporal fracture extending into the middle ear with\nassociated hemotympanum. These are better characterized on dedicated temporal\nbone CT from ___ and head CT from ___.\n5. Significant paranasal sinus disease with hyperdense fluid within the\nsphenoid sinus which may represent blood versus inspissated secretions.\n6. Comminuted fracture of the distal right clavicle with inferiorly displaced\nfracture fragment an adjacent hematoma.\n7. Multifocal airspace disease with small bilateral pleural effusions, right\ngreater than left, suspicious for aspiration and/or pneumonia." + }, + { + "input": "Previously seen hemorrhage has resolved. Encephalomalacia is seen in both\ntemporal region from evolution of previously seen contusions. There is no new\nhemorrhage seen. Mild to moderate brain atrophy identified. There is no\nmidline shift or hydrocephalus. The previously seen or fractures less\nseparate.", + "output": "No acute abnormalities. Resolution previously seen hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial hemorrhage. No large territorial infarction. No\nskull fractures. No midline shift or other mass effect." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. Periventricular white matter\nhypodensity likely represents sequela of chronic small vessel disease.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses demonstrate minimal mucosal thickening in the bilateral maxillary\nsinuses. The remainder of the imaged paranasal sinuses are clear. The\nmastoid air cells and middle ear cavities are clear.", + "output": "1. No acute intracranial hemorrhage. If clinically indicated, consider MRI\nfor better evaluation for acute ischemia" + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of acute large territorial infarct or acute intracranial\nhemorrhage.\n2. Within limits of this noncontrast examination, no definite evidence of\nintracranial mass.\n3. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct or intracranial mass." + }, + { + "input": "CT HEAD:\nThere is no evidence for acute hemorrhage, vascular territorial infarction,\nmass effect, or edema. A rounded hypodensity in the left basal ganglia\n(02:15) may represent a chronic lacunar infarction versus prominent\nperivascular space. The ventricles and sulci are mildly prominent compatible\nglobal parenchymal volume loss.\n\nA mucous retention cyst is seen in the right maxillary sinus. The remainder\nof the paranasal sinuses, middle ear cavities, and mastoid air cells are\nclear. The patient is status post bilateral lens resections..\n\nCTA HEAD AND NECK:\nThere is a normal 3 vessel aortic arch identified. The vertebral arteries are\npatent without high-grade stenosis or occlusion.\n\nThe bilateral common carotid arteries are patent. There is no evidence of\ninternal carotid stenosis by NASCET criteria.\n\nThe cavernous carotid arteries are tortuous bilaterally. Again, there is a\n3-4 mm left M1/M2 bifurcation aneurysm which is laterally directed (3:\n272-274). Probable infundibular origin is seen at the right M1/M2 bifurcation\n(3:276).\n\nAdditional, probable infundibula are seen inferiorly directed extending from\nthe bilateral cavernous/supraclinoid internal carotid arteries (3:274 on the\nleft, 3:275 an 277 on the right). These are unchanged from the previous\nexamination. In addition, there is a probable infundibulum arising from the\nright lateral aspect of the anterior communicating artery (3:276) also\nunchanged.\n\nNo additional sites of potential aneurysm formation are identified\nintracranially. There is no evidence of high-grade vessel stenosis or\nocclusion. The dural venous sinuses are patent.\n\n\nOTHER:\nThe lungs apices are clear bilaterally. A small, punctate calcified granuloma\nin the left lung apex unchanged. The thyroid is again heterogeneous with a\nlarge, 5.6 cm right-sided thyroid nodule causing rightward displacement of the\nright subclavian and common carotid arteries. Prominent bilateral cervical\nlymph nodes are identified, none of which are pathologically enlarged by CT\nsize criteria.", + "output": "1. No evidence for acute intracranial hemorrhage or vascular territorial\ninfarction.\n2. Unchanged, 3-4 mm laterally directed aneurysm extending from the left M1/M2\nbifurcation.\n3. Additional sites of probable infundibular origins versus small aneurysms\ninvolving the right M1/M2 bifurcation, bilateral cavernous/supraclinoid ICAs,\nand anterior communicating artery.\n4. No additional sites of potential aneurysm are identified intracranially. \nNo evidence of high-grade vessel stenosis or occlusion.\n5. Unchanged heterogeneous thyroid with a dominant right-sided nodule\nmeasuring up to 5.6 cm. As previously noted, not dedicated nonurgent thyroid\nultrasound is recommended for further evaluation.\n\nRECOMMENDATION(S): As previously noted, not dedicated nonurgent thyroid\nultrasound is recommended for further evaluation.\n\nNOTIFICATION: Updated findings were conveyed by Dr. ___ to the ___ QA\nnurses via email at 15:29 on ___, 2 minutes after interpretation\nof the findings." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, shift of normally midline\nstructures, or evidence of acute major vascular territorial infarction. No\nevidence of intracranial masses or vasogenic edema. Ventricles and sulci are\nmildly prominent consistent with age-related involutional changes.\n\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process. No evidence of intracranial mass within the\nlimits of this noncontrast CT scan." + }, + { + "input": "CTA NECK:\nThere is a normal 3 vessel aortic arch identified. Evaluation of the distal\nV2 and V3 segments is somewhat limited secondary to extensive streak artifact\nfrom dental amalgam. Allowing for this, the vertebral arteries appear patent\nbilaterally.\n\nThe bilateral common carotid arteries are patent. There is no evidence of\ninternal carotid stenosis by NASCET criteria.\n\nNondedicated imaging of the intracranial arterial vasculature demonstrates a\nprobable 2-3 mm left M1/M2 bifurcation aneurysm (2:270). At the right M1/M 2\nbifurcation, there is an additional questionable, 1-2 mm aneurysm (601:23).\n\nProbable small infundibula are also noted extending inferiorly from the\ncavernous internal carotid arteries, measuring 3-4 mm on the left (2:272) and\n2mm on the right (2:274).\n\nAllowing for this, the visualized portions of the intracranial vasculature\nappear patent without high-grade stenosis. The left posterior communicating\nartery is patent, a normal variant. The patient is status post bilateral lens\nresections.\n\n\nOTHER:\nThe lungs apices are clear bilaterally. A small calcified granuloma is seen\nwithin the left lung apex. A heterogeneous, 4.2 x 3.1 x 5.6 cm right-sided\nthyroid nodule is incidentally noted, causing rightward displacement of the\nright subclavian and common carotid arteries.. Multiple prominent cervical\nlymph nodes are seen bilaterally, measuring up to 7 mm in short axis at the\nleft level 2a station (2:139). None of which are pathologically enlarged by\nCT size criteria.", + "output": "1. Grossly patent cervical vasculature without high-grade stenosis, occlusion,\nor evidence for dissection.\n2. Included portions of the intracranial vasculature demonstrate several\nprobable small aneurysm at the bilateral M1/M2 bifurcations, measuring 2-3 mm\non the left and 1-2 mm on the right. Recommend follow-up examination with\ndedicated brain CTA or MRA for further evaluation.\n3. Small bilateral cavernous ICA infundibulum versus additional sites of small\naneurysm.\n4. 5.6 cm heterogeneous right-sided thyroid nodule, for which dedicated\nthyroid ultrasound is recommended on a nonurgent basis.\n\nRECOMMENDATION(S): 1. Multiple small apparent intracranial aneurysms. \nRecommend dedicated brain CTA or MRA.\n\n2. Thyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or ___, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150.\n\nNOTIFICATION: As the ordering physician ___ is not in the\n___ patging directory, the impression and recommendation above was entered\nby Dr. ___ on ___ at 13:31 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." + }, + { + "input": "There is a 2.7 cm x 4.3 cm x 3.9 cm peripherally enhancing, centrally necrotic\nlymph node at the left station II cervical chain, deep to the\nsternocleidomastoid, posterior to the submandibular gland, and lateral to the\ncarotid (02:52).\n\nThere is a 1.2 cm TV x 1.9 cm AP x 2.2 cm SI heterogeneous, centrally\ncalcified lymph node at right station III cervical chain (2:62; 06:19).\n\nThere are no additional suspicious lymph nodes by size or morphology. There\nis a 1.1 cm hypodense nodule within the right thyroid lobe (2:77). There is a\ncoarse calcification within the right thyroid lobe measuring 6 mm (2:74). The\nsalivary glands are unremarkable. There is mild asymmetric prominence of the\nleft palatine tonsil (02:48), otherwise the pharynx and larynx are\nunremarkable.\n\nThere is asymmetric enlargement of the left mylohyoid muscle with ill-defined\nlow-density lesion within the deep fibers measuring approximately 2.7 cm SI x\n0.9 cm TV x 2.9 cm AP (02:55; 05:20).\n\nThere is mild mucosal thickening within the bilateral frontal sinuses and\npartial opacification of the ethmoid sinuses. The mastoid air cells and\nmiddle ears are clear. The masticator and parapharyngeal spaces are\nunremarkable. There is artifact from dental almalgam that obscures adjacent\nstructures, otherwise the dentition is intact. There is anterior cervical\nfusion from C5 through C7 with intact hardware and osseous ___.\n\nThe vasculature is patent with calcific atherosclerosis at the bilateral\ncarotid bifurcations and bulbs. There is a 7 mm AP x 4 mm TV x 6 mm SI oval\nhyperdense mass at the dorsum sella (05:29; 06:34; 02:17) which has similar\nattenuation as the circle ___. This may represent an aneurysm or a dense\nor enhancing mass, perhaps arising from the infundibulum.\n\nThere is motion artifact. The lung apices which limit spatial resolution. \nWithin this limitation, the lung apices are clear.", + "output": "1. 2.7 x 4.3 x 3.9 cm peripherally enhancing, centrally necrotic lesion a\ncervical chain lymph node suspicious for neoplastic nodal disease.\n2. Asymmetric enlargement of the left mylohyoid muscle with ill-defined focal\narea of hypodensity within the anterior deep fibers which could represent a\nlesion versus denervation. This could be further characterized with dedicated\nneck MRI.\n3. Asymmetric enlargement of the left palatine tonsil. Recommend direct\nvisualization to assess for a mucosal lesion.\n4. 1.2 x 1.9 x 2.2 cm microlobular lesion at right station III deep cervical\nchain which demonstrates T2 hyperintensity on prior MR from ___\nand is relatively unchanged in size as compared to ___. Findings\nfavor calcified phleboliths within a venolymphatic malformation with\ndifferential including a calcified lymph node. This is likely benign given\nits stability in comparison to ___.\n5. 1.1 cm nodule within the right thyroid lobe. Per the ___ College of\nRadiology guidelines, absent higher risk clinical indicators, incidental\nthyroid nodules less than 1.5 cm in patient's greater than ___ years of age do\nnot require ultrasound evaluation.\n6. 7 x 4 x 6 mm oval hyperdense suprasellar mass at the dorsum sella. \nRecommend dedicated noncontrast head CT to assess for calcification and head\nand pituitary MRI and MRA for further characterization.\n\nRECOMMENDATION(S): Recommend dedicated noncontrast head CT and head and\npituitary MRI with head MR angiogram to further characterize the suprasellar\nlesion.\nRecommend direct visualization of the pharynx to evaluate for a left palatine\ntonsil mucosal lesion.\nConsider dedicated neck MRI to evaluate the left mylohyoid lesion.\n1.1 cm nodule within the right thyroid lobe. Per the ___ College of\nRadiology guidelines, thyroid nodules less than 1.5 cm in patient's greater\nthan ___ years of age do not require imaging follow up." + }, + { + "input": "There is no evidence of acute hemorrhage mass effect midline shift or\nhydrocephalus. Gray-white matter differentiation is maintained. There is\nslight prominence seen within the suprasellar region where a mass was\nidentified on the MRI of the pituitary gland of ___. No\ncalcification is identified.\n\nThe visualized paranasal sinuses are clear. No skull fracture is seen.", + "output": "No acute intracranial abnormalities are identified. No suprasellar\ncalcification is seen." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nPreviously noted thickening of the infundibulum is not well assessed on the\ncurrent exam.\n\nThere is no evidence of acute fracture. There is partial opacification of the\nright more so than left mastoid air cells. Mild mucosal thickening is noted\nin the ethmoid air cells and bilateral frontal sinuses. The visualized\nportion of the sphenoid sinus, left mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable. There are\nmultiple dental caries in the imaged maxillary teeth. Incisive canal cyst is\nnoted.", + "output": "1. No acute intracranial abnormalities on the noncontrast head CT.\n2. Multiple dental caries in the imaged maxillary teeth. Further assessment\nwith dental exam is recommended.\n3. Mild sinus disease and partial right mastoid air cell opacification." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass. The ventricles and sulci are prominent consistent with age related\natrophy. Periventricular and subcortical white matter hypodensities are\nnonspecific, but likely reflect the sequela of chronic microvascular\ninfarction.\n\nNo acute osseous abnormalities seen. Incidental note is made of congenital\nnonunion of the posterior arch of C1. The paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The orbits are unremarkable apart\nfrom right lens replacement. Dense atherosclerotic calcifications of the\ncavernous carotid arteries and mild to moderate atherosclerotic calcifications\nof the V4 segments of the distal vertebral arteries.", + "output": "No acute intracranial abnormality." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. There is mild\nprominence of the ventricles and sulci suggestive of involutional changes.\nMild periventricular white matter hypodensities in a configuration most\nsuggestive chronic small vessel ischemic disease.\n\nThere is mild mucosal wall thickening in the right frontoethmoidal recess and\nright frontal sinus. The remainder of the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is a left dominant vertebrobasilar system. There are mild\ncalcifications of the bilateral intracranial internal carotid arteries without\nsignificant stenosis. The vessels of the circle of ___ and their principal\nintracranial branches appear patent without significant stenosis, occlusion,\nor aneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is heavy calcified and noncalcified atherosclerotic plaque in the aortic\narch. There are atherosclerotic calcifications at the origin of the great\nvessels, without significant stenosis. There is moderate stenosis at the\norigin of the right subclavian artery. There is mild narrowing at the origin\nof the bilateral vertebral arteries secondary to atherosclerotic\ncalcification. There is mild narrowing of the V1 segment of the left\nvertebral artery secondary to atherosclerotic calcification (7:98). There is\nadditionally punctate atherosclerotic calcification in the proximal V2 segment\nof the left vertebral artery.\n\nThere are severe bilateral atherosclerotic calcifications of the carotid\nbifurcations. There is near complete occlusion of the right internal carotid\nartery at the level of the bifurcations with a thin wisp of residual contrast\nflow (7:141). There is roughly 50% stenosis of the left internal carotid\nartery by NASCET criteria.\n\nThe carotid and vertebral arteries and their major branches are otherwise\npatent with no evidence of occlusionor dissection.\n\nOTHER:\n8 mm triangular left apical nodule is unchanged from the prior chest CT\nexamination. The visualized portion of the thyroid gland is within normal\nlimits. There is no lymphadenopathy by CT size criteria. There is moderate\nmultilevel cervical spondylosis.", + "output": "1. Near occlusion of the right internal carotid artery at the level of the\ncarotid bifurcation with thin wisp of residual contrast flow.\n2. 50% stenosis of the left internal carotid artery by NASCET criteria.\n3. Scattered cervical atherosclerotic disease, as described, with cervical\nvasculature otherwise patent without occlusion or dissection.\n4. No acute intracranial abnormality.\n5. Patent intracranial vasculature without significant stenosis, occlusion, or\naneurysm.\n6. Stable 8 mm triangular left apical subpleural nodule.\n\nRECOMMENDATION(S): Follow-up chest CT examination is recommended in ___, as recommended on the prior chest CT examination." + }, + { + "input": "There is no evidence of acute large territory infarction,intracranial\nhemorrhage,edema,or discrete mass. There is prominence of the ventricles and\nsulci suggestive of involutional changes. Periventricular and subcortical\nwhite matter hypodensities are nonspecific but compatible with chronic small\nvessel disease changes.\n\nLeft parietal burr hole is again seen. There is no evidence of fracture. \nSoft tissue density seen in the left external auditory canal, compatible with\ncerumen. The visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Involutional and chronic small vessel disease changes." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence for acute hemorrhage, edema, mass effect, or acute major\nvascular territorial infarction. Unchanged hypodensity in the left frontal\nsubcortical white matter on image 2:22, nonspecific but likely secondary to\nchronic small vessel ischemic disease based on the prior MRI. Mild prominence\nof the ventricles and sulci is again seen indicating mild global parenchymal\nvolume loss. All components of the left lateral ventricle a larger than the\nright, as before, which may be secondary to congenital or developmental\nfactors. Basal cisterns are preserved.\n\nLeft anterior parietal burr hole is again noted. Mild mucosal thickening in\nthe ethmoid air cells. Small mucous retention cyst in the right maxillary\nsinus. Mastoid air cells and middle ear cavities are well aerated. Left\nmastoid is underpneumatized. The orbits appear unremarkable.\n\nCTA NECK:\nConventional branching of the great vessel origins. Mild calcified plaque at\nthe left subclavian artery origin without flow-limiting stenosis. There is\nminimal noncalcified plaque in the proximal right ICA and mild mixed,\npredominantly noncalcified plaque in the proximal left ICA, without stenosis\nby NASCET criteria. Left vertebral artery is dominant. No evidence for\nflow-limiting stenosis in the right or left cervical vertebral arteries.\n\nCTA HEAD:\nThere is minimal calcified plaque in the carotid siphons and in the\nintracranial left vertebral artery without flow-limiting stenosis. Non\ndominant intracranial right vertebral artery is hypoplastic. There is\notherwise no evidence for flow-limiting stenosis in the major intracranial\narteries. No evidence for an aneurysm. The dural venous sinuses are patent.\n\nThe right intradural vertebral artery is diminutive, and the left vertebral\nartery is dominant. Otherwise the basilar artery, and the bilateral vertebral\nartery are unremarkable. There is no evidence of high-grade occlusion,\naneurysm, or vascular malformation.\n\nOTHER:\nRight submandibular gland is atrophic. No lymphadenopathy by CT criteria. \nThe thyroid is partially obscured by streak artifact from concentrated\ncontrast in the bilateral lower cervical and upper chest wall veins, but\ngrossly unremarkable in appearance.\n\nThere is moderate calcified pleural/parenchymal scarring at the lung apices,\npresent dating back to multiple prior studies, for example a chest CT from ___.\n\nThere are degenerative changes in the cervical spine. A sclerotic lesion in\nthe right C3 vertebral body on image 3:164 was not associated with edema on\nthe last cervical spine MRI from ___, probably a bone island.", + "output": "1. No evidence for acute intracranial abnormalities. MRI would be more\nsensitive for an acute infarction or recurrent lymphoma, if clinically\nwarranted.\n2. Mild bilateral proximal ICA atherosclerosis without stenosis by NASCET\ncriteria.\n3. No evidence for flow-limiting stenosis in the major intracranial arteries. \nMinimal atherosclerosis of bilateral carotid siphons and intracranial left\nvertebral artery." + }, + { + "input": "There is a 20 x 12 mm soft tissue mass adjacent to the maxillary alveolus in\nthe pre maxillary region (4: 76) which mildly enhances compared to the\nadjacent musculature. There is no underlying bony erosion identified. There\nis no regional lymphadenopathy seen. Mild mucosal thickening is identified\nwithin the maxillary sinuses with a retention cyst in the alveolar recess of\nright maxillary sinus. Mild mucosal thickening identified adjacent to both\ninfundibula of ostiomeatal units. No periapical lucencies about the maxillary\nteeth identified.\n\nThere is no evidence of soft tissue mass or asymmetry within the\nsphenopalatine recesses or cavernous sinus. Both orbits are symmetric and\nnormal in appearance without intra or extraconal mass lesion. Both globes\ndemonstrate normal appearances.\n\nNo enhancing brain lesions are identified in the partially visualized brain. \nMild mucosal thickening is seen in the remaining sinuses without fluid levels\nor aerosolized secretions.\n\nThe mandible shows normal appearances without periapical lucencies or bony\nerosion.", + "output": "1. 20 x 12 mm soft tissue mass in the pre maxillary region is overall\nunchanged compared to the previous MRI of ___. No regional\nlymphadenopathy is identified or underlying bony erosion is seen.\n2. Mild mucosal thickening in maxillary sinuses.\n3. No intra orbital mass lesions.\n4. No asymmetry or mass in the sphenopalatine recesses or cavernous sinuses." + }, + { + "input": "A subtle area of hypodensity in the left thalamus (02:13), extending into the\nleft cerebral peduncle (02:12) is new compared to the prior CT from ___, and no correlating abnormality in this area was identified on the prior\nMRI from ___. There is no intracranial hemorrhage, edema, mass effect,\nor acute vascular territorial infarction. A focal hypodensity in the deep\nwhite matter of the left frontal lobe (02:22) is similar compared to the prior\nCT and MRI. The ventricles and sulci are unchanged in size and configuration,\nwith persistent slight asymmetric enlargement of the left lateral ventricle\ncompared to the right. There is no shift of the normally midline\nstructures.The basal cisterns appear patent and there is preservation of the\ngray-white matter differentiation.\n\nA left frontal burr hole defect is again seen. No fracture or suspicious\nosseous lesion is identified.The included paranasal sinuses, and middle ear\ncavities are clear. The mastoids are underpneumatized.", + "output": "1. New subtle areas of hypodensity in the left thalamus extending into the\nleft cerebral peduncle could represent progression of lymphoma. A dedicated\nMRI with and without contrast is recommended.\n2. No acute intracranial hemorrhage is seen." + }, + { + "input": "There is no evidence of acute territorial infarction or hemorrhage. Left\nposterior limb of the internal capsule hypodensity extending into the left\ncerebral peduncle is again noted, and corresponds to the abnormalities seen on\nFLAIR sequence on recent MRI. Focal white matter hypodensity in the left\nfrontal centrum semiovale (02:22) is nonspecific, but may be due to chronic\nsmall vessel ischemic disease. Mild prominence of the ventricles and sulci is\nsuggestive of age-appropriate involutional changes.\n\nLeft frontal burr hole is again seen. Mucosal thickening in the left\nmaxillary sinus is minimal. There is mild mucosal thickening in the ethmoid\nair cells, sphenoid sinuses, and left frontoethmoidal recess. The mastoid air\ncells and middle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No acute intracranial hemorrhage or new mass effect.\n2. Hypodensity within the posterior limb of the left internal capsule\nextending into the left cerebral peduncle appears similar to the signal\nabnormalities seen on prior MRI and are better assessed on that modality. No\nnew gross lesions are identified on this CT exam, but MRI with contrast is a\nmore sensitive study." + }, + { + "input": "Right frontal scalp hematoma demonstrates mixed attenuation, predominantly\nhypodense, contains scattered foci of gas, likely reflecting recent\nintervention, and currently measures 17 mm in greatest thickness (2:19),\npreviously 22 mm. No underlying calvarial fracture identified. No new scalp\nor intracranial hematoma identified.\n\nThere is no acute large territorial infarction, edema or mass. There is no\nshift of normally midline structures. Basal cisterns are patent and there is\npreservation of gray-white matter differentiation. Scattered periventricular\nand subcortical white matter hypodensities are nonspecific, though likely the\nsequelae of chronic small vessel ischemic disease. Prominent ventricles and\nsulci suggest age-related involutional changes.\n\nVisualized paranasal sinuses, mastoid air cells and middle ear cavities are\nclear. Visualized portions of the orbits are unremarkable. Moderate\natherosclerotic calcification of the cavernous portions of the bilateral\ninternal carotid arteries are noted.", + "output": "1. Interval decrease in size of mixed-attenuation, predominantly hypodense\nright frontal scalp hematoma, currently measuring 17 mm in greatest thickness\nand containing scattered foci of gas, likely reflecting recent intervention.\n2. No acute large territorial infarction or intracranial hemorrhage.\n3. Chronic changes, including age-related global atrophy and white matter\nsmall vessel ischemic disease." + }, + { + "input": "Allowing for patient motion and beam hardening artifact which limits\nevaluation of posterior fossa, there are multiple hyperdensities with\nsurrounding edema involving the bilateral cerebellar hemispheres. This\nresults in compression of the fourth ventricle and secondary obstructive\nhydrocephalus with enlargement of the lateral and third ventricles, new from\nthe previous examination. There is crowding involving the prepontine cistern\nand foramina magnum, also new from the previous examination.\nThere is high density along the tentorium bilaterally, suggesting subdural\nhemorrhage. High density in the cerebellar sulci suggest a component of\nsubarachnoid hemorrhage.\n\nNo additional sites of definite intracranial hemorrhage are identified. There\nis no evidence of recent supratentorial infarction. No evidence for\ntransependymal flow of CSF. A chronic infarct within the left corona radiata\nis noted.\n\nThe paranasal sinuses and mastoid air cells are clear. Patient is status post\nright lens replacement. Cervical posterior fusion hardware is partially\nimaged.", + "output": "1. Motion degraded examination, particularly affecting evaluation of the\nposterior fossa.\n2. Bilateral cerebellar hemorrhage with surrounding edema that compress the\nfourth ventricle, new from prior examination.\n3. This results in new obstructive hydrocephalus involving the lateral and\nthird ventricles. Crowding is seen at the prepontine cistern and upper\nforamina magnum, worrisome for early inferior herniation. Consultation with\nNeurosurgery, followed by Neurology, is recommended.\n4. Subdural hematoma along the tentorium and subarachnoid hemorrhage are\npresent in the posterior fossa.\n\nNOTIFICATION: Findings were conveyed by Dr. ___ to Dr. ___\ntelephone at 16:35 on ___, 2 minutes after interpretation." + }, + { + "input": "Re-demonstrated are multiple posterior fossa hyperdensities with surrounding\nedema involving the bilateral cerebellar hemispheres, with blood tracking\nalong the bilateral tentorium. The fourth ventricle is compressed as on prior\nwith secondary obstructive hydrocephalus and enlargement of the lateral and\nthird ventricles. Basilar cistern crowding most prominent at the prepontine\ncistern and foramina magnum appears unchanged from earlier same day study.\n\nOverall, fourth ventricular compression, posterior fossa mass effect, and\nhydrocephalus are worse than on the prior study. Tentorial subdural hematoma\nalso appears somewhat worse.\n\nHypodensity over the left corona radiata is unchanged. No displaced calvarial\nfractures are noted. The visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. Patient is status post right\nlens replacement. Cervical fixation screws and hardware is partially imaged\nthrough C2.", + "output": "1. Increase posterior fossa mass effect, fourth ventricular compression, and\nhydrocephalus since the earlier study of ___.\n2. Increase in tentorial subdural hematoma.\n3. Bilateral cerebellar hemisphere hemorrhage and edema suggesting hemorrhagic\ninfarction.\n\nNOTIFICATION: The findings were discussed with the neurosurgical team, M.D.\nby ___, M.D. on the telephone on ___ at 5:15 pm, at the\ndiscovery of the findings.\n\nA revised report indicating progression of hemorrhage, edema, posterior fossa\nmass effect, and hydrocephalus since the earlier study ___ was discussed\nby telephone by Dr. ___ with Dr. ___ 6:25pm ___, 5 minutes after\nreviewing the images." + }, + { + "input": "Patient is status post right frontal approach ventricular catheter placement,\nwith tip in the body of the right lateral ventricle. There is right frontal\npneumocephalus within expected limits. Ventriculomegaly is minimally improved\nsince prior.\n\nPosterior fossa hemorrhage, in addition to blood tracking along the tentorium\nbilaterally is unchanged since prior. Compression of the fourth ventricle is\nsimilar to prior. Basilar cistern and foramen magnum crowding are similar to\nprior. There is no evidence of acute territorial infarction or large mass. \nLeft corona radiata hypodensity is unchanged since prior.\n\nThere is no evidence of fracture. Cervical spine fusion hardware is partially\nimaged. The paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The orbits are unchanged since prior. Endotracheal tube is partially\nimaged.", + "output": "Interval placement of a right frontal approach ventricular catheter, with tip\nin the body of the right lateral ventricle and minimally improved\nventriculomegaly since prior." + }, + { + "input": "Right frontal approach ventriculostomy tip terminates near the right foramina\n___, unchanged compared to prior.\n\nAgain demonstrated, is similar degree of posterior fossa/bilateral cerebellar\nhemorrhage with surrounding vasogenic edema and similar effacement of the\nfourth ventricle and prepontine cistern. Resultant obstructive upstream\nhydrocephalus is stable compared to prior. There is similar degree of\ncrowding of the foramen magnum.\n\nSubdural extension of hemorrhage along the bilateral tentorium cerebelli is\nsimilar prior. Similar degree of subarachnoid hemorrhage within the sulci of\nthe posterior fossa.\n\nThere is new small volume bilateral occipital horn dependently layering\nintraventricular hemorrhage, right greater than left (02:14).\n\nThere is no evidence of acute large territorial infarction.\n\nThe ventricles and sulci are unchanged in size and configuration.\n\nPosterior cervical spinal fusion hardware is partially visualized. Otherwise,\nno acute osseous abnormalities seen. There is partial opacification of the\nbilateral mastoid air cells which may be seen with prolonged supine\npositioning in the inpatient setting. Otherwise, the partially imaged\nparanasal sinuses and middle ear cavities are clear. The orbits demonstrate no\nacute abnormalities.", + "output": "1. Redemonstration of posterior fossa hemorrhage with effacement of the\nfourth ventricle and stable resultant obstructive upstream hydrocephalus.\n2. Interval increase in bilateral occipital horn intraventricular hemorrhage.\n3. Similar degree of local mass effect." + }, + { + "input": "There has been interval removal of a right frontal ventricular catheter. A\nmoderate amount of pneumocephalus in the frontal horn of the right lateral\nventricle is new. There is a small to moderate amount of intraparenchymal and\nmild subarachnoid hemorrhage tracking along the course of the recently removed\nventriculostomy catheter. Surrounding vasogenic edema is mild and there is no\nsignificant mass effect.\n\nPeriventricular and deep white matter hypodensities are nonspecific, but\nlikely represent sequela of chronic small vessel ischemic disease.\n\nThe size of the ventricles is unchanged from prior. Layering hemorrhage in\nthe dependent lateral ventricles is unchanged. There is a similar degree of\nposterior fossa and cerebellar hemorrhage.\n\nCrowding at the foramen magnum and effacement of the fourth ventricle,\nquadrigeminal and ambient cisterns is unchanged.\n\nNo large territorial infarction. Right frontal pneumocephalus is unchanged.\n\nPosterior cervical spinal fusion hardware is partially visualized.\n\nThe paranasal sinuses and mastoid air cells are clear. The right ocular lens\nhas been surgically replaced.", + "output": "1. New small to moderate hemorrhage tracking along the course of the recently\nremoved ventriculostomy catheter. There is a small amount of surrounding\nvasogenic edema without significant mass effect or midline shift.\n2. Interventricular and posterior fossa hemorrhage is unchanged.\n3. Effacement of the fourth ventricle, ambient and quadrigeminal cisterns and\ncrowding at the foramen magnum is also unchanged.\n4. Additional findings described above.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 1:34 pm, 10 minutes after\ndiscovery of the findings." + }, + { + "input": "Again demonstrated, is a stable right frontal intraparenchymal hemorrhage\nalong the site of prior ventriculostomy with surrounding vasogenic edema and\nintraventricular extension involving small stable layering hemorrhage in the\nbilateral occipital horns.\n\nThere is a similar degree of posterior fossa and cerebellar intraparenchymal\nhemorrhage (2:6) and trace subdural hemorrhage tracking along the tentorium\ncerebelli bilaterally (02:14). Additionally, there is similar partial\neffacement of the fourth ventricle cerebral aqueduct and crowding of the\nforamen magnum.\n\nThere is no evidence of acute large territorial infarction.\n\nThe ventricles and sulci are unchanged in size and configuration. There is\ninterval redistribution of intraventricular pneumocephalus with decreased air\nin the right frontal horn and increased air in the right temporal horn\n(02:12).\n\nRight frontal calvaria defect from prior ventriculostomy is visualized. \nOtherwise, no additional acute is osseous abnormalities are identified. The\npartially imaged paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The orbits demonstrate no acute abnormalities.", + "output": "Interval redistribution of intraventricular pneumocephalus. Otherwise, no\nsignificant interval change of multi-compartmental intracranial hemorrhage." + }, + { + "input": "The right frontal intraparenchymal hemorrhage with surrounding vasogenic edema\nis similar in size and configuration when compared to the study of ___. No new areas of hemorrhage are noted. There has been interval\nresolution of the pneumocephalus in the anterior horn of the right ventricle. \nFocal pneumocephali along the inner table of the right frontal lobe and in the\nright temporal horn are present, but have decreased in size. Bilateral small\nlayered hemorrhages in the occipital horns are again noted.\n\nThere is a slight redistribution of hematocrit associated with the\nintraparenchymal hemorrhage in the posterior fossa, but no evidence of new\nhemorrhage. Intraparenchymal hemorrhages involving both cerebellar\nhemispheres are again seen.\nThere is no significant shift of midline structures. There is mild effacement\nof the ambient cistern on the left. Overall, basal cisterns appear patent.\n\nHypodensity in the left basal ganglia likely representing a previous infarct\nis present.\n\nAgain noted is a right frontal calvarial defect from prior ventriculostomy. \nNo acute fractures are seen. Fusion rods are seen through the imaged Atlas. \nThere is also a partially imaged nasogastric tube. The paranasal sinuses,\nmastoid cells, and middle ear cavities are unremarkable.", + "output": "1. Stable appearance of right frontal intraparenchymal, posterior fossa, and\ncerebellar hemorrhages, without evidence of new bleed.\n2. Interval improvement of pneumocephali.\n3. Patent basal cistern." + }, + { + "input": "The right globe appears normal without evidence of radiopaque foreign body. \nThe intra and extraconal fat is preserved.\n\nThe left lobe appears normal without evidence of radiopaque foreign body. A 1\nmm radiopaque density in the region of the left trochlea likely represents a\ncalcified trochlear apparatus (series 3, image 23). The intra and extraconal\nfat is preserved.\n\nThere is minimal mucosal thickening in the ethmoid air cells, maxillary\nsinuses and sphenoid sinuses. There is evidence of prior fiberoptic\nendoscopic sinus surgery. The mastoid air cells in external auditory canals\nare clear. Although the study is not designed to evaluate the intracranial\ncontents, the visual portion of the brain is unremarkable.", + "output": "1. No radiopaque foreign body in the right orbit.\n2. 1 mm radiopaque density in the region of the left trochlea most likely\nrepresents a calcified cochlear apparatus." + }, + { + "input": "Limited evaluation due to timing of contrast bolus.\n\nThere is a congenitally hypoplastic right vertebral artery with dominant left\nvertebral artery. The right vertebral artery at the level of C1 is patent\nwithout vessel irregularity. Along the posterior right arch there is an\nossific fragment just anterior to the vertebral artery (2:194) as it traverses\nintra cranially (2:195). The carotid and vertebral arteries and their major\nbranches are patent with no evidence of stenoses. No evidence for dissection\nis seen.By NASCET criteria, there is no stenosis of the internal carotid\narteries.\n\nLimited evaluation of the osseous structures again demonstrates anterior and\nposterior arch of C1 fractures with an avulsed transverse ligament. There is\n3 mm lateral subluxation of the right C1 lateral mass with 2 mm lateral\nsubluxation of the left C1 lateral mass. C1 fracture is better characterized\non dedicated CT cervical spine performed the same day.\n\nLimited assessment of the lung apices is unremarkable. The thyroid is within\nnormal limits.", + "output": "1. Patent vasculature. No evidence of vertebral artery dissection\n2. Anterior and posterior C1 right arch fracture with mild bilateral lateral\nmass subluxation and avulsed transverse ligament, better characterized on\ndedicated CT cervical spine performed the same day." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are prominent consistent with global cerebral volume\nloss.\n\nNo acute fracture is seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial pathology identified. Please note MRI is more sensitive\nfor small intracranial lesions." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. There is minimal fluid in the bilateral\nmaxillary sinuses. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD:\nThere is no evidence for acute hemorrhage, vascular territorial infarction,\nmass effect, or edema. The ventricles and sulci are normal in size and\nappearance.\n\n The paranasal sinuses, middle ear cavities, and mastoid air cells are clear.\nThe orbits are grossly unremarkable bilaterally.\n\n\nCTA HEAD AND NECK:\nThere is a normal 3 vessel aortic arch identified. The vertebral arteries are\npatent without high-grade stenosis or occlusion.\n\nThe bilateral common carotid arteries are patent. There is no evidence of\ninternal carotid stenosis by NASCET criteria.\n\n The intracranial vasculature is grossly patent without high-grade stenosis,\nocclusion, or aneurysm greater than 3 mm. The dural venous sinuses are patent.\n\n\nOTHER:\nThe lungs apices are clear bilaterally. The thyroid gland is unremarkable in\nappearance. There is no cervical lymphadenopathy by CT size criteria.", + "output": "1. Normal head and neck CTA." + }, + { + "input": "No acute fracture. The mandible and temporomandibular joints appear normal. \nExtensive periapical lucencies are seen involving multiple maxillary and\nmandibular teeth compatible with periodontal disease. The pterygoid plates\nare intact.\n\nEthmoid sinuses are partially opacified. There is mucosal thickening of the\ninferior frontal, sphenoid, and left maxillary sinuses and layering\nlow-density fluid in the right maxillary sinus.\n\nSoft tissue swelling with locules of soft tissue gas suggesting laceration are\nnoted adjacent to the left mandible. There is no evidence of abnormal fluid\ncollections.\n\nBilateral mastoids appear normal.\n\nRight scleral buckle is present along with evidence of right lens resection. \nThe globes are otherwise intact. The extraocular muscles, optic nerves, and\nretrobulbar fat appear normal.", + "output": "1. No acute fracture or temporomandibular joint dislocation. Soft tissue\nswelling and laceration overlying the left mandible.\n2. Extensive periapical lucencies involving multiple maxillary and mandibular\nteeth suggestive of periodontal disease. Correlation with dental exam\nrecommended.\n3. Sinus disease as described." + }, + { + "input": "There is soft tissue edema and locules of soft tissue gas compatible with\nlaceration involving the left forehead and posterolateral to the left jaw. No\nacute fracture is seen. There is no evidence of acute territorial infarction,\nhemorrhage, edema, or mass. The ventricles and sulci are normal in size and\nconfiguration.\n\nNo osseous abnormalities seen. There is partial opacification of the ethmoid\nsinuses. Layering low-density fluid in the right maxillary sinus and mucosal\nthickening noted in the inferior frontal and left maxillary sinuses. The\nmastoid air cells and middle ear cavities are clear. Right scleral buckle is\npresent and the patient is status post right lens resection. Orbits are\notherwise unremarkable.", + "output": "1. No intracranial hemorrhage or acute fracture.\n2. Soft tissue swelling and laceration overlying the left frontal bone and\nleft mandible." + }, + { + "input": "There is no evidence of acute large territorial infarction, intracranial\nhemorrhage, edema, or mass effect.\n\nThere is prominence of the ventricles and sulci suggestive of age advanced\ncerebral volume loss.\n\nNo acute fracture is seen. There is a moderate sized right maxillary sinus\nmucous retention cyst. Otherwise, the remaining paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear.", + "output": "No acute intracranial process. No evidence acute intracranial hemorrhage or\nfracture." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is trace mucosal thickening of the\nleft maxillary sinus. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are otherwise clear. Changes\nrelated to left partial mastoidectomy are noted. The visualized portion of\nthe orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Evaluation for mass is limited in the absence of IV contrast. There is no\nedema or mass effect to suggest intracranial metastatic disease. If there is\nsignificant clinical concern for metastatic disease, MRI should be obtained." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass. Mild periventricular white matter hypodensities likely represent\nchronic microangiopathy. There is mild prominence of the ventricles and sulci\nsuggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No evidence of acute territory infarction or hemorrhage." + }, + { + "input": "Partially limited exam due to patient motion, within this limits, grossly the\ngray-white matter differentiation is maintained. There is no evidence of\nacute intracranial hemorrhage,edema,or mass. Generalized brain parenchymal\natrophy with prominent the ventricles and sulci, likely age related and\ninvolutional nature. Periventricular white matter hypodensities are\nnonspecific and suggest mild chronic small vessel disease, grossly unchanged.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.There is dental hardware in\nthe maxillary bone and mandible.", + "output": "1. Limited exam due to patient motion, within this limitation, there is no\nevidence of acute intracranial process or hemorrhage.\n2. Subtle areas of low attenuation in the subcortical white matter suggests\nchronic microvascular ischemic disease.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 4:05 pm, 5 minutes\nafter discovery of the findings." + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass. The ventricles and sulci are normal in size and configuration. The basal\ncisterns are patent and there is preservation of gray-white matter\ndifferentiation.No osseous abnormalities seen. The paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nProminent ventricles and sulci are suggestive of age-related involutional\nchanges.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion or aneurysm formation. Multifocal\nmild narrowing of the cavernous carotid arteries bilaterally is compatible\nwith atherosclerotic disease. There is also and stenosis of the right A1\norigin. The dural venous sinuses are patent.\n\nCTA NECK:\nCalcified and noncalcified plaque at the bilateral carotid bifurcations\nresults in approximately 90% occlusion of the right internal carotid artery\n(3:150) and 80% occlusion of the left internal carotid artery (3:140). There\nis mild narrowing and atherosclerotic calcification at the origin of the left\nvertebral artery. The right vertebral artery origin appears widely patent. \nThere is no flow-limiting stenosis, occlusion, or dissection within the\nvertebral arteries. No dissection is identified within the carotid arteries.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Calcified and noncalcified plaque at the bilateral carotid bifurcations\nresulting in approximately 90% occlusion of the right internal carotid artery\nand 80% occlusion of the left internal carotid artery.\n2. Multifocal mild narrowing of the cavernous carotid arteries bilaterally,\ncompatible with atherosclerotic disease. Stenosis of the right A1 segment is\nalso noted.\n3. Mild narrowing and atherosclerotic calcification at the origin of the left\nvertebral artery." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nlarge mass. Left basal ganglia chronic lacunar infarct is again seen. \nPeriventricular and subcortical white matter hypodensities are nonspecific,\nbut likely represent chronic small vessel ischemic disease. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. Complete opacification of the right\nsphenoid sinus is unchanged since prior. The paranasal sinuses, mastoid air\ncells, and middle ear cavities are otherwise clear. The right orbit is\nunremarkable. Dystrophic left globe with calcified lines is unchanged since\nprior. Multiple periodontal lucencies are again seen. There is bilateral\ncarotid siphon calcification.", + "output": "No acute intracranial hemorrhage." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nMildly limited study due to beam hardening artifact and motion degradation of\nthe skullbase. Within these confines:\n\nThere is no evidence of acute intracranial hemorrhage, infarction, edema, or\nmass effect. The ventricles and sulci are normal in caliber and\nconfiguration. Bilateral mild periventricular white matter hypodensity is\nnon-specific, but compatible with mild changes of chronic white matter\nmicroangiopathy.\n\n No evidence of a displaced calvarial fracture. Aerosolized secretions are\nseen in the sphenoid sinus. Remaining visualized paranasal sinuses, mastoids,\nmiddle ear cavities are well pneumatized and clear. The globes and orbits are\nunremarkable.\n\nCT PERFUSION:\nSubjective review of CT perfusion images demonstrates no evidence of elevated\nmean transit time/T-max greater than 6 seconds, nor areas of abnormally\ndecreased cerebral blood flow or abnormal cerebral blood volume. No\nconvincing evidence of ischemic penumbra or infarct core. CBF <30% volume 0\nmL, T-max >6 seconds volume 4 mL.\n\nCTA HEAD:\nThere is a left dominant vertebral artery, a normal variant. Fetal type left\nPCA, a normal anatomic variant. The left P1 is not well seen, either\ndiminutive or absent. Widely patent vertebrobasilar system. Patent bilateral\nposterior cerebral arteries with normal distal runoff.\n\nThere are areas of mild luminal narrowing of the cavernous, supraclinoid, and\nparaophthalmic intracranial ICAs bilaterally due to calcified plaque. \nOtherwise, the remaining portions of the bilateral intracranial internal\ncarotid arteries and the bilateral anterior and middle cerebral arteries are\npatent with normal distal runoff.\n\nPatent major dural venous sinuses.\n\nCTA NECK:\nThere is moderate motion degradation focally at the level of the carotid bulbs\nand proximal ICAs which somewhat limits evaluation. Within these confines:\n\nThere is mild calcified plaque at the origin of the right internal carotid\nartery which does not appear to cause luminal narrowing by NASCET criteria\n(___).\n\nThere is focal calcified plaque at the origin of the left cervical ICA,\ncausing approximately 15 % luminal narrowing by NASCET criteria (series ___,\nimage 23).\n\nThe cervical vertebral arteries are tortuous but otherwise widely patent and\nunremarkable bilaterally.\n\nOTHER:\nThere is moderate calcification of the aortic arch. Arch branch vessel\norigins are patent. Proximal arch vessels are severely tortuous but otherwise\nwidely patent, including the innominate, proximal left common carotid, left\nsubclavian, and proximal right subclavian. There is a 2 mm pulmonary nodule\nseen in the lateral aspect of the right upper lobe (04:14). The thyroid is\nunremarkable. Scattered bilateral multilevel cervical lymph nodes are not\npathologically enlarged. Prevertebral paraspinal soft tissues are without\nacute focal abnormality. There is an exaggerated cervical lordosis. There\nappear to be age-indeterminate compression deformities of the T2 through at\nleast T8 vertebral bodies, not well assessed on this study. No definite\naggressive focal osseous lesion seen.", + "output": "Study is limited due to moderate motion degradation. Within these confines:\n\n1. No evidence of acute intracranial abnormality.\n2. CT perfusion without convincing evidence of ischemic penumbra or infarct\ncore.\n3. Mild narrowing of the intracranial carotid siphons bilaterally due to\ncalcified plaque. Otherwise, widely patent circle of ___ vasculature\nwithout additional stenosis, occlusion, or aneurysm.\n4. 15% luminal narrowing of proximal left ICA due to calcified plaque. \nOtherwise, widely patent bilateral cervical vertebral and carotid arteries. \nNo right ICA stenosis by NASCET criteria.\n5. Suggestion of multiple contiguous compression deformities in the upper\nthoracic spine spanning T2-T8, not well evaluated on this study and\nage-indeterminate. Correlate with patient's symptoms and consideration of\ndedicated CT cervical spine imaging, or comparison with outside hospital prior\nexams, if available.\n6. Incidentally noted 2 mm solid pulmonary nodule in the lateral right upper\nlobe. Recommend correlation with patient risk factors in consideration of\nfollow-up dedicated CT chest imaging, as above. Other incidental findings, as\nabove.\n\nRECOMMENDATION(S): For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\n\nAgain noted is a 1.7 x 1.0 cm intraparenchymal hemorrhage at the left\ntemporal/ occipital junction, stable in size. Mild surrounding edema has\nslightly increased. 4 mm hemorrhage in the left temporal lobe is also stable\nwith minimal surrounding edema (series 3, image 16. No new hemorrhages are\nnoted. There is no evidence of new loss of gray/ white matter differentiation.\nVentricle and cisterns are normal in size.\n\nThere is severe opacification of bilateral anterior ethmoid air cells\nextending into the frontoethmoidal recesses, as well as moderate mucosal\nthickening in the inferior right frontal sinus and mild mucosal thickening in\nthe inferior left frontal sinus, unchanged. There is minimal mucosal\nthickening in the left maxillary sinus. There is mild to moderate mucosal\nthickening as well as likely fluid in the sphenoid sinuses. Sphenoid sinus\nabnormalities have progressed since ___, likely related to\nprolonged supine positioning in the inpatient setting. Mastoid air cells are\nclear.\n\n\nCTA AND CTV HEAD:\n\nMultifocal atherosclerotic calcification of the carotid siphons is noted\nwithout flow-limiting stenosis. The ACA, MCA and their major branches are\nunremarkable. Atherosclerotic calcification of the bilateral mid intracranial\nvertebral arteries are also noted.\n\nThere is thrombosis of the left transverse sinus extending to the torcula\nmedially, as well as thrombosis of the left sigmoid sinus and jugular bulb.\nThere is reconstitution of flow within the left internal jugular vein at the\ninferior margin of the jugular foramen. Extensive prominent cortical and\nmedullary blood vessels in the left parietal, occipital, and temporal region\nmost likely represent venous collaterals secondary to sinus thrombosis.\nHowever, enlarged. Dural arterial branches cannot be definitively excluded.\nBranches of the left posterior cerebral artery also approach the area of the\nabnormal blood vessels and a difficult to evaluate.\n\nVisualized portions of the common carotid and extracranial internal carotid\narteries are unremarkable.\n\nOTHER FINDINGS:\n\n\n\nBilateral palatine tonsiliths are noted, presumably sequela of prior\ninfection. No suspicious sclerotic or lytic osseous lesions are seen.", + "output": "1. Thrombosis of the left transverse sinus, sigmoid sinus and jugular bulb,\nwith reconstitution of the left internal jugular vein at the inferior margin\nof the jugular foramen.\n2. Extensive venous collaterals in the left parietal, occipital, and temporal\nregion. Abnormal dural arterial branches or abnormal branches of the left\nposterior cerebral artery cannot be definitively excluded. Conventional\ncerebral angiogram would be more sensitive for excluding an AV fistula.\n3. The dominant left temporal/ occipital hemorrhage is stable in size with\nmild, but slightly increased surrounding edema. Additional 4 mm focus of\nhemorrhage in the left temporal lobe is stable.\n4. Persistent opacification of anterior ethmoid air cells and frontoethmoidal\nrecesses, with right greater than left mucosal thickening in the inferior\nfrontal sinuses ; please correlate with symptoms. New fluid and mucosal\nthickening in the sphenoid sinuses is likely related to prolonged supine\npositioning in the inpatient setting." + }, + { + "input": "Evaluation is somewhat limited due to motion artifact. There is\nredemonstration of a 1.5 x 1.2 cm intraparenchymal hemorrhage in the left\ntemporal lobe with minimal edema. Additional focus of hemorrhage in the left\ntemporal lobe is again seen and measures approximately 4 mm (series 2a, image\n10). There is no evidence of shift of normally midline structures or of\ninfarction. Ventricles and sulci are normal in size and configuration. The\nbasal cisterns appear patent and there is preservation of gray-white matter\ndifferentiation. Known venous sinus thrombosis is not appreciated on this\nnoncontrast enhanced study.\n\nThere is no fracture. Aerosolized secretions are seen in the right\nfrontoethmoidal recess. There is mucosal thickening and fluid in the ethmoid\nair cells, sphenoid sinuses, and left maxillary sinus. The bilateral middle\near cavities and mastoid air cells are clear.", + "output": "Redemonstration of intraparenchymal lobar cerebral hemorrhages essentially\nstable since prior examinations." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect or\nlarge territorial infarction. The ventricles and sulci are normal in size\nconfiguration. The basal cisterns are patent. Gray-white matter\ndifferentiation is preserved.\n\nThere is no fracture. The nasal septum is mildly leftward deviated with a\nleft-sided spur (3:2). The partially imaged paranasal sinuses, mastoid air\ncells and middle ear cavities are clear.", + "output": "1. No acute intracranial abnormality.\n2. Mild leftward deviation of the nasal septum with a left-sided spur." + }, + { + "input": "There is no intracranial hemorrhage, edema, mass effect or major vascular\nterritorial infarct. Prominent ventricles and sulci are compatible with mild\nglobal age-related atrophy. Basal cisterns are preserved. There is no shift of\nnormally midline structures. Gray-white matter differentiation is preserved. \nNo osseous abnormality is identified. The scalp overlying the left calvarium\nis thicker than the right, which may be due to asymmetric soft tissue edema.\nParanasal sinus mucosal thickening with mucous retention cysts in the\nbilateral maxillary sinuses and air-fluid levels in the bilateral maxillary\nand sphenoid sinuses may in part be related to intubation. Hyperdensity within\nthe nasopharynx may represent blood products related to intubation.", + "output": "No acute intracranial abnormality. If clinical concern for stroke is high, MRI\nis more sensitive.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with ___\n___ on the telephone on ___ at 11:25 a.m.." + }, + { + "input": "NON-CONTRAST HEAD CT: There is no evidence of infarct, hemorrhage, or mass. \nThe ventricles, cisterns and sulci are age-appropriate.\n\nCTA HEAD AND NECK: The aortic arch has mild calcific arteriosclerosis. There\nis three-vessel takeoff off the aortic arch with no stenosis of these great\nvessel origins.\n\nThe left vertebral artery is markedly dominant. There is minimal calcific\narteriosclerosis of the carotid bifurcations bilaterally, and the cervical\ninternal carotid arteries are quite tortuous, but there is no flow-limiting\nstenosis within the neck.\n\nCTA HEAD: The right A1 segment is slightly dominant. No posterior\ncommunicating arteries are identified. The dural venous sinuses and major\nintracranial veins are patent. There is no evidence of intracranial\nflow-limiting stenosis or aneurysm.\n\nThere are age-related mild osseous degenerative changes.", + "output": "No apparent acute intracranial pathology. No flow-limiting\nstenosis or aneurysm. No explanation for the patient's headache is seen." + }, + { + "input": "There is mild smooth circumferential wall thickening of the subglottic trachea\n(2:66) extending for approximately 7-cm in craniocaudal dimension. The airway\nis otherwise patent.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. Tonsils appear normal without enlargement or hyperemia. The\nthyroid gland appears normal. There is no lymphadenopathy by CT criteria. The\nneck vessels are patent. No mass lesion or abscess identified. Major\ncervical vessels appear unremarkable. No retropharyngeal abscess or\nprevertebral soft tissue swelling.\n\nThe imaged portion of the lung apices show mild biapical pleural thickening. \nThere are no concerning pulmonary nodules. No concerning lytic or sclerotic\nlesions. Mild degenerative changes as cervical spine are most severe at the\nlevels C4-3 where there is disc height loss and the anterior osteophytosis.", + "output": "1. Nonspecific mild circumferential wall thickening of the subglottic trachea\nmay relate to an infectious or inflammatory process. Airway remains patent.\n2. No evidence of abscess." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nMild periventricular, subcortical and deep white matter hypodensities are\nlikely sequelae of chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Mild calcification of the cavernous\nportions of the internal carotid arteries are noted.", + "output": "1. No acute intracranial process. Specifically no intracranial hemorrhage.\n\n2. Chronic changes as described above." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is massive intraventricular hemorrhage, greater on the right than left\nas well as subarachnoid hemorrhage filling the right sylvian fissure. There\nis a dense FLAIR of clot in the ambient cistern surrounding a large\nnon-opacified aneurysm in the expected location of the right posterior\ncommunicating artery.\nThere is severe hydrocephalus with periventricular hypodensities suggesting\ntransependymal resorption of CSF.\nThere is dense calcifications of the cavernous and supraclinoid internal\ncarotid arteries bilaterally as well as the vertebral arteries bilaterally. \nThere is no evidence of infarction, within the limitations of the other\nabnormalities documented on the scan. There is right to left midline shift.\nNo masses are identified. No osseous abnormalities are detected.\nThere is fluid in the nasopharynx and partial opacification of the ethmoid air\ncells, greater on the right than left. The patient is intubated..\n\nCTA HEAD:\nThere is an approximately 18 mm aneurysm arising from the supraclinoid right\ninternal carotid artery the expected origin of the posterior communicating\nartery. The ICA is heavily calcified in this location, but the aneurysm\nitself appears free of calcification. There is a wide aneurysm neck,\nmeasuring at least 12 mm in diameter.\nThere is fusiform dilatation of the basilar artery.\nNo other aneurysms are identified. There is extensive intracranial\natheromatous disease with narrowing and irregularity of the anterior and\nposterior circulation arterial branches down to the limit of resolution of\nCTA.\n\nCTA NECK:\nThere is calcified plaque at the origins of the great vessels and along the\naortic arch. There are calcified plaques at the origins of the internal\ncarotid arteries bilaterally with no evidence of stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Massive subarachnoid hemorrhage dear hydrocephalus.\n2. Approximately 18 mm aneurysm arising at the origin of the right posterior\ncommunicating artery\n3. Fusiform dilatation of the basilar artery.\n4. Extensive intracranial atheromatous disease. The" + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration for age. Areas of\nconfluent periventricular, subcortical and deep white matter hypodensity are\nin a configuration most suggestive of chronic small vessel ischemic disease.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is mild atherosclerotic calcification in the V4 segment of the left\nvertebral artery without significant narrowing. There is mild narrowing of\nthe right P1/P2 portion of the right PCA. There are moderate atherosclerotic\ncalcifications of the bilateral intracranial internal carotid arteries without\nsignificant narrowing. The vessels of the circle of ___ and their\nprincipal intracranial branches otherwise appear patent without significant\nstenosis, occlusion, or aneurysm formation. The dural venous sinuses are\npatent.\n\nCTA NECK:\nThere are mild atherosclerotic calcifications of the aortic arch. There are\nmoderate atherosclerotic calcifications at the origins of the great vessels,\nwithout significant narrowing, most severe at the origin of the left\nsubclavian artery. There is moderate atherosclerotic calcification at the\norigin of the right subclavian artery without significant narrowing. There is\nmild right and trace left atherosclerotic calcification at the origins of the\nvertebral arteries without significant narrowing. There is moderate\natherosclerotic calcification at the bilateral carotid bifurcations. There is\nadditional focal moderate calcification in the proximal left internal carotid\nartery producing up to 60% stenosis by NASCET criteria. There is 80% stenosis\nof the right internal carotid artery by NASCET criteria just distal to\nbifurcation. There is also moderate left and mild right narrowing of the\nexternal carotid artery origins. The carotid and vertebral arteries and their\nmajor branches otherwise appear patent without evidence of dissection or\nocclusion.\n\nOTHER:\nThere is a 3 mm nodule in the right upper lobe (07:23). Small areas of mucous\nplugging are noted in the subsegmental upper lobe airways (07:54, 60). The\nimaged lung apices are otherwise clear. There are bilateral thyroid nodules,\nwith up to a 14 mm densely rim calcified nodule in the right lobe (7:91). \nThere is no lymphadenopathy by CT size criteria. There is moderate multilevel\ncervical spondylosis. Lucency through the anterior arch of C1 is unchanged\ndating back to ___.", + "output": "1. No acute intracranial abnormality.\n2. Patent intracranial arterial vasculature without significant stenosis,\nocclusion, or aneurysm.\n3. 80% right and 60% left stenosis of the proximal internal carotid arteries\nby NASCET criteria.\n4. Otherwise patent cervical arterial vasculature without occlusion or\ndissection.\n5. 3 mm pulmonary nodule in the right upper lobe.\n6. Multiple bilateral thyroid nodules with up to a 14 mm densely rim calcified\nnodule in the right lobe. The ___ College of Radiology guidelines\nsuggest that in the absence of risk factors for thyroid cancer, no further\nevaluation is recommended.\n\nRECOMMENDATION(S):\n1. The ___ Society guidelines for pulmonary nodule guidelines suggest\nfor pulmonary nodules less than or equal to 4mm, no follow-up needed in\nlow-risk patients, and 12 month follow-up in high risk patients.\n2. Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "There is no evidence of infarction,intracranial hemorrhage,edema,or midline\nshift. The ventricles and sulci are normal in size and configuration.\n\nSurrounding soft tissue stranding and swelling seen along the left face. \nThere is a minimally displaced fracture through the left nasal bone. There is\nno evidence of skull fracture. Minimal fluid level of the left maxillary\nsinus. Otherwise, the remaining visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. Soft tissue swelling and stranding along the left face.\n2. Left nasal bone fracture, to be correlated clinically regarding acuity.\n3. No evidence of intracranial hemorrhage or skull fracture.\n4. Minimal fluid level of the left maxillary sinus.\n5. Please see dedicated maxillofacial CT for assessment of facial bones." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is moderate to severe stenosis involving the entire M1 segment of left\nMCA with focal stenosis also involving the M2 branches. Otherwise,\nintracranial vasculature is grossly unremarkable without other areas of focal\nstenosis. The intracranial is circulation is patent with no aneurysm formation\ngreater than 3 mm.\n\nThe dural venous sinuses are patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent. There is thin\nlinear filling defect along posterior wall the proximal right ICA just distal\nto the bulb (04:37), raising possibility of a small carotid web..\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No acute intracranial abnormality.\n2. There is moderate to severe stenosis involving the M1 and proximal M2\nbranches of the left MCA. Otherwise, unremarkable intracranial vasculature.\n3. Possible small right sided carotid web.\n4. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection.\n5. No dural venous sinus thrombosis.\n\nNOTIFICATION: Updated left MCA findings were discussed by Dr. ___ with Dr.\n___ at 16:15 on ___." + }, + { + "input": "The patient is status post extraction ___ 32. , there is mild mucosal\nthickening the right maxillary sinus, likely consistent with mucous retention\ncyst. Subtle fat stranding within the subcutaneous tissue overlying both both\nplatysma muscles (image 15, series 2), with a 6 x 8 mm in transverse\ndimension rounded area of low density, probably consistent with small amount\nof fluid on the left platysma. Evaluation of the aerodigestive tract\ndemonstrates no exophytic mass, nor areas of focal mass effect. Evaluation of\nthe cervical lymph chains demonstrate no pathologic lymphadenopathy by imaging\ncriteria. The visualized salivary glands are unremarkable in appearance. No\nthyroid mass is seen. Neck vessels are patent without associated fat\nstranding. Upper lung fields are clear. No bony abnormality is seen.", + "output": "1. Subtle fat stranding within subcutaneous tissue overlying both platysma\nmuscles may be postsurgical in nature however can be seen in the setting of a\nmild cellulitis. Clinical correlation is recommended.\n2. 6 x 8 mm in transverse dimension rounded area overlying the area of the\nleft platysma muscle, suggestive of a small amount of fluid. There is no\nevidence of extension into the danger space or upper mediastinum. The major\nvascular structures appear patent." + }, + { + "input": "There is no acute hemorrhage mass effect midline shift or hydrocephalus.\nExuberant vascular calcifications are seen in the posterior fossa. There is\nbeen no significant interval change. Mild to moderate brain atrophy and small\nvessel disease are seen.", + "output": "No acute intracranial abnormalities are identified. No change since the\nprevious CT examination." + }, + { + "input": "There is no evidence of hemorrhage, acute infarction, edema, mass, or mass\neffect. A 6 mm hypodensity in the area of the right basal ganglia/external\ncapsule may represent sequela of prior/chronic lacunar infarct versus a\ndilated perivascular space. Elsewhere, there is preservation of gray-white\nmatter differentiation. The basal cisterns are patent. There is no shift of\nnormally midline structures. Prominence of the ventricles and sulci is\ncompatible with age-related atrophy. Periventricular and subcortical white\nmatter hypodensities are compatible with chronic small vessel ischemic change.\nHyperostosis frontalis interna is noted. The visualized paranasal sinuses and\nmastoid air cells are clear. The patient is status post bilateral lens\nremoval; otherwise, the globes and bony orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Chronic findings including global atrophy and chronic white matter small\nvessel ischemic change." + }, + { + "input": "There is no acute large territorial infarction, intracranial hemorrhage, edema\nor mass effect. A punctate hypodensity in the right basal ganglia/ external\ncapsule is unchanged and may represent a chronic lacune versus perivascular\nspace. Periventricular and subcortical white matter hypodensities are\nnonspecific, though likely sequelae of small vessel ischemic disease. \nProminent ventricles and sulci suggest age-related involutional changes.\n\nNo acute fracture identified. Hyperostosis frontalis interna is noted. There\nis mild mucosal thickening of left ethmoid air cells come anteriorly. Minimal\nair slight secretions are seen in the left frontal sinus. Mastoid air cells\nand middle ear cavities are well aerated.", + "output": "1. No acute intracranial process." + }, + { + "input": "There is no evidence of acute vascular territorial\ninfarction,hemorrhage,edema, or mass effect. A punctate hypodensity in the\nright basal ganglia may represent a chronic lacune versus perivascular space\nand appears similar to prior. Subcortical and periventricular white matter\nhypodensities are nonspecific, likely the sequelae of small vessel ischemic\ndisease in a patient of this age. There is prominence of the ventricles and\nsulci suggestive of involutional changes. Atherosclerotic calcifications are\nseen along bilateral carotid siphons.\n\nThere is no evidence of fracture. Hyperostosis frontalis interna is noted. \nThe partially imaged left maxillary sinus demonstrates new opacification with\nsubtle sclerosis of the sinus wall, suggesting chronic inflammation. There is\nmild mucosal thickening of the ethmoid air cells. The visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nThe visualized portion of the orbits show bilateral lens replacement.", + "output": "1. No acute intracranial process.\n2. Paranasal sinus disease." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or mass\neffect. Ventricles and sulci are prominent, consistent with age-related\nglobal parenchymal loss. Periventricular, subcortical, and deep white matter\nhypodensities are nonspecific, but likely represent sequela of chronic\nmicrovascular ischemic disease. Again seen in the right basal ganglia is\npunctate hypodensity, likely prior lacune versus perivascular space. These\nfindings are similar to prior.\n\nThere is no evidence of acute fracture. Again seen is hyperostosis frontalis\ninterna, unchanged. There is near complete opacification of the left\nmaxillary and frontal sinuses. There is also a mild-to-moderate mucosal\nthickening of the bilateral anterior ethmoid air cells, left greater than\nright. Mastoid air cells and middle ear cavities are clear.", + "output": "1. No acute intracranial abnormality.\n2. Unchanged global parenchymal loss and likely sequela of chronic\nmicrovascular ischemic disease.\n3. Paranasal sinus disease, as above." + }, + { + "input": "Evaluation is limited by patient motion. There is no evidence of a grossly\ndisplaced fracture, large acute territorial infarction,hemorrhage,edema,or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific but likely sequelae of chronic small vessel\nischemic disease.\n\nThere is near complete opacification of the left maxillary sinus. The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavitiesare otherwise clear. Status post bilateral lens replacement; the\nvisualized portion of the orbits are otherwise normal.", + "output": "1. Evaluation is significantly limited by patient motion. Within this\nlimitation, no large hemorrhage or acute territorial infarction is identified.\n2. Chronic small vessel ischemic disease. Involutional changes.\n3. No acute displaced calvarial fracture." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema,or mass. Mild\nperiventricular and subcortical white matter hypodensities are nonspecific but\nlikely represent sequela of chronic small vessel ischemic disease. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is severe bilateral hyperostosis frontalis interna. Other than mild\nmucosal thickening in the left maxillary sinus and the left anterior ethmoid\nair cells, the visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. Status post bilateral lens replacement. \nOtherwise, the visualized portion of the orbits are normal.", + "output": "No evidence of fracture, hemorrhage or infarction." + }, + { + "input": "There is no evidence of acute fracture, infarction,hemorrhage,edema, or mass. \nPeriventricular and subcortical white matter hypodensities are nonspecific but\nlikely sequelae of chronic small vessel ischemic disease. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nNote is made of hyperostosis frontoparietalis. There is near complete\nopacification of the left frontal sinus and partial opacification of the\nbilateral anterior ethmoid air cells; otherwise, the visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. \nStatus post bilateral lens replacement; otherwise, the visualized portion of\nthe orbits are normal.", + "output": "1. No acute hemorrhage or infarction identified.\n2. Atrophic changes. Probable sequelae of chronic small vessel ischemic\ndisease." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere are scattered periventricular and subcortical white matter\nhypodensities, nonspecific but likely reflect sequelae of chronic small vessel\nischemic disease. There is no evidence of infarction,hemorrhage,edema,ormass.\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits demonstrate\npostsurgical changes related to bilateral lens replacement with a right\nscleral band.\n\nCTA HEAD:\nThere is a stent in the M1 segment of the left middle cerebral artery. There\nis mild calcified atherosclerotic plaque in the bilateral cavernous and\nsupraclinoid segments of the internal carotid arteries. There is fetal type\norigin of the bilateral posterior cerebral arteries, a normal anatomic\nvariant.\nThe vessels of the circle of ___ and their principal intracranial branches\notherwise appear patent without stenosis, occlusion, or aneurysm. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nAtherosclerotic calcifications are noted along the aortic arch and origins of\nthe major vessels without stenosis.\nBilateral carotid and vertebral artery origins are patent.\nCalcified and noncalcified atherosclerotic plaque is noted at the bilateral\ncommon carotid artery bifurcations resulting in 20% stenosis of the proximal\nleft internal carotid artery and no stenosis of the right internal carotid\nartery by NASCET criteria.\nThe carotidandvertebral arteries and their major branches otherwise appear\npatent with no evidence of stenosis or occlusion.\n\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is demonstrates a 9 mm hypodense nodule in the right thyroid\nlobe. There is no lymphadenopathy by CT size criteria.", + "output": "1. No evidence of infarction, hemorrhage, mass effect or midline shift.\n2. Scattered periventricular and subcortical white matter hypodensities,\nnonspecific but may reflect sequelae of chronic small vessel ischemia.\n3. Stent in the left M1 segment of the MCA. Comparison with prior studies may\nbe helpful for further evaluation.\n4. Otherwise patent circle of ___ without evidence of stenosis,occlusion,or\naneurysm.\n5. Mild atherosclerotic plaque at the bilateral common carotid artery\nbifurcations with 20% atheromatous stenosis of the proximal left internal\ncarotid artery.\n6. Otherwise patent bilateral cervical carotid and vertebral arteries without\nevidence of stenosis, occlusion, or dissection." + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass. The ventricles and sulci are normal in size and configuration. No\nosseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process. Of note MR is more sensitive in detection of\ninfarcts." + }, + { + "input": "There is a large subgaleal hematoma overlying the right frontal and parietal\nbone. There is no underlying fracture. There is no evidence of acute large\nterritorial infarction,intracranial hemorrhage,edema,or mass. There is a\nprobable chronic infarct in the pons (02:10). Additional chronic lacunar\ninfarcts are present in both basal ganglia, and right centrum semiovale. \nAdditional periventricular and subcortical white matter hypodensity is\nnonspecific, but likely reflect sequelae of chronic small vessel ischemic\ndisease. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\n There is mucosal thickening in the anterior ethmoid air cells, otherwise the\nparanasal sinuses are clear. Right mastoid air cells are under pneumatized\nand partially opacified. Left mastoid air cells appear clear. The visualized\nportion of the orbits are unremarkable, with the exception of bilateral lens\nreplacements.", + "output": "1. Large right frontoparietal subgaleal hematoma. No underlying calvarial\nfracture or intracranial hemorrhage.\n2. Multiple chronic lacunar infarcts, as described above." + }, + { + "input": "There are several metallic staples within the subcutaneous tissues of the\nright vertex with interval decrease in size of the previously-seen subgaleal\nhematoma. There continues to be a hyperdense frontoparietal scalp hematoma\nmeasuring up to 4.3 x 1.5 cm in the axial plane.\n\nThere is no evidence of acute large territory infarction,hemorrhage,edema, or\nmass. Redemonstration of hypodensities in the right pons (series 2, image 14)\nand in the right posterior centrum semiovale (series 2, image 23), which\nlikely represent chronic infarcts. The ventricles and sulci are normal in\nsize and configuration for age.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The right\nmastoid air cells are underpneumatized. Patient is status post bilateral lens\nreplacements. The visualized portions of the orbits are otherwise\nunremarkable.", + "output": "Interval decrease in size of large right subgaleal hematoma, although there\nappears to be a residual collection of acute blood products. No evidence of\nadditional intracranial or extracranial hemorrhage." + }, + { + "input": "There is trace minimal parafalcine subdural hematoma along the mid falx\nextending posteriorly, similar compared to ___ allowing for\ndifferences in modality. Hematoma is less dense compared to the ___,\ncompatible with evolution. There is no evidence of acute territorial\ninfarction, edema, or large mass. Periventricular and subcortical white\nmatter hypodensities are nonspecific, but likely represent chronic small\nvessel ischemic disease. There is mild prominence of the ventricles and sulci\nsuggestive of involutional changes.\n\nThere is no evidence of fracture. There is mild mucosal thickening in the\nanterior ethmoid air cells. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are otherwise clear. The orbits\nare unremarkable. There is bilateral carotid siphon and vertebral artery\ncalcification.", + "output": "Trace minimal parafalcine subdural hematoma along the mid falx extending\nposteriorly, similar in size compared to ___ allowing for differences\nin modality. Hematoma is less dense compared to the ___, compatible\nwith evolution." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nTrace amount of hyperdense material tracking along the posterior left aspect\nof the falx is compatible with a small subdural hematoma.\n\nThere is no evidence of infarction or mass effect. There is mild\nperiventricular white matter hypoattenuation compatible with small vessel\ndisease. The ventricles and sulci are normal in size and configuration. 7 x 9\nmm in transverse dimension and 8 by 17 mm in sagittal projection calcification\ncentered in the right tentorium is again seen and appears unchanged as well as\nfrontal and parietal dural calcifications.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere are calcifications of the carotid siphons. There is a partial\npersistent fetal origin of the left PCA with a diminutive left P1 segment,\nlikely congenital. There is mild-to-moderate focal narrowing of the right PCA\nP2 segment (5:97). The vessels of the circle of ___ and their principal\nintracranial branches appear normal otherwise with no evidence of stenosis,\nocclusion, or aneurysm. There are mild calcifications of the intracranial\nvertebral arteries. The dural venous sinuses are patent.\n\nThere are calcifications of the visualized carotid bifurcations.\n\nDegenerative changes of the upper cervical spine, consistent with anterior and\nposterior spondylosis and uncovertebral hypertrophy at C2-C3 and C3-C4 levels\nare partially evaluated this examination.", + "output": "1. There is a trace amount of hyperdense material tracking along the posterior\nleft aspect of the falx compatible with a small subdural hematoma.\n2. No intracranial dissection, aneurysm or occlusion.\n3. Mild-to-moderate focal narrowing of the right PCA P2 segment.\n4. Mild white matter small vessel disease.\n5. Dystrophic dural calcifications appear unchanged." + }, + { + "input": "Again seen is relatively stable focal hyperdensity along the superior,\nposterior fall also (series 2, image 24, 25), measuring 4 mm in width,\nconsistent with the extra-axial hemorrhage, most likely representing acute\nsubdural hematoma versus less likely subarachnoid hemorrhage. There is no\nevidence of large territorial infarction edema,or mass effect. Ventricles and\nsulci are mildly prominent consistent with age-related global parenchymal\nloss, unchanged compared to prior. Periventricular, subcortical, and deep\nwhite matter hypodensities are mild and nonspecific, but likely represent\nsequela of chronic microvascular ischemic disease.\n\nThere is no evidence of acute fracture. There is mild mucosal thickening of\nthe bilateral maxillary sinuses and anterior ethmoid air cells. Mastoid air\ncells and middle ear cavities are clear. Patient is status post bilateral\nlens resections.", + "output": "1. Relatively unchanged hyperdensity along the falx consistent with relatively\nunchanged extra-axial hemorrhage, most likely subdural hematoma. No\nsuggestion of large territorial infarction, edema, or mass effect.\n2. Prominence of the ventricles and sulci consistent with age-related global\nparenchymal loss and likely sequela of chronic microvascular ischemic disease." + }, + { + "input": "Left frontal lobe encephalomalacia with ex vacuole dilatation of the frontal\nhorn of the left lateral ventricle remains unchanged. There is no evidence of\nnew acute territorial infarction,hemorrhage,edema,or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. \nPatient is status post bilateral lens replacement. Otherwise the orbits are\nunremarkable.", + "output": "1. No acute intracranial process.\n2. No calvarial fracture." + }, + { + "input": "Extensive hypodensity involving the left temporal lobe, occipital lobe,\nbilateral thalami, and the left aspect of the midbrain (2; 16) consistent with\nposterior cerebral artery territory infarction. Additionally, hypodensities\nare noted in bilateral cerebellum (2; 11). Encephalomalacia is noted in the\nright occipital lobe consistent with prior infarct. There is hyperdensity of\nthe distal basilar suggesting thrombus. There is no evidence of hemorrhage,\nedema, or mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific but suggest chronic small vessel ischemic\nchanges.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits demonstrate bilateral lens replacement.\n\nET tube is partially visualized.", + "output": "1. Extensive hypodensity involving the left temporal lobe, left occipital\nlobe, bilateral thalami, and the left mid brain consistent with large left PCA\nterritory infarct as well hypodensities in as bilateral cerebellum are noted.\n2. No evidence of midline shift or hemorrhage." + }, + { + "input": "There is no evidence of acute large territory infarction,hemorrhage,edema, or\nmass. The ventricles and sulci are normal in size and configuration.\n\nThere is a small right parietal subgaleal hematoma. There is mild mucosal\nthickening throughout the ethmoid air cells. There is minimal opacification\nof a right sided mastoid air cell. There is no evidence of fracture. The\nvisualized portion of the paranasal sinuses, left mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "Small right parietal subgaleal hematoma without calvarial fracture or\nintracranial hemorrhage." + }, + { + "input": "Study is limited by motion.\nThere is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are slightly prominent for the patient's age, suggesting\nmild cortical volume loss, however, this finding is nonspecific.\n\nThere is mild soft tissue swelling in the right parietal region (image 25,\nseries 28), there is no evidence of underlying fracture. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Study is limited by motion. No acute intracranial process.\n2. Mild soft tissue swelling is noted on the right parietal convexity with no\nevidence of underlying fracture.\n3. Prominent sulci for the patient's age, suggesting cortical volume loss,\nthis finding however is nonspecific." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThe hypodensity associated with loss of gray-white matter differentiation in\nthe right temporal and occipital lobes in the PCA distribution is consistent\nwith known acute infarct. Elsewhere, there is no evidence of additional acute\ninfarction, hemorrhage, edema, mass, or mass effect. The ventricles and sulci\nare normal in caliber and configuration. The basal cisterns are patent. The\nvisualized paranasal sinuses, mastoid air cells, and middle ear cavities are\nwell pneumatized and clear. The globes and orbits are unremarkable.\n\nCTA HEAD:\nThere is likely severe/occlusion stenosis involving the proximal P2 segment of\nthe right PCA (series 3, images 249 and 248). The PCA distal to this on the\nright is not well seen. There is relative oligemia of the right\ntemporo-occipital infarcted area as compared with the normal left side. There\nis a small, approximately 2 x 2 mm posteromedially projecting infundibulum at\nthe expected origin of the right posterior communicating artery (3:247). \nThere is mild focal luminal narrowing of the very proximal M1 segment of the\nright MCA (3:250), presumably related to underlying atheromatous disease. \nOtherwise, the remainder of the circle of ___ vasculature and principal\nintracranial branches are patent without additional area of stenosis,\nocclusion, or aneurysm. The major dural venous sinuses are grossly patent.\n\nCTA NECK:\nPatent bilateral vertebral and carotid arteries in the neck. No ICA stenosis\nby NASCET criteria. No dissection.\n\nOTHER:\nScattered bilateral multilevel cervical lymph nodes are not pathologically\nenlarged. Thyroid is within normal limits. Bone apices are grossly clear. \nNo concerning focal osseous lesions.", + "output": "1. Severe luminal stenosis of the proximal P2 segment of the right PCA, with\nsegments distal to this not well seen/opacified. Relative oligemia of the\nright temporo-occipital PCA distribution infarct.\n2. 2 x 2 mm posteromedially projecting infundibulum arising from the expected\nlocation of the origin of the right posterior communicating artery.\n3. Mild focal luminal stenosis of the proximal segment of the right MCA\npresumably due to underlying atheromatous disease.\n4. Otherwise, patent and unremarkable circle ___ vasculature.\n5. Hypodensity in the right medial temporal and occipital lobes corresponding\nto known acute infarct in this location. No acute intracranial hemorrhage.\n6. Patent bilateral vertebral and carotid arteries in the neck. No ICA\nstenosis by NASCET criteria." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass, mass effect, or large\nvascular territory infarction. The ventricles and sulci are normal in size and\nconfiguration for the patient's age. The basal cisterns are patent. There is\npreservation of gray-white matter differentiation.\n\nNo fracture is identified. The visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The soft tissues and orbits are\nunremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "Patient motion degrades evaluation of the exam and making this a nondiagnostic\nstudy.", + "output": "Nondiagnostic study secondary to degradation from patient motion." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\n\nThere is no evidence of acute hemorrhage or infarction. Patient is status\npost occipital craniotomy. An unchanged 1.7 x 1.6 cm calcified rounded lesion\nis seen in the left posterior fossa, and likely represents a calcified\nmeningioma, with no significant mass effect, there are multiple unchanged\nsupratentorial dural-based calcifications. There is prominence of the\nventricles and sulci suggestive of involutional changes.\n\nThere is near complete opacification of the right maxillary sinus. The right\nmastoid air cells are also opacified. These findings may indicate chronic\nsinus disease. The other visualized portions of the paranasal sinuses,left\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid arteries appear normal without evidence of stenosis or occlusion. \nThere is dominance of the left vertebral artery as compared to the right\nvertebral artery, which is a normal anatomic variant. The rightvertebral\nartery appears to be hypoplastic at the V4 segment as compared to the left\nvertebral artery V4 segment, but appears patent and is most likely congenital.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\n\nAtherosclerotic calcifications are noted in the aortic arch, the origin of the\nright vertebral artery, bilateral bifurcations of the carotid arteries, and\nthe bilateral carotid siphons. There is slight fullness noted of the left\npiriform recess as compared to the right.\n\nCervical spine alignment is maintained.\n\nOTHER:\nSmall pleural effusions are seen bilaterally, right greater than left. The\nvisualized portion of the thyroid gland is within normal limits. There is no\nlymphadenopathy by CT size criteria.", + "output": "1. Hypoplastic V4 segment of the right vertebral artery without significant\nocclusion or stenosis. No aneurysm is seen greater than 3 mm.\n2. There is a 1.7 x 1.6 cm calcified rounded lesion in the left posterior\nfossa which most likely represents a calcified meningioma, with no evidence of\nmass effect.\n3. Near complete opacification of the right maxillary sinus and right mastoid\nair cells, which may indicate chronic sinus disease.\n4. Small pleural effusions seen in the bilateral lungs, right greater than\nleft.\n5. Atherosclerotic calcifications seen bilaterally throughout the vasculature,\nas described above.\n6. No evidence of acute hemorrhage, infarcts, or fractures." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territory infarct. Gray-white matter\ndifferentiation is preserved. There is no hydrocephalus. The visualized\nparanasal sinuses minimal mucosal thickening of the bilateral ethmoid air\ncells. The remainder of the partially imaged paranasal sinuses are clear.. \nThe mastoid air cells are clear. No acute fracture is seen.", + "output": "No acute intracranial process." + }, + { + "input": "Evaluation is moderately limited by motion beam hardening artifact at the\nvertex and skullbase. No acute intracranial hemorrhage, edema, or mass effect\nis identified. Ventricles and sulci are normal in size configuration. Pineal\ncalcification noted incidentally.\n\nNo acute fracture is see.. There is mild mucosal thickening of the ethmoid\nsinuses. The remaining the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The orbits are unremarkable.", + "output": "1. No acute intracranial process on mildly motion limited exam." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Hyperdense appearance of the dura along the right frontal lobe at\nthe site of prior surgery likely region reflect postsurgical change. \nVentricles and sulci appear normal in overall pattern. Basilar cisterns are\npatent. Minimal mucosal thickening within the maxillary sinuses. Mastoid air\ncells and middle ear cavities appear well aerated. Postsurgical changes\ninvolving the frontal bone noted.", + "output": "No acute intracranial process. Postsurgical changes in the right frontal\nlobe." + }, + { + "input": "Left : The external auditory canal is normal. The middle ear cavity is clear.\nThe ossicles and tegmen are intact. There is no evidence for enlarged\nvestibular aqueduct or superior semicircular canal dehiscence. The facial\nnerve follows a normal course through the middle ear. There is no evidence for\ninner ear dysplasia. There is minimal amount of fluid layering within the\nleft mastoid air cells, which are otherwise clear. There is no abnormal\nenhancement on post contrast imaging.\nRight: The external auditory canal is normal. The middle ear cavity is clear.\nThe ossicles and tegmen are intact. There is no evidence for enlarged\nvestibular aqueduct or superior semicircular canal dehiscence. The facial\nnerve follows a normal course through the middle ear. There is no evidence for\ninner ear dysplasia. The mastoids are clear. There is no abnormal enhancement\non post contrast imaging.\nOther: Visualized brain and neck soft tissues are normal.", + "output": "1. Minimal amount of fluid layering within the left mastoid air cells. \nOtherwise, normal temporal bone examination.\n2. No acute intracranial process noted within visualized portions of the\nbrain.\n\nNOTIFICATION: The findings were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 5:38 ___, 15 minutes after\ndiscovery of the findings." + }, + { + "input": "A mixed density subdural hemorrhage overlying the right cerebral hemisphere\nmeasures 1.6 cm in greatest axial thickness, similar to the prior study. \nSubdural hemorrhage is also seen layering along the falx and tentorium. There\nis moderate sulcal and right lateral ventricle effacement resulting in 12 mm\nleftward midline shift, previously 11 mm. There is partial effacement of the\nfrontal and temporal horns of the right lateral ventricle.\n\nThere is no intraventricular hemorrhage, intraparenchymal hemorrhage, or\nsubarachnoid hemorrhage visualized. There is no evidence of acute major\nvascular territorial infarction.\n\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated.\n\nThe bony calvarium is intact.", + "output": "Acute on chronic right subdural hemorrhage with 12 mm leftward midline shift,\nnot significantly changed since the prior study." + }, + { + "input": "Patient is status post right-sided craniotomy for evacuation of subdural\nhematoma. Expected postsurgical changes are noted, including small amount of\nnearby edema and blood products, as well as moderate pneumocephalus along the\nright frontal convexity. Small amount of residual blood is seen layering\nalong the falx. No evidence of new intracranial hemorrhage or acute large\nterritorial infarction. Persistent effacement of the right-sided sulci and\nright lateral ventricle. Leftward shift of midline structures measures 5 mm,\nimproved from 12 mm on prior study.\n\nDense vascular atherosclerotic calcifications are seen in the carotid siphons\nbilaterally. The visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. Expected postsurgical changes status post right-sided craniotomy for\nevacuation of subdural hematoma.\n2. Mild persistent effacement of the right-sided sulci and right lateral\nventricle, with leftward shift of midline structures measuring 5 mm, improved\nfrom 12 mm on prior study.\n3. No evidence of new intracranial hemorrhage or acute large territorial\ninfarction." + }, + { + "input": "Again demonstrated are postsurgical changes related to a right-sided\ncraniotomy with interval decrease in now small volume pneumocephalus. There\nhas been interval removal of the intracranial drain. There has been improved\neffacement on the right lateral ventricle now with 4 mm of right-to-left\nmidline shift, previously 5 mm (02:16). There is decreased right frontal\nsulcal edema compared to prior exam. Hyperdense material, likely compatible\nwith postoperative blood products, at the evacuation site appear similar to\nslightly decreased in extent. Residual hemorrhagic blood products near the\nanterior falx is decreased compared to recent exam, currently measuring up to\n6 mm in width, previously 8 mm (02:23). Isodense subdural collection in the\nright frontal convexity measures up to 5 mm in width and was previously\nobscured by pneumocephalus on the prior exam (02:16). There is no new areas\nof intracranial hemorrhage or evidence of infarction.\n\nMultiple surgical skin staples are seen overlying the right frontotemporal\nconvexity.\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. Patient is status post bilateral lens replacements.", + "output": "1. Status post right sided craniotomy with interval removal of an intracranial\ndrain and improved pneumocephalus.\n2. Improved effacement of the right lateral ventricle and right frontal sulci\nwith now 4 mm of leftward midline shift, previously 5 mm.\n3. Interval decrease in hemorrhagic blood products at the anterior falx.\n4. No new areas of intracranial hemorrhage." + }, + { + "input": "Right parietal craniotomy. Interval near resolution of right hemispheric\nsubdural collection, tiny residual low-density collection.. Mild dural\nthickening. No acute blood products. Mild-to-moderate cerebral, moderate\ncerebellar atrophy. Findings consistent with mild chronic small vessel\nischemic change.. Mild opacification inferior bilateral mastoid air cells,\nwith calcification, consistent with chronic from a shin.. Minimal paranasal\nsinus disease. Degenerative arthritis right temporomandibular joint.", + "output": "Near resolution of subdural fluid collection.\nBrain parenchymal atrophy." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction, mass or midline\nshift. There is no hydrocephalus. Visualized paranasal sinuses and mastoid\nair cells are clear. There is no fracture.", + "output": "Unremarkable unenhanced head CT." + }, + { + "input": "The examination is partially limited due to patient motion. There is no acute\nintracranial hemorrhage,acute infarction, mass or midline shift. The\nventricles and sulci are normal in size and configuration. The basal cisterns\nare patent and there is preservation of gray-white matter differentiation. The\norbits are unremarkable. There is no fracture. The visualized paranasal\nsinuses, middle ear cavities and mastoid air cells are clear. There has been\nno significant interval change compared to the same day prior study.", + "output": "Unremarkable unenhanced head CT without change from earlier same day\nexamination." + }, + { + "input": "There has been interval placement of a bolt through the right frontal bone\nwhich terminates approximately 1.2 cm into the right frontal lobe as measured\nfrom the inner table of the calvarium. There is no evidence of hemorrhage,\nhowever, hardware artifact limits sensitivity for detection of hemorrhage in\nthe immediate vicinity of the bolt. There is no evidence of infarction, mass\nor edema, or shift of normally midline structures. There is no\nventriculomegaly. The paranasal sinuses and mastoid air cells are clear. There\nis no evidence of fracture.", + "output": "1. Interval placement of right frontal bone bolt. No evidence of hemorrhage;\nhowever, hardware artifact limits sensitivity for detection of hemorrhage in\nthe immediate vicinity of the bolt.\n2. Otherwise, unchanged unenhanced head CT." + }, + { + "input": "Again seen is right frontal bolt insertion through the frontal bone, in\nunchanged position. There is no evidence of hemorrhage; however, sensitivity\nfor detection of hemorrhage is lowered in the immediate vicinity of the bolt\ndue to hardware artifact.\n\nThere is no evidence of infarct, mass effect, edema, shift of normally midline\nstructures, or ventriculomegaly. The basal cisterns are patent. The\nvisualized paranasal sinuses are clear. The mastoid air cells are clear. There\nis no evidence of fracture.", + "output": "No evidence of hemorrhage; however, CT sensitivity for detection of hemorrhage\nis lowered in the immediate vicinity of bolt due to hardware artifact. No\nsignificant interval change in unenhanced CT head." + }, + { + "input": "There is a small hypodense tract in the right frontal lobe with a punctate\nhigh density focus which may represent trace blood products with prior bolt\nplacement. There is no other focus of hemorrhage,acute infarction, mass or\nmidline shift. There is no hydrocephalus. The ventricles and sulci are\nnormal in size and configuration. The basal cisterns are patent and there is\npreservation of gray-white matter differentiation. The orbits are\nunremarkable. Visualized paranasal sinuses and middle ear cavities are clear.\nCompared to the prior study, there has been interval increased opacification\nof the bilateral mastoid air cells. There is no fracture.", + "output": "1. Small hypodense tract in the right frontal lobe with punctate focus of\ntract hemorrhage from removal of bolt hardware.\n2. Interval increase in opacification of the bilateral mastoid air cells which\nin the correct context could represent mastoiditis/related to intubation, etc.\nCorrelate clinically" + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. No evidence of intracranial mass." + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass. The ventricles and sulci are prominent, associated with age-advanced\ninvolution changes. No osseous abnormalities seen. The paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "No acute intracranial abnormalities." + }, + { + "input": "Interval right parietal craniotomy, and surgical resection of a ring-enhancing\ncystic mass lesion of the right parietal lobe, with expected postsurgical\nchanges. There is postprocedural pneumocephalus with small foci of air in the\nright parietal lobe and along the right frontal convexity and surgical cavity.\nPostsurgical subarachnoid hemorrhage along the sulci adjacent to the surgical\nbed, extending anteriorly towards the falx and leftward into the left parietal\nlobe. There is no mass effect or midline shift. Persistent and grossly\nunchanged vasogenic edema is noted in the surgical bed.\n\nThere are mild aerosolized secretions of the bilateral maxillary sinuses. The\nvisualized portion of the remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Status post interval right parietal craniotomy, and surgical resection of a\nright parietal lobe ring-enhancing cystic mass lesion, with expected\npostsurgical changes, including pneumocephalus, subarachnoid hemorrhage, and\nvasogenic edema of the surgical bed as described above.\n2. No mass effect or midline shift." + }, + { + "input": "7 mm dense extra-axial left temporal lesion is unchanged since ___, likely representing a calcified meningioma (2:8).\n\nThere are postsurgical changes from high right frontal craniotomy and subdural\nhematoma evacuation. Right lateral convexity subdural hematoma has decreased\nin size with right frontal component measuring up to 12 mm in thickness,\npreviously 18 mm, and right parietal component measuring up to 14 mm in\nmaximal thickness, previously 18 mm. However, the collection appears slightly\nincreased in density as compared to the ___ examination, which may\nreflect a subacute on chronic component. Associated mass effect has improved\ncompared to the prior examination, with relaxation of effacement of the\nadjacent sulci, and now with up to 5 mm of leftward midline shift, previously\n7 mm.\n\nThere is no evidence of large territorial infarct. The ventricles and sulci\nare stable in size and configuration.\n\nThere is no evidence of fracture. There is complete opacification of the\nvisualized portion of the left maxillary sinus, with dense central component,\nslightly increased as compared to the prior examinations. The remainder of\nthe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavitiesare otherwise clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Interval decrease in size of a right lateral convexity subdural hematoma\nmeasuring up to 14 mm in maximal thickness of the right parietal component,\nthough with slightly increased density compared to ___ examination,\nwhich ___ represent a subacute on chronic component.\n2. Reduction of associated mass effect, now with up to 5 mm of leftward\nmidline shift, previously 7 mm.\n3. Unchanged dense 7 mm left temporal extra-axial lesion, likely reflecting a\ncalcified meningioma. If clinically indicated, contrast brain MRI may be\nobtained for further evaluation.\n4. Complete opacification of the visualized left maxillary sinus with central\ndense component, increased compared to the prior examination, suggestive of\nchronic sinusitis with inspissated mucus or fungal colonization. Given\nisolated involvement, ENT evaluation should be considered.\n\nNOTIFICATION: Dr. ___ was aware of these findings at time of dictation,\nper ___ medical record note." + }, + { + "input": "There has been a decrease in the volume of a right-sided chronic subdural\nhematoma since the prior study. A small residual right frontal subdural\ncollection is again seen. There is minimal local mass effect on the adjacent\nright frontal lobe. There is no other evidence of mass effect. There is no\nevidence of infarction,new hemorrhage, edema, or mass. The ventricles and\nsulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Decreased volume of right-sided subdural hematoma since the study of ___.\n2. No evidence of new hemorrhage." + }, + { + "input": "Patient is status-post right frontal craniotomy. Right subdural drain is in\nplace. Moderate pneumocephalus is present with bifrontal predominance, right\ngreater than left. Mixed density right subdural blood products have been\nevacuated. Small amount of hyperdense blood immediately deep to the\ncraniotomy is likely epidural, measuring 10 mm on image 2:26. Right subdural\ncollection of hypodense fluid, air, and small amount of blood measures up to\n1.4 cm from the inner table along the right frontal convexity compared to 22\nmm previously. There is partial improvement in right sulcal effacement. \nShift of midline structures now measures 4 mm, decreased. The lateral and\nthird ventricles have slightly re-expanded but remain small for age. The\nbasal cisterns are not compressed. There is a new small left subdural\nhygroma.\n\nNo new hemorrhage is seen. No evidence for an acute major vascular\nterritorial infarction.\n\nThere is near complete opacification of the partially visualize left maxillary\nsinus with hyperdense and partially calcified material, likely inspissated\nsecretions, though fungal colonization is also possible. There is associated\nmild sclerosis of the visualized left maxillary sinus walls, indicating\nsequela of chronic inflammation. Right anterior ethmoid air cells demonstrate\na small mucous retention cyst and minimal mucosal thickening.", + "output": "1. Status post right subdural hematoma evacuation with small amount of likely\nepidural blood deep to the right craniotomy, and a 14 mm right subdural\ncollection of fluid, air, and minimal blood. Partial improvement in\nassociated mass effect.\n2. No evidence for new hemorrhage.\n3. New small left subdural hygroma with pneumocephalus.\n4. Chronic left maxillary sinusitis with osseous remodeling is partially\nvisualized. Hyperdense and partially calcified material in the left maxillary\nsinus likely represents inspissated secretions, though fungal colonization is\nalso possible.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 5:33 AM, less than 10\nminutes after discovery of the findings." + }, + { + "input": "The patient is status post right frontal craniotomy. An intracranial drain\nterminates within the subdural space overlying the right frontal lobe. \nPneumocephalus overlying the frontal lobes bilaterally has decreased. \nBilateral mixed density extra-axial collections with probable epidural\ncomponents are unchanged, measuring up to 15 mm in thickness on the right, and\n6 mm on the left. There is no evidence of new hemorrhage.\n\nImproving right to left midline shift, currently measuring 2 mm. The\nventricular system is unchanged in configuration. The basal cisterns are\npatent. There is no evidence of infarction or edema. A 6 x 5 mm partially\ncalcified lesion arising from the inner table of the left temporoparietal\ncalvarium likely represents a small meningioma (series 3, image 8).\n\nThere is no evidence of fracture. Near complete opacification of the left\nmaxillary sinus with the sclerotic walls and calcified inspissated secretions,\nlikely representing chronic sinusitis. Otherwise, the visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nThe visualized portion of the orbits are unremarkable.", + "output": "1. Status post right frontal craniotomy. Stable bilateral mixed density\nextra-axial collections. No evidence of new hemorrhage.\n2. Improving midline shift.\n3. 6 mm partially calcified lesion arising from the inner table of the left\ntemporoparietal calvarium, likely a small meningioma.\n4. Chronic left maxillary sinusitis." + }, + { + "input": "The patient is status post right frontal craniotomy and removal of previously\nseen intracranial drain. Re-demonstration of pneumocephalus overlying the\nfrontal lobes bilaterally, grossly unchanged. Bilateral mixed density\nextra-axial collections are grossly unchanged, measuring up to 13 mm in\nthickness in the axial dimension on the right and 9 mm on the left. There is\nno evidence of new hemorrhage or infarction. There is stable 2 mm leftward\nmidline shift. The ventricles are unchanged in configuration. The basal\ncisterns are patent.\n\nAgain seen is a 7 mm calcified lesion arising from the inner table of the left\ntemporoparietal calvarium (03:11), unchanged, likely representing a small\nmeningioma.\n\nPatient is status post right frontal craniotomy. No acute osseous abnormality\nis noted. Again seen is near complete opacification of left maxillary sinus\nwith adjacent wall sclerosis, suggestive of chronic sinusitis. The visualized\nportion of the other paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Status post right frontal craniotomy and removal of intracranial drain.\n2. Stable bilateral mixed density extra-axial collections and pneumocephalus,\nwithout evidence of new hemorrhage.\n3. Stable 2 mm leftward midline shift.\n4. 7 mm calcified lesion arising from the inner table of the left\ntemporoparietal calvarium, unchanged, likely representing a small meningioma\n5. Chronic left maxillary sinusitis." + }, + { + "input": "Patient is status post right craniotomy for subdural evacuation, with interval\nresolution of pneumocephalus. Compared with ___, right\nfrontoparietal subdural hematoma is increased in size and density, measuring\nup to 2.1 cm along the anterior component, compared with 1.3 cm previously,\nand 2.3 cm posteriorly, compared with 1.4 cm (2:13, 22). Previously\npredominantly hypodense, the collection is overall isodense with scattered\nfoci of hyperintensity, consistent with acute blood products (2:7, 12). A\nleft subdural collection is decreased in size, currently measuring up to 6 mm,\ncompared with 8 mm previously (2:20). There has been interval increase in\nrightward midline shift compared with prior, currently measuring up to 4 mm,\ncompared with 2 mm previously. Basal cisterns are patent. There is no\nevidence of acute large territorial infection. Again seen is a 7 mm calcified\nlesion arising from the inner table of the left temporoparietal calvarium,\nunchanged, and likely representing a small meningioma.\n\nThere is no evidence of fracture. There is mild mucosal thickening in the\npartially visualized left maxillary sinus and ethmoid air cells. The\nvisualized portion of the remainder of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. Overall increase in size and density of a right subdural hematoma,\ncurrently measuring up to 2.3 cm compared with 1.4 cm previously, with several\nfoci of internal hyperdensity consistent with acute and subacute blood\nproducts.\n2. A small left subdural hematoma is decreased in size.\n3. Interval increase in associated mass effect, with leftward midline shift up\nto 4 mm, compared with 2 mm previously.\n4. Paranasal sinus disease as described.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with ___\n___ at ___ clinic on the telephone on ___ at 2:39 pm, 5\nminutes after discovery of the findings." + }, + { + "input": "There is no evidence of acute large territorial infarct, hemorrhage, edema, or\nmass effect. Prominent ventricles and sulci are suggestive age-related\ninvolutional changes. Periventricular white matter hypodensities are\nconsistent with chronic small vessel ischemic disease.There is no evidence of\nfracture. The visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass. Prominence of the ventricles and sulci are suggestive of age related\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific but likely represent sequelae of chronic small\nvessel ischemic disease. Calcification of the carotid siphons and\nvertebrobasilar system are noted.\n\nNo acute osseous abnormalities seen. The paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. Patient is status post bilateral lens\nreplacements.", + "output": "No acute intracranial abnormality." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are normal in size and configuration.\n\nThere is a small mucous retention cyst in the right maxillary sinus and mild\nmucosal thickening inferiorly in the left maxillary sinus. The visualized\nportion of the paranasal sinuses, mastoid air cells,and middle ear cavities\nare otherwise clear. The visualized portion of the orbits are normal.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. The dural venous\nsinuses are patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent.\nAllowing for pulsation artifact at the level of the carotid bulbs bilaterally,\nthere is no evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. No evidence of dissection.\n\n\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. There is mild cervical spondylosis loss of the normal cervical\nlordosis, which may be positional. Note is made of a right-sided palatine\ntonsillith.", + "output": "1. No evidence of mass, hemorrhage or infarction.\n2. Mild maxillary sinus mucosal findings, as described.\n3. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n4. Allowing for motion artifact at the carotid bulbs bilaterally, patent\nbilateral cervical carotid and vertebral arteries without evidence of\nstenosis, occlusion, or dissection." + }, + { + "input": "There is no evidence of acute vascular territorial infarction,hemorrhage,\nedema, or mass infarct. A chronic infarct is seen in the left subcortical\nwhite matter, similar to prior. Subcortical and periventricular white matter\nhypodensities are nonspecific, likely the sequelae of small vessel ischemic\ndisease in a patient of this in a patient of the coli a small vessel ischemic\ndisease there is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture. A left parietal subgaleal hematoma is noted.\nThere is thinning of the bilateral posterior parietal bones, similar to prior.\nThere is mild mucosal thickening of the ethmoid air cells. The visualized\nportion of the remaining paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits show bilateral lens\nreplacement.", + "output": "1. No acute intracranial process. Left parietal subgaleal hematoma without\nunderlying fracture." + }, + { + "input": "Subtle, apparent asymmetric hypodensity in the paramedian left occipital lobe\nsubcortical white matter (for example, 02:13) appears similar to the previous\nexamination.\n\nAllowing for this, there is no evidence for acute intracranial hemorrhage or\nvascular territorial infarction. Very minimal periventricular and subcortical\nwhite matter hypodensities are nonspecific, but compatible with chronic\nmicroangiopathy in a patient of this age. The ventricles and sulci are\nage-appropriate and normal in both size and configuration. The basal cisterns\nare patent. A 7 mm left frontal extra-axial partially calcified lesion is\nmost compatible with a meningioma, with underlying hyperostosis of the inner\ntable (series 2, image 21).\n\nThe paranasal sinuses, middle ear cavities, and mastoid air cells are well\naerated and clear. The orbits are unremarkable bilaterally, allowing for a\nleft-sided lens replacement. No evidence for skull fracture or suspicious\nosseous lesion.", + "output": "1. No evidence of acute infarct or intracranial hemorrhage. Previously seen\nleft frontal subdural hematoma has resolved.\n2. Re-identified is subtle hypodensity of the left occipital subcortical white\nmatter overall similar to prior examination. This could represent sequela of\nprior trauma given the clinical history and question of cerebral edema on\nprior examination versus potentially sequela of chronic small vessel ischemic\ndisease. This could be further evaluated with MRI as clinically indicated.\n3. Left frontal partially calcified 7 mm extra-axial lesion, compatible with a\nmeningioma." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration. There is a\npunctate hyperdensity in the posterior aspect of the right frontal horn that\nlikely represents a venous structure.\n\nThere is mucosal thickening of the ethmoid air cells and bilateral maxillary\nsinuses. The visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nnormal.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect or\nlarge territorial infarction. The ventricles and sulci are normal in size\nconfiguration. The basal cisterns are patent. Gray-white matter\ndifferentiation is preserved.\n\nThere is no fracture. There is minimal mucosal thickening in the partially\nimaged paranasal sinuses and a small mucous retention cyst in the right\nfrontoethmoidal recess. The mastoid air cells and middle ear cavities are\nclear. There is a tiny contusion of the posterior scalp.", + "output": "1. No acute intracranial abnormality.\n2. Tiny contusion of the posterior scalp." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or mass\neffect. Ventricles and sulci are age-appropriate.\n\nThere is no evidence of fracture. Incidentally noted is an osteoma within the\nleft frontal sinus, measuring 1.5 cm. There is mild mucosal thickening of the\nbilateral anterior ethmoid air cells. The visualized portion of the remaining\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThe study is mildly degraded by motion. There is a hyperdense mid right M1\nMCA. No intracranial hemorrhage or mass. Bilateral basal ganglia\ncalcification is incidentally noted. Ventricles and sulci are prominent,\nsuggestive of involutional changes. Periventricular and subcortical white\nmatter hypodensity is nonspecific, but likely reflect sequelae of chronic\nsmall vessel ischemic disease.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is occlusion of the mid right M1 middle cerebral artery, with distal\noligemia (4:252). The vessels of the circle of ___ are otherwise patent.\nNo aneurysm.\n\nCTA NECK:\nRespiratory motion causes mild to moderate degradation of the neck vessels.\n\nWithin this limitation, the carotidandvertebral arteries and their major\nbranches appear normal with no evidence of stenosis or occlusion. There is\nmild atherosclerotic calcification at both carotid bifurcations. There is no\nevidence of internal carotid stenosis by NASCET criteria.\n\nCT PERFUSION: There is a mismatch of blood flow and T-max in the right MCA\nterritory, with the infarct core centered in the right thalamus measuring\napproximately 4.4 cc.\n\nOTHER:\nEvaluation of the lung apices is limited by respiratory motion. The lung\napices are grossly clear. Thyroid gland is unremarkable. Cervical lymph\nnodes are not enlarged.", + "output": "1. No intracranial hemorrhage.\n2. Occlusion of the mid M1 middle cerebral artery.\n3. Core infarct centered in the right thalamus measuring approximately 4.4 cc.\nThe penumbra involves the remainder of the right MCA territory." + }, + { + "input": "Several images through the vertex were repeated due to motion artifact on the\ninitial scan.\n\nEarly subacute right MCA territory infarct is again seen involving the right\ninsular cortex, right putamen, right internal capsule. No evidence for\nhemorrhagic transformation.\n\nSmall early subacute infarcts seen in the left frontal subcortical white\nmatter and in the left posterior parietal cortex on the recent MRI are not\nwell seen by CT.\n\nSlightly older subacute infarct in the left frontal lobe, with evidence of\nprior hemorrhagic transformation on the recent MRI, is stable in extent (3:6).\n\nChronic right parietal infarct is again seen on image 2:22, better defined on\nthe prior MRI due to motion artifact.\n\nPeriventricular and subcortical white matter hypodensities are otherwise\nnonspecific but likely sequela of chronic small vessel ischemic disease in\nthis age group. Ventricles and sulci demonstrate age-appropriate size.\n\nNo evidence for suspicious bone lesions. No significant paranasal sinus\ndisease. Nasogastric tube is partially imaged.", + "output": "1. Early subacute right MCA territory infarct appears stable in extent\ncompared to the prior MRI, without evidence for hemorrhagic transformation.\n2. Small early subacute infarcts in the left frontal subcortical white matter\nand left posterior parietal cortex, seen on the recent MRI, not well seen by\nCT.\n3. Slightly older subacute infarct in the left frontal lobe, with evidence of\nprior hemorrhagic transformation of the recent MRI, is stable in extent.\n4. Chronic right parietal infarct is also again noted." + }, + { + "input": "There is no evidence of acute large territory infarction, hemorrhage, edema,\nor mass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Mild ethmoid and maxillary sinus\nthickening, left greater than right. The visualized portion of the mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Mild sinus disease, as described above." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, or loss of\ngray/white matter differentiation. Ventricles, sulci, and basal cisterns are\nnormal in size.\n\nThere is no evidence of fracture. An 8 mm well-circumscribed soft tissue\ndensity in the right paramedian parietal scalp at the vertex is unchanged\ncompared to prior exam, statistically likely a sebaceous cyst (02:29). There\nis mild right and mild-to-moderate left ethmoid air cell mucosal thickening. \nThere is mild-to-moderate mucosal thickening in the partially imaged left\nmaxillary sinus. Mastoid air cells are grossly clear allowing for absence of\ndedicated bone algorithm images.", + "output": "No evidence for acute intracranial abnormalities." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the mastoid air\ncells and middle ear cavities are clear. There is trace bilateral maxillary\nsinus and sphenoid sinus mucosal thickening. Incidentally noted is a left\nfrontal sinus osteoma. The visualized portion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territorial infarct. Prominence of the\nventricles and sulci is consistent with involutional changes. Periventricular\nand subcortical white matter hypodensities are likely sequelae of chronic\nsmall vessel disease. The visualized paranasal sinuses are clear. The\nmastoid air cells are clear. No acute fracture is seen.", + "output": "No acute intracranial process." + }, + { + "input": "The patient is status post right frontal craniotomy and burr hole placement. \nThe catheter, previously draining the extra-axial space in the right frontal\nlobe, has been removed. There has been interval evolution and redistribution\nof the right iso to hypodense frontoparietal subdural hematoma, which has\nmarkedly decreased in size. The right frontoparietal subdural hematoma\nmeasures 4 mm in thickness in the right frontal lobe, previously measuring 1.8\ncm, and measures 1.1 cm in thickness and the right parietal lobe, previously\nmeasuring 1.3 cm. No new hemorrhage is identified. There is decreased local\nmass effect upon the right frontal and parietal lobes. The right lateral\nventricle is no longer effaced. The right to left midline shift has resolved.\nThere is no evidence of infarction.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Expected evolution and interval decrease in the size of the right\nfrontoparietal subdural hematoma with marked decrease in the local mass effect\nand resolution of the right to left midline shift. No new hemorrhage." + }, + { + "input": "Compared to the most recent prior examination, there has been interval\ndrainage of a the right subdural hematoma. The hematoma is smaller than on\nthe prior examination and measures 1.9 cm at its widest diameter (previously\n2.5 cm). There is 7 mm of leftward shift of normally midline structures which\nis improved from the prior study when midline shift measure 1.4 cm. There is\nno evidence of new hemorrhage or of infarction. Mixed density fluid within\nthe subdural collection likely represents blood products of varying ages.\nThere is high-density blood around the catheter, likely related to recent\nintervention.", + "output": "1. Interval decrease in a large right sided subdural fluid collection status\npost catheter placement. Leftward shift of normally midline structures is\nimproved as described above. No new hemorrhage or infarction is detected" + }, + { + "input": "Enlarged cervical lymph nodes are identified, specifically the largest is seen\non the right at level 4 (2:56) which measures 1.5 x 1.8 cm, previously 1.4 x\n1.7 cm. A 1.2 cm right supraclavicular node (2:61) had previously measured\n1.0 cm. Additional enlarged right supraclavicular lymph nodes are also seen\nmeasuring up to 1.4 x 1.2 cm (02:50) and 1.1 x 0.9 cm (02:47). These findings\nmay explain asymmetry compared to the left on physical exam. These nodes\ndemonstrate areas of hypoenhancement centrally suggesting necrosis.\n\nThe parotid glands and submandibular glands are unremarkable. There are\nseveral subcentimeter nodules in the thyroid bilaterally.\n\nThere is medial is a shin of the left true vocal cord and aryepiglottic fold\nraising the possibility of left vocal cord paralysis. Aerodigestive tract is\notherwise unremarkable.\n\nMajor vascular structures are grossly unremarkable.\n\nIncluded paranasal sinuses and mastoids are clear.\n\nNo acute osseous abnormalities.\n\nPlease see report from chest CT acquired concurrently for additional details\nincluding abnormalities in the lungs and adenopathy in the mediastinum.", + "output": "1. Right-sided necrotic cervical adenopathy including abnormal supraclavicular\nlymph nodes which could explain asymmetry at the neck base on physical exam. \nNo other findings to explain symptoms.\n2. Findings raise the possibility of left-sided vocal cord paralysis, which\ncould potentially be explained necrotic adenopathy in the prevascular region.\n3. Please see chest CT report for additional details" + }, + { + "input": "CT head shows no evidence of hemorrhage, or loss of gray-white matter\ndifferentiation. No midline shift or hydrocephalus seen.\n\nCT angiography of the neck shows normal appearance of the carotid and\nvertebral arteries without stenosis or occlusion or dissection.\n\nCT angiography of the head shows normal appearance of the arteries of the\nanterior and posterior circulation without stenosis or occlusion or aneurysm\ngreater than 3 mm in size.", + "output": "No significant abnormalities on CT of the head without contrast. No\nsignificant abnormalities on CT angiography of the head and neck." + }, + { + "input": "The patient is intubated with fluid in the oropharynx and hypopharynx. A 1.3\ncm linear radiopaque foreign object is seen within the proximal esophagus at\nthe level of T1- T2 (series 2, image 79). No evidence of esophageal\nperforation or surrounding fluid collection. Please refer to the chest CT\nwith the same date for evaluation of the intrathoracic structures.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. The neck vessels are patent.\n\nA large mucous retention cyst is seen within the right maxillary sinus. \nMucosal thickening involving ethmoid air cells bilaterally, as well as left\nmaxillary sinus. Scoliosis of the cervicothoracic spine noted. There is mild\nheight loss of the C6 vertebral body appears chronic. No suspicious osseous\nlesions.", + "output": "1. 1.3 cm linear radiopaque foreign object within the proximal esophagus at\nthe level of T1-T2. No evidence for esophageal perforation, associated\npneumomediastinum, or adjacent fluid collection. Please refer to the chest CT\nwith the same date for evaluation of the intrathoracic structures.\n2. Scoliosis of the cervicothoracic spine with likely chronic mild height loss\nof the C6 vertebral body without priors for comparison.\n3. Paranasal sinus disease." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. Mastoid air cell tip is opacified on the right\nside. Otherwise, the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute large vessel territorial infarction, acute\nhemorrhage, edema, mass effect or midline shift. There are multiple\nhypodensities in the bilateral basal ganglia likely related to remote lacunar\ninfarcts. There is preservation of the gray-white matter differentiation of\nthe insular cortex bilaterally. The ventricles and sulci are normal in size\nand configuration.\n\nThere is a mucous retention cyst and mild mucosal thickening in the left\nmaxillary sinus. There is mucosal thickening of the ethmoid air cells and\nfrontal sinus. There is limited pneumatization of the sphenoid sinuses. \nMastoid air cells are well aerated. The orbits appear unremarkable.\n\nCTA NECK:\nCommon origin of the innominate and left common carotid arteries is a normal\nvariant. There is noncalcified plaque mildly narrowing the proximal right\ncommon carotid artery. Right internal carotid artery is widely patent without\nstenosis by NASCET criteria. Left common carotid artery is widely patent. \nThere is mixed calcified and noncalcified plaque in the proximal left internal\ncarotid artery causing ___ stenosis by NASCET criteria.\n\nThere is mild calcified and noncalcified plaque in the proximal left\nsubclavian artery without evidence for flow-limiting stenosis. Evaluation of\nthe dominant left vertebral artery origin is limited by beam hardening\nartifact from concentrated radiopaque contrast in the adjacent veins. \nHowever, there appears to be severe stenosis of the left vertebral artery\norigin secondary to predominantly noncalcified plaque. Remaining course of\nthe left vertebral artery is widely patent. Non dominant right vertebral\nartery is diminutive and widely patent, entering the cervical spine at C5\nrather than C6, a normal variant.\n\nCTA HEAD:\nThere is nonvisualization of the distal 2-3 mm of the diminutive non dominant\nright vertebral artery, and small caliber of the distal 7 mm of the dominant\nleft vertebral artery, both just proximal to the basilar artery origin,\nunclear whether congenital or secondary to atherosclerosis. There is a right\n___ complex. There is also a prominent left ___, which may provide\nadditional supply to the right ___ territory. There is fetal configuration\nof the right posterior cerebral artery. There is mild irregularity of the P1\nand P2 segments of the left posterior cerebral artery with short-segment mild\nstenosis of the left P2 segment, best seen on images 3:248, 601:42, 460:1.\n\nThere is mild calcified plaque within bilateral carotid siphons without\nevidence for flow-limiting stenosis. Right A1 segment is hypoplastic. No\nflow-limiting stenosis is otherwise seen in the anterior circulation arteries.\n\nNo evidence for an aneurysm. The dural venous sinuses are patent.\n\nOTHER:\nThe thyroid is mildly prominent without evidence for nodules warranting\nsonographic evaluation. No lymphadenopathy by CT criteria. Mild dependent\natelectasis in the included upper lungs. Degenerative changes in the cervical\nspine. Ossification of the anterior longitudinal ligament of the cervical\nspine is also noted.", + "output": "1. No evidence for acute intracranial hemorrhage or acute major vascular\nterritorial infarction. Multiple small chronic infarcts in the basal ganglia\nand adjacent white matter. MRI would be more sensitive for an acute\ninfarction, if clinically warranted.\n2. Mixed plaque causing ___ stenosis of the proximal left ICA by NASCET\ncriteria\n3. Predominantly noncalcified plaque causing severe stenosis of the dominant\nleft vertebral artery origin.\n4. Nonvisualization of the distal 2-3 mm of the diminutive non dominant right\nvertebral artery, and small caliber of the distal 7 mm of the dominant left\nvertebral artery, both just proximal to the basilar artery origin, unclear\nwhether congenital or secondary to noncalcified atherosclerosis.\n5. Mild irregularity of the left posterior cerebral artery P1 and P2 segments,\nwith short-segment mild stenosis of the left P2 segment, likely secondary to\nnoncalcified atherosclerosis." + }, + { + "input": "Neck CTA: There is scattered atherosclerotic vascular disease. The aortic\narch demonstrates conventional three-vessel branch configuration. The origins\nof the great vessels are patent. The vertebral arteries are patent throughout\ntheir courses within the neck. There is irregularity of the right proximal\ninternal carotid artery with a linear filling defect posteriorly and medially\nsuggesting focal dissection . Additionally, the right external carotid artery\nis occluded at its origin with thrombus seen just distal to its origin. The\nmore distal right external carotid artery is reconstituted however this could\nbe from retrograde flow. The combination of findings may represent the\nsequelae of reported history of recent blunt trauma.\n\nThere is soft tissue swelling over the anterior mandible with additional soft\ntissue laceration and multiple foci of air extending deep to the platysma\nmuscle to the level of the superior thyroid cartilage, with air in the right\nsubmandibular space. There is soft tissue stranding in the region of the vocal\nfolds and hyperdense material within the right piriform sinus.\n\nThere are postoperative changes of bilateral maxillary antrostomies with\ndiffuse paranasal sinus mucosal thickening. The orbits mastoid air cells\nappear unremarkable. There are atheromatous calcifications within bilateral\ncavernous internal carotid arteries. The visualized structures of the brain\nappear unremarkable.\n\nThe lung apices are unremarkable. The thyroid gland, submandibular glands,\nand parotid glands appear normal. There are prominent bilateral cervical lymph\nnodes though non appearing to meet pathologic size criteria.", + "output": "1. Irregularity of the right proximal internal carotid artery with a linear\nfilling defect posteriorly and medially suggesting focal dissection. \nAdditionally, the right external carotid artery is occluded at its origin with\nthrombus seen just distal to its origin. The more distal right external\ncarotid artery is reconstituted although this could be from retrograde flow. \nThe combination of findings may represent the sequelae of reported history of\nrecent blunt trauma.\n2. Soft tissue laceration anterior to the mandible with subcutaneous air\ntracking deep to the platysma muscle into the right submandibular space and\ninferiorly to the level of the superior thyroid cartilage with additional\nhyperdense material within the right piriform sinus which could represent\nblood.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\nby telephone on ___ at 1:28 ___." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nPeriventricular white-matter hypodensities are nonspecific, but likely reflect\nsequelae of chronic microvascular ischemic disease.\n\nThere is a small amount of left frontal soft tissue scalp swelling without\nevidence of an underlying fracture. There is complete opacification of the\nleft sphenoid sinus with adjacent hyperostosis, suggestive of chronic\nsinusitis. Otherwise, the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear.", + "output": "1. No acute intracranial hemorrhage or fracture.\n2. Likely chronic paranasal sinus disease." + }, + { + "input": "Images are degraded by motion artifact. There is no evidence of\ninfarction,hemorrhage, edema, or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. Periventricular and subcortical\nwhite matter hypodensities are nonspecific, but likely sequela of chronic\nsmall vessel ischemic disease.\n\nThere is no evidence of fracture. As before, there is near complete\nopacification of the left sphenoid sinus with wall sclerosis, suggesting\nchronic sinusitis. Small amount of fluid in the inferior most right mastoid\nair cells. There is mild mucosal thickening in the left maxillary sinus. The\nvisualized portion of the remaining paranasal sinuses, left mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No evidence of fracture, infarction or hemorrhage.\n\n2. Paranasal inflammatory sinus disease." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema, or mass\neffect. Periventricular and subcortical white matter hypodensities are\nnonspecific but likely sequelae of chronic small vessel ischemic disease. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges.\n\nThere is no evidence of fracture. There is complete opacification of the\nposterior left ethmoid air cells extending into the left sphenoid sinus with\nassociated hyperostosis consistent with chronic sinusitis. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable. Carotid\nsiphon calcifications are moderate.", + "output": "1. No evidence of an acute intracranial abnormality on noncontrast head CT.\n2. Marked atrophy and chronic microangiopathy.\n3. Chronic sinusitis." + }, + { + "input": "There is no evidence of large vascular territory infarction,hemorrhage,edema,\nor mass affect. There is prominence of the ventricles and sulci are similar\nto prior and suggestive of involutional changes. Periventricular and\nsubcortical white matter are nonspecific but likely represents chronic small\nvessel disease.\n\nThere is no evidence of acute fracture. Re-demonstration of opacification of\nthe left sphenoid sinus with hyperostosis suggestive of chronic sinus disease.\nThe remaining visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits\ndemonstrate bilateral lens replacement. Dense calcifications of bilateral\ncavernous internal carotid arteries are noted.", + "output": "1. No acute intracranial process. Previously noted extra-axial hyperdensity\nnear the vertex is likely artifactual." + }, + { + "input": "The study is moderately limited by motion artifact despite repeat imaging. \nThere is no evidence of acute large territory infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Bilateral periventricular, subcortical and deep white\nmatter hypodensities are nonspecific but most likely represent sequela of\nchronic small vessel ischemic changes.\n\nLeft frontal subgaleal hematoma is demonstrated. There is no evidence of\nfracture. There is partial chronic opacification of the left sphenoid sinus. \nPartial opacification of the right inferior mastoid air cells are also noted. \nThe remaining paranasal sinuses, left mastoid air cells, and middle ear\ncavities are clear. The patient is status post bilateral lens replacement. \nOrbits are otherwise unremarkable.", + "output": "1. The study is moderately limited by motion.\n2. Left frontal subgaleal hematoma. No acute fracture.\n3. No acute intracranial process." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. There is stable prominence of ventricles and sulci consistent\nwith age related involutional changes. Periventricular and subcortical white\nmatter hypodensities are also unchanged consistent with chronic microvascular\nischemic disease. The basal cisterns are patent. Imaged paranasal sinuses,\nmastoid air cells and middle ear cavities appear well aerated. Carotid siphon\ncalcification noted. Small amounts of gas within the right posterior scalp\nmay reflect laceration. No fracture.", + "output": "No acute intracranial process. Chronic changes as described." + }, + { + "input": "There is a 9 mm thick predominately low density subdural collection overlying\nthe right cerebral hemisphere. There is some associated high density\ncomponents overlying the temporal lobe. This is new since ___. \nAcute subarachnoid blood seen overlying the right parietal and temporal lobes.\nMidline structures are bowed to the left though similar compared to prior\nwithout evidence of subfalcine herniation.\n\nThere is no evidence of infarction edema,or mass. There is prominence of the\nventricles and sulci suggestive of involutional changes. There is calcified\natherosclerotic plaque at the cavernous portions of bilateral internal carotid\narteries and bilateral intracranial vertebral arteries.\n\nThere is no visualized fracture. The sphenoid sinus is nearly entirely\nopacified. A few scattered opacified mastoid air cells noted at the right\nmastoid tip. The visualized portion of the other paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. There are bilateral lens\nreplacements.", + "output": "1. Predominately low-density subdural collection overlying the right cerebral\nhemisphere with some hyperdense components suggesting component of acute\nsubdural hemorrhage.\n2. Right frontal and temporal subarachnoid hemorrhage.\n3. No acute fracture." + }, + { + "input": "Prominent streak artifact is present. There is no evidence of infarction,\nhemorrhage, edema, or mass. The ventricles and sulci are normal in size and\nconfiguration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or\nmass-effect. The ventricles and sulci are age-appropriate.\n\nThere is no evidence of acute fracture. There is mild mucosal thickening in\nthe ethmoid air cells and minimal mucosal thickening in the left maxillary\nsinus. The visualized portion of the orbits are unremarkable. No orbital\nhematoma.\n\nThere are several round/oval, soft tissue density, partly calcified lesions\nwithin the scalp over the forehead and bilateral parietal regions, which are\nnonspecific, but may represent vascular malformations.", + "output": "1. No evidence of acute intracranial process or fracture.\n2. Unremarkable appearance of the orbits. No orbital hematoma." + }, + { + "input": "There is no evidence of intracranial hemorrhage,acute large territorial\ninfarction,edema,or mass. The ventricles and sulci are age appropriate. \nSubtle areas of low attenuation distributed the subcortical white matter are\nnonspecific, and may reflect changes due to chronic small vessel disease,\nbetter depicted in the prior MRI of the head in ___.\n\nNear complete opacification of the right frontal sinus. Partial opacification\nof the bilateral ethmoid air cells. Mild mucosal thickening of the bilateral\nmaxillary sinuses. Minimal thickening of the bilateral sphenoid sinuses. The\nvisualized portion of the remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nnormal.\n\nThere is redemonstration of several ovoid, partially calcified soft tissue\ndensity lesions overlying the soft tissues of the scalp, similar in appearance\nto prior study and possibly representing partially calcified sebaceous cysts.", + "output": "1. No evidence of acute intracranial process or hemorrhage.\n2. Moderate paranasal sinus disease as described above.\n3. Redemonstration of numerous ovoid, partially calcified soft tissue density\nlesions overlying the soft tissues of the scalp, similar in appearance to\nprior study and possibly representing sebaceous cysts.\n4. No definite evidence of abscess identified within the scalp. If clinically\nindicated, then further evaluation with targeted ultrasound could be\nconsidered.\n5. Paranasal sinus disease." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema,or mass. The\nventricles and sulci are normal in caliber and configuration.\n\nThere is an air-fluid level in the left maxillary sinus, with mucosal\nthickening in the left nasal concha and ethmoidal air cells. There is trace\nopacification in the sphenoid sinuses. Mastoid air cells and middle ear\ncavities are clear. Several round, soft tissue density, partially calcified\nlesions within the scalp over the forehead and bilateral parietal regions are\nunchanged dating back to ___, nonspecific but possibly representing\nsebaceous cyst. The visualized portion of the orbits are normal.", + "output": "1. No evidence of mass, edema, hemorrhage or infarction.\n2. Paranasal sinus inflammatory disease." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. \nPeriventricular and subcortical white matter hypodensities may with present\nchronic small vessel disease. There is mild prominence of the ventricles and\nsulci consistent with involutional changes.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial findings." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Basilar cisterns are\npatent.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute hemorrhage mass effect midline shift or\nhydrocephalus. Gray-white matter differentiation is maintained. There is no\nevidence of age inappropriate brain atrophy or significant subcortical white\nmatter ischemic disease. Bone images are unremarkable and the visualized\nparanasal sinuses are clear.", + "output": "1. No significant abnormalities on head CT without contrast.\n2. Clinical history suggests suspicion for intracranial aneurysm. Given\npatient's and disc digital disease, MRA without contrast of the head can help \nfor further evaluation if clinically indicated." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear patent without stenosis, occlusion, or aneurysm formation greater than\n3mm. Calcified atherosclerotic plaque at the V4 segment of the left vertebral\nartery with no significant luminal narrowing. Severe atherosclerotic\ncalcification of the carotid siphons, but no high-grade stenosis. Less than 2\nmm outpouching at dorsal aspect of left internal carotid artery terminus\nsuggestive of infundibulum (series 3; image 276). The dural venous sinuses\nare patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear patent with\nno evidence of stenosis or occlusion. There is prominent beam hardening\nartifact from dental hardware partly obscuring the left vertebral artery at C2\nlevel. The right vertebral artery is hypoplastic with corresponding smaller\nsize of the right transverse foramina compared to the left side.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. Moderate disc degenerative disease affecting the cervical spine\nwith mild degrees of reversed lordosis. Sternal wires, and evidence of\nprevious CABG.", + "output": "1. No acute intracranial abnormality.\n2. Patent circle of ___ without evidence of severe stenosis,occlusion,or\nmore than 3 mm aneurysm. Less than 2 mm suspected infundibulum at the left\nposterior choroidal artery origin.\n3. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection within the confines of prominent beam\nhardening artifact from dental hardware." + }, + { + "input": "There is no evidence of fracture, infarction, hemorrhage, edema, or mass\neffect. The ventricles and sulci are normal in size and configuration. \nThere is dense calcification of the cavernous carotid arteries bilaterally and\nthe supraclinoid segment of the left internal carotid artery. There is dense\ncalcification of the vertebral arteries bilaterally.\n\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\nThe orbits are unremarkable.", + "output": "Prominent atherosclerotic arterial calcification. Otherwise normal study." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Unfused posterior arch of C1 is\nincidentally noted, congenital.", + "output": "Normal head CT." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or new mass. The\nventricles and sulci are mildly prominent in size, suggestive of mild atrophy.\nA known small arachnoid cyst at the right cerebello-pontine angle is better\nassessed on prior dedicated MRI.\n\nNo acute osseous abnormalities seen. The paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormalities." + }, + { + "input": "CTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nMild beading is noted within the V3 segment of the right vertebral artery\n(2:162, 602b:35). Less apparent is possible beading of the left V3 segment\n(series 2, image 170). The carotid and vertebral arteries and their major\nbranches appear otherwise normal with no evidence of stenosis or occlusion.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear, allowing for respiratory\nmotion. The visualized portion of the thyroid gland is within normal limits.\nThere is no lymphadenopathy by CT size criteria. Patient is status post\nendoscopic sinus surgery with minimal anterior ethmoidal air cell mucosal\nthickening (2:183, 602b:6). Incidental note is made of a torus mandibularis. \nNo suspicious osseous abnormalities.", + "output": "Mild beading within the right V3 segment is consistent with mild type 2\nfibromuscular dysplasia. More equivocal beading of the left V3 segment. \nOtherwise normal appearance of the major arteries of the head and neck." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema, or mass\neffect. There is moderate prominence of the ventricles and sulci suggestive\nof involutional changes. Incidental note is made of a partial empty sella.\n\nThere is no evidence of fracture. No definite soft tissue injury identified. \nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "No hemorrhage or other acute intracranial abnormality on noncontrast head CT.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 1:04 pm, 10 minutes after\ndiscovery of the findings." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nThere is preservation of gray-white matter differentiation. Basal cisterns\nare patent.\n\nNo fracture identified. Mild mucosal thickening is seen within the right\nsphenoid sinus. The remaining imaged paranasal sinuses are clear. Mastoid air\ncells and middle ear cavities are well aerated. Visualized portions of the\norbits are unremarkable.", + "output": "No acute intracranial abnormalities." + }, + { + "input": "Dental amalgam streak artifact limits study. There is moderate atheromatous\nplaque at the bilateral carotid bulbs. The major vessels are otherwise\nunremarkable.\n\nThe suprahyoid and infrahyoid neck is otherwise unremarkable. Scattered\nsubcentimeter nonspecific lymph nodes are noted throughout the neck\nbilaterally, without definite enlargement by CT size criteria. No masses or\nfluid collections are identified.\n\nThere is mild mucosal thickening and/or a small amount of fluid within the\nleft maxillary sinus.", + "output": "1. Dental amalgam streak artifact limits study.\n2. No evidence of cervical lymphadenopathy, mass, or fluid collection.\n3. Nonocclusive atheromatous plaque at bilateral carotid bulbs. If clinically\nindicated, consider carotid ultrasound for further evaluation.\n4. Paranasal sinus disease, as described." + }, + { + "input": "Mild mucosal thickening is identified in both maxillary sinuses. A fluid\nlevel is seen in the left maxillary sinus. The drainage pathways of both\nmaxillary sinuses are slightly narrowed by mucosal thickening but remain\npatent. The frontal ethmoid and sphenoid sinuses demonstrate no evidence of\nfluid level or aerosolized secretions. Bony outlines of the sinuses are\nmaintained.\n\nThe nasal septum remains midline. There is no septal spur identified. The\nnasal passages are clear. No periapical lucencies identified about the\nmaxillary teeth.\n\nThe visualized nasopharynx orbits and brain are unremarkable.", + "output": "1. Mucosal thickening in both maxillary sinuses with a fluid level in the left\nmaxillary sinus.\n2. Narrowed but patent drainage pathways of the maxillary sinuses." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territory infarct. Prominence of the\nventricles and sulci, consistent with cortical volume loss, is more prominent\nthan expected for a patient of this age. Left basal gangliar lacunar infarct\nis seen. Also old left cerebellar infarct. Focal asymmetric region of\nhypodensity in the high left frontal lobe (series 2, image 25), appears to\nextend to the cortex on coronal imaging, and may represent a prior infarct. \nHowever, MRI is recommended for further assessment. The visualized paranasal\nsinuses demonstrate minimal mucosal thickening in the bilateral ethmoid air\ncells and in the left sphenoid sinus.. The mastoid air cells are clear. No\nacute fracture is seen.", + "output": "No acute intracranial hemorrhage or acute fracture.\n\nFocal asymmetric hypodensity in the high left frontal lobe appears to extend\nto the cortex on coronal imaging and may represent a prior infarct. However,\ngiven lack of priors for comparison, MRI is recommended for further\ncharacterization.\n\nGlobal cortical volume loss, more prominent than expected given patient age.\n\nLeft basal gangliar lacunar infarct.\n\nRECOMMENDATION(S): Brain MRI." + }, + { + "input": "There is no evidence of acute large vascular territory\ninfarction,hemorrhage,edema,or mass effect. Focal asymmetric region of\nhypodensity in the left frontal lobe near the vertex which appears to be\nextending to the cortex is again demonstrated, unchanged from prior and may\nrepresent a prior infarct. Chronic lacunar infarct in the left basal ganglia\nare noted. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes, greater than expected for age. Periventricular\nsubcortical white matter hypodensities are nonspecific but suggest chronic\nsmall vessel ischemic changes.\n\nThere is no evidence of acute fracture. Chronic fracture deformity of the\nleft lateral orbital wall and nasal bones are unchanged from prior. The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial process." + }, + { + "input": "There is expected interval evolution of the previously known small right\nfrontal subdural hemorrhage since prior exam in ___. No evidence of\ninfarction,new focus of hemorrhage, edema, or mass. The ventricles and sulci\nare normal in size and configuration. There is unchanged appearance of a\nhypodensity in the left cerebellum, previously described as a chronic nodal\ninfarct on prior MRI in ___.\n\nThere is no evidence of fracture. Mild mucosal thickening is seen the\nbilateral ethmoid air cells. Otherwise, the remaining visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nThe visualized portion of the orbits are unremarkable.", + "output": "1. Expected interval evolution of the previously noted small right frontal\nsubdural hemorrhage compared to prior exam in ___. No evidence of\ninfarction or new focus of intracranial hemorrhage." + }, + { + "input": "Compared to ___, expected interval evolution of previously seen\nsmall right frontal subdural hemorrhage with 2 unchanged foci of hyperdensity\n(2A/25). There is no evidence of infarction, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. Unchanged right parietal scalp hematoma. \nThere is minimal mucosal thickening in some anterior ethmoidal air cells. \nOtherwise, the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The orbits are unremarkable.", + "output": "1. Compared to ___, no new hemorrhage.\n2. Expected interval evolution of previously seen small right frontal subdural\nhemorrhage." + }, + { + "input": "There is small chronic left cerebellar infarct, stable since prior. Previously\nseen subdural hemorrhage has resolved. There is no evidence of acute\ninfarction,new hemorrhage,edema,or mass. The ventricles and sulci are normal\nin size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "There has been interval resolution of previously seen hemorrhage.\nThere is no new hemorrhage." + }, + { + "input": "CT HEAD: There are subtle hypodensities corresponding to the embolic infarcts\nseen on recent MRI dated ___. The majority of lesions seen on outside\nhospital MRI are not appreciated on the non contrast head CT. There is no\nlarge vascular territorial infarct, or hemorrhage. The ventricles, sulci and\ncisterns are unremarkable. There is no space-occupying lesion.\n\nThe orbits, visualized soft tissues and mastoid air cells are unremarkable.\nMinimal left frontal sinus mucosal thickening. There is an enteric tube in\nplace.\n\nCTA HEAD: [] There is calcified atherosclerotic disease of the carotid\nsiphons without evidence of significant stenosis. The anterior cerebral, and\nmiddle cerebral arteries are unremarkable. There is a fetal type left PCA with\na hypoplastic T1 segment. The posterior circulation is otherwise unremarkable.\n\nThere is no evidence of vessel occlusion, aneurysm or other vascular\nabnormality.", + "output": "1. Noncontrast head CT demonstrates a few small subtle hypodensities\ncorresponding to the embolic infarcts seen on outside hospital MRI dated ___. The majority of the lesions that were identified on prior MRI are not\nappreciated on the non contrast head CT. There is no large vascular\nterritorial infarct or hemorrhage.\n2. Unremarkable head CTA without evidence of significant stenosis, aneurysm or\nother vascular abnormality." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass\neffect. The ventricles and sulci are normal in size and configuration.\n\nThe frontal sinuses are underpneumatized. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion or dissection. There is no evidence of\ninternal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. There are bilateral hypodense\nthyroid nodules measuring up to 1.9 x 1.3 cm in the right lobe (5:97). There\nis no lymphadenopathy by CT size criteria.", + "output": "1. No acute intracranial abnormality.\n2. Patent intracranial vasculature without significant stenosis, occlusion, or\naneurysm.\n3. Patent cervical vascular without significant stenosis, occlusion, or\ndissection.\n4. Bilateral hyperdense thyroid nodules measuring up to 1.9 x 1.3 cm in the\nright lobe. The ___ College of Radiology guidelines suggest thyroid\nultrasound for further evaluation.\n5. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct.\n\nRECOMMENDATION(S): Bilateral hyperdense thyroid nodules measuring up to 1.9 x\n1.3 cm in the right lobe. The ___ College of Radiology guidelines\nsuggest thyroid ultrasound for further evaluation.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 16:47 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or infarction. The\nventricles and sulci are normal in size and configuration. The basal cisterns\nappear patent and there is preservation of gray-white matter differentiation.\n\nNo fracture is identified. The visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are essentially clear. The globes are\nunremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. No evidence acute intracranial hemorrhage or fracture.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 3:11 pm, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute intracranial hemorrhage, or infarction. \nVentricles and sulci are normal in size and configuration. The basilar\ncisterns are patent, there is otherwise good preservation of the gray-white\nmatter differentiation.\n\nNo acute fracture is identified. The visualized paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The globes are unremarkable.\n\nCTA HEAD:\nThe right internal carotid artery is normal. A small vascular infundibulum is\nseen arising medially from the supraclinoid portion of the right internal\ncarotid artery. The right middle cerebral artery is normal. There is normal\narborization of the distal right MCA vessels. The left internal carotid\nartery is normal. The left middle cerebral artery is normal. There is normal\narborization of the distal left MCA vessels. The bilateral anterior cerebral\narteries are normal. The vertebral arteries are normal. The basilar artery\nis normal. There is fetal type configuration of the bilateral posterior\ncerebral arteries. Mild atherosclerotic disease is seen throughout the\nintracranial vessels. The dural venous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No acute intracranial abnormalities identified. Unremarkable CTA of the\nhead without evidence of significant stenosis.\n2. No evidence of internal carotid artery stenosis by NASCET criteria." + }, + { + "input": "There are hypodensities in the periventricular white matter, likely the\nsequelae of chronic small vessel ischemia. Intracranial ICA and vertebral\nartery atherosclerotic calcifications noted.\n\nThere is no intracranial hemorrhage, evidence of recent infarction, mass, or\nshift of normally midline structures. There is no ventriculomegaly. The\nvisualized paranasal sinuses and mastoid air cells are clear. There is no\nevidence of fracture.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "There is chronic left occipital lobe infarct, with adjacent large meant of the\nleft occipital horn secondary to atrophy, stable since prior. There is no\nevidence of acute infarction,hemorrhage,edema, or mass. Probably severe\nchronic small vessel ischemic changes. No hydrocephalus.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute changes. Stable chronic left occipital lobe infarct. Severe chronic\nsmall vessel ischemic changes." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute findings." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No intracranial hemorrhage or acute fracture." + }, + { + "input": "A mixed density right subdural hematoma has increased in size since ___, now measuring up to 21 mm in short axis on coronal images. Areas of\nincreased hyperdensity within the subdural hematoma is concerning for acute on\nchronic hemorrhage. Associated mass effect on the right parietal lobe is mild\ngiven that the brain is slightly atrophic. No shift of normally midline\nstructures. A left extra-axial intermediate density subdural fluid collection\nmeasuring up to 14 mm on axial images is overall unchanged, likely chronic\n(series 2, image 27). Ventricle size and configuration is within normal\nlimits the patient's age. Gray-white matter differentiation appears\npreserved. Bilateral cavernous internal artery calcifications are mild.\n\nNo acute fracture. The partially imaged paranasal sinuses are clear. The\nmastoid air cells and middle ear cavities are clear. The orbits are\nunremarkable other than a left lens replacement.", + "output": "1. Interval increase in size of right subdural hematoma with new hemorrhage\nsince ___.\n2. Stable size of left subdural hematoma." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territorial infarct. Prominence of the\nventricles and sulci is consistent with atrophy. Periventricular and\nsubcortical white matter hypodensities are likely sequelae of chronic small\nvessel disease. Left occipital encephalomalacia suggests prior infarct,\npartially in the left PCA territory. The visualized paranasal sinuses\ndemonstrate near complete opacification of the left maxillary sinus. There is\nminimal mucosal thickening in the right maxillary sinus. There is near\ncomplete opacification of the right sphenoid sinus and areas of opacification\nin the bilateral ethmoid air cells. Partially imaged periapical lucency is\nseen about a posterior left maxillary tooth, not fully imaged or well\nassessed. The mastoid air cells are clear. No acute fracture is seen.", + "output": "No acute intracranial process. Old left occipital infarct.\n\nPartially imaged periapical lucency about a posterior left maxillary tooth,\nnot fully imaged or well assessed.\n\nSinus disease." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is loss of gray-white matter differentiation and subtle hypodensity\ninvolving the right posterior frontal lobe and possibly the right insula in\nthe right MCA territory, compatible with acute infarction in the setting of\nassociated vascular abnormalities which are described below. No evidence for\nacute intracranial hemorrhage. No significant mass effect; a symmetric\nappearance of the lateral ventricles is unchanged compared to ___. \nThe ventricles and sulci are overall enlarged due to global age-related\nparenchymal volume loss. Chronic left occipital infarct is again seen. \nPeriventricular, deep, and subcortical white matter hypodensities are also\nagain seen, nonspecific but likely sequela of chronic small vessel ischemic\ndisease in this age group.\n\nMucous retention cysts and mucosal thickening are seen in the left maxillary\nsinus and right sphenoid sinus. There is a large periapical lucency of the\nleft maxillary first molar with dehiscence of the buccal cortex on image\n3:203. Mastoid air cells are well aerated. The orbits are unremarkable.\n\nCTA NECK:\nThere is a 3 vessel aortic arch with calcified plaque in the arch and included\ndescending aorta. There is irregular, predominantly noncalcified plaque\nmildly narrowing the proximal left subclavian artery.\n\nThere is irregular, predominantly noncalcified plaque in the proximal right\ninternal carotid artery, causing ___ stenosis by NASCET criteria. \nRemainder of the right cervical ICA is diffusely irregular, which may be seen\nin the setting of fibromuscular dysplasia, but is likely caused by\natherosclerosis in this age group. There is also high-grade narrowing of the\nproximal right external carotid artery. Appearances are grossly similar to\nthe prior MRI allowing for differences in modalities.\n\nOn the left, there is mild narrowing of the mid common carotid artery by\nmixed, predominantly calcified plaque. There is irregular mixed, ulcerated\nplaque in the proximal left internal carotid artery causing approximately\n60-70% stenosis by NASCET criteria. High-grade stenosis was seen on the prior\nMRA.\n\nRight vertebral artery is severely stenotic at its origin due to calcified\nplaque; its remaining course is patent with minimal calcified plaque in the V4\nsegment.\n\nCalcified plaque causes mild to moderate narrowing of the left vertebral\nartery origin. Evaluation of the left V1 segment is limited by tortuosity. \nFlattening of the distal left V1 segment adjacent to the left transverse\nprocess of C7, images 3:107 and 452:45, is more likely atherosclerotic than\nmechanical. There is minimal calcified plaque in the V4 segment.\n\nCTA HEAD:\nThere is extensive calcified plaque in bilateral carotid siphons. There is\nabrupt cut-off of the distal M1 segment of the right middle cerebral artery,\nwhich is new from the ___ MRI, with with poor opacification of distal\nbranches. The left MCA is patent, without evidence of high-grade stenosis or\nocclusion. Bilateral anterior cerebral arteries appear patent.\n\nSlight luminal irregularity of distal posterior cerebral arteries is likely\ndue to atherosclerosis. No evidence for intracranial aneurysm greater than 3\nmm.\n\nOTHER:\nThere is fluid in the visualized esophagus, which can be seen in the setting\nof esophageal dysmotility or reflux. The visualized lung apices demonstrate\nmild subpleural fibrotic changes and dependent atelectasis. The thyroid is\nunremarkable. There is no pathologically enlarged cervical lymph nodes\nidentified.", + "output": "1. Subtle hypodensity and loss of gray-white matter involving the posterior\nright frontal lobe and right insula in the right middle cerebral artery\nterritory, suggestive of acute infarction. No acute hemorrhage.\n2. Chronic left occipital infarction is again seen.\n3. New, abrupt occlusion of the right M1 segment with poor opacification of\ndistal branches.\n4. Multifocal atherosclerotic disease within the intracranial vasculature,\npredominantly involving the bilateral cavernous ICAs and with mild bilateral\nintracranial vertebral involvement. Irregularity of bilateral distal\nposterior cerebral arteries is presumably also atherosclerotic.\n5. Irregular ulcerated plaque causing approximately 60-70% stenosis of the\nproximal left internal carotid artery by NASCET criteria.\n6. Irregular, predominantly noncalcified plaque in the proximal right internal\ncarotid artery causing ___ stenosis by NASCET criteria. The mid and distal\nright internal carotid artery is tortuous and irregular, more likely due to\natherosclerosis of fibromuscular dysplasia in this age group.\n7. Severe stenosis of the right vertebral artery origin. Mild to moderate\nstenosis at the left vertebral artery origin. Mild to moderate narrowing of\nthe distal left V1 segment, which may be secondary to atherosclerosis or\nmechanical effect from the left C7 transverse process.\n8. Mucous retention cysts and mucosal thickening in the left maxillary and\nright sphenoid sinuses. Periapical lucency of the left maxillary first molar\nwith dehiscence of the buccal cortex, which may represent an odontogenic\nsource of paranasal sinus inflammation. Please correlate clinically.\n\nRECOMMENDATION(S): MRI has already been performed at the time of final\ndictation for better assessment of the infarction.\n\nNOTIFICATION: Urgent findings of acute infarction and right MCA occlusion\nwere reported electronically to the emergency department by Dr. ___ on\n___ at 12:51." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, or loss of gray/ white matter\ndifferentiation. The ventricles and sulci are normal in size for age.\n\nThere is no fracture. There is mild mucosal thickening. In the partially\nvisualized bilateral maxillary sinuses. There is moderate mucosal thickening\nin the right anterior ethmoid air cells. Bilateral mastoid air cells,\npneumatized right petrous apex, and partially pneumatized left petrous apex\nare well-aerated.", + "output": "No evidence for acute intracranial abnormalities. No fracture." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or acute large\ninfarction. The ventricles and sulci are normal in size and configuration. \nThe basal cisterns appear patent and there is preservation of gray-white\nmatter differentiation. No fracture is identified. The visualized paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The globes are\nunremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Head CT: There is no evidence of intracranial hemorrhage or mass effect.\nThere has been expected evolution of a hypodensity within the right thalamus\ncompatible with a lacunar infarct. There is no evidence of additional\ninfarction. The ventricles and basal cisterns appear normal. The orbits, skull\nbase, and paranasal sinuses appear normal.\n\nHead an CTA: There is no evidence of intracranial aneurysm, vascular\nmalformation, or vessel occlusion, or significant stenosis. The anterior\ncerebral arteries, middle cerebral arteries, and posterior cerebral arteries\nappear normal.", + "output": "1. Interval evolution of right thalamic lacunar infarct.\n2. No evidence of new infarct or hemorrhage.\n3. No evidence of aneurysm or stenosis within the intracranial vasculature." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema,or discrete mass. \nPeriventricular and subcortical white matter hypodensities are nonspecific but\nlikely sequelae of chronic small vessel ischemic disease. Several small\nhypodensities within the bilateral basal ganglia and periventricular white\nmatter may reflect lacunar infarct. There is prominence of the ventricles and\nsulci suggestive of involutional changes.\n\nThere is no evidence of fracture. There is mucosal thickening within the\nethmoid air cells. There is partial opacification of the bilateral mastoid\nair cells. Otherwise, the visualized portion of the paranasal sinuses, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial hemorrhage or acute large territory infarct.\n2. White matter changes consistent with chronic small vessel ischemic disease.\nScattered lacunar infarct in the bilateral basal ganglia.\n3. Partial opacification of the bilateral mastoid air cells and mucosal\nthickening within the ethmoid air cells." + }, + { + "input": "There is severe soft tissue swelling, fat stranding, and enhancement about the\nright external auditory canal, compatible with severe right otitis externa. \nFluid is noted within the right middle ear cavity, and there is fluid within\nthe adjacent right mastoid air cells (3:16), likely reflective of right otitis\nmedia. No underlying bony destruction or drainable fluid collection. \nMultiple adjacent prominent, though not pathologically enlarged, lymph nodes\nare likely reactive in nature (601b:50, 59). Brain enhances normally without\nfocal enhancing lesion or definite structural abnormality.\n\nIncluded paranasal sinuses are clear. Very mild amount of fluid in the left\nmastoid air cells is identified.", + "output": "Findings compatible with severe right otitis externa with fluid in the middle\near cavity concerning for otitis media. No bony destruction or drainable\nfluid collection." + }, + { + "input": "The patient is status post right parietal craniotomy for prior hematoma\nevacuation. As compared to the prior examination dated ___, there has\nbeen no significant interval change. Redemonstrated is a large, right,\nhypodense, extra-axial fluid collection layering along the cerebral convexity\nmeasuring up to 1.8 cm (03:25), previously measuring up to 2.0 cm. There is\nmild dural hyperdense thickening, unchanged from prior exam underlying the\ncraniotomy site, compatible with postsurgical changes. Similarly, a\nmoderate-sized, left extra-axial fluid collection most prominent along the\nleft frontal lobe convexity measures up to 7 mm in diameter (03:11), stable\nfrom the prior examination.\n\nThere is no evidence for acute intracranial hemorrhage, mass, midline shift,\nor large territorial infarction. The ventricles and sulci are moderately\nenlarged, compatible with age related atrophic changes. Periventricular and\nsubcortical white matter hypodensities are noted, likely the sequelae of\nchronic small vessel ischemic disease.\n\nThere is persistent partial opacification of the right mastoid air cells, as\nwell as partial opacification of the bilateral ethmoid air cells. The\nremainder of the paranasal sinuses, left mastoid air cells, and middle ear\ncavities are clear. A scleral buckle is noted on the right, and the patient\nis status post bilateral lens replacements.", + "output": "Stable appearance of bilateral extra-axial hypodense subdural fluid\ncollections, larger on the right, which likely correlate with chronic subdural\nhematomas. No evidence for acute intracranial hemorrhage." + }, + { + "input": "When compared to the most recent study of ___, there has been no\nsignificant interval change.\n\nThere are bilateral chronic hypodense extra-axial collections, measuring 1.9\ncm on the right, and 0.6 cm on the left (02:27). No acute intracranial\nhemorrhage. Approximately 2 mm hyperdense dural thickening underlying the\nprior craniotomy site (02:20) is similar in appearance, and consistent with\npostsurgical change. No shift of midline structures.\n\nThere is no acute major vascular territorial infarction, edema, or mass. \nBilateral basal ganglia calcifications. Prominent ventricles and sulci are\nsuggestive of age-related involutional changes.\n\nNo acute fracture. Mild mucosal thickening of the bilateral ethmoid air\ncells. Remainder of the visualized paranasal sinuses are clear. Partial\nfluid opacification of the right mastoid air cells. Left mastoid air cells\nare clear. Scleral buckle node on the right. Status post bilateral lens\nreplacements.", + "output": "1. No acute intracranial process.\n2. Chronic bilateral extra-axial collections, measuring 1.9 cm on the right,\nand 1.6 cm on the left." + }, + { + "input": "Patient is status post evacuation of a right-sided subdural hematoma. Expected\npost surgical changes are identified, including moderate pneumocephalus and\nsurrounding soft tissue swelling. Small linear hyperdensity is seen in the\nright frontoparietal lobe, likely residual subdural hematoma and blood from\nrecent procedure. There is a 10 mm leftward shift of midline structures with\nsubfalcine herniation. Effacement of sulci in the right frontoparietal lobes\nis again seen, secondary to mass effect. There is effacement of the frontal\nand occipital horns of the right lateral ventricle. Fluid fluid level is\nidentified within the known left subdural hematoma with hyperdense blood\nlayering posteriorly.\n\nThere is mild opacification of the mastoid air cells bilaterally, right worse\nthan left. There is mucosal thickening of the ethmoidal air cells. Fluid\nwithin the nasopharynx is likely secondary to endotracheal intubation.\nOtherwise the remaining visualized paranasal sinuses and middle ear cavities\nare clear. Scleral band is noted on the right.", + "output": "1. Status post evacuation of right subdural hematoma with expected\npostsurgical changes.\n\n2. Redemonstration of left-sided frontoparietal subdural hematoma with\nhyperdense blood layering posteriorly.\n\n3. 10 mm leftward shift of midline structures .\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 11:39 ___, 15 minutes after discovery\nof the findings." + }, + { + "input": "There has been a prior right parietal craniotomy. The right convexity chronic\nsubdural hematoma is not significantly changed in thickness from CT on ___, although prior areas of pneumocephalus have resorbed and filled\nin with fluid. The left convexity chronic subdural hematoma is also not\nsignificantly changed in thickness from CT on ___. Mass effect on\nthe cerebral hemispheres due to the bilateral convexity chronic subdural\nhematomas is unchanged. Leftward midline shift has improved, measuring 4 mm\nfrom 8 mm. The basal cisterns remain patent and symmetric. There are chronic\nlacunar infarcts of the basal ganglia bilaterally. There is no evidence of\nacute cortical infarction.\n\nThe visualized paranasal sinuses are clear. There is increased partial\nopacification of the right mastoid air cells compared to the prior CT. The\nleft mastoid air cells are clear. Again noted is a right scleral band.", + "output": "Stable size bilateral convexity chronic subdural hematomas. Pneumocephalus\nwithin the right chronic subdural hematoma has been resorbed and replaced by\nfluid. Mass effect on the cerebral hemispheres is unchanged, although leftward\nmidline shift has improved from 8 mm to 4 mm." + }, + { + "input": "There is an approximately 1.9 x 1 cm heterogeneous area in the left palatine\ntonsil measuring 60 ___. There is mild left-sided effacement of the airway. \nNo retropharyngeal edema is seen.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. The cervical common and internal carotid arteries are patent.\n\nThe very partially imaged portion of the lung apices are clear.There are no\naggressive osseous lesions.", + "output": "Left palatine tonsil phlegmon without clear drainable fluid collection." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. There is mild prominence of the ventricles and sulci, suggestive\nof global atrophy. There is subtle periventricular hypoattenuation,\nnonspecific but can be seen in chronic small vessel ischemic disease.\n\nThere is mild mucosal thickening the bilateral ethmoid air cells. Remaining\nparanasal sinuses are clear. Mastoid air cells and middle ear cavities are\nwell aerated. The bony calvarium is intact.", + "output": "No acute intracranial abnormality." + }, + { + "input": "CT HEAD WITHOUT CONTRAST: Hypodensity of the left inferior occipital lobe is\ncompatible with subacute to chronic infarct. There are mild periventricular\nand subcortical white matter hypodensities, nonspecific, but compatible with\nchronic microangiopathy in a patient of this age. There is no evidence of\nacute intracranial hemorrhage or mass effect. The sulci, ventricles and\ncisterns are within expected limits for the patient's age related global\ncerebral volume loss. The orbits are unremarkable. There is mild mucosal\nthickening of the paranasal sinuses. The mastoid air cells are essentially\nclear.\n\nCTA HEAD: Occlusion of the right internal carotid artery with reconstitution\nvia collaterals at the carotid terminus is identified. Atherosclerotic\ncalcification of the left internal carotid artery is mild. The ACA, MCA and\ntheir major branches are unremarkable. The PCAs, basilar artery and vertebral\narteries are unremarkable. There is no evidence of aneurysm.\n\nCTA NECK: There is a 3 vessel arch. Mild atherosclerotic calcification at the\norigin of the right brachiocephalic and bilateral subclavian arteries does not\nresult in high-grade stenosis. The bilateral common carotid arteries are\nunremarkable. The mild atherosclerotic calcification of the left internal\ncarotid artery did does not result in stenosis by NASCET criteria. There is\ncomplete occlusion of the right cervical internal carotid artery at the\nbifurcation with reconstitution at the carotid terminus intracranially. The\nleft vertebral artery is dominant. Otherwise, the contour and course of the\nvertebral arteries are unremarkable to the skullbase.\n\nOTHER: No suspicious osseous lesions. Ground-glass attenuation of the right\nupper lobe along the bronchi may represent infectious/inflammatory etiology\n(series 3, image 10). Clinical correlation is recommended. There is minimal\nright apical paraseptal emphysematous change. The thyroid gland is\nunremarkable. The visualized aerodigestive tract is grossly unremarkable.\nThere is no cervical lymphadenopathy by size criteria.", + "output": "1. Hyperdensity of the left inferior occipital lobe is compatible with\nsubacute to chronic infarct. This is better evaluated on concurrent MRI head.\nNo other intracranial abnormality on noncontrast head CT.\n2. There is complete occlusion of the right internal carotid artery from the\ncarotid bifurcation to the carotid terminus with distal reconstitution\nsecondary to collaterals from the circle ___. The remainder the\nintracranial circulation is unremarkable.\n3. Ground-glass attenuation of the right upper lobe along the bronchi likely\nrepresents infectious/inflammatory etiology. Clinical correlation is\nrecommended.\n\nRECOMMENDATION(S): Clinical correlation and potentially followup CT chest as\nindicated following treatment for impression 3.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 1:35 ___, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "No evidence of acute infarction,hemorrhage,edema, or mass effect. \nEncephalomalacia in the left occipital lobe is compatible with prior infarct,\nas seen on prior MRI from ___. Bilateral periventricular and\nsubcortical white matter hypodensities correspond to T2/FLAIR signal\nabnormalities on prior MRI, likely sequelae of chronic small vessel ischemic\ndisease. Bilateral, symmetric prominence of ventricles and sulci indicates\ncortical volume loss, similar to prior exam. Atherosclerotic internal carotid\nartery calcifications are mild-to-moderate.\n\nNo evidence of fracture. The paranasal sinuses are only partially imaged. \nThe left maxillary sinus is near completely opacified with aerosolized\nsecretions, suggesting an acute component of sinusitis. Some of the ethmoidal\nair cells bilaterally are partially opacified. Mucosal thickening within the\nright final sinus is mild. Remaining paranasal sinuses are clear. The left\nmastoid air cells are underpneumatized and opacified. The is small in fluid\nin the left middle ear cavity. No evidence of osseous erosions. The right\nmastoid air cells and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. No hemorrhage or acute infarct.\n2. Old left occipital lobe infarct.\n3. Opacification with aerosolized secretions in the left maxillary sinus\nraising possibility of active inflammation.\n4. Fluid in the left mastoid air cells left middle ear cavity could suggest\nsequelae of inflammation or infection. Correlate with clinical assessment. \nNo evidence of osseous erosions." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction or midline shift.\nThere is no hydrocephalus. There is no enhancing mass lesion or edema. \nVisualized paranasal sinuses and mastoid air cells are clear. There is no\nfracture. Incidentally noted is a developmental venous anomaly in the left\nparietal region para", + "output": "No significant abnormalities are seen on head CT with contrast. No enhancing\nbrain lesions or areas of BM edema seen." + }, + { + "input": "A 10 x 8 mm focus of hemorrhage in the right anteromedial temporal lobe with a\nthin rim of surrounding edema appears grossly unchanged compared to prior. \nThere is no evidence of acute territorial infarction or mass effect. The\nventricles and sulci are mildly prominent in keeping with age-related\ninvolutional change. Extensive, confluent periventricular and subcortical\nwhite matter hypodensities are nonspecific, but likely represent sequela of\nchronic ischemic microvascular disease. A small area of encephalomalacia in\nthe left parietal lobe is unchanged. Atherosclerotic calcifications are noted\nwithin the bilateral intracranial carotid arteries.\n\nNo acute fractures are seen. Multiple tiny osteomas measure up to 3 mm are\nseen in the left mastoid air cells (03:14). Small mucous retention cysts are\nseen in the bilateral maxillary sinuses. There is mild mucosal thickening and\naerosolized secretions in the right maxillary sinus as well as mild mucosal\nthickening in the bilateral ethmoid air cells. Otherwise, the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "1. No significant change in a 10 x 8 mm focus of hemorrhage in the right\nanteromedial temporal lobe. No new foci of intracranial hemorrhage are\nidentified. No acute vascular territorial infarction.\n2. Paranasal sinus disease, as above.\n3. Extensive chronic small vessel disease." + }, + { + "input": "Since the prior study on ___, there has been evolution of multiple\nhemorrhagic contusions. This is accompanied by an increase in adjacent edema.\nThere is likely trace subarachnoid hemorrhage in the left frontal lobe (2:26).\nSubdural hemorrhage layering along the left tentorium (series 601b, image 85)\nand right temporal lobe (2:8) are not significantly changed in size. There is\nno new hemorrhage.\n\nApproximately 4 mm were shift of midline structures is unchanged (2:17). No\nevidence of acute infarction or mass. Ventricles and sulci are normal in\nsize.\n\nRight temporal bone fracture is re-demonstrated. There is opacification of\nthe right mastoid air cells. Left mastoid air cells are clear. There is\nmucosal thickening of all visualized paranasal sinuses.", + "output": "1. Interval evolution of extensive hemorrhagic contusions and subdural, and\nsubarachnoid hemorrhage as described above.\n2. No new hemorrhage.\n3. Unchanged 4 mm rightward shift of midline structures.\n4. Known right temporal bone fracture." + }, + { + "input": "There is no evidence of no acute large territory infarction, hemorrhage,\nedema, or mass. The ventricles and sulci are prominent compatible with\nage-related. Focal hypodensity in the left basal ganglia is compatible with a\nchronic lacunar infarct.\n\nNo osseous abnormalities seen. There is mild right sinus and ethmoidal air\ncell mucosal thickening otherwise the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormalities, specifically no subdural hematoma or\nskull fracture." + }, + { + "input": "Periventricular hypodensities due to mild-to-moderate changes of small vessel\ndisease are unchanged. There is no evidence of age inappropriate brain or\nmedial temporal atrophy. A small hypodensity in the left putamen (03:13) is\nunchanged and may indicate a chronic lacune. There is no acute intra-axial\nhemorrhage or subdural hematoma.\n\nThe visualized paranasal sinuses are clear. No skull fracture is seen.", + "output": "Mild to moderate changes of small vessel disease in the white matter. No\nsignificant change from previous CT." + }, + { + "input": "There is no evidence of large acute territorial infarction,hemorrhage,edema,or\nnew mass. Minimal hyperdensity along the lateral aspect of the right frontal\ntemporal lobe (6:7) is felt to be artifactual and was present to a lesser\nextent on the prior CT. 5 mm hyperdensity at the foramen ___ is again\nlikely reflective of a colloid cyst (02:12). There is prominence of the\nventricles and sulci suggestive of involutional changes. Periventricular and\nsubcortical white matter hypodensities are nonspecific, but likely reflect the\nsequela of chronic microvascular infarction.\n\nThere is no evidence of fracture. Small air-fluid level is seen in the left\nsphenoid sinus. The visualized portion of the remaining paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Small air-fluid level in the left sphenoid sinus which clinical correlation\nfor acute sinusitis is suggested.\n3. 5 mm hyperdensity at the level of the foramina of ___, likely colloid\ncyst, unchanged." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nExtensive hypodensity involving the right temporal lobe as well as involving\nthe inferior aspect of the right parietal lobe is noted. While there is\nlikely encephalomalacia involving the very anterior-inferior right temporal\nlobe (for example see series 3, image 12), the bulk of the more extensive\nhypodensity involving the more lateral temporal lobe and extending inferiorly\nto involve the right parietal lobe has an appearance more suggestive of late\nsubacute or early chronic infarct (see series 3, images 16 setting, 18, and\n19). Note, superimposed acute infarction would be difficult to detect by CT\ngiven this appearance.\n\nThere is no evidence of hemorrhage. There is no mass effect. The basal\ncisterns are patent. There is no shift of the normally midline structures. \nProminence of the ventricles and sulci is consistent with global involutional\nchange. Periventricular and deep white matter hypodensities bilaterally are\nnonspecific however compatible with sequelae of chronic white matter\nmicroangiopathy. The globes and bony orbits are intact. The visualized\nparanasal sinuses and mastoid air cells are clear.\n\nCTA HEAD:\nThere is extensive, circumferential calcification of the intracranial carotid\narteries bilaterally involving the distal petrous segments, as well as the\ncavernous and supraclinoid segments, causing likely mild-to-moderate narrowing\nof the lumen bilaterally (see series ___ and ___).\n\nThe right distal vertebral artery (V4 segment) is diminutive as it pierces the\ndura near the foramen magnum, however is grossly patent until its confluence\nwith the left vertebral artery to form the basilar. Otherwise, the imaged\ncircle of ___ vasculature is patent without evidence of additional areas\nstenosis, occlusion, or aneurysm greater than 3 mm.\n\nThere is non-opacification of the left jugular bulb and sigmoid sinus,\nprobably chronically occluded given left IJ findings although ultimately\nage-indeterminate. The left transverse sinus is patent. The remaining imaged\nmajor dural venous sinuses are grossly patent.\n\nCTA NECK:\nPatent bilateral vertebral and carotid arteries. There is mild calcification\nof the proximal left ICA and right carotid bulb without significant luminal\nnarrowing. There is no ICA stenosis by NASCET criteria.\n\nMild to moderate aortic arch calcifications are noted. A stent is seen within\nthe left subclavian vein. The left IJ is not opacified and appears\nchronically occluded, unchanged in appearance from prior CTA chest. The left\nsubclavian vein stent appears grossly patent on limited evaluation.\n\nOTHER:\nThe large right pleural effusion and mediastinal lymphadenopathy are only\npartially imaged, better assessed on the dedicated CTA chest from ___. \nA benign-appearing calcified left thyroid nodule is again seen.", + "output": "1. Hypodensity involving the right temporal and inferior parietal lobes, with\nloss of gray-white matter differentiation, has an appearance suggestive of\nlate subacute to early chronic infarction. Given this appearance, sequelae of\nsuperimposed acute infarction would be difficult to evaluate by CT. Consider\nMRI head for further evaluation.\n2. Focus of encephalomalacia anterior right temporal lobe likely reflects\nchronic infarct.\n3. Non-opacification of left IJ likely reflects chronic occlusion, unchanged\nin appearance from prior CTA chest from ___ (with respect to the\nportions of the IJ visualized at that time). Grossly patent left subclavian\nvein stent on limited evaluation.\n4. Non-opacification of the left jugular bulb and sigmoid sinus, likely\nchronic given known left IJ occlusion, is ultimately age-indeterminate in the\nabsence of prior exams. Correlate with prior outside hospital imaging, if\navailable.\n5. Partially imaged right pleural effusion and mediastinal lymphadenopathy,\nbetter assessed on prior CT chest from ___.\n\nRECOMMENDATION(S): Consider MRI head for further evaluation of superimposed\nacute-on-chronic infarction involving the right temporal and/or parietal\nlobes.\n\nNOTIFICATION: The findings and recommendations above, including modification\nto preliminary interpretation regarding concern for subacute to early chronic\nright temporoparietal infarct, were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 12:47 ___, 15\nminutes after discovery of the findings." + }, + { + "input": "There is no evidence of fracture, hemorrhage, infarction, mass or midline\nshift. There is no hydrocephalus. The ventricles and sulci are enlarged\nconsistent with atrophy. Visualized paranasal sinuses and mastoid air cells\nare clear. There is no fracture.", + "output": "Atrophy. No evidence of fracture, hemorrhage or infarction." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass effect, midline shift,\nor acute major vascular territorial infarct. Gray-white matter differentiation\nis preserved. Ventricles and sulci are unremarkable.\n\nIncluded paranasal sinuses and mastoids are essentially clear. Skull and\nextracranial soft tissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute large territorial infarction, acute intracranial\nhemorrhage, edema, or mass.\n\nLeft basal ganglia encephalomalacia with ex vacuo dilatation of the left\nlateral ventricle is noted. Additional right frontal encephalomalacia is\nnoted. Subcortical white matter hypodensities adjacent to this area (03:18)\nlikely reflect changes related to chronic small vessel ischemic disease. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges.\n\nThere is no evidence of fracture. The visualized portion of the mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable. Right ethmoid air cell mucosal thickening is\npresent.", + "output": "1. No evidence of acute intracranial hemorrhage or acute large territorial\ninfarction.\n2. Chronic left basal ganglia and right frontal infarcts.\n3. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct." + }, + { + "input": "There is no evidence of acute hemorrhage mass effect midline shift or\nhydrocephalus. Gray-white matter differentiation is maintained.\n\nContrast administration abnormal parenchymal or vascular and meningeal\nenhancement seen.", + "output": "No significant abnormalities are seen on head CT with and without contrast." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is a large left parietal scalp soft tissue hematoma. Nasal bone\nfracture, of indeterminate age. Deformity of the nasal septum. No parietal\nbone fracture. There is otherwise no evidence of fracture. Aside from mild\nmucosal thickening of the anterior ethmoidal air cells, the visualized portion\nof the paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. Large left parietal scalp soft tissue swelling, hematoma..\n2. Nasal bone fracture, of indeterminate age.\n3. No intracranial hemorrhage or calvarial fracture." + }, + { + "input": "Essentially nondisplaced fracture of nasal bone, of indeterminate age. No\ndefinite fracture of the frontal process maxilla.\nThe left mandibular medial incisor terminates abruptly, possibly posttraumatic\nin etiology (601:42). Hyperdense material in the right aspect of the lower\nlip likely represents foreign body related to recent trauma (2:90). There is\nsoft tissue swelling and stranding in this region and overlying the right\nmaxilla (2:69).\n\n Periapical lucencies are seen involving the right maxillary premolars\nunderlying the soft tissue swelling and the left second mandibular premolar.\nMultiple left maxillary molars are absent. Numerous dental caries are\npresent. Probable breakthrough of the buccal side right maxillary alveolar\nridge adjacent to periapical lucency, likely from underlying subclinical or\nclinical infection.\n\nAside from mild mucosal thickening of the anterior ethmoidal air cells and\nmaxillary sinuses, the visualized paranasal sinuses are well aerated. Nasal\nseptum has complex curve, deviated to the left posteriorly, into the right\nanteriorly. No definite fracture of the nasal septum.\nThere is no evidence of abnormal fluid collections.\nBilateral mastoids appear normal.\nThe globes, extraocular muscles, optic nerves, and retrobulbar fat appear\nnormal.\nThe visualized upper aerodigestive tract appears normal.\nThe mandible and temporomandibular joints appear normal. Nonspecific soft\ntissue density in the right external auditory canal likely represents cerumen.", + "output": "1. Nasal bone fracture, of indeterminate age.\n2. Abrupt termination of the left mandibular medial incisor, and tips of\ncentral maxillary incisors may be posttraumatic.\n3. Hyperdense abnormalities in the lower lip, associated laceration, likely\nrepresent foreign bodies, possibly tooth fragments.\n4. Right anterior pre maxillary soft tissue swelling, may be posttraumatic,\nphlegmon secondary to periapical dental infection should be excluded.\n5. Numerous dental caries, periapical lucencies, and absent teeth, likely\nchronic for which dental evaluation is recommended.\n\nRECOMMENDATION(S): Dental evaluation is recommended." + }, + { + "input": "There is no acute intracranial hemorrhage, edema, mass effect, loss of gray/\nwhite matter differentiation. There is mild to moderate age-related cerebral\natrophy with associated prominence of the ventricles as well as sulci.\nScattered periventricular white-matter hypodensities are most likely the\nsequelae of chronic small vessel ischemic disease in a patient of this age.\n\nThere is no fracture. Visualized paranasal sinuses and mastoid air cells are\nclear.", + "output": "No evidence of acute intracranial abnormalities." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nMild mucosal thickening involving the ethmoid air cells. The visualized\nportion of the mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable. Small partially calcified\nThornwaldt cyst. Calcification of the longus coli ligament is noted.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTV HEAD:\nNo evidence of dural venous sinus thrombosis. The right transverse sinus is\nhypoplastic, a normal anatomic variant.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria. Left occipital artery arising from the proximal\nleft internal carotid is a variant.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nlarge territory infarct or intracranial hemorrhage.\n2. Unremarkable CTA head without high-grade stenosis, occlusion or aneurysm.\n3. Unremarkable CTV head. No dural venous sinus thrombosis.\n4. Unremarkable CTA neck. No stenosis of the cervical internal carotid\narteries by NASCET criteria.\n5. An addendum can be added once all the reformatted images have been reviewed\nand there are additional findings." + }, + { + "input": "Thre is a small hypodense left extra-axial fluid collection, measuring 4 mm at\nits thickest point (601:39), which may represent a chronic subdural hematoma\nversus an acute subdural hygroma. There is no evidence of acute hemorrhage,\nlarge vascular territory infarct, edema, mass effect, or fracture. There is\nprominence of the ventricles and sulci, suggestive of age-appropriate\ninvolutional changes. Calcific atherosclerosis of the bilateral carotid\nsiphons and bilateral vertebral arteries is noted.\n\nThere is mucous retention cyst in the left maxillary sinus (601:13). The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are otherwise clear. The visualized portion of the orbits are\npreserved.", + "output": "1. No acute intracranial hemorrhage.\n2. Small hypodense left extra-axial fluid collection may represent a chronic\nsubdural hematoma versus acute subdural hygroma.\n3. Age-appropriate global cerebral volume loss and atherosclerotic disease." + }, + { + "input": "Small hypodense left extra-axial fluid collection again seen, similar to\nslightly less conspicuous compared to the prior study, again may represent\nchronic subdural hematoma. Minimal 2 mm rightward midline shift is stable. \nNo acute intracranial hemorrhage is seen. Redemonstrated prominence of the\nventricles and sulci is consistent with involutional change. Prominence of\nthe ventricles and sulci is consistent with atrophy. Mild periventricular\nwhite matter hypodensities are likely sequelae of chronic small vessel\ndisease. The partially imaged paranasal sinuses demonstrate mild mucosal\nthickening of the ethmoid air cells and aerosolized secretions in the left\nmaxillary sinus. The mastoid air cells are clear. No acute fracture is seen.", + "output": "No acute intracranial hemorrhage.\n\nSmall hypodense left extra-axial fluid collection again seen, similar to\nslightly less conspicuous compared to ___, again may represent\nchronic subdural hematoma. Stable minimal 2 mm rightward midline shift." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute major vascular territory\ninfarction,hemorrhage,edema,or mass effects. There is mild prominence of the\nventricles and sulci for patient's given age, although unchanged.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormalities on noncontrast head CT. Specifically\nno large territory infarct or intracranial mass effect. No intracranial\nhemorrhage." + }, + { + "input": "There is no evidence of fracture, acute large territory\ninfarction,hemorrhage,edema,or mass effect. Unchanged areas of\nencephalomalacia involving the right frontal, right basal ganglia and right\nanterior temporal lobes. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. Periventricular and subcortical white\nmatter hypodensities are nonspecific, but likely represent sequelae of chronic\nsmall vessel ischemic changes.\n\nPatient is post right pterional craniotomy. No acute fractures. Again seen\nis a right MCA clip and basilar artery coil.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No acute intracranial abnormality. Specifically, no intracranial\nhemorrhage\n2. Post right pterional craniotomy with unchanged postsurgical changes, right\nMCA clip and basilar coil. Multiple areas of encephalomalacia involving the\nright frontal, right basal ganglia and temporal lobes are similar." + }, + { + "input": "There has been no significant interval change. Evidence of prior embolization\nof the basilar artery and right MCA clip again noted. Postsurgical changes\nand encephalomalacia again noted in the right temporal lobe and inferior right\nfrontal lobe. No acute intra-axial or extra-axial hemorrhage, edema, shift of\nnormally midline structures, or evidence of acute major infarction. Imaged\nparanasal sinuses appear well aerated as do the mastoid air cells and middle\near cavities. Craniectomy changes along the right temporal bone and\ncraniotomy changes involving the right frontoparietal bone.", + "output": "No acute hemorrhage. Similar pattern of encephalomalacia and postsurgical\nchanges in the right inferior frontal and right inferior temporal lobe with\nevidence of prior right MCA clip and basilar artery embolization." + }, + { + "input": "The patient is status post right frontotemporal craniotomy. There is\nencephalomalacia in the right temporal and inferior right frontal lobe,\nunchanged compared to prior. Right MCA clip and prior embolization of the\nbasilar artery are again noted. There is no evidence of new large territory\ninfarction, intracranial hemorrhage, or mass effect.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No new large territory infarction or intracranial hemorrhage.\n2. Stable right temporal and inferior frontal lobe encephalomalacia and\npostsurgical changes following right frontotemporal craniotomy.\n3. Redemonstration of right MCA clip and prior embolization of the basilar\nartery." + }, + { + "input": "There are hypodensities along the right frontal and temporal lobes consistent\nwith volume loss seen previously, unchanged. In conjunction with a right MCA\nclip, embolization of basilar artery, and right craniotomy, they represent\npostsurgical changes that are stable since at least ___.\n\nOtherwise, there is no evidence of fracture, acute large territory\ninfarction,hemorrhage,edema,or mass effect. The ventricles and sulci are\nnormal in size and configuration.\n\nThere is mild mucosal thickening of the ethmoid air cells. Otherwise, the\nvisualized portion of the other paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nnormal.", + "output": "1. No acute intracranial process, without evidence of acute intracranial\nhemorrhage.\n2. Again seen postsurgical changes status post right frontotemporal\ncraniotomy." + }, + { + "input": "Again seen is an aneurysm clip in the right sylvian fissure with surrounding\nright temporal lobe encephalomalacia. Metallic density also noted in the\nregion of the basilar tip which could represent a previously coiled aneurysm. \nThere is no evidence of acute territorial infarction, hemorrhage, edema or\nmass. Ventricles and sulci are normal in overall size and configuration. \nThere is preservation of gray-white matter differentiation. Scattered white\nmatter hypodensities are nonspecific but potentially due to chronic small\nvessel disease.\n\nLeft parietal scalp hematoma seen without underlying fracture. The imaged\nparanasal sinuses are clear. Mastoid air cells and middle ear cavities are\nwell aerated. Hyperostosis of the maxillary sinus walls could indicate prior\nchronic inflammation. Visualized portions of the orbits are unremarkable.", + "output": "No acute intracranial abnormalities." + }, + { + "input": "Slightly motion limited exam, particularly at the skullbase. Metallic\ndensities in the lesion of the basilar artery and right sylvian fissure are\nunchanged. Encephalomalacia in the right temporal lobe appears unchanged. \nThere is new small area of encephalomalacia in the right frontal lobe. There\nis no evidence of infarction, hemorrhage, edema, or mass. The ventricles and\nsulci are normal in size and configuration.\n\nChronic changes from prior right frontotemporal craniotomy are noted. No\nacute osseous abnormalities seen. There is almost complete opacification of\nthe right maxillary sinus and mild mucosal thickening of the left maxillary\nsinus. Otherwise, the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. Hyperostosis of the right maxillary sinus wall suggests\nchronic right maxillary sinusitis. The orbits are unremarkable.", + "output": "1. Slightly motion limited exam. Within this limitation, no acute\nintracranial process.\n2. New area of right frontal encephalomalacia. Unchanged right temporal\nencephalomalacia.\n3. Moderate paranasal sinus disease as described above." + }, + { + "input": "Right pterional craniotomy is again noted with presumable right MCA aneurysm\nclip. Hyperdense material, likely coils, noted in the region of the basilar\nartery. These findings are all similar compared to prior. There is right\nfrontal and temporal lobe encephalomalacia as seen previously.\n\nThere is no intracranial hemorrhage, mass effect, or evidence of infarct.\n\nLeft canal wall up mastoidectomy changes are noted. Mucosal thickening noted\nin the right maxillary sinus with hyperostosis of the walls suggesting chronic\ninflammation. Other included paranasal sinuses or mastoids are essentially\nclear.", + "output": "No acute intracranial process.\nPostoperative changes as above and right-sided encephalomalacia, similar to\nprior." + }, + { + "input": "The patient is status post right frontotemporal craniotomy. Encephalomalacia\nof the right temporal lobe and right frontal lobe appears stable. A subtle\nhypodensity of the right frontal lobe and right internal capsule (02:14\nthrough 16) appears unchanged. A presumed right MCA aneurysm clip is again\nseen. Redemonstrated metallic densities, likely coils, in the region of the\nbasilar artery.\n\nNo evidence of acute intracranial hemorrhage, large territory infarction,\nedema, or mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of acute fracture. Partial opacification of the right\nmaxillary sinus is partially imaged. Otherwise, the visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Stable right frontal and temporal encephalomalacia.\n3. Other findings, as described above." + }, + { + "input": "There is no evidence of acute large territorial infarction, intracranial\nhemorrhage, edema, or mass. Right pterional craniotomy, right MCA aneurysm\nclip. Coiling posterior fossa. Chronic encephalomalacia right temporal,\nbasal frontal lobes, stable. Findings consistent with mild-to-moderate\nchronic small vessel ischemic changes. No acute infarct, no hydrocephalus. \nNo significant change since ___.. Partial left mastoidectomy. Trace\nmucosal thickening paranasal sinuses, chronic right maxillary sinus\nperiostitis.\nThere is mild soft tissue scalp swelling overlying the left posterior scalp\n(03:47)..", + "output": "No acute findings intracranially.\nPostoperative changes.\nChronic encephalomalacia right temporal, frontal lobes, stable.\nMild soft tissue swelling left parietal scalp." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema,or new mass-effect. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Chronic encephalomalacia in the right temporal, and basal frontal\nlobes is stable.\n\nThere is no evidence of acute fracture. Status post prior right craniotomy. \nRight MCA aneurysm clip is unchanged in position. A coil is demonstrated the\nposterior fossa as on prior. Moderate mucosal thickening of the partially\nimaged left maxillary sinus.", + "output": "1. No acute intracranial hemorrhage. No acute large territorial infarction. \nNo acute osseous findings.\n2. Chronic encephalomalacia in the right temporal and frontal lobes is stable.\n3. Postoperative changes after prior right craniotomy, right MCA clipping and\nposterior circulation coiling are again demonstrated." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,or\nmass. Right MCA territory encephalomalacia is unchanged. Periventricular and\nsubcortical white matter hypodensities are nonspecific but likely sequelae of\nchronic small vessel ischemic disease. There is prominence of the ventricles\nand sulci suggestive of involutional changes.\n\nThere is subcutaneous edema and a small subgaleal hematoma in left parietal\nregion. There is no evidence of fracture. Right frontotemporal craniotomy\nchanges are stable. An aneurysm clip in the right middle cranial fossa is\nunchanged. Aneurysm coils posterior fossa. There is moderate paranasal sinus\nmucosal thickening. The mastoid air cells are clear. Patient appears\nstatus-post canal wall up left mastoidectomy. The visualized portion of the\norbits are unremarkable.", + "output": "1. No evidence of an acute intracranial abnormality.\n2. Subcutaneous edema and small subgaleal hematoma in the left parietal\nregion.\n3. Stable right frontotemporal encephalomalacia. Aneurysm treatment..\n4. Paranasal sinus disease." + }, + { + "input": "There is no evidence of acute large territory infarction,\nintracranialhemorrhage,edema,or discrete mass. Right temporofrontal\nencephalomalacia and postsurgical change from prior partial right craniotomy\nand right MCA aneurysm clip are again seen. There is prominence of the\nventricles and sulci suggestive of involutional changes. Periventricular and\nsubcortical white matter hypodensities are nonspecific but compatible with\nchronic small vessel ischemia.\n\nThere is no evidence of fracture. Patient is status post partial left\nmastoidectomy. There is mild mucosal thickening of the left maxillary sinus. \nOtherwise, the visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavitiesare essentially clear. The visualized portion of the\norbits are unremarkable.", + "output": "No acute intracranial abnormality. Chronic encephalomalacia as described" + }, + { + "input": "Surgical hardware streak artifact limits examination.\n\nThe patient is status post right frontotemporal craniotomy and right MCA\naneurysm clipping. The patient has redemonstrated right temporal frontal\nencephalomalacia. There is no evidence of acute fracture,\ninfarction,hemorrhage,edema, or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. There are areas of\nperiventricular and subcortical white matter hypoattenuation that are\nnonspecific but most likely represent chronic small vessel disease.\n\nThe patient is status post subtotal left mastoidectomy. Mucosal thickening of\nthe ethmoid air cells is seen. There is near complete opacification of the\nleft maxillary sinus, with suggested expansion of left maxillary sinus ostium\n(see 601:30), new compared to ___ prior exam (see 601:26 on this\nprior exam). The visualized portion of the orbits are preserved. Chronic\nright nasal bone fracture is again seen.", + "output": "1. Surgical hardware streak artifact limits examination.\n2. Within limits of study, no evidence of acute intracranial hemorrhage or\ncalvarial fracture. Please note MRI of the brain is more sensitive for the\ndetection of acute infarct.\n3. Grossly stable right frontotemporal encephalomalacia.\n4. Grossly stable postsurgical changes as described.\n5. Paranasal sinus disease with findings concerning for left maxillary\nantrochoanal polyp, as described.\n6. Chronic right nasal bone fracture." + }, + { + "input": "Status post right frontotemporal craniotomy and right MCA aneurysm clipping. \nThe aneurysm clip demonstrates streak artifact which limits evaluation of the\nadjacent structures. Right temporal frontal encephalomalacia is unchanged. \nNo evidence of acute large territory infarction, hemorrhage, edema or mass\neffect. There is prominence of the ventricles and sulci suggestive of global\nvolume loss. There are moderate areas of hypoattenuation in the\nperiventricular and subcortical white matter which are nonspecific but may\nrepresent sequela of chronic small vessel disease. Unchanged vascular coils\nidentified in the posterior fossa along the tract of the tip of the basilar\nartery causing significant streak artifact.\n\nPatient is status post left mastoidectomy. Mucosal thickening of the ethmoid\nair cells and maxillary sinuses have increased since prior CT head dated ___. There is near complete opacification of the left maxillary\nsinus with expansion of the left maxillary sinus ostium, (series 601, image\n21), unchanged from prior. There is near complete opacification of the\nposterior right ethmoid air cells. The visualized orbits are unremarkable. \nChronic right nasal bone fractures are again demonstrated.", + "output": "1. Surgical vascular hardware causes streak artifact limiting evaluation.\n2. No evidence of acute large territory infarction, intracranial hemorrhage or\ncalvarial fracture.\n3. Stable postsurgical changes as described above.\n4. Stable right frontotemporal encephalomalacia.\n5. Stable paranasal sinus disease with findings concerning for left maxillary\nantral choanal polyp.\n6. Chronic right nasal bone fracture." + }, + { + "input": "The patient is status post right frontotemporal lobe craniotomy with right MCA\naneurysm clipping. Streak artifacts from the aneurysm clip limits diagnostic\nevaluation. There is also streak artifact from basilar tip likely from\naneurysm coiling. The right frontotemporal encephalomalacia is unchanged. \nThere is no evidence of large territorial infarction,hemorrhage,edema,or mass.\nInvolutional changes are unchanged. Bilateral periventricular and subcortical\nwhite matter hypodensities are nonspecific but most likely represent sequela\nchronic small vessel ischemic changes. Mild bilateral carotid siphon and left\nvertebral artery calcifications are noted.\n\nNo calvarial fracture. Mucosal thickening of the ethmoid air cells and\nbilateral maxillary sinuses are mild. The remaining visualized paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear with post\nmastoidectomy appearance of the left mastoid air cells. The visualized\nportion of the orbits are normal.", + "output": "1. No acute intracranial process or calvarial fracture.\n2. Status post right frontotemporal lobe craniotomy with right MCA aneurysm\nclipping with chronic right frontotemporal encephalomalacia." + }, + { + "input": "The patient is status post right frontotemporal lobe craniotomy with right MCA\naneurysm clipping and likely basilar clipping, with streak artifact limiting\nevaluation in the areas. Right frontotemporal encephalomalacia is similar to\nprior. There is no evidence of acute fracture, acute large territorial\ninfarction,hemorrhage,edema,or mass. The ventricles and sulci are stable size\nand configuration. There are periventricular and subcortical hypodensities,\nwhich may represent small vessel ischemic changes.\n\nThere is mild mucosal thickening of the bilateral maxillary sinuses. The\nvisualized portion of the remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavitiesare essentially clear. The visualized portion of the\norbits are normal.", + "output": "1. No acute intracranial abnormality.\n2. Stable postsurgical changes from right frontotemporal lobe craniotomy and\naneurysm clipping." + }, + { + "input": "CT head:\n\nPatient is status post right frontotemporal lobe craniotomy with right MCA\naneurysm clipping and likely basilar clipping, with streak artifact limiting\nevaluation in these areas. Right frontotemporal encephalomalacia is similar\nto prior. No evidence of acute fracture, acute large territorial infarction,\nhemorrhage, edema, or mass. The ventricles and sulci are stable in size and\nconfiguration. Periventricular and deep white matter hypodensities are\nnonspecific but likely sequela of chronic small vessel ischemic changes.\n\nCTA HEAD: There is a paucity of vessels in the distal M3 segment on the left. \nMultiple draining veins are noted on the right consistent with a developmental\nvenous anomaly extending from the right periventricular region to the deep\nvenous system (603:35).. Otherwise, the vessels of the circle of ___ and\ntheir principal intracranial branches are without stenosis, occlusion, or\naneurysm. The dural venous sinuses are patent.\n\nCTA NECK: Bilateral carotid and vertebral artery origins are patent. The\ncarotidandvertebral arteries and their major branches appear normal with no\nevidence of stenosis or occlusion.\n\n1.3 cm spiculated nodule in the right upper lung.", + "output": "1. Postoperative changes of clipping of the right MCA aneurysm with\nencephalomalacia and findings suggestive of coiling of the basilar tip\naneurysm are again noted. No acute hemorrhage. Other findings as described.\n2. Patent cervical and intracranial arteries without large vessel occlusion\nhigh-grade stenosis or aneurysm greater than 3 mm in size.\n3. Right upper lung spiculated nodule. Correlate with findings of same day\nchest CT for further description." + }, + { + "input": "Patient is status post right sided craniotomy, right MCA aneurysm clipping and\nbasilar embolization with mild streak artifact. Again seen is right\nfrontotemporal encephalomalacia. There is stable right frontal subcortical\nand right basal ganglia hypodensity in the right frontal lobe which may\nreflect small vessel ischemic changes. There is no evidence of acute\nintracranial hemorrhage. There is mild prominence of the ventricles and sulci\nsuggestive of age-related involutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavitiesare essentially clear. The visualized portion of the orbits are\nnormal.", + "output": "1. No evidence of acute intracranial hemorrhage.\n2. Stable changes status post right-sided craniotomy and aneurysm clipping." + }, + { + "input": "The patient is status post right-sided pterional craniotomy, right MCA\naneurysm clipping, and basilar artery embolization, with metallic streak\nartifact limiting evaluation of the adjacent structures. Within these\nlimitations, there is no evidence of acute large territorial\ninfarction,hemorrhage,edema,or mass. There is stable encephalomalacia in the\nright temporal lobe and right frontal lobe. Mild subcortical and\nperiventricular white matter hypodensities are nonspecific but compatible with\nsequelae of chronic small vessel ischemic disease. There is prominence of the\nventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are normal.", + "output": "1. No acute intracranial process.\n2. Stable changes from prior right frontal craniotomy and aneurysm clipping.\n3. Encephalomalacia in the right temporal and frontal lobes, unchanged." + }, + { + "input": "There is no evidence for dissection or pseudoaneurysm in the visualized\ncarotid and vertebrobasilar system.\n\nThere is conventional orientation of the great vessels arising from the aortic\narch. The common carotid arteries are widely patent. There is partially\ncalcified atheromatous plaque at the carotid bulbs extending into the origins\nof the internal carotid arteries, but no stenosis of the cervical internal\ncarotid arteries by NASCET criteria. The visualized vertebrobasilar system is\npatent.\n\nThere is no fracture or malalignment in the cervical spine, within confines of\nnondedicated examination. There is no hyperdense hematoma within the spinal\ncanal.\n\nThere are no traumatic soft tissue findings in the neck. No suspicious\nmucosal abnormality is identified. The major salivary glands and thyroid\ngland are unremarkable. There is no cervical lymphadenopathy based on size\ncriteria and morphology.\n\nSpiculated 1.4 cm right upper lobe pulmonary nodule is re-identified. A CTA\nchest performed concurrently has been dictated separately.", + "output": "1. No evidence of dissection or pseudoaneurysm in the neck. There is mild\natherosclerotic disease of the carotid bifurcations without evidence of\ncervical internal carotid artery stenosis by NASCET criteria.\n2. No fracture or malalignment in the cervical spine within confines of non\ndedicated examination of the cervical spine.\n3. Re-identified is a spiculated 1.4 cm right upper lobe pulmonary nodule. \nPlease refer to the separate CTA chest report for further findings and\nrecommendations." + }, + { + "input": "Patient is status post right temporal craniotomy, right MCA aneurysm clipping,\nbasal artery embolization. Encephalomalacia is again seen in the right\ntemporal and right frontal lobes. There is no evidence of fracture, acute\nlarge territory infarction, intracranialhemorrhage,edema,or discrete mass. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Periventricular and subcortical white matter hypodensities are\nnonspecific but compatible with chronic small vessel ischemia.\n\nMild mucosal thickening of the right maxillary sinus. The visualized portion\nof the paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are normal.", + "output": "1. No acute intracranial abnormality.\n2. Encephalomalacia and postsurgical change again seen in the right temporal\nand right frontal lobes." + }, + { + "input": "No acute large territory infarction or intracranial hemorrhage. The patient is\nstatus post right parietal craniotomy, right MCA aneurysm clipping, and\nbasilar artery embolization. There are regions of encephalomalacia in the\nright frontal and temporal lobes and in the right internal capsule likely\nrelated to prior infarcts. Ventricles and sulci are prominent likely related\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific and likely represent chronic ischemic small\nvessel disease. Hyperdensity in the right globus pallidus is unchanged from\nprior examination, likely senescent calcifications.\n\nThe visualized portion of the paranasal sinuses and middle ear cavities are\nclear. The mastoid air cells are coalesced bilaterally. The visualized\nportion of the orbits are normal.", + "output": "1. No acute intracranial hemorrhage or large territory infarct.\n2. Postsurgical changes related to right parietal craniotomy, right MCA\nclipping, and basilar artery embolization.\n3. Probable chronic infarcts in the right frontal lobe, right parietal lobe,\nand right basal ganglia.\n4. Involutional changes and probable small vessel chronic ischemic disease\nabove.\n\nIMPRESSION:\n\n\n1. No acute intracranial hemorrhage or large territory infarct.\n2. Postsurgical changes related to right parietal craniotomy, right MCA\nclipping, and basilar artery embolization.\n3. Probable chronic infarcts in the right frontal lobe, right parietal lobe,\nand right basal ganglia.\n4. Involutional changes and probable small vessel chronic ischemic disease\nabove." + }, + { + "input": "CTA HEAD:\n\nLarge right frontal, temporal, and parietal craniotomy is re-identified,\nassociated with prominent encephalomalacia involving the right anterior and\ninferior temporal lobe.\n\nAn elongated radiopaque aneurysm clip involves an anterior M2 segment branch\nof the right middle cerebral artery. There is also evidence of previous\nbasilar artery tip embolization. The vessels of the circle of ___ and\ntheir principal intracranial branches otherwise appear unremarkable without\nhigh-grade stenosis, occlusion, or additional aneurysm. The dural venous\nsinuses are patent.\n\nCTA NECK:\nAtherosclerotic calcifications involve the origins of the right and left\nbrachiocephalic arteries. The origins of the bilateral common carotid and\nvertebral arteries are patent. There are moderate atherosclerotic\ncalcifications involving the carotid bulb bilaterally. There is no evidence of\ninternal carotid stenosis bilaterally by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion.\n\nOTHER:\nThere is a persistent irregular spiculated mass measuring 1.3 x 1.1 cm\ninvolving the right lung apex. Which. The thyroid gland is unremarkable. \nThere is no lymphadenopathy by CT size criteria. There is asymmetric\neffacement of the left hypopharynx (series 2, image 117), felt to be\nartifactual as this finding is not visualized on prior examinations ___ and ___.", + "output": "1. Right pterional craniotomy. Aneurysm clipping involving an anterior M2\nsegment branch of the right middle cerebral artery. Evidence of prior basilar\nartery tip embolization.\n2. Metallic artifact from the clip and coil pack results in suboptimal\nevaluation of adjacent structures, otherwise the circle of ___ appears\npatent without evidence of high-grade stenosis,occlusion,or aneurysm.\n3. Moderate atherosclerotic calcifications involving the carotid bulb\nbilaterally. Patent bilateral cervical carotid and vertebral arteries without\nevidence of stenosis, occlusion, or dissection. No evidence cervical internal\ncarotid artery stenosis by NASCET criteria.\n4. Irregular spiculated pulmonary nodule within the right pulmonary apex\nsuspicious for neoplasm. Follow-up imaging and possible biopsy recommended\nfor more definitive evaluation.\n5. There is asymmetric effacement of the left hypopharynx, felt to be\nartifactual as this finding is not visualized on prior examination of ___ and ___." + }, + { + "input": "There is no evidence of fracture, acute large vascular territory\ninfarction,hemorrhage,edema,or mass. Stable appearance of right frontal lobe,\ntemporal lobe, and right internal capsule encephalomalacia, likely related to\nprior infarcts. Redemonstration of a right MCA clip and basilar artery coil. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Subcortical and periventricular white matter hypodensities are\nnonspecific, however likely represents sequela of chronic small vessel\nischemic disease.\n\nPostsurgical changes related to prior right parietal craniotomy, similar to\nprior study.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No acute intracranial abnormality, specifically no evidence of acute large\nvascular territory infarction or hemorrhage.\n2. Stable appearing right frontal lobe, temporal lobe and right internal\ncapsule encephalomalacia likely related to prior infarcts.\n3. The patient is noted to be status post right parietal craniotomy, right MCA\nclip, and basilar artery coiling." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass effect. The ventricles and sulci are normal in size and configuration. \nMild soft tissue swelling right frontal scalp compare right forehead.\n\nNo acute fractures are seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process.\nMild scalp soft tissue swelling." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are normal in size and configuration.\n\nSmall sphenoid sinus mucous retention cysts. The visualized portion of the\nremaining paranasal sinuses,mastoid air cells,and middle ear cavities are\nclear. There is rightward nasal septum deviation and a right bony nasal spur\nnearly contacting the adjacent inferior turbinates. The visualized portion of\nthe orbits are unremarkable.\n\nCTA HEAD:\nThe proximal basilar artery is fenestrated (series 564, image 11; series 4,\nimages 227-230). The vessels of the circle of ___ and their principal\nintracranial branches appear normal without stenosis, occlusion, or aneurysm\nformation. The dural venous sinuses are patent.\n\nCTA NECK:\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nPERFUSION:\nNo significant cerebral blood flow, blood volume, or transit time mismatches.\n\nOTHER:\nMild biapical scarring. No significant pulmonary nodules in the partially\nimaged lungs. The visualized portion of the thyroid gland is within normal\nlimits. There is no lymphadenopathy by CT size criteria.", + "output": "Unremarkable head and neck CTA." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territorial infarct. Prominence of the\nventricles and sulci is consistent with atrophy. Periventricular and\nsubcortical white matter hypodensities are likely sequelae of chronic small\nvessel disease. The visualized paranasal sinuses demonstrate mild mucosal\nthickening in bilateral ethmoid air cells. The remainder of the paranasal\nsinuses are clear. The mastoid air cells and middle air cavity is are clear. \nNo acute fracture is seen.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass. The ventricles and sulci are prominent consistent with age-related\natrophy. Periventricular and subcortical white matter hypodensities likely\nrepresent the sequela of chronic small vessel ischemic disease.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. The cavernous portion of the internal\ncarotid arteries are calcified.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema,or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Partly calcified 8 mm subcutaneous\nnodule within the left frontal scalp (02:19) may reflect a sebaceous cyst.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes,\nslightly out of proportion to the expected degree in this age group.\n\nThere is no evidence of acute fracture. There is a 4 mm osteoma in the\nposterior right ethmoid air cells. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormalities." + }, + { + "input": "There are left level III hyperenhancing lymph nodes including a 4 x 4 mm lymph\nnode that are in the region of increased iodine radiotracer uptake seen on\nrecent nuclear medicine scan (2:46). Two smaller approximately 2-3 mm\nhyperenhancing foci, likely nodes seen more inferiorly (2:51, 53). There is\nalso a prominent and enhancing left level IIB lymph node that measures 9 x 3\n(2:39). This node had not been hyperenhancing on prior neck CT. No abnormal\nradiotracer uptake seen on prior nuclear medicine study, however lesion\nremains suspicious.\n\nSmall foci of enhancement measuring up to 3 mm are noted in the right level IV\narea (2:61, 70).\n\nThere is also abnormal right level IV soft tissue which may represent a\nconglomerate of lymph nodes (2:80), likely correlates with ultrasound of the\nneck. These are new since prior CT scan. Degree of enhancement in this region\nis somewhat limited due to streak artifact from adjacent dense intravenous\ncontrast. These nodes are contiguous with right paratracheal lymph nodes\nextending into the upper mediastinum, with overall increased soft tissue\ndensity when compared to prior, remote CT scan. No abnormal tracer uptake seen\non recent nuclear medicine study.\n\nThere is also an enlarged hypoenhancing level VI lymph node on the left that\nmeasures 18 x 11 mm (2:81). This was not seen on prior CT scan.\n\nThe patient is status post total thyroidectomy.\n\nEvaluation of the aerodigestive tract demonstrates no exophytic mass, nor\nareas of focal mass effect. The visualized salivary glands are unremarkable in\nappearance. Neck vessels are patent, and an aberrant right subclavian artery\nis noted. Upper lung fields are clear. No bony abnormality is seen.", + "output": "1. Left level III enhancing lymph nodes measure up to 4 mm are noted in the\nregion of increased iodine radiotracer uptake on prior nuclear medicine scan.\n2. Hyperenhancing enlarged left level II and 2 tiny enhancing foci on the\nright at level 4 are concerning given hyperenhancement.\n3. Enlarged right level IV nodes which correlate with recently biopsied\nnodes. Abnormal adenopathy extending into the upper mediastinum in the right\nparatracheal region new since remote CT.\n4. Enlarged not hypervascular left level 6 node, also new." + }, + { + "input": "Patient is status post bilateral modified neck dissection with thickening of\nthe soft tissues and loss of the fat planes anterior to the\nsternocleidomastoid muscles. Patient is also status post thyroidectomy. No\nabnormal enhancement noted in the thyroidectomy bed.\n\nThere are no visualized enlarged or hyperenhancing right cervical lymph nodes.\n\nThere is an abnormal heterogeneously hyperenhancing lymph node on the left at\nlevel 2B (02:51) which measures 1.4 x 0.8 cm, previously 0.9 x 0.3 cm. \nSmaller adjacent more medial hyperenhancing nodule measuring 4 mm (02:49) is\nunchanged.\n\nThere is a hyperenhancing 5 mm structure at level 3 on the left (2:61)\nsuspicious for hyper enhancing node, similar compared to prior. Additional\nsmall nodule of enhancement more inferiorly at level 3 (2:68) measuring 4 mm\nis also unchanged. Adjacent relatively hyperdense structures are compatible\nwith veins which are seen to connect to the internal jugular vein (2:69).\n\nThere is a 0.9 x 0.8 cm left level 4 node (2:92) and although not\npathologically enlarged or hyperenhancing has demonstrated interval growth\nsince ___ where it had measured 0.5 x 0.5 cm. Similar smaller left\nlevel 4 lymph node measuring 0.5 cm (2:82) had measured 0.2 cm on prior.\n\nThere are hyperenhancing upper mediastinal nodes. Specifically, there is a\nhyperenhancing 0.8 x 0.7 cm prevascular node (2:111). Additional smaller\nhyperenhancing foci in the anterior mediastinum to the left of midline (2:109)\nmeasuring 0.4 x 1.0 cm, previously 0.4 x 0.8 cm are noted. Heterogeneously\nenhancing right paratracheal nodes are seen although not pathologically\nenlarged (2:102) measuring 0.7 cm short axis similar to prior. There is an\nenlarged hyperenhancing node measuring 0.9 x 1.0 cm anterior to this SVC\n(2:110), previously a 0.4 cm. Homogeneous soft tissue in the anterior\nmediastinum is likely thymic tissue.\n\nIncluded intracranial structures are grossly unremarkable.\n\nParanasal sinuses and mastoids are clear. Aberrant, retroesophageal right\nsubclavian artery is noted. Vascular structures are otherwise unremarkable.\n\nThe parotid glands and submandibular glands are unremarkable.\n\n\n\nThere is a 3 mm left apical pulmonary nodule which is unchanged dating back to\n___.\n\nNo focal suspicious osseous lesion identified.", + "output": "1. Heterogeneously hyperenhancing left level 2B lymph node (02:51) which has\nenlarged since prior suspicious for metastasis. Additional small but hyper\nenhancing left-sided nodes (2B and 3) are similar compared to prior.\n2. Left level 4 lymph nodes which are not pathologically enlarged by size nor\nhyperenhancing but have enlarged since ___.\n3. Hyperenhancing prevascular and right paratracheal nodes as on prior with\ninterval enlargement of a hyperenhancing lymph node anterior to the SVC\n(2:110).\n4. No enlarged or hyperenhancing right-sided cervical lymph nodes." + }, + { + "input": "There is no evidence of acute large territory infarction, hemorrhage, edema,\nor mass/mass effect. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. Periventricular and subcortical white\nmatter hypodensities are nonspecific, but likely reflect sequelae of chronic\nsmall vessel ischemic disease.\n\nThere is no evidence of fracture. There is opacification of the bilateral\nmastoid air cells and fluid within the right maxillary sinus and oropharynx\nlikely related to prolonged supine positioning with intubation. Subgaleal\nfluid that is fairly low density is identified, which may be related to\nanasarca.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nlarge territory infarct. Please note MRI is more sensitive for detection of\nacute infarct.\n2. Fluid within the mastoid air cells, right maxillary sinus and oropharynx\nlikely related to prolonged supine positioning with intubation." + }, + { + "input": "There is no evidence of acute major vascular territorial infarction,\nhemorrhage, edema, or mass. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. Mild bilateral periventricular white\nmatter hypodensities are nonspecific, but likely a sequela of chronic small\nvessel disease.\n\nNo acute fracture. There is extensive mucosal thickening involving all\nparanasal sinuses with the exception of the frontal sinuses, increased from ___. Bilateral mastoid air cells are completely fluid filled. Imaged\norbits are unremarkable. A nasogastric tube is partially imaged.\n\nUnchanged appearance of subgaleal prominence that may be related to underlying\nfluid status.", + "output": "1. No acute intracranial hemorrhage or evidence of acute territorial\ninfarction.\n2. Worsening paranasal sinus secretions and fluid within the mastoid air\ncells, may be related to supine positioning/intubation." + }, + { + "input": "There is no hemorrhage, acute large vascular territorial infarction, or edema.\nThe basal cisterns are patent. There is no shift of normally midline\nstructures. There is preservation of gray-white matter differentiation. \nMarked prominence of the ventricles and sulci could be secondary to\nage-related involutional change, however, in the correct clinical setting this\nappearance could represent normal pressure hydrocephalus. Mild\nperiventricular and subcortical white matter hypodensities are likely sequelae\nof chronic small vessel ischemic change. The imaged paranasal sinuses and\nmastoid air cells are clear. The globes and bony orbits are unremarkable.", + "output": "1. No hemorrhage, acute infarct, mass or edema.\n2. Diffuse brain atrophy with secondary prominent ventricles and sulci, versus\nearly changes of NPH in the correct clinical setting." + }, + { + "input": "There is no evidence of large territorial infarction, hemorrhage, edema, or\nmass effect. There is cerebral volume loss, slightly progressed for age. The\nbasilar cisterns are patent. There is minimal diffuse, supraventricular white\nmatter hypodensity, which may due to small vessel ischemic disease. No\nosseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Prominence of\nventricles and sulci is consistent with age related involutional changes. \nThere is mild periventricular white matter hypodensities, likely the sequela\nof chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Prominence of the ventricles and sulci consistent with age\nrelated global atrophy. Ill-defined periventricular and subcortical white\nmatter hypodensities are nonspecific likely due to the sequela of chronic\nsmall vessel ischemic changes. The imaged paranasal sinuses are clear.\nMastoid air cells and middle ear cavities are well aerated. The bony calvarium\nis intact.", + "output": "No acute intracranial process." + }, + { + "input": "Overlying and surgical hardware, venous contrast pooling and dental amalgam\nstreak artifact limits examination.\n\nCT HEAD WITHOUT CONTRAST:\nNo evidence acute infarction, intracranial hemorrhage mass or edema. There is\na hypodensity in the right putamen which likely represents a chronic lacune\ninfarct or prevascular space. There is a punctate calcification within the\nright basal ganglia which likely represent sequela of prior inflammation or\ninfection. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThe paranasal sinuses, mastoid air cells and middle ear are well pneumatized.\nThe patient is status post bilateral lens replacement surgery.\n\nCTA HEAD:\nThere are nonocclusive probable atherosclerotic calcifications of bilateral\ncarotid siphons.\nThere is moderate narrowing of the right M3 segment of the MCA.\nThere is mild narrowing of the left M1 segment of the MCA.\nThere is moderate narrowing of the M2 and M3 segments of the left MCA.\nThere is moderate to severe narrowing of the right P1 segment of the PCA.\nThere is moderate narrowing of the V4 portion of the left vertebral artery.\nThe left posterior cerebral artery demonstrates a fetal origin.\nOtherwise, the vessels of the circle of ___ and their principal\nintracranial branches are grossly patent without definite evidence of\nocclusion, or aneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is nonocclusive narrowing by calcified atherosclerosis of the bilateral\nvertebral artery origins. Bilateral common carotid artery origins are grossly\npatent. Otherwise, the major branches of the carotid and vertebral arteries\nappear grossly preserved with no definite evidence of occlusion. There is no\nevidence of internal carotid stenosis by NASCET criteria. Nonocclusive\ncalcified plaque is noted to narrow bilateral proximal external carotid\narteries. Question right internal carotid artery origin web versus\nnoncalcified plaque (see 602:34).\n\nOTHER:\nThe visualized portion of the lungs demonstrate 3 mm left upper lobe pulmonary\nnodule (see 3:6).. The visualized portion of the thyroid gland is within\nnormal limits. Question enlarged right piriform sinus versus volume averaging\nartifact. Within limits of study, no definite evidence of cervical mass. A\nleft-sided pacemaker is partially visualized. There is no lymphadenopathy by\nCT size criteria. Left maxillary central incisor periapical lucency is noted.\nRight mandibular central incisor probable periapical lucency is also noted\n(see 3:176). Limited imaging of the cervical spine demonstrates multilevel\ncervical spondylosis.", + "output": "1. Overlying and surgical hardware, venous contrast pooling and dental amalgam\nstreak artifact limits examination.\n2. No acute intracranial abnormality. Please note MRI of the brain is more\nsensitive for the detection of acute infarct.\n3. Nonocclusive atherosclerotic changes of circle of ___ as described.\n4. Otherwise, grossly patent circle of ___ without definite evidence of\nocclusion,or aneurysm.\n5. Bilateral external carotid artery nonocclusive probable atherosclerotic\ndisease.\n6. Question right internal carotid artery with versus noncalcified plaque.\n7. Otherwise, grossly patent bilateral cervical carotid and vertebral arteries\nwithout definite evidence of occlusion,or dissection.\n8. Question distortion of right vocal cords versus volume averaging artifact. \nIf not artifactual, finding may be seen in the setting of cord paralysis. If\nclinically indicated, consider correlation with laryngoscopy.\n9. Probable periodontal disease as described.\n10. 3.5 mm left upper lobe pulmonary nodule. Please see recommendation below.\n\nRECOMMENDATION(S): For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 17:06 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." + }, + { + "input": "No evidence of infarction, hemorrhage, edema, or mass. The ventricles and\nsulci are normal in size and configuration.\n\nThere is a small posterior vertex subgaleal hematoma with subcutaneous\nemphysema and scalp laceration (series 602b, image 44, 45; series 601b, image\n102). No evidence of fracture. No pneumocephalus. No epidural hematoma. \nPolypoid mucosal thickening in the partially imaged bilateral maxillary\nsinuses is mild. The mastoid air cells and middle ear cavities are clear. \nThe orbits are within normal limits.", + "output": "1. No intracranial hemorrhage.\n2. Small vertex subgaleal hematoma with tiny pockets of soft tissue air likely\nfrom associated scalp laceration.\n3. No calvarial fracture.\n4. Paranasal sinus disease as described." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, or acute major\nvascular territorial infarction. The infarct in the subcortical white matter\nof the right precentral gyrus with possible cortical extension, which was seen\non the MRI from ___, is not well seen by CT. Again seen are extensive\nperiventricular, deep, and subcortical white matter hypodensities which are\nnonspecific but likely sequela of chronic small vessel ischemic disease in\nthis age group. Also again seen is moderate global parenchymal volume loss\nwith disproportionately severe involvement of the medial temporal lobes, and\nassociated prominence of the ventricles and sulci.\n\nNo evidence for concerning osseous abnormalities seen. Again seen is a small\nosteoma in the left posterior ethmoid air sinus. Thickening of the frontal\nsinus septum and some of the bilateral anterior ethmoid septa is again seen,\nsuggesting sequela of prior inflammation, though no significant opacification\nis seen at this time. Mastoid air cells are well aerated. The orbits appear\nunremarkable.\n\nAgain demonstrated, is degeneration of the pannus posterior to the dens which\nresults in stenosis and crowding of the cervicomedullary junction, similar to\nthe CT from ___.", + "output": "No acute hemorrhage or mass effect. No evidence for an acute major vascular\nterritorial infarction. MRI would be more sensitive for an acute infarction,\nif clinically warranted." + }, + { + "input": "No evidence of acute infarction,hemorrhage,edema, or mass effect. Nonspecific\nhypodensities in the periventricular, subcortical, and centrum semiovale white\nmatter can be seen with sequelae of chronic small vessel ischemic disease. \nBilateral, symmetric prominence of the ventricles and sulci indicates cortical\nvolume loss.\n\nNo evidence of fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable. Degenerative pannus posterior to the dens\n(series 602, image 41) results in stenosis of the cervicomedullary junction.\n\nAsymmetric fullness of the left fossa of ___ (series 2, image 2).", + "output": "1. No intracranial hemorrhage.\n2. Probable sequelae of chronic small vessel ischemic disease. Please note\nthat MR is more sensitive for detection of early stroke.\n3. Prominent ventricles, probably appropriate for prominence of the sulci and\nreflective of atrophy.\n4. Degenerative pannus posterior to the dens results in stenosis of the\ncervicomedullary junction. Clinical correlation is recommended.\n5. Asymmetric fullness of the left fossa of ___, without definitive\nmass lesion. Clinical correlation is recommended with direct visualization as\nindicated.\n\nRECOMMENDATION(S): MRI if clinically concerned for acute stroke.\n\nNOTIFICATION: The additional findings detailed in impression 4 and 5\ndiscussed with Dr. ___. by ___, M.D. on the telephone on\n___ at 9:02 am, 20 minutes after discovery of the findings." + }, + { + "input": "There is mild atherosclerotic disease at the carotid bifurcations, bilaterally\nwithout significant stenosis.\n\nThe V4 segment of the left vertebral artery is diminutive. There is mild\nnarrowing at the origin of the V4 segment of the right vertebral artery\n(series 4, image 233).\n\nThere is minimal partially calcified plaque involving the distal common and\nthe proximal internal carotid arteries, bilaterally.\n\nOtherwise, the vertebral and carotid arteries and their origins are\nunremarkable. No stenosis by NASCET criteria.\n\nEvaluation of the lung apices is limited by respiratory motion. No worrisome\npulmonary nodules. Bilateral thyroid hypodensities measure up to 7 mm.\n\nThere is enlargement of the main pulmonary artery up to 3.6 cm.\n\nThere is extensive partially calcified pannus posterior to the dens resulting\nin moderate spinal canal narrowing at C1-C2 (series 4, image 127). A right\nparamedian moderate broad-based posterior disc bulge at C5-6 results in\nmoderate canal narrowing with significant attenuation of the thecal sac. \nBulky calcification of the posterior longitudinal ligament results in\nmultilevel mild canal narrowing worse at C4-C6.\n\nA rounded density on the sagittal MIPS images (series 7, image 48) is\nartifactual and does not have a correlate on the axial images.", + "output": "1. Mild atheromatous changes without carotid stenosis by NASCET criteria.\n2. Multilevel moderate degenerative change in the cervical spine, as detailed\nabove.\n3. Enlargement of the main pulmonary artery up to 3.6 cm, which can be\ncommonly seen in pulmonary hypertension.\n4. Bilateral thyroid nodules measure up to 7 mm." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are normal in size and configuration.\n\nThere is moderate mucosal thickening of the ethmoid, sphenoid and maxillary\nsinuses. The mastoid air cells,and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. There is\nfetal type origin of the right posterior cerebral artery. The dural venous\nsinuses are patent.\n\nCTA NECK:\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No aneurysm or vertebral dissection.\n2. No acute intracranial abnormality.\n3. No stenosis or occlusion of the circle of ___ and cervical arteries.\n4. Moderate pansinusitis." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThe gray-white matter differentiation is intact without evidence of acute\ninfarct, hemorrhage, mass, or mass effect. There are focal hypodensities\nwithin the bilateral basal ganglia which may represent remote lacunar infarcts\nversus prominent perivascular spaces. There is periventricular white matter\nhypodensity which is nonspecific but likely presenting sequela of chronic\nmicroangiopathy. There is mild prominence of the ventricles and cortical\nsulci. The extra-axial spaces are unremarkable. The bilateral lenses are\nabsent. The soft tissues and calvarium are unremarkable. The paranasal\nsinuses and mastoid air cells are clear.\n\nCTA HEAD:\nThere is small anterior density at the right clinoid segment internal carotid\nartery seen on the spleen measured sequence (660:21) which corresponds to\natherosclerosis on the source images (5: 268). There is a mildly patulous\nappearance at the confluence the bilateral A1 segment anterior cerebral\narteries and anterior communicating artery without frank aneurysm. There is\ncalcific atherosclerosis without stenosis of the bilateral carotid siphons and\nV4 segment vertebral arteries.\n\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThere is calcific atherosclerosis at the right carotid bifurcation, and\ncarotid bulb, with focal were extensive calcification at the post bulbar\nproximal right internal carotid artery with approximately 50% luminal stenosis\n(5:168). There is calcific atherosclerosis at the left carotid bifurcation\nand carotid bulb without significant luminal stenosis. There are codominant\nvertebral arteries with calcification at the origin of the left vertebral\nartery without significant stenosis. There is calcific atherosclerosis of the\naortic arch. There is no evidence of significant stenosis by NASCET criteria.\n\nThere are multilevel degenerative changes of the cervical spine without\nfracture or malalignment. There centrilobular emphysema within the lung\napices. There is no lymphadenopathy. The thyroid gland is unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Patent head and neck vasculature without occlusion, dissection, or\naneurysm.\n3. Approximately 50% luminal stenosis at the post bulbar proximal right\ninternal carotid artery.\n4. Centrilobular emphysema." + }, + { + "input": "There is no acute intracranial hemorrhage, edema, mass effect, or evidence of\nlarge vascular territorial infarction. The ventricles and sulci are slightly\nprominent, suggesting age related involutional changes. Periventricular white\nmatter hypodensities are compatible with chronic small vessel ischemic\ndisease. There is preservation of grey-white matter differentiation and the\nbasal cisterns are patent.\n\nThere is no fracture. The imaged paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nPeriventricular and subcortical white matter hypodensities are noted, likely\nthe sequelae of chronic small vessel ischemic disease. There is preservation\nof gray-white matter differentiation. The basal cisterns remain patent.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Calcifications\nare noted within the bilateral internal carotid arteries. Chronic healed left\norbital floor fracture. The visualized portion of the orbits are otherwise\nunremarkable.", + "output": "1. No evidence for acute intracranial hemorrhage or large vascular\nterritorial infarction.\n2. Moderate, age related involutional changes and evidence of chronic small\nvessel ischemic disease." + }, + { + "input": "The left maxillary sinus is almost completely opacified with hyperdense\nmaterial that may represent inspissated secretions or fungal colonization. \nThe right maxillary sinus demonstrates mild mucosal thickening. The ethmoid\nair cells are nearly completely opacified with intermediate density material. \nThe middle ear cavities and mastoid air cells are grossly clear. The left\nfrontal sinus is nearly completely opacified. The right frontal sinus\ndemonstrates an air-fluid level. The ostiomeatal units are obstructed\nbilaterally. The frontoethmoidal recesses are obstructed bilaterally. There\nis moderate mucosal thickening of the bilateral sphenoid sinuses.\n\nThere is asymmetric soft tissue visualized in the left retro antral fat pad\nand a possible bony dehiscence of the lateral wall of the left maxillary sinus\n(301:26, 2:26), which may indicate invasive pattern. There is slight bony\nremodeling of the lateral wall of the left maxillary sinus which may indicate\nchronicity. The cribriform plates are intact. The lamina papyracea are\nintact.\n\nVisualized portions of the brain demonstrate no acute abnormalities.", + "output": "Substantial opacification of the paranasal sinuses, particularly the left\nmaxillary sinus, with mixed hyperdensities may represent inspissated\nsecretions or fungal colonization.\n\nPossible invasive component evidenced by increased soft tissue in the left\nretro antral fat pad and possible maxillary wall bony dehiscence." + }, + { + "input": "There evidence of right and left frontal and left temporal encephalomalacia. \nThere is no evidence of new infarction,hemorrhage,or edema. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits show left eye lens displacement and calcification. \nIncreased density in the left globe.", + "output": "1. No evidence of acute infarction or intracranial hemorrhage.\n2. Extensive chronic bifrontal and left temporal tissue loss\n3. There is left lens dislocation and calcification. There is increased\ndensity in the left globe compatible with retinal detachment." + }, + { + "input": "No fractures are identified.\nThere is mild soft tissue swelling of the inferior lip, with punctate\nradiopaque foreign body (image image 101, series 2.)\nThere is minimal mucosal thickening in the maxillary sinuses and anterior\nethmoid air cells, and there is a very small right maxillary sinus mucous\nretention cyst.\nThere is no evidence of abnormal fluid collections.\nBilateral mastoids appear normal.\nThe globes, extraocular muscles, optic nerves, and retrobulbar fat appear\nnormal. There is a tiny calcification in the region of the left lacrimal\ngland, which is nonspecific.\nThe visualized upper aerodigestive tract appears normal.\nThe mandible and temporomandibular joints appear normal.\nBilateral cervical lymph nodes, particularly level 1 B nodes are increased in\nnumber, but are not pathologically enlarged by CT size criteria, which is\nnonspecific.", + "output": "1. No evidence of maxillofacial fracture.\n2. Mild soft tissue swelling in the inferior lip with punctate radiopaque\nforeign body as described above\n3. Minimal paranasal sinus disease as described above." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nEncephalomalacia from prior left parietal temporal infarction. There is no\nevidence of acute large territory infarction,hemorrhage,edema,ormass. The\nventricles and sulci are normal in size and configuration.\n\nThickening of the ethmoid sinus and right maxillary sinus. The visualized\nportion of the mastoid air cellsand middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nMild calcified atherosclerosis at the origin of the bilateral internal\narteries without significant luminal narrowing. There is left vertebral\ndominance, which is a normal anatomic variant. The carotidandvertebral\narteries and their major branches appear normal with no evidence of stenosis\nor occlusion. There is no evidence of internal carotid stenosis by NASCET\ncriteria.\n\nOTHER:\nModerate degenerative changes joint space narrowing and osteophyte formation. \nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No acute intracranial process.\n2. Vessels of the head and neck appear patent and without high-grade stenosis,\nocclusion, or aneurysmal change.\n3. Sinus disease as described above." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or infarction.\n\nThe ventricles and sulci are enlarged, out of proportion for the patient's\nage, as seen on the prior study.\n\nThe basal cisterns appear patent and there is preservation of gray-white\nmatter differentiation.\n\nThe visualized bony structures are grossly unremarkable. Again seen is\nsuperficial soft tissue irregularity with punctate calcifications in the left\nfrontal region, which is unchanged. Minimal atherosclerotic calcifications\nare noted within the cavernous carotid arteries.\n\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\n\nThe globes are unremarkable.", + "output": "No evidence of acute intracranial process. Global atrophy, out of proportion\nfor the patient's age, and again may relate to chronic anticonvulsant therapy\nor substance abuse." + }, + { + "input": "There is no evidence of large territorial infarction,acute intracranial\nhemorrhage,edema,or mass. The ventricles and sulci are enlarged, out of\nproportion for the patient's age, as described previously. Basal cisterns\nremain patent.\n\nThere is no evidence of fracture. There is re-demonstration of superficial\nsoft tissue irregularity with punctate calcifications in the left frontal\nregion, as seen in ___. Rounded metallic density is seen adjacent to\nthe right mandibular condyle. There is minimal mucosal thickening in the\nethmoidal air cells. The visualized portion of the remaining paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial hemorrhage.\n\n2. Re-demonstration of global atrophy, out of proportion for the patient's\nage as described previously." + }, + { + "input": "No evidence of acute infarction,hemorrhage,edema, or mass effect. Bilateral,\nsymmetric prominence of the ventricles and sulci indicates cortical volume\nloss, similar to prior Bilateral cavernous internal carotid artery\ncalcifications are mild.\n\nNo evidence of fracture. Round density adjacent right mandibular condyle is\nunchanged (series 303, image 11). Tiny mucous retention cyst in the partially\nimaged right maxillary sinus. Remaining partially imaged paranasal sinuses\nare clear. The mastoid air cells and middle ear cavities are clear\nbilaterally. The visualized portion of the orbits are preserved. Left\nfrontal supraorbital scalp partially calcified probable scar is grossly\nunchanged. Grossly stable punctate nonspecific right parotid calcification is\nnoted.", + "output": "1. No hemorrhage or fracture.\n2. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described.\n3. Grossly stable radiopaque foreign body versus dense calcification posterior\nto right mandible.\n4. Paranasal sinus disease , as described." + }, + { + "input": "There is a 3 vessel aortic arch. Mild atherosclerotic calcification of the\nproximal descending aorta is noted. The common carotid, cervical internal\ncarotid and cervical vertebral arteries are widely patent. The distal cervical\ninternal carotid arteries measure 5 mm in diameter on the left and 4 mm in\ndiameter on the right.\n\nAtherosclerotic calcifications of the carotid siphons are noted without\nflow-limiting stenosis. In the distal cavernous right internal carotid artery,\nthere is a 4 mm medially projecting aneurysm with a broad neck (series 2,\nimage 216), unchanged compared to ___ MRI. There is an azygos\nanterior cerebral artery, a normal variant. Middle cerebral arteries are\nunremarkable. There is fetal origin of the left posterior cerebral artery.\nThere is a small fenestration at the origin of the basilar artery. There is no\nflow limiting stenosis or aneurysm in the intracranial posterior circulation.\n\nMild mucosal thickening of the right maxillary sinus and a small mucous\nretention cyst in a right posterior ethmoid air cell is noted. Right greater\nthan left palatine tonsiliths are light sequela of prior infection. No\nsuspicious sclerotic or lytic osseous lesions are identified. There are\nmultilevel degenerative changes of the cervical spine. There is a 5 mm focus\nof pulmonary ground-glass opacity in the left upper lobe (series 2, image 55),\nand a 2 mm ground-glass nodule in the right upper lobe (series 2, image 47).", + "output": "1. 4 mm medially projecting, broad-necked aneurysm of the distal cavernous\nright internal carotid artery, unchanged compared to ___ MRA.\n2. 5 mm ground-glass pulmonary nodular density in the left upper lobe and 2 mm\nground-glass nodular density in the right upper lobe. Given the ground glass\nappearance of these lesions, recommend follow up chest CT in ___ months.\n\nNOTIFICATION: Impression item 1, discrepant from the preliminary report, was\nemailed by Dr. ___ to the ___ QA nurses list on ___ at 09:17." + }, + { + "input": "CT HEAD:\nThere is no evidence for acute hemorrhage, vascular territorial infarction,\nmass effect, or edema.\n\nThe ventricles and sulci are prominent compatible with global parenchymal\nvolume loss. Periventricular and subcortical white matter hypodensities are\nnoted, a nonspecific finding that most likely represents the sequelae of\nchronic small vessel ischemic disease.\n\nMild mucosal thickening is seen in scattered ethmoid air cells bilaterally. \nThe remainder of the paranasal sinuses, middle ear cavities, and mastoid air\ncells are clear. The orbits are grossly unremarkable bilaterally.\n\n\nCTA HEAD AND NECK:\nThere is a normal 3 vessel aortic arch identified. The vertebral arteries are\npatent without high-grade stenosis or occlusion.\n\nThe bilateral common carotid arteries are patent. Mild calcifications are seen\nat the left carotid bulb. There is no evidence of internal carotid stenosis by\nNASCET criteria.\n\nModerate calcifications are noted at the bilateral cavernous internal carotid\narteries. Allowing for this, the intracranial vasculature is grossly patent\nwithout high-grade stenosis, occlusion, or aneurysm greater than 3 mm. There\nis a fetal origin of the left posterior cerebral artery. The dural venous\nsinuses are patent.\n\n\nCTA PERFUSION:\nNo evidence of increased mean transit time or decreased cerebral blood\nflow/volume to suggest acute ischemia or infarction.\n\n\nOTHER:\nWithin the right upper lobe, there is a 5 cm sub solid nodule, age\nindeterminate. The remainder of the visualized lungs apices are clear\nbilaterally. The thyroid gland is unremarkable in appearance. There is no\ncervical lymphadenopathy by CT size criteria.", + "output": "1. No evidence for acute intracranial hemorrhage or large vascular territorial\ninfarction by CT.\n2. Grossly patent intracranial and cervical vasculature without high-grade\nstenosis, vessel occlusion, or aneurysm greater than 3 mm.\n3. CTA perfusion: No evidence of increased mean transit time or decreased\ncerebral blood flow/volume to suggest acute ischemia or infarction.\n4. Incidentally noted 5 mm sub solid nodule in the right upper lobe. Findings\nare age indeterminate.\n\nRECOMMENDATION(S): For an incidentally detected single ground-glass nodule\nsmaller than 6mm, no CT follow-up is recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of hemorrhage,edema,ormass.\nFew well-defined deep white matter hypodensities are nonspecific may represent\nchronic small vessel ischemic changes, acute to subacute infarcts are unlikely\ngiven stability since ___.. No acute cortical infarcts.\nThere is mild generalized parenchymal volume loss, most likely age related. \nMild prominence of the ventricular system and extra-axial CSF spaces is\nunchanged and compatible with the previously mentioned parenchymal volume\nloss.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\n\nBroad-based 2.0 mm aneurysm distal cavernous right ICA, similar to prior,\nmedially directed. Calcifications bilateral cavernous, paraclinoid ICA, with\nmild narrowing.\nScattered atherosclerotic changes along both cavernous ICAs without high-grade\nstenosis. Vessels of the circle of ___ and their principal intracranial\nbranches appear normal without stenosis, occlusion, or aneurysm formation. \nNote is made of a left fetal PCA. Right posterior communicating artery is\npresent. Probable small segment fenestration at the vertebrobasilar junction\n(series 4, image 236, series 307, image 37 and series 310, image 8), normal\nanatomic variant. The dural venous sinuses are patent.\n\nCTA NECK:\nNormal 3 vessel aortic arch. The carotidandvertebral arteries and their major\nbranches appear normal with no evidence of stenosis or occlusion. There is no\nevidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\n5 mm ground-glass nodule left lung apex, stable since prior, no further\nfollow-up indicated.. Mild pleural thickening, subpleural scarring posterior\nright lung apex, stable. Degenerative changes spine. Mild anterolisthesis\nC3-C4, likely degenerative.", + "output": "1. No acute findings.\n2. 2.0 mm medially directed distal right ICA cavernous segment aneurysm,\nsimilar.\n3. Patent intracranial and cervical vasculature.\n\nRECOMMENDATION(S): For an incidentally detected single ground-glass nodule\nsmaller than 6mm, no CT follow-up is recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" + }, + { + "input": "Interval increase in mild thickening of the bilateral sphenoid sinuses with\naerosolized secretions as well as thickening and opacification of the\nbilateral ethmoid air cells is consistent with sinus disease. There is\nminimal nasal septum deviation with small bony spur formation, better depicted\nin the coronal images (image 34, series 5).\nThe ostiomeatal units are mildly narrowed. The cribriform plates are intact. \nThe lamina papyracea are intact. Limited views of the brain demonstrate mild\nprominent ventricles and sulci, likely age related and involutional in nature,\nthere is normal pattern of enhancement in the major vascular structures.", + "output": "1. Mild thickening of the bilateral sphenoid and ethmoid air cells with\naerosolized secretions, likely representative of sinus disease." + }, + { + "input": "No fractures are identified. There is no evidence of facial swelling.\n\nAgain seen is mucosal thickening of the ethmoid air cells and bilateral\nsphenoid sinuses with aerosolized secretion, similar to ___. There is\nmild hyperostosis of the sphenoid sinus walls, unchanged from prior\nexamination compatible with sequela of chronic sinusitis. Mild mucosal\nthickening of the left maxillary sinus is also unchanged. Mild mucosal\nthickening of the ethmoid air cells. Mild mucosal thickening of the frontal\nethmoidal recesses. Small right greater than left Haller cells. Mild mucosal\nthickening along the ostiomeatal infundibulum which are otherwise patent. No\nevidence of cortical breakthrough of the adjacent bony structure. The\nremaining paranasal sinuses are essentially clear.\n\nThere is no evidence of abnormal fluid collections.\n\nTrace fluid in the left mastoid air cells is noted. The right mastoid air\ncells are clear.\n\nThe globes, extraocular muscles, optic nerves, and retrobulbar fat appear\nnormal.\nThe visualized upper aerodigestive tract appears normal.\nThe mandible and temporomandibular joints appear normal.", + "output": "1. Redemonstration of mucosal thickening of the ethmoid air cells, left\nmaxillary sinus, and bilateral sphenoid sinuses with aerosolized secretion in\nthe sphenoid sinuses, likely reflecting paranasal sinus disease, similar in\nextent compared to ___. There is mild sphenoid sinus walls,\ncompatible with history of chronic sinusitis. No evidence of underlying bony\ndisruption.\n2. Additional findings as described above" + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are prominent, consistent with age-related\ninvolutional change. There is mild mucosal thickening as well as multiple\nsmall mucous retention cysts in the left ethmoid air cells. The remaining\nvisualized paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "1. No acute intracranial process.\n2. Paranasal sinus disease, as above." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is an acute intraparenchymal hemorrhage within the left inferior\nparietal lobule with moderate associated vasogenic edema. There is local mass\neffect with narrowing of the atrium of left lateral ventricle. There is no\nmidline shift. The basilar cisterns are patent.\n\nThere is mild global parenchymal volume loss. Confluent areas of low\nattenuation within the subcortical and periventricular white matter\nnonspecific, but likely reflect the sequela of moderate chronic small vessel\ndisease.\n\nThe orbits are unremarkable. There is minimal mucosal thickening within the\nright maxillary sinus and tiny retention cyst within the left sphenoid sinus. \nThe paranasal sinuses the middle ear cavities and mastoid air cells are\notherwise clear.\n\nCTA HEAD:\nThere is mild atherosclerotic plaque within the internal carotid arteries\nwithout stenosis. There is a fetal type right PCA. The vessels of the circle\n___, vertebral arteries, and basilar artery are patent without stenosis.\n\nNo aneurysm or vascular malformation is identified.\n\nCTA NECK:\nThere is moderate atherosclerotic plaque within the aortic arch. The left\ncommon carotid artery is derived from the brachiocephalic artery.\n\nThere is moderate atheromatous atherosclerotic plaque at the bilateral carotid\nbulbs without internal carotid artery stenosis by NASCET criteria.\n\nThe left vertebral artery is dominant. The vertebral arteries are patent\nwithout stenosis.\n\nOTHER:\nThere are few subcentimeter nodules within the thyroid gland, for which no\nfurther follow-up is recommended.\n\nThere are no enlarged cervical lymph nodes.\n\nThere is mild centrilobular emphysematous disease. The lungs are otherwise\nclear.", + "output": "1. Acute intraparenchymal hemorrhage within the left inferior parietal lobule\nwith mild local mass effect. There is no underlying vascular malformation. \nThis is likely secondary to cerebral amyloid angiopathy. Recommend contrast\nenhanced MR head in ___ months to exclude underlying mass.\n2. Probable moderate chronic small vessel disease.\n3. Mild intracranial atherosclerotic vascular disease, without stenosis.\n4. Moderate extracranial atherosclerotic vascular disease, without internal\ncarotid artery stenosis by NASCET criteria. Patent vertebral arteries without\nstenosis.\n5. Subcentimeter nodules in the thyroid.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Head CT: There is no evidence of hemorrhage, edema, masses, mass effect, or\ninfarction. The ventricles and sulci are normal in caliber and configuration.\nNo fractures are identified. The orbits are unremarkable. There are mucous\nretention cysts in the bilateral maxillary sinuses. The remainder of the\nparanasal sinuses are clear. The mastoid air cells and middle ear cavities are\nwell pneumatized and clear.\n\nHead CTA: There is again noted absent flow beyond the proximal right M1\nsegment, with numerous collateral vessels noted along the course of the right\nMCA distribution. There is suggestion of partial reconstitution of the distal\nright M2 and M3 segments. These findings are essentially unchanged from\noutside hospital CTA of ___.\n\nOtherwise, the intracranial internal carotid arteries, anterior cerebral\narteries, left middle cerebral artery, codominant vertebral arteries, basilar\nartery and bilateral posterior cerebral arteries are unremarkable without\nevidence of stenosis or aneurysm. The previously noted left P1 segment focal\nstenosis is not demonstrated on the current examination.", + "output": "1. Absence of right M1 segment with numerous collateral vessels suggested to\nat least partially reconstitute right M2 and M3 vessels, with overall\nasymmetric caliber of right MCA distribution vessel relative the left, stable\ncompared to ___ prior examination. Findings concerning for ___\ndisease, with differential considerations including vasculitis. Recommend\nclinical correlation. If clinically indicated, MRI and MRA Brain with\nprofusion imaging may be obtained for further evaluation.\n2. There is no evidence of acute infarct, however MRI is more sensitive for\nthe evaluation of acute infarct.\n3. Previously reported left P1 segment focal stenosis is not demonstrated on\ncurrent examination." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThe ventricles, sulci, and cisterns are enlarged, likely related to\ninvolutional change. There are small focal hypodense foci within the right\nputamen and left external capsule that may reflect prominent perivascular\nspaces or old lacunar infarcts. Areas of low density within the\nperiventricular white matter are nonspecific but likely the reflect the\nsequela of chronic small vessel disease. No large infarct, intracranial\nhemorrhage, or mass effect.\n\nA 16 mm ovoid lucent area within the right occipital bone with smooth margins\nand a central area of calcification most likely reflects an arachnoid\ngranulation or other benign vascular or fibro-osseous lesion. There are\nbilateral lens replacements. The orbits are otherwise unremarkable.\n\nCTA HEAD:\nThere is moderate atherosclerotic plaque within the carotid siphons, without\nsignificant stenosis.\n\nThe anterior middle cerebral arteries are patent without stenosis. There is a\nnormal anterior communicating artery complex.\n\nThe posterior cerebral arteries are patent without stenosis. The left\nposterior communicating artery is patent. A right posterior communicating\nartery is not seen.\n\nThe vertebral arteries and basilar artery are patent without stenosis.\n\nNo aneurysm greater than 2 mm or arteriovenous malformation is identified.\n\nCTA NECK:\nThere is moderate atheromatous and atherosclerotic plaque within the aortic\narch.\n\nThere is mild atherosclerotic plaque at the carotid bulb, with less than 50%\nstenosis by NASCET criteria. The right common carotid and internal carotid\narteries are patent without stenosis.\n\nThere is mild atherosclerotic plaque at the left carotid bulb and within the\nproximal left internal carotid artery. The common carotid artery and internal\ncarotid artery are patent without stenosis.\n\nThe vertebral arteries are patent without stenosis.\n\nOTHER:\nThere is a tiny nodule in the right true vocal cord (series 3, image 100).\n\nNo enlarged lymph nodes are identified within the neck.\n\nThere is a 5 mm pulmonary nodule within the apical segment of the right upper\nlobe (series 3 image 22). Areas of ground-glass opacity and areas of air\ntrapping are seen within the imaged upper lobes. These findings may reflect\natelectasis superimposed on small airways disease and/or hypersensitivity\npneumonitis.", + "output": "1. No large infarct or acute intracranial hemorrhage.\n2. Mild intracranial and extracranial atherosclerosis, without significant\nstenosis.\n3. 5 mm pulmonary nodule within the right upper lobe. Recommend chest CT in\n12 months if the patient is at high risk for malignancy, as clinically\nindicated." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Well-defined\nhypodensities in the right basal ganglia and left external capsule reflect\nchronic lacunar infarcts. Mild chronic microangiopathy. There is prominence\nof the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Bilateral lens\nreplacement. Moderate carotid siphon calcification.", + "output": "No evidence of an acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Mild\nprominence of the ventricles and sulci is consistent with age related\ninvolutional changes.\n\nThere is a 1.6 x 1.9 cm osteoma arising from the floor of the left maxillary\nsinus. There is mild mucosal thickening of the right maxillary sinus with\nhyperostosis of the sinus walls suggesting chronic inflammation. Partial\nopacification of the right mastoid air cells is also noted. The paranasal\nsinuses, left mastoid air cells, and middle ear cavities are otherwise clear. \nThe orbits are unremarkable.", + "output": "No acute intracranial process. No evidence of intracranial mass on this\nnoncontrast head CT, but please note that MRI with contrast is a more\nsensitive imaging examination to assess for the presence of small masses." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are minimally prominent, consistent with mild global\ninvolutional changes..\n\nAside from mild right maxillary sinus mucosal thickening, visualized portion\nof the paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.\n\nCT PERFUSION: There are patchy areas of bilateral, primarily bifrontal\nincreased T-max with a volume of 58 mL, also seen in the right temporal lobe\nas well as the bilateral proximal regions, not confined to a single vascular\nterritory, favored to be artifactual. There is no decreased cerebral blood\nflow. Review of cerebral blood volume, cerebral blood flow, and mean transit\ntime and T-max perfusion maps does not demonstrate an area of focal abnormal\nperfusion. Note that the AIF peak is at 90 ___ units with a slow\ndownsloping plateau at approximately 40 ___ units, which may represent\na technical limitation of the perfusion component of this study.\n\nCTA HEAD:\nThere are fetal type PCAs bilaterally, a normal anatomic variant. Posterior\ncommunicating arteries are patent bilaterally. Overall, the circle of ___\nvasculature and principal intracranial branches are patent without evidence\nsignificant stenosis, occlusion, or aneurysm. Major dural venous sinuses are\npatent.\n\nCTA NECK:\nThe origin of the supraaortic vessels appears normal, punctate vascular\narteriosclerotic calcifications are visualized in the aortic arch, the carotid\nand vertebral arteries and their major branches appear normal with no evidence\nof stenosis or occlusion. There is no evidence of internal carotid stenosis by\nNASCET criteria.\n\nOTHER:\nSevere centrilobular and mild paraseptal emphysema is seen at the lung apices.\nNo cervical lymphadenopathy. Thyroid is unremarkable.", + "output": "1. No acute intracranial process by unenhanced head CT.\n2. Unremarkable CTA head and neck. Patent neck and circle of ___\nvasculature.\n3. No evidence of focal abnormal perfusion. Areas of bilateral increased mean\ntransit time not adhering to a particular vascular territory are favored to be\nartifactual.\n4. Severe biapical centrilobular emphysema." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nPeriventricular, subcortical and deep white matter hypodensities likely\nreflect the sequela of chronic microvascular infarction. The basal cisterns\nremain patent. There is preservation of gray-white matter differentiation. \nAtherosclerotic calcifications are seen involving the cavernous carotid and\ndistal vertebral arteries.\n\nThere is no evidence of fracture. Mild mucosal thickening is seen involving\nthe floor of both maxillary sinuses, suggestive mild ongoing inflammation. \nThe visualized portion of the remaining paranasal sinuses, and middle ear\ncavities are clear. The mastoid air cells are hyperaerated bilaterally, but\nappear clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No evidence for acute intracranial process.\n2. Moderate, age-related atrophic changes." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute intracranial hemorrhage. No extra-axial fluid\ncollection or mass lesion is seen. Moderate prominence of the ventricles and\nsulci is suggestive of involutional changes.\n\nPatchy to confluent periventricular and subcortical white matter\nlow-attenuation changes are nonspecific, but likely reflect chronic small\nvessel ischemic disease.\n\nThe paranasal sinuses are essentially clear, noting mild bilateral mucosal\nthickening of the ethmoid air cells. The orbits are unremarkable noting\nbilateral lens replacements. Fluid opacifies the bilateral mastoid tips. The\nmiddle ears are otherwise clear..\n\nCTA HEAD:\nThere are mild to moderate atherosclerotic calcifications of the parasellar\ncarotid arteries. Otherwise, the vessels of the circle of ___ and their\nprincipal intracranial branches appear normal without stenosis, occlusion, or\naneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nEvaluation of the aortic arch demonstrates moderate scattered atherosclerotic\ncalcifications with mild atherosclerotic calcifications of the right and left\ncommon carotid artery origins. Mild-to-moderate narrowing of the bilateral\nvertebral artery origins secondary to atherosclerotic disease is noted. \nOtherwise, the carotid and vertebral arteries and their major branches appear\nunremarkable with no evidence of high-grade stenosis or occlusion. There is no\nevidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nEvaluation of the visualized lung parenchyma demonstrates multiple scattered\nbilateral pulmonary nodules. The dominant left nodules include a 5 mm left\nupper lobe pulmonary nodule (series 3, image 18). There is an irregular\nnodular opacity measuring up to 7 mm in the superior segment of the left lower\nlobe (image 25 series 3). The dominant right pulmonary nodule measures\napproximately 4 mm (series 3, image 14). The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. Asymmetric effacement of the left piriform sinus can be seen on\nprior CT cervical spine of ___. Remainder the visualized\naerodigestive tract is grossly unremarkable.\n\nFusion of the C3 through C5 vertebral bodies slightly progressed from\nexamination ___. Anterolisthesis of C2 on C3 and retrolisthesis of C5 on C6\nhas also mildly progressed. The bones are diffusely demineralized. \nMultilevel degenerative changes results in mild-to-moderate spinal canal\nnarrowing at C5-C6 with severe bilateral neural foraminal narrowing at these\nlevels. The patient is status post median sternotomy.", + "output": "1. No evidence of acute territorial infarction, intracranial hemorrhage, or\nmass lesion on noncontrast head CT.\n2. Moderate cerebral atrophy and chronic small vessel ischemic disease.\n3. Mild-to-moderate atherosclerotic calcifications at the great vessel\norigins. Otherwise, patent carotid and vertebral arteries without focal\nstenosis, occlusion, or aneurysm formation. There is no stenosis of the\ncervical internal carotid arteries by NASCET criteria.\n4. Moderate atherosclerotic calcifications of the parasellar internal carotid\narteries. Otherwise, patent circle of ___ without focal stenosis,\nocclusion, or aneurysm formation.\n5. Multiple pulmonary nodules as described above, better evaluated on prior CT\na chest of ___. Please refer to prior examination for additional\ndetails and recommendations.\n6. Asymmetric effacement of the left piriform sinus, similar in appearance to\nCT cervical spine of ___.\n7. Additional findings described above." + }, + { + "input": "A left parietal scalp hematoma and laceration are noted, with no evidence of\nunderlying fracture. There is no evidence of infarction, hemorrhage, edema,\nor mass. The ventricles and sulci are normal in size and configuration.\nThere is no evidence of fracture. There is a moderate amount of ethmoidal and\nleft maxillary mucosal thickening. Otherwise, the visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No evidence of intracranial hemorrhage, fracture, edema, mass effect or\ninfarction. Left scalp hematoma and laceration. The anterior facial bones\nare not imaged on this examination." + }, + { + "input": "There is beam hardening artifact through the medulla and pons. There is no\nevidence of acute hemorrhage, edema, mass effect, or loss of gray/ white\nmatter differentiation. The ventricles, sulci, and cerebellar folia are mildly\nprominent, indicating mild global parenchymal atrophy. ___ symmetrically\nprominent left cerebellar sulcus may reflect congenital asymmetry or sequela\nof a small chronic left cerebellar hemisphere infarct.\n\nNo osseous abnormalities seen. The partially visualized paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. Mild global cerebral and cerebellar atrophy." + }, + { + "input": "Images are motion degraded, particularly at skullbase. Within these confines:\n\nThere is no evidence of hemorrhage, edema, or mass effect. Ventricles and\nsulci are mildly prominent for patient's age. There is no shift of normally\nmidline structures. Basal cisterns are patent. Gray-white matter\ndifferentiation is preserved. Enlarged posterior fossa space likely reflects\ncisterna magna.\n\nThe orbits are unremarkable. Paranasal sinuses and mastoid air cells are\nclear. Middle ear cavities are clear. Soft tissue within external auditory\ncanals bilaterally likely reflects cerumen. The calvarium appears intact.", + "output": "1. Images are motion degraded. Allowing for this, no acute intracranial\nabnormality is identified. Please note, small extra-axial hemorrhages may not\nbe visualized secondary to the degree of motion particularly at the skullbase.\n2. No displaced skull fractures." + }, + { + "input": "The parotid glands and submandibular glands are unremarkable. Bilateral\nthyroid nodules are noted, better characterized on recent thyroid ultrasound.\n\nThere is no cervical adenopathy. There are however partially calcified\nnonenlarged lower cervical lymph nodes.\n\nPartially calcified biapical scarring and bronchiectasis superimposed on\nbackground of centrilobular emphysema is noted. Multiple calcified lymph\nnodes are identified in the mediastinum.\n\nThere is asymmetric soft tissue fullness of the nasopharynx on the left\ncompared to the right (02:17) with secondary asymmetry of the fossa of\n___. Parapharyngeal fat is preserved no underlying osseous erosion of\nthe underlying clivus. Adjacent vasculature is unremarkable.\n\nThe aerodigestive tract otherwise appears normal. Included paranasal sinuses\nand mastoids are clear besides scattered partial opacification of the right\nethmoids and partially opacified left mastoid tip..\n\nVascular structures in the neck are grossly unremarkable.\n\nIncluded intracranial structures appear normal.\n\nNo focal suspicious osseous lesion identified. Degenerative changes in there\nis seen in the spine there is ossification of the posterior longitudinal\nligament spanning C3-4 through C4-5 which contributes to moderate canal\nnarrowing at these levels. There is severe right foraminal narrowing at C5-6\ndue to uncovertebral joint osteophytes. Moderate to severe right foraminal\nnarrowing at C3-4.", + "output": "1. Asymmetric fullness of the soft tissues in the nasopharynx on the left for\nwhich correlation with direct visualization and perhaps biopsy is suggested as\nnasopharyngeal carcinoma would certainly be possible. No evidence of\nadenopathy or definite invasion of the skullbase. MRI could be considered for\nmore clear soft tissue delineation.\n2. Partially calcified lower cervical and mediastinal lymph nodes as well as\ncalcified scarring with traction bronchiectasis in the lung apices compatible\nwith prior tuberculosis.\n3. Degenerative changes in the spine including ossification the posterior\nlongitudinal ligament resulting in moderate canal narrowing at C3-4 through\nC4-5." + }, + { + "input": "There is no evidence of acute major infarction,hemorrhage,edema,or discrete\nmass. Hypodensities in the subcortical white matter are nonspecific and\nunchanged compared to prior, but may represent a sequelae of chronic small\nvessel ischemic disease. There is mild prominence of the sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is polypoid mucosal thickening along the antral floors of the bilateral\nmaxillary sinuses and left sphenoid sinus. The frontal sinuses and ethmoid\nair cells are clear, as are the mastoid air cells and middle ear cavities. \nThe ostiomeatal units are partially occluded by in nasal cavity mucosal\nthickening. The cribriform plates are intact. A small nasal septal defect is\nagain noted (601:49) The nasal septum is midline. The anterior clinoid\nprocesses are not pneumatized. The lamina papyracea are intact. The sphenoid\nsinus septum is midline with insertion upon the sellar floor.", + "output": "1. Mild maxillary and sphenoid sinus mucosal thickening.\n2. Known small nasal septal defect.\n3. No new osseous erosion is detected." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe right parotid gland is enlarged and heterogeneous when compared to the\nnormal-appearing left gland and is poorly enhancing with no discrete mass\nidentified, measuring up to 3.8 x 3.7 cm. The remaining salivary glands\nenhance normally and are without mass or adjacent fat stranding. The thyroid\ngland appears normal.There are prominent lymph nodes adjacent to the right\nparotid however are not enlarged by CT criteria. The neck vessels are patent.\n\nPlease refer to the concurrent CT scan of the chest for intrathoracic\nfindings.", + "output": "1. Enlarged hypoenhancing right parotid gland without discrete mass\nidentified. Given the low T2 signal seen on the MRI of the cervical spine, if\nthere is concern for a parotid malignancy, further evaluation with a dedicated\ncontrast enhanced MRI is recommended." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration. Postoperative\nchanges of pituitary resection noted.\n\nPostop changes of transsphenoidal resection are noted. There is higher per\nostosis of the sphenoid sinus walls. There is mucosal thickening in the\nbilateral maxillary sinuses. The mastoid air cells and middle ear cavities\nare clear. The native lenses have been removed bilaterally.", + "output": "1. No acute intracranial abnormalities.\n2. Paranasal sinus disease.\n3. Postoperative changes of pituitary resection noted." + }, + { + "input": "There is no evidence of fracture, large territorial\ninfarction,hemorrhage,edema,or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. Periventricular deep white\nmatter hypodensities are nonspecific, likely sequela of chronic small vessel\nischemia.\n\nPostoperative changes secondary to trans-sphenoidal resection are noted. \nAgain seen hyperostosis of the sphenoid sinus walls. There is mild mucosal\nthickening of the ethmoid and bilateral maxillary sinuses. The native lenses\nhave been removed bilaterally.", + "output": "1. No acute intracranial abnormalities.\n2. Postoperative changes of pituitary resection noted." + }, + { + "input": "There is no evidence of intracranial hemorrhage,acute large territorial\ninfarction,edema,or mass. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. Periventricular and subcortical\nhypodensities are nonspecific, though likely sequela of chronic small vessel\nischemic disease.\n\nPostoperative changes related to transsphenoidal resection are again noted. \nHyperostosis of the sphenoid sinus walls is similar to prior. Mild mucosal\nthickening of the bilateral maxillary sinuses and bilateral ethmoid air cells.\nThe visualized portion of the remaining paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The native lenses have been removed\nbilaterally. The visualized portion of the orbits are otherwise normal.", + "output": "1. No evidence of acute intracranial abnormality.\n2. Stable postoperative changes of transsphenoidal pituitary resection." + }, + { + "input": "There is no evidence of acute fracture, infarction,hemorrhage,edema, or mass. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Periventricular and deep white matter hypodensities are nonspecific,\nbut most likely related to chronic small vessel ischemia.\n\nPostoperative changes related to prior transsphenoidal resection of a\npituitary macroadenoma are again noted. Hyperostosis of the sphenoid sinus is\nsimilar to prior with small amount of mucosal thickening seen in the sphenoid\nsinus.\n\nOtherwise, the visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The native lenses are removed bilaterally.", + "output": "1. No evidence of acute intracranial abnormality.\n2. Stable postoperative appearance from transsphenoidal pituitary macroadenoma\nresection." + }, + { + "input": "There is no evidence of fracture, acute large territorial\ninfarction,hemorrhage,edema,or mass. Periventricular and subcortical white\nmatter hypodensities are nonspecific but likely sequelae of chronic small\nvessel ischemic disease. There is prominence of the ventricles and sulci\nsuggestive of involutional changes.\n\nRedemonstration of postoperative changes related to prior transsphenoidal\nresection of a pituitary macroadenoma and hyperostosis of the sphenoid sinus\nwalls. There is mild mucosal thickening of the sphenoid sinuses; otherwise,\nthe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal apart\nfrom bilateral lens replacements.", + "output": "No acute intracranial abnormality." + }, + { + "input": "A rounded 3 mm right frontal calcification along the inner table (series 3,\nimage 40) likely represents dural calcification versus a very small\nmeningioma. Otherwise, there is no intra or extra-axial mass effect, acute\nhemorrhage or infarct. Sulci, ventricles cisterns are within expected limits\ngiven the degree of patient's age related global cerebral volume loss. The\nvisualized paranasal sinuses are clear. The orbits are unremarkable. There\nis small amount of fluid in the right mastoid tip. There are no skull\nfractures. The visualized extracranial soft tissues are grossly unremarkable.", + "output": "1. No acute hemorrhage or infarct.\n2. 3 mm calcification along the right frontal calvarial inner table,\npotentially representing a dural calcification versus small meningioma." + }, + { + "input": "SOFT TISSUES: There is fat stranding and soft tissue thickening over the\nright lower lip.\n\nMAXILLOFACIAL BONES: The maxillofacial bones are intact, without fracture.\nThe zygomatico-maxillary complex is intact. The lateral pterygoid plates are\nintact.\n\nMANDIBLE: The mandible is without fracture or temporomandibular joint\ndislocation. The temporomandibular joints are symmetric, without significant\ndegenerative change.\n\nDENTITION: Dental amalgams cause severe streak artifact which limits\nevaluation of the dentition.\n\nSINUSES: The paranasal sinuses are intact and clear. The ostiomeatal units\nare patent.The mastoid air cells are partially opacified bilaterally. The\nmiddle ear cavities are clear.\n\nNOSE: There is no nasal bone fracture. Nasopharyngeal soft tissues are\nunremarkable. There is no nasal septal hematoma.\n\nORBITS: The orbits, including the laminae papyracea, are intact. The globes\nare intact with non-displaced lenses and no intraocular hematoma. There is no\npreseptal soft tissue edema. There is no retrobulbar hematoma or fat\nstranding.\n\nAllowing for imaging technique optimized for the face, the limited included\nportion of the brain is grossly unremarkable.", + "output": "1. No fracture.\n2. The temporomandibular joints are intact.\n3. Evaluation of the dentition is limited due to streak artifact from dental\nfillings." + }, + { + "input": "Head CTA: The bilateral mild-to-moderate ligamentous recommendations. No\nvascular occlusion stenosis or hydrocephalus identified. There are bilateral\nfetal type posterior cerebral arteries with consequent small left basilar\nsystem. Within the posterior circulation, there is narrowing of the midportion\nof the basilar artery which could be secondary to congenital variation or due\nto remote thrombosis and recanalization. There is no evidence of aneurysm in\nthe posterior circulation. Left basal ganglia hemorrhage is identified as on\nthe prior CT. There is no evidence of abnormal vascular structures.\nNeck CTA: The carotid and vertebral arteries and their major branches are\npatent with no evidence of stenoses. There is no evidence of internal carotid\nstenosis by NASCET criteria. Vascular calcifications are seen in the aortic\narch. The proximal left common carotid artery shows an apparent filling defect\non reconstructed images which appears to be artifactual.\n\nDegenerative changes are seen in the cervical spine. Small less than 5 mm\nhypodensity seen in the isthmic portion of the thyroid.", + "output": "The small caliber of the mid basilar artery could be due to congenital\nvariation or due to remote thrombosis and recanalization. Left basal ganglia\nhemorrhage is identified without evidence of aneurysm or abnormal vascular\nstructures. No vascular occlusion or stenosis on CT angiography of the neck." + }, + { + "input": "There is no acute intra-axial or extra-axial hemorrhage, edema, shift of\nnormally midline structures, or evidence of acute major vascular territorial\ninfarction. Prominence of the ventricles and sulci is consistent with\ninvolutional changes. There is partial opacification of the bilateral ethmoid\nair cells. There is mild mucosal thickening of the right sphenoid sinus, and\nsmall mucous retention cyst in the left maxillary sinus. The remaining imaged\nparanasal sinuses are clear. Mastoid air cells and middle ear cavities are\nwell aerated. The bony calvarium is intact. Postoperative changes of the\nglobes noted.", + "output": "No acute intracranial process." + }, + { + "input": "Image quality is limited by motion artifact.\n\nHead CT: There has been mild interval progression of hypodensity in the left\nfrontoparietal cortex with associated loss of gray-white matter\ndifferentiation. This is continuous with a more superior region of hypodense\nleft frontoparietal cortex with loss of gray-white matter differentiation.\nThese findings are consistent with an evolving acute MCA territory infarct\n(series 4, image 18 and image 22). A linear hyperdensity within the adjacent\nleft frontal lobe is similar to prior study, possibly a thrombus within an MCA\nbranch or a focus of calcification, less likely hemorrhage. There is no\nevidence of hemorrhage elsewhere. The basal cisterns are patent, and there is\nno shift of normally midline structures. There is no ventriculomegaly. \nCalcification of the bilateral intracranial internal carotid arteries is\nnoted. The visualized paranasal sinuses and mastoid air cells are clear. \nThere is mild rightward deviation of the nasal septum. The globes and bony\norbits are unremarkable.\n\nHead CTA: There are no intracranial vascular abnormalities. There is no\nevidence of aneurysm greater than 3 mm, stenosis, or occlusion.\n\nNeck CTA: There is mild arthrosclerotic calcification of the aortic arch with\na normal 3 vessel takeoff of the great vessels. There is calcification noted\nalong the course of both subclavian arteries. There is calcification along\nthe proximal the left vertebral artery with resulting moderate to severe\nnarrowing. There is extensive calcified plaque involving the common carotid\narteries bilaterally. There is extensive calcified plaque at the carotid\nbulbs with extension along the proximal internal carotid arteries as well as\nalong the course of the proximal external carotid arteries. Evaluation of\npercentage of carotid artery stenosis is somewhat limited by the extensive\ndegree of calcification. However, there is appears to be at least 55-65%\nstenosis of the internal carotid arteries bilaterally.\n\nThe distal right internal carotid artery measures 3.6 mm and the distal left\ninternal carotid artery measures 3.3 mm.\n\nThe thyroid and salivary glands image normally. There are mild emphysematous\nchanges in the lung apices. There are degenerative changes in the cervical\nspine.", + "output": "1. Image quality it is mildly to moderately degraded by motion artifact\n\n2. Evolving left acute MCA territory infarct. No new infarction or evidence\nof new acute hemorrhage.\n\n3. No evidence of aneurysm, vascular malformation, or stenosis on head CTA.\n\n4. Extensive calcification of the bilateral cervical common carotid arteries,\nexternal carotid arteries, and internal carotid arteries. The extensive\ncalcification combined with motion artifact makes precise estimate of the\ndegree of stenosis difficult. However, there appears to be at least 55-65%\nstenosis of the internal carotid arteries bilaterally.\n\n5. Calcification along the course of the proximal left vertebral artery\nresulting in moderate to severe stenosis." + }, + { + "input": "CT head without contrast:\nThere is no evidence of acute infarction,hemorrhage,edema, or mass effect. \nThe ventricles and sulci are prominent, suggestive of involutional disease.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.\n\nCT cervical spine without contrast:\nAlignment is normal with the exception of grade 1 anterolisthesis of C3-C4.No\nacute cervical spine fractures are identified.There is multilevel cervical\ndegenerative changes, most severe at C5-C6 with severe bilateral neural\nforaminal stenosis secondary to osteophytic formation with mild spinal canal\nstenosis.\n\nFrom C2-3 to C4-C5 and C6-T1 there is no spinal canal or neural foraminal\nstenosis.\n\nThere is no prevertebral soft tissue swelling.There is atelectasis of the\nbilateral lung apices.\n\nCT lumbar spine without contrast:\nGrade 1 retrolisthesis of L3-L5. There is a linear fracture of L2 vertebra\nwith mild compression of the inferior endplate. There is no retropulsion or\nspinal stenosis. There are degenerative changes in the lumbar spine with\ndecreased disc space but without high-grade spinal stenosis. No paraspinal\nhematoma is seen.\n\n\nThere is mild calcification of the abdominal aorta with no flow limiting\nstenosis.", + "output": "1. No evidence of acute intracranial abnormality. Specifically no evidence\ninfarct or hemorrhage.\n2. No evidence of acute cervical spine fracture.\n3. Fracture through the L2 vertebra with mild compression of the inferior\nendplate without retropulsion. The soft margins of the fracture cleft\nindicate an acute fracture." + }, + { + "input": "There is no BB marking the area of pain. Bilateral submandibular glands appear\nnormal in size and morphology without evidence for inflammatory changes or\nfocal masses. Bilateral parotid glands also appear normal. There is no\nevidence for sialolithiasis. There are scattered nonenlarged level 1a, 1b, 2,\n3, and 4 lymph nodes bilaterally, without suspicious features.\n\nThere is an indeterminate soft tissue density in the right vallecula, which\nmay relate to the lingual tonsil. The proximal/mid cervical right internal\ncarotid artery is medialized, indenting the posterior pharyngeal wall. Major\nvascular structures of the neck are otherwise unremarkable.\n\nRight thyroid lobe is larger than the left, similar to the prior chest CT.\nMultiple small thyroid nodules seen on the ___ thyroid ultrasound\nare not appreciated on the present CT.\n\nEvaluation of the visualized upper lungs is limited by respiratory motion\nartifact and incomplete expansion. No definite focal abnormality is seen.\n\nMastoid air cells and partially visualized paranasal sinuses are clear.\n\nThe bones are demineralized. No suspicious lytic or sclerotic bone lesions are\nidentified. There is evidence of ACDF at C5-6. While this exam is not\ntechnically optimized for evaluation of osseous detail, no evidence of\nhardware related complications is seen, and alignment from C3-4 through C7-T1\nis anatomic. There is minimal anterolisthesis of C2 on C3.", + "output": "1. While there is no BB marking the specific area of pain, no evidence for a\nmass or inflammatory change is identified in the left submandibular region or\nelsewhere in the neck.\n2. Indeterminate soft tissue density in the right vallecula, which may relate\nto the lingual tonsil. Recommend correlation with direct visualization.\n3. Previously noted thyroid nodules are not adequately reassessed." + }, + { + "input": "The patient is status post suboccipital craniotomy and resection of an AVM\nwith postsurgical changes. Streak artifact slightly limits evaluation. There\nis small area of low attenuation about surgical bed, likely postsurgical. \nThere is a small amount of pneumocephalus overlying the frontal lobes\nbilaterally. There is also a small amount of blood products within the\nresection cavity, and at foramen magnum. There is trace blood products in the\nposterior margin of left sylvian fissure series 2, image 17.\n\nThere is no evidence of infarction,edema, or mass. The ventricles and sulci\nare normal in size and configuration. There is no hydrocephalus.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Status post suboccipital craniotomy and resection of an AVM with a small\nvolume blood products near surgical bed, at foramen magnum and at the left\nsylvian fissure, small amount of pneumocephalus." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is stable encephalomalacia of the bilateral frontal lobes there is focal\nhypodensity along the medial left parietal lobe. Multiple stable intracranial\ncalcifications are seen. Chronic left insular cortex lacunar infarction is\nseen. There is focal hypodensities in the pons, likely representing sequelae\nof prior infarction.\n\nThere is no evidence of no evidence of hemorrhage, edema, or mass. Prominent\nventricles and sulci are compatible with age-related volume loss. \nPeriventricular white matter hypodensities are consistent with chronic small\nvessel ischemic disease.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\nAtherosclerotic vascular calcifications are noted of bilateral vertebral and\ncavernous portions of internal carotid arteries.\n\nCTA HEAD:\nThere is dense atherosclerotic calcification of the cavernous internal carotid\narteries. There is focal cut off of the mid right A2 segment, series 5, image\n212. Otherwise, the vessels of the circle of ___ and their principal\nintracranial branches appear normal without stenosis, occlusion or aneurysm\nformation. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is atherosclerotic calcification of the aortic arch. There is\natherosclerotic calcification in the bilateral carotid bulbs. There is\napproximately 30% stenosis of the right internal carotid artery by NASCET\ncriteria. There is no left internal carotid artery stenosis by NASCET\ncriteria. There is atherosclerosis of the origin of the bilateral vertebral\narteries. Otherwise, the carotid and vertebral arteries and their major\nbranches appear normal with no evidence of stenosis or occlusion.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. Extensive periapical lucencies and dental caries are seen appear", + "output": "1. Stable bifrontal encephalomalacia, likely sequelae of prior infarct. No\nacute hemorrhage.\n2. Area of hypodensity in the medial left parietal lobe, which appears to have\nbeen present on the prior CT, but appears more prominent likely given\ndifferences in technique and secondary to sulcal prominence.\n3. Focal cut off of the mid right A2 segment of uncertain chronicity.\n4. Approximately 30% stenosis of the proximal right internal carotid artery by\nNASCET criteria.\n5. Extensive dental disease, recommend dental consultation." + }, + { + "input": "There is a new subacute right anterior cerebral artery distribution\ninfarction. Again demonstrated is encephalomalacia involving the bilateral\nfrontal lobes. Left insular cortex lacunar infarction is chronic. Focal\nhypodensity within the pons, is likely also secondary to a prior infarction.\n\nThere is no evidence of hemorrhage. Prominent ventricles and sulci is likely\nsecondary to age related involutional changes. Periventricular white matter\nhypodensity is consistent with chronic small vessel ischemic disease. \nExtensive vertebral and carotid artery calcifications are seen.\n\nThe visualized paranasal sinuses are clear. The mastoid air cells, and middle\near cavities are unremarkable.", + "output": "1. New right anterior cerebral artery distribution infarction, appears\nsubacute.\n2. Stable bifrontal encephalomalacia with a background of senescent volume\nloss.\n\nNOTIFICATION: ___ were d/w Dr. ___ by Dr. ___ by phone at 1p\non the day of the exam, approximately 5 minutes after discovery." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nIncreased area of right anterior cerebral artery distrubution hypodensity with\ngyriform curvilinear cortical hyperdensities likely representing laminar\nnecrosis. A more rounded area of hyperdensity near the vertex is also new\n(03:28). Encephalomalacia of the bilateral frontal lobes greater on the right\nthan the left appears similar to prior. Prominence of the ventricles and\nsulci is likely related to involutional changes. Periventricular white matter\nhypodensities are nonspecific but likely reflect sequela of chronic small\nvessel ischemic disease.\n\nThere is a small amount of fluid within the right maxillary sinus. The\nremaining visualized portion of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable. Extensive the duct jet neck disease is again seen with numerous\nperiapical lucencies and dental caries.\n\nCTA HEAD:\nStable appearance compared to CTA dated ___. Chronic occlusion of\nthe mid A2 segment on the right is unchanged. The vessels of the circle of\n___ are otherwise patent with no aneurysm greater than 3 mm are high-grade\nstenosis. Similar appearance of atherosclerotic plaque in the proximal right\ninternal carotid artery with approximately 30% stenosis by NASCET criteria. \n___ nodularity in the right upper lobe is likely infectious or\ninflammatory in etiology. A 3 mm left upper lobe pulmonary nodule is noted\n(05:19). Recommend evaluation of the remainder of the chest with non emergent\nchest CT. The thyroid is heterogeneous with multiple small nodules. Extensive\ndental disease is again noted. The dural venous sinuses are patent.\n\nCTA NECK:\nSimilar appearance of atherosclerotic plaque in the proximal right internal\ncarotid artery with approximately 30% stenosis by NASCET criteria. There is\nno evidence of left internal carotid stenosis by NASCET criteria. There is\natherosclerotic does of the origin of the bilateral vertebral arteries.\n\nOTHER:\n___ nodularity in the right upper lobe is likely infectious or\ninflammatory in etiology. A 3 mm left upper lobe pulmonary nodule is noted\n(05:19). The thyroid is heterogeneous with multiple small subcentimeter\nnodules. Extensive dental disease is again noted.", + "output": "1. Increased hypodensity in the distribution of the anterior cerebral artery\ncompatible with evolving infarct.\n2. New gyriform curvilinear line cortical hyperdensities likely reflecting\nlaminar necrosis. More rounded area of hyperdensity at the vertex could also\nreflect laminar necrosis, although a small amount of hemorrhage cannot be\nexcluded. MRI could be helpful to confirm as clinically warranted.\n3. Unchanged appearance of the CTA from ___ with chronic\nocclusion of the mid A2 segment on the right.\n4. Stable approximately 30% stenosis of the proximal right internal carotid\nartery by NASCET criteria.\n5. Extensive dental disease. Dental consultation continues to be recommended.\n\nRECOMMENDATION(S): Recommend evaluation of the remainder of the chest with\nnon emergent chest CT." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding.There is an approximately 4 mm hypodensity in the left lobe of the\nthyroid gland (series 2, image 59). This nodule does not meet ACR follow-up\nguidelines for further evaluation. Otherwise, the thyroid gland appears\nnormal.\nThere is a mildly prominent left submandibular lymph node not meeting CT\ncriteria for lymphadenopathy.\nThere is no evidence of mass or fluid collections.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.", + "output": "No evidence of a neck mass, with particular attention to the right." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nloss of gray/white matter differentiation. Ventricles, sulci, and basal\ncisterns are normal in size. Cerebellar tonsils are normally positioned.\n\nThere is no evidence of fracture. The orbits appear unremarkable. There is a\nsmall mucous retention cyst and mild mucosal thickening in the partially\nimaged right maxillary sinus, and mild mucosal thickening in the partially\nimaged left maxillary sinus. Frontal sinuses are not pneumatized. Mastoid\nair cells are well aerated.", + "output": "No evidence for an acute intracranial abnormality or calvarial fracture." + }, + { + "input": "CT Head: There is a centrally hyperdense and eccentrically peripherally\nisodense mass in the right prepontine cistern, suspicious for an aneurysm.\nThis corresponds to the mass seen on MRI from ___. There is mass\neffect on the pons. There is no intracranial hemorrhage. There is no evidence\nof acute infarct. There is no midline shift.\n\nThere is mucosal thickening and fluid in the maxillary and sphenoid sinuses.\nThe mastoid air cells are clear. The orbits are normal. There is no displaced\ncalvarial fracture.\n\nCTA Head: The intracranial internal carotid arteries are normal in\nconfiguration. The right A1 is hypoplastic. The left anterior cerebral artery\nis normal. There is a normal anterior communicating artery complex. The middle\ncerebral arteries are patent with normal contrast enhancement and branching\npattern.\n\nThere is a large aneurysm arising from the P1 segment of the right PCA. The\naneurysm is narrow-necked with a neck measuring 3 mm and a dome measuring 14\nmm. The aneurysm is oriented posteroinferiorly. This aneurysm appears to be\npartially thrombosed in its left peripheral aspect. There is a 3 mm aneurysm\narising from the right P1-P2 junction opposite the large aneurysm. The small\naneurysm is orientated anterosuperiorly. The right PCA is fetal type.\n\nThe left PCA, bilateral superior cerebellar, basilar, and vertebral arteries\nare normal.\n\nCTA Neck: The visualized aortic arch and origins of the great vessels are\nunremarkable.\n\nThe right common, internal and external carotid arteries are normal in\nappearance. There is no evidence of a significant stenosis by NASCET criteria\nor a dissection.\n\nThe left common, internal and external carotid arteries are normal in\nappearance. There is no evidence of a significant stenosis by NASCET criteria\nor a dissection.\n\nThe cervical portions of the vertebral arteries demonstrate normal\nenhancement. There is no evidence of a significant stenosis by NASCET criteria\nor a dissection.", + "output": "1. Large narrow-necked saccular aneurysm of the P1 segment of the right PCA,\nmeasuring up to 14 mm in greatest dimension.\n2. Right P1 -P2 junction 3 mm aneurysm arising opposite the large aneurysm.\n3. No intracranial hemorrhage." + }, + { + "input": "Patient is status post coiling of a partially thrombosed right P1 aneurysm\nwith significant beam hardening artifact limiting evaluation of the inferior\nbrain. Hyperdense material is now seen within the aneurysm related to recent\nintervention. There is persistent vasogenic edema surrounding the right\nthalamus. Hypodensity in the right cerebellum likely reflects a prior infarct.\nNo acute hemorrhage or large vascular territorial infarction is identified.\nThe ventricles and sulci are slightly prominent, likely related to global\natrophy. The basal cisterns are not fully evaluated but appear patent and\nthere is preserved gray white matter differentiation.\n\nNo osseous abnormalities seen. There is partial opacification of the\nbilateral sphenoid and maxillary sinuses as well as mucosal thickening of the\nethmoid air cells with aerosolized secretions likely related to recent\nintubation. The mastoid air cells and middle ear cavities are clear.", + "output": "1. Status post coiling which limits the evaluation of the inferior brain.\n2. Within this limitation, no large acute vascular territorial infarction or\nhemorrhage is identified.\n3. Stable right thalamic vasogenic edema.\n4. Old right cerebellar infarct." + }, + { + "input": "There is no evidence of acute hemorrhage mass effect midline shift or\nhydrocephalus. Gray-white matter differentiation is maintained. Extensive\nbony changes are identified within the clivus and skull from patient's known\nmultiple myeloma. No evidence of subdural hematoma seen.", + "output": "No acute intracranial abnormalities or hemorrhage are identified. Extensive\nlytic changes within the clivus and skull due to multiple myeloma, unchanged\nfrom previous MRI." + }, + { + "input": "There is been no significant interval change. The small hyperdense focus\nlikely due to a cavernous malformation with associated developmental venous\nanomaly is again seen at the left frontal convexity region. No acute\nhemorrhage mass effect midline shift or hydrocephalus seen. Mild brain atrophy\nand small vessel disease seen. Artifacts from left-sided cochlear implant\nagain identified.\n\n.", + "output": "No significant interval change since the previous CT examination. No acute\nabnormalities are seen. Left superior frontal hyperdense focus likely due to\na cavernous malformation is again seen." + }, + { + "input": "Head CT and CTA images are limited by beam hardening artifact emanating from\nthe patient's left-sided cochlear implant.\n\nCT HEAD:\nAllowing for beam hardening artifact over the left parietal and posterior\nlobes, there is no evidence for acute intracranial hemorrhage, edema, mass\neffect, or acute major vascular territorial infarction. A rounded hyperdense\nfocus within the left frontal centrum semiovale is unchanged from the ___ CT\nand likely represents a cavernous malformation, without surrounding edema. \nSubsequent CTA images demonstrate an adjacent left frontal developmental\nvenous anomaly.\n\nThe ventricles and sulci are moderately enlarged compatible with global\nparenchymal volume loss. Periventricular, deep, and subcortical white matter\nhypodensities are grossly unchanged, nonspecific but likely the sequelae of\nchronic small vessel ischemic disease.\n\nStatus post left and probably also right canal wall up mastoidectomy and left\ncochlear implant. Bilateral middle ear cavities are clear. There is moderate\npolypoid mucosal thickening in the right sphenoid sinus and mild aerosolized\nsecretions in the left sphenoid sinus. There is mild mucosal thickening in\nthe frontoethmoidal recesses.\n\nStatus post bilateral cataract surgery. Unchanged small hyperdense focus seen\nalong the lateral aspect of the posterior right globe.\n\nCTA NECK:\nThere is a 3 vessel aortic arch with mild calcified plaque at the origin of\nthe great vessels. There is mild calcified plaque at bilateral common carotid\nartery bifurcations, extending into the proximal internal and external carotid\narteries, without internal carotid stenosis by NASCET criteria. There is a\nfocus of calcified plaque at the right vertebral artery origin with mild\nassociated stenosis. Remaining cervical course of the right vertebral artery\nappears widely patent. There are small foci of calcified plaque in the V2 and\nV3 segments of the left vertebral artery without evidence for associated\nflow-limiting stenosis.\n\nCTA HEAD:\nThere is calcified plaque within bilateral carotid siphons without evidence\nfor flow-limiting stenosis. There is early branching of the M1 segment of the\nright middle cerebral artery. In addition, there is mild to moderate\nnarrowing of an inferior division branch, images 601:21, 302:25, presumably\natherosclerotic. There is diffuse irregularity of the A3 pericallosal left\nanterior cerebral artery with multifocal narrowing, up to moderate to severe\non image 601:19, most likely atherosclerotic.\n\nThere is mild calcified plaque of bilateral V4 segments of the vertebral\narteries without evidence for flow-limiting stenosis. Moderate calcifications\nare seen involving the bilateral cavernous internal carotid arteries. \nPosterior cerebral arteries demonstrate mild to moderate right and moderate to\nsevere left P2 segment narrowing, presumably atherosclerotic.\n\nThere is no evidence for an aneurysm. The dural venous sinuses are patent.\n\n\nOTHER:\nThe right thyroid lobe is enlarged with multiple nodules, which measure up to\n1.5 cm on image 3:101. No enlarged cervical lymph nodes by CT criteria. Mild\ndependent atelectasis in the included upper lungs. Mild mosaic attenuation\nwithin the included upper lungs may be secondary to incomplete expansion. \nUpper thoracic esophagus is distended and patulous, similar to the prior\nthoracic spine CT from ___. There are degenerative changes in the\ncervical spine.", + "output": "1. Head CT and CTA images are limited by beam hardening artifact from the left\ncochlear implant.\n2. No evidence for acute intracranial hemorrhage or acute major vascular\nterritorial infarction. MRI would be more sensitive for an acute infarction,\nif clinically warranted.\n3. Stable left frontal centrum semiovale calcified lesion, likely a cavernous\nmalformation, with an adjacent developmental venous anomaly.\n4. Mild cervical atherosclerosis without carotid stenosis by NASCET criteria\nor flow-limiting vertebral stenosis.\n5. Multifocal intracranial atherosclerosis, most extensive in the right MCA\ninferior division, left ACA 3 pericallosal branch, and left PCA P2 segment.\n6. The right thyroid lobe is enlarged with multiple nodules, up to 1.5 cm.\n7. Patulous upper thoracic esophagus, similar to prior.\n\nRECOMMENDATION(S): Thyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or ___, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "Noncontrast CT head: There is increased density in the left frontoparietal\nregion (series 2; image 24),, unchanged compared to ___,\npreviously characterized as cavernous malformation. Adjacent linear\nhyperdensity which extends superiorly to the vertex is also largely unchanged,\nlikely associated venous anomaly. Hardware from left-sided cochlear implant\nobscures the right middle and posterior cranial fossa is from streak artifact.\nNo suggestion of acute intracranial hemorrhage or large territorial\ninfarction.\n\nCTA head and neck: There is no high-grade stenosis, occlusion, or aneurysm of\nthe major vessels of the head and neck. A developmental venous anomaly is\nseen at the left parietal cortex adjacent to the calcification non 2D present\ncavernous malformation.\n\nCT perfusion: Cerebral blood flow less than 30%-0 mL; T-max greater than 6\nseconds volume-15 mL; total mismatch 15 mL\n\nNo concerning parenchymal consolidation or nodularity in the visualized lung\napices. There is heterogeneity of the right lobe of the thyroid gland, with\nnodule measuring up to 1.7 cm in size. Dedicated, nonemergent thyroid\nultrasound can be considered for further evaluation if not previously\nperformed. Note is also made of somewhat dilated esophagus.", + "output": "1. Unchanged appearance on head CT with calcification in the left\nfrontoparietal region representing cavernous malformation within adjacent\ndevelopmental venous anomaly.\n2. CT perfusion shows Cerebral blood flow less than 30%-0 mL; T-max greater\nthan 6 seconds volume-15 mL; total mismatch 15 mL\n3. No vascular occlusion or stenosis on CT angiography of the head neck." + }, + { + "input": "Exam is limited from streak artifact from left cochlear implant, particularly\nthe left hemisphere. However, within these limitations:\n\nA region of hypodensity extending from the right corona radiata and extending\ninto the posterior right basal ganglia/putamen is new compared to ___ and slightly worsened compared to ___, and likely represents\nan evolving acute infarction.\n\nThere is no evidence of intracranial hemorrhage or mass within limitations of\nthis noncontrast study.\n\nAgain demonstrated, is a 6 mm round hyperdensity in the left centrum semiovale\nwhich likely represents a cavernous malformation. A adjacent tubular\nhyperdensity extending superiorly from the hyperdensity likely represents an\nassociated developmental venous anomaly, unchanged.\n\nThe ventricles and sulci are unchanged in size and configuration. Left frontal\nperiventricular hypodensity likely represents chronic white matter\nmicroangiopathic changes (02:20), similar to ___.\n\nNo acute osseous abnormalities seen. There is mild mucosal thickening in the\nbilateral sphenoid sinuses. The remaining paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The orbits demonstrate no acute\nabnormalities.", + "output": "Right corona radiata/basal ganglia region of hypodensity likely represents an\nevolving acute infarction. No evidence of hemorrhagic transformation. MRI\nbrain may be considered for further evaluation of extent.\n\nRECOMMENDATION(S): MRI brain may be considered if clinically warranted\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 3:54 pm, 5 minutes\nafter discovery of the findings." + }, + { + "input": "There is no evidence of acute large territory infarction, hemorrhage, edema,\nor mass. The ventricles and sulci are normal in size and configuration.\n\nThere is a chronic left lamina papyracea defect. No acute osseous\nabnormalities seen. The paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\n\nMild mucosal thickening within bilateral maxillary sinuses. The remaining\nimaged paranasal sinuses are clear. Mastoid air cells and middle ear cavities\nare well aerated. The bony calvarium is intact. Chronic left lamina papyracea\ndefect again noted.", + "output": "No acute intracranial process." + }, + { + "input": "NON-ENHANCED HEAD CT:\nThe small left subdural fluid collection is unchanged since the outside\nhospital CT from ___. No new hemorrhage is seen. The ventricles and sulci\nare normal in size and configuration. The basal cisterns appear patent and\nthere is preservation of gray-white matter differentiation. No fracture is\nidentified. The visualized paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The globes are unremarkable.\n\nNECK CTA:\nThere is a normal 3 vessel arch, with mild atherosclerotic calcification. The\nbilateral vertebral arteries and common carotid arteries are widely patent\nwithout evidence of dissection or occlusion. There is no significant internal\ncarotid artery stenosis by NASCET criteria. Small calcified plaques at the\nbilateral internal carotid artery origins do not result in hemodynamically\nsignificant stenosis.\nThe distal cervical internal carotid arteries measure 4.5 mm on the right and\n4.3 mm on the left.\nThe cervical spine demonstrates mild multilevel degenerative change. The\nthyroid gland is unremarkable. No lymphadenopathy by CT size criteria. The\nvisualized lung apices are clear.\n\nHEAD CTA:\nThe intracranial internal carotid and vertebral arteries, and their major\nbranches, are patent without hemodynamically significant stenosis, dissection,\nor aneurysm. Incidentally noted is infundibular origin of the inferolateral\ntrunks of the C4 segments of the internal carotid arteries bilaterally.", + "output": "Small left hemispheric subdural fluid collection is unchanged.\n\nPatent head and neck vessels. No significant carotid stenosis by NASCET\ncriteria." + }, + { + "input": "There has been an interval decrease in the size of a acute on chronic subdural\nhematoma extending along the left parietal convexity, now measuring up to 5 mm\nin width (601b:80, previously 8 mm). There is no appreciable mass effect or\nshift of the midline structures. No additional foci of hemorrhage are\nidentified. As seen previously, the ventricles and sulci are somewhat\nprominent, suggestive of age-related involutional changes or atrophy. The\nbasal cisterns appear patent and gray-white matter differentiation is\npreserved.\n\nThe visualized bony structures are grossly unremarkable. The paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The globes are\nunremarkable.", + "output": "Interval decrease in size of a left parietal acute on chronic subdural\nhematoma. No evidence of interval new hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mild mucosal thickening in the\nethmoid air cells and right maxillary sinus. The visualized portion of the\nother paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\nThe visualized portion of the orbits are unremarkable. Adenoidal hypertrophy\nis likely within normal limits for this age group.", + "output": "No acute intracranial abnormality." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nPlease refer to subsequent brain MRI demonstrating an acute to early subacute\ninfarction within the left cerebral peduncle. Otherwise, no evidence of\ninfarction, hemorrhage. The ventricles are normal in size without midline\nshift. There is mild bilateral maxillary and ethmoid air cell sinus disease.\n\nCTA HEAD:\nThe left posterior communicating artery is not visualized. There is fetal\ncontinuation of the right posterior cerebral artery. There are mild vascular\ncalcifications of the cavernous and clinoid segments of bilateral internal\ncarotid arteries. Otherwise, there is no evidence of stenosis, occlusion, or\naneurysm formation.\n\nCTA NECK:\nThere is common origin of the brachiocephalic and left common carotid\narteries. There are noncalcified plaque of bilateral common carotid arteries.\nOtherwise, there is no stenosis, occlusion, or dissection. There is no\ninternal carotid artery stenosis by NASCET criteria. There are mild vascular\ncalcifications of the aortic arch.\n\nOTHER:\nThere is bibasilar dependent atelectasis. There is head debris within the\nesophageal lumen. There is no lymphadenopathy per size criteria. The thyroid\ngland appears unremarkable. Streak artifact related to dental amalgam limits\nevaluation of adjacent structures. There is right first premolar periapical\nlucency.", + "output": "1. No evidence of hemorrhage. Please refer to subsequent MRI demonstrating\nleft middle cerebral peduncle acute to early subacute infarction.\n2. No evidence of stenosis, occlusion, or aneurysm formation.\n3. Right first premolar dental ___." + }, + { + "input": "There is a hyperdense 2.5 by 1.6 cm likely enhancing lesion in the right\nfrontal cortex, with no significant edema or mass effect of the adjacent\nstructures. There is no evidence of acute infarction, or intracranial\nhemorrhage. The ventricles are normal in size and configuration. The major\nvascular structures enhance normally.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. 2.5 cm likely enhancing lesion in the right frontal lobe concerning for\nmalignancy/metastatic disease.\n\n2. There is no significant mass effect or shifting of the adjacent\nstructures.\n\nRECOMMENDATION(S): MRI of the head with and without contrast is a more\nsensitive examination to rule out intracranial metastatic disease." + }, + { + "input": "Patient is status post right frontal craniotomy for mass resection with\nexpected postsurgical changes, including small volume, anti-dependent\npneumocephalus and small volume hemorrhage within the margins of the resection\ncavity, for example (02:22).\n\nThere is no evidence of large territorial infarction, edema or midline shift. \nThe ventricles and sulci are age-appropriate.\n\nA small mucous retention cyst is seen in the right maxillary sinus. The\nvisualized portion of the other paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The imaged orbits are unremarkable.", + "output": "1. Status post right frontal craniotomy for mass resection with expected\npostsurgical changes, including small volume hemorrhage around the periphery\nof the resection cavity.\n2. No evidence of large territory infarction, edema or midline shift." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. \nPeriventricular white-matter hypodensities are nonspecific, but likely\nrepresent sequela of chronic microangiopathic disease. There is prominence of\nthe ventricles and sulci suggestive of involutional changes.\n\nThere are bilateral nasal bone fractures of indeterminate age (3:1). There is\nmild mucosal thickening in the bilateral sphenoid and maxillary sinuses and\nanterior ethmoid air cells. The visualized portion of the mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No evidence of acute intracranial abnormalities.\n2. Bilateral nasal bone fractures of indeterminate age (series 3, image 1).\n\nNOTIFICATION: The findings were discussed with MICU Blue Resident ___,\nM.D. on the telephone on ___ at 1:41 ___, 20 minutes after discovery of\nthe findings." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nThere is minimal mucosal thickening of bilateral maxillary sinuses. There is\npartial opacification of bilateral anterior ethmoid air cells. The remaining\nimaged paranasal sinuses are clear. Mastoid air cells and middle ear cavities\nare well aerated. The bony calvarium is intact.\n\nSoft tissue swelling overlying the left parieto-occipital scalp.", + "output": "Soft tissue swelling overlying the left parieto-occipital scalp.\nNo evidence of acute fracture or hemorrhage." + }, + { + "input": "No evidence of acute large territorial infarction. No intracranial\nhemorrhage, edema or mass. Dural thickening overlying the right parietal lobe\nis likely related to prior craniotomy (601:66). There is mild prominence of\nthe ventricles and sulci compatible with age advanced involutional change. \nPeriventricular and subcortical white matter hypodensities are nonspecific but\nlikely reflect the sequelae of chronic small vessel ischemic disease.\n\nPrior craniotomy is noted in the region of the right posterior parietal bone. \nNo acute displaced fracture. Mucous retention cysts in the left maxillary\nsinus. Paranasal sinuses, middle ear cavities and mastoid air cells are\notherwise unremarkable. Partially visualized orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Postsurgical changes in the right posterior parietal bone with associated\ndural thickening.\n3. Cerebral atrophy, advanced for age.\n4. Probable sequelae of chronic small vessel ischemic disease." + }, + { + "input": "There is no evidence of acute large territorial infarction, intracranial\nhemorrhage, edema, or mass.\n\nThere is prominence of the ventricles and sulci suggestive of age-related\ncerebral volume loss. Periventricular and subcortical white matter\nhypodensities are nonspecific, though likely sequelae of chronic small vessel\nischemic disease.\n\nNo acute osseous abnormalities seen. Small mucous retention cyst in the left\nmaxillary sinus. The remaining imaged paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The orbits demonstrate no acute\nabnormalities.", + "output": "No acute intracranial process within limitations of this noncontrast study. No\nevidence of acute intracranial hemorrhage or acute fracture." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nthere is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall configuration and size\nfor age. Basal cisterns are patent.\n\nA right frontal scalp hematoma is noted without underlying fracture. Small\nfluid levels are seen within the sphenoid and right maxillary sinuses. Mild\nmucosal thickening in the left maxillary sinus noted. The nasal bones appear\ngrossly well aligned. The nasal septum also appears grossly well aligned and\ncorrelation with concurrently performed CT facial bones is recommended. There\nis aerosolized fluid filling the nasopharynx. Mastoid air cells and middle\near cavities appear well aerated. The bony calvarium is intact.", + "output": "1. No acute intracranial process.\n2. Frontal scalp hematoma, no definite fracture.\n3. Fluid within the nasopharynx and within the sphenoid and right maxillary\nsinus, likely blood products given facial trauma. Please refer to same-day\nfacial bone CT for further details." + }, + { + "input": "There is no evidence of acute major territorial infarction, hemorrhage, edema,\nor large mass. The ventricles and sulci are are prominent, consistent with\nage.\n\nNo acute fracture is seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Basilar cisterns are\npatent.\n\nIncluded paranasal sinuses and mastoids are clear. Mild soft tissue swelling\nseen in the occipital region to the left of midline without discrete hematoma\nor underlying fracture.", + "output": "No acute intracranial process." + }, + { + "input": "Head CT: There is stable right frontal hypodensity likely representing\nsequela of remote prior infarct. Otherwise, there is no evidence of acute\ninfarct or intracranial hemorrhage. Sulci, ventricles and cisterns are within\nexpected limits given the degree of age-appropriate global cerebral volume\nloss. There are mild periventricular and subcortical white matter\nhypodensities, which are nonspecific, but commonly seen in setting of small\nvessel ischemic disease in a patient of this age. Atherosclerotic\ncalcification of the carotid siphons are noted. Incidental note is made of a\nmetopic suture. The paranasal sinuses are essentially clear. The orbits are\nunremarkable noting bilateral lens replacements. The mastoid air cells and\nmiddle ear cavities are well pneumatized and clear.\n\nHead CTA: Allowing for atherosclerotic calcifications, the intracranial ICA,\nACA, MCA and their major branches are unremarkable without evidence of large\nvessel occlusion or aneurysm. The left vertebral artery is dominant and there\nis fetal origin of the right PCA. Otherwise, the remainder the posterior\ncirculation is also unremarkable.\n\nNeck CTA: There is a 3 vessel arch. Ectasia of the ascending aorta is noted\nmeasuring up to 3.3 cm. Extensive atherosclerotic calcification of the aortic\narch and origins of the common carotid, subclavian and vertebral arteries are\nnoted without evidence of occlusion. Atherosclerotic calcification of the\ncarotid bifurcations is noted. The left cervical internal carotid artery 5 mm\ndistally and 6 mm proximally; there is no stenosis by NASCET criteria. The\nright cervical internal carotid artery measures 5 mm distally and 7 mm\nproximally; there is no stenosis by NASCET criteria.\n\nOther: Prominent right palatine tonsil tonsilliths are noted. Otherwise, the\nremainder of the aerodigestive tract is unremarkable. The thyroid gland is\nunremarkable. There is no cervical lymphadenopathy by CT size criteria. The\nmajor salivary glands are unremarkable. Mild biapical pleural-parenchymal\nscarring is noted with a 3 mm pulmonary nodule in the right lung apex (series\n5, image 97). In addition, there is biapical interlobular septal thickening\nextending to the pleura. This may represent mild pulmonary congestion.\nClinical correlation is recommended. Multilevel degenerative changes of the\ncervical spine is noted without suspicious blastic or lytic osseous lesions.", + "output": "1. Extensive atherosclerotic disease of the thoracic aorta, origins of the\ncommon carotid, vertebral and subclavian arteries as well as of the carotid\nsiphons are noted without evidence of large vessel occlusion. There is no\ndissection or intracranial aneurysm larger than 3 mm.\n2. Right frontal hypodensity is noted, compatible with subacute to chronic\ninfarct. Otherwise, no evidence of acute infarct.\n3. There is interlobular septal thickening of the visualized lung, much may\nrepresent mild pulmonary congestion. Clinical correlation is recommended.\n4. There is a small 3 mm pulmonary nodule in the right lung apex. If the\npatient has known risk factors such as smoking, no further followup is\nrecommended. If there are risk factors, a 12 month followup with CT chest is\nrecommended to document stability." + }, + { + "input": "There is no evidence of acute intracranial infarction,hemorrhage,edema,or mass\neffect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific, however likely due to chronic small vessel\nischemic disease in this age group. There is encephalomalacia of the left\nparieto-occipital lobe with ex vacuo dilatation of the lateral ventricle,\nunchanged from prior exam.\n\nThere is no evidence of acute fracture. Patient is status post left occipital\ncraniotomy with stable postsurgical changes. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "No acute intracranial abnormalities.\nStable post surgical changes from left occipital craniotomy and\nencephalomalacia of the left parieto-occipital lobe with ex-vacuo dilatation\nof the left lateral ventricle." + }, + { + "input": "There is no evidence of fracture, acute major infarction,hemorrhage,edema,or\nmidline shift. Bilateral basal ganglia calcifications are demonstrated. The\nventricles and sulci are prominent consistent with age-related involutional\nchange. Mild mucosal thickening of the ethmoid air cells. Otherwise, the\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are normal.", + "output": "No evidence of intracranial hemorrhage." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci prominent compatible with global volume loss.\n\nIncluded paranasal sinuses and mastoids are essentially clear. Skull and\nextracranial soft tissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "The study is moderately degraded by motion. Within these limitations, there\nis no evidence of acute territorial infarction, hemorrhage, edema, or mass\neffect. The ventricles and sulci are prominent consistent with age-related\ninvolutional change. Mild periventricular and subcortical white matter\nhypodensities are nonspecific, but likely represent sequela of chronic\nischemic microvascular disease.\n\nNo acute fractures are seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Prominent fat stranding is demonstrated in the soft tissue in the region of\nthe right lower face, inferior to the right parotid gland. There is\nassociated thickening of the right platysma and fat stranding posterior/deep\nto the right platysma. There is a mild amount of fat stranding that crosses\nthe midline into the left submental soft tissue. Associated bilateral\nprominent cervical lymph nodes are noted but not reactive lymph nodes are\nnoted but are not enlarged by CT size criteria or morphologically\nabnormal-appearing. No evidence of a drainable fluid collection. No soft\ntissue gas is seen. No radiopaque foreign body is demonstrated in the soft\ntissue. No evidence of an acute odontogenic process. The paranasal sinuses\nare clear. The visualized salivary glands are unremarkable, and no radioopaque\nsialolith is identified. No prevertebral soft tissue swelling or evidence of\nretropharyngeal the soft tissue swelling or fluid collection. The visualized\nneck vasculature appears patent. The thyroid gland is unremarkable. The\nincompletely visualized upper lungs are clear. Multi-level, mild degenerative\nchanges are noted in the cervical spine.", + "output": "Predominantly right-sided facial cellulitis as above - stranding also noted\ndeep to the right platysma. No soft tissue gas or drainable fluid collection." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of intracranial hemorrhage. There is no mass effect,\nhydrocephalus or shift of the normally midline structures. Gray-white matter\ndistinction appears preserved. Somewhat striking is a focal area of\nhypodensity in the left coronal radiata of the frontal lobe near the left body\nof the left lateral ventricle measuring about 1 cm. Elsewhere the brain is\nunremarkable. Surrounding soft tissues are unremarkable. There is no\nevidence fracture or bone destruction. There is a polypoid focus suggesting a\nmucous retention cyst in the sphenoid sinus. Visualized mastoid air cells and\nparanasal sinuses otherwise appear clear.", + "output": "Focal hypodensity of 1 cm in deep left frontal white matter. Although this\nmay be a small old infarct or focal area of chronic ischemic change (although\ndoubt is cast upon this possibility by an otherwise normal appearing brain),\ndifferential diagnosis includes subacute infarct or edema. However,\ndemyelination, focal neoplasm, or even possibly cerebritis are among\npossibilities.\n\nCorrelation with clinical findings is recommended. Findings are non-specific\nbut could be better assessed by MR imaging with gadolinium to refine the\ndifferential diagnosis." + }, + { + "input": "Motion artifact limits images through the skullbase, lower posterior fossa,\nand lower cerebrum. There is otherwise no evidence for acute intracranial\nhemorrhage, edema, mass effect, or acute major vascular territorial\ninfarction. Again seen is a chronic infarct in the left corona radiata. \nVentricles, sulci, and basal cisterns are age-appropriate. Cerebellar tonsils\nare normally positioned.\n\nNo evidence for a fracture or suspicious bone lesion. A left anterior ethmoid\nair cell is opacified. There is mucosal thickening within the other left\nanterior and posterior ethmoid air cells, as well as within the left\nfrontoethmoidal recess and inferior left frontal sinus. There is mild mucosal\nthickening in the right anterior ethmoid air cells and likely in the right\nfrontoethmoidal recess, with small mucous retention cyst in the inferior right\nfrontal sinus. There is mild mucosal thickening in the small mucous retention\ncyst in the right posterior ethmoid air cells. There is mild mucosal\nthickening in the partially visualized maxillary sinuses. There are mucous\nretention cysts within bilateral sphenoid sinuses. The sphenoid septum is\nthickened, which may represent sequela of chronic inflammation. Mastoid air\ncells appear grossly well-aerated allowing for motion artifact.", + "output": "1. Mildly motion limited exam. No evidence for acute intracranial\nabnormalities or mass effect.\n2. Paranasal sinus disease." + }, + { + "input": "There is no evidence of acute major infarction,hemorrhage,edema,or discrete\nmass. The ventricles and sulci are age-appropriate. Minimal periventricular\nwhite matter hypodensity is unchanged from prior and likely represents sequela\nfrom chronic microangiopathy.\n\nThere is no acute fracture. Mild thickening of the bilateral sphenoid\nsinuses, otherwise the visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "No acute intracranial findings." + }, + { + "input": "Bifrontal crescentic hypodensities along the frontal lobes are suspicious for\nsubdural hygromas. Otherwise, no evidence of acute intracranial hemorrhage\nterritorial infarction, edema,or mass. Periventricular and subcortical white\nmatter hypodensities are demonstrated, nonspecific but could represent sequela\nof chronic microangiopathy. There is prominence of the ventricles and sulci\nsuggestive of involutional changes.\n\nThere is no evidence of fracture. Mild mucosal thickening is noted in the\nright maxillary sinus. Otherwise, the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Bifrontal crescentic hypodensities along the frontal lobes are suspicious for\nsubdural hygromas. Otherwise, no acute intracranial findings.\n\nCOMMENTS ON ATTENDING REVIEW:\n\n1. Punctate hyperdensity over the left frontal operculum on images 2:16,\n601:23 almost certainly represents an artifact, given linear artifact crossing\nthe entire image at this level. Otherwise, no acute hemorrhage.\n2. Mild prominence of bifrontal extra-axial spaces may be secondary to the\nglobal parenchymal volume loss with commensurate prominence of the ventricles\nand sulci. However, small subdural collections may also be considered, either\nhygromas or chronic hematomas.\n3. Small chronic infarct in the right caudate head.\n4. Small amount of fluid in the right maxillary sinus. Mild mucosal\nthickening in the ethmoid air cells, frontoethmoidal recesses, and inferior\nfrontal sinuses.\n\nRECOMMENDATION(S): Repeated head CT for reassessment of the presumed artifact\nover the left frontal operculum.\n\nNOTIFICATION: The final interpretation and the recommendation above was\ndiscussed with ___ NP or PA, by ___, M.D. on\nthe telephone on ___ at 10:34 am, 5 minutes after discovery of the\nfindings.\n\nElectronic preliminary report by Dr. ___ was provided at approximately\n01:13 on ___." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. Chronic\ninfarct in the right caudate head is noted. There is prominence of the\nventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. Small amount of layering fluid is seen in\nthe right maxillary sinus, unchanged. Otherwise, the visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nThe visualized portion of the orbits are unremarkable.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "2.9 x 1.9 cm extra-axial CSF density area anterior to the left frontal lobe\nlikely reflects an arachnoid cyst which exerts minimal mass effect upon the\nadjacent frontal lobe. There is no acute large territorial infarction,\nintra-axial or extra-axial hemorrhage, or edema. There is no shift of\nnormally midline structures. Basal cisterns are patent is preservation\ngray-white matter differentiation.\n\nNo acute fracture identified. The imaged left maxillary sinus appears\ncompletely opacified. Remaining visualized paranasal sinuses, mastoid air\ncells and middle ear cavities are clear. Visualized portions of the orbits\nare unremarkable. Foci of soft tissue gas are noted in the right parotid\ngland without focal fluid collection. Mild soft tissue irregularity is noted\noverlying the right frontal bone.", + "output": "1. No acute intracranial hemorrhage.\n2. 2.9 x 1.9 cm left frontal extra-axial CSF density lesion compatible with\nan arachnoid cyst.\n3. Soft tissue gas in the region of the right parotid gland. Correlation\nwith site of any facial laceration is recommended as this could be tracking\nfrom that region. No associated fluid collection." + }, + { + "input": "There is no evidence of infarction,hemorrhage, or edema. There is prominence\nof the ventricles and sulci suggestive of involutional changes. \nPeriventricular white-matter hypodensities are nonspecific, but may be sequela\nof chronic ischemic small vessel disease. A 0.5 cm round calcific density\nposterior to the petrous portion of the left temporal bone (03:12) appears new\nsince the prior CT.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute hemorrhage or large territorial infarction.\n2. A 0.5 cm round calcification posterior to the petrous portion of the left\ntemporal bone, new since ___, and possibly a calcified meningioma or dural\nbased calcification." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute infarction, hemorrhage, or edema. Mild moderate\ngeneralized cerebral atrophy with ex vacuo dilatation of ventricular system.\nA 5 mm calcific density the left CP angle may represent a small partially\ncalcified meningioma or dural calcification.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\n2 to 3 mm superiorly projecting bulbous aneurysm arising from the mid M1\nsegment of the left MCA (series 2, image 233). The rest of the vessels of the\ncircle of ___ and their principal intracranial branches are patent without\nmarked stenosis, occlusion, or aneurysm formation. The slightly prominent\nparasagittal enhancing structure (series 2, image 266) is thought to represent\na venous structure. The dural venous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nMultiple bilateral pulmonary nodules noted the largest measuring 6 mm in\ndiameter in the left upper lobe (series 2, image 29). The visualized portion\nof the thyroid gland is within normal limits. There is no lymphadenopathy by\nCT size criteria.\n\nDiffuse tracheal wall thickening involving the posterior tracheal membrane. \nSoft tissue density is noted within the left external auditory canal, which\nmay represent cerumen. Bilateral ethmoid air cell mucosal thickening is\npresent.\n\nGrossly stable well-circumscribed right parietal and frontal calvarial lucent\nlesions are noted compared to ___ prior exam (2:307, 318 on current study and\n3:18,20 on ___ prior exam), which may represent hemangiomas or venous lakes.\n\nQuestion proximal 1.2 cm and is partially calcified thyroid isthmus nodule\nversus artifact (see 2:69; 601:27).\n\n Scattered subcentimeter nonspecific lymph nodes are noted throughout the neck\nbilaterally, without definite enlargement by CT size criteria.", + "output": "1. Study limited secondary to venous contamination.\n2. No acute intracranial infarct or hemorrhage. No mass.\n3. 2-3 mm superiorly projecting bulbous aneurysm arising from the mid M1\nsegment of the left MCA. If clinically indicated, consider neurosurgery\nconsult for further evaluation.\n4. 5 mm calcific density in the left CP angle may represent a small partially\ncalcified meningioma or a small dural calcification if clinically indicated,\nconsider contrast brain MRI for further evaluation.\n5. Multiple bilateral pulmonary nodules noted the largest measuring 6 mm in\ndiameter in the left upper lobe. Please see recommendation section below.\n6. Diffuse tracheal wall thickening involving the posterior tracheal membrane.\nInflammatory and less likely infective causes should be excluded. Pulmonology\nconsult advised.\n7. Minimal paranasal sinus disease, as described.\n8. Approximately 1.2 cm thyroid isthmus nodule versus artifact. Please see\nrecommendation below.\n9. Nonspecific subcentimeter cervical lymph nodes as described.\n\nRECOMMENDATION(S):\n1. For incidentally detected multiple solid pulmonary nodules measuring 6 to\n8mm, a CT follow-up in 3 to 6 months is recommended in a low-risk patient,\nwith an optional CT follow-up in 18 to 24 months. In a high-risk patient, both\na CT follow-up in 3 to 6 months and in 18 to 24 months is recommended.\n2. See the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___\n3. Fairly diffuse tracheal wall thickening involving the posterior tracheal\nmembrane. Inflammatory and less likely infective causes should be excluded.\nPulmonology consult advised.\n4. Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or older.\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 16:30 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, or acute major\nvascular territorial infarction. Periventricular and subcortical white matter\nhypodensities are nonspecific but likely sequela of chronic small vessel\nischemic disease, similar to prior. Age-related global parenchymal volume\nloss is again seen with prominent ventricles and sulci. 5 mm ossified\nmeningioma is again seen slightly anterior to the left internal auditory\ncanal, along the left petrous apex (image 3:13). Several small anterior\nparafalcine lipomas are again incidentally noted.\n\nThere is no evidence of fracture. There is mild mucosal thickening in the\nethmoid air cells. Mastoid air cells are well aerated. The orbits are\ngrossly unremarkable on noncontrast CT.", + "output": "No evidence for an acute intracranial abnormality or displaced calvarial\nfracture." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. There is redemonstration of right globus pallidus\ncalcification, a 5 mm calcified meningioma or dural calcification adjacent to\nthe left petrous apex, along with several tiny anterior parafalcine lipomas,\nunchanged in size or appearance from prior exam.\n\nThere is no evidence of fracture. There is mucosal thickening of the ethmoid\nair cells. Otherwise, the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nAgain noted is a parasagittal left frontal hematoma involving the corpus\ncallosum and demonstrating intraventricular extension with now more blood\nvisualized in the bilateral occipital horns and also in the fourth ventricle,\nnew from the prior outside CT and likely due to redistribution. There has\nbeen mild increase in size of the bilateral temporal horns, suggestive of\ndeveloping hydrocephalus. Scattered subarachnoid hemorrhage is also\nidentified along the high left frontal lobe, in the interpeduncular cistern as\nwell as in the right frontal lobe, sylvian fissure and along the right\nparieto-occipital region, new from the prior outside CT.\n\n There is mild generalized parenchymal volume loss, most likely age related.\n\nPeriventricular hypodensities are nonspecific but suggestive of chronic small\nvessel ischemic changes.\nAtherosclerotic changes along both V4 segments and cavernous ICAs are noted.\n\nThe paranasal sinuses and mastoid air cells appear clear.\n\n\nCTA HEAD:\n\nSeveral subcentimeter enhancing lesions at the gray-white matter junction are\nidentified in the left frontal lobe (series 3, image 253), in the right\nfrontal lobe (series 3, image 265) and in the parasagittal right parietal lobe\n(series 3, image 260), suspicious for intracranial metastatic disease.\n\nA small blush of contrast is seen along the anteromedial aspect of the\nhematoma (series 3, image 256 which could represent active extravasation.\n\nThere are extensive atherosclerotic changes along both cavernous ICAs. There\nis a focal moderate to severe stenosis at the left ICA communicating segment. \nThe anterior circulation appears otherwise unremarkable without evidence of\ndissection, occlusion or aneurysm formation greater than 3 mm.\n\nThere are circumferential atherosclerotic changes along the left V4 segment\nresulting in severe stenosis. Note is made of bilateral posterior\ncommunicating arteries, normal anatomic variant. The remainder of the\nposterior circulation appears otherwise unremarkable.\n\nCTA NECK:\nThere are atherosclerotic changes at both carotid bifurcations but without\nevidence of internal carotid stenosis by NASCET criteria. There is remodeling\nof the mid cervical left vertebral artery in the transverse foramen secondary\nto hypertrophic degenerative changes (series 3, image 118). The\ncarotidandvertebral arteries and their major branches appear otherwise\nunremarkable with no evidence of stenosis or occlusion.\n\nOTHER:\nMultiple left upper lobe pulmonary nodules measuring up to 8 mm which likely\nrepresents metastasis. A 1.8 cm round enhancing supraclavicular midline mass\nlikely represents lymphadenopathy series 3, image 67). There is an additional\nleft supraclavicular lymphadenopathy (series 3, image 50 and 63).\n\nA 2.5 x 1.8 cm mass in the left retropharyngeal/prevertebral space likely\nrepresents necrotic lymphadenopathy (series 3, image 102).\n\nThere is a large enhancing mass centered around the C6 vertebral body with\nextension into the spinal canal/neural foramina (series 3, image 131) and\nassociated osseous destruction of adjacent structures series 3, image 98). \nFor example, there is osseous destruction of the left fourth, fifth, sixth and\nseventh transverse processes series) 3, image 102 and 103).", + "output": "1. Unchanged parasagittal left frontal hematoma involving the corpus callosum\nand demonstrating intraventricular extension, now with more blood visualized\nin the bilateral occipital horns an in the fourth ventricle, new from the\nprior outside CT and likely due to redistribution.\n2. Mild increase in size of the bilateral temporal horns, suggestive of\ndeveloping hydrocephalus.\n3. Scattered subarachnoid hemorrhage in the left frontal lobe, interval the\nocular system in, right frontal lobe, right sylvian fissure and right\nparieto-occipital region, new from the prior outside CT.\n4. Small contrast blush along the anteromedial aspect of the hematoma could\nrepresent extra of extravasation.\n5. Subcentimeter enhancing intraparenchymal lesions, suspicious for\nintracranial metastatic lesions.\n6. Large destructive osseous lesion in the C6 vertebral body with suggestion\nof extension into the spinal canal/neural foramina, suspicious for osseous\nmetastatic disease. Additional lytic osseous lesions in the left fourth\nthrough seventh transverse processes.\n7. Left upper lobe pulmonary nodules, suspicious for metastatic disease.\n\nRECOMMENDATION(S): Neurosurgical consultation." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Normal study." + }, + { + "input": "There is no evidence of large territory infarction, hemorrhage, edema, or mass\neffect. The ventricles and sulci are normal in size and configuration. There\nis no acute fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Please note that MRI is more sensitive for the evaluation of masses than\nCT." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. There is preservation of\ngray-white matter differentiation. The basal cisterns remain patent.\n\nNo osseous abnormalities seen. Vascular calcifications are seen bilateral\ncavernous carotid and bilateral vertebral arteries. The paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "No evidence for acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nA right thalamic intraparenchymal hemorrhage measures approximately 2.2 x 1.1\ncm. Mild effacement of the right lateral ventricle. The basal cisterns are\npatent. A left posterior precentral gyrus infarct is likely chronic, but new\nfrom the head CT of ___.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n===\n\nAtherosclerotic calcification of the bilateral proximal internal carotid\narteries, without high-grade stenosis.. Atherosclerotic calcification of the\nright V3 segment, causing probable mild narrowing. Mild atherosclerotic plaque\nin the right V4 segment.\n\n\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. Multiple periapical lucencies in the\nmaxilla and mandible. Numerous upper mediastinal lymph nodes, previously seen\non the chest CT from ___, and not enlarged by CT size criteria.", + "output": "1. Right thalamic hemorrhage. No underlying vascular malformation or adjacent\ndevelopmental venous anomaly is identified. Deep venous system is patent.\n2. Mild atherosclerotic disease otherwise patent cervical and intracranial\nvasculature without stenosis occlusion or aneurysm greater than 3 mm in size.\n3. Other findings as described above." + }, + { + "input": "Again noted is parenchymal hemorrhage in the right thalamus measuring 1.1 x\n2.2 cm (series 2:21), unchanged from CTA head and neck ___ 13:07. \nThere is intraventricular extension with a small amount of hemorrhage in the\noccipital horn of the left lateral ventricle, unchanged. There is no evidence\nof new or worsening hemorrhage. Ventricles are unchanged in size. Again\nnoted is a chronic infarction in the left precentral gyrus.\n\nThere is mild mucosal thickening in the bilateral anterior ethmoid air cells. \nRemaining paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "1. Stable right thalamic intraparenchymal hemorrhage with intraventricular\nextension into the occipital horn of the left lateral ventricle.\n2. No new or worsening hemorrhage.\n3. Chronic infarction of the left precentral gyrus." + }, + { + "input": "Again seen is the intraparenchymal hemorrhage centered in the right thalamus\nwhich appears slightly more prominent there to CT from ___ but\ngrossly unchanged compared to MR from ___ given modality\ndifference. Small amount of layering blood in the occipital horn of the left\nlateral ventricle is grossly unchanged. 1-2 mm leftward midline shift is\nunchanged. Effacement of the right lateral ventricle is also unchanged. No\nnew intracranial hemorrhage. There is no evidence of large territorial\ninfarction or mass.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Right thalamic intraparenchymal hemorrhage, unchanged compared to MR from\n___ given modality difference but slightly more prominent compared\nto CT from ___. Unchanged blood in the occipital horn of the left\nlateral ventricle. No new hemorrhage.\n2. Stable mass effect from the right thalamic intraparenchymal hemorrhage\nincluding 1-2 mm leftward midline shift and effacement of the right lateral\nventricle.\n3. Additional findings described above." + }, + { + "input": "There is no evidence of acute large territory infarction,\nintracranialhemorrhage,edema,or discrete mass. The ventricles and sulci are\nnormal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass, mass effect, or large\nvascular territory infarction. The ventricles and sulci are slightly more\nprominent than in the prior exam from ___, consistent with age-related volume\nloss. There are subtle mild periventricular confluent white matter\nhypodensities, consistent with chronic small vessel ischemic disease. The\nbasal cisterns are patent. Calcifications are noted along the cavernous\nportions of the bilateral carotid arteries.\n\nNo fracture is identified. The visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass. The ventricles and sulci are prominent, consistent with age related\nvolume loss. Periventricular white matter hypodensities are consistent with\nchronic small vessel ischemic disease. Dense calcifications of the bilateral\ncavernous segments of the internal carotid arteries are noted. The left\nvertebral artery is ectactic and calcified.\n\nA small frontal sclerotic bone island is stable since ___ (3:26). \nOtherwise, no osseous abnormalities seen. The paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial hemorrhage." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is an 11 mm rounded intraparenchymal hemorrhage centered in the\nposterior limb of the right internal capsule (03:20). There is minimal\nassociated mass effect, with mild surrounding vasogenic edema. No other focus\nof hemorrhage is seen.\n\nThere is no evidence of acute large territorial infarct, or mass. There is\nmoderate prominence of the ventricles and sulci suggestive of involutional\nchange. Scattered areas of periventricular, subcortical and deep white matter\nhypodensities are in a configuration most suggestive of chronic small vessel\nischemic disease.\n\nThere is trace mucosal wall thickening in the bilateral frontoethmoidal\nrecesses and floor of the left maxillary sinus. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are otherwise\nclear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere are mild concentric atherosclerotic calcifications of the bilateral\nintracranial internal carotid arteries, without significant narrowing. There\nis diffuse dolichoectasia of the central circle of ___ vasculature, which\ncan be seen in the setting of chronic hypertension. There is a left dominant\nvertebrobasilar system with hypoplastic V4 segment of the right vertebral\nartery. There is normal variant fetal type origin of the left posterior\ncerebral artery. There is punctate atherosclerotic calcification of the mid\nM1 segment of the right MCA without significant narrowing. The vessels of the\ncircle of ___ and their principal intracranial branches appear patent\nwithout significant stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThere are mild atherosclerotic calcifications of a variant 2 vessel aortic\narch. There is mild atherosclerotic calcification at the origins of the\nbilateral vertebral arteries without significant narrowing. The right\nvertebral artery appears hypoplastic, congenital. There are mild calcified\nand noncalcified atherosclerotic plaques along the bilateral carotid\nbifurcations without internal carotid artery stenosis by NASCET criteria. The\ncarotid and vertebral arteries and their major branches otherwise appear\npatent with no evidence of dissection, stenosis or occlusion. There is no\nevidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. Scattered mediastinal lymph\nnodes are mildly prominent, though not enlarged by size criterion. The\nesophagus appears distended, with some areas of layering fluid, with mild\nprominence of the esophageal wall. The visualized portion of the thyroid\ngland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. 11 mm intraparenchymal hemorrhage centered in the posterior limb of the\nright internal capsule is likely hypertensive. No other hemorrhage or acute\nlarge vascular territorial infarct.\n2. Patent intracranial arterial vasculature without significant stenosis,\nocclusion, or aneurysm.\n3. Patent cervical arterial vasculature without significant stenosis,\nocclusion, or dissection.\n4. Dolichoectatic central circle of ___ vasculature, which can be seen in\nthe setting of chronic hypertension.\n5. Distended esophagus with fluid levels and suggestion of wall thickening,\nsuggestive of esophageal motility dysfunction.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\n___ on the telephone on ___ at 5:54 pm, 5 minutes after discovery of\nthe findings." + }, + { + "input": "There is a 2.2 x 1.5 cm intraparenchymal hemorrhage with mild surrounding\nedema centered in the posterior limb of the right internal capsule, abutting\nthe right thalamus, slightly increased in size compared to the prior study. \nThere is mild mass effect without midline shift. Extensive vascular\ncalcifications of the bilateral carotid siphons and bilateral middle cerebral\narteries are noted. Periventricular white matter hypodensities are\nnonspecific, but likely reflect sequelae of chronic small vessel ischemic\ndisease. Prominence of the ventricles and sulci suggest involutional changes.\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "Mildly increased size of a right-sided intraparenchymal hemorrhage centered at\nthe level of the posterior limb of the internal capsule. No new site of\nhemorrhage." + }, + { + "input": "Compared to the prior exam from ___, there has been no significant\ninterval change in the size of the 1.7 x 1.6 cm intraparenchymal hemorrhage\nwith mild surrounding edema centered within the posterior limb of the right\ninternal capsule abutting the right thalamus. The extent of local mass effect\nis unchanged compared to the prior exam. There does appear to be slight\ninterval improvement in the density of the hemorrhage.\n\nProminence of the ventricles and sulci is likely related to age related\ninvolutional changes. Extensive vascular calcifications are seen within the\nsiphons. The visualized paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The globes are unremarkable.", + "output": "No significant interval change in the size of the 1.7 cm right-sided\nintraparenchymal hemorrhage centered at the level of the posterior limb of the\ninternal capsule/thalamus, with surrounding vasogenic edema. There may be\nslight interval improvement in the density of the hemorrhage consistent with\nappropriate evolutionary changes.\n\nNo new hemorrhage identified." + }, + { + "input": "There is improved subarachnoid blood with appropriate interval evolution. New\nintraventricular hemorrhage within the posterior horns of the lateral\nventricle. Small scalp hematoma is also intervally decreased compared to\n___. No new intraparenchymal blood.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "Overall improved subarachnoid hemorrhage with residual acute to subacute blood\nproducts. New intraventricular hemorrhage within the occipital horns of the\nlateral ventricle is likely secondary to redistribution of hemorrhage." + }, + { + "input": "Interval evolution of known subarachnoid blood is noted, less conspicuous than\nprior study. Unchanged appearance in small amount of intraventricular blood\nin the bilateral occipital horns of the lateral ventricles. No evidence of\nnew hemorrhage.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Bilateral lens\nreplacements are noted. Evolving left frontotemporal scalp subgaleal\nhematoma.\n\nLeft occipital calvarial osteoma is again noted (see 02:12).", + "output": "1. Interval evolution of known subarachnoid blood, less conspicuous compared\nto most recent prior exam.\n2. Small posterior horn intraventricular blood seen stable.\n3. No areas of new hemorrhage.\n4. Evolving left frontotemporal scalp subgaleal hematoma.\n5. Left occipital calvarial osteoma." + }, + { + "input": "Evaluation is mildly limited by streak artifact. There is no evidence of\ninfarction, hemorrhage, edema, or mass. The ventricles and sulci are normal in\nsize and configuration.\n\nThere is fracture of the frontal process left maxilla, there is mild\nassociated nasal soft tissue swelling, clinically correlate whether this is\nacute fracture. There is incomplete fusion of posterior C1 arch. The\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\norbits are unremarkable. There is mild scalp soft tissue swelling overlying\nthe left parietal calvarium.", + "output": "Intracranial contents are normal.\nThere is mild left parietal scalp soft tissue swelling.\nThere is fracture of the frontal process left maxilla, there is mild\nassociated nasal soft tissue swelling, clinically correlate whether this is\nacute fracture." + }, + { + "input": "There is no evidence of fracture, acute territorial\ninfarction,hemorrhage,edema,or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes.\n\nThere is trace amount of fluid in the right maxillary sinus. Otherwise, the\nvisualized portion of the remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nnormal apart from bilateral lens replacements.", + "output": "No acute intracranial abnormality." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nA large right parieto-occipital hematoma measures approximately 5.6 cm TRV by\n3.1 cm AP by at least 6.7 cm CC with moderate surrounding edema resulting in\nlocal mass effect as well as local sulcal effacement, effacement of the\noccipital horn of the right lateral ventricle and midline shift to the left of\napproximately 5 mm. Additional subdural hematoma is seen layering along the\nfalx and right tentorium. Additional periventricular deep subcortical white\nmatter hypodensities are nonspecific however may be secondary to chronic\nmicroangiopathy. The ventricles and sulci appear to be age-appropriate. A\nmucous retention cyst is seen involving the left maxillary sinus. Mild\nmucosal sinus thickening seen involving the ethmoid air cells. The remainder\nthe visualized paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The globes are unremarkable.\n\nCTA HEAD:\nThe vertebral arteries bilaterally are normal. The basilar artery is normal. \nNote is made of a fetal type configuration of the left PCA. The right\nposterior cerebral artery is normal. The left internal carotid artery\ndemonstrates moderate atherosclerotic disease along the cavernous segment. \nThe left IC is otherwise unremarkable. The left middle cerebral artery is\nnormal. There is normal arborization of the distal left MCA vessels. The\nright internal carotid artery is normal. Moderate atherosclerotic disease is\nseen within the cavernous segment of the right internal carotid artery. The\nright middle cerebral artery is normal. There is normal arborization of the\ndistal right MCA vessels. The anterior cerebral artery and anterior\ncommunicating arteries are normal. Dural venous sinuses are patent.\n\nCTA NECK:\nModerate atherosclerotic disease is seen at the aortic arch. The right common\ncarotid and internal carotid arteries are normal without evidence of internal\ncarotid artery stenosis by NASCET criteria. The left common carotid and\ninternal carotid artery are normal without evidence of internal carotid artery\nstenosis by NASCET criteria. The left vertebral artery is normal. The right\nvertebral artery is normal.\n\nOTHER:\nThe visualized apices of the lungs are clear. The thyroid is normal. There\nis no cervical lymphadenopathy.", + "output": "1. Large right parieto-occipital 6.7 cm hematoma is seen with extensive\nsurrounding vasogenic edema and local mass effect, with midline shift to the\nleft of approximately 5 mm. There is extension of the hematoma to the\nsubdural space along the falx and right tentorium.\n2. Unremarkable CTA of the head without evidence of aneurysm or severe\nstenosis. Moderate intracranial atherosclerotic disease.\n3. No evidence of internal carotid artery stenosis by NASCET criteria." + }, + { + "input": "An approximately 5.8 x 7.0 x 4.0 cm hemorrhagic infarct involving the right\nparieto-occipital lobe with mild-to-moderate surrounding edema results in\nlocal mass effect, similar appearance compared to the prior study. Hyperdense\nthickening along the right tentorium and along the falx compatible with\nsubdural hemorrhage, similar in appearance compared to the prior study. There\nis 5 mm midline shift and effacement of the occipital horn of the lateral\nventricle. There is sulcal effacement along the right cerebral convexity. \nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "1. Large hemorrhagic infarct involving the right parieto-occipital lobe with\nmild-to-moderate surrounding edema results in mild midline shift, effacement\nof the occipital horn of the right lateral ventricle, and sulcal effacement\nalong the right cerebral convexity. Findings are similar to the prior study.\n2. Hyperdense thickening along the right tentorium and along the falx\ncompatible with subdural hemorrhage, similar in appearance compared to the\nprior study." + }, + { + "input": "Study is limited by motion degradation.\n\nThere is a large focus of intraparenchymal hemorrhage in the right\nparieto-occipital region with surrounding vasogenic edema. There is blood\nlayering upon the right tentorial leaflet. This is grossly unchanged as\ncompared to MRI head ___ and CT head ___. There is mass\neffect with partial effacement of the occipital horn of the right lateral\nventricle, unchanged. There is no new or worsening intracranial hemorrhage. \nVentricles and sulci are unchanged in appearance from ___.\n\nWithin the limitations of motion degradation, the paranasal paranasal sinuses\nare clear. Mastoid air cells and middle ear cavities are well aerated. The\nbony calvarium is intact.", + "output": "Study is limited by motion degradation.\n\nIntraparenchymal hemorrhage in the right parietal occipital region with\nsurrounding vasogenic edema is unchanged as compared to MRI head ___\nand CT head ___. No definite evidence of new or worsening\nintracranial hemorrhage." + }, + { + "input": "The study is mildly motion degraded. There is no evidence of acute large\nterritorial infarction,hemorrhage,edema,or discrete mass. Encephalomalacia of\nthe right insular cortex extending into the parietal lobe probably reflecting\na chronic infarct is unchanged. The ventricles and sulci are normal in size\nand configuration.There is no evidence of fracture. The visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nThe visualized portion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "NECT: No intracranial hemorrhage is identified. There is an area of\nhypodensity in the left occipital lobe which is well-defined, consistent with\nsubacute infarct. Hypodensity seen on the right occipital lobe is likely a\nprominent fissure. Old lacunar infarct is noted in the right thalamus.\n\nCTA neck:\nThere is an ulcerated hypodense noncalcified plaque in the left internal\ncarotid origin suggesting lipid rich plaque at this location. There is 40%\nnarrowing at this location by NASCET criteria. There is a narrowing at the\nright internal carotid origin secondary to atherosclerotic plaque without\nstenosis by NASCET criteria.\nThere is a questionable left vertebral artery stenosis at the origin,\nconspicuous in the coronal and sagittal reformats but not apparent in the\naxial source image. Bilateral internal carotid arteries course posterior to\nthe pharynx.\n\nCTA head:\nThere is intraluminal filling defect in the basilar artery concerning for\ndissection.\nP1 segment of the left PCA shows proximal narrowing and irregularity, also\nconcerning for thrombus.\nThere is severe narrowing of the distal petrous and cavernous portion of the\nleft internal carotid artery.\n\nThyroid is enlarged and inhomogeneous, and a cyst is identified in the right\nthyroid lobe.\n\nCTP: Increased MTT and decreased CBV & CBF of the area of interest in the left\noccipital lobe consistent with subacute infarct.", + "output": "1. Subacute infarct is identified in the left occipital lobe.\n\n2. There is intraluminal filling defect in the basilar artery concerning for\ndissection.\n\n3. P1 segment of the left PCA shows proximal narrowing and irregularity\nconcerning for thrombus.\n\n4. There is an ulcerated noncalcified plaque in the left internal carotid\norigin causing 40% stenosis by NASCET criteria.\n\n5. Thyroid is enlarged and inhomogeneous, and a cyst is identified in the\nright thyroid lobe. If clinically indicated, further evaluation with\nultrasound may be helpful." + }, + { + "input": "Evolving infarction in the left PCA distribution appears more hypodense. There\nis a tiny chronic appearing lacune in the right thalamus. There is no sign of\nacute major vascular territorial infarction. No hemorrhage, mass effect or\nedema. The ventricles are normal in size and configuration. The basal\ncisterns appear patent.\n\nThe visualized bony structures are grossly unremarkable. The paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.\n\nAtherosclerotic mural calcification of the cavernous internal carotid arteries\nis noted. The globes are unremarkable.", + "output": "Chronic left PCA infarct and old right thalamic lacune. No acute intracranial\nprocess." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The patient is status post bilateral cataract surgery.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nare patent without stenosis, occlusion, or aneurysm formation. There are mild\natherosclerotic calcifications of the bilateral cavernous and internal carotid\narteries. The right A1 segment is not visualized and may be hypoplastic or\nabsent. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is a normal 3 vessel branching pattern, with ectatic aortic arch. There\nare mild atherosclerotic calcifications of the bilateral carotid bifurcations.\nThe carotid and vertebral arteries and their major branches are patent with no\nevidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Patent circle of ___.\n2. Patent vasculature in the neck with no evidence of internal carotid artery\nstenosis by NASCET criteria.\n3. No acute intracranial abnormality." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or mass\neffect. The ventricles and sulci are mildly prominent, consistent with\ninvolutional change.\n\nThere is no evidence of acute fracture. There is mild mucosal thickening the\nbilateral anterior ethmoid air cells. Mucous retention cyst is noted in the\nmedial aspect of the right maxillary sinus. The visualized portion of the\nremaining paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute large territory infarction,hemorrhage,edema, or\nmass effect. Periventricular and subcortical white matter hypodensities are\nnonspecific, but likely reflect sequelae of chronic small vessel ischemic\ndisease. 7 mm rounded hypodensity in the right thalamus most likely\nrepresents a lacunar infarct. Atherosclerotic vascular calcifications of the\ncavernous internal carotid arteries and bilateral V4 vertebral artery segments\nis noted. There is mild prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of acute fracture. Mild anterior ethmoid air cell\nmucosal thickening is noted. There partial opacification of the left mastoid\nair cells. The visualized portion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Atherosclerotic\ncalcifications are noted within the intracranial ICAs and vertebral arteries.\n\nThere is mucosal thickening in the ethmoid air cells and left sphenoid sinus. \nIncluded paranasal sinuses and right mastoids are otherwise essentially clear.\nThere is opacification of left mastoid tip as seen previously. There is right\nperiorbital soft tissue swelling without underlying fracture.", + "output": "Right periorbital soft tissue swelling without underlying fracture or acute\nintracranial hemorrhage." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. There is mild prominence of the ventricles and sulci suggestive of\ninvolutional changes. Mild periventricular and subcortical white matter\nhypodensities, nonspecific but compatible with sequelae of chronic small\nvessel ischemic disease.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nbilateral maxillary sinuses, right maxillary sinus mucous retention cysts, and\npartial opacification of the left mastoid air cells. Otherwise, the\nvisualized portion of the paranasal sinuses and middle ear cavities are clear.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Mild mucosal thickening of the left ethmoid\nair cells and maxillary sinus. Otherwise, the visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable. A 1.7 x 0.6 cm lipoma\noverlying the left temporoparietal calvarium is again seen.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,or\nmass effect. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nanterior ethmoid air cells and partial opacification of the right sphenoid\nsinus. Otherwise, the visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nintracranial hemorrhage.\n2. No acute displaced calvarial fracture." + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass. There is prominence of the ventricles and sulci for patient of this\nage. A prominent perivascular space is again noted within the right basal\nganglia.\n\nThere is no acute fracture. There is opacification of a single right ethmoid\nair cell on the right. Otherwise, the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of intracranial hemorrhage.\n2. Age advanced involutional changes." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nScattered areas of mainly subcortical white matter hypodensity, most prominent\nin the bifrontal and bilateral occipital lobes appears 7 improved compared to\n___, given difference in technique.\n\nThere is no evidence of infarction, hemorrhage, increasing edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is opacification of 2 anterior right ethmoid air cells. The remainder\nof the visualized portion of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.\n\nCTA HEAD:\nThere is a punctate atherosclerotic calcification in the ophthalmic segment of\nthe left internal carotid artery. Anterior communicating artery is noted with\nan infundibular origin on the left. There is also an infundibular origin of\nthe left posterior communicating artery. The vessels of the circle of ___\nand their principal intracranial branches appear patent with no evidence of\nluminal irregularity, stenosis, occlusion, or aneurysm. The dural venous\nsinuses are patent.\n\nA moderate left-sided pleural effusion is seen on the smart prep series.", + "output": "1. Improving subcortical white matter hypodensity as compared to the MR\nexamination from ___.\n2. No territorial infarct or hemorrhage.\n3. Patent intracranial vasculature without stenosis, occlusion or aneurysm. \nIncidental left posterior communicating artery infundibulum.\n4. Moderate left-sided pleural effusion." + }, + { + "input": "There are postsurgical changes from left suboccipital craniotomy and resection\nof the mass centered in the left cerebellar hemisphere. There is expected\npneumocephalus and postoperative blood products within the resection bed. The\nright cerebellar lesion is stable in appearance. Vasogenic edema in the\nbilateral cerebellar hemispheres is overall unchanged and results in\neffacement of the fourth ventricle.\n\nThere is no evidence of acute territorial infarction or unexpected\nintracranial hemorrhage. Mild hypodensities in the periventricular and\npontine white matter are nonspecific but most likely represent chronic\nmicroangiopathic changes.\n\nThe ventricles are stable in size without evidence of hydrocephalus.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.\n\nNo calvarial fracture is identified. The extracranial soft tissues are\nunremarkable.", + "output": "1. Postsurgical changes from left suboccipital craniotomy and resection of\nthe left cerebellar mass. No evidence of unexpected intracranial hemorrhage or\nacute complication.\n2. Unchanged right cerebellar lesion, vasogenic edema in the bilateral\ncerebellar hemispheres, and effacement of the fourth ventricle.\n3. Stable ventricular size without evidence of hydrocephalus." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. There is mild prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture. Minimal mucosal secretions are seen in the\nposterior right ethmoid air cells. Fluid is seen in several bilateral mastoid\nair cells. There is increased sclerosis of the left mastoid air cells. There\nis partial opacification of the bilateral middle ear cavities. The visualized\nportion of the remaining paranasal sinuses are clear. The visualized portion\nof the orbits show evidence of bilateral lens replacement.", + "output": "1. No acute intracranial process.\n2. Partial opacification of the middle ear cavities and bilateral mastoid air\ncells is likely chronic." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, acute\nmass effect, or acute large vascular territorial infarct. However, in the\nleft frontoparietal region, there is a well circumscribed, heterogeneously\nhyperdense, partially calcified 4.4 x 3.8 x 3.5 cm extra-axial mass which\nappears to originate from the dura and demonstrates mass effect on the left\nfrontal lobe (2:28, 602b:56). No midline shift or cerebral edema is seen. No\nadjacent, associated cortical destruction is identified. There is no evidence\nof downward herniation.\n\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. There is preservation of of gray-white matter differentiation. The\nbasal cisterns remain patent.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "1. No evidence of acute intracranial hemorrhage.\n2. 4.4 x 3.8 x 3.5 cm left frontal parietal heterogeneously hyperdense, likely\npartially calcified extra-axial mass, with some mass effect on the adjacent\nleft frontal lobe. No midline shift or cerebral edema seen. Findings are\nstatistically most likely to represent a meningioma." + }, + { + "input": "Head CT demonstrates a calcified left parasagittal mass measuring 4.5 x 4 cm\nin approximate size adjacent to the left side of the falx. Mild mass effect\nis seen on the adjacent brain. There is no hydrocephalus or midline shift.\n\nCT venography of the head demonstrates normal flow in the superior sagittal\nsinus adjacent to the meningioma which appears attached to the left side of\nthe sinus wall. No evidence of stenosis of the sinus seen at this level. The\nsuperior sagittal sinus remains patent. The transverse sinuses are also\npatent.", + "output": "1. 4.5 x 4 cm left parasagittal meningioma attached to the left side of the\nsuperior sagittal sinus.\n2. The superior sagittal sinus is patent and demonstrate no significant\nnarrowing adjacent to the meningioma.\n3. The remaining dural sinuses are patent without stenosis or occlusion or\nevidence of thrombosis." + }, + { + "input": "Patient is status post left frontal craniotomy for resection of high left\nparamedian meningioma with postsurgical changes visualized in the resection\nbed including mixed density subdural blood products and pneumocephalus. This\nresults in mass effect on the anterior horns of the lateral ventricles\nbilaterally. Small foci subarachnoid hemorrhage are visualized at the vertex.\nThe basal cisterns are patent. No appreciable midline shift is identified. \nThere is no evidence of infarction. The ventricles and sulci are otherwise\nnormal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Patient is status post left frontal craniotomy for resection of high left\nparamedian meningioma with postsurgical changes including mixed density\nsubdural blood products and pneumocephalus visualized, as well as small foci\nof subarachnoid hemorrhage at the vertex." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Mildly\nprominent ventricles and sulci is compatible with age related involutional\nchanges. The basal cisterns appear patent and there is preservation of\ngray-white matter differentiation.\n\nNo osseous abnormalities seen. There is mucosal thickening in the left\nmaxillary sinus and the bilateral ethmoid air cells. The remaining paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable. Atherosclerotic calcifications of the carotid siphons are\nnoted.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is right periorbital soft tissue swelling. There is a comminuted\nbilateral displaced nasal bone fracture and nasal septal fracture (3:12, 14). \nThere is mucosal thickening in the bilateral maxillary sinuses, left sphenoid\nsinus, and ethmoid air cells. The visualized portion of the mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. Bilateral comminuted displaced nasal bone fractures and nasal septal\nfracture with overlying soft tissue swelling.\n2. No acute intracranial hemorrhage.\n3. Right frontal supraorbital scalp soft tissue swelling with subcutaneous\nemphysema and laceration.\n4. Paranasal sinus disease as described." + }, + { + "input": "Mild mucosal thickening of the right maxillary sinus and anterior ethmoidal\nair cells, with moderate mucosal thickening of the left maxillary sinus and\nleft sphenoid sinus. Again seen is complete erosion of the left maxillary\nsinus floor, unchanged since ___. The paranasal sinuses are\notherwise normally aerated, with no mucosal thickening or air-fluid levels\nidentified. The ostiomeatal units are patent. The cribriform plates are\nintact. The lamina papyracea are intact. The nasal septum is markedly\ndeviated to the left. Small amount of oropharyngeal secretions are again\nnoted. Small amount of soft tissue within bilateral external auditory canals\nis consistent with cerumen. Calcification of the cavernous portions of the\ninternal carotid arteries are noted.\n\nNo interval change in nonspecific partially visualized right cervical soft\ntissue density with surgical clips most consistent with patient's known right\nparapharyngeal carcinoma resection (4:1).\n\nChronic mildly displaced comminuted bilateral nasal bone fractures are\npresent. No acute fracture. No focal lytic or blastic lesions worrisome for\nmalignancy. Previously noted skin erosions, sclerosis and destructive changes\nof the inferior and posterior margins of the left external auditory canal have\nresolved. Of note the complete mandible was not imaged. Imaged portions of\nbilateral mandibular condyles are notable for mild degenerative changes at the\ntemporomandibular joint without subluxation.\n\nThe extracranial, petrous and cavernous segments of the right internal carotid\nartery are not identified. This vessel was present on ___. \nComparison to a chest CT of ___ did not reveal the proximal right\ncommon carotid artery. Therefore, it is possible that the absence of the\nright internal carotid artery is chronic. The supraclinoid segment of the\nvast is present, apparently filling from the ophthalmic artery.", + "output": "1. The study is incomplete not including the entire mandible. Patient will\nbe contacted to return for a full CT without contrast at no additional charge.\n2. partially visualized nonspecific right cervical soft tissue density is\nmost consistent with patient's known right parapharyngeal carcinoma resection,\nunchanged since ___.\n3. Occlusion of the right internal carotid artery proximal to its\nsupraclinoid segment. Limited prior imaging suggests this may be chronic.\n4. Mild degenerative changes of bilateral temporomandibular joints without\nsubluxation. Of note complete mandible was not imaged.\n5. Paranasal sinus inflammatory disease.\n\nRECOMMENDATION(S): Due to incomplete evaluation of the mandible a repeat\nnoncontrast CT scan of the facial bone is recommended at no additional cost to\nthe patient for evaluation of the osseous structures. Alternatively patient\ncould obtain a dedicated MR with attention along the mandible for assessment\nof the soft tissues.\n\nNOTIFICATION: The findings and the recommendation for a repeat CT scan were\ndiscussed with Dr. ___ by ___, M.D. on the telephone on\n___ at 3:06 pm, 20 minutes after discovery of the findings." + }, + { + "input": "There is bony destruction, with bone loss, fragmentation involving the\nsuperior aspect of the left mandibular body for approximately 26 mm in length,\nwith residual intact floor of the mandibular body which appears sclerotic.. \nNo associated soft tissue mass. Strong suggestion of adjacent or a cutaneous\nfistula.\n\nModerate mucosal thickening involving the left maxillary sinus and mild\nmucosal thickening involving the right maxillary sinus. Abscess floor of the\nleft maxillary sinus, with oral antral fistula coronal image 13. Probably\nchronic nasal bone fracture. Erosive changes along the medial margin anterior\nright mandibular body, lingual surface, coronal image 11, axial image 91\nseries 5, no definite soft tissue mass adjacent to it, likely related to\nosteonecrosis. Remainder of the anterior mandibular bodies, mandibular\nsymphysis are sclerotic without destruction.\n\nEvaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect. Retained secretions present in the nasopharynx. \nPostoperative changes right radical neck dissection with absent right\nsternocleidomastoid, right internal jugular vein. Posttreatment changes, with\na trophic parotid, submandibular glands.. Right parotid gland is completely\nfatty replaced. Postoperative changes right carotid space for prior tumor\nresection, with residual soft tissue thickening, likely treatment related.\n\nNo adenopathy.\nNo suspicious thyroid gland lesions. Occlusion of bilateral common carotid,\ninternal carotid arteries, extending from the origins of both common carotid\narteries. Mild origin narrowing right subclavian artery, with ectasia at the\nlevel of the first rib measuring 1.8 cm. Large caliber patent visualized both\nvertebral arteries\n\nThe orbits appear normal.\n9 mm soft tissue nodule/lymph node posterior inferior to the right lobe of\nthyroid (series 5, image 184), is more prominent compared with 0.7 cm on ___.\n\nBiapical pleural-parenchymal scarring has progressed compared to prior CT\nchest done ___. Multiple bilateral irregular upper lobe pulmonary\nnodules/scarring are noted. 0.7 cm irregular nodular opacity left upper lobe\nseries 5 image with irregular outline. Adjacent area of branching nodular\nopacity with tiny nodules image 249. Irregular elongated pulmonary\nscarring/opacity in the peripheral aspect of the right upper lobe is\nincompletely imaged (series 5, image 231 through 252) and demonstrates\nincrease density and size compared to prior CT chest done ___. \nModerate centrilobular pulmonary emphysema.\n\nAdvanced degenerative changes cervical spine. Anterolisthesis C3-C4, C4-C5,\nretrolisthesis C6-C7, multilevel endplate hypertrophic changes, disc space\nnarrowing, similar compared with ___ spine CT. Multilevel\nsignificant central canal narrowing, probably moderate to severe at C4-C5\nlevel, probably similar to prior, suggestion of cord flattening. Clinically\ncorrelate for myelopathy. Chronic fracture right first rib", + "output": "Bone destruction, fragmentation anterior left mandibular body, consistent with\nosteonecrosis, with adjacent oro-cutaneous fistula.\n\nAbsent floor of the left maxillary sinus, with oral antral fistula.\n\nSmall area of cortical irregularity lingual surface anterior right mandibular\nbody, suggestive of osteonecrosis.\n\nWhile there is no associated mass, physical exam recommended to exclude soft\ntissue mass at about 3 locations.\n\nOcclusion of the bilateral common carotid, internal carotid arteries.\n\nPostsurgical, posttreatment changes in the neck, no evidence of\nresidual/recurrent mass or adenopathy.\n\nSevere degenerative changes cervical spine with moderate to severe central\ncanal narrowing C4-C5 level, probable cord flattening, clinically correlate\nfor symptoms of myelopathy.\n\nMarked biapical pleural-parenchymal scarring has progressed since ___. \nMultiple bilateral irregular upper lobe pulmonary nodules, the most concerning\nmeasures 0.7 cm. Linear irregular scarring/nodule in the peripheral aspect of\nthe right upper lobe is incompletely imaged. Dedicated CT chest advised.\n\nRECOMMENDATION(S): Dedicated CT chest to evaluate the pulmonary nodules.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 10:39 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." + }, + { + "input": "In comparison to CT from ___, there is redemonstration of\nfragmentation of the anterior left mandibular body and oro cutaneous fistula. \nThere is no drainable fluid collection. Osseous destruction is more prominent\ncompared with ___.\n\nSubtle focus of cortical irregularity at the lingual surface of the anterior\nright mandibular body is unchanged in appearance from prior. Evaluation of\nthe aerodigestive tract demonstrates no mass and no areas of focal mass\neffect.\n\nCortical defect at the floor of the left maxillary sinus is re-demonstrated,\nwith moderate mucosal thickening. There is mild mucosal thickening of the\nright maxillary sinus. There is partial opacification of the bilateral\nmastoid air cells. The remaining paranasal sinuses and middle ear cavities\nare essentially clear.\n\nThe salivary glands are atrophic, similar to prior.The thyroid gland appears\nnormal. A rounded soft tissue density posterior to the right lobe of the\nthyroid measures 6 mm, previously 9 mm, most likely representing a lymph node\n(3:159). There is no lymphadenopathy by CT criteria. The patient is status\npost radical right neck dissection, with postsurgical, postradiation changes. \nFullness at the right carotid space at the site of tumor does seen ___ is\nsimilar compared with ___, most likely treatment related change. \nBilateral common carotid occlusion, extending through the bilateral internal\ncarotid arteries, and mild narrowing of the proximal right subclavian artery\n(3:166), with poststenotic ectasia (3:154), is unchanged. Blunted epiglottis\ntip, with intact petiole, stable since ___, likely treatment related, direct\nevaluation recommended. Mild asymmetry at the level of the vocal cords,\nstable since ___.\n\nBiapical scarring of the lungs is similar in extent to prior.. There are foci\nof perivascular nodular and ground-glass opacities, for example in the left\nupper lobe (3:207, 3:197) and right upper lobe (3:187), which are irregular\nand difficult to measure but overall similar in size and appearance. Moderate\ncentrilobular emphysema is again seen.\n\nIrregularity of the nasal bone likely represents chronic fracture. There are\nsevere degenerative changes of the cervical spine, including anterolisthesis\nof C3 on C4 and C4 on C5, and mild retrolisthesis of C6 on C7, loss of\nintervertebral disc space, most significant at C3-4, ___ and C6-7, and\nmultilevel anterior and posterior osteophytosis. Degenerative changes result\nin moderate to severe spinal canal narrowing at C4-5, C5-6 and C6-7. \nRe-demonstrated chronic fracture of the right first rib.", + "output": "Compared to prior study from ___, there is no significant change,\nincluding the following:\n\n-Bony destruction of the left anterior mandibular body, with oro cutaneous\nfistula, without drainable fluid collection. Findings are worsened since\n___, likely represent osteoradionecrosis. Underlying malignancy or\nosteomyelitis cannot be excluded, are less likely. Lack of adjacent soft\ntissue stranding argues against soft tissue infection. Clinical exam\nrecommended.\n-Small cortical irregularity at the anterior right mandibular body, may be\ntreatment related, exclude underlying neoplasm..\n-Defect in the floor of the left maxillary sinus, consistent with oro antral\nfistula.\n-Posttreatment changes neck, no evidence of adenopathy or primary neoplasm.\n-Severe degenerative changes of the cervical spine,.\n-Multiple nodular and ground-glass opacities in the bilateral lung apices,\nunchanged in size and appearance. Follow-up chest CT recommended.\n-Occluded bilateral common carotid arteries." + }, + { + "input": "Mild atherosclerotic calcification and plaque does not significantly narrow\nthe origin of the right brachiocephalic artery. Soft plaque results in at\napproximately 50% narrowing of the midportion of the right brachiocephalic\nartery (series 4, image 75). The right subclavian artery is opacified however\nthe axillary artery is poorly evaluated secondary to adjacent streak artifact\nfrom venous reflux. The left subclavian artery is unremarkable.\n\nThere is complete occlusion of the left common carotid and internal carotid\narteries. Similarly, the right common carotid and internal carotid arteries\nare also occluded.\n\nMinimal atherosclerotic calcification does not narrow the left vertebral\nartery origin. The left vertebral artery is dominant and is otherwise\nunremarkable noting atherosclerotic calcification at the V3 segment. The\nright vertebral artery origins unremarkable. Soft plaque results in severe\nnarrowing of the right V1 segment at the C7 level (series 4, image 120). The\nright vertebral artery caliber is unremarkable distally to the V4 segment,\nnoting mild atherosclerotic calcification in the right V3 segment.\n\nAtherosclerotic calcification at the origin of the left thyrocervical trunk\n(series 4, image 89) does not result in significant narrowing. The left\ninferior thyroid artery is patent demonstrating mild atherosclerotic\ncalcification near its origin. The left ascending cervical artery appears\npatent to at least the C3 level. What appears to be the transverse cervical\nartery appears patent.\n\nAtherosclerotic calcification near the origin of the right thyrocervical trunk\ndoes not result in significant narrowing. The visualized right inferior\nthyroid artery is diminutive and demonstrates multifocal regions of narrowing\nand is difficult to completely visualized. What appears to be the right\ntransverse cervical artery appears patent proximally. Although its distal\nbranches are also difficult to visualize. The right ascending cervical artery\nappears patent to at least the C3 level.\n\n\nOTHER:\n\nLytic fragmentation of the left aspect of the mandible with a oral cutaneous\nfistula (series 4, image 203) is overall similar to examination of ___. There is a left maxillary sinus oral antral fistula (series 4, image\n235).\n\nMild mucosal thickening of the ethmoid air cells with moderate mucosal\nthickening of the left greater than right maxillary sinus alveolar recesses. \nThe mastoid air cells appear clear. Visualized orbits are unremarkable. \nChronic nasal bone deformities are re-identified.\n\nEvaluation of the aerodigestive track demonstrates no definite focal mass\nlesion. The epiglottis and aryepiglottic folds are thickened, presumably\nposttreatment in nature.\n\nThe major salivary glands are atrophic. The thyroid is unremarkable. No\ncervical lymphadenopathy by size criteria. Rounded soft tissue posterior to\nthe right lobe of the thyroid measures approximately 4 mm, likely a lymph\nnode.\n\n3 mm anterolisthesis of C3 on C4, 2 mm anterolisthesis of C4 on C5, 1-2 mm\nretrolisthesis of C5 on C6 and C6 on C7 is unchanged. This results in at\nleast moderate spinal canal narrowing at C3-C4 and C5-C6. Severe left and\nmoderate right C5-C6, severe bilateral C6-C7 neural foraminal narrowing is\nnoted.\n\nHealed fracture deformity of the left first rib is unchanged. No acute\nosseous abnormality.\n\nExtensive biapical pleuroparenchymal scarring, with central lobular and\nparaseptal emphysematous changes as well as bronchiectasis is overall similar\nto prior exam. Multiple foci of perivascular nodular and ground-glass\nopacities are similar to prior exam. A dominant spiculated 4 mm left upper\nlobe nodule (series 4, image 26) and dominant 9 mm nodule in the right upper\nlobe are re-identified.", + "output": "1. Complete occlusion of the left and right common carotid and internal\ncarotid arteries.\n2. Severe short-segment narrowing of the right vertebral artery at the C7\nlevel, with distal reconstitution.\n3. The left thyrocervical trunk is dominant. Mild atherosclerotic\ncalcification at its origin does not result in significant narrowing. \nAllowing for mild atherosclerotic calcification, the left inferior thyroid\nartery, left ascending cervical artery and what appears to be the left\ntransverse cervical artery are patent.\n4. The right thyrocervical trunk a smaller relative to the right. The right\ninferior thyroid arteries diminutive in demonstrates multiple of focal regions\nof narrowing and is difficult to completely visualized. What appears to be\nthe right transverse cervical artery appears patent proximally.\n5. Findings compatible with left mandible radio-osteonecrosis with oral\ncutaneous fistula is overall similar to examination of ___.\n6. Oral antral fistula of the left maxillary sinus is re-identified.\n7. Additional findings as described above, unchanged from prior CT neck of ___." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nRight parietal lesions with resultant vasogenic edema are re-demonstrated and\nhave resultant mass effect on occipital and temporal horns of the right\nlateral ventricle. These are better described on recent MRI dated ___. No new intraparenchymal hemorrhage or large territorial infarct. No\nsignificant midline shift.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. Mild\ncalcification of bilateral carotid siphons. The dural venous sinuses are\npatent.\n\nCTA NECK:\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nCT perfusion: CBF <30% volume: 17ml\nTmax>6.0s volume: 24 ml\nMismatch volume: 7ml\nMismatch ratio: 1.4\n\nOTHER:\nThe visualized portion of the lungs are notable for a 1.5 cm right lung apex\nnodule. The visualized portion of the thyroid gland is within normal limits.\nThere is no lymphadenopathy by CT size criteria.", + "output": "1. No evidence of infarction or hemorrhage.\n2. Neck vessels are patent.\n3. Re-demonstrated right parietal lesion with resultant vasogenic edema better\ndescribed on MRI from ___." + }, + { + "input": "Study is degraded by motion.\n\nThe patient is status post right parietal craniotomy for resection of right\nparietal lobe masses. There is predominantly hypodense fluid with scattered\nhyperdense blood and foci of pneumocephalus within the surgical bed and along\nthe right parietal lobe. Bifrontal pneumocephalus is also noted. Vasogenic\nedema in the right parietal lobe is similar to prior studies. 5-6 mm leftward\nmidline shift is also unchanged. Effacement of the right lateral ventricle is\nunchanged. There is increased sulcal effacement throughout the brain. The\nbasal cisterns are patent similar to prior studies. No additional foci of\nintracranial hemorrhage or large territory infarction.\n\nThere is no evidence of fracture. Postoperative subcutaneous edema, swelling,\nand emphysema along the right parietal craniotomy site are noted along with\nskin staples. No superficial fluid collection identified. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Study is degraded by motion.\n2. Status post right parietal craniotomy for resection of right parietal low\nmasses with postoperative changes including fluid containing acute blood and\nfoci of pneumocephalus at the surgical bed and along the right parietal lobe. \nPostoperative bifrontal pneumocephalus and right parietal soft tissue changes\nalso noted.\n3. Local vasogenic edema and mass effect including 5-6 mm left for midline\nshift and effacement of the right lateral ventricle associated with the right\nparietal lobe masses are unchanged.\n4. Interval increased diffuse sulcal effacement compared to ___,\nmay be postoperative." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,or\nmass effect. The ventricles and sulci are normal in size and configuration.\n\nThere is soft tissue swelling and subcutaneous air over the midline of the\nbilateral frontal bones as well as in the right periorbital region. There is\nno evidence of fracture. Focal ossified density over the left frontal bone,\njust left of midline, likely reflects a small exostosis. There is mild\nmucosal thickening of the right anterior ethmoid air cells. The visualized\nportion of the remaining paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are otherwise\nunremarkable.", + "output": "1. Soft tissue swelling over the bilateral frontal bones, just right of\nmidline, as well as in the right periorbital region without underlying acute\nfracture.\n2. No acute intracranial abnormality." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture. There is mild mucosal thickening in the\nright sphenoid sinus. Otherwise the remaining paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. Status post bilateral lens\nreplacement. Otherwise the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. No calvarial fracture." + }, + { + "input": "Mucosal thickening and partial opacification of the inferior left frontal and\nanterior left ethmoid air cells is seen. The anterior clinoid processes are\nnot pneumatized. The lamina papyracea are intact. The sphenoid sinus septum is\nmidline with insertion upon thesellar floor.\n\nDebris is noted in the bilateral external auditory canals, left greater than\nright, with no associated erosions, likely representing cerumen.\n\nThere is expansion of the sella turcica, secondary to the pituitary mass which\nis better seen on the prior MRI. There is atherosclerotic calcification of\nthe cavernous internal carotid arteries which are displaced laterally.", + "output": "1. Expansion of the sella turcica secondary to the pituitary mass, which is\nbetter seen on the prior MRI.\n2. Left frontoethmoid sinus disease." + }, + { + "input": "Patient is status post endoscopic transnasal transsphenoidal pituitary tumor\nremoval. Presumed packing material is present within the sella turcica. \nThere is a small amount of surrounding expected postsurgical pneumocephalus. \nFoci of air also present within the nasal cavity, likely secondary to recent\nprocedure.\n\nThere is redemonstration of a heterogeneously hyperdense mass in the left\nbasal ganglia which measures approximately a 13 x 9 mm, consistent with a\ncavernoma. There is no evidence of acute infarction or hemorrhage. The\nventricles and sulci are normal in size and configuration.\n\nThere is mild mucosal thickening of the ethmoidal air cells. The remaining\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Status post endoscopic transsphenoidal pituitary tumor removal with\nexpected postsurgical changes and presumed packing material present within the\nsella turcica.\n2. Redemonstration of a known 13 mm left basal ganglia cavernoma.\n3. No acute intracranial abnormality." + }, + { + "input": "Patient is status post endoscopic transnasal transsphenoidal pituitary tumor\nremoval. Presumed packing material is again noted in the sella turcica. No\ninterval change in postoperative appearance from examination of ___.\n\nThe known cavernoma is again demonstrated as a hyperdense mass in the left\nbasal ganglia, unchanged. There is no evidence of acute large territory\ninfarction, acute hemorrhage, edema, or mass effect. The ventricles and sulci\nare normal in size and configuration.\n\nThere is no evidence of fracture. Packing material is noted in the nasal\ncavity. There is mucosal thickening in the ethmoid and left maxillary\nsinuses. The visualized portion of the orbits are unremarkable.", + "output": "1. Postoperative changes related to recent pituitary tumor removal are stable\ncompared to 1 day ago.\n2. Known left basal ganglia cavernoma is unchanged.\n3. No new intracranial hemorrhage or acute large territorial infarct." + }, + { + "input": "Patient is status post endoscopic transsphenoidal pituitary tumor removal. \nThere is no substantial change in the postoperative appearance compared to the\nCT scan from 1 day prior. Presumed packing material is again noted in the\nsella turcica. Known cavernoma in the head of the left caudate is unchanged. \nThere is no interval hemorrhage, edema, or shift of normally midline\nstructures.\n\nPartial opacification of the paranasal sinuses is unchanged. Mastoid air\ncells and middle ear cavities are clear. Orbits are unremarkable.", + "output": "1. Expected postoperative changes related to recent pituitary tumor removal.\n\n2. Unchanged left basal ganglia cavernoma." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nRe-identified is an evolving 1.6 x 1.7 cm enhancing focal hyperdensity within\nthe right parietal lobe with surrounding vasogenic edema, most consistent with\nknown brain abscess, previously measuring 1 x 1.9 cm on the MRI study of ___ (02:23). Focal hyperdensity is likely representative of blood\nproducts, as correlated with susceptibility gradient noted on MRI from ___.\n\nAdditionally, the previously identified 1.4 x 2 cm rim enhancing dural-based\nabscess is re-identified. It currently measures 1.4 x 1.4 cm with a hypodense\nfocus and rim enhancement (04:21, 02:21).\n\nThe 1.4 x 1.7 cm right occipital abscess contains a hypodense focus with rim\nenhancement, measuring 1.5 x 1.2 cm (04:12).\n\nThere is slight effacement of the posterior right lateral ventricle involving\nthe right occipital horn (02: 17, 19), in the setting of vasogenic edema. No\nappreciable midline shift.\n\nThere is no evidence of large territory infarction, new acute hemorrhage or\nnew area of infection. The ventricles and sulci are normal in size and\nconfiguration.\n\nThere is no gross evidence of acute fracture. The ethmoid, sphenoid, frontal\nand maxillary sinuses are clear. The middle ear cavities and mastoid air cells\nare unremarkable. The visualized portion of the orbits are unremarkable.\n\nCTA head:\nMinimal calcification of the carotid siphons. CT angiography of the head shows\nnormal appearance of the arteries of the anterior and posterior circulation\nwithout stenosis or occlusion. No definite aneurysm greater than 3 mm in size\nidentified. The proximal V3 and V2 segments of the vertebral arteries appear\ngrossly unremarkable. Patent dural venous sinuses.\n\nOther: Partially visualized endotracheal tube in stable position.", + "output": "1. Re-visualized are 3 relatively stable, evolving, focal areas of\nenhancement, consistent with known brain abscesses. One hyperdense lesion\nlocated in the right parietal lobe is consistent with an abscess complicated\nby hemorrhage.\n2. The surrounding vasogenic edema in the setting of infection is causing\neffacement of the posterior right lateral ventricle and the occipital horn. \nNo appreciable midline shift.\n3. No new areas of infection.\n4. Patent circle of ___ without evidence of stenosis,occlusion,or\naneurysm." + }, + { + "input": "There is redemonstration of two right parietal lobe and one right occipital\nlobe rim enhancing lesions, better evaluated on prior MR from ___ likely consistent with brain abscesses. The largest of these has\nunchanged surrounding edema with local mass effect without evidence of midline\nshift (2:22). No new lesions are identified. No new areas of hemorrhage or\ninfarct are identified. The ventricles and sulci are normal in size and\nconfiguration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. Redemonstration of two right parietal lobe and one right occipital lobe\nrim enhancing lesions, better evaluated on prior MR from ___\nlikely consistent with brain abscesses, with no interval change in comparison\nto CTA ___.\n\n2. No new lesions are identified." + }, + { + "input": "No evidence for acute intracranial hemorrhage, edema, mass effect, or acute\nmajor vascular territorial infarction. Extensive, largely confluent\nhypodensities in the subcortical, deep, and periventricular white matter of\nthe cerebral hemispheres, as well as hypodensity in the bilateral pons, are\nsimilar to the prior CT and MRI, nonspecific but most likely sequela of\nchronic small vessel ischemic disease in this age group. Age-related global\nparenchymal volume loss is again seen with prominent ventricles and sulci.\n\nThere is no evidence of displaced calvarial fracture. Status post bilateral\ncataract surgery. Mild mucosal thickening in the right greater than left\nfrontoethmoidal recesses. Mastoid air cells are well aerated.", + "output": "No evidence for acute intracranial abnormalities or displaced calvarial\nfracture." + }, + { + "input": "Aero digestive tract: There no mass.\n\nIf there is a mass, please insert field choice -->\n\nNeck lymph nodes: There is no adenopathy involving bilateral levels ___. \nThere is no retropharyngeal adenopathy.\n\nExtra nodal tumor spread: Not applicable.\n\nDeep neck muscles, masticator space: Unremarkable.\n\nBones, skull base:\nThere is no suspicious osteoblastic or lytic lesion. 2 mm retrolisthesis of\nC5 on C6 with moderate to severe loss of C5-C6 and C6-7 loss of disc height\nwith endplate sclerosis and subcortical cystic change is degenerative. There\nis no evidence of high-grade spinal canal narrowing. Uncovertebral facet\narthropathy results in moderate to severe right, moderate left C5-C6 and\nmoderate right and mild left C6-C7 neural foraminal narrowing.\n\nJugular foramen, carotid canal, pterygopalatine fossa, infraorbital foramen,\nother skull base foramina are not involved.\n\nVessels: The cervical vessels appear unremarkable.\n\nBrachial Plexus: There is no brachial plexus contact or invasion.\n\nThyroid, salivary glands: There is no evidence of abnormal enhancement or\nenlargement of the left submandibular gland relative to the right. However,\nthe left submandibular duct is asymmetrically prominent (series 2, image 19\nthrough 22), with mild asymmetric enhancement of the left sublingual space\n(series 2, image 1) and possibly sublingual gland. No evidence of radiopaque\nbody to suggest sialolith.\n\nThe right submandibular gland and sublingual space is unremarkable. The\nparotid glands are unremarkable.\n\nThe thyroid demonstrates multiple hypoattenuating nodules measuring up to 4\nmm.\n\nOther findings: There are no lung nodules.", + "output": "1. No evidence of sialolith. However, there is abnormal enlargement of the\nleft submandibular duct and asymmetric enhancement of the left sublingual\nspace and possibly sublingual gland. This may represent sequela of passed\nstone and sialoadenitis. Continued clinical follow-up and repeat imaging\nfollowing resolution of symptoms is recommended to document resolution of\nasymmetric enlargement of the left submandibular duct and enhancement within\nthe left sublingual space.\n2. No cervical lymphadenopathy by size criteria. The parotid glands, right\nsubmandibular glands are unremarkable.\n3. The thyroid demonstrates multiple hypoattenuating nodules measuring up to 4\nmm.\n4. Additional findings as described above.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "Aero digestive tract:\n\nThere is no mass.\nIf there is a mass, please insert field choice -->\n\nNeck lymph nodes:\nThere is no adenopathy involving bilateral levels ___.\nThere is no retropharyngeal adenopathy.\n\nExtra nodal tumor spread:\nNot applicable.\n\nDeep neck muscles, masticator space:\nNot applicable.\n\nBones, skull base:\nThere are no suspicious osteoblastic or lytic lesions. 2 mm retrolisthesis of\nC5 on C6 with loss of disc height at C5-C6 and C6-C7 is compatible\ndegenerative change and similar in appearance to prior exam.\nThere are no findings suggestive of perineural tumor extension.\nJugular foramen, carotid canal,pterygopalatine fossa,infraorbital\nforamen,other skull base foramina are unremarkable.\n\nVessels:\nThe cervical vessels are patent.\n\nBrachial Plexus:\nUnremarkable.\n\nThyroid, salivary glands:\nThe left submandibular duct remains dilated and increased in caliber when\ncompared to prior exam. For example distally near the submandibular caruncle,\nthe submandibular duct measures approximately 6 mm in diameter versus 3 mm on\nprior exam. There remains asymmetric enhancement of the left sublingual\ngland, without definitive focal mass or evidence of sialolith. No definite\ninflammatory stranding involving the left sub mandibular gland.\n\nThe right submandibular and sublingual glands appear unremarkable.\n\nThe parotid glands are symmetric and unremarkable.\n\nRe-identified are subcentimeter thyroid nodules, unchanged from prior exam.\n\nOther findings:\nThere are no lung nodules. Although not optimized for such evaluation\nvisualized brain parenchyma is unremarkable.", + "output": "1. Interval increase size of the left submandibular duct when compared to\nprior examination. For example, the left submandibular duct near the\nsubmandibular caruncle measures approximately 6 mm, previously measuring 3.\n2. There may be mild enhancement of the left sublingual gland relative to the\nright. No definite inflammatory stranding associated with the left\nsubmandibular gland. No sialolith identified.\n3. Given persistent and increased enlargement of the left submandibular duct,\nrecommend further evaluation with direct visualization and possibly MRI neck\nor ultrasound as clinically indicated.\n4. No cervical lymphadenopathy by size criteria.\n5. Additional findings described above, including subcentimeter thyroid\nnodules, unchanged from prior exam.\n\nRECOMMENDATION(S): Given persistent and increased enlargement of the left\nsubmandibular duct, recommend further evaluation with direct visualization and\npossibly MRI neck or ultrasound as clinically indicated.\n\n Thyroid nodule. No ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or ___, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 08:23 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." + }, + { + "input": "There is poor contrast bolus opacification of the arteries on the CTA limiting\nthe evaluation. Study is further limited secondary to patient body habitus. \nWithin these confines:\n\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Study limited secondary to poor bolus tracking and patient body habitus.\n2. Within limits of study, no acute intracranial abnormality.\n3. No evidence of acute intracranial hemorrhage.\n4. No evidence ofaneurysm greater than 3 mm, dissection or vascular\nmalformation, or significant luminal narrowing." + }, + { + "input": "The study is slightly degraded by patient motion artifact.\n\nThere is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass effect. The ventricles and sulci are normal in size and\nconfiguration.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nethmoid air cells. The orbits are unremarkable. The mastoid air cells middle\nears are well pneumatized and clear.", + "output": "The study is slightly degraded by patient motion artifact.\n\n1. No intracranial hemorrhage.\n2. No acute displaced calvarial fracture." + }, + { + "input": "There is a right frontal subgaleal hematoma without underlying fracture. \nThere is no evidence of acute intracranial hemorrhage, infarction or edema. A\ncalcified 10 x 6 mm left frontal calcified lesion is stable from prior exam\nand is likely a meningioma (series 3:image 52).\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "1. Right frontal subgaleal hematoma without underlying fracture.\n2. No acute intracranial abnormality.\n3. Stable 10 mm left frontal calcified lesion is likely a meningioma." + }, + { + "input": "There is no evidence of infarction, hemorrhage,or edema. There is a 5 x 9 x 5\nmm extra-axial calcified mass adjacent to the inner table of the left parietal\ncalvarium, likely a small meningioma. The ventricles and sulci are normal in\nsize and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of fracture or intracranial hemorrhage.\n2. 9 mm calcified extra-axial mass adjacent to inner table of the left\nparietal calvarium, likely a small meningioma." + }, + { + "input": "Please note that the inferior most aspect of the posterior fossa was excluded\nfrom imaging. Re-identified is a dense left frontal extra-axial calcification\nmeasuring 9 x 5 mm, unchanged, which may represent a heavily calcified\nmeningioma. There is no evidence of infarction, hemorrhage, edema,or other\nmass. The ventricles and sulci are normal in size and configuration for age. \nFew scattered areas of periventricular and subcortical white matter\nhypodensity are in a configuration most suggestive chronic small vessel\nischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality. Specifically, no hemorrhage.\n2. Unchanged 9 x 5 mm left frontal extra-axial dural calcification which may\nrepresent a heavily calcified meningioma." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. An ossified\nextra-axial lesion overlying the left frontal bone is unchanged, likely a\nmeningioma (03:49), no soft tissue component.. Nonspecific periventricular\nand deep subcortical white matter hypodensities most likely represent mild\nchronic small vessel ischemic disease.\n\nThere is no evidence of fracture. An empty sella is unchanged from multiple\nprior studies (602:41). The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable. Left shoulder arthroplasty.", + "output": "1. No evidence of acute intracranial process.\n2. Suggestion of small ossified left frontal meningioma." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema,or discrete mass. There\nis prominence of the ventricles and sulci suggestive of involutional changes. \nUnchanged ill-defined hypodensity in the right periventricular white matter on\nseries 2, image 20 is unchanged and likely reflect small vessel disease are in\ntiny lacune.\n\nThere is no evidence of fracture. 0.9 cm calcified dural-based lesion at the\nleft superior frontal region is consistent with a meningioma. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable. Empty\nsella is unchanged", + "output": "No acute findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is mild mucosal thickening in the maxillary sinuses (right greater than\nleft) with an air-fluid level within the right maxillary sinus, which can be\nseen in the setting of acute sinusitis. The mastoid air cells and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere are mild calcifications of the carotid siphons. There is a persistent\nfetal origin of the left PCA. The vessels of the circle of ___ and their\nprincipal intracranial branches appear otherwise normal without stenosis,\nocclusion, or aneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThere is a 3 mm right upper lobe pulmonary nodule (3:83). The visualized\nportion of the thyroid gland is within normal limits. There is no\nlymphadenopathy by CT size criteria.", + "output": "1. No evidence of intracranial hemorrhage or large territorial infarct.\n2. No evidence dissection, aneurysm or occlusion of the head neck. No\nevidence of carotid stenosis by NASCET criteria." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. The ventricles and sulci are normal in size and configuration. \nFindings consistent with mild chronic small vessel ischemic change.\n\nThere is no evidence of fracture. Mild mucosal thickening paranasal sinuses. \nClear mastoids, orbits.", + "output": "No acute intracranial abnormality.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 5:02 pm, 2\nminutes after discovery of the findings." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD:\nPunctate diffusion-weighted hyperintense signal within the right hippocampus\nseen on prior MRI is beyond the resolution of CT technique. Otherwise, there\nis no evidence for acute hemorrhage, vascular territorial infarction, mass\neffect, or edema. The ventricles and sulci are normal in size and appearance.\n\n The paranasal sinuses, middle ear cavities, and mastoid air cells are clear.\nThe orbits and globes are grossly unremarkable bilaterally.\n\n\nCTA HEAD AND NECK:\nA normal, three-vessel aortic arch is identified. The vertebral arteries are\npatent without high-grade stenosis or occlusion. The bilateral common carotid\narteries are patent. There is no evidence of internal carotid stenosis by\nNASCET criteria.\n\nMild calcifications are seen within the bilateral cavernous internal carotid\narteries. The vessels of the circle of ___ and their principal\nintracranial branches are patent without high-grade stenosis, occlusion, or\naneurysm formation. The dural venous sinuses are patent.\n\n\nOTHER:\nThe lungs apices are clear bilaterally. The thyroid gland is unremarkable in\nappearance. Multiple prominent bilateral cervical lymph nodes are noted, none\nof which are pathologically enlarged by ct size criteria. A coarse\nsubcentimeter calcification is noted in the left thyroid gland which is mildly\nheterogeneous but without focal nodule.", + "output": "1. Known punctate right hippocampal diffusion-weighted hyperintense lesion\ndemonstrated on prior MRI is beyond the resolution of CT technique. No\nevidence for acute large territory infarct or intracranial hemorrhage on\nnoncontrast head CT.\n2. Mild multifocal atherosclerotic disease, as above. Otherwise, widely\npatent intracranial and cervical vasculature without high-grade stenosis or\nocclusion.\n3. Mildly heterogeneous thyroid gland with coarse calcifications seen in the\nleft thyroid lobe.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass effect. The ventricles and sulci are normal in size and configuration. \nThere is a right frontal subgaleal hematoma. There is no evidence of an\nunderlying fracture. The visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. There is exotropia of the left\nglobe.", + "output": "1. No evidence of hemorrhage or fracture.\n\n2. There is apparent exotropia of the left globe.\n\n3. Small right frontal scalp hematoma." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Basilar cisterns are\npatent.\n\nIncluded paranasal sinuses and mastoids are essentially clear besides\npartially opacified ethmoid air cells bilaterally. Right frontal scalp\nhematoma seen without underlying fracture.", + "output": "No acute intracranial process." + }, + { + "input": "Study is mildly degraded by motion. There is no evidence of infarction,\nhemorrhage, edema, or mass. The ventricles and sulci are normal in size and\nconfiguration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Study is mildly degraded by motion.\n2. No acute intracranial abnormality.\n3. No evidence acute intracranial hemorrhage or fracture." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass effect. The ventricles and sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. There is mucosal thickening of some anterior\nethmoidal air cells and the left sphenoid sinus. The paranasal sinuses,\nmastoid air cells, and middle ear cavities are otherwise clear. The orbits are\nunremarkable.", + "output": "No acute intracranial abnormalities on noncontrast head CT." + }, + { + "input": "There is no intracranial hemorrhage, edema, mass effect, or acute vascular\nterritorial infarction. The ventricles and sulci are slightly prominent, due\nto age related involutional changes. Minimal scattered periventricular and\nsubcortical white matter hypodensities likely reflect the sequelae of chronic\nsmall vessel ischemic disease. Calcifications of the cavernous portions of the\ninternal carotid arteries and intradural portions of the vertebral arteries\nare noted. There is no shift of the normally midline structures.The basal\ncisterns appear patent and there is preservation of the gray-white matter\ndifferentiation.\n\nA previously described ossific density along the inner table of the left\nfrontal lobe (02:20), is unchanged.Mild mucosal thickening is present in the\nanterior ethmoid air cells. Otherwise, the remaining visualized paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.The orbits are\nunremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Stable meningioma versus dural calcification along the inner table of the\nleft frontal bone." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, mass, mass effect or\nlarge territorial infarction. Mild prominence of the ventricles and sulci is\nlikely related to age related involutional changes. Periventricular and deep\nsubcortical white matter hypodensities are likely related to chronic small\nvessel ischemic disease. The basilar cisterns are patent. Of note, two fat\ndensity lesions are seen along the dura of the straight sinus and torcula,\nmeasuring up to 8 mm.\n\nNo acute fracture is identified. The visualized paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. Calcifications are seen within\nthe carotid siphons bilaterally. The patient is status post bilateral lens\nreplacement surgery. The orbits are otherwise unremarkable.", + "output": "1. No acute intracranial abnormalities identified.\n2. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described.\nPlease note MRI of the brain is more sensitive for the detection of acute\ninfarct if there is further clinical concern." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass. There\nis prominence of the ventricles and sulci suggestive of involutional changes.\nPeriventricular, subcortical and deep white matter hypodensities are\nnonspecific but likely the sequelae of chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. There is minimal ethmoid air cell and left\nmaxillary sinus mucosal thickening. The visualized portion of the remaining\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable. Dense cavernous carotid\nand vertebral artery calcifications are noted.", + "output": "1. No acute intracranial abnormality.\n2. Age appropriate global atrophy and probable small vessel ischemic changes." + }, + { + "input": "There is mild soft tissue swelling over the posterior vertex and right\nparietal bone without underlying fracture. There is an approximately 6 x 6 mm\nfocus of increased density along the right tentorium cerebelli concerning for\nsmall extra-axial hemorrhage, possibly subarachnoid hemorrhage as appears\ninferior to the tentorium. Additional punctate hyperdensity in a left frontal\nlobe sulcus may represent tiny subarachnoid hemorrhage (series 2; image 28,\nseries 602; image 40).\n\nThere is no edema or mass effect. There is no acute territorial infarction. \nThe ventricles and sulci are prominent consistent with age related global\natrophy. Periventricular, subcortical, and deep white matter hypodensities\nare nonspecific, but likely to represent sequela of chronic microvascular\nischemic disease.\n\nThere is notable calcification of the bilateral V4 segments of the vertebral\narteries as well as the lacerum, cavernous, and supraclinoid portions of the\ninternal carotid arteries. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable. Punctate radiopaque focus overlying the left\nnasal bone is unchanged.", + "output": "1. 6 mm focus of acute extra-axial blood along the right tentorium cerebelli,\npossibly subarachnoid hemorrhage rather than subdural given its location\ninferior to the tentorium.\n2. Additional possible punctate focus of subarachnoid hemorrhage in a left\nfrontal lobe sulcus.\n3. Mild soft tissue swelling over the vertex and right parietal bone without\nfracture.\n4. Age-appropriate global atrophy and probable small vessel ischemic changes." + }, + { + "input": "The previously mentioned 6 mm focus of acute extra-axial blood along the right\ntentorium cerebelli, today is less conspicuous. The previously seen small\npunctate hyperdensity in the left frontal lobe sulcus is no longer seen. \nThere is no acute territorial infarction. There is no edema,or mass effect. \nThe ventricles and sulci are prominent configuration, consistent with\ngeneralized atrophy.\n\nThere is no evidence of fracture. Improvement of the right soft tissue\nswelling overlying the parietal bone. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Previously seen 6 mm focus of acute SAH in the right tentorium cerebelli is\nless conspicuous. The small punctate hyperdensity in the left frontal lobe\nsulcus is no longer seen.\n2. No acute intracranial abnormality on noncontrast head CT. Specifically no\nnew hemorrhage or acute large territory infarct.\n3. Additional findings as described above." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. There are patchy periventricular and subcortical\nhypodensities. This is a nonspecific finding and most likely rep small vessel\nischemic gliotic change in a patient of this age. This appears similar to\nprevious.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Vascular\ncalcification is noted. The visualized portion of the orbits are\nunremarkable.\n\nA right ___ catheter is partially visualized.", + "output": "1. No evidence of acute large territorial infarction or intra-axial\nhemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nPeriventricular and subcortical white matter hypodensities are consistent with\nmoderate chronic small vessel disease. Small metallic density overlies soft\ntissues of the nose. Small tentorial lipoma.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial process." + }, + { + "input": "There is no acute hemorrhage mass effect midline shift or hydrocephalus. \nHypodensities in the periventricular white matter indicate more moderate\nchanges of small vessel disease. There is mild to moderate brain atrophy.", + "output": "1. No acute intracranial abnormalities." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nRight periorbital swelling is noted. There is no evidence of fracture. The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality. Right periorbital swelling without\nvisualized fracture." + }, + { + "input": "A 2.1 x 1.5 x 2.8 cm fluid collection (02:45, 601b:26, 602b:43) with subtle\nrim enhancement and surrounding edema that tracks down into the left piriform\nsinus with possible trace extension into the retropharyngeal space to the\nlevel of C6 (263) is most consistent with a left peritonsillar abscess. There\nis mild not pathologically enlarged and associated lymphadenopathy.\n\n Neck vessels are patent.\n\nThe upper lung fields are clear. Multiple thyroid nodules are noted, which\ncould be further evaluated by nonemergent thyroid ultrasound. There is\npartially calcified atherosclerotic plaque along the aortic arch. An aberrant\nright subclavian artery is incidentally noted. The patient is edentulous,\nhowever periapical lucencies are seen surrounding maxillary teeth, and a\nperiapical lucency with a sclerotic border in a left mandibular premolar\n(02:41).", + "output": "1. 2.1 x 1.5 x 2.8 cm fluid collection with subtle rim enhancement and\nsurrounding edema that tracks down into the left piriform sinus with possible\ntrace extension into the retropharyngeal space at the level of C6 (263) is\nmost consistent with a left peritonsillar abscess.\n2. Multinodular thyroid gland could be further evaluated nonemergent thyroid\nultrasound." + }, + { + "input": "There are scattered parenchymal calcifications. Periventricular hypodensity\nis nonspecific, likely related to chronic small vessel ischemic disease. \nThere is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sterile slightly prominent likely representing age related\ninvolutional changes. Moderate atherosclerotic calcifications are noted in\nthe vertebrobasilar system. Burrhole is noted in the right frontal region of\nthe skull.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of intracranial hemorrhage.\n2. Confluent areas of low density in the subcortical and periventricular white\nmatter are nonspecific, and may reflect changes due to chronic microvascular\nischemic disease." + }, + { + "input": "There is no evidence of acute major vascular territorial\ninfarction,hemorrhage,edema, or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. Chronic infarct in the left\ncerebellar hemisphere is re-demonstrated. Ill-defined confluent regions of\nhypodensity are seen in the periventricular, subcortical and deep white\nmatter, which are nonspecific but likely due to chronic sequela of\nsmall-vessel ischemic disease. A burr hole is noted in the right frontal bone\nwith small amount of encephalomalacia noted along the prior catheter tract. \nDense atherosclerotic calcifications are seen in the V4 segments of bilateral\nvertebral arteries as well as both carotid siphons.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormalities. Please note that MRI is more\nsensitive for detection of acute infarction.\n2. Chronic microangiopathy and age related global atrophy." + }, + { + "input": "CTA HEAD:\nThere are extent calcifications of the carotid siphons, with mild-to-moderate\nnarrowing of supraclinoid ICA. The vessels of the circle of ___ and their\nprincipal intracranial branches appear normal without stenosis, occlusion\nbulbous left M1 terminus, with suggestion of 1.5 mm broad-based aneurysm,\nstable since ___. The V4 segments of the vertebral arteries demonstrate mild\ncalcifications. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is an aberrant right subclavian artery. Mild atherosclerotic narrowing\nof the proximal left subclavian artery.\nCalcifications of the origins bilateral ICAs result in approximately 20%\nstenosis on the right, and 35% narrowing on the left by NASCET criteria. \nThere is mild atherosclerotic narrowing of the proximal left common carotid\nartery.\nThere are calcifications of the origins of the vertebral arteries with\nmild-to-moderate narrowing on the left, and probably mild narrowing on the\nright.\nOtherwise, the carotid and vertebral arteries and their major branches appear\notherwise normal. Aberrant right subclavian artery seen, developmental\nvariant.\n\nOTHER:\nThe visualized portion of the lungs are clear. There are a couple hypodense\nnodules within the bilateral thyroid lobes measuring up to 1.6 cm on the right\non coronal images, and 0.9 cm on the left. There is no lymphadenopathy by CT\nsize criteria. There is chronic infarct in the left cerebellum, stable. \nSevere chronic small vessel ischemic changes. There is chronic small cortical\ninfarct in the right frontal lobe", + "output": "Bilateral proximal ICA narrowing, measuring 20% on the right, 35% on the left.\nMild-to-moderate left vertebral artery origin narrowing.\nSevere chronic small vessel ischemic changes, chronic left cerebellar and\nright frontal lobe infarcts.\nSuggestion 1.5 mm left M1 terminus aneurysm, probably stable since ___.\nThyroid nodules, measuring up to 1.6 cm.\n\nRECOMMENDATION(S):\n1. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or older, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. Chronic\nleft cerebellar, basal ganglia, thalamus lacunar infarcts. Findings\nconsistent with severe chronic small vessel ischemic changes. Right frontal\nburr hole, small area frontal encephalomalacia, stable. Brain parenchymal\natrophy.\n\nNo fractures are seen. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "No acute intracranial abnormality.\nStable chronic infarcts, chronic small vessel ischemic changes." + }, + { + "input": "There is no evidence of acute large territorial infarctionhemorrhage,edema,or\nmass. Redemonstration of chronic left cerebellar, basal ganglia and bilateral\nthalamic lacunar infarcts. Periventricular and subcortical white matter\nhypodensities are nonspecific but likely sequelae of chronic small vessel\nischemic disease. There is prominence of the ventricles and sulci suggestive\nof involutional changes. Dense atherosclerotic calcifications noted within\nthe intracranial ICAs.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Unchanged chronic infarcts and chronic small vessel ischemic changes." + }, + { + "input": "There is no evidence of acute fracture, acute large territorial\ninfarction,hemorrhage,edema,or mass. Periventricular and subcortical white\nmatter hypodensity is nonspecific, but likely reflect sequelae of chronic\nsmall vessel ischemic disease. Changes following right frontal burr hole are\nredemonstrated. Chronic lacunar infarcts again seen in the bilateral basal\nganglia, thalami, and left cerebellar hemisphere. There is prominence of the\nventricles and sulci suggestive of involutional changes.\n\nThe paranasal sinuses, mastoid air cells and middle ear cavities are clear. \nThe orbits are unremarkable. Right frontal burr hole is noted.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of large territory infarction,hemorrhage,edema, or mass\neffect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture. The visualized paranasal sinuses are clear.\nThe orbits are unremarkable, noting bilateral lens replacements. The left\nmastoid air cells and bilateral middle ears are well pneumatized and clear. \nFluid opacification of the right mastoid air cells with sclerosis would\nsuggest history of prior chronic mastoiditis. Soft tissue debris in the right\nexternal auditory canal statistically most likely represents cerumen.", + "output": "1. No acute intracranial abnormality on noncontrast CT head. Specifically no\nacute large territory infarct or intracranial hemorrhage.\n2. Additional findings described above, including opacification and sclerosis\nof the right mastoid tip." + }, + { + "input": "Venous contrast pooling overlying hardware, and dental amalgam streak artifact\nand patient body habitus limits study.\n\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute territorial infarction, intracranial hemorrhage,\nedema, or mass. Mild prominence of the ventricles and sulci is suggestive of\ninvolutional changes. There is also prominence of the bifrontal extra-axial\nCSF spaces. There is no mass effect or midline shift.\n\nThere are postsurgical changes of bilateral lens replacement. There is mild\nmucosal thickening of the ethmoid sinuses. The mastoid air cells and middle\near cavities are clear. Soft tissue attenuation in the right external\nauditory canal likely relates to cerumen.\n\nCT PERFUSION:\nPerfusion maps are nondiagnostic.\n\nCTA HEAD:\nThere are moderate nonocclusive atherosclerotic calcifications of the carotid\nsiphons and supraclinoid internal carotid arteries and left greater than right\nV4 segments. Nonocclusive narrowing of the proximal right P1 segment is\nnoted. The left A1 segment is hypoplastic, a normal anatomic variant. \nOtherwise, the vessels of the circle of ___ and their principal\nintracranial branches demonstrate opacification without focal stenosis,\nocclusion, or aneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is a common origin of the right brachiocephalic and left common carotid\narteries, a normal anatomic variant. There are moderate scattered\natherosclerotic calcifications of the aortic arch and great vessel origins.\n\nThere are moderate to severe atherosclerotic calcifications of the left\ncarotid bifurcation with approximately 50% stenosis of the proximal left\ninternal carotid artery by NASCET criteria.\n\nThere are mild calcified noncalcified atherosclerotic plaques along the course\nof the right common carotid and right internal carotid artery. There is no\nevidence of occlusion. There is no internal carotid artery stenosis by NASCET\ncriteria.\n\nThere is severe narrowing of the origin and proximal portion of the right\nvertebral artery likely due to atherosclerotic disease. There are\nmild-to-moderate multifocal areas of luminal irregularity and narrowing of the\nleft vertebral artery. The cervical vertebral arteries are tortuous in\ncourse. There is no evidence of occlusion.\n\nOTHER:\nThere is moderate centrilobular emphysema. There is biapical scarring. An\napproximately 2 mm left upper lobe pulmonary nodule seen (see 05:39).\n\nThe esophagus is patulous. The thyroid is heterogeneous due to underlying\nnodules, largest is in approximately 1 cm nodule in the thyroid isthmus (image\n62 of series 5). Additional 5 mm right thyroid lobe nodule is noted (see\n5:70).\n\nThere is no lymphadenopathy by CT size criteria.\n\nThere is minimal anterolisthesis of C3 on C4. Multilevel degenerative changes\nof the cervical spine.", + "output": "1. Venous contrast pooling overlying hardware, and dental amalgam streak\nartifact and patient body habitus limits study.\n2. No evidence of acute territorial infarction, intracranial hemorrhage, or\nmass. Please note MRI of the brain is more sensitive for the detection of\nacute infarct.\n3. Nondiagnostic CTP.\n4. Mild parenchymal volume loss.\n5. Nonocclusive atherosclerotic narrowing of circle of ___ as described.\n6. Otherwise, patent circle of ___ with no evidence focal stenosis,\nocclusion, or aneurysm.\n7. Approximately 50% stenosis of the proximal left internal carotid artery by\nNASCET criteria.\n8. No right internal carotid artery stenosis by NASCET criteria.\n9. Mild-to-moderate multifocal luminal irregularity and narrowing due to\natherosclerotic disease of the cervical vasculature. No occlusion.\n10. 2 mm left upper lobe pulmonary nodule. Please see recommendation section\nbelow.\n11. Thyroid isthmus approximately 1 cm and approximately 5 mm right thyroid\nlobe nodules.\n\nRECOMMENDATION(S): For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" + }, + { + "input": "HEAD CT: The subarachnoid hemorrhage in the pre pontine and suprasellar\ncisterns is less prominent on current study. However evaluation is sub optimal\ndue to extensive streak artifact. There is redistribution of the subdural\nhematoma along the right side of the falx. Bilateral intraventricular\nhemorrhages have increased from prior study. There is stable enlargement of\nthe ventricles.\n\nThere is mild left maxillary sinus mucosal thickening with aerated secretions.\nThere is complete opacification of the right maxillary sinus with central\nhyperdensity which may represent either inspissated secretions or fungal\ninfection. There is widening of the accessory ostium with questionable polyp.\n\nHEAD CTA: Unremarkable anterior and posterior circulations. There is no\nevidence of significant stenosis, vessel occlusion or aneurysm greater than 2\nmm.\n\nNECK CTA: There is a left-sided aortic arch and. The innominate and left\ncommon carotid arteries have a common origin, a normal variant.\n\nThere is calcified atherosclerotic disease at the carotid bulb bilaterally,\nleft greater than right. The common carotid, internal carotid and external\ncarotid arteries are widely patent without evidence of significant stenosis\nbased on NASCET criteria.\n\nThe vertebral arteries are unremarkable.\n\nThere are mild degenerative changes of the cervical spine.", + "output": "The subarachnoid hemorrhage in the pre pontine and suprasellar cisterns is\nless prominent on current study. There is redistribution of the subdural\nhematoma along the right side of the falx. The bilateral intraventricular\nhemorrhages have increased in size, but the ventricle size and configuration\nare unchanged.\n\nUnremarkable head and neck CTA without evidence of significant stenosis,\ndissection or aneurysm." + }, + { + "input": "Previously described subarachnoid and intraventricular hemorrhage is similar\nin appearance to prior examination. Subdural blood along the falx is largely\nunchanged in appearance from the prior study. There is no evidence of new\nhemorrhage or territorial infarction. The basal cisterns are patent there is\npreservation of gray-white matter differentiation. There is complete\nopacification of the right maxillary sinus, unchanged from the prior study\nwith no evidence of other paranasal sinus abnormality. The mastoid air cells\nare well aerated. There is no significant interval change in the size of the\nventricles. The globes are unremarkable. Surgical staples are seen in the\nscalp posteriorly.", + "output": "Previously described subarachnoid, intraventricular hemorrhage and parafalcine\nsubdural blood are unchanged in appearance from the prior exam. No new\nevidence of hemorrhage or infarction." + }, + { + "input": "Previously seen blood products have resolved. There is no acute intra or\nextra-axial hemorrhage is seen. There is no fluid collection identified. There\nis brain atrophy including medial temporal atrophy. Small vessel disease is\nnoted. Small amount of fluid is seen in the left maxillary sinus otherwise\nthe visualized sinuses are clear.", + "output": "Resolution of previously seen blood products. No acute hemorrhage seen. Brain\natrophy." + }, + { + "input": "There is no evidence of fracture, infarction, hemorrhage, edema, or mass. \nThe ventricles and sulci are normal in size and configuration. There is no\nabnormal enhancement on post contrast images.\n\nMild mucosal thickening of the visualized paranasal sinuses. Otherwise, the\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No evidence of infarct or mass.\n2. Mild paranasal sinus disease." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. Nonspecific\nperiventricular white matter hypodensities likely reflect sequela of chronic\nsmall vessel ischemic disease.\n\nThere is no evidence of fracture. There is hospital opacification of\nbilateral mastoid air cells and fluid seen in bilateral maxillary and sphenoid\nsinuses. Otherwise, the visualized paranasal sinuses and and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No evidence of hemorrhage or infarction." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nAgain seen is hyperdensity in the sulci in bilateral parietal lobes and\noccipital lobes, unchanged compared to the prior head CT from ___ in keeping with subarachnoid hemorrhage. Also seen is small amount of\nlayering intraventricular hemorrhage in the occipital horn of left lateral\nventricle, unchanged.\n\nThere is no evidence of infarction, edema, or mass. The ventricles and sulci\nare normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses,mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal with no evidence of stenosis,occlusion or aneurysm. The dural\nvenous sinuses are patent.", + "output": "1. Stable subarachnoid hemorrhage in bilateral occipital and parietal lobes\nwith flaring intraventricular hemorrhage in the occipital horn of left lateral\nventricle.\n2. Normal CT of the head. Specifically, no intracranial aneurysm is seen." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. Right orbit is unremarkable. Phthisis bulbi\nis noted in the left globe.", + "output": "No acute intracranial abnormality.\n\nNOTIFICATION: No acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of infarction or hemorrhage.\n\n2. No fracture." + }, + { + "input": "There is no intracranial hemorrhage seen. There is no mass effect, midline\nshift, hydrocephalus. Brain and medial temporal atrophy and extensive changes\nof small vessel disease are seen progressed from the CT examination. There is\nno fracture.", + "output": "No hemorrhage seen. Brain and medial temporal atrophy progressed from previous\nCT." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation\nis preserved. Ventricles are symmetric and unremarkable. Scattered areas of\nsubcortical and deep white matter hypodensity in a configuration suggestive of\nchronic small vessel ischemic disease. Basilar cisterns are patent.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial\nsoft tissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Mild\nbilateral periventricular and subcortical white matter hypodensities are\nnonspecific, but may represent a sequela of chronic small vessel ischemic\nchanges. There is prominence of the ventricles and sulci suggestive\ninvolutional changes.\n\nThere is no evidence of fracture. There is mucosal thickening within\nbilateral ethmoid air cells. Remainder of the visualized portions of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. \nThere is prominent leftward deviation of the nasal septum with a large left\nwere projecting spur. The visualized portion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territory infarct. Gray-white matter\ndifferentiation is preserved. Mild periventricular and subcortical white\nmatter hypodensities again noted, may represent sequela of chronic small\nvessel ischemic change. There is no hydrocephalus. The visualized paranasal\nsinuses are clear. The mastoid air cells are clear. No acute fracture is\nseen.", + "output": "No acute intracranial process." + }, + { + "input": "Images are degraded by motion. Within these limitations, there is no evidence\nof a large territorial infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are prominent in keeping with generalized parenchymal\nvolume loss.\n\nNo osseous abnormalities seen. There is partial opacification of the left\nmaxillary sinus. Otherwise, the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear.", + "output": "Images are moderately degraded by motion artifact. Within this limitation,\nthere is no large intracranial bleed identified." + }, + { + "input": "There is no evidence of fracture, acute infarction,hemorrhage,edema,or mass. \nSubcortical and periventricular white matter hypodensities suggestive of\nchronic small vessel ischemic disease. There is prominence of the ventricles\nand sulci suggestive of involutional changes.\n\nThere is minimal mucosal thickening in the left maxillary sinus. Otherwise,\nthe paranasal sinuses are clear. The mastoid air cells are clear. Bilateral\nlens replacements noted.", + "output": "No acute intracranial process." + }, + { + "input": "Head CT: There is a large arteriovenous malformation in the left\ntemporoparietal region with few punctate areas of high density within the\nvascular nidus likely representing calcifications. There is bilateral\nintraventricular hemorrhage with no evidence of hydrocephalus. There is an\narea of low density in the right temporal lobe which could represent a\nperivascular space or a small lacune. There is no evidence of large\nterritorial infarction. There is no shift of midline structures. The orbits\nare unremarkable. The paranasal sinuses and mastoid air cells are clear. The\ncalvaria and skull base are intact.\n\nHead CTA: A large arteriovenous malformation in the temporoparietal lobe is\nseen. The primary arterial feeder appears to be the enlarged superior\ndivision of the left MCA. There is additional arterial supply from the\nenlarged left ACA and also an enlarged left fetal PCA. Meningeal and dural\nfeeders are also noted superiorly and laterally. The venous drainage is\nsuperficial into the straight sinus and superior sagittal sinus. No definite\ndeep venous drainage is identified. A 4 mm aneurysm projecting inferiorly from\nthe proximal left MCA is noted (series 3, image 261).\n\nNeck CTA: There is normal three-vessel take-off from the aortic arch. There\nis a combination of hard and soft plaque involving the carotid arteries,\nbilaterally. The distal left and right ICA Dmin measure 6 mm and 5.7 mm,\nrespectively. There is no evidence of internal carotid artery stenosis by\nNASCET criteria.\n\nThe soft tissues of the neck are unremarkable. The lung apices are clear.", + "output": "1. Large left temporoparietal arteriovenous malformation with associated\nacute intraventricular hemorrhage, but no evidence of hydrocephalus.\n2. Arterial supply of the AVM is largely from an enlarged left MCA,\nparticularly its superior division, with additional contributions from the\nleft ACA as well as a fetal-type left PCA; there is a small contribution from\nthe right ACA, as well. Finally, there are also a few dural feeders,\nreflecting external carotid arterial supply.\n3. Drainage of the AVM appears entirely to the superficial venous system,\nwith no definite deep venous drainage pathway identified.\n4. 4 mm aneurysm projecting inferiorly from the proximal M1 segment of the\nleft MCA\n5. Unremarkable CTA of the neck, with no steno-occlusive disease, the\nindication for which is unclear.\n\nCOMMENT: Comparison with any previous (___) studies, once uploaded to PACS,\nwould be most helpful." + }, + { + "input": "Multiple calcifications are again seen in the left parietal lobe within the\npreviously demonstrated arteriovenous malformation. Again seen is blood\nfilling the lateral, third, and fourth ventricles, without interval change.\nThe ventricles remain normal in size. The sulci are also stable in size, and\nno clear evidence for parenchymal edema is seen. The basal cisterns are not\ncompressed. There is no herniation. Hypodensity in the region of the right\nsylvian fissure on image 3:15 corresponds to volume averaging.\n\nThe bones are unremarkable. The imaged paranasal sinuses and mastoid air cells\nare well aerated.", + "output": "Stable diffuse intraventricular hemorrhage. Stable size of the ventricles\nwithout hydrocephalus. Calcifications within the left parietal AVM nidus are\nagain seen." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction or midline shift.\nThere is no hydrocephalus. There is no edema. There is no fracture. The\nprevious intraventricular hemorrhage is resolving, now not really perceptible,\nunchanged asymmetry of the left ventricular atrium is re- demonstrated. The\npatient has known left temporoparietal arteriovenous malformation evidence by\nmultiple calcified vessels in this area.\n\nVisualized paranasal sinuses and mastoid air cells are clear.", + "output": "KNOWN LEFT TEMPOROPARIETAL ARTERIOVENOUS MALFORMATION. RESOLVING\nINTRAVENTRICULAR HEMORRHAGE WITHOUT EVIDENCE OF NEW HEMORRHAGE. NO EVIDENCE OF\nHYDROCEPHALUS." + }, + { + "input": "Overall, there has been an interval increase in hyperdense blood compared to\nthe prior exam from ___ with increased blood seen along the\nlateral ventricles, third ventricle, and fourth ventricle. Serpiginous areas\nof increased density may be secondary to contrast from the patient's recent\nprocedure, however a subarachnoid hemorrhage cannot be excluded. There is no\nevidence of hydrocephalus. Embolic material obscures the left superior\nhemisphere secondary to artifact. The basilar cisterns are patent.\n\nNo acute fractures identified. The visualized paranasal sinuses, mastoid air\ncells and middle ear cavities are clear. The globes are unremarkable.", + "output": "1. Interval increase in hyperdense blood compared to the prior exam from ___ with increased blood seen along the lateral ventricles, third and\nfourth ventricle. Serpiginous areas of increased density may be secondary to\ncontrast from patient's recent procedure, however a subtle subarachnoid\nhemorrhage cannot be excluded.\n\n2. Embolic material obscures detailed evaluation of the left hemisphere,\nhowever if there is further clinical concern for stroke, an MRI may be helpful\nfor further evaluation.\n\nNOTIFICATION: Findings were discovered and discussed with Dr. ___ by Dr. ___.\n___ by phone at 7:00 pm on the day of the exam." + }, + { + "input": "Streak artifacts from coils in the left parietal lobe cause significant streak\nartifact limiting evaluation. Hemorrhage in the lateral and fourth ventricles\nhas notably decreased. Hyperdense material, likely hemorrhage, in the Sylvian\nfissure and in the left parietal sulci is also decreased but persistent. There\nis no evidence of new intracranial hemorrhage. The ventricles and sulci remain\nstable in size and configuration. The basal cisterns are patent. Gray-white\nmatter differentiation unobscured by streak artifact remains preserved.\n\nThe included paranasal sinuses, mastoid air cells and middle ear cavities are\nclear.", + "output": "Streak artifact limits the exam. Resolving intraventricular and left\nsubarachnoid hemorrhage. No evidence of new hemorrhage or other acute\nintracranial abnormality.\nLeft M1 aneurysm noted; better assessed on prior CTA study" + }, + { + "input": "This CT examination is limited by significant streak artifacts most prominent\nin the left parietal lobe. There is hypodense fluid within the left lateral\nventricle, where hyperdense fluid was previously seen on the prior study\n(___). This is consistent withevolution of intraventricular hemorrhage.\nThere is no new intracranial hemorrhage. No shift of midline structures. There\nis no evidence of acute infarction.\nHyperdensity noted within the left Sylvian fissure represents a dilated vein,\nbetter demonstrated on prior CTA dated ___. The basal cisterns are patent.\nNo fracture or suspicious osseous lesion is identified. Paranasal sinuses,\nmastoid air cells and middle ear cavities are clear. Sphenoid septations\ninsert on carotid groove.\nBilateral orbits are unremarkable.", + "output": "Interval evolution of known intraventricular hemorrhage allowing for the coil\nartifacts. No new hemorrhage." + }, + { + "input": "Limited evaluation due to beam hardening artifact from embolization coils,\npredominately within the left parietal lobe. Again seen is hyperdensity\nwithin the left sylvian fissure consistent with a dilated vein better assessed\non prior CTA from ___. The basal cisterns are patent. Within\nthe confines of this technically limited examination, there is no evidence of\nacute large territorial infarction, large volume hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Limited evaluation due to beam hardening artifact from embolization coils\npredominately within left parietal lobe.\n2. No acute large territorial infarct or large volume hemorrhage." + }, + { + "input": "Patient is status post resection of cerebellar mass with expected postsurgical\nchanges noted and small amount of pneumocephalus at the surgical site on the\nright cerebellar region. There is mild vasogenic edema surrounding the\nsurgical cavity on the right with minimal asymmetry of the fourth ventricle\nand posterior perimesencephalic cisterns, supratentorially, there is small\namount of pneumocephalus along the right Meckel's cave and posterior aspect of\nthe right temporal fossa, there is no evidence of intracranial hemorrhage. \nThere is a small heterogeneous area on the left thalamus (series 3, image 16),\nabutting towards the third ventricle, partially evaluated in this exam,\nprobably consistent with a second mass lesion, correlation with MRI of the\nbrain with and without contrast is recommended. Postsurgical pneumocephalus\nnoted on the left frontal convexity. Periventricular and subcortical white\nmatter hypodensities are nonspecific but likely sequelae of chronic small\nvessel ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Expected postsurgical changes identified in the posterior fossa, the\npatient is status post resection of cerebellar mass. There is also\npneumocephalus in the right Meckel's cave, and left frontal region.\n\n2. Mild asymmetry and heterogeneous density is noted on the left thalamus\nabutting towards the left side of the third ventricle, partially evaluated in\nthis exam, correlation with prior exams and MRI of the head with and without\ncontrast are recommended for further characterization of this finding.\n\nRECOMMENDATION(S): Mild asymmetry and heterogeneous density is noted on the\nleft thalamus abutting towards the left side of the third ventricle, partially\nevaluated in this exam, correlation with prior exams and MRI of the head with\nand without contrast are recommended for further characterization of this\nfinding." + }, + { + "input": "There is global subtle loss of gray-white matter differentiation concerning\nfor global ischemia. There is no evidence of intra hemorrhage, edema or mass.\nThere is no sulcal effacement and the basilar cisterns are patent.\n\nThere is no evidence of fracture. There is moderate mucosal thickening of the\nbilateral ethmoid air cells and air-fluid levels noted in the bilateral\nmaxillary sinuses and sphenoid sinuses. There is a nasoenteric tube in place.\nThe mastoid air cells and middle ear cavities are clear. The visualized\nportions of the orbits are unremarkable.", + "output": "Subtle loss of gray-white matter differentiation raises the concern for\npossible global cerebral ischemia." + }, + { + "input": "No radiopaque foreign body is seen along the aerodigestive tract. The parotid\nand salivary glands appear symmetric and normal. There is no tonsillar\nenlargement. Imaged paranasal sinuses are well aerated. No fracture is seen.\nMultilevel degenerative changes are noted within the cervical spine. The\nimaged lung apices are clear. The imaged portion of the mediastinum is\nunremarkable. No pneumomediastinum.", + "output": "No radiopaque foreign body." + }, + { + "input": "There is no evidence of large territorial infarction, acute intracranial\nhemorrhage, edema, or mass. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. Periventricular white matter hypodensities\nare nonspecific, but likely sequela of chronic small vessel ischemic disease. \nMild atherosclerotic calcifications of the cavernous carotid arteries are\nnoted.\n\nThere is no evidence of fracture. Mild bilateral maxillary sinus mucous\nthickening and partial opacification of the right inferior mastoid air cells\nsuggest mild ongoing inflammation. The visualized portion of the remaining\nparanasal sinuses,left mastoid air cells, and middle ear cavities are clear. \nThe visualized portion of the orbits are unremarkable.", + "output": "No evidence of acute intracranial hemorrhage or calvarial fracture." + }, + { + "input": "The partially visualized aortic arch has dense calcific arteriosclerosis. \nThere is no anatomic variation of the 3 vessel origin of the great vessels. \nThere is mild luminal irregularity into the origin of the right\nbrachiocephalic and left common carotid arteries due to calcific plaque but no\nflow-limiting stenosis. There is moderate narrowing of the left subclavian\norigin due to mixed plaque as well.\n\nThe right common carotid artery has normal course and caliber. The cervical\nright internal carotid artery is tortuous but has normal caliber. The\nvisualized intracranial right internal carotid is mildly narrowed but poorly\nvisualized at the petrous segment and has otherwise normal caliber.\n\nThe left common carotid artery has otherwise normal course and caliber. There\nis minimal calcific plaque of the left carotid bifurcation. There is a small\nrim of soft plaque within the posterior aspect of the left internal carotid\nartery origin. This vessel is patulous proximally. There is no flow-limiting\nstenosis of the left cervical internal carotid, which is mildly tortuous. The\npartially visualized intracranial portion has mild effacement of the petrous\nportion, which is not well visualized.\n\nBilaterally, the external carotid arteries have normal course, caliber and\nbranching pattern, though there is minimal calcific plaque at the origin of\nthe left external carotid artery.\n\nThe vertebral arteries are codominant. The right vertebral artery has normal\ncourse and caliber.\n\nThere is mild calcific plaque of the left vertebral artery origin, but no\nflow-limiting stenosis. The remainder of the left vertebral artery has normal\ncourse and caliber. \n\nThe partially visualized proximal basilar artery has normal caliber.\n\nA moderate to large in size right pleural effusion is partially visualized. \nThere is a suture within the right lung apex, compatible with prior resection,\npartially visualized as well with mild underlying emphysematous changes. Mild\nmaxillary sinus mucosal thickening and osseous degenerative changes are also\nincidentally noted. The left lobe of the thyroid extends inferiorly slightly,\nbut there is no focal thyroid mass. There are no suspicious findings within\nthe neck.", + "output": "1. No flow-limiting stenosis of the internal carotid arteries. Soft plaque\nwithin the left internal carotid artery origin does not significantly naarow\nthe lumen.\n2. Moderate atherosclerosis of the origin of the left subclavian artery.\n3. Post-surgical changes right lung with moderate-to-large pleural effusion." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. There\nis prominence of the ventricles and sulci suggestive of involutional\nchanges.There is no evidence of fracture. There is a chronic deformity in the\nright lamina 3 she appear large mucous retention cyst noted in the right\nmaxillary sinus. There is partial opacification of the right mastoid air\ncells. The visualized portion of the remaining paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. There is prominence of the ventricles and sulci suggesting cortical\nvolume loss, likely age-related and involutional in nature. Dense vascular\narteriosclerotic calcifications are present the carotid siphons bilaterally.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nmaxillary sinuses. There is partial opacification of the left mastoid air\ncells. The visualized portion of the orbits are unremarkable with the\nexception of bilateral lens replacements.", + "output": "No acute intracranial hemorrhage or evidence of acute large territorial\ninfarction." + }, + { + "input": "There is no evidence of acute major vascular territorial\ninfarction,hemorrhage,edema, or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. There is mild mucosal thickening is seen in\nthe bilateral ethmoid air cells. There is partial opacification of the left\nsphenoid sinus and bilateral mastoid air cells, left greater than right. \nVisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavitiesare otherwise clear. The visualized portion of the orbits are\nunremarkable.\n\nAbnormal appearance of the calvarium is noted with widening of the diploic\nspace. Regions of cortical thickening and sclerosis with multiple lucent\nregions are also noted.", + "output": "1. No acute major intracranial abnormality.\n2. Abnormal appearance of the calvarium with expansion, mixed sclerosis and\nlucency. Findings may represent Paget's disease though metastatic disease is\nnot excluded. If desired and if clinically relevant, bone scan could be\nobtained to evaluate for additional lesions." + }, + { + "input": "This exam was aborted due to patient noncooperation. Only 1 lateral scout\nimage was able to be obtained.", + "output": "This exam was aborted due to patient noncooperation. Only 1 lateral scout\nimage was able to be obtained." + }, + { + "input": "There is no evidence of territorial infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\nThere is no evidence of fracture. There is minimal mucosal thickening of the\nethmoid air cells. A mucous retention cyst is seen within the left maxillary\nsinus. The mastoid air cells are clear. The visualized portion of the orbits\nare unremarkable.", + "output": "1. No acute intracranial process. Sinus disease as described above." + }, + { + "input": "Exam is slightly limited by motion.\n\nThere is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Small hypodensity in the left basal ganglia is\nunchanged and compatible with chronic lacune.\n\nThere is no evidence of acute fracture. Moderate mucosal thickening is noted\nin the left maxillary sinus. Partial opacification of bilateral ethmoid air\ncells and left mastoid air cells is noted. The visualized portion of the\norbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute hemorrhage, edema, mass effect, or acute major\nvascular territorial infarction. Ventricles, sulci, and basal cisterns are\nnormal in size.\n\nA subtle soft tissue density is seen in the right epitympanum, most likely\ninflammatory. The ossicles are not assessed in high-resolution detail, but\nmild erosion cannot be excluded compared to the contralateral side. The\nmastoid air cells are clear.\n\nThere is fluid and mild mucosal thickening in the right sphenoid sinus. There\nis mild mucosal thickening, small mucous retention cysts, and possible trace\nfluid in the left sphenoid sinus. There is moderate fluid and/or mucosal\nthickening in the ethmoid air cells, extending into the frontoethmoidal\nrecesses and inferior frontal sinuses bilaterally. There is mild-to-moderate\nmucosal thickening with polypoid components/mucous retention cyst within\nbilateral maxillary sinuses, and small aerosolized secretions in the left\nmaxillary sinus.\n\nThe orbits appear unremarkable.\n\nCTA NECK:\nThere is a 3 vessel aortic arch. There is mild mixed plaque in the proximal\nright internal carotid artery and calcified plaque at the bifurcation of the\nleft common carotid artery, without stenosis by NASCET criteria. The\nvertebral arteries appear widely patent.\n\nCTA HEAD:\nThere is mild calcified plaque in the bilateral carotid siphons without\nevidence for flow-limiting stenosis. No evidence for flow-limiting stenosis\nelsewhere in the major intracranial arteries. There is fetal type origin of\nthe left posterior cerebral artery. The dural venous sinuses are patent.\n\nOTHER:\nNo pathologically enlarged lymph nodes by CT criteria. The thyroid appears\nunremarkable. Evaluation of the included upper lungs is limited by\nrespiratory motion artifact. Multilevel degenerative changes in the cervical\nspine, with severe appearing spinal canal stenosis at C5-C6, though\nincompletely evaluated.", + "output": "1. No dense for acute intracranial abnormalities. MRI would be more sensitive\nfor posterior fossa pathology, if clinically warranted.\n2. Subtle soft tissue density in the right epitympanum with suspected mild\nossicle erosion, concerning for cholesteatoma.\n3. Paranasal sinus disease including fluid may indicate acute sinusitis in\nappropriate clinical setting. Please correlate with symptoms.\n4. Mild atherosclerosis at bilateral internal carotid artery origins without\nstenosis by NASCET criteria. Normal appearance of cervical vertebral\narteries.\n5. No evidence for intracranial arterial stenosis. Mild calcified plaque\nwithin bilateral carotid siphons.\n\nRECOMMENDATION(S): Noncontrast temporal bone CT, which may be performed in\nthe outpatient setting.\n\nNOTIFICATION: Preliminary report in PACS, including concern for right\ncholesteatoma and recommendation for temporal bone CT, was provided at 20:46\non ___ by Dr. ___." + }, + { + "input": "Slightly limited examination due to patient motion, within this limitation,\ngrossly there is no evidence of territorial infarction,intracranial\nhemorrhage,edema,or mass. The ventricles and sulci are normal in size and\nconfiguration. There is preservation of gray-white matter differentiation. \nThe basal cisterns are patent.\n\nThere is no evidence of fracture. A mucous retention cyst is seen in the left\nmaxillary sinus. Mild mucosal thickening is noted in the right maxillary\nsinus. The remainder of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "No evidence for acute intracranial process or hemorrhage." + }, + { + "input": "There is no evidence of acute territorial infarction, acute intracranial\nhemorrhage, edema, or large mass. There is prominence of the ventricles and\nsulci suggestive of involutional changes.\n\nThere is no evidence of acute fracture. There is mild mucosal thickening in\nthe frontoethmoidal recesses bilaterally. There is moderate to severe mucosal\nthickening in the ethmoid air cells. There is moderate mucosal thickening in\nthe maxillary sinuses bilaterally. There is severe mucosal thickening in the\nleft sphenoid sinus and mild mucosal thickening in the right sphenoid sinus. \nThe mastoid air cells are underpneumatized bilaterally and partially\nopacified.", + "output": "1. No acute intracranial process.\n2. Sinus disease as described." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass. The ventricles and sulci are normal in size and configuration.\nPeriventricular white matter hypodensities are likely reflective of the\npatient's known multiple sclerosis, but better assessed on the previous MRI.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Minimal soft tissue swelling is noted\noverlying the right periorbital region.", + "output": "1. Mild right periorbital soft tissue swelling without evidence of fracture.\n2. No acute intracranial process.\n3. Periventricular white matter hypodensities likely reflective of the\npatient's known multiple sclerosis, better assessed on the previous MRI." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or mass\neffect. Ventricles and sulci are age-appropriate. Atherosclerotic vascular\ncalcifications are noted. There are periventricular and subcortical\nlucencies, which may represent small vessel ischemic changes.\n\nThere is no acute fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are preserved.", + "output": "1. No acute intracranial abnormality. Please note MRI of the brain is more\nsensitive for the detection of acute infarct.\n2. No evidence acute intracranial hemorrhage or fracture." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nA 12 mm hyperdense focus of mildly hyperdense presumed hemorrhage is seen\nalong the right deep sylvian fissure/right temporal lobe, similar to what is\ndescribed in the outside CT report, unclear whether subarachnoid or\nparenchymal. No evidence for parenchymal edema or mass effect. Ventricles,\nsulci, and basal cisterns are normal in size.\n\nThere are bifrontal subcutaneous foci of air and bifrontal mild subgaleal soft\ntissue swelling compatible with contusion and laceration. There is no\nevidence for a fracture. There is a 6 x 2 mm lucent lesion in the left\nfrontal bone lateral to the frontal sinus, image 3:85, without aggressive\nfeatures, possibly an epidermoid or hemangioma.\n\nThe orbits appear unremarkable. Paranasal sinuses and mastoid air cells\nappear well-aerated. The adenoids are mildly prominent. Bilateral palatine\ntonsilliths are consistent with sequela of prior infections.\n\nCTA HEAD:\nThe timing of the scan relative to the contrast bolus is slightly suboptimal. \nNo evidence for flow-limiting stenosis or aneurysm. No evidence for abnormal\nblood vessels in the region of the right perisylvian hemorrhage. The dural\nvenous sinuses are patent.", + "output": "1. 12 mm mildly hyperdense presumed hemorrhage along the right deep sylvian\nfissure/temporal lobe, unclear whether subarachnoid or parenchymal. No\nparenchymal edema or mass effect.\n2. Bifrontal scalp contusion and laceration. No evidence for a fracture.\n3. 6 x 2 mm lucent lesion in the left frontal bone lateral to the frontal\nsinus, without aggressive features, possibly an epidermoid or hemangioma.\n4. Mildly prominent adenoids. Please correlate clinically whether this may be\nexplained by recent upper respiratory infection/inflammation, or whether\ndirect visualization is clinically warranted.\n5. Unremarkable CTA head.\n6. During this exam an intravenous extravasation occurred. For details please\nsee note in electronic medical record/OMR. The patient has received\ninstruction on how to manage this event at home.\n\nNOTIFICATION: Electronic preliminary report was provided on ___ at\n07:10 by Dr. ___." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence ofinfarction,hemorrhage,midline shiftormass-effect. The\nventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear patent without stenosis, occlusion, or aneurysm. The dural venous\nsinuses are patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion.\n\n\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No acute intracranial abnormality.\n2. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n3. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema,or mass. The\nventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. Normal study." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nMinimal periventricular and subcortical white matter hypodensities are\nnonspecific but likely sequelae of chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable, noting evidence of a right lens\nreplacement.", + "output": "1. No evidence of hemorrhage, infarction, or other significant intracranial\nabnormalities." + }, + { + "input": "There is mild mucosal thickening and likely small mucous retention cysts in\nthe maxillary sinuses, bilaterally. Mucosal thickening in the ethmoid air\ncells is mild.\n\nThere is partial opacification of the frontal sinuses and the frontoethmoidal\nrecesses, compatible with sinusitis.\n\nMucosal thickening in the sphenoid sinuses is moderate, bilaterally.\n\nNo evidence of bony erosion. No evidence of fracture.\n\nThe orbits are unremarkable. There is no deep fluid collection.\n\nFor assessment of the neck please see CT neck from the same date.", + "output": "1. Mild-to-moderate sinus disease, as described above. No discrete fluid\ncollection. Please see CT neck from the same date." + }, + { + "input": "There is medialization of the carotid arteries, bilaterally. There are\nmultiple enlarged retropharyngeal lymph nodes (series 7 image 32, series 3,\nimage 23), which appear mildly increased from MR ___. Additional,\nbilateral cervical chain lymph nodes measure at the are borderline enlarged,\ndiffusely. There is no prevertebral fluid collection. There is enlargement\nof the adenoids and prominence of the soft palate without a discrete fluid\ncollection.\n\nThere is mild mucosal thickening in the sphenoid, ethmoid, frontal and\nmaxillary sinuses.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules.Bilateral opacification of the mastoid air cells is moderate\nand similar to MR ___", + "output": "1. Retropharyngeal lymphadenopathy without a discrete fluid collection or site\nof infection. Additional, diffuse bilateral cervical lymph nodes are\nborderline enlarged. Enlargement of the adenoids and prominence of the soft\npalate are likely reactive, but appears similar to ___. Of note,\nthere is medialization of the carotid arteries, bilaterally.\n2. Moderate opacification of mastoid air cells, bilaterally is similar to ___.\n3. There is mild mucosal thickening in the frontal, ethmoid, sphenoid and\nmaxillary sinuses." + }, + { + "input": "There is mild mucosal thickening of the left maxillary sinus and minimal\nmucosal thickening of the right maxillary sinus, improved from prior study, as\nwell as mild mucosal thickening of the bilateral sphenoid sinuses, improved\nfrom prior. Mild mucosal thickening of the bilateral ethmoid air cells is\nsimilar to prior, though slightly increased in the left compared to prior\n(06:59). The frontal sinuses are clear.\n\nThere is no evidence of bony erosion. The ostiomeatal units are patent. The\ncribriform plates are intact. The lamina papyracea are intact.\n\nThe orbits are unremarkable.", + "output": "Mild, chronic appearing paranasal sinus disease, as described above, overall\nimproved from prior though with slight increase in mucosal thickening of the\nleft ethmoid air cells, without evidence of complication. No evidence of bony\nerosion, orbital, or intracranial extension." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nEvaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears preserved.Bilateral cervical chain lymph\nnodes are not pathologically enlarged by CT size criteria. The neck vessels\nare grossly patent.\n\nLimited imaging lungs are grossly clear.There are no definite focal osseous\nlesions. Limited imaging of the mastoid air cells again demonstrate partial\nbilateral opacification.", + "output": "1. Dental amalgam streak artifact limits study.\n2. No deaf evidence of cervical abscess.\n3. Scattered subcentimeter nonspecific lymph nodes without definite\nenlargement by CT size criteria, which may be reactive.\n4. Partial opacification of bilateral mastoid air cells, better demonstrated\non concurrently obtained temporal bone CT." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere are postoperative changes after bilateral craniotomy for aneurysm\nclipping as well as right-sided pipeline stent placement. There is no\nevidence of infarction, hemorrhage, edema, or mass. The ventricles and sulci\nare normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nImages of the regions of the prior aneurysms are obscured by artifact from the\nhardware. Within these limitations, there is no evidence of residual or\nrecurrent aneurysm patent lumen. No new vascular abnormalities are detected. \nThere is no evidence of vasospasm. The vessels of the circle of ___ and\ntheir principal intracranial branches appear normal with no evidence of\nstenosis, occlusion, or aneurysm. The dural venous sinuses are patent.", + "output": "1. Status post bilateral aneurysm clipping and right supraclinoid internal\ncarotid artery pipeline stent placement with expected post procedural changes.\n2. No evidence of hemorrhage or infarction.\n3. Arteriogram is limited by artifacts from the hardware. Within these\nlimitations, there is no evidence of residual or recurrent aneurysm patent\nlumen." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of a large territorial infarction,\nhemorrhage, edema, or mass effect. The ventricles and sulci are normal in\nsize and configuration.\n\nThe right frontal sinus is hypoplastic, likely congenital. There is mild\nmucosal thickening of the left ethmoid air cells. The visualized portion of\nthe mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThere is a punctate calcified granuloma within the left upper lobe. The\nvisualized portion of the thyroid gland is within normal limits. There is no\nlymphadenopathy by CT size criteria.", + "output": "1. No acute intracranial abnormality.\n2. Normal CTA head and neck.\n3. Mild inflammatory changes of the left ethmoid air cells." + }, + { + "input": "No intra-axial or extra-axial hemorrhage, edema, shift of normally midline\nstructures, or evidence of acute major vascular territorial infarction. There\nis age advanced atrophy most notable in the cerebellum. Basal cisterns are\npatent. Paranasal sinuses are mostly clear. Mastoid air cells and middle ear\ncavities are well aerated. Bony calvarium is intact.", + "output": "No acute intracranial process. Age advanced atrophy." + }, + { + "input": "Postsurgical changes are seen in the left middle fossa. There is a tiny amount\nof extra-axial hyperdense material seen adjacent to the craniotomy surgical\nsite, likely trace subdural (3, 20). There is a small amount of expected\npneumocephalus. Hypodense material containing air at the floor of the middle\ncranial fossa is likely secondary to Surgiflo material (series 3, image 8).\nThere is no evidence of unexplained hemorrhage, edema, mass effect, shift of\nnormally midline structures or acute major vascular territorial infarction. \nProminent sulcus potentially from volume loss/encephalomalacia seen in the\nright the occipital lobe (3: 21, 22). This is unchanged from prior. Ventricles\nand sulci are otherwise normal in size and configuration. The basal cisterns\nappear patent and there is preservation of gray-white matter differentiation.\n\nPostsurgical osseous changes from recent left middle fossa craniotomy are\nidentified with surrounding soft tissue swelling. Fluid and secretions are\nseen within the left middle ear cavity, left mastoid air cells, left sphenoid\nsinus and the ethmoidal air cells. There is a small amount of mucosal\nthickening of the left maxillary sinus. Otherwise, the remaining visualized\nparanasal sinuses, right mastoid air cells, and right middle ear cavity are\nclear.", + "output": "Expected postsurgical changes in the left middle fossa. No unexplained acute\nintracranial abnormality." + }, + { + "input": "Left craniotomy is again seen. Pneumocephalus has resolved. There is linear\ndural hyperdensity deep to the craniotomy, compatible with dural thickening.\nPreviously noted minimal left extra-axial blood products have either\ncompletely resolved or decreased to trace amounts. There is no acute\nhemorrhage, edema, or loss of gray/ white matter differentiation. The\nventricles, basal cisterns, and cerebral sulci are normal in size.\n\nThere is mild mucosal thickening in bilateral anterior ethmoid air cells.\nThere is a small osteoma in a right posterior ethmoid air cell. There is a\nsmall mucous retention cyst and a small amount of aerosolized secretions in\nthe left sphenoid sinus.\n\nLeft mastoid air cells and left middle ear cavity are partially opacified,\nlikely secondary to recent surgery. Right middle ear cavity and right mastoid\nair cells are well aerated.", + "output": "Dural thickening deep to the left craniotomy. Previously noted small amount of\nextra-axial hemorrhage deep to the craniotomy has either resolved or decreased\nto trace amounts. No new hemorrhage." + }, + { + "input": "There is no evidence of large acute territorial infarction, hemorrhage, edema,\nor mass/mass-effect. There is prominence of the ventricles and sulci\nsuggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality on noncontrast head CT." + }, + { + "input": "There is no evidence of acute vascular territorial\ninfarction,hemorrhage,edema,or definite mass. Mild periventricular and\nsubcortical white matter hypodensities are nonspecific, and likely related to\nsmall vessel ischemic disease in a patient of this age. There is prominence\nof the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process. If there is a clinical concern for brain\nmetastases, MRI brain is a more sensitive exam." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. Calcifications are\nseen along bilateral carotid siphons.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nethmoid air cells. The visualized portion of the remaining paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute large territory infarction,hemorrhage,edema, or\nmass. There is mild prominence of the ventricles and sulci suggestive of\ninvolutional changes, similar to prior. Dense atherosclerotic calcifications\nof the bilateral carotid siphons are again seen. Senescent calcifications\nwithin the right basal ganglia are again seen.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No intracranial hemorrhage, evidence of acute large territory infarction,\nor calvarial fracture.\n2. Mild global involutional changes appear similar to prior." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, more acute major\nvascular territorial infarction. Mild global parenchymal volume loss with\nmild prominence of the ventricles and sulci. Mild periventricular white\nmatter hypodensities are nonspecific but likely sequela of mild chronic small\nvessel ischemic disease in this age group, similar to prior.\n\nNo evidence for suspicious bone lesions. A small lucency in the left parietal\nbone on image 3:53 is unchanged dating back to the head CT from ___.\n\nThere is mild mucosal thickening of the anterior ethmoid air cells. Mastoid\nair cells are well aerated. The orbits are unremarkable.", + "output": "No evidence for acute intracranial abnormalities. MRI would be more sensitive\nfor intracranial metastatic disease, if clinically warranted." + }, + { + "input": "There is no evidence of acute large territorial infarction, intracranial\nhemorrhage, edema, or mass.\n\nThere is prominence of the ventricles and sulci suggestive of age-related\ncerebral volume loss. Mild periventricular and subcortical white matter\nhypodensities are nonspecific, though likely sequelae of chronic small vessel\nischemic disease. Moderately severe atherosclerotic calcifications are seen\ninvolving the cavernous carotid arteries.\n\nNo acute osseous abnormalities seen. Small lucencies in the bilateral\nparietal bones are stable compared to priors. There is minimal opacification\nof the left-sided mastoid air cells suggestive mild ongoing inflammation. The\npartially imaged paranasal sinuses, right-sided mastoid air cells, and middle\near cavities are clear. The orbits demonstrate no acute abnormalities.", + "output": "No acute intracranial process. No intracranial hemorrhage." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nacute major vascular territorial infarction. Mild periventricular white\nmatter hypodensities are nonspecific but likely sequela of mild chronic small\nvessel ischemic disease in this age group. There is unchanged mild prominence\nof the ventricles and sylvian fissures, likely age-related.\n\nThere is no evidence of fracture. There is mild mucosal thickening within the\nleft frontoethmoidal recess and bilateral anterior ethmoid air cells. There\nis also minimal mucosal thickening in the left posterior ethmoid, trace\naerosolized secretions and trace fluid in the left sphenoid, and tiny mucous\nretention cyst with trace adjacent secretions in the right sphenoid sinuses. \nPartially imaged maxillary sinuses appear clear. Middle ear cavities and\nmastoid air cells appear clear. Status post right cataract surgery.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. Mild inflammatory changes in the paranasal sinuses, as detailed above." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect. There is prominence of the lingual and palatine tonsils\nwith some striation which could reflect inflammatory change. Asymmetric\nincreased enhancement at the right tongue base, image 50 of series 3 this\ncauses some crowding of the oropharynx in combination with a medialized right\ninternal carotid artery. A hypodense structure in midline on image 3 of\nseries 52 likely represents the uvula which is crowded by the prominent\ntonsil.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears mildly bulky and heterogeneous with\nsubcentimeter nodules which do not require further imaging evaluation in the\nabsence of additional clinical concern.There is no lymphadenopathy by CT\ncriteria. The neck vessels are patent.\n\nThere is centrilobular emphysema partially imaged at the lung apices. The\nimaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.", + "output": "Prominence of the lingual and palatine tonsils which may be reactive. There\nis no definite focal fluid collection.\nAsymmetric increased enhancement at the right tongue base can be correlated\nwith direct visualization.\nSubcentimeter thyroid nodules do not require additional imaging assessment of\nthe absence of clinical concern.\nPartially imaged emphysema at the lung apices.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or older.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150.\n\nNOTIFICATION: The updated findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 9:29 am, 5 minutes\nafter discovery of the findings." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema,or mass. There\nthere is age-appropriate prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The patient is status post bilateral lens replacement\nsurgery. Otherwise, the visualized portion of the orbits are normal.", + "output": "No evidence of fracture, mass, infarction or hemorrhage." + }, + { + "input": "When compared to prior, there has been no significant interval change in size\nand configuration of the ventricles with enlargement of the lateral, third and\nfourth ventricles. The right frontal approach ventriculostomy catheter seen\nwith tip in the frontal horn of the left lateral ventricle. There is no\nintra-axial or extra-axial hemorrhage, mass, midline shift, or acute vascular\nterritorial infarct. Gray-white matter differentiation is preserved. \nPeriventricular and subcortical white matter hypodensities are similar in\nappearance compared to prior. Atherosclerotic calcifications seen within the\nintracranial ICAs bilaterally.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "Ventriculostomy catheter in place. Stable appearance of the enlarged\nventricular system, unchanged over multiple priors." + }, + { + "input": "When compared to most recent prior, there has been slight interval decrease in\nthe size of the enlarged lateral, third, and fourth ventricles. The right\nfrontal approach ventriculostomy catheter is again seen with tip in the\nfrontal horn of the left lateral ventricle. There is no intra-axial or\nextra-axial hemorrhage, mass, midline shift, or acute vascular territorial\ninfarct. Gray-white matter differentiation is preserved. Periventricular and\nsubcortical white matter hypodensities are similar in appearance compared to\nprior study and likely reflect the sequela of small vessel chronic ischemic\ndisease. Atherosclerotic calcifications seen within the intracranial ICAs\nbilaterally.\n\nThe orbits are unremarkable. Included paranasal sinuses and mastoids are\nclear. Skull and extracranial soft tissues are unremarkable.", + "output": "1. Stable Right frontal approach ventriculostomy catheter with tip in the\nfrontal horn of the left lateral ventricle.\n2. Interval slight decrease of ventriculomegaly as described.\n3. Grossly stable, probable small vessel ischemic changes as described." + }, + { + "input": "There has been a slight increase in ventricular caliber since the study of ___. There are no other significant changes. Again seen is a right\nfrontal approach shunt catheter that terminates in the frontal horn of the\nleft lateral ventricle. Again seen is dilatation of the third and lateral\nventricles. There is no evidence of mass, hemorrhage or infarction. \nCavernous carotid arterial calcification is again seen and unchanged.", + "output": "Slight increase in ventricular caliber since ___.\nOtherwise unchanged appearance of hydrocephalus with left frontal ventricular\nshunt in place." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nThe mastoid air cells and middle ear cavities are well aerated. The bony\ncalvarium is intact. Right frontal sinus near complete opacification with\nareas of calcification are noted.\n\nLeft parietal scalp subcutaneous hematoma and emphysema are noted.", + "output": "1. No acute hemorrhage or fracture.\n2. Left parietal scalp hematoma and laceration.\n3. Right frontal chronic and / or fungal sinusitis." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nSOFT TISSUES: There is no stranding, fluid collection, hematoma, or other\nsoft tissue abnormality.\n\nMAXILLOFACIAL BONES: The maxillofacial bones are intact, without fracture.\nThe zygomatico-maxillary complex is intact. The lateral pterygoid plates are\nintact.\n\nMANDIBLE: The mandible is without fracture or temporomandibular joint\ndislocation. Asymmetric flattening of the left mandibular condyle with\nsubchondral cysts is noted (see 602 B: 128- 140) is noted, without definite\nfracture identified.\n\nDENTITION: There are no dental fractures. There is no remarkable periodontal\ndisease, periapical lucency, or odontogenic abscess.\n\nSINUSES: There is complete opacification of right frontal sinus with a small\ninternal ossified structure which may reflect an osteoma. Otherwise that\nparanasal sinuses are intact and clear. The ostiomeatal units are patent. The\nmastoid air cells and middle ear cavities are clear.\n\nNOSE: There is no nasal bone fracture. Nasopharyngeal soft tissues are\nunremarkable. There is no nasal septal hematoma.\n\nORBITS: The orbits, including the laminae papyracea, are intact. The globes\nare intact with non-displaced lenses and no intraocular hematoma. There is no\npreseptal soft tissue edema. There is no retrobulbar hematoma or fat\nstranding.", + "output": "1. Dental amalgam streak artifact limits study.\n2. No definite acute maxillofacial bone fracture.\n3. Left mandibular condyle probable degenerative changes versus chronic\nfracture, with no definite evidence of acute fracture.\n4. Probable right frontal sinus osteoma.\n5. Right frontal sinus disease as described.\n6. Please see noncontrast head CT from same day for description of\nintracranial and calvarial structures." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute infarction,hemorrhage,edema,ormass. The\nventricles and sulci are normal in size and configuration.\n\nThere is mild mucosal thickening in the maxillary sinuses and anterior ethmoid\nair cells. Mastoid air cells are clear. The visualized portion of the orbits\nare normal.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. The dural venous\nsinuses are patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion.\n\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No acute intracranial abnormality on noncontrast CT head.\n2. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n3. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. Prominent dural\ncalcifications are incidentally noted.\n\nThere is no evidence of fracture. There is mucosal thickening of the right\nsphenoid sinus. Otherwise, the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable. Soft tissue swelling overlying the right\noccipital calvarium.", + "output": "No acute intracranial abnormality. Soft tissue stranding, potentially small\nscalp hematoma overlying the occipital bone." + }, + { + "input": "There is no evidence of acute major infarction,hemorrhage,edema,or discrete\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular white matter hypodensities are\nnonspecific but may reflect the sequelae of chronic microvascular ischemic\ndisease.\n\nThere is no evidence of fracture. There is mild mucosal sinus thickening of\nthe anterior and posterior ethmoid air cells. Otherwise, the visualized\nportions of the remaining paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are notable for\nbilateral lens replacements..", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of new large territorial infarction,hemorrhage,edema,or\nmass.\n\nAgain seen are multiple hypodensities scattered throughout the brain,\nconsistent with known septic emboli and better seen on prior MR from ___. There is mild associated surrounding edema. There is a possibly new\nhypodensity in the anterior limb of the left internal capsule, measuring 0.6 x\n0.4 cm (series 2/image 17).\n\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. There is periventricular and subcortical white matter hypodensity,\nwhich is nonspecific, but likely represents chronic microvascular ischemic\nchanges.\n\nThere is no evidence of fracture. There is minimal mucosal thickening of the\nbilateral maxillary sinuses and opacification of some of the anterior\nethmoidal air cells. Otherwise, the visualized portion of the paranasal\nsinuses, and middle ear cavities are clear. There is a partially visualized\nnasoenteric tube. There is near complete opacification of the bilateral\nethmoid air cells, similar to ___. The patient is status post right\nlens replacement. Otherwise, the visualized portion of the orbits are\nunremarkable.", + "output": "1. No evidence of intracranial hemorrhage.\n2. Compared to MRI brain dated ___, stable appearance of multiple\nhypodensities scattered throughout the brain, consistent with known septic\nemboli and associated with mild surrounding edema.\n3. There is a possibly new 0.6 cm hypodensity in the anterior limb of the left\ninternal capsule, which may represent a new infarction. Given motion\ndegradation of the MRI, this may have been present on ___, but poorly\nvisualized or it is a new finding." + }, + { + "input": "No fractures are identified.\nThere is no evidence of facial swelling.\nThere is mild mucosal thickening of the ethmoid air cells with fluid\nopacification of a single left ethmoid air cell (02:40). There is also mild\nmucosal thickening of the bilateral sphenoid sinuses. The remainder of the\nvisualized paranasal sinuses are well aerated.\nThere is no evidence of abnormal fluid collections.\nBilateral mastoids appear normal.\nPatient is status post right lens replacement. The globes, extraocular\nmuscles, optic nerves, and retrobulbar fat appear normal.\nThe visualized upper aerodigestive tract appears normal.\nThe mandible and temporomandibular joints appear normal. There is a\nperiapical lucency around the most medial right mandibular tooth. The\nmandibular central incisors, bilateral first through third mandibular molar,\nand bilateral maxillary premolar and molar teeth are absent (2:163). The\nright first maxillary molar tooth remains in situ.\n\nEndotracheal tube and enteric tube are visualized in situ.", + "output": "1. Multiple absent mandibular and maxillary teeth as described above. \nPeriapical lucency around the medial most right mandibular tooth.\n2. Mild paranasal sinus disease as described above." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of large territorial infarction, intracranial hemorrhage,\nedema, or mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Subcortical and periventricular white matter\nhypodensities are nonspecific, but likely reflect the sequela of chronic small\nvessel ischemic disease.\n\nThere is no fracture. The visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits demonstrate prior lens surgery and are otherwise normal.\n\nCTA HEAD:\nMild calcified atheromatous plaque is seen in the intracranial internal\ncarotid arteries bilaterally without stenosis. The vessels of the circle of\n___ and their principal intracranial branches appear normal without\nstenosis, occlusion, or aneurysm. The dural venous sinuses are patent.\n\nCTA NECK:\nThere's atherosclerotic calcification of the aortic arch with a combination of\ncalcified and soft plaque material (series 3, image 1), atherosclerosis,\ntortuosity of the left subclavian artery and brachiocephalic trunk. Bilateral\ncarotid and vertebral artery origins are patent. There is no evidence of\ninternal carotid stenosis by NASCET criteria.The carotidandvertebral arteries\nand their major branches appear normal with no evidence of stenosis or\nocclusion.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is normal. There is no lymphadenopathy by CT size criteria. \nMultilevel degenerative change of the visualized cervicothoracic spine with\nendplate sclerosis, intervertebral disc space narrowing, osteophytosis and\nfacet hypertrophy. There's approximately 2 mm of anterolisthesis of C7 on T1.", + "output": "1. There is no evidence of acute intracranial process or hemorrhage. Mild\nglobal atrophy with chronic small vessel ischemic disease.\n2. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n3. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is a hypodensity in the right posterior cerebellum measuring\napproximately 3.8 x 1.7 cm with mass effect on the fourth ventricle without\nevidence of hydrocephalus (2; 8) and may reflect vasogenic edema from an\nadjacent mass and less likely an infarct. MR is recommended for further\nevaluation.\n\nThere is no evidence of acute intracranial hemorrhage.\n\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is a 4 mm bilobed aneurysm at the junction of left A1 segment and the\nanterior communicating artery oriented anteriorly and inferiorly. The rest of\nthe circle of ___ and its principal branches do not demonstrate evidence of\nstenosis, occlusion, dissection, or aneurysmal formation of greater than 2-3\nmm.\n\nThe dural venous sinuses are patent.\n\nCTA NECK:\nThe vertebral arteries and their major branches appear normal with no evidence\nof stenosis or occlusion. There is a dominant left vertebral artery. There\nis a mild amount of atherosclerotic calcifications at the bilateral carotid\nbifurcations without significant stenosis. There is no evidence of significant\ninternal carotid stenosis by NASCET criteria bilaterally.\n\nOTHER:\nThere is a 1.0 cm right thyroid lobe hypodense nodule again noted. Right upper\nhilar 2.0 cm mass again noted with enlarged right hilar and right paratracheal\nnodes, better seen on recent CT chest ___.", + "output": "1. Hypodense region within the right posterior cerebellum with mass effect on\nthe fourth ventricle, more likely to be vasogenic edema from adjacent mass\nrather than an infarct. MR recommended for further evaluation. No\nhydrocephalus.\n2. 4 mm anterior communicating artery aneurysm.\n3. Bilateral mild atherosclerotic calcifications at the carotid bifurcations\nwithout significant stenosis.\n4. 1.0 cm right thyroid lobe hypodense nodule.\n5. Right upper hilar mass and hilar lymphadenopathy better evaluated on recent\nchest CT.\n\nRECOMMENDATION(S): MR brain with and without contrast." + }, + { + "input": "There has been interval right occipital craniectomy with mesh reconstruction. \nInterval resection of right cerebellar mass. Minimal blood products\nmarginates surgical cavity. There is no parenchymal hematoma. Previously\nseen additional left cerebellar lesion is not as well seen. Surrounding\ncerebellar edema is similar. Significant effacement of the fourth ventricle\nhas mildly improved. Mildly improved mass effect on the brainstem. There is\nno hydrocephalus. There is mild intracranial pneumocephalus. There is no\nevidence of infarction, hemorrhage, edema, or mass. The ventricles and sulci\nare normal in size and configuration.\n\nThere is no evidence of fracture. There is trace opacification at the right\nmaxillary sinus. Otherwise, the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "Interval resection of right cerebellar mass, minimal blood products\nmarginating surgical cavity. Minimally improved posterior fossa mass effect. \nNo hydrocephalus." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Normal head and neck CTA." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is a small area of right frontal\nscalp thickening that may represent a tiny posttraumatic hematoma or perhaps a\nremnant of the right frontal hematoma seen in ___. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "Normal study." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Normal study." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is evidence of a prior nasal bone fracture. There is an air-fluid level\nin the right maxillary sinus with extensive opacification of the ethmoid air\ncells extending into the inferior frontal sinuses, aerosolized secretions in\nthe left sphenoid sinus, and mild left maxillary sinus mucosal thickening. \nThe visualized portions of the mastoid air cells and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. No evidence of acute intracranial abnormality.\n2. Severe paranasal sinus disease including aerosolized secretions and an\nair-fluid level in the right maxillary sinus raising the possibility of an\nacute sinusitis. However, if there is concern for facial injury, consider\nfacial CT.\n\nRECOMMENDATION(S): Facial CT if there is concern for facial injury." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, mass, mass effect or\nlarge territorial infarction. Prominent ventricles and sulci are likely\nrelated to age related involutional changes. Periventricular and deep\nsubcortical white matter hypodensities are likely related to chronic small\nvessel ischemic disease. The basilar cisterns are patent, and there is\notherwise preservation of the gray-white matter differentiation.\n\nThere is mild mucosal thickening of the ethmoid air cells. Otherwise, the\nvisualized paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The globes are unremarkable. Atherosclerotic calcifications are seen\nwithin the cavernous carotid arteries.", + "output": "No acute intracranial abnormalities identified." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nThere is no evidence of fracture. There is minimal mucosal thickening of the\nright maxillary sinus. The remaining visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Note is made of atherosclerotic\ncalcification of the internal carotid arteries bilaterally.", + "output": "No acute intracranial process." + }, + { + "input": "No intra-axial or extra-axial hemorrhage, edema, shift of normally midline\nstructures, or evidence of acute major vascular territorial infarction. \nPeriventricular and subcortical white matter hypodensities are likely sequelae\nof chronic small vessel ischemic disease. There is prominence of the\nventricles and sulci suggestive of involutional changes.Single punctate\nhyperdensity within the right posterior parietal lobe (02:21) is noted, likely\na focal calcification.\n\nThere is no acute fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable. Calcification of the cavernous portions of\nthe internal carotid arteries noted.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass. A single punctate microcalcification is re- demonstrated within the\nposterior right parietal lobe (series 2, image 22). Subcortical, deep, and\nperiventricular white matter hypodensities are nonspecific, but likely\nrepresent the sequela of chronic microvascular ischemic disease. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nAtherosclerotic vascular calcifications are noted of bilateral cavernous\nportions of internal carotid arteries.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. No evidence acute intracranial hemorrhage or fracture.\n3. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described." + }, + { + "input": "Sequences are mildly degraded by motion artifact. There is no evidence of\ninfarction, hemorrhage, edema, or mass. The ventricles and sulci are\nprominent in keeping with global generalized volume loss. Patchy and\nconfluent subcortical, deep and periventricular white matter hypodensities are\nnonspecific but likely represent chronic microvascular ischemic change. \nCalcification of the cavernous carotid arteries are again noted.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality. Extensive chronic microvascular ischemic\nchange." + }, + { + "input": "The study is mildly degraded by motion artifact. Within this limitation,\nthere is no evidence of acute territory infarction,hemorrhage,edema, or mass. \nAs on prior, there is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular, subcortical, and deep white matter\nhypodensities are nonspecific, but may reflect sequela of chronic ischemic\nsmall vessel disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Atherosclerotic calcifications of the\ncavernous carotid arteries are noted.", + "output": "No acute intracranial abnormality. No acute hemorrhage or calvarial fracture." + }, + { + "input": "Interval decrease in the left soft tissue swelling of the oropharynx and\nhypopharynx. There has been a decrease in the size of the previously seen\nsoft tissue hypodensity adjacent to the left medial pterygoid muscle,\ncurrently measuring 2 x 1 cm. Small left ___ tonsillar calcification is\nagain seen. Bilateral cervical lymph nodes, likely reactive. Airway is\npatent. Interval decrease in the soft tissue swelling of the left\naryepiglottic fold.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal.The neck vessels are patent.\n\nBilateral pleural effusions, not seen in the prior CT. There are no\nconcerning pulmonary nodules. There are no osseous lesions.", + "output": "1. Interval improvement of the soft tissue swelling and asymmetry of the left\noropharynx and hypopharynx, with decrease in size of the peritonsillar\nphlegmon, most likely resolving. An abscess formation cannot be excluded, so\nclinical correlation is needed.\n2. Interval appearance of bilateral pleural effusions." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction, mass or midline\nshift. There is no hydrocephalus. Visualized paranasal sinuses and mastoid\nair cells are clear. There is no fracture. There are two small right frontal,\none right occipital, and larger left frontotemporal scalp contusions.", + "output": "Several small scalp contusions within larger left frontotemporal scalp\ncontusion. No evidence of acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute, large territory infarction. There is no\nevidence of acute hemorrhage,edema,or mass. The ventricles and sulci are\nnormal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No evidence of acute intracranial abnormality." + }, + { + "input": "Again demonstrated are findings of left hemitongue denervation with\nfatty replacement. There is no focal mass to suggest local recurrence of\ntumor.\n\nThe previously metastatic right level 2 lymph node appears similar to the most\nrecent examination, measuring approximately 8 mm in diameter.\n\nThe previously metastatic left level 2 lymph node is also similar to prior,\nmeasuring approximately 7 mm in diameter. \n\nThere is no suspicious new lymphadenopathy.\n\nPost-radiation changes within the anterior neck are similar to prior with\nedematous changes within the fat of the anterior neck and adjacent\nmusculature. \n\nThere are no suspicious osseous lesions. Degenerative change to the spine are\nagain demonstrated. There are no suspicious lesions with in the lung apices. \n\n\nIncidentally noted are scattered regions of paranasal sinus mucosal\nthickening.", + "output": "Overall similar to the prior examination with post-treatment\nchanges, but no evidence of recurrence." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of large vascular territory infarction, hemorrhage,\nedema, or mass. Ventricles and sulci are prominent, consistent with advanced\nage-related global parenchymal loss. Subcortical, periventricular and deep\nwhite matter hypodensities are nonspecific, but likely reflect the sequela of\nchronic microangiopathic ischemic disease.\n\nThere is no fracture. The visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portions of the\norbits are normal.\n\nCTA HEAD:\nThere are extensive atherosclerotic calcifications of the carotid siphons with\nmultifocal stenoses, ranging from mild to moderate. The vessels of the circle\n___ and their principal intracranial branches appear normal without\nocclusion or aneurysm. The dural venous sinuses are patent. The venous\nstructures of the neck are not opacified, limiting evaluation.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThere are areas of mild luminal irregularity within the right common carotid\nartery, likely related to noncalcified atherosclerotic plaques. Incidental\nnote of medialization of the right cervical ICA. Otherwise, the\ncarotidandvertebral arteries and their major branches appear normal with no\nevidence of stenosis or occlusion.\n\nOTHER:\nThere are scattered ground-glass opacities and septal thickening in keeping\nwith the patient's history of heart failure. There is diffuse mediastinal\nlymphadenopathy in keeping with the patient's history of T-cell leukemia. The\nvisualized portion of the thyroid gland is within normal limits. There are\nretained secretions within the oropharynx and a partially visualized\nnasogastric tube in the left naris. There is a pacemaker in the left\nprepectoral space with leads partially visualized.", + "output": "1. There is no evidence of large vascular territory infarction, hemorrhage,\nedema, or mass.\n2. Patent circle of ___ without evidence of high-grade\nstenosis,occlusion,or aneurysm greater than 3 mm. There are extensive\natherosclerotic calcifications of the carotid siphons with multifocal stenoses\nranging from mild to moderate.\n3. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection. Mild atherosclerosis of the right\ncommon carotid artery.\n4. Diffuse mediastinal lymphadenopathy in keeping with the patient's history\nof T-cell leukemia.\n5. Scattered ground-glass opacities and septal thickening, which may reflect\ndegree of heart failure exacerbation." + }, + { + "input": "There is no evidence of fracture, acute large territory\ninfarction,hemorrhage,edema,or mass effect. The ventricles and sulci are\nnormal in size and configuration.\n\nThe anterior ethmoid air cells are partially opacified. Otherwise, the\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear.", + "output": "No acute intracranial abnormality." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are normal.\n\nCTA HEAD:\nAn intravascular stent is demonstrated within the right carotid siphon and\nappears patent. The vessels of the circle of ___ and their principal\nintracranial branches appear normal without stenosis, occlusion, or aneurysm. \nThe dural venous sinuses are patent.\n\nThere is persistent luminal narrowing of the right V4 vertebral artery (series\n3, image 239, 242), as seen on the prior MRI. Overall unchanged in extent. No\nis calcification demonstrated.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent. There is no\nevidence of internal carotid stenosis by NASCET criteria. The\ncarotidandvertebral arteries and their major branches appear normal with no\nevidence of stenosis or occlusion.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No acute intracranial abnormality. No evidence of an acute stroke,\nhemorrhage, or mass\n2. Focal narrowing of the right intradural V4 segment of the vertebral artery,\nalso noted on prior MRI. Otherwise unremarkable CTA of the head and neck." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No evidence of intracranial hemorrhage or acute large territorial infarct. \nEvaluation for acute infarction is limited on CT." + }, + { + "input": "CT HEAD:\nThere is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass effect. Periventricular and subcortical white matter hypodensities\nare nonspecific, but likely reflect sequelae of chronic small vessel ischemic\ndisease. Prominence of the ventricles and sulci suggest involutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is moderate atherosclerotic calcification of the petrous ICAs\nbilaterally. Heavy carotid siphon calcification is also noted. Moderate\ncalcification at the origin of the of the supraclinoid ICAs bilaterally is\nnoted.\n\nThere is mild irregularity of the right P2 segment.\n\nDiffuse moderate to severe irregularity of the right intracranial vertebral\nartery compatible with atherosclerotic disease. Near occlusion of the right\nvertebral artery near the bifurcation. The left vertebral artery appears\nwidely patent.\n\nThe dural venous sinuses are patent.\n\nMultiple enhancing lesions are noted in the parotid glands, the largest no\nmeasures 1.5 x 2.0 cm in the right parotid gland (4:216).\n\nCTA NECK:\nThere is moderate atherosclerotic plaque at the aortic arch and origin of the\ngreat vessels.\n\nThe right common carotid artery is severely narrowed secondary to\natherosclerotic plaque at its origin. There is mild calcification and\nnarrowing at the distal right common carotid artery. There is no stenosis of\nthe right cervical internal carotid artery by NASCET criteria. The distal\ncervical segment of the right ICA is ectatic (4:220).\n\nThe left common carotid artery is mildly narrowed by atherosclerotic plaque. \nMild atherosclerotic plaque is seen the mid segment of the left common carotid\nartery. There is heavy atherosclerotic calcification at the left carotid bulb.\nThere is moderate narrowing at the origin of the left internal carotid artery.\nThere is short segment narrowing of the distal cervical segment of the left\ninternal carotid artery secondary to calcified and noncalcified plaque with\napproximately 60% stenosis by NASCET criteria.\n\nThe right vertebral artery is diffusely occluded by heavy atherosclerotic\nplaque with distal reconstitution at the right V3 segment (4:212). There is\nsevere narrowing of the right V4 segment secondary to atherosclerotic plaque.\n\nThe left vertebral artery is widely patent with the exception of mild\nnarrowing focally of the left V4 segment secondary to atherosclerotic\ncalcification.\n\nOTHER:\nLarge bilateral pleural effusions are partially imaged. Interlobular septal\nthickening and fluid in the fissures is compatible with volume overload.\nModerate paraseptal emphysema is noted in the lung apices.\n\nMultiple enlarged mediastinal lymph nodes are noted measuring up to 1.7 cm.\n\nThe visualized portion of the thyroid gland is within normal limits.\n\nNo suspicious osseous lesions.", + "output": "1. There is short segment narrowing of the distal cervical segment of the left\ninternal carotid artery secondary to calcified and noncalcified plaque causing\napproximately 60% stenosis by NASCET criteria. There is no right cervical\ninternal carotid artery stenosis by NASCET criteria.\n2. Diffuse right cervical vertebral artery occlusion with reconstitution at\nthe right V3 segment appears chronic. The intracranial right vertebral artery\nis diffusely narrowed secondary to atherosclerotic disease.\n3. Atherosclerotic calcification of the intracranial circulation is\nidentified, most prominently noted of the right vertebral artery, with severe\nstenosis near its junction with the basilar. The remainder of the\nintracranial circulation demonstrates no high-grade stenosis, occlusion or\naneurysm.\n4. Multiple enhancing lesions in the parotid glands, the largest measure 1.5 x\n2.0 cm in the right parotid gland. Findings likely represent bilateral\nWarthin's tumors. These can be further evaluated with ultrasound.\n5. Mediastinal lymphadenopathy partially imaged measuring up to 1.7 cm.\n6. Large bilateral pleural effusions." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates an area of mass effect at\nthe left piriform sinus and left hypopharynx extending to the level of the\ntrue vocal cords. Overall this appears less prominent compared to the prior\nstudy and may be related to treatment effect.\n\nThere is nonspecific increased density at the right superficial lobe of the\nparotid gland with extension to the skin and obliteration of the subcutaneous\nfat. This is not well evaluated by this modality. The bilateral external\nauditory canals are maintained.\n\nThe left parotid and remaining salivary glands enhance normally and are\nwithout mass or adjacent fat stranding. The thyroid gland appears normal.\nThere is no lymphadenopathy by CT criteria. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.Multilevel degenerative\nchanges with mild anterolisthesis of C5 on C5.", + "output": "1. Soft tissue fullness without definite discrete mass at the right\nsuperficial parotid lobe extending to the skin, not well evaluated by this\nmodality. No lymphadenopathy.\n2. Fullness of the left hypopharynx, decreased compared to the prior study. \nThis may be related to treatment effect.\n\nRECOMMENDATION(S): Parotid MRI is recommended for further evaluation of the\nright parotid gland and adjacent soft tissues.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 16:50 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." + }, + { + "input": "There is no evidence of fracture, hemorrhage, edema, mass effect, or\ninfarction. The ventricles and sulci are normal in size and configuration.\nThere is a small forehead hematoma. The imaged paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear.", + "output": "Small forehead hematoma, without underlying fracture, or acute intracranial\nprocess." + }, + { + "input": "CTA HEAD:\nPreviously seen sellar and suprasellar mass displaces the terminal internal\ncarotid arteries laterally and the A1 segment of the right anterior cerebral\nartery anteriorly. The A1 segment of the left anterior cerebral artery is\nvery diminutive and the remainder of the left anterior cerebral artery is\nsupplied from the contralateral side by the anterior communicating artery. \nThe vessels of the circle of ___ and their principal intracranial branches\notherwise appear normal with no evidence of stenosis, occlusion, or aneurysm.\nThe dural venous sinuses are patent.\n\n\nExpansion of the sella turcica relates to known sellar/suprasellar mass,\nbetter evaluated on the recent MR examination of ___. There is no\nevidence of infarction, hemorrhage, or shift of normally midline structures. \nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No evidence of suspicious focal flow-limiting stenosis, or aneurysm in the\nanterior and posterior circulations.\n\n2. Sellar/suprasellar mass is better evaluated on recent MRI examination." + }, + { + "input": "Postoperative changes are identified within the sella and sphenoid sinus. For\nless in the suprasellar region due to previously identified mass on CT\nangiography of ___ appears to have decreased. No subarachnoid or\nintracranial hemorrhage is seen. No hydrocephalus.", + "output": "Postoperative changes in the sella. Small amount of barium expected\npostsurgical changes are seen. No intracranial hemorrhage or hydrocephalus." + }, + { + "input": "Images are limited by motion artifact.\n\nThe patient is status post right frontal craniotomy. Mild pneumocephalus is\npresent. There is an extra-axial collection of blood and foci of air deep to\nthe craniotomy, measuring up to 9 mm from the inner table. There is minimal\nadjacent right frontal sulcal effacement.\n\nThere are parenchymal foci of blood in the right occipital and parietal lobes\nwith mild surrounding edema. There is also bilateral sulcal subarachnoid\nhemorrhage, right greater than left. There is also subarachnoid hemorrhage in\nthe right sylvian fissure and bilateral suprasellar cistern.\n\nThere is new leftward shift of midline structures, measuring approximately 5\nmm. There is effacement of the lateral and third ventricles compared to the\npresurgical study, effacement of the basal cisterns , and possible mild right\nuncal herniation.\n\nFat packing and blood within n the hypoplastic sphenoid sinuses are consistent\nwith postsurgical change. A defect is again seen in the posterior wall of the\nsphenoid sinuses secondary to prior transsphenoidal resection. Severe\nopacification of the ethmoid air cells has increased from the pre-surgical CT.\nThere is moderate mucosal thickening in the maxillary sinuses with\nsuperimposed layering secretions, compared to only fluid in the maxillary\nsinuses on the pre-surgical CT. The ethmoid and maxillary sinus findings are\nlikely secondary to the recent surgery and supine positioning.", + "output": "1. New foci of parenchymal hemorrhage within the right occipital and inferior\nparietal lobes with mild surrounding edema, etiology uncertain. New\nsubarachnoid hemorrhage within right greater than left sulci, as well as in\nthe right sylvian fissure and bilateral suprasellar cistern.\n2. Status post right frontal craniotomy with extra-axial hematoma measuring up\nto 9 mm and mild effacement of the adjacent right frontal sulci.\n3. New leftward shift of midline structures. New effacement of the lateral\nand third ventricles, and of the basal cisterns. Possible mild right uncal\nherniation.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:10 ___, 2 minutes after\ndiscovery of the findings." + }, + { + "input": "The study is limited by motion artifact as well as artifact from the patient's\nprotective eye goggles, even though images were repeated.\n\nThe patient is status post right craniotomy. Right front subdural collection\ndeep to the craniotomy measures 12 mm in maximal wet compared to 9 mm\npreviously, and demonstrates increased density of blood products, indicating\ninterim rebleeding. There is slightly increased right frontal sulcal\neffacement.\n\nThere is also increased hyperdense subdural blood along the tentorium, right\ngreater than left.\n\nRight greater than left subarachnoid hemorrhage along the convexities, and\nsubarachnoid hemorrhage in the right sylvian fissure, is not significantly\nchanged.\n\nRight occipital and inferior parietal parenchymal hemorrhages with surrounding\nedema are not significantly changed\n\nLeftward shift of midline structures measures approximately 7 mm on image 7:17\ncompared to approximately 5 mm previously at the same level. The lateral and\nthird ventricles, and the basal cisterns, remain effaced. Mild right uncal\nherniation is probably present, similar to prior.\n\nHyperdense material fat packing are again seen in the hypoplastic sphenoid\nsinuses, as well as a defect in the posterior walls of the sphenoid sinuses,\nconsistent with prior transsphenoidal resection of a suprasellar mass. There\nis moderate mucosal thickening and secretions in bilateral maxillary sinuses,\nas well as mucosal thickening and fluid/secretions severely opacifying the\nethmoid air cells, similar to prior.", + "output": "1. Motion limited exam.\n2. Increased size and density of the right frontal subdural hematoma deep to\nthe right craniotomy, with increased right frontal sulcal effacement and\nslightly increased leftward shift of midline structures.\n3. Unchanged right occipital and inferior parietal parenchymal hemorrhages\nwith surrounding edema. Unchanged right greater than left subarachnoid\nhemorrhage.\n4. Unchanged effacement of the supratentorial ventricles and of the basal\ncisterns with probable and mild right uncal herniation.\n5. Postsurgical changes are again seen in the sphenoid sinuses.\n\nNOTIFICATION: The findings were discussed with ___, P.A. , and\n___, N.P. by ___, M.D. on the telephone on ___ at\n9:40 AM, 30 minutes after discovery of the findings. Dr. ___ paged Ms.\n___ 5 minutes after discovery of the findings, but Ms. ___ could not be\nreached earlier. However, Ms. ___ and Ms. ___ both stated that Dr.\n___ was already aware of the findings." + }, + { + "input": "NECT: Patient is status post right craniotomy, with postsurgical changes\nincluding a stable degree of pneumocephalus, soft tissue swelling and\nsubcutaneous emphysema. The hyperdense extra-axial fluid collection overlying\nthe right frontal convexity, intraparenchymal hemorrhage in the right\nparieto-occipital white matter appears stable, and diffuse subarachnoid\nhemorrhage also appear unchanged from noncontrast head CT ___. The\nlateral and third ventricles are almost completely effaced, as are the basal\ncisterns, which is unchanged. There is 5.5 mm of leftward midline shift, which\nis stable from prior.\n\nPostsurgical changes from transsphenoidal surgery are also noted. There\ncontinues to be hypodense material in the sphenoid sinus, consistent with\nrecent transsphenoidal surgery There continues to be moderate mucosal\nthickening in the bilateral maxillary sinuses and fluid filling the ethmoid\nair cells. Visualized portions of the orbits appear normal.\n\nCTV: Study is degraded by contrast bolus timing. There are minimal filling\ndefects in the left sigmoid dural venous sinus, which appears consistent with\narachnoid granulation. Additionally, the left transverse sinus is likely\naplastic, consistent with MP RAGE in the ___ brain MRI. Distal\nfilling is preserved.", + "output": "1. Stable right parieto-occipital intraparenchymal hemorrhage, diffuse\nsubarachnoid hemorrhage and right frontal subdural hemorrhage. There is a\nstable amount of leftward midline shift.\n2. Study is degraded by contrast bolus timing. Within this confines: Small\nfilling defects seen in the left mid sinus likely represent arachnoid\ngranulations. Distal filling is preserved. If there remains concern for\nvenous sinus thrombosis, consider obtaining a contrast enhanced MRV.\n3. Stable right craniotomy postoperative changes with an unchanged degree of\npneumocephalus, soft tissue swelling and subcutaneous emphysema.\n\nRECOMMENDATION(S):\nWithin above described technical limitations, small filling defects seen in\nthe left mid sinus likely represent arachnoid granulations. Distal filling is\npreserved. If there remains concern for venous sinus thrombosis, consider\nobtaining a contrast enhanced MRV." + }, + { + "input": "Overlying hardware streak artifact limits examination.\n\nPatient is post right craniotomy, with expected postsurgical changes and\nresolving pneumocephalus. The extra-axial fluid collection overlying the\nright frontal convexity measures approximately 6 mm in thickness, previously 8\nmm (3:19).\n\nNonspecific right frontal hypodensity is noted (see 03:11), better visualized\non current examination, and may been present on ___ prior CTA (see\n03:13 on prior CTA).\n\nCompared with the most recent study, diffuse subarachnoid hemorrhage is\nevolving, while the known intraparenchymal hemorrhage involving the right\nparieto-occipital white matter is stable in size, approximately 3.4 cm (3:18).\nThere appears to be an increased amount of edema associated with this\nintraparenchymal hemorrhage, indicated by surrounding hypodensity. In\naddition, there is increased leftward shift of normally midline structures\nmeasuring approximately 9 mm, compared with 6 mm previously (3:15). Again,\nthe third ventricle appears almost completely effaced, similarly with the\nbasal cisterns, unchanged. The left lateral ventricle appears more open when\ncompared with the prior study.\n\nMixed density collection underlying the incision site is slightly larger than\nthe prior study, with a small amount of subcutaneous emphysema (there is\nthickening of the bilateral maxillary sinuses with complete opacification of\nthe sphenoid sinuses. 3:13). The visualized portion of the remaining\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Overlying hardware streak artifact limits examination.\n2. Interval increase edema surrounding right parieto-occipital\nintraparenchymal hemorrhages, with increased leftward midline shift up to 9 mm\n(previously 6 mm on ___.\n3. Grossly stable extra-axial fluid collection overlying right frontal\nconvexity.\n4. Grossly stable evolving diffuse subarachnoid hemorrhage.\n5. Slightly larger mixed density postoperative collection underlying the\nincision site.\n6. Nonspecific right frontal hypodensity, better visualized on current\nexamination, and may been present on ___ prior CTA. While finding\nmay represent evolving postoperative changes, evolving infarct is not excluded\non the basis examination. If clinically indicated, consider brain MRI for\nfurther evaluation.\n\nNOTIFICATION: Impression items ___ were communicated via telephone by Dr.\n___ to ___ (neurosurgery NP) at 10:51 on ___, 2 min\nafter discovery." + }, + { + "input": "In comparison to the prior CT performed on ___, there has been\ninterval evolution of extensive intracranial hemorrhage. There is 6 mm\nsubdural hemorrhage layering along the right frontal lobe (06:14), extending\nposteriorly along the anterior right temporal lobe, similar to the prior study\nperformed on ___. Right parieto-occipital intraparenchymal\nhemorrhage measures 1.6 x 1.5 cm (06:16), previously 1.9 x 1.4 cm. \nPosteriorly in the right occipital lobe, the intraparenchymal hematoma\nmeasures 1.7 x 1.3 cm, little changed. Prior subarachnoid hemorrhage is no\nlonger apparent. No new hemorrhage. Surrounding edema in the right frontal\nand parietal occipital lobes are again noted.\n\nMass effect and effacement of the right lateral ventricle is stable. No\nchange in approximately 6 mm leftward shift of midline structures (06:16).\n\nNo evidence of acute vascular territorial infarction.\n\nNo acute fracture. There are postsurgical changes related to recent\ncraniotomy and transsphenoidal surgery. Extensive mucosal secretions in all\nvisualized paranasal sinuses. Mastoid air cells and middle ear cavities are\nclear. Visualized orbits are unremarkable.\n\nEvaluation of the soft tissues reveals scalp swelling along the craniotomy\nsite.", + "output": "1. No new hemorrhage or vascular territorial infarction.\n2. Stable size of 6 mm right frontal subdural hematoma, extending along the\nanterior temporal lobe.\n3. Evolving right parietal/occipital intraparenchymal hematomas.\n4. Effacement of the right lateral ventricle and 6 mm leftward shift of\nmidline structures, unchanged." + }, + { + "input": "The patient has undergone prior right frontal craniotomy and trans-sphenoidal\nsurgery with postsurgical changes noted in the sphenoid as seen previously. \nExtra-axial linear hyperdensity overlying the right frontal lobe is felt to\nrepresent postsurgical change, rather than acute hemorrhage. Encephalomalacia\nin the right parieto-occipital region represents the sequela of prior\nintraparenchymal hematomas. Previously noted right frontal subdural hematoma\nhas resolved. No acute intracranial hemorrhage, large vascular territorial\ninfarction, or edema. Previously noted shift of midline structures has\nresolved. Ventricles and sulci are normal in size configuration. The basal\ncisterns appear patent.\n\nThere is no evidence of fracture. Mucosal thickening is noted within the\nsphenoid sinuses. Remaining visualized paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The frontal sinuses are hypoplastic. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Prior right frontal craniotomy and trans-sphenoidal surgery.\n3. Right parieto-occipital encephalomalacia represents sequela of prior\nintraparenchymal hematomas." + }, + { + "input": "Again are noted grossly stable postsurgical changes related to prior right\nfrontal craniotomy and transsphenoidal surgery.\n\nThere is no evidence of acute large territorial infarct oracute intracranial\nhemorrhage.\n\nGrossly stable right parieto-occipital areas of encephalomalacia are again\nnoted.\n\nAgain seen, is an enlarged sella turcica with a heterogeneous mass in the\nsella extending into the suprasellar region and suprasellar cistern, while\nbetter evaluated on MRI from ___, in largest craniocaudal dimension the\nmass now measures 2.5 cm, previously 2.3 cm. Allowing for differences\ntechnique, ventricular size is grossly unchanged compared to ___\nprior outside exam.\n\n The visualized portion of the mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. No evidence of acute intracranial hemorrhage or acute large territorial\ninfarct.\n2. Grossly stable ventricular size compared ___ outside prior\nnoncontrast head CT.\n3. Limited visualization of patient's known heterogeneous sellar/suprasellar\nmass with question interval increase in craniocaudal dimension compared to\nprior MRI from ___. If clinically indicated, consider contrast brain MRI\nfor further evaluation" + }, + { + "input": "Again, the patient is status post right frontal craniotomy and partial\ntranssphenoidal resection of a craniopharyngioma, with stable postsurgical\nchanges.\n\nRedemonstrated is a predominantly cystic and mildly complex suprasellar mass\nmeasuring approximately 2.4 x 2.1 cm, most recently measuring 2.2 x 2.5 cm on\nthe prior CT examination. Allowing for differences in patient position, this\nmass appears unchanged in both size and morphology. Within limitations of CT,\nthere is apparent unchanged mass effect by this mass on local structures,\nincluding the optic chiasm with extension towards the right optic nerve.\n\nThere is no evidence of acute intracranial hemorrhage or large territorial\nportion. Several small areas of encephalomalacia are again noted within the\nright frontal, temporal, and occipital lobes, unchanged from the previous\nexamination.\n\nThe ventricles and sulci are normal in size and configuration. There is\npreservation of gray-white matter differentiation.\n\nThe frontal sinuses are underpneumatized. The remainder of the visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Essentially unchanged interval size morphology of a predominantly cystic\nand mildly heterogeneous suprasellar mass which today measures 2.4 x 2.1 cm\nand exerts unchanged local mass effect on the optic chiasm with extension\ntowards the right optic nerve, within confines of CT technique.\n2. No evidence for acute intracranial hemorrhage or large territorial\ninfarction.\n3. Stable postsurgical changes following previous right frontal craniotomy\nand transsphenoidal surgery." + }, + { + "input": "A 2.2 x 2.5 cm cystic lesion suprasellar lesion with mass effect on the\nsuprasellar cistern is grossly stable compared to prior MRI. There is no\nevidence of acute large territorial infarction, hemorrhage, or new mass. \nRight temporal and occipital encephalomalacia is unchanged. There is also\nencephalomalacia of the inferior right frontal lobe underlying the craniotomy,\nunchanged. The ventricles and sulci are normal in size and stable compared to\nrecent MRI.\n\nRight pterional craniotomy and transsphenoidal postsurgical changes appear\nstable. There is no acute fracture. There is mucosal thickening of the\nethmoidal air cells and bilateral sphenoid sinuses. The mastoid air cells and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "Stable appearance of 2.5 cm cystic suprasellar lesion compared to most recent\nMRI. No evidence of acute intracranial hemorrhage or hydrocephalus." + }, + { + "input": "Streak artifact from metal framework limits evaluation at the level of the\nupper cervical spine.\n\nAgain, patient is status post right frontal craniotomy and resection of\ncraniopharyngioma with postsurgical changes and re-demonstration of the 2.6 x\n2.9 cm mixed solid and cystic lesion in the suprasellar region with\nenhancement. Encephalomalacia noted in the right frontal, temporal, and\noccipital regions are unchanged from prior.\n\nThere is no evidence of infarction, or hemorrhage or midline shift. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is mild mucosal thickening of the sphenoid sinuses. The visualized\nportion of the remaining paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.\n\nPartial visualization of ET tube is seen.", + "output": "1. Streak artifact from metal framework limits evaluation at the level of the\nupper cervical spine.\n2. Re-demonstration of 2.6 x 2.9 cm mixed cystic and solid lesion in the\nsuprasellar region with enhancement.\n3. Status post right frontal craniotomy and resection of craniopharyngioma." + }, + { + "input": "Patient is status post drainage of a suprasellar cystic lesion and placement\nof a right frontal approach drainage catheter, the tip of the catheter\nterminating in superior aspect of the cyst. The cyst appears slightly\ndecreased in size, measuring 2.0 x 1.9 x 1.4 cm, compared with 2.4 x 2.1 x 1.6\ncm previously. There is minimal pneumocephalus underlying the tract catheter\ninsertion site. Small areas of encephalomalacia in the right frontal,\noccipital and temporal lobes are not significantly changed. There is no\nevidence of acute large territorial infarction,hemorrhage,or edema. The\nventricles and sulci are normal in size and configuration.\n\nAgain seen are changes related to prior right craniotomy. There are surgical\nstaples overlying the right frontal region. There is no evidence of fracture.\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Interval slight decrease size of a suprasellar cystic lesion status post\ndrainage catheter placement.\n2. No intracranial hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, ormass effect. The\nventricles and sulci are normal in size and configuration.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "CTA head: The carotid siphons are patent. The anterior and bilateral\nposterior communicating arteries are visualized. There is a fetal type right\nposterior cerebral artery. There are codominant vertebral arteries. The\nanterior and posterior circulations are patent without occlusion, dissection,\nsignificant stenosis, or aneurysm. The dural venous sinuses are patent.\n\n\nCTA neck:\nThere is a 3 vessel aortic arch. The carotid arteries are patent without\nsignificant stenosis by NASCET criteria. There are codominant, patent\nvertebral arteries. There is no evidence of occlusion, dissection, stenosis,\nor aneurysm.\n\nThe lung apices are clear. There is no fracture or osseous lesion. The\nthyroid and salivary glands are unremarkable. The pharynx, larynx, oral\ncavity, and nasal cavities are unremarkable. The masticator and\nparapharyngeal spaces are unremarkable. There is streak artifact secondary to\ndental almalgam. There is no lymphadenopathy by CT criteria.", + "output": "1. No acute intracranial abnormality.\n2. Patent head and neck vasculature." + }, + { + "input": "Dental almalgam streak artifact limits study. Within these confines:\n\nEvaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. Scattered subcentimeter\nnonspecific lymph nodes are noted throughout the neck bilaterally, without\ndefinite enlargement by CT size criteria. The neck vessels are patent. There\nis a small mucous retention cyst in the right maxillary sinus. Otherwise, the\nvisualized paranasal sinuses, mastoid air cells and middle ear cavities are\nclear. The visualized portions of brain parenchyma are unremarkable.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There is moderate multilevel degenerative changes in the\ncervical spine, most severe at the C5-C6 level, with posterior osteophyte\ncomplex at this level causing at least mild spinal canal stenosis. Probable\nhealing left T2 anterior rib fracture new compared to prior exam (see 2:5 on\ncurrent study and ___ on prior exam).", + "output": "1. Dental almalgam streak artifact limits study, especially of oral cavity.\n2. No definite CT evidence for parotitis or sialoadenitis.\n3. Moderate multilevel degenerative changes involving the cervical spine.\n4. Probable healing left T2 anterior rib fracture new compared to the prior\nexam. Recommend correlation with direct examination and trauma history, and\nattention on followup imaging.\n\nRECOMMENDATION(S):\n1. Probable healing left T2 anterior rib fracture new compared to the prior\nexam. Recommend correlation with direct examination and trauma history, and\nattention on followup imaging." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. There is partial opacification of the\nethmoid air cells bilaterally. Partial opacification of the bilateral mastoid\nair cells is also seen, and is nonspecific. The middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable. Mild\natherosclerotic calcifications of the cavernous carotid arteries.", + "output": "1. No acute intracranial abnormality.\n2. Mild paranasal sinus disease and partial opacification of the bilateral\nmastoid air cells could reflect ongoing inflammation." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction, mass or midline\nshift. There is no hydrocephalus. Mild prominence of the ventricles and sulci\nis suggestive of age related involutional change. Small areas of subcortical\nand deep white matter hypodensity are suggestive of chronic small vessel\nischemic change. The basal cisterns are patent and there is preservation of\ngray-white matter differentiation. The orbits are unremarkable.\nAtherosclerotic calcifications are noted in the carotid siphons and distal\nvertebral arteries. Visualized paranasal sinuses and left mastoid air cells\nare clear.\nSmall amount of fluid in the right mastoid air cells series 3, image 14, new\nsince the prior study. There is no fracture.", + "output": "No acute intracranial hemorrhage or mass effect.\nSmall amount of fluid in the right mastoid air cells, new since the prior\nstudy of ___.\nCorrelate clinically to decide on the need for further workup or followup." + }, + { + "input": "Head CT: There is no intra or extra-axial mass effect, acute hemorrhage or\ninfarct. Sulci, ventricles and cisterns are within expected limits given the\ndegree of age-appropriate global cerebral volume loss, which is also unchanged\nfrom prior exams. The paranasal sinuses are essentially clear. There bilateral\nlens replacements. The orbits are otherwise unremarkable. The mastoid air\ncells marrow cavities are well pneumatized and clear. No acute osseous\nabnormalities.\n\nHead and neck CTA: Incidental note is made of a 2 vessel arch, a common\nanatomic variant. Long segment beaded appearance of the bilateral distal\nextracranial internal carotid arteries from the upper cervical levels to the\nskull base is noted, compatible with fibromuscular dysplasia and similar in\nappearance to prior exam. Atherosclerotic calcification and mild stenosis of\nthe origin of the right vertebral artery. Otherwise, the contour, caliber and\ncourse of the extracranial vertebral arteries are unremarkable from their\norigins to the skullbase, noting a left dominant vertebral artery. The distal\ncervical internal carotid arteries measure 4 mm in diameter on the left and 4\nmm in diameter on the right. The proximal cervical internal carotid arteries\nmeasure 6 mm in diameter on the left and 4 mm in diameter on the right. There\nis no significant extracranial internal carotid artery stenosis by NASCET\ncriteria. There is no evidence of aneurysm formation or other vascular\nabnormality.\n\nIncidental note of a apparent azygos ACA. Otherwise, the intracranial ICA,\nMCA, PCA and their major branches are unremarkable. The remainder the\nposterior circulation, noting a dominant left vertebral artery is\nunremarkable. No evidence larger than 3 mm.\n\nOther: The lung apices demonstrates a ground-glass mosaic attenuation, which\nmay be seen in the setting of inflammatory or infectious etiology. Clinical\ncorrelation recommended. No focal nodules noted. The thyroid gland is\nunremarkable. The visualized aerodigestive tract is unremarkable. No cervical\nlymphadenopathy by CT size criteria.\n\nMild degenerative changes of the cervical spine without evidence of suspicious\nblastic or lytic osseous lesions.", + "output": "1. No evidence of intracranial hemorrhage or infarct.\n2. Again noted is beaded appearance of the distal ICA bilaterally, which\nlikely represents fibromuscular dysplasia.\n3. No evidence of intracranial aneurysm." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Brain\nparenchymal atrophy. Findings consistent with mild chronic small vessel\nischemic changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nAgain seen is a large extra-axial collection along the right cerebral\nconvexity consistent with the patient's known subdural hematoma. Components\nof mixed density with areas of hyperdensity suggest acute on chronic\nhemorrhage within the hematoma. There has been interval increase in maximum\nthickness of the hematoma now measuring up to 28 mm (series 3, image 30) from\npreviously 25 mm and mildly worsening midline shift, now measuring up to 12 mm\nfrom previously 10 mm (series 3, image 26).\nThere is unchanged effacement of the sulci along the right cerebral convexity\nand right lateral ventricle.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nNote is made of the left vertebral artery arising directly from the aortic\narch.\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nGravity dependent atelectasis in the visualized lungs. The visualized portion\nof the thyroid gland is within normal limits. There is no lymphadenopathy by\nCT size criteria.", + "output": "1. Enlarging acute on chronic right subdural hematoma now measuring up to 28\nmm in maximum thickness from previously 25 mm.\n2. Worsening midline shift now measuring 12 mm from previously 10 mm.\n3. Patent intra and extracranial vasculature without evidence of stenosis,\ndissection, occlusion or aneurysm formation." + }, + { + "input": "There are postsurgical changes from right frontoparietal craniotomy and\nevacuation of the loculated subdural hemorrhage along the right cerebral\nconvexity. A subdural drain terminates at the level of the right frontal\nlobe.\n\nPneumocephalus and new hyperdense blood products overlying the right cerebral\nconvexity measure up to 2.1 cm. The subdural hemorrhage along the right-side\nof the falx is unchanged in sized but is increased in density. There is new\nsubarachnoid hemorrhage within the left superior frontal sulcus.\n\nThere is unchanged mass-effect on the right cerebral hemisphere with partial\neffacement of the right lateral ventricle and 10 mm of leftward midline shift.\n\nThere is no evidence of infarction. There are mild periventricular white\nmatter hypodensities, which are nonspecific but may represent chronic\nmicroangiopathic changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Postsurgical changes from right frontoparietal craniotomy and evacuation of\na right cerebral convexity loculated subdural hemorrhage.\n2. Marked reduction in the volume of subdural fluid since the study of ___. Marked reduction in associated mass effect.\nNew subdural extra-axial blood products overlying the right cerebral convexity\nmeasuring up to 2.1 cm.\n3. New subarachnoid hemorrhage within the left superior frontal sulcus.\n4. No significant change in the resulting mass-effect or midline shift.\n\nNOTIFICATION: Findings were reported by ___, MD to ___,\nNP by phone on ___ at 23:05." + }, + { + "input": "Re-demonstrated are postsurgical changes following right frontotemporal\ncraniotomy with subdural drain placement for evacuation of a subdural\nhematoma. Acute blood products overlying the right frontoparietal convexity,\nand parafalcine subdural blood products are similar. Right subarachnoid\nhemorrhage is slightly increased (02:22). Leftward midline shift is slightly\ndecreased, measuring up to 8 mm. Effacement of the right lateral ventricle is\nsimilar. Basilar cisterns appear open. Subarachnoid hemorrhage layering in\nthe left frontal sulci is similar. There is new trace left intraventricular\nhemorrhage. There is no evidence of infarction.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Similar extent of acute right subdural hemorrhage following craniotomy and\ndrain placement, with interval increase in right-sided subarachnoid\nhemorrhage. Interval decrease in leftward midline shift, now measuring 8 mm\n(Previously 11 mm).\n2. Similar left subarachnoid hemorrhage.\n3. New small volume left intraventricular hemorrhage." + }, + { + "input": "Status post right craniotomy. Since the prior CT, the right subdural drain\nhas been removed. Comparison of the mixed, though predominantly hyperdense\nright subdural hematoma to the prior CT is limited by differences in patient\nhead position. The hematoma appears to measure 2.7 cm from the inner table at\nthe level of the right frontal lobe on image 3:31, unchanged when measured in\nthe same fashion on the prior study. At the level of the right parietal lobe,\nit measures 17 mm on image 3:26, also unchanged. There is less air and more\nhypodense fluid in the right subdural space compared to 1 day prior. Small\namount of prior falcine hyperdense subdural blood is stable. Leftward shift\nof midline structures measures 8 mm, unchanged. Partial effacement of the\nright lateral and third ventricles is unchanged. Stable small amount of blood\nin the occipital horn of the left lateral ventricle. No uncal herniation.\n\nLeft frontal subarachnoid hemorrhage appears stable.\n\nNo evidence for new hemorrhage or new major vascular territorial infarction.\n\nVisualized paranasal sinuses and mastoid air cells appear grossly clear.", + "output": "1. Comparison of the mixed, though predominantly hyperdense right subdural\nhematoma to the ___ CT is limited by differences in patient head\nposition. Within this limitation, no evidence for hematoma enlargement. \nThere is less air and more hypodense fluid in the right subdural space.\n2. Stable 8 mm leftward shift of midline structures. Stable partial\neffacement of the right lateral and third ventricles.\n3. Stable small amount of blood in the occipital horn of the left lateral\nventricle.\n4. Stable left frontal subarachnoid hemorrhage." + }, + { + "input": "There are postsurgical changes from right frontoparietal and evacuation of a\nright cerebral convexity subdural hemorrhage. Large residual right acute\nright hemispheric subdural hematoma is similar, measuring up to 17 mm. The\nadditional subdural hemorrhage along the falx is also unchanged. Stable small\nvolume subarachnoid hemorrhage. The scattered foci of pneumocephalus are not\nsignificantly changed. The small amount of layering hemorrhage in the\noccipital horn of the left-lateral ventricle is also unchanged. Stable 8 mm\nmidline shift to the left. Stable mild right uncal herniation. Patent\nprepontine cistern, patent foramen magnum. No hydrocephalus.\n The visualized portion of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Stable large right hemispheric subdural hematoma, small volume\nsubarachnoid hemorrhage, trace intraventricular hemorrhage. Midline shift,\nmild right uncal herniation is stable." + }, + { + "input": "Interval right hemispheric subdural hematoma evacuation, craniectomy. Midline\nshift has decreased to 5 mm. Small volume subarachnoid, intraventricular\nhemorrhage, stable. Subdural blood products layering along the falx is\nsimilar. No new or increasing hemorrhage is identified. No evidence of acute\nlarge territorial infarct. No hydrocephalus. Decreased midline shift. Drain\nin place.\n\n The visualized portion of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Interval right hemispheric subdural hematoma evacuation, with small\nresidual.\n2. Decreased midline shift.\n3. Otherwise unchanged." + }, + { + "input": "Postsurgical changes after right craniectomy with subdural hematoma\nevacuation. Slight interval increased herniation of brain parenchyma through\nthe craniectomy defect is noted. Mild interval redistribution and evolution\nof by lateral frontal subarachnoid hemorrhages. Subdural hematoma along the\nfalx appears overall similar. Hemorrhage product within the occipital horns\nappears slightly more prominent, but likely secondary to redistribution. \nThere appears to be minimally increased subdural hematoma along the left\ntentorium (series 2, image 13), also likely secondary to redistribution. \nRight-sided postoperative temporoparietal subdural hemorrhage/fluid collection\nis unchanged in size with evidence of evolution. Left-sided midline shift has\ndecreased to 1.9 mm. No evidence of definite new acute hemorrhage or infarct.\nNo significant midline shift. Sulci, ventricles and cisterns are within\nexpected limits for the patient's age. No evidence of hydrocephalus at this\ntime.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, and middle ear cavities are clear. There is partial\nfilling of the right mastoid air cells. The visualized portion of the orbits\nare unremarkable.", + "output": "1. Improvement in midline shift.\n2. Previous subarachnoid and subdural hemorrhage demonstrate expected\nevolution and redistribution. No definite new hemorrhage.\n3. Stable postsurgical changes from right-sided craniectomy.\n4. Additional findings described above." + }, + { + "input": "Postsurgical changes are seen after right sided craniectomy for subdural\nhematoma evacuation. Previous seen subdural hematoma has undergone expected\nevolutional changes, and shows mild decrease in size since prior imaging. \nSubarachnoid hemorrhage seen in the left frontal convexity appears slightly\nless conspicuous. The ventricles appear slightly larger with increased\nintraventricular hemorrhage in the occipital ventricular horns and slightly\nlarger third ventricle, there is no evidence of transependymal migration of\nCSF to indicate acute hydrocephalus. There is no evidence of acute\ninfarction.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, and middle ear cavities are clear. There is partial filling of the\nright mastoid sinus. The visualized portion of the orbits are unremarkable.", + "output": "1. Postsurgical changes after right-sided craniectomy. Expected evolutional\nchanges of subdural hematoma with mild decrease in size. Subarachnoid\nhemorrhage in the left frontal convexity appears less conspicuous.\n2. The lateral ventricles appear slightly larger, with increased\nintraventricular hemorrhage layering in the occipital ventricular horns. \nThere is no evidence or transependymal migration of CSF to indicate or suggest\nacute hydrocephalus." + }, + { + "input": "There is no evidence of no evidence of infarction, hemorrhage, edema, or\nmass. The ventricles are normal in size and configuration. Sulci are\nprominent, consistent with age-related involutional changes. Basal cisterns\nare patent.\n\nThere is no evidence of fracture or osseous abnormality. Trace paranasal\nsinus mucosal thickening. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Generalized cerebral atrophy." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThere is mild, polypoid mucosal thickening in the bilateral maxillary sinuses.\nThe mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches are patent with no\nevidence of stenosis or occlusion. Minimal soft plaque is noted at the right\ncarotid bifurcation with no evidence of internal carotid stenosis by NASCET\ncriteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The left thyroid lobe contains\n1.4 and 1.0 cm hypodense nodules, increased in size from the prior\nexamination. There is no lymphadenopathy by CT size criteria.", + "output": "1. Normal CTA of the head.\n2. No evidence of internal carotid artery stenosis by NASCET criteria.\n3. Interval increase in the size of two left thyroid lobe nodules. Recommend\nclinical correlation. If clinically indicated, consider thyroid ultrasound\nfor further evaluation.\n\nRECOMMENDATION(S):\n-Interval increase in the size of two left thyroid lobe nodules. Recommend\nclinical correlation. If clinically indicated, consider thyroid ultrasound\nfor further evaluation." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial process. ." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Mucosal thickening of the right maxillary\nsinus as well as the sphenoid sinuses bilaterally in the ethmoid air cells. \nOtherwise, the visualized portion of the paranasal sinuses are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no acute intracranial hemorrhage, evidence of acute major vascular\nterritorial infarction, edema or mass effect. The ventricles and sulci are\nslightly prominent likely sequela of age related involutional changes.\nPeriventricular and subcortical comparable and white matter hypodensities\nlikely sequela of chronic small vessel ischemic disease, correlating to\nfindings on MR dated ___. There is no shift of normally midline\nstructures. Incidental note is made of bilateral basal ganglia calcifications\nof clinical insignificant. The basal cisterns are clear. The gray white\nmatter differentiation appears preserved.\n\nNo fracture is identified. The visualized paranasal sinuses demonstrates mild\nmucosal thickening within right frontal, ethmoidal, and bilateral maxillary\nsinuses. The mastoid air cells and middle ear cavities are clear.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute large territory infarction,hemorrhage,edema,or\nmass. Periventricular and subcortical white matter hypodensities are\nnonspecific but likely sequelae of chronic small vessel ischemic disease. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges.\n\nThere is no evidence of fracture. There is mild mucosal thickening within the\nethmoid air cells, sphenoid sinuses, and maxillary sinuses bilaterally. The\nremainder of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Mild mucosal thickening within the paranasal sinuses." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. There are patchy\nperiventricular hypodensities, nonspecific but similar to ___ and likely a\nsequela of chronic microangiopathy. Bilateral basal ganglia calcification are\nagain identified.\n\nThere is mild generalized parenchymal volume loss, similar to prior and most\nlikely age related. Mild prominence of the ventricular system and extra-axial\nCSF spaces is consistent with the previously mentioned parenchymal volume\nloss.\n\nThere is mild mucosal thickening in the right frontal sinus, along the ethmoid\nair cells and in the left sphenoid as well as right maxillary sinuses. The\nvisualized portion of the mastoid air cells,and middle ear cavities are clear.\nThe visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere are mild atherosclerotic changes along both carotid siphons and the\nright V4 segment but without significant stenosis. The vessels of the circle\n___ and their principal intracranial branches appear normal without\nstenosis, occlusion, or aneurysm formation. Note is made of a prominent right\nposterior communicating artery, normal anatomic variant. The dural venous\nsinuses are patent.\n\nCTA NECK:\nNormal 3 vessel aortic arch. There are some atherosclerotic changes at both\ncarotid bifurcations but without evidence of internal carotid stenosis by\nNASCET criteria. The carotid arteries and their major branches appear normal\nwith no evidence of stenosis or occlusion. There are mild irregularities along\nthe cervical course of both vertebral arteries either due to noncalcified\natheromatous disease or hypertrophic degenerative changes of the cervical\nspine but without significant stenosis.\n\nOTHER:\nThere are no suspicious pulmonary nodules. There are several hypodense\nnodules in the right thyroid gland, measuring up to 9 mm and most likely\nrepresenting thyroid cysts. There are metallic clips in the expected region\nof the thyroid isthmus and left thyroid lobe which are surgically absent. \nThere is no lymphadenopathy by CT size criteria.", + "output": "1. No evidence of acute infarction, hemorrhage or intracranial mass.\n2. Nonspecific patchy periventricular hypodensities, similar to ___ and most\nlikely sequela of chronic microangiopathy.\n3. Patent intracranial and cervical vasculature without evidence of high-grade\nstenosis, occlusion, dissection or aneurysm formation greater than 3 mm." + }, + { + "input": "Again seen is stable encephalomalacia in the right MCA territory from sequela\nof prior infarct. There is resultant ex vacuo dilatation of the right lateral\nventricle and wallerian degeneration along the cortical spinal tract. In\ngeneral, the ventricles and sulci are prominent consistent with age related\nglobal atrophy. Periventricular, subcortical, and deep white matter\nhypodensities are nonspecific, but likely represent sequela of chronic\nmicrovascular ischemic disease. There is no evidence of acute\ninfarction,hemorrhage,edema,or mass effect.\n\nThere is no evidence of fracture. There is partial opacification of the right\nmastoid air cells. The visualized portion of the paranasal sinuses and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial process.\n2. Stable encephalomalacia in the right MCA territory with resultant ex vacuo\ndilatation of the right lateral ventricle.\n3. Likely sequela of chronic microvascular ischemic disease." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nSubtle area of low attenuation in the pons towards the left is suggestive of\nischemic changes, of uncertain chronicity. Supratentorially there is a\nsimilar area of low attenuation in the left frontal lobe, anterior to the\ncauda nucleus, also suspicious for chronic ischemic changes. There is no\nevidence of acute intracranial hemorrhage, mass, mass effect or shifting of\nthe normally midline structures. The ventricles and sulci are normal in size\nand configuration for patient's age. Mucous retention cyst is identified in\nthe left maxillary sinus, there is mild mucosal thickening in the right\nmaxillary sinus. The middle ear cavities and mastoid air cells are clear.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere are mild calcified and noncalcified atherosclerotic plaque involving the\ncavernous and communicating segment of the ICA, otherwise the distal ICA show\nno flow-limiting stenosis. The anterior, posterior, and middle cerebral\narteries are unremarkable. The vertebrobasilar arteries are widely patent. \nThere is no aneurysm or vascular malformation. The dural venous sinuses are\npatent.\n\nCTA NECK:\nClassic branching of the thoracic aorta is demonstrated. The bilateral common\ncarotid arteries are widely patent. The bilateral internal carotid arteries\nhave normal caliber without evidence of flow-limiting narrowing by NASCET\ncriteria. The bilateral cervical vertebral arteries and their major branches\nare normal without stenosis or occlusion. T\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.There is an incidental note of a patulous esophagus. Mild\ndegenerative changes are visualized throughout the cervical spine, slightly\nmore pronounced at C6-C7 level.", + "output": "1. Mild calcified and noncalcified atherosclerotic plaque involving the\ncavernous and communicating segment of the ICA, otherwise unremarkable CT of\nthe head and neck without evidence of flow-limiting stenosis.\n2. Areas of low-attenuation in the pons and adjacent to the head of the\ncaudate nucleus on the left are suggestive of chronic ischemic changes.\n3. There is no evidence of acute intracranial hemorrhage. If there is\npersistent clinical concern related with acute/subacute ischemic changes,\ncorrelation with MRI of the head is recommended." + }, + { + "input": "The aerodigestive tract is unremarkable. Specifically, there is no evidence of\nforeign body. However, assessment of the base of tongue the slightly limited\nby streak artifact from dental amalgam. There is no lymphadenopathy by CT size\ncriteria. The soft tissues of the neck are otherwise unremarkable. Mild\nmucosal thickening of the maxillary sinuses bilaterally is noted. The lung\napices are clear. There is no suspicious osseous lesion. No prevertebral or\nretropharyngeal soft tissue swelling is present. Multilevel degenerative\nchanges are present in the cervical spine. 1", + "output": "No evidence of foreign body in the aerodigestive tract. Streak artifact\nsomewhat limits assessment of the base of the tongue." + }, + { + "input": "There is no evidence of hemorrhage, edema, or infarction. The ventricles and\nsulci are normal in size and configuration. The basal cisterns appear patent\nand there is preservation of gray-white matter differentiation. There is an\narea of increased soft tissue density measuring 1.3 x 1.0 cm in the\nsella/suprasellar region and postsurgical changes at the anterior aspect of\nthe sella.\n\nNo fracture is identified. There is a small amount of fluid in the left\nmastoid air cells. The visualized paranasal sinuses, right mastoid air cells,\nand middle ear cavities are clear. The globes are unremarkable. Degenerative\nchanges are seen in the bilateral temporomandibular joints with calcifications\nin the region of the joint spaces.", + "output": "1. No acute intracranial process.\n\n2. Increased soft tissue density in the sella/suprasellar region and\npostsurgical changes at the anterior aspect of the sella. Comparison with\nprior exams or followup MR imaging as an outpatient would be helpful for\nfurther evaluation for interval change of known pituitary lesion.\n\nNOTIFICATION: Updated findings from original wet read were communicated via\nthe ED QA nurses at 9:29 p.m. on ___." + }, + { + "input": "No evidence of infarction, hemorrhage, edema, or mass. The ventricles and\nsulci are normal in size and configuration for the patient's age.\n\nThere is no evidence of fracture. There is moderate mucosal thickening of the\nright ethmoidal air cells. Subtle mucosal thickening in the right sphenoid\nsinus. The visualized paranasal sinuses are otherwise clear. Middle ear\ncavities and mastoid air cells are clear. Orbits are unremarkable.", + "output": "1. No evidence of mass, hemorrhage or infarction.\n2. Mild-to-moderate paranasal sinus inflammatory disease." + }, + { + "input": "There is no evidence of acute territorial infarction,intra hemorrhage,edema,or\nmass effect. The ventricles and sulci are minimally prominent, suggestive of\nmildly age advanced involutional change.\n\nThere is no evidence of fracture. Partial opacification of the left mastoid\nair cells may be due to prolonged recumbent positioning. Aside from mild\nmucosal thickening in the right sphenoid sinus, the visualized portion of the\nparanasal sinuses, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "There is no evidence of acute intracranial process or hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is mild\nprominence of the ventricles and sulci suggestive involutional changes. \nAtherosclerotic vascular calcifications are noted of bilateral cavernous\nportions of internal carotid arteries. There are periventricular and\nsubcortical lucencies, which may represent small vessel ischemic changes.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable. Again are noted\nlow-lying cerebellar tonsils", + "output": "1. No acute intracranial abnormality.\n2. No evidence acute intracranial hemorrhage or fracture.\n3. Re-demonstration of patient's known Chiari 1 malformation.\n4. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration. Periventricular\nand subcortical white matter hypodensities are nonspecific but likely\nreflective of sequelae of chronic small vessel ischemic disease. \nAtherosclerotic vascular calcifications are demonstrated along the cavernous\nportions of the carotid arteries. Cerebellar tonsils are low lying, extending\napproximately 7 mm beneath the foramen magnum, compatible with the patient's\ngiven history of Chiari malformation.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Unchanged low lying cerebellar tonsils compatible with the patient's\nhistory of Chiari malformation." + }, + { + "input": "Midline nasopharyngeal soft tissues are enlarged without evidence for a\ndiscrete mass. No exophytic mass or mass effect is seen elsewhere along the\naerodigestive tract. Palatine and lingual tonsils are not enlarged. Left\npalatine tonsilliths are likely sequela of prior infections.\n\nA lesion with thick, irregular peripheral contrast enhancement is demonstrated\nat the left angle of the mandible measuring 1.9 x 1.6 cm likely representing a\nnecrotic lymph node, level 1B. Right level 1B lymph nodes are not enlarged.\n\nA subcutaneous cystic lesion without evidence for contrast enhancement is seen\nslightly posteriorly and inferiorly to the above-described presumed pancreatic\nlymph node, overlying the sternocleidomastoid, image 3:43. A similar\nsubcutaneous cystic lesion without rim enhancement measuring 1.6 x 1.6 cm is\nseen in the left submental subcutaneous fat (image 3:47). A similar\nsubcentimeter lesion is seen in the subcutaneous fat overlying the right\nsubmandibular gland, image 3:46. These may represent sebaceous cysts, though\nmalignancy cannot be excluded given the clinical context and associated\nfindings.\n\nThe above-described presumed necrotic lymph node is contiguous with the\nanterior margin of the left submandibular gland. No focal lesion is seen\nwithin the left submandibular gland proper. Right submandibular gland and\nbilateral parotid glands appear unremarkable.\n\nThe thyroid is grossly unremarkable. There is a right level 4 lymph node\nconglomerate 2.0 cm transverse by 1.3 cm AP on images 3:69-67, extending into\nthe superior mediastinum. There are several nonenlarged left level 4 lymph\nnodes.\n\nThere is calcified plaque at right greater than left common carotid artery\nbifurcations. This exam is not technically optimized for quantifying carotid\nstenosis. Internal jugular veins are patent.\n\nIntracranial contents are better assessed on the preceding head CT and brain\nMRI. Embolization material is again seen in the anterior suprasellar cistern,\nlikely secondary to a coiled aneurysm, with streak artifact.\n\nThe left maxillary sinus and several left middle and anterior ethmoid air\ncells are completely opacified. Posterolateral wall of the left maxillary\nsinus is thickened and sclerotic. Medial wall of the left maxillary sinus\nexpands into the nasal cavity. Left ostiomeatal unit is occluded. There is a\nsmall mucous retention cyst in the contralateral right maxillary sinus. \nMastoid air cells appear clear. Partially imaged orbits appear unremarkable.\n\nNo evidence for suspicious lytic or sclerotic bone lesions, though MRI would\nbe more sensitive for osseous metastases. Degenerative changes in the\ncervical spine.\n\nMediastinal lymphadenopathy and pulmonary nodules are better assessed on the\nconcurrent CT torso.", + "output": "1. 1.9 x 1.6 cm presumed necrotic lymph node at the left angle of the\nmandible, level 1B, contiguous with the anterior margin of the left\nsubmandibular gland.\n2. Subcutaneous cystic lesions without evidence for contrast enhancement\noverlying the left sternocleidomastoid, in the left submental region, and\noverlying the right submandibular gland. These may represent sebaceous cysts\nthough malignancy cannot be excluded given the clinical context.\n3. Right level 4 lymph node conglomerate, 2 x 1.3 cm extending into the\nsuperior mediastinum. Mediastinal lymphadenopathy is better assessed on the\nconcurrent CT torso. Multiple nonenlarged left level 4 lymph nodes.\n4. Enlarged midline nasopharyngeal soft tissues without evidence for discrete\nenhancing mass. This may be reactive in the setting of chronic sinusitis, but\ncould be better assessed by direct visualization if clinically warranted.\n5. Chronic left maxillary and anterior ethmoid sinusitis with complete\nopacification and osseous remodeling.\n6. Intracranial metastatic disease, pulmonary nodules suspicious for\nmalignancy, and mediastinal lymphadenopathy are better assessed on the\nsame-day brain MRI and chest CT, respectively." + }, + { + "input": "Area of focal hypoattenuation in the left corpus callosum likely reflects\nknown metastasis (2:19), with post treatment change. No new mass lesion is\nidentified, with previously noted enhancing supratentorial and infratentorial\nfoci seen on MRI not clearly identified on the current noncontrast CT.\n\nSmall heterogeneous isodose to slightly hyperdense subdural hematoma overlying\nthe right cerebral convexity measures up to 8 mm thick, minimally smaller in\nthe interval without significant shift of normally midline structures. No new\nareas of intracranial hemorrhage.\n\nThere is no evidence of fracture or acute large territorial infarction. \nStreak artifact from prior coiling of an anterior communicating artery\naneurysm slightly limits assessment of the adjacent inferior frontal lobes.\nPeriventricular and subcortical confluent areas of hypoattenuation in both\ncerebral hemispheres, most pronounced in the left frontal lobe, likely reflect\npost treatment changes. Focal hypodensities within the basal ganglia\nbilaterally likely reflect chronic lacunar infarcts. There is prominence of\nthe ventricles and sulci suggestive of involutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal. \nBilateral cavernous carotid artery calcifications are noted. Mucous retention\ncyst is seen in the right maxillary sinus. Hyperostosis of the left maxillary\nsinus wall suggests sequela of chronic inflammation. Partially imaged is a 9\nmm subcutaneous cyst in the left occipital soft tissues, likely a sebaceous\ncyst.", + "output": "1. Minimally smaller subacute to chronic subdural hematoma overlying the right\ncerebral convexity measuring up to 8 mm thick. No new areas of intracranial\nhemorrhage or midline shift.\n2. Focal area of hypoattenuation in the left corpus callosum corresponds to\nknown metastasis. Confluent areas of white matter hypoattenuation in both\ncerebral hemispheres, most pronounced in the left frontal lobe, likely reflect\npost treatment changes.\n3. Previously demonstrated enhancing foci within the brain parenchyma on prior\nMRI are not well visualized on current CT exam. Consider further evaluation\nwith MRI with IV contrast to assess for interval change in known metastatic\ndisease.\n\nRECOMMENDATION(S): Consider further evaluation with MRI with IV contrast to\nassess for interval change in known metastatic disease." + }, + { + "input": "Surgical hardware artifact limits study.\n\nAgain demonstrated, is a subacute chronic right cerebral convexity subdural\nhematoma measuring 8 mm in thickness, similar to prior. Known intracranial\nmetastases, represent a scattered areas of hypodensity in both hemispheres,\nare better assessed on same day MRI. Known extracranial metastases are\nunchanged. There is diffuse white matter vasogenic edema, left greater than\nright, from prior radiation therapy.\n\nNo acute large territorial infarction.\n\nThe ventricles and sulci are grossly stable in configuration. The basilar\ncisterns are patent.\n\nNo acute osseous abnormalities seen. Partially imaged paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The orbits demonstrate\nno acute abnormalities. Coils from prior embolization are again seen near the\nright cavernous sinus. Atherosclerotic vascular calcifications are noted.\nLeft frontal and left suboccipital soft tissue probable sebaceous cysts are\nagain noted (see 4, 7).", + "output": "1. Limited study as described.\n2. Grossly stable right hemisphere subacute to early chronic subdural\nhematoma.\n3. Findings compatible patient's known brain metastatic disease and treatment\nrelated changes, better demonstrated on same day brain MRI.\n4. Grossly stable ventricular size.\n5. Within limits of study, no definite evidence of acute intracranial\nhemorrhage or fracture." + }, + { + "input": "Streak artifact limits evaluation of pons and midbrain.\n\nA 2 mm hyperdense focus abutting the anterior left tentorial leaflet is\nnonspecific (2:13, 602:51 601:69).\n\nThere is no evidence of infarction, edema,or mass effect. The ventricles and\nsulci are preserved in size and configuration.\n\nThere is no evidence of calvarial fracture. Right frontotemporal scalp soft\ntissue swelling.", + "output": "1. Streak artifact limits evaluation of pons and midbrain.\n2. Nonspecific approximately 2 mm hyperdense focus abutting anterior left\ncerebellar tentorial leaflet. While finding may represent dural or choroid\ncalcification, small acute hemorrhage is not excluded on the basis of this\nexamination. If prior outside imaging is available, consider correlation for\nfinding stability.\n3. No definite evidence of acute calvarial fracture.\n4. Right frontotemporal scalp soft tissue swelling.\n5. Please see concurrently obtained maxillofacial CT for description of\nmaxillofacial findings." + }, + { + "input": "There is no evidence of acute major vascular territory\ninfarction,hemorrhage,edema, or mass. The ventricles and sulci are unchanged\ncompared to ___. As seen on the prior exam from ___, there is again\napproximately 13 mm descent of cerebellar tonsils through the foramen magnum\nresulting in severe crowding at the craniocervical junction and is consistent\nwith Chiari 1 malformation (602:40). Mild soft tissue swelling is seen along\nthe left frontal scalp (2:8).\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are preserved. Partially empty sella is again noted.", + "output": "1. No acute intracranial abnormality.\n2. No evidence acute intracranial hemorrhage or fracture.\n3. Left frontal scalp soft tissue swelling.\n4. Grossly stable probable Chiari 1 malformation as described." + }, + { + "input": "There is subtle curvilinear hyperdensity outlining the sulci of the inferior\nleft frontal lobe (___) which is suspicious for a left frontal subarachnoid\nhemorrhage. There is no evidence of fracture, acute large territory\ninfarction,or mass. The ventricles and sulci are normal in size and\nconfiguration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "Subtle curvilinear hyperdensity outlining the sulci of the inferior left\nfrontal lobe is concerning for an acute left frontal subarachnoid hemorrhage. \nNo underlying fracture. CTA head is recommended for further evaluation.\n\nNOTIFICATION: The findings and follow-up recommendations were discussed with\n___ QA nurses, R.N. by ___, M.D. Via email on ___ at 12:43\nam, 1 minutes after discovery of the findings." + }, + { + "input": "CT HEAD NONCONTRAST\n\n-Redemonstration of a subtle curvilinear hyperdensity within the sulci of the\nleft inferior frontal lobe (2:14), unchanged in size or distribution since\nprior, which again remains suspicious for a small subarachnoid hemorrhage.\n-No evidence of acute large territory infarct.\n\nCTA HEAD\n\n-No evidence of dissection, occlusion, flow limiting stenosis, or aneurysm\nformation within the great vessels in the head. The vessels of the\n___ and their principal intracranial branches are patent. The\ndural venous sinuses appear patent.\n-There is a focal region of mild smooth luminal narrowing involving the\nintracranial left V4 segment (3:10), with a similar caliber of the immediately\nproximal and distal V4 segments. This appears to be within normal limits on\nthe coronal maximum intensity projection images.\n\nCTV HEAD\n\n\n-The superior sagittal and transverse sinuses are patent without evidence of\ndural venous sinus thrombosis. The visualized cortical veins appear patent.", + "output": "1. Redemonstration of hyperdensity in left frontal sulci suspicious for\nsubarachnoid hemorrhage.\n2. Normal CT angiography and CT venography of the head. No signs of an\naneurysm or arteriovenous malformation seen. No abnormal vascular structures\nare seen in the left frontal region to indicated dural AV fistula.\n3. Consider MRI for further evaluation.\n\nRECOMMENDATION(S): MRI for further evaluation." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nSubtle asymmetric hypodensities in the right frontal centrum semiovale and\ncorona radiata as well as some ill-defined areas in the right internal capsule\nappears similar to the recent CT examination. There is no definite loss of\ngray-white matter differentiation. There is no evidence of hemorrhage, edema,\nor mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is mild polypoid mucosal wall thickening in the bilateral maxillary\nsinuses, trace mucosal wall thickening in the bilateral sphenoid air cells,\nleft posterior ethmoid air cells and left frontal ethmoidal recess. The\nremainder of the visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the orbits\nare unremarkable.\n\nCTA HEAD:\nThere are trace atherosclerotic calcifications of the V4 segments of the\nbilateral vertebral arteries without significant narrowing. There are mild\natherosclerotic calcifications of the bilateral intracranial internal carotid\narteries without significant narrowing. The vessels of the circle of ___\nand their principal intracranial branches otherwise appear patent without\nsignificant stenosis, occlusion, or aneurysm formation. The dural venous\nsinuses are patent.\n\nCTA NECK:\nThere are mild atherosclerotic calcifications of the aortic arch. There are\nmild atherosclerotic calcifications at the origins of the great vessels most\nprominent of the left subclavian artery without significant narrowing. There\nare moderate atherosclerotic calcifications at the origin of the right\nsubclavian artery without significant narrowing. Calcified atherosclerotic\nplaque at the origin of the left vertebral artery produce mild narrowing. \nCalcified and noncalcified atherosclerotic plaque at the origin and proximal\ncomponent of the right vertebral artery produces moderate narrowing. There\nare moderate to severe right greater than left atherosclerotic calcifications\nat the carotid bifurcations. This produces a 30% narrowing on the right by\nNASCET criteria. There is no significant left internal carotid artery\nstenosis by NASCET criteria. There is a tiny ulcerated atherosclerotic plaque\nin the distal left internal carotid artery (5:178). The carotid and vertebral\narteries and their major branches otherwise appear patent with no evidence of\ndissection, high-grade stenosis or occlusion. .\n\nOTHER:\nThere is a 4 x 5 mm pulmonary nodule in the right upper lobe (5:4). The\nthyroid gland is not well appreciated. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Nonspecific subtle asymmetric hypodensities in the right frontal centrum\nsemiovale and corona radiata and right internal capsule representing either\ninfarct or chronic small vessel ischemic disease. MR can be obtained for\nfurther characterization.\n2. Patent intracranial vasculature without significant stenosis, occlusion, or\naneurysm formation.\n3. Scattered areas of cervical atherosclerotic disease most notable for 30%\nnarrowing of the right internal carotid artery by NASCET criteria. Moderate\nnarrowing of the proximal right vertebral artery and mild narrowing of the\nleft vertebral artery at its origin. Otherwise patent cervical vasculature\nwithout high-grade stenosis, occlusion, or dissection.\n4. 4 x 5 mm pulmonary nodule in the right upper lobe. The ___ Society\nguidelines for pulmonary nodule guidelines suggest for pulmonary nodules\ngreater than 4 mm or less than 6mm, 12 month follow-up in low-risk patients,\nand ___ month follow-up in high risk patients." + }, + { + "input": "Limited examination due to patient motion. Right MCA territory infarct is not\nwell identified on the current examination. There is no evidence of\nhemorrhage. Nonspecific periventricular white matter hypodensities are likely\nrelated to small vessel ischemic disease. There is prominence of the\nventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No significant changes are visualized since the prior examination, there is\nno evidence of acute intracranial hemorrhage or mass effect.\n2. Unchanged confluent areas of low density in the subcortical and\nperiventricular white matter, which are nonspecific and may reflect changes\ndue to small vessel disease." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect. Bilateral palatine tonsilliths are noted.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.", + "output": "Normal neck CT." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThe patient is status post right frontoparietal craniectomy. The patient is\nstatus post interval placement of a right frontal approach ventriculostomy\ncatheter, which terminates within the parenchyma of the left caudate. Linear\nhyperdensity along the tract of the ventriculostomy catheter in the bilateral\nfrontal lobes represents blood products related to catheter placement. There\nare multiple new surgical skin staples in the right frontal scalp. A tiny\nfocus of pneumocephalus is located adjacent to the ventriculostomy catheter in\nthe right frontal lobe. The diffuse subarachnoid hemorrhage, left greater\nthan right and predominantly involving the suprasellar and basal cisterns as\nwell as sylvian fissures, has increased from the prior examination. The\nsubarachnoid hemorrhage appears to expanded the left sylvian fissure and sulci\nof the left frontal and temporal lobes. There is also subarachnoid hemorrhage\nlayering dependently within the occipital horns of the lateral ventricles,\nthird, and fourth ventricles, unchanged from the prior examination. The\nencephalomalacia of the right frontal lobe is unchanged. A mixed density,\npredominantly hyperdense, left cerebral subdural hematoma is new from the\nprior examination and measures 1.1 cm in thickness. A 1.1 cm left-to-right\nmidline shift is new from the prior examination.\n\nThere is mild mucosal thickening in the bilateral ethmoid air cells. The\nvisualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nAn irregular, lobulated aneurysm of the left MCA bifurcation measures 1.2 x\n1.1 cm. No other aneurysms are identified. There is mild narrowing and\nirregularity of the right A1 and left M1 segments. There is mild narrowing\nand irregularity of the right P1 and P2 segments. Multi focal moderate\nnarrowing and irregularity involves the left P1 and P2 segments. The\nremainder of the Circle of ___ is patent. The dural venous sinuses are\npatent. Both internal carotid and vertebrobasilar system show dolichoectasia.\n\nCTA NECK:\nThere is a normal 3 vessel branching pattern of the aortic arch. The origins\nof the great vessels are patent. The carotid and vertebral arteries and their\nmajor branches are patent with no evidence of stenosis or occlusion. There is\nno evidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThere is a calcified granuloma in the right upper lobe. An endotracheal tube\nterminates within the trachea, below the clavicles. There is fluid and debris\nwithin the nasopharynx. The visualized portion of the thyroid gland is within\nnormal limits. There is no lymphadenopathy by CT size criteria.", + "output": "1. Irregular, lobulated 1.2 cm left MCA bifurcation aneurysm.\n2. Narrowing and irregularity of the right A1, left M1 and bilateral P1 and P2\nsegments, left greater than right, which may represent atherosclerotic\ndisease.\n3. New, acute left subdural hematoma and new 1.1 cm left-to-right midline\nshift and subfalcine herniation.\n4. Interval increase in the diffuse subarachnoid hemorrhage, left greater than\nright.\n5. Patent vasculature in the neck." + }, + { + "input": "Intervally, there has been left frontal craniectomy and left lateral convexity\nsubdural hematoma evacuation. Postoperative changes are present including\npneumocephalus and blood products in the overlying soft tissues. Left lateral\nconvexity subdural hematoma has decreased in size now measuring roughly 8 mm\nin maximal thickness. However, there is increasing left frontal\nintraparenchymal hemorrhage at site of known aneurysm now measuring roughly\n3.9 x 3.7 cm, previously 2.5 x 1.8 cm. Additionally, there is increasing\nsubarachnoid hemorrhage, mainly with increased components seen along the\nposterior left frontal lobe (02:15). Because of this, there is increasing\nmass effect with near complete effacement of the left lateral ventricle and\npersistent rightward shift of midline structures of roughly 10 mm. There is\nincreased crowding of the suprasellar cistern as compared to the prior exam. \nAdditionally, a right frontal approach ventriculostomy catheter again a\ncrosses midline and terminates in the region of the left caudate, and there is\nincrease in size of a intraparenchymal hemorrhage affecting the genu of the\ncorpus callosum measuring 2.0 x 0.8 cm, previously 1.2 x 0.6 cm. Diffuse\nareas of subarachnoid hemorrhage seen within the occipital horns of the\nlateral ventricles, third and fourth ventricle as well as diffusely along the\nbasal cisterns, overall appearing slightly increased compared to prior\nexamination.\n\nChanges are seen from prior right frontoparietal craniectomy. Small amount of\nfluid is seen layering in the right sphenoid air cell. There are areas of\nmucosal wall thickening in bilateral ethmoid air cells and right maxillary\nsinus. Mastoid air cells are well-aerated. Orbits are grossly unremarkable.", + "output": "1. Intervally increasing areas of intraparenchymal and subarachnoid\nhemorrhage, as detailed above with worsening mass effect.\n2. Postsurgical changes from left frontal craniectomy and subdural hematoma\nevacuation.\n3. Unchanged positioning of a right frontal approach ventriculostomy catheter\nterminating in the region of the left caudate, with increasing\nintraparenchymal hemorrhage at the genu of the corpus callosum along the\ncourse of the catheter.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 5:25 AM, 2 minutes after\ndiscovery of the findings." + }, + { + "input": "Subtle hypodense areas within the left supplemental frontal motor area and\nleft temporoparietal lobe likely correspond to areas of slow diffusion seen on\nthe recent MR from earlier in the day. Encephalomalacia in the left\ncerebellar hemisphere is also noted. No new intracranial hemorrhage,\nterritorial infarction, mass or edema is seen. There is prominence of the\nventricles and sulci suggestive of involutional changes. Periventricular\nwhite matter hypodensities are nonspecific but likely sequela of chronic small\nvessel ischemic changes. There is no evidence of fracture, and a left\nparietal skull osteoma is incidentally noted (series 3: Image 30). There is a\nmucous retention cyst in the left maxillary sinus, and there is mild mucosal\nthickening of the anterior bilateral ethmoid air cells. The visualized\nportion of the other paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The patient is status post bilateral lens replacement.", + "output": "1. No new intracranial hemorrhage or new territorial infarction.\n2. Subtle hypodense areas in the left frontoparietal lobes likely correspond\nto infarctions better seen on the same day MRI." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of large territorial infarction, acute\nintracranial hemorrhage, or edema. There is evolution of previously seen\ninfarctions in the left frontoparietal lobes when compared with the prior\nstudy from ___. Hypodensity in the inferior left cerebellum\ncorresponds to chronic infarction. The ventricles and sulci are prominent,\nsuggestive of age related involutional changes. Periventricular white matter\nhypodensities are nonspecific, likely sequela of chronic small vessel ischemic\ndisease.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere are vascular calcifications of the cavernous and clinoid segments of\nbilateral internal cerebral arteries and the left M1 segment of the middle\ncerebral artery, otherwise, the vessels of the circle of ___ and their\nprincipal intracranial branches appear normal without stenosis, occlusion, or\naneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nThere are vascular calcifications at the bilateral carotid bifurcations and\nproximal internal carotid arteries. There is moderate narrowing of the V 2\nsegment of the left vertebral artery at C4 level (6: 138) secondary to facet\nand uncovertebral joint arthropathy. The carotid arteries and their major\nbranches appear patent with no evidence of stenosis or occlusion. There is no\nevidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nIncidental note is made of a trace right pleural effusion. There is\nheterogeneous thyroid gland with an exophytic heterogeneous right thyroid\nnodule containing calcifications as seen on the CTA from ___. There\nis no lymphadenopathy by CT size criteria. Multilevel, multifactorial\ndegenerative changes throughout the cervical spine consistent with anterior\nand posterior spondylosis, more severe from C4 through C7 levels.", + "output": "1. No evidence of large territorial infarction or acute intracranial\nhemorrhage.\n2. Evolution of previously seen infarction in the left frontoparietal lobe and\nchronic infarction in the left cerebellum.\n3. Patent circle of ___ and the principal intracranial branches. Vascular\ncalcifications are identified at the distal left M1 segment (6:261).\nAtherosclerotic disease identified throughout the anterior circulation. There\nis no evidence of significant stenosis, occlusion or aneurysm.\n4. Moderate narrowing of the V2 segment of the left vertebral artery at C4\nlevel secondary to degenerative changes. Otherwise, no evidence of stenosis,\nocclusion, or dissection.\n5. Heterogeneous and enlarged right thyroid gland with an exophytic right\nthyroid nodule. The ___ College of Radiology guidelines suggest thyroid\nultrasound for further evaluation.\n\nRECOMMENDATION(S): Heterogeneous and enlarged right thyroid gland with an\nexophytic right thyroid nodule. The ___ College of Radiology guidelines\nsuggest thyroid ultrasound for further evaluation." + }, + { + "input": "CT HEAD:\nThere is no convincing evidence for acute intracranial hemorrhage or vascular\nterritorial infarction. The ventricles and sulci are prominent, compatible\nwith age related trophic changes. The basal cisterns remain patent.\n\nThere are unchanged regions of chronic encephalomalacia within the right\nfrontal lobe and left cerebellum (series 2, image 4, 22). There is apparent\nhypodensity in the left postcentral gyrus, age indeterminate, not definitively\nseen on prior examination, potentially representing artifact from volume\naveraging. Apparent hyperdensity within the medial left temporal lobe is\nlikely artifactual given is only seen on one slice (series 2 image 13).\n\nThe paranasal sinuses, middle ear cavities, and mastoid air cells are clear. \nThe orbits are unremarkable bilaterally.\n\n\nCTA HEAD AND NECK:\nMild atherosclerotic calcifications of the aortic arch, at the carotid\nbifurcations, and cavernous carotid arteries bilaterally. There is no\nstenosis of the cervical internal carotid arteries by NASCET criteria. There\nis stenosis with mild poststenotic dilatation of the left V3 segment (series\n3, image 183 measuring approximately 4 mm, similar in appearance to prior\nexamination.\n\nMild atherosclerotic calcifications at the distal left M1 branch (603:21) is\nunchanged from the prior examination. Otherwise, the circle of ___ and its\nmajor branches are patent without high-grade stenosis, occlusion, or aneurysm\nformation. There is a fetal origin of the left posterior cerebral artery. \nInfundibular origin of the right superior cerebellar artery is re-identified. \nThe dural venous sinuses are patent.\n\nMild narrowing of the V2 segment of the left vertebral artery at the C4\ntransverse foramen secondary to degenerative changes, unchanged compared to\nprior.\n\n\nOTHER:\nThe visualized portion of the lungs are clear. The right thyroid gland\nremains enlarged and heterogeneous, unchanged from the prior CT examination\nperformed on ___. There is no lymphadenopathy by CT size criteria.", + "output": "1. No evidence for acute intracranial hemorrhage or definitive evidence for\nacute large territory infarct. Chronic findings of encephalomalacia within\nthe right frontal lobe and left cerebellum are unchanged. There is apparent\nincreased hypodensity of the left postcentral gyrus, which may be artifactual\nversus age indeterminate infarct, not clearly seen since examination ___.\n2. Mild calcifications at the distal left M1 segment, and moderate\ncalcifications in the bilateral cavernous internal carotid arteries are\nsimilar to the previous examination. Otherwise, patent intracranial\nvasculature.\n3. Mild narrowing of the left V2 segment at the level of C4, unchanged from\nprevious examination and secondary to osseous degenerative changes. \nOtherwise, no evidence of high-grade stenosis or dissection within the\nvasculature of the neck. Unchanged appearance of mild poststenotic dilatation\nof the left V3 segment measuring approximately 4 mm.\n4. There is no stenosis of the cervical internal carotid arteries by NASCET\ncriteria.\n5. Unchanged heterogeneous enlarged right thyroid gland. If clinically\nrelevant and not previously performed, recommend dedicated thyroid ultrasound.\n\nRECOMMENDATION(S): If clinically indicated, MRI, if there are no\ncontraindications could be performed for further evaluation of impression 1.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 18:57 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of large territorial infarct, acute\nintracranial hemorrhage, edema, or mass. Prominent ventricles and sulci are\ncompatible with age-related volume loss. Periventricular white matter\nhypodensities are consistent with chronic small vessel ischemic disease.\n\nThe visualized portion of the mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable. A retention\ncyst is seen in the left maxillary sinus with mucosal thickening in the\nethmoid sinuses. And impacted left mandibular tooth is seen. There is a\nright maxillary radicular cysts. A 1.9 cm AP x 0.8 cm exophytic osteoma from\nthe left temporal calvarium.\n\nCTA HEAD:\nThere is atherosclerotic calcification of the bilateral cavernous carotid\narteries. There is irregularity in atherosclerotic calcification of the left\nM1 segment of the MCA with normal flow seen distally. There is minimal\nirregularity of the right P1 segment of the PCA, likely secondary to\natherosclerotic calcification. Otherwise, vessels of the circle of ___ and\ntheir principal intracranial branches appear normal without stenosis,\nocclusion or aneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThere is a multi nodular enlarged thyroid gland. Dense atherosclerotic\ncalcification of the left coronary artery is seen. The visualized portion of\nthe thyroid gland is within normal limits. There is a 3.2 cm AP x 2.4 cm TR\nlow-density mass in the left aortopulmonary window (see 05:25). Multilevel\ndegenerative changes are noted throughout the cervical spine.", + "output": "1. No evidence of acute intracranial hemorrhage.\n2. Mild irregularity of the left M1 and right P1 segments, likely secondary to\natherosclerotic calcification, otherwise no evidence of aneurysm greater than\n3 mm, dissection or vascular malformation.\n3. A 3.2 cm low density lesion in the left aortopulmonary window. \nDifferential considerations include duplication cyst, lymphocele and necrotic\nlymphadenopathy. Recommend comparison with prior studies and clinical\ncorrelation. If clinically indicated, an MRI of the chest can be acquired for\nfurther evaluation.\n4. Multi nodular thyroid gland. Recommend clinical correlation. If\nclinically indicated, consider thyroid ultrasound for further evaluation.\n5. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct.\n6. Paranasal sinus disease as described.\n7. Findings suggestive dental impaction as described. Recommend clinical\ncorrelation and correlation with dental exam.\n\nRECOMMENDATION(S):\n1. A 3.2 cm low density lesion in the left aortopulmonary window. \nDifferential considerations include duplication cyst, lymphocele and necrotic\nlymphadenopathy. Recommend comparison with prior studies and clinical\ncorrelation. If clinically indicated, an MRI of the chest can be acquired for\nfurther evaluation.\n2. Multi nodular thyroid gland. Recommend clinical correlation. If\nclinically indicated, consider thyroid ultrasound for further evaluation.\n3. Findings suggestive dental impaction as described. Recommend clinical\ncorrelation and correlation with dental exam." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Normal study." + }, + { + "input": "There is no evidence of acute hemorrhage mass effect midline shift or\nhydrocephalus. Gray-white matter differentiation is maintained. Mild to\nmoderate prominence of the sulci seen indicating brain atrophy.\n\nThe visualized paranasal sinuses are clear. No skull fracture is seen.", + "output": "No acute intracranial abnormalities are identified." + }, + { + "input": "There is a subtle hypodensity in the right parietal lobe adjacent to the\nlateral ventricle seen best on axial and coronal views, (series 2, image 16,\nand series 601 be a, image 75), which allowing for differences in technique\nappears new since prior examination. There is no evidence of hemorrhage, mass\neffect or shift of normally midline structures. Ventricles and sulci are are\nprominent in size, likely secondary to age related involutional changes. Mild\nperiventricular white matter hypodensities are likely the sequela of chronic\nsmall vessel ischemic disease. The basal cisterns appear patent and there is\npreservation of gray-white matter differentiation.\n\nThere is no fracture. There is mucosal thickening of the ethmoid air cells\nand a small incompletely visualized mucous retention cyst is noted in the left\nmaxillary sinus. There is minimal to mild opacification of the mastoid air\ncells bilaterally. Otherwise, the remaining visualized paranasal sinuses and\nmiddle ear cavities are clear. .", + "output": "Subtle hypodensity in the right parietal lobe which appears new since prior\nexamination. However please note that prior examination is from an outside\nhospital, and changes could relate to positioning and technique. These\nfindings were discussed with the ordering physician, ___ via\ntelephone on ___ at 00:28. There is low suspicion for acute ischemia\non physical exam and clinical parameters. However recommendation for MRI was\nprovided if any concern arises. Otherwise, no acute intracranial abnormality." + }, + { + "input": "Patient is status post evacuation of the right mixed density subdural hematoma\nwith a drain in place. Pneumocephalus is most consistent with history of\nprocedure. Layering hyperdensity along the right frontal convexity is similar\nto prior exam, though evaluation is mildly limited due to presence of\nintravenous contrast on the prior exam. There is mild leftward shift of\nmidline median structures by 4 mm, decreased from prior exam.\n\nPatient is status post right craniotomy and burr hole placements. The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Status post evacuation of the right mixed density subdural hematoma with a\ndrain in place. Pneumocephalus, likely reflecting instrumentation. No strong\nevidence of new hemorrhage or large territory infarct.\n2. Interval improvement in leftward midline shift, now measuring 4 mm." + }, + { + "input": "Patient is status post right craniotomy for evacuation of a right mixed\ndensity subdural hematoma now status post interval removal of a subdural\ndrain. Overall, there is decreased pneumocephalus compared to prior CT. \nLayering of hyperdense fluid along the right frontal convexity is again\nsimilar to prior exam and overall thickness of the subdural collection is\nsimilar to prior, for example, measuring 1.0 cm in greatest thickness (2; 17),\npreviously also measuring 1.0 cm. There is persistent mass-effect with\neffacement the right frontal as well as mild leftward midline shift measuring\n4 mm, similar to prior exam. There is no evidence of infarction, hemorrhage,\nedema, or mass. The ventricles and sulci are normal in size and\nconfiguration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Status post interval removal of a subdural drain with persistent unchanged\ntoward midline shift measuring 4 mm and similar thickness of the mixed density\nsubdural collection. Overall slightly decreased pneumocephalus." + }, + { + "input": "Patient is status post right frontal craniotomy with postoperative changes\nincluding a interval decrease in the amount of pneumocephalus. There remains\na mixed density extra-axial fluid collection overlying the right frontal\nconvexity, which measures up to 1 cm. This causes an unchanged degree of\nmass-effect upon the right frontal lobe with some effacement the sulci and\nminimal effacement of the right lateral ventricle. There are hyperdense blood\nproducts overlying the inferior right frontal convexity (02:15), but this is\nnot significantly changed in comparison with ___. There is\napproximately 4 mm of leftward midline shift, which is unchanged.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Grossly unchanged mixed extra-axial fluid collection with a small amount of\nacute blood products. There remains a similar amount of minimal mass effect\nupon the right frontal lobe with leftward midline shift measuring 4 mm,\nunchanged.\n2. Status post right frontal craniotomy with interval slight decrease in the\ndegree of pneumocephalus." + }, + { + "input": "Patient is status post right frontal craniotomy with re-demonstration of\npostoperative changes including pneumocephalus. There is re-demonstration of\nthe mixed density extra-axial fluid collection over the right frontal\nconvexity measuring 1.0 cm in greatest thickness (2; 18), unchanged. \nHyperdense blood products are noted layering dependently, similar to most\nrecent prior. There is persistent mass effect with effacement of the right\nfrontal lobe sulci and minimal mass effect on the right lateral ventricle. \nStable leftward midline shift measuring 4 mm. No new foci of hemorrhage. No\nlarge vascular territory infarction.\n\nThe ventricles and sulci are unchanged in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No significant interval change in right mixed density subdural hematoma\nstatus post evacuation in right frontal craniotomy with unchanged\npneumocephalus. No new foci of hemorrhage.\n2. No significant change in midline shift." + }, + { + "input": "Previously seen right-sided subdural hematoma has resolved. No residual\nsubdural collection or acute hemorrhage identified. No midline shift or\nhydrocephalus. Postoperative changes are again seen. Bone images are\nunremarkable.", + "output": "Resolution of previously seen subdural hematoma without signs of acute\nhemorrhage." + }, + { + "input": "There is no evidence of large territorial infarction hemorrhage, edema, or\nmass effect. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mucosal thickening involving the\nfrontal, sphenoid, and maxillary sinuses well as the ethmoid air cells. The\nmastoids and middle ear cavities are unremarkable. The visualized portion of\nthe orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is re- demonstration of right temporal encephalomalacia, likely from\nprior infarct. There is no acute intracranial hemorrhage, acute infarction,\nlarge mass or midline shift. There is no hydrocephalus. The ventricles and\nsulci are mildly prominent, most likely secondary to age-related atrophy. \nNonspecific periventricular, subcortical and deep white matter hypodensity\nmost likely represents chronic small vessel ischemic disease. The basal\ncisterns are patent and there is preservation of gray-white matter\ndifferentiation. The orbits are unremarkable. The visualized paranasal\nsinuses, middle ear cavities and mastoid air cells are clear. There is no\nfracture.", + "output": "1. No acute intracranial abnormality.\n2. Chronic right temporal encephalomalacia likely from prior infarct." + }, + { + "input": "Subdural hemorrhage overlies the right frontal, parietal, and temporal lobes\nand contains foci of pneumocephalus. The largest component of the subdural\nhemorrhage overlies the frontal lobe, measuring up to 8 mm. There is a left\nfrontal subdural hemorrhage measuring up to 4 mm. Subdural hemorrhage along\nthe falx measures up to 4 mm. Small amount of subdural hemorrhage is tracking\nalong the tentorium on the right. There is approximately 3 mm of shift of\nmidline structures to the left.\n\nThere are right temporal and inferior right frontal lobe contusions and\nsuspected left temporal and anterior inferior left frontal lobe contusions as\nwell.\n\nThere is bilateral subarachnoid hemorrhage, most extensive overlying the left\nfrontal lobe. There is also subarachnoid hemorrhage in the bilateral sylvian\nfissures and throughout the right cerebral hemisphere. Subarachnoid\nhemorrhage is also seen layering in the interpeduncular cistern. The sulci are\nnot as well seen as on prior, especially at the left vertex, potentially due\nto redistribution of blood. The ventricles are stable in configuration\ncompared to outside CT.\n\nThere is a sagittally oriented frontal calvarial fracture seen to\ninvolve/parallel the sagittal suture. There is a primarily longitudinal right\ntemporal bone fracture that extends posteriorly along the lambdoid suture,\nwhere it is seen to overlie the right transverse sinus. It also extends to\nthe middle ear with fluid in the mastoids and middle ear. There is\ninvolvement of the anterior external auditory canal, and posterior aspect of\nthe glenoid fossa.\n\nThe maxillary sinuses bilaterally are almost completely full of aerosolized\nsecretions. The nasal septum is deviated to the right. There are aerosolized\nsecretions in the right sphenoid sinus and mild mucosal thickening in the\nethmoid air cells. The visualized portion of the orbits are unremarkable.\n\nThere is significant scalp hematoma overlying the right temporal bone and mild\nsoft tissue swelling along the midline frontal bone at the vertex.", + "output": "1. Multiple areas of subdural hemorrhage. The largest component of the\nsubdural hemorrhage overlies the right frontal lobe, measuring up to 8 mm.\n2. There are right temporal and inferior right frontal lobe contusions and\nsuspected left temporal and anterior inferior left frontal lobe contusions.\n3. There is bilateral subarachnoid hemorrhage, most extensive overlying the\nleft frontal lobe.\n4. There is a primarily longitudinal right temporal bone fracture that extends\nposteriorly along the lambdoid suture, where it is seen to overlie the right\ntransverse sinus.\n5. There is a sagittally oriented frontal calvarial fracture seen to\ninvolve/parallel the sagittal suture.\n\nRECOMMENDATION(S): CTV is suggested to evaluate for transverse sinus injury." + }, + { + "input": "LEFT: Left mastoid fracture is re-identified, similar in appearance to prior\nexam, which extends into the middle cranial fossa (series 300b, image 42) at\nthe posterior aspect of the mastoid antrum. There is partial opacification of\nthe mastoid air cells with high density fluid compatible with hemorrhage. \nHemotympanum opacifies the middle ear cavity. A fracture lucency extends\nthrough the anterior wall of the external auditory canal involving the\ntemporal mandibular joint. The right mandibular condyle is intact. Although\nincudal long process, lenticular process and stapes are poorly visualized,\nparticularly the stapes, secondary to adjacent high density material, the\nossicular chain appears grossly intact.\n\nAlthough evaluation of the tegmen tympani is slightly suboptimal secondary to\nopacification of the epitympanum, no clear defect or dehiscence is identified.\n\nThe otic capsule appears intact. There is no evidence for enlarged vestibular\naqueduct or superior semicircular canal dehiscence. The facial nerve follows a\nnormal course through the middle ear. There is no evidence for inner ear\ndysplasia.\n\nRIGHT: Soft tissue debris is seen in the external auditory canal, presumably\ncerumen. The external auditory canal is otherwise normal. Trace soft\ntissue/fluid is seen in the facial an tympanic recess (series 4, image 113). \nOtherwise, the remainder of the tympanic cavity is clear. There is no osseous\nerosion. The ossicles and tegmen are intact. There is no evidence for\nenlarged vestibular aqueduct or superior semicircular canal dehiscence. The\nfacial nerve follows a normal course through the middle ear. There is no\nevidence for inner ear dysplasia. The mastoids are clear.\n\nOTHER: Extensive right greater than left subdural, subarachnoid and anterior\ntemporal lobe contusions are again identified, similar appearance to prior CT\nexamination. The basilar cisterns are patent. Enteric tube is noted coiled\nwithin the oral cavity. Near-complete opacification with hyperdense material\nwithin the maxillary sinuses as well as dependent more hyperdense material\nwithin the visualized sphenoid sinuses are noted.", + "output": "1. Right temporal bone fracture with extension into the middle cranial fossa\nat the posterior aspect of the mastoid antrum and through the anterior wall of\nthe external auditory canal is re-identified, similar in appearance to prior\nexam.\n2. There is right hemo-tympanum, which limits evaluation of the ossicles,\nparticularly the stapes. However within these confines, there is no evidence\nfor ossicular chain disruption. The right otic capsule is intact.\n3. Evaluation of the right tegmen tympani is also suboptimal secondary to\nopacification of the middle ear. Within these confines, no clear evidence for\ntegmen tympani dehiscence or defect.\n4. Trace soft tissue/fluid is seen in the left sinus tympani and facial recess\nwithout evidence of osseous erosion, which likely represents sequela of prior\notitis. The left ossicular chain is intact. Otherwise, unremarkable CT of\nthe left temporal bone." + }, + { + "input": "A hyperdense, heterogeneous subdural hematoma extending along the right\ncerebral convexity is unchanged from the prior examination. A small left\nfrontal subdural hematoma is also noted, unchanged. Multiple foci of\nbilateral hemorrhagic contusions and diffuse subarachnoid hemorrhage are also\nlargely unchanged. Mild leftward shift of the midline structures is\nessentially stable. There has been interval placement of a right frontal\napproach ventriculostomy catheter, the tip which terminates immediately\nsuperior and anterior to the frontal horn of the right lateral ventricle. The\nventricles and sulci are grossly normal in size and configuration. The basal\ncisterns remain patent, and there is no evidence of impending downward\nherniation.\n\nA right parietal subgaleal hematoma is again noted. A nondisplaced paramedian\nfracture through the frontal bone is again noted to extend from the coronal\nsuture to the level of the frontal sinuses. A complex fracture through the\nright temporal bone is grossly unchanged, better visualized on the patient's\ndedicated temporal bone CT. There is near complete opacification the\nbilateral maxillary sinuses. Air-fluid levels are noted within the right\nsphenoid sinus. Mild mucosal thickening seen within the frontal and left\nsphenoid sinuses. Partial opacification involves the right mastoid air cells.", + "output": "1. Essentially stable, multifocal subarachnoid hemorrhage, bilateral\nhemorrhagic parenchymal contusions, and bilateral subdural hematomas, as\ndescribed above, with minimal leftward midline shift and no evidence of\ndownward herniation.\n2. Interval placement of a right frontal approach ventriculostomy catheter\nwhich appears to terminate adjacent to the frontal horn of the right lateral\nventricle.\n3. Stable, nondisplaced midline parasagittal frontal bone fracture.\n4. Unchanged appearance of a comminuted right temporal bone fracture." + }, + { + "input": "Stable appearance of known hyperdense subdural hematoma extending along the\nright cerebral convexity, unchanged from prior CT head from ___. A\nsmall left frontal subdural hematoma is also unchanged. Multiple foci of\nbilateral hemorrhagic contusions and diffuse subarachnoid hemorrhage are also\nlargely unchanged. Mild interventricular hemorrhage is seen in the\ninterpeduncular cisterns and remains unchanged from prior imaging.\n\nLeftward midline shift remains stable at 2.4 mm today as compared to 2.5 mm\nfrom ___. Right frontal approach ventriculostomy catheter is\nunchanged, with tip termination visualized superior and anterior to the\nfrontal horn of the right lateral ventricle. The ventricles and sulci are\ngrossly normal in size and configuration. The basilar cisterns are patent.\n\nA right parietal subgaleal hematoma is again noted. The known right temporal\ncomplex fracture and nondisplaced fracture through the frontal bone with\nextension to the frontal sutures is unchanged from prior study from ___.\n\nThere is near complete opacification of the bilateral maxillary sinuses.\nAir-fluid levels are again seen within the right sphenoid sinus. Mild mucosal\nthickening seen within the left sphenoid sinus and the bilateral frontal\nsinuses, left greater than right. The right mastoid air cells remain partially\nopacified. The visualized portion of the orbits are unremarkable.", + "output": "1. Stable appearance of known subdural hematoma along the right cerebral\nconvexity. Multiple foci of bilateral hemorrhagic contusions and diffuse SAH\nremain unchanged from prior imaging in ___. Stable appearance of\nslight leftward midline shift.\n2. Temporal and frontal fractures remain unchanged.\n3. Ventriculostomy catheter remains positioned adjacent to the frontal horn of\nthe right lateral ventricle." + }, + { + "input": "The patient is status post interval right hemicraniectomy with expected\npostoperative changes including pneumocephalus and hyperdense material\nlayering along the surgical site. There is now minimal rightward shift of the\nmidline structures secondary to this and decompressive craniectomy.\n\nA right frontal approach intracranial pressure monitorhas been removed. A new\nleft frontal intracranial pressure monitor has been placed with the tip in the\nleft frontal white matter.\n\nThere has been expected evolution of diffuse subarachnoid hemorrhage. \nSimilarly, numerous bilateral, predominantly bifrontal, hemorrhagic contusions\nare also minimally changed from prior examination. No discrete new foci of\nhemorrhage is identified.\n\nA nondisplaced right paramedian fracture through the frontal bone extends from\nthe coronal suture to the frontal sinuses, unchanged. Similarly, a complex\nfracture through the right temporal bone appears grossly unchanged.\n\nThere is partial opacification of the bilateral mastoid air cells, right\ngreater than left. The left maxillary sinus is completely opacified. An\nair-fluid levels seen within the right maxillary, left frontal, and right\nsphenoid sinuses. The ethmoid air cells are partially opacified. The orbits\nare grossly normal in appearance.", + "output": "1. Status post decompressive right hemicraniectomy with expected postoperative\nchanges.\n2. Interval placement of a left frontal approach intracranial pressure monitor\nterminating in the left frontal white matter.\n3. Unchanged appearance of diffuse subarachnoid hemorrhage and bilateral\nhemorrhagic contusions.\n4. Right temporal and right paramedian frontal bone fractures, similar in\nappearance from the prior examination." + }, + { + "input": "The patient is status post interval right hemicraniectomy with expected\npneumocephalus and hemorrhage layering along the surgical site. The previously\nnoted numerous bilateral, predominantly bifrontal, hemorrhagic contusions are\nminimally changed from the prior imaging study in ___. There is\ncontinuing evolution of the diffuse subarachnoid hemorrhage with\nredistribution of blood products and increase in surrounding edema around the\nhemorrhage sites.\n\nThe minimal rightward midline shift remains stable compared to prior exam. No\nevidence of new hemorrhage is identified.\n\nThe left frontal intracranial pressure monitor is placed with the tip in the\nleft frontal white matter.\nThe nondisplaced right paramedian fracture through the frontal bone extends\nfrom the coronal suture to the frontal sinuses is redemonstrated, unchanged. A\ncomplex fracture through the right temporal bone also appears grossly\nunchanged.\n\nThe bilateral maxillary sinuses appear partially opacified, left greater than\nright. The bilateral mastoid air cells are also partially opacified, right\ngreater than left. Air-fluid levels are seen within the right frontal, and\nright sphenoid sinuses. The ethmoid air cells have mild mucosal thickening. \nThe visualized portion of the orbits are unremarkable.", + "output": "1. Redemonstrated numerous bilateral hemorrhagic contusions appear minimally\nchanged from prior imaging study in ___ with continuing evolution\nof diffuse SAH and increase in edema surrounding contusion sites.\n2. Unchanged appearance of known fractures in the right temporal and right\nparamedian frontal bones.\n3. No evidence of new hemorrhage." + }, + { + "input": "Again seen are postoperative changes related to prior right frontoparietal\ncraniectomy without any overlying prosthesis / reconstruction. There is\ninterval resolution of previously seen intracranial hemorrhage. Associated\nencephalomalacia and volume loss in the right frontal lobe.\n\nNo acute intracranial infarction, hemorrhage or mass effect is seen. There is\nslight midline shift towards the left, partly secondary to craniotomy and\npartly because of patient positioning.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Interval resolution of previously seen intracranial hemorrhage status post\nright frontal craniectomy, encephalomalacia and volume loss in right frontal\nlobe.\n2. No acute intracranial abnormality." + }, + { + "input": "The patient is status post prior craniectomy and hematoma evacuation, with\ninterval cranioplasty. Large volume persistent volume loss is again noted\nwithin the right frontoparietal lobe.\n\nThere is no evidence of hemorrhage or infarction. Mild persistent leftward\nmidline shift has mildly improved as compared to the prior examination.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No evidence of hemorrhage or infarction.\n2. Status post right cranioplasty with massive right frontoparietal lobe\nencephalomalacia and volume loss." + }, + { + "input": "The patient is status post prior craniectomy and hematoma evacuation, with\ninterval cranioplasty. Again noted is large volume encephalomalacia involving\nthe right frontoparietal lobe. There is approximately 8 mm leftward shift of\nmidline structures (3:14), which is similar to ___.\n\nHigh-density material within the right frontal lobe (3:13, 3:20) likely\nrepresents hemorrhage within the operative bed. No evidence of infarction.\n\nVisualized paranasal sinuses are clear. There is partial opacification of the\nbilateral mastoid air cells. Middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Significant right frontoparietal volume loss status post prior hematoma\nevacuation, with areas of hemorrhage in the operative bed.\n2. Stable 8 mm leftward shift of midline structures." + }, + { + "input": "Right-sided postoperative changes identified. Previously seen pneumocephalus\nhas considerably decreased. Residual subdural collection is seen measuring\napproximately 3 cm of the frontal lobes and 12 mm more posteriorly in the\nfrontal lobe. There is mass effect on the right lateral ventricle. There is\nhydrocephalus with the ventricular size increased slightly including the\ntemporal horns compared with the previous CT of ___. No acute\nblood products are seen.", + "output": "Pneumocephalus has resolved with residual subdural producing mass effect and\nmild midline shift. No acute blood products are seen. The ventricular size\nhas slightly increased compared with ___." + }, + { + "input": "The patient is status post right frontotemporal craniotomy and evacuation of a\nhematoma with interval decrease in the size of the right frontal epidural\nfluid collection, measuring up to 1.0 cm in thickness, previously measuring\n1.3 cm. The right frontal subdural fluid collection has resolved. The\nlocules of gas within the epidural fluid collection have resolved. The right\nfrontal dural thickening and calcifications are unchanged. The local mass\neffect upon the right frontal lobe has decreased in comparison to the prior\nexamination. There is decreased effacement of the frontal horn of the right\nlateral ventricle. No acute intracranial hemorrhage or infarction is\nidentified.\n\nThere is encephalomalacia in the right frontal, parietal, and temporal lobes\nwith associated ex vacuo dilatation of the frontal and temporal horns of the\nright lateral ventricle. The mild-to-moderate dilatation of the remainder of\nthe ventricles is unchanged. The confluent hypoattenuation in the left\nperiventricular and subcortical white matter are unchanged.\n\nThe previously seen right to left midline shift has resolved.\n\nThe fracture of the right petrous temporal bone is unchanged. The right\nmastoid air cells are partially opacified.\n\nThe left maxillary sinus contains a small amount of aerosolized secretions. \nThe orbits are unremarkable.", + "output": "1. Status post right frontotemporal craniotomy with interval decrease in the\nsize of the underlying right frontal epidural fluid collection and or\nresolution of the right frontal subdural fluid collection with decreased local\nmass effect.\n2. No acute intracranial hemorrhage or infarction.\n3. Unchanged right petrous temporal bone fracture." + }, + { + "input": "There has been evidence of a right frontoparietal craniectomy. Subjacent to\nthe craniectomy, there appears to be extra-axial crescentic density similar to\ngray matter thought likely to reflect chronic subdural hematoma. Postsurgical\ndural thickening likely contributes as well. This appears to have been\npresent on examination dated ___, unchanged in extent. There is no\nacute hemorrhage, edema, or mass effect. Ventriculomegaly out of proportion\nto sulci appears stable relative to prior examination. Encephalomalacia\ninvolving the bilateral frontal lobes, right greater than left, as well as\ntemporal lobes bilaterally appear stable. Periventricular white matter\nhypodensity is similar in extent to prior study. Given degree of\nventriculomegaly, question transependymal CSF flow.\n\nThere is no shift of normally midline structures. Basal cisterns are patent. \nGray-white matter differentiation is overall preserved. Frontal and sphenoid\nsinuses are clear. Ethmoidal air cells are without mucosal thickening. Mild\nmucosal thickening involves the right maxillary sinus. Bilateral mastoid air\ncells and middle ear cavities are clear. Soft tissue density within the\nexternal auditory canals bilaterally likely reflects cerumen.", + "output": "1. Right frontoparietal craniectomy with subjacent extra-axial crescentic\nprobable pachymeningeal thickening and possible chronic subdural hematoma. \nThis appears to been present on examination dated ___ and unchanged. \nNo new hemorrhage is identified. No evidence of mass effect.\n\n2. Ventriculomegaly out of proportion to sulci potentially due to global\nvolume loss as on prior. Periventricular white matter hypodensity does raise\npossibility of transependymal flow of CSF in the setting of hydrocephalus\nalthough appearance has not significantly changed and this is not likely\nacute.\n\n3. Encephalomalacia involving the bilateral frontal and temporal lobes\nbilaterally." + }, + { + "input": "Overall appearance is unchanged from the recent prior study. Patient is\nstatus post right frontoparietal craniotomy with a crescentic intermediate\ndensity fluid collection underlying the surgical site, similar to the prior\nstudy and either representing pachymeningeal thickening or chronic subdural\nhematoma. Marked ventriculomegaly out of proportion to sulcal effacement is\nunchanged from the prior study. Bifrontal encephalomalacia and extensive\nperiventricular and deep subcortical white matter hypodensity are also\nunchanged. There is no midline shift and the basal cisterns remain patent.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. Nonspecific soft tissue density in the external\nauditory canals bilaterally likely represents cerumen. The visualized portion\nof the orbits are unremarkable.", + "output": "1. Unchanged appearance status post right frontoparietal craniotomy with\nventriculomegaly out of proportion to sulcal effacement and extensive\nperiventricular white matter hypodensity suggesting transependymal flow of\nCSF.\n2. No new or enlarging intracranial hemorrhage.\n3. Unchanged crescentic right frontal extra-axial intermediate density fluid\ncollection, which may represent a chronic subdural hematoma versus\npachymeningeal postoperative thickening." + }, + { + "input": "A left frontal approach ventriculoperitoneal shunt catheter has been placed\nwith the tip situated near the septum pellucidum. Small amount of left\nanterior pneumocephalus is noted. There is no significant interval change to\nthe size of the ventricles. For example, the third ventricle measures 17 mm,\npreviously 18 mm. There is no acute hemorrhage or large vascular territorial\ninfarction. Patient is status post right frontal parietal craniotomy with\nintermediate density fluid collection underlying the surgical site measuring\nup to 9 mm, unchanged since the prior study. Bifrontal encephalomalacia and\nsignificant periventricular and subcortical white matter hypodensities are\nunchanged.\n\nThere is mild mucosal thickening within the right maxillary sinus. The\nremaining visualized portion of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable. Small amount of soft tissue emphysema is seen at the left\nocciput.", + "output": "1. Status post left frontal approach ventriculoperitoneal catheter placed\nterminating at the septum pellucidum. No change to ventricle size.\n2. No acute intracranial hemorrhage.\n3. Additional findings as described above." + }, + { + "input": "Again seen is a left frontal approach ventriculoperitoneal shunt terminating\nnear the septum pellucidum. Pneumocephalus is decreased since the prior\nstudy. There is no acute hemorrhage or large vascular territorial infarction.\nThe ventricle size is largely unchanged. For example the third ventricle\nmeasures 17 mm, previously also 17 mm. Patient is status post right\nfrontoparietal craniotomy with intermediate density fluid collection\nunderlying the surgical site measuring up to 8 mm, also unchanged since the\nprior study. Bifrontal encephalomalacia and significant periventricular and\nsubcortical white matter hypodensities are again noted.\n\nAir-fluid level is seen within the right maxillary sinus. The remaining\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Status post left frontal approach ventriculoperitoneal shunt placement with\npersistent ventriculomegaly, unchanged.\n2. No acute intracranial process." + }, + { + "input": "Allowing for technical differences the appearance of the ventricles is\nunchanged. A left frontal VP shunt terminates in the region of the foramen of\n___, unchanged.\n\nThe patient is status post right frontoparietal craniotomy with an underlying\nintermediate density fluid collection which measures up to 8 mm, unchanged. \nMass effect is minimal. There are multiple tiny punctate hyperdense foci\n(series 3, image 29) in the posterior aspect of the collection, unchanged.\n\nAnterior bifrontal encephalomalacia is unchanged. Periventricular confluent\nhypodensities are also unchanged. No acute hemorrhage or acute large\nterritory infarct.\n\nThe visualized orbits are unremarkable. An air-fluid level in the right\nmaxillary sinus is noted.", + "output": "1. Unchanged ventriculomegaly.\n2. Unchanged fluid collection underlying the right frontoparietal craniotomy\nwith minimal mass effect." + }, + { + "input": "Patient is status post right frontoparietal craniotomy. The left frontal\nventriculostomy catheter terminates near the foramina ___ and is\nunchanged in position.\n\nExtra-axial mixed density fluid collection extending along right frontal\nconvexity with maximum diameter up to 1 cm is noted, and appears slightly\nenlarged compared to ___ prior exam\n\nThere is grossly stable prominence of the ventricles and sulci suggestive\ninvolutional changes. Confluent hypodensity in the bilateral frontal and\noccipital subcortical white matter is stable. There is no shift of the\nnormally midline structures.\n\nThere is a small amount of fluid layering in the right maxillary sinus, which\nis reduced from prior study. Mild mucosal thickening of the left maxillary\nsinus is noted. The visualized portion of the orbits are unremarkable.", + "output": "1. Right frontal mixed density extra-axial fluid collection, slightly enlarged\ncompared to prior exam measuring up to 1 cm in maximum diameter, again\nsuggestive of subacute to chronic subdural hematoma.\n2. Left frontal ventriculostomy catheter terminates in stable position in the\nfrontal horn of the left lateral ventricle near the foramen of ___.\n3. Stable ventriculomegaly.\n4. Grossly stable nonspecific confluent white matter lesions as described.\n5. Paranasal sinus disease as described." + }, + { + "input": "The patient is status post right frontoparietal craniotomy with the left\nfrontal ventriculostomy catheter terminating near the foramina of ___,\nunchanged in position compared to the prior exam. Right frontal extra-axial\nmixed density fluid collection extending along the frontal convexity with a\nmaximum diameter of 1.2 cm demonstrates interval evolution. No acute\nintracranial hemorrhage is identified. Prominence of the ventricles and sulci\nis likely related to age related involutional changes. Confluent hypodensity\nin the bifrontal and occipital subcortical white matter is unchanged compared\nwith prior exam likely secondary to chronic small vessel ischemic disease. \nThere is no shift of the normally midline structures.\n\nThe visualized paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear.", + "output": "1. No significant interval change in the size of the right frontal mixed\ndensity, predominantly hypodense extra-axial fluid collection, measuring up to\n1.2 cm compared to the prior exam from ___, demonstrating interval\nevolution of patient's known subdural hemorrhage. No new intracranial\nhemorrhage is identified.\n2. Stable position of the left frontal ventriculostomy catheter in the frontal\nhorn of left lateral ventricle near the foramen of ___.\n3. Chronic small vessel ischemic disease." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage,or edema. There is no\nmidline shift or mass effect. The basilar cisterns are patent.\n\nThe ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of acute hemorrhage, infarct, or fractures." + }, + { + "input": "Mucosal thickening and aerosolized secretions are seen in the left maxillary\nsinus. Mild, minimal mucosal thickening is also seen throughout scattered\nethmoid air cells. The remainder of the visualized paranasal sinuses, middle\near cavities, and mastoid air cells are well aerated and clear.\n\nThere is severe narrowing of the left ostiomeatal infundibulum secondary to\nmucosal thickening and secretions. The frontoethmoidal recesses are patent.\nThe cribriform plates are intact. The right anterior clinoid process is\npneumatized, and the left is not. Nasal passages are clear.\n\nThe lamina papyracea are intact. The nasal septum is there is leftward nasal\nseptal deviation and spurring. No convincing periapical lucency is\nidentified.\n\nThe orbits are grossly unremarkable, bilaterally. A solitary, lytic lesion is\nseen within the right frontal bone (03:40), of uncertain clinical\nsignificance. It appears unchanged compared to the previous MRI of ___ and likely represents a venous Lake. Limited evaluation of the\nintracranial contents appears within normal limits.", + "output": "1. Multifocal sinus disease, most prominent in the left maxillary sinus where\nthere are aerosolized secretions which may suggest an underlying acute\ncomponent.\n2. Severe narrowing of the left ostiomeatal complex secondary to mucosal\nthickening and secretions.\n3. Left-sided septal deviation with septal spur narrowing the left nasal\npassage." + }, + { + "input": "Mildly calcified aortic arch, which is otherwise normal. 3 vessel\nconfiguration. There is mild calcification in the proximal left subclavian\nartery without stenosis.\n\nThere is a curvilinear eccentric dense structure in the right common carotid\nartery extending from image 112 of series 2, branching into the right external\ncarotid artery, and continuing to the middle meningeal artery at foramen\nspinal some on image 207 of series 2, also seen for example on sagittal images\n16 through 18 and on coronal images 26 through 36. It is contiguous with\ndense embolization material consistent with the patient's history of dural AVF\npost embolization.\n\nThere is calcified and noncalcified plaque at the bilateral carotid\nbifurcations which does not appear to cause hemodynamically significant\nstenosis by an ___ ET criteria.\n\nThe bilateral vertebral artery origins are patent. The bilateral cervical\nvertebral arteries are patent without evidence of stenosis, dissection, or\nocclusion. The left vertebral artery is dominant, and the right vertebral\nartery is mildly hypoplastic.\n\nThere is a mucous retention cyst in the left maxillary sinus. Posterior fossa\nis mostly obscured by dense artifact from the embolization material. There\nare bilateral lens replacements. No cervical lymphadenopathy by size\ncriteria. The patient is post thyroidectomy. Included lung apices are\ngrossly clear within the confines of respiratory motion.", + "output": "1. Dense structure extending from the right common through middle meningeal\narteries, contiguous with embolization material from the treated arteriovenous\nfistula. Although this could be related to postprocedural change, it could\nalso reflect a retained wire fragment or cement in a retained catheter\nfragment. Clinical correlation suggested.\n\nNOTIFICATION: The findings were discussed with ___, NP by ___\n___, M.D. on the telephone on ___ at 4:39 pm, 10 minutes after\ndiscovery of the findings." + }, + { + "input": "There are old-appearing bilateral lamina papyracea fractures. There is no\ninduration of the adjacent fat or associated fat stranding. The adjacent left\nethmoid air cells are opacified, an acute component lamina papyracea fracture\non the left is difficult to exclude. There is minimal mucosal thickening of\nthe right maxillary sinus. The remainder of the imaged paranasal sinuses are\nessentially clear.. Partially imaged mastoid air cells are clear. The\norbital floors are intact. The pterygoid plates are intact. The ostiomeatal\nunits are patent.", + "output": "1. Old appearing bilateral lamina papyracea fractures. However, given the\nadjacent left ethmoid air cells are opacified, an acute component of the left\nlamina papyracea fracture is difficult to entirely exclude. No adjacent fat\nstranding or induration.\n2. No acute fracture seen elsewhere." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage, edema,or mass\neffect. The ventricles and sulci are normal for patient age. Bilateral\ntentorial calcification is seen. Extensive arterial calcifications.\n\nThere is no evidence of fracture. There is chronic periostitis of bilateral\nmaxillary sinuses, consistent with chronic inflammation. Partial\nopacification of the left anterior ethmoid air cells. Complete opacification\nof the left maxillary sinus, partially calcified polypoid soft tissue fullness\nextending into the left nasal cavity, consider inverted papilloma, or possibly\nantral choanal polyp with associated fungal colonization. ENT consult\nrecommended.\n\nClear mastoids. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Extensive arterial calcifications intracranially, extra cranially.\n3. Soft tissue fullness with partial calcification lateral wall left nasal\ncavity, extending into the maxillary sinus. Consider inverted papilloma, or\npossibly antrochoanal polyp with associated fungal colonization. ENT consult\nrecommended.\n\nRECOMMENDATION(S): ENT consult." + }, + { + "input": "There is complete opacification of the left maxillary sinus with some dense\nmaterial which probably is mineralized or calcified, the opacification is\nextending towards the nasal cavity and to the left anterior ethmoidal recess,\nwith narrowing of the infundibulum. There is associated sclerosis of the left\nmaxillary bones. There is no evidence of intracranial lesion. No evidence of\nleft orbital invasion.\nBone defect on the coronal view of the left maxillary bone (image 55, series\n601), could be related to prior surgery, correlation needed.\n\nSalt and pepper appearance of the skull which given the clinical context\nsuggests renal osteodystrophy.\n\nThere is no evidence of facial swelling.\nRight paranasal sinuses are well aerated.\nBilateral mastoids appear normal.\nLeft lens replacement. The globes, extraocular muscles, optic nerves, and\nretrobulbar fat appear normal.\nPeriodontal disease with periapical lucencies on the left maxillary bones.\nThe visualized upper aerodigestive tract appears normal.\nThe mandible and temporomandibular joints appear normal.\n\nExtent intra and extracranial arterial calcifications.", + "output": "Complete opacification of the maxillary sinuses with dense material extending\ninto the nasal cavity suggests antral choanal polyp with possible underlying\nfungal colonization.\n\nRECOMMENDATION(S): ENT consult recommend" + }, + { + "input": "Patient is status post fixation hardware of the mandible. There is extensive\nsubcutaneous edema about the hardware and extending into the submandibular\nspace, somewhat more prominent on the left than the right. There is\nassociated cutaneous thickening. There is no focal fluid collection or\nabscess formation however. The left submandibular gland is not well\ndelineated. There is no calcific density. The right submandibular gland is\nhomogeneous in attenuation.\n\nThere is no prevertebral or retropharyngeal edema. Palatine tonsils are\nsymmetric in size and otherwise unremarkable. Aerodigestive tract is without\nmass effect.\n\nThyroid gland is homogeneous in attenuation without focal nodularity. \nScattered cervical nodes are not pathologically enlarged. The parotid glands\nare symmetric in attenuation without inflammatory changes or focal\ncalcifications.\n\nThe orbits are unremarkable. Imaged paranasal sinuses are clear. Mastoid air\ncells bilaterally and middle ear cavities are clear.\n\nImaged portions of the brain parenchyma are unremarkable without an acute\nabnormality.\n\nLung apices are clear. Vessels of the head and neck are patent without\nsignificant stenosis.", + "output": "Extensive subcutaneous edema and cutaneous thickening about mandibular\nhardware, left greater than right. No focal abscess is identified. No deep\nneck infection. Bilateral maxillary sinuses are clear." + }, + { + "input": "There is no acute intracranial hemorrhage, acute infarction, edema or mass\neffect. The ventricles and sulci are prominent thought to reflect sequela of\nage related volume loss. Extra axial hypodensity along bilateral frontal\nconvexities, left greater than right may reflect subdural hygroma or\nalternatively a chronic subdural hematoma or volume loss. The basal cisterns\nare clear. The gray white matter differentiation appears preserved.\n\nNo acute fracture is identified. There is minimal ethmoidal mucosal\nthickening as well as mucosal thickening within the right maxillary sinus. The\nremainder of the visualized paranasal sinuses, middle ear cavities, and\nmastoid air cells are clear.", + "output": "No acute intracranial abnormality. Hypodensity within the bilateral frontal\nextra-axial spaces, left greater than right, may reflect small subdural\nhygroma or alternatively a chronic subdural hematoma or volume loss. No\npriors\nCorrelate clinically to decide on the need for further workup or followup.\n(known history of cirrhosis of liver )" + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is a partially calcified enhancing extra-axial left cerebellopontine\nangle mass abutting the tentorial incisura. There is no evidence of\ninfarction, hemorrhage, edema, or midline shift. There is mild diffuse\nparenchymal volume loss. The paranasal sinuses appear clear.\n\nCTA HEAD:\nThere are mild vascular calcifications of the cavernous segments of bilateral\ninternal carotid arteries. There is a hypoplastic right vertebral artery, a\ncongenital variant. 2 mm focal outpouching of the mid basilar artery (series\n3, image 215; series 454, image 6) is identified, likely representing a small\naneurysm. Otherwise, the remainder of the intracranial vasculature appears\npatent without evidence of stenosis, occlusion, dissection, or aneurysm.\n\nCTA NECK:\nThere are mild vascular calcifications of the bilateral carotid bifurcations\nwithout internal carotid artery stenosis by NASCET criteria. The bilateral\nvertebral arteries appear patent with a congenitally dominant vertebral\nartery. There are vascular calcifications of the aortic arch. There is\nprominence of the pulmonary trunk and visualized left pulmonary artery of\nprominent pulmonary artery\n\nOTHER:\nThere is a 3 mm hypodense left thyroid nodule. There are nonspecific\nperipheral parenchymal opacities, which may be related to atelectasis. There\nis no lymphadenopathy per size criteria.", + "output": "1. Partially calcified enhancing left cerebellopontine angle mass, possibly\nrepresenting a meningioma.\n2. Mild vascular calcifications with otherwise patency of the intracranial\nvasculature without stenosis, occlusion or dissection. 2 mm outpouching of\nthe mid basilar artery may represent a small aneurysm.\n3. Mild atherosclerotic disease at the bilateral carotid bifurcations without\ninternal carotid stenosis by NASCET criteria.\n4. 3 mm hyperdense left thyroid lobe nodule. The ___ College of\nRadiology guidelines suggest that in the absence of risk factors for thyroid\ncancer, no further evaluation is recommended.\n5. Nonspecific mild prominence of the pulmonary arteries, which may be related\npulmonary hypertension." + }, + { + "input": "There is been interval left occipital craniectomy. There is extensive\npneumocephalus, within normal limits given the patient's reported recent\nsurgery. There is no evidence of intracranial hemorrhage. There is no\nmidline shift or edema. Ventricles and sulci are unchanged from MRI head ___. There are mild atherosclerotic calcifications of bilateral carotid\nsiphons.\n\nThere is minimal mucosal thickening of the right maxillary sinus. Remaining\nparanasal sinuses are clear. Mastoid air cells and middle ear cavities are\nwell aerated.", + "output": "Status post left occipital craniectomy and resection of left temporal\nmeningioma with extensive pneumocephalus. No evidence of intracranial\nhemorrhage." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nCT HEAD WITHOUT CONTRAST:\nNo evidence of acute intracranial hemorrhage, large territorial infarct,\nedema, mass or subsequent mass-effect.\n\nMultiple EEG leads appreciated. No acute fractures or soft tissue edema. There\nis moderate to severe fluid opacification of the bilateral ethmoid sinuses and\nnear complete fluid opacification of the left maxillary sinus, likely\nsecondary to intubation. Patient is status post left partial mastoidectomy.\nMiddle ear cavities are clear. Patient is status post right lens replacement\nwith a left silicone ocular injection.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear preserved without stenosis, occlusion, or aneurysm formation. The\ndural venous sinuses are patent.\n\nCTA NECK:\nMinimal left vertebral artery origin nonocclusive atherosclerotic\ncalcification is noted. Otherwise, the carotidandvertebral arteries and their\nmajor branches appear preserved with no evidence of stenosis or occlusion.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\n\nCTV:\nNo evidence of dural venous sinus thrombosis.\n\nOTHER:\nBiapical scarring is noted. There is patchy consolidations in bilateral lung\nfields, concerning for pneumonic processes (series 4, image 37). Additionally,\nthere is mild dependent atelectasis bilaterally. There is a 14 x 6 mm\ncollection of air in the right paratracheal region (series 4, image 57), which\nmay be iatrogenic.\n\nAdditionally, there is nonspecific fluid collection in the oropharynx. Full\nexamination limited by dental artifacts.\n\nOf note, the nasogastric tube appears to descend towards the right. Consider\nchecking location of the nasogastric tube.", + "output": "1. Dental amalgam streak artifact limits study.\n2. No evidence of acute intracranial hemorrhage, large territorial infarct.\nPlease note MRI of the brain is more sensitive for the detection of acute\ninfarct.\n3. Patent circle of ___ without definite evidence of stenosis,occlusion,or\naneurysm.\n4. Nonocclusive probable atherosclerotic narrowing of left vertebral artery\norigin narrowing.\n\n5. Otherwise, patent bilateral cervical carotid and vertebral arteries without\ndefinite evidence of stenosis, occlusion, or dissection.\n6. No evidence of dural venous sinus thrombosis.\n7. Nonspecific patchy consolidations in bilateral lung fields. If clinically\nindicated, consider dedicated chest imaging for further evaluation.\n8. 14 x 6 mm collection of air in the right paratracheal region, which may be\niatrogenic. Attention on follow-up on chest x-ray.\n9. The nasogastric tube appears to descent towards the right. Consider\nchecking location of the nasogastric tube." + }, + { + "input": "Head CT: There is no evidence of acute intracranial hemorrhage or mass\neffect. The ventricles and basal cisterns appear normal. There is confluent\nsubcortical white matter hypodensity which is nonspecific though presumably on\nthe basis of sequelae of chronic small vessel ischemic disease.\n\nHead CTA: There are atheromatous calcifications bilateral cavernous internal\ncarotid arteries.\n\nNeck CTA: The aortic arch demonstrates conventional three-vessel branch\nconfiguration. The origins of the great vessels are patent. The origin of\nthe right subclavian artery is tortuous. The origin of the right common\ncarotid artery is tortuous. The vertebral arteries are codominant. There is\nminimal atherosclerotic plaque at the origins of the bilateral proximal\ninternal carotid arteries without stenosis by NASCET criteria. There is no\nevidence of dissection or occlusion. Incidentally noted the left vertebral\nartery origin from the aortic arch.\n\nThe lung apices are unremarkable. The thyroid gland, submandibular glands,\nand parotid glands appear normal. There is multilevel cervical spondylosis. \nNo osseous lesions are seen.", + "output": "1. No evidence of acute intracranial hemorrhage or mass effect.\n2. Confluent subcortical white matter hypodensity, nonspecific though likely\nsequelae of chronic microangiopathy.\n3. No evidence of aneurysm, vascular malformation, or occlusion within the\nvasculature of the head and neck.\n4. Mild scattered atheromatous vascular disease without proximal internal\ncarotid artery stenosis by NASCET criteria." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect or\nlarge territorial infarction. Similar to the prior study, the ventricles and\nsulci are slightly prominent suggesting age-related atrophy. Periventricular\nwhite matter hypodensities are nonspecific but may reflect chronic\nmicrovascular ischemic disease. The basal cisterns are patent. Gray-white\nmatter differentiation is preserved.\n\nThere is no fracture. There is new opacification of right mastoid air cells. \nThe middle ear cavities are clear. The partially visualized paranasal sinuses\nand left mastoid air cells are clear. There are atherosclerotic calcifications\nof the cavernous internal carotid arteries.", + "output": "1. No evidence of intracranial hemorrhage or large territorial infarction.\nEvaluation of the posterior fossa is limited on CT. If there is continued\nclinical concern for infarct an MRI may be obtained.\n2. New opacification of the right mastoid air cells compatible with ongoing\ninflammation." + }, + { + "input": "There is no evidence of hemorrhage, mass, mass effect or infarction. Mildly\nprominent ventricles and sulci are likely related to age related involutional\nchanges. Periventricular and deep subcortical white matter hypodensities\nlikely secondary to a small vessel ischemic disease. The basilar cisterns are\npatent, there is otherwise good preservation of gray-white matter\ndifferentiation.\n\nNo fracture is identified. The visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are unremarkable.", + "output": "1. Chronic findings unchanged since ___. No evidence of\nhemorrhage or infarction. ." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nlarge mass. Periventricular and subcortical white matter hypodensities are\nnonspecific, but likely represent chronic small vessel ischemic disease. \nProminence of the ventricles and sulci is suggestive of involutional changes.\n\nNo fracture seen. The imaged portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The imaged portion of the orbits are\nunremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of large territory infarction, hemorrhage, edema, or\nmass/mass-effect. Mild prominence of ventricles and sulci is suggestive of\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific, but likely represent chronic small vessel\nischemic disease.\n\nThere is no evidence of fracture. Aerosolized secretions are present in the\nleft sphenoid sinus. A focus of mucosal thickening is present the left\nmaxillary sinus. There is near complete opacification of the bilateral mastoid\nair cells with fluid extending into the left middle ear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality on noncontrast head CT." + }, + { + "input": "There is a large right convexity subdural hemorrhage of heterogeneous density\nwith multiple compartments, measuring 1.9 cm in maximum dimension. A\nlentiform component of the collection at the level of the right frontal lobe\nis noted on image 2:19, but it is unlikely to be epidural as there is no\nassociated fracture. The collection causes 1.1 cm leftward shift of normally\nmidline structures. There is effacement of the right lateral ventricle and\nthird ventricle with associated enlargement of the left lateral ventricle.\nThere is also mild right uncal herniation with mass effect on the midbrain and\neffacement of the main perimesencephalic cisterns.\n\nThere are additional sites of subdural hemorrhage along the right anterior and\nleft posterior falx, and possible trace subdural blood along the superior\nsurface of the bilateral tentorium.\n\nGray-white matter differentiation appears preserved.\n\nNo fracture is identified. There is trace mucosal thickening in the frontal,\nethmoid, and maxillary sinuses. Mastoid air cells and middle ear cavities are\nclear. Bilateral lens replacements are noted.", + "output": "Large right convexity subdural hemorrhage, heterogeneous but predominantly\nacute, resulting in 1.1 cm leftward shift of midline structures and mild uncal\nherniation. Additional foci of subdural hemorrhage along the falx\nbilaterally." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Mild involutional changes are compatible with age related\ninvolutional changes. There is mild periventricular white matter hypodensity\nwhich is suggestive of chronic microvascular ischemic disease. Small fluid\nlevels are noted within the bilateral maxillary sinuses. There is near\ncomplete opacification of the left sphenoid sinus with mild aerosolized fluid\nwithin the right sphenoid and bilateral posterior ethmoidal air cells. \nMastoid air cells and middle ear cavities are well aerated. The bony\ncalvarium is intact.", + "output": "No acute hemorrhage or fracture. Chronic changes detailed above." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The lateral and\nthird ventricles are disproportionately enlarged compared to the sulci. This\nfinding is more pronounced compared to prior MRI. Additionally, a 1.8 cm x\n1.8 cm extra-axial cystic lesion is seen in the velum interpositum, likely\nrepresenting an arachnoid cyst. A partially empty sella is seen. These\nfindings raise the possibility of hydrocephalus, uncertain if obstructive or\ncommunicating.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. A subcentimeter\nlow-attenuation lesion is seen in the left thyroid lobe. There is no\nlymphadenopathy by CT size criteria.", + "output": "1. Disproportionately enlarged lateral and third ventricles compared to the\nsulci, more pronounced compared to prior MRI.\n2. 1.8 cm x 1.8 cm extra-axial cystic lesion in the velum interpositum,\nlikely representing an arachnoid cyst. Partially empty sella. These findings\nraise the possibility of hydrocephalus, uncertain if obstructive or\ncommunicating.\n3. NORMAL circle of ___ and cervical vessels.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:31 am." + }, + { + "input": "There is a 1.7 x 1.7 cm homogeneously hyperdense sellar mass. Hemorrhage\nwithin the mass cannot be excluded. No additional foci of intracranial\nhemorrhage. Small hypodensity in the right basal ganglia is consistent with\nold lacunar infarction. There is no evidence of new large territorial\ninfarction or edema. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. There is ex vacuole dilatation of the\nfrontal horn of the right lateral ventricle. Bilateral periventricular and\nsubcortical white matter hypodensities are nonspecific but most likely\nrepresent sequela of chronic small vessel ischemic changes. Atherosclerotic\ncalcifications are seen in the bilateral carotid siphons.\n\nThere is no evidence of fracture. There is partial opacification of the\nethmoid air cells. There is mild mucosal thickening of the bilateral\nmaxillary sinuses. The remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. Patient status post bilateral lens\nreplacement.", + "output": "1. A 1.7 x 1.7 cm hyperdense sellar mass. Hemorrhage within the mass cannot\nbe excluded. Pituitary MRI can provide further assessment.\n2. No additional acute intracranial process.\n3. No calvarial fracture." + }, + { + "input": "The small subdural hematoma is seen in the region of the anterior falx. There\nis no other abnormality identified. No intraparenchymal hematoma seen. There\nis no mass effect, midline shift or hydrocephalus.", + "output": "Small anterior falx subdural hematoma which by virtue of density appears to be\nsubacute. No prior studies for direct comparison." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Previously seen anterior falx subdural hematoma has resolved. \nVentricles and sulci are prominent consistent with age-related involutional\nchange.\n\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact. There is a left lens\nreplacement. Mild atherosclerotic calcifications of the cavernous carotid\narteries are present.", + "output": "No acute intracranial process." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Confluent periventricular and\nsubcortical white matter hypodensities are again seen likely sequela of\nchronic small vessel disease. Bilateral basal ganglia and thalamic\nhypodensities are also noted, likely combination of prominent perivascular\nspaces and chronic lacunar infarcts. Ventricles and sulci are prominent\ncompatible with global volume loss.\n\nAerosolized debris is noted within the right sphenoid sinus. Included\nparanasal sinuses and mastoids are otherwise clear. Skull and extracranial\nsoft tissues are unremarkable.", + "output": "No acute intracranial process. Global volume loss and confluent white matter\nhypodensity which is likely sequela of chronic small vessel disease." + }, + { + "input": "There is no evidence of large vascular territory\ninfarction,hemorrhage,edema,or mass effect. There is prominence of the\nventricles and sulci suggestive of involutional changes. Again demonstrated,\nis severe periventricular and subcortical white matter hypodensities,\nconsistent with chronic microvascular ischemic disease. Bilateral basal\nganglia and thalamic hypodensities are also noted similar to prior.\n\nThere is no fracture. Mild mucosal thickening of the sphenoid sinus. The\nvisualized portion of the remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. There is a small ___ and preseptal\nhematoma without underlying fracture or signs of globe injury.", + "output": "1. No acute hemorrhage or fracture.\n2. Chronic small vessel disease.\n3. Small left ___ hematoma." + }, + { + "input": "There is a massive midline prevertebral hematoma approximately 12.8 cm in\ncraniocaudal dimension and 6.8 (TR) x 4.4 (AP) cm. Urgent CTA is required to\nassess active bleeding, ? carotid injury. There is associated mass-effect on\nthe airway most pronounced at the level of the epiglottis. Consider urgent\nintubation for airway protection.\n\nAn acute hyperextension fracture is noted at the anterior inferior corner of\nC4 without distraction or alignment abnormality. Fracture is best appreciated\non the sagittal reformats, series 602b image 28 through 31. There is minimal\nanterolisthesis of C2 on C3 which is likely chronic/related to degeneration. \nDisc disease is most notable spanning C4 through C7 with loss of disc space,\ndisc osteophyte complexes which result in mild to moderate central spinal\ncanal narrowing. In addition, uncovertebral joint hypertrophy noted at\nmultiple levels results in severe neural foraminal narrowing at C4-5 and C5-6\non the left. The lung apices notable for emphysema. Prevertebral hematoma\nextends to the level of the superior mediastinum. Thyroid is unremarkable.", + "output": "Massive prevertebral hematoma with associated hyper extension teardrop\nfracture at C4 without alignment abnormality or distraction. Recommend urgent\nCTA to assess active bleeding.\n\nRECOMMENDATION(S):\n-Intubation for airway protection.\n-C-spine collar placement given acute fracture at C4." + }, + { + "input": "There is a retropharyngeal hematoma spanning from the level of C2 to T1,\nmeasuring 12.3 cm with max diameter measuring 4.6 x 2.9 cm on the axial\ndimension, overall similar in prior examination. Of note, there is a fluid\nfluid level within the ___ the hematoma (series 2, image 135). At the\nlevel C3-4 disc space, there is vigorous, active extravasation of intravenous\ncontrast into the hematoma (2:150). The hematoma appears to be connected to a\nsmall prevertebral arterial vessel (series 2, image 144) although this region\nof enhancement cannot be definitively connected to a larger vessel. The\nexpanded hematoma displaces the esophagus anteriorly and somewhat narrows the\nairways, though the central airways remain patent. The retroperitoneal\nhematoma extends into the mediastinum to the level of pulmonary artery\nbifurcation. There is trace linear hyperdensity, likely representing\nadditional site of extravasation (series 2, image 103) at the level of the\nthyroid gland, without definitive source.\n\nThere is layering fluid in the sphenoid sinus. Mild mucosal thickening is\nseen in the posterior ethmoid air cells. The visualized paranasal sinuses,\nmastoid air cells, middle ear cavities are otherwise patent. Moderate\ncalcifications are seen at the bilateral carotid siphons. While this exam is\nnot tailored for intracranial contents, the visualized circle of ___\nappears patent. No territorial infarct is seen. Prominent left periorbital\nhematoma and soft tissue stranding is noted.\n\nBy NASCET criteria, there is no significant stenosis of the ICA bilaterally. \nThe left vertebral artery is diminutive throughout its course, likely\ncongenital variation.\n\nDegenerative changes of the cervical spine with disc space and vertebral body\nheight loss, most severe at C4 through C7 is noted. C4 anterior teardrop\nfracture is better visualized on prior examination.", + "output": "1. Extensive retropharyngeal hematoma spanning from C2 through T1, measuring\n4.6 x 2.6 cm axially with active extravasation. Unclear whether this\nrepresents active extravasation from prevertebral artery versus\nretropharyngeal branch artery, although the associated vessel does appear to\nbe likely prevertebral (series 2, image 144). Consultation with neurosurgery\nis recommended.\n2. An additional linear focus of hyperdensity along the lateral aspect of the\nhematoma inferiorly (series 2, image 103) cannot be connected to a larger\nvessel. This could represent venous hemorrhage. Close attention on followup\nis recommended.\n3. Additional findings described above.\n\nNOTIFICATION: The findings were discussed with ___ resident by ___,\nM.D. on the telephone on ___ at 10:03 am, 5 minutes after discovery of\nthe findings.\n The findings were discussed with ___, M.D. by ___, M.D. on the\ntelephone on ___ at 10:30 am, 30 minutes after discovery of the findings." + }, + { + "input": "In comparison with the recent CT neck, there is interval decrease in size of a\nretropharyngeal hematoma which now measures 4.2 x 1.7 cm, previously 4.6 x 2.9\ncm. The previously seen hematocrit levels are not visualized on this study. \nThis could be secondary to mass effect from intubation and the endotracheal\ntubes. The hematoma extends from C2 through visualized right aspect of the\nposterior mediastinum. However, the extent of hematoma within the mediastinum\nappears more prominent when compared to prior examination and findings remain\nconcerning for active extravasation versus redistribution secondary to mass\neffect from the intubation. There is stranding within the soft tissues of the\nlower neck.\n\nThere are subcentimeter cervical lymph nodes, possibly reactive. There are\nvascular calcifications of the aorta and origins of the great vessels. The\nthyroid gland appears unremarkable. There are multilevel degenerative changes\nof the cervical spine. There is dependent atelectasis within the visualized\nlung apices.", + "output": "1. Redemonstration of retropharyngeal hematoma extending from C2 through the\nright aspect of the posterior mediastinum, slightly decreased in size from the\nprior study with nonvisualized hematocrit levels previously seen, likely\nsecondary to mass effect from endotracheal tubes and intubation.\n2. The hematoma extends to the posterior mediastinum. The component in the\nmediastinum appears more prominent when compared to prior examination. This\ncould represent redistribution, however the findings could represent continued\nactive extravasation and close interval followup is recommended to document\nstability/growth." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nAgain seen is confluent periventricular and subcortical, brainstem white\nmatter hypodensities, nonspecific, however likely sequela of severe chronic\nsmall vessel ischemic disease in the absence of acute symptoms, similar.. \nBilateral basal ganglia and thalamic hypodensities are also unchanged, thought\nto represent a combination of prominent perivascular spaces and chronic\nlacunar infarcts. Tiny chronic right cerebellar infarct, stable.\n\nThere is no evidence of acute fracture. There is moderate opacification with\nfluid in the sphenoid sinus. Submucosal retention cyst in the left maxillary\nsinus is. Trace fluid in the inferior left mastoid air cells. Otherwise, the\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable. \nDense calcifications in the carotid siphons are noted.", + "output": "1. Findings most consistent with severe chronic small vessel ischemic changes\nin the absence of acute symptoms. No intracranial hemorrhage.\n2. Paranasal sinus disease, suggestive of acute sphenoid sinusitis in the\nabsence of recent intubation." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no acute hemorrhage. There is no evidence for edema or acute major\nvascular territorial infarction. Again seen are extensive confluent\nhypodensities in the subcortical, deep, and periventricular white matter of\nthe cerebral hemispheres, grossly similar to ___, nonspecific but\nlikely sequela of chronic small vessel ischemic disease in this age group. \nModerate global parenchymal volume loss is again seen with prominent\nventricles and sulci.\n\nThere are aerosolized secretions in the right maxillary sinus, as well as\nmucosal thickening and moderate mucous retention cysts in bilateral maxillary\nsinuses. There are dependent secretions in the right sphenoid sinus. Mastoid\nair cells are well aerated. There is evidence of bilateral cataract surgery.\n\nCTA NECK:\nCommon origin of the innominate and left common carotid arteries is a normal\nvariant. There is calcified plaque in the proximal right internal carotid\nartery without stenosis by NASCET criteria, and calcified plaque in the\nproximal left internal carotid artery with approximately 30% stenosis by\nNASCET criteria, unchanged. Calcified adjacent to bilateral vertebral artery\norigins without clear evidence for vertebral artery origin narrowing. \nCervical courses of bilateral vertebral arteries appear widely patent. Non\ndominant left vertebral artery is diminutive, as seen previously.\n\nCTA HEAD:\nThere is calcified plaque in bilateral carotid siphons without evidence for\nflow-limiting stenosis. There is mild calcified plaque in the proximal V4\nsegment of the right vertebral artery without flow-limiting stenosis. There\nis ___ termination of the non dominant left vertebral artery. There is no\nevidence for flow-limiting stenosis elsewhere in the major intracranial\narteries. There is no evidence for an aneurysm. Dural venous sinuses are not\noptimally assessed on this exam, but appear grossly patent.\n\nOTHER:\nThe thyroid is grossly unremarkable. The mediastinal hematoma seen on ___ is no longer evident. No enlarged lymph nodes by CT criteria. \nNonenlarged paratracheal and AP window lymph nodes are again seen. Mild\ncentrilobular emphysema and mild dependent atelectasis are noted in the\nincluded upper lungs; there evaluation is otherwise limited by expiratory\nphase of respiration. There are degenerative changes in the cervical spine.", + "output": "1. No evidence for acute intracranial abnormalities. In the setting of\nextensive chronic supratentorial white matter abnormalities, which are\nnonspecific but likely sequela of chronic small vessel ischemic disease in\nthis age group, MRI would be more sensitive for a recent infarction.\n2. Aerosolized secretions in the right maxillary sinus and dependent\nsecretions in the right sphenoid sinus. Please correlate clinically whether\nthe patient may have symptoms of sinusitis.\n3. Unchanged bilateral proximal carotid atherosclerosis with approximately 30%\nleft carotid stenosis by NASCET criteria, and no right carotid stenosis by\nNASCET criteria.\n4. No evidence for flow-limiting stenosis in the major intracranial arteries." + }, + { + "input": "Patient is status post right-sided craniotomy. Increased amount of low-density\nfluid collection is seen in the right-sided evacuation cavity resulting\nincreased mass effect. Leftward midline shift is increased from less than 5 mm\nto more than 10 mm since ___. Hyperdense material is noted in the fluid\ncollection, which represents rearrangement of existing blood or increased\nhemorrhage. Encroachment on quadrigeminal cistern by bilateral medial temporal\nlobes is noted, right greater than left.\n\nFluid level is seen in the right maxillary sinus. There is mucosal thickening\nof ethmoid sinus and mild partial opacification of right mastoid air cells.", + "output": "1. Increased amount of low-density fluid collection in the right-sided\nevacuation cavity is causing increased mass effect and leftward midline shift.\nThere is encroachment on quadrigeminal cistern by bilateral medial temporal\nlobes, right greater than left, also increased from ___.\n\n2. Hyperdense material noted in the fluid collection could represent either\nrearrangement of existing blood or increased hemorrhage.\n\n\n\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 1:45 ___, 5 minutes after discovery of the\nfindings." + }, + { + "input": "Patient is status post right-sided craniotomy. Pneumocephalus has minimally\ndecreased. There is no significant interval change in the heterogeneous\nright-sided 1.7 cm subdural collection, with unchanged areas of hyperdense\nacute hemorrhage. Leftward shift of midline structures is unchanged. Mass\neffect on the right lateral ventricle and the right aspect of the\nquadrigeminal cistern is unchanged. There is an unchanged small hyperdense\nleft subdural hematoma, image 2:22.\n\nMucosal thickening in the paranasal sinuses and partial opacification of the\nright mastoid air cells are similar to the prior exam, likely related to\nprolonged supine positioning in the inpatient setting.", + "output": "1. Unchanged large right mixed-density subdural collection and unchanged\nassociated mass effect.\n2. Unchanged small left subdural hematoma." + }, + { + "input": "The previously seen right-sided subdural hematoma has decreased in size. There\nis an approximately 9 mm subdural seen in the frontal region anteriorly and 16\nmm at the convexities which is predominantly hypodense . Linear high density\nmaterial along the periphery appears to be due to mineralization and\ncalcification. No definite acute hemorrhage is seen. Small amount of air is\nseen in the subdural space and at the craniotomy site.\n\nThere is no mass effect, midline shift or hydrocephalus. Mild effacement of\nthe sulci seen.", + "output": "Further decrease in size of the subdural hematoma seen on the previous CT.\nResidual hyperdense subdural as described. No acute hemorrhage." + }, + { + "input": "Patient is status post right frontal craniotomy. The previously seen right\nsided subdural hematoma appears slightly increased in size at the convexity,\nmeasuring up to 25 mm, felt to relate to redistribution and maybe some\ninternal membrane formation. The majority of the hematoma remains hypodense\nwith surrounding linear high-density material at the periphery which appears\nto be due to mineralization and calcifications as seen on prior CT\nexamination. Pneumocephalus has resolved. There is no acute hemorrhage, mass\neffect, shift of normally midline structures or acute major vascular\nterritorial infarction. Ventricles and sulci are normal in size and\nconfiguration. The basal cisterns appear patent and there is preservation of\ngray-white matter differentiation.\n\nThere is mild mucosal thickening of the ethmoidal air cells. Aerosolized\nsecretions are seen in the right sphenoid sinus. Minimal mucosal thickening\nis noted within the right maxillary sinus, incompletely imaged. Otherwise, the\nremaining visualized paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The globes are unremarkable. There is atherosclerotic\ncalcification of the cavernous carotids bilaterally.", + "output": "Right sided subdural hematoma appears slightly increased in size at the\nconvexity, felt to relate to redistribution and maybe some internal membrane\nformation. Stable appearance of linear high density material at the periphery,\nfelt to reflect mineralization/calcification." + }, + { + "input": "In comparison to the previous examination, the previously seen right subdural\nhematoma is present and unchanged in size, effacement of the sulci and degree\nof midline shift, with approximately 5.5 mm of midline shift towards the left.\nThere is a new small left occipital-parietal subdural hematoma noted which was\nnot seen on the previous examination.\n\nSubcortical and periventricular white matter hypodensities are consistent with\nchronic small vessel ischemic disease.\n\nThe basal cisterns appear patent and there is preservation of gray-white\nmatter differentiation.\n\nThe visualized bony structures are grossly unremarkable. There is a mucous\nretention cyst in the sphenoid sinus, moderate mucosal thickening in the\nethmoid air cells, mild mucosal thickening in the right maxillary, otherwise\nhe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\n\nThe globes are unremarkable.", + "output": "1. There is a previously seen a right-sided subdural hematoma which is\nunchanged in size. There is small 5.5 mm midline shift towards the left,\nunchanged from the previous examination.\n\n2. There is a new left occipital -parietal subdural hematoma which was not\nseen on the previous study." + }, + { + "input": "The patient is status post right-sided craniotomy and evacuation of a subdural\nhematoma. Postsurgical changes are seen in the adjacent soft tissues of the\nright scalp with subcutaneous emphysema. There is extensive pneumocephalus as\nwell as 5 mm of leftward shift of normally midline structures. There is a 6\nmm-wide mixed attenuation subdural collection on the right. A left subdural\nhematoma is minimally smaller in size from ___, now measuring 3-mm\nwide.\n\nNo hydrocephalus is present.\n\nThe basal cisterns appear patent and there is preservation of gray-white\nmatter differentiation.\n\nThere is diffuse thickening of the paranasal sinuses and maxillary sinuses\nwith an air-fluid level seen in the right maxillary sinus. The mastoid air\ncells are clear.\n\nThe globes are unremarkable. An endotracheal tube and enteric tube are\nidentified. There are marked carotid siphon calcifications seen.", + "output": "Status post right-sided craniotomy and evacuation of a subdural hematoma with\npostsurgical changes and extensive pneumocephalus. Decreased size of mixed\nattenuation right subdural hematoma with 5 mm of leftward shift of normally\nmidline structures. Small left-sided subdural hematoma is minimally smaller\nin size from ___." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema,or discrete\nmass. The ventricles and sulci are normal in size and configuration.\n\nThere is rightward deviation of the nasal septum with a left-sided nasal spur.\nThere is nodular mucosal thickening within the right maxillary sinus. \nOtherwise the imaged paranasal sinuses appear well aerated. The the middle\near cavities and mastoid air cells are clear. The native lenses have been\nsurgically removed bilaterally.", + "output": "1. No acute intracranial process.\n2. Rightward deviation of the nasal septum with left-sided nasal spur." + }, + { + "input": "There are postoperative changes at left frontal craniotomy site with small\namounts of hemorrhage and several air locules along the frontal\ninterhemispheric fissure.\n\nThere is a 7 mm rightward shift of midline structures and effacement of the\nfrontal horns lateral ventricles bilaterally.\n\nBasal cisterns are patent. The paranasal sinuses and mastoid air cells are\nclear. The ocular lenses have been resected. The orbits otherwise appear\nnormal.", + "output": "-Postoperative changes of after resection of a left frontal tumor resection.\n-Persistent mass effect." + }, + { + "input": "Postoperative changes of left frontal craniotomy for left frontal parafalcine\nlesion resection are again noted. Allowing for slight differences in\npositioning and measuring techniques, the overall size and configuration of\nthe left frontal edema has not significantly changed. Left frontal and\nparafalcine hematocrit is overall similar to minimally increased in size,\nwhich may reflect redistribution. Pneumocephalus is slightly decreased. \nThere is similar mass effect with a 6-7 mm rightward shift of midline\nstructures. Basal cisterns are patent.\nNo new focus of acute hemorrhage is identified. There is no territorial\ninfarction.\n\nLeft frontal craniotomy with soft tissue edema, without acute fracture\nparanasal sinuses, mastoid air cells, and auditory canals are grossly clear. \nPatient is status post bilateral lens replacement, otherwise orbits are\nunremarkable.", + "output": "-Postoperative changes of left frontal craniotomy with overall similar to\nminimally increased size left frontal edema, with slight redistribution of\nassociated hematocrit.\n-Similar mass effect with mild rightward shift of midline structures.\n-No evidence of new hemorrhagic focus or territorial infarction." + }, + { + "input": "The patient is status post left frontal craniotomy and resection of a left\nfrontal parafalcine meningioma. There is fluid, locules of air and small\nvolume hyperdense material within the surgical bed likely secondary to\npostsurgical changes. Additionally there is soft tissue gas overlying the\nleft frontal region extending to the left temporal region again likely\nconsistent with post operative changes. Left cerebral vasogenic edema is not\nsignificantly changed compared to prior study. No evidence of large territory\ninfarct. The ventricles and sulci demonstrate unchanged configuration. There\nhas been interval decrease of rightward midline which currently measures 9 mm\nin previously measured 1.3 cm on recent MR. ___ basal cisterns remain patent.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. There are bilateral lens replacements. Otherwise,\nthe orbits are unremarkable.", + "output": "1. Postsurgical changes from left frontal craniotomy and resection of a left\nfrontal parafalcine meningioma.\n2. No evidence of large territory infarct or unexpected intracranial\nhemorrhage.\n3. Interval decrease of rightward midline shift. Unchanged left frontal\nvasogenic edema." + }, + { + "input": "Patient is status post left frontal craniotomy and resection of a left frontal\nparafalcine meningioma. There has been interval increase in size of fluid and\nhyperdense material within the surgical bed. There has been interval\ndevelopment of small area of subarachnoid hemorrhage along the left frontal\nlobe. There has been interval decrease of frontal pneumocephalus. There is\nno acute large territory infarction . The rightward midline shift measures 6\nmm, previously 8 mm.\n\nThere is trace layering of interventricular hemorrhage at the occipital horn\nbilaterally. The ventricles demonstrate mild interval increase in size. The\nsulci demonstrate unchanged configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Interval development of a small amount of subarachnoid hemorrhage along the\nanterior left frontal lobe.\n2. Trace layering interventricular hemorrhage in the occipital horns\nbilaterally and mild interval increase in ventricular size, suggesting\ncommunicating hydrocephalus.\n3. Minimal interval increase of volume fluid and amount of hyperdense\nmaterial/hemorrhage within the surgical bed, which is still likely due to\nevolving postsurgical changes.\n4. Interval decrease of rightward midline shift.\n\nRECOMMENDATION(S): The findings were discussed with ___, N.P.\nby ___, M.D. on the telephone on ___ at 6:35 pm, 5 minutes\nafter discovery of the findings." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema, or\nmass. Periventricular and subcortical white matter hypodensities are\nnonspecific but likely sequelae of chronic small vessel ischemic disease. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges.\n\nNo evidence of fracture. Mild paranasal sinus mucosal thickening with\nprominent bilateral maxillary sinus mucous retention cysts. The patient is\nintubated and the nasopharynx and imaged oropharynx are opacified by fluid. A\nsingle right petrous apex air cell is partially opacified. The mastoid air\ncells and middle ear cavities otherwise appear clear. The orbits appear\nunremarkable.", + "output": "1. No evidence of an acute intracranial abnormality.\n2. Mild probable chronic microangiopathic changes and mild parenchymal\natrophy." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Normal study." + }, + { + "input": "Redemonstration of left cerebellar intraparenchymal hematoma measuring\napproximately 18 x 21 mm in transverse dimension, with associated surrounding\nvasogenic edema and mild surrounding mass effect. No herniation. No new focus\nof hemorrhage. Again confluent areas of low density are re- demonstrated in\nthe subcortical white matter, which are nonspecific and may reflect changes\ndue to small vessel disease. The bony structures and soft tissues are\nunremarkable, mucosal thickening remains unchanged in the right maxillary\nsinus, likely consistent with mucous retention cyst, the mastoid air cells are\nclear.", + "output": "Essentially no change from 11 hr prior, stable left cerebellar\nintraparenchymal hemorrhage with associated vasogenic edema and surrounding\nmass effect, with no evidence of herniation or new focus of hemorrhage." + }, + { + "input": "Previously seen left cerebellar intraparenchymal hematoma, minimal surrounding\nedema, mild mass effect on the fourth ventricle, and degree of midline shift,\nare not significantly changed. There is no hydrocephalus.\nImaged portions of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The orbits are unremarkable.", + "output": "No significant change. No new hemorrhage." + }, + { + "input": "There is no change in size of left cerebellar intraparenchymal hemorrhage\nmeasuring 2.3 x 1.8 cm (2:9) with mild surrounding vasogenic edema. There is\nno evidence of new hemorrhage. Gray-white matter differentiation is preserved.\nThe lateral ventricles are normal in size and configuration without\nhydrocephalus. The basal cisterns are patent.", + "output": "1. No appreciable change in left cerebellar hemorrhage.\n2. If there is continued clinical concern for infarct an MRI may be obtained." + }, + { + "input": "HEAD CT: There is a 2.6 x 2.0 cm hyperdense round area in the left cerebellar\nhemisphere (02:17) with surrounding hypodensity, compatible with vasogenic\nedema, which possibly extends into the left cerebellar peduncle. There is no\nmass effect or shift of normally midline structures at this time. The fourth\nventricle remains patent without intraventricular extension. Periventricular\nwhite matter hypodensities are compatible with sequela of chronic\nmicrovascular ischemic disease. The gray-white matter interface elsewhere is\npreserved without evidence of acute major vascular territorial infarct in the\ncerebrum. The ventricles and sulci are normal in size and configuration for\nthe patient's age. The basal cisterns appear patent. The orbits and globes are\nunremarkable. The right maxillary sinus contains a mucous retention cyst and\nsmall air-fluid level with mild mucosal thickening. The remainder of the\nimaged paranasal sinuses, middle ear cavities and mastoid air cells are clear\nbilaterally. The bony calvaria appear intact.", + "output": "1. 2.6 cm intraparenchymal hemorrhage in the left cerebellar hemisphere with\nsurrounding vasogenic edema. There may be edema extending into the left\ncerebellar peduncle, though this is not definite. MRI with contrast is\nrecommended for further evaluation and to assess for an underlying mass\nlesion.\n2. No significant local mass effect or evidence of herniation." + }, + { + "input": "Head CTA: Again noted is hyperdense left cerebellar hemisphere parenchymal\nhemorrhage from similar in size to prior CT examination performed at outside\nhospital. Intracranial ICA, ACA, MCA and their major branches are\nunremarkable. The vertebral arteries are roughly codominant. The basilar\narteries and posterior cerebral arteries are also unremarkable. There is no\nevidence of intracranial aneurysm larger than 3 mm. There is no spot sign\nwithin the in the parenchymal hemorrhage. The dural venous sinuses are patent.\n\nNeck CTA: There is a 3 vessel arch. There is ectasia of the ascending aorta\nmeasuring 4 cm. In addition, the pulmonary artery is prominent measuring\napproximately 3.1 cm. Otherwise, the right brachiocephalic, subclavian and\ncommon carotid arteries are unremarkable. The vertebral arteries are\ncodominant and unremarkable. There are minimal atherosclerotic calcification\nof the left carotid bifurcation is seen. The right distal cervical internal\ncarotid artery measures 5 mm and the proximal cervical internal carotid artery\nmeasures approximately 9 mm. The left distal cervical internal carotid artery\nit measures 5 mm and the proximal left cervical internal carotid artery\nmeasures 9 mm. There is no cervical internal carotid artery stenosis by NASCET\ncriteria.\n\nOther:\nPolypoid mucosal thickening with aerated mucous in the right maxillary sinus\nis noted. There is a tiny mucous retention cyst in the right sphenoid sinus.\nThe remainder of the paranasal sinuses are essentially clear. The orbits are\nunremarkable. The mastoid air cells and middle ear cavities are well\npneumatized and clear. Adherent soft tissues seen in the external auditory\ncanals, likely representing cerumen.\n\nEvaluation for pulmonary nodules is limited secondary to respiratory motion\nartifact. Biapical dependent atelectasis is noted. The aerodigestive tract is\nunremarkable. The thyroid gland is unremarkable. There is no cervical\nlymphadenopathy by CT size criteria. In the submandibular and parotid glands\nare unremarkable. Prominent multilevel cervical spondylosis with reversal of\nthe normal cervical lordosis is noted. There are no suspicious blastic or\nlytic osseous lesions.", + "output": "1. Roughly unchanged appearance of left cerebellar hemisphere parenchymal\nhemorrhage without evidence spot sign.\n2. There is enlargement of the main pulmonary artery. Clinical correlation\nwith are hypertension is recommended.\n3. There is ectasia of the ascending thoracic aorta.\n4. Otherwise, essentially unremarkable CTA of the head and neck without\nevidence of significant stenosis, occlusion or aneurysm." + }, + { + "input": "There has been interval hemorrhagic transformation of a left MCA stroke with\nnew large left intraparenchymal hemorrhage (03:15) and extensive left\nsubarachnoid hemorrhage extending up to the convexity (03:25). There is no\nsignificant midline shift. Ventricular configuration is unchanged and the\nbasal cisterns are patent. Hyperdensity within the interpeduncular cistern\nmay represent a small amount of free distributed blood (03:12). No other\nintraventricular hemorrhage is identified. Hypodensity within the left\nthalamus likely represents a chronic infarction (03:17). There is prominence\nof the ventricles and sulci compatible with age related involutional changes. \nExtensive periventricular and deep subcortical white matter hypodensities are\nnonspecific follows likely represent the sequelae of chronic small vessel\nischemic disease.\n\nThere is no evidence of fracture. The left maxillary sinus is hypoplastic\nwith inspissated secretions (3:3). Air-fluid levels are seen within bilateral\naspects of the sphenoid sinus with associated cortical thickening suggesting\nchronic sphenoidal sinusitis (3:6). The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are otherwise clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Interval hemorrhagic conversion of a left MCA territory infarction with\nleft frontal lobe intraparenchymal and subarachnoid hemorrhage. No associated\nventricular dilatation or midline shift.\n2. Likely chronic sphenoidal sinusitis.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 11:29 AM, 2 minutes\nafter discovery of the findings." + }, + { + "input": "Compared to the prior study obtained 6 hours earlier, there is no significant\nchange of the hemorrhagic transformation of left MCA distribution infarct with\nleft frontal intraparenchymal hemorrhage and left subarachnoid hemorrhage\nextending from the left sylvian fissure superiorly to the convexity. The\nintraparenchymal hemorrhage measures approximately 5.9 x 2.1 cm, not\nsignificantly changed from prior. There is no midline shift. There is\nminimal stable mass effect on left lateral ventricle. The ventricular\nconfiguration is unchanged and the basal cisterns remain patent. No\nhemorrhages are identified. There are periventricular and subcortical\nlucencies, which may represent small vessel ischemic changes.\n\nThere is no evidence of fracture. Fluid in the bilateral sphenoid sinuses is\nunchanged. Again seen is a hypoplastic left maxillary sinus. The mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. Grossly stable hemorrhagic conversion of left MCA territory infarction with\nleft frontal intraparenchymal and subarachnoid hemorrhage.\n2. No new hemorrhage identified.\n3. No ventriculomegaly or midline shift." + }, + { + "input": "Again seen is hemorrhagic transformation of the left MCA infarct with left\nintraparenchymal hemorrhage and left subarachnoid hemorrhage extending up to\nthe convexity, unchanged from prior study. There is increased edema with\nsulcal effacement. No evidence of midline shift or effacement of the left\nlateral ventricle.\n\nAgain seen is a hypoplastic left maxillary sinus with mucosal thickening and\nhyperostosis. Again seen are air-fluid levels in the sphenoid sinus with\nhyperostosis of the adjacent walls. The visualized portion of the remaining\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the left orbit is unremarkable. Right lens replacement\nis noted.", + "output": "1. Hemorrhagic transformation of the left MCA infarct with stable\nintraparenchymal and subarachnoid hemorrhage, with interval increase edema and\nsulcal effacement.\n2. No evidence of midline shift, with stable ventricular size.\n3. Paranasal sinus disease as described." + }, + { + "input": "Confluent extensive hypodensity and areas of loss of gray-white matter\ndifferentiation in the left frontal lobe and anterior left temporal lobe as\nwell as the basal ganglia are unchanged, compatible with known left MCA\nterritory infarct. Left frontal and parietal lobe intraparenchymal hemorrhage\nis overall similar in size to the prior exams if not slightly smaller,\nmeasuring up to 5.5 x 2.1 cm in the axial plane (series 3, image 18). Adjacent\nsubarachnoid hemorrhage appears unchanged. Edema has increased slightly in\nthere is greater mass effect with deformity of the left lateral ventricle and\nminimal left-to-right midline shift. There is no evidence of new hemorrhage\nor new infarction.\n\nMucosal thickening and wall sclerosis in the left maxillary sinus and sphenoid\nsinus appear unchanged. The remaining partially imaged paranasal sinuses are\nclear. The mastoid air cells and middle ear cavities are centrally clear. \nThe orbits are unremarkable other than right lens replacement.", + "output": "1. Evolving left middle cerebral artery distribution hemorrhagic infarction\nwith slightly increased mass effect and midline shift.\n\n2. Left frontal and parietal intraparenchymal and subarachnoid hemorrhage,\noverall unchanged.\n\n4. No evidence of new hemorrhage or new infarct." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage or mass. Loss of\ngray-white matter differentiation in the region of the left insula is\nconcerning for acute ischemia in the left MCA distribution (02:13). The\npatient likely received prior IV contrast as the vascular structures and in\nparticular the venous sinuses appear opacified. There is prominence of the\nventricles and sulci suggestive of involutional changes. Periventricular\nwhite matter hypodensities are likely sequela of chronic small vessel ischemic\ndisease. Small regions of hypodensity in the bilateral occipital lobes (2:15,\n17) may represent areas of prior infarction.\n\nThere is no evidence of fracture. There is evidence of prior endoscopic sinus\nsurgery. Hyperostoses of the left maxillary sinus and sphenoid sinus walls\nalong with mild mucosal thickening in the bilateral maxillary sinuses and\npartial opacification of the sphenoid sinuses suggests chronic inflammation. \nThe visualized portion of the remaining paranasal sinuses and middle ear\ncavities are clear. Partial opacification of the left mastoid air cells may\nalso reflect ongoing inflammation. The right globe appears to be deviated\ntowards the left resulting in dysconjugate gaze.", + "output": "1. No acute intracranial hemorrhage.\n\n2. Subtle loss of gray-white matter differentiation in the left insula is\nconcerning for acute ischemia in the left MCA distribution." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. Empty sella is\nnoted.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute infarction, hemorrhage, edema or mass.\n2. Empty sella is noted. This likely represents a normal variant but\ncorrelation with fundoscopic exam to assess for papilledema is recommended\ngiven that idiopathic intracranial hypertension cannot be excluded." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. The basal cisterns appear\npatent and there is preservation of grey-white matter differentiation.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Head CTA: There is no evidence of aneurysm, vascular malformation, or\nocclusion within the intracranial vasculature. The posterior cerebral\narteries, middle cerebral arteries, and anterior cerebral arteries appear\nnormal. The dural venous sinuses appear patent.\n\nNeck CTA: The aortic arch demonstrates a common origin of the left common\ncarotid artery and brachiocephalic artery. The origins of the great vessels\nare patent. The vertebral arteries are codominant. There is no evidence of\nproximal internal carotid artery stenosis by NASCET criteria. There is no\nevidence of dissection or vascular occlusion within the neck. The lung apices\nare unremarkable. The thyroid gland, submandibular glands, and parotid glands\nappear normal. No osseous lesions are seen.", + "output": "1. No evidence of aneurysm, vascular malformation, or occlusion, or stenosis\nwithin the intracranial vasculature." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction, mass or midline\nshift. There is no hydrocephalus. The ventricles and sulci are normal in size\nand configuration for age. The basal cisterns are patent and there is\npreservation of gray-white matter differentiation. Visualized paranasal\nsinuses and mastoid air cells are clear. There is a superficial right\nperiorbital hematoma with several locules of subcutaneous gas visualized.\nThere is no retrobulbar extension of hematoma. The globes are intact. There is\nno underlying fracture.", + "output": "1. No acute intracranial abnormality.\n2. Superficial right periorbital hematoma with subcutaneous emphysema but\nwithout retrobulbar extension of hematoma or underlying fracture. Globe is\nintact." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Basilar cisterns are\npatent.\n\nRight forehead hematoma seen without underlying fracture. Included paranasal\nsinuses and mastoids are clear. Skull and extracranial soft tissues are\nunremarkable.", + "output": "Forehead hematoma without underlying fracture or acute intracranial\nhemorrhage." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions. A 0.8 cm hypoenhancing right\nthyroid nodule is too small to warrant additional follow-up.", + "output": "No radiopaque foreign body seen in the upper aerodigestive tract." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Minimal\nperiventricular and subcortical white matter hypodensities are nonspecific but\nlikely sequelae of chronic small vessel ischemic disease. Nonspecific\nprominence of the extra-axial spaces at the vertex. The ventricles and sulci\nare otherwise normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No evidence of an acute intracranial abnormality." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Basilar cisterns are\npatent.\n\nIncluded paranasal sinuses and mastoids are essentially clear. There is a\npartially visualized right orbital floor fracture with herniation of fat into\nthe maxillary sinus. This is incompletely visualized and age indeterminate\nbased on images provided.", + "output": "No acute intracranial process.\nPartially visualized right orbital floor fracture with herniation of fat into\nthe maxillary sinus, incompletely visualized on this exam and the acuity is\nuncertain. Consider dedicated CT." + }, + { + "input": "There is no evidence of acute large territory infarction,hemorrhage,edema, or\nmass effect. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The patient is status post bilateral\nmaxillary antrostomies. There is severe mucosal thickening in the right\nmaxillary sinus and mild-to-moderate mucosal thickening in the left maxillary\nsinus with inspissated secretions. The partially imaged right maxillary sinus\nis completely opacified. There is mild mucosal thickening throughout the\nethmoid air cells. The visualized portion of the mastoid air cells and middle\near cavities are clear.", + "output": "1. No acute intracranial hemorrhage or calvarial fracture.\n2. Paranasal sinus disease." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact. There is a moderate\nsized subgaleal hematoma at the posterior vertex.", + "output": "No acute intracranial process. Moderate subgaleal hematoma at the posterior\nvertex. No fracture." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect.\nProminent ventricles and sulci are suggestive of age-related involutional\nchange. Extensive periventricular, subcortical, and deep white matter\nhyperintensities are consistent with chronic small vessel ischemic disease.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of infarct, hemorrhage, or mass effect.\n2. Age-related involutional changes and sequela of chronic small vessel\nischemic disease." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass effect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. There are periventricular and subcortical hypodensities,\nwhich may represent small vessel ischemic changes. Prominent dural\ncalcifications are unchanged.\n\nThere is a soft tissue swelling overlying the left supraorbital frontal\ncalvarium, with a subcutaneous hematoma measuring approximately 2.1 x 1.4 cm,\nwithout underlying fracture. There is mild mucosal thickening of the\nbilateral ethmoid air cells. The visualized portion of the remaining\nparanasal sinuses, mastoid air cells, and middle ear cavitiesare essentially\nclear. There are bilateral lens replacements. The visualized portion of the\norbits are otherwise unremarkable.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nintracranial hemorrhage or large territory infarct.\n2. Soft tissue swelling and 2.1 x 1.4 cm subcutaneous hematoma overlying the\nleft frontal calvarium, without underlying fracture.\n3. Additional findings described above." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nPeriventricular white matter hypodensities likely related to chronic small\nvessel disease.\nVascular arteriosclerotic calcifications are seen in the carotid siphons and\ndistal vertebral arteries bilaterally.\n\nThere is no evidence of fracture. The frontal sinus is hypoplastic, there is\nmucosal thickening in both maxillary sinuses, with the remaining of the\nparanasal paranasal sinuses clear, the mastoid air cells,and middle ear\ncavities are normally pneumatized. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial process or hemorrhage.\n2. Paranasal sinus disease as described above." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or infarction. The\nventricles and sulci are normal in size and configuration. The basal cisterns\nappear patent and there is preservation of gray-white matter differentiation. \nThe area of possible subdural hematoma along the free edge of the right\ntentorium is no longer visualized. The alternatives are a rapidly resolving\ntiny subdural hematoma or other artifact on the prior study.\n\nThe visualized bony structures are grossly unremarkable. There is mucosal\nthickening within the bilateral maxillary and sphenoid sinuses. Mucosal\nthickening with air fluid levels and aerosolized secretions are seen within\nthe bilateral ethmoid air cells. The middle ear cavities and mastoid air cells\nare clear. The globes are unremarkable.", + "output": "1. No evidence of hemorrhage.\n2. Multifocal sinus disease, as above." + }, + { + "input": "There is diffuse loss of gray-white matter differentiation and mild sulcal\neffacement, indicating diffuse cerebral edema. There is no acute hemorrhage. \nThe ventricles and basal cisterns do not appear compressed, but the patient's\nbaseline is not known. Cerebellar tonsils are normally positioned.\n\nThere is no evidence of fracture. Fluid in the paranasal sinuses may be\nrelated to endotracheal intubation. There are also mucous retention cysts in\nthe maxillary sinuses. Mastoid air cells are well aerated.", + "output": "Diffuse loss of gray-white matter differentiation with mild sulcal effacement\nindicates diffuse cerebral edema. No effacement of basal cisterns or\nherniation. No acute hemorrhage.\n\nRECOMMENDATION(S): Results were communicated to the emergency department\nelectronically by Dr. ___. Please see the WET READ section were for the\ntiming of the preliminary report." + }, + { + "input": "No evidence of acute large territorial infarction, acute intracranial\nhemorrhage, edema, or mass effect. The ventricles and sulci are right, likely\nsecondary to age-related involutional changes.\n\nA well corticated calvarial defect is noted within the left parietal\ncalvarium, consistent with provided history of prior craniotomy. No acute\nosseous abnormalities. Mild mucosal thickening in the bilateral maxillary\nsinuses. The remaining paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. Bilateral lens replacements.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThe ventricles, sulci, and cisterns appear normal. There is no intracranial\nhemorrhage or mass effect. The orbits are unremarkable.\n\nThere is a small mucous retention cyst within the left sphenoid sinus. The\nparanasal sinuses, middle ear cavities, and mastoid air cells are otherwise\nclear.\n\nThere are decompressive suboccipital craniotomy changes. There also changes\nrelated surgical resection of the posterior arch of C1.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. There is a\nfetal type left PCA. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is ulcerated plaque at the left carotid bulb, without less than 20%\nstenosis of the left internal carotid artery by NASCET criteria. There is no\nright internal carotid artery stenosis by NASCET criteria. The vertebral\narteries are patent without stenosis.\n\nOTHER:\nThere are no enlarged cervical lymph nodes. The lung apices are clear. There\nare thoracic laminectomy changes.", + "output": "1. No intracranial hemorrhage or mass effect.\n2. Unremarkable CTA head.\n3. Mild extracranial atherosclerosis with ulcerated plaque at the left carotid\nbulb with less than 20% stenosis of the left internal carotid artery by NASCET\ncriteria. No right internal carotid artery stenosis or vertebral artery\nstenosis." + }, + { + "input": "Head CT: There is no evidence of acute intracranial hemorrhage or mass\neffect. The ventricles and basal cisterns appear normal. There is confluent\nsubcortical white matter hypodensity which is nonspecific though may relate to\nsequelae of chronic small vessel ischemic disease. The orbits and paranasal\nsinuses are unremarkable.\n\nHead CTA: The middle cerebral arteries, posterior cerebral arteries, and\nanterior cerebral arteries appear normal. An anterior communicating artery\nseen. There is no evidence of aneurysm or vascular malformation. The dural\nvenous sinuses appear patent.\n\nNeck CTA: The aortic arch demonstrates conventional three-vessel branch\nconfiguration. The origins of the great vessels are patent. The vertebral\narteries are codominant. There is minimal atherosclerotic plaque within the V4\nsegment of the left vertebral artery and also atherosclerotic narrowing of the\nbilateral V4 segments of the vertebral arteries. There is atheromatous soft\nplaque at the origin of the bilateral proximal internal carotid arteries the\nwithout evidence of stenosis by NASCET criteria. Images and evaluation of the\nproximal right internal carotid artery is obscured secondary to motion\nartifact.\n\nThe lung apices are unremarkable. The thyroid gland, submandibular glands, and\nparotid glands appear normal. A few intra parotid lymph nodes are noted. No\nosseous lesions are seen. There is multilevel cervical spondylosis. There are\nmultiple prominent though not clearly pathologically enlarged cervical lymph\nnodes as well as the right peritracheal lymph node.", + "output": "1. No evidence of acute intracranial hemorrhage or mass effect.\n2. Confluent subcortical white matter hypodensity, may be on the basis of\nchronic small vessel ischemic disease.\n3. No evidence of aneurysm, vascular malformation, or vascular occlusion\nwithin the vasculature of the head and neck.\n4. Atherosclerotic narrowing of the bilateral V4 segments of the vertebral\narteries." + }, + { + "input": "Redemonstrated is the patient's known large sialolith measuring 2.5 x 1.7 cm\nwithin the right submandibular gland. The right submandibular gland itself\nappears enlarged, surrounding this sialolith. Overall, although the sialolith\nitself appears unchanged in size, the right submandibular gland has enlarged\nas compared to the prior examination from ___. Mild associated hyperemia\nand adjacent inflammatory stranding appears new. There is mild local mass\neffect on the adjacent parapharyngeal space and upper oropharynx, slightly\nprogressed from the previous examination.\n\nOtherwise, evaluation of the aerodigestive tract demonstrates no mucosal mass\nand no additional areas of focal mass effect.\n\nThe remainder of the salivary glands enhance normally and are without mass or\nadjacent fat stranding.A subcentimeter hypodensity in the right thyroid lobe\nappears new from the previous examination.There is no lymphadenopathy by CT\ncriteria. The neck vessels are patent.\n\nThe imaged lung apices demonstrate mild paraseptal and centrilobular\nemphysematous changes. No lobar consolidation or suspicious pulmonary nodule.\nMild calcifications are seen at the aortic arch.There are no osseous lesions.", + "output": "1. Stable size of a known right submandibular sialolith, with modest interval\nenlargement of the right submandibular gland with new gland hyperemia and\nsurrounding inflammatory changes. Findings may represent an acute on chronic\nprocess, including infection or inflammation secondary to gland obstruction.\n2. Resultant mild mass effect on the superior right oropharynx has modestly\nincreased from the previous examination.\n3. No evidence of associated pathologic cervical lymphadenopathy.\n4. New subcentimeter hypodense nodule in the right thyroid lobe.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or older.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "The left vertebral artery arises directly from the aortic arch. In the\nproximal left vertebral artery, there is an intraluminal filling defect which\nlikely represents thrombus secondary to small focal dissection. This finding\nhas not significantly changed compared to prior study dated ___. The\nright vertebral artery is within normal limits.\n\nThere is mild plaque at the right greater than left carotid bifurcation. There\nis no stenosis of the internal carotid arteries by NASCET criteria.\n\nThe distal cervical internal carotid arteries measure 3.4 mm in diameter on\nthe left and 3.9 mm in diameter on the right.\n\nThe visualized soft tissues of the neck are unremarkable. The lung apices are\nclear. Mild degenerative changes are seen in the cervical spine.", + "output": "Intraluminal filling defect within the proximal left vertebral artery which\nlikely represents thrombus secondary to small focal dissection. The findings\nwere discussed by Dr. ___ with Dr. ___ on the telephone on\n___ at 12:15 pm, ten minutes after discovery of the findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of large acute territorial infarction or intracranial\nhemorrhage. The ventricles are normal in size without mass effect or midline\nshift. There is diffuse parenchymal volume loss with commensurate prominence\nof the sulci and cisterns. There is near complete opacification of the right\nmaxillary sinus with internal focus of hyperdensity (5:186), with inspissated\nsecretions and sclerosis of the right maxillary sinus wall. There is right\nmaxillary sinus mild chronic periostitis. The remaining paranasal sinuses and\nbilateral mastoid air cells appear clear. The orbits and visualized soft\ntissues appear unremarkable.\n\nCTA HEAD:\nThe vascular calcifications of the clinoid and cavernous segments of bilateral\ninternal carotid arteries with moderate narrowing of the carotid terminus on\nthe left, and mild narrowing on the right. There is mild narrowing of the\nmedial M1 segment of the right MCA, likely atherosclerotic. Otherwise, the\nvessels of the circle of ___ and the principal intracranial vasculature\nappear patent without occlusion, stenosis, or discrete aneurysm formation. \nA-comm, bilateral PCOM are not definite identified. The major dural venous\nsinuses appear patent. There is diminutive caliber of the left posterior\ncommunicating artery and anterior communicating artery, with a patent right\nposterior communicating artery. The basilar artery, posterior cerebral\narteries and superior cerebellar arteries are patent. The bilateral\nintracranial vertebral arteries are patent.\n\nCTA NECK:\nThe left vertebral artery arises directly from the aorta. There is moderate\nnarrowing of the proximal V1 segment of the left vertebral artery, which\narises directly from the aortic arch, weight there is short-segment\ncalcification and eccentric wall thickening, similar to prior, which may be\nsequela of chronic dissection or atherosclerotic disease. Otherwise, the\nremaining segment of the left vertebral artery is patent. There is artifact\nand the proximal V1 segment of the right vertebral artery which partially\nlimits its evaluation. Right vertebral artery is otherwise patent. Vertebral\narteries are codominant. There is approximately 20% diffuse narrowing of the\nright internal carotid artery per NASCET criteria. There is mild\ncalcification at the origin of the left internal carotid artery without\nstenosis per NASCET criteria. There is mild origin narrowing of the left\ncommon carotid artery, probably similar compared to prior. Otherwise,\nbilateral common carotid arteries are patent. The left internal jugular vein\nthere is not well opacified, but is unchanged from ___. The right IJ\nappears patent.\n\nOTHER:\nStreak artifact related to dental amalgam limits evaluation of adjacent\nstructures. There is no lymphadenopathy per size criteria. The thyroid gland\nappears unremarkable. There is biapical pleuroparenchymal scarring. There\nare degenerative changes in the cervical spine.", + "output": "1. No evidence of large acute territorial infarction or intracranial\nhemorrhage.\n2. Proximal left vertebral artery focal moderate narrowing is stable, may be\nsequela of chronic dissection or atherosclerotic disease.\n3. There is moderate narrowing of left carotid terminus.\n4. Right maxillary sinus opacification with internal hyperdensity and sinus\nwall sclerosis, consistent chronic sinusitis, with the central inspissated\nsecretions or allergic fungal sinusitis. Presence of small area of\ncalcification within the sinus raises suspicion of mycetoma. There is no\nretro antral or orbital floor soft tissue infiltration." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\n\nThere is partial opacification of the bilateral ethmoid air cells. There is\nmoderate to severe mucosal thickening of the ethmoid air cells, left frontal\nsinus, bilateral sphenoid sinuses, and bilateral maxillary sinuses with\npneumatized fluid in the bilateral right worse than left maxillary sinuses. \nMastoid air cells and middle ear cavities are well aerated. The bony calvarium\nis intact.", + "output": "1. No intracranial hemorrhage or other acute intracranial abnormality.\n2. Paranasal sinus disease, as detailed above, is nonspecific. Clinical\ncorrelation for acute sinusitis is recommended." + }, + { + "input": "There is interval placement of a right frontal approach ventriculostomy drain\nwith tip terminating near the proximal third ventricle. There is\nredemonstration of extensive subarachnoid hemorrhage in the sylvian fissures,\nsuprasellar cistern and along the falx, not substantially changed from prior\nstudy. There is extensive right frontal and temporal lobe hematoma, which has\nmildly increased in size from the prior study. There is approximately 10 mm\nof right to left midline shift, unchanged. There is a small amount of\nlayering hemorrhage is seen within the occipital horn of the left lateral\nventricle, increased from prior study (02:15). There is increased dilatation\nof the temporal and occipital horns of the left lateral ventricle.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. An endotracheal tube is partially\nvisualized within the oral cavity.", + "output": "1. Interval placement of a right frontal approach ventriculostomy drain with\ntip terminating within the proximal third ventricle.\n2. Enlargement of the right frontal and temporal lobe hematoma with 10 mm\nright-to-left midline shift.\n3. Increase in the small amount layering hemorrhage within the occipital horn\nof the left lateral ventricle.\n4. Redemonstration of extensive bilateral subarachnoid hemorrhage, right\ngreater than left, unchanged.\n5. Increased dilatation of the temporal and occipital horns of the left\nlateral ventricle." + }, + { + "input": "There has been a right-sided craniotomy, evacuation of the right temporal lobe\nhematoma and clipping of the right middle cerebral artery bifurcation aneurysm\nwith expected postoperative changes.\n\nThere is 9 mm of midline shift, slightly decreased compared to ___.\n\nRedemonstration of a right frontal approach ventriculostomy drain with the tip\nterminating in the proximal third ventricle. Previously noted subarachnoid\nhemorrhage is substantially reduced in volume, although some layering\nhemorrhage is re-demonstrated in the right frontal sulci and right sylvian\nfissure.\nThere is no evidence of fracture. There is trace fluid in the right mastoid\nair cells. Otherwise, the visualized portions of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portions\nof the orbits are unremarkable. There are calcifications in the bilateral\ncavernous sinus carotid arteries.", + "output": "1. Status post evacuation of right temporal lobe hematoma and clipping of\nright middle cerebral artery bifurcation aneurysm with expected postoperative\nchanges.\n2. Right frontal approach ventriculostomy drain with the tip terminating\nwithin the proximal third ventricle." + }, + { + "input": "Patient is status post right-sided craniotomy for evacuation of right temporal\nlobe hematoma and clipping of right middle cerebral artery bifurcation\naneurysm, with expected postoperative changes. Redemonstration of right\nfrontal approach ventriculostomy drain with the tip terminating in the\nproximal third ventricle. Interval decrease in pneumocephalus in the right\ntemporal lobe region and anterior to bilateral frontal lobes.\n\nSince prior exam on ___, there has been reduction in volume of\nsubarachnoid hemorrhage, with some layering hemorrhage re-demonstrated in the\nright frontal sulci and right sylvian fissure. The occipital horn of the left\nlateral ventricle demonstrates a decreased amount of layering hyperdensity and\nis decreased in size in compared to ___. There is approximately 7\nmm of midline shift, slightly decreased compared to ___.\n\nRedemonstration of unchanged soft tissue swelling and air in the soft tissue\noverlying the right frontotemporal region.\n\nThere is no evidence of acute traumatic fracture. There is trace fluid in the\nright mastoid air cells. Otherwise, the visualized portions of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportions of the orbits are unremarkable. There are calcifications of the\nbilateral cavernous sinus carotid arteries.", + "output": "1. Status post evacuation of right temporal lobe hematoma and clipping of the\nright middle cerebral artery bifurcation aneurysm, with expected postoperative\nchanges.\n2. No new hemorrhage.\n3. Right frontal approach ventriculostomy drain with the tip terminating\nwithin the proximal lower ventricle." + }, + { + "input": "A right frontal ventricular drain has been removed. There is a small\nintraparenchymal hemorrhage which has appeared along the tract since its\nremoval within the anterior right frontal lobe. Postoperative changes and\nhemorrhage along the right middle cranial fossa show no definite short-term\nchange. Aneurysm clip is also unchanged. More generally, areas of\nsubarachnoid hemorrhage in basal regions as well as along the right frontal\nconvexity are also stable. Very similar layering hemorrhage in the left\noccipital horn. The right cerebral sulci are again effaced with moderate edema\nat the postoperative site and along the posterior right temporal lobe.\nAssociated leftward shift measures up to 8 mm, which is stable. Ventricles are\nunchanged. Similar small quantity of pneumocephalus. Surrounding soft tissue\nstructures are unremarkable. Visualized paranasal sinuses and mastoid air\ncells appear clear. Stable postoperative changes along the calvarium.", + "output": "Status post removal of right ventricular drain with small quantity of new\nhemorrhage along the tract. Otherwise no significant change.\n\nNOTIFICATION: The findings were discussed with ___ APN, M.D. by\n___, M.D. on the telephone on ___ at 12:55 am." + }, + { + "input": "There are again postsurgical changes related to right pterional craniotomy and\nclipping of the MCA aneurysm. Extra-axial fluid subjacent to the craniotomy\nsite is again demonstrated as well as mild scattered postoperative\npneumocephalus. There is continued subarachnoid hemorrhage overlying the\nright frontal, parietal, and temporal lobes. There is a similar degree of\nedema in the right hemisphere greatest in the temporal lobe, and also subtle\nhypoattenuation in the right caudate head. Small intraparenchymal hematoma in\nthe superior right frontal lobe related to previous catheter tract noted. \nThere is continued leftward midline shift measuring up to approximately 7 mm\nwhich does not appear significantly changed. Similar degree of layering\nintraventricular hemorrhage in the occipital horns, more conspicuous on the\nleft than on the right.\n\nThe imaged portions of the mastoid air cells and paranasal sinuses are clear. \nImaged portions of the orbits are unremarkable.", + "output": "1. Stable postoperative examination following right MCA aneurysm clipping with\ncontinued areas of subarachnoid hemorrhage, intraventricular hemorrhage, and\npostoperative changes. Leftward midline shift is similar to the previous\nstudy." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nEvolving postoperative changes right frontal craniotomy of right MCA aneurysm\nclipping with slight interval improvement in diffuse subarachnoid hemorrhage. \nThere is stable intraventricular hemorrhage. Punctate hyperdensity in the\nregion of the right temporal lobe (03:50) is stable compared to prior. No new\nintracranial hemorrhage. Interval improvement in leftward midline shift\nmeasuring 4 mm, previously 7 mm. Diffuse right cerebral sulcal effacement and\neffacement of the posterior right lateral ventricle appear similar.\n\nCTA HEAD:\nAneurysm clip is noted at the region of the right MCA. There is mild narrowing\nof the right M1 MCA, just proximal to the aneurysm clip, similar to prior. \nHowever, there is unremarkable vascular flow in the distal right MCA branches.\n\nThe remainder of the circle of ___ and their principal intracranial\nbranches appear unremarkable without stenosis, occlusion, or aneurysm\nformation greater than 3mm. No definite evidence for vasospasm.\n\nThe dural venous sinuses are patent.\n\nFluid opacification of the right mastoid air cells and middle ear. The left\nmastoid air cells middle ears appear clear. Paranasal sinuses are essentially\nclear. The orbits are unremarkable. An enteric tube is a identified.", + "output": "1. A stable postoperative changes of right MCA aneurysm clipping with slight\nimprovement in diffuse subarachnoid hemorrhage. Stable layering\nintraventricular hemorrhage. No new intracranial findings.\n2. Unchanged mild narrowing of the right M1 segment just proximal to the\naneurysm clip; otherwise unremarkable vascular flow in the distal right MCA\nbranches.\n3. The remainder of the CTA head is unremarkable. No definite evidence of\nvasospasm." + }, + { + "input": "The patient is status post right craniotomy and post clipping of a middle\nmeningeal artery aneurysm. The previously seen areas of subarachnoid\nhemorrhage in the right frontal lobe are less conspicuous. The extent of local\nmass effect including sulcal effacement and minor narrowing of the right\nlateral ventricle are relatively stable. Edema compared to prior is less\nhypodense, slightly improved. There is decreased intraventricular hemorrhage.\nNo significant midline shift. Pneumocephalus in the setting of postsurgical\nstatus is improved as well (02:12). Stable ventriculomegaly without worsening\nhydrocephalus.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Stable postoperative changes of the right MCA aneurysm clipping.\n2. Interval improvement in subarachnoid and intraventricular hemorrhage,\nedema, midline shift and pneumocephalus. Stable sulcal effacement and slight\neffacement of the right lateral ventricle. No worsening hydrocephalus." + }, + { + "input": "As before, the patient is status post right craniotomy and clipping of a right\nMCA aneurysm. The bilateral subarachnoid is less conspicuous compared to\nprior study with residual hemorrhage seen along the right frontoparietal\nconvexity. Intraventricular hemorrhage is decreased with a small amount of\nresidual layering hemorrhage in the occipital horns of the lateral ventricle. \nNo new intracranial hemorrhage is identified. There is a similar degree of\nmass effect, sulcal effacement and minimal effacement of the right lateral\nventricle compared to the most recent prior study. There is no significant\nmidline shift. Expected postsurgical changes including small volume\npneumocephalus are again present.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Stable postoperative changes following right MCA aneurysm clipping.\n2. Stable sulcal effacement in the right cerebral hemisphere. The ventricles\nare unchanged in size.\n3. Continued interval improvement in subarachnoid and intraventricular\nhemorrhage. No new intracranial hemorrhage is identified." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nNo evidence for acute intracranial hemorrhage, edema, mass effect, or acute\nmajor vascular territorial infarction. Normal size of the ventricles, sulci,\nand basal cisterns.\n\nThe orbits are unremarkable. There is minimal mucosal thickening in the left\nmaxillary sinus. Mastoid air cells appear grossly well-aerated.\n\nCTA NECK:\nThere is a 3 vessel aortic arch with widely patent great vessel origins. No\nevidence for arterial dissection, atherosclerosis, or stenosis. Specifically,\nthere is no carotid stenosis by NASCET criteria.\n\nCTA HEAD:\nThe left A1 segment is hypoplastic, a normal variant. There is otherwise no\nevidence for flow-limiting stenosis or aneurysm in the major intracranial\narteries. The dural venous sinuses are patent.\n\nOTHER:\nBilateral prominent cervical lymph nodes a likely secondary to the patient's\nyoung age. There is a hyperenhancing 10 mm nodule in the lower pole of the\nright thyroid lobe or immediately caudal to the right thyroid lobe, image\n3:87.\n\nThere is a 2 mm pulmonary nodule in the apical left upper lobe on image 3:___,\nmost likely secondary to small-airways plugging in a ___ patient. \n___ guidelines for incidentally discovered pulmonary nodules do\nnot apply to patient's younger than ___, but do not recommend routine chest CT\nfollow-up of asymptomatic, incidentally discovered pulmonary nodules smaller\nthan 6 mm.", + "output": "1. No evidence for acute intracranial abnormalities. MRI would be more\nsensitive for an acute infarction if clinically warranted.\n2. Normal CTA of the head and neck.\n3. 10 mm hyperenhancing nodule either in the lower pole of the right thyroid\nlobe or immediately caudal to the right thyroid lobe.\n\nRECOMMENDATION(S): Thyroid nodule. Ultrasound evaluation recommended if not\npreviously performed elsewhere.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or ___, or with suspicious findings.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150.\n\nNOTIFICATION: Electronic preliminary report was provided on ___ at\n22:15 by Dr. ___. Dr. ___ the additional finding of the\nthyroid nodule and the ultrasound recommendation above to the ED QA nurses\nlist on ___ at 16:39." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territory infarct. Gray-white matter\ndifferentiation is preserved. Prominence of the bifrontal extra-axial spaces\nis stable. Mild prominence of the ventricles and sulci is stable. Punctate\nhyperdensity at the left frontal horn corresponds to punctate enhancing focus\non prior MRI. T2 hyperintensities and concern for metastatic disease on\nprior MRI was better assessed on MRI. The visualized paranasal sinuses\ndemonstrate minimal mucosal thickening in bilateral ethmoid air cells. The\nremainder of the visualized paranasal sinuses are clear.. The mastoid air\ncells are clear. There is a nondisplaced right nasal bone fracture of\nindeterminate age. There is also a displaced fracture nasal spine of the\nmaxilla, displaced to the right.", + "output": "No acute intracranial process. Nondisplaced right nasal bone fracture of\nindeterminate age. Fracture of the nasal spine of the maxilla." + }, + { + "input": "Please note that intracranial metastases noted on recent MRI brain are not\nseen on the current CT. There is no hemorrhage, edema, infarct, or large\nmass. Ventricles and sulci are normal in size and configuration. Basal\ncisterns are patent.\n\nNo fracture. Mild leftward nasal septal deviation. Imaged paranasal sinuses\nare clear. There has been prior maxillary sinus repair bilaterally.", + "output": "No evidence of traumatic injury.\nPlease note that intracranial metastases noted on recent MRI of the brain are\nnot evaluated by CT." + }, + { + "input": "Please note that the known intracranial metastases noted on prior MRI are not\nseen on the current CT. There is no evidence of large territorial\ninfarction,acute intracranial hemorrhageor edema. There are scattered\nperiventricular white matter hypodensities which could be combination of small\nvessel disease, post treatment related or due to underlying metastases The\nventricles and sulci are unchanged in size and configuration. Basal cisterns\nare patent\n\nThere is no evidence of acute fracture. Old fracture through the frontal\nprocess of the maxilla on the right is noted. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. \nPostoperative changes seen at the lateral aspect of the maxillary sinuses\nbilaterally. Incidental note of mild leftward nasal septal deviation again\nmade. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n\n2. Please note that the intracranial metastases seen on prior exam are not\nwell characterized by CT." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nlarge mass. Periventricular and subcortical white matter hypodensities are\nnonspecific, but likely represent chronic small vessel ischemic disease. The\nventricles and sulci are normal in size and configuration.\n\nNo acute fracture seen. Old fracture through the frontal process of the\nmaxilla on the right is unchanged. Postoperative changes are again seen at the\nlateral aspect of the maxillary sinuses bilaterally. Mild leftward nasal\nseptal deviation is similar to prior. The paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. 2 mm right pericallosal lesion identified on MRI is not well characterized\nby CT." + }, + { + "input": "Evaluation is moderately limited by motion. Midline frontal scalp soft tissue\nswelling and locules of subcutaneous gas are compatible with laceration. No\nunderlying acute fracture. There is no evidence of acute large vascular\nterritory infarction, intracranial hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration for age.\n\nThere is near complete opacification of the right maxillary sinus with\nhigh-density material which likely represents inspissated secretions or fungal\ncolonization, likely chronic sinus disease given thickening and sclerosis of\nthe surrounding bone. There is partial opacification of the ethmoid sinuses. \nThe remaining paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The orbits are unremarkable.", + "output": "1. Frontal scalp soft tissue swelling and laceration.\n2. No acute fracture or intracranial hemorrhage.\n3. Sinus disease as described." + }, + { + "input": "There is no evidence of infarction, hemorrhage, or edema. An extra-axial 2.0\nx 1.0 cm rounded lesion at the left vertex (series 601b, image 82) likely\nrepresents a meningioma. The ventricles and sulci are normal in size and\nconfiguration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No hemorrhage, edema or large territorial infarction.\n2. A 2.0 x 1.0 cm rounded extra-axial lesion at the left vertex likely\nrepresents a meningioma." + }, + { + "input": "NONCONTRAST CT HEAD: There is no intra or extra-axial mass effect, acute\nhemorrhage or acute large territorial infarct. Prominent ventricles and sulci\nsuggest age-related involutional changes. Periventricular and subcortical\nwhite matter hypodensities are nonspecific, though likely sequelae of chronic\nsmall vessel ischemic disease. Rounded hypodensities in the bilateral basal\nganglia likely reflect old lacunes. Encephalomalacia in the left cerebellar\nhemisphere is consistent with prior infarct.\n\nCTA HEAD: Focal 2 mm outpouching within the C6 segment of the left internal\ncarotid artery could represent aneurysm or infundibulum (3:250). Moderate\natherosclerotic calcification addition and narrowing of the right petrous and\nlacerum internal carotid artery. Extensive atherosclerotic calcification of\nthe bilateral cavernous through supraclinoid internal carotid arteries results\nin bilateral mild to moderate narrowing. The right A1 segment is generally\nhypoplastic. Otherwise, vessels of the circle of ___ and their principal\nintracranial branches are patent without evidence of occlusion or high-grade\nstenosis.\n\nCTA NECK: There is a 3 vessel arch. The left vertebral artery is occluded\nthroughout much of its cervical course with focal reconstitution in scattered\nV2 segments throughout its cervical course, reconstitutes in the proximal\nportion of the V3 segment via muscular collaterals (series 3, image 208-9),\nand is again completely occluded in the mid-to-distal portions of the V4\nsegment. Focal 2 mm outpouching in the distal V4 segment just before joining\nthe basilar artery (3:236) most compatible with remnant V4, although a small\naneurysm is not entirely excluded. Atherosclerotic calcification of the right\nvertebral artery origin results in at least moderate narrowing. Otherwise,\nthe right vertebral artery and common carotid arteries are patent throughout\ntheir cervical course without evidence of occlusion, high-grade stenosis,\ndissection or aneurysm formation. Moderate calcified plaque at the bilateral\ncarotid bifurcation. There is approximately 50% stenosis of the right\ncervical internal carotid artery by NASCET criteria. There is approximately\n10% stenosis of the left cervical internal carotid artery by NASCET criteria. \nExtensive atherosclerotic calcification of the bilateral subclavian arteries\nare noted, resulting in mild to moderate narrowing throughout most of their\nvisualized course.\n\nRight innominate artery stent is patent. Extensive atherosclerotic\ncalcification of the great vessels with chronic ulcerated plaques within the\naortic arch and proximal descending thoracic aorta.\n\nOTHER: Bilateral peribronchovascular and ground-glass opacities,\npredominantly within the left upper lobe, suggest infectious etiology.\nPartially visualized bilateral nonhemorrhagic pleural effusions with\nassociated atelectasis. Moderate paraseptal and centrilobular emphysema. \nProminent mediastinal lymph nodes, likely reactive. Thyroid gland is\nunremarkable without discrete nodule. There is no cervical lymphadenopathy by\nsize criteria", + "output": "1. Focal 2 mm outpouching within the C6 segment of the left internal carotid\nartery present aneurysm or infundibulum.\n2. Focal 2 mm outpouching of the basilar artery at the left V4 bifurcation,\nmost likely represents remnant V4 artery. Aneurysm is not entirely excluded\nbut considered much less likely.\n3. Near complete occlusion of the left vertebral artery throughout its\ncervical course with scattered short focal reconstitution in V2 segments with\nreconstitution at the V3 segment from muscular collaterals with subsequent\nreocclusion within the mid-to-distal portions of the V4 segment.\n4. 50% stenosis of the right and 10% stenosis of the left cervical internal\ncarotid arteries by NASCET criteria.\n5. Extensive atherosclerotic disease with chronic ulcer plaques of the aorta\nand proximal descending thoracic aorta. Additional prominent atherosclerotic\ndisease as described above.\n6. Bilateral peribronchovascular ground-glass opacities predominantly within\nthe left upper lobe, suggestive of infectious etiology.\n7. Bilateral nonhemorrhagic pleural effusions with associated atelectasis." + }, + { + "input": "No evidence of acute large territorial infarction, acute intracranial\nhemorrhage, edema, or mass effect. The ventricles and sulci are normal in\nsize and configuration.\n\nNo acute osseous abnormalities. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial abnormalities or mass effect." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nHypodensity in the periventricular white matter is nonspecific but likely\nrelated to chronic microvascular changes. Subsequent MRI of the brain\ndemonstrates a focus of subacute infarct in the right frontoparietal region.\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are prominent due to mild atrophy.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe M1 segment of the left middle cerebral artery is irregular, likely due to\nnoncalcified atherosclerotic plaques. Hypoplastic A1 segment of the left ACA.\nAdditionally, there is mild narrowing of the right P2 segment. Otherwise, the\nremainder of the vessels of the circle of ___ and their principal\nintracranial branches appear normal without stenosis, occlusion, or aneurysm\nformation. The dural venous sinuses are patent. There are mild\natherosclerotic calcifications of the cavernous and supraclinoid internal\ncarotid arteries.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria. There are mild atherosclerotic calcifications at\nthe origin of the bilateral subclavian arteries with no significant stenosis.\n\nOTHER:\nThe visualized portion of the lungs shows focal opacity in the right upper\nlobe along the right major fissure (03:12). A 3 mm right upper lobe nodule is\nalso noted (03:56). Note is made of a 3.6 x 2.2 cm heterogeneous nodule in\nthe right thyroid lobe. There is no lymphadenopathy by CT size criteria. \nModerate degenerative changes are noted in the cervical spine.", + "output": "1. Subsequent MRI of the brain demonstrates a focus of subacute infarct in the\nright frontoparietal region. Please refer to dedicated MRI report.\n2. Irregularities throughout the M1 segment of the left middle cerebral artery\nare likely due to non calcified pleural plaques.\n3. 3 mm right upper lobe lung nodule, which requires a ___ year chest CT\nfollow-up if the patient has risk factors by ___ criteria. Focal\nopacity in the right upper lobe likely represents atelectasis.\n4. 3.6 x 2.2 cm heterogeneous nodule in the right thyroid lobe. Thyroid\nultrasound is recommended for further evaluation.\n\nRECOMMENDATION(S): Thyroid US is recommended for further evaluation of\nnodule.\n___ year chest CT is recommended if patient has risk factor, as described above.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 17:18 into the Department of\nRadiology critical communications system for direct communication to the\nreferring provider." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nLow-density change right lateral thalamus, internal capsule posterior limb,\nconsistent subacute infarct.\n\nThere is a partially calcified extra-axial right parietal mass measuring 4.4 x\n2.0 cm, compatible with meningioma.\n\nWithin the confines of CT, there is no evidence of other acute large vascular\nterritory infarct elsewhere, nor evidence of intracranial hemorrhage, or\nextra-axial collection, midline shift or herniation.\n\nThere is no displaced calvarial fracture. The visualized paranasal sinuses\nare clear. The right mastoid and middle ear cavities clear. There is a left\nmastoid effusion and left middle ear effusion. There is bilateral mild\nproptosis. The globes and orbits are otherwise without acute abnormality.\n\nCTA HEAD:\nThe right vertebral artery is diminutive following the origin of the right\nposterior inferior cerebellar artery (___), however remains patent to the\nbasilar origin. Left dominant vertebral artery, widely patent. Basilar\nartery widely patent. There is a fetal type left PCA, a normal anatomic\nvariant. The left P1 PCA is not well seen, either diminutive or absent. Left\nPCOM is large and widely patent. Conventional right PCA anatomy with a widely\npatent right PCOM and right P1 PCA. The P2 and more distal bilateral\nposterior cerebral artery branches are widely patent with preserved distal\nrunoff.\n\nThere is mild left and moderate right calcified plaque affecting the cavernous\nand left supraclinoid intracranial ICAs, causing mild-to-moderate right and\nmild left luminal narrowing. Otherwise, the remaining portions of the\nbilateral intracranial internal carotid arteries and the bilateral anterior\nand middle cerebral arteries are patent with normal distal runoff.\n\nNo aneurysm or large vessel occlusion. Major dural venous sinuses are patent.\n\nCTA NECK:\nCalcified plaque at the right carotid bulb and proximal right extracranial ICA\ncauses 30% luminal narrow by NASCET criteria (see series ___: 31). The\nremainder of the right extracranial carotid arteries unremarkable.\n\nCalcified plaque at the left carotid bulb and proximal left extracranial ICA\ncauses 40% luminal narrowing by NASCET criteria (242___:8). The remainder of\nthe left extracranial carotid artery is unremarkable.\n\nNote, the extracranial ICAs take a retropharyngeal course for short-segment\nother length at the level of C3 (3:137).\n\nThe extracranial vertebral arteries are normal.\n\nThere is mild calcified plaque at the aortic arch and arch branch vessel\norigins, not causing significant luminal narrowing. Arch branch vessels are\notherwise normal, widely patent throughout their visualized course.\n\nOTHER:\nCoarse, 5 mm focus of calcification in the right lower pole of the thyroid is\nnoted (3:63). The remainder of the thyroid is diffusely enlarged, mildly\ninhomogeneous and nodular, consider multinodular goiter or thyroiditis. Small\nparotid lymph nodes are noted bilaterally. There are scattered bilateral\nmultilevel cervical lymph nodes which are mildly numerous and prominent, for\nexample there is a left level 2A lymph node measuring 15 x 12 mm, however\nappearing to retain normal features including fatty hilum. These may be\nreactive in nature. No aggressive focal osseous lesion. No suspicious\npulmonary nodule.", + "output": "1. Acute right thalamic, internal capsule infarct.\n2. 4.4 cm partially calcified right parietal meningioma.\n3. Mild intracranial ICA calcified plaque. Otherwise, normal CTA head.\n4. Approximately 40% left and 30% right proximal ICA luminal narrowing. \nOtherwise normal CTA neck.\n5. Heterogeneous thyroid gland may be from multinodular goiter or thyroiditis.\n6. Moderate opacification left mastoid, middle ear.. Correlate clinically\nwith signs of left otitis media or otomastoiditis." + }, + { + "input": "There is redemonstration of a small focus of subarachnoid hemorrhage just\nanterior to the corpus callosum and lateral ventricles, not significantly\nchanged compared to prior study. An additional focus of hemorrhage is seen\nwithin the left lateral ventricle, slightly increased from prior study. Mild\nlayering hemorrhage is seen within the lateral ventricle bilaterally,\nleft-greater-than-right, increased from prior study.\nA small left convexity subdural hematoma is increased slightly in size since\nthe prior study. There remains no mass effect associated with this.\nThere is no evidence of infarction, mass-effect, midline shift, or\nhydrocephalus. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture. There is a moderate amount of layering\nhemorrhage within the Left maxillary sinus, unchanged. There is a mild amount\nof fluid within the left sphenoid sinus and moderate mucosal thickening of the\nbilateral ethmoid air cells, unchanged from prior study. Otherwise, the\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. There is a left periorbital hematoma and soft tissue\nswelling overlying the Left maxilla, unchanged", + "output": "1. Left anterior interhemispheric subarachnoid hemorrhage, unchanged from\nprior study.\n2. Slight interval increase in intraventricular hemorrhage with layering fluid\nseen in both lateral ventricles, increased compared to prior study.\n3. Enlargement of a still small left convexity subdural hematoma.\n4. No evidence of infarction, midline shift, or hydrocephalus.\n5. Layering hemorrhage within the left maxillary sinus, unchanged." + }, + { + "input": "CT Head: There is no acute intracranial hemorrhage, mass effect, edema, or\nlarge territorial infarction. The ventricles and sulci are normal in size and\nconfiguration. The visualized bones are unremarkable in appearance.\n\nCTA Head and Neck: There is no evidence of flow-limiting stenosis in the\ncervical and intracranial carotid and vertebral arteries and their major\nbranches. There is no evidence of dissection. Incidental note is made of a\ndominant left vertebral artery. The left internal carotid artery measures 8 mm\nproximally and 6 mm distally. The right internal carotid artery measures 9 mm\nproximally and 5 mm distally. There are subtle broad-based aneurysm at the MCA\nbifurcations bilaterally, measuring approximately 2 mm (series 5:209).\nThe thyroid is unremarkable. The lung apices are clear. Visualized osseous\nstructures are unremarkable.", + "output": "1. No evidence of flow limiting stenosis in the cervical and intracranial\ncarotid and vertebral arteries and their major branches.\n2. 2 mm broad-based aneurysms involving the MCA bifurcations bilaterally.\n\n\nChange in WET READ was paged to Dr. ___ by Dr. ___ on ___\nat 545 p.m, 5 min after they were made." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nNo evidence of hemorrhage, infarct, mass or subsequent mass-effect. There is a\ncircular focus of hypodensity near the right caudate region, most likely\nreflecting perivascular space or prior small vessel ischemic disease (series\n2, image 17). Patchy hypodensity along the bilateral deep white matter are\nnonspecific, but most likely reflect small vessel ischemic disease.\n\nThe visualized paranasal sinuses are clear except for mild fluid opacification\nof the right sphenoid sinus. Partial opacification of the right mastoid air\ncells. Visualized orbits are unremarkable.\n\nCTA HEAD:\nIntracranially, the circle ___ and ___ arterial branches are patent. No\nstenosis or aneurysm.\n\nThyroid gland are unremarkable. Mild atelectasis bilaterally.\n\nCTA NECK:\nMild calcified atherosclerotic disease of the aortic arch without stenosis.\nThe cervical portions of the ICAs and vertebral arteries are patent.\nSpecifically, no stenosis by NASCET criteria. No aneurysm.\n\nOTHER:\nMild dependent atelectasis of bilateral lung fields. The visualized thyroid\nglands are within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No hemorrhage, infarct, mass or subsequent mass-effect.\n2. Normal head and neck CTA." + }, + { + "input": "There is diffuse symmetric pre epiglottic space edema, without CT evidence of\nfocal mass or fluid collection. Mild diffuse supraglottic laryngeal edema. \nGlottis is patent. Normal epiglottis. Thickened arypiglottic folds\nsymmetrically. Otherwise, evaluation of the aerodigestive tract demonstrates\nno mass and no areas of focal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding.Thyroid gland is diffusely imaging is enlarged, without evidence of\nfocal mass, consider thyroiditis. There few scattered bilateral neck\nsubcentimeter lymph nodes, normal by CT size criteria. There is no\nlymphadenopathy by CT criteria. The neck vessels are patent. There is diffuse\nsoft tissue edema.\n\nScratched there are no osseous lesions. There is asymmetric probable atrophy\nof the right temporal lobe, suboptimally evaluated on this scan. Head CT\nwithout contrast recommended in further evaluation, specifically to more\ncompletely evaluate brain parenchyma temporal lobe, and to exclude potential\nof right temporal horn trapping which is probably unlikely. Mild\nopacification of the sphenoid sinuses with secretions. Paranasal sinuses are\notherwise clear. Patent mastoid air cells, middle ear cavities. There is\nperiodontal disease of the posterior most left mandibular tooth extending into\nthe tooth apex\n\nDegenerative changes in the cervical spine, with multilevel disc osteophyte\ncomplexes, posterior element degenerative changes. There is endplate\nsclerosis at C5-C6 level, likely degenerative in etiology, disc space\ninfection is unlikely unless clinically suspected. Retropharyngeal and\nprevertebral symmetric stranding and probable trace fluid extends from C2 to\nC6, may represent reactive edema. Jugular veins patent. No fluid\ncollections.\n\nPlease refer to chest CT report from today for thoracic findings. There are\nmild-to-moderate bilateral pleural effusions. Tracheal secretions. Mild\npulmonary edema with interlobular septal thickening. Centrilobular emphysema\nground-glass opacity right upper lobe medially. 0.2 cm nodule right apex. \nMild diffuse circumferential wall thickening of the proximal esophagus,\nconsider esophagitis, better seen on chest CT.", + "output": "1. No adenopathy.\n2. Diffuse edema. Symmetric mucosal, submucosal edema involving supraglottic\nlarynx, involving pre epiglottic ___ be reactive, inflammatory, can be\nseen with medication allergic reactions, no focal masses are seen. No\nepiglottic thickening.\n3. Mild retropharyngeal, prevertebral symmetric edema extends from C2 through\nC6, nonspecific, may be reactive endplate irregularity at C5-C6 level, is\nlikely degenerative, disc space infection is unlikely unless clinically\nsuspected, clinically correlate, consider MRI if indicated.\n4. Diffusely enlarged thyroid gland, without focal nodule, consider\nthyroiditis.\nPleural effusions, refer to chest CT report for thoracic findings.\n5. Mild diffuse circumferential wall thickening of the proximal esophagus,\nconsider esophagitis, better seen on chest CT.\n6. Incompletely imaged probable asymmetric atrophy of the right temporal lobe,\nrecommend CT head without contrast to further evaluate, and to exclude\npotential other pathology.\n\nRECOMMENDATION(S): Head CT without contrast." + }, + { + "input": "There is prominence of ventricles including temporal horns. The temporal\nhorns are enlarged out of proportion for ventricular enlargement indicative of\nmedial temporal atrophy. Hypodensities in the white matter indicates small\nvessel disease. No hemorrhage is seen. There are no focal hypodensities\nindicative of encephalomalacia in the temporal lobes.", + "output": "Medial temporal atrophy is identified which is more pronounced on the right. \nModerate-to-severe changes of small vessel disease. No acute intracranial\nabnormalities or mass effect." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is relatively stable intraparenchymal hemorrhage involving the right\nbasal ganglia, internal capsule, thalamus. Also seen is intraventricular\nhemorrhage involving the right lateral ventricle and fourth ventricle. There\nis interval surrounding vasogenic edema. No midline shift is seen.\n\nThere is an osteoma in the left frontal sinus. Also seen is mild mucosal\nthickening in bilateral ethmoid air cells. The remaining visualized paranasal\nsinuses and mastoid air cells are clear. Bilateral middle ear cavities are\nclear. The orbits appear unremarkable noting prior bilateral cataract\nsurgery.\n\nCTA HEAD:\nThere is minimal atherosclerosis involving bilateral cavernous carotid\narteries. The vessels of the circle of ___ and their principal\nintracranial branches appear otherwise unremarkable without stenosis,\nocclusion or aneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is a 4 vessel arch with the left vertebral artery or regenerating from\nthe aortic arch. There is mild atherosclerosis involving bilateral carotid\nbifurcations causing approximately 40% steatosis on the right and 30% stenosis\nof the left by NASCET criteria.\n\nThe carotid and vertebral arteries and their major branches appear otherwise\nunremarkable with no evidence of occlusion.\n\nIncidentally seen is hypoplastic left vertebral artery.\n\nOTHER:\nThere is hazy airspace opacity in bilateral upper lung zones, likely secondary\nto expiratory imaging. Also seen are multiple thyroid nodules, the largest\nmeasuring approximately 5 mm the left lobe of thyroid in keeping with\nmultilobular goiter. Cervical lymphadenopathy is seen.", + "output": "1. Relatively stable intraparenchymal and intraventricular hemorrhage\ninvolving the right basal ganglia, internal capsular, thalamus, right lateral\nventricle and fourth ventricle.\n2. Atherosclerosis involving bilateral carotid bifurcations causing caudal 40%\nstenosis on the right and 30% of the left by NASCET criteria.\n3. Mild intracranial atherosclerosis.\n4. Otherwise, unremarkable CTA of head and neck." + }, + { + "input": "Areas of high density demonstrated on the right thalamic region, consistent\nwith acute intraparenchymal hemorrhage and extending into the the right basal\nganglia involving the posterior limb of the internal capsule and in the right\nthalamus are similar to prior. Acute hemorrhagic changes in the right lateral\nventricle and the fourth ventricle are also similar to prior. There is no\nevidence of acute territorial infarction or large mass. The ventricles and\nsulci are similar in size and configuration compared to prior.\n\nNo fracture seen. Left frontal sinus osteoma is again seen. Mild mucosal\nthickening in the ethmoid air cells is similar to prior. The imaged portion\nof the paranasal sinuses, mastoid air cells, and middle ear cavities are\notherwise clear. The orbits are unremarkable.", + "output": "1. No significant change since earlier today, including areas of multi focal\nhemorrhage, involving the right thalamic region, right basal ganglia and\nposterior limb of internal capsule.\n\n2. Unchanged intraventricular hemorrhage with no evidence of hydrocephalus." + }, + { + "input": "The study is limited by motion artifact, as well as by rightward tilt of the\npatient's head.\n\nThe hemorrhage centered in the right internal capsule and thalamus is stable\nin size was slightly decreased density. Surrounding edema is stable. \nHemorrhage within the right lateral ventricle is also stable. No new\nhemorrhage is seen. The ventricles are stable in size. The frontal horn of\nthe right lateral ventricle remains larger than the left. Bilateral\nperiventricular white matter hypodensity has not changed significantly. Basal\ncisterns do not appear compressed.\n\nThe bones are unremarkable. An osteoma is again seen in the left frontal\nsinus.", + "output": "Technically limited exam. No significant change in the right deep white\nmatter/thalamic hemorrhage with extension into the right lateral ventricle. \nStable ventricular size." + }, + { + "input": "There is a 1.4 x 1.8 cm known intraparenchymal hemorrhage, which may be\nminimally increased in size since ___, previously measured at 1.4 x 1.6\ncm. Surrounding hypodensity around the intraparenchymal bleed represents\nincreased edema. There is no significant midline shift. The previously noted\nintraventricular hemorrhage is not well visualized on current exam. There is\nno evidence of new acute major vascular territorial infarction. The imaged\nparanasal sinuses are clear. Mastoid air cells and middle ear cavities are\nwell aerated. The bony calvarium is intact. A subcentimeter osteoma is\nincidentally noted in the left frontal sinus. Patient has had bilateral lens\nreplacements.", + "output": "1.4 x 1.8 cm known intraparenchymal hemorrhage, which may be minimally\nincreased since ___, previously measured at 1.4 x 1.6 cm, with surrounding\nedema and no midline shift. No evidence of additional new hemorrhage." + }, + { + "input": "There have been no significant changes since the study of ___. \nAgain seen is tissue loss involving the right thalamus and posterior limb of\nthe right internal capsule corresponding to the hematoma noted in ___. There\nis a tiny chronic lacune in the left caudate head, unchanged. There is no\nevidence of recent infarction.\nThere is no evidence of new hemorrhage,edema,or mass. The ventricles and\nsulci are mildly enlarged but well within the range of normal for age. There\nis unchanged periventricular white matter hypodensity that suggest chronic\nsmall vessel ischemia. Again seen and unchanged are a right frontal sinus\nosteoma and a well-circumscribed lucency in the right occipital bone that\nlikely reflects an arachnoid granulation..\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare otherwise clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No evidence of mass, hemorrhage or recent infarction.\n2. Chronic tissue loss related to prior right thalamic and posterior limb\ninternal capsule lacune." + }, + { + "input": "Chronic infarct of the right thalamus and posterior limb of the internal\ncapsule. A focal hypodensity within the left insular lobe appears unchanged,\nlikely chronic infarct. No evidence of acute, large territorial infarction. \nNo evidence of acute intracranial hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nPeriventricular white-matter hypodensities are nonspecific, likely sequela of\nchronic ischemic small vessel disease, focus of low attenuation in the right\nside of the thalamus is sequela of prior hemorrhagic event (3:16).\n\nProbable osteoma within the left frontal sinus (3:13). Otherwise, the\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are normal.", + "output": "No evidence of acute, large territory infarction or hemorrhage." + }, + { + "input": "Study is mildly degraded by motion. Within these confines: There is no\nevidence of large territorial infarction, hemorrhage, edema, or mass effect. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Calcifications are seen in the bilateral basal ganglia. Cerebellar\ncalcifications are also noted.\n\nThere is no evidence of fracture. The visualized portion of the mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable. Right ethmoid air cell mucosal thickening is\npresent.", + "output": "1. Study is mildly degraded by motion.\n2. No acute intracranial abnormality.\n3. Within limits of study, no evidence acute intracranial hemorrhage or\nfracture.\n4. Paranasal sinus disease as described.\n5. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct." + }, + { + "input": "There is no evidence of acute large territory infarct,hemorrhage,edema,or mass\neffect. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial abnormalities on noncontrast head CT. Specifically no\nintracranial hemorrhage or large territory infarct. However, MRI would be\nmore sensitive for detection of subtle or acute infarct, if there are no\ncontraindications." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThere is mild mucosal wall thickening in the bilateral maxillary sinuses. The\nremainder of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is normal variant hypoplastic V4 segment of the right vertebral artery\nwith ___ termination. There is normal variant partial fetal type supply of\nthe right posterior cerebral artery. There is variant hypoplasia of the right\nA1 segment of the anterior cerebral artery. The vessels of the circle of\n___ and their principal intracranial branches otherwise appear normal\nwithout stenosis, occlusion, or aneurysm formation. The dural venous sinuses\nare patent.\n\nCTA NECK:\nThe right vertebral artery is hypoplastic, a normal variant, but patent. The\ncarotid and vertebral arteries and their major branches appear normal with no\nevidence of dissection, stenosis or occlusion. There is no evidence of\ninternal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Normal head and neck CTA.\n2. No intracranial hemorrhage or infarct." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. There is\nmild prominence of the ventricles and sulci suggestive of volume loss. Again\nseen is dural calcification along the interhemispheric fissure, not\nsignificantly changed from ___.\n\nSmall left supraorbital hematoma seen without underlying fracture. There is\nno evidence of fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable. Calcification of the bilateral carotid\nsiphons and vertebral arteries are noted.", + "output": "No acute intracranial abnormality or fracture." + }, + { + "input": "Head CT: No intracranial hemorrhage is identified. There is no mass, mass\neffect or midline shift. An area of encephalomalacia within the right parietal\nlobe is unchanged from the prior MRI examination. The ventricles, cerebral\nsulci and cisterns are age appropriate.\n\nCTA head: There is a lobulated aneurysm with a narrow neck extending\ninferiorly and medially from the cavernous segment of the left internal\ncarotid artery measuring 4.5 x 6.5 mm. The neck of the aneurysm is near the\norigin of the left posterior communicating artery. A 3 mm aneurysm which\ntapers distally extends laterally from the cavernous segment of the right\ninternal carotid artery at the level of the right posterior communicating\nartery. There is a shallow, less than 2 mm, outpouching along the left aspect\nof the use distal basilar artery. No other aneurysm is identified.\n\nThere are atherosclerotic calcifications involving both carotid siphons\nwithout significant stenosis. The major intracranial vessels are patent. There\nis a normal anterior communicating artery complex, and both posterior\ncommunicating arteries are visualized. P1 segments of the posterior cerebral\narteries are present.\n\nCTA neck: The the aortic arch demonstrates a normal branching pattern. There\nis atherosclerotic calcifications of the left at the origin subclavian artery\nand causing at least a mild narrowing. Both vertebral arteries are patent. The\nleft vertebral artery is dominant.\n\nThe bilateral common carotid, internal carotid and external carotid arteries\nare patent. There is calcified and noncalcified atherosclerotic plaques at\nboth carotid bifurcations without significant stenosis by NASCET criteria.\nThere is no evidence for dissection.\n\nAtelectasis and mild central lobular emphysema is seen at the lung apices.", + "output": "1. Bilateral cavernous internal carotid artery aneurysms near the origins of\nthe posterior communicating arteries, left greater in size than right.\n2. Shallow distal basilar artery aneurysm.\n3. No intracranial hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. Periventricular white matter\nhypodensities likely sequela of chronic small vessel disease.\n\nHyperostosis frontalis interna is present with, no significant osseous\nabnormalities seen. The paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality.\n\nNOTIFICATION: No acute intracranial abnormality." + }, + { + "input": "There is no acute hemorrhage, edema, mass effect or acute large vascular\nterritorial infarction. The ventricles and sulci are normal in size and\nconfiguration. The basal cisterns appear patent and there is preservation of\ngray-white matter differentiation.\n\nNo fracture is identified. The mastoid air cells, middle ear cavities, and\nvisualized paranasal sinuses are clear. The globes are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThere is minimal calcified atherosclerotic plaque about the right carotid\nbifurcation. The carotidandvertebral arteries and their major branches\notherwise appear normal with no evidence of stenosis or occlusion. There is no\nevidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. Small lymph nodes are seen which are not enlarged by imaging\ncriteria. Metallic density is again seen in the posterior soft tissues of the\nneck.", + "output": "Essentially normal head and neck CTA." + }, + { + "input": "There is a small left caudate head chronic lacune. Otherwise, there is no\nevidence of acute infarction,hemorrhage,edema, or mass. There is mild\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Carotid siphon calcifications are\nmild bilaterally.", + "output": "1. No acute intracranial process.\n2. 4 mm left chronic lacunar infarct or in the left caudate head.\n3. Chronic findings include mild background global involutional change and\nmild vascular calcifications." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. A mucous retention cyst is noted in the\nleft sphenoid sinus. There is mild opacification of the ethmoid air cells. \nThe left maxillary sinus is almost completely opacified.", + "output": "1. No acute intracranial abnormality.\n2. Paranasal sinusitis." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Prominence of the ventricles and sulci could represent\nage-related involution changes. Punctate calcification left sylvian fissure\nis stable, likely vascular. Tiny focus of calcification upper right sylvian\nfissure or inferior right frontal operculum, stable, may be superficial\nparenchymal from prior inflammatory process or vascular, similar.\n\nThe imaged paranasal sinuses are clear, aside from minimal opacification of\nleft mid ethmoid air cell.. Mastoid air cells and middle ear cavities are\nwell aerated. The bony calvarium is intact.", + "output": "No acute intracranial abnormality" + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. A\npunctate calcification in the right sylvian fissure and punctate calcification\nin the left sylvian fissure are unchanged from prior.\n\nThere is no evidence of fracture. There is minimal opacification of the mid\nleft ethmoid air cells. The visualized portion of the remaining paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Mild atherosclerotic calcifications are seen in the\nbilateral carotid siphons. Punctate calcification is seen in the right\nsylvian fissure, potentially vascular in etiology.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial process. Specifically, no intracranial hemorrhage." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or\nmass-effect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Mild periventricular white-matter hypodensities are\nnonspecific, but likely represent sequela of chronic small vessel ischemic\ndisease.\n\nThere is no evidence of fracture. Small mucous retention cysts are noted in\nthe right maxillary sinus. The visualized portion of the other paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process. No findings to correlate to patient's\npresentation." + }, + { + "input": "Head CT: Subarachnoid hemorrhage in the basal cisterns and in the\ninterhemispheric fissure consistent with a ruptured anterior communicating\nartery aneurysm. The ventricular size and shape is appropriate for age and\nnot significantly enlarged compared with previous CT.\n\nRight femoral artery: no significant vessel stenosis, tortuosity or other\nabnormality precluding catheterization of the abdomina aorta.\n\nLeft common carotid artery: there is no evidence of carotid stenosis. No\nflow limitation. No tortuosity. The left carotid artery bifurcation appears\nto be and usually low approximately C6 level although the precise bifurcation\nis obscured in the lateral position by the shoulders and the chest.\n\nLeft internal carotid artery: The intracranial vessels visualized, the distal\nleft ICA, proximal distal MCA and ACA branches are well-visualized. No\naneurysms are identified.\n\nRight common carotid artery: There is no evidence off carotid disease or\nstenosis. No significant stenosis\n\nRight internal carotid artery: The intracranial views, the distal right ICA,\nproximal distal MCA andACA branches are well-visualized. Vessel caliber\nsmooth and tapering. There is a bilobed anterior communicating cerebral\naneurysm sized 2.5 x 3 millimeters that is projecting to the left. There is a\nsmall branch which is directing towards the frontal lobe that emerges from the\nA-comm complex close to the neck of the aneurysm.\n\nRight vertebral artery: The right vertebral artery is dominant and fills the\nbasilar artery and the most of the posterior fossa circulation except for the\nleft plica territory. No aneurysms identified.\n\n\n\nRight internal carotid artery arteriogram after deployment of coils. After\ndeployment of the coils, the anterior communicating artery aneurysm was\ncompletely occluded ___ 1). Patency of the A-comm complex and the\npatency of branch arising at the neck of the aneurysm was confirmed.", + "output": "1. bilobed anterior communicating cerebral aneurysm status post successful\nendovascular coiling\nI,Dr., ___, I was personally present and participated in the entirety of \nthe procedure; I have reviewed the above images and agree with the findings as\nstated above.\n\nRECOMMENDATION(S):\n1. Return to the neuro ICU for management.\n2. Daily aspirin 325" + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is interval reduction of previously noted subarachnoid hemorrhage with\nresidual hyperdense acute hemorrhage at central sulcus and cingulate sulcus\nwith maximum thickness of subarachnoid hemorrhage of 4 mm pericallosal region;\njust superior to the recently treated anterior communicating artery aneurysm.\nThere is no imaging signs to suggest interventricular extension. There is no\nevolving hydrocephalus.\n\nThere is no evidence of acute territorial infarction, , edema, ,mass-effect or\nmidline shift. The ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe beam hardening artifact caused by endovascular coiling material limiting\nthe assessment of the anterior communicating artery region. Taking into\nconsideration difference in technique; there is no imaging signs to suggest\nfocal stenosis or vascular vasospasm of the intracranial circulation.\n\nOther vessels of the circle of ___ and their principal intracranial\nbranches appear normal with no evidence of stenosis, occlusion,oraneurysm. The\ndural venous sinuses are patent.", + "output": "1. Status post anterior communicating artery aneurysm endovascular coiling.\n2. Interval decrease of previously noted subarachnoid hemorrhage with residual\nacute hemorrhage at central sulcus, pericallosal and cingulate fissures.\n3. No imaging signs to suggest significant vasospasm of intracranial\nvasculature.\n4. No other intracranial aneurysm." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass. \nProminent ventricles and sulci suggest age related involutional changes. \nPeriventricular white matter hypodensities are consistent with chronic small\nvessel ischemic disease.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable. Vascular\narthrosclerotic calcifications are noted in the cavernous segments of the\ninternal carotid arteries.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass.\nPeriventricular white matter hypodensities are consistent with chronic small\nvessel ischemic disease. Atherosclerotic vascular calcifications are noted of\nbilateral vertebral and cavernous portions of internal carotid arteries.\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is a dominant left A2 with a fenestration at its origin. There is\natherosclerotic calcification of the cavernous and petrous internal carotid\narteries. Atherosclerotic calcification in the left V4 segment of the\nvertebral artery is seen. Otherwise, the vessels of the circle of ___ and\ntheir principal intracranial branches appear normal without stenosis,\nocclusion or aneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is atherosclerotic calcification at the aortic arch bilateral carotid\nbulbs. In addition, atherosclerotic calcification at the origins of bilateral\ninternal carotid arteries is seen resulting in 40% stenosis on the right and\n37% stenosis in the left according to the NASCET criteria. Atherosclerotic\ncalcification at the origin of the left vertebral artery results in\nnonocclusive stenosis. Otherwise, the carotid and vertebral arteries and\ntheir major branches appear normal with no evidence of stenosis or occlusion.\n\nOTHER:\nSubpleural reticular opacities are seen in the bilateral lung apices. There\nis associated traction bronchiectasis. The visualized portion of the thyroid\ngland is within normal limits. There is no lymphadenopathy by CT size criteria\nalthough the pretracheal lymph nodes are prominent. Degenerative changes are\nseen throughout the cervical spine, worse at C5-C6.", + "output": "1. Periventricular and subcortical white matter hypodensities are nonspecific,\nbut commonly seen in setting of chronic microangiopathy in a patient of this\nage. No acute territorial infarct. No evidence of occlusive thrombus or\ndissection in the head or neck.\n2. 40% stenosis of the right and 37% stenosis of the left internal carotid\nartery's according to NASCET criteria.\n3. Subpleural reticular opacities in the bilateral lung apices, likely\nsecondary to fibrosis.\n\nRECOMMENDATION(S): Pulmonary evaluation is recommended for the lung fibrosis\nif the patient has not previously been evaluated by a pulmonologist." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\nThere is no evidence of fracture. Moderate to severe opacification of the\nethmoid air cells bilaterally as well as moderate mucosal thickening of the\nfrontoethmoidal recess es, and mild mucosal thickening of the sphenoid and\nmaxillary sinuses is present. The visualized portion of the mastoid air cells\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Paranasal sinus disease." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema,or mass-effect. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There are multiple left maxillary sinus\nmucous retention cysts. There is a small right maxillary sinus mucous\nretention cyst. The paranasal sinuses, mastoid air cells and middle ear\ncavities are otherwise clear. The visualized portion of the orbits are\nunremarkable.", + "output": "No acute intracranial abnormality" + }, + { + "input": "Evaluation is moderately limited by motion artifact as well as streak artifact\nfrom dental amalgam.\n\nVisualized, there is no evidence of acute intracranial hemorrhage, edema, mass\neffect, or loss of gray/white matter differentiation. Ventricles, sulci, and\nbasal cisterns appear normal in size.\n\nThere is no evidence of acute fracture. There is a deformity of the right\nlamina papyracea, which may be secondary to a chronic fracture, with\nencroachment onto the right anterior ethmoid. There is minimal mucosal\nthickening in the bilateral anterior ethmoid air cells. There is moderate\nmucosal thickening and mucous retention cyst in the left maxillary sinus and\nmild mucosal thickening with mucous retention cysts in the right maxillary\nsinus. Middle ear cavities, right mastoid air cells, and partially imaged\nleft mastoid air cells appear well-aerated. There is periapical lucency and\ncaries ___ 16 (3:6).", + "output": "1. Moderately motion limited exam.\n2. No evidence for acute intracranial abnormalities.\n3. Periapical lucency and caries ___ 16. Please correlate with dental exam\nregarding active inflammation.\n4. Mucosal thickening and mucous retention cysts within left greater than\nright maxillary sinuses. Odontogenic etiology may be considered.\n5. Right lamina papyracea deformity, which may be secondary to a chronic\nfracture, with encroachment onto the right anterior ethmoid." + }, + { + "input": "There is no evidence of acute territory infarction, hemorrhage, edema, or mass\neffect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes, slightly greater than would be expected for the\npatient's age.\nThere is no evidence of fracture. 1 cm lucency of the right parietal\ncalvarium is unchanged from examination of ___ and likely represents an\nosseous hemangioma (series 5, image 27). The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No evidence of hemorrhage or acute large territorial infarction." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular, subcortical and deep white matter\nhypodensities are nonspecific, but likely reflect the sequela of chronic\nmicrovascular infarction. Dense atherosclerotic calcifications of the\ncavernous carotid arteries and mild atherosclerotic calcifications of the\ndistal vertebral arteries are noted.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Patient is\nstatus post bilateral lens replacements with a right scleral buckle noted. \nMild soft tissue swelling is noted along the right posterior parietal scalp.", + "output": "No acute intracranial hemorrhage or mass effect. No fracture." + }, + { + "input": "There is no evidence of acute major vascular territory\ninfarction,hemorrhage,edema, or mass effect. The ventricles and sulci are\nnormal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nlarge territory infarct or intracranial hemorrhage." + }, + { + "input": "There has been interval placement of a right frontal approach drainage\ncatheter which terminates in the frontal horn of the right lateral ventricle\nnear the foramen of ___. The right lateral ventricle is decreased in\ncaliber, now measuring approximately 7 mm in with (previously 9 mm). There\nexpected postprocedural changes, including pneumocephalus along the right\nfrontal convexity. A left hemisphere intraparenchymal bleed is unchanged,\nmeasuring 3.8 x 4.1 cm (02:17, previously 3.9 x 4.0 cm). Extensive\nsubarachnoid hemorrhage involving the bilateral frontal, parietal, and\ntemporal lobes, as well as in the suprasellar, ambient, and prepontine\ncisterns are unchanged. There is intraventricular blood in the third\nventricle, left lateral ventricle, right occipital horn, and layering in the\nfourth ventricle, all unchanged. Rightward shift of normally midline\nstructures measures 3 mm, previously 2 mm. There is no evidence of infarct.\n\nNo osseous abnormalities seen. There is minimal mucosal thickening of the\nright sphenoid sinus and ethmoid air cells. The other visualized paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "1. Interval placement of a right frontal approach drainage catheter\nterminating in the frontal horn of the right lateral ventricle near the\nforamen of ___, with slight decompression of the right lateral ventricle.\n2. Unchanged left hemisphere intraparenchymal bleed as well as extensive\nsubarachnoid hemorrhage and intraventricular blood layering in the third, left\nlateral, right occipital horn, and fourth ventricles.\n3. Unchanged 3 mm rightward shift of normally midline structures." + }, + { + "input": "Again seen is extensive bilateral subarachnoid hemorrhage filling all basal\ncisterns as well as all cerebral convexities. The left frontal temporal\nintraparenchymal hemorrhage is stable to minimally increased in size with the\nlargest component measuring approximately 4.7 x 3.9 cm, previously 4.4 x 4.1\ncm with surrounding vasogenic edema. There is now a 5 mm rightward shift of\nmidline structures, previously 4 mm. A right frontal approach EVD terminates\nnear the foramen of ___. There is however, interval increase in size of the\nventricles. For example the third ventricle now measures 8 mm, previously in\n3 mm. The temporal horns of the lateral ventricles are also dilated. \nLayering intraventricular blood is unchanged.\n\nThere is no evidence of fracture. Patient is status post coiling of a left\nMCA bifurcation aneurysm. There is mucosal thickening involving the bilateral\nfrontal, sphenoid, and left maxillary sinuses as well as the ethmoid air\ncells. The mastoid air cells and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Interval minimal increase in the left frontal temporal intraparenchymal\nhematoma with surrounding vasogenic edema.\n\n2. Interval increase in lateral and third ventricle size. EVD in place.\n\n3. Slight increase and rightward shift of midline structures, now 5 mm.\n\nNOTIFICATION: Findings were discussed with ___, NP by ___, MD\nvia phone at 22:00 on ___, 10 minutes following discovery." + }, + { + "input": "Metal artifact from left MCA aneurysm coil and motion limits diagnostic\nevaluation. A right frontal approach EVD terminates near the foramen of\n___. Small residual pneumocephalus overlying the right frontal lobe is\nnoted, decreased compared to prior exam (see 4B: 15 on current study and\n02:14 on prior exam).\n\nAgain noted is extensive subarachnoid hemorrhage filling all of the basal\ncisterns and all of the cerebral convexities. The intraparenchymal hemorrhage\ncentered in the left frontotemporal region measures 4.8 x 3.8 cm (4a:18),\ngrossly unchanged in size as compared to CT head ___ 21:00. \nHowever, the degree of vasogenic edema surrounding this intraparenchymal\nhemorrhage has increased since comparison study. The degree of rightward\nmidline shift measures up to 7 mm(4a:17), previously 5 mm on comparison study.\nThe size of the ventricles are unchanged from comparison study. The third\nventricle measures 8 mm in maximal diameter (4a:13), previously 8 mm on\ncomparison study. The dilated temporal horns are unchanged in size. The\nfourth ventricle is patent. However evaluation of the suprasellar cistern is\nextremely limited due to metal artifact from left MCA coil.\nLayering intraventricular hemorrhage is grossly stable.\n\nMucosal thickening involving the bilateral frontal, sphenoid, and left\nmaxillary sinuses and bilateral ethmoid air cells are noted. Mastoid air\ncells and middle ear cavities are preserved.", + "output": "1. Study limited secondary to aneurysm coil mass streak artifact and motion.\n2. Increased vasogenic edema surrounding left frontotemporal intraparenchymal\nhemorrhage.\n3. Interval increased rightward midline shift, now measuring 7 mm, previously\n5 mm.\n4. Stable ventriculomegaly and EVD position.\n5. Grossly stable left frontotemporal intraparenchymal, subarachnoid and\nintraventricular hemorrhage.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with NP ___\n___ on the telephone on ___ at 1:17 ___, 5 minutes after discovery\nof the findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is a right frontal approach external ventricular device, terminating in\nthe region of foramen of ___, which is unchanged in position. There is\nslightly increased effacement of the left frontal horn of the lateral\nventricle with unchanged size of the right frontal horn and prominence of the\nright temporal horn. There is slightly increased rightward midline shift\nmeasuring 5 mm, previously 4 mm. There is no uncal herniation. There is\nsimilar effacement of the suprasellar cistern. Foramen magnum is patent.\n\nThere is a grossly similar size of the left parenchymal hematoma. There is\nslight increase in surrounding vasogenic edema with sulcal effacement and\ncerebral edema. Again seen is bilateral diffuse subarachnoid hemorrhage with\nslight interval redistribution. There is slight increase in intraventricular\nhemorrhage within the right occipital horn.\n\nStreak artifact related to coil embolization of left M1/2 aneurysm limits\nevaluation of adjacent structures. There is moderate paranasal sinus disease,\nwith worsened opacification of the ethmoid, sphenoid sinuses, with secretions\nin the sphenoid sinus and worsened secretions in the left maxillary sinus with\nstable mucosal thickening in bilateral maxillary sinuses. There is persistent\nopacification of the nasopharynx, which is likely iatrogenic related to\nintubation and anterior to placement.\n\nCTA HEAD:\nThere is stable mild narrowing of the high cervical right ICA with adjacent\natherosclerotic calcification. There is coil embolization of the left M1/2\naneurysm with streak artifact limiting evaluation of the adjacent structures. \nIn comparison with the prior study, there is decreased caliber of the left A1\nsegment, and possibly left M1 segment, suggesting vasospasm. Right A1 is\nhypoplastic, stable since ___. Otherwise, the vessels of the\ncircle of ___ and the major intracranial vasculature appear patent. Small\ncaliber left PCOM is patent. Patent A-comm. There is no evidence of\ndissects, or new aneurysm.", + "output": "1. Stable left parenchymal hemorrhage with mild increase in adjacent edema and\nsulcal effacement, effacement to the left lateral ventricle, and minimally\nincreased midline shift to the right. There is slight increase in\nintraventricular hemorrhage and redistribution of diffuse subarachnoid\nhemorrhage.\n2. There is mildly reduced caliber of left A1 segment compared to prior, and\npossibly reduced caliber of left M1 segment, suggesting vasospasm.\n3. Status post coil embolization of left M1/ M2 aneurysm with surrounding\nstreak artifact limiting evaluation of the adjacent structures.\n4. Increased paranasal sinus disease, which may be related to intubation." + }, + { + "input": "Compared with the prior study, there is slight increase in the vasogenic edema\nassociated with the known large left fronto temporal hematoma, evidenced by\nmore effacement of the frontal horn of the left lateral ventricle (02:14). \nThere is persistent 5-6 mm rightward shift of normally midline structures. \nExtensive subarachnoid hemorrhage and layering intraventricular hemorrhage is\ngrossly unchanged.\n\nThe right frontal approach EVD is unchanged in position, without evidence of\nassociated adjacent hemorrhage. Streak artifact from left M1/2 aneurysm\ncoiling limits evaluation of adjacent structures. No new hemorrhage detected.\nBasal cisterns remain patent.\n\nMucosal thickening of the bilateral maxillary sinuses, and sphenoid sinuses,\nand ethmoidal air cells is mild to moderate. The visualized portion of the\nremaining paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. Compared with the prior study, no change in the positioning of the right\nfrontal approach EVD. No evidence of associated tracking hemorrhage.\n\n2. Slightly increased vasogenic edema that due to the left frontotemporal\nhematoma, evidenced by increased effacement of the frontal horn of the left\nlateral ventricle (see series 2, image 14). Basal cisterns remain patent.\n\n3. No new hemorrhage detected.\n\nNOTIFICATION: The above findings were communicated via telephone by Dr.\n___ to the ordering clinician ___ at 01:05 on ___,\n2 min after discovery." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nKnown large left frontotemporal intraparenchymal hemorrhage is again seen with\nassociated vasogenic edema causing mass effect and effacement of the sulci and\nleft lateral ventricle, with layering in the occipital horn of the right\nlateral ventricle. Underlying subarachnoid hemorrhage is likely due to\nredistribution of blood products. Right frontal burr hole approach\nventriculostomy shunt is seen with the tip terminating in the area of the\nforamen of ___.\nPatient is status post coil placement, producing significant metal artifact.\nThere is persistent shift of normally midline structures, unchanged.\nThere is no evidence of no evidence of infarction or mass.\n\nThere is some mucosal thickening of the left sphenoid sinus. Otherwise, the\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is mild diffuse vasospasm of the vessels in the head, with no areas of\nocclusion. As described above, there is a shunt terminating at the level of\nthe foramen of ___. The dural venous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No significant change in large left frontotemporal intraparenchymal\nhemorrhage, with associated vasogenic edema and mass effect.\n2. There is mild diffuse vasospasm of the vessels in the head, with no areas\nof occlusion.\n3. Ventriculostomy shunt is seen with the tip terminating in the area of the\nforamen of ___.\n4. No evidence stenosis or occlusion in the vessels of the neck." + }, + { + "input": "Study is limited by metal hardware artifact from recent surgical coiling of\nthe left MCA aneurysm.\n\nStable appearance of the right frontal approach ventriculostomy tube that\nappears to terminate at the foramen of ___. Aneurysmal coil is noted in the\nleft frontal lobe consistent with the left MCA aneurysm coil.\n\nEvolving left frontal temporal intraparenchymal hemorrhage with grossly stable\nadjacent edema compared to ___ prior exam is noted. There is\nstable effacement of the left lateral ventricle and a stable right ward\nmidline shift measuring 5 mm, unchanged from the ___ CT head.\nExtensive subarachnoid hemorrhage and layering intraventricular hemorrhage is\ngrossly unchanged. There are no new foci of intraparenchymal hemorrhage.\n\nMild mucosal thickening noted in the ethmoid and the bilateral maxillary\nsinuses. There is moderate mucosal thickening noted in the sphenoid sinuses. \nThere is soft tissue opacification noted in right and left mastoid air cells. \nThe middle ear cavities are patent. Findings are unchanged from the ___ CT head without contrast\n\nThe visualized portion of the orbits are unremarkable.", + "output": "1. Left MCA aneurysm coil mass streak artifact limits examination.\n2. Evolving known left frontotemporal intraparenchymal hemorrhage with grossly\nstable adjacent edema compared to ___ prior exam.\n3. Stable left lateral ventricle effacement and 5 mm rightward midline shift.\n4. Extensive subarachnoid hemorrhage and layering blood within the posterior\nhorn of the right lateral, chain.\n5. Within limits of study, no definite new hemorrhage identified.\n6. Stable position of the right frontal approach ventriculostomy catheter." + }, + { + "input": "Left MCA aneurysm coil mass and left ear overlying hardware streak artifact\nsubstantially limits examination.\n\nStable position of the right frontal approach ventriculostomy catheter with\nthe tip terminating at the foramen ___. Since ___ this morning, there has\nbeen interval decrease in the amount of dependent blood within the posterior\nhorn of the right lateral ventricle.\n\nThe left frontal temporal intraparenchymal hemorrhage and surrounding edema\nremains grossly stable in comparison to the ___:30 head CT, with stable\neffacement of the left lateral ventricle and stable rightward midline shift\nmeasuring 5 mm.\n\nExtensive subarachnoid hemorrhage is again noted. Within the limitations of\nthe study there are no new foci of intraparenchymal hemorrhage.\n\nThere is mild mucosal thickening noted in the ethmoid and bilateral maxillary\nsinuses and moderate mucosal thickening of the bilateral sphenoid sinuses. \nThere is soft tissue opacification of the right and left mastoid air cells. \nMiddle ear cavities are patent. Findings are unchanged from the ___ CT head without contrast.\n\nThe visualized portion of the orbits are unremarkable.", + "output": "1. Left MCA aneurysm coil and left ear hardware streak artifact substantially\nlimits this study.\n2. Stable left frontal temporal intraparenchymal hemorrhage and surrounding\nedema.\n3. Stable left lateral ventricle effacement and 5 mm rightward midline shift.\n4. Grossly stable subarachnoid and intraventricular hemorrhage.\n5. Stable right frontal approach ventriculostomy catheter.\n6. Within limits of study, no definite new hemorrhage." + }, + { + "input": "Of note, streak artifact from the left MCA aneurysm coil somewhat limits\nassessment of adjacent structures. A right frontal approach ventriculostomy\ncatheter appears to terminate at the foramen of ___. Left MCA aneurysm\ncoil.\n\nThere is stable appearance of a known left frontal temporal intraparenchymal\nhemorrhage with surrounding edema. Subarachnoid hemorrhage is also unchanged.\nSmall volume intraventricular hemorrhage is minimally more prominent in the\nright occipital horn, likely from redistribution. No evidence of acute\ninfarction or new foci of intracranial hemorrhage. There is persistent\nrightward midline shift, measuring up to approximately 8 mm. The ventricles\nappear slightly more prominent compared to the earlier same-day prior exam. \nThere is no definite uncal herniation.\n\nMild mucosal thickening is seen in the right maxillary sinus, right sphenoid\nsinus, ethmoid air cells. Moderate mucosal thickening is seen in the left\nsphenoid sinus. Aerosolized secretions are seen in the left maxillary sinus\nand sphenoid sinuses. There is persistent partial opacification of the\nmastoid air cells, right greater than left. Findings in the paranasal sinuses\nand mastoids are likely from tube use. The visualized portion of the orbits\nare unremarkable. An ETT and enteric tube are partially visualized.", + "output": "1. Ventricular system is mildly more prominent, continued follow-up\nrecommended.\n2. Intracranial hemorrhage is stable." + }, + { + "input": "Metallic artifact from left MCA bifurcation aneurysm coil pack results in\nsuboptimal evaluation of adjacent structures. Within this confine:\n\nA right trans frontal ventriculostomy catheter with tip terminating along the\ninferior margin of the anterior right lateral ventricle is unchanged in\nposition from prior examination. There is interval decrease conspicuity of\nleft frontal temporal parenchymal hematoma when compared to the prior exam. \nSurrounding white matter edema pattern is similar in configuration. Bilateral\nventricular hemorrhages within the dependent portions of the occipital horns\nare similar. Subarachnoid hemorrhage within the bilateral frontal parietal\nconvexity and occipital lobes are slightly less prominent. No new hemorrhage\nis identified.\n\nMinimal improvement in rightward midline shift, now measuring approximately 6\nmm compared to prior measured 8 mm. There appears to be minimal increased\nsize of the ventricles when compared to the prior examination. For example,\nthe third ventricle now measures approximately 6 mm when compared to\npreviously measured 3 mm (series 2 a, image 13) and the frontal horn of the\nright lateral ventricle measures approximately 9 mm compared to previously\nmeasured 8 (series 2 a, image 13) the fourth ventricle appear similar to prior\nexamination.\n\nThe basilar cisterns are patent. Aerosolized mucus is seen in the sphenoid\nand left maxillary sinus. The remainder the visualized paranasal sinuses are\nessentially clear. The orbits are unremarkable. Fluid signal is noted in the\nright greater than left mastoid air cells. No acute osseous abnormality.", + "output": "1. Minimally decreased conspicuity of left frontal temporal parenchymal\nhematoma and improved rightward midline shift now measuring approximately 6 mm\nversus prior 8 mm.\n2. Mild interval increased size of the ventricles. For example the third\nventricle now measures approximately 6 mm versus previously measured 3 mm and\nthe right lateral ventricle frontal horn measures approximately 9 mm versus\npreviously measured 8 mm.\n3. Expected interval evolution of additional multi compartment hemorrhage as\ndescribed above." + }, + { + "input": "Metallic artifact from left MCA bifurcation aneurysm coil packing results in\nsuboptimal evaluation of the adjacent structures. Within this confine:\n\nA right trans frontal ventriculostomy catheter with tip terminating along the\ninferior margin of the anterior right lateral ventricle is unchanged in\nposition. There is interval resolution of previously seen right frontal\nparenchymal hemorrhage with residual geographic right frontotemporal white\nmatter hypodensity and mild cortical thickening compatible with\nencephalomalacia. Ventricular and subarachnoid hemorrhages have resolved. \nInterval resolution of left ventricular effacement and rightward midline\nshift. The right lateral ventricle is unchanged in appearance from prior\nexamination. The left lateral ventricle is now symmetric compared to the\nright.\n\nThere is no evidence of acute large territory infarct or intracranial\nhemorrhage. Aerosolized mucus is seen in the sphenoid sinus. Otherwise, the\nremainder of the visualized paranasal sinuses are essentially clear. The\norbits are unremarkable. Mastoid air cells middle ears are well pneumatized\nand clear. No acute osseous abnormality.", + "output": "1. Interval resolution of multi compartment intracranial hemorrhages from\nprior examination.\n2. There remains right frontal parietal white matter hypodensity compatible\nwith encephalomalacia, with resolution of line shift and effacement of the\nleft lateral ventricle.\n3. The right lateral ventricle is unchanged in size from prior examination. \nThe left lateral ventricle is not symmetric to the right ventricle.\n4. Unchanged position of a right trans frontal ventriculostomy catheter." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nRe-identified is a right frontal approach VP shunt catheter, with the tip\nterminating in the approximate region of the foramen of ___. Moderate\ndiffuse ventriculomegaly appears unchanged compared to the MR examination from\n___, slightly increased since ___. There are mild\nareas of periventricular white matter hypodensity, which may reflect\ntransependymal edema.\n\nA roughly 30 x 28 mm focus of left frontotemporal hypodensity represents\nevolution of previously seen intraparenchymal hemorrhage, appearing slightly\ndecreased in size with reduction of surrounding edema as compared to ___, as evidence by reduction of associated mass effect.\n\nThere is susceptibility artifact from coil embolization of a left M2\nbifurcation aneurysm, with associated streak artifact limiting localized\nevaluation.\n\nThere is no evidence of acute large territorial infarction, new hemorrhage, or\nlarge mass.\n\nThe visualized orbits are unremarkable. Small mucous retention cysts are seen\nin the right maxillary sinus, sphenoid sinus, with scattered opacification\nethmoid air cells. Mild fluid is seen in the right mastoid tip.\n\nCTA HEAD:\nStreak artifact from left MCA bifurcation aneurysm coil limits localized\nevaluation. Streak artifact obscures a portion of the distal left M1 and\nproximal M2 vasculature, though distal opacification of the left MCA territory\nappears preserved. The vessels of the circle of ___ and their principal\nintracranial branches otherwise appear patent without significant stenosis,\nocclusion, or new aneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nThere are mild atherosclerotic calcifications of the aortic arch. There is a\nvariant 2 vessel aortic arch. Calcified and noncalcified atherosclerotic\nplaque of the proximal left subclavian artery produces moderate narrowing\n(5:63). There are mild atherosclerotic calcifications at the bilateral\ncarotid bifurcations without narrowing by NASCET criteria. There is focal\natherosclerotic calcification of the mid to distal right internal carotid\nartery, though without narrowing by NASCET criteria. The right internal\ncarotid artery appears diffusely hypoplastic compared to the left. The\ncarotid and vertebral arteries and their major branches otherwise appear\npatent without high-grade stenosis, occlusion, or dissection..\n\nOTHER:\nThere is moderate to severe centrilobular emphysema. The visualized portion\nof the lungs are otherwise clear. There is a 5 mm densely calcified left lobe\nthyroid nodule. There is no lymphadenopathy by CT size criteria. There are\nmoderate multilevel degenerative changes of the cervical spine.", + "output": "1. Slight reduction in size and interval evolution in appearance of a known\nleft frontotemporal hematoma.\n2. No new hemorrhage or acute large territorial infarct.\n3. Unchanged positioning of a right frontal approach VP shunt catheter, with\npersistent moderate ventriculomegaly unchanged since ___,\nslightly increased since ___, with suggestion of transependymal\nedema.\n4. Coil embolization of a left MCA bifurcation aneurysm.\n5. Otherwise patent intracranial arterial vasculature without significant\nstenosis, occlusion, or new aneurysm formation.\n6. Moderate focal narrowing of the proximal left subclavian artery. Otherwise\npatent cervical arterial vasculature without high-grade stenosis, occlusion,\nor dissection.\n7. Moderate to severe centrilobular emphysema.\n8. 5 mm densely calcified left lobe thyroid nodule. The ___ College of\nRadiology guidelines suggest that in the absence of risk factors for thyroid\ncancer, no further evaluation is recommended.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "Artifact secondary to left MCA coil limits diagnostic evaluation. Again seen\nis subacute to chronic intraparenchymal hematoma involving the left frontal\nlobe and insula with similar appearance compared to ___. There\nis no new hemorrhage. There is no evidence of infarction or mass. The\nventricular dilatation has improved, particularly in the bilateral temporal\nhorns. Sulci are unchanged. There is no midline shift. The right frontal\napproach VP shunt is in unchanged position terminating at the foramen of\n___.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Similar appearance of the subacute to chronic intraparenchymal hematoma\ninvolving the left frontal lobe and insula with improved hydrocephalus.\n2. No new hemorrhage.\n3. Unchanged right frontal approach VP shunt terminating at the foramen of\n___." + }, + { + "input": "There is extensive streak artifact from left MCA aneurysm coil which limits\nassessment.\n\nThere is continued evolution of a left frontal and insular hematoma with some\nresulting encephalomalacia. There is also an area of hypodensity in the\ninferior left temporal lobe which likely reflects the same process. There is\nno acute hemorrhage, large vascular territory infarction, mass effect, or\nshift of normally midline structures.\n\nA right frontal approach VP shunt terminates near the foramen of ___, as\nbefore, with interval decrease in ventricular size. For example the third\nventricle now measures 10 mm previously 13 mm. The right temporal horn now\nmeasures 3 mm, previously 7 mm. Ex vacuo dilatation of the left temporal horn\nis noted.\n\nThere is no evidence of fracture. Small mucous retention cysts are noted in\nthe right posterior and anterior ethmoid air cells. The remaining visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. The study is limited due to streak artifact from left MCA aneurysm coil.\n2. Interval evolution of left frontotemporal chronic hematoma with\nencephalomalacia.\n3. No evidence of acute hemorrhage.\n4. Grossly stable right frontal approach ventriculostomy catheter with\ninterval decrease in size of ventricles, as described." + }, + { + "input": "Dental amalgam streak artifact and mild motion limits study.\n\nCT HEAD WITHOUT CONTRAST:\nSevere diffuse bilateral subarachnoid hemorrhage within the bilateral frontal,\nparietal, and temporal lobes, as well as the suprasellar, ambient and pre\npontine cisterns, has not significantly changed compared to the prior exam\nfrom 17:36 performed on same day. A large left frontal intraparenchymal\nhematoma measures approximately 4 cm by 3.5 cm, also unchanged compared to the\nprior exam. Intraventricular blood is seen within the third ventricle,\nlateral ventricles and fourth ventricle also similar to the prior exam. There\nis rightward shift of the midline structures of approximately 3 mm stable\ncompared to the prior exam. There is no definite evidence of an acute\ninfarction.\n\nMild mucosal sinus thickening is seen involving the ethmoid air cells. The\nremainder the visualized paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The globes are unremarkable. Right parietal scalp soft\ntissue swelling is noted. This no evidence of fracture.\n\nCTA HEAD:\nThe basilar artery is unremarkable. The bilateral PCAs are patent. The left\ninternal carotid artery demonstrates mild atherosclerotic disease at the\ncavernous segment. A bilobed 1 cm x 0.4 cm aneurysm is seen at the left M1/M2\nbifurcation, series 7, image 244 there is normal arborization of the distal\nleft MCA vessels. The right internal carotid artery, is asymmetrically\ndiminutive however demonstrates appropriate flow. The right middle cerebral\nartery and distal branches are unremarkable. The right A1 segment of the\nanterior cerebral artery is hypoplastic. The left A1 segment is dominant. A\nnormal anterior communicating artery complex is seen. The distal anterior\ncerebral arteries are unremarkable. The dural venous sinuses are patent.\n\nCTA NECK:\nMild atherosclerotic calcifications are seen along the aortic arch. The right\ncommon carotid, and internal carotid arteries are normal without evidence of\nstenosis by NASCET criteria. A focal area of stenosis is seen in the right C2\nsegment of the internal carotid artery, series 7, image 184 secondary to\natherosclerotic plaque however with reconstitution of the caliber. The left\ninternal carotid artery, and common carotid arteries are unremarkable. There\nis no evidence of internal carotid artery stenosis by NASCET criteria. \nMild-to-moderate atherosclerotic plaque is seen at the left internal carotid\nartery bifurcation. The left vertebral artery is normal. The right vertebral\nartery is unremarkable.\n\nOTHER:\nNote is made of left mainstem intubation. Diffuse interlobular septal\nthickening, consistent with pulmonary edema seen within the apices of lungs. \nDependent consolidations, may be secondary to atelectasis or aspiration. \nSmall bilateral pleural effusions are identified.", + "output": "1. Dental amalgam streak artifact and mild motion limits study.\n2. Stable diffuse severe bilateral subarachnoid hemorrhage with\nintraventricular extension as well as left frontal intraparenchymal\nhemorrhage, compared to the most recent prior exam from 17:36 performed on\nsame day.\n3. Bilobed 1 cm x 0.4 cm aneurysm is seen arising off the left M1/M2\nbifurcation, a adjacent to the large intraparenchymal hemorrhage.\n4. Unremarkable CTA of the neck without evidence of internal carotid artery\nstenosis by NASCET criteria. A focal area of stenosis is seen within the C2\nsegment of the right internal carotid artery, secondary to calcific\natherosclerotic plaque.\n5. Left mainstem intubation. Recommend repositioning the endotracheal tube.\n6. Bibasilar atelectasis versus aspiration.\n7. Mild pulmonary edema and small bilateral pleural effusions.\n\nRECOMMENDATION(S): Recommend repositioning the endotracheal tube.\n\nNOTIFICATION: The findings were discussed with Dr ___. by ___\n___, M.D. on the telephone on ___ at 8:50 ___, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "No intracranial hemorrhage is identified. There is no mass, mass effect or\nmidline shift. The ventricles are normal in size and configuration. There is\nno evidence for territorial infarct. The gray-white matter differentiation is\nwell preserved.\n\nNo fracture or other abnormality of the calvarium is identified. The\nvisualized paranasal sinuses and the mastoid air cells are clear.", + "output": "Normal CT examination of the head." + }, + { + "input": "Small hyperattenuating focus adjacent to the sylvian fissure measures 6 mm and\nmay represent small focus of most likely subarachnoid hemorrhage (02:19,\n601:78). No evidence acute large territorial infarction, edema,or mass.\n\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges beyond expected for age. Mild periventricular and subcortical\nhypodensities are nonspecific, though likely sequela of chronic small vessel\nischemic disease.\n\nThere is no evidence of fracture. Moderate paranasal sinus disease, including\nmoderate mucosal thickening within the right maxillary sinus, bilateral\nethmoid air cells, and layering fluid within the right sphenoid sinus. The\nvisualized portion of the remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Small hyperattenuating focus adjacent to the sylvian fissure, which may\nrepresent small focus of most likely subarachnoid hemorrhage. Recommend\ncontinued attention on follow-up studies to assess for interval change.\n2. Global parenchymal volume loss beyond expected for age.\n3. Moderate paranasal sinus disease.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 1:10 am, shortly after discovery\nof the findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nPunctate focus of hyperdensity in the left parietal lobe along the posterior\naspect of the sylvian fissure, not substantially changed compared to prior\nstudy, may represent a focus of subarachnoid or intraparenchymal hemorrhage. \nThere is no evidence of infarction, new hemorrhage,edema,ormass. The\nventricles and sulci are normal in size and configuration.\n\nThere is mucosal thickening in the ethmoid air cells and right maxillary\nsinus. There are secretions in the sphenoid sinus. The visualized portion of\nthe paranasal sinuses, mastoid air cells,and middle ear cavities are otherwise\nclear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. There is atheromatous\ncalcification of the carotid siphons bilaterally. Fetal origin of the PCAs\nbilaterally is incidentally noted. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is atheromatous calcification of the origin of the left vertebral\nartery, which arises directly from the aortic arch. Bilateral carotid and\nvertebral artery origins are otherwise patent.\nThere is atheromatous calcification of the bifurcation of the right common\ncarotid artery. There is no evidence of internal carotid stenosis by NASCET\ncriteria.\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion.\n\n\n\nOTHER:\nExtensive ground-glass opacities in the lungs bilaterally appear unchanged\nsince the chest CT of ___. The visualized portion of the thyroid\ngland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Unchanged appearance of the focal hyperdensity in the left parietal lobe,\nwhich may represent acute hemorrhage.\n2. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n3. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection.\n4. Extensive bilateral consolidative pulmonary opacities in the bilateral\nupper lobes." + }, + { + "input": "There is no evidence of acute intracranial infarction, hemorrhage, edema,\normass effect. The ventricles and sulci are normal in size and configuration.\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. There\nis prominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. There are aerosolized secretions within the\nsphenoid sinuses bilaterally. There is mild mucosal thickening in the\nmaxillary sinuses bilaterally. Otherwise, the visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial hemorrhage or fracture.\n2. Paranasal sinus disease." + }, + { + "input": "Evaluation of soft tissue lesions is suboptimal secondary to lack of IV\ncontrast. Within this confine:\n\nThere is a large hyperdense mass entered in the right tongue with extension\nacross midline anteriorly with large ulceration measuring approximately 2.9 x\n2.0 cm (AP, TRV series 2, image 22). There is likely involvement of the right\nsublingual space. The mass involves the right tongue base, with thickening of\nthe epiglottis. The right lateral wall of the oral and hypopharynx is\nthickened. There is apparent extension into the parapharyngeal spaces in\nobliteration of the right carotid space sagittal planes. There is loss of the\nnormal fat plane surrounding the right sternocleidomastoid muscle and of the\nright anterior neck to the level of the thyroid. The paraglottic fat appears\ngrossly intact and there is no evidence of involvement of the glottis.\n\nMultiple calcified bilateral lymph nodes are identified. No discrete normal\nlymph node is identified on the right, and there is likely conglomerate\nlymphadenopathy with suggestion of central hypoattenuation, concerning for\nnecrotic jugulodigastric lymphadenopathy.\n\nThe thyroid gland is normal. The infratemporal fossa the is unremarkable. \nThe visualize skull-base foramina are intact.\n\nEvaluation of neck vessel patency is limited in the absence of IV contrast.\n\nThe patient is cachectic. There is an endotracheal tube and the bilateral\nbrachiocephalic vein and SVC stent. There is atherosclerotic calcification of\naortic arch and its branches.\n\nVisualized intracranial structures are normal. No focal osteolytic lesion is\nidentified. The patient is partially edentulous. There is an unchanged\nsclerotic lesion in the right mandible (___), unchanged from ___,\nlikely representing a bone island. There is minimal mucosal thickening of the\nbilateral maxillary sinuses, right sphenoid sinus and ethmoidal air cells.\n\nThere are innumerable pulmonary nodules, highly concerning for metastases in\nthe lung apices. There is centrilobular and paraseptal emphysema. Please see\nsame day CT chest for further details.", + "output": "1. Evaluation is suboptimal without IV contrast. Within this confine:\n2. Large heterogeneous ulcerative right tongue mass with extension across\nmidline of the tongue, involvement of the right base of the tongue extending\nto the hypopharynx and epiglottis. Likely involvement of the right sublingual\nspace.\n3. There is abnormal thickening of the right oral and hypopharynx with loss of\nthe normal right parapharyngeal fat and right anterior neck extending to the\nthyroid gland. Loss of fat plane of the right sternocleidomastoid muscle is\nidentified.\n4. No normal right sided lymph node is identified. There is an apparent more\nconglomerate soft tissue focus with central hypoattenuation along the coarsely\njugulodigastric lymph nodes, concerning for necrotic lymph node mass.\n5. Innumerable pulmonary nodules described above. Clinical correlation for\nmetastatic disease is recommended. Please refer to dedicated chest CT for\nfurther details.\n6. Additional findings described above.\n\nRECOMMENDATION(S): Evaluation of the soft tissues is suboptimal secondary to\nlack of IV contrast. MRI without contrast soft tissue neck could yield\nadditional information as clinically indicated." + }, + { + "input": "When compared to prior PET-CT of ___, there is significant interval\nenlargement of a heterogeneously enhancing lesions centered in the right\ntongue, crossing midline, extending to the base of the tongue and hypopharynx.\nThere may be involvement of the right geniohyoid/genioglossus complex. A\nlarge ulceration is identified along the anterior lateral right aspect, not\nseen on PET-CT. There is effacement of the bilateral vallecula and thickening\nof the epiglottis. The paraglottic fat is grossly preserved. The abnormal\nthickening and enhancement of the right lateral wall of the oral and\nhypopharynx is identified. Abnormal enhancement is seen in the right\nsublingual space. There is near complete occlusion of the hypopharynx.\n\nIn the region of previously described abnormal level IIa lymph node on PET-CT,\nis a large cystic peripherally enhancing mass measuring approximately 3.6 x\n2.2 x 4.0 cm (AP, TRV, SI ; series 3, image 37) which appears to be contiguous\nwith a smaller level 3 multi cystic peripherally enhancing lesion measuring\napproximately 1.4 x 1.4 by 1.1 cm (AP, TRV, SI ; series 3, image 42). This\nappears significantly enlarged from prior exam, compatible with conglomerate\nnecrotic lymph node. The boundaries of the lymph node mass is poorly defined,\nhighly concerning for extracapsular extension. There is mass effect on the\nright jugular vein without occlusion or definitive evidence for enhancement. \nThe lymph node mass also contacts the right common carotid artery without\nevidence of encasement or invasion. The right sternocleidomastoid muscle is\npoorly defined, abutting the lymph node mass, concerning for involvement.\n\nThere is abnormal peripheral enhancement and central hypo attenuation of the\nright palatine tonsil (series 3, image 21). The soft palate also appears\nheterogeneous. The trigeminal fat pads are preserved. The skull-base\nforamina are unremarkable.\n\nThe thyroid gland is unremarkable. No focal osteolytic lesion. Re-identified\nis a right brachiocephalic and left subclavian vein stents, which demonstrates\npostcontrast opacification although the more distal aspect of the left\nsubclavian stent appears collapsed.\n\nThe patient is status post tracheostomy. There are multiple pulmonary nodules\nin the bilateral lung apices with superimposed paraseptal and centrilobular\nemphysematous changes. These lesions may be secondary to\naspiration/infectious process or metastatic disease. Please refer to\ndedicated chest CT performed on the same day for further details.", + "output": "1. Large heterogeneously enhancing ulcerative mass centered in the right\ntongue with extension past the midline, involving the bilateral base of tongue\nand likely extension into the right lingual space is identified, significantly\nincreased in size from examination of PET-CT of ___. There is\nlikely involvement of the right aspect of the geniohyoid/genioglossus complex.\n2. Near-complete occlusion of the hypopharynx is identified. Abnormal\nenhancement and thickening of the right lateral wall of the oropharynx\n(including the right palatine tonsil), hypopharynx is identified. There\nappears to be abnormal thickening of the soft palate.\n3. In the region of previously described hypermetabolic abnormal right level\nIIa lymph node is a conglomerate 1.4 x 1.4 x 1.1 cm peripherally enhancing\ncystic mass which is contiguous with a smaller level III lesion compatible\nwith a conglomerate jugulodigastric necrotic lymphadenopathy. The margins of\nthe lesion is hazy and ill-defined, highly concerning for extracapsular\nextension. This is significantly increased in size and abnormality from prior\nPET-CT of ___.\n4. The necrotic lymph node mass exerts mass effect on the adjacent in internal\njugular and common carotid arteries without evidence of occlusion or\ndefinitive invasion.\n5. The right sternocleidomastoid muscle is poorly defined, also concerning for\ntumoral involvement.\n6. Multiple pulmonary nodules in the visualize lungs, which may represent any\ncombination of metastatic disease, infectious/inflammatory etiology or\naspiration. Please refer to dedicated chest CTs performed on the same day for\nfurther details." + }, + { + "input": "Overall, there has been significant interval progression of a heterogeneously\nenhancing lesion centered in the right tongue compared to the prior exam from\n___. The mass now extends through the styloid mandibular foramen,\nand likely involves the right parotid gland. Medially, the heterogeneously\nenhancing lesion crosses midline with increased involvement of the left\ntongue, and inferiorly has expanded into the oro and hypopharynx. The\nnasopharynx demonstrates increased fluid likely secondary to obstruction from\nthis mass. The oro and hypopharynx above the level of the tracheostomy tube\nare completely occluded. Overall, the or pharyngeal airway demonstrates\nincreased edema.\n\nExtensive right facial overlying soft tissue swelling is seen. The known\nnecrotic mass within the right neck, now measures 4.1 cm x 2.4 cm, increased\nin size compared to the prior exam at which time this measured no more than\n3.6 cm. The mass does approximate closely the carotid and internal jugular\nvein on the right, however aside from mass effect on the internal jugular\nvein, there is no evidence of extraluminal contrast extravasation concerning\nfor acute ulceration. The right IJ is significantly compressed secondary to\nthe mass, however flow is still preserved within the right internal jugular\nvein. Effacement of the bilateral vallecula, and thickening of the epiglottis\nhas also progressed compared to the prior exam. There is increased\ninvolvement of the genioglossus/geniohyoid complex. The right\nsternocleidomastoid muscle is poorly defined, abutting the lymph node mass,\nconcerning for involvement. Increased necrosis is seen involving the right\npalatine tonsil concerning for involvement. The soft palate also appears to\nbe heterogeneous concerning for extension. The mastoid air cells bilaterally\nare completely opacified.\n\nThe thyroid gland is normal. Bilateral parenchymal opacities, have increased\ncompared to the prior exam. Moderate right and small left pleural effusions\nare also larger compared to the prior exam. Fluid secretions are seen within\nthe lumen of the tracheostomy tube in the dependent portion.\n\nThe lungs bilaterally demonstrate extensive centrilobular and paraseptal\nemphysema. Please note that there is worsening dislocation of the bilateral\nmandibular condyles, new on the prior study however worsening since the study\nfrom ___.", + "output": "1. No evidence of active extravasation from the right internal carotid artery\nat the level of the mass. The mass abuts the artery, however there is no\nevidence of flow limiting stenosis.\n2. Significant interval worsening of patient's disease, with now complete\nocclusion of the oral and hypopharynx and inferior extension of soft tissue. \nNasopharynx is filled with secretions and fluid, likely secondary to\nobstruction.\n3. Interval increase in bilateral mandibular dislocations, compared to the\nmost recent prior exam from ___, at which time this was new compared\nto the exam from ___.\n4. Extensive bilateral parenchymal opacities within the lung apices could be\nsecondary to multi focal pneumonia versus metastatic lesions. Follow-up chest\nCT after treatment is recommended for further evaluation.\n5. Small amount of secretions are seen within the tracheostomy tube.\n6. Interval increase in soft tissue swelling overlying the right face.\n\nNOTIFICATION: The findings were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 4:04 ___, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "The study is moderately degraded by motion despite partially repeating the\naxial images. There is no evidence of fracture, infarction,hemorrhage,edema,\nor mass. The ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "The study is moderately degraded by motion, despite repeating the axial\nimages. Within the limitation of the study the examination appears normal." + }, + { + "input": "Study is moderately motion degraded. Hyperdensity along the right temporal\nlobe (series 2; image 13) likely represents artifact.\n\nThere is no evidence of large territorial infarction,hemorrhage,edema,or mass\neffect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular, subcortical, and deep white matter\nhypodensities are nonspecific, but likely represent sequela of chronic\nmicrovascular ischemic disease.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nbilateral maxillary sinuses. The visualized portion of the remaining\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. \nPatient is status post bilateral lens replacements.", + "output": "Study is moderately motion degraded.\n\n1. No acute intracranial abnormality.\n2. Involutional changes and likely sequela of chronic microvascular ischemic\ndisease." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema, or mass\neffect. Periventricular and subcortical white matter hypodensities are\nnonspecific but likely sequelae of chronic small vessel ischemic disease. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges.\n\nUnchanged chronic nasal bone fractures. There is no evidence of new fracture.\nRightward nasal septum deviation anteriorly. Leftward nasal septum deviation\nposteriorly with a leftward pointing bony nasal spur contacting the left\ninferior turbinate. Large left maxillary sinus mucous retention cyst with\nmild maxillary sinus and ethmoid air cell mucosal thickening. The visualized\nportion of the mastoid air cellsand middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No evidence of an acute intracranial abnormality on noncontrast head CT. \nSpecifically no intracranial hemorrhage or large territory infarct.\n2. No acute displaced calvarial fracture." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Prominence of\nventricles and sulci suggestive of involutional changes.\n\nChronic nasal bone fracture is noted. Mucous retention cyst is noted in left\nmaxillary sinus. There is mild mucosal thickening of the right maxillary\nsinus. Otherwise, the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Ventricles\nand sulci are enlarged suggesting cerebral atrophy. Basal cisterns are patent\nand there is preservation of gray-white matter differentiation. Mild\nperiventricular white matter hypodensities likely sequela of chronic small\nvessel disease. Calcifications are seen within the vertebral arteries and\ncarotid siphons bilaterally.\n\nNo osseous abnormalities seen. There is mild mucosal thickening within the\nethmoid air cells. The paranasal sinuses are otherwise clear. The orbits are\nunremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Minimal mucosal thickening in the left\nmaxillary sinus. The visualized portion of the remaining paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "Normal study." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere has been interval increase in size of a large right frontal\nintraparenchymal hemorrhage with hematocrit level, currently measuring 5.8 x\n2.0 cm, previously 4.7 x 2.2 cm (02:27). There is a similar degree of\nadjacent vasogenic edema and mild increase in adjacent sulcal effacement. \nAdditional site of intraparenchymal hemorrhage centered within the left\ntemporal lobe is also increased in size, currently measuring 3.9 x 2.6 cm,\npreviously 1.8 x 1.3 cm (02:15). There is interval increase in surrounding\nleft temporal vasogenic edema with new mild effacement of the temporal horn of\nthe left lateral ventricle. There is approximately 1-2 mm of rightward\nmidline shift, new from prior (02:18). The previously seen left convexity\nsubdural hematoma measures up to 5 mm in width, unchanged in size, but appears\nto extend into the left temporal intraparenchymal hematoma. There is mild\neffacement of the ambient cistern bilaterally, without convincing evidence of\nuncal herniation. There is no evidence of infarction.\n\nExtensive paranasal sinus disease involving the bilateral sphenoid sinuses,\nright maxillary sinus, and posterior ethmoid air cells. The remainder of the\nvisualized paranasal sinuses are clear. There is trace fluid in the left\nmastoid air cells. Bilateral lens replacements are noted.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nSmall bilateral pulmonary nodules measure up to 3 mm (3: 35, 52, 58, 76, 84). \nMultinodular thyroid gland with hypodense nodules measuring up to 1.1 cm in\nthe right thyroid lobe (3:105). There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Interval increase in size of bilateral intraparenchymal hematoma centered\nwithin the right frontal and left temporal lobes, as detailed above.\n2. 1-2 mm of rightward midline shift is new compared to prior exam.\n3. Left subdural hematoma is unchanged in size.\n4. Normal head and neck CTA.\n5. Bilateral pulmonary nodules measure up to 3 mm. Please refer to ___\ncriteria below for follow-up recommendations.\n6. Multinodular thyroid gland, with a 1.1 cm hypodense nodule in the right\nupper lobe. This may be further evaluated with non urgent thyroid ultrasound\nif clinically indicated.\n\nRECOMMENDATION(S): For incidentally detected multiple solid pulmonary nodules\nsmaller than 6mm, no CT follow-up is recommended in a low-risk patient, and an\noptional CT follow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" + }, + { + "input": "Again demonstrated is a large right frontal intraparenchymal hematoma with\nfluid-fluid level measuring 5.5 x 2.1 cm, previously 5.8 x 2.0 cm, likely\nunchanged allowing for differences in imaging technique. There is a similar\ndegree of local mass effect with vasogenic edema and effacement of the\nsurrounding sulci. Additional focus of intraparenchymal hemorrhage centered\nwithin the left temporal lobe measures 3.6 x 2.2 cm, previously 3.9 x 2.6 cm. \nThis appears similar to prior exam with and unchanged degree of surrounding\nvasogenic edema and sulcal effacement. A left subdural hematoma measures 5 mm\nin width, unchanged. There is a similar degree of intraventricular blood. \nLeft parietal subarachnoid blood products is not appear appreciably changed. \nNo new areas of intracranial hemorrhage or infarction. No shift of midline\nstructures.\n\nMultiple air-fluid levels are demonstrated in the bilateral maxillary sinuses\nand sphenoid sinuses with mild mucosal thickening of the posterior ethmoid air\ncells. There is trace fluid in the left-sided mastoid air cells, similar to\nprior. The visualized orbits are unremarkable.", + "output": "1. Intraparenchymal hematoma centered within the right frontal lobe and left\ntemporal lobe are not appreciably changed in size or local mass effect as\ncompared to the most recent prior exam.\n2. Similar appearance of a left subdural hematoma, left parietal subarachnoid\nhemorrhage, and intraventricular hemorrhage.\n3. No new areas of hemorrhage.\n4. Paranasal sinus inflammatory disease." + }, + { + "input": "Left temporal intraparenchymal hemorrhage with mild vasogenic edema is\nunchanged. Right frontal hemorrhage and surrounding vasogenic edema is also\nunchanged in size.\n\nThe small subdural hemorrhage along the left cerebral convexity, posterior\nfalx and tentorium is not significantly changed.\n\nA trace amount of subarachnoid hemorrhage along the bilateral cerebral\nconvexities is also unchanged.\n\nSmall amount of layering hemorrhage in the occipital horns of the lateral\nventricles is stable. The ventricles are unchanged in size without evidence\nof hydrocephalus.\n\n There is no evidence of acute large territorial infarction or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes with\nsimilar mild effacement of the sulci in the right frontal lobe due to cerebral\nedema.\n\nThere is no midline shift. Basal cisterns are patent.\n\nThere is no evidence of fracture. There is postsurgical changes from left\ncanal up mastoidectomy. Partial opacification of the remaining left mastoid\nair cells and nonspecific partial opacification of the right mastoid cells. \nThere is layering Fluid in the sphenoid sinuses, which is most likely\nsecondary to intubation. A partially visualized right nasogastric tube is\nnoted.. There are bilateral lens replacements. Otherwise, the orbits are\nunremarkable.", + "output": "No significant change in the multi-compartmental intracranial hemorrhage, as\ndetailed above." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nIncidental note is made of bilateral basal ganglia calcifications. There are\natherosclerotic calcifications in the bilateral cavernous carotids.\n\nPatient is status post right parietal craniotomy. There is a small amount of\ncalcification underlying the surgical site, likely postsurgical. There is no\nevidence of fracture. There is minimal mucosal thickening in the bilateral\nmaxillary sinuses. The visualized portion of the remainder of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Patient is\nstatus post bilateral lens replacement. The visualized portion of the orbits\nare otherwise unremarkable.", + "output": "No fracture or acute intracranial process." + }, + { + "input": "A small scalp laceration is identified in overlying the left occiput (3:44,\n602b:61). There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the mastoid air\ncells and middle ear cavities are clear. The visualized portion of the orbits\nare unremarkable. There is minimal right maxillary, bilateral sphenoid and\nbilateral frontal sinus mucosal thickening.", + "output": "1. No evidence of acute intracranial hemorrhage or fracture.\n2. Left occipital scalp laceration.\n3. Paranasal sinus disease as described." + }, + { + "input": "Patient is status post interval resection of left frontal meningioma with\nre-expansion of the brain and reduction in rightward shift, now measuring up\nto at most 5 mm, compared to 12 mm before. Trace hemorrhage and small\nquantities of pneumocephalus along the resection site. Residual vasogenic\nedema in the frontal lobe adjacent to the prior site of the tumor. \nSurrounding soft tissue structures are unremarkable. Partly imaged polypoid\ncyst in the right maxillary sinus. Otherwise, paranasal sinuses and mastoid\nair cells appear clear. Craniotomy changes along the anterior left frontal\nbone. Subcutaneous drain in place.", + "output": "Anticipated postoperative appearance shortly after resection of large left\nfrontal meningioma." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. There is no evidence of\nfracture. There is calcification of the left MCA. The visualized portion of\nthe mastoid air cells, and middle ear cavities are clear. The right sphenoid\nsinus is filled with fluid representing a chronic process. The visualized\nportion of the orbits are unremarkable.", + "output": "No hemorrhage, infarction, edema, or mass." + }, + { + "input": "Lesion seen on prior ultrasound in the right parotid gland is not as clearly\ndelineated. There is a vague relatively hypodense region in the superficial\nportion of the right parotid gland measuring 11 x 8 mm (2:34 and 4:5). The\nright parotid gland is otherwise unremarkable.\n\nThe left parotid gland and submandibular glands are unremarkable. There is a\n5 mm nodule in the right lobe of the thyroid. There is no cervical\nadenopathy.\n\nThe aerodigestive tract appears normal. Mucosal thickening is noted in the\nright ethmoid air cells, left frontal sinus, and bilateral maxillary sinuses.\n\nVascular structures in the neck are grossly unremarkable.\n\nIncluded intracranial structures appear normal.\n\nNo focal suspicious osseous lesion identified.", + "output": "Focal right parotid lesion was better seen by prior ultrasound, only vaguely\nidentified on the current exam. If further characterization desired, MRI\nwould offer improved visualization. However, differential for focal parotid\nlesion includes primary parotid neoplasm, more likely benign than malignant. \nThis lesion is less likely to be a lymph node." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. A ___ intestinal tube is partially\nvisualized.", + "output": "No evidence of an acute intracranial abnormality." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThere is mild prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThere is variant direct origin of the left vertebral artery from the aortic\narch. The carotid and vertebral arteries and their major branches appear\nnormal with no evidence of stenosis or occlusion. There is no evidence of\ninternal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "Normal head and neck CTA." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Focal hypodensities in the right\ncaudate head, left lentiform nucleus as well as the left thalamus are likely\nchronic lacunar infarcts versus prominent perivascular spaces. \nPeriventricular and subcortical white matter hypodensities are likely sequela\nof chronic small vessel disease. Ventricles and sulci are within normal\nlimits.\n\nMaxillary sinus mucosal thickening is noted. Included paranasal sinuses and\nmastoids are otherwise clear. Right parietal calvarial osteoma is noted. \nSkull and extracranial soft tissues are otherwise unremarkable.", + "output": "No acute intracranial process. White matter hypodensities which are likely\nsequela of chronic small vessel disease. A few bilateral basal ganglia and\nleft thalamic hypodensities, probable lacunar infarcts." + }, + { + "input": "There is hypodensity in the region of the right insula, suggestive of a right\nMCA infarct, similar in appearance to prior CT that was performed on ___ prior to thrombectomy (2:14).\n\nThere is no evidence of hemorrhagic conversion, or mass. There are scattered\nperiventricular white matter hypodensities, consistent with chronic small\nvessel ischemic disease. There is prominence of the ventricles and sulci\nsuggestive of involutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "Hypodensity in the region of the right insula suggestive of a right MCA\ninfarct, consistent with the patient's known right M1/M2 junction stroke. \nThere is no evidence of hemorrhagic conversion." + }, + { + "input": "Diffuse hypodensity with loss of gray-white matter differentiation in the\nright MCA territory is consistent with subacute appearance of known right MCA\ninfarct. No evidence intracranial hemorrhage. Scattered periventricular and\nsubcortical hypodensities are nonspecific, but likely sequela of chronic small\nvessel ischemic disease. There is prominence of the ventricles and sulci\nsuggestive of involutional changes.\n\nNo evidence of fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are normal.", + "output": "1. No evidence of intracranial hemorrhage.\n2. Diffuse hypodensity with loss of gray-white matter differentiation in the\nright MCA territory, consistent with subacute appearance of known right MCA\ninfarct, demonstrating expected evolution." + }, + { + "input": "There is subtle loss of gray-white matter differentiation in the right frontal\nand parietal region which may represent early ischemia. There is mild\nperiventricular white matter disease suggestive of chronic microvascular\nischemia. There is no evidence of intracranial hemorrhage, edema, or mass. \nThere is mild diffuse brain atrophy. There is mild intracranial vascular\ncalcification. There is mild right parietal scalp soft tissue swelling.\n\nNo osseous abnormalities seen. Mild right posterior ethmoid air cell mucosal\nthickening. The remaining paranasal sinuses, mastoid air cells, and middle\near cavities are clear. There is scleral calcification on the right side. \nThe orbits are otherwise unremarkable.", + "output": "1. Subtle loss of gray-white matter differentiation in the right frontal and\nparietal region which may represent early ischemia.\n2. No acute intracranial hemorrhage.\n3. Mild diffuse brain atrophy.\n4. Mild chronic microvascular ischemia.\n5. Right parietal scalp soft tissue swelling." + }, + { + "input": "Please note the study is mildly degraded by motion. There is no evidence of\nacute territorial infarction, hemorrhage, , or large mass. Periventricular\nhypodensities are visualized. Note is made of decreased space surrounding the\nvery Ms. ___ cephalic cistern (02:11). This is difficult to evaluate given\nthe limited evaluation on motion limited study. There is paucity of cerebral\nsulci given patient's age. Both the paucity of sulci, hypodensities in the\nwhite matter and decreased space in near the quadrigeminal cistern are\nsuspicious for cerebral edema in proper clinical setting. However, clinical\ncorrelation is recommended.\n\nThere is no evidence of fracture. The paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The orbits are unremarkable.", + "output": "Study is mildly degraded by motion. No hemorrhage is identified. There is\npaucity of cerebral sulci hypodensity in the white matter and decreased space\nin the quadrigeminal cistern suspicious for cerebral edema related to hypoxic\nevent. Further evaluation can be obtained by a follow-up CT or MRI.\n\nRECOMMENDATION(S): Follow-up CT or MRI.\n\nNOTIFICATION: The preliminary read was revised and findings were notified as\nbelow.\nThe findings were discussed with ___, M.D. by ___, M.D.\non the telephone on ___ at 3:26 ___, 5 minutes after discovery of the\nfindings." + }, + { + "input": "Dental amalgam artifact limits portions of this study. Within these\nlimitations and the limitations of this portable CT technique, there is global\neffacement of the sulci, loss of gray-white matter differentiation, diffuse\neffacement of basilar cisterns and fourth ventricle. These findings are\nlikely due to global hypoxic ischemia. The fourth ventricle is effaced however\nthere is no ventriculomegaly and the remaining ventricles are unchanged in\nsize configuration compared to prior study from ___.\n\nWithin the limitations of the study, there is no evidence of infarction or\nhemorrhage.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.\n\nThe visualized portion of the orbits demonstrate prior right lens surgery and\nare otherwise unremarkable", + "output": "Global swelling likely due to global hypoxic ischemia." + }, + { + "input": "There is a large midline heterogeneously hyperdense invasive mass measuring\n3.5 x 4.5 x 6.0 cm, weekly arising from the skull base. The mass likely\narises from the sella or clivus and extends superiorly into the suprasellar\nspace with extension posteriorly into the left anterior pons (02:12, 602:43). \nInferiorly, the mass extends into the sphenoid sinuses and mild anterior\nextension into the bilateral posterior ethmoidal air cells (2:7). There is\nosseous destruction of the clivus into sinuses. Extension to the bilateral\ncavernous sinuses cannot be excluded. This most likely represents a pituitary\nadenoma.\n\nThe mass occupies the suprasellar cistern but otherwise the remaining cisterns\nare patent. The optic nerves, chiasm and tracts are not well visualized, but\nthe location of the mass suggests that they are dramatically elevated and\ndraped over it. No evidence of midline shift.\n\nNo evidence of infarct or hemorrhage.\n The paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\nThe orbits are unremarkable.", + "output": "1. Large, invasive midline mass likely rising from the sella may represent a\npituitary macroadenoma. MRI is recommended for further evaluation.\n2. No evidence of significant fracture, infarction or hemorrhage.\n\nRECOMMENDATION(S): Gadolinium-enhanced MRI brain is recommended for further\nevaluation of a large midline skull base mass." + }, + { + "input": "6.0 x 4.5 x 3.5 cm midline heterogeneously hyperdense mass, is unchanged. \nNear complete replacement of the clivus by tumor. Tumor probably crosses\nbilateral petroclival synchondrosis and infiltrates petrous apex on both\nsides. Probable onto bilateral cavernous sinus. Marked osseous bowing in\nsignificant anterior displacement of the posterior wall of the sphenoid sinus.\nSella turcica is markedly expanded. Mass effect on the hypothalamus, third\nventricle, basal frontal lobe. Tumor extends to the level of the foramina\n___ and nearly fills the third ventricle. Pre pontine component of the\ntumor exerts mass effect on the ventral pons and midbrain. Interpeduncular\ncistern is expanded. No tumor extent into the nasopharynx. No tonsillar\nherniation.\n\nTumor involved/abuts anterior and posterior circulation which cannot be fully\nassessed on this scan.\n\nFindings favor large pituitary macroadenoma. Less likely consideration\nincludes chordoma. MRI would be helpful in further evaluation.\n\nNo evidence of large territorial infarction or hemorrhage. The ventricular\nsystem is unchanged. No evidence of midline shift. No hydrocephalus.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Small well-circumscribed\nindeterminate osseous lesion left parietal ___ be benign. Hyperostosis\naround the right frontal sinus is likely reactive.", + "output": "Large mass centered at the sella, clivus, with significant osseous, parasellar\nsuprasellar extension. Findings favor large pituitary macroadenoma. Other\nconsiderations, including clival chordoma, are less likely. MRI would be\nhelpful in further evaluation.\n\nRECOMMENDATION(S): Gadolinium-enhanced MRI brain is recommended for further\nevaluation of large midline mass." + }, + { + "input": "CT PERFUSION:\nThere is small acute infarct in the right caudate head, seen on color maps and\nsource images from CT perfusion.\nOtherwise, there is decreased cerebral blood volume and cerebral blood flow in\nthe gray matter and subcortical white matter of the left cerebral hemisphere. \nMild prolonged transit time is seen in the bilateral posterior occipital\nlobes, and questionable prolonged transit time is seen in the anterior left\nfrontal lobe.\n\nCTA HEAD:\nThe heterogeneously enhancing mass is again seen with sellar, suprasellar, and\nclival involvement. Bilateral invasion of the petrous apices, and remodeling\nof the posterior sphenoid sinus wall with some free tumor extension into the\nleft sphenoid sinus is also evident. Tumor probably involves the bilateral\nposterior optic canals although this is suboptimally evaluated on this\nexamination.\n\nThe mass extends through the circle of ___ with probable mass effect and\nmild narrowing of the bilateral A1 ACAs (right greater than left) and\nbilateral posterior communicating arteries. There is moderate-to-severe focal\nnarrowing of the bilateral paraclinoid ICA segments due to mass effect between\nthe mass and anterior clinoid processes. Posterior protrusion of the mass\nalso exhibits mass effect with mild focal narrowing of the right P1 PCA, left\nP1 and P2 PCA, distal basilar artery, with displacement of left SCA, and left\nAICA, basilar artery posteriorly. Mild focal narrowing is also seen in the\nright P2 PCA segment. The arteries do not exhibit evidence of occlusion or\naneurysm formation. There is mild narrowing at the proximal cavernous ICA\nsegment with atherosclerosis and ectasia of the distal left cavernous ICA.\n\nHypoenhancement of the cavernous sinuses likely represents bilateral cavernous\nsinus involvement by the tumor. The dural venous sinuses are otherwise\npatent.\n\nCTA NECK:\nThere is mild narrowing of the right vertebral artery origin. Mild narrowing\norigin left subclavian artery. Otherwise, the carotid and vertebral arteries\nand their major branches appear normal with no evidence of stenosis or\nocclusion. There is no evidence of internal carotid stenosis by NASCET\ncriteria.\n\nOTHER:\nOther than minimal atelectasis, the visualized portion of the lungs are\ngrossly clear. A 2.7 cm hypoenhancing lesion is seen within the right lobe of\nthe thyroid. There is no lymphadenopathy by CT size criteria.", + "output": "1. Acute infarct right caudate head.\n2. Decreased cerebral blood flow and cerebral blood volume in the left\ncerebral hemisphere gray matter and subcortical white matter. Mild prolonged\ntransit time in the posterior occipital lobes and questionably within the\nanterior left frontal lobe.\n3. Large central skullbase mass, with intracranial extent, most likely giant\npituitary macroadenoma.\n4. Moderate-to-severe focal narrowing of the bilateral paraclinoid ICA\nsegments due to mass effect between the mass and anterior clinoid processes.\nPosterior tumor extent, mass effect on the brainstem, and multivessel mild\nvessel narrowing. Suprasellar tumor extent, with mild narrowing of the\nbilateral A1 ACAs and posterior communicating arteries\n5. 2.7 cm hypoenhancing lesion in the right thyroid lobe.\n\nRECOMMENDATION(S):\n-MR with contrast is recommended for better characterization of the tumor and\npossible involvement of the bilateral optic canals.\n-Ultrasound is recommended for 2.7 cm right thyroid lobe lesion.\n- Thyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or older, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "Head CT prior to the administration of contrast demonstrates a large sellar\nmass with erosion of the clivus petrous apicitis and extension of soft tissues\ninto the region of sphenoid sinus. Vascular calcifications of carotids are\nidentified. The findings are suggestive of a invasive pituitary adenoma. \nPreviously demonstrated infarcts on MRI are not clearly apparent on the\ncurrent study.\n\nCT angiography of the head demonstrates the precavernous and cavernous portion\nof the carotid arteries outlining the mass. The pre cavernous portions of the\ncarotid arteries are adjacent to anteriorly as well as posteriorly and on the\nmedial aspect of the sellar mass. The A1 segment but both anterior cerebral\narteries are elevated. Both supraclinoid internal carotid arteries are\ndisplaced laterally. This findings are secondary to displacement from the\nlarge suprasellar component of the mass. Similarly, posteriorly the mass\nextends and displaces the basilar tip as well as the proximal posterior\ncerebral arteries. Posterior cerebral artery outline both lateral aspect of\nthe mass.", + "output": "CT angiography were performed for surgical planning demonstrates a large\ninvasive pituitary adenoma with its relationship to the cavernous and\nsupraclinoid internal carotid arteries and displacement of the adjacent\nvascular structures. No vascular occlusion is seen." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nLarge hyperdense sellar/suprasellar mass is again demonstrated, better\nassessed on the recent MRI. There is mass effect on the anterior aspect of\nthe third ventricle, as seen previously, without dilatation of the lateral\nventricles. The mass extends into the interpeduncular and prepontine cisterns\nto the left of midline, remodeling the brainstem, as seen previously. The\nmass also extends into bilateral cavernous sinuses. There is unchanged edema\nin the right inferior posterior frontal parenchyma adjacent to the mass. No\nevidence for new edema or acute hemorrhage.\n\nThe above described mass extends into the sphenoid sinuses, as seen\npreviously. There are aerosolized secretions in the inferior frontal sinus,\nwithout evidence for occlusion of the right frontoethmoidal recess. Mastoid\nair cells appear well-aerated. The orbits appear unremarkable.\n\nCTA HEAD:\nThe sellar/suprasellar mass contacts the cavernous internal carotid arteries,\nwhich also contain mild calcified plaque, without significant narrowing. \nNarrowing of bilateral paraclinoid internal carotid arteries is unchanged. \nSupraclinoid internal carotid artery to displaced laterally, as before. A1\nsegments of the anterior cerebral arteries are displaced superiorly, as seen\npreviously. The disc basilar artery is displaced posteriorly, and the\nproximal posterior cerebral arteries are splayed along the posterior aspect of\nthe mass, also seen previously. No evidence for new vascular stenosis. No\nevidence for an aneurysm.\n\nThe dural venous sinuses are patent.", + "output": "Large hyperdense sellar/suprasellar mass is again demonstrated, with stable\nmass effect on the brain parenchyma and on the adjacent arteries compared to\nthe recent prior studies, as detailed above." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Mild atrophy.\n\nNo osseous abnormalities seen. Small mucous retention cyst small amount of\naerosolized secretions in the right sphenoid sinus. Otherwise, the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Periventricular white matter hypodensities are nonspecific, but\nlikely reflect sequelae of chronic small vessel ischemic disease. Prominence\nof the ventricles and sulci suggest involutional changes. There is trace\nright sphenoid sinus mucosal thickening and mild right maxillary sinus mucosal\nthickening. The remaining imaged paranasal sinuses are clear. Mastoid air\ncells and middle ear cavities are well aerated. The bony calvarium is intact.", + "output": "There is no evidence of acute intracranial process or hemorrhage." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, infarction, edema,\normass effect. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Mild mucosal thickening of bilateral\nethmoid air cells is identified. The visualized portion of the remaining\nparanasal sinuses and mastoid air cells are clear. There is impacted cerumen\nin the bilateral middle ear cavities. The visualized portion of the orbits\nare unremarkable.", + "output": "No acute intracranial hemorrhage or fracture." + }, + { + "input": "There is no evidence of acute large territory infarct,hemorrhage,edema,or mass\neffect. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. New, moderate left sphenoid sinus mucosal\nthickening with aerosolized secretions. Mild ethmoid air cell mucosal\nthickening. The visualized portion of the remaining paranasal sinuses and\nmiddle ear cavities are clear. Trace mastoid air cell opacification,\nminimally changed since ___. Debris in the bilateral external auditory\ncanals likely reflects impacted cerumen. The visualized portion of the orbits\nare unremarkable.", + "output": "1. No evidence of an acute intracranial abnormality noncontrast head CT.\n2. Possible acute sphenoid sinusitis. Clinical correlation is recommended." + }, + { + "input": "Limited evaluation of the skullbase due to patient motion. There is no\nevidence of infarction, hemorrhage, edema, or mass effect. The ventricles and\nsulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Evaluation of the skullbase is limited due to patient motion within this\nlimitation: There is no acute intracranial process." + }, + { + "input": "There is no evidence of large vascular territory infarction, acute\nintracranial hemorrhage hemorrhage, edema, or mass effect. Periventricular,\nsubcortical and deep white matter hypodensities are nonspecific but suggest\nchronic small vessel disease. The ventricles and sulci are prominent in size\nand configuration, consistent with age related involutional changes.\n\nNo osseous abnormalities seen. Mild mucosal thickening of the ethmoid air\ncells. The remaining paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The orbits are unremarkable apart from bilateral lens\nreplacements. Atherosclerotic calcifications of the cavernous portions of\nbilateral internal carotid arteries are noted.", + "output": "No acute intracranial process including acute large vascular territory\ninfarction or hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are normal in size and configuration. Prominence of the\npituitary with a superiorly convex margin raises the possibility of an\nunderlying lesion.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No acute intracranial pathology.\n2. Enlarged appearance of the pituitary for a patient of this age raising the\npossibility of underlying enlargement/adenoma.\n\nRECOMMENDATION(S): Dedicated nonurgent MRI can be performed to further\ncharacterize pituitary.\n\nNOTIFICATION: The finding of impression point 2 with recommendation was\ndiscussed with ___, M.D. by ___, M.D. on the telephone on\n___ at 11:22 ___, 3 minutes after discovery of the findings." + }, + { + "input": "Please note that motion artifact limits evaluation. There is no evidence of\nacute large territorial infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are mildly prominent in size but normal in configuration, compatible\nwith age appropriate atrophy. There is preservation of gray-white matter\ndifferentiation, and the basal cisterns are patent. Subcortical and\nperiventricular white matter hypodensities reflect chronic small vessel\nischemic disease (2a:17).\n\nNo acute osseous abnormalities seen. Mucosal sinus thickening of the right\nmaxillary sinus is identified. The remaining paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The orbits are unremarkable.", + "output": "Please note that this study is limited by motion artifact. However, no\nevidence of acute intracranial hemorrhage or evidence of acute large\nterritorial infarction.\n\nRECOMMENDATION(S): Please note that MRI is a more sensitive examination for\nthe detection of acute infarction." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, mass effect, or acute\nischemia. There is a right transfrontal VP shunt catheter, the tip of which \nlies within the frontal horn of the left lateral ventricle. The ventricles\nappear normal in size and are not significantly changed from most recent CT\nhead although comparison with prior studies may be useful for evaluation of\nventricular size stability.\n\nThe orbits, skull base, and paranasal sinuses appear unremarkable.\n\nThere is asymmetric fullness within the right posterior nasopharyngeal soft\ntissues, effacing the fossa of Rosenmueller, which could represent redundant\nlymphoid tissue although direct visualization is recommended to exclude\nunderlying malignancy. The mastoid air cells appear clear. Remaining major\nglandular and muscular structures throughout the neck are normal in\nappearance. Numerous small upper mediastinal lymph nodes are also noted.\nImaged lung apices appear unremarkable.\n\nEvaluation of the intracranial vasculature demonstrates evidence of prior\naneurysmal clipping in the region of the ACom complex, the surrounding region\nof which of is not interpretable although there is no evidence of additional\naneurysm larger than 2 mm, vascular malformation, or hemodynamically\nsignificant stenosis.\n\nThe aortic arch demonstrates conventional branch configuration. The vertebral\narteries are co-dominant. There is no evidence of hemodynamically significant\nstenosis within the vasculature of the neck.", + "output": "1. No evidence of acute intracranial hemorrhage, ischemia or mass effect.\n2. Right transfrontal ventriculostomy catheter with no short-interval change\nin ventricular size.\n3. Evidence of prior ACom complex aneurysm clipping without evidence of\nadditional aneurysm, vascular malformation, or hemodynamically significant\nstenosis within the head or neck.\n4. Asymmetric fullness within the right posterior nasopharyngeal soft tissues\nwhich may simply represent redundant lymphoid tissue; however, direct\nvisualization is recommended to exclude underlying malignancy." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are mildly enlarged for the patient's age suggesting\natrophy. Mild periventricular white matter hypodensities are likely sequela of\nchronic small vessel disease. The basal cisterns are patent and there is\npreservation of gray-white matter differentiation.\n\nNo osseous abnormalities seen. There is fluid within the sphenoid sinus and\nmild mucosal thickening of the ethmoid air cells, improved from ___. The\nparanasal sinuses and mastoid air cells are otherwise clear. The orbits are\nunremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\n\nThere is a mucous retention cyst in the right maxillary sinus and mild mucosal\nthickening in the bilateral ethmoid air cells. Mastoid air cells and middle\near cavities are well aerated. The bony calvarium is intact. Hyperostosis\nfrontalis internus is incidentally noted. There is mild atherosclerotic\ncalcification of the left carotid siphon.", + "output": "No acute intracranial abnormality. Specifically, no evidence of edema or mass\neffect." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Mild atropy. Otherwise normal study." + }, + { + "input": "The visualized paranasal sinuses are normally pneumatized. There are trace\nright posterior ethmoid air cell aerosolized secretions. There is mild\nmucosal thickening in the maxillary sinuses there is narrowing of the left\ninfundibulum due to mucosal thickening (602:60), however the remainder of the\nleft drainage pathways widely patent. The right drainage pathways including\nthe ostiomeatal unit is patent. There is no evidence of sinonasal mass.\n\nThe lamina papyracea are intact. The cribriform plates are intact. The\nanterior clinoid processes are not pneumatized. The sphenoid sinus septum is\nleft of midline and inserts just medial to the anteromedial aspect of the bony\nleft carotid canal; left carotid canal is well covered by bone. There is\nslight rightward nasal septal deviation with a spur.\n\nThere is absence of much of the maxillary dentition. The pterygoid plates are\nintact. Imaged portions of the brain and orbits are unremarkable on limited\nevaluation. Carotid siphon calcifications are noted bilaterally.", + "output": "Narrowing of the left infundibulum due to mucosal thickening with patent\ndrainage pathways. Patent right drainage pathways. Minimal aerosolized\nsecretions in the right posterior ethmoid air cells. No fluid levels or\naerosolized secretions. Right-sided septal spur. No evidence of sinonasal\nmass." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. New from prior is an area of left\nfrontal encephalomalacia. Ventricles and sulci are prominent compatible with\nglobal volume loss.\n\nThere is right posterior parieto-occipital scalp hematoma without underlying\ncalvarial fracture. Included paranasal sinuses and mastoids are clear besides\npartially opacified left mastoid tip and mucous retention cyst in the left\nsphenoid sinus. Skull and extracranial soft tissues are otherwise\nunremarkable.", + "output": "Right parieto-occipital scalp hematoma without underlying calvarial fracture\nor acute intracranial hemorrhage.\nFocal area of encephalomalacia in the left frontal lobe which is new since\n___." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. A focal area\nof left frontal encephalomalacia is again seen. There is prominence of the\nventricles and sulci, unchanged from CT head ___.\n\nA right posterior parieto-occipital scalp hematoma is again seen. There is no\nevidence of fracture. There is a left sphenoid sinus mucous retention cyst;\nthe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavitiesare otherwise clear. Status post bilateral lens replacement; the\nvisualized portion of the orbits are unremarkable.", + "output": "1. No evidence of NEW hemorrhage.\n2. Unchanged right parieto-occipital scalp hematoma without underlying\ncalvarial fracture." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage. No edema, shift of\nnormally midline structures, or evidence of acute major vascular territorial\ninfarction. Ventriculomegaly is unchanged. There is an unchanged appearance\nof a chronic left frontal infarct basal cisterns are patent. Age related\ninvolutional changes are re-demonstrated. The imaged paranasal sinuses are\nwell aerated aside from a small retention cyst in the left sphenoid sinus. \nThe mastoid air cells and middle ear cavities are clear. The bony calvarium\nis intact. Small focus of scalp soft tissue swelling is seen along the right\nocciput. Extensive scalp vascular calcifications are noted.", + "output": "No acute intracranial process. Chronic changes as above." + }, + { + "input": "There is no evidence of acute major vascular territory\ninfarction,hemorrhage,edema,or large mass. There is prominence of the\nventricles and sulci suggestive of involutional changes. There is unchanged\nappearance of a chronic left frontal infarct (02:22). Ill-defined\nperiventricular and subcortical white matter hypodensities are nonspecific but\nlikely due to chronic sequela of small-vessel ischemic disease. \nAtherosclerotic calcifications are seen in both carotid siphons.\n\nThere is no evidence of fracture. A mucous retention cyst is seen in the left\nsphenoid sinus. Otherwise, the remaining visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormalities." + }, + { + "input": "There is stable encephalomalacia in the left frontal lobe. There is no\nevidence of acute infarction,hemorrhage,edema, or mass. Mild periventricular\nand subcortical white matter hypodensities are nonspecific, likely the chronic\nsequelae of small vessel ischemic disease. There is prominence of the\nventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. A submucosal retention cyst is seen in the\nleft sphenoid sinus. There is mild mucosal thickening of the ethmoid air\ncells. The visualized portion of the remaining paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits shows bilateral lens replacement.", + "output": "1. No evidence of acute intracranial process.\n2. Stable left frontal lobe encephalomalacia." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nThere is no evidence of fracture. Mild mucosal thickening of the left\nmaxillary sinuses noted with polypoid mucosal thickening of the left sphenoid\nsinus. Mild mucosal thickening of left anterior ethmoid air cells is also\nnoted. The visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are otherwise clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. No acute intracranial process. Mild paranasal sinus inflammatory changes." + }, + { + "input": "There is no evidence of acute major infarct,hemorrhage, edema, or mass effect.\nProminent ventricles and sulci are suggestive of age-related involutional\nchange. There is no evidence of fracture. There is a mucous retention cyst\nwithin the left sphenoid sinus. The visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are otherwise clear. The visualized portion of\nthe orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nPeriventricular white matter hypodensities are likely the sequela of chronic\nsmall vessel ischemic disease.\n\nThere is no evidence of fracture. There is a small mucous retention cyst in\nthe left sphenoid sinus. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n\nNOTIFICATION: The findings were discussed with ___, NP by ___\n___, M.D. on the telephone on ___ at 3:32 ___, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "New left parietal scalp soft tissue swelling is noted (see 04:20). There is\nno evidence of infarction, hemorrhage, edema, or mass. There is prominence of\nthe ventricles and sulci suggestive involutional changes. There are\nperiventricular and subcortical lucencies, which may represent small vessel\nischemic changes. Atherosclerotic vascular calcifications are noted of\nbilateral cavernous portions of internal carotid arteries.\n\nThere is no evidence of fracture. A grossly stable approximately 8 mm left\nfrontal calvarial sharply marginated skull lesion with thin peripheral\nsclerotic rim, intact inner and outer tables of the calvarium and trabecular\nthickening without definite associated cortical breakthrough or soft tissue\ndensity is again noted (see 302b:18 on current study, 601b:36 on ___ prior exam). The visualized portion of the mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable. Left sphenoid sinus mucous retention cyst versus polyp is\nnoted.", + "output": "1. No acute intracranial abnormality, with no evidence of acute intracranial\nhemorrhage or fracture.\n2. Left parietal scalp soft tissue swelling.\n3. Grossly stable approximately 8 mm left frontal calvarial probable\nintraosseous hemangioma, as described.\n4. Paranasal sinus disease as described.\n5. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described." + }, + { + "input": "There is a stable appearance of the known right greater than left subdural\nhematoma which again appears as a hyperdense convexity layering along the falx\nand tentorium. There are no new areas of hemorrhage seen. There is no shift of\nnormally midline structures. The basal cisterns are patent. There is no\nevidence of infarct.", + "output": "1. Unchanged right-greater-than-left parafalcine and tentorial subdural\nhematoma. No evidence of mass effect.\n2. No new areas of hemorrhage. No evidence of infarct." + }, + { + "input": "Previously seen right convexal, posterior falcine and tentorial subdural\nhemorrhages are no longer seen. Hemorrhage within the fourth ventricle is also\nno longer seen. There is no acute intra-axial or extra-axial hemorrhage, mass,\nmidline shift, or acute vascular territorial infarct. Focal white matter\nhypodensity in the right frontal lobe is again seen, likely a prominent\nperivascular space. Gray-white matter differentiation is preserved. Ventricles\nare prominent in size as are the sulci, stable in configuration compared to\nprior.\n\nMild mucosal thickening seen within the maxillary sinuses. Included paranasal\nsinuses and mastoids are otherwise clear. Skull and extracranial soft tissues\nare unremarkable.", + "output": "No acute intracranial process. Interval resolution of the subdural hematomas\nseen on prior." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nCT HEAD WITHOUT CONTRAST:\nThe right frontal lobe demonstrates loss of gray-white matter differentiation\nwith hypodensity corresponding to an acute infarction. There is no evidence\nof intracranial hemorrhage. There is left frontal centrum semiovale\nhypodensity, likely chronic infarction. There is diffuse parenchymal volume\nloss with prominence of the ventricles and sulci. There is left parietal\ncalcification, possibly dural or representing a calcified meningioma (4:270). \nThe paranasal sinuses and bilateral mastoid air cells appear clear. There is\ncerumen within bilateral external auditory canals.\n\nCT HEAD PERFUSION:\nThere is a right frontal lobe mismatch defect between the cerebral blood flow,\ncerebral blood volume and mean transit time (342:8, 341:9) compatible with an\narea of number. There is a central matched defect between the cerebral blood\nflow and cerebral blood volume compatible with an ischemic core.\n\nCTA HEAD:\nThe right M2 superior division demonstrates attenuation of flow (4: 240) with\nmoderate luminal narrowing and relative paucity of cortical vessels\ncorresponding to the site of the right frontal lobe infarction. There are\nmild vascular calcification of the clinoid and cavernous segments of bilateral\ninternal carotid arteries. There is nonvisualization of the left anterior\ncerebral artery, likely a congenital variant. Otherwise, the intracranial\nvasculature appears patent without evidence of stenosis, occlusion, or\naneurysm.\n\nCTA NECK:\nThere is atherosclerotic disease of the bilateral carotid bifurcations without\ninternal carotid artery stenosis by NASCET criteria. The bilateral vertebral\narteries appear patent.\n\nOTHER:\nThe gland appears unremarkable. There is dependent atelectasis within the\nlung apices. There is nonspecific 9 x 5 mm right upper lobe ground-glass\nopacity (04:28). There is no evidence of lymphadenopathy per size criteria.", + "output": "1. Dental amalgam streak artifact limits study.\n2. Right frontal lobe acute to subacute infarction, without intracranial\nhemorrhage. Corresponding CT perfusion images demonstrate right frontal lobe\npenumbra with a central ischemic core.\n3. Probable chronic infarction within the left frontal centrum semiovale.\n4. Probable left parietal calcified meningioma.\n5. Moderate luminal narrowing of the right M2 segment superior division with\npaucity of distal cortical vessels corresponding to the site of the right\nfrontal lobe infarction.\n6. Atherosclerotic disease at the carotid bifurcations without internal\ncarotid artery stenosis by NASCET criteria.\n7. Nonspecific 9 x 5 mm right upper lobe ground-glass opacity. The ___\nSociety guidelines for pulmonary nodule guidelines suggest for ground glass\nnodules greater than 5 mm CT followup at 3 months.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 6:20 am, 0 minutes\nafter discovery of the findings." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nlarge territorial infarction.\n\nCerebral atrophy is noted. There are periventricular white matter\nhypodensities, which are most likely sequela of chronic small vessel ischemic\ndisease. The basal cisterns appear patent and there is preservation of\ngray-white matter differentiation.\n\nThe visualized bony structures are grossly unremarkable. Stable calcified\nstructure along inner table of left parietal bone, likely osteoma versus\ncalcified meningioma. The paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. Atherosclerotic mural calcification of the bilateral\ninternal carotid arteries is noted. The globes are unremarkable.", + "output": "No acute intracranial abnormality. Stable calcified structure along inner\ntable of left parietal bone, likely osteoma versus calcified meningioma." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are prominent, compatible with global age related\natrophy. Periventricular and subcortical white matter hypodensities likely\nreflect the sequelae of chronic small vessel ischemic disease.\nThe previously described calcified structure along the inner table of the left\nparietal calvarium is unchanged, dural calcification or calcified meningioma.\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\nThe orbits are unremarkable.", + "output": "No acute intracranial process. No significant change since the prior study\nfrom 11 hr ago." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nlarge mass. There is right basal ganglia calcification. There is prominence\nof the ventricles and sulci suggestive involutional changes. There are\nperiventricular and subcortical lucencies, which may represent small vessel\nischemic changes. Atherosclerotic vascular calcifications are noted of\nbilateral cavernous portions of internal carotid arteries.\n\nThere is no evidence of fracture. The posterior arch of C1 is unfused. The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are preserved.", + "output": "1. No acute intracranial abnormality.\n2. No evidence acute intracranial hemorrhage or fracture.\n3. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described." + }, + { + "input": "Some of the images were repeated. However, a portion of the study limited by\nmotion artifact has not been repeated.\n\nNo evidence for acute intracranial hemorrhage, edema, mass effect, or loss of\ngray/white matter differentiation. Ventricles and sulci are age-appropriate. \nBasal cisterns are preserved. Cerebellar tonsils are normally positioned.\n\nThere is a left occipital subgaleal and subcutaneous hematoma. No evidence\nfor an acute displaced fracture. There is internal fixation hardware along\nthe right lateral orbital rim.\n\nLeft mastoid air cells are opacified without osseous erosion. Right mastoid\nair cells and bilateral middle ear cavities appear well-aerated.\n\nThere is moderate opacification of the left sphenoid sinus with mucous\nretention cysts and mucosal thickening. There is mild mucosal thickening and\nmucous retention cysts in the right sphenoid sinus with near complete\nopacification of the pterygoid recess. There is mild mucosal thickening in\nthe right posterior ethmoid air cells. There is extensive opacification of\nmultiple bilateral anterior ethmoid air cells extending into the\nfrontoethmoidal recesses. Right frontal sinus is completely opacified. There\nis a fluid level in the left frontal sinus. There is mild mucosal thickening\nin the visualized upper portions of the maxillary sinuses. Rightward nasal\nseptal deviation is partially imaged.", + "output": "1. Motion limited exam.\n2. No evidence for acute intracranial abnormalities.\n3. Left occipital subgaleal and subcutaneous hematoma. No evidence for an\nacute displaced fracture.\n4. Extensive paranasal sinus disease, including fluid in the left frontal\nsinus. Please correlate clinically with any associated symptoms of acute or\nacute-on-chronic sinusitis.\n5. Left mastoid air cell opacification without osseous erosion. Please\ncorrelate with any associated symptoms." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute findings." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Prominent\nventricles and sulci are consistent with age-related involutional change. \nPeriventricular and deep subcortical white matter hypodensities are\nnonspecific but compatible with sequela of chronic small vessel ischemic\ndisease.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No intracranial mass lesions are identified, allowing for the limitations of\nthis noncontrast study. CT with contrast or MR would be more sensitive for\nassessment of intracranial mass lesions." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere are small focal hypodensities involving the left thalamus, left corona\nradiata and body of the corpus callosum, reflecting chronic lacunes. There is\nno evidence of hemorrhage,edema,mass or recent infarction. The ventricles and\nsulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is moderate calcified and noncalcified atherosclerotic plaque of the\npetrous, cavernous and supraclinoid segments of the bilateral internal carotid\narteries without significant flow limiting stenosis. The remaining vessels of\nthe circle of ___ and their principal intracranial branches appear normal\nwithout stenosis, occlusion, or aneurysm formation. The dural venous sinuses\nare patent.\n\nCTA NECK:\n There is calcified and noncalcified atherosclerotic plaque at the bilateral\ncommon carotid artery bifurcations. There is 80% luminal narrowing of the\nproximal left internal carotid artery involving the vessel origin per NASCET\ncriteria. No stenosis is seen in the right internal carotid artery per\nNASCET criteria. The left vertebral artery is dominant. Otherwise, the\ncarotidandvertebral arteries and their major branches otherwise appear normal\nwith no evidence of occlusion.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is is visualized and demonstrates a 8 mm peripherally calcified\nnodule in the left thyroid lobe. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No evidence of hemorrhage or recent infarction.\n2. 80% stenosis of the origin and proximal left internal carotid artery.\n3. Small left thalamic hypodensity, corona radiata and body of the corpus\ncallosum, likely related to remote infarcts.\n4. Subcentimeter peripherally calcified left thyroid lobe nodule." + }, + { + "input": "No fractures are identified.\nThere is no evidence of facial swelling.\nIn the right maxillary sinus, there is a large and small mucous retention\ncyst, (3:16, 21). On the left, there is also a small mucous retention cyst\nwith mild mucosal thickening (03:14). Partial opacification of the lateral\nleft sphenoid sinus (03:30). Otherwise, the right sphenoid, ethmoid, and\nfrontal sinuses are well aerated. The lamina papyracea is intact.\nThere is no evidence of abnormal fluid collections.\nBilateral mastoids appear normal. Cerumen noted in the middle ear cavity on\nthe right.\nThe globes, extraocular muscles, optic nerves, and retrobulbar fat appear\nnormal.\nThe visualized upper aerodigestive tract appears normal.\nThe mandible and temporomandibular joints appear normal. There is, however a\ncracked tooth ___ 3)\nwith associated periapical lucency (3:2, 8).\nIncidentally noted asymmetrically enlarged left foramen Vesalius (03:27),\nunchanged since ___.", + "output": "1. Mucous mucosal thickening and bilateral retention cysts within the\nmaxillary sinuses as well as partial opacification of the lateral left\nsphenoid sinus. No evidence of abnormal fluid collections.\n2. Cracked right molar surface ___ 3) with associated periapical lucency. \nDental consultation is recommended.\n\nRECOMMENDATION(S): Dental consultation is recommended." + }, + { + "input": "There is no evidence of fracture, acute large vascular territory\ninfarction,hemorrhage,edema,or mass. The ventricles and sulci are normal in\nsize and configuration. Periventricular white matter hypodensities are\nnonspecific, however likely represents sequela of chronic small vessel\nischemic disease.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No acute intracranial abnormality on noncontrast CT head. Specifically no\nevidence of acute large territory infarct or intracranial hemorrhage." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nHeterogeneous density in the right frontal lobe measuring approximately 11 mm\nis unchanged from the previous study. Also similar are extensive\nperiventricular and subcortical white matter hypodensities, nonspecific but\nprobably reflect sequela of severe form of chronic microangiopathy. Multiple\nsmall bilateral basal ganglionic and white matter lacunar infarcts.\n\nNo acute intracranial hemorrhage or acute territorial infarction.\n\nStatus post lens removal surgery of both globes. Otherwise both globes and\norbits are normal. Paranasal sinuses and mastoid air cells are clear.\n\nCTA HEAD:\nBackground of moderate atherosclerotic changes affecting intracranial anterior\ncirculation more pronounced at right M1 segment and left P1 segment. Also\nthere is calcified atherosclerotic plaque at intracranial segment of left\nvertebral artery with underlying moderate stenosis. Otherwise; the vessels of\nthe circle of ___ and their principal intracranial branches appear patent\nwithout severe stenosis, occlusion, or aneurysm. The dural venous sinuses are\npatent.\n\nCTA NECK:\nCalcified atherosclerotic plaque causing about more than 70% luminal narrowing\nat left vertebral artery origin. Otherwise; bilateral carotid and right\nvertebral artery origins are patent. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion.\n\nOTHER:\nThere is enlargement of the ascending aorta. The visualized portion of the\nlungs are clear. The visualized portion of the thyroid gland is within normal\nlimits. There is no lymphadenopathy by CT size criteria.", + "output": "1. Right frontal hyperdensity with small foci of calcification with no\nsurrounding vasogenic edema; appearance could represent cavernous\nmalformation.\n2. Background of severe chronic microangiopathy with multiple bilateral\nlacunar infarcts.\n3. Background of moderate atherosclerotic disease affecting intracranial\ncirculation with patent circle of ___ without evidence of severe\nstenosis,occlusion,or aneurysm.\n4. Severe stenosis at origin of left vertebral artery caused by calcified\natherosclerotic plaque. The left vertebral artery arises directly from the\naorta." + }, + { + "input": "Exam is slightly motion degraded. Within this limitation the following\nobservations are made. Subarachnoid hemorrhage is noted in the right sylvian\nfissure and potentially on the left as well (02:20). Subarachnoid blood also\nnoted in the parasagittal right frontal lobe near the vertex. There is an\noblong 5 x 9 mm hyperdense focus abutting the septum pellucidum on the left\nwithin the lateral ventricle suspicious for hemorrhage. Layering blood noted\nwithin the occipital horn of the left lateral ventricle. No additional\nhemorrhage.\n\nThere is enlargement of the ventricles and sulci suggesting global volume\nloss. Prominent extra-axial CSF space overlying the frontal lobes bilaterally\nis compatible with small low-density subdural collections. Periventricular\nand subcortical white matter hypodensities are likely sequela of chronic small\nvessel disease. Possible 11 mm pineal cyst. There is no midline shift,\nbasilar cisterns are patent.\n\nThere is left parietal scalp hematoma and laceration without underlying\nfracture. Included paranasal sinuses and mastoids are clear. Skull and\nextracranial soft tissues are unremarkable.Endotracheal and enteric tubes are\npartially visualized.\n\nPlease see dedicated report a probable cervical spine for description of\nvisualized fracture.", + "output": "1. Subarachnoid and intraventricular hemorrhage as above.\n2. Small bifrontal subdural low-density collections, potentially chronic\nsubdural hematomas versus hygromas.\n3. Left parietal scalp laceration and hematoma without underlying fracture.\n4. Please see dedicated cervical spine CT for details of C-spine fractures." + }, + { + "input": "CTA NECK:\nThere is a 3 vessel aortic arch. There is extensive, mostly calcified plaque\nin the visualized distal ascending aorta, aortic arch, and proximal descending\naorta. There is mostly calcified plaque at the great vessel origins without\nassociated stenosis. There is mild calcified plaque in the proximal right\ninternal carotid artery without flow-limiting stenosis. There is calcified\nplaque in the proximal left internal carotid artery causing approximately 80%\nstenosis by NASCET criteria. Bilateral cervical vertebral arteries appear\nwidely patent. There is no evidence for cervical carotid or vertebral\ndissection.\n\nCTA HEAD:\nThere is calcified plaque in bilateral carotid siphons without evidence for\nflow-limiting stenosis. There is no evidence for flow-limiting stenosis\nelsewhere in the intracranial circulation. There is no evidence for\ndissection or aneurysm. The dural venous sinuses are patent.\n\nOTHER:\nThe brain parenchyma is better assessed on the immediately preceding head CT. \nIntraventricular hemorrhage is again noted.\n\nAgain seen is a left parietal subgaleal hematoma with overlying scalp\nlaceration. No fracture is seen.\n\nThere is minimal mucosal thickening in the ethmoid air cells and trace fluid\nin the left maxillary sinus. Middle ear cavities and mastoid air cells, as\nwell as pneumatized petrous apices, appear well-aerated. There is evidence of\nbilateral cataract surgery.\n\nType 2 odontoid fracture is again seen, better assessed on the immediately\npreceding cervical spine CT. Degenerative changes are also again visualized\nin the cervical spine. A bone island is again noted in the left lateral mass\nof C1.\n\nThe endotracheal tube terminates approximately 4 cm above the carina. \nOroesophageal tube is partially visualized.\n\nThe included upper lungs demonstrate emphysema and subpleural reticulation,\nsuggesting combined emphysema pulmonary fibrosis, as well as\npleural/parenchymal scarring at the apices. A precarinal lymph node measures\n1.5 cm in short axis, mildly enlarged. There are multiple additional\nnonenlarged bilateral paratracheal lymph nodes and AP window lymph nodes.\n\nThere are no enlarged cervical lymph nodes. The thyroid gland appears grossly\nunremarkable.", + "output": "1. No evidence for dissection involving the cervical or major intracranial\narteries.\n2. Calcified plaque in the proximal left internal carotid artery with\napproximately 80% stenosis by NASCET criteria.\n3. Intracranial hemorrhage is better assessed on the immediately preceding\nnoncontrast head CT.\n4. Left parietal subgaleal hematoma is again noted.\n5. Type 2 odontoid fracture is again seen, better assessed on the immediately\npreceding cervical spine CT.\n6. Emphysema and subpleural reticulation in the included upper lungs,\nsuggesting combined emphysema pulmonary fibrosis interstitial lung disease. \nPlease correlate clinically." + }, + { + "input": "Compared to prior exam there is similar appearance of subarachnoid blood in\nthe right sylvian fissure. There is also blood in the left sylvian fissure\nwhich appears more prominent compared to prior exam additional new foci of\nsubarachnoid hemorrhage in the left temporal lobe may represent redistribution\nof prior hemorrhage in this area or new subarachnoid hemorrhage. Subarachnoid\nblood in the parasagittal right and left frontal and right parietal lobes also\nagain seen. Layering blood in the occipital horn of the left lateral\nventricle as well as the hyperdense focus abutting the septum pellucidum in\nthe left lateral ventricle appears unchanged. Hypodense material overlying\nbilateral frontal lobes (03:22) measure up to 7 mm on the right and 8 mm on\nthe left in maximal thickness. No additional hemorrhages seen. No midline\nshift. Basal cisterns appear patent. There is prominence of the ventricles\nand sulci suggestive of involutional changes. Periventricular white matter\nhypodensities suggestive of chronic small vessel ischemic disease.\n\nThere is soft tissue swelling over the left parietal scalp. There has been\ninterval placements of skin staples over a laceration in this location. There\nis no evidence of fracture. The visualized portion of the mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Multiple foci of subarachnoid hemorrhage with intraventricular extension as\ndescribed above.\n2. New left temporal subarachnoid hemorrhage likely represent redistributed\nblood previously seen in the left sylvian fissure.\n3. Grossly stable bifrontal nonspecific subdural collections. Findings again\nconcerning for subacute to chronic hematomas versus hygromas.\n4. Evolving left parietal scalp subgaleal hematoma.\n5. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct." + }, + { + "input": "Images were repeated due to motion artifact. The best quality images, series\n6, are still mildly limited by motion artifact. There is no evidence for\nacute intracranial hemorrhage, edema, mass effect, acute major vascular\nterritorial infarction, or chronic extra-axial collection. Normal size of the\nventricles, sulci, and basal cisterns.\n\nMild left frontal subgaleal and supraorbital soft tissue swelling. No\nevidence for intraorbital hematoma. No displaced fracture seen.\n\nLeft maxillary sinuse is atelectatic and completely opacified with\nhigh-density material, compatible with inspissated secretions or fungal\ncolonization. Left ostiomeatal unit is probably not completely occluded but\nis not adequately assessed with this technique, particularly given the motion\nartifact. Mild mucosal thickening in the bilateral anterior ethmoid air cells\nand left frontoethmoidal recess, without evidence for left frontoethmoidal\nrecess occlusion. Right and partially visualized left mastoid air cells are\nwell aerated.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. Left frontal subgaleal and supraorbital soft tissue swelling. No evidence\nfor intraorbital hematoma. No displaced fracture seen.\n3. Chronic left maxillary sinusitis with atelectasis of the left maxillary\nsinus and high density opacifying material, compatible with inspissated\nsecretions versus fungal colonization." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates left submandibular soft\ntissue thickening along the left posterior oropharynx with locules of gas\nmeasuring approximately 1.8 x 1.7 cm causing severe airway narrowing which\nappears to track to the left posterior mandible. This appears to reflect a\nfluid collection with central gas. The air and fluid may be a consequence of\nrecent surgery. However the extensive edema suggests infection in this area,\nin other words an abscess.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions. Calcification of the\ninternal carotid arteries are noted.\n\nMild mucosal thickening of the maxillary sinus is noted bilaterally. \nAdditional visualized paranasal sinuses, mastoid air cells and middle ear\ncavities are clear.\n\nCortical irregularity with 3 mm osseous fragment along the left posterior\nmaxilla (601b:35) is physical bya consequence of prior dental extraction.", + "output": "1. Asymmetric soft tissue thickening along left posterior oropharynx with\nlocules of gas spanning an area of 1.8 cm which tracks to the left posterior\nmandible worrisome for infection.\n2. Severe airway narrowing\n3. Posterior left maxillary cortical irregularity is likely due to prior\ndental extraction.\n\nNOTIFICATION: The findings were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 2:38 AM, 5 minutes after\ndiscovery of the findings.\n\nThe revised report indicating the presence of an abscess was generated after\nthe patient had been taken to the OR for drainage. Therefore, no further\nnotification was provided." + }, + { + "input": "There is no acute hemorrhage, edema, mass effect, or CT evidence for an acute\nmajor vascular territorial infarction. There is a chronic infarct involving\nthe right caudate head, anterior aspects of the right internal and external\ncapsules, and right corona radiata, with associated ex vacuo enlargement of\nthe frontal horn of the right lateral ventricle. There is another chronic\ninfarct in the posterior limb of the right internal capsule. There are\nill-defined areas of low-density in the subcortical and deep white matter of\nthe cerebral hemispheres, nonspecific but likely sequela of chronic small\nvessel ischemic disease in this age group. There is moderate global\nparenchymal volume loss with prominent ventricles and sulci.\n\nNo concerning bone lesion is seen. There is mild mucosal thickening in the\npartially visualized maxillary sinuses. Other imaged paranasal sinuses and\nmastoid air cells are well aerated.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. Chronic infarcts involving the right caudate head and adjacent deep white\nmatter.\n3. Supratentorial white matter hypodensities are nonspecific but likely\nsequela of chronic small vessel ischemic disease in this age group.\n\nRECOMMENDATION(S): MRI would be more sensitive for an acute infarction, if\nclinically warranted." + }, + { + "input": "Bifrontal approach deep brain stimulators are in place and unchanged in\nposition. There is no evidence of acute intracranial hemorrhage, edema, mass\neffect or shift shift of normally midline structures. There is no evidence of\ninfarction. Periventricular and subcortical white matter hypodensities are\ncompatible with sequela of chronic microvascular ischemic disease. The basal\ncisterns are patent. There is preservation of gray-white matter\ndifferentiation again seen are calcifications within the left basal ganglia,\nunchanged from the prior study. Additionally, small venous calcification seen\nsupratentorially there is unchanged.\n\nThere is calcification in both cerebellar hemispheres as well as along the\nsurface of the cerebellum on the left.\n\nThere is no evidence of acute fracture. Mural calcification of the the\ninternal carotid arteries is again seen. The globes are unremarkable. There is\nmucosal thickening, air-fluid levels and mucous retention cysts seen in both\nthe left and right maxillary sinus. Additionally, there is partial\nopacification of the ethmoid air cells and an air-fluid level in the left\nsphenoid sinus. The nasal septum is midline. The mastoid air cells are\npartially aerated with fluid seen bilaterally. The middle ear cavities are\nclear.", + "output": "No evidence of hemorrhage or infarction. No significant change from the prior\nexam." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are prominent suggesting involutional changes..\n\nThere is mild mucosal thickening in the inferior maxillary sinuses. \nOtherwise, the visualized portion of the paranasal sinuses, mastoid air\ncells,and middle ear cavities are clear. The visualized portion of the orbits\nare normal.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. The A1 segment of the\nright anterior cerebral artery is mildly hypoplastic, anatomic variant. There\nis an approximately 2.5 mm suspected aneurysm at the right posterior\ncommunicating artery origin best seen on image 23 of series 602, projecting\ninferiorly and medially. This appears to involve the origin of the diminutive\nright posterior communicating artery. The dural venous sinuses are patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent. The left vertebral\nartery is slightly dominant.\nThere is mild atherosclerotic calcification at the origin of the right\ninternal carotid artery, and there is mild multifocal irregularity of the\nright internal carotid artery which is most likely to reflect underlying\natheromatous plaque in this age group. However, there is no evidence of\ninternal carotid stenosis by NASCET criteria. The course of the left internal\ncarotid artery is partially medialized and parapharyngeal. The proximal\ncommon carotid arteries are tortuous, particularly on the left side.\n\n\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. There are multilevel degenerative changes in the cervical spine.", + "output": "1. No large vascular territorial infarct or hemorrhage.\n2. Probable aneurysm at the origin of the right posterior communicating artery\nmeasuring approximately 2.5 mm.\n3. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n4. Patent bilateral cervical carotid and vertebral arteries without evidence\nof hemodynamically significant stenosis, occlusion,or dissection.\n\nNOTIFICATION: Discussed by phone at 14:18 on ___ with Dr. ___." + }, + { + "input": "There is a small to moderate amount of bilateral anterior parafalcine\nsubarachnoid hemorrhage. There are trace bifrontal subdural hematomas near\nthe vertex. A small right temporal hyperdense focus is thought to be\nartifactual or may represent a cortical vein (series 2, image 11). No\nsignificant mass effect or midline shift. The basilar cisterns are patent. \nEvidence of acute infarction.\n\nA small occipital scalp hematoma is noted. Age-indeterminate, nondisplaced\nright nasal bone fracture new from ___. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Small bifrontal subdural hematomas without significant mass effect or\nmidline shift. Small to moderate amount of bilateral parafalcine subarachnoid\nhemorrhage. A small right temporal hyperdense focus is thought to be\nartifactual or may represent a cortical vein.\n2. Age-indeterminate, nondisplaced right nasal bone fracture new from ___." + }, + { + "input": "Interval decrease in extent of anterior parafalcine subarachnoid hemorrhage\nfrom prior CT head ___. Trace bifrontal subdural hematomas near the\nvertex are less apparent compared to prior. A previously seen right temporal\nhyperdense focus is not identified on this exam. No significant mass effect. \nThere is no evidence of infarction,new hemorrhage, or mass effect. The\nventricles and sulci are within expected limits in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Slight decrease in extent of anterior parafalcine subarachnoid hemorrhage and\nbifrontal subdural hematomas near the vertex. No new hemorrhage, no\ninfarction." + }, + { + "input": "There is a subtle focal nodularity within the right cerebellopontine angle\nmeasuring 0.7 cm (2:9), with poorly visualized and questionable additional\nareas of hyperdensity within the cerebellopontine angle, but is difficult to\nvisualize on this noncontrast head CT.\n\nOtherwise, there is no evidence of acute intracranial hemorrhage or\nterritorial infarction. The ventricles are normal in size. The visualized\nparanasal sinuses and bilateral mastoid air cells appear clear.", + "output": "1. No evidence of infarction or intracranial hemorrhage.\n2. Questionable hyperdense nodularity within the right cerebellopontine angle,\nwhich is difficult to evaluate on this noncontrast head CT. Dedicated\ncontrast-enhanced MRI is recommended.\n\nRECOMMENDATION(S): Contrast-enhanced MRI is recommended." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. There is periventricular white matter hypodensity which is\nsuggestive of chronic microvascular ischemic disease. There are age related\ninvolutional changes. The imaged paranasal sinuses appear well aerated as do\nthe mastoid air cells and middle ear cavities. There is carotid siphon\ncalcification. The bony calvarium is intact.", + "output": "No acute intracranial process. Moderate small vessel disease." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nlarge mass. Prominence of the ventricles and sulci is suggestive of\ninvolutional changes.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Evaluation of the skullbase is limited due to motion artifact. There is no\nevidence of cranial hemorrhage, edema, shift of normally midline structures,\nor infarction. Ventricles and sulci are normal in size and configuration. The\nimaged paranasal sinuses are clear. Mastoid air cells and middle ear cavities\nare well aerated. The bony calvarium is intact. There is a small scalp\nhematoma overlying the right frontal calvarium.", + "output": "Small right frontal scalp hematoma. Otherwise normal study." + }, + { + "input": "There is no intracranial hemorrhage, edema, mass effect, or acute vascular\nterritorial infarction. The ventricles and sulci are normal in size and\nconfiguration. There is no shift of the normally midline structures.The basal\ncisterns appear patent and there is preservation of the gray-white matter\ndifferentiation.\n\nA hematoma is present about the right frontotemporal subcutaneous soft\ntissues, with a locule of gas along the right frontal soft tissues (02:16). \nNo underlying calvarial fracture is identified. The paranasal sinuses and\nfacial bones are better characterized on concurrently obtained maxillofacial\nCT.", + "output": "No acute intracranial abnormality. Right frontotemporal scalp hematoma with\nlaceration, with no evidence of underlying calvarial fracture. Paranasal\nsinuses and facial bones are better characterized on concurrently obtained\nmaxillofacial CT." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration. Mild\nperiventricular and subcortical white matter hypodensities are nonspecific,\nhowever likely due to chronic small vessel ischemic disease.\n\nThere is no evidence of acute fracture. Moderate mucosal thickening of the\nbilateral ethmoid air cells and bilateral maxillary sinuses are seen. The\nvisualized portion of the remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "No acute intracranial abnormalities." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema,or mass effect. There\nis prominence of the ventricles and sulci suggestive of involutional changes. \nPeriventricular and subcortical white matter hypodensities are nonspecific but\nsuggest chronic small vessel ischemic changes.\n\n There is no evidence of fracture. Nasoenteric tube is partially visualized. \nDecreased pneumatization of bilateral mastoid air cells are similar to prior.\nAgain there is mild mucosal thickening of bilateral ethmoid air cells and\nbilateral maxillary sinuses. The visualized portion of the remaining\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No evidence of mass, hemorrhage or infarction infarction." + }, + { + "input": "Mixed attenuation lesions in the medial left temporal lobe and left cerebellar\npeduncle are consistent with known lesions in these areas and post treatment\nchanges, better evaluated on the recent MRI of ___. Periventricular\nwhite matter hypodensities are nonspecific but likely sequelae of chronic\nsmall vessel ischemic disease or post treatment change. There is no evidence\nof hemorrhage. There is no mass effect or shift of normally midline\nstructures. Gray-white matter differentiation is grossly preserved.\n\nThere is no fracture. Lytic lesions in the left occipital bone are unchanged\nand may represent arachnoid granulations (series 3, image 21).\n\nMucosal thickening in the maxillary and ethmoid sinuses has increased compared\nto the prior examination. The mastoid air cells and middle ear cavities are\nclear. The orbits are unremarkable.", + "output": "1. No intracranial hemorrhage or other acute intracranial abnormality.\n2. Left medial temporal lobe and middle cerebellar peduncle lesions are\ngrossly stable, but better evaluated on the recent MRI of ___." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nHeterogeneous left medial temporal lobe and left cerebellar lesions,\nassociated with post treatment changes within the left medial temporal lobe,\nlining the ependymal surface of the left lateral ventricle, and left\ncerebellar peduncle are unchanged from the prior examination. Otherwise,\nthere is no evidence for vascular territorial infarction, acute hemorrhage, or\nmass effect.\n\nThe ventricles and sulci are prominent given the patient's stated age, but\nappear unchanged. The basal cisterns remain patent. There is preservation of\ngray-white matter differentiation.\n\nA mucous retention cyst in the right maxillary sinus is unchanged. The\nremainder of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.\n\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. A large\narachnoid granulation is noted in the right transverse sinus. Otherwise, the\ndural venous sinuses are patent.\n\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\n\nOTHER:\nBiapical pleural thickening is noted. Within the medial left upper lobe,\nthere is a 8 x 5 mm solid pulmonary nodule which appears minimally increased\nin size as compared to the prior examination (6:66). Several additional\nmillimetric pulmonary nodules are noted. The thyroid gland is unremarkable in\nappearance. There is no lymphadenopathy by CT size criteria.", + "output": "1. Stable post treatment changes within the medial left temporal lobe, left\nlateral ventricular ependymal surface, and left cerebellar peduncle. No\nevidence for acute intracranial process. No significant changes identified in\nthe left medial temporal lobe and left cerebellar lesions.\n2. Unremarkable CTA head and neck examination.\n3. Biapical pleural thickening and pulmonary nodules measuring up to 8 mm\nwithin the medial left upper lobe. Recommend attention at follow-up dedicated\nchest CT imaging." + }, + { + "input": "No evidence of acute infarction or intracranial hemorrhage. Compared with MRI\nhead on ___, lesions in the posterior left temporal lobe and left\ncerebellum along the left tentorium and containing calcification are not\nsignificantly changed allowing for differences in modality. Surrounding\nencephalomalacia in the left cerebellum and edema in the left temporal lobe is\nnot significantly changed. Additional previously seen small foci of\nenhancement on MRI are not well seen on CT. No definite new lesions within\nthe limitations of noncontrast CT. There is prominence of the ventricles and\nsulci suggestive of involutional changes. Periventricular white matter\nhypodensities are nonspecific, however not significantly changed from prior\nand may represent post treatment changes or chronic small vessel ischemic\ndisease.\n\nThere is a small amount of soft tissue overlying the left vertex (___). \nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No fracture or acute intracranial process." + }, + { + "input": "As seen previously, there is a slightly hyperdense and partially calcified 2.4\nx 1.7 cm left temporal lesion, which is not substantially changed in size or\nappearance compared to prior studies accounting for differences in technique. \nEncephalomalacia of the adjacent left temporal lobe and left cerebellar\nhemisphere is not substantially changed. There is no evidence of fracture,\nacute large territory infarction,hemorrhage,edema,or definite new intracranial\nlesion within the limits of this study. There is prominence of the ventricles\nand sulci suggestive of involutional changes. Periventricular and subcortical\nwhite matter hypodensities are nonspecific but not substantially changed\ncompared to prior and may represent sequelae of chronic microangiopathic\nischemic disease or posttreatment changes.\n\nThere is opacification of several ethmoid air cells. The visualized portion\nof the remaining paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are normal.", + "output": "1. No evidence of acute intracranial abnormality.\n\n2. Slightly hyperdense and partially calcified 2.4 x 1.7 cm left temporal\nlesion, which is not substantially changed in size or appearance compared to\nprior studies accounting for differences in technique." + }, + { + "input": "There has been no significant interval change in size of the dominant left\nfrontal intraparenchymal hematoma measuring approximately 3.4 x 4.5 cm\n(previously, 3.4 x 4.5 cm when measured in a similar manner on the prior\nexam). There is also no significant change in surrounding vasogenic edema and\nno significant change in associated partial effacement of the frontal horn of\nthe left lateral ventricle. There is no significant midline shift. There is\nsimilar size of a intraparenchymal hematoma in the right frontal lobe\nmeasuring approximately 2.0 x 1.6 cm. Intraparenchymal hematoma in the low\nright cerebellum measuring 1.4 x 2.9 cm and surrounding edema is also\nre-identified. Small amount of subarachnoid and subdural blood overlying the\nfrontal convexities bilaterally is also grossly stable. Subarachnoid blood in\nthe bilateral parietal lobes is grossly stable. There is expected evolution\nwith slightly decreased density of small left temporal subdural hematoma\nmeasuring up to 3 mm (02:15). A hyperdense focus in the superior right\nparietal lobe (02:23) may represent additional focus of intraparenchymal\nhemorrhage, but is also stable from prior. Intraventricular hemorrhage is\nunchanged. There is no evidence of new hemorrhage. No hydrocephalus. No\nherniation. Unchanged 6 mm thick CSF collection overlying the right frontal\nlobe, likely representing a posttraumatic subdural hygroma.\n\nNondisplaced right occipital bone fracture is again seen. The paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable. Bilateral lens replacements are noted.", + "output": "1. Stable dominant left frontal intraparenchymal hematoma with unchanged mild\nmass effect on the frontal horn of the left lateral ventricle, but no\nsignificant midline shift.\n2. Expected evolution with similar size of right frontal and right cerebellar\nintraparenchymal hematomas. A punctate focus of right parietal vertex\nhemorrhages unchanged.\n3. Grossly stable small areas of subarachnoid and subdural hemorrhage over the\nbilateral frontal lobes, bilateral parietal lobes, and left temporal lobe. \nDependent hemorrhage within the ventricles are also unchanged.\n4. Additional findings as described above." + }, + { + "input": "Again seen is a 4.5 x 3.3 cm left frontal lobe hematoma without significant\ninterval changes. Surrounding vasogenic edema also appears similar. \nEffacement of the frontal horn of the left lateral ventricle is unchanged. No\nmidline shift. The right frontal lobe hematoma measuring approximately 2.5 x\n1.5 cm is unchanged. Bifrontal subdural and subarachnoid hemorrhage are\ngrossly unchanged. Bilateral parietal subarachnoid hemorrhage is also\nunchanged. The right cerebellar hemisphere hematoma appears enlarged\nmeasuring 3.7 x 1.8 cm. Right superior parietal subarachnoid hemorrhage has\nincreased in size (series 2, image 26). Small left temporal subdural hematoma\nis unchanged. No evidence of new hemorrhage. There is no evidence of large\nterritorial infarction,edema,or mass. The ventricles and sulci are unchanged.\n\nAgain seen is nondisplaced right occipital bone fracture. No new fractures. \nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. Patient status post bilateral lens replacement.", + "output": "1. Interval mild increase in size of the right cerebellar hemisphere hematoma\nmeasuring 3.7 x 1.8 cm axial images. Otherwise stable, frontal\nintraparenchymal hematoma with unchanged local mass effect.\n2. Interval increase in size of the right superior parietal lobe subarachnoid\nhemorrhage.\n3. Unchanged right frontal intraparenchymal hematoma, bifrontal subdural and\nsubarachnoid hemorrhage, and bilateral parietal subarachnoid hemorrhage.\n4. No new intracranial hemorrhage.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 5:05 am, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "Pre-existing 4.5 x 3.3 cm left frontal lobe intraparenchymal hematoma with\ntrace amount of subdural hematoma overlying the left frontal convexity is\nsimilar in size. Similarly, 1.2 x 1.4 cm right frontal lobe hematoma with\ntrace amount of hemorrhage extending along the right frontal convexity is\nsimilar in distribution. Punctate focus of hemorrhage of the right frontal\nlobe is also unchanged (02:21). Unchanged bifrontal subdural hematomas. \nScattered areas of subarachnoid hemorrhage trace amount intraventricular blood\nproducts from redistribution are less conspicuous on today's exam. \nFurthermore, the pre-existing right cerebellar intraparenchymal hematoma has\nsomewhat decreased in overall size, now measuring 3.1 x 1.4 cm, previously 3.7\nx 1.8 cm, which may be related to the slice selection. Surrounding edema is\ngrossly similar in the right cerebellar hemisphere (02:10). There is no\nevidence of new large territory infarct or enlarging intracranial hemorrhage.\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. \nPatient is status post bilateral lens replacements. Otherwise, the visualized\nportion of the orbits are unremarkable. There is a nasoenteric catheter,\npartially imaged.", + "output": "1. No evidence of new large territory infarct or enlarging intracranial\nhemorrhage.\n2. Overall stable or decreasing size of pre-existing hemorrhage as described\nabove." + }, + { + "input": "Again seen is a large left frontal lobe intraparenchymal hematoma with trace\namount of subdural hematoma overlying the left frontal convexity, which\nmeasures 4.6 x 3.5 cm, not substantially changed from ___. \nSurrounding left frontal edema is similar in extent. Right frontal lobe\nhematoma with trace amount of subdural hemorrhage measures stable, though less\nconspicuous compared to prior exams (02:21). Bifrontal low-density\nextra-axial fluid collections are overall similar in size, measuring 1.0 cm on\nthe right and 6.2 cm on the left.\n\nIn addition, right cerebellar hematoma measuring 3.1 x 1.3 cm continues to\nevolve and appear less conspicuous on today's exam. Surrounding edema is\noverall similar in degree.\n\nDue to the presence of extensive edema surrounding pre-existing hematoma,\nevaluation for subtle territory infarct is difficult. However, no new large\nterritorial infarct is seen.\n\nThere is no significant midline shift. The basal cisterns remain patent.\n\nNasoenteric catheter is partially imaged. There is no evidence of acute\nfracture. Visualized portions of the paranasal sinuses, mastoid air cells and\nmiddle ear cavities are clear. Patient is status post bilateral lens\nreplacements. Otherwise, the visualized portion of the orbits are\nunremarkable.", + "output": "1. No evidence of new large territory infarct or enlarging intracranial\nhemorrhage.\n2. Overall stable or decreasing size of pre-existing hemorrhage as described\nabove." + }, + { + "input": "There is continued evolution of a left frontal lobe hematoma, now measuring up\nto 5.7 x 3.5 cm, grossly unchanged from prior. Effacement of the left lateral\nventricle is similar to that seen 3 days prior. There is no significant shift\nof midline structures. A right frontal hematoma with subdural component\ncontinues to evolve with slight increase in adjacent vasogenic edema (02:11). \nA right cerebellar hemisphere intraparenchymal hemorrhage also continues to a\nvault with a similar amount of vasogenic edema (2:7).\n\nThe the degree of subarachnoid hemorrhage primarily seen in the left temporal\nand parietal sulci is stable. Low-density extra-axial fluid collections\noverlying both frontal convexities are stable. There is no increasing\nhemorrhage or evidence of acute infarction. Periventricular and subcortical\nwhite matter hypodensities are nonspecific but likely reflect sequelae of\nchronic small vessel ischemic disease. Dense atherosclerotic vascular\ncalcifications of the cavernous internal carotid arteries are again\ndemonstrated.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable with the exception of bilateral lens\nremoval.", + "output": "1. Continued evolution a dominant left frontal intraparenchymal hematoma, with\na similar degree of adjacent vasogenic edema and effacement of the frontal\nhorn of the left lateral ventricle.\n2. Additional evolving intraparenchymal, subdural and subarachnoid hemorrhage\nis grossly unchanged, as described above.\n3. No evidence of new hemorrhage or acute infarction." + }, + { + "input": "Again seen is continued evolution of a left frontal lobe hematoma now\nmeasuring approximately 5.2 x 3.0 cm, grossly unchanged from the prior when\nallowing for differences in measurement technique. Associated vasogenic edema\nis unchanged. There is mild associated effacement of the left lateral\nventricle which is unchanged in appearance. There is no evidence of\nhydrocephalus. There is no significant midline shift. The previously seen\nright subdural hematoma is minimally smaller in appearance with an evolved\nappearance of associated blood products. The previously seen right cerebellar\nhemisphere intraparencyhmal hemorrhage is unchanged in appearance. There is an\nimproved appearance of subarachnoid hemorrhage within the left temporal and\nparietal sulci likely secondary to redistribution. There is no evidence of\nnew hemorrhage or infarction. The overall appearance of intracranial edema is\nunchanged.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable with the exception of bilateral lens\nremoval.", + "output": "1. No evidence of new hemorrhage or infarction.\n2. Continued evolution of left frontal lobe hematoma, stable in size.\nPreviously seen right subdural hematoma is minimally smaller in appearance\nwith an evolved appearance of associated blood products. The previously seen\nright cerebellar hemisphere intraparencyhmal hemorrhage is unchanged in\nappearance. There is an improved appearance of subarachnoid hemorrhage within\nthe left temporal and parietal sulci likely secondary to redistribution.\n3. Overall appearance of intracranial brain edema is unchanged.\n4. There is no evidence of hydrocephalus or significant midline shift.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 12:09 pm, 5 minutes\nafter discovery of the findings." + }, + { + "input": "Compared with outside CT head on ___, there is interval increase\nin size of bifrontal intraparenchymal hematomas and surrounding edema,\ncurrently measuring up to 5.7 x 4.1 x 3.3 cm on the left and 2.8 x 1.8 by 1.6\ncm on the right. Additionally, there is an intraparenchymal hematoma in the\nright cerebellum measuring 3.1 x 1.6 by 1.1 cm. There is a small amount\nsubarachnoid and subdural blood overlying the frontal convexities,\nsubarachnoid head in the bilateral parietal lobes, and the left parietal\nsubdural hematoma measuring up to 3 mm in thickness. Dependent hemorrhage\nwithin the occipital horns of the lateral ventricles is identified. There is\nlocalized mass-effect with effacement of the adjacent sulci and mild\neffacement of the frontal horn of the left lateral ventricle. No midline\nshift. There is also mildly asymmetric CSF space overlying the right frontal\nlobe measuring up to 6 mm thick relative to the left, without bridging veins\nextending to the calvarial surface. This may represent a traumatic subdural\nhygroma.\n\nNondisplaced linear fracture of the right occipital bone extending obliquely\nfrom the lambdoid suture to the occipital condyle (series 4, image 11 through\n39). The visualized portion of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. Patient is status post bilateral lens\nreplacement. The visualized portion of the orbits are otherwise unremarkable.", + "output": "1. Interval worsening of larger intraparenchymal hematomas in the bifrontal\nlobes and right cerebellum with surrounding edema. No midline shift.\n2. Small amount of bifrontal subarachnoid and subdural blood, and 3 mm left\nparietal subdural hematoma. Dependent hemorrhage is seen in the occipital\nhorns of the ventricles.\n3. Asymmetric 6 mm thick extra-axial CSF space overlying the right frontal\nlobe, without apparent bridging veins extending to the calvarial surface. \nThis may represent a posttraumatic subdural hygroma.\n4. Nondisplaced right occipital fracture extending from the lambdoid suture to\nthe occipital condyle.\n5. Additional findings as described above.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 6:52 am, 2 minutes after discovery\nof the findings.\n\n The additional finding of a right occipital fracture was discussed with ___\n___, NP by ___, M.D. on the telephone on ___ at 9:21 am, 5\nminutes after discovery of the findings." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration. Incidental note is\nmade of posterior extension of the cava septum pellucidum, consistent with\ncavum vergae.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormalities." + }, + { + "input": "There is no evidence of intracranial hemorrhage, acute large territorial\ninfarction, edema,or mass. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. Periventricular and subcortical\nhypodensities are nonspecific, though likely sequela of chronic small vessel\nischemic disease.\n\nThere is no evidence of fracture. There is layering fluid and locules of air\nwithin the left maxillary sinus, which may represent sinusitis. Minimal\nmucosal thickening of the bilateral ethmoid air cells. The visualized portion\nof the remaining paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No evidence of acute intracranial abnormality.\n2. Layering fluid and locules of air within the left maxillary sinus, findings\nwhich may represent acute sinusitis and clinical correlation is suggested." + }, + { + "input": "There is no evidence of infarction, hemorrhage, or edema. There is prominence\nof the ventricles with the effacement of the sulci consistent with\nhydrocephalus. 2.2 x 1.7 cm well-circumscribed ovoid hypodensity at the level\nof the foramen ___ is of fluid density.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Calcification of the internal carotid\narteries are noted.", + "output": "1. Obstructive hydrocephalus from a 2.2 cm hypodense lesion at the level of\nthe foramen of ___. The lesion likely is suggestive of craniopharyngioma." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nIntermediate density suprasellar mass measuring roughly 2.6 x 1.9 cm, with\ncranial extension to the foramen ___ is unchanged. There is unchanged\nmass effect and deformity of the posterior aspect of the optic chiasm. \nModerate ventriculomegaly is unchanged. There is mild a rim of\nperiventricular white matter hypodensity, likely representing transependymal\nedema.\n\nThere is no evidence of infarction, or hemorrhage. The ventricles and sulci\nare unchanged in size and configuration.\n\nThere is mild mucosal wall thickening in the bilateral maxillary sinuses. The\nremainder of the visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the orbits\nare unremarkable.\n\nCTA HEAD:\nThe A1 segments of the anterior cerebral arteries pass inferiorly to the\nsuprasellar mass, with contact, without luminal narrowing. The vessels of the\ncircle of ___ and their principal intracranial branches appear patent with\nno evidence of significant stenosis, occlusion, or aneurysm. The dural venous\nsinuses are patent. Small 2 mm protuberance is at the expected position of\nboth posterior cerebral arteries following the internal carotid arteries\nappear to be due to infundibula.", + "output": "1. Unchanged intermediate density 2.6 x 1.9 cm suprasellar mass extending to\nthe level of the foramen of ___, likely representing craniopharyngioma, with\npersistent posterior deformity of the optic chiasm. Bilateral A1 segments of\nthe anterior cerebral arteries past inferiorly to and contact this mass,\nwithout luminal narrowing.\n2. Unchanged moderate obstructive hydrocephalus with mild transependymal\nedema.\n3. Patent intracranial vasculature without significant stenosis, occlusion,.\n4. Bilateral posterior communicating artery origin protuberance most likely\ndue to infundibula given conical appearance." + }, + { + "input": "Patient is status post right frontotemporal craniotomy for suprasellar mass\nresection. Postoperative changes include pneumocephalus, swelling and mass\neffect, with new right parietal subarachnoid hemorrhage and small\nintraventricular hemorrhage bilaterally, along with residual calcifications in\nthe sella. There is no evidence of infarction.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Postoperative changes including pneumocephalus, swelling and mass effect.\n2. New right parietal subarachnoid hemorrhage and small bilateral\nintraventricular hemorrhage.\n3. Residual calcifications in the sella." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere are postsurgical changes from right frontal craniotomy and suprasellar\nmass resection. Postoperative pneumocephalus has improved. 1.7 x 1.0 cm\nright frontal intraparenchymal hemorrhage with surrounding vasogenic edema is\nunchanged. Inferiorly, roughly 3.1 x 1.2 cm right frontal intraparenchymal\nhemorrhage is unchanged in size, with slightly increased vasogenic edema, with\nhemorrhage and edema extending into the right temporal lobe, as seen on the\nprior examination. Overlying subdural blood product in fluid appears grossly\nunchanged. Right insular subarachnoid hemorrhage appears unchanged. There is\na similar degree of mass effect as compared the prior examination, with up to\n8 mm of leftward midline shift, and effacement of the right lateral ventricle.\nThere is no new hemorrhage.\n\nResidual calcifications are seen within the sella (02:11).\n\nLarge right hemispheric scalp hemorrhage and fluid collection has increased in\nsize compared to the prior examination measuring up to 1.9 cm in thickness. \nFat stranding is seen extending inferiorly along the face and periorbital\nregion.\n\nThere is no evidence of large territorial infarction, or new hemorrhage. The\nventricles and sulci are stable in size and configuration. There is small\namount of intraventricular hemorrhage layer within the occipital horns of the\nlateral ventricles. Small amount of intraventricular air is again seen.\n\nThere is minimal mucosal wall thickening in the inferior aspects of the\nbilateral maxillary sinuses as well as in the left sphenoid air cell. The\nremainder of the visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the orbits\nare unremarkable.\n\nCTA HEAD:\nThere is no CTA spot sign to suggest active hemorrhage. The vessels of the\ncircle of ___ and their principal intracranial branches appear patent with\nno evidence of significant stenosis, occlusion, or aneurysm. The dural venous\nsinuses are patent. Again, there is irregular, beaded appearance of the\nbilateral internal carotid arteries, which are patent.", + "output": "1. Postsurgical changes from right frontal craniotomy and sellar mass\nresection with residual calcifications in the sella suggestive of residual\ntumor.\n2. Unchanged areas of right frontal intraparenchymal hemorrhage, right insular\nsubarachnoid hemorrhage and intraventricular hemorrhage, with mildly increased\nsurrounding vasogenic edema, though degree of mass effect appears unchanged\ncompared the prior examination with up to 8 mm leftward midline shift, and\neffacement of the right lateral ventricle. Pneumocephalus has mildly improved\ncompared the prior examination. No new focus of hemorrhage. No CTA spot sign\nto suggest active hemorrhage.\n3. Increasing right hemispheric superficial soft tissue hemorrhage and fluid\ncollection, with increasing swelling extending to the right face and\nperiorbital soft tissues.\n4. Otherwise patent intracranial vasculature without significant stenosis,\nocclusion, or aneurysm.\n5. Persistent irregular beaded appearance of the internal carotid arteries,\nwhich can be seen in the setting of fibromuscular dysplasia.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 6:07 AM, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "Postoperative changes right frontal craniotomy. Decreased intracranial\npneumocephalus. 1.7 cm x 1.1 cm anterior right frontal parenchymal hematoma,\nsimilar size, mildly increased surrounding edema. Stable inferior right\nfrontal hemorrhage, largest component measures 2.7 cm x 1.0 cm, with mildly\nmildly more prominent surrounding low attenuation change. Mildly less\nprominent anterior right temporal lobe parenchymal hematoma, stable\nsurrounding edema.\nMildly less prominent subarachnoid hemorrhage.\nSimilar extra-axial hemorrhage overlying anterior basal right frontal lobe.\nStable anterior left parafalcine low-attenuation fluid collection.\nSmall volume intraventricular hemorrhage within occipital horns, third\nventricle, similar.\n1.1 cm right to left midline shift, similar.\nIncreased effacement of the third ventricle. Mildly more prominent effacement\nof the right lateral ventricle. Mildly more dilated left lateral ventricle.\nEfface suprasellar, perimesencephalic cisterns, stable. Partial effacement\npre pontine cistern, similar. Patent foramina magnum. No tonsillar\nherniation. Stable suprasellar calcified 0.9 cm mass.\n\nThe left mastoid air cells and middle ear cavities are grossly clear. Partial\nopacification right mastoid air cells. Grossly clear paranasal sinuses. The\norbits are unremarkable.", + "output": "1. Similar intracranial hemorrhage. No new hemorrhage.\n2. Stable leftward shift of midline structures.\n3. Decreased size of the third ventricle. Mildly more dilated left lateral\nventricle and mildly more effaced bilateral ventricle.\n4. Stable effacement of the suprasellar, perimesencephalic, pre pontine\ncisterns." + }, + { + "input": "Stable exam.\nStable 2 areas of intraparenchymal hemorrhage right frontal lobe, one\ninvolving anterior right frontal lobe, second within inferior basal frontal\nlobe extending into basal ganglia, both with stable surrounding edema. Stable\nintraparenchymal hemorrhage anterior right temporal lobe. Stable subarachnoid\nhemorrhage predominantly within right sylvian fissure. Stable small volume\nextra-axial hemorrhage overlying inferolateral right frontal lobe, deep to the\nright frontal craniotomy.\nStable right to left midline shift, 1.0 cm. Stable partial effacement right\nlateral ventricle. Mildly dilated left lateral ventricle, stable. Mild\nintracranial pneumocephalus, stable\nStable partially calcified suprasellar mass, 0.9 cm. Effaced suprasellar,\nperimesencephalic, pre pontine cisterns, stable. Patent foramina magnum.\nPostoperative changes in the soft tissues right scalp, with some fluid and\nair, similar.\n\nPartial opacification right mastoid air cells, similar. The visualized\nportion of the paranasal sinuses,left mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "No significant change compared to ___ at 21:16." + }, + { + "input": "There stable subdural collection overlying the right frontal lobe deep to the\nright frontal craniotomy with increased edema in slightly increased midline\nshift. There is concern for loss of gray white interface of the right\ntemporal and parietal lobes which may possibly represent artifact but is\nworrisome for developing infarct.\n\nThere are stable intraparenchymal hemorrhages of the anterior right frontal\nlobe and inferior basal frontal lobe extending into the basal ganglia. There\nis a stable intraparenchymal hemorrhage involving the anterior right temporal\nlobe. There is stable subarachnoid hemorrhage of the sylvian fissure. There\nstable subdural collection overlying the right frontal lobe deep to the right\nfrontal craniotomy with a leftward midline shift is unchanged. There is a\nstable partially calcified suprasellar mass.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Stable subdural collection overlying the right frontal lobe deep to the\nright frontal craniotomy with slightly increased edema and increased midline\nshift.\n2. Concern for loss of grey white interface right temporal and parietal lobes\nworrisome for developing infarct versus possible artifact.\n3. Stable intraparenchymal hemorrhages of the right anterior temporal and\nright frontal lobe extending into the basal ganglia.\n\nNOTIFICATION: The findings were discussed with ___, N.P. by ___\n___, M.D. on the telephone on ___ at 6:05 ___, 10 minutes after\ndiscovery of the findings." + }, + { + "input": "There has been interval expected evolution of blood products related to recent\nsurgery in the right frontal lobe. There is also decreased edema and mass\neffect. There is a hypodense right frontal subdural collection which measures\nup to 13 mm in thickness which exerts mass-effect on the right frontal lobe. \nMild generalized effacement of right cerebral sulci noted with mass-effect on\nthe right lateral ventricle causing 10 cm of leftward midline shift. The\nsuprasellar cistern remains partially effaced. No new sites of hemorrhage. \nAreas of hypodensity in the right frontal lobe and to a lesser extent right\ntemporal lobes is consistent with developing encephalomalacia and likely a\nsmall component of edema. Craniotomy site appears uncomplicated though there\nis a hypodense subgaleal collection. Previously noted pneumocephalus has\nlargely resolved.", + "output": "Expected evolution of blood products in the right frontal lobe in this patient\nwith recent craniotomy. Hypodense right frontal subdural collection causes\nmass-effect which results in mild right cerebral sulcal effacement and\nleftward shift of midline structures. Continued close followup advised." + }, + { + "input": "Right frontoparietal craniotomy from resection of craniopharyngioma. Stable\nzone of low attenuation anterior, basilar right frontal lobe, anterior right\ntemporal lobe. There is no new intraparenchymal hemorrhage. 0.8 cm right to\nleft midline shift, minimally improved compared with 0.9 cm on prior exam. \nThere is decreased effacement of the right lateral ventricle, right frontal\nhorn on today's exam. There is no left ventricular trapping. Stable low\ndensity fluid collection overlying anterior right frontal lobe near craniotomy\nsite, stable linear high attenuation density at its base, with stable mass\neffect on the adjacent frontal lobe. There is a stable small low-attenuation\nextra-axial fluid collection overlying anterior medial left frontal lobe,\nalong the falx cerebri. there is stable effacement of the suprasellar cistern.\nThere is stable suprasellar foci of calcification. There is no new evidence\nof infarction, hemorrhage, . There is no evidence of new hydrocephalus.\n\nExtracranial fluid collection overlying craniotomy site has decreased The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Postoperative changes.\n2. Stable low-attenuation changes right frontal, temporal lobes. Stable\nbifrontal extra-axial fluid collections. Minimally improved midline shift.\n3. No new hemorrhage." + }, + { + "input": "Patient is status post right frontoparietal craniotomy for resection of\ncraniopharyngioma with expected postoperative changes. Stable area of\nlow-density within the right inferior frontal and right anterior temporal\nlobes. 6 mm leftward midline shift is minimally improved, previously\nmeasuring 8 mm on ___. There is mild interval decreased effacement\nof the frontal horn of the right lateral ventricle. There is no evidence of\nhydrocephalus or intraventricular hemorrhage. Area of hypodensity within the\nright frontal lobe, with an associated linear hyperdensity along its base, has\ndecreased in size over the interval, now measuring 2.4 cm in greatest\ndimension, compared to 3.0 cm from ___, and is associated with\nminimal mass effect on the adjacent frontal lobe, which is also less\npronounced compared to study. Small hypodense, extra-axial fluid collection\noverlying the anterior left frontal lobe along the falx measures 8 mm and is\noverall unchanged in size. There is stable effacement of the suprasellar\ncistern. A small focus of suprasellar calcification is again seen.\n\nThere is no evidence of acute large territorial infarction. No foci of\nintraparenchymal hemorrhage.\n\nSoft tissue prominence and fluid collection overlying the right frontoparietal\ncraniotomy site has decreased in size. Visualized portions of the paranasal\nsinuses, mastoid air cells and middle ear cavities are clear. As portions of\nthe orbits are unremarkable", + "output": "1. Status post right frontoparietal craniectomy with expected postoperative\nchanges, including interval decrease in size of soft tissue swelling and fluid\ncollection overlying the right frontoparietal craniotomy site.\n2. Stable area of low-density within the right inferior and anterior temporal\nlobes.\n3. Interval decrease in size of area of hypodensity within the right frontal\nlobe with associated linear hyperdensity at its base, with interval decrease\nin mass effect on adjacent frontal lobe.\n4. Minimally improved midline shift, now measuring 6 mm.\n5. Stable suprasellar cistern effacement.\n6. Stable bifrontal extra-axial fluid collections." + }, + { + "input": "The patient's head is markedly tilted to the left, limiting evaluation.\n\nPatient is status post right craniotomy for resection of a craniopharyngioma. \nExtra-axial hypodense collection deep to the craniotomy appears decreased in\nsize, with unchanged underlying dural hyperdensity. Large area of hypodensity\ninvolving the right frontal and right anterior lobes is not significantly\nchanged. Mild leftward shift of midline structures appears improved but\nevaluation is limited by differences in patient head position. Left anterior\nparafalcine hypodense collection is stable. There is persistent effacement of\nsuprasellar cistern. Small focus of suprasellar calcification is again noted.\nNo new hemorrhage is seen. The lateral and third ventricles have increased in\nsize since ___.\n\nSmall subcutaneous fluid collection superficial to the right craniotomy is\nstable.\n\nThe visualized paranasal sinuses and mastoid air cells appear grossly\nwell-aerated.", + "output": "1. Evaluation comparison to prior studies is limited by extreme leftward tilt\nof the patient's head.\n2. No acute hemorrhage.\n3. Right frontal hypodense subdural collection appears decreased. Left\nanterior parafalcine hypodense subdural collection is stable. Mild leftward\nshift of midline structures may have decreased, though evaluation is limited.\n4. Enlargement of the lateral and third ventricles since ___,\nwhich may in part be related to decreased right-sided mass effect. However,\nin the setting of persistent suprasellar cistern effacement, an element of\nhydrocephalus cannot be excluded.\n\nNOTIFICATION: Impression item 4 was discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 11:12 AM, 40 minutes after\ndiscovery of the findings." + }, + { + "input": "There has been interval placement of a right frontal approach VP shunt, with\nthe tip terminating near the left foramen of ___. The ventricles are\ndecreased in caliber, with the third ventricle measuring 5 mm (previously 8\nmm). The patient is also status post right frontal craniotomy, with expected\nevolution of small bifrontal fluid collections, similar in size compared to\nprior exam from ___ but decreased compared to ___. \nHypodensity involving the right frontal lobe extending down into the right\ntemporal lobe is similar in appearance. There is no evidence of interval\ninfarct. There is no evidence of hemorrhage or mass.\n\nThere is no evidence of fracture. Postprocedural subcutaneous emphysema is\nnoted in the extracranial soft tissues. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Interval placement of a right frontal approach VP shunt with the tip\nterminating near the left foramen of ___, resulting in decreased caliber of\nthe ventricles. The third ventricle now measures 5 mm (previously 8 mm). \nExpected post procedural findings including subcutaneous emphysema and\nextracranial soft tissues.\n2. Expected evolution of small bifrontal fluid collections, similar in size\ncompared to the most recent exam in ___, but decreased compared to ___.\n3. No evidence of interval infarct or hemorrhage." + }, + { + "input": "There is hypoattenuation of the bifrontal, right parietal and bilateral\ntemporal and left occipital regions consistent encephalomalacia. There is ex\nvacuo dilatation of the frontal, occipital and temporal horns of the right\nlateral ventricle. There is no evidence of an acute large territory\ninfarction,hemorrhage,edema,or mass. The ventricles and sulci are stable in\nsize and configuration.\n\nThe patient is status post a right frontotemporal craniotomy. The underlying\ndural thickening is better demonstrated on MRI brain dated ___. \nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute large territory infarction or intracranial hemorrhage.\n2. There is encephalomalacia in the bifrontal, right parietal and bitemporal\nand left occipital regions with ex vacuo dilatation of right lateral\nventricle. These areas are better demonstrated on prior MRI brain dated ___." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nA deformity of the left lamina papyracea likely represents old fracture,\nunchanged from ___.\n\nAir-fluid levels in the maxillary sinuses. There is moderate mucosal\nthickening of the ethmoid air cells. There is trace opacification of the left\nmastoid air cells. Severe degenerative changes noted at the temporomandibular\njoints.", + "output": "No acute intracranial abnormality." + }, + { + "input": "Venous contrast pooling and dental amalgam streak artifact and patient body\nhabitus limits study.\n\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are prominent, consistent global cerebral volume loss. There are\nperiventricular and subcortical lucencies, which may represent small vessel\nischemic changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The patient is status post bilateral lens replacement.\n\n\nCTA HEAD:\nNonocclusive atherosclerotic narrowing of the cavernous and supraclinoid\nsegments of bilateral internal carotid arteries and the distal right V3\nsegment are seen.\n\nOtherwise, the vessels of the circle of ___ and their principal\nintracranial branches appear preserved without stenosis, occlusion, or\naneurysm formation.\n\nThe dural venous sinuses are patent.\n\n\nCTA NECK:\nArtifact limits evaluation of mid left common carotid artery. A 4 vessel\naortic arch is seen. The origins of the bilateral carotid and vertebral\narteries are grossly patent.\n\nAtherosclerotic changes of the carotid bifurcations are seen without definite\nmoderate or high-grade narrowing of the internal carotid arteries, by NASCET\ncriteria.\n\nOsteophyte narrows right and left vertebral artery V2 segment at C5 (see\n3:146).\n\nOtherwise, the common carotid and vertebral arteries appear grossly preserved\nwith no evidence of stenosis or occlusion.\n\nOTHER:\nThe visualized portion of the lungs are clear.\n\nStreak artifact limits evaluation of thyroid gland.\n\nThere is no lymphadenopathy by CT size criteria.\n\nDegenerative changes of the cervical spine are seen.", + "output": "1. Venous contrast pooling and dental amalgam streak artifact and patient body\nhabitus limits study.\n2. No acute intracranial abnormality. Please note MRI of the brain is more\nsensitive for the detection of acute infarct.\n3. Nonocclusive atherosclerotic narrowing of circle of ___ as described.\n4. Otherwise, grossly patent circle of ___ without definite evidence of\nstenosis,occlusion,or aneurysm.\n5. Atherosclerotic calcifications of bilateral cervical internal carotid\narteries as described.\n6. Occlusive narrowing of bilateral vertebral artery V2 segments by\nosteophytes as described.\n7. Artifact limits evaluation of mid left common carotid artery.\n8. Otherwise, grossly patent bilateral cervical carotid and vertebral arteries\nwithout definite evidence of stenosis, occlusion, or dissection.\n9. Additional findings as described above." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. The basal cisterns appear\npatent and there is preservation of gray-white matter differentiation. There\nis no abnormal enhancement following contrast administration.\n\nNo osseous abnormalities seen. There is mild mucosal thickening in the right\nethmoid air cells. The remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process. No abnormally enhancing lesions." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction.\n\nProminence of ventricles and sulci are compatible with age related\ninvolutional changes. Old chronic lacunar infarcts are noted in the bilateral\nbasal ganglia. Ill-defined periventricular and subcortical white matter\nhypodensities are nonspecific but likely due to the sequela of chronic small\nvessel ischemic changes.\n\nMild mucosal thickening is noted in the left ethmoid air cells. Dental\nhardware is seen extending superiorly into the the left maxillary sinus\n(series 2: Image 2) with adjacent mild mucosal thickening. Partial\nopacification of the left mastoid air cells are noted. Right mastoid air\ncells and middle ear cavities are well aerated. The bony calvarium is intact. \nSoft tissue swelling and a scalp hematoma is noted in the right frontal\nregion. Dense atherosclerotic calcifications are noted involving the\ncavernous carotid arteries.", + "output": "1. No acute intracranial process. Chronic lacunar infarcts are noted in the\nbilateral basal ganglia.\n\n2. Soft tissue swelling and scalp hematoma are noted in the right frontal\nregion." + }, + { + "input": "There is no intra or extra-axial mass effect, acute hemorrhage or territorial\ninfarct. Sulci, ventricles and cisterns are within expected limits for the\npatient's age related mild global cerebral volume loss. The paranasal sinuses\nare clear. The orbits are unremarkable. Mastoid air cells are clear.\n\nRe-identified is a lytic 7 x 2 mm right parietal skull inner table lesion\n(series 7, image 38), unchanged from examination of ___, but new\nor increased in size since examination ___. Given the stability\nover ___ years, likely represent a ___ or potentially osseous\nhemangioma.", + "output": "1. 7 x 2 mm right parietal skull inner table lytic lesion, unchanged in\nconfiguration since examination of ___. Given stability in size\nover ___ years, this likely represents a ___ or potentially osseous\nhemangioma. Close attention on followup examinations is recommended." + }, + { + "input": "Overlying hardware streak artifact limits examination. There is no evidence\nof infarction, hemorrhage, edema, or mass. The ventricles and sulci are\nnormal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable. Right anterior ethmoid air cell mucosal thickening\nis present.", + "output": "1. Overlying hardware streak artifact limits examination.\n2. No acute intracranial abnormality.\n3. Within limits of study, no evidence acute intracranial hemorrhage or\nfracture.\n4. Paranasal sinus disease as described." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. Normal study." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nQuestion minimally displaced nasal bone fracture (3:13). No other fractures\nare identified. Mild mucosal thickening is noted within the ethmoid air cells\nand sphenoid sinuses bilaterally. Remainder of the visualized paranasal\nsinuses, mastoid air cells and middle ear cavities are clear. Orbits are\nunremarkable.", + "output": "1. No acute intracranial hemorrhage.\n2. Question minimally displaced nasal bone fracture. Recommend correlation\nfor focal tenderness." + }, + { + "input": "Compared to ___, there has been interval right frontoparietal\ncraniotomy for resection of a right frontoparietal mass. There are expected\npostoperative changes, including pneumocephalus, trace extra-axial fluid and\nedema with sulcal effacement. Previously seen right cerebellar mass is\nunchanged. Other previously seen intraparenchymal lesions are better\nvisualized on prior MRI. There is persistent, but decreased, right to left\nmidline shift, measuring 0.7 cm with near complete effacement of the right\nlateral ventricle. The basal cisterns remain patent. There is no evidence of\ninfarction.\n\nThere is no evidence of fracture. There are mucous retention cysts in the\nright maxillary sinus. Otherwise, the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Expected postoperative changes from right frontoparietal craniotomy for\nresection of a right frontoparietal mass, including pneumocephalus, trace\nextra-axial fluid and edema with sulcal effacement.\n2. Persistent, but decreased, right to left midline shift, measuring 0.7 cm\nand near complete effacement of the right lateral ventricle. Basal cisterns\nremain patent." + }, + { + "input": "Postoperative changes right occipital craniectomy. Post biopsy change within\nright cerebellar lesion, small volume blood products within surgical cavity,\nmeasuring 1.2 cm. Extensive edema involving right cerebellum extending to the\nvermis is similar compared with prior. Fourth ventricle is patent. Other\nlesions supratentorially were better seen on prior exams, no evidence of\nhemorrhage within these. No evidence of infarct. Right parietal craniotomy.\nThe ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Mild paranasal sinus disease, submucosal\nretention cysts bilateral maxillary sinuses. Otherwise, the visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "Postoperative changes right cerebellum, small volume blood products within\nsurgical cavity. Remainder as above" + }, + { + "input": "Post biopsy changes are seen in the right frontal lobe with expected edema and\nsmall amount pneumocephalus the right frontal convexity. A focus of\nhyperdensity in the postsurgical bed likely represents small amount of blood\nproducts. There is resultant mass effect on the right lateral ventricle with\neffacement and 7 mm leftward midline shift (02:17). Vasogenic edema is again\nnoted in the right temporal lobe and right occipital lobe, compatible with\nknown sites of metastasis.\n\nThe patient is status post prior right suboccipital craniectomy and prior\nright parietal craniotomy. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. Post biopsy changes seen in the right frontal lobe with small focus of\nhyperdensity in the postsurgical bed, likely residual blood products.\n2. Mass-effect in the right frontal lobe causes effacement of the right\nlateral ventricle and 7 mm leftward midline shift.\n3. Redemonstration of vasogenic edema in the right temporal lobe and right\noccipital lobe, compatible with known metastasis." + }, + { + "input": "Right frontal lobe low-attenuation change centered at the deep white matter,\nsimilar compared with head CT ___, improved since MRI brain ___. Other lesions seen on ___ have also decreased, right\ncerebellum, right temporal lobe. Few speckled foci of mineralization, likely\ntreatment related. No new lesions. No hemorrhage, midline shift or\nhydrocephalus. No evidence of acute infarct.\n\nRight temporal craniotomy, right suboccipital craniectomy, right frontal burr\nhole.", + "output": "Decreased lesions since ___.\nNo new lesions.\nNo acute intracranial findings." + }, + { + "input": "Compared to prior study, the subtle hyperdensity at the right tentorial\nleaflet best seen on the coronal images, is no larger. Additionally the\nhyperdensity at the left tentorium is unchanged. There is no new hemorrhage.\nThe ventricles and sulci are normal in configuration and there is no major\nterritorial infarct. The basal cisterns are patent and there is normal\ngray-white differentiation.\n\nAs seen on the CT from 1 day prior, multiple left-sided skull fractures are\nagain appreciated. There is partial opacification of the sphenoid sinuses\nbilaterally. The mastoid air cells and middle ear cavities are clear. Left\ntemporal subgaleal hematoma is essentially unchanged in size.", + "output": "No evidence of new hemorrhage. Unchanged left temporal subgaleal hematoma and\nbilateral tentorial hyperdensities likely indicating subdural hemorrhage." + }, + { + "input": "There is mucosal thickening in the maxillary sinuses bilaterally with several\nmucous retention cysts a in the right maxillary sinus. There is minimal\nmucosal thickening in the ethmoid and frontal sinuses. The sphenoid sinus\nappears clear. The ostiomeatal units are patent. There is leftward deviation\nof the nasal septum with a spur. The cribriform plates are intact. The lamina\npapyracea are intact.", + "output": "1. Paranasal sinus inflammatory changes." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal are mildly enlarged for the patient's age suggesting mild\ncerebral atrophy. The basal cisterns are patent and there is preservation of\ngray-white matter differentiation.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The patient is\nstatus post bilateral lens resections. Otherwise, the visualized portion of\nthe orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute large territorial infarction, intracranial\nhemorrhage, edema, or mass. Tiny punctate hypodensity adjacent to left\nputamen likely represents a prominent perivascular space (02:17).\n\nThe ventricles and sulci are normal in size and configuration.\n\nNo acute osseous abnormalities seen. There is scattered mild mucosal\nthickening of the paranasal sinuses. Otherwise, the mastoid air cells and\nmiddle ear cavities are clear. The orbits demonstrate no acute abnormalities.\n\nThere is mild asymmetric left periorbital/preseptal swelling and soft tissue\nstranding over the left pre maxillary tissues. No evidence of drainable fluid\ncollections. No evidence of postseptal involvement.", + "output": "Asymmetric mild left periorbital/preseptal swelling with stranding extending\nover the left pre maxillary soft tissues. No evidence of postseptal\ninvolvement or drainable fluid collections within limitations of this\nnoncontrast study.\n\nNo acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent. Bilateral small infundibula are seen as an\nincidental finding at the origin of posterior communicating arteries.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy.", + "output": "1. Major intracranial and cervical arteries are patent without stenosis or\ndissection." + }, + { + "input": "Assessment for the presence of infection or abscess is limited without\nintravenous contrast. There is thickening of the retropharyngeal soft tissues\n(___) with loss of fat planes, which is concerning for phlegmonous\nchanges of the retropharyngeal space. These changes are seen extending from\nthe level of C2 approximately to the level of C7. No definite fluid collection\nis identified.\n\nEvaluation of the aerodigestive tract demonstrates no exophytic mucosal mass\nor focal areas of mass effect. The tonsils, submandibular glands and parotid\nglands are unremarkable within limitations of this unenhanced study. The\nsubmandibular soft tissues are unremarkable. The nasopharyngeal and\noropharyngeal soft tissues are unremarkable.\n\nNo cervical lymphadenopathy is seen. There is a 1.1 x 1.3 cm hyperdense\nnodule in the right lobe of the thyroid.\n\nThe imaged intracranial structures are unremarkable. Streak artifact from\ndental hardware limits evaluation for periodontal disease, though no obvious\nperiodontal or odontogenic abscess is identified.\n\nThere is an area of apparent pulmonary scarring within the left lung apex\n(4:44). Additionally, there is a 4 mm pleural based nodule in the left lower\nlobe (2:64).\n\nMultilevel, multifactorial degenerative changes are seen throughout the\nvisualized cervical spine. There is no osseous destructive lesion concerning\nfor malignancy within the cervical spine.", + "output": "1. Thickening of the retropharyngeal soft tissues and loss of fat planes\nwithin this region is concerning for phlegmonous changes of the\nretropharyngeal space. No definite drainable fluid collection present.\nRecommend additional evaluation with noncontrast MR of the neck.\n\n2. Small hyperdense right-sided thyroid nodule. Recommend nonemergent\nthyroid ultrasound for additional evaluation, if this has not already been\nperformed.\n\n3. Scarring at the left apex, and 4 mm pleural based nodule in the left lower\nlobe. Recommend attention on followup.\n\nNOTIFICATION: These findings were discussed with Dr. ___ by Dr. ___\ntelephone at 3:22pm on ___, 10 minutes after discovery." + }, + { + "input": "CT Head: There is no evidence of hemorrhage, midline shift, mass, mass effect,\nor acute infarction. The ventricles, sulci and basal cisterns are normal in\ncaliber and configuration. No fractures are identified.\n\nCTA Head: There is adequate opacification of the internal carotid, anterior\ncerebral, middle cerebral, vertebrals, basilar and posterior cerebral\narteries. There is mild atherosclerotic calcification of the bilateral carotid\nsiphons. The anterior communicating artery is well visualized. The left\nvertebral artery is dominant. The left posterior communicating artery is well\nvisualized. The right posterior communicating artery is not definitely seen.\nThere is no evidence of aneurysm formation, occlusion, dissection or vascular\nmalformation.\n\nCTA Neck: There is a left-sided aortic arch with conventional origin of the\nmajor branch vessels. There is adequate opacification of the bilateral common\ncarotid, internal carotid and vertebral arteries, without high-grade\nnarrowing. There is mild diffuse atherosclerotic calcifications, particularly\nat the carotid bulbs. The left vertebral artery is dominant. There is no\nevidence of significant stenosis at the origins or throughout the or courses\nof these vessels.\n\nThere are postsurgical changes with multiple surgical clips in the right\nsupraclavicular region, related to partial first rib resection, as described\non prior CTA chest of ___. This study is not optimized for evaluation\nof the venous system.\n\nRight internal carotid artery (minimal dimension in mm):\n\nProximal: 7.5\n\nDistal: 4.5\n\nLeft internal carotid artery (minimal dimension in mm):\n\nProximal: 8.5\n\nDistal: 4.5.\n\nAdditional findings: The paranasal sinuses and mastoid air cells are clear.\nThe nasopharynx, oropharynx, hypopharynx and larynx are unremarkable. The\nthyroid gland demonstrates homogeneous density. There is no evidence of\nenlarged lymph nodes by CT criteria. The visualized lung apices are clear.\nThere are postsurgical changes of the cervical spine, with anterior fusion at\nC4-C5. Moderate degenerative changes are seen throughout the cervical spine.", + "output": "1. No evidence of acute intracranial process.\n\n2. Unremarkable CTA of the head without evidence of stenosis, dissection or\naneurysm.\n\n3. CTA Neck demonstrates mild diffuse atherosclerotic disease without evidence\nof stenosis, dissection or pseudoaneurysm. There is no stenosis of internal\ncarotid arteries by NASCET criteria." + }, + { + "input": "Patient is status post right parietal craniotomy and resection of largest\nfocus of metastatic disease in the right parietal lobe. Small hyperdense foci\nalong the superior aspect of the resection cavity (02:25) may represent\ncalcification. Hyperdense serpiginous foci along the superior left\ntemporal/posterior left parietal lobes (for example, 02:18) in the region of\npreviously described leptomeningeal disease may be related to leptomeningeal\nmetastatic disease, although subarachnoid hemorrhage cannot be excluded. \nAreas of disease enhancement described and better characterized on the\nprevious MRI are not seen on this unenhanced study.\n\nThe right subdural extra-axial collection has improved compared to prior, now\nmeasuring up to 5 mm, previously 8 mm. Effacement of the frontal horn of the\nright lateral ventricle appears similar. However, there is new enlargement of\nthe lateral and third ventricles. The cerebral aqueduct and fourth ventricle\nappear patent and grossly normal in size, although the latter is questionably\nmore conspicuous than prior. No herniation identified. No midline shift.\n\nThere is mild sulcal effacement and possible subtle loss of gray-white matter\ndifferentiation about the left frontal lobe. Additionally, there is increased\nperiventricular white matter hypodensity, left greater than right, about the\nbilateral frontal horns which could be related to transependymal edema or post\nradiation change.\n\nThe previously described 7 mm pineal region cystic focus was better evaluated\non the previous MRI.\n\nThere is no evidence of fracture. Other than a mucous retention cyst within\nright sphenoid sinus, the visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. New enlargement of the lateral and third ventricles concerning for\nhydrocephalus of unclear etiology. The fourth ventricle is grossly normal in\nsize but is questionably more conspicuous than prior. Notably, the previously\ndescribed cystic lesion within the pineal region was better evaluated on the\nprevious MRI and does not appear to obstruct the cerebral aqueduct on sagittal\nimages.\n2. Mild diffuse sulcal effacement about the left frontal lobe with left\ngreater than right periventricular white matter hypodensity may be related to\npost radiation changes or transependymal edema in the setting of possible\nhydrocephalus. No herniation or midline shift.\n3. Interval decrease in right extra-axial collection measuring 5 mm,\npreviously 8 mm.\n4. New serpiginous hyperdense foci along the superior left temporal/posterior\nleft parietal lobes may be related to previously described left meningeal\ndisease within this region, although subarachnoid hemorrhage cannot be\nexcluded." + }, + { + "input": "Evaluation is limited by patient motion. Within these confines: There is\ninterval development of intraparenchymal hemorrhage in the left frontal lobe\nsince the prior exam measuring 1.2 cm. There is also interval increased size\nof previously seen hemorrhage along posterior aspect of resection cavity now\nmeasuring approximately 3.1 cm, potentially parenchyma (series 4A, image 21). \nExpected post-surgical changes following the left frontal craniotomy and tumor\nsection are noted including pneumocephalus, and resection edema is again noted\nalong the surgical bed. The ventricles and sulci are stable in size and\nconfiguration. No new infarction is seen. There is no evidence of fracture. \nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. New 1.2 cm intraparenchymal hemorrhage in the left frontal lobe. \nSignificant interval enlargement of previously seen hemorrhage along the\nposterior aspect of the resection cavity, which may be parenchymal, measuring\n3.17 cm.\n2. Expected post-surgical changes following craniotomy and tumor resection. \nNo significant interval change in degree of mass effect from left frontal\nwhite matter edema pattern and effacement of the frontal horns of the lateral\nventricles.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with ___ NP\non the telephoneon ___ at 10:34 AM, 10 minutes after discovery of the\nfindings." + }, + { + "input": "Left frontal craniotomy is again seen. Pneumocephalus has slightly decreased.\nSmall amount of extra-axial blood products along the anterior left frontal\nlobe and left anterior falx is stable to minimally increased ; evaluation is\nlimited by differences in patient positioning. Blood products in the left\nfrontal surgical bed slightly increased superiorly, image 4b:22. The\npreviously seen 9 mm focus of left frontal white matter hemorrhage posterior\nand superior to the surgical bed is unchanged (image 4:24).\n\nNew compared to ___ is a 7 mm focus of blood in the right frontal white\nmatter (image 4:20).\n\nThere is extensive bifrontal cortical and white matter edema, as seen\npreviously. There is unchanged compression of the frontal horns of the lateral\nventricles. The basal cisterns are patent.\n\n The imaged paranasal sinuses and mastoid air cells are grossly well-aerated.", + "output": "1. Slightly increased blood products in the left frontal surgical bed.\n2. New 7 mm focus of blood in the right frontal white matter.\n3. Stable 9 mm focus of blood in the left frontal white matter\nposterior/superior to the surgical bed.\n4. Persistent extensive bifrontal cortical and white matter edema. Stable\nmass effect.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ on the telephoneon ___ at 2:40 ___, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "The patient is status post bifrontal craniotomy and meningioma resection with\npostprocedural hemorrhage. Compared to the prior CT from ___, the\npreviously identified left frontal intraparenchymal hemorrhage has decreased\nin density, and the smaller more superiorly located focus of hemorrhage has\nsimilarly evolved. Bifrontal vasogenic edema is essentially unchanged,\nresulting in mass effect upon the frontal horns bilaterally. Ventricular size\nis unchanged. There is no evidence of new hemorrhage. Basal cisterns are\npatent.\n\nParanasal sinuses, mastoid air cells and middle ear cavities are clear. Post\ncraniotomy changes in the scalp are as expected.", + "output": "Post bifrontal craniotomy for meningioma resection with evolution of left\nfrontal lobe foci of hemorrhage, and unchanged appearance of bifrontal edema,\nhowever no evidence of new hemorrhage, further sulcal effacement, or\nherniation." + }, + { + "input": "Again seen is evidence of bifrontal craniotomy and recent meningioma\nresection. Specifically, there is been an interval decrease in the extent of\nstill persistent left greater than right bifrontal vasogenic edema, with\nminimal mass-effect on the frontal horns of the lateral ventricles, improved\nsince prior. The small focus of intraparenchymal left frontal acute blood\nproducts has resolved since prior study. Apparently new is a small (2.8 x 0.8\nx 1.2 cm AP x CC x TV) amount of extra-axial fluid in the midline at the\nresection site (series 602b, image 40, series 2, image 27, and series 601b,\nimage 37), likely a small amount of acute blood products. There is no\nevidence of hemorrhage elsewhere. There is no acute large vascular\nterritorial infarction. The ventricles and sulci are stable in caliber and\nconfiguration aside from decreased mass-effect on the frontal horns, as above.\nThe basal cisterns are patent.\n\nThe visualized paranasal sinuses are clear. There is bilateral partial\nmastoid air cell opacification, new since prior. Carotid siphon\ncalcifications are noted. The patient is status post bilateral lens removal;\notherwise, the globes and bony orbits are intact and unremarkable.", + "output": "1. Small (2.8 x 0.8 x 1.2 cm AP x CC x TV) focus of acute extra-axial blood\nproducts underlying the meningioma resection site is new.\n2. Interval resolution of previous identified small focus of left frontal\nintraparenchymal hemorrhage.\n3. Mild interval decrease in the extent of left greater than right bifrontal\nvasogenic edema, with decreased mass-effect on the frontal horns of the\nlateral ventricles. Patent basal cisterns.\n4. New bilateral partial mastoid air cell opacification.\n\nNOTIFICATION: The findings above were discussed by Dr. ___\nwith Dr. ___ on the telephoneon ___ at 10:10 ___, 10 minutes after\ndiscovery of the findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST: There is a large, rounded, extra-axial,\nwell-circumscribed hyperdense mass within the anterior left frontal lobe\nmeasuring 4.0 (CC) x 3.3 (AP) x 3.4 (TV) cm (601b:18, 603b:30). This mass\nenvelopes a large calcification of the anterior falx, and demonstrates\nnumerous peripheral calcifications. A region of vasogenic edema is noted\nwithin the anterior left deep white matter adjacent to the mass. There is\nmild local mass effect and sulcal effacement predominantly along the anterior\nfrontal lobe, with approximately 5 mm of rightward shift of the typically\nmidline structures.\n\nA large right parielta dural calcifcation at the vertex may represent a\ncalcified menigioma versus ossified dural plaque. There is no evidence of\nsuperimposed intracranial hemorrhage. Allowing for the bifrontal sulcal\neffacement secondary to the aforementioned mass effect, the ventricles and\nsulci are mildly prominent and suggestive of age the basal cisterns are\npatent. There is preservation of gray-white matter differentiation.\n\nThe visualized portion of the paranasal sinuses,mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\nCalcifications are noted within the bilateral cavernous carotid arteries.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal with no evidence of stenosis, occlusion or aneurysm. Several\ndistal branches of the left ACA are displaced secondary to the large left\nfrontal lobe mass, without evidence for overt occlusion. The meningiom\ndisplaces the falx and extend towards the anterior portion of the superior\nsaggital sinus, causing at least severe attentuation.", + "output": "1. Large, hyperdense, extra-axial mass, likely a meningioma, compressing the \nleft anterior frontal lobe, causing local mass effect and 5 mm of rightward\nmidline shift.\n2. Unremarkable appearance of the circle of ___ without evidence for \nocclusion, dissection, or aneurysm formation.\n3. Severe attentuation versus occlusion of the anterior third of the superior\nsaggital sinus, secondary to the adjacent mass. If further delineation is\nrequired, MRV could be performed." + }, + { + "input": "The patient is status post left frontal craniotomy and tumor resection. \nExpected postoperative changes including pneumocephalus and a small amount of\nhyperdense blood products are seen in the surgical bed. Vasogenic edema is\nagain noted adjacent to the surgical bed, consistent with prior exams. There\nis no evidence of new infarct or hemorrhage. There is 7 mm of rightward\nmidline shift, similar to prior exam. The ventricles and sulci are stable in\nconfiguration from prior exam.\n\nThere is no evidence of fracture, allowing for postsurgical changes. The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "Expected postoperative appearance status post left frontal craniotomy and\ntumor resection." + }, + { + "input": "A number of hyperdense masses are seen at the gray-white junction, the largest\nmeasuring 9.4 mm in greatest dimension (02:21). Similar masses are also seen\nin the cerebellum, but are difficult to assess on noncontrast evaluation. The\nlargest in the right cerebellum measures 1 cm (601b:80). Moderate right\nfrontal edema is noted. There is surrounding edema. There is no midline\nshift. The basilar cisterns are patent.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Multiple hyperdense masses at the gray-white junction with surrounding\nedema are concerning for metastases, likely hemorrhagic. Intracranial\nmetastases can be better evaluated with MRI." + }, + { + "input": "There are multiple supra and infratentorial metastatic lesions with\nhemorrhagic components and surrounding edema that appears stable when compared\nto prior head CT and MR. ___ is no evidence of new metastatic lesions. \nThere is no evidence of acute large territory infarction, or new hemorrhage. \nThere is no midline shift. The ventricles and sulci are normal in size and\nconfiguration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Multiple stable supra and infratentorial metastatic lesions with\nhemorrhagic component surrounding edema.\n2. No evidence of new metastatic lesions, acute large territory infarct or new\nhemorrhage." + }, + { + "input": "A few punctate foci of subarachnoid blood are seen within the left posterior\nparietal lobe sulci (601:86, 602:48). No additional intracranial hemorrhage\nis seen. There is no evidence of acute large territorial infarction, edema,or\nmass-effect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular white-matter hypodensities are\nnonspecific, but likely represent sequela chronic small vessel ischemic\ndisease. Focal hypodensity within the right basal ganglia likely reflects a\nchronic lacune.\n\nThere is no evidence of acute fracture. Minimal mucosal thickening is seen\nwithin ethmoid air cells. The visualized portion of the remaining paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Mild soft\ntissue swelling is seen about the right periorbital region. The visualized\nportion of the orbits are otherwise unremarkable.", + "output": "1. Few punctate foci of subarachnoid blood within the left posterior parietal\nlobe sulci. No mass effect.\n2. Right periorbital soft tissue swelling. No acute fracture.\n\nNOTIFICATION: The updated findings were communicated with ___, MD,\nby ___, MD, on the telephone on ___ at 17:20." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, or mass. There is prominence\nof the ventricles and sulci suggestive of age-related involutional changes.\nPeriventricular and subcortical hypodensities are nonspecific, however likely\ndue to chronic small vessel ischemic disease. Hypodensity in the right corona\nradiata (02:20) is seen.\n\nThere is no evidence of acute fracture. There is mucosal thickening of the\nethmoid air cells and bilateral maxillary sinuses. Mucous retention cysts are\nseen in the right maxillary sinus. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Patient is\nstatus post bilateral lens replacements", + "output": "1. No acute intracranial hemorrhage.\n2. Hypodensity in the right corona radiata, indeterminate chronicity. MRI\nwould be more sensitive in detection of acute infarcts." + }, + { + "input": "Neck CTA: There is a dens fracture extending into the left C2 transverse\nforamen, as seen on dedicated cervical spine CT from ___. There is\na focal dissection of the V3 segment of the left vertebral artery within the\nC2 transverse foramen (series 2, image 190). There is normal opacification of\nthe left vertebral artery above and below the dissection.\n\nThere is calcification of the origin of the right vertebral artery. The right\nvertebral artery is otherwise normal.\n\nThere is soft and calcified atherosclerotic plaque at the left carotid\nbifurcation is causing 25% stenosis of the left proximal internal carotid\nartery by NASCET criteria.\n\nThere is soft and calcified atherosclerotic plaque at the right carotid\nbifurcation but no internal carotid artery stenosis by NASCET criteria.", + "output": "1. Focal dissection of the V3 segment of the left vertebral artery within the\nleft C2 transverse foramen at the site of the dens fracture seen on recent CT\nfrom ___. There is normal opacification of the left vertebral\nartery above and below the dissection.\n2. Dens fracture extending into the left C2 transverse foramen. Please refer\nto dedicated CT cervical spine for further evaluation.\n3. Atherosclerotic plaque causing 25% left proximal internal carotid artery\nstenosis by NASCET criteria." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect or\nlarge territorial infarction. The ventricles and sulci are prominent\nsuggesting age-related atrophy. Mild periventricular white matter\nhypodensities are nonspecific but may reflect chronic microvascular ischemic\ndisease. The basal cisterns are patent. Gray-white matter differentiation is\nmaintained.\n\nThere is no fracture. There is minimal mucosal thickening in the partially\nimaged left maxillary sinus and ethmoidal air cells. The frontal and sphenoid\nsinuses are clear. The mastoid air cells and middle ear cavities are clear. \nThere are atherosclerotic calcifications of the cavernous internal carotid\narteries.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute intracranial infarction,hemorrhage,edema, or\nmass effect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Subcortical and periventricular white matter\nhypodensities are nonspecific, however likely represent sequela of chronic\nsmall vessel ischemic disease. There are atherosclerotic calcifications in\nthe bilateral cavernous carotids.\n\nThere is no evidence of acute fracture. There is mucosal thickening in the\nbilateral maxillary sinuses, sphenoid sinuses, right frontal sinus, and\nethmoid air cells. The visualized portion of the left frontal sinus, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Paranasal sinus disease as described." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass effect. There is prominence of the ventricles and sulci suggestive of\nage-related global atrophy. Minimal periventricular, subcortical, and deep\nwhite matter hypodensities are nonspecific, but likely represent sequela of\nchronic microvascular ischemic disease.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nleft sphenoid, bilateral frontal, and bilateral maxillary sinuses. There is\nmucosal thickening of the bilateral ethmoid air cells. The visualized portion\nof the remaining paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nintracranial hemorrhage or large territory infarct. The\n2. Findings consistent with age-related global atrophy and likely sequela of\nchronic microvascular ischemic disease.\n3. Additional findings described above." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. Minimal\nsubcortical and periventricular white matter hypodensities are nonspecific,\nlikely sequelae of chronic small vessel ischemic disease. There is prominence\nof the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. There is mild mucosal thickening of\nbilateral maxillary sinuses and moderate mucosal thickening of the ethmoid air\ncells. The visualized portion of the remaining paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. No acute intracranial abnormality on noncontrast CT head. Specifically no\nintracranial hemorrhage or large territory infarct.\n2. No displaced calvarial fracture.\n3. Additional findings described above." + }, + { + "input": "There is no mass effect, hydrocephalus or shift of normally midline\nstructures. No evidence of acute intracranial hemorrhage. Gray-white matter\ndistinction appears preserved. Surrounding soft tissue structures are\nunremarkable. Visualized paranasal sinuses show mild ethmoid sinus mucosal\nthickening, but otherwise these appear clear. Mastoid air cells also appear\nclear. No evidence of fracture or bone destruction. Moderate vascular\ncalcification.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Subcentimeter hypodensity in the right basal ganglia\nlikely reflects a chronic lacune (02:14). Periventricularand subcorticalwhite\nmatter hypodensities are nonspecific, but likely reflect the sequela of\nchronic microvascular infarction. Mild atherosclerotic calcifications of the\ncavernous carotid arteries are visualized.\n\nIncidental note is made is of hyperostosis frontalis interna. There is no\nevidence of fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. Hyperdense material\nwithin the left external acoustic meatus likely represents a hearing aid. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territory infarct. Gray-white matter\ndifferentiation is preserved. Prominence of the ventricles and sulci is\nconsistent with involutional changes. Mild periventricular hypodensity is\nmost consistent with sequela of chronic small vessel disease. Punctate left\nthalamic lacunar infarct is noted. The visualized paranasal sinuses are\nclear. The mastoid air cells are clear. No acute fracture is seen.", + "output": "No acute intracranial process." + }, + { + "input": "There is a large left frontal scalp hematoma. There is no evidence of\nfracture, infarction, intracranial hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. There is a small dural\ncalcification or partially calcified meningioma overlying the left parietal\nconvexity, best seen on images 62 through 65 of series 601b.\n\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\nThe orbits are unremarkable.", + "output": "1. Left frontal scalp hematoma.\n2. Dural calcification versus small calcified left parietal convexity\nmeningioma.\n3. Otherwise normal study" + }, + { + "input": "Study is somewhat limited by motion artifact despite multiple acquisitions.\n\nThere is no acute hemorrhage, edema or significant shift of normally midline\nstructures. The ventricles and sulci are normal size and configuration for\nage. Scattered periventricular white matter hypodensities, while nonspecific,\npresumably sequela from chronic small vessel ischemic disease. Otherwise, the\ngray-white matter differentiation is preserved and there is no evidence for an\nacute infarction. The basal cisterns are patent.\n\nThe included paranasal sinuses and mastoid air cells are well-aerated and\nclear. There is no acute fracture. The lenses and globes are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of hemorrhage or mass effect. As compared to prior\nexamination dated ___, the lateral ventricles are increasingly\nnarrow, and there is mild sulcal effacement. However, the basal cisterns\nappear patent and there is preservation of gray-white matter differentiation.\n\nThe visualized bony structures are grossly unremarkable. There is mucosal\nthickening seen within the bilateral ethmoidal air cells and frontal sinuses.\nAerosolized secretions are seen within the left sphenoid sinus. Partial\nopacification of the bilateral mastoid air cells is noted. The bilateral\nmaxillary sinuses and middle ear cavities are grossly clear. The globes are\nunremarkable.\n\nNOTE ADDED AT ATTENDING REVIEW: 3: Are considerably smaller than on the prior\nstudy and the sulci are largely effaced. These findings may be the result of\nbrain swelling the of a variety of etiologies. The gray-white differentiation\nappears reduced compared to the prior examination, raising a concern of\nextensive bilateral infarction. There is no evidence of herniation.", + "output": "1. Mild bilateral sulcal effacement and narrowing of the lateral ventricles\nis suggestive of underlying cerebral edema. This may be due to diffuse\ninfarction. However, reversible causes of edema with present similar imaging\nfindings. There is no evidence of uncal or transtentorial herniation.\n2. No evidence of hemorrhage.\n3. Multifocal sinus disease, as above.\n\nNOTIFICATION: Findings were conveyed by Dr. ___ to the neurology team at\n22:18 on ___." + }, + { + "input": "Again seen is diffuse sulcal effacement bilaterally, with compression of the\nventricular system. There are some areas of the bilateral posterior\ntemporoparietal regions with more conspicuous hypodensity, concerning for\nincreasing cerebral edema. Correlation with MRI is recommended.\n\nThere is no evidence of hemorrhage. There is crowding of the suprasellar\ncistern as on prior, but the quadrigeminal plate cistern and perimesencephalic\ncisterns remain patent. The cerebellar tonsils remain normally positioned. \nThere is no shift of midline structures. There is minimal sphenoid and frontal\nsinus mucosal thickening. The bilateral maxillary sinuses, ethmoid air cells,\nand mastoid air cells are well-aerated. There is no evidence of fracture. The\nglobes are unremarkable.", + "output": "1. Subtle increased in hypodensity in the bilateral posterior temporoparietal\nregions, suggesting worsening cerebral edema. Correlation with MRI is\nrecommended.\n2. Stable diffuse mass effect including sulcal effacement, and unchanged\nbilateral ventricular compression. No definite herniation or shift of midline\nstructures.\n3. No evidence of hemorrhage.\n\nNOTIFICATION: The above findings were discussed over the phone by Dr. ___\nwith Dr. ___ on ___ @ 9:36AM. At that time, it was recommended to\nobtain MRI brain for correlation with the above findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere are focal hypodensities within the posterior fossa bilaterally, right\ngreater than left (2:7, 11), likely consistent with known history of\ncerebellar stroke. There is no evidence of acute large territory\ninfarction,hemorrhage,edema,ormass. Note is made of multiple areas of\nincreased attenuation along the margins of the lateral ventricles, consistent\nwith nodular gray matter heterotopia. The ventricles and sulci are otherwise\nnormal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are normal. \nIncidental note is made of a punctate hyperdense focus in the right palatine\ntonsil, which may represent a tonsillith.\n\nCTA HEAD: Minimal calcification of the carotid siphons patent dural venous\nsinuses. Incidentally noted fetal origin of the posterior cerebral artery on\nthe right. The major vessels in the ___ including the posterior\ncirculation appear patent without evidence of dissection, stenosis, occlusion\nor aneurysm greater than 3 mm.\n\nCTA NECK: Conventional 3 vessel arch with minimal calcification of the aortic\narch and carotid bifurcations bilaterally. The right vertebral artery is not\nvisualized in the V1 and proximal V2 segments, it is reconstituted at about\nC6. There does appear to be collateral flow to the region of the chronically\noccluded vertebral segment from the spinal and intercostal vessels. The left\ndominant vertebral artery appears grossly unremarkable. The bilateral carotid\nvessels appear patent without evidence of stenosis or occlusion. There is no\nevidence of internal carotid artery stenosis bilaterally per NASCET criteria.\n\nOther: Ectatic ascending aorta and enlarged main pulmonary artery are noted.\nThe visualized lung parenchyma and thyroid gland appear unremarkable. No\nlymphadenopathy by CT criteria. Mild to moderate multilevel degenerative\nchanges of the visualized spine with grade 1 anterolisthesis of C2 on C3 and\nC4 on C5. No evidence of high-grade canal narrowing.", + "output": "1. Scattered focal hypodensities in the posterior fossa bilaterally, likely\nconsistent with known history cerebellar stroke.\n2. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n3. Nonvisualized right V1 and proximal V2 segments, likely chronic occlusion\ngiven appearance of collateral flow. Otherwise, there is no evidence of\ndissection, new occlusion or aneurysm.\n4. Incidentally noted ectatic ascending aorta and enlarged main pulmonary\ntrunk, possibly related to known congenital heart disease.\n5. Subependymal nodular gray matter heterotopia." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nare small bilaterally and symmetric. Sulci are normal in size and\nconfiguration.\n\nNo osseous abnormalities seen. Near complete opacification of the sphenoid\nsinus is present with aerosolized secretions. The remaining paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable. Soft tissue nodule within the right parietal scalp may reflect\na sebaceous cyst.", + "output": "1. No acute intracranial process.\n2. Sphenoid sinus disease, and clinical correlation is recommended for acute\nsinusitis." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass effect.\nThe ventricles and sulci are normal in size and configuration. There is\nprominence of the ventricles and sulci suggestive of age-related cerebral\nvolume loss. Periventricular and subcortical white matter hypodensities are\nnonspecific, though likely sequelae of chronic small vessel ischemic disease.\n\nNo osseous abnormalities seen. There is mild mucosal thickening of the\nethmoidal air cells and bilateral maxillary sinus mucous retention cysts. \nOtherwise, the mastoid air cells and middle ear cavities are clear.", + "output": "1. No evidence of acute intracranial process.\n2. Mild paranasal sinus disease as described above.\n3. Age-related cerebral atrophy and probable chronic small vessel ischemic\nchanges as described." + }, + { + "input": "Aero digestive tract: There is a ovoid heterogeneously hyperdense mass in the\noral cavity with coarse internal calcifications destroying much of the body of\nthe right mandible and displacing the right mandibular central and lateral\nincisor teeth ___ 25 and 26). Central area of hypodensity may reflect focus\nof necrosis (02:36). This mass measures approximately 3.6 x 4.5 x 3.3 cm in\ngreatest ___ causes mass effect upon the tongue.\n\nNeck lymph nodes: Prominent right level Ia lymph node measures up to 8 mm in\ngreatest short axis dimension (02:48), and prominent right level 1b lymph\nnodes measure up to 9 mm in greatest short axis dimension (2: 44). Enlarged\nleft level Ia node measures up to 10 mm in greatest short axis dimension\n(02:51). Additional prominent right level II and III lymph nodes are noted\n(2: 45, 52). No retropharyngeal adenopathy.\n\n\nDeep neck muscles, masticator space: The mass appears to extend to the right\nplatysma and likely involves it. The right masseter does not appear involved.\n\nBones, skull base:\nThere is osseous destruction of much of the body of the right mandible as\ndescribed above.\nThere are no findings suggestive of perineural tumor extension. Jugular\nforamen, carotid canal, pterygopalatine fossa, infraorbital foramen, other\nskull base foramina are not involved.\n\nVessels: There is no vascular invasion.\n\nBrachial Plexus: There is no brachial plexus contact or invasion.\n\nThyroid, salivary glands: There is a heterogeneously enhancing 2.1 x 1.3 cm\nleft thyroid nodule. Submandibular and parotid glands are unremarkable.\n\nOther findings: There are no lung nodules. Multiple dental caries are seen.", + "output": "1. 3.6 x 4.5 x 3.3 cm heterogeneously hyperdense mass centered within and\ndestroying the right mandibular body highly worrisome for neoplasm. This mass\nappears to extend and involve the right platysma.\n2. Prominent right cervical lymph nodes primarily involving levels I a and IB\nas described.\n3. 2.1 cm heterogeneous left thyroid nodule. Thyroid ultrasound is\nrecommended for further assessment.\n\nRECOMMENDATION(S): Thyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or older, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial hemorrhage. No large territorial infarction. No acute\nor displaced skull fractures." + }, + { + "input": "Multiple images were repeated due to motion artifact on the initial scan. \nThere is no evidence for acute hemorrhage, edema, mass effect, or acute major\nvascular territorial infarction. There is mild global parenchymal volume loss\nwith associated prominence of the ventricles and sulci.\n\nNo evidence for a fracture allowing for motion artifact. Mild mucosal\nthickening is noted in the maxillary sinuses.", + "output": "Motion limited exam. No evidence for acute intracranial abnormalities. No\nevidence for calvarial fracture on limited evaluation." + }, + { + "input": "There is no evidence of acute large territory infarct,hemorrhage,edema,or mass\neffect. The ventricles and sulci are normal in size and configuration. Very\nmild periventricular and subcortical hypodensities are likely sequelae of\nchronic small vessel ischemic changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nintracranial hemorrhage or acute large territory infarct." + }, + { + "input": "There is no evidence of fracture, acute large territorial\ninfarction,hemorrhage,edema,or mass. There are bilateral subcortical and\nperiventricular white matter hypodensities, nonspecific but compatible with\nsequelae of chronic small vessel ischemic disease. There is prominence of the\nventricles and sulci suggestive of involutional changes.\n\nThere is a small scalp hematoma overlying midline frontal scalp (3:39). There\nis minimal mucosal thickening of the posterior right ethmoid air cells. \nOtherwise, the visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The patient is status post bilateral lens\nreplacement surgery. Otherwise, the visualized portion of the orbits are\nnormal.", + "output": "1. Small scalp hematoma overlying the midline frontal scalp. Otherwise, no\nevidence of intracranial hemorrhage or fracture.\n2. Chronic microangiopathic and involutional changes." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. No osseous abnormalities seen.\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\nThe orbits are unremarkable.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "There is no evidence of acute large territorial infarction, acute intracranial\nhemorrhage, or edema. There is mild prominence of the ventricles and sulci\nsuggestive of involutional changes. There is a region of hypodensity in the\nleft frontal lobe compatible with volume loss/encephalomalacia.\n\nThere is no evidence of acute displaced fracture. Irregularity of the left\nzygomatic process may reflect sequelae of remote trauma. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Hypodensity in the left frontal lobe compatible with volume\nloss/encephalomalacia, possibly related to an old infarct.\n3. Age advanced parenchymal involutional changes." + }, + { + "input": "Re- demonstrated is a small acute left parietal subdural hematoma, with slight\ninterval redistribution of blood products, overall not appreciably changed in\ncomparison to prior head CT from ___ at 20:45. There is no\nevidence of interval rebleeding. No new focus of hemorrhage is identified. \nThere is no significant mass effect. There is no evidence of acute\ninfarction. An ill-defined right thalamus hypodensity is unchanged, possibly\nsequela of prior lacunar infarct. Bilateral periventricular white matter\nhypodensity are nonspecific, unchanged, consistent with sequelae of chronic\nsmall vessel ischemic disease. Mild prominence of the ventricles and sulci is\nconsistent with age-appropriate global atrophy. The basal cisterns are\npatent. There is unchanged left frontal sinus and ethmoid air cell mucosal\nthickening. The partially imaged maxillary sinuses and the left mastoid air\ncells are clear. There is a stable postoperative appearance of the right\ncanal up mastoidectomy. Carotid siphon calcifications are noted. The globes\nand bony orbits are intact and unremarkable.", + "output": "1. Unchanged small acute left parietal subdural hematoma. No mass effect. No\nevidence of new intracranial hemorrhage.\n2. Possible chronic right thalamic lacunar infarct.\n3. Chronic findings including age appropriate global cerebral atrophy, white\nmatter small vessel ischemic changes, and vascular calcifications." + }, + { + "input": "There is no evidence of fracture, hemorrhage, infarction, mass or midline\nshift. There is no hydrocephalus. Visualized paranasal sinuses and mastoid\nair cells are clear.", + "output": "Normal study." + }, + { + "input": "There is no evidence of acute large territorial infarction,acute intracranial\nhemorrhage,edema,or mass effect. There is prominence of the ventricles and\nsulci suggestive of involutional changes. Periventricular and subcortical\nwhite matter hypodensities are nonspecific, but likely a sequelae of chronic\nsmall vessel ischemic changes.\n\nThere is no evidence of fracture. Mild mucosal thickening of bilateral\nethmoid air cells and small mucous retention cyst in the left maxillary sinus.\nThe visualized portion of the remaining paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "No acute intracranial abnormality. No fractures." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is a small hypodensity within the left caudate head, that is\nnonspecific, (series 2, image 19), probably representing ischemic change of\nuncertain chronicity, if there is persistent clinical concern for\nacute/subacute ischemic changes, correlation with brain MRI is advised. There\nis no evidence of large vascular territory infarction, hemorrhage, edema or\nmass. Ventricles and sulci are age appropriate. There are mild hypoattenuation\nin the periventricular white matter nonspecific but likely sequela of chronic\nmicrovascular ischemic disease.\n\nThere is mild mucosal thickening of the left maxillary sinus. There is soft\ntissue density in the bilateral external auditory canal that may represent\ncerumen. The other paranasal sinuses, middle air and mastoid air cells are\nwell pneumatized. The visualized orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent. Incidentally noted, the A1 segment of the right\nACA and the anterior communicating artery are absent likely congenital. The\nbilateral A2 segments of the ACA are derived from the left A1 segment, (series\n458 image 14) which is a normal anatomic variant. The bilateral cavernous and\nsupraclinoid portions of the intracranial internal carotid arteries\ndemonstrate calcified atherosclerosis more pronounced on left, without\nhigh-grade stenosis.\n\nCTA NECK:\nThe bilateral carotid arteries demonstrate soft and calcified atherosclerosis\nwithout evidence of high-grade stenosis or occlusion. There are punctate\ncalcifications along the V2 segment of the left vertebral artery, otherwise,\nthe vertebral arteries and their major branches appear normal with no evidence\nof stenosis or occlusion. There is no evidence of internal carotid stenosis by\nNASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. There are mild degenerative changes demonstrated in the visualized\ncervical spine.", + "output": "1. The bilateral carotid arteries demonstrate soft and calcified\natherosclerosis without evidence of high-grade stenosis or occlusion by\nNASCET criteria.\n2. Small hypodensity within the left caudate nucleus, that is nonspecific,\nprobably representing ischemic change of uncertain chronicity, if there is\npersistent clinical concern for acute/subacute ischemic changes, correlation\nwith brain MRI is advised.\n3. Paranasal sinus disease as described above.\n\nRECOMMENDATION(S): There is a small hypodensity within the left caudate head\nthat is nonspecific, (series 2, image 19), probably representing ischemic\nchange of uncertain chronicity, if there is persistent clinical concern for\nacute/subacute ischemic changes, correlation with brain MRI is recommended." + }, + { + "input": "Motion, venous contrast pooling andpatient body habitus limits study. Within\nthese confines:\n\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute large territorial\ninfarction,hemorrhage,edema,ormass. Left frontal and thalamic\nencephalomalacia compatible with patient's known remote infarcts are noted. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. There are periventricular and subcortical lucencies, which may\nrepresent small vessel ischemic changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are preserved.\n\nCTA HEAD:\n Nonocclusive atherosclerotic narrowing of the petrous, cavernous and\nsupraclinoid segments of the bilateral internal carotid arteries are seen. \nThe left A1 segment is dominant and the right A1 segment is hypoplastic. \nNonocclusive irregularity distal left A2 segment is noted.\n\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. The dural venous\nsinuses are patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent.\n\nNonocclusive calcified probable atherosclerotic narrowing of the distal right\nV1 and proximal V3 segments is noted. Nonocclusive calcified probable\natherosclerotic narrowing of the left proximal V2 segment at approximately\nC6-7 level is seen.\n\nAt least partially calcified probable atherosclerotic plaque is seen at the\nleft internal carotid artery origin with approximately 25% stenosis by NASCET\ncriteria.\n\nAt least partially calcified probable atherosclerotic plaque is seen at the\nright internal carotid artery origin with approximately 50% stenosis by NASCET\ncriteria.\n\nOtherwise, the carotidandvertebral arteries and their major branches appear\ngrossly preserved with no evidence of stenosis or occlusion.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. Probable congenital non fusion of posterior arch of C1 is again\nseen. Soft tissue densities are noted within bilateral external auditory\ncanals which may represent cerumen.", + "output": "1. Limited study as described.\n2. No acute intracranial abnormality, with no definite evidence of acute large\nterritorial infarct. Please note MRI of the brain is more sensitive for the\ndetection of acute infarct.\n3. Atrophy, probable small vessel ischemic changesand chronic infarcts as\ndescribed.\n4. Nonocclusive atherosclerotic narrowing of circle ___ as described.\n5. Otherwise, grossly patent circle of ___ without evidence of\nstenosis,occlusion,or aneurysm.\n6. Nonocclusive cervical arterial atherosclerotic disease as described,\nminimally progressed compared to ___ prior CTA exam.\n7. Otherwise, grossly patent bilateral cervical carotid and vertebral arteries\nwithout evidence of stenosis, occlusion, or dissection." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,intracranial hemorrhage,edema,ormass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Small broad-based exostosis arising from\nthe left parietal calvarium. Small amount of soft tissue within the right ear\ncanal, likely cerumen. Mild mucosal thickening within the right maxillary and\nsphenoid sinuses. Otherwise, the visualized portion of the paranasal sinuses,\nmastoid air cells,andmiddle ear cavities are clear. The visualized portion of\nthe orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\n3 mm nodule within the right upper lobe (series 3, image 16). Minimal\nparaseptal emphysematous changes. Otherwise, the visualized portion of the\nlungs are clear. Tiny right posterolateral tracheal diverticulum (series 3,\nimage 62). The visualized portion of the thyroid gland is within normal\nlimits. There is no lymphadenopathy by CT size criteria. Anterior cervical\nfixation hardware at C6-7, which is unremarkable in appearance. No suspicious\nosseous lesions.", + "output": "1. No acute intracranial abnormalities. Normal head and neck CTA.\n2. 3 mm nodule within the right upper lobe of the lung, which does not require\nfollow-up in a low risk patient.\n\nRECOMMENDATION(S): For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___." + }, + { + "input": "Overlying hardware streak artifact limits examination.\n\nThere is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of age-related cerebral\nvolume loss. Atherosclerotic vascular calcifications are noted of bilateral\nvertebral and cavernous portions of internal carotid arteries.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear.", + "output": "1. Overlying hardware streak artifact limits examination.\n2. No acute intracranial process. Please note MRI of the brain is more\nsensitive for the detection of acute infarct.\n3. Within limits of study, no definite evidence of intracranial hemorrhage.\n4. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nRe-demonstrated is a 6.7 x 2.4 cm intraparenchymal hemorrhage centered in the\nright frontal/temporal region with intraventricular extension, effacement of\nthe right lateral ventricle, and mass effect with 6 mm of leftward midline\nshift. Overall, this is mildly increased in size compared to 8 hours prior. \nThere is also likely some component of subarachnoid hemorrhage in the right\nsylvian fissure. Evaluation of the posterior fossa is limited by motion,\nhowever the interpeduncular and suprasellar cisterns appear patent, although\nwith a small amount of acute blood products. There is no evidence of acute\ninfarct.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without occlusion, or aneurysm formation. There is mild\ncalcification of the cavernous internal carotid arteries which does not result\nin stenosis. The dural venous sinuses are patent.\n\nCTA NECK:\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is minimal calcified plaque at\nboth carotid bifurcations. There is no evidence of internal carotid stenosis\nby NASCET criteria.\n\nOTHER:\nA large right pleural effusion is present. There are multifocal ground-glass\nopacities in the left upper lobe. An endotracheal tube is in place,\nterminating above the carina. A right internal jugular central venous\ncatheter is present. There is some or a pharyngeal secretions, and the\nenteric tube is slightly coiled in the oropharynx. Multilevel degenerative\nchanges of the cervical spine are noted.", + "output": "1. Slight increase in the size of a right frontal/temporal lobe\nintraparenchymal hemorrhage with intraventricular extension, effacement of the\nright lateral ventricle and mass effect with 6 mm of leftward midline shift.\n2. No evidence of aneurysm, vascular malformation, or vascular occlusion.\n3. Large right pleural effusion and left upper lobe ground-glass opacities are\nmore completely evaluated on the recent CT torso." + }, + { + "input": "The study is limited due to streak artifact from scalp electrodes.\n\nThere is redemonstration of a right frontal intraparenchymal hemorrhage\nmeasuring 6.8 X 3.3 cm, previously 6.9 x 3.2 cm, with surrounding vasogenic\nedema, not substantially changed allowing for differences in patient\npositioning. Blood is noted layering in the occipital horns of the lateral\nventricles bilaterally, decreased in extent in the body of the right lateral\nventricle but now also seen within the third and fourth ventricles, likely due\nto redistribution. There is persistent effacement of the right lateral\nventricle and third ventricle, and stable mild prominence of the left lateral\nventricle. Stable approximately 6 mm leftward shift of midline structures.\n\nApparent superficial hyperdensities projecting over the posterior occipital\nand parietal cortex may represent motion artifact versus subarachnoid\nhemorrhage. This is similar in appearance to the prior motion limited CTs\nfrom ___ at 19:06 and at 10:37, but not seen on the ___ 07:22\nCT which was not degraded by motion in this area.\n\nNo concerning osseous findings. There is fluid in the sphenoid sinuses and\nnasopharynx, likely secondary to endotracheal intubation. Orogastric tube is\nalso partially imaged. Mastoid air cells are grossly well-aerated. The\norbits are grossly unremarkable.", + "output": "1. Stable large right frontal intraparenchymal hemorrhage with stable mass\neffect.\n2. Stable intraventricular hemorrhage allowing for some redistribution from\nthe lateral ventricle into the third and fourth ventricles\n3. Apparent superficial hyperdensities projecting over the posterior occipital\nand parietal cortex may represent motion artifact versus subarachnoid\nhemorrhage. This is similar in appearance to the prior motion limited CTs from\n___ at 19:06 and at 10:37, but not seen on the ___ 07:22 CT\nwhich was not degraded by motion in this area.\n4. New fluid within the bilateral sphenoid sinuses and nasopharynx, likely\nsecondary to endotracheal intubation" + }, + { + "input": "The study is limited due to streak artifact from scalp electrodes.\n\nAgain seen is a right frontal intraparenchymal hemorrhage measuring\napproximately 6.7 x 3.2 cm, previously 6.8 x 3.3 cm, with surrounding\nvasogenic edema, not substantially changed from prior when allowing for\ndifferences in patient positioning. The extent of intraventricular hemorrhage\nis similar, with blood layering in the occipital horns of the lateral\nventricles bilaterally and within the third ventricle. There is similar\nappearance of peripheral hyperdensities involving the bilateral cerebral\nhemispheres which may represent a combination of motion and streak artifact\nversus subarachnoid hemorrhage. There is similar effacement of the right\nlateral ventricle and third ventricle. The degree of leftward shift of\nmidline structures is slightly decreased, now measuring 3 mm, previously 6 mm.\n\nThere is no evidence of fracture. There is similar fluid within the sphenoid\nsinuses and nasopharynx, likely related to intubation. The visualized\nportion of the remaining paranasal sinuses, mastoid air cells, and middle ear\ncavitiesare essentially clear. The visualized portion of the orbits are\nunremarkable. An endotracheal tube and orogastric tube are partially imaged.", + "output": "1. Stable large right frontal intraparenchymal hemorrhage, with similar to\nslight decrease in mass effect.\n2. No significant change in intraventricular component, with blood layering\nwithin the occipital horns of the lateral ventricles and within the third\nventricle.\n3. Similar appearance of peripheral hyperdensities projecting over the\nbilateral cerebral hemispheres, which may represent subarachnoid hemorrhage." + }, + { + "input": "Again demonstrated is a right-sided frontal parietal intraparenchymal\nhemorrhage measuring 6.8 x 3.1 cm, previously 6.7 x 3.2 cm. Intra ventricular\nhemorrhage is unchanged and ventricular size is stable. There is a mild\nincrease in surrounding vasogenic edema. Midline shift is unchanged at 3 mm\nwith similar effacement of the right lateral and third ventricle. No evidence\nof herniation there is persistent subarachnoid hemorrhage along the bilateral\noccipital lobes, not significantly changed from prior. There is no evidence\nof new areas of intraparenchymal hemorrhage.\n\nThere is no evidence of new infarction or fracture.\n\nThere is complete opacification of the right sphenoid sinus and partial\nopacification of the left. Otherwise, the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Right-sided frontal parietal intraparenchymal hemorrhage is not significant\nchanged from prior.\n2. Midline shift is stable without evidence of herniation. Ventricular\neffacement is unchanged.\n3. Multiple areas of bilateral occipital subarachnoid hemorrhage, stable\ncompared to prior." + }, + { + "input": "There is an acute large intraparenchymal hemorrhage spanning the right frontal\nregion to the right basal ganglia, measuring 6.9 x 3.2 x 4.9 cm (AP x TV x\nCC), with associated vasogenic edema. Intraventricular hemorrhagic extension\nnoted in the occipital horns of lateral ventricles. There is effacement of\nthe right frontoparietal sulci as well as notable effacement of right lateral\nventricle and third ventricle. 6 mm leftward midline shift with subfalcine\nherniation. No evidence of transtentorial herniation.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Large 6.9 cm acute right frontal intraparenchymal hemorrhage complicated by 6\nmm leftward midline shift with subfalcine herniation. The presentation is not\ntypical of a traumatic contusion. Differential includes hypertension, amyloid\nangiopathy, or underlying neoplasm among less common causes.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:20 am, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. Gray-white matter\ndifferentiation is preserved.\nNo osseous abnormalities are seen. The paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial findings." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. There is slight asymmetry of the parotid glands, with the left\nbeing larger than the right, though no discrete underlying mass is identified.\nThis is similar in appearance to examination of ___ The thyroid gland\nappears normal. There is no lymphadenopathy by CT criteria. The neck vessels\nare patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.", + "output": "1. Asymmetric enlargement of the left parotid gland compared to the right,\nwithout discrete underlying mass or evidence of parotitis. This is similar in\nappearance to MRI head of ___.\n2. Otherwise unremarkable contrast-enhanced CT examination of the neck." + }, + { + "input": "Dental amalgam streak artifact limits study.\nCT HEAD:\nThere is no evidence for acute hemorrhage, vascular territorial infarction,\nmass effect, or edema. The ventricles and sulci are normal in size and\nappearance.\n\nMaxillary mucous retention cysts are noted bilaterally. The remainder of the\nparanasal sinuses, middle ear cavities, and mastoid air cells are clear. The\norbits are grossly unremarkable bilaterally.\n\n\nCTA HEAD AND NECK:\nThere is a normal 3 vessel aortic arch identified. The vertebral arteries are\npatent without high-grade stenosis or occlusion.\n\nThe bilateral common carotid arteries are patent. Minimal left internal\ncarotid artery origin narrowing is noted (see 602:40). There is no evidence\nof internal carotid stenosis by NASCET criteria.\n\nMild calcifications are seen in the cavernous carotid arteries bilaterally. \nAllowing for this, the intracranial vasculature is grossly patent without\nhigh-grade stenosis, occlusion, or aneurysm greater than 3 mm.\n\nThere is a fetal origin of the left posterior cerebral artery, a normal\nvariant. The left A1 segment is hypoplastic, also a normal variant. The\ndural venous sinuses are patent.\n\nOTHER:\nThe lungs apices are clear bilaterally. The thyroid gland is grossly\npreserved. There is no cervical lymphadenopathy by CT size criteria.", + "output": "1. Dental amalgam streak artifact limits study.\n2. No acute intracranial abnormality. Please note MRI of the brain is more\nsensitive for the detection of acute infarct.\n3. Nonocclusive circle of ___ probable atherosclerotic changes as\ndescribed. Otherwise, patent circle of ___ without definite evidence of\nstenosis, occlusion, or aneurysm greater than 3 mm.\n4. Minimal left internal carotid artery probable atherosclerotic changes\nwithout definite high-grade stenosis by NASCET criteria. Otherwise, patent\ncervical carotid arterial and vertebral arteries without definite evidence of\nstenosis, dissection, or occlusion." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nStreak artifact from dental amalgam limits evaluation of the posterior fossa. \nOtherwise, there is no evidence of acute intracranial hemorrhage, edema, mass\neffect, or acute major vascular territory infarction. The ventricles are\nnormal in size. There is mild biparietal sulcal prominence in keeping with\nmild parenchymal volume loss. Basal cisterns are preserved.\n\nThere is mild mucosal thickening within left greater than right maxillary\nsinuses with adjacent periapical lucencies of bilateral maxillary molars. \nThere is trace mucosal thickening in the ethmoid air cells. Mastoid air cells\nappear well-aerated. The orbits appear unremarkable.\n\nCTA HEAD:\nCalcifications are seen in the bilateral carotid siphons without flow-limiting\nstenosis. No evidence for flow-limiting stenosis or aneurysm elsewhere in the\nmajor intracranial arteries. Right A1 segment is hypoplastic, a normal\nvariant. No evidence for an aneurysm. The dural venous sinuses are patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent. Calcifications are\nseen at the level of the bifurcations of the right common carotid artery. \nThere is no stenosis at the bilateral internal carotid arteries by NASCET\ncriteria. Bilateral vertebral arteries appear widely patent.\n\nOTHER:\nThe thyroid is significantly enlarged and multinodular with the left lobe\ngreater than the right, measuring 6.5 x 4.4 cm (3; 73) with tracheal deviation\nto the right side. There are prominent morphologically normal cervical lymph\nnodes bilaterally. The included upper lungs appear unremarkable allowing for\nmotion artifact. There are degenerative changes in the cervical spine.", + "output": "1. No evidence of acute intracranial abnormality. MRI would be more sensitive\nfor an acute infarction, if clinically warranted.\n2. Mild atherosclerosis of the proximal right internal carotid artery without\nstenosis by NASCET criteria. No left carotid stenosis by NASCET criteria. \nPatent vertebral arteries.\n3. No evidence for flow-limiting stenosis in the major intracranial arteries.\n4. Periapical lucencies of bilateral maxillary molars and adjacent\ninflammatory changes in the maxillary sinuses. Please correlate with dental\nexam and associated symptoms.\n5. Enlarged multinodular thyroid with the left lobe measuring 6.5 x 4.4 cm\nwith tracheal deviation to the right side. Recommend thyroid ultrasound and\nclinical evaluation.\n\nRECOMMENDATION(S): Recommend thyroid ultrasound.\n\nNOTIFICATION: The impression and recommendation above were entered by Dr.\n___ on ___ at 16:27 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass. The\nventricles and sulci are minimally prominent, and appropriate for age.\n\nNo osseous abnormalities seen. There is mild mucosal thickening of the\nmaxillary sinuses bilaterally. The mastoid air cells, and middle ear cavities\nare clear. There is periapical lucency about several of the maxillary molars\nbilaterally. The orbits are unremarkable.\n\nCalcification of the internal carotid siphons and right vertebral artery is\nagain noted.", + "output": "1. There is no evidence of acute fracture, infarction,hemorrhage,edema, or\nmass.\n2. Periapical lucency of several bilateral upper molars is noted. Correlate\nclinically for signs symptoms of inflammation." + }, + { + "input": "There is minimal occipital scalp soft tissue swelling (see 602b:41). There is\nno evidence of infarction, hemorrhage, edema, or mass. The ventricles and\nsulci are normal in size and configuration.\n\nMild widening of the right lambdoid suture relative to the left may indicate\nan element of diastasis. Partial opacification of right mastoid air cells is\nnoted. There is minimal mucosal thickening of the right maxillary sinus. The\nremainder of the visualized portion paranasal sinuses and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Minimal midline occipital scalp soft tissue swelling.\n2. Mild widening of the right lambdoid suture relative to the left may\nindicate mild diastases, versus positioning artifact.\n3. Partial opacification of right mastoid air cells.\n4. No evidence of acute intracranial hemorrhage.\n5. Minimal paranasal sinus disease as described.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 6:15 AM." + }, + { + "input": "There is no evidence of fracture, infarction, hemorrhage, edema or mass. The\nventricles and sulci are normal in size and configuration. There is no\nabnormal enhancement.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. No mass effect or abnormal enhancement to suggest intracranial metastatic\ndisease, however CT is relatively insensitive for the detection of\nintracranial masses. If there is significant clinical concern, MRI with and\nwithout contrast can be obtained." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Normal study." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. There is mild prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture. There is minimal opacification of the\ninferior left mastoid air cells, suggestive of mild ongoing inflammation. The\nvisualized portion of the paranasal sinuses, right-sided mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable. Mild atherosclerotic calcifications of the distal left\nvertebral and cavernous carotid arteries are visualized.", + "output": "No acute intracranial abnormality. No acute fracture." + }, + { + "input": "Study is markedly limited due to patient motion despite 2 imaging attempts. \nImages above the level of the third ventricle are not diagnostic. Below the\nlevel of the third ventricle, no acute hemorrhage, edema, or loss of\ngray/white matter differentiation is seen. Mild age-related parenchymal\nvolume loss is noted. No lower calvarial or skullbase fracture is identified.\nMastoid air cells, middle ear cavities, and visualized portions of the\nparanasal sinuses are well aerated. There is evidence of bilateral cataract\nsurgery.", + "output": "Extremely limited study due to patient motion. Structures above the third\nventricle are not assessed. No evidence for acute abnormalities below the\nlevel of the third ventricle.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 5:49 AM, 2 minutes after\ndiscovery of the findings." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Basilar cisterns are\npatent.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "The left vertebral artery arises directly from the aortic arch. The carotid\nand vertebral arteries and their major branches are patent with no evidence of\nstenoses. No evidence for dissection is seen.\n\nBy NASCET criteria, there is a no stenosis of the ICAs.\n\nThere is atelectasis and opacification of the left maxillary sinus. The dens\nfracture is again seen, better visualized on the prior dedicated CT C-spine.", + "output": "1. No flow-limiting stenosis, occlusion, or dissection of the cervical\nvasculature.\n\n2. Dens fracture again seen, better visualized on the prior dedicated CT\nC-spine." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema,or mass. The\nventricles and sulci are normal in size and configuration. Periventricular\nand subcortical white matter hypodensity is nonspecific but likely reflect\nsequelae of chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "Comminuted minimally displaced nasal bone fractures are unchanged. Previously\ndescribed nondisplaced linear lucency extending from the left maxilla into the\nsinus is not well visualized on exam; however, there is deformity of the\nanterior wall of maxilla. No additional fractures are identified. Prominent\nS-shaped of the nasal septum with a large leftward projecting spur anteriorly\nand a smaller rightward projecting spur posteriorly is identified. There is\nbilateral concha bullosa.\n\nHyperdense material within the left maxillary sinus has decreased since prior\nexam. There is partial opacification of the ethmoid air cells and of the\nright is frontal sinuses. Milder opacification of the remainder the paranasal\nsinuses as well as air-fluid level in the right maxillary sinus is identified.\nSphenoid sinus septations insert on the carotid grooves.\n\nThe orbits are unremarkable. The mastoid air cells middle ear cavities are\nwell pneumatized and clear.\nPreviously described very punctate focus of air at the level of the right\ncribriform plate on the prior maxillofacial CT examination is decreased and\nless conspicuous; minimal deformity of the cribriform plate with fracture is\nnoted adjacent, as before series 103b, image 38. There is no evidence for\npneumocephalus elsewhere. Right frontal subgaleal hematoma and soft tissue\nswelling have decreased in size when compared to prior exam.\nSwelling over the lateral aspect of the right periorbital orbital soft tissues\nand the right zygoma series 4, image 5 with increased attenuation, similar to\nthe prior.\n\nSulci, ventricles and cisterns are within expected limits given the degree of\nglobal cerebral age related volume loss. There is no evidence of acute\nintracranial hemorrhage or territorial infarct. Bilateral basal cognitive\ncalcifications are stable.", + "output": "1. Previously described very punctate focus of air at the level of the right\ncribriform plate on the prior maxillofacial CT examination is decreased and\nless conspicuous; minimal deformity of the cribriform plate with fracture is\nnoted adjacent, as before. No pneumocephalus otherwise.\n2. Minimally displaced nasal bone fractures are unchanged.\n3. Previously described left maxillary fracture is not well evaluated on\ncurrent exam. No new fractures.\n4. High density material in the paranasal sinuses described above, presumably\nhemo sinus.\n5. No acute intracranial hemorrhage or territorial infarct.\n6. Decreased size of right frontal subgaleal hematoma.\n7. Swelling over the lateral aspect of the right periorbital orbital soft\ntissues and the right zygoma with increased attenuation and a nodular focus,\nsimilar to the prior. Correlate clinically" + }, + { + "input": "CT Head: There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. Normal gray-white\nmatter differentiation is preserved.No osseous abnormalities seen. The\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\norbits are unremarkable.\n\nCTV: No evidence of dural venous sinus thrombosis. The left transverse and\nsigmoid sinuses are diminutive compared to the right which is likely a\ncongenital variant.", + "output": "1. Unremarkable noncontrast head CT without evidence of acute intracranial\nprocess.\n\n2. No evidence of dural venous sinus thrombosis." + }, + { + "input": "There is no evidence of fracture, acute major infarction,hemorrhage,edema,or\ndiscrete mass. The ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "No acute intracranial findings." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, or mass effect. \nVentricles, sulci, and basal cisterns are normal in size for age. 3 mm\nectopia of the left cerebellar tonsil, image 602:44, is unchanged compared to\nthe cervical spine MRI from ___. Partially empty sella is again\nseen.\n\nNo evidence for a fracture. The orbits are unremarkable.\n\nMild thickening of the bilateral ethmoid air cells. A small mucous retention\ncyst is partially imaged in the included portion of the right maxillary sinus.\nMastoid air cells and middle ear cavities are clear. Enlargement of the\nnasopharyngeal soft tissues is grossly similar to the cervical spine MRIs from\n___ and ___, which demonstrated an incompletely evaluated cystic\nnasopharyngeal lesion.", + "output": "1. No evidence of acute intracranial abnormalities.\n2. 3 mm ectopia of the left cerebellar tonsil, unchanged compared to the\ncervical spine MRI from ___.\n3. Chronic partially empty sella.\n4. Enlargement of the nasopharyngeal soft tissues, grossly similar to the\ncervical spine MRIs from ___ and ___, which demonstrated an incompletely\nevaluated cystic nasopharyngeal lesion. Consider non urgent ENT evaluation if\nnot previously performed.\n\nRECOMMENDATION(S): Consider non urgent ENT evaluation if not previously\nperformed." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or shift of normally\nmidline structures. The ventricles and sulci are normal in size and\nconfiguration.\n\nThere is no evidence of fracture. Extensive right maxillary mucosal\nthickening is identified. The visualized portion of the remaining paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial hemorrhage or mass effect." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nThere are periventricular and subcortical hypodensities, which may represent\nsmall vessel ischemic changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial process." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or mass\neffect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture. Extensive subcutaneous emphysema in the\nbilateral eyelids, lower face, bilateral masticator space, and posterior neck\nare consistent with recent surgery. There is mild mucosal thickening of the\nbilateral frontal sinuses and ethmoid air cells. The remaining paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. There is a nasogastric tube in place.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nlarge territory infarct or intracranial hemorrhage.\n2. Extensive subcutaneous emphysema in the bilateral eyelids, lower face,\nbilateral masticator space, and posterior neck, consistent with recent\nsurgery." + }, + { + "input": "Dental amalgam streak artifact limits study. Additionally, please note that\nno definite cervical vascular contrast enhancement is noted\n\nPostsurgical changes related to patient's known tracheal resection,\nreconstruction, dehiscence repair and washout are noted. There has been\ninterval level of previously noted tracheostomy tube. A JP drain is noted\nanterior to the trachea. Nonspecific soft tissue density is noted from the\nlevel of the thyroid cartilage inferiorly to the superior sternal margin,\nwhich may be postoperative. Minimal subcutaneous emphysema is located along\nthe right tracheal margin (see 301:39; 601: 34-40).\n\nEvaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears preserved.Scattered subcentimeter\nnonspecific lymph nodes are noted throughout the neck bilaterally, without\ndefinite enlargement by CT size criteria. Within limits of study, the neck\nvessels are grossly patent.\n\nThe imaged portion of the lung apices demonstrate emphysematous changes.There\nare no osseous lesions. Right sphenoid sinus aerosolized mucosal thickening\nis present. Bilateral ethmoid air cell mucosal thickening is present. Left\nsided nasogastric tube is partially imaged. Soft tissue densities are noted\nwithin bilateral external auditory canals which may represent cerumen. \nLimited imaging the spine demonstrates multilevel degenerative changes.", + "output": "1. Dental amalgam streak artifact and lack of intravascular contrast limits\nstudy. As documentation reports administration of intravenous contrast,\nquestion contrast extravasation versus limited bolus tracking.\n2. Postoperative changes related in patient's known interval tracheostomy\nremoval, tracheal resection, reconstruction, dehiscence repair, and washout\nwith JP drain noted anterior to trachea, as described.\n3. Grossly patent airway with nonspecific minimal subcutaneous emphysema along\nright trachea as described. While findings may be postoperative in nature,\ntracheal anastomotic leak is not excluded on the basis examination." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. There\nis prominence of the ventricles and sulci suggestive of involutional changes.\n\nBilateral maxillary mucous retention cysts and mucosal thickening of the\nethmoid air cells are noted. The remaining visualized portions of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are normal.", + "output": "1. No evidence of fracture, mass, hemorrhage or infarction." + }, + { + "input": "Intravascular contrast remains present from recent CTA of the chest. There is\nno evidence of infarction, hemorrhage, edema, or mass. The ventricles and\nsulci are normal in size and configuration.\n\nThere is skin thickening and fat stranding of the left occipital scalp and\nposterior auricular region. No osseous abnormalities seen. There is mild\nmucosal thickening of the ethmoid and maxillary sinuses. The paranasal\nsinuses are otherwise clear. The mastoid air cells and middle ear cavities\nare clear. The orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Skin thickening and fat stranding of the left occipital scalp and posterior\nauricular region. This may be due to dependent edema but cellulitis it cannot\nbe excluded by imaging. Direct inspection suggested." + }, + { + "input": "The left frontoparietal region, periventricular, series 2, image 17, though a\n2.2 x 1.8 cm rounded hypodensity with suggestion of subtle punctate\nhyperdensity within. There may be subtle adjacent edema. No midline shift or\nherniation is seen. No acute intracranial hemorrhage is seen. Bilateral\nperiventricular subcortical white matter hypodensities suggest sequela of\nchronic small vessel disease. There is no hydrocephalus. The visualized\nparanasal sinuses demonstrate opacification of some ethmoid air cells. The\nremainder the imaged paranasal sinuses are clear. The mastoid air cells and\nmiddle ear cavities are clear.", + "output": "2.2 x 1.8 x 1.7 cm left periventricular frontoparietal hypodensity with subtle\npunctate hyperdensity within and possible subtle adjacent edema, worrisome for\nintracranial mass. MRI would provide further characterization. No midline\nshift.\n\nRECOMMENDATION(S): Brain MRI if no contraindication." + }, + { + "input": "Patient is status post stereotactic biopsy of a left frontoparietal lesion\nwith surrounding edema, now with postoperative changes including mild\npneumocephalus. There is also a 11 x 14 mm acute hematoma within this lesion\n(3:21). No other areas of acute hemorrhage. Again, this lesion closely abuts\nthe left lateral ventricle, but does not result in any significant mass\neffect. No shift of midline structures.\n\nNo evidence of major vascular territorial infarction. The paranasal sinuses\nare clear. There is mild opacification of bilateral mastoid air cells, which\nmay be related to supine positioning. The orbits are unremarkable.", + "output": "Postoperative changes status post stereotactic biopsy of a left frontoparietal\nlesion, including a new 11 x 14 mm hematoma/blood products at the biopsy site." + }, + { + "input": "There is grossly stable 11 x 14 mm hyperdensity at the biopsy site in the\nleft parietal lobe. There has been minimal interval increased to surrounding\nedema. No new areas of hemorrhage are identified. Postsurgical changes\nincluding a left parietal burr hole and a small amount of postoperative\npneumocephalus are unchanged. Ventricles and sulci are unchanged in size and\nconfiguration. The basal cisterns are patent and there is preservation of\ngray-white matter differentiation.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No significant change in size of a 11 mm post biopsy hematoma with minimal\nincrease in surrounding edema.\n2. No new areas of hemorrhage identified." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. The\ngray-white matter differentiation is preserved. The ventricles and sulci are\nnormal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. Postsurgical changes of bilateral lens replacement.\n\nCT PERFUSION:\nThe perfusion images demonstrate no significant perfusion abnormalities or\nfindings to suggest mismatch.\n\nCTA HEAD:\nThere are mild to moderate atherosclerotic calcifications of the parasellar\ninternal carotid arteries. There is a 1 mm outpouching along the\nposteromedial aspect of the distal right internal carotid artery, which is\nfavored to represent an infundibulum at the origin of an atretic right\nposterior communicating artery (image 256 of series 4). There is also\nmoderate narrowing in the left P2 segment of the left posterior cerebral\nartery. There is no evidence of occlusion. The dural venous sinuses are\npatent.\n\nCTA NECK:\nThe evaluation of the aortic arch demonstrates a common origin of the right\nbrachiocephalic and left common carotid arteries, a normal variant. The right\nvertebral artery is dominant. The left vertebral artery is small in caliber\nwith moderate narrowing of the proximal left V2 segment (image 136 of series\n4). The carotid arteries and their major branches appear normal with no\nevidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nLow-attenuation and apparent filling defects in the central portions of the\nleft internal jugular vein at the jugular foramen (image 220 of series 4) are\nfavored to be due to mixing artifact versus a filling defect.\n\nOTHER:\nSecretions are present within the trachea. There is centrilobular and\nparaseptal emphysema in the upper zones. There is an irregular 5 x 7 mm\nnodule in the left apex with a tiny focus of gas attenuation. There is\nbiapical scarring. The visualized portion of the thyroid gland is within\nnormal limits. There is no lymphadenopathy by CT size criteria.", + "output": "1. No evidence of large territorial infarct, acute intracranial hemorrhage, or\nmass lesion.\n2. Mild-to-moderate atherosclerotic calcifications of the parasellar internal\ncarotid arteries.\n3. No findings to suggest perfusion abnormality.\n4. Suspected infundibulum at the origin of an atretic right posterior\ncommunicating artery.\n5. Moderate narrowing of the left P2 segment. Otherwise, patent circle of\n___ with no evidence of occlusion.\n6. Small caliber left vertebral artery with mild-to-moderate moderate\nnarrowing of the proximal left V2 segment.\n7. Irregular 6 mm nodule in the left apex with a tiny focus of gas attenuation\nis indeterminate. Given the irregular, somewhat spiculated appearance,\nrecommend further evaluation with dedicated CT chest.\n\nFOLLOWUP: Follow-up imaging is recommended with a noncontrast CT chest in 3\nmonths to assess for interval change." + }, + { + "input": "There is a 0.9 x 0.4 x 0.8 cm (AP x TV x SI) lobular hyperdensity along the\nright-sided aspect of the falx (axial series 2 image 18, coronal 601b, image\n41). This hyperdensity measures 90 Hounsfield units. The appearance is most\nconsistent with a focal acute subdural hematoma. It is less likely a\nnon-heavily calcified meningioma. Correlation with CT sinuses from ___ is not helpful as this area was not completely included. No additional\nfoci of suspicious for intracranial hemorrhage are identified. There is no\nmass effect or midline shift.\n\nThere is no evidence of an acute cortical infarct. The ventricles and sulci\nare normal in size and configuration.\n\nNo osseous abnormalities seen. The visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The orbits are unremarkable.", + "output": "Approximately 0.9 cm lobular hyperdensity along the right-sided aspect of the\nfalx (well seen coronal series 601b, image 41), most likely a focal acute\nsubdural hematoma. A non-heavily calcified meningioma is also considered\npossible but much less likely. No fracture. Followup noncontrast head CT can\nbe for performed to evaluate stability.\n\nNOTIFICATION: Findings discussed by Dr. ___ of radiology with Dr.\n___ of the Urgent Care Center by phone at 13:45 ___." + }, + { + "input": "Previously seen subdural hematoma in the region of falx has resolved. No acute\nhemorrhage is identified. There is no mass effect midline shift or\nhydrocephalus. Mild to moderate brain atrophy seen. There is no evidence of\nacute hemorrhage mass effect midline shift or hydrocephalus. Gray-white matter\ndifferentiation is maintained.\n\nThe visualized paranasal sinuses are clear. No skull fracture is seen.", + "output": "Resolution of previously seen subdural hematoma. No acute abnormalities are\nseen." + }, + { + "input": "There is no evidence of acute large territory infarction,hemorrhage,edema,or\nmass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Normal study." + }, + { + "input": "Again seen is the hypodensity in the right temporal parietal region consistent\nwith posttreatment changes related to resection of known glioma. There is no\nevidence of large territorial infarction,hemorrhage,edema,or new mass. The\nventricles and sulci are normal in size and configuration. Prominent\nsubarachnoid space posterior to the cerebellar vermis could be due to ___\ncisterna magna versus arachnoid cyst.\n\nRight temporoparietal craniotomy is again noted. No evidence of acute\nfracture. The visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial process. Specifically, no new mass based on CT.\n2. Stable posttreatment changes and prior craniotomy of the right temporal\nparietal region. MRI would be more sensitive for more subtle changes." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect. Ventricles, basal\ncisterns, and cerebral sulci are normal in size for age. Cerebellar tonsils\nterminate at the lower margin of the foramen magnum, which is within normal\nlimits.\n\nThere is no fracture.\n\nThere are aerosolized secretions in the left middle and posterior ethmoid air\ncells, and a partially imaged mucous retention cyst in the visualized portion\nof the left maxillary sinus. Mastoid air cells are well aerated. Prominent\nnasopharyngeal soft tissues may be secondary to the patient's relatively young\nage and/or upper respiratory inflammation.", + "output": "1. No evidence for an acute intracranial abnormality.\n2. Fluid in the left middle and posterior ethmoidal air cells, which may\nrepresent acute sinusitis in appropriate clinical setting. Prominent\nnasopharyngeal soft tissues may be secondary to the patient's relatively young\nage and/or upper respiratory inflammation. Please correlate clinically." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThere is a nonenhancing 9 mm cystic lesion in the left parotid tail, overall\nsimilar to examination of ___. Otherwise, the remainder of the major\nsalivary glands are unremarkable.\n\nThere is diffuse cervical lymphadenopathy, most prominently characterized by\nlevel 2A lymph nodes measuring up to 2.0 cm in long axis, overall similar to\nexamination of ___. Prominent axillary lymph nodes are also identified,\nbetter evaluated on concurrent CT chest. Allowing for respiratory motion\nartifact, visualized lungs are grossly clear. There are small thyroid nodules\nmeasuring up to 6 mm, previously evaluated by thyroid ultrasound.\n\nNo suspicious osseous lesions. No high-grade spinal canal or neural foraminal\nnarrowing. The cervical vessels appear patent. Although not optimized for\nsuch evaluation, visualized brain parenchyma is grossly unremarkable. The\nvisualized paranasal sinuses are essentially clear. The mastoid air cells\nmiddle ears are well pneumatized and clear.", + "output": "1. Although no direct comparison is available on PACS, diffuse cervical\nlymphadenopathy most prominently characterized by level IIa lymph nodes\nmeasuring up to 2 cm in long axis are overall similar in appearance to MRI\ncervical spine examination of ___.\n2. Thyroid nodules measuring up to 6 mm, previously evaluated by ultrasound in\n___.\n3. There are enlarged axillary lymph nodes, better evaluated on concurrent CT\nchest.\n4. 9 mm cystic lesion in the left parotid tail appears similar in size to\nexamination of ___. This could be further evaluated with ultrasound.\n5. Additional findings described above." + }, + { + "input": "No evidence of intracranial hemorrhage, edema, or mass effect. \nPeriventricular, subcortical, and deep white matter hypodensities bilaterally\nare nonspecific and could reflect sequelae of chronic small vessel ischemic\ndisease, age indeterminate in the absence of priors. Bilateral, symmetric\nprominence of the ventricles and sulci is nonspecific but likely reflect\nage-related involutional change. Bilateral cavernous internal carotid and\nvertebral artery calcifications are noted.\n\nNo calvarial fractures are identified.\n\nScalp lacerations with subcutaneous emphysema and hematoma/contusion is noted\nin the bilateral frontal soft tissue, more pronounced on the left (series 2,\nimage 20, ___. A punctate radiopaque density within the left superficial\nscalp at the site of the laceration (03:52) may reflect a foreign body. Some\nof the left mastoid air cells are partially or completely opacified without a\nclear fracture line identified. No pneumocephalus.\n\nThe right mastoid air cells are clear. Mucosal thickening of the right\nfrontal sinus is mild. Some of the ethmoidal air cells are partially\nopacified. The visualized portions of the remaining paranasal sinuses are\notherwise essentially clear. The visualized orbits are unremarkable other\nthan bilateral lens replacements. Degenerative changes in the bilateral\ntemporal mandibular joints, particularly on the right are severe.\n\nCervical spine fractures will be described in detail in the cervical spine\nreport from the same day.", + "output": "1. No intracranial hemorrhage. Bilateral frontal scalp lacerations and\npunctate radiopaque density within the superficial soft tissues at the site of\nthe left frontal laceration as described.\n\n2. Partial opacification of left mastoid air cells without a definite\nfracture line identified.\n\n3. Nonspecific white matter hypodensities bilaterally could reflect sequelae\nof chronic small vessel ischemic disease.\n\n4. Cortical volume loss, age-related.\n\n5. Please refer to the dedicated CT spine report for description of findings\nincluding multiple fractures.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 6:20 ___, 10 minutes after discovery\nof the findings." + }, + { + "input": "There is a normal 3 vessel branching pattern of the aortic arch. The origins\nof the great vessels are patent. Mild calcified and noncalcified plaque\ninvolves the bilateral carotid bifurcations with no evidence of internal\ncarotid artery stenosis by NASCET criteria. The bilateral common and external\ncarotid arteries are patent.\n\nThe vertebral arteries, including their origins, are patent with no evidence\nof dissection. No intimal flap is identified.\n\nThe fractures of the bilateral anterior and posterior arches of C1 and at the\nbase of the odontoid process of C2 are unchanged in appearance and alignment. \nThe C3-C4 intervertebral disc space remains widened.\n\nThere is minimal opacification pacification in the left mastoid tip.\n\nA 4 mm hypodense nodule is in noted in the left thyroid lobe. There is a\ncalcified granuloma in the right upper lobe.", + "output": "1. Patent vertebral arteries with no evidence of injury or dissection.\n2. Unchanged appearance and alignment of the C1 and C2 fractures." + }, + { + "input": "There are new bilateral anterior parietal burr holes with bilateral SEPS\ndevices. There are bilateral subdural collections of layering hyperdense and\nintermediate density blood, fluid, and air. The right collection measures 1.3\ncm along the right frontal convexity (03:20), and previously 1.9 cm at the\nsame level. The left collection measures 0.9 cm (03:26), previously 1.4 cm at\nthe same level. There are acute blood products within both of these fluid\ncollections. Bilateral sulcal effacement has decreased. Effacement of the\nlateral and third ventricles has substantially improved. Previously noted\nminimal leftward shift of midline structures has resolved. The basal cisterns\nare not compressed. There is no CT evidence for an acute major vascular\nterritorial infarction. Mild periventricular and deep white matter\nhypodensities are nonspecific but likely sequela of mild chronic small vessel\nischemic disease in this age group.\n\nPolypoid lesion in the bilateral nasal cavity, near complete opacification of\nthe right frontal sinus and frontoethmoidal recess, opacification of the lower\nleft frontal sinus extending into the frontoethmoidal recess, moderate to\nsevere opacification of the ethmoid air cells, moderate polypoid mucosal\nthickening in the maxillary sinuses, and mild mucosal thickening in right\ngreater than left sphenoid sinuses is unchanged since the presenting CT from ___. Right concha bullosa contains an unchanged polypoid density. \nThere is increased opacification of the left concha bullosa. Mastoid air\ncells and middle ear cavities are well aerated.", + "output": "1. Bilateral mixed density subdural collections are smaller than the evacuated\nbilateral isodense subdural hematomas seen on ___. Bilateral sulcal\neffacement has decreased, and effacement of the lateral and third ventricles\nhas substantially improved.\n2. Nasal polyps and pansinusitis are again noted." + }, + { + "input": "Again noted are bilateral anterior parietal burr holes with bilateral SEPS\ndevices, results in streak artifact limits examination.\n\nThere are bilateral subdural collections of layering hyperdense and\nintermediate density blood, fluid, and air which are decreased in size as\ncompared to CT head ___. The right collection measures 0.9 cm along\nthe right frontal convexity (03:21), previously 1.3 cm on ___. The\nleft collection measures 0.6 cm (03:21), previously 0.8 cm. Degree of sulcal\neffacement has improved. There is no midline shift. Basal cisterns are\npatent. Mild periventricular and deep white matter hypodensities are\nnonspecific but likely sequela of mild chronic small vessel ischemic disease\nin this age group. Atherosclerotic vascular calcifications are noted of\nbilateral cavernous portions of internal carotid arteries.\n\nPolypoid lesion in the bilateral nasal cavity, near complete opacification of\nthe right frontal sinus and frontoethmoidal recess, opacification of the lower\nleft frontal sinus extending into the frontoethmoidal recess, moderate to\nsevere opacification of the ethmoid air cells, moderate polypoid mucosal\nthickening in the maxillary sinuses, and mild mucosal thickening in right\ngreater than left sphenoid sinuses are again noted. Within the right ethmoid\nair cells (see 601b:35, 602b:39) and right frontal sinus (see 602b:32) some\nareas mucosal thickening demonstrate high density. Mastoid air cells and\nmiddle ear cavities are aerated. Soft tissue density is noted within the left\nexternal auditory canal which may represent cerumen.", + "output": "1. Overlying surgical hardware streak artifact limits examination.\n2. Evolving bilateral postsurgical changes related to SEPS placement and\nsubdural evacuation.\n3. Interval decrease in size of mixed density acute on subacute subdural\ncollections, as described.\n4. Decreased bilateral sulcal effacement compared to CT head ___.\n5. Paranasal sinus disease with areas concerning for chronic and / or fungal\nsinusitis, as described." + }, + { + "input": "There has been interval removal of left-sided SEPS device since CT head ___. Again noted are bilateral anterior parietal burr holes.\n\nAgain noted a bilateral subdural collections of layering hyperdense and\nintermediate density blood, fluid, air which are unchanged in size as compared\nto CT head ___. Again noted is mild degree of sulcal effacement,\nunchanged. There is no midline shift. Basal cisterns are patent. Mild\nperiventricular deep white matter hypodensities are nonspecific but likely\nsequelae of chronic small vessel ischemic disease in this age. There are\natherosclerotic vascular calcifications in the bilateral cavernous portions of\nthe internal carotid arteries. There is no new intracranial hemorrhage or\nevidence of acute major vascular territorial infarction. Ventricles and sulci\nare normal in overall size and configuration.\n\nAgain noted is a polypoid lesion in the bilateral nasal cavity. There is\nalmost complete opacification of the right frontal sinus, opacification of the\nleft frontal sinus, moderate to severe opacification ethmoid air cells and\nmucosal thickening of the maxillary sinuses and mucosal thickening in the\nright greater than left sphenoid sinuses. Polypoid lesion in the bilateral\nnasal cavity, near complete opacification of. Mmastoid air cells and middle\near cavities are well aerated.", + "output": "1. Interval removal of left SEPS device since CT head ___.\n2. Mixed density acute on subacute subdural hematomas are unchanged in size as\ncompared to CT head ___.\n3. Mild sulcal effacement of the bilateral frontal lobes is unchanged." + }, + { + "input": "Overall, compared to the prior CT from ___, there has been interval\nimprovement in the size of the bilateral subdural hematomas, on the right\nmeasuring up to 1.3 cm and on the left measuring up to 1.1 cm. Areas of\nincreased density are seen within the subdural hematomas bilaterally\nsuggestive of acute/subacute on chronic bleeding. Mass effect on the local\nparenchyma is unchanged compared to the prior exam however there is no\nevidence of midline shift. The basilar cisterns are patent. Periventricular\ndeep subcortical white matter hypodensities are likely sequelae of chronic\nmicroangiopathy. There is no evidence of acute intracranial infarction.\n\nAgain noted is a polypoid lesion within the bilateral nasal cavities. Near\ncomplete opacification of the right frontal sinus, appears mildly improved\ncompared to the similar to the prior exam. Moderate mucosal sinus thickening\ninvolving the ethmoid air cells also appears unchanged compared to the prior\nexam. The mastoid air cells, and middle ear cavities are clear.", + "output": "1. Overall, interval decrease in the size of the bilateral mixed density\nsubdural hematomas, however with areas of increased density suggestive of an\nacute/subacute on chronic component.\n2. Stable mild sulcal effacement of the bilateral frontal lobes. No evidence\nof midline shift.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 16:31 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." + }, + { + "input": "There is been near resolution to resolution of the bilateral subdural\nhematomas.\n\nProminence of the ventricles and sulci likely relates to age related\ninvolutional changes. Redemonstrated are areas of moderate periventricular\nand deep subcortical white matter hypoattenuation likely representing sequela\nof chronic microangiopathy. There is no acute large territorial infarction,\nmass effect or midline shift.\n\nThere is no evidence of fracture. Redemonstrated is a retention cyst versus\nmucosal polyp within the right frontal sinus. There is mild mucosal\nthickening is present within the maxillary sinuses and ethmoid air cells. The\nvisualized portion of the mastoid air cells and middle ear cavities are clear.\nThe visualized portion of the orbits are unremarkable.", + "output": "1. Resolved to nearly resolved bilateral subdural hematomas.\n2. Moderate nonspecific patchy white matter hypoattenuation can be seen in\nthe setting of chronic microangiopathy.\n3. Paranasal sinus inflammatory changes as detailed above." + }, + { + "input": "There is no hemorrhage, edema, or mass effect. Ventricles and sulci are\nmildly pronounced suggestive mild atrophy, perhaps slightly advanced for\nstated age. There is no shift of normally midline structures. Basal cisterns\nare patent. Gray-white matter differentiation is preserved.\n\nThe orbits are unremarkable. Imaged paranasal sinuses demonstrate mild\nmucosal thickening within the ethmoidal air cells bilaterally and right\nsphenoid sinus. Bilateral mastoid air cells and middle ear cavities are\nclear. The bony calvarium appears intact.", + "output": "1. No acute intracranial abnormality. Please note that MRI may be helpful in\nidentifying a seizure focus.\n2. Mild atrophy, perhaps slightly advanced for stated age." + }, + { + "input": "The patient is status post left occipital craniotomy and meningioma resection,\nwith the expected postsurgical changes, including a small amount of\npneumocephalus in the posterior fossa, suprasellar cistern, right frontal\nconvexity, and vertex, as well as swelling and gas within the soft tissues\noverlying the surgical site. A 4 x 7 mm hyperdensity in the left cerebellar\nhemisphere (4:8) is consistent with a small focus of hemorrhage near the\nsurgical site. There is a small amount of edema near the surgical site.\n\nThere is no evidence of large territorial infarction or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\nThe orbits are unremarkable.", + "output": "1. 4 x 7 mm focus of blood in the left cerebellar hemisphere adjacent to the\nsurgical site.\n2. Status post left occipital craniotomy and meningioma resection, with the\nexpected postsurgical changes as described above, including pneumocephalus." + }, + { + "input": "CTA HEAD:\nCut off of a posterior M3 branch of the right middle cerebral artery is\nredemonstrated in keeping with prior thrombus (2:247). Otherwise, the vessels\nof the circle of ___ and their principal intracranial branches appear\nnormal without stenosis, occlusion, or aneurysm formation. The dural venous\nsinuses are patent.\n\nAgain noted is hypodensity in the right frontoparietal lobe in keeping with\nchronic infarct. There is a new hypodense area in the left frontal lobe\n(2:306), that is new compared to the prior MRI of the brain. There is no\nevidence of no evidence of hemorrhage, edema, or mass. The ventricles and\nsulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs shows interlobular septal thickening in\nboth apices, likely related to fluid overload. The visualized portion of the\nthyroid gland demonstrates a 3 mm hypodense nodule within its right lobe. \nThere is no lymphadenopathy by CT size criteria.", + "output": "1. Chronic occlusion of a posterior M3 branch of the right middle cerebral\nartery is redemonstrated with chronic infarct in the right frontoparietal\nlobe.\n2. Hypodensity in the left frontal lobe is new when compared to prior MRI from\n___ and is suggestive of an subacute infarct. MRI of the brain is\nrecommended to exclude superimposed infection.\n3. Partially visualized lung apices shows interlobular septal thickening that\nis likely related to fluid overload.\n4. 3 mm thyroid gland nodule does not require further follow-up according to\nACR guidelines.\n\nRECOMMENDATION(S): MRI of the brain is recommended for further evaluation.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 15:47 into the Department of\nRadiology critical communications system for direct communication to the\nreferring provider." + }, + { + "input": "Again seen are stable subacute infarcts in the left frontal lobe, without\nevidence of hemorrhage. There is chronic stable infarct in the inferior right\nparietal lobe. There is no evidence of new infarction, hemorrhage,. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. There is benign left parietal bone\nhemangioma or lipoma.", + "output": "1. There has been no interval change. There are stable subacute left frontal\nlobe, and chronic right inferior parietal lobe infarcts. There is no\nhemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Normal study" + }, + { + "input": "Widening of the CSF space overlying the posterior aspect of the left frontal\nlobe is unchanged since ___ possibly reflecting an arachnoid cyst or just\nprominent extra-axial space. There is no evidence of acute intracranial\nhemorrhage, edema, mass effect or large territorial infarction. The\nventricles and sulci are prominent suggesting age-related atrophy. \nPeriventricular and subcortical white matter hypodensities suggest sequela of\nchronic microvascular ischemic disease. The basal cisterns are patent. \nGray-white matter differentiation is maintained.\n\nThere is no fracture. The partially imaged paranasal sinuses, mastoid air\ncells and middle ear cavities are clear. There are scattered atherosclerotic\ncalcifications of the cavernous internal carotid arteries.", + "output": "No acute intracranial abnormality." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is cytotoxic edema in the left occipital and posterior temporal lobes,\nthe full extent of which is better appreciated on subsequent MRI, indicating\nan acute infarction. There is no acute intracranial hemorrhage. There is no\nsignificant mass effect from the infarction at this time, and no shift of\nmidline structures. Ventricles and basal cisterns are normal in size. Again\nseen is a fluid density structure in the right middle cranial fossa which\nremodels the anterior right temporal lobe, similar to PET-CT examination of ___, compatible with an arachnoid cyst.\n\nThere is mild mucosal thickening in the ethmoid air cells and frontoethmoidal\nrecesses. There is mild polypoid mucosal thickening with small mucous\nretention cysts in the right maxillary sinus there are right maxillary\nperiapical lucencies with dehiscence of the buccal cortex on image 5:219 and\nsuspected dehiscence of the right maxillary sinus floor. There is mild\nmucosal thickening in the inferior left maxillary sinus. There are bilateral\nconcha bullosa. Mastoid air cells are well aerated. There is evidence of\nleft cataract surgery. There are multiple periapical lucencies in the\nmandible.\n\nCTA NECK:\nThere is a four vessel aortic arch with the non dominant left vertebral artery\noriginating directly from the arch between the left subclavian and left common\ncarotid arteries, a normal variant. The left vertebral artery enters the\ncervical spine at C6 rather than C7, another normal variant. The carotid and\nvertebral arteries are patent without flow-limiting stenosis or dissection.\n\nCTA HEAD:\nThere are mild vascular calcifications of the cavernous and paraclinoid\nsegments of the internal carotid arteries without flow-limiting stenosis. \nThere is no evidence for flow-limiting stenosis or aneurysm involving other\nmajor intracranial arteries. Fetal configuration of the right posterior\ncerebral artery is noted. Dural venous sinuses are patent.\n\nOTHER:\nEvaluation of the included upper lungs is limited by respiratory motion\nartifact mild dependent atelectasis is present. There are multiple\nnonenlarged bilateral paratracheal and AP window lymph nodes visualized\nportion of the heart appears enlarged. The thyroid gland is unremarkable. \nThere is no lymphadenopathy. There are degenerative changes in the cervical\nspine.", + "output": "1. Acute infarction involving the left occipital and posterior temporal lobes,\nin the posterior cerebral artery territory. No acute hemorrhage.\n2. Unchanged right middle cranial fossa arachnoid cyst.\n3. Head and neck CTA demonstrates no evidence of flow-limiting stenosis or\ndissection.\n4. The non dominant left vertebral artery arises directly from the aortic\narch, a normal variant.\n5. Multiple right maxillary and bilateral mandibular periapical lucencies. In\nthe setting, inflammatory changes in the right maxillary sinus may be\nodontogenic. Please correlate clinically whether active dental inflammation\nmay be present.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 5:00 pm, 2\nminutes after discovery of the findings." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Basilar cisterns are\npatent.\n\nIncluded paranasal sinuses are clear. Few scattered opacified mastoids are\nidentified, left greater than right. Skull and extracranial soft tissues are\nunremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Mild periventricular white matter hypodensity is suggestive of\nchronic microvascular ischemic disease. Ventricles and sulci are mildly\nprominent likely due to age related involutional change. Basal cisterns are\npatent. The imaged paranasal sinuses are mostly clear aside from a retention\ncyst or polyp in the lower left maxillary sinus. The mastoid air cells and\nmiddle ear cavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is a large right frontal subgaleal hematoma measuring 1.9 cm. No\nevidence of underlying fracture or intracranial hemorrhage. There is no\nevidence of infarction,edema,or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. Periventricular white matter\nhypodensities consistent with small vessel ischemic changes. A fracture of\nthe right C1 lateral mass is better seen on the cervical spine CT.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal. \nPatient is status post bilateral lens replacement.", + "output": "1. Large 1.9 cm right frontal subgaleal hematoma without evidence of\nunderlying fracture or intracranial hemorrhage." + }, + { + "input": "Mild calcified atherosclerotic plaque is noted along the aortic arch and\norigins of the major vessels. The carotid and vertebral artery origins are\npatent.\n\nThere is mild calcified and noncalcified atherosclerotic plaque at the\nbilateral common carotid artery bifurcations without high-grade stenosis. The\ncarotidandvertebral arteries and their major branches are patent with no\nevidence of high-grade stenoses, dissection or occlusion. There is no\nstenosis of the internal carotid arteries by NASCET criteria.\n\nThere is redemonstration of a fracture involving the right lateral mass of C1\nextending to the right transverse foramen and a mildly displaced fracture of\nthe C7 spinous process involving the bilateral lamina with overlying soft\ntissue swelling. Partially visualized fractures of the upper thoracic spine\nare noted, better evaluated on the dedicated cervical and chest CT.\n\nThere are multiple bilateral hypodense thyroid nodules with several enhancing\nnodules measuring up to 1.7 cm in the right thyroid lobe.", + "output": "1. No definite evidence of carotid or vertebral artery dissection, occlusion\nor high-grade stenosis.\n2. Redemonstrated fractures involving the right lateral mass of C1 extending\nto the right transverse foramen and spinous process/lamina fractures of C7 and\nupper thoracic spine, better evaluated on the dedicated CT cervical spine and\nCT chest.\n3. Multinodular goiter with enhancing nodules measuring up to 1.7 cm in the\nright thyroid lobe. Recommend follow-up thyroid ultrasound on a nonurgent\nbasis.\n\nRECOMMENDATION(S): Thyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or older, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "Examination is moderately motion degraded despite repeat imaging. Within this\nlimitation, there is no intra-axial or extra-axial hemorrhage, mass effect,\nmidline shift, or acute major vascular territorial infarct. Gray-white matter\ndifferentiation is preserved. Ventricles and sulci and unremarkable. Basilar\ncisterns are patent. Dense atherosclerotic calcifications noted within the\nintracranial ICAs bilaterally.\n\nIncluded paranasal sinuses and mastoids are essentially clear. Skull and\nextracranial soft tissues are unremarkable.", + "output": "Motion degraded exam without visualized acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nNote is made of bilateral basal ganglial calcifications. Periventricular\nwhite matter hypodensities are consistent with sequela of chronic small vessel\nischemic disease.\n\nThere is no evidence of fracture. Mucosal thickening and a mucous retention\ncyst is seen in the left maxillary sinus. More mild mucosal thickening is\nseen in the right maxillary sinus and bilateral anterior ethmoid air cells. \nFluid is layering in the right sphenoid sinus. Remaining visualized paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No intracranial hemorrhage.\n2. Paranasal sinus inflammatory disease, as described above. Recommend\ncorrelation with symptoms." + }, + { + "input": "Study is moderately degraded by motion.\n\nThere are 2 small chronic cerebellar infarcts, 1 on each side. There is no\nacute large territorial infarction, intracranial hemorrhage, edema, or mass\neffect. There are few coarse calcifications in the subcortical white matter,\nof unlikely significance may be related to distant inflammatory, infectious or\nischemic episode. The ventricles and sulci are enlarged suggesting age\nrelated atrophy. There are moderate chronic small vessel ischemic changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Moderately motion limited examination.\nThere are small chronic cerebellar infarcts, generalized parenchymal atrophy,\nand moderate chronic small vessel ischemic changes." + }, + { + "input": "Evaluation of the vertex is limited by patient motion. There is no evidence\nfor acute hemorrhage, edema, or mass effect. A chronic infarction is again\nseen in the left cerebellum. Multiple coarse calcifications are again seen\nalong the cortex, as well as in the basal ganglia and midbrain, suggestive of\nprior infection. There are extensive supratentorial white matter\nhypodensities, as before, nonspecific but likely sequela of chronic small\nvessel ischemic disease in this age group. There is age-related global\nparenchymal volume loss with prominent ventricles and sulci.\n\nThere is no evidence of acute fracture. There are aerosolized secretions in\nthe left maxillary sinus and partial bilateral mastoid air cell opacification,\nwhich may be secondary to prolonged supine positioning in the inpatient\nsetting.", + "output": "No evidence for acute intracranial abnormalities." + }, + { + "input": "The study is moderately motion degraded despite repeat acquisitions. Within\nthis limitation: There is no definite evidence of acute large territorial\ninfarction,hemorrhage,edema, or mass effect. There is prominence of the\nventricles and sulci suggestive of involutional changes. Periventricular and\nsubcortical white matter hypodensities are nonspecific but suggest chronic\nsmall vessel ischemic changes\n\nThere is no evidence of fracture. Moderate mucosal thickening of the right\nmaxillary sinus noted. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. The study is moderately motion degraded despite repeat acquisitions. \nWithin this limitation: No definite evidence of acute intracranial abnormality\non noncontrast head CT. Specifically no large territory infarct or\nintracranial hemorrhage. Please note, MR is more sensitive for evaluation of\nintracranial mass." + }, + { + "input": "Evaluation is moderately limited due to patient motion, particularly within\nthe inferior cranium.\n\nThere is no evidence of acute large territory infarction,hemorrhage,edema,or\nmass. Chronic infarcts in the bilateral cerebellar hemispheres are again\nseen. However, there is new focal loss of gray-white matter differentiation\nbetween the right superior and middle frontal sulci (02:19) consistent with\nchronic infarct as well. Otherwise, periventricular and subcortical white\nmatter hypodensities are nonspecific but appear similar to prior and likely\nrepresent chronic microangiopathic changes. There is prominence of the\nventricles and sulci suggestive of involutional changes.\n\nThere is bilateral hyperostosis frontalis interna. There is no evidence of\nfracture. The anterior ethmoid air cells are partially opacified. Otherwise,\nthe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear.", + "output": "Chronic infarct near the vertex of the right frontal lobe, as above, is new\nsince the prior CT of ___. No acute large territory infarction or\nintracranial hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive involutional changes,\ngrossly unchanged. There are grossly stable periventricular and subcortical\nlucencies, which may represent small vessel ischemic changes, allowing for\ndifference in technique. Atherosclerotic vascular calcifications are noted of\nbilateral cavernous portions of internal carotid arteries.\n\nThere is no evidence of fracture. The visualized portion of the mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are preserved. Approximately 6 mm right parietal scalp at least\npartially calcified probable sebaceous cyst is again noted (see 02:24 on\ncurrent study and 06:14 on prior brain MRI). Right sphenoid sinus air-fluid\nlevel is noted (see 3:4).", + "output": "1. No acute intracranial abnormality.\n2. No evidence acute intracranial hemorrhage or fracture.\n3. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described.\n4. Right sphenoid sinus paranasal sinus disease, concerning for acute\nsinusitis." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass.\n\nThe ventricles and sulci are normal in size and configuration. A tiny focus\nof fat is seen along the falx superiorly to where the straight sinus joins the\ntorcula (series 2, image 12 and series 3, image 240).\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. Small bilateral posterior communicating arteries are\npresent. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere are atherosclerotic changes along both carotid siphons but without\nhigh-grade stenosis. The vessels of the circle of ___ and their principal\nintracranial branches appear normal without stenosis, occlusion, or aneurysm\nformation. The dural venous sinuses are patent.\n\nCTA NECK:\nNormal 3 vessel aortic arch. There are mild atherosclerotic changes at both\ncarotid bifurcation but without evidence of internal carotid stenosis by\nNASCET criteria.\nThe carotidandvertebral arteries and their major branches appear otherwise\nunremarkable with no evidence of stenosis or occlusion.\n\nOTHER:\nThere is gravity dependent atelectasis. No suspicious pulmonary nodules. \nThere is a 6 mm heterogeneous nodule in the superior right thyroid lobe\n(series 3, image 86). The remainder of the visualized thyroid gland is\nunremarkable. There is no lymphadenopathy by CT size criteria.", + "output": "1. No evidence of acute infarction, intracranial hemorrhage or mass.\n2. Patent intracranial and cervical vasculature without evidence of\ndissection, stenosis, occlusion or aneurysm formation greater than 3 mm." + }, + { + "input": "Evaluation of the oral to hypopharynx is slightly limited secondary to motion\nartifact and evaluation of the oral cavity is limited secondary to artifact\nfrom dental hardware.\n\nThere is an external BB overlying a right preauricular 1.3 x 1.6 x 1.4 cm\nsubcutaneous lesion demonstrating very mild enhancement, isointense to that of\nthe skin, with suggestion of mild surrounding inflammatory stranding, exerting\nanterior mass effect on the auriculotemporal artery. The lesion appears\ncontiguous with the skin, which appears thickened. There is a preserved fat\nplane between this lesion and parotid glands. No evidence of bony extension.\n\nThere is no lymphadenopathy by CT size criteria. The parotid glands,\nsubmandibular glands are unremarkable. The infratemporal fossa anterior\nregarding fossa also appear unremarkable.\n\nVisualized brain is unremarkable. The paranasal sinuses are essentially clear,\nnoting a small mucous retention cyst in the right maxillary sinus. The mastoid\nair cells are a cavities are well pneumatized and clear. The orbits are\nunremarkable.\n\nThere is a 9 mm pulmonary nodule in the right upper lobe demonstrating\nperipheral calcification (series 3, image 95). Multiple of calcifications into\nthe left upper lobe is also noted. In addition, multiple calcified lymph nodes\nare seen in the mediastinum. The combination of these findings is consistent\nwith prior granulomatous disease. There are peripheral nonspecific\nground-glass opacities as well as biapical pleural parenchymal scarring.\n\nMultilevel degenerative changes, most prominent at the C4-5 through C6-7\ndemonstrating loss of disc height, vacuum disc phenomenon, endplate sclerosis\nand posterior marginal osteophytes. No suspicious blastic or lytic osseous\nlesions.", + "output": "Nonspecific 1.6 cm lesion in the right pre-auricular subcutaneous tissue\ndemonstrating mild enhancement. At this point, the differential is rather\nbroad and may represent lymphadenopathy, infectious process, or soft tissue\nneoplasm. Further evaluation with ultrasound and or MRI, if there no\ncontraindications, in this region is recommended." + }, + { + "input": "Patient is status post interval resection of the pre-auricular soft tissue\nlesion on the right. There is some asymmetric soft tissue changes in this\nregion (03:20) without discrete mass is identified. This could be post\ntreatment related. Thickening of the right platysmas also slightly post\nradiation related.\n\nThe parotid glands, submandibular glands, and thyroid are unremarkable. There\nis no cervical adenopathy.\n\nThe aerodigestive tract appears normal. Included paranasal sinuses and\nmastoids are clear besides minimal mucosal thickening in the right maxillary\nsinus.\n\nVascular structures in the neck are grossly unremarkable.\n\nIncluded intracranial structures appear normal.\n\nDegenerative changes noted in the spine without suspicious osseous lesion.\n\nPartially calcified nodular opacities in the right upper lobe are unchanged.\nBronchiectasis in the upper lobes bilaterally as well as biapical right\ngreater than left pleural based scarring. Calcified mediastinal lymph nodes\nare again noted. These findings overall suggest prior granulomatous disease.", + "output": "Interval resection with loss of the fat planes in the preauricular region on\nthe right, likely post treatment related. No discrete mass lesion identified.\nNo cervical adenopathy." + }, + { + "input": "Head CT: There is no evidence of acute intracranial hemorrhage or mass\neffect. There is mild diffuse brain parenchymal volume loss. There is\nconfluent subcortical white matter hypodensity which is nonspecific though\npresumably on the basis of sequelae of chronic small vessel ischemic disease.\nThe orbits and paranasal sinuses are unremarkable.\n\nHead CTA: There is atheromatous plaque within the bilateral cavernous\ninternal carotid arteries. The anterior cerebral arteries, middle cerebral\narteries, and posterior cerebral arteries appear normal. There is no evidence\nof aneurysm, vascular malformation, or occlusion within the intracranial\nvasculature.\n\nNeck CTA: The aortic arch demonstrates conventional three-vessel branch\nconfiguration. There is atheromatous vascular disease within the aortic arch.\nThe origins of the great vessels are patent. The right vertebral artery is\ndominant. There is focal narrowing of the distal left vertebral artery. \nThere is minimal atherosclerotic plaque at the origins of the bilateral\nproximal internal carotid arteries, left greater than right, with no stenosis\nby NASCET criteria.\n\nThere are multiple right upper lobe pulmonary nodules in combination with\nmultiple calcified mediastinal lymph nodes which could represent sequelae of\nprior granulomatous disease. Comparison with prior exams or CT of the chest\ncould be performed for further evaluation, as clinically warranted. There is\nthickening of the platysma on the right side, as well as loss of some of the\nfat planes in the submandibular region and an enlarged, 1.5 cm right level II\na lymph node which appears unchanged. These findings may reflect post\ntreatment related change. The thyroid gland, submandibular glands, and parotid\nglands are unremarkable. There is multilevel cervical spondylosis.", + "output": "1. No evidence of acute intracranial hemorrhage or mass effect.\n2. Brain parenchymal volume loss and presumed sequelae of chronic small vessel\nischemic disease.\n3. No evidence of aneurysm, vascular malformation, or occlusion within the\nvasculature of the head and neck.\n4. Focal narrowing of the distal left vertebral artery.\n5. Multiple right upper lobe pulmonary nodules in combination with multiple\ncalcified mediastinal lymph nodes which could represent sequelae of prior\ngranulomatous disease.\n6. Presumed post treatment related changes of the right side of the neck with\nand enlarged right level II a lymph node which is unchanged.\n\nRECOMMENDATION(S): Regarding pulmonary nodules, comparison with prior exams\nor CT of the chest could be performed for further evaluation, as clinically\nwarranted." + }, + { + "input": "Left : The external auditory canal is normal. The middle ear cavity is clear.\nThe ossicles and tegmen are intact. There is no evidence for enlarged\nvestibular aqueduct or superior semicircular canal dehiscence. The facial\nnerve follows a normal course through the middle ear. There is no evidence for\ninner ear dysplasia. The mastoids are clear. There is no abnormal enhancement\non post contrast imaging.\n\nRight: Enhancing soft tissue obliterating the fat planes measuring\napproximately 2.4 x 2.2 cm (AP, TRV) anterior to the auricle extending to the\nlevel of the posterior temporal mandibular joint and with mild the soft tissue\nthickening at the ostium of the external auditory canal is noted. There is no\nextension into the masticator space. Associated inflammatory stranding\nsurrounding the parotid gland with hyperemia is more pronounced when compared\nto prior exam of ___. No confluent fluid collections are identified. \nMinimal opacification of the mastoid air cells along the posterior wall of the\nexternal auditory canal (series 3, image 125) appears new from prior exam\nalthough there is no definitive evidence of osseous erosion.\n\nThe middle ear cavity is clear. The ossicles and tegmen are intact. There is\nno evidence for enlarged vestibular aqueduct or superior semicircular canal\ndehiscence. The facial nerve follows a normal course through the middle ear.\nThere is no evidence for inner ear dysplasia. The mastoids are clear. There is\nno abnormal enhancement on post contrast imaging.\n\nOther: Visualized brain are normal.", + "output": "1. Enhancing 2.4 x 2.2 cm soft tissue anterior to the right auricle extends\nto the level of the posterior temporal mandibular joint anteriorly. This is\ncontiguous with skin thickening of the proximal portion of the external\nauditory canal posteriorly. Associated inflammatory stranding and hyperemia\nof the right parotid gland is noted. The findings are compatible with\nexternal otitis/ phlegmon without confluent fluid collection to suggest\nabscess.\n2. There is no extension into the right masticator space.\n3. Mild opacification of the mastoid air cells adjacent to the posterior wall\nof the external auditory canal is noted without definitive osseous dehiscence,\npresumably reactive in nature.\n4. The middle ear cavities and inner ear structures are unremarkable\nbilaterally." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are prominent compatible with age-related atrophy. Small area of\nleft occipital encephalomalacia is noted (601:83), unchanged. Periventricular\nand subcortical white matter hypodensities likely reflect sequelae of chronic\nsmall vessel ischemic disease.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial findings, specifically no evidence of intracranial\nbleed." + }, + { + "input": "Fat stranding and soft tsoft tissues overlying the right periorbital region. \nThere is no evidence ofinfarction,hemorrhage,edema,mass or mass effect. \nProminence of the sulci and ventricles is suggestive of involutional changes. \nThe multiple hypodensities within the periventricular, deep and subcortical\nwhite matter that are nonspecific but likely sequela of chronic microvascular\nischemic disease. There is calcified atherosclerosis demonstrated at the\nbilateral carotid siphons.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "1. Right periorbital soft tissue swelling is noted without underlying fracture\nor hematoma.\n2. No evidence of acute intracranial process, specifically no large\nterritorial infarction or hemorrhage.\n3. Supratentorial white matter changes are likely nonspecific but may\nrepresent sequela of chronic microvascular ischemic disease." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction, mass or midline\nshift. There is no hydrocephalus. Visualized paranasal sinuses and mastoid\nair cells are clear. There is no fracture. There are mild small vessel\nischemic changes in the white matter.", + "output": "Unremarkable unenhanced head CT. No acute findings." + }, + { + "input": "There is no evidence of hemorrhage, infarction or midline shift. There is no\nhydrocephalus. There is no edema. There is no fracture.\n\nVisualized paranasal sinuses and mastoid air cells are clear.", + "output": "No evidence of mass, hemorrhage or infarction." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nlarge mass. Periventricular and subcortical white matter hypodensities are\nnonspecific, but likely represent chronic small vessel ischemic disease. \nProminence of the ventricles and sulci is suggestive of involutional changes. \nCavernous carotid artery calcifications are seen.\n\nNo acute osseous abnormalities seen. The paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass effect. Prominent ventricles and sulci are suggestive of age-related\ninvolutional change. Mild periventricular white matter hypodensities are\nconsistent with chronic small vessel ischemic disease.\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute major infarction,intracranial\nhemorrhage,edema,or discrete mass. There is prominence of the ventricles and\nsulci suggestive of involutional changes. Nonspecific ventricular\nhypodensities could represent sequela of chronic small vessel disease, largely\nunchanged.\n\nThere is no acute fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Prominence of\nthe ventricles and sulci is consistent with age related involutional changes. \nMild nonspecific periventricular white matter hypodensities are suggestive of\nchronic small vessel ischemic disease. Atherosclerotic calcifications of the\ncavernous portions of the carotid arteries and of the right vertebral artery\nare noted.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "No evidence of acute large territorial infarction, acute intracranial\nhemorrhage, edema, or mass effect. The ventricles and sulci are prominent,\nlikely reflective of age-related volume loss. Periventricular hypodensities\nare nonspecific, but likely reflect chronic small vessel ischemic changes. \nModerate distal right vertebral arterial and bilateral carotid siphon\ncalcifications.\n\nNo acute osseous abnormalities. The paranasal sinuses are clear. The mastoid\nair cells and middle ear cavities are clear.", + "output": "No acute intracranial process." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nAero digestive tract: The calcified structure identified on the radiograph in\nthe larynx at the level of C4-5 is suggested to correspond to calcification of\nthe left cricoid cartilage (2:56, 602:34). Otherwise, no radiopaque foreign\nbody concerning for a chicken bone is identified. There are some secretions\nin the vallecula. Pharyngeal soft tissues are otherwise grossly preserved.\n\nNeck lymph nodes: Cervical lymph nodes measuring up to 7 mm are not enlarged\nby CT size criteria, and are nonspecific. Retropharyngeal nodes are not\nenlarged\n\nBones, skull base: The imaged osseous structures are unremarkable.\n\nThyroid, salivary glands: Grossly preserved.\n\nOther findings: The imaged portions of the lung apices are clear.", + "output": "1. Dental amalgam streak artifact limits study.\n2. Within limits of study, no definite evidence of radiopaque foreign body\nconcerning for an ingested chicken bone in the imaged esophagus, pharynx,\nlarynx or cervical trachea.\n3. Radiopaque structure seen on radiograph likely corresponds to calcification\nof the left cricoid cartilage, as described above.\n4. Subcentimeter nonspecific lymph nodes as described." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. There\nis a right prominent perivascular space. The ventricles and sulci are normal\nin size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No fracture or acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Prominent\nventricles and sulci are consistent with age-related involutional change. \nPeriventricular white matter hypodensities are consistent with sequela of\nchronic small vessel ischemic disease.\n\nNo acute osseous abnormalities seen. There is complete opacification of the\nleft maxillary sinus with surrounding bony sclerosis, suggesting chronic\ninflammation. Hyperdense material within the left maxillary sinus could\nsuggest colonization with fungal elements. Fluid is seen within several\nleft-sided mastoid air cells and anterior ethmoid air cells. Remaining\nvisualized paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear The orbits are unremarkable.", + "output": "1. No acute intracranial process.\n\n2. Opacification of the left maxillary sinus, with evidence of chronic\ninflammation. Hyperdense material within the left maxillary sinus could\nsuggest colonization with fungal elements." + }, + { + "input": "There is no evidence of acute infarct,hemorrhage, edema, or mass effect.\nProminent ventricles and sulci are suggestive of age-related involutional\nchange. Periventricular white matter hypodensities are consistent with\nchronic small vessel ischemic disease and similar in distribution compared to\n___.\n\nThere is no evidence of fracture. There is complete opacification of the left\nmaxillary sinus and mucosal thickening of the right maxillary sinus and\nscattered anterior and posterior ethmoid air cells. Hyperdensity within the\nleft maxillary sinus could be due to chronic inspissated secretions or fungal\nsuperinfection. The other visualized paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Age-related involutional changes and sequela of chronic small vessel\nischemic disease, similar in appearance compared to ___.\n3. Complete opacification of the left maxillary sinus and mucosal thickening\nof the right maxillary sinus and scattered anterior and posterior ethmoid air\ncells. Hyperdensity in the left maxillary sinus could be due to chronic\ninspissated secretions although fungal superinfection or hemorrhage are\npossible." + }, + { + "input": "The study is mildly limited by motion artifact. There is no evidence for\nacute hemorrhage, edema, or loss of gray/ white matter differentiation. \nPeriventricular, deep, and subcortical white matter hypodensities are grossly\nunchanged, nonspecific but likely sequelae of chronic small vessel ischemic\ndisease. Mild parenchymal volume loss with prominent ventricles and sulci is\nagain noted.\n\nAgain seen is near complete opacification of the left maxillary sinus with\nmural sclerosis, consistent chronic sinusitis. There is increased, now\ncomplete opacification of a left anterior ethmoid air cell, image 3:4,\ncompared to ___. Mastoid air cells are grossly well-aerated.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. Evidence of chronic left maxillary sinusitis is again seen. Increased, now\ncomplete opacification of a left anterior ethmoid air cell, which may be\nsecondary to prolonged supine positioning in the inpatient setting, but please\ncorrelate clinically whether there evidence for worsening sinusitis." + }, + { + "input": "The patient is slightly rotated compared to the prior exam. The patient has\nbeen intubated in the interim.\n\nThere is no evidence of infarction, hemorrhage, edema, or mass. Gray-white\nmatter differentiation appears preserved throughout. Periventricular and\nsubcortical white matter hypodensities are mild and nonspecific, likely\nsequelae of chronic small vessel ischemic disease, unchanged. There is mild\ndilatation of the ventricles and sulci in an atrophic pattern, unchanged. The\nbasal cisterns are patent. No shift of normally midline structures.\n\nNo osseous abnormalities seen. The left maxillary sinus is now completely\nopacified, slightly worse from the prior exam. Associated hyperostosis of the\nleft maxillary sinus wall is similar, suggesting a degree of chronicity. \nSmall air-fluid level and mucosal secretions in the left sphenoid sinus are\nnew. Mucosal thickening in the right sphenoid sinus is minimal. Partial\nopacification of the anterior left ethmoidal air cells is overall unchanged. \nOpacification in the right ethmoidal air cells is minimal. Opacification of\nthe right maxillary sinus with a polypoid mucous retention cyst or polyp is\nmild. Mucosal thickening of the left frontal sinus is mild. The visualized\nright frontal sinus is clear. Air-fluid levels in the bilateral nasal\npassages and nasopharynx is new, likely related to interval intubation. \nPartial opacification of the bilateral mastoid air cells may be secondary to\nprolonged dependent positioning, unchanged.\n\nA 1.8 x 1.2-cm hypodense, ovoid lesion in the soft tissue of the right\nposterior scalp is unchanged and could represent an inflamed sebaceous cyst\n(series 2, image 7).\n\nThe orbits are unremarkable.", + "output": "1. No evidence of infarction or hemorrhage. Note that MR is more sensitive\nfor the detection of for stroke.\n\n2. Slightly progressive left greater than right paranasal sinus disease,\nperhaps related to interval intubation.\n\n3. Age-related mild involutional changes.\n\n4. Probable sequelae of chronic small vessel ischemic disease, unchanged." + }, + { + "input": "A subtle area of increased density measuring 5-mm, in the inferior right\nfrontal lobe, series 2, image 10 is new compared to the prior exam from ___.\nNo other area of acute hemorrhage is identified. There is no evidence of mass,\nmass effect, or large territorial infarction. Mildly prominent ventricles and\nsulci is likely related to age related involutional changes. The basilar\ncisterns are patent, and there is otherwise good preservation gray-white\nmatter differentiation.\n\nThere is near complete opacification of the left maxillary sinus. The right\nmaxillary sinus is unremarkable. The visualized paranasal sinuses are\notherwise unremarkable. The mastoid air cells and middle ear cavities\nbilaterally are normal. No acute fractures identified, however the calvarium\nappears to be diffusely demineralized, with a permeative appearance,\nconcerning for an infiltrative process. The globes are unremarkable.", + "output": "1. Subtle area of increased density in the inferior right frontal lobe, it is\nnew compared to the prior exam from ___, measuring 5 mm (2;10). This is\nlikely secondary to artifact, rather than hemorrhage, however a repeat CT in 6\nhr is recommended for further evaluation.\n\n2. Demineralized, diffuse permeative appearance of the calvarium is concerning\nfor an infiltrative process. Metastatic disease cannot be excluded, and\nappears to have progressed compared to the prior exam from ___." + }, + { + "input": "Moderate atrophic changes are stable. There is again white matter hypo\ndensity along periventricular white matter in the frontal and parietal lobes\nwhich is similar to prior findings and although not specific most commonly due\nto chronic small vessel ischemic disease. There is no shift of midline\nstructures. Gray-white matter distinction appears preserved. Surrounding\nsoft tissue structures are unremarkable. The mastoid air cells appear clear. \nThere is mild mucosal thickening of the partly visualized ethmoid and left\nmaxillary sinus. Sphenoid sinuses are unusually large but clear. Trace fluid\nis present in mastoid air cells posteriorly on both sides. Posterior skull\nthickening and sclerosis with many small lucencies could be seen with\nhyperparathyroidism.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture. There is complete opacification of the left\nmaxillary sinus with surrounding bony sclerosis suggesting chronic\ninflammation. There is also opacification of the left anterior ethmoid air\ncells. The remaining visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear.\n\nThe left superior ophthalmic vein is prominent but unchanged in size since at\nleast examination of ___, likely representing varix.\n\nOtherwise, the visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial process on noncontrast head CT.\n2. Parenchymal atrophy.\n3. Opacification of the left maxillary sinus with evidence of chronic\ninflammation." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Incidentally noted is an\nempty sella.\n\nIncluded paranasal sinuses and mastoids are clear, besides mucosal thickening\nin the right sphenoid sinus. Skull and extracranial soft tissues are\nunremarkable.", + "output": "No acute intracranial process, no hemorrhage.\nEmpty sella which can be seen incidentally. While this can be a normal\nvariant and incidental, clinical correlation regarding idiopathic intracranial\nhypertension is suggested." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,intracranial hemorrhage, edema, mass, mass\neffect or shifting of the normally midline structures.\n\nThe ventricles and sulci are normal in size and configuration for patient's\nage.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is a posteriorly directed 3 mm saccular aneurysm at the origin of the\nright posterior communicating artery.\n\nOtherwise, the vessels of the circle of ___ and their principal\nintracranial branches appear normal without stenosis, or occlusion.\n\nThe dural venous sinuses are patent.\n\nCTA NECK:\nNormal 3 vessel aortic arch.\nThere is moderate narrowing at the origin of the left vertebral artery. Focal\nnarrowing of the proximal V1 segment of the left vertebral artery secondary to\nadjacent degenerative osteophytes is noted (series 3, image 100). The\ncervical course of both vertebral arteries is otherwise unremarkable.\n\nThe carotid arteries and their major branches appear normal with no evidence\nof stenosis or occlusion.\n\nThere are mild atherosclerotic changes along both carotid bifurcations but\nwithout evidence of significant internal carotid stenosis by NASCET criteria.\n\nOTHER:\nNo suspicious pulmonary nodules. There is a 7 mm hypodense nodule in the left\nthyroid lobe for which no follow-up is recommended according to current\nguidelines. The remainder of the thyroid gland appears unremarkable. There\nis no lymphadenopathy by CT size criteria. Mild-to-moderate multilevel\ndegenerative changes are visualized throughout the cervical spine consistent\nwith anterior and posterior spondylosis, more significant from C4-C5 through\nC6-C7 levels.", + "output": "1. No evidence of acute infarction, hemorrhage or intracranial mass.\n2. Posteriorly directed 3 mm saccular aneurysm at the origin of the right\nposterior communicating artery.\n3. Moderate narrowing at the origin of the left vertebral artery.\n4. Otherwise patent intracranial and cervical vasculature without evidence of\nvessel occlusion or dissection.\n\nNOTIFICATION: The primary team was aware of these findings at the time of\nthis interpretation." + }, + { + "input": "Hypodensity within the left posterior limb of the internal capsule is\nconsistent expected evolution of the infarct seen on the prior MRI. There is\nno evidence of hemorrhagic transformation. No under infarction is identified.\nThe 2.2 cm heterogeneous mass in the sella is unchanged from the prior CT and\nwas better characterized on the recent MRI. Prominent ventricles and sulci\nsuggest age related atrophy. Periventricular white matter hypodensities are\nnonspecific but likely represent sequela of chronic small vessel ischemic\ndisease. The basal cisterns appear patent and there is preservation of\ngray-white matter differentiation.\n\nNo fracture is identified. The visualized paranasal sinuses, mastoid air cells\nand middle ear cavities are clear. The globes are unremarkable.\nAtherosclerotic mural calcification of the vertebral and internal carotid\narteries is noted.", + "output": "1. Expected evolution of the infarct in the left posterior limb of the\ninternal capsule with no evidence of hemorrhagic transformation.\n2. No evidence of other infarction.\n3. Mass in the sella was better characterized on recent brain MRI, likely a\npituitary macroadenoma." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, shift of normally\nmidline structures or acute major vascular territorial infarction. There is\ninterval evolution of the infarct in the left posterior limb of the internal\ncapsule with no evidence of complication. There is re- demonstration of a 2.0\ncm mass in the sella, unchanged since from prior CT and better characterized\non prior MRI. Prominence of ventricles and sulci is consistent with age\nrelated involutional changes. Periventricular white matter hypodensities are\nlikely the sequela of chronic small vessel ischemic disease. The basal\ncisterns appear patent and there is otherwise preservation of gray-white\nmatter differentiation.\n\nThere is no fracture. There is a small osteoma in the left frontal sinus. \nOtherwise, the visualized paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The globes are unremarkable.", + "output": "1. No acute intracranial abnormality. Interval appropriate evolution of\ninfarct in the left posterior limb of the internal capsule.\n2. Known sellar mass, better characterized on prior MRI as a pituitary\nmacroadenoma." + }, + { + "input": "The study is moderately limited by patient motion.\n\nThere is a small left parafalcine subdural hematoma measuring 3 mm in maximal\nwidth, without mass effect on the adjacent brain parenchyma. There is no\nevidence of parenchymal hemorrhage, edema, or loss of gray/ white matter\ndifferentiation. There are foci of low density in the subcortical, deep, and\nperiventricular white matter of the cerebral hemispheres, nonspecific but\nlikely sequela of chronic small vessel ischemic disease in a patient of this\nage. Mild prominence of ventricles and sulci indicate age-related parenchymal\nvolume loss.\n\nNo osseous abnormalities seen. Fluid levels within the paranasal sinuses are\nlikely secondary to prolonged supine positioning and endotracheal intubation.", + "output": "1. Small left parafalcine subdural hematoma without mass effect on the brain\nparenchyma. Discussion with clinical team reveals that the patient had\nintraoperative placement of lumbar drain, which can predispose the patient to\nsubdural hematomas.\n2. No evidence for an acute major vascular territorial infarct.\n\nRECOMMENDATION(S): MRI would be more sensitive for an acute infarction, if\nclinically warranted.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 10:15 AM, 5 minutes after discovery of the\nfindings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere are chronic appearing bilateral cerebellar infarcts. There is no\nevidence of no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. Areas of confluent\nperiventricular, subcortical and deep white matter hypodensity are compatible\nwith chronic small vessel ischemic disease.\n\nThere are several mucous retention cysts in the right greater than left\nmaxillary sinuses with background mild mucosal wall thickening. The remainder\nof the visualized portion of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.\n\nCTA HEAD:\nThere is hypoattenuation of the distal V4 segment of the left vertebral artery\nwith opacification not well seen in the terminal segment (5:225), likely\nrepresenting severe stenosis. There is mild narrowing of the bilateral\ncavernous and supra clinoid internal carotid arteries secondary to\natherosclerotic calcification. There is a 2 mm lateral outpouching of the\nophthalmic segment of the right internal carotid artery, representing either a\nsmall aneurysm or ulcerative atherosclerotic plaque. The vessels of the\ncircle of ___ and their principal intracranial branches appear normal\nwithout stenosis, occlusion, or aneurysm formation. The dural venous sinuses\nare patent.\n\nCTA NECK:\nThere is mild atherosclerotic calcification of the aortic arch. There is mild\natherosclerotic calcification at the origin of the right vertebral artery and\ntrace at the left vertebral artery. The left vertebral artery is congenitally\nhypoplastic. There is mild atherosclerotic calcified and noncalcified plaque\nat the carotid bifurcations. There is mild narrowing of the distal internal\ncarotid artery at the level of C2 secondary to atherosclerotic disease, though\nnot significant by NASCET criteria. The carotid and vertebral arteries and\ntheir major branches appear normal with no evidence of stenosis or occlusion.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Chronic bilateral cerebellar infarcts.\n2. No acute intracranial abnormality.\n3. Scattered areas of atherosclerotic disease at the origins of the bilateral\nvertebral arteries, carotid bifurcations and distal left internal carotid\nartery. Otherwise patent cervical vasculature without significant stenosis,\nocclusion or dissection.\n4. Hypoattenuation of the distal most V4 segment of a hypoplastic left\nvertebral artery, likely representing hypoplasia or atherosclerotic disease. \nMild narrowing of the bilateral cavernous and supra clinoid internal carotid\narteries it otherwise patent intracranial vasculature without occlusion.\n5. 2 mm lateral outpouching of the ophthalmic segment of the right internal\ncarotid artery representing either a small aneurysm or ulcerative\natherosclerotic plaque." + }, + { + "input": "There is no evidence of acute major vascular territory\ninfarction,hemorrhage,edema, or mass. Brain parenchymal atrophy, most\nprominent at the frontal, temporal lobes, more prominent since ___.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormalities.\n2. Brain parenchymal atrophy." + }, + { + "input": "There is left frontal lobe hypodensity consistent with infarction, potentially\nsubacute. At the peripheral of the anterior aspect of the hypodensity is a\napproximately 0.7 cm curvilinear hyperdensity which is consistent with acute\nbleed. There is no evidence of additional large territorial infarction,\nedema,or mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Mild bilateral carotid siphon calcifications are noted.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. \nStatus post bilateral lens replacement. Otherwise the orbits are\nunremarkable.", + "output": "Left frontal lobe hypodensity with 0.7 cm peripheral curvilinear hyperdensity\nin the anterior aspect, concerning for hemorrhagic conversion of a left\nfrontal lobe potentially subacute infarction.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 8:16 pm, 2 minutes after\ndiscovery of the findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nUnchanged moderate-sized area of low attenuation in the left frontal lobe\ncompatible with subacute infarction, involving M4/M ___ MCA zone. Tiny linear\nhyperdensity along the anterior and superior medial aspect is unchanged,\nlikely represent small focus of hemorrhage, less likely calcification.\n\nSymmetric mildly decreased gray-white matter differentiation anterior\nbilateral frontal lobes is likely related to the scanner, where there is\nconcern for global ischemia, brain MRI without contrast recommended.\n\nNo new areas of intracranial hemorrhage. Mild brain parenchymal atrophy. No\nmidline shift. No additional areas of infarction noted.\n\nMild leftward deviation of the nasal septum. Small mucous retention cyst in\nthe left maxillary sinus laterally. Aerosolized secretions in the\nnasopharynx. Clear mastoids and middle ear cavities. Probable cerumen in the\nright external auditory canal. Suggestion mild fullness in the posterior,\nleft, extraconal orbit, may be volume averaging, if there is orbital symptoms,\norbital CT recommended in further evaluation to exclude infiltrative process. \nBilateral proptosis.\n\nCTA HEAD:\nModerate narrowing left P1 segment PCA.\n\nMild narrowing right M3 branch.\n\nMild attenuation of the caliber left anterior sylvian M3 branch, likely\nnarrowed.\n\nIf atherosclerotic changes with mild narrowing bilateral cavernous, clinoid\nICA.\n\nPatent dural venous sinuses.\nNo evidence of occlusion or aneurysm.\n\nCTA NECK:\nBovine aortic arch anatomy. Moderate left and mild right nonocclusive\ncalcifications at the carotid bifurcations.\n\nThere is approximately 45% stenosis left ICA origin by predominantly calcified\nplaque, by NASCET criteria.\n.\nNo right ICA stenosis by NASCET criteria.\n\nMild to moderate origin narrowing left vertebral artery. Tortuous vertebral\narteries otherwise, the carotidandvertebral arteries and their major branches\nopacify without evidence of focal stenosis or occlusion.\n\nOTHER:\nEnteric and endotracheal tubes are partially visualized.\n\nConsolidations in the posterior right upper lung, greater than the posterior\nleft upper lung, better assessed on chest x-ray ___, consistent with pneumonia or aspiration.\n\nHeterogeneous attenuation of bilateral thyroid lobes, probable 0.9 cm left\nnodule., No further follow-up according to guidelines.\n\nAdvanced degenerative changes cervical spine, disc space narrowing, disc\nosteophyte complexes. 3 mm anterolisthesis C3-C4, likely degenerative.", + "output": "1. Stable subacute left frontal lobe infarction involving M4/M5 MCA zone,\nsmall focus of probable hemorrhage\n2. Findings consistent with bilateral pneumonia or aspiration, refer to chest\nx-ray.\n3. Bilateral proptosis. Indeterminate mild fullness extraconal left posterior\norbit,, if there are orbital symptoms, recommend further imaging to exclude\ninfiltrative process.\n4. Approximately 45% stenosis left ICA.\n5. Mild to moderate origin narrowing left vertebral artery.\n6. Intracranial atherosclerotic disease, with multifocal narrowing, most\nprominent at P1 segment left PCA.\n7. Multifocal lung consolidations posteriorly, consider pneumonia or\naspiration.\n8. Advanced degenerative changes spine.\n\nRECOMMENDATION(S): Thyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or older, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "There is apparent pseudo-normalization in the attenuation of the known left\nposterior frontal lobe subacute infarct, which may be related to contrast\nenhancement or fogging phenomenon. An adjacent small linear hyperdensity is\nconsistent with hemorrhagic blood products as seen on prior MR head performed\n___. No new areas of hemorrhage are identified. Known scattered\ninfarctions or at the right corona radiata, right frontal, left parietal, left\noccipital lobes are better evaluated on prior MR head performed ___. No new areas of infarction. There is prominence of the ventricles and\nsulci suggestive of involutional changes.\n\nThere is no evidence of fracture. Small left maxillary mucous retention cyst.\nOtherwise, the remaining visualized paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Evolving subacute infarct of the left posterior frontal lobe with stable\nhemorrhagic focus. No new areas of hemorrhage are identified.\n2. Additional known scattered bihemispheric infarctions are better evaluated\non prior MRI head performed ___." + }, + { + "input": "Hypodensity in the left posterior frontoparietal region is compatible with\nknown infarct. Associated foci of hyperdensity are slightly more conspicuous\nfrom prior representing known hemorrhagic conversion. Degree of sulcal\neffacement is unchanged and there is no midline shift. No evidence of\nhydrocephalus. Ventricles and sulci are somewhat prominent compatible with\nage related involutional change. Known infarcts in the right corona radiata,\nright frontal, left parietal and left occipital lobes are better seen on the\nprior MR.\n\n___ is no evidence of fracture. Small left maxillary retention cyst is\nagain noted. The visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable. Patient is status post endotracheal intubation.", + "output": "Left posterior frontoparietal infarct with associated hemorrhagic conversion\nis slightly more conspicuous from prior. This implies slight interval\nhemorrhage, predominantly into the subarachnoid space.\nThere is no midline shift or hydrocephalus." + }, + { + "input": "Since the previous study, the left-sided convexity subdural hematoma has\nconsiderably decreased. Minimal residual isodense extra-axial collection is\nseen in this region. There is no acute hemorrhage. Brain atrophy and small\nvessel disease are again seen. Right maxillary sinus soft tissue changes are\nnoted.", + "output": "Decrease in size of the left parietal frontal convexities subdural hematoma\nwith minimal changes remaining. No acute hemorrhage." + }, + { + "input": "Limited exam secondary to motion artifact. There is no evidence of acute\nlarge territorial infarction, hemorrhage, edema, or mass effect. There is\nagain enlarged ventricles with disproportionate enlargement of the temporal\nhorns, consistent with the patient's known Alzheimer's disease and progressed\ncompared to ___.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. This exam is limited secondary to motion artifact. Within these\nlimitations, there is no evidence of acute large territorial infarct,\nhemorrhage, edema, or mass effect. Please note, however, that MR is more\nsensitive in the detection of acute stroke or intracranial mass.\n2. Redemonstration of enlarged ventricles with disproportionate enlargement of\nthe temporal horns is consistent with the patient's known Alzheimer's disease\nand progressed compared to ___." + }, + { + "input": "Patient is status post embolization of the right frontal AVM with streak\nartifacts limiting the assessment of the adjacent parenchyma. There is no\nevidence of large territorial infarction, hemorrhage, edema, or mass effect. \nThe ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of acute fracture. Mild soft tissue swelling over the\nfrontal sinus is likely due to recent trauma. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "1. Status post embolization of the right frontal AVM with streak artifacts\nlimiting assessment. Within limits, no acute intracranial abnormalities.\n2. Mild soft tissue swelling over the frontal sinus." + }, + { + "input": "There is swelling and subcutaneous emphysema of left frontal subgaleal soft\ntissues in the reported area of head strike, consistent with a scalp\nhematoma.. There is no fracture of the underlying frontal bone. There is no\nevidence of infarction, hemorrhage, edema, or mass. The ventricles and sulci\nare normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses is notable for mild thickening\nof the ethmoid air cells. The remainder of the mastoid air cells and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. A frontal subgaleal hematoma without fracture of the underlying frontal\nbone.\n2. No intracranial hemorrhage or acute large territorial infarction." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes, not significantly changed compared with MRI brain ___. Incidental note is made of bilateral basal ganglia calcifications.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No fracture or acute intracranial process." + }, + { + "input": "There is are subtle linear hyperdensities in the right postcentral gyrus (4:21\nand 5:55) and an additional area of hyperdensity in a portion of the cingulate\ngyrus adjacent to the posterior body of the corpus callosum (5:51 and 4:19),\nconcerning for subtle subarachnoid hemorrhage. There is no evidence of acute\nlarge territorial infarction,, edema,or mass effect. The ventricles and sulci\nare normal in size and configuration. Basal cisterns are normal in size.\n\nNo suspicious bone lesion is seen. There is trace fluid within bilateral\nmastoid tip air cells, which may be secondary to prolonged supine positioning\nin the inpatient setting. Partially imaged paranasal sinuses appear grossly\nwell-aerated allowing for absence of dedicated bone algorithm images. \nPartially imaged orbits are unremarkable.", + "output": "Possible minimal subarachnoid hemorrhage in the right postcentral gyrus and\ncingulate gyrus.\n\nNOTIFICATION: The findings were discussed with ___, N.P. by ___\n___, M.D. on the telephone on ___ at 12:34 pm, 5\nminutes after discovery of the findings." + }, + { + "input": "There is no evidence of territorial infarction, edema, or mass. Previously\ndescribed linear hyperdensities in the right post central gyrus and singular\ngyrus adjacent to the posterior body of the corpus callosum are stable and\ncertainly not grown (6:58, 52, 50). No midline shift. No definite new\nhyperdensity suggest intracranial hemorrhage. The ventricles and sulci are\nnormal in size and configuration. No acute fracture seen. Minimal bilateral\nmaxillary sinus mucosal thickening and mucous retention cysts and stable trace\nfluid within the bilateral mastoid air cells. The orbits are unremarkable.", + "output": "Stable, certainly not grown linear hyperdensities the could represent trace\nsubarachnoid hemorrhage in the right postcentral gyrus and cingulate gyrus. \nAlternatively, this could be due to a small DVA or artifactual. No definite\nnew hemorrhage or midline shift. No infarct." + }, + { + "input": "The previously seen hyperdensity in the right frontal lobe is no longer\nvisible compared to study from 12 hours prior. There is no evidence of acute\nlarge territory infarction,new hemorrhage,edema,or mass. There is no midline\nshift. The basal cisterns are patent. The ventricles and sulci are normal in\nsize and configuration.\n\nThere is no evidence of fracture. There is redemonstration of mild bilateral\nmaxillary sinus mucosal thickening and mucous retention cysts. There is trace\nfluid within the bilateral mastoid air cells. Otherwise, the visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. The previously seen hyperdensity in the right frontal lobe is no longer\nvisible.\n2. No evidence of new intracranial hemorrhage." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema\nor mass. Ventricles and sulci are normal in size and configuration for the\npatient's age. The previously described linear hyperdensities the right\npostcentral gyrus and cingulate gyrus are not seen.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process. No evidence of intracranial hemorrhage." + }, + { + "input": "No fractures are identified.\nThere is no evidence of facial swelling.\nMinimal mucosal thickening within the maxillary sinuses bilaterally. \nOtherwise, the visualized paranasal sinuses are well aerated.\nTriangular soft tissue density within the frontal process of the maxilla on\nthe right with surrounding sclerosis measuring 1.5 cm, likely a chronic\ndacrocystocele (series 6, image 16), unchanged.\nThere is no evidence of abnormal fluid collections.\nBilateral mastoids appear normal.\nThe globes, extraocular muscles, optic nerves, and retrobulbar fat appear\nnormal.\nThe visualized upper aerodigestive tract appears normal.\nThe mandible and temporomandibular joints appear normal.\nNo acute intracranial process within the brain parenchyma on these limited\nimages.", + "output": "1. Minimal mucosal thickening within the maxillary sinuses bilaterally. \nRemaining paranasal sinuses are clear without air-fluid levels.\n2. Probable 1.5 cm chronic dacrocystocele within the frontal process of the\nmaxilla on the right." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are within expected limits in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are normal.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. The dural venous\nsinuses are patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. Mild elongation of the right-side of\ncalcified stylohyoid ligament measuring 3.2 cm. Right Port A cath and\ncatheter noted passing through the right internal jugular vein and its tip is\nnot included.\n\nCT PERFUSION: RAPID perfusion maps demonstrate no definite focal CBV or MTT\ndefects.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Unremarkable noncontrast head CT. No evidence of acute large territory\ninfarct or intracranial hemorrhage.\n2. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n3. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection.\n4. No evidence of perfusion defects on RAPID CT." + }, + { + "input": "No evidence of acute large territory infarct or intracranial hemorrhage. The\nsulci, ventricles and cisterns are within expected limits for the patient's\nage. Periventricular and subcortical mild white matter hypodensities are\nnonspecific, but compatible with chronic microangiopathy in a patient of this\nage.\n\nApparent interval thickening of the posterior falx is almost certainly\nsecondary to recent contrast enhanced study and retained contrast in the\nsuperior sagittal sinus.\n\nThere is no evidence of acute large territory, infarction,hemorrhage,edema, or\nmass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are normal.", + "output": "1. No acute large territory infarct or intracranial hemorrhage.\n2. Mild apparent thickening of the posterior falx is almost certainly\nsecondary to contrast opacification of the superior sagittal sinus secondary\nto recent contrast administration.\n3. Additional findings described above." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. The\nventricles and sulci are age appropriate.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear.", + "output": "1. No acute intracranial process." + }, + { + "input": "There is a 9 mm extra-axial hematoma at the anterior aspect of the right\nmiddle cranial fossa. Given overlying right sphenoid fracture, this is\npersists for an epidural hematoma.\n\nThere is no evidence of acute infarction, edema, or mass. There is prominence\nof the ventricles and sulci suggestive of involutional changes. Left frontal\nand insular encephalomalacia may be sequela of prior infarct as on prior. \nThere is new right frontal encephalomalacia also likely from prior infarct,\nnew since ___. Scattered periventricular and subcortical hypodensities are\nlikely from chronic small vessel ischemic disease.\n\nAs above, there is a nondisplaced right-sided calvarial fracture running along\nthe coronal suture inferiorly to involve the greater wing of the sphenoid with\noverlying subcutaneous swelling.\n\nMinimally displaced right zygomatic arch fracture is noted without overlying\nsoft tissue swelling, to be correlated clinically for acuity. There is\nmucosal thickening of the left maxillary sinus, sphenoid sinus, left ethmoid\nair cells and left frontal sinus. The visualized portion of the other\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. A 9 mm right middle cranial fossa extra-axial, likely epidural hematoma\ngiven overlying nondisplaced calvarial fracture.\n2. Right zygomatic arch fracture, to be correlated clinically regarding acuity\n3. Chronic involutional changes and sequela of prior infarcts.\n\nNOTIFICATION: The updated findings regarding intracranial hemorrhage and\nfractures were discussed with ___ , M.D. by ___, M.D.\non the telephone on ___ at 9:08 ___, 1 minute after discovery of the\nfindings." + }, + { + "input": "No interval change since prior examination. Again seen is a 0.9 cm\nextra-axial hematoma at the anterior aspect of the right middle cranial fossa\nwhich tracks along the right frontotemporal convexity. Given overlying right\nsphenoid fracture this remains concerning for an epidural hematoma.\n\nThere is no evidence of infarction, edema, or mass. There is prominence of\nthe ventricles and sulci suggestive of involutional changes. Left frontal \nencephalomalacia may be sequelae of prior infarcts as seen on prior study. \nPreviously noted right frontal encephalomalacia is unchanged in appearance and\nappears new since ___. Scattered periventricular and subcortical\nhypodensities are likely sequela from chronic small vessel ischemic disease.\n\nAgain seen is a nondisplaced right sided calvarial fracture running along the\ncoronal suture inferiorly to involve the greater wing of the sphenoid with\noverlying subcutaneous tissue swelling. Right zygomatic arch fracture is of\nindeterminate age. Mild mucosal thickening of the ethmoidal air cells, right\nsphenoid sinus, and left frontal sinus are noted. The additional visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable. Soft\ntissue within bilateral external auditory canal most consistent with cerumen.", + "output": "1. No interval change since prior examination.\n2. Stable 0.9 cm right middle cranial fossa extra-axial, likely epidural\nhematoma given overlying nondisplaced calvarial fracture. No new hemorrhage.\n3. Right zygomatic arch fracture is of undetermined age.\n4. Chronic findings as described above including sequelae of prior infarcts." + }, + { + "input": "Study is moderately degraded by motion. Within these confines:\n\nThe previously identified right extra-axial hematoma has resolved. There is\nno evidence of acute large territorial infarction,new hemorrhage,edema,or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Bilateral frontal lobe encephalomalacia is unchanged. \nPeriventricular and subcortical white matter hypodensities are nonspecific but\nlikely sequelae of chronic small vessel ischemic disease.\n\nNo evidence of acute fracture. Previously identified right calvarial and\nzygomatic arch fractures are less well identified, likely a combination of\ninterval healing and limitations from motion artifact. There is mild polypoid\nthickening of the left maxillary sinus. The visualized portion of the\nremaining paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable. Soft tissue\ndensities are noted within bilateral external auditory canals which may\nrepresent cerumen.", + "output": "1. Study is moderately degraded by motion.\n2. Within limits of study, no definite evidence of acute intracranial\nhemorrhage or large territorial infarct. Please note MRI of the brain is more\nsensitive for the detection of acute infarct.\n3. Grossly stable bifrontal chronic infarcts and global involutional changes.\n4. Paranasal sinus disease as described." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema, or\nmass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial process on noncontrast head CT." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nThere is preservation of gray-white matter differentiation. The basal\ncisterns remain patent.\n\nThere is no evidence of fracture. The remainder mucosal thickening is seen\nwithin the left maxillary sinus. Of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. Dense calcifications are seen within the\nbilateral cavernous carotid and distal left vertebral artery. The visualized\nportion of the orbits are unremarkable.", + "output": "Mild age related involutional changes without evidence for acute intracranial\nhemorrhage or large vascular territorial infarction." + }, + { + "input": "Frontal sinus is clear. The frontal recesses are clear, patent. The left and\nright infundibula are patent. The remaining components of left and right\nostiomeatal units are patent. Maxillary, sphenoid sinuses, ethmoid air cells\nclear. No air-fluid levels.\n\nNo acute fracture is identified.\n\nThe infundibula are bordered superiorly and laterally by orbital walls. The\ncribriform plates are intact. The lamina papyracea are intact. The right\nanterior clinoid process is pneumatized. The left anterior clinoid process is\nnot pneumatized. The sphenoid sinus septum is left of midline and inserts on\nthe anteromedial bony covering of the left carotid canal. Carotid canals\notherwise well-covered by bone. There is leftward nasal septal deviation with\na small spur.\n\nNo aggressive focal osseous lesions. Visualized portions of the mastoids,\nmiddle ear cavities are clear. Globes and orbits are unremarkable. \nVisualized portion of the brain parenchyma are unremarkable on limited\nevaluation.", + "output": "1. No evidence of fracture.\n2. Clear paranasal sinuses." + }, + { + "input": "Patchy areas of sclerosis are visualized within the cervical and upper\nthoracic vertebral bodies and neural arches consistent with sclerotic\nmetastatic disease. There is no evidence of pathologic fracture seen. Stasis\nare also seen in the visualized ribs and clavicles. For details of soft\ntissue within the spinal canal no, correlate with the subsequent MRI of ___ performed at ___.\n\nMild to moderate degenerative changes are seen. Pleural thickening/effusion\nis seen at the right upper lung, unchanged from the CT chest of ___.", + "output": "1. Sclerotic metastatic disease involving the visualized bony structures.\n2. Degenerative changes better evaluated on subsequent MRI of ___\nperformed at ___." + }, + { + "input": "In the right parietal lobe, there is a hyperdensity measuring 2.5 x 1.9 cm\n(02:17 with a surrounding edema, which may represent either hyperdense mass\ncausing vasogenic edema or superimposed focus of intracranial hemorrhage.\nThere is mild effacement of the gyri in the right parietal lobe. There is\nminimal effacement of the right posterior horn of the lateral ventricle. \nThere is no other areas of hemorrhage or infarction. There is prominence of\nthe ventricles and sulci suggestive of involutional changes. Periventricular\nand subcortical white matter hypodensities are nonspecific, however likely due\nto chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Patient is\nstatus post bilateral lens removal.", + "output": "1. Right parietal lobe hyperdensity indicative of lobar hemorrhage, concerning\nfor mass lesion with superimposed hemorrhage.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 3:39 ___, 2 minutes after discovery\nof the findings. The patient has been transferred to the ___ ED per request\nfrom the referring physician." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\n\nRedemonstrated is a right ccipital lobe hematoma measuring 20 x 23 mm,\npreviously 20 x 24 mm with surrounding vasogenic edema (03:15). The overall\nappearance and mass effect on adjacent sulci is stable. There is no shift of\nnormally midline structures. There is no new hemorrhage. The ventricles are\nstable in size and configuration. Basal cisterns are patent. Gray-white\nmatter differentiation is preserved.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear.\nPatient is status post bilateral cataract extractions.\n\n\nCTA HEAD:\n\nThere is mild calcified plaque along the cavernous portion of the right\ninternal carotid artery. The vessels of the circle of ___ and their\nprincipal intracranial branches appear normal with no evidence of stenosis,\nocclusion, or aneurysm. The dural venous sinuses are patent. No vascular\nabnormalities are identified associated with the hematoma.", + "output": "1. 20 x 23 mm right occipital hematoma with surrounding vasogenic edema and\nmild mass effect on adjacent sulci is overall unchanged compared to the prior\nexamination. No new hemorrhage.\n\n2. Unremarkable head CTA without evidence of stenosis, occlusion, or aneurysm\nformation. No vascular abnormalities identified associated with the hematoma." + }, + { + "input": "There is no evidence of infarction. In the region of previously identified\nintraparenchymal bleed in the right occipital lobe, there is again\nhyperdensity with surrounding peripheral enhancement. This lesion measures\n2.4 x 2.7 cm. Adjacent edema is similar to noncontrast CT head from 2 days\nprior. No additional lesion is identified. Ventricles and sulci are normal\nin size and configuration. Basal cisterns are patent. Major vessels appear\npatent.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "2.4 x 2.7 cm peripherally enhancing lesion in the region of previously\nidentified intraparenchymal hemorrhage. This is a nonspecific finding, but\ngiven the patient's history of melanoma, could be compatible with a metastatic\nlesion." + }, + { + "input": "Postsurgical changes status post right occipital craniotomy include\npneumocephalus with multiple locules of air in the surgical site, temporal\nfossa of, and anterior cranial fossa. There is edema in and around the\nsurgical site without significant mass effect on surrounding structures. The\nthere is no significant shift of normally midline structures. There is a\nsmall amount of intra and extra-axial hyperdense material in the surgical\nsite, likely representing left over blood products from resection of the\npreviously seen intraparenchymal hemorrhage. No evidence of acute infarct. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Periventricular white matter hypodensities are nonspecific but likely\nrepresent sequelae of chronic small vessel ischemic disease.\n\nSmall mucous retention cysts in the left maxillary sinus. The visualized\nparanasal sinuses and mastoid air cells are otherwise essentially clear. \nPatient is status post bilateral lens replacement, otherwise the visualized\nportion of the orbits are unremarkable.", + "output": "1. Expected postsurgical changes status post right occipital craniotomy with\nresection of intraparenchymal hemorrhage including pneumocephalus and edema at\nthe surgical site. There is a small amount of residual hemorrhage. No\nsignificant mass effect or midline shift." + }, + { + "input": "In comparison to the prior study from ___, there is a decreased\namount of hyperdense material adjacent to the right occipital resection cavity\n(for example see series 4, image 18 for a small focus of residual blood\nproducts). Pneumocephalus is persistent and minimally decreased in quantity\nalong the right frontal convexity, with additional small foci seen adjacent to\nthe resection cavity. Regional white matter hypodensity adjacent to the\nresection cavity in the right occipital lobe is not appreciably changed.\n\nThere is no evidence of new focus of hemorrhage elsewhere, or CT evidence of\nsuperimposed acute large vascular territorial infarction. Small hypodensity\nnear the right putamen is unchanged, likely representing a dilated\nperivascular space or a chronic lacunar infarct. There is preservation of\ngray-white matter differentiation. The ventricles sulci are stable and normal\nin size and caliber. There is no shift of normally midline structures. The\nbasal cisterns are patent. Carotid siphon and distal vertebral artery\ncalcifications are noted, unchanged.\n\nThere is minimal linear enhancement in the region surrounding the resection\ncavity. No nodular enhancement. No additional concerning foci of enhancement\nare seen elsewhere. Right occipital calvarial defect in mild overlying scalp\nsoft tissue irregularity is noted. There is no evidence of fracture. Skin\nstaples are seen along the left temporoparietal region. The visualized\nparanasal sinuses and mastoid air cells are clear. The globes, aside from\nbilateral lens removal, are unremarkable. The bony orbits are intact.", + "output": "Evolving postsurgical changes status post right occipital craniotomy and\nresection of mass, detailed above. Small focus of residual blood products\nadjacent to the resection cavity site. No new large focus of hemorrhage. \nAside from minimal linear enhancement at the resection cavity, there is no\nnodular enhancement, or abnormal focus of enhancement elsewhere." + }, + { + "input": "Study is mildly degraded by motion. Encephalomalacia in the right occipital\nregion, just to the right the posterior falx, is consistent with a resection\ncavity from prior surgery. Small right occipital calvarial defect with mild\noverlying scalp soft tissue scalp irregularity is unchanged. Skin staples are\nnoted along the right occipital convexity at the site of prior surgical\nresection.\n\nThere is no evidence of new acute large territorial infarction, hemorrhage,\nedema or mass. Small focus of hypodensity near the right putamen is unchanged\nand likely represents a prominent perivascular space or chronic lacunar\ninfarct. Mildly prominent ventricles and sulci suggest age-appropriate\ninvolutional changes.\n\nNo fracture identified. The imaged paranasal sinuses are clear. Mastoid air\ncells and middle ear cavities are well aerated. Patient is status post\nbilateral lens removal. Otherwise, visualized portions of the globes are\nunremarkable. Atherosclerotic vascular calcifications are noted of bilateral\nvertebral and cavernous portions of internal carotid arteries.", + "output": "1. Study is mildly degraded by motion.\n2. No acute intracranial abnormalities.\n3. Small area of encephalomalacia within the right occipital region,\nconsistent with prior surgical resection.\n4. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described.\n5. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct." + }, + { + "input": "CTA neck:\nA stent is seen in the right internal carotid artery which is patent.\n\nCalcified atherosclerotic plaques affecting aortic arch and origins of the\nsuperior mediastinal great vasculature with no significant stenosis.\n\nModerate atherosclerotic calcified plaques affecting both internal carotid\narteries at origins and at bilateral carotid siphons. The left internal\ncarotid artery is mildly tortuous. There is no evidence of flow-limiting\nstenosis, occlusion, or dissection\n\nThere is severe calcified atherosclerotic changes causing severe narrowing of\nboth vertebral arteries at origin. There is a focal moderate to severe\nnarrowing of bilateral vertebral arteries secondary degenerative disease at\nC5-6. There is no evidence of complete occlusion or dissection.\n\nThere is moderate centrilobular emphysema. Small left thyroid lobe nodule\nmeasuring 0.7 cm. Pretracheal mildly enlarged lymph node measuring 2.3 x 1.1\ncm.\n\nMultilevel, multifactorial degenerative changes are visualized throughout the\ncervical spine, including partial interbody fusion at C3-C4 level.", + "output": "1. Status post right internal carotid artery carotid artery stenting with a\npreserved normal intraluminal flow through it.\n2. Severe calcified atherosclerotic changes affecting both vertebral arteries\nat origin more the right-side.\n3. Moderate to severe narrowing of bilateral vertebral arteries at level C5-C6\ncaused by external compression by uncovertebral osteophytosis." + }, + { + "input": "Re-demonstrated mixed density subdural collection along the left cerebral\nconvexity, the largest with measuring 14 mm, stable compared to prior (03:31).\nNo new areas of hemorrhage. No significant midline shift. Basal cisterns are\npatent. There is no evidence of large territory infarction or edema. There\nis prominence of the ventricles and sulci suggestive of involutional changes. \nThere are mild periventricular white matter hypodensities, nonspecific, most\nlikely sequela of chronic small vessel disease. Moderate calcification in the\ncarotid siphons.\n\nThere is no evidence of fracture. Aside from a small mucosal retention in the\nright maxillary sinus (3:1), the visualized portion of the frontal, ethmoid,\nsphenoid and mastoid air cells are clear. The middle ear cavities are clear. \nThe visualized portion of the orbits are unremarkable.", + "output": "1. Stable mixed density subdural collection along the left cerebral convexity\nwithout evidence of new hemorrhage or midline shift." + }, + { + "input": "There is no evidence of acute territorial infarction. Re-demonstrated is a\nmixed density subdural collection along the left cerebral convexity, measuring\nup to 14 mm, similar compared to prior. There is no significant change in\nthis collection. No significant midline shift. The basal cisterns are\npatent. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific but likely sequelae of chronic small vessel\nischemic disease. Prior bilateral thalamic and left caudate head lacunar\ninfarcts are noted. Right occipital encephalomalacia is again noted. \nAdditionally, focal encephalomalacia in the left precentral gyrus is again\nnoted. Calcifications are seen in the carotid siphons.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Mixed density subdural collection along the left cerebral convexity,\nessentially unchanged in size, without evidence of new hemorrhage or midline\nshift." + }, + { + "input": "The study is somewhat limited due to motion artifact. Overall unchanged\nappearance of the mixed density extra-axial fluid collection on the left,\nconsistent with the known acute on chronic subdural hemorrhage without\nsignificant mass effect. There is no evidence of large vascular territory\ninfarction, new hemorrhage, edema, or mass. Ventricles and sulci are\nprominent, consistent with age-related global parenchymal loss. Subcortical,\nperiventricular and deep white matter hypodensities are nonspecific, but\nlikely reflect the sequela of chronic microangiopathic ischemic disease. \nThere are diffuse intracranial atherosclerotic calcifications.\n\nThere is no fracture. There is partial opacification of the right maxillary\nsinus and associated mucosal thickening, otherwise, the visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\nThe visualized portion of the orbits demonstrate prior lens surgery and are\notherwise normal. The patient is edentulous.", + "output": "1. The study is somewhat limited due to motion artifact. However within the\nlimitations of the study, there is an overall unchanged appearance of the\nmixed density extra-axial fluid collection the left without significant mass\neffect, consistent with known acute on chronic subdural hemorrhage.\n2. There is no large vascular territory infarction, new hemorrhage, edema, or\nmass.\n3. Global age-related parenchymal loss within expected range for age and white\nmatter changes likely reflects sequelae of chronic microangiopathic ischemic\ndisease." + }, + { + "input": "Study is mildly degraded by motion. There is no evidence of acute\ninfarction,hemorrhage,edema, or mass. The ventricles and sulci are normal in\nsize and configuration. Bilateral thalamic hypodensities most likely reflect\nold lacunar infarcts. Periventricular white matter hypodensities are\nnonspecific but likely represent chronic small vessel ischemic changes.\n\nThere is mild soft tissue swelling in the right frontal scalp. There is no\nevidence of fracture. There are bilateral lamina papyracea defects, likely\nchronic. There is mild mucosal thickening of the ethmoid air cells. The\nremaining paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Right frontal scalp soft tissue swelling. No fracture." + }, + { + "input": "Head CT: Previously described right inferior cerebellar hemisphere\nencephalomalacia is unchanged from prior exam. There is a rounded\nhypoattenuating focus in the ventral pons, likely secondary to beam hardening\nartifact. There is no evidence of hemorrhage, edema, masses, mass effect, or\nacute infarction. The ventricles and sulci are normal in caliber and\nconfiguration. Mild mucosal thickening of the ethmoid air cells is noted. The\nremainder the paranasal sinuses are clear. The orbits are unremarkable. The\nmastoid air cells and middle ear cavities are well pneumatized and clear. No\ndisplaced calvarial fractures are identified.\n\nHead CTA: Extensive atherosclerotic calcification of the carotid siphons as\nwell as right greater than left paraclinoid ICAs are noted. The right A1\nsegment is not visualized. The MCAs, remainder of the ACA and their major\nbranches are unremarkable without evidence of aneurysm, stenosis or occlusion.\n\nThere is stenosis of the distal right V4 segment (5- 248). In addition, there\nis focal stenosis of the proximal left V4 segment (___), with eccentric\nlikely calcification and potential the intimal flap as well as focal narrowing\nof the left V4 as it joins the basilar artery. The remainder of the posterior\ncirculation is unremarkable. The posterior communicating arteries are not\nvisualized.\n\nNeck CTA: There is a normal 3 vessel arch. Atherosclerotic calcifications of\nthe aortic arch and ectasia of the ascending aorta measuring approximately 3.7\ncm is noted. Mild atherosclerotic calcifications at the origins of the\nbrachiocephalic vessels are noted. Atheromatous soft plaque and\natherosclerotic calcifications at the bilateral carotid bifurcations is\nidentified. There is no cervical internal carotid artery stenosis by NASCET\ncriteria. The origins, contour and course of the vertebral arteries are\nunremarkable to the level of the skullbase.\n\nOther: The parotid and submandibular glands are unremarkable. The\naerodigestive tract is also unremarkable. The right thyroid lobe is enlarged\nand demonstrates a heterogeneous early enhancing 2.0 x 2.4 x 2.3 cm (TRV, AP,\nSI) posterior nodule extending into the superior mediastinum, unchanged from\nprior CT chest of ___.\n\nThere are stable prominent paratracheal and prevascular lymph nodes measuring\nup to 1.0 cm in short access, the majority of which demonstrates fatty hilum\nand reniform shape. One such right pretracheal lymph node (___) also\ndemonstrates calcifications, which may be sequela of prior granulomatous\ndisease.\n\nThere are a few 3 mm right apical ground-glass opacities (___), likely\ninfectious/inflammatory in nature. There are scattered a stable calcified\ngranulomas.\n\nMultilevel cervical spondylosis most prominent at C3-C4 with there is a large\nposterior disc osteophyte complex is noted without suspicious blastic or lytic\nosseous lesions. Nuchal ossification posterior to the C4 and C5 spinous\nprocess ease are also identified.", + "output": "1. There is no evidence of acute infarct or intracranial hemorrhage.\n2. Right cerebellar hemisphere encephalomalacia is unchanged from prior exam.\n3. Hypodensity in the ventral pons is considered compatible with beam\nhardening artifact. However, if there is clinical concern for prior infarct in\nthis region repeat CT or MRI if there no contraindications may yield\nadditional information.\n4. There is no evidence of occlusion or aneurysm the head and neck arterial\nvessels.\n5. There is multifocal stenosis of the bilateral V4 segments. Recommend\nclinical correlation.\n6. Extensive atherosclerotic calcification of the intracranial internal\ncarotid arteries are noted.\n7. The visualized lung apices suggest right apical ground-glass opacities.\nRecommend clinical correlation and correlation with dedicated chest imaging." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No infarction, hemorrhage, edema, or mass." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThe gray-white matter differentiation is intact without evidence acute\ninfarct, hemorrhage, mass, or mass effect. The ventricles and cortical sulci\nare normal in caliber or configuration. There is hyperostosis frontalis. \nThere is extra-axial calcified mass at the right sphenoid wing measuring 1.0 x\n1.2 cm (601b:30). There are calcified masses at the bilateral extra-axial\nconvexities, the largest on the right measures 1.5 x 0.9 cm (601:36). The\nlargest on the left measures 0.7 x 0.4 cm (601:30). The left lens is absent. \nThere is a small mucous retention cyst within the left sphenoid sinus. The\nmastoid air cells and middle ears are clear. The soft tissues are\nunremarkable. The bilateral carotid siphons are patent. There is a 2 mm\noutpouching\n\nThere is a 2 x 3 mm inferior posterior and laterally projecting outpouching\nfrom the right communicating segment internal carotid artery just superior to\nposterior communicating artery, possibly at the level of the anterior\nchoroidal artery (602:17). The anterior and right posterior communicating\narteries are visualized. Left posterior communicating artery is not\ndefinitively visualized. There is a right dominant vertebral artery. The\nanterior and posterior circulations are patent without occlusion, dissection,\nor significant stenosis.", + "output": "1. 2 x 3 mm posterior inferior and laterally projecting outpouching from the\nright communicating segment internal carotid artery, just superior to the\nposterior communicating artery. Finding likely represents a small aneurysm\nwith differential including an infundibulum. This is relatively unchanged in\ncomparison to ___, given differences in modality.\n2. Extra-axial calcified mass is at the cerebral convexities and right\nsphenoid wing, likely representing calcified meningiomas versus dural\ncalcifications.\n3. No acute intracranial abnormality." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nCT HEAD WITHOUT CONTRAST:\nThe ventricles, sulci, and cisterns appear normal. There is no large acute\ninfarct, intracranial hemorrhage, or mass effect.\n\nThere is a left lens extraction. The paranasal sinuses, middle ear cavities,\nand mastoid air cells are clear.\n\nCTA HEAD:\nThere is mild intracranial atherosclerosis, without high-grade stenosis or\nocclusion. There is a 3 mm posteriorly directed aneurysm versus an\ninfundibulum of the anterior choroidal artery, without appreciable change from\nthe ___ CTA head. No vascular malformation is identified.\n\nCTA NECK:\nThere is a mild atheromatous atherosclerotic plaque within the aortic arch. \nThere is mild atheromatous atherosclerotic plaque at the bilateral carotid\nbulbs, with less than 50% internal carotid artery stenosis by NASCET criteria.\n\nThe left vertebral artery is derived from the aortic arch. The origin of the\nright and left vertebral arteries is severely degraded due to artifact. An\nunderlying stenosis cannot be excluded. The vertebral arteries otherwise\npatent without high-grade stenosis. The right vertebral artery is dominant. \nThe left vertebral artery is diminutive.\n\nOTHER:\nThere are no enlarged cervical lymph nodes.\n\nThere is thick ossification of the posterior longitudinal ligament at C4-5\nlevels with severe spinal canal narrowing. There is severe neural foraminal\nnarrowing at multiple levels due to uncovertebral and facet joint hypertrophy.", + "output": "1. Dental amalgam streak artifact limits study.\n2. No large acute infarct, acute intracranial hemorrhage, or mass effect. \nPlease note MRI of the brain is more sensitive for the detection of acute\ninfarct.\n3. Mild intracranial atherosclerosis. No definite large vessel occlusion.\n4. 3 mm aneurysm versus infundibular origin of the right anterior choroidal\nartery, similar in appearance to the ___ CTA head.\n5. Degraded evaluation of the origin of the bilateral vertebral arteries due\nto artifact. An underlying stenosis cannot be excluded. The vertebral\narteries are otherwise patent without high-grade stenosis. There is mild\nextracranial atherosclerotic vascular disease, without internal carotid artery\nstenosis by NASCET criteria. If clinically indicated, consider contrast neck\nMRA for further evaluation.\n6. Severe spinal canal narrowing due to thick ossification of the posterior\nlongitudinal ligament at C4-5 and multilevel severe neural foraminal\nnarrowing. If clinically indicated, consider cervical spine MRI for further\nevaluation.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 21:06 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. Mild mucosal thickening is demonstrated\nwithin the ethmoid air cells. The visualized portion of the remaining\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable. Mild soft tissue swelling\nis noted overlying the right frontal bone.", + "output": "Mild right frontal soft tissue swelling. Otherwise no acute intracranial\nabnormality." + }, + { + "input": "Multiple foci of subarachnoid and intraparenchymal hemorrhage are seen\ninvolving the right frontal and parietal lobes, for example (02:23, 26, 27). \nAreas of hemorrhage in the right frontal lobe and some of the areas in the\nright parietal lobe are new.\n\nThere is no evidence of infarction, edema,or mass effect. There is no midline\nshift. The basal cisterns remain patent. There is prominence of the\nventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Re-demonstration of intraparenchymal and subarachnoid hemorrhage in the right\nparietal lobe, with new small foci of hemorrhage seen in the right frontal and\nparietal lobes." + }, + { + "input": "There are multiple foci of subarachnoid and intraparenchymal hemorrhage. \nAnteriorly in the right frontal lobe, a small focus of subarachnoid hemorrhage\nis unchanged compared with most recent prior study of ___ at 22:44\n(03:33). Posterior and superior to this in the pre frontal gyrus of the right\nfrontal lobe, small foci of intraparenchymal hemorrhage are unchanged\nmeasuring up to 6 and 5 mm (03:34). Just posterior to this within the very\nanterior right parietal region near the vertex, a globular, proximally 13 mm\nfocus of subarachnoid hemorrhage is unchanged (03:35).\n\nNew from most recent prior study are small foci of likely acute\nintraparenchymal hemorrhage in the right parieto-occipital region (for example\nsee series 3 images 21, 22, 24, 25, and 26). No other new foci of\nintracranial hemorrhage are identified.\n\nThere is no evidence of acute infarction, mass, or mass effect. There is\npreservation of gray-white matter differentiation. The ventricles and sulci\nare minimally prominent, unchanged, consistent with an age related\ninvolutional change. The basilar cisterns are patent. No shift of the\nnormally midline structures.\n\nNo evidence of fracture. Visualized paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are well pneumatized and clear. The patient is status\npost right lens removal; otherwise, the globes and bony orbits are intact and\nunremarkable. Mild bilateral carotid siphon calcifications are noted. A tube\nis seen in the left nasal cavity.", + "output": "1. New small foci of acute intraparenchymal hemorrhage within the right\nparieto-occipital region. Additional foci of acute subarachnoid and\nintraparenchymal hemorrhage elsewhere in the right frontal and parietal lobes\nare unchanged, as above. No mass effect.\n2. Unchanged chronic findings including age-appropriate global involutional\nchange and mild vascular calcifications.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 8:49 pm, 5 minutes\nafter discovery of the findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nA 1.3 cm focus of right parietal intraparenchymal hemorrhage near the vertex\nis unchanged in size. Foci of subarachnoid hemorrhage in the right frontal\nlobe near the vertex (series 2, image 29) is unchanged.\n\nRight occipital subarachnoid hemorrhage is mildly less conspicuous in\ncomparison to the prior examination.\n\nA 6 mm focus of intraparenchymal hemorrhage in the left cerebellar hemisphere\n(series 2, image 7) is unchanged from ___.\n\nThere is no new focus of hemorrhage. No significant mass effect or midline\nshift.\n\nPeriventricular and deep white matter hypodensities are nonspecific but likely\nrepresent sequelae of chronic small vessel ischemic disease. No large\nterritorial infarction.\n\nThere is mild prominence of the ventricles and sulci, likely representing\nage-related volume loss.\n\nThe right lens has been surgically replaced, the globes are otherwise\nunremarkable.\n\nThe carotid siphons are heavily calcified.\n\nThe paranasal sinuses are clear.\n\nA hypodensity in the anteroinferior right temporal lobe (series 3, image 90),\nis unchanged from ___ and likely represents encephalomalacia from\nprior injury or infarction.\n\nCTA HEAD:\nAssessment of the neck vessels is moderately limited by motion. The left\nvertebral artery is diminutive, otherwise the vessels of the circle of ___\nand their principal intracranial branches appear normal with no evidence of\nstenosis, occlusion, or aneurysm. The dural venous sinuses are patent.", + "output": "1. Assessment of the neck vessels is moderately limited by motion. Within\nthese limitations no evidence of dissection, flow-limiting stenosis or\naneurysm greater than 3 mm.\n2. Multiple foci of subarachnoid hemorrhage and intraparenchymal hemorrhage\nare unchanged from ___, as detailed above." + }, + { + "input": "Seen again are multiple sites of intraparenchymal hemorrhage within the right\nparietal lobe near the vertex and within the left cerebellar hemisphere,\nunchanged. Small volume subarachnoid hemorrhage within the right frontal lobe\nnear the vertex and within the right occipital lobe is also unchanged.\n\nThere is no evidence for new/acute intracranial hemorrhage. No vascular\nterritorial infarction is identified. There is no mass, mass effect, edema,\nor midline shift.\n\nThe ventricles and sulci are prominent compatible global parenchymal volume\nloss. Periventricular and subcortical white matter hypodensities are noted, a\nnonspecific finding that most likely represents the sequelae of chronic small\nvessel ischemic disease.\n\nThere is no evidence for displaced calvarial fracture. The visualized portion\nof the paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The patient is status post right lens replacement.", + "output": "1. Multiple sites of intraparenchymal and subarachnoid hemorrhage, as above,\nsimilar from ___.\n2. No evidence for new acute intracranial hemorrhage. No vascular territorial\ninfarction.\n3. Background global parenchymal volume loss and evidence of chronic small\nvessel ischemic disease.\n4. Additional findings described above." + }, + { + "input": "Re-demonstration of multiple sites of intraparenchymal hemorrhage within the\nright parietal and frontal lobes, near the vertex, and within the left\ncerebellar hemisphere, which are unchanged.\n\nThere is no evidence of new large territorial ischemic infarction,new\nhemorrhage,edema,or mass effect. There is no midline shift. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nPeriventricular and subcortical white-matter hypodensities are nonspecific,\nbut likely represent sequela of chronic small vessel ischemic disease.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Re-demonstration of multiple sites of intraparenchymal hemorrhage in the\nright parietal and frontal lobes and left cerebellar hemisphere, which are\nunchanged.\n2. No evidence of new acute intracranial hemorrhage or large territorial\nischemic infarction." + }, + { + "input": "There is re-demonstration of multiple sites of intraparenchymal hemorrhage\nwithin the right parietal and right frontal lobes which appear to have\ndecreased in size and conspicuity from prior study with no new intracranial\nhemorrhage identified, compatible with evolution. There is increased\nassociated parenchymal edema pattern adjacent to the hemorrhages, also within\nexpected evolution. Metal artifact limits evaluation of the posterior fossa\nthough no large intracranial hemorrhage is identified. There is no evidence\nof acute large territory infarction,edema,or mass effect. There is prominence\nof the ventricles and sulci suggestive of involutional changes.\nPeriventricular and subcortical white matter hypodensities are nonspecific,\nbut likely reflect sequelae of chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. Fluid is visualized in the bilateral\nsphenoid and bilateral maxillary sinuses. The visualized mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Re-demonstrated multiple intraparenchymal hemorrhage in the right parietal\nand frontal lobes which have decreased in size and conspicuity from prior\nstudy with incomplete evaluation of previously visualized left cerebellar\nhemisphere intraparenchymal hemorrhage secondary to metal artifact.\n2. There is increased edema pattern adjacent to the hemorrhages, also within\nexpected evolution.\n3. No new intracranial hemorrhage or acute large territory infarction\nidentified.\n4. Additional findings described above." + }, + { + "input": "Dental amalgam and overlying hardware streak artifact limits study.\n\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive involutional changes. There\nare periventricular and subcortical lucencies, which may represent small\nvessel ischemic changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. Prosthetic left eye is again noted. 10 mm hyperdense\nlesion in the scalp overlying the left parietal region may be a sebaceous\ncyst.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. 2 mm\noutpouching in the right supraclinoid ICA (5:227) and 3 mm outpouching in the\nleft supraclinoid ICA (5:229) at the expected origins of bilateral posterior\ncommunicating arteries are noted.\nThe dural venous sinuses are patent.\n\nCTA NECK:\nCalcified and noncalcified plaque narrowing the origin of the left internal\ncarotid artery without definite high-grade stenosis by NASCET criteria is\nnoted. The carotid and vertebral arteries and their major branches appear\npreserved with no definite evidence of stenosis or occlusion. There is no\nevidence of internal carotid stenosis by NASCET criteria.\n\nCT PERFUSION:\nCT perfusion study is suboptimal due to poor bolus tracking. Within limits of\nstudy, no definite focal area of decreased cerebral blood flow or increased\nT-max is noted.\n\nOTHER:\nThe visualized portion of the thyroid gland is within normal limits. \nScattered subcentimeter nonspecific lymph nodes are noted throughout the neck\nbilaterally, without definite enlargement by CT size criteria.\n\n4.7 x 2.5 cm right perihilar lesion is identified in the right upper lobe with\nassociated metallic marker. Multiple other nodular opacities are identified in\nimaged portion of bilateral lungs measuring 1.1 cm or less. Partially imaged\nmain pulmonary artery measures 35 mm in diameter, grossly unchanged. 4 mm\nleft frontal calvarium circumscribed lucency is noted (see 5: 275).", + "output": "1. Dental amalgam and overlying hardware streak artifact limits study.\n2. Limited cerebral perfusion imaging as described. Within limits of study,\nno definite focal perfusion defect identified. Please note MRI of the brain\nis more sensitive for the detection of acute infarct.\n3. Grossly patent circle of ___ without definite evidence of stenosis or\nocclusion.\n4. Grossly patent bilateral cervical carotid arteries with probable\natherosclerotic changes of left internal carotid artery without definite\nhigh-grade stenosis by NASCET criteria.\n5. Grossly patent bilateral cervical vertebral arteries.\n6. 2 mm outpouching in the right supraclinoid ICA and 3 mm outpouching in the\nleft supraclinoid ICA are likely infundibula with differential considerations\nof small aneurysms.\n7. Right upper lobe mass and multiple other smaller pulmonary nodules are\nconsistent with history of metastatic lung cancer.\n8. Patient's previously noted left frontal and temporal concerning lesions not\ndefinitely visualized on this examination. Please note contrast brain MRI is\nmore sensitive for the evaluation of intracranial metastatic disease and for\nacute infarct.\n9. 4 mm left frontal calvarium well-circumscribed lucency. While finding may\nrepresent hemangioma or venous Lake, lytic metastatic lesion is not excluded\non the basis of this examination. If clinically indicated, consider bone scan\nfor further evaluation\n10. Nonspecific subcentimeter lymph nodes throughout the neck as described. \nIf clinically indicated, consider FDG PET-CT for further evaluation\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 16:08 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass effect, midline shift,\nor acute major vascular territorial infarct. Periventricular and subcortical\nwhite matter hypodensities are likely sequela of chronic small vessel disease.\nVentricles and sulci are prominent compatible with global volume loss. \nBasilar cisterns are patent.\n\nIncluded paranasal sinuses and mastoids are clear. Left globe prosthesis is\nnoted. Rounded partially calcific structure in the left parietal scalp is\nlikely a sebaceous cyst as seen on prior. Partially calcified degenerative\nchanges noted at the left temporomandibular joint.", + "output": "Known enhancing lesions seen on recent MRI are not clearly delineated by CT. \nNo new mass effect." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or\nmass-effect. Prominence of ventricles and cerebral sulci are compatible with\nage-related involutional changes. There are mild periventricular white matter\nhypodensities compatible with chronic small vessel ischemic disease given the\npatient's age.\n\nThere is mild mucosal thickening of the ethmoid air cells. The mastoid air\ncells are normal. There are postoperative changes of the left orbit.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThere is a retropharyngeal course of the left ICA. The origin of the right\nvertebral artery is not well seen, possibly secondary to beam hardening and\nmotion artifact. Allowing for this, there is likely at least moderate\nnarrowing of the origin of the right vertebral artery secondary to\natherosclerotic disease. The carotid and vertebral arteries and their major\nbranches appear otherwise normal with no evidence of stenosis or occlusion.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nRedemonstrated scattered pulmonary nodules and dominant right upper lobe\nperihilar mass with fiducial marker. The visualized portion of the thyroid\ngland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No acute intracranial abnormality.\n2. No evidence of dissection, aneurysm or occlusion. No significant ICA\nstenosis by NASCET criteria.\n3. At least moderate narrowing of a suboptimally evaluated right vertebral\nartery origin likely secondary to atherosclerotic plaque.\n4. Mild white matter chronic small vessel ischemic disease.\n5. Parenchymal involutional changes, likely age related.\n6. Redemonstrated scattered pulmonary nodules and dominant right upper lobe\nperihilar mass with fiducial marker. See prior CT chest for complete details." + }, + { + "input": "There is no evidence of acute large vascular territory\ninfarction,hemorrhage,edema,or mass effect. Focal hypodense area in the right\ncerebellar hemisphere (03:10) may correspond to the area of signal abnormality\nseen on the previous MRI and appears grossly unchanged. There is prominence\nof the ventricles and sulci suggestive of involutional changes. \nPeriventricular and subcortical white matter hypodensities are nonspecific but\nsuggest chronic small vessel ischemic changes.\n\nMild cavernous carotid artery calcifications are noted.\n\nThere is no evidence of fracture. 1.0 cm subcutaneous nodule with\ncalcification noted over the left vertex is unchanged compared to prior,\nlikely a sebaceous cyst. Re-demonstration of 1.0 cm bony protrusion along the\nright frontal region, unchanged from priors. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. Left\neye prosthesis and postoperative changes are unchanged from prior.", + "output": "No acute intracranial process. No calvarial fracture." + }, + { + "input": "The known abnormality in right cerebellar hemisphere on MR from ___ is not well visualized on today's exam. There is no evidence of large\nterritorial infarction,hemorrhage,edema,or new mass. There is prominence of\nthe ventricles and sulci suggestive of involutional changes. Bilateral\nperiventricular and subcortical white matter hypodensities are nonspecific but\nmost likely represent sequela of chronic small vessel ischemic changes.\n\nThere is no evidence of fracture. 0.9 cm soft tissue nodule in the left\nvertex is unchanged. The visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. Left eye prosthesis is again\nnoted. Otherwise the orbits are unremarkable. Inflammatory changes centered\nat the right parotid gland better assessed on dedicated right neck CT.", + "output": "No acute intracranial process. Partially visualized inflammatory changes\ncentered at the right parotid gland better assessed on dedicated CT neck." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe right parotid gland appears edematous with surrounding fat stranding,\nwhich could represent parotitis. No rim enhancing fluid collection or mass\nwithin the right parotid gland is identified. No stone is identified. \nOtherwise, the remaining salivary glands enhance normally and are without mass\nor adjacent fat stranding. The thyroid gland appears normal. There is no\nlymphadenopathy by CT criteria. The neck vessels are patent.\n\nThere is a 4.1 x 2.2 cm right upper lobe mass with fiducial marker, seen on\nprior chest CT. Otherwise no focal consolidation in the visualized bilateral\nchest.There are no osseous lesions. No fracture. Level degenerative changes\nof the cervical spine are noted.", + "output": "1. Edematous right parotid gland with surrounding fat stranding, concerning\nfor parotitis. No stone, abscess, or mass is identified.\n2. Re-demonstration of a 4.1 x 3.2 cm right upper lobe mass, consistent with\nknown lung cancer." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nProminence of ventricles and sulci likely reflect involutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. Prosthetic left eye is noted.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent. Symmetric 1 mm focal outpouching at bilateral\nsupraclinoid ICAs (958:22) are likely infundibula.\n\nCTA NECK:\nBilateral internal carotid arteries are tortuous. There is 40% narrowing at\nthe proximal left common carotid (8:459). There is no stenosis of the right\ninternal carotid artery by NASCET criteria.\nFocus of heavy calcification is noted at the left vertebral artery origin with\nlumen narrowing.\nOtherwise, the carotid and vertebral arteries and their major branches appear\nnormal with no evidence of stenosis or occlusion.\n\nOTHER:\nKnown right lung mass and bilateral pulmonary nodules are again demonstrated. \nThe visualized portion of the thyroid gland is within normal limits. There is\nno lymphadenopathy. Right parotid gland is more hyperdense compared to the\nleft and demonstrates mild overlying fascial thickening. Previously seen\nsurrounding fat stranding has resolved.", + "output": "1. 40% narrowing of the proximal left common carotid is identified. \nOtherwise, major intracranial and cervical arteries are patent without\nstenosis.\n2. Previously seen fat stranding surrounding the asymmetrically large right\nparotid gland is resolved since ___ and may reflect improved\nparotiditis.\n3. Known lung mass and nodules are again demonstrated." + }, + { + "input": "There is no evidence of acute large territory infarction,hemorrhage,edema, or\nmass effect. Encephalomalacia related to chronic infarcts are again seen\nwithin the right frontal lobe, left parietal lobe, left occipital lobe, and\nright cerebellum. There is moderate prominence of the ventricles and sulci\nsuggestive of involutional changes, similar to prior. Dense atherosclerotic\ncalcifications of the bilateral carotid siphons and left intracranial\nvertebral artery are seen.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "No CT evidence of acute large territory infarct. Re-demonstrated bilateral\nchronic infarcts appear similar to the prior CT. No intracranial hemorrhage. \nMRI is more sensitive in detecting acute ischemia." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass. Areas of encephalomalacia are again demonstrated in the right\nfrontal lobe, bilateral parietal lobes, and left greater than right occipital\nlobes, and right cerebellum. Moderate prominence of the ventricles and sulci\nis suggestive of involutional changes. There is no evidence of mass effect or\nmidline shift.\n\nThere is mild mucosal thickening of the ethmoid and left maxillary sinus. The\nmastoid air cells are clear. The visualized portion of the orbits are\nunremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nEvaluation of the aortic arch demonstrates extensive calcified and\nnoncalcified atherosclerotic plaques of the aortic arch and great vessel\norigins.\n\nThe left vertebral artery is dominant. There is a linear filling defect in\nthe left distal V2 segment, which appears similar compared to prior MRA dated\n___ and ___. There are also mild atherosclerotic\ncalcifications of the left V4 segment.\n\nModerate to severe narrowing at the origin the right vertebral artery is again\ndemonstrated with poststenotic dilatation, unchanged. The right vertebral\nartery is small in caliber with narrowing of the right V4 segment. This\nappears more conspicuous compared to prior MRI.\n\nThere are mild-to-moderate atherosclerotic calcifications at the common\ncarotid bifurcations. There is no evidence of internal carotid stenosis by\nNASCET criteria.\n\nTriangular-shaped infundibulum of the basilar tip is unchanged.\n\nOTHER:\nThere is a 3 mm nodule in the right apex (image 75 series 3). The esophagus\nis patulous. The thyroid gland is heterogeneous in appearance, which may be\ndue to subcentimeter nodules, there is a punctate calcification on the left\nthyroid lobe measuring approximately 2 x 2 mm in transverse dimension (image\n93, series 3), according with the current ACR guidelines, no follow-up is\nnecessary. There is no lymphadenopathy by CT size criteria.\n\nThere are multilevel degenerative changes of the cervical spine, most\npronounced at C3-C4, C5-C6, and C6-C7 with intervertebral disc space\nnarrowing, hypertrophic endplate changes, and posterior disc osteophyte\ncomplexes.", + "output": "1. Stable CT appearance of the head with no evidence of acute large\nterritorial infarct or intracranial hemorrhage.\n2. Linear filling defect in the distal left V2 segment is unchanged compared\nto ___, and may reflect a chronic dissection or vertebral artery\nfenestration.\n3. Unchanged moderate to severe right vertebral artery origin narrowing with\npoststenotic dilatation.\n4. Small caliber of the right distal V4 segment, which appears more\nconspicuous compared to prior MRA.\n5. Unchanged basilar tip infundibulum.\n6. Patent circle of ___ with no evidence of focal stenosis, occlusion, or\naneurysm formation.\n7. A 3 mm nodule in the right apex is indeterminate.\n\nRECOMMENDATION(S): For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___.\n\n Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or older.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "Facial bone findings are better evaluated on CT sinus ___.\n\nStreak artifact from bullet fragments/shrapnel partially obscure the view,\nlimiting evaluation. Bullet path appears to be from right frontal to left\nfrontal with separation of the calvarium. A scalp hematoma overlies a 1.7 cm\ndefect noted in the right frontal bone with extension of bony and metal\nfragments into the bilateral frontal and left temporal lobe. There is,\nadditionally a comminuted fracture of the left frontal and left temporal bone.\nThe largest metal fragment abuts the left temporal bone.\n\nSubarachnoid hemorrhage is seen at the vertex, including on the left. The falx\nappears thickened and there may be a parafalcine subdural hematoma. There is\nlikely a left frontal extra-axial hematoma at the vertex, which is partially\nobscured by artifact. There is effacement of the sulci and loss of gray-white\nmatter differentiation, bilaterally consistent with diffuse cerebral edema.", + "output": "1. Bullet path appears to be from right frontal to left frontal with\nseparation of the calvarium. 1.7 cm diastasis/fracture if the right frontal\nbone with extension of bony and metal fragments into the left temporal and\nbilateral frontal lobes. Comminuted fracture of the left frontal and left\ntemporal bone. See concurrent CT face for further details regarding numerous\nfacial fractures.\n\n2. Diffuse cerebral edema.\n\n3. Possible small parafalcine subdural hematoma. Likely extraaxial hemorrhage\nat the vertex, largely obscured by artifact..\n\n4. Subarachnoid hemorrhage at the vertex on the left." + }, + { + "input": "Study partially limited by motion. Within this limitation, there is no\nevidence of large vascular territory infarction, hemorrhage, edema, or mass\neffect. The ventricles and sulci are prominent in size and configuration\nconsistent with age related atrophy. Nonspecific periventricular and\nsubcortical white matter hypodensities suggest chronic small vessel ischemic\nchanges.\nNo evidence of fracture. The paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The orbits demonstrate bilateral lens replacement. \nMild atherosclerotic calcifications of the cavernous carotid arteries are\nseen.", + "output": "No evidence of acute intracranial process such as hemorrhage or large vascular\nterritory infarction. No evidence fracture." + }, + { + "input": "Bilateral skullbase fractures are identified involving the carotid canals, on\nthe right visualized on the images 34 through 37, series 102, and on the left \nimages 28 through 32, series 102, extending towards the left petrous apex,\ncorrelation with CTA is advised. Multiple lucencies identified in the\noccipital bone are consistent with sutures and venous channels, with no frank\nevidence of fracture throughout the occipital bone. Small right\nparieto-occipital scalp hematoma is stable in size.\n\nA 5 x 5 cm focus of intraparenchymal hemorrhage is seen within the left\nparietal lobe (series 2 image 16). There is no evidence of infarction,edema,\nor mass. The ventricles and sulci are normal in size and configuration.\n\nThere is unchanged mild opacification of the right mastoid air cells. There\nis near complete opacification of the sphenoid sinus with dense material,\nlikely consistent with residual blood products. Otherwise, the visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Bilateral skullbase fractures involving the carotid canals and extending\ntowards the left petrous apex as described in detail above.\n2. Small right parietal occipital scalp hematoma without underlying fracture\nvisualized.\n3. Stable 5 cm round focus of intraparenchymal hemorrhage within the left\ntemporoparietal region.\n\nRECOMMENDATION(S): Correlation with CTA of the head and neck is recommended\nto evaluate for possible vascular injury related with bilateral skullbase\nfractures.\n\nNOTIFICATION: The findings were discussed with ___, NP. by ___\n___, M.D. on the telephone on ___ at 10:20 AM, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is an unchanged rounded focus of intraparenchymal hemorrhage along the\nleft parietal convexity measuring 5 x 5 mm (02:17). There is no new\nhemorrhage. There is infarction, edema, or mass on this unenhanced study. \nThe ventricles are normal in size without midline shift. The basal cisterns\nare patent.\n\nAgain seen are minimally displaced bilateral skullbase fractures involving the\ncarotid canals (3:239). There is mild mucosal opacification of bilateral\nmaxillary sinuses. There is dense material again seen within bilateral\nsphenoid sinuses with air-fluid level, compatible with blood products. There\nis partial opacification of bilateral mastoid air cells.\n\nCTA head:\nThe bilateral internal carotid arteries adjacent to the carotid canal\nfractures demonstrate no evidence of a dissection or stenosis. There is no\ndistention of the ophthalmic veins or inferior petrosal sinuses to suggest an\nindirect carotid cavernous fistula. The vessels of the circle of ___ and\nthe principal intracranial branches appear patent without stenosis, occlusion,\nor aneurysm formation. The dural venous sinuses are patent. The basilar and\nintracranial vertebral arteries are patent.\n\nCTA neck:\nThere is a 3 vessel aortic arch. The bilateral common, internal, and\nvertebral arteries are patent without significant stenosis per NASCET\ncriteria, occlusion, or dissection.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Fractures of the bilateral carotid canals again seen without carotid\ndissection or stenosis. No evidence of distention of the of ophthalmic veins\nor inferior petrosal sinuses to suggest interact carotid cavernous fistula.\n2. Stable 5 mm rounded focus of intraparenchymal hemorrhage along the left\nparietal convexity.\n3. Residual blood products again seen within the sphenoid sinuses." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, mass, mass effect or\nlarge territorial infarction. The ventricles and sulci are normal in size and\nconfiguration. The basilar cisterns are patent common there is otherwise good\npreservation gray-white matter differentiation.\n\nNo acute fracture is identified. The visualized paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The globes are unremarkable.", + "output": "No acute intracranial abnormalities identified.\n\nRECOMMENDATION(S): Please note that MRI with contrast would be a more\nsensitive evaluation for the detection of small intracranial masses." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nPeriventricular and subcortical white matter hypodensities are nonspecific but\nlikely reflect sequelae of chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nanterior ethmoid air cells, otherwise the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of fracture, acute large territory\ninfarction,intracranial hemorrhage,edema,or mass effect. There is prominence\nof the ventricles and sulci suggestive of involutional changes.\nPeriventricular and subcortical white matter hypodensities are nonspecific but\nlikely sequelae of chronic small vessel ischemic disease.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "No acute intracranial process." + }, + { + "input": "There has been interval placement of stereotactic biopsy frame. Multiple\ncentral enhancing masses in the bilateral basal ganglia, medial left parietal\nlobe, mamillary body, and right cerebral peduncle are again demonstrated,\nwhich were better evaluated on prior MRI. Vasogenic edema and mass effect\nappear unchanged.\nThe ventricles and sulci are stable in size and configuration. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Multiple central enhancing masses, surrounding vasogenic edema, and mass\neffect are unchanged and were better evaluated on prior MR." + }, + { + "input": "In comparison to the previous examination from the same date, multiple large,\ncentrally hypodense masses in the bilateral basal ganglia and the left\nthalamus are unchanged in size. Additional smaller masses are better\nevaluated on the prior MR. ___ 4 mm hyperdense focus in the mass in the right\nbasal ganglia. Likely represents blood products from recent biopsy. Overall\nvasogenic edema is unchanged. Leftward midline shift is mildly increased now\nmeasuring 5 mm (previously 3 mm. Effacement of the lateral ventricles and\nthird ventricles is unchanged. There is no infarction.\n\nA right frontal burr hole is noted. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. A small focus of blood products is seen in the patient's right basal\nganglia mass consistent with biopsy. Mild leftward midline shift is mildly\nincreased. Otherwise, no significant changes in comparison to the prior\nexamination." + }, + { + "input": "Again seen are bilateral multiple large hyperdense masses in bilateral basal\nganglia and left thalamus, increased in size compared to prior in ___ and ___. The masses cause 5 mm rightward shift, new since ___. Compared to prior, the masses are for homogeneous in attenuation\ncentrally, which may be due to interval internal hemorrhage. Addition,\n___ adjacent to the left ventricle is also larger, and demonstrating\na focus of ___, which may represent a focus of hemorrhage. There is\nextensive vasogenic edema.\n\nThere is no evidence of acute fracture. Patient is status post right frontal\ncraniotomy. The visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. Interval enlargement of bilateral hyperdense masses in the basal ganglia\nand left lateral ventricle with a focus of ___ be due to interim\nhemorrhage. New 5 mm rightward shift.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 12:10AM, 2 minutes after discovery of the\nfindings." + }, + { + "input": "There is a large area of intraparenchymal hemorrhage in the right cerebellum\nmeasuring approximately 4.1 x 4.0 cm with surrounding edema causing mass\neffect with compression of the fourth ventricle and compression of right sided\nambient cistern. 2 additional subcentimeter foci of intraparenchymal\nhemorrhage are noted within the high right parietal and left parietal lobes. \nThere is no other evidence of hemorrhage or acute large territorial\ninfarction. There is prominence of the ventricles and sulci is secondary to\nage related involutional changes. Nonspecific periventricular white matter\nhypodensities are likely secondary to chronic small vessel ischemic disease.\n\nThere are no acute fractures seen. Status post sinus surgery. There is\npolypoid thickening adjacent to the nasal septum. There is mild mucosal\nthickening of the right maxillary sinus. There is opacification of the left\nand ethmoidal air cells. Otherwise, the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear.", + "output": "1. Right cerebellar intraparenchymal hemorrhage measuring up to 4.1 cm with\nassociated edema causing mass effect and compression on the fourth ventricle\nand right ambient cistern.\n2. Additional foci of intraparenchymal hemorrhage in the left and right\nparietal lobes.\n\nRECOMMENDATION(S): Multiple foci of intraparenchymal hemorrhage is concerning\nfor underlying lesions. Consider MRI for further evaluation.\n\nNOTIFICATION: The findings were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 1:14 pm, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "The patient is status-post suboccipital craniectomy for large infratentorial\nhematoma evacuation with extensive infratentorial and supratentorial\npneumocephalus. The overall volume of hyperdense material reflecting right\ncerebellar hemisphere intraparenchymal hemorrhage has substantially decreased,\nnow irregular and filling portions of an area spanning approximately 2.2 x 1.6\ncm. Mass effect on the fourth ventricle has decreased significantly in the\ninterim. The quadrigeminal plate cistern is now only slightly effaced. \nAdditional postoperative changes include extensive subcutaneous emphysema\nextending from the lower occipital region into the upper cervical neck. There\nis also adjacent fat stranding and overlying cutaneous staples. A small focus\nof left parietal lobe intraparenchymal hemorrhage is unchanged and spans\napproximately 8 x 5 mm (series 2, image 23). A small focus of right parietal\nintraparenchymal hemorrhage is also unchanged and spans approximately 7 x 5\nmm. A very small amount of right parietal subarachnoid hemorrhage is\nunchanged (series 2, image 22). No new hemorrhage. No evidence of large\nterritorial infarction.\n\nPatient is status-post endoscopic sinus surgery with polypoid thickening of\nthe nasal septum and partial opacification of the ethmoid air cells. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Substantial interval improvement of a large right cerebellar hemisphere\nhematoma status-post suboccipital craniotomy with decreased mass effect on the\nfourth ventricle and basilar cisterns. Expected postsurgical changes include\npneumocephalus and subcutaneous emphysema.\n2. Small bilateral parietal lobe intraparenchymal hemorrhage is and a small\nright parietal subarachnoid hemorrhage are unchanged. No evidence of new\nhemorrhage.\n3. Status-post endoscopic sinus surgery with polypoid thickening of the nasal\nseptum. Recommend correlation with prior ENT history/examination." + }, + { + "input": "Patient is status-post suboccipital craniectomy for large infratentorial\nhematoma evacuation. Postoperative changes include extensive pneumocephalus\nand subcutaneous emphysema minimally improved compared to 16 hours prior. \nEffacement of the fourth ventricle is probably unchanged. The quadrigeminal\nplate cistern remains minimally effaced. Small bilateral parietal lobe\nintraparenchymal hemorrhages are unchanged. No evidence of new intracranial\nhemorrhage. No evidence of large territorial infarction. Periventricular and\nsubcortical white matter hypodensities are nonspecific but likely sequelae of\nchronic small vessel ischemic disease.\n\nPatient is status-post endoscopic sinus surgery with polypoid thickening of\nthe nasal septum and partial opacification of the ethmoid air cells. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Continued evolution of postsurgical changes status-post suboccipital\ncraniectomy and infratentorial hematoma evacuation including slightly\ndecreased pneumocephalus and subcutaneous emphysema. No evidence of new or\nenlarging hemorrhage.\n2. Small bilateral parietal lobe intraparenchymal hemorrhages are unchanged.\n3. Status-post endoscopic sinus surgery with polypoid thickening of the nasal\nseptum. Recommend correlation with prior ENT history/examination." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass effect, midline shift,\nor acute major vascular territorial infarct. Gray-white matter differentiation\nis preserved. Ventricles and sulci are prominent compatible with global volume\nloss.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process. No evidence of intracranial metastases based\non an unenhanced head CT." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of acute fracture. There is subtle lucency in the right\noccipital condyle, possibly representing a metastatic osseous lesion (6:7). \nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable. Soft tissue in the right external auditory canal is presumably\ncerumen.", + "output": "1. No acute intracranial abnormalities.\n2. Subtle lucency in the right occipital condyle, possibly a metastatic\nosseous lesion, compatible with history of osseous metastatic disease." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration\nfor the patient's age. The imaged paranasal sinuses are essentially clear. \nMastoid air cells and middle ear cavities are well aerated. The bony calvarium\nis intact.", + "output": "No acute intracranial hemorrhage or fracture." + }, + { + "input": "CTA NECK:\n3 vessel aortic arch. Mild calcified plaque in the proximal left subclavian\nartery and in the proximal descending aorta. Mild mixed plaque in the proximal\nright internal carotid artery and minimal mixed plaque in the proximal left\ninternal carotid artery, without stenosis by NASCET criteria. No carotid\ndissection. The right vertebral artery is dominant, and the left vertebral\nartery is diminutive. Bilateral vertebral arteries appear widely patent\nwithout stenosis or dissection.\n\nCTA HEAD:\nAtherosclerotic calcifications are seen at the carotid siphons without\nflow-limiting stenosis. Anterior and middle cerebral arteries appear patent\nwithout flow-limiting stenosis.\n\nThere is mild calcified plaque in the proximal V4 segment of the right\nvertebral artery, proximal to the right ___, without flow-limiting\nstenosis. There is ___ termination of the nondominant left vertebral artery. \nIn addition to the right ___, there is a large left-sided branch of the\nintracranial right vertebral artery, which has anastomoses with the left ___.\nSmall bilateral AICAs are also present.\n\nThere is a web-like high-grade stenosis in the proximal basilar artery,\nproximal to bilateral AICA origins, images 602b:38, 603b:27, and 359:25.\n\nThere is no evidence for an aneurysm.\n\nThe dural venous sinuses are patent.\n\nOTHER:\nThere is atelectasis in the included upper lungs. There is mild paraseptal\nemphysema in the included right upper lobe and at the left apex. The\nvisualized portion of the thyroid gland is within normal limits. There is no\nlymphadenopathy by CT size criteria. There are multilevel degenerative\nchanges in the cervical spine. There is trace fluid in right mastoid tip air\ncells. This exam is not technically optimized for evaluation of the brain\nparenchyma.", + "output": "1. No evidence for arterial dissection in the neck or intracranial\ncompartment.\n2. Web-like high-grade stenosis in the proximal basilar artery, proximal to\nbilateral AICA origins.\n3. ___ termination of the non dominant left vertebral artery. In addition to\nthe right ___, there is a large left-sided branch of the intracranial right\nvertebral artery, which has anastomoses with the left ___.\n\nNOTIFICATION: Presence of the proximal basilar artery stenosis, which was not\nincluded in the WET READ, was emailed by Dr. ___ to Dr. ___ on ___ at 19:49." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,or\nmass-effect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular white-matter hypodensities are\nnonspecific, but likely reflect sequela of chronic small vessel disease.\n\nThere is no evidence of fracture. A mucous retention cyst is seen in the\nright frontal sinus. Severe mucosal thickening seen in the ethmoid air cells.\nThe visualized portion of the mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\n\nMild mucosal thickening is noted in the ethmoid air cells bilaterally. The\nremaining paranasal sinuses appear clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process. Please note that MRI with contrast is a more\nsensitive examination to assess for the presence of a mass lesion." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. No lymphadenopathy. The neck\nvessels are patent. No evidence of periapical lucency or odontogenic abscess.\nNo tonsillar enlargement or evidence of peritonsillar collection. No\nretropharyngeal edema.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.\n\nPartially visualized is a Port-A-Cath imbedded within the right chest wall.", + "output": "No acute findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThere are moderate mucous retention cysts in the left maxillary sinus. The\nremainder of the visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the orbits\nare unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion or dissection. There is no evidence of\ninternal carotid stenosis by NASCET criteria. There is asymmetric early\nfilling and distention of the venous plexus surrounding the distal V2 and V3\nsegments of the left vertebral artery (5:173 through 196). There is no\nevidence of underlying vertebral artery injury.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No acute intracranial abnormality.\n2. Early asymmetric filling and venous distension of the venous plexus\nsurrounding the distal left V2 and V3 segments of the left vertebral artery,\nsuspicious for arteriovenous fistula, versus anatomical vascular variation.\n3. Otherwise patent cervical vasculature without significant stenosis,\nocclusion or dissection.\n4. Patent intracranial vasculature without significant stenosis, occlusion, or\naneurysm." + }, + { + "input": "There is no evidence of acute large territorial infarction, intracranial\nhemorrhage, edema, or mass effect.\n\nThe ventricles and sulci are normal in size and configuration.\n\nNo acute osseous abnormalities seen. There are slight secretions in the right\nposterior ethmoid air cells. Otherwise, the partially imaged paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The orbits\ndemonstrate no acute abnormalities.", + "output": "No acute intracranial abnormality on noncontrast head CT. Specifically no\nintracranial mass effect or hemorrhage." + }, + { + "input": "Motion degraded images at the craniocervical junction. No evidence of\nsignificant stenosis, occlusion, or dissection. No evidence of internal\ncarotid artery stenosis by NASCET criteria.\n\nThe visualized portions of the lung apices appear clear. The thyroid gland\nappears unremarkable. There is no evidence of lymphadenopathy per size\ncriteria.", + "output": "1. No evidence of significant stenosis, occlusion, or dissection." + }, + { + "input": "There is enlarged and heterogeneous appearance of the right palatine tonsil\n(2:37-39), consistent with tonsillitis. There is no organized drainable\nperitonsillar fluid collection at this time. There is mild resultant\nnarrowing of the aerodigestive tract, which remains otherwise widely patent. \nThere are multiple enlarged bilateral cervical lymph nodes, the largest of\nwhich measures 2.5 x 1.8 cm in right level IIA (2:45).\n\nThe salivary glands enhance normally and are without mass.The thyroid gland is\nunremarkable. Contrast bolus timing is not optimal to evaluate the neck\nvessels, but no gross filling defect detected.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions. Small mucosal retention\ncysts identified in the left maxillary sinus.", + "output": "Right palatine tonsillitis. No drainable fluid collection. Prominent lymph\nnodes including level 2A right node, to 2.5 x 1.8 cm." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Mild prominence of the ventricles and sulci are likely related to\nage-related involutional changes. Periventricular and subcortical white\nmatter hypodensities are nonspecific, but likely reflect sequelae of chronic\nsmall vessel ischemic disease. Mucosal thickening of the ethmoid air cells is\nnoted. The remaining imaged paranasal sinuses are clear. Mastoid air cells\nand middle ear cavities are well aerated. The bony calvarium is intact.", + "output": "No evidence of acute hemorrhage or large vascular territory infarction." + }, + { + "input": "Study is severely limited due to patient motion.\n\nWithin these limitations, there is no evidence of large territorial infarction\ninfarction,hemorrhage,edema, or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. Periventricular, subcortical,\nand deep white matter hypodensities are nonspecific, but likely consistent\nwith chronic microvascular ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Severely limited study due to patient motion. Within these limitations, no\nevidence of large territorial infarction or hemorrhage.\n2. White matter hypodensities are nonspecific, but likely represent chronic\nmicrovascular ischemic disease." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. Moderate ventriculomegaly appears similar to the prior study from\n___. Periventricular and subcortical white matter hypodensities are\nsimilar to prior, suggestive of chronic microangiopathy. Mild atherosclerotic\ncalcifications of the cavernous carotid arteries and distal left vertebral\nartery are noted.\n\nThere is no evidence of acute calvarial fracture. The visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nThe visualized portion of the orbits are unremarkable. Mild soft tissue\nswelling overlies the posterior vertex.", + "output": "1. No acute intracranial process.\n2. Moderate ventriculomegaly is unchanged. As before, degree of ventricular\nenlargement is out of portion for the degree of sulcal atrophy, and findings\ncould be due to normal pressure hydrocephalus or predominant central brain\natrophy." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or acute vascular\nterritorial infarction. Periventricular white matter hypodensities are\nnonspecific but likely sequelae of chronic small vessel ischemic disease. \nProminent ventricles and sulci reflecting global atrophy is more than expected\nfor age. Basal cisterns are patent. Gray-white matter differentiation is\npreserved.\n\nNo fracture is identified. Partially imaged paranasal sinuses are clear. \nMastoid air cells and middle ear cavities are clear. The orbits are\nunremarkable. .", + "output": "No evidence of hemorrhage or acute infarction." + }, + { + "input": "There is no hemorrhage, edema, or mass effect. Ventricles and sulci are\nmildly prominent. Periventricular and subcortical white matter hypodensities\nare nonspecific, likely sequela of chronic small vessel ischemia. There is no\nshift of normally midline structures. Basal cisterns are patent. Gray-white\nmatter differentiation is preserved.\n\nThe orbits are unremarkable. Imaged paranasal sinuses demonstrate mild\nethmoidal air cell mucosal thickening. Mastoid air cells and middle ear\ncavities bilaterally are clear.", + "output": "No acute intracranial abnormality." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is extensive right parietal and temporal vasogenic edema. There is a\nsecond more discrete 1.5 x 1.0 cm focus of hypodensity centered in the right\ninternal capsule or thalamus (series 2, image 16) which corresponds to\ndiscrete FLAIR signal abnormality on MR ___. There is no definite\nabnormal enhancement on postcontrast imaging.\n\nThere is unchanged effacement of the right hemispheric sulci and approximately\n10 mm of leftward midline shift. There is mild attenuation of the occipital\nhorn of the right lateral ventricle. There is likely mild uncal herniation\nwith mild effacement of both the right and left cerebral peduncles (series 2,\nimage 12).\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe PCAs, bilaterally have fetal origins. The V4 segment of the right\nvertebral artery is diminutive. Otherwise, the vessels of the circle of\n___ and their principal intracranial branches appear normal with no\nevidence of stenosis, occlusion, or aneurysm. The dural venous sinuses are\npatent.", + "output": "1. No flow limiting stenosis, dissection or aneurysm greater than 3 mm.\n2. Extensive right parietotemporal vasogenic edema is not significantly\nchanged from prior MR. ___ second more discrete hypodense focus centered in the\nright internal capsule or thalamus, corresponding to discrete FLAIR signal\nabnormality on the prior MR is suspicious for a second lesion. The pattern of\ninvolvement is suggestive of an infiltrative neoplasm\n3. 10 mm of leftward midline shift is unchanged. No hydrocephalus. Mild\nuncal herniation with mild effacement of the bilateral cerebral peduncles." + }, + { + "input": "The patient is status post right parietal craniotomy for biopsy of a right\nhemispheric infiltrating mass. Postsurgical changes including a small amount\nof pneumocephalus is present. No evidence of hemorrhage or acute territorial\ninfarct. There is stable 5 mm of leftward midline shift. No evidence of\ntonsillar or uncal herniation. The basal cisterns are patent. The\nventricular size is unchanged.\n\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\nThe orbits are unremarkable.", + "output": "Small amount of postsurgical pneumocephalus post right parietal craniotomy and\nbiopsy of an infiltrating right cerebral mass. Unchanged 5 mm leftward\nmidline shift." + }, + { + "input": "Evaluation is limited by motion and streak artifact.\n\nWithin these limits, there is no evidence of large acute infarction,\nintracranial hemorrhage, edema, or mass. There is mild prominence of the\nventricles and sulci suggestive of involutional changes. No acute fracture. \nAtherosclerotic vascular calcifications are noted of bilateral cavernous\nportions of internal carotid arteries.\n\nDependent fluid in nasopharynx, sphenoid sinus, and ethmoid sinus, which may\nbe related intubation status. Right maxillary sinus mucosal thickening is\npresent. The mastoid air cells, and middle ear cavities are clear. The orbits\nare preserved. Left suboccipital proximally 0.7 x 1 cm probable lymph node is\nseen (see 2:5).", + "output": "1. Study degraded by motion and streak artifact.\n2. No acute intracranial abnormality. Please note MRI of the brain is more\nsensitive for the detection of acute infarct.\n3. No evidence acute intracranial hemorrhage or fracture.\n4. Nonspecific 0.7 x 1 cm left suboccipital probable lymph node, which may be\nreactive." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nAn acute subdural hematoma, overlying the left cerebral convexity, measures 9\nmm in thickness, unchanged from the recent prior examination. The sulci of\nthe left cerebral hemisphere are slightly effaced. No new hemorrhages are\nidentified. There is no evidence of infarction, midline shift, or mass. The\nventricles are normal in size.\n\nThere is mild mucosal thickening in the left maxillary sinus and moderate\nmucosal thickening in the right sphenoid sinus. The mastoid air cells are\nclear. No displaced calvarial fracture is identified. A rounded metallic\ndensity is noted in the right parietal scalp.\n\nCTV HEAD:\nThe superior sagittal, transverse, sigmoid, and straight sinuses are patent. \nThe internal cerebral veins and proximal internal jugular veins are patent. \nThere is no evidence of venous sinus thrombosis.\n\nThe circle of ___ is grossly patent.", + "output": "1. No evidence of dural venous sinus thrombosis.\n2. Unchanged, acute subdural hematoma, measuring 9 mm in thickness, in the\nleft cerebral convexity. No new hemorrhages." + }, + { + "input": "Unchanged, mixed attenuation left frontotemporal subdural hematoma measuring\nup to 5 mm from the inner table of the cranium. Mild mass effect on the\nadjacent sulci is unchanged. There is no evidence of midline shift. The\nbasal cisterns appear patent. The configuration of ventricles is unchanged. \nNo new focus of hemorrhage. No large territorial infarction.\n\nThere is no evidence of fracture. An air-fluid level is seen in the right\nsphenoid sinus. Otherwise, the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. Unchanged, small mixed-attenuation left frontotemporal subdural hematoma. \nNo new focus of hemorrhage. No evidence of infarction." + }, + { + "input": "There is little change in comparison to the prior examination of ___.\nResidual mixed density subdural hemorrhage along the left frontotemporal\nconvexity has decreased since ___. There is no new hemorrhage. There\nis no shift of normally midline structures. The ventricles are stable in size\nand configuration. Basal cisterns are patent. Gray-white matter\ndifferentiation is preserved.\n\nThere is a 5 mm metallic density in the right parietal scalp, similar to the\nprior examinations. There is no fracture. Paranasal sinuses are notable for\naerosolized secretions in the right sphenoid sinus. The mastoid air cells and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "Residual mixed density left frontotemporal subdural hematoma has decreased in\nsize since ___, but stable from one day prior. No new hemorrhage." + }, + { + "input": "The residual mixed density left frontotemporal convexity subdural hemorrhage\ncausing minimal effacement of the lateral horn of the left lateral ventricle\nis unchanged from recent prior studies. There is no new or enlarging\nhemorrhage. There is no evidence of infarction, edema, or mass. The\nventricles and sulci are stable in size and configuration.\n\nThere is no evidence of fracture. A rounded metallic object in the right\nparietal scalp is unchanged from prior studies. Aerosolized secretions in the\nsphenoid sinus and mild mucosal thickening of the anterior ethmoidal air cells\non the left greater than right maxillary sinuses are unchanged from the\nimmediate prior study. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are otherwise clear. The\nvisualized portion of the orbits are unremarkable. A sclerotic lesion in the\nleft side of the clivus is again identified, perhaps a hemangioma.", + "output": "Unchanged left frontotemporal convexity subdural hematoma. No evidence of new\nor enlarging hemorrhage." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, or loss of\ngray/white matter differentiation. Ventricles, sulci, and basal cisterns are\nnormal in size.\n\nThere is a chronic fracture of the left zygomatic arch with mild associated\ndeformity, but no evidence for contusion in the adjacent fat (series 3, image\n9). There is no evidence of acute fracture. Minimal mucosal thickening\nwithin the partially visualized maxillary sinuses. Partially visualized\nmastoid air cells are well aerated.", + "output": "1. No evidence of acute intracranial abnormalities.\n2. Chronic fracture of the left zygomatic arch. No acute fracture seen.\n\nRECOMMENDATION(S): MRI would be more sensitive for an acute infarction, if\nclinically warranted" + }, + { + "input": "There is no evidence of infarction, hemorrhage, or edema. Two calcified\nextra-axial lesions measuring 10 x 6 mm in the right frontal region (2:23) and\n9 x 7 mm in the left parietal region (2:25) are most compatible with small\nmeningiomas. There is slightly asymmetric mineralization of the basal ganglia\non the left greater than the right. Periventricular white matter hypodensities\nare compatible with sequela of chronic microvascular ischemic disease. The\nventricles and sulci are normal in size and configuration for the patient's\nage. Dense vascular calcification of the bilateral carotid siphons is noted.\n\nOrthopedic hardware is seen in the occiput extending to the upper cervical\nspine posteriorly. No osseous abnormalities seen. There is mild\nsphenoethmoid thickening. The orbits are unremarkable. The bilateral lenses\nhave been replaced.", + "output": "1. No evidence of acute intracranial process.\n2. Two small calcified extra-axial lesions in the right frontal and left\nparietal regions are most compatible with small meningiomas." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nHypodensity is noted within the right insula, corona radiata, and precentral\ngyrus, worrisome for late acute/subacute infarction. No additional areas of\npossible infarction are identified. There is no evidence of no evidence of\nhemorrhage, edema, or mass. The ventricles and sulci are prominent,\ncompatible with global cerebral atrophy. Periventricular and subcortical\nwhite matter hypodensities are nonspecific and likely reflect chronic small\nvessel ischemic disease.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\nSeveral small, ossified, dural-based right frontal and left parietal masses\nlikely represent meningiomas. Calcifications are noted in the bilateral\ncavernous carotid arteries. Orthopedic hardware extends from the occiput to\nthe upper cervical spine, as visualized.\n\nCTA HEAD:\nDense calcifications are noted within the bilateral cavernous and supraclinoid\ninternal carotid arteries, resulting in moderate to severe stenosis at these\nlevels. The vessels of the circle of ___ and their principal intracranial\nbranches otherwise appear normal without occlusion or aneurysm formation. The\ndural venous sinuses are patent.\n\nCTA NECK:\nThe V2 segment of the left vertebral artery is not well visualized for a\nshort-segment (3:124), reconstituting as it enters the foramen transversarium\nat the level of C4 (3:131). Otherwise, the remainder of the carotid and\nvertebral arteries and their major branches appear normal with no evidence of\nstenosis or occlusion. There is no evidence of internal carotid stenosis by\nNASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Late acute/subacute infarctions involving the right insula, coronary\nradiata, and precentral gyrus, confirmed on subsequent MRI examination.\n2. No evidence for acute intracranial hemorrhage.\n3. Focal, short segment non opacification of the V2 segment of the left\nvertebral artery, suggestive of occlusion versus less likely chronic\ndissection at this level.\n4. Moderate to severe stenosis of the bilateral cavernous and supraclinoid\ninternal carotid arteries. No evidence for focal occlusion or aneurysm\ngreater than 3 mm." + }, + { + "input": "Head CT: There is no evidence of acute intracranial hemorrhage or mass\neffect. There is a prior suboccipital craniectomy. There is encephalomalacia\nof the right cerebellar hemisphere which is likely on the basis of prior\ninfarct. There is a focus of hypodensity within the right coronal radiata\nwhich may represent sequelae of chronic small vessel ischemic disease or prior\nischemia in. There are 2 punctate calcifications within the right temporal and\nright parietal lobes which may represent sequelae of prior trauma or\ninfection. The orbits are unremarkable. There is right maxillary sinus and\nethmoid sinus mucosal thickening. The patient is edentulous.\n\nHead and neck CTA: There is no evidence of pathologic large vessel occlusion,\nhemodynamically significant stenosis, or dissection within the vasculature of\nthe neck. The vertebral arteries are codominant.\n\nThere is no evidence of aneurysm, hemodynamically significant stenosis, or\nfocal vessel cut off within the intracranial vasculature.\n\nThe lung apices are unremarkable. The major glandular muscular structures\nthroughout the neck appear normal.", + "output": "1. No evidence of acute intracranial hemorrhage or mass effect.\n2. Postoperative changes suboccipital craniectomy and chronic right cerebellar\nhemisphere encephalomalacia.\n3. Focal hypodensity within right chronic radiata may represent sequelae of\nchronic small vessel ischemic disease although chronicity indeterminate\nwithout comparison exam.\n4. Cortical calcifications within the right parietal and right temporal lobe\nwhich may represent sequelae of prior infection or inflammation.\n5. No evidence of aneurysm, hemodynamically significant stenosis, or\npathologic large vessel occlusion within the vasculature of the head or neck." + }, + { + "input": "There is no intracranial hemorrhage, edema, mass effect, or pathologic\nextra-axial collection. The ventricles and sulci are normal in size and\nconfiguration. All components of the right lateral ventricle larger than the\nleft, indicating congenital or developmental etiology. There is no shift of\nthe normally midline structures.The basal cisterns appear patent. There is\npreservation of the gray-white matter differentiation.\n\nThere is no calvarial fracture. The globes appear intact, and the remainder of\nthe orbits appear unremarkable on noncontrast assessment.\n\nA comminuted fracture involving the left mandibular angle and body is present,\nwith extensive bony fragmentation at the level of the ankle (03:24), and 4 mm\nlateral displacement of a free fragment on image 401b:69. There is associated\nadjacent soft tissue swelling, with lobules of gas deep and superficial to the\nfracture. The fracture disrupts the alveolar nerve canal. There is also\nfracture through 1 of the roots of the ___ #18, the second left maxillary\nmolar (602b:57).\n\nThere is anterior and inferior displacement of the right mandibular condyle\nfrom the glenoid fossa, even though the patient's mouth is closed, suggesting\nsubluxation. Left temporomandibular joint is well aligned.\n\nNo other facial fractures are identified. The visualized paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. Comminuted left mandibular fracture involving the angle and body, with\ndisruption of the alveolar nerve canal and a fracture of 1 of the roots of the\n___ #18.\n3. Apparent subluxation of the right temporomandibular joint in closed mouth\nposition." + }, + { + "input": "There is no hemorrhage, infarction, edema, large mass, or mass effect. There\nis no shift of normally midline structures, and the basal cisterns are patent.\nThe ventricles and sulci are normal in caliber and configuration. There is\npreservation of gray-white matter differentiation. There is a small ethmoid\nair cell mucosal polyp; otherwise, the visualized paranasal sinuses and\nmastoid air cells are clear. The globes and bony orbits are unremarkable. \nMinimal bilateral carotid siphon calcifications are noted.", + "output": "No acute intracranial process." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are prominent, consistent global cerebral volume loss. There are\nperiventricular and subcortical lucencies, which may represent small vessel\nischemic changes.\n\nThere is mild mucosal thickening of the left sphenoid sinus. The mastoid air\ncells,and middle ear cavities are clear. The patient is status post bilateral\nlens replacement..\n\nCTA HEAD:\nThere is moderate focal narrowing of the right P2 segment (3:245), with patent\ndistal run-off. There is fetal origin of the right posterior cerebral artery.\n\nThere is severe focal narrowing of the distal most aspect of the right\nvertebral artery, at its junction with the basilar artery.\n\nAtherosclerotic changes of the cavernous and supraclinoid segments of the\nbilateral internal carotid arteries are seen without occlusion.\n\nOtherwise, the vessels of the circle of ___ and their principal\nintracranial branches appear preserved without stenosis, occlusion, or\naneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nGrossly stable 1.6 cm x 1.6 cm pseudoaneurysm arising from the aortic arch is\nseen with other scattered ulcerated plaques throughout the visualized thoracic\naorta.\n\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria. The origins of the great vessels and vertebral\narteries are preserved.\n\nOTHER:\nMild biapical emphysematous changes are seen. A 1.2 cm bleb is seen in the\nright upper lobe. Multiple low-attenuation thyroid lesions are seen measuring\nup to 0.7 cm. There is no lymphadenopathy by CT size criteria. Degenerative\nchanges of the cervical spine are seen with multilevel moderate to severe\nbilateral foraminal narrowing.", + "output": "1. Dental amalgam streak artifact limits study.\n2. Focal narrowing of the right P2 segment with patent distal run-off.\n3. Severe focal narrowing of distal right V4 segment vertebral artery.\n4. Nonocclusive atherosclerotic changes of the intracranial internal carotid\narteries.\n5. Otherwise, patent circle of ___ without definite evidence of\nstenosis,occlusion,or aneurysm.\n6. Grossly patent bilateral cervical carotid and vertebral arteries without\ndefinite evidence of stenosis, occlusion, or dissection.\n7. Grossly stable aortic arch pseudoaneurysm with other scattered adjacent\nulcerated plaques, better demonstrated on concurrently obtained torso CTA.\n8. No acute infarct or intracranial hemorrhage. Please note MRI of the brain\nis more sensitive for the detection of acute infarct.\n9. Multiple low-attenuation thyroid lesions measuring up to 0.7 cm." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no exophytic mass nor areas\nof focal mass effect. Evaluation of the cervical lymph chains demonstrate no\npathologic lymphadenopathy by imaging criteria. The visualized salivary glands\nare unremarkable in appearance. Post thyroidectomy changes are noted. Neck\nvessels are patent. Upper lung fields are clear. The mastoid air cells are\nclear, without evidence of osseous destruction or overlying fluid collection.\n\nThere are moderate to severe multilevel degenerative changes throughout the\ncervical spine including anterior/posterior osteophytes, uncovertebral\nhypertrophy and loss of intervertebral disc space height, with mild the spinal\ncanal narrowing at C4-C5 (602b:33).", + "output": "No acute abnormality identified within the neck. Clear mastoid air cells\nwithout evidence for mastoiditis. No peritonsillar or retropharyngeal\nabscess." + }, + { + "input": "Encephalomalacia is noted within the anterior right temporal lobe and anterior\ninferior right frontal lobe. Ventricles and sulci are prominent compatible\nwith global volume loss. Periventricular white matter hypodensities are\nlikely sequela of chronic small vessel disease. There is no intra-axial or\nextra-axial hemorrhage, mass effect or midline shift. Basilar cisterns are\npatent. Dense atherosclerotic calcifications noted within the intracranial\nICAs and vertebral arteries.\n\nMucosal thickening noted in the ethmoid air cells and maxillary sinuses and\nthere is a small amount of fluid layering within the sphenoid sinus. Partial\nopacification of left mastoid tip is noted. Right orbital floor fixation\nhardware is noted.", + "output": "Encephalomalacia in the right temporal and frontal lobes. No acute\nintracranial hemorrhage. No acute process." + }, + { + "input": "Exam was repeated due to patient motion.\n\nThere is no evidence of acute infarction,hemorrhage,edema, or mass. Again\nseen is encephalomalacia within the anterior right temporal lobe and anterior\ninferior right frontal lobe consistent with chronic infarct. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nSubcortical and periventricular white matter hypodensities are nonspecific,\nhowever likely represent sequela of chronic small vessel ischemic disease. \nThere are dense atherosclerotic calcifications in the bilateral cavernous\ncarotids and vertebral arteries.\n\nLeft orbital wall hardware is partially visualized. There is no evidence of\nfracture. There is mild mucosal thickening in the right sphenoid and\nmaxillary sinuses and ethmoid air cells, similar to prior. Partial\nopacification of the left mastoid tip is unchanged. The visualized portion of\nthe remainder of paranasal sinuses, right mastoid air cells, and middle ear\ncavities are clear. Patient is status post left lens replacement. The\nvisualized portion of the orbits are otherwise unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "CTA HEAD:\nThere is mild narrowing of the bilateral supra clinoid internal carotid\narteries from calcified atherosclerotic disease. There is mild narrowing of\nthe V4 segment of the right vertebral artery by calcified atherosclerotic\ndisease. There is trace atherosclerotic calcification in the left V4 segment\nof vertebral artery, likely causing moderate narrowing due to congenital\nhypoplasia in this right dominant vertebrobasilar system. There is variant\nconjoint infundibular origin of the bilateral PCAs and ICAs. The vessels of\nthe circle of ___ and their principal intracranial branches appear patent\nwithout occlusion, or aneurysm formation. The dural venous sinuses are\npatent.\n\nCTA NECK:\nThere is mild calcified and noncalcified atherosclerotic plaque at the origins\nof the great vessels which do not cause significant stenosis. The left\nvertebral artery is non opacified starting from the origin with a subtle\nreconstitution at the distal V2 segment. There is moderate to severe\ncalcified and noncalcified plaque at the left carotid bifurcation with milder\ninvolvement on the right. Despite this, there is only roughly 20% stenosis of\nthe origin of the left internal carotid artery by NASCET criteria. There is\nno significant right internal carotid artery stenosis by NASCET criteria. The\ncarotid and right vertebral arteries and their major branches are otherwise\npatent with no evidence of occlusion.\n\nOTHER:\nThere is minimal dependent atelectasis. The visualized portion of the lungs\nare clear. The visualized portion of the thyroid gland is within normal\nlimits. There is no lymphadenopathy by CT size criteria.", + "output": "1. Non opacification of the V1 segment of a hypoplastic left vertebral artery,\nlikely occluded at its origin, with reconstitution distally at the distal V2\nsegment.\n2. Patent intracranial vasculature without aneurysm.\n3. Prominent calcified and noncalcified plaque at the left carotid\nbifurcation, though with only roughly 20% stenosis of the proximal left\ninternal carotid artery by NASCET criteria.\n4. Mild narrowing of the bilateral supra clinoid internal carotid arteries and\nright V4 segment of the vertebral artery by calcified atherosclerotic disease.\n5. Moderate narrowing of the V4 segment of the left vertebral artery by\ncalcified atherosclerotic disease." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are prominent compatible with global volume\nloss. Additionally, there is prominent extra-axial CSF density, similar\ncompared to prior. Remarkable. Basilar cisterns are patent.\n\nRight maxillary sinus is nearly entirely opacified. Sclerosis of the\nmaxillary sinus wall suggest component of chronic inflammation. Included\nparanasal sinuses and mastoids are otherwise essentially clear. Skull and\nextracranial soft tissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or large mass. The\nventricles and sulci are normal in size and configuration.\n\nNo fracture seen. The paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The orbits are unremarkable.", + "output": "Normal study." + }, + { + "input": "Head CT: In comparison with the most recent examination, again a small round\nill-defined hypodensity is identified in the right occipital lobe (image 16,\nseries 2), measuring approximately 5 x 7 mm in transverse dimension, probably\nrepresenting a prominent perivascular space versus chronic ischemic change,\nthere is no evidence of acute intracranial hemorrhage or mass effect, the\nventricles appear slightly asymmetric, the right ventricular body appears\nlarger than the left, likely consistent with an anatomical developmental\nvariant, the sulci are normal in size and configuration. The soft tissues and\ncranial bony structures are unremarkable.\n\nHead and neck CTA: The carotid and vertebral arteries and their major branches\nare patent with no evidence of stenoses. The distal cervical internal carotid\narteries measure 4.7 mm in diameter on the left and 4.3 mm in diameter on the\nright. There is no evidence of aneurysm formation or other vascular\nabnormality. The lung apices are clear. The cervical bony structures are\ngrossly unremarkable.", + "output": "Unchanged small ill-defined hypodensity identified in the right occipital\nlobe, probably representing a prominent perivascular space versus chronic\ninfarct. There is no evidence of mass effect, intracranial hemorrhage or\nsignificant changes since the prior study.\n\nCT of the head and neck appears grossly normal with no evidence of significant\narteriosclerotic disease, dissection or flow-limiting stenosis, no aneurysms\nare seen." + }, + { + "input": "Head CT: There is no evidence of hemorrhage, edema, mass, mass effect, or\ninfarction. The ventricles and sulci are normal in size and configuration. No\nfracture is identified.\n\nHead and neck CTA: The carotid and vertebral arteries and their major branches\nare patent with no evidence of stenosis. There is no evidence of stenosis by\nNASCET criteria in the right or left internal carotid arteries. The distal\ncervical internal carotid arteries are normal in diameter bilaterally. There\nis no evidence of aneurysm formation or other vascular abnormality.", + "output": "Normal study\n\nNOTIFICATION: These findings were communicated to Dr. ___ telephone\nat 10:15 on ___ by Dr. ___ at the time of discovery." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nlarge territorial infarction. The ventricles and sulci are normal in size and\nconfiguration. The basal cisterns appear patent and there is preservation of\ngray-white matter differentiation.\n\nThere is no evidence of acute fracture. The paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The globes are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "Head CT: Areas of hypodensity are seen within the left caudate body and left\nputamen corresponding to the areas of infarct seen on the recent brain MR.\n___ is no intracranial hemorrhage. No mass, mass effect or midline shift is\npresent. Left maxillary mucosal thickening is noted.\n\nCTA head: The major intracranial vessels are patent. There is no evidence for\nsignificant stenosis or occlusion. No aneurysm or arterial venous malformation\nis detected. There is a normal anterior communicating artery complex. Both\nposterior communicating arteries are visualized.\n\nCTA Neck: The aortic arch demonstrates a normal branching pattern. Both\nvertebral arteries are patent. The bilateral common carotid, internal carotid\nand external carotid arteries are patent.", + "output": "1. Evolving infarcts within the left basal ganglia. No intracranial\nhemorrhage.\n2. Normal CT angiogram of the head and neck without evidence of significant\nstenosis." + }, + { + "input": "There is no evidence of infarction,intracranial hemorrhage,edema,or mass. The\nventricles and sulci are normal in size and configuration.\n\nFrontal sinus fracture, hemorrhage in the left frontal sinus and associated\nsubgaleal hematoma are better seen on the dedicated CT sinus from the same\nday. Aside from opacification of the frontal sinuses, ethmoid air cells and\nright maxillary sinus, the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. No intracranial abnormalities.\n2. Left frontal sinus fracture, hemorrhage in the left frontal sinus, and\nsubgaleal hematoma are better seen on the dedicated CT sinus from the same\nday." + }, + { + "input": "There is comminuted fracture of the anterior wall of the left frontal sinus\nwith approximately 6 mm central depression. There is associated opacification\nof the left frontal sinus with aerosolized debris and layering hemorrhage. \nThere is mild mucosal thickening of the right frontal sinus with small amount\nof layering fluid. The skin overlying the left frontal sinus is mildly\nthickened with multiple foci of subcutaneous emphysema along the fracture\nmargin (03:24). Multiple dermal calcifications are nonspecific.\n4 mm focus of sclerosis in the anterior left calvarium above the superior\norbital wall and right mandibular body likely represent bone islands (02:22,\n108). Periapical lucency around the upper left first incisor may be due to\ndental caries versus trauma (2:81).\nMild deformity of the nasal bone may be related to trauma.\nThere is opacification of the bilateral anterior ethmoid air cells. Mucosal\nthickening of the right maxillary sinus is minimal.\n\nThere is no evidence of abnormal fluid collections.\nBilateral mastoids appear normal.\nThe globes, extraocular muscles, optic nerves, and retrobulbar fat appear\nnormal.\nThe visualized upper aerodigestive tract appears normal.\nThe mandible and temporomandibular joints appear normal.", + "output": "1. Comminuted fracture of the anterior wall of the left frontal sinus with\napproximately 6 mm central depression. Associated hemorrhage within the left\nfrontal sinus and subgaleal hematoma.\n2. Periapical lucency around the upper left first incisor, which may be due to\ndental caries or trauma." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is a moderate right parietal subgaleal hematoma. Aside from mild\nmucosal thickening of the anterior ethmoidal air cells, the sphenoid sinus,\nand and bilateral maxillary sinuses, visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of acute intracranial process.\n2. Right parietal subgaleal hematoma without associated calvarial fracture." + }, + { + "input": "Technique is limited secondary to inadequate timing of the contrast bolus.\nWithin the confines of this limitation:\n\nAgain noted is a pericentimeter hyperdense focus within the right temporal\nlobe without evidence of significant enhancement. There are several small\nvessels in the periphery of this focus but no evidence of aneurysm. This\nfinding is most consistent with a cavernous malformation.\n\nCTA Head: There is adequate opacification of the internal carotid, anterior\ncerebral, middle cerebral, vertebral, basilar and posterior cerebral arteries.\nThere is no significant atherosclerotic disease. The anterior communicating\nartery is well visualized. The left vertebral artery is dominant. The\nposterior communicating arteries are not identified. There is no evidence of\naneurysm formation, stenosis, occlusion, dissection or vascular malformation.\n\nCTA Neck: There is a left-sided aortic arch with conventional origin of the\nmajor branch vessels. There is adequate opacification of the bilateral common\ncarotid, internal carotid and vertebral arteries, without stenosis. There is\nmoderate diffuse atherosclerotic calcifications, particularly at the carotid\nbulbs. The left vertebral artery is dominant. There is no evidence of\nhigh-grade stenosis at the origins or throughout the courses of these vessels.\n\nRight internal carotid artery (minimal dimension in mm):\n\nProximal: 8.5\n\nDistal: 4.5\n\nLeft internal carotid artery (minimal dimension in mm):\n\nProximal: 8.0\n\nDistal: 4.5\n\nAdditional findings: There is mild mucosal thickening of the maxillary\nsinuses. Otherwise, the paranasal sinuses and mastoid air cells are clear. The\nnasopharynx, oropharynx, hypopharynx and larynx are unremarkable. The thyroid\ngland demonstrates homogeneous density. There is no evidence of enlarged lymph\nnodes by CT criteria. The visualized lung apices are clear. There the are no\nsuspicious osseous lesions.", + "output": "Technique is limited secondary to inadequate timing of the contrast bolus.\nWithin the confines of this limitation:\n\n1. Unchanged hyperdense focus within the right temporal lobe without evidence\nof significant enhancement or aneurysm, most consistent with a cavernous\nmalformation. MRI head with and without contrast may be performed for further\nevaluation.\n\n2. CTA of the head demonstrates no evidence of stenosis, occlusion or\naneurysm.\n\n3. CTA of the neck shows no evidence of stenosis, dissection or occlusion.\nThere is no internal carotid artery stenosis by NASCET criteria." + }, + { + "input": "Lymph nodes:\n2 left intraparotid nodules superficial lobe, series 2, image 11, 12, likely\nintraparotid lymph nodes, larger measures 5 mm short axis, probably preserved\nfatty hilum, no inhomogeneous enhancement, too small to characterize, likely\nreactive. 5 mm mildly hypervascular left parotid tail nodule.\n\nNo adenopathy at the bilateral level ___, retropharyngeal, suboccipital nodes.\n\nNo aerodigestive tract mass.\n\nOther:\nOtherwise normal salivary, thyroid glands. Patent neck vessels. Clear\nvisualized lungs. Degenerative changes spine.", + "output": "1. Few small parotid nodules. No definite adenopathy." + }, + { + "input": "5.4 cm x 4.4 cm wide,dd by 1.0 cm thick left frontal scalp soft tissue mass,\npartially exophytic, centrally ulcerated, with subcutaneous fat infiltration. \nNo sclerosis or bone erosion. Edema of the scalp at the vertex. No CT\nevidence of perineural tumor. 5 mm left intraparotid nodule.\n\n1.6 cm x 0.8 cm low-attenuation intraosseous abnormality right parietal bone\nnear vertex, appears very low-density on soft tissue windows, likely\nrepresents lipoma or hemangioma, inner, outer cortex is intact..\n\nThere is no evidence of fracture, infarction, hemorrhage, edema, or\nintracranial mass. The ventricles and sulci are normal in size and\nconfiguration. There is no abnormal enhancement on post contrast images.\n\nTrace mucosal thickening paranasal sinuses. Clear mastoids, normal orbits.", + "output": "1. Left frontal scalp mass. No adjacent bone erosion or sclerosis.\n2. Right parietal bone lesion, most likely benign.\n3. Normal intracranial contents." + }, + { + "input": "There are bilateral symmetric soft tissue masses within the upper part of the\nanterior nasal passage centered within the olfactory recesses as demonstrated\non the MR head from ___. The soft tissue masses are separated by\nthe nasal septum which does not show any evidence bony erosion or sclerosis. \nThere is no definitive involvement of the cribriform plate. These findings\nfavored to represent nasal polyps but malignancy cannot be excluded and direct\nexamination should be considered.\n\nOtherwise the visualized paranasal sinuses are well aerated. There is no\nevidence of abnormal fluid collections. There is no evidence of facial\nswelling. No fractures are identified. The bilateral mastoids appear normal.\nThe globes, extraocular muscles, optic nerves and retrobulbar fat appear\nnormal. The visualized upper aerodigestive tract appears normal. The\nmandible and temporomandibular joints appear normal.", + "output": "1. Bilateral symmetric soft tissue masses within the upper part of the\nanterior nasal passage. These soft tissue masses are separated by the nasal\nseptum which does not show any evidence of bony erosion or sclerosis. There\nis no definite involvement of the cribriform plate. These findings are\nfavored to represent nasal polyps but malignancy cannot be excluded and direct\nexamination should be considered." + }, + { + "input": "Within the C2 vertebral body there is an area of sclerosis at the site of the\ninfiltrative process seen on MR dated ___. This finding may\nrepresent a sclerotic metastases or a previously treated metastasis. There is\nno pathological fracture at this level. Within the dens of C2 there is a\npunctate sclerotic lesion which is felt most likely to represent a bone\nisland. There is no evidence of lytic metastases.\n\nNo enhancing lesions are seen within the neck. No masses seen within the\ncarotid space or jugular foramina bilaterally. The salivary glands enhance\nnormally and are without mass or adjacent fat stranding. The thyroid gland is\nunremarkable without evidence of an enhancing lesion. Evaluation of the\naerodigestive tract demonstrates no mass and no areas of focal mass effect. \nThe neck vessels are patent.\n\nSeveral level V lymph nodes are noted within the posterior triangle on the\nright, while none of these are enlarged by CT criteria they are multiple in\nappearance.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules", + "output": "1. No enhancing lesions are seen within the neck. No masses seen within the\ncarotid space or jugular foramina bilaterally.\n2. Sclerotic lesion at the level of C2 which may represent a sclerotic\nmetastasis or previously treated metastasis. No other concerning bony lesions\nare identified.\n3. Several level V lymph nodes are noted within the posterior triangle on the\nright, while none of these are enlarged by CT criteria they are multiple in\nappearance." + }, + { + "input": "There is extensive acute intracranial hemorrhage involving bilateral cerebral\nhemispheres, which may be minimally worse compared to the prior CT performed\nearlier on the same date. However, evaluation for subtle changes is somewhat\nlimited by differences in patient positioning and motion artifact.\n\nThere is a right temporal epidural hematoma measuring up to 1.2 cm in greatest\ndimension (2:11) that is grossly similar in appearance compared to the prior\nstudy performed several hours earlier. There is also the right temporal\nsubdural hematoma measuring up to 4 mm (5:16). Known 3 mm left parietal\nsubdural hematoma is better assessed on the prior study (3:40, reference CT). \nThere may also be an approximately 2 mm subdural layering along the tentorium\n(5:10). Bilateral intraparenchymal hemorrhage involves the left frontal and\nbilateral temporal lobes, left greater than right.\n\nNo intraventricular hemorrhage. No shift of midline structures.\nProminent ventricles and sulci may be due to involutional changes, although\nsomewhat out of proportion for patient's age.\n\nThere is an acute nondisplaced fracture of the squamous portion of the right\ntemporal bone (3:19). Acute nasal bone fracture is also seen (3:5). No other\nfractures are identified. Mucosal thickening is seen within the bilateral\nethmoid air cells, right maxillary sinus and bilateral sphenoid sinuses. \nMastoid air cells are clear bilaterally. The orbits are unremarkable. \nExtensive superficial scalp swelling is seen on the right.", + "output": "1. Overall findings may be minimally worse compared to the reference CT\nperformed earlier on the same date, other evaluation for subtle differences is\nlimited by differences with patient positioning and motion artifact.\n2. Acute nondisplaced right temporal bone fracture resulting in a 1.2 cm\nright temporal epidural hematoma.\n3. 4 mm right temporal subdural hematoma, and likely also layering along the\ntentorium. Known 3 mm left parietal subdural hematoma is better assessed on\nthe prior study.\n4. Extensive bi-temporal and left frontal intraparenchymal hemorrhage.\n5. Acute nasal bone fracture." + }, + { + "input": "The study is limited by motion artifact. However, within these confines:\nRedemonstrated extensive acute intracranial hemorrhages involving the\nbilateral cerebral hemispheres which appear stable compared to prior imaging\nfrom ___. There is increased edema surrounding the bilateral\nintraparenchymal hemorrhages, left greater than right, with local mass effect\ncausing sulcal effacement in the left frontal and temporal regions.\n\nRedemonstrated right temporal subdural hematoma measuring up to 1.1 cm in\ngreatest dimension appears stable compared from prior study on previous day. \nThe right temporal subdural hematoma measures 4 mm and is grossly unchanged\nfrom prior study. The left parietal subdural hematoma is not well visualized\non this exam but is better assessed on prior reference CT from ___.\n\nThe ventricles and sulci are normal in size and configuration. Ill-defined\nperiventricular and subcortical white matter hypodensities are visualized\nbilaterally, representing a sequela of chronic ischemic small vessel changes. \nThere is no midline shift. There is a small amount of intraventricular\nhemorrhage seen in the trigone of the right lateral ventricle.\n\nThe known acute fractures of the nasal bone and right temporal bone appear\ngrossly unchanged and are better assessed on bone algorithm reformats from\nprior exams. There is opacification in the sphenoid sinuses, right greater\nthan left, with hemorrhagic density fluid material. Mild mucosal thickening\nis seen in the right maxillary sinus. The bilateral ethmoid sinuses have mild\nmucosal thickening, right greater than left. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable. There is continued scalp\nswelling is seen on the right hemisphere.", + "output": "1. Redemonstrated extensive acute intracranial hemorrhages of bowel in the\nbilateral cerebral hemispheres have increased surrounding edema with local\nmass effect, but overall appear stable compared to prior imaging from ___.\n2. Small amount of interventricular hemorrhage is seen in the trigone of the\nright lateral ventricle, likely from redistribution of blood products.\n3. There are no new hemorrhages or infarcts.\n4. Known acute fractures of the nasal bone and right temporal bone are\nunchanged from prior exam." + }, + { + "input": "In comparison to the prior CT performed on ___, there is increasing\nedema surrounding the left temporal intraparenchymal hemorrhages/contusions\nwhich results in 7 mm rightward shift of midline structures. There is also\nevidence of uncal herniation on the left. Other foci of intraparenchymal\nhemorrhage in the right temporal and left frontal lobes appear stable.\n\nSubdural hematoma in the right parietal and temporal lobes measures up to 1.1\ncm in greatest dimension (2:10), also stable. Subarachnoid hemorrhage is\nnoted predominantly in the right cerebral hemisphere. Trace intraventricular\nhemorrhage is present. No new foci of hemorrhage.\n\nNo evidence of acute major vascular territorial infarction. There is mass\neffect on the left lateral ventricle from adjacent edema and hemorrhage, with\nmild interval increase in size of the right lateral ventricle.\n\nKnown minimally displaced acute fractures of the right frontal sinus outer\ntable (03:20, 602b:48), nasal bone (3:4), right temporal bone (___), as\nwell as nondisplaced right inferior orbital wall fracture (series 601b:21,\n3:1) are again seen. No new fractures are identified.\n\nMucosal thickening is present in the bilateral ethmoid air cells, right\nmaxillary sinus and bilateral sphenoid sinuses. Left maxillary sinus appears\nwell aerated. There is a small amount of fluid in the posterior mastoid air\ncells bilaterally.", + "output": "1. New 7 mm rightward shift of midline structures with left uncal herniation\nas a result of increasing edema surrounding left temporal intraparenchymal\nhemorrhage/contusion.\n2. Otherwise expected evolution of remaining foci of intraparenchymal,\nsubdural and subarachnoid hemorrhages affecting bilateral cerebral\nhemispheres.\n3. Mass effect on the left lateral ventricle with slight increase in size of\nthe right lateral ventricle.\n4. Known fractures of the right frontal sinus, nasal bone, orbital floor and\nright temporal bone as described. If clinically indicated, consider facial\nbone CT for further evaluation.\n5. Paranasal sinus disease as described.\n\nRECOMMENDATION(S): If clinically indicated, consider facial bone CT for\nfurther evaluation.\n\nNOTIFICATION: Preliminary findings were telephoned to Dr. ___ by\n___ on ___ at 7:37AM, approximately 1 minute after discovery." + }, + { + "input": "Again seen is a left temporal lobe intraparenchymal hematoma with surrounding\nvasogenic edema, similar in size and extent compared to prior CT, allowing for\ndifferences in planes of scanning. Associated mass effect upon the underlying\nleft lateral ventricle resulting rightward shift of normally midline\nstructures is similar to minimally increased, measuring 8 mm (04:15,\npreviously 7 mm). Although the left lateral ventricle appear similar in\ncaliber, the right lateral ventricle is similar to minimally increased in\nsize. There is possible mildly increased effacement of the left ambient\ncistern and transtentorial herniation. Other foci of intraparenchymal\nhemorrhage in the left frontal lobe and right temporal lobe also appear\nunchanged.\n\nEpidural blood along the right temporal lobe is similar to slightly decreased\nin maximum thickness, measuring 10 mm (302b:36, previously 13 mm). \nSubarachnoid blood involving the superior right sulci is persistent but less\napparent. Intraventricular blood is no longer well appreciated.\n\nFractures through the outer table of the right frontal sinus, nasal bone,\nright temporal bone, and inferior orbital wall are unchanged. There is mild\nmucosal thickening within the bilateral sphenoid sinuses. The other\nvisualized paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear.", + "output": "1. A left temporal lobe intraparenchymal hematoma is unchanged in size, but\nthere is trace increased surrounding vasogenic edema with increased mass\neffect upon the underlying left lateral ventricle, rightward shift of normally\nmidline structures (8 mm, previously 7 mm), effacement of the left ambient\ncistern, and transtentorial herniation.\n2. Other foci of intraparenchymal hemorrhage in the left frontal and right\ntemporal lobes are unchanged, as is epidural blood along the right temporal\nlobe. Subarachnoid blood along the superior right cerebral hemisphere is\npersistent but less apparent.\n\nNOTIFICATION: These findings were communicated via telephone by Dr. ___\n___ to Dr. ___ at 14:54 on ___, approximately 5 minutes\nafter discovery." + }, + { + "input": "Patient is status post left hemicraniectomy for decompression due to a large\nleft temporal intraparenchymal hemorrhage with vasogenic edema. A drainage\ncatheter terminates at the left temporal region. There is overall decreased\namount of blood products in the left temporal lobe. The vasogenic edema is\nlargely unchanged, with persistent mass effect on the left lateral ventricle,\ncausing 8 mm rightward shift of midline structures, previously also 8 mm. \nThere is no definite evidence of downward herniation on this study. Scattered\nsmaller foci of intraparenchymal hemorrhage in the left frontal lobe and the\nright temporal lobe are overall unchanged.\n\nEpidural blood along the right temporal lobe is unchanged, measuring 11 mm in\nmaximum thickness from the skull. No definite subarachnoid or\nintraventricular hemorrhage is identified.\n\nFractures through the outer table of the right frontal sinus, nasal bone,\nright inferior orbital wall, and right anterior temporal bone are again\nidentified. There is persistent mucosal thickening and the bilateral sphenoid\nsinuses. The remaining visualized paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The globes are unremarkable.", + "output": "1. Status post left hemicraniectomy for decompression due to a large temporal\nintraparenchymal hemorrhage with decreased blood products. There is unchanged\nvasogenic edema and rightward shift of midline structures of 8 mm. No\ndefinite transtentorial herniation is seen on this study.\n2. Remaining intraparenchymal and extra-axial hemorrhage are overall\nunchanged. No new hemorrhage.\n3. Re- demonstration of multiple skull and facial bone fractures." + }, + { + "input": "The patient is status post left hemicraniectomy, with expected postsurgical\nchanges such as left frontal pneumocephalus and air along the surgical site,\nsimilar to slightly decreased, with a surgical drain unchanged in position. \nThere is protrusion of the left cerebral hemisphere through the craniectomy\ndefect, with decrease in rightward shift of normally midline structures, now\nmeasuring 5 mm (previously 8 mm). Blood along the surgical site is unchanged.\nLeft temporal intraparenchymal blood is similar compared to the most recent CT\nhead, but decreased compared to preoperative exam. Vasogenic edema is likely\nsimilar. Intraparenchymal hematomas in the right temporal and left frontal\nlobes are also unchanged. Extra-axial blood along the right temporal lobe is\nsimilar to minimally decreased in maximum thickness, now measuring 10 mm. The\nbasal cisterns appear more patent compared to the most recent CT. There is no\nevidence of acute infarct.\nFractures through the outer table of the right frontal sinus, nasal bone,\nright inferior orbital wall, and right anterior temporal bone are again seen. \nThere is mucosal thickening of the bilateral sphenoid sinuses and\nopacification of posterior left ethmoid air cells. The other visualized\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Status post left hemicraniectomy with expected postsurgical changes as\ndescribed above. Air along the surgical site is similar to slightly\ndecreased, with a surgical drain unchanged in position.\n2. Unchanged left temporal intraparenchymal hemorrhage and surrounding\nvasogenic edema, with decreased rightward shift of normally midline\nstructures, now measuring 5 mm. Decreased mass effect upon basal cisterns.\n3. No new hemorrhage identified. Unchanged intraparenchymal and extra-axial\nhemorrhage." + }, + { + "input": "Again seen is intraparenchymal hemorrhage, predominantly within the left\ntemporal lobe with surrounding vasogenic edema, as well as in the left frontal\nand right temporal lobes, grossly unchanged compared to the day prior.\nExtra-axial blood along the right temporal lobe is also unchanged. The\npatient is status post left hemi craniectomy, with a small amount of blood\nproduct and air along the surgical site, unchanged in configuration and\namount. A small amount of subarachnoid blood along the right parietal sulci\nsuperiorly (04:20, 18) likely reflect redistribution of blood products. A\ntiny amount of blood previously layering within the occipital horn of the\nright lateral ventricle is no longer apparent. There is herniation of left\ncerebral parenchyma through the surgical defect, with decreased rightward\nshift of normally midline structures which now measures 2 mm (previously 5\nmm). Ventricular and basal cistern configuration is unchanged.\nFractures through the outer table of the right frontal sinus, nasal bone,\nright inferior orbital wall, and right anterior temporal bone are unchanged. \nThere is again mucosal thickening of the bilateral sphenoid sinuses. There is\na small amount of fluid layering within posterior left ethmoid air cells. The\nother visualized paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear.", + "output": "1. Status post left hemi craniectomy, with the expected postsurgical changes\nas described above. Decreased rightward shift of normally midline structures,\nnow measuring 2 mm (previously 5 mm).\n2. Unchanged intraparenchymal hemorrhage, predominantly within the left\ntemporal lobe with surrounding vasogenic edema, and right temporal lobe\nextra-axial hematoma.\n3. Newly apparent subarachnoid blood along the right parietal sulci superiorly\nlikely reflects redistribution of blood products." + }, + { + "input": "Postsurgical changes from left hemicraniectomy are present. Post surgical\nchanges including pneumocephalus are present. There is edema within the left\nand right temporal and left frontal lobes, in the region of prior\nintraparenchymal hemorrhage. High density blood products seen previously in\nthis region are less conspicuous. No new area of hemorrhage is identified. \nThere is a small amount of fluid within the surgical cavity. Minimal high\ndensity in this region likely represents acute blood product (series 4, image\n19). There is minimal shift of midline structures to the left by\napproximately 3 mm. The basal cisterns are patent.\n\nThere is no acute fracture. The paranasal sinuses are clear. The globes are\nunremarkable.", + "output": "1. Post surgical changes from left craniectomy including pneumocephalus, fluid\nand air within the surgical bed as well as a small amount of high density\nblood.\n2. Edema in the left temporal, frontal, and right frontal lobes in the region\nof intraparenchymal hemorrhage. No new areas of hemorrhage." + }, + { + "input": "Left-sided frontoparietal craniectomy is identified. There has been evolution\nof previously seen left temporal parietal region hypodensity. There is ex\nvacuo dilatation of the left temporal horn. Hypodensity seen inferior to\nfrontal region likely due to encephalomalacia. No acute hemorrhage is\nidentified.", + "output": "Decreasing and swelling at the site of left sided cranioplasty. Evolution of\nchanges seen. No acute hemorrhage." + }, + { + "input": "The patient has undergone interval left frontoparietal cranioplasty. \nPneumocephalus, and high-density blood products are seen within the surgical\nbed, particularly overlying the left temporal lobe. Again seen are areas of\nhypodensity within the bilateral inferior frontal lobes, most consistent with\nencephalomalacia, and left temporoparietal lobe hypodensity, with associated\nex vacuo dilatation of the temporal horn of the left lateral ventricle. There\nis no shift of the normally midline structures. No new areas of hypodensity\nare identified. The basal cisterns are patent.\n\nHigh-density material containing a few foci of gas is seen within the left\nexternal auditory canal. The mastoid air cells, middle ear cavities, and\nvisualized paranasal sinuses appear clear. The globes are unremarkable.", + "output": "1. Status post left frontoparietal cranioplasty, with expected postoperative\nchanges, including pneumocephalus, and blood products within the surgical bed,\nparticularly overlying the left temporal lobe.\n2. Encephalomalacia of the bilateral inferior frontal lobes, and left\ntemporoparietal lobe, with associated ex vacuo dilatation the temporal horn of\nthe left lateral ventricle.\n3. High-density material containing a few foci of gas within the left external\nauditory canal. Recommend correlation with direct visualization." + }, + { + "input": "Since the prior CT from ___, there is a new left frontal extra-axial\nfluid collection, the majority of which is low in density, however is bordered\nby a hyperdense material (03:22), likely reflective of blood products. There\nis resultant sulcal effacement and mass effect upon the left frontal lobe, and\nrightward shift of the midline structures by 5 mm (03:17). The previously\nidentified extra-axial blood along the left frontal convexity (03:13) is\nunchanged, and the postsurgical hemorrhage adjacent to the low anterior left\ntemporal lobe, going through a bony defect, has redistributed, however the\namount of subgaleal fluid has increased (03:12).\nVentricular size is unchanged. No evidence of acute infarct. The paranasal\nsinuses are clear.", + "output": "1. New left frontal convexity extra-axial fluid collection, the majority of\nwhich is low density, with some adjacent acute blood, resulting in mass effect\non the left frontal lobe and rightward shift of the midline structures by 5\nmm.\n2. Interval increase in left temporal subgaleal fluid collection, likely\nrelated to recent cranioplasty.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with ___\n___ with Neurosurgery on the telephoneon ___ at 10:26 AM, 3 minutes\nafter discovery of the findings." + }, + { + "input": "Left cranioplasty is again seen. Left extra-axial collection of fluid, air,\nand a small amount of blood products is again demonstrated. Comparison to the\n___ CT is limited by differences in patient head position. While\nthe collection does appear slightly larger, measuring 1.5 cm in its maximal\ndiameter (previously 1.2 cm) (series 601b, image 76), there is no change in\nmild rightward shift of midline structures and no change in the size of the\nleft lateral ventricle to confirm true increase in size of the collection. \nThere is no change in the amount of blood within the collection. No new\nparenchymal edema is seen.\n\nThere is a collection of fluid and air in the scalp overlying the left\ncranioplasty, as seen previously, with slight redistribution. A 7 mm focus of\nacute blood within this collection on image 2 a: 17 appears new. Layering\nhyperdense blood products within this collection are unchanged.\n\nRight temporal bone fracture is again seen. Bilateral nasal bone fractures\nand other right facial bone fractures are again partially visualized.\n\nThere is small amount of fluid in the left mastoid air cells. Right mastoid\nair cells and partially visualized paranasal sinuses appear grossly\nwell-aerated.", + "output": "1. Left extra-axial collection of fluid, air, and small amount of hyperdense\nblood appears slightly larger compared to ___, but comparison is\nlimited by differences in patient head position. There is no change in\nassociated mass effect and no increase in acute blood products.\n2. Collection of air, fluid, and blood in the left scalp overlying the\ncranioplasty contains a new 7 mm focus of acute blood products. The\ncollection is not significantly changed in size, allowing for redistribution.\n\nNOTIFICATION: Preliminary interpretation of interval enlargement of the left\nextra-axial collection was discussed with Dr. ___ telephone at 23:10\non ___ by Dr. ___, 5 min after discovery." + }, + { + "input": "There has been interval removal of the left frontotemporoparietal calvarium\nand interval placement of a drain overlying the left frontoparietal lobes. A\ncollection overlying the exposed brain contains fluid and a similar degree of\nhyperdense blood products and air.\n\nMidline shift seen on ___ is resolved. The temporal horn of the\nleft lateral ventricle is increased in size likely due to the patient's\ndecompression.\n\nA right temporal bone and numerous facial bone fractures are unchanged. There\nis a large amount of edema within the superficial soft tissues overlying the\nleft mandible, unchanged.\n\nThere is mild opacification of the mastoid air cells bilaterally. The\nparanasal sinuses are unremarkable.", + "output": "1. Interval removal left frontotemporoparietal calvarium and drain placement\nwith resolution of midline shift. A collection of air and fluid contains a\nsmall amount hyperdense blood products.\n\n2. Numerous fractures involving right temporal and facial bones are unchanged." + }, + { + "input": "There is motion artifact which limits spatial resolution.\n\nThere is left craniectomy anatomy with skin staples and emphysema within the\noverlying soft tissues. There is unchanged extra-axial hemorrhage overlying\nthe left cerebral convexity. There is dilatation of the ventricles which has\nprogressively increased in comparison to prior studies consistent with\nworsening hydrocephalus. There is periventricular hypodensity which may\nrepresent transependymal flow. There is worsening of effacement of the\ncortical sulci and and degree of parenchymal herniation through the\ncraniectomy defect. There is no midline shift. The basal cisterns are\npreserved without evidence of downward herniation. There are radiopaque leads\noverlying the scalp. There are evolving contusions at the bilateral anterior\ntemporal and orbital frontal cortices. There is a nondisplaced right temporal\nbone fracture. There are bilateral nasal bone, right inferior orbit, and\nright anterior maxillary bone fractures.\n\nThere is no evidence of acute infarct or mass. The visualized paranasal\nsinuses and mastoid air cells are clear.", + "output": "1. Worsening hydrocephalus with progressive mass effect causing sulcal\neffacement and parenchymal herniation through the craniectomy defect. There\nis periventricular hypodensity which may represent transependymal flow.\n2. Evolving bilateral anterior temporal and orbital frontal contusions.\n3. Stable left convexity extra-axial hemorrhage.\n4. Redemonstration of multiple fractures, as described.\n\nNOTIFICATION: Results discussed with nurse ___ by Dr.\n___ at 1630 on ___ via telephone 5 minutes after discovery." + }, + { + "input": "Again noted is left craniectomy anatomy with skin staples and emphysema within\nthe overlying soft tissues. Decreasing extra-axial hemorrhage is noted\noverlying the left cerebral convexity. Dilation of the ventricles has\ndecreased since the most recent examination, and is similar to the degree of\nventricular dilatation from ___. Periventricular hypodensity seems to\nhave improved since the most recent examination, there was persistent. The\nbasilar cisterns are patent. Again noted are evolving contusions at the\nbilateral anterior temporal and orbital frontal cortices. Multiple, stable\nfractures are noted.\n\nThe paranasal sinuses are clear. Fluid may be seen within scattered mastoid\nair cells, though image quality is degraded by motion.", + "output": "Improved hydrocephalus from the most recent examination." + }, + { + "input": "Large left craniectomy defect is again seen. There is no fluid collection\neither deep or superficial to the dura. There is no acute hemorrhage, edema,\nor mass effect. Areas of encephalomalacia are again seen in bilateral\ninferior frontal lobes and in left greater than right temporal lobes, with\nassociated enlargement of temporal horn and atrium of the left lateral\nventricle, as well as temporal horn of the right lateral ventricle. The\nremainder of the ventricular system is also prominent, out of proportion to\nthe size of the sulci but unchanged.\n\nVisualized paranasal sinuses and mastoid air cells are well aerated.", + "output": "No change compared to ___. Multiple areas of posttraumatic volume\nloss are again demonstrated in the brain parenchyma. No fluid collection\neither the deep or superficial to the dura at the left craniectomy site." + }, + { + "input": "Patient is status post left frontoparietal craniectomy with associated\npostsurgical changes including mild hyperdense dural thickening and expected\nex vacuo dilatation of the left lateral ventricular temporal horn. Punctate\n0.2 cm hyperdensity along the left temporal dural surface is stable since\nprior examination. Anterior inferior bifrontal hypodensities are also likely\nfrom remote prior trauma.\n\nThere is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of acute fracture. Deformity of the anterior wall of the\nfrontal sinus is compatible with remote fracture. The visualized portion of\nthe paranasal sinuses,right mastoid air cells, and middle ear cavities are\nclear. Left mastoids are partially opacified. The visualized portion of the\norbits are unremarkable.", + "output": "1. Status post left frontoparietal craniectomy with associated postsurgical\nchanges including mild dural thickening and ex vacuo dilatation of left\nlateral ventricle temple horn.\n2. No acute intracranial process. Specifically no intracranial hemorrhage." + }, + { + "input": "There is been no interval change compared to the prior CT performed on ___.\n\nPostsurgical changes after left frontoparietal craniectomy including\nhyperdense dural thickening is again noted. Again seen is extensive left\ntemporal lobe atrophy and bilateral inferior frontal tissue loss, all\nsuggesting prior trauma.\n\nThere is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci, suggestive of involutional changes. \nAdditional note is made of ex vacuo dilation of the left lateral ventricle.\n\n Remote right frontal sinus trauma. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No interval change from ___. Chronic atrophy due to prior trauma.\nNo evidence of hemorrhage or infarction." + }, + { + "input": "Left-sided craniectomy is seen. The bulging through the craniectomy defect of\nthe brain parenchyma has decreased. Encephalomalacia again seen. No acute\nhemorrhage or midline shift identified. Ventricular prominence again\nidentified but has decreased since the previous study.", + "output": "No acute abnormalities are identified. The ventricular size may have slightly\ndecreased compared to the prior study." + }, + { + "input": "The patient is status post left craniectomy. Encephalomalacia in the temporal\nand frontal lobes bilaterally is stable. Enlargement of the temporal horns of\nthe lateral ventricles, left greater than right, is stable. There is some of\nfracture, hemorrhage or recent infarction.\n The visualized portion of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Encephalomalacia is stable." + }, + { + "input": "The patient has had left craniectomy with interval cranioplasty with expected\npost-operative changes in the overlying soft tissue and underlying tiny amount\nof pneumocephalus.\n\nThere is interval increased diffuse cerebral edema with narrowing of the\nbilateral sulci as well as effacement of the bilateral ambien cisterns. There\nis narrowing of the quadrigeminal and suprasellar cisterns as well. The\nconfiguration and size of the ventricles is similar with persistent ex vacuo\ndilation of the left lateral ventricle temporal horn.\n\nThe bilateral basal ganglia are diffusely hypodense (Series 2, image 15) and\nthe left hemisphere appears hypodense particularly in the left occipital lobe\n(e.g., series 2, image 13) and left frontoparietal lobe (e.g., series 2, image\n15). Grey-white matter distinction in the left hemisphere is less conspicuous\nand may be lost. These findings are highly concerning for hypoxic-ischemic\n___ injury with possible infarcts.\n\nIncreased symmetric hyperdensity of the subdural space may be due to\npseudohyperdensity from diffuse edema. No intraparenchymal hemorrhage.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Findings concerning for hypoxic-ischemic injury as described above.\n2. Recommend further evaluation with MRI ___.\n\nRECOMMENDATION(S): MR ___ to further evaluate for infarct/hypoxic injury.\n\nNOTIFICATION:\nThe findings were discussed with ___ nurse by ___, M.D.\non the telephone on ___ at 12:10 ___, 1 minutes after discovery of the\nfindings.\nThe findings were discussed with ___, N.P. by ___, M.D. on\nthe telephone on ___ at 12:18 ___, 1 minutes after discovery of the\nfindings." + }, + { + "input": "CT head: The patient is status post left cranioplasty earlier in the day. \nRe-identified is a left hemispheric loss of gray-white differentiation\ninvolving the left frontal parietal and occipital lobes, with interval\ndevelopment of small hemorrhages of the left frontal lobe (series 2, image 16,\n20, 21 22). There remains diffuse hypodensity of the bilateral basal ganglia\ninvolving the caudate, putamen, globus pallidus as well as thalamus.\n\nIncreased edema results in effacement of the left lateral ventricle and third\nventricle as well as 7 mm rightward midline shift. There is no clear\nhyperdensity within the visualized superior sagittal sinus, torcula,\ntransverse sinuses were sigmoid sinuses to suggest thrombus. There may be\ncrowding of the basilar cisterns. The right lateral ventricle is unchanged\nfrom prior exam. Close attention for impending herniation is recommended.\n\nThe paranasal sinuses are essentially clear. The orbits are unremarkable. \nThe mastoid air cells middle ear cavities are well pneumatized and clear. The\npatient is intubated. The patient is status post recent cranioplasty.\n\nCTA head: The intracranial ICA, ACA, MCA and their major branches are\nunremarkable. The bilateral vertebral arteries, basilar arteries, PCA and\ntheir major branches are also unremarkable. There is mild paucity of\nenhancement along the left hemisphere however this is secondary to edema and\ninfarct/ischemia. The posterior circulation is also unremarkable\n\nAlthough the timing of the exam is not optimized for evaluation of the dural\nvenous sinuses, the superior sagittal sinus, transverse sinuses, great\ncerebral veins, ___ and ___ veins are grossly patent on sagittal\nMIP reconstructions.\n\nCTA neck: There is a normal 3 vessel arch. The right vertebral artery is\ndominant. Otherwise, the right brachiocephalic, bilateral common carotid,\nbilateral internal carotid, subclavian and vertebral arteries are\nunremarkable. There is no stenosis of the internal carotid arteries by NASCET\ncriteria.\n\nOther: There is a 3 mm pulmonary nodule of the left lung apex. Otherwise,\nthe visualized lungs are grossly clear. Median sternotomy wires are noted. The\nthyroid gland is grossly unremarkable. There is no cervical lymphadenopathy by\nsize criteria. The major salivary glands are unremarkable. No suspicious\nblastic or lytic osseous lesions.", + "output": "1. Re-identified is hypodensity of the left hemisphere and bilateral basal\nganglia with worsening edema, resulting in effacement of the left lateral\nventricle, third ventricle and 7 mm rightward midline shift. The overall\nfindings remain suspicious for global hypoxic event.\n2. Interval development of small left frontal hemorrhages as described above.\n3. There is mild paucity of arterial opacification along the left parietal\nlobe and occipital lobe, secondary to edema and infarct/ischemia. Otherwise,\nunremarkable CTA of the head.\n4. Unremarkable CTA of the neck.\n5. Additional findings described above.\n6. The examination is not optimized for evaluation of the dural venous\nsinuses. If there remains high clinical suspicion for as thrombosis, repeat\nCT view or MRI head with without contrast with MRV is recommended.\n\nRECOMMENDATION(S): If there remains high clinical suspicion for as\nthrombosis, repeat CT view or MRI head with without contrast with MRV is\nrecommended.\n\nNOTIFICATION:\nPreliminary results discussed with Dr. ___ by ___ at 17:30\non ___, 5 minutes after discovery of the findings." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are prominent in keeping with mild generalized\nparenchymal volume loss, additionally an arachnoid cyst is identified in the\nright temporal fossa measuring approximately 17 x 40 mm in transverse\ndimension (image 10, series 4.\n\nNo suspicious osseous abnormalities seen. 1.1 x 0.5 cm calcification along\nthe left posterior petrous portion of the temporal bone and may reflect a\nsmall calcified meningioma. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear apart from a small polyp/mucous retention cyst\nin the left maxillary sinus (image 2, series 4). The orbits are unremarkable.", + "output": "1. There is no evidence of acute intracranial process or hemorrhage.\n\n2. Suspected small meningioma along the posterior left petrous portion of the\ntemporal bone.\n\n3. Arachnoid cyst is identified in the right temporal fossa." + }, + { + "input": "SOFT TISSUES: There is no stranding, fluid collection, hematoma, or other\nsoft tissue abnormality. There is mild skin thickening left pre malar face,\nclinically correlate..\n\nBONES: The maxillofacial bones are intact, without fracture. The\nzygomatico-maxillary complex is intact. The lateral pterygoid plates are\nintact. Periodontal disease right maxilla tooth 5\n\nSINUSES: Small mucous retention cysts are identified in the left maxillary\nsinus. There is mild opacification of the ethmoid sinus. The remaining\nparanasal sinuses are intact and clear. Mildly narrowed left frontoethmoid\nrecess. Remaining Ostiomeatal units are patent. The mastoid air cells and\nmiddle ear cavities are clear.\n\nNOSE: There is no nasal bone fracture. Nasopharyngeal soft tissues are\nunremarkable. There is no nasal septal hematoma. Nasal septum is deviated to\nthe right.\n\nORBITS: The orbits, including the laminae papyracea, are intact. The globes\nare intact with non-displaced lenses and no intraocular hematoma. There is no\npreseptal soft tissue edema. There is no retrobulbar hematoma or fat\nstranding.\n\nAllowing for imaging technique optimized for the face, the limited included\nportion of the brain show small benign arachnoid cyst right middle cranial\nfossa. Grossly unremarkable.", + "output": "1. No evidence of acute paranasal sinusitis.\n2. Mild left premalar skin thickening, clinically correlate.\n3. Periodontal disease about tooth 5. ." + }, + { + "input": "Beam hardening artifact related with dental amalgam limits portions of this\nstudy. Mucous retention cysts of the left maxillary sinus and mild\nopacification of the ethmoidal air cells are unchanged from prior exam on ___. There is no evidence of air-fluid levels or bony destruction to\nsuggest acute infection. The remaining paranasal sinuses are normally\naerated, with no mucosal thickening or air-fluid levels identified. The\nostiomeatal units are patent. The cribriform plates are intact. The lamina\npapyracea are intact. The intracranial structures demonstrates an unchanged\nleft petrous probably calcified meningioma (image 21, series 4). Unchanged\nright temporal fossa arachnoid cyst.", + "output": "1. Dental amalgam artifact limits portions of this study.\n2. Mucous retention cyst identified in the left maxillary sinus, and mild\nopacification of the ethmoidal air cells, unchanged from prior examination in\n___." + }, + { + "input": "No fractures are identified.\nThere is no evidence of facial swelling.\nThere are 2 submucosal retention cyst in the left maxillary sinus, stable\nsince prior. There is stable mild opacification of single left ethmoid air\ncell. The paranasal sinus ostia are patent. There is no fluid in the\nparanasal sinuses. There is nasal septal deviation to the right, stable. \nNasal cavity is clear. There is no retro antral, premalar or orbital soft\ntissue infiltration.\nThere is no evidence of abnormal fluid collections\nBilateral mastoids appear normal.\nThe golbes, extraocular muscles, optic nerves and retrobulbar fat appear\nnormal.\nThe visualized upper aerodigestive tract appears normal.\nThe mandible and temporomandibular joints appear normal. There is linear\nperiapical linear lucency outlining root of right maxilla tooth 5, which had\nprior pulpectomy, may represent post treatment change versus residual\ninfection, dental consultation recommended. There is no adjacent soft tissue\nedema.\nThere is benign arachnoid cyst in the right middle cranial fossa.", + "output": "1. 2 submucosal retention cysts in the left maxillary sinus are stable. No\nnew paranasal sinus disease.\n2. Periapical linear lucency right maxilla tooth 5, may represent\nposttreatment change in a tooth with prior polypectomy versus residual\ninfection, dental consult recommended." + }, + { + "input": "There is no evidence of infarction, hemorrhage,edema. Small ossified\nmeningioma versus osteoma in the left lateral posterior fossa measuring 0.8\ncm, stable. There is small benign arachnoid cyst in the right middle cranial\nfossa, stable since prior. Probable tiny chronic lacunar infarct in the left\nputamen versus prominent prevascular space, stable. There is generalized\nbrain parenchymal atrophy, stable since prior.\n\nThere is no evidence of fracture. Mild opacification of the ethmoid sinus,\nsmall submucosal retention cyst in the left maxillary sinus. Otherwise, the\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "There are no acute intracranial changes." + }, + { + "input": "There is no acute intracranial hemorrhage, edema, mass effect, or evidence of\nlarge vascular territorial infarction. There is mild age-related cerebral\natrophy with associated mild prominence of the ventricles and sulci. There is\nage-related mineralization of the basal ganglia bilaterally. There are\nnon-specific periventricular and subcortical white matter hypodensities which\ncan be seen in patients with chronic small vessel ischemia.\n\nNo focal osseous abnormalities are seen. There is complete opacification of\nseveral right anterior ethmoid air cells and right frontoethmoidal recess.\nThere is severe mucosal thickening in the left frontoethmoidal recess without\ncomplete occlusion. There is mild mucosal thickening in other left anterior\nethmoid air cells and in bilateral frontal sinuses. There is mild mucosal\nthickening with possible trace fluid in bilateral maxillary sinuses. There is\nfluid in bilateral sphenoid sinuses. The mastoid air cells and middle ear\ncavities are clear.", + "output": "No evidence for an acute intracranial abnormality. MRI would be more\nsensitive for an acute infarction, if clinically warranted." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nlarge territorial infarction. Prominent ventricles and sulci, as well as\nslightly prominent extra-axial spaces, suggest mild age-related cerebral\natrophy. Mild periventricular white matter hypodensities are likely sequela of\nchronic small vessel ischemic disease. The basal cisterns appear patent.\n\nThe visualized bony structures are grossly unremarkable. There is\nopacification of several anterior ethmoidal cells and frontoethmoidal\nrecesses, with fluid levels in bilateral frontal sinuses. There is slight\nmucosal thickening and small amount of fluid in bilateral sphenoid sinuses.\nThese findings are not significantly changed compared to prior study. Mastoid\nair cells are clear.", + "output": "No evidence for acute intracranial abnormalities or interval change compared\nto 1 day earlier." + }, + { + "input": "There is no evidence of acute major vascular territory\ninfarction,hemorrhage,edema, or mass. Very small lacunar infarct in left\ncaudate head is new since ___ but likely chronic. There is prominence of the\nventricles and sulci suggestive of involutional changes. Mild atherosclerotic\ncalcifications are seen in the carotid siphons. There is partial\nvisualization of a well-circumscribed soft tissue lesion in the left parotid,\nwhich appears unchanged since ___, incompletely characterized (2:1).\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormalities. Specifically, normal large infarct or\nintracranial hemorrhage. Very small lacunar infarct in the left caudate is\nprobably chronic, although new since the remote prior comparison study.\n2. There is partial visualization of a well-circumscribed soft tissue lesion\nin the left parotid, which appears unchanged since ___, but\nincompletely characterized. Differential includes primary neoplasm.\n\nRECOMMENDATION(S): A dedicated ultrasound of the left parotid is recommended\nin short-term follow-up.\n\nNOTIFICATION: Findings and recommendations discussed with Dr. ___\nat 20:45 by telephone on ___." + }, + { + "input": "There is interval evolution of a left posterior parietal chronic infarction. \nThere is a small chronic left caudate head infarction.\n\nOtherwise, there is no evidence of new acute large territorial infarction,\nintracranial hemorrhage, edema, or mass.\n\nThe ventricles and sulci are normal in size and configuration.\n\nNo acute osseous abnormalities seen. Again demonstrated, is near complete\nopacification of the right maxillary sinus and moderate mucosal thickening of\nthe left maxillary sinus. There is scattered moderate mucosal thickening of\nthe ethmoid air cells. Sphenoid sinuses are relatively clear. Frontal\nsinuses are relatively clear. The bilateral mastoid air cells and middle ear\ncavities are clear. The orbits demonstrate no acute abnormalities.", + "output": "1. No acute large territorial infarction. No intracranial hemorrhage. No\nacute intracranial process.\n2. Chronic left parietal and left basal ganglia infarction.\n3. Chronic paranasal sinus disease as described above.\n\nRECOMMENDATION(S): If there is persistent clinical concern related with\nacute/subacute ischemic changes, correlation with MRI is recommended." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of intracranial,edema,ormass. The ventricles are normal\nin size and configuration. Encephalomalacia related to prior chronic infarct\nin the left parietal occipital region is noted, causing mild prominent sulci\nand mild volume loss.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are normal.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. The dural venous\nsinuses are patent.\n\nCTA NECK:\nThere is 5 x 3 mm outpouching from the medial aspect of the proximal cervical\nright ICA (3:139), which could represent a pseudoaneurysm or sequela of prior\nulcerated plaque, similar compared to the reference study from ___. \nThere is moderate narrowing of the bilateral carotid bulbs due to\npredominantly noncalcified atherosclerotic plaque. Otherwise patent bilateral\ncervical carotid and vertebral arteries without evidence of stenosis,\nocclusion, or dissection.\n\nUnchanged 0.5 cm outpouching from the aortic arch (3:27), possibly an unusual\nductus diverticulum or Kommerell's diverticulum at the origin of an\nundeveloped or chronically occluded aberrant right subclavian artery.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. Mild degenerative changes are visualized throughout the cervical\nspine, more significant at C6-C7 level.", + "output": "1. No evidence of acute intracranial hemorrhage.\n2. Encephalomalacia in the left parieto-occipital lobe, related to prior\ninfarct.\n3. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n4. Pseudoaneurysm versus sequela of ulcerated plaque involving the proximal\ncervical right ICA. Otherwise unremarkable CTA of the neck." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nThere is hyperostosis frontalis. Discrete focus of hypodensity in the left\nbasal ganglia may represent a prominent perivascular space versus chronic\ninfarct (02:11).\n\nThere is no evidence of acute fracture. Mucosal thickening of the ethmoid air\ncells, right frontal and right sphenoid sinuses noted. There is trace amount\ndebris within the left sphenoid sinus. The visualized portion of the mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable. Moderate carotid siphon calcifications are seen.", + "output": "1. No acute intracranial abnormalities on noncontrast head CT.\n2. Global atrophy. Left basal ganglial perivascular space versus chronic\ninfarct." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or mass\neffect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes..\n\nThere is no evidence of fracture. Mucosal thickening of the ethmoid air cells\nand right frontal and sphenoid sinuses is noted as well as the right maxillary\nsinus. The mastoid air cells and middle ear cavities are clear. Intracranial\nvascular calcifications are re-demonstrated. The visualized portion of the\norbits are unremarkable.", + "output": "-No acute intracranial abnormality." + }, + { + "input": "There is ___ evidence of acute hemorrhage. Appearance of the ventricles and\nsulci are similar to the prior MR. ___ patient is ___ right craniotomy\nwith expected postsurgical changes noted and better assessed on prior MR. ___\nshift of normally midline structures. The perimesencephalic cisterns are\npatent. Nonspecific subcortical, periventricular, and deep white matter\nhypodensities may represent sequelae of chronic small vessel ischemic disease\nor more likely sequelae of radiation therapy.\n\nThe incompletely visualized paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The orbits are unremarkable.", + "output": "___ evidence of acute intracranial abnormality including ___ intracranial\nhemorrhage. Post right craniotomy changes and left posterior parietal lobe\nwhite matter hypodensity likely corresponding to the enhancing lesion better\nseen on prior MR." + }, + { + "input": "Some of the images were repeated due to motion artifact on the initial scan\nacquisition. There is no evidence of acute hemorrhage, edema, mass effect, or\nacute major vascular territorial infarction. Ventricles and sulci are\nprominent consistent with moderate age-related parenchymal volume, without\nclear frontal lobe predominance. Periventricular, subcortical, and deep white\nmatter hypodensities with bifrontal predominance are nonspecific, but likely\nrepresent sequela of chronic microvascular ischemic disease in this age group.\n\nNo evidence for suspicious bone lesion or fracture. Dependent secretions and\nfluid in the right concha bullosa. Mild mucosal thickening within bilateral\nethmoid air cells, extending into the frontoethmoidal recesses. Mild mucosal\nthickening in the maxillary sinuses and sphenoid sinuses. Left mastoid air\ncells and partially visualized right mastoid air cells appear clear.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. Supratentorial white matter hypodensities are nonspecific but likely\nsequela of chronic small vessel ischemic disease in this age group.\n3. Dependent secretions and fluid in the right concha bullosa, which may be\nsecondary to prolonged supine positioning, but please correlate with any\ninflammatory symptoms." + }, + { + "input": "There is no evidence of acute large territorial infarction,acute intracranial\nhemorrhage, edema, or mass. There is prominence of the ventricles and sulci\nsuggestive ofmild age-related atrophy.\n\nThere is no evidence of fracture. There is mucosal thickening and mucous\nretention cysts the right maxillary sinus, bilateral sphenoid sinuses in\nbilateral ethmoidal air cells is likely secondary to prolonged supine\npositioning in the inpatient setting and/or intubation. Otherwise, the\nremaining visualized portion of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear.\n\nThe visualized portions of the orbits are unremarkable.", + "output": "1. No acute intracranial process or hemorrhage.\n2. Paranasal sinus disease as described. Please correlate with any symptoms\nof sinus infection." + }, + { + "input": "Beam hardening artifact limits evaluation of posterior fossa and brainstem. \nThere is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Atherosclerotic vascular calcifications are noted of\nbilateral cavernous portions of internal carotid arteries.\n\nThere is no evidence of fracture. Complete fluid opacification of the right\nmastoid air cells and near complete fluid opacification of the left mastoid\nair cells without evidence of underlying fracture. Right ethmoid air cell\nprobable mucous retention cyst is seen. The visualized portion of the and\nleft middle ear cavity is clear. The visualized portion of the orbits are\nunremarkable.\n\nPartially visualized nasoenteric tube.", + "output": "1. Beam hardening artifact limits evaluation of posterior fossa and brainstem.\n2. No evidence of acute large territorial infarction or intracranial\nhemorrhage. Please note MRI of the brain is more sensitive for the detection\nof acute infarct.\n3. Paranasal sinus disease and bilateral mastoid and right middle ear fluid,\nas described, with which is nonspecific, but may be seen in the setting of\nmastoiditis." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Periventricular and subcortical\nwhite matter hypodensities corresponds to FLAIR hyperintensity on prior MRI,\nunchanged. Hypodensity in the right cerebellar hemisphere (2:11) likely a\nchronic infarct though not clearly delineated on prior MRI. Ventricles and\nsulci and unremarkable. Basilar cisterns are patent.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process.\nDiffuse white matter hypodensities, similar compared to prior exams.\nChronic appearing small right cerebellar infarct though new since ___." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass effect. The ventricles and sulci are prominent in keeping with\nage-related involutional change. Mild periventricular hypodensities are\nnonspecific, but likely represent sequela of chronic ischemic microvascular\ndisease. Postsurgical encephalomalacia is noted in the inferior frontal lobe\nposterior to the sphenoid sinus in keeping with recent mucocele/fungal ball\nresection. The sella turcica remains expanded.\n\nNo acute fractures are seen. There is partial opacification of the ethmoid\nair cells and right sphenoid sinus, likely related to recent intubation and/or\nrecent procedure. Otherwise, the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear.", + "output": "1. No acute intracranial process.\n2. Postsurgical changes are noted adjacent to the sphenoid sinus." + }, + { + "input": "Patient is status post sphenoidotomy and posterior septectomy. There is a 2.2\nx 2.4 cm mildly hyperdense collection with punctate foci of internal\nhyperdensity is demonstrated within the sphenoid sinus (301:35). There is\nstable dehiscence of the medial walls of the bilateral carotid canals, right\ngreater than left. Thinning of the medial wall the right optic nerve canal is\nunchanged. Large pocket of air is also demonstrated within the sphenoid sinus\nand extending anteriorly into the ethmoid air cells. There is continued mild\nto moderate mucosal thickening of the ethmoid air cells. Bilateral maxillary\nsinuses and frontal sinuses are clear. Hyperdense material seen within the\nnasopharynx and extending superiorly into the nasal turbinates is associated\nwith multiple punctate foci of air (301:45)..\n\nNo drainable fluid collections are identified.\nEnteric tube and endotracheal tube are partially visualized.", + "output": "1. Postsurgical changes of a sphenoidotomy and posterior septectomy. There is\nhyperdense material seen within the nasopharynx and extending superiorly into\nthe nasal turbinates, associated with multiple punctate foci of air. Findings\nmay be secondary to hemorrhagic products post surgical in etiology, however it\nwould be difficult to exclude an underlying infectious process.\n2. 2.4 cm mildly hyperdense collection within the sphenoid sinus is\ndemonstrated. Evaluation is limited in the setting of an unenhanced scan.\n3. Persistent thinning of the medial wall the right optic nerve canal and\nstable dehiscence of the medial walls of the bilateral carotid canals, right\ngreater than left." + }, + { + "input": "Enteric tube and endotracheal tube are partially evaluated on current exam. \nEvaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands are grossly without mass or adjacent fat stranding. The\nthyroid gland appears normal. There is no lymphadenopathy by CT criteria. No\nevidence of a drainable fluid collection.\n\nEvaluation of the lungs is better assessed on same day CT chest. There are no\nosseous lesions.\n\nLimited evaluation of the intracranial structures reveals no acute\nabnormality.", + "output": "Limited examination in the setting of an unenhanced scan. No abnormal masses\nor fluid collections are identified." + }, + { + "input": "There is no evidence of acute large territorial infarction, although please\nnote that MRI is more sensitive in its early detection. There is no\nintracranial hemorrhage. Gray-white matter differentiation appears preserved\nbilaterally. Periventricular and subcortical white matter hypodensities are\nnonspecific but likely reflect the sequelae of chronic small vessel ischemic\ndisease. The basal cisterns are patent. There is prominence of the\nventricles and sulci compatible with age related involutional changes. There\nis likely a focus of encephalomalacia in the anterior right cerebellar\nhemisphere.\n\nThere is no acute fracture. There are postsurgical changes from functional\nendoscopic sinus surgery. Mild mucosal thickening is noted in the right\nmaxillary sinus. There is near complete opacification of the ethmoid air\ncells. Air-fluid levels noted in the sphenoid sinus. There is partial\nopacification of the mastoid air cells which is most likely secondary to\nintubation. Visualized orbits are unremarkable.", + "output": "No acute intracranial process. Please note that MRI is more sensitive in the\ndetection of acute infarct." + }, + { + "input": "No evidence of cavernous sinus thrombosis. No evidence of invasive fungal\ndisease. The superior ophthalmic veins are unremarkable and not enlarged.\n\nAgain, patient is status post sphenoidotomy and posterior septectomy. The\nhyperdense fluid collection within the sphenoid sinus is again seen and\nsimilar to prior. There is stable dehiscence of the medial walls of bilateral\ncarotid canals, right greater than left. Thinning of the medial wall of the\nright optic nerve canal is unchanged. There is no drainable fluid collection.\n\nStable mild to moderate mucosal thickening of the ethmoid air cells are again\ndemonstrated.\nMild mucosal thickening of the right maxillary sinus is noted, increased from\nprior. The left maxillary sinus and left frontal sinus are clear. There is\nincreased opacification of the right frontal sinus.\n\nAir-fluid level is also noted in the posterior nasopharynx, slightly improved\ncompared to prior. ET tube and orogastric tube are again partially\nvisualized.\n\nA 1.3 cm subcutaneous lesion is unchanged from prior, likely a dermoid cyst,\ncorrelate clinically.", + "output": "1. No evidence of cavernous sinus thrombosis.\n2. No evidence of invasive fungal disease.\n3. Postsurgical changes from sphenoidotomy and posterior septectomy are again\ndemonstrated, similar to prior.\n4. Bony defects including dehiscence of bilateral carotid canal medial walls\nand thinning of the medial wall of the right optic nerve canal are similar to\nprior." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nThere are periventricular and subcortical hypodensities which are nonspecific,\nbut suggestive of chronic small vessel ischemic changes.\n\nThere is no evidence of fracture. Again noted is complete opacification of\nthe right sphenoid sinus with high density material centrally which is\nunchanged from the prior CT in ___. There is new left maxillary sinus\nmucosal thickening. There is also new mild mucosal thickening in the\nbilateral ethmoid air cells and left maxillary sinus. Frontal and right\nmaxillary sinuses are clear. The visualized portion of the orbits are\nunremarkable. There are several scalp densities (2:13, 14) measuring up to\n1.2 cm, which may represent sebaceous cysts.", + "output": "1. No acute intracranial hemorrhage or evidence of major vascular territorial\ninfarction.\n2. Atrophy and probable chronic small vessel ischemic changes.\n3. Grossly stable complete opacification of the right sphenoid sinus with\ncentral calcifications, which may represent chronic sinusitis, fungal\nsinusitis or inspissated secretions compared to prior exam.\n4. Additional new paranasal sinus disease as described.\n5. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct." + }, + { + "input": "There has been continued expansion of the sphenoid sinus, which contains\nhigh-density material and some areas of calcification. Since ___, there has\nbeen continued loss of apparent bone along the superior aspect of the sinus. \nIn addition, there has been suprasellar extension soft tissue/content of the\nsinus. Findings raise concern for sphenoid sinus mucocele with some\nsuprasellar extension. Skullbase MRI is recommended for further assessment.\n\nThere is no evidence of acute intracranial hemorrhage, midline shift, or acute\nlarge vascular territorial infarct. Mild prominence of the ventricles and\nsulci is consistent with mild involutional changes. There are mild\nperiventricular white matter hypodensity", + "output": "Findings worrisome for sphenoid sinus mucocele with suprasellar extension;\ncontinued expansion of the sphenoid sinus which contains high-density material\nand some areas of calcification, which has been present since at least ___,\nbut with significant expansion since that time. New since ___, there is now\nsuprasellar extension of soft tissue. Recommend skullbase MRI for further\nevaluation.\n\nNo acute intracranial hemorrhage." + }, + { + "input": "Again seen is a 2.8 x 3.2 x 3.2 cm sphenoid sinuses mucocele with internal\nareas of hyperdensity and calcification and suprasellar extension. There is\ndehiscence of the medial walls of the bilateral carotid canals (right greater\nthan left). The mucocele partially bulges into the right cavernous sinus. \nThere is thinning of the medial wall the right optic nerve canal. The\nmucocele also bulges into the posterior left ethmoid air cells with resulting\nthinning of the anterior wall of the left sphenoid sinus. There is sparing of\nthe bilateral anterior clinoid processes, foramina Rotundum, and Vidian\ncanals.\n\nThere is mild mucosal thickening of the ethmoid air cells. The remaining\nparanasal sinuses are normally aerated, with no mucosal thickening or\nair-fluid levels identified. The ostiomeatal units are patent. The cribriform\nplates are intact. The lamina papyracea are intact.", + "output": "Unchanged appearance of a sphenoid sinus mucocele with suprasellar extension,\nand dehiscence of the bilateral carotid canals and medial wall of the right\noptic canal." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction, mass or midline\nshift. A hyperdensity is again noted in the left pons, previously\ncharacterized as a cavernous malformation. There is no hydrocephalus. \nVisualized paranasal sinuses and mastoid air cells are clear. There is no\nfracture.", + "output": "No acute intracranial process. Cavernous malformation in the left pons again\nnoted." + }, + { + "input": "Compared to ___, interval increase in bifrontal hemorrhagic\ncerebral contusions (___) measuring 6.5 x 2.5 cm in aggregate, previously 5.8\nx 2.3 cm. There is associated edema. No significant change in multiple foci\nof subarachnoid hemorrhage as well as a contusion in the right parietal lobe. \nBifrontal extra-axial fluid collections are also unchanged. No acute\ninfarction or mass. No midline shift. The basal cisterns are patent. The\npatient is status post left frontal craniotomy with multiple clips and an\nunchanged heterogeneous extra-axial mass, measuring approximately 3.2 x 2.0 cm\n(___).\n\nRe- demonstration of right parietal partially displaced fracture with large\nright subgaleal hematoma. . Interval increase in mucous. There are multiple\nmucous retention cysts and mucosal thickening in the bilateral maxillary and\nsphenoid sinuses. The mastoid air cells and middle ears are unremarkable. \nThe orbits are unremarkable.", + "output": "1. Compared to ___, interval increase in bifrontal hemorrhagic\ncerebral contusions, as described above.\n2. Extra-axial fluid collections and subarachnoid hemorrhage are unchanged.\n3. No midline shift. Basal cisterns are patent.\n\nNOTIFICATION: The findings were discussed with ___, N.P. by ___\n___, M.D. on the telephone on ___ at 6:06 AM, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "Re-demonstrated are bifrontal hemorrhagic cerebral contusions which together\nmeasure 6.5 x 2.7 cm (03:17), unchanged in size as compared to CT head ___. There is bifrontal right greater than left subarachnoid\nhemorrhage, unchanged. A hyperdense left frontal extra-axial fluid collection\nmeasuring 7 mm in maximal thickness (03:19) is unchanged. A thin hyperdense\nright frontal extra-axial fluid collection appears mildly decreased in size. \nThere is a hemorrhagic contusion in the right parietal lobe measuring 0.6 x\n0.9 cm (03:30), unchanged. There is also focus of subarachnoid hemorrhage\nalong the right paracentral region (03:30), unchanged.\n\nPatient is status post left frontal craniotomy and multiple surgical clips.\nNear the left frontal craniotomy site there is ill-defined left frontal\nhypodensity with local mass effect measuring approximately 2.8 x 2.0 cm\n(03:25) and local atrophy which is unchanged from ___. The\netiology of this is uncertain and correlation with prior studies, preferably\npreoperative, it would be helpful..\n\nThere is no evidence of new or worsening intracranial hemorrhage. The degree\nof surrounding vasogenic edema and mass effect is unchanged. There is no\nmidline shift. There is a mucous retention cyst in the right maxillary sinus.\nThere is mild mucosal thickening in the left maxillary sinus, bilateral\nethmoid air cells, bilateral frontal sinuses, and bilateral sphenoid sinuses. \nMastoid air cells and middle ear cavities are aerated.", + "output": "1. Very mild decrease in size of right frontal extra-axial hemorrhage as\ncompared to CT head ___. Otherwise, extra-axial hemorrhage,\nsubarachnoid hemorrhage, and hemorrhagic cerebral contusions, as detailed\nabove, are unchanged.\n\n2. Degree of mass effect is unchanged. There is no midline shift.\n\n3. Ill-defined left frontal hypodensity near the left frontal craniotomy with\nlocal mass effect and atrophy is unchanged from ___ and\ncompatible with postsurgical changes, focal cortical atrophy, and edema. \nCorrelation with more remote prior imaging and history may be considered for\nfurther evaluation." + }, + { + "input": "There has been interval evolution appearance of bifrontal hemorrhagic\ncontusions, with interval decrease in size of dense hemorrhagic component,\nwith decreased surrounding edema, development of areas of encephalomalacia,\nand overall reduction of localized mass effect, with re-expansion of the\nfrontal horns of the bilateral lateral ventricle. Thin left frontal subdural\nhematoma has decreased in size and evolved in appearance, now measuring 2 mm\nin thickness, previously 7 mm. Areas of scattered subarachnoid hemorrhage\nhave resolved. A right parietal hemorrhagic contusion has also evolved in\nappearance (04:23). Right parafalcine subdural hemorrhage has essentially\nresolved. Right frontal extra-axial blood products have also essentially\nresolved. Again seen are postsurgical changes from left frontal craniotomy\nwith numerous surgical clips seen. Likely pre-existing encephalomalacia\nunderlying the prior surgical site is seen. There is no evidence of acute\nlarge vascular territorial infarction, new hemorrhage,increasing edema,or\nmass. There is mild prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture. There is moderate right and mild left\npolypoid mucosal wall thickening of the maxillary sinuses, moderate mucosal\nwall thickening of the bilateral anterior ethmoid air cells, as well as near\ncomplete opacification of the right frontal sinus with air-fluid level seen. \nSphenoid sinuses are grossly clear. The orbits are grossly unremarkable. The\nmastoid air cells are grossly clear. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Interval evolution appearance of bifrontal hemorrhagic contusions with\ninterval decrease of dense hemorrhagic component and reduced mass effect. No\nnew hemorrhage is seen.\n2. Near resolution of previously noted left frontal subdural hematoma with\nresidual 2 mm intermediate density component.\n3. Interval evolution appearance of a right parietal hemorrhagic contusion.\n4. Essential resolution of the previously noted scattered areas of\nsubarachnoid hemorrhage, right frontal extra-axial hemorrhage and right\nfrontal parasagittal subdural hemorrhage.\n5. Postsurgical changes from prior left frontal craniotomy with an ill-defined\narea of underlying likely pre-existing encephalomalacia. Correlation with\nprior imaging and surgical record would be helpful.\n6. Paranasal sinus disease, as described, with air-fluid level in the right\nfrontal sinus which can be seen in the setting of acute sinusitis." + }, + { + "input": "There has been no significant interval change. Hypodensities in the frontal\nregion indicative of encephalomalacia again seen. Soft tissue changes in the\nsinuses are again visualized. Postoperative changes are seen. There is no\nhydrocephalus or midline shift. Acute hemorrhage is identified.", + "output": "Stable appearance of bifrontal encephalomalacia and postoperative changes. \nAcute abnormalities." + }, + { + "input": "Overall, there has been no appreciable interval change from outside hospital\nimaging. There is a right mildly displaced parietal skull fracture with an\noverlying subgaleal hematoma. Tiny focus of pneumocephalus is noted adjacent\nto the right temporal lobe (03:17). A subdural hematoma overlies the right\ncerebral hemisphere measuring up to 6 mm wide. On the contralateral side,\nthere is a subdural hematoma along the left cerebral hemisphere measuring up\nto 5 mm wide. There is also extension of the subdural hematoma along the\nright posterior falx. There are multifocal extra-axial hemorrhages along the\nright medial frontal, right posterior parietal, right temporal, and left\nfrontal lobes with extension into the adjacent sulci consistent with\nsubarachnoid hemorrhage. There is also subarachnoid hemorrhage within the\nbifrontal sulci as well as hemorrhagic contusions, unchanged. There is\nbilateral frontal encephalomalacia and evidence of clips in the\ninterhemispheric fissure. Left frontal craniotomy calvarial defects are\nnoted. There is a 3.5 x 2.0 cm heterogeneous extra-axial hypodense mass sub\nadjacent to the left craniotomy site (02:19). There is no midline shift or\nevidence of herniation.\n\nThere are mucous retention cysts in the bilateral maxillary sinuses, right\ngreater than left. The ethmoidal air cells and sphenoid sinuses are slightly\nobscured by artifact, however demonstrate scattered opacification and mild\nmucosal thickening, respectively. The visualized portion mastoid air cells\nand middle ear cavities are clear. The visualized portion of the orbits are\nobscured by artifact however within these limitations are unremarkable.", + "output": "1. Overall, no interval change from the outside hospital imaging.\n2. Right parietal partially displaced skull fracture with large right\nsubgaleal hematoma and adjacent subarachnoid hemorrhage overlying the right\nfrontal and parietal lobes. Additional areas of subarachnoid hemorrhage\noverlying both frontal lobes and right temporal lobe.\n3. Bilateral subdural hematomas with extension along the posterior falx\ncerebri.\n4. Bilateral frontal hemorrhagic cerebral contusions.\n5. 3.5 x 2.0 cm left frontal hypodense extra-axial mass sub-adjacent to left\nfrontal craniotomy. Additionally, bifrontal relatively symmetric\nencephalomalacia is noted along with clips in the interhemispheric fissure. \nCorrelation with previous surgical history is recommended.\n6. Paranasal sinus disease." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute hemorrhage, edema, mass effect, or loss of\ngray/white matter differentiation. Mild age-related prominence of the sulci\nis noted. The ventricles are normal in size for age.\n\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nBoth orbits are unremarkable. There are no postseptal intraorbital\ninflammatory changes. Evaluation of the right supraorbital soft tissues is\nslightly limited by artifact from protective eye goggles. No clear evidence\nfor preseptal periorbital inflammatory change is seen.\nCTA HEAD:\nThe visualized distal cervical right internal carotid artery has a\nretropharyngeal course. There is mild calcified plaque in the distal cervical\nright internal carotid artery and the visualized mid cervical left internal\ncarotid artery without stenosis.\n\nThere is mild calcified plaque in bilateral carotid siphons without associated\nstenosis. The vessels of the circle of ___ and their principal\nintracranial branches are patent with no evidence of flow-limiting stenosis or\naneurysm. Dolichoectasia of the left vertebral and basilar arteries is noted.\n\nCTV HEAD:\nThe major dural venous sinuses are patent. There is normal, symmetric\nenhancement of the bilateral cavernous sinuses. The superior ophthalmic veins\nare symmetric and normal in caliber.", + "output": "1. No evidence of postseptal orbital cellulitis. Allowing for artifact from\nprotective eye goggles, no clear evidence for preseptal periorbital cellulitis\nis seen.\n2. No evidence for acute intracranial abnormalities.\n3. No evidence of cavernous sinus or major dural venous sinus thrombosis.\n4. No evidence for flow-limiting stenosis or aneurysm in the major\nintracranial arteries." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect or shift of normally\nmidline structures. The ventricles and sulci are normal in size and\nconfiguration for the patient's age. The basal cisterns appear patent and\ngray-white matter differentiation is preserved. The intracranial vessels are\nmildly opacified from recent coronary angiography. The orbits and globes are\nunremarkable. The imaged paranasal sinuses, mastoid air cells, middle ear\ncavities are clear. The bony calvaria appear intact.", + "output": "No evidence of infarction. However since the patient already had a contrast\nload for angiography, the sensitivity for an acute infarction is decreased. If\nthere is further concern for infarction, consider MRI. ." + }, + { + "input": "Some of the images are limited by motion artifact even though they were\nrepeated. Small recent infarcts in the right centrum semiovale and left\ncingulate gyrus seen on the ___ MRI are not visible on the present\nnoncontrast CT. There is no acute hemorrhage, mass effect, or CT evidence for\nan acute major vascular territorial infarction. A small chronic infarct is\nagain seen extending from the anterior right internal capsule into the corona\nradiata, images 2: ___. Chronic infarct of the right basal ganglia is again\ndemonstrated. There also mild periventricular white matter hypodensities,\nnonspecific but likely sequela of mild chronic small vessel ischemic disease\nin this age group. The ventricles and sulci are age-appropriate. \nAtherosclerotic calcification of the bilateral cavernous internal carotid\narteries is noted.\n\nThere is no evidence of fracture. There is moderate mucosal thickening and\nmucous retention cyst in the partially visualized left maxillary sinus. There\nis a small mucous retention cyst in the partially visualized right maxillary\nsinus. A right anterior ethmoid air cell and a left middle ethmoid air cell\nare completely opacified. There is mild mucosal thickening in additional\nbilateral anterior ethmoid air cells. These findings are unchanged compared\nto the ___ CT. The mastoid air cells are well aerated.", + "output": "1. No acute intracranial hemorrhage.\n2. Small recent infarcts in the right centrum semiovale and left cingulate\ngyrus seen on the ___ MRI are not visible on the present\nnoncontrast CT.\n3. No CT evidence for an acute major vascular territorial infarction.\n4. Stable small chronic infarct involving the anterior right internal capsule\nand corona radiata." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific, but likely reflect sequelae of chronic small\nvessel ischemic disease.\n\nThere is no evidence of fracture. There is soft tissue swelling noted along\nthe left frontal subcutaneous tissues. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Left frontal soft tissue swelling without acute fracture. Please note that\nthe nasal bones were not entirely imaged on this exam." + }, + { + "input": "There is a large amount of intraventricular hemorrhage, which is expanding the\nright lateral ventricle, and extending into the third and fourth ventricles. \nThere is a small amount of hemorrhage layering in the left lateral ventricle,\nthough there is moderate enlargement of the left lateral ventricle. Due to\nthe large amount of hemorrhage in the right lateral ventricle, the\nintraventricular septum is bowed leftward by approximately 9 mm. There is no\ndefinite evidence of intraparenchymal or subdural hemorrhage.\n\nThe ventricles are moderately enlarged. The size of the ventricles before the\nhemorrhages is unknown, though the large size is concerning for hydrocephalus.\nThere are periventricular confluent white matter hypodensities, greater on the\nright than the left, which likely represents transependymal flow of CSF and\nedema from the mass effect of the expanded ventricles.\n\nAtherosclerotic calcifications are noted in the intracranial arteries. There\nis complete opacification of the right frontal sinus. The remainder of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. No\nfracture is identified. The patient has a left globe prosthesis. The soft\ntissues are otherwise unremarkable.", + "output": "Large/extensive intraventricular hemorrhage, as described above with moderate\ndilation of the ventricles with periventricular hypodense appearance from\nedema/CSF seepage, etc. At the time of this dictation, the initial CT is\nunavailable for comparison. If it becomes available, an addendum will be\nadded.\n\nNOTIFICATION: The findings, including the fact that the prior exam is not\navailable in PACS, were discussed by Dr. ___ with Dr. ___ on the telephone\non ___ at 2:52 AM, 5 minutes after discovery of the findings." + }, + { + "input": "Again seen is a large amount of intraventricular hemorrhage expanding the\nright lateral ventricle and extending into the third and fourth ventricles. \nThere is also intraventricular blood layering in the occipital horn of the\nleft lateral ventricle. There is slightly increased leftward bowing of the\nintraventricular septum by 13 mm, previously 9 mm. There has also been\ninterval increase in the hydrocephalus with the temporal horn of the left\nlateral ventricle measuring 17 mm, previously 15 mm. Periventricular\nhypodensities, more prominent on the right, likely represents transependymal\nCSF migration versus vasogenic edema along with white matter changes. There\nis sulcal effacement in the right cerebral hemisphere, compared to the left. \nThe basal cisterns appear patent without evidence of downward herniation.\n\nNo osseous abnormalities seen. Again seen is complete opacification of the\nright frontal sinus with slightly dense contents, related to inspissated\ncontents are fungal etiology if there are risk factors. The remaining\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. Note\nis made of a left globe prosthesis.", + "output": "1. Large intraventricular hemorrhage expanding the right lateral ventricle\nextending into the third and fourth ventricles with interval increased\nleftward bowing of the intraventricular septum with mild subfalcine\nherniation.\n\n2. Interval increase in hydrocephalus.\n\n3. No evidence of downward herniation.\n\n4. Right frontal sinus opacification with slightly dense contents" + }, + { + "input": "New from the prior examination is placement of a right frontal approach EVD\nwhich terminates in the atrium/occipital horn of the right lateral ventricle. \nMassive intraventricular hemorrhage is again demonstrated, which is expanding\nthe right ventricle and is minimally increased from the prior examination done\nat 00:19. Leftward bowing of the interventricular septum has increased 2 1.3\ncm from midline (previously 1 cm) consistent with increasing hemorrhage/mass\neffect. Hemorrhage extends into the third and fourth ventricles as before. \nAdditionally, blood within the occipital horn of the left lateral ventricle is\nminimally increased. New from the prior examination is a 6 mm high density\nfocus within the left parieto-occipital lobe with adjacent edema which could\nrepresent an area of evolving parenchymal hemorrhage.\n\nThe ventricles are enlarged, as before. Periventricular confluent white\nmatter hypodensity greater on the right than on the left could represent\ntransependymal flow of CSF and edema. Atherosclerotic calcifications of the\nintracranial arteries are again demonstrated. Complete opacification of the\nright frontal sinus is unchanged.", + "output": "Interval placement of a right-sided EVD which terminates in the occipital horn\nof the right lateral ventricle.\n\nExtensive intraventricular hemorrhage as described above is minimally\nincreased from the prior examination. Correlate clinically for etiology.\n\n6 mm high-density focus within the left parieto-occipital lobe with minimal\nsurrounding edema is new from the prior examination and could represent a\nsmall area of intraparenchymal hemorrhage.\n\nNOTE ON ATTENDING REVIEW:\n\nThe above mentioned 6mm slightly dense focus in the left parietal lobe can be\nrelated to volume averaging of adjacent cortical margins rather than\nhemorrhage. Attention on followup.\nPeriventricular hypodensity and sulcal effacement of the right cerebral\nhemisphere, grossly similar to the prior study" + }, + { + "input": "The right frontal approach external ventricular drain again terminates the\nright atrium/occipital horn of lateral ventricle. Volume of intraventricular\nblood appear similar compared to the prior study, however there is\nredistribution with new hyperdense components the left occipital ventricular\nhorn. Ventricular size has not significantly changed, enlarged as before. \nThere is bowing of the interventricular septum to the left by 13 mm,\npreviously 12 mm. Hyperdense foci seen in the left frontoparietal region\n(03:22, 19) may represent foci of intraparenchymal or subarachnoid blood. \nConfluent periventricular white matter hypodensities are more prominent in the\nright cerebral hemisphere.\nThe suprasellar cistern is more effaced than on the prior study, and the\nperimesencephalic cistern is patent however slightly effaced. Foramen magnum\ndemonstrates appropriate amount of CSF space with no strong evidence of\ntonsillar herniation.\n\nNo fracture. There is opacification of scattered right mastoid air cells,\nhowever the majority of the paranasal sinuses are clear. Unchanged left globe\nprosthesis.", + "output": "1. Unchanged position of right frontal approach external ventricular drain.\n2. Redistribution of intraventricular hemorrhage with no evidence of new\nhemorrhage.\n3. Hyperdense foci in the left frontoparietal region may represent foci of\nintraparenchymal or subarachnoid hemorrhage.\n4. Slight interval increase in effacement of the suprasellar and\nperimesencephalic cisterns, however appropriate amount of CSF space in foramen\nmagnum." + }, + { + "input": "Please note that this study is somewhat motion degraded.\n\nA 1 x 0.9 cm focus of hemorrhage is seen in the left cerebellum. Linear\nhyperdensity between the left cerebellar hemisphere and the inner table of the\nleft occipital bone and mastoid portion of the left temporal bone most likely\nrepresents motion artifact (2:8).\nProminent ventricles and sulci are consistent with age-related involutional\nchange. Periventricular white matter hypodensities are consistent with\nsequela of chronic small vessel ischemic disease. No acute large vascular\nterritorial infarction. The basal cisterns are patent.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. There is a 1 cm left cerebellar hemorrhage. Underlying mass lesion is not\nexcluded. This may reflect an occult vascular malformation. Recommend MR\nwith contrast for further evaluation, once this acute episode has resolved.\n2. Linear hyperdensity between the left cerebellar hemisphere and the inner\ntable of the left occipital bone and mastoid portion of the left temporal bone\nmost likely represents motion artifact." + }, + { + "input": "When compared to ___ CT head without contrast, the previously\ndescribed hyperdense left cerebellar 1 cm x 0.9 cm hemorrhagic foci is\nessentially stable in appearance and now measures 0.8cm x 0.9cm. There are no\nnew hemorrhagic foci noted. The deep, subcortical, periventricular white\nmatter hypodensities are nonspecific and likely represent sequela of chronic\nmicrovascular disease. There is prominence of the ventricles and sulci\nsuggestive of involutional changes.\n\nThere is no evidence of fracture.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. Postsurgical changes related to prior bilateral\ncataract surgery are noted. The visualized portion of the orbits are\notherwise unremarkable.", + "output": "1. When compared to ___ CT head without contrast, the previously\ndescribed 1 cm x 0.9 cm hemorrhagic foci is stable in appearance and now\nmeasures 0.8 cm x 0.9 cm. There are no new hemorrhagic foci noted." + }, + { + "input": "Evaluation is mildly limited by motion. The left cerebellar hemorrhagic focus\nmeasures 8 x 9 mm is stable from ___, without significant mass effect. \nNo new areas of hemorrhage. The ventricles and sulci are prominent consistent\nwith involutional changes, stable since ___. Periventricular\nhypodensities may represent small vessel ischemic changes. No new area of\nlarge vascular territory hypodensity. The basal cisterns are patent.", + "output": "No significant change from ___. Stable left cerebellar hemorrhagic\nfocus measuring 9 x 8 mm." + }, + { + "input": "There is no evidence of hemorrhage, infarction or midline shift. There is no\nhydrocephalus. There is no edema. There is no fracture.\n\nVisualized paranasal sinuses and mastoid air cells are clear.", + "output": "Normal study" + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, edema, hemorrhage or mass. There are mild\nperiventricular white matter hypodensities, nonspecific, most likely sequela\nof chronic small vessel disease. The ventricles and sulci are prominent,\nlikely related to involutional changes.\n\nThere is no gross evidence of acute fracture. The ethmoid, sphenoid, frontal\nand maxillary sinuses are clear. The middle air cavities are unremarkable. The\nvisualized portion of the orbits are unremarkable.\n\nCTA neck:\nCommon origin of the innominate and left common carotid vessels, normal\nvariant. Mild to moderate calcification at the level of the aortic arch and\nleft carotid bifurcation. Tortuous course of the left vertebral artery\nappreciated at the origin. Dominant left vertebral artery. There is\napproximately 25% stenosis of the left internal carotid artery by NASCET\ncriteria (602:30). No stenosis of the right internal carotid artery by NASCET\ncriteria. CT angiography of the neck shows normal appearance of the carotid\nand vertebral arteries without occlusion or dissection.\n\nCTA head:\nModerate calcification of the carotid siphons. Mild tortuosity of the right\ninternal carotid artery prior to insertion into the petrous bone. \nIncidentally note of the right vertebral artery ending at the posterior\ninferior cerebellar artery. CT angiography of the head shows normal\nappearance of the arteries of the anterior and posterior circulation without\nstenosis or occlusion or aneurysm greater than 3 mm in size. Patent dural\nvenous sinuses.\n\nOther: Small bilateral pleural effusions. There is a 1 cm lobulated pleural\nbased hyperdensity in the right upper lobe (3:6), new in comparison to the\nstudy ___, that may represent a nodule or area of loculated fluid.\nThe thyroid gland appears unremarkable. No lymphadenopathy by CT criteria. \nDiffuse osteoporosis and moderate multilevel degenerative changes in the\ncervical spine. There is disc space narrowing with facet hypertrophy and\ncorresponding neural foraminal narrowing, right greater than left, most\nprominently between C3-C5. Minimal canal narrowing at the level of C3-C4 due\nto posterior osteophytes (602:25).", + "output": "1. No acute intracranial abnormality.\n2. Patent circle of ___ without evidence of stenosis, occlusionor aneurysm.\n3. Patent bilateral cervical carotid and vertebral arteries without evidence\nof occlusion or dissection.\n4. Small pleural effusions bilaterally.\n5. There is a 1 cm pleural placed lobulated hyperdensity in the right upper\nlobe, new in comparison study ___, that may represent small loculated\nfluid collection in the setting of pleural effusions or a lung nodule. In the\ncorrect clinical setting, follow-up chest imaging may be considered." + }, + { + "input": "The ventricles sulci are enlarged, likely secondary to age related atrophy.\nExtensive periventricular white matter changes are consistent with small\nvessel ischemic disease. Hypodensity in the right frontoparietal lobe likely\nrepresent sequela prior infarction.\n\nNo osseous abnormalities seen. Mild mucosal thickening is noted within the\nleft maxillary sinus. Air-fluid levels in the sphenoid sinuses, bilaterally\nmay represent acute sinusitis. Otherwise, the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The orbits are unremarkable. \nProminent vascular calcifications are noted.", + "output": "1. No acute intracranial abnormality.\n2. Hypodensity in the right temporoparietal lobe likely represents sequela of\nprior infarction.\n3. Moderate to severe brain parenchymal atrophy and small vessel ischemic\ndisease." + }, + { + "input": "Small hypodensity in the left cerebellar hemisphere likely simply represents a\nprominent cerebellar folia (2, 9). Unchanged hypodensity in the left\nthalamus, consistent with a chronic lacunar infarct. There is no evidence of\nacute infarction, hemorrhage, edema, or mass. There is prominence of the\nventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Aside from\nbilateral lens removal, the globes and bony orbits are intact and\nunremarkable. Carotid siphon calcifications are noted.", + "output": "1. No acute intracranial process. No hemorrhage.\n2. Unchanged chronic left thalamic lacunar infarct.\n3. Unchanged chronic findings including age-appropriate global involutional\nchange and vascular calcifications." + }, + { + "input": "Right: There is trace soft tissue debris marginating the inferior aspect of\nthe tympanic membrane within the external auditory canal (7:85). The tympanic\nmembrane is thin. The ossicular chain is intact. The middle ear and mastoid\nair cells are clear. The facial nerve takes a normal course through the\nmiddle ear, without osseous uncovering. The scutum is intact. The tegmen and\notic capsules are intact without evidence of superior semicircular canal\ndehiscence or otospongiosis. There is no evidence of inner ear dysplasia. \nThere is normal size morphology as the vestibular aqueduct and internal\nauditory canals. There is a normal course of the vasculature. The skull base\nand temporal mandibular joints are unremarkable.\n\nLeft: There is a 5 mm globose soft tissue projection from the posterior\naspect of the extraosseous external auditory canal (5:64; 9:4). The tympanic\nmembrane is thin. The ossicular chain is intact. The middle ear and mastoid\nair cells are clear. The scutum is intact. The facial nerve takes a normal\ncourse to the middle ear without osseous uncovering. The tegmen and otic\ncapsules are intact without evidence of superior semicircular canal dehiscence\nor otospongiosis. The internal auditory canal and vestibular aqueducts\ndemonstrate normal size morphology. There is a normal course uncovering of\nthe vasculature. The skull base and temporal mandibular joints are\nunremarkable.\n\nThe visualized intracranial structures are unremarkable. There is a\nmoderately sized inferior left maxillary sinus mucous retention cyst which\ndemonstrates internal hyperdensity. There is partial opacification of the\nbilateral ethmoid sinuses.", + "output": "Right:\n\n1. Minimal soft tissue debris marginating the inferior tympanic membrane\nwithin the external auditory canal.\n2. Otherwise unremarkable appearance of the right ear structures.\nLeft:\n\n1. 5 mm soft tissue projection from the posterior aspect of the extra osseous\nexternal auditory canal which could represent a soft tissue lesion. Recommend\ndirect visualization.\n2. Otherwise unremarkable appearance of the left middle and inner ear\nstructures. No evidence of jugular abnormality.\nOther :\n\n1. Moderate left inferior maxillary sinus mucous retention cyst with central\nhyperdensity consistent with inspissated mucus versus fungal colonization.\n2. Partial opacification of the bilateral ethmoid sinuses." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Moderate mucosal thickening of the\nbilateral ethmoid air cells and mild mucosal thickening of the bilateral\nmaxillary sinuses. Remainder of the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No CT evidence of a mass lesion, edema or mass effect. No acute intracranial\nabnormality." + }, + { + "input": "Right internal carotid artery pipeline stent is in place. There is no acute\nintracranial hemorrhage,acute infarction, mass or midline shift. There is no\nhydrocephalus. The ventricles and sulci are normal in size and configuration\nfor age. The basal cisterns are patent and there is preservation of gray-white\nmatter differentiation. There are a few areas of nonspecific subcortical white\nmatter hypodensity which may represent chronic small vessel ischemic disease.\nThe orbits are unremarkable. Visualized paranasal sinuses and mastoid air\ncells are clear. There is no fracture.", + "output": "Unremarkable unenhanced head CT." + }, + { + "input": "Head CT: There is a focal region of low attenuation in the white matter of\nright frontal lobe (series 3, image 15) which appears to be new compared to\nprior study dated ___. There is no evidence of hemorrhage, edema,\nmass or midline shift. There is no hydrocephalus. There is periventricular\nwhite matter low attenuation which is nonspecific but in a patient of this age\nlikely on the basis of chronic small vessel ischemic disease and the sites\nwere detailed above is unchanged since prior. Visualized paranasal sinuses and\nmastoid air cells are clear. There is no evidence of fracture.\n\nHead CTA: Patient is status post bilateral ICA pipe line stent placement.\nThere is no definite evidence of residual aneurysm. No new aneurysms are\ndetected. There is no evidence of vascular malformation, stenosis, or\nocclusion.", + "output": "1. Focus of low attenuation in the white matter the right frontal lobe which\nis new compared to prior study dated ___. MRI could be performed for\nfurther evaluation.\n\n2. Periventricular white matter low attenuation which is nonspecific but in a\npatient of this age likely on the basis of chronic small vessel ischemic\ndisease.\n\n3. Patient is status post bilateral ICAs pipe-line stents. There is no\ndefinite evidence of either residual aneurysm or new aneurysm formation." + }, + { + "input": "There is no evidence of fracture, acute large territory\ninfarction,hemorrhage,edema,or mass.. There is prominence of the ventricles\nand sulci suggestive of involutional changes, increased since ___. There is\nprominence of the bifrontal extra-axial spaces.\n\nSmall left frontal subgaleal hematoma. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "Small left frontal subgaleal hematoma. No acute intracranial hemorrhage or\nacute calvarial fracture." + }, + { + "input": "A small right frontal, parafalcine subdural hematoma is unchanged in size\ncompared to the outside hospital head CT from earlier on the same date. There\nis no midline shift. Layering hyperdensity along the posterior falx and right\ntentorial leaflet also appears unchanged compatible with small subdural\nhematoma. No change in venous epidural hematoma (7.5 mm in maximal thickness)\nabutting the superior sagittal sinus (601b:63). Ventricles and sulci are\nnormal in size and configuration. Basal cisterns are patent. There is no\nacute fracture. Vertex subgaleal hematoma is small and stable. The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Stable frontal parafalcine and right supratentorial subdural hematoma\ncompared to the outside hospital head CT from earlier today.\n2. Stable venous epidural hematoma adjacent to the superior sagittal sinus." + }, + { + "input": "There is been interval resolution of previously seen small frontal parafalcine\nhematoma. The small subdural hematoma along the right tentorial leaflet and\nposterior falx is stable in appearance. Additionally, the epidural hematoma\nalong the superior sagittal sinus is improved, but a small component remains\n(series 601b, image 57). No new foci of intracranial hemorrhage are\nidentified. Subtle hypodensity at the anterior inferior frontal lobes\n(601b:21) is compatible with expected evolution of previously seen contusions.\nThere is no evidence of infarction, ,edema, or mass. The ventricles and sulci\nare normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Resolution of small right frontal parafalcine subdural hematoma.\n2. Stable small right tentorial leaflet and posterior falx subdural hematoma.\n3. Decrease in size of small venous epidural hematoma.\n4. Anterior inferior frontal lobe contusions show expected interval\nevolution, no longer hyperdense.\n5. No new intracranial hemorrhage." + }, + { + "input": "In the superior aspect of the right parotid gland, just anterior to the level\nof the external auditory canal, there is an area of increased enhancement\n(9:12,15; 7b:33) with asymmetry of the overlying soft tissues but no\nsignificant subcutaneous stranding. No focal collection or abscess is\nidentified. There is minimal heterogeneity throughout the remainder of the\nright parotid gland compared to the left. Several punctate calcifications are\nnoted in both parotid glands, which are predominantly superficial in location\nand not associated with ductal dilatation.\n\nEvaluation of the aerodigestive tract demonstrates no exophytic mucosal mass\nor focal areas of mass effect. The tonsils and submandibular glands are\nunremarkable without evidence of tonsillar, peritonsillar or retropharyngeal\nabscess. The submandibular soft tissues are unremarkable. The nasopharyngeal\nand oropharyngeal soft tissues are unremarkable.\n\nNo cervical lymphadenopathy is seen. The thyroid gland is unremarkable. The\ncervical vessels enhance without evidence of high-grade stenosis or occlusion\nalthough this study is not as optimal as a dedicated CTA.\n\nThe imaged intracranial structures are unremarkable. Streak artifact from\ndental hardware limits evaluation for periodontal disease, though no obvious\nperiodontal or odontogenic abscess is identified.\n\nThe imaged lung apices are clear. A right Port-A-Cath is in place.\n\nThere is no osseous destructive lesion concerning for malignancy in the\ncervical spine.", + "output": "No obstructing stone or dilated ducts in the parotid glands. An area with mild\ninflammatory changes in the superior aspect of the right parotid gland just\nanterior to the level of the external auditory canal may represent early\nparotitis with no abscess.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\ntelephone on ___ at 5:30 ___, during discovery of the findings." + }, + { + "input": "Head CTA: There is a dural-based mass which measures 6.1 cm AP x 5.1 cm\ntransverse, centered over the right frontotemporal region, causing 1.7 cm of\nleftward midline shift and associated mass effect on the right lateral\nventricle. The ventricles appear stable in size when compared to recent head\nCT. The basal cisterns appear patent however a mass made cause mild uncal\nherniation. There is no hemorrhage.\n\nThere is no evidence of aneurysm, vascular malformation, or occlusion within\nthe intracranial vasculature. The mass is predominantly supplied by branches\nof the right MCA.", + "output": "1. Large right frontotemporal dural-based mass causing leftward midline shift\nand probable mild uncal herniation as well as mass effect on the right lateral\nventricle which likely represents a large meningioma.\n2. No aneurysm, vascular malformation, or occlusion within the intracranial\nvasculature. The mass is predominantly supplied by branches of the right MCA." + }, + { + "input": "The patient has undergone interval right frontotemporal craniotomy for\nresection of a large meningioma. There is interval improvement in the\nleftward shift of midline structures, which is currently 8 mm and decreased\nfrom 13 mm. Expected pneumocephalus is noted and a small amount of\nintraparenchymal hemorrhage is seen (series 3: Image 10). Small amount of\nsubdural hematoma is noted layering posteriorly. No new infarction is seen.\n\nThe ventricles and sulci are normal in size and configuration. The paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "Expected postsurgical changes following right frontotemporal craniotomy and\nmeningioma resection with interval improvement in leftward shift structure and\nsmall intraparenchymal and subdural hemorrhage." + }, + { + "input": "There is no evidence of infarction,hemorrhage,edema,or mass-effect. There is\nprominence of the ventricles and sulci suggestive of age-related atrophy.\nPeriventricular and subcortical white-matter hypodensities are nonspecific,\nbut likely represent sequela of chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Periventricular and subcortical white-matter hypodensities are nonspecific,\nbut likely represent sequela of chronic small vessel ischemic disease." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\npathologic extra-axial collection. Gray/white matter differentiation is\npreserved. The ventricles and sulci are normal in size. Small soft tissue\ndensity indenting the body of the left lateral ventricle (series 3, image 23)\ncorresponds to the focal gray matter heterotopia seen on the prior MRI.\n\nThere is a small right parietal subgaleal hematoma with an overlying\nlaceration. No fracture is seen. There is mild mucosal thickening in the\npartially visualized maxillary sinuses. The remainder of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. Small right parietal subgaleal hematoma with overlying laceration. No\nfracture." + }, + { + "input": "Subarachnoid hemorrhage seen overlying the bilateral frontal lobes. There is\nalso relatively I so a 10 Ewing 5 mm thick suspected subdural hematoma\noverlying the left frontal lobe (02:17). No additional intracranial\nhemorrhage. No mass effect. Enlarged ventricles and sulci are compatible\nwith volume loss. There is encephalomalacia in the left parieto-occipital\nregion suggestive of a chronic infarct.\n\nPlease see dedicated maxillofacial CT for details of the face and sinuses. \nThere is no calvarial fracture.", + "output": "Bilateral frontal subarachnoid hemorrhage. Small left frontal subdural\nhematoma anteriorly.\nPlease see concurrent maxillofacial CT for details of facial fractures." + }, + { + "input": "Motion limited exam. Similar pattern of bifrontal subarachnoid hemorrhage,\nsmall in overall extent. Tiny left frontal subdural hematoma is not\nconspicuous. Otherwise, no change. Opacification of the right maxillary\nsinus again noted with right CMC fracture partially visualized, better\nassessed on recent facial bone CT. Swelling is noted in the right face.", + "output": "Similar extent of mild bifrontal subarachnoid hemorrhage. No new hemorrhage. \nPrevious left frontal subdural hematoma not clearly seen." + }, + { + "input": "There is no evidence of definitive acute intracranial hemorrhage, edema, mass\neffect, or large territorial infarction. Punctate foci of hyperdensity are\nnoted within the bilateral basal ganglia, right greater than left, likely\nreflecting calcifications. The ventricles and sulci are normal in size and\nconfiguration. The basal cisterns appear patent and there is preservation of\ngray-white matter differentiation.\n\nThe visualized bony structures are grossly unremarkable. The paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The globes are\nunremarkable.", + "output": "1. No definitive evidence of intracranial hemorrhage or large vascular\nterritory infarction.\n2. Asymmetric punctate hyperdensities within the bilateral basal ganglia\ncommon on the right, likely reflect underlying calcifications.\n\nNOTE ON ATTENDING REVIEW:\n\nAdditional history of cirrhosis, end-stage renal disease.\nA few hypodense foci are noted in frontal lobes, in the periventricular and\nsubcortical locations.\nSlightly less conspicuous cerebral sulci -? Variant/ mild edema.\nStudy somewhat limited due to motion related artifacts.\nNo priors available.\nConsider close followup or further workup with MRI if not contraindicated as\nneeded.\nIrregularity of the left distal clavicle, partially imaged." + }, + { + "input": "A right extra-axial subdural fluid collection along the frontal convexity\nmeasures up to 1.7 cm in short axis on axial images is predominantly hypodense\nwith strands of increased density compatible with evolving hemorrhage. A\nsimilar left, largely chronic, mixed density subdural hematoma along the left\nfrontal convexity measures up to 9 mm in short axis on axial images (series 2,\nimage 14). Local mass effect on adjacent sulci is present but mild given\nprominent extra-axial spaces. No shift of normally midline structures. The\nbasal cisterns are patent. No evidence of acute infarct. Bilateral\nnonspecific white matter hypodensities may be sequelae of chronic small vessel\nischemic disease. Prominence of ventricles and sulci indicate cortical volume\nloss that is likely age related. Bilateral cavernous internal carotid\ncalcifications are mild-to-moderate.\n\nNo acute fracture. Mucosal thickening in the right sphenoid sinus is mild. \nOtherwise, the remaining partially imaged paranasal sinuses are essentially\nclear. The mastoid air cells and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Evolving large chronic mixed-density bilateral frontal convexity subdural\nhemorrhages (1.7 cm right and 9 mm left in short axis on axial images) without\nmidline shift.\n\n2. Cortical atrophy.\n\n3. Probable sequelae of chronic small vessel ischemic disease. No evidence\nof acute infarct." + }, + { + "input": "There are bifrontal subdural hematomas, measuring 8 mm on the left, previously\n9 mm, and 16 mm on the right, previously 17 mm. There is no new hyperdense\ncomponent to suggest acute interval hemorrhage compared to ___. Ventricles\nand sulci are mildly prominent, indicative of involutional change. \nPeriventricular white matter hypodensities are nonspecific but likely a\nsequela of chronic small vessel ischemia. No evidence of acute infarct. \nBasal cisterns are patent.\n\nNo fracture. Aside from mild mucosal thickening of the right sphenoid sinus,\nthe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Stable chronic bifrontal subdural hematoma compared to ___.\n2. Age related involutional and chronic microvascular changes." + }, + { + "input": "Evaluation is limited due to motion artifact.\n\nLarge superficial left frontal/parietal parenchymal hematoma extending to the\ninsula measures 6.8 x 3.9 cm in maximal axial cross-section on image 2:20,\nsubstantially increased compared to the study from approximately 3 hours\nprior, when it measured 4.3 x 3.2 cm. There is surrounding vasogenic edema. \nThere is partial effacement of the left lateral and third ventricles, and a 4\nmm rightward shift of midline structures. Left subarachnoid hemorrhage is\nalso increased. Basal cisterns are not compressed. There is ___ cisterna\nmagna versus retrocerebellar arachnoid cyst.\n\nNo displaced fracture is seen allowing for motion artifact. There is minimal\nmucosal thickening in the ethmoid and maxillary sinuses. Mastoid air cells\nappear well-aerated allowing for motion artifact. The orbits appear\nunremarkable.", + "output": "1. Motion limited exam.\n2. Substantial interim enlargement of the large superficial left\nfrontal/parietal/insular parenchymal hematoma compared to approximately 3\nhours prior, now 6.8 x 3.9 cm. Increased partial effacement of the left\nlateral and third ventricles. 4 mm rightward shift of midline structures.\n3. Increased left sulcal subarachnoid hemorrhage.\nCOMMENT: The combination of superficial parenchymal and subarachnoid\nhemorrhage may be seen in amyloid angiopathy. CTA head right been performed,\ndemonstrating no evidence for an arteriovenous malformation.\n\nRECOMMENDATION(S): MRI brain with and without contrast to assess for evidence\nof amyloid angiopathy or intracranial mass." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nRedemonstration of intraparenchymal and subarachnoid hemorrhage in and related\nto the left frontal, parietal, and temporal lobes, and left insula with\nsurrounding edema. There is no significant change in the size of the\nintraparenchymal hemorrhage compared prior. There is associated sulcal\neffacement and unchanged 4 mm rightward midline shift and mass effect on the\nleft lateral ventricle, which is partially compressed. Small amount of\nsubarachnoid hemorrhage seen within the right sylvian fissure is well. There\nis no evidence of infarction, new hemorrhage,ormass. The ventricles and sulci\nare otherwise normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are essentially clear. The visualized portion of the orbits are\nunremarkable. Nasal septal perforation is noted.\n\nCTA HEAD:\nNo vascular abnormality is identified underlying the left-sided cerebral\nhemorrhage. There is mild atheromatous calcification of the carotid siphons\nbilaterally. The right A1 segment is absent. This is a normal variant. The\nvessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. The dural venous\nsinuses are patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion.\n\n\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. Nasogastric tube in situ, with the tip below the imaged field. \nPatient is intubated, with the tip of the endotracheal tube and may\nmid-trachea.", + "output": "1. Redemonstration of the intraparenchymal hemorrhage and subarachnoid\nhemorrhage in and related to the left frontal, parietal and temporal lobes,\nwith stable 4 mm rightward midline shift.\n2. No vascular abnormality is identified underlying the left-sided cerebral\nhemorrhage. Patent circle of ___ without evidence of stenosis,occlusion,or\naneurysm.\n3. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection." + }, + { + "input": "Patient is status post left frontoparietal hemi-craniectomy with Hemovac drain\nplacement. The surgical bed contain fluid, air and hyperdense hemorrhage\nmeasures 3.8 x 1.6 cm in maximal axial cross-section (03:22), the latter\ndecreased in size comparison to the preoperative studies. Left subarachnoid\nhemorrhage remains present. The previously seen 4 mm rightward shift of\nmidline structures has resolved. Prior partial effacement of the left lateral\nventricle is now partially improved with partial re-expansion.\n\nBasal cisterns are not compressed. There is unchanged ___ cisterna magna\nversus retrocerebellar arachnoid cyst, with unchanged questionable mild\nposterior cerebellar remodeling.\n\nMinimal mucosal thickening of the ethmoid air cells is noted. Endotracheal\ntube is partially imaged.", + "output": "1. Approximately 3.8 x 1.6 cm residual parenchymal hematoma in the left\nsurgical bed, smaller than on the presurgical studies. Residual subarachnoid\nhemorrhage is also present.\n2. Mild residual effacement of the left lateral ventricle, partially improved\ncompared to presurgical studies. Previously noted rightward shift of midline\nstructures has resolved." + }, + { + "input": "Study quality is mildly degraded due to beam hardening artifact from scalp\nstaples as well as motion artifact.\n\nPatient is status post left frontoparietal hemicraniectomy with Hemovac drain\nplacement. The surgical bed contains fluid, air and evolving hyperdense\nintraparenchymal hemorrhage, measuring 4.7 x 3 cm at its largest dimension\n(02:25), previously 3.3 x 2.5 cm. Surrounding vasogenic edema is slightly\nincreased in size compared to prior. There is a 5 mm rightward midline shift,\npreviously not appreciable. There is relatively stable partial effacement of\nthe left lateral ventricle. Unchanged left subarachnoid hemorrhage. The\nventricles and sulci are stable in size. Basal cisterns remain patent.\n\nUnchanged ___ cisterna magna versus retrocerebellar arachnoid cyst. \nUnchanged minimal mucosal thickening of the ethmoid air cells. Partially\nvisualized endotracheal and orogastric tube. The visualized portion of the\norbits are unremarkable.", + "output": "1. Patient status post left frontoparietal craniectomy. Stable\npneumocephalus and an evolving intraparenchymal hemorrhage as well as\nrelatively stable subarachnoid hemorrhage.\n2. Slightly increased vasogenic edema in the surround with 5 mm rightward\nmidline shift and partial effacement left lateral ventricle.\n3. No hydrocephalus." + }, + { + "input": "As before, the patient is status post left frontoparietal hemicraniectomy. An\nexternal drain has been removed. As before, the surgical bed contains fluid,\nair and hyperdense intraparenchymal hemorrhage measuring approximately 5.0 x\n4.0, previously 4.9 x 3.8 cm (02:24). There is similar extent of subarachnoid\nhemorrhage in the left cerebral vertex. No new hemorrhage is identified. \nThere is a similar degree of surrounding edema. There has been interval\ndecrease in rightward midline shift, now measuring approximately 2 mm,\npreviously 5 mm. There is slightly decreased effacement of the left lateral\nventricle. The basal cisterns remain patent. There is unchanged ___\ncisterna magna versus a retrocerebellar arachnoid cyst.\n\nAside from mild mucosal thickening in the bilateral, right greater than left,\nethmoid air cells and bilateral sphenoid sinuses, the visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nThe visualized portion of the orbits are normal.", + "output": "1. Re-demonstrated are postsurgical changes after hematoma evacuation related\nto left frontoparietal craniectomy.\n2. Slight interval decrease in mass effect, with decreased effacement of the\nleft lateral ventricle as well as decrease in rightward midline shift.\n3. Grossly stable left intraparenchymal and subarachnoid hemorrhage and\ncerebral edema." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nlarge mass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The posterior arch of C1 is unfused. The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute large territory infarction,\nintracranialhemorrhage,edema,or discrete mass. There is prominence of the\nventricles and sulci suggestive of involutional changes. Periventricular and\nsubcortical white matter hypodensities are nonspecific but compatible with\nchronic small vessel ischemia.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "The parotid glands, submandibular glands, and thyroid are unremarkable. There\nis no cervical adenopathy.\n\nThe aerodigestive tract appears normal. Included paranasal sinuses and\nmastoids are clear.\n\nAtherosclerotic calcifications noted at the aortic arch, carotid bulbs, distal\nleft ICA as well as the intracranial ICAs.\n\nIncluded intracranial structures are grossly unremarkable.\n\nNo focal suspicious osseous lesion identified. Degenerative changes are noted\nin the spine including uncovertebral joint hypertrophy, left worse than right\nat C5-C6 resulting in mild to moderate left foraminal narrowing. No critical\ncanal or foraminal narrowing.\n\nExtensive centrilobular emphysema is noted at the lung apices. Left chest\nwall port is seen with catheter in the SVC.", + "output": "No focal abnormality to explain patient's symptoms. No visualized mass." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Periventricular and subcortical\nwhite matter hypodensities are mild, likely sequela of chronic small vessel\ndisease. Ventricles and sulci are unremarkable. Basilar cisterns are patent.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nHypodensity in the right occipital lobe is suggestive of a subacute right PCA\nterritory infarction. No intracranial hemorrhage. The ventricles and sulci\nare normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe distal branches of the right posterior cerebral artery are not well\nvisualized and are likely occluded (series 603, image 32). Mild\natherosclerotic calcification of the bilateral internal carotid arteries\nwithout significant luminal narrowing. The remaining vessels of the circle of\n___ and their principal intracranial branches appear normal without\nstenosis, occlusion, or aneurysm formation. The dural venous sinuses are\npatent.\n\nCTA NECK:\nThere is retropharyngeal course of the common carotid arteries, left vertebral\nartery is dominant, which is a normal anatomic variant. Otherwise, the\ncarotidandvertebral arteries and their major branches appear patent with no\nevidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs demonstrate bilateral ground-glass\nopacities suggesting overload, please correlate. The visualized portion of\nthe thyroid gland is within normal limits. Multiple, bilateral prominent lymph\nnodes, which are not enlarged by size criteria.", + "output": "1. Subacute right posterior cerebral artery territorial infarction.\n2. Distal branches of the right posterior cerebral artery are not clearly\nvisualized and are likely occluded.\n3. Retropharyngeal course of the common carotid arteries with no evidence of\nstenosis.\n\nNOTIFICATION: The findings were discussed with Dr. ___ by ___, M.D.\non the telephone on ___ at 5:31 pm, 5 minutes after discovery of the\nfindings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nEncephalomalacia in the right occipital lobe is consistent with expected\nevolution of previously seen right PCA territory infarction. No evidence of\nnew large territorial infarction. No intracranial hemorrhage. The ventricles\nand sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are normal.\n\nCTA HEAD:\nThe distal branches of the right posterior cerebral artery are not\nwell-visualized, unchanged in appearance compared to prior CTA head/neck from\n___. Otherwise, no evidence of dissection, occlusion, high-grade\nstenosis, or aneurysm greater than 3 mm. Mild atherosclerotic calcification at\nthe bilateral carotid siphons. There is no evidence of dural venous sinus\nthrombosis.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent.\nThere is mild atheromatous calcification of the left carotid bulb. There is\nno evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. Note is again made of a retropharyngeal\ncourse of the common carotid arteries bilaterally.\n\n\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. There is an old infarct in the right occipital lobe. No acute intracranial\nabnormality is identified.\n2. The distal branches of the right posterior cerebral artery are not\nwell-visualized, unchanged in appearance compared to prior CTA head/neck from\n___. Otherwise, no evidence of dissection, occlusion, high-grade\nstenosis, or aneurysm greater than 3 mm.\n3. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection.\n4. Note is again made of a retropharyngeal course of the common carotid\narteries bilaterally." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nChronic right occipital infarct is again visualized. No evidence for acute\nintracranial hemorrhage or acute major vascular territorial infarction. \nAge-appropriate size of the ventricles, sulci, and basal cisterns.\n\nUnchanged arachnoid granulation with thinning of the outer table in the right\nparietal bone on image 2:277 compared to ___. No suspicious calvarial\nlesions identified. Trace mucosal thickening in the frontoethmoidal recesses.\nOther paranasal sinuses and mastoid air cells appear essentially well aerated.\nThe orbits appear unremarkable.\n\nCTA NECK:\n3 vessel aortic arch is again demonstrated. Technically limited visualization\nof the proximal common carotid and subclavian artery secondary to beam\nhardening artifact from the shoulder girdles, given the patient's body\nhabitus. Mild atherosclerotic plaque at the left subclavian artery origin\nwithout flow-limiting stenosis. No right or left internal carotid stenosis by\nNASCET criteria, though mild calcified plaque is present in the proximal left\ninternal carotid artery. Medialized courses of bilateral common carotid\narteries are again noted.\n\nSlightly limited visualization of bilateral vertebral artery origins and of\nthe V1 segment of the non dominant right vertebral artery. Otherwise, no\nevidence for vertebral artery stenosis.\n\nCTA HEAD:\nThere is calcified plaque within bilateral carotid siphons without evidence\nfor flow-limiting stenosis. Persistent nonvisualization of the distal right\nPCA branches. No evidence for new flow-limiting stenosis in the major\nintracranial arteries. No evidence for an aneurysm. The dural venous sinuses\nare patent.\n\n\nOTHER:\nProminent nonenlarged cervical lymph nodes, similar to ___. The\nthyroid is unremarkable. Nondiagnostic evaluation of the included upper lungs\nsecondary to respiratory motion artifact, with diffuse ground-glass\nattenuation. Enlargement of the main pulmonary artery is again seen,\nsuggesting pulmonary arterial hypertension. There are degenerative changes in\nthe cervical spine.", + "output": "1. No evidence for acute intracranial abnormalities. Chronic right occipital\ninfarct is again demonstrated. MRI would be more sensitive for an acute\ninfarction, if clinically warranted.\n2. Left ICA origin atherosclerosis without stenosis by NASCET criteria.\n3. Persistent nonvisualization of distal right PCA branches. No evidence for\nnew occlusion or flow-limiting stenosis in the major intracranial arteries." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\ninfarction. The ventricles and sulci are normal in size and configuration. \nThe basal cisterns appear patent and there is preservation of gray-white\nmatter differentiation.\n\nNo fracture is identified. The visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The globes are intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or infarction. The\nventricles and sulci are normal in size and configuration. The basal cisterns\nappear patent and there is preservation of gray-white matter differentiation.\n\nNo fracture is identified. The visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The globes are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or acute infarction.\nThe ventricles and sulci are normal in size and configuration for age. Basal\ncisterns are patent. Gray- white matter differentiation is preserved.\n\nNo fracture is identified. Partially imaged paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no acute hemorrhage, edema or shift of the normally midline\nstructures. Prominence of the ventricles and sulci is compatible with age\nrelated involutional changes. Scattered subcortical white matter\nhypodensities, while nonspecific, are presumably sequela from chronic small\nvessel ischemic disease. Evidence of chronic infarction is seen in the right\noccipital lobe. Otherwise, the gray-white matter differentiation is preserved\nand there is no evidence for an acute vascular territorial infarction. \nCalcifications are seen within the carotid siphons.\n\nThe included paranasal sinuses and mastoid air cells are well-aerated. The\nimaged lenses and globes are unremarkable. There is no fracture. Severe\nright side TMJ degenerative changes are present.", + "output": "No acute intracranial process." + }, + { + "input": "Geographic loss of gray-white involving the right superior temporal lobe and\nparietal lobe compatible with acute infarct. This is not seen on CT head of\n___. Associated sulcal and right ventricular fffacement is\nidentified compatible with edema pattern. There is no midline shift. The\nbasilar cisterns remain patent. No evidence of intracranial hemorrhage.\n\nRight frontal parietal subcutaneous emphysema and subgaleal hematoma is\nsignificantly improved from outside hospital examination with overlying skin\nclosure staples. No skull fractures. The paranasal sinuses are essentially\nclear. The mastoid air cells middle ear cavities are well pneumatized and\nclear. The orbits are unremarkable. Comminuted nondisplaced C1 fracture re-\nidentified.", + "output": "1. Acute geographic infarct involving the right superior temporal lobe to the\nparietal lobe.\n2. No evidence of hemorrhagic conversion.\n3. Additional findings described above.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ on the telephoneon ___ at 1:43 ___, at the time of\ndiscovery of the findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is an evolving acute infarction in the right parietotemporal lobe with\nloss of the gray-white matter differentiation and effacement of the adjacent\nsulci. There is no acute intracranial hemorrhage, midline shift, or\nextra-axial fluid collection.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\nThe left frontoparietal scalp hematoma is unchanged. There are skin staples\nalong the left vertex. No calvarial fracture is identified. A small amount\nof subcutaneous emphysema is noted in the left frontoparietal scalp.\n\nCTA HEAD:\nThe inferior division of the right M2 segment occludes on 3: 271 with distal\nreconstitution of the M3 branches. The remainder of the vessels of the circle\n___ and their intracranial branches are patent without evidence of\nstenosis, occlusion, or aneurysm. The dural venous sinuses are patent. There\nare mild atherosclerotic calcifications of the bilateral cavernous and supra\nclinoid internal carotid arteries.\n\nCTA NECK:\nThere is a normal 3 vessel branching pattern of the aortic arch. The carotid\nand vertebral arteries and their major branches are patent with no evidence of\nstenosis or occlusion. There is mild calcified and noncalcified plaque at the\nbilateral carotid bifurcations with no evidence of internal carotid stenosis\nby NASCET criteria. There is no evidence of dissection.\n\nOTHER:\nPatchy ground-glass densities in the lung apices likely represent atelectasis.\nThere is a 0.6 cm hypodense nodule in the right thyroid lobe. There is no\nlymphadenopathy by CT size criteria.\n\nThe comminuted, nondisplaced fractures of the right anterior arch and the left\ntransverse process of C1 are unchanged. There is a comminuted, mildly\ndistracted fracture of the T1 spinous process. A nondisplaced fracture of the\nright manubrium is unchanged.", + "output": "1. Evolving, acute infarction in the right MCA distribution with occlusion of\nthe inferior division of the right M2 segment.\n2. Patent vasculature in the neck with no evidence of internal carotid artery\nstenosis by NASCET criteria or vertebral artery dissection.\n3. Comminuted, nondisplaced fractures of the right anterior arch and left\ntransverse process of C1, comminuted fracture of the T1 spinous process,\nnondisplaced fracture of the right manubrium." + }, + { + "input": "As compared to the prior examination dated ___, there has again\nbeen interval evolution of a right MCA territorial infarction. There is no\nevidence of hemorrhagic conversion or other intracranial hemorrhage. Mild\nedema and mass effect on the right lateral ventricle appears minimally\nincreased from the prior examination. The basal cisterns remain patent.\n\nA laceration is noted overlying the left frontal bone without underlying\nfracture. Redemonstrated is a nondisplaced fracture through the right\nanterior arch and left transverse process of C1. The visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nThe visualized portion of the orbits are unremarkable.", + "output": "Expected interval evolution of the right MCA territorial infarction, without\nevidence of hemorrhagic conversion." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThere is mild prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is mild narrowing of the V4 segment of the left vertebral artery\nsecondary to atherosclerotic calcification. There are mild right greater than\nleft calcifications of the intracranial internal carotid arteries, without\nsignificant stenosis. The vessels of the circle of ___ and their principal\nintracranial branches otherwise appear patent without significant stenosis,\nocclusion, or aneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is mild atherosclerotic calcification at the origin of the\nbrachiocephalic artery. There is minimal atherosclerotic calcification at the\norigin of the right internal carotid artery without significant stenosis. The\ncarotid and vertebral arteries and their major branches otherwise appear\npatent with no evidence of significant stenosis ,occlusion or dissection.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No acute intracranial abnormality.\n2. Mild narrowing of the V4 segment of the left vertebral artery secondary to\natherosclerotic calcification. Otherwise patent intracranial vasculature\nwithout significant stenosis, occlusion, or aneurysm.\n3. Patent cervical vasculature without significant stenosis, occlusion, or\ndissection." + }, + { + "input": "There is no evidence acute hemorrhage, edema, mass effect, or acute major\nvascular territorial infarction. However, evaluation for brainstem or\nthalamic infarcts by CT compared to MRI is particularly limited. Nonetheless,\nthere is no change in the size of the fourth ventricle, third ventricle, or\nbasal cisterns. Cerebral sulci mildly prominent due to age-related\nparenchymal volume loss. Small chronic infarcts are again seen in the\nposterior inferior right cerebellar hemisphere, in the left caudate body and\ncorona radiata. Periventricular white matter hypodensities are nonspecific\nbut likely sequela of chronic small vessel ischemic disease in this age group.\n\nEndotracheal and orogastric tubes are noted. Paranasal sinuses and mastoid\nair cells appear grossly well-aerated allowing for absence of dedicated bone\nalgorithm images.", + "output": "No evidence for acute hemorrhage, mass effect, or acute major vascular\nterritorial infarction MRI would be more sensitive for acute posterior\ncirculation territory infarction, if clinically warranted." + }, + { + "input": "Study is limited secondary to patient positioning.\n\nHypodensities consistent with known infarctions in the bilateral cerebellar\nhemispheres and pons are unchanged in configuration compared to prior MRI,\nallowing for difference technique. Previously seen infarct of the bilateral\noccipital lobes and bilateral posteromedial temporal lobes is better\nappreciated on prior MRI. The small focus of hypodensity in the right\ninferior cerebellar hemisphere is without CT evidence of active hemorrhage. \n(Series 2, image 7). Within limits of study, there is no definite evidence of\nacute intracranial hemorrhage. There is no evidence of cerebellar tonsillar\nherniation.\n\nThe ventricles and sulci are grossly stable in size and configuration, without\ndefinite evidence of ventriculomegaly. Periventricular white matter\nhypodensities are nonspecific, but likely reflect sequelae of chronic small\nvessel ischemic disease. Chronic lacunar infarct in the left periventricular\nwhite matter is stable in appearance. Atherosclerotic vascular calcifications\nare noted of bilateral vertebral and cavernous portions of internal carotid\narteries.\n\nThere is no evidence of fracture. There is trace fluid noted in the sphenoid\nsinuses. The visualized portion of the mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are preserved. \nEndotracheal and nasoenteric tubes are partially visualized.", + "output": "1. Study limited secondary to patient positioning.\n2. Expected evolution of patient's known multifocal infarcts as described,\nwithout definite evidence of hemorrhagic transformation.\n3. Within limits of study, no definite evidence of new large acute\nterritorial infarct or acute intracranial hemorrhage." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\n There is no evidence of acute infarct, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. Periventricular\nwhite matter hypodensities are nonspecific, but likely reflect sequelae of\nchronic small vessel ischemic disease. There is a focal hypodensity in the\nleft basal ganglia suggestive of chronic infarct.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is a filling defect involving the proximal and mid basilar artery and\nboth distal segments of the vertebral arteries. Proximal to this, there is\nfocal stenosis of the left vertebral artery at the level of the foramen\nmagnum. There is no anterograde flow seen in the basilar artery. The\nposterior communicating arteries are diminutive bilaterally. The posterior\ncerebral arteries are patent bilaterally. There is narrowing abnormality in\nthe distal anterior cerebral arteries bilaterally that may be artifact but\ncould be intracranial atheromatous disease. The remaining visualized portions\nof the anterior and middle cerebral arteries appear normal without occlusion\nor aneurysm formation. There are calcifications with narrowing in the\ncavernous carotid artery. The dural venous sinuses are patent.\n\nCTA NECK:\nScattered atherosclerotic calcifications are noted in the aortic arch, at the\norigins of right brachiocephalic artery, left common carotid artery, and left\nsubclavian artery, and involving the left and right common carotid, and left\ninternal carotid artery. The carotid arteries and their major branches appear\nnormal with no evidence of stenosis by NASCET criteria or occlusion. There is\nstenosis at the origin of the left vertebral artery.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Filling defect involving the basilar artery and bilateral vertebral\narteries concerning for acute basilar artery thrombosis.\n2. Distal anterior cerebral artery atheromatous disease with narrowing\nabnormality versus artifact.\n3. Stenosis at the origin of the left vertebral artery.\n\nNOTIFICATION: The findings were discussed with ___, M.D. and\n___ MD by ___, M.D. on the telephone and in person on\n___ at approximately 5:05 pm, approximately 5 minutes after discovery of\nthe findings." + }, + { + "input": "There is a right hyperdense middle cerebral artery with hypodensity in the\nright inferolateral frontal lobe with extension into the right insular region\nand right temporal lobe and loss of gray-white matter differentiation\n(___). There is no evidence of intracranial hemorrhage. There is\nprominence of the ventricles and sulci suggestive of age-related cerebral\nvolume loss. Periventricular, subcortical and deep white matter hypodensities\nare nonspecific, though likely sequelae of chronic small vessel ischemic\ndisease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits demonstrate prior right lens surgery but otherwise are\nunremarkable.", + "output": "Right frontotemporal acute/subacute infarct with hyperdense right middle\ncerebral artery. No intracranial hemorrhage." + }, + { + "input": "CTA HEAD:\n\nThere is focal near occlusive thrombus at the M1 segment at the right middle\ncerebral artery bifurcation (series 2, image 249). Partially occlusive\nthrombus extends into the proximal portion of the inferior (series 2, image\n248) and superior M2 division (series 2, image 254). There is reconstituted\nflow within the distal vessels.\n\nRemainder of the circle of ___ is unremarkable. There is no aneurysm or\nvascular malformation. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is a two vessel arch. The carotid and vertebral arteries and their major\nbranches appear normal with no evidence of stenosis or occlusion. There is no\nevidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are notable for mild paraseptal emphysema.\nThe visualized portion of the thyroid gland is within normal limits. There is\nno lymphadenopathy by CT size criteria. There is multilevel cervical spine\ndegeneration. Note is made of a right lens replacement. There are bilateral\noptic disc drusens.", + "output": "1. Near occlusive thrombus at the right MCA bifurcation, with partially\nocclusive thrombus extending into the inferior and superior divisions of the\nright M2 segment of the MCA. Distal vessels demonstrate reconstitution of\nflow.\n2. Circle of ___ vessels otherwise unremarkable." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass. The ventricles and sulci are moderately enlarged, compatible with\nage related atrophic changes. Periventricular and subcortical white matter\nhypodensities are noted, likely the sequelae of chronic small vessel ischemic\ndisease. There is preservation of gray-white matter differentiation. The\nbasal cisterns remain patent.\n\nThere is no evidence of fracture. Partial opacification and mild mucosal\nthickening is noted within the bilateral ethmoid air cells. The remainder of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nThe patient is status post bilateral lens replacement.", + "output": "1. No acute intracranial process.\n2. Moderate global cerebral atrophy and evidence of chronic small vessel\nischemic disease." + }, + { + "input": "Although better appreciated on the prior MRI, again seen are multiple\nhyperdense intracranial metastatic lesions including a 1.0 cm lesion in the\nright cerebral convexity (02:26), a 7 mm lesion along the right superior falx\n(02:25) and a lesion in the right cerebellum with central hyperdensity (2:8). \nMultiple calvarial lesions including a 6 mm lucency in the right parietal bone\n(02:26) are also better appreciated on the prior brain MRI. There is no\nevidence of fracture, acute territorial infarction,hemorrhage, oredema. There\nis prominence of the ventricles and sulci suggestive of involutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No acute infarct.\n2. Multiple hyperdense metastatic calvarial and intraparenchymal lesions are\nagain seen, although better appreciated on prior MRI. The hyperdense nature\nof these lesions is most compatible with intratumoral hemorrhage when\ncorrelated to the MRI brain performed ___." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. \nVentricles and sulci are mildly prominent, consistent with age-related global\nparenchymal loss. There are atherosclerotic vascular calcifications of\nbilateral cavernous portions of internal carotid arteries.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No acute intracranial abnormality.\n2. Age-related atrophy, and atherosclerotic vascular disease as described." + }, + { + "input": "There is no evidence of fracture, infarction,, hemorrhage,mass effect or\nmidline shift. The ventricles and sulci are enlarged consistent with age\nrelated involutional change.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.\nAgain seen are bilateral parietal bone lucencies that suggest metastases.", + "output": "1. No evidence of intracranial hemorrhage.\n2. No evidence of brain parenchymal metastases.\n3. Parietal bone lesions likely represent osseous metastases." + }, + { + "input": "Within the left superior frontal gyrus there is an intraparenchymal hematoma\nwhich measures 2.3 x 1.8 cm in axial ___. Just above it there is\nextra-axial hemorrhage measuring 1.7 x 0.6 cm with fluid fluid level, it may\nrepresent recent or active hemorrhage. There is also subarachnoid hemorrhage\nlocated predominantly in along the left frontal convexities but also to a\nsmaller extent in the bilateral parieto-occipital as well as the right frontal\nconvexities. There is a right frontal parietal subdural hematoma measuring 4\nmm from the inner table (03:22). There is also additional hyperdensity along\nthe anterior falx (03:24) as well as the right tentorium cerebellum compatible\ntiny subdural bleeds. There is no abnormal shift of midline structures or\nevidence of downward herniation. The ventricles and sulci are normal in size\nfor patient's age.\n\nThere is no evidence of calvarial fracture. Scattered scalp lacerations\ncontaining foci of air are identified over the right frontal bone. Mucous\nretention cyst is present in the left maxillary sinus. The remaining\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. Bilateral lens replacements are noted. Atherosclerotic\ncalcifications of the bilateral carotid siphons are also present.", + "output": "1. 2.3 x 1.8 cm left frontal lobe acute intraparenchymal hematoma. Adjacent\nextra-axial hemorrhage with fluid fluid level, may represent recent or active\nbleed.\n\n2. Subarachnoid acute hemorrhage.\n\n3. Small volume subdural acute hemorrhage.\n\nNOTIFICATION: Findings were discussed with ___ by ___ phone\nat 8:15pm on ___, 10 minutes following discovery." + }, + { + "input": "Compared to ___, expected interval evolution of a left frontal\nlobe intraparenchymal hematoma. Again seen is subarachnoid hemorrhage in the\nbilateral frontal, parietal and occipital lobes and cerebellum. The left\nfrontal intraparenchymal hematoma measures 2.5 x 1.5 cm (___) in axial\n___, previously 2.3 x 1.8 cm. No significant change in a right frontal\nextra-axial fluid collection, measuring approximately 0.4 cm (___),\npreviously 0.4 cm. Extra-axial blood is also identified along the anterior\nfalx and right tentorium, as before. No abnormal shift to midline structures\nor evidence of downward herniation. There is no evidence of infarction or\nmass. The ventricles and sulci are normal in size and configuration. Again\nseen are bilateral carotid siphon calcifications.\n\nNo significant change in a posterior midline subgaleal hematoma without\nunderlying or other fracture. There is a mucous retention cyst in the left\nmaxillary sinus. And minimal mucosal thickening of the ethmoidal air cells. \nOtherwise, the visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. Status post bilateral lens replacement.", + "output": "1. Compared to ___, expected interval evolution of a left frontal\nlobe intraparenchymal hematoma, measuring 2.5 x 1.5 cm, previously 2.3 x 1.8\ncm.\n2. No significant change in multiple small extra-axial fluid collections along\nthe right frontal lobe, anterior falx and right tentorium.\n3. Minimal interval redistribution of subarachnoid blood in the bilateral\nfrontal, parietal, and occipital lobes and cerebellum.\n4. No evidence of new intracranial hemorrhage." + }, + { + "input": "There is a small acute right cerebral subdural hematoma measuring 9 mm in\nmaximal thickness (02:16). Adjacent to this is a subtle hypodense right\nsubdural collection, series 601b, image 62, measuring 4 mm in maximal\nthickness (601b:63), likely representing a component of chronic subdural\nhematoma. No other focus of hemorrhage is appreciated. Encephalomalacia in\nthe left frontal lobe is a sequela prior intraparenchymal hemorrhage. \nPeriventricular white matter hypodensities are indicative of chronic small\nvessel ischemia. Prominence of the ventricles and sulci suggest age-related\natrophy. There is no fracture. Paranasal sinuses are clear.", + "output": "Small right cerebral subdural hematoma, acute with tiny adjacent chronic\ncomponent. No significant mass effect." + }, + { + "input": "There is no evidence of fracture, infarction,intracranial hemorrhage,edema,or\nmass. The ventricles and sulci are normal in size and configuration. There\nis a questionable area of low attenuation in the left cerebellar hemisphere\n(series 4, image 6), probably related with beam hardening artifact, however\nthere's any clinical concern related with this finding, correlation with MRI\nis advised. There is an unchanged small area of low attenuation in the left\nbasal ganglia consistent with possible lacunar ischemic change versus\nprominent perivascular space (4:13).\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The lenses are absent bilaterally, additionally there\nis persistent deformity of the left eye globe (series 4, image 4), and minimal\nasymmetry in the posterior aspect of the right eye globe (series 4, image 6),\nthe possibility of colobomas is a consideration, please correlate.", + "output": "1. Questionable area of low attenuation in the left cerebellar hemisphere may\nrepresent a hardening being artifact, if there is persistent clinical concern\nrelated with this finding, correlation with MRI is advised.\n\n2. Unchanged lacunar ischemic event versus perivascular space in the left\nbasal ganglia as described above.\n\n3. Deformity of the left eye globe is again identified, and minimal asymmetry\nof the posterior aspect of the right eye globe, the possibility of colobomas\nsince a consideration." + }, + { + "input": "The patient is status post suboccipital craniectomy. Areas of\nencephalomalacia remains unchanged in the superior aspect of the cerebellum. \nA right frontal approach ventriculostomy catheter terminates in the foramen of\n___, there is unchanged encephalomalacia in the right frontal lobe. There\nis no evidence of acute infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are stable in size and configuration compared to prior\nexam in ___.\n\nThere is no evidence of acute fracture. An old burr hole is noted in the left\nfrontal cortex, unchanged. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. Patient status post suboccipital craniectomy with unchanged cerebellar\nencephalomalacia.\n\n2. A right frontal ventriculostomy catheter entering via right frontal burr\nhole remains unchanged, with the tip terminating in the area of the foramen of\n___, there is unchanged area of encephalomalacia on the right frontal lobe.\n\n3. No evidence of acute infarct, hemorrhage, or mass effect. No evidence of\nhydrocephalus." + }, + { + "input": "Right frontal approach ventriculostomy catheter is seen with tip at the\nforamen of ___, unchanged. Hypodensity surrounding the tract of the\ncatheter is unchanged with associated ex vacuo dilatation of the frontal horn\nof the right lateral ventricle. Encephalomalacia is noted within the\ncerebellum involving bilateral hemispheres with secondary enlargement of the\nfourth ventricle, overall stable in configuration. Suboccipital craniectomy\nchanges are again noted.\n\nThere is no acute hemorrhage, mass effect, or evidence of acute infarct. The\nventricles are stable in configuration.\n\nLeft frontal burr hole is unchanged. Mild mucosal thickening noted in the\nethmoids. Remaining paranasal sinuses and mastoids are clear.", + "output": "1. No acute intracranial process, no hemorrhage.\n2. Cerebellar encephalomalacia unchanged from prior.\n3. Right frontal approach ventriculostomy catheter stable in positioning with\nunchanged configuration of the ventricles." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nA right frontal approach intraventricular catheter tip remains in position\nwith tip terminating near the foramen of ___. There is redemonstration of\nencephalomalacia in the right frontal lobe with associated ex vacuo dilatation\nof the frontal horn of the right lateral ventricle. The ventricles are stable\nin size and configuration.\n\nChronic infarct changes are noted in the bilateral cerebellar hemispheres\nmedially unchanged. Postsurgical changes suboccipital craniectomy.\n\nAdditional patchy to confluent low-attenuation changes in the right parietal\nlobe extending to the right lateral ventricle trigone may reflect chronic\ninfarction.\n\nNo evidence of acute intracranial hemorrhage.\n\nMild mucosal thickening of the paranasal sinuses. The mastoid air cells and\nmiddle ear cavities are clear. Unremarkable intraorbital contents.\n\nCTA HEAD:\nThere are mild nonocclusive atherosclerotic calcifications of the cavernous\ninternal carotid arteries.\n\nThe right A1 segment is hypoplastic, a normal anatomic variant. There is\nmoderate luminal narrowing of the right cerebral artery A2 segment (5:262)\nwithout occlusion. Otherwise, the anterior circulation demonstrates normal\nopacification without evidence of occlusion.\n\nThe middle cerebral arteries demonstrate normal opacification without evidence\nof focal stenosis or occlusion.\n\n There are persistent fetal origins of the bilateral posterior cerebral\narteries. The basilar artery is small in caliber, likely congenital variant. \nThere is normal opacification of the bilateral posterior cerebral arteries.\n\nThe right transverse sinus is hypoplastic, a normal anatomic variant. The\ndural venous sinuses are otherwise patent.\n\nCTA NECK:\nThe cervical carotid arteries arteries and their major branches appear normal\nwith no evidence of stenosis or occlusion. There is no evidence of internal\ncarotid stenosis by NASCET criteria.\n\nThe vertebral arteries are codominant and slightly small in caliber, but\ndemonstrate normal opacification without evidence of occlusion.\n\nOTHER:\nNo suspicious pulmonary nodules within limitations of respiratory motion.\n\nThe esophagus is patulous.\n\nThe thyroid lobes are enlarged and contain heterogeneous low-density nodules,\nwhich are difficult to visualize due to artifact.\n\nNo lymphadenopathy by CT size criteria.", + "output": "1. Stable size of the ventricular system in the setting of a right frontal\napproach ventriculostomy catheter, unchanged in position.\n2. Unchanged encephalomalacia in the right frontal lobe. Probable chronic\ninfarct in the right parietal lobe extending to the right lateral ventricle.\n3. Postsurgical changes of suboccipital craniectomy with chronic volume loss\nbilateral medial cerebellar hemispheres.\n4. Moderate luminal narrowing of the right A2 segment without evidence of\nocclusion.\n5. Otherwise, patent circle of ___ with no evidence of focal stenosis or\nocclusion.\n6. Patent neck vasculature with no evidence of internal carotid artery\nstenosis by NASCET criteria." + }, + { + "input": "CT HEAD:\nThere is no evidence for acute hemorrhage, vascular territorial infarction,\nmass effect, or edema. The ventricles and sulci are normal in size and\nappearance. There is preservation of gray-white matter differentiation. The\nbasal cisterns remain patent.\n\nMild mucosal thickening is seen throughout scattered ethmoid air cells\nbilaterally. The remainder of the paranasal sinuses, middle ear cavities, and\nmastoid air cells are clear. The orbits are grossly unremarkable bilaterally.\n\n\nCTA HEAD AND NECK:\nThere is a normal 3 vessel aortic arch. The vertebral basilar system is\nleft-sided dominant, a normal variant. The vertebral arteries are patent\nwithout high-grade stenosis or occlusion. A fenestration is seen within the\nmid basilar artery.\n\nThe bilateral common carotid arteries are patent. Minimal left and moderate\nright partially calcified atherosclerotic plaque is seen at the carotid bulbs.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\n\nMild bilateral calcifications are seen within the cavernous internal carotid\narteries. Allowing for this, the intracranial vasculature is grossly patent\nwithout high-grade stenosis, occlusion, or aneurysm greater than 3 mm. The\ndural venous sinuses are patent.\n\n\nOTHER:\nThe lungs apices are clear bilaterally. Thyroid gland is mildly heterogeneous\nwithout focal suspicious nodule greater than 1 cm. Numerous scattered\nbilateral cervical lymph nodes are seen, none of which are pathologically\nenlarged by CT size criteria. Scattered soft tissue density material within\nthe anterior mediastinum may reflect residual thymic tissue versus mediastinal\nlymphadenopathy.", + "output": "1. No evidence for acute intracranial hemorrhage or vascular territorial\ninfarction.\n2. Patent intracranial and cervical vasculature without high-grade stenosis,\nvessel occlusion, or aneurysm greater than 3 mm.\n3. Additional findings, as above." + }, + { + "input": "Motion artifact mildly limits evaluation. There is no evidence of acute\nhemorrhage, edema, mass effect, or loss of gray/white matter differentiation. \nVentricles, sulci, and basal cisterns are normal in size.\n\nNo evidence for concerning bone lesions. There is minimal mucosal thickening\nin the frontoethmoidal recesses and in the partially imaged maxillary sinuses.\nThere is a small focus of dependent secretions versus small dependent mucous\nretention cyst in the right sphenoid sinus. Mastoid air cells are well\naerated. The visualized portion of the orbits are unremarkable.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. Paranasal sinus disease." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Again demonstrated is right frontal lobe white matter hypodensity\nwith ex vacuo dilatation of the right lateral ventricle compatible with prior\ninfarct. Mild prominence of the ventricles and sulci suggests involutional\nchanges. The imaged paranasal sinuses are clear. Mastoid air cells and\nmiddle ear cavities are well aerated. The bony calvarium is intact. Moderate\natherosclerotic calcifications of the distal right vertebral artery and both\ncavernous carotid arteries are noted.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute intracranial hemorrhage, mass, mass effect or\nshifting of the normally midline structures, the previously detected area of\nmagnetic susceptibility on the right cerebral hemisphere on a prior MRI of the\nhead dated ___ is not identified in the images without contrast and\nit was no seen in the prior CT of the head in ___. The ventricles and sulci\nare normal in size and configuration, the orbits are unremarkable, the\nparanasal sinuses are notable for mucosal thickening the frontal sinus on the\nleft, frontoethmoidal recesses, ethmoidal air cells, sphenoid sinus and right,\napparently patient is status post bilateral antrostomies and uncinectomies,\nthe mastoid air cells and middle ear cavities are clear. The bony structures\ndemonstrate prominent arachnoid granulations in the occipital bone (image 10,\nseries 2), unchanged since the prior CTA on ___.\n\nCTA HEAD:\nThere is evidence of vascular enhancement throughout the circle of ___ with\npatency of the anterior, middle, and posterior cerebral arteries, no flow\nstenotic lesions or aneurysms larger than 3 mm in size are seen. The\nposterior circulation demonstrates patency of the basilar artery with dominant\nright vertebral artery, likely consistent with anatomical vascular variation.", + "output": "1. There is no evidence of acute intracranial hemorrhage or mass effect.\n\n2. The previously detected focus of magnetic susceptibility in the right\ncerebellar hemisphere is not clearly seen in the current exam, and likely is\nconsistent with chronic micro hemorrhagic change only visible by MRI.\n\n3. No flow stenotic lesions or aneurysms are seen throughout the circle of\n___.\n\n4. Anatomical vascular variation consistent with dominance of the right\nvertebral artery.\n\n5. Paranasal sinus disease as described detail above." + }, + { + "input": "There is no evidence of acute large territory infarction,\nintracranialhemorrhage,edema,or discrete mass. There is prominence of the\nventricles and sulci suggestive of involutional changes. Periventricular and\nsubcortical white matter hypodensities are nonspecific but compatible with\nchronic small vessel ischemia. Redemonstration of encephalomalacia involving\nthe bilateral, right greater than left, occipital lobes, as well as the could\nor infarcts in the left pons and right basal ganglia similar to prior.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Redemonstration of chronic changes as above." + }, + { + "input": "No fractures are identified.\n\nThere is extensive dental and periodontal disease including periapical lucency\nabout the right upper molar tooth (series 3:155).\n\nMinimal mucosal thickening of the ethmoidal air cells and bilateral maxillary\nsinuses is noted. Bilateral Haller cells are present.\n\nThe mastoid air cells are clear.\n\nThere is no evidence of facial swelling.\n\nThe globes, extraocular muscles, optic nerves, and retrobulbar fat appear\npreserved.\n\nThe visualized upper aerodigestive tract appears preserved.\n\nThe mandible and temporomandibular joints appear preserved.\n\nThe pterygoid plates and lamina papyracea are intact.\n\nExtensive degenerative change including anterior vertebral body osteophytes\nare partially visualized in the upper cervical spine. Soft tissue densities\nare noted within bilateral external auditory canals which may represent\ncerumen. There is rightward nasal septal deviation with bony spur.", + "output": "1. Extensive dental and periodontal disease as described.\n2. No evidence of maxillofacial fracture.\n3. Minimal paranasal sinus disease as described.\n4. Rightward nasal septal deviation with bony spur.\n5. Limited imaging of cervical spine demonstrates multilevel degenerative\nchanges." + }, + { + "input": "Redemonstration of encephalomalacia of the bilateral occipital lobes, right\ncerebellum and right basal ganglia. There is no evidence of fracture, large\nterritory infarction,hemorrhage,or edema. There is prominence of the\nventricles and sulci suggestive of involutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No evidence of fracture or intracranial hemorrhage.\n2. Redemonstrated regions of encephalomalacia are unchanged." + }, + { + "input": "There is no evidence of acute major infarction,hemorrhage,edema,or large mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Mild mucosal thickening is noted in the\nright sphenoid sinus. The visualized portion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. There is\nfetal type origin of the left PCA with a hypoplastic left P1 segment. The\ndural venous sinuses are patent.\n\nCTA NECK:\nThe carotidandright vertebral arteries and their major branches appear normal\nwith no evidence of stenosis or occlusion. There is no evidence of internal\ncarotid stenosis by NASCET criteria. A linear filling defect is seen the\njunction of the V2 and V3 segments of the left vertebral artery (series 3,\nimage 177), felt more likely to represent artifact rather than a dissection.\n\nOTHER:\nThe visualized portion of the lungs are clear. A 1.1 x 1.1 cm slightly\nhypodense lesion is seen in the left thyroid lobe. An adjacent subcentimeter\nlow-attenuation lesion is also seen. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Linear defect at the junction of the V 2 and V3 segments of the left\nvertebral artery, felt more likely to represent artifact rather than a\ndissection. If a dissection is suspected, an MRA of the neck with and without\ncontrast with an axial T1 fat-sat sequence may be of benefit.\n2. No acute intracranial process.\n3. Normal CTA of the head.\n4. Low-attenuation thyroid nodules measuring less than 1.5 cm.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Age related involutional changes are noted. There is complete\nopacification of the partially imaged left maxillary sinus which contains\nhypodense fluid likely representing chronic sinus disease. Aerosolized\nsecretions also noted within the right sphenoid sinus which may represent\nacute sinus disease. Mastoid air cells and middle ear cavities are well\naerated. The bony calvarium is intact.", + "output": "No acute intracranial process. Sinus disease as stated." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are enlarged suggesting age related atrophy.\nPeriventricular white matter hypodensities are likely sequela of chronic small\nvessel disease. The basal cisterns are patent there is preservation of\ngray-white matter differentiation.\n\nNo osseous abnormalities seen. Near complete opacification of the left\nmaxillary sinus with sclerosis of the overlying bone, compatible with chronic\nsinusitis. The remainder of the paranasal sinuses are clear.", + "output": "No acute intracranial abnormality. Sinus disease, as detailed above." + }, + { + "input": "HEAD CT: A hyperdense extra-axial collection along the left anterior temporal\nlobe now measures 2.8 x 1.5 cm (previously 2.6 x 1.3 cm), which is minimally\nincreased in size with similar extent of surrounding edema compared to ___. A small hyperdense left subdural hematoma along the posterior left\ncerebral convexity is not significantly changed. A small predominantly\nhypodense right subdural collection with several hyperdense foci of also a\nrelatively stable compared to the most recent prior CT. Subarachnoid blood\nproducts in the bilateral temporoparietal sulci are overall unchanged in\nextent. No new focus of hemorrhage is detected. There is no shift of normally\nmidline structures. The ventricles are unchanged in size and configuration\nwithout evidence of hydrocephalus. The basal cisterns remain patent. The\ngray-white matter interface is preserved without evidence of acute major\nvascular territorial infarct. There is mild mucosal thickening in the ethmoid\nair cells and bilateral frontoethmoid recesses. The remainder of the imaged\nparanasal sinuses, middle ear cavities and mastoid air cells are clear\nbilaterally. The bony calvaria appear intact.", + "output": "1. Minimal increase in size of hyperdense extra-axial collection along the\nanterolateral left temporal lobe with similar extent of surrounding edema.\n2. Unchanged extent of small bilateral subdural hematomas and bilateral\nsubarachnoid blood products." + }, + { + "input": "There is no evidence of fracture, large territory\ninfarction,hemorrhage,edema,or mass effect. The ventricles and sulci are\nnormal in size and configuration.\n\nMucosal thickening is seen within the bilateral maxillary sinuses. Otherwise,\nthe remainder of the visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are normal. Further description of a fluid collection posterior to the\nupper cervical spinal be reported in the concurrently performed CT C-spine.", + "output": "No acute intracranial process." + }, + { + "input": "There is similar extent of bifrontal lobe edema and patchy left frontal\nhyperdensity is similar to prior CT. This corresponds with the edema and\nenhancement on the MR from ___. There is stable 3 mm rightward shift\nof midline structures. There has not been interval hemorrhage or acute major\nvascular territorial infarction. The ventricles and sulci are stable in size\nand configuration. The basilar cisterns are patent.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No acute intracranial pathology.\n2. Similar bifrontal lobe edema and left frontal hyperdensity corresponding to\nthe edema and enhancement seen on prior MR and concerning for underlying\nmass/neoplastic process." + }, + { + "input": "The patient is status left frontal lobe open biopsy. Expected postsurgical\nchanges and pneumocephalus are identified. There is no evidence of hemorrhage\nor infarction. There is no midline shift the ventricles and sulci are\nunchanged in size or configuration.", + "output": "1. Postsurgical changes and pneumocephalus seen status post left frontal lobe\nopen biopsy." + }, + { + "input": "The patient is status post left frontal craniotomy. Expected postsurgical\nchanges and pneumocephalus are again identified, with interval decrease in the\namount of pneumocephalus seen. Minimal rightward midline shift is unchanged\nfrom prior exam. There is no evidence of infarction or new hemorrhage. The\nventricles and sulci are unchanged in size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "Expected evolution of postsurgical changes status post left frontal\ncraniotomy." + }, + { + "input": "Patient is status post left frontal craniotomy for resection of a astrocytoma.\nExpected postsurgical changes with pneumocephalus, fluid within the left\nfrontal resection cavity, and minimal blood products along the resection\ncavity are noted. There is 3 mm rightward shift of normally midline\nstructures, which is similar in appearance to recent MRI examination of ___. Small hypodensity measuring 3 mm in maximal width to the\ninner table along the right frontal convexity is most consistent with small\nhygroma. No additional hemorrhage. The basal cisterns are patent.\n\nMinimal effacement of the frontal horn of the left lateral ventricle secondary\nto minimal mass effect from pneumocephalus. Otherwise, the ventricles and\nsulci are normal in size and configuration. There is no territorial acute\ninfarct.\n\nAllowing for postsurgical changes, there is no evidence of fracture. The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable. \nExpected postoperative subcutaneous emphysema overlying the frontal calvaria\nand skin closure staples are noted.", + "output": "1. Status post left frontal craniotomy for resection of astrocytoma with\nexpected postsurgical changes including pneumocephalus, fluid within resection\ncavity, small hygroma, minimal blood products layering in resection cavity,\nand 3 mm rightward shift of normally midline structures." + }, + { + "input": "There is asymmetric enlargement of the right palate teen tonsil with a small\nhypodense collection noted on series 2, image 27 deep to the right tonsillar\ntissue measuring approximately 1.3 x 1.5 cm likely a developing abscess/\nphlegmon. There is no discrete peripheral rim to suggest a well-formed\nabscess. There is also asymmetric thickening of the right air in G all wall\nextending inferiorly through the level of the epiglottis compatible with\npharyngitis. There is mild airway compromise at the level of the uvula. \nSalivary glands appear normal. No signs of dental infection. Mild mucosal\nthickening is noted within the right maxillary sinus. The imaged vessels\nappear patent. No lymphadenopathy. The thyroid gland is normal. Upper lungs\nappear well aerated. The mediastinum and mediastinal vessels appear normal. \nThe superior mediastinum", + "output": "Enlargement of the right palate tonsil with small developing peritonsillar\nabscess with thickening of the right pharyngeal mucosa compatible with\npharyngitis." + }, + { + "input": "The left cerebellar infarct is re-demonstrated. No evidence of hemorrhagic\ntransformation. No new vascular territorial infarctions are identified. The\nassociated cytotoxic edema appears slightly more conspicuous compared to the\ninitial CTA on ___, but is grossly unchanged from the recent MRI on\n___. There is stable mass effect and effacement of the fourth ventricle. \nNo shift of midline structures. Basal cisterns are patent. The third and\nlateral ventricles are normal in size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "Overall stable left cerebellar infarction without evidence of hemorrhagic\ntransformation. Stable mass effect on the fourth ventricle compared to MRI\n___." + }, + { + "input": "Head CT: Hypodensity within the left cerebellum is consistent with patient's\nknown infarction, and appears to have progressed compared to the CT performed\nat 08:23 the same day. There is no evidence of acute intracranial hemorrhage,\nor mass. The ventricles and sulci are normal in size and configuration. The\nbasilar cisterns are patent.\n\nHead CTA: There is patulous flow within the left vertebral artery throughout\nthe V4 segment. The left posterior inferior cerebellar artery is not well\nseen, however there appears to be a small amount of flow within the left\nanterior inferior cerebellar artery (5;240). Although difficult to discern on\nthe source images, flow within the left superior cerebellar artery can be seen\non the reconstructed images. The anterior circulation appears to be well\npreserved. The right A1 segment is dominant and the left A1 segment is\nhypoplastic. Bilateral posterior communicating arteries are patent.\n\nNeck CTA: There is complete occlusion of the left vertebral artery from the\norigin, to the level of C2/C3, at which point the vessel appears to\nreconstitute. The remainder of the left vertebral artery demonstrates\nextremely patulous flow, particularly along its intracranial course. There is\nno evidence of significant carotid artery stenosis per NASCET criteria.\n\nThe thyroid is heterogeneous. The visualized apices of lungs are clear. \nThere is no cervical lymphadenopathy. There is mild mucosal thickening\ninvolving the right maxillary sinus. The sphenoid sinus, ethmoid air cells\nand frontal sinuses are clear. The globes are unremarkable.", + "output": "1. Hypodensity within the left cerebellum is consistent with patient's known\ninfarction, however appears to have progressed compared to the CT performed at\n08:23 the same day.\n2. No evidence of acute intracranial hemorrhage.\n3. Complete occlusion of the left vertebral artery from the origin, to the\nlevel of C2/C3, at which point there is reconstitution of the vessel,\npresumably via retrograde flow. The left V4 segment demonstrates patulous\nblood flow. Recommend clinical correlation.\n4. Absence of flow is seen within the left posterior inferior cerebellar\nartery. There is attenuation of flow within the left anterior inferior\ncerebellar artery. Flow within the left superior cerebellar artery is seen on\nthe reconstructed images.\n5. Heterogeneous thyroid gland as described. Recommend clinical correlation. \nIf clinically indicated, consider thyroid ultrasound for further evaluation.\n\nRECOMMENDATION(S):\n1. Complete occlusion of the left vertebral artery from the origin, to the\nlevel of C2/C3, at which point there is reconstitution of the vessel,\npresumably via retrograde flow. Recommend clinical correlation.\n2. Heterogeneous thyroid gland as described. Recommend clinical correlation. \nIf clinically indicated, consider thyroid ultrasound for further evaluation." + }, + { + "input": "Apparent 15 mm hypodensity in the right parietal region may simply reflect a\nprominent extra-axial CSF space or possibly a arachnoid cyst, unchanged from\nprior MRI from ___.\n\nElsewhere is no evidence of acute large vascular territory infarct,\nhemorrhage, edema, additional mass, or mass effect.\n\nThe ventricles and sulci are prominent, compatible with global parenchymal\nvolume loss.\n\nBilateral ill-defined periventricular and deep white matter hypodense foci are\nnon-specific, but compatible with mild-to-moderate changes of chronic white\nmatter microangiopathy.\n\nNo displaced calvarial fracture.\n\nThere is opacification of the right frontal sinus, the right frontal ethmoid\nair cells, and the right maxillary sinus. Within the right maxillary sinus\nopacification there are areas high density suggested (see 4:7). The mastoids\nand middle ear cavities are clear.\n\nThe globes and orbits are preserved. Carotid siphon calcifications are noted\nbilaterally.", + "output": "1. No acute intracranial abnormality.\n2. Paranasal sinus disease with findings concerning for chronic and/or fungal\nsinusitis, or polyposis, as described.\n3. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described.\n4. If continued concern for Alzheimer's disease, consider FDG brain PET for\nfurther evaluation." + }, + { + "input": "There is opacification of the right maxillary sinus with obliteration of the\ndrainage pathway. Soft tissue changes and opacification also seen in the\nright anterior ethmoid air cells and frontal sinus. This findings seem to be\nunchanged compared to the prior CT. The right maxillary sinus contents\ndemonstrate high density indicative of inspissated secretions versus fungal\ncolonization. The maxillary teeth are absent and there is no lucencies within\nthe interval a margins of the maxilla. There is no septal spur identified. \nThe visualized nasopharynx orbits are unremarkable. Visualized brain again\ndemonstrates small vessel disease and brain atrophy.", + "output": "1. Findings suggestive of sinusitis involving the right maxillary anterior\nethmoid and frontal sinuses. Obliteration of drainage pathways of the right\nmaxillary and frontal sinuses. Overall no change since the previous CT head.\n2. The remaining sinuses are clear with minimal mucosal thickening." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are normal in size and configuration.\n\n0.6 cm peripherally calcified lesion within the left frontal scalp is most\nconsistent with a calcified subaceous cyst or epidermoid. There is no\nevidence of fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable. Calcification of bilateral internal carotid\narteries are noted.", + "output": "1. No acute intracranial process. Specifically no intracranial hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial process." + }, + { + "input": "Surgical changes related to prior airway reconstruction involving the hyoid\nbone, cricoid cartilage, arytenoid cartilage and the tracheal cartilage are\nunchanged. A tracheostomy tube is in place, terminating approximately 4.4 cm\nabove the carina, unchanged. There is unchanged subglottic stenosis with\nincreased soft tissue seen in the region of the true vocal cords and\narytenoids. The superior hypopharynx, oropharynx, nasopharynx are normal and\nwidely patent. No abnormal fluid collection is identified on noncontrast CT. \nRetropharyngeal fat is normal without fluid collection. The esophagus is\nmostly collapsed and not evaluated on this study.\n\nThe visualized paranasal sinuses are clear. There is leftward deviation of the\nnasal septum. There are bilateral prominent cervical and supraclavicular lymph\nnodes, unchanged compared to ___. The palatine tonsils and the\nadenoids are also prominent, unchanged. The visualized salivary glands are\nunremarkable in appearance. The thyroid gland is prominent without CT\nevidence for focal lesions, unchanged.\n\nVisualized upper lungs are clear.\n\nNo suspicious bone lesions are seen.", + "output": "1. No significant interval change in the appearance of subglottic airway\nstenosis. No evidence for a fluid collection. Please note that the esophagus\nis not adequately evaluated on this study.\n2. Stable prominent cervical lymph nodes and lymphoid tissues of the\nWaldeyer's ring compared to ___." + }, + { + "input": "A tracheostomy is present at the level of the thyroid gland. The laryngeal\ncartilage is deformed at this level. Mild edema in the larynx superior to the\ntracheostomy is present without discrete drainable fluid collection (2:52,\n601b:33).\n\nEvaluation of the posterior oropharynx is mildly limited by dental artifact. \nNo abnormalities are appreciated.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. There is no lymphadenopathy by CT criteria. The neck vessels are\npatent.\n\nA subcentimeter right thyroid nodule is present, unchanged. Unless there is\nadditional clinical concern, based on ACR guidelines further evaluation is not\nrecommended given the patient's age (less than ___ years old) and nodule size\n(less than 1.0 cm).\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions. Incidentally noted is a left\nport-a-cath, partially visualized.", + "output": "Tracheostomy is present at the level of the thyroid gland. Mild edema in the\nlarynx superior to the tracheostomy is present without discrete drainable\nfluid collection." + }, + { + "input": "Tracheostomy at the level of the thyroid is unchanged from prior examination. \nRe-identified is deformity of the laryngeal and thyroid cartilage, superior\nthe tracheostomy with stenosis of the airway at this level, unchanged from\nprior exam.\n\nThere is mild edema and thickening of the larynx above the tracheostomy,\nsimilar in appearance to prior examination of ___ without evidence\nof increased enhancement or fluid collection. There is no cervical\nlymphadenopathy by size criteria. Re-identified is a sub cm thyroid nodule in\nthe left lobe, unchanged from prior exam for which no further follow-up is\nrecommended by current ACR guidelines for incidentally noted thyroid nodules.\n\nThe major salivary glands are unremarkable. The cervical vessels are patent. \nThe visualized lung apices are clear. There is a left Port-A-Cath unchanged\nin position from prior exam.\n\nNo suspicious osseous lesions.", + "output": "1. Tracheostomy at the level of the thyroid is unchanged from prior exam.\n2. Unchanged deformity of the laryngeal and thyroid cartilage superior the\ntracheostomy with stenosis of the airway.\n3. Mild edema and thickening of the larynx abut the tracheostomy is similar in\nappearance to prior examination without evidence of increased enhancement or\nfluid collection." + }, + { + "input": "The tracheostomy at the level of the thyroid is unchanged from the prior\nexamination. Deformity of the laryngeal and thyroid cartilage with stenosis\nof the airway just superior to the level of the tracheostomy, is unchanged. \nEvaluation of the aerodigestive tract demonstrates no mass.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal, except for an unchanged sub cm\nleft thyroid nodule. There is no lymphadenopathy by CT criteria. The neck\nvessels are patent. No fluid collection is present.\n\nThe imaged portion of the lung apices are clear. There are no osseous lesions.\nThe left Port-A-Cath is unchanged in position.", + "output": "1. Unchanged appearance of the tracheostomy at the level of the thyroid with\nstenosis of airway just superior to this level. These findings are unchanged\nsince ___.\n\n2. No evidence of abscess." + }, + { + "input": "Again noted is a tracheostomy, with the tube terminating in the upper thoracic\ntrachea, unchanged in position. There is again deformity of the laryngeal and\ntracheal cartilage, with stenosis just superior to the level of the\ntracheostomy, similar in appearance compared to ___. Asymmetric\nincreased prominence of the right false vocal cord is also similar in\nappearance compared to ___. Oropharyngeal airway remains collapsed,\nlikely secondary to the tracheostomy. There is no evidence for a mass,\ninflammatory change, or organized fluid collection in the neck.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. A left parotid 12 mm oval nodule, probably a lymph node, on image\n3:29 is stable dating back to the earliest available comparison exam from ___. The thyroid gland again demonstrates a subcentimeter\nhypodensity in the upper pole of the left lobe. Cervical lymph nodes are\nprominent, but not pathologically enlarged by CT size criteria. The neck\nvessels are patent.\n\nVisualized upper lungs appear clear. No concerning bone lesion is seen.\n\nThere is mucosal thickening opacifying a single right anterior ethmoid air\ncell. Other paranasal sinuses and mastoid air cells are well aerated. This\nexam is not technically optimized for evaluation of the included brain\nparenchyma, but no concerning abnormality is seen on limited evaluation.", + "output": "1. No evidence for new inflammatory change or fluid collection to explain the\npatient's symptoms.\n2. Unchanged appearance of the tracheostomy. Unchanged deformity of the\nlaryngeal and tracheal cartilage resulting in stenosis of the airway just\nsuperior to the level of the tracheostomy.\n3. Unchanged prominence of the right false vocal cord compared ___." + }, + { + "input": "Patient is status post tracheostomy with chronic subglottic stenosis, not\nsignificantly changed compared to prior. No evidence for soft tissue\ninfection or surrounding abscess.\n\nThere is a 12 mm left parotid oval nodule, stable since ___, likely\nrepresenting a lymph node. Mildly prominent right parotid lymph nodes are\nseen. Otherwise, the salivary glands enhance normally and are without mass or\nadjacent fat stranding.Multiple hypodense thyroid nodules are small and do not\nrequire follow-up imaging.There is no lymphadenopathy by CT criteria. The neck\nvessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.", + "output": "Similar chronic subglottic stenosis status post tracheostomy. No evidence for\nsoft tissue infection or surrounding abscess." + }, + { + "input": "There is no evidence of infarction or hemorrhage. The sulci and ventricles\noverall are prominent, however, the ventricles are enlarged out of proportion\nto the sulci which could suggest normal pressure hydrocephalus. There is no\nevidence of CSF outflow obstruction. Additionally, there is a region of\nsubcortical white matter hypodensity centered in the right frontoparietal\nregion with adjacent sulcal effacement. There is no obvious cause for this\nwithin the limits of an unenhanced exam. However, this raises concern for\nunderlying vasogenic edema.\n\nNo osseous abnormalities seen. There is mild thickening of the maxillary,\nethmoid, frontal and sphenoid sinuses bilaterally. Otherwise, the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The patient is\nstatus post bilateral lens replacement. Otherwise, the orbits are\nunremarkable.", + "output": "1. No intracranial hemorrhage.\n2. Ventricular enlargement out of proportion to the sulci could suggest\nnormal pressure hydrocephalus. No evidence of CSF outflow obstruction.\n3. A region of subcortical white matter hypodensity in the right\nfrontoparietal region with adjacent sulcal effacement raises concern for\nunderlying vasogenic edema. As there is no obvious cause within the limits of\nan unenhanced scan, recommend correlation with prior imaging or MR for further\nevaluation.\n4. Paranasal sinus disease, as described above.\n\nRECOMMENDATION(S): Recommend correlation with prior imaging or MR for further\nevaluation of subcortical white matter hypodensity with adjacent sulcal\neffacement in the right parietal lobe." + }, + { + "input": "CT HEAD:\nThere is no evidence for acute intracranial hemorrhage. Subcortical white\nmatter hypodensity which may represent vasogenic edema within the right\nfrontoparietal region near the vertex and extending to the posterior right\nperiventricular white matter appears similar to the previous examination,\nallowing for differences in patient positioning.\n\nThere is mild associated mass effect with effacement of the sulci at this\nlevel (for example, 02:26). The ventricle, however, is slightly expanded at\nthis level. No midline shift or evidence of impending downward herniation. \nFindings may reflect an underlying mass with associated edema, with infarction\nfelt less likely.\n\nOtherwise, no additional candidate sites for vascular territorial infarction. \nThe ventricles and sulci are enlarged, with ventricular enlargement that is\nout of proportion with sulcal enlargement. This is similar to the previous\nexamination without convincing evidence for transependymal flow of CSF or\nfocal obstruction.\n\nMild mucosal thickening and mucous retention cysts are seen in the right\nmaxillary sinus. There is partial opacification and mucosal thickening\naffecting numerous bilateral ethmoid air cells and the right frontal sinus,\nwith stenosis of the right frontoethmoidal recess. Minimal mucosal thickening\nis also seen in the right sphenoid sinus. The remainder of the paranasal\nsinuses, middle ear cavities, and mastoid air cells are clear. The patient is\nstatus post bilateral lens resections..\n\n\nCTA HEAD AND NECK:\nThere is a normal 3 vessel aortic arch with mild calcifications at the origin\nof the great vessels. Mild-to-moderate calcifications are seen at the origin\nof the left V1 segment. Mild calcifications are also seen in the bilateral V4\nsegments. The vertebral arteries are patent without high-grade stenosis or\nocclusion.\n\nThe bilateral common carotid arteries are patent. Minimal left and moderate\nright partially calcified atherosclerotic plaque is seen at the carotid bulbs.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\n\nModerate calcifications are seen in the bilateral internal carotid arteries. \nMild narrowing is seen within the proximal right P1 segment (601:29). \nAllowing for this, the intracranial vasculature is grossly patent without\nhigh-grade stenosis, occlusion, or aneurysm greater than 3 mm.\n\n\nOTHER:\nThe lungs apices are clear bilaterally. The thyroid is unremarkable in\nappearance. There are multiple prominent bilateral cervical lymph nodes\nidentified, none of which are pathologically enlarged by CT size criteria.", + "output": "1. No evidence for acute intracranial hemorrhage, and no definite evidence for\nvascular territorial infarction.\n2. Persistent, confluent hypodensity predominantly within the right posterior\nperiventricular white matter extending into the parietal lobe surface with\neffacement of the adjacent sulci. Findings likely represent vasogenic edema,\nwith concern for underlying mass. Ischemia is felt less likely. Recommend\ncontrast enhanced MRI for further evaluation.\n3. Unchanged, disproportionate ventricular enlargement relative to global\nparenchymal volume loss. In the correct clinical setting, these findings may\ncorrelate with normal pressure hydrocephalus. No evidence for ventricular\nobstruction at this time.\n4. Multifocal atherosclerotic disease within the intracranial and cervical\nvasculature, as detailed above, without high-grade stenosis, occlusion, or\naneurysm greater than 3 mm." + }, + { + "input": "There is no evidence of acute major vascular territory infarction, edema or\nmass effect. No abnormally enhancing mass lesions are identified. Evaluation\nfor subtle intracranial hemorrhage is limited by the administration of\nintravenous contrast although none is noted. Ventricles and sulci are normal\nin size and configuration. Basal cisterns are patent.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is asymmetrical enlargement of the left parotid gland inferiorly which\nis best appreciated on the coronal images (601b:36). There is also extensive\nsurrounding fat stranding which appears to extend from the inferior margin of\nthe left parotid gland inferiorly to the level of the thyroid cartilage\n(601b:35). No drainable fluid collection is identified. Several enlarged\ncervical lymph nodes are seen on the left, measuring up to 1.8 cm at level IIb\n(2:54). There is also a 1.5 cm level IV lymph node on the left (2:81). Major\nvessels are patent. Specifically, there is no evidence of jugular vein\nthrombosis as clinically queried.\n\nEvaluation of the aerodigestive tract demonstrates no exophytic mass, nor\nareas of focal mass effect. No thyroid mass is seen. Upper lung fields are\nclear. No bony abnormality is seen.", + "output": "1. Asymmetrical enlargement of the left parotid gland inferiorly with\nsurrounding fat stranding extending inferiorly to the level of the thyroid\ncartilage. Along with left cervical lymphadenopathy, this may represent acute\nparotiditis in the setting of known Sjogren's syndrome. However, given the\ndegree of adjacent fat stranding, primary cellulitis with secondary\ninvolvement of the parotid gland cannot be excluded. No drainable fluid\ncollection identified.\n3. Patent internal jugular veins bilaterally." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. There\nis prominence of the ventricles and sulci suggestive of involutional changes. \nPeriventricular and subcortical white matter hypodensities consistent with\nsmall vessel ischemic changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No evidence of acute intracranial abnormality." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Prominence of the ventricles and sulci suggest involutional\nchanges. There is complete opacification of the right maxillary sinus and\npartial opacification of the left maxillary sinus with hyperdense material. \nThere is trace mucosal thickening of bilateral sphenoid sinuses bilateral and\nbilateral ethmoid air cells. The frontal sinuses are clear. There is partial\nopacification of the right mastoid air cells. The left mastoid air cells and\nmiddle ear cavities are well aerated.\nThe bony calvarium is intact.", + "output": "1. No acute intracranial process.\n2. Paranasal sinus disease with hyperdense mucosal thickening may represent\nfungal sinusitis." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territory infarct. Mild periventricular white\nmatter hypodensity is nonspecific, but may be sequela of chronic small vessel\ndisease; correlate with concern for a demyelinating process given patient age.\nThere is no hydrocephalus. The visualized paranasal sinuses are clear. The\nmastoid air cells are clear. No acute fracture is seen.", + "output": "No acute intracranial hemorrhage.\n\nMild periventricular white-matter hypodensities are nonspecific, but possibly\nsequela of chronic small vessel disease; correlate with concern for\ndemyelinating process given patient age." + }, + { + "input": "No evidence for acute intracranial hemorrhage or edema. Small size of the\nventricles and sulci is within normal limits for the patient's age,\nparticularly since the basal cisterns are preserved. Cerebellar tonsils are\nnormally positioned.\n\nThere is a large left frontal subgaleal hematoma extending to the medial\ncanthus and over the left nasal bridge. No evidence for a fracture or\nintraorbital hematoma.\n\nThere is hypodense fluid layering in the right sphenoid sinus. There are mild\naerosolized secretions in the left sphenoid sinus. There is polypoid mucosal\nthickening plus/minus mucous retention cyst in the bilateral posterior ethmoid\nair cells. There is a mild-to-moderate mucosal thickening plus/minus trace\nfluid in the bilateral anterior ethmoid air cells. There is mild mucosal\nthickening within the partially imaged bilateral maxillary sinuses, and a\npartially imaged mucous retention cyst in the left maxillary sinus. Mastoid\nair cells appear well aerated.", + "output": "1. Large left frontal subgaleal hematoma extending to the medial canthus and\nover the left nasal bridge. No evidence for a fracture or intraorbital\nhematoma.\n2. No evidence for acute intracranial abnormalities.\n3. Paranasal sinus disease, including fluid in the right sphenoid sinus,\naerosolized secretions in the left sphenoid sinus, and possible additional\nfluid in the anterior ethmoid air cells. Please correlate with any associated\nactive inflammatory symptoms." + }, + { + "input": "There is a large left frontal subgaleal hematoma extending to the medial\ncanthus and over the left nasal bridge. No evidence for a fracture or\nintraorbital hematoma. The orbits overall unremarkable on noncontrast CT.\n\nThere is fluid layering in the right sphenoid sinus. There are mild\naerosolized secretions in the left sphenoid sinus. There is polypoid mucosal\nthickening plus/minus mucous retention cysts in the bilateral posterior\nethmoid air cells. There is mild-to-moderate mucosal thickening, plus/minus\ntrace fluid, in the bilateral anterior ethmoid air cells. There is mild\nmucosal thickening in the maxillary sinuses with a small mucous retention cyst\non the left. Right ostiomeatal unit is occluded by mucosal thickening. Left\nostiomeatal unit is narrowed by mucosal thickening but patent. There is\nrightward nasal septal deviation.\n\nMastoid air cells and middle ear cavities are well aerated.\n\nLeft palatine tonsillith is consistent with sequela of prior infection. There\nis motion at the level of the epiglottis and glottis.\n\nThis exam is not technically optimized for evaluation of the included upper\ncervical spine. As visualized, no fracture or subluxation is seen.\n\nConcurrent head CT is reported separately.", + "output": "1. Large left frontal subgaleal hematoma extending to the medial canthus in\nover the left nasal bridge. No evidence for a fracture or intraorbital\nhematoma.\n2. Paranasal sinus disease, including fluid in the right sphenoid sinus and\naerosolized secretions in the left sphenoid sinus. Please correlate\nclinically regarding any associated active inflammatory symptoms." + }, + { + "input": "The patient is status post trans-sphenoidal resection of the previously\ndemonstrated sellar/suprasellar mass. There is hyperdense blood and fluid in\nthe sella and suprasellar cistern, as well as air in the sella. On the\npresurgical imaging, the mass had a left-sided component extending superiorly,\nanterior to the thalamus, and indenting the inferior surface of the left\nlateral ventricle. Presently, there is fluid in this location. The ventricles\nappear stable in size and configuration without hydrocephalus ; the frontal\nhorn of the left lateral ventricle and the anterior left aspect of the third\nventricle remain distorted. Other than the suprasellar cistern, the basal\ncisterns are normal in appearance. There is no hemorrhage in the brain\nparenchyma. There is no evidence for parenchymal edema or loss of gray/ white\nmatter differentiation.\n\nThere is fat packing in the sphenoid sinus with surrounding soft tissue\ndensity which may represent postsurgical change or mucosal thickening. There\nis mild mucosal thickening in bilateral maxillary sinuses with a minimal\namount of fluid in the right maxillary sinus. There is a fluid level in the\nright frontal sinus. There is mild to moderate mucosal thickening in anterior\nethmoid air cells with possible superimposed fluid. Mastoid air cells are well\naerated.", + "output": "1. S/p sellar/suprasellar mass resection with blood products and fluid in the\nsella and suprasellar cistern, as well as fluid anterior to the left thalamus,\nat the site of the left superior component of the resected mass.\n2. Stable distortion of the frontal horn of the left lateral ventricle and\nanterior left aspect of the third ventricle. No hydrocephalus. Small amount\nof blood in the lateral ventricles.\n3. No evidence for hemorrhage or edema in the brain parenchyma." + }, + { + "input": "Expected postoperative changes are noted within the right frontal lobe and\nfrontal scalp soft tissues status post resection of right frontal mass,\nincluding subcutaneous emphysema, pneumocephalus and skin staples. Small\namount of hyperdense blood and hypoattenuating fluid are noted within the\nresection bed. Extensive right frontoparietal hypodense edema is grossly\nsimilar in distribution when compared to the ___ head MRI. There\nare no new areas of intraparenchymal hemorrhage outside of resection bed. 5\nmm leftward midline shift has minimally progressed, previously measuring 3.6\nmm. No new acute large territory ischemic infarct.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Status post resection of right frontal lobe mass, small amount of\nhyperdense blood and fluid is noted within the resection bed.\n2. Extensive right frontoparietal hypodense edema has not significantly\nchanged since ___ head MRI." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. There is encephalomalacia of the inferior right frontal lobe\n(2:16) likely representing sequela of prior traumatic injury. There is a mild\nsoft tissue prominence in the right frontal region (2:25, 602:18), and mild\nsoft tissue swelling overlying the left frontal area. There is mild\nprominence of the ventricle and sulci compatible with mild involutional\nchanges. Periventricular and subcortical white matter hypoattenuation is\nnonspecific but can be seen in chronic small vessel ischemic disease.\n\nThere is partial opacification of the bilateral ethmoid air cells and mucous\nretention cysts in both maxillary sinuses. There is complete opacification of\nthe right frontal sinus. There is a mildly displaced left nasal bone fracture\n(3:16) without associated soft tissue swelling.", + "output": "1. No acute intracranial abnormality.\n2. Mild bifrontal soft tissue swelling.\n3. Mildly displaced left nasal bone fracture, without associated soft tissue\nswelling, is likely nonacute.\n4. Right frontal encephalomalacia is likely sequela of prior traumatic injury." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass effect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular, subcortical, and deep white matter\nhypodensities are likely sequelae of chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. Minimal opacification of the left mastoid\nair cells are noted. Moderate mucosal thickening of the sphenoid sinus and\nethmoid air cells with mild maxillary sinus mucosal thickening is present. \nThe additional visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. Soft tissue within bilateral external\nauditory canals is most consistent with cerumen. The visualized portion of\nthe orbits are unremarkable. Calcification of the cavernous portions of\ninternal carotid arteries are noted. The patient is intubated with\nopacification of the posterior nasal cavity and nasopharynx.", + "output": "1. No acute intracranial abnormality on noncontrast head CT.\n2. Specifically no intracranial hemorrhage. Chronic changes as described\nabove.\n3. Large amount of nasopharyngeal secretions, presumed sequela of intubation." + }, + { + "input": "CT head: There is extensive periventricular and deep white matter hypodensity\nwhich is nonspecific but likely represent sequela of chronic advanced\nmicroangiopathy. Otherwise the gray-white matter differentiation is intact\nwithout acute territorial infarct, hemorrhage, mass, or mass effect. There is\nprominence of the ventricles and cortical sulci consistent volume loss. The\nextra-axial spaces are unremarkable. There is calcification of the bilateral\ncarotid siphons. The bilateral lenses are absent, otherwise the orbits are\nunremarkable. Lumen the calvarium and soft tissues are unremarkable. There\nis mild mucosal thickening within the paranasal sinuses. There is a small\namount of fluid layering within the sphenoid and left maxillary sinuses. \nThere is fluid and aerosolized secretions within the nasal and oral pharynx. \nThere is a left mastoid air cell effusion. There are endotracheal and enteric\ntubes in place. The right frontal sinus is hypoplastic with and bony\nenostosis in the right calvarium.\n\nCTA head: There is calcifications bilateral carotid siphons which are patent\nwithout significant stenosis. The anterior and bilateral posterior\ncommunicating arteries are visualized. There is mild right dominance of the\nvertebral arteries. The anterior and posterior circulations are patent\nwithout occlusion, dissection, significant stenosis, aneurysm, or vascular\nmalformation. The dural venous sinuses are patent.\n\nCTA neck: There is a 3 vessel aortic arch. There is calcific atherosclerosis\nof the aortic arch origins of great vessels without significant stenosis. \nThere is calcific atherosclerosis of the bilateral carotid arteries without\nstenosis by NASCET criteria. The vertebral arteries are patent with mild\nright dominance. There is no occlusion, dissection, significant stenosis, or\naneurysm.\n\nThere are dental caries involving right mandibular molar first premolar teeth\n(603:21). Multilevel degenerative changes of the cervical spine without\nfracture or osseous lesion. The thyroid and salivary glands are unremarkable.\nThere is no lymphadenopathy CT criteria. The masticator, parapharyngeal, and\ncarotid spaces are unremarkable. There is a 1.8 cm TV x 1.3 cm AP posterior\nmidline lower cervical subcutaneous oval cystic lesion, likely representing a\nsebaceous cyst (05:109). There is a small amount of airspace disease at the\ndependent portions of the bilateral upper lobes. There is paraseptal\nemphysema and apical pulmonary parenchymal scarring.", + "output": "1. No acute intracranial abnormality without territorial infarct, hemorrhage,\nor mass effect on noncontrast head CT. MRI would be more sensitive for subtle\ninfarcts, particularly of the posterior fossa. Hypodensity of the left\nfrontal lobe described in resident wet read is felt to be secondary to volume\naveraging through a sulcus.\n2. Patent intracranial neck vasculature without occlusion, dissection,\nsignificant stenosis, or aneurysm.\n3. Right mandibular dental caries, as described. Recommend follow-up with\ndentistry.\n4. Posterior midline subcutaneous cystic lesion at neck likely representing a\nsebaceous cyst.\n5. Small amount of dependent airspace disease at the bilateral upper lobes\nwhich may represent atelectasis, aspiration, and/or underlying pneumonia.\n\nRECOMMENDATION(S): Right mandibular dental caries, as described. Recommend\nfollow-up with dentistry." + }, + { + "input": "There is no evidence of acute large territory infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular white matter hypodensities are\nnonspecific but likely chronic sequela of small-vessel ischemic disease.\n\nThere is mild bilateral hyperostosis frontalis interna. There is no evidence\nof fracture. The visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Nonspecific white matter changes, likely chronic sequela of small-vessel\nischemic disease.\n3. Mild global involutional changes within normal limits for patient's age." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute vascular territorial infarct. Periventricular and subcortical white\nmatter hypodensities are likely sequela of chronic small vessel disease and\noverall are similar compared to prior. Gray-white matter differentiation is\npreserved. Ventricles and sulci are prominent compatible with global volume\nloss, not out of proportion to patient's age. Dense atherosclerotic\ncalcifications noted within the intracranial ICAs bilaterally.\n\nMucous retention cyst seen within the right maxillary sinus. Other paranasal\nsinuses and mastoids are essentially clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute territory infarction,hemorrhage,edema, or mass. \nModerate subcortical, deep, and periventricular white matter hypodensities are\nnonspecific, but likely represent the sequela of chronic microvascular\nischemia. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture. Small amount of soft tissue within the\nright ear canal likely represents cerumen. Aerosolized secretions are seen\nwithin the left sphenoid sinus. Mild mucosal thickening within the inferior\nmaxillary sinuses bilaterally. The visualized portion of the mastoid air\ncells and middle ear cavities are clear. Patient is status post bilateral\nlens resections. Senile scleral calcifications are seen bilaterally.", + "output": "1. No evidence of acute fracture or intracranial hemorrhage.\n2. Mild paranasal sinus disease." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nCT HEAD:\nThere is no evidence for acute hemorrhage, vascular territorial infarction,\nmass effect, or edema.\n\nThe ventricles and sulci are diffusely prominent compatible global parenchymal\nvolume loss. Periventricular and subcortical white matter hypodensities are\nnoted, a nonspecific finding that most likely represents the sequelae of\nchronic small vessel ischemic disease.\n\nMucosal thickening is seen in the bilateral maxillary and sphenoid sinuses, as\nwell as scattered ethmoid air cells. Aerosolized secretions are seen in the\nleft sphenoid sinus. The remainder of the paranasal sinuses, middle ear\ncavities, and mastoid air cells are clear. The patient is status post\nbilateral lens replacements..\n\nCTA HEAD AND NECK:\nThere is a normal 3 vessel aortic arch identified. The vertebral arteries are\npatent without high-grade stenosis or occlusion.\n\nThe bilateral common carotid arteries are patent. Calcifications are seen at\nthe bilateral carotid bulbs. This extends into the right proximal internal\ncarotid artery resulting in ___ stenosis by NASCET criteria. There is no\nevidence of the left internal carotid stenosis by NASCET criteria.\n\nModerate severe calcifications are seen involving the bilateral cavernous\ninternal carotid arteries. Left PCOM origin problem and infundibula on is\nnoted (3:264). Allowing for this, the intracranial vasculature is grossly\npatent without high-grade stenosis, occlusion, or aneurysm greater than 3 mm. \nThere is a fetal origin of the right posterior cerebral artery. The dural\nvenous sinuses are patent.\n\nOTHER:\nIncidentally noted is a right azygos lobe. Otherwise, the imaged portions of\nthe lungs are grossly clear bilaterally. The thyroid gland is heterogeneous\nwith a hypodense 9 mm right-sided dominant nodule. Nonspecific subcentimeter\nmediastinal lymph nodes are noted (see for example see 3: 22). There is no\ncervical lymphadenopathy by CT size criteria.", + "output": "1. Dental amalgam streak artifact limits study.\n2. No evidence for acute intracranial hemorrhage or vascular territorial\ninfarction. Please note MRI of the brain is more sensitive for the detection\nof acute infarct.\n3. Global parenchymal volume loss and evidence of chronic small vessel\nischemic disease.\n4. Multifocal atherosclerotic disease involving the cervical vasculature, as\nabove, with ___ stenosis by NASCET criteria involving the right proximal\nICA. No significant left ICA stenosis by NASCET criteria.\n5. Grossly patent intracranial vasculature without high-grade stenosis,\nocclusion, or aneurysm.\n6. 9 mm right thyroid nodule. Please see recommendations below.\n7. Paranasal sinus disease with findings concerning for acute sinusitis, as\ndescribed.\n8. Nonspecific subcentimeter mediastinal lymph nodes, which may be reactive.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or older.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "There is evidence of fracture, hemorrhage, infarction, masses or mass effect. \nVentricles and sulci are normal in overall size and configuration. The imaged\nparanasal sinuses are clear. Mastoid air cells and middle ear cavities are\nwell aerated. The bony calvarium is intact.", + "output": "Normal study." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Encephalomalatic changes are again noted in the right\nfrontal lobe; unchanged from prior study. Round hypodensity in the left basal\nganglia is consistent with old left thalamic infarct; also unchanged from\nprior. Scattered subcortical and periventricular white matter hypodensities\nare nonspecific and likely represent sequela of chronic microvascular ischemic\nchanges.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses demonstrates mild mucosal thickening of the ethmoid air cells and\nmild-to-moderate mucosal thickening of the left and right maxillary sinuses\nwith thickened walls, in keeping with chronic sinusitis. The remainder of the\nparanasal sinuses, mastoid air cells,and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute large territorial infarction or intracranial hemorrhage.\n2. Paranasal sinus disease as described above." + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass. The ventricles and sulci are normal in size and configuration.There is\nno acute fracture. The visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of large territorial infarction, hemorrhage, edema, or\nlarge mass. The ventricles and sulci are markedly enlarged, compatible with\nage related atrophic changes. Periventricular and subcortical white matter\nhypodensities are noted, likely the sequelae of chronic small vessel ischemic\ndisease. There is preservation of gray-white matter differentiation. The\nbasal cisterns remain patent.\n\nThere is no evidence of fracture. Lobulated mucosal thickening and mucous\nretention cyst is noted in the left maxillary sinus. An additional mucous\nretention cyst is seen in the left sphenoid sinus. The remainder of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Advanced global cerebral atrophy and evidence of chronic small vessel\nischemic disease." + }, + { + "input": "There is no intra or extra-axial mass effect, acute hemorrhage or large\nterritorial infarct. The sulci, ventricles and cisterns are unchanged and\nwithin expected limits for the degree of prominent age related global cerebral\nvolume loss. There are periventricular and subcortical white matter\nhypodensities, which are nonspecific and unchanged from prior exam, compatible\nwith chronic microangiopathy in a patient of this age. A single mucous\nretention cyst is noted in the left sphenoid sinus. The remainder the\nvisualized paranasal sinuses are essentially clear. The orbits are\nunremarkable noting bilateral lens replacements. The mastoid air cells and\nmiddle ears are well pneumatized and clear. No acute osseous abnormality.", + "output": "1. No acute intracranial abnormality on noncontrast head CT.\n2. Specifically no large territory infarct or intracranial hemorrhage." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass effect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular, subcortical, and deep white matter\nhypodensities are likely sequelae of chronic small vessel ischemic disease.\n\nSmall right posterior scalp hematoma is noted. There is no evidence of\nfracture. Mild mucosal thickening of the left maxillary sinus and ethmoidal\nair cells are noted. The additional visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are notable for bilateral lens replacement. \nCalcification of the cavernous portions of the internal carotid arteries are\nnoted.", + "output": "1. No acute intracranial abnormality on noncontrast head CT.\n2. Specifically, no intracranial hemorrhage. Chronic changes as described\nabove.\n3. Right posterior parietal subgaleal hematoma without associated calvarial\nfracture." + }, + { + "input": "There is no evidence of hemorrhage, infarction, mass or midline shift. \nCalcifications of the basal ganglia are noted. There is no hydrocephalus. \nVisualized paranasal sinuses and mastoid air cells are clear. Under\npneumatization of the left mastoid air cells is noted. There is no fracture.", + "output": "Normal study." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nHypodensity in the left basal ganglia is unchanged, likely a dilated\nperivascular space or a chronic lacunar infarct, unchanged. There is no\nevidence of infarction, hemorrhage, edema, mass, or mass effect.\n\nThe ventricles and sulci are normal in caliber and configuration.\n\nThe globes and orbits are unremarkable.\n\nThe visualized paranasal sinuses and mastoids appear clear.\n\nCTA HEAD:\nSlight luminal irregularity of the distal right vertebral artery likely\nreflects mild underlying atheromatous disease. Otherwise, widely patent and\nunremarkable vertebrobasilar system. Fetal configuration left PCA is noted. \nLeft P1 segment is not well seen, either diminutive or absent. Conventional\nright PCA anatomy. Patent but diminutive right posterior communicating\nartery. Left PCOM is widely patent. Patent bilateral P2 and more distal\nposterior cerebral arteries with normal distal runoff.\n\nThere is a 1-2 mm infundibulum at the origin of the left ophthalmic artery\n(3:238).\n\nBilateral cavernous and supraclinoid intracranial ICA segment calcification\ncauses areas of mild luminal narrowing.\n\nOtherwise, the remaining portions of the bilateral intracranial internal\ncarotid arteries and the bilateral anterior and middle cerebral arteries are\npatent with normal distal runoff.\n\nNo additional stenosis. No aneurysm. No occlusion.\n\nThe left transverse sinus is diminutive and not well-visualized; otherwise,\nthe remaining visualized major dural venous sinuses appear patent.\n\nCTA NECK:\nAside from a portion of the distal right V1 segment of the extracranial\nvertebral artery, which is somewhat obscured by artifact due to reflux of\ncontrast bolus into adjacent veins (3:91 for example), the right vertebral\nartery is widely patent and unremarkable throughout the neck. Similarly, the\nleft vertebral artery is widely patent and unremarkable.\n\nWidely patent bilateral cervical carotid arteries. No luminal ICA narrowing\nby NASCET criteria. Patent external carotid arteries.\n\nNo evidence of dissection.\n\nImaged portions of the aortic arch demonstrate minimal calcified plaque. Arch\nbranch vessel origins are widely patent and unremarkable.\n\nOTHER:\nScattered bilateral multilevel cervical lymph nodes, most prominent at level 2\nbilaterally, are slightly increased in number but image early pathologically\nenlarged and retain normal features. These may be reactive in nature. No\naggressive focal osseous lesions. For mediastinal lymph nodes are slightly\nnumerous, not individually enlarged. There are scattered bilateral small\naxillary lymph nodes, partially visualized. 3 mm solid pulmonary nodule,\nright lung apex (___). Left lung apex clear.", + "output": "1. No acute intracranial abnormality.\n2. Aside from a short-segment of proximal (V1 segment) right vertebral artery\nwhich is obscured by refluxed contrast bolus into adjacent veins, widely\npatent and unremarkable bilateral cervical vertebral and carotid arteries. No\nevidence of dissection. No ICA narrowing by NASCET criteria.\n3. 1-2 mm infundibulum, origin of the left ophthalmic artery. Mild narrowing,\ncavernous and paraclinoid intracranial ICAs bilaterally due to calcified\nplaque. Otherwise, unremarkable circle ___ vasculature. No occlusion,\nadditional stenosis, or aneurysm.\n4. Unchanged dilated perivascular space or chronic lacunar infarct, left basal\nganglia.\n5. Mildly numerous cervical and upper mediastinal lymph nodes retain normal\nmorphology and are not enlarged, possibly reactive. Other incidental\nfindings, as above.\n\nRECOMMENDATION(S): For incidentally detected nodules smaller than 6mm in the\nsetting of an incomplete chest CT, no CT follow-up is recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nNonspecific periventricular and deep subcortical white matter hypodensities\nmost likely represent mild chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. Aside from mild mucosal thickening of the\nanterior ethmoidal air cells and of the maxillary sinuses, the visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No evidence of acute intracranial process.\n2. Age advanced involutional changes and nonspecific white matter\nhypodensities likely representing mild chronic small vessel ischemic disease." + }, + { + "input": "Limited study due to motion artifact, despite repeat attempt. Within this\nlimitation:\n\nThere is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\n\nModerate right periorbital hematoma and soft tissue swelling (2:15). Bony\norbits are unremarkable bilaterally without evidence of fracture. No evidence\nof intraconal or extraconal hematoma. There is a small, minimally displaced\nright nasal bone fracture (3:15), age-indeterminate, without evidence of\nadjacent hematoma, subcutaneous air or involvement of adjacent sinuses. No\nadditional fractures identified. The imaged paranasal sinuses are clear.\nMastoid air cells and middle ear cavities are well aerated.", + "output": "1. Limited study due to motion, despite repeat attempt.\n2. No visualized acute intracranial abnormalities.\n3. Moderate right periorbital hematoma and soft tissue prominence. Bony orbits\nare intact. No evidence of intraconal or extraconal hematoma.\n4. Small, age-indeterminate, minimally displaced right nasal bone fracture. \nNo additional fractures identified." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are within expected limits in size and configuration.\n\nNo acute osseous abnormalities seen. Status post right parietal craniotomy,\nunchanged. Partial opacification of a few inferior right mastoid air cells. \nOtherwise, the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The orbits are unremarkable.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nlarge territory infarct or intracranial hemorrhage.\n2. No acute displaced calvarial fracture." + }, + { + "input": "Images are limited by motion artifact. There is extensive bone-related beam\nhardening artifact projecting over the cortex of the cerebral hemispheres,\nmost prominent along the superficial right frontal lobe on images ___,\nwhere a concavity in the inner table causes exaggerated bone-related beam\nhardening artifact. While there is no definite evidence for acute\nintracranial hemorrhage on routine or thin slice images, it is difficult to\nexclude hemorrhage. There is no evidence for edema, mass effect, or large\nvascular territorial infarction. Ventricles, sulci, and basal cisterns are\nnormal in size. Cerebellar tonsils are normally positioned.\n\nThe patient is status post right parietal craniotomy. There is minimal\nmucosal thickening in the partially visualized maxillary sinuses, as well as\nin bilateral inferior frontal sinuses and anterior ethmoid air cells. There\nis fluid in few right mastoid tip air cells. Left mastoid air cells are well\naerated. The orbits are unremarkable.", + "output": "Motion limited exam. While there is no definite evidence for acute\nintracranial hemorrhage, it is difficult to exclude small amount of hemorrhage\nover the right frontal convexity.\n\nRECOMMENDATION(S): Repeated head CT.\n\nNOTIFICATION: The impression and the recommendation above were discussed with\n___, M.D. by ___, M.D. on the telephone on ___ at 4:35 ___,\n5 minutes after discovery of the findings." + }, + { + "input": "There is no evidence of intracranial hemorrhage, edema, mass effect or\ninfarction. The ventricles and sulci are normal in size and configuration.\nThe visualized paranasal sinuses, middle ear cavity and mastoid air cells are\nclear.\n\nThere is a fracture near the vertex of the left parietal bone with 7mm of\ndepression of the inner table medially. There is a small amount of\npneumocephalus associated with a fracture. There is a large laceration and\nsubgaleal hematoma at the vertex extending along the left parietal scalp. \nThus, this appears to be an open wound.\n\nAgain there are left nasal bone fractures without associated skin swelling.\nThese may be chronic.", + "output": "Depressed fracture of the left parietal bone with a displaced of fracture\nfragments medially towards the intracranial structures and a small amount of\npneumocephalus. Large scalp laceration and hematoma near the vertex and\nextending along the left parietal scalp." + }, + { + "input": "Previously noted depressed fracture at left parietal vertex is again seen\nwithout significant change; possible minimal callus formation. A component of\nthe bone, is seen to indent the left frontal lobe series 2, image 24 as\nbefore, without significant mass effect.\nNo acute intracranial hemorrhage or mass effect.\nThe ventricles, the extra-axial CSF spaces and the sulci are unremarkable and\nsimilar to prior.\nNo suspicious osseous lesions noted.\nEnlarged adenoids mildly narrowing the nasopharynx with fullness in the fossae\nof ___ as before. Mild mucosal thickening in the ethmoid air cells.\nDecrease in the previously noted soft tissue swelling in the left parietal\nscalp region.", + "output": "No significant change in the appearance of the previously noted depressed\nfracture at the left parietal vertex; possible minimal callus; persistent\nindentation on the left frontal lobe by the bone as before.\nEnlarged adenoids mildly narrowing the nasopharynx with fullness in the fossae\nof ___ as before. Correlate clinically" + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is a 4.7 x 2.7 cm right cerebellar hematoma with extension into the\nthird and fourth ventricles and foramina Luschka. There is a mild amount of\nsurrounding edema. There is evidence of a small right frontal corona radiata\nchronic lacune. Mild periventricular white matter hypodensities are\ncompatible with small vessel disease. The ventricles and sulci are normal in\nsize and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere are atherosclerotic calcifications of the carotid siphons. There is no\nevidence of a spot sign in the hematoma. There is also no evidence of an\narteriovenous malformation. The vessels of the circle of ___ and their\nprincipal intracranial branches appear otherwise normal without stenosis,\nocclusion, or aneurysm formation. No the dural venous sinuses are patent.\n\nCTA NECK:\nThere are atherosclerotic calcifications of the right carotid bulb, left\ncarotid bifurcation and distal left cervical ICA. The carotid and vertebral\narteries and their major branches appear otherwise normal with no evidence of\nstenosis or occlusion. There is no evidence of internal carotid stenosis by\nNASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Right cerebellar hematoma measuring up to 4.7 cm and demonstrating\nextension into the third and fourth ventricles.\n2. The hemorrhage extends into the ventricular system\n3. No dissection, aneurysm or occlusion of the head neck.\n4. No evidence of ICA stenosis by NASCET criteria.\n5. Small old right frontal corona radiata infarct.\n6. Mild white matter small vessel disease.\n\nRECOMMENDATION(S): There are calcifications of the origin of the left\ncervical vertebral artery." + }, + { + "input": "Again seen is an approximately 4.8 x 2.7 cm intraparenchymal hemorrhage in the\nright cerebellar hemisphere with extension into the third and fourth\nventricles, overall similar in appearance compared to prior. There is minimal\ndependent hemorrhage within the bilateral occipital horns, slightly more\nprominent when compared to prior exam compatible with redistribution. There\nis mild to moderate surrounding edema with mild mass effect without suggestion\nof cerebellar tonsillar herniation, although there is crowding of the foramen\nmagnum, unchanged from prior exam. Rounded hypodensity in the right centrum\nsemiovale, bilateral basal ganglia common in the white matter of the right\noccipital lobe likely represent remote injuries. There is no evidence of\nacute, large territorial infarction. Ventricles and sulci are minimally\nprominent consistent with age appropriate involutional changes. \nPeriventricular white matter hypodensities are nonspecific, but likely\nrepresent sequela of chronic microvascular ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Unchanged approximately 4.8 x 2.7 cm intraparenchymal hemorrhage in the\nright cerebellar hemisphere with breakthrough into the third and fourth\nventricles. Minimally increased redistributed hemorrhage into the occipital\nhorns of the lateral ventricles. Mild to moderate surrounding edema with mild\nmass effect without evidence of tonsillar herniation, although there is\ncrowding of the foramen magnum, unchanged from prior exam.\n2. Multiple round hypodensities, as above, suggestive of prior insults. \nAge-appropriate involutional changes and likely sequela of chronic\nmicrovascular ischemic disease.\n3. Additional findings described above." + }, + { + "input": "There is mild mucosal thickening of the left maxillary sinus with associated\nhyperostosis of the left maxillary sinus walls, likely representing sequela of\nchronic sinusitis. Periapical lucency ___ tooth number 12, with the tooth\nnot visualized is noted. There is mild mucosal thickening along the bilateral\ninfundibulum of the ostiomeatal units. Miniscule bilateral Haller cells\ndemonstrate mild mucosal thickening. The frontal sinuses are not pneumatized.\nTrace mucosal thickening along the anterior ethmoid air cells is noted. The\nremainder the paranasal sinuses are clear. No aggressive osseous dehiscence\nor lesions are noted. The orbits are unremarkable. The cribriform plates and\nlamina papyracea are intact.\n\nThere is minimal left-sided curvature of the nasal septum without perforation.\n\nThe mastoid air cells and middle ears are well pneumatized and clear. The\nskull-base foramina are preserved. No abnormalities of the visualized neck\nspaces. Although not optimized for such evaluation, visualized brain\nparenchyma is unremarkable.", + "output": "1. Mild mucosal thickening of the left maxillary sinus with associated\nhyperostosis of the maxillary sinus walls, likely represent sequela of chronic\nsinusitis. Periapical lucency ___ tooth 12 (with the tooth not visualized)\nis noted.\n2. There is no evidence of aggressive osseous dehiscence or soft tissue\nabnormality.\n3. Additional mild paranasal sinus disease and other findings described above." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. Low-lying tonsils may be seen\nin the setting of Chiari I malformation. No osseous abnormalities seen. The\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\norbits are unremarkable.", + "output": "1. No evidence of acute infarct or hemorrhage.\n2. Low-lying tonsils may be seen in the setting of Chiari I malformation. \nPlease correlate clinically." + }, + { + "input": "There has been interval evolution of the previously seen right MCA territory\ninfarction with hemorrhagic conversion. There is increased edema and mass\neffect with effacement of the right lateral ventricle and increased leftward\nmidline shift, which now measures 7 mm (previously 3 mm). No new infarction is\nseen. The basal cisterns appear patent and there is preservation of\ngray-white matter differentiation.\n\nNo fracture is identified. Mucous retention cyst is seen in the right ethmoid\nair cells. Otherwise, the visualized paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The globes are unremarkable.", + "output": "Interval evolution of the previously seen right MCA territory infarct with\nhemorrhagic conversion. Increased edema resulting in increased effacement of\nthe right lateral ventricle and increased leftward midline shift, which now\nmeasures 7 mm (previously 3 mm). No evidence of new infarction.\n\nNOTIFICATION: Findings communicated to Dr. ___ at 1:21 a.m. on ___ by phone." + }, + { + "input": "In comparison to the previous study, there is no increase in hemorrhage,\nextension of infarction, or increased mass effect. The hemorrhagic right MCA\ndistributioninfarction appears unchanged . There is mild mass effect with\nleftward shift of midline structures, this is unchanged from the previous\nexamination.\n\nThe basal cisterns appear patent and there is preservation of gray-white\nmatter differentiation.\n\nThe visualized bony structures are grossly unremarkable. There is a mucous\nretention cyst in the right ethmoid sinus, otherwise the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear.\n\nThe globes are unremarkable.", + "output": "No increased hemorrhage, extension of the infarction though or increased mass\neffect from the previous study." + }, + { + "input": "In comparison the previous study. There is no increase in hemorrhage,\nextension of infarction are increased mass effect. There is mild mass effect\nwith leftward shift of midline structures unchanged from the prior\nexamination.\n\nThe basal cisterns appear patent and there is preservation of gray-white\nmatter differentiation.\n\nThe visualized bony structures are grossly unremarkable. There is mucous\nretention cyst in the right ethmoid sinus otherwise the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear.\n\nThe globes are unremarkable.", + "output": "1. There is no increased hemorrhage, extension of infarction or increased mass\neffect from the previous study." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no exophytic mass, or area\nof focal mass effect. Borderline 1 cm left level IIa lymph node (03:30) is\nunchanged since ___. 0.8 cm right level IIa lymph node (03:29) is also\nstable. There is no new cervical lymphadenopathy. There has been progression\nof retention cysts/ polyps in the bilateral maxillary sinuses. Visualized\nsalivary glands are unremarkable. No thyroid mass is seen. The major arterial\nstructures of the neck are patent. There is no high-grade spinal canal or\nneural foraminal narrowing.\n\nOpacities in the lung apices are better evaluated on concurrent CT of the\nchest.", + "output": "1. Borderline 1 cm left level IIa lymph node unchanged since ___ of doubtful\nclinical significance. No new cervical lymphadenopathy.\n2. Opacities in the lung apices are better evaluated on concurrent CT of the\nchest reported separately." + }, + { + "input": "Both maxillary sinuses demonstrate mucosal thickening and secretions with\nnarrowing and obliteration of the drainage pathways. There is also soft\ntissue change seen within the right frontal sinus with mucosal thickening in\nthe remaining sinuses. The soft tissue opacification of the sinuses appears\nto have increased from the previous CT of the neck where maxillary sinuses\nwere partially visualized.\n\nThere is deviation of the nasal septum to the right with a septal spur which\ncontacts the right inferior turbinate. The visualized nasopharynx orbits and\nbrain are unremarkable.", + "output": "1. Extensive bilateral maxillary sinus soft tissue changes and secretions. \nObliteration of the drainage pathways of both maxillary sinuses.\n2. Soft tissue change in the right frontal sinus with mucosal thickening in\nthe remaining sinuses.\n3. Deviated nasal septum to the right with septal spur contacting the right\ninferior turbinate." + }, + { + "input": "There is no evidence for a an enhancing intracranial mass, nor pathologic\nleptomeningeal or pachymeningeal contrast enhancement. There is no acute\nintracranial hemorrhage, loss of gray/ white matter differentiation, or\npathologic extra-axial collection. Small foci of low density in the\nsubcortical and deep white matter of the cerebral hemispheres are nonspecific.\nStatistically, there are likely sequela of chronic small vessel ischemic\ndisease in a patient of this age.The ventricles and sulci are normal in size\nfor age.\n\nThe bones are demineralized without evidence for suspicious lytic or sclerotic\nlesions. The imaged paranasal sinuses and mastoid air cells are well aerated.", + "output": "No CT evidence for intracranial metastatic disease." + }, + { + "input": "No fractures are identified.\nThere is no evidence of facial swelling.\nVisualized paranasal sinuses are well aerated.\nThere is no evidence of abnormal fluid collections.\nBilateral mastoids appear normal.\nThe globes, extraocular muscles, optic nerves, and retrobulbar fat appear\nnormal.\nThe visualized upper aerodigestive tract appears normal.\nThe mandible and temporomandibular joints appear normal.\nThere is mucosal thickening in the ethmoid air cells bilaterally. There is a\nsmall mucosal retention cyst in the left maxillary sinus. There is mild\nmucosal thickening in the left frontal sinus.", + "output": "1. Mild ethmoid and left frontal sinus mucosal thickening. Otherwise normal\nstudy." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage or edema. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nPeriventricular and subcortical white matter hypodensities consistent with\nsmall vessel ischemic changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No evidence of acute intracranial abnormality. Specifically no evidence of\nintracranial hemorrhage or fracture." + }, + { + "input": "Head CT: There is prominent subarachnoid hemorrhage within the right cerebral\nhemisphere, predominantly centered within the right sylvian fissure. There is\nintraventricular extension of hemorrhage into the occipital horns of the\nbilateral lateral ventricles. There is mass effect on the frontal horn of the\nright lateral ventricle. There are bilateral old lacunes. There is mild\ndiffuse brain parenchymal volume loss. There is a right periorbital soft\ntissue hematoma with unchanged fracture through the superior orbital rim. \nThere is scattered paranasal sinus mucosal thickening.\n\nHead CTA: The right vertebral artery terminates in a posterior inferior\ncerebral artery. There is atherosclerotic plaque within the V4 segment of the\nleft vertebral artery. Atheromatous calcifications are present within the\nbilateral cavernous internal carotid arteries. The left posterior cerebral\nartery is predominantly fetal in origin. . The left A1 segment is\nhypoplastic. There is no evidence of aneurysm or other source of subarachnoid\nhemorrhage. The dural venous sinuses appear patent.", + "output": "1. Subarachnoid hemorrhage centered within the right sylvian fissure with\nintraventricular extension.\n2. No evidence of aneurysm or vascular malformation.\n3. Unchanged right supraorbital rim fracture with periorbital hematoma." + }, + { + "input": "There is no evidence of no evidence of infarction, hemorrhage, edema, or\nmass. The ventricles and sulci are mildly enlarged, compatible with age\nrelated atrophic changes. Periventricular and subcortical white matter\nhypodensities are noted, likely the sequelae of chronic small vessel ischemic\ndisease. Bilateral chronic, lacunar infarcts are stable in appearance from\nthe prior examination. There is preservation of the gray-white matter\ndifferentiation. Basal cisterns are patent.\n\n\nThere is no evidence of fracture. There is partial opacification of bilateral\nethmoid air cells. The visualized portion of the remaining paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. Calcifications are\nnoted within the left vertebral and bilateral cavernous carotid arteries. The\nvisualized portion of the orbits are unremarkable.", + "output": "Moderate, age-related cerebral atrophy and sequelae of chronic small vessel\nischemic disease, without acute intracranial process." + }, + { + "input": "There has been significant interval resolution of prior subarachnoid\nhemorrhage, with a small residual degree of hyperdense material seen\npredominantly within the mid right temporal parietal sulci. There is no\nevidence of acute infarction, new hemorrhage, edema, or mass. Periventricular\nand subcortical white matter hypodensities are noted, likely the sequelae of\nchronic small vessel ischemic disease. Old bilateral lacunes are again noted.\nThe ventricles and sulci are normal in size and configuration. Mild mucosal\nthickening is noted within the bilateral maxillary sinuses. The remainder of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "Significant interval resolution of prior subarachnoid hemorrhage without\nevidence of new intracranial hemorrhage or acute ischemia." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, or acute major\nvascular territorial infarction. Ventricles and sulci are essentially\nage-appropriate.\n\nThere is no evidence for a fracture. There are mucous retention cysts and\nmild mucosal thickening in the partially visualized maxillary sinuses. There\nis moderate opacification of bilateral anterior ethmoid air cells with\nelements of mucosal thickening and possibly fluid. There is opacification of\nthe frontoethmoidal recesses with mild mucosal thickening in the inferior\nfrontal sinuses. Middle ear cavities, mastoid air cells, and partially\npneumatized petrous apex air cells are clear.", + "output": "No evidence for an acute intracranial abnormality or calvarial fracture." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal.There are several prominent lymph\nnodes within the bilateral submandibular space but no cervical lymphadenopathy\nby size criteria.The bilateral carotid arteries and internal jugular veins are\npatent. Of note, the right internal jugular vein is diminutive.\n\nPeriapical lucencies are seen involving ___ teeth 3, 5, 28, and 30 (3:28, 21,\n30, 31). There are small retention cysts in the bilateral maxillary sinuses.\n\nThere is a well delineated rounded a centrally located filling defect within\nthe left brachiocephalic vein (3:66), which does not appear to extend into the\nleft subclavian vein, left internal jugular vein, or to the superior vena\ncava. Contrast is seen within the left subclavian vein and refluxing to the\nleft internal jugular vein, however, there is a lack of reflux into the left\nsuperior intercostal vein (3:68), suspicious for extension of thrombus.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There is a 1.8 cm nonenhancing rounded low-density\nstructure within the superior mediastinum, anterior to the aortic arch (3:75),\nbetter characterized on prior MR.\n\n___ is heterogeneous sclerosis of the C2 through C6 vertebrae, which may\nrepresent metastatic disease. No pathological fracture is identified. There\nare mild multilevel degenerative changes in the cervical spine.", + "output": "1. Thrombus within the left superior intercostal vein with partial extension\ninto the left brachiocephalic vein.\n2. Heterogeneous sclerosis of the C2 through C6 vertebrae, which may represent\nmetastatic disease.\n3. Periapical lucencies involving several right mandibular and maxillary\nteeth, which is concerning for periodontal and periapical infection." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Normal study. No hemorrhage." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territorial infarct. Prominence of the\nventricles and sulci is consistent with cortical volume loss. Prominence of\nthe extra-axial spaces, vertically in the bifrontal regions and at the vertex,\nlikely consistent with cortical volume loss. Focal hypodensity in the\nbilateral cerebral hemispheres likely consistent with prior infarcts. The\nvisualized paranasal sinuses demonstrate minimal mucosal thickening in the\npartially imaged left maxillary sinus. There is also mucosal thickening of\nthe right sphenoid sinus. The mastoid air cells are clear. No acute fracture\nis seen.", + "output": "No acute intracranial hemorrhage. Chronic changes." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect. There is no mass effect upon the trachea or esophagus\nthroughout the imaged portions of the neck.\n\nThere are several enlarged right level 3, level 4 lymph nodes, largest level 3\non the right measuring 15 x 14 mm (08:45), which are contiguous with enlarged\nright supraclavicular and thoracic inlet lymph nodes. There is left\nsupraclavicular adenopathy. Infiltrative adenopathy about trachea at the\nthoracic inlet, and about great vessels. Findings consistent with metastatic\ndisease from known lung adenocarcinoma. Remaining sequela of metastatic\ndisease in the chest will be described in a separate report.\n\nParotid, submandibular, and thyroid glands are normal. The neck vasculature\nis homogeneous.\n\nThe included portions of the intracranial structures are grossly normal. The\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\norbits and globes are normal. There are degenerative changes in the\nvisualized cervical spine. No periodontal disease.", + "output": "1. Lower neck, supraclavicular, thoracic inlet adenopathy, consistent with\nmetastases\n2. Please see a separate report discussing the intrathoracic findings." + }, + { + "input": "Study is limited secondary to streak artifact. No evidence acute hemorrhage. \nNo evidence of large vascular territory infarction. There is prominence of\nthe ventricles and sulci suggestive of involutional changes. Atherosclerotic\nvascular calcifications are noted of bilateral vertebral and cavernous\nportions of internal carotid arteries.\n\nSoft tissue swelling is seen overlying the right parietal scalp. There is no\nevidence of acute fracture. Left maxillary sinus retention cyst versus polyp\nis seen. The visualized portion of the remaining paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. Study is limited secondary to streak artifact.\n2. Within limits of study, no evidence of acute intracranial hemorrhage or\nlarge vascular territory infarction.\n3. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct.\n4. Right parietal scalp soft tissue swelling without definite evidence of\nfracture.\n5. Paranasal sinus disease as described.\n\nNOTIFICATION: ___" + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nAtherosclerotic vascular calcifications are noted.\n\nRight parietal soft tissue swelling is similar to the prior study (03:33). \nThere is no evidence of fracture. The side from the left maxillary mucous\nretention cyst, the visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "As compared to the prior examination from approximately 24 hours prior,\nre-demonstrated is a stable acute to subacute left subdural hematoma extending\nalong the left convexity with associated sulcal effacement. No new areas of\nhemorrhage are seen. There is no significant mass effect or midline shift.\nThere is no evidence of acute large territorial infarction. There is no\nevidence of edema or mass. There is prominence of the ventricles and sulci\ncompatible with age related involutional changes. Periventricular and\nsubcortical white matter hypodensities are felt to likely represent the\nsequela of chronic small vessel ischemic disease.\n\nA right frontal calvarial defect is again seen, compatible with a chronic\npostprocedural etiology. No acute calvarial fractures identified. Visualized\nportion of the paranasal sinuses, mastoid air cells and middle ear cavities\nare clear. Visualized orbits are unremarkable.", + "output": "1. Interval stability of left-sided acute to subacute subdural hematoma. No\nnew areas of hemorrhage are seen. No evidence of interval large territorial\ninfarction." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is prominence of the ventricle and sulci, suggestive of involutional\nchanges. There is periventricular and subcortical extensive white matter\nhypodensities are nonspecific but could be related to severe form of chronic\nsmall vessel disease.\n\nThere is no evidence of hemorrhage,edema,ormass. The ventricles and sulci are\nstable in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are normal.\n\nCTA HEAD:\nThere is redemonstration of a 5 mm right MCA aneurysm (series 3, image 62). \nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or other aneurysm. The dural\nvenous sinuses are patent.", + "output": "1. Normal head CT.\n2. Right middle cerebral artery aneurysm, unchanged since the CTA of ___.\n3. Otherwise patent circle of ___ without evidence of stenosis,occlusion,or\naneurysm." + }, + { + "input": "Patient is status post right MCA aneurysm clipping. There are expect\npostoperative changes including pneumocephalus, the small extra-axial fluid\ncollection, a small amount of hemorrhage in the sylvian fissure, and skin\nstaples. There is no evidence of infarction. Periventricular and subcortical\nwhite matter hypodensities are nonspecific but compatible with chronic small\nvessel ischemia.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavitiesare essentially clear. The visualized portion of the orbits are\nnormal.", + "output": "1. Expected postsurgical changes following right MCA aneurysm clipping.\n2. No evidence of infarction.\n3. There is minimal hemorrhage in the sylvian fissure." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nStatus post right MCA aneurysm clipping with stable pneumocephalus and a small\nextra-axial fluid collection. Small volume subarachnoid blood products in the\nright frontal lobe is not appreciably changed. No new areas of intracranial\nhemorrhage or recent infarction. The ventricles and sulci are unchanged in\nconfiguration. Confluent periventricular and subcortical white matter\nhypodensities are nonspecific but likely related to chronic microvascular\nischemic disease.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are normal.\n\nCTA HEAD:\nStatus post right MCA aneurysm clipping without evidence of residual or\nrecurrent aneurysm. There is slight interval decrease in caliber of the\nbilateral A1 segments, right M1 segment and distal right MCA branch vessels as\ncompared to the prior preoperative examination of ___. There is\nno occlusion. There is a subtle protuberance superior to the region of the\naneurysm clip (___) is unclear whether this is due to residual aneurysm or\nan adjacent vascular structure. The vessels of the circle of ___ and their\nprincipal intracranial branches otherwise appear patent without stenosis,\nocclusion, or new aneurysm. The dural venous sinuses are patent.\nWith similar", + "output": "1. Postsurgical changes related to right MCA aneurysm clipping without\nevidence of recurrent or residual aneurysm.\n2. Minimal decreased in size of the bilateral A1 segments, right M1 segment\nand distal MCA branches but no clear evidence of focal vaso spasm\n3. Aneurysm clip is seen in the right MCA region with a small protuberance\nsuperior to the clip which could be adjacent vascular structure or residual\naneurysm. This can be further evaluated with conventional angiography is\nindicated. Otherwise patent circle ___ without high-grade stenosis,\nocclusion or new aneurysm.\n4. No significant interval change in evolving small subarachnoid hemorrhage in\nthe right sylvian fissure and frontal lobe, pneumocephalus and small\nextra-axial fluid collection. No significant mass effect or midline shift.\n5. No definite large territory infarct or new hemorrhage, however MRI is more\nsensitive for evaluation of infarcts." + }, + { + "input": "Again noted is a heterogeneously and peripherally enhancing lobulated mass\ncentered in the right temporal lobe measuring approximately 5.7 x 4.8 cm (TRV,\nAP). Although better evaluated on outside hospital CT and MRI performed on the\nsame day, there is essentially unchanged appearance of right hemispheric\nsulcal effacement, effacement of the right lateral ventricle and third\nventricle as well as perimesencephalic cisterns with 1 cm leftward midline\nshift as well as mass effect on the brainstem. Again noted is mild right uncal\nherniation.\n\nThe lesion demonstrates significant neovascularity without evidence of a spot\nsign. Multiple draining veins are seen draping the margins of the lesion. The\nlesion abuts but does not efface the right transverse and sigmoid sinus.\n\nThe ICA, ACA, MCA and the major branches are otherwise unremarkable without\nevidence of aneurysm, stenosis or occlusion. The vertebral arteries are\nroughly codominant. The posterior circulation is unremarkable.\n\nProminent right choroid plexus calcification of the posterior body of the\nright lateral ventricle is noted (series 5, image 162), unchanged from outside\nhospital CT, which artificially appears as a vascular outpouching adjacent to\na large vein (series ___, image 1).", + "output": "1. The intracranial circulation is widely patent without evidence of stenosis\nor occlusion. No intracranial aneurysms larger than 3 mm.\n2. Heterogeneously and peripherally enhancing lobulated right temporal lobe\nmass demonstrates significant neovascularity as well as prominent draining\nvessels draping its margins." + }, + { + "input": "There is been interval right frontotemporal craniotomy with resection of the\npatient's previously known right temporoparietal lobe mass. Blood products\nand pneumocephalus are noted within the surgical bed. Additional\npneumocephalus is seen throughout the right cerebral hemisphere. There is been\ninterval decrease in extent of right to left midline shift, now measuring up\nto approximately 5 mm, previously having a noted to measure up to 1 cm. Areas\nof edema are noted in the posterior right frontal and right temporal lobes,\nsimilar to the ___ prior brain MRI.\n\nA right maxillary sinus mucous retention cyst versus polyp is again partially\nvisualized.", + "output": "1. Interval right frontotemporal craniotomy with resection of patient's\npreviously noted right temporoparietal lobe mass, with associated postsurgical\nchange as described.\n2. Decreased right-to-left midline shift, now measuring up to 5 mm, previously\nhaving measured 10 mm.\n3. Continued areas of right frontal and temporal lobe edema." + }, + { + "input": "In this patient with recent MRI demonstrating findings suggestive of tumor\nprogression, there is a similar pattern of right cerebral vasogenic edema. \nPeriventricular white-matter hypodensity may reflect post treatment changes. \nNo acute hemorrhage is seen. No midline shift. Postsurgical changes in the\nright calvarium noted. Paranasal sinuses, mastoid air cells and middle ear\ncavities are well aerated.", + "output": "No acute hemorrhage. Similar pattern of right cerebral edema in this patient\nwith known recurrent GBM." + }, + { + "input": "There is no evidence of acute major vascular territorial infarction,\nhemorrhage, edema, or mass. There is mild prominence of the ventricles and\nsulci suggestive of involutional changes. Periventricular and subcortical\nwhite matter hypodensities are nonspecific, but may reflect the sequela of\nchronic microvascular infarction.\n\nThere is no evidence of fracture. Dependent secretions are noted in the left\nmaxillary and sphenoid sinuses. There are is also mild mucosal thickening of\nthe ethmoid air cells bilaterally. Mastoid air cells and middle ear cavities\nare clear. Visualized portions of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Paranasal sinus disease, for which clinical correlation with acute\nsinusitis is recommended." + }, + { + "input": "The paranasal sinuses are normally aerated, with no mucosal thickening or\nair-fluid levels identified. The ostiomeatal units are patent. The cribriform\nplates are intact. There is no nasal septal defect. The nasal septum is\nmidline. The right anterior clinoid process is pneumatized and the left\nanterior clinoid process is not pneumatized. The lamina papyracea are intact.", + "output": "Normal sinus CT." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes,\nslightly out of proportion to expected degree in this age group. \nPeriventricular and subcortical hypodensities are nonspecific, however likely\ndue to mild chronic small vessel ischemic disease.\n\nThere is no evidence of acute fracture. Right frontal subgaleal hematoma\noverlying the right frontal calvarium is small. Skin staples are in place. \nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial abnormalities. Mild right forehead soft tissue\nswelling.\n2. Generalized brain parenchymal atrophy, mild chronic small vessel ischemic\nchanges.." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass. There\nis prominence of the ventricles and sulci suggestive of involutional changes,\nadvanced for age. Periventricular white matter hypodensities are nonspecific\nbut likely represent sequela of chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Global atrophy, advanced for stated age, and likely related to chronic\nalcohol use." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nMild periventricular white matter hypodensities most consistent with chronic\nsmall vessel disease.\n\nThere is no evidence of fracture. Mild opacification of the ethmoid air\ncells. The rest of visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear.", + "output": "1. No acute intracranial findings.\n2. Mild sinus disease." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, shift of normally\nmidline structures or evidence of acute major vascular territorial infarction.\nProminent ventricles and sulci is consistent with age related involutional\nchanges. Periventricular white matter hypodensities are likely the sequela of\nchronic small vessel ischemic disease. Chronic right occipital infarct is\nagain seen. The basal cisterns appear patent and there is otherwise\npreservation of gray-white matter differentiation.\n\nThere is no fracture. The visualized paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The globes are unremarkable.", + "output": "No acute intracranial abnormality. Chronic microvascular ischemic disease.\nOld right occipital infarct." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are enlarged suggesting global atrophy. Periventricular\nwhite matter hypodensities are likely sequela of chronic small vessel ischemic\ndisease. A chronic right occipital infarct is again seen. The basal cisterns\nare patent and there is preservation of gray-white matter differentiation.\n\nNo acute fracture is seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. Dense calcifications are noted in the carotid\nsiphons bilaterally.", + "output": "No acute intracranial abnormality. Chronic changes of small vessel disease,\ncerebral atrophy, and chronic right occipital infarct." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or large vascular\nterritorial infarction. The ventricles and sulci are appropriate in size for\nage with evidence of age-related parenchymal involution. Mild periventricular\nwhite matter hypodensities are noted, compatible with sequela of mild chronic\nsmall vessel ischemic disease. The basal cisterns appear patent.\n\nNo lytic or sclerotic bone lesions suspicious for malignancy are identified PA\nA tiny mucous retention cyst is seen in the left sphenoid sinus.", + "output": "No evidence for an acute intracranial abnormality. MRI would be more sensitive\nfor detection of intracranial metastatic disease or acute infarct, if\nclinically warranted." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect.\n\nThe right parotid gland is asymmetrically enlarged in comparison to the left. \nThere is periglandular stranding, consistent with the patient's history of\nright-sided parotitis. A rim enhancing, hypodense collection is seen within\nthe superficial to mid right parotid gland measuring 1.8 x 1.6 cm, most\nconsistent with a right parotid abscess. The left parotid gland is largely\nunremarkable. The thyroid gland appears normal. There is no lymphadenopathy\nby CT criteria. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear. There are no osseous\nlesions.", + "output": "1. Right parotid abscess measuring 1.8 x 1.6 cm." + }, + { + "input": "There is no evidence of large territorial infarction,acute intracranial\nhemorrhage, edema, or mass. There is unchanged stable flattening of the right\nposterior parietal lobe with prominence of the adjacent extra-axial space, as\nseen in ___. Ventricles and sulci are slightly more prominent than\ntypically expected given patient age, as also seen on prior studies. .\n\nNo acute fracture is seen. The visualized portion of the paranasal sinuses\ndemonstrate minimal mucosal thickening in right ethmoid air cells and right\nmaxillary sinus, partially imaged. The mastoid air cells are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial hemorrhage." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or mass\neffect. Again seen is mild prominence of the sulci and ventricles, suggestive\nof mild underlying global parenchymal loss. Also again seen is fluid density\nextra-axial prominence at the left frontal vertex, with scalloping of the\ninner table, likely an arachnoid cyst.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality on noncontrast CT head. Unchanged arachnoid\ncyst along the left frontal vertex." + }, + { + "input": "Motion artifact limits evaluation.\n\nThere is no evidence of acute hemorrhage, edema, mass effect, or acute major\nvascular territorial infarction.. A small extra-axial fluid density structure\nis again seen at the left anterior frontal vertex, with mild associated\ncalvarial scalloping, probably representing arachnoid cyst. Mild global\nparenchymal volume loss is again seen with prominent ventricles and sulci.\n\nNo clear evidence for suspicious bone lesions. The visualized portion of the\nparanasal sinuses and mastoid air cells appear grossly well-aerated allowing\nfor absence of dedicated bone algorithm images.", + "output": "Mildly motion limited exam. No evidence for acute intracranial abnormalities.\nMRI would be more sensitive for intracranial metastatic disease, if clinically\nwarranted." + }, + { + "input": "There is mild, diffuse loss of gray-white differentiation, concerning for\nglobal hypoxic ischemic injury. This is most pronounced in the right frontal\nlobe, bilateral temporal lobes, thalamus. Some of the findings are likely\nartifact related. There is no evidence of hemorrhage or mass effect. The\nventricles and sulci are mildly prominent keeping with age-related\ninvolutional change.\n\nNo acute fractures are seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable. Patient is\nintubated.", + "output": "Areas of loss of gray-white differentiation, suggestive of global hypoxic\ninjury. Brain MRI without contrast recommended.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 3:07 am, 5 minutes\nafter discovery of the findings." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor large mass. The ventricles and sulci are normal in size and configuration\nfor patient's age. There is no sulcal effacement or downward herniation.\n\nThere is no evidence of fracture. There is mild mucosal thickening in the\nleft maxillary sinus. The visualized portion of the remainder of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. No signs of edema." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is geographic hypodensity at the left occipital cortex consistent late\nsubacute to chronic infarction. Otherwise the right minor matter\ndifferentiation is intact without acute infarct, hemorrhage, mass, or mass\neffect. There is prominence of the ventricles and cortical sulci consistent\nwith volume loss. There is periventricular white matter hypodensity which is\nnonspecific but likely secondary to chronic small vessel disease. There is\nlinear calcification at the left squamous temporal dura which may represent\ndural calcification of a small calcified meningioma, calcific atherosclerosis\n(5:324).\n\nThere is calcification of the bilateral carotid siphons. The bilateral lenses\nare absent. There is a left scleral band. There is mild mucosal thickening\nwithin the bilateral frontal ethmoid and sphenoid sinuses. The bilateral\nmastoid air cells and middle ears are clear. The calvarium and soft tissues\nare unremarkable.\n\nCTA HEAD:\nThe anterior communicating artery is visualized. The bilateral posterior\ncommunicating arteries are not definitively seen. There is dense calcific\natherosclerosis of the bilateral carotid siphons without significant luminal\nstenosis. The left vertebral artery is mildly wound dominant. The anterior\nand posterior circulations are patent without occlusion, dissection, or\naneurysm. There is early bifurcation of the bilateral M2 segments. The left\ninferior M 2 division is diminutive relative to the right, with unremarkable\ndistal run-off. This is likely congenital nature.\n\nThe dural venous sinuses are patent.\n\nCTA NECK:\nThere is calcific atherosclerosis of the aortic arch. There is 3 vessel\naortic arch with calcific atherosclerosis at the origin of the great vessels,\nwithout significant luminal stenosis.\n\nThere dense calcific atherosclerosis at left carotid bifurcation and bulb with\napproximately 50% stenosis at the carotid bulb NASCET criteria (653:3).\n\nThere is calcific atherosclerosis at the right carotid bifurcation and carotid\nbulb with approximately 25% luminal stenosis at the carotid bulb by NASCET\ncriteria.\n\nThe vertebral arteries are patent. There is no occlusion, dissection, or\naneurysm.\n\nThe small centrilobular emphysema within the lung apices. There is\nheterogeneous enhancement of thyroid gland with questionable 5 mm right\nthyroid gland hypodense nodule. There is no lymphadenopathy by CT criteria. \nThere is marked degenerative change at the bilateral costomanubrial,\nsternoclavicular, and atlantodens articulations with bulky pannus formation. \nThere are multilevel degenerative changes at cervical spine without fracture\nor osseous lesion. There is confluent following osteophyte formation at the\nupper thoracic spine. There is streak artifact secondary to dental almalgam. \nThere are periapical lucency at the bilateral maxillary molars. The pharynx,\nlarynx, oral cavity, nasal cavities are unremarkable. Incidental note is made\nof dependent aerosolized debris in the right posterior lateral aspect of the\ntrachea at the level of the manubrium (series 5, image 93). The salivary\nglands are unremarkable. The masticator and carotid spaces are unremarkable.", + "output": "1. A geographic hypodensity at the left occipital lobe which may represent a\nlate subacute or chronic infarction. Correlate with outside prior imaging or\nconsider head MRI to further characterize this finding.\n2. No CT evidence of acute intracranial infarction, hemorrhage, mass, or mass\neffect.\n3. Patent intracranial vasculature without occlusion, stenosis, dissection, or\naneurysm. Calcific atherosclerosis of the bilateral carotid siphons without\nsignificant luminal stenosis.\n4. Calcific atherosclerosis at the bilateral carotid bulbs with approximate\n25% luminal stenosis on the right and 50% luminal stenosis on the left. \nOtherwise patent neck vasculature without dissection, occlusion, or aneurysm.\n5. Marked degenerative changes at the costomanubrial, sternoclavicular, and\natlantodens articulations with bulky pannus formation suggestive of CPPD\narthropathy." + }, + { + "input": "The study is somewhat degraded by patient motion. Within these confines:\n\nThere is unchanged left occipital hypodensity from examination of ___, likely sequela of prior infarct. There is no evidence of acute infarct,\nhemorrhage, edema, or mass. There is prominence of the ventricles and sulci\nsuggestive of involutional changes.\n\nThere is no evidence of fracture. There is mild mucosal thickening in the\nbilateral maxillary sinuses. The remaining visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial hemorrhage." + }, + { + "input": "Study is mildly degraded by motion. Dental almalgam streak artifact limits\nstudy.\n\nThere is no evidence of hemorrhage, edema, or mass. There is prominence of the\nventricles and sulci suggestive of involutional changes. Periventricular,\nsubcortical and deep white matter hypodensities are again noted. Left frontal\nand left basal ganglia areas of hyperdensity, similar to ___ prior\nexam, are again noted.\n\nThere is a stable 2 mm punctate calcification in the anterior left temporal\nlobe (see 4a:10). A stable left occipital chronic infarct is again seen.\n\nThere is no evidence of fracture. There maxillary sinus and ethmoid air cell\nmucosal thickening. The visualized portion of the mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable. Right maxillary molar periapical lucency is noted (see 4a:1). \nDense calcification in the carotid siphons are noted. There is evidence of\nbilateral lens replacements and scleral banding.", + "output": "1. Study limited by mild motion degradation and dental streak artifact.\n2. Redemonstration of probable small vessel ischemic changes, with nonspecific\nadditional focal left frontal and basal ganglia areas of hypodensity,\nunchanged compared to ___ prior exam. While finding may represent\nsmall vessel ischemic changes, subacute to chronic infarcts are not excluded\non the basis examination. Recommend clinical correlation. If clinically\nindicated, consider MRI brain for further evaluation.\n3. Paranasal sinus disease as described.\n4. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct.\n\nRECOMMENDATION(S):\n1. Redemonstration of probable small vessel ischemic changes, with nonspecific\nadditional focal left frontal and basal ganglia areas of hypodensity,\nunchanged compared to ___ prior exam. While finding may represent\nsmall vessel ischemic changes, acute to subacute infarcts are not excluded on\nthe basis examination. Recommend clinical correlation. If clinically\nindicated, consider MRI brain for further evaluation.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\non the ___ ___ at 2:07 ___, 20 minutes after discovery of the\nfindings." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territory infarct. Hypodensities in the\nposterior right frontal and medial right temporal regions are grossly stable. \nGray-white matter differentiation is preserved. There is no hydrocephalus. \nThe visualized paranasal sinuses are clear. The mastoid air cells are clear. \nNo acute fracture is seen. Bifrontal calvarial defects relate to prior\nsurgery are re- demonstrated.", + "output": "No acute intracranial process\n\nPlease note that MRI is more sensitive in the evaluating the posterior fossa." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nAgain demonstrated is right medial temporal lobe encephalomalacia with\nassociated ex vacuo dilatation of the temporal horn of the right lateral\nventricle, not appreciably changed compared to ___. A hypodense\ntract seen in the right parietal lobe is associated with a calvarial defect,\nlikely related to prior intervention (___). There is no evidence of\ninfarction,hemorrhage,edema,ormass. The ventricles and sulci are otherwise\nnormal in size and configuration.\n\nMultiple calvarial defects are unchanged and related to prior surgery. \nExtensive paranasal sinus disease is seen involving the bilateral maxillary\nsinuses, ethmoid air cells, and left sphenoid sinus. Mastoid air cells and\nmiddle ear cavities are grossly clear. The visualized orbits are\nunremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK: Left dominant vertebral artery system is incidentally noted.\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER: Areas of ground-glass nodularity in the right upper lobe measure up to\n6 mm (03:29). The visualized thyroid is unremarkable.", + "output": "1. Unchanged right medial temporal lobe encephalomalacia as compared to ___. No evidence of infarction or hemorrhage.\n2. Patent head and neck vasculature.\n3. Stable calvarial defects, likely related to prior surgery.\n4. Ground-glass nodularity in the right upper lobe measures up to 6 mm. \nFindings may be infectious or inflammatory in etiology. Dedicated CT chest\nmay be considered if clinically indicated." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. There is\npreservation of gray-white matter differentiation. A solitary, coarse,\ncalcification is noted within the anterior left frontal lobe, perhaps an old\ngranuloma. The basal cisterns remain patent.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No evidence of mass, hemorrhage or infarction." + }, + { + "input": "There is a minimally displaced fracture of the superior orbital wall extending\nthrough the right frontal sinus (series 2, image 36). There fracture line\ninvolves the inner table and extends along the sphenoid to the level of the\norbital apex (series 400, image 101) although there does not appear to be\nevidence of extensive associated hematoma at the level of the apex. The\nfracture extends to the right fovea ethmoidalis as well. The cribriform\nplates appear intact.\n\nThere is a right zygomaticomaxillary complex fracture with fractures involving\nthe anterior and lateral maxillary walls, zygomatic arch, as well as\nnondisplaced fracture lines in the sphenoid and temporal bones (involving the\nmastoid air cells). The anterior and lateral maxillary wall fractures are\ncomminuted and displaced, with fracture fragments of the lateral maxillary\nwall inside the maxillary sinus. The zygomatic arch fracture is only minimally\ndisplaced. There is also a laterally displaced fracture of the medial right\norbital wall.\n\nThere is left frontal and periorbital facial swelling with small high-density\nforeign bodies in the skin.\n\nThere is also right periorbital skin injury with embedded small high-density\nforeign bodies.\n\nThere is layering fluid in the right frontal sinus and anterior ethmoid air\ncells. There is layering fluid in the right maxillary sinus.\n\nThe left mastoid appears normal.\n\nWhile hyperdense radiopaque foreign bodies abut the bilateral globes, there\ndoes not appear to be definitive contour abnormality to suggest rupture. No\nhyperdense material within the globes to suggest hemorrhage. The extraocular\neye muscles appear thin and intact. There is no intraconal fatty stranding or\nhematoma. Minimal subperiosteal hematoma along the right orbital roof exerts\nminimal mass effect on the superior rectus, which is otherwise intact. The\nright inferior orbital wall fracture is minimally depressed without evidence\nof extraocular muscle entrapment.\n\nThe visualized upper aerodigestive tract appears normal. ET tube is partially\nimaged.\n\nThe mandible and temporomandibular joints appear normal.", + "output": "1. Complex right facial fractures involving the right zygomaticomaxillary\ncomplex, superior medial and inferior orbital walls as described above.\n2. The superior orbital wall fracture extends to the level of the orbital apex\nwithout evidence of large hematoma. The fracture also extends through the\nfrontal sinus to the inner table.\n3. Hyperdense radiopaque foreign bodies abuts the bilateral globes without\ndefinitive contour abnormality to suggest rupture. Allowing for expected\nmass-effect from subperiosteal hematoma of the right orbital fractures, the\nextraocular eye muscles are unremarkable.\n4. Please refer to concurrent CT head for additional intracranial findings\nincluding right frontal subarachnoid hematoma and right anterior middle\ncranial fossa epidural hematoma." + }, + { + "input": "The patient is intubated. Comminuted fractures of the frontal and lateral\nwalls of the right maxillary sinus as well as minimally displaced fracture of\nthe right zygoma, right orbital medial wall and right orbital roof are\nre-demonstrated, better assessed on dedicated CT of the face.\n\nHigh-density fluid in the right maxillary sinus with air-fluid levels is\nconsistent with hematoma extending superiorly into the ethmoids and right\nfrontal sinuses. Left frontal temporal suture material appears similar to\nprior. A large right parietal subgaleal hematoma with locules of air is\nre-demonstrated without underlying fracture in this region.\n\nOverlying the right temporal lobe, an extra-axial hyperdense collection\nmeasures 3 mm, previously 6 mm on prior (02:15). Right frontal subarachnoid\nhemorrhage is stable or slightly less prominent than on prior (2:23, 2:22). \nNo definite new areas of hemorrhage. There is no evidence of infarction,\nedema, or mass. The ventricles and sulci are normal in size and configuration.\n\nMastoid air cells and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "1. Slightly smaller right temporal extra-axial hemorrhage and stable or\nslightly less prominent right frontal subarachnoid hemorrhage.\n2. No new hemorrhage, infarct, or midline shift.\n3. Redemonstrated right ZMC and right superior/medial orbital wall fractures.\n4. Stable right parietal subgaleal hematoma without underlying fracture." + }, + { + "input": "Right:\nThere is a vertically oriented fracture in the parasagittal plane through the\nanterolateral mastoid air cells with partial right mastoid air cell\nopacification (301:147, 304: 209), but no extension through the middle ear or\ninner ear. The external auditory canal contains fluid and debris. There is a\nsmall amount of nonspecific soft tissue density in Prussak's space (301:153,\n304:163). The middle ear cavity is otherwise clear. The ossicles,\nscutumandtegmen are intact. There is no evidence for enlarged vestibular\naqueduct or superior semicircular canal dehiscence. The facial nerve follows a\nnormal course through the middle ear. There is no evidence for inner ear\ndysplasia.\n\nLeft :\nThe external auditory canal contains nonspecific soft tissue density, likely\ncerumen. The middle ear cavity is clear. The ossicles, scutum,andtegmen are\nintact. There is no evidence for enlarged vestibular aqueduct or superior\nsemicircular canal dehiscence. The facial nerve follows a normal course\nthrough the middle ear. There is no evidence for inner ear dysplasia. There is\ntrace opacification of left mastoid air cells.\n\n\nOther:\nRight zygomatic maxillary complex fractures, right orbital fractures, and\nintracranial contents are better assessed on the ___ head and facial\nbone CTs. There is persistent blood in the right frontal and right maxillary\nsinus.", + "output": "1. Parasagittal fracture through the superficial anterolateral right mastoid\nair cells, without extension to the middle or inner ear. Partial\nopacification of right mastoid air cells.\n2. Small soft tissue density in right Prussak's space without erosion of the\nscutum or ossicles is nonspecific, compatible with inflammatory debris or\nblood products.\n3. No left temporal bone fracture. Trace opacification of left mastoid air\ncells.\n4. Right zygomatic maxillary complex fractures, right orbital fractures, and\nintracranial contents are better assessed on the ___ head and facial\nbone CTs." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nSOFT TISSUES: There is increased attenuation within the right masticator\nspace, likely residual fluid related to recent surgery and/or trauma. There\nis no fluid collection. Asymmetry of the right buccal fat pad may be\nposttraumatic or postsurgical in nature. The imaged suprahyoid neck otherwise\nappears unremarkable.\n\nMAXILLOFACIAL BONES AND PARANASAL SINUSES: There is interval plate and screw\nfixation of the anterior and lateral walls of the right maxillary sinus. \nResidual blood products within the right maxillary sinus are noted.\n\nThe right zygomaticomaxillary complex fractures otherwise appear similar to\nthe prior study. The complex fracture within the orbital plate of the right\nfrontal bone extends into the orbital plate of the ethmoid bone and right\nfrontal sinus. The right frontal recess appears intact. There is interval\nclearing of blood products within the right frontal sinus.\n\nThe complex fracture within the greater wing of the sphenoid extends into the\nsuperior and inferior orbital fissures. The right inferior orbital fissure is\nnarrowed due to angulation of fracture fragments from the greater wing of\nsphenoid. The orbital apex appears preserved. The optic canal appears\nintact.\n\nThere is trace opacification of the right ethmoid air cells adjacent to the\nfracture of the orbital plate of the right ethmoid bone. The fracture extends\nfrom the anterior ethmoidal foramina into the posterior ethmoidal foramina.\n\nThere are trace residual blood products within the petrous portion of the\nright temporal bone as a result of a fracture that extends in the anterior to\nposterior dimension with inferior extension into the lateral condylar fossa.\nThe right middle ear cavity is clear. The ossicular chain and right facial\nnerve canal appear intact.\n\nThere is a small mucous retention cyst within the left maxillary sinus. The\nleft paranasal sinuses and drainage pathways are otherwise clear.\n\nNOSE: There is no nasal bone fracture. Nasopharyngeal soft tissues are\nunremarkable. There is no nasal septal hematoma.\n\nMANDIBLE: The mandible is without fracture or temporomandibular joint\ndislocation. The temporomandibular joints are symmetric, without significant\ndegenerative change.\n\nDENTITION: The right maxillary sinus fractures do not extend into the\nalveolar process of the right maxillary bone.There is no remarkable\nperiodontal disease, periapical lucency, or odontogenic abscess.\n\nORBITS: There are persistent subperiosteal blood products overlying the\nfracture of the orbital plate of the right maxillary sinus. Otherwise, there\nis no retrobulbar hematoma or fat stranding. The globes are intact with\nnon-displaced lenses and no intraocular hematoma. The fracture does extend\ninto the infraorbital canal and nasolacrimal duct, without clear bony\ncompromise.\n\nBRAIN: The previously identified 6 mm thick epidural hematoma adjacent to the\nright greater wing of sphenoid and the small traumatic subarachnoid hemorrhage\noverlying the right middle frontal gyrus are no longer seen.", + "output": "1. Right zygomaticomaxillary fracture status post plate and screw fixation of\nthe anterior and lateral walls of the right maxillary sinus.\n2. The complex fracture within the orbital process of the right frontal bone\nextends through the inner table of the right frontal sinus and inferiorly into\nthe orbital plate of the ethmoid bone.\n3. Small residual right orbital floor subperiosteal hematoma. The intraconal\nand extraconal spaces and globes are otherwise unremarkable.\n4. Please note that the study is limited due to streak artifact related to\ndental amalgam." + }, + { + "input": "Small hyperdensity layering along the right middle frontal gyrus (series 2,\nimage 23) is compatible with subarachnoid hemorrhage. Linear extra-axial\nhyperdensity along the left frontal lobe (series 2, image 24) is felt to be\nlikely artifact. A 6 mm thick lenticular shaped extra-axial hematoma along\nthe anterior right anterior temporal lobe is compatible with epidural\nhematoma, likely venous in nature as the sphenoparietal sinus exists in this\nregion.\n\nThere is no evidence of acute large territory infarct or definite parenchymal\ncontusion/edema. The sulci, ventricles and cisterns are within expected\nlimits for the patient's age.\n\nThere is a moderate scalp hematoma overlying the right parietal occipital\nregion. There is a moderate soft tissue injury of the scalp overlying the\nleft frontal region with small high-density foreign bodies. No skull\nfracture. Please refer to concurrent CT maxillofacial for description of\nright ZMC fracture as well as fractures of the right orbital walls. The\nvisualized globes demonstrate no definitive contour abnormality to suggest\nrupture.", + "output": "1. Small subarachnoid hemorrhage overlying the right middle frontal gyrus as\nwell as 6 mm thick epidural hematoma overlying the right anterior temporal\nlobe. No definitive evidence for parenchymal hemorrhage/contusion.\n2. Please refer to concurrent CT maxillofacial for description of right ZMC\nand right orbital wall fractures.\n\nNOTIFICATION: The change in wet read with new findings of small subarachnoid\nhemorrhage and epidural hematoma as described above was discussed with Dr. \n___, M.D. by ___, M.D. on the telephone on ___ at 1:02\npm, 40 minutes after discovery of the findings." + }, + { + "input": "A region of encephalomalacia within the left frontal lobe is stable since at\nleast ___. There is no evidence of acute territorial infarction, hemorrhage,\nedema, or mass. Subcortical, deep, and periventricular white matter\nhypodensities are nonspecific, but likely represent the sequela of chronic\nmicrovascular ischemic disease. There is prominence of the ventricles and\nsulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the mastoid air\ncells, and middle ear cavities are clear. Status post bilateral lens\nresections. Minimal bilateral ethmoid air cell mucosal thickening is present.", + "output": "1. No evidence of fracture or intracranial hemorrhage.\n2. Stable encephalomalacia within the left frontal lobe." + }, + { + "input": "CT Head: There is an extra-axial hyperdense focus along the right parietal\nconvexity measuring approximately 10 mm in depth by 14 mm in length. This\nresults in the mild mass effect on the adjacent sulci. There is also evidence\nof a thin rim of the hyperdensity along the bilateral cerebral convexities.\nThese findings are most consistent with subdural hemorrhages. The basilar\ncisterns are well patent without evidence of herniation.\n\nThe left frontal lobe demonstrates a region of hypodensity and volume loss,\nmost consistent with encephalomalacia, most likely from a prior insult. There\nis is generalized prominence of the ventricles and sulci, and most consistent\nwith generalized cerebral volume loss. There are confluent regions of\nhypodensity throughout the deep and periventricular white matter, most likely\nsequela of chronic microvascular ischemic disease.\n\nThere is no midline shift or acute infarction. The paranasal sinuses and\nmastoid air cells are clear, except for a retention cyst within the left\nsphenoid sinus. The orbits demonstrate postsurgical changes of cataract\nsurgery. No fractures are identified.\n\nCTA Head: There is adequate opacification of the internal carotid, anterior\ncerebral, middle cerebral, vertebral, basilar and posterior cerebral arteries.\nThere is moderate to severe atherosclerotic calcification of the bilateral\ncarotid siphons, with areas of approximately 50% narrowing within the\ncavernous segments ___ and ___. The anterior communicating artery is well\nvisualized. The vertebral arteries are codominant. The left posterior\ncommunicating artery is robust, with a hypoplastic left P1, giving rise to a\nleft fetal PCA. The right posterior communicating artery is diminutive. There\nis no evidence of aneurysm formation, high-grade stenosis (more than 70%),\nocclusion, dissection or vascular malformation.", + "output": "1. Extra-axial hyperdense focus along the right parietal convexity, with a\nthin rim of hyperdensity along the bilateral cerebral convexities, most\nconsistent with subdural hemorrhages. There is mild mass effect on the right\nparietal lobe sulci from the right parietal lobe subdural hematoma, which has\na depth of 10 mm. No evidence of midline shift or herniation.\n\n2. CTA of the head shows moderate to severe atherosclerotic disease of the\nbilateral carotid siphons with approximately 50% narrowing of the lumen of the\ncavernous segments of the internal carotid arteries. No evidence of aneurysm,\nocclusion or vascular malformation." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass. The\nventricles and sulci are mildly prominent suggestive of mild atrophy, slightly\ngreater than expected for age. Mild periventricular and subcortical white\nmatter hypodensities are nonspecific, but likely reflect the sequela of\nchronic microvascular infarction.\n\nSmall soft tissue defect and tiny focus of subcutaneous air in the right\nsupraorbital area is suggestive of laceration. There is no underlying\nfracture and no osseous abnormalities seen. There is moderate mucosal\nthickening of the frontal sinuses, bilateral maxillary sinuses, and the left\nsphenoid sinus. There is partial opacification of the right frontal ethmoidal\nrecess as well as several ethmoidal air cells. The mastoid air cells and\nmiddle ear cavities are clear. Visualized orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Right supraorbital laceration. No acute fracture.\n3. Moderate paranasal sinus disease as described above." + }, + { + "input": "No acute maxillofacial fractures are identified.\nThere is no evidence of facial swelling.\nThere is a small left maxillary sinus mucous retention cyst adjacent to the\nalveolar recess. Otherwise, the remainder of the paranasal sinuses are clear.\nThere is no evidence of abnormal fluid collections.\nThe bilateral mastoid air cells middle ears are well pneumatized and clear.\nThe globes, extraocular muscles, optic nerves, and retrobulbar fat appear\nnormal.\nThe visualized upper aerodigestive tract appears normal.\nThe mandible and temporomandibular joints appear normal.\n\nAlthough not optimized for such evaluation, visualized brain parenchyma is\ngrossly unremarkable. Please refer to concurrent MRI head without contrast of\n___ for additional details.", + "output": "1. No evidence for acute maxillofacial fracture. No facial soft tissue\nswelling is identified.\n2. Additional findings described above." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, loss of\ngray/white matter differentiation, or pathologic extra-axial collection. \nVentricles and sulci are normal in size for age.\n\nThere is no evidence of fracture. There is minimal mucosal thickening in the\nethmoid air cells and mild mucosal thickening in the partially visualized\nmaxillary sinuses. Mastoid air cells and middle ear cavities are well\naerated. The orbits are unremarkable.", + "output": "No evidence for an acute intracranial abnormality or calvarial fracture." + }, + { + "input": "There is no evidence of acute vascular territorial infarction, hemorrhage,\nedema, or mass. Sulci are prominent which is inappropriate for patient's age.\nVentricles are soft.\nThere is no evidence of fracture. Mild mucosal thickening within the\nbilateral ethmoid air cells and posterior right sphenoid sinus. Remainder of\nthe visualized paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "No acute intracranial process. Age inappropriate prominence of sulci." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass. Tiny\nleft thalamic lacune appears chronic (11:5). The ventricles and sulci are\nnormal in size and configuration.\n\nNo osseous abnormalities seen. Frontal sinuses are not pneumatized. The\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\norbits are unremarkable.", + "output": "No acute intracranial abnormality. Tiny chronic appearing left thalamic\nlacune." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. There is thickening of the maxillary and\nsphenoid sinus mucosa bilaterally with changes compatible with maxillary\nantrostomy as well as opacifications in the ethmoid sinuses and nasal septae. \nThese findings are compatible with chronic sinus disease. The orbits are\nunremarkable.", + "output": "1. No intracranial abnormalities.\n2. Bilateral paranasal mucosal thickening, as above, with postsurgical changes\ncompatible with history of chronic sinus disease." + }, + { + "input": "The patient is status post apparent bilateral antrostomies and partial\nethmoidectomies. There is diffuse hyperostosis of right greater than left\nmaxillary and sphenoid sinus walls (series 2, image 31; series 601, image 99)\ncompatible with history of chronic sinusitis. There is moderate mucosal\nthickening of the right maxillary sinus, mild mucosal thickening with\ndependent aerosolized debris in the left maxillary sinus. Posterior nasal\npolyposis extending into the residual ethmoid air cells is identified. There\nis opacification of the bilateral sphenoethmoidal recesses and sphenoid ostia\nwith moderate mucosal thickening of the sphenoid sinuses. The left\npneumatized sphenoid sinus lateral recess is opacified completely. The\nfrontal sinuses are essentially clear. There remains enlargement of the right\nsuperior ophthalmic vein.\n\nThere is opacification of the right neo infundibulum. Mucosal thickening\nalong the left neo ostium is also noted.\n\nSubtle lucency along the right sphenoid sinus lateral wall adjacent to the\norbital apex (series 2, image 19) appears well corticated and may represent a\nprominent nutrient channel. No discrete osseous destruction is identified.\n\nThe lamina papyracea and cribriform plates are intact.\n\nBetter evaluated on MRI of earlier in the day is mild intraconal fatty\nstranding and perineural neuritis of the right orbit. Mild inflammatory\nstranding of the extra-ocular eye muscles or soft tissue stranding involving\nthe orbital apex, right supra and infra orbital fissures are not well\nvisualized on CT examination.", + "output": "1. The patient is status post bilateral antrostomies and likely partial\nethmoidectomies with hyperostosis of the right greater than left maxillary and\nsphenoid sinus walls compatible with chronic sinusitis.\n2. There is posterior nasal polyposis extending into the residual ethmoid air\ncells. Opacification of the bilateral sphenoid ethmoidal recesses and\nsphenoid ostia with moderate mucosal thickening of the sphenoid sinuses. \nRight greater than left mucosal thickening of the maxillary sinuses.\n3. No evidence of frank osseous dehiscence. As described above, there is a\nwell corticated lucency along the right sphenoid sinus lateral wall adjacent\nto the orbital apex. This could represent a prominent nutrient channel.\n4. Please refer to concurrent MRI of the orbits for additional details, not\nwell visualized on CT examination." + }, + { + "input": "Soft tissue changes predominate due to mucosal thickening is seen in both\nmaxillary sinuses. Fluid levels or aerosolized secretions are seen in both\nmaxillary sinuses. There appear to be prior functional endoscopic sinus\nsurgery. The right sided neo Ostium appears to be obliterated. Mucosal\nthickening is also visualized in the sphenoid sinuses with small fluid level\nin the left sphenoid sinus. Linear lucency through the lateral wall of the\nright sphenoid sinus (03:32) could be due to a vascular channel and is\nunchanged from the previous CT. Soft tissue changes are visualized within the\nupper parts of both nasal passages with polypoidal appearance suggestive of\npolyposis. There is pneumatization of the Crista again lie. Thickening is\nseen in both maxillary sinus walls indicative of chronic sinusitis. Mild\nthickening of the sphenoid sinus walls is also seen. No bony dehiscence is\nidentified at the skullbase.\n\nSubtle soft tissue changes seen at the right orbital apex (2:66) are better\nvisualized on the previous MRI.", + "output": "1. Soft tissue changes in the visualized sinuses involving predominantly the\nmaxillary ethmoid and sphenoid sinuses with findings suggestive of acute on\nchronic sinusitis.\n2. Polypoidal soft tissue swelling within the nasal passages could be due to\nnasal polyposis but other inflammatory changes could have similar appearance\nand clinical correlation recommended with direct visualization.\n3. Orbital soft tissue changes are better visualized on previous MRI." + }, + { + "input": "There has been no significant interval change. Again a small calcific density\nin the right posterior temporal region adjacent to the ctransverse venous\nsinuses is identified. There is no significant interval change seen. There\nis no surrounding edema seen. No new abnormalities are identified. No\nhemorrhage midline shift or hydrocephalus seen. Mild prominence of sulci again\nnoted.", + "output": "No significant interval change since the previous CT examination and a small\ncalcification adjacent to the right tentorium and transverse sinus . This\nmost likely represents a small calcified meningioma." + }, + { + "input": "Mildly limited CTA secondary to poor vessel opacification.\n\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. Hypodensity in the\nright parietal lobe and adjacent to the atrium of the right lateral ventricle\nextending to the cortical surface, age indeterminate without prior studies for\ncomparison (series 3, image 18, 17). Burr holes noted in the right posterior\nparietal bone, possibly from prior ventriculostomy catheter, per documented\nhistory in OMR.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Age indeterminate hypodensity in the right parietal lobe, as described\nabove.\n2. Mildly limited study secondary to poor vessel opacification, particularly\nof the cervical vertebral arteries. Within this limitation, normal head and\nneck CTA.\n\nRECOMMENDATION(S): If there is concern for acute infarction, MRI should be\nconsidered." + }, + { + "input": "There is no evidence of acute, large territorial infarction,hemorrhage,edema,\nor mass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci and unremarkable. Basilar cisterns are\npatent.\n\nIncluded paranasal sinuses and mastoids are clear besides scattered mucosal\nthickening in the ethmoid air cells. Skull and extracranial soft tissues are\nunremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "9 mm hyperdensity is suspicious for hemorrhagic focus is seen in the left\nsylvian fissure (04:16), probably intraparenchymal given surrounding edema. \nThere are scattered areas of suspected subarachnoid hemorrhage including\noverlying the left parietal lobe, in the right sylvian fissure,\ninterpeduncular cistern, and right ambient cistern. There is interventricular\nhemorrhage involving the left ventricular posterior horn/atrium,\ninterpeduncular cistern. Although subtle hyperdensities at the anteroinferior\naspect of the cerebellum adjacent to the bone may be artifactual, findings are\nconcerning for contusion/subarachnoid hemorrhage in the setting of high impact\ntrauma.\n\nSulci of the inferior temporal and occipital lobes appear effaced. There is\nalso mild effacement of the suprasellar cisterns. The foramen magnum remains\npatent.\n\nThere is a slightly displaced fracture of the right occipital condyle. No\nother acute fracture is identified. There is a fracture of the right lamina\npapyracea, though no associated stranding is noted. In addition, there is\npartially imaged hardware from ORIF of mandibular fractures. The lamina\npapyracea fractures age indeterminate. Ethmoidal air cells and nasal passages\nare partially opacified. An endotracheal tube as well as and nasoenteric tube\nare partially imaged.\nThe orbits are unremarkable.\nThere is a large subgaleal hematoma with hyperdense debris, likely foreign\nbodies, overlying the posterior vertex.", + "output": "1. Scattered areas of subarachnoid hemorrhage, intraventricular hemorrhage,\nand intraparenchymal hemorrhage in the left subinsular region.\n2. Crowding of the sulci raises the possibility of cerebral edema. Consider\ndiffuse axonal injury in context of additional intraparenchymal hemorrhage and\nhigh impact injury. MRI would more accurately assess this.\n3. Although subtle hyperdensities at the anteroinferior aspect of the\ncerebellum adjacent to the bone may be artifactual, findings are concerning\nfor contusion/subarachnoid hemorrhage in the setting of high impact trauma.\n4. Small slightly displaced right occipital condyle fracture.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:50 pm, 2 minutes after\ndiscovery of the findings." + }, + { + "input": "In comparison to the study of ___, there has been interval\nplacement of a frontal approach neurovent that terminates in the right frontal\nlobe, about 7 mm from the falx (02:23). Re-demonstrated 10 mm hyperdensity of\nthe subinsular intraparenchymal hemorrhage versus focus of diffuse axonal\ninjury, previously 9 mm (02:15), with mild surrounding edema. There are new\nareas of focal hyperdensity, likely consistent with diffuse axonal injury\n(02:15, 25, 26).\n\nUnchanged interventricular extension, right greater than left, most\nprominently in the posterior horns (02:14) and interpeduncular fossa (02:12). \nBasal cisterns remain patent.\n\nScattered subarachnoid hemorrhage at the left parietal lobe, left occipital\nand left cerebellar regions (2:9, 11, 19).\n\nThere is sulcal effacement and diffuse edema seen at the vertex and\nparieto-temporal regions.\n\nThere is soft tissue swelling bilaterally and known fractures of the lamina\npapyracea and right occipital condyle. Status post ORIF of the mandible\nbilaterally.\n\nThe mastoid air cells are clear. The ethmoid, sphenoid, frontal sinuses are\npartially opacified. The middle air cavities are unremarkable. The visualized\nportion of the orbits are unremarkable. Partially visualized nasogastric tube\nin the left nares and endotracheal tube.", + "output": "1. Interval placement of frontal approach neurovent that terminates in the\nright frontal lobe.\n2. Relatively similar, diffuse intraparenchymal, subarachnoid and\nintraventricular hemorrhages with some new areas of focal hyperdensity,\nsuggesting diffuse axonal injury." + }, + { + "input": "Surgical and overlying hardware streak artifact limits examination.\n\nThe right frontal approach catheter has been removed. Again seen are multiple\nscattered hyperdense foci, likely reflecting diffuse axonal injury (for\nexample, 2: 26). A left subinsular hyperdense focus measuring 0.9 cm (02:14)\nmay reflect intraparenchymal hemorrhage. Previously seen subarachnoid\nhemorrhage within the left cerebellum and left parietal and occipital lobes\nhave decreased in conspicuity. Intraventricular hemorrhage most pronounced\nwithin the occipital horn of the left lateral ventricle has not substantially\nchanged. No definite new hemorrhage is identified. Edema most pronounced at\nthe vertex and temporoparietal regions appear unchanged.\n\nThe ventricular size and configuration appears unchanged. The basilar\ncisterns are patent. There is no midline shift.\n\nA fracture of the right lamina papyracea is again seen. Diffuse left frontal\nand periorbital soft tissue swelling is new. Postsurgical changes following\nORIF of the mandible.\n\nCompared to the most recent prior study, opacification of the frontal,\nsphenoid, and maxillary sinuses have increased, now partially to completely\nopacified. Complete opacification of the ethmoid air cells. Aerosolized\ncomponents are seen within the bilateral maxillary sinuses, against a\nbackground of moderate mucosal thickening. Minimal nonspecific bilateral\nmastoid fluid is seen. These findings may be related intubation status.\n\nA nasogastric tube is partially imaged. Limited imaging the orbits again\nsuggest bilateral exophthalmos versus volume averaging artifact.", + "output": "1. Surgical and overlying hardware streak artifact limits examination.\n2. Interval removal of the right frontal approach catheter.\n3. Grossly stable intraparenchymal, subarachnoid, and intraventricular\nhemorrhages, and findings suggestive of diffuse axonal injury.\n4. Grossly stable ventricles with no definite midline shift.\n5. Within limits of study, no definite new hemorrhage identified.\n6. New, left frontal and periorbital soft tissue swelling." + }, + { + "input": "Streak artifact from surgical and overlying hardware limit evaluation.\n\nPreviously noted scattered hyperdense foci concerning for diffuse axonal\ninjury and intraparenchymal hemorrhage of the left subinsular cortex are less\nconspicuous on this exam. Likewise, the previously seen blood products in the\nventricle and left basal ganglia cannot be fully evaluated on this examination\ndue to possible of evolution of collection or from presence of IV contrast. \nNo midline shift. The ventricle size and diffuse sulci effacement are\nunchanged compared to prior.\n\nThere is no gross evidence of acute fracture. Age-indeterminate medialization\nof the right lamina papyracea (02:21). Near complete opacification of the\nsphenoid (3:8) and ethmoid sinuses (03:10). There is partial opacification of\nthe maxillary sinuses bilaterally (3:6) and right frontal sinus (03:14). The\nmiddle air cavities are unremarkable. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Previously seen blood products in the parenchyma and ventricle are less\nconspicuous on this exam, related to evaluation or presence of IV contrast\nevolution or IV contrasted the striation. Interval change is difficult to\nassess.\n2. No evidence of abscess or hydrocephalus.\n3. Stable extensive sinus disease and mild fluid in the nasopharynx that may\nbe related to patient's intubation status." + }, + { + "input": "Surgical and overlying hardware limit evaluation.\n\nAero digestive tract: There is no mass. Mild fluid in the nasopharynx, which\nmay be related to intubation status (02:31).\n\nNeck lymph nodes: Numerous prominent cervical lymph nodes, likely reactive,\nnot pathological by CT criteria.\n\nExtra nodal tumor spread: There are no findings suggestive of extra nodal\nextension.\n\nDeep neck muscles, masticator space: There is no muscle invasion. No abnormal\nfluid collections.\n\nBones, skull base:\nThere is no bone involvement. No acute fractures.\nThere are no findings suggestive of perineural tumor extension. Jugular\nforamen, carotid canal, pterygopalatine fossa, infraorbital foramen, other\nskull base foramina are not involved.\n\nVessels: There is no vascular invasion.\n\nBrachial Plexus: There is no brachial plexus contact or invasion.\n\nThyroid, salivary glands: There is no mass.\n\nOther findings: There are no lung nodules. Partially visualized ETT and left\nchest tube (2:99) . Partially visualized central line coursing through the\nright subclavian vein. Stranding seen in the fat plane secondary to\nsubcutaneous edema (2:87).", + "output": "1. No fluid collection is seen in the neck.\n2. Extensive soft tissue edema.\n3. Fluid within the sinuses and nasopharynx likely related to intubation." + }, + { + "input": "Again seen are multiple congenital abnormalities, including Chiari 2\nmalformation, corpus callosum dysgenesis stenogyria and absence of the septum\npellucidum, better assessed on prior MRI exams.\n\nTwo right frontal approach VP shunt catheters are in unchanged position,\nterminating in the frontal horn of left lateral ventricle and near the left\nforamen of ___, respectively. The ventricles are stable in size and\nconfiguration compared to the last MRI from ___. Right trigonal\narachnoid cyst was better appreciated on the prior MRI. Periventricular white\nmatter hypodensities are grossly unchanged. No evidence for acute hemorrhage\nor edema.\n\nNo evidence for concerning bone lesions. Evidence of prior bilateral\ncraniotomy is noted. Mild mucosal thickening in the paranasal sinuses. \nMastoid air cells are well aerated.", + "output": "1. Multiple congenital abnormalities are again demonstrated.\n2. Stable position of 2 right frontal approach VP shunt catheters. Stable\nsize and configuration of the ventricles.\n3. No evidence for acute intracranial abnormalities." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are larger than expected for the patient's age.\n\nSuggestion of fracture of the tip of the nasal bone, of indeterminate age. \nThere is chronic right maxillary sinus atelectasis. Otherwise, the visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable. There is\nright periorbital soft tissue swelling.", + "output": "Right periorbital soft tissue swelling.\nSuggestion of fracture of nasal bone tip, of indeterminate age." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. Prominent right level 2B lymph\nnode is slightly enlarged by size criteria and measures approximate 19 x 7 mm\nin transverse dimension (series 2, image 40), prominent level 2A lymph node\nis also enlarged by size criteria (series 2, image 48), measuring\napproximately 7 x 15 mm in transverse dimension. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.", + "output": "Slightly prominent level II right-sided lymph node are consistent with\nlymphadenopathy by radiological criteria, please correlate with the provided\nhistory of possible lymphoma.\n\nNOTIFICATION: The findings were discussed initially with ___,\nM.D. by ___, M.D. on the telephone on ___ at 4:44\npm, 10 minutes after discovery of the findings, additional findings were\ncommunicated to Dr. ___, by Dr. ___ at 17:37 on ___,\n20 minutes after discovery of the findings." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. The basal cisterns appear\npatent and there is preservation of gray-white matter differentiation.\n\nNo osseous abnormalities seen. There is mild mucosal thickening in the\nethmoid air cells and also opacification of 1 right-sided ethmoid air cell. \nThe remainder of the imaged paranasal sinuses clear. There is minimal\nopacification of inferior left mastoid air cells, which may have also been\npresent on the prior study. The right mastoid air cells are clear. No acute\nfracture is seen.", + "output": "No evidence of acute intracranial process. Please note that MRI is more\nsensitive for detection of acute ischemia." + }, + { + "input": "Neck CTA:\n\nThe carotid and vertebral arteries and their major branches are patent with no\nevidence of stenoses. There is no evidence of internal carotid stenosis by\nNASCET criteria. The left vertebral artery is dominant. There is minimal\ncalcification of the right carotid bifurcation. The distal left internal\ncarotid artery measures 4.0 mm and the distal right internal carotid artery\nmeasures 3.9 mm.\n\nHead CTA:\n\nThere are no intracranial arterial stenosis or occlusion. There are fetal type\nposterior cerebral arteries noted bilaterally with slightly bulbous appearance\nof the basilar tip, unchanged compared to ___, but no evidence for a\nsaccular aneurysm.\n\nOther:\n\nThere is complete opacification of a right posterior ethmoid air cell and a\nleft anterior ethmoid air cell. A large torus ___ is incidentally\nnoted. Soft tissues of the neck are unremarkable. There is mild pleural/\nparenchymal scarring at the visualized lung apices. A small peripheral\nbronchiole at the right apex is dilated. There are multilevel degenerative\nchanges in the spine.", + "output": "Mild atherosclerosis of the right carotid bifurcation. No occlusion or\nstenosis in the cervical or intracranial vasculature. No evidence for an\nintracranial aneurysm." + }, + { + "input": "Compared to study 12 hr prior there is mild increase in the bilateral left\ngreater than right subdural hematoma with extension along the falx and\ntentorium with increased mass effect on the posterior horn of the left lateral\nventricle. There is minimally increased midline shift measuring 3.7 mm\n(previously 2.4 mm). Also noted is new hemorrhage tracking along the posterior\nhorn and atrium of the right lateral ventricle suggesting intraventricular\nhemorrhage however differential includes intraparenchymal hemorrhage. (2: 15).\nWithin the posterior fossa a lentiform shaped hyperdense lesion raises concern\nfor a venous epidural hematoma, without an associated occipital bone fracture.\nAlthough differential includes subdural hematoma, this is less likely. No\nsignificant change in left occipital soft tissue swelling. Mild prominence of\nventricles and sulci are consistent age related cortical volume loss. The\nbasal cisterns are patent. There is otherwise preservation of gray-white\nmatter differentiation.\n\nTwo craniotomy holes are noted along the frontal bones. Severe degenerative\ndisease is seen within the anterior and lateral components of the atlantoaxial\njoint with persistent rotation of C1 on C2 similar to outside scan from 12\nhours prior raising concern for rotary subluxation. Although more likely\nrelated to patient's head positioning close attention on followup studies is\nrecommended. No acute fracture seen. The visualized paranasal sinuses, mastoid\nair cells and middle ear cavities are clear. The globes are unremarkable.", + "output": "1. Small increase in left greater than right subdural hematoma with extension\nalong the falx and tentorium, causing mildly increased mass effect along the\nposterior horn of the left lateral ventricle and slightly increased shift of\nmidline structures.\n2. No evidence of central herniation.\n3. Possible left infratentorial venous epidural hematoma.\n4. Right intraventricular hemorrhage within the atrium and posterior horn of\nthe lateral ventricle, however differential includes intraparenchymal\nhemorrhage.\n5. Severe atlanto-axial degenerative joint disease with rotation of C1 on C2,\nlikely related to patient head positioning; rotatory fixation is a more remote\nconsideration, and should be correlated clinically. Close attention on\nfollow-up imaging is recommended.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\non the telephone on ___ at 9:45 AM, 5 minutes after discovery of the\nfindings." + }, + { + "input": "Compared to study 1.5 days prior there is mild improvement in right subdural\nhematoma. Persistent left subdural hematoma with extension along the falx and\ntentorium with improvement in mass effect on the posterior horn of the left\nlateral ventricle. Stable midline shift measuring 2.6 mm (previously 3.7 mm).\nPreviously identified hemorrhage tracking along the posterior horn of the\nright lateral ventricle is now isointense to parenchyma consistent with\nevolution of hemorrhage. No new intraparenchymal hemorrhage. Mild interval\nthinning of the lentiform shaped hyperdense lesion with a fluid level wiithin\nthe posterior fossa suspicious for a venous epidural hematoma without an\nassociated occipital bone fracture. Improved subarachnoid hemorrhage.\nInterval improvement in left occipital soft tissue swelling. Mild prominence\nof ventricles and sulci are consistent age-related cortical volume loss. The\nbasal cisterns are pain. There is otherwise preservation of gray matter\nunchanged.\n\n2 craniotomy holes are again seen within the frontal bones. Severe\ndegenerative disease is seen throughout the anterior and lateral components of\nthe atlantoaxial joint with incomplete evaluation on today's study in a\npatient with previous concern of possible rotary subluxation. No acute\nfractures seen. The visualized paranasal sinuses, mastoid air cells and middle\near cavities are clear. The globes are unremarkable.", + "output": "1. Interval decrease in right subdural hematoma and subarachnoid hemorrhage.\n2. Stable left subdural hematoma with extension along the falx and tentorium\nwith improved mass effect along the posterior horn of the left lateral\nventricle and stable mild shift of midline structures.\n3. No evidence of central herniation.\n4. Mild thinning of the left infra tentorial venous epidural hematoma, since\nprevious examination.\n5. Expected evolution of right intraventricular hemorrhage. No new\ninterventricular hemorrhage.\n6. Limited evaluation of the atlantoaxial joint." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\nThere is no evidence of fracture. There is bilateral moderate mucosal\nthickening in the ethmoid and maxillary sinuses. The visualized portion of\nthe orbits are unremarkable.", + "output": "1. No fracture, hemorrhage, mass-effect or infarction." + }, + { + "input": "SOFT TISSUES: There is prominence the superficial soft tissues overlying the\nmaxilla anteriorly.\n\nMAXILLOFACIAL BONES: There are multiple tiny fractures of the maxilla\nadjacent to ___ 8, 9, 10 (series 2, image 74) with mild anterior displacement\n___ 9. The lateral pterygoid plates are intact.\n\nMANDIBLE: The mandible is without fracture or temporomandibular joint\ndislocation. The temporomandibular joints are symmetric, without significant\ndegenerative change.\n\nDENTITION: There are no dental fractures. There is no remarkable periodontal\ndisease, periapical lucency, or odontogenic abscess.\n\nSINUSES: There is moderate mucosal thickening of the maxillary sinuses and\nethmoid air cells bilaterally. The ostiomeatal units are patent. The mastoid\nair cells and middle ear cavities are clear.\n\nNOSE: There is no nasal bone fracture. Nasopharyngeal soft tissues are\nunremarkable. There is no nasal septal hematoma.\n\nORBITS: The orbits, including the laminae papyracea, are intact. The globes\nare intact with non-displaced lenses and no intraocular hematoma. There is no\npreseptal soft tissue edema. There is no retrobulbar hematoma or fat\nstranding.\n\nAllowing for imaging technique optimized for the face, the limited included\nportion of the brain is grossly unremarkable.", + "output": "1. Multiple tiny displaced fractures of the maxilla adjacent to ___ 8, 9, 10\nwith minimal displacement ___ 9. No additional fractures are identified." + }, + { + "input": "The patient is status post ORIF of the previously seen left orbital floor\nfracture. The fixation plate across the left orbital floor appears well\npositioned without evidence for complications. Previously seen left\nintraorbital fat herniation and left inferior rectus entrapment have been\nreduced and relieved. The left inferior rectus is thickened and edematous. \nComminuted left orbital floor fracture fragments remain visible. Blood is\nagain seen in the left maxillary sinus. Left periorbital soft tissue swell is\nagain seen.\n\nMild irregularity and minimal step-off in the left nasal bone again seen on\nimage 2:94, of unknown chronicity in the absence of clear overlying soft\ntissue swelling.\n\nThere is mild mucosal thickening of the bilateral ethmoid air cells and\nsphenoid sinuses.\n\nMastoid air cells and middle ear cavities are well aerated. Visualized soft\ntissues of the upper neck appear unremarkable on noncontrast CT. This exam is\nnot technically optimized for evaluation of the included brain parenchyma; no\nconcerning abnormalities are seen.", + "output": "1. S/p left orbital floor fracture ORIF without evidence for hardware related\ncomplications.\n2. Successful reduction of left intraorbital fat herniation and relief of left\ninferior rectus entrapment. The left inferior rectus is edematous.\n3. Minimally displaced left nasal bone fracture of uncertain chronicity is\nagain demonstrated." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. \nPeriventricular and subcortical white matter hypodensities, nonspecific but\nprobably reflect sequela of chronic microangiopathy. There is mild\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "No evidence of fracture, mass, hemorrhage or infarction." + }, + { + "input": "Hypodensity in the left posterior fossa in the territory of the posterior\ninferior cerebellar artery could represent a subacute stroke or less likely\nhemorrhage into a arachnoid cyst. The area of hypodensity causes mass effect\non the fourth ventricle.\nNo osseous abnormalities seen. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Soft tissue density is noted within\nthe left external auditory canal which may represent cerumen.", + "output": "1. Hypodensity in the left posterior fossa in the territory of the posterior\ninferior cerebellar artery could represent a subacute stroke or may represent\nan extra-axial structure such as epidermoid or arachnoid cyst. Recommend\nclinical correlation. If clinically indicated, brain MRI may be obtained for\nfurther evaluation.\n\nRECOMMENDATION(S):\n1. Hypodensity in the left posterior fossa in the territory of the posterior\ninferior cerebellar artery could represent a subacute stroke or may represent\nan extra-axial structure such as epidermoid or arachnoid cyst. Recommend\nclinical correlation. If clinically indicated, brain MRI may be obtained for\nfurther evaluation." + }, + { + "input": "CTA HEAD: The vessels of the circle of ___ and their principal intracranial\nbranches are patent, without high grade stenosis, occlusion,\nmalformation,aneurysm greater than 3 mm in sizeor other vascular abnormality. \nThe dural venous sinuses are patent. The right ___ vessel is visualized. \nThe left ___ is not visualized.\n\nCTA NECK: The carotid and vertebral arteries and their major branches are\npatent with no evidence of stenoses. There is no evidence of internal carotid\nstenosis by NASCET criteria.The carotid,vertebralandsubclavian artery origins\nare patent.\n\nLimited evaluation of the brain reveals a stable hypodensity involving\nmajority of the left cerebellar hemisphere without enhancement, suggestive of\na subacute infarct. No significant mass effect is seen. The ventricles,\nsulci and cisterns are patent. No intracranial hemorrhage is seen.\n\nThe visualized paranasal sinuses, mastoid air cells and middle ear cavities\nare clear. There is a soft tissue filling defect in the left external\nauditory canal, likely cerumen.\n\n\nOTHER: The visualized portion of the lungs are clear. The visualized portion\nof the thyroid gland is within normal limits. There is no lymphadenopathy by\nCT size criteria.", + "output": "1. Nonvisualization of left ___. Patent right ___ vessel.\n2. Otherwise, Normal head and neck CTA.\n3. Subacute infarct involving majority of the left cerebellar hemisphere as\ndescribed above." + }, + { + "input": "Patient is status post interval craniotomy and resection of left anterior\ntemporal lesion. Small hemorrhage at the site measures 13 mm in diameter not\nsignificantly changed from the MR allowing for differences in modality. White\nmatter abnormality associated with the lesion again extends into the more\nposterior temporal lobe and the left frontal lobe.\nThere is moderate pneumocephalus associated with recent surgery not\nsignificantly changed. There is mild rightward shift which is 4-5 mm that is\nagain stable. Ventricles are stable. Anticipated air is again present in\nsurrounding soft tissues. Visualized paranasal sinuses and mastoid air cells\nare clear.", + "output": "Status post craniotomy and left temporal lobe resection. Anticipated small\nhemorrhage, without significant interval change allowing for differences in\nmodality, at the site, as well as unchanged pneumocephalus." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, or large\nmass. Periventricular and subcortical white matter hypodensities are\ncompatible with the patient's history of multiple sclerosis. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "No hemorrhage or fracture." + }, + { + "input": "Again seen is hyperdense subdural blood layering in the left posterior\nconvexity, left temporal lobe, and along the falx, somewhat larger than on the\nprior study. Also somewhat increased since the previous examination is\ndiffuse left-sided subarachnoid hemorrhage. There are now scattered foci of\nright-sided subarachnoid hemorrhage. There is left-sided mass effect with\neffacement of sulci and of the left lateral ventricle. There is a slight\ndegree of left to right midline shift.\n\nThere is mixed hypo and hyperdensity in the left posterior temporal lobe that\nsuggest a component of intraparenchymal hemorrhage, likely due to hemorrhagic\ncontusion. There is no evidence of infarction, edema,or mass. \nAtherosclerotic calcifications are seen in the bilateral carotid siphons.\n\nThere is diastasis of the left lambdoid suture with overlying scalp hematoma. \nThere is no other evidence of fracture. There is mild mucosal thickening of\nthe ethmoid air cells. The remaining paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Mildly enlarged left-sided subdural hematoma compared to an outside CT of 2\nhours earlier.\n2. Mildly increased subarachnoid hemorrhage compared to the prior CT.\n3. Diastasis of the left lambdoid suture with overlying scalp hematoma.\n4. Probable left posterior temporal lobe hemorrhagic contusion" + }, + { + "input": "Re-demonstration is the hyperdense subdural blood layering in the left\nposterior convexity, left temporal lobe, along the falx without significant\ninterval changes. Subarachnoid blood in the left frontal, parietal, and\ntemporal lobes are unchanged. Foci of hyperdensity in the right (series 2,\nimage 25) and right temporal lobe (series 2, image 6) appears somewhat more\nconspicuous compared to hours prior, which likely reflects redistribution of\nsubarachnoid hemorrhage. No midline shift. The sulci and ventricles are\nunchanged. There is no evidence of large territorial infarction, edema,or\nmass.\n\nThere is no evidence of fracture. Soft tissue swelling in the left posterior\nscalp is again noted. Mild mucosal thickening of the ethmoid air cells is\nunchanged. The remaining paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Unchanged left subdural hematoma. Unchanged subarachnoid hemorrhage in the\nleft frontal, parietal, and temporal lobes.\n2. Right vertex and temporal lobe hyperdense foci appear somewhat more\nconspicuous compared to prior studies, likely reflecting redistribution of\narachnoid hemorrhage.\n3. Left posterior scalp soft tissue swelling." + }, + { + "input": "The study is somewhat limited by streak artifact.\n\nWithin this limitation, compared to the most recent prior study, the left\nsubdural continues to layer in the left posterior convexity, left temporal\nlobe, and along the falx. Slightly increased distribution of subarachnoid\nhemorrhage along the left frontal parietal and temporal lobes, within expected\nlimits for redistribution. There is increasing hypodensity of the left\ntemporal and parietal lobes with slightly increased prominence of parenchymal\nhemorrhage, compatible with evolving contusions. Hemorrhage along the right\nanterior temporal lobe is similar to prior exam.\n\nThere is increased subarachnoid hemorrhage layering along the right parietal\nand temporal convexity, slightly greater than would be expected for\nredistribution. Close attention on follow-up is recommended.\n\nA small amount of blood layers in the bilateral occipital horns of the lateral\nventricles, new from the prior study, but compatible with redistribution. No\nacute large territory infarct no midline shift.\n\nRe-identified is diastasis of the left lambdoid suture. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable. Soft\ntissue swelling of the left posterior scalp is improved. Enteric and\nendotracheal tubes are noted.", + "output": "1. Interval development of subarachnoid hemorrhage having the right parietal\noccipital convexity, slightly greater than would be expected for\nredistribution. Close attention on follow-up is recommended to exclude\nincreasing hemorrhage.\n2. Redistribution of left convexity subarachnoid hemorrhage and subdural\nhemorrhage. Hemorrhage within the bilateral ventricles are new from prior\nexam, but within expected limits for redistribution.\n3. Increased conspicuity of left temporal parietal lobe contusions and edema\npattern. Close attention on follow-up is recommended.\n4. No evidence for hydrocephalus.\n5. No evidence of acute large territorial infarction.\n6. Additional findings as described above.\n\nNOTIFICATION: The findings were discussed with Dr. ___. by Dr. \n___, M.D. on the telephone on ___ at 11:49 am, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "Tiny chronic subdural hematoma overlies left parietal lobe, measures 3 mm in\nthickness, compared with 0.8 cm on ___.\n\nThere is no evidence of acute infarction,hemorrhage,edema, or mass. Chronic\ninfarct left occipital, temporal lobe junction, similar to prior. Moderate\ngeneralized brain parenchymal atrophy, most prominent at the frontal lobes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Postoperative changes right orbit", + "output": "No acute findings.\nTiny chronic left subdural hematoma, decreased since prior.\nStable chronic infarct.\nBrain parenchymal atrophy." + }, + { + "input": "The study is limited by patient motion. The posterior fossa structures\nincluding the cerebellum are not adequately assessed.\n\nNo evidence of acute hemorrhage or mass are not identified. No definite\nevidence of acute infarct. Area of encephalomalacia, may be posttraumatic or\nchronic infarct, involving posterior left temporal, adjacent occipital lobe,\nsimilar compared with prior. Previously seen intracranial hemorrhage has\nnearly resolved, with small area of chronic subdural hemorrhage overlying left\nparietal lobe measuring 0.5 cm in thickness. Advanced generalized brain\nparenchymal atrophy, most prominent in the frontal lobes. No definite\nevidence of acute infarct.\n\nThe visualized portions of the cranium demonstrates no acute fracture. The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Significantly motion degraded exam.\n2. No definite acute hemorrhage.\n3. Intracranial hemorrhage has nearly resolved since prior, residual small\nchronic subdural hematoma is present. Chronic posttraumatic area of\nencephalomalacia or chronic infarct, again seen." + }, + { + "input": "There is no acute intra-axial or extra-axial hemorrhage, edema, shift of\nnormally midline structures, or evidence of acute major vascular territorial\ninfarction. There is a tiny subdural collection along the left parietal\nvertex measuring up to 4 mm, with density matching that of the adjacent brain\nsuggesting a subacute bleed. There is no associated mass effect. Again seen\nis a chronic focus of encephalomalacia in the left occipital lobe. Age\nrelated involutional changes are noted. Ventricles are stably prominent. \nBasal cisterns are patent. The imaged paranasal sinuses are well aerated. \nThe mastoid air cells and middle ear cavities are clear. Bony calvarium is\nintact.", + "output": "1. No acute hemorrhage.\n2. Tiny subacute left cerebral subdural hematoma measuring 4 mm.\n3. Chronic encephalomalacia left occipital lobe, unchanged." + }, + { + "input": "Subacute subdural hematoma measuring approximately 4 mm near the left parietal\nvertex is unchanged. No new hemorrhage or associated mass effect. No\nevidence of acute infarct, edema, or mass. Chronic focal encephalomalacia in\nthe left occipital lobe is unchanged. Again seen is moderate generalized\nbrain parenchymal atrophy, most prominent at the frontal lobes.\n\nLarge left frontal subgaleal hematoma is new. There is no evidence of\nfracture, especially underlying this hematoma. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavitiesare grossly\nclear. Postoperative changes re-demonstrated in the right orbit. The\nvisualized portion of the orbits are unchanged.", + "output": "1. Posttraumatic left frontal subgaleal hematoma without evidence of fracture.\n2. Stable subacute subdural hematoma. No new intracranial hemorrhage or\nassociated mass effect." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThe gray-white matter differentiation is intact without evidence of infarct,\nhemorrhage, mass, or mass effect. The ventricles and extra-axial spaces are\nunremarkable. The orbits, calvarium, and soft tissues are unremarkable. The\nparanasal sinuses and mastoid air cells are clear.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion or aneurysm formation. The dural\nvenous sinuses are patent. There is a left fetal origin posterior cerebral\nartery.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. There are multiple small\nbilateral hypodensities within the thyroid gland the largest of which measures\n8 mm in the posterior left gland (5:116). There scattered prominent, but not\npathologically enlarged deep cervical lymph nodes.", + "output": "1. Normal head CT.\n2. Patent intracranial and neck vasculature without stenosis, occlusion, or\naneurysm to\n3. Multiple small nodules within the thyroid gland measuring up to 8 mm, as\ndescribed. This could be further characterized with a dedicated neck\nultrasound." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Normal study." + }, + { + "input": "There is extensive thickening of the skin overlying the left malar eminence\nwith an apparent large ulceration or other defect. A small satellite area of\nskin thickening is present slightly superior to the bulk of the abnormality. \nThere is extensive induration of the subcutaneous tissues underlying the\nlesion. Thickening involves the left mass inner muscle with uncertain\ninvolvement of the lateral pterygoid muscle. The underlying bone appears\nnormal. No abnormal fluid collections are identified.\nOverall, the imaging appearance is more worrisome for neoplasm than infection.\nThere is no evidence of fracture, infarction, hemorrhage, edema, or\nintracranial mass. The ventricles and sulci are normal in size and\nconfiguration. There is no abnormal enhancement on post contrast images.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Large left malar eminence and infratemporal fossa skin lesion with\nunderlying tissue induration. Normal appearance of the bones and no evidence\nof abnormal fluid collections. Although either is possible, at the appearance\nsomewhat favors neoplasm over infection." + }, + { + "input": "Extensive area of increased density and thickening of the skin overlying the\nleft malar eminence and infratemporal fossa with induration of the underlying\ntissues. Deep excavated appearance of the left hyper dense lesion, is\nsuggestive of ulceration. There is probable involvement of the left temporalis\nmuscle. Left master muscle appears edematous. There is no evidence of\nabnormal fluid collection or lymphadenopathy. Lesion is close to the\nzygomatic arch, however there is no evidence of osseous extension.\n\nOtherwise evaluation of the aerodigestive tract demonstrates no mass and/or\nareas of focal mass-effect. The salivary glands enhance normally and are\nwithout mass or adjacent fat stranding. The thyroid gland appears normal. \nThe neck vessels are patent. Bilateral maxillary sinus mucous retention cysts\nare appreciated.\n\nThe imaged portion of the lung apices are clear.\n\nThe visualized portion of the brain parenchyma appears grossly unremarkable. \nPlease see concurrent contrast enhanced CT head for further evaluation.", + "output": "1. Extensive area of increased density and thickening of the skin overlying\nthe left malar eminence and infratemporal fossa with induration of the\nunderlying tissues. There is no evidence of osseous involvement. There is no\nevidence of an abnormal fluid collection or lymphadenopathy, therefore\nfavoring neoplasm versus an infectious etiology." + }, + { + "input": "Please note that there is motion artifact which limits evaluation of\nintracranial structures. Within these limitations, there is no large acute\ninfarct or definite intracranial bleed. No midline shift. There is\nprominence of the ventricles and sulci suggestive of involutional changes,\nunchanged. Atherosclerotic calcifications are seen in both carotid siphons.\n\nThere is no evidence of fracture. A mucous retention cyst is seen in the\nright maxillary sinus. There is moderate mucosal thickening in the left\nmaxillary sinus. Otherwise, the remaining visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Please note there is motion artifact which limits evaluation of\nintracranial structures. Within these limitations, no large acute infarct or\nobvious intracranial bleed.\n2. Moderate paranasal sinus disease, as described above." + }, + { + "input": "CT HEAD:\nThere is a large, intraparenchymal hemorrhage centered within the medial left\ncerebellar hemisphere and cerebellar vermis. This extends inferiorly into the\nforamina magnum, and superiorly into the fourth ventricle. This results in\nmild mass effect along the posterior aspect of the pons and medulla, resulting\nin mild anterior displacement.\n\nThere is no evidence for supratentorial, intracranial hemorrhage. No large\nvascular territorial infarction within limitations of CT.\n\nThe lateral ventricles, third ventricle, and sulci are all prominent,\ncompatible with global parenchymal volume loss. Evaluation for obstruction is\ndifficult at this early point, as the fourth ventricle is filled with\nhemorrhage.\n\n Periventricular and subcortical white matter hypodensities are noted, a\nnonspecific finding that most likely represents the sequelae of chronic small\nvessel ischemic disease.\n\nThere is no evidence for acute skull fracture. Mild mucosal thickening is\nseen in scattered ethmoid air cells. The remainder of the paranasal sinuses,\nmiddle ear cavities, and mastoid air cells are clear. The orbits are grossly\nunremarkable bilaterally.\n\n\nCTA HEAD AND NECK:\nThere is a normal 3 vessel aortic arch. The vertebral arteries are patent\nwithout high-grade stenosis or occlusion.\n\nThe bilateral common carotid arteries are patent. There is no evidence of\ninternal carotid stenosis by NASCET criteria.\n\nThe bilateral posterior communicating arteries are patent, normal variant. \nAllowing for this, the intracranial vasculature is grossly patent without\nhigh-grade stenosis, occlusion, or aneurysm greater than 3 mm.\n\nAlong the inferior, medial aspect of the left tentorium, there is a tangle of\nirregular vessels which measures approximately 8 x 4 mm (3:252), and which\ndrains into the left internal cerebral vein, suspicious for an arteriovenous\nmalformation. No convincing evidence for active arterial extravasation at\nthis time.\n\n\nOTHER:\nA trace right-sided pleural effusion with adjacent atelectasis is noted. \nOtherwise, no large consolidation or suspicious pulmonary nodule. An\nendotracheal tube is noted terminating at the lower thoracic trachea. The\nthyroid gland is unremarkable in appearance. There is no cervical\nlymphadenopathy by CT size criteria.", + "output": "1. Large intraparenchymal hemorrhage centered within the left medial\ncerebellar hemisphere and cerebellar vermis, with surrounding edema and mild\nmass effect.\n2. Extension of hemorrhage into the foramina magnum inferiorly, and into the\nfourth ventricle superiorly with mild mass effect along the posterior aspects\nof the pons and medulla.\n3. 8 x 4 mm tangle of irregular vessels along the inferior medial aspect of\nthe left tentorium within the posterior fossa, draining into the left internal\ncerebral vein. Findings are suspicious for an AVM, and could be further\ncharacterized by cerebral angiography.\n4. Otherwise, grossly patent intracranial and cervical vasculature with\nwithout high-grade stenosis, occlusion, or dissection. No definite aneurysm\nis identified.\n5. Moderate global parenchymal volume loss. No definite evidence for\nventricular obstruction at this time.\n6. Evidence of chronic small vessel ischemic disease." + }, + { + "input": "Patient is status post right frontal approach external ventricular drain\nplacement with its tip terminating in the frontal horn of the right lateral\nventricle. There is associated right frontal pneumocephalus. Again seen is\nthe infratentorial hematoma, eccentrically centered at the left cerebellum,\nextending into the foramina magnum and fourth ventricle. There is also small\namount of layering intraventricular blood in the occipital horn of the\nbilateral lateral ventricles. When compared to CTA head and neck performed 2\nhours prior, there is slight change in configuration but no significant\nincrease in size. The ventricles and sulci are grossly unchanged in size and\nconfiguration. Effacement of the pre pontine cistern is unchanged. No\nmidline shift. No evidence of tonsillar herniation. No new hemorrhage or\nlarge territorial infarction is identified. Periventricular hypodensities are\nagain noted, which could represent transependymal flow and/or chronic small\nvessel ischemic changes.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nethmoid air cells. The remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Status post right frontal approach external ventricular drain placement\nwith associated pneumocephalus without significant interval changes of the\nventricular configuration or size.\n2. Overall unchanged infratentorial hematoma eccentrically centered at the\nleft cerebellum, extending into the foramina magnum and fourth ventricle with\nunchanged local mass effect. Unchanged small amount of layering blood in the\noccipital horns of the bilateral lateral ventricles. No new intracranial\nhemorrhage." + }, + { + "input": "Patient is status post right frontal approach EVD catheter with tip\nterminating in the frontal horn of the right lateral ventricle. There is\nagain associated right frontal pneumocephalus, slight improved compared to\nprior.\n\nRe-demonstration of the left cerebellar and vermian intraparenchymal hematoma\nwith extension into the fourth ventricle, the quadrigeminal cistern, the\nforamen magnum, as well as a small amount of layering intraventricular blood\nin the occipital horns bilaterally, overall similar to minimally increased\nfrom prior. Effacement of the prepontine cistern is similar to prior. No\nevidence of tonsillar herniation. No new hemorrhage. There is no midline\nshift. The size and configuration of lateral ventricles are similar to prior.\nSmall bilateral tentorial subdural hematomas are similar to prior, measuring\nup to 3 mm in thickness.\n\nThere is no evidence of infarction.\n\nThere is no evidence of fracture. Skin staples in the right frontal region\nagain demonstrated. Mild mucosal thickening of the ethmoid air cells are\nagain noted. The visualized portion of the remaining paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. Right frontal approach EVD catheter with slightly improved pneumocephalus.\n2. Left cerebellar hemisphere and vermian intraparenchymal hematoma with\nextension to the fourth ventricle, foramen magnum and basal cisterns are\nunchanged compared to prior. No evidence of tonsillar herniation. Small\nbilateral tentorial subdural hematomas are similar to prior.\n3. No new foci of hemorrhage." + }, + { + "input": "A right frontal approach ventriculostomy catheter seen with the tip\nterminating near the right foramen of ___. There is similar appearance of a\nlarge left cerebellar hemisphere and vermian intraparenchymal hematoma with\nextension into the fourth ventricle, foramen magnum, and basilar cisterns\nsince ___. Small layering intraventricular hemorrhages are noted\nin the occipital horns of the lateral ventricles, unchanged. Small bilateral\ntentorial subdural hematomas are similar to the prior studies dating back to\n___. Effacement of the prepontine cistern is also similar to\nprior.\n\nNo evidence tonsillar herniation. No acute large major infarct is identified.\nThe ventricles remain enlarged, but unchanged. There is no new hemorrhage or\nmidline shift. There has been interval redistribution of a small amount of\nknown left frontal pneumocephalus.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Patient is intubated.", + "output": "1. Overall, similar appearance of a large left cerebellar hemisphere and\nvermian intraparenchymal hemorrhage with extension to the fourth ventricle,\nforamen magnum, and basilar cisterns since ___. No new acute\nlarge infarct or new intracranial hemorrhage.\n2. Small layering intraventricular hemorrhages in the occipital horns of the\nlateral ventricles are unchanged.\n3. Small bilateral tentorial subdural hematomas are similar to prior exams.\n4. Right frontal approach ventriculostomy catheter is in unchanged position." + }, + { + "input": "Since the previous study the patient has undergone posterior fossa craniectomy\nfor decompression. Previously seen blood products in the superior cerebellar\nregion have decreased. Pneumocephalus is identified. The mass effect has\nalso slightly decreased. There is a right frontal ventricular drain entering\nto the anterior horn. No new hemorrhage is seen. The ventricular size has\nslightly decreased but the ventricles remained somewhat dilated.", + "output": "1. Posterior fossa craniectomy for removal of intra cerebellar hematoma. \nExpected postsurgical changes are seen. No new hemorrhage.\n2. Slightly decreased ventricular size which remain somewhat prominent." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nPatient is status post suboccipital craniectomy and evacuation of posterior\nfossa hematoma. Pneumocephalus has decreased. There is suboccipital fluid\ncollection measuring 6.6 cm transverse by 3.9 cm AP, which contains a small\namount of air, with decreased air and increased fluid compared to ___.\n\nResidual posterior fossa blood products have decreased compared to ___. There is persistent bilateral cerebellar edema with effacement of the\nfourth ventricle. Right frontal approach ventriculostomy catheter terminates\nnear the right foramen of ___. Lateral and third ventricles are smaller\ncompared to ___. Small amount of blood in the occipital horns of\nthe lateral ventricles is stable. No evidence for new hemorrhage or edema. \nMild age-related prominence of the cerebral sulci is again noted.\n\nThere is trace fluid in the left sphenoid sinus. A right posterior ethmoid\nair cell is opacified. There is mild mucosal thickening in other bilateral\nethmoid air cells, as well as along the floors of the maxillary sinuses and in\nthe right sphenoid sinus. There is mild partial opacification of bilateral\ndependent mastoid air cells. The fluid and the partial mastoid air cell\nopacification may be secondary to prolonged supine positioning in the\ninpatient setting.\n\nCTA NECK:\nThere is a 3 vessel aortic arch. Cervical carotid arteries are widely patent\nwithout stenosis by NASCET criteria. Cervical vertebral arteries are also\nwidely patent.\n\nCTA HEAD:\nThere is a small tangle of blood vessels along bilateral lower vermis,\ncorresponding to the partially resected AVM diagnosed on prior conventional\ncerebral angiography, with apparent arterial supply from the left ___ and\ndrainage into the straight sinus. There is an additional small tangle of\nvessels along the anterior superior aspect of the left cerebellum, image\n3:257, corresponding to the second AVM diagnosed on prior conventional\ncerebral angiography, with apparent arterial supply from the left superior\ncerebellar artery and drainage into the left internal cerebral vein. However,\nrete renal supply and venous drainage are better assessed on the preceding\nconventional cerebral angiography. There is no evidence for flow-limiting\nstenosis or aneurysm in the major intracranial arteries. Dural venous sinuses\nare patent, with dominance of the right transverse sinus, right sigmoid sinus,\nand right internal jugular vein again noted.\n\nOTHER:\nEndotracheal and orogastric tubes are present. The thyroid is grossly\nunremarkable. Partially visualized subsegmental dependent pulmonary opacity\nin the posterior right upper lobe could represent aspiration, pneumonia,\nversus asymmetric focal atelectasis. There is also mild dependent atelectasis\nin the included upper left lung. Small left pleural effusion is partially\nvisualized, and trace right pleural fluid cannot be excluded. There are\ndegenerative changes in the cervical spine.", + "output": "1. Compared to ___, residual posterior fossa blood products have\ndecreased. Cerebellar edema persists with compression of the fourth\nventricle. Right frontal ventriculostomy catheter remains in place, and\ndilatation of the lateral and third ventricles has decreased.\n2. Suboccipital fluid collection overlying the craniectomy site, with less air\nand more fluid compared to ___.\n3. Essentially normal neck CTA.\n4. Partially resected AVM along bilateral lower vermis and a second AVM\nanterior to the left superior cerebellum are again demonstrated, with arterial\nsupply and venous drainage discussed above, better assessed on prior\nconventional cerebral angiography.\n5. Partially visualized subsegmental dependent pulmonary opacity in the\nposterior right upper lobe could represent aspiration, pneumonia, or\nasymmetric focal atelectasis. Partially visualized small left pleural\neffusion and possible trace right pleural fluid." + }, + { + "input": "Patient is status post suboccipital craniectomy and resection of cerebellar\nAVM. Right frontal approach ventriculostomy catheter terminates at the right\nforamina ___. Small amount of intraventricular hemorrhage at the lateral\nventricle posterior horns are similar to before. Hypodense appearance of the\ncerebellar vermis and pons is also similar to before. There is persistent\ncompression of the fourth ventricle. Small amount of fluid and air is noted\nin the subcutaneous tissues overlying the suboccipital craniectomy.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Postsurgical changes are noted related to suboccipital craniectomy and\ncerebellar AVM resection.\n2. Hypodense appearance of the cerebellar vermis and pons is similar to ___. There is persistent compression of the fourth ventricle." + }, + { + "input": "The patient is status post suboccipital craniectomy for resection of a\ncerebellar AVM. Hypodense appearance of the cerebellar vermis and pons is\ngrossly unchanged. There remains persistent attenuation of the fourth\nventricle. Trace blood products layer in the posterior horns of the lateral\nventricles, similar to prior. A right frontal approach ventriculostomy\ncatheter terminates in the anterior horn of the right lateral ventricle, in\nunchanged position. Ventricular size is stable. No new hemorrhage or acute\nlarge territorial infarct. Periventricular and subcortical white matter\nhypodensities are nonspecific, but likely reflect sequelae of chronic small\nvessel ischemic disease. There is prominence of the sulci, suggestive of\ninvolutional changes.\n\nThere been an interval increase in the fluid collection overlying the\nsuboccipital craniectomy site, now measuring 6.1 x 2.5 cm.\n\n The visualized portion of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Ventricular size is unchanged in comparison with ___.\n2. Continued evolution of postsurgical changes following a suboccipital\ncraniectomy.\n3. Similar appearance of edema primarily within the cerebellar vermis and pons\nwith associated attenuation of the fourth ventricle.\n4. Unchanged trace intraventricular hemorrhage." + }, + { + "input": "The patient is status post suboccipital craniectomy. Increased hypodensity of\nthe vermis, bilateral middle cerebellar peduncles, dentate gyrus and pons\n(series 3, image 11) is similar to examination of ___, but\nslightly increased since examination ___. Mild effacement of the\nfourth ventricle is unchanged.\n\nThe remaining gray-white matter differentiation is maintained. Trace of blood\nproducts in the posterior horns of lateral ventricles, slightly decreased\nsince prior. A right frontal approach ventriculostomy catheter terminates in\nthe anterior horn of the right lateral ventricle, unchanged since prior. \nVentricular size is stable since ___, and decreased in size since\n___. No new hemorrhage.\n\nThe fluid collection overlying the sub occipital craniectomy site is grossly\nstable, measuring 6.2d x 2.5 cm.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Ventricular size is unchanged since ___.\n2. Decreased in the amount of intraventricular hemorrhage.\n3. Similar appearance of the postsurgical changes of suboccipital craniectomy.\n4. Similar appearance of the cerebellar edema." + }, + { + "input": "When compared to the head CT performed earlier today, there is interval\nincrease in the right frontal subcutaneous emphysema surrounding entry site of\nthe right frontal approach ventriculostomy catheter. Pneumocephalus tracks\nalong the catheter's trajectory. Please note that the tip of the catheter\ndoes not terminate within the ventricle, it terminates within parafalcine\nregion of the right frontal lobe anterior to the anterior horn of the right\nlateral ventricle (301:139). Dependent hyperdense blood is again seen within\nthe bilateral occipital horns of the lateral ventricles, overall similar to\nprior. The ventricles remain prominent in size, unchanged from earlier today.\n\nThere is unchanged hypodensity of the cerebellar vermis, bilateral middle\ncerebellar peduncles, dentate gyrus and pons which continues to demonstrate\nmild effacement of the fourth ventricle, similar to most recent prior.\n\nPost suboccipital craniectomy changes including the 6.3 x 2.6 cm extra-axial\nfluid collection overlying the craniectomy site are unchanged from earlier\ntoday.\n\nThere is no evidence of acute large territorial infarction.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Status post placement of right frontal approach VP shunt, please note that\nthe tip of the catheter does not terminate within the ventricle, it terminates\nwithin parafalcine region of the right frontal lobe anterior to the anterior\nhorn of the right lateral ventricle.\n2. Increased right frontal subcutaneous emphysema in keeping with recent\nprocedure.\n3. Unchanged prominence of the bilateral lateral ventricle with small amount\nof dependent blood in the occipital horns.\n4. Stable post suboccipital craniectomy changes including the 6.3 x 2.6 cm\nextra axial fluid collection overlying the craniectomy site.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 7:46 pm, 3 minutes after\ndiscovery of the findings." + }, + { + "input": "Postoperative changes right VP shunt plate it prior right frontal burr hole,\npostoperative changes in the scalp soft tissues. VP shunt seems terminate in\nthe brain parenchyma anterior to the right frontal horn. Pneumocephalus has\nmildly improved. Small volume intraventricular blood products, likely\nprocedure related, stable mildly prominent ventricular size, stable since\nprior. Generalized brain parenchymal atrophy. Hypodensities in bilateral\ncerebral hemispheres may represent moderate chronic small vessel ischemic\nchanges, periventricular edema related to enlarged ventricular system is\npossible.\n\nThere is persistent hypodensity in the cerebellar vermis, bilateral middle\ncerebellar peduncles, dentate gyrus, and pons, which continues to demonstrate\nmild effacement of the fourth ventricle, similar to prior, may be procedure\nrelated..\n\nPatient is status post suboccipital craniectomy with unchanged postoperative\nchanges, including a 6.3 x 2.6 cm extra-axial fluid collection overlying the\ncraniectomy site (previously 6.3 x 2.6 cm).\n\nThere is no evidence of acute large territorial infarction. Generalized brain\nparenchymal atrophy.\n\nThere is no evidence of acute fracture. There is mild mucosal thickening of\nthe bilateral ethmoid air cells. Additionally, there is unchanged partial\nopacification of the bilateral mastoid air cells. The visualized portion of\nthe remain paranasal sinuses and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. VP shunt placement, tip seems to terminate anterior to the right frontal\nhorn in the brain parenchyma.\n2. Unchanged ventricular size, trace intraventricular blood products.\n3. Stable post suboccipital craniectomy, low-attenuation changes throughout\ncerebellum which may be sequela of prior hemorrhage or procedure related. \nUnchanged 6.3 x 2.6 cm extra-axial fluid collection overlying the craniectomy\nsite, may be procedure related, pseudomeningocele cannot be excluded.." + }, + { + "input": "The patient is status post suboccipital craniectomy with redemonstration of a\nlarge fluid collection which appears mildly increased since prior and measures\n7.2 x 3.7 cm. The collection appears to track more inferiorly, extending to\nthe level of C1.\n\nThe tip of a right frontal ventriculostomy drain is again noted to terminate\nwithin the parafalcine region of the right frontal lobe anterior to the\nanterior horn of the lateral ventricle. The size of the ventricles are\nhowever unchanged since prior. There is no pneumocephalus. Hyperdense blood\nis seen within both occipital horns of the lateral ventricles, not\nsignificantly changed since prior.\n\nUnchanged hypodensities within the cerebellar vermis, middle cerebellar\npeduncles, dentate gyrus and pons with continued mild effacement of the fourth\nventricle. There is no large territorial infarction.\n\nNo acute fracture. There is a small air-fluid level in the left sphenoid\nsinus. The orbits are unremarkable.", + "output": "1. Post suboccipital craniectomy with mild increase in size of a large fluid\ncollection adjacent to the craniectomy site.\n2. The tip of the right frontal approach VP shunt catheter does not terminate\nwithin the ventricle, but rather in a parafalcine location within the right\nfrontal lobe, similar in appearance and placement to the CT head dated ___.\n3. Unchanged ventricular size with a small amount of hemorrhage layering\ndependently in the except it'll horns bilaterally." + }, + { + "input": "Patient is status post occipital craniectomy. Again redemonstrated the 3.7 x\n7.2 cm soft tissue fluid collection, which has been partially imaged in\ntoday's study.\nAgain seen the tip of the right frontal ventriculostomy drain in the same\npara-falcine position. Ventricles appear prominent but unchanged since prior\nstudy. Residual dependent hemorrhage in the occipital horns of the lateral\nventricles, decreased since prior.\n\nPeriventricular and white matter hypodensities are nonspecific, and unchanged\nsince prior studies.\n\nThere is no large vascular territory infarction, new hemorrhage. Mild and\nbilateral brain parenchymal atrophy.\n\nThere is no evidence of acute fracture. Mild mucosal thickening of the\nethmoid air cells with opacification of a single right posterior ethmoid air\ncell. Mild dependent fluid in the right sphenoid sinus. The orbits are\nunremarkable. The mastoid air cells are clear.", + "output": "1. Post suboccipital craniectomy with adjacent large fluid collection, similar\nin size.\n2. The ventricles are prominent, but unchanged in size from prior examination.\n3. Decrease amount of blood products in the lateral ventricles.\n4. Again seen the tip of the great from the ventriculostomy catheter in the\nright parafalcine location.\n5. No acute large territory infarct. No new hemorrhage. Additional findings\nas described above." + }, + { + "input": "A right frontal ventriculoperitoneal shunt catheter terminates in the right\nparafalcine parenchyma, unchanged from ___ (02:14). The patient is\nstatus post suboccipital craniectomy, and there is a 5.5 x 7.2 cm fluid\ncollection in the surgical bed and imaged posterior neck soft tissues,\nslightly increased from ___ (2:5). The ventricles are slightly more\nprominent in comparison to ___.\n\nThere is resolution of hemorrhage in the ventricles. No new or enlarging\nintracranial hemorrhage, evidence of acute large territorial infarct, edema or\nmass. The sulci are prominent, compatible with involutional changes. \nSubcortical white matter hypodensities are nonspecific but likely reflect\nsequelae of chronic small vessel ischemic disease.\n\nWith the exception of mild anterior ethmoid air cell mucosal thickening, the\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial hemorrhage, edema or evidence of acute large\nterritorial infarct.\n2. Slight increase in the prominence of the lateral and third ventricles in\ncomparison with ___. Stable position of the ventriculostomy catheter\nterminating in the right parafalcine parenchyma.\n3. Interval slight increase in the size of a fluid collection adjacent to the\nsuboccipital craniectomy site, now measuring 5.5 x 7.2 cm." + }, + { + "input": "Study is degraded by motion. Right frontal approach ventricular peritoneal\nshunt catheter terminates in the right parafalcine parenchyma, unchanged. \nPatient is status post suboccipital craniectomy. Partially imaged fluid\ncollection at the surgical bed 6.7 x 5.2 cm is not significantly changed from\nbefore. Enlarged ventricles are stable compared to 1 day ago, but larger\ncompared to ___.\n\nThere is no evidence of infarction, hemorrhage, edema, or mass.\n\nPeriventricular white matter hypodensities are unchanged and may reflect\nchronic small vessel disease. Prominent sulci are likely related to\ninvolutional changes.\n\nMild partial opacification of right ethmoid air cell is noted. Minimal amount\nof fluid is noted in the left sphenoid sinus. The visualized portion of the\norbits are preserved. Multiple metallic markers are noted on the skin. Soft\ntissue densities are noted within bilateral external auditory canals which may\nrepresent cerumen.", + "output": "1. Study is degraded by motion.\n2. No definite interval change identified.\n3. Ventriculomegaly is stable from 1 day ago, but larger compared to ___.\n4. Stable position of right frontal approach VP shunt terminating in the\nparafalcine right frontal parenchyma.\n5. Grossly stable suboccipital craniectomy site fluid collection, as\ndescribed." + }, + { + "input": "Right frontal approach ventriculostomy catheter terminates in right lateral\nventricle anterior horn. Small focus pneumocephalus is noted in the right\nanterior horn. Patient is post suboccipital craniectomy and AVM resection. \nFluid collection the craniectomy site measures 7.3 x 0.9 cm, slightly larger\nfrom 6.7 x 5.2 cm 7 hours ago. There is no evidence of infarction,\nhemorrhage, edema, or mass. Enlarged ventricles are unchanged in size\ncompared to 7 hours ago.\n\nThere is no evidence of fracture. Small amount of fluid is noted in the left\nsphenoid sinus. The visualized portion of the orbits are unremarkable.", + "output": "1. Right frontal approach ventriculostomy catheter terminates in the right\nlateral ventricle anterior horn.\n2. Ventriculomegaly is unchanged compared to 7 hours ago.\n3. Fluid collection in the suboccipital craniectomy site is larger compared to\n7 hours ago." + }, + { + "input": "Right frontal approach ventriculostomy catheter is again seen. Ventricular\nsize and configuration is unchanged. Patient is status post suboccipital\ncraniectomy. Fluid collection along the postsurgical site is decreased in\nsize, now approximately 3.7 cm AP (602:46), previously 5.5 cm. \nPeriventricular and subcortical white matter hypodensities are likely sequela\nof chronic small vessel disease. Hypodensities in the cerebellar hemispheres\nare compatible with previously seen parenchymal hemorrhages.\n\nIncluded paranasal sinuses and mastoids are essentially clear besides partial\nopacification of right posterior ethmoid air cells. Skull and extracranial\nsoft tissues are unremarkable.", + "output": "Right frontal approach ventriculostomy catheter with stable configuration of\nthe ventricles. No acute intracranial hemorrhage.\nPostoperative changes of suboccipital craniectomy and decrease in size of the\nfluid collection at the postoperative site." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. Old right caudate head lacunar\ninfarct is noted\n\nNo osseous abnormalities seen. There is minimal mucosal thickening of the\nethmoidal air cells and bilateral maxillary sinuses. Otherwise the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are prominent compatible with global volume\nloss. Scattered periventricular and subcortical white matter hypodensities\nare likely sequela of chronic small vessel disease. Basilar cisterns are\npatent. Atherosclerotic calcifications noted in the intracranial ICAs\nbilaterally.\n\nIncluded paranasal sinuses and mastoids are essentially clear noting mild\nmucosal thickening in the ethmoid air cells and partially opacified mastoid\ntips bilaterally. Skull and extracranial soft tissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Sulci are\nnormal in size and configuration for patient's age. There is nonspecific mild\nasymmetry of the lateral ventricles, with the left lateral ventricle noted to\nbe slightly larger than the right, without evidence of ventriculomegaly. \nAtherosclerotic vascular calcifications are noted of bilateral vertebral and\ncavernous portions of internal carotid arteries.\n\n The visualized osseous structures are osteopenic. No osseous abnormalities\nseen. The paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. There has been left lens placement.", + "output": "1. No acute intracranial process.\n2. No evidence acute intracranial hemorrhage or fracture." + }, + { + "input": "There is a large mixed attenuation intraparenchymal hemorrhage involving the\nright frontal lobe in the midline and subarachnoid extension tracking along\nthe cingulate sulcus posteriorly into the region of the posterior corpus\ncallosum the superior component measures approximately 5.1 x 2.9 4.5 cm (3:25,\n104b:53). The inferior, posterior component measures 2.9 x 2.7 x 1.4 cm\n(104b:64, 3:19). A smaller right frontal intraparenchymal hemorrhage measures\napproximately 1.3 x 1.2 cm (03:26). There is also subarachnoid hemorrhage\nalong the bilateral frontal gyri. There is approximately 8 mm leftward shift\nof normally midline structures, best appreciated on coronal view (104b:43). \nThe suprasellar and quadrigeminal plate cisterns remain patent at this time. \nEncephalomalacia identified in the left frontal lobe from prior\nintraparenchymal hemorrhage in ___. There is mild asymmetry of the left\nlateral ventricle temporal horn, slightly more prominent compared to\nexamination ___. Close attention for developing hydrocephalus is\nrecommended.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Large mixed attenuation intraparenchymal hemorrhage involving the medial\nright frontal lobe with subarachnoid extension along the cingulate sulcus,\ntracking posteriorly into the region of the posterior corpus callosum.\nSubarachnoid hemorrhage in in the adjacent bilateral frontal gyri. The\nhemorrhage measures up to 5.1 cm superiorly and 2.9 cm inferiorly. There is\nassociated 8 mm leftward shift of normally midline structures.\n2. Smaller right frontal intraparenchymal hemorrhage measures 1.3 cm.\n3. The basilar cisterns remain patent at this time.\n4. Mild asymmetry of the left lateral ventricle temporal horn. Close\nattention on followup examination is recommended to exclude developing\nhydrocephalus.\n5. Given the presence of multiple prior hemorrhages, this may represent\namyloid angiopathy.\n\nNOTIFICATION: The above findings were communicated via telephone by Dr.\n___ to Dr. ___ in the ED at 9:30 on ___, 1 min after\ndiscovery." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits, aside from a 6 mm hypodense nodule in\nthe right thyroid lobe, which requires no specific follow-up imaging. There is\nno lymphadenopathy by CT size criteria.", + "output": "Normal head and neck CTA." + }, + { + "input": "Head CT: There is an unchanged region of low attenuation in the left anterior\nfrontal lobe. There is no evidence of hemorrhage. There is no evidence of\nextra-axial collection, mass effect, or midline shift. The ventricles and\nsulci are normal in caliber and configuration. The orbits are unremarkable.\nNo fractures are identified. There is mucosal thickening with in the right\ngreater than left maxillary sinuses with a superimposed left maxillary sinus\nmucous retention cysts. Remaining paranasal sinuses and mastoid air cells are\nclear.\n\nHead CTA: There are no intracranial vascular abnormalities. There is no\nevidence of aneurysm, stenosis or occlusion. There is a hypoplastic right A1\nartery noted.\n\nNeck CTA: There is moderate arthrosclerotic calcification of the thoracic\naortic arch. The carotid and vertebral arteries and their major branches are\npatent with no evidence of stenoses. There is calcification of the right\ngreater than left carotid bifurcations with atherosclerotic disease. There\nis no evidence of internal carotid stenosis by NASCET criteria. The distal\nleft common carotid artery measures 4.5 mm and the distal l right internal\ncarotid artery measures 3.5 mm.\n\nThe thyroid gland enhances heterogeneously with several bilateral focal\nhypodense lesions noted. The lung 8apices are clear. Degenerative changes are\nnoted in the spine.", + "output": "1. No significant interval change in region of low attenuation in the left\nanterior frontal lobe. No evidence of hemorrhage.\n\n2. No evidence of aneurysm, malformation, stenosis, or occlusion on head CTA.\n\n3. No significant stenosis by NASCET criteria on Neck CTA.\n\n4. Heterogeneously enhancing thyroid gland with several bilateral discrete\nnodules. If not already performed, a dedicated thyroid ultrasound could be\nobtained on a non urgent basis for further evaluation." + }, + { + "input": "Study is mildly degraded by motion. There is no evidence of acute large\nterritorial infarction,hemorrhage,edema, or mass. There is prominence of the\nventricles and sulci suggestive of involutional changes. There are\nperiventricular and subcortical hypodensities, which may represent small\nvessel ischemic changes. Atherosclerotic vascular calcifications are noted of\nbilateral vertebral and cavernous portions of internal carotid arteries.\n\nThere is no evidence of fracture. There is mucosal thickening of the right\nsphenoid sinus and right frontal sinus. Minimal nonspecific right mastoid\nfluid is noted. The visualized portion of the middle ear cavities are clear. \nThe visualized portion of the orbits are preserved. Soft tissue density is\nnoted within the left external auditory canal, which may represent cerumen.", + "output": "1. Study is mildly degraded by motion.\n2. No acute intracranial abnormality.\n3. Within limits of study, no definite evidence of acute intracranial\nhemorrhage or fracture.\n4. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described.\n5. Paranasal sinus disease and nonspecific minimal right mastoid fluid, as\ndescribed." + }, + { + "input": "No fluid collection is identified in the neck. The fat planes of the\nsuprahyoid and infrahyoid neck compartments are preserved. Evaluation of the\naerodigestive tract demonstrates no exophytic mass, nor areas of focal mass\neffect. Evaluation of the cervical lymph chains demonstrate numerous prominent\nlymph nodes, particularly in levels 2 a and 2 B as well as in the\nsubmandibular region, some of them measuring up to 13 x 14 mm in sagittal\nprojection (image 42, series 301b), please note that this examination is\nlimited without contrast. The visualized salivary glands are unremarkable in\nappearance. No thyroid mass is seen. Upper lung fields are clear. No bony\nabnormality is seen. No significant degenerative changes of the cervical\nspine are identified.", + "output": "1. No evidence of fluid collection.\n\n2. Numerous bilateral prominent lymph nodes as described above, suggestive of\nlymphadenopathy." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, or acute major\nvascular territorial infarction. Ventricles, sulci, and basal cisterns are\nnormal in size. Cerebellar tonsils are normally positioned. Mild\nperiventricular and subcortical white matter hypodensities are nonspecific but\nmost likely sequela of mild chronic small vessel ischemic disease in this age\ngroup.\n\nThere is no evidence of displaced fracture. There is mild mucosal thickening\nof the anterior ethmoid air cells and visualized upper portions of the\nmaxillary sinuses. There are aerosolized secretions in the left sphenoid\nsinus. Mastoid air cells and middle ear cavities appear well-aerated. The\nvisualized portion of the orbits are unremarkable. A nonenlarged,\nmorphologically normal lymph node is incidentally noted in the partially\nvisualized right parotid gland.", + "output": "1. No evidence for subdural hematoma or acute intracranial abnormalities.\n2. No evidence for a calvarial fracture.\n3. Aerated secretions in the left sphenoid sinus may indicate acute sinusitis\nin the proper clinical setting. Please correlate with symptoms." + }, + { + "input": "There is no evidence of large territorial infarction, acute intracranial\nhemorrhage, edema, or mass effect. The ventricles and sulci are normal in\nsize and configuration.\n\nThere is no evidence of fracture. Incidental note is made of partial\nopacification of the bilateral mastoid air cells, left greater than right. \nThe visualized portion of the paranasal sinuses and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial hemorrhage or evidence of paranasal mucosal sinus\nthickening.\n\n2. Incidental note of partial opacification of the bilateral mastoid air\ncells, left greater than right." + }, + { + "input": "No fractures are identified.\nThere is no evidence of facial swelling.\nThere is minimal mucosal thickening of the left sphenoid sinus. Otherwise,\nthe visualized paranasal sinuses are well aerated.\nThere is no evidence of abnormal fluid collections.\nBilateral mastoids appear normal.\nThe globes, extraocular muscles, optic nerves, and retrobulbar fat appear\nnormal.\nThe visualized upper aerodigestive tract appears normal.\nThe mandible appears normal. There is mild anterior displacement of the head\nof the right mandibular condyle in the right temporomandibular joint relative\nto the left side. There does not appear to be a frank dislocation.", + "output": "Mild anterior displacement of the head of the right mandibular condyle in the\nright temporomandibular joint relative to the left side. Correlation with\npatient's site of pain is recommended as this could be unrelated to trauma. \nNo frank dislocation. No fracture." + }, + { + "input": "Compared to study 13 hours prior there is no significant interval change.\nAgain noted is small foci of subarachnoid hemorrhage in the right frontal lobe\n(02:14). Stable 4 mm small hemorrhagic contusion along the course of the\nright occipital bone fracture at the periphery of the mid right cerebellar\nhemisphere (2:70). No new intracranial hemorrhage. No mass effect or shift of\nmidline structures. Prominence of the ventricles are out of proportion to\npatient's age and may represent communicating hydrocephalus or age related\ncentral atrophy. Periventricular, subcortical and deep white matter\nhypodensities are likely sequelae chronic small vessel ischemic disease. The\nbasal cisterns are patent and there is overall preservation of gray-white\nmatter differentiation. No evidence of herniation. Stable small right\nposterior scalp subgaleal hematoma.\n\nStable right occipital bone fracture which does not extend into the foramen\nmagnum or occipital condyle. Visualized paranasal sinuses, mastoid air cells\nand middle ear cavities are clear. The maxillary sinuses are underpneumatized.\nThe globes are notable for bilateral surgery.", + "output": "1. Stable small right frontal subarachnoid hemorrhage without associated mass\neffect or shift of midline structures. No central herniation.\n\n2. Enlarged ventricles, as before, may represent age-related central atrophy\nor communicating hydrocephalus in the proper clinical setting.\n\n3. Stable 4 mm hemorrhagic contusion in the posterior aspect of the right\ncerebellar hemisphere, along the course of the right occipital fracture. Close\nattention on follow-up imaging is recommended.\n\n4. Stable small right occipital scalp subgaleal hematoma.\n\n5. Fracture of the right lateral aspect of the occipital bone, which does not\nextend into the foramen magnum or occipital condyle." + }, + { + "input": "Previously noted right frontal hemorrhage has resolved. The ventricles\nslightly larger than on the prior examination and correlation for NPH should\nbe performed. Periventricular hypodensity could represent small vessel\nischemic change or transependymal CSF migration. There is an old lacune in the\nright cerebellum. Right occipital nondisplaced fracture is unchanged. .", + "output": "Resolution of previously seen right frontal hemorrhage. No acute hemorrhage." + }, + { + "input": "Subtle hyperdensity adjacent to the left sylvian fissure (02:15, 4:115) is\noverall stable from the exam obtained at 03:52 on the same day. There is no\nnew areas of hemorrhage or territorial infarct. The ventricles and sulci are\nstable in size and configuration.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "Stable, subtle subarachnoid hemorrhage along the left sylvian fissure. No new\nor enlarging hemorrhage. No new territorial infarct." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or large\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Extensive periventricular and subcortical white matter\nhypodensities are noted, most compatible with small vessel ischemic disease in\na patient of this age. Right basal ganglia chronic appearing lacunar infarcts\nnoted.\n\nThere is no evidence of fracture. A small left supraorbital hematoma is\npresent. The left maxillary sinus is nearly entirely opacified with\nsecretions. The remainder of the paranasal sinuses are clear. The bilateral\nmastoid air cells are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute major vascular territorial\ninfarction,hemorrhage,edema, or mass. The ventricles and sulci are normal in\nsize and configuration.\n\nThere is no evidence of fracture. There is mild opacification of the right\nsphenoid sinus. Otherwise, paranasal sinuses, mastoid air cells, middle ear\ncavities are patent. The visualized portion of the orbits are unremarkable.", + "output": "Normal intracranial contents.\nThere is mild opacification of the right sphenoid sinus." + }, + { + "input": "There is no evidence of acute intracranial infarction,hemorrhage,edema,or mass\neffect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are likely secondary to chronic small vessel ischemic disease. \nThere is preservation of gray-white matter differentiation. The basal\ncisterns are patent.\n\nThere is no evidence of fracture. Mucosal thickening is seen in the left\nmaxillary sinus. The remainder of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No evidence for acute intracranial process." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Periventricular white matter hypodensities are nonspecific, but\nlikely reflect sequelae of chronic small vessel ischemic disease. Prominence\nof the ventricles and sulci suggest involutional changes. Nonspecific\nnasopharynx did secretions and bilateral ethmoid air cell mucosal thickening\nis present, which may be related intubation status. Mastoid air cells and\nmiddle ear cavities are well aerated. There is no definite acute fracture. \nChronic left perfusion defect is again noted (see 03:13 on current study and\n2:5 on ___ prior exam). Left premalar 9 x 4 mm soft tissue density,\nwhich may represent a sebaceous cyst is noted (see 2:1). Minimal right\nparietal scalp soft tissue swelling is present (see 2: 25).", + "output": "1. No acute intracranial abnormality.\n2. No evidence acute intracranial hemorrhage or fracture.\n3. Right parietal scalp minimal soft tissue swelling.\n4. Extensive atrophy and probable small vessel ischemic changes as described.\n5. Left premalar soft tissue 9 x 4 mm probable sebaceous cyst." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular, subcortical, and deep white-matter\nhypodensities are nonspecific, but may represent sequela of chronic ischemic\nsmall vessel disease. A left premalar soft tissue density appears similar to\nprior, likely a sebaceous cyst. Focal skin thickening of the scalp overlying\nthe right temporal region (03:15) appears similar.\n\nThere is no evidence of acute fracture. Chronic deformity of the left lamina\npapyracea is unchanged. Partial opacification of the left mastoid air cells\nis similar to prior. Otherwise, the visualized portion of the paranasal\nsinuses, right mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality. No acute hemorrhage or calvarial fracture." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Nonspecific periventricular and deep subcortical white\nmatter hypodensities most likely represent moderate chronic small vessel\nischemic disease.\n\nThere is no evidence of acute fracture. Deformity of the left lamina\npapyracea is chronic. Aside from trace fluid in the left mastoid air cells,\nthe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The frontal sinuses are hypoplastic. The visualized\nportion of the orbits are unremarkable. Focal area of skin thickening\noverlying the right temporal region is unchanged.", + "output": "1. No evidence of acute intracranial process.\n2. Age advanced involutional changes." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema,or mass.\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Periventricular, subcortical and deep white matter hypodensities are\nnonspecific, but likely reflect the sequela of chronic microvascular\ninfarction.\n\nThere is no evidence of acute fracture. Chronic deformity of the left lamina\npapyracea is re-demonstrated. Partial opacification of the left inferior\nmastoid air cells is demonstrated. The visualized portion of the paranasal\nsinuses, right mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable. Focal area of skin\nthickening overlying the right temporal region is unchanged.", + "output": "No acute intracranial abnormality. No acute fracture." + }, + { + "input": "There is no evidence of hemorrhage, edema, shift of normally midline\nstructures, or infarction. Prominent ventricles and sulci are suggestive\ninvolutional changes. Periventricular and subcortical white matter\nhypoattenuation is nonspecific but can represent chronic small vessel ischemic\ndisease.\n\nThere is wall sclerosis in the left maxillary sinus. Otherwise, maxillary\nsinuses are patent. Partial opacification of the left mastoid air cells is\nunchanged from CT head ___. Chronic deformity of the left lamina\npapyracea is again noted. There is no evidence of acute fracture.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute large territory infarction,\nintracranialhemorrhage,edema,or discrete mass. There is prominence of the\nventricles and sulci suggestive of involutional changes, which are age\nadvanced.\n\nThere is no evidence of acute fracture. Chronic defect in the left lamina\npapyracea likely from prior trauma. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Age advanced involutional changes." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage or edema. The\nventricles and sulci are enlarged in an atrophic pattern. Periventricular\nwhite matter hypodensities consistent with small vessel ischemic changes.\n\nPartial opacification and thickening of the left maxillary sinus wall\nconsistent with chronic sinusitis. Otherwise, the visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. \nThere has been a chronic left medial orbital wall blowout fracture, unchanged.\nOtherwise, the visualized portion of the orbits are normal.", + "output": "1. No evidence of fracture, mass, hemorrhage or infarction.\n2. Atrophy." + }, + { + "input": "There is no evidence of fracture, acute territorial\ninfarction,hemorrhage,edema,or mass effect. There is prominence of the\nventricles and sulci suggestive of involutional changes. There are nonspecific\nscattered periventricular and subcortical white matter hypodensities in the\ncerebral hemispheres bilaterally and likely related to chronic small vessel\nischemic changes.\n\nThere is underpneumatization of the frontal sinuses bilaterally. There is\nchronic defect of the left lamina papyracea, likely sequelae of prior trauma,\nsimilar to prior. Minimal mucosal thickening is seen involving the right\nmaxillary sinus. The visualized portion of the remaining paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are normal.", + "output": "1. No acute intracranial process." + }, + { + "input": "No acute fractures are identified. There is chronic fracture deformity of the\nleft lamina papyracea.\nThere is no evidence of facial swelling. There is irregular skin thickening\nthroughout.\nHyperostosis of the left maxillary sinus walls suggests sequela chronic\nsinusitis. There is mild mucosal thickening of the right maxillary sinus. \nOtherwise, the visualized paranasal sinuses appear clear. There is under\npneumatization of the frontal sinuses. There is no evidence of abnormal fluid\ncollections.\nBilateral mastoids appear normal.\nThe globes, extraocular muscles, optic nerves, and retrobulbar fat appear\nnormal.\nThe visualized upper aerodigestive tract appears normal.\nThe mandible and temporomandibular joints appear normal.", + "output": "1. No acute fracture is identified.\n\nNOTIFICATION: The findings were discussed with Dr. ___. by ___,\nM.D. in person on ___ at 10:15 pm, 5 minutes after discovery of the\nfindings." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass effect.\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. There are bilateral nonspecific scattered periventricular and\nsubcortical white matter hypodensities likely related to chronic small vessel\nischemic changes.\n\nThere is again chronic defect of the left lamina papyracea likely sequelae of\nprior trauma similar to prior. Hyperostosis of the left maxillary sinus wall\nsuggests chronic sinusitis similar to prior. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are normal.", + "output": "1. No acute intracranial process." + }, + { + "input": "No acute fractures are identified. Chronic fracture deformity of the left\nlamina papyracea again demonstrated.\nThere is no evidence of facial swelling. Diffuse irregular skin thickening is\nagain noted compatible with physical exam.\nHyperostosis of left maxillary sinus walls again sequelae of chronic\nsinusitis. Mild mucosal thickening of the right maxillary sinus is again\nnoted. Otherwise, visualized paranasal sinuses are well aerated. Right-sided\nnasal spur is noted.\nThere is no evidence of abnormal fluid collections.\nBilateral mastoids appear normal.\nThe globes, extraocular muscles, optic nerves, and retrobulbar fat appear\nnormal.\nThe visualized upper aerodigestive tract appears normal.\nThe mandible and temporomandibular joints appear normal.", + "output": "1. No acute fractures identified." + }, + { + "input": "There is no evidence of fracture, acute large territorial\ninfarction,hemorrhage,edema,or mass. Periventricular and subcortical white\nmatter hypodensity is nonspecific, but likely reflect sequelae of chronic\nsmall vessel ischemic disease. There is prominence of the ventricles and\nsulci suggestive of involutional changes. Chronic deformity of the left\nlamina papyracea.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "No acute intracranial abnormality. Motion limited exam." + }, + { + "input": "There is no evidence of fracture, acute large territory\ninfarction,intracranial hemorrhage,edema,or mass effect. There is prominence\nof the ventricles and sulci suggestive of involutional changes.\nPeriventricular and subcortical white matter hypodensities are nonspecific but\nlikely sequelae of chronic small vessel ischemic disease.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "No evidence of acute large territory infarction, intracranial hemorrhage, or\nfracture." + }, + { + "input": "Study is degraded by motion. Within these confines:\n\n There is no evidence of fracture, infarction,hemorrhage,edema, or mass\neffect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific but can suggest chronic small vessel ischemic\nchanges. Dense bilateral cavernous carotid atherosclerotic calcifications are\nseen.\n\nThere is a large left frontoparietal subgaleal scalp hematoma. Small scalp\nhematoma is noted over the right vertex. There are overlying skin staples. \nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are grossly\npreserved.", + "output": "1. Limited study as described.\n2. Within limits of study, no definite evidence of acute cranial hemorrhage\nor fracture.\n3. Left frontoparietal parietal scalp hematoma. Small adjacent scalp hematoma\noverlying the right vertex.\n4. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described. Please note MRI of the brain is more sensitive\nfor the detection of acute infarct." + }, + { + "input": "Skin staples and left parietal subgaleal hematoma noted. There is no\nintra-axial or extra-axial hemorrhage, edema, shift of normally midline\nstructures, or evidence of acute major infarction. Age advanced involutional\nchanges are present. Ventricles are stably prominent. Periventricular white\nmatter hypodensities suggest chronic microvascular ischemic disease. Imaged\nparanasal sinuses are clear. Mastoid air cells and middle ear cavities are\nwell aerated. The bony calvarium is intact.", + "output": "No acute intracranial hemorrhage. No fracture. Left parietal subgaleal\nhematoma. Mild small vessel disease. Age advanced involutional changes." + }, + { + "input": "There is redemonstration of a 3.8 cm left parietal subgaleal hematoma with\nskin staples. 4 There is no evidence of fracture, infarction,\nhemorrhage,edema,or mass. There is prominence of the ventricles and sulci\nsuggestive of involutional changes, which are advanced for the patient's age. \nPeriventricular and subcortical white matter hypodensities are nonspecific but\ncompatible with chronic small vessel ischemia.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "No evidence of fracture, mass, infarction or new hemorrhage.\nLeft parietal scalp hematoma.." + }, + { + "input": "There is a large subgaleal hematoma along the left parietal region with\noverlying skin staples. There is no underlying fracture.\n\nThere is no acute large territory infarction, intracranial hemorrhage, edema,\nor mass effect. Ventricles and sulci are prominent, consistent with global\nparenchymal loss beyond that expected for patient's age. Periventricular and\nsubcortical white matter hypodensities are nonspecific, but may represent\nsmall vessel ischemic changes.\n\nThere is mild mucosal thickening of the left maxillary sinus. Theimaged\nportions of the remaining paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. Chronic deformity in the left lamina papyracea is likely\nfrom old trauma.", + "output": "1. Large subgaleal hematoma along the left parietal region with overlying skin\nstaples. No underlying fracture.\n2. No acute intracranial abnormality.\n3. Global parenchymal loss beyond that expected for patient's age." + }, + { + "input": "Large left parietal subgaleal hematoma with overlying skin staples is overall\nunchanged in appearance. No underlying fracture. Chronic left lamina\npapyracea deformity is likely from old trauma. There is no evidence of acute\nfracture,acute large territory infarction, intracranial hemorrhage, edema, or\nmass effect. Ventricles and sulci are prominent, consistent with global\nparenchymal loss beyond that expected for patient's age. Periventricular,\nsubcortical, and deep white matter hypodensities are nonspecific, but may\nrepresent small vessel ischemic changes.\n\nThe imaged portions of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. No evidence of injury to the globes or intraorbital\nstructures.", + "output": "1. Large subgaleal hematoma along the left parietal region with overlying skin\nstaples is similar to slightly decreased in size. No underlying fracture.\n2. No acute intracranial abnormality.\n3. Global parenchymal loss beyond the expected for the patient's age." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Scattered white matter\nhypodensities are nonspecific though likely due to chronic small vessel\ndisease.. Ventricles and sulci are prominent compatible with global volume\nloss out of proportion to patient's age.\n\nIncluded paranasal sinuses and right mastoids are essentially clear. \nPartially opacified left mastoid tip with adjacent sclerosis suggests chronic\ninflammation size of the left parietal scalp hematoma has decreased in the\ninterim. Chronic defect in the left lamina papyracea is again noted. Skull\nand extracranial soft tissues are otherwise unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Head CT: Age advanced involutional changes are noted. There is\nperiventricular white matter hypodensity suggesting chronic microvascular\nischemic disease. Ventriculomegaly is unchanged. No acute hemorrhage or\nedema. Basal cisterns are patent. Paranasal sinuses are clear as are the\nmastoid air cells and middle ear cavities. Bony calvarium is intact.\n\nCervical spine CT: No acute fracture. Alignment is preserved. There is\ndegenerative disease in the mid and lower cervical spine with mild endplate\nspurring and mild loss of disc space at C5-6 and C6-7 levels. No critical\ncentral canal or neural foraminal stenosis. There is dense carotid bulb\ncalcification. Severe emphysema at the lung apices. The imaged thyroid is\nunremarkable. The upper esophagus appears thickened.", + "output": "Head CT: No acute findings.\nCervical spine CT: No acute fracture or alignment abnormality. Partially\nvisualized thickened upper esophagus. Severe emphysema at the lung apices." + }, + { + "input": "There is no evidence of infarction,hemorrhage,edema,or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. There are tiny midline and right frontal\nscalp hematomas (602:47 and 601:14). The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are normal.", + "output": "No evidence of fracture, mass or intracranial hemorrhage.\nTiny scalp contusions." + }, + { + "input": "There is no evidence of acute large territorial\ninfarction,hemorrhage,edema,or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. Periventricular and subcortical\nwhite matter hypodensities are nonspecific, but likely reflect the sequela of\nchronic microvascular infarction.\n\nSmall left parietal soft tissue swelling is demonstrated without underlying\nfracture (602:72). Partial opacification of the left mastoid air cells\nsuggests mild ongoing inflammation. Frontal sinuses are not pneumatized. The\nvisualized portion of the remaining paranasal sinuses, right mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are normal.", + "output": "1. Small amount soft tissue swelling within the parietal scalp. No acute\nfracture.\n2. No acute intracranial abnormality." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass effect.\nThere is prominence of the ventricles and sulci which is advanced for patient\nage. Nonspecific white matter hypoattenuation most likely reflect chronic\nsmall vessel disease in this age group.\n\nStable, nonspecific skin thickening of the right zygomatic subcutaneous tissue\n(series 2 image 5 and two subcentimeter foci of hyperattenuation in the right\nfrontal scalp. Hyperostosis of the left maxillary sinus may represent sequela\nof chronic sinusitis. The visualized portion of the paranasal sinuses,\nmastoid air cells, and is unchanged when compared to prior middle ear\ncavitiesare well pneumatized. The visualized portion of the orbits are\nnormal.", + "output": "No acute intracranial abnormality.\nGeneralized volume loss is advanced for patient age. Nonspecific white matter\nhypoattenuation most likely reflect chronic small vessel disease in this age\ngroup.\nNonspecific dermal thickening overlying the right zygomatic arch and areas of\ndermal thickening and hyperattenuation in the frontal region can be correlated\nwith direct inspection." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass. Prominent ventricles and sulci are seen, greater than expected given\npatient age. There are areas of periventricular and subcortical white matter\nhypoattenuation that are nonspecific but most likely represent chronic small\nvessel disease.\n\nSubtle hyperostosis of the left maxillary sinus may be sequela of chronic\nsinusitis. There is partial opacification of the left mastoid air cells,\nsimilar to prior. The remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of fracture, acute large territory\ninfarction,hemorrhage,edema,or mass effect. Age advanced involutional changes\nare noted. Prominence of the ventricles is stable from the most recent prior.\nPeriventricular white matter hypodensities likely represent sequelae of\nchronic small vessel ischemic changes.\n\nThe imaged paranasal sinuses appear well aerated as do the mastoid air cells\nand middle ear cavities. The bony calvarium is intact. The visualized\nportion of the orbits are normal.", + "output": "1. No acute intracranial process.\n2. Age-advanced involutional changes. Stable ventricular enlargement. Mild\nsmall vessel disease." + }, + { + "input": "No evidence of acute large territorial infarction, acute intracranial\nhemorrhage, edema, or mass effect. The ventricles and sulci are prominent,\nslightly advanced for patient's age and may be related to chronic alcohol use.\nPeriventricular hypodensities are nonspecific, but likely reflect chronic\nsmall vessel ischemic changes. Again seen left basal ganglia lacunar infarct\nis noted.\n\nMinimal soft tissue thickening along the posterior left parietal calvarium may\nrepresent a tiny subgaleal hematoma. No acute osseous abnormalities. The\nparanasal sinuses are clear. The mastoid air cells and middle ear cavities are\nclear. The orbits are unremarkable.", + "output": "1. No acute intracranial process. No fractures.\n2. Advanced involutional changes, which may be in part related to alcohol use." + }, + { + "input": "There is prominence of the ventricles, sulci, and left frontoparietal\nextra-axial space adjacent to the calvarium, likely due to volume loss and\npossibly a small low-density subdural fluid collection. There is no evidence\nof large territorial infarction, acute hemorrhage, edema, or mass. The\nsubcortical, deep, and periventricular white matter hypodensities are\nnonspecific, but likely represent the sequela of chronic microvascular\nischemic disease.\n\nThere is no evidence of fracture. Defect in the left lamina papyracea is\ncompatible with prior, chronic fracture. There is opacification of few\nmastoid air cells bilaterally, unchanged since ___. The visualized portion\nof the paranasal sinuses, andmiddle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of fracture or intracranial hemorrhage.\n2. Prominence of the left frontoparietal extra-axial space adjacent to the\ncalvarium, likely due to a combination of volume loss and possibly a small\nlow-density subdural fluid collection, potentially chronic subdural hematoma\nversus hygroma.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 3:41 ___, 5 minutes\nafter discovery of the findings." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass effect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Mild periventricular white matter hypodensities are\nnonspecific, but likely a sequela of chronic small vessel disease.\n\nThere is no evidence of fracture. Visualized paranasal sinuses are clear. \nWall thickening of the left maxillary sinus is likely a sequela of chronic\ninflammation. Partial fluid opacification of the mastoid air cells on the\nleft. Middle ear cavities are clear. The visualized portion of the orbits\nare unremarkable.\n\nEvaluation of the soft tissues reveals chronic right temporal skin thickening\n(04:15).", + "output": "No acute intracranial abnormality on noncontrast head CT." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territorial infarct. Prominence of the\nventricles and sulci is consistent with involutional changes, more prominent\nthan typically seen in a patient of this age, but similar to prior..\nPeriventricular white matter hypodensities are likely sequelae of chronic\nsmall vessel disease. The visualized paranasal sinuses are clear. There is\nre-demonstrated partial opacification of left mastoid air cells. The middle\near cavities are clear. No acute fracture is seen. Right temporal skin\nthickening is again seen, possibly slightly more prominent as compared the\nprior study. There is also skin thickening in the bilateral pre maxillary\nregions.", + "output": "No acute intracranial process. Chronic changes.\n\nRight temporal skin thickening again seen, possibly slightly more prominent as\ncompared the prior study. There is also skin thickening in the bilateral pre\nmaxillary regions." + }, + { + "input": "Thin linear density deep to the left frontal bone, with areas of hyperdensity\nand isodensity relative to the brain parenchyma, images ___, appears\nstable. There is no new intracranial hemorrhage, edema, mass effect, loss of\ngray/ white matter differentiation. The ventricles and sulci are normal in\nsize and configuration for age.\n\nThere is no fracture. There is fluid and mucosal thickening in the inferior\nfrontal sinuses, frontoethmoidal recesses, ethmoid air cells, and visualized\nportions of the maxillary sinuses, similar to the prior exam, except that the\nmaxillary sinuses were not included on the prior exam. Postsurgical changes\nare partially visualized in the right maxillary sinus. Mastoid air cells are\nunderpneumatized and partially opacified bilaterally, unchanged.", + "output": "1. Stable thin linear density deep to the left frontal bone, iso- to\nhyperdense to the brain parenchyma, compatible with a small subdural hematoma\nor dural thickening. No evidence for new intracranial abnormalities.\n2. Unchanged abnormal appearance of the paranasal sinuses, which may be\nrelated to prolonged supine positioning or sinusitis. Please correlate with\nsymptoms." + }, + { + "input": "There has been complete resolution of the tiny left subdural collection seen\nin the CT from ___. There is no hemorrhage, edema, mass, mass effect\nor large vascular territorial infarction. The ventricles and sulci are normal\nin size and configuration. There is preservation of grey-white matter\ndifferentiation and the basal cisterns are patent.\n\nNo fracture is identified. There is concentric mucosal thickening and\naerosolized secretions of the bilateral maxillary and sphenoidal sinuses as\nwell as opacification of scattered ethmoidal cells..", + "output": "1. Complete resolution of left subdural collection seen on prior CT. No\nevidence of acute intracranial process.\n2. Inflammatory sinus disease of indeterminate chronicity." + }, + { + "input": "The patient status post left frontal craniotomy and right burr hole placement.\n\nThere are small bifrontal and right temporal subdural hematomas with extensive\nsubarachnoid hemorrhage involving the right frontal, temporal, occipital and\nparietal lobes, as well as the left parietal and occipital lobes. There is\napproximately 4 mm of leftward midline shift. A trace amount of hematoma is\nseen within the occipital horn of the left lateral ventricle. Trace hematoma\nin the interpeduncular cistern was better seen on the prior study, but likely\nstill present. The ventricles are stable morphology without hydrocephalus. \nNo evidence of acute large territorial infarct. There may be mildly increased\nedema of the right frontal superior and middle gyrus cortices when compared to\nprior examination, likely reactive.\n\nUnchanged transversely oriented fracture of the left temporal bone with\nassociated opacification of the left mastoid air cells. Although not\noptimized for such evaluation, the ossicles appear grossly intact however\nclinical correlation is recommended. There is diastasis of the left squamosal\nsuture.\n\nThe orbits are unremarkable. Mild mucosal thickening of the ethmoid air cells\nand partial opacification of the left sphenoid sinus. Trace punctate focus of\nair within the mucous adjacent to the left sphenoid sinus wall (series 3,\nimage 8) is identified without evidence of definite fracture through the\nsphenoid. The right mastoid air cells middle ears are clear.", + "output": "1. Unchanged small bifrontal and right temporal subdural hematomas with\nextensive bilateral subarachnoid hemorrhage, as detailed above. There is 4 mm\nof leftward midline shift, unchanged. Trace hemorrhage in the occipital horn\nof the left lateral ventricle and the interpeduncular cistern appears similar\nto prior. No hydrocephalus, large territorial infarction or new hemorrhage.\n2. There appears to be mildly increased edema of the right superior middle\nfrontal gyrus cortices, likely reactive secondary to subarachnoid hemorrhage. \nAttention on follow-up is recommended\n3. Unchanged left horizontally oriented temporal bone fracture with associated\nhemorrhage in the mastoid air cells. Unchanged diastasis of the left\nsquamosal suture.\n4. Additional findings described above." + }, + { + "input": "There is a similar overall pattern of scattered cerebral subarachnoid\nhemorrhage as compared with the prior exam performed 11 hours earlier, with\nsubarachnoid hemorrhage most conspicuous at the right frontal vertex. There\nis again noted to be a small right cerebral subdural hematoma measuring up to\n6 mm. No new sites of hemorrhage. No shift of midline structures. No signs\nof herniation. Ventricles are normal in size. No intraventricular\nhemorrhage. Again seen is a longitudinal fracture of the left temporal bone\nwhich partially extends into the left middle ear cavity. There is extension\nsuperiorly of this fracture line with associated diastasis of the squamosal\nsuture. There is partial opacification of the left mastoid air cells. A\nsmall fluid level in left sphenoid sinus is noted.", + "output": "1. Stable pattern of hemorrhage including scattered subarachnoid hemorrhage\nand small right cerebral subdural hematoma.\n2. Longitudinally oriented left temporal bone fracture involving the middle\near cavity." + }, + { + "input": "Left : Re-identified is diastasis of the squamosal suture, which extends into\na longitudinally oriented fracture through the mastoid portion of the temporal\nbone and to the middle ear, which appears to spare the otic capsule. The\ninner ear structures appear intact. Opacification of the mastoid air cells\nand partial opacification of the mesotympanum is identified. The ossicles\nappear grossly intact without dislocation. Although the stapes is difficult\nto visualize secondary to hemotympanum, it also appears grossly intact.\n\nNo definite defect through the tegmen tympani. The superior semicircular\ncanal is not dehisced. The vestibular aqueduct appears unremarkable. The\nfacial nerve canal appears grossly unremarkable. The external auditory canal\ndemonstrates cutaneous thickening, with a fracture line along the posterior\nwall (series 4, image 88). The anterior wall of the internal auditory canal\nand glenoid fossa appear unremarkable. The fracture lucency does not appear\nto involve the facial nerve.\n\nRight: The external auditory canal is normal. The middle ear cavity is clear.\nThe ossicles and tegmen are intact. There is no evidence for enlarged\nvestibular aqueduct or superior semicircular canal dehiscence. The facial\nnerve follows a normal course through the middle ear. There is no evidence for\ninner ear dysplasia. The mastoids are clear.\n\nThere is increased widening of the right temporomandibular joint, not seen on\noutside hospital CT examination, which may be positional in nature.\n\nOther: Bilateral subarachnoid hemorrhages are re-identified.", + "output": "1. Diastasis of the left squamosal suture extending into a longitudinally\noriented fracture through the mastoid portion of the left temporal bone, which\nextends to the middle ear and posterior wall of the auditory canal.\n2. Opacification of the left mastoid and of the left mesotympanum is\nidentified. The left ossicles appear intact. The left facial canal appears\ngrossly intact although evaluation is suboptimal secondary to degree of middle\near opacification.\n3. The left otic capsule appears intact. The left inner ear structures appear\nunremarkable.\n4. Unremarkable right temporal bone.\n5. Mild widening of the right temporomandibular joint, not seen on outside\nhospital CT examination, which may be positional in nature. Correlation with\npatient's symptoms is recommended.\n6. Additional findings described above. Please refer to CT heads performed on\nthe same day for additional details." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is loss of gray-white differentiation and hypodensity involving the\nright anterior middle cerebral artery territory, including the insular cortex.\nNo hemorrhage is seen.\n\nThe ventricles and sulci are normal in size and configuration.\n\nThere is mild mucosal thickening of the left maxillary and right sphenoid\nsinuses. The mastoid air cells,and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.\n\n\nCTA HEAD:\nThere is abrupt cut off of the mid right M1 segment distal to an\ninferoposterior branch takeoff. Peripheral collateral branches are seen\ndemonstrating minimal flow. There is overall relative hypoperfusion of the\nanterior and mid right middle cerebral artery.\n\n Atherosclerotic changes of the cavernous and supraclinoid segments of the\nbilateral internal carotid arteries are seen without stenosis.\n\nOtherwise, the vessels of the circle of ___ and their principal\nintracranial branches appear normal without stenosis, occlusion, or aneurysm\nformation. There is fetal origin of the left posterior cerebral artery. The\ndural venous sinuses are patent.\n\n\nCTA NECK:\n Atherosclerotic changes of the carotid bifurcations are seen without\nnarrowing of the internal carotid arteries, by NASCET criteria.\n\nThere is moderate focal narrowing of the left V2 segment (3:108), with patent\ndistal run-off.\n\n\nOTHER:\nBiapical emphysematous changes are seen. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. Degenerative changes of the cervical spine are seen.", + "output": "1. Large mid and anterior right middle cerebral artery territory infarct. No\nhemorrhage.\n2. Abrupt cut off of the mid right M1 segment mainly anterior division with\nminimal flow within the peripheral branches, likely due to collateral flow.\n3. Moderate focal narrowing of the left V2 segment with patent distal run-off.\n4. No narrowing of the cervical internal carotid arteries, by NASCET criteria." + }, + { + "input": "Motion artifact mildly limits evaluation. No evidence for acute intracranial\nhemorrhage, edema, mass effect, or acute major vascular territorial\ninfarction. Confluent subcortical, deep, and periventricular white matter\nhypodensities are again seen, nonspecific but likely sequela of chronic small\nvessel ischemic disease in this age group. New hypodensity in the left\nposterior internal capsule/globus pallidus, image 2:13, appears new compared\nto ___, versus not seen previously due to slice selection, compatible\nwith a chronic infarct versus prominent perivascular space. There is mild\nglobal parenchymal volume loss with prominent ventricles and sulci, progressed\ncompared to ___.\n\nThere is no evidence of fracture. There is complete opacification of the left\nfrontal sinus, anterior left ethmoid air cells, and the partially visualized\nleft maxillary sinus, with hyperostosis of their walls. Opacifying contents\nare not hyperdense. Left ostiomeatal unit and left frontoethmoidal recess are\nexpanded and occluded. Soft tissue density opacifying the left nasal cavity\nmay represent mucosal thickening versus polyps.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. Complete opacification of the left frontal, anterior ethmoid, and maxillary\nsinuses, with wall hyperostosis indicating chronicity. Left frontoethmoidal\nrecess and left ostiomeatal unit are occluded with expansile soft tissue\ndensity, suggestive of polyps. Soft tissue density in the left nasal cavity\nmay also reflect polyps and/or mucosal thickening. These findings are new\ncompared to ___." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, or loss of\ngray/white matter differentiation. The ventricles, sulci, and basal cisterns\nare normal in size and configuration.\n\nThe bones are unremarkable. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavitiesare well aerated.", + "output": "1. Normal study." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere are scattered opacification involving bilateral ethmoid air cells and\nsphenoid sinuses consistent with paranasal sinuses disease. The visualized\nportion of the mastoid air cells, and middle ear cavities are clear.", + "output": "1. No acute intracranial pathology.\n2. Mild paranasal sinuses disease." + }, + { + "input": "Large hypodensity involving the right MCA territory is new from ___, but\notherwise appears chronic. Background periventricular and subcortical white\nmatter hypodensities are nonspecific the can be seen as sequelae of chronic\nsmall vessel ischemic disease. No acute intracranial hemorrhage.\n\nA left frontal scalp hematoma is small to moderate. No evidence of acute\nfracture seen. Paranasal sinus disease is mild. The visualized portion of\nthe mastoid air cells and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No intracranial hemorrhage.\n2. Large area of right MCA territory infarct, new from ___ but otherwise\nappears chronic. If clinical concern for acute stroke, MRI is more sensitive.\n3. Probable sequelae of chronic small vessel ischemic disease.\n4. Left frontal scalp hematoma. No acute fracture.\n\nNOTIFICATION: The findings and impression were discussed with ___,\nM.D. by ___, M.D. on the telephone on ___ at 3:55 pm, 1\nminutes after discovery of the findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nLarge right parietal encephalomalacia likely sequela prior infarct is\nunchanged from examination of ___. Superimposed confluent right\ngreater than left periventricular and subcortical white matter hypodensities\nare nonspecific, but compatible with chronic microangiopathy in a patient of\nthis age. No intracranial hemorrhage or intra or extra-axial mass effect.\n\nThere is mild mucosal thickening of the ethmoid air cells and frontal\nethmoidal recesses. The right maxillary sinuses strike and demonstrates\nmild-to-moderate mucosal thickening. Mild mucosal thickening of the left\nmaxillary sinus is also identified. The orbits are unremarkable, noting\nbilateral lens replacements. The mastoid air cells middle ears well\npneumatized and clear. No acute osseous abnormality.\n\nCTA HEAD:\nMild atherosclerotic calcification of the bilateral internal carotid arteries\nare noted. The left A1 segment is hypoplastic, a normal variant. Fetal type\norigin of the left posterior cerebral artery is identified. The right\nvertebral artery is dominant. Otherwise, the vessels of the circle of ___\nand their principal intracranial branches appear normal with no evidence of\nstenosis, occlusion, or aneurysm. The dural venous sinuses are patent.", + "output": "1. Allowing for common anatomic variation and mild atherosclerotic disease,\nessentially unremarkable CTA of the head.\n2. No acute intracranial abnormality on noncontrast head CT. Large right\nparietal encephalomalacia and likely sequela of chronic microangiopathy (right\ngreater than left) is unchanged from CT head of ___.\n3. Additional findings described above." + }, + { + "input": "Markedly limited exam secondary to patient motion and related artifact. Within\nthat limitation there is no evidence of acute large territorial infarction,\nintracranial hemorrhage, edema or mass. No evidence of shift of normal midline\nstructures. The gray-white matter differentiation in the basal ganglia and\ninsular cortices appears preserved. The ventricles and sulci are prominent\nconsistent with age-related involutional change. Subcortical and\nperiventricular white matter hypodensities are nonspecific but may reflect the\nsequelae of chronic small vessel ischemic disease. The posterior fossa is not\nwell assessed. There is a subtle ovoid 8 x 15 mm hypodensity margin the\nposterior limb of the right internal capsule and thalamus (2:17) which could\nrepresent a lacunar infarct of indeterminate chronicity.\n\nNo evidence of fracture. Paranasal sinuses, mastoid air cells and middle ear\ncavities appear clear. There is dense calcification of intra cranial ICAs.\nPatient is status post bilateral lens replacements.", + "output": "Limited examination secondary to patient motion.\n\n1. Ovoid hypodensity at the margin of the posterior limb of the right internal\ncapsule and thalamus raises concern for lacunar infarct though of unclear\nchronicity. Clinical correlation is advised.\n2. Age-related parenchymal atrophy. Probable chronic small vessel ischemic\ndisease.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 11:16 pm, 5 minutes\nafter discovery of the findings." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction, mass or midline\nshift. The ventricles and sulci are unchanged in size. A partially empty sella\nis again noted. There is mucosal thickening within the frontal and ethmoid\nsinuses. The mastoid air cells are clear. There is no fracture.", + "output": "Partially empty sella. Otherwise unremarkable non contrast CT scan of the\nbrain." + }, + { + "input": "There is been interval placement of a right frontal approach\nventriculoperitoneal shunt catheter with the tip projecting over the left\ncaudate nucleus. A tiny amount of pneumocephalus tracks along the catheter.\nThere is no evidence of hemorrhage, edema, mass effect or infarction. The\nventricles and sulci are normal in size and configuration. The basal cisterns\nappear patent and there is preservation of gray-white matter differentiation.\n\nNo fracture is identified. There is a mucous retention cyst in the left\nmaxillary sinus. The remaining visualized paranasal sinuses, mastoid air cells\nand middle ear cavities are clear. The globes are unremarkable.", + "output": "Interval placement of a right frontal approach ventriculoperitoneal shunt\ncatheter with tip projecting over the left caudate nucleus." + }, + { + "input": "Right frontal approach ventriculostomy catheter is unchanged in position.\nConfiguration of the ventricles is stable. There is no intra-axial or\nextra-axial hemorrhage, mass, midline shift, or acute vascular territorial\ninfarct. Gray-white matter differentiation is preserved. Ventricles are\nsymmetric and unremarkable. An expanded partially empty sella is again noted.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "Right frontal approach ventriculostomy catheter unchanged. No acute\nintracranial process." + }, + { + "input": "The right frontal approach ventriculostomy catheter position and course are\nunchanged from the prior exam. The overall size and configuration of\nventricles is unchanged without hydrocephalus.\n\nNo evidence of acute territorial infarction, hemorrhage, edema, or mass\neffect. No shift of normally midline structures. The basal cisterns are\npatent. Unchanged partial empty sella.\n\nNo evidence of fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. No significant interval change. Similar position of the right frontal\napproach ventriculostomy catheter without hydrocephalus.\n2. Re-identified is partial empty sella." + }, + { + "input": "Right frontal approach ventriculoperitoneal shunt tip projects over the left\nthalamus and is unchanged in appearance. The ventricular size is unchanged. \nNo acute hemorrhage seen. No midline shift seen. No periventricular edema.", + "output": "No acute abnormalities or change since ___." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Mild left frontal, ethmoid, and left\nmaxillary mucosal thickening. Otherwise, the visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No evidence of fracture or intracranial hemorrhage.\n2. Mild paranasal sinus disease." + }, + { + "input": "Again seen are scattered areas of subarachnoid hemorrhages, for example in\nright frontal lobe and left parietal lobe near the vertex similar to the\noutside prior CT from ___. A 8 mm focus of hyperdensity at the left\nvertex may represent subarachnoid hemorrhage versus small intraparenchymal\nhematoma, but remains unchanged.. A 5 mm subdural hemorrhage is seen layering\nalong the falx and extends posteriorly, unchanged (02:27). Bifrontal and left\ntemporal encephalomalacia is unchanged. There is no evidence of acute major\nvascular territory infarction or new intracranial hemorrhage. There is no\nmidline shift. Prominence of the ventricles and sulci are likely due to\nage-related involutional changes, unchanged. Ill-defined periventricular\nsubcortical white matter hypodensities are nonspecific but likely due to\nchronic sequela of small-vessel ischemic disease.\n\nThere is no evidence of fracture. There is near complete opacification of the\nethmoid air cells and maxillary sinuses. Layering fluid is seen in the right\nsphenoid sinus. Aerated secretions are noted in the left sphenoid sinus. The\nmastoid air cells and middle ear cavities appear grossly clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Overall, stable appearance of bihemispheric scattered subarachnoid\nhemorrhages compared to the outside CT from ___.\n2. 8 mm focus of hyperdensity at the left vertex may represent subarachnoid\nhemorrhage versus small intraparenchymal hematoma, but is unchanged.\n3. 5 mm subdural hemorrhage seen layering along the falx and extending\nposteriorly remains unchanged. No evidence of new intracranial hemorrhage or\nlarge acute infarct.\n4. Extensive paranasal sinus disease, as described above." + }, + { + "input": "CT head without contrast:\nThere is no evidence of definite evidence infarction, hemorrhage, edema, or\nmass. There are prominent ventricles and sulci, consistent with involutional\nchanges. Subcortical, periventricular and deep white matter hypodensities are\nnonspecific, but likely reflect the sequela of chronic microangiopathic\nischemic disease. High density in the vascular structures indicate prior\ncontrast administration.\n\nThere are moderate atherosclerotic calcifications of the right vertebral\nartery, spanning V3 through V4, as well as mild left vertebral artery\ncalcifications of V4. There are calcifications the basilar artery. There\nalso moderate atherosclerotic calcifications of the carotid siphons\nbilaterally.\n\nThere is no fracture. The visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portions of the\norbits are normal.\n\nCT PERFUSION:\nThere is increased mean transit time in the left MCA territory, without\ncorresponding decreased blood flow or blood volume in this region. In the\nright periventricular region there is an area of decreased blood blood flow\nwhich is smaller than the area of transit time likely indicating an artifact.\n\nThe patient underwent subsequent carotid and cerebral angiography, which\nshowed a severe stenosis of the internal carotid artery at the common carotid\nartery bifurcation and underwent successful angioplasty.", + "output": "1. Increased mean transit time in the left MCA territory is indicative of area\nof ischemia. Likely artifact in the right periventricular region. There is\nno definite evidence of large vascular territory infarction, hemorrhage, or\nmass. Mild-to-moderate atherosclerotic calcifications of the vertebral\narteries, basilar artery, as well as the intracranial ICAs bilaterally.\n2. Prominent sulci and ventricles consistent with global atrophy, as well as\nchronic microangiopathic white matter changes.\n3. Increased density in the vascular structures on noncontrasted CT indicate\nprior contrast injection." + }, + { + "input": "Prior administration of contrast somewhat limits interpretation of these\nimages.\n\nThere is no evidence of new definite infarction, intracranial hemorrhage,\nmass, mass effect or shifting of the normally midline structures. There is\nmild effacement of the sulci on the left, extending to the frontal region with\nindistinctness of the left insular ribbon, likely related with underlying\nedema. There is subtle hyperattenuation within the external capsule, which\nmay represent stasis of previously administered contrast, also related to\nedema.\n\nThere are prominent ventricles and sulci, consistent with involutional\nchanges. Specifically, there are enlarged temporal horns, speaking to the\npatient's known dementia. Subcortical, periventricular and deep white matter\nhypodensities are nonspecific, but likely reflect the sequela of chronic\nmicroangiopathic ischemic disease. Redemonstrated is high density within the\nvascular structures, indicating prior contrast administration.\n\nRedemonstration of moderate atherosclerotic calcifications of the right\nvertebral artery, spanning V3 through V4, as well as mild left vertebral\nartery calcifications. There are mild calcifications of the basilar artery,\nas well as moderate atherosclerotic calcifications of the carotid siphons\nbilaterally.\n\nThere is no fracture. The visualized portion the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The patient is status post\nbilateral lens replacement surgery, otherwise the visualized portion of the\norbits is clear.\n\nInterval placement of endotracheal tube, which terminates out of view.", + "output": "1. Interval development of mild effacement of the sulci on the left extending\nto the frontal region, also with indistinctness of the insular ribbon,\nconsistent with edema related to prior ischemia. There is no evidence of\nintracranial hemorrhage, mass, or new definite infarction.\n2. Prominent ventricles and sulci, consistent with involutional changes and\nthe patient's known dementia, as well as microangiopathic white matter\nchanges.\n3. Redemonstration of diffuse atherosclerotic calcifications, as noted above." + }, + { + "input": "There is a normal, three-vessel branching pattern of the aortic arch. The\norigins of the great vessels are patent.\n\nEvaluation of the bilateral distal common carotid, carotid bifurcations, and\nproximal internal carotid arteries from C3-C6 is severely limited by motion. \nThe remainder of the common carotid and internal carotid arteries are normal\nin appearance. There is no evidence of stenosis by NASCET criteria. There is\nno evidence of contrast extravasation or pseudoaneurysm of the external\ncarotid artery branches.\n\nBoth vertebral arteries, including their origins, are patent. The right\nvertebral artery is dominant and the left vertebral artery is hypoplastic. \nThe left vertebral artery terminates as the left posterior inferior cerebellar\nartery, a normal anatomic variant.\n\nThe patient is status post interval placement of a metallic sideplate with\nmultiple screws transfixing a comminuted, nondisplaced fracture of the left\nparasymphyseal and mandibular body. The comminuted, nondisplaced fracture of\nthe left mandible, extending from the left condylar neck to the symphysis and\ninvolving the left inferior alveolar foramen, is unchanged in appearance and\nextent.\n\nThe comminuted, mildly displaced fractures of the nasal bones and bilateral\nfrontal processes of the maxilla with no overlying soft tissue swelling are\nunchanged. No other fractures are identified.\n\nThe moderate mucosal thickening of the left maxillary sinus and multiple\nperiapical lucencies in the maxilla are unchanged.\n\nThere is severe centrilobular emphysema.\n\nThe C5, C6, and C7 vertebral bodies are fused. There are thick, bulky,\nflowing ossifications of the anterior longitudinal ligament in the cervical\nspine from C4-C7, consistent with diffuse idiopathic skeletal hyperostosis. \nThe paraspinal soft tissues are normal.", + "output": "1. No evidence of vascular injury. However, evaluation of the distal\nbilateral common carotid, bifurcations, and proximal internal carotid arteries\nis severely limited by motion and a repeat examination may be obtained if\nthere is continued clinical concern for injury.\n2. Status post fixation of a comminuted, nondisplaced fracture of the left\nmandible, involving the inferior alveolar foramen.\n3. Chronic nasal bone fractures." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass effect. The ventricles and sulci are normal in size and configuration\nfor the patient's age.\n\nThere is no evidence of fracture. There is under-pneumatization of the right\nmastoid air cells, a normal variant. Otherwise, the visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality on noncontrast CT head. Specifically no\nacute large territory infarct or intracranial hemorrhage. No displaced\ncalvarial fracture." + }, + { + "input": "There is no evidence of infarction,intracranial hemorrhage,edema,or mass. \nThere is mild prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture. Minimal mucosal thickening and aerosolized\nsecretions within the right sphenoid sinus. Otherwise, the visualized portion\nof the paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality. Specifically, there is no evidence of\nhemorrhage.\n2. Minimal paranasal sinus disease." + }, + { + "input": "There is no evidence of infarction,intracranial hemorrhage,edema,or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Mild thickening of the right sphenoid\nsinus. Mastoid air cells and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. There is no evidence of acute intracranial process or hemorrhage.\n2. No fractures are identified.\n\nNOTIFICATION: The findings were entered into the PACS communication System at\n15:56 ___." + }, + { + "input": "Study is degraded by motion. Within these confines:\n\n There is no evidence of fracture, infarction,hemorrhage,edema, or mass\neffect. Periventricular and subcortical white matter hypodensities are\nnonspecific but can suggest chronic small vessel ischemic changes. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nAtherosclerotic vascular calcifications are noted. Atherosclerotic vascular\ncalcifications are noted.\n\nAerosolized right sphenoid sinus mucosal thickening is present. The\nvisualized portion of the mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are preserved.", + "output": "1. Study is degraded by motion.\n2. Within limits of study, no acute intracranial abnormality. Please note\nMRI of the brain is more sensitive for the detection of acute infarct.\n3. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described.\n4. Paranasal sinus disease, as described." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass. Periventricular and subcortical white matter hypodensities, including a\nvery conspicuous area in the left frontal lobe, are nonspecific but probably\nreflect sequela of chronic microangiopathy and chronic ischemic change in the\nleft frontal lobe. Prominence of the ventricles and sulci may reflect\nage-related involutional changes.\n\nNo acute fracture is seen. Again noted is mild aerosolized mucosal thickening\nin the right sphenoid sinus with a calcification. Otherwise the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "1. There is no evidence of acute intracranial process or hemorrhage.\n\n2. No fractures are identified.\n\n3. Subcortical areas of low attenuation, and left frontal area of low density\nis consistent with changes due to chronic small vessel disease, and chronic\narea of ischemia in the left frontal lobe." + }, + { + "input": "There is a focus of encephalomalacia in the left frontal lobe near the vertex\nunchanged likely the site of prior infarction. Age related involutional\nchanges are noted. There is no acute hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles are normal in size. Basal cisterns are patent. The\nimaged paranasal sinuses notable for minimal aerosolized material within the\nright sphenoid sinus. The mastoid air cells and middle ear cavities appear\nwell aerated. The bony calvarium is intact.", + "output": "Small chronic infarct in the upper left frontal lobe. No acute hemorrhage or\nfracture." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. \nHypodensity involving the left frontal lobe is unchanged and likely related to\nchronic infarction. The ventricles and sulci are mildly prominent, consistent\nwith involutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no acute hemorrhage, edema, or mass-effect. Prominent ventricles and\nsulci likely related flexed involutional changes, similar relative to\nexaminations dated ___. There is no shift of normally midline\nstructures. Basal cisterns are patent. Periventricular white matter\nhypodensity is nonspecific, likely sequela of chronic small vessel ischemia. \nGray-white matter differentiation is preserved.\n\nThere is near complete opacification of the posterior left ethmoidal air cell\nas well as complete opacification of the left sphenoid sinus. Findings are\nassociated with hypertrophy of the bone surrounding the sphenoid sinus\nconsistent with chronic changes. Mucosal thickening involves the right\nsphenoid sinus. Bilateral mastoid air cells and middle ear cavities are clear\nbilaterally. The bony calvarium appears intact.", + "output": "1. No acute intracranial abnormality. Chronic sinus disease involves the left\nsphenoid sinus. No aerosolized secretions or air-fluid levels.\n\n2. Prominent ventricles and sulci, likely age related volume loss." + }, + { + "input": "There is no acute intracranial hemorrhage, acute infarction, edema or mass\neffect. The ventricles and sulci are normal in size and configuration for\npatient's age. The basal cisterns are clear. The gray white matter\ndifferentiation appears preserved.\n\nNo acute fracture is identified allowing for the sutures.\nA lucent focus in the right side of the sphenoid series 3, image 10,, may\nrelate to fat content and non-specific in appearance.\nThe visualized paranasal sinuses, mastoid air cells and middle ear cavities\nare clear.", + "output": "No acute intracranial hemorrhage or mass effect or obvious acute fracture.\nCorrelate clinically to decide on the need for further workup or followup." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or infarction.\n\nThe ventricles and sulci are normal in size and configuration.\n\nThe basal cisterns appear patent and there is preservation of gray-white\nmatter differentiation.\n\n\n\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. A\nlucent focus on the right side of the sphenoid sinus (series 3, image 8) is\nunchanged in appearance and remains nonaggressive. The visualized bony\nstructures are otherwise unremarkable.\n\nThe globes are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There are acute bilateral subdural hematomas, measuring up to 9 mm on the left\nand 10 mm on the right. The right subdural hematoma is largest in size\noverlying the right temporal lobe. It is seen overlying the right frontal\nlobe anteriorly as well and tracks along the right tentorium. This appearance\nis similar compared to prior exam. Acute subdural hematoma overlying the left\nfrontal and temporal lobes on the left is also similar in appearance compared\nto prior. There is mild effacement of the adjacent sulci without evidence of\nherniation. There is no evidence of infarction, edema,or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nA right-sided subgaleal hematoma is demonstrated adjacent to the right vertex\nwith overlying staples. There is no evidence of fracture.\n\nLeft maxillary sinus is near completely opacified. Scattered opacified\nethmoid air cells are also noted. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare otherwise clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Acute bilateral subdural hematomas, measuring up to 9 mm on the left and 10\nmm on the right. Mild effacement of the adjacent sulci. No evidence of\nherniation. Overall, appearance is similar compared to prior.\n2. Right parietal scalp hematoma without underlying fracture." + }, + { + "input": "Hyperdense subdural hematoma along the right convexity, predominantly\nfrontotemporal, measures 9 mm in maximal thickness on image 2:15, unchanged\nallowing for slight redistribution. Unchanged extension over the right\nfrontal pole. Unchanged extension along the right tentorium and unchanged\nminimal extension along the right posterior falx. Unchanged mild right\ntemporal sulcal effacement.\n\nHyperdense subdural hematoma over the left frontal, parietal, and temporal\nconvexity measures approximately 7 mm in maximal thickness on image 2:18,\nunchanged when measured in the same fashion. Unchanged extension over the\nleft frontal pole. Unchanged mild left frontal and temporal sulcal\neffacement.\n\nNo shift of midline structures or effacement of basal cisterns. Stable size\nof the ventricles. No evidence for new hemorrhage or acute major vascular\nterritorial infarction.\n\nRight suboccipital scalp hematoma is again seen, image 3:13. The previously\nseen subgaleal hematoma at the right parietal vertex now appears\ncircumferential with bilateral involvement of the parietal vertex. Skin\nstaples are again seen overlying the anterior aspect of the right parietal\nvertex. No evidence for a fracture. The orbits are unremarkable on\nnoncontrast CT without evidence for intraorbital hematoma.\n\nMaxillary sinuses are not fully imaged. Unchanged complete opacification of\nthe visualized portion of the left maxillary sinus with foci of central\nhyperdensity, which was fully imaged on the prior study. Unchanged polypoid\nmucosal thickening occluding the left ostiomeatal unit. Unchanged mild\nmucosal thickening in the visualized portion of the right maxillary sinus and\nunchanged mucosal thickening occluding the right ostiomeatal infundibulum. \nUnchanged mild right and moderate left anterior ethmoid air cell mucosal\nthickening, extending into the frontoethmoidal recesses. Unchanged mild\nmucosal thickening in the bilateral sphenoid sinuses. Mastoid air cells and\nmiddle ear cavities are well aerated.", + "output": "1. Unchanged appearance of bilateral acute subdural hematomas allowing for\nminimal redistribution of the right subdural hematoma. Unchanged mild\nbilateral temporal and left frontal sulcal effacement. No shift of midline\nstructures.\n2. No evidence for new intracranial hemorrhage.\n3. Previously seen right parietal vertex subgaleal hematoma has redistributed,\nnow circumferential with bilateral involvement of the parietal vertex. Right\nsuboccipital scalp hematoma is unchanged. No evidence for a fracture.\n4. Paranasal sinus disease is again demonstrated, as detailed above. Central\nhyperdensity within the completely opacified left maxillary sinus may reflect\ninspissated secretions versus fungal colonization. Polypoid soft tissue\ndensity occluding the left ostiomeatal infundibulum may reflect a polyp." + }, + { + "input": "Redemonstration of a subdural hematoma along the right frontotemporal\nconvexity, measuring 6 mm in maximal diameter (series 2, image 11), which\nappears more heterogeneous and less dense compared to the most recent prior\nexam, compatible with expected evolution of subdural hematoma. Similar to\nprior, there is layering of the subdural along the right tentorium and mild\ntemporal sulcal effacement. No significant midline shift.\n\nAdditionally, along the left frontoparietal convexity, there is\nredemonstration of a subdural hematoma measuring 6 mm in maximum diameter,\nwhich appears more heterogeneous and less dense compared to most recent prior\nexam, compatible with expected evolution of subdural hematoma. Unchanged mild\nsulcal effacement. No significant midline shift.\n\nNo new areas of intracranial hemorrhage. There is no evidence of acute large\nterritory infarction or discrete mass. The ventricles and sulci are normal in\nsize and configuration. Minimal periventricular white matter hypodensities are\nnonspecific, but likely reflect the sequela of chronic microvascular\ninfarction.\n\nRedemonstration of a right suboccipital scalp hematoma, similar to prior. \nRedemonstration of right frontal scalp staples. No acute fracture. Mild\nmucosal thickening of the imaged left maxillary sinus. The visualized portion\nof the remaining paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Expected evolution of known bilateral subdural hematomas, unchanged in\nsize, with mild sulcal effacement.\n2. No evidence of new intracranial hemorrhage." + }, + { + "input": "Again demonstrated is a hyperdense subdural hematoma along the right\nfrontotemporal convexity measuring up to 7 mm in maximal diameter, previously\n6 mm on most recent prior exam performed ___ (02:13). This\ndemonstrates similar density compared to most recent prior exam, and is\ndecreased in density compared to exam performed ___, compatible with\nexpected evolution of the subdural hematoma. There is a similar degree of\nadjacent sulcal effacement and mass effect. There is unchanged extension of\nsubdural hematoma along the right tentorium and posterior falx.\n\nA 6 mm left frontoparietal convexity subdural hematoma with hyperdense blood\nproducts in its inferior most aspect and isointense to hypointense pelvic gray\nmatter collection along its superior aspect, has a similar appearance and\nconfiguration compared to most recent prior exam (02:15). Adjacent sulcal\neffacement and mass effect is also similar.\n\nThere is no midline shift of structures. Mild prominence of the ventricles\nand sulci is likely related to age-related involutional change, and appears\nsimilar in configuration compared to the most recent prior exam. No evidence\nof new intracranial hemorrhage. No large vascular territory infarction.\n\nRight suboccipital hematoma is unchanged in appearance compared to prior exam.\nSurgical staples are again seen along the right vertex. No acute fracture. \nParanasal sinus disease involving the left maxillary sinus and ethmoid air\ncells is only partially evaluated. The middle ear cavities and mastoid air\ncells are clear. The visualized orbits are preserved. Soft tissue density is\nnoted within the right external auditory canal, which may represent cerumen.", + "output": "1. Grossly stable appearance of right frontotemporal and left frontoparietal\nsubdural hematomas without evidence of midline shift.\n2. No new areas of intracranial hemorrhage or infarction.\n3. Paranasal sinus disease, as detailed above.\n4. Additional findings as described." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is moderate mucosal thickening with aerosolized secretions in the\nbilateral ethmoid air cells. The remainder of the visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "1. No acute intracranial process.\n2. Paranasal sinus disease, as detailed above." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is a mucosal retention cysts in the\nright maxillary sinus and mild mucosal thickening in left maxillary sinus. \nThe visualized portion of the remainder of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "No fracture or acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Aside from small amount of layering fluid\nwithin the left maxillary sinus, the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. 0.6 cm nodule left parotid gland,\npartially seen.", + "output": "No evidence of acute intracranial process.\nSuggestion of acute left maxillary sinusitis.\nSmall left parotid gland nodule, partially seen. Clinical exam recommended." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction, mass or midline\nshift. There is no hydrocephalus. Visualized paranasal sinuses and mastoid\nair cells are clear. There is no fracture.", + "output": "No acute intracranial abnormalities identified." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nadvanced generalized brain parenchymal atrophy, stable since prior. There is\nmild chronic small vessel ischemic changes, stable\n\nThere is no evidence of fracture. Presumed mild mucosal thickening of the\nanterior wall left maxillary sinus with adjacent periostitis, indicating\nchronic sinusitis, this area is suboptimally seen on only last image, if there\nis concern for paranasal sinus disease, maxillofacial sinus CT would be\nhelpful in further evaluation. There is no pre antral or retro antral soft\ntissue thickening. Otherwise, the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "There are no acute intracranial changes.\nThere is advanced generalized brain parenchymal atrophy.\nOnly partially seen is left maxillary sinus, with presumed mild mucosal\nthickening of the anterior wall and adjacent mild periostitis." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Prominent ventricles and sulci compatible with age-related\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are seen and nonspecific, but likely represent sequelae of small\nvessel ischemic disease.\n\nThere is mild mucosal thickening in the bilateral ethmoid air cells. There is\nalso mild mucosal thickening the anterior wall of the left maxillary sinus,\nunchanged from CT head ___. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No intracranial hemorrhage or other acute intracranial abnormality." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, intracranial hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are normal. The\nsoft tissues are unremarkable, no fractures are identified.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal with no evidence of stenosis, occlusion,oraneurysm the right\nvertebral artery is dominant. The major dural venous sinuses are patent,\nthere is no evidence of dural venous sinus thrombosis.", + "output": "1. There is no evidence of acute intracranial process or hemorrhage.\n2. Normal CTA of the head, with no evidence of flow stenotic lesions or\naneurysms.\n3. Normal CTV of the head, with no evidence dural venous sinus thrombosis." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are normal.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Though this exam was performed without contrast administration, there is high\ndensity in the blood pool likely from CTA performed earlier the same day.\n\nThere is no evidence of acute major vascular territorial infarction, edema, or\nmass. No evidence of acute intracranial hemorrhage, accounting for residual\nenhancement from recent intravenous contrast administration. There is slight\nprominence of the density at the distal distal left M1 (02:11) in the region\nof prior cut off. Prominence of the ventricles and sulci are consistent with\nage-related involutional change. Mild bilateral periventricular white matter\nhypodensities are nonspecific, but likely reflect a sequela of chronic small\nvessel disease.\n\nThere is no evidence of fracture. There is bilateral maxillary sinus mucosal\nthickening, mild on the right, and severe on the left. Mastoid air cells and\nmiddle ear cavities are clear. Right orbit is unremarkable. There is\nevidence of prior lens replacement on the left.", + "output": "No intracranial hemorrhage based on a contrast enhanced study. Residual\nvascular enhancement from recent intravenous contrast enhancement. Slightly\nprominent high density at the distal left M1 which could be due to diffuse\nhigh density in the blood pool from recent contrast administration though\nunderlying thrombus cannot be excluded." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is an irregular hypodensity in the left temporoparietal region with loss\nof gray-white differentiation which is nonspecific but may represent an\nacute/subacute infarction, (series 2, image 17). In the left frontal region is\nan area of encephalomalacia that likely represent sequela of chronic infarct,\n(series 2, image 20). No evidence of hemorrhage. No midline shift. Multiple\nhypodensities within the periventricular white matter are likely sequela of\nmicrovascular ischemic disease.\n\nThere is mild mucosal thickening of the bilateral ethmoid air cells. There is\ncomplete opacification of the left maxillary sinus with hypertrophy of the\nsurrounding bone which suggests a chronic process. The visualized portion of\nthe other paranasal sinuses,mastoid air cells, and middle ear cavities are\nclear. The patient is status post left lens replacement surgery.\n\nCTA HEAD:\nThere is a saccular dilatation of the distal left M1 at the junction of the\nproximal M2, (series 4, image 249) consistent with an aneurysm which measures\nup to 3 mm, (series 4, image 249). The A1 portion of left ACA is hypoplastic\ncompared to the right, (series 558, image 23). The left M1 is minimally\nasymmetrically hypoplastic when compared to the right, (series 558 image 25). \nThe other vessels of the circle of ___ and their principal intracranial\nbranches appear normal without stenosis, or occlusion. There are no other\naneurysms noted. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is diffuse atherosclerotic disease demonstrated in the bilateral carotid\narteries. The left internal carotid arteries demonstrate 50 percent stenosis\nby NASCET criteria, (series 4 image 180-186). The right internal carotid\nartery does not demonstrate stenosis by NASCET criteria. The vertebral\narteries are notable for hypoplasia or narrowing of the V4 segment on the\nright, the left vertebral artery is dominant and demonstrates stenosis at its\norigin.\n\nOTHER:\nIn the visualized lungs, there is are small bilateral pleural effusions with\ncompressive atelectasis. The visualized thyroid is unremarkable. There is no\nlymphadenopathy by CT size criteria. Mild multilevel degenerative changes are\nvisualized throughout the cervical spine.", + "output": "1. An irregular hypodensity in the left temporoparietal region is nonspecific\nbut may represent an acute/subacute infarction.\nAt the distal left M1 adjacent to the proximal M2 is an aneurysm which\nmeasures up to 3 mm.\n2. The left internal carotid artery demonstrates 50% stenosis by NASCET\ncriteria.\n3. Narrowing and stenosis identified the origin of the left vertebral artery,\nthere is mild narrowing at the V4 segment of the right vertebral artery,\nprobably hypoplastic or related with arteriosclerotic disease.\n4. Small bilateral pleural effusions with compressive atelectasis demonstrated\n\nRECOMMENDATION(S): Follow-up brain MRI is recommended to further characterize\nthe" + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or large mass. The\nventricles and sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. A small focus of hyperdensity\nin the left basal ganglia is compatible with calcification.\n\nNo osseous abnormalities seen. There is aerosolized debris in the right\nsphenoid sinus. The mastoid air cells and middle ear cavities are clear. The\norbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass effect. There is prominence of the sulci and ventricles, which is likely\nin part secondary to senescent related volume loss. However, enlargement of\nthe temporal horns with MTA score of approximately 3 on the left is\nvisualized. Correlation with patient cognitive status is recommended.\nModerate periventricular subcortical white matter hypodensities are\nnonspecific, but likely represent sequela of chronic ischemic microvascular\ndisease. There are dense atherosclerotic calcifications in the bilateral\nintracranial carotid arteries and vertebral arteries.\n\nNo acute fractures are seen. There is trace fluid within the right mastoid\nair cells. Otherwise, the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The orbits are unremarkable aside from bilateral lens\nreplacement.", + "output": "1. No acute intracranial abnormality on noncontrast CT head. Specifically no\nacute large territory infarct or intracranial hemorrhage.\n2. Increased diffuse cerebral volume loss, presumably senescent related since\nexamination of ___. However, there does appear to be slightly\ndisproportionate prominence of the temporal horns, with MTA score of\napproximately 3 on the left. Clinical correlation with patient cognitive\nstatus is recommended.\n3. Additional findings as described above." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is a 12 mm of hypodensity within the left thalamus which likely\nrepresent subacute stroke better characterized on MR brain dated ___. No hemorrhagic transformation, new infarction or mass-effect. The\nventricles and sulci are prominent suggesting involutional changes. The mild\nhypodensities within the subcortical and periventricular white matter that are\nnonspecific but likely sequela of microvascular ischemic disease. Moderate\ncalcified atherosclerosis involves the bilateral carotid siphons and V4\nsegments of the vertebral arteries.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are essentially clear. The visualized portion of the orbits\ndemonstrate post surgical changes related to bilateral lens replacement.\nCTA HEAD:\nThere is a left fetal type PCA which is a normal anatomic variant. The\ncarotid siphons demonstrate mild calcified atherosclerosis by remain widely\npatent. The vessels of the circle of ___ and their principal intracranial\nbranches appear normal without stenosis, occlusion, or aneurysm formation. \nThe dural venous sinuses are patent.\n\nCTA NECK: Moderate stenosis is seen at the origin of the right vertebral\nartery. Severe stenosis is seen the origin of the left vertebral artery with\nhypo attenuation of the V1 through V3 segments.\nThe bilateral vertebral arteries demonstrate moderate calcified\natherosclerosis which result in mild narrowing most pronounced at the origins\nbilaterally. There is decreased opacification at the and the V1 to V3\nsegments of left vertebral artery which increases at the V4 segment. The\ncarotidand arteries and their major branches appear normal with no evidence of\nocclusion or dissection. There is no evidence of internal carotid stenosis by\nNASCET criteria.\n\nOTHER:\nThere is moderate atherosclerosis involving the aortic arch and supra-aortic\nvessels which results in mild luminal narrowing. Moderate bilateral pleural\neffusions are seen. There is a 9 mm well-circumscribed hypodensity within the\nleft thyroid lobe which likely represents a thyroid nodule. There is\nmediastinal lymphadenopathy, for example there is a subcarinal lymph node\nwhich measures 12 mm in short axis , (series 3, image 13). There is no\naxillary or supraclavicular lymphadenopathy by CT size criteria. Compression\ndeformity of T4 is of indeterminate chronicity.", + "output": "1. A subacute infarction within the left thalamus, unchanged. No hemorrhagic\ntransformation no infarction or mass effect.\n2. Significant atherosclerosis at the V4 segments of the vertebral arteries\nresulting in mild luminal narrowing. Hypoattenuation of the V1-V3 segments of\nthe left vertebral artery may be secondary to stenosis at the origin or\nextensive atherosclerotic disease.\n3. A 9 mm hypodensity within the left thyroid lobe likely represents a thyroid\nnodule.\n4. Small to moderate bilateral pleural effusions.\n5. Compression deformity of T4 is of indeterminate chronicity.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or older.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150.\n2" + }, + { + "input": "There is no evidence of acute large infarction,hemorrhage,edema, or mass. \nPeriventricular and subcortical white matter hypodensities are similar to\nprior. Hypodensity in the right medial frontal gyri (02:10) is likely volume\naverage from a sulcus. Hypodensity in the left thalami is most consistent\nwith a chronic area of infarction. There is prominence of the ventricles and\nsulci suggestive of involutional changes. Heavy calcifications within the\nbilateral ICA at the cavernous sinus and vertebral arteries.\n\nThere is no evidence of fracture. Partial opacification of the right mastoid\nair cells is nonspecific. The visualized portion of the paranasal sinuses,\nleft mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Status post bilateral lens\nreplacement.", + "output": "1. No acute intracranial findings. No fractures.\n2. Hypodensities in the periventricular and subcortical white matter are\nnonspecific, however most likely sequela from chronic small vessel disease." + }, + { + "input": "Examination is limited due to motion artifact. Left basal ganglia lacunar\ninfarct is redemonstrated. There is no evidence of fracture,\ninfarction,hemorrhage,edema, or mass. There is marked enlargement of the\nventricles and sulci suggestive of cerebral atrophy.. Periventricular white\nmatter hypodensities consistent with chronic small vessel ischemic changes. \nThere is a chronic infarct in the medial left thalamus.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. Status post bilateral lens replacements. Otherwise,\nthe visualized portion of the orbits are normal.", + "output": "1. No evidence of acute intracranial abnormality.\n2. Cerebral atrophy, chronic left thalamic infarct, and small vessel ischemic\nchanges are unchanged." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation\nis preserved. Ventricles are symmetric and unremarkable. Basilar cisterns\nare patent.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial\nsoft tissues are unremarkable.", + "output": "1. No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. There is a chronic lacunar infarct in the left corona radiata. \nPeriventricular and subcortical white matter hypodensities are nonspecific but\nlikely sequelae of chronic small vessel ischemic disease. the ventricles and\nsulci are normal in size and configuration.\n\nThere is a large right parietal subgaleal hematoma. Some apparent\nirregularity at the cutaneous surface raise the possibility of a focal\nlaceration. There is no evidence of fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable. Senile scleral\ncalcifications are noted. There are moderate to severe carotid siphon\ncalcifications and mild left V4 segment calcification. Degenerative changes\nnoted at the right temporomandibular joint.", + "output": "1. There is a large right parietal subgaleal hematoma with a possible\noverlying laceration.\n2. No evidence of intracranial hemorrhage.\n3. Chronic ischemic and involutional changes." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass effect. The ventricles and sulci are prominent in keeping with\nage-related involutional change. Re-demonstrated is a chronic lacunar infarct\nin the left corona radiata. Atherosclerotic calcifications are again noted in\nthe bilateral carotid siphons.\n\nNo acute fractures are seen. Aside from mild mucosal thickening in the\nbilateral ethmoid air cells, the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable aside from\nbilateral lens replacement.", + "output": "1. No acute intracranial process.\n2. Redemonstration of chronic ischemic and involutional changes." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema,or mass effect. \nThere is prominence of the ventricles and sulci suggestive of cerebral\natrophy. Periventricular white matter hypodensities consistent with small\nvessel ischemic changes.\n\nMinimal opacification of the bilateral maxillary sinuses. The remaining\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. Status post bilateral lens replacements. The visualized\nportion of the orbits are normal.", + "output": "1. No evidence of acute intracranial abnormality.\n2. Stable age-related cerebral atrophy and small vessel ischemic changes." + }, + { + "input": "Patient is status post right frontal craniotomy and re-resection of a right\nfrontal lesion with expected postsurgical pneumocephalus and subcutaneous\nemphysema. Hyperdensity around the edges of the resection site are noted in\naddition to air. The ___ the cavitation contains isodense material. \nIsodense extra-axial fluid is noted along the right frontal convexity. There\nis no midline shift. Small amount of vasogenic edema is noted in the right\nfrontal periventricular region which is overall unchanged compared to the\npreoperative study.\n\nThere is no evidence of acute infarction or unexpected intracranial\nhemorrhage. The ventricles and sulci are normal in size and configuration. \nCalcifications in the region of the left anterior temporal dura.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Status post right frontal craniotomy and re-resection of a right frontal\noligoastrocytoma.\n2. Small amount of vasogenic edema in the right frontal lobe surrounding the\nresection cavity is not significantly changed compared to the preoperative\nstudy.\n3. No acute infarction or unexpected intracranial hemorrhage." + }, + { + "input": "Patient is post right frontal craniotomy for tumor resection, with expected\npostsurgical changes again seen. Small volume pneumocephalus is mildly\ndecreased. Small areas of hyperdense material in the resection cavity,\npredominantly posteriorly (3:34) and inferiorly (3:29) are compatible with\nacute hemorrhage, and is overall increased from ___.\n\nThere is persistent edema in the right frontal lobe white matter.\n\nThere is no evidence of acute large territorial infarction ornew\nintraparenchymal hemorrhage elsewhere in the brain. There is no midline\nshift. The configuration of the ventricles are unchanged.\n\nThere is mild mucosal thickening in the bilateral maxillary sinuses. The\nvisualized portion of the mastoid air cells and middle ear cavities are clear.\nThe visualized portion of the orbits are unremarkable.", + "output": "1. Post right frontal craniotomy for tumor resection.\n2. Small areas of blood products in the resection cavity are overall slightly\nincreased from ___.\n3. No new intraparenchymal hemorrhage elsewhere in the brain or evidence of\nacute large territorial infarction." + }, + { + "input": "The adenoids are not enlarged. There is mild right tonsillar region fullness\nwithout evidence for an enhancing mass. Right lingual tonsil is minimally\nlarger than the left. There are mild secretions in the right vallecula.\n\nThere appears to be fatty atrophy of the main parotid glands with hypertrophy\nof bilateral accessory parotid glands. Submandibular glands are not well seen\nand likely also atrophic.\n\nThe thyroid appears unremarkable.\n\nWithin the atrophic right parotid gland, there are mildly enlarged lymph nodes\nwithout fatty hila, versus nodules, measuring 10 mm in long axis on image 2:39\nand 9 mm in short axis on image 300:54, 02:34. There are only scattered\nnonenlarged lymph nodes with fatty hilar in the atrophic left parotid gland.\n\nRight level 2b lymph node measures 19 mm in long axis, images 300:64, 2:36,\nmildly enlarged. Mildly enlarged left level 2B lymph node measures 13 mm in\nlong axis on image 2:34. Level 1, 2 B, and lower cervical lymph nodes are not\npathologically enlarged by CT criteria.\n\nMajor cervical arteries and veins are patent.\n\nThis exam is not technically optimized for evaluation of the included brain\nparenchyma, though no concerning abnormalities are seen on limited assessment.\nThere are mucous retention cysts in the maxillary sinuses.\n\nThere are degenerative changes in the cervical spine.\n\nThere is unchanged minimal pleural/parenchymal scarring at the included lung\napices.", + "output": "1. Mild right tonsillar region fullness without evidence for an enhancing\nmass.\n2. Fatty atrophy of the main parotid gland with hypertrophy of bilateral\naccessory parotid glands. Submandibular glands are not well seen and likely\nalso atrophic.\n3. Within the atrophic right parotid gland, there are mildly enlarged lymph\nnodes without fatty hila, versus nodules, up to 10 mm in long axis.\n4. Mildly enlarged bilateral level 2 B lymph nodes.\n\nRECOMMENDATION(S): ENT evaluation. If clinically warranted, PET-CT could be\nconsidered after ENT evaluation.\n\nNOTIFICATION: Electronic wet reading was provided by Dr. ___ at the\ncompletion of this report, approximately 16:40 on ___." + }, + { + "input": "There is no definite evidence of large territorial infarction, hemorrhage,\nedema, or mass. The ventricles and sulci are normal in size and\nconfiguration. Cavum septum pellucidum is noted. Chronic right basal ganglia\ninfarct is seen (see 02:16). Atherosclerotic vascular calcifications are\nnoted of bilateral vertebral and cavernous portions of internal carotid\narteries.\n\nThere is no evidence of fracture. The visualized portion of the mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable. Minimal bilateral ethmoid air cell and maxillary\nsinus mucosal thickening is present.", + "output": "1. No move evidence of acute intracranial hemorrhage or large territorial\ninfarct.\n2. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct.\n3. Paranasal sinus disease as described." + }, + { + "input": "There is no evidence of large territorial infarction, acute intracranial\nhemorrhage, edema, or mass. The ventricles and sulci are normal in size and\nconfiguration. Re-demonstration of the cavum septum pellucidum.\n\nThere is no evidence of fracture. There is mild bilateral maxillary sinus\nthickening, as well as the right sphenoid sinus aerosolized secretions and\nmild left sphenoid sinus mucosal thickening. The visualized portion of the\nremaining paranasal sinuses mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "No acute intracranial hemorrhage or fracture detected." + }, + { + "input": "There is a right trans frontal ventriculostomy catheter, which terminates\nwithin the anterior horn of the left lateral ventricle. Ventricular size and\nconfiguration is unchanged compared to the MR dated ___.\n\nA metastatic lesion with coarse central calcification is re-demonstrated\nwithin the right parietal lobe, better evaluated on the prior MR. ___ is\nmoderate surrounding vasogenic edema, which is also similar in distribution. \nAlthough there are no prior CTs for comparison, there are calcifications\nwithin the right cerebellum (series 2, image 6), which appear to be new and\nlikely metastatic in origin. Multiple additional metastatic foci are better\nevaluated on the prior MR.\n\n___ is no evidence of acute territorial infarction or hemorrhage.\n\nNumerous sclerotic lesions are seen throughout the calvarium, compatible with\nmetastatic disease. There is no evidence of fracture. The visualized portion\nof the paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. Right transfrontal ventriculostomy catheter, terminating within the\nanterior horn of the left lateral ventricle. Ventricular size and\nconfiguration is unchanged.\n2. Unchanged appearance of the metastatic lesion within the right parietal\nlobe with surrounding vasogenic edema. Additional metastatic parenchymal\nlesions are better evaluated on prior MR, however there does appear to be at\nleast 1 new lesion within the right cerebellum.\n3. Numerous sclerotic lesions throughout the calvarium, also compatible with\nmetastatic disease." + }, + { + "input": "There is re- demonstration of a small acute intraparenchymal hemorrhage in the\nright frontal lobe, stable in size and configuration compared to prior study\nfrom earlier today. In addition, there is a linear hyperdensity in the\ndependent portion of the right lateral ventricle occipital horn, concerning\nfor a small intraventricular bleed, which was also previously seen.\n\nA predominantly hypodense mass in the left frontal lobe is again seen, which\nappears to cross midline through the head of the corpus callosum into the\ncontralateral hemisphere and measuring approximately 3.6 x 2.1 cm. There is a\nsmall hyperdense internal component which could reflect internal bleed.\nOverall, this mass appears unchanged compared to prior study. There appears\nto be unchanged associated vasogenic edema and local mass effect.\n\nThe ventricles and sulci are moderately prominent due to age-related cerebral\natrophy. The basal cisterns appear patent. There is subcortical and\nperiventricular white matter hypodensities, which are most likely sequela of\nchronic small vessel ischemic disease. Small hypodensity in the left basal\nganglia likely represents an old lacunar infarct.\n\nThe visualized bony structures are grossly unremarkable. There is mild\nmucosal thickening in the anterior ethmoidal air cells. The frontal and\nmaxillary sinuses, mastoid air cells, and middle ear cavities are clear.\nAtherosclerotic mural calcification of the bilateral internal carotid arteries\nis noted. The globes are unremarkable.", + "output": "1. Compared to earlier study, there is stable small intraparenchymal\nhemorrhage in the right frontal lobe and tiny amount of blood within the\noccipital horn of the right lateral ventricle.\n2. Redemonstration of a large left frontal mass which appears to extend to\nthe contralateral hemisphere through the corpus callosum head. MRI is\nrecommended for further characterization." + }, + { + "input": "Again seen is a small focus of intraparenchymal hemorrhage in the right\nfrontal lobe measuring 6 mm unchanged since the previous exam. A small linear\nhyperdensity within the occipital horn of the right lateral ventricle persists\npossibly representing a small amount of intraventricular hemorrhage (series 3,\nimage 21). The hypodense left frontal mass extending into the rostrum of the\ncorpus callosum with a small central focus of hyperdensity is unchanged. There\nis no evidence of new hemorrhage or of infarction. The ventricles and sulci\nremain enlarged, although unchanged in size and configuration compared to the\nprior study. The visualized paranasal sinuses, mastoid air cells and middle\near cavities are clear. There is no acute fracture.", + "output": "1. Stable right frontal lobe intraparenchymal hemorrhage and stable possible\nright intraventricular hemorrhage.\n2. Unchanged left frontal lobe mass for which further evaluation with MRI is\nrecommended." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere are multiple small soft tissue lesions within the scalp and neck\nbilaterally, compatible with the patient's known history of neurofibromatosis.\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are normal in size and configuration. A few scattered parenchymal\ncalcifications are seen throughout the brain bilaterally, nonspecific, but\npossibly relating to prior infection.\n\nA small amount of soft tissue within the ear canals bilaterally, likely\ncerumen. Mild mucosal thickening within the inferior left maxillary sinus. \nVolume loss, atelectasis of the left greater than right maxillary sinus from\nchronic inflammation. Otherwise, the visualized portion of the paranasal\nsinuses, mastoid air cells,and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.\n\nCTA HEAD:\n2 mm bulbous abnormality of the right calloso-marginal artery series 7, image\n327, may represent infundibulum versus aneurysm.\nMinimal atherosclerotic calcifications of the cavernous carotid arteries\nbilaterally. The vessels of the circle of ___ and their principal\nintracranial branches appear normal without stenosis, occlusion, or aneurysm\nformation. The dural venous sinuses are patent.\n\nCTA NECK:\nNumerous neurofibromas are seen throughout the cervical and upper thoracic\nspine, many of which widen the bilateral neural foramina, similar compared to\nthe MR dated ___. Plexiform neurofibromas at C6-7 and C7-T1\ndemonstrate significant intraspinal components with marked compression of the\nspinal cord at these levels (series 7 image 112, 120). Although multiple\nneurofibromas contact and cause anterior displacement of the vertebral\narteries bilaterally, there is no evidence of vertebral artery stenosis or\nocclusion. The carotidarteries and their major branches appear normal with no\nevidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nExtensive changes of neurofibromatosis with virtually every nerve thick in the\nneck, including brachial plexus, sympathetic chain, vagus nerve, exiting\ncervical nerves.. Numerous supraclavicular and mediastinal soft tissue\nlesions are visualized, overall similar in appearance compared to the PET-CT\ndated ___, compatible with neurofibromas. Multiple additional\nsoft tissue lesions within the subcutaneous tissues of the chest and back\ncompatible with additional neurofibromas, for example series 7, image 24. \nGround-glass opacities within the dependent portion of the lungs bilaterally,\nlikely atelectasis. The visualized portion of the thyroid gland is within\nnormal limits. There is no lymphadenopathy by CT size criteria. Multilevel\nforaminal expansion in the spine, consistent with neurogenic tumors.\n\n2 mm superficial nodule left true vocal cord series 7, image 128, may\nrepresent small tumor. ENT consult recommended. No evidence of left vocal\ncord paralysis.", + "output": "1. 2 mm infundibulum versus aneurysm right callosomarginal artery.\n2. 2 mm nodule left true vocal cord, possibly neurofibroma, ENT consult\nrecommended.\n3. Findings consistent with extensive neurofibromatosis 1.\n4. Cervical spinal canal component of the tumor was better seen on MRI,\nincluding cord compression..\n5. No arterial narrowing in the head, neck. There are areas of neck arterial\ndisplacement secondary to neurofibromas.\n6. Patent, moderately flattened jugular veins in the neck from mass effect." + }, + { + "input": "There is no evidence of fracture, infarction, hemorrhage, edema,or mass. The\nventricles and sulci are normal in size and configuration. There is no\nabnormal enhancement on post contrast images.\n\nThere is moderate amount of superficial subcutaneous fat stranding overlying\nthe right occipital bone likely representing cellulitis. There is associated\nskin thickening. There is no drainable fluid collection or abscess. There is\nmild mucosal thickening of the bilateral maxillary sinuses, right greater than\nleft. The remaining visualized portions of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the orbits\nare unremarkable.", + "output": "1. Subcutaneous fat stranding along the right posterolateral neck extending\nsuperiorly to the level of the mid occiput most compatible with cellulitis. \nNo deeper extension.\n2. No acute intracranial abnormalities." + }, + { + "input": "There is superficial subcutaneous fat stranding along the right post for\nlateral neck extending from the level of the pinna and tracking inferiorly to\nthe lower neck. There is no fluid collection or subcutaneous gas. Small\nfocus of nodularity in the right upper posterior neck on series 2, image 16\ncould represent a small reactive lymph node. The underlying muscles appear\nunremarkable. Overall findings are most suggestive of cellulitis.\n\nThe salivary glands appear normal. Tonsillar structures are normal. Air or\ndigestive tract is patent. Thyroid gland is normal. No retroperitoneal\nedema. The upper lungs appear clear. The superior mediastinum appears\nnormal. No signs of dental infection. Bony structures appeared intact and\nunremarkable. Minimal mucosal thickening is noted within the imaged paranasal\nsinuses.", + "output": "Findings consistent with cellulitis in the right posterolateral neck.\nNo signs of deeper extension or complication." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territory infarct. Gray-white matter\ndifferentiation is preserved. Subtle hypodensity in the right parietal\nsubcortical white matter is stable. There is no hydrocephalus. The\nvisualized paranasal sinuses demonstrate aerosolized secretions in the very\nsuperior left maxillary sinus. The remainder of the maxillary sinuses are not\nimaged. There is minimal mucosal thickening in the left ethmoid air cells. \nThe frontal sinuses are underpneumatized.. The mastoid air cells are clear. \nNo acute fracture is seen.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of large territory infarction, hemorrhage, edema, or mass\neffect. There is age-related cortical volume loss with prominence of the sulci\nand ventricles. Nonspecific periventricular white matter hypodensities are\nseen, most consistent with small vessel ischemic disease.\n\nLarge left frontal hematoma is seen. No definite underlying fracture is\nidentified. Small fluid is seen in the left maxillary sinus. There is mild\nmucosal thickening in the right maxillary sinus. The mastoid air cells and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Large left frontal hematoma without definite underlying skull fracture or\nintracranial abnormality.\n2. Small air-fluid level of the left maxillary sinus without definite fracture\nidentified. If there is concern for facial fracture, dedicated CT of the\nfacial bones can be considered." + }, + { + "input": "There is enlargement of the left palatini tonsil. No discrete drainable fluid\ncollection is identified. Pharyngeal mucosal edema seen extending inferiorly\non the left to involve the left lateral wall of the oropharynx with subsequent\nasymmetry of the upper left piriform sinus and vallecula. No discrete fluid\ncollection is seen.\n\nThe parotid and submandibular glands glands enhance normally and are without\nmass or adjacent fat stranding.There is bilateral cervical adenopathy with\nleft level 2 node measuring up to 2.8 cm long axis and a right level 2 node\nmeasuring up to 2.1 cm. These are likely reactive. Few hypodense nodules are\nseen in the right thyroid lobe, the largest measuring 9 mm in the lower pole.\n\nThe neck vessels are patent. There is mild mucosal thickening of the left\nmaxillary sinus.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules.", + "output": "Left palatine tonsillar enlargement without drainable collection. Edema\nextending inferiorly along the left oropharyngeal wall. Bilateral cervical\nadenopathy, likely reactive." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Ventricles\nand sulci are preserved. Incidental note is made of a partially empty sella.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of acute intracranial hemorrhage or fracture.\n2. Nonspecific partially empty sella. If concern for intracranial\nhypertension consider MRI orbits further evaluation." + }, + { + "input": "Images were repeated due to motion artifact on the initial scan. The repeated\nscan, series 6, demonstrates only mild motion artifact through the lower\ncerebrum.\n\nNo evidence for acute hemorrhage, edema, mass effect, or loss of gray/white\nmatter differentiation. Ventricles, sulci, and basal cisterns are within\nnormal limits allowing for normal-variant ___ cisterna magna. Partially\nempty sella is again noted. The cerebellar tonsils are normally positioned.\n\nNo evidence for concerning osseous abnormalities. Mild mucosal thickening in\nthe ethmoid air cells and partially visualized maxillary sinuses. Mastoid air\ncells and middle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. Partially empty sella is again noted. No other signs for intracranial\nhypertension, but if there is a clinical concern, correlation with\nophthalmological exam would be helpful." + }, + { + "input": "Since head CT from 3 days prior, there has been reaccumulation of an acute\nleft subdural hematoma measuring approximately 16 mm in greatest width at the\nvertex extending along the entire cerebral convexity including the tentorium. \nAdditionally, a low-density right subdural collection has also increased\nmeasuring approximately 10 mm in greatest width with a small high density\ncomponent along the right occipital bone. A small amount of intraventricular\nhemorrhage within the occipital horns is redemonstrated. Overall ventricular\nsize and configuration is unchanged. The basal cisterns are patent and there\nis preservation of gray-white matter differentiation. There is no large\nterritorial infarction. There is no significant shift of midline structures. \nPostsurgical changes from left frontal craniotomy are again seen. Low-density\nfluid and air overlying the left frontal and parietal bones, most likely post\nsurgical.\n\nNo osseous abnormalities seen. Fluid is seen within the left maxillary sinus\nand mucosal thickening of the ethmoid air cells. Fluid within the\nnasopharynx, likely secondary to intubation. The orbits are unremarkable.", + "output": "1. Reaccumulation of acute left subdural hematoma measuring approximately 16\nmm in greatest width at the vertex. Small amount of intraventricular\nhemorrhage not significantly changed. Overall ventricular size is unchanged. \nNo significant shift of midline structure\n2. Interval increase in low density right subdural collection with suggestion\nof an acute component along the right occipital bone.\n\nNOTIFICATION: Findings discussed with ___ on ___ at 22:30\nby Dr. ___ the telephone, ___ minutes after findings made." + }, + { + "input": "In comparison to the most recent noncontrast head CT on ___, there is\nbeen no significant interval change in the size of the left subdural hematoma.\nAgain noted is an old right subdural hematoma with evidence of acute blood\nlayering posteriorly along the right occipital lobe (2:11). Intraventricular\nhemorrhage is unchanged. No shift of midline structures. Postsurgical changes\nfrom left frontal craniotomy are re-demonstrated, with slight interval\ndecrease in superficial swelling/edema.\n\nNo evidence of acute major vascular territorial infarction. Prominent\nventricles and sulci suggest age-related volume loss. There are bilateral\nperiventricular hypodensities which are nonspecific but suggest chronic small\nvessel ischemic disease. There is mucosal thickening within the bilateral\nmaxillary sinuses, left greater than right as well as the ethmoid air cells. \nMild opacification of bilateral mastoid air cells is also seen. Orbits are\nunremarkable.", + "output": "1. Overall no significant interval change of 15 mm left subdural hematoma,\nintraventricular hemorrhage and postoperative changes. No new hemorrhage.\n2. Unchanged appearance of old right subdural hematoma with acute blood\nlayering posteriorly over the right occipital convexity." + }, + { + "input": "The patient is status post left craniotomy. A left subdural hematoma along\nthe lateral convexity appears similar in size to prior exam and measures 13 mm\nin width (series 3:image 18). The hematoma appears less dense reflecting\nevolution of blood products. There is unchanged left frontal sulcal\neffacement. There has been interval decrease in the right hypo 10 subdural\ncollection. Minimal rightward shift of midline structures has slightly\nincreased, and the lateral ventricles are slightly larger than before, which\nis likely due to the decreased size and mass effect of the right subdural\ncollection. Small amount of dependent intraventricular hemorrhage is again\nseen in the occipital horns of the lateral ventricles. No new hemorrhage or\nparenchymal edema is seen.\n\nPeriventricular white matter hypodensities are likely sequela of chronic small\nvessel ischemic disease.\n\nPartial opacification of the bilateral mastoid air cells is noted, likely due\nto the patient's prolonged supine position.", + "output": "1. Stable size of left subdural hematoma with decreased density.\n2. Interval decrease in size of the right subdural collection.\n3. Slightly increased size of lateral ventricles and slightly increased mild\nrightward shift of midline structures are secondary to the decreased size of\nthe right subdural collection." + }, + { + "input": "Please note the study is degraded by motion. The patient is status post left\ncraniotomy. A left subdural hematoma along the left lateral convexity has not\nsignificantly changed in size but is possibly decreased in maximum depth, now\nmeasuring approximately 12 mm in depth, previously 13 to 14 mm. The density\nof the collection does not appear significantly changed. Minimal rightward\nshift of the normally midline structures of approximately 3 mm is also stable.\nThe paranasal sinuses, and middle ear cavities are clear. The mastoid air\ncells are opacified bilaterally. The orbits are unremarkable.", + "output": "1. A left subdural hematoma and minimal shift of the normally midline\nstructures appears relatively stable compared to the prior CT ___.\n\n2. No evidence of new hemorrhage." + }, + { + "input": "There has been interval left frontal craniotomy for evacuation of left\nhemisphere subdural hematoma, which in comparison to the outside hospital\nradiograph has significantly improved. There is continued mass effect upon\nthe left frontal lobe with effacement of the left lateral ventricle. There is\nsignificantly improved left-to-right midline shift, now measuring up to 4 mm. \nExpected postoperative pneumocephalus overlying the frontal convexities\nbilaterally. There remains a small left frontal subdural collection with\nareas of hyperdense fluid indicative of hemorrhage. Maximal thickness of the\nsubdural hematoma is 7 mm. Hyperdense intraventricular contents in the\noccipital horns bilaterally (03:17) is indicative of intraventricular\nextension of hemorrhage. Periventricular white matter hypodensities are\nlikely a sequela of chronic small vessel ischemia. No evidence of acute\ninfarction.\n\nPost craniotomy changes in the left frontal scalp. There is a minimal mucosal\nthickening of the maxillary sinuses and ethmoid air cells. Mastoid air cells\nand middle ear cavities are clear.", + "output": "1. Status post left frontal craniotomy for subdural hematoma evacuation with a\nresidual 7 mm left frontal subdural collection with hyperdense components\nindicative of hemorrhage.\n2. 4 mm rightward shift of the midline structures, as well as effacement of\nthe left lateral ventricle and left frontal lobe, significantly improved from\nthe outside hospital CT." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nPeriventricular and subcortical white matter hypodensities are nonspecific but\nlikely sequelae of chronic small vessel ischemic disease.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Calcifications of the bilateral\ncavernous carotid arteries and vertebral arteries are noted.", + "output": "1. No evidence of hemorrhage, infarction, or other acute intracranial\nabnormality.\n2. Age-appropriate atrophy and probable chronic small vessel ischemic changes." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territorial infarct. Prominence of the\nventricles and sulci is consistent with cortical volume loss. Subtle\nperiventricular and subcortical white matter hypodensities are likely sequelae\nof chronic small vessel disease. The visualized paranasal sinuses are clear. \nThe mastoid air cells and middle ear cavities are clear. No acute fracture is\nseen.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nGray-white matter differentiation is maintained. Subcortical and\nperiventricular white matter hypodensities, correlate with T2/FLAIR\nhyperintesities on prior MRI from ___, likely represent sequelae from\nsmall chronic vessel disease. There is no evidence of intracranial\nhemorrhage, edema, or mass. Ventricles and sulci are prominent from\ninvolutional changes.\nNo osseous abnormalities. There is partial opacification of the right\nmaxillary sinus with air-fluid level suggesting an ongoing inflammatory\nprocess, there is mild mucosal thickening on the left maxillary sinus. \nMastoid air cells and middle ear cavities are clear.\n\nCTA HEAD:\nThere is a grossly unchanged 3 mm outpouching contour at the right MCA, at the\nlevel the A1/M1 bifurcation in the right carotid terminus. The remainder\nvessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nHeavily calcified aortic arch and main branches without significant stenosis. \nFocal calcified plaque in both common carotid bifurcations without significant\nstenosis. Also heavily calcified both ICAs at the cavernous segments without\nsignificant stenosis.\nHeavily calcified left V4 segment without stenosis. Multifocal areas of\nnarrowing in the right V4 segment with substantial distal narrowing (4:190),\nin an already hypoplastic and mildly calcified right vertebral artery.\nThe carotidandmajor branches of both vertebral arteries appear normal with no\nevidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nCentrilobular emphysema. The visualized portion of the thyroid gland is\nwithin normal limits. There is no lymphadenopathy by CT size criteria. \nMultilevel degenerative changes throughout cervical spine, more significant\nfrom C4 through C6 levels, consistent with posterior spondylosis.", + "output": "1. No evidence of acute intracraneal process or hemorrhage.\n2. Grossly unchanged 3 mm aneurysm of the right MCA at the level of the A1/M1\nbifurcation, right carotid terminus.\n3. Multifocal areas of narrowing along the V4 segment of the right vertebral\nartery with substantial narrowing distally, however patent.\n4. Extensive atherosclerosis involving the aortic arch and main branches, as\nwell as bilateral ICA at the cavernous segments and both vertebral arteries,\nleft worse than right. No evidence of internal carotid stenosis by NASCET\ncriteria." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. Note is\nmade of a fetal origin of the left PCA. The dural venous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\n4 mm ground-glass and 8 mm calcified left apical pulmonary nodules are\nunchanged since ___ (Series 5, image 48, 42). The lungs are otherwise clear.\nThe left thyroid is surgically absent. Right thyroid is unremarkable. There\nis no lymphadenopathy by CT size criteria.", + "output": "1. No acute intracranial process.\n2. Normal head and neck CTA.\n3. Left apical pulmonary nodules, stable since ___, requiring no further\nfollow-up." + }, + { + "input": "Osseous structures are significant for degenerative changes of the\ncervical spine, particularly the facets at C4-5 bilaterally, and C5-6, left\ngreater than right. The soft tissues of the head and neck are unchanged with\nscattered lymph nodes that do not appear pathologic.\n\nThe thoracic aortic stent graft is partially visualized. It appears similar\nto the examination of one year ago. The transposed left subclavian artery has\nminimal irregularity at its origin, likely postoperative, similar to prior,\nbut no significant stenosis. The brachiocephalic artery is moderately\ntortuous with a small amount of soft plaque proximally, but no significant\nflow limiting stenosis, also similar to prior.\n\nThe right common carotid artery has mild mixed soft and calcific plaque\ndistally involving its bifurcation.\n\nThe right internal carotid artery origin is involved by this mixed plaque but\nwithout significant narrowing, only minimal luminal irregularity. The\ncervical right internal carotid artery is tortuous, looping at the level of\nthe C2-C3 articulation, but maintains normal caliber. The intracranial right\ninternal carotid artery has mild calcific atherosclerotic irregularity of the\ncavernous portion, but no flow-limiting stenosis.\n\nThe right external carotid artery origin has minimal luminal irregularity due\nto soft plaque but otherwise is normal course, caliber and branching pattern.\n\nThe left common carotid artery is widely patent with mild luminal irregularity\ndistally due to soft plaque.\n\nThe left internal carotid artery has mild luminal irregularity at its origin,\ndue to soft plaque extending from the carotid bifurcation. There is no\nflow-limiting stenosis. Similar to the right, there is a loop of the cervical\nleft internal carotid artery at the level of the C1-C2 articulation. The\nintracranial left internal carotid artery is moderately narrowed due to\ncalcific plaque within the cavernous segment.\n\nThe left external carotid artery has minimal luminal irregularity at its\norigin but otherwise normal course, caliber and branching pattern.\n\nThere is mild narrowing of the right vertebral artery origin due to soft\nplaque. There is mild irregularity of the right V4, intracranial segment, of\nthe right vertebral artery due to calcific plaque but no flow-limiting\nstenosis. The left vertebral artery has mild-to-moderate narrowing at its\norigin due to soft plaque. The right vertebral artery is slightly dominant. \nThe left vertebral artery otherwise has normal course and caliber.\n\nThe visualized intracranial vessels are patent. The anterior communicating\nartery is patent. No posterior communicating arteries are identified.\n\nThe venous structures are unremarkable.", + "output": "No flow-limiting stenosis. Little change compared to the prior\nexamination. Status post thoracic aortic stent placement, partially\nvisualized, also similar to prior. Please see thoracic CTA for further\ndetails." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. A small,\nextra-axial CSF space the posterior fossa likely represents an incidental ___\ncisterna magna versus arachnoid cyst. The basal cisterns are patent. There\nis preservation of gray-white matter differentiation.\n\nA large, subgaleal hematoma overlying the right parietal bone is noted without\nunderlying skull fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Subgaleal hematoma at the right scalp vertex without underlying skull\nfracture." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of hemorrhage, infarction, edema, or mass effect. The\nventricles are normal in size. The paranasal sinuses and bilateral mastoid\nair cells appear clear.\n\nCTA HEAD:\nThere is no evidence of stenosis, occlusion, or aneurysm formation. The\nvisualized principal arterial branches appear patent. There is a nonspecific\nprominent vessel extending along the right temporal convexity and draining\ninto the right transverse sinus (601b:13), which may be a congenital variant. \nOtherwise, the visualized dural venous sinuses appear patent.\n\nCTA NECK:\nThere is a noncalcified plaque at the origin of the right internal carotid\nartery without stenosis by NASCET criteria. There is no evidence stenosis,\nocclusion, or dissection. There is no internal carotid artery stenosis by\nNASCET criteria. There is a punctate focus of air slightly superior to the\nleft C2 transverse foramina (5:170) of uncertain significance. There is a\ncommon origin of the brachiocephalic and left carotid artery.\n\nOTHER:\nThe thyroid gland and visualized lung apices appear unremarkable. There is no\nlymphadenopathy per size criteria. Streak artifact related to dental amalgam\nlimits evaluation of adjacent structures.", + "output": "1. No evidence of infarction, hemorrhage, or edema.\n2. No evidence of stenosis, occlusion, aneurysm formation, or dissection." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. There is cerebral involutional change which is age-appropriate. \nThere is notable cerebellar atrophy. Ventricles are normal in size. \nParanasal sinuses, mastoid air cells and middle ear cavities are well aerated.\nThe bony calvarium is intact.", + "output": "No acute intracranial process. Cerebellar atrophy." + }, + { + "input": "The palatine tonsils are enlarged. In the right peritonsillar region there is\na focal ill-defined low-density collection measuring 17 x 11 x 16 mm (AP by\ntransverse by CC). The orodigestive tract is deviated to the left, secondary\nto this collection however, it remains widely patent.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. There are multiple thyroid nodules as seen previously the largest\nis located in the right isthmus and measures 10 mm. Although none meet size\ncriteria to be concerning for malignancy, there are numerous prominent level 2\nnodes, greater on the right than left. The neck vessels are patent.\n\nA 6 mm right apical pulmonary nodules unchanged from ___. There are no\nosseous lesions. There is mild mucosal thickening in the ethmoid air cells. \nThe visualized paranasal sinuses are otherwise clear. The visualized orbits\nare unremarkable.", + "output": "1. Enlarged palatine tonsils with a focal ill-defined hypodense right\nperitonsillar collection measuring 17 x 11 x 16 mm, concerning for developing\nabscess.\n2. Multinodular thyroid which can be evaluated with nonemergent thyroid\nultrasound if not done so recently.\n3. Stable right apical pulmonary nodule." + }, + { + "input": "The contrast bolus timing is suboptimal. Again seen is an enlarged right\npalatine tonsil, not significantly changed in size compared to prior exam. \nThere continues to be a suggestion of central hypodensities, less conspicuous\ncompared to prior exam, concerning for phlegmonous change. There is stable\ndeviation of the or digestive tract to the left, which remains patent. There\nis stable enlargement of a level 2a node on the right (02:34).\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. Thyroid is stably enlarged, containing multiple hypodensities,\nconsistent with a multinodular goiter. There is no lymphadenopathy by CT\ncriteria. The neck vessels are patent.\n\nThe image portion of the lung apices again demonstrate 6 mm right apical\npulmonary nodule, unchanged from ___. There are no osseous lesions. The\nvisualized orbits are unremarkable. Mild mucosal thickening of the ethmoid\nair cells are stable. Small amount of debris is seen within the trachea,\nlikely secretions (2:77).", + "output": "1. No significant interval change in the enlarged right palatine tonsil with\nconcern for phlegmonous change. However, contrast bolus timing is suboptimal\nfor evaluation for abscess at this exam.\n2. Stable enlarged right level 2a node." + }, + { + "input": "In the region of the right palatine tonsil, there is a 2.4 x 1.6 x 1.6 cm\nhypodensity suggestive of a peritonsillar abscess. This is in the same\nlocation as multiple prior exams. There is mass effect on the airway, which\nis narrowed but patent.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding.There is a multinodular thyroid, similar to prior.There is no\nlymphadenopathy by CT criteria. The neck vessels are patent.\n\nThe imaged portion of the lung apices demonstrate unchanged 7 mm nodules at\nthe right apex.There are no osseous lesions.", + "output": "There is a 2.4 x 1.6 x 1.6 cm hypodensity in the region of the right palatine\ntonsil, suggestive peritonsillar absces in a similar location compared to\npriors s. Mass-effect results in a narrowed but patent airway." + }, + { + "input": "Images are limited by motion artifact, which limits evaluation for subtle loss\nof gray/white matter differentiation. There is apparent loss of gray/white\nmatter differentiation in the left parietal and superior occipital lobes on\nimages ___. There is no evidence for acute hemorrhage. Residual\nintravascular contrast from the prior outside CTA limits evaluation for the\npreviously seen left MCA thrombus.\n\nThere is encephalomalacia in the right parietal lobe and extending slightly\ninto the posterosuperior right upper lobe, compatible with prior infarction. \nExtensive confluent subcortical, deep, and periventricular white matter\nhypodensities are nonspecific but most likely represent chronic small vessel\nischemic changes. There is global parenchymal volume loss with prominent\nventricles and sulci.\n\nNo concerning osseous abnormalities are seen allowing for motion artifact. \nThere is mild mucosal thickening in the ethmoid air cells and frontoethmoidal\nrecesses. There is trace fluid within bilateral sphenoid sinuses, likely\nsecondary to the partially visualized endotracheal and orogastric tubes. \nMastoid air cells appear grossly clear.", + "output": "1. Substantially motion limited exam.\n2. No acute intracranial hemorrhage.\n3. Apparent loss of gray-white matter differentiation the left parietal and\nsuperior left occipital lobes, suggesting an acute infarction.\n4. Residual intravascular contrast from the prior outside CTA limits\nevaluation for the previously seen left MCA thrombus.\n\nRECOMMENDATION(S): Brain MRI for better assessment of acute infarction." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Faint basal ganglia calcifications are present. A focal\nparenchymal calcification on the right parietal subcortical white matter\nnoted. Ventricles and sulci are normal in overall size and configuration. The\nimaged paranasal sinuses are clear. Partial opacification of the right\nmastoid air cells though the right middle ear cavity remains well aerated. \nThe left mastoid air cells and middle ear cavity peer well aerated. The bony\ncalvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "Minimally depressed right nasal bone fracture is seen. No additional acute\nfracture is identified.\nDegenerative changes are seen at the bilateral temporomandibular joints. The\nmandible is intact.\nVisualized paranasal sinuses are well aerated. Very minimal mucosal\nthickening is seen at anterior ethmoid air cells. The remainder of the imaged\nparanasal sinuses are clear. The ostiomeatal units are patent bilaterally.\nThere is no evidence of abnormal fluid collections.\nBilateral mastoids appear normal.\nThe orbits are intact.\nPeriapical lucency is seen at the mandibular right central incisor and\npossibly left central incisor. Dental amalgam causes streak artifact and\nlimits assessment of other teeth.", + "output": "1. Minimally depressed right nasal bone fracture. No additional acute facial\nbone fracture seen.\n2. Periapical lucency at the mandibular right central incisor and possibly\nmandibular left central incisor, consistent with periodontal disease.\n3. Degenerative changes at the bilateral temporomandibular joints." + }, + { + "input": "Subtle focal thickening along the anterior falx on series 2, image 90 is felt\nto more likely represent focal thickening of the falx rather than a tiny focus\nof acute subdural hematoma. No acute intracranial hemorrhage is seen\nelsewhere. There is no evidence of midline shift, mass effect, or acute large\nvascular territorial infarct. Prominence of the ventricles and sulci is\nconsistent with involutional changes. Periventricular and subcortical white\nmatter hypodensities are likely sequelae of chronic small vessel disease. The\nvisualized paranasal sinuses are clear. The mastoid air cells are clear. No\nacute fracture is seen.", + "output": "Subtle focal thickening along the anterior falx on series 2, image 90 is felt\nto more likely represent focal thickening of the falx versus a tiny focus of\nacute subdural hematoma. No acute intracranial hemorrhage seen elsewhere." + }, + { + "input": "NONCONTRAST CT HEAD:\n\nThere is no evidence of acute fracture, large territorial infarction,\nhemorrhage, edema,or mass-effect. The ventricles and sulci are\nage-appropriate. Mild periventricular white-matter hypodensities are\nnonspecific, but likely represent sequela of chronic microangiopathic disease.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. Patient is post bilateral native lens replacement.\n\nCT PERFUSION:\nThis portion of the exam was incomplete, as described in the Technique section\nabove, and is nondiagnostic.", + "output": "1. No acute intracranial process.\n2. CT perfusion portion of the exam was incomplete and is nondiagnostic due to\nacute change in patient's clinical status during scanning." + }, + { + "input": "Overlying hardware artifact limits examination. Right sphenoid sinus\naerosolized mucosal thickening is seen. Minimal left maxillary sinus mucosal\nthickening is present. The paranasal sinuses demonstrate no air-fluid levels\nidentified. The ostiomeatal units are patent.\n\nThe cribriform plates are intact. The lamina papyracea are intact. Sigmoid\nnasal septal deviation is present. There is pneumatization of bilateral\nanterior clinoid processes. Left palatine tonsil demonstrates 3 approximately\n5 mm peripherally enhancing collections. The right palatine tonsil\ndemonstrates an approximately 4 mm peripherally enhancing collection. Right\npalatine tonsil probable tonsillith is seen. Approximately 4 mm right parotid\nperipherally enhancing structure with suggested central low-density is noted.", + "output": "1. Limited study as described.\n2. Paranasal sinus disease , as described.\n3. Bilateral palatine tonsil subcentimeter peripherally enhancing collections\nas described concerning for small abscesses.\n4. Approximately 4 mm right parotid peripherally enhancing structure with\nsuggest central low-density. Differential considerations include necrotic\nlymph node and abscess.\n5. Segmental nasal septal deviation.\n6. Pneumatization of bilateral anterior clinoid processes." + }, + { + "input": "There is no evidence of infarction, edema, or mass effect. The ventricles and\nsulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Normal study." + }, + { + "input": "CTA HEAD AND NECK:\nThe examination is limited secondary to suboptimal contrast bolus timing. \nWithin this limitation:\n\nThere is a normal 3 vessel aortic arch. There is a left-sided dominant\nvertebral basilar system. Moderate severe calcifications are seen in the left\nV4 segment, which remains patent. The right V4 segment is diminutive, but\nalso remains patent.\n\nThe common carotid and their major branches appear patent without high-grade\nstenosis or occlusion. There is no evidence of internal carotid stenosis by\nNASCET criteria.\n\nModerate calcifications are seen in the bilateral cavernous internal carotid\narteries. The vessels of the circle of ___ and their principal\nintracranial branches are patent without high-grade stenosis, occlusion, or\naneurysm formation. The dural venous sinuses are patent.\n\nNondedicated, contrast enhanced evaluation of the brain parenchyma is grossly\nunremarkable.\n\nOTHER:\nThe lungs apices are clear bilaterally. The thyroid gland is unremarkable in\nappearance. Prominent cervical lymph nodes are noted bilaterally, none of\nwhich are pathologically enlarged by CT size criteria.", + "output": "1. Nondedicated contrast enhanced evaluation of the parenchyma without\nconvincing evidence for extra-axial fluid collection or large vascular\nterritorial infarction.\n2. Suboptimal CT examination secondary to contrast bolus timing. Allowing for\nthis, grossly patent intracranial and cervical vasculature without evidence\nfor occlusion or dissection.\n3. Moderate calcifications involving the bilateral cavernous carotid arteries,\nwith severe calcifications in the left V4 segment." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute large territory infarction, intracranial\nhemorrhage, or mass. There is a focus of encephalomalacia and volume loss with\nex vacuo dilatation of the right lateral ventricle seen in the right\nfrontoparietal region. Periventricular white matter hypodensities are\nnonspecific but likely represent sequelae of chronic microangiopathic ischemic\ndisease in this age group.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The patient is status post bilateral lens\nreplacement. Otherwise, the visualized portion of the orbits are normal.\n\nCTA HEAD:\nAs seen on CT head, there is encephalomalacia of the right frontotemporal\nregion with ex vacuo dilatation of the right lateral ventricle, consistent\nwith chronic right MCA territory infarct.\n\nThe right internal carotid artery is completely occluded at the bifurcation of\nthe common carotid artery and reconstitutes at the level of M1 with cross\nfilling and backflow, unchanged from prior. The superior and inferior\ndivisions of the right M1 segment are diminutive. The right PCA is fetal type.\nNo evidence of acute vascular occlusion, stenosis, or aneurysm in the vessels\nof ___. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is a focal chronic dissection focal atherosclerotic disease at the level\nof C4-5 of the right vertebral artery, (3; 145). The V2-3 segment of the left\nvertebral artery demonstrates beading, which can be seen in the setting of\nfibromuscular dysplasia or atherosclerotic disease. Calcifications are seen at\nthe bifurcation of the bilateral common carotid arteries. No evidence of acute\naneurysm, dissection, or stenosis.\n\nOTHER:\n10 mm left thyroid nodule seen. Biapical scarring at the lung apices is seen.\nMild degenerative disease along the cervical spine. There is no\nlymphadenopathy by CT size criteria.", + "output": "1. Redemonstrated chronic right MCA territory infarct with encephalomalacia of\nthe right frontotemporal region and ex vacuo dilatation of the right lateral\nventricle.\n2. Complete occlusion of the right internal carotid artery from the\nbifurcation of the common carotid artery to the level of M1 segment of the\nright MCA.\n3. Focal chronic dissection or atherosclerotic disease at the level of C4-5 of\nthe right vertebral artery.\n4. V2-3 segment of the left vertebral artery demonstrates beading which could\nrepresent fibromuscular dysplasia or atherosclerotic disease.\n5. 10 mm left thyroid nodule can be further evaluated by thyroid ultrasound if\nclinically desired." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nPartial empty sella is identified.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormalities on noncontrast head CT.\n2. Global atrophy." + }, + { + "input": "CTA HEAD:\nThere are mild atherosclerotic changes along both carotid siphons but without\nsignificant stenosis. The vessels of the circle of ___ and their principal\nintracranial branches appear normal without stenosis, occlusion, or aneurysm\nformation. Note is made of a fetal right PCA, normal anatomic variant.\nThe dural venous sinuses are patent.\n\nCTA NECK:\nNormal 3 vessel aortic arch. There are mild atherosclerotic changes at both\ncarotid bifurcations but without evidence of internal carotid stenosis by\nNASCET criteria.\nThe carotidandvertebral arteries and their major branches appear otherwise\nunremarkable with no evidence of stenosis or occlusion.\n\nOTHER:\nThere is gravity dependent atelectasis and a trace right pleural effusion. No\nsuspicious pulmonary nodules. The visualized portion of the thyroid gland is\nwithin normal limits. There is no lymphadenopathy by CT size criteria.", + "output": "1. Patent intracranial and cervical vasculature without evidence of\ndissection, stenosis, occlusion or aneurysm formation greater than 3 mm." + }, + { + "input": "There is no evidence of infarction,hemorrhage,edema, or mass. The ventricles\nand sulci are normal in caliber for age..\n\nThere is no evidence of fracture. There is mild calcification of the\ncavernous carotid arteries bilaterally. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavitiesare essentially\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. Normal study." + }, + { + "input": "In the right frontal lobe, there is a predominantly cystic lesion measuring\n3.9 x 2.5 x 2.6 cm (TRV x AP x CC) with a thin internal septation. A focus of\ncalcification is seen at the anterior wall of this lesion. At the posterior\nmargin, there is curvilinear hyperdensity, which may represent hemorrhage or\ncalcification. It is unclear whether this lesion is entirely located in the\nextra-axial space. There is also surrounding vasogenic edema in the right\nfrontal lobe. There appears to be associated hyperostosis of the right\nsphenoid wing (series 3, image 10).\n\nCalcifications are present in the bilateral basal ganglia as well as the\ndentate nuclei. Prominence of the ventricles and sulci suggest age related\nglobal atrophy. There is no abnormal shift of midline structures. No large\nacute vascular territorial infarction is identified.\n\nThere is no evidence of fracture. There is partial opacification of the right\nsphenoid sinus. The remaining visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. Patient is status post\nbilateral lens replacements. Atherosclerotic calcifications of the bilateral\ncarotid siphons are noted.", + "output": "1. 3.9 x 2.5 x 2.6 cm minimally complex cystic structure in the right frontal\nlobe with posterior curvilinear hyperdensity, which may represent\ncalcification, hemorrhage felt to be less likely. Exact location of this\nlesion is difficult to ascertain. If extra-axial, given the associated\nhyperostosis of the right sphenoid, this may represent a cystic meningioma. \nIf intra-axial,ganglioglioma or possibly oligodenroglioma (although atypical\nin appearance). Metastasis is not excluded. MRI is recommended for further\nevaluation.\n2. Calcifications within the bilateral basal ganglia and dentate nuclei. This\nmay be a sign of normal aging, or can be seen in hypoparathyroidism or Fahr's\ndisease. Clinical correlation is recommended.\n\nRECOMMENDATION(S): MRI brain with and without contrast." + }, + { + "input": "There is no evidence of fracture, acute large territorial\ninfarction,hemorrhage,edema,or mass. There are mild bilateral periventricular\nand subcortical white matter hypodensities, nonspecific but compatible with\nsequelae of chronic small vessel ischemic disease. The ventricles and sulci\nare normal in size and configuration for age.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "No acute intracranial process." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no exophytic mass, nor\nareas of focal mass effect. Evaluation of the cervical lymph chains\ndemonstrate no pathologic lymphadenopathy by imaging criteria. The visualized\nsalivary glands are unremarkable in appearance. No thyroid mass is seen. Neck\nvessels are patent. Upper lung fields are clear. No bony abnormality is seen.\n\nThe orbits and globes are unremarkable. The extraocular muscles are symmetric\nbilaterally. There is no abnormality in the intraconal fat. The paranasal\nsinuses, mastoid air cells and middle ear cavities are clear. The imaged\nportions of the major intracranial vessels are patent.", + "output": "1. No evidence of orbital cellulitis.\n2. No evidence of sinus disease. No retro-orbital collection.\n3. Symmetry of the extraocular muscles bilaterally." + }, + { + "input": "There is no evidence of acute large territorial infarction,intracranial\nhemorrhage,edema, or mass. The ventricles and sulci are normal in size and\nconfiguration.\n\nThere is no evidence of fracture. A small 2 mm rounded radiopaque foreign\nbody is seen in the soft tissues anterior to the left frontal bone (series 3,\nimage 8 and series 602b, image 46). There is moderate mucosal thickening of\nthe ethmoid air cells bilaterally and left sphenoid sinus, and mild mucosal\nthickening of the maxillary sinuses bilaterally. The mastoid air cells are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. No evidence of acute intracranial process. No fractures identified.\n2. Rounded 2 mm radiopaque foreign body in the soft tissues anterior to the\nleft frontal bone.\n3. Sinus disease involving the ethmoid and maxillary sinuses bilaterally as\nwell as the left sphenoid sinus." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThe chronic lacunar infarctions in the bilateral cerebellar hemispheres are\nunchanged. There is no evidence of no evidence of acute infarction,\nhemorrhage, edema, or mass. The ventricles and sulci are normal in size and\nconfiguration. Patchy hypoattenuation in the supratentorial white matter is\nnonspecific, but likely represents the sequela of chronic small vessel\nischemic disease. There is mild diffuse cerebral and cerebellar volume loss.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion or aneurysm formation. The left P1\nsegment is hypoplastic. The dural venous sinuses are patent.\n\nCTA NECK:\n\nEvaluation of the left common carotid artery is limited due to artifact from\nthe dense contrast within the left jugular vein. The visualized left common\ncarotid and right common carotid arteries are patent. The internal carotid\narteries are patent. There are atherosclerotic calcifications of the carotid\nbifurcations with no evidence of internal carotid stenosis by NASCET criteria.\nEvaluation of the vertebral arteries at C2-C3 and C3-C4 is limited due to\nextensive beam hardening artifact from the dental amalgam. The remainder of\nthe visualized vertebral arteries are patent. The left vertebral artery is\ndominant.\n\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.\n\nThere is reversal of the cervical lordosis with severe, multilevel\ndegenerative changes of the cervical spine.\n\nThe penetrating atherosclerotic ulcer of the aortic arch, distal to the origin\nof the left subclavian artery, is unchanged in size, measuring 2.9 x 1.5 cm.\nThe fusiform aneurysmal dilatation of the ascending aorta, measuring 4.3 cm,\nis unchanged.", + "output": "1. Patent circle of ___.\n2. No evidence of internal carotid artery stenosis by NASCET criteria.\n3. No acute intracranial abnormality.\n4. No significant change in the penetrating atherosclerotic ulcer of the\naortic arch and 4.3 cm fusiform aneurysmal dilatation of the ascending aorta." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There are\nsequelae of remote infarcts in the bilateral cerebellum and left basal\nganglia. The ventricles and sulci are prominent, consistent with involutional\nchanges. There is periventricular and subcortical white matter hypodensity,\nwhich is nonspecific, but likely represents chronic microvascular ischemic\nchanges. There are calcifications of the bilateral carotid siphons and V4\nsegment of the left vertebral artery.\n\nNo osseous abnormalities seen. There is minimum of mucosal thickening of the\nright maxillary sinus and ethmoidal air cells. Cerumen is noted in the\nbilateral external axillary canals. The paranasal sinuses, mastoid air cells,\nand middle ear cavities are otherwise clear. Status post right lens\nreplacement. The left orbit is unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Involutional changes and likely chronic microvascular ischemic changes." + }, + { + "input": "There is no evidence of fracture, large territory infarct\ninfarction,hemorrhage,or edema. The ventricles and sulci are normal in size\nand configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No evidence of acute intracranial hemorrhage or large territory infarct." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territorial infarct. Prominence of the\nventricles and sulci is consistent with involutional changes. The visualized\nparanasal sinuses are clear. The mastoid air cells and middle ear cavities\nare clear. No acute fracture is seen. Cortical thickening along the outer\ntable of the right frontal bone, spanning approximately 2.8 x 0.8 cm, series\n2, image 21, nonspecific, possibly an osteoma.", + "output": "No acute intracranial process.\n\nCortical thickening along the outer table of the right frontal bone spanning\n2.8 x 0.8 cm, nonspecific, may represent an osteoma." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Prominent ventricles and sulci compatible with age-related\ninvolutional changes.\n\nThere is minimal mucosal thickening in the bilateral ethmoid air cells. \nMastoid air cells and middle ear cavities are well aerated. The bony calvarium\nis intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute large territory infarction,hemorrhage,edema,or\nmass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mild thickening of the ethmoid air\ncells. The remainder of the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. There is no evidence of acute intracranial process or hemorrhage." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Mild sulcal and ventricular prominence is likely reflective of age\nrelated involution. Ventricles and sulci are normal in overall size and\nconfiguration. Mild mucosal thickening is seen within the ethmoidal air cells.\nOtherwise the paranasal sinuses appear well aerated. Mastoid air cells and\nmiddle ear cavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nInvolutional changes are age appropriate. The imaged paranasal sinuses are\nclear. Mastoid air cells and middle ear cavities are well aerated. The bony\ncalvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Mild periventricular white matter hypodensity likely reflect\nchronic microvascular ischemic disease. Basal removed calcifications are\nnoted. Age related involutional changes are present. Ventricles and sulci\nare normal in overall size and configuration. The imaged paranasal sinuses are\nclear. Mastoid air cells and middle ear cavities are well aerated. The bony\ncalvarium is intact.", + "output": "No acute intracranial process. Mild small vessel disease. If there is\nfurther concern for metastatic disease, MRI is advised." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, intracranial hemorrhage, edema, mass, or\nmass effect. The ventricles and sulci are normal in caliber and\nconfiguration. The visualized paranasal sinuses and mastoids appear clear. \nCarotid siphon calcifications are noted bilaterally.\n\nCT PERFUSION:\nAutomated RAPID CT algorithm calculates a volume of 0 mL brain parenchyma with\na CBF <30%, as well as volume of 6 mL brain parenchyma with Tmax > 6 seconds\n(the latter felt to be spurious, near the skullbase in the inferior right\nfrontal lobe and medial right temporal lobe). Subjective review of CBF, CBV,\nand MTT/T-max maps show no evidence of decreased cerebral blood flow, abnormal\ncerebral blood volume, or prolonged mean transit time.\n\nSubjective review of arterial inflow (AIF) and venous outflow (VOF) time\nintensity curves demonstrate normal, expected curves compatible with\nappropriate selection of AIF and VOF regions of interest. There is mild\nmotion degradation on 3-plane time-translation curves. Overall, findings are\ncompatible with a technically adequate study, without evidence of infarct core\nor ischemic penumbra.\n\nCTA HEAD:\nDistal left V4 vertebral artery demonstrates moderate focal luminal narrowing,\nlikely due to underlying atheromatous plaque (4:218); distal to this the\nartery is patent to the basilar origin. The basilar artery demonstrates areas\nof mild luminal narrowing. There are fetal type bilateral posterior cerebral\narteries. The P1 PCAs are widely patent, however diminutive. Widely patent\nbilateral posterior communicating arteries which are prominent. The P2 and\nmore distal bilateral posterior cerebral arteries widely patent with preserved\ndistal runoff bilaterally.\n\nThe cavernous and supraclinoid intracranial carotid arteries demonstrate mild\ncalcified plaque causing areas of minimal luminal narrowing bilaterally. \nOtherwise, the remaining portions of the bilateral intracranial internal\ncarotid arteries and the bilateral anterior and middle cerebral arteries are\npatent with normal distal runoff.\n\nNo aneurysm or large vessel occlusion. Left transverse sinus is diminutive\nand not well opacified or well evaluated on this study. The remaining\nvisualized major dural venous sinuses appear grossly patent on nondedicated\nevaluation.\n\nCTA NECK:\nThe left vertebral artery is not opacified from its origin through the V1\nsegment, and through the majority of the V2 segment. There is a short segment\nof mid to distal left V2 segment which is opacified, likely reconstituted from\ncollaterals (4:148-161), however the vessel is not opacified distal this again\nthrough the remainder of the V2 segment to the very proximal V3 segment\n(4:95), where again it is opacified, likely reconstituted from collaterals,\nfaintly patent to the V4 segment and distal to this.\n\nThe right cervical vertebral artery is widely patent.\n\nThere is minimal calcified plaque at the carotid bulbs, not causing ICA\nluminal narrowing by NASCET criteria. The remaining portions of the bilateral\ncervical carotid arteries are widely patent and unremarkable.\n\nThere is mild calcified plaque at the aortic arch, minimally affecting the\narch branch vessel origins, arch branch vessels are otherwise normal.\n\nOTHER:\nThyroid unremarkable. No right cervical adenopathy. There is mild left\nsupraclavicular adenopathy, lymph nodes measuring up to 12 x 9 mm (series 4,\nimages 91, 92). No other left cervical adenopathy. There is bulky multi\nstation mediastinal adenopathy no visible axillary adenopathy. No aggressive\nfocal osseous lesions. Severe cervical spine degenerative changes. There are\nmultifocal biapical pulmonary nodules, left significantly worse than right,\nnearly confluent on the left extending from the superior margin of the left\nhilum. There is nodular interlobular septal thickening and perifissural\nthickening. There is subpleural reticulation and ground-glass most apparent\nwithin the peripheral, inferior bilateral upper lobes and superior segments of\nthe bilateral lower lobes. These findings appear progressed since CTA chest\nfrom ___.", + "output": "1. No acute intracranial abnormality by unenhanced head CT.\n2. CT brain perfusion without evidence infarct core or ischemic penumbra.\n3. Non-opacification of the majority of the left cervical vertebral artery in\nthe neck, with apparent reconstitution along the mid V2 segment, as well as\nthe V3 and V4 segments and intracranially. This could reflect sequelae of\nchronic atheromatous disease, as the proximal V1 segment appears unchanged\nsince ___, however findings distal to this are ultimately\nage-indeterminate. If there is clinical concern for acute dissection, MRA\nneck could be performed for further evaluation.\n4. Remainder of the neck arterial vessels (right vertebral artery, bilateral\ncarotid arteries) are widely patent.\n5. Patent intracranial circle of ___ vasculature with areas of mild luminal\nnarrowing due to atheromatous plaque. No aneurysm or large vessel occlusion.\n6. Interval progression of biapical pulmonary parenchymal abnormalities and\nmediastinal adenopathy, appearance suggestive of pulmonary metastatic disease\nwith left apical lymphangitic carcinomatosis." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are normal in size and configuration for age.\n\nThere is no evidence of fracture. Mild mucosal thickening is seen within the\nethmoid air cells and right sphenoid sinus which may suggest mild ongoing\ninflammation. Please refer to the subsequent temporal bone CT examination for\ndiscussion of the mastoid air cells. The visualized portion of the remaining\nparanasal sinuses,and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. No evidence of hemorrhage or acute infarction.\n\n2. Please note that MRI is more sensitive for detection of an acute ischemic\nevent if there is high clinical suspicion." + }, + { + "input": "Left : There is moderate soft tissue thickening along the external auditory\ncanal. External auditory canal is patent. There is a small amount of soft\ntissue in the middle ear cavity. The middle ear cavity is otherwise clear.\nThe ossicles and tegmen are intact. There is no evidence for enlarged\nvestibular aqueduct or superior semicircular canal dehiscence. The facial\nnerve follows a normal course through the middle ear. There is no evidence for\ninner ear dysplasia. There is mild partial opacification of the mastoid air\ncells extending into the mastoid tip. There is no evidence of bony\ndestruction or coalescence. There is no adjacent fluid collection. No\nabnormal enhancement.\n\nRight: External auditory canal is patent and appears unremarkable. The middle\near cavity is clear. The ossicles and tegmen are intact. There is no evidence\nfor enlarged vestibular aqueduct or superior semicircular canal dehiscence.\nThe facial nerve follows a normal course through the middle ear. There is no\nevidence for inner ear dysplasia. The mastoids are clear with exception of\nminimal fluid at the mastoid tip. There is no abnormal enhancement on post\ncontrast imaging.\n\nOther: Visualized brain and neck soft tissues are normal. Mild mucosal\nthickening is seen within the maxillary sinuses bilaterally.", + "output": "1. On the left, there is diffuse soft tissue thickening along the external\nauditory canal with partial opacification of the mastoid air cells without\nevidence of bony destruction to suggest malignant otitis externa. Small\namount of soft tissue in the lateral attic. The ossicles are intact.\n\n2. On the right, minimal opacification of the mastoid tip is present without\nevidence for bony destruction." + }, + { + "input": "There is a left inferior orbital blowout fracture with hyperdensity in the\nleft maxillary sinus, representing blood. The orbits are intact and there is\nno evidence of extraocular muscle entrapment. The intraconal fat is normal.\nThe remainder the visualized paranasal sinuses are clear. Right frontal and\nleft occipital scalp hematomas are small.\nThere is no intracranial hemorrhage or edema. The ventricles and sulci are\nnormal in size and configuration. The basal cisterns are patent and there is\nnormal gray-white matter differentiation.", + "output": "1. Left inferior orbital wall blowout fracture with blood in the left\nmaxillary sinus.\n2. No intracranial hemorrhage or other fracture is seen.\n3. Small right frontal and left occipital scalp hematomas.\n\nATTENDING NOTE: There is herniation of orbital fat through the defect with\ndeformed inferior rectus muscle. Clinical correlation recommended to exclude\nentrapment." + }, + { + "input": "The previously identified left parafalcine subdural hematoma has now resolved.\nNo new intracranial hemorrhage is identified. There is no mass, mass effect or\nmidline shift. The ventricles, cerebral sulci and cisterns are age\nappropriate. Small areas of hypodensity within the periventricular white\nmatter are most likely the sequela of chronic small vessel ischemic disease.\n\nNo fracture or other abnormality of the calvarium is identified. Both mastoids\nare underpneumatized. There is mucosal thickening within the visualized right\nmaxillary sinus.", + "output": "Interval resolution of a left parafalcine subdural hematoma. No new\nintracranial hemorrhage is identified." + }, + { + "input": "The exam is somewhat motion limited.\n\nWithin these limitations, there is no evidence of acute large vascular\nterritorial infarction, hemorrhage, edema, or mass/mass effect. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The imaged paranasal sinuses are clear. \nChanges related to prior bilateral mastoidectomies are noted. The right\nmiddle ear is opacified.", + "output": "1. Motion limited exam.\n2. No acute intracranial pathology on noncontrast head CT. Specifically no\nintracranial hemorrhage.\n3. Bilateral mastoidectomies with opacified right middle ear. No calvarial\nfracture." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "Normal study" + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass. The ventricles and sulci are normal in size and configuration for\npatient's age. There is no evidence of fracture. The visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nPatient is status post bilateral lens replacements.", + "output": "No acute intracranial process." + }, + { + "input": "Volume loss of the right parotid gland is likely related to prior neck\ndissection. The expected fat planes within the right pre styloid\nparapharyngeal space and right submandibular space are less conspicuous than\nthe left, similar in appearance to the ___ PET CT exam. No\nenlarged cervical lymph nodes are identified.\n\nThere is a 5 mm cutaneous nodule overlying the alveolar bone of the right\nmaxilla (series 2 image 36), unchanged from the ___ CT neck exam.\n\nThere is mild mixed atheromatous atherosclerotic plaque at the bilateral\ncarotid bulbs. The major vessels of the neck are otherwise unremarkable.\n\nThe suprahyoid and infrahyoid neck are otherwise unremarkable.\n\nThe paranasal sinuses and mastoid air cells are clear. The orbits are\nunremarkable.\n\nUncovertebral and facet joint arthropathy result in moderate right neural\nforaminal narrowing at C5-6.\n\nA small calcified pulmonary nodule within the right upper lobe (series image\n121) is consistent with a granuloma.", + "output": "No enlarged cervical lymph nodes. No significant change from the previous\nstudy." + }, + { + "input": "Partially limited study due to extensive streak artifact from dental amalgam. \nRedemonstrated is a 0.5 cm cutaneous nodule (3:9), 2 cm anterior to the left\near, stable since prior.\n\nEvaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nNo significant change in volume loss of the right parotid gland, likely\nrelating to prior neck dissection, stable appearance since ___. No\nadenopathy.. Otherwise, the salivary glands enhance otherwise normally and\nare without mass or adjacent fat stranding. The thyroid gland appears normal.\nThere is no lymphadenopathy by CT criteria.There are no morphologically\nabnormal subcentimeter lymph nodes. The neck vessels are patent.\n\nThere is a small calcified granuloma within the right upper lobe (3:89).There\nare no osseous lesions. Degenerative changes cervical spine.", + "output": "1. No evidence of adenopathy or metastases.\n2. 0.5 cm skin nodule left face, stable." + }, + { + "input": "No mass or enlarged cervical lymph nodes are identified.\n\nThere is moderate predominantly atheromatous plaque within the bilateral\ncarotid bulbs and proximal internal carotid arteries.\n\nThere is mild mucosal thickening within the alveolar recess of the bilateral\nmaxillary sinuses.\n\nThere is moderate cervical degenerative disc disease.\n\nThere is probable atelectasis within the deep and upper and lower lobes.\n\n5 mm cutaneous nodule overlying the right maxilla (series 2, image 8),\nunchanged from prior examinations, compatible with a nevus.", + "output": "1. No enlarged cervical lymph nodes by size criteria.\n2. No interval change from prior exam." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are normal. \nDebris is noted in the external auditory canals, probably cerumen.\n\n\nCT PERFUSION: OLEA perfusion maps demonstrate no definite focal CBV or MTT\ndefects.\nThere is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.", + "output": "1. No acute intracranial abnormality.\n2. No definite perfusion deficit." + }, + { + "input": "There is no intra or extra-axial mass effect, acute hemorrhage or large\nterritory infarct. The sulci, ventricles and cisterns are within expected\nlimits for the patient's minimal senescent related global cerebral volume\nloss. Periventricular and subcortical white matter hypodensities are\nnonspecific, but compatible with chronic microangiopathy in a patient of this\nage. Minimal mucosal thickening of the anterior ethmoid air cells. \nOtherwise, the visualized paranasal sinuses are essentially clear. The orbits\nare unremarkable. The mastoid air cells and middle ears are well pneumatized\nand clear. Occipital scalp soft tissue swelling and hematoma is identified\nwithout underlying acute displaced calvarial fracture.", + "output": "-No acute intracranial abnormality on noncontrast head CT. Specifically no\nlarge territory infarct or intracranial hemorrhage.\n-No acute displaced calvarial fracture. Occipital scalp soft tissue swelling\nand hematoma is identified." + }, + { + "input": "Aero digestive tract: Imaging was performed with the vocal cords adducted.\nThis limits evaluation of the soft tissues of the true cords. Within this\nlimitation: No abnormality is identified in relation to the right arytenoid\nand true vocal cord. There is no sclerosis of the arytenoid cartilage. No\nabnormal enhancement. The paraglottic fat is intact. Normal appearance of the\nupper aerodigestive tract.\n\nNeck lymph nodes: There is no adenopathy involving bilateral levels ___. \nThere is no retropharyngeal adenopathy.\n\nExtra nodal tumor spread: There are no findings suggestive of extra nodal\nextension.\n\nDeep neck muscles, masticator space: There is no muscle invasion.\n\nBones, skull base:\nThere is no bone involvement.\nThere are no findings suggestive of perineural tumor extension. Jugular\nforamen, carotid canal, pterygopalatine fossa, infraorbital foramen, other\nskull base foramina are not involved. The imaged mastoid air cells and\nparanasal sinuses are clear. There is moderate degenerative change of the\nlower cervical spine, most marked at C5-T1 levels, with reduced intervertebral\ndisc height.\n\nVessels: There is no vascular invasion. Note is made of calcification of the\ncarotid artery bifurcation bilaterally, at the aortic arch and in the\nintracranial left internal carotid artery, consistent with calcified atheroma.\n\nBrachial Plexus: There is no brachial plexus contact or invasion.\n\nThyroid, salivary glands: There is no mass.\n\nOther findings: There is mild emphysematous change peripherally at the right\napex. The previously noted opacity in the peripheral aspect of the left upper\nlobe remains, however this is partially imaged. Sternotomy wires noted.", + "output": "Within the limitation of the imaging being performed with the vocal cords\nadducted, no abnormality is identified in relation to the right arytenoid and\ntrue vocal cord." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, intracranial hemorrhage, edema, or mass. \nSmall hypodensities in the subcortical white matter of the left insula likely\nreflects the sequela of chronic small vessel ischemic disease. The ventricles\nand sulci are normal in size and configuration.\n\nThere is no fracture. Mild mucosal thickening of the right maxillary sinus\nand ethmoid air cells, the frontal sinus is hypoplastic. The visualized\nportion of the remaining paranasal sinuses, mastoid air cells, and middle ear\ncavities are otherwise clear. The visualized portions of the orbits are\nnormal. Bilateral tonsilliths are visualized.\n\nCTA HEAD:\nEvaluation of the arterial vasculature is limited due to delayed image\nacquisition after the contrast bolus.\n\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. The left vertebral\nartery is dominant. Hypoplastic A1 segment of the right ACA. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent. There is no\nevidence of internal carotid stenosis by NASCET criteria. The carotid and\nvertebral arteries and their major branches appear normal with no evidence of\nstenosis or occlusion.\n\nOTHER:\nThe visualized portion of the lungs are clear without focal consolidation. \nThe visualized portion of the thyroid gland is normal. There is no\nlymphadenopathy by CT size criteria.", + "output": "1. Normal head CT. No evidence of hemorrhage or infarction.\n2. Patent circle of ___ without evidence of stenosis, occlusion, or\naneurysm.\n3. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territory infarct. Gray-white matter\ndifferentiation is preserved. Small 7 mm focal hypodensity along the superior\naspect of the left lentiform nucleus, series 2, image 15, most likely\nrepresents a chronic lacunar infarct. There is also small lacunar infarct\nalong the head of the left caudate nucleus. The visualized paranasal sinuses\ndemonstrate mucosal thickening of the right sphenoid sinus. There is mild\nmucosal thickening of bilateral ethmoid air cells with near complete\nopacification of 1 of the ethmoid air cells.. The mastoid air cells are\nclear. No acute fracture is seen.", + "output": "No acute intracranial process, including no acute intracranial hemorrhage.. \nLeft-sided lacunar infarct." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThere is moderate mucosal thickening in the left maxillary sinus. The\nremainder of the visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the orbits\nare unremarkable.\n\nCTA HEAD:\n5 x 3 mm aneurysm at the origin of the left ___ is unchanged from the prior\nMRA examination (3:210). The vessels of the circle of ___ and their\nprincipal intracranial branches otherwise appear patent without stenosis,\nocclusion, or new aneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is a 3 vessel aortic arch. There are trace atherosclerotic\ncalcifications of the aortic arch. The carotid and vertebral arteries and\ntheir major branches appear patent with no evidence of dissection, stenosis or\nocclusion. There is no evidence of internal carotid stenosis by NASCET\ncriteria.\n\nOTHER:\nSegmental and subsegmental filling defects in the pulmonary arteries in the\nbilateral lung apices were better characterized on the recent prior outside\nhospital chest CT examination. There is a 1 mm pulmonary nodule in the right\napex (___). The visualized portion of the lungs are otherwise clear. The\nvisualized portion of the thyroid gland is within normal limits. There is no\nlymphadenopathy by CT size criteria.", + "output": "1. No acute intracranial abnormality.\n2. Unchanged 5 x 3 mm aneurysm at the origin of the left ___.\n3. Otherwise patent intracranial vasculature without significant stenosis,\nocclusion, or new aneurysm.\n4. Patent cervical arterial vasculature without significant stenosis,\nocclusion, or dissection.\n5. Segmental and subsegmental bilateral upper lobe pulmonary emboli, as seen\non the recent prior outside hospital chest CTA.\n6. 1 mm right apical pulmonary nodule. The ___ Society guidelines for\npulmonary nodule guidelines suggest no follow-up needed in low-risk patients." + }, + { + "input": "Ill-defined areas of hyperdensity seen scattered within the cortex of the\nbilateral frontal lobes is concerning for metastatic disease. Also noted, are\nmore discrete hyperdense foci concerning for metastasis, as on series 2, image\n10 in the left frontal lobe at the gray-white matter junction and series 2,\nimage 15 in the left frontal lobe, parafalcine region. No associated\nvasogenic edema or sulcal effacement though findings are highly concerning for\nmetastasis. There is no intra-axial or extra-axial hemorrhage, evidence of\nacute major vascular territorial infarction or midline shift. Basilar\ncisterns are patent. Ventricles are normal in size. The paranasal sinuses,\nmastoid air cells, and middle ear cavities are well aerated. The orbits are\nunremarkable. Also noted are several lytic calvarial lesions (03:39, 41, 49,\n52) which appear new from prior PET-CT and are concerning for metastasis.", + "output": "1. Ill-defined hyperdense foci within the bilateral frontal cortex concerning\nfor metastasis. Recommend MRI to further assess.\n2. Calvarial lytic lesions concerning for metastasis.\n3. No hemorrhage.\n\nRECOMMENDATION(S): Contrast enhanced brain MRI.\n\nNOTIFICATION: Findings were discussed with Dr. ___ at the time of\ninitial review." + }, + { + "input": "Multiple diffuse subtle hyperdense foci at the gray-white junction (series 5,\nimage 17, 20 16, 23) are consistent with metastases seen on MR head ___. There are no new hyperdense foci in comparison to ___. \nThere is no evidence of hydrocephalus, intracranial hemorrhage, significant\nmass effect or midline shift.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Extensive metastatic disease appears unchanged from ___. There is\nno evidence of hydrocephalus, intracranial hemorrhage, significant mass effect\nor midline shift." + }, + { + "input": "There is no acute intracranial hemorrhage, acute infarction, edema or mass\neffect. The ventricles and sulci are mildly prominent likely reflective of age\nrelated involutional changes. There is no shift of normally midline\nstructures. The basal cisterns are clear. The gray white matter\ndifferentiation appears preserved. Note is made of a calcified extra-axial\nlesion within the left posterior fossa, likely a small meningioma, 9 x 12mm\n(602b:66) without adjacent edema.\n\nNo fracture is identified. The visualized paranasal sinuses, mastoid air\ncells and middle ear cavities are clear. Extensive calcification of the\ncarotid siphon and vertebral arteries is noted.", + "output": "No acute intracranial abnormality. Small meningioma in the posterior fossa." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Prominent ventricles and sulci likely represent age related\nglobal atrophy. Periventricular white matter hypodensities are nonspecific\nbut likely represent sequela of small-vessel ischemic disease.\n\nThere is suggestion of subtle asymmetric right cerebellar hemisphere\nhypodensity (series 2, image 7), which is likely artifactual in nature,\nhowever given the patient's clinical symptoms, acute subtle infarct is not\nentirely excluded.\n\nVentricles and sulci are normal in overall size and configuration. Calcified\nextra-axial lesion within the left posterior fossa measuring up to 1.2 cm\n(2:8) is unchanged from comparison study and likely represents a small\nmeningioma. There is no adjacent edema.\n\nThere is mild mucosal thickening in the bilateral ethmoid air cells. .\nMastoid air cells and middle ear cavities are well aerated. The bony calvarium\nis intact. Moderate atherosclerotic disease of the V4 portions of bilateral\nvertebral arteries and cavernous, clinoid, and lacerum portions of the\nbilateral ICAs is noted.", + "output": "1. Suggestion of subtle asymmetric right cerebellar hemisphere hypodensity\n(series 2, image 7), likely artifactual. However, given the patient's\nclinical symptoms, if there no contraindications, MRI would be more sensitive,\nfor subtle acute infarcts, particularly in the posterior fossa. Otherwise,\nthere is no other evidence for acute intracranial abnormality on noncontrast\nhead CT.\n\n2. Stable calcified 1.2 cm extra-axial lesion within the left posterior fossa\nlikely representing a small meningioma." + }, + { + "input": "There is no evidence of infarction, intracranial hemorrhage, edema, mass, or\nmass effect. The ventricles and sulci are mildly prominent, compatible with\nglobal parenchymal volume loss.\n\nBilateral mild periventricular white matter hypodense foci are non-specific,\nbut compatible with mild changes of chronic white matter microangiopathy.\n\nThere is no abnormal enhancement. The major dural venous sinuses are patent.\n\nThere are extensive carotid siphon and distal vertebral artery atherosclerotic\ncalcifications.\n\nNo fractures are identified. The visualized paranasal sinuses and mastoids\nappear clear. Aside from right lens extraction, the globes and orbits are\nwithin normal limits.", + "output": "1. No acute intracranial abnormality. No evidence of abnormal enhancement\nafter contrast administration.\n2. Mild age-congruent global parenchymal volume loss. Within limitation of\nCT, no specific pattern of brain parenchymal atrophy identified to suggest an\nunderlying primary neurodegenerative process.\n3. Mild changes of chronic white matter microangiopathy.\n4. Extensive distal vertebral and intracranial ICA vascular calcification,\nstable." + }, + { + "input": "There is no evidence of acute hemorrhage,edema, or mass. There is prominence\nof the ventricles and sulci suggestive of involutional changes. There is\nnonspecific diffuse, symmetric periventricular and subcortical white matter\nhypodensities, which limit evaluation for subtle infarcts. However, no large\nterritory infarct is seen.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable. Nasoenteric tube is\npartially visualized.", + "output": "1. Diffuse, symmetric periventricular and subcortical white matter\nhypodensities. Findings are nonspecific. Differential includes, systemic\nmetabolic abnormalities and chronic small vessel ischemic disease in this age\ngroup.\n2. Mild age related involutional changes.\n3. No hemorrhage or large territorial infarct." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is a mucous retention cysts in a few\nethmoid air cells. The frontal sinuses are under pneumatized. Otherwise, the\nvisualized paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges.\n\nThere is minimal opacification of a few of the left mastoid air cells. The\nremainder of the visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the orbits\nare unremarkable.\n\nCTA HEAD:\nA 7 x 6 mm saccular aneurysm of the right supra clinoid ICA is unchanged from\n___ (7:260). No other aneurysm is identified. There is punctate\ncalcified atherosclerotic focus in the V4 segment of the left vertebral\nartery. There is a right dominant vertebrobasilar system. There is mild\nnarrowing from atherosclerotic calcifications of the bilateral supra clinoid\ninternal carotid arteries. There are infundibular origins of the bilateral\nPCAs and SCA. The vessels of the circle of ___ and their principal\nintracranial branches appear patent without significant stenosis, or\nocclusion. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is mild atherosclerotic calcification at the origin of the left\nsubclavian artery. There is mild tortuosity of the great vessels. The carotid\nand vertebral arteries and their major branches appear normal with no evidence\nof stenosis or occlusion. There is no evidence of internal carotid stenosis by\nNASCET criteria.\n\nOTHER:\nMosaic parenchymal attenuation is likely secondary to submaximal inspiration. \nThe visualized portion of the thyroid gland is within normal limits. There is\nno lymphadenopathy by CT size criteria.", + "output": "1. Stable 7 x 6 mm saccular aneurysm of the right supra clinoid internal\ncarotid artery.\n2. Otherwise patent intracranial vasculature without new aneurysm.\n3. Patent cervical vasculature without dissection." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal for age in size and configuration. A stent\ndevice is seen in the cavernous and supraclinoid right internal carotid\nartery.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe stent device within the right internal carotid artery covers the origin of\nthe previously documented supraclinoid aneurysm. The aneurysm appears\nconsiderably smaller than on the catheter arteriogram the aneurysm now\nmeasures approximately 5 mm in its greatest dimension. Comparison across\ntechniques limits evaluation to the MR of ___. The vessels of the\ncircle of ___ and their principal intracranial branches otherwise appear\nnormal without stenosis, occlusion, or aneurysm formation. The dural venous\nsinuses are patent.\n\nCTA NECK:\nThere is irregularity of the distal cervical internal carotid arteries\nbilaterally in a pattern that suggests fibromuscular disease. The carotid and\nvertebral arteries and their major branches appear normal with no evidence of\nstenosis or occlusion. There is no evidence of internal carotid stenosis by\nNASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. There is an 8 mm hypodense\nnodule in the right lobe of the thyroid gland. There is no lymphadenopathy by\nCT size criteria.", + "output": "1. Reduced size of the right supraclinoid internal carotid artery aneurysm\nsince the catheter arteriogram of ___\n2. No evidence of hemorrhage" + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, mass, or mass effect.\n The ventricles and sulci are mildly prominent, compatible with global\nparenchymal volume loss.\n The visualized mastoids appear clear. Stent is noted in the expected\nlocation of the right intracranial ICA. Minimal bilateral ethmoid air cell\nand left frontal sinus mucosal thickening is present.\n\nCTA HEAD:\nThere is mild calcified plaque within the distal vertebral arteries\nbilaterally, right more than left, causing mild luminal narrowing. Otherwise,\nthe visualized distal vertebral arteries are widely patent. The basilar\nartery is widely patent. Slightly bulbous basilar tip, unchanged. \nConventional bilateral PCA anatomy. The posterior communicating arteries are\nnot well seen, either diminutive or absent. Patent bilateral posterior\ncerebral arteries with normal distal runoff.\n\nLuminal irregularity of the right more than left distal extracranial ICAs is\nunchanged in appearance from prior exam, again displaying a pattern suggestive\nof underlying fibromuscular dysplasia. There is suggestion of a short, focal\ndissection flap along the posterior margin of this irregular distal\nextracranial right ICA (03:10 compared with 3:175 and 174 on the prior study\nfrom ___, as well as series 17, image 1 of the study). There is no\nevidence of propagation of a dissection flap distally, and the visible\nproximal artery is unremarkable.\n\nThere is a stent seen within the right intracranial ICA, extending from the\ncavernous segment through the supraclinoid segment. Although artifact from\nthe stent somewhat limits evaluation of the lumen, grossly, there is flow\nwithin the lumen of the stent identified, and normal opacification of the\nright intracranial ICA both proximal and distal to the stent.\n\nCompared with the prior CTA, there remains some residual filling of the\nsupraclinoid aneurysm sac, however significantly smaller, now measuring only 4\nx 4 mm in axial ___ (3:62), previously 6 x 4 mm when measured in a\nsimilar fashion (series 3, image 62 on the current study compared with series\n3, image 225 on the prior study).\n\nThere is moderate calcified atheromatous plaque affecting the proximal right\ncavernous, and left cavernous and paraclinoid intracranial ICA, causing areas\nof mild-to-moderate luminal narrowing.\n\nOtherwise, the remaining portions of the bilateral intracranial internal\ncarotid arteries and the bilateral anterior and middle cerebral arteries are\npatent with preserved distal runoff. No definite evidence of additional\naneurysm, new area of stenosis, or occlusion.\n\nThe major dural venous sinuses are not well opacified, precluding adequate\nevaluation of this exam.", + "output": "1. Interval decrease in opacification/filling of the right intracranial ICA\naneurysm status post pipeline embolization, with the opacified portion of\naneurysm sac now measuring 4 x 4 mm, previously 6 x 4 mm in ___.\n2. Although not fully evaluated due to artifact, grossly preserved flow within\nthe lumen of the right intracranial ICA stent, and opacification of the ICA\nboth proximal and distal to the stent.\n3. Grossly stable possible short-segment/focal dissection along the posterior\nextracranial ICA, unchanged appearance since ___.\n4. Grossly stable luminal irregularity of the visualized distal extracranial\nICAs, in a pattern concerning for of underlying fibromuscular dysplasia.\n5. Nonocclusive probable atherosclerotic changes as described.\n6. No acute intracranial abnormality by noncontrast head CT." + }, + { + "input": "Study is significantly limited by motion degradation.\n\nThere is no evidence of hemorrhage, edema, shift of normally midline\nstructures, or infarction. Prominent ventricles and sulci compatible with\nage-related involutional changes. Confluent periventricular subcortical white\nmatter hypoattenuation is nonspecific but could represent chronic small vessel\nischemic disease in this age group.\n\nThere is mild mucosal thickening of bilateral ethmoid air cells and bilateral\nmaxillary sinuses. The remaining paranasal sinuses are clear. Mastoid air\ncells and middle ear cavities are well aerated. The bony calvarium is intact.", + "output": "1. Within the limitations of significant motion degradation, no evidence of\nmass, hemorrhage or infarction.\n2. Prominent confluent areas of subcortical and periventricular white matter\nhypoattenuation is nonspecific in etiology but in this age group, likely\nrepresents chronic small vessel ischemic disease" + }, + { + "input": "There is interval thickening of the subglottic airway without evidence of a\ndiscrete mass. No abscess. Several prominent cervical lymph nodes are\noverall unchanged in appearance. These neck vessels are patent. There is\nmild mucosal thickening of the bilateral maxillary sinuses, similar to\nprevious exam. Multiple dental caries are noted. The thyroid is unremarkable.\n\nIncidental prominence of the ventricles and sulci, suggesting cortical volume\nloss that is likely age-related, is grossly stable.\n\nMulti-level degenerative changes in the cervical spine are overall unchanged. \nMild anterolisthesis of C4 on C5 is stable. Chronic deformity of the right\nshoulder osseous structures is better visualized on chest radiograph. No\nsuspicious lytic or sclerotic bony lesion.\n\nThe incompletely visualized lungs are grossly unremarkable.", + "output": "1. Thickening of subglottic airway is increased from the prior exam - may be\nfrom primary radiation change, but cannot exclude recurrence or mass. No\ndefinite mass; no abscess. Recommend endoscopy to further evaluate.\n\n2. Stable appearance and size of cervical lymph nodes.\n\n3. Numerous dental caries should be correlated with dental exam." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are prominent consistent with age-related atrophy. Confluent\nperiventricular and subcortical white matter hypodensities, increased since\n___, likely represent the sequela of chronic small vessel ischemic disease.\nThere is no evidence of fracture. There is minimal mucosal thickening in the\nparanasal sinuses. The mastoid air cells are clear. There is cerumen in the\nexternal auditory canals. The visualized portion of the orbits are\nunremarkable. There is a soft tissue nodule on the left posterior occiput\nmeasuring 1.5 cm that may represent a sebaceous cyst.", + "output": "1. No acute intracranial process.\n2. Confluent periventricular and subcortical white matter hypodensities,\nlikely the sequela of chronic small vessel ischemic disease have progressed\nsince ___." + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass. The ventricles and sulci are enlarged consistent with age related\natrophy. Extensive confluent periventricular and subcortical white matter\nhypodensities are consistent with chronic small vessel disease and have not\nsignificantly changed from ___. There is a soft tissue nodule overlying\nthe posterior right parietal bone which is unchanged from ___.\n\nThere is no evidence of fracture. A chronic right lamina papyracea fracture\npresent. The visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No evidence of intracranial hemorrhage.\n2. Chronic changes of cerebral atrophy and small vessel disease." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates area of narrowing in the\nupper trachea at the level of the thoracic inlet, similar to prior from ___. \nNo evidence of extrinsic compression of the airway by a discrete mass. \nSuperior to the level of stenosis is a focal nodular thickening of the mucosa\nin the subglottic larynx (02:53) is was not present on prior.\n\nThe salivary glands are grossly without mass based on exam performed without\ncontrast. No adjacent fat stranding.Hypodense left lower pole thyroid nodule\nmeasuring 7 mm is similar to prior.\n\nEnlarged cervical level 1A lymph node measuring 1.2 x 1.3 cm is similar to\nprior(2; 41).\n\nBones: 3 mm anterolisthesis of C4 on C5, likely degenerative is unchanged from\nprior in ___. There is mild-to-moderate multilevel degenerative changes with\nloss of disc height, osteophyte formation, facet hypertrophy, and\nuncovertebral hypertrophy, most severe from C3-C4 through C6-C7.\n\nThere are numerous dental caries with adjacent periapical suit lucencies\ninvolving the mandibular and maxillary teeth. Sclerosis of the mandible\nsuggests chronic inflammation. Mastoid air cells are clear bilaterally.\n\nEvaluation of the chest is better seen on concurrent chest CT.", + "output": "Upper tracheal narrowing in at the level of the thoracic inlet, similar to\n___. There is no evidence of extrinsic compression by a discrete mass, and\nthis may be due to tracheal stenosis.\nFocal nodular soft tissue of the subglottic larynx on the right which is new\nsince ___. Given history of prior malignancy, direct visualization is\nsuggested to exclude underlying mass." + }, + { + "input": "Of note, the study is suboptimal due to moderate amount of patient motion\nartifact which limits evaluation of intracranial structures. Within these\nlimitations, there is no evidence of gross acute major vascular territory\ninfarction,hemorrhage,edema, or mass. Extensive confluent periventricular\nsubcortical white matter hypodensities are nonspecific but likely due to\nsevere chronic small vessel ischemic changes, similar. Prominent ventricular\nsystem, mildly out of proportion to degree of cortical atrophy, similar to\npriors. Atherosclerotic calcifications are noted in the bilateral carotid\nsiphons.\n\nThere is no evidence of acute fracture. Moderate opacification of the\nsphenoid sinuses, with mucosal thickening and fluid, partial opacification of\nthe ethmoid sinuses, mild mucosal thickening of the maxillary sinuses;\nopacification paranasal sinuses likely related to intubation. There is\nchronic fracture of the right medial orbital wall, similar to prior. The\nmastoid air cells and middle ear cavities appear clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Extensive confluent low-attenuation changes in bilateral cerebral\nhemispheres, stable since prior, likely sequela of severe chronic small vessel\nischemic changes.\n2. Prominent ventricular system, mildly out of proportion to degree of\ncerebral atrophy, stable since priors.\n3. Opacified paranasal sinuses, likely from intubation." + }, + { + "input": "Extensive periventricular and subcortical white matter hypodensities limits\nevaluation for acute change. Within these limits, there is no evidence of\nacute infarction,hemorrhage,edema, or mass. There is prominence of the\nventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of acute fracture. Triangular area of hyperdensity along\nthe left posterior calvarium measuring 1.5 cm associated with a punctate\ncalcification at the skin is unchanged from prior exam (02:14). There is\naerosolized debris within the nasopharynx. Nasal tube is partially imaged. \nTrace mucosal thickening is seen in the bilateral maxillary sinuses. Moderate\nmucosal thickening is seen in the ethmoid air cells. The visualized portion\nof the remain paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable. Soft\ntissue densities in the bilateral external auditory canals are nonspecific,\nhowever likely cerumen.", + "output": "1. No acute intracranial abnormalities, though mildly limited by extensive\nperiventricular and subcortical white matter hypodensities.\n2. Aerosolized debris within the nasopharynx with a nasoenteric tube in place.\n3. Mild sinus disease as noted above.\n4. Unchanged hyperdensity along the left posterior calvarium." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\ngeneralized prominence of the ventricles, sulci, and cisterns consistent with\ngeneralized volume loss. This is unchanged from the prior study.\n\nNo osseous abnormalities seen. There is mild mucosal thickening of ethmoids\nand left maxillary sinus. There is a small osteoma in the left sphenoid sinus,\nunchanged. The left lens is much smaller in size than on prior CT from ___, consistent with interval lens surgery. The orbits are otherwise\nunremarkable.", + "output": "No traumatic or otherwise acute abnormality." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nCerebellar tonsils low lying, do not meet criteria for Chiari malformation\nhowever.\n\nThere is partial opacification and air-fluid levels of the bilateral maxillary\nand sphenoid sinuses, likely related to intubation.", + "output": "1. No acute intracranial abnormality.\n2. Partial opacification of the paranasal sinuses, likely related to\nintubation" + }, + { + "input": "There is no evidence of acute hemorrhage, edema, or mass effect or major\ninfarct.\nThe ventricles and sulci are normal in size and configuration.\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear.\nSphenoid sinus septation inserts towards the left carotid groove.\nThe orbits are unremarkable. Mildly prominent adenoids, with mild fullness in\nthe fossa of Rosenmuller on both sides.", + "output": "No acute intracranial hemorrhage or mass effect.\nCorrelate clinically with neurologic examination to decide on the need for\nfurther workup or followup." + }, + { + "input": "Compared to head CT from 1 day prior, there is no significant change in a\nsmall subdural hematoma along the anterior falx. No new hemorrhage is seen. \nThere is no mass effect. Ventricles and sulci are enlarged suggesting age\nrelated atrophy. Periventricular white matter hypodensities are likely\nsequela of chronic small vessel disease. There are dense calcifications\nwithin the carotid arteries bilaterally. Views of the osseous structures are\ngrossly unremarkable. There is fluid within the mastoid air cells. The\nremainder of the paranasal sinuses are clear. The globes are intact.", + "output": "No significant change to small subdural hematoma layering along the anterior\nfalx. No new hemorrhage." + }, + { + "input": "No significant interval change from the prior exam. No evidence of acute\ninfarction, hemorrhage, edema, or mass effect. Left frontal developmental\nvenous anomaly is again noted. Slightly more inferior hyperdensity in the\nperiventricular white matter adjacent to the body of the left lateral\nventricle (601 b: 50) without surrounding edema is again seen. The\nconfiguration of the ventricles and sulci are unchanged and within normal\nlimits. The perimesencephalic cisterns are patent. No or shift of normally\nmidline structures.\n\nNo fracture. Moderate mucosal thickening and aerosolized secretions in the\nleft maxillary sinus are unchanged and may suggest ongoing infectious or\ninflammatory process. Nonspecific, small amount of fluid in the right mastoid\nair cells is also grossly unchanged. The remaining paranasal sinuses and the\nleft mastoid air cells are clear. The orbits are unremarkable.", + "output": "1. No significant interval change.\n\n2. Stable-appearing left frontal lobe developmental venous anomaly that\ndrains into a left cortical vein without any interval development of\nsurrounding edema. The slightly more inferior hyperdensity may represent a\ncavernoma and non-emergent MR can be performed for further evaluation. This\nrecommendation was discussed with Dr. ___ from the care team at\n1:45 ___ on ___.\n\n3. No evidence of acute hemorrhage.\n\n4. Possible ongoing left maxillary sinus infection or inflammation for which\nclinical correlation is recommended." + }, + { + "input": "NON-CONTRAST HEAD CT: Left subdural hematoma is again seen (series 2, image\n15, 17, 21). No shift of normally midline structures. The basal cisterns are\npatent. No evidence of infarct; gray-white matter differentiation is\npreserved. Ventricles are normal in size. Mucosal thickening of the\nethmoidal air cells bilaterally is mild. The remaining partially imaged\nparanasal sinuses are clear. The mastoid air cells and middle ear cavities\nare clear. No evidence of fracture. The orbits are unremarkable.\n\nCTA HEAD:\nA small out-pouching at the origin of the left fetal PCOM has the appearance\nof an infundibulum, although a tiny aneurysm cannot definitely be excluded. \nThe right A1 segment is hypoplastic, a normal variant. The anterior and\nposterior arterial circulation appears preserved without evidence of critical\nstenosis or abrupt cut off. The dural venous sinuses are patent.", + "output": "1. Small left subdural hematoma. No shift of normally midline structures.\n\n2. No evidence of infarct.\n\n3. Small out-pouching at origin of the left PCOM with fetal configuration has\nthe appearance of an infundibulum, although a tiny aneurysm cannot definitely\nbe excluded.\n\n4. Patent anterior and posterior arterial circulation without evidence of\nsignificant stenosis." + }, + { + "input": "Previously noted small left subdural hematoma along the left convexity is no\nlonger discernible on axial CT images.There is no new acute intracranial\nhemorrhage, edema, mass effect, or loss of gray/ white matter differentiation.\nThe ventricles and sulci are normal in size for age. The basal cisterns are\nnormal in size.\n\nNo concerning osseous abnormality is seen. A single right middle ethmoid air\ncell remains opacified. Other imaged paranasal sinuses and mastoid air cells\nare well aerated.\n\nThe previously noted tiny outpouching at the left posterior communicating\nartery origin cannot be reassessed on noncontrast CT.", + "output": "Previously noted small left subdural hematoma is no longer discernible. No\nnew intraabnormalities are identified." + }, + { + "input": "There is no evidence of hemorrhage, acute large territorial infarction,\nedema,or mass. There is prominence of the ventricles and sulci suggestive of\nage-related involutional changes. Periventricular and subcortical\nhypodensities are nonspecific, though likely sequela of chronic small vessel\nischemic disease. Encephalomalacia at the inferior left frontal lobe is\nunchanged, likely sequela of prior infarction.\n\nThere are nondisplaced right nasal bone fractures of indeterminate age. There\nis complete opacification of the left maxillary sinus and partial\nopacification of the left ethmoid air cells. The visualized portion of the\nremaining paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear.", + "output": "1. Nondisplaced right nasal bone fractures of indeterminate age.\n2. No evidence of acute intracranial abnormality.\n3. Age-related volume loss and sequela of chronic small vessel ischemic\ndisease.\n4. Complete opacification of the imaged left maxillary sinus and partial\nopacification of anterior left ethmoid air cells." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no acute intracranial infarction, hemorrhage, edema, mass, or mass\neffect. The ventricles and sulci are prominent, compatible with global\nparenchymal volume loss. Bilateral periventricular and deep white matter\nhypodense foci are non-specific, but compatible with mild-to-moderate changes\nof chronic white matter microangiopathy.\n\nLeft frontal encephalomalacia is again noted. Complete opacification of left\nmaxillary sinus partially visualized. The remaining imaged paranasal sinuses\nare grossly clear. The middle ear cavities and mastoid air cells are clear. \nAside from bilateral lens extraction, the globes and orbits are within normal\nlimits.\n\nCTA HEAD:\nModerate luminal narrowing, proximal left P2 PCA (3:225), presumably due to\nunderlying atheromatous plaque. There are areas of moderate and moderate to\nsevere luminal narrowing of the more distal P3/P4 PCA branches, which appear\npatent.\n\nModerate luminal narrowing, proximal right P2 PCA (3:227). As on the left,\nthe distal right P3/P4 PCA branches are irregular and attenuated likely\nreflecting areas of moderate and severe luminal narrowing (for example see\nseries 603, image 32).\n\nCalcified plaque causes areas of mild luminal narrowing of the cavernous\nintracranial ICAs bilaterally. There is moderate focal luminal narrowing of\nthe distal left M1 MCA (603:28). There is moderate focal luminal narrowing of\nthe proximal right M ___ MCA (603:30). Distal MCA branches are patent with\nnormal runoff. Patent bilateral anterior cerebral arteries with normal distal\nrunoff.\n\nGrossly patent major dural venous sinuses. No arteriovenous malformation\nidentified.\n\nCTA NECK:\nMild-to-moderate narrowing, origin of the left vertebral artery (454:15). \nOtherwise, patent bilateral cervical vertebral and carotid arteries in the\nneck. No ICA stenosis by NASCET criteria.\n\nOTHER:\nThyroid is unremarkable. No pathologically enlarged cervical lymph nodes are\nidentified. Moderate arch calcifications are noted including at the origin of\nthe left subclavian artery causing mild luminal narrowing. Arch branch\nvessels are otherwise patent and within normal limits. There are moderate to\nsevere multilevel cervical spine degenerative changes. Nondisplaced fractures\nof the nasal bone are noted, age-indeterminate.", + "output": "1. No acute intracranial process by unenhanced head CT. No acute infarction.\n2. Areas of moderate left and severe right P2 and P3/P4 PCA luminal narrowing,\nlikely due to underlying atheromatous disease. Moderate left distal M1 and\nproximal right M2 bilateral MCA luminal narrowing, also likely due to\nunderlying atheromatous disease. Otherwise, remaining circle of ___\nvasculature is patent without additional stenosis, occlusion, or aneurysm.\n3. Mild-to-moderate narrowing, origin of the left vertebral artery. \nOtherwise, patent bilateral cervical vertebral and carotid arteries. No ICA\nstenosis by NASCET criteria.\n4. Left frontal encephalomalacia, as seen previously.\n5. Additional chronic intracranial findings include global involutional\nchanges and mild to moderate changes of chronic white matter microangiopathy.\n6. Completely opacified left maxillary sinus. Correlate clinically with signs\nof acute sinusitis." + }, + { + "input": "CT HEAD WITHOUT CONTRAST: There is no acute evidence of hemorrhage, edema,\nmass effect, or recent infarction. There is a chronic right cerebellar ___\ndistribution infarct The ventricles and sulci are normal in size and\nconfiguration. There is no fracture. The imaged paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear.\n\nCTA HEAD: There is a 5 mm aneurysm seen arising from the intracranial left\ninternal carotid artery at the expected origin of the left posterior\ncommunicating artery. No new aneurysms are detected. This appears unchanged\ncompared to prior study The vessels of the circle of ___ and their\nprincipal intracranial branches are patent, without high grade stenosis. The\ndural venous sinuses are patent.", + "output": "Unchanged 5 mm intracranial left internal carotid artery aneurysm from the\nexpected origin of the left posterior communicating artery." + }, + { + "input": "No acute intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Along the middle cranial fossa on the right on series 2, image 7,\nthere is a subtle hyperdensity which is thought to represent artifact, less\nlikely a small meningioma. Small vessel disease is mild. Age related\ninvolutional changes are noted. Ventricular prominence likely reflect central\natrophy. Basal cisterns are patent. There is pansinus opacification with\nfluid levels and aerosolized fluid suggesting acute sinus disease. Mastoid\nair cells and middle ear cavities are well aerated. The bony calvarium is\nintact.", + "output": "1. No acute intracranial findings.\n2. Pansinus disease, likely acute." + }, + { + "input": "There is no intra or extra-axial mass effect, acute hemorrhage or infarct. \nThe sulci, ventricles and cisterns are within expected limits for the\npatient's age. There is no downward herniation of the cerebellar tonsils.\nThere does not appear to be \"sagging\" of the brainstem indents the clivus. \nThe visualized orbits are unremarkable without clear evidence of abnormal\ntortuosity of the optic nerves or imaging evidence for papilledema. There is\nan apparent partial empty sella (series 6, image 40). Mucosal thickening of\nthe ethmoid air cells is noted. The remainder the visualized paranasal\nsinuses are clear. The mastoid air cells and middle ear cavities are well\npneumatized and clear.", + "output": "1. No intra or extra-axial mass effect, acute hemorrhage or infarct.\n\n2. There is a partial empty sella which is nonspecific and is commonly an\nincidental finding. Although it could be secondary to increased intracranial\npressure, there are no other secondary signs to suggest this as an etiology." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration\ngiven the patient's age. There are periventricular and subcortical mild white\nmatter hypodensities, which are nonspecific, but compatible with chronic\nmicroangiopathy in a patient of this age.\n\nThere is mucosal thickening of the bilateral ethmoid air cells. Mastoid air\ncells and middle ear cavities are well aerated. The bony calvarium is intact.", + "output": "No intracranial hemorrhage, fracture, or other acute intracranial abnormality." + }, + { + "input": "CT HEAD WITHOUT CONTRAST: The linear hyperdensity in the right pons is not as\nwell visualized, better seen on the prior CT. There is no evidence of no\nevidence of acute territorial infarction, hemorrhage, edema, or mass effect. \nProminent ventricles and sulci are compatible with age-related volume loss. \nPeriventricular white matter hypodensities are consistent with chronic small\nvessel ischemic disease. Atherosclerotic vascular calcifications are noted of\nbilateral vertebral and cavernous portions of internal carotid arteries.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. Bilateral cataract extractions are seen. Impacted\nbilateral maxillary molars are seen.\n\nCTA HEAD: There is atherosclerotic calcification of the cavernous internal\ncarotid arteries. A diminutive right A1 segment of the anterior cerebral\nartery is seen. There are multiple punctate calcifications in the\nsubarachnoid spaces, which corresponds to vascular lumens with normal\nopacification seen distally. There segmental narrowing and high-grade\nstenosis (with near occlusion) of the distal right V4 vertebral artery. Fetal\norigin of the right the posterior cerebral artery is noted. Otherwise, the\nremainder of vessels of the circle of ___ and their principal intracranial\nbranches appear normal without stenosis, occlusion or aneurysm formation.\nThere is lack of contrast opacification of the left transverse sinus extending\nto the left brachiocephalic vein, likely secondary to compression of the left\nbrachiocephalic vein against the aortic arch and manubrium (series 5, image\n59) rather than thrombus. A left cardiac device electrode is identified\ntraversing the left brachiocephalic vein into the visualized superior vena\ncava. The remainder of the dural venous sinuses are patent.\n\nCTA NECK: There is atherosclerotic calcification of the aortic arch and\nbranch vessels. The main pulmonary artery is enlarged measuring up to 3.6 cm.\nAtherosclerotic calcification of the carotid bulbs is noted. Otherwise, the\nremainder of the carotid and vertebral arteries and their major branches\nappear normal with no evidence of stenosis or occlusion. There is\napproximately 20% stenosis of the proximal right internal carotid artery by\nNASCET criteria. Retropharyngeal course of the right internal carotid artery\nis identified.\n\nOTHER:\nThere is a 0.7 cm right nodule in the superior portion of the right lower\nlobe. Geographic lucencies are noted in the bilateral upper lobes, which may\nbe secondary to air trapping. There are sub cm nodules in the bilateral\nthyroid lobes, which do not meet criteria for imaging follow-up according to\nthe ___ College of Radiology guidelines. There is no lymphadenopathy by\nCT size criteria. Partially visualized pacemaker wires are seen. \nDegenerative changes are noted throughout the cervical spine.", + "output": "1. Hyperdensity in the right pons is not well visualized on this study, better\nseen on the prior CT. This could potentially represent a developmental venous\nanomaly or potentially cavernous malformation.\n2. No opacification of the left transverse sinus to the left brachiocephalic\nvein, likely represent compression of the left brachiocephalic vein against\nthe manubrium and aortic arch resulting in slow flow and back pressure rather\nthan thrombus.\n3. However, MRI with and without contrast, if there no contraindications,\ncould be performed for further evaluation of impression 1 and 2. If there is\nhigh clinical concern for dural sinus thrombosis, and MRI is delayed given the\npatient's cardiac device, CT venogram could be performed.\n4. No other evidence for intracranial hemorrhage.\n5. Punctate calcifications in the terminal intra cerebral vasculature with\nnormalization of distal flow, likely secondary atherosclerotic disease versus\nnonocclusive calcified emboli.\n6. Segmental narrowing and near occlusion of the distal right the V4 segment\nof the vertebral artery, with distal reconstitution, likely secondary to\natherosclerotic stenosis.\n7. A 0.7 cm right upper lobe lung nodule. Recommend a completion CT chest for\nfurther evaluation.\n8. Approximately 20% stenosis of the proximal right internal carotid artery by\nNASCET criteria.\n9. No evidence for aneurysm or vascular malformation.\n10. Enlargement of the pulmonary arteries which may be secondary to pulmonary\nartery hypertension.\n\nRECOMMENDATION(S): Recommended a completion CT chest for further evaluation." + }, + { + "input": "Ventricles, cisterns and sulci appear within normal limits. There is no mass\neffect, hydrocephalus, or shift of normally midline structures. Gray-white\nmatter distinction appears preserved. There is no evidence of intracranial\nhemorrhage. Surrounding soft tissue structures are unremarkable. Visualized\nparanasal sinuses and mastoid air cells appear clear. No evidence of fracture\nor bone destruction.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are normal in size and configuration.\n\nThere are small mucous retention cysts in the maxillary sinuses and there is\nmild mucosal thickening in the anterior ethmoid air cells, left greater than\nright. Otherwise the visualized portion of the paranasal sinuses, mastoid air\ncells,and middle ear cavities are clear. The visualized portion of the orbits\nare unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation greater than\n3mm. The dural venous sinuses are patent.\n\nCTA NECK:\nVariant aortic arch anatomy with common origin of the brachiocephalic and left\ncommon carotid arteries.\nBilateral carotid and vertebral artery origins are patent.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion.\n\n\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.\n\nCT PERFUSION: RAPID perfusion maps demonstrate no definite focal CBV or MTT\ndefects.\n\nCBF <30% volume = 0\nTmax >6.0s volume = 0\nMismatch volume = 0\nMismatch ratio = 0", + "output": "1. No acute intracranial abnormality.\n2. Patent circle of ___ without definite evidence of stenosis,occlusion,or\naneurysm.\n3. CT perfusion demonstrates no definite abnormality.\n4. Patent bilateral cervical carotid and vertebral arteries without definite\nevidence of stenosis, occlusion, or dissection." + }, + { + "input": "No evidence of acute infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mild paranasal sinus disease. \nOtherwise, The visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. There is no acute intracranial process." + }, + { + "input": "Right frontal subarachnoid hemorrhage is similar to the previous exam (02:23).\nThe subdural hematoma at the right vertex is unchanged since the prior study\nmeasuring 6 mm. The thin subdural hematoma extending more posteriorly\noverlying the right parietal lobe is somewhat more conspicuous as is the\nsubdural hematoma along the posterior aspect of the falx and tentorium on the\nright but was present on prior. There is no acute territorial infarction. The\nventricles and sulci are enlarged compatible with atrophy. Again seen is left\nparietal subgaleal hematoma. The visualized paranasal sinuses, mastoid air\ncells and middle ear cavities are clear. There is no fracture.", + "output": "1. Stable right frontal subarachnoid hemorrhage and small right frontal\nsubdural hematoma near the vertex. Increased conspicuity of subdural hematoma\nat the right vertex posteriorly, measuring about 6 mm in maximum thickness. \nSubdural hematoma along the posterior aspect of the falx and right tentorium\nwas present on prior but is more conspicuous on the current exam. No\nsignificant mass effect." + }, + { + "input": "Small right frontal subarachnoid hemorrhage has decreased in extent, images\n401b:50 and 2b:22. A small focus of right superior frontal subdural blood has\ndecreased in density and minimally decreased in size, image 401b:56. Subdural\ncollection at the right parietal vertex is no longer seen. There is persistent\nsubdural blood along the right posterior falx and right occipital pole, with\nslightly increased thickness of blood along the right occipital pole likely\nreflecting redistribution from the right parietal vertex. No evidence for new\nhemorrhage is seen.\n\nThere is no evidence for edema mass effect in the brain parenchyma. Numerous\nfoci of low density are again seen in the subcortical, deep, and\nperiventricular white matter of the cerebral hemispheres, likely sequela of\nchronic microvascular infarcts in a patient of this age. Moderate global\ncerebral atrophy with associated prominence of the ventricles and sulci is\nagain noted. A small lipoma is again incidentally noted in the anterior falx.\n\nPreviously noted left scalp hematoma has decreased in size. There is no\nfracture. There is mild mucosal thickening in the left maxillary sinus. Other\nimaged paranasal sinuses and mastoid air cells are well aerated.", + "output": "1. Small right frontal subarachnoid hemorrhage has decreased in extent.\n2. Small right superior frontal subdural hematoma has decreased in density and\nminimally decreased in size. Previously noted right superior parietal hematoma\nhas redistributed inferiorly to the level of the right occipital pole. Small\nright posterior parafalcine subdural hematoma is unchanged.\n3. Overall, no new hemorrhage is seen." + }, + { + "input": "Again seen is a hyperdense subdural hematoma over the right convexity, overall\nstable in size but with slight dependent redistribution of blood products. It\nmeasures up to 1.6 cm from the inner table at the level of the frontal lobe. \nSmall amount of blood along the right posterior falx is also unchanged. Mild\nright frontal sulcal effacement, mild leftward shift of midline structures,\nand mild effacement of the right lateral ventricle and third ventricle, are\nunchanged. Minimal right frontal subarachnoid hemorrhage is now less\nconspicuous, image 2:19. No new hemorrhage is identified.\n\nAge-related cerebral atrophy with prominent ventricles and sulci is again\nnoted. Periventricular, deep, and subcortical white matter hypodensities are\nnonspecific but likely sequela of chronic small vessel ischemic disease in a\npatient of this age.\n\nThere is no fracture. The paranasal sinuses, mastoid air cells, and middle\near cavities are clear.", + "output": "1. Stable appearance of right subdural hematoma with unchanged mass effect.\n2. Trace right frontal subarachnoid hemorrhage, decreased compared to\napproximately 5.5 hr earlier." + }, + { + "input": "Hyperdense subdural hematoma along the right convexity has overall slightly\ndecreased in size, with slight posterior redistribution, though it remains\nthickest in the frontal region. Subdural blood is again seen along the falx,\nmore prominent posteriorly. Subdural blood along the right tentorium is more\nconspicuous, which may reflect redistribution. There is minimal residual\nright frontal sulcal effacement, improved in the interim. Leftward shift of\nmidline structures has decreased, now minimal. Effacement of the right lateral\nand third ventricles decreased. Left lateral ventricle is stable in size.\nOverall, the ventricles and sulci are prominent due to age-related cerebral\natrophy.\n\nPreviously noted tiny focus of right frontal subarachnoid hemorrhage persists,\nimage 2:21.\n\nPeriventricular, deep, and subcortical white matter hypodensities are again\nseen, likely sequela of chronic small vessel ischemic disease in a patient of\nthis age. A small chronic infarct is again seen in the left putamen.\n\nThere is mild mucosal thickening in the left maxillary sinus. Other visualized\nparanasal sinuses and mastoid air cells are clear.", + "output": "1. Mild interval decrease in right subdural hematoma with improvement in mass\neffect, which is now minimal. Also slight posterior redistribution of blood\nproducts.\n2. Stable tiny focus of right frontal subarachnoid hemorrhage." + }, + { + "input": "There has been evolution of the subdural hemorrhage along the right\nfrontoparietal convexity, with decreased density of known blood in this\nregion. Leftward shift of the normally midline structures is unchanged since\n___. Degree of subdural blood along the right tentorium is also stable\nand more confined. There is continued effacement of the sulci in the right\nparietal lobe. No new area of hemorrhage is identified.\nC2 fractures partially included.\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "Interval evolution of right frontoparietal and supratentorial subdural\nhemorrhage with persistent mass effect.\nNo evidence of new hemorrhage or increase in volume of blood." + }, + { + "input": "There is no change in the distribution of previously seen right frontal and\noccipital subdural hematoma with blood layering in the left occipital horn.\nStable approximately 4 mm of rightward midline shift is appreciated.\nThe ventricles and sulci are prominent, the combination of the aforementioned\nhemorrhage and age. No osseous abnormalities seen. The paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "The right subdurals and left interventricular hemorrhages are unchanged as\ncompared to head CT without contrast dated ___ at 19:16. Stable\nmild rightward midline shift." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal for age in size and configuration.\n\nThere is near complete opacification of the left mastoid air cells and\nextensive opacification of the right mastoid air cells. There is partial\nopacification of the middle ears bilaterally. The visualized portion of the\nparanasal sinuses are clear. The right lens has been resected. Otherwise,\nthe visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The A1\nsegment of the right anterior cerebral artery is hypoplastic, a normal\nvariant. The dural venous sinuses are patent.\n\nCTA NECK:\nThere are minimal calcified atherosclerotic plaques at the origins of the\ninternal carotid arteries bilaterally. There is no evidence of internal\ncarotid stenosis by NASCET criteria. The left vertebral artery arises\ndirectly from the aortic arch and demonstrates a mild stenosis at its origin. \nOtherwise, the carotid and vertebral arteries and their major branches appear\nnormal with no evidence of other stenosis or occlusion.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Extensive mastoid and middle ear opacification. Status post resection of\nthe right lens. Otherwise normal head CT.\n2. Normal head CTA.\n3. Minimal plaque at the origins of the internal carotid arteries bilaterally\nwithout stenosis." + }, + { + "input": "There is prominence of the ventricles and sulci suggestive of involutional\nchanges, unchanged. There are periventricular and subcortical lucencies,\nwhich may represent small vessel ischemic changes. Atherosclerotic vascular\ncalcifications are noted of bilateral cavernous portions of internal carotid\narteries.\n\nThere is no mass effect, hydrocephalus or shift of normally midline\nstructures. There is no evidence of intracranial hemorrhage.\n\nGrossly stable near complete opacification of bilateral mastoid air cells is\nnoted. Bilateral middle ear opacification is again noted.\n\nLimited imaging of skullbase demonstrate numerous lucencies of the sphenoid\nbones.", + "output": "1. No evidence of acute intracranial abnormality. Please note MRI of the brain\nis more sensitive for the detection of acute infarct.\n2. Bilateral mastoid air cell opacification and middle ear, unchanged.\n3. Limited imaging of skullbase suggests numerous sphenoid bone lucencies\nwhich are nonspecific. While findings may represent normal variant such as\nvascular channels or pneumatization, differential considerations of metastatic\ndisease and multiple myeloma are not excluded on the basis of this\nexamination. If concern for myeloma or metastatic disease, consider skullbase\nMRI for further evaluation.\n4. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described.\n\nNOTIFICATION: Findings discussed with Dr. ___ by Dr. ___ at\n6:25 pm by telephone on ___.\n\n The impression and recommendation above was entered by Dr. ___ on\n___ at 18:47 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider." + }, + { + "input": "There is no acute intracranial hemorrhage, edema, mass effect, loss of gray/\nwhite matter differentiation, or pathologic extra-axial collection. Small\nfoci of low density in the periventricular, deep, and subcortical white matter\nof the cerebral hemispheres are again seen, nonspecific but likely sequela of\nchronic small vessel ischemic disease in a patient of this age.The ventricles\nand sulci are mildly prominent due to age-related parenchymal involutional\nchanges. The intracranial compartment appears unchanged compared to ___.\n\nNo calvarial fracture is seen. There is mild mucosal thickening in the\nfrontoethmoidal recesses, anterior ethmoid air cells, sphenoid sinuses, and\npartially visualized maxillary sinuses. Visualized mastoid air cells are well\naerated.", + "output": "No evidence for acute intracranial abnormalities. No evidence for a calvarial\nfracture." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no acute hemorrhage, edema, mass effect, or loss of gray/white matter\ndifferentiation. Areas of low-density in the subcortical, deep, and\nperiventricular white matter of the cerebral hemispheres are nonspecific but\nlikely sequela of chronic small vessel ischemic disease in this age group. \nVentricles and sulci are mildly to moderately prominent due to age-related\nparenchymal volume loss. Extra-axial spaces in the posterior fossa are also\nprominent, indicating volume loss.\n\nThere is mild mucosal thickening in bilateral ethmoid air cells. There is\nmucosal thickening and small mucous retention cysts within bilateral maxillary\nsinuses. There are periapical lucencies in the maxilla bilaterally. Mastoid\nair cells appear grossly well-aerated.\n\nCTA NECK:\nThere is a 3 vessel aortic arch. There is calcified plaque within the arch\nand visualized proximal descending aorta. The carotid and vertebral arteries\nand their major branches appear widely patent with no evidence of\nflow-limiting stenosisor dissection. Specifically, there is no evidence of\ninternal carotid stenosis by NASCET criteria. The left common carotid artery\nis medialized. The left vertebral artery is dominant.\n\nCTA HEAD:\nThere is mild calcified plaque in bilateral carotid siphons without\nflow-limiting stenosis. No evidence for flow-limiting stenosis is seen\nelsewhere in the major intracranial arteries. There is a 2 mm\nposteriorly/laterally projecting outpouching at the origin of the right\nposterior communicating artery, image 5:222, suggesting a small aneurysm. \nThere is fetal configuration of the right posterior cerebral artery, a normal\nvariant. The major dural venous sinuses are patent.\n\nOTHER:\nEvaluation of the included upper lungs is limited by respiratory motion\nartifact. There is mild right apical bronchiectasis. The right thyroid lobe\nis enlarged with multiple nodules. The apparent largest nodule measures 2.2\ncm on image 5:87. There is no cervical lymphadenopathy by CT size criteria. \nThere are degenerative changes in the cervical spine.", + "output": "1. No evidence for acute intracranial abnormalities on noncontrast CT.\n2. No evidence for flow-limiting arterial stenosis in the neck or intracranial\ncompartment.\n3. 2 mm posteriorly/laterally projecting outpouching at the origin of the\nright posterior communicating artery, suggesting a small aneurysm.\n4. Enlarged right thyroid lobe with multiple nodules, measuring up to\napproximately 2.2 cm.\n\nRECOMMENDATION(S): Thyroid ultrasound is recommended if not previously\nperformed elsewhere.\n\nNOTIFICATION: Presence of the probable 2 mm aneurysm of the right internal\ncarotid artery, which was not included in the preliminary report, was reported\nover the telephone by Dr. ___ to Dr. ___ at 13:34 on ___, 10 min after discovery." + }, + { + "input": "Postsurgical changes are seen following resection of right temporal mass with\nexpected pneumocephalus, small amount subarachnoid blood in the resection bed,\nand superficial surgical staples. Previously seen 15 mm of leftward midline\nshift is mildly improved, now measuring up to 10 mm (02:16). There is\npersistence of right temporal edema and mass effect including sulcal and\nlateral ventricular effacement and mildly improved right-sided uncal\nherniation. No evidence of new large acute infarct.\n\n The visualized portion of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Expected postsurgical changes including pneumocephalus, small amount of\nsubarachnoid blood in the resection bed, and superficial surgical staples.\n2. Interval improvement in previously seen marked mass effect and leftward\nmidline shift, now measuring up to 10 mm." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere are expected postoperative changes from a right temporal craniotomy and\nresection of the right temporal lobe mass, including right frontal and\nscattered areas of surgical site pneumocephalus. Mass effect similar to\nrecent MRI, including 11 mm leftward shift of midline structures, effacement\nof the right lateral ventricle without entrapment, right uncal and subfalcine\nherniation, unchanged. White matter hypodensity surrounding the resection\nsite is unchanged.\n\nThere is no evidence of new acute large vascular territory infarct or\nunexpected area of hemorrhage. The visualized paranasal sinuses and mastoids\nappear clear. The globes and orbits are unremarkable.\n\nCTA HEAD:\nLeft dominant vertebral artery, a normal anatomic variant. The right\nvertebral artery is diminutive following the origin of the right posterior\ninferior cerebellar artery (___), not well seen. Basilar artery widely\npatent. Patent bilateral posterior cerebral arteries with preserved distal\nrunoff.\n\nThere is slightly decreased arborization seen in the area of white matter\nhypodensity in the right temporal lobe. Otherwise, the remaining portions of\nthe bilateral intracranial internal carotid arteries and the bilateral\nanterior and middle cerebral arteries are patent with normal distal runoff.\n\nNo large vessel occlusion. No aneurysm.\n\nCTV HEAD:\nSimilar to the findings from the recent MRI, there is an apparent rounded\nhypodense filling defect within the very lateral aspect of the right\ntransverse sinus. As better delineated on the MRI, the filling defect appears\nto be situated within the superior aspect of the sinus, possibly external to\nthe sinus and compressing the lumen (e.g. surgical material). Filling defect\nis unchanged in size and extent.\n\nThe left transverse sinus is diminutive, likely developmental, grossly patent.\n\nThe remainder of the deep venous system including the remaining components of\nthe more medial right transverse sinus, the confluence of the sinuses, the\nstraight sinus, vein of ___, paired internal cerebral veins, and superior\nsagittal sinus, are patent without evidence of filling defect to suggest\nthrombus.", + "output": "1. Unchanged rounded apparent filling defect/indentation on the lateral aspect\nof the right transverse sinus; this could represent postsurgical change\nindenting the sinus or extending into the sinus. This area was filled with\nair on the previous MRI examination. The appearances is atypical for\nthrombosis. However, this cannot be completely excluded except for a\nfollow-up examination.\n2. Remainder of the deep venous system is patent, without evidence of\nthrombosis elsewhere.\n3. Patent circle of ___ vasculature. No large vessel occlusion, stenosis,\nor aneurysm.\n4. Expected postoperative changes from recent right temporal craniotomy and\nresection.\n5. Stable intracranial mass-effect with unchanged right uncal and subfalcine\nherniation. No ventricular entrapment.\n6. No new unexpected hemorrhage or evidence of acute large vascular territory\ninfarct.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___. \n___, M.D. on the telephone on ___ at 4:15 pm, at the discovery of the\nfindings." + }, + { + "input": "The patient is status post resection of right temporal glioblastoma with\nevolving post surgical changes involving the superior most aspect of the\ntemporal lobe where there is residual edema and a small focus of\npneumocephalus. A sliver of hyperdensity in the extra-axial space at this\nlocation is nonspecific and possibly represents posttreatment dural thickening\n(02:13). No acute large territorial infarction or definite intracranial\nhemorrhage. Ventricles and sulci are normal in size and configuration aside\nfrom mild encephalomalacia involving the right temporal horn. Only minimal\nresidual leftward shift of normally midline structures by 3 mm is present,\nimproved in the interval.\n\nThere is no evidence of fracture. Right temporoparietal craniotomy changes\nare noted. The visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. Evolving post resection changes in the right temporal lobe including small\namount of residual edema and a small focus of pneumocephalus, with decreased\nmass effect and midline shift. A sliver of extra-axial hyperdensity at the\nprior resection site is favored to represent post treatment dural thickening.\n2. No definite evidence of intracranial hemorrhage." + }, + { + "input": "Beam hardening artifact limits study.\n\nThere is no evidence of fracture, infarction,hemorrhage,edema, or mass. There\nis prominence of the ventricles and sulci suggestive of involutional changes. \nThere are periventricular and subcortical lucencies, which may represent small\nvessel ischemic changes. Atherosclerotic vascular calcifications are noted.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits demonstrate\nbilateral lens replacement postoperative changes. Deformation of bilateral\nposterior globes is grossly unchanged compared to ___ prior exam.\n\nLimited imaging the parotid glands demonstrate bilateral subcentimeter\nnonspecific probable lymph nodes.", + "output": "1. Limited exam, as described.\n2. No acute intracranial abnormality, with no definite evidence of acute\nintracranial hemorrhage or acute large territorial infarct.\n3. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described." + }, + { + "input": "There is an acute right cerebellar hemisphere intraparenchymal hemorrhage\nspanning 1.4 x 1.1 cm, with minimal surrounding edema. (Series 2, image 6). \n0.5 cm focus of parenchymal hemorrhage in the posterosuperior left temporal\nlobe, involving subcortical white matter of the superior temporal gyrus. 0.9\ncm focus of hemorrhage to the left vertex near the junction of the left\nsuperior and middle frontal gyri, with linear component, may represent focus\nof intraparenchymal and subarachnoid hemorrhage. Additional scattered\nsubarachnoid hemorrhage in the sulci of both cerebral hemispheres, most\nevident overlying both frontal and parietal lobes. Tiny focus of hemorrhage\nwithin left occipital horn. No significant mass-effect. The ventricles and\nsulci are normal in size and configuration. The basal cisterns are patent.\n\nThere is hypoattenuation and volume loss in the left parietal lobe, presumably\nrelated to prior infarction. No evidence of acute or subacute, large\nterritorial infarction. No evidence of mass.\n\nThere is no evidence of fracture. The patient is intubated with fluid and\naerosolized secretions in the right maxillary sinus and nasopharynx. There is\nmild left maxillary sinus mucosal thickening. There is patchy mastoid air\ncell opacification, possibly related to prolonged supine patient positioning.", + "output": "1. Areas of scattered convex all subarachnoid hemorrhage. ___ foci of small\nparenchymal hemorrhage, 2 in the left cerebral hemisphere, 1 in right\ncerebellum. No hydrocephalus. Tiny focus of intraventricular hemorrhage left\noccipital horn. No midline shift or edema.. Findings are likely related to\ncoagulopathy. Cerebral amyloid angiopathy, RCVS are statistically less likely\ngiven clinical circumstance. Recommend follow-up CT within 12 hours or sooner\nif patient decompensates.\n2. Left parietal lobe chronic infarction.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 5:51 pm, less than 5\nminutes after discovery of the findings." + }, + { + "input": "Acute right cerebellar intraparenchymal hemorrhage measures 2.0 x 2.9 cm\n(series 2:7), previously measuring 1.1 x 1.5 cm on CT head ___. \nDiffuse subarachnoid hemorrhage, most prominent along the bifrontal sulci,\nappears worse.\nLinear focus of intraparenchymal hemorrhage to the left of the vertex near the\njunction of the left superior and middle frontal gyri (series 2:19) is\nunchanged. Focus of intraparenchymal hemorrhage in the posterosuperior left\ntemporal lobe measuring 0.6 mm across maximal diameter (series 2:13) is\nunchanged. Small focus of intraventricular hemorrhage in the left occipital\nhorn is unchanged. Left parietal encephalomalacia is again noted.\n\nThere is no midline shift. Ventricles and sulci are unchanged in size. There\nis no evidence of a large territorial infarction.\n\nPatient is intubated with aerosolized secretions in the right maxillary sinus\nand nasopharynx. There is mucosal thickening of the left maxillary sinus. \nThere is unchanged opacification of the mastoid air cells.", + "output": "1. Acute right cerebellar intraparenchymal hemorrhage is larger as compared to\nCT head ___. It now measures 2.0 x 2.9 cm, previously measuring 1.1\nx 1.5 cm.\n2. Diffuse subarachnoid hemorrhage, most prominent along the bilateral frontal\nsulci is worse.\n3. 2 small foci of intraparenchymal hemorrhage in the left temporal and left\nfrontal lobes are unchanged\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\n___ on the telephone on ___ at 6:32 am, 5 minutes after discovery\nof the findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nExamination due to patient motion, within this limitation, grossly there is no\nevidence of acute large territorial infarction, intracranial hemorrhage,\nedema, or mass.\n\nThere is prominence of the ventricles and sulci suggestive of age-related\ncerebral volume loss. Periventricular and subcortical white matter\nhypodensities are nonspecific, though likely sequelae of chronic small vessel\nischemic disease.\n\nNo acute osseous abnormalities seen. The partially imaged paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The orbits demonstrate\nno acute abnormalities.\n\nCTA HEAD:\nThere is moderate calcification of the paraclinoid segment of the right ICA\nwith focal mild-to-moderate stenosis distally (4: 225-228). Otherwise, the\nremaining vessels of the circle of ___ and their principal intracranial\nbranches appear normal without stenosis, occlusion, or aneurysm formation. \nThe dural venous sinuses are patent.\n\nCT PERFUSION:\nNo evidence of perfusion abnormality, ischemia or infarction.\n\nCTA NECK:\nThe origin of the supraaortic branches is normal with 3 branching pattern, the\ncommon carotid arteries are normal. Arteriosclerotic calcifications are\nvisualized at the cervical carotid bifurcations with no evidence of stenosis\nby NASCET criteria. The vertebral arteries are patent bilaterally with no\nevidence of flow stenotic lesions, there is dominance of the right vertebral\nartery.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. Mild multilevel degenerative changes are visualized throughout the\ncervical spine consistent with anterior and posterior spondylosis as well as\nsclerotic changes at C5-C6 and C6-C7 levels.", + "output": "1. Mild to moderate stenosis of paraclinoid segment distal right ICA. \nOtherwise no evidence of occlusion, dissection, or flow-limiting stenosis.\n2. No evidence of perfusional abnormalities.\n3. No evidence of ICA stenosis bilaterally by NASCET criteria." + }, + { + "input": "There are regions of white matter hypodensity and left frontal lobe compatible\nwith patient's history of recent infarct. There is no intracranial hemorrhage.\nWithin the limitations of the CT exam, there is no new large territorial acute\ninfarct. There is no mass effect. The ventricles and sulci are normal. The\nbasal cisterns are patent. Periventricular white matter hypodensities are\nlikely sequela of chronic small vessel disease.\n\nThe visualized bony structures are grossly unremarkable. Mild mucosal\nthickening of the ethmoid air cells. The mastoid air cells are poorly\npneumatized and middle ear cavities are clear. The globes are unremarkable.", + "output": "Left MCA territory hypodensities consistent with known history of recent\ninfarct. No intracranial hemorrhage. No new large territorial acute\ninfarction within limitations of CT. If clinically concerned, please obtained\nMRI as it is more sensitive to detect acute stroke." + }, + { + "input": "Head CT: There is low attenuation noted in the left coronal radiata\nconsistent with known left MCA territory infarction. There is no evidence of\nacute hemorrhage. The ventricles and sulci are normal in caliber and\nconfiguration. No fractures are identified. The orbits are unremarkable. The\nparanasal sinuses and mastoid air cells are clear.\n\nHead CTA: There is a paucity of vessels in the left MCA territory compared to\nthe right. There is narrowing of the left M2 branch of the MCA just distal to\nits trifurcation and severe narrowing of the superior division of the left\nMCA. There is reconstitution of distal flow. The remaining vasculature is\nunremarkable without evidence of aneurysm or vascular malformation.", + "output": "1. Low attenuation in the left MCA territory consistent with known left MCA\nterritory infarction. No evidence of hemorrhagic transformation.\n\n2. Paucity of vessels in the left MCA territory compared to the right with\nnarrowing of the left M2 segment of the left MCA and its superior division." + }, + { + "input": "Image quality is degraded by suboptimal contrast bolus timing.\n\nThere is a common origin of the left common carotid artery and the right\nbrachiocephalic artery noted. The carotid and vertebral arteries and their\nmajor branches are patent with no evidence of stenoses. No evidence for\ndissection is seen. Intracranial vasculature is better visualized on prior\nexam from 1 day prior incidentally noting an azygos variant of the ACA and\ntapering of the distal left M1 branch of the MCA and small caliber of the left\nMCA branches as previously detailed.\n\nThere is no significant stenosis of the internal carotid arteries by NASCET\ncriteria. The distal right ICA measures 3.8 mm. The distal left ICA measures\n3.9 mm\n\nThere is mucosal thickening in the ethmoid air cells and sphenoid sinus. The\nright mastoid air cells are clear. The left mastoid air cells are\nunderpneumatized. The soft tissues of the neck are unremarkable. The thyroid\ngland is unremarkable. There is a bulla in the right lung apex. The lungs are\notherwise clear. There are degenerative changes throughout the spine.", + "output": "Image quality is degraded by suboptimal contrast bolus timing.\n\nNo significant stenosis by NASCET criteria." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nPeriventricular and subcortical hypodensities are nonspecific, however likely\ndue to chronic small vessel ischemic disease in this age group.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormalities." + }, + { + "input": "There is no evidence of acute large territory infarction,hemorrhage,edema, or\nmass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "Multiple bilateral nasal bone fractures are demonstrated, some of which are\nchronic and similar in appearance to study of ___ while others,\nparticularly in the most distal aspect of the nasal bones (02:55) appear to be\nnew, with unchanged mild displacement of the bilateral proximal fractures. \nThis results in associated leftward nasal septum deviation. Soft tissue\nswelling surrounds the nodes and bilateral malar region.\n\nThe mandible and temporomandibular joints appear normal.\n\nMucosal thickening is seen in the bilateral nasal canals, ethmoidal air cells,\nand left maxillary sinus. The remaining visualized paranasal sinuses are\nclear. The imaged bilateral mastoids are well pneumatized and clear.\n\nThere is no evidence of abnormal fluid collections.\n\nThe globes, extraocular muscles, optic nerves, and retrobulbar fat appear\nnormal.\nThe visualized upper aerodigestive tract appears normal.", + "output": "Soft tissue swelling in the nasal and bilateral malar regions with multiple\nbilateral nasal bone fractures, some of which are chronic and unchanged,\nthough distal-most bilateral fractures appear new. Mildly displaced proximal\nfractures and resultant leftward nasal septum deviation is unchanged from\nprior study." + }, + { + "input": "There is no evidence of acute large vascular territory infarction, acute\nhemorrhage edema, or mass effect. Age-related prominence of the ventricles\nand sulci is noted. Mild periventricular white matter hypodensities are\nnonspecific but likely sequela of chronic small vessel ischemic disease in\nthis age group.\n\nThere is no evidence of fracture. Small amount of fluid is noted in the left\nsphenoid sinus. Middle ear cavities and mastoid air cells are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No evidence for acute intracranial abnormalities or fracture.\n2. Fluid in the left sphenoid sinus. Please correlate clinically whether the\npatient may have symptoms of acute sinusitis." + }, + { + "input": "There is no evidence of territorial infarction,intracranial\nhemorrhage,edema,or mass. The ventricles and sulci are prominent suggesting\ncortical volume loss, there is no evidence of transependymal migration of CSF.\n\nNo fractures are identified. Minimal mucosal thickening within the inferior\nright maxillary sinus. Otherwise, the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. There is no evidence of acute intracranial process or hemorrhage, no\nfractures are identified.\n\n2. Prominent ventricles and sulci for the patient's age suggesting cortical\nvolume loss." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema,or mass. There is\nprominence of the ventricles and sulci suggestive of age advanced involutional\nchanges.\n\nThere is no evidence of acute fracture. Chronic fracture at the junction of\nthe right mandibular condyle and ramus is again noted. The visualized portion\nof the paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. No acute fracture.\n3. Mild global atrophy, advanced for age." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass effect. Similar to prior, there is prominence of the ventricles and\nsulci suggestive of age advanced involutional change. There are\nperiventricular and subcortical lucencies, which may represent small vessel\nischemic changes. Atherosclerotic vascular calcifications are noted of\nbilateral cavernous portions of internal carotid arteries.\n\nNo acute fractures are seen. There is mucosal thickening in the bilateral\nmaxillary sinuses. The visualized portion of the mastoid air cells, and\nmiddle ear cavities are clear. The orbits are preserved.", + "output": "1. No acute intracranial abnormality. Please note MRI of the brain is more\nsensitive for the detection of acute infarct.\n2. No evidence acute intracranial hemorrhage or fracture.\n3. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described.\n4. Paranasal sinus disease , as described." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are stable in configuration. Basilar cisterns\nare patent.\n\nMucosal thickening noted in the ethmoid air cells, sphenoid sinuses as well as\nthe maxillary sinuses. Fluid seen layering within the maxillary sinuses\nbilaterally. Soft tissue swelling seen in the right supraorbital region\nwithout underlying fracture. Skull and extracranial soft tissues are\nunremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Image quality is degraded by motion, necessitating multiple repeat imaging\nseries.\n\nNo evidence of acute large territorial infarction, acute intracranial\nhemorrhage, edema, or mass effect. The ventricles and sulci are prominent,\nlikely reflective of age-related involutional changes, although somewhat\nexaggerated for patient's age.\n\nNo acute osseous abnormalities. Mild mucosal thickening of the ethmoid air\ncells. Severe mucosal opacification of the left maxillary sinus. The mastoid\nair cells, and middle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No acute fractures.\n2. No acute intracranial process.\n3. Age advanced global volume loss.\n4. Severe mucosal opacification of the left maxillary sinus. Clinical\ncorrelation for paranasal sinus disease recommended." + }, + { + "input": "There is no evidence of fracture, acute large territorial\ninfarction,hemorrhage,edema,or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. Mild periventricular and\nsubcortical white matter hypodensities are nonspecific, but likely reflect the\nsequela of chronic microvascular infarction.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "No acute intracranial pathology. Specifically, no evidence of intracranial\nbleed or calvarial fracture." + }, + { + "input": "There is an ill-defined soft tissue lesion centered at the tracheoesophageal\ngroove on the right. It measures approximately 3.4 cm TRV by 2.2 cm AP\n(2:68). There is lack of clear margins for exact measurements and the fat\nplanes between the lesion in the posterior aspect of the right thyroid lobe,\nthe trachea, and the esophagus are obscured. There is apparent intraluminal\nsoft tissue extension into the trachea suspicious for invasion as previously\ndemonstrated. There has been interval placement of the stent which is seen\njust below the level of the mass. There is some soft tissue extending medial\nto the superior margin of the stent with subsequent narrowing of the airway\nwhich has a minimal transverse diameter of 6 mm.\n\nThere is diffuse thickening of the aryepiglottic folds, stranding in the\nparaglottic fat and the piriform sinuses are effaced compatible with prior\nradiation treatment.\n\nThere are multiple prominent mediastinal lymph nodes, with only 1\npathologically enlarged and measuring 12 mm. No significant cervical\nlymphadenopathy is identified.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no suspicious osseous lesions.", + "output": "1. Invasive mass centered at the right tracheoesophageal groove with lack of\nfat planes and apparent involvement of the thyroid, invasion into the trachea\nand loss of fat plane with the adjacent esophagus.\n2. Status post interval stenting of the trachea noting that the mass is\ncentered at and above the level of the stent with persistent narrowing of the\nairway with a minimal diameter of 6 mm.\n3. Changes in the larynx compatible with prior radiation treatment.\n4. Prominent mediastinal lymph nodes, with only 1 pathologically enlarged. No\ncervical lymphadenopathy." + }, + { + "input": "An endotracheal tube terminates approximately 6.5 cm above the carina, as\nmeasured on the frontal scout image, terminating near the proximal portion of\nthe tracheal stent. Previously noted soft tissue mass within the superior\nmargin of the tracheal stent has substantially decreased, and the stent now\nlies approximately 1 cm superior in location compared to the prior study.\n\nThere are secretions and mucosal edema lining the aerodigestive tract. \nPreviously noted laryngeal mucosal edema at the level of the thyroid cartilage\nhas decreased, although evaluation is slightly limited by the presence of the\nendotracheal tube. There is circumferential paratracheal soft tissue mass\nsurrounding the cricoid cartilage, FDG avid on the recent PET-CT performed on\n___. When compared to the preceding neck CT performed on ___, the posterior component appears smaller, consistent with recent\ndebulking. There is new soft tissue density/stranding anteriorly at this\nlevel (03:53), which likely reflects posttreatment change/edema. Slightly\nmore inferiorly, there is a linear radiodensity overlying the skin, which\ncould reflect prior tracheostomy tube placement.\n\nThere is no cervical adenopathy. There are several enhancing mediastinal\nnodes, the largest in the left lower paratracheal station measures up to 2.1 x\n1.1 cm.\n\nThe parotid and submandibular glands enhance homogeneously. Thyroid gland is\nunremarkable. Major cervical vessels are patent. There is mild calcified\natherosclerotic plaque. No internal carotid artery stenosis by NASCET\ncriteria.\n\nEvaluation of the included lung parenchyma reveals multiple nodules, the\nlargest measuring up to 7 mm (series 3, images 62, 79, 84). These are not\ndefinitely identified on prior studies.\n\nIncluded images of the brain parenchyma is grossly unremarkable. Mild mucosal\nthickening in the maxillary sinuses, along with a mucous retention cyst on the\nleft. Air-fluid levels are present in the sphenoid sinuses bilaterally. \nMastoid air cells and middle ear cavities are grossly clear.\n\nMultilevel degenerative changes are noted throughout the cervical spine, which\nare most pronounced between C3 through C5. Evaluation of the soft tissues\nreveals mild subcutaneous fat stranding along the neck, which may reflect\nposttreatment change.", + "output": "1. Compared to ___, posterior paratracheal soft tissue has\ndecreased, consistent with recent debulking. New soft tissue stranding\nanterior to the cricoid cartilage likely reflects edema/inflammation from\nrecent treatment and intervention.\n2. Interval decrease in soft tissue within the superior lumen of the tracheal\nstent, which now appears slightly superior in location.\n3. Several enhancing mediastinal lymph nodes, the largest measuring 1.1 x 2.1\ncm in the left lower paratracheal station.\n4. Several new lung nodules measuring up to 7 mm, may be infectious or\ninflammatory. A follow-up chest CT may help for further assessment, if\nclinically indicated.\n\nRECOMMENDATION(S): A follow-up chest CT may help for further assessment, if\nclinically indicated." + }, + { + "input": "Limited examination due to patient motion. In comparison with the most recent\nneck CT exam dated ___, the previously noted soft tissue mass\nadjacent to the superior margin of the tracheal stent apparently is slightly\nsmaller (image 54, series 2), with no significant change in the position of\nthe tracheal stent, the endotracheal tube has removed and the airway appears\npatent, no fluid collection or abscess formation is identified. The previously\ndescribed soft tissue mass surrounding the cricoid cartilage is not clearly\nseen in the current study there is no evidence of cervical lymphadenopathy,\nhowever there are persistent slightly prominent enhancing mediastinal lymph\nnodes in the anterior paratracheal region measuring approximately 6 x 11 mm in\ntransverse dimension (image 80, series 2). The previously noted lung\nparenchyma nodules appear less conspicuous (image 87, series 2), please\ncompared with the prior exam in ___, (image 84, series 3) and probably\ninfectious or inflammatory in nature.\nMultilevel, multifactorial degenerative changes throughout the cervical spine\nconsistent with spondylosis and narrowing of the intervertebral disc spaces\nfrom C3/C4 through C7/T1 level and remains unchanged. The visualized\nintracranial structures are grossly unremarkable. The orbits are normal, the\nparanasal sinuses again demonstrate a mucous retention cyst on the left\nmaxillary sinus. There is interval improvement in the previously seen mucosal\nthickening involving the sphenoid sinus. The mastoid air cells are clear.", + "output": "1. Limited examination due to patient motion. The previously noted soft\ntissue mass adjacent to superior margin of the tracheal stent apparently is\nslightly smaller, there is no change in the position of the tracheal stent.\n\n2. No fluid collections of abscess formations are identified.\n\n3. The previously described soft tissue mass surrounding the cricoid\ncartilage is not clearly seen the current study.\n\n4. The previously noted lung parenchyma nodules are less conspicuous in the\ncurrent study.\n\n5. There is interval improvement in the previously seen mucosal thickening\ninvolving the sphenoid sinus." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nPosttreatment changes following partial laryngectomy and radiation treatment\nare seen in the proximal trachea with soft tissue swelling and abrupt\nnarrowing with near complete obstruction at the level of the presumed\nrecurrent tumor (series 2: Image 42). A tracheostomy is noted in the mid to\ndistal trachea which appears patent and terminates approximately 4.2 cm above\nthe carina (series 601b: Image 29). Evaluation of the aerodigestive tract\ndemonstrates no mass and no areas of focal mass effect.\n\nThe salivary glands are grossly without mass or adjacent fat stranding. The\nthyroid gland appears normal. Scattered subcentimeter nonspecific lymph nodes\nare noted throughout the neck bilaterally, without definite lymphadenopathy by\nCT size criteria. Limited portions of the visualized brain appear\nunremarkable. A mucous retention cyst is noted in the left maxillary sinus.\n\nThe imaged portion of the lung apices are remarkable for mild dependent\natelectasis. 3 mm solid (see 2:85), 3 mm ground-glass (see 2:78), 5 mm solid\n(see 02:31) and 2 mm solid (see 2:65) right upper lobe nodules are noted. An\napproximately 3 mm left lower lobe ground-glass nodules noted (see 2:84).\n\nMultilevel degenerative changes are seen in the cervical spine with disc space\nnarrowing, anterior bridging osteophytes, and endplate sclerosis, most\npronounced at the C3-C4 and C4-C5 levels. A right central line is\nincompletely evaluated in the superior SVC.", + "output": "1. Dental amalgam streak artifact limits study.\n2. Posttreatment changes related to partial laryngectomy radiation treatment\nare seen in the proximal trachea with soft tissue swelling an abrupt narrowing\nwith near complete occlusion at the level of the presumed tumor recurrence.\n3. Tracheostomy noted in mid to distal trachea approximately 4.2 cm above the\ncarina.\n4. Grossly patent trachea.\n5. Multiple right and at least 1 left, pulmonary nodules, not definitely noted\non ___ prior chest CTA. If clinically indicated, consider\ndedicated chest CT for further evaluation." + }, + { + "input": "Status post partial laryngectomy. Compared to the prior neck CT there is\nsubstantially increased soft tissue swelling and prevertebral edema extending\nfrom the lower nasopharynx into the hypopharynx. A more focal ovoid\napproximately 1.9 x 1.4 x 2.1 cm area of nodular edematous soft tissue with\nmild peripheral heterogeneous enhancement in the posterior laryngeal wall,\njust inferior to the epiglottis is larger compared to prior exam (series 602,\nimage 18). There is new or significantly worsened edema and peripheral\nenhancement of the epiglottis extending into the glottis. These findings\ncombine to cause almost total airway obstruction extending from the level of\nthe glottis to the level of the tracheostomy tube. The pre and paraglottic\nfat appears grossly preserved. There is new inflammatory stranding of the\nprevertebral space evidence of peripherally enhancing fluid collection (series\n602, image 19).\n\nThere is new inflammatory stranding with effacement of the fat adjacent to the\nbilateral submandibular glands, (series 2, image 47) as well as of the fascial\nplanes anterior to the sternocleidomastoid muscles. The masticator spaces and\nparotid spaces appear intact.\n\nAt the entry site of the tracheostomy tube there is new significant soft\ntissue swelling, with irregularity of the luminal wall, measuring approximate\n1.8 cm in greatest thickness. It is difficult to differentiate between the\nsoft tissue swelling and the wall of remaining trachea, and much of the\ncartilage below the cricoid is not well visualized (series 2, image 69 through\n80), potentially demineralized or eroded. There is no definite evidence for\nextraluminal gas, although there is evidence of small pockets of air along the\nmural irregularity (series 2, image 77).. No definite fistulous track with\nthe adjacent esophagus although the intervening fat plane has been\nobliterated.\n\nThe thyroid gland is not well seen and heterogeneous when compared to prior\nexam (series 2, image 71).Multiple small right paratracheal mediastinal lymph\nnodes are likely reactive.\n\nVessels of the head and neck appear patent. There are multilevel degenerative\nchanges of the cervical spine with significant disc height loss at the C3-4\nand C4-5 levels. Apical scarring in the left lung is similar to exam from\n___. Scarring or atelectasis in the right upper lobe is also similar\nto prior exam. There are new nodular opacities in the apex of the right lung\nmeasuring up to 8 mm and in the left apex measuring up to 6 mm which are not\nas well seen on exam from ___.\n\nAlthough not optimized for such evaluation, visualized brain is grossly\nunremarkable.\nThere is a mucous retention cyst in the right maxillary sinus. There is\nmucosal thickening of the right sphenoid sinus. Fluid opacifies the left\nmastoid air cells. The orbits are unremarkable. Bilateral lens replacements\nare noted.\n\nComminuted and distracted with the right proximal humerus, potentially\ninvolving the surgical neck is identified.", + "output": "1. Increased soft tissue swelling, pharyngeal and parapharyngeal edema\nextending from the lower nasopharynx into the hypopharynx with increased size\nof a previously seen mildly peripherally enhancing more focal area of more\nnodular edematous soft tissue measuring approximately 1.9 cm in the posterior\nlaryngeal wall, just inferior to the epiglottis.\n2. There is new edema/thickening of the epiglottis with mild peripheral\nenhancement which in combination with impression 1, results in near complete\nobstruction of the airway.\n3. New substantial soft tissue thickening around the tracheostomy entry site\nas well as increased thickening of the proximal tracheal wall consistent with\ntracheitis. In addition, the cartilage of the trachea at the tracheostomy\nsite is poorly visualized compared to prior examination and may be\ndemineralized or eroded. The borders between the soft tissue and tracheal\nwalls is obliterated.\n4. No definite evidence of drainable fluid collection or abscess.\n5. The constellation of above findings could represent sequela of interval\nradiation therapy (the patient does not appear to receive treatment for\nlaryngeal cancer at this institution and correlation with outside imaging and\nclinical history if available is recommended) versus infectious etiology.\n6. No definite evidence of fistulous connection with the esophagus. No\ndefinite extra mural gas is noted, although pockets of gas is seen within the\nsoft tissue surrounding the tracheostomy.\n7. Pulmonary nodules in the apices of bilateral lungs new since prior exam may\nreflect sequela of inflammatory process or aspiration. Consider further\nevaluation with chest CT.\n8. Additional findings as described above." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration for the patient's\nage.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No evidence of acute infarct, hemorrhage, or fracture." + }, + { + "input": "Thin, left parafalcine 3 mm subdural hematoma again seen along the falx near\nthe vertex. Not tracks inferiorly and extends slightly along the tentorium on\nthe left.\n\nBilateral parenchymal hemorrhages in the cingulate gyri again noted, larger on\nthe left than on the right. On the left the hemorrhage when measured in the\nsagittal plane measures 5.8 cm AP x 1.9 cm cc, previously 5.1 cm AP x 1.3 cm\ncc. The hemorrhage on the right in the sagittal plane measures 3.5 cm AP x\n1.2 cm cc, unchanged. The degree of surrounding edema is slightly increased. \nSmall amount of hemorrhage layering dependently in the occipital horn of the\nleft lateral ventricle as on prior. Components of interventricular blood also\nnoted along the septum pellucidum.\n\nSize and configuration of the ventricles and sulci are unchanged. Curvilinear\nhigh-density structure most likely calcification seen in the left frontal\noperculum (601:26), unchanged. No significant mass effect. Gray-white matter\ndifferentiation is preserved.\n\nPartially opacified left ethmoid air cells and mucosal thickening noted in the\nleft frontal sinus. Included paranasal sinuses and mastoids are otherwise\nclear. Skull and extracranial soft tissues are unremarkable.", + "output": "1. Bilateral cingulate gyrus parenchymal hemorrhages, larger on the left and\nslightly enlarged compared to yesterday's exam.\n2. No significant interval change of the left parafalcine subdural hematoma\nwhich has slightly redistributed. Persistent small amount of intraventricular\nhemorrhage." + }, + { + "input": "Again demonstrated are bilateral parenchymal hemorrhages in the cingulate\ngyri, larger on the left than on the right. The hemorrhage appears slightly\nlarger on the left, now measuring 6.1 x 1.9 cm compared to 5.8 x 1.9 cm\npreviously. On the right, the hemorrhage appears similar to the previous\nexamination at approximately 3.6 x 1.2 cm compared to 3.5 x 1.2 cm previously\n(measurements performed on radiologist sagittal reconstructions for similar\ntechniques to the previous examination. Surrounding vasogenic edema again\nseen. The degree of associated mass effect does not appear significantly\nchanged. Scattered intraventricular hemorrhage is again demonstrated along\nseptum pellucidum as well as layering in the occipital horns of the lateral\nventricle, not significantly changed.\n\nThe subdural hematoma along the left falx near the vertex, measuring\napproximately 3 mm. Extension along the left tentorium is again demonstrated\nand does not appear significantly changed.\n\nStable ventricular size and configuration. Likely left frontal operculum\ncalcification again seen.\n\nThere is again partial opacification of the ethmoid air cells and mucosal\nthickening in the left frontal sinus. The visualized paranasal sinuses and\nmastoid air cells are otherwise clear. No calvarial fracture is demonstrated,\nand the visualized portion of the orbits are unremarkable. A right lens\nreplacement is noted.", + "output": "1. The left cingulate gyrus intraparenchymal hemorrhage appears slightly\nincreased compared to the previous examination, although there is no\nsignificant change in the degree of associated mass effect.\n2. The right cingulate gyrus intraparenchymal hemorrhage appears similar to\nthe previous examination.\n3. No significant change in left parafalcine and tentorial subdural hematoma.\n4. No significant change in the intraventricular hemorrhage." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nRedemonstrated bilateral intraparenchymal hemorrhage in bilateral cingulate\ngyri, measuring 5.8 cm on the left and 2.8 cm on the right, not substantially\nchanged from ___. Layering blood products in the occipital horn\nof the left lateral ventricle and the scattered intraventricular hemorrhage in\nthe septum pellucidum are unchanged. Degree of vasogenic edema is similar. And\ntiny hyperdensity in the left frontal lobe (02:14) with surrounding mild\nvasogenic edema is unchanged from prior. Unchanged left parafalcine subdural\nhematoma. There is no midline shift. Prominent sulci and ventricles are\nunchanged.\n\nStatus post lens removal surgery of the right globe. Otherwise, both orbits\nare normal. Paranasal sinuses and mastoid air cells are clear.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. The dural venous\nsinuses are patent.", + "output": "1. Essentially unchanged bilateral intraparenchymal hemorrhage at cingulate\ngyri, bilateral fornices and septum pellucidum with no underlying vascular\nmalformation.\n2. Redemonstration of intraventricular bioccipital layering hemorrhagic\nproducts more the left side with no evolving acute hydrocephalus.\n3. Unchanged subdural hematoma along the falx cerebri.\n4. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\nNo abnormal vascular structures are seen. The superior sagittal sinus appear\npatent." + }, + { + "input": "Redemonstration of intraparenchymal hemorrhage with surrounding vasogenic\nedema within the bilateral cingulate gyri measuring 5 on the left and 2.9 cm\non right, similar to most recent prior CT dated ___. \nAdditionally, there is persistent layering hyperdensity in the occipital horn\nof the left lateral ventricle. Additionally, there is redemonstration of a 3\nmm subdural hematoma along the falx. No new foci of intracranial hemorrhage\nor acute large territory infarction noted.\n\n There is prominence of the ventricles and sulci suggestive of involutional\nchanges.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavitiesare essentially clear. Patient is status post right lens\nreplacement.", + "output": "1. Redemonstration of intraparenchymal hemorrhage within the bilateral\ncingulate gyri, layering hemorrhage within the occipital horn of the left\nlateral ventricle, and a 3 mm subdural hematoma, all similar in size and\nappearance compared to prior CT dated ___.\n2. No new intracranial hemorrhage identified." + }, + { + "input": "There has been near resolution of the bilateral cingulate hyperdense\nparenchymal blood products, with minimal residual hyperdense blood products on\nthe left, and decreased surrounding edema. There has been interval resolution\nof the previously seen small parafalcine subdural hematoma. Previously seen\nintracranial hemorrhage has also resolved. There is unchanged prominence of\nthe ventricles and sulci, likely secondary to parenchymal involutional\nchanges. No evidence for new hemorrhage or edema. Mild periventricular white\nmatter hypodensities are again seen, non-specific but likely secondary to\nchronic small vessel ischemic disease in this age group.\n\nNo concerning osseous findings. The visualized paranasal sinuses and mastoid\nair cells appear grossly unremarkable. Status post right cataract surgery.", + "output": "1. Near complete resolution of the bilateral singular hyperdense blood\nproducts with minimal residual hyperdense blood products on the left. \nDecreased surrounding edema.\n2. Resolution of parafalcine subdural hematoma. Resolution of\nintraventricular hemorrhage.\n3. No new hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. Mild\nperiventricular and subcortical white matter hypodensities are demonstrated,\nmost prominent in the periventricular white matter near the left lateral\nventricle (series 2 image 20). Findings are nonspecific but suggestive of\nmild chronic small vessel disease.\n\nThere is no evidence of fracture. There is a focal area of relative density\nwithin the frontal bone, which likely represents a bone island (series 3,\nimage 14). There is moderate bilateral thickening in the ethmoid air cells. \nAdditionally, there is a air-fluid level seen within the right maxillary sinus\nwhich is incompletely imaged. The left maxillary sinus and bilateral\nsphenoids are clear. The bilateral mastoid air cells are clear. Both lenses\nhave been replaced. Otherwise the visualized orbits are within normal limits.", + "output": "1. No acute intracranial findings. No large territorial infarction,\nintracranial hemorrhage or fracture.\n2. Findings suggestive of mild chronic small vessel disease." + }, + { + "input": "CTA HEAD:\nAn inferolaterally directed outpouching of the extradural right cavernous\ninternal carotid artery is seen, measuring 2 mm from base to the neck with a\n2.4 mm wide neck (2:217). This most likely represents an infundibulum versus\nsmall aneurysm.\n\nAn inferolaterally directed outpouching of the left cavernous internal carotid\nartery is seen, measuring 1.1 mm from base to the neck with a 1.5 mm wide neck\n(2:221). This represents infundibulum versus aneurysm.\n\nA posteriorly directed outpouching of the right supraclinoid internal carotid\nartery is seen (2:224), likely representing an infundibulum.\n\nOtherwise, the vessels of the circle of ___ and their principal\nintracranial branches appear normal without stenosis or occlusion. There is\nfetal type origin of the posterior cerebral arteries with hypoplastic P1\nsegments. The dural venous sinuses are patent.\n\n\nCTA NECK:\nModerate narrowing is seen at the origin of a diminutive left vertebral artery\nwith patent distal run-off. Otherwise, the origins of the great vessels,\nsubclavian arteries and right vertebral artery are unremarkable.\n\n Atherosclerotic changes of the carotid bifurcations are seen with 25% right\nand 0% left narrowing of the internal carotid arteries, by NASCET criteria. \nThe vertebral arteries appear normal with no evidence of stenosis or\nocclusion.\n\n\nOTHER:\n 2 mm nodules are seen in the upper lobes (2:11, 25, 58, 70). Biapical\nemphysematous changes are seen. The visualized portion of the thyroid gland\nis within normal limits. There is no lymphadenopathy by CT size criteria. \nBilateral breast implants are partially visualized.", + "output": "1. 2 mm infundibulum versus small aneurysm of the extradural right cavernous\ninternal carotid artery.\n2. 1 mm outpouching of the extradural left cavernous internal carotid artery,\nrepresenting infundibulum versus aneurysm.\n3. No stenosis or occlusion of the circle of ___ arteries.\n4. 5% right and 0% left narrowing of the cervical internal carotid arteries,\nby NASCET criteria.\n5. Moderate narrowing at the origin of a diminutive left vertebral artery with\npatent distal run-off.\n6. Multiple 2 mm nodules in the upper lobes.\n\nRECOMMENDATION(S): For incidentally detected multiple solid pulmonary nodules\nsmaller than 6mm, no CT follow-up is recommended in a low-risk patient, and an\noptional CT follow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" + }, + { + "input": "CT HEAD: Patient is status post left pterional craniotomy for clipping of MCA\nbifurcation aneurysm. Artifact from the clip obscures visualization of the\nadjacent brain parenchyma. There is a small area of anterior left temporal\nencephalomalacia as seen on prior MRI. There is no acute intra-axial or\nextra-axial hemorrhage, major vascular infarction, mass or midline shift.\nGray-white matter differentiation is otherwise preserved. Ventricles and\nsulci are symmetric and unremarkable.\n\nVisualized paranasal sinuses and mastoid air cells are clear besides mucosal\nthickening in the right maxillary sinus and an opacified right posterior\nethmoid air cell.. The skull and extracranial soft tissues are unremarkable.\n\nCTA HEAD: Patient is status post left MCA terminus bifurcation aneurysm\nclipping. There is residual opacification within the lumen of the aneurysm\nbelow the clip. This fusiform aneurysm measures at least 6 mm beyond the\nexpected size the lumen of the MCA branch along a 9 mm length of the vessel.\n\nThere is a 1.5 mm posterior outpouching arising from the left ICA terminus\n(5:99), similar compared to prior.\n\nAtherosclerotic calcifications seen along the cavernous ICAs bilaterally\nwithout significant stenosis. No additional aneurysm is identified. A left\nposterior communicating artery is identified as well as an anterior\ncommunicating artery. No right-sided posterior communicating artery\nidentified.", + "output": "1. Postoperative changes of left pterional craniotomy for left MCA aneurysm\nclipping.\n2. No acute intracranial process.\n3. Residual filling of a left MCA bifurcation aneurysm measuring approximately\n6 x 9 mm.\n4. Additional 2 mm posterior outpouching at the left ICA terminus worrisome\nfor an additional aneurysm, unchanged since prior MRA." + }, + { + "input": "There is no evidence of acute large vascular territory\ninfarction,hemorrhage,edema, or mass effect. Hypodensity in the right caudate\nhead of CSF attenuation suggest prior infarct. Periventricular white matter\nhypodensities are nonspecific but suggest small vessel ischemic disease. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges.\n\nThere is no evidence of fracture. Right frontal sinus and right anterior\nethmoid sinus is opacified. The visualized portion of the other paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits demonstrate bilateral lens replacements. There is an\nimpacted left maxillary tooth (3; 8). Dense bilateral coronary calcifications\nof the cavernous portions of the internal carotid arteries.", + "output": "No evidence of acute large vascular territory infarction or hemorrhage.\nNo fracture." + }, + { + "input": "There is a small amount of skin induration within the right periorbital\nregion. There is no evidence of underlying fracture.\n\nThere is no evidence of large territorial infarction, hemorrhage, edema, or\nmass. The mild subcortical and deep white matter hypodensities are\nnonspecific, but likely represent the sequela of chronic microvascular\nischemic disease. There is mild prominence of the ventricles and sulci\nsuggestive of involutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The patient is status post bilateral lens resections.", + "output": "Small amount of skin induration within the right periorbital region, but no\nevidence of underlying fracture or intracranial hemorrhage." + }, + { + "input": "There is no acute intracranial hemorrhage, edema, mass effect, or loss of\ngray/ white matter differentiation. There is no pathologic extra-axial\ncollection. Foci of low density in the subcortical, deep, and periventricular\nwhite matter are nonspecific. There is mild age-related prominence of the\nventricles and sulci.\n\nNo lytic or sclerotic osseous lesions seen. There is partial left mastoid air\ncell opacification. Right mastoid air cells are well aerated. There is a small\nfocus of mucosal thickening or dependent secretions in the pterygoid recess of\nthe left sphenoid sinus. Frontal sinuses are hypoplastic.", + "output": "1. No acute hemorrhage.\n2. Supratentorial white matter hypodensities without mass effect are most\nlikely sequela of chronic small vessel ischemic disease in a patient of this\nage. However, the sensitivity of noncontrast CT for any underlying small\nmetastases is poor.\n\nRECOMMENDATION(S): MRI with and without contrast would be significantly more\nsensitive for intracranial metastatic disease, if clinically warranted and not\ncontraindicated." + }, + { + "input": "Head CT: There is no evidence of hemorrhage or mass effect. There is moderate\nbrain parenchymal volume loss for age. There has been interval evolution of\nhypodensity within the midbrain and bilateral thalami which, given the\nterritory, likely represents infarction in the territory of an artery of\nPercheron. There is no evidence of new infarction. Incidental note is made of\ncavum septum pellucidum. The orbits and skull base are unremarkable. There is\nbilateral maxillary sinus mucosal thickening including a left maxillary sinus\nmucosal retention cyst.\n\nHead CTA: The anterior cerebral arteries, middle cerebral arteries, and\nposterior cerebral arteries are normal in appearance. An anterior\ncommunicating artery and bilateral posterior communicating arteries are seen.\nThere is no evidence of aneurysm, pathologic large vessel occlusion, or\nflow-limiting stenosis within the intracranial vasculature.\n\nNeck CTA: The aortic arch demonstrates a conventional three-vessel branch\nconfiguration. The origins of the great vessels are patent. The origin of the\nleft common carotid artery is tortuous. The left vertebral artery is slightly\ndominant. There is minimal nonocclusive calcified plaque at the origin of the\nleft proximal internal carotid artery. There is no evidence of vessel\nocclusion or dissection within the vasculature of the neck. There is no\nevidence of internal carotid artery stenosis by NASCET criteria.\n\nThere is biapical pulmonary scarring. The thyroid gland, submandibular glands,\nand parotid glands appear unremarkable. There is multilevel cervical\nspondylosis. No osseous lesions are seen. The remaining major soft tissue and\nmuscular structures throughout the neck are unremarkable. There is no cervical\nlymphadenopathy.", + "output": "1. Interval evolution of hypodensity within the midbrain and bilateral thalami\nwhich, given the distribution, likely represents infarction in the territory\nof the artery of Percheron.\n2. No evidence of stenosis, vascular occlusion, or aneurysm within the\nvasculature of the head and neck." + }, + { + "input": "There is no acute hemorrhage, edema, mass effect or acute large vascular\nterritorial infarction. The ventricles and sulci are normal in size and\nconfiguration. Periventricular and deep subcortical white matter\nhypodensities are unchanged as compared to the prior study, likely represent\nchanges associated with microvascular disease. The basal cisterns appear\npatent and there is preservation of gray-white matter differentiation.\n\nNo fracture is identified. The mastoid air cells, middle ear cavities, and\nvisualized paranasal sinuses are clear. The globes are unremarkable.", + "output": "1. No acute intracranial process.\n\n2. Stable appearing periventricular and deep subcortical white matter\nhypodensities likely represent changes associated with chronic microvascular\ndisease." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nEvaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no cervical\nlymphadenopathy by CT criteria. The neck vessels are patent.\n\nPolypoid mucosal thickening of the left maxillary sinus is moderate. \nRemaining imaged paranasal sinuses are clear. The mastoid air cells and\nmiddle ear cavities are clear. The orbits are unremarkable. Cavernous\ninternal carotid artery calcifications are mild bilaterally.\nPlease refer to the dedicated chest CT from the same day for description of\nfindings including extensive mediastinal lymphadenopathy.\n\nNo definite focal osseous lesions identified. Multilevel degenerative changes\nin the cervical spine are most pronounced at C5 through T1. Atherosclerotic\nvascular calcifications are seen in bilateral carotid bifurcations.", + "output": "1. Dental amalgam streak artifact limits study.\n2. No cervical lymphadenopathy.\n3. Paranasal sinus disease.\n4. Extensive mediastinal lymphadenopathy. Please see concurrently obtained\ncontrast chest CT for description of thoracic structures." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nVery minimal mucosal thickening is seen within the right frontal ethmoidal\nrecess. The visualized portion of the remaining paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are normal.", + "output": "No acute intracranial abnormality" + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass. The ventricles and sulci are more prominent than the prior study\ncompatible with progressive atrophy. There is periventricular white matter\nhypodensity consistent with chronic small vessel ischemic disease.\n\nNo osseous abnormalities seen. There is mild mucosal thickening of the left\nsphenoid sinus. The remainder of the paranasal sinuses, mastoid air cells and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Progression of atrophy and chronic small vessel ischemic disease since the\nprior study from ___." + }, + { + "input": "There is a new hypodensity involving the right occipital lobe from ___,\ncompatible with acute-subacute infarction involving the right PCA territory. \nThere is been a slight increase in the degree of ventricular dilation from\n___. For example, the third ventricle measures 15 mm in transverse\ndimension, previously 14 mm. Scattered periventricular white matter\nhypodensities are compatible with chronic small vessel ischemic disease. The\nbasal cisterns are patent.\n\nThere is mild mucosal thickening within the ethmoid air cells. Otherwise, the\nincluded paranasal sinuses and mastoid air cells are well-aerated. The imaged\nlenses and globes are normal. No acute fracture. Deformity of the nasal bone\nand septum is consistent with prior fracture.", + "output": "1. Hypodensity involving the right occipital lobe is compatible with\nacute-subacute infarction involving the right PCA territory. 2. Slight\nincrease in degree of ventricular dilation." + }, + { + "input": "In the vascular territory of the right PCA, there is a hypodense area\ncorresponding to the FLAIR and diffusion abnormality seen on the recent MRI\ncompatible with evolving infarction. Within this area there is a small\nhyperdense area spanning 1.1 cm representing hemorrhagic transformation. There\nis no shift of midline structures. The ventricles remain enlarged, stable\nsince the prior study. White matter hypodensities are the sequela of chronic\nsmall vessel ischemic disease.\n\nA small amount of mucosal thickening is noted in the left maxillary sinus;\notherwise the paranasal sinuses and mastoid air cells are clear.", + "output": "Hemorrhagic transformation within an evolving right occipital lobe infarct." + }, + { + "input": "There is no significant interval change in the right occipital infarct with a\nsmall amount of parenchymal blood. Prominence of the ventricles and sulci is\nconsistent with age-related involutional changes. There are non-specific\nperiventricular and subcortical white matter hypodensities which can be seen\nin patients with chronic small vessel ischemia. There is no fracture. Again\nseen is minimal mucosal thickening of the left maxillary sinus. Otherwise, the\nimaged paranasal sinuses, mastoid air cells, and middle ear cavities are clear", + "output": "No significant interval change in the right of occipital infarction with\npetechial hemorrhage." + }, + { + "input": "No interval change in the right occipital infarct with central petechial\nblood. There are no new hemorrhagic lesions or infarction. The ventricles and\nsulci are moderately prominent due to age-related cerebral atrophy. There is\nsubcortical, deep, and priventricular white matter hypodensities, which are\nmost likely sequela of chronic small vessel ischemic disease. The basal\ncisterns appear patent and there is preservation of gray-white matter\ndifferentiation.\n\nThe visualized bony structures are grossly unremarkable. The paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "Stable right occipital infarct with small amount of parenchymal blood,\nunchanged from prior study. New hemorrhagic lesions." + }, + { + "input": "There is no acute intracranial hemorrhage, acute infarction, large mass or\nmidline shift. There is no hydrocephalus. The ventricles and sulci are\nprominent suggestive of age-related involutional change. Areas of\nperiventricular, subcortical and deep white matter hypodensity suggestive of\nchronic small vessel ischemic disease. The basal cisterns are patent and there\nis preservation of gray-white matter differentiation. The orbits are\nunremarkable. There is trace thickening in bilateral sphenoid air cells. The\nvisualized paranasal sinuses, middle ear cavities and mastoid air cells are\nclear. Atherosclerotic calcifications are noted in the carotid siphons.\n\nNote is made of small bifrontal, left temporal and basal cistern\npneumocephalus without underlying fracture.", + "output": "Small pneumocephalus without associated cranial traumatic findings can be\nexplained by recent lumbar intradural lesion resection. No hemorrhage or\nterritorial infarct.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with ___, PA\non the telephone on ___ at 11:55 AM, 2 minutes after discovery of the\nfindings." + }, + { + "input": "There is no evidence of intracranial hemorrhage. There is no mass effect,\nhydrocephalus or shift of the normally midline structures. The gray-white\nmatter distinction appears preserved. Surrounding soft tissues are\nunremarkable. There is no evidence for fracture or dislocation. The\nvisualized paranasal sinuses and mastoid air cells appear clear.", + "output": "No evidence of acute intracranial process or injury." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Atrophy and\nventriculomegaly are noted. Prominence of the ventricles and sulci are out of\nproportion to patient's age. There is no evidence of outflow tract\nobstruction.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of mass, hemorrhage or infarction.\n2. Diffuse cortical atrophy and ventriculomegaly is out of proportion to\npatient's age." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration for the patient's\nage. There is a stable tectal lipoma (02:12). Benign calcifications are seen\nin the basal ganglia bilaterally.\n\nThere is no evidence of acute fracture. There is partial opacification of the\nanterior ethmoidal air cells. Otherwise, the visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "1. No acute intracranial process." + }, + { + "input": "Patient is status post right frontal burr hole approach stereotatic biopsy of\nthe previously noted right parietal lesion. There is a small 9 x 8 mm focus\nof hemorrhage within the biopsied lesion as well as a small amount of\nsubarachnoid blood within an adjacent frontal sulcus. Surrounding vasogenic\nedema is re- demonstrated. Small amount of pneumocephalus is expected. \nConfiguration of the ventricles and sulci is unchanged. The basal cisterns are\npatent and there is preservation of gray-white matter differentiation. The\nvisualized paranasal sinuses, mastoid air cells and middle ear cavities are\nclear.", + "output": "Postoperative changes from stereotactic biopsy of a right parietal mass with a\nsmall amount of intralesional hemorrhage as well as a small amount of\nsubarachnoid blood in an adjacent frontal sulcus." + }, + { + "input": "Hypodensity in the right parietal lobe represents the known mass which has\npreviously been biopsied. There has been expected evolution of blood products\nwithin the right parietal mass. There is no evidence of acute hemorrhage or\nnew area of edema. The ventricles and sulci are prominent consistent with\nage-related atrophy. Confluent periventricular and subcortical white matter\nhypodensities likely represent the sequela of chronic small vessel ischemic\ndisease. There is a right frontal burr hole. The paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute hemorrhage. Expected evolution of blood products in a right parietal\nmass from recent biopsy." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. The basal cisterns appear\npatent and there is preservation of gray-white matter differentiation.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable. Note is made of\nan enlarged largely empty sella.", + "output": "1. No evidence of acute intracranial process.\n\n2. Enlarged largely empty sella. This is not necessarily of significance,\nbut could represent a sign of idiopathic intracranial hypertension in the\nappropriate clinical circumstances. Clinical correlation recommended." + }, + { + "input": "CT Head: There is no evidence of hemorrhage, midline shift, mass, mass effect,\nor acute infarction. The ventricles, sulci and basal cisterns are normal in\ncaliber and configuration. No fractures are identified.\n\nCTA Head: There are two focal outpouchings within the most distal petrous\nsegment (3 -229-230, and ___ of the left internal carotid artery. These are\nmost consistent with aneurysms. The most superior of these 2 outpouchings\nmeasures approximately 9 x 8 mm (___), and the most inferior of these 2\noutpouchings measures approximately 7 x 6 mm (___).\n\nOtherwise, there is adequate opacification of the internal carotid, anterior\ncerebral, middle cerebral, vertebral, basilar and posterior cerebral arteries.\nThe anterior communicating artery is well visualized. The left vertebral\nartery is dominant. There are bilateral prominent posterior communicating\narteries, giving rise to bilateral fetal PCA. There is no evidence of other\nevidence of aneurysm formation, stenosis, dissection or vascular malformation.\n\nCTA Neck: There is a left-sided aortic arch with conventional origin of the\nmajor branch vessels. There is adequate opacification of the bilateral common\ncarotid, internal carotid and vertebral arteries, without high-grade\nnarrowing. There is no significant atherosclerotic disease identified. The\nleft vertebral artery is dominant. There is no evidence of significant\nstenosis at the origins or throughout the or courses of these vessels.\n\nRight internal carotid artery (minimal dimension in mm):\n\nProximal: 8.0\n\nDistal: 5.0\n\nLeft internal carotid artery (minimal dimension in mm):\n\nProximal: 8.0\n\nDistal: 5.0\n\nAdditional findings: There are retention cysts in the bilateral maxillary\nsinuses. Otherwise, paranasal sinuses and mastoid air cells are clear. A focal\ncalcification in the right tonsillar region is most likely a tonsilolith.\nOtherwise, the nasopharynx, oropharynx, hypopharynx and larynx are\nunremarkable. The thyroid gland demonstrates a hypoenhancing nodule within the\nleft thyroid lobe measuring approximately 6 x 5 mm. There is no evidence of\nenlarged lymph nodes by CT criteria. The visualized lung apices are clear. The\nosseous structures are unremarkable.", + "output": "1. No evidence of acute intracranial process.\n2. Two focal outpouchings from the most distal petrous segment of the left\ninternal carotid artery, which are most consistent with aneurysms.\n3. CTA head shows no other evidence of aneurysm. No evidence of stenosis.\n4. CTA Neck shows no evidence of stenosis, dissection or pseudoaneurysm. There\nis no stenosis of internal carotid arteries by NASCET criteria.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with ___\n___ (ED QA Nurse) on ___ at 1:18 ___, 15 minutes after discovery of the\nfindings." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The mastoid air cells, and middle ear cavities\nare clear. The orbits are unremarkable. There is minimal mucosal thickening in\nthe left anterior ethmoid air cells and the frontal sinus.", + "output": "1. No fracture or acute hemorrhage.\n2. Minimal paranasal sinus disease as described.\n\nNOTIFICATION: No acute fracture or hemorrhage." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,or\nmass effect. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality. Please note that MRI is more sensitive for\ndetection of acute infarction." + }, + { + "input": "There is no evidence of no evidence of infarction, hemorrhage, edema, or\nmass. The ventricles and sulci are normal in size and configuration. There is\npreservation of gray-white matter differentiation. The basal cisterns remain\npatent. There is no evidence of fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "There is no evidence of infarction,intracranial hemorrhage,edema,or mass. \nThere is mild prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "There is no evidence of acute intracranial process or hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. There is a small occipital scalp\nhematoma and subcutaneous air.", + "output": "1. No acute intracranial process.\n2. Small occipital scalp hematoma and subcutaneous air." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass effect. The ventricles and sulci are normal in size and\nconfiguration.\n\nThere is a large subgaleal hematoma overlying the right parietal bone near the\nvertex. There is no evidence of fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No intracranial hemorrhage. No acute intracranial abnormality on\nnoncontrast head CT.\n2. Large subgaleal hematoma overlying the right parietal bone. No evidence of\nunderlying fracture." + }, + { + "input": "The known left frontal subarachnoid hemorrhage appears less hyperdensite when\ncompared to ___, compatible with evolution of blood products. There\nis persistent mild edema of the adjacent parenchyma, similar to prior. There\nis no evidence of new intra-axial hemorrhage or ischemic infarct. There is no\nevidence of mass. There is prominence of the ventricles and sulci suggestive\nof involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Persistent left frontal subarachnoid hemorrhage with expected evolution of\nblood products without evidence of new hemorrhage or infarct." + }, + { + "input": "Faint hyperdensity within the left frontal sulcus compatible with known\nsubarachnoid hemorrhage is again seen (02:27). However when compared to ___ head CT it appears less dense and less conspicuous today, consistent\nwith evolution of blood products. There are no new areas of acute intra-axial\nhemorrhage. There is no evidence of acute large territorial infarction,edema,\nor mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nethmoid air cells bilaterally. The remainder of the visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Interval decrease in density of the known left frontal subarachnoid\nhemorrhage since ___ head CT is consistent with expected evolution of\nblood products. No new areas of acute intra-axial hemorrhage or infarct." + }, + { + "input": "There is no evidence of infarction,intracranial hemorrhage,edema,or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. There is mild asymmetry of the\nparotid glands, partially evaluated in this exam, please correlate.", + "output": "1. There is no evidence of acute intracranial process or hemorrhage, no\nevidence of intracranial mass.\n\n2. Mild asymmetry of the parotid glands, partially evaluated in this exam,\nplease correlate and if clinically warranted, correlation with parotid\nultrasound or CT of the neck are recommended.\n\nRECOMMENDATION(S): Mild asymmetry of the parotid glands, partially evaluated\nin this exam, please correlate and if clinically warranted, correlation with\nparotid ultrasound or CT of the neck are recommended." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nTrace soft tissue swelling along the right posterior occiput (02:10). No\nunderlying fracture. The paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass. Patient is post left frontal craniotomy for meningioma resection, as\ndescribed on the previous study. Left frontal encephalomalacia is unchanged,\nas is the dural-based hyperdensity overlying this region (2:20). Ventricles\nand sulci are prominent, consistent with age related volume loss. \nPeriventricular white matter hypodensities are likely sequela of chronic small\nvessel ischemic disease. Basal cisterns are patent.\n\nOther than the post left frontal craniotomy changes, no osseous abnormalities\nseen. The paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The orbits are unremarkable.", + "output": "1. No acute intracranial hemorrhage or fracture.\n\n2. Unchanged left frontal encephalomalacia, craniotomy defect, and\ndural-based hyperdensity post meningioma resection." + }, + { + "input": "Dental almalgam streak artifact limits study. Compared to the prior study\nperformed 7 hours earlier there is no significant change. Mixed density\nbilateral subdural hematomas are again seen with hyperdense blood along the\ninferior posterior subdural space compatible with an acute component and more\nisodense collection along the vertex compatible with a subacute component. \nThe left subdural collection again measures approximately 3 mm in maximum\ndiameter, and the right measures approximately 2 mm in maximum diameter. \nThere is no significant mass effect or shift of normally midline structures.\n\nStable postsurgical changes related to left frontal mass resection, with\nassociated left frontal encephalomalacia is unchanged. There is prominence of\nthe ventricles and sulci suggestive of involutional changes, grossly\nunchanged. Periventricular white matter hypodensities are nonspecific, but\nlikely reflect sequelae of chronic small vessel ischemic disease.\nAtherosclerotic vascular calcifications are noted of bilateral cavernous\nportions of internal carotid arteries.\n\nThere is no evidence of fracture. Note is made of a prominent torus palatini.\nThe visualized portion of the mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable. Soft tissue\ndensities are noted within bilateral external auditory canals which may\nrepresent cerumen. Minimal bilateral maxillary sinus mucosal thickening is\npresent. The patient is partially edentulous. A left dental periapical\nlucency is noted (see 602b:63, 601b:30 A-comm 03:10).", + "output": "1. Dental almalgam streak artifact limits study.\n2. Stable bilateral acute on chronic subdural hemorrhages.\n3. Postsurgical changes related to prior left frontal mass resection, with\nstable left frontal encephalomalacia.\n4. Paranasal sinus disease as described.\n5. Periodontal disease as described." + }, + { + "input": "There is a extra-axial hematoma along the left lateral convexity measuring\napproximately 10 mm in width. There is a more nodular component measuring 19\nmm in width from the inner table, and a epidural hematoma cannot be excluded\n(series 2:image 23). There is associated sulcal effacement, and mild mass\neffect causes 4 mm of rightward shift of midline structures. A small amount\nof subarachnoid hemorrhage is also noted along the left temporal lobe (series\n2:image 15).\n\nHypodensity in the left frontal and parietal lobes as well as within the\ninsula and along the left cortical spinal tract is seen. Findings suggest\nprior infarct. In addition, the left cerebral peduncle and upper pons are\nslightly smaller when compared to the right. There is a large right frontal\nsubgaleal hematoma.\n\nThere is a nondisplaced fracture of the right zygomatic arch (series 3:image\n17). A nondisplaced fracture through the anterior wall of the right\nmaxillary sinus/inferior orbital rim is also seen (series 2:image 8). There\nare nondisplaced fractures of the right lateral orbital rim (series 3:image\n22). There is also a nondisplaced right nasal bone fracture (series 3:image\n19). Associated blood is seen within the paranasal sinuses. There is a\nnondisplaced fracture at the base of the frontal bone along the coronal\nsuture, which extends to the right greater sphenoid wing (series 3:image 36,\n30, 26).\nMild proptosis of the right globe is seen, and the globes are intact. Mild\namount of right extraconal gas and hematoma is seen. No intraconal\nretrobulbar hematoma is seen.", + "output": "1. Left subdural hematoma causing 4 mm rightward shift of midline structures.\nA more nodular component is seen, and an epidural hematoma cannot be excluded.\n2. Small amount of left temporal subarachnoid hemorrhage.\n3. Multiple facial, calvarial, and nasal bone fractures. Associated blood in\nthe paranasal sinuses.\n4. Large right frontal subgaleal hematoma.\n5. Hypodensity along the left frontal and parietal lobes suggestive of prior\ninfarct with possible wallerian degeneration." + }, + { + "input": "An extra-axial hematoma along the left lateral convexity measures\napproximately 17 mm in with from the inner table, at its widest portion, not\nsignificantly changed compared to the prior exam. There however appears to be\nan interval increase in extra-axial hematoma, extending to the vertex, now\nmeasuring up to 1.5 cm, previously measuring no more than 0.9 cm. There is no\nsignificant change in the mild mass effect, resulting in 4 mm of rightward\nshift of the midline structures. A small amount of subarachnoid hemorrhage in\nthe left temporal lobe is overall unchanged compared to the prior exam.\n\nA hypodensity within the left frontal, and parietal lobes as well as within\nthe insula and left cortical spinal tract is re- demonstrated, this is of\nuncertain significance and correlation with an MR study may be helpful. It is\npossible noted reflects prior injury, however there is no definite atrophy\nassociated with this, although this is difficult to assess in the presence of\nsuperimposed mass effect from the hemorrhage a right frontal subgaleal\nhematoma is unchanged compared to the prior exam.\n\nRe demonstrated are multiple fractures, including a fracture through the\nanterior wall of the right maxillary sinus, and right inferior orbital rim. \nAdditional fractures include nondisplaced right nasal bone fracture, as well\nas a nondisplaced fracture of the base of the frontal bone. The globes are\nunremarkable.", + "output": "1. Slight interval increase in the left subdural hematoma, however no\nsignificant interval change in adjacent mass effect, with persistent 4 mm\nrightward shift of the midline structures.\n2. No interval change in the nodular component of the hematoma.\n3. Unchanged subarachnoid hemorrhage.\n4. Multiple facial, calvarial, and nasal bone fractures." + }, + { + "input": "Left-sided extra-axial hematoma is overall unchanged compared to the prior\nexam. The widest nodular component measures approximately 1.6 cm. There is\nstable 4 mm rightward shift of the midline structures. Small amount of\nsubarachnoid hemorrhage in the left temporal lobe is also unchanged compared\nto the prior exam. Left hemispheric white matter hypodensity that appears far\nmore extensive than the cortical defect is unchanged since the prior exam. \nAgain, the significance of this is uncertain and correlation with prior\nstudies or an MRI examination would be helpful.\n\nRe demonstrated are multiple fractures, including afracture through the\nanterior wall of the right maxillary sinus, and right lateral orbital rim. \nAdditional fractures include nondisplaced right nasal bone fracture as well as\na nondisplaced fracture of the base of frontal bone. Overall, there has been\nan interval increase in hemorrhage within the maxillary sinuses bilaterally,\nsphenoid sinuses and near complete opacification of the ethmoid air cells. \nThe mastoid air cells, and middle ear cavities are clear.", + "output": "1. No significant interval change in the size of the left subdural hematoma\nand associated 4 mm rightward shift of the midline structures.\n2. Stable left temporal subarachnoid hemorrhage.\n3. Interval increase in hemorrhagic opacification of the maxillary sinuses,\nsphenoid sinuses, and near complete opacification of the ethmoid air cells.\n4. Multiple fractures as previously described.\n5. Old tissue loss in the left temporal lobe. White matter hypodensity of\nuncertain significance may be better assessed with comparison to old imaging\nstudies or with MR." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere has been interval evolution of the subdural hematoma, overlying the left\ncerebral convexity. The subdural hematoma is unchanged in size, measuring 1.6\ncm in thickness. The left subdural hematoma is predominantly isodense. The\npreviously identified subarachnoid hemorrhage overlying the left temporal lobe\nis not as well visualized due to interval evolution of blood products. The\nleft subdural hematoma exerts stable local mass effect, more focal overlying\nthe left frontoparietal lobe, and effacement of the adjacent sulci. The 4 mm\nleft-to-right midline shift is unchanged. The hypoattenuation in the left\ncorona radiata and centrum semiovale is unchanged. No new hemorrhage is\nidentified.\n\nThere has been improved aeration of the frontal, maxillary, and sphenoid\nsinuses. The right mastoid air cells are partially opacified. A small right\nfrontal scalp hematoma has decreased in size.\n\nCTA HEAD:\nThe left petrous true internal carotid artery is occluded with multiple, short\nsegments of partial reconstitution of the cavernous left internal carotid\nartery. The reconstituted segments left cavernous internal carotid artery are\nirregular. The ophthalmic arteries are patent. Atherosclerotic\ncalcifications involve the cavernous segments of the internal carotid\narteries. The right internal carotid artery is patent. The anterior, middle\ncerebral, and posterior cerebral arteries are patent. No aneurysms are\nidentified.\n\nAtherosclerotic calcifications involve the intradural segments of the\nvertebral arteries. Focal atherosclerotic calcifications in the right distal\nintradural vertebral artery on image 236, series ___ cause severe stenosis\nor occlusion of the right intradural vertebral artery. The left intradural\nvertebral artery is patent. The dural venous sinuses are patent.\n\nCTA NECK:\nThe left internal carotid artery occludes just distal to its origin on image\n179, series 3. There is calcified and noncalcified plaque at the carotid\nbifurcations. No evidence of right internal carotid stenosis is identified.\n\nThere is a linear filling defect in the left vertebral artery on image 142,\nseries 3 at C5. The remainder of the left vertebral artery is patent. The\nV1, V2, and V3 segments of the right vertebral artery are patent.\n\nOTHER:\n\nThe nondisplaced fracture of the right nasal bone and frontal calvarium,\nextending into the zygoma and anterior wall of the maxillary sinus are\nunchanged. The nondisplaced fracture of the left transverse process of C7 and\nspinous process of C6 spinous process are unchanged. There are multiple acute\nto subacute appearing fractures of the right first through fourth ribs.\n\nThe enlarged aortopulmonary, pretracheal, and paratracheal lymph nodes are\nunchanged.\n\nBilateral pleural effusions are partially visualized. A nasoenteric tube and\nright PICC are partially visualized. The thyroid gland is unremarkable.", + "output": "1. Occlusion of the left internal carotid artery just distal to its\nbifurcation with short segments of irregular reconstitution in the cavernous\nand supra clinoid segments.\n2. Linear filling defect in the left vertebral artery at C5, which may be\nartifactual or may represent a focal dissection.\n3. Focal atherosclerotic calcifications in the right distal intradural\nvertebral artery, which may cause short-segment occlusion or severe stenosis.\n4. Interval evolution of the left cerebral convexity subdural hematoma with\nstable local mass effect and left-to-right midline shift. No new hemorrhage.\n5. Unchanged fractures of the right nasal bones, right frontal calvarium,\nright zygoma, left C7 transverse process, and C6 spinous process.\n6. Acute to subacute appearing fractures of the right first through fourth\nribs.\n\nNOTIFICATION: Additional findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 10:26 AM." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass. \nProminent ventricles and sulci suggest age related global atrophy.\nPeriventricular and subcortical white matter hypodensities are nonspecific,\nbut likely reflect sequelae of chronic small vessel ischemic disease. The\nbasal cisterns appear patent and there is preservation of gray-white matter\ndifferentiation. There is chronic right lentiform nucleus lacune.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "There is no evidence of acute major vascular territory infarction, acute\nhemorrhage, edema, or mass effect. Ventricles and sulci are enlarged due to\nage-related parenchymal volume loss, as before. Periventricular, deep, and\nsubcortical white matter hypodensities are nonspecific, but likely reflect\nsequelae of chronic small vessel ischemic disease. Foci of low density are\nalso again seen in bilateral lentiform nuclei, compatible with chronic\ninfarcts versus prominent perivascular spaces.\n\nThere is no evidence of fracture. There is evidence of bilateral cataract\nsurgery and possibly also scleral banding. Partially visualized left\nmaxillary sinus is almost completely opacified with layering hyperdense\nmaterial. Only a small portion of the left maxillary sinus was included on\nthe prior head CT, and it was well-aerated at that time. There is also mild\nto moderate mucosal thickening with aerosolized secretions in the hypoplastic\nright sphenoid sinus, new since the prior CT. Mild mucosal thickening in the\nethmoid air cells and frontoethmoidal recesses, without occlusion of the\nfrontoethmoidal recesses, is similar to the prior CT. Mastoid air cells and\nmiddle ear cavities are well aerated.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. Compared to ___, there is new layering hyperdense material, compatible\nwith inspissated secretions or fungal colonization, within the partially\nvisualized left maxillary sinus, resulting in near complete opacification. \nThere is also new mucosal thickening and aerosolized secretions in the right\nsphenoid sinus, suggesting active inflammation. Please correlate with\nsymptoms." + }, + { + "input": "Left : The external auditory canal is normal. The middle ear cavity is clear.\nThe ossicles and tegmen are intact. There is no evidence for enlarged\nvestibular aqueduct or superior semicircular canal dehiscence. The facial\nnerve follows a normal course through the middle ear. There is no evidence for\ninner ear dysplasia. The mastoids are clear.\n\nRight: The external auditory canal is normal. The middle ear cavity is clear.\nThe ossicles and tegmen are intact. There is no evidence for enlarged\nvestibular aqueduct or superior semicircular canal dehiscence. The facial\nnerve follows a normal course through the middle ear. There is no evidence for\ninner ear dysplasia. The mastoids are clear.\n\nOther: Included images of the brain demonstrate enlargement of the ventricles\nand sulci in an atrophic pattern as expected for age.\nThe lenses have been resected.\nOtherwise, the visualized brain and neck soft tissues are normal.", + "output": "1. Normal temporal bone CT. Note that noncontrast CT is quite limited for\ndetecting internal auditory canal soft tissue lesions." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Ventricles and sulci are prominent\ncompatible global volume loss. Periventricular and subcortical white matter\nhypodensities likely sequela of chronic small vessel disease. Focal\nhypodensities in the bilateral basal ganglia and thalami are suggestive of\nchronic lacunar infarcts. Small areas of encephalomalacia in the anterior\ninferior right frontal lobe and anterior right temporal lobe are noted,\nunchanged and likely posttraumatic. Additional area of encephalomalacia in\nthe anterior left frontal lobe.\n\nSoft tissue swelling with subcutaneous gas suggestive of hematoma with\nlaceration overlying the frontal bone on the left without underlying fracture.\nIncluded paranasal sinuses and mastoids are essentially clear. Skull and\nextracranial soft tissues are otherwise unremarkable.", + "output": "1. Left frontal scalp laceration with hematoma without underlying fracture.\n2. No acute intracranial process.\n3. Global volume loss, white matter changes suggestive of chronic small vessel\ndisease, and chronic lacunar infarcts. Presumably post traumatic\nencephalomalacia the anterior inferior right frontal lobe and anterior right\ntemporal lobe." + }, + { + "input": "There is no evidence of acute intracranial infarction,hemorrhage,edema,or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Confluent periventricular and subcortical white matter\nhypodensities are nonspecific, however likely due to chronic small vessel\nischemic disease in this age group and similar to prior exam. Lacunar infarct\nin the left thalamus is noted.\n\nThere is no evidence of acute fracture. There is diffuse mild mucosal\nthickening of the ethmoid air cells and sphenoid sinuses. Otherwise, the\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The nasopharynx and the oropharynx contain secretions;\npatient is intubated. Patient is status post bilateral lens replacements.", + "output": "1. No acute intracranial abnormalities." + }, + { + "input": "Study is limited by the absence of intravenous contrast.\n\nThere are partially visualized endotracheal tube and left nasogastric tube in\nplace. There is a small amount of layering fluid within the pharynx and\nlarynx and partial opacification of the right mastoid air cells, which is\nlikely secondary to intubation.\n\nEvaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThere are periapical lucencies surrounding the bilateral maxillary central\nincisors and right mandibular central incisor, which may represent periapical\nabscesses.\n\nThe salivary glands are without mass or adjacent fat stranding. The thyroid\ngland appears normal. There is no lymphadenopathy by CT criteria.\n\nThere is biapical pleuroparenchymal scarring. There are two 3 mm pulmonary\nnodules in the right upper lobe (series 4, image 196 and 233). There is mild\ndependent atelectasis in the lung apices. A small left pleural effusion is\nnoted.\n\nThere are moderate to severe multilevel degenerative changes of the cervical\nspine, which most pronounced at the C6-7 and C7-T1 levels. No suspicious\nosseous lesions are identified.", + "output": "1. No acute abnormality in the neck to explain patient's symptoms.\n2. Periapical lucencies surrounding the bilateral maxillary central incisors\nand right mandibular central incisor, which may represent periapical\nabscesses.\n3. Two 3 mm pulmonary nodules in the right upper lobe. Please see\nrecommendations below.\n\nRECOMMENDATION(S): For incidentally detected multiple solid pulmonary\nnodules smaller than 6 mm, no CT follow-up is recommended in a low-risk\npatient, and an optional CT follow-up in 12 months is recommended in a\nhigh-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" + }, + { + "input": "Image quality is compromised by poor bolus timing that results and extensive\nvenous opacification and relatively low density of the arteries.\nThere is a three vessel aortic arch with mild atherosclerotic calcifications. \nThe origin of branch vessels and are patent. Calcifications are present at\nthe origin of the vertebral arteries bilaterally without occlusion. There is\nmixed plaque in the carotid bulbs bilaterally extending into the proximal left\ninternal carotid artery without luminal narrowing. The carotid and vertebral\narteries and their major branches are patent with no evidence of stenoses. No\nevidence for dissection is seen.\n\nMild mucosal thickening in bilateral maxillary and sphenoid sinuses is noted. \nThe mastoid air cells and middle ear cavities are clear. There is fatty\natrophy of the parotid and submandibular glands. There is no cervical\nlymphadenopathy.\n\nDiffuse fat stranding in the region of the right clavicle and upper chest wall\nlikely relates to recent removal of a port in this region. There is no\ndrainable fluid collection in this region. Multiple mildly prominent right\nsupraclavicular and axillary lymph nodes are noted.\n\nThe imaged lungs are notable for mild atelectasis. There are no suspicious\nlytic or sclerotic osseous lesions.\n\nVisualized brain parenchyma is Unremarkable.", + "output": "1. Unremarkable neck CTA. No internal carotid artery stenosis by NASCET\ncriteria.\n\n2. Diffuse subcutaneous fat stranding at the base of the neck and upper chest\nwall on the right likely relates to recent removal of a port from this region.\nThere is no drainable fluid collection." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Normal study." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no intra or extra-axial mass effect, acute hemorrhage or large\nterritory infarct. The sulci, ventricles and cisterns are within expected\nlimits for the patient's age. There is partial empty sella.\n\nSuggestion of mild tortuosity or increased CSF space of the optic nerve sheath\ncomplex on nondedicated examination. The orbits are otherwise unremarkable.\n\nA very small mucous retention cyst in the right maxillary sinus alveolar\nrecess is noted. The remainder the paranasal sinuses are essentially clear. \nThe mastoid air cells middle ears are well pneumatized and clear. No\nsuspicious osseous lesion.\n\nCTA HEAD: Examination is suboptimal secondary to phase of contrast bolus. \nWithin this confine:\nThe right A1 segment is congenitally hypoplastic. Otherwise, the intracranial\nICA, ACAs, MCAs and their major branches are without evidence of high-grade\nstenosis, occlusion or aneurysm. The posterior circulation is also\nunremarkable.\n\nCTV HEAD:\nThe left transverse and sigmoid sinus is congenitally hypoplastic, with\ndiminutive in shallow sigmoid groove. Otherwise, the superior sagittal sinus,\ninternal cerebral veins, vein of ___, basilar veins ___ straight\nsinus, confluence of sinuses, transverse and sigmoid sinuses as well as\nvisualized internal jugular veins are patent.", + "output": "1. There is partial empty sella. Suggestion of possible mild tortuosity of\nthe optic nerve sheath complexes. The findings could represent underlying\nidiopathic intracranial hypertension. Clinical correlation is recommended for\nsource of patient headache.\n2. Otherwise, unremarkable noncontrast CT head. Specifically no evidence of\nintracranial mass effect, acute hemorrhage or infarct.\n3. Suboptimal CTA of the head secondary to phase of contrast bolus. Within\nthis confines: Unremarkable CTA of the head.\n4. Unremarkable CTV of the head: No evidence of dural venous sinus thrombosis.\n5. Additional findings as described above." + }, + { + "input": "There has been no significant interval change in overall size of a hypodense\nleft frontal subdural collection which measures up to 8 mm in thickness,\nsimilar from prior. Given hypodense contents, this collection likely\nrepresents a subacute chronic left subdural hematoma. There is no significant\nmass effect. Ventricles are normal in size and configuration. No evidence of\ninterval large territorial infarction. Periventricular and subcortical white\nmatter hypodensities are nonspecific but likely reflect the sequelae of\nchronic small vessel ischemic disease.\n\nNo evidence of fracture. Minimal opacification of the right inferior most\nmastoid air cells. Otherwise the mastoid air cells, middle ear cavities and\nparanasal sinuses are well aerated. The orbits are within normal limits.", + "output": "Small subacute to chronic appearing left frontal subdural hematoma without\nsignificant mass effect." + }, + { + "input": "Left hypodense frontal subdural fluid collection measures up to 8 mm in\ngreatest thickness, similar to prior, likely representing a chronic subdural\nhematoma. There is no evidence of infarction,new foci of hemorrhage,or edema.\nThere is no midline shift. Basal cisterns appear patent. There is prominence\nof the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. 8 mm hypodense left frontal subdural fluid collection is similar to prior,\nlikely chronic subdural hematoma. Evidence of new hemorrhage." + }, + { + "input": "Small left hemispheric low-density, chronic subdural hematoma overlies\nfrontal, parietal lobes. It measures 3 mm in thickness at the level of the\nroof of lateral ventricles today, compared with 5 mm on ___. No\nacute hemorrhage. Stable extra-axial prominence bilaterally overlying\ncerebellum, likely from atrophy\n\nThere is no evidence of infarction,new hemorrhage,edema,or mass. Cerebellar\natrophy. Clear mastoids, paranasal sinuses, bones, orbits.", + "output": "Small left hemispheric chronic subdural hematoma, mildly decreased.\nNo acute hemorrhage." + }, + { + "input": "Tiny left hemispheric chronic subdural hematoma, decreased since prior. No\nacute blood products. There is no evidence of infarction, hemorrhage, edema,\nor mass. Cerebellar atrophy, stable. Probable chronic subdural hygromas or\nhematomas underlying bilateral tentorium.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Tiny residual chronic subdural hematoma, decreased.\nNo acute hemorrhage." + }, + { + "input": "Limited examination due to patient motion. There is no evidence of\ninfarction, hemorrhage, edema, or mass. The ventricles are normal in size in\nappearance.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial process. Specifically no intracranial hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\nThere is no evidence of fracture. There is a small right maxillary sinus\nmucous retention cyst. Otherwise, the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial hemorrhage or territorial infarct." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture. Air-fluid level is seen within the sphenoid\nsinus. Mild to moderate circumferential mucosal thickening is seen within the\nright maxillary sinus, frontoethmoidal recess and right-sided ethmoid air\ncells. The visualized portion of the remain paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. No acute intracranial hemorrhage or mass effect.\n2. Right-sided paranasal sinus disease with air-fluid level in the sphenoid\nsinus suggestive of acute sinusitis. Clinical correlation is needed." + }, + { + "input": "There is no evidence of acute large territorial infarction, intracranial\nhemorrhage, edema, or discrete mass. Ventricles are stable in overall size\nand configuration. Involutional changes are slightly age advanced. No acute\nosseous abnormalities seen. The partially imaged paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The orbits demonstrate no acute\nabnormalities.", + "output": "1. No acute intracranial process.\n2. Interval resolution of previously paranasal sinus disease.\n\nRECOMMENDATION(S): If there is further concern for intracranial metastatic\ndisease, MRI is advised." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema,or large mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Study is degraded by motion and streak artifact related to overlying hardware.\n\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of intraparenchymal hemorrhage. Question focal hypodense\nregion with loss of gray-white matter differentiation visualized in the right\nfrontal lobe versus artifact (02:20) without evidence of midline shift or mass\neffect on the adjacent parenchyma.\n\nThe deep, periventricular white matter hypodensities are nonspecific and\nlikely represent sequela of chronic microvascular ischemic disease. These\nfindings correlate with the periventricular white matter FLAIR\nhyperintensities seen on the ___ had MR. ___ is prominence of the\nventricles and sulci suggestive of involutional changes..\nPostsurgical changes related to prior bilateral cataract surgery is noted.\n\n\nCTA HEAD:\nNonocclusive atherosclerotic calcifications are visualized in bilateral\ncavernous internal and supraclinoid internal carotid arteries. Nonocclusive\natherosclerotic calcifications are noted in the right vertebral artery V4\nsegment. There is suggested fenestration of the anterior communicating\nartery, which is a normal variant. The vessels of the circle of ___ and\ntheir principal intracranial branches otherwise appear patent without definite\nstenosis, occlusion, or aneurysm formation. The dural venous sinuses are\npatent.\n\nCTA NECK:\n\nAtherosclerotic calcifications are visualized in the aortic arch. \nNonocclusive atherosclerotic calcification is noted at the origin of the right\nvertebral artery. The carotid and vertebral arteries and their major branches\notherwise appear normal with no evidence of stenosis or occlusion. There is no\nevidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs demonstrate right upper lobe bullae (see\n03:39). The visualized portion of the thyroid gland is within normal limits.\nThere is no lymphadenopathy by CT size criteria.", + "output": "1. Study is degraded by motion and streak artifact related to overlying\nhardware.\n2. No evidence of acute intracranial hemorrhage.\n3. Question right frontal acute to subacute infarct versus artifact. Please\nnote MRI of the brain is more sensitive for the detection of acute infarct.\n4. Mild atherosclerotic calcifications noted in the aortic arch, the bilateral\ncavernous and supraclinoid internal carotid arteries, and in the V4 segment of\nthe left vertebral artery without evidence of significant occlusion, stenosis,\ndissection, or aneurysm.\n5. Partially visualized lungs demonstrate right upper lobe bullae." + }, + { + "input": "Study is moderately degraded by motion. There is an approximately 3 cm x 3 cm\nhypodense focus within the right frontal lobe (3a: 20) that correlates with\nthe T2/FLAIR hyperintensity noted in the ___ MR. ___ focus\nappears stable in size in comparison to prior imaging.\n\nThe smaller left parietal-occipital T2 FLAIR hyperintense focus noted in the\n___ MR is not appreciated in this study and likely due to the\nlimitations of CT imaging modality.\n\nThere are no new foci of infarcts noted. There are no acute hemorrhages nor\nmasses seen. There is stable diffuse cortical atrophy with prominence of the\nsulci and ventricles. There is stable intraparenchymal sequela of chronic\nmicrovascular ischemic disease.\n\nThere is no evidence of fracture.\n\nThere is mild mucosal thickening of the ethmoid air cells. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare otherwise clear. Postsurgical changes related to bilateral lens\nreplacements are noted. The visualized portion of the orbits are otherwise\nunremarkable.", + "output": "1. Study is moderately degraded by motion.\n2. Stable appearance of the 3 cm right frontal lobe hypodense region\nconsistent with infarct when compared to the ___ MRI, without\ndefinite evidence of hemorrhagic transformation.\n3. The smaller left parietal-occipital infarct not clearly visualized on\ncurrent examination, which may be secondary to differences in technique." + }, + { + "input": "There is an evolving right frontal infarction. There is no evidence of\nhemorrhagic transformation. The known left parieto-occipital infarction is\nnot well demonstrated on today's examination. No evidence of new acute\nterritorial infarction. The predominantly periventricular white matter\nhypodensities likely represent sequela of chronic microvascular ischemic\ndisease. No mass or mass-effect. There is mild prominence of the ventricles\nand sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Patient is\nstatus post bilateral lens resections.\n\nAtherosclerotic calcifications are noted of the cavernous carotid arteries\nleft vertebral artery.", + "output": "Evolving right frontal infarction without evidence of hemorrhagic\ntransformation. Known left parieto-occipital infarction is not well seen on\ntoday's examination." + }, + { + "input": "There has been evolution of hypodensity involving the right frontal lobe,\nconsistent with prior infarction (series 2, image 22). Subtle hypodensity in\nthe left parietal lobe consistent with known prior infarct in this location\n(series 2, image 19). No new acute large territorial infarction is seen. \nThere is no intracranial hemorrhage, edema, or mass effect. The ventricles\nand sulci are enlarged suggesting cerebral atrophy. Periventricular and\nsubcortical white matter hypodensities are nonspecific but likely sequela of\nchronic small vessel disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. There have\nbeen bilateral lens replacements. Note is made of calcifications of the\nbilateral cavernous carotid arteries.", + "output": "No evidence of intracranial hemorrhage. Evolution of right frontal and left\nparietal infarcts when compared to ___." + }, + { + "input": "No evidence of infarction, hemorrhage, edema, or mass. The ventricles and\nsulci are normal in size and configuration.\n\nNo evidence of fracture. Mucosal thickening of the partially imaged left\nmaxillary sinus is moderate. The visualized portion of the remaining\npartially imaged paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable other than\nbilateral lens replacements.", + "output": "1. No hemorrhage or fracture\n\n2. Left paranasal sinus disease." + }, + { + "input": "CT head: The gray-white matter differentiation is intact without acute\nterritorial infarct, hemorrhage, mass, or mass effect. The ventricles and\ncortical sulci are normal caliber configuration. The extra-axial spaces are\nunremarkable. The orbits, calvarium, and soft tissues are unremarkable. The\nparanasal sinuses, mastoid air cells, and middle ears are clear.\n\nCTA head: The bilateral intracranial internal carotid arteries are patent. \nThe anterior and bilateral posterior communicating arteries are visualized. \nThere codominant vertebral arteries. The anterior posterior tear circulations\nare patent without occlusion, dissection, significant stenosis, or aneurysm. \nThere is no evidence of vascular malformation. There is normal enhancement of\nthe major cortical and deep veins and the dural venous sinuses, without\nevidence of thrombosis.\n\nCTA neck all there is a 3 vessel aortic arch with patent subclavian arteries. \nThe carotid arteries are patent without significant stenosis by NASCET\ncriteria. The vertebral arteries are patent and demonstrate codominant is. \nThere is no evidence of vascular occlusion, dissection, significant stenosis,\nor aneurysm.\n\nThere is prominence of the adenoid, palatine, and lingual tonsils. There are\nprominent bilateral cervical lymph nodes. The largest on the right measure\n1.4 x 1.4 cm at level II (7:127). The largest on the left measures 2.4 x 0.6\ncm at level II (7:136). There are mildly prominent bilateral parotid lymph\nnodes, otherwise the salivary glands are unremarkable. The thyroid gland is\nunremarkable. The masticator and parapharyngeal spaces are unremarkable. The\nlarynx, nasal cavity, and oral cavities are unremarkable. The dentition is\nintact. There is no fracture or osseous lesion. Limited imaging lungs\ndemonstrate an approximately 2 mm right apical pulmonary nodule (see 5:59,\n602b:61).", + "output": "1. No acute intracranial abnormality.\n2. Patent intracranial neck vasculature without occlusion, dissection,\nsignificant stenosis, or aneurysm.\n3. Prominent adenoid, palatine, and lingual tonsils and prominent cervical\nlymph nodes, which may be reactive. Correlate with signs and symptoms of a\nsystemic infectious or inflammatory process.\n4. 2 mm right upper lobe pulmonary nodule. ___ recommendations\nsuggest no further follow-up in low risk patients, 12 month follow-up in\nhigh-risk patients.\n5. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or infarction.\n\nThe ventricles and sulci are normal in size and configuration.\n\nThe basal cisterns appear patent and there is preservation of gray-white\nmatter differentiation.\n\nThe visualized bony structures are grossly unremarkable.\n\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\n\nThe globes are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no acute intracranial hemorrhage, edema, mass effect or shift of\nnormally midline structures. Right frontal approach ventriculoperitoneal\nshunt catheter is in stable position and the tip terminates in the anterior\nhorn of the right lateral ventricle. The ventricles are stable in size and\nconfiguration compared to ___. Moderate dilatation persists, with the\ntemple horns of the lateral ventricles measuring 8-9 mm. The basal cisterns\nappear patent and gray-white matter differentiation is preserved. Note is\nmade of a right globe prosthesis. Dependent fluid is noted in the left\nsphenoid sinus. The remaining imaged paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The bony calvaria appear intact.", + "output": "1. Right frontal approach VP shunt catheter is in stable position compared to\npriors.\n2. Moderate ventriculomegaly, also unchanged from priors." + }, + { + "input": "Motion artifact mildly limits study.\n\nThere is no evidence of acute large territorial infarction,hemorrhage,edema,or\nmass effect. There is prominence of the ventricles and sulci suggestive of\nage-related atrophy. Trace periventricular white-matter hypodensities are\nnonspecific, but likely represent sequela of chronic small vessel disease. \nDense atherosclerotic calcifications noted within the intracranial ICAs.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable. Soft tissue edema is noted\nin the left periorbital region.", + "output": "1. No acute intracranial abnormality.\n2. Left periorbital soft tissue swelling without underlying fracture." + }, + { + "input": "HEAD CT: There is no evidence of hemorrhage, mass effect, or infarction. The\nventricles and sulci are prominent indicative of mild parenchymal volume loss.\n\nThe orbits, paranasal sinuses, mastoid air cells and visualized soft tissues\nare unremarkable.\n\nHEAD AND NECK CTA: There is minimal calcified plaque of the intracranial\ninternal carotid arteries without evidence of significant stenosis. There is\nan anterior communicating artery fenestration and a hypoplastic left A1\nsegment. The anterior and middle cerebral arteries are otherwise unremarkable.\nThere is a fetal type left PCA with hypoplastic and P1 segment. There is a\nvery small right posterior communicating artery with a triangular out pouching\nat its origin likely representing an infundibulum.\n\nThere is a left-sided aortic arch. The common carotid, internal carotid and\nexternal carotid arteries are widely patent without evidence of significant\nstenosis (based on NASCET criteria) or dissection. The distal right ICA is\ntortuous with a loop at the C2 level. The distal left ICA is also tortuous\nand partially takes a retropharyngeal course.\n\nThe thyroid gland is heterogeneous in density, but without a discrete nodule.\n\nAt C4-C5 and C6-C7, there are uncovertebral and facet osteophytes resulting in\nmoderate to severe bilateral neural foraminal narrowing. There is mild\ncervical spondylosis at the other levels.", + "output": "Unremarkable non contrast head CT without evidence of infarct, mass effect or\nhemorrhage.\n\nUnremarkable head and neck CTA without evidence of significant stenosis,\ndissection or aneurysm.\n\nHeterogeneous thyroid gland without evidence of discrete nodule. An ultrasound\nmay be helpful for further evaluation as clinically warranted." + }, + { + "input": "Hypodensity and loss of gray-white matter differentiation in the distribution\nof the right MCA consistent with acute territorial infarction. There is no\nevidence of new hemorrhage or infarction. There is significant compression of\nthe right lateral and a 2 mm leftward shift of normally midline structures. \nThe basal cisterns appear patent there is preservation of gray-white matter\ndifferentiation on the left. No fracture is identified. Of note, these images\nare limited by motion artifac.", + "output": "Hypodensity and loss of gray-white matter differentiation in the distribution\nof the right MCA consistent with acute infarction. Significant compression of\nthe right lateral ventricle with a 2 mm leftward shift of normally midline\nstructures. No evidence of new hemorrhage or infarction from the prior\nexamination.\n\nNOTIFICATION: These findings were communicated to Dr. ___ telephone by\nDr. ___ at 11:38 on ___ at the time of discovery." + }, + { + "input": "Again seen is hypodensity and loss of gray-white matter differentiation in the\ndistribution of the right MCA consistent with evolving infarction. There is no\nevidence of new hemorrhage or infarction. Adjacent vasogenic edema and\ncompression of the right lateral ventricle is unchanged. The basal cisterns\nare patent and there is preservation gray-white matter differentiation on the\nleft. No evidence of acute fracture. Chronic infarct in the distribution of\nthe left PCA is unchanged in appearance.", + "output": "Evolution of right MCA infarct with no evidence of new hemorrhage or\ninfarction." + }, + { + "input": "In the left lateral neck extending from the postoperative site of prior\ndiverticulum resection into the overlying subcutaneous soft tissues, there is\na rim enhancing collection of fluid/debris and air measuring 7.0 x 4.4 x 5.1\ncm (series 6, image 137 and series 601, image 25). There is apparent\nextension inferiorly along the upper esophagus to the level of the T1-T2\nvertebral body level. There is deviation of the trachea to the right as a\nresult of mass effect. There is no evidence of fistulous tract to the skin.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid appears normal. There is no lymphadenopathy by CT\ncriteria though one hyperenhancing node inferior to the postoperative site in\nthe upper mediastinum is likely reactive..The neck vessels are patent. There\nis a small amount of fluid in the left maxillary sinus.\n\nThe imaged portion of the lung apices are notable for subpleural reticular\nmarkings and centrilobular emphysema. There are no osseous lesions.", + "output": "Large collection with air and fluid/debris measuring 7.0 x 4.4 x 5.1 cm\ncentered at the postoperative bed of prior diverticulum resection extending to\nthe overlying subcutaneous tissues. There is rightward tracheal deviation as\nresult of mass effect. Cervical vessels are patent." + }, + { + "input": "There is interval resolution of previously identified left superior\nmediastinal collection between thyroid bed and carotid space to\nsupraclavicular region with residual hypodense soft tissue thickening with\nmaximum thickness of about 12 mm. No underlying residual organized\ncollection. Almost complete resolution of previously identified superior\nmediastinal fat stranding and inflammatory changes.\n\nThere is air-filled oval-shaped lower neck density lateral to inferior\nanterior at the level of cervical esophagus measuring about 10 x 9 mm; which\nmay be related to focal dilatation of cervical esophagus versus residual\ndiverticulum.\n\nAero digestive tract:\nThere is no mass.\n\nNeck lymph nodes:\nThere is no adenopathy involving bilateral levels ___.\nThere is no retropharyngeal adenopathy.\nSuperior mediastinal pretracheal lymph nodes measuring up to 16 mm, stable\nsince CT chest dated ___.\n\nExtra nodal tumor spread:\nThere are no findings suggestive of extra nodal extension.\n\nDeep neck muscles, masticator space:\nThere is no muscle invasion.\n\nBones, skull base:\nThere is no bone involvement.\nThere are no findings suggestive of perineural tumor extension.\nJugular foramen, carotid canal,pterygopalatine fossa,infraorbital\nforamen,other skull base foramina are not involved.\n\nVessels:\nThere is no vascular invasion.\n\nBrachial Plexus:\nThere is no brachial plexus contact or invasion.\n\nThyroid, salivary glands:\nThere is no mass.\n\nOther findings:\nThe visualized aspect of the lungs demonstrate grossly unchanged bilateral\nfibrotic changes, involving bilateral anterior aspect of left upper lobes;\nbetter characterized on the CT chest dated ___. Trace mucosal\nthickening involving left maxillary sinus with air-fluid levels. Partially\nvisualized nasogastric feeding tube.", + "output": "1. Interval resolution of previously identified left superior mediastinal and\nleft supraclavicular collection with residual soft tissue thickening with\nmaximum thickness at left superior paratracheal region of 12 mm.\n2. No residual or new organized collections.\n3. Oval-shaped air-filled in the lateral aspect of cervical esophagus\n(301:138); may be related to intraluminal air, post treatment changes or\nresidual diverticulum.\n4. No neck lymphadenopathy or aero digestive tract masses.\n5. The visualized aspect of the lungs demonstrate grossly unchanged bilateral\nfibrotic changes, involving bilateral anterior aspect of left upper lobes." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, or acute major\nvascular territorial infarction. Unchanged mild global parenchymal volume\nloss with prominent ventricles and sulci. Unchanged mild periventricular\nwhite matter hypodensities, nonspecific but likely sequela of mild chronic\nsmall vessel ischemic disease in this age group.\n\nAllowing for absence of dedicated bone algorithm images, no displaced\ncalvarial fracture is identified. Opacification of a right anterior ethmoid\nair cell is again seen. Mastoid air cells are grossly unremarkable.", + "output": "No evidence of acute intracranial hemorrhage or other acute intracranial\nabnormalities." + }, + { + "input": "Abnormal brainstem. There is low-density change in the pons, with somewhat\ntriangular appearance, which is PCOM of low-attenuation compared with ___, and is new compared with ___. Different considerations\nare central pontine myelinolysis, less likely ischemia as sequela of basilar\nartery thrombosis which is unlikely given normal density of the basilar\nartery, demyelinating, inflammatory process..\n\nGeneralized brain parenchymal atrophy. No hemorrhage, hydrocephalus or\nmidline shift. Chronic nasal bone fracture. Clear mastoids, paranasal\nsinuses.", + "output": "Abnormal central pons, appearance strongly favors central pontine\nmyelinolysis, differential considerations as above. If there is concern for\nischemia, MRA brain, MRI brain recommended." + }, + { + "input": "There is no evidence of hemorrhage, infarction, edema,or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of acute fracture. Remote appearing fractures of the\nfrontal process of the left maxilla and left nasal bone as well as the right\nlamina papyracea are demonstrated. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Patient is intubated.", + "output": "No evidence of acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute large vascular territorial infarction, acute\nhemorrhage, edema,or mass effect. Hypoattenuation with volume loss in the\ncentral pons is unchanged since ___ and better defined compared to\nearlier CTs, suggesting encephalomalacia from prior insult. Subtle focal\nhypoattenuation along the inferior aspect of the right putamen on image 2:13,\nas well as additional periventricular and deep white matter hypodensities, are\nunchanged nonspecific, likely sequela of chronic small vessel ischemic disease\nin this age group. Mild global parenchymal volume loss is again seen with\nmildly prominent ventricles and sulci.\n\nA chronic left nasal bone fracture is again seen. A nasoenteric catheter is\npartially imaged. There is a are air-fluid levels in the right maxillary\nsinus and left sphenoid sinus, and increased partial opacification of anterior\nethmoid air cells, which may be secondary to prolonged supine positioning in\nthe inpatient setting. Mastoid air cells are not well assessed in the absence\nof dedicated bone algorithm images.", + "output": "1. No evidence of an acute intracranial abnormality. MRI would be more\nsensitive for global hypoxic ischemic injury or focal acute infarction, if\nclinically warranted.\n2. Central pontine encephalomalacia, similar to ___ and\nprogressed compared to ___, which be secondary to prior central\npontine myelinolysis. Please correlate with clinical history." + }, + { + "input": "There is a large 2.6 x 3.3 cm hyperdense, lobulated mass along the posterior\nparietal falx new compared to the prior head CT dated ___ (2:21). \nThere is asymmetric vasogenic edema surrounding the lesion greater on the left\n(5.5 x 2.9 by 5.0 cm) than the right. An additional 1.1 x 0.8 x 0.9 cm\nrounded lesion in the right frontal lobe likely represents a site of\nmetastasis and has surrounding vasogenic edema measuring approximately 2.0 x\n3.8 cm (2:19). There is no midline shift or herniation. Mild this face mint\nof the left lateral ventricle posterior horn. There is no evidence of\nfracture, acute large vascular territory infarction,hemorrhage. The\nventricles and sulci are normal in size and configuration aside from mild\neffacement of the left posterolateral horn.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. 2.6 x 3.3 cm hyperdense, lobulated mass along the posterior parietal falx,\nwith extension into both the right and left hemispheres concerning for\nmetastasis. There is surrounding vasogenic edema, more extensive on the left\nthan the right.\n2. An additional 1.1 x 0.8 x 0.9 cm rounded lesion in the right frontal lobe\nwith surrounding vasogenic edema likely represents a second site of\nmetastasis.\n3. No evidence of herniation or midline shift.\n\nRECOMMENDATION(S): MRI of the brain recommended to further evaluate likely\nmetastatic disease.\n\nNOTIFICATION: The findings were discussed by ___, M.D. with\n___ m.D. on the telephoneon ___ at 7:14 pm, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "Again seen is a 2.8 x 3.5 x 4.0 cm hyperdense lobulated mass along the\nposterior parietal falx with a region of surrounding asymmetric vasogenic\nedema, left measuring 3.5 x 5.5 x 5.0 cm greater than the right, unchanged\ncompared to prior CT imaging (series 2, image 22). The lesion abuts the\nexpected location of the superior sagittal sinus. Redemonstration of a stable\n1.2 x 1.4 x 1.3 cm hypodense rounded lesion in the right frontal lobe with\nsurrounding vasogenic edema measuring 2.0 x 3.8 cm (series 2, image 20). \nThere is no midline shift.\n\nThere are new areas of hyperdensity along the left posterolateral convexity\nand the right frontotemporal region with sharp linear demarcations, which are\nlikely artifacts. There is no evidence of new acute large vascular territory\ninfarct, hemorrhage, edema, mass effect, or fracture. The ventricles and\nsulci are otherwise within expected limits in size and configuration.\n\nThere is mucosal thickening of the ethmoid air cells. The visualized portion\nof the paranasal sinuses, mastoid air cells, and middle ear cavities are\notherwise clear. The visualized portion of the orbits are preserved.", + "output": "1. Stable 2.8 x 3.5 x 4.0 cm hyperdense lobulated mass along the posterior\nparietal falx and 1.2 x 1.4 x 1.3 cm hypodense rounded lesion in the right\nfrontal lobe, both with surrounding edema. These lesions were better\ncharacterized on recent brain MRI dated ___.\n2. New hypodensities at the left posterolateral complexity and right\nfrontotemporal region with sharp linear demarcations, which likely represent\nartifact rather than acute hemorrhage.\n3. No evidence of new acute large vascular territory infarct, hemorrhage,\nworsening edema, worsening mass effect, or fracture.\n4. Mild paranasal sinus disease, which is a common finding in the inpatient\nsetting." + }, + { + "input": "There is a 3.3 x 2.4 hyperdense mass along the posterior parietal falx with\nsurrounding asymmetric vasogenic edema, similar in appearance compared to\nprior, the left region measures 6.1 x 2.4 cm. There is a rounded hypodense\nmass with hyperdense rim in the right frontal lobe measuring 1.2 x 1.0 cm,\nsurrounding vasogenic edema measures 3.7 x 1.5 cm. There remains no midline\nshift. Ventricles and sulci are stable in appearance compared to prior. \nThere are no areas concerning for acute intracranial hemorrhage.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. Redemonstration of intracranial metastatic lesions with similar surrounding\nvasogenic edema, better characterized on most recent brain MRI. No evidence\nof increased mass effect or midline shift.\n2. There are no areas concerning for acute intracranial hemorrhage." + }, + { + "input": "There is no evidence of fracture, acute large territorial\ninfarction,hemorrhage,edema,or mass. There are bilateral basal ganglia\ncalcifications. There is mild prominence of the ventricles and sulci\nsuggestive of involutional changes. Minimal periventricular and subcortical\nwhite matter hypodensities are nonspecific, but likely reflect the sequela of\nchronic microvascular infarction.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal. \nThere is a stable high riding right jugular bulb. There is hyperostosis\nfrontalis interna.", + "output": "No acute intracranial pathology." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, mass, or mass effect. \nThe ventricles and sulci are normal in caliber and configuration.\n\n The visualized paranasal sinuses and mastoids appear clear. The globes and\norbits are unremarkable.\n\nCTA HEAD:\nSlightly bulbous appearance to the basilar tip. Otherwise, unremarkable\npatent vertebrobasilar system. Patent bilateral posterior cerebral arteries\nwith normal distal runoff.\n\nMinimal calcified plaque in the cavernous segments of the intracranial ICAs\nbilaterally causes mild luminal narrowing. Otherwise, the remaining portions\nof the bilateral intracranial internal carotid arteries and the bilateral\nanterior and middle cerebral arteries are patent with normal distal runoff.\n\nPatent major dural venous sinuses.", + "output": "1. Minimal calcified plaque within the cavernous intracranial ICAs causing\nmild luminal narrowing bilaterally. Otherwise, unremarkable CTA head.\n2. No acute intracranial abnormality." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "No evidence for acute intracranial findings." + }, + { + "input": "There is gray and white matter hypodensity involving the right frontal and\ntemporal lobes, compatible with known right MCA territory subacute infarction.\nThere is mild effacement of the adjacent sulci and the right lateral\nventricle. There is no significant midline shift. The basal cisterns are\npatent. There is no evidence of hemorrhage or mass. The ventricles and sulci\nare normal in size and configuration.\n\nThere is no evidence of fracture. Multiple probable scalp sebaceous cysts are\nagain seen. The visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. Redemonstration of right MCA territory subacute infarction without evidence\nof hemorrhagic transformation.\n2. Mild effacement of the adjacent right cerebral sulci and right lateral\nventricle without evidence of midline shift." + }, + { + "input": "Acute/early subacute right MCA distribution infarct involving insula, M 2, M 5\nzones. Acute infarct left MCA distribution, involving insula, M1, M2, M4, M\n5, M 6 zones, similar to, and better seen since yesterday. Left-sided\nfindings are new since ___. No hemorrhage, no hydrocephalus, no\nherniation.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Acute left MCA distribution infarct, better seen since yesterday.\nSubacute right MCA distribution infarct, similar.\nNo hemorrhage." + }, + { + "input": "Bilateral MCA subacute infarcts are again seen. Hyperdensity centrally within\nthe left MCA infarct distribution (03:25), concerning for hemorrhagic\ntransformation, is stable compared to prior. No definite new large territory\ninfarction. The ventricles and sulci are stable in configuration. No\nhydrocephalus or downward herniation..\n\nThere is no evidence of acute fracture. There is mild mucosal thickening\nthroughout the anterior ethmoid air cells. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "Stable distribution of bilateral MCA subacute infarct with stable evidence of\nhemorrhagic transformation centrally within the left MCA infarct distribution.\nNo definite new large territory infarction or intracranial hemorrhage.\n\nPer review of the neuro critical OMR, hemorrhagic transformation is already\nknown." + }, + { + "input": "Bilateral MCA subacute infarcts are again seen. foci of ___ are \nappears similar to prior (02:21). No evidence of new large territory\ninfarction. Surrounding edema involving both MCA territories are similar. \nRelative ___ in the right temporal lobe in series 2, image 16 is\nlikely artifactual given that only persists in 1 slice. The ventricles and\nsulci are normal in size and configuration.\n\nThere is no evidence of fracture. Mild mucosal thickening of the right\nmaxillary sinus is unchanged. Mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. Bilateral large MCA territory subacute infarct with hemorrhagic foci\ncentrally in the left MCA infarct distribution, in the setting of known\nhemorrhagic transformation.\n2. No new areas of infarction." + }, + { + "input": "Redemonstration of evolving bilateral MCA territory infarcts with surrounding\nedema. Small hyperdense foci within the left MCA territory infarct measuring\nup to 1.1 cm (03:26) are not significantly changed and compatible with known\nhemorrhagic transformation. There is no evidence of hemorrhagic\ntransformation in the right MCA territory infarct.\n\nThere is no midline shift or evidence of new acute large territorial\ninfarction. The ventricles and sulci are unchanged in size and configuration.\n\nThere is no evidence of fracture. Again seen is mild mucosal thickening of\nthe ethmoid air cells and right maxillary sinus. The visualized portion of\nthe mastoid air cells and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Material in the bilateral external\nauditory canals is unchanged and likely represents cerumen.", + "output": "1. Redemonstration of evolving bilateral MCA territory infarcts with\nsurrounding edema and similar appearance of hemorrhagic transformation in the\nleft MCA territory infarct.\n2. No evidence of hemorrhagic transformation in the right MCA territory\ninfarct.\n3. No evidence of new acute large territorial infarction." + }, + { + "input": "Bilateral MCA territory infarcts and associated edema appear similar to the\nprior study. Allowing for differences in technique and modality, small\nhyperdense foci within the left MCA territory infarct most consistent with\nhemorrhagic transformation, are unchanged compared to the MR ___. \nNo evidence of hemorrhagic transformation within the right MCA territory\ninfarct or new intracranial hemorrhage elsewhere. No evidence of new\ninfarction.\n\nThe size and configuration of the ventricles and sulci, including sulcal\neffacement about the regions of edema, are unchanged.\n\nThere is no evidence of fracture. There is mild mucosal thickening in the\nright anterior ethmoid air cells and right maxillary sinus. The visualized\nportion of the mastoid air cells and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable. Material within the\nbilateral external auditory canals is again seen and likely represents\ncerumen. A 6 mm ovoid subcutaneous hyperdensity along the right\nfrontoparietal scalp (02:17) is unchanged and may represent a sebaceous cyst.", + "output": "1. Redemonstration of evolving bilateral MCA territory infarcts with similar\nassociated edema and stable appearance of hemorrhagic transformation in the\nleft MCA territory infarct. No evidence of new hemorrhage or other\ninfarction.\n2. Mild paranasal sinus disease.\n3. Stable 6 mm subcutaneous hyperdensity along the right frontoparietal scalp\nis nonspecific but may represent a sebaceous cyst" + }, + { + "input": "Bilateral MCA distribution subacute infarcts. Areas of cortical mildly\nincreased attenuation at the right MCA infarct territory is more prominent\nsince ___, is consistent with cortical petechial microhemorrhage. \nNo parenchymal hematoma on the right.\nSmall areas of hemorrhage in the left MCA infarct territory have been\ndecreasing, no new hemorrhage.\nNo new infarct. There is significant beam hardening attenuation in the left\ncerebellum, which may a common fourth appearance, early subacute infarct could\nhave similar appearance if there are any new posterior fossa symptoms. No\nhydrocephalus, no midline shift, no herniation. Clear mastoids, paranasal\nsinuses.", + "output": "1. Bilateral MCA distribution subacute infarcts, similar in size.\n2. Increasing cortical linear microhemorrhage right MCA distribution. No\nparenchymal hematoma on the right.\n3. Decreasing left MCA distribution blood products.\n4. Beam hardening attenuation artifact left cerebellum versus subacute\ninfarct, new, correlate with posterior circulation symptoms." + }, + { + "input": "Continued evolution of known bilateral MCA distribution infarctions. \nPreviously described areas of increased cortical attenuation in the\ndistribution of the right MCA are compatible with cortical petechial\nmicrohemorrhage and have decreased compared to most recent prior exam (for\nexample 02:18). No evidence of new intracranial hemorrhage. No midline\nshift. Prominence of the ventricles and sulci are compatible with\ninvolutional change.\n\nA 6 mm soft tissue density within the subcutaneous soft tissues of the right\nparietal lobe may reflect a small sebaceous cyst (02:18), and is unchanged\ncompared to prior exam. There is no evidence of fracture. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Continued evolution of bilateral MCA distribution infarctions.\n2. Decreased degree of cortical linear microhemorrhage in the right MCA\ndistribution as compared to ___.\n3. No evidence of new intracranial hemorrhage." + }, + { + "input": "Study is degraded by motion.\n\nNONCONTRAST HEAD CT:\nWithin the limitations of the study, there is subtle loss of the gray-white\ninterface in the right MCA distribution concerning for acute infarction. No\nevidence of hemorrhage,edema,or mass. The ventricles and sulci are preserved\nin size and configuration. Approximately 9 mm left temporal scalp probable\nsebaceous cyst is noted (see 02:12). Nonspecific probable intravascular air\nis noted throughout the skullbase, which may be related to recent catheter\nangiography.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.\n\nRAPID CT PERFUSION:\nCT perfusion: Mismatched perfusion defect is demonstrated in the right MCA\nterritory.\nCBF<30% volume: 11 mL\nT-max > 6.0s volume: 55 mL\nMismatch volume: 44 mL\nMismatch ratio: 5.0", + "output": "1. Study is degraded by motion.\n2. Mismatched perfusion defect in the right MCA territory concerning for\nevolving acute ischemic stroke.\n3. Perfusion data as follows: CBF<30% volume: 11 mL, T-max > 6.0s volume: 55\nmL, Mismatch volume: 44 mL.\n4. Within limits of study, no definite evidence of acute intracranial\nhemorrhage. Please note MRI of the brain is more sensitive for the detection\nof acute infarct.\n\nNOTIFICATION: The findings were discussed with B ___, N.P. by ___\n___, M.D. on the telephone on ___ at 4:45 pm, 5 minutes\nafter discovery of the findings.\n\nAn ED urgent attention notice was placed by the ED Radiology resident with the\nfollowing Wet Read below." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nNo evidence of acute infarction, hemorrhage, edema, mass, or mass effect. \nHypodensity in the inferior right frontal lobe near the skullbase likely\nrepresents a focus of cystic encephalomalacia (2:70). There is an additional\nfocus of encephalomalacia in the left temporal lobe (02:12). The ventricles\nand sulci demonstrate stable prominence compatible with global involutional\nchanges.\n\nNo evidence of an acute fracture. There is near complete opacification of the\nright maxillary sinus, as well as mild ethmoid air cell mucosal thickening;\nthe left maxillary sinus is clear. The frontal and sphenoid sinuses are\nclear. The mastoid air cells and middle ear cavities are well pneumatized and\nclear bilaterally.\n\nCTA HEAD:\nThere are areas of very mild luminal narrowing of the distal (V4) vertebral\nartery due to calcified plaque. The basilar artery demonstrates\nmild-to-moderate stenosis at its midportion (3:225), but is otherwise patent. \nThe right P1 is diminutive but patent. There is a prominent right posterior\ncommunicating artery which is patent. The left P1 is normally sized and\npatent. There is occlusion or near occlusion of the distal left P1 near the\nP1-P2 junction of left PCA (3:246). The left posterior communicating artery\nis relatively small in caliber but is patent and supplies the more distal left\nPCA branches, which are patent.\n\nAnteriorly, calcified plaque causes mild luminal narrowing of the petrous,\ncavernous and supraclinoid segments of the bilateral ICAs. Otherwise, the\nanterior circle of ___ vasculature is patent without additional area of\nstenosis, occlusion, or aneurysm. The right transverse sinus is not well\nseen, possibly diminutive/hypoplastic. Otherwise, the remainder of the imaged\ndural venous sinuses are grossly patent. No arteriovenous malformation is\nidentified.\n\nCTA NECK:\nPatent bilateral vertebral and carotid arteries in the neck. The carotid\narteries are tortuous bilaterally, including the ICAs near the skullbase. No\nICA stenosis by NASCET criteria. Aortic arch branch vessel origins are patent\nand unremarkable. Mild arch calcifications are seen.\n\nOTHER:\nNo cervical lymphadenopathy. Thyroid demonstrates mild heterogeneity likely\nreflecting small nodules. Within limitation of extensive respiratory motion\nartifact, the lung apices are grossly clear. Moderate to severe degenerative\nchanges are worst at C4-5, C5-6 and C6-7.", + "output": "1. No acute intracranial process by unenhanced head CT.\n2. Focal near occlusion or occlusion of the distal left P1 PCA; the distal\nleft PCA branches are supplied by a diminutive but patent left posterior\ncommunicating artery.\n3. Mild-to-moderate luminal narrowing of the mid basilar artery. Areas of\nmild luminal narrowing affecting the bilateral distal V4 vertebral arteries\nand petrous, cavernous, and supraclinoid ICAs bilaterally. No additional area\nof stenosis, occlusion. No aneurysm.\n4. Patent bilateral vertebral and carotid arteries. No ICA stenosis by NASCET\ncriteria.\n5. Foci of encephalomalacia in the inferior right frontal and left temporal\nlobes.\n6. Pansinus mucosal thickening with near complete opacification of the right\nmaxillary sinus. Correlate clinically with signs of acute sinusitis." + }, + { + "input": "There is no evidence of infarction,hemorrhage,edema,or mass. There there is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are normal.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Ventricles\nand sulci are prominent, consistent with age-related global parenchymal loss.\nMild subcortical, periventricular and deep white matter hypodensities are\nnonspecific, but likely reflect the sequela of chronic microangiopathic\nischemic disease. EEG scalp leads are present.\n\nThere is no fracture. The visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear aside from mild left maxillary\nsinus mucosal thickening. The visualized portion of the orbits demonstrate\nprior lens surgery and are otherwise normal.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no acute hemorrhage mass effect midline shift or hydrocephalus. \nProminence of temporal horns indicate medial temporal atrophy which is\nunchanged from the previous study. No skull fracture is identified.", + "output": "No acute intracranial abnormalities are identified." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. There\nis mild prominence of the ventricles and sulci suggestive of involutional\nchanges.\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No evidence of infarct, hemorrhage, edema, mass effect, or fracture.\n2. Mild age-appropriate brain atrophy." + }, + { + "input": "There is no evidence of acute large vascular territory infarct, hemorrhage,\nedema, mass effect, or fracture. There is prominence of the ventricles and\nsulci, suggestive of age-appropriate involutional changes. There are\nperiventricular and subcortical hypodensities, which are nonspecific but may\nrepresent small vessel ischemic changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are preserved.", + "output": "1. No evidence of intracranial hemorrhage or acute large vascular territory\ninfarct. Please note that MRI of the brain is more sensitive for the\ndetection of acute infarct, if there are no contraindications.\n2. Age-appropriate global cerebral volume loss.\n3. Probable chronic small vessel ischemic changes." + }, + { + "input": "NON-CONTRAST HEAD CT: There is no evidence of intracranial hemorrhage, mass,\nor infarct. The ventricles, cisterns, and sulci are age appropriate. \nBilateral maxillary sinus mucosal thickening is noted.\n\nCTA NECK: Within the lateral aspect of the left tonsillar pillar is a 1.3 ML\nx 0.9 AP well-circumscribed oval hypodensity, best seen on the axial images,\nwith adjacent punctate densities which may represent calcifications. There is\nno appreciable adjacent inflammatory change.\n\nThere is three-vessel origin off the aortic arch without stenosis.\n\nThe left vertebral artery is slightly dominant.\n\nThe carotid bifurcations are unremarkable. There is no flow-limiting stenosis\nwithin the neck.\n\nCTA HEAD: A patent right posterior communicating artery is demonstrated. The\nanterior communicating artery is patent. There is no evidence of aneurysm or\nflow-limiting stenosis or large vessel occlusion within the head. The dural\nvenous sinuses and major intracranial veins are patent.", + "output": "1. No evidence of acute intracranial pathology. No evidence of aneurysm,\nflow-limiting stenosis, or large vessel occlusion within the head or neck.\n2. Oval hypodensity within the lateral aspect of the left tonsillar pillar. \nThis may represent a tonsillar cyst, sequela of prior inflammation, among\nother possibilities. An abscess is far less likely given the lack of adjacent\ninflammatory changes as well as the lack of fever or other infectious symptoms\naccording to the note by Dr. ___ neurology on ___. Ear, nose,\nand throat evaluation is suggested. If it is clinically necessary to further\nwork this up radiographically, an MRI with and without gadolinium of the neck\ncould be obtained." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nlarge mass. Prominence of the ventricles and sulci is suggestive of\ninvolutional changes.\n\nHyperdense lesion anterior to the globe measuring approximately 1.7 x 0.7 cm\nwhich appears to exert mild mass effect on the right globe (series 2 a, image\n9 ; series 602b, image 27)). The right globe appears grossly intact. There\nis no evidence of post septal hematoma. There is mild mucosal thickening of\nthe bilateral maxillary sinuses with mild hyperostosis of the sinus walls\ncompatible with history of chronic sinusitis. Otherwise, the remainder the\nvisualized paranasal sinuses are essentially clear. The mastoid air cells\nmiddle ear cavities are well pneumatized and clear. Soft tissue debris in the\nbilateral external auditory canals are noted, likely representing cerumen. \nThere is a 3 mm thick left occipital subgaleal hematoma without underlying\nskull fracture.", + "output": "1. No acute intracranial abnormality on noncontrast head. Specifically no\nintracranial hemorrhage.\n2. Prominent right preseptal periorbital swelling and 1.7 cm soft tissue\nhyperdense lesion which appears to exert mild mass effect on the right globe. \nNo postseptal hematoma is identified. The right globe itself appears intact. \nThe 1.7 cm hyperdense soft tissue lesion is known to clinicians at the time of\nthis dictation." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass. Old left thalamic lacunar infarct is again noted. Prominent ventricles\nand sulci consistent with age-related involutional changes.\n\nAgain seen is a hyperdense lesion anteromedial to the right globe measuring\napproximately 1.9 x 0.8 cm (2:3, 601:25, 602:15) without evidence of mass\neffect on the right globe, unchanged from prior study. The right globe\nappears grossly intact. No postseptal hematoma is identified. Mild\nhyperostosis of the maxillary sinus walls is consistent with known history of\nchronic sinusitis. Otherwise, the remaining visualized paranasal sinuses are\nessentially clear. The mastoid air cells and middle ear cavities are clear. \nNo fracture is identified.", + "output": "1. No acute intracranial process. Specifically, no acute intracranial\nhemorrhage.\n2. Re-demonstrated 1.9 x 0.8 cm hyperdense lesion anteromedial to the right\nglobe without evidence of mass effect on the right globe. No evidence of\npostseptal hematoma.\n3. Mild hyperostosis of the maxillary sinus walls consistent with known\nhistory of chronic sinusitis." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema, or\nmass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are preserved.", + "output": "1. No acute intracranial abnormality.\n2. No evidence acute intracranial hemorrhage or fracture." + }, + { + "input": "Right MCA coil mass streak artifact limits examination.\n\nThere is no acute hemorrhage, edema, or mass effect. Two coils are identified\nwithin the right middle cerebral artery, present on examination dated ___. New right basal ganglia and right parietal areas of hyperdensity are\nnoted (see 05:20, 05:14). There is no acute hemorrhage. No shift of normally\nmidline structures or mass effect.\n\nVentricles and sulci are age appropriate in size and configuration. New right\nposterior lentiform nucleus and right parieto-occipital hypodensities are\nnoted, suggestive of chronic infarcts.\n\nVisualized paranasal sinuses, mastoid air cells, and inner ear cavities are\nclear.", + "output": "1. Postsurgical changes related to patient's known right MCA two aneurysms\nstatus post stent assisted coiling, with right MCA coil mass streak artifact\nlimiting examination.\n2. Within limits of study, no evidence of hemorrhage.\n3. Right basal ganglia and parietal encephalomalacia are new since prior\nexamination concerning for interval chronic infarctions.\n4. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct." + }, + { + "input": "Streak artifact from two right middle cerebral artery coils limits diagnostic\nevaluation of the adjacent area.\n\nCompared with ___, there are two new areas of right frontal hypodensity,\nlikely representing subacute to chronic infarct (2:20,22). Again seen are\nchronic infarcts in the right parietal lobe and basal ganglia. There is no\nintracranial hemorrhage. No shift of normally midline structures is present. \nVentricles and sulci appropriate in size and configuration for the patient's\nage. Basal cisterns are patent. No mass effect.\n\nThere is no evidence of fracture. There is minimal mucosal thickening in the\nright maxillary sinus. The visualized portion of the remainder of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "Two areas of right frontal hypodensity are new compared with ___, likely\nrepresenting subacute to chronic infarcts, however these could be further\ncharacterized with MRI.\n\nRECOMMENDATION(S): MRI brain." + }, + { + "input": "There is no evidence of large territorial infarction, hemorrhage, edema, or\nmass effect. The ventricles and sulci are normal in size and configuration.\n\nNo acute fracture is identified. There is significant soft tissue swelling\nhematoma in the right periorbital region. The paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute fracture or intracranial abnormality." + }, + { + "input": "There is symmetric enlargement of the palatini tonsils which appear relatively\nhomogeneous. The nasopharyngeal adenoid tissues are also prominent. There is\nno evidence of peritonsillar or retropharyngeal abscess.\n\nThere are a few prominent bilateral anterior cervical lymph nodes, such as a\nleft level 2 lymph node measuring 9 x 18 mm (series 2, image 35).\n\nEvaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland is mildly heterogeneous and probably contains a\nfew subcentimeter hypodense. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.", + "output": "1. Symmetrically enlarged palatine tonsils, prominent adenoids and a few\nbilateral prominent anterior cervical lymph nodes are likely reactive.\n2. There is no evidence of retropharyngeal or peritonsillar abscess.\n3. A few subcentimeter hypodense thyroid nodules. According to current\n___ College of Radiology guidelines, no follow-up is indicated.\n Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or older." + }, + { + "input": "Head CT: Small hypodense foci in the right centrum semiovale and the anterior\nleft periventricular white matter are compatible with sequelae of prior\nchronic lacunar infarcts (for example see series 3, image 27 and image 30). \nOtherwise, there is preservation of gray-white matter differentiation. There\nis no hemorrhage or acute infarction. The basal cisterns are patent. There\nis no shift of normally midline structures. The ventricles and sulci are\nnormal in caliber and configuration. The visualized paranasal sinuses and\nmastoid air cells are clear. The globes and bony orbits are unremarkable.\n\nHead CTA: Limited evaluation due to poor contrast bolus timing. Within this\nlimitation, there are no intracranial vascular abnormalities. There is no\nevidence of aneurysm , stenosis or occlusion.\n\nNeck CTA: Seen at the level of C4, there ___ hypodense linear structure\nwithin the lumen of the proximal left common carotid artery (for example see\nseries 7 images 209, 206, and 205). While dissection at this location is\npossible, it is most likely artifactual due to motion. Otherwise, the\nbilateral carotid and vertebral arteries are patent without evidence of\nsignificant stenosis. The internal carotid arteries are patent without\nevidence of stenosis by NASCET criteria. The proximal right ICA measures 9\nmm; the distal right ICA measures 6 mm. The proximal left ICA measures 9 mm;\nthe distal left ICA measures 6 mm.\n\nAgain seen is the ___ type B aortic dissection, with origination of the\nintimal flap just distal to the distal margin of the takeoff of the left\nsubclavian artery, and extension inferiorly. The thyroid is unremarkable. \nThe partially imaged lung apices are clear. Mild multilevel cervical spine\ndegenerative changes seen. Alignment is normal. There is no cervical or\nsupraclavicular lymphadenopathy by CT size criteria. The partially imaged\naerodigestive tract appears unremarkable.", + "output": "1. Limited study due to poor contrast bolus timing and motion. Within this\nlimitation, no evidence of superior extension ___ type B aortic\ndissection.\n2. Linear hypodensity at the level C4 involving the proximal left ICA, while\npossibly representing a focal dissection, is most likely artifactual secondary\nto motion. Otherwise, patent bilateral carotid and vertebral arteries.\n3. Though limited by motion and contrast timing, no evidence of intracranial\nvascular abnormality.\n4. No acute infarction or hemorrhage. Chronic bilateral white matter lacunar\ninfarcts." + }, + { + "input": "There is no evidence of infarction,hemorrhage,edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nThere is calcification of the cavernous carotid and vertebral bilaterally.\n\nAn NG tube and ET tube are partially imaged. There is no evidence of\nfracture. Mild mucosal thickening of the bilateral maxillary sinuses. \nProbable mucous retention cyst in the right sphenoid sinus. Partial\nopacification of the left anterior ethmoid air cells. Otherwise, the\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "No evidence of hemorrhage or infarction." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Periventricular and subcortical\nwhite matter hypodensities are likely sequela of chronic small vessel disease.\nVentricles and sulci are prominent compatible with global volume loss.\n\nRight mastoid tip is partially opacified. Included paranasal sinuses and left\nmastoids are essentially clear. Skull and extracranial soft tissues are\nunremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of intracranial hemorrhage, acute large territorial\ninfarction, edema,or mass effect. There is prominence of the ventricles and\nsulci suggestive of involutional changes. Periventricular and subcortical\nhypodensities are nonspecific, though likely sequela of chronic small vessel\nmicroangiopathy.\n\nThere is no evidence of acute fracture. Right mastoid tip is again minimally\nopacified. The visualized portion of the paranasal sinuses, remaining mastoid\nair cells, and middle ear cavities are clear.", + "output": "No evidence of acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema,or mass.\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Diffuse periventricular and subcortical white matter hypodensities\nare not nonspecific, however likely due to chronic small vessel ischemic\ndisease in this age group.\n\nThere is no evidence of acute fracture. There is mild mucosal thickening of\nthe ethmoid air cells and chronic opacification of the right inferior mastoid\nair cells. The visualized portion of the paranasal sinuses, left mastoid air\ncells, and middle ear cavities are clear. Patient is status post bilateral\nlens replacements. The visualized portion of the orbits are unremarkable. \nDense atherosclerotic calcifications of the cavernous carotid arteries.", + "output": "No acute intracranial abnormality on noncontrast CT." + }, + { + "input": "There is no acute intracranial hemorrhage, edema, mass effect or acute\ninfarction. The ventricles and sulci are mildly prominent consistent with\natrophy. The visualized paranasal sinuses and mastoid air cells are clear.\nThere is no acute fracture.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "The patient is status post of left middle turbinectomy and ethmoidectomy with\nan apparent posterior neo ostium. There is apparent right antrostomy and\npartial ethmoidectomies. There are bilateral Haller cells, larger on the\nleft. The bilateral neo ostia are clear.\n\nMinimal mucosal prominence of the inferior frontal sinuses and anterior\nresidual ethmoid air cells with opacification of a single posterior residual\nethmoid air cell is identified. Trace mucosal prominence of the left inferior\nmaxillary sinus is also identified. The remainder the paranasal sinuses are\nessentially clear.\n\nThere is leftward deviation of the nasal septum with appearance suggesting\nprior septoplasty.\n\nThe lamina papyracea and cribriform plates are intact. The visualized orbits\nare unremarkable. The mastoid air cells middle ear cavities are well\npneumatized and clear.\n\nAlthough the examination is not optimized for evaluation of the brain\nparenchyma, visualized brain is grossly unremarkable.", + "output": "1. The patient is status post left middle turbinectomy and ethmoidectomy. \nThere is apparent right antrostomy and partial ethmoidectomies with\npreservation of the right middle turbinate. A large posterior ostium of the\nright maxillary sinus is noted, which may be postsurgical in nature. \nCorrelation with surgical history is recommended.\n2. The right maxillary sinus is essentially clear.\n3. Trace mucosal prominence of the left inferior maxillary sinus is\nidentified.\n4. Additional findings described above including bilateral Haller cells." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is a 36 x 18 mm acute intraparenchymal hemorrhage centered within the\nright superior parietal lobule with mild associated vasogenic edema, similar\nto outside hospital CT examination of ___.. There is local mass\neffect, however no midline shift.\n\nThere is no large acute infarct. The ventricles, sulci, and cisterns\notherwise appear normal.\n\nThere is minimal mucosal thickening on the floor of the frontal sinuses and\nwithin the anterior ethmoid air cells. The middle ear cavities and mastoid\nair cells are clear. Incidental note is made a probable dehiscent bony\ncovering of the horizontal petrous segments of the bilateral carotid canals.\n\nCTA HEAD:\nA small linear filling defect within the lacerum segment of the left internal\ncarotid artery most likely reflects nonocclusive atheromatous plaque (series\n3, image 247). There is mild atherosclerotic plaque within the intracranial\ninternal carotid arteries without stenosis. The vessels of the circle ___\nand ___ branches are patent without stenosis. There is mild atherosclerotic\nplaque within the intracranial vertebral arteries without stenosis. The\nbasilar artery is patent without stenosis.\n\nNo aneurysm or high-flow vascular malformation is identified.\n\nCTA NECK:\nThere is mild atherosclerotic plaque within the bilateral internal carotid\narteries, with less than 20% stenosis by NASCET criteria. There is minimal\natherosclerotic plaque within the right vertebral artery. The extracranial\nvertebral arteries are patent without stenosis.\n\nOTHER:\nThe thyroid gland appears mildly heterogeneous with a few calcifications. \nSmall nodules measuring up to 2 mm are noted.\n\nThere are several enlarged lymph nodes within the right axilla, with a\ndominant, incompletely imaged 2-3 cm node (series 3, image 16).\n\nThere are no enlarged cervical or superior mediastinal lymph nodes.\n\nThe imaged lung apices are clear.", + "output": "1. Acute 36 x 18 mm intraparenchymal hemorrhage within the right superior\nparietal lobule, unchanged from outside hospital CT examination, without an\nunderlying high-flow vascular malformation. There is local mass effect due to\nthe acute hemorrhage and associated vasogenic edema, however no midline shift.\nContrast enhanced MRI is recommended to exclude underlying mass, unless\ncontraindicated.\n2. Mild intracranial and extracranial atherosclerosis, without significant\nstenosis or occlusion.\n3. Several moderately enlarged right axillary lymph nodes. Recommend\ncorrelation with physical exam, mammogram, and possible tissue sampling as\nclinically indicated.\n4. Heterogeneous thyroid, with small nodules measuring up to 2 mm.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "In comparison with the prior examinations, there is trace of residual blood\nproducts in the right parietal region (images 22 through 24, series 2), with\nminimal areas of low-attenuation suggesting mild residual vasogenic edema\n(image 21, series 2), there is no evidence of mass effect. After the\nadministration of intravenous contrast material, there is minimal pattern of\nenhancement towards the right parietal region better depicted in the sagittal\nand coronal reformations (image 72, series 601 and image 33, series 602), the\npossibility of underlying developmental venous anomaly is a consideration, if\nclinically warranted long-term followup with MRI of the head is recommended\nfor further characterization, alternatively if the patient refused MRI due to\nclaustrophobia, CTA/CTV of the head can be performed. No other areas of\nabnormal enhancement are identified. The ventricles and sulci are normal in\nsize and configuration the major arterial vascular structures enhance normally\nand demonstrate normal distribution. The orbits appear normal, the paranasal\nsinuses, middle ear cavities, mastoid air cells are clear.", + "output": "1. Almost complete resolution of the previously noted right parietal\nhemorrhage, with a trace of edema, residual blood products and enhancement in\nthis region as described detail above\n2. The possibility of underlying developmental venous anomaly in the right\nparietal region is a consideration, however not clearly identified in this\nexam, if there is no clinical contraindication and clinically warranted,\nlong-term follow-up in 6 months to ___ year with MRI of the head with and\nwithout contrast is advised for further characterization of the right parietal\nregion. Alternatively if the patient refused the use of MRI due to\nclaustrophobia, CTA/CTV of the head can be performed in 6 months to ___ year, to\nevaluate the right parietal region.\n3. There is no evidence of acute intracranial process or new areas of\nhemorrhage.\n\nRECOMMENDATION(S): The possibility of underlying developmental venous anomaly\nin the right parietal region is a consideration, however not clearly\nidentified in this exam, if there is no clinical contraindications and\nclinically warranted, long-term follow-up in 6 months to ___ year with MRI of\nthe head with and without contrast is advised for further characterization of\nthe right parietal region, alternatively if the patient refuse MRI due to\nclaustrophobia, a CTA/CTV of the head can be performed in 6 months to ___ year,\nhowever with less resolution in comparison with MRI to detect developmental\nvenous anomalies." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\n\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of hemorrhage, infarction, edema or mass effect. \nVentricles and sulci are mildly prominent suggestive of age related atrophy.\nThe basal cisterns are clear. The gray white matter differentiation appears\npreserved.\n\nNo fracture is identified. Partial opacification of the right ethmoidal air\ncells and minimal mucosal thickening within the left sphenoid sinus is noted.\nThe remaining parrot nasal sinuses, mastoid air cells and middle ear cavities\nare clear. Carotid siphon vascular calcifications are mild.", + "output": "Mild atrophy. Otherwise normal study." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Mild\nprominence of the ventricles and sulci likely reflects age related\ninvolutional changes.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable. Right-sided lens\nreplacement is noted.", + "output": "No acute intracranial process." + }, + { + "input": "Enhancing soft tissue and thickening at the base of the epiglottis and\nextending into the areepiglottic folds and vocal folds has markedly improved,\nthough residual mild enhancement and soft tissue thickening remains.\nAsymmetric nodular soft tissue seen at the tongue base on the previous\nexamination is not appreciated on the current examination.\n\nThe left level 3 lymph node which was noted to be a hot on PET scan has\ndiminished in size. Previously this node measured 7 mm in short axis (5mm on\nthe PET CT) and now measures less than 2 mm in short axis. Other scattered\nsubcentimeter cervical lymph nodes have diminished in size is well.\n\nThe parotid glands, submandibular glands and sublingual spaces are normal. The\nthyroid gland is normal.\n\nCervical spine degenerative changes are present. Mild emphysematous changes\nare seen within the visualized upper lobes. Calcified atherosclerotic plaque\nis noted at the aortic arch and carotid bifurcations.", + "output": "1. Marked interval improvement of supraglottic enhancing soft tissue with\nminimal residual enhancement and soft tissue thickening remaining.\n2. The small left level 4 lymph node which was noted to be metabolically\nactive on the PET CT has decreased in size. There is no pathologic adenopathy\nby CT criteria." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territory infarct. Gray-white matter\ndifferentiation is preserved. There is mild cortical volume loss. There is\nno hydrocephalus. The visualized paranasal sinuses demonstrate minimal\nmucosal thickening of the maxillary sinuses and bilateral ethmoid air cells.. \nThe mastoid air cells are underpneumatized bilaterally and opacified. The\nbilateral middle ear cavities are also opacified, which appears new since\nPET-CT from ___. No acute fracture is seen.", + "output": "No acute intracranial process.\n\nOpacification of bilateral underpneumatized mastoid air cells and the\nbilateral middle ear cavities. Opacification of the middle air cavities\nappears new from PET-CT from ___. Correlate with\ninfectious/inflammatory process and recommend nonemergent temporal bone\nhigh-resolution CT for further assessment.\n\nRECOMMENDATION(S): Nonemergent temporal bone high-resolution CT for further\nassessment." + }, + { + "input": "There is no hemorrhage, major vascular territorial infarction, mass, or shift\nof the normally midline structures. The size and shape of the ventricles and\nsulci are normal. The differentiation of grey and white matter is preserved. \nVisualized paranasal sinuses and mastoid air cells are clear. There is no\nfracture.", + "output": "Normal head CT" + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nNo evidence for acute intracranial hemorrhage, edema, mass effect, or acute\nmajor vascular territorial infarction. Extensive hypodensities in the\nsupratentorial white matter are nonspecific but likely sequela of chronic\nsmall vessel ischemic disease in this age group. Moderate global parenchymal\nvolume loss is again seen with prominent ventricles and sulci.\n\nThere is no evidence for displaced calvarial fracture. There is a small\nmucous retention cyst along the floor of the right maxillary sinus. The\nremainder of the paranasal sinuses and mastoid air cells appear well aerated. \nThe orbits appear unremarkable.\n\nCTA NECK:\nConventional 3 vessel branching of the aortic arch. There is mild calcified\nplaque within bilateral proximal internal carotid arteries without stenosis by\nNASCET criteria. No evidence for carotid dissection.\n\nLeft vertebral artery is dominant. Left vertebral artery origin is obscured\nby streak artifact from concentrated radiodense contrast in the adjacent\nveins, as intravenous contrast was administered through the left upper\nextremity. Otherwise, left vertebral artery demonstrates no evidence for\nstenosis, and no evidence for a regularity or dissection at the level of the\nleft C7 fracture.\n\nNon dominant cervical right vertebral artery is widely patent, with mild\ncalcified plaque in the V4 segment which does not cause flow-limiting\nstenosis.\n\nCTA HEAD:\nMild calcifications along both carotid siphons without flow-limiting stenosis.\nNo evidence for flow-limiting stenosis elsewhere in the major intracranial\narteries. No evidence for an aneurysm. Dural venous sinuses are patent.\n\nOTHER:\nAgain seen is a nondisplaced fracture of the left lateral mass of C7 extending\ninto the transverse foramen and transverse process. There also bilateral\nupper anterior rib fractures as seen on the prior CT torso. Small right\napical pneumothorax is new compared to the ___ CT torso but seen\non subsequent chest radiographs, most recent on ___. There is a\npartially imaged left pleural effusion and bilateral dependent atelectasis.\n\nThere is subcentimeter nodularity in the right thyroid lobe, which does not\nwarrant ultrasound according to the size and age based ACR guidelines.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. Nondisplaced fracture of the left lateral mass of C7 involving the\ntransverse foramen and multiple bilateral upper anterior rib fractures, as\nseen on the cervical spine and torso CTs from ___.\n3. Small right apical pneumothorax, new compared to the CT torso from ___, but seen on subsequent chest radiographs, most recent ___.\n4. Left vertebral artery origin is obscured by streak artifact from\nconcentrated contrast in the adjacent veins, as the intravenous contrast was\nadministered through the left upper extremity. Otherwise, the vertebral\nartery appears widely patent without evidence for dissection or intramural\nhematoma at the level of the left C7 fracture.\n5. No evidence for carotid dissection or stenosis by NASCET criteria.\n6. No evidence for flow-limiting stenosis in the major intracranial arteries." + }, + { + "input": "Patient body habitus and dental amalgam and venous contrast pooling streak\nartifact limits study. Within these confines:\n\nCT HEAD WITHOUT CONTRAST:\nNonspecific probable calcification of the right superior frontal gyrus is\ngrossly unchanged (02:25 on current study and 03:31 on ___ prior\nexam). There is no evidence of infarction,hemorrhage,edema,ormass.\nThere is redemonstration of extensive hypodensities in the supratentorial\nwhite matter which is nonspecific but likely sequela of chronic small vessel\nischemic changes. There is unchanged diffuse parenchymal volume loss. The\nstable prominence of the ventricular system and extra-axial CSF spaces,\nconsistent with the previously mentioned parenchymal volume loss.\n\nThere is very mild mucosal thickening along the floor of both maxillary\nsinuses. The remainder of the paranasal sinuses appears clear. The\nvisualized portion of the mastoid air cells,and middle ear cavities are clear.\nThe visualized portion of the orbits are preserved.\n\nCTA HEAD:\nThere are minimal atherosclerotic changes along both carotid siphons and\nbilateral V4 segments without high-grade stenosis. Otherwise, the vessels of\nthe circle of ___ and their principal intracranial branches appear\npreserved without definite stenosis, occlusion, or aneurysm formation. The\ndural venous sinuses are grossly patent.\n\nCTA NECK:\nDental amalgam streak artifact especially limits evaluation of bilateral\ndistal V2 segments, with multiple linear defect suggested within bilateral\nvertebral arteries at C2-3 level likely artifactual, grossly similar compared\nto prior exam (see 3:172 on current study and 7:224 on prior exam). There are\nminimal atherosclerotic changes at both carotid bifurcations without evidence\nof internal carotid stenosis by NASCET criteria.\n\nThe left vertebral artery is again noted to be dominant. Streak artifact\nlimits evaluation of left vertebral artery origin. Otherwise, the\ncarotidandvertebral arteries and their major branches appear preserved with no\ndefinite evidence of stenosis or occlusion.\n\nOTHER:\nThere is redemonstration of the left C7 lateral mass fracture with extension\ninto the transverse foramina and transverse process. Bilateral upper anterior\nrib fractures also again identified. There has been interval resolution of a\nsmall right apical pneumothorax. There unchanged subcentimeter hypodense\nnodules in the right thyroid lobe. Limited imaging lungs demonstrate biapical\nscarring. There is no lymphadenopathy by CT size criteria.", + "output": "1. Patient body habitus and dental amalgam and venous contrast pooling streak\nartifact limits study.\n2. No evidence of acute infarction, hemorrhage or intracranial mass. Please\nnote MRI of the brain is more sensitive for the detection of acute infarct.\n3. Minimal nonocclusive probable atherosclerotic changes of circle ___ as\ndescribed.\n4. Otherwise, grossly patent circle of ___ without definite evidence of\nstenosis,occlusion,or aneurysm greater than 3 mm.\n5. Minimal nonocclusive cervical internal carotid artery origin\natherosclerotic changes without definite high-grade stenosis by NASCET\ncriteria.\n6. Streak artifact limits evaluation of left vertebral artery origin and\nbilateral distal vertebral artery V2 segments as described.\n7. Otherwise, grossly patent bilateral cervical carotid and vertebral arteries\nwithout definite evidence of stenosis, occlusion, or dissection.\n8. Redemonstration of the left C7 lateral mass fracture with extension of the\ntransverse foramina transverse process.\n9. Bilateral anterior rib fractures as described." + }, + { + "input": "There is a large left parietal subgaleal hematoma that slightly crosses the\nmidline (601:67, 602:53) and measures approximately 1.2 cm in maximum\nthickness. A punctate hyperdense material is visualized within the\nsubcutaneous fat just deep to the scalp skin in the area of this hematoma\n(602:47, 601:78). An underlying acute fracture is not seen.\n\nThere is no evidence of acute large intracranial territorial\ninfarction,hemorrhage,edema, or mass effect. Prominence of the ventricles and\nsulci is most consistent with involutional changes. Confluent bilateral\nperiventricular and subcortical white matter hypodensities most likely relates\nto patient's history of multiple sclerosis, underlying small vessel ischemic\nchange is not excluded.\nPartially imaged paranasal sinuses are clear. The mastoid air cells are\nclear. Calcification along the cavernous portions of the internal carotid\narteries are seen bilaterally.", + "output": "1. Large left parietal subgaleal hematoma measuring 1.2 cm in maximum\nthickness without evidence of an underlying fracture. No acute intracranial\nhemorrhage.\n2. There is a punctate hyperdense material within the subcutaneous fat just\ndeep to the scalp skin in the area of the left parietal scalp hematoma.\n3. Confluent bilateral periventricular and subcortical white matter\nhypodensities most likely relate to patient's history of multiple sclerosis,\nunderlying small vessel ischemic change may also be present." + }, + { + "input": "Image quality is degraded by patient motion.\n\nNo evidence of acute large territorial infarction, acute intracranial\nhemorrhage, edema, or mass effect. The ventricles and sulci are prominent,\nlikely reflective of age related involutional changes. Confluent\nperiventricular,subcortical and deep hypodensities may represent a combination\nof patient's known multiple scoliosis and chronic small vessel ischemic\nchanges.\n\nNo acute osseous abnormalities. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. Status post right lens replacement.", + "output": "Image quality is degraded by patient motion.\n\n1. No large acute intracranial process. No CT evidence of an intracranial\nmass, of the MRI with contrast is a better modality for evaluation.\n2. Confluent periventricular, subcortical and deep white matter hypodensities\nmay represent a combination of patient's known multiple scoliosis and chronic\nsmall vessel ischemic changes." + }, + { + "input": "There is no evidence of fracture, acute large territorial\ninfarction,hemorrhage,edema,or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. Confluent areas of white matter\nhypoattenuation are seen bilaterally within the subcortical, periventricular,\nand deep white matter, as seen previously.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. Patient is status post right lens replacement. Mild\natherosclerotic calcifications of the cavernous carotid arteries..", + "output": "1. No acute intracranial abnormality.\n2. Unchanged confluent white matter hypoattenuation in the cerebral\nhemispheres bilaterally which may reflect a combination of the patient's\nmultiple sclerosis and chronic microvascular angiopathy." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Prominent ventricles and sulci likely represent age-related\ninvolutional changes.\n\nThere is mild mucosal thickening bilateral ethmoid air cells. Remaining\nparanasal sinuses are clear. Superior ophthalmic veins are significantly\ndilated bilaterally, a new finding since remote prior since ___. There is no\nretro-orbital edema, enlarged extraocular muscles or proptosis. Mastoid air\ncells and middle ear cavities are well aerated. The bony calvarium is intact. \nThere are moderate atherosclerotic calcifications of the bilateral carotid\nsiphons.", + "output": "No intracranial hemorrhage or other acute intracranial abnormality.\nDilated superior ophthalmic veins. This can be an incidental finding in the\nsetting of varices and Valsalva during the examination. Possibility of\nincreased venous pressure in the setting of arterialized flow or cavernous\nsinus abnormality is not excluded.\n\nNOTIFICATION: Update discussed by Dr. ___ with Dr. ___." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\n\nNo evidence of acute fracture. Sequelae from previous trauma to the nasal\nbone is noted. Defect in the left lamina papyracea is also from prior healed\ntrauma. Mucosal thickening of the left maxillary sinus. Otherwise, the\nremaining imaged paranasal sinuses are essentially clear. Mastoid air cells\nand middle ear cavities are well aerated.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci that is advanced for patient's age.\n\nThere is no evidence of acute fracture. Again seen are sequelae from previous\ntrauma to the nasal bone. Mild mucosal thickening along the floor of each\npartly imaged maxillary sinus. Otherwise, the visualized portion of the\nremaining paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "No evidence of acute intracranial process or injury." + }, + { + "input": "No acute intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major infarction. There is age\nadvanced involutional changes most notable in the cerebellum. Ventricles are\nnormal in size. Paranasal sinuses are mostly well aerated. Mastoid air cells\nand middle ear cavities are clear. The bony calvarium is intact.", + "output": "No acute intracranial abnormality. Age advanced involutional changes." + }, + { + "input": "Again demonstrated is a small left parietal scalp hematoma which appears\nslightly decreased in size compared to ___, with multiple foci of\nsubcutaneous gas and overlying surgical skin staples.\n\nA small hyperdensity in the right occipital lobe is less conspicuous compared\nto prior CT head and may reflect a small subarachnoid bleed (02: ___. \nOtherwise, there is no evidence of large territory infarction. No new foci of\nhemorrhage are identified. Prominent right frontal extra-axial subarachnoid\nspaces are again noted. There is no midline shift of structures.\n\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable, aside from bilateral lens\nreplacements.", + "output": "1. Small hyperdensity in the right occipital lobe is less conspicuous compared\nto prior CT head and may reflect a small resolving subarachnoid hematoma. \nOtherwise, no evidence of new bleed or large territory infarction.\n2. Re-demonstration of a small left parietal scalp hematoma with overlying\nsurgical staples. No evidence of acute fracture." + }, + { + "input": "There is no evidence of infarction,intracranial hemorrhage,edema,or mass. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Prominent extra-axial spaces are stable from prior. Periventricular\nsubcortical white matter hypodensities are nonspecific but likely reflect the\nsequela of chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. There is thickening the anterior ethmoidal\nair cells. Otherwise, the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. Patient is status post\nbilateral lens replacements.", + "output": "1. No evidence of acute intracranial process.\n2. Prominent extra-axial spaces and involutional changes are stable from\nprior.\n3. Sequelae of chronic small vessel ischemic disease." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is a small left parietal scalp hematoma with foci of subcutaneous gas. \nSuperficial skin laceration. Surgical skin staples are present. No\nradiopaque foreign bodies are evident. No evidence of underlying calvarial\nfracture. The calvarium is intact.\n\nThere are prominent right frontal and bi-interhemispheric extra-axial\nsubarachnoid spaces. There is mild effacement of the adjacent right frontal\nsulci.\n\nThere is no evidence of infarction, hemorrhage, or mass. The ventricles are\nage-appropriate in size and configuration. There is no midline shift.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is mild luminal irregularity and narrowing of the bilateral M1 and M2\nsegments as well as the bilateral A1 and A2 segments. There is mild luminal\nnarrowing of the bilateral P1 segments. Otherwise, the vessels of the circle\n___ and their principal intracranial branches appear normal without\nocclusion or aneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nThe origins of the bilateral vertebral arteries are tortuous. There are mild\natherosclerotic calcifications at the bilateral common carotid artery\nbifurcations. Otherwise, the carotidandvertebral arteries and their major\nbranches appear normal with no evidence of stenosis or occlusion. There is no\nevidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nNo suspicious pulmonary nodules are evident. There are tiny low-density\nlesions in the thyroid gland. The thyroid is otherwise unremarkable. There\nis no lymphadenopathy by CT size criteria.", + "output": "1. Small left parietal scalp laceration with underlying hematoma formation. \nNo evidence of radiopaque foreign bodies.\n2. No evidence of fracture.\n3. No evidence of infarction or intracranial hemorrhage.\n4. Mild multifocal atherosclerotic disease of the circle of ___ with no\nevidence of occlusion or aneurysm formation.\n5. Patent neck vasculature with no evidence of stenosis or aneurysm formation." + }, + { + "input": "There is no acute intracranial hemorrhage, edema, mass effect, or evidence of\nlarge vascular territorial infarction. The ventricles and sulci are normal in\nsize and configuration for patient's age. There are non-specific\nperiventricular and subcortical white matter hypodensities which can be seen\nin patients with chronic small vessel ischemia. There is no fracture. The\nimaged paranasal sinuses are clear. The bilateral mastoid air cells are under\npneumatized and partially filled with fluid. The middle ear cavities are\nclear bilaterally. There is debris in both external auditory canals, likely\ncerumen.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territorial infarct. Prominence of the\nventricles and sulci is consistent with involutional changes. Periventricular\nand subcortical white matter hypodensities are likely sequelae of chronic\nsmall vessel disease. Punctate right basal gangliar lacunar infarct is noted.\nCoarse bilateral tentorium calcifications are seen. The visualized paranasal\nsinuses are clear. The mastoid air cells are clear. No acute fracture is\nseen.", + "output": "No acute intracranial process." + }, + { + "input": "The inferior-most aspect of the left cerebellar hemisphere is not included in\nthe study. Within the visualized brain, there is no evidence of acute large\nterritorial infarction,hemorrhage,edema, or mass. There is prominence of the\nventricles and sulci suggestive of involutional changes. As on prior, a\npunctate right basal gangliar lacunar infarct is noted. Periventricular and\nsubcortical white matter hypodensities are unchanged and likely sequela from\nchronic small vessel disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Both lenses\nhave been replaced.", + "output": "1. No acute intracranial process." + }, + { + "input": "There is no evidence of hemorrhage, mass, mass effect or infarction. Mild\nprominence of the ventricles and sulci is likely related to age related\ninvolutional changes.\n\nNo fractures identified. The visualized paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear.", + "output": "1. No evidence of hemorrhage or infarction. If there is further clinical\nconcern for a stroke, an MRI may be helpful for further evaluation." + }, + { + "input": "The previously noted left intraventricular hemorrhage has resolved. There is\nno acute intracranial hemorrhage,acute infarction, mass or midline shift. The\nventricles and sulci are unchanged in size and configuration and are slightly\nprominent, likely due to atrophy. There is periventricular white matter\nhypodensity, likely chronic small vessel ischemic disease. . Visualized\nparanasal sinuses and mastoid air cells are clear. There is no fracture.", + "output": "Interval resolution of a right intraventricular hemorrhage. No new\nhemorrhage." + }, + { + "input": "Examination is limited secondary to motion. The large parenchymal hemorrhage\ncentered in the left parietal lobe measures approximately 6.6 cm AP x 3.0 cm\nTRV x 5.3 cm cc not significantly changed in size given differences in\npositioning. It now appears more dense, not unexpected. There is however,\nnow component of intraventricular hemorrhage seen within the lateral, third\nand fourth ventricles. There is effacement of the cerebral hemisphere on the\nleft. Degree of rightward midline shift cannot be accurately assessed though\nis mild.\n\nComponent of subarachnoid hemorrhage seen overlying the right parietal lobe\nwhich is new.\n\nIt is difficult to assess for changes in ventricular size though interval\nenlargement is suspected.\n\nThe left mastoid air cells are entirely opacified. Remaining paranasal\nsinuses and right mastoids are grossly clear.", + "output": "Large parenchymal hemorrhage centered in the left parietal lobe, unchanged in\nsize, though now with interventricular hemorrhage.\nComponent of subarachnoid hemorrhage.\nGiven significant motion and subsequent artifact, change in ventricular size\ncannot be accurately assessed though the ventricles may have slightly\nenlarged." + }, + { + "input": "Limited examination due to patient motion, within this limitation, the\ndominant portion of a large left frontoparietal intraparenchymal hematoma is\nminimally changed in size and measures 6.8 x 2.9 cm, previously measured 6.6 x\n3.0 cm (series 2, image 20). Intraventricular hemorrhage is essentially\nunchanged. Scattered subarachnoid hemorrhage is slightly increased, for\nexample in the left sylvian fissure. 4 mm of rightward midline shift is\nunchanged. Effacement of the basal cisterns is improved. The ventricles\nappear unchanged in size with similar amount of intraventricular hemorrhage.\n\nThere is no evidence of fracture. Nonspecific complete opacification of the\nleft mastoid air cells is unchanged. The visualized portion of the paranasal\nsinusesand middle ear cavities are clear. Bilateral lens replacements are\nnoted.", + "output": "A large left frontoparietal intraparenchymal hematoma is minimally changed. \nMidline shift is unchanged, but effacement of the basal cisterns is improved. \nScattered subarachnoid hemorrhage is increased, possibly reflecting\nredistribution.\nGrossly unchanged intraventricular hemorrhage" + }, + { + "input": "The dominant portion of the large left parietal/occipital/posterior frontal\nintraparenchymal hematoma is unchanged allowing for differences in patient\nposition, currently 6.5 x 3.0 cm, previously measuring 2.9 x 6.8 cm (2: 20). \nIntraventricular extension is again seen with slight redistribution. There is\nslightly less blood in the frontal horn of the left lateral ventricle, with\nslight decrease in the size of the left frontal horn. There is persistent\nblood in the body of the left lateral ventricle with unchanged compression of\nthe atrium and occipital horn, and slightly increased secondary dilatation of\nleft temporal horn. There is unchanged blood in the contralateral right\noccipital horn. The third ventricle is only mildly effaced, and the right\nlateral ventricle is stable in size. Decreased in size compared to prior\nresulting in decreased left frontal horn size due to increased drainage. 4 mm\nrightward shift of midline structures is stable.\n\nBilateral sulcal subarachnoid hemorrhage is difficult to compared to the ___ motion limited CT; it appears either stable or minimally\nincreased.\n\nThere is new right parafalcine hypodense subdural fluid, consistent with a\nhygroma, 4 mm in width. Minimal left parafalcine and left para tentorial\nhyperdense subdural hematoma is stable.\n\nA small mucous retention cyst is again noted in the left maxillary sinus. \nUnchanged complete opacification of the left mastoid air cells and left middle\near cavity dating back to the first available exam from ___,\nunclear whether secondary to prolonged supine positioning in the inpatient\nsetting or inflammatory causes. Bilateral lens replacements are noted.", + "output": "1. Stable large left parenchymal hemorrhage.\n2. No significant change in intraventricular hemorrhage allowing for slight\nredistribution. Slightly decreased blood in the left frontal horn with\ndecreased size of the left frontal horn. Slightly increased dilatation of\nleft temporal horn secondary to continued compression of the atrium of the\nleft lateral ventricle. No other change in ventricular size.\n3. Bilateral subarachnoid hemorrhage is either stable or minimally increased\ncompared to the motion limited exam from ___.\n4. Stable minimal left parafalcine and left para tentorial hyperdense subdural\nhemorrhage.\n5. New 4 mm right parafalcine hypodense subdural fluid collection consistent\nwith a hygroma." + }, + { + "input": "There is large acute parenchymal hematoma within left frontal, parietal lobe. \nIt measures 1.6 cm x 3.3 cm maximum diameter, difficult to compare given\ndifference in orientation of the patient and images, probably slightly\nincreased since ___ at 09:53, waiting measured 6.5 cm x 3.0 cm. \nThere has areas of inhomogeneous attenuation within hematoma, with fluid fluid\nlevels, which can be seen with coagulopathy or hyperacute hemato is ma. Small\nvolume of intraventricular extension within body left lateral ventricle, right\noccipital horn, similar the. Slight dilatation left temporal horn, similar. \nEdema surrounding hematoma has mildly worsened, and expected finding. \nExtensive subarachnoid hemorrhage over bilateral cerebral hemispheres, right\ngreater than left, and cerebellum, is similar. Small right parafalcine\nsubdural hematoma with possible component of hygroma the similar. 3 mm left\nto right midline shift, similar. Minimal left uncal herniation, similar. The\npreserved prepontine cistern, foramen magnum.\n\nComplete opacification left mastoids, left middle ___ be reactive,\nconsider otomastoiditis.", + "output": "Large left hemispheric acute parenchymal hematoma, probably mildly increased. \nInhomogeneous areas within hematoma with fluid fluid levels, a risk factor of\nhematoma expansion.\nIntraventricular, subarachnoid hemorrhage, similar.\nMild left uncal herniation, mild midline shift, similar.\nComplete opacification left mastoid air cells, middle ear, consider\notomastoiditis." + }, + { + "input": "Again demonstrated is a large acute parenchymal hematoma within the left\nfrontal and parietal lobe measuring approximately 7.1 x 3.1 cm in maximum\ndiameter (02:18) with surrounding vasogenic edema. This is difficult to\ncompare to the most recent prior CT head given differences in orientation, but\nappears minimally increased in size compared to exam performed ___ where it measured 6.5 x 3.0 cm. There is continued intraventricular\nextension into the body of the left lateral ventricle and right occipital horn\nof the lateral ventricle. Extensive subarachnoid hemorrhage over the\nbilateral cerebral hemispheres, right greater than left appear similar. Small\nright parafalcine subdural hematoma appears similar. There is a stable 3 mm\nrightward shift of midline structures, similar to prior exam. Mild effacement\nof the anterior horn of the left lateral ventricle is unchanged. Minimal left\nuncal herniation is stable.\n\nThere is no evidence of acute fracture. There is continued complete\nopacification of the left mastoid air cells and middle ear cavity. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Re-demonstration of a large left hemispheric parenchymal hematoma with\nsurrounding vasogenic edema, which may be minimally increased in size compared\nto ___.\n2. Stable intraventricular, subarachnoid, and parafalcine hemorrhage.\n3. Unchanged mild left uncal herniation and 3 mm shift of midline structures.\n4. Continued complete opacification of the left mastoid air cells and middle\near cavity." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. A subtle hypodensity within the anterior limb of the internal\ncapsule on series 2, image 14 is indeterminate and may represent small vessel\ndisease or an acute lacune. Diffuse sulcal prominence may reflect early\natrophy. Ventricles are normal in size and configuration. The imaged paranasal\nsinuses are clear. Mastoid air cells and middle ear cavities are well aerated.\nThe bony calvarium is intact.", + "output": "Tiny hypodensity within the white matter of the right internal capsule may\nrepresent a small lacune versus focal small vessel disease. Otherwise\nunremarkable exam." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or mass\neffect. A small, subtle hypodensity in the anterior limb of the right\ninternal capsule is unchanged and likely reflects sequela small vessel\nischemic disease or old lacunar infarct (2:14). There is prominence of the\nventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territory infarct. Gray-white matter\ndifferentiation is preserved. Again seen prominence of the extra-axial spaces\nin particular, the bifrontal extra-axial spaces, similar to prior. There is\nno hydrocephalus. The visualized paranasal sinuses are clear. The mastoid\nair cells are clear. No acute fracture is seen.", + "output": "No acute intracranial hemorrhage." + }, + { + "input": "In the area of the right palatine tonsil, there is an area of lobulated\nhyperdensity measuring 3.4 cm by 2.1 cm x 2.0 cm with subtle peripheral,\ndiscontinuous enhancement along its upper and lower margin, consistent with\nphlegmon, and early developing peritonsillar abscess. There is mild stranding\nand edema in the adjacent right parapharyngeal fat and adjacent mucosal edema.\nThere is moderate oropharyngeal narrowing at the level of the tonsils. \nPosterior nasopharyngeal and left palatine tonsil are enlarged, likely\nreactive.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal.Multiple prominent lymph nodes\nbilaterally are likely reactive. Largest lymph nodes measure 1.8 cm short\naxis level 2 a on the right. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.", + "output": "1. Right peritonsillar phlegmon with probable early abscess formation along\nits upper and lower edges. Moderate airway narrowing oropharynx.\n2. Symmetric bilateral neck adenopathy, likely reactive." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size.Note is made of septum cavum pellucidum, an\nanatomic variation.\nThere is no evidence of fracture. There is partial opacification of the\nmastoid air cells. The visualized portion of the paranasal sinusesand middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial abnormality." + }, + { + "input": "CTA neck:\n\nThere is a conjoined origin of the left common carotid artery and the\nbrachiocephalic artery.\nThe origins of the major brachiocephalic vessels demonstrate normal patency.\n\nThe right common, internal and external carotid arteries are normal in\nappearance. There is no evidence of a significant stenosis by NASCET criteria.\nNo long segment stenosis or flap seen to suggest dissection.\nThe left common, internal and external carotid arteries are normal in\nappearance. There is no evidence of a significant stenosis by NASCET criteria.\nNo long segment stenosis or flap seen to suggest dissection.\n\nThe right vertebral artery is dominant. The left vertebral artery is\ndevelopmentally small, coursing through developmentally small transverse\nforamina. The left vertebral artery nearly completely terminates in ___ and\n___ only a tiny contribution to the basilar artery. There is no evidence of a\nsignificant stenosis or a dissection of either vertebral artery.\nBasilar artery is diminutive.\nThe superior cerebellar arteries are normal. There is a right fetal origin PCA\nand a left fetal type PCA.\nThin lucency at the anterior aspect of left transverse foramen of C4 -? \nCongenital/trauma. Patent left vertebral artery at this level. (Se 2, im\n184)\nIntracranial arteries are not completely included as not targeted.\n\nCT neck:\n\nSphenoid sinus septation inserts on the right carotid groove.\nThe included paranasal sinuses and the mastoid air cells are grossly clear.\n\nSmall nodes are noted, not enlarged by size criteria.\nLucency noted around the right maxillary molar, can relate to unerrupted tooth\nor dental etiology.\nMild fullness in the left pyriform sinus.\nThyroid, salivary glands and the aerodigestive tract are unremarkable.\nMildly prominent adenoids with fullness in the foci of Rosenmuller on both\nsides.\n\nThe visualized included upper lungs are clear.", + "output": "Patent major arteries of neck as above. No long segment stenosis or flap seen\nto suggest dissection on CT.\n(Thin lucency at the anterior aspect of left transverse foramen of C4 -? \nCongenital/trauma. Patent left vertebral artery at this level, however).\nLucency noted around the right maxillary molar, can relate to unerrupted tooth\nor dental etiology.\nMild fullness in the left pyriform sinus and prominent adenoids.\nCorrelate clinically" + }, + { + "input": "No acute infarction, hemorrhage, edema, or mass effect. There is slight\nprominence of the extraaxial space at the vertex and anteriorly suggesting\nsome cortical volume loss. The ventricles and sulci are otherwise normal in\nsize and configuration. No shift of normally midline structures. The\nmesencephalic cisterns are patent. Incidental bilateral basal ganglia\ncalcifications are noted and within normal limits. Extensive dural\ncalcifications are also noted in normal. There is hyperostosis frontalis\ninterna, normal.\n\nSmall right frontal midline soft tissue hematoma with tiny pockets of\nsubcutaneous emphysema compatible with history of laceration. No acute\nfracture is seen. . The incompletely visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. No air-fluid levels identified in\nthe sinuses. Other than bilateral lens replacement, the orbits are\nunremarkable.", + "output": "1. No acute intracranial abnormality including no intracranial hemorrhage.\n2. No fracture.\n3. Small right frontal laceration with hematoma." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. Relative high\ndensity of the intracranial vessels relates to recent intravenous contrast\nadministration. Prominence of the bifrontal extra-axial spaces was seen\npreviously.\n\nThere is no evidence of fracture. There is mild mucosal thickening in the\nleft sphenoid sinus. Remainder of the paranasal sinuses are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Normal study." + }, + { + "input": "Minimal nonspecific left frontal (03:32) and right parietal (03:49) scalp soft\ntissue swelling is noted. There is no evidence of acute infarction,\nhemorrhage, edema, mass, or mass effect. Periventricular and scattered foci\nof deep white matter hypodensity are nonspecific, however unchanged since ___, in compatible with the sequelae of chronic small vessel microangiopathy.\nMild prominence of ventricles and sulci is consistent with age-appropriate\nglobal atrophy. Carotid siphon calcifications are noted. The visualized\nparanasal sinuses and mastoid air cells are clear. The globes and bony orbits\nare intact and unremarkable. Soft tissue density is noted within the left\nexternal auditory canal which may represent cerumen.", + "output": "1. No acute intracranial abnormality, with no evidence of acute intracranial\nhemorrhage.\n2. Minimal left frontal and right parietal scalp soft tissue swelling without\nevidence of underlying fracture.\n3. Stable atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described." + }, + { + "input": "Mild mucosal thickening is noted within the left maxillary sinus. There is\nmild prominence of the bilateral palatine tonsils. No evidence of surrounding\nfat stranding or focal fluid collections. Evaluation of the aerodigestive\ntract demonstrates no exophytic mass, nor areas of focal mass effect.\nEvaluation of the cervical lymph chains demonstrate no pathologic\nlymphadenopathy by imaging criteria. The visualized salivary glands are\nunremarkable in appearance. Thyroid gland is unremarkable. Neck vessels are\npatent. Upper lung fields are clear. No fractures are identified.", + "output": "Mild prominence of the bilateral palatine tonsils, maybe due to a mild\ntonsillitis, without surrounding fat stranding or focal fluid collection. No\nlymphadenopathy." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass effect. Age advanced involutional changes noted.\n\nNo acute fractures are seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Age advanced involutional changes can be correlated clinically." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass. There is mild prominence of the ventricles and sulci suggestive of\ninvolutional changes. Atherosclerotic calcifications are noted within the\ncarotid siphons bilaterally.\n\nThere is no evidence of fracture. There is mild mucosal thickening within the\nbilateral ethmoid air cells. Aerosolized secretions are noted in the right\nmaxillary and left sphenoid sinuses, findings that can be seen in the setting\nof acute sinusitis. Mastoid air cells and middle ear cavities are clear. The\nvisualized orbits are unremarkable.", + "output": "1. No acute intracranial hemorrhage or evidence of vascular territorial\ninfarction on noncontrast head CT.\n2. Aerosolized secretions in the right maxillary and left sphenoid sinuses, a\nnonspecific finding that should be correlated clinically for acute sinusitis." + }, + { + "input": "There is no evidence of large territorial infarction, hemorrhage, edema, or\nmass. There is prominent ventricles and sulci, related to the involutional\nchanges, similar to the prior exam.\n\nThere is no evidence of fracture. Small aerosolized secretions are seen in\nthe right maxillary sinus. The visualized portion of the orbits, mastoid air\ncells, and middle ear cavities are otherwise unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of large territory infarction,hemorrhage,edema, or mass. \nThe ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of large territorial infarction. Please note that MRI is more\nsensitive for the evaluation of acute stroke than CT and can be obtained if\nclinically indicated." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territory infarct. Gray-white matter\ndifferentiation is preserved. Prominence of the ventricles and sulci is\nsuggestive of involutional changes. The visualized paranasal sinuses\ndemonstrate mucosal thickening in the partially imaged bilateral ethmoid air\ncells and minimal mucosal thickening in the sphenoid sinuses. The frontal\nsinuses are relatively underpneumatized.. The mastoid air cells are clear. \nNo acute fracture is seen.", + "output": "No acute intracranial process." + }, + { + "input": "Head CT: There is no evidence of hemorrhage, edema, masses, mass effect, or\ninfarction. The ventricles and sulci are normal in caliber and configuration.\nNo fractures are identified.\n\nHead and neck CTA: The carotid and vertebral arteries and their major branches\nare patent with no evidence of stenoses. The distal cervical internal carotid\narteries measure 5 mm in diameter on the left and 5 mm in diameter on the\nright. There is no evidence of aneurysm formation or other vascular\nabnormality.", + "output": "Normal Study" + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No fracture or intracranial hemorrhage." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Periventricular, subcortical, and deep white matter hypodensities\nin the left cerebral hemisphere are nonspecific, but consistent with chronic\nmicrovascular ischemic disease. Ventricles and sulci are normal in overall\nsize and configuration. The imaged paranasal sinuses are clear. Mastoid air\ncells and middle ear cavities are well aerated. The bony calvarium is intact. \nThe bilateral carotid arteries are moderately calcified.", + "output": "1. No acute intracranial process.\n2. Periventricular, subcortical, and deep white matter hypodensities in the\nleft cerebral hemisphere are nonspecific, but consistent with chronic\nmicrovascular ischemic disease." + }, + { + "input": "The study is limited by motion artifact. There is no evidence for an\nenhancing intracranial mass. No pathologic leptomeningeal or pachymeningeal\ncontrast enhancement is identified. There is no evidence for edema or mass\neffect. Evaluation for acute blood products is limited in the absence of a\nprecontrast scan, but no evidence for hemorrhage is seen. Areas of low\ndensity in the supratentorial white matter are nonspecific but likely sequela\nof chronic small vessel ischemic disease in this age group. Ventricles and\nsulci are prominent due to age-related parenchymal volume loss.\n\nNo suspicious lytic or sclerotic bone lesion is identified. Evaluation of the\nmastoid air cells is limited by motion artifact. There are small mucous\nretention cysts in bilateral maxillary sinuses, as well as mucosal thickening\nin the left anterior ethmoid.", + "output": "Motion limited exam. No evidence for intracranial malignancy.\n\nRECOMMENDATION(S): MRI would be significantly more sensitive for intracranial\nmalignancy, particularly leptomeningeal disease, if clinically warranted." + }, + { + "input": "There is geographic white matter edema pattern of the right parietal lobe\nextending to the anterior temporal lobe (series 2, image 12 through 20), with\nassociated sulcal effacement and mass effect on the occipital horn of the\nright lateral ventricle. There may be mild involvement of the right splenium.\nNo ventriculomegaly is identified.\n\nThere is right middle frontal gyrus encephalomalacia (series 2, image 14) with\nmild volume loss. This corresponds to a region of subtle enhancement on\nexamination of ___, potentially than representing subacute infarct. \nUnderlying lesion is not excluded.\n\nThere is no large acute territorial infarct. No intracranial hemorrhage is\nidentified.\n\nSmall mucous retention cyst in the right maxillary sinus with mild mucosal\nthickening of the ethmoid air cells is noted. The orbits are unremarkable\nnoting bilateral lens replacements. No suspicious osseous lesions. The\nmastoid air cells and middle ears are well pneumatized and clear.", + "output": "1. Geographic edema pattern of the right parietal lobe extending to the\nanterior temporal lobe with associated sulcal effacement and mass effect on\nthe occipital horn of the right lateral ventricle, concerning for underlying\nmass. There may be mild involvement of the right splenium.\n2. Regional right frontal lobe encephalomalacia with mild volume loss\npresumably representing prior infarct. However, underlying lesion is not\nentirely excluded.\n3. No acute large territory infarct or intracranial hemorrhage.\n\nRECOMMENDATION(S): Further evaluation with MRI brain with without contrast.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 5:17 ___, 2 minutes after\ndiscovery of the findings." + }, + { + "input": "Since prior exam, abnormalities involving bilateral occipital lobes have\nmildly improved, with glass effacement of the bilateral occipital horns and\natria of the lateral ventricles, decreased sulcal effacement, decreased\nsurrounding occipital and inferior parietal edema, findings may represent\nchanges from interval treatment response or evolution of encephalomalacia\npossibly related to infarcts. Edema involving undersurface of the right\ntemporal lobe has worsened, raising possibility for underlying mass.\n\nThere is stable chronic infarct involving anterior right frontal lobe. .\n\nThere is no large territory acute infarction. There is no ventriculomegaly. \nThere is no intracranial hemorrhage.\n\nAir-fluid level and moderate mucosal thickening are noted in the right\nmaxillary sinus. Paranasal sinuses are otherwise clear. Left Mastoid air\ncells are clear. There is minimal opacification of inferior right mastoid air\ncells.\n\nVisualized orbits are unremarkable.", + "output": "1. Decrease bioccipital mass effect, mildly decreased edema, differential\nconsiderations include evolving late subacute to chronic infarcts,\npostradiation changes given history of radiation therapy. Mildly increased\nright temporal lobe edema with associated sulcal effacement, mass cannot be\nexcluded.\n2. No large territorial infarction or intracranial hemorrhage.\n3. Suggestion of acute paranasal sinusitis, with fluid in the right maxillary\nsinus." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass. \nSuggestion of small lacunar infarct in the left corona radiata, likely\nchronic. There few left hemispheric small hypodensities involving deep white\nmatter, likely represent moderate chronic small vessel ischemic changes, if\nclinically indicated, MRI would be helpful in further evaluation. Generalized\nbrain parenchymal atrophy.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "Probable moderate chronic small vessel ischemic changes, and probable chronic\nlacunar infarct; if clinically indicated, MRI would be helpful in further\nevaluation.\nGeneralized brain parenchymal atrophy\nNo hemorrhage." + }, + { + "input": "There is a stable 3 mm hyperdense focus in the right cerebellum (series\n2:image 7). There is no evidence of acute vascular territorial infarction,\nmass or edema. Cavum septum pellucidum et vergae is incidentally noted. The\nventricles and sulci are normal in size and configuration. There is a right\nfrontal subgaleal hematoma without underlying fracture.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Similar small 3 mm focus in the right cerebellum may reflect a small\nmicrohemorrhage or calcification. No surrounding edema.\n2. Right frontal subgaleal hematoma without underlying fracture." + }, + { + "input": "There is no evidence of acute hemorrhage mass effect midline shift or\nhydrocephalus. Gray-white matter differentiation is maintained. Mild brain\natrophy is seen.\n\nThe visualized paranasal sinuses are clear. No skull fracture is seen.", + "output": "No significant intracranial abnormalities are identified." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect or\nlarge territorial infarction. The ventricles and sulci are prominent as before\nsuggesting age-related involutional changes. The basal cisterns are patent.\nGray-white matter differentiation is maintained. Mild periventricular white\nmatter hypodensities suggest sequela of chronic microvascular ischemic\ndisease.\n\nThere is no evidence of acute fracture. There is chronic opacification of\nright mastoid air cells. The middle ear cavities are clear. The globes are\ngrossly intact.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. The basal cisterns\nappear patent and there is preservation of grey white matter differentiation.\n\nNo acute fracture is seen seen. There is a small mucous retention cyst in an\nanterior left-sided ethmoid air cell. An anterior right-sided ethmoid air cell\nis fluid filled. The remaining visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Laceration and swelling along the right posterior scalp noted (03:46) without\nunderlying fracture.\n\nThere is no evidence of acute large territory infarction,hemorrhage,edema,or\nlarge mass. There is diffuse cortical atrophy and prominence of the\nventricles and sulci in keeping with involutional changes. The deep\nsubcortical periventricular white matter hypodensities are nonspecific but\nlikely represent sequela of chronic microvascular ischemic changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Right posterior scalp laceration and swelling, no fracture. No intracranial\nhemorrhage." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration. There are\nprominent dural calcifications along the falx cerebri and overlying the\nfrontal and parietal lobes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "No significant intracranial abnormality." + }, + { + "input": "Right parietal intraparenchymal hemorrhage, measuring approximately 27 x 22\nmm, not significantly changed compared to prior study. No new hemorrhage\nlesions identified. Mild mass effect is re-demonstrated with slight narrowing\nof the right occipital ventricular horn. No midline shift is seen. The basal\ncisterns appear patent.\n\nThe visualized bony structures are grossly unremarkable. The paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Atherosclerotic\nmural calcification of the bilateral internal carotid arteries is noted. The\nglobes are unremarkable.", + "output": "Stable right parietal intraparenchymal hemorrhage. No new hemorrhagic lesions." + }, + { + "input": "Status post right craniotomy for resection of a parietal hemorrhagic \nlesion/hematoma. There are expected soft tissue changes and evidence of prior\ncraniotomy in the right parietal region. Pneumocephalus is expected\npostoperatively. There is a minimal amount of edema in the right parietal lobe\npresumably related to surgery. Minimal high density adjacent to the resection\nbed may represent a tiny amount of hemorrhage or surgical changes.\nThe gray-white matter differentiation preserved. There is no evidence of mass\neffect. The basal cisterns are patent. There is no downward herniation.\nThere is cerumen in the bilateral external auditory canals.\nThe ventricles and sulci are normal in size and configuration.\nThere is minimal mucosal thickening in the ethmoid air cells; otherwise, the\nparanasal sinuses are clear.\nThere is evidence of prior right mastoid surgery. The mastoid air cells are\nclear.\nThe orbits are unremarkable.\nA small lucent focus in the left frontal bone - se 4, im 44, is stable since\n___ and can represent a small hemangioma, etc.", + "output": "Expected postoperative appearance status post right craniotomy for resection\nof the lesion.\nNo significant new hemorrhage or mass effect." + }, + { + "input": "NECT HEAD\n\nThere is a 3.2 x 3.1 cm acute intraparenchymal hematoma in the right posterior\nparietal lobe, with mild to moderate surrounding edema. There is also slightly\nincreased attenuation of the overlying cortex, which may relate to congestion\nor contusion along with small foci of subarachnoid hemorrhage adjacent, latter\nbetter seen on the subsequent MRI.\nThere is mass effect on the atrium of the right lateral ventricle along with\nadjacent sulcal effacement.\nThere are multiple small hypodense foci in the subcortical and periventricular\nwhite matter, nonspecific in appearance.\nThe ventricles, extra-axial CSF spaces and sulci elsewhere are unremarkable.\n\nNo suspicious osseous lesions are noted.\nThe mastoid air cells are clear.\nThe petrous apices are pneumatized left more than right.\nMild ethmoidal mucosal thickening on both sides.\nSphenoid sinus has one major septation and 1 minor septation, the latter\ninserts on the left carotid groove.\nMild mucosal thickening in the right side of the frontal sinus.\n\nCT ANGIO HEAD\n\nThe major intracranial arteries of the anterior and the posterior circulation\nare patent, without focal flow-limiting stenosis, occlusion or aneurysm more\nthan 3 mm within the resolution of the study. The right posterior inferior\ncerebellar artery origin is faintly seen.\nNo obvious abnormal blood vessels are noted in the region of the right\nposterior parietal hematoma.\nThe enhancement in the venous sinuses in the venous tributaries is grossly\nunremarkable though not targeted.\nMinimal calcifications are noted in the right cavernous carotid segment.\n\nCT ANGIO NECK\n\nSlightly suboptimal due to the slightly decreased intensity of the bolus.\nThe origins of the arch vessels are patent.\nMinimal calcifications are noted in the aortic arch.\n2 vessel aortic arch pattern, with common origin of the brachiocephalic trunk\nand the left common carotid artery.\nRight vertebral artery is dominant.\nThe vertebral arteries is slightly tortuous in course with scattered\ncalcifications in the left vertebral artery. No focal flow-limiting stenosis\nor occlusion noted.\n\nThe common carotid arteries are patent.\nMild calcifications are noted at the common carotid bifurcations, without\nfocal flow-limiting stenosis or occlusion.\nThe cervical internal carotid arteries or patent, without focal flow-limiting\nstenosis or occlusion.\nThere is mild focal dilation of the left proximal cervical internal carotid\nartery proximally, with some narrowing question related to tortuosity.\n\nCT NECK\n\nMild fullness in the left pyriform sinus.\nMultiple small nodes are noted in both sides of the neck, not abnormally\nenlarged by size criteria.\nNo obvious mass like lesions noted.\nMild degenerative changes in the cervical spine without significant canal or\nforaminal narrowing.", + "output": "1. A 3.2x3.1cm right posterior parietal lobe acute intraparenchymal hematoma\nwith some surrounding edema and mass effect. No abnormal vessels in the\nvicinity.\nPlease see subsequent MRI for additional findings and discussion.\n2. Patent major intra and extracranial arteries as discussed above.\n3. Mild fullness in the left pyriform sinus and multiple small nodes not\nenlarged by size criteria however correlate clinically." + }, + { + "input": "There is no acute intracranial hemorrhage, edema, or mass-effect. Prominent\nventricle and sulci reflect age related volume loss. There is no shift of\nnormally midline structures. Basal cisterns are patent. Periventricular and\nsubcortical white matter hypodensities are nonspecific, likely sequela of\nchronic small vessel ischemia. Gray-white matter differentiation is\npreserved. Relative density along the midline falx and tentorial leaflets\nlikely represent areas of calcification.\n\nThe orbits are unremarkable. Mucosal thickening involves the ethmoid air\ncells and partially imaged maxillary sinuses. Mastoid air cells and middle\near cavities are clear. Carotid siphon vascular calcifications are moderate. \nThe bony calvarium is intact.", + "output": "No acute intracranial hemorrhage. At the site of reported subdural hematoma,\na thickened hyperdense appearance of the falx is more consistent with chronic\nmineralization." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is a hypoplastic right ACA A1 segment and an azygos ACA. The vessels of\nthe circle of ___ and their principal intracranial branches appear normal\nwithout stenosis, occlusion, or aneurysm formation. The dural venous sinuses\nare patent. Incidentally noted is fenestration of proximal basilar artery.\n\nCTA NECK:\nThere is a left dominant vertebrobasilar system with a hypoplastic right\nvertebral artery V4 segment, likely congenital. The carotid and vertebral\narteries and their major branches appear otherwise normal with no evidence of\nstenosis or occlusion. There is no evidence of internal carotid stenosis by\nNASCET criteria.\n\nOTHER:\nThere is biapical pleural parenchymal scarring of the lungs. The visualized\nportion of the thyroid gland is within normal limits. There is no\nlymphadenopathy by CT size criteria.", + "output": "1. No acute intracranial abnormality.\n2. No evidence of dissection, aneurysm or occlusion of the head and neck. No\nsignificant ICA stenosis by NASCET criteria." + }, + { + "input": "There is no evidence of acute hemorrhage ,edema ,mass effect,or loss of gray/\nwhite matter differentiation. There is prominence of the ventricles and sulci\nsuggestive of global prior involutional changes. Subcortical, deep, and\nperiventricular white matter hypodensities are specific but likely sequela of\nchronic small vessel ischemic disease.\n\nThere is no evidence of fracture. A large mucous retention cyst is noted in\nthe right maxillary sinus. There is mild mucosal thickening in the left\nmaxillary sinus. Mastoid air cells are well aerated. There is evidence of\nbilateral lens replacement.", + "output": "No evidence for acute intracranial abnormalities." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass\neffect. Calcification at the anterior cranial fossa on the right may\nrepresent a calcified meningioma (03:26). The ventricles and sulci are normal\nin size and configuration. Patchy hypoattenuation in the supratentorial white\nmatter is nonspecific, but likely represents the sequela of chronic small\nvessel ischemic disease. There is mild diffuse cerebral volume loss.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion or aneurysm formation. The right\nvertebral artery terminates as the posterior inferior cerebellar artery. \nThere is fetal origin of the left posterior cerebral artery, a normal anatomic\nvariant. The left A1 segment is hypoplastic. The dural venous sinuses are\npatent.\n\nCTA NECK:\nThere is densely calcified atherosclerotic plaque at the bilateral carotid\nbifurcations and proximal internal carotid arteries. The lumen of the left\nproximal internal carotid artery measures 2.5 mm. The normal distal left\ninternal carotid artery measures 4 mm. The lumen of the right proximal\ninternal carotid artery measures 3.6 mm. The lumen of the more distal normal\nright internal carotid artery measures 4.2 mm. There are atherosclerotic\ncalcifications at the origins of the vertebral arteries, which are patent. \nThe left vertebral artery is dominant.\n\nOTHER:\nThere are calcified pleural plaques in the upper lobes. The round,\nwell-circumscribed, hypodense nodule in the left inferior thyroid lobe\nmeasures 0.9 cm. There is no lymphadenopathy by CT size criteria.", + "output": "1. Approximately 40% stenosis of the left proximal internal carotid artery by\nNASCET criteria.No evidence of stenosis of the right internal carotid artery\nby NASCET criteria.\n2. Unremarkable CTA of the head." + }, + { + "input": "Head CT: There is no evidence of hemorrhage, edema, masses, mass effect, or\ninfarction. The ventricles and sulci are normal in caliber and configuration.\nNo fractures are identified.\n\nHead CTA: There is a right cavernous ICA aneurysm measuring 20 x 17 mm, which\nis calcified and partially thrombosed. The aneurysm is extradural. There are\nno other intracranial vascular abnormalities.\n\nNeck CTA: The carotid and vertebral arteries and their major branches are\npatent with no evidence of stenoses. There is no evidence of internal carotid\nstenosis by NASCET criteria.", + "output": "Partially thrombosed right cavernous ICA aneurysm." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nAn approximately 3 mm right nasal septal fat tissue density is noted ___ 129,\nsee 601b:33, 602b:68, 2:39). Allowing for difference in technique, this\nfinding is grossly stable compared to the ___ prior examination (see\n12:18 on prior exam), and is partially visualized on the ___ prior\nexam (see 9:1 on this examination). No definite nasal septal perforation,\nadjacent bony sclerosis or bony remodeling is noted.\n\n\nMinimal right maxillary sinus mucosal thickening is present. The ostiomeatal\nunits are patent. The cribriform plates are intact. There is no nasal septal\ndefect. Minimal leftward nasal septal deviation with bony spur is noted. A\nleft-sided concha bullosa is noted. The anterior clinoid processes are not\npneumatized. The lamina papyracea are intact. The sphenoid sinus septum is\nmidline with insertion upon the sellar floor.", + "output": "1. Dental amalgam streak artifact limits study.\n2. Approximately 3 mm soft tissue density arising from nasal septum right\nmargin without definite associated bony or nasal septal destruction are bony\nremodeling. Allowing for difference technique, finding is grossly stable\ncompared to ___ prior exam, and may have been present on ___ prior exam. Differential considerations include congenital, infectious,\ninflammatory etiologies, with neoplastic etiologies less likely but not\nexcluded. Recommend correlation with direct examination.\n3. Minimal paranasal sinus disease as described.\n4. Minimal leftward nasal septal deviation bony spur.\n5. Left-sided concha bullosa.\n\nRECOMMENDATION(S): Approximately 3 mm soft tissue density arising from nasal\nseptum right margin without definite associated bony or nasal septal\ndestruction are bony remodeling. Allowing for difference technique, finding\nis grossly stable compared to ___ prior exam, and may have been\npresent on ___ prior exam. Differential considerations include\ncongenital, infectious, inflammatory etiologies, with neoplastic etiologies\nless likely but not excluded. Recommend correlation with direct examination." + }, + { + "input": "Please note that the study is motion degraded and limits evaluation of\nintracranial structures. Within these limitations, there is no evidence of\nobvious infarction, large hemorrhage,edema,or mass. The ventricles and sulci\nare normal in size and configuration.\n\nThere is no evidence of definite fracture. There is near complete\nopacification of the left frontal sinus, both ethmoid air cells, maxillary\nsinuses, and right sphenoid sinus. Mild mucosal thickening is also noted in\nthe left sphenoid sinus. The mastoid air cells appear grossly clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Please note that the study is motion degraded limits evaluation of\nintracranial structures. Within these limitations, no obvious intracranial\nabnormalities are seen.\n2. Extensive paranasal sinus disease, as above.\n\nRECOMMENDATION(S): If there is high clinical concern for small intracranial\nhemorrhage, a short-term follow-up CT can be obtained." + }, + { + "input": "There is a linear area of hypodensity in the left occipital lobe (series 2b,\nimage 22), which appears to correspond to a sulcus on coronal view. There is\nno intracranial hemorrhage. Ventricles and sulci are normal in size and\nconfiguration. There is no acute fracture. The paranasal sinuses are clear. \nThe orbits are unremarkable.", + "output": "Linear area of hypodensity in the left occipital lobe appears to correspond to\na sulcus on coronal view. A small demyelinating lesion is however, not\nexcluded. If the patient develops further symptoms an MRI can be considered\nfor further evaluation.\n\nRECOMMENDATION(S): If the patient develops further symptoms an MRI can be\nconsidered for further evaluation.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ on the ___ ___ at 10:13 ___, 10 minutes after discovery\nof the findings." + }, + { + "input": "Compared with CT head on ___, there is a small amount of\nsubarachnoid blood in the left sylvian fissure, left frontoparietal sulci and\nat the left vertex which appears slightly more than would be expected for\ninterval redistribution of previously seen focus of subarachnoid hemorrhage at\nthe left vertex ___, 19, 28). In addition, there is new right-sided\nsubarachnoid hemorrhage, and a small amount of intraventricular hemorrhage\nlayering in the occipital horns of the lateral ventricles (02:16). No\nevidence of acute large territorial infarction. There is stable mild\nprominence of the ventricles and sulci suggestive of age-related involutional\nchanges. Subcortical and periventricular white matter hypodensities are\nnonspecific, however likely represent sequela of chronic small vessel ischemic\ndisease. Relative ___ of the intercerebral vasculature is likely due\nto retained contrast from CTA chest performed earlier on same day.\n\nThere is partially visualized ___ in the spinal canal at the\ncraniocervical junction correlating with subdural hematomas seen on MRI\nperformed on same day.\n\nThere are small left and right parietal subgaleal hematomas. There is no\nevidence of fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. Patient is status post\nbilateral lens replacement. The visualized portion of the orbits are\notherwise unremarkable.", + "output": "1. Interval increase left subarachnoid hemorrhage, with new right subarachnoid\nhemorrhage and small amount of blood layering in the occipital horns of the\nlateral ventricles.\n2. Blood seen within the spinal canal at the craniocervical junction, as seen\non MRI performed earlier on same day.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 6:50 pm, 1 minutes after\ndiscovery of the findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nUnchanged appearance of subarachnoid blood products in the left frontoparietal\nregion and bilateral posterior parietal regions. No interval change in the\nmild in appearance of blood products in left sylvian fissure, bilateral\noccipital horn. No new areas of hemorrhage or large territory infarction.\nMucosal thickening the bilateral ethmoid air cells. The other paranasal\nsinuses, middle air and mastoid air cells are well pneumatized. The patient is\nstatus post bilateral lens replacement surgery. Bilateral staphyloma.\n\nA left parietooccipital scalp hematoma is identified, overall similar to prior\nexamination without underlying calvarial fracture.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThere is a normal 3 vessel arch. The bilateral common carotid, subclavian and\nvertebral arteries are unremarkable. There is no stenosis of the right\ncervical internal carotid artery by NASCET criteria. A single linear filling\ndefect of the posterior left carotid bifurcation (series 3, image 157) is\nwithout evidence of abnormal vessel wall thickening or surrounding\ninflammatory stranding. This is most compatible with a carotid web. \nOtherwise, the remainder of the right internal carotid artery is unremarkable\nand is without stenosis by NASCET criteria..\n\nOTHER:\nThere are biapical pulmonary nodules measuring up to 4 mm (series 3, image 85\nand 33). A calcified granuloma of the left lower lobe (series 3, image 14) is\nnoted. The thyroid is unremarkable. Visualized aerodigestive tract is\nunremarkable. There is no cervical lymphadenopathy by size criteria. \nSubcutaneous and paraspinal inflammatory stranding of the upper to mid\nposterior cervical spine is identified compatible with known history of\ntrauma. There is no prevertebral soft tissue swelling. No acute osseous\nabnormality..", + "output": "1. No interval change in diffuse subarachnoid hemorrhage from prior\nexamination. No new hemorrhage. No acute large territory infarct.\n2. Unremarkable CTA of the head without evidence of vasospasm.\n3. A linear single filling defect of the posterior left carotid bifurcation\nwithout evidence of mural thickening or surrounding from phlegm ___\nstranding, most compatible with a carotid web. There is no stenosis of the\nleft cervical internal carotid artery by NASCET criteria. If there is high\nconcern for dissection given patient's traumatic history, axial T1 noncontrast\nfat saturated sequences through the neck can be performed.\n4. Otherwise the remainder of the CTA neck is unremarkable.\n5. Small 4 mm pulmonary nodules. Additional findings as described above.\n\nRECOMMENDATION(S):\n1. Likely left carotid web. If there is a high clinical concern for\ndissection given patient's clinical history of trauma, axial T1 noncontrast\nfat saturated sequences through the neck can be performed.\n2. For incidentally detected multiple solid pulmonary nodules smaller than\n6mm, no CT follow-up is recommended in a low-risk patient, and an optional CT\nfollow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___\n\nNOTIFICATION: The additional finding of likely carotid web in the left\ncarotid bifurcation was discussed with Dr. ___. by ___,\nM.D. on the telephone on ___ at 6:23 pm, 10 minutes after discovery of\nthe findings." + }, + { + "input": "The study is limited by motion artifact. Within these confines:\n\nPreviously seen subarachnoid blood within the left sylvian fissure, bilateral\nparietal lobes, and right temporoparietal region persist, but are not as\nconspicuous on the prior CT from ___. Intraventricular blood\nwithin the occipital horns of the lateral ventricles appears mildly decreased\nfrom prior. No new hemorrhage is identified. There is prominence of the\nventricles and sulci suggestive of involutional changes. Periventricular\nwhite matter hypodensities are nonspecific, likely sequela of chronic ischemic\nsmall vessel disease, better seen on the prior MRI.\n\nA left parietal subgaleal hematoma measuring approximately 1.9 cm (03:27)\nappears slightly decreased in size from the prior CT. There is no evidence of\nacute fracture. The visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. Aside from bilateral lens\nreplacements, the visualized portion of the orbits are unremarkable.", + "output": "The study is limited by motion artifact. Within these confines:\n\n1. Interval decrease in conspicuity of subarachnoid blood within the left\nsylvian fissure, bilateral parietal lobes, and right temporoparietal region. \nMild interval decrease in intraventricular blood within the lateral\nventricles. No new hemorrhage identified.\n2. Interval decrease in size of a left parietal subgaleal hematoma." + }, + { + "input": "Small amount of left vertex frontal subarachnoid hemorrhage, nonaneurysmal\npattern, along the left central sulcus is noted (02:24). There is no evidence\nof infarction, edema, or mass. The ventricles and sulci are normal in size and\nconfiguration. Mild periventricular white matter hypodensities are suggestive\nof chronic small vessel ischemic disease.\n\nThere is a large left parietal subgaleal hematoma with small foci of\nsubcutaneous air suggesting associated laceration at this location. No\nosseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. Small volume left vertex subarachnoid hemorrhage, nonaneurysmal pattern.\n2. Large left parietal subgaleal hematoma, laceration. No fractures." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are prominent consistent with age-related atrophy.\nConfluent periventricular and subcortical white matter hypodensities likely\nrepresent the sequela of chronic small vessel ischemic disease. There is no\nevidence of fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable. The cavernous portion of the internal carotid\narteries are calcified.", + "output": "No acute intracranial process. The mandible is not imaged on this study." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nNo evidence for acute hemorrhage, edema, mass effect, or acute major vascular\nterritorial infarction. Mild periventricular, deep, and subcortical white\nmatter hypodensities are nonspecific but likely sequela of chronic small\nvessel ischemic disease in this age group. Mild age-related prominence of the\nventricles and sylvian fissures. There is minimal mucosal thickening in the\nparanasal sinuses. Mastoid air cells appear grossly well-aerated. The orbits\nappear unremarkable.\n\nCTA NECK:\nThe left vertebral artery arises directly from the aortic arch, a normal\nvariant. The right vertebral artery is dominant. Bilateral vertebral\narteries appear widely patent. There is a retropharyngeal course of the\ncommon carotid arteries. There is mild calcified plaque in the proximal left\ninternal carotid artery without stenosis by NASCET criteria. There is no\nright carotid stenosis by NASCET criteria.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal patent without evidence for flow-limiting stenosis or aneurysm\nthere is bilateral fetal type configuration of the posterior cerebral\narteries, with larger contribution from the posterior communicating arteries\ncompared to the P1 segments. The dural venous sinuses are patent.\n\nOTHER: Bilateral palatine tonsilliths are consistent with sequela of prior\ninfections. The thyroid is unremarkable. No pathologically enlarged lymph\nnodes by CT criteria. Moderate right and mild left lung apex paraseptal\nemphysema, as well as mild centrilobular emphysema within bilateral included\nupper lungs. Degenerative changes in the cervical spine.", + "output": "1. No evidence for acute intracranial abnormalities. MRI would be more\nsensitive for an acute infarction, if clinically warranted.\n2. Mild atherosclerosis of the proximal left ICA without stenosis by NASCET\ncriteria.\n3. The left vertebral artery arises directly from the aortic arch, a normal\nvariant.\n4. Normal CTA of the circle of ___.\n5. Emphysema in the visualized upper lungs." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci and unremarkable. Basilar cisterns are\npatent.\n\nAerosolized secretions and mucosal thickening noted in the left sphenoid\nsinus. Mucous retention cysts and mucosal thickening seen in the partially\nvisualized maxillary sinuses. There is nasal septal perforation. The\nbilateral inferior turbinates are also largely absent.", + "output": "No acute intracranial process, no hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration for age.\n\nThere is no evidence of fracture. There is complete opacification of the\nright frontal sinus, with chronic periostitis, no evidence of sinus expansion\nor bone destruction, similar to prior. The visualized portion of the\nremaining paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits show a right scleral band.", + "output": "1. No acute intracranial process.\n2. Isolated complete opacification right frontal sinus, stable." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Complete opacification of the right frontal\nsinus with associated chronic periostitis is unchanged. The visualized\nportion of the remaining paranasal sinuses, mastoid air cells and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear.\n\n3.6 cm heterogeneously enhancing nodule is seen within the right thyroid lobe.\nThyroid mass exerts mass effect and displacement of the common carotid artery\nand internal jugular vein. Mild mass effect on the trachea.\n\nMedialized right true vocal cord, with mild atrophy of the muscle, enlargement\nof the laryngeal ventricle and right piriform sinus, consistent with right\nvocal cord paralysis/paresis. In view of this and thyroid abnormality, ENT\nconsult recommended. There is no lymphadenopathy by CT size criteria. \nProbable benign fibro-osseous lesion right mandible. No lytic abnormality,\ncortical destruction or soft tissue mass.", + "output": "1. No acute intracranial process.\n2. No evidence of stenosis, occlusion, dissection or aneurysm.\n3. 3.6 cm right thyroid mass, local mass-effect. Findings consistent with\nright vocal cord paralysis/paresis. ENT consult, thyroid ultrasound\nrecommended.\n\nRECOMMENDATION(S): ENT consult, thyroid ultrasound.\n\nNOTIFICATION: The findings were discussed with ___ QA nurses via ___ by\n___, M.D. On ___ at 11:00 am, 10 minutes after discovery\nof the findings." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, effect,\nor acute large vascular territorial infarct. No hydrocephalus is seen.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal si sinuses demonstrates mild mucosal thickening of the left\nmaxillary sinus and left sphenoid sinus. The mastoid air cells are clear.", + "output": "No evidence of acute intracranial hemorrhage." + }, + { + "input": "Study is limited by motion degradation.\n\nHypodense area in the left occipital and temporal lobes in the region of the\nleft posterior cerebral artery is unchanged from CT head ___ a\ncorresponds to evolving left posterior cerebral artery infarct with\ncharacterized on MRI ___. There are ill-defined hyperdense foci\nwithin this area which are unchanged from ___ and compatible with\nblood products seen. There is no definite evidence of worsening hemorrhage.\n\nThere is midline shift. Ventricles and sulci are stable from ___ there\nis mucosal thickening of the bilateral ethmoid air cells, sphenoid sinus, and\nbilateral maxillary sinuses. There is a mucous retention cyst in the left\nmaxillary sinus. Mastoid air cells middle ear cavities are patent. The bony\ncalvarium is intact.", + "output": "Hypodense area in the left occipital and temporal lobes compatible with\nevolving left posterior cerebral artery infarction. Hyperdense foci within\nthis area compatible with blood products and is grossly unchanged from CT head\n___. No definite evidence of worsening hemorrhage." + }, + { + "input": "Dental amalgam streak artifact limits study. There is a defect at the base of\nthe tongue which may be due to prior surgery. At the left posterior tongue is\nincreased soft tissue prominence and enhancement. Additionally there are two\nsmall peripherally enhancing small fluid collections that appear to be\nconnected and measure 5 mm and 11 mm respectively. There is mild thickening\nof epiglottis and aryepiglottic folds which is likely secondary to the\nadjacent the infectious/inflammatory process. The airway remain widely patent.\nThe parotid glands, submandibular glands are unremarkable. There are small\ncervical lymph nodes that do not meet CT criteria for lymphadenopathy.\n\nThere is no prevertebral edema or retropharyngeal abscess.\n\nThere is minimal mucosal thickening of the bilateral ethmoid sinuses and left\nmaxillary sinus. The right mastoid air cells are partially opacified which\nmay represent sequela of prior infection. The other included paranasal\nsinuses and left mastoid air cells are clear.\n\nVascular structures in the neck are grossly unremarkable.\n\nIncluded intracranial structures appear normal.\n\nNo focal suspicious osseous lesion identified.", + "output": "1. Increased tissue prominence, enhanced and small abscesses are demonstrated\nat the left posterior tongue suggestive of an infectious process. Differential\nconsiderations include an infected thyroglossal duct cyst, however a\nneoplastic lesion cannot be excluded. Direct examination of the oral cavity\nis advised to further characterize.\n2. No evidence of cervical adenopathy." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass. There is encephalomalacia in the left frontal parietal lobe\ncompatible with prior old infarct. There is also a hypodensity in the left\ncorona radiata as well as the right thalamus likely reflecting prior old\ninfarcts. Prominent ventricles and sulci suggest age related global atrophy. \nPeriventricular and subcortical white matter hypodensities are nonspecific,\nbut likely reflect sequelae of chronic small vessel ischemic disease. The\nbasal cisterns appear patent and there is preservation of gray-white matter\ndifferentiation.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No evidence of acute intracranial hemorrhage.\n2. Multiple areas of encephalomalacia in the left frontal parietal lobe,\ncorona radiata, and right thalamus compatible with prior infarcts." + }, + { + "input": "There is bilateral periventricular and subcortical white matter hypodensity\nalong the parietal lobe, asymmetrically prominent to the right and progressed\nfrom examination of ___, nonspecific, but felt most likely to\nrepresent sequela of chronic microangiopathy in a patient of this age. There\nmay be asymmetric subtle hypo peau density of the left anterior temporal lobe\n(series 2, image 9), felt likely to be artifactual. No definite acute large\nterritory infarct or intracranial hemorrhage. The sulci, ventricles and\ncisterns are within expected limits for the degree of mild senescent related\nglobal cerebral volume loss. Prominent bilateral internal carotid and\nvertebral artery calcifications are identified. Visualized paranasal sinuses\nare clear. The mastoid air cells middle ears are well pneumatized and clear. \nNo acute osseous abnormality.", + "output": "1. Bilateral periventricular and subcortical white matter hypodensities along\nthe parietal lobes, asymmetrically prominent to the right and progressed from\nexamination of ___, nonspecific, but felt likely to represent\nsequela of chronic microangiopathy.\n2. There may be subtle hypodensity of the left anterior temporal lobe, felt\nlikely to be artifactual. However clinical correlation is recommended.\n3. Subtle superimposed acute infarcts would be better evaluated with MRI, if\nthere are no contraindications.\n4. No evidence of acute large territorial infarct. No intracranial\nhemorrhage.\n5. Additional findings described above." + }, + { + "input": "Very subtle focal 4 mm hyperdensity in the right periventricular occipital\nregion seen on coronal series 601, image 78 and sagittal series 602, image 37 \ncould represent a small tiny focus of subarachnoid hemorrhage versus possibly\ntiny cavernoma. This was not seen on prior CT from ___. No acute\nintracranial hemorrhage seen elsewhere. Prominence of the ventricles and\nsulci is consistent with involutional changes. Periventricular and\nsubcortical white matter hypodensities are likely sequelae of chronic small\nvessel disease. Bilateral basal ganglia lacunar infarcts are seen. The\nvisualized paranasal sinuses are clear. The mastoid air cells are clear. No\nacute fracture is seen.", + "output": "Subtle focal 4 mm hyperdensity best seen on coronal and sagittal images in the\nright periventricular occipital region, possibly representing a tiny focus of\nsubarachnoid hemorrhage versus small cavernoma. This finding was not seen on\nprior CT from ___.\n\nGlobal involutional changes. Extensive bilateral periventricular subcortical\nwhite matter hypodensities may be sequela of chronic small vessel disease." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\nThere is no evidence of fracture. There is mild mucosal thickening in the\nethmoid air cells. The remainder of the paranasal sinuses are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Status post left frontal craniotomy and resection of left frontal dural-based\nmass. Cavity at the site of resection measures approximately 2.8 x 1.4 cm\n(2:13) and contains a small amount of extra-axial fluid, as expected. Linear\ncalcific density along the inferior aspect of the resection margin is likely\nresidual from the calcified mass. There is mild left pneumocephalus, as\nexpected. Linear hyperdensity along the superior aspect of the craniotomy\n(2:17) is favored to represent thickened dura rather than hemorrhage.\n\nExtensive left frontal and parietal lobe edema appears grossly similar to the\nrecent MRI. There is stable mass effect including partial effacement of the\nleft lateral ventricle and approximately 5 mm rightward midline shift. No\nevidence of acute large territory infarction or intracranial hemorrhage.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. Other than bilateral lens replacements, the the\nvisualized portion of the orbits are normal.", + "output": "1. Status post left frontal craniotomy and resection of left frontal\ndural-based mass with expected postsurgical changes. Curvilinear hyperdensity\nin the dependent aspect of the resection cavity likely represents residual\nfrom the calcified mass. Additionally, linear hyperdensity along the superior\naspect of the resection margin is favored to represent thickened dura rather\nthan acute hemorrhage.\n2. Stable left frontoparietal edema and mass effect, including 5 mm rightward\nmidline shift." + }, + { + "input": "Dental amalgam streak artifact and motion limits study. There is no evidence\nof acute infarction, hemorrhage, edema, or mass. There is mild prominence of\nthe ventricles and sulci suggestive involutional changes. There are\nperiventricular and subcortical lucencies, which may represent small vessel\nischemic changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Dental amalgam streak artifact and motion limits study.\n2. No acute intracranial abnormality. Please note MRI of the brain is more\nsensitive for the detection of acute infarct.\n3. No evidence of acute intracranial hemorrhage or fracture." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Ventricles\nand sulci are mildly prominent consistent with age related involutional\nchanges. Periventricular, subcortical, and deep white matter hypodensities\nare nonspecific, but likely suggestive of chronic microvascular ischemic\ndisease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. There are\nchanges from bilateral lens replacement surgery. The orbits are otherwise\ngrossly unremarkable.", + "output": "No acute intracranial abnormality. No evidence of intracranial hemorrhage or\nfracture." + }, + { + "input": "There is no evidence of acute large territory infarction,hemorrhage,edema,or\ndiscrete mass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is a small hyperdensity in the posterior right thalamus measuring\napproximately 1.0 x 0.7 cm (03:24) compatible with a intraparenchymal\nhemorrhage. There is no edema, large territorial acute infarct, or shift of\nnormally midline structures. Prominent ventricles and sulci compatible with\nchronic involutional changes. .The imaged paranasal sinuses are clear.\nMastoid air cells and middle ear cavities are well aerated. The bony calvarium\nis intact.", + "output": "1. Right thalamic intraparenchymal hemorrhage measuring approximately 1.0 x\n0.7 cm. There is no prior imaging for this patient." + }, + { + "input": "SOFT TISSUES: Moderate soft tissue edema and fat stranding in the bilateral\nperiorbital and infraorbital soft tissue. No soft tissue gas.\n\nMAXILLOFACIAL BONES: The maxillofacial bones are intact, without fracture.\nThe zygomatico-maxillary complex is intact. The lateral pterygoid plates are\nintact.\n\nMANDIBLE: The mandible is without fracture or temporomandibular joint\ndislocation. The temporomandibular joints are symmetric, without significant\ndegenerative change.\n\nDENTITION: There are no dental fractures. There is no remarkable periodontal\ndisease, periapical lucency, or odontogenic abscess.\n\nSINUSES: There is mild aerosolized secretion of the left sphenoid sinus. \nThere is mild mucosal thickening of the right maxillary sinus. The mastoid\nair cells and middle ear cavities are clear.\n\nORBITS: The orbits, including the laminae papyracea, are intact. The globes\nare intact and no intraocular hematoma. There is no retrobulbar hematoma or\nfat stranding. The patient appears status post bilateral lens replacement.\n\nNECK: An approximately 2.3 x 1.7 cm homogeneously attenuated,\nwell-circumscribed lesion within the right parotid gland (53 ___ is perhaps\nslightly decreased in size since ___ where measured 2.3 x 2.2 cm (series 3,\nimage 55) and could represent a pleiomorphic adenoma or node.\n\nAllowing for imaging technique optimized for the face, the limited included\nportion of the brain is grossly unremarkable.", + "output": "1. No fracture identified.\n2. Moderate bilateral periorbital and infraorbital soft tissue swelling. No\nretroorbital abnormality.\n3. 2.3-cm right parotid gland lesion, similar or smaller since ___, could\nrepresent a pleiomorphic adenoma or lymph node.\n4. Paranasal sinus disease as above.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\n___ ACSin ___ ___ at 11:45 ___, 15 minutes after discovery of the\nfindings." + }, + { + "input": "There is no acute hemorrhage, edema or shift of the normally midline\nstructures. Slight prominence of the ventricles sulci is compatible with age\nrelated involutional changes. Periventricular and subcortical white matter\nhypodensities, while nonspecific, are presumably sequela from chronic small\nvessel ischemic disease. A more focal hypodensity in the left thalamus is\nlikely a prior lacunar infarction. Otherwise, the gray-white matter\ndifferentiation is preserved and there is no evidence for an acute territorial\nvascular infarction. The basilar cisterns are patent. Dense calcifications are\nseen within the carotid siphons and vertebral arteries.\n\nSmall mucous retention cyst is seen within the left sphenoid sinus. Otherwise,\nthe included paranasal sinuses and mastoid air cells are well-aerated. \nBilateral proptosis is unchanged. Stranding in the soft tissues overlying the\nright parietal bone may relate to recent injury.", + "output": "No evidence of acute intracranial process or injury." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass. Subcortical and periventricular white matter hypodensities are\nnonspecific, however likely represent sequela of chronic small vessel ischemic\ndisease. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. There are bilateral vertebral artery calcifications\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality on noncontrast head CT.\n2. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described." + }, + { + "input": "Evaluation is mildly limited by motion despite repeat acquisition. There is no\nevidence of infarction, hemorrhage, edema, or mass. The ventricles and sulci\nare prominent consistent involutional changes. Periventricular hypodensities\nmay represent small vessel ischemic changes. Dense atherosclerotic\ncalcifications noted within the intracranial ICAs.\n\nNo fracture identified. The paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Images are slightly degraded by motion despite repeat acquisition. There is\nno evidence of acute infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nPeriventricular and subcortical white matter hypodensities are nonspecific,\nbut likely the sequela of chronic microvascular infarction. Dense\natherosclerotic calcifications are noted involving both cavernous carotid and\ndistal vertebral arteries.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Exam is slightly motion degraded, particularly on the reformatted views. \nThere is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Mild periventricular white matter hypodensities are nonspecific\nbut potentially due to chronic small vessel disease. Ventricles and sulci are\nprominent compatible with global volume loss.\n\nIncluded paranasal sinuses and mastoids are grossly clear. Skull and\nextracranial soft tissues are unremarkable.", + "output": "Slightly motion degraded exam without visualized acute intracranial process." + }, + { + "input": "The study is markedly limited by patient motion despite repeat imaging.\n\nThere is no evidence of acute large territorial infarction,hemorrhage,edema,\nmidline shift, or mass. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. Periventricular, subcortical and deep\nwhite matter hypodensities are nonspecific, but likely reflect the sequela of\nchronic microvascular infarction. Dense atherosclerotic calcifications are\nnoted within the cavernous carotid and distal vertebral arteries.\n\nThere is no evidence of fracture. Opacification of a right anterior ethmoid\nair cell suggests ongoing inflammation. The visualized portion of the\nremaining paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable. Small amount\nof subcutaneous gas is noted within the right infratemporal fossa, likely\nrelated to intravenous manipulation.", + "output": "1. The study is markedly degraded by patient motion.\n2. No gross acute intracranial process." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. There is\nan old right thalamic lacunar infarct noted. There is prominence of the\nventricles and sulci suggestive of involutional changes. Periventricular\nwhite matter hypodensities are nonspecific but suggestive of chronic small\nvessel ischemic disease. Note is made of calcifications of bilateral\nvertebral arteries and the bilateral carotid siphons.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Hyperdensity\nof the lenses bilaterally is suggestive of cataracts.", + "output": "1. No evidence of hemorrhage or recent infarction" + }, + { + "input": "There is no acute hemorrhage, edema, mass effect or acute large vascular\nterritorial infarction. Prominent ventricles and sulci are consistent with\nage-related involutional change. Periventricular white matter hypodensities\nare consistent with chronic small vessel ischemic disease. The basal cisterns\nappear patent and there is preservation of gray-white matter differentiation.\n\nNo fracture is identified. The mastoid air cells, middle ear cavities, and\nvisualized paranasal sinuses are clear. The globes are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There has been further interval increase in the extent of diffuse\nintraparenchymal hemorrhage with surrounding vasogenic edema involving the\nleft temporal, parietal, and occipital lobes, now measuring up to 10.2 cm in\ngreatest diameter. Most notable increase is seen at the left vertex (___). \nOther areas have not significantly changed in size though are more dense, not\nunexpected.\n\nThere has also been increase in rightward shift of midline structures, now\nmeasuring approximately 1.6 cm compared to 1.0 cm on prior study. Suprasellar\ncisterns are effaced and there is left uncal herniation. There is slight\ninterval increase in the extent of left-sided frontal convexity subdural\nhematoma, now measuring 8 mm compared to 7 mm on prior study. There is\ngrossly stable appearance of intraventricular hemorrhage. There is increased\neffacement of the left lateral ventricle, most notably involving the frontal\nand occipital horns.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear besides fluid\nlayering within the left maxillary sinus. The visualized portion of the\norbits are unremarkable.", + "output": "1. Interval worsening of diffuse intraparenchymal hemorrhage with surrounding\nvasogenic edema involving the left temporal, parietal, and occipital lobes,\nwith increased rightward shift of midline structures. Effacement of the\nsuprasellar cisterns and left uncal herniation.\n2. Slight interval increase in extent of left subdural hematoma.\n3. Grossly stable appearance of intraventricular hemorrhage.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 04:05 pm, 1 minute after\ndiscovery of the findings." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Please note brain MRI is more sensitive for the evaluation of micro\nhemorrhages." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is mild asymmetric hypodensity of the right cerebellar hemisphere white\nmatter, not seen on CTA source images, compatible with artifact. Otherwise,\nthere is no evidence of no evidence of territorial infarction, hemorrhage,\nedema, or mass effect. The ventricles and sulci are normal in size and\nconfiguration.\n\nThere is a small mucous retention cyst of the right maxillary sinus. The\nremainder of the visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the orbits\nare unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nIncidental note is made of an aortic origin of the left vertebral artery. The\ncarotid and vertebral arteries and their major branches appear normal with no\nevidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits, noting sub cm hypo attenuating nodules.\nThere is no lymphadenopathy by CT size criteria.", + "output": "1. No acute intracranial process on noncontrast head CT. Mild asymmetric\nhypodensity of the right cerebellar hemisphere white matter, almost certainly\nartifact as this is not seen on CTA source images.\n2. Unremarkable CTA of the head and neck, allowing for common anatomic\nvariation. No evidence of dissection." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. The hypodensities within the frontal lobes bilaterally\nare stable since at least ___ and due to prior electrode placement.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. A fat containing lesion within the\nleft parietal occipital soft tissues likely represents a lipoma, unchanged\nsince ___ (series 3, image 27).", + "output": "1. No acute intracranial process.\n2. Chronic hypodensities within the frontal lobes bilaterally due to prior\nelectrode placement." + }, + { + "input": "No evidence of hemorrhage, edema, or mass effect. The small subcortical\ninfarct in the left frontotemporal lobe corona radiata on prior outside\nhospital MRI has no definite correlate on this unenhanced CT. The ventricles\nand sulci are normal in size and configuration for the patient's age.\n\nNo evidence of fracture. The patient is edentulous. A 4-mm osteoid osteoma\nin the ethmoid sinuses unchanged (series 4, image 32). The visualized portion\nof the paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. No intracranial hemorrhage.\n2. Small infarct in left frontal lobe on outside hospital recent MRI is not\nwell visualized on this unenhanced CT." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or\ndiscrete mass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nbilateral maxillary sinuses. The remaining paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable. There is left periorbital and preseptal hematoma. \nNo retrobulbar hematoma.", + "output": "1. No acute intracranial process.\n2. No fractures. Left periorbital and preseptal hematoma." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Carotid siphon calcifications are\nmild.", + "output": "Atrophy. No evidence of mass, hemorrhage or infarction." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Aerosolized secretions in right sphenoid\nsinus is unchanged compared to most recent prior. Otherwise the remaining\nvisualized portions of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "CTA NECK:\nThere is a normal 3 vessel aortic arch. The carotid arteries are patent from\ntheir origin without stenosis, dissection or occlusion. No internal carotid\nartery stenosis by NASCET criteria.\n\nThe vertebral arteries are patent from their origin without evidence of\nstenosis or occlusion. No definite evidence of dissection..\n\nSeen again at the level of C5 is a fracture involving right articular facet,\npedicle, lamina,, probably extending into foramen transversarium. Minimal\ncaliber change of the adjacent vertebral artery, likely secondary to adjacent\nmass effect from the fracture, no definite evidence of dissection on CT, no\nintimal flap.\n\nOTHER:\nImaged thyroid gland is grossly unremarkable. There is no cervical\nlymphadenopathy by CT size criteria. The imaged lung apices are essentially\nclear with the exception of trace dependent atelectasis on the left. \nSymmetric lymphoid hypertrophy lingual tonsils, palatine tonsils.", + "output": "1. Known fracture at C5 level. Minimal associated right vertebral artery\ncaliber change at C5 level, likely secondary to mild mass effect from adjacent\nfracture fragment, no direct evidence of dissection.\n2. Otherwise normal CTA." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, or loss of gray/\nwhite matter differentiation. The ventricles, basal cisterns, and sulci are\nnormal in size and configuration.\n\nNo osseous abnormalities seen. The visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear.", + "output": "No evidence for acute intracranial abnormalities.\n\nRECOMMENDATION(S): If clinically warranted, MRI would be more sensitive for\nevaluating the patient's neurologic symptoms." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nPERFUSION: The perfusion is symmetric without areas of mismatch.\n\nCBF <30% volume: 0ml\nTmax>6.0s volume: 0ml\nMismatch volume: 0ml\nMismatch ratio: None\n\nOTHER:\nThe visualized portion of the lungs are clear. Mosaic attenuation of lung\napices may be related to the respiratory phase or mild air trapping. The\nvisualized portion of the thyroid gland is within normal limits. There is no\nlymphadenopathy by CT size criteria.", + "output": "1. Normal head and neck CTA.\n2. Patent dural venous sinuses.\n3. Normal perfusion.\n4. No acute intracranial abnormalities." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute intracranial hemorrhage, mass, mass effect or\nlarge territorial infarction. Ventricles and sulci are age appropriate. \nPeriventricular deep subcortical white matter hypodensities likely sequelae of\nchronic microangiopathy. The basilar cisterns are patent, there is otherwise\ngood preservation gray-white matter differentiation.\n\nNo acute fracture is identified. The visualized paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The globes are unremarkable.\n\nCTA HEAD:\nThe vertebral arteries are normal. The basilar artery is normal. There is\nfetal type configuration of the bilateral posterior cerebral arteries. \nModerate atherosclerotic disease is seen along the cavernous segment of the\nbilateral internal carotid arteries. The left internal carotid artery is\notherwise normal. The left middle cerebral artery is normal. There is normal\narborization of the distal left MCA vessels. The right internal carotid\nartery is otherwise normal. The right middle cerebral artery is normal. \nThere is normal arborization of the distal right MCA vessels. The A1 segment\nof the right anterior cerebral artery is hypoplastic. The anterior cerebral\nartery is otherwise unremarkable. The dural venous sinuses are patent.\n\nCTA NECK:\nModerate atherosclerotic disease is seen along the aortic arch, with moderate\nstenosis at the origin of the right common carotid artery. Moderate stenosis\nis seen along the origin of the left common carotid artery. Severe stenosis\nis seen at the origin of the right vertebral artery. A short segment\nocclusion is seen at the proximal left vertebral artery, with reconstitution\nof flow at the level of C6-C7. The remainder of the left vertebral artery is\ndiminutive in appearance however demonstrates preserved flow. The right\nvertebral artery is unremarkable. The right common carotid artery and\ninternal carotid artery are unremarkable without evidence of internal carotid\nartery stenosis by NASCET criteria. The left common carotid artery is\nunremarkable. There appears to be at least 65% stenosis of the left internal\ncarotid artery by NASCET criteria.\n\nOTHER:\nThe visualized apices of lungs are clear. The thyroid is normal. There is no\ncervical lymphadenopathy.", + "output": "1. No acute intracranial abnormalities identified.\n2. Severe stenosis is seen at the origin of the right vertebral artery. Near\ncomplete short-segment occlusion is seen at the proximal left vertebral\nartery, with reconstitution of flow at the level of C6-C7. The remainder of\nthe left vertebral artery is diminutive in appearance.\n3. At least 65% stenosis of the left internal carotid artery by NASCET\ncriteria. No evidence of right internal carotid artery stenosis by NASCET\ncriteria.\n4. Unremarkable CTA of the head without evidence of aneurysm. Hypoplastic A1\nsegment of the right anterior cerebral artery is likely congenital in\netiology." + }, + { + "input": "There is effacement of the left piriform sinus with no definite mass seen.\nEvaluation of the aerodigestive tract is otherwise unremarkable without\ndemonstrates mass or focal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid appears normal. There is no lymphadenopathy by CT\ncriteria. The neck vessels are unremarkable.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. Left chest wall dual lead pacing device is partially\nvisualized. There is mild degenerative change of the cervical and upper\nthoracic spine without suspicious osseous lesion. A mucous retention cyst\nseen in the left maxillary sinus. Other paranasal sinuses and mastoids are\nclear. Orbits are unremarkable.", + "output": "No soft tissue mass or abnormality to explain patient's reported symptoms." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction, mass or midline\nshift. There is no hydrocephalus. The ventricles and sulci are prominent due\nto moderate to atrophy. There are foci of subcortical and periventricular\nwhite matter hypodensity, most likely sequela of chronic small vessel ischemic\ndisease in a patient of this age. The visualized paranasal sinuses and mastoid\nair cells are clear. There is no fracture.\n\nThere is a laceration and soft tissue swelling in the right supraorbital\nregion. There is no evidence for intraorbital hematoma. The globes appear\nintact. There is no fracture.\n\nThere is moderate mucosal thickening within bilateral anterior and right\nposterior ethmoid air cells. Other visualized paranasal sinuses and mastoid\nair cells are well aerated.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. Right supraorbital laceration and soft tissue swelling. No evidence for\nintraorbital hematoma. No evidence for a fracture." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is mild\nprominence of the ventricles and sulci suggestive of involutional changes. \nThere is a 7 mm extra-axial calcification of adjacent to the left frontal\nlobe, possibly a calcified meningioma. There is a nonspecific punctate\ncalcification adjacent to the right cerebellar hemisphere, which most likely\nrepresents a dural calcification. Periventricular and subcortical white\nmatter hypodensities are nonspecific but can be seen in setting of chronic\nsmall vessel ischemic disease. Calcifications are noted within the V4\nsegments of the vertebral arteries and intracranial ICAs.\n\nNo evidence of acute fracture. Paranasal sinuses, middle ear cavities and\nmastoid air cells are clear. Orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. No evidence of metastatic disease within limitation of a non-contrast head\nCT. If there is high clinical suspicion, further evaluation with a\ncontrast-enhanced MRI is recommended.\n3. A 7 mm extra-axial calcification adjacent to the left frontal lobe is\nnonspecific but most likely represents a calcified meningioma." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "Study is mildly degraded by motion. Streak artifact limits evaluation of\nsella.\n\n There is an approximately 7 (AP) x 7 (TV) x 6 (SI) mm suprasellar structure\nwith question minimal peripheral enhancement and mass effect on pituitary\ngland, better demonstrated on prior pituitary MRI (see 2:7; 04:10; 602:46;\n302:44; 601:42; through 03:42). Within limits of study, no definite large\ncalcification of this structure is noted, however evaluation for calcification\nis limited due to streak artifact. Previously questioned outside\ncalcification is not able to be visualized on current study (see 203:42 on ___ prior outside head CT).\n\nThere is no evidence of fracture, infarction, hemorrhage or edema. The\nventricles and sulci are preserved in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits demonstrate\ndysconjugate gaze versus motion artifact.", + "output": "1. Streak artifact limits evaluation of sella. Study is also mildly degraded\nby motion.\n2. Allowing difference in technique, grossly stable pituitary stalk mass with\nmass effect on pituitary gland, better demonstrated on prior pituitary MRI. \nWithin limits of study, no definite evidence of large lesion calcification\nidentified.\n3. Question dysconjugate gaze versus artifact.\n4. No acute intracranial abnormality." + }, + { + "input": "The left occipital epidural hematoma has increased in size now measuring 10 mm\nin greatest dimension in the axial plane, previously 4 mm. This causes\neffacement of the adjacent occipital sulci. There are small bilateral\nsubdural hematomas along the inferior aspect of the tentorium measuring 3 mm\nin greatest dimension on the right (602b:40) and 2 mm in greatest dimension on\nthe left (601b:76). This appears slightly increased from prior. Bifrontal\nsubarachnoid hemorrhage has also slightly increased from prior as has\nsubarachnoid hemorrhage in the cerebellum. There is a small amount of\nhemorrhage in the trigeminal plate cistern. There is no shift of normally\nmidline structures and the basal cisterns remain patent. There is prominence\nof the ventricles and sulci suggestive of involutional changes.\nPeriventricular and subcortical white matter hypodensities are nonspecific,\nbut likely reflect sequelae of chronic small vessel ischemic disease.\nThe nondisplaced left occipital fracture is again visualized the left\noccipital subgaleal hematoma appears similar to prior The visualized portion\nof the paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear.", + "output": "1. Increased size of left occipital epidural hematoma now measuring 10 mm in\ngreatest dimension, previously 4 mm with associated increased effacement of\nthe adjacent occipital sulci.\n2. Increased bifrontal and cerebellar subarachnoid hemorrhage.\n3. Increased subdural hematoma along the tentorium bilaterally.\n4. Unchanged left occipital fracture." + }, + { + "input": "A nondisplaced left occipital bone fracture is similar to the prior\nexamination. A left occipital epidural hematoma measuring approximately 9 mm\nin maximum dimension from the inner table on axial images is grossly stable\ncompared to the prior examination (02:10). Bifrontal subarachnoid\nhemorrhages, right greater than left are also stable. A hyperdensity along\nthe inferior margin of the left tentorium, potentially representing a small\nsubdural hematoma was more conspicuous on the prior examination. Previously\nseen hyperdense focus in the trigeminal plate cistern is no longer visualized.\nThere is no new hemorrhage. Ventricles are stable in size and configuration\nwith small amount of blood in the left occipital ventricular horn (image 15,\nseries 2). There is no shift of normally midline structures. Gray-white\nmatter differentiation is preserved.\n\nPartially imaged paranasal sinuses, mastoid air cells, middle ear cavities are\nclear. The orbits are unremarkable.", + "output": "Unchanged nondisplaced left occipital fracture, multiple intracranial\nhemorrhages as described above are overall unchanged compared to the prior\nexamination." + }, + { + "input": "There has been interval decrease in size of the isodense bilateral\nfrontoparietal subdural hematomas, small on the right and trace on the left. \nInterval resolution of the previously seen right frontal subarachnoid\nhemorrhage is noted. There is new right temporal extra-axial hyperdense\nhemorrhage, best seen on series 3 image ___. No underlying mass effect or\nmidline shift is seen.\n\nThere is no evidence of infarction, edema, or mass. Prominent ventricles and\nsulci are compatible with age-related volume loss. Periventricular white\nmatter hypodensities are consistent with chronic small vessel ischemic\ndisease. Atherosclerotic vascular calcifications are noted of bilateral\nvertebral and cavernous portions of internal carotid arteries.\n\n\nThere is re- demonstration of the left occipital fracture. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Interval decrease in size of the subacute to chronic bilateral\nfrontoparietal subdural hematomas, right greater than left. Resolution of the\nright frontal subarachnoid hemorrhage.\n2. New small right temporal extra-axial, likely subdural, right temporal\nconvexity acute hematoma.\n3. Redemonstration of the left occipital calvarial fracture.\n\nRECOMMENDATION(S): The findings were discussed with ___, P.A. by\n___, M.D. on the telephone on ___ at 2:53 ___, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass. Prominent ventricles and sulci suggest age related involutional\nchanges. Periventricular white matter hypodensities are consistent with\nchronic small vessel ischemic disease No osseous abnormalities seen. Minimal\nopacification is seen in the inferior left mastoid air cells. Otherwise, the\nvisualized paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute hemorrhage, edema, mass, or acute major vascular\nterritorial infarction. Mild age-related prominence of the ventricles and\nsulci is noted. Foci of low density in the periventricular and deep white\nmatter of the cerebral hemispheres are nonspecific but likely sequela of\nchronic small vessel ischemic disease in this age group.\n\nThere is mild mucosal thickening in the ethmoid air cells and maxillary\nsinuses, as well as a small mucous retention cyst in the right maxillary\nsinus. Mastoid air cells appear grossly well aerated allowing for volume\naveraging artifact in the absence of dedicated bone algorithm reformations. \nThere is evidence of bilateral cataract surgery.\n\nCTA NECK:\nThere is extensive mixed plaque along a three vessel aortic arch which extends\ninto the origin of branch vessels. Atherosclerosis results in approximately\nmoderate luminal narrowing of the left proximal subclavian artery, and mild\nnarrowing of the innominate artery and proximal left common carotid artery. \nThere is extensive calcified plaque along the proximal right subclavian\nartery. There is calcified plaque at the origin of the dominant left\nvertebral artery with mild narrowing, as well as mild calcified plaque in the\nV2 segment at C7 without narrowing. The non dominant right vertebral artery\nsmall in caliber with calcified plaque causing at least moderate narrowing of\nits origin.\n\nThere is calcified plaque in bilateral distal common carotid and proximal\ninternal carotid arteries, with approximately 60-70% narrowing of the proximal\nright internal carotid artery and approximately 40% narrowing of the proximal\nleft internal carotid artery by NASCET criteria. There is also mixed plaque\nmildly narrowing the distal cervical left internal carotid artery.\n\nCTA HEAD:\n\nThere is mixed plaque along the petrous segment of the left internal carotid\nartery with moderate luminal narrowing. Calcified plaque along the petrous\nsegment of the right internal carotid artery results in mild luminal\nnarrowing. There is calcified plaque along the cavernous and supracarotid\ninternal carotid arteries bilaterally without flow-limiting stenosis. Major\nanterior circulation branches demonstrate no evidence for flow-limiting\nstenosis. A1 segment of the left anterior cerebral artery is mildly\nhypoplastic, consistent with normal variation.\n\nThere is calcified plaque mildly narrowing the proximal V4 segment of the\ndominant right vertebral artery, and and a punctate focus of calcified plaque\nin the proximal V4 segment of the right vertebral artery at the ___,\nwith ___ termination of the right vertebral artery. Basilar artery and its\nbranches appear patent.\n\nThere is no evidence for an aneurysm. Dural venous sinuses appear patent.\n\n\nOTHER:\nDilatation of the main pulmonary trunk up to 3.9 cm is suggestive of\nunderlying pulmonary arterial hypertension. Evaluation of the visualized lung\nparenchyma is limited by imaging during expiration. There no pulmonary\nconsolidation seen. There is a calcified granuloma in the right upper lobe on\nimage 5:41. The thyroid gland is unremarkable. There is no lymphadenopathy by\nCT size criteria. There are degenerative changes in the cervical spine.", + "output": "1. No evidence of acute intracranial abnormalities.\n2. Mostly calcified plaque causes approximately 60-70% stenosis of the\nproximal right internal carotid artery and approximately 40% stenosis of the\nproximal left internal carotid artery by NASCET criteria.\n3. Mixed plaque also causes mild narrowing of the distal cervical left\ninternal carotid artery and moderate narrowing of the petrous left internal\ncarotid artery.\n4. Approximately moderate narrowing of the proximal left subclavian artery. \nMild narrowing of the nondominant left vertebral artery origin. Also mild\nnarrowing of the left V4 segment by calcified plaque.\n5. At least moderate narrowing of the origin of the non dominant, diminutive\nright vertebral artery, which terminates as ___.\n6. Enlargement of the main pulmonary artery suggests pulmonary arterial\nhypertension." + }, + { + "input": "In the left palatine peritonsillar area, there is a rim enhancing hypodensity\nmeasuring 1.8 x 1.2 x 1.7 cm (2:52, 601b:33). The hypodensity exerts mild\nmass-effect and narrows the oropharynx. Mild effacement of the vallecula and\nthe left piriform sinus may be secondary to edema and phlegmonous changes. No\ndefinite fluid collection is seen in the subglottic soft tissues. Mild\nlymphadenopathy in the left neck at cervical level 2A and B are likely\nreactive.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions. Heavy calcifications and\natheromatous disease is noted in the aortic arch with mild increased caliber\nof the left common carotid artery, measuring up to 2.0 cm at the origin with\nmild narrowing by noncalcified atheroma.", + "output": "1. Abscess in the left palatine tonsil area, may represent peritonsillar\nabscess. No evidence of prevertebral abscess. Mild narrowing of the central\nairway in the oropharynx. Effacement of the vallecula and the left piriform\nsinus, likely due to phlegmonous changes and edema.\n2. Calcified in atheromatous aortic arch with dilation of the left common\ncarotid artery. No evidence of dissection." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Prominence of\nventricles and sulci are consistent with cortical volume loss and atrophy.\nPeriventricular, subcortical, and deep white matter hypodensities are likely\nsequelae of chronic small vessel ischemic disease.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable. Calcification of\nbilateral cavernous portions of internal carotid arteries are present.", + "output": "1. Chronic changes as described above including cortical volume loss and\natrophy.\n2. No intracranial hemorrhage." + }, + { + "input": "There is no evidence of acute intracranial infarction,hemorrhage,edema, or\nmass effect. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of acute fracture. Please note that the nasal bones and\nthe inferior orbits were not fully included on the images. The imaged\nparanasal sinuses demonstrate minimal mucosal thickening in the left sphenoid\nsinus and a small mucous retention cyst in the left sphenoid sinus. The\nmaxillary sinuses were not included. The imaged mastoid air cells are clear.", + "output": "1. No acute intracranial findings. Please note that the nasal bones and the\ninferior orbits were not fully included on the images." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\nThere is no evidence of fracture. Carotid siphon calcifications bilaterally\nare noted. The visualized portion of the mastoid air cells and middle ear\ncavities are clear. Partial opacification of posterior ethmoid air cells is\nnoted. The paranasal sinuses are otherwise clear. The visualized portion of\nthe orbits are unremarkable.", + "output": "1. No evidence of acute intracranial process." + }, + { + "input": "There is no evidence of infarction,hemorrhage,edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nPeriventricular white matter hypodensities are nonspecific, likely due to\nchronic small vessel ischemic disease in this age group.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Atrophy. No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute large territory infarction, hemorrhage, edema,\nor mass effect. The ventricles and sulci are prominent compatible with age\nrelated involutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific, but likely reflect sequelae of chronic small\nvessel ischemic disease, unchanged.\n\nNo acute osseous abnormalities seen. Mild ethmoid air cell mucosal thickening\nis visualized otherwise the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The orbits are unremarkable.", + "output": "1. No acute intracranial abnormalities specifically no evidence of\nintracranial bleed or fracture.\n2. Additional findings as described above." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no hemorrhage, edema, or mass effect. Prominent ventricles and sulci\nreflect age related volume loss. Periventricular white matter hypodensities\nare nonspecific although likely sequela of chronic small vessel ischemia. \nBasal cisterns are patent. Gray-white matter differentiation is preserved.\n\nOrbits are unremarkable. Imaged paranasal sinuses, bilateral mastoid air\ncells, and middle ear cavities are clear. Bony calvarium is intact.\n\nCTA head and neck: There is a three vessel aortic arch. Bilateral carotid\narteries within the neck are without significant atherosclerotic plaque or\ncalcifications. Calcifications involve the bilateral cavernous segments of\nthe carotid arteries, symmetric and mild. Incidental note is made of a\nfenestrated left A1 segment. The middle cerebral arteries are patent and\nsymmetric in arborization. Anterior and posterior cerebral arteries are\nopacified. Basilar artery is patent and normal in caliber. Bilateral\nvertebral arteries are patent. Atherosclerotic plaque involves the right\nvertebral artery at the C2-C3 level.\n\nBiapical pleuroparenchymal scarring is symmetric and mild. Lungs are\notherwise clear. Aerodigestive tract is without mass effect. There is no\nadenopathy. Thyroid gland is homogeneous in attenuation.", + "output": "1. Patent head and neck vessels.\n\n2. No acute intracranial abnormality on noncontrast head CT." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. The neck vessels are patent.\n\nThere is mild atelectasis posteriorly in the lung apices, greater on the right\nthan left. Otherwise, the imaged portion of the lung apices are clear and\nthere are no concerning pulmonary nodules. There are no osseous lesions.", + "output": "1. Mild apical atelectasis. Otherwise normal study\n2. Normal appearance of the salivary glands." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. There is mucosal thickening and mucous\nretention cyst in the left maxillary sinus. Partial opacification ethmoid\nsinuses. Prominent right nasal septal spur are noted. There is tiny benign\nbone island at the right superior orbital wall. The remain paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "No acute intracranial process.\nMild paranasal sinus disease." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Bilateral periventricular subcortical white matter\nhypodensities are nonspecific but most likely represent sequela chronic small\nvessel ischemic changes.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nethmoid air cells. The remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable. Atherosclerotic vascular calcifications are noted of bilateral\ncavernous portions of internal carotid arteries.", + "output": "1. No acute intracranial abnormality.\n2. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct.\n3. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described." + }, + { + "input": "There is no evidence of intracranial hemorrhage. Atrophy is mild and includes\nwidening of bifrontal extra-axial spaces. The gray-white matter\ndifferentiation appears preserved. There are very small lacunar infarcts in\nthe lentiform nucleus on the left as well as the left subinsular cortex. A\npunctate lacunar infarct is also suspected along the anterior limb of the left\ninternal capsule. There is no mass effect or shift of the normally midline\nstructures. Surrounding soft tissue structures are unremarkable. Cavernous\ncarotid arteries are heavily calcified. Vertebral arteries appear mildly\ncalcified. There is no evidence for fracture or bone destruction. Visualized\nparanasal sinuses and mastoid air cells appear clear.", + "output": "No evidence of acute intracranial process. Few small suspected lacunar\ninfarcts, likely to be chronic." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, or acute large\nterritorial infarction. Patient is status post left frontal craniotomy. There\nis a subjacent encephalomalacia in the left frontal lobe with ex vacuo\ndilatation of the frontal horn of the left lateral ventricle. The basal\ncisterns are patent. Gray-white matter differentiation is elsewhere\npreserved.\n\nThere is no acute fracture. There are minimal aerosolized secretions in the\nposterior left ethmoid air cells (03:13). The remaining paranasal sinuses are\nclear. The mastoid air cells and middle ear cavities are clear. There are\natherosclerotic calcifications of the cavernous internal carotid arteries.", + "output": "1. No acute intracranial hemorrhage or evidence of acute mass effect.\n2. Status post left frontal craniotomy with area of encephalomalacia in the\nleft frontal lobe presumed secondary to prior mass excision per patient\nhistory. No prior head CT is available for comparison. MRI is more\nsensitive in detecting acute ischemia." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Basilar cisterns are\npatent.\n\nIncluded paranasal sinuses and mastoids are essentially clear. Skull and\nextracranial soft tissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass.\nSubcortical and periventricular white matter hypodensities are nonspecific,\nlikely the sequelae of chronic small vessel ischemic disease. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. A subgaleal hematoma is seen overlying the\nleft side of the frontal bone. There is mild mucosal thickening of the\nethmoid air cells. The visualized portion of the remaining paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. Soft tissue density\nseen in bilateral external auditory canals, likely cerumen. The visualized\nportion of the orbits show bilateral lens replacement.", + "output": "No acute intracranial abnormality. Small frontal subgaleal hematoma without\nevidence of underlying fracture." + }, + { + "input": "Multiple images were repeated due to motion artifact, but the exam remains\nmildly limited by motion. No acute hemorrhage is seen. There is a linear\nhyperdensity in the location of the M1 segment of the left middle cerebral\nartery. There is another globular hyperdensity at the basilar tip. There are\npunctate foci of hyperdensity in the right sylvian fissure (2a: 13), in a\nright temporal sulcus (2a: 15), in the right postcentral sulcus (2a: 21) and\nin the anterior interhemispheric fissure (2 a: 13, 2a:20). There is also\napparent subtle hypodensity with subtle loss of gray/ white matter\ndifferentiation involving the left insula frontal lobe, anterior parietal\nlobe, and possibly portions of the temporal lobe, in the middle cerebral\nartery territory. There is minimal sulcal effacement. The left lateral\nventricle is minimally smaller than the right. There is no significant shift\nof midline structures and no compression of basal cisterns.\n\nPartially visualized paranasal sinuses and mastoid air cells are grossly\nwell-aerated.", + "output": "1. Linear hyperdensity in the M1 segment of the left middle cerebral artery is\nconsistent with either calcified thrombus or or an embolized foreign body. \nThere is a similar globular finding at the basilar tip, and additional\npunctate similar findings in the location of the right MCA branches and in the\nlocation of the A2 segments of the anterior cerebral arteries.\n2. While evaluation is limited by motion artifact, there appears to be a\ndeveloping acute infarction on the left middle cerebral artery territory.\n3. No acute hemorrhage.\n\nNOTIFICATION: The findings were discussed with ___, cardiology NP\nor PA, by ___, M.D. on the telephone on ___ at 3:18 ___, 2\nminutes after discovery of the findings." + }, + { + "input": "As suggested on the prior noncontrast head CT, there is evidence of left\nmiddle cerebral artery territory infarction with scattered areas of loss of\ngray-white matter differentiation. There is new left cerebral hemisphere\nedema resulting in effacement of the ipsilateral sulci and lateral ventricle\nwith approximately 1 mm of midline shift. A crescentic area of hyper\nattenuation appears confined to the left putamen and globus pallidus without\nevidence mass effect. Some of the left MCA sylvian point branches appear\nhyperdense, may represent residual contrast from non perfused vessels or\nvessel thrombosis. Somewhat linear areas of hyperattenuation paralleling the\nsulci overlying the left frontoparietal lobe likely reflect intravascular\ncontrast in left middle cerebral artery branches, less likely petechial\nmicrohemorrhage or subarachnoid hemorrhage. The basal cisterns are patent. \nAn area of hypoattenuation in the right parieto-occipital lobe is unchanged\nand may reflect subacute or chronic infarction. The previously identified\nlinear hyperdensity in the proximal middle cerebral artery appears smaller and\nmeasures up to 4 mm in length, previously 6 mm. Additional scattered\nhyperdensities including the basilar tip, anterior cerebral arteries, and\nright middle cerebral artery branches are unchanged. Small bilateral\ncerebellar hemisphere hypodensities are seen, similar to prior, likely\nrepresent chronic, less likely subacute infarcts. There is chronic lacunar\ninfarct in the bilateral caudate nuclei, stable.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. An endotracheal tube is partially\nvisualized.", + "output": "1. Areas of loss of gray-white matter differentiation the left MCA territory,\nconsistent with acute infarcts, with increasing edema in the left hemisphere,\nresulting in sulcal, left ventricular effacement, with approximately 1 mm of\ncontralateral midline shift. Component of reperfusion edema is possible.\n2. Increased attenuation of the left putamen and globus pallidus, suggests\ncontrast staining given clinical scenario. Component of hemorrhage cannot be\nexcluded.\n3. Left MCA M 3 branches have increased attenuation, may represent residual\ncontrast staining or occlusion. Somewhat linear areas of hyperattenuation\nparalleling the sulci of the left frontoparietal lobe likely reflect\nintravascular contrast, less likely subarachnoid hemorrhage or cortical\npetechial microhemorrhage.\n4. Hypoattenuation in the right parieto-occipital lobe could reflect subacute\nor chronic infarction. More detailed evaluation could be performed with MRI.\n5. Small chronic infarcts elsewhere.\n\nNOTIFICATION: The findings were discussed with ___, NP, by\n___, M.D. on the telephone on ___ at 10:07 ___, less than 10\nminutes after discovery of the findings." + }, + { + "input": "Compared to ___ at 20:33, no new or growing hemorrhage. Slight\ninterval increase in left cerebral hemisphere edema resulting in increased\neffacement of the ipsilateral sulci and lateral ventricle (particularly the\noccipital horn) as well as 0.4 cm of rightward shift of the normally midline\nstructures, previously 0.1 cm. Minimal evolution of a previously seen area of\nhyperattenuation confined to the left putamen and globus pallidus. Unchanged\nleft middle cerebral artery territory infarction with scattered areas of\ngray-white matter differentiation loss. Unchanged hypoattenuation in the\nright parieto-occipital lobe, which may represent subacute or chronic\ninfarction. Minimal interval increase in a previously identified linear\nhyperdensity in the proximal middle cerebral artery, measuring 0.4 cm. \nAdditional hyperdensities including the basilar tip, anterior cerebral\narteries and right middle cerebral artery branches are unchanged. Unchanged\nleft cerebellar hypodensities, likely representing chronic infarcts. \nUnchanged bilateral caudate nuclei chronic lacunar infarcts.\n\nNo osseous abnormalities seen. There is a partially visualized nasogastric\ntube. There is minimal mucosal thickening of some anterior ethmoidal air\ncells. Otherwise, the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The orbits are unremarkable.", + "output": "1. Compared to ___ at 20:33, no new or growing hemorrhage. Slight\ninterval increase in left cerebral hemisphere edema resulting in increased\neffacement of the ipsilateral sulci and lateral ventricle as well as 0.4 cm of\nrightward shift of the normally midline structures, previously 0.1 cm.\n2. Evolution of a previously seen left MCA infarct and area of increased hyper\nattenuation in the left putamen and globus pallidus, which may represent\nhemorrhage or contrast staining which is unchanged from the prior study.\n3. Multiple subacute and chronic infarcts throughout the brain." + }, + { + "input": "Study is moderately motion degraded despite repeated acquisitions.\n\nCompared to ___, there has been interval increase in sequela of\nleft MCA infarct, with increased left cerebral hemisphere edema, increased\neffacement of the ipsilateral sulci and the left lateral ventricle, and\nincreased area of loss of gray-white matter differentiation. There is\nincreased rightward midline shift, now measuring 7 mm, previously measuring 4\nmm. Previously seen area of hyperattenuation in the left putamen and globus\npallidus is not well appreciated on the current study a which previously may\nhave represented contrast staining from a cerebral angiogram although\nevaluation is suboptimal secondary to motion artifact. Subtle region of\nrelative ___ of the left frontal vertex with Hounsfield units similar\nto that of the contralateral gray matter, likely representing residual non\ninfarcted tissue rather then hemorrhage product (series 2, image 30). Re-\ndemonstration of area of hypoattenuation in the right parieto-occipital lobe,\nwhich likely represents prior infarct.\n\nThere is no evidence of fracture. The visualized portion of the mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable. Endotracheal and nasogastric tubes are noted.", + "output": "1. Study is severely limited by motion artifact.\n2. Compared to ___, interval increase in sequela of left MCA\ninfarct, with increased left cerebral hemisphere edema, increased rightward\nmidline shift, now measuring 7 mm, and increased area of loss of gray-white\nmatter differentiation.\n3. The right lateral ventricle appears similar to prior examination. The\nbasilar cisterns remain grossly patent, however evaluation through the\nskullbase is severely limited and if there is concern for uncal herniation,\nrepeat examination is recommended.\n4. Small region of subtle relative ___ of the left frontal vertex\nwith Hounsfield units similar to the contralateral normal gray matter, likely\nrepresenting residual non-infarcted tissue rather than hemorrhage product. \nHowever, close attention on followup is recommended.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 10:00 AM, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "Limited examination due to patient motion. Compared to ___,\ninterval increase in sequelae of prior left MCA infarct with increased left\ncerebral hemisphere edema, increased effacement of the ipsilateral sulci and\nleft lateral ventricle and increased loss of gray-white differentiation. \nAllowing for differences in head position, rightward shift of the normally\nmidline structures measures 1.5 cm (___), previously 0.7 cm. A focus of\nhyperdensity in the left posterior parietal lobe (___) may represent non\ninfarcted tissue with hemorrhage not excluded. Increased size of the right\ntemporal horn is concerning for entrapment. Multiple stable left cerebellar\nhypodensities, likely representing chronic infarcts. Stable bilateral caudate\nnuclei chronic lacunar There is no evidence of infarction, hemorrhage, edema,\nor mass. The ventricles and sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The patient is intubated and there is a\nnasogastric tube. Minimal mucosal thickening in some anterior ethmoidal air\ncells. Otherwise, the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The orbits are unremarkable.", + "output": "1. Limited exam due to patient motion. Compared to ___, interval\nincrease in sequelae of prior left MCA infarct with increased left cerebellar\nhemisphere edema, increased effacement of the ipsilateral sulci and left\nlateral ventricle in increase loss of gray-white differentiation.\n2. Rightward shift of the normally midline structures measures 1.5 cm,\npreviously 0.7 cm.\n3. Increase in size of the right temporal horn is concerning for entrapment.\n4. Multiple subacute and chronic infarcts throughout the brain.\n\nNOTIFICATION: The findings were discussed with ___. by ___, M.D.\non the telephone on ___ at 4:54 AM, 2 hours after discovery of the\nfindings." + }, + { + "input": "Evaluation of lungs and trachea are limited due to motion artifact. Within\nthis limitation, of the aerodigestive tract demonstrates no mass and no areas\nof focal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy. The\nneck vessels are patent.\n\nRight shoulder prosthesis causes beam hardening artifact. There are no\nsuspicious osseous lesions. Small mucous retention cyst is noted in the left\nmaxillary sinus.\nFocally ectatic right vertebral artery V4 segment measures 6 mm in diameter\n(2:3).", + "output": "1. No infection or abscess is identified.\n2. Evaluation of trachea and lungs are limited due to motion artifact.\n3. Focally ectatic right vertebral artery V4 segment measures 6 mm in\ndiameter." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, or edema. Ventricles\nand sulci are age-appropriate. Atherosclerotic calcifications noted within\nthe vertebral arteries and intracranial ICAs.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nleft maxillary and sphenoid sinuses. The bilateral visualized portions of the\nmastoid air cells and middle ear cavities are clear. Patient is status post\nleft lens replacement, otherwise the visualized portion of the orbits are\nunremarkable.", + "output": "No evidence of large vascular territory infarction, hemorrhage, or edema." + }, + { + "input": "There is no evidence of recent vascular territorial\ninfarction,hemorrhage,edema,or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. There is a probable pineal\ncyst.\n\nNo evidence of calvarial fracture. There are dense atherosclerotic\ncalcifications in the carotid siphons. The left maxillary sinus is partially\nopacified with some inspissated mucus. The ethmoidal air cells, mastoid air\ncells, and middle ear cavities are clear. A right shoulder prosthetic is\nnoted on the localizer images.", + "output": "1. No acute intracranial abnormality." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no acute hemorrhage, edema, or loss of gray/ white matter\ndifferentiation. Periventricular white matter hypodensities are nonspecific\nbut may be secondary to chronic microangiopathy. The ventricles and sulci are\nage appropriate. The basilar cisterns are not compressed.\n\nNo suspicious calvarial lesion is seen. There is partial mastoid air cell\nopacification, left greater than right. There is minimal mucosal thickening\nin the right anterior ethmoid air cells and the right frontoethmoidal recess,\nand mild mucosal thickening in the right posterior ethmoid. Other paranasal\nsinuses are well-aerated. The orbits appear unremarkable.\n\n\nCTA NECK:\n\nThere is a 3 vessel aortic arch. There is calcified plaque at the great\nvessel origins without flow-limiting stenosis. There is predominantly\ncalcified plaque in the right distal common carotid and proximal internal\ncarotid arteries without stenosis by NASCET criteria. There is predominantly\ncalcified plaque in the left distal common carotid and proximal internal\ncarotid arteries with approximately 50% stenosis by NASCET criteria.\n\nCalcified plaque at the left vertebral artery origin causes mild to moderate\nstenosis. Uncovertebral osteophytes at C5-C6 cause mild narrowing of the left\nvertebral artery, images 3:143 and 451:1. A focal linear hypodensity is seen\nwithin the V2 segment of the left vertebral artery at the level of C3, image\n3:181, concerning for a short-segment dissection. Distal to the dissection,\nthe cervical left vertebral artery maintains normal caliber.\n\nThe right vertebral artery is widely patent. There is a small focus of\ncalcified plaque in the right subclavian artery near the right vertebral\nartery origin, which does not extend into the right vertebral artery origin.\n\nCTA HEAD:\n\nThere is calcified plaque in bilateral carotid siphons without flow-limiting\nstenosis. No evidence for flow-limiting stenosis is seen elsewhere in the\nintracranial arteries. There is no evidence for an aneurysm. Note is made of\na fetal type configuration of the right PCA. The dural venous sinuses are\npatent.\n\nOTHER:\nBiapical pleural/parenchymal scarring is noted with calcifications. A\nspiculated 0.7 cm noncalcified nodule is seen within the apical right upper\nlobe, image 3:80. There are multiple nonenlarged paratracheal lymph nodes\nbilaterally, as well as multiple nonenlarged AP window and left paraaortic\nlymph nodes. Main pulmonary artery is mildly enlarged, 3.2 cm, suggesting\nmild pulmonary arterial hypertension. The thyroid gland is small and low in\ndensity, suggesting low iodine content. Partial fatty replacement of the\nright submandibular gland is noted. No enlarged cervical lymph nodes are\nseen. There are degenerative changes in the cervical spine.", + "output": "1. No acute intracranial abnormalities identified.\n2. No evidence for flow-limiting stenosis involving the major intracranial\narteries.\n3. Approximately 50% stenosis of the distal left common carotid and proximal\nleft internal carotid artery by NASCET criteria. Atherosclerosis of the\ndistal right common carotid and proximal right internal carotid artery without\nstenosis by NASCET criteria.\n4. Short-segment dissection is seen involving the V2 segment of the left\nvertebral artery at the level of C3, with normal distal caliber.\n5. Calcified plaque mildly to moderately narrowing the left vertebral artery\norigin.\n6. Biapical pleural/parenchymal scarring with calcifications may be secondary\nto prior granulomatous disease. 0.7 cm spiculated noncalcified nodule in the\napical right upper lobe is indeterminate.\n7. Mild enlargement of the main pulmonary artery, suggesting mild pulmonary\narterial hypertension.\n\nRECOMMENDATION(S):\n1. MRI would be more sensitive for an acute infarction, if clinically\nwarranted.\n2. Recommend chest CT in 3 months for reassessment of the right apical nodule.\n\nNOTIFICATION:\n1. The presence of left vertebral dissection was discussed with Dr. ___,\n___. by ___, M.D. on the telephone on ___ at 12pm, 10 minutes\nafter discovery of the findings.\n2. The final impression and recommendations above were entered by Dr. ___\n___ on ___ at 09:34 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." + }, + { + "input": "There is residual arterial contrast from presumed prior study seen on the\nimages.\n\nThere is no evidence of infarction, hemorrhage, or edema. There is no midline\nshift or mass effect. Gray-white differentiation is preserved. Basilar\ncisterns are patent.\n\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Ill-defined periventricular and subcortical white matter\nhypodensities likely represent a sequela of chronic ischemic small vessel\nchanges. There is a small area of low density in the left internal capsule\nwhich likely represents an old infarct.\n\nThere is no evidence of fracture. Mild mucosal thickening is seen the\nbilateral ethmoid sinuses. There is moderate mucosal thickening seen in the\nsphenoid sinuses. The other visualized portions of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. No evidence of acute intracranial abnormalities. There is residual\ncontrast from presumed prior study seen on the images.\n2. Small area of low density in the left internal capsule likely represents an\nold infarct." + }, + { + "input": "This study is limited by motion degradation.\n\nThere is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Hypoattenuation of the lentiform nuclei bilaterally likely\nrepresents encephalomalacia from sequelae of hypoxic ischemic injury,\npreviously characterized on MRI head ___. Prominent ventricles and\nsulci are somewhat advanced given the patient's reported age.\n\nThere is mild mucosal thickening the bilateral ethmoid air cells. Mastoid air\ncells and middle ear cavities are well aerated. The bony calvarium is intact.", + "output": "1. No acute intracranial abnormality.\n2. Encephalomalacia of the lentiform nuclei bilaterally likely secondary to\nsequelae of hypoxic ischemic injury, previously characterized on MRI head ___." + }, + { + "input": "Similar overall pattern of bilateral encephalomalacia bilateral basal ganglia\nincluding bilateral caudate head and lentiform nuclei. Findings are unchanged\nfrom MRI of the head from ___. Generalized atrophy is notable for\nage. There is no intra-axial or extra-axial hemorrhage, edema, shift of\nnormally midline structures, or evidence of acute major vascular territorial\ninfarction. The ventricles are similar in overall size and configuration,\nmildly prominent for age. The basal cisterns are patent. The imaged\nparanasal sinuses, mastoid air cells and middle ear cavities are well aerated.\nThe bony calvarium is intact.", + "output": "No acute intracranial process. Unchanged pattern of encephalomalacia in the\nbilateral basal ganglia. Age advanced involutional changes." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema,or mass effect. \nThere is prominence of the ventricles and sulci suggestive of age-related\nvolume loss. Periventricular, subcortical and deep white-matter hypodensities\nare nonspecific, but likely represent sequela chronic small vessel disease.\n\nThere is no evidence of acute fracture. Mild deformity of the right nasal\nbone may be chronic. There is a mottled, lucent appearance of the calvarium,\nwors most pronounced e posteriorly. The left frontal sinus is completely\nopacified. There is moderate to severe mucosal thickening of the right\nfrontal sinus, ethmoid air cells and left maxillary sinus. There is mild\nmucosal thickening in the right maxillary sinus. Hyperostosis of the\nmaxillary sinus walls is noted. There is trace opacification of the left\nmastoid air cells. The visualized portion of the middle ear cavities are\nclear. Patient is status post bilateral lens replacement. Mild\natherosclerotic calcifications of the cavernous carotid arteries are\ndemonstrated.", + "output": "1. No acute intracranial abnormality.\n2. Mottled, lucent appearance of the calvarium, which may be due to\nosteopenia. However, correlation with any oncologic history is recommended.\n3. Paranasal sinus disease with hyperostosis of the maxillary sinus walls\nsuggestive of chronic inflammation." + }, + { + "input": "In comparison to previous study, there is no evidence of new acute\nintracranial hemorrhage, edema, mass effect, or large territorial infarction.\nThe previously noted 5 mm parietal infarction is not able to be seen on this\nexamination.\n\nProminent ventricles and sulci suggest age-related involutional changes or\natrophy. Microcalcifications noted in the basal ganglia, bilaterally.\n\nThe basal cisterns appear patent and there is preservation of gray-white\nmatter differentiation.\n\nThe visualized bony structures are grossly unremarkable. There is mild mucosal\nthickening of the ethmoid sinuses, otherwise the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear.\n\nThe globes are unremarkable.", + "output": "1. No evidence of new infarcts, hemorrhage, edema, mass effect." + }, + { + "input": "There is no evidence of large territorial infarction, acute intracranial\nhemorrhage, edema, or mass. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. Periventricular white matter hypodensities\nare nonspecific, but likely sequela of chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No evidence of acute intracranial hemorrhage or large territorial infarction." + }, + { + "input": "No intra-axial or extra-axial hemorrhage, edema, shift of normally midline\nstructures, or evidence of acute major infarction. Age advanced involutional\nchanges are present. Ventricles are normal in size. The imaged paranasal\nsinuses appear well aerated. The mastoid air cells and middle ear cavities\nare clear. Bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. There\nis prominence of the ventricles and sulci suggestive of involutional changes.\n\nThere appears to be an scalp hematoma within the soft tissues overlying the\nright posterior parietal calvarium (2:30) without underlying fracture.\n\nThere is mucosal thickening within the bilateral maxillary sinuses and ethmoid\nair cells. Otherwise, the remainder of the visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are normal.", + "output": "1. No acute intracranial process.\n2. Scalp hematoma and laceration within the soft tissues overlying the right\nposterior parietal bone at the vertex." + }, + { + "input": "The bilateral carotid and vertebral arteries are patent. There is no evidence\nof active arterial extravasation in the neck. Calcified plaque causes\napproximately 12% proximal left ICA luminal narrowing, and 30% proximal right\nICA luminal narrowing by NASCET criteria. The distal right ICA proximal\nskullbase, there is moderate focal plaque, both calcified and noncalcified,\nwhich causes an additional area of at least 30% luminal stenosis by NASCET\ncriteria (series 2 image 168 and 204). Calcified plaque at the origin of the\nleft vertebral artery likely causes mild luminal narrowing. The remainder of\nthe left vertebral artery is patent and unremarkable to the basilar origin. \nOtherwise, patent bilateral vertebral and carotid arteries.\n\nThere is mild-to-moderate calcification of the aortic arch and of the aortic\narch branch vessels, including the innominate and left subclavian arteries. \nBranch vessels remain patent.\n\nThere is diffuse retropharyngeal soft tissue and fascial thickening, along\nwith right worse than left neck fascial thickening and subcutaneous fat\nstranding. Given stability of these findings compared with the prior FDG\nPET-CT of ___, findings likely relate to post treatment changes in\nthis patient with a history of prior squamous cell carcinoma of the tonsil and\ntongue. A few foci of air anterior to the cervical spine are also unchanged\nfrom ___, and likely relate to degenerative changes in the cervical\nspine. There are no pathologically enlarged cervical lymph nodes. Thyroid is\nunremarkable. Mild bilateral maxillary sinus mucosal thickening is partially\nvisualized. Imaged base of the brain is grossly unremarkable on limited\nevaluation. Lung apices are grossly clear. Moderate multilevel cervical\nspine degenerative changes are worst at C5-6 and C6-7.", + "output": "1. No evidence of active arterial extravasation in the neck.\n2. Patent bilateral vertebral and carotid arteries. 12% left and 30% right\nproximal ICA narrowing by NASCET criteria. Additional area of 30% luminal\nstenosis of the distal right ICA due to calcified and noncalcified\natherosclerotic plaque.\n3. Diffuse retropharyngeal and right worse than left soft tissue and fascial\nthickening without focal fluid collection, unchanged in appearance since\n___, likely relating to post treatment changes from therapy for prior\nknown squamous cell carcinoma of the tongue and tonsil. No cervical\nlymphadenopathy. Other incidental findings, as above." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, or mass lesion. The\nventricles and sulci are normal in size and configuration with no mass effect\nor midline shift.\n\nThere is mild-to-moderate mucosal thickening of the ethmoid, maxillary, and\nsphenoid sinuses. There is also hyperdense material in the right ethmoid\nsinuses. The mastoid air cells are clear. Unremarkable intraorbital\ncontents.\n\nCTA HEAD:\nMild luminal narrowing and contour deformity of the left internal carotid\nartery cavernous segment (images 220-225 of series 3) is likely due to\nnoncalcified atherosclerotic plaque.\n\nThere are extensive left and moderate right atherosclerotic calcifications of\nthe parasellar internal carotid arteries. There is persistent fetal origin of\nthe bilateral posterior cerebral arteries. Otherwise, the vessels of the\ncircle of ___ and their principal intracranial branches appear normal\nwithout stenosis, occlusion, or aneurysm formation. The dural venous sinuses\nare patent.\n\nCTA NECK:\nStandard 3 vessel aortic arch anatomy with mild scattered atherosclerotic\ncalcifications of the great vessel origins. Moderate atherosclerotic\ncalcifications of the bilateral common carotid artery bifurcations and\nproximal internal carotid arteries. There is approximately 30% narrowing of\nthe proximal right internal carotid artery by NASCET criteria. There is\napproximately 10% narrowing of the proximal left internal carotid artery by\nNASCET criteria. There are moderate atherosclerotic calcifications of the\norigins of the vertebral arteries. The vertebral arteries are otherwise\npatent.\n\nOTHER:\nThere is thickening of the right tonsillar pillar with mild asymmetry compared\nto the contralateral side. There is also diffuse soft tissue and fascial\nthickening along the retropharyngeal region, similar to prior exam. These may\nrelate to postprocedural changes.\n\nThe lung windows show biapical scarring. No suspicious pulmonary nodules are\nevident. There is no lymphadenopathy by CT size criteria.\n\nThe periapical lucencies involving the bilateral mandibular molars may reflect\nperiodontal disease.\n\nBone windows demonstrate moderate to severe multilevel degenerative changes,\nmost pronounced at C5-C6 and C6-C7 with intervertebral disc space narrowing,\nhypertrophic and cystic endplate changes, and posterior disc osteophyte\ncomplexes.", + "output": "1. No acute intracranial abnormalities.\n2. Approximately 30% right and approximately 10% left stenosis of the proximal\ninternal carotid arteries by NASCET criteria.\n3. Moderate to extensive atherosclerotic calcifications of the parasellar\ninternal carotid arteries. Otherwise, patent circle of ___ with no\nstenosis or aneurysm formation.\n4. Stable diffuse retropharyngeal soft tissue thickening, which likely relates\nto post procedural changes from prior history of squamous cell carcinoma.\n5. Paranasal sinus disease as described above." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect. There is mucosal thickening and enhancement along the\npharynx, extending to the level of the piriform sinuses and laryngeal\nvestibule, which may represent chronic radiation changes or acute\ninflammation. There is diffuse soft tissue fascial thickening in the\nretropharyngeal region, similar to prior exam. There is no active\nextravasation of contrast.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. The neck vessels are patent with severe atherosclerotic disease\nof the carotid arteries, right greater than left.\n\nThe imaged portion of the lung apices show mild biapical scarring and there\nare no concerning pulmonary nodules. There are no osseous lesions.\n\nThere is mild mucosal thickening of bilateral maxillary sinuses.", + "output": "1. Pharyngeal mucosal thickening and enhancement which may represent acute\npharyngitis or chronic radiation changes, recommend clinical correlation.\n2. No active extravasation of contrast.\n3. Stable diffuse retropharyngeal soft tissue thickening, likely due to prior\nradiation." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of acute fracture. There is mucosal thickening of the\nethmoid air cells and right sphenoid sinus. The visualized portion of the\nremaining paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable. Soft tissue\ndensity in the right external auditory canal is nonspecific, though likely\ncerumen.", + "output": "1. No acute intracranial abnormalities. However, MRI would be more sensitive\nin detection of acute infarction.\n2. Moderate sinus disease." + }, + { + "input": "There is no evidence of acute intracranial infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of acute fracture. Submucosal retention cysts are seen\nin the right maxillary and left sphenoid sinus. There is mild right maxillary\nand left sphenoid sinus mucosal thickening. Inspissated secretions are seen\nin the ethmoid air cells. The visualized portion of the remaining paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Scattered foci of air are seen within\nthe left masticator space, likely within cutaneous veins.", + "output": "1. No acute intracranial abnormality." + }, + { + "input": "Study is limited due to motion artifact. Within this limitation, there is no\nevidence of fracture, infarction,hemorrhage,edema,or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nThere are periventricular and subcortical hypodensities, which may represent\nsmall vessel ischemic changes.\n\nThere is is a chronic left medial orbital wall blowout fracture. There is\nmild opacification of the bilateral ethmoid air cells. There are aerated\nsecretions in the bilateral sphenoid sinuses. The mastoid air cells and\nmiddle ear cavitiesare essentially clear. The left eye status post\nenucleation and prosthesis.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect or acute large vascular\nterritory infarction. Mild prominence of the ventricles and sulci suggest age\nrelated atrophy. Minimal periventricular white matter hypodensities are\nnonspecific but likely represent sequela of chronic small vessel ischemic\ndisease. The basal cisterns appear patent and there is preservation of\ngray-white matter differentiation.\n\nNo fracture is identified. The visualized paranasal sinuses, mastoid air cells\nand middle ear cavities are clear. The globes are unremarkable.\nAtherosclerotic mural calcification of the vertebral and internal carotid\narteries is noted.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of intra or extra-axial mass effect, acute hemorrhage or\nlarge territorial infarction. There is mild prominence of the sulci and\nventricles, within expected limits for the degree of stable senescent related\nglobal cerebral volume loss. Mild periventricular and subcortical white\nmatter hypodensities are nonspecific and unchanged, commonly seen in the\nsetting of chronic microangiopathy in a patient of this age. More focal\nhypodense lesion in the right corona radiata/external capsule most likely\nrepresenting a chronic infarct, new since examination of ___.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nMild to moderate calcific atherosclerotic changes of the carotid siphons\nbilateral with no significant narrowing. The vessels of the circle of ___\nand their principal intracranial branches appear normal without significant\nstenosis, occlusion, or aneurysm formation. The dural venous sinuses are\npatent.\n\nCTA NECK:\nModerate mixed calcific and soft tissue plaque atherosclerotic change of the\naortic arch and proximal great arteries results in mild narrowing of the\nbrachiocephalic and left common carotid and mild to moderate of the left\nsubclavian artery at its origin. Mild narrowing at the origin of the left\nvertebral artery.\n\nThere is less than 40 % stenosis at the proximal internal carotid arteries\n(insignificant according to NASCET criteria). No free floating thrombus noted\nin the carotid bulbs bilateral.\n\nMulti level short segment mild to moderate stenosis of the basilar artery. \nModerate narrowing is noted in the V3 segment and proximal V4 segment of the\nleft vertebral artery, with a complete occlusion of the distal V4 segment of\nthe left vertebral artery.\n\nIn addition, a 2-3 mm pseudo aneurysm of the left V3 segment (series 5, image\n170) is identified. No surrounding inflammatory stranding to suggest acute\nprocess.\n\nMild narrowing of the distal right V4 segment.\n\nThe branches of the external carotid arteries appear patent bilateral. \nSpecifically there is no significant wall thickening or irregularity of the\ntemporal arteries bilateral.\n\nOTHER:\n5 mm peribronchiolar vascular nodule in the right upper lobe has a spiculated\nappearance but is nonspecific. There are a couple of small partially\ncalcified cervical level 3 and completely calcified level 6 lymph nodes on the\nright. Atrophic appearance of the thyroid.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Periventricular\nhypodense changes most likely representing microangiopathy with a more focal\nchronic infarct in the basal ganglia.\n2. Less than 40% narrowing of the proximal ICAs bilateral secondary to soft\nplaque and atherosclerotic calcification. No free-floating plaque.\n3. The external carotid arteries are patent. Specifically there is no\nsignificant wall thickening or irregularity of the temporal arteries\nbilateral, within confines of CTA technique.\n4. There is a 2-3 mm pseudoaneurysm of the left V3 segment, without\nsurrounding inflammatory stranding to suggest acute process. This is felt to\nbe chronic.\n5. Moderate narrowings in the distal V3 and V4 segments of the vertebral\narteries with complete occlusion of the distal left vertebral artery V4\nsegment as described above. Multiple short-segment mild-to-moderate\nnarrowings noted in the basilar artery.\n6. Moderate mixed calcific and soft tissue plaque atherosclerotic change of\nthe aortic arch and proximal great arteries results in mild narrowing of the\nbrachiocephalic and left common carotid and mild to moderate of the left\nsubclavian artery at its origin.\n7. 5 mm peribronchovascular nodule in the right upper lobe.\n\nRECOMMENDATION(S): For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommend in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nNo evidence of infarction, hemorrhage, edema, mass, or mass effect. The\nventricles and sulci are prominent, compatible with global parenchymal volume\nloss. Moderate changes of chronic white matter microangiopathy are similar to\nprior. Paranasal sinuses and mastoids appear clear. Carotid siphon\ncalcifications noted bilaterally. Aside from bilateral lens extraction,\nglobes and orbits are within normal limits. Tiny chronic infarct left\nparietal lobe at the vertex, left centrum semiovale periventricular white\nmatter.\n\nCTA HEAD:\nThere is severe, near occlusive luminal narrowing of the distal left vertebral\nartery at the V3/V4 junction at the level of the foramen magnum (3:69); left\nV4 segment is diminutive but patent distal to this, giving rise to a patent\nleft posterior inferior cerebellar artery, with a small branch joining the\nright vertebral artery at the basilar origin. There is focal moderate luminal\nnarrowing of the very proximal basilar artery (3:184). Distal to this, there\nis mild luminal narrowing of the mid to distal basilar artery (3:182). \nFindings are unchanged.\n\nLeft P1 PCA is small but patent. Left posterior communicating artery is also\nsmall but patent. Appearance suggests conventional left PCA anatomy with\nmoderate to severe luminal narrowing of the left P1 segment PCA (see series\n603, image 21), unchanged. There are areas of mild luminal narrowing\naffecting the more distal left PCA branches including the P2 and P3 segments,\nhowever there is preserved distal runoff.\n\nOn the right, the P1, P2, and more distal right PCA branches appear widely\npatent with normal distal runoff. Small but patent right PCOM.\n\nThere is circumferential calcified plaque affecting the cavernous and\nsupraclinoid intracranial ICAs bilaterally, causing only mild luminal\nnarrowing, unchanged. Otherwise, the remaining portions of the bilateral\nintracranial internal carotid arteries and the bilateral anterior and middle\ncerebral arteries are patent with normal distal runoff.\n\nNo aneurysm. No large vessel occlusion. Major dural venous sinuses are\npatent.\n\nCTA NECK:\nPrimarily noncalcified atheromatous plaque at the right carotid bulb and\nproximal extracranial ICA does not cause luminal narrowing by NASCET criteria.\nRemainder of the right carotid artery is unremarkable.\n\nMild calcified plaque at the left common carotid origin is partially\nvisualized, unchanged. Scattered areas of atheromatous plaque throughout the\nleft cervical carotid artery are noted, including in the common carotid and at\nthe carotid bulb, unchanged from prior, not causing significant luminal\nnarrowing by NASCET criteria. Otherwise, left cervical carotid artery is\nwidely patent and unremarkable.\n\nCalcified plaque at the origin of the right vertebral artery causes mild\nluminal narrowing. Remainder of the right cervical vertebral artery is\ntortuous but patent.\n\nModerate focal luminal narrowing of the V2 segment of the left vertebral\nartery at the level of C2-3 (03:132) is unchanged. 1-2 mm focal outpouching\nalong the lateral aspect of the left V3 vertebral artery is unchanged (3:154);\nthis could represent a small pseudoaneurysm or vessel infundibulum. Moderate\nnarrowing V4 segment left vertebral artery. Otherwise, remainder of the left\nvertebral artery is tortuous but otherwise patent and unremarkable.\n\nCalcified plaque right innominate artery origin with suggestion of a small\nulceration within a posteriorly located noncalcified atheromatous plaque\n(03:16); the plaque is unchanged, the ulceration appears new, overall no\nsignificant luminal narrowing.\nAt least moderate luminal narrowing of the proximal left subclavian artery due\nto atheromatous plaque, unchanged (03:27). Severe calcification of the right\nsubclavian artery causing moderate luminal narrowing, unchanged (03:53). More\ndistal subclavian arteries are patent.\n\nOTHER:\nNo pathologic cervical adenopathy. Small calcified granuloma, right lung apex\n(3: 31). 2 mm solid pulmonary nodule, medial left lung apex (___). \nScarring superomedial right upper lobe, similar. Otherwise, visualized lung\napices are clear. No aggressive focal osseous lesions.", + "output": "1. No acute intracranial abnormality.\n2. Small chronic infarcts.\n3. Multifocal high-grade narrowing distal left vertebral artery, basilar\nartery, left P1 PCA, stable.\n4. Mild luminal narrowing intracranial ICAs, distal left P2/P3 PCA branches,\nstable.\n5. Possible small laterally projecting 1-2 mm left V3 vertebral artery\npseudoaneurysm versus infundibulum is unchanged.\n6. Moderate narrowing left V2 segment, mild narrowing right vertebral artery\norigin, stable. Widely patent cervical ICA bilaterally.\n7. Severe aortic arch and arch branch vessel atheromatous disease, new small\nulceration ___ innominate artery.\n8. Areas of moderate luminal narrowing of the bilateral subclavian arteries,\nunchanged." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territorial infarct. There is prominence of\nthe ventricles and sulci suggestive of involutional changes. Focal\nhypodensities involving the bilateral basal ganglia are consistent with\nchronic lacunar infarcts. Periventricular and subcortical white matter\nhypodensities are nonspecific but likely sequelae of chronic small vessel\nischemic disease.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. Patient is status post bilateral lens replacements.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of fracture, acute infarction,hemorrhage,edema,or mass. \nRedemonstrated chronic basal ganglia lacunar infarcts. Periventricular and\nsubcortical white matter hypodensity is nonspecific, but likely reflect\nsequelae of chronic small vessel ischemic disease. There is prominence of\nthe ventricles and sulci suggestive of involutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, loss of\ngray/white matter differentiation. Ventricles, sulci, and basal cisterns are\nnormal in size for age.\n\nNo fracture is seen. There is a fluid level and mild mucosal thickening in\nthe partially visualized right maxillary sinus. There is mild mucosal\nthickening in the right ethmoid air cells. Mastoid air cells and middle ear\ncavities are well aerated. Prominent nasopharyngeal soft tissues are within\nnormal limits for the patient's young age. The orbits are unremarkable.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. Fluid in the right maxillary sinus may indicate acute inflammation in\nappropriate clinical setting. Please correlate with symptoms." + }, + { + "input": "The corpus callosum hematoma and subarachnoid hemorrhage are not significantly\nchanged from CTA study from ___.\n\nHowever, there is interval increase in the amount of the intraventricular\nhematoma within bilateral occipital ventricular horn. The lateral ventricles\nare also increased in size. The third ventricle is slightly more effaced.\nThese findings are concerning for a communicating hydrocephalus\n(extraventricular obstructive hydrocephalus), as well as an element of\nintraventricular obstructive hydrocephalus due to mass effect from the\nintraparenchymal hematoma as well as from clotted blood products within the\nthird ventricle.\n\nThere is otherwise no new hemorrhagic lesions. The basal cisterns appear\npatent and there is preservation of gray-white matter differentiation.\n\nThe visualized bony structures are grossly unremarkable. The paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "1. Multicompartmental hemorrhage with interval increase in the amount of blood\nin bilateral lateral ventricles.\n2. Interval increase in the size of bilateral lateral ventricles, likely\nrepresenting a combination of communicating and obstructive\nhydrocephalus, the latter reflecting both clotted blood within the ventricular\nchain and mass effect upon both the ___ ventricle and the superior portion of\nthe sylvian aqueduct from adjacent parenchymal hematoma.\n3. No new hemorrhagic lesions.\n\nNOTIFICATION: Findings were discussed with Mr. ___, PA (Neurosurgery\nservice) by Dr. ___ the telephone at 11:00 AM on ___, 20 min\nafter the images were reviewed." + }, + { + "input": "Since prior study, patient is now status post frontal craniotomy. In addition,\nthere is a new right frontal approach ventriculostomy catheter is seen, with\ntip terminating in the level of the third ventricle.\n\nCorpus callosum hematoma and subarachnoid hemorrhage looks similar in size and\ndistribution compared to the prior study. Intraventricular hemorrhage is also\nunchanged. However, the temporal ventricular horns are slightly less\nprominent.\n\nThere is no evidence of new hemorrhagic lesions.\n\n\nThe visualized bony structures are grossly unremarkable. The paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "1. Status post right frontal approach ventricular shunt catheter with tip\nterminating in appropriate position. The temporal ventricular horns are\nslightly less prominent compared to prior exam which is prior to shunt\nplacement.\n2. Stable multi compartment hemorrhage. No new hemorrhagic lesions." + }, + { + "input": "Right frontal approach ventriculostomy catheter is again seen, with tip\nterminating in the level of the third ventricle, unchanged location since\nprior study.\n\nCorpus callosum hematoma is unchanged. Extent of subarachnoid hemorrhage is\nsimilar in size and distribution compared to prior study. Intraventricular\nhemorrhage is also unchanged. Diffuse sulcal effacement within the left\nhemisphere is again demonstrated. There is no evidence of new hemorrhagic\nlesions. There is preservation of gray-white matter differentiation.\n\nThe visualized bony structures are grossly unremarkable. The paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "No significant change since prior study on ___ with stable multi\ncompartment hemorrhage. There are no evidence of new hemorrhagic lesions." + }, + { + "input": "The right frontal approach ventriculostomy catheter is again seen with its tip\nterminating at the level of the third ventricle, unchanged in position. The\nventricles are stable in size. Intraventricular hemorrhage, corpus callosal\nhematoma, and subarachnoid hemorrhage appear unchanged.\n\nSince the prior exam, there has been a bifrontal craniectomy with iatrogenic\nmaterial covering a portion of the defect. The bilateral frontal lobes extend\nslightly through the defect. Focal superficial hypodensity in the left\nanterior superior frontal lobe, image 2:23 is unchanged, compatible with\ncontusion or infarction. 5 mm focus of blood within this abnormality is\nslightly larger than before, image 2:23. Diffuse cerebral edema with sulcal\neffacement are again seen. Basal cisterns are not compressed, and there is no\ntranstentorial or cerebellar tonsil herniation.\n\nFluid in the nasopharynx, nasal cavity, and paranasal sinuses is likely\nrelated to endotracheal intubation. The mastoid air cells are clear.", + "output": "1. Stable intraventricular, parenchymal corpus callosum, and subarachnoid\nhemorrhage. Stable size of the ventricles.\n2. Status post bifrontal craniectomy. The bilateral frontal lobes extend\nslightly through the defect. Diffuse cerebral edema persists, but there is no\ncompression of the basal cisterns or downward herniation.\n3. Unchanged contusion or infarct in the left anterior superior frontal lobe.\n5 mm focus of blood within this abnormality has slightly increased compared to\n1 day earlier." + }, + { + "input": "Again seen is a bifrontal craniectomy with surgical material covering the\ncraniectomy defect. A right frontal approach ventriculostomy catheter is\nunchanged in position. Ventricles are stable in size. Intraventricular\nhemorrhage, corpus callosum hematoma and subarachnoid hemorrhage are largely\nunchanged. A focal hypodensity in the left anterior superior frontal lobe\n(series 2, image 22) is unchanged. A small focus of blood within this\nabnormality has decreased in size and conspicuity from the prior study. There\nis persistent, diffuse cerebral edema with sulcal effacement. The basal\ncisterns are patent and there is no transtentorial or cerebellar tonsillar\nherniation.\n\nFluid in the nasopharynx, nasal cavity and paranasal sinuses is most likely\nrelated to endotracheal intubation and is unchanged. The mastoid air cells are\nclear.", + "output": "1. Stable intraventricular, parenchymal corpus callosum and subarachnoid\nhemorrhage.\n2. Minimal decrease in small focus of blood within a the left frontal lobe\nhypodensity compared to the prior." + }, + { + "input": "When compared to prior study dated ___, there been no\nsignificant interval changes. Patient is status post bifrontal craniectomy\nwith surgical material covering the craniectomy defect. There is a right\nfrontal approach ventriculostomy catheter which appears unchanged in position.\nExtensive intraventricular hemorrhage is unchanged in appearance. Extensive\nsubarachnoid hemorrhage as well as corpus callosum hematoma is stable in\nappearance. A hypodensity within the left frontal lobe appears stable as does\nsmall focus of blood (3:26). The degree of diffuse sulcal effacement is\nadditionally unchanged. The basal cisterns appear patent with no evidence of\ntranstentorial or cerebellar tonsillar herniation.\n\nVisualized paranasal sinuses demonstrate air-fluid levels within the frontal,\nmaxillary, and sphenoid sinuses bilaterally. Partial opacification of the\nethmoidal air cells is noted. Mastoid air cells are clear bilaterally. Middle\near cavities bilaterally in are clear.", + "output": "When compared to prior study dated ___, there been no\nsignificant interval changes. Stable appearing extensive intraventricular,\ncorpus callosum, and subarachnoid hemorrhage.\n\nStable appearing left frontal lobe hypodensity with small focus of blood." + }, + { + "input": "Patient is status post bifrontal craniectomy. A right frontal approach\nventriculostomy catheter appears unchanged in position.\n\nExtensive intraventricular hemorrhage, subarachnoid hemorrhage, as well as\ncorpus callosum hematoma are stable in appearance. There is no new foci of\nhemorrhage.\n\nThe degree of diffuse sulcal effacement is also unchanged. The basal cisterns\nare patent.\n\nThere is no new evidence of new infarction within the limitation of artifacts\nand lower image quality as a portable study.\n\nAir-fluid levels are seen in the frontal, bilateral maxillary sinuses, and\nsphenoid sinuses. Mastoid air cells and middle ear cavities are clear\nbilaterally.", + "output": "Since prior study on ___, there is stable-appearing extensive\nintraventricular, subarachnoid, as well as corpus callosum hemorrhage. There\nis no new foci of hemorrhage." + }, + { + "input": "A right frontal approach ventriculostomy catheter is again seen, tip unchanged\nin position within the third ventricle. The lateral ventricle sizes, including\ndilated left temporal ventricular horn, are unchanged in size and\nconfiguration since prior study on ___.\n\nIntraventricular hemorrhage and corpus callosum hematoma are stable. There is\nslightly decreased in the extent of subarachnoid hemorrhage. No new areas of\nhemorrhage are seen.\n\nThere is preservation of gray-white matter differentiation and no evidence of\nnew acute large territorial infarction.\n\nThe frontal sinus is partially opacified. Mucosal thickening is seen in the\nbilateral maxillary sinus, ethmoid air cells, and sphenoid sinus. These\nfindings are consistent with prolonged intubation in an inpatient setting.", + "output": "1. Since prior study on ___, there is stable appearing extensive\nintraventricular and corpus callosum hemorrhage. There is interval decrease in\nthe extent of subarachnoid hemorrhage. There are no new areas of hemorrhage.\n2. No evidence of new acute large territory infarction." + }, + { + "input": "The patient is status post bilateral frontal craniectomy. There is again seen\na left nare NG tube. There has been interval removal of right-sided\nventriculostomy catheter.\n\nThere is continued evolution of known intraventricular hemorrhage and corpus\ncallosum hematoma. The previously documented subarachnoid hemorrhage continues\nto decrease in extent. There is no new area of hemorrhage, or new large\nterritorial infarct seen.\n\nThere is no intracranial mass or shift of normally midline structures. The\nbasal cisterns are patent. There is stable dilation of the temporal horn of\nthe left lateral ventricle.\n\nThere has been an interval decrease in the amount of right maxillary, ethmoid\nair cell, and sphenoidal sinus mucosal thickening. There is continued left\nmaxillary sinus mucosal thickening, as well as partial opacification of\nmastoid air cells bilaterally.", + "output": "1. Continued evolution of known intraventricular hemorrhage and corpus\ncallosum hematoma. Continued decrease in extent of known subarachnoid\nhemorrhage.\n2. No new area of hemorrhage, or new large territorial infarct." + }, + { + "input": "The patient is status post bifrontal craniectomy. There is no significant\nchange in prior known corpus callosum hematoma with adjacent cerebral edema,\nsmall superior frontoparietal subarachnoid hemorrhage, and bilateral\nintraventricular hemorrhage. There is stable lateral ventriculomegaly\nbilaterally. There is no evidence of new hemorrhage or of infarction. There is\nhardware artifact from the anterior cerebral artery aneurysm clip. There is no\nshift of normally midline structures. There is sphenoidal and left maxillary\nmucosal thickening, along with left mastoid air cell opacification.", + "output": "1. No evidence of infarction or new hemorrhage.\n2. Unchanged lateral ventriculomegaly bilaterally.\n3. Continued evolution of known corpus callosum hematoma with surrounding\nedema, subarachnoid hemorrhage, and bilateral IVH." + }, + { + "input": "There are postoperative changes of prior bifrontal craniectomy. Herniation of\nbrain through the craniectomy site is decreased when compared to prior exam.\nThe right frontal ventriculostomy catheter has been removed. Previously\ndescribed intraventricular hemorrhage and hematoma within the corpus callosum\nhave resolved.\n\nThere is no evidence of new intracranial hemorrhage or mass effect. The\nventricles and basal cisterns appear normal. There is metallic artifact within\nthe anterior cerebral artery region compatible with known history of prior\npericallosal artery aneurysm coiling.\n\nThe orbits and paranasal sinuses are unremarkable.", + "output": "1. Postoperative change of bifrontal craniectomy with decreased herniation of\nbrain parenchyma through the craniectomy defect.\n2. Resolved intraventricular hemorrhage and corpus callosum hematoma.\n3. No new intracranial hemorrhage." + }, + { + "input": "The patient is status post coil embolization of a pericallosal artery\naneurysm. A large degree of subarachnoid and intraparenchymal hemorrhage, as\nwell as intraventricular hemorrhage layering within the occipital horns of\nboth lateral ventricles, is grossly unchanged as compared to the prior\nexamination. The hematoma in the corpus callosum is larger than on the CTA\nexamination of ___ at 19:50\n\nThe visualized bony structures are grossly unremarkable. The paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The globes are\nunremarkable.", + "output": "1. Status post coil embolization of a pericallosal artery aneurysm.\n2. Unchanged degree of subarachnoid, intraparenchymal, intraventricular\nhemorrhage.\n3. Enlarged corpus callosum hematoma since ___" + }, + { + "input": "Patient is status post bifrontal cranioplasties with postsurgical changes and\nsmall amount of expected pneumocephalus. Streak artifact from the coil pack\nrelated to the pericallosal aneurysm slightly limits evaluation. There is\nsmall amount of extra-axial blood deep to the cranioplasties. There is mild\nnew subarachnoid hemorrhage involving the in the right sylvian fissure and\nright frontal sulci. There is a 1.4 x 0.8 cm hemorrhagic contusion with mild\nsurrounding edema in the inferior right frontal lobe.\n\nThere is no shift of midline structures. Ventricles and sulci are slightly\nsmaller than on ___, but this could be related to the interim\ncranioplasties rather than intracranial hemorrhage, as there is no evidence\nfor parenchymal edema.\n\nThere is a small focus of mucosal thickening in the superior right frontal\nsinus adjacent to the cranioplasty.\n\nThere is new fluid in the left frontal and left maxillary sinuses, and new\nopacification of several left anterior ethmoid air cells, as well as increased\nsecretions in the right sphenoid sinus. There is partial bilateral mastoid air\ncell opacification. These findings could be secondary to prolonged supine\npositioning in the inpatient setting, particularly given the recent surgery.", + "output": "1. S/p bifrontal cranioplasties with small amount of underlying extra-axial\nhemorrhage bilateral.\n2. New mild right sylvian and frontal subarachnoid hemorrhage.\n3. New hemorrhagic contusion in the inferolateral right frontal lobe.\n4. Diffuse interim decreased size of the ventricles and sulci, which could be\nrelated to the interim cranioplasties rather than intracranial hemorrhage, as\nthere is no evidence for parenchymal edema. Recommend close follow up.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\non the telephone on ___ at 12:45 AM, 5 minutes after discovery of the\nfindings." + }, + { + "input": "Bifrontal cranioplasties are again seen.Pneumocephalus has slightly decreased.\nMidline frontal dural thickening and calcifications are again seen. Streak\nartifact from the coils related to the pericallosal aneurysm slightly limits\nevaluation. Right sylvian and frontal subarachnoid hemorrhage. Appears stable.\nRight inferolateral frontal hemorrhagic contusion. Demonstrates stable amount\nof hemorrhage and stable surrounding edema. Small amount of right frontal\nextra-axial blood deep to the cranioplasty also appears unchanged. There is no\nevidence for new hemorrhage or new parenchymal edema. However, lateral and\nthird ventricles appear minimally smaller than 8 hr earlier. Basal cisterns\nare stable in size. There is no herniation.\n\nAgain seen is an area of encephalomalacia in the superior medial left frontal\nlobe, in the anterior cerebral artery territory.\n\nThere is a small focus of mucosal thickening in the superior right frontal\nsinus abutting the cranioplasty.\n\nThere is persistent fluid in the left frontal and left maxillary sinuses, and\npersistent opacification of sever left anterior ethmoid air cells. There also\npersistent secretions in the right sphenoid sinus. There is partial bilateral\nmastoid air cell opacification. These findings are likely secondary to\nprolonged positioning in the inpatient setting.", + "output": "1. Stable mild right sylvian and frontal subarachnoid hemorrhage. Stable\nhemorrhagic contusion in the right frontal lobe. Stable small right frontal\nextra-axial hematoma deep to the cranioplasty.\n2. While there is no overt evidence for parenchymal edema, the lateral and\nthird ventricles appear minimally smaller than 8 hr earlier. Recommend close\nfollow up." + }, + { + "input": "CT head: The corpus callosum hematoma, subarachnoid hemorrhage,\nintraventricular hemorrhage are not significantly changed from CT on ___. Ventricle size is stable. There is no midline shift. Again\nnoted is a coil pack in the region of the pericallosal artery. The osseous\nstructures are normal. The paranasal sinuses, mastoid air cells, and tympanic\ncavities are clear. The orbits are normal.\n\nCTA head: The intracranial internal carotid arteries are normal in\nconfiguration.\n\nThere is a coil pack in the left pericallosal artery. No residual aneurysm is\nidentified. The parent left anterior cerebral artery supplying the left\npericallosal artery is normal with no evidence of vasospasm. The right\nanterior cerebral artery is normal. The anterior communicating artery region\nappears unremarkable.\n\nThe middle cerebral arteries are patent with normal contrast enhancement and\nbranching pattern.\n\nThe vertebral and basilar arteries demonstrate normal enhancement without\nstenosis or occlusion. The posterior cerebral arteries have a normal caliber\nand branching pattern.\n\nThere is no evidence of stenosis, occlusion, or arteriovenous malformation.", + "output": "1. No evidence of vasospasm status post left pericallosal artery aneurysm\ncoiling. Please note that vasospasm typically affects distal arterial branches\nmore than proximal arterial branches and, therefore, is not always well\nevaluated by CTA.\n2. Stable corpus callosum hematoma and multi compartment hemorrhage. Stable\nventricle size." + }, + { + "input": "Post procedural changes from bifrontal craniotomies and cranioplasty. Since\nprior, there is new moderate to large volume pneumocephalus. There is\nsuggestion that the the midline burr hole inferiorly, connects with the\nfrontal sinus (series 603b, image 43). A 1.9 x 1.1 cm low-density collection\nwithin the subcutaneous tissues overlying the right frontal bone with foci of\nair, concerning for a a pseudomeningocele (Series 2, image 10). Additionally,\nsoft tissue air is present over the left frontal bone as well.\n\nAneurysm coil in the region of the interhemispheric fissure, unchanged in\nposition causing mild streak artifact. High density along the site is\nunchanged from ___, likely artifactual, although a small amount of\nresidual hemorrhage cannot entirely be excluded. Area of encephalomalacia\nwith in the right frontal lobe in the region of prior hemorrhage as well as an\narea of encephalomalacia in the left frontal lobe at the vertex, unchanged as\nwell as hypodensity of the body of the corpus callosum. There is no\nsignificant shift of midline structures. The basal cisterns are patent and\nthere is preservation of gray-white matter differentiation.\n\nThere is fluid within the left maxillary sinus, ethmoid air cells, and left\nfrontal sinuses. The mastoid air cells are clear. The globes are\nunremarkable. .", + "output": "1. New moderate to large volume pneumocephalus with apparent connection\nbetween a midline burr hole and the frontal sinus, consultation with\nneurosurgery is advised.\n2. 1.9 x 1.0 cm low-density collection overlying the right frontal bone,\nconcerning for a pseudomeningocele." + }, + { + "input": "As seen on the CT from 12 hr prior, there are postprocedural changes from\nbifrontal craniotomies and cranioplasty. Moderate volume pneumocephalus is\nunchanged. Connection between the left frontal sinus and an inferior frontal\nburr hole is redemonstrated (60___:7). There is a peripherally enhancing,\nlow-density collection in the subcutaneous tissues overlying the right frontal\nbone demonstrates an air-fluid level, and now measures 4.2 x 1.3 cm (4:8),\nwith the interval increase in size likely secondary to increased volume of\nair. There is peripheral enhancement with this collection, which could be\npostsurgical or infectious.\n\nAneurysm coil in the anterior interhemispheric fissure is unchanged in\nposition resulting in streak artifact. Areas of encephalomalacia in the\nfrontal lobes bilaterally are likely related to prior intervention or\nhemorrhage. No evidence of new hemorrhage, mass effect, or midline shift.\n\nThere is fluid within the frontal sinuses, ethmoid air cells bilaterally, and\nmaxillary sinuses, left greater than right. Sphenoid sinuses, mastoid air\ncells, and middle ear cavities are clear.", + "output": "1. Stable probable pseudomeningocele communicating with collection overlying\nright frontal bone as described.\n2. Peripheral enhancement of collection overlying right frontal bone which is\nnonspecific, and may be of reactive versus infectious etiology. Recommend\nclinical correlation.\n3. Stable postsurgical changes related to prior craniotomies and aneurysm\nclipping as described." + }, + { + "input": "The patient is status post bifrontal craniectomy. Subcutaneous air along the\nsurgical margin is expected. There is a small amount of the high-density\nmaterial overlying the dura at the surgical bed, more extensive on the left\nthan right, likely representing postsurgical change with a small superimposed\namount of blood on the left.\n\nPreviously seen right frontal scalp fluid and air collection has decreased in\nsize, now measuring 2.7 x 0.7 cm (series 3, image 9).\n\nA coil pack is again seen in the anterior interhemispheric fissure. No acute\nparenchymal or subarachnoid hemorrhage is seen. Foci of encephalomalacia in\nthe medial left frontal lobe and in inferolateral right and left frontal lobes\nare again seen. The anterior frontal lobes appears slightly expanded following\ncraniectomy, but no new loss of gray/ white matter differentiation is seen. \nThe ventricles are normal in size.\n\nThere is essentially complete opacification of the anterior ethmoid air cells\nand frontal sinuses bilaterally, increased compared to the presurgical CT. \nSmall amount of fluid and mucosal thickening are seen within the left\nmaxillary sinus. The mastoid air cells are clear.", + "output": "1. Status post bifrontal craniectomy with minimal blood products overlying the\ndura on the left.\n2. No evidence for intradural hemorrhage or new parenchymal edema.\n3. Right frontal scalp fluid in air collection has decreased in size.\n4. Essentially complete opacification of the anterior ethmoid air cells and\nfrontal sinuses bilaterally has increased compared to the presurgical CT." + }, + { + "input": "The patient is status post frontal craniectomy. There is encephalomalacia in\nthe left frontal region. The coil is visualized in the interhemispheric\nregion. No acute hemorrhage or other acute abnormalities seen. There is no\nhydrocephalus or midline shift.", + "output": "Further evaluation of previously seen changes of encephalomalacia. \nCraniectomy. No acute abnormalities." + }, + { + "input": "The patient is status post bifrontal craniectomy. There has been interval\nimprovement of the overlying postsurgical subcutaneous fluid and air and\nresolution of the right frontal air-fluid collection. No new fluid collection\nis seen. A coil is again noted in the anterior interhemispheric fissure\n(series 2: Image 17). Encephalomalacia of the medial left frontal lobe and\nright inferior frontal lobe are again seen (series 2:image 10, 18). Ex vacuo\ndilation of the frontal horns of the lateral ventricles is also seen (series\n2:image 17).\n\nThere is no evidence of new or acute large territorial infarction, hemorrhage,\nedema, or mass. There is no abnormal enhancement on post contrast images.\n\nComplete opacification of the bilateral frontal sinuses is noted with\nimprovement in aeration of the frontal ethmoid air cells. Minimal mucosal\nthickening of the ethmoid air cells is noted, and the remaining visualized\nparanasal sinuses, middle ear cavities and mastoid air cells are clear.", + "output": "1. Interval improvement of the bifrontal subcutaneous postsurgical changes and\nresolution of the right frontal fluid collection.\n2. No acute intracranial process.\n3. Improvement in opacification of the anterior ethmoid air cells with\ncontinued complete opacification of the bilateral frontal sinuses." + }, + { + "input": "Frontal craniectomy is identified. Postoperative changes are seen in the\nregion of genu of corpus callosum. Left frontal encephalomalacia is seen. \nThere is no ventriculomegaly. There is no acute hemorrhage mass effect or\nmidline shift.\n\nThe visualized paranasal sinuses are clear.", + "output": "No acute intracranial abnormalities are identified. No significant change\nsince the previous study. Examination is performed for evaluation of\ncranioplasty." + }, + { + "input": "Patient is status post bifrontal cranioplasty. Subcutaneous drain is in\nplace. There is moderate postoperative pneumocephalus as well as a small\namount of extra-axial blood layering over bilateral frontal lobes. Left\nfrontal encephalomalacia is unchanged. A coronal in the interhemispheric\nregion is unchanged. There is otherwise no evidence of new infarction, \nedema, or mass. The ventricles and sulci are unchanged in size and\nconfiguration.\nThere is no evidence of fracture. Small amount of fluid is noted in the\nbilateral frontal sinuses, likely postoperative. The visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are\notherwise clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Postsurgical changes from bifrontal cranioplasty with moderate\npneumocephalus and small amount of layering extra-axial blood.\n2. Unchanged left frontal encephalomalacia." + }, + { + "input": "Patient status post bifrontal cranioplasty. In the interval, there has been\nreplacement of pneumocephalus from the bifrontal epidural space with fluid\nmeasuring up to 14 mm in maximal thickness with a crescentic shape as on\nprior. A small amount of residual gas is seen within this collection. There\nis a similar overall pattern of mass effect. No herniation or shift of\nmidline structures. There is increased frontal subgaleal edema which expands\nthe soft tissues of the anterior scalp extending along the left periorbital\nspace. Chronic encephalomalacia in the left superior frontal lobe is\nunchanged. A metallic clip noted in the interhemispheric region near the genu\nof the corpus callosum. Ventricles appear size stable from recent exam. No\nedema or evidence of acute major vascular territorial infarction. The basal\ncisterns appear patent. Imaged paranasal sinuses are clear. Mastoid air\ncells and middle ear cavities are well aerated.", + "output": "Status post bifrontal cranioplasty with mild residual pneumocephalus and\nincreased epidural fluid collection along the cranioplasty site. Subgaleal\nedema in the bifrontal space likely extending to the left periorbital region. \nPlease correlate for possible communication of subgaleal and epidural fluid." + }, + { + "input": "SOFT TISSUES: Besides the soft tissue abnormality surrounding the left orbit,\nas detailed below, there is no stranding, fluid collection, hematoma, or other\nsoft tissue abnormality.\n\nBONES: Postsurgical changes are present from bifrontal cranioplasty. Again,\nthere is a similar degree of fluid within the bifrontal epidural space. \nIntermediate density bifrontal subgaleal fluid, is similar to slightly\nincreased in volume when compared to the prior examination, which may be\nsecondary to differences in scan angle. There is interval resolution of\npneumocephalus.\n\nSINUSES: There is moderate mucosal wall thickening of the bilateral frontal\nsinuses. The remainder of the paranasal sinuses are intact and clear. The\nostiomeatal units are patent. The visualized mastoid air cells and middle ear\ncavities are clear.\n\nNOSE: There is no nasal bone fracture. Nasopharyngeal soft tissues are\nunremarkable. There is no nasal septal hematoma.\n\nORBITS: The orbits, including the laminae papyracea, are intact. The globes\nare intact with non-displaced lenses and no intraocular hematoma.There is\ntrace left preseptal edema and skin thickening, most prominent inferior to the\nleft orbit in the pre maxillary soft tissues, slightly asymmetrically\nprominent when compared to the right. However, it should be noted that some\nof these subgaleal fluid adjacent to the cranioplasty appears to track\nadjacent to the left orbit, as seen previously. There is no postseptal\ncomponent. There is no periorbital fluid collection. There is no retrobulbar\nhematoma or fat stranding.\n\nAllowing for imaging technique optimized for the orbits, the limited included\nportion of the brain is grossly unremarkable.", + "output": "1. Left periorbital soft tissue edema and skin thickening may represent\nperiorbital cellulitis, though some of these findings may be secondary to\ntracking of the postsurgical subgaleal fluid adjacent to the left orbit, as\nwas seen on the prior head CT. No postseptal component to suggest orbital\ncellulitis.\n2. Postsurgical changes from bifrontal cranioplasty with a similar degree of\nepidural fluid. The subgaleal fluid may be slightly increased in size,\nhowever this is likely secondary to differences in scan angulation." + }, + { + "input": "The patient is status post removal of synthetic cranioplasty. Expected\npostprocedural changes are noted, including subgaleal edema and air. There is\nno evidence of intracranial hemorrhage. Edema in the frontal lobes is noted\n(series 3, image 16). Ventricles are not enlarged. There is no shift of\nnormally midline structures. Gliosis in the left superior frontal lobe is\nunchanged. Postsurgical changes after clipping of pericallosal aneurysm is\nseen.\n\nThere is no fracture. The mastoid air cells and middle ear cavities are\nclear. The imaged paranasal sinuses are clear.", + "output": "1. Status post removal of cranioplasty with expected postprocedural changes. \nNo evidence of intracranial hemorrhage.\n2. Edema in the bilateral frontal lobes." + }, + { + "input": "Patient is status post bifrontal craniectomy. As compared to prior head CT\nexamination from ___, there has been interval resolution of\nsubgaleal edema and air at the surgical site. Edema of the bifrontal lobes is\nalso improved.\n\nThere is no evidence of large territorial infarction or acute hemorrhage. \nVentricles are normal in size. There is redemonstration of gliosis at the\nleft frontal lobe. Postsurgical changes related to clipping of a pericallosal\naneurysm are again noted. Imaged paranasal sinuses are clear. Mastoid air\ncells and middle ear cavities are clear.", + "output": "1. Status post bifrontal craniectomy with expected postsurgical changes and\ninterval resolution of subgaleal edema and air.\n2. Interval improvement of bifrontal edema." + }, + { + "input": "At the level of right C2 fracture, the vertebral artery is markedly tortuous\nwith a hairpin turn without any definite evidence of vascular injury.\n\nThe carotid and vertebral arteries and their major branches are patent with no\nevidence of stenoses. No evidence for dissection is seen.\n\nThere is no evidence of internal carotid artery stenosis by NASCET criteria.\n\nThere is mild atherosclerosis involving the aortic arch. Also seen is mild\natherosclerosis involving bilateral cavernous carotid arteries, right greater\nthan left, partially visualized.\n\nA pocket of air is partially visualized in the left axillary region. Further\nevaluation with dedicated imaging can be performed as clinically indicated.\n\nThe previously seen fracture involving the right C2 transverse foramen is\nbetter evaluated on dedicated CT of the cervical spine.", + "output": "1. No evidence of vascular injury related to the C2 fracture.\n2. Mild atherosclerosis. Otherwise, unremarkable CT of the neck.\n3. Fracture of the right C2 transverse foramen, better evaluated on prior CT\nof the cervical spine." + }, + { + "input": "CT Head: There is no evidence of hemorrhage, midline shift, mass, mass effect,\nor acute infarction. The ventricles, sulci and basal cisterns are normal in\ncaliber and configuration. No fractures are identified.\n\nCTA Head: There is a large saccular aneurysm arising from the basilar tip,\nprojecting superiorly and measuring approximately 8 x 7 x 7 mm (SI x TR x AP).\nThe bilateral posterior cerebral arteries originate proximal to this aneurysm.\nThe aneurysm demonstrates smooth lobulations with a focal rightward projecting\noutpouching (11; 237).\n\nThere is adequate opacification of the internal carotid, anterior cerebral,\nmiddle cerebral, vertebral, basilar and posterior cerebral arteries. There is\nmild calcified and noncalcified atherosclerotic disease of the bilateral\ncarotid siphons. The anterior communicating artery is well visualized. The\nleft vertebral artery is dominant. The posterior communicating arteries are\nnot definitely seen. There is no evidence of stenosis, occlusion, dissection\nor vascular malformation. No other aneurysm is identified.\n\nCTA Neck: There is a left-sided aortic arch with conventional origin of the\nmajor branch vessels. There is moderate calcified and noncalcified plaque\nwithin the aortic arch. There is diffuse atheromatous disease, particularly at\nthe right common carotid artery, right bifurcation and origin of the right\ninternal carotid artery. The left internal carotid artery origin also\ndemonstrates noncalcified plaque. There is adequate opacification of the\nbilateral common carotid, internal carotid and vertebral arteries, without\nhigh-grade narrowing. The left vertebral artery is dominant. There is no\nevidence of significant stenosis at the origins or throughout the courses of\nthese vessels.\n\nRight internal carotid artery (minimal dimension in mm):\n\nProximal: 5.5\n\nDistal: 4.0\n\nLeft internal carotid artery (minimal dimension in mm):\n\nProximal: 7.0\n\nDistal: 4.1\n\nAdditional findings: The paranasal sinuses and mastoid air cells are clear.\nThe nasopharynx, oropharynx, hypopharynx and larynx are unremarkable. The\nthyroid gland demonstrates homogeneous density. There is no evidence of\nenlarged lymph nodes by CT criteria. The visualized lung apices are clear,\nwith multiple centrilobular and paraseptal cystic lesions, consistent with\nparaseptal and centrilobular emphysema. There are moderate to severe\ndegenerative changes of the cervical spine, particularly at C5-C6 and C6-C7.", + "output": "1. No evidence of acute intracranial process.\n\n2. Large saccular and smoothly lobulated aneurysm arising from the basilar\ntip, projecting superiorly and measuring approximately 8 x 7 x 7 mm.\n\n3. No evidence of stenosis or occlusion or dissection.\n\n4. CTA Neck demonstrates moderate diffuse atherosclerotic disease particularly\nat the common carotid artery, right bifurcation and right and left internal\ncarotid artery origins, as described above. There is no stenosis of internal\ncarotid arteries by NASCET criteria." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of large territory infarction,hemorrhage,edema,mass\neffect ormass. The ventricles and sulci are normal in size and configuration.\nThere is mild calcified atherosclerosis at the bilateral carotid siphons.\n\nThere is mild mucosal thickening of the bilateral ethmoid air cells in\nbilateral maxillary sinuses. The visualized portion of the other paranasal\nsinuses,mastoid air cells,and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent. Incidentally noted is a fetal left posterior\ncerebral artery and a right fetal type posterior cerebral artery which are\nnormal anatomic variants.\n\nCTA NECK:\nThe bilateral carotid arteries demonstrate mild atherosclerotic disease. The\ncarotidandvertebral arteries and their major branches appear normal with no\nevidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. There is no lymphadenopathy by\nCT size criteria. An endotracheal and orogastric tube are noted.", + "output": "1. Normal head and neck CTA, without evidence of internal carotid arteries\nstenosis by NASCET criteria.\n2. No acute intracranial process, specifically no large territory infarction\nor hemorrhage." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. Chronic\nleft cerebellar infarcts, stable. Chronic lacunar infarct right thalamus,\nleft caudate body, left occipital lobe, small chronic cortical infarct right\nprecentral gyrus, seen on prior. Findings consistent with severe chronic\nsmall vessel ischemic changes. Findings consistent with chronic infarct\nversus chronic posttraumatic encephalomalacia left anterior and posterior\norbital gyrus, stable.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute findings.\nChronic infarcts, stable.\nSevere chronic small vessel ischemic changes." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. There\nis prominence of the ventricles and sulci suggestive of significant\ninvolutional changes. Calcifications are noted within the right temporal lobe\nalong the course of the right MCA (2:7, 8).\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The native lenses have been removed bilaterally.", + "output": "1. No acute intracranial abnormalities.\n2. Significant involutional changes.\n3. Calcifications within the right temporal lobe along the course of the right\nMCA. This finding may represent an aneurysm. See recommendations below.\n\nRECOMMENDATION(S): Non urgent CTA head is recommended for further evaluation." + }, + { + "input": "There is no evidence of fracture, recent territorial\ninfarction,hemorrhage,edema,or mass. Small chronic right cerebellar infarct\nis again noted. There is prominence of the ventricles and sulci suggestive of\nsignificant involutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. Status post bilateral lens replacement. There is\nsoft tissue swelling with skin staples in the right parietal region compatible\nwith skin laceration, with a possible tiny subgaleal hematoma in this region. \nNo underlying fracture.\n\nRedemonstrated calcification in the area of the right temporal lobe, along the\ncourse of the right MCA (series 2:7).", + "output": "1. No acute intracranial process. Specifically, no intracranial hemorrhage.\n2. Right parietal soft tissue swelling and possible tiny subgaleal hematoma,\nwithout evidence of underlying fracture.\n3. Redemonstrated calcification within the right temporal lobe along the\ncourse of the right MCA. This finding may represent an aneurysm which could\nmeasure 5 mm. Please see recommendation below for follow-up\n4. Significant involutional changes.\n\nRECOMMENDATION(S): Recommend nonemergent CTA head and neck." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute intracranial hemorrhage, mass, mass effect or\nshifting of the normally midline structures, prominent ventricles and sulci\nappear unchanged. Calcification along the right middle cerebral artery is also\nunchanged and is consistent with a 5 x 4 mm saccular aneurysm, better depicted\nin the CTA of the head described below in this report. The orbits are notable\nfor bilateral lens replacement, the paranasal sinuses, middle ear cavities and\nmastoid air cells are clear.\n\nCTA OF THE HEAD.\nThere is a partially calcified saccular aneurysm at the right middle cerebral\nartery bifurcation, apparently arising from the inferior division, oriented\nlaterally and inferiorly, measuring approximately 5 x 4 mm in transverse\ndimension (7:64). There is a second aneurysm at the junction of the left A1\nsegment and anterior communicator artery (7:66), measuring approximately 6.5 x\n4.2 mm in transverse dimension, there is hypoplasia of the A1 segment on the\nright, the posterior circulation at the left MCA are patent as well as the\nbasilar artery. Grossly no flow stenotic lesions are visualized in the\n___.\n\nCTA OF THE NECK. Vascular atherosclerotic calcifications are seen in the\naortic arch, the origin of the supraaortic vessels is normal with 3 branching\npattern, vascular atherosclerotic calcifications are seen in the left\nsubclavian artery, punctate vascular atherosclerotic calcifications are seen\nat the cervical carotid bifurcations, with no evidence of stenosis by NASCET\ncriteria. Both vertebral arteries are patent, the left vertebral artery is\ndominant, the posterior circulation appears normal with patent basilar artery.\n\nOTHER FINDINGS:\n\n\nMultilevel degenerative changes are visualized throughout the cervical spine,\ngrossly unchanged since the prior CT of the cervical spine performed on ___, the patient is status post CABG. The left thyroid lobe is\nsurgically removed, the right thyroid lobe is heterogeneous without discrete\nnodule, the lung apices are clear.", + "output": "1. There is a partially calcified saccular aneurysm at the right middle\ncerebral artery bifurcation, apparently arising from the inferior division,\noriented laterally and inferiorly, measuring approximately 5 x 4 mm in\ntransverse dimension (7:64).\n\n2. There is a second aneurysm at the junction of the left A1 segment and\nanterior communicating artery (7:66), measuring approximately 6.5 x 4.2 mm in\ntransverse dimension, there is hypoplasia of the A1 segment on the right.\n\n3. Vascular atherosclerotic calcifications are seen in the left subclavian\nartery, punctate vascular atherosclerotic calcifications are seen a" + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nLeft maxillary sinus probable mucous retention cyst is noted. Left ethmoid\nair cell and bilateral maxillary sinus mucosal thickening is present. Left\nfrontal sinus mucosal thickening is present. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact. Minimal left frontal\nsupraorbital scalp soft tissue swelling is present (see 05:21). Minimal right\npremalar soft tissue swelling is present (see 5:7). Left palatine tonsillith\nis present (see 5:2). Multiple maxillary periapical lucencies are noted. \nMultiple dental cavities and teeth with absent crowns are also noted.", + "output": "1. No acute intracranial abnormality.\n2. No evidence acute intracranial hemorrhage or fracture.\n3. Minimal left supraorbital frontal scalp and right pre malar soft tissue\nswelling.\n4. Paranasal sinus disease, as described.\n5. Extensive periodontal and dental disease as described, with multiple teeth\nsuggestive of absent crowns versus cavities. If clinically indicated,\nconsider correlation with dental examination.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 12:53 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." + }, + { + "input": "There is no evidence of hemorrhage, edema, or mass effect. There is a subtle\nhypodensity along the anterior limb of the left internal capsule, acuity is\nuncertain but likely chronic. There are periventricular and subcortical\nhypodensities which represent chronic microangiopathy. There is slight\nprominence of the subcortical hypodensity in the left temporal lobe, which may\nbe due to the patient's orientation. In the setting of chronic\nmicroangiopathy, sensitivity for small infarcts is decreased, MRI is more\nsensitive for acute infarction. No evidence of large territorial infarct.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Patient is\nstatus post left cataract surgery.", + "output": "1. No evidence hemorrhage or large territorial infarct on noncontrast head CT.\n2. Subtle hypodensities in the left anterior internal capsule and the left\ntemporal lobe in the setting of chronic microangiopathic changes are\nnonspecific, likely due to chronic disease and patient positioning. Please\nnote that an MRI is more sensitive for acute infarction.\n3. Additional findings described above." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect. There is asymmetry of the tonsillar region right prominent\nthan the left side (02:24).\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding.Multiple bilateral hypodense thyroid nodules measure up to 1.2 cm\n(301:101).Multiple bilateral cervical nodes are prominent, measuring up to 0.8\ncm, for example, a right level IIa node (301:51).The neck vessels are patent.\n\nSevere centrilobular and paraseptal emphysema of the lung apices.There are no\nworrisome osseous lesions. Multilevel degenerative changes of the cervical\nspine, most prominent within the upper cervical spine.", + "output": "1. Multiple, bilateral prominent cervical nodes which are not enlarged by\nimaging criteria.\n2. Prominence of the right tonsillar region. Direct visualization can help\nfor further assessment.\n3. Multiple bilateral hypodense thyroid nodules, measuring up to 1.2 cm.\n4. Severe centrilobular and paraseptal emphysema of the imaged lung apices." + }, + { + "input": "Hypoattenuation involving the left postcentral gyrus with loss of gray-white\nmatter differentiation is new from prior study and concerning for infarction\n(05:23).\nNo evidence of hemorrhage or significant mass effect.\nPeriventricular white-matter hypodensities have not significantly changed when\ncompared to the prior study, remain nonspecific but could represent sequela of\nchronic small vessel disease. Also noted is a subtle focal hypodensity in the\nanterior limb of the left internal capsule, also similar to the prior study. \nThere is mild largely unchanged prominence of the ventricles and sulci\nsuggestive of involutional changes.\n\nIn comparison to the study from ___, a new circumscribed 8 mm cortical\nlucency is noted in the left parietal bone extending to the outer table\n(05:24). Otherwise, there is no evidence of fracture. The visualized portion\nof the paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. New hypoattenuation involving the left postcentral gyrus with loss of\ngray-white matter differentiation, concerning for infarction. MR is more\nsensitive for detection and evaluation of acute infarcts and is recommended.\n2. No evidence of hemorrhage or significant mass effect.\n3. New circumscribed 8 mm cortical lucency in the left parietal bone.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 2:27 pm, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. The ventricles and sulci prominent in size compatible with global\nvolume loss.\n\nThere is no evidence of fracture. Patient is status post endoscopic sinus\nsurgery. Visualized paranasal sinuses and mastoids are clear. Soft tissue\nswelling overlying the forehead on the right without underlying calvarial\nfracture.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of large vessel infarction,hemorrhage,edema,ormass. The\nventricles and sulci are normal in size and configuration.\n\nThere is a mucous retention cyst within left maxillary sinus. Otherwise, the\nvisualized portion of the paranasal sinuses, mastoid air cells,and middle ear\ncavities are clear. The visualized portion of the orbits are normal.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. There is normal\nappearing 3 vessel aortic arch configuration. The dural venous sinuses are\npatent. The right transverse sinus is dominant and the left is diminutive.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their damajor branches appear normal with\nno evidence of stenosis or occlusion.\n\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Normal head CT.\n2. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n3. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection.\n4. Left maxillary sinus mucus retention cyst." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nNo evidence for acute intracranial hemorrhage or acute major vascular\nterritorial infarction. Stable 6 mm meningioma along the right parietal\nconvexity at the vertex, image 2:27, without mass effect on the brain\nparenchyma. Normal size of the ventricles, sulci, and basal cisterns.\n\nThere are dependent secretions versus mucosal thickening in the inferior left\nfrontal sinus and in scattered bilateral ethmoid air cells. Left\nfrontoethmoidal recess may be occluded, not fully assessed. There is mild\nmucosal thickening in the sphenoid sinuses along the anterior walls. Mastoid\nair cells are grossly well-aerated allowing for technique. The orbits are\nunremarkable.\n\nCTA NECK:\nThere is a 3 vessel aortic arch. There is mild calcified plaque involving the\nvisualized aortic arch, proximal descending aorta, and great vessel origins\nwithout flow-limiting stenosis. There is mixed, predominantly noncalcified\nplaque in the proximal left subclavian artery, approximately 1.5 cm distal to\nits origin, causing high-grade stenosis spanning approximately 1 cm. \nBilateral vertebral arteries appear widely patent. There is mild mixed plaque\nat the origin of the right internal carotid artery and mild calcified plaque\nat the origin of the left internal carotid artery without stenosis by NASCET\ncriteria.\n\nCTA HEAD:\nThere is noncalcified plaque mildly narrowing the proximal cavernous left\ninternal carotid artery, image 3:220. There is mixed plaque mildly narrowing\nthe mid cavernous left internal carotid artery, image ___. There is mild\ncalcified plaque within the right carotid siphon without evidence for\nflow-limiting stenosis. No evidence for flow-limiting stenosis elsewhere in\nthe major intracranial arteries. No evidence for an aneurysm. The dural\nvenous sinuses are patent.\n\nOTHER:\nThe thyroid is grossly unremarkable. No lymphadenopathy by CT criteria. Mild\ndependent atelectasis in the included upper lungs. No concerning osseous\nabnormalities seen. Anterior endplate osteophytes in the visualized upper\nthoracic spine.", + "output": "1. No evidence for acute intracranial abnormalities. MRI would be more\nsensitive for an acute infarction or other posterior fossa pathology, if\nclinically warranted.\n2. Stable 6 mm right parietal vertex meningioma without mass effect on the\nbrain parenchyma.\n3. Dependent secretions versus mucosal thickening in the inferior left frontal\nsinus and scattered bilateral ethmoid air cells, with probable occlusion of\nthe left frontoethmoidal recess. Please correlate with any associated\nsymptoms.\n4. Mixed plaque within the left subclavian artery approximately 1.5 cm distal\nto its origin, which causes high-grade stenosis spanning approximately 1 cm.\n5. Mild atherosclerosis of bilateral internal carotid artery origins without\nstenosis by NASCET criteria.\n6. Mild atherosclerotic narrowing of proximal and mid cavernous left internal\ncarotid artery. Right carotid siphon calcifications without flow-limiting\nstenosis. No evidence for high-grade stenosis involving the major\nintracranial arteries." + }, + { + "input": "LEFT:\nThe external auditory canal is normal. The tympanic membrane is intact. The\nmiddle ear cavity is well pneumatized and clear. The ossicular chain is\nintact. The scutum is sharp. The tegmen is intact. There is no evidence of\ninner ear dysplasia. There is no evidence of otosclerosis. The superior\nsemicircular canal appears well-covered by bone. The internal auditory canal\nis normal. The bony facial nerve canal describes a normal course. The\nvestibular aqueduct is not enlarged. The mastoid is well developed, with a\nfew fluid-filled air cells seen near the mastoid tip, otherwise largely clear\n(06:32).\n\nRIGHT:\nThe external auditory canal is unremarkable. The tympanic membrane is normal.\nThe middle ear cavity is well pneumatized and clear. The ossicular chain is\nintact. Scutum is sharp. The tegmen is intact. There is no evidence of\ninner ear dysplasia. There is no evidence of otosclerosis. The superior\nsemicircular canal is well covered by bone. The IAC is unremarkable. The\nbony facial nerve canal describes a normal course. The vestibular aqueduct is\nnot enlarged. The mastoid is well developed and clear.\n\nOther: The left petrous apex is pneumatized and clear. There are mild\nbilateral carotid siphon calcifications. The visualized brain and neck soft\ntissues are normal although the examination is not dedicated for such\nevaluation.", + "output": "1. No evidence of right or left superior semicircular canal dehiscence.\n2. Aside from a few fluid-filled left mastoid air cells near the mastoid tip,\nunremarkable right and left CT temporal bone." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute large territorial infarction, intracranial\nhemorrhage, or mass. The ventricles and sulci are normal in size and\nconfiguration.\n\nUnremarkable intraorbital contents. Minimal mucosal thickening of the\nparanasal sinuses. The mastoid air cells and middle ear cavities are clear.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThere is a common origin of the right brachiocephalic and left common carotid\narteries, a normal anatomic variant. The carotid and vertebral artery and\ntheir major branches demonstrate opacification with no evidence of stenosis or\nocclusion. There is no evidence of internal carotid stenosis by NASCET\ncriteria.\n\nOTHER:\nNo suspicious pulmonary nodules.\n\nPartially calcified left hilar lymph nodes likely reflects sequela of\ngranulomatous infection.\n\nThe thyroid gland is heterogeneous likely secondary to nodules.\n\nNo lymphadenopathy by CT size criteria.\n\nNo suspicious osteolytic or osteoblastic lesions. Multilevel degenerative\nchanges, most pronounced at C5-C6.", + "output": "1. No acute intracranial abnormalities.\n2. Patent head and neck vasculature with no evidence of focal stenosis,\nocclusion, or aneurysm." + }, + { + "input": "Please note the study is mildly degraded by motion and unusual patient\npositioning. There is no evidence of acute territorial infarction,\nhemorrhage, edema, or large mass. The ventricles and sulci are normal in size\nand configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable. The patient has a tongue piercing. At the apex of the left\nmandibular first premolar there is prominent periapical lucency which appears\nslightly expansile.", + "output": "1. Study is mildly degraded by motion and unusual patient positioning.\n2. No acute intracranial process.\n3. Periapical lucency abutting the left mandibular first premolar is\nindeterminate and may represent a dentigerous cyst. Correlate with dental\nexam." + }, + { + "input": "There is a 3.8 x 4.5 x 3.3 cm round, heterogeneous region centered in the left\nparietal lobe with both hypodense and hyperdense components worrisome for\nacute intraparenchymal hemorrhage, possibly within a pre-existing mass (series\n2, image 23). High-density blood products are also present in the left medial\ntemporal lobe (series 2, image 12) and right temporal lobe sulci (series 2,\nimage 13) compatible with subarachnoid blood. A small high-density focus in\nthe right frontal lobe (series 2, image 23) is also compatible with\nsubarachnoid hemorrhage. No midline shift, marked vasogenic edema effacement\nof the ventricles or basal cisterns.\n\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Moderate atherosclerotic calcifications of the cavernous carotid\narteries are noted.\n\nThere is no evidence of fracture. Burr hole over the left parietal bone and\ncraniotomy changes over the left frontal bone are demonstrated. There is\nopacification of the left sphenoid sinus with sclerosis and thickening of the\nsurrounding sinus walls indicative of chronic inflammation. The left\nmaxillary sinus demonstrates mild mucosal thickening. Mastoid air cells and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable apart from prior right lens replacement.", + "output": "1. 3.8 x 4.5 x 3.3 cm heterogeneous round area with hyperdense component in\nthe left parietal lobe concerning for acute bleed within an underlying mass.\nNo significant vasogenic edema, mass effect, or midline shift. MRI with IV\ncontrast can be obtained for further assessment.\n2. Acute subarachnoid hemorrhage within the right frontal and bilateral\ntemporal lobes.\n3. No acute fractures, however there are postprocedural changes to the left\nfrontal and parietal bones indicating prior craniectomy and burr hole,\nrespectively.\n4. Age-related cortical atrophy.\n\nRECOMMENDATION(S): MRI of the brain with IV contrast." + }, + { + "input": "A large focus of intraparenchymal hemorrhage is noted at the left cerebral\nvertex involving the left frontal and parietal lobes. There is interval\n(<2hrs) increase in size of this parenchymal hemorrhage, previously measuring\n3.0 x 2.9 x 4.4 cm and currently measuring 4.1 x 4.2 x 7.5 cm. A fluid-fluid\nlevel is seen within this collection and there is surrounding edema. Local\nmass effect is noted on the adjacent sulci without midline shift or downward\nherniation. Several foci of subarachnoid hemorrhage again seen in the right\nfrontal and temporal lobe and in the posterior aspect of the left temporal\nlobe. No subdural or epidural hematoma is seen. No acute fracture. Left\nparietal burr hole unchanged. Sinuses remain partially opacified.", + "output": "Significant interval increase in size of a parenchymal hematoma at the left\nfrontoparietal vertex. Stable scattered small volume subarachnoid hemorrhage.\nNo midline shift or downward herniation.\n\nNOTIFICATION:\n\n The findings were discussed with ___, M.D. by ___, M.D. in\nperson on ___ at 5:20 pm, 0 minutes after discovery of the findings." + }, + { + "input": "Again demonstrated is a left frontoparietal intraparenchymal hemorrhage with\nlayering of high-density products, which appears similar in size from the\nprior study. There is similar mass effect with local sulcal effacement though\nthere is no midline shift or downward herniation. Subarachnoid hemorrhage in\nthe right temporal, left medial temporal and right frontal lobes appears\nunchanged.\n\nThere is no acute fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "Overall unchanged size of the left frontoparietal intraparenchymal hemorrhage.\nNo change in sulcal effacement in the left parietal and occipital lobes, no\nevidence of midline shift or herniation. Similar pattern of subarachnoid\nhemorrhage." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is mild soft tissue swelling of the right supraorbital scalp. No\nsignificant subgaleal hematoma. There is irregularity of the right nasal bone\ncompatible with a fracture (03:21). There is extensive mucosal thickening of\nthe maxillary and bilateral anterior ethmoid sinuses.", + "output": "1. Right nasal bone fracture.\n2. Extensive sinus mucosal thickening of the maxillary and anterior ethmoid\nair cells.\n3. No intracranial abnormality." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\n\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial abnormality." + }, + { + "input": "CTA head: Atherosclerotic calcifications are noted within the cavernous and\nsupra clinoid internal carotid arteries bilaterally. The intracranial internal\ncarotid arteries are normal in configuration. The anterior and middle cerebral\narteries are patent with normal contrast enhancement and branching pattern.\nThere anterior communicating artery region appears unremarkable.\n\n\n\nThe vertebral and basilar arteries demonstrate normal enhancement without\nstenosis or occlusion. The posterior cerebral arteries have a normal caliber\nand branching pattern. The posterior communicating arteries are not\nvisualized.\n\n\n\nThere is no evidence of stenosis, occlusion, aneurysm, or arteriovenous\nmalformation.\n\n\n\nCTV head: There is asymmetric narrowing of the proximal right transverse and\ndistal sigmoid sinuses which may be congenital in nature. There is otherwise\nnormal enhancement of the superior sagittal sinus, straight sinus, transverse\nsinuses, and sigmoid sinuses. The jugular bulbs and proximal jugular veins are\npatent. Evaluation of the deep venous systems reveals normal enhancement in\nthe thalamostriate veins and internal cerebral veins. The vein ___ is\nalso unremarkable.\n\n\n\nPersistent high density is noted within the quadrigeminal plate cistern and\nlayering along the right aspect of the tentorium, better appreciated on the\nearlier noncontrast CT head.", + "output": "1. Unremarkable appearance of the vasculature of the head, without significant\nstenosis, occlusion, aneurysm, arteriovenous malformation, or dural venous\nsinus thrombosis.\n2. Persistent high density is noted within the quadrigeminal plate cistern and\nlayering along the right aspect of the tentorium, better appreciated on the\nearlier noncontrast CT head, consistent with hemorrhage." + }, + { + "input": "There is no evidence of acute major vascular territorial infarction,\nhemorrhage, edema, or large mass. There is age appropriate prominence of the\nventricles and sulci suggestive of involutional changes. There is no acute\nfracture. The visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable. Carotid siphon calcifications are noted. Mild, right greater\nthan left temporomandibular joint degenerative changes are noted.", + "output": "1. No acute intracranial abnormality.\n2. Mild global atrophy.\n3. Mild TMJ arthritis." + }, + { + "input": "CTA HEAD:\nThere is mild bilateral calcified atherosclerotic disease in the distal\ncavernous and paraclinoid internal carotid arteries bilaterally. The vessels\nof the circle of ___ and their principal intracranial branches otherwise\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThere is a three vessel aortic arch with no appreciable atherosclerotic\ndisease. The branch vessels and the origin of the common carotid and\nvertebral arteries are widely patent. A linear filling defect along a short\nsegment of the left cervical internal carotid artery at the level of C2 may\nrepresent a focal dissection flap (2:108). There is no occlusion. The\ncarotid and vertebral arteries and their major branches otherwise appear\nnormal with no evidence of stenosis or occlusion. There is no evidence of\ninternal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The thyroid gland is within\nnormal limits. There is no lymphadenopathy by CT size criteria.", + "output": "1. Unremarkable head CTA\n2. Focal dissection of the left internal carotid artery at the level of C2\nwithout occlusion." + }, + { + "input": ".Comparison with the prior MR study, obtained approximately one month ago\nre-demonstrates soft tissue density material adjacent to the lateral aspect of\nthe nose, with extension through a nearly 10 mm bony defect along the medial\naspect of the anterior wall of the left maxillary sinus. This bony gap is\nconsiderably larger, compared to a prior neck CT scan obtained at the ___\n___ on ___. As seen on the prior MR study, the soft\ntissue mass extends to the medial canthus of the left eye. Again, there is\nsubtotal opacification of the left maxillary sinus with soft tissue material,\nwhich could be either tumor, inflammatory mucosal thickening, or a combination\nof the two. There is a tiny area of osteolysis adjacent to the frontal\nprocess of the left maxilla, as seen on image 49, series 2. This finding may\nhave been present on the prior neck CT scan from ___, though its scans\nare of lower resolution than the present directed study. There are number of\npunctate calcific densities along the anterior and lateral margin of the mass\nlateral to the left side of the nose. The etiology of these findings is\nuncertain. Perhaps they are dystrophic calcifications, also seen along the\nskin surface in the anterior maxillary regions. There are number of surgical\nclips within the left submandibular region and within the left side of the\nneck, apparently reflecting prior neck dissections surgery. There is also\nstranding within the subcutaneous fat of the anterior aspect of the neck on\nboth sides, as well as thickening of the platysma muscle. Upon review of the\nCare Web notes of this patient, the patient has undergone radiation therapy,\nwhich could account for these latter findings.\n\nSeen on the sagittal reconstructions is multilevel cervical spondylosis,\nincluding prominent disc space narrowing at C3-4 and C4-5, as well as small\nanterior bridging osteophytes at these interspaces and a small disc protrusion\nat C4-5. There is also probable mild-to-moderate cord compression due to a\nposterior spondylitic ridge and congenital narrowing of the AP diameter of the\nbony central spinal canal at the incompletely delineated C5-6 interspace. At\nthis same interspace, there is possible prominent bilateral neural foraminal\nstenosis", + "output": "Increase in size of bony gap involving the anterior wall of the left maxillary\nsinus. If no surgery has been performed in this area since the priors neck CT\nstudy in ___, the increase in the size of this osteolytic region raises the\nquestion of involvement of this area by tumor. Please see above report for\ndetails and other findings. Cervical spondylosis and spinal stenosis, for\nwhich dedicated cervical spine MRI scanning is suggested.\n\nRECOMMENDATION(S): Cervical spine MRI scanning." + }, + { + "input": "Anterior face:\nAgain seen is 3.8 cm x 2.1 cm x 1 1.9 cm mass involving left pre antral soft\ntissues, nasal labial fold, left lateral nasal sidewall, nasal ala, probable\nextension into the nasal vestibule. 1.2 cm bone defect involving medial\nmargin of the anterior wall left maxillary sinus with enhancing soft tissue\nextending through it consistent with tumor invasion of the bone. Enhancing\nsoft tissue extends and fills left infraorbital foramen consistent with\nperineural tumor extension. Destruction and expansion of the distal aspect\nleft infraorbital foramen was better seen on ___ dedicated\nmaxillofacial CT. No intraorbital tumor along the inferior orbit.\nFocal erosion at the frontal process left maxilla near its base series 4,\nimage 26 consistent with tumor invasion. Asymmetric soft tissue fullness\nalong the left lateral margin of the nasal vestibule consistent with tumor\nextension. Additional asymmetric soft tissue fullness left lateral nasal\ncavity wall, medial to the frontal process left maxilla, medial to the very\ninferior aspect of the nasolacrimal duct, may represent tumor involvement of\nthe very anterior aspect of the inferior turbinates.\nSuperiorly, soft tissue thickening and tumor extension extend into the\ninferior eyelid and fills prevertebral space at the level of the medial\ncanthus. No definite postseptal tumor extension. Clinically correlate to\nexclude very distal aspect of the medial rectus involvement. No definite\ntumor at the pterygopalatine fossa, infraorbital foramen. Symmetric\nappearance of the foramina ovale, foramen rotundum.\n\nAero digestive tract:\n\nThere is no mass. Probable posttreatment changes in the hypopharynx, mild\nsymmetric mucosal thickening\n\nNeck lymph nodes:\nNo level 1 adenopathy. Left neck node dissection. Posttreatment changes.\nThere is no adenopathy involving bilateral levels ___.\nThere is no retropharyngeal adenopathy.\n\n\nExtra nodal tumor spread:\n\nThere are no findings suggestive of extra nodal extension.\n\n\nDeep neck muscles, masticator space:\n\nThere is no muscle invasion.\n\n\nBones, skull base:\nPerineural tumor along the left infraorbital foramen, infraorbital canal.\n\nBone destruction anterior maxilla adjacent tumor, as described above.\n\nNormal jugular foramen, carotid canal, pterygopalatine fossa, infraorbital\nforamen, other skull base foramina are not involved.\n\n\nVessels:\n\nThere is no vascular invasion.\n\n\nBrachial Plexus:\n\nThere is no brachial plexus contact or invasion.\n\n\nThyroid, salivary glands:\n\nThere is no mass. Left submandibular gland is surgically absent.\n\n\nOther findings:\n\nThere are no lung nodules. Chronic fracture right clavicle. Degenerative\nchanges spine. Congenital narrowing spinal canal.", + "output": "1. 3.8 cm locally invasive mass left nasal sidewall, nasal ala, nasal labial\nfold, pre antral soft tissues, inferior periorbital soft tissues, with\nadjacent bone invasion.\n2. Perineural tumor extension into the left infraorbital canal.\n3. No adenopathy." + }, + { + "input": "Interval postsurgical changes, resection of the anterior, medial wall left\nmaxillary sinus, resection of the inferior, portion of the medial wall left\norbit, rhinoplasty, bone graft anterior wall left maxillary sinus, metal plate\nleft maxilla, inferior, medial orbit, nodes. Bone graft at anterior wall left\nmaxillary sinus is partially resolved.\n\n2 cm by 1.8 cm nodule at the inferior left recipient bed/upper lip is most\nconsistent with tumor. Left pre antral fullness, better evaluated on contrast\nenhanced CT neck from today. Opacification left nasal cavity, smooth opacity\nof the periphery left maxillary sinus, likely inflammatory. Intact hard\npalate essentially clear remaining paranasal sinuses. Right concha bullosa.\n\nDemineralization left maxilla between teeth ___, may represent postsurgical\nchange/early osteoradionecrosis. Cavity, periodontal disease, periapical\nlucency very posterior left maxillary molar. Normal intraorbital contents,\nnormal retro antral soft tissues, normal pterygopalatine fossa.. Dental\ndisease maxilla. Degenerative changes cervical spine, congenital narrow\nspinal canal, multilevel mild-to-moderate central canal narrowing.", + "output": "Postsurgical changes.\nNodular 2 cm probable recurrent tumor inferior left recipient bed/upper lip.\nLeft pre antral flat soft tissue, may be postsurgical." + }, + { + "input": "Anterior face:\nThe patient is status post wide local resection of the left maxillary sinus\nanterior, medial wall, inferior left orbit, medial left orbit, left nasal is\nbone, frontal process of the maxilla, partial rhinectomy, bone reconstruction,\nwith free flap in place.\n\nNew left paramedian 2.0 cm x 1.8 cm x 1.9 cm heterogeneously enhancing round\nsubcutaneous mass along the inferior margin of the free flap, at the recipient\nbed, probably involving upper lip. No adjacent bone erosion. \nDemineralization of the left maxilla, may represent postradiation change,\nearly radiation necrosis.\n\nThere is soft tissue along the posterior anterior margin of the reconstructed\nanterior maxillary wall, adjacent anterior left nasal cavity including floor,\nabutting nasal septum. Most of this is fairly low in attenuation, may be\ninflammatory or postsurgical. There is some enhancement along the left pre\nantral soft tissues which may represent portion of normal graft, without\ndistortion of the adjacent vasculature. Tumor at this level cannot be\nexcluded, however, there is no nodularity. Preserved retro antral soft\ntissues.\n\nNormal pterygopalatine fossa, intraorbital contents\n\nBone graft at the left anterior maxillary wall is partially resorbed.\n\nAero digestive tract:\nThere is no mass. Posttreatment change is re-demonstrated in the hypopharynx.\n\nNeck lymph nodes:\nLeft neck dissection. Inferior left jugular vein is not well seen, similar to\nprior. There is no adenopathy involving bilateral levels ___. There is no\nretropharyngeal adenopathy.\n\nExtra nodal tumor spread:\nThere are no findings suggestive of extra nodal extension.\n\nDeep neck muscles, masticator space:\nThere is no muscle invasion.\n\nBones, skull base:\nThe patient is status post wide local resection of the left face, partial\nrhinectomy and skullbase resection with left nasal sidewall/maxillary bone\nreconstruction.\n\nThere are no findings suggestive of perineural tumor extension.\n\nNormal jugular foramen, carotid canal, pterygopalatine fossa, infraorbital\nforamen, other skull base foramina are not involved.\n\nVessels:\nThere is no vascular invasion.\n\nBrachial Plexus:\nThere is no brachial plexus contact or invasion.\n\nThyroid, salivary glands:\nThere is no mass.\n\nOther findings:\nThere are no lung nodules. Degenerative changes of the cervical spine are\nseen with multilevel mild-to-moderate spinal canal narrowing. Congenital\nnarrowing spinal canal. Multilevel probably moderate central canal narrowing\ncervical spine. An old right clavicular fracture is seen. Periodontal\ndisease, cavities very posterior left maxillary molar.", + "output": "1. Extensive postsurgical changes left face.\n2. 2.0 cm enhancing nodule along the inferior margin recipient bed/upper lip,\nmost likely recurrent tumor. NIRADS 3, biopsy recommended.\n3. Left pre antral flat mildly enhancing soft tissue, may represent portion of\nfree flap if some muscle was transferred. Otherwise, NIRADS 2B, consider PET\nscan or short interval follow-up.\n4. Remainder of findings in left maxillary sinus, left nasal cavity likely\npostsurgical/reactive, no clear evidence of tumor.\n5. Demineralization segmental left maxilla, may represent postradiation\nchange.\n6. No adenopathy.\n7. Moderate to severe central canal narrowing cervical spine." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Postsurgical changes along the left orbital floor with clips in\nthe left scalp soft tissues. The imaged paranasal sinuses appear well\naerated. Mastoid air cells and middle ear cavities are clear. Bony calvarium\nis intact.", + "output": "No acute intracranial process." + }, + { + "input": "Since prior study, patient is now status post left-sided cranioplasty.\nExtra-axial fluid is seen in the frontal lobe, deep to the cranioplasty site,\nmeasuring 10 mm in maximum diameter. The left temporal basal kink is again\nseen, unchanged. There is no evidence of acute hemorrhagic or ischemic\nlesions.\n\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "Status post left-sided cranioplasty with expected postsurgical changes. No\nevidence of acute hemorrhage." + }, + { + "input": "Head CT: There has been little significant change since the prior study. Again\nseen is left temporal tissue loss, a cranioplasty and a small fluid collection\nunderlying the cranioplasty. The fluid collection is somewhat smaller the neck\nand on the prior study and the scalp swelling has resolved. There is no\nevidence of hemorrhage and no evidence of interval infarction. There is no\nmass effect or midline shift.\n\nHead CTA: There is no evidence of an arteriovenous malformation. There is a\nprominent vessel, likely a vein, in the left the cerebellopontine angle\ncistern. No other vascular abnormalities are detected. .", + "output": "Stable appearance of the left temporal tissue loss and cranioplasty. Decreased\nvolume of fluid underlying the cranioplasty. Prominent left CPA cistern the\nvessel, likely a vein. This would be better evaluated with comparison to\nprior vascular imaging." + }, + { + "input": "There are postsurgical changes of left frontoparietal cranioplasty.\nExtra-axial fluid deep to the cranioplasty has decreased since the CT on ___. There is no intracranial hemorrhage or evidence of acute\ninfarction. Encephalomalacia of the left temporal lobe and basal ganglia with\nex vacuo dilatation of the left lateral ventricle is unchanged. Ventricles are\notherwise normal in size. Basal cisterns are patent. There is no midline\nshift. Visualized paranasal sinuses, mastoid air cells, and tympanic cavities\nare clear. The visualized orbits are normal.", + "output": "1. No intracranial hemorrhage or evidence of acute infarction. Left temporal\nlobe and basal ganglia encephalomalacia, unchanged.\n2. Postsurgical changes of left frontoparietal cranioplasty. Decreased\nextra-axial fluid deep to the cranioplasty compared to CT from ___." + }, + { + "input": "The patient is status-post left frontoparietal cranioplasty. The extra-axial\nfluid collection deep to the cranioplasty (Series 3, Image 16) as well as\nchronic dural calcification is unchanged.\n\nThere is no evidence of acute infarction, hemorrhage, edema, or mass. Left\ntemporal cortical tissue loss is consistent with encephalomalacia and\nunchanged. Left basal ganglia encephalomalacia is also unchanged. Prominent\nbilateral ventricles and sulci are unchanged overall and more pronounced on\nthe left from ex vacuo dilatation.\n\nThere is no suspicious bony lesion. The paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n\n2. No significant interval change from the prior CT." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass. The ventricles and sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. There is moderate mucosal thickening and\nmucous retention cysts in the bilateral maxillary sinuses. There is moderate\nmucosal thickening the anterior ethmoidal air cells and bilateral sphenoid\nsinuses. Otherwise, the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality.\nModerate paranasal sinus disease." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles are symmetric and unremarkable.\n\nIncluded paranasal sinuses and mastoids are clear besides mucosal thickening\nin the right ethmoid air cells. Skull and extracranial soft tissues are\nunremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass effect. There is severe cerebral volume loss disproportionately\naffecting the frontotemporal lobes with relative sparing of the parietal and\noccipital lobes, likely representing frontotemporal dementia. Superimposed\nperiventricular and subcortical white matter hypodensities are nonspecific,\nbut compatible with chronic microangiopathy in a patient this age.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nlarge territory infarct or intracranial hemorrhage.\n2. No acute displaced calvarial fracture.\n3. Severe cerebral volume loss disproportionately affecting the frontal and\ntemporal lobes with relative sparing of the parietal occipital lobes. This is\ncompatible with clinically suspected frontotemporal dementia\n\nNOTIFICATION: The findings were discussed with Dr. ___, M.D. by\n___, M.D. on the telephone on ___ at 4:11 pm, 15 minutes\nafter discovery of the findings." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,or\nmass effect. There is prominence of the ventricles and sulci suggestive of\nglobal volume loss particularly affecting the temporal lobes. There are thin\nlow-density subdural fluid collections which may represent chronic subdural\nhematomas versus hygromas, measuring up to 4 mm on both sides. No secondary\nmass effect. Periventricular white-matter hypodensities are nonspecific, but\nlikely represent sequela of chronic small vessel ischemic disease.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. Left\nmaxillary tooth periapical lucency with adjacent sclerosis suggesting chronic\ninflammation as well as breakthrough the lingual surface of the alveolar\ncortex. The visualized portion of the orbits are unremarkable. There is a\nlarge subgaleal hematoma near the skull vertex.", + "output": "1. No acute intracranial abnormality or fracture. Global volume loss,\nparticularly in the temporal lobes.\n2. Bilateral 4 mm low-density subdural fluid collections, potentially chronic\nsubdural hematomas or hygromas.\n3. Large subgaleal hematoma near the skull vertex.\n\nNOTIFICATION: Update was discussed with Dr. ___ by Dr. ___." + }, + { + "input": "Large bilateral cerebral subdural hematomas measuring up to 2.4 cm on the left\nand 1.5 cm on the right. Mixed density blood ___ are seen within the\nbilateral subdural hematomas with both hyperdense and hypodense fluid\nsuggesting acute on chronic blood products. There is 6 mm of rightward\nmidline shift. No evidence of downward herniation. The basal cisterns remain\npatent. The temporal horns are enlarged, though this may reflect temporal\nlobe atrophy in a patient with provided diagnosis of Alzheimer's disease. \nThere is no evidence of large territorial infarction,edema,or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Large bilateral cerebral acute on chronic subdural hematomas, with 6 mm of\nrightward midline shift. No evidence of herniation.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 9:51 pm, less than 5 minutes\nafter discovery of the findings." + }, + { + "input": "Compared with CT head performed earlier on same day, there is no significant\nchange in large bilateral mixed density subdural hematomas, left greater than\nright. Mass effect on the lateral ventricles, left greater than right, and\nrightward midline shift measuring up to 6 mm is not significantly changed. \nThe ventricles are stable in size, with unchanged dilation of the temporal\nhorns of the lateral ventricles. Basal cisterns are patent. No evidence of\nacute large territorial infarction or new intracranial hemorrhage.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Stable bilateral mixed density subdural hematomas and associated mass effect\nincluding net rightward midline shift measuring up to 6 mm." + }, + { + "input": "There is no significant change in the size of large bilateral mixed density\nsubdural hematomas, left greater than right. There has been evolution of\nblood products in the dependent portions of the bilateral subdural which were\npreviously hyperdense and is currently isodense, (series 2, image 18). \nGrossly unchanged rightward midline shift, which currently measures up to 6 mm\nand previously measured up to 6 mm but most recent prior CT head. Ventricular\nand sulcal effacement is unchanged. The basal cisterns remain patent. No\nevidence of new hemorrhage or large vascular territory infarction.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare well pneumatized. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No significant change in the size of large bilateral mixed density subdural\nhematomas, left greater than right.\n2. No interval change in rightward midline shift." + }, + { + "input": "There is no acute hemorrhage, edema, mass effect, loss of gray/ white matter\ndifferentiation, or pathologic extra-axial collection. Ventricles, sulci, and\nbasal cisterns are normal in size.\n\nThere is no evidence of fracture. The visualized portion of the orbits are\nunremarkable. The temporomandibular joints appear well aligned in closed\nmouth position.\n\n There is mild mucosal thickening of the left ethmoidal air cells. Other\nvisualized paranasal sinuses are clear. There is trace fluid in bilateral\nmastoid tip air cells. Middle ear cavities are well aerated.", + "output": "No acute intracranial process.\n\nNOTIFICATION: The images were reviewed with and findings were discussed by\nDr. ___ with ___ In personon ___ at 2:00 AM, 1\nminutes after discovery of the findings." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "Normal study." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of territorial infarction, intracranial\nhemorrhage,edema,or mass. The ventricles and sulci are normal in size and\nconfiguration for the patient's age.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses demonstrate mild mucosal thickening in the anterior ethmoidal air\ncells, no air-fluid levels are identified, the mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "No evidence of acute intracranial process or hemorrhage." + }, + { + "input": "There is no hemorrhage, edema, or mass effect. Ventricles and sulci are age\nappropriate in size and configuration. There is no shift of normally midline\nstructures. Basal cisterns are patent.\n\nThe orbits are unremarkable. The bony calvarium is intact. Imaged paranasal\nsinuses are essentially clear. Bilateral mastoid air cells and middle ear\ncavities are clear bilaterally.", + "output": "No acute intracranial abnormality. No mass effect. MRI is a more sensitive\nmodality for detection of small lesions." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, mass effect, midline\nshift, or mass. The ventricles and sulci are normal in size and configuration.\nNo bony abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of hemorrhage, infarction, mass, edema, or shift of\nnormally midline structures. Mild prominence the ventricles and sulci is\ncompatible with age related involutional change. The visualized paranasal\nsinuses and mastoid air cells are clear. The globes and bony orbits are\nunremarkable. Bilateral carotid siphon calcifications are noted.", + "output": "1. No acute intracranial process.\n2. Chronic findings including mild age-appropriate global atrophy and vascular\ncalcifications." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Basilar cisterns are\npatent.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable. Orbits are unremarkable. Extraocular muscles are\nsymmetric. The globes and optic nerves are unremarkable and symmetric.", + "output": "No acute intracranial process. No orbital abnormality based on an unenhanced\nCT." + }, + { + "input": "Images of the orbits appear normal.\nNo fractures are identified.\nThere is no evidence of facial swelling.\nVisualized paranasal sinuses are well aerated.\nThere is no evidence of abnormal fluid collections.\nBilateral mastoids appear normal.\nThe globes, extraocular muscles, optic nerves, and retrobulbar fat appear\nnormal.\nThe visualized upper aerodigestive tract appears normal.\nThe mandible and temporomandibular joints appear normal.", + "output": "1. Normal study." + }, + { + "input": "There is no evidence of acute large territory infarct,hemorrhage,edema, or\nmass effect. The ventricles and sulci are within expected limits in size and\nconfiguration.\n\nThere is no evidence of fracture. There is mild to moderate opacification of\nbilateral ethmoid air cells and right frontal ethmoidal recess, and mild\nmucosal thickening of the bilateral sphenoid sinuses. The visualized portion\nof the remaining paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable. No acute\nosseous abnormality. Thinning of the left parietal calvarium is unchanged\nfrom prior examination.", + "output": "1. No acute intracranial abnormality. Specifically no intracranial hemorrhage\nor acute large territory infarct. No intracranial mass effect.\n2. Mild paranasal sinus disease. Clinical correlation with patient's symptoms\nis recommended.\n3. Unchanged thinning of the left parietal calvarium. This is of uncertain\nclinical significance. This may be seen bilaterally in the setting of an\nage-related process (typically middle to advanced age), potentially secondary\nto osteoporosis. In this patient this may be a congenital finding." + }, + { + "input": "There is no evidence of acute, large territorial infarction,hemorrhage,edema,\nor mass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. An ossific density within the right\nanterior ethmoid air cells measures 1.0 cm (3:7), likely an osteoma. Moderate\nmucosal thickening of the ethmoid air cells and partially imaged, left greater\nthan right, maxillary sinuses. Otherwise, the visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality. No evidence of acute hemorrhage.\n2. Other findings, as described above." + }, + { + "input": "CTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear without stenosis, occlusion, or aneurysm formation. A hypoplastic\nright A1 segment is seen. The dural venous sinuses are patent.\n\nCTA NECK:\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThere is moderate mucosal thickening of the ethmoid and maxillary sinuses. \nThere is left-sided TMJ arthropathy. Biapical pulmonary scarring is seen. A\n5 mm nodule is seen in the right upper lobe (02:47). The visualized portion\nof the thyroid gland is within normal limits. There is no lymphadenopathy by\nCT size criteria.", + "output": "1. No stenosis, occlusion or aneurysm of the circle of ___ vessels.\n2. Unremarkable CTA of the neck.\n3. A 5 mm nodule seen in the right upper lobe.\n4. Left-sided TMJ arthropathy.\n\nRECOMMENDATION(S): For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" + }, + { + "input": "There is no evidence of fracture, acute large territorial\ninfarction,hemorrhage,edema,or mass. The ventricles and sulci are normal in\nsize and configuration.\n\nThere is extensive paranasal sinus disease with a moderate amount of fluid\nwithin the frontal sinus, extensive opacification of the bilateral ethmoid air\ncells, and aerosolized fluid within the bilateral sphenoid sinuses, overall\nincreased from prior study. There is redemonstration of a 10 mm osteoma in\nthe right anterior ethmoid air cell, unchanged (2:3). The visualized portion\nof the orbits are normal.", + "output": "1. No acute intracranial process.\n2. Extensive paranasal sinus disease, increased from prior studies. \nCorrelation for acute sinusitis is recommended." + }, + { + "input": "Severe opacification with aerosolized mucus of the frontal sinus is similar to\nthat examination of ___ allowing for technical differences. There\nis moderate to severe left-greater-than-right opacification of the ethmoid air\ncells, with aerosolized debris in the left Onodi cells. Mild mucosal\nthickening of the sphenoid sinuses. A 6 mm osteoma appears to obstruct the\nright frontoethmoidal recess (series 7, image 72). There is complete\nopacification of the left frontoethmoidal recess. Aerosolized\nright-greater-than-left moderate mucosal thickening of the maxillary sinuses\nis noted. There is complete opacification of the bilateral ostiomeatal\ninfundibulum. There is apparent remodeling and expansion of the right\ninfundibulum (series 6, image 36). Minimal leftward deviation of the nasal\nseptum without nasal septal perforation. Minimal polypoid mucosal thickening\nextends into the right middle meatus. The cribriform plates and lamina\npapyracea appear intact.\n\nRe-identified is prominence of the bilateral lacrimal glands, unchanged from\nprior examination. The orbits are otherwise unremarkable. The mastoid air\ncells middle ears well pneumatized and clear. No acute osseous abnormality.", + "output": "1. A 6 mm osteoma appears to obstruct the right frontoethmoidal recess. There\nis complete opacification of the left frontoethmoidal recess\n2. Severe past furcation with aerosolized material of the frontal sinus,\nmoderate to severe left-greater-than-right opacification of the ethmoid air\ncells with aerosolized debris in the left Onodi cells.\n3. Right greater than left aerosolized moderate opacification of the maxillary\nsinuses with opacification of the bilateral ostiomeatal infundibulum. There\nis appearance of expansion and remodeling of the right infundibulum, with\npolypoid extension of soft tissue density into the right middle meatus.\n4. The mucosal disease is similar to MRI examination of ___ allowing\nfor technical differences.\n5. Prominent bilateral lacrimal glands unchanged in configuration from\nexamination of ___ year prior. Additional findings described above." + }, + { + "input": "There is no evidence of intracranial hemorrhage, infarction, edema, or mass. \nThe ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No evidence of intracranial hemorrhage, fracture, or infarction." + }, + { + "input": "HEAD CT: There is no evidence of acute intracranial hemorrhage, mass effect,\nor loss of gray/ white matter differentiation. The ventricles and basal\ncisterns appear normal. Visualized bones, mastoid air cells, and paranasal\nsinuses are unremarkable.\n\n\nHEAD AND NECK CTA: The cervical carotid and vertebral arteries and their\nmajor branches are patent without evidence of dissection or hemodynamically\nsignificant stenosis. The distal cervical internal carotid arteries measure\n3.6 mm in diameter on the left and 3.5 mm in diameter on the right. The\naortic arch demonstrates conventional, three-vessel configuration. The\nvertebral arteries are codominant.\n\nThere is no evidence of aneurysm, focal vessel cut off, or hemodynamically\nsignificant stenosis within the intracranial vasculature. The right A1\nsegment is hypoplastic.\n\n\nOTHER FINDINGS: \n\nThere is mild pleural/parenchymal scarring at the visualized lung apices.", + "output": "1. No evidence of acute intracranial abnormalities. MRI would be more\nsensitive for an acute infarction or other pathology to explain the patient's\nsymptoms, if clinically warranted.\n2. Normal CTA of the head or neck." + }, + { + "input": "There is no evidence of acute large territory infarct, hemorrhage, edema, or\nmass effect. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No evidence of acute displaced fracture or intracranial hemorrhage." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or mass\neffect. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality. No acute fracture." + }, + { + "input": "CT HEAD\nThere is no evidence of acute infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. The left vertebral artery arises\ndirectly from the aorta, a normal variation.\n\nOTHER:\nAsymmetry of the left vallecula may be due to asymmetric hypertrophy of the\nlingual tonsil or a mass. Recommend direct visualization for further\nevaluation.\n\nEvaluation of the lung parenchyma is limited by respiratory motion. Within\nthis limitation, the visualized portion of the lungs are clear. Evaluation of\nthe thyroid gland is limited by streak artifact from the contrast bolus.\nWithin this limitation, the visualized portion of the thyroid gland is within\nnormal limits. There is no lymphadenopathy by CT size criteria.", + "output": "No significant abnormalities on CT of the head without contrast. No\nsignificant abnormalities on CT angiography of the head and neck." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal for age.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial findings." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. The patient is status post left internal carotid endarterectomy\nwith postoperative obscuration of fat planes unchanged since the CTA of ___. The right internal carotid artery has a retropharyngeal course. \nThe neck vessels are patent.\n\nPatchy, ground-glass densities in the visualized lung likely represent\natelectasis. There are multilevel degenerative changes of the cervical spine,\nmost advanced from C5-C7.\n\nThe mastoid air cells are clear. The left external auditory canal contains a\nsmall amount of cerumen.", + "output": "No findings to account for the patient's left neck/ear pain." + }, + { + "input": "There is no evidence of fracture, acute large territory\ninfarction,hemorrhage,edema,or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. Periventricular and subcortical\nwhite matter hypodensities are nonspecific but compatible with chronic small\nvessel ischemia.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavitiesare essentially clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Involutional and chronic small vessel disease changes." + }, + { + "input": "Motion, venous contrast pooling, overlying hardwareanddental amalgam streak\nartifactand patient body habitus limits study.\n\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute territorial infarction,intracranial\nhemorrhage,edema,ormass. Chronic left basal ganglia lacunar infarct is\nunchanged. There are periventricular and subcortical lucencies, unchanged,\nwhich may represent small vessel ischemic changes. There is prominence of the\nventricles and sulci suggestive of involutional changes.\n\nThe visualized portion of the orbits demonstrate bilateral lens replacements.\n\nCTA HEAD:\n\nFetal type anatomy in the right posterior cerebral artery, a common normal\nvariant is noted. The patient is right vertebral artery dominant.\n\nThere are atherosclerotic calcifications of the bilateral cavernous carotid\narteries, left greater than right, without significant stenosis. Nonocclusive\natherosclerotic narrowing of the right internal carotid artery petrous\nsegments noted.\n\nOtherwise, the vessels of the circle of ___ and their principal\nintracranial branches appear grossly preserved without stenosis, occlusion, or\naneurysm. The dural venous sinuses are grossly patent.\n\nCTA NECK:\nRight vertebral artery origin nonocclusive atherosclerotic calcification is\nnoted. Bilateral carotid and left vertebral artery origins are patent.\n\nThere is moderate calcified and noncalcified plaque formation at the right\ncarotid bifurcation without definite moderate or severe internal carotid\nartery stenosis by NASCET criteria.\n\nThere is noncalcified plaque formation at the left carotid bifurcation without\ndefinite moderate or high-grade stenosis by NASCET criteria.\n\nOtherwise, the bilateral vertebral arteries appear preserved with no evidence\nof stenosis or occlusion.\n\nCT PERFUSION: RAPID perfusion maps demonstrate no definite focal CBV or MTT\ndefects.\nCBF<30% volume: 0 mL\nT-max > 6.0s volume: 0 mL\nMismatch volume: 0 mL\nMismatch ratio: None\n\nOTHER:\nThe visualized portion of the lungs are grossly clear. Trace fluid is\nincidentally noted within the superior pericardial recesses. The visualized\nportion of the thyroid gland is preserved. Scattered subcentimeter\nnonspecific lymph nodes are noted throughout the visualized portion of the\nneck bilaterally, without definite enlargement by CT size criteria. Bilateral\nmaxillary sinus and ethmoid air cell mucosal thickening is present. Soft\ntissue densities are noted within bilateral external auditory canals which may\nrepresent cerumen.", + "output": "1. Limited study as described.\n2. No acute intracranial abnormality. Please note MRI of the brain is more\nsensitive for the detection of acute infarct.\n3. Nonocclusive atherosclerotic narrowing of circle ___ as described.\n4. Otherwise, grossly patent circle of ___ without evidence of\nstenosis,occlusion,or aneurysm.\n5. Nonocclusive cervical arterial atherosclerotic disease as described.\n6. Otherwise, grossly patent bilateral cervical carotid and vertebral arteries\nwithout definite evidence of stenosis, occlusion, or dissection.\n7. CT perfusion imaging demonstrates no focal cerebral blood volume or mean\ntransit time defects.\n8. Additional findings as described above." + }, + { + "input": "Left frontal lobe lesions are demonstrated for pre-surgical planning. There\nis mass effect on the ventricles. The anterior cerebral arteries in proximity\nto the lesion.\nNo herniation. No large hemorrhage.", + "output": "Left frontal lobe lesions are again demonstrated, little to no change as\ncompared to prior MRI exam dated ___." + }, + { + "input": "The patient is status post stereotactic biopsy of a left frontal mass, which\nappears unchanged from the prior study, including the mass effect from the\nextensive surrounding vasogenic edema. There is no acute hemorrhage in the\nbiopsy bed. There is expected minimal pneumocephalus. There is minimal\nrightward shift of midline structures, superiorly, and unchanged from the\nprior study. The basal cisterns are patent. Gray-white matter differentiation\nis preserved. The ventricles and sulci are normal in size and configuration. \nThere are aerosolized secretions in the right sphenoid sinus. There are\nmucous retention cysts in the ethmoid air cells and right maxillary sinus. The\nmastoid air cells and middle ear cavities are clear.", + "output": "No evidence of acute postoperative hemorrhage." + }, + { + "input": "Nasal septal deviation to the right.. There is minimal mucosal thickening of\nthe ethmoid sinuses and sphenoid sinus. Otherwise, paranasal sinuses are\nnormally aerated, with no mucosal thickening or air-fluid levels identified. \nThere is no evidence of focal fluid collections. The ostiomeatal units are\npatent and the cribriform plates are intact. The lamina papyracea are intact.\nThere is no evidence of fractures. There is partial visualization of the ETT.\n\nThere is mild opacification of the mastoid air cells bilaterally, which is\ngrossly stable from prior head CT performed ___, may be related to\nintubation.. The visualized middle ear cavities are clear. The visualized\nportion of the bilateral orbits are unremarkable. There are multiple\nperiapical lucencies the visualized maxilla, may be from extensive periodontal\ndisease or inflammatory/infectious process. There are dental cavities. \nDental consult recommended.\n\nAdjusting for differences in imaging technique, the visualized portion of the\nbrain parenchyma appears grossly normal.", + "output": "1. Mild mucosal thickening paranasal sinuses, without fluid.\n2. Mild opacification of the mastoid air cells bilaterally, likely related to\nintubation.\n3. Dental cavities. Periapical lucencies multiple teeth at the maxilla, may\nrepresent extension of periodontal disease or periapical cyst, granulomas,\ninfection, or combination. Dental consult recommended." + }, + { + "input": "No enhancing brain lesions are identified. There is no midline shift mass\neffect or hydrocephalus. No lytic or sclerotic lesions are seen within the\nskull.", + "output": "No enhancing brain lesions are identified. No mass effect or hydrocephalus." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. A crescentic hyperdense area along the left temporoparietal\nregion (02:15) is likely artifactual. Ventricles and sulci are normal in\noverall size and configuration. The imaged paranasal sinuses are clear.\nMastoid air cells and middle ear cavities are well aerated. The bony calvarium\nis intact with no evidence of fractures.", + "output": "No evidence of intracranial hemorrhage.\n\nRECOMMENDATION(S): Given the clinical history of severe concussion symptoms,\nand if clinically warranted, correlation with MRI of the brain is advised." + }, + { + "input": "There is no evidence of large territorial infarctionhemorrhage,edema,or mass\neffect. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process. Please note that MRI is more sensitive for\nidentification of intracranial metastases." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Prominence of the ventricles and sulci suggest involutional\nchanges.\n\nMinimal mucosal thickening is seen involving the sphenoid sinuses bilaterally\nand a left posterior ethmoid air cell. The remaining imaged paranasal sinuses\nare clear. Mastoid air cells and middle ear cavities are well aerated. The\nbony calvarium is intact. Globes are intact.", + "output": "No acute intracranial process. Please note that MRI with IV contrast would be\nmore sensitive for detection of a small mass lesion." + }, + { + "input": "There is no acute intracranial hemorrhage, edema, mass effect or shift of\nnormally midline structures. The ventricles and sulci are normal in size and\nconfiguration for the patient's age. The basal cisterns appear patent and\ngray-white matter differentiation is preserved. The orbits and globes are\nunremarkable. There is a bifrontal subgaleal scalp hematoma in the\nsupraorbital region, more so on the right. Mild mucosal thickening aerosolized\nsecretions are noted in the included portions of the maxillary sinuses and\nethmoid air cells. Bilateral nasal bone fractures are partially included\n(3:1).", + "output": "1. No intracranial hemorrhage.\n2. Frontal subgaleal scalp hematoma.\n3. Nasal bone fractures better assessed on CT facial bones.\n4. Paranasal sinus inflammatory disease.\n\nNOTIFICATION: D/w Dr. ___ at 6:30 p.m.." + }, + { + "input": "A right frontal subgaleal hematoma (2:10) and a partially visualized nasal\nbone fracture (3:1) are again seen There is no evidence of new infarction,\nhemorrhage, edema, or mass. The ventricles and sulci are normal in size and\nconfiguration.\n\nMild mucosal thickening is seen within the bilateral ethmoid air cells and\nmaxillary sinuses. A mucous retention cyst is noted in the right maxillary\nsinus. The other paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The orbits are unremarkable.", + "output": "No acute intracranial process. Right frontal subgaleal hematoma and nasal bone\nfractures are again noted." + }, + { + "input": "Again seen in the medial left cerebellar hemisphere is a 9 mm circular\nhyperdensity with a surrounding hypodense rim, compatible with a focus of left\ncerebellar hemispheric hemorrhage with minimal surrounding edema, not\nappreciably changed since prior head CT from ___ at 21:47. As on\nprior exam, there is no significant mass effect. The basal cisterns remain\npatent, and there is no shift of normally midline structures. No\nnew/additional foci of hemorrhage are identified. There is no evidence of\nacute large vascular territorial infarction. The ventricles and sulci are\nunchanged in size and configuration, compatible with likely age-related global\natrophy. Mild periventricular and subcortical white matter hypodensity is\ncompatible with the sequelae of chronic small vessel ischemic change. The\nvisualized paranasal sinuses and mastoid air cells are clear. The patient is\nstatus post bilateral lens removal; otherwise, the globes and bony orbits are\nintact and unremarkable. Bilateral carotid siphon calcifications are noted.", + "output": "1. Stable 9 mm medial left cerebellar hemispheric focus of hemorrhage with\nminimal surrounding edema. No significant mass-effect. No new foci of\nhemorrhage identified.\n2. Chronic findings, including age-related global atrophy, white matter small\nvessel ischemic change, and vascular calcifications." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction, mass or midline\nshift. No enhancing lesions to suggest metastatic disease. The intracranial\nvessels are patent. There is no hydrocephalus. Visualized paranasal sinuses\nand mastoid air cells are clear. There is no fracture.", + "output": "No evidence of metastatic disease." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nDeformity of the nasal bone appears chronic, there is no soft tissue swelling.\nMild paranasal sinus disease with mucosal thickening most prominent in the\nethmoid sinus. Mastoid air cells and middle ear cavities are clear.. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Nasal bone fracture is most likely chronic, correlate with clinical\nsymptoms.\n3. Paranasal sinus disease." + }, + { + "input": "Exam is limited due to patient motion.\n\nThere is grossly no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is a depressed fracture of the anterior wall of the left maxillary\nsinus. The left maxillary sinus partially opacified with hyperdense material,\nsuggestive of blood products. Otherwise, the visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. \nThere appears to be a chronic defect of the lateral left maxillary sinus wall.", + "output": "1. Depressed fracture of the anterior wall the left maxillary sinus with\nlikely intra sinus blood products.\n2. Limited image quality, however, grossly, no acute intracranial hemorrhage\nor infarct." + }, + { + "input": "There are comminuted fractures of the anterior wall and the posterolateral\nwall of the left maxillary sinus. The lateral maxillary sinus fracture\nfragment is displaced medially. Additionally, there are fractures of the left\nzygomatic arch, the left lateral orbital wall, and the left inferior orbital\nrim. The globes, extraocular muscles, optic nerves, and retrobulbar fat appear\nnormal.\n\nThere is partial opacification of the left maxillary sinus with hyperdense\nmaterial, with mucosal thickening of the ethmoid air cells. Otherwise, the\nremainder of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear.\n\nThe visualized upper aerodigestive tract appears normal.\nThe mandible and temporomandibular joints appear normal.", + "output": "1. Multiple fractures within the left mid face, including comminuted fractures\nof the left maxillary sinus anterior and lateral walls, a fracture of the left\nzygomatic arch, the left lateral orbital wall, and the left inferior orbital\nrim.\n2. Partial opacification of the left maxillary sinus with hyperdense material,\nwhich may represent blood products." + }, + { + "input": "Study is significantly degraded due to motion artifact. The posterior fossa\nevaluation is limited. There are no large areas of acute intracranial\nhemorrhage. There is no midline shift. There are no areas of large edema. \nThe ventricles and sulci are normal in size and configuration.\n\nAgain seen multiple fracture within the left mid face, including the left\nmaxillary sinus anterior and lateral walls, left zygomatic arch and left\nlateral orbital wall, better evaluated on recent CT sinus. Nearly complete\nopacification of the left maxillary sinus.", + "output": "1. Significantly degraded study due to motion artifact. No large areas of\nacute intracranial hemorrhage, midline shift or areas of large edema.\n2. Multiple fractures left facial fractures, better evaluated on recent\nmaxillofacial CT." + }, + { + "input": "Exam is mildly motion degraded despite repeat acquisition. There is no\nintra-axial or extra-axial hemorrhage, mass, midline shift, or acute major\nvascular territorial infarct. Gray-white matter differentiation is preserved.\nVentricles and sulci are unremarkable. Basilar cisterns are patent.\n\nLeft maxillary sinus mucosal thickening is noted. Left ZMC fracture and nasal\nbone fractures are unchanged compared to prior. Included paranasal sinuses\nand mastoids are otherwise essentially clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "Mildly motion degraded exam without acute intracranial process.\nChanges of left ZMC fracture better seen on yesterday's maxillofacial CT." + }, + { + "input": "The study is mildly motion degraded.\n\nThere is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territorial infarct. The ventricles and sulci\nare normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal. \nLeft zygomatic arch fracture appears similar configuration to the prior study\nfrom ___. Previously seen nasal bone fractures are not fully imaged on\nthis study.", + "output": "1. No acute intracranial abnormality.\n2. Chronic left zygomatic arch fracture." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nasymmetric volume loss of the left parietal and temporal lobes with prominence\nof the left sylvian fissure. Prominence of the ventricles is likely age\nrelated. Periventricular white matter hypodensities are nonspecific but\nlikely reflect the sequelae of chronic microvascular ischemic disease.\n\nThere is no evidence of fracture. There is trace mucosal thickening of the\nbilateral maxillary sinuses and ethmoid air cells. The remainder of the\nvisualized paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Prominent\nventricles and sulci are consistent with age-related involutional change. \nPeriventricular white matter hypodensities are nonspecific, however, may\nrepresent chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of acute intracranial hemorrhage.\n\n2. No fractures are identified." + }, + { + "input": "Evaluation of the neck reveals no enhancing mass. There is no cervical\nlymphadenopathy. No mass is detected along the course of the right or left\nvagus or recurrent laryngeal nerves. The parotid and submandibular glands are\nnormal. The major arterial structures of the neck enhance symmetrically\nwithout significant stenosis. Evaluation of the aerodigestive tract reveals no\ngross exophytic mucosal mass. Calcifications and fullness in the\nnasopharyngeal soft tissues are unchanged since ___.\n\nThere is a 6 mm hypodense nodule in the right lobe of the thyroid. The\nincluded lung apices are clear. There are moderate degenerative changes in the\ncervical spine", + "output": "No evidence of cervical mass and especially no abnormality along recurrent\nlaryngeal nerves to explain patient's vocal paralysis." + }, + { + "input": "There is no evidence of acute infarction,intracranial hemorrhage, edema, or\nmass effect. There is prominence of the ventricles and sulci suggestive of\nage-related cerebral volume loss. Confluent and scatteredperiventricular and\nsubcortical white matter hypodensities are nonspecific, though likely sequelae\nof chronic small vessel ischemic disease.\n\nThere is no evidence of acute fracture. There is scattered mucosal thickening\nand mucous retention cysts of the ethmoidal air cells and bilateral maxillary\nsinuses. The remaining visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "No acute intracranial process. No acute intracranial hemorrhage." + }, + { + "input": "Streak artifact from dental amalgam limits evaluation of the oral cavity and\noverlying soft tissues.\n\nSOFT TISSUES: There is subcutaneous soft tissue hyperdensity and stranding of\nbilateral infraorbital soft tissues. Additionally, small left frontal scalp\nsoft tissue swelling is present.\n\nMAXILLOFACIAL BONES: The maxillofacial bones are intact, without fracture.\nThe zygomatico-maxillary complex is intact. The lateral pterygoid plates are\nintact.\n\nMANDIBLE: The mandible is without fracture or temporomandibular joint\ndislocation. The temporomandibular joints are symmetric, without significant\ndegenerative change.\n\nDENTITION: There are no dental fractures. There is periapical lucency along\nthe left maxillary molar.\n\nSINUSES: There is polypoid mucosal thickening in the left maxillary sinus. \nThe ostiomeatal units are patent. The mastoid air cells and middle ear\ncavities are clear.\n\nNOSE: There is irregularity of the nasal bones with no overlying soft tissue\nswelling. Nasopharyngeal soft tissues are unremarkable. There is no nasal\nseptal hematoma. A 1.6 cm nasal septal perforation is seen. The nasal septum\nis deviated to the right with a small nasal spur. There is pneumatization of\nthe left anterior clinoid process.\n\nORBITS: The orbits, including the laminae papyracea, are intact. The globes\nare intact with non-displaced lenses and no intraocular hematoma. There is no\npreseptal soft tissue edema. There is no retrobulbar hematoma or fat\nstranding.\n\nAllowing for imaging technique optimized for the face, the limited included\nportion of the brain is grossly unremarkable.", + "output": "1. Dental amalgam streak artifact limits study.\n2. No acute facial bone or skull base fractures.\n3. Induration and hematoma of bilateral infraorbital soft tissues and small\nleft frontal scalp soft tissue swelling.\n4. Left maxillary molar dental disease with associated left maxillary sinus\ndisease concerning for odontogenic sinusitis as described. Please note that\noroantral fistula is not excluded on the basis examination. Dental\nconsultation is recommended.\n5. Irregularity of the nasal bones without overlying soft tissue swelling,\nsuggestive of chronic fractures.\n6. 1.6 cm nasal septal perforation.\n7. Rightward nasal septal deviation." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Nasal septal deviation to the right.", + "output": "Normal intracranial contents. No hemorrhage." + }, + { + "input": "There is no acute intracranial hemorrhage, acute infarction, suspicious mass\nor midline shift. There are bilateral likely arachnoid cyst in the posterior\nfossa measuring 2.3 and 1.8 cm. There is no hydrocephalus. The ventricles and\nsulci are enlarged consistent with atrophy. There are mild periventricular\nwhite matter hypodensities most consistent with sequelae of chronic small\nvessel ischemic disease. There is mucosal thickening in the right maxillary\nsinus. The fluid fills the frontal sinuses. There is mucosal thickening in the\nethmoid air cells. Otherwise the visualized paranasal sinuses and mastoid air\ncells are clear. There is no fracture.", + "output": "No acute intracranial process. Sinus disease." + }, + { + "input": "There is no evidence of acute major infarction,hemorrhage,edema,or discrete\nmass. The ventricles and sulci are normal in size and configuration.There is\nno acute fracture. Mucosal thickening is noted within the paranasal sinuses,\nmild. The mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial injury." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nMinimal mucosal thickening is seen in the left maxillary sinus. The\nvisualized portion of the remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nnormal.", + "output": "1. No acute intracranial abnormality." + }, + { + "input": "Status post left craniotomy. Decreased pneumocephalus since ___. \nHyperdense left subdural subdural blood products measure approximately 4 mm\nfrom the inner table at the level of the left frontal lobe on image 2:50,\npreviously up to 8 mm. Hyperdense subdural blood products along the left\ntemporal convexity are not significantly changed. Hyperdense subdural blood\nproducts along the falx and tentorium have redistributed into more dependent\nposition, less along the falx on more along the bilateral tentorium.\n\nHyperdense subarachnoid hemorrhage in the right sided sulci has almost\ncompletely resolved, with small amount remaining along the right occipital\nlobe on images 2:15, 601:71.\n\nThere is a stable parenchymal hemorrhage centered in the right thalamus,\nextending into the right hypothalamus and right cerebral peduncle of the\nmidbrain. Mild surrounding edema is stable. There is a stable left globus\npallidus calcification without evidence for hemorrhage or edema.\n\nRight frontal catheter has been removed.\n\nThe lateral ventricles have re-expanded. There is minimal effacement of the\nright aspect of the third ventricle, which is likely directly related to the\nright thalamic hemorrhage. The sulci have also re-expanded, now mildly\nprominent due to age-related global parenchymal volume loss. Basal cisterns\nare not compressed. Other than minimal leftward shift of the third ventricle,\nthere is no shift of the midline structures.\n\nNo evidence for an acute major vascular territorial infarction. Scattered\nsmall white matter hypodensities are nonspecific but likely sequela of chronic\nsmall vessel ischemic disease in this age group.\n\nLeft scalp fluid collection overlying the craniotomy has increased compared to\n___. The non dependent portion of the collection contains air.\n\nMild mucosal thickening in the paranasal sinuses. An osteoma is again seen in\nthe left maxillary sinus. Mastoid air cells are well aerated.", + "output": "1. Left convexity subdural hematoma has slightly decreased along the frontal\nlobe, remaining unchanged along the temporal lobe. Small subdural hematoma\nalong the tentorium and bilateral falx has redistributed into more dependent.\n2. Near complete resolution of hyperdense right sulcal subarachnoid\nhemorrhage.\n3. Stable parenchymal hematoma centered in the right thalamus with extension\nto the right hypothalamus and right cerebral peduncle of the midbrain, with\nstable mild surrounding edema.\n4. Aside from minimal residual effacement of the right aspect of the third\nventricle by the right thalamic hematoma, the ventricles and sulci have\nre-expanded, and shift of other midline structures has resolved.\n5. Increased left scalp fluid collection overlying the left craniotomy, with\nair within its nondependent portion." + }, + { + "input": "CT HEAD:\nThe patient is again status post left frontal craniotomy and evacuation of a\nsubdural hematoma. Postoperative changes are noted including a subgaleal\nfluid collection overlying the craniotomy site.\n\nSubjacent to the craniotomy site along the left frontal convexity there is a\nmild residual 2-3 mm thick subdural hematoma component demonstrating mixed\ndensity residual fluid collection. There is no evidence of new hemorrhage.\n\nAn intraparenchymal hemorrhage centered within the right thalamus is unchanged\nfrom the previous examination allowing for expected evolution of blood\nproducts. Similarly, subtle subarachnoid hemorrhage noted within the right\nparieto-occipital lobe sulci has decreased since conspicuity from previous\nexamination.\n\nOtherwise, there is no evidence of infarction, mass effect, or edema. The\nventricles and sulci are grossly within normal limits an age-appropriate.\n\nA probable osteoma versus calcified mucous retention cyst is seen in the left\nmaxillary sinus. Mild mucosal thickening is noted in scattered ethmoid air\ncells. The remainder of the paranasal sinuses, middle ear cavities, and\nmastoid air cells are clear. The orbits are grossly unremarkable bilaterally.", + "output": "1. Status post left frontal craniotomy and subdural hematoma evacuation with\nexpected postoperative changes.\n2. No evidence of new hemorrhage.\n3. No evidence of infarction.\n4. Expected evolution of a now small left frontal subdural hematoma, mild\npredominately right-sided subarachnoid hemorrhage, and a small right thalamic\nintraparenchymal hematoma." + }, + { + "input": "Patient is post left craniotomy and evacuation of the previous subdural\nhemorrhage overlying the left cerebral convexity, with expected postsurgical\nchanges, including bifrontal and left-sided pneumocephalus, blood products at\nthe surgical bed, and overlying soft tissue swelling and skin staples. There\nis subarachnoid blood in the bilateral frontoparietal sulci, tracking along\nthe tentorium, as well as in the right suprasellar cistern and along the right\nperimesencephalic cistern (___). There is also been placement of a right\nfrontal approach neurovent, which terminates in the region of the right\nfrontal lobe parenchyma (2: 19:20).\n\nPrevious or rightward shift of normally midline structures has resolved\n(02:19).\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Post left craniotomy and evacuation of the previous subdural hemorrhage,\nwith expected postsurgical changes including pneumocephalus, blood products at\nthe surgical bed, and subarachnoid blood bilaterally, as well as in the right\nsuprasellar cistern and along the right perimesencephalic cistern.\n\n2. Previous rightward shift of normally midline structures has resolved.\n\n3. Right frontal approach neurovent terminates in the region of the right\nfrontal lobe parenchyma." + }, + { + "input": "The lung both sides of the falx within the frontal and anterior parts of a\nparietal lobes there are moderate areas of subarachnoid hemorrhage and a small\nsubdural component at the site is also likely. There is an extensive but thin\nsubdural hemorrhage on the left overlying primarily the left frontal and\ntemporal convexities. Its maximal width is 3 mm. There are a number of small\nintraparenchymal hemorrhages in the left frontal lobe, the large measuring up\nto 7 mm although mostly 2-3 mm. There is a suspected tiny hemorrhage along\nthe right corpus callosum. Subarachnoid hemorrhage is also moderately\nextensive along the medial left middle cranial fossa with involvement of the\nleft temporal sulci including extensive along part of the Sylvian fissure. A\nmuch smaller amount of right anterior frontal subarachoid hemorrhage is also\npresent separately. A focus of acute hemorrhage is also detected in the body\nof the right lateral ventricle near the midline. There is no mass effect. \nBony and soft tissue injuries are discussed in the separate report regarding\nfacial bones. Although there are fractures of each sphenoid wing, none is\ndisplaced or depressed into the cranium.", + "output": "Extensive acute intracranial hemorrhage, including subcortical\nintraparenchymal hemorrhages worrisome for shear injuries." + }, + { + "input": "Redemonstrated are multiple foci of intracranial hemorrhage. This includes\nleft frontal and parafalcine subdural hematoma, bilateral intraventricular\nhemorrhage in occipital horns, intraparenchymal hemorrhage within the\nbilateral frontoparietal and left temporal lobes, and subarachnoid hemorrhage\nalong the left sylvian fissure. A foci of intraparenchymal hemorrhage within\nthe right frontal lobe appears new. Otherwise, the overall degree of\nhemorrhage is relatively stable, allowing for interval redistribution of blood\nproducts.\n\nThe basal cisterns remain grossly patent and there is no evidence of downward\nherniation. Prominent ventricles and sulci likely represent age related\natrophy . Redemonstrated are numerous facial bone fractures and a left frontal\nsubgaleal hematoma and soft tissue swelling in the face, left more than right,\nbetter evaluated on the recent CT maxillofacial examination. There is\npersistent opacification of the bilateral ethmoidal air cells, left maxillary\nsinus (likely hemorrhage), and right sphenoid sinus. Mucosal thickening is\nnoted within the left sphenoid and right maxillary sinuses. The middle ear\ncavities and mastoid air cells are clear.", + "output": "Redistribution of multifocal intracranial hemorrhage, as above. A single focus\nof right frontal intraparenchymal hemorrhage appears new. No evidence of\ndownward herniation.\nNote on attending reviewe:\n\nA few foci of intraparenchymal hemorrhage in the left frontal lobe and in the\nleft middle cranial fossa are slightly increased compared to the recent CT\nhead study of ___\n\nClose followup as needed" + }, + { + "input": "There is encephalomalacia in the left frontal lobe, unchanged since the prior\nstudy in ___. Patient is status post left frontal craniotomy. There\nis no evidence of acute major vascular territory infarction,hemorrhage,edema,\nor mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. There are ill-defined periventricular and subcortical\nwhite matter hypodensities which are nonspecific but likely due to sequela of\nchronic small vessel ischemic disease. Atherosclerotic calcifications are\nseen along the bilateral carotid siphons.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Patient is\nstatus post bilateral lens resections.", + "output": "1. No acute intracranial abnormalities.\n2. Chronic encephalomalacia is again seen in the left frontal lobe, unchanged\nsince ___.\n3. Chronic microangiopathy and age related global atrophy." + }, + { + "input": "There is no evidence of territorial infarction, intracranial hemorrhage,\nedema, or mass. The ventricles and sulci are normal in size and configuration.\n\nThere is a partially imaged depressed fracture of the left lateral wall of the\nmaxilla with likely hemorrhagic high attenuation fluid in the left maxillary\nsinus. Also noted is a displaced comminuted fracture of the lateral wall of\nthe left sinus adjacent to the carotid canal. There is likely hemorrhagic\nfluid in sphenoid sinus.\n\nNo acute calvarial fracture. Small left supraorbital hematoma. The orbits\nare unremarkable.", + "output": "-Partially imaged depressed fracture of the left lateral wall of the maxilla\nwith likely hemorrhagic high attenuation fluid in the left maxillary sinus.\n- Comminuted fracture of the lateral wall of the left sphenoid sinus.\n-No acute calvarial fracture or intracranial hemorrhage.\n-Refer to report for maxillofacial CT obtained the same day for additional\nmaxillofacial findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of intracranial infarction,hemorrhage,edema,ormass. The\nventricles and sulci are normal in size and configuration.\n\nThere is hemorrhage within the left maxillary sinus and a depressed fracture\nof its lateral wall, and a minimally displaced fracture of the left orbital\nfloor. No intraorbital abnormality is identified. There is also hemorrhage\nwithin the sphenoid sinus and a comminuted fracture of the lateral wall of the\nleft sphenoid sinus. The minimally displaced fracture of the posterior wall\nof the sphenoid sinus is not appreciated (only thick slices have been\nacquired). The left zygomatic arch fracture is again noted. There is soft\ntissue swelling overlying the left masseter muscle and left zygoma. There is\nalso swelling of the left temporalis muscle. There are mild secretions in the\nleft ethmoid air cells posteriorly. The paranasal sinuses, mastoid air\ncells,and middle ear cavities are otherwise clear.\n\nCTA HEAD:\nThere is a tiny locule of gas medial to the cavernous left internal carotid\nartery, likely secondary to the sphenoid sinus fracture. There is no evidence\nof intracranial vessel injury. The vessels of the circle of ___ and their\nprincipal intracranial branches appear normal without stenosis, or occlusion,\ndissection or aneurysm formation greater than 3mm. A tiny 1 mm aneurysm is\nseen within the M1 section of the left middle cerebral artery (3; 232.) the\ndural venous sinuses are patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion.\n\n\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. There is mild cervical spondylosis, with reduced intervertebral\ndisc height at C5-C6 level.", + "output": "-No acute intracranial abnormality.\n-Redemonstration of the left maxillary sinus and left sphenoid sinus fractures\nand associated hemorrhage within these sinuses.\n-No evidence of intracranial vessel injury. Patent circle of ___ without\ndefinite evidence of stenosis,occlusion, or dissection.\n-1 mm aneurysm within the M1 section of the left middle cerebral artery (3;\n232).\n-Patent bilateral cervical carotid and vertebral arteries without definite\nevidence of stenosis, occlusion, or dissection." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration for age.\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The right parietal scalp hematoma is decreased\nin size.", + "output": "Normal brain. Please note that MRI would be more sensitive for the detection\nof acute infarct." + }, + { + "input": "There is no evidence of fracture, hemorrhage, edema, mass effect, or\ninfarction.\n\nThe ventricles and sulci are minimally enlarged consistent with age related\natrophy periventricular white matter hypodensities are suggestive of chronic\nsmall vessel ischemic disease.\n\nThe basal cisterns appear patent and there is preservation of gray-white\nmatter differentiation.\n\nThe visualized bony structures are grossly unremarkable.\n\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\n\nThe globes are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Study is slightly in limited by motion. There is no evidence of large\nterritorial infarction, acute hemorrhage, edema, or mass effect. The\nventricles and sulci are normal in size and configuration\n\nNo acute fracture is seen. Mild mucosal thickening of the right ethmoid air\ncells are seen. The other paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process.\n\nNOTIFICATION: No acute intracranial process." + }, + { + "input": "There is no evidence of fracture,infarction,hemorrhage,edema,or mass. There\nis prominence of the ventricles and sulci suggestive of involutional changes.\nThere are extensive periventricular and subcortical hypodensities, which may\nrepresent small vessel ischemic changes.\n\nThere is mild mucosal thickening of the left maxillary sinus, and a small\nhigh-density, likely inspissated mucous retention cyst in the right sphenoid\nsinus. The visualized portion of the remaining paranasal sinuses are clear. \nThere is partial opacification of the right mastoid air cells. The left\nmastoid air cells and bilateral middle ear cavities are clear.. The\nvisualized portion of the orbits are normal.", + "output": "1. No acute intracranial abnormality.\n2. Extensive periventricular and subcortical hypodensities are nonspecific,\nthough can be seen with chronic small vessel ischemic changes.\n3. Paranasal sinus disease, as described above." + }, + { + "input": "Patient body habitus, dental amalgam and venous contrast: Streak artifact\nlimits study.\n\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of large territorial infarction,hemorrhage,edema,ormass. \nThe ventricles and sulci are mildly prominent, consistent with involutional\nchanges. Small, scattered hypodensities in the periventricular in deep white\nmatter nonspecific, but most likely related to chronic small vessel ischemia.\n\nBilateral maxillary sinus mucosal thickening is present. Aerosolized\nsecretions are demonstrated in the bilateral ethmoid air cells. The sphenoid\nsinuses are clear. The mastoids are clear. The visualized portion of the\norbits are preserved.\n\nCTA HEAD:\nNonocclusive narrowing is noted at bilateral P1-2 junctions. Minimal right\ninternal carotid artery cavernous segment nonocclusive probable\natherosclerotic calcifications are noted. A right-sided PCOM probable\ninfundibulum is noted (see ___: 58). Otherwise, the vessels of the\ncircle of ___ and their principal intracranial branches appear preserved\nwithout stenosis, occlusion, or aneurysm formation. The dural venous sinuses\nare patent.\n\nCTA NECK:\nThe carotidandvertebral arteries and their major branches appear preserved\nwith no evidence of stenosis or occlusion. The left vertebral artery is\ndominant throughout its course. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThere is mild dependent atelectasis in the visualized lung fields. An\napproximately 3 mm right upper lobe pulmonary nodule is noted (see 3:81).\n\nNonspecific enlarged lymph nodes at level 2 bilaterally measuring up to 1.8 cm\non the right and 1.7 cm on the left (series 3: Image 195). Additional\nscattered subcentimeter nonspecific lymph nodes are noted throughout the neck\nbilaterally and mediastinum , without definite enlargement by CT size\ncriteria.\n\nA 3.1 cm x 2.1 cm mixed density nodule with calcific components is\ndemonstrated in the right lobe of the thyroid (series 3: Image 90). \nAdditional 3 mm left thyroid lobe nodules noted (see 3:110).\n\nRight maxillary first molar periapical lucencies is noted (see 602:24; 3:230)", + "output": "1. Patient body habitus, dental amalgam and venous contrast: Streak artifact\nlimits study.\n2. No evidence of large territorial infarction or hemorrhage. Please note MRI\nof the brain is more sensitive for the detection of acute infarct.\n3. Probable nonocclusive atherosclerotic narrowing of circle of ___ as\ndescribed.\n4. Otherwise, grossly patent circle of ___ without definite evidence of\nstenosis,occlusion,or aneurysm.\n5. Patent bilateral cervical carotid and vertebral arteries without definite\nevidence of stenosis, occlusion, or dissection.\n6. Nonspecific enlarged lymph nodes at level II bilaterally measuring up to\n1.8 cm, an additional scattered subcentimeter nonspecific lymph nodes\nthroughout the neck and mediastinum.\n7. 3 cm x 2 cm nodule mixed density nodule with calcific components in the\nright lobe of the thyroid for which nonurgent ultrasound follow-up is\nrecommended.\n8. Paranasal sinus disease, as described.\n9. Approximately 3 mm right upper lobe pulmonary nodule.\n10. Right maxillary first molar periodontal disease as described.\n\nRECOMMENDATION(S):\n1. Non urgent ultrasound for further evaluation of nodule in the right lobe of\nthe thyroid.\n2. For incidentally detected single solid pulmonary nodule smaller than 6 mm,\nno CT follow-up is recommended in a low-risk patient, and an optional CT in 12\nmonths is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" + }, + { + "input": "Evaluation is motion degraded despite repeat acquisition. The image portion\nof the mid to upper neck is grossly unremarkable allowing for the moderate to\nsevere motion artifact.\n\nWithin confines of mild-to-moderate motion degradation, there is no intra or\nextra-axial mass effect, acute hemorrhage or large territory infarct. The\nsulci, ventricles and cisterns are within expected limits for the degree of\nmild senescent related global cerebral volume loss. There are periventricular\nand subcortical white matter hypodensities, which are nonspecific, but\ncompatible with chronic microangiopathy in a patient of this age. There may\nbe a lacunar infarct of the right caudate body (series 14, image 18). No\ndefinite osseous abnormality. The visualized paranasal sinuses are\nessentially clear. The orbits are unremarkable. The mastoid air cells and\nmiddle ears are essentially clear.", + "output": "Examination is motion degraded despite repeat acquisition. Within this\nconfine:\n\n1. No acute large territorial infarct, intracranial mass effect for\nhemorrhage.\n2. Likely lacunar infarct of the right caudate body and mild periventricular\nand subcortical white matter hypodensities, nonspecific, but compatible with\nchronic microangiopathy in a patient of this age.\n3. If there are no contraindications, MRI would be more sensitive for subtle\nmetastatic disease.\n4. Additional findings as described above." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal with no evidence of stenosis, occlusion, or aneurysm. The dural\nvenous sinuses are patent.\n\nCTV HEAD: The dural venous sinuses appear normal. There is no evidence of\nsinus thrombosis.", + "output": "1. Normal head CTA and CTV." + }, + { + "input": "Deep brain stimulator devices terminate in the region of the thalami\nbilaterally with appropriate postsurgical changes. There is subsequent streak\nartifact mildly distorting the images. There is no evidence of acute\nterritorial infarction,hemorrhage,edema, or mass. There is prominence of the\nventricles and sulci suggestive of involutional changes.\n\nBifrontal burr holes are seen. There is no evidence of fracture. The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable. \nModerate atherosclerotic changes are seen within the cavernous carotid\narteries.", + "output": "1. Deep brain stimulator devices terminating in the region of the thalami\nbilaterally.\n2. No acute intracranial process." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or mass.\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Mild bilateral carotid siphon calcifications are noted. Findings\nconsistent with mild-to-moderate chronic small vessel ischemic change.\n\nThere is no evidence of fracture.. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute findings." + }, + { + "input": "There is no evidence of acute large territorial infarction, acute intracranial\nhemorrhage, edema, or mass. The ventricles and sulci are prominent consistent\nwith age-related atrophy. Confluent periventricular and subcortical white\nmatter hypodensities likely represent the sequela of chronic small vessel\nischemic disease. There are few scattered calcifications in the basal\nganglia.\nNo acute osseous abnormalities seen. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. The cavernous portions of the\ninternal carotid arteries are calcified.", + "output": "No acute intracranial abnormality." + }, + { + "input": "A small right parietal subarachnoid hemorrhage (series 2, image 23; series\n601, image 75) and parafalcine subarachnoid hemorrhage (series 2, image 22;\nseries 601, image 43) are unchanged. There is no evidence of new\nhemorrhageinfarction,edema,or mass. Periventricular and subcortical white\nmatter hypodensities are nonspecific but likely sequelae of chronic small\nvessel ischemic disease. The ventricles and sulci are normal in size and\nconfiguration.\n\nThere is a right occipital subgaleal hematoma. There is no evidence of\nfracture. There is hyperostosis frontalis interna. There is mild mucosal\nthickening with an air-fluid level in the right maxillary sinus and a small\nmucous retention cyst in the left maxillary sinus. The remaining paranasal\nsinuses are clear. The mastoid air cells and middle ear cavities are clear. \nA left lens replacement is noted.", + "output": "Unchanged small amounts of subarachnoid hemorrhage." + }, + { + "input": "There is no acute intracranial hemorrhage, acute infarction, large mass or\nmidline shift. There is no hydrocephalus. The ventricles and sulci are normal\nin size and configuration. The basal cisterns are patent and there is\npreservation of gray-white matter differentiation. The orbits are\nunremarkable. Visualized paranasal sinuses and mastoid air cells are clear. \nThere is a frontal scalp hematoma without underlying fracture.", + "output": "No acute intracranial abnormality. Frontal scalp hematoma without underlying\nfracture." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, shift of normally\nmidline structures or infarction. Ventricles and sulci are normal in size and\nconfiguration. The basal cisterns appear patent and there is preservation of\ngray-white matter differentiation.\n\nThere is no fracture. The visualized paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The globes are unremarkable.", + "output": "Normal study" + }, + { + "input": "There is a small amount of subarachnoid hemorrhage seen in the right frontal\nlobe (02:17), as well as along the falx in the left frontal lobe medially\n(02:13), minimally increased in size from most recent prior. There is also a\nfocus of hyperdensity within the right lateral ventricle, increased from\nprior, compatible with intraventricular hemorrhage (2: 16).\n\nThere is no edema, shift of normally midline structures, or evidence of acute\nmajor vascular territorial infarction. Ventricles and sulci are prominent\ncompatible with involutional changes. There are periventricular and\nsubcortical hypodensities, which may represent small vessel ischemic changes.\n\nThe imaged paranasal sinuses are clear. Partial opacification of the right\nmastoid air cells are noted. Left mastoid air cells and middle ear cavities\nare well aerated. The bony calvarium is intact. Hyperdensity in the soft\ntissues overlying the right frontal and parietal bones is decreased from\nprior, compatible with scalp hematoma. Mild atherosclerotic calcifications\ninvolving the cavernous carotid arteries are demonstrated.", + "output": "1. Compared to most recent prior, there is slight increase in size of\nsubarachnoid hemorrhage within the bilateral frontal lobes as well as a slight\nincrease in intraventricular hemorrhage within the right lateral ventricle. \nNo midline shift or change in ventricular size.\n2. Right frontoparietal scalp hematoma, decreased in size compared to the\nprior exam, without underlying fracture." + }, + { + "input": "Small focus of subdural and associated subarachnoid hemorrhage in the left\nfrontal parafalcine is essentially unchanged (02:15). There has been mild\ndecrease in the volume of hemorrhage in the right lateral ventricle, although\nhemorrhage is still present (02:16).\n\nSubtle right frontal parenchymal contusions (series 2, image 19) is unchanged\nfrom prior examination.\n\nThere may be subtly increased extra-axial CSF space overlying the right\nfrontal lobe measuring approximately 1 mm when compared to the prior\nexamination on a comparable level. While this could be artifactual secondary\nto patient positioning, a small subtle subdural hygroma is not entirely\nexcluded.\n\nThere is no evidence of acute large territorial infarction,new hemorrhage, or\nmass effect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Confluent periventricular and subcortical white-matter\nhypodensities are nonspecific, but likely reflects sequela of chronic small\nvessel disease.\n\nThere is no evidence of fracture. A mucous retention cyst is seen in the\nright maxillary sinus. The visualized portion of the other paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable. A right frontal subgaleal hematoma is similar\nto prior.", + "output": "1. Compared to ___ at 12:09, unchanged appearance of small left\nfrontal parafalcine subdural and associated subarachnoid hemorrhage. \nUnchanged appearance of punctate right frontal lobe contusions.\n2. Mild decrease in volume of right lateral intraventricular hemorrhage.\n3. Right frontal subgaleal hematoma is similar to prior.\n4. There is equivocal millimetric increased extra-axial CSF space overlying\nthe right frontal lobe, which may be artifactual secondary to patient\npositioning. However a small subtle developing subdural hygroma is not\nentirely excluded.\n5. Additional findings described above." + }, + { + "input": "Aero digestive tract: There is no mass or mass effect.\n\nNeck lymph nodes: Scattered cervical chain lymph nodes demonstrate normal\nmorphology and are not pathologically enlarged by CT size criteria. These\nmeasure up to 7 mm in short axis in the right level II station (3:69). There\nis no retropharyngeal adenopathy.\n\nDeep neck muscles, masticator space: Muscle bulk appears well maintained. \nThere is no organized fluid collection or soft tissue abnormality.\n\nA skin marker is placed over the region of patient's palpable abnormality in\nthe right supraclavicular region (02:50). No underlying soft tissue\nabnormalities are seen.\n\nBones, skull base: Diffuse osseous metastatic disease involving the cervical\nspine spanning C3-C4, better evaluated on prior MR spine performed ___. This is likely unchanged. There is stable fusion of C5-C6. No acute\nfractures are identified.\n\nVessels: The visualized head and neck vasculature appears grossly patent.\n\nThyroid, salivary glands: 5 mm left thyroid nodule is not appreciably changed\ncompared to ___ (3:117). The salivary glands enhance normally without\nevidence of mass.\n\nOther findings: Multiple biapical lung nodules are demonstrated. Please refer\nto same day dedicated CT chest for further evaluation.\n\nThere is trace mucosal thickening of the right sphenoid sinus. The remainder\nof the visualized paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized globes are notable for bilateral lens\nreplacements.\n\nAlthough this study is not tailored for the evaluation of intracranial\nstructures, no overt abnormalities are demonstrated.", + "output": "1. No underlying soft tissue mass or other abnormality is seen in the region\nof patient's palpable abnormality in the right supraclavicular region.\n\n2. Scattered cervical chain lymph nodes are not pathologically enlarged by CT\nsize criteria.\n\n3. Diffuse osseous metastases involving the cervical spine is likely\nunchanged and better evaluated on recent MR spine performed ___.\n\n4. 5 mm left thyroid nodule is not substantially changed compared to ___. No further follow-up is recommended.\n\n5. Multiple biapical lung nodules. Please refer to same day CT chest for\ndescription of the intrathoracic findings.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150.\n\nNOTIFICATION: Preliminary findings were discussed with ___, MD\nby ___, MD via telephone on ___ at 3:59 pm." + }, + { + "input": "Motion artifact slightly limits evaluation particularly of the posterior\nfossa. There is no evidence of acute large territory infarction, hemorrhage,\nedema, or mass. The ventricles and sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. There is mild mucosal thickening of the\nethmoidal air cells. There is partial opacification of a right sphenoid\nsinus. The mastoid air cells and middle ear cavities are clear. The orbits\nare unremarkable.", + "output": "No evidence of acute hemorrhage or large territory infarction." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no intra or extra-axial mass effect acute hemorrhage or large\nterritory infarct. The sulci, ventricles and cisterns are within expected\nlimits for the patient's mild senescent related global cerebral volume loss. \nThere is minimal mucosal thickening within the right sphenoid sinus lateral\nrecess. The remainder the paranasal sinuses are essentially clear. The\nmastoid air cells middle ears arm a ties and clear. The orbits are\nunremarkable. There is no suspicious osseous abnormality, noting bilateral\nlens replacements and elongated AP dimension of the globes, compatible with\naxial myopia or staphyloma..\n\nCTA HEAD:\nMild atherosclerotic calcification of the internal carotid arteries are noted.\nOtherwise, the vessels of the circle of ___ and their principal\nintracranial branches appear normal without stenosis, occlusion, or aneurysm\nformation. The dural venous sinuses are patent.\n\nCTA NECK:\nMinimal atherosclerotic calcification of the aortic arch and origins of the\nright brachiocephalic, left common carotid and left subclavian arteries is\nnoted. Atherosclerotic calcification of the left carotid bifurcation results\nin less than 30% stenosis by NASCET criteria. Atherosclerotic calcification\nof the right carotid bifurcation results in less than 20% stenosis by NASCET\ncriteria. The left vertebral artery is dominant. The vertebral arteries are\nunremarkable from their origins to the skullbase.\n\nOTHER:\nThere are multiple small pulmonary nodules measuring up to 4 mm in the\nbilateral upper lobes (series 3, image 45, 75, 82, 84), not clearly seen on\nprior CT examination of ___. The left lobe of the thyroid demonstrates 2\nsmall hypoattenuating nodules measuring up to 6 mm, for which no further\nevaluation is suggested by ___ recommendations for incidentally noted thyroid\nnodules in the absence of prior history of malignancy. There is no cervical\nlymphadenopathy by size criteria.", + "output": "1. No acute intracranial abnormality on noncontrast head CT.\n2. Unremarkable CTA of the head.\n3. Minimal atherosclerotic calcification at the carotid bifurcations results\nin less than 30% stenosis of the left and less than 20% stenosis of the right\ninternal carotid arteries by NASCET criteria. Otherwise unremarkable CTA of\nthe neck.\n4. Multiple small pulmonary nodules as described above measuring up to 4 mm.\n5. Additional findings as described above.\n\nRECOMMENDATION(S): For incidentally detected multiple solid pulmonary nodules\nsmaller than 6mm, no CT follow-up is recommended in a low-risk patient, and an\noptional CT follow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" + }, + { + "input": "Scattered discrete hypodensities within the deep subcortical white matter\nlikely represent demyelinating lesions. Subacute infarction, sequelae of\nchronic small vessel ischemic change, and old lacunar infarctions cannot be\nentirely excluded. There is no loss of gray-white differentiation to suggest\nacute vascular territory infarction. There is no evidence of hemorrhage,\nedema, or mass. The ventricles and sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No evidence of acute vascular territory infarction, hemorrhage, edema, or\nmass.\n2. Scattered hypodensities most consistent with demyelinating lesions, less\nlikely subacute infarction, sequelae of chronic small vessel ischemia, or old\nlacunar infarctions." + }, + { + "input": "Head CTA: There are no intracranial vascular abnormalities. There is no\nevidence of aneurysm, stenosis or occlusion. No abnormal enhancing mass\nlesions are seen in the brain parenchyma. Of note, the scattered\nhypodensities described on the non-contrast CT head performed on the same date\nare not well visualized on the current contrast-enhanced study.\n\nNeck CTA: The carotid and vertebral arteries and their major branches are\npatent with no evidence of stenoses. There is no evidence of internal carotid\nstenosis by NASCET criteria. The left vertebral artery arises from the aortic\narch, a normal variant.\n\nThere is mild dependent atelectasis bilaterally. Remainder of the visualized\nupper lung zones are otherwise unremarkable. Thyroid gland is unremarkable. \nMild multilevel degenerative changes are seen throughout the visualized\ncervical spine.", + "output": "1. No evidence of dissection, stenosis or aneurysm >3 mm in the major head\nand neck arteries.\n2. Please see the separate non-contrast CT report for details on the white\nmatter hypodensities previously described." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nA small mucous retention cyst is again demonstrated in the right maxillary\nsinus. Otherwise, the imaged portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. Again demonstrated is hyperdense\nmaterial within the right globe reflecting postsurgical changes of previous\nvitrectomy, similar to the prior study. Otherwise, the visualized portion of\nthe orbits are normal.", + "output": "No evidence of intracranial hemorrhage or other acute intracranial process." + }, + { + "input": "There is no evidence of fracture, acute large territory infarction,\nhemorrhage, edema, or mass effect. There is mild prominence of the ventricles\nand sulci suggestive of involutional changes out of proportion to patient's\nage.\n\nThere is mild mucosal thickening of the ethmoid air cells and maxillary\nsinuses. Multiple bilateral maxillary sinus mucous retention cysts are also\npresent. Theimaged portions of the remaining paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The patient has undergone right\nvitrectomy. Extensive arterial calcifications are seen along the scalp in\nthis patient with history of diabetes4.", + "output": "1. No acute intracranial abnormality." + }, + { + "input": "There is asymmetric soft tissue swelling involving the right hypopharynx\nextending to the glottis with effacement of the right piriform sinus (series\n2, image 51). There is mild-to-moderate narrowing of the supraglottic airway.\nNo organized collection or definitive hyperdensity to suggest hematoma.\n\nThere is asymmetric prominence of the right laryngeal ventricle/laryngocele\n(series 2, image 60; series 601, image 45), with asymmetry of the right vocal\ncord, and clinical correlation for vocal cord paralysis is recommended.\n\nRight-sided central catheter as well as a left central catheter via the left\ninternal jugular vein is identified. There are prominent left level 2 B\ncervical lymph nodes measuring up to 1.5 cm in long axis (series 2, image 39),\nwhich may be reactive in nature. Otherwise, there is no other cervical\nlymphadenopathy by size criteria. The thyroid is enlarged with a prominent\nisthmus, unchanged from prior exam. Visualized lung apices are clear.\n\nNo suspicious osteoblastic or lytic lesions. The parotid and submandibular\nglands are unremarkable. The cervical vessels are patent.\n\nChronic silicone injection in right globe. There remainder of the visualized\norbits are grossly unremarkable. Small mucous retention cysts in the\nbilateral maxillary and right sphenoid sinuses with mild mucosal thickening of\nthe ethmoid air cells. The mastoid air cells middle ears are clear.", + "output": "1. Asymmetric soft tissue swelling involving the right posterior hypopharynx\nextending to the glottis mucosa,with focal mild narrowing of the supraglottic\nairway, which remains patent.\n2. No organized collections or findings suggestive of a hematoma.\n3. Prominent left level 2 B cervical lymph nodes measuring up to 1.5 cm in\nlong axis, potentially reactive in nature. Of note, a left central catheter\nvia the internal jugular vein is adjacent to the lymph nodes.\n4. Additional findings as described above." + }, + { + "input": "There is no evidence of fracture, large territorial\ninfarction,hemorrhage,edema,or mass. There is mild prominence of the\nventricles and sulci suggestive of involutional changes out of proportion to\nthe patient's age.\n\nThere is near complete opacification of the left maxillary sinus. Multiple\nmucous retention cysts are visualized in the right maxillary sinus. Complete\nopacification of the right sphenoid sinus and near complete opacification of\nthe left sphenoid sinus. Moderate opacification of the bilateral posterior\nethmoid air cells. Near complete opacification of the bilateral mastoid air\ncells and of the left middle ear cavity. Patient is status post right\nvitrectomy. Extensive arterial calcifications are seen along the scalp\nconsistent with the patient's known history of diabetes. There is also\nhyperdensity in the left vitreous, unchanged, which can be correlated for\nhistory of retinal detachment surgical intervention.", + "output": "1. No evidence of intracranial hemorrhage, large territorial infarction, or\nfracture.\n2. Moderate to severe bilateral sinus disease described above with near\ncomplete opacification of the left maxillary sinus and complete opacification\nof the right sphenoid sinus.\n3. New near complete opacification of the bilateral mastoid air cells and left\nmiddle ear cavity." + }, + { + "input": "The study is limited due to patient motion, within this limitation, grossly\nthere is no evidence of territorial infarction,intracranial\nhemorrhage,edema,or mass. The ventricles and sulci are normal in size and\nconfiguration for patient's age.\n\nThere is no evidence of fracture. There is a mucous retention cyst in the\nright maxillary sinus. The visualized portion of the remaining paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "The study is limited due to patient motion, within this limitation, there is\nno evidence of acute intracranial process or hemorrhage." + }, + { + "input": "The patient is status post tracheostomy with collapse of the upper airways in\nthe region of nasopharynx and hypopharynx.\n\n\nThe arteries of the neck are patent without stenosis occlusion or dissection. \nThere is no evidence of contrast extravasation identified.\n\nThere is left periorbital soft tissue swelling identified without fluid\ncollection. Diffuse soft tissue stranding is identified throughout the soft\ntissues likely secondary to edema. Retention cyst is seen in both maxillary\nsinuses with mucosal thickening. The walls of the sinuses are intact.\n\nPartially visualized intracranial arteries are patent and basal cisterns are\npatent. The left jugular vein is visualized throughout its length in the\nneck. The right jugular vein is not identified in its midportion. 2 central\nvenous catheters are in place.\n\nDiffuse bilateral consolidative opacities are seen in the lungs. Please see\nthe separately perform CT a chest for further details. There is increased\ndensity within the right lobe secondary to postsurgical changes.", + "output": "1. Left periorbital soft tissue swelling with findings suggestive of adjacent\nmild chronic sinus disease but without intra orbital hematoma. Postoperative\nchanges in the right globe.\n2. Patent cervical arteries without occlusion stenosis or dissection.\n3. Diffuse pulmonary opacities could be secondary to pulmonary edema,\nhemorrhage or pneumonia. Correlate with the CT of the chest of the same day\nfor further details." + }, + { + "input": "There is diffuse subcutaneous edema throughout the face. There is additional\nskin and subcutaneous thickening along the left periorbital region. No\ndrainable fluid collection is identified.\n\nThere is mild mucosal thickening in the ethmoid air cells and bilateral\nmaxillary and sphenoid sinuses. Mucous retention cysts are noted within the\nbilateral maxillary sinuses and left sphenoid sinus. No air-fluid levels\nidentified. The ostiomeatal units are patent.\n\nThere is an intra-ocular silicone injection within the right globe. Medial\nbowing of the left lamina papyracea most likely represent sequela from remote\ntrauma.\n\nA large caries is noted within the right third maxillary molar.\n\nThere is enlargement of the adenoids resulting in severe narrowing of the\nnasopharynx.", + "output": "1. Left preseptal orbital cellulitis.\n2. No CT evidence of acute sinusitis.\n3. Large caries within the right third maxillary molar." + }, + { + "input": "Aero digestive tract:\nThere is redemonstrated severe narrowing of the nasopharyngeal and\noropharyngeal airway. Patient is status post tracheostomy.\n\nNeck lymph nodes:\nBilateral cervical lymph nodes are prominent without meeting size criteria for\nlymphadenopathy. Prominent supraclavicular lymph nodes measure up to 0.9 cm.\n\nBones, skull base:\nThere are mucous retention cysts in the bilateral maxillary sinuses and left\nsphenoid sinus. There is partial opacification of the bilateral mastoid air\ncells. There is partial opacification of the left middle ear cavity.\n\nVessels:\nAlthough not well opacified, visualized neck vasculature is grossly\nunremarkable.\n\nThyroid, salivary glands:\nThere is no mass.\n\nOther findings:\nThere is redemonstration of subcutaneous edema throughout the face, which\nextends into the neck. Patient is status post right globe intra-ocular\nsilicone injection.\n\nThere is redemonstrated left orbit lateral bowing of the sclera, consistent\nwith staphyloma, new from ___ and increased since ___. \nRedemonstrated left preseptal stranding is consistent with preseptal\ncellulitis. Mild left intraconal stranding is concerning for postseptal\ncellulitis (301:25). There is no substantial proptosis. There is medial\nbowing of the left lamina papyracea, likely sequelae of remote trauma.\n\nPlease refer to separate report on same-day CT chest for complete description\nof the thoracic findings.", + "output": "1. Left preseptal orbital cellulitis with new stranding posterior to the left\nglobe, which is concerning for developing postseptal orbital cellulitis.\n2. Lateral scleral bowing of the left orbit, similar to the prior study from 1\nday prior and increased since ___, concerning for staphyloma secondary\nto infection.\n3. No evidence of venous thrombosis in the neck, within the limitations of\nsuboptimal contrast timing." + }, + { + "input": "There is no evidence of acute large territorial infarction, intracranial\nhemorrhage, edema, or mass.\n\nThe ventricles and sulci are normal in size and configuration.\n\nNo acute osseous abnormalities seen. Small mucous retention cysts of the\nright maxillary sinus. Otherwise, the partially imaged paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The orbits demonstrate\nno acute abnormalities.", + "output": "No acute intracranial process. No evidence of intracranial hemorrhage." + }, + { + "input": "Limited study due to poor contrast bolus as a result of inadequate venous\naccess. Within this limitation, the carotidandvertebral arteries and their\nmajor branches are patent with no evidence of stenoses. There is no stenosis\nof bilateral ICA by NASCET criteria. No evidence of arterial contrast in the\nvisualized pharynx or trachea.\n\nOTHER: Tracheostomy tube in place. Diffuse bilateral ground-glass opacities\nin visualized lungs likely related to pulmonary edema. Prominent mediastinal\nnodes are likely reactive. Diffuse subcutaneous edema in the neck and upper\nchest. Bilateral maxillary and sphenoid sinuses mucosal thickening. \nRe-identified is staphyloma of the left globe and silicone injection in the\nright globe. Re-identified is left periorbital cellulitis or soft tissue\nswelling.", + "output": "1. Limited study due to poor contrast bolus as a result of inadequate venous\naccess. Within this limitation, the carotidandvertebral arteries and their\nmajor branches are patent with no evidence of stenoses. There is no\nsignificant stenosis of bilateral ICA by NASCET criteria. No evidence of\narterial contrast in the visualized pharynx or tracheal\n2. Diffuse bilateral ground-glass opacities in visualized lungs likely related\nto pulmonary edema and atelectasis. Underlying airspace disease cannot be\nexcluded on the basis of this examination.\n3. Left globe staphyloma as well as left periorbital cellulitis re-identified.\nAdditional findings described above." + }, + { + "input": "There is no evidence of acute infarction,intracranial hemorrhage,edema,or\nmass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of acute fracture. Largely unchanged mucous retention\ncyst is redemonstrated in the right maxillary sinus. Otherwise, the imaged\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "No acute intracranial findings." + }, + { + "input": "There is no evidence of infarction,hemorrhage,edema, or mass. The ventricles\nand sulci are normal enlarged for age in an atrophic pattern.\n\nThere is no evidence of fracture. Hyperdense material nearly completely fills\nthe right globe, new since ___. This reflects the vitrectomy and\nsilicone injection performed in ___. Otherwise, the visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nThe visualized portion of the orbits are unremarkable.", + "output": "1. No evidence of mass, hemorrhage or infarction.\n2. Atrophy.\n3. Status post right ocular silicone coil injection." + }, + { + "input": "There is no evidence of acute, large territorial infarction,hemorrhage,edema,\nor mass effect. The ventricles and sulci are prominent for age, stable from\nprior.\n\nThere is no evidence of fracture. Mild, left periorbital soft tissue\nswelling, similar to prior exam. Mild mucosal thickening of the ethmoid air\ncells. Mucous retention cyst in the right maxillary sinus. Otherwise, the\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The patient is status post right ocular silicone\ninjection. Otherwise, the visualized portion of the orbits are unremarkable.", + "output": "1. No evidence of acute hemorrhage or calvarial fracture. No acute\nintracranial abnormality on noncontrast head CT.\n2. Mild, left periorbital soft tissue swelling, overall similar to prior exam.\n3. Additional findings described above" + }, + { + "input": "No acute fractures are identified. Subtle left anterior lamina papyracea\nchronic fracture with fat herniation is unchanged from prior examinations\n(series 2, image 37). Mild left periorbital soft tissue swelling, similar to\nprior CT examination. Mucous retention cysts in the bilateral maxillary\nsinuses. Mild mucosal thickening of the ethmoid air cells. Otherwise, the\nvisualized paranasal sinuses are well aerated. There is no evidence of\nabnormal fluid collections. Bilateral mastoids appear normal. Aside from\nright ocular silicone injection, the globes, extraocular muscles, optic\nnerves, and retrobulbar fat appear normal. The visualized upper aerodigestive\ntract appears normal. The mandible and temporomandibular joints appear\nnormal.", + "output": "1. No evidence of acute fracture.\n2. Mild left periorbital soft tissue swelling, similar to prior exams.\n3. Additional findings described above." + }, + { + "input": "There is no evidence of acute, large territorial infarction,intracranial\nhemorrhage,edema,or mass. The ventricles and sulci are slightly prominent for\nage, stable from prior.\n\nThere is no evidence of fracture. Mucous retention cysts in the bilateral\nmaxillary sinuses. Mild mucosal thickening of the ethmoid air cells. \nOtherwise, the visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The patient is status post right ocular\nsilicone injection. Otherwise, the visualized portion of the orbits are\nunremarkable.", + "output": "There is no evidence of acute intracranial process or hemorrhage." + }, + { + "input": "There is no evidence of acute large territory infarct,hemorrhage,edema, or\nmass effect. The ventricles and sulci are within expected limits in size and\nconfiguration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Patient is\nstatus post right ocular silicone injection.", + "output": "1. No acute intracranial abnormality on noncontrast CT head. Specifically no\nacute large territory infarct or intracranial hemorrhage. No intracranial\nmass effect.\n2. Additional findings described above." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are within expected limits and size and\nconfiguration.\n\nThere is mild mucosal thickening of the bilateral ethmoid air cells and both\nsphenoid sinuses. Ear cavities are well aerated. The bony calvarium is\nintact. Patient is status post right ocular silicone injection.", + "output": "No acute intracranial abnormality on noncontrast CT head. Specifically, no\nacute large territory infarct or intracranial hemorrhage." + }, + { + "input": "There is no evidence of acute major vascular territory\ninfarction,hemorrhage,edema,or discrete mass. Age advanced involutional\nchanges are notable.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Patient is\nstatus post right ocular silicone injection.", + "output": "1. No acute intracranial abnormalities.\n2. Significantly age advanced involutional changes." + }, + { + "input": "There is no evidence of intracranial hemorrhage, acute large territorial\ninfarction, edema,or mass. Mild brain parenchymal atrophy.\n\nChronic fracture left medial orbital wall, similar. Retention cysts maxillary\nsinuses, trace mucosal thickening. Clear mastoids. Patient is status post\nright ocular silicone injection.", + "output": "No acute intracranial findings." + }, + { + "input": "There is no evidence of infarction,hemorrhage,edema,or mass. Parenchymal\natrophy is similar the prior study.\n\nThere is no evidence of fracture. Extensive paranasal sinus disease has\nworsened from prior, with partial bilateral anterior ethmoid air cell\nopacification and fluid in the sphenoid sinuses. Maxillary sinus mucous\nretention cyst and mucosal thickening is also slightly worse. There are small\namounts of fluid in the maxillary sinuses bilaterally and the sphenoid sinus. \nRight globe vitreal injection is re-demonstrated.", + "output": "No evidence of mass, hemorrhage or infarction.\nAtrophy.\nParanasal sinus inflammatory changes." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass effect. Mild brain parenchymal atrophy. Ventricles appear grossly\nunchanged in size and configuration as compared to prior study.\n\nThere is no evidence of fracture. Extensive paranasal sinus disease has\nworsened from prior, with air-fluid layering in the left frontal sinus as well\nas bilateral sphenoid sinuses. The bilateral ethmoid air cells are partially\nopacified. Maxillary sinuses are not captured on the current exam. The\nmastoid air cells, and middle ear cavities are clear. Right globe material\ninjection is re-demonstrated.", + "output": "1. No acute intracranial abnormalities. Specifically, no evidence of acute\ninfarction, hemorrhage, or mass-effect.\n2. Worsening paranasal sinus disease as compared to study on ___, as\noutlined above." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nacute major vascular territorial infarction. Scattered periventricular and\ndeep white matter hypodensities are nonspecific in this age group, better\nassessed on the preceding brain MRI. Mild prominence of the ventricles and\nsulci is unexpected for the patient's age.\n\nThere is no evidence of fracture.\n\nExtensive paranasal sinus abnormalities are again demonstrated. There is\nincreased, near complete opacification of the right sphenoid sinus and\nincreased, complete opacification of the left sphenoid sinus, and grossly\nunchanged, extensive aerosolized secretions in the posterior ethmoid air\ncells, which may be secondary to prolonged supine positioning in the inpatient\nsetting. There are mucous retention cysts and polypoid mucosal thickening in\nthe partially imaged maxillary sinuses, left greater than right. There is\nmild mucosal thickening in the anterior ethmoid air cells, decreased compared\nto extensive opacification seen on ___. Frontal sinuses are now\nwell aerated with resolution of the previously seen fluid. There is a small\namount of fluid in the dependent mastoid tip air cells, left greater than\nright, which may be secondary to prolonged supine positioning in the\ninpatient.\n\nSequela of vitreous injection are again seen in the right globe.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. Mild global parenchymal volume loss, unexpected for the patient's age, and\nscattered supratentorial white matter hypodensities, nonspecific in this age\ngroup. Please refer to the ___ MRI report for further detail.\n3. Extensive, increased opacification of the sphenoid sinuses and extensive\nunchanged opacification of the posterior ethmoid air cells, which may be\nsecondary to prolonged supine positioning in the inpatient setting. However,\naeration of the anterior ethmoid air cells and frontal sinuses has improved\nwith resolution of fluid. Mucosal thickening and mucous retention cyst within\nleft greater than right maxillary sinuses are unchanged." + }, + { + "input": "There is no evidence of acute large territory infarction,\nintracranialhemorrhage,edema,or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes, advanced for patient's given\nage.\n\nThere is no evidence of fracture. Mucosal retention cysts are seen within the\nbilateral maxillary sinuses. Otherwise, the visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavitiesare essentially\nclear. Right globe ventral injection is again seen.", + "output": "1. No acute intracranial abnormality.\n2. Mild parenchymal atrophy is similar to prior exams." + }, + { + "input": "Post suboccipital craniectomy changes re-identified. There is no evidence of\npseudomeningocele associated with the midline craniectomy defect or evidence\nof convincing fluid collection in the adjacent soft tissues. A cleft in the\noverlying posterior scalp soft tissues remain similar. Given differences in\ntechnique appearance is similar to the prior MRI scan.\n\nThere is no evidence of infarction,hemorrhage,edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavitiesare well aerated. The visualized portion of the orbits are\nnormal.", + "output": "1. S/p suboccipital craniectomy without evidence of interval change or\ncomplication.\n2. No evidence of acute intracranial abnormality." + }, + { + "input": "There are postsurgical changes from occipital craniectomy. A previous bone\nflap at the surgical site has been removed since the CT in ___. \nSoft tissue thickening at the surgical defect is demonstrated without a\ndefinite focal fluid collection.\n\nThere is no evidence of fracture, infarction, hemorrhage, edema, or mass. \nThe ventricles and sulci are stable in size and configuration. There is no\nabnormal enhancement on post contrast images.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. Postsurgical changes with midline occipital craniectomy defect following\nbone flap removal. There is no definite fluid collection or inflammatory\nchange at the surgical site." + }, + { + "input": "There is increased density along the tentorium as well as in the retro clival\nregion indicative of subdural hematoma. Increased density in the posterior\nfalx also indicates small subdural hematoma. A 3 mm high density along the\ninner table in the right frontal region (02:21) indicate a small right\nconvexity subdural hematoma. There is no hydrocephalus or midline shift. \nSubcutaneous emphysema is seen in the suboccipital region.", + "output": "Acute subdural hematoma along the falx and retro clival region. Small subdural\nhematoma along the right frontal convexity region. No intraparenchymal\nhemorrhage. Small amount of suboccipital subcutaneous emphysema is\nidentified. The extent of subcutaneous emphysema in the neck is not fully\nevaluated." + }, + { + "input": "Again seen is subdural blood in the bilateral tentorium, posterior falx, and\nretro-clival area without substantial interval changes. Anterior parafalcine\nsubdural blood has decreased in size. The right frontal convexity subdural\nblood has decreased in size and density distant with interval evolution. \nThere is no evidence of large territorial infarction,new foci of intracranial\nhemorrhage,edema,or mass. The ventricles and sulci are stable in size and\nconfiguration.\n\nThere is no evidence of fracture. Subcutaneous emphysema in occipital scalp\nis again noted. The visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are preserved.", + "output": "1. Stable subdural blood along the tentorium, posterior falx, and retro clival\narea.\n2. Interval improvement of the subdural blood along the anterior falx and\nright frontal convexity.\n3. No evidence of new intracranial hemorrhage." + }, + { + "input": "Postoperative changes suboccipital area. Small subacute subdural hematoma\noverlying tentorium, posterior to clivus, is less prominent. Trace subacute\nto chronic right hemispheric subdural hematoma, less prominent.. \nEncephalomalacia posterior, superior right cerebellar vermis.\n\nThere is no evidence of new hemorrhage,edema,or mass. The ventricles and\nsulci are normal in size and configuration. No parenchymal hemorrhage.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Interval evolution of subdural blood products.\nNo new hemorrhage. No hydrocephalus." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No hemorrhage, infarction or fracture is seen." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is a large chronic infarction involving essentially the entire left\nsuperior division middle cerebral artery territory, a portion of the inferior\ndivision territory and much of the left anterior cerebral artery cortical\ndistribution. There is ex vacuo dilatation of the left lateral ventricle. \nThere is generalized prominence of the sulci and of the right lateral\nventricle in an atrophic pattern. There is periventricular white matter\nhypodensity often attributed to chronic small vessel ischemia. No masses are\nidentified and there is no evidence of recent infarction.\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The lenses have been removed. Otherwise, the\nvisualized portion of the orbits are unremarkable. There is calcification of\nthe cavernous carotid arteries bilaterally and mild calcification of the\nintracranial vertebral arteries.\n\nCTA HEAD:\nThe supraclinoid internal carotid arteries are patent bilaterally as are the\nA1 segments and M1 segments of the anterior and middle cerebral arteries\nrespectively. On the right, there is mild narrowing at the middle cerebral\nartery bifurcation. On the left, the superior division of the middle cerebral\nartery appears absent, in keeping with the large area of infarction. There is\nnarrowing and irregularity of the distal segment of the left anterior\ncerebral artery, consistent with the L distribution of the anterior cerebral\nartery infarction. The right anterior cerebral artery appears normal.\nThere is irregular narrowing, presumably atherosclerotic, involving the\nbasilar artery without occlusion or focal stenosis. The dural venous sinuses\nare patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is minimal atherosclerotic plaque\nat the internal carotid artery origins, at calcified on the right and\nnoncalcified on the left. There is no evidence of internal carotid stenosis\nby NASCET criteria.\n\nOTHER:\nThere is scarring at the left pulmonary apex and scarring or partial\nconsolidation and the right pulmonary apex. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Chronic infarction in the left middle cerebral and anterior cerebral artery\ndistributions.\n2. No evidence of hemorrhage or recent infarction.\n3. Since of the superior division of the left middle cerebral artery and\nnarrowing and irregularity of the distal left anterior cerebral artery\ncompatible with the distribution of infarction.\n4. Scarring or consolidation in the right pulmonary apex." + }, + { + "input": "There is no evidence of acute major territorial infarction,hemorrhage,edema,or\ndiscrete mass. The ventricles and sulci are normal in size and\nconfiguration.A mucous retention cyst is noted in the sphenoid sinuses. The\nmastoid air cells and middle ear cavities are clear. The visualized portion\nof the orbits are normal.", + "output": "No acute intracranial process." + }, + { + "input": "There are large confluent regions of encephalomalacia seen within the\nbilateral frontal parietal lobes in addition to the bilateral cerebellar\nhemispheres of uncertain chronicity, correlation with prior examinations if\navailable is advised. There is no evidence of acute intracranial hemorrhage,\nmass effect, or shift of the midline structures. Prominent ventricles and\nsulci are noted, with preferential enlargement of the ventricular system\ncompatible with central cerebral atrophy. The basal cisterns are grossly\npatent and there is preservation of gray-white matter differentiation.\n\nThe visualized bony structures are grossly unremarkable. A small, left frontal\nsubgaleal hematoma is noted. There is mucosal thickening and an air-fluid\nlevels seen within the right maxillary sinus. The remainder of the paranasal\nsinuses and mastoid air cells are grossly clear. The globes are unremarkable.", + "output": "1. No evidence of acute intracranial hemorrhage.\n2. Large regions of encephalomalacia within the bilateral frontoparietal lobes\nand bilateral cerebral hemispheres. Although no prior imaging is available for\ndirect comparison, findings are likely secondary to the patient's known\nhistory of anoxic brain injury.\n3. Moderate, predominantly central cerebral atrophy.\n4. Left frontal subgaleal hematoma. No evidence of fracture." + }, + { + "input": "There is a small area of hypodensity in the left frontal lobe white matter\n(601:78). There is asymmetric hypodensity in the left middle cranial fossa\nadjacent to the left anterior temporal horn (301:20).\n\nThere is a small mucous retention cyst in the inferior right maxillary sinus\nand a tiny mucous retention cyst in the medial left maxillary sinus. The\nother paranasal sinuses are normally aerated, with no mucosal thickening or\nair-fluid levels identified. The ostiomeatal units remain patent. An\naccessory left maxillary ostium is present (2:32)\n\nThe cribriform plates are intact. The lamina papyracea are intact. A\nnasoenteric tube is partly imaged.", + "output": "1. Small area of hypodensity in the left frontal lobe white matter is\nnonspecific, but may represent an infectious/inflammatory process. Recommend\nfurther evaluation with contrast enhanced brain MRI.\n2. Asymmetric hypodensity in the left middle cranial fossa adjacent to the\nleft anterior horn is incompletely evaluated and may represent an arachnoid\ncyst. This could also be further evaluated on MRI.\n3. Minimal paranasal sinus disease involving the bilateral maxillary sinuses.\n\nRECOMMENDATION(S): Contrast enhanced brain MRI." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nMinimal bilateral maxillary sinus and ethmoid air cell mucosal thickening is\npresent. Otherwise, the paranasal sinuses are normally aerated, with no\nair-fluid levels identified. The ostiomeatal units are patent.\n\nThe cribriform plates are intact. The lamina papyracea are intact. There is\nminimal rightward nasal septal deviation with bony spur that contacts the\nright inferior nasal turbinate. Bilateral Haller cells are present.\n\nLeft temporal bone mastoidectomy postoperative changes are seen. Left\nmaxillary second premolar periapical lucency is noted (see 602: 89-96). Right\nmaxillary first premolar periapical lucency seen (see 602: 50-55).", + "output": "1. Dental amalgam streak artifact limits study.\n2. Minimal paranasal sinus disease , as described.\n3. Left temporal bone mastoidectomy postoperative changes.\n4. Left maxillary second and right maxillary first premolar probable\nperiodontal disease, as described.\n5. Bilateral Haller cells.\n6. Rightward nasal septal deviation with bony spur that contacts the right\ninferior nasal turbinate." + }, + { + "input": "At the vertex, there is a 3.6 cm transverse by 3.9 cm AP by 3.8 cm\ncraniocaudal Left parafalcine calcified mass, likely extra-axial, abutting the\nfalx with a dural tail, most likely representing a meningioma.\n\nThere is effacement and buckling of the falx, left frontal cortex, with\nsurrounding vasogenic edema.\n\nThere is no acute hemorrhage, extension into the superior sagittal sinus, or\naggressive remodeling of the inner table of the calvarium.\n\nThere is no herniation syndrome.", + "output": "Large Left parasagittal extra-axial calcified mass, probable meningioma, with\nadjacent edema of the Left frontal lobe. This may be better characterized by\nMRI if clinically warranted.\n\nNOTIFICATION: Large Left parasagittal extra-axial calcified mass, probable\nmeningioma, with adjacent edema of the Left frontal lobe. This may be better\ncharacterized by MRI if clinically warranted." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage. There are hyperdense\nlesions in the left posterior parafalcine (image 2:23) and in the right\nfrontal regions (image 2:21), with no definitive correlate on prior MR and may\nreflect new metastatic disease. There are new scattered calcification foci\nlikely also reflect metastatic disease or response to treatment. No midline\nshift or acute mass effect is seen.\n\nThe ventricles and sulci are prominent related to age-related cerebral\natrophy. There is periventricular white matter hypodensities, which are most\nlikely sequela of chronic small vessel ischemic disease. The basal cisterns\nappear patent and there is preservation of gray-white matter differentiation.\n\nMultiple lucent foci are again seen in the cranium again raise concern for\nmetastases metastatic lesions. The paranasal sinuses are clear. The left\nmastoid air cells are opacified. Bilateral middle ear cavities are clear.", + "output": "1. No definitive acute intracranial hemorrhage.\n2. Hyperdense lesions are seen in the left posterior parafalcine (image 2:23)\nand in the right frontal regions (image 2:21), with no definitive correlate on\nprior MR and may reflect new metastatic disease. Small intracranial\nmetastatic lesions are better assessed on MR, but there is no evidence of\nedema or mass effect in this study.\n3. New scattered calcification foci likely also reflect metastatic disease or\nresponse to treatment.\n4. Multiple lucent foci in the cranium, concerning for metastatic lesions.\n5. Opacification of the left mastoid air cells, please correlate with clinical\nhistory for mastoiditis." + }, + { + "input": "No adenopathy.\n\nNo aerodigestive tract mass.\n\n1 cm left thyroid nodule. Normal salivary glands. Patent neck vessels. \nDegenerative changes spine. Refer to chest CT for thoracic findings from\ntoday, including left lung nodule. Mild paranasal sinus disease.", + "output": "1. No mass or adenopathy" + }, + { + "input": "Again demonstrated is a large right frontal hematoma measuring 3.4 x 3.3 x 3.2\ncm (SI by TRV by AP; series 601, image 53 and series 2, image 21), previously\nmeasuring 3.5 x 3.3 x 3.2 cm. This is associated with surrounding vasogenic\nedema and local mass effect. Moderate right frontal subarachnoid blood\nproducts are not appreciably changed compared to the prior exam. No new areas\nof intracranial hemorrhage are identified. There is no evidence of midline\nshift. No evidence of recent infarction. The ventricles and sulci are\nunchanged in size and configuration.\n\nThere is trace fluid layering in the right maxillary sinus and left sphenoid\nsinus. Mild-to-moderate mucosal thickening is demonstrated in the left\ngreater than right anterior ethmoid air cells. The remainder of the paranasal\nsinuses, mastoid air cells, middle ear cavities are clear. Patient is status\npost right lens replacement.", + "output": "1. Unchanged right frontal hematoma measuring up to 3.4 cm with associated\nvasogenic edema and local mass effect. No midline shift.\n2. Right frontal subarachnoid blood products are largely unchanged in\nconfiguration and extent compared to the prior exam. No new areas of\nintracranial hemorrhage.\n3. No evidence of recent infarction." + }, + { + "input": "Unchanged 3.3 x 3.5 cm right frontal intraparenchymal hematoma with similar\nsurrounding edema and mass effect. There is no midline shift.\n\nThere is no evidence of new hemorrhage. There is a similar degree of\nsubarachnoid hemorrhage in the right cerebral hemisphere.\nCalcified vessels adjacent to the hematoma appear unchanged since the prior\nstudy. There is no evidence of fracture, infarction. The ventricles and\nsulci are normal in size and configuration.\n\nParanasal sinus disease noted with mild mucosal thickening of the left\nsphenoidal sinus. The air cells,and middle ear cavities are clear. The\nvisualized portion of the orbits are normal.", + "output": "1. Unchanged right frontal hematoma measuring up to 3.5 cm, with associated\nedema and local mass effect.\n2. There is no evidence of new hemorrhage.\n3. Similar degree of right cerebral subarachnoid hemorrhage.\n4." + }, + { + "input": "Unchanged 3.5 x 3.0 cm right frontal intraparenchymal hematoma with a similar\namount of surrounding edema and mass effect. There is no midline shift or\nsubfalcine or uncal herniation. Subarachnoid hemorrhage is again seen\ndiffusely throughout the right hemisphere, not substantially changed compared\nto prior. There is no new or additional intracranial hemorrhage identified.\n\nThere is no evidence of acute large territory infarction, fracture, or\nincreasing cerebral edema. The ventricles and sulci are normal in size and\nconfiguration.\n\nThere is mild mucosal thickening of the bilateral maxillary sinuses and left\nsphenoid sinus. The visualized portion of the remaining paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. There is a right lens\nreplacement. The visualized portion of the orbits are normal.", + "output": "1. Unchanged 3.5 cm right frontal hematoma with surrounding edema and local\nmass effect.\n2. Similar degree of subarachnoid hemorrhage distributed throughout the right\nhemisphere.\n3. No new intracranial hemorrhage." + }, + { + "input": "Since prior exams, the 3.5 cm right frontal parenchymal hemorrhage (2:22) is\nnow hypodense. Previously seen mass effect has essentially resolved. \nSlightly anterior hyperattenuating area with associated calcifications\nmeasuring 2.1 x 1.6 cm (2:23) is compatible with known arteriovenous\nmalformation as seen on prior. Draining veins are noted at the vertex (2:25),\nbetter characterized by prior CTA. There is no evidence of acute hemorrhage. \nThere is no midline shift.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "Sequela of prior right frontal parenchymal hemorrhage related to underlying a\nAVM with decreased mass effect. No evidence of acute hemorrhage." + }, + { + "input": "Punctate 4 mm hyperdense focus in the right cerebellar hemisphere (2:6) is\nunchanged since ___ and is unlikely to represent hemorrhage. There is no\nacute intracranial hemorrhage, acute infarction, large mass or midline shift.\nThere is no hydrocephalus. The ventricles and sulci are normal in size and\nconfiguration. The basal cisterns are patent and there is preservation of\ngray-white matter differentiation. The orbits are unremarkable. The\nvisualized paranasal sinuses, middle ear cavities and mastoid air cells are\nclear. There is no fracture.", + "output": "1. No acute intracranial abnormality.\n2. Nonspecific 4 mm calcification in the right cerebellum unchanged since ___\nshould not be confused with hemorrhage and is likely choroid calcification in\nthe Foramen of Luschka." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Mucous retention cyst within the right\nmaxillary sinus. Otherwise, the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Prominent ventricles and sulci likely represent age related\ninvolutional changes. There is periventricular white matter hypoattenuation,\nspecifically adjacent to the temporal horn of the left lateral ventricle,\nwhich is nonspecific but can be seen as sequela of chronic small vessel\nischemic disease.\n\nThere is a mucus retention cyst in the right maxillary sinus. mastoid air\ncells and middle ear cavities are well aerated. The bony calvarium is intact.", + "output": "1. No acute intracranial process.\n2. Periventricular white matter hypoattenuation, specifically adjacent to the\ntemporal horn of the left lateral ventricle, unchanged from CT head ___, is nonspecific but can be seen as sequela of chronic small vessel\nischemic disease." + }, + { + "input": "There is no evidence of acute, large territorial infarction,hemorrhage,edema,\nor mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular white-matter hypodensities are\nnonspecific, likely sequela of chronic ischemic small vessel disease.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction,intracranial hemorrhage,edema,or mass. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Periventricular and subcortical white matter hypodensities are\nnonspecific but likely sequelae of chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Punctate\nradiopaque foreign body is again seen in the superior aspect of the left\norbit, unchanged since the prior head CT dated ___, otherwise, the\nvisualized portion of the orbits are unremarkable.", + "output": "There is no evidence of acute intracranial process or hemorrhage." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,intracranial hemorrhage,edema,ormass. \nMinimal residual left parietal subdural hemorrhage visualized. The ventricles\nand sulci are normal in size and configuration.\n\nRight maxillary sinus mucosal inclusion cyst. The visualized portion of the\nparanasal sinuses, mastoid air cells,and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nAtherosclerotic calcification of the bilateral internal carotid arteries and\nbilateral vertebral arteries. There is mild luminal narrowing, without\nocclusion of the right V3 segment vertebral artery and distal left vertebral\nartery. The remaining vessels of the circle of ___ in the principal\nintracranial branches appear patent with segmental areas of mild narrowing\nsuggesting arteriosclerotic disease, no aneurysms are identified, the major\ndural venous sinuses are patent.\n\nCTA NECK:\nAtherosclerotic calcification without significant luminal narrowing of the\naortic arch and bilateral common carotid arteries. There is also mild\nnarrowing and tortuosity of the right vertebral artery immediately after its\ntakeoff from the right subclavian artery. No evidence of stenosis or\nocclusion of the carotidandvertebral arteries and their major branches. There\nis no evidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nRedemonstration parenchymal opacification of the right lung, likely\nrepresenting re-expansion pulmonary edema and right pleural effusion. \nFindings of the chest are better visualized on recent CT chest dated ___. Enlarged thyroid gland with nodularity. In the right lobe of the\nthyroid, there is a 1.8 x 2.3 cm hypodense lesion (series 4, image 96). No\nlymphadenopathy by CT size criteria. Mild multilevel degenerative changes\nthroughout cervical spine, more significant at C3-C4 consistent with narrowing\nof the intervertebral disc space and mild spondylosis.\n\nCT BRAIN PERFUSION:\nT-max > 4.0 s volume: 10 mL\nT-max > 6.0 s volume: 0 mL\n\nCBF < 30 % volume: 0 mL", + "output": "1. No acute intracranial abnormality.\n2. Atherosclerotic calcification without significant luminal narrowing of the\nbilateral common carotid arteries, bilateral internal carotid arteries, and\nbilateral vertebral arteries.\n3. Atherosclerotic calcification causing mild luminal narrowing without\nocclusion of the right V3 segment vertebral artery and distal left vertebral\nartery.\n4. Enlarged thyroid gland with nodularity. A 2.3 cm hypodense right thyroid\nlobe lesion is not fully characterized and warrants further evaluation with a\ndedicated thyroid ultrasound.\n\nRECOMMENDATION(S): Thyroid ultrasound for evaluation of a 2.3 cm right\nthyroid lobe lesion.\n\n Thyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or older, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "No evidence of infarction,hemorrhage, edema, or mass effect. Bilateral,\nsymmetric prominence of the ventricles and sulci indicates cortical volume\nloss. Encephalomalacia in the anterior inferior left frontal lobe is chronic.\nBilateral basal ganglia calcifications are normal for the patient's age. \nBilateral cavernous internal carotid artery calcifications are mild, worse on\nthe left.\n\nNo evidence of acute fracture. Postsurgical changes are demonstrated in the\nleft calvarium. The visualized portion of the paranasal sinuses are clear. \nThe left mastoid air cells and middle ear cavities are clear. Some of the\nright mastoid air cells posteriorly are opacified, new since ___ (e.g.,\nseries 3, image 13). No obvious masses seen along the eustachian tube for the\nfossa Rosenmuller. The visualized portion of the orbits are unremarkable.", + "output": "1. No hemorrhage or fracture.\n2. Partial opacification of right mastoid air cells, nonspecific but new since\n___. Could be inflammatory and correlation with clinical assessment and\nhistory is recommended." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Again seen is\nchronic encephalomalacia in the anterior left inferior frontal lobe. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nSubcortical and periventricular white matter hypodensities are nonspecific,\nhowever likely represent sequela of chronic small vessel ischemic disease. \nThere are atherosclerotic calcifications in the bilateral cavernous carotids. \nIncidental note is made of bilateral basal ganglia calcifications.\n\nPatient is status post left craniotomy. There is no evidence of fracture. \nPartial opacification of the right mastoid air cells is not significantly\nchanged. The visualized portion of the paranasal sinuses, left mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "No fracture or acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence acute hemorrhage, edema, mass effect, or acute major\nvascular territorial infarction. Mild global parenchymal volume loss is again\nseen with mild prominence of ventricles and sulci, similar to the prior MRI. \nIll-defined hypodensities in the periventricular, deep, and subcortical white\nmatter are nonspecific but likely sequela of chronic small vessel ischemic\ndisease in this age group.\n\nThere is mild mucosal thickening in the right sphenoid sinus with a small\nmucous retention cyst anterolaterally. There is minimal mucosal thickening in\nthe maxillary and anterior ethmoid sinuses. There is a defect in the medial\nwall of the left maxillary sinus. Mastoid air cells appear well-aerated. The\norbits are unremarkable.\n\nCTA NECK:\nAberrant right subclavian artery is noted. There is mild mixed plaque in the\nproximal left subclavian artery without flow-limiting stenosis. There is mild\nmixed plaque in the proximal right internal carotid artery and mild\npredominantly calcified plaque in the proximal left internal carotid artery\nwithout stenosis by NASCET criteria. Vertebral arteries are widely patent. \nLeft vertebral artery is dominant.\n\nCTA HEAD:\nThere is calcified plaque in bilateral carotid siphons without flow-limiting\nstenosis. No flow-limiting stenosis is seen in the anterior cerebral or\nmiddle cerebral arteries. P2 segments of bilateral posterior cerebral\narteries are irregular, presumably secondary to atherosclerosis, with\nnear-occlusion of the right P2 segment spanning 2 mm, and distal\nreconstitution, images 601:35, 456:24. There is no evidence for an aneurysm. \nThe dural venous sinuses are patent.\n\nOTHER:\nBiapical pleural-parenchymal scarring. Mild bronchial wall thickening with\nretained secretions may represent bronchial inflammation. The thyroid is\nsmall with relatively low density, suggesting low iodine content; please\ncorrelate clinically. There is no lymphadenopathy by CT size criteria. There\nare degenerative changes in the cervical spine.", + "output": "1. No evidence for acute intracranial abnormalities. MRI would be more\nsensitive for an acute infarction, if clinically warranted.\n2. Mild atherosclerosis of bilateral proximal internal carotid arteries\nwithout stenosis by NASCET criteria.\n3. Irregularity of the P2 segments of bilateral posterior cerebral arteries,\npresumably atherosclerotic, with short-segment (2 mm) near occlusion of the\nright P2 segment and distal reconstitution.\n4. Aberrant right subclavian artery, a normal variant.\n5. Mild bronchial wall thickening at the included lung apices, likely\ninflammatory.\n\nNOTIFICATION: Impression item 3, which were not included in the preliminary\nreport, was emailed to the ED QA nurses list by Dr. ___ on ___\nat 11:12." + }, + { + "input": "There is no acute intracranial hemorrhage, edema, mass effect, or evidence of\nlarge vascular territorial infarction. The ventricles and sulci are normal in\nsize and configuration. The asymmetrically small focal or of the right lateral\nventricle abutting secondary to a congenital/ developmental process. There is\nno fracture. The imaged paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is a 3 vessel aortic arch. Common carotid, internal carotid, and\nvertebral arteries are widely patent without evidence for dissection or\nstenosis. The distal cervical internal carotid arteries measure 4.0 mm in\ndiameter on the left and 4.0 mm in diameter on the right.\n\nThere is mild pleural/ parenchymal scarring at the visualized lung apices. 2\nmm nodule in the left thyroid lobe is of unlikely clinical significance.\nProminent bilateral level 2 lymph nodes, as well as prominent adenoids,\npalatine tonsils, and lingual tonsils, are likely related to the patient's\nyoung age. The left palatine tonsil is larger than the right, without evidence\nfor surrounding inflammation, abscess, or mass lesion. There are secretions in\nthe left vallecula.\n\nThere is a small mucous retention cyst in the right maxillary sinus.\n\nThere is no evidence for cervical spine or other fracture. Alignment of the\ncervical and visualized upper thoracic spine is normal. There is no\nprevertebral edema.", + "output": "1. Normal neck CTA without evidence for arterial injury.\n2. Left palatine tonsil is slightly larger than the right without evidence for\nfocal abnormalities. Please correlate clinically.\n3. No fracture or subluxation in the cervical spine." + }, + { + "input": "A 1.7 x 2.4 x 3.4 cm rounded hypodense lesion with mild peripheral enhancement\nextends medially from the left peritonsillar region and is causing mild\nnarrowing of the aerodigestive tract. No obvious well demarcated wall is\nhowever noted on the present study.\nThere is obliteration of the adjacent fat planes including the parapharyngeal\nspace and prevertebral muscles. Punctate calcification is noted in the right\npalatine tonsil.\nA few mildly prominent nodes are noted in level 2, left more than right.\n\nThere is enlargement of the adenoids with fullness in the foci of ___\non both sides.\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. The neck vessels are patent.\nSmall anterior osteophyte noted at C7-T1 level anteriorly.\nMild straightening of the cervical spine.\nNo prevertebral swelling appreciated.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.\nThere is a slightly prominent vascular structure a venous tributary in the\nleft cerebellar hemisphere series 2, image 103, incompletely included.", + "output": "1. Enlarged adenoids and palatine tonsils along with fullness in the foci of\n___ and a mildly prominent neck nodes.\nLeft palatine tonsil larger than the right with focal hypodense appearance\nwithin, that can relate to focal edema/phlegmon/ evolving abscess causing mild\nnarrowing of the aerodigestive tract; obliteration of the adjacent fat planes\nas detailed above.\n\n2. A slightly prominent vascular structures in the left cerebellar hemisphere,\npartly included.\nCorrelation with dedicated imaging of the head on an nonemergent basis can be\nconsidered, with CT or MRI pre and postcontrast.\nOther details as above.\n\nRECOMMENDATION(S): Rec. ENT consult" + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no intra or extra-axial mass effect, acute hemorrhage or large\nterritory infarct. The sulci, ventricles and cisterns are within expected\nlimits for the patient's age. There are very mild periventricular and\nsubcortical T2/FLAIR white matter hyperintensities, which are nonspecific, but\ncompatible with chronic microangiopathy in a patient this age. Opacification\nof scattered ethmoid air cells as well as nasal polyps are noted. A moderate\nsize left maxillary sinus mucous retention cysts as well as superimposed mild\nmucosal thickening of the bilateral inferior maxillary sinuses are noted. \nThere is mild mucosal thickening of the inferior frontal sinuses with\nopacification of the frontal ethmoidal recesses. The orbits are unremarkable.\nThe mastoid air cells and middle ears are well pneumatized and clear. No\nacute osseous abnormality.\n\nCTA HEAD:\nThere is mild atherosclerotic calcification of the internal carotid arteries. \nOtherwise, the intracranial ICA, MCA, ACA and their major branches are\nunremarkable without evidence of high-grade stenosis, occlusion or aneurysm. \nThe right A1 segment is slightly hypoplastic relative to the left, a normal\nanatomic variant. The posterior circulation is also unremarkable. The dural\nvenous sinuses are patent.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nlarge territory infarct or intracranial hemorrhage. Mild periventricular and\nsubcortical white matter hypodensities are nonspecific, but compatible with\nchronic microangiopathy in a patient of this age.\n2. Essentially unremarkable CTA of the head without evidence of aneurysm.\n3. Paranasal sinus disease and nasal polyposis as described above." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mild mucosal thickening in the\nleft frontal sinus and aerosolized debris in the left sphenoid sinus. The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavitiesare otherwise clear. The visualized portion of the orbits are\nunremarkable.", + "output": "There is no evidence of acute intraparenchymal hemorrhage, no acute\nintracranial process." + }, + { + "input": "The exam is mildly limited due to patient motion. There is a right frontal\nsubgaleal hematoma (series 2a:image 10). There is no underlying fracture.\nThere is no evidence of acute infarction, hemorrhage, edema, or mass effect. \nThe ventricles and sulci are normal in size and configuration.\n\nA C1 fracture is better seen on the dedicated cervical spine CT. There is\nmucosal thickening of the bilateral ethmoid air cells and bilateral sphenoid\nand maxillary sinuses. The other visualized paranasal sinuses, middle ear\ncavities and mastoid air cells are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. Right frontal subgaleal hematoma without underlying fracture. No acute\nintracranial process.\n2. C1 vertebral fracture is better seen on the dedicated cervical spine CT." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. Mild\nperiventricular hypodensities are nonspecific but may reflect chronic small\nvessel ischemic changes.\n\nThere is no evidence of acute fracture, and deformity of the right zygomatic\narch is noted. A chronic left lateral C1 fracture is partially visualized. \nThere is opacification of the right posterior ethmoid air cells. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThere is no fracture. Other than hypoplastic frontal sinuses (normal\nvariant), the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The orbits are unremarkable.", + "output": "Normal head CT." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Normal study." + }, + { + "input": "The carotid and vertebral arteries and their major branches are patent with no\nevidence of dissection or aneurysm. There is no evidence of vascular at the\nsite of the left C4 transverse process fracture or elsewhere in the neck. The\nleft vertebral artery is developmentally smaller than the right. There is mild\natheromatous disease of the bilateral proximal internal carotid arteries with\nno significant stenosis by NASCET criteria.", + "output": "1. No evidence of vascular injury.\n2. C4 left transverse process fracture, better characterized on recent\ndedicated CT cervical spine." + }, + { + "input": "Again noted is a fracture through the left transverse foramen of C4 (series 4,\nimage 68). No other fractures of the cervical spine is identified.\n\nThere is a normal 3 vessel arch. Mild atherosclerotic calcifications of the\naortic arch as well as the left subclavian artery is noted. The common carotid\narteries are unremarkable. The origins of the bilateral vertebral arteries are\nunremarkable. The right vertebral artery is dominant. At the level of the\nhyaloid, there is apparent stenosis of the left vertebral artery prior to its\nentry to the transverse foramina, which may be artifactual secondary to beam\nhardening artifact from surrounding venous reflux versus atherosclerotic\ndisease. Flow reconstitutes immediately distal to this region of apparent\nstenosis. Otherwise, the remainder of the course and caliber of the vertebral\narteries are unremarkable to the skullbase without evidence of filling defect\nor contour abnormality to suggest dissection at the level of the left C4\ntransverse foraminal fracture. Mild atherosclerotic calcification and\natheromatous plaque formation of the left internal carotid artery is noted. \nHowever, there is no significant internal carotid artery stenosis of either\nside by NASCET criteria. The right distal extracranial ICA measures 4.8 mm and\nthe proximal ICA measures 7.9 mm. The distal left extracranial ICA measures\n5.2 mm and measures 5.8 mm proximally.\n\nAtherosclerotic calcifications of the carotid siphons is noted.\n\nThe visualized brain is unremarkable.\n\nThere is mild mucosal thickening, left greater than right of the maxillary\nsinuses. In addition, there is hyperostosis of the left maxillary sinus walls\nconsistent with history of chronic sinusitis. S-shaped curvature with\nrightward projecting spur of the nasal septum is also identified. The\nremainder the visualized paranasal sinuses are clear. The mastoid air cells\nand middle ear cavities on the right are clear. Trace fluid within the\ninferior was aspects of the mastoid air cells is noted.\n\nThe major salivary glands, visualized aerodigestive track, infratemporal fossa\nand pterygopalatine fossa are unremarkable.\n\nThere is a 3 mm the pulmonary nodule in the left upper lobe (series 2, image\n43). There is also a 3 mm subpleural pulmonary nodule in the right lung apex,\nwhich may be an scarring or atelectasis. Additional 3 mm nodule in the left\nmajor fissure is noted, almost certainly a fissural lymph node (series 2,\nimage 8). Mild biapical pleural-parenchymal scarring as well as emphysematous\nchanges are noted.", + "output": "1. Again identified is a left C4 transverse foraminal fracture. Although\nthere is apparent stenosis of the left V1 segment of the left vertebral artery\nat the level of the hyoid, this may be artifactual secondary to surrounding\nvenous reflux versus area of atherosclerotic disease. There is no evidence of\ndissection or filling defect at the level of the C4 fracture.\n2. Allowing for mild atherosclerotic disease, without significant stenosis of\nthe extracranial internal carotid arteries by NASCET criteria, the remainder\nof the CTA of the neck is unremarkable.\n3. 3 mm pulmonary nodule in the left upper lobe. If the patient has a history\nof smoking or other risk factors, a followup CT in 12 months is recommended\nper ___ society. If the patient has no known risk factors such smoking,\nno followup is recommended." + }, + { + "input": "Previously seen intracranial hemorrhages have increased in size. A right\nfrontal lobe hemorrhagic contusion measures 2.0 x 1.5 cm, previously 1.4 x 0.5\ncm (series 2, image 13). An adjacent subdural hematoma measures 2 mm from the\ninner table, unchanged. A left frontal subdural hematoma has increased in\nsize, previously minimal and now 7 mm from the inner table (series 2, image\n14). An inferior left frontal lobe hemorrhagic contusion measures 1.4 x 1.0\ncm, previously 1.1 x 0.7 cm (series 400, image 26). A left temporal lobe\nhemorrhagic contusion measures 2.3 x 1.1 cm, previously tiny. A\nsupratentorial subdural hematoma layering along the falx has increased and\nmeasures approximately 3 mm in thickness, previously 1 mm (series 400, image\n75). Scattered subarachnoid hemorrhages seen in the sulci of the frontal\nlobes and left temporal lobe. Trace intraventricular hemorrhage layers in the\noccipital horns of the lateral ventricles.\n\nThere is an acute longitudinal left temporal bone fracture extending through\nthe mastoid with associated patchy mastoid air cell and middle ear\nopacification and small locules of pneumocephalus (series 3, image 22; series\n400, image 68). Suboptimal evaluation of the ossicles. The carotid canal\nappears intact.\n\nNo evidence of large territorial infarction. The ventricles and sulci are\nprominent, suggestive of chronic involutional changes. A left lamina\npapyracea fracture is unchanged since ___. Comminuted nasal bone\nfractures are unchanged since ___. A punctate cutaneous calcification\noverlying the midline frontal bone is unchanged since ___ (series 2,\nimage 9). Mild maxillary sinus mucosal thickening. The remaining paranasal\nsinuses are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Scattered intracranial hemorrhages have increased in size, including\nbifrontal and left temporal hemorrhagic contusions, bifrontal and left\ntentorium subdural hematomas, and scattered subarachnoid hemorrhage, as\ndescribed in the findings.\n2. Longitudinal left temporal bone fracture extending through the mastoid with\na small amount of pneumocephalus. Suboptimal evaluation of the ossicles. The\ncarotid canal appears grossly intact. Recommend temporal bone CT for further\nevaluation.\n\nRECOMMENDATION(S): Longitudinal left temporal bone fracture extending through\nthe tegmen mastoid with a small amount of pneumocephalus. Suboptimal\nevaluation of the ossicles. The carotid canal appears grossly intact.\nRecommend temporal bone CT for further evaluation.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 7:09 am, less than 5\nminutes after discovery of the findings." + }, + { + "input": "There has been a further increase in the volume of hemorrhage associated with\nthe right frontal contusion. There is also an increase in the surrounding\nedema. There is an increase in the volume of left inferior frontal hemorrhage\nand of extra-axial left frontal hemorrhage. Again seen is a subdural hematoma\nalong the left tentorium. This has increased somewhat in thickness since the\nprior study.\nAgain seen is a left anterior temporal hemorrhagic contusion. There is no\nevidence of increased hemorrhage, although there may be a mild increase in the\nvolume of edema.\nThe small amount of hemorrhage in the occipital horns of the lateral\nventricles has evolved in density with no evidence of new hemorrhage.", + "output": "1. There is been somewhat increase in the volume of intraparenchymal and\nextra-axial hemorrhage since the study of ___.." + }, + { + "input": "Right anterior frontal parenchymal hemorrhagic contusion is stable in size. \nSurrounding edema is stable in extent with increased hypodensity, representing\nexpected interim evolution. Small adjacent right anterior frontal subdural\nand subarachnoid hemorrhage is stable.\n\nSmall amount of left anterior frontal subdural and subarachnoid hemorrhage is\nstable.\n\nLeft temporal hemorrhagic contusion with surrounding edema, as well as\nadjacent subdural and subarachnoid hemorrhage, are stable.\n\nThere is no significant shift of midline structures. Mild rightward deviation\nof the septum pellucidum is unchanged compared to remote head CT from ___. No new hemorrhage or parenchymal edema is seen. Periventricular\nand subcortical white matter hypodensities are again seen, nonspecific but\nlikely sequela of chronic small vessel ischemic disease in this age group. \nMild global parenchymal volume loss with prominent ventricles and sulci is\nagain noted.\n\nChronic nasal bone fractures are again partially visualized, previously\npresent in ___. Chronic left lamina papyracea fracture is again seen with\nunchanged herniation of the orbital fat into the ethmoid and unchanged\ndeformity of the left medial rectus. No acute fracture is seen. There is\nmild mucosal thickening and wall sclerosis in the partially visualized left\nmaxillary sinus, similar to ___. There is partial, left greater than right\nmastoid air cell opacification.", + "output": "1. Stable right frontal and left temporal hemorrhagic contusions with stable\nsmall adjacent subarachnoid and subdural hemorrhage. Stable small left\nfrontal subdural and subarachnoid hemorrhage. No new hemorrhage.\n2. Chronic nasal bone fractures and left lamina papyracea fracture are again\nnoted.\n3. Chronic left maxillary sinus inflammation is again noted." + }, + { + "input": "Right anterior frontal parenchymal hemorrhagic contusion and left temporal\nhemorrhagic contusion, with surrounding edema, are unchanged. Small right\nfrontal subdural and subarachnoid hemorrhage as well as left temporal subdural\nand subarachnoid hemorrhage is grossly unchanged. A small amount of left\nfrontal subdural and subarachnoid hemorrhage is also unchanged. No new\nhemorrhage is definitively identified, however, evaluation of the posterior\nfossa is limited due to streak artifact. No definite midline shift is\nidentified. The basilar cisterns are patent. Periventricular and subcortical\nwhite matter hypodensities are likely the sequela of small-vessel ischemic\ndisease. There is evidence of cortical volume loss.\n\nChronic facial fractures are unchanged. Mild paranasal sinus mucosal\nthickening is also unchanged. There is bilateral mastoid air cell\nopacification, greater on the left than on the right.", + "output": "1. Overall, stable study from 2 days prior." + }, + { + "input": "NON-ENHANCED HEAD CT:\n\nThere is no evidence of hemorrhage, edema, mass effect, or large territorial\ninfarction. The ventricles and sulci are normal in size and configuration. The\nbasal cisterns appear patent and there is preservation of gray-white matter\ndifferentiation.\n\nThe bones are unremarkable. There is significant mucosal thickening of the\nright maxillary sinus extending into the right anterior ethmoid air cells,\nhowever the remaining paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear.\n\nHEAD CTA:\nProjecting anteriorly off the anterior communicating artery at the junction of\nthe left internal carotid, there is a 2.6 x3.5 mm saccular aneurysm with 2.4\nmm neck. Compared to ___, this has not significantly changed.\nThe internal carotid, middle cerebral, and anterior cerebral arteries are\npatent with no evidence of steno-occlusive disease. Bilateral intracranial\nvertebral, basilar, and posterior cerebral arteries enhance normally with no\nocclusion or aneurysm formation.", + "output": "1. No significant intracranial abnormality on the nonenhanced head CT.\nSignificant mucosal thickening of the right maxillary sinus extending into the\nright anterior ethmoid air cells\n2. A 2.6x3.5 mm anteriorly projecting anterior communicating artery aneurysm\nat the junction of the left internal carotid is not significantly changed\nsince ___, however has developed a more saccular appearance from its\ninitial presentation on CTA in ___.\nINR/NS consult to decide on further management" + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThere is mild mucosal thickening of the maxillary sinuses (right greater than\nleft), right sphenoid sinus and ethmoid air cells. The mastoid air cells and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.\n\nCTA HEAD:\nNo significant change in the 2 mm anterior communicating artery aneurysm\ndirected anteriorly and superiorly. The vessels of the circle of ___ and\ntheir principal intracranial branches appear otherwise normal without\nstenosis, occlusion, or additional aneurysm formation. The dural venous\nsinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThere is a 3 mm right upper lobe pulmonary nodule (03:33). The visualized\nportion of the thyroid gland is within normal limits. There is no\nlymphadenopathy by CT size criteria.", + "output": "1. No acute intracranial abnormality.\n2. Unchanged 2 mm anterior communicating artery aneurysm.\n3. No evidence of dissection or occlusion. No significant ICA stenosis by\nNASCET criteria.\n4. Mild paranasal sinus disease.\n5. A 3 mm right upper lobe pulmonary nodule. Per the ___ ___ criteria\nno further imaging is recommended in low risk patients. High-risk patients may\nreceive an optional CT chest in 12 months." + }, + { + "input": "Limited examination due to patient motion. Within this limitation, there is\nno evidence of infarction, hemorrhage, edema, or mass. The ventricles and\nsulci are normal in size and configuration.\n\nNo fractures are identified. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "There is no evidence of acute intracranial process, specifically there is no\nevidence of intracranial hemorrhage, no fractures are identified." + }, + { + "input": "Dental amalgam and sternotomy sutures streak artifact and poor bolus tracking\nlimits study.\n\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. Both external auditory canals contain cerumen, left\ngreater than right. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nare patent without stenosis, occlusion, or aneurysm formation. There are mild\natherosclerotic calcifications of the bilateral cavernous and supra clinoid\ninternal carotid arteries. The left A1 segment is not visualized and may be\nhypoplastic or absent. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is poor opacification of the arteries due to the phase of contrast,\nlimiting evaluation. Dense contrast within the right internal jugular vein\nlimits evaluation of the right common and proximal cervical internal carotid\narteries. There is an aberrant right subclavian artery. The carotid and\nvertebral arteries and their major branches are patent with no evidence of\nstenosis or occlusion. There is no evidence of internal carotid stenosis by\nNASCET criteria. There is no evidence of dissection.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. Median sternotomy wires are noted. Multilevel degenerative changes\nof the cervical spine are grossly similar to the prior examination. Soft\ntissue densities are noted within bilateral external auditory canals which may\nrepresent cerumen.", + "output": "1. Dental amalgam and sternotomy sutures streak artifact and poor bolus\ntracking limits study.\n2. Within limits of study, no definite evidence of dissection.\n3. Grossly patent circle of ___\n4. Limited evaluation of the vasculature in the neck due to the phase of\ncontrast and dense contrast within the right internal jugular vein. Within\nthese confines, the vasculature in the neck is patent with no evidence of\ninternal carotid artery stenosis by NASCET criteria.\n5. No acute intracranial abnormality.\n6. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect .\nCerebral volume loss with prominence of the bifrontal extra-axial spaces, left\ngreater than right. These could represent tiny chronic subdural\nhematomas/hygromas versus bifrontal atrophy.\n\nNo acute fracture is seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear.", + "output": "1. No acute intracranial abnormality\n2. Cerebral volume loss with prominence of the bifrontal extra-axial spaces,\nleft greater than right. These could represent tiny chronic subdural\nhematomas/hygromas versus bifrontal atrophy." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass effect, midline shift,\nor acute major vascular territorial infarct. Scattered predominant\nsubcortical white matter hypodensities may be sequela of chronic small vessel\ndisease. Gray-white matter differentiation is preserved. Ventricles and sulci\nand unremarkable. Basilar cisterns are patent.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process. MRI would be more sensitive for detection of\nintracranial metastases." + }, + { + "input": "Head CT: There is no evidence of hemorrhage, edema, masses, mass effect, or\ninfarction. There is a focus of calcification within the left MCA cistern\nthat is new compared to prior CT from ___. The ventricles and\nsulci are normal in caliber and configuration. No fractures are identified.\n\nHead and neck CTA: There is bovine aortic arch anatomy, a normal variant. The\ncervical carotid and cervical vertebral arteries and their major branches are\npatent with no evidence of stenoses. There is mild calcification of the right\ncarotid bifurcation.\n\nThe intracranial vertebral arteries, vertebrobasilar junction, and basilar\nartery are normal. The superior cerebellar arteries are normal. The right PCA\nand right posterior communicating artery are normal. There is a fetal origin\nleft PCA, a normal variant.\n\nThere is calcification within the left distal M1 branch and proximal M2\nbranches. There is relatively diminished blood flow within the left M2\nbranches compared to the right side. The right MCA is normal. The bilateral\nACAs and anterior communicating artery are normal.\n\nCT head perfusion: There is subtle increased mean transit time and subtle\ndecreased cerebral blood flow in the left cerebral hemisphere in the\ndistribution of the left MCA. Cerebral blood volume is preserved.", + "output": "Calcific thrombus in the left distal M1 and proximal M2, new from prior CT on\n___. This appears to be hemodynamically significant with\ndiminished blood flow in left M2 branches on CTA and evidence of oligemia in\nthe corresponding left MCA territory on CTP.\n\nNOTIFICATION: The discrepancy between the WET READ and final read was\ndiscussed with Dr. ___ at the time of interpretation, approximately\n11:30 ___." + }, + { + "input": "Head CT: There is no evidence of intracranial hemorrhage. The ventricles and\nbasal cisterns appear normal. There is no evidence of infarction. There is a 5\nmm calcification corresponding to the region of the left MCA bifurcation.\nAdditionally, there are other punctate calcifications throughout the cortical\nsulci which may represent atheromatous disease although prior\nneurocysticercosis would be a diagnostic consideration. The orbits, skull\nbase, and paranasal sinuses are unremarkable.\n\nHead CTA: There is a 5 mm calcification at the junction of the left M1 and M2\nbranches which conforms to the branching pattern of the vessels and is felt to\nmost likely represent atheromatous vessel wall calcification rather than\ncalcified embolus. The left M1 and M2 branches appear asymmetrically small and\nstenosis at the level of this calcification cannot be excluded. The anterior\ncerebral arteries, posterior cerebral arteries, and right middle cerebral\nartery appear patent. There is no evidence of aneurysm or focal vessel cut off\nwithin the intracranial vasculature.", + "output": "1. Calcification at the junction of the left M1 and M2 branches which conforms\nto the branching pattern of the vessels and is felt to most likely represent\natheromatous vessel wall calcification rather than calcified embolus.\n2. Attenuated left M1 and M2 branches, stenosis at the level of calcification\nis not excluded.\n3. No evidence of infarct.\n4. Additional punctate calcifications throughout the bilateral cortical sulci\nwhich may represent additional atheromatous calcification although an\nadditional diagnostic consideration would be prior neurocysticercosis." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction, mass or midline\nshift. There is no hydrocephalus. The ventricles and sulci are normal in size\nand configuration. Calcification in the left middle cerebral artery in cistern\nis unchanged from the prior study as are other scattered punctate\ncalcifications in both cerebral hemispheres. The basal cisterns are patent and\nthere is preservation of gray-white matter differentiation. Visualized\nparanasal sinuses and mastoid air cells are clear. There is a right parietal\nscalp hematoma without underlying fracture. The orbits are unremarkable", + "output": "1. No acute intracranial abnormality. Right parietal scalp hematoma.\n2. Unchanged calcification in the left middle cerebral artery cistern\ncorresponding to calcific thrombus in the left middle cerebral artery on prior\nCTA." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nmass effect, midline shift, or large mass. The ventricles and sulci are normal\nin size and configuration. Focal calcification in the left middle cerebral\nartery cistern is unchanged in appearance and was noted to correspond to\ncalcified thrombus in the left middle cerebral artery on a prior CTA. There\nare additional scattered punctate intraparenchymal calcifications which appear\nstable and may reflect prior infection. No bony abnormalities seen. The\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\norbits are unremarkable. Skin staples over the right posterior scalp are\nnoted.", + "output": "No acute intracranial process." + }, + { + "input": "NONCONTRAST HEAD CT:\n\nThe 5 mm branching calcification in the distal M1/proximal M2 segment of the\nleft MCA, and scattered punctate superficial frontal and parietal\ncalcifications, are all stable compared to the recent ___ exams but new\ncompared to ___, compatible with sequela of endocarditis complications, given\nthe history of endocarditis in ___. There is no evidence of hemorrhage,\nedema, infarction, mass or midline shift. There is no hydrocephalus.\n\nTiny mucus retention cyst in the right maxillary sinus and mild mucosal\nthickening in the left maxillary sinus are noted. The mastoid air cells are\nclear.\n\nHEAD CTA:\n\nThe M1 segment of the left middle cerebral artery proximal to the above\ndescribed 5 mm calcification in the distal M1/proximal M2 segments, and the\nleft MCA branches distal to the calcification, are smaller compared to the\nright middle cerebral artery, without change compared to ___ or ___. The remaining intracranial arteries demonstrate no\nhemodynamically significant stenosis or occlusion. There is no evidence for\nan aneurysm. There is a fetal posterior cerebral artery on the left. The\nright posterior cerebral artery receives approximately equal contributions\nfrom the right posterior communicating artery and and basilar artery. \nBilateral low-lying PICAs are again incidentally noted.", + "output": "1. 5 mm branching calcification in the distal M1/proximal M2 segment of the\nleft MCA, and scattered punctate superficial frontal and parietal\ncalcifications, are unchanged compared to the recent ___ exams, but new\ncompared to ___, compatible with sequela of endocarditis complications, given\nthe history of endocarditis in ___.\n2. Proximal and distal to the 5 mm calcification, the left middle cerebral\nartery is smaller than the right, unchanged compared to ___ and ___.\n3. No evidence of new parenchymal or vascular abnormalities." + }, + { + "input": "The study is limited by motion particularly in the posterior fossa. Within\nthis limitation:\n\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.Basal cisterns\nare patent, and there is preservation of gray-white matter differentiation.\n\nSmall mucous retention cyst within the left maxillary sinus. Otherwise, the\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.\n\nPatient is status post median sternotomy with mild asymmetry of the sternum.\n\nCTA HEAD:\nThere is a 4 mm calcification near left MCA bifurcation near the distal M1 and\nproximal M2 segment, similar to prior study in ___ (602b:32, 3:251)\nand can be compatible with calcified embolus versus in situ calcification\ngiven history of endocarditis. In addition, there are multiple scattered\ncalcifications in bilateral cerebral hemispheres, unchanged since ___. There\nmay be mild narrowing of the distal left MCA branches distal to the\ncalcification. The remaining vessels of the circle of ___ and their\nprincipal intracranial branches appear normal without stenosis, occlusion, or\naneurysm formation. There is a left fetal posterior cerebral artery noted\npreviously. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is a dominant right vertebral artery with hypoplastic left vertebral\nartery. The carotid and vertebral arteries are patent throughout their\ncervical and intracranial portions, without evidence of dissection, occlusion,\nstenosis or aneurysm formation. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. Endotracheal tube is visualized terminating above the carina with\nmild secretions seen around it.", + "output": "1. No evidence of acute infarction or hemorrhage.\n2. 4 mm calcification in the left MCA distal M1 and proximal M2 segments,\nunchanged since ___. ___ represent calcified embolus rather than in situ\ncalcification given history of endocarditis.\n3. Unchanged multiple scattered calcifications in bilateral cerebral\nhemispheres.\n4. No evidence of new vascular abnormalities.\n5. Mild asymmetry of the sternum status post median sternotomy\n6. Mild tracheal secretions surrounding the ET tube." + }, + { + "input": "There is no evidence of acute infarction,intracranial hemorrhage,edema,or\ndiscrete mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular white matter hypodensities are\nnonspecific but may reflect sequela of small vessel disease.\n\nThere is no evidence of fracture. The imaged portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No evidence of acute infarction or intracranial hemorrhage." + }, + { + "input": "Extensive streak artifact from dental amalgam limits evaluation, particularly\nof the gingiva. No definite focal mass is seen within limitations.\n\nBilateral torus mandibularis, similar to ___.\n\nMild leftward deviation of the nasal septum with associated bony spur, which\ncontacts the left middle and inferior turbinates. There is mild mucosal\nthickening the ethmoid sinuses. Minimal mucosal thickening of the maxillary\nand sphenoid sinuses. Small mucous retention cyst in the inferior left\nmaxillary sinus. No air-fluid levels are identified. There is no evidence of\nosseous thickening or erosion.\n\nThe mastoid air cells and middle ear cavities are grossly clear. Mild soft\ntissue attenuation in the bilateral external auditory canals likely relates to\ncerumen.\n\nThe globes are intact. The intraconal and extraconal fat planes are\npreserved.\n\n Although the examination is not optimized for evaluation of the brain\nparenchyma, no abnormalities are evident.", + "output": "1. Extensive streak artifact from dental amalgam limits evaluation,\nparticularly of the gingiva. Although no definite focal mass is seen, however\nconsider further evaluation with contrast-enhanced MRI particularly given\npositive physical exam findings.\n2. Bilateral torus mandibularis, similar to ___.\n3. Paranasal sinus disease as described above." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nmaxillary sinuses. The mastoid air cells, and middle ear cavities are clear. \nThe visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute major vascular territory\ninfarction,hemorrhage,edema, or mass effect. The ventricles and sulci are\nwithin expected limits in size and configuration.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nright inferior maxillary sinus. The remainder the paranasal sinuses are\nessentially clear. The mastoid air cells middle ears arm ties and clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormalities on noncontrast CT head. Specifically,\nno acute large territory infarct or intracranial hemorrhage.\n2. No acute displaced calvarial fracture." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Basilar cisterns are\npatent.\n\nMucosal thickening seen the maxillary sinuses, worse on the right. There is\nethmoid air cell and sphenoid sinus mucosal thickening. Mastoid air cells are\nclear. Skull and extracranial soft tissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute major infarction,hemorrhage,edema,or discrete\nmass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is minimal mucosal thickening of the\nbilateral ethmoid sinus. The visualized portion of the other paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "Head CT: There is no evidence of hemorrhage, edema, infarction, mass or\nmidline shift. There is no hydrocephalus. Visualized paranasal sinuses and\nmastoid air cells are clear. There is no evidence of fracture.\n\nHead CTA: Tip is dilatation of the left pericallosal artery with a dramatic\nenlargement of the and apparent vein along the surface of the corpus callosum.\nThis most likely reflects a pial or dural arteriovenous fistula. There is no\nevidence of aneurysm or stenosis.", + "output": "Findings suggest a pial or dural arterivenous fistula fed by the left\npericallosal artery." + }, + { + "input": "HEAD CT: There is no hemorrhage, infarction, edema, mass or mass effect. The\nventricles and sulci are normal in caliber and configuration. There is no\nshift of normally midline structures, and the basal cisterns are patent. There\nis minimal sphenoid sinus mucosal thickening, otherwise the paranasal sinuses\nand mastoid air cells are clear. The patient is status post bilateral lens\nremoval, otherwise the globes and bony orbits are unremarkable.\n\nCTA HEAD: Appearing to arise from the A2 segment of the ACA are multiple\ndraining veins via a fistulous connection. (Note, it is unclear from the CTA\nimages whether the fistulous connection and draining veins arise from the\nright or left ACA branches; however, correlation with recent cerebral\nangiogram suggests that the fistula arises from a branch of the right anterior\ncerebral artery.) Specifically, a dilated pericallosal artery demonstrates\nearly draining via a dilated and tortuous vein coursing along the surface of\nthe corpus callosum and ultimately draining via the inferior sagittal sinus. \nAdditionally, there is also a second draining vein which courses anteriorly\nand inferiorly and which appears to terminate at the cribriform plate. \nOverall, this appearance is unchanged from prior CTA from ___,\nsuggestive of a pial or dural arterial venous fistula.\n\nThe remainder of the intracranial vasculature is patent without evidence of\nstenosis, occlusion, or aneurysm greater than 3 mm.", + "output": "Unchanged CTA head findings suggestive of a dural arteriovenous fistula fed by\na pericallosal artery, possibly arising from the right anterior cerebral\nartery. Study performed with fiducials for operative planning." + }, + { + "input": "The patient is status post a bifrontal craniotomy. There is subcutaneous air\nin the surrounding soft tissues and a small amount of pneumocephalus from the\nrecent surgery. Additionally, in the left frontal lobe, there is\npostoperative hematoma and probably a small amount of subarachnoid hemorrhage.\nThis may be within the surgical cavity, and clinical correlation is required. \nThere is also a thin right anterior cerebral convexity subdural hematoma. \nThere is associated edema with effacement of the adjacent sulci as well as the\nlateral ventricles, bilaterally. There is a small amount of intraventricular\nhemorrhage, greater on the left than the right. There is no focal hypodensity\nto suggest a large vascular territory infarction.\n\nThe visualized paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The orbits are unremarkable. Soft tissue edema is noted around\nthe craniotomy site.", + "output": "Status post frontal craniotomy and dural AV fistula resection with small to\nmoderate amount of intraparenchymal hemorrhage in the left frontal lobe, small\namount of intraventricular hemorrhage, and a small amount of subarachnoid and\nsubdural hemorrhage, as described above.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\n___, neurosurgery NP, on the telephone on ___ at 9:22 ___, 5\nminutes after discovery of the findings." + }, + { + "input": "Compared to head CT from 4 hours prior, there has been no significant interval\nprogression in a left frontal postoperative intraparenchymal hemorrhage\nmeasuring approximately 2.5 x 3.9 cm in greatest dimension. Mild surrounding\nedema, also unchanged. Overall ventricular size and configuration unchanged. \nSmall amount of intraventricular hemorrhage within the occipital horn of the\nleft lateral ventricle stable. Small subdural hematoma layering along the\nfalx and the right frontal vertex unchanged, measuring up to 8 mm. \nPostoperative pneumocephalus is present, as expected. Postsurgical changes\nfrom bifrontal craniotomy are present. No new areas of hemorrhage identified.\nNo significant shift of midline structures. The basal cisterns are patent.\n\nNo osseous abnormalities seen. There is fluid within the sphenoid sinuses. \nThe remainder of the paranasal sinuses are clear. The orbits are\nunremarkable.", + "output": "Compared to head CT from 4 hours prior there is no significant change in left\nfrontal intraparenchymal hemorrhage, intraventricular hemorrhage, and subdural\nhematoma layering along the right frontal cerebral convexity after bifrontal\ncraniotomy. No new hemorrhage identified." + }, + { + "input": "Compared to head CT from one day prior, there is new intraparenchymal\nhemorrhage with surrounding edema involving the right frontal lobe. Left\nfrontal intraparenchymal hemorrhage and right frontal subdural hematoma, not\nsignificantly changed in size. Additionally, intraventricular blood within\nthe occipital horn of the left lateral ventricle also stable. Postoperative\npneumocephalus has minimally decreased. Ventricles and sulci are unchanged in\nsize and configuration. Postsurgical changes from bifrontal craniotomy are\nagain noted.\n\nNo osseous abnormalities seen. Fluid is present within the left sphenoid\nsinus. Paranasal sinuses are otherwise clear.", + "output": "1. New right frontal intraparenchymal hemorrhage and edema.\n2. Stable left frontal intraparenchymal hemorrhage, right subdural hematoma,\nand intraventricular hemorrhage.\n\nNOTIFICATION: Findings were discussed over the telephone with Chip ___\nby Dr. ___ on ___ at 00:30, 0 minutes after discovery." + }, + { + "input": "Since head CT from one day prior, there is no significant interval change to\nthe bifrontal intraparenchymal hemorrhages and edema. Intraventricular\nhemorrhage within the occipital horn of the left lateral ventricle and 5 mm\nright subdural hematoma, also stable. Ventricular size and configuration is\nunchanged. No new areas of hemorrhage. There is no significant shift of\nmidline structures. Postsurgical changes from bifrontal craniotomy, again\nseen.\n\nThere is no acute osseous abnormality. There is mucosal thickening within the\nsphenoid sinuses and ethmoid air cells. The paranasal sinuses are otherwise\nclear.", + "output": "1. Stable bifrontal parenchymal hemorrhages with adjacent edema.\n2. Stable intraventricular hemorrhage and right subdural hematoma.\n3. No new hemorrhage identified." + }, + { + "input": "Please note the study is mildly degraded by motion. There is stable left\ngreater than right bifrontal hemorrhage with adjacent edema, intraventricular\nhemorrhage, and 5 mm right hemispheric subdural hemorrhage.\nThere is new fluid in bilateral sphenoid sinuses, and there been interval\nplacement of a left-sided nasogastric tube. There is stable postsurgical\nchanges related to bifrontal craniotomy and resection of dural AVM.\nVentricular size and configuration is unchanged. No new areas of hemorrhage. \nThere is no significant shift of midline structures.", + "output": "1. Please note the study is mildly degraded by motion.\n2. Stable bifrontal intraparenchymal hemorrhages and adjacent edema.\n3. Stable right cerebral subdural and intraventricular hemorrhage.\n4. No new hemorrhage is identified.\n5. New paranasal sinus fluid as described, may be related to interval\nplacement of nasogastric tube." + }, + { + "input": "Again seen is bifrontal intraparenchymal hemorrhage with surrounding edema,\nsimilar on the left but increased on the right with adjacent subdural\nhemorrhage. There is resultant mass effect, with new effacement of the basal\ncisterns. Effacement of the frontal horns of the bilateral lateral ventricles\nis unchanged. Blood layering within the occipital horn of the left lateral\nventricle is similar to slightly decreased. There is no shift of normally\nmidline structures. There is no evidence of acute large territorial infarct.\n\nThe patient is status post bifrontal craniotomy and resection of a dural AVF,\nwith the expected postsurgical changes. Mucosal thickening of the left\nsphenoid sinus is unchanged, but now with aerosolized secretions. The other\nvisualized paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The orbits are unremarkable.", + "output": "1. Redemonstration of bifrontal intraparenchymal hemorrhage, now with\nincreased hemorrhage in the right frontal lobe and new right frontal convexity\nsubdural blood.\n2. Increased mass effect, with new effacement of the basal cisterns.\n3. Unchanged effacement of the frontal horns of the bilateral lateral\nventricles and decreased blood layering within the occipital horn of the left\nlateral ventricle.\n\nNOTIFICATION: At the time of discovery, the neurosurgery team was aware of\nthe findings and taking the patient to the OR." + }, + { + "input": "Since head CT from 12 hours prior there has been no significant interval\nchange. Postsurgical changes from bifrontal hemicraniectomy again noted. \nBifrontal intraparenchymal hemorrhage with surrounding edema, not largely\nchanged. Also unchanged is small amount of intraventricular blood layering\nwithin the occipital horn of the left lateral ventricle and right frontal\nsubdural hematoma measuring up to 8 mm. Effacement of the frontal horns of\nthe bilateral lateral ventricles is unchanged. There is no evidence of acute\nlarge territorial infarction. No new areas of hemorrhage are seen.\n\nNo osseous abnormalities seen. Aersolized secretions within the sphenoid\nsinus again seen. The remainder of the paranasal sinuses are clear. The\norbits are unremarkable.", + "output": "No significant change in the appearance of the head compared to 12 hours prior\nwith bifrontal intraparenchymal hemorrhage, right subdural hematoma, and\nintraventricular hemorrhage. No new hemorrhage identified.\nSince the examination obtained earlier on the same day, the front bone flap\nhas been removed. The examination is otherwise unchanged.\n," + }, + { + "input": "Please note the study is moderately degraded by motion. Compared to the prior\nexam from ___, there has been interval extension of the craniectomy\ninvolving the frontal bone. There is stable to slight interval improvement of\nbifrontal intraparenchymal hemorrhage with appropriate interval evolution,\nmeasuring 2.4 cm x 2.1 cm in the right frontal lobe (2;23) (previously\nmeasuring up to 2.7-cm) and in the left frontal lobe, measuring up to 3.4 cm\n(2;24) (previously measuring up to 4.4-cm). Although there appears to be\nslight interval increase in the extent of the surrounding edema, given the\ndifferences in acquisition technique, there has been no significant interval\nchange in the extent of effacement of the frontal horns of the bilateral\nlateral ventricles. A small amount of intraventricular hemorrhage is seen in\nthe occipital horn of the left lateral ventricle. There has been interval\nimprovement of the right subdural hematoma, now measuring up to 5 mm\n(previously measuring 8-mm). No definite new areas of hemorrhage are seen.\n\nThe visualized paranasal sinuses demonstrates minimal mucosal sinus\nthickening. The orbits are unremarkable.", + "output": "1. Study is moderately degraded by motion.\n2. Stable to slightly improved of bifrontal intraparenchymal hemorrhage, right\nsubdural hematoma, and intraventricular hemorrhage.\n3. Within limits of study, no definite new hemorrhage is identified.\n4. Slight interval increase of bifrontal edema." + }, + { + "input": "There are post-surgical changes status post bifrontal craniectomy. \nIntraparenchymal hemorrhage is noted within the bilateral frontal lobes with\nsurrounding edema, overall similar in appearance compared to the recent CT on\n___. There is persistent mass effect on the frontal horns of the lateral\nventricles bilaterally, although this appears to have improved. The right\nfrontal subdural hematoma is smaller in size (3:17), measuring 3 mm on today's\nstudy (previously measuring up to 5 mm). Again noted is a small\nintraventricular hemorrhage in the occipital horn of the left lateral\nventricle, unchanged. No new hemorrhage. No shift of midline structures.\nNo osseous abnormalities seen. There is mild mucosal thickening within the\nright anterior ethmoid air cells. Aerosolized secretions are again noted\nwithin the left sphenoid sinus. Mastoid air cells are clear. The orbits are\nunremarkable.", + "output": "1. Stable bi-frontal intraparenchymal hemorrhage and surrounding edema, with\nslight interval decrease in mass effect on the frontal horns of the lateral\nventricles.\n2. Interval decrease in right frontal subdural hematoma, and stable appearance\nof left intraventricular hemorrhage.\n3. No new intracranial hemorrhage or major vascular territory infarction." + }, + { + "input": "There is evolution of the bifrontal hematomas and right lenticulostriate\ndistribution lacune or infarction since the prior examination. This is\nassociated with a decrease in the mass effect underlying the large craniectomy\ndefect. Hypodensity in the right pons was not definitely seen on ___, but\nnow appears chronic. This may have been a lacune that was to acute to be\ndetectable at that time. It does not appear to represent wallerian\ndegeneration. There is no evidence of new infarction or hemorrhage. With the\nresolution of mass effect, the ventricles have enlarged and appear\nconsiderably larger than on the study of ___. This may reflect a\ncomponent of hydrocephalus, perhaps related to prior intraventricular\nhemorrhage.", + "output": "Evolution of bifrontal hematoma is since ___ with a reduction in the\ndegree of swelling.\nStatus post bifrontal craniectomy.\nEvolving right lenticulostriate distribution and right pontine hypodensities\nthat are likely infarctions." + }, + { + "input": "Status post bifrontal cranioplasty, there are 2 new foci of hemorrhage with\nlayering blood products at the right frontal lobe. Bifrontal volume loss is\nunchanged since ___. There is minimal mass-effect with mild stable\neffacement of the right frontal horn. There is pneumocephalus layering non\ndependently. There is no evidence of new infarction. The patient is status\npost bilateral lens replacement. The paranasal sinuses are well aerated.", + "output": "1. Interval development of 2 new foci of right frontal hemorrhage, since ___.\n2. Status post cranioplasty, there is stable minimal mass effect.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with PA ___ the\ntelephone on ___ at 11:58 AM, 5 minutes after discovery of the findings." + }, + { + "input": "Frontal postoperative changes are identified. Encephalomalacia is seen in\nboth frontal lobes. Considerably evolved from the previous study. No acute\nhemorrhage is seen. Ex vacuo dilatation of the frontal horns identified\nbilaterally. There is no midline shift.", + "output": "Bilateral frontal encephalomalacia. No acute abnormalities." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction or midline shift.\nThere is no hydrocephalus. There is no edema. Age appropriate involutional\nchanges are noted.\n\nVery minimal mucosal thickening is noted within the maxillary sinuses however\nthe mastoids, sphenoid and ethmoid air cells are all clear.\n\nThere is no fracture identified. A small amount of soft tissue swelling and a\nlaceration with subcutaneous gas is noted over the right orbit. The globes\nare intact.", + "output": "No acute intracranial process or fracture. Right periorbital soft tissue\nswelling and laceration." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of a discrete acute large territorial infarction. There\nis a chronic infarct involving right caudate head, internal capsule, putamen,\nwith associated atrophy and prominence of adjacent right frontal horn as seen\non head CT earlier today. There is mild generalized parenchymal atrophy. \nThere is no mass effect or midline shift. The paranasal sinuses and bilateral\nmastoid air cells appear clear.\n\nCTA HEAD:\nThere is a hypoplastic A1 segment of the right anterior cerebral artery, which\nis likely a congenital variant. The right A2 segment of the anterior cerebral\nartery arises from a common origin with the left anterior cerebral artery. \nRight PCOM is patent. Left PCOM is not identified. Otherwise, the circle of\n___ and the principal intracranial vasculature appear patent. The left\nposterior communicating artery is not well visualized. The basilar artery,\nbilateral vertebral arteries, superior cerebellar and posterior cerebral\narteries appear patent. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is mild narrowing of the left subclavian artery at the level of the\nfirst rib. The bilateral common carotid, internal carotid and vertebral\narteries are patent. There is no evidence of stenosis per NASCET criteria.\n\nOTHER:\nThere is mild paraseptal emphysema. Streak artifact related to dental amalgam\nlimits evaluation of the adjacent structures. There is 1.1 cm left posterior\ntriangle lymph nodes series 5, image 96, 80 stable compared with CT cervical\nspine ___, it has enlarged compared with 0.8 cm on ___\ncervical spine MRI. There are no other enlarged lymph nodes The thyroid gland\nappears unremarkable.", + "output": "1. No evidence of discrete acute large territorial infarction or hemorrhage.\n2. There is chronic infarct centered on right basal ganglia.\n3. No evidence of stenosis, occlusion, dissection, or aneurysm formation.\n4. There is indeterminate enlarged left posterior triangle lymph node\nmeasuring 1.1 cm, stable since ___, it has enlarged from 0.8 cm on ___. Consider inflammatory, lymphoproliferative disorder." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Mild\ngeneralized parenchymal atrophy is likely age related. Mild prominence of the\nventricular system and extra-axial CSF spaces is most likely due to the\npreviously mentioned parenchymal atrophy. There are periventricular and\nsubcortical lucencies, which may represent small vessel ischemic changes. \nAtherosclerotic vascular calcifications are noted of bilateral cavernous\nportions of internal carotid arteries.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Soft tissue\ndensities in the external auditory canals bilaterally likely represents\ncerumen. The visualized portion of the orbits are preserved.", + "output": "1. No acute intracranial abnormality.\n2. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct.\n3. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. Brain parenchymal atrophy, most prominent at the sylvian fissures. \nPeriventricular and subcortical white matter hypodensities are nonspecific,\nbut likely reflect sequelae of mild-to-moderate chronic small vessel ischemic\ndisease. Atherosclerotic vascular calcifications the cavernous internal\ncarotid arteries are noted.\n\nThere is no evidence of fracture. With the exception of mild anterior ethmoid\nair cell mucosal thickening, the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable. Partially seen is well-circumscribed\nsubcutaneous 2.1 cm lesion posterior right neck, may represent sebaceous cyst,\nclinically correlate.", + "output": "No acute intracranial abnormality.\nSuggestion of 2.1 cm sebaceous cyst right neck, clinically correlate." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nlarge mass. Periventricular and subcortical white matter hypodensities are\nnonspecific, but likely represent chronic small vessel ischemic disease. There\nis prominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of acute fracture. There is scattered opacification of\nethmoid air cells. The visualized portion of the remainder of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are otherwise clear. \nCerumen is noted in the bilateral external auditory canals. There is severe\ncalcification of the carotid siphons bilaterally.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute large territorial infarction, intracranial\nhemorrhage, edema, mass, or mass effect.\n\nThe ventricles and sulci are normal in size and configuration.\n\nThere is mild subgaleal swelling with overlying staples along the left\nparietal scalp from recent laceration repair. No underlying fracture\nidentified. Otherwise, no acute osseous abnormalities seen. The partially\nimaged paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The orbits demonstrate mild asymmetry of the right lamina papyracea and\nsuggestive of possible fracture of uncertain chronicity versus anatomical\nvariation (image 29, series 3), otherwise, the orbits are unremarkable.", + "output": "1. No acute intracranial process. No evidence of intracranial hemorrhage or\nfracture.\n2. Mild left parietal subgaleal swelling with overlying staples.\n3. Mild asymmetry of the medial wall of the right orbit, involving the lamina\npapyracea, probably related with chronic fracture versus anatomical variant,\nplease correlate." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and deep white white-matter\nhypodensities are nonspecific, but most likely related to chronic small vessel\nischemia. In addition, a hypodensity in the right cerebellum is most likely\nrelated to prior infarct and was present on previous scan dated ___.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nbilateral mastoid sinuses. Otherwise, the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality, specifically, no evidence of large\nterritorial infarction, hemorrhage, or brain abscess." + }, + { + "input": "The previously seen hyperdense foci in the bilateral frontal lobes are not\nvisualized. There is no evidence of intracranial hemorrhage or cerebral\ncontusion. There is no evidence of acute large territorial\ninfarction,edema,or mass. The basal and suprasellar cisterns are patent. \nThere is mild prominence of the ventricles and sulci suggestive of\ninvolutional changes. There are subcortical and periventricular white matter\nhypodensities, nonspecific but compatible with sequelae of chronic small\nvessel ischemic disease. A hypodensity in the right cerebellum most likely\nrepresents a prior infarct and appears unchanged from prior study dated ___.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No evidence of intracranial hemorrhage or cerebral contusion." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect or recent infarction.\nMultiple lacunar infarcts in the bilateral basal ganglia are again seen. Right\noccipital lobe encephalomalacia is also stable. Prominent ventricles and sulci\nsuggest age-related atrophy. Subcortical and periventricular white matter\nhypodensities are consistent with chronic small vessel ischemic disease.\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\nAtherosclerotic mural calcification of the vertebral and internal carotid\narteries is noted.", + "output": "No evidence of hemorrhage or new infarct." + }, + { + "input": "There is no evidence of infarction,hemorrhage,edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable. There is dental caries in\n___ 4. There is periapical lucency around treated ___ 6.", + "output": "1. No acute intracranial abnormalities. Please note that evaluation for\nintracranial mass is more sensitive on MRI.\n2. Dental caries in ___ 2 4. Periapical lucency around the treated ___ tooth\n6 suggestive of periodontal disease." + }, + { + "input": "There are 2 right frontal round hyperdense masses centered at the gray-white\nmatter differentiation with surrounding moderate vasogenic edema concerning\nfor hemorrhagic metastases. The larger lesion measures 2.1 x 1.8 cm (series\n2, image 26). The smaller lesion measures 0.8 x 0.6 cm (series 2, image 30). \nThere is local effacement of the sulci in the region of these masses, but no\nshift of normally midline structures. No other evidence of intracranial\nhemorrhage. No evidence of large territorial infarction. The ventricles and\nsulci are normal in size and configuration. The basal cisterns are patent.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. There is a large periapical lucency\ninvolving the right maxillary canine.", + "output": "Two right frontal round hyperdense masses measuring up to 2.1 and 0.8 cm with\na moderate mount of adjacent vasogenic edema, concerning for hemorrhagic\nmetastases.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 9:12 pm, approximately\n10 minutes after discovery of the findings, updated notification at 21:43." + }, + { + "input": "Status post right craniotomy and resection of a previously seen hemorrhagic\nmetastatic lesion in the right frontal lobe with expected postsurgical changes\nincluding small foci of pneumocephalus at the craniotomy site and hyperdense\nmaterial which may represent small amount hemorrhage. Associated vasogenic\nedema at this site of the former or metastasis is not significantly changed. \nA second 0.7 cm hyperdense round metastatic lesion in the right frontal lobe\nis not significantly changed compared to prior. No significant midline shift.\nAdditional small metastatic lesions seen on the recent MR are not well seen on\nthis exam. Size of the ventricles and sulci is normal and unchanged from\nprior. No evidence of acute infarction or additional areas of hemorrhage.\n\nApart from the right-sided craniotomy changes and, no acute osseous\nabnormalities. The paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The orbits are unremarkable.", + "output": "Status post right-sided craniotomy and resection of a hemorrhagic right\nfrontal metastatic lesion. No significant change in associated right frontal\nvasogenic edema or in the appearance of an additional unresected 0.7 cm right\nfrontal hemorrhagic metastasis. No significant midline shift or\nhydrocephalus." + }, + { + "input": "The patient is status post right craniotomy to resect a hemorrhagic metastatic\nlesion in the right frontal lobe. There is persistent expected postsurgical\nchanges including small amount of dural thickening as well as extensive right\nfrontal lobe white matter hypodensity consistent with edema. The amount of\nedema may have minimally increased. The slightly hyperdense 6 mm lesion in\nthe right frontal lobe surrounded by the edema is unchanged and appears to\ncorrespond to 1 of the hemorrhagic metastases seen on the preoperative CT\n(series 2, image 23).\n\nIn the left precentral gyrus, a 6 mm hyperdensity may correspond to the\nhemorrhagic metastasis seen on prior MRI (series 2, image 23). Since the\nprior MRI the amount of surrounding white matter hypodensity has markedly\nincreased, likely reflecting increased vasogenic edema (e.g. Series 2, image\n25). There is also subtle hypodensity in the left temporal lobe which was not\nclearly seen on the prior exams and may be a new area of tumor involvement,\nalthough hemorrhage is not identified (series 2, image 15).\n\nNo definite new acute intracranial hemorrhage.\n\nNo shift of normally midline structures. Right lateral ventricle anterior\nhorn effacement from edema is mild.\n\nEthmoidal air cell mucosal thickening is mild. Remaining paranasal sinuses\nare clear. Mastoid air cells and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No definite new focal acute hemorrhage.\n2. Interval increase in left frontal lobe white matter hypodensity, likely\nvasogenic edema adjacent to the left pre frontal sulcus 6 mm hyperdensity\nwhich is likely corresponding to the hemorrhagic metastasis on prior MRI.\n3. Status post right craniectomy with expected postsurgical change including\nright frontal lobe vasogenic edema, perhaps minimally increased from the prior\nexam. 6 mm hyperdensity in the right frontal lobe may be the smaller\nhemorrhagic metastasis, unchanged.\n4. No shift of normally midline structures." + }, + { + "input": "Patient is status post right craniectomy with expected postoperative findings,\nincluding vasogenic edema, of the partially visualized right frontal lobe,\nslightly worse compared to prior. Left frontal lobe white matter hypodensity\nis only partially visualized on this exam. Intracranial findings are more\nthoroughly discussed on MR head from ___ at 21:49.\n\nPatient is status post extraction multiple maxillary and mandibular teeth. \nThere is a large periapical lucency adjacent to the right first premolar. \nThere are broad lucencies surrounding the roots of the mandibular incisors as\nwell as multiple maxillary molar teeth bilaterally, more severe on the right.\n\nThere is mild mucosal thickening of the anterior ethmoid air cells. The\nremaining paranasal sinuses are normally aerated, with no mucosal thickening\nor air-fluid levels identified. The ostiomeatal units are patent, but there is\nmucosal thickening of the right ostiomeatal complex. The cribriform plates\nare intact. The lamina papyracea are intact.", + "output": "1. Patient is status post extraction of maxillary and mandibular teeth. \nPeriapical lucencies surround the roots of multiple maxillary and mandibular\nteeth suggesting chronic infection.\n2. Mucosal thickening of the right ostiomeatal complex. Ostiomeatal units are\npatent bilaterally.\n3. Please see dictation from MR head from ___ at 21:49 for full\ndescription of intracranial findings." + }, + { + "input": "Patient is status post right parietal craniotomy. There is post treatment\nchange in its in the underlying right frontal lobe which given differences in\ntechnique have not changed since ___. There is no intracranial\nhemorrhage, mass effect, or midline shift. Enhancing lesions detected by\nprior MRI are not delineated by this CT.\n\nMucosal thickening seen throughout the paranasal sinuses. Mastoids are\npartially opacified.", + "output": "No acute intracranial process.\nPost treatment changes noted on the right. Known enhancing lesions seen on\nprior MRI are not delineated by this CT. No mass effect, no hemorrhage." + }, + { + "input": "Postsurgical changes related to prior right frontal craniotomy is again seen. \nGrossly stable right frontal encephalomalacia is again noted.\n\nThere is no evidence of infarction, hemorrhage or edema. The ventricles and\nsulci are stable in size and configuration. Within limits of this noncontrast\nstudy, there is no definite evidence of intracranial mass.\n\nThere is no evidence of acute fracture. The visualized portion of the orbits\nare preserved. Nonspecific left middle ear opacification is noted. Bilateral\nmastoid air cell nonspecific fluid is seen. Bilateral maxillary sinus and\nethmoid air cell mucosal thickening is present.", + "output": "1. Postsurgical changes related to right frontal craniotomy.\n2. Within limits of this study, no definite evidence of intracranial mass. \nPatient's previously noted left frontal enhancing mass on ___\ncontrast brain MRI is not definitely visualized on current exam, which may be\nrelated to differences in technique. Please note contrast brain MRI is more\nsensitive for the evaluation of intracranial metastatic disease.\n3. No definite evidence of acute intracranial hemorrhage.\n4. Paranasal sinus disease , nonspecific bilateral mastoid fluid and left\nmiddle ear opacification, as described." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, or edema. A\npartly calcified extra-axial mass along the left tentorium measuring 0.9 x 1.4\nx 0.9 cm (601b:78, 602b:44) may reflect a meningioma. There is no significant\nmass-effect. There is no shift of normally midline structures. \nPeriventricular, subcortical and deep white matter hypodensities are\nnonspecific, but likely reflect the sequela of chronic microvascular\ninfarction.\n\nMild soft tissue swelling overlies the left occipital and frontal bones. \nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Mild atherosclerotic calcifications\nare demonstrated involving the cavernous carotid arteries.", + "output": "1. No acute intracranial hemorrhage or fracture.\n2. 0.9 x 1.4 x 0.9 cm partly calcified extra-axial mass along the left\ntentorium, likely a calcified meningioma, without significant mass effect. \nThis can be confirmed with a contrast-enhanced MRI on a nonemergent basis.\n\nRECOMMENDATION(S):\n\n1. 0.9 x 1.4 x 0.9 cm partly calcified extra-axial mass along the left\ntentorium, likely a calcified meningioma, without significant mass effect.\nThis can be confirmed with a contrast-enhanced MRI on a nonemergent basis." + }, + { + "input": "CTA images are severely limited by small, suboptimal late contrast bolus\ntiming with nearly all enhancement in the venous phase. Examination is also\nlimited by body habitus.\n\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD AND NECK: Neck CTA is essentially nondiagnostic. There is a variant\n2 vessel aortic arch. Some degree of enhancement is noted in the central\ncircle of ___ arterial vasculature which appears grossly patent, though\ndistal evaluation and evaluation for subtle abnormality is essentially not\npossible. The dural venous sinuses appear patent.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. Scattered prominent cervical lymph\nnodes are visualized, a common finding for this age group. Small\ncalcifications are noted in the bilateral parotid glands. The adenoids and\npalatine tonsils are prominent, within expected limits for the patient's age,\npotentially reactive.", + "output": "1. CTA evaluation is exquisitely limited by insufficient and late contrast\nbolus timing. The central circle of ___ vasculature appears grossly\npatent, though distal evaluation and evaluation for subtle abnormality is\nessentially impossible. The neck CTA is essentially nondiagnostic. If\nvascular evaluation remains clinically warranted, the examination will have to\nbe repeated.\n2. No intracranial hemorrhage, or acute large territorial infarct.\n\nRECOMMENDATION(S): If vascular evaluation remains clinically warranted, the\nexamination will have to be repeated.\n\nNOTIFICATION: ED QA nursing staff was emailed on ___ at 11:39." + }, + { + "input": "CT HEAD:\nThere is no evidence for acute hemorrhage, mass effect, or edema. No evidence\nof loss of gray-white differentiation. The ventricles and sulci are mildly\nprominent compatible global parenchymal volume loss. Periventricular and\nsubcortical white matter hypodensities are noted, a nonspecific finding that\nmost likely represents the sequelae of chronic small vessel ischemic disease.\n\nThere is no evidence for displaced calvarial fracture. Hyperostosis frontalis\nis noted bilaterally. Mild mucosal thickening is seen in the ethmoid air cells\nwith involvement of the left frontoethmoidal junction. The remainder of the\nparanasal sinuses, middle ear cavities, and mastoid air cells are clear. The\norbits are grossly unremarkable bilaterally.\n\n\nCTA HEAD AND NECK:\nThe vertebral arteries are patent without high-grade stenosis or occlusion.\n\nThe bilateral common carotid arteries are patent. Mild right and moderate left\ncalcifications are seen involving the bilateral carotid bulbs. However, there\nis no appreciable internal carotid stenosis by NASCET criteria.\n\nModerate calcifications are seen in the bilateral cavernous internal carotid\narteries. There is an early bifurcation of the left M1/M2 branch. The\ndominant inferior left M2 branch subsequently demonstrates abrupt cutoff\n(4:219) at its mid portion, compatible with vessel occlusion. There is\nsubsequent decreased arborization of the more distal left-sided M3/M4 branches\nrelative to the right.\n\nThere is short-segment high-grade stenosis of the left P2 segment (series 554,\nimage 5). The right middle cerebral artery and its distal branches are\npatent. Similarly, the anterior cerebral arteries and the remainder of the\nposterior cerebral arteries appear grossly patent bilaterally. The dural\nvenous sinuses are patent.\n\n\nCTA PERFUSION:\nWithin the left parieto-occipital and temporal lobes, there is a confluent\narea of increased mean transit time worrisome for cerebral ischemia. There is\nno definite focus of quantitatively decreased cerebral blood volume or\nperfusion to suggest infarction at this time. However, visual inspection of\ncerebral blood flow does suggest decreased blood flow (series 331, image 25)\nof the left temporal parietal lobe.\n\n\nOTHER:\nThe lungs apices are clear bilaterally, allowing for atelectasis and\nrespiratory motion. There is a 1.6 cm right-sided thyroid nodule there is no\ncervical lymphadenopathy by CT size criteria. The softened S is mildly\npatulous demonstrating aerosolized debris (series 4, image 32). Multilevel\ncervical spondylosis does not result in high-grade spinal canal narrowing. \nProminent facet arthropathy is identified resulting in moderate left C3-C4,\nmoderate bilateral C5-C6 and moderate to severe right C6-C7 neural foraminal\nnarrowing.", + "output": "1. No acute intracranial hemorrhage. No clear loss of gray-white\ndifferentiation at this time.\n2. CTA perfusion demonstrates confluent areas of cerebral ischemia centered\nwithin the left parieto-occipital and temporal lobes. No focal area of\nquantitatively decreased cerebral blood flow/volume to suggest infarction at\nthis time by RAPID CT. However, visual inspection demonstrates decreased\ncerebral blood flow in the left temporal parietal lobe. Final infarct size\ncan be evaluated with MRI, if there are no contraindications.\n3. Abrupt cutoff of a mid left inferior M2 branch with subsequent decreased\narborization of the more distal branches on the left relative to the right,\ncompatible with large vessel occlusion.\n4. Multifocal sites of atherosclerosis, as above, without additional sites of\nhigh-grade stenosis, occlusion, or aneurysm greater than 3 mm.\n5. 1.6 cm right-sided thyroid nodule.\n6. Additional findings described above.\n\nRECOMMENDATION(S): Thyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or older, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territorial infarct. The ventricles and sulci\nare normal in size and configuration. Gray-white differentiation is preserved.\n\nNo acute fracture is seen. . There is partial opacification of right ethmoidal\nair cells. The remaining paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute major vascular territory infarction,intracranial\nhemorrhage,edema,or discrete mass. Ventricles are normal in size. Sulcal\nprominence is age advanced.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormalities.\n2. Age advanced involutional changes." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nMild periventricular white matter hypodensity is symmetric and nonspecific,\nhowever compatible with sequelae of chronic small vessel ischemia.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial process. No hemorrhage.\n2. Global atrophy is greater than expected for patient's age.\n3. Mild changes of chronic white matter microangiopathy." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nlarge mass. Periventricular and subcortical white matter hypodensities are\nnonspecific. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes, advanced for age.\n\nThere is no evidence of fracture. There is mild mucosal thickening in the\nright sphenoid sinus. There a few scattered opacified posterior right mastoid\nair cells. The visualized portion of the remaining paranasal sinuses, left\nmastoid air cells, and middle ear cavities are otherwise clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Combination of age advanced brain atrophy and mild white matter\nhypodensities could reflect HIV encephalopathy." + }, + { + "input": "There is streak artifact secondary to dental almalgam which obscures adjacent\nstructures.\n\nThere is an oval radiodense lesion lateral to the right maxillary molars\nmeasuring 0.7 x 1.2 cm, deep to the buccinator muscle (4:69). This has an\nattenuation measuring up to 308 Hounsfield units. Otherwise the soft tissues\nare unremarkable.\n\nThe orbits including the lamina papyracea are intact. The globes are intact\nwith nondisplaced lenses and no intra-ocular hematoma. There is no preseptal\nsoft tissue edema. There is no retro-orbital hematoma or fat stranding.\n\nThe visualized intracranial structures are unremarkable.\n\nThere are multiple sclerotic lesions throughout the visualized calvarium. \nThere is a mixed lytic and sclerotic lesion within the dens measuring 9 mm\n(7:84). There is a sclerotic lesion involving the right aspect of the C4\nvertebral body extending to the lateral mass and lamina (6:129).\n\nThere is mild mucosal thickening in a small mucous retention cyst within the\ninferior right maxillary antrum. Otherwise the paranasal sinuses, mastoid air\ncells, and middle ears are clear. A grossly stable approximate 1.5 x 2.0 cm\nright middle cranial fossa probable arachnoid cyst is again noted (see 4:133).", + "output": "1. Streak artifact secondary to dental amalgam obscures adjacent structures.\n2. Within limits of study, no definite evidence of intraorbital metastasis,\nosteolysis or periorbital edema.\n3. Multiple sclerotic calvarial lesions in addition to lesions at C2 and C4\nconsistent with osseous metastatic disease. These findings are better\ncharacterized on dedicated head MRI and from ___.\n4. 0.7 x 1.2 cm oval radiopaque lesion lateral to right maxillary molars and\ndeep to the buccinator muscle which was present on prior MRI from ___ but new in comparison to ___ prior exam. Differential\nconsiderations include postsurgical change or developing sialolith. Recommend\ncorrelation with intraoral examination and surgical history.\n5. Grossly stable 1.5 x 2.3 cm right middle cranial fossa probable arachnoid\ncyst.\n6. Paranasal sinus disease as described.\n\nRECOMMENDATION(S): 0.7 x 1.2 cm oval radiopaque lesion lateral to right\nmaxillary molars and deep to the buccinator muscle which was present on prior\nMRI from ___ but new in comparison to ___ prior exam. \nDifferential considerations include postsurgical change or developing\nsialolith. Recommend correlation with intraoral examination and surgical\nhistory." + }, + { + "input": "Nodular dural mets along the left frontal and right parietal lobes appear\ngrossly unchanged. Areas of associated edema are demonstrated over the right\nparietal and left frontal lobes, a component of which may reflect post\ntreatment change, grossly similar to the prior MRI (series 2, images 21, 24).\n\nThere is no evidence of acute large territorial infarction or acute\nintracranial hemorrhage. No midline shift is demonstrated. Mild effacement\nof the right anterior horn of the lateral ventricle is not changed in\nappearance from ___. The cisterns are patent.\n\nMultiple soft tissue nodular components are seen along the biparietal and left\nfrontal scalp compatible with known extracranial metastatic disease. \nExtensive heterogeneous and mottled appearance of the calvarium is compatible\nwith osseous metastatic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial hemorrhage or new acute large territorial infarct. \nNo acute fractures.\n2. Redemonstration of nodular dural metastatic disease with associated edema,\nmost prominent in the right parietal and left frontal lobes, grossly similar\nto the recent MRI. There is mild effacement of the anterior right lateral\nventricle, as on prior.\n3. Extracranial scalp and extensive calvarial metastases are overall grossly\nunchanged in appearance." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are age-appropriate.\n\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial hemorrhage or other acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction,hemorrhage,edema,or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. The ventricles and sulci are normal in size and configuration for\nthe patient's age. Subcortical white matter hypodensities most prominent in\nthe right parietal and left frontal lobes are nonspecific, but may reflect\nsequela of chronic small vessel disease.\n\nThere is no evidence of fracture. Small mucosal retention cysts in the right\nfrontal sinus and right maxillary sinus. Remainder of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. Periapical lucency\nnoted in relation to the left maxillary bicuspid to. The visualized portion\nof the orbits are unremarkable.", + "output": "1. No acute intracranial findings.\n2. Subcortical white matter hypodensities are nonspecific, would be compatible\nwith chronic small vessel disease.\n3. Periapical lucency about a left maxillary bicuspid tooth may reflect\nperiodontal disease. Correlation with dental exam is recommended.\n4. Paranasal sinus disease." + }, + { + "input": "CT HEAD WITHOUT CONTRAST (done on the same day):\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is mild atherosclerotic calcification involving the petrous and\ncavernous segment of the bilateral ICA. The vessels of the circle of ___\nand their principal intracranial branches appear normal without stenosis,\nocclusion, or aneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. Multilevel degenerative disc changes with of the spine are noted.", + "output": "1. Grossly unremarkable head and neck CTA without hemodynamically significant\nstenosis or narrowing." + }, + { + "input": "The frontal, sphenoid, and maxillary sinuses are clear. There is minimal\nmucosal thickening in bilateral ethmoid air cells, without fluid. The\nostiomeatal units and frontoethmoidal recesses are patent. There is no\nevidence for erosion or sclerosis in the walls of the paranasal sinuses or\nnasal cavity. The nasal septum is midline.\n\nThe middle ear cavities and partially imaged mastoid air cells are clear.\n\nThere are periodontal lucencies involving ___ 4, 5, and 12, and to a lesser\nextent ___ 6. While these extent to the apex, there are no localized\nperiapical lucencies in the maxilla. ___ 12 also contains caries. ___ 1, 3,\n13, 14, and 16 are absent.\n\nA torus ___ is incidentally noted, a normal variant.\n\nThe orbits and nasopharyngeal soft tissue contours appear unremarkable on\nnoncontrast assessment.\n\nThis exam is not technically optimized for evaluation of the included brain\nparenchyma. No concerning abnormalities are seen on limited assessment.", + "output": "1. No evidence for acute or chronic sinusitis.\n2. Multiple periodontal lucencies in the maxilla. ___ 12 also contains\ncaries. Please correlate clinically whether active dental inflammation may be\npresent." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Bilateral\nhyperdensities in the region of the circle of ___ and ICA likely represent\nvascular calcifications. There is prominence of the ventricles and sulci\nsuggestive of involutional changes.\n\nThere is no evidence of fracture. There is complete opacification of the left\nfrontal sinus. There is partial opacification the bilateral ethmoid air\ncells. There is mild mucosal thickening of the bilateral maxillary sinuses. \nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "No acute intracranial process. Bilateral hyperdensities in the region of the\ncircle of ___ and ICA likely represent vascular calcifications." + }, + { + "input": "The right submandibular gland is asymmetrically enlarged with mild surrounding\ninflammatory changes. There are at least 2 punctate (1-2 mm) stones in the\nproximal and mid right submandibular duct, which is dilated up to 9 mm. The\nmost distal aspect of the submandibular duct is not evaluated due to streak\nartifact from dental hardware. Subcentimeter right submandibular nodes are\nseen. Right parapharyngeal and submandibular stranding is noted. Asymmetry\nof the oropharynx which is slightly deviated to the left is noted.\n\nThe thyroid appears atrophic.There is no lymphadenopathy by CT criteria. The\nneck vessels are patent.\n\nEvaluation of the aerodigestive tract demonstrates no mass.\n\nThere is a 3 mm subpleural nodule in the right lung apex (3:136), which was\nnot seen on priors. 2 mm calcified granuloma in the right lung apex (3:185)\nand 2 mm pulmonary nodule in the left lung apex (3:35) are stable since\n___.\n\nOssification of the PLL is noted extending from C2 through C6 resulting in\nmost extensive, severe canal narrowing at the C4 vertebral body level. \nPartially imaged median sternotomy wires are seen. Note is made of a dilated\nmain pulmonary artery measuring up to 3.8 cm, nonspecific but which can be\nseen in the setting of pulmonary arterial hypertension. Periapical lucency\nnoted around the right mandibular first premolar with cortical breakthrough of\nthe anterior alveolar ridge.\n\nMild mucosal thickening of the bilateral maxillary sinuses noted.", + "output": "1. Acute right submandibular sialadenitis. Two punctate (1-2 mm) calculi are\nseen in the proximal and mid right submandibular duct. The distal aspect of\nthe right submandibular duct is not evaluated due to streak artifact from\ndental hardware, and additional distal calculi or other causes of obstruction\ncannot be excluded. The right submandibular gland is dilated up to 9 mm.\n2. Stranding involving the right submandibular and parapharyngeal spaces with\nmild mass effect on the upper airway.\n3. Periapical lucency noted around the right mandibular first premolar. \nCorrelate with dental disease.\n4. 3 mm subpleural nodule in the right lung apex was not seen on priors. \nPlease see ___ guidelines below.\n5. Ossification of posterior longitudinal ligament spanning C2 through C6 with\nsevere canal narrowing at the C4 vertebral body level.\n\nRECOMMENDATION(S): For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommend in a high-risk patient.\n\n___" + }, + { + "input": "Head CT: There is no evidence of hemorrhage, edema, masses, mass effect, or\ninfarction. The ventricles and sulci are normal in caliber and configuration.\nNo fractures are identified.\n\nHead CTA: There are no intracranial vascular abnormalities. There is no\nevidence of aneurysm, stenosis or occlusion.\n\nNeck CTA: The carotid and vertebral arteries and their major branches are\npatent with no evidence of stenoses. There is no evidence of internal carotid\nstenosis by NASCET criteria. The left vertebral artery is dominant. There is\nmild calcified plaque at the right carotid bifurcation. The distal right ICA\nmeasures 4.7 mm. The distal left ICA measures 4.4 mm.", + "output": "1. No evidence of hemorrhage, infarction, or mass effect on unenhanced CT\nhead\n\n2. No aneurysm, vascular malformation, stenosis, or occlusion on head CTA.\n\n3. No significant stenosis by NASCET criteria on neck CTA." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nEpidural hemorrhage along the prepontine, bilateral ambient and premedullary\ncisterns extending inferiorly along the anterior cervical spine to C2 has\ndecreased compared to ___, possibly due to redistribution into the\nspinal canal.\n\nLeft convexity subdural hematoma measures 1.2 cm at the level of the left\nparietal lobe on image 2:25, overall slightly increased in volume compared to\n___, with increased left parietal sulcal effacement and new mild\neffacement of the left lateral ventricle. However, no shift of midline\nstructures.\n\nThere is a mixed density right frontal convexity subdural hematoma, measuring\nup to 7 mm in width on image 2:24, increased in size compared to ___. However, the increases related to increased fluid rather than\nhyperdense blood. No definite right frontal sulcal effacement is seen.\n\nLeft greater than right paratentorial subdural hematoma is also again seen.\nThere is a new tiny focus of right posterior parafalcine subdural hematoma,\nimage 21, which may be secondary to redistribution.\n\nRight frontal scalp hematoma has slightly decreased. There is persistent soft\ntissue swelling in the region of the right cheek. No calvarial fracture is\nvisualized.\n\nThere is fluid and moderate mucosal thickening in the left maxillary sinus,\nsimilar to prior. There is moderate right and mild left anterior ethmoid air\ncell mucosal thickening with extension into the frontoethmoidal recesses. \nThere is a small amount of fluid and mucosal thickening in the right frontal\nsinus, increased compared to ___.\n\nMastoid air cells appear well-aerated. The orbits are unremarkable without\nintraorbital hematoma.\n\nCTA NECK:\nThere is a common origin of the innominate and left common carotid arteries, a\nnormal variant. There is mild calcified plaque in the proximal right internal\ncarotid artery and mild mixed plaque in the proximal left internal carotid\nartery, without stenosis by NASCET criteria. Also moderate calcified plaque\nin the proximal right external carotid artery and mild calcified plaque in the\nproximal left external carotid artery. No evidence for carotid dissection\n\nLeft vertebral artery is dominant, demonstrating a widely patent cervical\ncourse. Non dominant right vertebral artery demonstrates mild narrowing at\nits origin by a focus of calcified plaque. No evidence for vertebral\ndissection.\n\nCTA HEAD:\nAtherosclerotic changes of the cavernous and supraclinoid segments of the\nbilateral internal carotid arteries are seen without stenosis. Also mild\ncalcified plaque in the V4 segment of the left vertebral artery without\nflow-limiting stenosis. Right V4 segment is hypoplastic distal to ___\n___. Hypoplasia of the A1 segment of the right anterior cerebral artery is\ncongenital. Mild irregularity of distal MCA branches is likely\natherosclerotic. There is a mild stenosis of the P1 and proximal P2 segments\nof the left posterior cerebral artery.\n\nThere is no evidence for an aneurysm.\n\nThe dural venous sinuses are patent.\n\nOTHER:\nA severe compression deformity of T5 is seen, unchanged. No cervical spine\nfracture is identified. Multilevel cervical degenerative changes are noted. \nT5 and T4 vertebral body fractures are better characterized on the cervical\nspine MRI from ___. Status post median sternotomy.\n\nPeripheral fibrotic changes with honeycombing plus/minus paraseptal emphysema\nare again seen in the included upper lungs, right greater than left,\nrelatively similar to the chest CT from ___. Unchanged 11 mm\nprecarinal lymph node with a fatty hilus and unchanged 11 mm subcarinal lymph\nnode. 10 mm right upper paratracheal lymph node on image 3:60 measured 8 mm\non the ___ chest CT. Multiple additional nonenlarged mediastinal\nlymph nodes are also noted.\n\n3.5 cm enlargement of the main pulmonary artery compared to 2.9 cm in ___, suggesting pulmonary arterial hypertension. CABG related changes are\npartially imaged.\n\nThe thyroid is unremarkable.", + "output": "1. Decreased epidural hemorrhage along the prepontine, bilateral ambient and\npremedullary cisterns extending inferiorly along the anterior cervical spine\nto C2. This may be secondary to dependent redistribution to the spinal canal\n2. Interim enlargement of the left convexity hyperdense subdural hematoma with\nincreased mild left parietal sulcal effacement and increased effacement of the\nleft lateral ventricle, but no shift of midline structures.\n3. Mixed density 7 mm subdural hematoma over the right frontal region without\nsulcal effacement, with an on ___ due to increased hypodense\nfluid, but no increase in hyperdense blood.\n4. New 3 mm focus of subdural hemorrhage along the right parasagittal\nposterior falx, which may be secondary to redistribution. Unchanged bilateral\nparatentorial subdural hemorrhage.\n5. No evidence for cervical vertebral or carotid dissection. Mild narrowing\nof the origin of the diminutive non dominant right vertebral artery.\n6. Mild intracranial atherosclerosis, including irregularities of bilateral\ndistal MCA branches, and mild stenosis of the left P1 and proximal left P2\nsegment.\n7. T4 and T5 vertebral body fractures, better assessed on the MRI from ___.\n8. Chronic interstitial disease in the included upper lungs, similar to chest\nCT from ___. Mild mediastinal lymphadenopathy, not significantly\nchanged, likely reactive.\n9. New enlargement of the main pulmonary artery, suggesting pulmonary arterial\nhypertension. Please correlate clinically.\n\nRECOMMENDATION(S): Follow-up noncontrast head CT for reassessment of the\nenlarging left subdural hematoma.\n\nNOTIFICATION: Enlarging left subdural hematoma and recommendation for the\nfollow-up head CT were discussed with ___, neurosurgery NP or PA\nby ___, M.D. on the telephone on ___ at 8:51 pm, 5 minutes\nafter discovery of the findings." + }, + { + "input": "Predominantly low density left subdural hematoma is unchanged in size given\ndifferences in technique, measuring up to 10 mm in thickness. There is also a\nsmall isodense right subdural collection measuring approximately 3 mm in\nthickness, decreased compared to prior. Subdural along the falx and tentorium\nhas also decreased. There is no evidence of new hemorrhage. There is mild\neffacement of the adjacent sulci without midline shift. Ventricles are normal\nin size and configuration. Basal cisterns are patent.\n\nThere is no evidence of acute territorial infarction,edema,or mass. Mild\nsubcortical, deep, and periventricular white matter hypodensities are\nnonspecific, but likely represent the sequela of chronic microvascular\nischemia.\n\nThe right frontal scalp hematoma has resolved. There is no evidence of\nfracture. Moderate circumferential mucosal thickening within the left\nmaxillary sinus with high density, likely reflecting inspissated secretions,\ngiven the sclerosis of the adjacent maxillary walls, although progressed\ncompared to prior. The visualized portion of the remaining paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. No evidence of new hemorrhage.\n2. Left subdural hematoma is similar in size, but is now predominantly low\ndensity, reflecting the expected evolution of blood products. Small right\nsubdural hematoma, as well as subdural hemorrhage along the tentorium and falx\nhave decreased.\n3. Mucosal thickening within the left maxillary sinus has increased with high\ndensity, likely representing inspissated secretions of chronic sinusitis,\nalthough fungal infection can have a similar appearance." + }, + { + "input": "Small low-density left hemispheric subdural hematoma, significantly decreased\nsince prior, measuring 4 mm today, compared with 10 mm on prior.. No acute\nhemorrhage. Mild brain parenchymal atrophy. Findings consistent with\nmoderate chronic small vessel ischemic change. No hydrocephalus.\n\nNo fracture. Moderate mucosal thickening left maxillary sinus, with air-fluid\nlevel, improved since prior, consistent with improving acute sinusitis.. \nClear mastoids.", + "output": "Decreased low-density small left subdural hematoma.\nNo new hemorrhage..\nImproving left maxillary sinusitis." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. There is\nprominence of the ventricles and sulci suggestive of age-related cerebral\nvolume loss. Atherosclerotic vascular calcifications are noted of bilateral\ncavernous portions of internal carotid arteries. Periventricular and\nsubcortical white matter hypodensities are nonspecific, though likely sequelae\nof chronic small vessel ischemic disease. There is a chronic appearing\ninfarct in the right parietal lobe.\n\nThere is no evidence of fracture. There is a mucous retention cyst in the\nleft maxillary sinus. Otherwise, the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThere is periapical lucency surrounding the left maxillary central incisor,\n___ tooth 9 (2:21). There is lucency at a site of a prior right mandibular\nsecond molar extraction, ___ tooth 31 (2:29). There is no perimandibular or\npara maxillary abscess within the limitations of a noncontrast scan.\n\nThe salivary glands are grossly without mass or adjacent fat stranding. The\nthyroid gland appears normal. There is no lymphadenopathy by CT criteria.\n\nThere is a mucosal retention cyst in the left maxillary sinus. The visualized\nportions of the remainder of the paranasal sinuses and mastoid air cells are\nclear.\n\nThere are degenerative changes in the cervical spine. There are no osseous\nlesions.\n\n A right-sided PICC line is partially visualized. Please see dedicated CT\nchest performed on same day for description of the intrathoracic findings\nincluding moderate right and small left pleural effusions and bilateral\nconsolidations, right greater than left. Median sternotomy wires are\npartially visualized.", + "output": "1. Periapical lucency surrounding the left maxillary central incisor, ___\ntooth 9, and lucency at a site of a prior left mandibular first molar\nextraction, potentially representing sites of infection. Correlate with\ndental exam.\n2. No perimandibular or para maxillary abscess within the limitations of a\nnoncontrast scan.\n3. Please see dedicated CT chest performed on same day for intrathoracic\nfindings including moderate right and small left pleural effusions and\nbilateral upper lobe consolidations, right greater than left." + }, + { + "input": "Exam is repeated multiple times due to patient motion.\n\nThere is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. Again seen is a chronic right parietal infarct. There is prominence\nof the ventricles and sulci suggestive of involutional changes. Subcortical\nand periventricular white matter hypodensities are nonspecific, however likely\nrepresent sequela of chronic small vessel ischemic disease. There are\natherosclerotic calcifications in the bilateral cavernous carotids and\nvertebral arteries.\n\nThere is no evidence of fracture. There is a mucosal retention cyst in the\nleft maxillary sinus. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are prominent in keeping with age related generalized\nparenchymal volume loss. Subcortical and deep white matter hypodensities\nlikely reflect chronic microvascular ischemic change. Unchanged appearance of\nthe posterior fossa including a prominent fourth ventricle and cisterna magna.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality, specifically no evidence of an intracranial\nbleed." + }, + { + "input": "An intraparenchymal hemorrhage centered within the right frontal lobe has\nincreased in size. A previously 3.4 x 3.8 cm hemorrhage currently measures\n4.4 x 2.9 cm with an additional lobular component posteriorly measuring 1.6 x\n3.4 cm. This is associated with surrounding vasogenic edema and effacement of\nsulci. There is otherwise no significant mass effect. There is no shift of\nnormally midline structures. Basal cisterns are patent. Encephalomalacia\nwithin the right temporal lobe is noted. Gray-white matter differentiation is\npreserved.\n\nThe orbits are unremarkable. Imaged paranasal sinuses demonstrate moderate\nethmoidal air cell mucosal thickening. Mastoid air cells and middle ear\ncavities are clear. Bony calvarium appears intact.", + "output": "New hemorrhage within a right frontal lobe hematoma with increase in size,\nedema and mass effect.\n\nNOTIFICATION: The findings were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 6:55 am, 10 minutes after\ndiscovery of the findings." + }, + { + "input": "Compared with CT head performed earlier on same day, there is no significant\nchange in size a right frontal lobe intraparenchymal hematoma. There is\nminimal increase in surrounding vasogenic edema. There is associated\neffacement of the adjacent sulci, with no significant effacement of the right\nlateral ventricle. No new intraparenchymal hemorrhage or midline shift. \nBasal cisterns are patent. Encephalomalacia within the right temporal lobe is\nagain noted.\n\nThere is no evidence of fracture. There is mucosal thickening in the ethmoid\nair cells. The visualized portion of the remainder of paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "A right frontal intraparenchymal hematoma is stable in size, with minimal\nincrease in surrounding edema. No midline shift or new intracranial\nhemorrhage." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is a large left frontal intraparenchymal hemorrhage measuring 3.2 x 2.2\ncm, with surrounding edema, which appears increased in size compared to prior\nstudy. There are additional smaller foci of parenchymal hemorrhage in the\nleft frontal, temporal, and parietal lobe and right frontal lobe which also\nappear increased compared to prior study. There has been an increase in the\namount subarachnoid hemorrhage. There is 2.7 mm of midline shift to the\nright. There is right temporoparietal encephalomalacia. The ventricles and\nsulci are normal are prominent suggestive of involutional changes.\n\nThere is mild mucosal thickening of the ethmoid air cells. The visualized\nportion of the remaining paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is severe focal stenosis of the right P2 segment, with unremarkable\ndistal run-off (series 558, image 21). The remainder of the vessels of the\ncircle of ___ and their principal intracranial branches appear normal\nwithout stenosis, occlusion, or aneurysm formation. There is a fetal type\nleft PCA. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is moderate narrowing of the right V4 segment of the vertebral artery. \nIn addition, there appears to be moderate to severe stenosis secondary to\natherosclerotic disease of the left vertebral artery origin (series 556, image\n36). Under the left vertebral artery is unremarkable. There is 60% stenosis\nof the left internal carotid artery and 30% stenosis of the right internal\ncarotid artery by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. There is an 8.1 mm hypodense\nnodule within the right lobe of the thyroid. There is no lymphadenopathy by\nCT size criteria.", + "output": "1. Large left frontal intraparenchymal hemorrhage with smaller bilateral foci\nof parenchymal hemorrhage and subarachnoid hemorrhage, all which appears\nincreased compared to prior study.\n2. There is 60% stenosis of the left internal carotid artery and 30% stenosis\nof the right internal carotid artery by NASCET criteria. Moderate to severe\nstenosis secondary to atherosclerotic disease of the left vertebral artery\norigin.\n3. Short segment severe stenosis of the right P2 segment, with unremarkable\ndistal run-off. The remainder of the CTA head is unremarkable.\n4. No evidence of CTA spot sign.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. The basal cisterns\nappear patent, and there is preservation of gray-white matter differentiation.\n\nNo osseous abnormalities seen. There is mucosal thickening in the right\nsphenoid sinus. The remaining paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Evaluation at the level of the mandible is somewhat limited by dental hardware\nartifact.\n\nEvaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid appears normal.\n\nThere is mild left cervical adenopathy with level-II nodes up to 1.8 cm. \nAdditional asymmetric left-sided lymph nodes are noted although not\npathologically enlarged.\n\nSoft tissue density in the anterior mediastinum may represent residual thymus.\nThe neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.", + "output": "Mild left cervical adenopathy, nonspecific and potentially reactive. No\ndrainable collection." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect or\nlarge territorial infarction. The ventricles and sulci are prominent\nsuggesting age-related atrophy minimally progressed since the prior study.\nPeriventricular white matter hypodensities suggests chronic microvascular\nischemic disease. New hypodense focus in the periventricular left frontal\nwhite matter (02:20) is likely a chronic lacune. The basal cisterns are\npatent. Gray-white matter differentiation is preserved.\n\nThere is no acute fracture. There is mild scalp contusion along the right\nparieto-occipital scalp. The partially visualized paranasal sinuses, mastoid\nair cells and middle ear cavities are clear. There are atherosclerotic\ncalcifications of the cavernous internal carotid arteries and vertebral\narteries. The anterior arch of C1 is incompletely fused.", + "output": "No evidence of acute intracranial abnormality. New lacune in the left frontal\nlobe.\nMild scalp contusion along the right parieto-occipital scalp." + }, + { + "input": "There is no evidence of hemorrhage. There is preservation of gray-white\nmatter differentiation. There is no evidence of large mass, mass effect, or\nedema. Ventricles and sulci are normal in caliber and configuration. The\nbasal cisterns are patent. There is no shift of normally midline structures. \nSubcortical and periventricular white matter hypodensities are nonspecific,\nhowever compatible with the sequelae of chronic small vessel ischemia. The\nvisualized paranasal sinuses and mastoid air cells are clear. The globes are\nintact.", + "output": "1. No acute intracranial process. No evidence of hemorrhage.\n2. Chronic white matter small vessel ischemic changes." + }, + { + "input": "CT head shows postoperative changes with craniotomy in the left side. There\nis encephalomalacia in the left basal ganglia region. Previously seen\nhematoma in ___ has resolved. Mild ex vacuo dilatation of the left lateral\nventricle seen. There is no acute hemorrhage identified. Mild brain atrophy\nseen. There is atrophy of the left side of the midbrain indicative of\nwallerian degeneration.\n\n\n\nCT angiography of the head shows normal appearance of the arteries of the\nanterior and posterior circulation without stenosis or occlusion or aneurysm\ngreater than 3 mm in size. A small infundibulum at the left middle cerebral\nartery bifurcation is again seen. The left posterior cerebral artery is not\nwell visualized but the appearance is similar to the previous CTA examination.", + "output": "1. Encephalomalacia left basal ganglia region at the site of previously seen\nimaged ___ in ___. No acute hemorrhage.\n2. CT angiography of the head demonstrates no aneurysm or vascular occlusion. \nLeft posterior cerebral artery is not well visualized as on the previous CTA\nexamination of ___ and likely secondary to a variation." + }, + { + "input": "Bilateral predominantly hypodense subdural collections extending frontal the\noccipital region are unchanged compared to the previous CT examination of\n___ but also not significantly changed compared with CT of ___. No acute hemorrhage is identified.\nHypodensity in the right basal ganglia region as well as in the left caudate\nhead is also unchanged from the prior studies.", + "output": "No change in size in bilateral low-density subdural collections. No acute\nhemorrhage is identified." + }, + { + "input": "No significant change in the appearance of bilateral hypodense subdural\ncollections most prominent the frontal regions compared to the prior study. \nNo acute intracranial hemorrhage. No large territorial infarction. The\nconfiguration the ventricles and basal cisterns is unchanged, with persistent\neffacement of the sulci. Hypodensities in the right basal ganglia left\ncaudate appear stable from prior.\nThere is no evidence of fracture. Moderate thickening of the visualized left\nmaxillary sinus, otherwise the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "No acute interval changes. Similar appearance of bilateral low-density\nsubdural collections. No new hemorrhage, no evidence of new infarct." + }, + { + "input": "Re-demonstrated are bilateral hypodense subdural collections, most pronounced\nin the bilateral frontal regions. This measures up to 7 mm in thickness on\nthe left, unchanged. There is no evidence of acute territorial infarction,\nhemorrhage, edema, or mass effect. Hypodensities in the bilateral basal\nganglia, specifically the caudate heads are again noted. The ventricles\nappear similar to minimally decreased in size compared to ___. \nThere is persistent effacement of the sulci. Hyperdensities within the\nbilateral basal ganglia are unchanged.\n\nNo acute fractures are seen. Aside from partial opacification of the left\nmaxillary sinus and right ethmoid air cells, the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Similar appearance of bilateral, low-density chronic subdural collections\nversus hygromas." + }, + { + "input": "Re-demonstrated are bilateral hypodense subdural collections, most pronounced\nin the frontal regions. Allowing for differences in positioning, these\ncollections are unchanged, measuring up to 8 mm on the left and 5 mm on the\nright, previously 7 mm and 6 mm, respectively. No hematocrit level. No new\nintracranial hemorrhage.\n\nHypodensities in the bilateral basal ganglia, specifically the caudate heads\nare again noted and appears similar. Persistent diffuse effacement of the\nsulci appears similar as well. The ventricles are unchanged in configuration.\n\nThere is no evidence of fracture. The partially visualized left maxillary\nsinus is opacified with volume loss and bony wall thickening suggesting long\nchronicity. Otherwise, the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. No evidence of acute intracranial process.\n2. Similar appearance of bilateral low-density chronic subdural hematomas\nversus hygromas." + }, + { + "input": "Hypoattenuating subdural fluid collections are unchanged in size, allowing for\ndifferences in measurement technique, measuring up to 8 mm from the inner\ntable fell left and 6 mm from the inner table on the right. No evidence of\nacute intracranial hemorrhage. Effacement of the ventricles, cerebral sulci,\nand basal cisterns is unchanged. Chronic lacunar infarcts involving the right\ncaudate body, left caudate head, right external capsule, and right putamen are\nunchanged. No evidence of acute infarction. Benign globus pallidus\ncalcifications are noted. .\n\nNo evidence of fracture. Partial opacification of the ethmoid air cells is\nunchanged. Opacification of the partially imaged left maxillary sinus is\nunchanged. The sphenoid sinus, partially imaged right maxillary sinus,\nmastoid air cells, and middle ear cavities are clear.", + "output": "1. No evidence of an acute intracranial abnormality.\n2. Subdural fluid collections probably reflecting subdural hygromas are\nunchanged. Effacement of the ventricles, sulci, and basal cisterns is\nunchanged." + }, + { + "input": "The study is moderately limited by patient motion. Within these limitations:\n\nThere are grossly unchanged bilateral supratentorial low-density subdural\ncollections measuring 6 mm on the right, 8 mm on the left, compatible with\nhygromas. Effacement of the adjacent sulci, but no midline shift. No\nevidence of acute territorial infarction, hemorrhage, or mass. Chronic\nlacunar infarcts are seen within the right basal ganglia. There is a grossly\nunchanged small subdural hygroma along the left tentorium (02:14).\n\nThere is no evidence of fracture. The left maxillary sinus is completely\nopacified with wall sclerosis and atelectasis, chronic. Partial opacification\nof the posterior ethmoid air cells on the right. The mastoid air cells and\nmiddle ear cavities are clear. Status post bilateral lens replacement. \nOtherwise, the orbits are unremarkable.", + "output": "This examination is moderately limited due to patient motion. Within these\nlimitations, no acute intracranial findings. Unchanged bilateral subdural\nhygromas and also unchanged left tentorial hygroma." + }, + { + "input": "There is no evidence of infarction, hemorrhage, or edema. 3 mm extra-axial\ncalcification along the right cerebellum may reflect sequela of previous\ninfection, or small meningioma. The ventricles and sulci are normal in size\nand configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No fracture or acute intracranial findings." + }, + { + "input": "There is no evidence of fracture, acute large territorial\ninfarction,hemorrhage,edema,or mass effect. The ventricles and sulci are\nnormal in size and configuration. Left cerebellar chronic lacunar infarct,\nlacunar infarcts of the bilateral thalami and mild encephalomalacia of the\nleft frontal vertex is unchanged.\n\nCoarse dural calcification along the right tentorial leaflet (2:9) is again\nseen. The visualized portion of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nnormal.", + "output": "No acute intracranial hemorrhage or other acute intracranial abnormality to\nexplain the patient's altered mental status." + }, + { + "input": "NECT: Scattered subarachnoid hemorrhage overlies the left frontal lobe. There\nis a punctate hemorrhage which appears to be subcortical in location within\nthe right parietal lobe superiorly. No new intracranial hemorrhage is\nidentified. There is no mass effect or shifting of the midline structures.\nThere is an area of hypodensity within the left thalamus compatible with\ninfarct.\n\nCTA Neck: The aortic arch demonstrates a normal branching pattern. Both\nvertebral arteries are patent. The bilateral common carotid, external carotid\nand internal carotid arteries are patent. There is no evidence of significant\nstenosis by NASCET criteria or the dissection.\n\nCTA head: The major intracranial vessels are patent. There is no evidence for\naneurysm. Both posterior communicating arteries are visualized. There is a\nnormal anterior communicating artery complex. No significant stenosis is\nidentified.", + "output": "1. Left frontal subarachnoid and punctate right parietal intraparenchymal\nhemorrhage, unchanged.\n2. Left thalamic infarct slightly more conspicuous on the current examination.\n3. No evidence for mycotic aneurysm.\n4. No significant abnormalities on the CT angiography of the head and neck" + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute large territory infarct, hemorrhage, edema, or\nmass effect. The ventricles and sulci are within expected limits for the\npatient's age.\n\nThere is mild mucosal thickening of the ethmoid air cells and inferior frontal\nsinuses with opacification of the frontoethmoidal recesses. Mild mucosal\nthickening of the sphenoid sinuses with opacification of the sphenoid ostia. \nThere is opacification of the mastoid air cells. The middle ears are clear. \nThere are no suspicious osteoblastic or lytic lesions. The orbits are\nunremarkable.\n\nCTA HEAD:\nThere is a 1 cm right M1 bifurcation aneurysm with 2-3 mm neck. The superior\nand inferior M2 divisions arise from the aneurysm. The intracranial ICA, ACA\nand left and their major branches are unremarkable. Dominant right vertebral\nartery with left ___ vertebral artery termination is noted, a common normal\nanatomic variant. The posterior circulation is otherwise unremarkable.", + "output": "1. A 1 cm right M1 segment bifurcation aneurysm with 2-3 mm neck. The\nsuperior and inferior M2 divisions arise from the aneurysm.\n2. Allowing for common anatomic variation the remainder of the CTA head is\nunremarkable.\n3. Unremarkable noncontrast CT of the head.\n4. Paranasal sinus disease and mastoid air cell opacification as described\nabove.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 10:32 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. There is postsurgical change\nof right temporoparietal craniotomy with underlying hyperdense material\nconcerning for subdural hematoma measuring up to 5 mm in maximal thickness,\nstable compared to prior head CT at outside institution earlier today. There\nis no overlying soft tissue swelling.\n\nThe mastoid air cells, and middle ear cavities are clear. There is a left\nartificial globe. There opacification involving the right maxillary sinus,\nethmoid air cells with surrounding bone sclerotic changes consistent with\nchronic sinusitis. There are bilateral chronic zygomatic arch deformity.", + "output": "1. Right temporoparietal craniotomy with a focal region of underlying\nhyperdense material worrisome for acute subdural hematoma measuring up to 5 mm\nstable from previous study. No evidence of midline shift or herniation.\n2. Paranasal sinuses disease." + }, + { + "input": "Since the prior exam, there are new hypodensities in the bilateral basal\nganglia and thalami, more prominent on the right than the left. There is also\na new hypodensity in the left external capsule and in the periphery of the\nleft temporal lobe in the subcortical white matter (2, 14 and 10). Both lobes\nof the cerebellum are heterogeneous with diffuse ill-defined hypodensities.\n\nThere is no hemorrhage. No significant mass effect is noted surrounding the\nnew hypodensities. The ventricles and sulci are prominent for the patient's\nage. The basal cisterns are patent.\n\nNo fracture is identified. There is mild mucosal thickening in the ethmoidal\nair cells. The remainder of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The soft tissues and orbits are unremarkable.", + "output": "1. New scattered hypodensities in the bilateral basal ganglia, thalami, left\ntemporal lobe, and cerebellum. The etiology is unknown, though these could\nrepresent posterior reversible encephalopathy syndrome, HIV associated\nencephalitis, vasculitis, embolic phenomenon, or potentially infection such as\ntoxoplasmosis. Further evaluation with a contrast enhanced MRI is recommended.\n2. Diffuse atrophy, which is out of proportion for a patient of this age, and\nmay relate to HIV." + }, + { + "input": "HEAD CTA:\n\nThe vertebral arteries are normal; the right vertebral artery is dominant. The\nbasilar artery, superior cerebellar, and posterior cerebral arteries are\nnormal. The intracranial internal carotid arteries are normal. The middle\ncerebral arteries are normal. The anterior cerebral arteries are normal. The\nanterior communicating artery region is normal. There is no evidence of\naneurysm, stenosis or occlusion. The major dural venous sinuses are patent.\n\nVentricles, sulci, and cisterns are age-appropriate. Hypodensities described\non CT from earlier the same day are not well evaluated on this study optimized\nfor evaluation of the vasculature. No definite parenchymal enhancement is\nidentified within the limitations.\nThere is mucosal thickening of the maxillary sinuses.\nSphenoid sinus has 2 septations, the minor left inserts on the left carotid\ngroove.\n\nThere are periapical lucencies surrounding multiple maxillary teeth.\nThe mastoid air cells and tympanic cavities are clear. The orbits are normal.\n\nNECK CTA:\n\nThere is mild calcification of the aortic arch. There is 3 vessel aortic arch\nanatomy.\nThe included subclavian artery and cervical vertebral arteries on both sides\nare patent, without focal flow-limiting stenosis or occlusion.\nRight vertebral artery is dominant.\nThe common, internal, and external carotid arteries are patent.\nThere is no internal carotid artery stenosis by NASCET criteria.\n\nCT NECK:\n\nMildly prominent adenoids and palatine tonsils, with mild fullness in the foci\nof ___ on both sides.\nMultiple small nodes in both sides of the neck, some of which are mildly\nprominent, however not abnormally enlarged by size criteria.\nNo obvious intraluminal mass in the aerodigestive tract.\nThe submandibular, parotid, and thyroid glands are normal.\nNo lymphadenopathy is identified.\n\nThe included lungs are clear with minimal emphysematous changes.\nThere is mild degenerative disc and facet and uncovertebral joint disease of\nthe cervical spine.", + "output": "1. No stenosis, occlusion, or aneurysm of the major intracranial and\nextracranial arterial circulation.\n2. Parenchymal hypodensities described on CT head from earlier the same day\nare not well visualized on this study optimized for evaluation of the\nvasculature. No definite parenchymal enhancement is identified,however, this\nstudy is optimized for evaluation of the vasculature rather than the brain\nparenchyma.\n3. Maxillary periodontal disease and mild maxillary sinus mucosal thickening.\nOther details as above." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territory infarct. Gray-white matter\ndifferentiation is preserved. There is no hydrocephalus. The visualized\nparanasal sinuses are clear. The mastoid air cells are clear. No acute\nfracture is seen.", + "output": "No acute intracranial process on CT." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Aside from moderate mucosal thickening of\nthe anterior ethmoidal air cells and minimal mucosal thickening in the right\nsphenoid sinus,, the visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "There is a rim-enhancing, centrally hypodense 1.2 x 0.9 x 1.0 cm subcutaneous\nlesion overlying the left sternocleidomastoid the level of the hyoid bone,\n(3:99, 602:53). There is overlying skin thickening and mild adjacent fat\nstranding. The left external jugular vein and confluence with the left facial\nvein course between the lesion and the sternocleidomastoid, and there is also\nedema and fat stranding adjacent to the vein, though the vein remains patent.\n\nBilateral external jugular veins are large, as are multiple other veins of the\nanterior and posterior neck and visualized upper chest wall. However, the\nbilateral internal jugular veins appear patent with dominance of the right\ninternal jugular vein.\n\nEvaluation of the oral cavity is limited by streak artifact from dental\namalgam. Evaluation of the aerodigestive tract demonstrates no evidence for\nan exophytic mucosal mass. The salivary glands and the thyroid gland appear\nunremarkable. Bilateral level 2A lymph nodes the prominent but not\npathologically enlarged by CT criteria. No pathologically enlarged lymph\nnodes are seen allowing for numerous distended veins.\n\nThis exam is not technically optimized for evaluation of the included brain\nparenchyma, though no concerning abnormalities are seen on limited assessment.\nThere is mild mucosal thickening in the partially visualized ethmoid air\ncells. Mastoid air cells appear grossly clear allowing for absence of\ndedicated bone algorithm images.\n\nVisualized lung apices are clear.\n\nThere are degenerative changes in the cervical spine.", + "output": "1. 1.2 x 0.9 x 1.1 cm rim-enhancing subcutaneous lesion overlying the left\nsternocleidomastoid at the level of the hyoid bone, with overlying skin\nthickening and mild adjacent fat stranding, suggesting an infected sebaceous\ncyst or branchial cleft cyst. A necrotic lymph node with overlying\ninflammation is less likely.\n2. The left external jugular vein and confluence with the facial vein course\nbetween the above-described subcutaneous lesion and the left\nsternocleidomastoid, with surrounding edema and fat stranding at this level\nsuggesting superficial phlebitis, though the veins remain patent.\n3. All of the bilateral anterior and posterior neck veins, including the\nbilateral external jugular veins, the veins of the visualized upper chest\nwall, are dilated. Bilateral internal jugular veins are patent. This raises\nthe question SVC syndrome or other venous narrowing/occlusion below the neck. \nPlease correlate clinically.\n\nRECOMMENDATION(S): According to the ED discharge note, ENT evaluation has\nalready been recommended. Ultrasound would be helpful to differentiate\nbetween an infected cyst and a necrotic lymph node.\n\nNOTIFICATION: Electronic preliminary report was provided on ___ at\n03:59 by Dr. ___: \"Immediately anterior to the left sternocleidomastoid\nmuscle and superficial to the left external jugular vein is a small 1.2 x 0.9\nx 1.1 cm fluid collection with edema of the adjacent fat and overlying skin,\nlikely representing an epidermoid inclusion cyst, however cannot exclude\nsuperimposed infection.\"\n\nThe final impression and the recommendations above were emailed to the ED QA\nnurses list by Dr. ___ at 12:08 on ___." + }, + { + "input": "There is no evidence of fracture, acute territory\ninfarction,hemorrhage,edema,or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. ___ cisterna magna is\nincidentally noted again. Periventricular and subcortical white matter\nhypodensities are nonspecific, but likely reflect the sequela of chronic\nmicrovascular infarction.\n\nMild mucosal thickening within the right frontal sinus. The visualized\nportion of the remaining paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema,or discrete mass. The\nventricles and sulci are change appropriate. There is a left frontal scalp\nhematoma with associated soft tissue gas consistent with laceration. No\nradiopaque foreign body.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Left frontal scalp hematoma. No underlying fracture." + }, + { + "input": "Head CT: There is no evidence of hemorrhage, edema, masses, mass effect, or\ninfarction. The ventricles and sulci are prominent, compatible with moderate\nage-related involutional changes. Periventricular white matter hypodensities\nare compatible with moderate chronic small vessel ischemic changes. No\nfractures are identified. Physiologic calcifications of the globus pallidus\ninternus are noted.\n\nHead CTA: There are no intracranial vascular abnormalities. There is no\nevidence of aneurysm, stenosis or occlusion.\n\nNeck CTA: The carotid and vertebral arteries and their major branches are\npatent with no evidence of stenoses. There is no evidence of internal carotid\nstenosis by NASCET criteria. Nodular thickening of the right upper lobe is\nnoted (4:1). Patient appears to be status post right hemithyroidectomy. A\nsmall amount of ectopic thyroid tissue along the thyroglossal duct is noted\n(04:101). Adenoid tonsilliths are noted.\n\nPerfusion: Mildly increased mean transit time in the left posterior frontal/\nparietal region is seen without clear correlate on the blood flow and blood\nvolume images. This may represent watershed ischemia, or may be artifactual in\norigin as the other perfusion maps and head CTA do not have matching deficits.", + "output": "1. Mildly increased mean transit time and the left frontoparietal watershed\nregion without a clear correlate on other sequences may be artifactual in\norigin or may represent watershed ischemia.\n2. No evidence of hemorrhage, edema, mass, mass effect, or infarction.\n3. No evidence of occlusion, flow-limiting stenosis, or aneurysm >3 mm in the\nhead or neck.\n4. If clinically indicated, MRI can help for further assessment." + }, + { + "input": "There has been evolution of the left internal capsule infarction (03:15). \nThere are small scattered nonspecific hyperdense foci in the region of the\nleft MCA territory infarction that are not definitely seen on the most recent\nprior head CT (03:14). There is no large hemorrhage, edema, or mass. The\nventricles and sulci are prominent, compatible with moderate age-related\ninvolutional changes. Periventricular and deep subcortical white matter\nhypodensities are compatible with moderate chronic small vessel ischemic\nchanges.\n\nNo osseous abnormalities seen. The mastoid air cells, and middle ear cavities\nare clear. The orbits are unremarkable. Air-fluid levels are noted in the\nright sphenoid sinus.", + "output": "1. Nonspecific small hyperdense foci in the region of previously noted left\nMCA territory infarction, not definite seen on prior imaging. While findings\nmay represent small calcifications, small hemorrhages cannot be excluded on\nthe basis of this examination. Recommend clinical correlation and short-term\nimaging followup.\n2. Interval evolution of previously noted left internal capsule infarction.\n3. Moderate age-related involutional changes and moderate chronic small vessel\nischemic changes.\n4. Paranasal sinus disease as described, raising concern for acute sinusitis.\nRecommend clinical correlation." + }, + { + "input": "There is no evidence of recent territorial infarction,hemorrhage,edema,or\nmass. The ventricles and sulci are age appropriate. The cerebellar tonsils\nmay be slightly low lying, possibly congenital.\n\nNo calvarial fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are normal. Patient is status post right-sided craniotomy.", + "output": "1. No acute intracranial hemorrhage.\n2. Cerebellar tonsils may be slightly low lying, possibly congenital." + }, + { + "input": "Right frontal convexity mixed density subdural hematoma measures 6 mm\nmaximally, stable from ___. Resultant mild sulcal effacement and 4 mm\nof leftward shift of midline structures are unchanged from ___. \nMicrohemorrhage in the left cerebellar hemisphere described on previous MRI\nmay correspond to a focus of hyperdensity on this examination, likely\nunchanged given differences in technique (3:8). Intraventricular hemorrhage\nin the occipital horns of the lateral ventricles described on previous MRI is\nnot well-visualized on this examination. The ventricles are unchanged in size\nand configuration from ___. The basal cisterns are patent. No osseous\nabnormalities seen. The paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The orbits are unremarkable.", + "output": "1. Stable right frontal subdural hematoma measuring 8 mm with unchanged\nmidline shift. Basal cisterns remain patent.\n2. Possible left cerebellar microhemorrhage is likely unchanged from ___\ngiven differences in technique.\n3. No new areas of hemorrhage identified." + }, + { + "input": "Compared to the prior CT from ___, there has been overall interval\nimprovement of the right frontal convexity isodense subdural hematoma, now\nmeasuring up to 3 mm, previously measuring 6 mm, with the extra-axial fluid\ntracking superiorly to the level of the falx. There has been interval\nimprovement in the extent of the midline shift to the left, with residual 2 mm\nleftward midline shift. Mild local sulcal effacement has also improved\ncompared to the prior exam.\n\nNo new hemorrhage is identified. There is no evidence of acute intracranial\ninfarction. Prominence of the ventricles and sulci is likely related to age\nrelated involutional changes. Periventricular and deep subcortical white\nmatter hypodensities are likely sequelae of chronic small vessel ischemic\ndisease.\n\nThe visualized paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. No acute fractures identified. Burr hole changes are seen along\nthe right frontal calvarium.", + "output": "1. Interval improvement of the right frontal subdural hematoma, measuring up\nto 3 mm, previously measuring up to 6 mm, with interval improvement of the\nmidline shift and local mass effect. No new hemorrhage identified." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. Periventricular and subcortical white matter hypodensities are\nnonspecific but likely sequelae of chronic small vessel ischemic disease. \nThere is a possible small arachnoid cyst lateral to the left cerebellar\nhemisphere, unchanged since at least ___. There is prominence of\nthe ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. There are mild-to-moderate left\ntemporomandibular joint degenerative changes. There is mild right maxillary\nsinus, bilateral ethmoid air cell, and right sphenoid sinus mucosal\nthickening. The visualized portion of the mastoid air cellsand middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable\napart from bilateral lens resection. Carotid siphon calcifications are noted.", + "output": "No evidence of an acute intracranial abnormality." + }, + { + "input": "TUBES AND LINES:\nThe patient is intubated and there is an enteric tube in place.\n\nCT HEAD WITHOUT CONTRAST:\nThere has been interval increase in size of a known right parieto-occipital\nintraparenchymal hematoma measuring 9.1 x 5.0 cm, previously measuring up to\n8.2 cm approximately 3 hours earlier.\n\nThere is increased surrounding vasogenic edema with developing subfalcine and\nworsening uncal herniation. There has also been an increase in midline shift\nto the left measuring up to 1.8 cm (previously 1.0 cm) with near complete to\ncomplete effacement of the right lateral ventricle and mass effect on the left\nlateral ventricle. Note is made of interval enlargement of temporal and\noccipital horns of the left lateral ventricle, now measuring up to 1.6 cm\n(previously 1.1 cm), which raises suspicion for obstructive hydrocephalus\n(02:15).\n\nSlight increase in a right frontal convexity subdural hematoma measuring up to\n1.0 cm (02:23). A new small amount of hyperdense material in occipital horn\nof the left lateral ventricle is compatible with intraventricular hemorrhage.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere are atherosclerotic calcifications of the carotid siphons. There is\nevidence of a 1-2 mm infundibulum (3:300) at the left carotid terminus at the\norigin of the posterior communicating artery. There is also a 2 mm\ninfundibulum arising from the superior aspect of the mid left MCA M1 segment\n(3:307, ___. There are mild atherosclerotic calcifications of the V4\nsegment vertebral arteries. The vessels of the circle of ___ and their\nprincipal intracranial branches appear otherwise normal without stenosis,\nocclusion, or aneurysm formation. The dural venous sinuses are not well\nopacified, likely due to bolus timing.\n\nCTA NECK:\nThere is extensive calcified and noncalcified atherosclerotic plaque at the\ncarotid bifurcations with up to 10% stenosis of the right ICA origin by NASCET\ncriteria. There are atherosclerotic calcifications at the origin of the left\nvertebral artery resulting in at least moderate narrowing (3:94). The carotid\nand vertebral arteries and their major branches appear otherwise normal. There\nis no evidence of significant internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThere is evidence of consolidation within the posterior right upper lobe,\npossibly relating to aspiration event. There is mild centrilobular emphysema.\nThe visualized portion of the thyroid gland is within normal limits. There is\nno lymphadenopathy by CT size criteria.", + "output": "1. Interval increase in size of a known right parieto-occipital\nintraparenchymal hematoma, measuring 9.1 x 5.0 cm (previously 8.2 cm earlier\nthe same day).\n2. Increased surrounding vasogenic edema with developing subfalcine and\nworsening uncal herniation.\n3. Increase in midline shift to the left measuring up to 1.8 cm (previously\n1.0 cm) with near complete to complete effacement of the right lateral\nventricle and mass effect on the left lateral ventricle.\n4. Interval enlargement of the temporal and occipital horns of the left\nlateral ventricle raises suspicion for obstructive hydrocephalus.\n5. Slight increase in right frontal convexity subdural hematoma measuring up\nto 1.0 cm).\n6. Evidence of new small left lateral ventricle occipital horn\nintraventricular hemorrhage.\n7. No evidence dissection, aneurysm or occlusion of the head and neck. No\nsignificant ICA stenosis by NASCET criteria.\n8. Posterior right upper lobe consolidation possibly relates to an aspiration\nevent.\n\nNOTIFICATION: *** ED URGENT ATTENTION ***" + }, + { + "input": "There is no evidence of acute large territorial infarction, acute intracranial\nhemorrhage, edema, or mass effect. The ventricles and sulci are normal in\nsize and configuration. Periventricular and subcortical hypodensities are\nnonspecific, but likely reflect chronic small vessel ischemic changes.\n\nSoft tissue swelling at the right posterior parietal calvarium with no osseous\nabnormalities seen. The paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no acute intracranial hemorrhage, acute infarction, edema or mass\neffect. The ventricles and sulci are slightly prominent likely reflective of\nage related involutional changes. There is no shift of normally midline\nstructures. The basal cisterns are clear. The gray white matter\ndifferentiation appears preserved.\n\nNo fracture is identified. Deformity of the left lamina papyracea, can be\ncongenital or related to chronic trauma.\nMild mucosal thickening within the ethmoid air cells is noted. The remainder\nthe visualized paranasal sinuses, middle ear cavities, and mastoid air cells\nbilaterally are clear.\nVascular calcifications are noted in the cavernous carotid segments and distal\ncervical internal carotid arteries on both sides. The orbits are unremarkable.", + "output": "No acute intracranial hemorrhage or mass effect or obvious infarction.\nFor better evaluation of the posterior fossa, MR can be considered if not\ncontraindicated." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are normal in size and configuration.\n\nNo acute fracture is seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or mass\neffect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific but commonly seen with chronic small vessel\nischemic changes.\n\nThere is no acute fracture. There is mild mucosal thickening of the bilateral\nethmoid air cells and maxillary sinuses. The visualized portions of the other\nparanasal sinuses, middle ear cavities and mastoid air cells are clear. The\npatient is status post bilateral lens replacement. Calcifications along the\nbilateral carotid siphons are noted.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. Small lacunar\ninfarct in the left insular region.\n\nThe ventricles and sulci are age appropriate.\nNonspecific periventricular hypodensities, likely sequela of chronic small\nvessel ischemic changes.\nAtherosclerotic changes are seen along both cavernous ICAs and the bilateral\nV4 segments.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. Soft tissue densities in the bilateral external\nauditory canals most likely represents cerumen. The visualized portion of the\norbits are unremarkable.\n\nCTA HEAD:\nThere are severe calcifications along both cavernous ICAs without high-grade\nstenosis along the left ICA.\nThere are mild vessel wall irregularities along the bilateral M1 segments,\nright greater than left, but without high-grade stenosis and suggestive of\nintracranial atherosclerotic changes.\nA small left posterior communicating artery is present, normal anatomic\nvariant.\nThere are atherosclerotic plaques along the left V4 segment without high-grade\nstenosis. The vertebrobasilar junction appears unremarkable. Overall, the\nposterior circulation is small in caliber, likely congenital. Mild to\nmoderate vessel wall irregularities along the bilateral PCAs without\nhigh-grade stenosis and suggestive of intracranial atherosclerotic disease.\nThe dural venous sinuses are patent.\n\nCTA NECK:\nBovine type aortic arch with common origin of the right innominate and left\ncommon carotid arteries. There are mild mixed atheromatous and\natherosclerotic changes along the aortic arch, extending into the great\nvessels with mild narrowing of the origin of the left subclavian artery.\nThere are severe atherosclerotic changes at the bilateral carotid bifurcations\nwith complete occlusion of the right internal carotid artery which appears\nreconstituted from its cavernous portion.\nThere is an approximately 60% stenosis at the origin of the left ICA by NASCET\ncriteria.\n\nThere are small atherosclerotic plaques at the origin of both vertebral\narteries resulting in mild right and moderate severe stenosis\nThe cervical course of both vertebral arteries is otherwise unremarkable.\n\n\nOTHER:\nNo suspicious pulmonary nodules. Mild emphysematous changes in the bilateral\nupper lobes. The thyroid is multinodular with a dominant 1.6 cm heterogeneous\nright thyroid lobe mass. There is no lymphadenopathy by CT size criteria.", + "output": "1. No evidence of acute infarction, hemorrhage or intracranial mass.\n2. Nonspecific periventricular hypodensities, likely sequela of chronic small\nvessel ischemic changes.\n3. Diffuse atherosclerotic changes throughout the cervical vasculature\nresulting in an approximately 60% stenosis at the origin of the left ICA by\nNASCET criteria, mild left subclavian artery origin stenosis and moderate to\nsevere left as well as mild right vertebral artery origin stenosis.\n4. Complete occlusion of the right internal carotid artery with reconstitution\nfrom its cavernous portion.\n5. Vessel wall irregularities of the intracranial vasculature without\nhigh-grade stenosis, suggestive of intracranial atherosclerotic disease.\n6. Multinodular thyroid with dominant 1.6 cm heterogeneous nodule in the right\nthyroid lobe.\n\nRECOMMENDATION(S): Thyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or older, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "This exam is mildly limited by motion artifact.\n\nSubacute infarct is seen in the right MCA territory involving the right\nfrontal, parietal and temporal lobes, right basal ganglia. No significant\nmidline shift. The basal cisterns are patent. Similar to the MR there are\npunctate areas of hyperattenuation in the right basal ganglia, consistent with\nmicrohemorrhage. Mild subcortical and periventricular white matter\nhypodensities are nonspecific, likely the sequelae of chronic small vessel\nischemic disease. No new hemorrhage. No new infarct. If\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. The\nvisualized portion of the orbits show bilateral lens replacement.", + "output": "1. Stable large subacute right MCA distribution infarct, with area of\nmicrohemorrhage in the right basal ganglia, similar.\n2. No midline shift, no uncal herniation." + }, + { + "input": "There is mild motion artifact. Mild rightward tilt of the patient's head\nfurther limits evaluation.\n\nAgain seen is the evolving subacute infarct in the right MCA territory\ninvolving the insula, frontal, parietal and temporal lobes, similar in extent,\nand with stable extent of hemorrhagic conversion centered in the basal\nganglia. No evidence for new hemorrhage. Partial effacement of the right\nlateral ventricle is unchanged. No shift of midline structures or compression\nof basal cisterns. Foci of hypodensity in the subcortical and periventricular\nwhite matter away from the right MCA infarct are again seen, nonspecific but\nlikely sequela of chronic small vessel ischemic disease in this age group.\n\nThere is mild mucosal thickening in the right maxillary sinus. There is\nquestionable trace fluid in the left mastoid tip air cells, difficult to\nevaluate in the absence of dedicated bone algorithm images. The patient is\nstatus post bilateral cataract surgery. There are extensive calcifications of\nthe bilateral common carotid artery bifurcations. There are degenerative\nchanges in the included upper cervical spine.", + "output": "No significant change in the subacute right MCA territory infarct. Stable\nextent of hemorrhagic transformation centered in the basal ganglia. Stable\nmass effect." + }, + { + "input": "There is no acute hemorrhage, edema, mass effect, loss of gray/ white matter\ndifferentiation, or pathologic extra-axial collection. Ventricles, sulci, and\nbasal cisterns are normal in size. Mild hypodensity in bilateral centrum\nsemiovale is nonspecific but compatible with sequela of mild chronic small\nvessel ischemic disease in this age group.\n\nNo fracture is seen. There is a tiny mucous retention cyst along the anterior\nwall of the right sphenoid sinus. Other included paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear.", + "output": "No evidence for acute intracranial abnormalities." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific, but likely reflect the sequela of chronic\nmicrovascular infarction.\n\nLarge left frontal subgaleal hematoma with left periorbital soft tissue\nswelling is demonstrated. There is no evidence of fracture. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. Globes are intact.", + "output": "1. Large left frontal subgaleal hematoma and left periorbital soft tissue\nswelling without acute fracture. Intact globes.\n2. No acute intracranial hemorrhage or mass effect." + }, + { + "input": "There is no evidence of acute large territory infarction, hemorrhage, edema,\nor mass effect. The ventricles and sulci are normal in size and\nconfiguration.\n\nNo acute fracture is seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear.", + "output": "No acute intracranial abnormalities." + }, + { + "input": "Dental amalgam streak artifact limits study. Additionally, venous contrast\nconcentration prevents evaluation of left artery origin through mid V2\nsegment. Within these confines:\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nVenous contrast concentration prevents evaluation of left artery origin\nthrough mid V2 segment. Otherwise, the carotid and vertebral arteries and\ntheir major branches appear normal with no evidence of stenosis or occlusion.\nThere is no evidence of internal carotid stenosis by NASCET criteria. The\nright subclavian takes a retroesophageal course.\n\nOTHER:\n Scattered subcentimeter nonspecific lymph nodes are noted throughout the neck\nbilaterally, without definite enlargement by CT size criteria.", + "output": "1. Dental amalgam and venous contrast concentration streak artifact limits\nstudy.\n2. Patent circle of ___ without definite evidence of occlusion, stenosis,\nor aneurysm greater than 3 mm.\n3. Venous contrast concentration prevents evaluation of left artery origin\nthrough mid V2 segment.\n4. Otherwise, patent bilateral cervical carotid and vertebral arteries without\ndefinite evidence of stenosis by NASCET criteria, occlusion, or dissection.\n5. Nonspecific subcentimeter mildly prominent cervical lymph nodes as\ndescribed, which may be reactive.\n6. Of note during the examination following contrast injection with 70 cc of\nOptiray patient developed 2 hives in complained of skin itchiness. No\nadditional clinical findings were discovered on examination. This information\nwas relayed to ED team taking care patient.\n\nNOTIFICATION: Of note during the examination following contrast injection\nwith 70 cc of Optiray patient developed 2 hives and complained of skin\nitchiness. No additional clinical findings were discovered on examination.\nThis information was relayed to ED team taking care patient.\n\nThe findings were discussed with ___, M.D. by ___, M.D. on the\ntelephone on ___ at 11:03 pm." + }, + { + "input": "Head CT: There is no evidence of hemorrhage, edema, masses, mass effect, or\ninfarction. The ventricles and sulci are normal in caliber and configuration. \nThe basal cisterns appear patent and there is preservation of gray-white\nmatter differentiation. No acute osseous abnormality is identified. There is\nmucosal thickening in the bilateral maxillary sinuses, ethmoid air cells, and\nsphenoid sinuses. The mastoid air cells are clear. The globes are\nunremarkable.\n\nHead CTA: Again seen is a 1 mm protuberance arising from the superior aspect\nof the M1 branch of the right middle cerebral artery at the origin of the\nlenticulostriate arteries. There is a 2 mm infundibulum at the origin of the\nright inferior temporal artery at the level of the right MCA bifurcation. No\nadditional aneurysmal formation is identified. The intracranial vessels are\npatent without evidence of stenosis or occlusion. Atherosclerotic\ncalcifications of the carotid siphons are noted bilaterally.", + "output": "1. No evidence of acute intracranial process.\n\n2. Unchanged 2 mm infundibulum at the origin of the right anterior temporal\nvessel at the MCA bifurcation. Stable 1 mm infundibulum in the mid M1 segment\nof the MCA at the origin of the lenticulostriate arteries. No other aneurysmal\nformations identified." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or infarction. There\nis a small area of hypodensity involving the right basal ganglia which most\nlikely represents a chronic lacune.\n\nThe ventricles and sulci are normal in size and configuration.\n\nThe basal cisterns appear patent and there is preservation of gray-white\nmatter differentiation.\n\nEvaluation is somewhat limited due to motion artifact however there is no\nevidence of fracture.\n\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\n\nThe globes are unremarkable.", + "output": "No acute intracranial process. Chronic right basal ganglia lacunar infarct." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Normal study. No intracranial hemorrhage." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. Moderate\nbrain parenchymal atrophy. Chronic small vessel ischemic change. Tiny\nchronic right cerebellar infarct.\n\nThere is no evidence of fracture. Chronic left maxillary periostitis with\nnear complete opacification, consistent chronic sinusitis. Trace\nopacification remaining paranasal sinuses, likely from intubation. \nContraction of mastoid air cells with ossification.", + "output": "1. No acute intracranial process.\n2. Chronic left maxillary sinusitis.\n3. Moderate brain parenchymal atrophy." + }, + { + "input": "There is mild fat stranding and soft tissue swelling over the left periorbital\nand pre maxillary area as well over the nasal bridge and to a lesser extent\noverlying the right frontal bone and right pre maxillary region. No underlying\nfracture. There is mucosal thickening of the bilateral maxillary sinuses,\nanterior ethmoid air cell, and right frontal sinus. The visualized mastoid\nair cells and middle ear cavities are clear.\nThere is no evidence of abnormal fluid collections.\nThe globes, extraocular muscles, optic nerves, and retrobulbar fat appear\nnormal.\nThe visualized upper aerodigestive tract appears normal.\nThe mandible and temporomandibular joints appear normal.", + "output": "1. Mild soft tissue swelling over the left periorbital area, bilateral pre\nmaxillary soft tissues, right frontal region, and nasal bridge without\nunderlying fracture.\n2. Mucosal thickening of the bilateral maxillary sinuses and anterior ethmoid\nair cells as well as the right frontal sinus." + }, + { + "input": "There is no evidence of acute large territory infarction, hemorrhage, edema,\nor mass. The hypodensity within the right caudate head likely represents a\nchronic infarct (series 2, image 15). The subcortical, deep, and\nperiventricular white matter hypodensities are nonspecific, but likely\nrepresent the sequela of chronic microvascular ischemic disease. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nDense atherosclerotic calcifications are seen in the cavernous carotid and\ndistal vertebral arteries.\n\nThere is no evidence of fracture. There is moderate to severe mucosal\nthickening involving the right maxillary sinus with sclerosis and thickening\nof the sinus walls suggests a chronic sinus inflammation. Mild mucosal\nthickening is also noted involving the ethmoid air cells bilaterally. The\nvisualized portion of the mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. No evidence of acute territorial infarction or hemorrhage. Please note\nthat MRI is more sensitive for detection of acute infarction.\n2. Chronic small vessel ischemic changes.\n3. Paranasal sinus disease as described above." + }, + { + "input": "No acute intracranial hemorrhage. No acute infarction. No intracranial mass\nor mass effect. There is a 5 mm curvilinear calcification projecting off of\nthe superomedial aspect of the supraclinoid left ICA, raising the possibility\nof an aneurysm (series 3, image 27). There is atherosclerotic calcification of\nthe cavernous portion of the internal carotid arteries as well as the V4\nsegments of the vertebral arteries.\n\nThere are prominent ventricles and sulci bilaterally, consistent with moderate\nage-related involutional changes. Multiple periventricular and subcortical\nwhite matter hypodensities clearing in the bilateral basal ganglia likely\nrepresent sequela from chronic microangiopathy.\n\nThere is no evidence of fracture. There is a mucous retention cyst the right\nmaxillary and left sphenoid sinus, as well as fluid within the posterior right\nethmoid air cells. The visualized portion of the mastoid air cellsand middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial hemorrhage or territorial infarct.\n2. Apparent 5 mm outpouching off the supraclinoid left ICA, raising the\npossibility of an aneurysm.\n3. Moderate involutional changes with evidence of chronic microangiopathy.\n4. Atherosclerotic calcification of the intracranial carotid and vertebral\narteries.\n\nRECOMMENDATION(S): Consider head CTA or MRA for further evaluation of\npossible aneurysm." + }, + { + "input": "There is no evidence of major acute infarction, hemorrhage, edema, or mass\neffect. Small hypodensity in the anterior limb of the right internal capsule\nlikely represents a chronic lacunar infarct.\nProminent ventricles and sulci suggest age related global atrophy.\nPeriventricular and subcortical white matter hypodense foci are nonspecific,\nbut likely reflect sequelae of chronic small vessel ischemic disease.\nSmall focus of calcification in the left M2 branch is unchanged since ___.\nThe basal cisterns appear patent and there is preservation of gray-white\nmatter differentiation.\n\nNo osseous abnormalities seen.\nThere is mild mucosal thickening of the left maxillary sinus.\nThe remaining paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear.\nThe orbits are unremarkable. Status post bilateral lens replacement.", + "output": "No evidence of acute intracranial hemorrhage or mass effect or major\nterritorial infarct.\nCorrelate clinically to decide on the need for further workup or followup.\n\nRECOMMENDATION(S): Follow-up CT as pt. cannot have MRI can be considered if\nneeded after neurologic correlation." + }, + { + "input": "There is minimal haziness of the retropharyngeal fat spanning from C2-3 to the\nregion of C5-6, corresponding to the fluid and edema seen on MRI. \nAdditionally, there is a focal calcification to the left of midline at C5-6\n(02:59), in this region of edema. There is no abnormal enhancement or abscess\nclearly noted. Tonsillith in the left tonsillar pillar likely corresponds to\nprior infection. There is no cervical lymphadenopathy. The aerodigestive\ntract is clear. The imaged paranasal sinuses, mastoid air cells, and middle\near cavities are clear.\n\nThe neck vasculature enhances homogeneously. A hypodense lesion in the left\nlobe of the thyroid measuring 7 mm corresponds to a hyperintense lesion on T2\nweighted sequences on MRI with apparent peripheral enhancement. The parotid\nand submandibular glands are normal. Limited images of the lung apices are\nclear. Soft tissue in the anterior mediastinum likely corresponds to thymic\ntissue.\n\nNo osseous abnormality of the cervical spine or imaged ribs is noted including\nno fracture or subluxation. No calvarial fracture appreciated.", + "output": "1. Focal calcification to the left of midline in the retropharyngeal region,\nat C5-6, with haziness of the retropharyngeal fat corresponding to the fluid\nand edema seen on the outside hospital MRI. A possible etiology for the edema\nand neck pain is calcific tendinitis of the longus coli muscle, which resolves\nwith nonsteroidal anti-inflammatories and conservative treatment. Typically,\nthe calcification with this pathology is seen at C1-2, but has been reported\nto be seen at C5-6. No enhancement of the retropharyngeal soft tissues. \nReference: Park ___ W, ___ SH et al. Acute retropharyngeal calcific\ntendinitis: A case report with unusual location of calcification. Skeletal\nRadiology ___ 39:817-820.\n2. 7 mm hypodense left thyroid lesion for which dedicated thyroid ultrasound\nis recommended.\n\nRECOMMENDATION(S): Thyroid ultrasound is suggested for the 7 mm left thyroid\nhypodense lesion." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of large territorial infarction,hemorrhage,edema, mass\neffectormass. The ventricles and sulci are age-appropriate. Multiple\nhypodensities within the subcortical and periventricular white matter are\nnonspecific but likely sequela of chronic microvascular ischemic disease. The\nbilateral cavernous portions of the internal carotid arteries demonstrate\nmoderate calcified atherosclerosis. A possible left temporal lobe choroidal\nfissure cyst remains unchanged.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is calcified atherosclerosis within the bilateral intracranial internal\ncarotid arteries, and V4 portions of the left vertebral artery without\nevidence of significant stenosis. The vessels of the circle of ___ and\ntheir principal intracranial branches appear normal without stenosis,\nocclusion, or aneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nThe bilateral carotid arteries demonstrate calcified atherosclerosis, the\nright internal carotid artery demonstrates no stenosis by NASCET criteria. \nThe left internal carotid artery demonstrates 50% stenosis by NASCET criteria,\n(series 3 image 135-145), however there is no evidence of occlusion. \nThevertebral arteries demonstrate calcified atherosclerosis without\nsignificant stenosis or occlusion.\n\nOTHER:\nThe visualized lungs demonstrate severe centrilobular emphysema and bullous\nchanges. The thyroid is unremarkable. No lymphadenopathy by CT criteria is\nidentified. Multilevel degenerative changes are visualized throughout the\ncervical spine consistent with anterior and posterior spondylosis, more\nsignificant from C4 through C6 levels.", + "output": "1. The left internal carotid artery demonstrates calcified atherosclerosis and\n50% stenosis by NASCET criteria.\n2. Normal head CTA .\n3. No acute intracranial process or hemorrhage." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere are bilateral deep gray and deep white matter chronic infarctions and\nlacunes that are unchanged from prior CT 1 month ago.\n\nThere is no evidence of hemorrhage,edema,ormass. The ventricles and sulci are\nnormal in size and configuration. There are periventricular hypodensities that\nare nonspecific but most likely represent chronic small vessel ischemia\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\n\nCTA HEAD:\nCalcified atherosclerosis within the bilateral intracranial internal carotid\narteries, and V4 portions of the left vertebral artery without evidence of\nstenosis. The vessels of the circle of ___ and their principal\nintracranial branches appear normal without stenosis, occlusion, or aneurysm\nformation. The dural venous sinuses are patent.\n\nCTA NECK:\n\nThe bilateral carotid arteries demonstrate calcified atherosclerosis. The\nleft internal carotid artery demonstrates no stenosis by NASCET criteria. The\nright internal carotid artery demonstrates 50% stenosis by NASCET criteria,\nunchanged from prior Imaging on ___, and without evidence of\nocclusion. The vertebral arteries demonstrate calcified atherosclerosis\nwithout significant stenosis or occlusion.\n\nOTHER:\nThe visualized portion of the lungs demonstrate severe centrilobular emphysema\nand bullous changes. The visualized portion of the thyroid gland is within\nnormal limits. There is no lymphadenopathy by CT size criteria. There are\nmultilevel degenerative changes throughout the cervical spine consistent with\nanterior and posterior spondylosis, most consistent at the C4, C5, and C6\nlevels.", + "output": "1. The right internal carotid artery demonstrates calcified atherosclerosis\nwith 50% stenosis by NASCET criteria.\n2. Normal head CTA.\n3. No evidence of hemorrhage on noncontrast head CT." + }, + { + "input": "Venous contrast poolingand patient body habitus limits study.\n\nCT HEAD WITHOUT CONTRAST:\nRedemonstration of bilateral deep gray and deep white matter different ages\ninfarcts, unchanged or ___. There is no evidence of acute large\nterritorial infarction, acute intracranial hemorrhage, edema, or mass effect. \nThe ventricles and sulci are prominent, likely age related involutional\nchanges. Periventricular hypodensities are nonspecific, but likely reflect\nchronic small vessel ischemic changes.\n\nNo osseous abnormalities seen. The mastoid air cells, and middle ear cavities\nare clear. The orbits are preserved. Bilateral maxillary sinus mucosal\nthickening is present.\n\nCTA HEAD:\n Nonocclusive atherosclerotic narrowing of the cavernous and supraclinoid\nsegments of the bilateral internal carotid arteries and bilateral V4 segments\nare seen.\n\nOtherwise, vessels of the circle of ___ and their principal intracranial\nbranches are grossly preserved, without definite stenosis, occlusion, or\naneurysm formation greater than 3mm. The dural venous sinuses are grossly\npatent.\n\nCTA NECK:\nNonocclusive atherosclerotic calcifications of the aortic arch are noted. \nBilateral carotid and vertebral artery origins are patent. Nonocclusive\natherosclerotic calcifications of bilateral common carotid artery origins and\nleft subclavian artery origin.\n\nApproximately 30% stenosis of the left and 40% of the right internal carotid\nartery origins are noted. Otherwise, the carotid and vertebral arteries and\ntheir major branches appear patent. There is no evidence of moderate or\nhigh-grade internal carotid stenosis by NASCET criteria.\n\nOTHER:\nExtensive emphysematous changes affecting included upper lobes of both lungs\nwith multiple large apical blebs. The visualized portion of the thyroid gland\nis preserved. There is no lymphadenopathy by CT size criteria.", + "output": "1. Limited study, as described.\n2. Redemonstration of bilateral deep gray and deep white matter different ages\ninfarcts.\n3. Nonocclusive atherosclerotic narrowing of circle ___ as described.\n4. Otherwise, grossly patent circle of ___ without definite evidence of\nstenosis,occlusion,or aneurysm.\n5. Nonocclusive cervical arterial atherosclerotic disease as described.\n6. Otherwise, grossly patent bilateral cervical carotid and vertebral arteries\nwithout definite evidence of stenosis, occlusion, or dissection.\n7. Extensive emphysematous changes affecting included upper lobes of both\nlungs with multiple large apical blebs. Further evaluation by dedicated HRCT\nchest is advised.\n8. Additional findings as described above." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nMinimal mucosal thickening in the inferior aspect of the left maxillary\nsinus.. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nMild biapical pleural-parenchymal scarring. 6 mm thyroid nodule does not\nnecessitate routine thyroid ultrasound on imaging ground according to ACR\nguidelines. There is no lymphadenopathy by CT size criteria.", + "output": "1. No evidence of hemorrhage, mass or infarct.\n2. No evidence of aneurysm or occlusion.\n3. No significant carotid artery stenosis by NASCET criteria." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, ormass effect.\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Periventricular, subcortical hypodensities are consistent with\nchronic small vessel ischemic disease.\n\nThere is no evidence of fracture. Patient is status post transsphenoidal\nresection of the pituitary and post surgical changes are seen. The visualized\nportion of the other paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable. \nThere is evidence of left lens replacement. Dense carotid siphon\ncalcifications are seen bilaterally.", + "output": "1. No acute intracranial abnormalities.\n2. Status post transsphenoidal resection. Stable post surgical changes." + }, + { + "input": "Study is mildly degraded by motion.\n\nThere are postsurgical changes after prior transsphenoidal resection. Left\nsella mass measuring 1.3 x 1.3 cm is grossly unchanged from the recent MRI\ndated ___, accounting for differences in technique (400b:47).\n\nThere is no evidence of acute infarction, hemorrhage, or edema. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nBilateral periventricular and subcortical white matter hypodensities are\nnonspecific, but likely a sequela of chronic small vessel disease.\nAtherosclerotic vascular calcifications are noted of bilateral vertebral and\ncavernous portions of internal carotid arteries.\n\nThere is no evidence of fracture. The visualized portion of the mastoid air\ncells, and middle ear cavities are clear. Other than prior left lens\nreplacement, the orbits are unremarkable. Minimal bilateral maxillary sinus\nmucosal thickening is present.", + "output": "1. Study is mildly degraded by motion.\n2. No acute intracranial abnormality common no evidence of acute intracranial\nhemorrhage.\n3. Allowing for difference in technique, grossly stable size of a left sella\nmass, and postsurgical change related to prior transsphenoidal resection\ncompared to ___ prior exam.\n4. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass. There\nis prominence of the ventricles and sulci suggestive of involutional changes.\nPeriventricular and subcortical hypodensities are nonspecific, however likely\nsequela of chronic small vessel ischemic disease.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. \nPatient is status post left replacement.", + "output": "1. No acute intracranial abnormalities." + }, + { + "input": "There is no acute hemorrhage, edema or shift of the normally midline\nstructures. Prominence of the ventricles and sulci is compatible with age\nrelated involutional changes and is unchanged from ___. The\ngray-white matter differentiation is preserved and there is no evidence for an\nacute vascular infarction. The basal cisterns are patent. The known left\nsellar mass is unchanged from ___, accounting for differences in\ntechnique.\n\nThere is mild mucosal thickening within the maxillary sinuses, otherwise, the\nincluded paranasal sinuses and mastoid air cells are well-aerated. Defect in\nthe posterior aspect of the nasal septum and anterior walls of the sphenoid\nsinuses are compatible with prior transsphenoidal hypophysectomy. The lenses\nand globes are normal. There is no acute calvarial fracture.", + "output": "1. No acute intracranial process.\n2. Though incompletely evaluated, unchanged sellar mass from ___,\naccounting for differences in technique." + }, + { + "input": "In the right frontal lobe, there is a focus of hemorrhage measuring 6 x 6 mm.\nThis exerts no significant mass effect. There is no other focus of hemorrhage.\nThe ventricles are normal in size. There is no shift of the midline\nstructures. No subdural collections are noted. No evidence of loss of\ngray-white matter differentiation. Paranasal sinuses and mastoid air cells\nare clear.", + "output": "Small focus of hemorrhage in the right frontal lobe. No prior exams are\navailable for comparison on PACS at this time." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or infarction. There\nis a small area of hypodensity in the right frontal lobe at the location of\nthe prior hematoma. The ventricles and sulci are normal in size and\nconfiguration.The basal cisterns appear patent and there is preservation of\ngray-white matter differentiation.\n\nThe visualized bony structures are grossly unremarkable.There is right frontal\nscalp thickening, which likely represents scar.\nThere is minimal mucosal thickening of the ethmoid air cells and bilateral\nsphenoid sinuses. The maxillary sinuses are clear. The mastoid air cells are\nwell aerated.\n\nThe globes are unremarkable.", + "output": "Small hypodense focus at the area of prior hemmorhage, likely representing a\nsmall focus of fluid. No evidence of new hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nphysiologic calcification in the left globus pallidus. The brain is atrophic.\nThe ventricular system is unremarkable. There is vascular calcification in\nthe left vertebral artery.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. There is no evidence of hemorrhage, infarction, or mass." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no intra or extra-axial mass effect, acute hemorrhage or large\nterritory infarct. The sulci, ventricles cisterns are within expected limits\nfor the patient's mild senescent related global cerebral and loss. Mild\nperiventricular and subcortical white matter hypodensities are nonspecific,\nbut compatible with chronic microangiopathy in a patient this age.\n\nThere is mild mucosal thickening of the ethmoid air cells and maxillary\nsinuses. The maxillary sinus walls are hyperostotic with atretic appearance,\nlikely representing sequela of chronic sinusitis. The mastoid air cells are\npoorly pneumatized and sclerotic, with opacification of the left mastoid air\ncell and middle ears. The right mastoid air cells and middle ears are clear.\n\nThe orbits are unremarkable..\n\nCTA HEAD:\nModerate atherosclerotic calcification of the right greater than left\nparaclinoid ICAs is identified. Otherwise, the ACA, MCA and their major\nbranches are unremarkable without evidence of high-grade stenosis, occlusion\nor aneurysm. Short-segment stenosis of the distal right V4 segment and\nproximal basilar arteries is likely secondary to atherosclerotic disease. The\nremainder of the posterior circulation is unremarkable. The dural venous\nsinuses are patent.\n\nCTA NECK:\nMild atherosclerotic calcification of the aortic arch and bilateral carotid\nbifurcations are noted. Otherwise, the right brachiocephalic, bilateral\ncommon carotid, subclavian and vertebral arteries are unremarkable. The left\nvertebral artery is dominant, a normal variant. There is no stenosis of the\ncervical internal carotid arteries by NASCET criteria.\n\nOTHER: There is biapical pleuroparenchymal scarring with large calcified\ngranulomas, presumably sequela of chronic granulomatous disease. There is a 2\nmm left upper lobe nodule (series 3, image 25). There is suggestion of a\ncalcified upper mediastinal lymph node (series 3, image 1).\n\nThe thyroid is slightly heterogeneous demonstrating small nodules measuring up\n7 mm.\n\nThere is no cervical lymphadenopathy by size criteria. The visualized\naerodigestive tract is unremarkable.\n\nThere is mild cervical spondylosis without evidence of high-grade spinal canal\nor neural foraminal narrowing. No suspicious osteoblastic or lytic lesion.", + "output": "1. No acute intracranial abnormality on noncontrast CT head. Specifically no\nacute large territory infarct or intracranial hemorrhage.\n2. There is short-segment stenosis of the distal V4 segment and proximal\nbasilar artery, likely secondary to atherosclerotic disease. There is also\nmoderate atherosclerotic calcifications of the bilateral paraclinoid ICAs. \nThe remainder the CTA head is unremarkable. Allowing for mild atherosclerotic\ndisease, unremarkable CTA of the neck. There is no stenosis of the cervical\ninternal carotid arteries by NASCET criteria.\n3. Biapical pleuroparenchymal scarring with large calcified granulomas, as\nwell as likely calcified upper mediastinal lymph node. Findings are\ncompatible with sequela of prior granulomatous disease. There is a\nnoncalcified 2 mm left upper lobe pulmonary nodule.\n4. The thyroid is heterogeneous demonstrating small nodules measuring up to 7\nmm.\n5. Additional findings as described above.\n\nRECOMMENDATION(S): For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___\n\n\nThyroid nodule. No ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or ___, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "There is no evidence of acute large territory infarction,\nintracranialhemorrhage,edema,or discrete Mass. The ventricles and sulci are\nnormal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear.", + "output": "No acute intracranial abnormality." + }, + { + "input": "Right MCA territory encephalomalacia is again seen with areas of hyperdensity\nthought to represent calcification within this region, difficult to entirely\nexclude the possibility of subtle hemorrhage given its appearance and absence\nof priors. Otherwise, no signs of acute hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major infarction. Slight ex vacuo\ndilatation of the right frontal horn is noted. Otherwise been trigger size\nand shape is normal. Basal cisterns are patent.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "Chronic encephalomalacia in the right MCA territory with tiny foci of\nhyperdensity within the infarcted region thought to represent foci of\ncalcification. Please note that the absence of priors, impossible to truly\nexclude the possibility of subtle hemorrhage. Consider follow-up to confirm\nstability.\n\nNOTIFICATION: ___ MD notified by ___ van ___ MD by\ntelephone at 11:52 MA on ___ 5 minutes after discovery of findings." + }, + { + "input": "Within these limitations, there is no definite evidence of acute large\nterritorial infarction,hemorrhage,edema,or discrete mass. The ventricles and\nsulci are normal in size and configuration. The basilar cisterns are patent.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute findings." + }, + { + "input": "There is severe atrophy of the left cerebral hemisphere, with development of a\nporencephalic cyst measuring up to 11.8 cm in the sagittal diameter and 5.2 cm\nin the axial diameter. There is subcortical and periventricular white matter\nhypodensities, these are nonspecific however likely sequela of chronic small\nvessel ischemic disease. There is no evidence of fracture, acute large\nvascular territory infarction,hemorrhage,or edema. The right lateral\nventricles is normal in size, there is no evidence of ventricular obstruction.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal,\nhowever the patient appears to be status post bilateral lens surgery and there\nis a left scleral band noted.", + "output": "1. Severe chronic atrophy of the left hemisphere and development of a\nporencephalic cysts measuring 11.8 x 5.2 cm.\n2. There is no evidence of and acute large vascular territory infarction,\nhowever if stroke is of continued clinical concern, MRI of the brain would be\na more sensitive exam.\n3. Other findings as described above." + }, + { + "input": "Re-demonstration of severe atrophy involving the left cerebral hemisphere with\na left porencephalic cyst measuring 5.5 x 12.2 cm in largest axial, similar\nfrom prior and appearing to communicate with the left lateral ventricle\n(2:16). Atrophy involving the left greater than right anterior temporal lobes\nand right cerebral hemisphere are similar from prior.\n\nThere is no evidence of acute large territorial infarction, intracranial\nhemorrhage, edema or mass. Interval progression hypodensity within the right\nthalamus more conspicuous on prior and possibly the sequelae of prior, now\nremote infarction (2:14). Periventricular and subcortical white matter\nhypodensities are nonspecific but may reflect the sequelae of chronic small\nvessel ischemic disease. There is minimal leftward shift midline structures\nas on prior and likely due to underlying left cerebral hemisphere atrophy. \nThe basal cisterns are patent.\n\nVisualized paranasal sinuses, mastoid air cells and middle ear cavities clear.\nThe patient is status post right lens replacement and left scleral banding.", + "output": "1. No evidence of acute intracranial process.\n2. Stable interval appearance of severe chronic atrophy of the left cerebral\nhemisphere with a large 12.2 cm porencephalic cyst appearing to communicate\nwith the left lateral ventricle. Additional sites of brain parenchymal\natrophy as described above.\n3. Probable lacunar infarct in the right thalamus and sequelae of chronic\nsmall vessel ischemic disease." + }, + { + "input": "CT HEAD WITHOUT CONTRAST: Significant streak artifact limits evaluation of\nthe brainparenchyma. There is low-density and swelling in the left MCA\nterritory, including the frontal and parietal lobes and involving the left\ninsular cortex. These findings suggest an acute infarction in this\ndistribution\n\nThere is no evidence of no evidence ofhemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. There is\nhyperdensity at the left middle cerebral artery bifurcation, reflecting\nthrombus.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD: There is atherosclerotic calcification the cavernous internal\ncarotid arteries. There is a focal filling defect in the MCA bifurcation, at\nthe level of the superior left M2 branch, best seen on series 8, image 289. \nDecreased arborization left MCA branches is seen. There is atherosclerotic\ncalcification of the left V4 vertebral artery. The right vertebral artery is\ndiminutive in appearance. The distal right V3 and proximal/mid right V4\nvertebral artery are poorly visualized with reconstitution in the distal right\nV4 vertebral segment. These findings suggest distal right vertebral artery\nocclusion. There is no evidence for aneurysm formation. The dural venous\nsinuses are patent.\n\nCTA NECK: There is atherosclerotic calcification of the aortic arch and\nbranch vessels. There is atherosclerosis of the carotid bulbs. Otherwise,\nthe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. Degenerative changes are noted the bilateral sternoclavicular\njoint. Median sternotomy wires are partially visualized. Surgical clips are\nseen in the anterior mediastinum. There degenerative changes throughout the\nspine. Debris is noted in the supraglottic airway.", + "output": "1. Acute large left MCA infarction with no evidence of hemorrhage or midline\nshift.\n2. Focal thrombus in the superior left M2 MCA with decreased arborization of\nMCA branches on the left.\n3. Nonvisualization of the distal right V3/V4 vertebral artery, suggesting\ndistal occlusion." + }, + { + "input": "The study is mildly limited evaluation given streak artifact, predominantly in\nthe posterior fossa.\n\nThere is marked loss of gray-white matter differentiation in the left MCA\nterritory, involving the frontal and parietal lobe, and the insular cortex\nwith increased sulcal effacement. No hemorrhage, mass effect or midline shift\nis seen. Focal hyperdensity is noted within the left M2 MCA in the anterior\nsylvian fissure, consistent with known thrombus.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable. There is\natherosclerotic calcification of the cavernous internal carotid and vertebral\narteries.", + "output": "Evolving large acute left MCA infarction with increased sulcal effacement and\nno hemorrhage or midline shift." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territorial infarct. Prominence of the\nventricles and sulci is consistent with cortical volume loss. Periventricular\nand subcortical white matter hypodensities are likely sequelae of chronic\nsmall vessel disease. The visualized paranasal sinuses are clear. The\nmastoid air cells are clear. No acute fracture is seen. The patient appears\nto be status post bilateral lens replacements. Slight oblong appearance of\nthe globes can be seen in with myopia.", + "output": "No acute intracranial process.\n\nPatient appears to be status post bilateral lens replacements. Slight oblong\nappearance of the globes can be seen in with myopia." + }, + { + "input": "There is a common origin of the brachiocephalic and left common carotid\nartery, a normal variant. The bilateral cervical vertebral and internal\ncarotid arteries are patent without evidence of flow-limiting stenosis or\ndissection. The distal internal cervical carotid arteries measure 4 mm on the\nright, and 4 mm on the left.\n\nWithin the intracranial arterial vasculature, There is no evidence for\nflow-limiting stenosis or aneurysm. There is a right ___ complex, a\nnormal variant.\n\nEvaluation of the imaged upper lungs is limited by respiratory motion.\nDependent atelectasis is noted. There is a small right maxillary sinus mucous\nretention cyst. There is mild degenerative joint disease of the cervical\nspine.", + "output": "Normal CTA of the head and neck." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass effect.\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Periventricular, subcortical hypodensities are consistent with\nchronic small vessel ischemic disease. Fat density lesion compatible with\nlipoma seen in the suprasellar cistern (602b:41).\n\nThere is no evidence of fracture. Soft tissue swelling overlying the right\nparietal bone is seen. There is mucosal thickening of the ethmoid air cells. \nFew scattered opacified left mastoid air cells are noted. The visualized\nportion of the other paranasal sinuses,right mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormalities.\n2. Soft tissue swelling overlying the right parietal bone without underlying\nfracture." + }, + { + "input": "There is complete opacification of the right maxillary sinus, right middle and\nsuperior meatus, ethmoid air cells and right frontal sinus. There is mild\nbowing of the medial wall of the right maxillary sinus with expansion of the\nright infundibulum of the ostiomeatal unit. There is mild soft tissue\nextending into the right nasopharynx to the choana (series 2, image 28). The\ncenter process and ethmoid air cells on the right appear demineralized. Mild\nsclerosis of the frontal sinus walls would suggest a chronic process. The\nmaterial is slightly hyperdense and may represent inspissated secretions\nversus fungal colonization.\n\nThere is a periapical lucency ___ tooth #2 which is dehiscence and extends\ninto the inferior floor of the maxillary sinus (series 601b, image 61 and\nseries 3, image 6)\n\nMild mucosal thickening of the right maxillary sinus, frontal sinus, ethmoid\nair cells is noted. Minimal opacification of a few left anterior ethmoid air\ncells are noted.\n\nMucosal thickening of the left frontal ethmoidal recess is noted. The right\nfrontal ethmoidal recess and infundibulum are completely opacified.\n\nThe left infundibulum is patent. There are bilateral left larger than right\nHaller air cells, which is completely opacified on the right.\n\nThe left cribriform plate and bilateral lamina papyracea are intact. The\nright cribriform plate is demineralized and difficult to evaluate secondary to\nsoft tissue. However, no gross defects are identified.\n\nThe nasal septum is deviated to the right with a rightward projecting spur\nwithout evidence of nasal septal defect.\n\nThe sphenoid septum bifurcate inserts on the posterior wall of the sphenoid\nsinus and left carotid canal.\n\nThe anterior clinoid processes are not pneumatized.\n\nOld left MCA territory infarct involving the frontal lobe, insula and the left\nfrontal, temporal and parietal operculum is noted. Although the examination\nis not optimized for evaluation of the brain parenchyma, no new acute\nterritorial infarct is identified. Extensive atherosclerotic calcification of\nthe bilateral internal carotid arteries are noted.\n\nHyperdense left cerebellopontine angle lesion with extension into the left\ninternal auditory canal is re- identified, presumably representing a\nschwannoma. Allowing for differences in technique this is not substantially\ndifferent in size.", + "output": "1. Complete opacification of the right maxillary sinus, right middle and\nsuperior meatus, right ethmoid air cells and right frontal sinus. The\nmaterial is hyperdense and may represent inspissated secretions versus fungal\ncolonization.\n2. There a dehiscent ___ tooth periapical cyst extending into the right\nmaxillary sinus. Potentially this could represent an odontogenic sinusitis. \nHowever, clinical correlation and direct visualization as clinically indicated\nas process such as antrochoanal polyp is not excluded.\n3. Additional findings as described above.\n\n\nRECOMMENDATION(S): Point 2: Clinical correlation and direct visualization\nas clinically indicated as process such as antrochoanal polyp is not excluded" + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. There is\ndiffuse cerebral atrophy likely due to patient's age. Enlargement of the\nventricular system and extra-axial CSF spaces likely due to the previously\nmentioned age-related diffuse parenchymal atrophy.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are essentially clear. The visualized portion of the orbits are\nunremarkable. Small senescent calcifications are identified.\n\nCTA HEAD:\n1.1 x 1.1 cm cluster of serpiginous vessels is identified in left anterior\nfrontal lobe likely representing a vascular malformation.\n\nAtherosclerotic changes along both V4 segments resulting in severe stenosis.\n\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nAtherosclerotic changes at the origin of the great vessels from the aortic\narch. Moderate right vertebral artery origin stenosis. Severe left vertebral\nartery origin stenosis. The cervical portion of both vertebral arteries is\npatent. Mild atherosclerotic changes at the carotid bifurcations b\nbilaterally without significant stenosis. Atherosclerotic changes along the\ncarotid siphons bilaterally.\n\nThere is no evidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nDiffuse ground-glass attenuation and changes throughout the visualized lungs\ncan be seen with mild pulmonary edema. Scattered nodular ground-glass\ncomponents measuring up to 1.1 cm (series 3, image 13) could be inflammatory\nin etiology.\nThe visualized portion of the thyroid gland is within normal limits. There is\nno lymphadenopathy by CT size criteria.\nMultilevel degenerative changes throughout the cervical spine.", + "output": "1. Cluster of serpiginous vessels in the left anterior frontal lobe likely\nrepresents a small vascular malformation measuring 1.1 x 1.1 cm.\n2. Severe left vertebral artery origin stenosis. Moderate right vertebral\nartery origin stenosis.\n3. Severe bilateral V4 segment stenoses." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Again seen is mild periventricular white matter hypodensity which\nlikely reflect chronic microvascular ischemic disease. Involutional changes\nare age appropriate. Ventricles and sulci are normal in overall size and\nconfiguration. The imaged paranasal sinuses are clear. Mastoid air cells and\nmiddle ear cavities are well aerated. The bony calvarium is intact. Carotid\nsiphon calcification is noted.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction,intracranial hemorrhage,edema,or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses and middle ear cavities are clear. There is hypo pneumatization of\nthe bilateral mastoid air cells. The visualized portion of the orbits are\nunremarkable.", + "output": "1. There is no evidence of acute intracranial process or hemorrhage.\n2. Hypo pneumatization of the bilateral mastoid air cells incidentally noted." + }, + { + "input": "Again seen is diffuse loss of gray matter density and multiple focal\nhypodensities seen within the bilateral occipital lobes, temporal lobes,\nparietal lobes and frontal lobes compatible with anoxic brain injury similar\nin appearance from the prior exam. There is no evidence of hemorrhage or\nherniation. The basal cisterns appear patent there is no evidence of\nherniation. There is no evidence of acute fracture. Mucosal thickening within\nthe ethmoid air cells is seen. There is fluid in the sphenoid sinus. There is\nminimal mucosal thickening in the bilateral maxillary sinuses. The mastoids\nare clear. The globes are unremarkable.", + "output": "Diffuse loss of the normal gray matter density compatible with anoxic brain\ninjury. No evidence of herniation. No significant change from the prior\nexamination.\n\nNOTIFICATION: These findings were communicated to Dr. ___ at 19:45 on ___ via telephone by Dr. ___." + }, + { + "input": "There is a moderate-sized subgaleal hematoma overlying the left\nparieto-occipital calvarium. There is no evidence of underlying fracture.\n\nThere is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nAn 8 mm round density within the left suboccipital soft tissues likely\nrepresents a sebaceous cyst (series 3, image 21). Partial opacification of\nbilateral ethmoid air cells. There is also mucosal thickening, aerosolized\nsecretions, and an air-fluid level within the right maxillary sinus. The\nvisualized portion of the mastoid air cells and middle ear cavities are clear.\nThe visualized portion of the orbits are unremarkable.", + "output": "1. Moderate-size subgaleal hematoma overlying the left parieto-occipital\ncalvarium, but no evidence of underlying fracture or intracranial hemorrhage.\n2. 8 mm round density within left suboccipital soft tissues, likely a\nsebaceous cyst.\n3. Paranasal sinus disease with an air-fluid level within the right maxillary\nsinus. Correlate clinically for signs of acute sinusitis." + }, + { + "input": "CT HEAD WITHOUT CONTRAST: No acute large territorial infarction, hemorrhage,\nedema or mass. Ventricles and sulci are normal in size and configuration for\nthe patient's age. Prominent retro-cerebellar CSF space likely reflects a\n___ cisterna magna. No acute displaced fracture. Small mucous retention cyst\nin left maxillary sinus. Paranasal sinuses common mastoid air cells and\nmiddle ear cavities are otherwise clear. Orbits are unremarkable.\n\nCTA HEAD: Vessels of the circle of ___ and its principal intracranial\nbranches are normal without stenosis, occlusion or aneurysm formation. Dural\nvenous sinuses are patent.\n\nCTA NECK: Carotid and vertebral arteries the major branches are normal with no\nevidence of stenosis, dissection or occlusion. No internal carotid stenosis\nby NASCET criteria.\n\nOTHER: Benign-appearing punctate foci of calcification are noted in the left\nlingual tonsil and right palatine tonsil (3:165, 171). Visualized lung apices\nare clear. Thyroid gland is unremarkable. No lymphadenopathy by CT size\ncriteria.", + "output": "1. No acute intracranial process or hemorrhage.\n2. Unremarkable CTA head and neck." + }, + { + "input": "There is a comminuted mildly displaced fracture of the angle of the left\nmandible, violating inferior alveolar nerve canal.. No tooth socket\nevaluation. No temporomandibular joint dislocation. There is a comminuted\nmildly displaced blowout fracture of the right lamina papyracea with a 1.2 cm\nfracture fragment displaced medially by 0.2 cm. The orbital apex appears\npreserved. Right nasal bone, bilateral frontal process of the maxilla\nfractures. Left facial soft tissue swelling. Few air bubbles are seen in the\nleft masticator space, likely posttraumatic, without fluid collection to\nsuggest infection, clinically correlate.\nSubtle fracture of the left lateral pterygoid plate.\nPartial opacification of the right ethmoid air cells in part likely\nposttraumatic. There is mild mucosal thickening of the bilateral maxillary\nsinuses and soft tissue opacification of the right ostiomeatal unit. The left\nostiomeatal unit is patent. There is mild soft tissue swelling inferior to\nthe right orbit. Infraorbital canals partially traversed through the\nmaxillary sinus.\n\nVisualized bilateral mastoids appear normal.\nThe globes, extraocular muscles, optic nerves, and retrobulbar fat appear\nnormal.\nThe visualized upper aerodigestive tract appears normal.\nThe mandible and temporomandibular joints appear normal.", + "output": "1. Comminuted, mildly displaced fracture of the angle of the left mandible.\n2. Comminuted, mildly displaced blowout fracture of the right lamina\npapyracea.\n3. Nasal bone, frontal process of maxilla fractures..\n4. Suggestion of a fracture of left lateral pterygoid plate.\n5. Partial opacification of the right ethmoid air cells likely partially\nposttraumatic.\n6. Left facial soft tissue swelling, likely posttraumatic. Few air bubbles\nleft masticator space, likely posttraumatic, without evidence of fluid\ncollection to suggest superimposed infection, clinically correlate..\n\nRECOMMENDATION(S): The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 16:45, 20 minutes\nafter discovery of the findings." + }, + { + "input": "Dental amalgam and fixation hardware streak artifact limits study.\n\nPostsurgical changes with reduction and internal fixation of the fracture of\nthe left mandibular angle, with a surgical plate noted along the superior\nborder of left mandibular angle, supported with screws and associated with\nmultiple air locules. There are small air locules within the tissues adjacent\nto left mandibular fracture and there is left facial subcutaneous edema,\nlikely postsurgical. Edema is also noted in the subcutaneous tissue inferior\nto the right orbit.\n\nMaxillary arch bars are noted extending anteriorly from the first molars\nbilaterally. An arch bar is also noted in the mandible, also extending\nanteriorly from the first molars.\n\nAgain noted is a comminuted fracture of the right lamina papyracea displaced\nmedially and associated with narrowing and significant opacification of the\nright ethmoid sinus. The right nasal bone and bilateral maxillary frontal\nprocess fractures are overall unchanged from the prior study. An external\nnasal splint is noted.\n\nBilateral sphenoid sinus, ethmoid air cell, and maxillary sinus mucosal\nthickening is present. Bilateral ostiomeatal units are obstructed. Leftward\nnasal septal deviation is again noted. Mastoid air cells and middle ear\ncavities are grossly preserved.\n\nAgain is noted minimal nonspecific left facial soft tissue induration. \nBilateral orbits are preserved. The visualized upper aerodigestive tract is\npreserved.", + "output": "1. Dental amalgam and fixation hardware streak artifact limits study.\n2. Postoperative changes with internal fixation of the left mandibular angle\nfracture and placement of maxillary and mandibular arch bars, as described.\n3. Grossly stable additional maxillofacial fractures as described.\n4. Residual minimal left facial soft tissue induration.\n5. Paranasal sinus disease and leftward nasal septal deviation, as described." + }, + { + "input": "Severe motion degradation, limiting assessment. Within these confines:\n\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, mass, or mass effect. \nThe ventricles and sulci are normal in caliber and configuration. No\ndisplaced calvarial fracture. The visualized paranasal sinuses and mastoids\nappear clear. The globes and orbits are unremarkable.\n\nCTA HEAD:\nEssentially nondiagnostic CTA head examination due to extensive motion\ndegradation. The distal right vertebral artery is visible as patent. \nPortions of the basilar artery, and portions of the proximal bilateral\nposterior cerebral arteries and the right middle cerebral artery appear\npatent, however much of the remainder of the circle ___ is obscured and not\nwell defined due to the severity of the motion-related artifact. Further\nassessment is precluded.\n\nSome portions of the dural venous sinuses, primarily the right transverse and\nsigmoid sinus and jugular bulb, straight sinus, and portions of the superior\nsagittal sinus, are demonstrative patent, however much of the dural venous\nsystem is obscured by motion.\n\nCTA NECK:\nSuboptimal exam due to severe motion degradation and suboptimal timing of\nimaging following the contrast bolus. Within these confines:\n\nThe right common carotid artery is patent. There is calcified plaque at the\nright carotid bulb causing likely mild-to-moderate proximal right ICA luminal\nnarrowing. Although much of the right extracranial ICAs obscured due to\nmotion, the vessel appears grossly patent.\n\nOn the left, left common carotid artery is grossly patent. The left\nextracranial external and extracranial internal carotid arteries are largely\nobscured by motion and not well visualized.\n\nThe right cervical vertebral artery is grossly patent throughout the right\nneck, with the V3 segment obscured and not well assessed.\n\nThe left cervical vertebral artery is diminutive, and arises separately from\nthe aortic arch, a normal variant. The visible portions that are not obscured\nby motion appear patent; however, there are large areas of the V1, V2, V3\nsegments that are obscured and not well assessed; the V4 segment is not well\nvisualized.\n\nThe aortic arch is mildly calcified. Arch branch vessels are mildly calcified\nwith areas of mild luminal narrowing, otherwise grossly patent.\n\nOTHER:\nThere is dilation of the main pulmonary artery to 3.6 cm, suggestive of\nunderlying pulmonary hypertension. Multiple hypodense thyroid nodules are\nnoted, the largest solid-appearing confluent nodule in the left lower pole\nmeasuring 1.9 cm. There is a cystic nodule arising from the right lower\nthyroid pole measuring 3.3 cm. No aggressive focal osseous lesions. There is\nsuggestion of distal tracheal malacia and right and left mainstem bronchial\nmalacia/expiratory collapse. No suspicious pulmonary nodule is seen.", + "output": "1. No acute intracranial abnormality by unenhanced head CT.\n2. Nondiagnostic CTA head examination. Although portions of the posterior\ncerebral arteries in the right middle cerebral artery appear patent, these\nareas are not well assessed, and the remainder of the circle ___ is\nobscured by motion.\n3. Severely motion degraded CTA neck. Grossly, the common carotid arteries\nare patent bilaterally, and there is mild-to-moderate luminal narrowing of the\nproximal right extracranial ICA; the more distal right ICA is grossly patent\nhowever poorly evaluated in the upper neck. The left ECA and ICA in the neck\nare obscured. Grossly patent right vertebral artery, V3 portion obscured. \nPortions of the left vertebral artery appear patent however much of its course\nis obscured.\n4. Dilated main pulmonary artery, suggestive some component of underlying\npulmonary hypertension.\n5. Distal tracheal and right and left mainstem bronchial expiratory\ncollapse/malacia.\n6. Multiple thyroid nodules, the largest appearing cystic measuring 3.3 cm in\nthe right lower pole, the largest solid nodule in the left lower pole\nmeasuring 1.9 cm. Recommend thyroid ultrasound on a nonurgent/outpatient\nroutine basis for further assessment, if not recently performed elsewhere. \nOther incidental findings, as above.\n\nRECOMMENDATION(S): Consideration of routine/nonurgent outpatient thyroid\nultrasound." + }, + { + "input": "Persistent large right-sided cerebellar hemispheric mass with surrounding\nvasogenic edema measures approximately 5 x 3.5 cm (03:13) and is causing\ncompression and narrowing of the fourth ventricle. Persistent dilatation of\nbilateral lateral ventricles is consistent with obstructive hydrocephalus,\nunchanged since prior examination.\n\nPersistent tonsillar herniation with upward herniation of the cerebellar\nvermis is again noted. There is no evidence of acute territorial infarction,\nor hemorrhage.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Persistent large right-sided cerebellar hemispheric mass with vasogenic\nedema causing obstructive hydrocephalus, tonsillar herniation, and upward\nherniation of the cerebellar vermis, unchanged since prior examination.\n2. No hemorrhage." + }, + { + "input": "Status post right suboccipital craniectomy and resection of cerebellar mass\nwith mesh placement and associated postsurgical changes including\npneumocephalus and small amount hemorrhage within resection cavity. The\nfourth ventricle is unchanged in size with persistent mass effect and\nnarrowing due to vasogenic edema. There is stable hydrocephalus in comparison\nto prior examination.\n\nThere is persistent but improved tonsillar herniation and upward herniation of\nthe cerebellar vermis with minimal increase in the quadrigeminal plate\ncistern. There is no evidence of infarction.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Status post right suboccipital craniectomy and cerebellar mass resection\nwith associated postsurgical changes including pneumocephalus and small \namount hemorrhage within resection cavity.\n2. Stable ventriculomegaly with mild improvement in tonsillar herniation and\nupward herniation of cerebellar vermis." + }, + { + "input": "NON-CONTRAST HEAD CT: Abnormal hypodensity is seen in the left posterior\naspect of the left caudate head involving the adjacent putamen. Hypodensity\nis also seen in the anterior aspect of the right centrum semiovale. In\naddition, there is abnormal hypodensity involving the right putamen, as well\nas the left lateral thalamus and left inferior, medial temporal lobe. There\nis no evidence of hemorrhage and no evidence of mass or hydrocephalus.\n\nCTA NECK: There is a three-vessel aortic arch. The brachiocephalic, left\ncommon carotid and left subclavian arteries have no significant stenosis of\ntheir origins.\n\nThe left vertebral artery is dominant. The right is markedly small in caliber\nand irregular.\n\nThere is crescentic filling defect within the distal right common carotid\nartery, non-calcific, creating approximately 20% luminal narrowing. The\ncervical right internal carotid artery has no significant narrowing.\n\nThe left common and internal carotid artery, cervical portion, has normal\ncourse and caliber.\n\nCTA HEAD: Bilaterally, large, patent posterior communicating arteries provide\ndominant supply to the P2 segments. While there is no apparent large-vessel\nocclusion, there is a paucity of M3 branches, particularly in the inferior\ndivision on the right. In addition, there is focal narrowing of the left V4\nsegment of the left vertebral artery. There is no other evidence of\nflow-limiting stenosis, large-vessel occlusion or aneurysm in the head.", + "output": "1. Hypodensity within the right frontal corona radiata, right putamen, left\nhead of caudate, left lateral thalamus and left medial temporal lobe\nconcerning for infarct, age-indeterminate on CT. If clinically warranted, MRI\ncould be obtained to age these abnormalities.\n\n2. While there is no large-vessel occlusion within the head, there is slight\npaucity of distal M3 branches on the right compared to the left, particularly\non the inferior division.\n\n3. Crescentic filling defect of the distal left common carotid artery which\nmay be secondary to focal atherosclerosis or a focal dissection, though the\nlatter is less likely as the location is not typical.\n\n4. Marked irregularity of the right vertebral artery which is diffusely small\nin caliber and focal high-grade narrowing of the left vertebral artery V4\nsegment intracranially. These likely reflect a combination of hypoplastic\nvessels with underlying atherosclerosis or dissection." + }, + { + "input": "There is no evidence of hemorrhage, edema, or mass. There is a focal\nhypodensity in the right thalamus consistent with lacunar infarct. No other\ninfarct is identified. There are extensive calcifications of the vertebral\nartery and bilateral carotid arteries. The ventricles and sulci are normal in\nsize and configuration. There is no evidence of fracture. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No hemorrhage.\n2. Right thalamic lacunar infarct." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect or acute major\nvascular territorial infarction. Ventricles, sulci, and basal cisterns are\nnormal in size for age.\n\nThere is a small right frontal subgaleal hematoma without evidence for\ndisplaced fracture. There is minimal mucosal thickening in the anterior\nethmoid air cells. Mastoid air cells are clear. The orbits are unremarkable\non noncontrast CT.", + "output": "1. No evidence for an acute intracranial abnormality.\n2. Small right frontal subgaleal hematoma. No evidence for a displaced\nfracture." + }, + { + "input": "Dental almalgam and spinal fusion hardware streak artifact moderately limits\nstudy. These confines:\n\nEvaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. 6 mm hypodense right lobe thyroid nodule is unchanged. Previously\nFDG avid 10 x 7 mm right cervical II a and 8 x 4 mm right cervical level II B\nlymph nodes are grossly unchanged in size. The neck vessels are patent.\n\nLarge bilateral pleural effusions are better characterized on concurrent CT\ntorso examination. Endotracheal tube is in appropriate position. Upper\nenteric tube is partially imaged.\n\nThere are post corpectomy changes of C6 and C7 with intervertebral spacers as\nwell as anterior and posterior fusion hardware spanning C5 through T1. No\ndefinite hardware fracture or adjacent lucency is noted. The right\nprevertebral soft tissue component at the levels of C6 and C7 at the level of\nthe thyroid previously seen is difficult to evaluate given hardware artifact. \nPostsurgical changes are present in the adjacent soft tissues with areas of\nstranding. Skin staples overlie the posterior neck.", + "output": "1. Dental almalgam and spinal fusion hardware streak artifact moderately\nlimits study.\n2. Postsurgical changes from C6 and C7 corpectomy and C5 through T1 anterior\nand posterior fusion without definite evidence of hardware failure.\n3. Previously noted right C6-7 prevertebral soft tissue mass is not well\nvisualized on current study.\n4. Grossly stable prominent right cervical lymph nodes demonstrating FDG\navidity on prior PET-CT.\n5. Nonspecific 6 mm right thyroid nodule. Recommend correlation with risk\nfactors for thyroid cancer. If clinically indicated, thyroid ultrasound may\nbe obtained for further evaluation.\n6. Partially visualized bilateral large pleural effusions better visualized on\nconcurrently obtained torso CTA.\n\nRECOMMENDATION(S): Nonspecific 6 mm right thyroid nodule. Recommend\ncorrelation with risk factors for thyroid cancer. If clinically indicated,\nthyroid ultrasound may be obtained for further evaluation.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ on the ___ ___ at 7:46 ___, 2 minutes after discovery of\nthe findings." + }, + { + "input": "A small focus of hyperdensity is seen overlying the right frontal lobe (2:16)\nwhich may reflect a tiny focus of subdural blood or artifact. Otherwise, no\nadditional sites of intracranial hemorrhage are present. There is no evidence\nof acute large territorial infarction,edema,or mass effect. There is\nprominence of the ventricles and sulci suggestive of age-related volume loss. \nMild periventricular white-matter hypodensities are nonspecific, but likely\nrepresent the sequela chronic small vessel disease.\n\nA 1.6 cm subgaleal hematoma is seen over the right frontal bone (2:17). There\nis no evidence of fracture. Incidental note is made of hyperostosis frontalis\ninterna. Lucency within the right occipital bone likely reflects an arachnoid\ngranulation. There is mild mucosal thickening of the ethmoid air cells. The\nvisualized portion of the remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. Patient is status post right lens replacement.", + "output": "1. Small focus of hyperdensity seen adjacent to the right frontal lobe which\nmay represent a small subdural hematoma or artifact. Follow-up noncontrast\nhead CT is suggested in ___ hours.\n2. 1.6 cm subgaleal hematoma over the right frontal bone. No fracture." + }, + { + "input": "A subgaleal hematoma overlies the frontal bone on the right. There is no\nappreciable acute hemorrhage. There is no edema or mass effect. Ventricles\nand sulci are age appropriate in size and configuration. Minimal\nperiventricular white matter hypodensity is nonspecific. Basal cisterns are\nclear. Gray-white matter differentiation is preserved.\n\nThe orbits are unremarkable. Imaged paranasal sinuses, bilateral mastoid air\ncells, and middle ear cavities are clear. Left vertebral artery and carotid\nsiphon vascular calcifications are mild. Arachnoid granulation noted in the\noccipital bone.", + "output": "Subgaleal hematoma overlies the frontal bone on the right. No underlying bony\nabnormality. Previously seen focus hyperdensity along the right frontal lobe\nis less conspicuous, and most compatible with artifact. No evidence of\nintracranial hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nPeriventricular and subcortical white matter hypodensities are nonspecific,\nbut most likely represent chronic small vessel ischemia.\n\nThere is no evidence of fracture. Hyperostosis frontalis, unchanged. The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The patient is status post right lens resection. Mild\natherosclerotic calcifications of the distal left vertebral artery.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of hemorrhage,infarction,edema,or mass. The ventricles\nand sulci are normal in size and configuration.\n\nMild mucosal thickening of the bilateral ethmoid air cells. The visualized\nportion of the remaining paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are normal.", + "output": "Minimal paranasal sinus inflammatory changes. Otherwise normal study." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are normal in size and configuration. Incidental note is made of an\noccipital bone exostosis on the right.\n\nThere is a small mucous retention cyst in the left maxillary sinus. The\nvisualized portion of the remaining paranasal sinuses,mastoid air cells,and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nnormal.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. The dural venous\nsinuses are patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion.\n\nOTHER:\nThe visualized portion of the lungs is clear. The visualized portion of the\nthyroid gland is unremarkable.. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No acute intracranial findings.\n2. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n3. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection." + }, + { + "input": "Multiple areas of chronic infarction noted within the left PCA territory,\nbilateral MCA and ACA territories. These appear progressed from the prior CT\nexam. There is no hemorrhage. Periventricular white matter hypodensity is\ncompatible chronic microvascular ischemic disease. Extensive involutional\nchanges are noted. Ventricular size appears similar to the prior exam. \nBasilar cisterns are patent. The imaged bony structures are intact. Sinuses\nappear well aerated. Mastoid air cells and middle ear cavities are clear.", + "output": "Extensive encephalomalacia with chronic white matter disease without\nsuperimposed hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. The\nvisualized portion of the orbits are notable for bilateral lens replacements.", + "output": "1. No acute intracranial process.\n2. Visualized portions of the paranasal sinuses are essentially clear." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive involutional changes. No\nextra-axial fluid collection is identified. There is no midline shift.\n\nVisualized paranasal sinuses, bilateral mastoid air cells and middle ear\ncavities are clear. Numerous cutaneous calcifications are noted.", + "output": "1. Prominent bilateral extra-axial spaces within the frontal lobes are\nsymmetric and likely secondary to parenchymal atrophy.\n2. No acute intracranial abnormality." + }, + { + "input": "There has been interval placement of a new right frontal approach\nventriculostomy, with the shunt catheter terminating in the frontal horn of\nthe left lateral ventricle. A focus of pneumocephalus is seen in the midline\nanteriorly near the ventriculostomy catheter, consistent with recent\nprocedure. Hypodensity is again seen along the tract of the prior EVD in the\nright frontal lobe. The patient is status post left frontotemporal craniotomy,\nwhich is similar appearance to prior exam.\n\nThe lateral ventricles are again seen to be enlarged, but are slightly\ndecreased in size from prior exam. The ventricles and sulci are otherwise\nstable in configuration from prior exam. 4 mm of leftward midline shift is\nagain seen, unchanged from the prior two exams. There is no evidence of new\nhemorrhage, edema, mass effect, or infarction. The basal cisterns appear\npatent and there is preservation of gray-white matter differentiation.\n\nNo fracture is identified. Air is seen in the subcutaneous tissues along the\nright lateral calvarium, consistent with recent procedure. Minimal mucosal\nthickening is seen in the right ethmoid air cells. Otherwise, the visualized\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear The\nglobes are unremarkable.", + "output": "1. Interval placement of a new right frontal approach ventriculostomy, with a\nshunt catheter terminating in the frontal horn of the left lateral ventricle.\n\n2. Slight interval decrease in the size of the lateral ventricles." + }, + { + "input": "Again seen is a right frontal ventriculostomy with shunt catheter terminating\nin the frontal horn of the left lateral ventricle. A focus of pneumocephalus\nis again seen in the midline anteriorly near the ventriculostomy catheter.\nHyperdensity along the tract of the prior DVT in the right frontal lobe is\nunchanged. Left frontotemporal craniotomy is unchanged.\n\nThe lateral ventricles are enlarged and unchanged in size from the prior exam.\nVery minimal leftward midline shift is unchanged.\n\nThe basal cisterns are patent and there is preservation of gray-white matter\ndifferentiation. There is no evidence of new hemorrhage or infarction.\n\nThe visualized bony structures are grossly unchanged. The paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear.\n\nThe globes are unremarkable.", + "output": "Persistently enlarged lateral ventricles and minimal left leftward midline\nshift unchanged from the prior examination." + }, + { + "input": "There is an unchanged right frontal ventriculostomy, the tip terminating in\nthe frontal horn of the left lateral ventricle. No significant changes are\nvisualized since the most recent study. There is persistent enlargement of the\nlateral ventricles (10:2), the pneumocephalus has been resolved. The\nvisualized bony structures are unchanged, the patient is status post left\ntemporal frontal craniotomy, the paranasal sinuses and mastoid air cells are\nclear, the orbits are unremarkable.", + "output": "),\n\nPersistently enlarged lateral ventricles. Unchanged right frontal\nventriculostomy, the tip terminating in the frontal horn of the left lateral\nventricle. No significant changes are demonstrated since the more recent\nstudy." + }, + { + "input": "There is a left temporoparietal craniotomy, as before. Again seen is a right\nfrontal ventriculostomy catheter, with the tip in the contralateral frontal\nhorn, unchanged . The lateral ventricles remain enlarged, although decreased\nsince prior CT (currently measuring approximately 2.3 cm at the level of the\nbasal ganglia , previously 2.9 cm.) The temporal horns remain enlarged, but\nare also smaller. Encephalomalacia along a prior shunt tract is noted in the\nright frontal lobe.\n\nThere is no acute large territorial infarct, hemorrhage, or edema. No\nfractures identified. The paranasal sinuses, ethmoid air cells, and mastoid\nair cells are clear.", + "output": "Persistent but decreased enlargement of the lateral ventricles. Unchanged\nright frontal ventriculostomy catheter, with the tip terminating in the\ncontralateral frontal horn." + }, + { + "input": "Hypodensities in the right temporoparietal region and anterior right frontal\nlobe are suggestive of prior infarcts. The ventricles and sulci are prominent\ncompatible with global volume loss. There is no acute intra-axial or\nextra-axial hemorrhage, mass, midline shift or acute territorial infarct.\nBesides where detailed above, the gray-white matter differentiation is\npreserved.\n\nThe paranasal sinuses and mastoids are clear. The skull and extracranial soft\ntissues are unremarkable.", + "output": "Encephalomalacia suggesting prior infarcts and global volume loss without\nacute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are prominent consistent with atrophy. Atherosclerotic\nvascular calcifications are noted of bilateral vertebral and cavernous\nportions of internal carotid arteries. There are periventricular and\nsubcortical lucencies.\n\nNo osseous abnormalities seen. There is a mucous retention cyst versus polyp\nin the left maxillary sinus. There is partial opacification of the mastoid air\ncells bilaterally. The remainder of the paranasal sinuses and middle ear\ncavities are clear. The orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Within the limits of this noncontrast examination, no definite abnormal\nintracranial fluid collection identified.\n3. Please note contrast enhanced MRI is more sensitive for the evaluation of\nintracranial abscess.\n4. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described.\n5. Paranasal sinus disease as described." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Old bilateral cerebellar infarcts\nare noted. Scattered subcortical white matter hypodensities are likely\nsequela of chronic small vessel disease. Gray-white matter differentiation is\npreserved. Ventricles and sulci are prominent compatible with global volume\nloss. Basilar cisterns are patent. Dense atherosclerotic calcifications are\nnoted within the vertebral arteries and internal carotid arteries.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process, no hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are mildly enlarged suggesting age related atrophy.\nThere is no evidence of fracture. There is a mucous retention cyst in the\nleft maxillary sinus. The remainder of the paranasal sinuses are clear. The\nvisualized portion of the orbits are unremarkable. There are dense\natherosclerotic calcifications.", + "output": "No acute intracranial process." + }, + { + "input": "There is no acute hemorrhage, edema, or mass effect. A small focus of low\ndensity in the left occipital cortex on image 3:17 corresponds to the largest\nof the small acute infarctions seen on the ___ MRI. The other, smaller\nbilateral acute infarctions demonstrated on the ___ MRI are not\ndiscernible on the present CT. Vague supratentorial white matter hypodensity\nis compatible with sequela of chronic small vessel ischemic disease. \nAge-related parenchymal volume loss with prominent ventricles and sulci is\nagain seen.\n\nNo suspicious lytic or sclerotic bone lesions are seen. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare gross clear.", + "output": "1. No acute hemorrhage or mass effect.\n2. The largest small recent infarction seen on the ___ MRI in the\nleft occipital lobe is now visible with a small area of cortical hypodensity. \nThe other, smaller bilateral acute infarctions demonstrated on the recent MRI\nare not discernible on the present CT." + }, + { + "input": "Exam is motion degraded despite repeat acquisitions. There is no significant\nmass effect. No large intracranial hemorrhage or midline shift. Cannot\nassess for subtle change.\n\nNo displaced calvarial fractures. Paranasal sinuses and mastoids are grossly\nclear besides mucous retention cyst in the left maxillary sinus.", + "output": "Significantly motion degraded exam without visualized acute intracranial\nabnormality or hemorrhage." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. Gray\nand white matter differentiation is overall maintained. The ventricles and\nsulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.\n\nEndotracheal and orogastric tube are partially imaged. There are several\nloops of coiled tube partially imaged in the oropharynx.", + "output": "1. No acute intracranial process.\n2. Partially imaged loops of coiled tube in the oropharynx." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is a large right maxillary sinus mucous retention cyst and a tiny left\nmaxillary sinus mucous retention cyst. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are normal.", + "output": "No acute intracranial process." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. Carotid siphon calcification noted. The bony\ncalvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "Evaluation of the intracranial parenchyma is seen better on the concomitant\nand separately reported CT head examination performed on the same day.\n\nCTA HEAD:\nMild calcifications are seen in the bilateral cavernous internal carotid\narteries without evidence of flow limiting stenosis. Otherwise, the vessels\nof the circle of ___ and their principal intracranial branches appear\npatent without stenosis, occlusion, or aneurysm formation. The dural venous\nsinuses are patent.\n\nCTA NECK:\nCalcified atherosclerotic plaque at the proximal right internal carotid artery\nis noted, with resulting 55% stenosis by NASCET criteria. Mild partially\ncalcified atherosclerotic plaque is noted at the bilateral common carotid\nbifurcations without evidence of flow-limiting stenosis. Otherwise, the left\ncarotid and vertebral arteries and their major branches appear patent with no\nevidence of stenosis or occlusion.\n\nOTHER:\nThe visualized portion of the lung apices demonstrate mild pleural thickening\nand scarring, in addition to numerous sub-4 mm punctate micro nodules\nbilaterally. The visualized portion of the thyroid gland is within normal\nlimits. There is no lymphadenopathy by CT size criteria.", + "output": "1. Calcified atherosclerotic plaque within the proximal right ICA resulting in\n55% stenosis by NASCET criteria.\n2. Otherwise, patent intracranial and neck vasculature without high-grade\nstenosis, occlusion, or aneurysm formation.\n3. For description of the intracranial parenchymal findings, please see the\nseparate CT head examination performed on the same day.\n4. Multiple incidental sub-4 mm bilateral pulmonary nodules within the\nvisualized lung apices.\n\nRECOMMENDATION(S): ___ society recommendations for follow up of\npulmonary nodules: Solid nodules <= 4 mm: Low risk: No follow-up needed. High\nrisk: Follow-up at 12 months and if no change, no further imaging needed.\n\nThe ___ society pulmonary nodule recommendations are intended as\nguidelines for follow-up and management of newly incidentally detected\npulmonary nodules smaller than 8 mm, in patients ___ years of age or older. Low\nrisk patients have minimal or absent history of smoking or other known risk\nfactors for primary lung neoplasm. High risk patients have a history of\nsmoking or other known risk factors for primary lung neoplasm." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass effect. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Periventricular and subcortical white matter hypodensities are\nnonspecific but suggest chronic small vessel ischemic changes.\n\nThere is no evidence of fracture. Mild mucosal thickening of bilateral\nmaxillary sinuses, ethmoid sinuses and sphenoid sinuses are noted suggestive\nof mild ongoing inflammation. The visualized portion of the remaining\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.\n\nDense calcifications of bilateral cavernous internal carotid arteries are\nnoted.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of territorial infarction, intracranial hemorrhage,\nedema, or mass. Mild generalized cerebral atrophy with ex vacuo dilatation of\nthe ventricular system.\nThe previously noted focal area of hypodensity in the anterior right frontal\nlobe is thought to most likely represent volume averaging from the adjacent\nsulcus.\nMinimal mucosal thickening involving the paranasal sinuses. The visualized\nportion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nare patent without marked stenosis, occlusion, or aneurysm formation. There\nis early bifurcation of the right MCA with mild narrowing in the proximal\naspect of the superior division of the MCA. Mild narrowing of the right A2\nsegment. Calcific atherosclerotic changes of the carotid siphons bilateral,\nbut no marked stenosis. The dural venous sinuses are patent.\n\nCTA NECK:\nModerate calcific atherosclerotic changes noted at the proximal right ICA, but\nno stenosis according to NASCET criteria. Mild atherosclerotic changes in the\ndistal left common carotid and proximal left ICA, but no stenosis according to\nNASCET criteria. Dominant right vertebral artery. The vertebral arteries are\npatent. No dissection.\n\nOTHER:\nMild biapical pleural-parenchymal scarring. Mild centrilobular pulmonary\nemphysema. No suspicious pulmonary nodules or masses. Patulous appearance of\nthe esophagus. The visualized portion of the thyroid gland is within normal\nlimits. There is no lymphadenopathy by CT size criteria.", + "output": "No intracranial mass, hemorrhage or large acute territorial infarct.\n\nNo intracranial arterial aneurysm, occlusion or marked stenosis. Mild\narterial narrowings are most likely secondary to atherosclerotic disease.\n\nModerate atherosclerotic changes of the carotid arteries, but there is no ICA\nstenosis by NASCET criteria." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or mass\neffect. Ventricles and sulci are more prominent than expected for age,\nconsistent with global parenchymal volume loss. There are minimal\nperiventricular white matter hypodensities, which are nonspecific but likely\nrepresent sequela of chronic microvascular ischemic disease.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nbilateral anterior ethmoid air cells. The visualized portion of the remaining\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable. Mild atherosclerotic\ncalcifications of the cavernous carotid arteries are present.", + "output": "1. No acute intracranial abnormality.\n2. Global parenchymal loss out of proportion to that expected for age." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,or\ndiscrete mass. Significant involutional changes again noted. Ventricles are\nstably prominent.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Prominence of\nventricles and sulci is consistent with age related involutional changes. \nThere are periventricular and subcortical lucencies, which may represent small\nvessel ischemic changes. Atherosclerotic vascular calcifications are noted of\nbilateral cavernous portions of internal carotid arteries.\n\nNo osseous abnormalities seen. Mild mucosal thickening of the ethmoidal air\ncells and moderate mucosal thickening of the bilateral maxillary sinuses is\nnoted. The mastoid air cells and middle ear cavities are clear. The orbits\nare preserved.", + "output": "1. No acute intracranial abnormality.\n2. No evidence acute intracranial hemorrhage or fracture.\n3. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described." + }, + { + "input": "There is no evidence of acute large territory infarction,hemorrhage,edema,or\ndiscrete mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are grossly unchanged, and are nonspecific but may represent\nsmall vessel ischemic changes. There are atherosclerotic calcifications\nwithin the bilateral cavernous internal carotid arteries.\n\nThere is no evidence of acute fracture. There has been interval dense\nopacification of the right maxillary sinus, as well as the bilateral ethmoid\nair cells with low-density material. Otherwise the visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial hemorrhage or calvarial fracture.\n2. Similar global, age-advanced involutional changes with probable sequela of\nchronic small vessel ischemic disease.\n3. Paranasal sinus disease with interval opacification of the right maxillary\nsinus and ethmoid air cells." + }, + { + "input": "There is no acute hemorrhage, edema, or mass effect. Ventricles and sulci are\nage appropriate in size and configuration. There is no evidence of acute\nlarge territorial infarction. Basal cisterns are patent. There is no shift\nof normally midline structures. The calvarium is notable for a possible\nremote prior left frontal burr hole. Visualized paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere are multiple left-sided facial fractures. Specifically, there is a\nfracture of the inferior left orbital wall (3, 9 as well as 601 B, 25), which\nextends laterally to involve the lateral wall of the orbit (3, 11). There are\nfractures through the zygomatic process lower left (3, 11). Fracture line\nextends inferiorly to involve the anterior wall the left maxillary sinus (3,\n5), as well as the lateral wall (3, 5). High-density material likely\nreflecting blood products are seen mostly filling the left maxillary sinus. \nNo CT evidence of extraocular muscle entrapment on this exam on the left. \nThere is no fracture seen on the right. The lamina papyracea are intact. The\nnasal septum is midline. The frontal sinuses, ethmoid air cells are clear. \nThere is a small amount of mucosal thickening and aerosolized secretions in\nthe right mastoid sinus and sphenoid sinus. Mastoid air cells and middle ear\ncavities are well pneumatized and clear.\n\nThe globes are intact. Mild symmetric prominence of the superior ophthalmic\nveins is noted, nonspecific, possibly a normal variant. Otherwise, the\nintraorbital structures are normal. Carotid siphon calcifications are noted.", + "output": "1. Non- or minimally displaced left-sided facial fractures including inferior\nand lateral orbital wall, anterior and lateral wall of the maxillary sinus,\nand zygomatic arch fractures. Blood products fill the left maxillary sinus. \nNo CT evidence to suggest extraocular muscle entrapment. Intact globes and\nlamina papyracea.\n2. No intracranial hemorrhage or other intracranial sequelae of trauma." + }, + { + "input": "CTA HEAD:\nThe circle of ___ and the principal intracranial branches appear patent\nwithout stenosis, occlusion, dissection, or aneurysm formation. The\nintracranial bilateral carotid, basilar, and vertebral arteries appear patent.\nThe left posterior communicating artery is not well-visualized. The dural\nvenous sinuses appear patent.\n\nCTA NECK:\nThe bilateral common, internal, and vertebral arteries appear patent without\nstenosis, occlusion, or dissection. There is no stenosis of the internal\ncarotid arteries by NASCET criteria. There is a 3 vessel aortic takeoff with\npatency of the great vessels and bilateral subclavian arteries.\n\nOTHER:\nThe visualized lung apices demonstrate small bilateral pleural effusions with\nbiapical pleural-parenchymal scarring. Endotracheal tube is seen with small\namount of secretions within the distal trachea. An enteric tube is partially\nvisualized within the esophagus. There is a 0.5 x 0.4 cm right upper thyroid\nlobe hypodense nodule (2:98). There is no lymphadenopathy per size criteria.\n\nAgain seen are left-sided facial fractures including inferior and lateral\norbital wall, anterolateral wall of the maxillary sinus, and zygomatic arch,\nand likely the pterygoid plates. Again seen is near complete opacification of\nthe left maxillary sinus with blood products and partial opacification of the\nright maxillary sinus, ethmoid sinuses, and left sphenoid sinus. The\nbilateral mastoid air cells appear clear.\n\nBoth superior orbital veins are distended. However, there is no visualization\nof contrast within the cavernous sinuses or bulging of the cavernous sinuses\nnoted to suggest CTA evidence of CC fistula.", + "output": "1. No evidence of stenosis, occlusion, dissection, or aneurysm formation.\n2. Multiple left-sided facial fractures with paranasal opacification again\nseen.\n3. 5 mm hypodense right thyroid nodule.\n\nRECOMMENDATION(S): Right thyroid lobe nodule. The ___ College of\nRadiology guidelines suggest that in the absence of risk factors for thyroid\ncancer, no further evaluation is recommended." + }, + { + "input": "There is no evidence of acute large territory infarct, hemorrhage, edema, or\nmass effect. The ventricles and sulci are normal in size and configuration. \nPeriventricular and subcortical white matter hypodensities (for example series\n2, image 18) are nonspecific but likely sequelae of chronic small vessel\nischemic disease.\n\nThere are left zygomaticomaxillary complex fractures including the anterior\nwall of the left maxillary sinus, posterior wall the left maxillary sinus, and\nleft zygomatic arch as better detailed on same day a maxillofacial CT. There\nis a trace amount of mucosal thickening or fluid within the left maxillary\nsinus. The visualized portion of the remaining paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. Left zygomaticomaxillary complex fractures.\n2. No intracranial hemorrhage or large territorial infarction on noncontrast\nhead CT." + }, + { + "input": "There are minimally displaced fractures of the inferior left maxillary sinus\n(series 2, image 97) extending superiorly into both the anterior and posterior\nwalls of the maxillary sinus (series 2, image 78). In addition, the fracture\nlines extends through the junction of the maxillary sinus and left pterygoid\nbody, with the fracture plane involving the greater and lesser palatine\nforamen (series 2, image 93; series 602b, image 99). There is a separate\nminimally displaced fracture at the junction of the maxillary bone and left\nzygoma (series 2, image 67).\n\nThere are minimally and medially displaced fractures involving the left\nzygomatic arch (series 2, image 70). There is a separate fracture through the\nmedial aspect of the maxilla extending into the left nasolacrimal duct (series\n2, image 72). There is likely involvement of the left inferior alveolar\ncanal. There is a minimally displaced fracture of the left coronoid process\n(series 602b, image 132). There is no temporomandibular joint dislocation.\n\nBony dehiscence of the right orbital floor (series 601b, image 73) is\nidentified, likely representing sequela of prior fracture, with herniation of\nfat into the defect without involvement of the inferior rectus muscle.\n\nApparent mild angulation of the nasal bone likely represents sequela of\nchronic fracture deformity (series 602b, image 75)\n\nThere is mild mucosal thickening of the bilateral maxillary sinuses. Bilateral\nmastoids appear normal. The globes, extraocular muscles, optic nerves, and\nretrobulbar fat appear normal. The visualized upper aerodigestive tract\nappears normal.", + "output": "1. Minimally displaced left maxillary and zygomatic fractures as detailed in\nthe findings, including a fracture extending through the junction of the left\nmaxilla and pterygoid body involving the greater and lesser palatine canals.\n2. Minimally displaced left mandibular coronoid process fracture.\n3. The lack of associated hemosinus suggests that these fractures are more\nlikely subacute.\n4. Apparent mild angulation of the nasal bone likely represent sequela of\nchronic fracture deformity. Chronic fracture deformity of the right orbital\nfloor with herniation of fat, but no involvement of the inferior rectus muscle\nis identified.\n\nNOTIFICATION: The additional findings described in the impression above from\nresident wet read was entered by Dr. ___ on ___ at 10:53 into\nthe ED QA nurse ___ system for direct communication to the referring\nprovider." + }, + { + "input": "SOFT TISSUES: No stranding, fluid collection, hematoma, subcutaneous\nemphysema or other soft tissue abnormality.\n\nMAXILLOFACIAL BONES: The maxillofacial bones are intact, without fracture.\nThe zygomatico-maxillary complex is intact. The lateral pterygoid plates are\nintact.\n\nMANDIBLE: The mandible is without fracture or temporomandibular joint\ndislocation. Degenerative change involving the left temporal mandibular joint\nis mild to moderate with joint space narrowing and sclerosis.\n\nDENTITION: No dental fractures although detailed evaluation is limited by\nstreak artifact from dental hardware. Periapical loosening surrounding\nseveral of the left maxillary molar teeth is extensive with extension of\nlucencies to both the buccal and lingual cortices as well as areas of erosion\ninto the left maxillary sinus with disruption of the inferior maxillary sinus\nwall (e.g., series 3, image 91, 90; series 601b, image 61, 67). No clear\nevidence of associated abscess.\n\nSINUSES: Asymmetric mucosal thickening of intermediate density in the left\nmaxillary sinus is moderate, likely related to odontogenic process in the left\nmaxillary molar teeth as above. No significant increased sclerosis of the\nleft maxillary sinus walls. The left retroantral fat plane appears grossly\npreserved. No air-fluid levels or aerosolized secretions. The left\nostiomeatal unit is completely opacified with fluid or mucosal thickening.\n\nMucosal thickening of the bilateral ethmoidal air cells is mild. The right\nmaxillary sinus has mild mucosal thickening. The frontal sinuses and sphenoid\nsinuses are clear.\n\nNOSE: No nasal bone fracture. Nasopharyngeal soft tissues are unremarkable.No\nnasal septal hematoma. There is bilateral middle chondral bullosa without\nobstruction of the nasal cavity at these levels. There is mild apex left\nnasal septal deviation.\n\nORBITS: The orbits, including the laminae papyracea, are intact. The globes\nare intact with non-displaced lenses and no intraocular hematoma.No preseptal\nsoft tissue edema.No retrobulbar hematoma or fat stranding.\n\nThe mastoid air cells, partially imaged are clear. The middle ear cavities\nare clear. The visualized upper airway is clear. Allowing for imaging\ntechnique optimized for the face, the limited included portion of the brain\nis grossly unremarkable.", + "output": "Bilateral paranasal sinus disease which is moderate and most pronounced in the\nleft maxillary sinus and complete opacification of the left ostiomeatal unit,\nlikely secondary to dental disease in the left maxillary molar teeth with\ncortical disruption extending into the left inferior maxillary sinus wall.\n\nDisruption of the lingual and buccal surfaces of the mandibular cortex\nassociated with this odontogenic process is also noted but node discrete fluid\ncollections are identified in the adjacent soft tissue." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nleft maxillary sinus with a mucous retention cyst. The remaining paranasal\nsinuses are clear. The mastoid air cells are well aerated. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of hemorrhage, infarct, or mass." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute large territorial infarction, acute intracranial\nhemorrhage, edema, or mass effect. The ventricles and sulci are normal in\nsize and configuration.\n\nNo osseous abnormalities seen. Moderate fluids opacifications of the right\nfrontal sinus. Near complete opacification of the right maxillary sinus with\nintermediate density fluid is nonspecific but raises concern for sinusitis.\nModerate fluid opacification of anterior ethmoid air cells, right greater than\nleft. The remaining paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation greater than\n3mm. The dural venous sinuses are patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nPunctate arteriosclerotic calcification is identified at the left carotid\nbifurcation (series 3, image 149), with no evidence of stenosis NASCET\ncriteria. The carotidandvertebral arteries and their major branches appear\nnormal with no evidence of stenosis or occlusion.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No acute intracranial abnormality, specifically no evidence of an acute\ninfarct, intracranial mass, or hemorrhage.\n2. Near complete opacification of the right maxillary sinus, extending into\nthe right ethmoid clear cells and right frontal sinus, raises concern for\nsinusitis, probably acute on chronic etiology.\n3. Unremarkable CTA of the head without evidence of stenosis,occlusion,or\naneurysm.\n4. Punctate vascular arteriosclerotic calcification identified at the left\ncervical carotid bifurcation with no evidence of stenosis by NASCET criteria,\notherwise, unremarkable CTA of the neck without evidence of stenosis,\nocclusion, or dissection." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. There is mild prominence of the ventricles and sulci compatible\nwith age-related involutional changes.\n\nThere is mild mucosal thickening bilateral ethmoid air cells, there is mucosal\nthickening in the left frontal sinus and opacification of the left\nfrontoethmoidal recess. There is mild mucosal thickening in the right\nsphenoid sinus and a mucous retention cyst in the left sphenoid sinus. The\nbony calvarium is intact.", + "output": "No acute intracranial abnormality on noncontrast head CT. Specifically no\nlarge territory infarct or intracranial hemorrhage." + }, + { + "input": "There is no evidence of acute intracanial hemorrhage, edema, ormass efect.\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Periventricular white matter hypodensities are nonspecific but likely\na sequela of chronic small vessel ischemia.\nThere is no evidence of fracture.\nThere is thickening of the calvarial bones, with diffusely altered density,\npredominantly sclerotic/gound dlass with several round sclerotic foci ; there\nis also more pronounced lucent appearance, in the left side of the clivus and \nin the occipital bones.\nThere is opacification of the posterior nasopharynx, nasal cavity, scattered\nethmoid air cells. Mastoid air cells and middle ear cavities are clear. \nSphenoid sinus septation inserts on the right carotid groove.", + "output": "1. No acute intracranial hemorrhage or mass effect.\n2. Diffusely altered density of the skull bones, predominantly\nsclerotic/ground glass with several round sclerotic foci ; there is also more\npronounced lucent appearance, in the left side of the clivus and in the\noccipital bones. This can relate to metabolic/endocine bone disease, \nneoplastic etiology or Paget's disease, etc.\nCorrelate clinically and further workup or followup as needed.\n\n(Pl. Note the MRN on PACS for this study is different and listed ___ ___\n)" + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, large vascular\nterritory infarction, edema,or mass effect. There is prominence of the\nventricles and sulci suggestive of involutional changes. Periventricular\nwhite matter hypodensities are nonspecific but likely represent sequelae of\nchronic small vessel ischemia.\n\nThere is no evidence of fracture. There is re-demonstration of diffuse\nthickening of the bony calvarium with multiple sclerotic focal lesions. The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial process such as hemorrhage. No fracture identified.\n2. Re-demonstration of diffuse thickening of the bony calvarium with multiple\nsclerotic lesions suggestive of hyperparathyroidism, other metabolic diseases,\nPaget's disease or, less likely, metastatic disease." + }, + { + "input": "There is no evidence of hemorrhage, edema, or mass. There is a small\nhypodensity in the inferior left frontal lobe which is related to volume\naveraging (3:18). Ventricles and sulci are prominent, consistent with global\nparenchymal loss. Subcortical, periventricular and deep white matter\nhypodensities are nonspecific, but likely reflect the sequela of chronic\nmicroangiopathic ischemic disease.\n\nThere is no fracture. There is diffuse thickening of the calvarium with\nmultiple sclerotic lesions, overall unchanged. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portions of the orbits are normal. Note is made of a dysconjugate\ngaze.", + "output": "1. No acute intracranial process. Specifically, there is no evidence of an\nacute frontal lobe infarct.\n2. Global parenchymal volume loss with moderate chronic microangiopathic\nischemic disease.\n3. Diffuse thickening of the osseous calvarium with numerous sclerotic foci,\nwhich may represent renal osteodystrophy/hyperparathyroidism. Differential\ndiagnosis includes Paget's disease and sclerotic metastases." + }, + { + "input": "There is no evidence of fracture, acute large territorial\ninfarction,hemorrhage,edema,or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. Periventricular and subcortical\nwhite matter hypodensities are nonspecific, but likely reflect sequelae of\nchronic small vessel ischemic disease.\n\nParanasal sinuses are clear.1 The mastoid air cells and middle ear cavities\nare clear bilaterally. Again seen is diffuse thickening of the calvarium with\nnumerous sclerotic foci. The visualized portion of the orbits are normal.", + "output": "1. No acute intracranial process.\n2. Redemonstrated global parenchymal volume loss and moderate chronic\nmicroangiopathic changes.\n3. Stable diffuse thickening of the osseous calvarium with numerous sclerotic\nfoci. This could reflect renal osteodystrophy/hyperparathyroidism, with\nPaget's disease or sclerotic metastases also considered in the differential." + }, + { + "input": "CT Head: Again seen is a hypodensity within the left cerebellar hemisphere, in\nparamedian location, consistent with patient's history of prior cerebellar\ninfarction. There is no evidence of new hypodensity or edema to suggest acute\ninfarction. There is no evidence of hemorrhage, midline shift, mass or mass\neffect. The ventricles, sulci and basal cisterns are normal in caliber and\nconfiguration. No fractures are identified.\n\nCTA Head: There is adequate opacification of the internal carotid, anterior\ncerebral, middle cerebral, vertebral, basilar and posterior cerebral arteries.\nThere is mild atherosclerotic calcification of the bilateral carotid siphons.\nThe anterior communicating artery is well visualized. The right vertebral\nartery is dominant. The left vertebral artery is diminutive throughout its\ncourse. The posterior communicating arteries are visualized. There is no\nevidence of aneurysm formation, occlusion, dissection or vascular\nmalformation.\n\nCTA Neck: There is a left-sided aortic arch with conventional origin of the\nmajor branch vessels. There is adequate opacification of the bilateral common\ncarotid, and internal carotid arteries, without high-grade narrowing. There is\nno significant atherosclerotic disease.\n\nThe a right vertebral artery is dominant. The left vertebral artery is\ndiminutive throughout its course, from its origin at the mid left subclavian\nartery. There is no evidence of luminal irregularity and diminutive appearance\nof the left vertebral artery is most likely on a congenital hypoplastic basis.\nThere is no evidence of significant stenosis at the origins or throughout the\ncourse of these vessels.\n\nRight internal carotid artery (minimal dimension in mm):\n\nProximal: 7.5\n\nDistal: 4.0\n\nLeft internal carotid artery (minimal dimension in mm):\n\nProximal: 8.0\n\nDistal: 4.5\n\nAdditional findings: The paranasal sinuses and mastoid air cells are clear.\nThe nasopharynx, oropharynx, hypopharynx and larynx are unremarkable. The\nthyroid gland demonstrates homogeneous density. There is no evidence of\nenlarged lymph nodes by CT criteria. The visualized lung apices are clear.\nThere are minimal degenerative changes of the cervical spine.", + "output": "1. No evidence of acute intracranial process. Hypodensity in the left\ncerebellar hemisphere is consistent with known chronic infarction.\n2. CTA head shows no evidence of stenosis, dissection or aneurysm.\n3. CTA neck demonstrates the small caliber of the left vertebral artery\nthroughout its course, most likely secondary to congenital hypoplasia.\n4. No stenosis of internal carotid arteries by NASCET criteria." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nHypodensity in the left frontal lobe in the MCA territory compatible with\nevolving infarct as seen on recent MRI. There is no evidence of no evidence of\nhemorrhage, edema, or mass. The ventricles and sulci are normal in size and\nconfiguration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is occlusion of the distal left M1 and left M2 segment of the MCA,\nunchanged from MRI, with some opacification of distal branches likely from\ncollaterals. There is occlusion of the intracranial internal carotid artery\nto the para ophthalmic region. The left A1 segment is diminutive although is\nunclear whether this is congenital versus thrombus. The remaining vessels of\nthe circle of ___ and their principal intracranial branches appear normal\nwithout stenosis, occlusion, or aneurysm formation. The dural venous sinuses\nare patent.\n\nCTA NECK:\nThere is occlusion of the left internal carotid artery extending from the\nbifurcation distally with reconstitution in the cavernous segment, possibly\nfrom retrograde flow, unchanged from MRA dated ___. The right\ncarotid and bilateralvertebral arteries and their major branches appear normal\nwith no evidence of stenosis or occlusion. There is no evidence of right\nproximal cervical internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are notable for centrilobular emphysema. \nThe visualized portion of the thyroid gland is within normal limits. There is\nno lymphadenopathy by CT size criteria.", + "output": "1. Evolving left MCA territory infarct.\n2. Occlusion of the left internal carotid artery from the level of the\nbifurcation with reconstitution in the cavernous segment, unchanged from prior\nMRA.\n3. Occlusion of the distal left M1 segment to left M2 segment of the MCA, with\ndistal reconstitution also unchanged.\n4. The left A1 segment is diminutive. It is uncertain whether this is\nsecondary to congenital hypoplasia versus thrombus." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect or infarction. The\nventricles and sulci are prominent compatible with age-related atrophy. \nPeriventricular and subcortical white matter hypodensities are nonspecific but\nsuggest chronic microvascular ischemic disease. The basal cisterns are\npatent. Gray-white matter differentiation is preserved.\n\nThe partially visualized paranasal sinuses, mastoid air cells and middle ear\ncavities are grossly clear. There are atherosclerotic calcifications of the\ncavernous internal carotid arteries and bilateral vertebral arteries.", + "output": "No evidence of metastatic disease. Please note MRI would be more sensitive\nfor small metastatic masses." + }, + { + "input": "There is no evidence of acute large territory infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nNasal bone fracture, likely chronic. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "Interval evolution of right frontal lobe infarct with slightly increased area\nof hypodensity noted in the right frontal lobe compared with prior CT head but\nsimilar to MR. ___ addition, there are foci of increased density within the\nhypodensity compatible with known blood products seen on recent MR, increased\nin extent compared to CT head but has similar to the MR head. There is ___\nevidence of new hemorrhage or new infarction. There is prominence of the\nventricles and sulci suggestive of involutional changes. Periventricular\nsubcortical white matter hypodensities are nonspecific but suggest chronic\nsmall vessel ischemic changes. Dense atherosclerotic calcifications of the\ncavernous carotid arteries are again noted.\n\nThere is ___ evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Interval evolution of right frontal lobe infarct with increased foci of\nhyperdensity compared with prior CT head and consistent with blood products as\ndemonstrated on recent MR. ___ new foci of hemorrhage or infarct." + }, + { + "input": "Again demonstrated is the hypodensity with loss of gray-white matter\ndifferentiation in the right frontal lobe compatible with recent infarction\nwith a foci of increased density within (2; 19), unclear if foci of hemorrhage\nbut appears unchanged compared to prior. No new infarct or foci of hemorrhage\nis noted. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific but suggest chronic small vessel ischemic\nchanges. Atherosclerotic calcifications noted within the intracranial ICAs\nand vertebral arteries.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Re-demonstration of right frontal lobe infarct with foci of relative increased\ndensity within. This could potentially be petechial hemorrhage or laminar\nnecrosis and appears unchanged compared to prior from 6 hours earlier." + }, + { + "input": "CTA HEAD AND NECK:\nThere is a normal 3 vessel aortic arch. Moderate atherosclerotic plaque with\npossible ulceration is noted within the proximal right brachiocephalic artery\n(2:61). The left proximal internal carotid artery takes a retropharyngeal\ncourse.\n\nOtherwise, the common carotid and internal carotid arteries are patent and\ngrossly unremarkable bilaterally. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nThere is a left-sided dominant vertebral basilar system, with tortuosity of\nthe proximal left V1 segment which remains patent. Moderate calcifications\nare seen within the left V4 segment. The right V4 segment terminates within\nthe ___.\n\nModerate calcifications are seen in the bilateral cavernous internal carotid\narteries. The vessels of the circle of ___ and their principal\nintracranial branches are patent without high-grade stenosis, occlusion, or\naneurysm formation. Several focal filling defects within the superior sagittal\nsinus (for example, 2:318), represent arachnoid granulations. The dural\nvenous sinuses are patent.\n\nAgain, there is a hypodensity identified within the right frontal lobe. For\nfurther description of the parenchymal findings, please see the separate CT\nnoncontrast head examination performed on ___.\n\n\nOTHER:\nA lobulated, left intraparotid mass with areas of hyperdensity along its\nperiphery, incompletely evaluated on this nondedicated examination. The lungs\napices are clear bilaterally. The thyroid gland is unremarkable in appearance.\nMultiple prominent bilateral cervical lymph nodes are noted, none of which are\npathologically enlarged by CT size criteria.", + "output": "1. Known, right frontal lobe hypodensity, better evaluated on the recent\nnoncontrast CT head and subsequent MR head examination, correlating with an\narea of acute infarction.\n2. Patent intracranial and cervical vasculature with areas of mild-to-moderate\natherosclerotic disease as detailed above. No evidence for high-grade\nstenosis, dissection, or aneurysm. There is no cervical internal carotid\nartery stenosis by NASCET criteria.\n3. Lobulated left intra parotid mass, better characterized on subsequent MR\nexamination.\n\nRECOMMENDATION(S): Further evaluation with ultrasound with eye towards biopsy\nfor left intra parotid mass." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are prominent in keeping with generalized parenchymal volume loss. \nScattered areas of subcortical deep white matter hypodensity likely reflect\nchronic microvascular ischemic change.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality identified." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is region of hypoattenuation involving the medial left cerebellum and\nleft cerebellar vermis correlating with the evidence of subacute infarct\nidentified on the more recently performed MRI head. There is no evidence of\nhemorrhage or mass effect. The ventricles and sulci are normal in size and\nconfiguration.\n\nThe patchy periventricular white matter hypoattenuation is compatible with\nsmall vessel disease given the patient's age.\n\nThere is mild mucosal thickening of the maxillary sinuses and ethmoid air\ncells. Bubbly mucosal secretions within the left sphenoid sinus can be seen\nin the setting of acute sinusitis. The mastoid air cells and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Region of hypoattenuation involving the medial left cerebellum and left\ncerebellar vermis correlate to the subacute infarct identified on the more\nrecently performed MRI head. The distribution correlates with the left ___.\n2. No evidence of dissection, aneurysm or occlusion of the head neck. No\nsignificant ICA stenosis by NASCET criteria.\n3. Patchy periventricular white matter small vessel disease.\n4. Mild inflammatory changes of the maxillary sinuses with bubbly mucosal\nsecretions in the left sphenoid sinus, which can be seen in setting of acute\nsinusitis." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Incidental\nnote is again made of a pineal gland cyst, which appear to previous grossly\nunchanged and measures approximately 11 x 7 mm in transverse dimension (image\n12, series 2). The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "There is no evidence of acute intracranial process or hemorrhage." + }, + { + "input": "An 8 mm hyperdense focus is visualized in the left frontoparietal region\n(series 2: Image 16) consistent with an intraparenchymal bleed. In addition,\nan 8 mm intraparenchymal bleed is visualized in the right occipital lobe\n(series 2: Image 12). An area of loss of gray-white matter differentiation in\nthe right frontal lobe at the level of the frontal horn of the lateral\nventricle is appreciated, consistent with prior infarct. Small amount of\nsubarachnoid blood is demonstrated in the right vertex. Trace amount of\nsubarachnoid blood is visualized in the left vertex. The ventricles and sulci\nare within expected limits in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. Two 8 mm areas of intraparenchymal hemorrhage, 1 in the left frontoparietal\nregion and the other in the right occipital lobe.\n2. Small amount of subarachnoid blood in the right vertex and trace amount in\nthe left.\n3. Loss of gray-white differentiation in the right frontal lobe, consistent\nwith acute infarct.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on\n___ at 5:19 am, 2 minutes after discovery of the findings." + }, + { + "input": "There is redemonstration of hyperdense foci within the left frontal parietal\nregion (series 2, image 15) and the right occipital lobe (series 2, image 15),\nwhich are not substantially changed in size measuring 8 mm, but demonstrate\nslightly more prominent surrounding vasogenic edema. There is persistent\nhyperdensity along the right aspect of the vertex (series 2, image 26),\nsuggestive of subarachnoid blood products. A additional tiny focus of\nhyperdensity along the left aspect of the vertex (series 2, image 26) could\nrepresent additional subarachnoid blood product.\n\nHypodensity and loss of gray-white matter differentiation in the right frontal\nlobe is unchanged in extent consistent with acute infarct (series 2, image\n14). There is mild effacement of the anterior horn of the right lateral\nventricle as seen previously. No evidence of hemorrhagic conversion.\n\nThere are additional regions of loss of gray-white differentiation involving\nthe right superior cerebellar hemisphere (series 304, image 21) and left\ncorona radiata (series 2, image 18) is much more prominent when compared to\nprior exam.\n\nNo midline shift. No evidence of herniation. The configuration of the\nventricles and sulci are stable.\n\nNo displaced calvarial fractures. The orbits are within normal limits. \nPatient is intubated with partial visualization a nasoenteric tube. The\nparanasal sinuses are clear. The mastoid air cells are partially opacified\nbilaterally, likely sequela of intubation.", + "output": "1. There is new loss of gray-white differentiation involving the right\nsuperior cerebellar hemisphere and left corona radiata, not readily seen on\nprior exam.\n2. Redemonstration of two 8mm foci of intraparenchymal hemorrhage within the\nleft frontal parietal and right occipital lobe, unchanged in size with\nslightly increased surrounding vasogenic edema. Mild effacement of the right\nlateral ventricle at the anterior horn is unchanged, the configuration of the\nventricles and sulci are stable.\n3. Small amount of subarachnoid blood in the vertex is unchanged.\n4. Redemonstration of a likely acute infarct in the right frontal lobe,\nunchanged in extent without evidence of hemorrhagic conversion.\n\nRECOMMENDATION(S):" + }, + { + "input": "There is redemonstration of multiple hyperdense foci in the left parietal lobe\n(3:18), right occipital lobe consistent with punctate intraparenchymal\nhemorrhages that appear unchanged compared to the study from ___.\n\nMultiple hyperdensities along the vertex are again seen (3:28, 32) consistent\nwith subarachnoid blood products.\n\nThere is loss of gray-white matter differentiation and hypoattenuation in the\nright frontoparietal lobe is greater in size compatible with an evolving right\nMCA territory infarction. There is a linear hyperdensity within the infarct\nthat likely represents hyperdense vessel in the sylvian fissure. There is\nsurrounding edema with sulcal effacement of the right cerebral convexity. \nMild effacement of the right lateral ventricle, similar to prior.\n\nThere are additional regions of focal hypoattenuation in the right cerebellar\nhemisphere (3:13), right parietal lobe (3:15), left frontal lobe (3:14) and\nleft corona radiata (3:21), more apparent than on the prior examination.\n\nNo displaced fracture. Mastoid air cells are partially opacified bilaterally,\nwhich is likely the sequela of prolonged intubation and supine positioning of\nin the patient's setting. The visualized portion of the paranasal sinuses and\nmiddle ear cavities are clear. The orbits are normal. An endotracheal and\nnasoenteric tube are partially visualized on the scout images.", + "output": "1. Interval increase in the size of the right frontoparietal hypoattenuation\ncompatible with evolution of infarct of the right MCA territory. No evidence\nof femoral junctions region. Mild surrounding edema with sulcal effacement of\nthe right cerebral convexity and effacement of the right lateral ventricle.\n2. Redemonstration of two foci of intraperitoneal hemorrhage within the left\nfrontoparietal and right occipital lobes, similar in size and appearance\ncompared to the study from 1 day prior.\n3. Small amount of subarachnoid blood in the vertex.\n4. Multiple focal areas of hypoattenuation in the left corona radiata, right\ncerebellar hemisphere, left frontal lobe and right frontal lobe, and right\noccipital lobe more conspicuous than on the prior examination consistent with\nevolving infarcts." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nPeriventricular and subcortical white matter hypodensities are nonspecific but\nlikely sequelae of chronic small vessel ischemic disease.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Cavernous carotid and vertebral\ncalcifications are noted.", + "output": "1. No evidence of hemorrhage or infarction." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of acute territorial infarction,\nhemorrhage, edema, or mass effect. The ventricles and sulci are normal in size\nand configuration.\n\nThere is moderate mucosal thickening of the right maxillary sinus. The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThere is minimal calcification of the descending aorta. The carotid and\nvertebral arteries and their major branches appear normal with no evidence of\nstenosis or occlusion. There is no evidence of internal carotid stenosis by\nNASCET criteria.\n\nOTHER:\nThere is ground glass opacity and consolidation in the left upper lobe of the\nlung only partially visualized by the current study. The visualized portion\nof the thyroid gland is within normal limits. There is no lymphadenopathy by\nCT size criteria. Soft tissue density in the bilateral external auditory\ncanals without osseous erosion or expansion likely represents cerumen.", + "output": "1. No acute intracranial abnormality on noncontrast head CT.\n2. No evidence of intracranial hemorrhage, aneurysm, or occlusion.\n3. Ground-glass opacity and consolidation in the left upper lobe of the lung\npartially visualized by the current study. This may be secondary to\natelectasis. Correlation with infectious process is recommended." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, mass, or mass effect. \nThe ventricles sulci are normal in caliber and configuration.\n\n The visualized paranasal sinuses, mastoid air cells, and middle ear cavities\nappear well-pneumatized and clear. The globes and orbits are unremarkable.\n\nCT PERFUSION:\nPerfusion images demonstrate normal symmetric perfusion. Rapid CT perfusion\nanalysis demonstrates 0 mL volume of CBF < 30% and/or T-max> 6 seconds.\n\nCTA HEAD:\nRight dominant vertebral artery, a normal variant. Fetal type left PCA, a\nnormal anatomic variant. The right P1 is patent and unremarkable. Left P1 is\nnot well seen, either diminutive or absent. Distal bilateral posterior\ncerebral arteries are patent with normal runoff.\n\nMild calcification of the cavernous intracranial ICAs bilaterally causing\nminimal/mild luminal narrowing. Otherwise, widely patent anterior circle of\n___ vasculature including bilateral anterior and middle cerebral arteries\nwith normal distal runoff.\n\nNo evidence of additional area of stenosis, occlusion, or aneurysm. No\narteriovenous malformation. Patent major dural venous sinuses.\n\nCTA NECK:\nMild motion degradation. Within these confines: Mild calcification of the\nproximal left ICA without stenosis rowing by NASCET criteria. Otherwise,\nwidely patent bilateral vertebral and carotid arteries in the neck. No right\nICA stenosis by NASCET criteria.\n\nOTHER:\nMild aortic arch calcifications and calcification at the origin of the common\norigin of the left common carotid artery and the brachiocephalic artery. \nOtherwise, the arch branch vessels are patent throughout their visualized\ncourse. Thyroid is unremarkable. No pathologically enlarged cervical lymph\nnodes. Mild right apical paraseptal emphysema. 2 mm calcified granuloma,\nmedial left lung apex. Prevertebral and paraspinal soft tissues are\nunremarkable. Mild cervical spine degenerative changes. No worrisome focal\nosseous lesions.", + "output": "1. No acute intracranial process by unenhanced head CT.\n2. Unremarkable CT perfusion.\n3. Mild calcification of the cavernous intracranial ICAs bilaterally causing\nminimal/mild luminal narrowing. Otherwise, unremarkable CTA head. No\nocclusion or aneurysm.\n4. Patent bilateral cervical vertebral and carotid arteries. No ICA stenosis\nby NASCET criteria." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThe ethmoid air cells are partially opacified. A small mucous retention cysts\nare present in the frontal and maxillary sinuses. The nasal septum is\ndeviated to the left. The orbits are unremarkable.\n\n\nCTA HEAD:\n\nThe right A1 segment is not visualized. A robust anterior communicating\nartery connects the right A2 segment to the left A1/A2 segment. A 6 x 6 mm\naneurysm arises from the junction of the anterior communicating artery with\nthe left A1/A2 segment (6:98), overall stable in size. There is an\napproximately 6 mm bilobed aneurysm at the right middle cerebral artery\nbifurcation arising near the anterior temporal branch and pointing inferiorly\nwith calcification. The P1 segments of the posterior cerebral arteries are\ndiminutive bilaterally with flow in the distal posterior cerebral arteries\npredominantly supplied by a robust posterior communicating arteries,\nconsistent with bilateral fetal PCA variants. The arteries of the circle of\n___ and its major branches are otherwise normal without flow limiting\nstenosis or occlusion. No new aneurysm is identified.\n\nThe dural venous sinuses are patent.", + "output": "1. Stable 6 mm aneurysm at the junction of the left A1/A2 segment with the\nanterior communicating artery. The aneurysm points anteriorly and to the left\nside.\n2. 6 mm right middle cerebral artery bifurcation aneurysm at the origin of the\nanterior temporal branch not well seen on the previous MRA.\n3. Absent right A1 segment.\n4. Bilateral fetal PCA variants." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Mild chronic small vessel ischemic change. Prominence of the\nventricles and sulci suggest involutional changes.\n\nChronic fracture right medial orbital wall. Chronic fracture tip of the nasal\nbone.", + "output": "No acute findings." + }, + { + "input": "Limited examination due to patient motion, within the limits of this exam\nthere is no evidence of large territorial infarction,acute hemorrhage,edema,or\nmass. Hypodensities are noted bilaterally in the cerebellar hemispheres and\nin the left cerebellar peduncle, which appear larger than the corresponding\nhyperintensities noted on MR from ___. This could represent\nvasogenic edema in the setting of infection, however, areas of cerebellar\ninfarction cannot be excluded in this exam. If clinically concerning, MR is\nmore sensitive for the characterization of acute infarction.\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinusesa and middle ear cavitiesare unremarkable. There is mild opacification\nof the mastoid air cells bilaterally. The visualized portion of the orbits\nare unremarkable.", + "output": "1. No evidence of large territory infarction, acute hemorrhage, edema, or\nmass.\n2. Hypodensities in the cerebellar hemispheres and left middle cerebellar\npeduncle appear more prominent when compared to the corresponding\nhyperdensities on MR from ___. These hypodensities could be\nattributed to vasogenic edema in the setting of infection, however, an area of\ncerebellar infarction cannot be excluded in this exam. If clinically\nconcerning, MR is more sensitive for characterizing acute infarcts." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\ngeneralized brain parenchymal atrophy, most prominent and moderate at the\nbilateral frontal lobes. No hydrocephalus. Probable mild chronic small\nvessel ischemic changes.\n\nThere is no evidence of fracture. Minimal opacification right mastoid air\ncells.. Otherwise, the visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "No acute intracranial findings.\nModerate bifrontal parenchymal atrophy." + }, + { + "input": "Ill-defined hypodensity in the inferior left frontal lobe (05:12) likely\nrepresents edema from known septic emboli better seen on recent MR head. \nThere is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Mild prominence of the ventricles and sulci suggest involutional\nchanges. The imaged paranasal sinuses are clear. Mastoid air cells and\nmiddle ear cavities are well aerated. The bony calvarium is intact.", + "output": "Ill-defined hypodensity in the inferior left frontal lobe (05:12) likely\nrepresents edema from known septic emboli better seen on recent MR head." + }, + { + "input": "The previously identified hypodensity in the inferior left frontal lobe is not\nwell visualized on today's exam. No new lesions are identified. There is no\nintra-axial or extra-axial hemorrhage. There is no evidence of infarction. \nThere has been interval development of bilateral subdural effusions, most\nprominent in the temporal frontal regions, with associated mass effect on the\ncortex (5:20). This finding is compatible with an underlying infectious\nprocess. While chronic subdural hematomas may have a similar appearance, the\nlack of prior evidence of subdural hematoma on prior imaging studies makes\nthis less likely. There is no evidence of midline shift. There is prominence\nof the ventricles and sulci suggestive of age-related involutional changes.\n\nThere is no evidence of calvarial fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable. There has been interval\nplacement of a right-sided ___ tube.", + "output": "1. There has been interval development of bilateral subdural effusions, most\nprominent in the temporal frontal regions, with associated mass effect on the\ncortex. This finding is compatible with an underlying infectious process.\nWhile chronic subdural hematomas may have a similar appearance, the lack of\nprior evidence of subdural hematoma on prior imaging studies makes this less\nlikely.\n2. The previously identified hyperdensity in the inferior left frontal lobe is\nnot well visualized on today's exam. No new lesions are identified within the\nlimitations of a nonenhanced CT.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 4:07 pm, 10 minutes after\ndiscovery of the findings." + }, + { + "input": "Rim enhancing lesions demonstrated on MRI are better assessed on MRI. Right\ngreater than left increased extra axial space overlying the frontal\nconvexities may be slightly decreased from ___, measuring up to\n10 mm on the right. There is no evidence of acute infarction, new or\nincreasing hemorrhage, new mass or edema.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Rim enhancing lesions demonstrated on prior MRI are not well seen on this\nexamination. There are no new or increasing areas of edema or mass effect.\n2. Extra-axial fluid collections noted on the prior MRI are decreased in size,\nmeasuring up to 10 mm on the right and difficult to measure on the left. \nThere is also decreased mass effect upon the underlying cerebral cortices. No\nacute hemorrhage." + }, + { + "input": "There is no evidence of a acute territorial infarction, intracranial\nhemorrhage, or edema. Prominent the bifrontal extra-axial spaces appear\nstable from prior CT and MRI measuring maximally 8 mm on the right. There is\nno midline shift. The basal cisterns are patent. Previously described sub\ncentimeter lesions are better appreciated on prior MRI. The ventricles and\nsulci are stable in size and configuration. No acute fracture seen. The\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\norbits are unremarkable.", + "output": "No intracranial hemorrhage. Stable prominent bifrontal extra-axial spaces." + }, + { + "input": "Rim enhancing lesions seen on MRI are better assessed on the most recent\npreceding MRI. There is no evidence of infarction, hemorrhage, edema, or\nmass. Prominence of the extra-axial spaces is unchanged, this finding is more\nsignificant towards the frontal convexity. The ventricles and sulci are\nunchanged in size and configuration.\n\nThere is no evidence of fracture. There is patchy nonspecific opacification\nof right mastoid air cells. The visualized portion of the paranasal sinuses\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable. Carotid siphon calcifications are severe. A presumed\nnasoenteric catheter is partially imaged.", + "output": "1. There is no evidence of acute intracranial process or hemorrhage\n\n2. Prominent extra-axial spaces appear unchanged." + }, + { + "input": "There is no evidence of acute major infarction,hemorrhage,edema,or large mass.\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Periventricular and subcortical hypodensities are nonspecific, but\nlikely chronic small vessel ischemic disease.\n\nThere is no acute fracture. There is mild mucosal thickening of the maxillary\nsinuses and bilateral ethmoid air cells. Trace fluid is noted in the sphenoid\nsinuses. The nasal cavities are mostly opacified with a catheter in the left\nnasal passage. The visualized portion of the mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable. Carotid siphon calcifications are moderate. Soft tissue\ndensity in the right external auditory canal is nonspecific, though likely\ncerumen.", + "output": "1. No acute intracranial abnormalities.\n2. Opacification of the paranasal sinuses as described above, likely related\nto placement of tube placements.\n3. Global atrophy and likely sequelae of small vessel disease." + }, + { + "input": "Despite repetition of the acquisition there is motion degradation affecting\nthe skullbase and posterior fossa.\n\nThere is no evidence of infarction, hemorrhage, edema, or mass. Bilateral\nperiventricular and subcortical white matter hypodensities are again noted in\nsimilar degree to prior CT, indicating moderate chronic small vessel disease. \nA punctate calcification in the left basal ganglia and bilateral hypodensities\nin both basal ganglia are stable. There is prominence of the ventricles and\nsulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Enteric and endotracheal tubes are\npartially visualized on the scout views.", + "output": "Motion degradation affecting visualization of the skullbase and posterior\nfossa. Within this limitation, no acute intracranial findings.\n\nNOTIFICATION: Motion degradation affecting visualization of the skullbase and\nposterior fossa. Within this limitation, no acute intracranial findings." + }, + { + "input": "There is no evidence of acute large territory infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific, but likely reflect sequelae of chronic small\nvessel ischemic disease.\n\nThere is no evidence of fracture. Mild left maxillary mucosal thickening is\ndemonstrated otherwise the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "No acute intracranial abnormality, specifically no evidence of intracranial\nbleed." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nPeriventricular and subcortical white matter hypodensities may reflect chronic\nsmall vessel disease.\n\nThere is no evidence of fracture. Small amount of fluid is noted in the\nsphenoid sinuses, which is unremarkable in an intubated patient.. The\nvisualized portion of the orbits are unremarkable.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, or acute major\nvascular territorial infarction. Again seen are periventricular, deep and\nsubcortical hypodensities, which nonspecific but may represent small vessel\nischemic changes given the patient's age and cardiovascular risk factors. \nAlso again seen are small hypodensities within bilateral lentiform nuclei,\ncompatible with chronic infarcts versus prominent perivascular spaces. There\nis age-related global parenchymal volume loss with prominent ventricles and\nsulci, as seen previously. Carotid and vertebral artery calcifications are\nagain noted.\n\nNo displaced fracture is seen. There is fluid and aerosolized secretions in\nthe left sphenoid sinus, present dating back to the presenting CT from ___, and aerosolized secretions in the right sphenoid sinus which have\nincreased compared to ___ (though the increased may be secondary to\nprolonged supine positioning and nasogastric intubation in the inpatient\nsetting. There is mild mucosal thickening in the anterior ethmoid air cells. \nThere is mild partial opacification of bilateral dependent mastoid air cells,\nwhich may be secondary to nasogastric intubation and prolonged supine\npositioning in the inpatient setting.", + "output": "1. No evidence for an acute intracranial abnormality or displaced fracture.\n2. Paranasal sinus disease, as discussed above." + }, + { + "input": "There is no evidence of acute major infarction,hemorrhage,edema,or discrete\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific, however likely due to chronic small vessel\nischemic disease in this age group.\n\nThere is no evidence of acute fracture. Polypoid mucous retention cysts and\nmucosal thickening is noted in the left sphenoid sinus. Trace air-fluid level\nis noted in the right sphenoid sinus. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Carotid siphon calcifications are\ndense.", + "output": "No acute intracranial abnormalities." + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or discrete\nmass. Prominence of the ventricles and sulci is consistent with age related\ninvolutional changes. Mild nonspecific periventricular white matter\nhypodensities are suggestive of chronic small vessel ischemic disease. \nExtensive atherosclerotic calcifications of the carotid siphons are noted.\n\nNo osseous abnormalities seen. Layering fluid and aerosolized secretions are\nseen in bilateral sphenoid sinuses. Paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Paranasal sinus disease as described above." + }, + { + "input": "There is no evidence of an acute large territory infarction,hemorrhage,edema,\nor mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific but likely chronic sequela of small-vessel\nischemic disease. Atherosclerotic vascular calcifications are noted of\nbilateral cavernous portions of internal carotid arteries.\n\nThere is no evidence of fracture. The left sphenoid sinus is partially\nopacified. The visualized portion of the mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are preserved.", + "output": "1. No acute intracranial hemorrhage or calvarial fracture.\n2. Paranasal sinus disease with findings suggestive of acute sinusitis, as\ndescribed." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nHypodensities in bilateral basal ganglia appear chronic.\n\nThere is no evidence of fracture. Mucous retention cyst is noted in the left\nsphenoid sinus. Minimal amount of fluid is noted in the right sphenoid sinus.\nThe visualized portion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema,or mass effect. \nThere is prominence of the ventricles and sulci suggestive of age-related\nvolume loss. Subcortical and periventricular white-matter hypodensities are\nnonspecific, but likely represent sequela of chronic small vessel disease.\n\nThere is no evidence of fracture. There is mild-to-moderate mucosal\nthickening of the ethmoid air cells. The visualized portion of the other\nparanasal sinuses and middle ear cavities are clear. There is minimal\nopacification of the right mastoid air cells, of indeterminate clinical\nsignificance. The left mastoid air cells are clear. Patient is status post\nright lens replacement.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no acute cortical infarct or acute intracranial hemorrhage.\n\nThere remains prominence of the intra and extra-axial CSF spaces, particularly\nat the frontal and temporal convexities, without sulcal effacement, in keeping\nwith mild to moderate preferential volume loss, not unexpected in patients of\nthis age group. There also chronic ischemic microangiopathic changes in the\nsubcortical white matter of the left frontal lobe. Cerebellar tonsils remains\nslightly low lying.\n\nNo dense vessel sign.\n\nRight lens replacement, gaze downward. Partial opacification of the right\nmastoid air cells, chronic appearing with secondary osteitis. Few pacchionian\ngranulations, but no suspicious lytic lesion.", + "output": "No acute cortical infarct. If there remains high clinical suspicion for\nhyperacute stroke, may repeat the study in 24 hours, for reassessment." + }, + { + "input": "No evidence of infarction, hemorrhage, edema, or mass. 6-mm, ovoid\nhypodensity in the right basal ganglia is a dilated perivascular space (series\n4A, image 13). Bilateral, symmetric prominence of the ventricles and sulci\nlikely reflects age-related involutional change.\n\nNo evidence of fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable other than postsurgical changes in the lenses.", + "output": "No hemorrhage or evidence of infarct. Note that MRI is more sensitive for the\ndetection of early stroke." + }, + { + "input": "Left : The external auditory canal is normal. The middle ear cavity is clear.\nThe ossicles and tegmen are intact. There is no evidence for enlarged\nvestibular aqueduct or superior semicircular canal dehiscence. The facial\nnerve follows a normal course through the middle ear. There is no evidence for\ninner ear dysplasia. The mastoids are clear.\n\nRight: The external auditory canal is normal. The middle ear cavity is clear.\nThe ossicles and tegmen are intact. There is no evidence for enlarged\nvestibular aqueduct or superior semicircular canal dehiscence. The facial\nnerve follows a normal course through the middle ear. There is no evidence for\ninner ear dysplasia. Trace fluid is noted within several posterior inferior\nmastoid air cells. No evidence of osseous erosion. No developing\nsubperiosteal or subcutaneous collections are seen.\n\nOther: Visualized brain and neck soft tissues are normal.", + "output": "-Trace fluid noted within several right posterior inferior mastoid air cells. \nNo evidence of osseous erosion or developing subperiosteal or subcutaneous\nfluid collection.\n-Otherwise, grossly unremarkable CT of the temporal bones." + }, + { + "input": "Evaluation is somewhat limited by motion artifact. There is no evidence of\nacute territorial infarction, hemorrhage, edema, or large mass. Right frontal\nperipherally calcified meningioma measures 1.3 cm. Periventricular and\nsubcortical white matter hypodensities are nonspecific, but likely represent\nchronic small vessel ischemic disease. Prominence of the ventricles and sulci\nis suggestive of involutional changes.\n\nNo acute osseous abnormalities seen. There is mild mucosal thickening\ninvolving the right sphenoid sinus. The remaining paranasal sinuses, mastoid\nair cells, and middle ear cavities are otherwise clear. The orbits are\nunremarkable.", + "output": "No acute intracranial process. 1.3 cm right frontal calcified meningioma\nwithout significant mass effect." + }, + { + "input": "There are multiple calcific densities in the bilateral cerebellum, bilateral\ntemporal lobes, right frontal lobe, increased in number compared to prior exam\nespecially in the cerebellum. The ventricles and sulci unchanged in size and\nconfiguration.\n\nThere is no evidence of acute fracture. Somewhat heterogeneous appearance of\nthe calvarium and focal sclerosis of the left mandibular ramus. There is\nmucosal thickening of the right maxillary sinus. There is partial\nopacification of the left mastoid air cells. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Interval increase in the number of calcific densities, especially in the\ncerebellum. Most likely represent treatment response in the setting of\nunderlying metastatic disease to the brain, and less likely granulomatous\ninfection or neurocysticercosis.\n2. Heterogeneous calvarium and sclerosis of the left mandible, possibly from\nmetastatic disease.\n3. MRI with and without contrast would help further characterize these\nfindings." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Prominent ventricles and sulci are consistent with age-related\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities seen, likely sequelae of chronic small vessel ischemic disease. \nNo fracture is seen. The imaged paranasal sinuses are clear. Mastoid air\ncells and middle ear cavities are well aerated.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute, large territorial\ninfarction,hemorrhage,edema,or large mass. There is prominence of the\nventricles and sulci suggestive of involutional changes. Periventricular\nwhite-matter hypodensities are nonspecific, likely sequela of chronic ischemic\nsmall vessel disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Aside from\nscleral calcifications, the visualized portion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "Head CT: There is no evidence of hemorrhage, edema, masses, mass effect, or\ninfarction. The ventricles and sulci are dilated in an atrophic pattern. The\nocular lenses have been resected. There is bilateral cavernous carotid\narterial calcifications. No fractures are identified.\n\nHead CTA: The intracranial carotid and right vertebral arteries and their\nmajor branches are patent with no evidence of stenoses, occlusions or aneurysm\nformation. The intracranial left vertebral artery is severely attenuated and\nirregular.\n\nNeck CTA: There is severe narrowing and irregularity of the left vertebral\nartery from its origin to its junction with the basilar artery. This is\ndramatically throughout the neck in a pattern suggestive of and extensive\ndissection. The uniform atrophy throughout its length without similar\nabnormalities and other vessels would be quite unusual for atheromatous\ndisease. There is atheromatous plaque with calcifications in the left\nsubclavian artery proximal and distal to the vertebral artery origin.\n\nThe right vertebral artery is dominant and appears normal.\n\nThere are calcified plaques involving the distal common carotid artery and\nproximal internal carotid arteries bilaterally. There is no evidence of\ninternal carotid artery stenosis by NASCET criteria.", + "output": "Atheromatous disease.\n\nSevere narrowing and irregularity of the left vertebral artery throughout its\ncourse. This suggests a dissection of indeterminate age." + }, + { + "input": "NECT Head: There is no evidence of hemorrhage, mass effect, edema, or \ninfarction. Prominent ventricles and sulci are consistent with age-related\ninvolutional changes. Periventricular and deep subcortical white matter\nhypodensities are consistent with chronic small vessel ischemic disease. The\nvisualized cranial bones are unremarkable in appearance.\n\nCTA H+N: Again seen is severe narrowing and irregularity of the left vertebral\nartery from its origin to its junction with the basilar artery, with unchanged\nappearance as compared to the prior study. This may represent chronic\ndissection or atheromatous disease. The right vertebral artery is dominant,\nand appears normal. Calcified plaques are seen involving the distal common\ncarotid artery and proximal internal carotid arteries bilaterally. There is no\nevidence of internal carotid artery stenosis by NASCET criteria.\n\nThe intracranial carotid and right vertebral arteries and their major branches\nare patent with no evidence of stenosis, occlusion, or aneurysm. The\nintracranial left vertebral arteries severely attenuated and irregular.\n\nThe visualized portions of the bilateral lung apices are grossly clear. The\nthyroid gland is unremarkable in appearance. There is no lymphadenopathy by CT\nsize criteria. Mild, multilevel, multifactorial degenerative changes are seen\nthroughout the cervical spine.", + "output": "Unchanged appearance of the left vertebral artery, which demonstrates severe\nnarrowing and irregularity from its origin to the junction with the basilar\nartery, which may represent chronic dissection or atheromatous disease." + }, + { + "input": "There is no acute intracranial hemorrhage, acute infarction, edema or mass\neffect. Prominent ventricles and sulci likely reflect age related involutional\nchanges. There is no shift of normally midline structures. The basal cisterns\nare clear. The gray white matter differentiation appears preserved.\n\nNo fracture is identified. The visualized paranasal sinuses, mastoid air\ncells and middle ear cavities are clear. Atherosclerotic calcifications of\nthe carotid siphon is incidentally noted.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There remains minimal ill-defined soft tissue asymmetry at the right base of\ntongue significantly decreased in size and enhancement when compared to prior\nexaminations. Thickening of the epiglottis, aryepiglottic folds and of the\nposterior pharynx with effacement of the bilateral vallecula is identified\nwithout focal mass lesion, which likely represent sequela of recent radiation\ntherapy. There is mild subcutaneous inflammatory stranding and thickening of\nthe anterior neck extending from the level of the submental space to the\nsternum also likely representing sequela of recent therapy.\n\nSignificant decrease size of an abnormal right level 2A lymph node now\nmeasuring approximately 1.4 x 0.9 cm (TRV, AP) previously measuring 2.1 x 2.0\ncm. There remains mild surrounding inflammatory stranding although the fat\nplane between this lymph node and the adjacent right submandibular gland is\ngrossly preserved (series 3, image 51). A previously described enlarged and\nabnormal right level 5A lymph node has also decreased in size and now\ndemonstrates a fatty hilum (series 3, image 48). There is no cervical\nlymphadenopathy by size criteria.\n\nThe right submandibular gland appears asymmetrically enlarged with mild\nsurrounding inflammatory stranding, presumably secondary to recent therapy. \nThe bilateral parotid glands and left submandibular gland are unremarkable.\n\nThe thyroid gland appears normal. The cervical vessels are patent. There is\nmultilevel degenerative cervical spondylosis without suspicious blastic or\nlytic osseous lesions. There is right greater than left mucosal thickening of\nthe maxillary sinuses. The visualized orbits are unremarkable. The mastoid\nair cells and middle ear cavities are well pneumatized and clear. The\nvisualized brain parenchyma is grossly unremarkable, allowing for limits for\nthe technique.\n\nThere are multiple pulmonary nodules, which include but are not limited to the\nfollowing dominant lesions: 6 mm right upper lobe pulmonary nodule (series 3,\nimage 113), 5 mm right upper lobe nodule (series 3, image 104), 5 mm\nsubpleural right upper lobe nodule (series 3, image 104), 4 mm right upper\nlower lobe nodule (series 3, image 106), and 4 mm left lower lobe nodule\n(series 3, image 115). There are subcentimeter nodules in the bilateral major\nfissures, which may represent fissural lymph nodes.", + "output": "1. Significant decrease size of a right base of tongue lesion which is now all\nill-defined. Significantly decreased size of previously described right level\nIIA and 5A lymphadenopathy.\n2. No new lymphadenopathy by size criteria.\n3. Inflammatory stranding and thickening of the aryepiglottic folds,\nepiglottis and posterior pharynx with effacement of the vallecula as well as\nsubcutaneous stranding of the anterior neck likely represents postradiation\nchanges. There appears to be post treatment mild inflammatory stranding and\nenlargement of the right submandibular gland as well.\n4. Multiple pulmonary nodules described above, with dominant 6 mm right upper\nlobe lesion. Some of these were seen on prior PET-CT however incompletely\nevaluated.\n\nRECOMMENDATION(S): Point 4: Recommend further evaluation with dedicated\nchest CT." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. Atherosclerotic calcification\nof the bilateral cavernous carotid arteries is noted.\nThere is a small scalp hematoma at the left vertex. There is no fracture. No\nosseous abnormalities seen. There is minimal mucosal thickening of the\nethmoid air cells. Otherwise, the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "The examination is suboptimal given lack of IV contrast for evaluation of soft\ntissues. Within this confine:\n\nThere is mild subcutaneous stranding and cutaneous thickening involving the\nleft ear (including the helix, antihelix and concha), which may represent any\ncombination of residual lesion and postoperative sequela. No definite\nulcerative lesion is identified.\n\nThere is a 1-2 mm subtle focus of cutaneous thickening at the level of the\nleft second medic process (series 3, image 9), nonspecific. Direct\nvisualization is recommended.\n\nAero digestive tract: There no mass.\n\nIf there is a mass, please insert field choice -->\n\nNeck lymph nodes: There is no adenopathy involving bilateral levels ___. \nThere is no retropharyngeal adenopathy.\n\nExtra nodal tumor spread: Not applicable. There are no findings suggestive of\nextra nodal extension.\n\nDeep neck muscles, masticator space: There is no muscle invasion.\n\nBones, skull base:\nThere is no bone involvement.\nThe skull-base foramina preserved. There are no findings suggestive of\nperineural tumor extension within confines of technique. Jugular foramen,\ncarotid canal, pterygopalatine fossa, infraorbital foramen, other skull base\nforamina are not involved.\n\nVessels: Vessels are grossly unremarkable on noncontrast examination.\n\nBrachial Plexus: Unremarkable. There is no brachial plexus contact or\ninvasion.\n\nThyroid, salivary glands: There is no mass. The parotid and submandibular\nglands are unremarkable. The thyroid is unremarkable.\n\nOther findings: There are no lung nodules.", + "output": "1. Evaluation for soft tissue lesions is suboptimal given lack of IV contrast.\nWithin this confine:\n2. Mild subcutaneous stranding and cutaneous thickening of the left ear, which\nmay represent any combination of residual lesion and postoperative sequela.\n3. There is no cervical lymphadenopathy by size criteria.\n4. There is a nonspecific 1-2 mm focus of cutaneous thickening at the level\nleft zygomatic process. Given patient's history of multiple nonmelanoma skin\nlesions, direct visualization is recommended.\n5. Additional findings as described above." + }, + { + "input": "There is significant bilateral lymphadenopathy, particularly along the\ninternal jugular chains and subpectoral regions. A right parotid lymph node\n(2, 24) measures 1.5 cm, previously 1.6. A 1.1 cm left parotid node (2, 19)\nwas previously 1.2 cm. A left level 1 node (2, 34) measuring 2.0 cm was\npreviously 2.0 cm. A right level 2 node (2, 44) measuring 2.5 cm had\npreviously measured 2.5 cm. A right level 5 node (248) measures 2.2 cm long\naxis, previously 2.3 cm. A left 2.1 cm long axis node (2, 39) had previously\nmeasured 2.2 cm. A left supraclavicular node (2, 51) measuring 2.6 cm long\naxis had previously measured 2.7 cm long axis. A partially visualized right\nsubpectoral node measures 3.7 x 2.3 cm, previously 3.5 x 2.4 cm. A right level\n5 lymph node (2, 33) measures 1.5 cm long axis, previously 1.8. A right\naxillary node (2, 57) measures 1.1 cm, previously 0.9 cm.\n\nBesides intraparotid lymphadenopathy, the parotid glands are otherwise\nunremarkable. The submandibular glands and thyroid appear normal. The\naerodigestive tract is normal. Mucosal thickening seen in the maxillary\nsinuses bilaterally and within the sphenoid sinus on the right. Other\nparanasal sinuses and mastoids are clear. Included intracranial structures are\nunremarkable.\n\nLung apices are clear. Left-sided central venous catheter is partially\nvisualized. Atherosclerotic calcifications noted at the aortic arch. Vascular\nstructures are otherwise unremarkable. Median sternotomy wires are noted.\nDegenerative changes are seen without suspicious osseous lesions identified.", + "output": "Overall, no significant interval change in the bilateral cervical adenopathy\nalthough some nodes appear marginally smaller and 1 right axillary node\nappears marginally larger, as detailed above." + }, + { + "input": "Extensive bilateral cervical lymphadenopathy is again seen.\n\n1.6 cm right parotid lymph nodes measured 1.5 cm previously, image 2:21. 1.1\ncm left parotid lymph node on image 2:18 is stable.\nLevel 1a lymph nodes measure up 1.4 cm on the right and 1.6 cm on the left,\nimage 2:43, compared to 1.2 and 1.0 cm previously.\nLevel 1b lymph nodes measure up to 2.3 cm on the right, image 2:32, and 2.4 cm\non the left, image 2:37, compared to 2.0 and 2.0 cm previously.\nRight level 2 lymphadenopathy now appears more confluent with interim\nenlargement of individual nodes. The largest discrete node measures 2.8 x 1.6\ncm on image 2:44 compared to 2.5 x 1.3 cm previously. Right level 2 lymph\nnodes partially compressed the right internal jugular vein, new from prior.\nLeft level 2 lymphadenopathy has also become more confluent with interim\nenlargement of individual nodes. The largest discrete node measures 2.9 x 1.9\ncm on image 2:42 compared to 2.1 x 1.4 cm previously. Effacement of the left\ninternal jugular vein has minimally increased.\nBilateral level 3, 4, and 5 lymphadenopathy has also progressed.\nBilateral supraclavicular and partially visualized subpectoral lymphadenopathy\nhas likewise progressed. Lymphadenopathy in the visualized upper mediastinum\nalso appears progressed.\n\nRight base of the tongue is slightly more prominent than the left, unchanged.\nOtherwise, there is no evidence for an exophytic mucosal mass. Submandibular\nglands are unremarkable. The thyroid is mildly prominent, and the right lobe\nis slightly larger than the left, unchanged.\n\nEvaluation of the visualized upper lungs is limited by incomplete the degree\nof inspiration. Concurrent chest CT is reported separately.\n\nMucosal thickening and mucous retention cysts are noted in the partially\nvisualized maxillary sinuses. Partially visualized mastoid air cells are\nclear.\n\nDegenerative changes are again seen in the cervical spine. Evidence of median\nsternotomy is again noted. No lytic or sclerotic bone lesion suspicious for\nmalignancy is identified.", + "output": "Progression of diffuse bilateral cervical, supraclavicular and subpectoral\nlymphadenopathy, as well as of the partially visualized mediastinal\nlymphadenopathy." + }, + { + "input": "There is no evidence of hemorrhage, mass effect or infarction. An ill-defined\nright frontal lobe hypodensity corresponds to the previously described lesion\nseen on recent MRI. Other smaller lesions described on MRI are less evident\non today's CT examination. The ventricles and sulci are normal in size and\nconfiguration. There is no impending herniation and the basal cisterns are\npatent.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of hemorrhage or evidence of intracranial hypertension.\n2. Ill-defined right frontal lobe hypodensity corresponds to the previously\ndescribed lesion seen on recent MRI." + }, + { + "input": "Postcontrast imaging of the brain was performed in a stereotactic frame prior\nto biopsy. The patient's known dominant lesion in the right frontal lobe is\nre- demonstrated. This, and additional lesions are better evaluated on recent\nMR brain.", + "output": "Post contrast head CT pre stereotactic biopsy." + }, + { + "input": "Postsurgical changes are noted from right frontal approach stereotactic brain\nbiopsy including right frontal burr hole and a small amount of hemorrhage\nwithin the right frontal biopsy bed. Surrounding right frontal hypodensity\ncorresponds to a mass better characterized on recent MR. ___ lesions\npreviously characterized on MR are not readily apparent on CT. There is no\nevidence of infarction. The ventricles and sulci are stable in size and\nconfiguration.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Expected postsurgical changes from right frontal approach stereotactic brain\nbiopsy with small focus of hemorrhage at the biopsy bed." + }, + { + "input": "Compared with the CT head from approximately 5 hr earlier, no change in the\npostsurgical changes from the right frontal approach stereotactic biopsy. In\nthe small amount of hemorrhage in the right frontal biopsy bed is unchanged in\nsize (04:19). No new acute intracranial hemorrhage is identified. \nSurrounding right frontal hypodensity corresponds to the mass better seen on\nthe recent MRI. No evidence of infarction. Ventricles and sulci are stable\nin size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The orbits are\nnot visualized on the current study.", + "output": "Compared with the CT head from 5 hr earlier, no change in the postsurgical\nchanges from the right frontal approach stereotactic biopsy, including the\nsmall amount of hemorrhage in the biopsy bed." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nMultiple periventricular and subcortical white matter hypodensities are\nsuggestive of chronic small vessel ischemic disease, more pronounced on the\nleft. Calcified atherosclerotic plaques are demonstrated in cavernous portion\nof the internal carotid arteries bilaterally.\n\nThere is no evidence of fracture. Mild mucosal thickening is seen within the\nethmoid air cells bilaterally, left sphenoid sinus, and left frontal sinus. \nThe visualized portion of the remaining paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "No acute intracranial process. No hydrocephalus." + }, + { + "input": "There is hypodensity in the right parietal lobe suggestive of infarction of\nindeterminate age. There is no acute intracranial hemorrhage. There is no\nevidence of fracture, infarction,hemorrhage,edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nOpacification of bilateral mastoid air cells and air-fluid level in the right\nmiddle ear cavity as well as fluid in the posterior nasopharynx is consistent\nwith intubation status. The visualized portion of the paranasal sinuses are\nclear. The visualized portion of the orbits are normal.", + "output": "1. Right parietal lobe hypodensity suggests infarct of indeterminate age. \nConsider MRI for further evaluation.\n2. No acute intracranial hemorrhage." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, or loss of\ngray/white matter differentiation. Mild periventricular and subcortical white\nmatter hypodensities are nonspecific but likely secondary to chronic small\nvessel ischemic disease in this age group. Ventricles and sulci are\nage-appropriate.\n\nNo suspicious bone lesion is seen. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No evidence for acute intracranial abnormalities." + }, + { + "input": "There is a mixed density subdural hematoma along the left cerebral convexity\nmeasuring up to 2.2 cm in width. There is secondary mass effect with a 1.7 cm\nrightward shift of midline structures, mild hydrocephalus of the contralateral\nlateral ventricle, including the bilateral temporal horns as well as diffuse\ncerebral sulcal effacement. There is effacement of the basilar cistern, There\nis a moderate amount amount of hyperdense material layering along the\nposterior aspect of the hematoma suggestive of an acute on chronic bleed. \nThere is no evidence of acute infarction.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Mixed density acute on chronic left-sided subdural hematoma, measuring up\nto 2.2 cm in width.\n2. 1.7 cm rightward shift of midline structures, secondary mild hydrocephalus,\ndiffuse sulcal effacement and effacement of the basilar cisterns, raising\nconcern for herniation, specifically left uncal herniation.\n\nNOTIFICATION: The findings were discussed with Dr. ___, M.D. by ___\n___, M.D. on the telephone on ___ at 8:21 ___, 5 minutes after\ndiscovery of the findings.\nPatient was already in the operating room at the time of attending review at\n20:50 the same day." + }, + { + "input": "Dental almalgam streak artifact limits study. The patient is status post for\nhole evacuation of the left subdural hematoma. There is expected\npostoperative pneumocephalus. A small amount of hyperdense blood products\nseen posteriorly with a small amount of residual chronic hematoma anteriorly. \nThere is decreased mass effect with decreased midline shift compared to prior\nnow 9 mm of rightward midline shift, previously 18 mm. There is persistent\nleft uncal herniation although the effacement of the suprasellar cistern is\nimproving. The quadrigeminal plate cistern is now patent.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Right maxillary first molar\nperiapical lucencies are noted (see 602 B: ___.", + "output": "1. Dental almalgam streak artifact limits study.\n2. Status post left frontoparietal burr hole evacuation of the left subdural\nhematoma with decreased mass effect compared to prior.\n3. Residual 9 mm of left-to-right midline shift, with interval decreased basal\ncistern effacement.\n4. Small residual acute on chronic left hemisphere subdural hemorrhage.\n5. Periodontal disease as described." + }, + { + "input": "Compared to the study performed ___ there is mild increase in\npneumocephalus and mixed acute on chronic left subdural hematoma with slight\nincrease in mass effect with 11 mm of rightward shift of normally midline\nstructures, previously 9 mm. Mild redistribution of subdural hematoma with\nincreased trace hemorrhage along the anterior falx. There is persistent\neffacement of the suprasellar and quadrigeminal plate cisterns. There is\nsimilar effacement of the left lateral ventricle with dilatation of the\ntemporal horn of the right lateral ventricle.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Periapical lucencies around the right\nmaxillary first molar are unchanged.", + "output": "Mild increased pneumocephalus and acute on chronic left subdural hematoma with\nresultant mild increase in mass effect now with 11 mm of rightward shift\n(approximately 9 mm on prior exam) of normally midline structures and\npersistent effacement of the suprasellar cistern and quadrigeminal plate\ncistern.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with ___\n___, NP on the telephone on ___ at 6:47 ___, 5 minutes after discovery\nof the findings." + }, + { + "input": "Left frontal craniotomy changes are seen. There has been interval decrease in\nsize of the extra-axial left frontoparietal collection, which is predominantly\nhypodense along its superior margin and measures 1.3 cm in greatest axial\ndimension. Stable increased hyperdensity of the extra-axial collection is\nnoted underlying the craniotomy site, likely representing postsurgical\nchanges. No new hemorrhage is seen. Normalization in position of the midline\nstructures is seen with no significant midline shift. Mild sulcal effacement\nis noted underlying the residual subdural.\n\nThere is no evidence of infarction, acute hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. Atherosclerotic\nvascular calcifications are noted of bilateral vertebral and cavernous\nportions of internal carotid arteries.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Interval decrease in size of the left frontoparietal chronic subdural\nhematoma with postsurgical changes and mild underlying sulcal effacement with\nno significant midline shift.\n2. No new intracranial hemorrhage." + }, + { + "input": "Patient is status post recent evacuation of the left cerebral subdural\nhematoma. In comparison with recent prior exam performed 3 days ago, there is\nno significant interval change in overall size of the hypodense fluid and gas\ncontaining left cerebral subdural collection. No signs of acute rebleeding. \nThere is a similar overall degree of mass-effect on the left cerebral\nhemisphere with approximately 12 mm rightward midline shift. The basal\ncisterns are patent. Gray-white matter differentiation is preserved. There\nis no acute fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable. Postoperative changes in the calvarium.", + "output": "No significant change in overall size of postoperative left cerebral subdural\ncollection containing hypodense fluid and gas with unchanged mass effect and\nshift of 12 mm midline structures to the right." + }, + { + "input": "Surgical changes from prior left frontoparietotemporal craniotomy are present.\nA left acute on chronic subdural hematoma is decreased in size as compared to\nprior, now measuring 1.9 cm, previously 2.4 cm. 5 mm focus of hyperdensity\nwithin the chronic component of the subdural hematoma (series 3, image 21) is\nfelt to reflect artifact from the adjacent edge of the volt. The remaining\nhemorrhagic components layering posteriorly within the hematoma appear\nslightly improved to stable. There is otherwise no new area of hemorrhage. \nShift of midline structures is stable, measuring up to 1.2 cm. Pneumocephalus\nis stable. There is no acute infarction.\n\n The visualized portion of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Interval decrease in size of the left frontoparietotemporal acute on\nchronic subdural hematoma.\n2. Stable shift of midline structures, measuring up to 1.2 cm." + }, + { + "input": "There has been interval removal of the patient's previously noted left frontal\nSEPS hardware. Evolving postsurgical changes related to left\nfrontoparietotemporal craniotomy are again noted.\n\nA stable left acute on chronic subdural hematoma is again noted, now measuring\n1.9 cm. 5 mm focus of hyperdensity within the chronic component of the\nsubdural hematoma (series 3, image ___ is\nagain noted, with new additional hyperdense material measuring up to 4 mm and\nwith Hounsfield units of approximately 215 (see 3:21).\n\nThe remaining hemorrhagic components again layering posteriorly within the\nhematoma are stable.\n\nThere is otherwise no new area of hemorrhage.\n\nShift of midline structures is stable, measuring up to 1.2 cm.\n\nThere is no evidence of large territorial infarction. The ventricles and\nsulci are stable in size and configuration.", + "output": "1. Interval removal of left frontal SEPS hardware,\n2. Grossly stable approximately 1.9 cm thick left acute on chronic subdural\nhematoma with focal hyperdensity that demonstrates new hyperdense component\nsuggestive of bone fragment versus surgical hardware with adjacent acute blood\nproducts. Recommend attention on followup imaging and correlation with\nneurologic exam.\n3. Stable approximate 1.2 cm left-to-right midline shift.\n4. Evolving postsurgical changes related to prior left frontoparietotemporal\ncraniotomy.\n\nRECOMMENDATION(S): Grossly stable approximately 1.9 cm thick left acute on\nchronic subdural hematoma with focal hyperdensity that demonstrates new\nhyperdense component suggestive of bone fragment versus surgical hardware with\nadjacent acute blood products. Recommend attention on followup imaging and\ncorrelation with neurologic exam.\n\nNOTIFICATION: The findings were discussed with ___, N.P By ___\n___, M.D. on the telephone on ___ at 3:50 ___, 5 minutes after discovery\nof the findings." + }, + { + "input": "Evolving postsurgical changes related to interval left frontoparietotemporal\ncraniotomy are noted with increased soft tissue stranding in the overlying\nscalp, subcutaneous emphysema, and pneumocephalus. A new, left-sided drain\nterminates in the residual subdural hematoma. Interval decrease in size of\nthe chronic left subdural hematoma with some interval redistribution. The\nremaining posterior component measures up to 1.6 cm and contains a small\namount of layering blood products. There is decreased mass effect with\ndecreased, rightward shift of midline structures, now measuring 8 mm compared\nto 10 mm on the prior study. Previously seen, minimal left uncal herniation\nis not seen. No acute intracranial bleed or territorial infarct. The\nventricles and sulci are stable in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Expected postsurgical changes related to interval craniotomy and evacuation\nof chronic left subdural hematoma. No evidence of postsurgical complications.\n2. Residual, posterior component of the left subdural hematoma is smaller, now\nmeasuring up to 1.6 cm. Interval decrease in mass effect and rightward\nmidline shift." + }, + { + "input": "Left-sided subdural drain is in unchanged position. Patient is status post\nleft frontal craniotomy with stable, expected postsurgical changes in the\noverlying scalp. There has been interval increase in size and extent of the\nleft hemisphere subdural hematoma, now measuring 2 cm in maximal diameter\ncompared to 1.6 cm on the prior study from ___, with new foci of\nhyperdensity adjacent to the superior frontal lobe (3, 23), consistent with\nacute blood products. Rightward midline shift is minimally increased, now\nmeasuring 8 mm. There is no loss of gray-white matter differentiation. The\nventricles are stable in size and configuration.", + "output": "1. Interval increase in size and extent of known left subdural hematoma with a\nnew acute on chronic component concerning for interval acute hemorrhage, now\nmeasured up to 2 cm in maximum diameter.\n2. Slight interval increase in mass effect and rightward midline shift, now\nmeasuring up to 8 mm.\n3. Status post left frontal craniotomy with left-sided subdural drain in\nstable position.\n\nNOTIFICATION: The findings were discussed with ___, NP by\n___, MD on the telephone on ___ at 4:13 ___, 2 minutes after\ndiscovery of the findings." + }, + { + "input": "Patient is status post left frontal craniotomy with expected postsurgical\nchanges in the overlying scalp which are not significantly changed since\nprior.\n\nLeft hemisphere subdural hematoma is not significantly changed in size or\nextent since prior, again demonstrating an approximately 5 mm high density\nstructure within the collection that may represent bone fragment versus\nsurgical hardware.\n\nRightward midline shift is also similar to prior, again measuring up to 8 mm.\n\nFoci of hyperdensity overlying the superior left frontal lobe are not\nsignificantly changed since prior. There is no evidence of acute large\nterritory infarction or large mass. The ventricles and sulci are stable in\nsize and configuration since prior.\n\nNo acute fracture seen. The imaged portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The orbits are unremarkable.", + "output": "1. Stable left acute on chronic subdural hematoma, with 5 mm high density\nstructure within collection again suggestive of bone fragment versus residual\nsurgical hardware.\n2. Stable 8 mm left-to-right midline shift.\n3. No new acute hemorrhage compared to ___.\n4. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct.\n5. Evolving postsurgical changes related to left frontal craniotomy and\nsubdural hematoma evacuation." + }, + { + "input": "The patient is status post left frontal craniotomy and subdural hematoma\nevacuation. Redemonstrated is a component of hyperdense material layering\nwithin the evacuation cavity, compatible with acute on chronic subdural\nhematoma. The overall extent morphology of this collection is largely\nunchanged from prior examination.\n\nNo additional foci of hemorrhage are identified. Persistent mass effect on\nthe left lateral ventricle is unchanged. Approximately 8 mm of right midline\nshift is again noted, stable from prior examination. The basal cisterns\nremain patent. There is preservation of gray-white matter differentiation\nwithout evidence for acute vascular territorial infarction.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "Stable appearance of a left acute on chronic subdural hematoma with persistent\nlocal mass effect and unchanged rightward midline shift. No additional sites\nof intracranial hemorrhage." + }, + { + "input": "Left-sided postoperative changes are identified. Left-sided subdural hematoma\nhas considerably decreased with minimal meningeal thickening remaining with\ncalcification in the left subdural space. No acute hemorrhage is identified. \nThere is no mass effect midline shift or hydrocephalus.", + "output": "Decrease in size of residual left-sided subdural with meningeal calcification\nseen compared to the previous CT. No acute abnormalities." + }, + { + "input": "There are postsurgical changes from left frontal craniotomy and subdural\nhematoma evacuation with underlying dural thickening and punctate\ncalcifications. The previously seen left subdural hematoma has completely\nresolved.\n\nThere is no evidence of infarction, new hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. Atherosclerotic\nvascular calcifications are noted of the left vertebral and cavernous portions\nof the bilateral internal carotid arteries.\n\nThere is no evidence of fracture. There is mild mucosal wall thickening in\nthe bilateral maxillary sinuses, right ethmoid air cells and a few left\nposterior ethmoid air cells. The remainder of the visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Interval resolution of left frontal subdural hematoma with the postsurgical\nchanges from left frontal craniotomy including underlying dural thickening and\ncalcification.\n2. No acute hemorrhage, infarct or mass effect." + }, + { + "input": "LEFT :\nThe external auditory canal is unremarkable. The middle ear cavity is clear.\nThe ossicles, scutum, andtegmen are intact. There is no evidence for enlarged\nvestibular aqueduct or superior semicircular canal dehiscence. The facial\nnerve follows a normal course. Mastoid air cells are well aerated. No\nevidence for lytic bone lesions.\n\nRIGHT:\nTrace linear density within the external auditory canal likely represents\ntrace cerumen, image 300:135. The middle ear cavity is clear. The ossicles,\nscutum, andtegmen are intact. There is no evidence for enlarged vestibular\naqueduct or superior semicircular canal dehiscence. The facial nerve follows\na normal course. Mastoid air cells are well aerated. No evidence for lytic\nbone lesions.\n\nOTHER:\nThis exam is not technically optimized for evaluation of the included brain\nparenchyma; no concerning abnormalities are seen. There is near complete\nopacification of the partially included left anterior ethmoid air cells. \nThere is fluid mucosal thickening, and a probable mucous retention cyst\nmoderately opacifying the left maxillary sinus without evidence for osseous\nremodeling. There are multiple bilateral periodontal lucencies in the\npartially imaged maxilla.", + "output": "1. Unremarkable CT appearance of bilateral temporal bones. No evidence for\notitis media or mastoiditis on either side.\n2. Fluid, mucosal thickening, and a probable mucous retention cyst moderately\nopacifying the left maxillary sinus. Near complete opacification of the\npartially imaged left anterior ethmoid air cells. Please correlate clinically\nregarding the possibility of acute sinusitis.\nMRI of the brain and skullbase would be more sensitive for further evaluation\nof the cranial nerves in the setting of facial droop and inability to\ncompletely close the eye, if clinically warranted." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Minimal atherosclerotic\ncalcifications are seen at the cavernous carotid arteries.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. \nPeriventricular and subcortical white matter hypodensities are nonspecific,\nbut likely reflect sequelae of chronic small vessel ischemic disease. \nProminence of the ventricles and sulci suggest involutional changes.\n\nThe paranasal sinuses demonstrate complete or near complete opacification and\ncontain high density material. The mastoid air cells and middle ear cavities\nare clear. Bilateral lends replacements noted. Fracture of the lamina\npapyracea bilaterally is of uncertain chronicity.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThere is moderate atherosclerotic plaque at the origin of the right common\ncarotid artery and mild atherosclerotic plaque at the origin of the left\ncommon carotid artery.\nThere is moderate calcification at the origin of the right vertebral artery.\nThe carotid and vertebral arteries and their major branches demonstrate no\nevidence of high-grade stenosis or occlusion. There is no evidence of internal\ncarotid stenosis by NASCET criteria.\n\nOTHER:\nA 1.6 cm ground-glass opacity is partially imaged in the right upper lobe\n(3:2). Moderate centrilobular emphysema is noted. A 9 mm nodular opacity in\nthe right lung apex likely represents apical scarring (03:52). The visualized\nportion of the thyroid gland is within normal limits. There is no\nlymphadenopathy by CT size criteria.", + "output": "1. No evidence of high-grade stenosis or occlusion.\n2. Diffuse paranasal sinus disease containing high-density material.\n3. Bilateral lamina papyracea fractures of uncertain chronicity.\n4. 1.6 cm partially imaged ground-glass opacity in the right upper lobe.\nFor incidentally detected nodules bigger than 8mm or morphologically\nsuspicious in the setting of an incomplete chest CT, follow-up with a complete\nchest CT is recommended.\n\nRECOMMENDATION(S): For incidentally detected nodules bigger than 8mm or\nmorphologically suspicious in the setting of an incomplete chest CT, follow-up\nwith a complete chest CT is recommended." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nLeft frontal scalp contusion is small. No evidence of fracture. Minimal\nmucosal thickening of the left maxillary sinus. The additional visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Small left frontal scalp contusion. No fracture.\n\n2. No acute intracranial process. Specifically, no intracranial hemorrhage." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is a hyperdense collection in the left frontal convexity, compatible\nwith subdural hematoma and measuring up to 6 mm in greatest diameter (02:10). \nThere is rightward shift of midline structures measuring up to 7 mm, however\nlikely not attributable to the hematoma. There is no evidence of acute large\nterritorial infarction. There is dilatation of the ventricles beyond expected\nfor patient's age and out of proportion to the sulci, raising the possibility\nfor hydrocephalus, however there is no prior imaging available at this time\nfor comparison. This is considered unlikely given lack abnormal enlargement\nof the temporal horns. This may be secondary to disproportionate of central\nvolume loss.\n\nThere is a nondisplaced, nondepressed right occipital skull fracture. Small\nsubgaleal hematoma is noted at the vertex. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Left frontal convexity subdural hematoma measuring up to 6 mm.\n2. Rightward shift of midline structures measuring up to 7 mm, however likely\nnot attributable to the hematoma.\n3. Nondisplaced, nondepressed right occipital skull fracture. Small subgaleal\nhematoma is noted at the vertex.\n4. Dilatation of the ventricles beyond expected for patient's age and out of\nproportion to the sulci, raising the possibility for hydrocephalus, however\nthere is no prior imaging available at this time for comparison. \nHydrocephalus however is felt to be less likely given lack of abnormal\nenlargement of the temporal horns. This could be secondary to\ndisproportionate central volume loss." + }, + { + "input": "No evidence of acute large territorial infarction, hemorrhage, edema, or mass\neffect. There is encephalomalacia centered in the right temporal lobe and\nparietal lobe with ex vacuo dilation of the right lateral ventricle body\nincluding the occipital as well as temporal horns. These parenchymal areas\ncorresponded to some areas of decreased tracer uptake on the prior PET-CT. \nDetailed evaluation of the right temporal lobe is limited secondary to\nextensive streak artifact from aneurysm coils from prior MCA aneurysm repair. \nThere are associated post right craniectomy changes.\n\nBackground bilateral, symmetric periventricular and subcortical white matter\nhypodensities are mild and may suggest sequelae of chronic small vessel\nischemic disease. Mild, background cortical volume loss is likely given\nprominence of the ventricles and sulci. Bilateral cavernous internal carotid\nartery calcifications are mild. Calcifications of the bilateral V4 segments\nare mild-to-moderate.\n\nSoft tissue scalp scarring at the vertex is noted (series 602b, image 49).\n\nAerosolized secretions in the bilateral maxillary sinuses, and left sphenoid\nsinus suggests a component of active on chronic sinusitis. Otherwise, mucosal\nthickening of the bilateral maxillary sinuses, bilateral sphenoid sinuses and\npartial opacification or complete opacification of some of the bilateral\nethmoidal air cells are moderate. The frontal sinuses are centrally clear. \nThe bilateral mastoid air cells are clear but somewhat underpneumatized. The\nmiddle ear cavities are clear. The visualized portions of the orbits are\nunremarkable.", + "output": "1. No acute intracranial hemorrhage.\n2. Status post right MCA aneurysm repair and right craniectomy.\n3. Right temporal and parietal lobe encephalomalacia.\n4. Probable sequelae of chronic small vessel ischemic disease and cortical\nvolume loss.\n5. Likely active on chronic sinusitis." + }, + { + "input": "The patient is status post right parietal craniotomy and resection of a right\nparietal lobe mass. There is postoperative pneumocephalus, and hemorrhagic\nproducts within the resection bed. Hemorrhage is also seen tracking along the\nright cerebellar tentorium, and within the quadrigeminal cistern. Edema is\nseen within the right parietal lobe, resulting in worsening effacement of the\nbody of the right lateral ventricle. No acute infarct.\n\nFluid is seen layering in the right sphenoid sinus. The remaining visualized\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nglobes are unremarkable.", + "output": "1. Status post right parietal craniotomy and resection of a right parietal\nlobe mass. There is postoperative pneumocephalus, and hemorrhagic products\nwithin the resection bed, tracking along the right cerebellar tentorium, and\nwithin the quadrigeminal cistern.\n2. Right parietal lobe edema results in worsening effacement of the body of\nthe right lateral ventricle.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ on the ___ ___ at 9:46 ___, 5 minutes after discovery of\nthe findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\n\nThere is an approximately 2 cm hyperdense, hemorrhagic and lesion in the\ninferior right parietal lobe with mild surrounding edema. In addition,\nrelatively small symmetric areas of hypodensity without mass effect are seen\nin the deep white matter of bilateral parietal lobes on image 2:19. The\nventricles and sulci airway from the lesion are normal in size and\nconfiguration.\n\nNew mucosal thickening and fluid in the paranasal sinuses, as well as fluid in\nthe nasopharynx, likely secondary to interim endotracheal intubation. Mastoid\nair cells are grossly well-aerated.\n\nCTA NECK:\nThere is a 3 vessel aortic arch. Evaluation of the V1 segment of the right\nvertebral artery and of the left vertebral artery origin is limited by\nartifacts. Otherwise, the carotid and vertebral arteries appear widely\npatent. There is no evidence of internal carotid stenosis by NASCET criteria.\n\nCTA HEAD:\nThere is mild calcification of the bilateral cavernous and supraclinoid\ninternal carotid arteries without flow-limiting stenosis. Other vessels of the\ncircle of ___ and their principal intracranial branches appear patent\nwithout stenosis, or aneurysm formation. Bilateral fetal posterior cerebral\narteries are noted, a normal variant. No abnormal arteries are seen within or\nnear the right inferior parietal mass. The major dural venous sinuses are\npatent.\n\nOTHER:\nEvaluation of the included upper lungs is limited by respiratory motion\nartifact. Dependent atelectasis is seen in the visualized right upper lung. \nThe endotracheal tube is well positioned. Thyroid gland appears grossly\nunremarkable. There is no serve lymphadenopathy by CT size criteria. \nMultilevel degenerative changes in the cervical spine are seen. No suspicious\nlytic or sclerotic bone lesions are detected.", + "output": "1. Approximate 2 cm hemorrhagic and/or calcified lesion in the inferior right\nparietal lobe with mild surrounding edema, but no significant mass effect, as\nseen on the CT from 1 day earlier.\n2. Normal neck CTA, allowing for artifact limiting evaluation of proximal\nvertebral arteries.\n3. Normal head CTA. No abnormal arteries in the region of the right inferior\nparietal mass.\n\nRECOMMENDATION(S): MRI with and without contrast is recommended for further\nevaluation of the right parietal mass." + }, + { + "input": "A large right frontoparietal intraparenchymal hematoma has increased in size\nsince 7 hours prior, now measuring approximately 6.1 x 5.8 x 6.1 cm. Interval\nincrease in mass effect and surrounding edema results in increased effacement\nof the adjacent sulci and increased midline shift now measuring 6 mm. \nIntraventricular blood products have slightly increased without evidence of\nobstructive hydrocephalus. The right ventricle is increasingly effaced. The\nventricles overall are stably prominent. Periventricular and subcortical\nwhite matter hypodensities are nonspecific but likely sequelae of chronic\nsmall vessel ischemic disease. Senile basal ganglia calcifications are noted.\n\nThere is no fracture. There are numerous tiny lytic lesions scattered\nthroughout the calvarium. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. Increased size of a large right frontoparietal intraparenchymal hematoma\nwith increased mass effect resulting in 6 mm of midline shift.\n2. Increased volume of intraventricular hemorrhage with stable ventricular\nsize. Please note, patient is at risk for obstructive hydrocephalus an\nattention on followup advised.\n3. Several lytic calvarial lesions raise potential concern for multiple\nmyeloma. Please correlate clinically.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 4:52 pm, less than 5\nminutes after discovery of the findings." + }, + { + "input": "Right frontal intraparenchymal hemorrhage with mild surrounding edema measures\napproximately 2.4 x 1.7 x 2.1 cm, which is similar to earlier today. There is\nalso a 2 mm focus of subarachnoid hemorrhage overlying the right frontal lobe\n(02:23), similar to prior. 3 mm foci of hemorrhage in the head of the right\ncaudate (02:15) and the right thalamus (602:35) are similar to prior. There\nis no evidence of acute territorial infarction or large mass. Periventricular\nand subcortical white matter hypodensities are nonspecific, but likely\nrepresent chronic small vessel ischemic disease. There is prominence of the\nventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of acute fracture. The right anterior ethmoid air cells\nare severely opacified. There is moderate mucosal thickening in the remainder\nof the ethmoid air cells. There is mild mucosal thickening and minimal\naerosolized secretions in the right maxillary sinus. There is mild mucosal\nthickening of the frontoethmoidal recesses bilaterally. The visualized portion\nof the mastoid air cells and middle ear cavities are clear. Bilateral carotid\nsiphon calcification is moderate.", + "output": "Multiple foci of right intraparenchymal hemorrhage and a focus of right\nsubarachnoid hemorrhage are similar to earlier today." + }, + { + "input": "Again seen is a small right parafalcine subdural hematoma measuring up to 4 mm\nextending along the right tentorium without significant interval change\ncompared to the outside hospital head CT from ___. There is no mass\neffect. There is no evidence of large territorial infarction,new\nhemorrhage,edema,or mass. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. Bilateral periventricular and subcortical\nwhite matter hypodensities are nonspecific but likely reflect sequela of\nchronic small vessel ischemic changes.\n\nSoft tissue swelling is again noted overlying the left frontal bone. There is\nno evidence of fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. Unchanged right parafalcine hematoma tracking along the right tentorium.\n2. No new hemorrhage or mass effect." + }, + { + "input": "The parotid glands and submandibular glands are unremarkable. There are\nthyroid nodules and cyst which were better characterized on recent prior\nultrasound, specifically a 1.7 x 1.1 cm cyst at the midportion of the right\nlobe. Posterior 1.1 x 0.8 cm nodule seen posteriorly in the right lobe. Other\nsmaller left lobe thyroid nodules are also noted, again better characterized\nby ultrasound. There is no surrounding inflammation. No mass effect or\nnarrowing of the trachea.\n\nThere is no cervical adenopathy.\n\nThe aerodigestive tract appears normal. Included paranasal sinuses and\nmastoids are clear.\n\nVascular structures in the neck are grossly unremarkable.\n\nIncluded intracranial structures are unremarkable.\n\nNo focal suspicious osseous lesion identified.Degenerative changes noted in\nthe spine notable at C5-6 and C6-7 with intervertebral disc height loss,\nposterior osteophytes and uncovertebral joint hypertrophy resulting in\nmoderate bilateral foraminal narrowing at these levels. Disc bulge at C4-5\neffaces the ventral CSF and likely contacts the ventral aspect of the cord.", + "output": "Thyroid cyst and nodules, better characterized on recent prior ultrasound. No\nsurrounding inflammatory changes or mass effect on the airway.\nDegenerative changes in the spine." + }, + { + "input": "Intracranial:\n1 cm hemorrhagic contusion inferior right temporal lobe mild surrounding\nedema, similar compared with ___ at 14:08.\n\nRight:\nThe external auditory canal is normal. The middle ear cavity is clear. The\nossicles and tegmen are intact. There is no evidence for enlarged vestibular\naqueduct or superior semicircular canal dehiscence. The facial nerve follows a\nnormal course through the middle ear. There is no evidence for inner ear\ndysplasia. The mastoids are clear. There is no abnormal enhancement on post\ncontrast imaging.\n\nLeft:\nA vertically oriented, nondisplaced longitudinal temporal bone fracture\nextends from the posterior squamous suture into the lateral mastoid air cells.\nFracture involves very inferior visualized portion of the parietal bone,\nsquamous portion of the temporal bone, extends inferiorly into the mastoid\nsegment, fraction through the left external auditory canal anterior and\nposterior walls involving tympanic segment. Fracture involves tegmen tympani,\nthere is no large defect of the tegmen. No definite involvement of the inner\near ossicles, which do not appear fractured or displaced. No pneumo\nlabyrinth. Petrous apex is intact. No definite transverse component of\nfracture. No definite otic capsule disruption. No definite disruption along\nthe seventh cranial nerve.\n\nThe middle ear cavity and external auditory canal are both nearly completely\nopacified, likely sequela of trauma. Left mastoid air cells are moderately\nopacified along the fracture plane, most other air cells are patent.\nThe ossiclesand tegmen are intact. There is no evidence for enlarged\nvestibular aqueduct or superior semicircular canal dehiscence. The facial\nnerve follows a normal course through the middle ear. There is no evidence for\ninner ear dysplasia.\n\nOther: There is minimal mucosal thickening within the bilateral sphenoid\nsinuses. Although not optimized for the evaluation of the cervical spine, no\nfracture is identified through the C1 vertebra and partially visualized\nodontoid process of the C2 vertebra. Visualized brain and neck soft tissues\nare normal.", + "output": "-Small hemorrhagic contusion right temporal lobe.\n-Longitudinal left temporal bone fracture. Opacified left middle ear,\npartially opacified left mastoid, posttraumatic.\n\nNOTIFICATION: The findings were discussed with ___, NP by ___,\nM.D. on the telephone on ___ at 3:27 pm, 3 minutes after discovery of\nthe findings." + }, + { + "input": "There is no evidence of large vascular territorial\ninfarction,hemorrhage,edema,or definite mass. Hypodensity in the right\nfrontal lobe and periventricular hypodensities are nonspecific however could\nbe related to chronic small vessel disease. There is mild prominence of the\nventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial findings." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass. An area of encephalomalacia in the right inferior frontal lobe is\nlikely reflective of the sequela of prior infarct. Prominent ventricles and\nsulci are compatible with age-related involutional change. Rather confluent\nperiventricular, deep, and subcortical white matter hypodensities are\ncompatible with sequela of chronic small vessel ischemic disease.\n\nNo osseous abnormalities seen. Small amount of fluid is seen within the\nbilateral sphenoid sinuses and maxillary sinuses. Mucosal thickening is noted\ninvolving multiple ethmoid air cells. The remaining visualized paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "1. No acute intracranial process.\n2. Right inferior frontal encephalomalacia may reflect the sequela of prior\ninfarct.\n3. Paranasal sinus disease." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. Again seen is unchanged area of encephalomalacia in the right\ninferior frontal lobe, likely reflective of sequela of prior infarct. \nProminent ventricles and sulci are compatible with age related global atrophy.\nUnchanged, confluent periventricular, deep, and subcortical white matter\nhypodensities are nonspecific, but compatible with sequela of chronic small\nvessel ischemic disease.\n\nThere is no evidence of fracture. Mild aerosolized secretions are noted in\nthe right sphenoid sinus. The visualized portion of the remaining paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial process. No fracture.\n2. Unchanged right inferior frontal encephalomalacia likely reflects sequela\nof prior infarct." + }, + { + "input": "There is no evidence of fracture, acute large territory\ninfarction,intracranial hemorrhage,edema,or mass effect. The ventricles and\nsulci are normal in size and configuration. Periventricular and subcortical\nwhite matter hypodensities are nonspecific but likely sequelae of chronic\nsmall vessel ischemic disease. Vascular atherosclerotic calcifications are\nseen in the carotid siphons and distal vertebral arteries bilaterally.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No evidence of acute large territory infarction or intracranial hemorrhage.\n2. Periventricular subcortical white matter changes, are nonspecific and may\nsuggest changes due to chronic small vessel ischemic disease." + }, + { + "input": "There is no evidence of fracture, large territorial\ninfarction,hemorrhage,edema,or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. There is redemonstration of\nmoderate hypodensity of the periventricular subcortical white matter,\nnonspecific but likely representing chronic microvascular ischemic disease. \nIntracranial vascular calcifications are noted.\n\nPartially imaged enteric tube noted. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are normal.", + "output": "1. No acute intracranial findings." + }, + { + "input": "No fractures are identified.\nThere is mild swelling in the pre mandibular soft tissues. No evidence of\nabscess formation.\nThe mandible and temporomandibular joints appear normal. Chronic appearing\ndeformity of the right maxillary molar is noted. There are no significant\nperiapical lucencies.\nVisualized paranasal sinuses are well aerated.\nThere is no evidence of abnormal fluid collections.\nVisualized mastoid air cells appear normal.\nThe visualized upper aerodigestive tract appears normal, noting a partially\nimaged NG tube.", + "output": "1. Mild swelling of the pre mandibular soft tissues without evidence of fluid\ncollections. No significant periapical lucencies." + }, + { + "input": "Postsurgical changes status post C6-7 ACDF the hardware appears to be in good\nposition in the C6-7 intervertebral disc space. There is expected\npostsurgical pre-vertebral soft tissue swelling and associated tissue\nemphysema at the level of the surgical site (series 2, image 72 and series\n602b, image 34). There is no evidence of a rim enhancing fluid collection or\nhemorrhage. There is a posterior osteophyte at C7.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is a prominent left\nsubmental lymph node that measures 9.3 mm in short axis. The neck vessels\nare patent.\n\nThere is a mucous retention cyst partially visualized left maxillary sinus. \nNo there is mosaic attenuation pattern in the visualized lung apices, which is\nnonspecific.", + "output": "1. Expected postsurgical changes status post C6-7 ACDF with pre vertebral soft\ntissue swelling and associated tissue emphysema at the level of the surgical\nsite. No evidence of a rim enhancing fluid collection or hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Bilateral\nperiventricular, subcortical and deep white matter hypodensities are\nnonspecific, but suggestive of chronic small vessel ischemic changes. There\nis prominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. Mild mucosal thickening in the ethmoid air\ncells bilaterally. Remainder of the visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no hemorrhage, edema, or mass-effect. Prominent ventricles and sulci\nreflect involutional changes, relative to ___, not progressed. \nNote is made of cavum septum pellucidum at vergae. Periventricular and\nsubcortical white matter hypodensity is nonspecific although likely sequela of\nchronic small vessel ischemia. There is no shift of normally midline\nstructures. Basal cisterns are patent.\n\nThe orbits are unremarkable. Imaged paranasal sinuses demonstrate mild\nmucosal thickening within the left maxillary sinus. Mastoid air cells and\nmiddle ear cavities bilaterally are clear. Carotid siphon vascular\ncalcifications are moderate. Soft tissue density within the right external\nauditory canal is likely cerumen.", + "output": "No acute intracranial abnormality." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of intracranial hemorrhage, infarction, edema, mass\neffect, or midline shift. There is diffuse parenchymal volume loss with\nprominence of the ventricles, sulci, and cisterns. There is a cavum septum\npellucidum et vergae. There is nonspecific periventricular and subcortical\nwhite matter hypodensity, likely a sequela of chronic small vessel\nmicroangiopathy. The paranasal sinuses and bilateral mastoid air cells appear\nclear. There is cerumen within the right external auditory canal.\n\nCTA HEAD:\nThere are moderate vascular calcifications of bilateral cavernous and clinoid\nsegments of internal carotid arteries with mild luminal narrowing. There is a\nleft dominant vertebral artery. There is a fetal type right posterior\ncerebral artery.\n\nCTA NECK:\nThere are calcified and noncalcified plaques at the bilateral carotid\nbifurcations, left greater than right, with approximately 30% left and no\nsignificant right internal carotid artery stenosis by NASCET criteria. There\nis medial retropharyngeal course of the left common carotid artery. The\nbilateral vertebral arteries appear patent. There are mild vascular\ncalcifications of the aortic arch.\n\nOTHER:\nThere is a 2.4 cm right thyroid nodule with calcifications and asymmetric\nenlargement of the right thyroid gland. Additional smaller bilateral thyroid\nnodules are present. There is moderate left and mild right pleural effusions\nwith adjacent pleuroparenchymal scarring. There is no evidence of\nlymphadenopathy per size criteria. There are multilevel degenerative changes\nof the cervical spine worse at C5-C6", + "output": "1. No evidence of acute infarction, intracranial hemorrhage, or edema. Please\nnote MRI of the brain is more sensitive for the detection of acute infarct.\n2. Diffuse parenchymal volume loss with probable chronic small vessel\nmicroangiopathy.\n3. intracranial vasculature atherosclerotic calcifications with mild luminal\nnarrowing, as described above.\n4. Bilateral carotid vascular calcifications with approximately 30% left and\nno significant right internal carotid artery stenosis.\n5. Moderate left and mild right pleural effusions with adjacent\npleuroparenchymal scarring, slightly decreased on the right from the prior CT.\n6. 2.4 cm partially calcified right thyroid thyroid lobe nodule with\nadditional bilateral smaller thyroid nodules. Please refer to prior thyroid\nultrasound recommendations dated ___ for additional details." + }, + { + "input": "There is no evidence of acute major vascular territorial\ninfarction,hemorrhage,edema,or definite mass. However, there is hyperdense\nappearance of the right MCA, best seen on series 2 image 14 as well as series\n601 image 45 concerning for acutely thrombosed right middle cerebral artery. \nNo evidence of cytotoxic edema or acute hemorrhage in the right MCA\ndistribution. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Cavum septum pellucidum et vergae incidentally noted. \nMild bilateral periventricular and subcortical white matter hypodensities are\nnonspecific, but likely reflect a sequela of chronic small vessel ischemic\ndisease.\n\nThere is no acute fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "Dense right middle cerebral artery, concerning for acute vascular thrombosis. \nRecommend CTA to further assess.\n\nRECOMMENDATION(S): CTA head" + }, + { + "input": "Motion artifact mildly limits evaluation.\n\nHyperdensity of the right MCA is less conspicuous than on the prior CT.\n\nThere is hypodensity and loss of gray/white matter differentiation involving\nthe right insula, right temporal lobe, and inferior right parietal lobe,\nconsistent with an evolving MCA territory infarct. There is associated sulcal\neffacement, but no significant effacement of the right lateral ventricle, and\nno shift of midline structures. No acute hemorrhage. No mass effect on the\nbasal cisterns.\n\nPre-existing periventricular, subcortical white matter hypodensities are again\nseen, nonspecific but likely sequela of chronic small vessel ischemic disease\nin this age group. Cavum septum pellucidum et vergae is again noted, a normal\nvariant. Mild global parenchymal volume loss with prominent ventricles and\nsulci is again seen. 2 mm fat density along the falx is consistent with a\nlipoma (02:26).\n\nThere is mild mucosal thickening in the ethmoid air cells and maxillary\nsinuses; evaluation is limited by motion artifact. There is evidence of\nbilateral lens replacement surgery.", + "output": "1. Motion limited exam.\n2. Evolving acute/early subacute right MCA territory infarct, involving the\ninsula, temporal lobe, and inferior parietal lobe. Minimal mass effect at\nthis time without shift of midline structures.\n3. No acute hemorrhage.\n4. Hyperdensity of the right MCA is less conspicuous than on the prior CT." + }, + { + "input": "As compared to the prior there is a more conspicuous hypodensity within the\nright MCA territory consistent with evolution of the a right MCA infarction. \nThere is no evidence of new infarction or hemorrhagic conversion. The\npreviously identified hyperdensity of the right MCA is not well identified on\nthis exam. There is no evidence of edema or mass. There is no midline shift.\nThere is mild prominence of the ventricles and sulci suggestive of age-related\ninvolutional changes. Cavum septum pellucidum et vergae is again noted. Mild\nbilateral periventricular and subcortical white matter hypodensities are\nnonspecific but are felt to likely represent sequela of chronic small vessel\nischemic disease.\n\nThere is no evidence of fracture. Again noted is mild mucosal thickening of\nthe ethmoid air cells and maxillary sinuses. The visualized portion of the\norbits are unremarkable with the exception of bilateral lens replacement\nsurgery.", + "output": "1. Compared to the prior examination there is a more conspicuous hypodensity\nwithin the right MCA territory consistent with evolution of a right MCA\ninfarction. There is no evidence of new infarction or hemorrhagic conversion." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territory infarct. Gray-white matter\ndifferentiation is preserved. There is no hydrocephalus. The visualized\nparanasal sinuses are clear. The mastoid air cells are clear. No acute\nfracture is seen.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of an abscess. Extensive upper mediastinal\nlymphadenopathy, is overall unchanged compared to the prior PET-CT from ___. For example a right upper paratracheal lymph node measures 3.6 cm x 2.6\ncm, series 3, image 59. A left upper paratracheal lymph node measures 1.3 cm\nx 2.1 cm, series 3, image 57 also unchanged compared to the prior exam. A\nlikely thyroid nodule off the inferior pole of the right thyroid gland\nmeasures 2.1 cm x 2 cm, also unchanged compared to the prior exam.\n\nCervical lymphadenopathy is also stable. For example a right level IIa lymph\nnode measures 1 cm x 0.8 cm, series 3, image 29, unchanged compared to the\nprior exam. A left level IIa lymph node measures approximately 1.3 cm x 1 cm,\nseries 3, image 3 to also unchanged compared to the prior exam. The left\nlevel 5 lymph node is approximately 1.4 cm in size and is also unchanged.\n\nThe visualized base of the brain is unremarkable. The globes are\nunremarkable. The visualized paranasal sinuses are clear.", + "output": "1. No evidence of an abscess or infection. Upper mediastinal and cervical\nlymphadenopathy is unchanged compared to the prior PET-CT from ___.\n2. Stable likely thyroid nodule off the inferior pole of the right thyroid\ngland measuring 2 cm." + }, + { + "input": "There has been interval development of a new right parietal intraparenchymal\nhemorrhage measuring approximately 2.7 x 1.6 cm (2b:37). This causes mild\nmass effect upon the occipital horn of the right lateral ventricle (2a:17).\nBilateral subarachnoid hemorrhages are grossly stable in appearance, however\nimages are slightly limited by motion artifact. Again, loss of gray-white\nmatter distinction in the left MCA territory is compatible with known large\nacute infarction (2a:18). There is no shift of normally midline structures,\nand the basal cisterns remain patent.\n\nThere is mild left maxillary mucosal sinus thickening. The visualized portion\nof the remaining paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Interval development of a 2.7 x 1.6 cm right parietal intraparenchymal\nhemorrhage, causing mild mass effect upon the occipital horn of the right\nlateral ventricle.\n\n2. Persistent bilateral subarachnoid hemorrhages and loss of gray-white\nmatter distinction in the left MCA territory, compatible with known large\nacute infarction.\n\n3. No shift of normally midline structures. Basal cisterns remain patent.\n\n This preliminary report was reviewed with Dr. ___\nradiologist.\n\nNOTIFICATION: The above findings were communicated via telephone by Dr.\n___ to Dr. ___ at 20:30 on ___, 5 min after discovery." + }, + { + "input": "When compared to the ___ CT without contrast, the right occipital\nhyperdense intraparenchymal hemorrhage and adjacent area of hypodense\nvasogenic edema appear stable in size and distribution. The mass effect on\nadjacent structures (including effacement of the occipital horn of the right\nlateral ventricle and the adjacent sulci) are also stable in appearance. The\npreviously described bilateral subarachnoid hemorrhage are also stable in\nappearance. There is continued evolution of the left upper division middle\ncerebral artery distribution infarction. There are no new hemorrhagic foci\nnor evidence of new acute large territorial infarction. There is no midline\nshift.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Stable appearance of the known acute left MCA infarction.\n2. Stable appearance of the right occipital hematoma.\n\n3. There are no new hemorrhagic foci nor evidence of new acute large\nterritorial infarction." + }, + { + "input": "Evolving acute infarction in the left MCA territory demonstrates increased\nmass-effect with greater effacement of the left lateral ventricle and\nincreased, though mild rightward shift of midline structures compared to 1 day\nearlier. No acute hemorrhage is definitively seen in the territory of the\ninfarction, allowing for slight bone related artifact along the left frontal\nlobe due to rightward tilt of the patient's head.\n\nRight occipital hyperdense intraparenchymal hemorrhage measures 2.5 x 1.6 cm,\npreviously 2.1 x 1.8 cm on ___ (02:12). Comparison is limited by\ndifferences in patient head position. Mild surrounding edema is stable. \nThere appears to be new mild effacement of the right ambient cistern, though\nthis appearance could be secondary to the rightward tilt of the patient's\nhead.\n\nTrace intraventricular hemorrhage in the occipital horn of right lateral\nventricle is new from ___.\n\nRight subarachnoid hemorrhage is less prominent. 2 mm right temporal subdural\nhematoma was not seen on any of the prior CTs.\n\nParanasal sinuses and mastoid air cells appear grossly well-aerated.", + "output": "1. Right occipital parenchymal hematoma appears essentially stable allowing\nfor differences in patient head position compared to ___.\n2. New right temporal subdural hematoma measuring 2 mm.\n3. Trace interventricular hemorrhage in the occipital horn on the right\nlateral ventricle, new from ___.\n4. Evolving large left MCA infarct, with slightly increased mass effect on the\nleft lateral ventricle and slightly increased, though mild rightward shift of\nmidline structures. Right ambient cistern appears to be mildly effaced\ncompared to ___, but this could be an artifact of rightward tilt of\nthe patient's head.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 1:35 ___, 2 minutes after\ndiscovery of the findings." + }, + { + "input": "There is left middle cerebral artery territory grey matter hypodensity\nsuggesting acute infarction. Asymmetric hyperdensity in the left M1 and M2\nsegments could be acute thrombus or calcification. Right worse than left\ndiffuse serpiginous hyperdensities in the subarachnoid space are most likely\nsubarachnoid hemorrhage. No shift of normally midline structures. Ventricles\nand sulci are otherwise normal in configuration for the patient's age. The\nperimesencephalic cisterns are patent. No evidence of fracture. The\npartially imaged paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The orbits are unremarkable.", + "output": "1. Large acute left MCA territory infarct.\n2. Bilateral, right worse than left subarachnoid hemorrhage.\n3. No prior imaging is available for comparison. Once the patient's real\nname becomes available, comparison with outside imaging can be performed and\nthis report may be modified.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 1:37 ___, 1 minutes after\ndiscovery of the findings." + }, + { + "input": "There is no evidence of large territorial infarction, hemorrhage, edema, or\nmass effect. The ventricles and sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "The carotid and vertebral arteries and their major branches are patent,\nwithout evidence of stenosis or a dissection.\n\nThe nondisplaced fracture of the left anterior body of C2 with extension into\nthe left C2 transverse foramen appears similar to ___ CT sinus. The\nposterior wall of the left transverse foramen is minimally displaced.\n\nThere are several dental caries and periapical lucencies.", + "output": "1. C2 fracture with extension into the left transverse foramen and facial\nfractures as previously identified. No findings to suggest a traumatic carotid\nor vertebral artery injury.\n2. Dental disease. Recommend nonemergent dental consultation.\n3. Please refer to the dictation for maxillofacial CT for detail regarding the\nright facial fractures.\n\nRECOMMENDATION(S): Dental consultation" + }, + { + "input": "Patient is status post right frontal ICP placement. The left frontotemporal\nand right frontotemporal and parietal subarachnoid hemorrhage appears more\nextensive, potentially from redistribution. Intraventricular hemorrhage is\nnow identified within the left lateral ventricle. There is a more conspicuous\nright hemispheric subdural hematoma measuring up to 4 mm overlying the right\noccipital lobe with no mass effect or shift of midline structures.\n\nAgain identified are multiple sites of intraparenchymal hemorrhage. There is\nblossoming of a right temporal lobe contusion. Cerebellar contusion on the\nleft (3:10) adjacent to the left temporo-occipital fracture is noted.\n\nAdditionally, there is increased density within the midbrain/cerebral left\ncerebral peduncle which may represent hemorrhage.\n\nIncreased density within the posterior fossa (3:18) may represent subdural\nblood along the tentorium versus subarachnoid hemorrhage in the posterior\nfossa.\n\n The gray white matter junction appears preserved elsewhere. The basal\ncisterns appear patent. Previously seen fractures through the left occipital\nand temporal bones as well as other skull base fractures are better delineated\non prior dedicated CT sinus/mandible examination. There is been resolution of\npneumocephalus. There is persistent partial opacification of bilateral\nmastoid airs cells as well as fluid within the bilateral maxillary, sphenoid\nand nasal sinuses. Frontal sinuses appear clear.\n\nA 3 mm hyperdensity in the nasopharynx on the right (3:10) may represent a\nforeign body. Additional hyperdensities in the right periorbital soft tissues\nare also noted. Enteric tube is coiled in oropharynx.", + "output": "1. More conspicuous bilateral subarachnoid hemorrhage, right greater than\nleft with intraventricular blood within the left lateral ventricle,\npotentially redistribution.\n\n2. Blossoming of right frontal, right temporal and left cerebellar\nintraparenchymal contusions.\n\n3. More conspicuous right subdural hemorrhage with no mass effect. High\ndensity in posterior fossa adjacent to incisura, potentially subdural blood\nalong the tentorium or adjacent subarachnoid blood.\n\n4. Increased density within the left midbrain/cerebral peduncle which may\nrepresent hemorrhage or contusion. Attention on follow up is recommended.\n\n5. Possible foreign body in the nasopharynx and within the right periorbital\nsoft tissues.\n\n6. Enteric tube coiled in the oropharynx" + }, + { + "input": "Previously seen radioopaque foreign body within the nasopharynx not seen. \nSeen best on sequence 3 image 38, there remains a left supraorbital\nradioopaque foreign body. Seen best on sequence 3 image 26, there is a\nradiodensity within the soft tissues lateral to the right zygoma. Prior\nradioopaque foreign body near the right globe on prior is no longer\nvisualized.\n\nMultiple sites of intraparenchymal hemorrhages are identified within the right\ntemporal and frontal lobes are again seen. Previously seen left cerebellar\ncontusion shows expected evolution. Within the cerebellum on the right, there\nis a more apparent hypodensity which may reflect prior infarction. Since\nprior examination dated ___, there appears to be a more conspicuous\nright posterior fossa extra axial hemorrhage measuring up to 3mm in thickness.\nBifrontal and parietotemporal subarachnoid hemorrhage again seen. There is\npersistent right parieto-occipital subdural hemorrhage as well as along the\nposterior falx and layering bilaterally along the tentorium, as well as likely\nsupracerebellar subarachnoid blood, unchanged. The basal cisterns are patent.\nThere is no shift the of midline structures. Gray-white matter junction is\notherwise preserved. There has been interval removal of ICP monitor.\n\nThere is persistent mucosal thickening within bilateral maxillary sinuses\nright greater than left. There is persistent fluid within the nasopharynx and\nincreased partial opacification of the frontal sinuses and sphenoid sinuses.\nTrace fluid is identified within bilateral mastoid air cells. Re-\ndemonstration of multiple skull fractures better described on sinus CT dated\n___.", + "output": "1. Prior radioopaque foreign body adjacent to right globe and within\nnasopharynx no longer visualized. Two radioopaque foreign bodies persist, one\nwithin the supraorbital soft tissues on the left and another within the soft\ntissues lateral to the right zygoma.\n\n2. Right posterior fossa extra axial hemorrhage more apparent on today's\nexamination but present on prior studies.\n\n3. Expected evolutionary changes of known multiple intraparenchymal\ncontusions and persistent subarachnoid and subdural hemorrhages." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, or infarction.\nThere is encephalomalacia in the left cerebral hemisphere and right temporal\nlobe. There has been interval resolution of blood products from most recent\nprior exam. Note is made of some ex vacuo dilatation of the temporal horn of\nthe right lateral ventricle.\n\nThe ventricles and sulci are normal in size and configuration.\n\nThe basal cisterns appear patent and there is preservation of gray-white\nmatter differentiation.\n\nA left occipital fracture is visible but slightly less distinct from the prior\nexamination.\n\nThere is minimal mucosal thickening involving the ethmoid air cells and there\nis a small mucous retention cyst seen in the left sphenoid sinus. The\nbilateral maxillary sinuses are clear. The right mastoid air cells are clear. \nThere is a minimal amount of fluid in the left mastoid air cells.\n\nThe globes are unremarkable.", + "output": "No evidence of acute intracranial process.\n\nEncephalomalacia in the left cerebellar hemisphere and right temporal lobe\nwith resolution of blood products." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is relatively stable acute intraparenchymal hemorrhage involving the\nleft globus pallidus insular cortex with minimal surrounding vasogenic edema\nand mass effect causing mild effacement of the frontal horn of right lateral\nventricle.\n\nThere is chronic encephalomalacia with volume loss in the right anterior\ntemporal and frontal lobes.\n\nThe ventricles, sulci and cisterns are symmetric and patent. There are\nminimal hypodensities in the subcortical and periventricular white matter,\nnonspecific, likely secondary to small vessel ischemic disease. There is\nintracranial atherosclerotic calcification. There is mild mucosal thickening\nin the right maxillary sinus and bilateral anterior ethmoid air cells. The\nremaining visualized paranasal sinuses and mastoid air cells are clear. \nBilateral middle ear cavities are clear. The orbits appear unremarkable.\n\nThere are periapical lucencies surrounding right maxillary molars.\n\nCTA HEAD:\nThere is atherosclerosis involving bilateral cavernous carotid arteries\ncausing moderate luminal narrowing involving the clinoid /supraclinoid ;eft\nICA as seen on image 5:263. The vessels of the circle of ___ and their\nprincipal intracranial branches appear otherwise unremarkable without \nocclusion or aneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is atherosclerosis involving bilateral vertebral artery origins causing\nsevere stenosis. There is a left dominant vertebral artery. The vertebral\narteries are otherwise patent along the remaining course. Dense vascular\narteriosclerotic calcifications are visualized in the aortic arch at the\norigin of the common carotid arteries.\n\nThere is atherosclerosis with dense calcifications involving bilateral carotid\nbifurcations without significant stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear noting dependent atelectasis and\nmild emphysematous changes. The visualized portion of the thyroid gland is\nwithin normal limits. There is no lymphadenopathy by CT size criteria. There\nare degenerative changes involving the visualized cervical spine. There is\natherosclerosis involving the aortic arch, especially at the left carotid\nartery origin.", + "output": "1. Intraparenchymal hemorrhage involving the left globus pallidus and insular\ncortex with associated vasogenic edema and mass effect.\n2. Atherosclerosis involving bilateral carotid bifurcations without\nsignificant stenosis by NASCET criteria.\n3. Severe atherosclerotic narrowing involving the origin of bilateral\nvertebral arteries.\n4. Atherosclerosis involving bilateral cavernous carotid arteries with\nmoderate luminal narrowing involving the left clinoid ICA." + }, + { + "input": "Again seen is an area of evolving intraparenchymal hemorrhage in the left\ninsular region with surrounding vasogenic edema measuring approximately 3.9 x\n2.2 cm, previously 4.5 x 2.5 cm slightly decreased in size. No new hemorrhage\nis identified. There is no significant shift of normally midline structures. \nNo large vascular acute territorial infarction is identified. Periventricular\nand subcortical white matter hypodensities are nonspecific, but likely reflect\nsequelae of chronic small vessel ischemic disease. There is prominence of the\nventricles and sulci compatible with age related global atrophy.\n\nThere is no evidence of fracture. There is mucosal thickening in the\nbilateral anterior ethmoid air cells. The remaining visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Slight interval decrease in the left intraparenchymal hemorrhage now\nmeasuring 3.9 x 2.2 cm. No new hemorrhage." + }, + { + "input": "[HEAD CTA: There is calcified atherosclerotic disease of the carotid siphons\nwithout evidence of significant stenosis. The anterior and middle cerebral\narteries are unremarkable. There is a fetal type left PCA with a hypoplastic\nP1 segment. The right posterior communicating artery is not identified. The\nposterior circulation is otherwise unremarkable.\n\nAgain noted are multiple fractures involving the left occipital bone, temporal\nbone, and skullbase. There are air-fluid levels in the bilateral maxillary and\nleft sphenoid sinuses.\n\nNECK CTA: There is calcified atherosclerotic disease of the carotid\nbifurcations bilaterally without evidence of significant stenosis based on\nNASCET criteria.\n\nThere is mild stenosis at the origin of the vertebral arteries. There is\nminimal irregularity of the V2 segment of the right vertebral artery likely\ndue to atherosclerotic disease.\n\nThere is no evidence of are dissection.\n\nThere is an endotracheal tube in place.\n\nThe fractures involving the cervical spine, and bilateral ribs are grossly\nunchanged from prior C-spine CT. There is also a comminuted left clavicular\nfracture the reside image from prior CT.\n\nThere is a left-sided chest tube in place. There are small bilateral\npneumothoraces. There are bilateral parenchymal opacities left greater than\nright likely reflecting a combination of pulmonary contusion and atelectasis.\nThere is emphysema involving the left chest wall.", + "output": "There is mild stenosis at the origin of the vertebral arteries bilaterally.\nThere is also some irregularity of the V2 segment of the right vertebral\nartery likely due to atherosclerotic disease. Otherwise unremarkable head and\nneck CTA without evidence of aneurysm or dissection.\n\nMultiple fractures involving the head, cervical spine, and bilateral ribs are\ngrossly unchanged. Comminuted left clavicular fracture was not imaged on prior\ncervical spine CT.\n\nSmall bilateral pneumothoraces. There is a left-sided chest tube in place.\nBilateral parenchymal opacities, left greater than right likely representing a\ncombination of a pulmonary contusions, and atelectasis." + }, + { + "input": "There is no evidence of acute hemorrhage mass effect midline shift or\nhydrocephalus. Gray-white matter differentiation is maintained. Mild brain\natrophy is seen. Vascular calcifications are noted.\n\nThe visualized paranasal sinuses are clear. No skull fracture is seen.", + "output": "No significant intracranial abnormalities are identified on CT head without\ncontrast." + }, + { + "input": "Head CT: There is no evidence of hemorrhage, edema, masses, mass effect, or\ninfarction. Prominent ventricles and sulci suggest age related global\natrophy. The basal cisterns appear patent and there is preservation of\ngray-white matter differentiation. No fractures are identified. Patient is\nstatus post bilateral cataract surgery.\n\nHead CTA: There is no evidence of aneurysm, stenosis or occlusion of the\nmajor intracranial vessels. The posterior communicating arteries are absent\nbilaterally. Atherosclerotic calcifications are seen at the carotid siphons.\n\nNeck CTA: There is approximately 50% stenosis of the right carotid bulb and\nthe proximal internal carotid artery. There is also approximately 62.5%\nstenosis of the left carotid bulb and the proximal internal carotid artery. \nThere is focal narrowing at the origin of the right vertebral artery without\ndistal flow limiting stenosis. Atherosclerotic calcifications are also seen in\nthe mid V4 segments bilaterally. Patient is status post anterior fusion of\nthe cervical spine at C3-C4. Multilevel degenerative changes are noted in the\ncervical spine.\n\nThere is dilation of the main pulmonary artery measuring up to 3.8 cm as well\nas the right pulmonary artery measuring 3.3 cm suggestive of underlying\npulmonary arterial hypertension. Atherosclerotic calcifications are noted at\nthe aortic arch.", + "output": "1. Moderate stenosis of bilateral carotid bifurcations by NASCET criteria as\ndescribed above.\n2. The circle of ___ and major intracranial branches are patent. Posterior\ncommunicating arteries are not identified, which is a normal variant.\n3. Enlargement of the main and right pulmonary arteries concerning for\nunderlying pulmonary arterial hypertension. Recommend clinical correlation.\n4. Postsurgical changes related to prior C3-4 anterior spine fusion." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThere is midline frontal scalp swelling. No osseous abnormalities seen. The\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\norbits are unremarkable.", + "output": "1. No evidence of fracture, mass, hemorrhage or infarction.\n2. Mild right frontal midline scalp swelling." + }, + { + "input": "There is no evidence of fracture, large territorial\ninfarction,hemorrhage,edema, or mass. The ventricles and sulci are normal in\nsize and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "No acute intracranial abnormality." + }, + { + "input": "Study is limited by extensive artifact from right cochlear implant. There is\nno evidence of acute large territory infarction,hemorrhage,edema, or mass. \nExtensive periventricular and subcortical white matter hypo attenuations are\nunchanged from prior CT dated ___. While non-specific, these likely\nrepresent severe chronic small vessel ischemic disease. There is prominence\nof the ventricles and sulci suggestive of involutional changes. The basal\ncisterns are preserved. Atherosclerotic calcifications are seen in the\nbilateral carotid siphons.\n\nThere is no evidence of fracture. There is mucosal thickening in the right\nsphenoid sinus and trace fluid in the left sphenoid sinus. There is mild\nmucosal thickening of the ethmoidal air cells. The visualized portion of the\nparanasal sinuses are clear. Soft tissue densities are noted within bilateral\nexternal auditory canals which may represent cerumen. There is partial\nopacification of the mastoid air cells, right greater than left. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No evidence of acute large territory infarction or intracranial hemorrhage.\n2. Extensive periventricular and subcortical white matter hypo attenuations\nare unchanged from prior CT head dated ___. While non-specific,\nthese likely represent severe chronic small vessel ischemic disease." + }, + { + "input": "Artifact from right cochlear implant limits evaluation.\n\nThere is no evidence of large territorial infarction,hemorrhage,edema,or\nmass-effect. There is prominence of the ventricles and sulci suggestive of\natrophy. There are extensive periventricular and subcortical white-matter\nhypodensities which are nonspecific, but likely represent sequela of severe\nchronic small vessel ischemic disease. Toxic leukoencephalopathy could have\nsimilar appearance. Findings are stable since head CT ___.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, left mastoid air cells, and middle ear cavities are clear. Partial\nopacification of the inferior right mastoid air cells again noted. The\nvisualized portion of the orbits are unremarkable. Redemonstration of\nbilateral carotid siphon calcifications.", + "output": "1. No acute intracranial abnormality.\n2. Findings most consistent with severe chronic small vessel ischemic changes;\nstable since ___ subacute toxic leukoencephalopathy could have\nsimilar appearance, is less likely." + }, + { + "input": "There is a right cochlear implant with causes streak artifact that somewhat\nlimits diagnostic evaluation. There is no evidence of acute large territorial\ninfarction,hemorrhage,edema,or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. Bilateral periventricular,\nsubcortical and deep white matter hypodensities are nonspecific but most\nlikely represent the sequela of chronic small vessel ischemic changes. \nAtherosclerotic calcifications are seen in the bilateral carotid siphons.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. The\nvisualized portion of the orbits are unremarkable. There are and endotracheal\ntube and an enteric tube.", + "output": "1. No acute intracranial process.\n2. No calvarial fracture." + }, + { + "input": "There is interval significant increase in left parafalcine subdural hematoma\nmeasuring up to 1.6 cm in greatest thickness (2; 26), previously measuring 9\nmm. There is increased density of the anterior left parafalcine subdural\nhematoma compared to prior. There is also slightly increased left frontal\nsubdural hematoma measuring up to 4 mm in greatest thickness (2; 26). \nInterval development of left temporal subdural hematoma measuring 4 mm in\nthickness (2; 13). Left tentorial subdural hematoma measures 3 mm in greatest\nthickness and has significantly increased compared to prior (601; 67). There\nis also a small right anterior subdural hematoma measuring 5 mm in greatest\nthickness, similar to prior (601; 25).\n\nSimilar to slightly increased subarachnoid hemorrhage in the left parietal\nsulci and small amount of subarachnoid blood is also noted in the right\nfrontal sulci (2; 25), not previously seen. Small amount of subarachnoid\nhemorrhage is also noted in bilateral frontal lobes (601; 30) similar to\nprior.\n\nThere is significant interval increase in mass effect with effacement of the\nleft hemispheric sulci and increased mass-effect on the left lateral\nventricle. No intraventricular extension is seen. Basal cisterns are patent.\n\nNo large vascular territory infarction.\n\nThere is no evidence of fracture. Mild mucosal thickening of the right\nmaxillary sinus is noted. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. Significant interval increase in left parafalcine subdural hematoma\nmeasuring up to 1.6 cm in greatest thickness. Interval increase in left\nfrontal subdural hematoma as well as interval development of left temporal\nsubdural hematoma is noted. There is increase in the left tentorial subdural\nhematoma. No midline shift. Basal cisterns are patent.\n2. Similar to slightly increased subarachnoid hemorrhage, seen in the left\nparietal sulci and bilateral frontal sulci with likely redistribution of\nsubarachnoid blood to the right frontal sulci near the vertex." + }, + { + "input": "Again seen is an acute left parafalcine subdural hematoma which measures up to\n1.6 cm in maximum width (series 2:24) with layering upon the left tentorium,\ngrossly unchanged from most recent CT head. Acute left frontal subdural\nhematoma measuring 5 mm from the inner table (series 2:16) is grossly\nunchanged. Within the limitations of motion degradation, left parietal,\noccipital and bilateral frontal acute subarachnoid hemorrhage is grossly\nunchanged. Previously characterized right anterior subdural hematoma noted on\nmost recent CT head is poorly visualized due to motion degradation.\n\nThere is persistent mass effect with sulcal effacement and narrowing of the\nleft lateral ventricle and 3 mm rightward midline shift (series 2:18), grossly\nunchanged and likely related with brain edema. Basal cisterns are patent.\n\nThere is no fracture. There is mild mucosal thickening of the right maxillary\nsinus. Remaining paranasal sinuses are clear. Mastoid air cells middle ear\ncavities are patent.", + "output": "Within the limitations of motion degradation, acute subdural and subarachnoid\nhemorrhage with persistent mass effect, sulcal effacement, brain edema towards\nthe left cerebral convexity, and 3 mm of rightward midline shift are unchanged\nas compared to CT head ___ 20:07. No evidence of new or worsening\nintracranial hemorrhage." + }, + { + "input": "Motion artifact markedly obscures the lower images of the scan (skullbase).\n\nWithin this limitation the left parafalcine subdural hematoma measuring up to\n16 mm in diameter appears similar compared to prior imaging. Left tentorial\nleaflet, left frontal as well as left temporal components of the hemorrhage\nare also unchanged. Subarachnoid hemorrhage in the left temporoparietal area\nappears slightly improved compared to prior. The ventricular profile is\nunchanged. No new acute large territorial infarct. Left cerebral hemispheric\nswelling appears fairly similar compared to prior\n\nNo displaced calvarial fractures. The paranasal sinuses and mastoid air cells\nappear clear.", + "output": "Motion artifact markedly obscures the lower images of the scan (skullbase). \nWithin this limitation:\n\n1. The left parafalcine hemorrhage as well as its left frontal, left temporal\nand left tentorial components appear fairly similar compared to prior imaging.\n2. Mild interval improvement of the associated left temporoparietal\nsubarachnoid hemorrhage.\n3. Ventricular profile is unchanged.\n4. No acute large territorial infarct." + }, + { + "input": "There is residual small volume left anterior parafalcine subdural hematoma\nmeasuring approximately 7 mm in thickness, and demonstrating areas of high\ndensity and isodense to the relative to gray matter (see 602:50; 601:36).\nBasilar cisterns are patent.\n\nThere is no evidence of acute large territorial infarction or mass.\n\nThere is mild prominence of the ventricles and sulci suggestive of\ninvolutional changes. There are periventricular and subcortical lucencies,\nwhich may represent small vessel ischemic changes. Atherosclerotic vascular\ncalcifications are noted of bilateral cavernous portions of internal carotid\narteries.", + "output": "1. Approximately 7 mm maximum thickness left anterior parafalcine acute on\nsubacute subdural hematoma, decreased in size compared to ___ prior\nexam. Please note findings are suggestive of repeat intracranial hemorrhage\nsince ___ prior exam.\n2. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described.\n3. Please see concurrently obtained maxillofacial CT for description of\nmaxillofacial structures." + }, + { + "input": "Dental amalgam streak artifact limits study. No fractures are identified.\nThere is no evidence of facial swelling. Sigmoid nasal septal deviation with\nbony spur is noted.\nThere is mucosal thickening of the right maxillary sinus and bilateral ethmoid\nair cells. Within the right maxillary sinus mucosal thickening small areas of\nhigh density are noted (see 601: 58-59).\nThere is no evidence of abnormal fluid collections.\nTrace right mastoid tip fluid is noted. Otherwise, bilateral mastoids appear\naerated with grossly preserved mastoid septa. The middle ear cavities are\ngrossly clear.\n Soft tissue densities are noted within bilateral external auditory canals\nwhich may represent cerumen.\nMultiple right mandibular teeth are absent crowns, demonstrate cavities and\nperiapical lucencies. Multiple right maxillary teeth are absent, with a\nresidual molar demonstrating periapical lucency (see 104:61).\nThe globes, extraocular muscles, optic nerves, and retrobulbar fat appear\npreserved.\nThe visualized upper aerodigestive tract appears preserved.\nThe mandible and temporomandibular joints appear preserved.\nLimited imaging of cervical spine demonstrates multilevel degenerative changes\nwith at least mild vertebral canal narrowing by disc osteophyte complex at\nC4-5.", + "output": "1. Dental amalgam streak artifact limits study.\n2. No evidence of fracture.\n3. No evidence of osseous destruction.\n4. Paranasal sinus disease with findings suggestive of chronic and/or fungal\nsinusitis, as described.\n5. Clear left and trace right mastoid tip fluid with preserved mastoid septa.\nWith no definite evidence of left or right otomastoiditis.\n6. Multiple right-sided mandibular and maxillary teeth absent crowns, with\nsuggested cavities and/or periodontal disease, as described.\n7. Limited imaging lungs demonstrate multilevel cervical spondylosis with at\nleast mild vertebral canal narrowing at C4-5. If concern for cervical spinal\ncord compression, consider cervical spine MRI for further evaluation.\n8. Bilateral external artery canal probable cerumen, with grossly clear\nbilateral middle ear cavities within the limits of this non dedicated\nexamination. If continued concern for subtle middle ear opacity, consider\ndedicated temporal bone CT for further evaluation.\n9. Please see concurrently obtained noncontrast head CT for description of\nintracranial structures.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 07:16 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." + }, + { + "input": "There is no evidence of acute large territory infarction,hemorrhage,edema, or\nmass. Bilateral extra-axial scattered calcifications may represent sequela of\nprior neurocysticercosis. There is prominence of the ventricles and sulci\nsuggestive of involutional changes.\n\nSmall left periorbital hematoma. No postseptal or intraconal abnormality\nnoted. Globe intact. No underlying fracture. Mild mucosal thickening of the\nbilateral maxillary and ethmoid sinuses. Otherwise, the visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "1. Small left periorbital hematoma without underlying fracture. Intact globe.\nNo retrobulbar hematoma.\n2. Mild sinus disease as described above." + }, + { + "input": "Study is mildly degraded by motion. Re-demonstrated, is a intraparenchymal\nhemorrhage of the right basal ganglia. Re-demonstrated, is intraventricular\nhemorrhage extending along the anterior horn and body of the right lateral\nventricle, body of the left ventricle, third ventricle and the bilateral\noccipital horns of the lateral ventricles, stable. (3: ___. \nRe-demonstrated, is a right frontal approach EVD catheter with tip in the body\nof the right ventricle,(03:17). Again seen are postsurgical changes including\nsmall amount of pneumocephalus, stable, (03:22). Re-demonstrated, is\nunchanged subarachnoid hemorrhage at the left temporal lobe, (03:15), stable. \nLeftward midline shift remains unchanged, (03:17). The basilar cisterns is\nwidely patent.\n\nThere is no evidence of fracture. There is mucosal thickening of the ethmoid\nsinus, (3:8). The visualized portion of the other paranasal sinuses, and\nmiddle ear cavities are clear. There is complete opacification of the right\nmastoid air cells and partial opacification of the left mastoid, (3:5). There\nis evidence of right lens replacement surgery (03:10).", + "output": "1. Re-demonstrated, is an unchanged intraparenchymal hemorrhage of the right\nbasal ganglia.\n2. Again seen, is unchanged, intraventricular hemorrhage that extends along\nthe anterior horn and body of right lateral ventricle, third ventricle and\nbilateral occipital horns of the lateral ventricles.\n3. Re-demonstrated is a right frontal approach EVD catheter with the tip\nterminating at the body of right lateral ventricle.\n4. Re-demonstrated, unchanged subarachnoid hemorrhage at the left temporal\nlobe.\n5. Unchanged leftward midline shift.\n6. Unchanged, postsurgical changes including small amount of pneumocephalus." + }, + { + "input": "Again noted is a right-sided basal ganglia hemorrhage extending to the right\nlateral ventricle and also seen in both occipital horns. A right-sided\nfrontal ventricular drain projects on the right lateral ventricle and tip near\nthe septum pellucidum. Prominence of temporal horns is unchanged. No new\nhemorrhage is seen.", + "output": "Overall unchanged appearance compared with ___ in right basal\nganglia hemorrhage extending to the ventricles and the ventricular size." + }, + { + "input": "There has been interval removal of right-sided ventricular drainage since CT\nhead ___. There is diffuse subarachnoid hemorrhage, most of\nwhich is in the bilateral frontal lobes, which is new since ___.\nThere is a parenchymal hemorrhage centered in the right caudate head measuring\n3.0 x 1.5 cm (series 2: 18), decreased in size from ___,\npreviously measuring 4.1 x 2.2 cm. Intraventricular hemorrhage in the\nbilateral occipital horns is decreased in size since ___. \nVentricles and sulci are unchanged.", + "output": "1. Diffuse acute subarachnoid hemorrhage is new as compared to ___ likely due to redistribution from intraparenchymal hemorrhage.\n2. Parenchymal hemorrhage centered in the right caudate head and\nintraventricular hemorrhage are decreased in size from ___.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\n___ on the telephone on ___ at 5:29 pm, 5 minutes after discovery of\nthe findings." + }, + { + "input": "Acute subarachnoid hemorrhage is noted overlying the bilateral parietal lobes\nnear the vertex. No other acute hemorrhage identified. Hypodensity in the\nperiventricular white matter adjacent to the horn of the right lateral\nventricle and right caudate is compatible with sequela of prior parenchymal\nhemorrhage. There is no mass effect, no midline shift. Prominence of the\nventricles and sulci is compatible with global volume loss. Calcification in\nthe right frontal lobe is unchanged, potentially related to overlying burr\nhole.\n\nMild mucosal thickening noted in the left maxillary sinus and ethmoid air\ncells. Remaining paranasal sinuses are clear. The right mastoids are poorly\npneumatized and partially opacified, unchanged. Skull and extracranial soft\ntissues are unremarkable.", + "output": "Acute biparietal subarachnoid hemorrhage.\nSequela of prior right frontal parenchymal hemorrhage." + }, + { + "input": "There is minimally increased small volume subarachnoid hemorrhage about the\nfalx overlying the bilateral parietal lobes, now extending anteriorly to the\nsulci of the posterior right frontal lobe. No other hemorrhage identified\noutside of this. Hypodensity in the periventricular white matter adjacent to\nthe horn of the right lateral ventricle and right caudate nucleus reflects\nsequelae of prior parenchymal hemorrhage. There is no evidence of acute\ninfarction, edema,or mass. Calcification within the right frontal lobe deep\nto the overlying burr hole may be related to the burring process. There is\nstable, mild prominence of the ventricles and sulci suggestive of involutional\nchanges. The bilateral carotid siphons and proximal intracranial vertebral\narteries are moderately calcified.\n\nThere is no evidence of fracture. Mild mucosal thickening is re-demonstrated\nin the left maxillary sinus. The remaining paranasal sinuses are grossly\nclear. Underpneumatization and partial opacification of the right mastoid air\ncells is unchanged. The middle ear cavities are clear. Patient is status\npost right lens replacement: Otherwise, the visualized portion of the orbits\nare unremarkable.", + "output": "1. Minimally increased small volume subarachnoid hemorrhage overlying the\nbilateral parietal lobes now extends anteriorly to the sulci overlying the\nposterior right frontal lobe. This may be secondary to changes in positioning\nand redistribution, although increased hemorrhage is difficult to exclude.\n2. No infarct or other areas of hemorrhage identified.\n3. Similar sequelae of prior intraparenchymal hemorrhage in the region of the\nright caudate nucleus.\n\nNOTIFICATION: The findings were discussed with ___, NP by\n___, M.D. on the telephone on ___ at 10:04 am, 3 minutes after\ndiscovery of the findings." + }, + { + "input": "The examination is moderately limited secondary to patient motion, allowing\nfor this:\n\nRedemonstrated is an area of hypodensity with superimposed hyperdensity in the\ninferior right frontal lobe. Overall this finding is similar to the prior\nexamination. There is mild, diffuse subarachnoid hemorrhage, also better seen\non recent MRI examination. No new sites for acute intracranial hemorrhage are\nidentified.\n\nThere is no evidence for large vascular territorial infarction by CT. No\nappreciable midline shift. The basal cisterns and foramina magnum remain\npatent. The ventricles and sulci are diffusely prominent, compatible with\nglobal parenchymal volume loss.\n\nThere is no evidence for displaced calvarial fracture. A left maxillary\nmucous retention cyst is seen. The right mastoid air cells are\nunderpneumatized. The remainder of the paranasal sinuses are grossly clear. \nThe patient is status post right lens replacement.", + "output": "1. Moderately motion degraded examination.\n2. Stable appearance of a hypodensity with superimposed hyperdensity in the\nright frontal lobe. Findings may reflect a hemorrhagic contusion or\nhemorrhagic conversion of prior infarct. Recommend continued attention on\nfollow-up.\n3. Stable, minimal residual bilateral subarachnoid hemorrhage.\n4. No evidence for new acute intracranial hemorrhage or acute territorial\ninfarction.\n5. Additional findings, as above." + }, + { + "input": "Study is mildly degraded by motion.\n\nCT HEAD:\nAgain seen is a large right basal ganglia intraparenchymal hemorrhage with\nintraventricular decompression. Overall, this appears minimally changed from\nthe previous examination. There is local surrounding vasogenic edema and mass\neffect, with approximately 5 mm of leftward midline shift. Trace hyperdensity\nalong the left sylvian fissure (02:17) may reflect subarachnoid hemorrhage. \nOtherwise, no new sites of hemorrhage are identified. There is no evidence\nfor vascular territorial infarction within the limits of CT. The ventricles\nand sulci otherwise\n\nOtherwise, there is no evidence for acute vascular territorial infarction,\nmass effect, or edema. No convincing evidence for ventricular obstruction at\nthis time.\n\nMild mucosal thickening is seen throughout scattered ethmoid air cells. The\nright mastoid air cells are under pneumatized and partially opacified. The\nremainder of the paranasal sinuses, middle ear cavities, and mastoid air cells\nare clear. The patient is status post right-sided lens replacement..\n\nCTA HEAD AND NECK:\nThere is a normal 3 vessel aortic arch identified. Incidentally, an aberrant\nright subclavian artery taking a retroesophageal course is noted. The\nvertebrobasilar system is left-sided dominant, a normal variant. The\nvertebral arteries are patent and mildly tortuous bilaterally.\n\nThe bilateral common carotid arteries are patent. Minimal calcified\natherosclerotic disease is seen at the right carotid bulb. Moderate left and\nmoderate severe right calcifications are seen involving the cavernous internal\ncarotid arteries, which remain patent.\n\nThere is a probable infundibulum of the branching point of the right M1/M2\nbifurcation (3:260). There is focal dilation and ectasia at the distal\nbasilar tip at the bifurcation of the bilateral posterior cerebral arteries. \nThis measures up to 4 mm and likely represents a basilar tip aneurysm (3:259).\n\nOTHER:\nThe lungs apices are clear bilaterally. A multinodular thyroid gland is noted,\nwith a dominant right thyroid nodule measuring up to 1.5 cm. There is no\ncervical lymphadenopathy by CT size criteria.", + "output": "1. Study is mildly degraded by motion.\n2. Large right basal ganglia small hemorrhage with intraventricular\ndecompression and probable small volume subarachnoid hemorrhage along the left\nsylvian fissure, overall unchanged from previous examination. Please note\nthat underlying mass is not excluded on the basis examination. Recommend\nfollow-up imaging to resolution. If clinically indicated, consider contrast\nbrain MRI for further evaluation.\n3. Local mass effect with partial effacement of the right lateral ventricle\nand 5 mm of leftward midline shift, also similar to the previous exam.\n4. No definite evidence for acute large territorial vascular territorial\ninfarction by CT. Please note MRI of the brain is more sensitive for the\ndetection of acute infarct.\n5. Background of global parenchymal volume loss and probable chronic\nmicroangiopathy.\n6. Probable, 4 mm basilar tip aneurysm at the level of the PCA bifurcation.\n7. Infundibulum versus small aneurysm at the right M1/M2 bifurcation.\n8. Multifocal atherosclerotic disease, as above, with otherwise grossly patent\nintracranial and cervical vasculature.\n9. Multinodular thyroid gland with largest nodule measuring up to\napproximately 1.5 cm. Please see recommendation below.\n\nRECOMMENDATION(S): Thyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or older, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "Patient is status post right frontal approach EVD catheter terminating in the\nbody of the right lateral ventricle. Small amount of pneumocephalus is seen. \nRedemonstration of right basal ganglia hemorrhage extending into the right\nlateral ventricle, the third and fourth ventricle, left lateral ventricle, as\nwell as layering in bilateral occipital horns, right greater than left,\noverall similar to prior. Re-demonstration of subarachnoid blood along the\nleft temporal lobe, similar to prior (2; 23). Leftward midline shift measures\nup to 5 mm, similar to prior. No new foci of hemorrhage. No large vascular\nterritory infarction. Basal cisterns are patent.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Postsurgical changes related to interval right frontal approach EVD\ncatheter placement, with tip in the right lateral ventricle, and small\npneumocephalus.\n2. Re-demonstration of right basal ganglia hemorrhage extending into the third\nand fourth ventricles as well as the left lateral ventricle similar to prior.\n3. Small amount of subarachnoid blood along the left temporal lobe is\nunchanged compared to prior.\n4. No new foci of hemorrhage.\n5. Grossly stable 5 mm right to left midline shift." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or acute large\ninfarction.\n\nThe ventricles and sulci are normal in size and configuration.\n\nThe basal cisterns appear patent and there is preservation of gray-white\nmatter differentiation.\n\nThe visualized bony structures are grossly unremarkable.\n\nThere is minimal mucosal thickening of the ethmoid air cells. The remainder of\nthe paranasal sinuses are clear. The mastoid air cells are well aerated.\n\nThe globes are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of large territorial infarction,intracranial\nhemorrhage,edema,or mass effect. The ventricles and sulci are normal in size\nand configuration.\n\nThere is no acute fracture. There is complete opacification of the left\nmaxillary sinus and partial opacification of the right maxillary sinus. There\nis also mucosal thickening of the left frontal and left anterior ethmoid air\ncells. There are foci of air within these areas, which can be seen in acute\nsinusitis as well as fungal colonization. The visualized portion of the\nremaining paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial hemorrhage or large territorial infarction.\n2. Complete opacification of the left maxillary sinus and partial\nopacification of the right maxillary sinus. Mucosal thickening left frontal\nand left anterior ethmoid air cells. Foci of air within these areas can be\nseen in acute sinusitis, and fungal colonization. Clinical correlation is\nadvised." + }, + { + "input": "There is no evidence of intracranial hemorrhage, recent infarct, mass or brain\nedema, or shift of normally midline structures. There is no ventriculomegaly.\nThere is minimal sphenoid sinus mucosal thickening. Otherwise, the paranasal\nsinuses and mastoid air cells are clear. There is no evidence of fracture.", + "output": "No evidence of acute intracranial process. No mass or ventriculomegaly." + }, + { + "input": "There is left frontal scalp soft tissue swelling with no evidence of\nunderlying fracture. There is no evidence of acute intracranial\nhemorrhage,edema,or mass. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. Minimal bilateral carotid siphon\ncalcifications are noted.\n\nThere is mild mucosal thickening of the ethmoid air cells. Otherwise, the\nremaining visualized paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No acute intracranial process or calvarial fracture.\n2. Left frontal scalp soft tissue swelling." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nmarked enlargement of the ventricles and sulci suggestive of involutional\nchanges. Periventricular and subcortical white matter hypodensities likely\nreflect chronic small vessel disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Moderate upper cervical spinal canal\nnarrowing is noted.", + "output": "1. No acute intracranial process." + }, + { + "input": "Several images through the vertex were repeated due to motion artifact on the\ninitial scan. 2 small foci of hemorrhage in the subcortical white matter of\nthe anterior right frontal lobe, image 2b:35, with minimal surrounding edema,\nare unchanged. These are compatible with hemorrhagic contusions, and less\nlikely diffuse axonal injury. No new hemorrhage is seen.\n\nExtensive periventricular, deep, and subcortical white matter hypodensity is\nagain seen, nonspecific but likely secondary to chronic small vessel ischemic\ndisease in this age group. Ventricles and sulci are enlarged due to\nage-related parenchymal volume loss.\n\nNo displaced fracture is seen. Visualized paranasal sinuses are well aerated.\nThe mastoids are underpneumatized bilaterally with paucity of air cells. \nBilateral mastoid antra and bilateral middle ear cavities are well aerated.", + "output": "Stable 2 small foci of hemorrhage in the right anterior frontal subcortical\nwhite matter, with stable minimal surrounding edema, compatible with\nhemorrhagic contusions. Diffuse axonal injury is less likely. No new\nabnormalities seen." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nRe-identified are areas of ill-defined hypodensity involving the right caudate\nhead/body as well as the lateral portion of the putamen and extending into the\nright corona radiata/centrum semiovale, suggestive of late acute to subacute\ninfarct. There is no evidence of hemorrhage, or mass. Moderate prominence of\nthe ventricles and sulci suggestive of involutional change. Scattered and\nconfluent areas of background periventricular, subcortical and deep white\nmatter hypodensities are in a configuration most suggestive of chronic small\nvessel ischemic disease.\n\nThe visualized portion of the paranasal sinuses are clear. There is partial\nopacification of underpneumatized bilateral mastoid air cells. The middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is a left dominant vertebrobasilar system with hypoplastic V4 segment of\nthe right vertebral artery. The V4 segment of the right vertebral artery\ndemonstrates fenestration. There is mild narrowing of the V4 segment of the\nleft vertebral artery secondary to atherosclerotic calcification. Moderate\natherosclerotic calcifications of the bilateral intracranial internal carotid\narteries produce mild narrowing on the left, and up to moderate narrowing at\nthe level of the right ICA terminus. There is abrupt loss of opacification of\nthe proximal M1 segment of the right MCA though distal opacification appears\npreserved, likely representing subtotal occlusion. There is mild focal\nnarrowing of the M1 segment of the left MCA secondary to likely\natherosclerotic disease (5:250). Distal arborization of the MCA branches\nappears grossly preserved. The remainder of the vessels of the circle of\n___ and their principal intracranial branches appear patent without\nadditional areas of occlusion, or aneurysm formation. The dural venous\nsinuses are patent.\n\nCTA NECK:\nThere are mild atherosclerotic calcifications of a 3 vessel aortic arch. \nThere is mild narrowing at the origins of the bilateral vertebral arteries\nsecondary to atherosclerotic calcification. There are moderate right greater\nthan left atherosclerotic calcifications at the carotid bifurcations. This\nproduces 20% narrowing of the right internal carotid artery by NASCET\ncriteria. There is no left internal carotid artery stenosis by NASCET\ncriteria. The carotid and vertebral arteries and their major branches\notherwise appear patent with no evidence of dissection, high-grade stenosis or\nocclusion.\n\nOTHER:\nThere is mucous inspissation of a subsegmental airway in the right apex\n(___). There is a 4 mm peribronchial nodule in the right upper lobe (05:24)\nand another 4 mm peribronchial nodule in the left upper lobe (05:23). There\nis a septated 9 mm hypodense right lobe thyroid nodule. There is no\nlymphadenopathy by CT size criteria. There is likely congenital block\nvertebra C5-C6.", + "output": "1. Acute to subacute infarct centered in the right basal ganglia with\nextension into the right frontal corona radiata/centrum semiovale.\n2. Abrupt cut off of the M1 segment of the right MCA with immediate\nreconstitution and preserved distal arborization likely representing subtotal\nocclusion.\n3. Mild narrowing of the left intracranial internal carotid artery and\nmoderate narrowing of the right ICA terminus.\n4. Mild narrowing of the V4 segment of the left vertebral artery.\n5. 20% stenosis of the right internal carotid artery by NASCET criteria.\n6. Remainder of the intracranial arterial vasculature is patent without\nadditional areas of occlusion or aneurysm formation.\n7. Otherwise patent cervical arterial vasculature without high-grade stenosis,\nocclusion, or dissection.\n8. 4 mm peribronchial nodules in the bilateral upper lobes. The ___\nSociety guidelines for pulmonary nodule guidelines suggest for pulmonary\nnodules less than or equal to 4mm, no follow-up needed in low-risk patients,\nand 12 month follow-up in high risk patients.\n9. 9 mm hypodense right lobe thyroid nodule. The ___ College of\nRadiology guidelines suggest that in the absence of risk factors for thyroid\ncancer, no further evaluation is recommended.\n\nRECOMMENDATION(S): The ___ Society guidelines for pulmonary nodule\nguidelines suggest for pulmonary nodules less than or equal to 4mm, no\nfollow-up needed in low-risk patients, and 12 month follow-up in high risk\npatients.\n\n Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "There is no evidence of acute, large territorial infarction,hemorrhage,edema,\nor mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular white-matter hypodensities are\nnonspecific, likely sequela of chronic ischemic small vessel disease.\n\nThere is no evidence of fracture. Rightward deviation of the nasal septum. \nPartial opacification of right mastoid air cells. Mild mucosal thickening of\nthe left sphenoid sinus. Otherwise, the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Aside from\nbilateral lens replacements, the visualized portion of the orbits are\nunremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute infarction,hemorrhage,edema,ormass. \nPeriventricular white matter hypodensity is non-specific, likely secondary to\nchronic small vessel ischemic disease. The ventricles and sulci are enlarged,\nconsistent with age-appropriate involutional changes.\n\nIf there is persisting clinical concern for stroke, MRI would be a more\nsensitive exam.\n\nCTA HEAD:\nAtherosclerotic calcifications are noted in the carotid siphons, resulting in\nmild narrowing bilaterally. The vessels of the circle of ___ and their\nprincipal intracranial branches appear normal without stenosis, occlusion, or\naneurysm. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is atherosclerotic calcification of the right subclavian near the\ntakeoff of the right vertebral artery. The bilateral carotid and vertebral\nartery origins appear patent with retropharyngeal course of the internal\ncarotid arteries. Areas of atherosclerotic calcification are noted in the\nbilateral vertebral arteries. The left vertebral artery has the appearance of\n50% stenosis (3:115), this may be secondary to either soft plaque from\natherosclerotic disease, or may be artifactual from nearby contrast filled\nvein.\nThere is atherosclerotic calcification and soft plaque of both common carotid\narteries at their bifurcation, causing up to moderate stenosis of the right\nICA (approximately 40% by NASCET criteria), and moderate/severe stenosis\n(approximately 50% by NASCET criteria), of the left ICA.\n\nOTHER:\nThere are emphysematous changes of bilateral lungs, as well as mild dependent\natelectasis. The visualized portion of the thyroid gland is within normal\nlimits. There is no lymphadenopathy by CT size criteria. Multilevel,\nmultifactorial degenerative changes throughout cervical spine, more\nsignificant from C3-C4 through C6-C7 levels.", + "output": "1. No acute intracranial abnormality is identified on noncontrast head CT.\n2. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\nMild narrowing of the internal carotid artery siphons is noted.\n3. There is bilateral stenosis the internal carotid arteries near the common\ncarotid bifurcation, with approximately 50% stenosis on the left and 40%\nstenosis on the right. There is a short-segment region of apparent stenosis\nof the left vertebral artery which may be artifactual, or secondary to soft\nplaque.\n\nRECOMMENDATION(S): MRI of the brain is recommended if there is continued\nclinical concern for stroke as it is a more sensitive exam." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\n\nThere is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass. The ventricles and sulci are normal in size and configuration. A focus\nof high density within the fourth ventricle is stable dating back to ___ and\nrepresents choroid plexus.\n\nThe visualized portion of the paranasal sinuses,mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal with no evidence of stenosis,occlusion or aneurysm. The dural\nvenous sinuses are patent.", + "output": "Unremarkable head CTA. Specifically, no evidence of intracranial aneurysm." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is mild atheromatous\natherosclerotic plaque at the right carotid bulb. There is no evidence of\ninternal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Normal CT head.\n2. Normal CTA head.\n3. Minimal extracranial atherosclerosis, without stenosis by NASCET criteria." + }, + { + "input": "The examination is slightly motion degraded. Within these confines:\n\nThere is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There are small mucous retention cyst in\nthe right frontal sinus. Otherwise, the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Study is mildly degraded by motion. There is no evidence of acute\nintracranial hemorrhage, edema, mass effect or large territorial infarction. \nThe ventricles and sulci are normal in size configuration for patient's age. \nThere is a probable 1.8 x 0.7 cm arachnoid cyst anterior to the right temporal\nlobe (04:12).\n\nThe partially imaged paranasal sinuses, mastoid air cells and middle ear\ncavities are grossly clear. The globes are unremarkable.", + "output": "1. Study is mildly degraded by motion.\n2. No acute intracranial abnormality. No evidence of acute intracranial\nhemorrhage.\n3. Probable 1.8 cm arachnoid cyst in the right middle cranial fossa. \nRecommend clinical correlation. If clinically indicated, brain MRI may be\nobtained for further evaluation.\n\nRECOMMENDATION(S): Probable 1.8 cm arachnoid cyst in the right middle cranial\nfossa. Recommend clinical correlation. If clinically indicated, brain MRI\nmay be obtained for further evaluation." + }, + { + "input": "No intra or extra-axial hemorrhage, mass effect, or shift of normally midline\nstructures. No CT evidence for acute, major vascular territorial infarction. \nMild prominence of the ventricles, sulci, and cisterns appears proportional.\n\nFatty involution of both parotid glands. Paranasal sinuses and mastoid air\ncells are well aerated.", + "output": "No acute intracranial pathology or significant change." + }, + { + "input": "The paranasal sinuses are normally aerated, with no mucosal thickening or\nair-fluid levels identified. The ostiomeatal units are patent. The cribriform\nplates are intact. There is no nasal septal defect. The nasal septum is\nmidline. The lamina papyracea are intact.", + "output": "1. No evidence of sinusitis." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect.\n\nThe thyroid gland is not visualized. There is fatty atrophy of the parotid\nglands bilaterally, right more than left. The submandibular glands are in\nnormal limits. There is no evidence of lymphadenopathy by CT criteria. The\nneck vessels are patent.\n\nThe imaged portion of the lung apices demonstrate subtle ground-glass\nopacities bilaterally (for example image 62, series 4) and mild interstitial\nopacities with mild atelectasis on the left, partially evaluated in this exam\nand apparently new since the prior CT of the chest dated ___, if\nclinically warranted, correlation with dedicated CT of the chest is advised. \nThere are no osseous lesions. The visualized paranasal sinuses and mastoid\nair cells are clear.", + "output": "There is no evidence of fluid collection or lymphadenopathy.\n\nRECOMMENDATION(S): Imaged portion of the lung apices demonstrates subtle\nground-glass opacities bilaterally, and mild atelectasis on the left,\npartially evaluated in this exam, if clinically warranted, correlation with\ndedicated CT of the chest is recommended." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are enlarged consistent with global parenchymal volume\nloss, slightly more pronounced in the temporal lobes bilaterally when compared\nto prior. Periventricular white matter hypodensities are again seen likely\nreflective of chronic microvascular ischemic change.\n\nNo osseous abnormalities seen. There mucosal thickening of the right frontal\nsinus, numerous ethmoid air cells and sphenoid sinuses. Air-fluid levels in\nboth maxillary sinuses are present. The mastoid air cells, and middle ear\ncavities are clear. The orbits are notable for lens replacements bilaterally..", + "output": "No acute intracranial abnormality.\n\nMarked parenchymal volume loss, slightly more prominent within the temporal\nlobes bilaterally when compared to prior.\n\nAir-fluid levels in both maxillary sinuses. Correlate clinically for acute\nsinusitis." + }, + { + "input": "There is no evidence of intracranial hemorrhage. There is no mass effect or\nshift of the normally midline structures. The ventricles, cisterns and sulci\nare enlarged consistent with atrophy, particularly prominent along medial\ntemporal lobes. Atrophy is moderate to severe. Periventricular white matter\nhypodensity in each cerebral hemisphere is mild and most suggestive of chronic\nsmall vessel ischemia. Surrounding soft tissue structures are unremarkable. \nNo fracture is identified. The visualized paranasal sinuses show moderate\nopacifications of ethmoid air cells, greater on the left than right, but\nmastoid air cells appear clear.", + "output": "No evidence of acute intracranial process or injury. Moderate to severe\natrophic changes. Moderate ethmoid sinus opacification suggesting\ninflammatory paranasal sinus disease." + }, + { + "input": "The mixed density left subdural hematoma has only slightly decreased in size.\nPreviously noted hyperdense foci within the collection have minimally\ndecreased in density. No definite new blood products is seen. Mild left sulcal\neffacement is unchanged. There is no shift of midline structures and no\nventricular effacement. There is no evidence for parenchymal edema or acute\nmajor vascular territorial infarction. Foci of low density are again seen in\nthe periventricular, deep, and subcortical white matter of the cerebral\nhemispheres, likely sequela of chronic small vessel ischemic disease in a\npatient of this age. Basal cisterns are normal in size. Internal carotid and\nvertebral artery calcifications are again noted.\n\nThere is no evidence for a fracture. The imaged paranasal sinuses are well\naerated. The mastoids are underpneumatized.", + "output": "The mixed-density left subdural hematoma has only slightly decreased in size,\nand its hyperdense components have slightly decreased in density. No evidence\nfor new blood products." + }, + { + "input": "There is asymmetric hyperdensity along the left frontal gyri, felt to most\nlikely represent artifact. There is no acute large vascular territory\ninfarct. There is no mass effect. The basal cisterns are patent.\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Periventricular and subcortical hypodensities are consistent with\nsmall vessel ischemic disease.\nThere is no evidence of fracture. 2 small hyperostosis measuring 5 mm are\nseen in the left frontal calvarium. There is a large scalp hematoma and\nlaceration overlying the left frontoparietal bone. The visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nThe visualized portion of the orbits are unremarkable. Bilateral carotid\nsiphon calcifications are seen.", + "output": "1. Asymmetric hyperdensity along anterior left frontal gyri, likely\nrepresenting an artifact. No acute large vascular territorial infarct. No\nmass effect.\n2. No acute fracture. Large scalp hematoma and laceration over the left\nfrontoparietal bone.\n3. Age-related atrophy and sequela of chronic small vessel ischemic disease.\n\nNOTIFICATION: The update wetread was discussed by Dr. ___ with Dr.\n___ on the ___ ___ at 11:34 AM." + }, + { + "input": "Subtle focal hyperdensity over the anterior left frontal lobe, is non\nanatomic, and felt to be artifactual (series 2, image 13). The ventricles and\nsulci are enlarged suggesting age related atrophy. Extensive periventricular\nand subcortical white matter hypodensities are nonspecific but likely sequela\nof chronic small vessel disease. There is no large territorial infarction. \nThere is no mass effect.\n\nA large soft tissue hematoma overlying the left parietal vertex has minimally\nincreased compared to prior. There is no acute fracture. The paranasal\nsinuses and mastoid air cells are clear. The patient has had bilateral lens\nreplacements. Orbits are otherwise unremarkable. There are calcifications in\nthe bilateral carotid siphons.", + "output": "1. Subtle focal hyperdensity overlying the anterior left frontal lobe, is non\nanatomic and felt to be artifactual. No definite evidence of acute\nintracranial hemorrhage.\n2. Minimal increase in size of large left posterior scalp hematoma." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nModerate size right posterosuperior subgaleal hematoma, without calvarial\nfracture. No osseous abnormalities seen. The paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The orbits are unremarkable.", + "output": "Moderate-sized right posterior subgaleal hematoma without acute calvarial\nfracture.\nNo acute intracranial hemorrhage." + }, + { + "input": "Left frontal encephalomalacia is appreciated, likely sequela of prior\ninfarction. There is no evidence of acute, large territorial\ninfarctionhemorrhage,edema,or mass effect. Ventricles and sulci are\nprominent, consistent with age-related global parenchymal loss. \nPeriventricular, subcortical, and deep white matter hypodensities are\nnonspecific, but likely represent sequela of chronic microvascular ischemic\ndisease.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nbilateral sphenoid and left maxillary sinuses as well as an air-fluid level in\nthe right sphenoid sinus. There is mild mucosal thickening of the ethmoid air\ncells, with inspissated secretions seen in the right posterior ethmoid air\ncells. The visualized portion of the remaining paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. Left frontal lobe encephalomalacia compatible with remote infarction.\n2. No intracranial hemorrhage or mass effect.\n3. Global parenchymal volume loss and likely sequela of chronic microvascular\nischemic disease.\n4. Paranasal sinus disease, as above. Inspissated secretions in the right\nposterior ethmoid air cells and air-fluid level in the right sphenoid sinus\nmay suggest a component of acute sinusitis." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\n\nThere is right periorbital soft tissue swelling without underlying fracture. \nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process. Right periorbital soft tissue swelling without\nunderlying fracture or acute intracranial hemorrhage." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. There is mild global atrophy, advanced for age, as seen\npreviously.\n\nThere is partial opacification of the bilateral ethmoid air cells and minimal\nmucosal thickening of the right sphenoid sinus and both maxillary sinuses.\nMastoid air cells and middle ear cavities are well aerated. The bony calvarium\nis intact. There are minimal atherosclerotic calcifications of bilateral\ncarotid siphons. Sclerotic focus in the right frontal bone may reflect a bone\nisland.", + "output": "1. No intracranial hemorrhage or other acute intracranial abnormality. Please\nnote that MRI is more sensitive for detection of intracranial mass.\n2. Mild global atrophy, advanced for age." + }, + { + "input": "There is no evidence of territorial infarction,acute intracranial\nhemorrhage,edema,or discrete mass. Prominence of the sulci reflect age\nadvanced involutional change. Ventricles are normal in size.\n\nLeft periorbital and maxillary soft tissue swelling with small hematoma.\n\nFracture involving the anterior wall of the left external auditory canal again\nnoted. Right orbital floor fracture is better assessed on concurrently\nperformed facial bone CT exam. Fluid is seen within the left external\nauditory canal. The visualized portion of the paranasal sinuses the most\nextensive opacification of the ethmoid air cells and maxillary sinuses\nbilaterally. Mastoid air cells and right auditory canal are grossly clear. \nThe visualized portion of the orbits are unremarkable.", + "output": "1. No intracranial hemorrhage.\n2. Fracture involving the anterior wall of the left external auditory canal\nwith opacification of the left external auditory canal.\n3. Partially visualized right orbital floor fracture, please refer to\nconcurrently performed facial bone CT for further details.\n4. Age advanced involutional changes." + }, + { + "input": "Left : As seen on prior maxillofacial CT, there is an acute mildly displaced\nfracture of left temporal bone at the posterior mandibular fossa with 2 mm of\ndistraction and posterolateral displacement of the lateral fragment extension\ninto the osseous external auditory canal (series 4, image 146; series 305,\nimage 87). Opacification of the left external auditory canal with high\nattenuation material and punctate hyperdensities suggests osseous fragments\nand hematocrit. Fracture through the left styloid process also noted. The\nmiddle ear cavity is clear. The ossicles and tegmen are intact. There is no\nevidence for enlarged vestibular aqueduct or superior semicircular canal\ndehiscence. The facial nerve follows a normal course through the middle ear.\nThere is no evidence for inner ear dysplasia. The mastoids are clear.\n\nRight: The external auditory canal is normal. The middle ear cavity is clear.\nThe ossicles and tegmen are intact. There is no evidence for enlarged\nvestibular aqueduct or superior semicircular canal dehiscence. The facial\nnerve follows a normal course through the middle ear. There is no evidence for\ninner ear dysplasia. The mastoids are clear.\n\nOther: Visualized brain is normal.", + "output": "1. Acute mildly displaced fracture of left temporal bone at the posterior\nmandibular fossa with 2 mm of distraction and posterolateral displacement of\nthe lateral fragment extension into the osseous external auditory canal. \nThere is also a likely acute fracture through the left styloid process.\n2. Opacification of the left external auditory canal with high attenuation\nmaterial and punctate hyperdensities suggests osseous fragments and\nhematocrit.\n3. Left middle ear is clear; ossicles, otic capsule, andtegmen are intact.\n4. No additional fractures identified.\n5. Normal CT of the right temporal bone." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nLeft temporal bone fracture, posterior mandibular fossa, is again seen and\nremains distracted by 2 mm with posterolateral displacement of the lateral\nfragment into the osseous external auditory canal.\n\nThere is fluid in the left maxillary sinus, a possible fluid level in the\nright maxillary sinus and mucosal thickening in bilateral maxillary sinuses\nand ethmoidal cells. Mastoid air cells, and middle ear cavities are clear. \nThe visualized portion of the orbits are unremarkable.", + "output": "Unchanged left temporal bone fracture with stable 2 mm destruction and\nposterolateral displacement of the lateral fragment.\nExtensive paranasal sinus inflammatory changes no new intracranial findings." + }, + { + "input": "Evaluation is limited due to marked artifact due to dental hardware and\ncervical spine hardware.\n\nEvaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions. Anterior fixation hardware\nis noted at the C3-7 levels. There is a mucous retention cyst in the right\nmaxillary sinus.", + "output": "Marked artifact due to dental hardware and cervical spine hardware, limiting\nevaluation. Within these limitations, no evidence of abscess." + }, + { + "input": "HEAD CT: There is increased hypodensity of the large right MCA distribution\ninfarct with increased edema, more pronounced sulcal effacement, compression\nof the right lateral and third ventricles, and 6 mm leftward shift of normally\nmidline structures (previously 3 mm). There is no evidence of acute\nintracranial hemorrhage. Areas of cystic encephalomalacia in the left\nfrontoparietal and left cerebellar hemisphere are unchanged, compatible with\nold infarcts. There is mild effacement of the right suprasellar cistern.\nOtherwise, the basal cisterns remain patent. A dense right middle cerebral\nartery is re- demonstrated. Calcification of the bilateral carotid siphons is\nnoted. The orbits and globes are unremarkable. There is mild mucosal\nthickening of the right maxillary sinus and ethmoid air cells. The remainder\nof the imaged paranasal sinuses, middle ear cavities and mastoid air cells are\nclear bilaterally. The bony calvaria appear intact.", + "output": "1. Evolving subacute extensive right MCA territory infarct with increased\nedema, more pronounced effacement of the ventricles and sulci, and increased\nmass effect with 6 mm leftward shift of normally midline structures.\n\n2. No evidence of downward herniation.\n\n3. No evidence of hemorrhagic conversion.\n\nNOTE ADDED IN ATTENDING REVIEW: There is evidence of early central\nherniation, with slight deformity of the right lateral aspect of the\nsuprasellar cistern and effacement of the right crural cistern with mass\neffect upon the ipsilateral cerebral peduncle of the midbrain, more marked\nsince the original \"___ \" CT obtained some 26 hr earlier." + }, + { + "input": "There is increased edema throughout the right hemisphere with sparing of the\nmedial subdural and frontal lobes. Edema extends into the typcial right ACA\nterritory at the vertex (2:25). The right MCA remains hyperdense, consistent\nwith thrombosis. Leftward subfalcine herniation herniation has worsened, now\nmeasuring 14 mm (previously 9 mm). The right lateral aspect of the suprasellar\nand right crural cisterns are even more effaced than on the study of ___. There is no evidence of hemorrhagic conversion.\n\nEncephalomalacia from left MCA infarction is unchanged. The orbits and globes\nare unremarkable. The imaged paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The bony calvaria appear intact.", + "output": "1. Evolving large right MCA infarction with extension into the right ACA\nterritory at the vertex, which may simply represent variant anatomy.\n2. Worsening right uncal herniation since NECT performed 16 hr earlier.\n3. No evidence of hemorrhagic conversion." + }, + { + "input": "CT HEAD:\nCentered within the anterior aspect of the right middle cranial fossa, there\nis a 1.6 x 1.1 cm hyperdense and partially calcified extra-axial dural-based\nmass demonstrating subsequent homogeneous enhancement on postcontrast\nsequences, and compatible with a meningioma. Mild local mass effect is noted.\nNo significant degree of parenchymal edema. No midline shift.\n\nThere is no evidence for vascular territorial infarction. No acute\nintracranial hemorrhage. The ventricles and sulci are normal in size and\nconfiguration. Periventricular and subcortical white matter hypodensities are\nnoted, a nonspecific finding that most likely represents the sequelae of\nchronic small vessel ischemic disease.\n\nMild mucosal thickening is seen throughout scattered ethmoid air cells. The\nright sphenoid sinus is underpneumatized. The remainder of the paranasal\nsinuses, middle ear cavities, and mastoid air cells are clear. Patient is\nstatus post bilateral lens replacement..\n\n\nCTA HEAD:\nDense calcifications are seen within the distal portions of the bilateral\nvertebral arteries, which remain patent. The basilar artery is patent. \nCalcifications are also noted in the left greater than right cavernous\ninternal carotid arteries, both of which remain patent.\n\nAllowing for this, the intracranial vasculature is grossly patent without\nhigh-grade stenosis, occlusion, or aneurysm greater than 3 mm. There is a\nfetal type origin of the left posterior cerebral artery, a normal variant. \nThe dural venous sinuses are patent.", + "output": "1. No evidence for acute intracranial hemorrhage or vascular territorial\ninfarction.\n2. 1.6 x 1.1 cm extra-axial enhancing partially calcified dural-based mass\nwithin the anterior aspect of the right middle cranial fossa, most compatible\nwith a meningioma.\n3. Patent intracranial vasculature without high-grade stenosis or aneurysm\ngreater than 3 mm." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is moderate opacification of the\nfrontal sinuses, anterior ethmoid air cells, similar to prior. There is mild\nmucosal thickening of the ethmoid sinuses, possible trace fluid, similar. The\nother visualized paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "Normal intracranial contents.\nParanasal sinus disease, similar." + }, + { + "input": "There is no intra or extra-axial mass effect acute hemorrhage or large\nterritory infarct. Previously seen subarachnoid hemorrhage within the right\nsylvian fissure is no longer identified. Sulci, ventricles and cisterns are\nwithin expected limits for the patient's age.\n\nThere is no acute osseous abnormality. Partial opacification of the frontal\nsinuses, with opacification of the bilateral frontal ethmoidal recesses and\nanterior ethmoid air cells is overall similar to prior examination. The\nremainder the visualized paranasal sinuses are clear. The orbits are\nunremarkable. The mastoid air cells and middle ears well pneumatized and\nclear.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nlarge territory infarct, intracranial hemorrhage.\n2. Paranasal sinus disease is overall similar to prior examination, with\npartial opacification of the frontal sinuses.." + }, + { + "input": "CT head: Redemonstrated is a large extra-axial dural-based enhancing mass\nwith calcifications, arising along the olfactory groove and planum\nsphenoidale,eccentric to the right, which measures approximately 6.2 AP by 5.4\nTV by 4.8 SI cm. There is significant surrounding parenchymal vasogenic edema.\nThere is local mass effect with effacement of sulci, mass effect upon the\nfrontal horn of the right lateral ventricle, and approximately 1.0 cm leftward\nmidline shift. There is associated focal right hyperostosis of the planum\nsphenoidale.\n\nThere is no evidence of acute intracranial hemorrhage or extra-axial fluid\ncollection. The paranasal sinuses and mastoid air cells are clear. Again noted\nis right frontal scalp soft tissue swelling. There is no fracture.\n\nCTA head: There are blood vessels extending from theplanum sphenoidale into\nthe mass. It is not clear whether these are arteries or veins.\n\nThe intracranial internal carotid arteries are normal in configuration. The\nanterior and middle cerebral arteries are patent with normal contrast\nenhancement and branching pattern. The anterior cerebral arteries are\ndisplaced to the left secondary to the above described mass. There anterior\ncommunicating artery region appears unremarkable.\n\nThere is ___ termination to the right vertebral artery. There is fetal origin\nof the bilateral posterior cerebral arteries. The vertebral, basilar, and\nsuperior cerebellar arteries otherwise demonstrate normal enhancement without\nstenosis or occlusion.\n\nThere is no evidence of stenosis, occlusion, aneurysm, or arteriovenous\nmalformation.", + "output": "Large right frontal extra-axial mass, consistent with a meningioma, arising\nalong the olfactory groove and planum sphenoidale, with local mass effect as\ndetailed above. No evidence of internal carotid or intracranial vertebral\nblood supply to the mass. Blood vessels (external carotid arterial branches\nand/or veins) extending from the planum sphenoidale into the mass are not\nadequately assessed. They may be better assessed by a conventional cerebral\nangiogram, if clinically warranted." + }, + { + "input": "Patient is status post right periorbital craniotomy and resection of a right\nplanum sphenoidale meningioma. There is re- demonstration of postoperative\npneumobilia. Centered within the surgical bed, there has been stepwise\nincrease in hemorrhage with total ___ now measuring roughly 4.9 x 4.7\nby 3.4 cm. This hemorrhage likely has both a intraparenchymal and extra-axial\ncomponent. There is also an increased of right frontal subdural hemorrhage\nmeasuring roughly 11 mm in maximal thickness. Additionally there has also been\nincrease of the prominent right subgaleal scalp hematoma. These have all\nintervally increased in size compared to the CTA from ___ in the MR from\n___. There is associated increased localized mass effect now with up to\n1.8 cm of leftward midline shift anteriorly, previously 13 mm. Additionally,\nthere is increased mass effect on the frontal horns of the lateral ventricles.\nThere is now a small component of intraventricular hemorrhage seen layering\nwithin the occipital horn of the right lateral ventricle. A small amount of\nsubarachnoid blood is seen within the bifrontal sulci, likely redistribution. \nExtensive associated vasogenic edema is roughly similar.\n\nThe basal cisterns appear expanded. There is no loss of gray-white matter\ndifferentiation. There is no definite infarct. The ventricles are mostly\nunchanged in size and configuration. There is re- demonstration of a\npostoperative opacification of the right frontal sinus and right anterior\nethmoid air cells. There is minimal mucosal thickening in the right sphenoid\nair cell. There is opacification of a few of the right mastoid air cells. The\nmiddle ear cavities are clear.", + "output": "Increasing hemorrhage within the surgical bed, right subdural space as well as\nthe prominent right scalp hemorrhage as above since both CT from ___ and\nMR from ___. There is now component of hemorrhage within the occipital\nhorn of the right lateral ventricle likely representing redistribution. There\nis associated increased localized mass effect with a prominent local leftward\nshift of midline structures. No definite infarct.\n\nNOTIFICATION: The findings were discussed by ___ with ___\non the telephone on ___ at 18:00, 5 minutes after discovery of the\nfindings." + }, + { + "input": "There are post-operative changes of prior right frontal and periorbital\ncraniotomy and resection of right planum sphenoidale meningioma with\nassociated post-operative pneumocephalus.\n\nWhen compared to prior study, there has been slight interval increase in size\nof inferior frontal right parenchymal hematoma with areas of new hyperdensity\ncompatible with evolution of and/or ongoing hemorrhage with increased\nvasogenic edema. There is slightly increased volume of subdural hemorrhage/\nfluid subjacent to the right frontal craniotomy site. Leftward midline shift\nhas also slightly increased. Intraventricular hemorrhage layering within the\nposterior horn of the right lateral ventricle appears unchanged.\n\nThe ventricular size appears stable. There is no evidence of new ischemia or\nmajor territorial infarct.\n\nProminent right-sided scalp subgaleal hematoma is unchanged.\n\nThe orbits, skull base, and remaining calvaria appear otherwise unremarkable.\n\nThere is no evidence of vascular malformation or aneurysm within the\nintracranial vasculature. There is focal narrowing of the bilateral proximal\nA2 segments of both ACAs, raising concern for circumferential mass effect from\nsurrounding hematoma/edema and/or focal vasospasm. There is no evidence of\narterial contrast extravasation. The distal intracranial arterial branches\nmaintain normal caliber and contour without evidence of diffuse intracranial\nvasospasm.", + "output": "1. Slight interval increase in size of inferior right frontal parenchymal\nhematoma with associated subdural blood products, mass effect, and vasogenic\nedema.\n2. Focal narrowing of the proximal A2 segments of both ACAs, concerning for\ncircumferential mass effect from surrounding hematoma/edema versus focal\nvasospasm.\n3. No evidence of arterial contrast extravasation or diffuse intracranial\nvasospasm." + }, + { + "input": "Patient is status post right frontal craniotomy and cranioplasty with\npostoperative pneumocephalus. Redemonstrated is a large right inferior frontal\nintraparenchymal hemorrhage and surrounding vasogenic edema. Although an\naccurate comparison is difficult, the hyperdense component of this hemorrhage\nmeasures 5.9 x 5.7 cm in maximum dimension (trv x ap, 2a:10), previously 5.3 x\n5.4 cm. Hyperdense subdural collection along the craniotomy margin is stable\nin maximum thickness. Mass effect on the right lateral ventricle and shift of\nnormally midline structures to the left is relatively unchanged. Hemorrhage\nlayering in the occipital horn of the right lateral ventricle appears stable.\nSubarachnoid blood in the frontal sulci is also stable. Basal cisterns remain\npatent. No new foci of hemorrhage identified.\n\nPartially imaged paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. Subcutaneous edema and hematoma overlying the craniotomy is noted.", + "output": "1. Slight interval increase in the size of large right inferior frontal lobe\nintraparenchymal hemorrhage. Right subdural and subarachnoid hemorrhages are\nrelatively unchanged. Mass effect on the right lateral ventricle and shift of\nnormally midline structures to the left appears stable. Post-operative changes\nand extensive soft-tissue swelling." + }, + { + "input": "When compared to most recent head CT, there has been no significant change in\nthe large right inferior frontal parenchymal hematoma with associated mass\neffect, leftward midline shift, and surrounding vasogenic edema. Subdural\nblood products and pneumocephalus adjacent to right periorbital craniotomy are\nunchanged. Volume of intraventricular extension of hemorrhage, greater within\nthe posterior horn of the right lateral ventricle, is not significantly\nchanged. Large right subgaleal scalp hematoma is similar in size when\ncompared to prior exam.\n\nThere is no evidence of new ischemia or new areas of hemorrhage. The\nventricular size is stable.\n\nEvaluation of the intracranial vasculature demonstrates no evidence of\naneurysm or vascular malformation. Previously described focal segmental areas\nof narrowing within proximal A2 segments now appear improved on the left\nthough persistent on the right. Again, this finding may represent\ncircumferential mass effect from edema and/or hematoma or focal vasospasm.\nThere is no evidence of a diffuse arterial vasospasm. There is no evidence of\ncontrast extravasation.", + "output": "1. No significant change in large inferior right frontal parenchymal hematoma\nwith associated mass effect, leftward midline shift, and vasogenic edema.\n2. Decreased narrowing of proximal A2 segment of the left with persistent\nnarrowing of proximal A2 segment of the right ACA, possibly related to local\nmass effect from adjacent hematoma and/or edema, or to focal vasospasm.\n3. No evidence of diffuse intracranial vasospasm or contrast extravasation." + }, + { + "input": "Right frontal/ parietal craniotomy with overlying scalp changes is again seen.\nHyperdense extra-axial right frontal collection deep to the craniotomy, with\nfoci of air, has slightly decreased in size. Blood products in the right\nfrontal surgical bed have also slightly decreased in extent and density.\nSevere leftward shift of midline structures appear is decreased by\napproximately 2 mm. Effacement of the frontal horns and anterior bodies of the\nlateral ventricles persist. Blood in the occipital horns of the lateral\nventricles persists. Vasogenic edema in the right frontal lobe, internal and\nexternal capsules, and in the left frontal lobe, persists without significant\ninterval change. Subarachnoid hemorrhage in multiple cerebral sulci has\ndecreased in density. There is no uncal herniation.\n\nSmall amount of fluid in bilateral dependent mastoid air cells is likely\nrelated to prolonged supine positioning. A defect in the right medial orbital\nwall is again noted new compared to presurgical imaging, likely related to the\ninterim resection.", + "output": "1. Slightly decreased extra-axial hematoma deep to the right craniotomy.\nMinimally decreased large right frontal parenchymal hemorrhage in the surgical\nbed. Expected evolution of subarachnoid hemorrhage. Stable intraventricular\nhemorrhage.\n2. Persistent significant, minimally decreased leftward shift of anterior\nmidline structures. Unchanged vasogenic edema in the frontal lobes, right\ngreater than left, and right deep white matter." + }, + { + "input": "NECT Head: There is no change in the size of frontal hematoma or surrounding\nedema. There is no change in mass effect is or shift of midline structures.\nThere is no change in the right frontal subdural hematoma and there is re-\ndemonstrated pneumocephalus.\n\nCTA H+N: There is no change in the caliber or displacement of the anterior\ncerebral arteries. There is no change in the caliber of the MCAs. There is no\nevidence of large vessel occlusion, dissection, or aneurysm > 3 mm. The PCAs\nare fetal with a small basilar artery unchanged from the previous examination.\nThe carotid and vertebral arteries and their major branches are patent with no\nevidence of stenoses.", + "output": "1. No change in the size of the right frontal hematoma, right subdural\nhematoma, or midline shift of structures.\n2. There is no change in slightly reduced caliber of the anterior cerebral\narteries or middle cerebral arteries.\n3. No new areas of hemorrhage or large areas of infarction are identified. No\naneurysm greater than 3 mm or a focal area of stenosis present." + }, + { + "input": "In comparison the previous examination, there is no change in the right\nfrontal subgaleal hematoma. There is no change in the large frontal\nintraparenchymal hemorrhage, associated edema, midline shift, intraventricular\nblood or associated mass effect. There is no change in the right frontal\nsubdural hemorrhage. There is expected evolution of subarachnoid hemorrhage.\nThere is no evidence of new hemorrhage.\n\nThe basal cisterns appear patent. There is a right frontal craniotomy. The\nvisualized paranasal sinuses, mastoid air cells and middle ear cavities are\nclear.", + "output": "1.No change in large right frontal intraparenchymal hemorrhage, midline shift,\nintraventricular blood, in right frontal subdural hemorrhage.\n\n2.Expected evolution of subarachnoid hemorrhage.\n\n3. In comparison to the previous study, No evidence of new hemorrhage or\ninfarction\n\nNOTIFICATION: Findings were communicated to ___ by Dr. ___\nat 1050 by phone on ___" + }, + { + "input": "CT head: In comparison to previous examination there is no change in the\nright frontal subgaleal hematoma. Patient status post craniotomy. There is no\nchange in large frontal intraparenchymal hemorrhage, associated edema, midline\nshift, interventricular blood or associated mass effect. There is no change in\nthe right frontal subdural hematoma. Expected evolution of subarachnoid\nhemorrhage. There is no evidence of new hemorrhage.\n\nCTA head: The intracranial internal carotid arteries are normal in\nconfiguration. There is displacement of the anterior cerebral arteries due to\ncompression by a mass effect. The middle cerebral arteries are patent with\nnormal contrast enhancement and branching pattern. The PCAs are fetal with a\nsmall basilar artery. The posterior communicating arteries are visualized.\n\nThere is no evidence of stenosis, occlusion, aneurysm, or arteriovenous\nmalformation. There is no change in caliber that would suggest vasospasm.", + "output": "1. Re- demonstration of unchanged large frontal intraparenchymal hemorrhage,\nright frontal subdural hematoma, evolution of subarachnoid hemorrhage.\n\n2. There is displacement of the anterior cerebral arteries due to compression\nby a mass effect.\n\n3. There is no change in caliber of the intracranial blood vessels that would\nsuggest vasospasm." + }, + { + "input": "Noncontrast CT head: The large right frontal parenchymal hemorrhage with\nassociated edema is not significantly changed in size or appearance from the\nprior exam. Mass effect with 6 mm of leftward midline shift is unchanged.\nSplaying of the frontal horns and mass effect on the ventricles are unchanged.\nLayering hemorrhage in the occipital horns is unchanged. The right frontal\nextra-axial hemorrhage is stable. No new intracranial hemorrhage is\nidentified. There is persistent mild pneumocephalus, unchanged.\nAgain noted are postsurgical changes of right frontal craniotomy. Right scalp\nswelling and subcutaneous gas are unchanged.\n\nCTA head: The intracranial vertebral arteries are patent. The basilar artery\nis patent. The internal carotid arteries are patent. There is diminutive\ncaliber of the right M1 relative to the left, new from preoperative CTA on ___ but unchanged from the most recent postoperative CTA on ___. Similarly, the right A1 and A2 segments are smaller than on preoperative\nCTA but are unchanged from recent postoperative CTA on ___.", + "output": "1. Stable CTA head compared to prior ___ with areas of vasospasm\nremaining present in the right ACA and right MCA territories, unchanged.\n2. Stable right frontal parenchymal hematoma, surrounding edema, and mass\neffect. Leftward midline shift of 6 mm is unchanged. Other areas of\nintracranial hemorrhage are also stable.\n3. Large right scalp soft tissue swelling." + }, + { + "input": "Patient is status post right frontal craniotomy. Again seen is the large\nright frontal parenchymal hemorrhage with associated edema. Mass effect and\nthe leftward midline shift is improved since ___. There is a partial\nresolution of the layering hemorrhage in the occipital horns. Small right\nparietooccipital subarchnoid hemorrhage is stable. No new intracranial\nhemorrhages is identified. There is no hydrocephalus. Visualized paranasal\nsinuses and mastoid air cells are clear. Right scalp soft tissue swelling is\nslightly improved.", + "output": "Improvement of right frontal parenchymal hemorrhage and associated edema since\n___." + }, + { + "input": "CT HEAD WITHOUT CONTRAST: The patient is status post right frontal craniotomy\nand resection of a midline meningioma. There is essentially unchanged\nappearance of large right frontal parenchymal hemorrhage with associated\nsurrounding edema, resulting in adjacent sulcal effacement and approximately\n1.5 cm leftward midline shift, which compresses the left frontal lobe\nresulting in vasogenic edema pattern. There is near complete if there is\nessentially complete effacement of the anterior horn and anterior body of the\nright lateral ventricle. Significant mass effect on the anterior horn of the\nleft lateral ventricle is also noted. The configuration of the ventricles are\nessentially unchanged from the prior exam. There remains a extra-axial\nhyperdense fluid collection overlying the right frontal lobe measuring\napproximately 8 mm in thickness, essentially unchanged in configuration and\nsize from the prior examination although there is interval resolution of\npreviously noted pneumocephalus. No evidence of new infarct or hemorrhage\nsince the prior exam.\n\nThere has been interval decrease in degree of previously described\nsubarachnoid hemorrhage is, most prominently noted in the posterior parietal\nlobes.\n\nThe paranasal sinuses are clear. The orbits are unremarkable. The mastoid air\ncells and middle ear cavities are well pneumatized and clear.\n\nRight frontal parietal subgaleal hematoma has decreased in size when compared\nto prior exam now measuring approximately 1.2 cm in thickness.\n\nCTA HEAD: The right A1 and proximal A2 segment remains narrowed in caliber and\ndemonstrates decreased contrast enhancement when compared to pre surgical CTA,\nconsistent with vasospasm. Conversely there is improvement in the degree of\nvasospasm of the bilateral M1 segments, distal right A2 and left A1 and A2\nsegments which demonstrates increased caliber and contrast enhancement when\ncompared to the immediate prior exam of ___, and comparable in size\ncompared to preoperative CTA. The vertebrobasilar system is diminutive and\nunchanged from prior exam of ___, with apparent fetal origins of the\nbilateral PCAs. Incidental note is made of a right vertebral ___ termination.", + "output": "1. Unchanged diminutive, irregular appearance of the A1 and proximal A2\nsegments of the right ACA, consistent with persistent vasospasm.\n2. Interval improvement in degree of vasospasm involving the remainder of the\nanterior circulation since the most recent CTA.\n3. Unchanged size of right frontal parenchymal hemorrhage with associated\nleftward midline shift and resulting effacement of the left frontal lobe and\nboth lateral ventricles. Interval resolution of previously noted postsurgical\npneumocephalus, and continued evolution of other postsurgical changes as\ndescribed above\n4. No evidence of new infarct or hemorrhage." + }, + { + "input": "The patient is status post right frontal craniotomy and resection of the\nmidline meningioma. There is evolution of a large right frontal parenchymal\nhemorrhage with surrounding edema, resulting in sulcal effacement and 8 mm of\nleftward shift of normally midline structures which is decreased from ___ when midline shift measured 1.5 cm. There is persistent compression of the\nanterior horn and anterior body of the right lateral ventricle, similar in\nappearance to the prior exam. Of note, the frontal horns of the lateral\nventricles appear slightly more prominent but this may be due to differences\nin patient positioning. The configuration of the ventricles is essentially\nunchanged. Additionally, an extra-axial fluid collection overlying the right\nfrontal lobe measuring approximately 7 mm in thickness is unchanged from the\nprior exam when it measured 8 mm and is consistent with stable subdural\nhemorrhage. There is a small focus of subarachnoid blood in the right\nparietal lobe, which is unchanged from the most recent prior exam. A small\nlocule of pneumocephalus is seen and not significantly changed. There is no\nevidence of new hemorrhage or territorial infarction.\n\n\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nPostsurgical changes are seen in the soft tissues adjacent to the craniotomy\nsite.", + "output": "The frontal horns of the lateral ventricles appear slightly more prominent as\ncompared to the prior head CT.\n\nNo significant change of a right frontal parenchymal hemorrhage with adjacent\nedema. There is persistent leftward midline shift with effacement of sulci in\nright frontal lobe right frontal subdural hemorrhage is unchanged from the\nprior exam.\n\nSmall focus of subarachnoid blood in the right parietal lobe is unchanged from\nthe most recent prior exam.\n\nNo evidence of new hemorrhage." + }, + { + "input": "Right craniotomy is again seen. Underlying extra-axial collection has\ndecreased in density compared to the ___ CT. It measures 9 mm from\nthe inner table on images 2:12 and 601b:20, compared to 8 mm on the ___ CT and 12 mm on the ___ MRI.\n\nHyperostosis of the right planum sphenoidale is again seen. Low to\nintermediate density extra-axial collection along the right planum\nsphenoidale, consistent with a chronic hematoma, has decreased in size\ncompared to the ___ CT and the ___ MRI. Extensive confluent\nwhite matter hypodensity remains present in the frontal lobes, greater on the\nright than left, similar to prior exams and compatible with a combination of\nvasogenic edema and gliosis. There is a minimal residual leftward shift of the\ninferior anterior falx, improved compared to ___ and ___. Also again seen is a small area of encephalomalacia extending from the\nright frontal periventricular white matter into the external capsule. Ex vacuo\nenlargement of the frontal horn and anterior body of the right lateral\nventricle is again seen, superimposed upon diffuse moderate ventriculomegaly.\n\nSmall linear focus of hyperdensity in the hypodense right frontal white matter\non images ___ is slightly larger and denser compared to ___ and\n___.\n\nThere is mild mucosal thickening in the lateral right frontal sinus adjacent\nto the craniotomy. Other visualized paranasal sinuses are well aerated. There\nis a small amount of layering fluid in bilateral mastoid air cells.", + "output": "1. Extra-axial collection underlying the right frontal craniotomy is not\nsignificantly changed in size, but has decreased in density compared to ___, indicating expected evolution of blood products.\n2. Chronic hematoma along the right planum sphenoidale has slightly decreased\nin size compared to ___ and ___.\n3. Mild residual leftward shift of the inferior anterior falx, improved\ncompared to prior exams.\n4. Right greater than left frontal white matter hypodensity, compatible with a\ncombination of edema and gliosis, as well as small area of right frontal\nperiventricular encephalomalacia, are again seen. Linear hyperdensity within\nthe right frontal white matter abnormality has slightly increased in size in\ndensity compared to ___, and may represent acute blood products,\nversus increasing mineralization. Recommend short interim follow up.\n\nNOTIFICATION: The impression above was entered by Dr. ___ on\n___ at approximately 15:35 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." + }, + { + "input": "Changes related to prior right craniotomy are again seen. The underlying\nextra-axial collection continues to decrease in size now measuring\napproximately 3 mm from the inner table, compared to 9 mm on the prior study.\nExtensive confluent white matter hypodense foci in the frontal lobes greater\non the right than the left are unchanged compared to the prior study\ncompatible with a combination of vasogenic edema and gliosis. Ex vacuo\ndilatation of the frontal horn and anterior body of the right lateral\nventricle is unchanged superimposed on moderate ventriculomegaly. A linear\nfocus of hyperdensity in the right frontal white matter is unchanged,\nconsistent with mineralization given the persistent dense appearance. There is\nno shift of normally midline structures. The basal cisterns appear patent.\nNear total empty sella as before.\nA small amount of layering fluid is again seen in the bilateral mastoid air\ncells.\nThe visualized paranasal sinuses and middle ear cavities are clear. The globes\nare unremarkable.", + "output": "1. Interval decrease in size of extra-axial collection underlying the right\nfrontal craniotomy.\n2. Otherwise stable appearance of the head with postsurgical changes." + }, + { + "input": "No significant interval change. Right frontal craniotomy is identified.\nEncephalomalacia is seen in the right frontal region. Slight prominence of\nextra-axial spaces identified. Calcification is seen within the area of\nencephalomalacia and the extra-axial region. There is mild-to-moderate\nprominence of ventricles as before. There is no acute hemorrhage identified.", + "output": "No significant interval change in right frontal encephalomalacia and\npostoperative changes since the previous CT of ___. No acute\nabnormalities are seen." + }, + { + "input": "There is a 4 mm acute subdural hematoma along the inner table of the right\nfrontal bone. There is 2 mm leftward shift of midline structures. The\nventricles and sulci are normal in size and configuration. There is extensive\navulsion injury at multiple locations in the scalp. There is soft tissue\ninjury with subcutaneous emphysema and radiopaque debris posterior to the left\near. There is no fracture. The imaged paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear.", + "output": "1. 4 mm right frontal acute subdural hematoma with 2 mm leftward shift of\nmidline structures. No skull fracture.\n2. Extensive avulsion injuries of the scalp. Wound with extensive radiopaque\nforeign material posterior to the left ear." + }, + { + "input": "There has been the little change compared to the earlier same day examination.\nThere is re- demonstration of a 4 mm right frontal subdural hematoma with\nassociated mass effect, minimal effacement of the right lateral ventricle and\n2 mm leftward shift of midline structures. There is no new focus of\nhemorrhage. There is no evidence of edema or infarct. The basal cisterns\nremain patent and there is preservation of gray-white matter differentiation. \nThe ventricles are stable in size and configuration.\n\nThere is re- demonstration of extensive soft tissue scalp injuries with\navulsion of the forehead and prominent right periorbital swelling with\nscattered areas of the subgaleal hematoma. Radiodense opacities persist in the\nscalp likely representing foreign bodies. There is no associated fracture. \nThere is minimal mucosal wall thickening of the posterior ethmoid air cells as\nwell as the left maxillary sinus. The remainder the visualized paranasal\nsinuses, middle ear cavities and mastoid air cells are clear. The orbits are\nintact.", + "output": "1. 4 mm right frontal subdural hematoma with associated 2 mm leftward shift of\nmidline structures unchanged from 6 hours prior. No new focus of hemorrhage.\n2. Extensive soft tissue injuries of the scalp with the demonstration of\nradiodensities likely representing foreign bodies unchanged from and better\ncharacterized on prior facial CT." + }, + { + "input": "There has been no significant interval change compared to the prior exam in\nthe extent of a 3 mm right frontal subdural hematoma with minimal associated\nmass effect. No new focus of hemorrhage is identified. There is no evidence of\nedema or infarct. The basilar cisterns are patent and there is otherwise good\npreservation of gray-white matter differentiation. The ventricles are normal\nin size and configuration.\n\nSignificant re- demonstration of extensive soft tissue scalp injuries are seen\nwith avulsion of the forehead and prominent right periorbital swelling with\nscattered areas of subgaleal hematoma particularly along the bilateral\nfrontoparietal calvaria. Punctate radiodense foreign bodies in the scalp\npersists. No fracture is identified. There is moderate mucosal sinus\nthickening involving the maxillary sinuses, sphenoid sinuses, ethmoid sinuses\nand frontal sinuses. The mastoid air cells and middle ear cavities are clear.\nFluid is seen in the nasopharynx. The extent of sinus disease has increased\ncompared to the prior exam from ___.", + "output": "1. No significant interval change in the 3 mm right frontal subdural\nhematoma. No new focus of hemorrhage is identified.\n\n2. Extensive soft tissue injuries of the scalp with demonstration of subtle\nforeign bodies, unchanged compared to the prior exam." + }, + { + "input": "Study is limited due to head tilting.\n\nThin subdural hematoma in the right frontal lobe is again seen. There is\nminimal mass effect and persistent effacement of sulci, not increased compared\nto prior study. No new hemorrhagic lesions are identified.\n\nDrains within the soft tissues along the convexity are seen, new since the\nprior study.\n\nBony structures are grossly unchanged. There is stable opacification of the\nsphenoid sinus. Ethmoid sinuses are less opacified. Mastoid air cells are\nclear bilaterally.", + "output": "1. Stable right frontal subdural hematoma with unchanged minimal mass effect.\n2. The extent of sinus disease has decreased compared to prior exam.\n\nNOTIFICATION: Results communicated to Dr. ___ by Dr. ___ the\ntelephone at 10:13 on ___, 5 min after the findings were made." + }, + { + "input": "Diffuse bilateral subarachnoid hemorrhage is extensive and extends into the\nperimesencephalic and basilar cisterns. The intraventricular hemorrhage is\nseen in the 5 this acute subdural hematoma along the entire left calvarium\nmeasures up to 12 mm on axial images, immediately deep to the left calvarial\nfracture, probably similar to the prior exam (series 2, image 22). No\ndefinite epidural hematoma, but this is difficult to exclude. Associated 5 mm\nright shift of normally midline structures is also relatively similar. \nPartial effacement of the left lateral ventricle, particularly the anterior\nhorn is also overall unchanged. Areas of small subdural hematoma along the\nleft posterior and anterior falx measure up to 4 mm in short axis, probably\noverall similar when accounting for redistribution (e.g. Series 2, image 26).\nA right subdural hematoma along the frontal parietal and temporal regions\nmeasures up to 7 mm in short axis, slightly increased from the prior exam\n(series 2, image 19). Partial effacement of the right ventricle has slightly\nincreased.\n\nGray-white matter differentiation throughout is indistinct with diffuse\nhypoattenuation of the entire brain, most likely from extensive edema in the\nsetting of trauma and extensive intracranial hemorrhage. There is probable\nuncal herniation, difficult to evaluate.\n\nBilateral mildly displaced calvarial parietal fractures extend to the vertex\nwhere they are contiguous. Large bilateral subgaleal hematomas measuring up\nto 15 mm on axial images overlying these fractures are larger (series 2, image\n23). There is also diastasis of the posterior aspect of the sagittal suture\nsecondary to associated posterior calvarial (occipital left) fracture. As a\nresult of the fractures, the vertex of the calvarium is slightly displaced\ninferiorly relative to the lateral calvarium (series 601, image 58).\n\nThe patient has been intubated in the interim. Small amount of fluid in the\nbilateral sphenoid sinuses and left maxillary sinus is unchanged. Some of the\nbilateral ethmoidal air cells are partially opacified. Fluid in secretions in\nthe oral nasopharynx and bilateral nostrils are likely related to intubation\nstatus. The mastoid air cells and middle ear cavities are clear.\n\nHyperdense blood in the posterior globes bilaterally have increased in the\ninterim (series 2, image 15). The globes appear to maintain a normal shape. \nThere is appearance of proptosis bilaterally. The retrobulbar fat appears\nclean without evidence of hematoma. The right lens has been replaced. The\nleft orbital nerve appears slightly larger compared to the right orbital nerve\non coronal images, nonspecific (series 601, image 23). The extraocular\nmuscles appear intact and there is no evidence to suggest orbital fracture.", + "output": "1. Extensive bilateral subarachnoid and subdural acute hematomas with\nsuggestion of interval increase in the right subdural hematoma. Similar 5 mm\nright shift of normally midline structures, partial effacement of the lateral\nventricles, and uncal herniation, probable downward herniation.\n2. Interval increase in bilateral subgaleal scalp hematomas overlying the\ncalvarial fractures.\n3. Extensive hypoattenuation of the brain parenchyma, consistent with diffuse\ncerebral edema, worse since the prior study.\n4. Bilateral parietal calvarial and posterior occiput fracture with slight\ninferior displacement of the separated fragment at the vertex.\n5. Bilateral proptosis with interval increase in bilateral posterior globe\nhemorrhage.\n\nNOTIFICATION: The findings, impression, and images were discussed with ___\n___, M.D. by ___, M.D. in person on ___ at 1853h , 1 minutes\nafter discovery of the findings." + }, + { + "input": "There is opacification of the right middle ear cavity and mastoid air cells,\nwith no evidence of temporal bone fracture. The ossicular chain is intact and\nwell-aligned. The tegmen is intact. The vestibular apparatus and aqueduct\nare unremarkable. The cochlea and semi circular canals are unremarkable,\nappropriate osseous covering. The tegmen is intact.", + "output": "1. No evidence of temporal bone fracture.\n2. Right middle ear and mastoid opacification." + }, + { + "input": "An intraventricular drain enters through a right frontal approach and the\ndistal tip terminates in the region of the third ventricle, unchanged in\nposition from the prior examination. The ventricles are slightly larger in\nsize. The patient is status post right craniotomy and a small collection of\nhemorrhage and air underlies the craniotomy site. A couple of punctate\nintraparenchymal hemorrhages are noted in the right frontal lobe at the\noperative site. An aneurysm clip is present within the region of the right\nposterior communicating artery origin. A new hypodensity is present within the\ninferior right caudate which likely represents a small infarct.", + "output": "1. Status post craniotomy for posterior communicating artery aneurysm clipping\nwith expected postoperative changes. A new hypodensity within the inferior\ncaudate likely represents infarct.\n2. The ventricles are slightly increased in size." + }, + { + "input": "Head CT: Unchanged subarachnoid hemorrhage identified in the left sylvian\nfissure. There is mild enlargement of the temporal ventricular horns, with no\nfrank evidence of transependymal migration of CSF. The soft tissues and bony\nstructures are unremarkable.\n\nCT of the head: There is a small 3 mm aneurysm in the right posterior cerebral\nartery (602:17) associated with the right fetal posterior cerebral 3,\ncorrelation with cerebral angiogram is advised.\n\nCT of the neck appears unremarkable with no evidence of flow stenotic lesions.", + "output": "1. Grossly unchanged right subarachnoid hemorrhage along the right sylvian\nfissure, without significant interval compared to prior exam.\n\n2. There is a 3 mm aneurysm at the proximal right MCA, posterior to the\nclinoid process as described above, note is made of a right fetal PCA,\ncorrelation with DSA is advised.\n\nNOTIFICATION: The findings were discussed by Dr. ___ With Dr. ___\non the telephone on ___ at the time of the the discovery." + }, + { + "input": "The patient is status post right frontal craniotomy with expected postsurgical\nchanges including subcutaneous air and pneumocephalus adjacent to the surgical\nsite. There is a new right frontal approach ventriculostomy catheter, which\nterminates in the third ventricle. A clip is noted in the area of the\nposterior communicating artery on the right. There is no evidence of new\nhemorrhage, edema, mass effect, or infarction. The ventricles and sulci are\nnormal in size and configuration. The basal cisterns appear patent and there\nis preservation of gray-white matter differentiation.\n\nNo fracture is identified. Mucosal thickening is seen in the ethmoid air\ncells, right sphenoid sinus, and bilateral maxillary sinuses. The mastoid air\ncells and middle ear cavities are clear. The globes are unremarkable.", + "output": "Expected postoperative appearance status post right frontal craniotomy with\nright frontal approach ventriculostomy catheter terminating in the third\nventricle. No evidence of new acute hemorrhage or infarct." + }, + { + "input": "Again, the patient is status post right frontal craniotomy with expected\npostsurgical changes including subcutaneous air pneumocephalus adjacent to the\nsurgical site. A right frontal approach ventriculostomy catheter is again\nseen terminating in the third ventricle and largely unchanged in appearance. \nThere is metallic streak artifact from a clip in the area of the posterior\ncommunicating artery on the right. The ventricles and sulci are unchanged in\nsize and configuration. There is no evidence of new hemorrhage, edema, mass\neffect or infarction. Basal cisterns appear patent and there is preservation\ngray-white matter differentiation. No acute fracture is identified.\n\nThe ethmoid air cells, sphenoid sinuses and bilateral maxillary sinuses are\nunchanged. The orbits are unremarkable.", + "output": "No evidence of new hemorrhage or infarction. No significant change from prior\nexamination." + }, + { + "input": "There is no evidence of fracture, hemorrhage, edema, shift of normally midline\nstructures, or infarction. Ventricles and sulci are normal in overall size and\nconfiguration. There is mild-to-moderate mucosal thickening of bilateral\nmaxillary sinuses and bilateral sphenoid sinuses. The remaining imaged\nparanasal sinuses are clear. Mastoid air cells and middle ear cavities are\nwell aerated. The bony calvarium is intact.", + "output": "Normal study." + }, + { + "input": "There is no evidence of acute large territory infarction,intracranial\nhemorrhageedema,or discrete mass. The ventricles and sulci are normal in size\nand configuration.\n\nAlong the left vertex, there is a 1.2 x 0.7 cm bony lesion arising from the\nouter table of the calvarium, suggestive of a benign osteoma. No evidence of\nacute fracture. The visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There periapical lucencies involving ___ teeth numbers 17, 18, and 22. \nAdjacent to the ___ 17 in 18 periapical lucencies, there is slightly\nincreased, asymmetric soft tissue density/fat stranding with an adjacent 2.1 x\n0.8 cm rim enhancing fluid collection (02:45) along the buccal side of the\nmandible. No erosive changes of the adjacent mandible.\n\nThe patient is intubated with the distal tip of the endotracheal tube located\nin the proximal right mainstem bronchus. A nasoenteric catheter is also\nnoted. There is substantial soft tissue swelling throughout the soft tissues\nadjacent to the cervical trachea and esophagus extending into the superior\nmediastinum. A drain is located just anterior to the cervical trachea at the\nlevel of T3. No discrete fluid collection is identified.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.\n\nThe right internal jugular and presumed right PICC catheters are noted.", + "output": "1. Periapical lucencies involving ___ teeth 17 and 18 demonstrate mild\nadjacent fat stranding and a 2.0 x 0.8 cm rim enhancing buccal fluid\ncollection consistent with a periodontal abscess.\n2. Fat stranding adjacent to the cervical trachea and esophagus are presumably\npostoperative in nature. No focal fluid collection." + }, + { + "input": "Study is somewhat limited by metallic streak artifact from the coil pack\nwithin the treated basilar artery aneurysm.\n\nThere is extensive subarachnoid hemorrhage throughout the sulci and basal\ncisterns; its evaluation is limited by intravascular contrast from the\npreceding cerebral angiogram. There is blood throughout the ventricular\nsystem, except for the frontal horn of the left lateral ventricle. The\nventricles are smaller than in ___. Right frontal approach EVD\nterminates in the region of the right foramen of ___. There is a 4.8 x 4.1\ncm parenchymal hematoma in the right frontal lobe along the course of the\nEVD. The anterior falx is slightly shifted to the left. Position of the\ncerebellar tonsils is suboptimally assessed.\n\nSmall amount of fluid in the left posterior ethmoid and partial left mastoid\nair cell opacification may be related to endotracheal intubation. Right\nmastoid is underpneumatized.", + "output": "1. Extensive subarachnoid hemorrhage. Evaluation of blood volume is limited by\nrecent intravascular contrast administration.\n2. Extensive intraventricular hemorrhage. Right frontal approach EVD\nterminates in the region of the right foramen of ___. The ventricles are\nslightly smaller than in ___.\n3. Large parenchyma hematoma in the right frontal lobe along the EVD catheter,\nwith mild leftward shift of the anterior falx.\n\nNOTIFICATION:\n___ was aware of these findings when contacted by Dr. ___\ntelephone on ___ at 7:29 ___, 2 minutes after discovery of the findings." + }, + { + "input": "Streak artifact from the coil pack in the treated basilar artery aneurysm\nlimits evaluation at adjacent levels.\n\nRight EVD has been removed. There is an unchanged large hematoma in the right\nfrontal lobe around the course of the prior EVD, with unchanged mild leftward\nshift of the anterior falx. New left frontal approach EVD terminates near the\nleft foramen of ___. There is extensive hemorrhage throughout the ventricles\nexcept for sparing of the left frontal horn, unchanged compared to several hr\nearlier. Ventricular size is also unchanged.\n\nExtensive subarachnoid hemorrhage is again seen in the sulci and basal\ncisterns. Compared to ___ head CT, CSF in the foramen magnum\nappears effaced, image 401b:43, highly suggestive of downward herniation of\nthe cerebellar tonsils.\n\nThere is increased fluid in the paranasal sinuses, posterior nasal cavity, and\nnasopharynx, as well as in left greater than right mastoid air cells, likely\nrelated to endotracheal intubation.", + "output": "1. New left frontal approach EVD terminates near the left foramen of ___.\nUnchanged extensive intraventricular hemorrhage. The ventricles are stable in\nsize compared to several hr earlier, though slightly smaller than in ___.\n2. Unchanged large hematoma in the right frontal lobe along the course of the\nprior right EVD, with unchanged mild leftward shift of the anterior falx.\n3. Unchanged extensive subarachnoid hemorrhage.\n4. Effacement of CSF in the foramen magnum compared to ___, highly\nsuggestive of downward herniation of the cerebellar tonsils." + }, + { + "input": "Streak artifact from the coil pack within the basilar artery aneurysm limits\nevaluation at adjacent levels. Extensive subarachnoid hemorrhage is again seen\nin the sulci and cisterns. Extensive intraventricular hemorrhage is also again\nseen. Frontal horns of the lateral ventricles are slightly smaller than on\n___. Other components of the ventricular system appear unchanged in\nsize. Left frontal approach ventriculostomy catheter terminates near the left\nforamen of ___, unchanged. Large right frontal parenchymal hematoma is again\nseen along the course of the prior right EVD. The hematoma appears less\nextensive than on ___, possibly due to surrounding contrast\nenhancement on the ___ CT scans, which were obtained soon after\ncerebral angiography. Mild leftward shift of the anterior falx is unchanged.\nThere is persistent downward herniation of the cerebellar tonsils compared to\n___.\n\nFluid is again seen in the paranasal sinuses, likely secondary to endotracheal\nintubation. Mastoid air cells are suboptimally assessed, but also appeared to\ncontain fluid levels bilaterally .", + "output": "1. Unchanged extensive subarachnoid and intraventricular hemorrhage.\n2. Frontal horns of lateral ventricles are slightly smaller than on ___, and the remainder the ventricular system is unchanged. Left EVD position\nunchanged.\n3. Large hematoma in the right frontal lobe at the site of the prior right EVD\nis stable, allowing for resolution of peripheral enhancement compared to the\nprior CTs which were obtained soon after cerebral angiography.\n4. Persistent downward herniation of the cerebellar tonsils compared to\n___." + }, + { + "input": "There is no significant interval change in right frontal intraparenchymal\nhematoma, intraventricular blood and subarachnoid hemorrhage since the\nprevious CT. Artifacts from coiling of basilar tip aneurysm again seen. Left\nfrontal ventricular drainage catheter is in the region of the left foramen of\n___ unchanged\n.", + "output": "Unchanged appearance of MPRAGE lung markings since the previous CT. There are\nno signs of loss of gray-white matter differentiation. ." + }, + { + "input": "There is no evidence of territorial infarction,acute hemorrhage,edema,or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The right maxillary sinus is partially\nopacified. Otherwise, the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable. A nasogastric tube is partially imaged.", + "output": "No fracture or acute intracranial process. Aerosolized secretions in the\nright maxillary sinus." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass effect.\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No acute intracranial abnormality on non-contrast CT head. Specifically\nno evidence of intracranial hemorrhage, fracture, or infarction." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinusesand mastoid air cells are clear. Material the bilateral external\nauditory canals likely corresponds to cerumen. The visualized portion of the\norbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nCTA HEAD:\nAs seen on prior MRA and CTA examinations, there is a lateral 4 x 2 mm\nsaccular outpouching of the cavernous portion of the left internal carotid\nartery (2:71). 1 mm inferior outpouching of the right A2 segment of the\nanterior cerebral artery, just distal to the anterior communicating artery is\nnoted, as seen on prior examinations (2:89).\n\nThe vessels of the circle of ___ and their principal intracranial branches\nappear patent with no evidence of significant stenosis, occlusion, or other\naneurysm. The dural venous sinuses are patent.\n\nA tiny mucous retention cyst is noted in the right maxillary sinus. The\nremainder the paranasal sinuses are clear. Soft tissue densities are noted\nwithin bilateral external auditory canals which may represent cerumen.", + "output": "1. Dental amalgam streak artifact limits study.\n2. 4 x 2 mm saccular outpouching of the cavernous portion of the left internal\ncarotid artery compatible with aneurysm seen on prior outside hospital\nexaminations.\n3. 1 mm inferior outpouching of the proximal A2 segment of the right anterior\ncerebral artery, just distal to the anterior communicating artery, likely\nrepresenting an infundibulum.\n4. Patent circle of ___ without definite stenosis or occlusion." + }, + { + "input": "Head CT: There is no evidence of acute hemorrhage, edema, masses, or mass\neffect. The ventricles and sulci are unchanged, and appear slightly prominent\nfor the patient's age, suggestive of mild atrophy, previously demonstrated by\nMRI. There is low attenuation in the periventricular and subcortical white\nmatter likely secondary to chronic small vessel ischemic disease. No\nfractures are identified. Calcification of the intracranial arterial\nvasculature is noted. The orbits are unremarkable. There is minimal mucosal\nthickening in the frontal sinuses, anterior ethmoid air cells, and right\nmaxillary sinus. The mastoid air cells are clear.\n\nHead CTA: There is a 6 mm fusiform aneurysm of the distal left vertebral\nartery/ proximal basilar artery (series 602b, image 44) and two approximately\n5 mm aneurysms of the mid basilar artery (series 602b, image 41). There is a\n5 mm aneurysm at the bifurcation of the right middle cerebral artery (series\n5, image 263) and a 4 mm aneurysm at the bifurcation of the left MCA (series\n5, image 254). There is mild irregularity with apparent beading of the left\ngreater than right posterior cerebral arteries, bilateral middle cerebral\narteries, and bilateral anterior cerebral arteries. There is also extensive\natherosclerotic calcification with irregularity and beading of the left\nvertebral artery and basilar artery. The left vertebral artery is dominant.\nThere is ___ termination of the right vertebral artery.\n\nNeck CTA: There is arthrosclerotic calcification of the aortic arch. There is\na normal three-vessel takeoff from the aortic arch. The carotid and vertebral\narteries and their major branches are patent with no evidence of stenoses. \nThere is mild calcified plaque at the bilateral carotid bifurcations without\nevidence of internal carotid stenosis by NASCET criteria. The distal right\ninternal carotid artery measures 4.8 mm. The distal left internal carotid\nartery measures 5.1 mm. There are several regions of punctate calcification\nalong the course of the left vertebral artery. There is a linear flap in the\nmid left vertebral artery which may represent a small focal dissection or\nulceration (series 5, image 142).\n\nThe lung apices are clear. The thyroid gland enhances normally. The salivary\nglands appear unremarkable. There are degenerative changes in the spine.", + "output": "1. Areas of low attenuation in the periventricular and subcortical white\nmatter likely secondary to chronic small vessel ischemic disease..\n\n2. Multiple subcentimeter aneurysms of the anterior and posterior circulation\nas detailed above. Irregularity with a beaded appearance of the intracranial\nvasculature is also noted as described in detailed above. This constellation\nof findings could be seen in the setting of arthrosclerotic disease but also\ncould be seen in the setting of vasculitis or fibromuscular dysplasia.\n\n3. Focal linear flap in the mid left vertebral artery which may represent a\nsmall focal dissection or small focal ulceration.\n\n4. No significant stenosis of the cervical internal carotid artery by NASCET\ncriteria." + }, + { + "input": "8.6 mm right supraclavicular lymph node measured 7.9 mm on the ___\nPET-CT, likely unchanged allowing for differences in technique and patient\nposition.\n5 mm left supraclavicular lymph node on image 4:38 is unchanged.\n7 mm oval right suboccipital nodule, possibly a lymph node, on image 4:17 is\nunchanged.\nNonenlarged bilateral level 2 and 3 lymph nodes do not appear significantly\nchanged compared to the prior PET-CT allowing for differences in technique.\nBilateral level 1B lymph nodes appear morphologically normal with preserved\nfatty hila, measuring 18 mm on the right on image 4:29 and 14 mm on the left\non image 04:27. Comparison to the prior PET-CT is substantially limited by\npositional differences for this level; these are either stable or only\nminimally larger.\n\nSubcutaneous nodule overlying the right trapezium on image 4:36 measures 7 mm\ncompared to 9 mm on the ___ PET-CT. It has been biopsied in the interim\non ___.\n\nThere is no evidence for an exophytic mucosal mass. Salivary glands and\nthyroid gland appear unremarkable.\n\nThere is moderate atherosclerotic plaque within the aortic arch, and within\nthe bilateral carotid bulbs. The suprahyoid and infrahyoid neck are otherwise\nunremarkable.\n\nNo suspicious bone lesions are seen. Uncovertebral and facet joint\nhypertrophy result in severe neural foraminal narrowing at multiple levels.\n\nThe left maxillary sinus is incompletely imaged, however the visualized lower\nportion is clear, improved from the ___ PET-CT (this improvement was\nalso seen on the ___ brain MRI). This exam is not technically\noptimized for evaluation of the included brain parenchyma; no concerning\nabnormalities are seen on limited assessment.\n\nPlease refer to the separate report for the concurrent ___ chest\nCT regarding pulmonary, mediastinal, and axillary findings.", + "output": "1. Comparison of cervical lymph nodes to the PET-CT from ___ is limited\nby differences in technique. There is minimal, if any, change in the 8-9 mm\nright supraclavicular lymph node and bilateral morphologically normal level 1B\nlymph nodes (mildly enlarged on the right, 18 mm). No significant change in\nthe nonenlarged left supraclavicular, bilateral level 2, and bilateral level 3\nlymph nodes.\n2. Stable 7 mm right suboccipital nodule, possibly a lymph node.\n3. 7 mm subcutaneous nodule overlying the right trapezium has decreased in\nsize since ___, status post interim percutaneous biopsy.\n4. Please refer to the separate report for the concurrent ___\nchest CT regarding pulmonary, mediastinal, and axillary findings." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nCervical lymph nodes appear fairly similar compared to prior:\nBilateral level 1 B lymph nodes (series 2, image 28 and 31) are not\npathological by size criteria and have a grossly preserved morphological\nappearance and appear similar compared to most recent imaging measuring 4 mm\nin diameter on the right and 2 mm in diameter on the left.\nRight level 5A lymph node (series 2, image 44) measures 8 mm in diameter,\nunchanged compared to prior as well as the left level 5 lymph node measuring 5\nmm in diameter (series 2, image 44) also unchanged compared to prior.\nNonenlarged left supraclavicular, and bilateral level 2 lymph nodes are\nunchanged.\n8 mm right sub occipital lymph node also appears fairly similar compared to\nprior imaging (series 2, image 25).\nNonenlarged left sub occipital lymph node is also essentially unchanged\n(series 2, image 22).\n3 mm nodule overlying the left trapezius (2, image 45) is unchanged. Soft\ntissue stranding in the posterior midline soft tissues at this level is also\nunchanged.\nSubcentimeter mediastinal lymph nodes appear fairly similar compared to prior\nimaging (there is possibly a slight decrease in size of the precarinal lymph\nnode currently measuring 8 mm in AP diameter, 9 mm previously).\n\nPreviously noted right supraclavicular FDG active lymph node not clearly\nvisualized on current examination (see 4:83; 03:50 on prior FDG PET-CT).\n\nFusiform aneurysmal dilatation of the ascending aorta measuring 40 mm in AP\ndiameter as well as dilatation of the left atrium and reference is made to the\nCT chest report of the same day. Mild moderate calcific atherosclerotic\nchanges of the aortic arch. Mild atherosclerotic changes of the carotid bulbs\nis noted. The thyroid gland and salivary glands are preserved. The paranasal\nsinuses are clear. The aerodigestive tract appears patent with no focal\nmasses. The imaged paranasal sinuses are clear. The mastoid air cells are\npneumatized.\n\nSpondylotic changes of the cervical spine is noted, with no definite focal\nosseous lesions, with at least mild vertebral canal narrowing at C3-4.", + "output": "1. Dental amalgam streak artifact limits study.\n2. There is no cervical adenopathy by size criteria.\n3. Scattered subcentimeter nonspecific lymph nodes throughout bilateral neck\nwithout definite enlargement by CT size criteria, grossly similar to ___ prior contrast neck CT. If concern for metastatic disease,\nconsider FDG PET-CT for further evaluation.\n4. Fusiform mild aneurysmal dilatation of the ascending aorta and dilatation\nof the left atrium again noted. Please see concurrently obtained chest CT for\ndescription of thoracic findings.\n5. Degenerative changes cervical spine with at least mild vertebral canal\nnarrowing C3-4. If clinically indicated, consider cervical spine MRI for\nfurther evaluation." + }, + { + "input": "A right suboccipital 8 x 10 mm (AP, SI; series 302, image 50; series 601,\nimage 53) lymph node, appears to have minimally increased in size since\nexamination of ___. Otherwise, there is no cervical\nlymphadenopathy by size criteria. New multifocal patchy foci of airspace\nconsolidation involving the visualized bilateral lung apices is better\nevaluated on concurrent CT chest. However, there does appear to be mildly\nincreased prominence of multiple mediastinal and paratracheal lymph nodes when\ncompared to the prior exam, potentially reactive.\n\nThe visualized aerodigestive track is unremarkable. The thyroid is\nunremarkable. Atherosclerotic calcification of the aortic arch and carotid\nbifurcations are identified, unchanged from prior examination. The cervical\nvessels appear grossly patent. The visualized orbits are unremarkable, noting\nright lens replacement. The visualized mastoid air cells and middle ears are\nwell pneumatized and clear.\n\nNo focal suspicious osseous lesion is identified.\n\nA 4 mm cutaneous nodule overlying the right upper thorax (series 302, image\n148), just inferior to the level of the clavicle is not clearly seen on prior\nchest CT of ___, felt likely to represent nevus however clinical\ncorrelation is recommended.", + "output": "1. A right suboccipital 8 x 10 mm lymph node appears to have minimally\nincreased in size from examination of ___. Close attention is\nrecommended.\n2. There is a 4 mm cutaneous nodule of the right upper anterior thorax just\ninferior to the level of the clavicle, not clearly seen on prior chest CT of ___, likely representing a nevus. Clinical correlation is\nrecommended.\n3. Interval development of multifocal patchy airspace opacities of the\nbilateral lung apices. These are better evaluated on concurrent CT chest.\n4. Increased size of multiple mediastinal and paratracheal lymph nodes,\npresumably reactive in nature.\n5. Additional findings described above." + }, + { + "input": "6.6 mm x 7.9 mm right suboccipital lymph node has decreased since ___, when it measured 8.4 mm x 11 mm. There are 2 mildly prominent left\nlevel 4 lymph nodes, mildly more prominent, larger of the 2 measures 6.8 mm x\n8.7 mm, compared with 4.9 mm x 8.2 mm ___\nOtherwise no change. No new neck adenopathy. Small subcentimeter lymph nodes\nin the mediastinum, refer to chest CT.\n\nRefer to chest CT for thoracic findings, there are patchy bilateral\nground-glass opacities in bilateral upper lungs, worsened since prior.\nA 0.4 cm cutaneous nodule overlying the right upper thorax (3:141) is\nunchanged from the prior studies.\n\nEvaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. The neck vessels are patent.\nThe visualized paranasal sinuses are clear. Evaluation of the visualized\norbits demonstrate bilateral native lenses to be absent.\n\nThere are no suspicious osseous lesions. Scattered degenerative changes of the\nvisualized spine.", + "output": "1. Decreased right suboccipital lymph node.\n2. More prominent subcentimeter lymph nodes left neck level 4.\n3. Cutaneous nodule anterior chest.\n4. Refer to chest CT for thoracic findings." + }, + { + "input": "Subcentimeter minimally prominent cervical and suboccipital lymph nodes are\nstable to decreased in size from examination of ___. There is no\ncervical lymphadenopathy by size criteria. The visualized aerodigestive tract\nis unremarkable. The thyroid is unremarkable.\n\nMinimal mucosal thickening of the ethmoid air cells. The remainder the\nparanasal sinuses are essentially clear. The mastoid air cells middle ears\nwell pneumatized and clear. The visualized orbits are unremarkable, noting\nbilateral lens replacements. Multilevel degenerative changes of the cervical\nspine without evidence of high-grade spinal canal or neural foraminal\nnarrowing. No suspicious osseous lesions.\n\nThe cervical vessels are patent. The visualized lungs are clear.", + "output": "1. Subcentimeter minimally prominent cervical and suboccipital lymph nodes are\nstable to decreased in size from examination of ___. There is no\ncervical lymphadenopathy by size criteria.\n2. Additional findings described above." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are prominent, suggestive of volume loss. \nPeriventricular and subcortical white matter hypodensities are nonspecific,\nbut likely reflect the sequela of chronic microvascular infarction. Mild\natherosclerotic calcifications of the distal vertebral and cavernous carotid\narteries are present.\n\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, or signs of\nacute major vascular territorial infarction. Prominent ventricles and sulci\nsuggesting age-related involutional changes or atrophy. Periventricular white\nmatter hypodensities are consistent with chronic small vessel ischemic\ndisease. The basal cisterns appear preserved.No fracture is identified. The\nvisualized paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The globes are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of territorial infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are prominent consistent with involutional changes. \nModerate periventricular white matter hypodensities are nonspecific, overall\nsimilar to ___, may suggest chronic small vessel ischemic changes. Right\nbasal hypodensities suggest lacunar infarcts, similar to ___. No acute\nfracture seen. The paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. Postsurgical changes involving the right orbit. \nPostsurgical changes involving the right globe noted.", + "output": "No acute intracranial process. White matter hypodensity likely small vessel\ndisease. Please note MRI would be more sensitive for evaluation of acute\nischemia and metastatic disease." + }, + { + "input": "The patient is status post right-sided frontal craniotomy. Underlying\nhypodensity within the right frontotemporal lobe likely reflects postsurgical\nencephalomalacia. There is no evidence of acute territorial infarction or\nintracranial hemorrhage. There is no mass, edema or mass effect. Dense\natherosclerotic calcifications of the cavernous carotid arteries and distal\nright vertebral artery are seen.\n\nMetallic clip is seen projecting within the sella. Chronic fracture of the\nfrontal process of the left maxilla is noted. There is no evidence of acute\nfracture. Partial opacification of the left mastoid air cells are noted. \nSmall mucous retention cyst is seen in the right maxillary sinus The\nvisualized portion of the remaining paranasal sinuses, right mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable. Lucencies within the partially imaged cervical spine\nare better seen on subsequent CT cervical spine and compatible with osseous\nmetastatic disease.", + "output": "1. No evidence of intracranial hemorrhage. No evidence of acute territorial\ninfarction however MRI is more sensitive.\n2. Status post right frontal craniotomy with underlying encephalomalacia in\nthe right frontotemporal lobe." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. \nProminence of ventricles and sulci is consistent with age related involutional\nchanges.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Prominent\nventricles and sulci are consistent with age-related volume loss. Few\nscattered white matter hypodensities are seen, likely a sequela of chronic\nsmall vessel disease.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. Mild ethmoidal sinus wall thickening. A defect\nin the right lamina papyracea is seen, suggestive of prior trauma. Incidental\nnote of a small mucous retention cyst in the left maxillary sinus. The\norbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Age-related volume loss." + }, + { + "input": "There is no evidence of acute intracranial infarction,hemorrhage,edema, or\nmass effect. The ventricles and sulci are normal in size and configuration. \nNo hydrocephalus is seen.\n\nThere is no evidence of acute fracture. There is minimal mucosal thickening\nof the ethmoid air cells and sphenoid sinuses. The mastoid air cells are\nclear.", + "output": "No evidence of acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The right sphenoid sinus contains a moderate\namount of aerosolized secretions with an air-fluid level. Otherwise, the\nremaining paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Air-fluid level in the right sphenoid sinus. Correlate with symptoms of\nacute sinusitis." + }, + { + "input": "A BB marker is placed overlying the right sternocleidomastoid muscle in the\narea of the patient's discomfort. No abnormality is identified. Evaluation of\nthe aerodigestive tract demonstrates no exophytic mass, nor areas of focal\nmass effect. Evaluation of the cervical lymph chains demonstrate no pathologic\nlymphadenopathy by imaging criteria. The visualized salivary glands are\nunremarkable in appearance. No thyroid mass is seen. Upper lung fields are\nclear. The visualized paranasal sinuses, mastoid air cells and middle ear\ncavities are clear. Note is made of an enlarged sella. Focal degenerative\nchanges at C6-C7 were there is disc space narrowing and end-plate sclerosis.", + "output": "1. Normal non-contrast CT of the neck. No evidence of abscess or airway\nobstruction.\n2. Focal degenerative changes at C6-C7.\n3. An enlarged sella is incidentally noted." + }, + { + "input": "Soft tissue evaluation is suboptimal secondary to lack of IV contrast. Within\nthis confines:\n\nEvaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions. Degenerative changes are\nnoted at C6-7 with endplate sclerosis, disc height loss and anterior\nosteophyte formation. Enlarged sella is partially imaged and appears similar\nto before.", + "output": "1. No evidence of abscess or phlegmon is identified within the limits of\nnoncontrast CT." + }, + { + "input": "There is re-demonstration of extensive right parieto-occipital\nintraparenchymal hemorrhage with surrounding vasogenic edema and effacement of\nadjacent sulci that demonstrates intraventricular extension which extends to\nthe level of the fourth ventricle with associated layering blood products in\nthe occipital horn of the left lateral ventricle, which is overall similar in\nappearance and size when compared with CT head of ___. There is a\nstable 1 cm leftward shift of the normally midline structures. No new\nintracranial bleed identified. The basal cisterns are patent. The ventricles\nand sulci are stable in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Stable right parieto-occipital intraparenchymal hemorrhage with\nintraventricular extension that extends to the level of the fourth ventricle\nwith associated vasogenic edema which results in stable 1 cm leftward midline\nshift.\n2. Ventricles stable in size from prior study." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is a large acute intraparenchymal hemorrhage within the right temporal\nand occipital lobes with decompression into the ventricular system. There is\nminimal midline shift. The basilar cisterns are patent. Size of the\nventricles are essentially unchanged from prior exam, without gross\nhydrocephalus.\n\nThere is a small area of confluent low attenuation within the left paracentral\nlobule, most consistent with a subacute infarct as identified on MRI.\n\nThere is probable moderate chronic small vessel disease.\n\nThe orbits are unremarkable.\n\nCTA HEAD:\nThere is heavy atheromatous atherosclerotic plaque within the carotid siphons,\nwith moderate stenosis in the supraclinoid segments.\n\nThe vessels of the circle ___ and ___ branches, vertebral arteries, and\nbasilar artery are patent. There are areas of mild stenosis, likely due to\natheromatous vascular disease.\n\nNo aneurysm or vascular malformation is identified.\n\nThe major cortical veins and dural venous sinuses are patent.\n\nCTA NECK:\nThere is moderate atherosclerotic plaque within the aortic arch.\n\nThere is moderate atheromatous plaque within the right common carotid artery. \nThere is heavy atheromatous atherosclerotic plaque at the right carotid bulb\nand moderate atheromatous plaque within the internal carotid artery with\napproximately 50% stenosis by NASCET criteria.\n\nThere is moderate atheromatous plaque within the left common carotid artery. \nThere is moderate atherosclerotic plaque within the carotid bulb and mild\natheromatous plaque within the internal carotid artery with less than 50%\nstenosis by NASCET criteria.\n\nThere is mild atheromatous plaque within the vertebral arteries without\nstenosis.\n\nOTHER:\nThe thyroid gland appears heterogeneous, with small nodules measuring up to 2\nmm.\n\nThere is probable atelectasis within the partially imaged lower lobes. No\nsuspicious osseous lesion. Multilevel cervical spondylosis characterized by\n2-3 mm retrolisthesis of C4 on C5 and C5 on C6 is identified. There is no\nevidence of high-grade spinal canal narrowing. Moderate C5-C6 bilateral and\nmoderate C6-C7 left neural foraminal narrowing is identified.", + "output": "1. Large intraparenchymal hemorrhage within the right temporal and occipital\nlobes, with decompression into the ventricular system. The ventricles are\nunchanged from prior examination without gross hydrocephalus.\n2. Patent dural venous sinuses.\n3. Intracranial atherosclerotic vascular disease, with moderate narrowing of\nthe supraclinoid segments of the internal carotid arteries. Otherwise, the\nremainder of the CTA head allowing for mild atherosclerotic disease is\nunremarkable without evidence of aneurysm or vascular malformation.\n4. Heavy extracranial atherosclerotic vascular disease, with approximately 50%\nstenosis of the right ICA and less than 50% stenosis of the left ICA by NASCET\ncriteria. Patent vertebral arteries.\n5. Additional findings as described above, including heterogeneous thyroid\nwith small nodules measuring up to 2 mm.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or older.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "There is re-demonstration of large intraparenchymal hemorrhage within the\nright temporal and occipital lobes with associated edema and unchanged minimal\nmidline shift. The basal cisterns remain patent. The ventricles and sulci\nare stable in size and configuration when compared to prior study.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "Large intraparenchymal hemorrhage within the right temporal and occipital\nlobes with no significant change from prior study and without progression of\nintracranial bleed. The ventricles remain stable in size from prior study." + }, + { + "input": "Allowing for differences in technique, there has been no significant interval\nchange in the size of the small right frontal parenchymal hemorrhage (2:12).\nThere has been interval full development of a new focus of intraparenchymal\nhemorrhage in the right frontal lobe (2:7). There is no significant mass\neffect. The ventricles and sulci are unchanged in size and configuration.\nIncidental note is made of a cavum septum pellucidum. There is preservation of\ngray-white matter differentiation, and the basal cisterns appear patent.\n\nNo osseous abnormalities seen. There is a small amount of fluid in the left\nsphenoid sinus. Otherwise the visualized paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The orbits are unremarkable.", + "output": "No evidence of subdural hematoma, but there are two right frontal hemorrhagic\ncontusions, at least one of which is new since the prior study.\n\nRECOMMENDATION(S): Repeat head CT for further evaluation.\n\nNOTIFICATION: Updated read and recommendations were discussed with Dr. ___\nby Dr. ___ telephone at 10:12 on ___, approximately 15 min after\ndiscovery." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are moderately enlarged, compatible with age related\ninvolutional changes. Periventricular white matter hypodensities are noted,\nlikely the sequelae of chronic small vessel ischemic disease. There is\npreservation of gray-white matter differentiation. The basal cisterns remain\npatent.\n\nNo osseous abnormalities seen. An air-fluid level is noted within the left\nsphenoid sinus. The remainder of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No evidence of acute intracranial process.\n2. Left sphenoid sinus air-fluid level may correlate with acute sinusitis. \nCorrelate with clinical findings." + }, + { + "input": "Hypodensity in the left cerebellum suggest subacute to chronic infarct (2; 9).\nModerate amount of periventricular and subcortical white matter hypodensities,\nparticularly in the right frontoparietal region, are nonspecific but can\nsuggest chronic small vessel ischemic changes. There is no evidence of large\nvascular territory infarction,hemorrhage,edema, or mass effect. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nModerate atherosclerotic calcifications are noted in bilateral cavernous\ncarotid arteries.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Left cerebellar hypodensity suggest subacute to chronic infarct. MR is\nmore sensitive for acute infarct. Additional hypodensities, particularly in\nthe right frontoparietal region are of indeterminate chronicity. No acute\nintracranial hemorrhage.\n2. Moderate small vessel ischemic disease.\nNOTE: MRI is recommended for further evaluation." + }, + { + "input": "There is no evidence of infarction,intracranial hemorrhage,edema,or mass. The\nventricles and sulci are normal in size and configuration. Subtle subcortical\nareas of low attenuation are nonspecific and may reflect changes due to small\nvessel disease, apparently stable since the prior exam\n\nThere is no evidence of acute fracture. Nasal bone fractures are already\npresent in ___. ethmoidal cells mucosal thickening. Remainder\nparanasal sinuses are clear, there is mild patchy mucosal thickening in the\nmastoid air cells bilaterally, the middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. There is no evidence of acute intracranial process or hemorrhage\n2. No fractures are identified.\n3. Patchy mucosal thickening identified and mastoid air cells bilaterally." + }, + { + "input": "There is no evidence of acute large vascular territory infarction, acute\nhemorrhage,edema,or mass effect. Again seen is a small chronic infarct in the\nleft external capsule. Also again seen are moderate periventricular, deep,\nand subcortical white matter hypodensities, nonspecific but suggestive of\nchronic small vessel ischemic disease. There is mild prominence of the sulci\nand ventricle, compatible with parenchymal involutional changes.\n\nThere is no evidence of fracture. There is mild partial bilateral mastoid air\ncell opacification, unchanged from prior study. There are small mucosal\nretention cysts in the right middle ethmoid and right inferior frontal sinus,\nunchanged. Status post bilateral cataract surgery. Prominent ossification of\nbilateral nasal cartilages is again noted.", + "output": "No evidence of acute intracranial abnormalities. No change compared to prior\nstudy dated ___." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nAgain seen is comminuted though minimally displaced lateral and inferior left\norbital wall fractures, as well as comminuted, minimally displaced anterior,\nlateral left maxillary fracture. The orbital wall fracture fragments are near\nanatomic in alignment aside from a 5 mm anteriorly angulated fragment near the\ninferolateral orbital wall (2:45, 601:69). This fragment does not appear to\nbe in contact with the intra orbital fat or extraocular muscles.\n\nThere is mildly expanded appearance of the left inferior rectus muscle, likely\nrelated to comminuted fracture of the inferior orbital wall. Otherwise, the\nglobes, extraocular muscles, optic nerves, and retrobulbar fat appear normal.\n\nThe left maxillary sinus contains hyperdense layering material with air-fluid\nlevels, likely representing blood products. The remaining sinuses are patent.\n\nThe nasal septum is mildly displaced with a right-sided spur, though not\ncontacting the middle turbinate. Middle turbinates are partially pneumatized,\nleft greater than right.\n\nBilateral mastoids appear preserved.\n\nThere is mild asymmetric induration and fat stranding of the overlying left\nfacial subcutaneous tissues, including the left premalar and left periorbital\npreseptal soft tissues. There is no definite postseptal soft tissue swelling\nnoted.\n\nThe visualized upper aerodigestive tract appears grossly preserved.\nThe mandible and temporomandibular joints appear grossly preserved, though\nlimited by streak artifact from dental amalgam.\n\nLimited imaging of cervical spine demonstrates degenerative changes in,\nincluding minimal C3 on C4 anterolisthesis, with partial fusion of C3 and C4\nvertebral bodies.\n\n8 mm hyperdensity in the interhemispheric region of lateral ventricles is\npartially imaged and better seen on the dedicated CT from ___ (see\n3:3; 601b:1437: 602b:74 on current study and 602b:29; 32:33 on prior exam).", + "output": "1. Dental amalgam streak artifact limits study.\n2. Comminuted, minimally displaced orbital wall blowout fracture, as\ndescribed.\n3. Comminuted, minimally displaced left maxillary sinus fractures with blood\nproducts, as described.\n4. Asymmetric enlargement of the left inferior rectus muscle, likely related\nto inferior orbital wall fracture. Entrapment cannot be excluded on the basis\nof imaging.\n5. Posterior lateral ventricle interhemispheric parasagittal partially imaged\n8 mm hyperdensity, grossly similar to prior outside exam. Differential\nconsiderations include intraparenchymal hemorrhage, intraventricular\nhemorrhage and mass. If clinically indicated, consider contrast brain MRI for\nfurther evaluation.\n6. Left premalar and periorbital preseptal soft tissue swelling." + }, + { + "input": "There is a large right frontal intraparenchymal hematoma with extension into\nthe right lateral ventricle with blood also present in the third and fourth\nventricles. There is hydrocephalus. There is mass effect with 7 mm shift of\nnormally midline structures to the left. There is subfalcial and\ntranstentorial herniation. Subarachnoid blood is present predominantly in the\ncerebellopontine angle cisterns. There are bilateral posterior fossa subdural\nhematomas with hemorrhage extending into the spinal canal. These produce\nsevere posterior fossa mass effect. The remaining basal cisterns are not well\nvisualized.\n\nFluid opacification of the mastoid air cells and air-fluid levels in the\nethmoid and sphenoid sinuses likely relates to endotracheal intubation and\nprolonged supine positioning.", + "output": "1. Large acute/subacute right frontal intraparenchymal hematoma with\nintraventricular extension as described above resulting in shift of normally\nmidline structures to the left. Subfalcal and transtentorial herniation\n\n2. Subarachnoid blood predominantly in the cerebellopontine angle cisterns.\n\n3. Disproportionate enlargement of the ventricles as compared to the sulci\nmay suggest developing communicating hydrocephalus.\n\n4. Posterior fossa subdural hematomas extending into the spinal canal with\nsevere posterior fossa mass effect\n\n\nNOTIFICATION:\n Findings and recommendations were discussed by Dr. ___ with Dr.\n___ , on ___ at 1:00 pm, via telephone, 5 min after discovery." + }, + { + "input": "There are atherosclerotic calcifications within the aortic arch, at the origin\nof the left subclavian, the carotid bifurcations, and carotid siphons\nbilaterally. There is a focal 47% stenosis of the left internal carotid\nartery just distal to the bifurcation by NASCET criteria (series 2, image\n148). There is no evidence of occlusion in the right internal carotid artery\nby NASCET criteria. The vertebral arteries are patent with no evidence of\nstenoses. There is no evidence of new aneurysm or dissection. The known right\ninternal carotid artery cavernous segment aneurysm is not fully assessed in\nthis examination but appears decreased in size since prior examinations,\nmeasuring approximately 2 x 2 mm (series 2, image 238). There is calcified\nplaque at the origin of the vertebral arteries bilaterally, mild on the right\nand moderate on the left.\n\nThere is biapical scarring. There are two 4 mm right upper lobe pulmonary\nnodules (series 2, image 4, 50). The thyroid gland is unremarkable. There is\nmoderate degenerative changes noted along the cervical spine.", + "output": "1. No evidence of new aneurysm or dissection.\n2. Known right internal carotid artery cavernous segment aneurysm is not fully\nassessed in this examination, but appears decreased in size since prior\nexaminations, measuring up to 2 mm.\n3. Focal 47% stenosis of the left internal carotid artery by NASCET criteria.\n4. No evidence of right internal carotid stenosis by NASCET criteria.\n5. Two 4 mm right upper lobe pulmonary nodules. As per ___ criteria,\nno follow-up needed in low-risk patients. For high risk patients, recommend\nfollow-up at 12 months and if no change, no further imaging needed.\n\nRECOMMENDATION(S):\n\n-Two 4 mm right upper lobe pulmonary nodules. As per ___ criteria, no\nfollow-up needed in low-risk patients. For high risk patients, recommend\nfollow-up at 12 months and if no change, no further imaging needed." + }, + { + "input": "There is a stable small right temporoparietal subdural hematoma without\nsignificant mass effect. No new intracranial hemorrhage. Left cerebellar\nhypodensity is stable since previous examination likely represents a subacute\nto chronic infarct. There is persistent enlargement of the ventricles with\nassociated periventricular hypodensity which is unchanged in appearance since\nprior study. No sulcal effacement. There is no evidence of edema or mass.\n\nThere is no evidence of fracture. Moderate mucosal thickening of the\nethmoidal air cells with a stable 2.9 x 2.2 cm polyp extending from the left\nnasal cavity into the left maxillary sinus. There is complete opacification\nof the right maxillary sinus with hyperdense secretions. The additional\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Stable small right temporoparietal subdural hematoma. No new intracranial\nhemorrhage.\n2. Stable subacute to chronic left cerebellar infarct.\n3. Persistent ventriculomegaly with periventricular hypodensity can be seen in\nthe setting of hydrocephalus with transependymal flow. Clinical correlation\nis recommended.\n4. 2.9 cm left nasal polyp extending into the left maxillary sinus.\n5. Complete opacification of the right maxillary sinus can be related to\nchronic inspissated secretions, or fungal disease.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 12:15 ___, 5 minutes after discovery of the\nfindings." + }, + { + "input": "Dental amalgam streak artifact limits study. Left maxillary and sphenoid\nsinus mucosal thickening is noted. The left ostiomeatal unit is obstructed\nand the right is patent.. The cribriform plates are intact. The lamina\npapyracea are intact. Scattered subcentimeter nonspecific lymph nodes are\nnoted throughout the visualized portion of the neck bilaterally and\nsuboccipital soft tissues , without definite enlargement by CT size criteria. \nMinimal rightward nasal septal deviation is noted.", + "output": "1. Dental amalgam streak artifact limits study.\n2. Paranasal sinus disease, as described.\n3. Minimal rightward nasal septal deviation." + }, + { + "input": "Study is mildly degraded by motion. Dental artifact limits study evaluation.\n\nThere is right periorbital and soft tissue swelling over the right maxillary\nbone with some fat stranding. There is also soft tissue thickening of the\nright pinna. There is no fluid collection, hematoma, or abscess.\n\nThere is a 1.9 x 1.6 cm enlarged IIa cervical jugulodigastric lymph node on\nthe right (301; 129). There is also a smaller but still enlarged 1.7 x 1.3 cm\nleft IIA cervical lymph node (301; 127). Additionally, although not\npathologically enlarged by CT size criteria, the other cervical lymph nodes on\nthe right side are larger and rounder compared to the left.\n\nThe maxillofacial bones are intact, without fracture. The zygomatico-maxillary\ncomplex is intact. The lateral pterygoid plates are intact.\n\nThe mandible is without fracture or temporomandibular joint dislocation.\nBilateral temporomandibular joint degenerative changes are noted.\n\nPartial opacification of bilateral maxillary sinuses is seen, with large\nmucous retention cysts bilaterally. Left sphenoid sinus mucosal thickening is\npresent. There are no air-fluid levels identified. The ostiomeatal units are\npatent. The mastoid air cells and middle ear cavities are clear.\n\nThere is no nasal bone fracture. Nasopharyngeal soft tissues are unremarkable.\nThere is no nasal septal hematoma. There is leftward nasal septal deviation\nwith bony spur.\n\nThe orbits, including the laminae papyracea, are intact. The globes are intact\nwith non-displaced lenses and no intraocular hematoma. There is some preseptal\nsoft tissue edema with mild fat stranding.There is no retrobulbar hematoma.\n\nOTHER:\n\nAllowing for imaging technique optimized for the face, the limited included\nportion of the brain is grossly preserved.\n\nCalcifications are seen in bilateral internal carotid arteries. Limiting the\nparotid glands demonstrate bilateral subcentimeter nonspecific probable lymph\nnodes.\n\nQuestion thickening of bilateral tympanic membranes. Question thickening of\nright external auditory canal soft tissue versus cerumen.\n\nLimiting imaging of the cervical spine demonstrates multilevel degenerative\nchanges with at least partial fusion of C3-4 vertebral bodies and at least\nmild vertebral canal narrowing and C3-4.", + "output": "1. Motion and dental artifact limits study.\n2. Right preseptal and right maxillary soft tissue swelling with some fat\nstranding, and soft tissue thickening of right pinna concerning for\ncellulitis.\n3. Question thickening of bilateral tympanic membranes and of right external\nauditory canal versus cerumen.\n4. Within limits of study, no definite evidence of abscess.\n5. Lymphadenopathy and additional scattered subcentimeter nonspecific lymph\nnodes, as described.\n6. Paranasal sinus disease , as described.\n7. Additional findings as described above." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass, mass\neffect, or large vascular territory infarction. The ventricles and sulci are\nprominent, consistent with age related volume loss. The size of the\nventricles is somewhat disproportional to the sulci, likely due to\npreferential central atrophy. The basal cisterns are patent. There is\npreservation of gray-white matter differentiation.\n\nNo fracture is identified. The visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. There is a moderate-sized scalp\nhematoma overlying the left superior scalp with subcutaneous air, consistent\nwith a laceration (3, 57). Additionally, there is a small scalp hematoma\noverlying the left frontal bone (3, 32). The soft tissues and orbits are\notherwise unremarkable.", + "output": "No acute intracranial abnormality. Left scalp hematomas, as described above." + }, + { + "input": "The study is performed with EEG electrodes in place. The imaging of the\ncranial vertex, as well as the inferior portion of the posterior fossa, is\nslightly degraded by motion artifact, but the acquisition was not repeated.\n\nThere is no intra - or extra-axial hemorrhage, the midline structures are in\nthe midline, and the ventricles and cisterns are normal in size and\nconfiguration. The a few poorly-defined, low-attenuation foci, particularly\nin right frontoparietal subcortical white matter, non-specific. Otherwise, the\ngray-white matter differentiation is preserved with no evidence of cerebral\nedema or space-occupying lesion.The posterior fossa structures are\nunremarkable.\n\nNo fracture or suspicious osseous lesion is identified. There is mucosal\nthickening with opacification involving scattered anterior and posterior\nethmoidal air cells, as well as the left fronto-ethmoidal recess. The\nremaining visualized paranasal sinuses, as well as the mastoid air cells and\nmiddle ear cavities are clear.The globes and orbits are symmetric and\nunremarkable.", + "output": "Slightly motion-limited study, with no definite acute intracranial\nabnormality. The findings involving right hemisphere subcortical white matter\nare non-specific, but may simply represent the sequelae of chronic small\nvessel ischemic disease.\n\nFurther evaluation by dedicated MR study, if feasible, may be warranted." + }, + { + "input": "CT HEAD- NECT\n\nNo acute intracranial hemorrhage or mass effect.\nMultiple hypodense foci are noted in the cerebral parenchyma in the frontal,\nparietal and the occipital lobes on both sides related to the acute infarcts,\nbetter seen on the recent MRI.\nThe ventricles, extra-axial CSF spaces on the sulci are unremarkable.\nModerate amount of fluid in the sphenoid sinus, left maxillary sinus, \nnasopharynx and mastoid air cells.\nBilateral ethmoidal mucosal thickening.\nPatient is intubated.\nNo suspicious osseous lesions are noted.\n\nCTA NECK:\n\nSevere irregular atherosclerotic disease with calcified and noncalcified\nplaques involving the ascending and descending thoracic aorta included, aortic\narch and the proximal supra-aortic branches, with 3 vessel aortic arch.\nThe common carotid and the cervical internal carotid arteries and the\nvertebral arteries are patent.\nMild-moderate narrowing of the left common carotid artery diffusely over a\nlong segment without flow limitation.\nRight vertebral artery is dominant. Mild narrowing at left vertebral artery\norigin\nNo flow-limiting stenosis or occlusion.\n\nLeft internal jugular vein is occluded starting slightly superior to the entry\nof the left internal jugular venous catheter.\n\nDistal cervical internal carotid artery measures 4.4 mm on the right and 4 mm\non the left\n\nCTA HEAD:\n\nThe major intracranial arteries of the anterior and the posterior circulation\nare patent, without focal flow-limiting stenosis, occlusion or obvious\naneurysm more than 3 mm.\nAtherosclerotic changes are noted in the cavernous carotid segments, with\ncalcified and noncalcified plaques and tiny outpouchings.\nAnterior and posterior communicating arteries are noted. There is likely a\nfenestration/duplication of the anterior communicating artery with focal\nprominence onto left side.\nThe anterior and middle cerebral arteries are patent.\n\nCT NECK:\n\nPatient is intubated with the ETT and orogastric tubes\nFluid in the nasopharynx, sphenoid sinus, left maxillary sinus and left\nmastoid air cells, left more than right, likely related to intubation.\nNo suspicious osseous lesions noted.\nMultilevel marked, multifactorial degenerative changes in the cervical spine,\nwith multilevel foraminal narrowing.\nNo obvious mass like lesions are noted in the neck allowing for the\nlimitations.\nLarge bilateral pleural effusions, with severe emphysematous changes in the\nincluded portions of the lungs.\n\nDistal cervical internal carotid artery measures 4.4 mm on the right and 4 mm\non the left", + "output": "1. No acute intracranial hemorrhage or mass effect. Multiple hypodense areas\nin the cerebral parenchyma on both sides, related to the multiple infarcts,\nbetter seen on the recent MRI study.\n2. Patent major intracranial arteries as described above.\n3. Severe atherosclerotic disease involving the aorta and the proximal\nportions of the great vessels, with mild-moderate narrowing of the left common\ncarotid artery diffusely over a long segment.\nNo distal flow limitation.\n4. Occluded left IJV from the level of the catheter entry point\n5. Multilevel marked, multifactorial degenerative changes in the cervical\nspine, with multilevel foraminal narrowing.\n6. Large bilateral pleural effusions, with severe emphysematous changes in the\nincluded portions of the lungs." + }, + { + "input": "There is no evidence of hemorrhage, edema, or\nmass effect. Prominent ventricles and sulci suggest age-related involutional\nchanges. Focal hypodensities are seen in the right frontotemporal region and\nthe right occipital region, reflect evolving infarctions seen on the MRI\nexamination of ___. There is a new hypodensity in the right frontal lobe,\nnot seen on the prior MRI, that also likely represents acute infarction. This\nis best seen on image 23 of series 2 and image 50 of series 601b. The basal\ncisterns appear patent and there is preservation of gray-white matter\ndifferentiation.\n\nNo fracture is identified. An air-fluid level with aerosolized secretions are\nseen in the left maxillary sinus. Fluid and mucosal thickening are seen in\nthe sphenoid sinus and ethmoid air cells. The mastoid air cells are partially\nopacified with fluid. The other visualized paranasal sinuses and middle ear\ncavities are clear. The globes are unremarkable.", + "output": "Evolving infarctions, better seen on the brain MRI ___. Small new right\nfrontal infarction. No evidence of hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of acute fracture. Again seen is minimally displaced\nnasal bone fracture and deviation of the nasal septum, unchanged from prior\nexam. The visualized portion of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial abnormalities." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is layering hemorrhage in the right occipital horn. Subarachnoid\nhemorrhage is noted along the frontal, parietal and temporal convexities. \nThere is focal hypodensity of the lateral left temporal lobe with adjacent\nhyperdense. Subarachnoid hemorrhage is also noted in the left quadrigeminal\nplate cistern and minimally within the interpeduncular cistern.\n\nThe ventricles and sulci are normal in size and configuration. Fluid is noted\nin the posterior nasopharynx and oropharynx, secondary to intubated status.\n\nThe visualized portion of the mastoid air cells, and middle ear cavities are\nclear. There is a fractures to the anterior right lamina papyracea with\nopacification of the ethmoid air cells. An air-fluid levels noted in the\nright maxillary sinus. Subcutaneous emphysema is noted in the superior right\norbit. In addition, there is a nondisplaced fracture of the right lateral\norbital wall, extending into the right frontal calvarium. Mild mucosal\nthickening of the left maxillary sinus is seen. An air-fluid levels noted in\nthe sphenoid sinus. Debris is noted in the bilateral external auditory\ncanals, with no associated erosions, likely secondary to cerumen.\n\nCTA HEAD: There is minimal atherosclerotic calcification in the left\ncavernous internal carotid artery.\nOtherwise, the vessels of the circle of ___ and their principal\nintracranial branches appear normal without stenosis, occlusion, or aneurysm\nformation.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. There is a heterogeneous\nthyroid gland, largest nodule on the right measuring 1 cm, for which no\nimaging follow-up is recommended per the ___ College of Radiology\nguidelines. There is no lymphadenopathy by CT size criteria. An endotracheal\nand orogastric tube are partially visualized. There is deformity and\nirregularity of the right humerus, likely secondary to prior chronic injury. \nDegenerative changes are noted throughout the cervical thoracic spine.", + "output": "1. Subarachnoid hemorrhage as described above.\n2. Edema in the lateral left temporal lobe likely secondary to a contusion\nwith hemorrhagic infarct less likely.\n3. No evidence of aneurysm greater than 3 mm, dissection or significant\nluminal narrowing.\n4. Fractures of the right lamina papyracea and right lateral orbital wall,\nextending into the right frontal calvarium.\n5. Deformity of the proximal right humerus on scout imaging, likely chronic in\netiology. If clinically indicated, consider dedicated humerus x-ray for\nfurther evaluation.\n\nNOTIFICATION: The findings were discussed with Dr. ___, M1.D. by ___\n___, M.D. on the telephone on ___ at 11:08 AM, 1 minutes after\ndiscovery of the findings." + }, + { + "input": "The left temporal hemorrhagic contusion is similar in appearance to the prior\nstudy.\n\nThe left frontal subarachnoid hemorrhage is also similar.\n\nLeft ambient cistern hemorrhage is similar to slightly increased. Bilateral\noccipital horn intraventricular hemorrhage is more conspicuous on the current\nstudy (series 2, image 18).\n\nHyperdensity in the left frontal lobe appears more consistent with another\nfocus of subarachnoid hemorrhage, rather than a contusion (series 2, image\n24).\n\nRight frontal subarachnoid hemorrhage is new or more conspicuous (series 2,\nimage 22).\n\nSmall right occipital subarachnoid hemorrhage appears stable (series 2, image\n17).\n\nPosterior left falcine thickening likely represents a small component of\nsubdural hemorrhage, not significantly changed since the prior study (series\n2, image 21).\n\nThere is no evidence of large territorial infarct or intracranial mass. \nVentricles and sulci are prominent, suggestive of age-related involutional\nchanges. Periventricular and subcortical white matter hypodensities are\nnonspecific but consistent with chronic small vessel ischemic changes. \nPneumocephalus has resolved.\n\nFractures of the right orbital roof, right lamina papyracea, and right nasal\nbone are again noted. Foci of right extraconal air has resolved.\n\nRight intraorbital hematoma is slightly larger than on the prior study.\n\nA hyperdense air-fluid level is noted in the right maxillary sinus. Mucosal\nthickening is noted in the left maxillary sinus. Air-fluid levels are noted\nin bilateral sphenoid sinuses and partial opacification bilateral ethmoid air\ncells, greater on the right. The mastoid air cells are clear. Soft tissue\ndensities are noted within bilateral external auditory canals which may\nrepresent cerumen.", + "output": "1. Increase in subarachnoid hemorrhage in the right frontal lobe, with\nincreased conspicuity of intraventricular hemorrhage.\n2. Stable small subdural hemorrhage along the falx.\n3. Nondisplaced right orbital roof, right lamina papyracea, and right nasal\nbone fractures again noted.\n4. Right intraorbital hematoma is slightly larger than prior.\n5. Right retrobulbar air and small left frontal pneumocephalus have resolved.\n6. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct." + }, + { + "input": "There is interval decrease in known subarachnoid hemorrhage in the bilateral\nfrontal, temporal, and parietal convexities with less apparent subfalcine and\ntentorial subdural hematomas. There is no shift of normally midline\nstructures, intracranial mass, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nLeft temporal hemorrhagic contusion is also less apparent although limited\nevaluation due to motion.\n\nThere is mucosal thickening in the bilateral ethmoid sinuses and left sphenoid\nsinus. Mastoid air cells and middle ear cavities are well aerated. The known\nright lateral orbital fracture, right lamina papyracea fracture, and right\nnasal bone fracture is stable appearing, and better assessed on recent CT\nsinus/maxillofacial from ___.", + "output": "1. Interval decrease in known subarachnoid hemorrhage and less apparent\nsubfalcine and left tentorial subdural hematoma as compared to CT scan from ___.\n2. Stable appearance of known right lateral orbital, right lamina papyracea,\nand right nasal bone fractures, better assessed on recent CT\nsinus/maxillofacial from ___." + }, + { + "input": "The frontal sinuses are clear. Mucosal thickening involving the ethmoidal air\ncells as well as layering fluid within the sphenoid sinuses has improved since\nsinus CT from ___. There is redemonstration of mild mucosal thickening\nof the bilateral maxillary sinuses. There is partial opacification of the\nvisualized mastoid air cells. Fluid is also present in the left middle ear. \nThe right ostiomeatal unit is patent. The left ostiomeatal unit is narrowed\nsecondary to mucosal thickening. The cribriform plates are intact.The\nanterior clinoid processes are not pneumatized. The lamina papyracea are\nintact.\n\nThere is redemonstration of known fractures involving the right lateral\norbital wall, right frontal bone, right maxillary bone and right nasal bone. \nThere is redemonstration of a soft tissue density surrounding the right\nsuperior oblique muscle, which could indicate a small hematoma or muscle\ninjury.", + "output": "1. Paranasal sinus disease involving the ethmoidal air cells and sphenoid\nsinuses appears improved.\n2. Stable paranasal sinus disease involving the bilateral maxillary sinuses.\n3. Known facial bone fractures." + }, + { + "input": "Please note the study is moderately degraded by motion. There is no evidence\nof acute territorial infarction or large mass. Left temporal hemorrhagic\ncontusion appears similar to prior. There is a small amount of subarachnoid\nhemorrhage overlying the frontal lobes bilaterally, similar to prior. \nPeriventricular and subcortical white matter hypodensities are nonspecific,\nbut likely represent chronic small vessel ischemic disease. Mild prominence\nof the ventricles and sulci is suggestive of involutional changes.\n\nPreviously seen right lateral orbital, right lamina papyracea, and right nasal\nbone fractures appears similar to prior, but better assessed on recent CT\nsinus. There is scattered mild mucosal thickening in the ethmoid air cells. \nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are otherwise clear. The visualized portion of the orbits are\nunremarkable.", + "output": "Study is moderately degraded by motion. No midline shift or new hemorrhage\nsince ___." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nThere are periventricular and subcortical lucencies, which may represent small\nvessel ischemic changes. Atherosclerotic vascular calcifications are noted of\nbilateral cavernous portions of internal carotid arteries.\n\nGrossly unchanged right orbital roof fracture is again noted. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. Soft tissue densities are noted within bilateral external auditory\ncanals which may represent cerumen.", + "output": "1. No definite acute subarachnoid and subdural hemorrhage noted.\n2. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described.\n3. Grossly stable right orbital roof fracture." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nPeriventricular and subcortical white matter hypodensities are nonspecific,\nbut may reflect sequelae of chronic microvascular ischemic disease. Stable,\nsubcentimeter hypodensities in the right basal ganglia and thalamus likely\nreflect old infarcts. Mild atherosclerotic calcifications are seen within the\ncavernous carotid arteries.\n\nStable, chronic right orbital roof fracture. There is no evidence of new\nfracture. The visualized portions of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portions of the\norbits are unremarkable. Soft tissue density within the external auditory\ncanals bilaterally is consistent with cerumen.", + "output": "No acute intracranial hemorrhage or large territorial ischemic infarct. \nPlease note that MRI is more sensitive for detection of acute infarction." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. There is debris within the right\nexternal auditory canal. Soft tissue density is noted within the right\nexternal auditory canal which may represent cerumen.", + "output": "1. No acute intracranial abnormality.\n2. No evidence of acute intracranial hemorrhage or fracture." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "No acute intracranial process. MRI is more sensitive if there is concern for\nacute ischemia." + }, + { + "input": "There is no evidence of large territory infarction,hemorrhage,edema,or mass. \nThe ventricles and sulci are age-appropriate.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality. No CT evidence of a mass lesion." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or\nmass-effect. There is prominence of the ventricles and sulci suggestive of\nage-related atrophy.\n\nThere are acute fractures of the right orbital floor, involving the right\ninfraorbital canal, and inferior aspect of the right lamina papyracea\n(601:29). This is associated with approximately 5 mm depression of the right\norbital floor. The right inferior rectus muscle closely abuts the fracture\narea. There is dependent hemorrhagic fluid in the right maxillary sinus and\nair in the right retro-orbital fat, associated with right sided proptosis. \nSmall volume dependent fluid in the right sphenoid sinus is also likely\nhemorrhagic.\n\nThere is also an acute, minimally displaced, fracture of the nasal bone on the\nright side (03:13). There is extensive soft tissue edema and small foci of\nsubcutaneous air surrounding the right orbit.\n\nThe visualized portion of the mastoid air cells, and middle ear cavities are\nclear. The left orbit is unremarkable.", + "output": "1. No acute intracranial process.\n2. Acute fracture and 5 mm depression of the right orbital floor (involving\nthe infraorbital canal). The right inferior rectus closely abuts the fracture\nsite and there is retro-orbital air with right-sided proptosis. Recommend\nclinical correlation for possible entrapment and compartment syndrome.\n3. Dependent hemorrhagic fluid in the right maxillary and sphenoid sinuses.\n\nRECOMMENDATION(S): Clinical correlation for possible right orbit entrapment\nand compartment syndrome, for impression point 2.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. in person on ___ at 3:08 pm, 2 minutes after discovery of the\nfindings." + }, + { + "input": "Postsurgical changes of a left parietal craniotomy are new compared to ___ with expected pneumocephalus and trace hyperdense fluid in the\nresection bed, likely postoperative in nature (for example 02:22). Previously\ndescribed 1.8 x 1.7 cm and 1.1 x 1.2 cm hyperdense masses in the left\noccipital and parietal lobes are not substantially changed in size compared to\nprior MR head, consistent with residual tumor burden (2: 17, 24). Extensive\nassociated vasogenic edema with associated mass effect resulting in\napproximately 3 mm of rightward shift of midline structures, which appears\nslightly improved compared to CT head performed ___ (02:18).\nThere is no evidence of infarction. Prominence of the ventricles and sulci is\nlikely age related and unchanged.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavitiesare essentially clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Postsurgical changes of a left parietal craniotomy. The hyperdense\nmetastases in the left parietal and occipital lobe masses are still present. \nThese are better characterized on prior MR head performed ___.\n2. Extensive vasogenic edema affecting the left cerebral hemisphere, which is\nslightly improved compared to prior MR head performed ___ and CT\nhead on ___.\n3. Unchanged 3 mm of rightward midline shift.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 8:16 pm, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "Again demonstrated are postsurgical changes of a left parietal craniotomy with\nstable pneumocephalus and trace hyperdense fluid within the surgical resection\nbed, likely postoperative in nature (for example 02:22). Hyperdensity in the\nleft parietal vertex is new compared to prior exam and may reflect blood\nproducts (02:26). Previously seen 1.8 cm and 1.4 cm hyperdense masses in the\nleft occipital and parietal lobes are not substantially changed compared to\nprior exam and are better evaluated on prior MR head. Extensive associated\nvasogenic edema with 3 mm of rightward shift of midline structures is not\nsubstantially changed. There is no definite evidence of acute large\nterritorial infarction.\n\nSkin staples and soft tissue swelling overlie craniotomy site. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are preserved.", + "output": "1. Postsurgical changes of a left parietal craniotomy with unchanged\npneumocephalus and increased hyperdense material in the left parietal vertex\nwhich may reflect blood products.\n2. Hyperdense metastases in left parietal and occipital lobes are unchanged\nand associated with extensive vasogenic edema resulting in 3 mm of midline\nshift, stable compared to prior exam." + }, + { + "input": "Expected postsurgical changes are seen from a left parietooccipital craniotomy\nwith tumoral resection including soft tissue swelling and pneumocephalus. \nThere is a small amount of subarachnoid and subdural hyperattenuation in the\nresection bed compatible with blood products. There is persistence of\nextensive vasogenic edema resulting in mass effect on the left lateral\nventricle and 3 mm rightward midline shift (03:26). There is no new major\ninfarction. The ventricles and sulci are unchanged. Surgical staples are\nagain seen in the left parietooccipital scalp.\n\n The visualized portion of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Expected postsurgical changes from left parietooccipital craniotomy and\ntumoral resection. Small amount of subarachnoid and subdural hyperattenuation\nin the resection bed is compatible with blood products. No evidence of new\nmajor infarct.\n2. Persistent extensive vasogenic edema demonstrates mass effect on the left\nlateral ventricle and results in 3 mm rightward midline shift." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration for the patient's\nage. The basal cisterns are patent and there is preservation of gray-white\nmatter differentiation.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "Normal study." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no intra or extra-axial mass effect, acute hemorrhage or large\nterritory infarct. The sulci, ventricles cisterns are within expected limits\nfor the patient's mild senescent related global cerebral volume loss. There\nare mild periventricular and subcortical white matter hypodensities, which are\nnonspecific, but compatible with chronic microangiopathy in a patient this\nage.\n\nThere is mild mucosal thickening of the ethmoid air cells and left maxillary\nsinus. The remainder the paranasal sinuses are essentially clear. The orbits\nare unremarkable, noting right lens replacement. The mastoid air cells and\nmiddle ears are clear. No acute osseous abnormality. Midline partially\ncalcified 1 cm subcutaneous nodule is compatible with a calcified sebaceous\ncyst.\n\nCTA HEAD:\nMild to moderate atherosclerotic calcification of the internal carotid\narteries are noted without high-grade stenosis. Otherwise, the remainder of\nthe ACA, MCA and their major branches are unremarkable without evidence of\nhigh-grade stenosis, occlusion or aneurysm. The posterior circulation is also\nunremarkable. The dural venous sinuses are patent.\n\nCTA NECK:\nThe patient is status post prior right sided carotid endarterectomy. Intimal\nhyperplasia results in at least 70% stenosis of the right cervical internal\ncarotid artery by NASCET criteria.\n\nAtherosclerotic calcification at the left carotid bifurcation results in\napproximately 70% stenosis of the left cervical internal carotid artery by\nNASCET criteria.\n\nAdditional atherosclerotic calcification of the aortic arch, origins of the\nright brachiocephalic, bilateral common carotid and subclavian arteries is\nidentified, resulting in mild stenosis. The right vertebral artery is\ndominant. Scattered atherosclerotic calcification at its origin and\nthroughout their courses does not result in high-grade narrowing.\n\nOTHER:\nThere is no cervical lymphadenopathy by size criteria. The thyroid\ndemonstrates a 8 mm hypoattenuating nodule in the right lobe. The visualized\naerodigestive tract is within expected limits.\n\nExamination of the lung apices is mildly degraded secondary to respiratory\nmotion. Very mild paraseptal emphysematous changes are noted. There is a 2\nmm right upper lobe pulmonary nodule (series 6, image 1). Left-sided cardiac\ndevice is partially visualized.\n\nNo suspicious osseous lesions. Minimal 2 mm anterolisthesis of C4 on C5 and 2\nmm retrolisthesis of C6 on C7 is identified. Degenerative loss of disc height\nat C 4 C5 and C5-C6 is moderate to severe with subcortical cystic change and\nendplate sclerosis. No high-grade spinal canal narrowing. Uncovertebral\nfacet arthropathy results in moderate left C3-C4, bilateral C4-C5 neural\nforaminal narrowing. There is severe right 6 C5-C6 and moderate left C5-C6\nneural foraminal narrowing.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nlarge territory infarct or intracranial hemorrhage.\n2. The patient is status post prior right-sided carotid endarterectomy. \nIntimal hyperplasia results in at least 70% stenosis of the right cervical\ninternal carotid artery by NASCET criteria. Atherosclerotic calcification of\nthe left carotid bifurcation results in at least 70% stenosis of the left\ncervical internal carotid artery by NASCET criteria.\n3. Allowing for additional atherosclerotic disease, the remainder of the CTA\nhead and neck is unremarkable.\n4. 2 mm right upper lobe pulmonary nodule and 8 mm right lobe of the thyroid\nnodule.\n5. Additional findings described above.\n\nRECOMMENDATION(S): For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommend in a high-risk patient.\n\nSee the ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___\n\n Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or older.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Periventricular and subcortical white matter hypodensities are\nnonspecific, but likely reflect sequelae of chronic small vessel ischemic\ndisease. Ventricles and sulci are normal in overall size and configuration. \nThere is mild mucosal thickening of the ethmoid air cells and maxillary\nsinuses. The mastoid air cells and middle ears are well pneumatized and\nclear. There are bilateral optic drusen. Otherwise, orbits are unremarkable,\nnoting right lens replacement. The bony calvarium is intact.", + "output": "-No acute intracranial abnormality on noncontrast head CT. Specifically no\nlarge territory infarct or intracranial hemorrhage.\n-Additional findings described above." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is diffuse subarachnoid and intraventricular hemorrhage with interval\nevolution. The right frontal ventriculostomy catheter tip is located within\nthe third ventricle and appears unchanged. The degree of hydrocephalus and\nnarrowing of the basilar cisterns appear similar to the ___ CT head.\nThere is no downward herniation or midline shift.\n\nThere is no loss of gray white matter differentiation to suggest a large\ninfarct. There is no definite intraparenchymal hemorrhage.\n\nThere is mild mucosal thickening within the bilateral maxillary sinuses,\nopacification of a few anterior ethmoid air cells, and aerosolized debris\nwithin the bilateral maxillary sinuses, right worse than left.\n\nCTA HEAD:\nThe exam is mildly degraded due to suboptimal arterial opacification and\nvenous contamination. Within this confine:\n\nThere is mild atherosclerotic plaque within the cavernous segments of the\ninternal carotid arteries, without stenosis.\n\nThere is an anteriorly directed anterior communicating artery aneurysm that\nmeasures approximately 7 mm in the AP dimension and 4 mm in the transverse\ndimension.\n\nThe anterior cerebral arteries and middle cerebral arteries are otherwise\npatent without high-grade stenosis.\n\nThe right posterior communicating artery is patent. A left posterior\ncommunicating artery is not seen. The posterior cerebral arteries are patent\nwithout high-grade stenosis.\n\nThe intracranial vertebral arteries and basilar artery are patent without\nstenosis.\n\nCTA NECK:\nThere is a 3 vessel aortic arch atherosclerotic plaque.\n\nThere is mild atherosclerotic plaque at the right carotid bulb, without\nsignificant stenosis by NASCET criteria. The right common carotid artery and\ninternal carotid arteries are patent without stenosis.\n\nThere is mild atherosclerotic plaque at the left carotid bulb, without\nsignificant stenosis by NASCET criteria. The left common carotid artery and\ninternal carotid arteries are patent without stenosis.\n\nThe V1 and proximal V2 segments of the bilateral vertebral arteries are\ndegraded secondary to photon starvation artifact. The bilateral V3 segments\nare patent without stenosis.\n\nOTHER:\nThe endotracheal and enteric tube. The visualized lung apices are clear. \nMild degenerative changes are visualized throughout the cervical spine,\nconsistent with mild spondylosis, more significant at C4/C5 level.", + "output": "1. 7 mm x 4 mm anterior communicating artery aneurysm post rupture with\ndiffuse subarachnoid and intraventricular blood products. The degree of\nhydrocephalus appears similar to the ___ CT post right frontal\nventriculostomy catheter placement.\n2. Mild intracranial atherosclerotic vascular disease. The exam is mildly\ndegraded due to suboptimal arterial opacification and venous contamination. \nWithin this confine, no high-grade intracranial arterial stenosis.\n3. Mild extracranial atherosclerotic vascular disease, without significant\nstenosis by NASCET criteria. Please note the V1 and proximal V2 segments of\nthe vertebral arteries are degraded due to artifact." + }, + { + "input": "Re-demonstrated is extensive subarachnoid hemorrhage, most pronounced within\nthe suprasellar cisterns and anterior interhemispheric fissure. New since the\nprior examination is a right frontal approach ventriculostomy catheter,\nterminating within the third ventricle, with a small amount of pneumocephalus.\nA small amount of intraventricular hemorrhage at the tip of the\nventriculostomy catheter is noted. There is persistent intraventricular\nhemorrhage within the lateral ventricles, third ventricle, and fourth\nventricle, with no substantial interval change in size of the ventricles\ncompared to the previous examinations. Dilatation of the temporal horns\nbilaterally is also similar.\n\nThere is no evidence of fracture. Aerosolized secretions are seen within the\nbilateral maxillary sinuses and sphenoid sinus. There is mucosal thickening\ninvolving the bilateral ethmoid air cells as well as the sphenoid sinuses. \nThese findings may be related to recent intubation. The middle ear cavities\nand mastoid air cells are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Status post right ventriculostomy catheter placement, with no substantial\ninterval change in dilatation of the ventricular system.\n2. Extensive subarachnoid and intraventricular hemorrhage appears grossly\nsimilar to prior exams." + }, + { + "input": "There is extensive subarachnoid hemorrhage layering in the sulci of both\nhemispheres, the sylvian fissures, and basilar cisterns. There is also\nintraventricular hemorrhage in the posterior horns of the lateral ventricles,\nthird and fourth ventricle. A right frontal approach ventriculostomy catheter\nis in place, terminating in the third ventricle. A new focus of hemorrhage is\nnoted adjacent to the catheter in the right frontal lobe (02:31). Compared to\n___, there has been slight interval decompression of the lateral\nventricles. The patient is status post A-comm aneurysm clip with streak\nartifact.\n\nThere is no evidence of fracture. Extensive sinus opacification involving the\nbilateral maxillary sinuses, anterior ethmoid air cells and sphenoid sinuses\nis similar to prior. The visualized portion of the orbits are unremarkable.", + "output": "1. New intraparenchymal blood in the right frontal lobe adjacent to the right\nfrontal approach ventriculostomy catheter.\n2. Extensive subarachnoid and intraventricular hemorrhage with evolution.\n3. There has been slight decompression of the lateral ventricles in comparison\nwith ___.\n4. Status post A-comm aneurysm coiling.\n\nNOTIFICATION: The findings were discussed with ___ NP by ___\n___, M.D. on the telephone on ___ at 3:56 am, 15 minutes after discovery\nof the findings." + }, + { + "input": "Dental amalgam, overlying hardware and A-comm aneurysm clip streak artifact\nlimits examination.\n\nThe known extensive subarachnoid hemorrhage layering in both cerebral\nhemispheres and sylvian fissures is less clearly visualized on today's study,\nwith expected redistribution. Intraventricular hemorrhages are again seen\nlayering in the posterior horns of the lateral ventricles, third, and fourth\nventricles. Interhemispheric hemorrhage superior to aneurysm clip is grossly\nstable. There is no midline shift. There is no definite new intracranial\nhemorrhage.\n\nThe tip of a right frontal approach ventriculostomy catheter is no longer\nnoted within the third ventricle, and is seen abutting the septum pellucidum. \nThe left lateral ventricle and third ventricle appear more prominent as\ncompared to the prior CT exam, concerning for developing obstructive\nhydrocephalus. A small focus of hemorrhage along the ventriculostomy tract\nappears grossly stable in size compared to the prior study in ___.\n\nMucous retention cysts and moderate mucosal thickening are seen in the\nmaxillary sinuses. Aerosolized secretions are also seen in the right\nmaxillary sinus. There is partial opacification of the ethmoid air cells. \nThere is complete opacification of the right sphenoid sinus and near complete\nopacification of the left sphenoid sinus. These findings may be related to\nintubation status. The mastoid air cells and middle ear cavities appear\ngrossly clear. The visualized portion of the orbits are unremarkable. There\nis no evidence of fracture.", + "output": "1. Dental amalgam, overlying hardware and A-comm aneurysm clip streak artifact\nlimits examination.\n2. Tip of a right frontal approach ventriculostomy catheter no longer within\nthe third ventricle, now adjacent to septum pellucidum.\n3. Interval increase prominence of the left lateral and third ventricle,\nconcerning for developing hydrocephalus.\n4. Grossly stable small focus of hemorrhage along the ventriculostomy tract in\nsize compared to the prior study in ___.\n5. Expected redistribution of known extensive subarachnoid, interhemispheric\nand intraventricular hemorrhages.\n6. Within limits of study, no new intracranial hemorrhage.\n\nNOTIFICATION: The findings were discussed with ___, N.P. by\n___, M.D. on the telephone on ___ at 10:12 am, 20 minutes after\ndiscovery of the findings." + }, + { + "input": "Again, dental amalgam, overlying hardware and A-comm aneurysm clipped streak\nartifact partially limit examination. Within these limits:\n\nThe known subarachnoid hemorrhage in both cerebral hemispheres and sylvian\nfissures is similar in appearance to the study dated ___. \nIntraventricular hemorrhages are again seen, layering in the occipital horns\nof the lateral , third, and fourth ventricles. Interhemispheric hemorrhage\nsuperior to the aneurysm clip is grossly unchanged. There is a small area of\nhemorrhage adjacent to the catheter, as before. There is no midline shift. \nThere is no definite new foci of intracranial hemorrhage.\n\nThe tip of the right frontal approach ventriculostomy catheter again abuts the\nseptum pellucidum. The ventricles appears stable in size compared to the\nprior exam.\n\nThere is no evidence of fracture. Mucous retention cyst and moderate mucosal\nthickening are seen in the maxillary sinuses bilaterally. Aerosolized\nsecretions are noted in the bilateral maxillary sinuses. There is partial\nopacification of the ethmoid air cells and complete opacification of the\nbilateral sphenoid sinuses. This is likely related to intubation status. The\nvisualized portion of the mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. No new intracranial hemorrhage appreciated.\n2. Stable appearance of known subarachnoid hemorrhage, ventriculostomy\ncatheter and ventricles." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThe metallic aneurysm coils result in a large amount of beam hardening\nartifact obscuring the area of the anterior communicating artery aneurysm.\nKnown subarachnoid hemorrhage overlying the hemispheres and sylvian fissures\nare unchanged in appearance. Intraventricular hemorrhage is again seen,\nlayering in the occipital horns of the lateral ventricles. Interhemispheric\nhemorrhage superior to the aneurysm clip is grossly unchanged. Again, there is\na small amount of blood adjacent to the catheter. The ventricles appear\nsmaller in size compared to the prior exam. There are aerosolized secretions\nwith air-fluid levels in bilateral maxillary sinuses. Near complete\nopacification of the ethmoids and sphenoid sinuses bilaterally with\naerosolized secretions, likely related to patient's prolonged intubation is\nunchanged.\n\nCTA HEAD:\nThere is mild MCA, PCA, SCA and basilar narrowing consistent with spasm. There\nis severe narrowing of the A2 segments of the ACA, which likely represents\nsevere spasm. The distal right vertebral artery and basilar artery also\nappears narrowed, suggesting spasm. The A1 segments are poorly visualized\nsecondary to metallic artifact.", + "output": "1. The metallic aneurysm coils result in a large amount of beam hardening\nartifact obscuring the area of the anterior communicating artery aneurysm.\n2. Multiple areas of intracranial arterial narrowing most likely representing\narterial vasospasm as described above. No acute arterial occlusion.\n3. Subarachnoid blood is approximately similar in volume compared to prior.\n4. There is mild interval decrease in size of the lateral ventricles.\n5. No new hemorrhage or large territorial infarct.\n\nNOTIFICATION: The findings were discussed with ___, N.P. by\n___, M.D. on the telephone on ___ at 4:38 pm, 15 minutes\nafter discovery of the findings." + }, + { + "input": "Evaluation at the level of the planum sphenoidale is limited by streak\nartifact related to aneurysm coils.\n\nScattered bihemispheric subarachnoid hemorrhage appears unchanged since 1 day\nprior. Intraventricular hemorrhage layering dependently within the occipital\nhorns of the lateral ventricles appears unchanged since 1 day prior, decreased\nsince 4 days prior. Patient is status-post right frontal approach\nventriculostomy catheter placement with the tip located in the third\nventricle, unchanged. There is hypoattenuation of brain parenchyma adjacent\nto the ventriculostomy catheter tract, however degree of mild associated\nhemorrhage product has improved. The ventricles are otherwise essentially\nnormal in size and configuration. Known right posterior convexity subdural\nhematoma is not as well appreciated. No evidence of new intracranial\nhemorrhage.\n\nApparent new hypoattenuation in the inferior bilateral occipital lobes could\nbe related to artifact, less likely infarct given the degree of\nhypoattenuation in the lack of a corresponding stroke on MRI 1 day prior. \nHypoattenuation in the frontal lobes and corpus callosum correspond to known\ninfarcts, better evaluated on MRI obtained 1 day prior. No new, large\nterritorial infarction.\n\nThere is mild mucosal thickening in the bilateral maxillary sinuses, moderate\nmucosal thickening and aerosolized secretions in the sphenoid sinus, and mild\nmucosal thickening in the ethmoid air cells, similar to the MRI obtained 1 day\nprior. There is mild rightward nasal septum deviation posteriorly. There is\npatchy bilateral mastoid air cell opacification, unchanged. An endotracheal\ntube and enteric catheter are partially imaged. Prominence of the superior\nophthalmic veins is unchanged. The orbits are otherwise unremarkable.", + "output": "1. Bihemispheric subarachnoid hemorrhage, bilateral intraventricular\nhemorrhage, right posterior convexity subdural hematoma, and scattered frontal\nlobe and corpus callosum infarcts are not appreciably changed since 1 day\nprior. No evidence of new intracranial hemorrhage or large territorial\ninfarction.\n2. Apparent new hypoattenuation of the inferior bilateral occipital lobes up\nfelt likely to represent artifact given no evidence of acute infarct on MRI\nhead of 1 day prior. However, clinical correlation and attention on follow-up\nis recommended." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nBilateral scattered subarachnoid hemorrhage, bilateral intraventricular\nhemorrhage, and right posterior convex CT's subdural hematoma are more\nconspicuous when compared with prior study. Right frontal approach\nventriculostomy catheter is unchanged in positioning with the tip located\nwithin the third ventricle. No new intracranial hemorrhages identified. The\nbasal cisterns are patent.\n\nMild mucosal thickening of the bilateral maxillary sinuses persists as well as\naerosolized secretions in the sphenoid sinus. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is no significant change in the appearance of multivessel vasospasms\npredominantly in the anterior circulation affecting the A1 segment of both\nanterior cerebral arteries as well as in the A 2 segments and both middle\ncerebral arteries right greater than left side. Mild vasospasm is also seen\nin the posterior circulation as before. No new vascular occlusion is seen.", + "output": "Persistent vasospasm is identified. No vascular occlusion is seen." + }, + { + "input": "There has been interval increase in the degree of ventricular dilation in\ncomparison with ___. There is increased prominence of the lateral\nventricles, including the temporal horns. The third ventricle is also\nslightly more prominent. There is no frank evidence of transependymal\nmigration of CSF.\n\nAgain demonstrated is an evolving subarachnoid hemorrhage, with an interval\ndecrease in visible hyperdense blood products. There remains a small amount\nof intraventricular hemorrhage noted in the posterior horn of the right\nlateral ventricle. There is no new or increasing hemorrhage.\n\nThe patient is status post right frontal approach ventriculostomy, which\nterminates in unchanged position with the tip terminating in the third\nventricle. A hyperdense focus adjacent to the catheter in the right frontal\nlobe is unchanged. Aneurysm coil is noted anteriorly.\n\nThere is no evidence of acute infarct or mass effect.\n\nPostsurgical changes from right frontal approach ventriculostomy catheter are\nnoted. The mastoid air cells are partially opacified, similar prior. There\nis mild mucosal thickening of the maxillary sinuses and anterior ethmoid air\ncells. The visualized portion of the orbits are unremarkable.", + "output": "1. Interval increase in ventricular dilatation, with increased prominence of\nthe lateral ventricles and particularly the temporal horns.\n2. Evolving subarachnoid hemorrhage status post aneurysm coiling.\n3. Status post right frontal approach ventriculostomy catheter in unchanged\nposition terminating in the third ventricle. A hyperdense focus adjacent to\nthe catheter in the right frontal lobe is unchanged.\n\nNOTIFICATION: The ordering clinician was paged on ___ at\napproximately 9:45 a.m. regarding the findings of interval increase in\nventricular dilatation without response." + }, + { + "input": "There has been interval removal of the right frontal approach VP shunt\ncatheter. There remains calcific density embedded within the right frontal\nlobe (02:20). The minimal edema surrounding the calcific density is along the\ntract of the ventriculostomy catheter, not significantly changed from prior\nexam (601:34). There is no midline shift. Compared to prior exam on ___, there is no significant interval change in the degree of\nventricular dilatation, allowing for differences in imaging plane. On the\ncoronal projection, the lateral ventricles measure 38 mm (601:42), stable from\nexam prior to removal of the ventriculostomy catheter. Evaluation for the\nthird ventricular size is limited as streak artifacts limited direct\ncomparison on the most immediate prior exam. However, there is no evidence of\nsignificant interval enlargement. The fourth ventricle remains dilated to a\nsimilar degree. However, the degree of ventricular dilation has progressed\nsince ___, though likely present on ___. The basal\ncisterns remain patent.\nSmall amount of layering hyperdensity remains in the occipital horn of the\nlateral ventricles, unchanged. Pre-existing subarachnoid hemorrhage continues\nto evolve and less conspicuous. Small amount remains along the sulci at the\nvertex (___). Aside from limited evaluation of the brain parenchyma near\nthe aneurysm coil, there is no strong evidence of increasing or new blood\nproducts or territorial infarct.\n\nThere is no evidence of acute fracture. Calcific density along the inner\ntable of right frontal calvarium around the burr hole likely represents\npostsurgical bony fragments. Skin staples remain intact. There is mild\nthickening of the sphenoid sinuses. Partial opacification of the bilateral\nmastoid air cells is likely related to supine positioning. The nasoenteric\ntube is partially imaged. The visualized portion of the remaining paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Grossly stable ventriculomegaly since removal of the ventriculostomy\ncatheter removal, similar to ___.\n2. Continued evolution of subarachnoid hemorrhage. No strong evidence of new\nor enlarging hemorrhage or large territory infarct." + }, + { + "input": "The exam is moderately limited by streak artifacts from the embolization coil\nand patient motion. Within these limits, there is no significant interval\nchange since most immediate prior exam. There is no evidence of new large\nhemorrhage or territorial infarct. There remains hyperdense material embedded\nwithin the right frontal lobe, unchanged from prior exam. The degree of\nhydrocephalus remains stable from prior exam. There is no significant midline\nshift. The basal cisterns remain patent.\nThe craniotomy and cranioplasty in the right frontal calvarium with associated\npostsurgical changes in the right frontal subcutaneous tissue is stable.\nThe nasoenteric tube is persistently present. The mastoid air cells are\npartially opacified, likely related to prolonged supine positioning. \nOtherwise, the visualized portion of the paranasal sinuses, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Moderately limited study due to streak artifacts and patient motion. No\nevidence of new large hemorrhage or territorial infarct.\n2. Stable ventriculomegaly." + }, + { + "input": "Patient is status post anterior communicating artery aneurysm coiling. Streak\nartifact from the coil pack limits evaluation at adjacent levels. Linear\ndensity with surrounding edema in the right frontal lobe, along the hypodense\ntract of a previous ventriculostomy catheter, is again seen. Minimal residual\ndependent blood products are present in the occipital horn of the right\nlateral ventricle. Previously seen subarachnoid hemorrhage is no longer\nvisualized. Ventriculomegaly is stable. No shift of midline structures. \nBasal cisterns are not compressed.\n\nSmall foci of low density in bilateral centrum semiovale on image 2:22, and in\nthe right splenium of the corpus callosum on image 2:19, are unchanged since\n___ CT, corresponding to foci of infarction which were acute on the\nMRI from ___. There is no evidence of new intracranial hemorrhage\nor acute large vascular territorial infarction.\n\nNo concerning osseous abnormalities are seen. The visualized paranasal\nsinuses are grossly well-aerated. There is trace fluid in bilateral mastoid\ntip air cells.", + "output": "1. Stable ventriculomegaly.\n2. Minimal residual blood in the occipital horn of the right lateral\nventricle. Previously seen subarachnoid hemorrhage is no longer visualized. \nNo new intracranial hemorrhage.\n3. Unchanged CT appearance of recent small infarcts in bilateral centrum\nsemiovale and right splenium of the corpus callosum." + }, + { + "input": "There is no hemorrhage, acute large vascular territorial infarct, or brain\nedema. There is preservation of gray-white matter differentiation. The basal\ncisterns are patent. There is no shift of normally midline structures.\nProminence of the ventricles and sulci is compatible with age related\ninvolutional change. Periventricular white matter hypodensities are likely\nthe sequelae of chronic small vessel ischemic change. Senescent\ncalcifications are seen in the bilateral basal ganglia. The imaged paranasal\nsinuses and mastoid air cells are clear. There is degenerative change of the\nleft temporomandibular joint. Bilateral intracranial carotid artery\ncalcifications are seen. The globes and bony orbits are intact. Soft tissue\ndensity within the right external auditory canal may reflect cerumen. There\nis mild soft tissue swelling overlying the superior left parietal calvarium. \nThere is no underlying fracture.", + "output": "No acute intracranial process." + }, + { + "input": "There is high density within the in sulci of the left posterior temporal lobe,\nbest seen on (series 601b, image 52). In additional, there are subtle area of\nhigh density present within sulci in the right frontal lobe (series 32, image\n39). Ventricles and sulci are enlarged suggesting age related atrophy. There\nis ex vacuo dilation of the right frontal horn of the lateral ventricle,\nlikely from prior basal gangliar infarction. Extensive periventricular and\nsubcortical white matter hypodensity, likely sequela of chronic small vessel\ndisease. The basal cisterns are patent and there is preservation of\ngray-white matter differentiation.\n\nNo acute osseous abnormalities seen. There is complete opacification of the\nleft maxillary sinus with bony sclerosis compatible with chronic sinus\ndisease. Opacification of the left ethmoid air cells, left frontal sinus, and\nright sphenoid sinus are also present. The mastoid air cells and middle ear\ncavities are clear.", + "output": "High density involving sulci of the left posterior temporal and right frontal\nlobe could represent acute subarachnoid blood with differentials including\nsiderosis related to chronic blood products, a short interval CT follow-up or\nMRI can be obtained for further evaluation." + }, + { + "input": "The hyperdensity in the left posterior temporal lobe sulcus is not well seen\non this exam. Otherwise, no significant interval change. Subtle area of high\ndensity in the sulci of the right frontal lobe is grossly unchanged. Stable\nprominence of the ventricles and sulci, which suggests cortical volume loss\nthat is likely age-related. Stable ex vacuo dilatation of the right frontal\nhorn of the lateral ventricle, which may be secondary to prior basal ganglia\ninfarct. Again seen is extensive periventricular and subcortical white matter\nhypodensities that are nonspecific but may represent sequelae of chronic small\nvessel ischemic disease. The perimesencephalic cisterns are patent. The\ngray-white matter differentiation is preserved. No shift of normally midline\nstructures.\n\nStable complete opacification of the left maxillary sinus with bony sclerosis,\ncompatible chronic sinus disease. Unchanged opacification of left ethmoidal\nair cells, left frontal sinus, and right sphenoid sinus. The mastoid air\ncells and middle air cavities are clear. No significant interval change. \nThere is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. Unchanged appearance of the\norbits.", + "output": "Hyperdensity in the left posterior temporal lobe sulcus is not well seen on\nthis exam. Otherwise, no significant interval change." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThe focus of late acute to subacute infarct identified within the anterior\nleft thalamus on recent MRI is not definitely identified on this less\nsensitive CT head study. There is no large territorial infarction,\nhemorrhage, edema, or mass-effect. The ventricles and sulci are normal in\nsize and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is a small 1-2 mm infundibulum at the right carotid terminus at the\norigin of the right posterior communicating artery. The there is a persistent\nfetal origin of the left PCA. The vessels of the circle of ___ and their\nprincipal intracranial branches appear otherwise normal without stenosis,\nocclusion, or aneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Focus of late acute to subacute infarct identified within the anterior left\nthalamus on recent MRI is not definitely identified on this less sensitive CT\nhead study.\n2. No dissection, aneurysm or occlusion of the head neck. No significant ICA\nstenosis by NASCET criteria." + }, + { + "input": "Calcifications are noted in the left basal ganglia. However, there is minimal\namount of hyperattenuation seen adjacent to the more lateral calcification,\nwhich may be artifactual but acute punctate intraparenchymal hemorrhage is not\nexcluded (02:11). There is no evidence of acute major vascular territory\ninfarction, edema, or mass. There is prominence of the ventricles and sulci\nsuggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Minimal amount of hyperattenuation adjacent to left basal ganglia\ncalcifications may be artifactual, however, small foci of intraparenchymal\nhemorrhage is not entirely excluded. No large acute infarct.\n\nRECOMMENDATION(S): Attention on follow-up study is recommended." + }, + { + "input": "No interval change of previously seen calcifications left basal ganglia. \nThere is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Prominent ventricles and sulci are seen consistent with\ninvolutional changes.\n\nNo evidence of acute fracture. The imaged paranasal sinuses are clear.\nMastoid air cells and middle ear cavities are well aerated. The bony calvarium\nis intact.", + "output": "Calcification in the left basal ganglia, unchanged since recent exam. No\nsurrounding edema or evidence of intracranial hemorrhage." + }, + { + "input": "Re-demonstration of geographic areas area of subacute infarcts involving the\nACA territory in the right frontal lobe (2:16) as well as the MCA territory in\nthe right frontoparietal lobe (2:22). Within the right frontal lobe ACA\ninfarct territory there is no evidence of hemorrhagic conversion. Within the\ninfarct territory in the right frontoparietal lobe there are several\ncurvilinear hyperdensities. Presumed dilated collateral vessels bloomed\nwithin this region on the prior MR head dated ___ suggesting that\nthese hyperdense structures may reflect cortical vessels, however the\npossibility of small foci of petechial hemorrhagic conversion or small amount\nof subarachnoid blood cannot be entirely excluded. No areas of new infarction\nare identified. No midline shift. Basal cisterns are patent. Ventricles and\nsulci are normal in size and configuration for patient age. Paranasal\nsinuses, mastoid air cells and middle ear cavities are clear. The visualized\norbits are unremarkable.", + "output": "1. Subacute infarcts involving the right ACA territory in the right frontal\nlobe as well as in the left MCA territory in the right frontoparietal lobe. \nNo new areas of infarct are seen.\n2. Curvilinear hyperdensities within the right frontoparietal lobe infarct may\nreflect dilated cortical vessels, however the presence of small amount of\nhemorrhagic conversion or subarachnoid blood cannot be entirely excluded on\nthe basis of this exam.\n\nNOTIFICATION: The findings were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 6:30 am, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST: There is an evolving subacute infarct in the right\nparietal lobe near the vertex. Gyriform hyperdensity along the postcentral\ngyrus in this region is compatible with cortical laminar necrosis. There is a\nchronic infarct in the parafalcine right frontal lobe. There is no new\ninfarct since comparison MRI ___. There is no intracranial\nhemorrhage, edema, mass effect or hydrocephalus. Mild periventricular white\nmatter hypodensities are compatible with chronic microangiopathic ischemic\ndisease.\n\nThe orbits are unremarkable. The paranasal sinuses and mastoid air cells are\nwell-aerated. The calvaria and skull base are unremarkable.\n\nCTA HEAD: There is no intracranial significant arterial stenosis or occlusion.\nThere is no appreciable beading of the intracranial arteries. There is no\naneurysm or vascular malformation. Incidental note is made of fetal origin of\nthe left posterior cerebral artery, benign variant. The dural venous sinuses\nare widely patent.\n\nCTA NECK: There is conventional orientation of the great vessels arising from\nthe aortic arch. The common carotid arteries are widely patent. There is\nminimal calcified atheroma at the left carotid bulb. There is no significant\nstenosis of the internal carotid arteries by NASCET criteria. The\nvertebrobasilar system is widely patent. The vertebral arteries are\ncodominant. No evidence of dissection in the neck.\n\nOTHER: There is no concerning soft tissue lesion in the neck. There are no\npathologically enlarged or abnormally configured cervical lymph nodes. No\nsuspicious nodules are identified on limited images through the lung apices.\nIncidental note is made of an enlarged pulmonary trunk measuring 3.6 cm. This\ncan be seen with pulmonary arterial hypertension.", + "output": "1. Evolving subacute infarct in the right parietal lobe near the vertex. \nGyriform hyperdensity along the postcentral gyrus in this region is compatible\nwith cortical laminar necrosis.\n2. Chronic infarct in the parafalcine right frontal lobe.\n3. No new infarct since comparison MRI ___. No other acute\nintracranial abnormality.\n4. No significant arterial stenosis or occlusion in the head and neck.\n5. Pulmonary trunk enlargement measuring 3.6 cm. This can be seen with\npulmonary arterial hypertension." + }, + { + "input": "No fractures are identified.\nThere is no evidence of facial swelling.\nThere is mild mucosal thickening of the right maxillary sinus. Minimal\nmucosal thickening of the posterior right ethmoid air cells and sphenoid\nsinuses. The ostiomeatal units are patent.\nThere is no evidence of abnormal fluid collections.\nBilateral mastoids appear normal.\nThe globes, extraocular muscles, optic nerves, and retrobulbar fat appear\nnormal.\nThe visualized upper aerodigestive tract appears normal.\nThe mandible and temporomandibular joints appear normal.", + "output": "Minimal to mild inflammatory changes of the paranasal sinuses as above." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage. Left periventricular white\nmatter hypodensity is similar in overall extent compared with recent MRI\nallowing for differences in modality. There is parenchymal calcification in\nthe left centrum semiovale better assessed on prior MRI. There is no midline\nshift or signs of herniation. Overall ventricular and sulcal pattern is\nunchanged. Again seen is opacification of the right sphenoid sinus with the\nremainder of the imaged paranasal sinuses appearing well aerated. The mastoid\nair cells and middle ear cavities are also well aerated. Postsurgical changes\nin the left parietal bone again noted.", + "output": "No acute hemorrhage. Postsurgical changes in the left cerebral hemisphere\nwith similar pattern of white matter hypodensity as compared with recent MRI." + }, + { + "input": "Study is mildly degraded by motion.\n\nLeft periventricular white matter hypodensity and parenchymal calcification\nare overall unchanged from ___. There is no evidence of acute\nintracranial hemorrhage.\n\nPostsurgical changes in the left parietal calvarium are noted.\n\nThe ventricles and sulci are unchanged in size and configuration from ___. There is no midline shift and the basal cisterns are patent.\n\nSphenoid sinus opacification demonstrates an air-fluid level which may be due\nto prolonged supine positioning.", + "output": "1. Study is mildly degraded by motion.\n2. No evidence of acute intracranial hemorrhage.\n3. Stable postsurgical changes, left periventricular white matter hypodensity,\nand parenchymal calcifications from ___.\n4. Sphenoid sinus disease as described, may be due to prolonged supine\npositioning." + }, + { + "input": "A parenchymal calcification adjacent to the atrium of the left lateral\nventricle with surrounding white matter hypodensity involving the entire left\nfrontal lobe is similar in distribution compared to ___. There is no\nevidence of interval infarct or hemorrhage. Prominent ventricles and sulci\nare suggestive age-related involutional changes. Periventricular white matter\nhypodensities in the right hemisphere are consistent with chronic small vessel\nischemic disease.\n\nThe patient is status post left craniotomy with expected postsurgical changes.\nThere is fluid layering in the left sphenoid sinus. The other visualized\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\norbits are unremarkable.", + "output": "No acute hemorrhage. Unchanged distribution of left periventricular\nparenchymal calcification and left frontal lobe white matter hypodensity." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. Prominence of the\nventricles and sulci compatible with moderate atrophic changes. \nPeriventricular white matter hyperintensities are compatible with chronic\nmicrovascular ischemic changes in a patient of this age. There are bilateral\nchronic putaminal lacunes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. Status post lens replacement bilaterally.\n\nCTA HEAD:\nAtherosclerotic calcifications noted at the bilateral cavernous and\nsupraclinoid internal carotid arteries without stenosis.\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThere is calcified plaque formation at the bilateral carotid bifurcations,\nwithout stenosis at either internal carotid artery by NASCET criteria. \nIncidentally noted retropharyngeal course of the right internal carotid\nartery.\nThe vertebral arteries appear normal with no evidence of stenosis or\nocclusion.\n\nOTHER:\nThere is medialization of the right vocal cord with prominence of the right\npiriform sinus suggesting vocal cord paralysis. Evaluation of the lungs\ndemonstrates two subcentimeter calcified granulomas as well as calcified left\nhilar lymphadenopathy, compatible with prior granulomatous disease. The\nvisualized portion of the thyroid gland is within normal limits. There is no\nlymphadenopathy by CT size criteria.", + "output": "Head CT:\n\n-No evidence of mass, hemorrhage or recent infarction.\n-Prominence of the ventricles and sulci compatible with moderate atrophic\nchanges.\n-Periventricular white matter hypodensities are compatible with chronic\nmicrovascular ischemic changes.\n\nCTA head:\n\n-No evidence of vascular stenosis, occlusion or aneurysm formation.\n-Mild opacification of cavernous sinus bilaterally likely secondary to venous\ncontamination.\n\nCTA neck:\n\n-Calcified plaque formation at the bilateral carotid bifurcations without\ninternal carotid artery stenosis by NASCET criteria.\n\nOther:\n\n-Findings suggesting vocal cord paralysis on the right.\n-Left upper lobe calcified granulomas with calcified left hilar adenopathy\ncompatible with prior granulomatous disease." + }, + { + "input": "There is no acute hemorrhage, edema, or mass effect. Ventricles and sulci are\nage appropriate in size and configuration. Basal cisterns are patent. \nGray-white matter differentiation is preserved.\n\nImaged paranasal sinuses, bilateral mastoid air cells, and middle ear cavities\nare clear. Soft tissue density in the external auditory canals most likely\nreflects cerumen. The orbits are unremarkable. The bony calvarium is intact.", + "output": "No acute intracranial abnormality." + }, + { + "input": "Head CT: There effacement of the sulci of the left sylvian fissure compatible\nwith left MCA territory infarct. There is no substantial mass effect or\nintracranial hemorrhage. The ventricles, cerebral sulci and cisterns are age\nappropriate.\n\nCT perfusion: Elevated mean transit time is seen throughout the territory of\nthe left middle cerebral artery. There is diminished cerebral blood flow and\nblood volume compatible with left middle cerebral artery territory infarct.\nThe decreased blood volume is more substantial within the posterior territory\nof the left MCA compatible with core infarct, and ischemia elsewhere within\nthe left MCA territory.\n\nCTA head: There is early bifurcation of the left MCA with complete occlusion\nof the superior M2 division and paucity of the left M2 branching vessels. A\nsmall nonocclusive thrombus or embolus is seen within the the supra clinoid\nsegment of the left internal carotid artery.\n\nNo other significant stenosis or occlusion is identified, though there are\ncalcified atherosclerotic plaques involving both carotid siphons.\n\nCTA neck: The aortic arch demonstrates a normal branching pattern. The\nbilateral common carotid, internal carotid and external carotid arteries are\npatent. Both vertebral arteries are patent. There is no evidence for\nsignificant stenosis by NASCET criteria, occlusion or dissection. The right\ninternal carotid artery is noted to take a retropharyngeal course.\n\nAtelectasis and mosaic attenuation is present at the lung apices. Cervical\nspine degenerative changes are noted.", + "output": "1. Left middle cerebral artery posterior territory infarct with ischemia in\nthe remainder of the left MCA territory. No intracranial hemorrhage.\n2. Early bifurcation of the left middle cerebral artery with complete\nocclusion of the M2 superior division and diminished distal branching." + }, + { + "input": "Intermediate hyperdensity within the left MCA territorial cortex, subcortical\nwhite matter, and basal ganglia are consistent with \"contrast staining\" from\nrecent angiogram, in the setting of left MCA infarction. The frontal horn of\nthe left lateral ventricle is slightly effaced due to cytotoxic edema in this\nterritory. There is no shift of normally midline structures. The basal\ncisterns appear patent. The orbits and globes are unremarkable. The imaged\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nbony calvaria appear intact.", + "output": "Evolving left MCA territorial infarction. No evidence of central herniation." + }, + { + "input": "There is increased hypodensity and loss of gray-white differentiation\nthroughout the left parietal, temporal, and occipital lobes. Hyperdensities\nwithin the effaced sulci likely represent contrast \"staining\" . Hyperdensity\nin the left basal ganglia is stable from ___ and measures 13 x\n12 mm (4:21). The left lateral ventricle remains effaced and shift of normally\nmidline structures is unchanged.\n\nThe basal cisterns appear patent and there is no evidence of central\nherniation. The orbits and globes are unremarkable. There is some fluid in\nthe mastoid tip air cells bilaterally. The imaged paranasal sinuses and middle\near cavities are clear. The calvaria appear intact.", + "output": "1. Evolving left MCA and PCA territorial infarction.\n\n2. Persistent hyperdensity in the left basal ganglia and sulci and likely due\nto contrast \"staining\". No definite hemorrhage, though short-term interval\nfollowup is recommended." + }, + { + "input": "There is minimal mucosal thickening of the ethmoid and maxillary sinuses. The\nostiomeatal units are patent. The cribriform plates are intact. There is no\nnasal septal defect. There is a likely secondary foramen in the right medial\nmaxillary sinus wall, series 601b, image 78. There is a left concha bullosa. \nThere is rightward deviation of the nasal septum. 2 mm right frontal osteoma.\nThe anterior clinoid processes are not pneumatized. The lamina papyracea are\nintact. The sphenoid sinus septum is midline with insertion upon the sellar\nfloor.\n\nAlthough the examination is not optimized for evaluation of the brain\nparenchyma, visualized brain is unremarkable.", + "output": "1. Minimal mucosal thickening of the ethmoid and maxillary sinuses with patent\nbilateral ostiomeatal units." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Basilar cisterns are\npatent.\n\nIncluded paranasal sinuses and mastoids are essentially clear besides mild\nmucosal thickening in the right sphenoid sinus. Swelling seen overlying the\nleft supraorbital region without underlying fracture.", + "output": "Left supraorbital soft tissue swelling without underlying fracture or acute\nintracranial hemorrhage." + }, + { + "input": "There are bilateral hyperdensities along the frontal sulci and in the sylvian\nfissure consistent with bilateral subarachnoid hemorrhage. There is a small\nright frontal subdural hematoma measuring up to 3 mm in thickness. There is a\nsmall right parafalcine subdural hematoma. There is no midline shift. There\nis no evidence of new hemorrhage. There is no evidence of infarction, edema,\nor mass effect. The ventricles and sulci are normal in size and\nconfiguration.\n\nThere is an acute fracture through the occipital bone with extension to the\nskull base and occipital condyle without definite involvement of the left\njugular foramina or carotid canal. There are air-fluid levels in the sphenoid\nsinuses containing high density fluid which may be hemorrhage.\nModerate opacification of the right ethmoid sinuses are noted. There is a\nsmall occipital scalp hematoma. The visualized portion of the remaining\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear.\nThere is soft tissue gas in the preseptal tissues of the right orbit and in\nthe right extraconal space, likely associated with cortical disruption of the\nright orbital roof.", + "output": "1. Acute bilateral subarachnoid hemorrhage.\n2. Acute right frontal and right parafalcine subdural hematoma.\n3. No evidence of new hemorrhage\n4. Acute left occipital fracture extending to the skullbase and anteriorly\nwithout definite involvement of the left jugular foramina or carotid canal. \nHowever, cannot exclude possible vascular injury.\n5. Soft tissue gas is noted in the preseptal tissues of the right orbit and\nright extraconal soft tissue gas associated with disruption of the orbital\nroof.\n6. Opacification of the right ethmoid and bilateral sphenoid sinuses with\nhyperdense material, likely hemorrhage are noted.\n\nNOTIFICATION: The findings were discussed with ___ of the trauma team,\nM.D. by ___, M.D. on the telephone on ___ at 12:07 am, 5 minutes\nafter discovery of the findings." + }, + { + "input": "There is no significant interval change in bilateral subarachnoid hemorrhage,\nand right frontal and parafalcine subdural hemorrhage.\nNo significant midline shift. No large vascular territory infarction. The\nventricles and sulci are stable in size and configuration.\n\nAcute fracture through the left occipital bone is again demonstrated extending\nto the skullbase and towards the direction of the carotid canal without\nevidence of definite cortical disruption.\n\nOpacification of the right sphenoid sinus and right ethmoid sinuses similar to\nprior. The visualized portion of the remaining paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear.\n\nThere is likely disruption of the right superior orbital roof with associated\nsoft tissue gas in the right extraconal space (601; 38).", + "output": "1. No significant interval change in bilateral subarachnoid hemorrhage and\nright frontal and parafalcine subdural hemorrhage.\n2. Right orbital extraconal soft tissue gas associated with likely disruption\nof the right superior orbital roof.\n3. Acute fracture through the left occipital bone again demonstrated extending\ntoward the direction of the carotid canal without evidence of definite\ncortical disruption.\n\nNOTIFICATION: The findings were discussed with Dr. ___, M.D. by ___\n___, M.D. on the telephone on ___ at 7:01 am, 5 minutes after discovery\nof the findings." + }, + { + "input": "There is no evidence of acute intracranial infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Mild periventricular and subcortical white matter\nhypodensities are nonspecific, but most likely sequela of chronic small vessel\nchange.\n\nThere is no evidence of fracture. There is mild thickening of the anterior\nethmoid air cells, as well as a small mucous retention cyst in left maxillary\nsinus. The visualized portion of the mastoid air cellsand middle ear cavities\nare clear.", + "output": "1. No acute intracranial process." + }, + { + "input": "There is a small right frontal parafalcine subarachnoid hemorrhage (series 2,\nimages ___. No other intracranial hemorrhage identified. There is no\nevidence of acute territorial infarction,edema,or mass. Periventricular and\nsubcortical white matter hypodensities are nonspecific but likely sequelae of\nchronic small vessel ischemic disease. There is prominence of the\nventricles and sulci suggestive of involutional changes.\n\nThere is extensive swelling and subcutaneous emphysema overlying the nasal\nbones. There are nondisplaced or minimally displaced nasal bone fractures\n(series 3, images 29 and 30). There is mild relatively diffuse paranasal\nsinus mucosal thickening. The mastoid air cells are clear. There is moderate\ncarotid siphon calcification and severe V4 segment calcification. Bilateral\nlens replacements are noted. The orbits are otherwise unremarkable.", + "output": "1. Small right frontal subarachnoid hemorrhage with no mass effect.\n2. Nasal bone fractures with overlying soft tissue swelling and subcutaneous\nemphysema." + }, + { + "input": "Mixed atheromatous and atherosclerotic changes at the origin of the left\nvertebral artery result in an at least moderate stenosis at its origin. The\ncervical course of the left vertebral artery is unremarkable.\n\nThere is an atherosclerotic plaque at the origin of the right vertebral artery\nresulting in severe stenosis at its origin. The right vertebral artery is\nsmall in caliber and partially only intermittently visualized throughout its\ncervical course, most likely due to atheromatous/atherosclerotic changes.\n\nThere are severe calcifications of the right V4 segment resulting in complete\nocclusion of the vessel.\n\nThere are also severe calcifications of the left V4 segment with areas of\nhigh-grade stenosis of the vessel (series 2, image 189 and 207). The left\nposterior inferior cerebellar arteries visualized. On the right, the ___\nterritory is most likely supplied from a ___ complex.\n\nThe bilateral common carotid and internal carotid arteries are unremarkable.\nThere is no evidence of ICA stenosis by NASCET criteria\n\nAgain noted are the right C5 transverse process, right C5 pedicle and C5\nspinous process fractures with extension of the fracture line in to the\ntransverse foramen. This is better evaluated on the concurrent CT of the\ncervical spine.\n\nNo suspicious pulmonary nodules in the visualized upper lobes. The thyroid\ngland is unremarkable. There is no lymphadenopathy by CT criteria.", + "output": "1. No evidence of traumatic vascular injury.\n2. Severe right and moderate left vertebral artery origin stenosis. \nHypoplastic right vertebral artery with intermittent visualization of its\ncervical portion likely due to atheromatous/atherosclerotic changes.\n3. Severe atherosclerotic changes of the bilateral V4 segments with complete\nocclusion of the right V4 segment before joining the basilar artery and at\nareas of high-grade stenosis of the left V4 segment.\n4. Unchanged fractures involving the right C5 transverse process, pedicle and\nspinous process, better evaluated on the concurrent CT of the cervical spine." + }, + { + "input": "The previously seen subarachnoid hemorrhage tracing along the right\nparafalcine is no longer visualized. However, there is a new left parietal\nsubarachnoid hemorrhage with extension to the occipital lobe. Additionally,\nthere is a new left parietal parafalcine focus of subarachnoid hemorrhage\nspanning approximately 5 mm.\n\n\nThere is a mildly displaced left nasal bone fracture and a nondisplaced right\nnasal bone fracture, unchanged from prior.\n\n\nThere is mild encephalomalacia of the right temporal lobe. There are\nperiventricular and subcortical white matter hypodensities are nonspecific,\nbut most likely related to chronic small-vessel ischemia. There is no\nevidence of large territorial infarction,hemorrhage,edema,or mass. The\nventricles and sulci are normal in size and configuration.\n\n\nThere is no evidence of fracture. There is opacification of the posterior\naspects of the bilateral ethmoid sinuses. There is mild increased mucus in\nthe bilateral maxillary sinuses. There are air-fluid levels of the bilateral\nsphenoid sinuses, consistent with intubation. The remaining visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. There is a periapical lucency of the left second molar. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Left parietal subarachnoid hemorrhage with extension to the occipital lobe\nthat was not seen on prior exam dating ___.\n2. Small foci of left parietal parafalcine subarachnoid hemorrhage measuring\napproximately 5 mm that was not seen on prior exam.\n3. Right parafalcine subarachnoid hemorrhage no longer visualized.\n\nNOTIFICATION: The findings were discussed by ___ with ___\non ___ at , 10 minutes after discovery of the findings." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. There is preservation of the\ngray-white matter differentiation. The basal cisterns remain patent.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial hemorrhage or other acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Mild\nprominence of the cerebellar sulci indicates mild atrophy, advanced for age. \nVentricles are normal in size and configuration.\n\nSubgaleal hematoma overlies the posterior parietal bone towards the apex. \nThere is no evidence of acute fracture. Mild mucosal thickening is seen\ninvolving the ethmoid air cells. The visualized portion of the remaining\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Posterior vertex subgaleal hematoma. No fracture.\n2. No acute intracranial hemorrhage or mass effect.\n3. Mild cerebellar atrophy, perhaps related to chronic alcohol use." + }, + { + "input": "There is a C1 vertebral body fracture ___ fracture) extending toward\nthe left transverse foramen with additional type II comminuted fracture of the\nodontoid process is unchanged when compared to prior exam. Multiple thoracic\nspine vertebral body compression deformities, likely acute, are unchanged when\ncompared to prior exam specifically with height loss of the T2, T3, T4 and T6\nvertebral bodies better characterized on prior imaging. No additional\nfractures are seen.\n\nThere is minimal atheromatous soft plaque and calcification within the aortic\narch although the origins of the great vessels are patent. The aortic arch\ndemonstrates conventional three-vessel branching configuration. The vertebral\narteries are codominant. The carotid arteries bifurcate in the mid-neck. There\nis atheromatous narrowing of the proximal bilateral internal carotid arteries,\nleft greater than right, though without evidence of hemodynamically\nsignificant stenosis by NASCET criteria.\n\nAt the level of the previously described C1 and C2 fractures. There is\ndefinite no evidence of vascular injury or contrast extravasation. Of note,\nthere is an adjacent tubular structure extending to the V3 portion of the left\nvertebral artery best seen on the coronal images (201B: 78 and 79) The right\ncommon carotid artery follows a partially medialized course. There is a tiny\n3 mm focal outpouching within the left supraclinoid ICA, near the takeoff of\nthe left posterior communicating artery (2:243), which may represent a small\naneurysm versus infundibulum.\n\nThe lung apices are unremarkable. There is a 0.8 cm partially calcified\nleft-sided thyroid nodule. Ultrasound examination could be performed for\nfurther evaluation, as clinically warranted. The submandibular glands and\nparotid glands appear normal. The remaining major soft tissue structures\nthroughout the neck are unremarkable. There is multi-level cervical\nspondylosis.\n\nThere is mild left maxillary sinus mucosal thickening.", + "output": "1. ___ type C1 vertebral body fracture with comminuted, type II odontoid\nprocess fracture, as previously described, without definite evidence of\nadjacent vascular injury by CTA imaging. There is however an outpouching of\nthe V3 portion of the left vertebral artery with a relatively tubular\nstructure which is thought to represent a branch vessel. In light of\nsignificant trauma, possibility of pseudoaneurysm is not entirely excluded.\nRepeat CTA with dual energy may help further characterize.\n2. Focal 3 mm outpouching of the left supraclinoid internal carotid artery,\nnear the takeoff of the left posterior communicating artery, which may\nrepresent small aneurysm versus infundibulum.\n3. Atheromatous vascular disease including narrowing of the proximal bilateral\ninternal carotid arteries, left greater than right, though without evidence of\nhemodynamically significant stenosis by NASCET criteria.\n\nNOTIFICATION:\n1. WET READ:\n\n\n\nThe principal arteries of the neck are well opacified throughout their course,\nwith no evidence of dissection, occlusion, critical stenosis, or\npseudoaneurysm. Specifically, the vertebral arteries are normal in course and\ncaliber throughout the V3 and V4 segments, at the level of previously\ndescribed cervical spine fractures, dictated separately on the CT of the\ncervical spine from ___. Mild bilateral atherosclerotic calcifications\nare present at the carotid bifurcations. Subcentimeter thyroid nodule (2:72)\nand biapical scarring are incidentally noted.\n\nFinal read pending 3D reformatted images.\n\nAdditional finding of the left vertebral artery was discussed by Dr. ___\nwith Dr. ___ at 15:25 on ___." + }, + { + "input": "There is an unchanged C1 vertebral body fracture extending toward the left\ntransverse foramen with additional type II comminuted fracture of the odontoid\nprocess. Multiple compression deformities of the upper thoracic spine are\nunchanged and better characterized on prior imaging.\nThere is atheromatous soft plaque and calcification within the aortic arch.\nThe origins of the great vessels remain patent. The aortic arch demonstrates\nconventional three-vessel branching configuration. The vertebral arteries are\ncodominant. Carotid arteries bifurcate in midneck. There is atheromatous\nnarrowing of the proximal bilateral internal carotid arteries, left greater\nthan right, without evidence of hemodynamically significant stenosis by NASCET\ncriteria.\nAt the level of the previously described C1 and C2 fractures there is no clear\nevidence of vascular injury or contrast extravasation. There is a tiny focal\noutpouching of the left supraclinoid internal carotid artery, near the takeoff\nof the left posterior communicating artery, which may represent a small\naneurysm versus infundibulum.\nLung apices are unremarkable. There is a 0.8 cm partially calcified left-sided\nthyroid nodule. The submandibular glands and parotid glands appear normal. The\nremaining major soft tissue structures throughout the neck are unremarkable.\nThere is multilevel cervical spondylosis.\nThere increased fluid in the bilateral maxillary sinuses, ethmoid sinuses, and\nsphenoid sinus. There is a new tracheostomy device.", + "output": "1. Unchanged C1 and C2 comminuted fractures, as described.\n2. No evidence of vascular injury.\n3. Unchanged aneurysm versus small infundibulum a left supraclinoid internal\ncarotid artery." + }, + { + "input": "Head CT: Study is suboptimal secondary to beam hardening artifact from\nstabilization hardware. Allowing for these limits, no gross evidence of acute\nterritorial infarct or new intracranial hemorrhages. Again noted is right\ngreater than left subdural collections overlying the frontal lobes measuring\nup to 9 mm in greatest thickness on the right, similar to slightly increased\nfrom prior examination allowing for differences in technique. Sulci,\nventricles and cisterns are within expected limits for the patient's age\nallowing for mild mass effect from the subdural hematomas/ hygromas. Again\nnoted is a layering hyperdense fluid seen within the frontal sinuses, ethmoid\nair cells and sphenoid sinuses compatible with blood products. Mucosal\nthickening and layering fluid is seen within the bilateral maxillary sinuses\nas well. No clear evidence of calvarial fractures. Unchanged appearance of\ncomminuted C1 fracture.\n\nHead CTA: Atherosclerotic calcification of the bilateral carotid siphons are\nnoted. Suggestion of a 2 mm outpouching at the left paraclinoid ICA is again\nidentified, potentially representing an infundibulum although aneurysm is not\nentirely excluded. Otherwise, the anterior cerebral and middle cerebral\narteries and their major branches are unremarkable. There is a fetal type\norigin of the right posterior cerebral artery. Otherwise the posterior\ncirculation is unremarkable. There is no aneurysm larger than 3 mm. .", + "output": "1. Suggestion of a 2 mm outpouching of the left paraclinoid ICA is again\nidentified, potentially representing an infundibulum although aneurysm is not\nexcluded. There is no evidence of additional aneurysms, in particular of the\nposterior communicating arteries.\n2. Stable to slightly increased size of frontal subdural hygromas or\nhematomas. No evidence of new intracranial hemorrhage or infarct.\n3. Additional findings as above.\n4. Please note no 3D reformats were available at the time of dictation. When\navailable and if there are additional findings, an addendum will be dictated." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are mildly prominent, likely related to volume loss.\nPeriventricular white matter hypodensities likely sequela of chronic small\nvessel disease. The basal cisterns are patent and there is preservation of\ngray-white matter differentiation.\n\nThere is stable aersolized high attenuation secretions within the right\nsphenoid sinus, also seen in ___ (series 3, image 12) that is grossly\nstable compared to the ___ prior CT examination. There is a small\namount of mucosal thickening within the left maxillary sinus. The remainder of\nthe paranasal sinuses are clear. The mastoid air cells and middle ear cavities\nare also clear. There is no evidence of fracture.", + "output": "1. No evidence of acute intracranial hemorrhage.\n2. No fracture identified.\n3. Stable right sphenoid sinus opacification which may represent inspissated\nmucus." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nlarge mass. Periventricular and subcortical white matter hypodensities are\nnonspecific, but likely represent chronic small vessel ischemic disease. There\nis prominence of the ventricles and sulci suggestive of involutional changes.\n\nLeft frontoparietal scalp hematoma is noted without underlying fracture. \nThere is scattered mucosal thickening of the anterior ethmoid air cells. The\nparanasal sinuses, mastoid air cells, and middle ear cavities are otherwise\nclear. The orbits are unremarkable.", + "output": "No acute intracranial process. Left frontoparietal scalp hematoma without\nunderlying fracture." + }, + { + "input": "Aortic arch and origin of great vessels are patent. There is moderate\natherosclerotic calcification at the proximal left ICA, not causing any\nsignificant narrowing by NASCET criteria. Bilateral CCA, right ICA are widely\npatent, without evidence of stenosis by NASCET criteria. Left V1, proximal V2\nsegments are small in caliber and are patent. At C3 level, left vertebral\nartery is occluded, and reconstitutes at C1 level. Left V3, V4 segments are\nirregular, with high grade stenosis at the left V4 segment series 3, image\n161. Findings are likely chronic, there was evidence of slow flow of the left\nvertebral artery above C1 level compared with MRI brain ___. \nRight vertebral artery is dominant and patent. Right Vertebral artery is\ntortuous at the level of right C4 foramen transversarium, without evidence of\ndissection. Visualized dural venous sinuses are patent.\nAgain seen are cervical spine fractures, better seen on CT exam ___. There is left lateral subluxation of C1 on C2, stable. There are\ndegenerative changes in the cervical spine. There is no evidence of\nadenopathy. Lung apices are clear.", + "output": "1. Left vertebral artery is small in caliber, which is likely congenital. \nThere is occlusion of the left vertebral artery at C3 level, with\nreconstitution at C1 level and areas of significant narrowing and ectasia\ninvolving V4 level. Findings may be sequela of chronic dissection, and are\nlikely similar compared with ___, to the extent seen on that\nexam.\n2. There is no evidence of right vertebral artery dissection.\n3. Bilateral internal carotid arteries are widely patent.\n4. Cervical spine fractures, as above, and as seen on prior." + }, + { + "input": "Comminuted fractures of the nasal bones are identified. There is minimally\ndisplaced fracture of the nasal process of the maxilla.\nNondisplaced fracture through the C4 right transverse foramen is again noted.\nChronic nonunion of C1 lateral mass and C2 dens fractures and leftward\nlisthesis of C1 on C2 are again noted.\nMucosal thickening is mild in the left maxillary sinus.\nSoft tissue swelling and laceration is present in the left frontal and zygoma.", + "output": "1. Comminuted fractures of the nasal bones. Minimally displaced fracture of\nthe nasal process of the maxilla.\n2. Nondisplaced fracture through the C4 right transverse foramen better\nassessed on dedicated cervical spine CT.\n3. Chronic nonunion of C1 lateral mass and C2 dens fractures and leftward\nlisthesis of C1 on C2." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction, mass or midline\nshift. There is no hydrocephalus. Visualized paranasal sinuses and mastoid air\ncells are clear. There is no fracture.", + "output": "Unremarkable unenhanced head CT." + }, + { + "input": "There are subtle hypodense collections along the bilateral frontal\nconvexities, left greater than right,, and right parietal, temporal lobes,\nwhich likely represent chronic subdural hematomas, or hygromas. No acute\nhemorrhage. There is a ventriculoperitoneal shunt in place with tip extending\nto the left lateral ventricle. Ventricles are of normal size, there are not\nslit-like.\n\nThere is no evidence of acute large territorial infarction, edema,or mass. \nBrain parenchymal atrophy. Findings consistent with chronic small vessel\nischemic change. There is more volume loss in the right hemisphere. Small\narea of encephalomalacia right parietal lobe near the VP shunt tract. No\nmidline shift, no herniation.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Bihemispheric low-density subdural fluid collections, consistent with\nchronic subdural hematomas or hygromas. No acute hemorrhage.\n2. Right greater than left brain parenchymal atrophy.\n3. Encephalomalacia right parietal lobe. VP shunt." + }, + { + "input": "There is redemonstration of a right posterior parietal approach VP shunt with\ntip traversing the septum pellucidum and terminating in the left lateral\nventricle in stable position. There is interval worsening bilateral lateral\nventricle, third ventricle and fourth ventricle hydrocephalus with prominent\ntransependymal CSF flow. There is no acute intracranial hemorrhage. There is\ninterval resolving bilateral subdural fluid collection. There is\nredemonstration of right posterior parietal lobe encephalomalacia. There is\nredemonstration of right greater than left cerebral atrophy.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. Interval worsening hydrocephalus involving all the ventricles with\nworsening transependymal CSF flow. No evidence of acute intracranial\nhemorrhage.\n2. Interval resolving bilateral subdural fluid collection.\n3. Stable right posterior parietal encephalomalacia.\n4. Right greater than left cerebral atrophy." + }, + { + "input": "Redemonstration of a right posterior parietal approach ventriculoperitoneal\nshunt catheter, similar to the previous examination. The lateral and third\nventricles as well as the fourth ventricle remains prominent, but are not\nsignificantly changed in size compared to the previous examination. There is\ncontinued confluent periventricular hypoattenuation in the white matter, which\nis nonspecific. There no evidence of worsening hydrocephalus compared to the\nmost recent previous examination, and there is no new extra-axial collection. \nThere is no evidence of developing acute/subacute vascular territorial\ninfarction. No new hemorrhage. Encephalomalacia is again seen in the right\nposterior parietal lobe.\n\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal, with\nbilateral lens replacements noted.", + "output": "1. Stable configuration of the ventricles with no evidence of worsening\nhydrocephalus compared to the exam on ___.\n2. No new extra-axial collection." + }, + { + "input": "Again seen is a right posterior parietal approach ventriculoperitoneal shunt\ncatheter, similar in position. There is no evidence of fracture,\ninfarction,hemorrhage,edema, or mass effect. The ventricles and sulci are\nprominent, unchanged in comparison to prior. Redemonstrated confluent\nperiventricular white matter hypodensity, similar to prior.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear.", + "output": "1. No evidence of acute intracranial pathology. No significant interval\nchange from ___. Stable appearance of the ventricles and right\nposterior parietal ventricular shunt." + }, + { + "input": "There is redemonstration of a right parietal approach ventriculostomy catheter\nwhose tip projects over the left lateral ventricle, similar to prior. The\ndegree of ventriculomegaly is overall unchanged. Periventricular and\nsubcortical white matter hypodensities are nonspecific but likely sequelae of\nchronic small vessel ischemic disease. There is no evidence of hemorrhage.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. Status post bilateral lens replacement; otherwise,\nthe visualized portion of the orbits are normal.", + "output": "1. No acute intracranial process.\n2. Stable positioning of the right parietal approach ventriculostomy catheter\nwhose tip projects over the left lateral ventricle. Stable appearance of the\nventricles." + }, + { + "input": "There is redemonstration of a right parietal approach ventriculostomy catheter\nwith the tip terminating in the left lateral ventricle, adjacent to the septum\npellucidum. Hydrocephalus is again seen with third ventricle measuring\napproximately 14 mm in transverse dimension, unchanged. Overall there is no\nevidence of fracture, acute major infarction,hemorrhage,edema,or mass effect. \nPeriventricular and subcortical white matter hypodensities are nonspecific but\ncan suggest chronic small vessel ischemic changes and or transependymal CSF\nmigration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. Unchanged position of ventriculostomy catheter with persistent\nhydrocephalus potentially concerning for shunt malfunction. Please see report\nfor same day shunt series.\n2. Periventricular white matter hypodensities likely reflect chronic\nmicrovascular disease though may also reflect transependymal CSF migration." + }, + { + "input": "There is no evidence of acute large territory infarction,intracranial\nhemorrhage,edema,or discrete mass. The ventricles and sulci are\nage-appropriate.\n\nDegenerative changes seen at the temporomandibular joints. There is no\nevidence of fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavitiesare essentially clear. Patient is\nstatus post bilateral lens replacements.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is minimal parafalcine subarachnoid hemorrhage within the left medial\nfrontal sulci (02:23, 601b:65). This appears grossly unchanged compared to\nthe sagittal reformats from the outside facility head CT performed earlier on\nthe same date. No other intracranial hemorrhage identified. There is no\nevidence of acute vascular territorial infarction, mass or edema. Ventricles\nand sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Unchanged small left frontal subarachnoid hemorrhage. No new intracranial\nhemorrhage identified." + }, + { + "input": "Again seen is a small left frontal subarachnoid hemorrhage (02:21). No new\nhemorrhage is identified. This is unchanged since the most recent\nexamination. There is no evidence of large territorial infarction, mass, or\nedema. The ventricles and sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "Unchanged small left frontal subarachnoid hemorrhage. No new hemorrhage\nidentified." + }, + { + "input": "1 cm x 0.8 mm x 0.6 mm exophytic nodule left nasal sidewall. Soft tissue\nthickening of the tip of the nose. Findings consistent with known neoplasms.\n\nNo involvement of the adjacent bones. No extension into the nasal vestibule,\nseptum. Symmetric appearance of infraorbital foramen and canal, without\nexpansion or soft tissue fullness.. Normal orbital contents.\n\nMultiple additional skin nodules at the forehead, right temple at the level of\nzygomatic arch, right inferolateral face, left supra zygomatic temple. \nAdditional nodule left infra-auricular soft tissues.\n\nVisualized intracranial structures, oropharynx, nasopharynx, larynx, upper\nneck soft tissues, vessels are normal. No adenopathy. Degenerative changes\nspine. Nasal septal deviation to the right.", + "output": "1. 2 nasal skin lesions.\n2. No evidence of perineural tumor, bone involvement or adenopathy.\n3. Additional skin lesions elsewhere, as above." + }, + { + "input": "The study is limited due to dental amalgam artifact.\n\nThere has been interval increase in size of previously noted left\ninfra-auricular region measuring approximately 1.5 x 0.8 cm (301:60, 601:109),\npreviously measuring approximately 11 x 4.5 mm (see 3:79 on prior exam). \nWithin limits of study, fat plane along medial margin of the mass and lateral\nmargin of adjacent parotid gland is grossly preserved (see 301: 57-73). No\nevidence of osseous invasion.\n\nExophytic nodule along the left nasal sidewall is no longer seen, and there is\nskin thickening in this region (see 301:61 on current study and 3:47 on prior\nexam).\n\nGrossly stable left frontal supraorbital scalp faint dermal lesion is again\nseen (see 301:20 on current study and 3:13 on prior exam).\n\nA second left lateral frontal supraorbital scalp dermal lesion is again seen\n(see 301:8 on current study and 3:4 on prior study).\n\nA third left frontal supraorbital frontal scalp lesion seen on prior exam is\nnot definitely identified on current study (see 3:6 on current study and 301:8\non prior exam).\n\nPreviously seen left suprazygomatic temple lesion is not definitely seen on\ncurrent study, though skin thickening is noted (see 3:32 on prior exam through\n1:41 on current study).\n\nPreviously noted right temple at levels of zygomatic arch lesion is not\nclearly seen on current study (see 3:54 on prior exam and 301:93 on current\nexam).\n\nPreviously noted right inferolateral face lesion is not clearly seen on\ncurrent study (see 3:106 on prior exam and 301:109 on current study).\n\nThere is no cervical lymphadenopathy by size criteria. Scattered\nsubcentimeter nonspecific lymph nodes are noted throughout the visualized\nportion of the neck bilaterally, without definite enlargement by CT size\ncriteria. An approximately 2 mm right parotid gland probable lymph node is\nagain seen (see 301:54 on current study and 3:73 on prior exam).\n\nThere is minimal mucosal thickening in the anterior ethmoid air cells. \nMastoid air cells and middle ear cavities are clear. The imaged neck\nvasculature is patent.\n\nLeft maxillary tooth periapical lucencies seen (see 602:96). Left mandibular\ntooth periapical lucency is also noted (see 602:101). Bilateral\ntemporomandibular joint degenerative changes are noted. Soft tissue density\nis noted within the left external auditory canal, which may represent cerumen.\nThe visualized osseous structures are osteopenic.", + "output": "1. Dental amalgam streak artifact limits study.\n2. Interval progression in size of left infra-auricular cutaneous lesion\nwithout definite invasion of the underlying parotid gland or osseous\nstructures as described.\n3. No lymphadenopathy by size criteria. Additional scattered subcentimeter\nnonspecific lymph nodes as described.\n4. Additional grossly stable cutaneous lesions as described.\n5. Nonvisualization of multiple previously noted dermal lesions as described. \nQuestion interval resection versus differences in technique.\n6. Minimal paranasal sinus disease , as described.\n7. Left maxillary and mandibular periodontal disease as described." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nNo evidence for acute hemorrhage, edema, mass effect, or acute major vascular\nterritorial infarction. Ventricles and sulci are normal in size.\n\nThere is a small amount of dependent secretions/fluid in the left sphenoid\nsinus. There is mild mucosal thickening in the right anterior ethmoid air\ncells with occlusion of the right frontoethmoidal recess and mild mucosal\nthickening in the inferior right frontal sinus. There is a mucous retention\ncyst in the left anterior ethmoid on image 4:220. There are small mucous\nretention cysts and mild mucosal thickening in the inferior right maxillary\nsinus. Mastoid air cells and middle ear cavities are clear. The orbits\nappear unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal widely patent without evidence for flow-limiting stenosis or\naneurysm. The dural venous sinuses are patent.\n\nCTA NECK:\nGreat vessel origins are widely patent. Bilateral common carotid and cervical\ninternal carotid arteries are widely patent without stenosis by NASCET\ncriteria. Dominant right vertebral artery is widely patent. Non dominant,\ndiminutive left vertebral artery arises directly from the aortic arch, a\nnormal variant, demonstrating no evidence for flow-limiting stenosis.\n\nCT PERFUSION:\nNo areas of decreased cerebral blood flow or increased mean transit time are\ndetected.\nCBF<30% Volume: 0 mL\nTmax > 6.0s: 0mL\n\nOTHER:\nThe visualized portion of the lungs are clear. A 2 mm hypoattenuating nodule\nin the right lobe of the thyroid does not warrant further imaging. No\npathologically enlarged lymph nodes by CT criteria. No evidence for\nsuspicious bone lesions.", + "output": "1. No evidence of acute intracranial abnormalities. MRI would be more\nsensitive for an acute infarction, if clinically warranted.\n2. Normal CTA of the head and neck. The left vertebral artery arises directly\nfrom the aortic arch, a normal variant." + }, + { + "input": "There is a low-attenuation nodule in the right submandibular gland measuring\napproximately 8 x 7 x 8 mm on image 3:30 and 06:27 with peripheral rim\nenhancement. This is likely not a cyst given the presence of internal\nvascularity on the prior ultrasound. Given the absence of overlying fat\nstranding, local lymphadenopathy and clinical signs and symptoms of infection,\nthis is unlikely to be abscess / phlegmon. This is concerning for a salivary\ngland neoplasm.\n\nNo focal mass is seen in the parotid gland. The previously described fatty\nlesions in the right parotid gland are favored to be glandular fat.\n\nThe left parotid and submandibular glands are unremarkable.\n\nEvaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect.\n\nThe thyroid gland appears normal. There is no lymphadenopathy by CT criteria.\nThe neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules.\n\nMultilevel, multifactorial degenerative changes are seen throughout the\ncervical spine, consistent with anterior and posterior spondylosis, bilateral\nuncovertebral hypertrophy, more severe from C3/C4 through C6/C7 levels.\n\nThere is a mucous retention cyst in the right maxillary sinus. The remaining\nvisualized paranasal sinuses are clear.", + "output": "1. Low-attenuation nodule in the right submandibular gland, favored to be a\nsalivary gland neoplasm. Please refer above for details.\n2. Previously described fatty lesions in the right parotid gland are favored\nto be glandular fat. No focal mass lesion is seen." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Periventricular and subcortical white matter hypodensities are\nnonspecific, but likely reflect sequelae of chronic small vessel ischemic\ndisease. Prominence of the ventricles and sulci suggest involutional changes.\nThe carotid siphons are calcified. The imaged paranasal sinuses are clear.\nMastoid air cells and middle ear cavities are well aerated. The bony calvarium\nis intact. Minimal left suboccipital scalp soft tissue swelling is noted (see\n601b:82).", + "output": "1. No evidence of acute hemorrhage or fracture.\n2. Minimal left suboccipital scalp soft tissue swelling.\n3. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct.\n4. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described." + }, + { + "input": "There is no hemorrhage, acute large vascular territorial infarction, or edema.\nThere is preservation of gray-white matter differentiation. The basal\ncisterns are patent, and there is no shift of normally midline structures. \nThe ventricles and sulci are normal in caliber and configuration. Sequelae of\nrecent surgery are seen, including fat stranding and subcutaneous emphysema in\nthe posterior neck soft tissues, a midline occipital bony defect status post\noccipital craniectomy, as well as small foci of posterior fossa gas, a larger\npocket of which has apparently migrated in an anti-dependent fashion just\nanterior to the pons, below the suprasellar cistern. Other than a small\nmucous retention cyst in the right sphenoid sinus, the visualized paranasal\nsinuses and mastoid air cells are clear. The globes and bony orbits are\nunremarkable.", + "output": "1. No acute intracranial process.\n2. Expected sequelae of recent surgery, including occipital bony defect,\npneumocephalus, and posterior neck soft tissue stranding and subcutaneous\nemphysema." + }, + { + "input": "There is no acute intracranial hemorrhage, edema, mass effect, or evidence of\nlarge vascular territorial infarction. The ventricles and sulci are normal in\nsize and configuration. There is a prominent arachnoid granulation in the\nlateral left transverse sinus (2:11).There are mild non-specific\nperiventricular and subcortical white matter hypodensities which can be seen\nin patients with chronic small vessel ischemia. There are atherosclerotic\ncalcifications of the bilateral cavernous carotid arteries. There is no\nfracture. The imaged paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear.", + "output": "No evidence of acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Within limits of study, no definite volume loss compared to ___ prior\nexam. Please note MRI of the brain is more sensitive for the evaluation of\nglobal and focal cerebral volume loss." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or shift of midline\nstructures. A 1.5 x 3.1 cm retrocerebellar CSF density space may represent an\narachnoid cyst ___ cisterna magna. The ventricles and sulci are normal in\nsize and configuration.\n\nThere is no evidence of fracture. There is complete opacification of the left\nmaxillary sinus which is atelectatic. High-density material is also seen\nwithin the left maxillary sinus. Mucosal thickening within the ethmoid air\ncells and sphenoid sinuses, as well as a small right mucous retention cyst,\nare also detected. Remaining paranasal sinuses appear clear. Mastoid air\ncells and middle ear cavities clear. Orbits are unremarkable.", + "output": "1. No acute intracranial hemorrhage.\n2. 3.1 x 1.5 cm posterior fossa arachnoid cyst versus ___ cisterna magna.\n3. Complete opacification of the left maxillary sinus which appears\natelectatic, findings compatible with sinusitis, likely acute on chronic. \nHigh-density material within the left maxillary sinus may be due to\ncolonization with fungal elements." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is bilateral anterior and\nposterior cervical chain, submandibular and submental lymphadenopathy, with\nthe largest lymph nodes being the jugulodigastric lymph nodes measuring up to\n1.3 cm in short axis on the right, and up to 1.6 cm on the left. The neck\nvessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.\n\nThere is complete opacification of the left maxillary sinus, with high-density\nmaterial partially imaged on the noncontrast head CT. The atelectatic\nappearance of the maxillary sinus suggests a chronic component.", + "output": "1. No evidence of retropharyngeal abscess.\n2. Complete opacification of the atelectatic left maxillary sinus, suggestive\nof acute on chronic sinusitis.\n3. Bilateral cervical lymphadenopathy is likely reactive, but should be\ncorrelated clinically and followed to resolution.\n\nRECOMMENDATION(S): Clinical follow-up to ensure resolution of bilateral\ncervical lymphadenopathy that is thought to be reactive." + }, + { + "input": "No evidence for acute infarction, hemorrhage, mass effect or edema.\nPeriventricular and subcortical white matter hypodensities are nonspecific but\nlikely sequelae of chronic small vessel ischemic disease. Asymmetric\nprominence of the right lateral ventricle, as seen on prior may be an anatomic\nvariant.\n\nSubtle scalp hematoma overlying the right posterior parietal bone. The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No acute territorial infarction or hemorrhage. No fracture.\n2. Small right posterior parietal scalp hematoma." + }, + { + "input": "The study is severely motion degraded despite repeated attempt.\n\nWithin this limitation, there is no evidence of acute territorial\ninfarction,intracranial hemorrhage,edema,or mass. There is prominence of the\nventricles and sulci suggestive of involutional changes. Asymmetric\nprominence of the right lateral ventricle is again demonstrated, unchanged and\npossibly congenital. Periventricular and subcortical white matter\nhypodensities are nonspecific, but likely reflect sequelae of chronic small\nvessel ischemic disease.\n\nNo visualized calvarial fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are normal.", + "output": "Severely motion degraded study. Within this limitation, no evidence of acute\nintracranial process." + }, + { + "input": "There is an acute left frontal parietal subdural hemorrhage measuring\napproximately 5 mm in maximal thickness. . There is mild effacement of\nadjacent sulci but no other significant mass effect. There is no other\nintracranial hemorrhage, edema or acute territorial infarction. The ventricles\nare enlarged, likely due to atrophy. There is periventricular white matter\nhypodensity consistent with chronic small vessel ischemic disease. More focal\nhypodensity within the left basal ganglia may represent a lacunar infarction.\n\nDiffuse geographic areas of sclerosis are noted in the calvarium with some\nmore discrete circumscribed lesions near the vertex. There is no acute\nfracture. There is mucosal thickening in of the right frontal sinus and\nmaxillary sinuses and complete opacification of the left frontal sinus. There\nis partial opacification of the mastoid air cells bilaterally though left\ngreater than right. The remainder of the paranasal sinuses and middle ear\ncavities are clear.", + "output": "1. Acute to subacute left frontoparietal subdural hemorrhage measuring 5 mm\nwith minimal mass effect on adjacent sulci.\n2. Multiple areas sclerosis in the calvarium worrisome for osseous metastases.\nCorrelate clinically for history of malignancy.\n3. Sinus disease and partial opacification of the mastoid air cells." + }, + { + "input": "The known left frontoparietal subdural hematoma measuring 5 mm in maximal\nthickness, without significant mass effect, has not significantly changed\n(3:18). There is no evidence of infarction, new hemorrhage, edema, or mass. \nThe ventricles and sulci are prominent, due to age related volume loss.\nPeriventricular white matter hypodensities, consistent with chronic small\nvessel ischemic disease, are unchanged. The more focal hypodensity in the left\nbasal ganglia is unchanged.\n\nNo change in the diffuse geographic areas of calvarial sclerosis, with more\ndiscrete lesions near the vertex. No acute fracture. The paranasal sinuses and\nmiddle ear cavities are clear. Partial opacification of the left greater than\nright mastoid air cells is unchanged. The orbits are unremarkable.", + "output": "1. No change in the known left frontoparietal subdural hematoma.\n\n2. No acute intracranial hemorrhage or infarction." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Basilar cisterns are\npatent.\n\nIncluded paranasal sinuses and mastoids are clear. Left supraorbital\nlaceration is noted without underlying fracture. Skull and extracranial soft\ntissues are otherwise unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is a hypodense subdural collection along the right cerebral convexity\nwith some septations consistent with a subacute to chronic subdural hematoma.\nThere is no hyperdensity to suggest acute hemorrhage. The hematoma measures 25\nmm in maximal dimension from the inner table and causes 5 mm of leftward shift\nof normally midline structures. There is effacement of the right frontal and\nparietal sulci with mild effacement of the anterior horn of the right lateral\nventricle and dilation of the temporal horn of the right lateral ventricle.\nThe overall appearance is unchanged compared to the MRI performed 4 hours\nprior. The basal cisterns appear patent and there is preservation of\ngray-white matter differentiation. The focal hypodensities in the right\nlentiform nucleus and caudate body suggest prior lacunar infarcts.\n\nNo fracture is identified. There is mucosal thickening in the bilateral\nsphenoid sinuses as well as the left ethmoid air cells and the left frontal\nsinus. The remaining visualized paranasal sinuses, mastoid air cells and\nmiddle ear cavities are clear. The globes are unremarkable.", + "output": "Large subacute to chronic right subdural hematoma causing 5 mm of leftward\nshift of normally midline structures. No evidence of acute hemorrhage." + }, + { + "input": "The patient is now status post right frontal craniotomy and decompression of\nthe subdural hematoma with a surgical drain in place. There is expected\npostoperative pneumocephalus in the subdural space. There is minimal high\ndensity fluid in the posterior subdural space, consistent with postoperative\nhemorrhage. The mass effect seen on the prior study has resolved, with no\nshift of midline structures seen.\n\nThere is no other acute intracranial hemorrhage nor evidence of large vascular\nterritorial infarction. The ventricles and sulci are normal in size and\nconfiguration. There are non-specific periventricular and subcortical white\nmatter hypodensities which can be seen in patients with chronic small vessel\nischemia. There is no fracture. There is mucosal thickening in the ethmoid air\ncells with aerosolized secretions in the sphenoethmoidal recesses. There are\nair-fluid levels in the sphenoid sinuses. The frontal and maxillary sinuses\nare clear. The mastoid air cells and middle ear cavities are clear.", + "output": "Status post decompressive right frontal craniotomy for subdural hematoma with\nresolution of the leftward shift of midline structures seen preoperatively. \nThere is expected minimal acute blood and pneumocephalus in the subdural\nspace." + }, + { + "input": "Patient is status post right frontal craniotomy with evacuation of right\nsubdural hemorrhage. Pneumocephalus is resolving. However, there is increasing\nsize of the mixed density subdural fluid collection particularly posteriorly\nmaximally measuring 2 cm (601b:69) previously 1.4 cm. Anteriorly the thickness\nis approximately unchanged. Degree of midline shift is stable approximately 2\nmm. Size and configuration of the lateral ventricles is unchanged with slight\nprominence of the right temporal horn. The basal cisterns are patent. There is\nno evidence of large territorial infarction; gray-white matter differentiation\nis preserved.\n\nAgain there is postoperative gas in the right masticator space and right\nscalp. Again there are aerosolized secretions in the left sphenoid ethmoidal\nrecess. Mucosal thickening in the ethmoidal air cells and sphenoid sinuses is\nunchanged. The mastoid air cells and middle ear cavities are clear.", + "output": "Slight increased size of right subdural mixed density collection particularly\nposteriorly as detailed above. No significant increase in midline shift and no\nevidence of central herniation.\n\nNOTIFICATION: The findings were telephoned to Dr. ___ by ___\nat 20:05, ___, 5 min after discovery." + }, + { + "input": "Patient is status post right frontal craniotomy with evacuation of right\nsubdural hemorrhage. There is stable pneumocephalus. The mixed density\nright-sided subdural fluid collection is grossly unchanged in size, with\nstable 2 mm leftward deviation of the normally midline structures. The size\nand configuration of the lateral ventricles is unchanged, with slight\nprominence of the right temporal horn. The basal cisterns appear patent.\nGray-white matter differentiation is preserved.\n\nAgain seen is postoperative gas in the right masticator space and right scalp.\nThere is fluid layering in the bilateral sphenoid sinuses and in multiple\nethmoid air cells. The mastoid air cells and middle ear cavities are clear.\nThe globes are unremarkable.", + "output": "No significant interval change in size of the mixed density right subdural\nfluid collection. Stable 2 mm of leftward deviation of the normally midline\nstructures." + }, + { + "input": "Patient is status post right frontal craniotomy with evacuation of right\nsubdural hemorrhage. When compared to most recent study dated ___, the\nextra-axial collection demonstrates evolving blood products, unchanged in\nsize. Previously identified pneumocephalus has resolved. No new hemorrhage is\nidentified. Subtle effacement of adjacent sulci is noted. There is no shift of\nnormally midline structures. Previously identified right basal ganglia\nhypodensity is nonspecific though may reflect prominent perivascular space or\nlacune. Gray-white matter differentiation is preserved. Basal cisterns are\nclear.\n\nIncreased from prior examination, there is fluid layering within the bilateral\nsphenoid sinuses with aerosolized secretions. Additionally there are\nsecretions noted within the ethmoidal air cells. Bilateral maxillary sinuses\ndemonstrate trace mucosal thickening. Mastoid air cells and middle ear\ncavities are clear. Postoperative changes of the right frontal bone again\nidentified.", + "output": "No significant interval change in the size of the mixed density right\nconvexity subdural fluid collection. No new hemorrhage identified.\n\nBilateral sphenoid sinus air-fluid levels with aerosolized secretions as well\nas ethmoidal cell aerosolized secretions." + }, + { + "input": "CT Head: There is no mass-effect, midline shift, or space-occupying lesion.\nThere is no hemorrhage or extra-axial fluid collection. There is no acute\nterritorial infarct.\nThere is prominence of the sulci in the posterior parietal lobes at the\nvertex, likely related to some degree of parenchymal volume loss.\nVentricles are normal in size. Basal cisterns are patent.\n\nThere is no displaced calvarial fracture. There is right frontoparietal scalp\nswelling. There is partial opacification of the left maxillary sinus. The\nparanasal sinuses are otherwise clear. The mastoid air cells and tympanic\ncavities are clear.\n\nCTA Head: The intracranial internal carotid arteries are normal in\nconfiguration. The anterior and middle cerebral arteries are patent with\nnormal contrast enhancement and branching pattern. There is a normal anterior\ncommunicating artery complex.\n\nThe vertebral and basilar arteries demonstrate normal enhancement without\nstenosis or occlusion. The posterior cerebral arteries have a normal branching\npattern. The posterior communicating arteries are visualized.\n\nThere is no evidence of stenosis, occlusion, aneurysm or arteriovenous\nmalformation.\n\nCTA Neck: The visualized aortic arch and origins of the great vessels are\nunremarkable.\n\nThe right common, internal and external carotid arteries are normal in\nappearance. There is no evidence of a significant stenosis by NASCET criteria\nor a dissection.\n\nThe left common, internal and external carotid arteries are normal in\nappearance. There is no evidence of a significant stenosis by NASCET criteria\nor a dissection.\nA tiny outpouching at the left common carotid division, may relate to\natheroscleroic disease or ulcerated plaque.\n\nThe cervical portions of the vertebral arteries demonstrate normal\nenhancement. There is no evidence of a significant stenosis by NASCET criteria\nor a dissection.\n\nMild degenerative changes in the cervical spine, with disc osteophyte complex\nat C6-7 level indenting the thecal sac outline.\n\nMucosal thickening/secretions along posterior trachea.\nEmphysematous changes in the lungs.", + "output": "1. Patent major arterial vasculature of the head, without significant\nstenosis (by NASCET criteria), dissection, or aneurysm. Arterial branches are\nbetter seen on the source images, Study somewhat limited due to venous\nenhancement.\n2. No significant stenosis (by NASCET criteria) or dissection of the major\ncervical arterial vasculature.\nA tiny outpouching at the left common carotid division, may relate to\natheroscleroic disease or ulcerated plaque.\n3. No acute territorial infarct, space-occupying lesion, or intracranial\nhemorrhage on noncontrast head CT.\n4. Right frontoparietal scalp hematoma. Some degree of volume loss in the\nposterior parietal lobes on both sides.\nOther details as above." + }, + { + "input": "Of note, there is motion artifact which limits evaluation of the intracranial\nstructures. Within these limitations, there is no evidence of acute major\nvascular territory infarction,hemorrhage,edema, or mass. The ventricles and\nsulci are normal in size and configuration.\n\nThere is a cortical irregularity seen along the right nasal bone thought to be\nchronic given absence of overlying soft tissue edema. (Series 3: Image 26). \nA mucous retention cyst is noted in the left maxillary sinus. Otherwise, the\nremaining visualized portion of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial abnormalities.\n2. Subtle deformity of the right nasal bone may be chronic. Please correlate\nclinically." + }, + { + "input": "The patient is post right fronto-parietal craniotomy, with expected post\noperative changes (pneumocephalus), without evidence of significant\nhemorrhage. There is a persistent area of low density in the right frontal\nlobe, likely a sequelae from prior mass effect. The ventricles and sulci are\nnormal in size and configuration.\nApart from postoperative changes, no osseous abnormalities seen. The paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "Expected postoperative changes after right frontal parietal craniotomy, with\nno significant hemorrhage or mass effect." + }, + { + "input": "Head CT: Postoperative changes are identified. Small amount of pneumocephalus\nis seen. Expected postsurgical seen changes seen without evidence of a\nhematoma. Hyperdensities at the right parietal region represent the areas of\nedema at the site of previously seen lesions. These are not completely\nevaluated.\n\nHead CTA: The intracranial arteries appear normal with no evidence of\nstenosis, occlusion, or aneurysm formation.\n\nThe site of craniotomy at the convexity and in the superior sagittal sinus is\nnot fully visualized. It appears to be displaced inward.", + "output": "Postoperative changes of craniotomy are seen at the parietal convexity region\nwith expected postsurgical changes. No arterial abnormalities are seen. The\nsuperior sagittal sinus appears to be displaced in the region of craniotomy\nand is not continuous visualized. It can be better delineated with MRI with\ngadolinium MPRAGE images, if clinically indicated." + }, + { + "input": "The patient is status post right sided craniotomy. There is a large area of\nintraparenchymal hemorrhage involving the right frontal and parietal lobes at\nthe vertex (series 2 a image 24) measuring 6.0 x 4.8 x 4.8 cm with surrounding\nedema and mass effect.\n\nA focus of hypodensity in the left frontal lobe is unchanged from mprior\nstudies. The ventricles are normal in size and configuration. The basal\ncisterns appear patent and there is preservation of gray-white matter\ndifferentiation.\n\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear.The globes are unremarkable.", + "output": "Large intraparenchymal hemorrhage involving the right frontal and parietal\nlobes (series 28, image 24 with surrounding edema and mass effect, new from\nthe prior examination done ___.\n\nNOTIFICATION: These findings were communicated immediately upon discovery to\nDr. ___ telephone at 03:32 on ___ by Dr. ___." + }, + { + "input": "There has been interval evacuation of the large intraparenchymal hemorrhage\ninvolving the right frontal parietal lobes, with a reduction the associated\nmass effect. There is residual postoperative air. There is bilateral mastoid\nair fluid levels, mostly symmetric prior examination.\nAside from postoperative changes, there is no osseous abnormalities seen. The\norbits are unremarkable.", + "output": "Evacuation of the right frontal and parietal lobe hematoma with mostly\nresolved associated mass effect." + }, + { + "input": "Since the most recent prior exam on ___ at 11:30, there is stable\nappearance of a right frontoparietal hemorrhage with surrounding edema and\nmultiple foci of air. There are no new areas of hemorrhage or midline shift.\nExpected changes are noted after right frontoparietal craniotomy, including\npneumocephalus layering anterior to the right frontal lobe and soft tissue\nchanges. A focal area of hypodensity in the left frontal lobe is unchanged,\nas well as hypodensity in the right frontal lobe, anterior to the area of\nintraparenchymal hemorrhage. Ventricles and sulci are normal in size and\nconfiguration. The basal cisterns are patent.\n\nThe mastoid air cells are partly opacified. The paranasal sinuses are clear.", + "output": "1. Stable appearance of intraparenchymal hemorrhage involving the right\nfrontal and parietal lobes.\n2. Known right frontal and parietal lobe ring-enhancing lesions are better\nassessed on recent MRI." + }, + { + "input": "There is no evidence of acute vascular territorial\ninfarction,hemorrhage,edema,or large mass. Hypodensities within the left\nbasal ganglia likely represent chronic infarcts. Mild subcortical and\nperiventricular white matter hypodensities are nonspecific, likely the sequela\nof small-vessel ischemic disease. There is prominence of the ventricles and\nsulci suggestive of involutional changes. Atherosclerotic calcifications are\nseen along bilateral carotid siphons.\n\nThere is no evidence of fracture. Incidental note is made of an osteoma\nwithin the right ethmoid air cells. There is mild mucosal thickening of the\nethmoid air cells. The visualized portion of the remaining paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The patient\nis status post right craniotomy with aneurysm clip placement. Areas of\nencephalomalacia are noted in the right frontal temporal lobes. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nThere is preservation of gray-white matter differentiation. The basal\ncisterns remain patent.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process. Regions of encephalomalacia within the right\nfrontal and right temporal lobes are likely secondary to chronic infarction." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of acute fracture. Chronic left orbital floor fracture\nidentified. Small left maxillary sinus mucous retention cyst and mild\nsphenoid sinus and ethmoid air cell mucosal thickening. The mastoid air cells\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "No evidence of an acute intracranial abnormality." + }, + { + "input": "Persistent small chronic left subdural fluid collection is noted layering\nalong the left frontal lobe and demonstrates a similar degree of mass effect\nwith mild midline shift unchanged from prior. Mild effacement of the left\nlateral ventricle is also similar to prior. There is no evidence of acute\nterritorial infarction, hemorrhage, edema, or large mass. Prominence of the\nventricles and sulci is suggestive of involutional changes.\n\nNo osseous abnormalities seen. Air-fluid level is seen in the left sphenoid\nsinus. The paranasal sinuses, mastoid air cells, and middle ear cavities are\notherwise clear. The orbits are unremarkable. Cavernous carotid and vertebral\nartery calcifications are seen.", + "output": "1. Persistent chronic left subdural collection layering along the left frontal\nlobe with similar mass effect and mild midline shift.\n2. No acute hemorrhage" + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Again seen is a chronic left CSF density subdural collection\noverlying the left frontal lobe with mild rightward shift of midline\nstructures, unchanged from prior. Ventricles and sulci are prominent,\nsuggestive of volume loss. Periventricular and subcortical white matter\nhypodensities are nonspecific, but likely reflect the sequela of chronic\nmicrovascular infarction.\n\nThere is near complete opacification of the left sphenoid sinus with\nhyperostosis of the surrounding sinus walls suggestive of chronic\ninflammation. Mild mucosal thickening in the bilateral ethmoid air cells is\nalso present.. The remaining imaged paranasal sinuses are clear. Mastoid air\ncells and middle ear cavities are well aerated. The bony calvarium is intact. \nVisualized orbits are unremarkable", + "output": "1. No acute intracranial process.\n2. Unchanged small left subdural hygroma or chronic hematoma with mild\nrightward shift of midline structures.\n3. Paranasal sinus disease." + }, + { + "input": "There is a stable hypodense subdural collection with stable mild rightward\nshift of midline structures, in stable partial effacement of the left lateral\nventricle. There is no acute hemorrhage and no evidence for an acute major\nvascular territorial infarction. Global parenchymal volume loss with\nprominent ventricles and sulci is again seen. Mild periventricular white\nmatter hypodensities are nonspecific, though likely reflect the sequela of\nchronic small vessel ischemic disease.\n\nThere is no evidence of fracture. There is moderate opacification of the left\nsphenoid sinus with dependent material, and associated wall thickening and\nsclerosis, similar to prior studies dating back to ___, consistent\nwith chronic sinusitis. There is also persistent mucous retention cyst in the\ninferior right maxillary sinus. Mastoid air cells are grossly well-aerated.", + "output": "1. Stable left subdural hygroma with stable mild mass effect.\n2. No evidence for acute intracranial abnormalities.\n3. Chronic left sphenoid sinusitis with osseous remodeling. Chronic right\nmaxillary sinus mucous retention cyst." + }, + { + "input": "Left frontal convexity 1.2 cm extra-axial CSF density collection exerting mild\nrightward mass effect on the underlying cerebral hemisphere with approximately\n8 mm rightward midline shift is unchanged from prior examination. No new\nlesions. No intra or extra-axial normal enhancing mass. No acute large\nterritory infarct or intracranial hemorrhage. The sulci, ventricles and\ncisterns are otherwise within expected limits for the patient's age. No acute\nosseous abnormality. Chronic opacification of the left sphenoid sinus with\nhyperostosis is compatible with chronic sinusitis. The remainder the\nparanasal sinuses are essentially clear. The orbits are unremarkable. \nMastoid air cells middle ears are well pneumatized and clear.", + "output": "1. Unchanged left subdural hygroma with 8 mm rightward midline shift.\n2. No new lesions.\n3. No acute large territory infarct or intracranial hemorrhage.\n4. Unchanged chronic left sphenoid sinusitis.\n5. Additional findings described above." + }, + { + "input": "There is re-demonstrated 1.2 cm extra-axial CSF density collection resulting\nin mild rightward shift of 8 mm, unchanged from study of ___. \nThere is no evidence of acute large territory infarction infarction,acute\nintracranial hemorrhage or edema. Lacunar infarct along the right external\ncapsule is seen, which appears new from ___, but otherwise chronic. \nThe ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is persistent opacification of the\nleft sphenoid sinus with adjacent hyperostosis consistent with chronic\nsinusitis. The partially imaged very inferior aspect of the right maxillary\nsinus demonstrates mucosal thickening. The mastoid air cells are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Right external capsule lacunar infarct new from ___, but otherwise\nchronic.\n3. Unchanged left subdural hygroma with resultant 8 mm rightward midline\nshift.\n4. Unchanged chronic left sphenoid sinusitis." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass effect. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Periventricular and subcortical white matter hypodensities are\nnonspecific but likely sequelae of chronic small vessel ischemic disease.\n\nThe bilateral vertebral arteries demonstrate dense calcifications. The\nbasilar artery is ectatic and hyperdense throughout, raising concern for\nrestenosis/occlusion, correlation with CTA is recommended.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Ectatic and hyperdense basilar artery, raising concern for restenosis. \nCorrelation with CTA is recommended.\n2. No evidence of acute intracranial hemorrhage.\n3. Periventricular and subcortical white matter hypodensities are nonspecific\nbut likely sequelae of chronic small vessel ischemic disease.\n\nRECOMMENDATION(S): CTA for further evaluation of the basilar artery.\n\nNOTIFICATION: Findings discussed with ___, MD, by ___ van ___,\nMD, by telephone at 12:50 ___ on ___, 25 minutes after discovery." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of large territory infarction,hemorrhage,edema,ormass. \nThere is stable prominence of the ventricle and cortical sulci, related to\nage-related involutional changes. Stable confluent hypodensity in the\nperiventricular and subcortical white matter suggestive of chronic small\nvessel ischemic changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is mild atherosclerotic calcification involving the cavernous and the\nsupraclinoid ICA without evidence of flow-limiting stenosis. Otherwise the\ndistal carotid arteries are patent. There is mild narrowing of the M1 segment\nof the left MCA. Moderate focal narrowing M2 right MCA branch. The ACAS are\nunremarkable. Fetal configuration of the right PCA which is patent. Moderate\nto severe narrowing of the P1/P2 segment of the left PCA.\n\nThere is a 8 x 8 mm focal dilatation of the basilar artery proximally. \nDistally there is mild narrowing. Otherwise the basilar artery is widely\npatent.\n\nThere is mild atherosclerotic calcification involving the bilateral V4 segment\nof the vertebral artery without evidence of flow narrowing stenosis.\n\nThe dural venous sinuses are patent.\n\nCTA NECK:\nConventional branching of the aortic arch is demonstrated. The bilateral\ncommon carotid arteries are widely patent. There is mild calcified and\nnoncalcified atherosclerotic plaques in the right proximal ICA near the\ncarotid bulb without evidence of high-grade stenosis. The left cervical ICA\nis widely patent without evidence of stenosis by NASCET criteria.\n\nThere is mild narrowing of the vertebral arteries at the C3-4 level due to\ndegenerative changes at the facet joints, left more so than right. Otherwise,\nthe cervical vertebral arteries appear normal without evidence of stenosis or\nocclusion.\n\nThere is no evidence of dissection.\n\nOTHER:\nLimited evaluation of the lung apices show mild bibasilar atelectasis. \nThyroid appear unremarkable. There is no lymphadenopathy by size criteria. \nNG tube is noted.", + "output": "1. No acute intracranial abnormality, specifically no evidence of large\nterritory infarction, hemorrhage or intracranial mass. Volume loss and white\nmatter hypodensities presumably related to chronic small vessel disease. No\nintracranial hemorrhage.\n2. Basilar artery is patent noting fusiform dilatation proximally and mild\nnarrowing distally.\n3. Regions atherosclerotic narrowing with intracranial vasculature\nspecifically, moderate to severe narrowing involving the P1/P2 segments of the\nleft PCA, and moderate narrowing of the M2 branch of the right MCA. Other\ndetails as above.\n4. Mild calcified and noncalcified atherosclerotic plaque in the right\nproximal ICA near the carotid bulb without evidence of high-grade stenosis. \nOtherwise patent bilateral cervical carotid and vertebral arteries without\nevidence of stenosis, occlusion, or dissection." + }, + { + "input": "There is no evidence of acute large territorial infarction, intracranial\nhemorrhage, edema, or mass.\n\nThere is prominence of the bifrontal subdural space and bilateral sylvian\nfissures, which most likely represents cerebral volume loss. Otherwise, the\nremaining ventricles and sulci are normal in size and configuration.\n\nNo acute osseous abnormalities seen. There is a 9 mm osteoma in the right\nfrontal sinus. There is mild mucosal thickening of the bilateral maxillary\nsinuses, ethmoid air cells and sphenoid sinuses. The, mastoid air cells, and\nmiddle ear cavities are clear. The orbits demonstrate no acute abnormalities.", + "output": "No acute intracranial process within limitations of this noncontrast study. No\nevidence of intracranial hemorrhage or acute fracture." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in caliber and configuration.\n\nThere is no evidence of fracture. Polypoid mucosal thickening the right\nfrontal and left sphenoid sinuses is seen. The intraorbital contents are\nnormal. The mastoid air cells are clear.", + "output": "Normal study" + }, + { + "input": "Evaluation is limited secondary to streak artifact from prior A-comm aneurysm\nembolization. Within this limitation:\n\nNo evidence of acute large territorial infarction, intracranial hemorrhage,\nedema or mass. There is evidence of a chronic infarct involving left caudate.\nPeriventricular and subcortical white matter hypodensities are nonspecific but\nmay reflect the sequelae of chronic small vessel ischemic disease in a patient\nof this age. Ventricles and sulci are normal in size configuration for the\npatient's age.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Note is made\nof concha bullosa. Addition, note is made of calcification the anterior\ninferior aspect the external ear canals bilaterally. The visualized portion\nof the orbits are unremarkable.", + "output": "1. No evidence of acute intracranial process or hemorrhage.\n2. Findings consistent with chronic infarct in the left caudate." + }, + { + "input": "CT head: The gray-white matter differentiation is intact without evidence of\ninfarct, hemorrhage, or mass effect. The ventricles and cortical sulci are\nnormal in caliber and configuration. The extra-axial spaces are unremarkable.\n\nThe orbits, soft tissues, and calvarium are unremarkable. There is mild\nmucosal thickening within the right maxillary sinus. The mastoid air cells\nand middle ears are clear. There is calcification of the inferior left\ncartilaginous external auditory canal.\n\nCTA head: There is a 2 mm posterior medially projecting outpouching from the\nanterior genu left cavernous segment internal carotid artery (5:190), which\nmay represent an ulceration, infundibulum, or small aneurysm. There is a\nhypoplastic right A1 segment. The bilateral posterior communicating arteries\nare visualized. There is a 6 mm TV x 5 mm AP x 6 mm SI anteriorly projecting\naneurysm from the anterior communicating artery with a 3 mm aneurysm neck\n(5:213; 603:27). There is a left dominant vertebral artery. The right\nvertebral artery is diminutive and predominantly terminates in the posterior\ninferior cerebellar artery. There is a low origin of the bilateral posterior\ninferior cerebellar arteries. There are bilateral fetal origin posterior\ncerebral arteries. There is normal enhancement of the dural venous sinuses. \nThere is no evidence of vascular malformation.\n\nCTA neck: There is a 2 vessel aortic arch with a common origin of the right\nbrachiocephalic and left common carotid arteries. The subclavian arteries are\npatent. The carotid arteries are patent without stenosis by NASCET criteria. \nThe vertebral arteries are patent and demonstrate left dominance. There is a\nlow origin of the bilateral posterior inferior cerebellar arteries.\n\nThe pharynx, larynx, oral cavity, and nasal cavities are unremarkable. The\nmasticator and parapharyngeal spaces are unremarkable. The salivary glands\nare unremarkable. The thyroid gland is heterogeneous multinodular which makes\nit difficult to measure a discrete dominant nodule the largest nodule in the\nright likely measures 0.9 x 1.2 cm (05:52). There are no suspicious lymph\nnodes by size or morphology. The lung apices are clear. The lung apices are\nclear. There are no suspicious lymph nodes by size morphology. There is\nstreak artifact secondary to dental almalgam which obscures adjacent\nstructures. There is no fracture or osseous lesion.", + "output": "1. 6 x 5 x 6 mm anteriorly projecting anterior communicating artery aneurysm\nwith a 3 mm aneurysm neck. No evidence of associated subarachnoid hemorrhage\nor other acute intracranial abnormality.\n2. 2 mm posterior medially projecting outpouching from the left anterior genu\ncavernous segment internal carotid artery which may represent a small\ninfundibulum, aneurysm, or ulceration.\n3. Patent intracranial and neck vasculature without occlusion, dissection, or\nsignificant stenosis.\n4. Heterogeneous multinodular thyroid gland with dominant nodule in the right\nthyroid lobe measuring 0.9 x 1.2 cm. Per the ___ College of Radiology\nguidelines, thyroid nodules measuring less than 1.5 cm in a patient greater\nthan ___ years of age do not require imaging surveillance, in the absence of\nclinical risk factors." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are prominent compatible with global volume\nloss.\nScattered opacification seen within the maxillary sinuses and ethmoid air\ncells. Included paranasal sinuses and mastoids are otherwise clear. Skull\nand extracranial soft tissues are unremarkable.", + "output": "No acute intracranial process, no hemorrhage." + }, + { + "input": "A moderate-sized subgaleal hematoma is seen overlying the left occipital\ncalvarium. Overlying skin staples are seen. There is no evidence of\nunderlying fracture.\n\nThere are multiple foci of subarachnoid hemorrhage involving the right\nfrontotemporal lobe and bilateral parietal lobes. There is also acute\nhemorrhage within the right portion of the suprasellar cistern and left aspect\nof the quadrigeminal plate cistern. There may be a small amount of acute\nsubdural hemorrhage along the left tentorium.\n\nThere is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nMild mucosal thickening involving the bilateral ethmoid, maxillary, and\nsphenoid sinuses. The visualized portion of the mastoid air cells and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Multiple foci of subarachnoid hemorrhage bilaterally, as described above. \nPossible small subdural hemorrhage along the left tentorium.\n2. Moderate-sized severely hematoma overlying the left calvarium without\nevidence of underlying fracture.\n3. Mild paranasal sinus disease." + }, + { + "input": "As before, there are multiple foci of subarachnoid hemorrhage involving the\nright temporal and left parietal lobes. As before there is also a small focus\nof extra-axial blood in the right medial frontal lobe. Subarachnoid\nhemorrhage in the right temporoparietal lobe is less conspicuous than prior. \nBlood is again seen in the suprasellar cistern, prepontine and the left\nquadrigeminal plate cistern, similar to prior. There is now a small amount of\nblood in the right occipital horn of the lateral ventricle, however, this is\nlikely due to redistribution of blood. As before, there may be a small amount\nof acute subdural hemorrhage along the left tentorium. No additional focus of\nhemorrhage is seen. There is no evidence of acute large vascular territorial\ninfarction, edema, or mass effect. The ventricles are unchanged in size. \nThere is similar appearance of the moderate sized left subgaleal hematoma\noverlying the left occipital bone. Skin staples are again present.\n\nNo acute fractures are seen. There is moderate mucosal thickening in the\nright ethmoid sinus and bilateral sphenoid and maxillary sinuses. There is\nnear complete opacification of the left ethmoid sinus. The mastoid air cells\nand middle ear cavities are clear. The orbits are unremarkable.", + "output": "1. Similar appearance of multiple foci of subarachnoid hemorrhage, as\ndescribed above. No additional focus of hemorrhage is appreciated.\n2. Possible small subdural hemorrhage along the left tentorium is unchanged.\n3. Redemonstration of a moderate-sized left subgaleal hematoma overlying the\noccipital bone.\n4. Mild paranasal sinus disease, as described above." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Prominence of\nventricles and sulci, predominantly bifrontal, is greater than expected for\nthe patient's age.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No evidence of hemorrhage or fracture. Prominence of ventricles and sulci,\npredominantly bifrontal, is greater than expected for the patient's age." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. There is\ngrossly stable prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. No evidence acute intracranial hemorrhage or fracture.\n3. Grossly stable global volume loss, greater than expected for age." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass effect. \nThere is prominence of the ventricles and sulci suggestive of age-related\nvolume loss.\n\nThere is no evidence of fracture. Small mucous retention cysts are seen in\nthe bilateral maxillary sinuses. The visualized portion of the other\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality.5" + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect or infarction. The\nventricles and sulci are normal in size and configuration. The basal cisterns\nappear patent and there is preservation of gray-white matter differentiation.\n\nNo fracture is identified. The visualized paranasal sinuses, mastoid air cells\nand middle ear cavities are clear. The globes are unremarkable.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "Head CTA: The intracranial carotid and vertebral arteries and their major\nbranches are patent with no evidence of stenoses, occlusion or aneurysm\nformation.\n\nNeck CTA: There is a 3 vessel takeoff from the aortic arch. There is no\nevidence of internal carotid artery stenosis by NASCET criteria. The distal\nleft internal carotid artery measures 5.2 mm in diameter and the distal right\ninternal carotid artery measures 4.7 mm in diameter. Cervical vertebral\narteries are patent .\n\nVisualized lung apices are clear.", + "output": "Unremarkable CTA of the head and neck." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. The dural venous\nsinuses are patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion.\n\n\n\nOTHER:\nThere is an approximately 5 mm nodule or a focus of atelectasis in the left\nupper lobe, incompletely evaluated. This was not seen on the subsequent chest\nCT, suggesting that it was atelectasis. The visualized portion of the lungs\nare clear. The visualized portion of the thyroid gland is within normal\nlimits. There is no lymphadenopathy by CT size criteria.", + "output": "1. No acute intracranial abnormality.\n2. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n3. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nMetallic density within the right external auditory canal is again seen,\npossibly reflecting a piercing. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are normal.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction,intracranial hemorrhage,edema,or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. A metallic density within the right\nexternal auditory canal may reflect a piercing (series 2, image 4).", + "output": "1. No acute intracranial process or hemorrhage." + }, + { + "input": "The visualized aortic arch and origins of the great vessels are unremarkable.\n\nThe right common, internal and external carotid arteries are normal in\nappearance. There is no evidence of a significant stenosis by NASCET criteria\nor a dissection.\n\nThe left common, internal and external carotid arteries are normal in\nappearance. There is no evidence of a significant stenosis by NASCET criteria\nor a dissection.\n\nThe cervical portions of the vertebral arteries demonstrate normal\nenhancement. There is no evidence of a significant stenosis by NASCET criteria\nor a dissection.\n\nThere is a filling defect within the left internal jugular vein. No filling\ndefect is identified in the right internal jugular vein.", + "output": "1. Normal appearance of the arterial vasculature of the neck, without\nsignificant stenosis (by NASCET criteria), dissection, or aneurysm.\n2. Filling defect in the left internal jugular vein. This may be artifactual\nas it is near the inflow sites of tributary veins. If there is clinical\nconcern, an ultrasound can be considered." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass effect. The ventricles and sulci are unremarkable in size and\nconfiguration.\n\nThere is no evidence of fracture. A mucous retention cyst in the left frontal\nsinus extending into the frontal ethmoidal recess as well as aerosolized\nmucous in the right frontal sinus is identified. The remainder the paranasal\nsinuses are essentially clear. The mastoid air cells middle ears well\npneumatized and clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality on noncontrast CT head. Specifically no\nintracranial hemorrhage.\n2. Paranasal sinus disease as described above." + }, + { + "input": "There is no intra or extra-axial mass effect, acute hemorrhage or territorial\ninfarct. Sulci, ventricles and cisterns are within expected limits for the\npatient's age. The paranasal sinuses are clear. The orbits are unremarkable.\nThe mastoid air cells are well pneumatized and clear. No calvarial fractures.", + "output": "1. Unremarkable noncontrast head CT." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria. Incidental note is made of a 4 vessel arch.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Normal head and neck CTA.\n2. No acute intracranial abnormalities." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Normal study." + }, + { + "input": "CTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Normal head and neck CTA." + }, + { + "input": "A large 3.7 x 2.9 cm hyperdense intraparenchymal hemorrhage in the right\ntemporal lobe is essentially unchanged from the same day earlier study\n(05:15). Small areas of adjacent intraparenchymal hemorrhage medially are\nunchanged. Extension of the hemorrhage into the occipital horn of the right\nlateral ventricle is similar, allowing for differences in patient positioning.\nNo shift of midline structures is present.\n\n There is prominence of the ventricles and sulci suggestive of involutional\nchanges. Periventricular and subcortical white-matter hypodensities are\nnonspecific, but likely represent sequela of chronic small vessel disease.\n\nThere is no evidence of fracture. There is moderate mucosal thickening within\nthe right maxillary sinus and ethmoid air cells. The visualized portion of\nthe other paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "Compared to the same day head CT at 17:57, the 3.7 cm intraparenchymal\nhemorrhage centered in the right temporal lobe with extension into the right\nlateral ventricle is essentially unchanged. No midline shift or herniation." + }, + { + "input": "Re-demonstration of large right temporal intraparenchymal hemorrhage,\nmeasuring up to 4.9 x 2.6 cm, overall similar in size compared to prior\nallowing for differences in technique. There is also layering of blood\nproducts in bilateral occipital horns of the ventricles, likely redistribution\nof previously seen intraventricular hemorrhage. No new foci of hemorrhage.\nThere is no large vascular territory infarction. There is no midline shift. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges and are unchanged from prior. Periventricular subcortical white\nmatter hypodensities are nonspecific but suggest chronic small vessel ischemic\nchanges.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nright maxillary sinus. The visualized portion of the remaining paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Right temporal lobe intraparenchymal hemorrhage overall unchanged in size\ncompared to prior allowing for differences in technique. There is layering of\nintraventricular hemorrhage within bilateral occipital horns, likely\nredistribution of previously seen intraventricular hemorrhage. No midline\nshift or change in size of the ventricles." + }, + { + "input": "Head CT: There is no evidence of hemorrhage, edema, masses, mass effect, or\nterritorial infarction. The ventricles and sulci are normal in caliber and\nconfiguration. No fractures are identified. Sphenoid and left maxillary sinus\nmucosal thickening is noted.\n\nHead and neck CTA: The carotid and vertebral arteries and their major branches\nare patent with no evidence of stenoses by NASCET criteria. There is minimal\ncalcified plaque at both intracranial internal carotid arteries without\nevidence of significant stenosis. There is no evidence of aneurysm formation\nor other vascular abnormality.\n\nThe parotid glands are enlarged containing numerous small cystic areas.\nAtelectasis is present within the upper lobes.\n\nA right internal jugular line is seen within the superior vena cava. A small\ncalcified right paratracheal lymph node is present.", + "output": "1. No intracranial hemorrhage or mass effect.\n2. Minimal intracranial atherosclerotic disease without significant stenosis\nor occlusion.\n3. Enlarged parotid glands containing numerous small cystic lesions. The\nappearance is most consistent with Sjogren syndrome, but may be related to the\npatient's known history of bulimia." + }, + { + "input": "There is no hemorrhage, edema, mass effect, midline shift, or mass. The\nventricles and sulci are normal in size and configuration. The basal cisterns\nare patent and there is normal gray-white matter differentiation.\nThere is mild soft tissue swelling in the scalp of the left temporal and\nparietal region. No calvarial fracture is seen. Please see the separately\ndictated CT of the facial bones for evaluation of facial fractures. The\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\norbits are unremarkable.", + "output": "No significant intracranial abnormality.\nSoft tissue swelling in the left parietal and temporal scalp." + }, + { + "input": "There is hypodensity within the right head of the caudate, the putamen and the\nanterior limb of the right internal reflecting the infarction seen on the MRI\nof ___. There is no evidence of hemorrhage or mass effect. \nVentricles and sulci are prominent likely reflective of age related atrophy. \nThere is no shift of normally midline structures. Basal cisterns are patent.\n\nSoft tissue thickening involves the left frontal scalp region without\nunderlying osseous abnormality. Minimal mucosal thickening involves the\nmaxillary sinuses bilaterally. Images are slightly motion degraded. \nBilateral mastoid air cells, middle ear cavities and remaining paranasal\nsinuses are clear. Soft tissue density within the external auditory canals\nbilaterally likely reflect cerumen. The orbits are unremarkable. Carotid\nsiphon vascular calcifications are minimal.", + "output": "No evidence of hemorrhage. Evolving right caudate and putaminal infarction.\n\nMinimal soft tissue thickening involves the left frontal scalp." + }, + { + "input": "Again seen are areas of hypodensity in the right caudate head, putamen, and\ninternal capsule corresponding to areas of infarction better evaluated on the\nMRI obtained 1 day prior. There is, however, a 5 x 5 mm focus of increased\ndensity in this area which could represent an area of increasing petechial\nhemorrhage (04:17). The ventricles and sulci are otherwise normal in size and\nconfiguration. There is no midline shift and the basal cisterns are patent.\n\nThere is no evidence of new infarction or mass. There is no evidence of\nfracture. The visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable. Unchanged soft tissue thickening of the left frontal scalp is\nnoted.", + "output": "1. Small focus of increased density within the infarcted right basal ganglia\nand internal capsule on recent MRI may represent petechial hemorrhage.\n2. No evidence of new infarction . Of note, MRI would better evaluate for a\ninfarction propagation.\n3. Minimal soft tissue thickening of the left frontal scalp is unchanged." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is hypodensity of the right caudate, right corona radiata and posterior\nlimb of the right internal capsule, better seen on the prior MRI. Mild\nassociated mass effect is seen with minimal effacement of the right frontal\nhorn. There is no evidence of no evidence of hemorrhage or mass.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\nA small left frontal scalp hematoma is seen. Soft tissue density is seen in\nthe right external auditory canal, with no associated erosions, likely\nrepresenting cerumen.\n\nCTA HEAD: There is multi focal narrowing of the distal right petrous and\ncavernous internal carotid artery. Atherosclerotic calcification in the left\ncavernous internal carotid artery is seen. A hypoplastic right A1 segment is\nseen. There is mild irregularity of the right P1 segment and distal posterior\ncerebral arteries, likely secondary to atherosclerotic disease. A patulous\nbasilar tip is seen. Otherwise, the vessels of the circle of ___ and their\nprincipal intracranial branches appear normal without stenosis, occlusion or\naneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is irregularity of the the aortic arch, consistent with atherosclerotic\ncalcification. There is atherosclerotic calcification of the origin of the\nright vertebral artery. There is approximately 50% stenosis at the origin of\nthe right internal carotid artery secondary to atherosclerosis. There is\napproximately 30% stenosis of the origin of the left internal carotid artery\nsecondary to atherosclerotic calcification and soft plaque. The vertebral\narteries and their major branches appear normal with no evidence of stenosis\nor occlusion.\n\nOTHER:\nThere partially visualized large bilateral pleural effusions with left apical\natelectasis. The visualized portion of the thyroid gland is within normal\nlimits. There is no lymphadenopathy by CT size criteria. Dental caries and\nperiapical lucency is noted along multiple teeth. Multilevel degenerative\nchanges in the cervical spine are seen, slightly more significant at C5/C6 and\nC6/C7 levels.", + "output": "1. Evolving right basal ganglia and corona radiata infarction with mild mass\neffect and mild effacement of the right frontal horn. No acute hemorrhage.\n2. Multi focal narrowing of the distal right petrous and cavernous internal\ncarotid arteries which is favored to represent asymmetric thrombus rather than\nirregularity from atherosclerotic disease.\n3. Atherosclerotic calcification at the origin of the bilateral internal\ncarotid arteries with 50% stenosis on the right and 30% stenosis on the left\naccording to NASCET criteria.\n4. Large partially visualized pleural effusions.\n5. Dental disease. Dental consultation is recommended." + }, + { + "input": "LEFT:\nThe external auditory canal is normal. The tympanic membrane is normal. The\nossicular chain is intact, unremarkable. The middle ear cavity is well\npneumatized and clear. The scutum is sharp. The tegmen is intact. There is\nno evidence of inner ear dysplasia. The bony IAC is unremarkable. The facial\nnerve canal describes a normal course. There is no evidence of otosclerosis. \nThe superior semicircular canal is fully covered by bone. There is no\nenlarged vestibular aqueduct. The mastoid is well developed and clear.\n\nRIGHT:\nSmall amount of debris along the floor of the external auditory canal likely\nrepresents cerumen. The external auditory canal is otherwise unremarkable. \nThe tympanic membrane is intact. The middle ear cavity is well pneumatized\nand clear. The ossicles are intact, normal. The scutum is sharp. The tegmen\nis intact. There is no evidence of inner ear dysplasia. The bony IAC is\nunremarkable. The facial nerve canal describes a normal course. The superior\nsemicircular canal is well covered by bone. There is no evidence of\notosclerosis. The vestibular aqueduct is not enlarged. The mastoid is well\ndeveloped and clear..\n\nNo definite mass or abnormal enhancement is identified within the left right\ninternal auditory canal or cerebellopontine angles, within limitation of CT. \nIAC's not expanded on either side.\n\nThe visualized paranasal sinuses appear clear. Visualized portions of the\nglobes, orbits, appear unremarkable. Multiple palatine tonsilliths are noted\nbilaterally. Prominent retrocerebellar CSF space is again noted, unchanged,\npartially visualized, similar to prior. Imaged brain parenchyma is\nunremarkable. Visualized major dural venous sinuses are patent.", + "output": "1. No evidence of IAC or cerebellopontine angle mass on CT..\n2. Normal temporal bones." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. The\nventricles and sulci are grossly stable in size and configuration, without\ndefinite evidence of ventriculomegaly. Bilateral posterior fossa probable\narachnoid cysts are again noted.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are preserved. \nLimited imaging of the parotid glands demonstrate bilateral subcentimeter\nnonspecific probable lymph nodes.", + "output": "1. No acute intracranial abnormality.\n2. Grossly stable bilateral posterior fossa probable arachnoid cysts, compared\nto ___ prior exam." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. Very few scattered\nperiventricular and subcortical white matter hypodensities are nonspecific,\nbut compatible with chronic microangiopathy in a patient of this age.\n\nThe visualized paranasal sinuses are clear. The orbits are unremarkable. \nCentered in the superior right parotid gland is a nonenhancing 2.6 x 1.5 cm\ncystic lesion, better evaluated on prior outside hospital MRI neck. Bilateral\ntemporomandibular joint degenerative changes are noted.\n\nCTA HEAD:\n5 mm leftward projecting anterior communicating artery complex aneurysm with 4\nmm neck is re-identified, unchanged from examination of ___. The\nremainder of the vessels of the circle of ___ and their principal\nintracranial branches appear normal with no evidence of stenosis, occlusion,\nor other aneurysm. The dural venous sinuses are patent.", + "output": "1. No acute intracranial abnormality on noncontrast head CT.\n2. 5 mm anterior communicating artery aneurysm with 4 mm neck is unchanged\nfrom examination of ___.\n3. Re-identified is a 2.6 cm cystic lesion centered in the right superior\nparotid gland, better evaluated on MRI neck of ___." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nLeft frontal subgaleal hematoma is seen. No acute fracture is seen. The\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\norbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Left frontal subgaleal hematoma. No underlying acute fracture." + }, + { + "input": "MAXILLOFACIAL BONES: There are acute fractures through the right lateral,\nmedial, and anterior maxillary wall with blood layering within the maxillary\nsinus. The zygomatico-maxillary complex is intact.There are also fractures to\nthe bilateral pterygoid plates. There is extensive soft tissue swelling at\nthe right face. Bilateral hardware from prior repairs are noted at the left\nlateral maxillary wall and anterior maxilla.\n\nMANDIBLE: There is an acute displaced acute fracture through the right\nmandibular ramus. There is also a nondisplaced fracture through the left\nmandibular body anteriorly. The temporal mandibular joint at appears well\nmaintained.\n\nDENTITION: There are no dental fractures. There is no remarkable periodontal\ndisease, periapical lucency, or odontogenic abscess.\n\nSINUSES: There is hyperdense material within the right maxillary sinus. The\nremaining paranasal sinus are clear.The ostiomeatal units are patent. The\nmastoid air cells and middle ear cavities are clear.\n\nNOSE: There is no nasal bone fracture. Nasopharyngeal soft tissues are\nunremarkable. There is no nasal septal hematoma. There is minimal leftward\ndeviation of the nasal septum with a bony spur contacting on the left inferior\nturbinate.\n\nORBITS: The orbits, including the laminae papyracea, are intact. The globes\nare intact with non-displaced lenses and no intraocular hematoma. There is no\npreseptal soft tissue edema. There is no retrobulbar hematoma or fat\nstranding.", + "output": "1. Acute fractures through the anterior, medial, and lateral right maxillary\nwall with blood within the maxillary sinus. Extensive soft tissue swelling at\nthe right face.\n\n2. Displaced fracture of the right mandibular ramus. Non-displaced fracture\nof the left mandibular body anteriorly.\n\n3. Bilateral pterygoid process fractures are identified." + }, + { + "input": "Redemonstrated intraparenchymal hemorrhages appear to be stable compared to\nprior imaging from ___. The previously described right temporal\nintraparenchymal hemorrhage is currently not seen on this exam and may be\nresolved. The bilateral subarachnoid hemorrhages in the frontal convexities\nappear stable with some redistribution of blood products. There are no new\nhemorrhages or infarcts.\n\nThe ventricles and sulci are normal in size and configuration.There is no\nmidline shift or mass effect. Gray-white differentiation is preserved. The\nbasilar cisterns are patent.\n\nThe redemonstrated known nondisplaced occipital fracture appears stable in\ncomparison to prior exam and better visualized on dedicated prior imaging. \nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Redemonstrated intraparenchymal hemorrhages and SAH are stable in\ncomparison to the prior exam from ___.\n2. The known nondisplaced occipital fracture is unchanged in comparison to\nprior exam.\n3. No new hemorrhages or infarcts." + }, + { + "input": "There is subtle subarachnoid hemorrhage overlying the right frontal\nconvexities. There are also hyperdense foci in the left frontal (601b:31) and\nright temporal lobes (02:12) concerning for contusions. There is no acute\nlarge vascular territorial infarction, mass effect, mass or shift of midline\nstructures. The basal cisterns appear patent and there is preservation of\ngray-white matter differentiation.\n\nThere is an acute nondisplaced calvarial fracture through the mid occipital\nbone. Other facial bone fractures are better characterized on concurrent\nfacial bone CT. There is opacification of the right maxillary sinus. \nRemaining visualized paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The globes are unremarkable.", + "output": "1. Subarachnoid hemorrhage overlying the right frontal convexities and\nbilateral intraparenchymal contusions.\n\n2. Nondisplaced calvarial fracture through the occipital bone at the midline." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, mass, mass-effect or\nlarge territorial infarction. The basilar cisterns are patent and there is\notherwise good preservation of the gray-white matter differentiation. Mild\nprominence of the ventricles and sulci is likely related to age-related\ninvolutional changes.\n\nNo acute fractures identified. The visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear.", + "output": "No acute intracranial abnormalities identified." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nlarge mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. There are minimal chronic small vessel ischemic\nchanges.\n\nThere is no evidence of fracture. There are aerosolized secretions in the\nmaxillary sinuses. The visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are otherwise clear. The orbits are\nunremarkable. There is bilateral carotid siphon and vertebral artery\ncalcification. Stable small sebaceous cyst right frontal scalp is stable. \nIntracranial carotid arterial calcifications.", + "output": "No acute intracranial process.\nMild secretions in the maxillary sinuses, consider acute sinusitis." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute intracranial hemorrhage, mass, mass effect or\nlarge territorial infarction. Ventricles and sulci are age appropriate. \nPeriventricular deep subcortical white matter hypodensities are likely\nsequelae of chronic microangiopathy. The previously noted focus of slow\ndiffusion in the left postcentral gyrus, is not well discerned on this exam. \nNo acute fracture is identified. The visualized paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The globes are unremarkable.\n\nCTA HEAD:\nThe bilateral vertebral arteries are normal. The patient has fetal type\nconfigurations of the bilateral PCAs, which are unremarkable. The left\ninternal carotid artery, middle cerebral artery are normal with normal\narborization of the distal left MCA vessels. The right internal carotid\nartery, and middle cerebral artery are normal with normal arborization of the\ndistal right MCA vessels. No aneurysms are identified. The dural venous\nsinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria. Moderate atherosclerotic calcifications are seen\nalong the bilateral ICA bifurcations.\n\nOTHER:\nThe thyroid gland bilaterally is enlarged and heterogeneous with punctate foci\nof calcifications seen within the left thyroid gland. The visualized apices\nof the lungs are clear. There is no cervical lymphadenopathy.", + "output": "1. No evidence of acute intracranial infarction. Specifically, the previously\nnoted focus of slow diffusion within the left postcentral gyrus on the prior\nMRI is not well discerned on this exam.\n2. No evidence of internal carotid artery stenosis by NASCET criteria. No\naneurysms are identified.\n3. Heterogeneous, enlarged thyroid gland with punctate foci calcifications\nwithin left thyroid gland. A dedicated thyroid ultrasound may be helpful for\nfurther evaluation if not previously performed." + }, + { + "input": "There is a focus of encephalomalacia in the region of the right putamen, which\nmay represent a a chronic lacune or prominent perivascular space. There is no\nevidence of acute large territorial infarction,hemorrhage,edema, or mass. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nbilateral ethmoid air cells. There is mild opacification of a few bilateral\nmastoid air cells. The remainder of the visualized portion of the remaining\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "No acute large territorial infarction, hemorrhage, edema, or mass effect. \nStable small focus of right occipital lobe encephalomalacia as well as prior\nleft cerebellar infarct. Overall stable diffuse periventricular white matter\nhypo densities that are nonspecific and can be seen as sequelae of chronic\nsmall vessel ischemic disease. Gray-white matter differentiation appears\nmaintained throughout. Bilateral symmetric prominence of ventricles and sulci\nsuggests cortical volume loss and are likely age-related, similar to the prior\nexam. The perimesencephalic cisterns are patent. No shift of normally\nmidline structures.\n\nNo fracture. There is mild mucosal thickening of the bilateral anterior\nethmoidal air cells. Otherwise, the remaining incompletely visualized\nparanasal sinuses appear clear. There is stable poor pneumatization of the\nbilateral mastoid air cells which are partially opacified. The middle ear\ncavities are clear. The appearance of the orbits is unchanged, including left\nlens replacement.", + "output": "No acute intracranial abnormality, including no intracranial hemorrhage." + }, + { + "input": "Patient is post left occipital craniotomy for open biopsy of a left\ntemporoparietooccipital mass. Small areas of hyperdense material in the\nbiopsy bed likely reflect procedure related hemorrhage (___). Small volume\nright pneumocephalus is noted, predominantly aggregated adjacent to the\ncraniotomy site and at the right frontal convexity.\n\nAn ill-defined heterogeneous mass involving the left posterior temporal,\nparietal and occipital lobes with surrounding vasogenic edema is better\nevaluated on prior MR studies. There is no evidence of acute large\nterritorial infarction. Effacement of the posterior portions of the right\nlateral ventricle is unchanged. The basal cisterns remain patent.\n\n The visualized portion of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Status post left occipital craniotomy with small amount of blood products\nat the biopsy bed and small volume right pneumocephalus. Attention on\nfollow-up imaging is recommended.\n2. Ill-defined heterogeneous mass involving the left posterior temporal,\nparietal and occipital lobes with surrounding vasogenic edema is better\nevaluated on prior MR studies." + }, + { + "input": "Pneumocephalus and postoperative changes from prior right occipital craniotomy\nand craniectomy are again noted with interval slight improvement of the degree\nof pneumocephalus. However there is interval increase in the size of\nhypodense edema at the surgical bed measuring approximately 5.1 x 4.3 cm on\naxial images (02:17), demonstrating loss of gray-white matter differentiation.\nThe ill-defined hypodense mass involving the right parietal, occipital lobe is\nre-demonstrated and overall unchanged, measuring approximate 2.7 x 1.9 cm on\naxial images (02:16). There is no acute intraparenchymal hemorrhage. There\nis prominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Interval increase in conspicuity and size of edema in the right occipital\nsurgical bed since ___ likely secondary to resolution of immediate\npostoperative changes.\n2. No acute intraparenchymal hemorrhage.\n3. Unchanged right hemispheric mass which is better characterized on prior MR.\n\n___: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 5:11 am, 1 minute after\ndiscovery of the findings." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\n\nThere is partial opacification of the right maxillary sinus. There is mucosal\nthickening of the left maxillary sinus, left sphenoid sinus, left frontal\nsinus, and bilateral ethmoid air cells. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No intracranial hemorrhage or other acute intracranial abnormality." + }, + { + "input": "Dental amalgam related artifact limits evaluation of the oral cavity and\nadjacent areas. The patient is status post ___ 19 implant removal; the\nmargins of the tooth socket are smoother compared to ___ consistent\nwith expected healing. There is new bone loss along the lateral margin ___\n20 implant compared to the prior study, images 8:9, 03:24. Allowing for the\ndental amalgam artifact, there is no change in the appearance of the oral\ncavity or floor of the mouth compared to the prior study, without evidence for\nan enhancing mass.\n\n19 x 9 mm enhancement in the region of the left pterygoid plexus on image 3:16\nis stable in extent; slightly increased conspicuity/avidity is likely\nsecondary to the phase of contrast enhancement as well as slightly different\nprojection of dental amalgam artifact compared to the prior study. Otherwise,\nno evidence for a parapharyngeal or carotid space mass.\n\nThere is no lymphadenopathy, and no appreciable change in nonenlarged cervical\nlymph nodes.\n\nA punctate calcification is again seen in the region of the distal left\nsubmandibular duct, image 3:27. The left submandibular gland is atrophic and\nfatty replaced, as seen previously. Right submandibular and bilateral parotid\nglands remain unremarkable.\n\nThe thyroid is unremarkable.\n\nThere is a 3 mm right upper lobe pulmonary nodule without evidence for\ncalcification, image 2:107.\n\nThere are degenerative changes in the cervical spine.\n\nThis exam is not technically optimized for evaluation of the included brain\nparenchyma; no concerning abnormalities are seen on limited assessment. There\nis minimal mucosal thickening in the visualized inferior portions of the\nmaxillary sinuses. Bilateral concha bullosa are partially imaged.", + "output": "1. The margins of the extracted ___ 19 implant socket a smoother compared to\n___, consistent with expected healing. However, there is new bone\nloss along the lateral margin ___ 20 implant; neoplastic versus benign\netiology cannot be differentiated on the basis of this exam.\n2. Allowing for dental amalgam related artifact, there is no evidence for a\nnew enhancing mass or other change in the appearance of the oral cavity/floor\nof the mouth.\n3. No evidence for lymphadenopathy.\n4. 3 mm right upper lobe pulmonary nodule.\n\nRECOMMENDATION(S): ___ society guidelines for management of\nincidentally discovered pulmonary nodules do not apply to patients with a\nknown primary malignancy. Consider chest CT for comprehensive evaluation of\nthe lungs, if there is no prior chest CT for comparison.\n\nNOTIFICATION: The impression and recommendation above were entered by Dr.\n___ on ___ at 10:49 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." + }, + { + "input": "Streak artifact from several dental fillings limits the evaluation of the oral\ncavity and adjacent soft tissues.\n\nAllowing for this artifact, there is no significant change of the floor of the\nmouth and oral cavity when compared to the most recent prior study from\n___.\nNo new enhancing lesion is identified.\n\nThere is no cervical lymphadenopathy by CT criteria.\n\nStable punctate calcification in the region of the distal right submandibular\nduct (series 2, image 23).\nStable atrophy of the left submandibular gland, demonstrating fatty\nreplacement. The right submandibular and bilateral parotid glands are\nunremarkable. The thyroid gland is unremarkable.\n\nThere has been interval removal of the left mandibular second premolar dental\nimplant ___ # 20) (series 3, image 68). The socket ___ tooth #19, which\nwas previously extracted, demonstrates increased bone density and now appears\nhealed. There is no evidence of new focal bone loss or dehiscence. The\nremaining visualized teeth appear otherwise unremarkable.\n\nThe visualized paranasal sinuses and mastoid air cells appear clear.\n\nAgain seen is a 3 mm left upper lobe pulmonary nodule, unchanged from ___. The previously seen 3 mm right pulmonary nodule is outside of the field\nof view on today's exam.", + "output": "1. No evidence for cervical lymphadenopathy or a new enhancing mass.\n2. Interval removal of the left mandibular second premolar dental implant ___\n# 20). Interval healing of the socket of the extracted ___ tooth # 19. No\nevidence of new bony dehiscence.\n3. A 3 mm left upper lobe pulmonary nodule is unchanged from ___. \nPreviously seen 3 mm right pulmonary nodule is outside the field of view of\ntoday's exam." + }, + { + "input": "The patient is status post complex oral surgery involving excision of the\nnative left mandible with fibular free flap reconstruction. Multiple surgical\nclips are demonstrated within the surgical bed. There is no discrete mass. \nLateral to the left mid sternocleidomastoid muscle there is a 5.2 cm x 2.0 cm\nx 3.6 cm fluid density well-circumscribed collection with air.\n\nThere is evidence of extensive lymph node dissection.\n\n There is stable atrophy of the left submandibular gland fatty replacement. \nThe right parotid glands, right submandibular gland and thyroid are\nunremarkable. There is no cervical adenopathy.\n\nAerodigestive tract is normal.\n\nIncluded paranasal sinuses and mastoids are clear. Vascular structures are\ngrossly patent. In the left submandibular space is a hypodensity adjacent to\na venous structure of unknown clinical significance.\n\nAreas of gas beneath the left mandibular fibular flap (4;17), raises concern\nfor possible wound dehiscence.\n\nThere is a large left lobar pulmonary embolism measuring 1.5 cm x 1.3 cm.\n\nA 3 mm pulmonary nodule is demonstrated at the right upper lobe. The 3 mm\npulmonary nodule in left upper lobe is not well demonstrated on current study.", + "output": "1. Second read request for a study performed and interpreted at ___\n___\n2. Large left lobar pulmonary embolism measuring 1.5 cm x 1.3 cm. Recommend\nCTA of the chest.\n3. Patient is status post complex oral surgery with excision of native left\nmandible and fibular free flap reconstruction. Lateral to the left mid\nsternocleidomastoid muscle there is a 5.2 cm x 2.0 cm x 3.6 cm fluid density\nwell-circumscribed collection that contains air. Differentials include\npostoperative seroma or infectious process.\n4. Areas of subcutaneous air beneath the fibular flap (4;17) raises concern\nfor wound dehiscence.\n5. The remaining surgical bed is unremarkable. There is no distinct mass.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on\n___ at 5:01 pm, 3 minutes after discovery of the findings by telephone." + }, + { + "input": "Site of primary malignancies not definitely seen. There is some dental\nartifact at this level which limits evaluation. Postoperative changes removal\nof implants tooth 19; underlying bone defect at tooth socket is likely related\nto postsurgical change. No other areas of osseous irregularity to suggest\nbone invasion. Lingual side oval veil ridges maintained. No evidence of deep\ntumor extent. No tumor near Mylohyoid, genioglossus, hyoglossus,\nstyloglossus. No involvement of the medial pterygoid, parapharyngeal or\ncarotid space.\n\nNo adenopathy. A trophic left submandibular gland, largely fatty replaced.\n\nOtherwise come the salivary glands enhance normally and are without mass or\nadjacent fat stranding. The thyroid gland appears normal.Neck vessels are\npatent.\n\nBenign calcified granuloma right lung. Degenerative changes spine. Mild\nanterolisthesis C3-C4, minimal retrolisthesis C5-C6, minimal anterolisthesis\nC6-C7, likely degenerative. Coronary artery calcifications.", + "output": "Primary floor of mouth, tongue malignancy is not definitely seen. Adjacent\nbone defect conforming to expected shape of dental implant removal, component\nof tumor is difficult to exclude on imaging. No additional bone erosions.\nNo adenopathy.\nCoronary artery calcifications." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nPeriventricular and subcortical white matter hypodensities are nonspecific,\nbut likely reflect sequelae of chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Bilateral lens\nreplacements are noted. Atherosclerotic calcifications of the carotid siphons\nare present bilaterally.", + "output": "1. No acute intracranial process.\n2. Chronic small vessel ischemic disease and parenchymal atrophy." + }, + { + "input": "Hypodensity in the right cerebellar hemisphere is new from the prior exam\n(series 8, image 2, 1). No evidence of hemorrhage, edema, or mass. Bilateral\nsymmetric prominence of the ventricles and sulci are consistent with\nage-related involutional change, unchanged. Nonspecific white matter\nhypodensities are also unchanged.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable other than bilateral lens replacements.", + "output": "New right cerebellar hemisphere infarct. No hemorrhage.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 5:06 ___, 3 minutes after\ndiscovery of the findings." + }, + { + "input": "There is no evidence of acute vascular territorial infarction, hemorrhage,\nedema, or mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and deep white matter hypodensities are\nlikely reflective of chronic small vessel ischemic changes. A right\ncerebellar hypodensity reflects prior infarct as noted on the prior MRI.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The patient is\nstatus post bilateral lens replacement.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute major vascular territorial infarction,\nhemorrhage, edema, or mass. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. Bilateral periventricular and deep white\nmatter hypodensities are nonspecific, but likely represent a sequela of\nchronic small vessel disease. Atherosclerotic calcifications are noted within\nthe bilateral carotid siphons and intracranial vertebral arteries.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial process on noncontrast head CT.\n2. Atrophy and probable chronic small vessel disease." + }, + { + "input": "CTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear patent without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThere is common origin of the brachiocephalic and left common carotid artery. \nThere is variant direct origin of the left vertebral artery from the aortic\narch. There is tortuosity of the right internal carotid artery with\nretropharyngeal course. The carotid and vertebral arteries and their major\nbranches appear patent with no evidence of stenosis or occlusion. There is no\nevidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nSubpleural bulla is noted in the left apex. The visualized portion of the\nlungs are otherwise clear. There are millimetric bilateral thyroid nodules\nfor There is no lymphadenopathy by CT size criteria. There are small to\nmoderate mucous retention cyst in the left maxillary sinus. The remainder of\nthe visualized paranasal sinuses are clear. There is periapical lucency\naround a left maxillary molar.", + "output": "1. Patent intracranial vasculature without significant stenosis, occlusion or\naneurysm.\n2. Patent cervical vasculature without significant stenosis, occlusion or\ndissection. No made of tortuous right internal carotid artery with\nretropharyngeal course.\n3. Millimetric bilateral thyroid lobe nodules. The ___ College of\nRadiology guidelines suggest that in the absence of risk factors for thyroid\ncancer, no further evaluation is recommended." + }, + { + "input": "There is no evidence of acute large vascular territorial\ninfarctionhemorrhage,edema,or mass. There is prominence of the ventricles and\nsulci suggestive of involutional changes. Small bilateral thalamic\nhypodensities, 1 on each side, likely represent chronic lacunar infarcts. \nPeriventricular and subcortical white matter hypodensities are nonspecific\nlikely reflect moderate chronic small vessel ischemic disease. Focus of\nsubacute ischemia would be difficult to exclude in the deep white matter. \nThere are no foci of cortical ischemia. There vertebral, carotid intracranial\natherosclerotic calcifications.\n\nThere is no evidence of fracture. There is mucosal moderate thickening of the\nleft maxillary sinus floor, partial opacification of the left mastoid tip. \nThere is a large periapical lucency involving left posterior most maxillary\ntooth with osseous suspension extending into the floor of the left maxillary\nsinus and osseous thinning with barely perceptible overlying bone, osseous\ndefect cannot be excluded. Remaining visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial hemorrhage.\n2. Chronic lacunar infarcts in the thalamus. There are moderate chronic\nsmall vessel ischemic changes. There is no CT evidence of cortical ischemia\nor hemorrhage.\n3. Large periapical lucency surrounding a left maxillary molar with probable\nosseous thinning, osseous defect cannot be excluded.. Adjacent floor of the\nleft maxillary sinus is moderately opacified from mucosal thickening." + }, + { + "input": "CTA HEAD:\nThere is a left dominant vertebrobasilar system. There is variant fetal type\norigin of the right PCA and partial fetal type origin of the left PCA. The\nvessels of the circle of ___ and their principal intracranial branches\nappear patent without significant stenosis, occlusion, or aneurysm formation. \nThe dural venous sinuses are patent.\n\nCTA NECK:\nThere are mild atherosclerotic calcifications of the aortic arch. There is\nvariant 4 vessel aortic arch with direct origin of the left vertebral artery. \nThere is minimal noncalcified atherosclerotic plaque at the carotid\nbifurcations without significant narrowing. The carotid and vertebral\narteries and their major branches appear patent with no evidence of\ndissection, significant stenosis or occlusion. There is no evidence of\ninternal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. There is a 10 mm\nhyperenhancing left lobe thyroid nodule (2:77). There is no lymphadenopathy\nby CT size criteria.\n\nThere is mild polypoid mucosal wall thickening in the floor of the left\nmaxillary sinus along with small bilateral maxillary sinus mucous retention\ncyst. There is large adjacent periapical lucency of a left maxillary molar,\nextending into the floor of the left maxillary sinus, raising the possibility\nof odontogenic sinusitis. The orbits are grossly unremarkable. There is\npartial opacification of a few left-sided mastoid air cells. The remainder\nthe visualized mastoid air cells and middle ear cavities are grossly clear. \nThere are mild degenerative changes of the cervical spine.", + "output": "1. Patent intracranial arterial vasculature without significant stenosis,\nocclusion, or aneurysm.\n2. Patent cervical arterial vasculature without significant stenosis,\nocclusion, or dissection.\n3. Left maxillary sinus mucosal wall thickening with large adjacent periapical\nlucency of a left maxillary molar extending into the floor left maxillary\nsinus, compatible with periodontal disease, raising the possibility of\nodontogenic sinusitis. Formal dental evaluation is advised.\n4. 10 mm hyperenhancing left thyroid lobe nodule. The ___ College of\nRadiology guidelines suggest that in the absence of risk factors for thyroid\ncancer, no further evaluation is recommended.\n\nRECOMMENDATION(S):\n1. Formal dental evaluation is advised.\n2. Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "Bifrontal areas of subcortical hypodensity are most consistent with sequela of\nchronic infarct. Additional foci of hypodensity in the bilateral basal\nganglia likely represent chronic lacunar infarcts. An area of focal\nhypodensity in the pons is also consistent with chronic infarct.\n\nThere is no evidence of acute large vascular territory infarction, hemorrhage,\nedema, or mass effect. The ventricles and sulci are prominent, consistent\nwith age-related involutional change. Periventricular and confluent\nsubcortical white matter hypodensities are consistent with sequela of chronic\nsmall vessel ischemic disease.\n\nThere is no evidence of fracture. Mucosal thickening is seen involving the\nleft maxillary sinus. Fluid is seen in scattered left-sided mastoid air\ncells. Remaining visualized paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The globes are unremarkable.", + "output": "1. No acute intracranial process." + }, + { + "input": "There is no evidence of large territory infarction,hemorrhage,edema,or\nmass-effect. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Fluid in the right maxillary sinus with\npartial opacification. Minimal opacification ethmoid sinuses. Otherwise, the\nvisualized portion of the other paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "No acute intracranial abnormality.\nFluid in the right maxillary sinus, consider acute sinusitis.." + }, + { + "input": "4.3 x 1.5 cm cystic within the midline posterior fossa is likely an arachnoid\ncyst. There is no evidence of =infarction,hemorrhage,edema, or mass. There\nis prominence of the ventricles and sulci suggestive of involutional changes,\nwithin the range expected for age. A right posterior temporal calcification\nmay reflect the sequelae of prior hemorrhage, infarction, or infection\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. \nStatus post left lens replacement. Otherwise, the visualized portion of the\norbits are unremarkable.", + "output": "No evidence of mass, hemorrhage or infarction." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nEvaluation significantly limited by motion artifact with no evidence of\ninfarction, or hemorrhage. The ventricles and sulci are prominent suggestive\nof age-related involutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are grossly clear. The visualized portion of the orbits are not\nwell assessed though grossly unremarkable.\n\nCTA HEAD:\nArtifact limits definitive assessment. However poor filling is visualized in\nthe left MCA distal to the bifurcation most pronounced in the superior\ndivision with less pronounced involvement of the inferior division. The\nremaining vessels of the circle of ___ and their principal intracranial\nbranches appear normal without substantial stenosis, occlusion, or aneurysm\nformation. The dural venous sinuses are patent.\n\nCTA NECK:\nThe vertebrobasilar system is left-side dominant. The carotid and vertebral\narteries and their major branches appear normal with no evidence of\nsubstantial stenosis or occlusion.\n\nOTHER:\nA small left pleural effusion is visualized otherwise the visualized portion\nof the lungs are clear. The thyroid is notable for a heterogeneous 8 mm left\nthyroid nodule (4:108). There is no lymphadenopathy by CT size criteria.", + "output": "1. No infarct identified though motion limits assessment for acute findings.\n2. Apparent poor filling of the left MCA distal to the bifurcation, to a\ngreater degree in the superior segment versus the inferior for which\ndefinitive evaluation is limited given substantial motion artifact." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nPatient is status post suboccipital craniectomy. Partially visualized fluid\noverlying the craniectomy site is similar compared to prior though not fully\nimaged on today's exam. No osseous abnormalities seen. The paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "No acute intracranial process. No evidence of hemorrhage." + }, + { + "input": "There is no acute intracranial hemorrhage. There is moderate periventricular,\nsubcortical, and deep white matter disease. The previously described right\nvestibular schwannoma is not well seen at the current study. There is mild\nintracranial vascular calcification. There is right posterior parietal scalp\nlaceration. Prominence of the sulci and ventricles is with involutional\nchanges.\n\nThere is an age indeterminate, likely chronic, left nasal bone deformity with\nno significant overlying soft tissue swelling. There is scattered\nopacification of left ethmoid air cells and sphenoid sinus.\n\nThe visualized portion of the mastoid air cells and middle ear cavities are\nclear. The visualized portion of the orbits are normal.", + "output": "1. Right posterior parietal scalp laceration with no evidence of underlying\nskull fracture.\n2. No acute intracranial hemorrhage.\n3. Moderate chronic microvascular ischemic disease." + }, + { + "input": "The carotidandvertebral arteries and their major branches are patent with no\nevidence of stenoses. No evidence for dissection is seen. The right\nvertebral artery is hypoplastic and appears to terminate in the posterior\ninferior cerebellar artery, anatomic variant.\n\nBy NASCET criteria, there is a 0 percent stenosis of the right ICA and a 0\npercent stenosis of the left ICA.\n\n\nPartially imaged soft tissue in the right cerebellopontine angle cistern\nextending into the internal auditory canal. This is consistent with history of\nvestibular schwannoma noted on review of the electronic medical record.\n\nProminence of the right tongue base may reflect enlargement of the lingual\ntonsil and can be correlated with direct inspection.\n\nAdditional findings include evidence of previous thyroidectomy, and multilevel\ndegenerative changes in the spine. Please refer to separate cervical spine\nreport for osseous findings.\n\nPlease refer to the separate CTA of the chest for thoracic findings.", + "output": "1. No evidence of dissection.\n2. No evidence of stenosis of the cervical internal carotid or vertebral\narteries.\n3. Partially imaged soft tissue in the right cerebellopontine angle cistern\nextending into the internal auditory canal. This is consistent with history of\nvestibular schwannoma noted on review of the electronic medical record.\n4. Prominence of the right tongue base may reflect enlargement of the lingual\ntonsil and can be correlated with direct inspection.\n5. Additional findings as above." + }, + { + "input": "There is no evidence of large vascular territorial infarction, hemorrhage,\nedema, or mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular, subcortical and deep white matter\nhypodensities are nonspecific but likely sequela of chronic small vessel\nischemic changes.\nThere is no evidence of fracture. There is mild mucosal thickening of the\nbilateral ethmoid air cells, and the visualized portion of the other paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process. No calvarial fracture." + }, + { + "input": "No evidence of acute infarction,hemorrhage,edema, or mass effect. Bilateral,\nsymmetric prominence of the ventricles and sulci indicate cortical volume\nloss. Periventricular, subcortical, and deep white matter hypodensities are\nnonspecific but likely sequelae of chronic small vessel ischemic disease,\nmoderate.\n\nNo evidence of fracture. The nasal septum is deviated to the right. The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The known small right IAC mass is not well imaged on this\nnondedicated exam. The visualized portion of the orbits are unremarkable.", + "output": "1. No intracranial hemorrhage or fracture.\n2. Cortical volume loss.\n3. Probable sequelae of chronic small vessel ischemic disease." + }, + { + "input": "There is no evidence of large territory infarction,hemorrhage,edema, or mass. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. There are subcortical and periventricular white matter\nhypodensities, nonspecific but likely sequela of chronic microvascular\nischemic disease.\n\nThere is no evidence of fracture. Sphenoid sinuses contain aerosolized\nmaterial. Hyperostosis of the sinus wall suggest chronic inflammation. The\nvisualized portion of the other paranasal sinuses, and middle ear cavities are\nclear. Postoperative changes of mastoidectomy versus erosive changes in the\nright mastoid air cells which is opacified. The partially visualized right\norbit is relatively unremarkable. Left globe is small and partially calcified\ncompatible with phthisis bulbi.\n\nSkin thickening seen in the left right periorbital region, particularly\nlaterally.", + "output": "1. No acute intracranial process.\n2. Right periorbital skin thickening.\n3. Postoperative changes of right mastoidectomy versus erosive changes in the\nright mastoid air cells which are mostly opacified." + }, + { + "input": "Head CT: There is no evidence of hemorrhage, edema, masses, mass effect, or\ninfarction. The ventricles and sulci are normal in caliber and configuration.\nNo fractures are identified. Patient is status post bilateral antrectomies and\nturbinectomies. There is mucosal thickening within the frontal, ethmoid,\nsphenoid, and right greater than left maxillary sinuses. The mastoid air cells\nare clear. The orbits are unremarkable.\n\nHead CTA: The intracranial carotid and vertebral arteries and their major\nbranches are patent with no evidence of stenoses, occlusions or aneurysm\nformation.\n\nNeck CTA: There is a normal three-vessel takeoff from the aortic arch. There\nis a stent seen in the right common carotid extending into the right proximal\ninternal carotid artery. The lumen of the carotid artery is patent within the\nstent. Imaging of the neck reveals no evidence of arterial stenosis or\nocclusion. There is soft and calcified plaque noted at the origin of the left\nproximal internal carotid artery which is mildly narrowed. There is no\nevidence of internal carotid artery stenosis by NASCET criteria. The distal\nright internal carotid artery measures 4.4 mm. The distal left internal\ncarotid artery measures 3.7 mm.", + "output": "Unremarkable noncontrast CT scan of the head.\n\nUnremarkable CTA of the head.\n\nPatient is status post stenting of the right common carotid and proximal right\ninternal carotid artery with patent lumen within the stent.\n\nHard and soft plaque at the origin of the left proximal internal carotid\nartery with mild narrowing." + }, + { + "input": "Bilateral temporal bone CT with contrast.\n\nRight side:\nMild opacification, fluid of the right mastoid air cells, approximately ___ of\nthe air cells is opacified, remainder of mastoid, pneumatized petrous air\ncells are clear. Clear middle ear cavity. No bone destruction, intact\nsigmoid plate, tegmen. No bone erosions, normal middle ear ossicles, normal\ninner ear., normal course of the facial nerve. Normal external ear,\nperiauricular soft tissues, Pina, parotid glands.\n\nLeft side:\nClear mastoids, middle ear.. Suboptimal visualization of the left\nsemicircular canals secondary to motion artifact, sequela of chronic\nlabyrinthitis with partial opacification is unlikely in the absence of\nclinical history, clinically correlate. Normal inner ear, IAC, EAC. Normal\npreauricular soft tissues, pinna, parotid glands.\n\nOther:\n No infiltration of the soft tissues of the petrous apex,, no adjacent bone\ndestruction, normal posterior nasopharynx. Normal visualized intracranial\nstructures.", + "output": "1. Mild right mastoid effusion, likely reactive, mastoiditis is unlikely.\n2. No bone destruction, normal vasculature, periauricular, skullbase soft\ntissues.\n3. Otherwise normal bilateral temporal bones." + }, + { + "input": "There is mild encephalomalacia in the left temporal lobe relating to a remote\nhemorrhagic contusion. There is no evidence of infarction, hemorrhage, edema,\nor mass. The ventricles and sulci are normal in size and configuration.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Encephalomalacia in the left temporal lobe relating to prior hemorrhagic\ncontusion. No evidence of hemorrhage or bony/soft tissue injury." + }, + { + "input": "CT head shows no evidence of hemorrhage, or loss of gray-white matter\ndifferentiation. No midline shift or hydrocephalus seen. A small retention\ncyst is seen in the left maxillary sinus. Mucosal thickening is seen in\nethmoid air cells and frontal sinuses.\n\nCT angiography of the neck shows normal appearance of the carotid and\nvertebral arteries without stenosis or occlusion or dissection.\n\nCT angiography of the head shows normal appearance of the arteries of the\nanterior and posterior circulation without stenosis or occlusion or aneurysm\ngreater than 3 mm in size.\n\nSmall lymph nodes are visualized within the upper neck not enlarged by imaging\ncriteria.", + "output": "1. No acute abnormalities on head CT. No hemorrhage or signs of contusion. \nMucosal thickening in the sinuses.\n2. No significant abnormalities on CT angiography of the neck. No vascular\nocclusion, stenosis or dissection seen.\n3. No significant abnormalities on CT angiography of the head." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nlarge territorial infarction. The ventricles and sulci are normal in size and\nconfiguration. The basal cisterns appear patent.\n\nThe visualized bony structures are grossly unremarkable. There is a small\nmucous retention cyst in the left maxillary sinus. The globes are\nunremarkable.", + "output": "No acute intracranial hemorrhage. No acute fracture." + }, + { + "input": "Head CT: There is no evidence of hemorrhage, edema, masses, mass effect, or\ninfarction. The ventricles and sulci are normal in caliber and configuration.\nNo fractures are identified. There is a mucous retention cyst in the left\nmaxillary sinus. The remaining paranasal sinuses and mastoid air cells are\nclear.\n\nCTA images are somewhat limited by suboptimal contrast bolus.\n\nHead CTA: There are no intracranial vascular abnormalities. There is no\nevidence of aneurysm, stenosis or occlusion. There is mild irregularity of\nthe left V4 segment likely reflecting arthrosclerotic disease.\n\nNeck CTA: The carotid and vertebral arteries and their major branches are\npatent with no evidence of stenoses. There is no evidence of internal carotid\nstenosis by NASCET criteria. There is mild calcification at the carotid\nbifurcations without stenosis. The distal right ICA measures 4.8 mm and the\ndistal left ICA measures 4.5 mm.", + "output": "1. No hemorrhage, infarction, or mass effect on unenhanced head CT.\n\n2. No evidence of aneurysm, stenosis, or occlusion on head CTA.\n\n3. No evidence of stenosis by NASCET criteria" + }, + { + "input": "Compared with CT head on ___, patient has undergone interval\nright craniotomy with evacuation of a right subdural hematoma, with a subdural\ndrain in place and expected postoperative pneumocephalus. A combination of\nmixed density blood and postoperative air in the right subdural space is\noverall decreased in size, measuring up to 18 mm in greatest thickness,\ncompared with 22 mm previously. There is new hyperdense blood products within\nthe collection, consistent with acute hemorrhage. There is improvement in\nmass effect on the adjacent sulci and right ventricle. No midline shift. \nBasal cisterns are patent.\n\nThere is prominence of the ventricles and sulci consistent with age-related\ninvolutional change. Subcortical and periventricular white matter\nhypodensities are nonspecific, however likely represent sequela of chronic\nsmall vessel ischemic disease. There are atherosclerotic calcifications in\nthe bilateral cavernous carotids and left vertebral artery.\n\nThere is no evidence of fracture. There is mild mucosal thickening in the\nright maxillary sinus. The visualized portion of the remainder of the\nparanasal sinuses are clear. There is unchanged opacification of the\nbilateral mastoid air cells and middle ear cavities. Patient is status post\nbilateral lens replacement. Senile scleral calcifications in the right are\nagain noted. The visualized portion of the orbits are otherwise unremarkable.", + "output": "1. Postoperative change status post interval craniotomy and evacuation of a\nmixed density right subdural collection, which is overall decreased in size,\nmeasuring up to 18 mm, compared with 22 mm previously, with new acute blood in\nthe cavity.\n2. Mass effect with effacement of the adjacent sulci and right ventricle is\nimproved. No midline shift. Basal cisterns are patent." + }, + { + "input": "Compared to the earlier same day examination, there has been removal of the\nright subdural drain with similar thickness of the mixed density right lateral\nconvexity subdural hematoma measuring up to 16 mm in maximal thickness, with\nsimilar degree of postoperative pneumocephalus. Associated mass effect is\nsimilar. No new hemorrhage is identified. There is no evidence of acute\nterritorial infarction, edema,or mass. The configuration of the ventricles\nand sulci is unchanged. There is no midline shift.\n\nThere is no evidence of fracture. The bilateral mastoid air cells remain\nopacified. There is mild mucosal wall thickening in the lateral aspect of the\nleft maxillary sinus as well as the bilateral frontoethmoidal recesses. There\nare changes from right parietal craniotomy. The visualized portion of the\norbits are unremarkable.", + "output": "Interval removal of a right subdural hematoma drain with unchanged size of the\nresidual mixed density right lateral convexity subdural collection with\nunchanged postoperative pneumocephalus. No new hemorrhage." + }, + { + "input": "Overall unchanged right subdural hematoma. Blood appears less dense the\ncurrent study and slightly different due to redistribution. The maximum width\nof the subdural hematoma is 16 mm in the parietal region. There is no acute\nhemorrhage. Similar degree of pneumocephalus. Mild mass effect is similar to\nprior study without midline shift.\nNo new hemorrhage is seen. Gray-white matter differentiation is maintained. \nThe ventricles are prominent bilaterally, along the unchanged, likely\nsecondary to differences in angulation and slice selection. Sulci are normal\nin size and configuration.\n\nPatient is status post right parietal craniotomy. The visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nThe visualized portion of the orbits are unremarkable.", + "output": "1. Right subdural hematoma is overall unchanged accounting for redistribution\nand slice selection.\n2. Unchanged postoperative pneumocephalus.\n3. No new hemorrhage." + }, + { + "input": "The previously noted heterogenous right subdural fluid collection demonstrates\ninterval decrease in size currently measuring 5 mm in diameter (previously 15\nmm). The amount of subdural air has also decreased. The post surgical\ncraniotomy changes are stable. Generalized cerebral atrophy with ex vacuo\ndilatation of the ventricular system is again noted. Periventricular\nhypodense changes most likely sequela of microangiopathy and is unchanged. No\nnew intracranial hemorrhage, large acute territorial infarct or mass.\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "Interval decrease in size of the right subdural fluid collection.\n\nPost craniotomy surgical changes are stable." + }, + { + "input": "The acute on chronic right subdural hematoma is unchanged measuring up to 2.2\ncm in maximum thickness. There is no evidence of new hemorrhage. Mass effect\non the adjacent sulci and on the right lateral ventricle, but no significant\nmidline shift. The basal cisterns are patent.\n\nThere is no evidence of acute territorial infarction,edema,or mass. \nSubcortical, deep, and periventricular white matter hypodensities are\nnonspecific, but likely represent the sequela of chronic microvascular\nischemia. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture. A sclerotic lesion within the right\nparietal calvarium likely represents a bone island. There is complete\nopacification of the bilateral mastoids and middle ear cavities, unchanged\ncompared to prior.The visualized portion of the paranasal sinuses are clear. \nThe patient is status post bilateral lens resections. Senile scleral\ncalcifications are seen on the right.", + "output": "1. Unchanged appearance of the acute on chronic right subdural hematoma\nmeasuring up to 2.2 cm in maximum thickness. No evidence of new hemorrhage.\n2. Mass effect on the adjacent sulci, but no evidence of midline shift.\n3. Complete opacification of the bilateral mastoid and middle ear cavities,\nunchanged." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates prominence of the uvula\nwithout focal fluid collections. No focal mass effect. Few reactive lymph\nnodes noted in the right masticator space. Fat planes are preserved. No\npharyngeal or retropharyngeal abscess.\n\nStreak artifact from dental amalgam is noted however no radiolucent foci in\nmandible or maxillary bone in relation to the teeth.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.", + "output": "Subtle prominence of the uvula and pharyngeal mucosa should be correlated\nclinically. No fluid collections noted in the neck, particularly no\nretropharyngeal abscess.\n\nNOTIFICATION: The final read impression was discussed with ___, M.D.\nby ___, M.D. on the telephone on ___ at 11:59 pm." + }, + { + "input": "There is no evidence of large territory infarction,hemorrhage,edema, or mass. \nThe ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial hemorrhage or definite fracture, although this would be\nbetter assessed on the concurrent maxillofacial CT." + }, + { + "input": "Linear lucency in the left orbital roof (02:38, 601:86) is likely a vascular\nchannel. No definite acute fracture is seen.\nThere is mild left facial soft tissue swelling, including overlying the left\npre maxillary region/cheek.\nVisualized paranasal sinuses are well aerated.\nThere is no evidence of abnormal fluid collections.\nPartially imaged mastoid air cells are clear.\nThe orbits are intact. No retrobulbar hematoma or fat stranding is seen.\nThe visualized upper aerodigestive tract appears normal.\nThe mandible and temporomandibular joints appear normal.", + "output": "No acute fracture seen. Linear lucency in the left orbital roof is likely a\nvascular channel.\n\nNo evidence of retrobulbar hematoma.\n\nNOTIFICATION: Updated findings discussed with ___ on ___\nat 21:10" + }, + { + "input": "There is a small nondisplaced fracture of the sphenoid bone near the lateral\nwall of the left sphenoid sinus and extending to it. There is also a\nminimally displaced fracture along the anterolateral left orbital\nwall/zygomatic bone with hemorrhagic fluid density products seen layering in\nthe bilateral sphenoid sinuses, left greater than right, and left maxillary\nsinus. Mild mucosal thickening is seen in the right maxillary sinus. Soft\ntissue swelling is noted along the left zygomatic region and a small\nlaceration is seen in the left temporal region.\n\nThere is no edema, shift of normally midline structures, or evidence of acute\nmajor vascular territorial infarction. There are ill-defined periventricular\nsubcortical white matter hypodensities are seen likely representing a sequela\nof chronic small vessel ischemic changes. Ventricles and sulci are normal in\noverall size and configuration. Mastoid air cells and middle ear cavities are\nwell aerated.", + "output": "1. Small nondisplaced left sphenoid fracture with extention to the left\nsphenoid sinus and minimally displaced left zygomatic fracture, with\nhemorrhagic fluid density products seen layering in the bilateral sphenoid\nsinuses, left greater than right, and left maxillary sinus.\n2. Soft tissue swelling along the left zygomatic region along with a small\nlaceration in the left temporal region.\n3. No acute intracranial process." + }, + { + "input": "SOFT TISSUES: There is a small laceration in the left temporal region with\nsoft tissue swelling noted along the left zygomatic arch.\n\nMAXILLOFACIAL BONES: There is fracture of the anterolateral left zygomatic\nbone (2:38),nondisplaced left sphenoid fracture with extension to the left\nsphenoid sinus. Hemmorrhagic blood density products seen layering in the\nbilateral sphenoid sinuses, left greater than right, and left maxillary sinus.\nPossible nondisplaced fracture of the left posterior maxillary wall (2:48).\nThe lateral pterygoid plates are intact.\n\nMANDIBLE: The mandible is without fracture or temporomandibular joint\ndislocation. The temporomandibular joints are symmetric, without significant\ndegenerative change.\n\nSINUSES: Hemorrhagic blood density products seen layering in the bilateral\nsphenoid sinuses, left greater than right, and left maxillary sinus. . The\nostiomeatal units are patent. The mastoid air cells and middle ear cavities\nare clear.\n\nNOSE: There is no nasal bone fracture.\nORBITS: The orbits, including the laminae papyracea, are intact. The globes\nare intact with no evidence of intraocular hematoma. There is no retrobulbar\nhematoma or fat stranding. Patient has had bilateral lens replacements.", + "output": "1. Fracture of the anterolateral left zygomatic bone,nondisplaced left\nsphenoid fracture with extension to the left sphenoid sinus. Possible\nnondisplaced fracture of the left posterior maxillary wall. Hemmorrhagic\nblood density products seen layering in the bilateral sphenoid sinuses, left\ngreater than right, and left maxillary sinus.\n2. Small laceration in the left temporal region with soft tissue swelling\nnoted overlying the left zygomatic arch." + }, + { + "input": "Study is mildly degraded by motion and dental streak artifact. There is a 2\nvessel aortic arch with common origin for the right common carotid and right\nbrachiocephalic trunk. There is mild atherosclerosis involving bilateral\ncarotid bifurcations, left greater than right without any stenosis by NASCET\ncriteria.\n\nThere is mild bilateral cavernous carotid artery calcifications.\nNo evidence of vertebral or carotid artery dissections.\n\nThere is subcutaneous emphysema and soft tissue stranding just lateral to the\nleft lateral orbit (06:339) with associated minimally displaced fracture at\nthe left lateral zygoma (6:329). Nondisplaced left zygomatic arch fracture is\nagain noted (see 06:22). Nondisplaced left maxillary sinus lateral wall\nfractures are again noted (see 6:287). Minimally displaced left C7 transverse\nprocess fractures again noted (see 6:150 on current study and 02:41 on prior\ncervical spine CT). There is mild mucosal thickening within the bilateral\nmaxillary sinuses with an inferior left maxillary mucous retention cyst. \nThere is a small fluid level within left sphenoid sinus. The bilateral lenses\nare absent. There senile calcifications at the extraocular muscle tendon\ninsertions.\n\nThe pharynx, larynx, oral cavity, and nasal cavities are unremarkable. The\nthe thyroid and salivary glands are unremarkable. The masticator\nparapharyngeal spaces are unremarkable. There are no suspicious lymph nodes\nby size or morphology.\n\nThere multilevel degenerative changes of the cervical spine without. There is\nre demonstration of a nondisplaced fracture at the base of the dens (08:31). \nThe mastoid air cells and middle ears are clear. Nonspecific left sphenoid\nand maxillary sinus mucosal thickening with fluid levels are again noted. The\nright and left mainstem pulmonary arteries are enlarged measuring up to 3.4 cm\nin maximum diameter (06:23). There are new small bilateral pleural effusions.", + "output": "1. Study is mildly degraded by motion and dental streak artifact.\n2. Patent neck vasculature without significant stenosis by NASCET criteria,\nand no evidence of dissection.\n3. Mild atherosclerosis of the cervical carotid arteries as described above.\n4. New small bilateral pleural effusions.\n5. Enlarged bilateral mainstem pulmonary arteries which may be seen with\npulmonary arterial hypertension.\n6. Redemonstration of a nondisplaced age indeterminate type 2 dens fracture,\nbetter visualized on recent prior cervical spine CT.\n7. Grossly stable minimally displaced left C7 transverse process fracture,\nbetter visualized on recent prior cervical spine CT.\n8. Minimally displaced left posterolateral zygoma, nondisplaced left zygomatic\narch and left maxillary sinus lateral wall fractures with overlying\nsubcutaneous emphysema and soft tissue stranding are better demonstrated on\ndedicated facial CT from ___." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema,or large mass. The\nventricles and sulci are normal in size and configuration.There is no evidence\nof fracture. The visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. There is preservation of\ngray-white matter differentiation. The basal cisterns appear patent.\n\nThere is no evidence of fracture. Partial opacification is noted of the\nbilateral ethmoid air cells. The remainder of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "No evidence of acute intracranial hemorrhage or mass effect." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear demonstrate\nno evidence of stenosis or occlusion. There are minimal atheorsclerotic\nplaques at the ICA origins bilaterally, but there is no evidence of internal\ncarotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Minimal atherosclerotic changes at the internal carotid artery origins\nbilaterally.\n2. Otherwise normal head and neck CTA." + }, + { + "input": "There is no acute intracranial hemorrhage, loss of gray/ white matter\ndifferentiation, edema or mass effect. The ventricles, stable sulci, and\nbasal cisterns are normal in size for age.\n\nNo fracture is identified. Mild mucosal thickening within a left middle\nethmoidal air cell is noted. There is a secondary defect in the medial wall of\nthe right maxillary sinus, with a small soft tissue density within the defect\nwhich may represent a polyp. Mastoid air cells and middle ear cavities are\nclear. The orbits are unremarkable.", + "output": "1. No evidence for an acute intracranial abnormality or fracture.\n2. Secondary defect in the medial wall of the right maxillary sinus, with a\nsmall soft tissue density within the defect which may represent a polyp." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process. If there is further concern for acute\ninfarction, recommend MRI." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mild mucosal thickening in the\nethmoid air cells and maxillary sinuses bilaterally. Remainder of the\nvisualized paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "Normal study." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are prominent consistent with generalized parenchymal\nvolume loss.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality identified." + }, + { + "input": "Compared with prior MRI and CT, patient has undergone interval left frontal\ncraniotomy for a previously seen ring enhancing lesion the left frontal lobe,\nwith a small amount of expected pneumocephalus. There is a small amount of\nhyperdense blood within the resection bed. Surrounding edema in the left\nfrontal lobe is not significantly changed in extent. Mass effect with\neffacement of the frontal horn of the left lateral ventricle and rightward\nmidline shift measuring up to 5 mm is not significantly changed. No evidence\nof acute large territorial infarction. There are atherosclerotic\ncalcifications in the bilateral cavernous carotids.\n\nThere is postoperative soft tissue swelling, subcutaneous air and surgical\nstaples overlying the left craniotomy site. There is no evidence of fracture.\nThere is partial opacification of a few left mastoid air cells, unchanged. \nThe visualized portion of the paranasal sinuses, right mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Status post left frontal craniotomy for resection of a left frontal lobe\nring-enhancing mass, with small amount of blood in the resection bed.\n2. No significant change in surrounding vasogenic edema and associated mass\neffect, with rightward midline shift measuring up to 5 mm." + }, + { + "input": "Patient is status post left frontal craniotomy. Compared with MRI head on ___ and outside CT head on ___, there is no\nsignificant change in vasogenic edema in the left frontal lobe. There is no\nsignificant change in mass effect with partial effacement of the frontal horn\nof the left lateral ventricle. Rightward midline shift along the anterior\nfalx up to 5 mm is not significantly changed. Basal cisterns are patent. \nThere is no evidence of infarction or hemorrhage. A previously seen punctate\nfocus of subacute infarct in the right cerebellum is better evaluated on MRI.\n\nThere is no evidence of fracture. There are partially visualized mucosal\nretention cysts in the right maxillary sinus. The visualized portion of the\nremainder of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No evidence of hemorrhage.\n2. No significant change in left frontal lobe edema and associated mass\neffect." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\n\nAn approximately 2.1 cm left hyperdense/hemorrhagic frontal lobe mass. \nVasogenic edema with 6 mm of rightward midline shift and mass effect on the\nipsilateral left lateral ventricle is unchanged. No evidence of intracranial\nhemorrhage.\n\nThe major vessels of the circle of ___ and their principal intracranial\nbranches appear normal without stenosis, occlusion, or aneurysm formation.\nIncidental posterior inferior cerebellar artery terminus right vertebral\nartery.\n\nIncidental developmental venous anomaly involving the left cerebellar\nhemisphere, left middle cerebellar peduncle, left pons.\n\nSmall mucous retention cyst in the right maxillary sinus. Cerumen present in\nthe left external auditory canal. Minimal fluid present in the left posterior\nmastoid air cell. The orbits appear normal.", + "output": "Hyperdense/hemorrhagic mass in the left frontal lobe with surrounding\nvasogenic edema as described above.\nNo associated vascular malformation/aneurysm. No abnormal vascular structures\nare seen.\n\nThe major vessels of the circle of ___ appear normal.\nIncidental finding of a DVA DVA in the left posterior fossa." + }, + { + "input": "There is no evidence of intracranial hemorrhage, edema, or mass. Mild\nprominence of the bilateral frontal extra-axial spaces, may represent\nhygromas. The ventricles and sulci are mildly prominent suggesting age related\nvolume loss. The basal cisterns are patent. There is a hypodensity involving\nthe left cerebellum, age indeterminate (series 2, image 9).\n\nNo osseous abnormalities seen. There is near complete opacification of the\nright maxillary sinus, with high density material. There is minimal mucosal\nthickening of the ethmoid air cells. Additionally, there is opacification of\nthe right mastoid air cells. The remainder of the paranasal sinuses, middle\near cavities, and left mastoid air cells are clear. A calcified soft tissue\nbump is noted along the right frontal bone (series 3, image 53).", + "output": "1. No evidence of intracranial hemorrhage.\n2. Hypodensity involving the left cerebellum is age indeterminate, given no\nprior studies.\n3. Mild prominence of the bilateral frontal extra-axial spaces may represent\nhygromas.\n4. Sinus disease, including near-complete opacification of the right maxillary\nsinus." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass. Stable\nappearing region of hypodensity in the left lobe of the cerebellum is\nconsistent with chronic infarct. Prominent ventricles and sulci are consistent\nwith age-related involutional change. Mild periventricular white matter\nhypodensities are consistent with chronic small vessel ischemic disease.\nIncidental note is made of bilateral basal ganglia calcifications.\n\nNo osseous abnormalities seen. Again seen is near complete opacification of\nthe low right mastoid air cells. The remaining left mastoid air cells, middle\near cavities, and visualized paranasal sinuses are clear. The globes are\nunremarkable.", + "output": "1. No acute intracranial process.\n\n2. Persistent near complete opacification of the right mastoid air cells.\nRecommend correlation with symptoms." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or large mass. The\nventricles and sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is mucosal thickening of the bilateral ethmoid air cells, maxillary\nsinuses, sphenoid sinuses, and the left frontal sinus. There are mucous\nretention cysts in the bilateral maxillary sinuses. This may be consistent\nwith intubation status. Bilateral mastoid air cells and external ear canals\nare clear.\n\nAlthough there is evidence of extensive chronic dental disease and prior\nperiodontal procedures including fillings and extractions, there is no\ndefinitive fluid collection. There are periapical lucencies around multiple\nteeth, for example, the right upper second molar, suggestive of acute or\nchronic infection. Bilateral third mandibular molars appear partially\nimpacted, with surrounding soft tissue and periapical lucencies. See for\nexample series 602, image 108, and series 301, image 26.\n\nThe cribriform plates are intact. The lamina papyracea are intact. There is\nno abnormal enhancement on post contrast images. The orbits are unremarkable.\nThere is no lymphadenopathy. There are no fractures.\n\nET and enteric tubes are present, with trace pooling of fluid posteriorly to\nthe ET tube.", + "output": "Evidence of extensive dental disease and prior periodontal procedures, without\ndefinitive fluid collection. In the setting of fever unknown origin and\nconcern for infection, clinical correlation is recommended to rule out the\npossibility of periodontal infection.\n\nPotential soft tissue related to periapical lucency at the right mandibular\nthird molar could be inflammatory or could relate to odontogenic tumor" + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass effect. \nThe ventricles and sulci are normal in size and configuration. Periventricular\nand subcortical white matter hypodensities are nonspecific but likely sequelae\nof chronic small vessel ischemic disease. There is a punctate calcification\nin the right occipitocerebellar region (2:10), probably along the dura common\nappears similar to additional scattered dural calcifications along the falx. \nCalcifications of the bilateral cavernous internal carotid arteries.\n\n\nThere is no evidence of fracture. There is a moderate mucosal thickening of\nthe bilateral maxillary sinuses, left greater than right. There is mild\nmucosal thickening of the bilateral ethmoid air cells and bilateral sphenoid\nsinuses. The visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. There is a tube in the right nostril which\nterminates below the level of the image; on the scout images, there is a\nnasoenteric tube and endotracheal tube, partially imaged. The visualized\nportion of the orbits are unremarkable. Vascular calcifications are present.", + "output": "1. No acute intracranial process.\n2. Sinus disease as described above." + }, + { + "input": "There is no evidence of acute large territory infarction,hemorrhage,edema,or\nmass effect. The ventricles and sulci are normal in size and configuration.\nPeriventricular and subcortical white matter hypodensities are nonspecific but\nlikely sequelae of chronic small vessel ischemic disease. Redemonstration of\npunctate calcification in the right occipital cerebellar region (02:11),\nprobably along the dura, and appearing similar to additional scattered dural\ncalcifications along the falx. There are calcifications of the bilateral\ncavernous sinus internal carotid arteries.\n\nThere is no evidence of fracture. Moderate mucosal thickening of the\nbilateral maxillary sinuses, left greater than right. There is an air-fluid\nlevel in the left maxillary sinus, unchanged compared to exam from ___. There is a deviated nasal septum with a left-sided nasal spur. Mild\nmucosal thickening of the bilateral ethmoid air cells and bilateral sphenoid\nsinuses. The visualized portion of the bilateral mastoid air cells and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No evidence of hemorrhage or acute large territorial infarction on\nnoncontrast CT head.\n2. Sinus disease as described above." + }, + { + "input": "Patient is status post left frontotemporal craniotomy for electrode/strip\nplacement. Streak artifact from metal hardware limits evaluation of the brain\nparenchyma. Moderate pneumocephalus overlying the left cerebellar hemisphere\nis compatible with postsurgical changes. There is a 3 mm rightward midline\nshift there is no intra-axial or extra-axial hemorrhage, edema, or evidence of\nacute major vascular territorial infarction. Ventricles and sulci are normal\nin overall size and configuration. The imaged paranasal sinuses are clear.\nMastoid air cells and middle ear cavities are well aerated.", + "output": "Status post left frontotemporal craniotomy and electrode/strip placement. \nPostsurgical changes are noted including a 3 mm rightward midline shift. \nStreak artifact limits evaluation of the brain parenchyma." + }, + { + "input": "Multiple depth electrodes are identified. Artifacts limit evaluation of the\nleft cerebral hemisphere but no large area of hemorrhage seen in the\nvisualized portions of the brain. Pneumocephalus is noted. Minimal midline\nshift as before on the MRI. Basal cisterns are patent.\n.", + "output": "CT performed for planning purposes demonstrates intracranial EEG electrodes\nwith artifacts limit the evaluation in the left cerebral hemisphere but in the\nvisualized portions no large hematoma seen. No hydrocephalus.\n\nRECOMMENDATION(S): ." + }, + { + "input": "Surgical hardware streak artifact limits exam. The patient is status post\nleft parietal craniotomy and electrode removal with overlying soft tissue\nswelling, subcutaneous air, and skin staples. Pneumocephalus overlying the\nleft frontal, parietal, and temporal lobes is expected. There is a thin\npostoperative extra-axial fluid collection measuring up to 7 mm in maximum\nthickness. There is a small amount of high density within this fluid\ncollection, likely postoperative blood products, which is within the expected\nrange. Mild mass effect on the adjacent sulci, with grossly stable\napproximately 4mm left to right midline shift.\n\nThere is no evidence of infarction,edema,or mass. The ventricles and sulci\nare normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Surgical hardware streak artifact limits exam.\n2. Status post left parietal craniotomy and electrode removal with expected\npostoperative changes including pneumocephalus and a 7 mm extra-axial fluid\ncollection containing a small amount of blood products.\n3. Grossly stable approximately 4mm left to right midline shift." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass effect. The ventricles and sulci are normal in size and configuration.\n\nNo acute fractures are seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear.", + "output": "No acute intracranial process. Of note, MRI is more sensitive for detection\nof intracranial masses." + }, + { + "input": "There is no evidence of acute hemorrhage mass effect midline shift or\nhydrocephalus. Gray-white matter differentiation is maintained. There is no\nabnormal enhancement seen. An incidental right frontal developmental venous\nanomaly is identified.", + "output": "No enhancing brain lesions are identified." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. There is mucosal thickening in the bilateral\nethmoidal air cells. The paranasal sinuses, mastoid air cells, and middle ear\ncavities are otherwise clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is been interval development of multiple foci of intraparenchymal\nhemorrhage within the left parietal lobe with possible involvement of the left\noccipital lobe, with surrounding vasogenic edema, new from ___. \nLargest of these lesions measures 1.4 x 1.5 x 1.9 cm. Additional punctate\nhemorrhagic foci are seen within the right parietal lobe (602b:33), and the\nright frontal lobe (601b:52). Ventricles and sulci are normal in size and\nconfiguration. There is no shift of the normally midline structures. The\nbasal cisterns appear patent.\n\nNo acute fracture is seen. Fluid is seen within scattered left-sided mastoid\nair cells. Mild paranasal sinus disease is seen involving scattered ethmoid\nair cells. Otherwise the visualized mastoid air cells, middle ear cavities\nand paranasal sinuses are clear. The orbits are unremarkable.", + "output": "1. Interval development of multiple foci of intraparenchymal hemorrhage within\nthe bilateral cerebral hemispheres, concerning for hemorrhagic metastases, new\nfrom ___. Recommend further evaluation with contrast-enhanced MRI.\n2. Vasogenic edema is seen surrounding the hemorrhagic foci in the left\nparietal lobe.\n\nRECOMMENDATION(S):\n1. Interval development of multiple foci of intraparenchymal hemorrhage within\nthe bilateral cerebral hemispheres, concerning for hemorrhagic metastases, new\nfrom ___. Recommend further evaluation with contrast-enhanced MRI." + }, + { + "input": "Multiple foci of intraparenchymal hemorrhage are unchanged since approximately\n24 hours prior. The largest intraparenchymal hemorrhage is located in the\nleft parieto-occipital lobe and measures 1.4 x 1.4 cm (series 5, image 18. \nAdditional, smaller adjacent hemorrhages as well as a punctate right\nparieto-occipital lobe and right frontal lobe hemorrhage are unchanged (series\n5, image 20). White matter hypoattenuation, most pronounced in the left\nparieto-occipital lobe is unchanged. No midline shift. The basal cisterns\nare patent. No evidence of new hemorrhage or large territorial infarction. \nThe ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Bilateral parenchymal hemorrhages with adjacent vasogenic edema most prominent\nin the left parieto-occipital lobe are unchanged with no significant\nmass-effect." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nArea of hypoattenuation with loss of gray-white differentiation is seen in the\nleft parietooccipital region consistent with acute or subacute infarct, with\ninternal hyperdense foci, consistent with hemorrhage, largest focus of\nhemorrhage measures 9 mm. Mildly hyperdense left M1 MCA terminus.\n\nChronic infarct left frontal operculum, lateral orbital gyrus, triangular in\nthe expected Broca's area. Advanced brain parenchymal atrophy, most prominent\nat the temporal lobes with severe hippocampal atrophy.\n\nThere is complete opacification of the right maxillary sinus and moderate\nmucosal thickening of the right ethmoid sinus. The mastoid air cells and\nmiddle ear cavities are clear. The patient is status post bilateral cataract\nsurgery. Tiny chronic infarct right cerebellum. Asymmetric prominence of the\nleft lacrimal gland, hyperemia, may be inflammatory or neoplastic. Opacified\nright maxillary sinus with volume loss consistent with atelectasis. Mild\natelectasis left maxillary sinus.. Degenerative changes spine.\n\nCT PERFUSION:\nCBF < 30% volume: 0 cc.\nT-max > 6 seconds: 439 cc, involving cerebellum, bilateral cerebral\nhemispheres, likely reflective of technically suboptimal exam.\nMismatch volume: 439 cc.\n\nColor maps:\nDecreased cerebral blood volume in the area of above-mentioned chronic left\nfrontal infarct.\nIncreased cerebral blood volume in the area of left parietal subacute infarct,\nwith matching increase in cerebral blood flow, and decreased matching T-max.\n\n\nCTA HEAD:\nArea of increased vascularity in the area of left parietal infarct.\nAtheromatous calcifications bilateral cavernous segments ICA with mild ectasia\non the left and no significant narrowing on either side.\nThe vessels of the circle of ___ and their principal intracranial branches\nappear otherwise normal without stenosis, occlusion, or aneurysm formation. \nThe dural venous sinuses are patent.\n\n\nCTA NECK:\nMild narrowing proximal right subclavian artery. Atherosclerotic\ncalcifications aortic arch. Mild origin narrowing left subclavian artery.\n\nMild narrowing mid right common carotid artery. Atherosclerotic plaque,\npartially calcified at the right ICA origin, with associated atheromatous\nulcer. 30% proximal right ICA narrowing by NASCET criteria.\n\nMild narrowing mid left CCA from atheromatous plaque. No left ICA narrowing\nby NASCET criteria\n\nPatent vertebral arteries bilaterally. Dominant left vertebral artery.\n\nOTHER:\nEndotracheal and enteric tubes are seen. Secretions from intubation within\nthe aerodigestive tract. The visualized portion of the lungs are clear. \nSternotomy wires are seen.", + "output": "1. Subacute infarct in the left parietal, occipital lobe, with hemorrhagic\ntransformation, associated hyperemia.\n2. Chronic infarct left frontal lobe. Moderate chronic small vessel ischemic\nchanges.\n3. Brain parenchymal atrophy, severe temporal lobe atrophy.\n4. Mild asymmetric enlargement, hyperemia left lacrimal gland, may be\ninflammatory or neoplastic.\n5. Mild atherosclerotic calcifications, no stenosis intracranially.\n6. 30% proximal right ICA narrowing, with ulcerated atheromatous plaque" + }, + { + "input": "Compared to the prior studies, the known infarct of the left parietooccipital\nregion with hemorrhagic conversion appears similar. No evidence of new areas\nof new hemorrhage. The chronic infarct of the left frontal lobe appears\nstable. A chronic infarct of the right cerebellum is again seen. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The right maxillary sinus remains\nopacified. Otherwise, the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. No significant change in the known infarct of the left parieto-occipital\nregion with hemorrhagic conversion. No evidence of new hemorrhage.\n2. Stable chronic infarcts of the left frontal lobe and right cerebellum." + }, + { + "input": "Seen again is the area of low attenuation at the left parietooccipital lobe\nconsistent with previously known subacute infarct which shows increased\ngyriform hyperintensity change. High attenuation is seen in the infarct\nconsistent with hemorrhagic transformation, which demonstrates interval\nimprovement compared to prior head CT from ___. There is no new\nareas of acute blood, infarct or mass effect. Chronic infarct seen in the\nleft frontal lobe it is unchanged compared to prior. Periventricular\nhypodensities consistent with chronic small vessel ischemic changes. \nInvolutional changes are seen.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Subacute infarct in the left parietooccipital lobe with expected\nevolutional change of previously seen hemorrhagic transformation. No acute\nblood seen.\n2. Unchanged chronic infarct seen in the left frontal lobe." + }, + { + "input": "There is redemonstration of a 2.4 x 2.5 cm round mass lesion in the right\nbasal ganglia which appears hyperdense peripherally with a hypodense 1.3 x 1.6\ncm central component with ___ of 14, slightly increased in size compared to\nprior overall and with increased fluid attenuating central component (2; 12). \nThere is significant adjacent vasogenic edema, increased in the interval and\ninvolving the midbrain and pons. Additional subcentimeter lesion previously\nseen on MR in the left basal ganglial region is not as well visualized on the\ncurrent study.\n\nThere is no evidence of large vascular territory infarction or acute\nintracranial hemorrhage.\n\nThere is interval increased leftward shift of normally midline structures to\n12 mm, previously 8 mm. There is interval increase in size of the right\noccipital horn, for example measuring 1.7 cm in diameter, previously measuring\n1.2 cm as well as increase in size of the right occipital horn and bilateral\ntemporal horns concerning for hydrocephalus. Crowding of the suprasellar\ncistern is concerning for early uncal herniation. There is no evidence of\ncrowding of the foramen magnum.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. Interval increase in right basal ganglia lesion with increased central\nfluid attenuating component. There is increased vasogenic edema extending to\nthe midbrain and pons. Worsening leftward midline shift to 12 mm, previously\n8 mm from 1 day prior.\n2. Interval increase in size of bilateral ventricles, most notably the right\noccipital horn, and correlate clinically for obstructive hydrocephalus.\n3. Crowding of the suprasellar cistern is concerning for early uncal\nherniation, not significantly changed compared to prior.\n\nNOTIFICATION: The findings were discussed with ___, m.D. by ___\n___, M.D. on the telephone on ___ at 8:45 am, 5 minutes after discovery\nof the findings." + }, + { + "input": "Patient is status post right frontal approach biopsy of a 2.5 cm x 2.2 cm\nround mass lesion in the right basal ganglia which appears hyperdense\nperipherally with a hypodense 1.2 x 1.4 cm central component, similar to prior\nexam. There is hyperdense material along the expected biopsy tract, not\nclearly visualized on pre biopsy imaging and likely represents a small amount\nof hemorrhage (series 3: Image 17). Expected postsurgical changes including\nsubcutaneous air and a few foci is of intracranial air are visualized (series\n3: Image 24, image 16). Significant adjacent vasogenic edema is similar. \nAdditional subcentimeter lesion previously seen on MRI in the left basal\nganglia is not well visualized. There is approximately 10 mm of leftward\nmidline shift, similar to prior. The right occipital horn measures 14 mm,\nunchanged. Crowding of the suprasellar cistern is again concerning for early\nuncal herniation. The foramen magnum is widely patent.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. Status post right frontal approach biopsy of right basal ganglia lesion\nwith a tiny amount of probable hemorrhage along the biopsy tract adjacent to\nthe lesion.\n2. Stable extensive vasogenic edema and 10 mm of leftward midline shift.\n3. Stable size of the bilateral ventricles with the right occipital horn again\nmeasuring 14 mm.\n4. Crowding of the suprasellar cistern is concerning for early uncal\nherniation, not significantly changed compared to prior.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on\n___ at 6:49 pm, 1 minutes after discovery of the findings." + }, + { + "input": "There is redemonstration of an ill-defined mass in the right basal ganglia\nmeasuring approximately 2.2 x 2.4 cm. There is significant surrounding\nhypodensity compatible with vasogenic edema involving the right frontotemporal\nlobes, right basal ganglia, right thalamus, and right mid brain. There is\nmass effect on the right lateral ventricle which remains patent as well as the\nright basal cisterns. There is approximately 8 mm leftward midline shift. \nWhen compared to prior MR from ___, there is stable to mild\nprogression of edema, particularly involving the right basal cisterns. There\nis no evidence of fracture or acute intracranial hemorrhage. Postsurgical\nchanges from prior biopsy noted in the right frontal bone.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. Redemonstration of an ill-defined mass in the right basal ganglia measuring\napproximately 2.2 x 2.4 cm, better evaluated on MRI.\n2. Significant surrounding hypodensity compatible with known vasogenic edema\ninvolving the right frontotemporal lobes, right basal ganglia, right thalamus,\nand right mid brain. There is mass effect on the right lateral ventricle\nwhich remains patent and the right basal cisterns. When compared to prior MR,\nthere is stable to mild progression of edema. In particular, there is\nsuggestion of slightly increased mass-effect on the right basal cisterns.\n3. 8 mm leftward midline shift (previously 6 mm on MR from ___ and\n10 mm on CT from ___." + }, + { + "input": "Head CT: Right cerebellar infarct is much better evaluated on prior MRI\nexamination. There is no intra or extra-axial mass effect or acute hemorrhage.\nSulci, ventricles and cisterns are within expected limits for the patient's\nage.\nExpanded empty sella, as before.\nNear-complete opacification of the right maxillary sinus and dependent\naerosolized mucous in the left maxillary sinus is identified. There is\nhyperostosis of both maxillary sinus walls compatible with chronic sinusitis.\nPartial opacification of the ethmoid air cells and frontal sinus and\nhyperostosis of the frontal sinuses are noted. 2 mm likely calcific density in\nthe superior palpebrae (series 5, image 247). The patient is status post right\nlens replacement.\nSmall dense foci along optic nerves, left more than right- se 3, im 8-?\nCalcifications.\nOtherwise, the orbits are unremarkable.\nThe mastoid air cells middle ear cavities are well pneumatized and clear.\nA small lucent focus in the right parietal bone series 5, image 318, can\nrepresent a small hemangioma or related to prominence of the intra diploic\nveins.\n\nHead CTA: Extensive atherosclerotic calcification of the petrous, cavernous\nand paraclinoid ICA is noted. The right A1 segment is hypoplastic. Otherwise,\nthe ACA, MCA and their major branches are unremarkable. The left posterior\ncommunicating artery is not visualized. Otherwise, the posterior circulation\nis also unremarkable. There is no aneurysm within the confines of CTA\ntechnique.\n\nNeck CTA:\nThere is a normal 3 vessel arch demonstrating mild atherosclerotic\ncalcifications.\nMild atherosclerotic calcification at the origins of both vertebral arteries\nare noted. Otherwise, the vertebral arteries are unremarkable in course and\ncontour to the level of the skullbase.\nRight greater than left atherosclerotic calcification of the carotid\nbifurcations results in 50% narrowing of the proximal cervical right internal\ncarotid artery and no significant narrowing of the proximal cervical left\ninternal carotid artery by NASCET criteria.\n\nOther: The lung apices are clear. There is no mediastinal, cervical or\naxillary lymphadenopathy by size criteria. Both thyroid lobes are enlarged.\nThe right thyroid lobe demonstrates a the 1.2 by 0.9 cm (TRV, AP) hypo\nattenuating inferior pole nodule. The left thyroid lobe contains a 1.2 x 1.0\ncm mid to inferior pole nodule demonstrating multiple chunky calcifications.\nThe aerodigestive tract is unremarkable. The parotid and submandibular glands\nare also unremarkable.\n\nThere is 3 mm anterolisthesis of C3 on C4, 2 mm anterolisthesis of C5 on C6\nand C7 on T1. Severe loss of disc height at C4-C5 through C7-T1 is noted with\nnear ankylosis of the C6-C7 level. There are also prominent posterior disc\nosteophyte complexes at these levels resulting in moderate spinal canal\nnarrowing and multilevel moderate to severe neural foraminal narrowing. No\nsuspicious blastic or lytic osseous lesions are identified.", + "output": "1. Right cerebellar infarct is much better evaluated on prior MRI examination.\nNo new territorial infarct is identified.\n2. Allowing for atherosclerotic calcification of the intracranial internal\ncarotid artery, the intracranial circulation demonstrate no stenosis,\nocclusion or aneurysm.\n3. There is 50% stenosis of the right proximal cervical internal carotid\nartery. Allowing for milder atherosclerotic disease, the remainder of the\ncervical vessels are unremarkable.\n4. There are bilateral thyroid lobe nodules measuring up to 1.2 cm. The left\nnodule contains chunky calcifications. This may be further evaluated with\nultrasound if clinically indicated.\n5. Severe cervical spondylosis as described above. This may be further\nevaluated with MRI if clinically indicated and symptomatic.\n6. Paranasal sinus disease as described above." + }, + { + "input": "There is no evidence of acute vascular territorial infarction, hemorrhage,\nedema, or mass. The ventricles and sulci are prominent, compatible with age\nrelated global involutional change. The known right cerebellar infarct is\nbetter depicted on the prior MRI.\n\nNo acute fracture is seen. There is near complete opacification the right\nmaxillary sinus, similar compared to the prior studies, with aerosolized\ndependent secretions in the left maxillary sinus, and underlying thickening of\nthe bony walls of the maxillary sinuses. There is partial opacification of\nthe anterior ethmoid air cells, and mucosal thickening in the bilateral\nfrontal sinuses. Sphenoid sinuses, mastoid air cells, and middle ear cavities\nare clear bilaterally.", + "output": "1. No acute intracranial process.\n2. Right cerebellar infarct is better depicted on prior MRI.\n3. Paranasal sinus inflammatory disease, as described above." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, or acute major\nvascular territorial infarction. Several small right cerebellar infarcts are\nbetter seen on the ___ MRI. Subcortical and periventricular\nwhite matter hypodensities are nonspecific, however likely represent sequela\nof chronic small vessel ischemic disease. There is prominence of the\nventricles and sulci suggestive of involutional changes.\n\nThere is a right frontal subgaleal hematoma. There is no evidence of\nfracture. There is complete near opacification of the right maxillary sinus,\nand mucosal thickening and aerosolized secretions in the left maxillary sinus,\nwith associated thickening of the bony walls of the maxillary sinuses, similar\nto prior. There is mild mucosal thickening in the ethmoid air cells and right\nfrontal sinus, similar to prior, with new mucous retention cyst in the right\nfrontal sinus. The walls of the left frontal sinus and left frontoethmoidal\nrecess, as well as the frontal sinus septum, sclerotic, as before, indicating\nsequela of chronic sinusitis, though the left frontal sinus appears well\naerated. Left frontoethmoidal recess is occluded by mucosal thickening. \nMastoid air cells are well aerated. Patient is status post left lens\nreplacement.", + "output": "1. No evidence for an acute intracranial process.\n2. Right frontal subgaleal hematoma without evidence for an underlying\nfracture.\n3. Chronic bilateral maxillary, frontal, and anterior ethmoid sinusitis." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mild opacification of the ethmoid\nair cells on the right. Otherwise, the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality. No fracture." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nlarge mass. Periventricular white matter hypodensities are nonspecific, but\nlikely represent chronic small vessel ischemic disease. Prominence of the\nventricles and sulci is suggestive of involutional changes.\n\nNo fracture seen. The imaged portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. There is punctate calcification at\nthe posterior left globe, possibly drusen and most likely chronic. There is\nsevere calcification of the carotid siphons bilaterally.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no intra or extra-axial mass effect, acute hemorrhage or infarct. \nThe sulci, ventricles and cisterns are within expected limits for the\npatient's age.\n\nSmall mucous retention cysts and mild mucosal thickening of the bilateral\nmaxillary sinus alveolar recesses is identified. Small mucous retention cyst\nin the right sphenoid sinus and mild mucosal thickening of the ethmoid air\ncells and frontal ethmoidal recesses is identified. The orbits are\nunremarkable. The mastoid air cells middle ears are well ties and clear.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nRe-identified is a right-sided aortic arch with aberrant left subclavian\nartery, compressing the esophagus against the trachea (series 3, image 51). \nThere is apparent 1.5 cm dilatation/aneurysm of the left subclavian artery\norigin at its origin. The bilateral common carotid, subclavian and vertebral\narteries are unremarkable without evidence of stenosis or occlusion. The\ninternal carotid arteries are unremarkable without stenosis by NASCET\ncriteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. The bilateral level 2B lymph nodes are\ntop-normal in size measuring approximately 1.5-1.6 cm in long axis. \nOtherwise, there is no cervical lymphadenopathy by size criteria. The\nvisualized aerodigestive tract is within expected limits. No suspicious\nosseous lesions.", + "output": "1. Re-identified is a right-sided aortic arch with aberrant left subclavian\nartery compressing the esophagus against the trachea. Re-identified is\nectasia/aneurysm of the left subclavian artery origin measuring approximately\n1.5 cm.\n2. The remainder of the CTA head and neck is unremarkable.\n3. Additional findings as described above." + }, + { + "input": "CT Head: Right frontal lobe encephalomalacia is noted. Faint hyperdensity\nwithin the right parieto-occipital region may represent trace subarachnoid\nhemorrhage. The ventricles, sulci and cisterns are age-appropriate. There is\nno mass-effect, midline shift, or space-occupying lesion. Lesions seen on MRI\n___ are not appreciated on this examination. Left maxillary mucous\nretention cyst is noted. The remaining paranasal sinuses are clear. The\nmastoid air cells are clear. The orbits and soft tissues are unremarkable. \nCalvarium is intact.\n\nCTA Head: The intracranial internal carotid arteries are normal in\nconfiguration. The anterior and middle cerebral arteries are patent with\nnormal contrast enhancement and branching pattern. The anterior communicating\nartery region is unremarkable.\n\nThe vertebral and basilar arteries demonstrate normal enhancement without\nstenosis or occlusion. The posterior cerebral arteries have a normal branching\npattern.\n\nThere is no evidence of stenosis, occlusion, aneurysm or arteriovenous\nmalformation.\n\nCTA Neck: The visualized aortic arch and origins of the great vessels are\nunremarkable. There is common origin to the innominate and left common\ncarotid arteries. The vertebral artery originates from the aortic arch.\n\nThe right common, internal and external carotid arteries are normal in\nappearance. There is no evidence of a significant stenosis by NASCET criteria\nor a dissection.\n\nThe left common, internal and external carotid arteries are normal in\nappearance. There is no evidence of a significant stenosis by NASCET criteria\nor a dissection.\n\nThe cervical portions of the vertebral arteries demonstrate normal\nenhancement. There is no evidence of a significant stenosis by NASCET criteria\nor a dissection. Incidentally noted is a left vertebral artery arising\ndirectly from the aorta.\n\nThe thyroid gland is normal in size and contour without evidence of mass or\ncyst. The salivary glands as visualized are normal without mass. No\nsignificant lymphadenopathy is appreciated; scattered subcentimeter lymph\nnodes are nonspecific. The aerodigestive tract is patent. No soft tissue mass\nor fluid collection is seen. Included bones appear intact and normally\nmineralized. Patient respiratory motion artifact precludes evaluation of the\nincluded upper lungs.", + "output": "1. Normal appearance of the vasculature of the head and neck, without\nsignificant stenosis (by NASCET criteria), dissection, or aneurysm.\n2. Right frontal encephalomalacia.\n3. Faint hyperdensity within the right parieto-occipital region may represent\nsubarachnoid hemorrhage.\n4. Lesions seen on MR ___ are not appreciated on this examination." + }, + { + "input": "There are multiple enlarged cervical lymph nodes, the largest right level 2A\nlymph node measuring 19 mm in diameter (series 4, image 59) which was not\nincreased in size on the prior study done ___. Multiple borderline\nenlarged lymph nodes (but appear pathological in number) in bilateral deep\njugular chains for example measuring 10 mm right level 3, measuring 12 mm left\nlevel 2, 14 mm level 4 on the left, 12 mm left level 5 a.\nProminence of the adenoids, palatine and lingual tonsils.\nEvaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. The neck vessels are patent.\nMild differential mucosal thickening of the left maxillary sinus.\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.", + "output": "Marked interval increase in size of cervical lymph nodes bilateral with the\nlargest lymph node measuring 19 mm in diameter at the right level 2A.\nCorrelation with histology is advised.\n\nThere is also prominence of lymphoid tissue in ___'s ring." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or\nmass-effect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular, subcortical and deep white-matter\nhypodensities are nonspecific, but likely represent sequela of chronic\nmicroangiopathic disease.\n\nThere is no evidence of acute fracture. Changes from prior maxillary\nantrostomies and sinus surgery are noted. There is moderate to severe mucosal\nthickening in the ethmoid air cells and moderate mucosal thickening in the\nleft frontal, right maxillary and right sphenoid sinuses. Additionally, there\nis sclerosis of the ethmoid sinus walls and bone demineralization involving\nthe anterior left lamina papyracea indicative of chronic inflammation. \nChronic appearing linear lucency is seen involving the frontal sinuses (03:32)\nwhich may be due to a prior healed fracture. The visualized portion of the\nmastoid air cellsand middle ear cavities are clear. The visualized portion of\nthe orbits are unremarkable.", + "output": "1. No acute intracranial process or fracture.\n2. Findings of chronic microangiopathic disease.\n3. Chronic appearing paranasal sinus disease." + }, + { + "input": "Slight asymmetry of extra-axial space overlying the left cerebral hemisphere\nwith fluid isodense CSF is equivocal for a chronic subdural hemorrhage or\nhygroma in the absence of prior study. There is no evidence of infarction,\nedema,or mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific but likely reflect sequelae of chronic small\nvessel ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable with the exception of bilateral lens\nreplacements.", + "output": "1. Slight asymmetry of the extra-axial CSF space overlying the left\nfrontoparietal convexity is equivocal for chronic subdural hematoma or\nhygroma. If clinically indicated, consider MRI brain for further evaluation.\n2. No definite evidence of acute hemorrhage or large territorial infarct." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, or loss of\ngray/white matter differentiation. Mild periventricular and subcortical white\nmatter hypodensities are nonspecific but likely sequelae of chronic small\nvessel ischemic disease in this age group. There is mild age-related\nparenchymal volume loss with mildly prominent ventricles and sulci.\n\nNo suspicious bone lesion is seen. There is opacification of bilateral\nfrontoethmoidal recesses with mild mucosal thickening in bilateral inferior\nfrontal sinuses. Several anterior ethmoid air cells are opacified on each\nside. There are aerosolized secretions in a right middle ethmoid air cell. \nThere is a mucous retention cyst in the left middle ethmoid air cell. Mastoid\nair cells are well aerated.", + "output": "No evidence of an acute intracranial abnormality." + }, + { + "input": "Chronic infarct posterior left temporal, inferior left parietal lobe. Small\nfoci low-density bilateral centrum semiovale, left greater than right, may\nrepresent chronic or subacute ischemia. Findings are essentially new since ___.\n No intracranial hemorrhage. No midline shift. No acute fracture. Trace\nmucosal thickening paranasal sinuses. Clear mastoids, orbits.", + "output": "1. Left temporal, parietal lobe chronic infarct.\n2. Bilateral centrum semiovale low densities may represent chronic or subacute\ninfarcts.\n3. No hemorrhage." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are prominent, consistent with volume loss. \nPeriventricular white matter changes are consistent with small vessel ischemic\ndisease.\n\nThere is mild mucosal thickening of the ethmoid air cells, maxillary, and\nsphenoid sinuses bilaterally. The frontal sinuses are clear. Mastoid air\ncells and middle ear cavities are well aerated. The bony calvarium is intact. \nThere is soft tissue swelling and hematoma in the right parietal subcutaneous\ntissues. A 1 cm sebaceous cyst is seen in the occipital soft tissues.\n\nAerosolized secretions in the aerodigestive tract are likely related to\nintubation.", + "output": "1. No acute intracranial process.\n2. There is soft tissue swelling and hematoma in the subcutaneous tissues\noverlying the right parietal bone." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable.\n\nMucosal thickening and aerosolized debris noted in the sphenoid sinuses, right\nworse than left. Included paranasal sinuses and mastoids are otherwise\nessentially clear. Skull and extracranial soft tissues are unremarkable.", + "output": "No acute intracranial process. Mucosal thickening and debris in the sphenoid\nsinus, to be correlated clinically, no other findings to explain patient's\nsymptoms." + }, + { + "input": "Interval development of apparent loss of gray-white differentiation involving\na right middle frontal gyrus sulcus (series 2, image 29) not seen on prior\nexaminations. Left postcentral gyrus encephalomalacia (series 2, image 32) is\nunchanged. There is interval evolution of the subarachnoid blood centered at\nthe pre pontine cistern which is smaller in size. No evidence of new\nintracranial hemorrhage. The size of the ventricles are unchanged compared to\nCT from ___. Hypodensity in the right centrum semiovale is\nconsistent with old infarction. No evidence of intracranial mass effect. The\nsulci are also unchanged.\n\nThere is no evidence of fracture. There is a mucous retention cyst in the\nleft sphenoid sinus. Otherwise, the remaining paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. Interval development of apparent loss of gray-white differentiation\ninvolving a right middle frontal gyrus sulcus, felt likely to represent\ninterval infarct. This can be confirmed with MRI, if there are no\ncontraindications.\n2. Interval evolution of the subarachnoid blood centered at the pre pontine\ncistern which has decreased in size. No new intracranial hemorrhage. No\nevidence of hydrocephalus.\n3. Additional findings described above." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Normal study." + }, + { + "input": "There is near complete opacification of the left maxillary sinus with polypoid\nextension into the left middle concha. The uncinate process of the\ninfundibulum is poorly visualized and may be demineralized with apparent\nexpansion of the opacified left infundibulum. The right infundibulum is\npatent. Mild mucosal thickening of the right maxillary sinus is identified. \nThere is scattered opacification of a few left ethmoid air cells. A small\nmucous retention cyst in the anterior right sphenoid sinus is noted. The left\nsphenoid sinus demonstrates a lateral recess. The frontal sinus is\nessentially clear. There is S-shaped curvature of the nasal septum without\nevidence of perforation. A small leftward projecting spur contacts the left\ninferior turbinate and a rightward projecting spur more posteriorly contacts\nthe middle turbinate. There is a large right Haller cell which is opacified. \nThe cribriform plates and lamina papyracea are intact.\n\nThe anterior clinoid processes are pneumatized. The sphenoid septum is\nbifurcates, inserting on the sellar floor and right carotid canal.\n\nAlthough the examination is not optimized for evaluation of the brain\nparenchyma, visualized brain is grossly unremarkable, incidentally noting a\ncavum septum pellucidum et vergae. The visualized orbits are unremarkable. \nThe mastoid air cells middle ears are well pneumatized and clear.", + "output": "1. Near complete opacification of the left maxillary sinus with polypoid\nextension into the left middle concha.\n2. There is apparent expansion of the opacified left infundibulum and the left\nuncinate process is poorly visualized, which may be demineralized.\n3. Additional mild sinus disease involving the right maxillary sinus, left\nethmoid air cells and right anterior sphenoid sinus.\n4. Opacified large right Haller cell and additional anatomic findings as\ndescribed above." + }, + { + "input": "There is no evidence of large territorial infarction, hemorrhage, edema, or\nmass. There is prominence of the ventricles and sulci, related to\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific, but compatible with chronic microangiopathy in\na patient of this age.\n\nThere is no evidence of fracture. There is minimal mucosal thickening in the\nright sphenoid sinus. The paranasal sinuses are otherwise clear. \nOpacification of several bilateral mastoid air cells are seen. The medial ear\ncavities are clear. The orbits are unremarkable.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nintracranial hemorrhage or acute large territory infarct." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nunchanged prominence of CSF spaces in the posterior fossa with atrophy of the\ncerebellum. The basal cisterns are patent and there is preservation of\ngray-white matter differentiation.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process" + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\n There is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are prominent, consistent global cerebral volume loss.There is\nunchanged cerebellar atrophy.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. There is\nfetal type origin of the posterior cerebral arteries. The dural venous\nsinuses are patent.\n\nCTA NECK:\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nPlatelike atelectatic changes seen in the right upper lobe.. The visualized\nportion of the thyroid gland is within normal limits. There is no\nlymphadenopathy by CT size criteria. Degenerative changes of the cervical\nspine are seen.", + "output": "1. No acute intracranial abnormality.\n2. Unchanged global cerebral volume loss and cerebellar atrophy.\n3. Normal CTA of the head neck." + }, + { + "input": "No evidence of acute infarction, hemorrhage, edema or mass. Encephalomalacia\nin the left frontal lobe and inferior left cerebellum are consistent with\nprior infarcts. The ventricles and sulci are normal size and configuration\nfor the patient's age.\n\nThere is no evidence of fracture. Mild anterior ethmoidal air cell, maxillary\nand sphenoid sinus thickening. The mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No evidence of acute intracranial process.\n2. Sequelae of remote left frontal and cerebellar infarcts as described above.\n3. Paranasal sinus disease." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles are symmetric and unremarkable.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "Normal head CT." + }, + { + "input": "CTA Head: The intracranial internal carotid arteries are normal in\nconfiguration. The anterior and middle cerebral arteries are patent with\nnormal contrast enhancement and branching pattern. There is a normal anterior\ncommunicating artery complex.\n\nThe vertebral and basilar arteries demonstrate normal enhancement without\nstenosis or occlusion. The posterior cerebral arteries have a normal branching\npattern. The posterior communicating arteries are not visualized.\n\nThere is no evidence of stenosis, occlusion, aneurysm or arteriovenous\nmalformation.\n\nCTA Neck: The visualized aortic arch and origins of the great vessels are\nunremarkable.\n\nThe right common, internal and external carotid arteries are normal in\nappearance without evidence of a significant stenosis by NASCET criteria or\ndissection.\n\nThe left common, internal and external carotid arteries are normal in\nappearance without evidence of a significant stenosis by NASCET criteria or\ndissection.\n\nThe cervical portions of the vertebral arteries demonstrate normal\nenhancement. There is no evidence of a significant stenosis or dissection.\n\nThe thyroid gland is normal in size and contour without evidence of mass or\ncyst. The salivary glands as visualized are normal without mass. No\nsignificant lymphadenopathy is appreciated; scattered subcentimeter lymph\nnodes are nonspecific. The aerodigestive tract is patent. The nasopharynx,\noropharynx, oral cavity, hypopharynx, supraglottic and infraglottic larynx,\nand trachea appear unremarkable. No soft tissue mass or fluid collection is\nseen. Included bones appear demonstrate degenerate changes.\n\nThe visualized included upper lungs demonstrate dependent hypoventilatory\nchanges and biapical scarring; patient respiratory motion artifact renders\nfurther assessment suboptimal. However, a 3 mm pleural-based right upper lobe\nnodule is noted as well as a punctate left apical nodule.", + "output": "1. Normal appearance of the vasculature of the head and neck, without\nsignificant stenosis (by NASCET criteria), dissection, or aneurysm.\n2. Tiny pulmonary nodules as above." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass. The ventricles and sulci are prominent, consistent with involutional\nchanges.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "For description of the parenchyma, please see the separate CT head noncontrast\nexamination performed earlier on the same day.\n\nCTA HEAD:\nTh there is moderate to severe calcifications seen within the bilateral\ncavernous internal carotid arteries, which remain patent. Otherwise, no\nevidence for high-grade stenosis within the intracranial vasculature. The\ndural venous sinuses are patent.\n\nCTA NECK:\nThe proximal left vertebral artery at its origin is not visualized. There is\ndistal reconstitution in the mid neck. There is thrombus in the V4 segment of\nthe left vertebral artery (___), which causes complete occlusion of the more\nproximal segment. There is focal aneurysmal dilation of the proximal left\n___ measuring up to 3 mm in diameter (3:235). The right vertebral artery is\nunremarkable.\n\nThe bilateral internal carotid arteries are patent through their course,\nthough there is 75% internal carotid stenosis on the right and 50% internal\ncarotid stenosis on the left using NASCET criteria. There is extensive\ncalcification of the bilateral carotid siphons.\n\nOTHER:\nThere is extensive ground-glass opacity in the bilateral lungs, compatible\nwith known pulmonary edema. There is a partially visualized endotracheal tube\nand enteric tube.", + "output": "1. For description of the parenchyma, please see the separate CT head\nnoncontrast examination performed earlier on the same day.\n2. The circle of ___ and its major vessels are grossly patent without\nhigh-grade stenosis.\n3. Complete occlusion of the left V4 segment, with nonvisualization of the\nleft V1 and V2 segments.\n4. Focal aneurysmal dilation of the proximal left ___ measuring up to 3 mm in\ndiameter.\n5. Additional sites of atherosclerotic disease, as above, including bilateral\nproximal ICA stenosis measuring 75% on the right and 50% on the left by NASCET\ncriteria.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 9:19 pm, 5 minutes after discovery of\nthe findings." + }, + { + "input": "Status post right orbital floor open reduction and internal fixation with\nassociated postsurgical changes including locules of gas along the preseptal\nsoft tissues. Minimally displaced comminuted nasal bone fracture, and frontal\nprocess of the right maxilla is unchanged since prior examination.\n\nMild right preseptal soft tissue swelling as well as soft tissue swelling\nalong the right zygomatic arch are unchanged since prior examination.\nMild mucosal thickening of ethmoidal air cells. Again seen is air-fluid level\nwithin the right maxillary sinus with aerosolized secretions. There is small\nsubmucosal retention cyst in the left maxillary sinus. Nasal septum is\nmidline. Additional visualized paranasal sinuses are well aerated.\n\nThere is no evidence of abnormal fluid collections. The globes, extraocular\nmuscles, optic nerves and retrobulbar fat appear normal.The visualized upper\naerodigestive tract appears normal.The mandible and temporomandibular joints\nappear normal.", + "output": "1. Status post open reduction internal fixation of right inferior orbital wall\nfracture with orbital plate in satisfactory position. No retrobulbar\nhematoma.\n2. Minimally displaced comminuted right nasal bone fracture.\n3. Stable right sided soft tissue swelling involving the preseptal region and\nzygomatic arch." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nlarge territorial infarction. There is ventriculomegaly of indeterminate\nchronicity. There is rounded dilation of frontal and posterior horns and the\nthird ventricle and fourth ventricle also appear dilated. Bilateral temporal\nhorns have a more normal pointed appearance. There is no notable\ntransependymal edema.\nThe basal cisterns appear patent and there is preservation of gray-white\nmatter differentiation.\n\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\nAtherosclerotic mural calcification of the internal carotid arteries is noted.\nLeft prosthetic globe is noted.", + "output": "1. No evidence of acute intracranial hemorrhage.\n\n2. Ventriculomegaly of indeterminate chronicity. Acute hydrocephalus is less\nlikely based on pointed temporal horns and lack of transependymal edema." + }, + { + "input": "There is no hemorrhage, edema, or mass effect. Prominent ventricles are out\nof proportion to the sulci though appear stable a enlarged since ___. There\nis no shift of normally midline structures. Basal cisterns are patent. \nGray-white matter differentiation is preserved. Periventricular and\nsubcortical white matter hypodensity does not appear to have progressed,\nnonspecific although likely sequela of chronic small vessel ischemia.\n\nLeft prostatic lobe is re- demonstrated. The right orbit is unremarkable. \nImaged paranasal sinuses are clear. Bilateral mastoid air cells and middle\near cavities are clear. Carotid siphon vascular calcifications are moderate. \nThe bony calvarium appears intact.", + "output": "1. No evidence of acute intracranial process or hemorrhage.\n\n2. Stable ventriculomegaly. No evidence to suggest acute hydrocephalus." + }, + { + "input": "There is no evidence of infarction or hemorrhage. Prominent ventricles are\nout of proportion to the sulci, though appear stable compared to at least ___. Periventricular and subcortical white matter hypodensities do not\nappear to have progressed and are likely the sequelae of chronic small vessel\nischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of fracture, hemorrhage or infarction.\n2. Enlarged ventricles unchanged since ___ or ___." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is minimal mucosal thickening in the\nbilateral ethmoid air cells. The remaining visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "The patient was scanned twice due to motion on the initial acquisition. The\nrepeated scan is also slight limited by motion artifact. There is no evidence\nof acute hemorrhage, edema, mass effect, or large vascular territorial\ninfarction. The ventricles and sulci are normal in size and configuration. \nThe basal cisterns appear patent.\n\nNo fracture is identified. There is a large lipoma superficial to the frontal\nbone bilaterally, measuring 6.1 x 1.8 x 4.9 cm. There is moderate mucosal\nthickening in the left frontal sinus extending into the frontoethmoidal\nrecess, and moderate mucosal thickening in bilateral ethmoid air cells,\nanterior and posterior on the right, and anterior only on the left. There is\nmild mucosal thickening in bilateral maxillary sinuses and small mucous\nretention cysts in the left maxillary sinus. There is mild mucosal thickening\nin the right sphenoid sinus. Mastoid air cells are clear.", + "output": "1. Mildly motion limited exam without evidence for acute intracranial\nabnormalities. MRI would be more sensitive for hypoxic ischemic injury, if\nclinically warranted.\n2. Large lipoma overlying the frontal bone bilaterally." + }, + { + "input": "Some of the images were repeated due to motion artifact on the initial scan.\n\nThere is no evidence of hemorrhage, edema, mass effect, or acute large\nvascular territorial infarction. The ventricles and sulci are normal in size\nand configuration. The basal cisterns are patent.\n\nNo fracture is identified. Mucosal thickening is again seen in the paranasal\nsinuses, which may be secondary to prolonged supine positioning in the\ninpatient setting. New endotracheal tube is noted on the scout image. Mastoid\nair cells and middle ear cavities are clear. A large lipoma is again seen\noverlying the frontal bone bilaterally.", + "output": "No evidence for an acute intracranial abnormality." + }, + { + "input": "No radiodense foreign body.\n\nThe salivary glands are grossly without mass or adjacent fat stranding.The\nthyroid gland appears normal. There is no lymphadenopathy by CT criteria.\n\nIncidentally noted left maxillary sinus mucous retention cyst. The imaged\nportion of the lung apices are clear and there are no concerning pulmonary\nnodules. There are no osseous lesions. There are mild multilevel degenerative\nchanges of the visualized spine, worst at C3-4 and C6-7 levels.", + "output": "1. No evidence of radiodense/radiopaque foreign body." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction, large mass or\nmidline shift. There is no hydrocephalus. The ventricles and sulci are normal\nin size and configuration. The basal cisterns are patent and there is\npreservation of gray-white matter differentiation. There is mild mucosal wall\nthickening of the left maxillary sinus and bilateral anterior ethmoid air\ncells. The remainder of the visualized paranasal sinuses and mastoid air cells\nare clear. The orbits are unremarkable. There is no fracture.", + "output": "No acute intracranial process." + }, + { + "input": "There is no hemorrhage, edema, mass effect, midline shift, or mass. The\nventricles and sulci are normal in size and configuration. The basal cisterns\nare patent and there is normal gray-white matter differentiation.\nNo bony abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No intracranial hemorrhage. No significant abnormality." + }, + { + "input": "There is no evidence of hemorrhage, acute large territorial infarction,\nedema,or mass. There is prominence of the ventricles and sulci suggestive of\nage-related involutional changes. Periventricular and subcortical\nhypodensities are nonspecific, though likely sequela of chronic small vessel\nischemic disease. There is a small right frontal subgaleal hematoma measuring\nup to 5 mm (2:21, 601:45).\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "1. No evidence of acute intracranial abnormality.\n2. Age-related volume loss and sequela of chronic small vessel ischemic\ndisease.\n3. Small right frontal scalp hematoma measuring up to 5 mm." + }, + { + "input": "There is re-demonstration of a 1.5 cm calcified extra-axial lesion along the\nleft inferior frontal lobe, similar to prior, likely a calcified meningioma. \nThere is no evidence of large vascular territory infarction,hemorrhage,edema,\nor mass effect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Soft tissue\ndebris within the external auditory canals likely reflect cerumen. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "The left inferior frontal calcified extra-axial lesion measuring 1.5 cm AP x\n1.4 cm TRV remains essentially unchanged dating back to ___. There is no\nintra-axial or extra-axial hemorrhage, midline shift, or acute major vascular\nterritorial infarct. Gray-white matter differentiation is preserved.\nVentricles and sulci are prominent compatible with global volume loss. \nBasilar cisterns are patent.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No significant interval change of ossified left inferior frontal extra-axial\nlesion compatible with meningioma since ___." + }, + { + "input": "A calcified extra-axial lesion along the left inferior frontal lobe is\nunchanged in overall size and appearance measuring approximately 15 x 15 mm\nmost likely a calcified meningioma. No intra-axial or extra-axial hemorrhage,\nedema, shift of normally midline structures, or evidence of major vascular\nterritorial infarction. Age related involutional changes are present. \nVentricles are normal in size. Basal cisterns are patent. Paranasal sinuses,\nmastoid air cells and middle ear cavities are well aerated. The bony\ncalvarium is intact.", + "output": "No acute intracranial process. 15 mm meningioma along the left inferior\nfrontal lobe unchanged." + }, + { + "input": "There is no evidence of territory infarction, intracranial hemorrhage, edema,\nor mass. Isodensity along the inner table of the left frontal lobe (series 2,\nimage 20) is favored to represent a subarachnoid vessel. Periventricular and\nsubcortical white matter hypodensities, nonspecific but probably reflect\nsequela of chronic microangiopathy. There is prominence of the ventricles and\nsulci, probably reflecting involutional changes.\n\nNo acute fracture is seen. There is mild mucosal thickening of the left\nmaxillary sinus, otherwise the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There has been a prior left maxillary antrostomy. The left maxillary sinus is\nfully aerated and the antrostomy is widely patent. There is no evidence of\nfluid, mass, or mucosal thickening involving the paranasal sinuses. There is\na small nasal septal defect.\nImages of the remainder of the paranasal sinuses appear normal. The paranasal\nsinuses are normally aerated, with no mucosal thickening or air-fluid levels\nidentified. The ostiomeatal units are patent. The cribriform plates are\nintact. The lamina papyracea are intact.", + "output": "1. Status post left maxillary antrostomy with no evidence of fluid, mass or\nmucosal thickening." + }, + { + "input": "There is no intracranial hemorrhage, edema, mass effect, or acute vascular\nterritorial infarction. Postsurgical changes related to prior right frontal\ncraniotomy with mesh repair are again seen, not significantly changed since\nprior study for ___. The ventricles and sulci are normal in size and\nconfiguration. There is no shift of the normally midline structures.The basal\ncisterns appear patent and there is preservation of the gray-white matter\ndifferentiation.\n\nMucosal thickening in the bilateral frontoethmoidal recesses, ethmoid air\ncells, and bilateral maxillary sinuses are again noted. The mastoid air cells\nand middle ear cavities are clear bilaterally.The orbits are unremarkable.", + "output": "No acute intracranial abnormality. Stable appearance of prior right frontal\ncraniotomy changes." + }, + { + "input": "There is no evidence of infarction,hemorrhage,edema,or mass. There is\nprominence of the ventricles and sulci suggestive of age-appropriate\ninvolutional changes.\n\nThere is no evidence of fracture. Within the right external auditory canal\nthere is soft tissue density that is likely cerumen. No evidence of mass in\nthe inner or middle ear cavity. The right middle ear cavity and mastoid air\ncells are clear. The ossicles and visualized portions of the semicircular\ncanal are within normal limits bilaterally. The visualized portion of the\nparanasal sinuses, left mastoid air cells, and left middle ear cavityare\nclear. The bilateral orbits are within normal limits.", + "output": "1. Soft tissue density within the right external auditory canal likely\nreflects cerumen. No evidence of mass otherwise seen in the right middle or\ninner ear. Clear right mastoid air cells and middle ear cavity with intact\nossicles on the right.\n2. No acute intracranial process." + }, + { + "input": "There is no acute hemorrhage, edema, mass effect, or evidence of acute major\nvascular territorial infarction. Ventricles and sulci are mildly prominent due\nto global parenchymal volume loss. Carotid siphon calcifications and proximal\nintracranial left vertebral artery calcifications are noted.\n\nNo suspicious bone lesion is seen. Sphenoid sinuses are underpneumatized and\nalmost completely opacified. There is mild right and moderate left frontal\nsinus mucosal thickening extending into the frontoethmoidal recesses. There\nis mild mucosal thickening in the partially visualized left maxillary sinus. \nMastoid air cells appear grossly well-aerated.", + "output": "No evidence for acute intracranial abnormalities. No mass effect.\n\nRECOMMENDATION(S): MRI would be more sensitive for intracranial metastatic\ndisease, if clinically warranted." + }, + { + "input": "Left frontal scalp hematoma noted. No evidence of underlying fracture or\nacute intracranial hemorrhage.\n\nThere is no evidence of acute major infarction,hemorrhage,edema,or discrete\nmass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Complete opacification of the left\nmaxillary sinus with sclerosis of the sinus walls is consistent with chronic\nsinusitis. No evidence of sinus wall erosion. Remainder of the visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.\n\n1.2 cm sebaceous cyst within the left parietal scalp (03:55) and a similar but\nsmaller 7 mm lesion within the right occipital scalp (03:36) noted.", + "output": "Left frontal scalp hematoma. No acute intracranial hemorrhage or fracture." + }, + { + "input": "There is no evidence of acute large territory infarction,\nintracranialhemorrhage,edema,or discrete mass. There is prominence of the\nventricles and sulci suggestive of involutional changes. Periventricular and\nsubcortical white matter hypodensities are nonspecific but compatible with\nsmall chronic small vessel ischemia.\n\nThere is no evidence of fracture. Soft tissue density seen in the bilateral\nexternal auditory canals likely represents cerumen. Mild mucosal thickening of\nthe bilateral sphenoid sinuses. Otherwise, the visualized portion of the\nparanasal sinuses, mastoid air cells and middle ear cavities are essentially\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Involutional and chronic small vessel disease changes.\n3. Mild mucosal thickening of the bilateral sphenoid sinuses." + }, + { + "input": "There is no evidence of acute large territorial infarction, intracranial\nhemorrhage, edema or shift of normal midline structures. Gray-white matter\ndifferentiation in the basal ganglia and insular cortices appears well\npreserved. The ventricles and sulci are prominent most consistent with\nage-related parenchymal atrophy. Chronic infarct left parietal lobe at the\nvertex. Periventricular and subcortical white matter hypodensities are\nnonspecific but likely reflect the sequelae of chronic small vessel ischemic\ndisease. No evidence of acute fracture. The visualized paranasal sinuses and\nmastoid air cells are clear. Soft tissue density material within the bilateral\nexternal ear canals is favored to represent cerumen. The visualized orbits\nare unremarkable.", + "output": "1. No evidence of acute intracranial process. Please note that MRI is more\nsensitive in the detection of acute infarct.\n2. Age-related parenchymal atrophy and probable chronic small vessel ischemic\ndisease." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema,or large mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nThere is subcortical white matter hypodensity in the left frontoparietal\nregion, nonspecific but likely sequelae of chronic small vessel ischemic\ndisease (02:21).\n\nThere is no evidence of fracture. There are bilateral maxillary sinus mucous\nretention cysts; the visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavitiesare otherwise clear. There is debris in the\nbilateral external auditory canals. The visualized portion of the orbits are\nunremarkable.", + "output": "No acute intracranial process. Chronic findings as described above." + }, + { + "input": "There is no evidence of infarction,hemorrhage,edema,or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of hemorrhage, edema, recent infarction, or shift of\nmidline structures. Persistent periventricular and subcortical white matter\nwhite matter hypodensities are again noted likely sequela of chronic small\nvessel ischemic changes. Encephalomalacia is again noted in the left occipital\nlobe. Calcifications of carotid and vertebral arteries are again noted. The\nvisualized mastoid air cells and paranasal sinuses are clear.\n\nThere is mild enlargement of the right parotid gland with mild increased\nstranding suggestive of parotitis. A 0.9 x 0.6 cm partially-visualized focus\nwith dystrophic calcification is noted anterior to the styloid process and\nlikely within the lateral parotid gland or just lateral to it and suggestive\nof old infection or trauma.", + "output": "1. No evidence of an hemorrhage or recent infarction. If clinical suspicion\nfor an infarction is high, MRI is the more sensitive study.\n\n2. There is mild enlargement of the right parotid gland with mild increased\nstranding suggestive of mild right parotitis.\n\n3. Partially visualized 0.9 x 0.6 cm focus with dystrophic calcification in\nthe lateral parotid gland or just lateral to it, likely sequela of old\ninfection or trauma.\n\nNOTIFICATION: These findings were discussed by Dr. ___ with Dr. ___\n___ telephone at the time of discovery at 6:03 pm on ___" + }, + { + "input": "There is a soft tissue mass in the superior mediastinum arising from the\nesophagus with invasion of adjacent structures including the thyroid gland,\ntrachea and left internal jugular vein. There is an impacted food bolus\nproximal to this mass in the upper esophagus. Please refer to same-day CT\nchest for further details regarding these findings. Proximally in the neck,\nno acute abnormalities are seen. The salivary glands appear normal. There is\nno lymphadenopathy in the neck. Carotids are calcified. No dental infection.\nImaged sinuses are clear. A calcified lymph node in the right parapharyngeal\nspace measures 9 mm.", + "output": "1. Impacted food bolus in the upper esophagus adjacent to known esophageal\nmass. Please refer to concurrently performed CT chest for further details.\n2. Otherwise unremarkable neck CT." + }, + { + "input": "Again noted is subarachnoid hemorrhage along the occipital lobes, left greater\nthan right, as well as subarachnoid hemorrhage along the left posterior\ntemporal lobe, left parietal lobe and in the left central sulcus. Thin\nsubdural blood along the left greater than right posterior convexities and in\nthe posterior fossa was better seen on the prior MRI, but some of it is seen\nalong the left occipital convexity on image 4:16. Trace blood remains visible\nin the occipital horn of the left lateral ventricle. The ventricles and sulci\nremain prominent due to parenchymal volume loss, unchanged.\n\nThe bones are unremarkable. The partially visualized paranasal sinuses and\nmastoid air cells are well aerated.", + "output": "1. Stable appearance of left greater than right subarachnoid hemorrhage and\ntrace intraventricular hemorrhage. Thin subdural blood along the left greater\nthan right posterior convexities and in the posterior fossa was better seen on\nthe prior MRI.\n2. No evidence for new intracranial abnormalities." + }, + { + "input": "There has been interval near-complete resolution of the previously noted\nsubarachnoid and intraventricular hemorrhage with trace residual blood\nproducts still visualized. There is no evidence of new infarction,\nhemorrhage, edema, or mass effect. The ventricles are prominent with potential\nincreased size of the bilateral frontal horns of the lateral ventricles,\nmeasuring approximately 1.1 cm on the left compared to previously measured 9\nmm. This may be secondary to differences in positioning and close attention\non followup is recommended to exclude developing hydrocephalus. \nPeriventricular and subcortical white matter hypodensities are nonspecific but\nfully seen in chronic microangiopathic changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The patient is\nstatus post bilateral lens replacement.", + "output": "1. No evidence of acute intracranial hemorrhage or territorial infarct.\n2. Near complete resolution of previously described subarachnoid and\nintraventricular hemorrhages.\n3. There may be increased size of the bilateral frontal horns the lateral\nventricles, with the left frontal horn measuring approximately 1.1 cm in\ngreatest with previously measuring 9 mm. While this may be secondary to\ndifferences in patient positioning, close attention on follow-up is\nrecommended to exclude developing hydrocephalus and clinical correlation with\npatient's symptoms is recommended." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of hemorrhage, edema, mass effect, or acute infarction. \nThe ventricles and sulci are normal in size and configuration.\n\nEndotracheal and enteric tubes are noted. There is fluid opacification of the\nnasal passage extending into the nasopharynx and oropharynx. Fluid in the\nparanasal sinuses and partial opacification of the mastoid air cells is likely\ndue to the intubated status. The visualized portion of the orbits are\nunremarkable.\n\nCTA HEAD:\nPunctate calcifications are present along the paraclinoid internal carotid\narteries bilaterally without stenosis or occlusion. The vessels of the circle\n___ and their principal intracranial branches appear normal with no\nevidence of stenosis, occlusion, or aneurysm. The dural venous sinuses are\npatent.", + "output": "1. No evidence of hemorrhage, edema or mass effect, or acute infarction.\n2. Unremarkable head CTA." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nEncephalomalacia is seen in the left mid MCA territory, likely secondary to\nremote infarct. There is no evidence of acute\ninfarction,hemorrhage,edema,ormass. The ventricles and sulci are normal in\nsize and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No acute intracranial abnormality.\n2. Chronic left MCA territory infarct.\n3. Normal head, neck CTA." + }, + { + "input": "Streak artifact from scalp electrodes limits examination.\nWithin limits of this study, there is no evidence of large territorial\ninfarction, acute intracranial hemorrhage, edema, or mass. The ventricles and\nsulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. Study limited due to streak artifact from scalp electrodes.\n2. Within limits of study, no definite acute intracranial hemorrhage\nidentified.\n3. Within limits of exam, no definite linear hyperdensity within cerebellum.\nPleural reflections are suggested bilaterally within imaging of posterior\nfossa. If continued clinical concern for intracranial hemorrhage, consider\nshort-term repeat brain imaging without scalp electrodes." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThe ventricles, sulci, and cisterns appear normal. There is no large acute\ninfarct, acute intracranial hemorrhage, or mass effect.\n\nThere is moderate mucosal thickening within the hypoplastic and atelectatic\nleft maxillary sinus. The floor of the left orbit appears slightly lower than\nthe right. There is mild mucosal thickening within the right maxillary sinus\nand within the floor of the left frontal sinus and frontal recess. Periapical\nlucency multiple mandibular teeth are identified.\n\nThe middle ear cavities and mastoid air cells are clear. The orbits are\notherwise unremarkable.\n\nCTA HEAD:\nThere is mild atheromatous and atherosclerotic plaque within the bilateral\nintracranial internal carotid arteries. More prominent focal soft plaque\nresulting in mild to moderate right petrous ICA narrowing (series 3, image\n263) is identified. Otherwise the remaining vessels of the circle of ___\nand their principal intracranial branches appear normal without stenosis,\nocclusion, or aneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is mild atheromatous atherosclerotic plaque at the bilateral carotid\nbulbs, with less than 20% stenosis by NASCET criteria. There is\natherosclerotic plaque at the origins of the vertebral arteries, resulting in\nmild stenosis. The vertebral arteries are patent.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Unremarkable noncontrast CT head. No large territory infarct or\nintracranial hemorrhage.\n2. Mild intracranial atherosclerosis, without high-grade stenosis or\nocclusion. No aneurysm is identified.\n3. Mild extracranial atherosclerosis, with less than 20% stenosis of the\nbilateral internal carotid arteries by NASCET criteria. Vertebral arteries\nare patent, noting mild stenosis at the origin secondary to atherosclerotic\nplaque.\n4. Complete opacification of the left maxillary sinus. The left maxillary\nsinus is hypoplastic and atelectatic. Periapical lucencies of multiple\nmaxillary teeth are identified." + }, + { + "input": "Punctate hyperdensity in the subcortical left frontal lobe is unchanged from\nthe prior study of the same date, consistent with dystrophic calcification on\nthe coronal view (602:43, 02:15). There is no evidence of infarction, edema,\nor large mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Nonspecific periventricular and deep subcortical white\nmatter hypodensities most likely represent mild chronic small vessel ischemic\ndisease.\n\nThere is no evidence of fracture. Aside from mild mucosal thickening of the\nanterior ethmoidal air cells, the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. Unchanged punctate hyperdensity in the left frontal lobe, consistent with\ndystrophic calcification rather than acute hemorrhage.\n2. Age related involutional changes and nonspecific white matter hypodensities\nlikely representing the sequelae of mild chronic small vessel ischemic\ndisease.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 9:25 pm, 5 minutes\nafter discovery of the findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of hemorrhage, edema, or mass. The small right\ncerebellar peduncle infarct is not well visualized on this study given the\nsize. The ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD: There is atherosclerotic calcification and irregularity of the\ncavernous internal carotid arteries.\nOtherwise, the vessels of the circle of ___ and their principal\nintracranial branches appear normal without stenosis, occlusion or aneurysm\nformation. The dural venous sinuses are patent.\n\nCTA NECK: Atherosclerotic calcification of the aortic arch and branch vessels\nis seen. There is a common origin between the brachiocephalic and left\ncarotid artery. Otherwise, the carotid and vertebral arteries and their major\nbranches appear normal with no evidence of stenosis or occlusion. There is no\nevidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThere is a 0.5 cm right upper lobe lung nodule, series 7, image 29 The\nvisualized portion of the thyroid gland is within normal limits. There is no\nlymphadenopathy by CT size criteria. Mild degenerative changes of the\ncervical spine are seen.", + "output": "1. No evidence of acute intracranial hemorrhage.\n2. No evidence of aneurysm greater than 3 mm, dissection or vascular\nmalformation, or significant luminal narrowing.\n3. A 0.5 cm right upper lobe lung nodule. Recommend a completion CT chest for\nfurther evaluation." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territory infarct. Gray-white matter\ndifferentiation is preserved. There is no hydrocephalus. The visualized\nparanasal sinuses are clear. The mastoid air cells are clear. No acute\nfracture is seen.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute hemorrhage acute large vast territorial\ninfarction, edema,or mass effect. Faint hypodensity is again seen in the\nright frontal white matter extending from the right lateral ventricle to the\ncortex. Possible small focus of cortical involvement was better seen on the\nprior MRI. This is compatible with a chronic infarct versus chronic small\nvessel ischemic change. Ventricles and sulci are age-appropriate in size.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence for an acute intracranial abnormality. MRI would be more\nsensitive for an acute infarction, if clinically warranted.\n2. Stable appearance of the chronic infarction versus chronic small vessel\nischemic change in the right frontal lobe." + }, + { + "input": "Cerebral gray-white matter differentiation maintained. There is no acute\nterritorial infarction,hemorrhage,or mass. No dense vessel sign.\n\nGaze forward.", + "output": "No acute territorial infarct. If there remains high clinical suspicion for\nhyperacute stroke, could consider CT reassessment in 24 hours." + }, + { + "input": "CTA HEAD:\n Widely patent vertebrobasilar system. Conventional bilateral PCA anatomy. \nDiminutive but patent bilateral PCOMs. Patent bilateral posterior cerebral\narteries with normal distal runoff.\n\nThe bilateral intracranial internal carotid arteries and the bilateral\nanterior and middle cerebral arteries are patent with normal distal runoff.\n\nNo significant stenosis, occlusion, or aneurysm. Major dural venous sinuses\nare patent. Asymmetric enhancement of the left versus right cavernous sinus\nis of unlikely clinical significance.\n\nCTA NECK:\nExamination is limited due to motion artifact and artifact related to dental\namalgam at the level of C3-C5, obscuring the carotid bulbs and ICA origins in\nthe neck bilaterally. Within this confine:\n\nThe imaged portions of the aortic arch and arch branch vessel origins are\npatent and unremarkable.\n\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nNo aggressive focal osseous lesions. No cervical or upper chest adenopathy. \nThere is a 4 mm ground-glass nodule, superior segment, left lower lobe\n(02:20). Lung apices otherwise grossly clear.", + "output": "1. Unremarkable CTA head. No circle of ___ stenosis, occlusion, or\naneurysm.\n2. Note that motion artifact and streak artifact from dental amalgam limits\nevaluation of the carotid bulbs and proximal extracranial ICAs in the neck. \nWithin this confine, the bilateral cervical vertebral and carotid arteries\nappear unremarkable, without evidence of dissection, stenosis, or occlusion.\n3. 4 mm ground-glass nodule, superior segment of the left lower lobe. No\nimaging follow-up is indicated.\n4. Please see separate report for intracranial findings from earlier same-day\nunenhanced head CT.\n\nRECOMMENDATION(S): For an incidentally detected single ground-glass nodule\nsmaller than 6mm, no CT follow-up is recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" + }, + { + "input": "Focal deep white matter hypodensity within the anterior right centrum\nsemiovale likely represents subacute infarct which was better seen on the\nreference MR of ___. Other small infarcts near ACA and MCA and MCA\nand PCA watershed regions are not readily seen on the current study.\n\nThere is no evidence of hemorrhage,edema,or mass. Hypodensity within the\ninferior right basal ganglia (02:14) likely represents an enlarged\nperivascular space rather than chronic lacunar infarct. There is prominence\nof the ventricles and sulci suggestive of involutional changes. There are\nsenescent calcifications within the bilateral basal ganglia. Prominence of\nthe falx and tentorium is likely due to recent contrast administration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Focal small subacute infarcts, better seen on prior MRI..\n2. No hemorrhage." + }, + { + "input": "Hypodensities in the right centrum semiovale persist, slightly less\nconspicuous than on prior exam (02:24; 02:33). There is no evidence of new\nacute infarction, intracranial hemorrhage, edema, or mass. The ventricles and\nsulci are stable. Punctate hypodensities in the right basal ganglia appear\nunchanged. No osseous abnormalities seen. The paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No evidence of new infarction or intracranial hemorrhage.\n2. Right centrum semiovale infarcts are less conspicuous than on prior." + }, + { + "input": "There is no evidence of infarction, intracranial hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration for age.\n\nA left parietal scalp hematoma is again seen without underlying fracture. A\nmucous retention cyst in the right sphenoid sinus and trace left sphenoid\nsinus mucosal thickening again seen. The remaining paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. Bilateral scleral plaques are\npresent. The orbits are otherwise unremarkable.", + "output": "There been no significant changes since the study of ___. Left\nparietal scalp hematoma, unchanged. No intracranial hemorrhage or fracture." + }, + { + "input": "There is no evidence of acute large territorial infarction, acute intracranial\nhemorrhage, edema, or mass. The ventricles and sulci are normal in size and\nconfiguration. The basal cisterns appear patent and there is preservation of\ngray-white matter differentiation. There is no abnormal enhancement on post\ncontrast images.\n\nNo acute osseous abnormalities seen. There is and air-fluid level within the\npartially visualized left maxillary sinus as well as mild mucosal thickening\nin the right maxillary sinus and ethmoid air cells. The mastoid air cells and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial abnormality.\n2. No abnormal enhancement on post contrast imaging.\n3. Paranasal sinus disease better assessed on concurrent sinus CT." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema, or\nmass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is soft tissue edema in the left\nforehead and eyelid with skin laceration. There is mild mucosal thickening of\nthe ethmoid air cells. Mucous retention cyst is seen in the left sphenoid\nsinus. The remaining paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable. \nSmall benign scalp lesion at the right forehead, may represent sebaceous cyst.", + "output": "1. No acute intracranial process.\n2. No calvarial fracture.\n3. Left forehead and eyelid soft tissue edema and skin laceration." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema,or discrete\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular white-matter hypodensities are\nnonspecific, but likely represent sequela of chronic microangiopathic disease.\n\nThere is mild mucosal thickening of the ethmoid air cells. The visualized\nportion of the other paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are normal.\n\nThere are moderate degenerative changes in the bilateral temporomandibular\njoints.", + "output": "1. No acute intracranial abnormality or fracture.\n2. Periventricular white-matter hypodensities are nonspecific, but likely\nrepresent sequela of chronic microangiopathic disease.\n3. Global parenchymal volume loss.\n4. Moderate degenerative changes in the bilateral temporomandibular joints." + }, + { + "input": "Images through the posterior fossa are limited by motion despite several\nrepeated acquisition attempts.\n\nThere is no evidence for acute intracranial hemorrhage, edema, mass effect, or\nacute major vascular territorial infarction. Periventricular and subcortical\nwhite matter hypodensities are nonspecific, but likely reflect sequelae of\nchronic small vessel ischemic disease. There is age-related global\nparenchymal volume loss with prominent ventricles and sulci.\n\nIncidentally noted is gas within the cavernous sinus, superior ophthalmic\nveins, and facial veins. The preceding head, chest, and abdomen CTs from ___\n___ have been performed without intravenous contrast. Therefore, the\nintravenous air may be secondary to venous line placement.\n\nThere is a midline bifrontal subgaleal hematoma with overlying laceration. \nThere is no evidence of fracture. The patient is status post bilateral\ncataract surgery. There is mild mucosal thickening of the anterior ethmoid\nair cells. Mastoid air cells are well aerated.", + "output": "1. Mildly motion limited evaluation of the posterior fossa.\n2. No evidence of acute intracranial hemorrhage or other acute intracranial\nabnormalities.\n3. Midline bifrontal subgaleal hematoma with overlying laceration. No\nevidence for calvarial fracture.\n4. Gas in the cavernous sinus, superior ophthalmic veins and facial veins is\nlikely related to intravenous line placement. Please correlate clinically.\n\nNOTIFICATION: Electronic wet reading was provided on ___ at 04:20\nby Dr. ___." + }, + { + "input": "There is no acute intracranial hemorrhage or midline shift. There is no\nhydrocephalus. Gray-white differentiation is maintained. Visualized paranasal\nsinuses and mastoid air cells are clear.Bone images unremarkable.", + "output": "No acute abnormalities are seen." + }, + { + "input": "No evidence of acute intracranial hemorrhage, mass effect, edema or acute\nlarge vascular territorial infarct is seen. There is prominence of the\nventricles and sulci suggestive of involutional changes. There is equivocal\ntiny 2 mm width sliver of a chronic right subdural hematoma along the right\nconvexity versus slightly prominent extra-axial space. Periventricular and\nsubcortical white matter hypodensities are nonspecific, likely sequela from\nchronic small vessel disease. Coarse bilateral basal gangliar calcifications\nand cerebellar calcifications, chronic.\nAtherosclerotic disease involving bilateral ICAs and distal vertebral\narteries.\n\nThe visualized portion of the paranasal sinuses, and middle ear cavities are\nclear. Trace fluid in the inferior right mastoid tip. Left mastoid air cells\nare under pneumatized.", + "output": "1. No acute intracranial process.\n2. Equivocal thin, 2 mm sliver of chronic subdural hematoma along the right\nconvexity versus slightly prominent extra-axial space. No prior available for\ncomparison.\n3. Periventricular and subcortical white matter hypodensities are\nnonspecific, likely sequela from chronic small vessel disease." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. There\nis prominence of the ventricles and sulci suggestive of involutional changes.\nThere are areas of periventricular and subcortical white matter\nhypoattenuation that are nonspecific but most likely represent chronic small\nvessel disease.\nCalcifications are seen in the basal ganglia, bilateral internal carotid\narteries, and left vertebral artery.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "No evidence of acute intracranial abnormality including large vascular\nterritory infarction." + }, + { + "input": "There is no evidence of fracture, acute large territory\ninfarction,hemorrhage,edema,or mass. The ventricles and sulci are normal in\nsize and configuration.\n\nThere is mild mucosal thickening and partial opacification of the ethmoid air\ncells. Otherwise, the visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are normal.", + "output": "1. No acute intracranial abnormality.\n2. Paranasal sinus disease." + }, + { + "input": "The patient is intubated, severely limiting evaluation of the glottic regions.\nIll-defined soft tissue thickening and enhancement in the region of the\nsupraglottis and glottis is identified without focal mass lesion. There is\neffacement and fatty stranding of the paraglottic fat, however no discrete\nerosion of the thyroid or cricoid cartilage is identified. The arytenoid\ncartilages appear intact. Subcutaneous inflammatory stranding of the neck\nextending from the suprasternal notch to the level of the hyoid bone is\nidentified, likely representing postradiation changes.\n\nFluid is seen within the nasopharynx with extension to the upper trachea. \nNear complete opacification of the larynx due to fluid, limiting evaluation of\nthe vocal cords.\n\nThe salivary glands enhance normally and are without mass lesion. The thyroid\ngland appears normal. There is no lymphadenopathy by CT criteria. The neck\nvessels are patent although atherosclerotic calcification and atheromatous\nplaque formation is noted.\n\nThe imaged portion of the lung apices are notable for bilateral dependent\natelectasis with small left and moderate right non hemorrhagic pleural\neffusions. No concerning pulmonary nodules. A endotracheal tube is noted with\ntip within the lower trachea. An enteric feeding tube is seen coursing\nthrough the esophagus with tip not visualized.\n\nStable small pericardial effusion is noted. Limited assessment of the osseous\nstructures are notable for mildly displaced left second and third rib\nfractures, with mildly displaced right second rib fracture. There are no\nworrisome osseous lesions.", + "output": "1. Near complete opacification of the larynx due to fluid and intubation,\nlimiting evaluation of vocal cords/glottic region. There is soft tissue\nthickening enhancement in the supraglottis and glottis, however poorly\nevaluated secondary to intubation. There is fatty inflammatory stranding in\neffacement of paraglottic fat and of the subcutaneous tissues of the lower\nneck, which may be secondary to postradiation changes.\n2. The thyroid cartilage and cricoid cartilage appear intact. There is no\ncervical lymphadenopathy by size criteria.\n3. Bilateral dependent atelectasis with small left and moderate right pleural\neffusions.\n4. Stable small pericardial effusion.\n5. Mildly displaced left second and third rib fractures, with mildly displaced\nright second rib fracture.\n6. No discrete neck mass.\n7. Support lines and tubes as described above.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ on the ___ ___ at 7:13 ___, 5 minutes after discovery of\nthe findings." + }, + { + "input": "There is no evidence of large territorial infarction, hemorrhage, edema, or\nmass. There is prominence of the ventricles and sulci suggesting age-related\natrophy. The the hypodensities within the basal ganglia bilaterally (series 2,\nimage 18) are unchanged compared to ___, and likely represent chronic\nlacunar infarcts.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The patient is\nstatus post bilateral cataract surgery. Otherwise, the visualized portion of\nthe orbits are unremarkable.", + "output": "1. No evidence of large territorial infarction or hemorrhage on noncontrast\nhead CT.\n2. Age-related atrophy and chronic lacunar infarcts." + }, + { + "input": "There is no evidence of acute large territory infarctionhemorrhage,edema,or\nmass effect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No evidence of intracranial hemorrhage or fractures." + }, + { + "input": "Head CT: There is agenesis of the corpus callosum and absence of the septum\npellucidum with dilation of the lateral, third and fourth ventricles,\nconsistent with a congenital midline abnormality. There is no acute\nintracranial hemorrhage, mass, mass effect or large territorial infarction. \nThe basilar cisterns are patent, and there is otherwise good preservation of\nthe gray-white matter differentiation. Bilateral parietal foramina are noted.\nSoft tissue density is noted within the left external auditory canal which may\nrepresent cerumen.\n\nHead CTA: There are no intracranial vascular abnormalities. There is no\nevidence of aneurysm, stenosis or occlusion. No posterior communicating\narteries are noted, which is a normal variant.\n\nNeck CTA: The carotid and vertebral arteries and their major branches are\npatent with no evidence of stenoses. There is no evidence of internal carotid\nstenosis by NASCET criteria. Mild atherosclerosis is seen within the carotid\narteries bilaterally.\n\nThe visualized apices of lungs are clear. Note is made of a large right\nthyroid goiter extending to the substernal region. There is no cervical\nlymphadenopathy.", + "output": "1. Agenesis of the corpus callosum and absence of the septum pellucidum with\nchronic dilation of the lateral ventricles as described, likely congenital. \nRecommend correlation with clinical history.\n2. No acute intracranial abnormality.\n3. Patent Circle of ___. No vascular abnormalities identified within the\nneck.\n4. Large right thyroid goiter, with extension to the substernal region. A\nnon-urgent thyroid ultrasound may be helpful for further evaluation.\n5. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct.\n\nRECOMMENDATION(S):\n1. Agenesis of the corpus callosum and absence of the septum pellucidum with\nchronic dilation of the lateral ventricles as described, likely congenital. \nRecommend correlation with clinical history.\n2. Large right thyroid goiter, with extension to the substernal region. A\nnon-urgent thyroid ultrasound may be helpful for further evaluation.\n3. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction, mass or midline\nshift. There is no hydrocephalus. Trace locule of gas within the right\nlateral ventricle, likely from earlier lumbar puncture. Visualized paranasal\nsinuses and mastoid air cells are clear. There is no fracture. .\n\nCTA of the head. The major vascular arterial and structures enhance normally\nwith no evidence of flow stenotic lesions or aneurysms larger than 3 mm in\nsize, the caliber and configuration of the arterial and venous structures are\nunremarkable.", + "output": "1. Trace of gas within the right lateral ventricle, likely from earlier lumbar\npuncture.\n2. Normal CTA of the head, without flow limiting stenosis, aneurysm greater\nthan 3 mm in size or vascular abnormality\n\nNOTIFICATION: A preliminary report was provided by Dr. ___ on ___." + }, + { + "input": "Aero digestive tract: There is no mass.\n\nNeck lymph nodes: There is no adenopathy involving bilateral levels ___. \nThere are a few scattered mildly prominent lymph nodes including on the left\nat levels 2A, 3, 4,, 5A, and 5 B which are slightly more numerous than similar\nappearing lymph nodes on the right side, but this is similar to the previous\nexamination and 1 of the largest lymph nodes is at level 2A measuring\napproximately 9 mm long axis by reread these are not considered enlarged by\nsize criteria. There is no retropharyngeal adenopathy.\n\nExtra nodal tumor spread: Not applicable.\n\nDeep neck muscles, masticator space: Musculature appears unremarkable..\n\nBones, skull base:\nThere are no acute osseous findings. There are multilevel degenerative\nchanges of the cervical spine.\n\nVessels: There is no vascular invasion.\n\nBrachial Plexus: There is no brachial plexus contact or invasion.\n\nThyroid, salivary glands: There is no mass. The parotid glands are nightly\nheterogeneous, nonspecific, similar to the examination in ___\n\nOther findings: There are no lung nodules. Subpleural blebs are noted at the\nlung apices as well as mild centrilobular emphysema more prominent at the\nright apex (image 85 series 2)", + "output": "No lymphadenopathy by size criteria and no mass at level 4 or level 5 on the\nleft, although there are a few mildly prominent subcentimeter lymph nodes\nwhich are similar to a neck CTA from ___.\n\nPartially imaged emphysematous changes at the lung apices." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute large territory infarct,hemorrhage,edema,ormass\neffect. The ventricles and sulci are within expected limits in size and\nconfiguration.\n\nMild opacification of both mastoid air cells worse on the left side. Minimal\nmucosal thickening involving left maxillary and right sphenoid sinus. \nOtherwise paranasal sinuses are clear. Both orbits and globes are normal.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear unremarkable without stenosis, occlusion, or aneurysm. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear unremarkable\nwith no evidence of stenosis or occlusion.\n\nOTHER:\nNo suspicious lung nodules. The visualized portion of the thyroid gland is\nwithin normal limits. There is no lymphadenopathy by CT size criteria. The\nconfiguration of lymph nodes are unchanged from prior CT neck of ___.", + "output": "1. No acute intracranial abnormality on noncontrast CT head. Specifically no\nevidence of acute large territory infarct or intracranial hemorrhage.\n2. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n3. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection.\n4. Additional findings described above." + }, + { + "input": "There is stable prominence of visualized ventricles. The remainder of the\nvisualized intracranial structures are unremarkable. The bilateral orbits are\nunremarkable. There is mild mucosal thickening within the bilateral maxillary\nsinuses.\n\nThere is no facial bone fracture. The visualized maxillary air cells and\nmiddle ears are clear. There are periapical lucencies at the left maxillary\nlateral incisor and canine tooth with anterior osseous dehiscence (2: 67). \nThere are additional smaller periapical lucencies at the right maxillary\nsecond molar (2:74),. There are multiple dental caries.\n\nThere is a torus palatini. The soft tissues are unremarkable. There is\ncalcification of the carotid siphons. There are degenerative changes of the\nvisualized cervical spine. There is a heterogeneous appearance of the dens\nwith a linear lucency at the anterior dens cortex at the level the C1 arch\n(602:80).", + "output": "1. No evidence of facial bone fracture.\n2. Cortical defect at the anterior superior dens at the level of the arch\nwhich may represent advanced degenerative changes\n3. Multiple periapical lucencies and dental caries, described. Recommend\nfollow-up dental examination, as clinically indicated." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nNo intracranial hemorrhage. There is a hyperdense appearance of the right ICA\nterminus extending along the M1 portion right MCA to the level of the M2\nbifurcation (2:15). There is loss of gray-white matter differentiation in the\nright insula consistent with acute infarct (2:17). There are dense\ncalcifications of the tentorium cerebelli bilaterally. No significant mass\neffect or edema.\n\nThe ventricles and sulci are normal in size and configuration.\n\nThere is no fracture. There is mucosal thickening of the right maxillary\nsinus and partial opacification of the ethmoid air cells. The visualized\nportion of the remaining paranasal sinuses, mastoid air cells, and middle ear\ncavities are otherwise clear. The visualized portions of the orbits are\nnormal.\n\nCTA HEAD:\nThere is complete occlusion of the M1 segment of the right MCA (4:231). There\nis minimal reconstitution of flow distally with substantially decreased\narborization relative to left.\n\nThere is a focal segment of narrowing of the left P1 segment with a somewhat\nirregular appearance of the vessel distally (4:217, 213). Similar irregularity\nis seen in the right P1 segment. The dural venous sinuses are patent. Note\nis made of asymmetric enlargement right superior ophthalmic vein (4:246) and\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent. There is\nmedialization of the cervical internal carotid arteries bilaterally.\nThere is 10% stenosis of the right internal carotid by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion.\n\nCT PERFUSION: RAPID perfusion maps demonstrate an area of increased MTT with a\ncorresponding decreased CBF involving the right MCA territory.\n\nCT PERFUSION:\nCBF<30%: 57 mL (right MCA territory).\nTmax >6.0s: 135 mL (right MCA territory).\nMismatch volume = 78 mL\nMismatch ratio = 2.4\n\nOTHER:\nThe visualized portion of the lungs are clear without focal consolidation. \nThe visualized portion of the thyroid gland is within normal limits. There is\nno lymphadenopathy by CT size criteria.", + "output": "1. Complete occlusion of the M1 segment of the right MCA with corresponding\nperfusion defects in the right MCA territory on CT perfusion. There is no\nevidence of hemorrhage. No mass effect. There is loss of gray-white matter\ndifferentiation of the right insular cortex compatible with infarction of the\nright MCA territory.\n2. Multifocal narrowing of the P1 segment of the left PCA with an irregular\nappearance of the vessel distally, which may be due to noncalcified atheroma.\n3. Patent bilateral cervical carotid and vertebral arteries without evidence\nof high-grade stenosis, occlusion,or dissection.\n4. Asymmetric enlargement of the right superior ophthalmic vein, which is\nnonspecific.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 9:08 pm, 2 minutes after\ndiscovery of the findings." + }, + { + "input": "A hyperdense appearance is seen in the intracranial vessels which may partly\ndue to retained contrast from recently performed CTA head and neck.\n\nIn comparison to prior there has been progression in loss of gray-white matter\ndifferentiation in the right MCA territory, for example now involving the\nright caudate lobe, putamen and insula (___). There is mild sulcal\neffacement at these levels. No intraparenchymal hemorrhage. A linear\nhyperdensity at the anteromedial aspect of the right putamen is favored to\nrepresent a vessel, however attention on follow-up is recommended (2:14).\n\nNo midline shift. The basal cisterns remain patent. Ventricles are in\nunchanged configuration.\n\nExtensive opacification of the anterior ethmoidal air cells with air-fluid\nlevels and copious secretions within the oropharynx (an endotracheal tube is\nappreciated on the scout views). No acute fracture. Visualized orbits are\nnormal.", + "output": "1. Interval progression of loss of gray-white matter differentiation in the\nright basal ganglia as described above.\n2. No definite evidence of intracranial hemorrhage. A linear hyperdensity at\nthe anteromedial aspect of the right putamen is favored to represent a vessel,\nhowever attention on follow-up is recommended.\n3. Hyperdense appearance is seen in the intracranial vessels which may be in\npart due to retained contrast recently performed CTA head and neck.\n4. Extensive opacifications in the anterior ethmoidal air cells with air-fluid\nlevels and copious secretions within the oropharynx, possibly due to intubated\nstatus." + }, + { + "input": "Evaluation is limited by motion artifact.\n\nIn the right insula and the right basal ganglia there is loss of gray-white\nmatter differentiation and sulcal effacement consistent with an evolving right\nMCA infarction. There is no evidence of intracranial hemorrhage. There is no\nmidline shift. The basal cisterns remain patent.\n\nThere is no evidence of fracture or mass. The ventricles and sulci are normal\nin size and configuration.\n\nSecretions are seen in the right maxillary sinus and the left sphenoid sinus\nwith opacification of several anterior ethmoid air cells. The visualized\nportion of the remaining paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are normal.", + "output": "1. Evolving right MCA infarction without evidence of hemorrhagic conversion." + }, + { + "input": "There are small defects of the medial maxillary wall with adjacent thinning of\nthe bony cortex and medial bowing most suggestive of cortical thinning/\nerosion from chronic sinusitis. Uncinate process appears to be intact\nbilaterally and there is no evidence of prior ethmoidectomy which would argue\nagainst prior antrostomy. There is complete opacification of the left\nmaxillary sinus. There is moderate to severe mucosal wall thickening of the\nright maxillary sinus. There is mild mucosal wall thickening of the left\nsphenoid air cell. The right sphenoid air cell is well-aerated. There is\ncomplete opacification of the left anterior ethmoid air cells and moderate to\nsevere mucosal wall thickening of the right anterior ethmoid air cells. There\nis moderate left-greater-than-right mucosal wall thickening of the posterior\nethmoid air cells. There is moderate mucosal wall thickening of the bilateral\nfrontal sinuses. There is complete opacification of the left frontoethmoidal\nrecess and a moderate mucosal wall thickening of the right frontoethmoidal\nrecess. An osteoma is noted in a right anterior ethmoid air cell. The\nostiomeatal units are occluded bilaterally. The nasal passages are partially\noccluded on the left. The cribriform plates are intact. There is no nasal\nseptal defect. The nasal septum is mildly bowed to the right. The anterior\nclinoid process is pneumatized on the right and not pneumatized on the left. \n. The lamina papyracea are intact. The sphenoid sinus septum is midline with\ninsertion upon the sellar floor.\n\nLimited evaluation of the brain is grossly unremarkable.", + "output": "1. Small defects of the medial maxillary wall with thinning and inward bowing\nof the cortex most suggestive of remodeling and erosion secondary to chronic\nsinusitis. Though the overall size of the wall defect, lack of changes of\nuncinectomy or ethmoidectomy argues against antrostomy, this remains a\npossibility and should be correlated with prior surgical history.\n2. Severe chronic sinusitis, as detailed above." + }, + { + "input": "An area of hypodensity within the left frontal lobe likely represents an area\nof prior subacute to chronic infarct. Irregular areas of hyperdensity are\nnoted within this region (2:17, 18, 19).\n\nThere is no evidence of acute large territorial infarction, edema, or mass.\nThe ventricles and sulci are normal in size and configuration. Periventricular\nand deep subcortical white matter hypodensities are consistent with sequela of\nchronic small vessel ischemic disease.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. Hypodensity in the left frontal lobe likely represents an area of subacute\nto chronic infarct, although no prior studies are available for comparison. \nIrregular areas of hyperdensity within this region in the left frontal lobe\nmay represent cortical laminar necrosis, or mineralization from prior\nhemorrhage. If there is ongoing concern for acute infarct, an MRI without\ncontrast can be performed for further evaluation.\n2. Small vessel disease." + }, + { + "input": "Previously seen left frontal infarct has evolved. There is no acute\nhemorrhage mass effect or midline shift. Mild brain atrophy and small vessel\ndisease are seen. There is no new loss of gray-white matter differentiation.", + "output": "Chronic left frontal lobe infarct. No acute hemorrhage." + }, + { + "input": "There is no evidence of acute intracranial large vascular territorial\ninfarction,hemorrhage,edema,or mass effect. Periventricular and subcortical\nwhite matter hypodensities are nonspecific, likely a sequelae of chronic small\nvessel ischemic disease in a patient of this age. There is prominence of the\nventricles and sulci suggestive of involutional changes. Mild atherosclerotic\ncalcifications are seen along bilateral carotid siphons. Of note, the\nvascular structures structures appear more hyperdense than typically seen,\ncorrelate with recent IV contrast administration.\n\nThere is no evidence of acute fracture. There is mild mucosal thickening of\nthe ethmoid air cells. The visualized portion of the remaining paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "1. No acute intracranial process. Of note, the vascular structures appear\nmore hyperdense than typically seen, correlate with recent IV contrast\nadministration." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territorial infarct. Mild prominence of the\nventricles and sulci is consistent with mild involutional changes. Mild\nperiventricular white matter hypodensities are nonspecific, but may be\nsequelae of chronic small vessel disease. The visualized paranasal sinuses\nshow mild mucosal thickening of the bilateral ethmoid air cells. There is\nalso mucosal thickening of the bilateral maxillary sinuses. The mastoid air\ncells are clear. No acute fracture is seen.", + "output": "No acute intracranial process." + }, + { + "input": "There is a small focus of hyperdensity in the right frontoparietal region\nadjacent to the falx, consistent with subarachnoid hemorrhage, not\nsignificantly changed from prior exam. There is no edema or shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are prominent, suggestive of volume loss. \nThere are periventricular and subcortical hypodensities, which may represent\nsmall vessel ischemic changes. The imaged paranasal sinuses are clear. The\nmastoid air cells are clear. The bony calvarium is intact.", + "output": "Small focus of subarachnoid hemorrhage in the right frontoparietal region,\nadjacent to the falx, not significantly changed from prior exam." + }, + { + "input": "There is no evidence of hemorrhage, edema, or mass. The ventricles and sulci\nare prominent, suggestive of global cerebral atrophy. Preservation of\ngray-white matter differentiation. There are several chronic lacunes in the\nputamina bilaterally and in the left thalamus. There is no evidence of recent\ninfarction. The basal cisterns remain patent.\n\nNo acute osseous abnormality is seen. There is partial opacification of the\nbilateral anterior and posterior ethmoidal air cells. There is a right\nethmoid sinus osteoma. The remainder of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute major vascular territorial infarction,\nhemorrhage, edema, or mass effect. The ventricles and sulci are normal in\nsize and configuration.\n\nThere is no evidence of fracture. There is complete opacification of the left\nfrontal sinus. Remainder of the visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Left frontal sinus disease." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. Mild mucosal thickening is noted within the\nsphenoid sinuses and posterior ethmoid air cells. The remaining paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "No acute intracranial abnormality. No fracture." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No evidence of infarction, hemorrhage, edema or mass.\n2. No evidence of aneurysm, dissection or vascular malformation, or\nsignificant luminal narrowing." + }, + { + "input": "Head CT: There is no evidence of hemorrhage, mass, or midline shift. There\nare patchy hypodensities in the basal ganglia and deep frontal white matter.\nThese are similar in distribution to FLAIR hyperintensities seen on MRI from\n___, when allowing for differences in comparing across\nmodalities. There is no hydrocephalus. There is mucosal thickening of the\nparanasal sinuses. There is a small osteoma in one of the left anterior\nethmoid air cells. The mastoid air cells and tympanic cavities are clear. \nThere is no evidence of fracture.\n\nHead CTA: The intracranial arteries demonstrate no evidence of stenosis,\nocclusion, aneurysm, or arteriovenous malformation. The right vertebral artery\nis dominant.\n\nThe dural venous sinuses are patent.", + "output": "1. No steno-occlusive disease or aneurysm of the intracranial arterial\ncirculation.\n2. No intracranial hemorrhage or large vascular territory infarct.\n3. Scattered hypodensities in the basal ganglia and deep white matter, grossly\nunchanged from MRI on ___. These are nonspecific and may be the\nsequela of chronic small vessel ischemic disease." + }, + { + "input": "A left frontal burr hole is present. There is a small area of intraparenchymal\nhemorrhage and a locule of air within the region of the left caudate head.\nThere is surrounding hypodensity consistent with edema. The frontal horn of\nthe left lateral ventricle is effaced likely due to the adjacent post biopsy\nchanges. There is no other intraparenchymal hemorrhage or acute infarction.\nThe basilar cisterns are patent. The visualized paranasal sinuses, mastoid air\ncells and middle ear cavities are clear. The bones are unremarkable.", + "output": "Post biopsy changes with a small amount of blood, edema and pneumocephalus in\nthe left caudate head with mass effect on the frontal horn of the left lateral\nventricle." + }, + { + "input": "There continues to be a 1.4 x 0.9 cm hemorrhage within the left caudate lobe\nwith surrounding edema causing mass effect along the frontal horn of the left\nlateral ventricle, similar to prior exam at 12:39 earlier in the day (3:12).\nSmall amount of pneumocephalus is also noted. No new hemorrhage or infarction\nis seen. The ventricles and sulci are normal in size and configuration. A left\nfrontal burr hole is noted. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "Stable small hemorrhage and edema in the left caudate head, with mass effect\non the frontal horn of the left lateral ventricle." + }, + { + "input": "There is near complete occlusion of the right IJ, consistent with patient's\nknown DVT from ___. There is a short segment of partial\nopacification of the upper IJ, however interval change compared to the prior\nultrasound is difficult given different modalities in assessment. The left IJ\nis unremarkable.\n\nThere is no cervical lymphadenopathy. The parapharyngeal, parotid, and\nperivertebral fat pads are well preserved. No pharyngeal masses seen. The\nvocal cords are normal. The visualized thyroid gland is unremarkable. The\nvisualized apices of the lungs are clear.", + "output": "1. Near complete occlusion of the right IJ consistent with patient's known\nchronic DVT, compared to exams dated back to ___.\n\n2. Left-sided IJ appears to be well opacified, without evidence of a filling\ndefect concerning for a DVT." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, mass, mass effect\nor midline shift. The ventricles and sulci are normal in size and\nconfiguration. Bifrontal white matter hypodensities, left greater than right,\nare distributed similarly to FLAIR hyperintensities on prior.\n\nLeft frontal burr hole is again seen. The imaged paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The orbits are unremarkable.", + "output": "No intracranial hemorrhage or acute process." + }, + { + "input": "Slightly limited evaluation due to patient positioning.\n\nHypodensity within the left frontal lobe and left basal ganglia is consistent\nwith biopsy changes and is grossly stable in appearance since ___ MR.\n___ is no evidence of infarction, hemorrhage, edema, or mass. The basal\ncisterns are patent. The ventricles and sulci are normal in size and\nconfiguration.\n\nLeft frontal burr hole is again seen. There is no evidence of acute fracture.\nAerosolized secretions and air-fluid levels are seen within bilateral\nmaxillary sinuses, there is mucosal thickening in the ethmoidal air cells and\nleft frontal sinus, suggesting an ongoing inflammatory process. The mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. Stable left frontal lobe and left basal gangliar hypodensity is consistent\nwith biopsy changes and grossly unchanged since ___ MR.\n2. No hemorrhage or large mass. Of note MR is more sensitive in detection of\nsubtle mass lesions.\n3. Paranasal sinus disease as described above." + }, + { + "input": "As on the prior study there is near complete occlusion of the right internal\njugular vein. The upper IJ appears opacified of the level of the skullbase\nbut occluded distally. There is apparent compensatory enlargement of the\nright anterior jugular and external jugular veins. There is a prominent level\nIIB lymph node on the left, demonstrate draining moderate pattern of\nenhancement, measuring up to 19 x 10 mm in sagittal projection, and 11 x 10 mm\nin transverse dimension (image 23, series 3, image 39, series 6 and image 43,\nseries 5), probably reactive in nature, additionally there is is slightly\nprominent right side level IIA lymph node (image 15, series 6 and image 27,\nseries 3), measuring up to 12 by 10.6 mm in sagittal projection and 10 x 7 mm\nin transverse dimension.\n\nEvaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect. The cervical esophagus is grossly normal. The vocal cords\nappear symmetric.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal.\n\nOpacification of the right maxillary sinus is unchanged since ___. \nThere is worsening opacification of the left maxillary sinus with new\nair-fluid level. Opacification of the ethmoid air cells is significantly\nimproved. Mild mucosal thickening in the sphenoid sinuses is unchanged. The\nmastoid air cells and middle ear cavities remain clear.", + "output": "1. Unchanged occlusion of the right internal jugular vein.\n2. Enlarged left level IIB and right IIA lymph nodes as described above.\n3. Worsening opacification of the left maxillary sinus with air-fluid level. \nUnchanged air-fluid levels in the right maxillary sinus. Significant\nimprovement of ethmoidal air cell opacification.\n4. Please note CT of the chest will be reported separately." + }, + { + "input": "Age-related involutional changes are fairly mild. There is no mass effect,\nhydrocephalus or shift of normally midline structures. Gray-white matter\ndistinction appears preserved. There is no evidence of intracranial\nhemorrhage. Surrounding soft tissue structures are unremarkable. Visualized\nparanasal sinuses and mastoid air cells appear clear. No evidence of fracture\nor bone destruction.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "There is no acute hemorrhage, edema, mass effect or acute large vascular\nterritorial infarction. The ventricles and sulci are normal in size and\nconfiguration. The basal cisterns appear patent and there is preservation of\ngray-white matter differentiation.\nNo fracture is identified. The mastoid air cells, middle ear cavities, and\nvisualized paranasal sinuses are clear. The globes are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is a large area of regional hypodensity with decreased gray-white\ndifferentiation affecting the right parietal and right temporal lobes, which\nis new compared to the MR dated ___, compatible with infarction. \nEffacement of the adjacent sulci, but no evidence of midline shift. Basal\ncisterns are patent.\n\nCurvilinear high density within the adjacent sulci likely represents a small\namount of subarachnoid hemorrhage (series 601, image 59), however this can be\nconfirmed with an MRI. There is also a focus of high density within the right\ntemporal lobe (series 601, image 41), likely another focus of hemorrhage,\neither subarachnoid or intraparenchymal.\n\nThere is no evidence of mass. Otherwise, the ventricles and sulci are normal\nin size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Large right MCA territory infarction, new since ___. \nEffacement of the adjacent sulci, but no significant mass effect.\n2. Small foci of hyperdensity overlying the right temporal and parietal lobes,\nlikely a combination of subarachnoid and intraparenchymal hemorrhage. This\ncan be confirmed with an MRI.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 12:00 am, 5 minutes\nafter discovery of the findings." + }, + { + "input": "TUBES AND LINES:\nPatient is intubated and there is an enteric tube in place. Retained\nnasopharyngeal secretions likely relate to intubation.\n\nCT HEAD WITHOUT CONTRAST:\nRedemonstrated is hypoattenuation and gray-white differentiation loss in the\nright temporal parietal region slightly more defined since ___. \nThere is persistent effacement of the adjacent cerebral sulci but no evidence\nof midline shift. Slight interval decrease in the trace amount petechial\nhemorrhage along the anterior margin of the infarct (02:15) and within the\nright temporal lobe (02:11). Prominent right cortical vessels likely relate\nto slow flow.\n\nNo evidence of a new infarct or new hemorrhage. The ventricles and sulci are\nnormal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is a 4 mm aneurysm arising from the right MCA M2 segment. There is a\npersistent fetal origin of the left PCA. The remaining vessels of the circle\n___ and their principal intracranial branches appear normal without\nstenosis, occlusion, or aneurysm formation. The dural venous sinuses are\npatent.\n\nCTA NECK:\nThe right vertebral artery V4 segment likely terminates into right ___. The\ncarotid and vertebral arteries and their major branches appear otherwise\nnormal with no evidence of stenosis or occlusion. There is no evidence of\ninternal carotid stenosis by NASCET criteria.\n\nOTHER:\nThere is a 4 mm left upper lobe subpleural pulmonary nodule (03:51). The\nvisualized portion of the thyroid gland is within normal limits. There is no\nlymphadenopathy by CT size criteria.", + "output": "1. Increased definition of an evolving subacute right temporal parietal\ninfarct.\n2. Slight interval decrease in trace right temporal parietal petechial\nhemorrhage.\n3. Evidence of a right MCA M2 segment 4 mm aneurysm, likely mycotic given\nhistory of endocarditis.\n4. Normal CTA neck without evidence carotid stenosis by NASCET criteria.\n5. Left upper lobe 4 mm pulmonary nodule. Per the ___ ___ criteria no\nfollow-up imaging is recommended in low risk patients. High-risk patients may\nreceive a follow-up chest CT in 12 months.\n\nRECOMMENDATION(S): For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" + }, + { + "input": "In comparison to the study from 1 day prior, right temporoparietal\nhypointensity with loss of gray-white differentiation, compatible with\ninfarction is unchanged. Persistent effacement of the adjacent sulci is also\nunchanged. Two small hyperintense foci, measuring up to 4 mm, in the right\ntemporal lobe, involved by infarct likely represent petechial hemorrhage. The\nmore inferior of these lesions measures 4 mm in the (series 2, image 11)\nappears increased from prior examination, while the more superior lesion\nmeasures approximately 2 mm and appears unchanged (series 2, image 15).\n\nNo new infarction. No midline shift.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Unchanged extent of the right temporoparietal infarction. Two tiny\n___ foci of hyperintensity likely represent petechial hemorrhage. \nThe more inferior focus in the right temporal lobe is mildly increased or new\nfrom the prior examination and measures 4 mm. The previously seen tiny focus\nof petechial hemorrhage is unchanged." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nMild, subtle diffuse hyperdensity in the right temporal lobe in the area of\nthe known right M2 infarct/aneurysm is more conspicuous in the current study. \nThe distribution appears to be cortical, and does not follow the sulci, likely\nnot SAH.\nRight temporal lobe and operculum gray-white matter differentiation loss\nconsistent with infarction, with areas of higher density, concerning for\npetechial hemorrhagic changes or reperfusion phenomenon in the prior area of\ninfarction.\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nInterval rapid increase in size of the known saccular right M2 aneurysm,\ncurrently measuring 6.5 x 6 mm, was 3 x 3.6 mm on ___. In the current\nstudy it appears more lobulated. Decrease in vascularity of the territory of\nthe MCA seen on the vascular 3D reconstructions, consistent with area of\ninfarction.\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nInterval appearance of bilateral central ground-glass opacities in the right\nupper lobe and left upper lobe and bilateral pleural effusion, larger on the\nright, consistent pulmonary edema.\nThe visualized portion of the thyroid gland is within normal limits. There is\nno lymphadenopathy by CT size criteria.", + "output": "1. The known right saccular m 2 aneurysm appears larger in size and more\nlobulated than in the prior study and now measures approximately 6.5 x 6 mm.\n2. There is increased subtle hyperdensity in the right temporal lobe, and\nhyperdensities in the right temporal lobe and operculum, suggesting petechial\nchanges and rib perfusion phenomenon in the prior infarct." + }, + { + "input": "Streak artifact in the right frontotemporal region arising from prior M2 coil\nembolization limits evaluation. There is diffuse hypodensity encompassing the\nright frontal, parietal, and temporal lobes, however with areas demonstrating\nthat are slightly less hypodense. There is ex vacuo dilation of the right\nlateral ventricle. Overall, this is consistent with encephalomalacia from\nprior chronic infarction, however, subacute infarction of the superior frontal\nparietal region cannot be excluded.\n\nThere is no evidence of acute fracture. There is mild ethmoid opacification\nthe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavitiesare otherwise clear.", + "output": "Streak artifact from prior coil embolization limits evaluation. Large chronic\ninfarction involving the right frontal, parietal, and temporal lobes. \nSubacute infarction, particularly of the superior frontal parietal region,\ncannot be excluded. No large hemorrhage is identified." + }, + { + "input": "Redemonstration of hypoattenuation in the right frontoparietal region,\ncerebellum, consistent with chronic infarction. Embolization material is again\ndemonstrated within the lateral right temporal lobe causing streak artifact. \nThere is no evidence of fracture, acute large territorial\ninfarction,hemorrhage,edema,or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "No acute intracranial process.\nChronic large right MCA distribution infarct. Small chronic cerebellar\ninfarcts." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nlarge territorial infarction. The ventricles are normal in size and\nconfiguration. Mild, age advanced volume loss is noted, stable from the prior\nexam. The basal cisterns appear patent and there is preservation of gray-white\nmatter differentiation.\n\nThe visualized bony structures are grossly unremarkable. The paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The globes are\nunremarkable.", + "output": "1. No evidence of acute intracranial hemorrhage or large vascular territory\ninfarction. MRI is more sensitive for the detection of subtle cerebral\nischemia.\n2. Mild, age advanced volume loss." + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass. The ventricles and sulci are normal in size and configuration. There is\nno evidence of fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is a moderate right frontotemporal subgaleal hematoma with small\nhyperdense components. There is no subjacent calvarial fracture. No\nintracranial hemorrhage, mass, edema, or infarct. Ventricles and sulci are\nnormal in size and configuration. Basal cisterns are patent.\nThere is scattered mucosal thickening of anterior and posterior ethmoid air\ncells, otherwise the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are normal.", + "output": "Moderate right frontotemporal subgaleal (scalp) hematoma with hyperdense\ncomponents representing more acute blood, but no fracture or evidence of\nintracranial hemorrhage." + }, + { + "input": "Slight motion slightly limits evaluation of the skullbase. There is no\nevidence of an acute large territorial infarction, hemorrhage,edema,or mass. \nThe ventricles and sulci are normal in size and configuration.\nThere is no evidence of fracture. There is minimal mucosal thickening of the\nanterior ethmoid air cells. The remaining paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Again seen is hyperdense material in the ventricles, along the falx, and\ntentorium, consistent with hemorrhage. Compared to prior examination the\namount of blood layering within the occipital horns has slightly decreased\nsince prior examination. The ventricles are unchanged in size or\nconfiguration. Patient is status post right frontal ventriculostomy catheter\nwith tip terminating in the third ventricle, unchanged in positioning. \nPreviously noted hyperdense subdural hematoma overlying the right frontal\nconvexity near the vertex is stable in size. No acute large territorial\ninfarction. Stable 0.4 cm rightward shift of normally midline structures.\n\nThere is no evidence of fracture. Patient is status post bilateral lens\nreplacement. The visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. Calcification the cavernous\nportions of internal carotid arteries are again noted.", + "output": "1. Minimal decrease in intraventricular layering blood.\n2. Stable 0.4 cm rightward shift of normally midline structures.\n3. Right frontal ventriculostomy catheter with tip terminating in the third\nventricle, unchanged since prior. Stable size/configuration of ventricles.\n4. No significant change in left parafalcine and falx subdural hematomas." + }, + { + "input": "Patient is status post right frontoparietal VP shunt catheter placement with\ntip terminating in the expected location of the foramen of ___, unchanged\nfrom prior exam. Again seen is hyper dense material in the ventricles, along\nthe falx and the tentorium, consistent with hemorrhage. However, the\ncomponent along the falx has decreased since prior exam. Mild\nventriculomegaly is stable. Subdural hematoma along the right frontal\nconvexity is not well seen on today's exam. No acute large territorial\ninfarction is seen. Rightward shift of midline structures, measuring up to 5\nmm to the right is not substantially changed from prior exam.\n The visualized portion of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. Patient is status post bilateral lens\nreplacements. However, the visualized portion of the orbits are unremarkable.\nDense calcifications of the bilateral carotid siphons are again noted.", + "output": "Interval decrease in hyperdense blood products layering along the falx. \nStable rightward midline shift and mild hydrocephalus, status post VP shunt\nplacement. No evidence of new territorial infarct or enlarging hemorrhage." + }, + { + "input": "Right frontal burr hole, with shunt in place, tip along the posterior, left\nmargin of the left frontal horn, abutting ependyma surface new since prior. \nPostoperative pneumocephalus within ventricular system. Trace volume\nparenchymal air along previously placed and now withdrawn ventricular drain. \nThere has been interval evolution of intraventricular blood products, which\nhave decreased since prior. Hydrocephalus has mildly improved, with decreased\nsize of the temporal horns, occipital horns. Frontal horns are mildly more\nexpanded, likely from presence of pneumocephalus. Left parafalcine subdural\nhematoma is predominantly low-attenuation 0, has been decreasing and involving\nsince ___, no interval new hemorrhage. Generalized brain parenchymal\natrophy. Trace subarachnoid hemorrhage, also present on prior, more apparent\nin the posterior margin right sylvian fissure today. There is no evidence of\nnew infarction,or mass. Minimal midline shift is stable. The ventricles and\nsulci are normal in size and configuration.\n\nSubmucosal retention cyst in the right maxillary sinus. Otherwise, the\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "Interval placement of VP shunt, tip abuts ependymal surface of posterior left\nfrontal horn. Evolution of intracranial blood products since prior, no\ndefinite new hemorrhage. Interval minimal decrease in size of temporal horns,\noccipital horns." + }, + { + "input": "Patient is status post right frontal burr hole with shunt in place, with tip\nterminating at the lateral margin of the left frontal horn, abutting the\nependymal surface, unchanged from prior exam. There is continued evolution of\nintraventricular blood products, significantly decreased compared to prior\nexam obtained 2 days prior. Bilateral frontal horn pneumocephalus has\ndecreased. In addition, left parafalcine subdural hematoma with predominantly\nlow attenuating fluid continues to decrease. Trace subdural hemorrhage in the\nright sylvian fissure is less conspicuous on today's exam. Subtle hypodensity\nin the right frontal lobe along the catheter tract is stable. There is no\nevidence of new hemorrhage or large territorial infarction. Diffuse global\natrophy is again noted. Overall size and distribution of the ventricles and\nbasal cisterns are unchanged.\n\nShunt catheter is seen running along the posterior right calvarium. Tiny foci\nof subcutaneous emphysema is noted along the track of the shunt on the right\nlateral neck, decreased from prior exam. Small aerosolized debris and\npolypoid mucous retention cyst is seen in the right maxillary sinus. \nOtherwise, the visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable. Soft tissue density in the left external auditory canal is\nnonspecific, though likely representing cerumen.", + "output": "-Overall decreased size of mixed density subdural hematoma and\ninterventricular layering fluid.\n-Stable hydrocephalus status post shunt placement.\n-No evidence of new or enlarging hemorrhage or new large territorial\ninfarction" + }, + { + "input": "Right VP shunt placement right frontal burr hole, tip is in the inferior left\nfrontal horn, just lateral to the foramen of ___. Mild interval decrease in\nventricular size, most evident at the right temporal horn. Previously seen\nintracranial hemorrhage has resolved. Stable small area of low attenuation\nsurrounding right VP shunt tract in the right frontal lobe. Suggestion of\nsmall chronic cortical infarct left parietal lobe versus volume averaging. \nThere is no evidence of acute infarction,hemorrhage,edema, or mass. Mild\ngeneralized brain parenchymal atrophy.\n\nThere is no evidence of fracture. Submucosal retention cyst right maxillary\nsinus. The visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "Interval improvement, with resolution of previously seen intracranial blood\nproducts, and mild decrease in ventricular size. No new hemorrhage." + }, + { + "input": "There is area of hypoattenuation in the right anterior parietal lobe,\ninvolving postcentral gyrus, possibly precentral gyrus, extending\ninferolaterally into the inferior parietal lobule, supra marginal gyrus and\ntip of the posterosuperior temporal lobe, new as compared to CT head ___, consistent with acute to early subacute infarct..\nRight frontal approach VP shunt terminates in the inferior left frontal horn,\nor adjacent parenchyma, unchanged in position from CT head ___. \nStable area of low attenuation surrounding the tract of the right VP shunt the\nfrontal lobe is again noted. There is minimal interval decrease in trabecular\nsize, most notable at the bilateral frontal horns.\n\nThere is mucosal thickening of the bilateral ethmoid air cells and left\nmaxillary sinus. There is partial opacification the right maxillary sinus. \nMastoid air cells and middle ear cavities are well aerated. The bony calvarium\nis intact. There are extensive atherosclerotic calcifications of bilateral\ncarotid siphons.", + "output": "1. Right MCA distribution acute to subacute infarction.\n2. Ventricles are minimally decreased in size as compared to CT head ___ with unchanged position of right frontal approach VP shunt." + }, + { + "input": "CTA NECK:\nThere is a 3 vessel aortic arch. There is mild calcified plaque within\nbilateral proximal internal carotid arteries without stenosis by NASCET\ncriteria. Bilateral vertebral arteries appear widely patent. Both carotid\nand vertebral arteries are tortuous.\n\nCTA HEAD:\nThere is calcified plaque within bilateral carotid siphons without evidence\nfor flow-limiting stenosis. There is no right M1 occlusion. Arborization of\nbilateral MCA branches appears relatively symmetric. There is fetal type\nconfiguration of the right posterior cerebral artery with larger caliber of\nthe posterior communicating artery compared to P1 segment, with unchanged mild\nnarrowing of the proximal right P1 segment which may be congenital. No\nflow-limiting stenosis is seen elsewhere in the major intracranial arteries. \nNo evidence for an aneurysm. Small fenestration in the proximal basilar\nartery is again noted. The dural venous sinuses are patent.\n\nOTHER:\nThe brain parenchyma, including right MCA territory infarction, is better\nassessed on the preceding noncontrast head CT. The ventricles are stable in\nsize. Right frontal approach VP shunt catheter terminates in unchanged\nposition adjacent to the inferior frontal horn of the left lateral ventricle.\n\nThere is evidence of bilateral cataract surgery. There is mild mucosal\nthickening in the left ethmoid air cells. There is mild mucosal thickening\nwith mucous retention cysts in the maxillary sinuses. Mastoid air cells\nappear grossly well-aerated allowing for absence of dedicated bone algorithm\nimages.\n\nThe thyroid is unremarkable. Bilateral nonenlarged cervical lymph nodes are\nnonspecific and likely reactive.\n\nEvaluation of the included upper lungs is limited by motion artifact and mild\ndependent atelectasis. Small peripheral nodules in the posterior right upper\nlobe cannot be excluded, up to 5 mm, images ___. No prior chest CTs\navailable for comparison.\n\nThere are degenerative changes in the cervical spine.", + "output": "1. Mild atherosclerosis of bilateral proximal internal carotid arteries\nwithout stenosis by NASCET criteria.\n2. No evidence for occlusion or flow-limiting stenosis in the major anterior\ncirculation arteries.\n3. Stable mild narrowing of the proximal P1 segment of the right posterior\ncerebral artery, likely congenital in the setting of fetal type configuration.\n4. Stable small fenestration of the proximal basilar artery.\n5. The brain parenchyma, including right MCA territory infarction, is better\nassessed on the preceding noncontrast head CT. Position of the right frontal\napproach VP shunt catheter and size of the ventricles are stable.\n6. Questionable pulmonary nodules measuring up to 5 mm, versus atelectasis, in\nthe posterior right upper lobe. Evaluation is limited by respiratory motion\nartifact.\n\nRECOMMENDATION(S): If there is no prior chest CT for comparison, then chest\nCT is recommended.\n\nNOTIFICATION: Impression items 6 and the recommendations above were emailed\nto the ED QA nurses list by Dr. ___ at 14:40 on ___." + }, + { + "input": "The right frontal approach VP shunt is in a similar position as the prior\nstudy.\n\n\nThe ventricular size is unchanged. Right frontal hypodensities also unchanged\ncompared to the previous MRI study of ___. Subtle areas of\nhyperdensity seen as susceptibility abnormalities within the infarcted area\nare unchanged. No new hemorrhage is seen.", + "output": "Evolving right frontal infarct. No acute or new hemorrhage since the MRI of ___." + }, + { + "input": "There is no evidence of acute large territory infarction,hemorrhage,edema,or\nmass. There is hypodensity within the right frontoparietal region which\nrepresents further evolution of prior infarction. There is a right frontal\napproach ventriculostomy catheter which terminates at the body of the left\nventricle, unchanged in position. The configuration of the ventricles and\nsulci is unchanged. There are moderate hypodensities within the subcortical\nand periventricular white matter in a nonspecific but may represent sequela of\nchronic microvascular ischemic disease. There is dense calcified\natherosclerosis at the bilateral carotid siphons.\n\nNo acute fracture is seen. There is mild mucosal thickening of the ethmoid\nsinuses. The visualized portion of the other paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear.", + "output": "1. No acute intracranial process.\n2. Interval evolution of prior right frontoparietal infarct.\n3. Unchanged position of right frontal approach ventriculostomy catheter. \nUnchanged configuration of the ventricles and sulci when compared to MR head\ndated ___." + }, + { + "input": "Right frontal approach ventriculostomy catheter remains in place with tip\nterminating along the body of the left lateral ventricle, unchanged. Stable\nventricular size and configuration compared to the previous study. There is\nagain a large area of encephalomalacia involving the right parietal lobe, and\nthere is again hypodensity along the right frontal catheter tract. \nNonspecific hypodensities in the white matter are again seen which are\nnonspecific but could reflect chronic microvascular disease at this age. \nThere is prominent atherosclerotic calcification involving the bilateral\ncarotid siphons. No hemorrhage is demonstrated.\n\nPartially imaged mucous retention cyst in the right maxillary sinus and\nminimal scattered mucosal thickening in the ethmoid air cells. Otherwise, the\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are normal.", + "output": "1. Shunted patient with no change in appearance of the right frontal approach\nventriculostomy catheter. Stable ventricular size and configuration compared\nto the previous exam.\n2. Redemonstration of right frontoparietal region infarct.\n3. Stable appearance of hypodensity along the right frontal catheter tract\nwhich may reflect gliosis." + }, + { + "input": "Overall, there is unchanged appearance of an extensive intraventricular and\nsubdural intrahemispheric hemorrhage as compared to the earlier same-day CT\nhead. The intraventricular hemorrhages seen in the lateral ventricles, left\ngreater than right and extends into the third ventricle and fourth ventricle. \nSubdural hemorrhage is also seen layering along the falx and tentorium\ncerebelli, unchanged. Trace left frontal and temporal convexity 2 mm thick\nsubdural hematoma is also unchanged. No evidence of new intracranial\nhemorrhage. The lateral ventricles appear enlarged, which can be concerning\nfor obstructive hydrocephalus, particularly in the absence of prior comparison\nstudies. There is no large acute infarct. There is no obvious midline shift.\n\nThere is no evidence of fracture. Mild mucosal thickening is seen in the\nmaxillary sinuses. A mucous retention cyst is seen in the right maxillary\nsinus. Otherwise, the remaining visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable. An ETT is partially visualized. \nAtherosclerotic calcifications are seen in the bilateral carotid siphons. \nPatient is status post bilateral lens resections.", + "output": "1. Overall, similar appearance of an extensive multi compartment hemorrhages\nas compared to the earlier same-day CT head exam.\n2. Prominence of the ventricles are concerning for obstructive hydrocephalus,\nbut overall similar in configuration from the immediate prior examination." + }, + { + "input": "A right frontal approach ventriculostomy catheter is in unchanged position\nwith tip terminating along the body of the left lateral ventricle. The\nventricles are unchanged in size and configuration compared to the prior\nstudy. Again seen, is chronic encephalomalacia in right frontoparietal\nvertex. There is also mild encephalomalacia along the tract of the\nventricular catheter, as before. Mild periventricular and subcortical white\nmatter hypodensities are nonspecific, but likely represent sequela of chronic\nischemic microvascular disease. There is no large acute vascular territorial\ninfarct or intracranial hemorrhage.\n\nThere is no acute fracture. There are multiple bilateral mucous retention\ncysts in the maxillary sinuses, a tiny mucous retention cyst in the left\nsphenoid sinus and mild mucosal thickening in the bilateral ethmoid air cells.\nOtherwise, the visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nnormal aside from bilateral lens replacement.", + "output": "1. No acute intracranial process.\n2. The ventricles are unchanged in size and configuration. Ventriculostomy\nagain noted.\n3. Redemonstration of chronic right frontoparietal encephalomalacia.\n4. Stable encephalomalacia along the tract of the right frontal catheter." + }, + { + "input": "A right frontal approach ventriculostomy catheter terminates in the body of\nthe left lateral ventricle, similar to prior. Right frontoparietal\nencephalomalacia and encephalomalacia along the ventriculostomy catheter tract\nare unchanged. There is no evidence of acute large territorial\ninfarction,hemorrhage,edema,or mass. There is prominence of the ventricles\nand sulci similar to prior. There are periventricular and subcortical\nhypodensities, which may represent small vessel ischemic changes.\n\nThere is no acute fracture. Bilateral maxillary mucous retention cysts are\nredemonstrated, and there is mild mucosal thickening of the bilateral\nmaxillary sinuses. The visualized portion of the remaining paranasal sinuses,\nmastoid air cells, and middle ear cavitiesare essentially clear. There are\nbilateral lens replacements.", + "output": "1. No acute intracranial abnormality.\n2. Unchanged position of right frontal approach ventriculostomy catheter,\nterminating in the left lateral ventricle." + }, + { + "input": "There has been interval placement of a right frontal approach ventriculostomy\ncatheter which terminates in the right lateral ventricle and abuts the septum\npellucidum.\n\nThere is new apparent 5 mm rightward midline shift as compared to the earlier\nsame-day CT head on ___, likely in part artifactual secondary to patient\npositioning.\n\nOtherwise, there is little interval change in the appearance of the known\nintraventricular and subdural hemorrhages as compared to the earlier same-day\nCT head exam. The intraventricular hemorrhages are again seen in the lateral\nventricles, left greater than right, with extension into the third ventricle\nand fourth ventricle. Subdural hemorrhages seen layering along the falx and\ntentorium, unchanged. No evidence of new intracranial bleed.\n\nThere is no evidence of fracture. Mild mucosal thickening is noted in the\nmaxillary sinuses with a mucous retention cyst in the right maxillary sinus. \nOtherwise, the visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Interval placement of a right frontal approach ventriculostomy catheter\nwhich terminates in the right lateral ventricle abutting the septum\npellucidum.\n2. New apparent 5 mm rightward midline shift compared to the earlier same-day\nCT head exam, likely in part artifactual secondary to patient positioning. \nClose attention on followup is recommended.\n3. Stable appearance of the known intraventricular and subdural hemorrhages. \nNo evidence of new intracranial bleed.\n\nNOTIFICATION: The findings were discussed with ___, N.P. by\n___, M.D. on the telephone on ___ at 5:30 am, 1 minutes after\ndiscovery of the findings." + }, + { + "input": "NONCONTRAST HEAD CT:\nIntraventricular hemorrhage filling the ventricular system is grossly\nunchanged in comparison with ___ at 04:10. There has been interval\nslight decrease in the size of the right lateral ventricle. A right frontal\napproach intraventricular catheter terminates near the foramen of ___. Left\nparafalcine subdural hematoma is similar in size and extent compared to prior.\nA hyperdense extra-axial fluid collection overlying the right frontal\nconvexity near the vertex has increased in size, and may reflect postoperative\nsubdural hematoma (02:24) there is about 5 mm of rightward shift of midline\nstructures, which is unchanged.\n\nThere is a right maxillary sinus mucous retention cyst and partial\nopacification of the left maxillary sinus. The imaged orbits are unremarkable\nwith the exception of lens replacements. Soft tissue density is noted within\nthe right external auditory canal which may represent cerumen.\n\nCTA HEAD:\nAtherosclerotic calcification in the cavernous internal carotid arteries is\nmoderate, without definite luminal narrowing. The vessels of the circle of\n___ and their major branches are patent without evidence of stenosis,\nocclusion or aneurysm.", + "output": "1. Extensive intraventricular hemorrhage and left parafalcine subdural\nhematoma with unchanged 5 mm of rightward midline shift.\n2. Right frontal subdural hematoma is slightly increased in comparison with ___ 4:10.\n3. Status post intraventricular catheter placement with interval slight\ndecrease in the size of the right lateral ventricle.\n4. Patent circle of ___, without definite evidence of aneurysm greater than\n3 mm, stenosis, or occlusion." + }, + { + "input": "Again seen is hyperdense material in the ventricles, along the falx, and the\ntentorium, consistent with history of hemorrhage. Compared to prior exam, the\namount of blood products layering in the lateral ventricles, third ventricle\nand along the falx are stable. The fourth ventricle remains dilated, though\nno longer contains a large amount of hyperdense blood products. Persistent\nnarrowing of the bilateral ambient cisterns are still present. Patient is\nstatus post right frontal ventriculostomy catheter with tip in the third\nventricle, unchanged in positioning. Previously noted hyperdense subdural\nhematoma overlying the right frontal convexity near the vertex has decreased\nin size. There is no evidence of acute infarction. Shift of midline\nstructures to the right is stable.\n Mucosal retention cyst is seen in the right maxillary sinus. Mucosal\nthickening in the left maxillary sinus is mild. Patient is edentulous. The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. Soft tissue density in the right external auditory canal\nis nonspecific, though likely cerumen. Patient is status post bilateral lens\nreplacements. Dense carotid siphon calcifications are noted.", + "output": "1. Overall similar amount of extensive intraventricular hemorrhage and left\nparafalcine subdural hematoma, though interval decrease in amount in the\nfourth ventricle. Rightward midline shift is stable." + }, + { + "input": "Again seen is a focus of intraparenchymal hemorrhage within the right basal\nganglia, which measures 1.9 x 1.2 cm, previously 1.9 x 1.1 cm. There is a\nsmall amount of surrounding edema. No new foci of hemorrhage are identified. \nThe ventricles and sulci are unchanged in size and configuration. There is no\nevidence of shift of the normally midline structures. The basal cisterns\nappear patent.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No significant interval change in size of the intraparenchymal hemorrhage\ncentered in the right basal ganglia, with small amount of surrounding edema. \nNo evidence of midline shift. No new foci of hemorrhage identified." + }, + { + "input": "Is a grossly stable approximately 2 x 1.1 cm (03:17) right basal ganglia\nparenchymal hemorrhage with adjacent edema. No new hemorrhages are\nidentified. There is no evidence of large territorial infarction. The\nventricles and sulci are normal in size and configuration. There is no\nmidline shift.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. Stable approximately 2 x 1.1 cm right basal ganglia intraparenchymal\nhemorrhage with adjacent edema.\n2. No new hemorrhage is identified.\n3. No midline shift." + }, + { + "input": "Evaluation of the oral cavity is limited secondary to metallic artifact from\ndental amalgam. Within these confines, the aerodigestive tract demonstrates\nno mass, and no areas of focal mass effect. There is no abnormal fluid\ncollection to suggest abscess.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. No sialolithiasis. The thyroid gland appears normal. There is no\nlymphadenopathy by CT criteria. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.\n\nMild mucosal thickening of bilateral maxillary sinuses, left sphenoid sinus\nare noted. Additional visualized paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear.", + "output": "1. Evaluation of the oral cavity, specifically the tongue is limited secondary\nto metallic artifact from dental amalgam. Within these confines, the\nvisualized aerodigestive tract demonstrates no mass or mass effect. No\nabnormal fluid collection to suggest abscess." + }, + { + "input": "There is no acute intracranial hemorrhage, edema, mass effect, or evidence of\nlarge vascular territorial infarction. The ventricles and sulci are\nprominent, suggesting age related involutional changes. Periventricular white\nmatter hypodensities are compatible with chronic small vessel ischemic\ndisease. There is preservation of grey-white matter differentiation and the\nbasal cisterns are patent.\n\nThere is no fracture. The imaged paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. Stable chronic defect in the right lamina\npapyracea with a small amount of fat herniation. Dural ossification along the\nleft greater sphenoid wing appears unchanged.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "There is unchanged appearance of a left parietal subdural hematoma measuring 9\nmm in greatest dimension from the inner table causing slight effacement of the\nunderlying sulci but no shift of normally midline structures. The basal\ncisterns remain patent. There is no evidence of infarction, edema, or mass.\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Periventricular and subcortical white matter hypodensities are\nnonspecific, but likely reflect sequelae of chronic small vessel ischemic\ndisease.\nThere is no evidence of fracture. There is mucosal thickening in the right\nsphenoid sinus. The remaining visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "Unchanged left parietal subdural hematoma with minimal effacement of the\nunderlying sulci but no shift of normally midline structures." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Prominent\nventricles and sulci are compatible with age-related volume loss.\nPeriventricular white matter hypodensities are consistent with chronic small\nvessel ischemic disease. There has been interval resolution of the previously\nseen left parietal subdural hematoma. Atherosclerotic vascular calcifications\nare noted of bilateral vertebral and cavernous portions of internal carotid\narteries.\n\n\nThere is no evidence of fracture. The visualized portion of the mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable. Debris is noted in the bilateral external auditory\ncanals with no associated erosions, likely secondary to cerumen. There is a\npartially calcified 1.3 cm right occipital scalp lesion, likely representing a\nsebaceous cyst or epidermoid. There is partial opacification of the lateral\nrecess of the right sphenoid sinus. Mucosal thickening of the ethmoid sinus\nis seen.", + "output": "1. No acute intracranial hemorrhage. Interval resolution of the previously\nseen left parietal subdural hematoma.\n2. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described.\n3. Mild paranasal sinus disease." + }, + { + "input": "The area of infarction in the left occipital lobe appears stable since ___. There is no new area of hemorrhage or infarction.\n Subcortical and periventricular white matter hypodensities are consistent\nwith chronic small vessel ischemic disease.\nThe basal cisterns appear patent.\n\nNo acute fracture is identified. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear.\nAtherosclerotic mural calcification of internal carotid arteries is noted.\nThe globes are unremarkable.", + "output": "The area of infarction in the left occipital lobe appears stable since ___." + }, + { + "input": "Grossly stable large right parietal intraparenchymal hemorrhage with adjacent\nedema is again noted.\nGrossly stable intraventricular hemorrhage with hyperdense blood products\nwithin bilateral lateral ventricle occipital horns is noted. Grossly stable\nmass effect and effacement of the frontal horn of the right lateral ventricle,\nthird ventricle, and right lateral ventricle are seen. The fourth ventricle\nis grossly patent. Grossly stable approximately 7 mm right to left midline\nshift is again seen. Grossly stable partial effacement of perimesencephalic\nand quadrigeminal plate cisterns are again seen. Grossly stable diffuse\nsubarachnoid hemorrhage is again noted.\n\nThere is no definite evidence of acute large territorial infarction or\nintracranial mass.\nOrogastric and endotracheal tubes are again partially visualized.", + "output": "1. Grossly stable intraparenchymal, subarachnoid, and intraventricular\nhemorrhages, as described.\n2. Within limits of study, no definite new acute intracranial hemorrhage.\n3. Grossly stable mass effect on left and right lateral and third ventricles.\n4. Grossly stable partial effacement of perimesencephalic and quadrigeminal\nplate cisterns, with approximately 7 mm right to left midline shift." + }, + { + "input": "Again demonstrated is an intra-parenchymal hemorrhage involving the right\nparietal and posterior aspect of the right frontal lobe, associated with\nextensive surrounding edema, overall not significantly increased when compared\nto the recent study from ___. There continues to the be mass\neffect with near complete effacement of the right hemispheric sulci, the\nmajority of the right lateral ventricle, and a right-to-left shift of normally\nmidline structures (8-10 mm) causing moderate effacement of the left\nventricle, not significantly increased from the previous study. Again seen is\nintraventricular extension of hemorrhage with layering blood seen in the\ndependent posterior horns. Also noted are stable foci of subarachnoid\nhemorrhage along the left hemispheric sulci. Mild partial effacement of the\nperimesencephalic and quadrigeminal cisterns is again noted.\n\nThere is no evidence of new hemorrhage or of infarction.\n\nThere is no acute fracture. Very mild mucosal thickening of the sphenoid\nsinuses and partial opacification of the sphenoid sinus are noted. Scratch", + "output": "1. Stable right parietal intraparenchymal hemorrhage with intraventricular\nextension and subarachnoid hemorrhages.\n2. Largely unchanged mass effect with right hemispheric sulci bilateral\nventricular effacement with mild leftward shift of normally midline\nstructures.\n3. No evidence of new hemorrhage." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nAgain seen is a large intraparenchymal hematoma centered in the right parietal\nand frontal lobes, overall spanning approximately 7.4 x 6.2 cm, not\nsignificantly changed. There is intraventricular extension of hemorrhage, with\nblood seen in the frontal horn of the right lateral ventricle, and layering in\nthe occipital horns of the bilateral ventricles. There is small amount of\nbilateral subarachnoid hemorrhage. There is surrounding edema in the right\nfrontal and parietal lobes, with effacement of the adjacent sulci and right\nlateral ventricle, as well as leftward midline shift measuring up to\napproximately 3- 4 mm, not significantly changed.\n\nThere is mild mucosal thickening in the bilateral maxillary sinuses and\nethmoid air cells. The visualized portion of the remainder of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.\n\nCTA HEAD AND NECK:\n\nThe vertebral arteries are patent without evidence of stenosis or occlusion. \nThe right common carotid artery is patulous, suggestive of prior\nendarterectomy. There is occlusion of the left internal carotid artery\ndistal to the bifurcation. There is reconstitution of flow in the cavernous\nsegment of the left internal common carotid artery, fed through the ophthalmic\nartery. The branches of the circle ___ including the left MCA are patent\nwithout significant stenosis. There is no arteriovenous malformation or\naneurysm visualized. The dural venous sinuses are patent.\n\nOTHER:\nThere is centrilobular emphysema at the lung apices. There is a 3 mm right\nupper lobe pulmonary nodule (03:26). Median sternotomy wires are partially\nvisualized. An endotracheal to terminates above the carina. Enteric tube is\npresent esophagus, the distal tip of which is not visualized. The visualized\nportion of the thyroid gland is within normal limits. There is no\nlymphadenopathy by CT size criteria.", + "output": "1. Large intraparenchymal hematoma centered in the right parietal and frontal\nlobes with intraventricular extension and bilateral subarachnoid hemorrhage,\nas well as surrounding edema and mass effect, are not significantly changed\ncompared with outside CT in LifeImage performed earlier on same day.\n2. No underlying arteriovenous malformation or aneurysm visualized.\n3. Complete occlusion of the left internal carotid artery distal to the\ncarotid bifurcation, with reconstitution of flow in the cavernous segment of\nthe left internal carotid artery, and patent branches of the left internal\ncarotid artery including the left MCA.\n4. Emphysema.\n5. 3 mm right upper lobe pulmonary nodule for which no CT follow-up is\nrequired per ___ guidelines below.\n\nRECOMMENDATION(S): For incidentally detected nodules smaller than 6mm in the\nsetting of an incomplete chest CT, no CT follow-up is recommended.\n\nSee the ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" + }, + { + "input": "Re-demonstrated is intraparenchymal hemorrhage in the right frontoparietal\nregion measuring 7.1 x 6.0 cm (02:20), grossly unchanged as compared to CTA\nhead and neck ___. There is intraventricular extension of contrast\nwith hemorrhage noted in the body of the right lateral ventricle and occipital\nhorns of the bilateral ventricles, unchanged. There is diffuse bilateral\nsubarachnoid hemorrhage,, grossly unchanged. There is mass effect with\napproximately 4 mm of leftward midline shift (02:19). Appearance of the\nventricles are unchanged. Basal cisterns are patent.\n\nParanasal sinuses are patent. Mastoid air cells middle cavities are patent. \nThere is no fracture.", + "output": "1. Right frontoparietal intraparenchymal hemorrhage with intraventricular\nextension and diffuse subarachnoid hemorrhage is grossly unchanged as compared\nto CTA head and neck ___. No new or worsening intraparenchymal\nhemorrhage.\n2. Mass effect with rightward midline shift of 4 mm is unchanged." + }, + { + "input": "Large right parietal parenchymal hematoma with extensive surrounding edema is\nagain seen, without evidence for expansion of hemorrhage. There is extension\nof blood into the body of the right lateral ventricle and occipital horn of\nthe contralateral left lateral ventricle, unchanged in extent. There is\ncomplete effacement of the posterior components of the right lateral\nventricle, severe effacement of the right frontal horn, severe effacement of\nthe third ventricle, and moderate effacement of the left lateral ventricle,\nunchanged. Leftward shift of midline structures at the level of the septum\npellucidum measures 8 mm compared to 7 mm when measured at the same level on\n___, which may be secondary to slightly increased right-sided\nedema. Partial effacement of the perimesencephalic and quadrigeminal plate\ncisterns is unchanged.\n\nSubarachnoid hemorrhage within the bilateral hemispheric sulci is unchanged.\n\nEndotracheal and orogastric tubes are again partially visualized. Visualized\nparanasal sinuses and mastoid air cells are grossly unremarkable allowing for\nabsence of dedicated bone algorithm images.", + "output": "1. Large right parietal parenchymal hematoma demonstrates no evidence for\nexpansion.\n2. Stable intraventricular hemorrhage. Stable complete effacement of the\nposterior right lateral ventricle, severe effacement of the right frontal horn\nand third ventricle, and moderate effacement of the left lateral ventricle.\n3. Leftward shift of midline structures measures 8 mm compared to 7 mm at the\nsame level ___, which may indicate a subtle increase in edema,\nversus slice selection given the 5 mm slice thickness.\n4. Stable partial effacement of the perimesencephalic and quadrigeminal plate\ncisterns.\n5. No significant change in bilateral subarachnoid hemorrhage." + }, + { + "input": "Evaluation is somewhat limited by streak artifact generated by an external\ntube surrounding the patient's head. There is no evidence of hemorrhage,\nedema, mass effect, shift of normally midline structures or infarction. \nProminence of ventricles and sulci is consistent with age related involutional\nchanges. The basal cisterns appear patent and there is preservation of\ngray-white matter differentiation.\n\nThere is no fracture. There is mild-to-moderate opacification the bilateral\nmastoid air cells, right worse than left. There is mild mucosal thickening of\nthe ethmoidal air cells and left maxillary sinus. Globes are unremarkable. \nAerosolized secretions within the nasopharynx likely secondary to endotracheal\nintubation. Scalp hematoma over the left vertex has improved.", + "output": "No acute intracranial abnormality." + }, + { + "input": "NECT Head: There is no evidence of acute intracranial hemorrhage, mass\neffect, edema, or large territorial infarction. The ventricles and sulci are\nnormal in size and configuration. The visualized cranial bones are\nunremarkable in appearance.\n\nCTA H+N: There is a hypodense focus in M1 segment of the right MCA , probably\nfenestration in part due to vessel likely widening at the segment. However, we\ncannot guarantee the lesion to be not a thrombus.\n\nThere is a combination of calcified plaque and hypodense noncalcified plaque\nin the right ICA. The hypodense plaque contains fat and therefore has a lipid\nrich necrotic that is prone to rupture. There is no stenosis of the right ICA\nby NASCET criteria.\n\nThere are calcified plaques in the left ICA narrowing the carotid bulb, which\nmeasures 50% stenosis at the left ICA bifurcation. This stenosis is more\nlikely an artifact. The left ICA also does not meet stenosis by NASCET\ncriteria.\n\nThe visualized portions of the bilateral lung apices are grossly clear. The\nthyroid gland is unremarkable in appearance. There is no lymphadenopathy by CT\nsize criteria.", + "output": "1. No evidence of hemorrhage. 2. Hypodense focus in M1 segment of the right\nMCA, likely fenestration rather than from thrombus. 3. No ICA stenosis by\nNASCET criteria." + }, + { + "input": "There is no evidence of fracture, hemorrhage, edema, mass effect, or\ninfarction. Prominence of the ventricles and sulci is consistent with\nage-appropriate involutional changes. There are atherosclerotic\ncalcifications of the intracranial vertebral arteries and internal carotid\narteries. There is a scalp hematoma over the left vertex. The imaged\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. \nClinical\n\nThere have been no significant changes since the head CT of ___ at\n23:57", + "output": "Left frontal scalp hematoma. No evidence of hemorrhage or fracture" + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. . There is\nmild prominence of the ventricles and sulci well within the range of normal\nfor age.\n\nThere is no evidence of fracture. There is extensive complete opacification\nof the left maxillary sinus. The nasal septum is deviated to the right the\nremaining visualized portion of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Normal head CT\n2. Paranasal sinus inflammatory changes." + }, + { + "input": "There is no evidence of hemorrhage, edema or infarction. Ventricles and sulci\nare within normal limits. Basal cisterns are patent. Gray-white matter\ndifferentiation is preserved.\n\nNo fracture is identified. There is mild mucosal thickening within the left\nsphenoid sinus. Otherwise, remainder of the visualized paranasal sinuses are\nclear. Mastoid air cells and middle ear canals are clear. Bilateral orbits are\nunremarkable.", + "output": "Minimal paranasal sinus inflammatory changes. Otherwise normal study." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass defect. The\nventricles and sulci are enlarged for the patient's age suggesting atrophy. \nAgain seen, is asymmetric enlargement of right greater than left lateral\nventricles with dilation of the right temporal horn, similar to ___. The\nbasal cisterns are patent and there is preservation of gray-white matter\ndifferentiation.\n\nNo osseous abnormalities seen. There is mucosal thickening within the ethmoid\nair cells. The remainder of the paranasal sinuses are clear. Aerosolized\nsecretions are present within the nasopharynx, likely secondary to intubation.", + "output": "No acute intracranial process. Chronic changes of cerebral atrophy and\nasymmetric dilation of the right greater than left lateral ventricles." + }, + { + "input": "Head CT: There are multiple areas with low attenuation in the basal ganglia\nand subcortical white matter bilaterally (images 13, 15, 18, 20 series 2),\nwhich are nonspecific and may represent a combination of small vessel disease\nand lacunar ischemic changes. There is no evidence of hemorrhage, edema, mass\nor mass effect. There is prominence of the ventricles and sulci consistent\nwith age-related changes. No fracture is identified. Mild mucosal thickening\nis identified in the ethmoidal air cells anteriorly.\n\nHead and neck CTA: The carotid and vertebral arteries and their major branches\nare patent with no evidence of stenosis. There is no evidence of aneurysms or\nocclusions in the circle of ___. There is patency of the major vascular\nstructures with dominance of the left anterior cerebral artery and patency of\nthe left posterior communicating artery.\n\nNote is made of mild degenerative changes throughout the cervical spine collar\nconsistent with posterior spondylosis, more significant at C5-C6 level, the\nairway appears patent, mild bilateral pleural scarring is identified at the\nlung apices.", + "output": "1. There are multiple areas of low density in the subcortical white matter and\nbasal ganglia, which are nonspecific and may represent a combination of small\nvessel disease and lacunar ischemic changes, if concern for acute or subacute\nischemic event, correlation with MRI is recommended.\n\n2. Patency of major vascular structures, no occlusions or aneurysms are seen." + }, + { + "input": "There is mild streak artifact from multiple scalp electrodes. Bilateral\nglobus pallidus hypodensities are again demonstrated, with interval resolution\npreviously seen mild associated expansion. There is no acute hemorrhage, new\nedema, or acute major vascular territorial infarction. Ventricles, sulci, and\nbasal cisterns are normal in size.\n\nThe bones are unremarkable. Near complete opacification of the mastoid air\ncells and ethmoid air cells has progressed compared to ___ and may be\nsecondary to prolonged supine positioning in the inpatient setting. Mucosal\nthickening and mucous retention cysts are again noted in the maxillary and\nsphenoid sinuses.", + "output": "1. Previously seen bilateral globus pallidus hypodensities, suggesting carbon\nmonoxide poisoning or other toxic metabolic injury, demonstrate interim\nresolution of the previously seen mild associated expansion.\n2. No acute hemorrhage and no evidence for other acute abnormalities." + }, + { + "input": "There is hypodensity the globus pallidus bilaterally. This is a pattern most\ntypical of carbon monoxide poisoning but may be due to other hypoxic injury. \nThere is no evidence of hemorrhage,edema,or mass. The ventricles and sulci\nare small, worrisome for diffuse swelling.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nbilateral maxillary, sphenoid and frontal sinuses, and moderate mucosal\nthickening of the bilateral ethmoid air cells. Aerosolized secretions in the\nposterior nasopharynx likely related to intubation. The mastoid air cells and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Hypodensity of the globus pallidus bilaterally along with a suggestion of\ndiffuse swelling raises concern for carbon monoxide poisoning or other hypoxic\ninjury.\n2. No evidence of hemorrhage\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 2:10 am, 1 minutes after\ndiscovery of the findings." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Basilar cisterns are\npatent.\n\nIncluded paranasal sinuses and mastoids are notable for mucosal thickening in\nthe maxillary sinuses. Skull and extracranial soft tissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Again demonstrated is a 8 mm parafalcine subdural hematoma, similar to prior\nexam performed 6 hours prior (2:8). No new areas of intracranial hemorrhage. \nNo evidence of infarction, edema, or midline shift. There is mild prominence\nof the ventricles and sulci suggestive of involutional changes.\n\nModerate calcification of the bilateral internal carotid siphons. Large left\nfrontal subgaleal hematoma is again seen. There is no evidence of fracture. \nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are notable for\nbilateral lens replacements.", + "output": "1. Essentially unchanged 8 mm parafalcine subdural hematoma. No new areas of\nintracranial hemorrhage or infarction.\n2. Large left frontal subgaleal hematoma." + }, + { + "input": "Previously seen cysts subdural hematoma along the falx has resolved. No acute\nhemorrhage is seen. There is no mass effect midline shift or hydrocephalus. \nThe gray-white matter differentiation is maintained. Visualized paranasal\nsinuses are clear. The previously seen soft tissue swelling in the left\nfrontal region has resolved.", + "output": "1. Resolution of previously seen subdural hematoma along the falx.\n2. Resolution of left frontal soft tissue swelling.\n3. No acute intracranial abnormalities." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nBilateral opacification of the mastoid air cells, right greater than left,\nwhich may be chronic. There is a slight amount of opacification of the right\nmiddle ear canal. The visualized portion of the paranasal sinuses and left\nmiddle ear cavities are clear. The visualized portion of the orbits are\nnormal.", + "output": "1. No acute intracranial process.\n2. Bilateral opacification of the mastoid air cells, right greater than left,\nwhich may be chronic.\n3. There is a slight amount of opacification of the right middle ear canal,\npossibly also chronic." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nProminent bifrontal extra-axial spaces with vessels coursing through them are\nconsistent with bilateral frontal lobe predominant atrophy. There is no\nsignificant temporal lobe atrophy the ventricles and sulci are otherwise\ngrossly normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent. Hypoplastic left P1 segment with patent left PCOM.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. There are degenerative changes in the cervical spine, with probably\nmoderate central canal narrowing at C4-C5, C5-C6 levels.", + "output": "1. No evidence for acute intracranial process.\n2. Patent vasculature of the head and neck, without evidence for stenosis or\naneurysm.\n3. Bilateral frontal lobe atrophy.\n4. Degenerative changes cervical spine." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema,or mass effect. There\nis again prominence of the bilateral frontal extra-axial spaces concerning for\nbilateral frontal lobe predominant atrophy. Otherwise, the ventricles and\nsulci are are grossly normal in size configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial process such as large vascular territory infarction\nor hemorrhage.\n2. Re-demonstration of bifrontal prominent extra-axial spaces consistent with\natrophy." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is mild prominence of the extra-axial spaces overlying the bilateral\nfrontal lobes.\n\nThe ventricular configuration appears normal.\n\nThere is no large infarct, intracranial hemorrhage, or mass effect. There is\nno extra-axial fluid collection.\n\nThe orbits appear normal. There is no depressed calvarial fracture.\n\nCTA HEAD:\nInternal carotid arteries, anterior cerebral arteries, and middle cerebral\narteries appear normal.\n\nThe vertebral arteries and basilar artery appear normal. The posterior\ncerebral arteries appear normal. A right posterior communicating artery is\nnot seen.\n\nNo aneurysm, stenosis, or vascular malformation is identified.", + "output": "Unremarkable CTA of the head. No findings to suggest vasospasm. No discrete\naneurysm is identified." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. Scattered subcortical white\nmatter hypodensities are seen involving both frontal lobes, which are\nnonspecific, but can be seen with chronic microvascular angiopathy. Minimal\natherosclerotic calcifications are seen in the involving the left cavernous\ncarotid artery.\n\nNo osseous abnormalities seen. There is mild mucosal thickening of the right\nsphenoid sinus. Remaining paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The orbits are unremarkable.", + "output": "No fracture or intracranial hemorrhage. Minimal right sphenoid sinus disease." + }, + { + "input": "There is a left parietal scalp hematoma. There is no other evidence of\nhemorrhage. There is no evidence of edema, shift of normally midline\nstructures, or infarction. Ventricles and sulci are normal in size and\nconfiguration.\n\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "Left parietal scalp hematoma. Otherwise normal study." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass effect. \nThere is prominence of the ventricles and sulci suggestive of volume loss. A\nfew subcortical white-matter hypodensities are nonspecific, but likely\nrepresent sequela of chronic small vessel disease.\n\nThere is no evidence of acute fracture. There is mild mucosal thickening in\nthe ethmoid air cells and bilateral maxillary and sphenoid sinuses. There is\npartial opacification of the bilateral mastoid air cells and middle ear\ncavities. The visualized portion of the orbits are unremarkable. An old\nright orbital floor fracture is again seen (3:3). A subgaleal hematoma is\nseen over the occipital bone on the left (3:28). Minimal calcification of the\nleft carotid siphon is again seen.", + "output": "1. No acute intracranial abnormality.\n2. Subgaleal hematoma over the occipital bone on the left without underlying\nfracture." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mild mucosal thickening in the\nleft maxillary sinus and ethmoid air cell. The visualized portion of the\nremainder of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No fracture or acute intracranial process.\n2. Mucosal thickening in the left maxillary sinus and ethmoid air cells." + }, + { + "input": "There is no evidence of large territory infarction,hemorrhage,edema, or mass. \nEncephalomalacia seen along the inferior right temporal lobe (02:10) the\nventricles and sulci are age-appropriate.\n\nThere is no evidence of fracture. Mild mucosal thickening of the bilateral\nethmoid air cells, left maxillary and left sphenoid sinuses are nonspecific. \nThe visualized portion of the other paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. Patient is status post left lens replacement. \nRight lens is not visualized. High density rounded foreign body, presumably\nalong the anterior aspect of the globe is presumably postsurgical.", + "output": "1. No acute intracranial process.\n2. Right temporal lobe encephalomalacia.\n3. High-density presumably postsurgical foreign body along the anterior aspect\nof the right globe, to be correlated clinically." + }, + { + "input": "There is no evidence of acute large territorial infarction,intracranial\nhemorrhage, edema, or mass effect. There is prominence of the ventricles and\nsulci suggestive of involutional changes. Gray-white matter differentiation\nis preserved.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process. Please note that MRI with contrast is more\nsensitive for detection of small masses." + }, + { + "input": "Examination is mildly degraded by motion.\n\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of large infarction, hemorrhage, edema, or mass. \nGray-white matter differentiation is preserved. The ventricles and sulci are\nnormal in size and configuration for age.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe basilar artery is hypoplastic, likely congenital. There is normal variant\nfetal type origin of the bilateral posterior cerebral arteries. There is\ncomplete occlusion of the proximal M1 segment of the left MCA with lack of\ndistal arborization of the branch vasculature. There is occlusion at the\norigin of the A1 segment of the left ACA with small area of reconstitution of\nthe remainder of the A1 segment and proximal A2 segment, likely secondary to\nthe anterior communicating artery, with complete occlusion of the proximal A2\nsegment of the left anterior cerebral artery. The remainder of the vessels of\nthe circle of ___ and their principal intracranial branches appear grossly\npatent without significant stenosis, additional areas of occlusion, or\naneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear grossly\npatent with no evidence of dissection, significant stenosis or occlusion.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThere is a large left and moderate right-sided pleural effusion, increased in\nsize compared the prior examination. There are wedge-shaped areas of\nsubpleural density in the bilateral upper lobes, partially visualized. \nSubsegmental pulmonary emboli are noted in the bilateral upper lobes. There\nis prominent fluid distention of the visualized portion of the esophagus. The\nvisualized portion of the thyroid gland is within normal limits. There is no\nlymphadenopathy by CT size criteria.", + "output": "1. No intracranial hemorrhage.\n2. Complete occlusion of the M1 segment of the left MCA and A1/ A2 segment of\nthe left ACA. No CT evidence of acute infarct may be due to acuity of\nvascular occlusion.\n3. Large left and moderate right-sided pleural effusions have increased in\nvolume compared to ___.\n4. Subsegmental bilateral upper lobe pulmonary emboli, as seen on the prior\nchest CT. Areas of wedge-shaped peripheral densities in the bilateral upper\nlobes may represent evolving pulmonary infarct.\n5. Prominently fluid distended esophagus is suggestive of esophageal motility\ndysfunction.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 12:55 AM, 5 minutes after\ndiscovery of the findings. By the time of communication, neurology was aware\nof the findings regarding ACA and MCA occlusion." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Mild thickening of the ethmoid sinuses. \nOtherwise, the visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No evidence of masses, hemorrhage or infarction.\n2. Mild paranasal sinus inflammatory changes." + }, + { + "input": "There are scattered foci high-density throughout the bilateral frontal lobes,\nright temporoparietal region and along the superior, anterior aspect of the\npons concerning for multiple foci of subarachnoid hemorrhage. There is no\nevidence of acute infarction. There is no mass effect. Prominence of\nventricles and sulci is seen, consistent with cortical volume loss. There is\nperiventricular and subcortical white matter hypodensities bilaterally most\nconsistent with sequela of chronic small vessel disease. There is no midline\nshift. 1.0 x 0.9 cm fat containing focus just anterior to the very superior\ncerebellum, just to the right of midline on series 2, image 11, is a fat\ncontaining structure, possibly a small dermoid/epidermoid.\n\nA fracture of the left orbital floor will be discussed on CT facial bones. \nThe visualized portion of the left maxillary sinus shows high-density material\nconsistent with blood. The mastoid air cells and middle ear cavities are\nclear. The globes are intact.", + "output": "Scattered foci of acute subarachnoid hemorrhage, as above. No midline shift or\nhydrocephalus. Facial bone fractures including left inferior orbital wall\nfracture detailed on dedicated facial bone CT.\n\n1.0 x 0.9 cm fat containing focus just anterior to the very superior\ncerebellum, just to the right of midline on series 2, image 11, is a fat\ncontaining structure, possibly a small dermoid/epidermoid." + }, + { + "input": "There is a fracture of the left orbital floor with herniation of both\nintraorbital fat and the inferior rectus muscle within the fracture defect. \nBlood and foci of air are seen within the left maxillary sinus. The right\nmaxillary sinus is clear. The ethmoid air cells are clear. The mastoid air\ncells and sphenoid sinus is clear. The globes are intact. There is subtle\nstranding of the retrobulbar fat on the left (03:48 including intraconal,\nsuggesting retrobulbar hematoma. There is marked left-sided facial soft\ntissue swelling with an approximately 1.7 x 3.6 cm subcutaneous hematoma\nwithin the left infraorbital soft tissues.\nThe mandible appears intact.", + "output": "1. Left orbital floor blow-out fracture with intra-ocular fat and the inferior\nrectus muscle herniating through the defect.\n2. Small left retrobulbar hematoma and stranding.\n3. Marked left-sided facial swelling with an approximately 3.6 cm subcutaneous\nhematoma within the left infraorbital soft tissues." + }, + { + "input": "Again seen is scattered areas of subarachnoid hemorrhage overlying bilateral\ncerebral hemispheres, interpeduncular cistern, similar to prior. There is no\nnew hemorrhage. There is no midline shift. There is no hydrocephalus pre\n\nThere is no evidence of acute major vascular territorial infarction or edema. \nThere is a fat containing lesion in the quadrigeminal plate cistern that\nmeasures 1.0 x 0.7 cm, consistent with a lipoma (3:16). Prominent ventricles\nand sulci are consistent with age-related involutional change. Mild bilateral\nperiventricular and subcortical white matter hypodensities are nonspecific,\nbut likely reflect a sequela of chronic small vessel disease. There is more\nprominent zone of low-attenuation left thalamus, may be secondary to\ntechnique, involving acute left thalamic infarct cannot be excluded,\nclinically correlate for acute symptoms, and if indicated, MRI exam is\nrecommended.\n\nPatient's known left orbital floor blow-out fracture is not captured on the\ncurrent study. Similarly, the retrobulbar fat stranding is better assessed on\nthe prior dedicated maxillofacial CT performed earlier on the same date. \nThere is extensive left periorbital and left facial soft tissue swelling. \nDegenerative changes bilateral temporomandibular joints.", + "output": "1. No new hemorrhage.\n2. No significant interval change in subarachnoid hemorrhage.\n3. There is area of low attenuation in left thalamus, more apparent since\nprior, may be technique related, if there are clinical symptoms for acute\nischemia, MRI exam is recommended.\n4. 1.0 x 0.7 cm quadrigeminal plate cistern lipoma.\n\nRECOMMENDATION(S): Brain MRI.\n\nNOTIFICATION: The findings and recommendation were discussed with ___\n___ by ___, M.D. on the telephone on ___ at 7:25 ___, 5\nminutes after discovery of the findings." + }, + { + "input": "There is a left cerebellar intraparenchymal hemorrhage spanning approximately\n5.0 x 2.4 cm (series 2, image 7). There is approximately 5 mm of sub\ntentorial rightward shift. There is crowding of the left aspect of the\nforamen magnum (series 601, image 68) without frank herniation. There is mass\neffect with compression of the left basal cisterns and fourth ventricle\n(series 2, image 9). High-density blood products appear to track along the\nleft sided transverse sinus and sagittal sinus.\n\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Additional periventricular and subcortical white matter\nhypodensities are demonstrated diffusely, suggestive of moderate to severe\nchronic microangiopathy. No large territorial infarction. No supratentorial\nmass effect is demonstrated.\n\nA round dural callus near the torcula (series 2, image 12) is unchanged. A\nquadrigeminal plate lipoma is posteriorly is also unchanged.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, right mastoid air cells, and middle ear cavities are clear. Left\nmastoid tip is partially opacified. Both lenses have been replaced, otherwise\nthe visualized portion of the orbits are unremarkable. Degenerative changes\nnoted at the right temporomandibular joint.", + "output": "1. Left cerebellar intraparenchymal hemorrhage measuring approximately 5.0 x\n2.4 cm, with mass effect which includes crowding of the left foramina magnum\nwithout discrete for herniation. Additional mass effect includes 5 mm of\nsubdural rightward shift, as well as compression of the left basal cisterns\nand fourth ventricle.\n2. No large territorial infarction. No acute or depressed skull fractures." + }, + { + "input": "Again seen is a left cerebellar intraparenchymal hematoma measuring 4.4 x 3.3\ncm, slightly larger compared with the prior study from ___, at that\ntime measuring 4.4 x 2.6 cm when measured in a similar fashion. Surrounding\nhypodensity is consistent with vasogenic edema, similar. Posterior fossa mass\neffect is also similar including rightward shift of midline, effacement of the\nfourth ventricle. No herniation.\n\nThere is no evidence of additional hemorrhage elsewhere. No evidence of acute\nlarge vascular territory infarct, or supratentorial mass effect. No\nextra-axial collection.\n\nThe ventricles and sulci are prominent, compatible with global parenchymal\nvolume loss.\n\nBilateral confluent periventricular, deep, and subcortical white matter\nhypodense foci are non-specific, but compatible with severe changes of chronic\nwhite matter microangiopathy.\n\nQuadrigeminal plate lipoma is again noted. There is a right-sided nasogastric\ntube. Aside from bilateral lens extraction, the globes and orbits are\nunremarkable. Carotid siphon calcifications are noted bilaterally.\n\n The visualized paranasal sinuses and right mastoid appear clear. Trace left\nmastoid effusion at the mastoid tip. Severe right TMJ degenerative changes.", + "output": "1. Mild interval increase in size of the acute left cerebellar\nintraparenchymal hematoma now measuring 4.4 x 3.3 cm, previously 4.4 x 2.6 cm.\nSurrounding vasogenic edema and posterior fossa mass effect is similar. \nEffacement of fourth ventricle without hydrocephalus, is overall similar to\nprior exam. No frank herniation.\n2. No new acute superimposed intracranial abnormality.\n3. Global parenchymal volume loss, severe changes of chronic white matter\nmicroangiopathy, and vascular calcifications, all unchanged.\n4. Unchanged small quadrigeminal plate lipoma." + }, + { + "input": "Dental amalgam streak artifact limits study. There is no evidence ofacute\nlarge territorial infarction,hemorrhage,edema,or mass. The ventricles and\nsulci are normal in size and configuration. There are mild atherosclerotic\ncalcifications of the clinoid and supraclinoid portions of the bilateral\ninternal carotid arteries.\n\nThere is no evidence of fracture. There is almost complete opacification of\nthe bilateral maxillary sinuses and bilateral ethmoid air cells. There is\nmild mucosal thickening of the bilateral sphenoid sinuses and left frontal\nsinus. There is partial opacification of the mastoid air cells. The middle\near cavities are patent. The visualized portion of the orbits are\nunremarkable. An endotracheal tube is partially visualized in the oropharynx.", + "output": "1. Dental amalgam streak artifact limits study.\n2. No evidence of acute intracranial hemorrhage or large territorial\ninfarction.\n3. Please note that MRI is more sensitive for the diagnosis of acute\ninfarction.\n4. Paranasal sinus disease as described." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect or\nlarge territorial infarction. The ventricles and sulci are normal in size\nconfiguration for patient's age. The basal cisterns are patent. Gray-white\nmatter differentiation is preserved. Incidentally there is prominent\ncalcification of the anterior falx.\n\nThere is no fracture. The mastoid air cells and middle ear cavities are clear,\nhowever the mastoid apices are omitted from view bilaterally. There is mild\nmucosal thickening in the partially imaged anterior left maxillary sinus and\nbilateral ethmoidal air cells. The frontal and sphenoid sinuses are clear.", + "output": "No evidence of acute intracranial abnormality." + }, + { + "input": "There is a tiny left frontal extra-axial collection measuring up to 2 mm\n(602:59), which likely represents a subdural hematoma. This is overall\nsimilar in size compared to the prior outside facility CT performed earlier on\nthe same day. Given its intermediate density, this may be subacute in nature.\nNo other hemorrhage is identified. There is no evidence of acute major\nvascular territorial infarction, edema, or mass. Prominence of the ventricles\nand sulci is compatible with atrophic changes, more than would be expected for\npatient's age.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nethmoid sinuses. Remainder of the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.\n\nEvaluation of the soft tissues is notable for soft tissue stranding/hematoma\nin the left facial region (03:12).", + "output": "1. No significant interval change in likely acute to subacute 2 mm left\nfrontal subdural hematoma. No new hemorrhage.\n2. Left facial soft tissue hematoma/swelling." + }, + { + "input": "There has been no significant interval change to slightly decrease conspicuity\nto the 2 mm extra-axial hyperdensity overlying the left frontal lobe (602:55).\nNo additional hemorrhage is demonstrated. No evidence of acute infarct, mass\nor edema. Prominence of the ventricles and sulci suggestive of involutional\nchanges. Periventricular and subcortical white matter hypodensities are\nnonspecific but likely reflect sequelae of chronic small vessel ischemic\ndisease. Atherosclerotic vascular calcification of the V4 vertebral artery\nsegments and cavernous internal carotid arteries are demonstrated.\n\nThere is soft tissue swelling about the left face. There is no evidence of\nfracture. There is mild mucosal thickening of the anterior ethmoid air cells\nbilaterally, otherwise the imaged paranasal sinuses, mastoid air cells and\nmiddle ear cavities are clear.The visualized portion of the orbits are\nunremarkable.", + "output": "No interval change to slightly decreased conspicuity to the 2 mm left frontal\nextra-axial hyperdensity, possibly reflecting a tiny subdural hematoma." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction or midline shift.\nThere is no hydrocephalus. There is no edema. There is no fracture.\n\nVisualized paranasal sinuses and mastoid air cells on the left are clear. \nMinimal opacification of the right mastoid air cells is likely related to\nongoing inflammation.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. Mild\natherosclerotic calcification of the left distal vertebral artery and both\ncavernous carotid arteries are noted.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No fracture or acute intracranial process." + }, + { + "input": "Overall, no progression of the subdural hematoma is since the most recent\nexam. The mixed density right extra-axial fluid collection overlying the\nright cerebral convexity that is consistent with a subdural hematoma is\nprobably overall unchanged or minimally decreased, now measuring up to 16 mm\ncompared to 19 mm previously. The lower density left extra-axial fluid\ncollection along the left frontal parietal convexity is overall unchanged,\nmeasuring 8 mm. High density along the anterior temporal subdural collection\nis unchanged measuring up to 19 mm, previously 19 mm. Local mass effect with\nsulcal effacement is unchanged. No shift of normally midline structures. \nBasal cisterns remain patent. Overall appearance of the ventricles is still\nunchanged. No evidence of a large territorial infarct. No new focal acute\nhemorrhage.\n\nNo evidence of acute fracture. Mucosal thickening of the right maxillary\nsinus is mild. There is slight mucosal thickening of the bilateral anterior\nethmoidal air cells. The remaining paranasal sinuses are clear. The mastoid\nair cells, middle ear cavities, and external auditory canals are clear. The\norbits are unremarkable.", + "output": "1. No interval progression in the bilateral subdural hematomas. No midline\nshift.\n2. No new focal acute hemorrhage.\n\nNOTIFICATION: The findings, images, and impression were reviewed and\ndiscussed by Dr. ___ with ___, PA in personon ___\nat 5:47 AM, in real time (0 seconds) after discovery of the findings." + }, + { + "input": "The patient is status post right frontal craniotomy for evacuation of right\nsubdural. Expected postoperative changes are noted, and a small drain is\npresent in the right subdural space, with expected interval decrease of the\nsize of the right subdural space. However, the left subdural hematoma appears\nslightly larger than on the CT from earlier in the day, now measuring 11 mm\nfrom the inner table, previously measuring 7 mm in the similar location.\nAdditionally, interval development of hyperdensity within the left subdural\ncollection is concerning for continued hemorrhage (series 2, image 23). There\nis 1 mm of midline shift to the right. The ventricles are similar in\nconfiguration, and the basal cisterns remain patent. Previously seen\neffacement of the right quadrigeminal plate cistern is improved on the prior\ncurrent study.\n\nThere is no fracture. Patchy mucosal thickening in bilateral ethmoid air\ncells is noted. The mastoid air cells and middle ear cavities are clear. \nIncidental note is made of a left frontal osteoma. The visualized globes are\nunremarkable.", + "output": "1. Status post right frontal craniotomy for evacuation of right subdural\nhematoma, with expected postoperative changes and interval decrease in size of\nright subdural collection.\n2. Interval increase in the left subdural hematoma, now measuring 11 mm, with\nnew hyperdense components compared to the study from earlier in the day. \nThere is new minimal rightward midline shift." + }, + { + "input": "The patient is status post right frontal craniotomy for evacuation of right\nsubdural hematoma. A drain remains in place terminating over the right\nfrontal lobe. The overall appearance of the right subdural hematoma is\nunchanged now measuring approximately 8 mm in greatest dimension from the\ninner table and still demonstrating mixed density and pneumocephalus. The\nleft acute on chronic subdural hematoma is also unchanged in size and\nappearance. There is approximately 1 mm of rightward shift of normally\nmidline structures, also unchanged. The ventricles and sulci are similar in\nconfiguration and size. The basal cisterns remain patent. Mild mucosal\nthickening of the right maxillary sinus is noted. Incidental note is again\nmade of a left frontal osteoma.", + "output": "1. Stable appearance status post right frontal craniotomy for evacuation of\nright subdural hematoma with expected postoperative appearance and stable size\nof residual subdural collection.\n2. Stable left acute on chronic subdural hematoma." + }, + { + "input": "The patient is status post right frontal craniotomy. A right subgaleal\nhematoma is noted. Large bilateral fluid collections are predominately\nhypodense and unchanged in size. A small amount of hyperdense material\nlayering along the left parietal and temporal lobe is mildly decreased from\nthe prior examination. There is no significant midline shift. The ventricles\nand sulci are similar in configuration and size. A left frontal osteoma is\nincidentally noted.", + "output": "Stable appearance of bilateral chronic subdural hematomas. There is a\nmoderate interval decrease in the amount of hyperdense blood bilaterally.\nThere is no significant midline shift." + }, + { + "input": "The patient is status post right frontal craniotomy. Underlying\npneumocephalus has resolved. Bilateral subdural hematomas are again noted. 4\nmm hypodense extra-axial collection along the posterior right frontal lobe,\nimage 5:21, has decreased since the prior CT.\n\nThe subdural collection along the left convexity has decreased slightly in\nmaximum thickness to 11 mm (previously 14 mm), and also decreased in size\nalong the inferior left frontal lobe. It does not appear significantly\nchanged in size anterior to the left temporal lobe. This collection\ndemonstrates decreased density since the prior exam, indicating expected\nevolution of blood products.\n\nLeft frontal, superior parietal, and anterior temporal sulcal effacement\npersists. Effacement of the left lateral ventricle appears partially\nimproved. The right lateral ventricle has re-expanded. Mild rightward shift\nof midline structures may have slightly increased, likely due to interim\nresolution of the right subdural collection.\n\nNo new hemorrhage or parenchymal edema is identified. Basal cisterns are not\ncompressed.\n\nAn osteoma is again seen within the left frontal sinus. Visualized paranasal\nsinuses otherwise demonstrate no fluid or significant mucosal thickening. \nMastoid air cells are well aerated.", + "output": "1. Right subdural collection has almost completely resolved with a small 4 mm\nresidual hypodense collection remaining.\n2. Left subdural collection remains large, but decreased in size compared to\n___, and with decreased density of blood products. Left sulcal\neffacement persists.\n3. No evidence for new hemorrhage.\n4. Left lateral ventricle has partially re-expanded, and right lateral\nventricle has completely re-expanded. Mild rightward shift of midline\nstructures has increased, likely due to the near complete resolution of right\nsubdural hematoma." + }, + { + "input": "There is a stable hypodense collection anterior to the left temporal lobe with\nstable mass effect on the underlying parenchyma. The previously seen right\nfrontal extra-axial hemorrhage is no longer visualized. There is a trace\nresidual isodense left frontoparietal subdural hematoma.\n\nThere is no evidence of infarction, new hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Right frontal craniotomy changes are seen. \nThe visualized portion of the mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable. There is\npartial opacification of the ethmoid sinuses. There is an unchanged 0.9 cm\nosteoma in the left frontal sinus.", + "output": "1. Trace residual chronic left frontoparietal subdural hematoma and stable\nchornic anterior left temporal subdural hematoma with stable mass effect on\nthe underlying parenchyma." + }, + { + "input": "CT head:\nThere is mixed density subdural hemorrhage on the left measuring up to 6 mm in\ndepth at the cerebral convexities and up to 1.9 mm in depth at the anterior\nleft middle cranial fossa (03:10) with hypodense fluid with layering and\npunctate areas of hyperdensity.\nThere is a mixed density right subdural hematoma measuring up to 8 mm in depth\nat the convexity with isointense fluid with serpiginous areas of hyperdensity.\nThere is mass effect with effacement of the cortical sulci and the suprasellar\ncistern. The basal cisterns are preserved. There is no significant midline\nshift or herniation. There is mild mass effect on the lateral ventricles,\nleft more than right. The gray-white matter differentiation is intact without\nevidence of acute territorial infarct or parenchymal hemorrhage. There is\ncalcification at the pineal gland.\n\nThe orbits, calvarium, and soft tissues are unremarkable. There is a left\nfrontal sinus small osteoma. There is mild mucosal thickening within the\nbilateral ethmoid and maxillary sinuses. The mastoid air cells and middle\nears are clear.\n\nCTA head: There is motion artifact which limits spatial resolution. There is\ntrace calcific atherosclerosis at the bilateral carotid siphons, which are\npatent. The anterior communicating artery is visualized. The bilateral\nposterior communicating arteries are not definitively seen. There are\ncodominant vertebral arteries. There is no evidence of occlusion, dissection,\nsignificant stenosis, or aneurysm. The dural venous sinuses are patent.\n\nCTA neck: There is a 2 vessel aortic arch with a common origin of the right\nbrachiocephalic and left common carotid arteries. There is mild calcific\natherosclerosis at the bilateral carotid bulbs and bifurcations, left more\nthan right without significant stenosis by NASCET criteria. There are patent,\ncodominant vertebral arteries. There is no evidence of occlusion, stenosis,\ndissection, or aneurysm.\n\nThe thyroid and salivary glands are unremarkable. There is no\nlymphadenopathy by CT criteria. There is no fracture or osseous lesion.\nThe lung apices are clear. There are median sternotomy wires. There are\npostsurgical changes at the pulmonary artery root.", + "output": "1. Bilateral mixed density subdural hematomas causing mass effect with\neffacement of the cortical sulci, lateral ventricles, and the suprasellar\ncistern. No midline shift or downward herniation.\n2. Motion artifact on the head CTA which mildly limit spatial resolution. \nWithin these limitations, the intracranial vasculature is patent without\nevidence of occlusion, stenosis, aneurysm, or vascular malformation.\n3. Patent neck vasculature." + }, + { + "input": "The intermediate density bilateral subdural hematomas along the cerebral\nconvexity, more dense on the right, are unchanged since the prior CT. There is\nno significant shift of the midline structures, and the suprasellar cistern is\nstill partially effaced. Hyperdense subdural collection in the left anterior\ninferior temporal region is also unchanged in quantity and distribution. No\nevidence of infarct. No evidence of tonsillar herniation.\n\nThere is scattered mucosal thickening of the ethmoid air cells bilaterally,\nand right maxillary sinus and an osteoma the left frontal sinus. Mastoid air\ncells and middle ear cavities are clear.\nNo displaced fracture appreciated.", + "output": "1. Stable bilateral subdural hematomas, more dense on the right, and unchanged\nleft anterior temporal subdural.\n2. Continued partial effacement of the suprasellar cistern.\n3. No evidence of tonsillar herniation." + }, + { + "input": "Study is substantially degraded by motion.\n\nThe right subdural hematoma overlying the right frontal and parietal lobes is\nof mixed density, measuring up to 1.5 cm (2a:19). This is not significantly\nchanged compared to the prior CT performed on ___. Lower density\nleft frontal subdural collection measures up to 0.7 cm from the inner table,\nalso stable. Left anterior temporal subdural hematoma is also unchanged. No\ndefinite new hemorrhage identified.\n\nNo evidence of acute major vascular territorial infarction. No shift of\nmidline structures.\n\nThere is no evidence of fracture. Minimal mucosal thickening is noted in the\nethmoid air cells bilaterally. Visualized portion of other paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. Study is substantially degraded by motion.\n2. Grossly stable mixed density subdural hematomas, measuring up to 1.5 cm on\nthe right and 0.7 cm on the left.\n3. Stable left anterior temporal subdural hematoma.\n4. Within limits of study, no definite new hemorrhage identified.\n5. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct." + }, + { + "input": "The mixed-density right extra-axial fluid collection overlying the right\ncerebral convexity, consistent with subdural hematoma, appears to have\nslightly increased in size in the interim, now measuring up to 19 mm compared\nto 15 mm previously. Lower density extra-axial fluid collection layering\nalong the left frontal parietal convexity is also perhaps minimally increased\nin size now measuring up to 8 mm compared to 7 mm previously. High-density\nanterior temporal subdural hematoma is also perhaps slightly increased in a\nintra, measuring up to 19 mm compared to 17 mm previously. These subdural\nhemorrhages exerts local mass effect, effacing the sulci. However, no shift\nof normally midline structures is identified. The overall appearance of the\nventricles is unchanged. No large territorial infarct. No new focal acute\nhemorrhage.\n\nNo acute fracture. The partially visualized paranasal sinuses are clear. The\nmastoid air cells and middle ear cavities are clear.\nThe orbits are unremarkable.", + "output": "1. Interval increase in right and left anterior temporal evolving subdural\nhematomas as well as low-density left subdural collection. No midline shift\nor herniation.\n2. No new acute focal hemorrhage.\n3. No large territorial infarct.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\n___, ED resident, on the telephoneon ___ at 12:05 AM, 1 minutes\nafter discovery of the findings." + }, + { + "input": "Large subgaleal hematoma overlying the left forehead without underlying\nfracture.\n\nNo evidence for acute infarction, intracranial hemorrhage, mass effect, or\nedema. Periventricular and subcortical white matter hypodensities are\nnonspecific but likely sequelae of chronic small vessel ischemic disease. The\nventricles and sulci are prominent, consistent with involutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "Soft tissue swelling and large subgaleal hematoma overlying the left forehead\nwithout underlying fracture. No intracranial hemorrhage." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nlarge territorial infarction. Prominent ventricles and sulci suggest\nage-related involutional changes. The basal cisterns appear patent and there\nis preservation of gray-white matter differentiation.\nThe visualized bony structures are grossly unremarkable. There is large\nmucous retention cyst in the left maxillary sinus. There is partial\nopacification of right sphenoid sinus. The remaining paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear.\n\nAtherosclerotic mural calcification of the internal carotid arteries is\nnoted. The globes are unremarkable.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass. The\nventricles and sulci demonstrate age-appropriate volume loss. \nPeriventricularand deep subcortical white matter hypodensities are compatible\nwith moderate chronic small vessel ischemic changes. A hypodensity in the\nright globus pallidus internus is compatible with a chronic lacunar\ninfarction.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Chronic lacunar infarction in the right globus pallidus.\n3. Moderate small vessel ischemic changes." + }, + { + "input": "Head CTA: There are no intracranial vascular abnormalities. There is no\nevidence of aneurysm, stenosis or occlusion.\n\nNeck CTA: The carotid and vertebral arteries and their major branches are\npatent with no evidence of stenoses. There is no evidence of internal carotid\nstenosis by NASCET criteria.", + "output": "Unremarkable head and neck CTA.\n\n This report is provided without 3D and curved reformats. When these images\nare available, and if additional information is obtained, then an addendum may\nbe given to this report." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\n There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no fracture. Scattered mucous retention cysts are noted in the right\nmaxillary sinus and sphenoid sinus. The visualized portion of the remaining\nparanasal sinuses, mastoid air cells, and middle ear cavities are otherwise\nclear. The visualized portions of the orbits are normal. There is no\nretrobulbar hematoma or mass.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. Hypoplastic left A1\nsegment. The distal left anterior cerebral artery appears patent. The dural\nvenous sinuses are patent. There is asymmetric prominence of the left\nsuperior ophthalmic vein, which is nonspecific in the absence of additional\nfindings (3:220).\n\nCTA NECK:\nNormal 3 vessel branching of the aortic arch. Bilateral carotid and vertebral\nartery origins are patent. There is no evidence of internal carotid stenosis\nby NASCET criteria. The carotidandvertebral arteries and their major branches\nappear normal with no evidence of stenosis or occlusion.\n\nOTHER:\nThe visualized portion of the lungs are clear. There is a 3 mm subpleural\nsolid nodule in the left upper lobe (3:49). The visualized portion of the\nthyroid gland is normal. There are multiple prominent subaortic and\nparatracheal lymph nodes, not pathologically enlarged by CT size criteria. \nProminence of the hila noted on the scout images may be related to the\npatient's history of sarcoidosis.", + "output": "1. No acute intracranial process. No evidence of large territory infarction\nor hemorrhage.\n2. Asymmetric prominence of the left superior ophthalmic vein is of uncertain\nsignificance in the absence of any additional orbital findings. Otherwise,\nnormal appearance of the orbits. No evidence of a retrobulbar mass. \nAssessment for inflammatory processes and cranial nerve abnormalities would be\nbetter performed with dedicated MRI of the brain and orbit which can be\nconsidered in the context of history of sarcoidosis.\n3. Patent circle of ___ without evidence of stenosis, occlusion, or\naneurysm.\n4. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection.\n5. Hilar prominence on scout images is likely related to known history of\nsarcoidosis with hilar lymphadenopathy better assessed on previous chest CT\nfrom ___." + }, + { + "input": "There is no hemorrhage, edema, mass effect, midline shift, or mass. Mild\nprominence of the ventricles and sulci is indicative of volume loss. The basal\ncisterns are patent and there is normal gray-white matter differentiation.\nStable thickening and calcification of the left parietal scalp, representing\nsequela of prior trauma. No acute fracture.\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\nThe orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Moderately motion degraded exam. Hypodensity in the right cerebellum is\nconsistent with chronic infarction. There is no evidence of fracture, new\ninfarction,hemorrhage,edema,or mass. Parenchymal atrophy has worsened since ___. bilateral carotid siphon calcifications are noted.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavitiesare essentially clear. The visualized portion of the orbits are\nnormal.", + "output": "1. Moderately motion degraded exam. Otherwise, no evidence of fracture, mass,\nhemorrhage or infarction." + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass. The ventricles and sulci are normal in size and configuration. Spinal\nfusion hardware is partially imaged. No osseous abnormalities seen. Frontal\nsinuses are underpneumatized. There is opacification of a few of the inferior\nright mastoid air cells. The paranasal sinuses, remainder of the mastoid air\ncells, and middle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are prominent, suggestive of volume loss. \nMucous retention cysts are noted in the bilateral maxillary sinuses. The\nremaining imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or\nmass-effect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. There are periventricular and subcortical lucencies,\nwhich may represent small vessel ischemic changes. Atherosclerotic vascular\ncalcifications are noted of bilateral cavernous portions of internal carotid\narteries.\n\nThere is no evidence of fracture. Small mucous retention cysts are seen in\nthe floor of the bilateral maxillary sinuses. The visualized portion of the\nand middle ear cavities are clear. Patient is post bilateral native lens\nreplacement. Minimal nonspecific left mastoid fluid is seen.", + "output": "1. No acute intracranial abnormality, with no definite evidence of acute\nintracranial hemorrhage.\n2. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described.\n3. Paranasal sinus disease minimal nonspecific left mastoid fluid, as\ndescribed." + }, + { + "input": "There is no evidence of large territorial infarction, hemorrhage, edema, or\nmass. The predominantly periventricular white matter hypodensities are\nnonspecific, but likely represent the sequela of chronic microvascular\nischemic disease. There is prominence of the ventricles and sulci suggestive\nof involutional changes.\n\nThere is no evidence of fracture. The right maxillary sinus is almost\ncompletely opacified. Thickening and sclerosis of the walls of the maxillary\nsinuses bilaterally is unchanged since ___. There is mild mucosal thickening\nwithin the right ethmoid air cells. The visualized portion of the mastoid air\ncells and middle ear cavities are clear. The patient is status post lens\nresection on the right. Otherwise, the visualized portion of the orbits are\nunremarkable.", + "output": "1. No evidence of acute intracranial abnormality on noncontrast head CT. \nSpecifically no large territory infarct or intracranial hemorrhage.\n2. The maxillary sinus walls are sclerotic, compatible with chronic sinusitis.\nInterval complete opacification of the right maxillary sinus from examination\nof ___." + }, + { + "input": "There is no acute large territorial infarction, hemorrhage, edema or mass. \nThere is no shift of normally midline structures. Basal cisterns are patent\nis preservation gray-white matter differentiation. Prominent ventricles and\nsulci suggest age-related involutional changes. Periventricular, deep and\nsubcortical white matter hypodensities are nonspecific, though likely sequelae\nof chronic small vessel ischemic disease.\n\nNo fracture identified. There is near-complete opacification of the right\nmaxillary sinus with mild mucosal thickening of the left maxillary sinus with\nhyperostosis of the sinus walls, which likely reflects chronic sinusitis. \nFluid within the ethmoidal air cells and posterior nasopharynx is likely\nrelated to the patient's intubated status. The remaining visualized portions\nof the paranasal sinuses, mastoid air cells and middle ear cavities are clear.\nVisualized portions of the orbits are unremarkable. Dense atherosclerotic\ncalcification of the cavernous portion of the bilateral internal carotid\narteries.", + "output": "1. No acute intracranial abnormalities.\n2. Chronic changes, including age-appropriate cortical atrophy and chronic\nsmall vessel ischemic disease.\n3. Chronic sinus inflammation involving the maxillary sinuses. Fluid within\nthe ethmoidal air cells and posterior nasopharynx likely related to the\npatient's intubated status.\n4. Dense atherosclerotic of calcification of the cavernous portion of the\nbilateral internal carotid arteries." + }, + { + "input": "The images are mildly degraded by motion artifact. There is no evidence of\ninfarction, hemorrhage, edema, or mass effect. Unchanged prominence of the\nventricles and sulci in keeping with generalized parenchymal volume loss. \nDeep white matter hypodensities are noted and although are nonspecific, likely\nreflect chronic microvascular ischemic change. Calcification of the carotid\nsiphons is noted.\n\nNo osseous abnormalities seen. Chronic sinus inflammation involving the right\nmaxillary sinus. Interval decreased extent of the mucosal thickening of the\nethmoid air cells and posterior nasopharynx. A small amount of fluid is noted\nin the right mastoid air cells. The orbits are unremarkable.", + "output": "No evidence of acute intracranial abnormality. Stable chronic findings as\ndescribed above." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. There\nis prominence of the ventricles and sulci suggestive of profound involutional\nchanges. There is redemonstration of periventricular and subcortical\nhypodensities nonspecific but may represent chronic microvascular ischemic\ndisease in this age group. Incidentally noted cavum septum pellucidum et\nvergae.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The patient is status post bilateral lens\nreplacements.", + "output": "1. No acute intracranial abnormalities.\n2. Unchanged atrophy." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass effect.\nThere is significant prominence of the ventricles and sulci suggestive of\ninvolutional changes, similar to prior. There are bilateral nonspecific\nscattered periventricular and subcortical white matter hypodensities likely\nrelated to chronic small vessel ischemic changes. Redemonstration of cavum\nseptum pellucidum et vergae.\n\nComminuted bilateral nasal bone fractures without significant adjacent soft\ntissue swelling is likely chronic, with similar to prior. No acute calvarial\nfractures identified. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits demonstrate bilateral lens replacement. Left parotid gland is\nfatty replaced.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of fracture, acute major infarction,hemorrhage,edema,or\ndiscrete mass. Incidental note is made of a cavum septum pellucidum et\nvergae. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific but likely reflect sequelae of chronic\nmicrovascular ischemic disease.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavitiesare essentially clear. The visualized portion of the orbits are\nnotable for bilateral lens replacements.", + "output": "1. No acute intracranial process.\n2. Global parenchymal volume loss." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere are extensive periventricular and subcortical white matter\nhypodensities. There is enlargement of the cerebral sulci and lateral\nventricles consistent with advanced cerebral volume loss, unchanged since the\nprior study from ___. There is prominence of the sylvian fissure and\ncallosal angle of approximately 77 degrees with relative preservation of the\nbilateral superior frontal sulci. There is no evidence of acute territorial\ninfarction,hemorrhage,edema,ormass.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are normal.\n\nCTA HEAD:\nIncidental note is made of an azygos variant of the ACA, a normal variant. 1\nmm inferiorly oriented outpouching of the right cavernous ICA (series 3, image\n206) is compatible with an infundibulum. The vessels of the circle of ___\nand their principal intracranial branches appear otherwise unremarkable\nwithout high-grade stenosis, occlusion, or aneurysm. The dural venous sinuses\nare patent.\n\nCTA NECK:\nMild atherosclerotic plaque is noted along the aortic arch and origins of the\nmajor vessels.\nBilateral carotid and vertebral artery origins are patent. The left vertebral\nartery is dominant, a normal variant. Multifocal short-segment moderate\nstenosis of the left vertebral artery secondary to extrinsic mass effect from\nosteophytes are identified at multiple levels, most prominently at C4-C5\n(series 3, image 132) and C5-C6 (series 3, image 118). There is medialization\nof the bilateral internal carotid arteries.\n\nMild atherosclerotic calcifications are noted at the bilateral carotid\nbifurcations. There is no evidence of internal carotid stenosis by NASCET\ncriteria.\nThe carotidandvertebral arteries and their major branches otherwise appear\npatent with no evidence of significant stenosis or occlusion.\n\n\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No acute intracranial abnormality on noncontrast CT head.\n2. Similar advanced parenchymal volume loss and chronic small vessel ischemic\nchanges in the supratentorial white matter. In addition, there is\ndisproportionate enlargement of the sylvian fissure relative to the superior\nfrontal sulci and callosal angle of approximately 77 degrees. While\nnonspecific this may be seen in the setting of NPH. Clinical correlation is\nrecommended.\n3. Patent circle of ___ without evidence of high-grade\nstenosis,occlusion,or aneurysm.\n4. Patent bilateral cervical carotid and vertebral arteries without evidence\nof high-grade stenosis, occlusion,or dissection. There are multifocal\nmoderate stenoses of the left V2 segment secondary to osteophytes as described\nabove.\n5. Additional findings described above." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territorial infarct. Prominence of the\nventricles and sulci is consistent with involutional changes. Septum\npellucidum et vergae is noted, congenital variant. Mild periventricular white\nmatter hypodensities are likely sequelae of chronic small vessel disease. The\nvisualized paranasal sinuses demonstrate partially imaged mucous retention\ncyst in the maxillary sinuses. The mastoid air cells are clear. No acute\nfracture is seen.", + "output": "No acute intracranial process.\n\nChronic changes, redemonstrated parenchymal volume loss.." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nSome of the images were repeated due to motion artifact. There is no evidence\nof acute hemorrhage, edema, mass effect, or acute major vascular intracranial\nfraction. There is redemonstrated profound diffuse parenchymal atrophy,\nstable in comparison to the prior study. There are periventricular and\nsubcortical hypodensities, which are nonspecific but may represent small\nvessel ischemic changes in a patient of this age. Incidentally noted cavum\nseptum pellucidum et vergae.\n\nThere is mild ethmoid mucosal thickening. Small mucous retention cysts are\nnoted within the right maxillary sinus. The mastoid air cells appear clear. \nStatus post bilateral lens replacements. Again seen is fatty replacement of\nthe left parotid gland.\n\nCTA NECK:\nMotion artifact from the aerodigestive tract and streak artifact from dental\namalgam limits evaluation. The aortic arch demonstrates mild atherosclerotic\ncalcifications. There are atherosclerotic calcifications at the origins of\nthe bilateral common carotid arteries without stenosis. There is mild\ncalcified plaque formation at the bilateral carotid bifurcations without\nsignificant stenosis by NASCET criteria. Proximal common carotid arteries are\nmedialized, coursing posterior to the thyroid gland and in close proximity\nwith the esophagus.\n\nThe bilateral vertebral artery origins appear patent, with note made of mild\natherosclerotic calcifications at the left vertebral artery origin. The left\nvertebral artery is dominant. There is short-segment focal narrowing of the\nleft vertebral artery at C5-C6, and to a lesser extent at C4-C5, by\nuncovertebral and facet osteophytes.\n\nCTA HEAD:\nAs before, there is an azygos anterior cerebral artery. Otherwise, the vessels\nof the circle of ___ and their principal intracranial branches appear\npatent without evidence for flow-limiting stenosis or aneurysm the dural\nvenous sinuses are patent.\n\nOTHER:\nThe thyroid is grossly unremarkable. There is no lymphadenopathy by CT size\ncriteria. No concerning abnormalities are seen in the included upper lungs\nallowing for nondedicated technique and respiratory motion artifact. There\nare degenerative changes in the cervical spine.", + "output": "1. No evidence for acute intracranial hemorrhage or acute major vascular\nterritorial infarction. MRI would be more sensitive for an acute infarction,\nif clinically warranted.\n2. Motion limited neck CTA. No change compared to ___. \nAtherosclerosis of bilateral proximal internal carotid arteries without\nstenosis by NASCET criteria. Short-segment focal narrowing of the left\nvertebral artery at C5-C6, and to a lesser extent at C4-C5, by uncovertebral\nand facet osteophytes.\n3. Head CTA demonstrates no evidence for flow-limiting stenosis or aneurysm in\nthe major intracranial arteries." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, mass effect, midline\nshift, or mass. The ventricles and sulci are normal in size and configuration.\nNo bony abnormalities seen. There is minimal mucosal thickening in the\nethmoid air cells and left maxillary sinus. The sphenoid sinus, frontal sinus\nThe mastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "The carotid and vertebral arteries and their major branches are patent with no\nevidence of stenoses. No evidence for dissection is seen. There are no signs\nof vascular trauma.\n\nBy NASCET criteria, there is no stenosis of the right or left internal carotid\narteries identified.\n\nThere is a 3 x 2 cm air-filled area to the right of the esophagus at the\nthoracic inlet most likely representing a Zenker's diverticulum. There is no\nfracture identified in the cervical spine degenerative changes are seen. The\nsmall hypodense nodule is seen in the right lobe of thyroid. There are bullous\nchanges at the lung apices.", + "output": "No evidence of arterial trauma dissection stenosis or occlusion in the neck." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema,or\ndiscrete mass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Mild thickening of the ethmoid air cells. \nOtherwise, the visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is extensive soft tissue gas extending from the chest wall superiorly\ninto the superficial and deep spaces of the neck. Air within the\nretropharyngeal space results in mass effect on the airway without significant\nairway compromise. Air is also seen tracking within the bilateral carotid\nspaces, parapharyngeal space, masticator spaces. No focal fluid collection.\n\nPeriapical lucencies involving several of the left mandibular teeth, which may\nrepresent chronic periodontal disease.\n\nThe thyroid gland appears normal. There is no lymphadenopathy by CT criteria.\n\nSevere emphysema is partially visualized in the lung apices with a partially\nvisualized right pneumothorax and pneumomediastinum.\n\nBones: No acute findings. Demineralized appearance of the upper thoracic\nvertebral bodies may reflect known metastatic disease.", + "output": "1. Extensive soft tissue gas tracking up from the chest.\n2. Retropharyngeal gas expands the retropharyngeal space with mild associated\nmass effect on the airway.\n3. Severe apical emphysema and partially visualized small right pneumothorax.\n4. Periapical lucencies of several left mandibular teeth may represent chronic\nperiodontal disease. Please correlate clinically." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage. A hypodensity\ninvolving the left frontal lobe and insula with loss of gray-white\ndifferentiation suggests a subacute with more chronic region posteriorly\ninvolving the left MCA territory. A chronic right PCA territory infarct is\npresent with ex-vacuo dilatation of the right lateral ventricle. The left\nlateral ventricle is unremarkable. There is no midline shift. Basal cisterns\nare patent. No acute fracture. A mucous retention cyst in the right\nmaxillary sinus is small. A 3 mm left inferior frontal osteoma is noted\nincidentally (03:28). The remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "Subacute/chronic left MCA infarct without evidence of hemorrhagic conversion.\nChronic right PCA infarct." + }, + { + "input": "There is no evidence of acute hemorrhage. There is been interval evolution of\nleft MCA territory hypodensity with increase in edema and compression of the\nbody of the left lateral ventricle. Hypodensity now extends more definitively\ninto the left temporal lobe. There is no midline shift. The ventricles and\nsulci are unchanged compared to prior. Chronic right PCA infarction findings\nincluding hypodensity and ex vacuo dilatation of the temporal horn of the\nright lateral ventricle are unchanged. Additional chronic left anterior\nfrontal infarct is also unchanged\n\nThere is no evidence of fracture. Again seen is mucous retention cyst in the\nright maxillary sinus. 3 mm left inferior frontal osteoma is again\nincidentally noted (series 2; image 12). The remaining visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nThe visualized portion of the orbits are unremarkable.", + "output": "1. Expected interval evolution of left MCA territory hypodensity with slight\nincrease in edema and compression of the body of the left lateral ventricle\nwithout midline shift. Hypodensity now extends more definitively into the\nleft temporal lobe. No hemorrhage.\n2. Ventricles and sulci are unchanged compared to prior.\n3. Chronic right PCA infarction findings including hypodensity and ex vacuo\ndilatation of the temporal horn of the right lateral ventricle and\npre-existing chronic left anterior frontal infarct unchanged.\n4. Unchanged incidentally noted 3 mm left inferior frontal osteoma." + }, + { + "input": "The patient has undergone right frontal craniotomy for subdural hematoma\nresection and drain placement. There is a small amount of fluid, air, and\nmore acute blood along the right frontal convexity, maximal thickness 7 mm\n(03:21). There is now 3 mm leftward shift of the midline structures,\npreviously 10 mm. No evidence of acute infarction. Mild mass effect upon the\nright frontal lobe. Basal cisterns are patent.\nPostoperative changes in the right frontal calvarium and scalp. Paranasal\nsinuses are clear. Orbits and globes are within normal limits.", + "output": "1. Status post right frontal craniotomy.\n2. Decreased leftward midline shift, now 3 mm.\n3. 7 mm hyperdense postoperative right frontal subdural hematoma." + }, + { + "input": "Patient is status post right frontal craniotomy with expected postsurgical\nchanges, including decreasing volume of intra-axial and extra-axial\npneumocephalus, as well as evolving blood products within the surgical bed. \nOverall volume of right frontal subdural fluid collection is unchanged since\nprior exam. Mild mass effect upon local sulci and adjacent right frontal lobe\npersists. 3 mm right-to-left midline shift is unchanged.\n\nThere is no evidence of new hemorrhage or infarct. Ventricular size is\nunchanged without evidence of hydrocephalus. Basal cisterns remain\nnon-compressed.\n\nAside for expected postoperative changes involving the right frontal calvarium\nand scalp, no new osseous or soft tissue abnormality. The visualized\nparanasal sinuses, mastoid air cells and middle ear cavities are clear. \nVisualized portions of the bony orbits and globes are unremarkable.", + "output": "1. Status post right frontal craniotomy with expected postsurgical changes. \nNo evidence of new hemorrhage or infarct.\n2. Stable 3 mm right-to-left midline shift.\n3. Unchanged volume of right frontal subdural hematoma with persistent mass\neffect on local sulci and adjacent right frontal lobe." + }, + { + "input": "There are postsurgical changes from right frontoparietal craniotomy and\nhematoma evacuation. There is residual right lateral convexity, mainly\nhypodense subdural collection measuring up to 8 mm in maximal thickness,\npreviously 10 mm, with minimal dense components seen along the dura, which\nlikely represents dural thickening. There is minimal associated mass effect\nwith crowding of the right frontoparietal sulci. There is no midline shift.\n\nThere is no evidence of infarction,new hemorrhage,edema,or large mass. There\nis moderate prominence of the ventricles and sulci suggestive of involutional\nchange. Vascular calcifications are noted in the vertebral arteries and\ncarotid siphons.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Interval decrease in size of an 8 mm, mainly hypodense right lateral\nconvexity chronic subdural hematoma, with dense component likely reflecting\ndural thickening given configuration. Minimal persistent adjacent mass effect\nwithout midline shift.\n2. No new hemorrhage, or acute large territorial infarct." + }, + { + "input": "Right craniotomy changes appear stable.\n\nSmaller right convexity subdural hematoma measuring 5 mm maximally, previously\n8 mm on ___. It remains predominantly hypodense with similar appearing\nminimally increased density inner rim suggestive of dural thickening. No\ndefinite new areas of hemorrhage. No infarct or midline shift. Visualized\nparanasal sinuses, inner ear or cavities, and mastoid air cells appear clear. \nSoft tissue density is noted within the left external auditory canal which may\nrepresent cerumen.", + "output": "1. Probable pulmonary right convexity subdural hematoma with decreased size,\nnow measuring 5 mm, previously 8 mm on ___ prior exam, as described.\n2. No definite evidence of new hemorrhage or acute large territorial infarct.\nPlease note MRI of the brain is more sensitive for the detection of acute\ninfarct." + }, + { + "input": "Tiny right extra-axial fluid collection has nearly resolved since ___,\nminimal dural thickening remains undermining craniotomy flap. Generalized\nbrain parenchymal atrophy stable. No hydrocephalus. There is no evidence of\ninfarction,acute hemorrhage,edema,or mass.\n\nThere is no evidence of fracture. Right frontoparietal craniotomy the\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "Interval near resolution of previously seen low-attenuation extra-axial fluid\ncollection, mild linear dural thickening remains at craniotomy site.\nNo new hemorrhage.\nBrain parenchymal atrophy." + }, + { + "input": "There is no intra or extra-axial mass effect, acute hemorrhage or large\nterritorial infarct. The sulci, ventricles and cisterns are within expected\nlimits for the degree of mild to moderate senescent related global cerebral\nvolume loss. There remains a thin rim of dural thickening overlying the right\nfrontoparietal convexity, unchanged from prior examination. The patient is\nstatus post right frontal parietal craniotomy, also unchanged in appearance. \nNo acute osseous abnormality. The visualized paranasal sinuses are clear. \nThe orbits are unremarkable. The mastoid air cells middle ears are well\npneumatized and clear.", + "output": "1. Unchanged mild dural thickening underlying a right frontal and parietal\ncraniotomy. No evidence for reaccumulation of previously described subdural\nhematoma.\n2. No acute intracranial abnormality on noncontrast head CT. Specifically no\nlarge territory infarct or new intracranial hemorrhage." + }, + { + "input": "Right frontoparietal craniotomy. There is no evidence of infarction,\nhemorrhage, edema, or mass. No hydrocephalus. Mild brain parenchymal\natrophy.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No residual or new hemorrhage." + }, + { + "input": "Trace subdural hemorrhage overlies the right frontoparietal area measuring 2\nmm in diameter is slightly decreased in size compared to multiple prior CTs.\n\nThere is no new intracranial hemorrhage, mass or large territorial infarct.\nThere is generalized cerebral atrophy with ex vacuo dilatation of the\nventricular system. Craniotomy changes are stable. The paranasal sinuses are\nclear. The orbits appear normal. The mastoid air cells are clear.", + "output": "No interval expansion of the known right subdural hemorrhage." + }, + { + "input": "The patient is status post prior right frontal parietal craniotomy, unchanged\nfrom prior exam. No residual right convexity subdural hematoma is identified.\nThere is no intra or extra-axial mass effect, acute hemorrhage or large\nterritorial infarct. The sulci, ventricles and cisterns are prominent, but\nwithin expected limits for the degree of mild senescent related global\ncerebral volume loss. No acute osseous abnormality. The visualized paranasal\nsinuses are essentially clear. The visualized orbits are unremarkable. The\nvisualized mastoid air cells middle ears are clear.", + "output": "1. Interval resolution of right convexity subdural hematoma. No evidence of\nre-expansion. No new intracranial hemorrhage.\n2. No acute intracranial abnormality on noncontrast head CT. Specifically no\nevidence for acute large territory infarct. No intracranial mass effect.\n3. Additional findings as described above." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "Normal head CT. Consider MRI for evaluation of acute ischemia." + }, + { + "input": "Study is mildly degraded by motion. There is no evidence of infarction,\nhemorrhage, edema, or mass. The ventricles and sulci are normal in size and\nconfiguration for age. There are periventricular and subcortical lucencies,\nwhich may represent small vessel ischemic changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Study is mildly degraded by motion.\n2. Within limits of study, no acute intracranial abnormality.\n3. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration for age. Subtle areas of\nperiventricular and subcortical white matter hypodensities likely represent\nchronic small vessel ischemic change\nThere is no evidence of fracture. Fluid in the posterior nasopharynx is\nsecondary to intubation. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect.\n\nThe salivary glands are without obvious mass or adjacent fat stranding. The\nthyroid gland appears normal. There is no lymphadenopathy by CT criteria\nthough evaluation is limited by lack of contrast.\n\nAn endotracheal tube is in place. Lungs are better characterized on separate\ndedicated CT torso examination. There is no fracture or dislocation. There\nis narrowing of the T1-T2 intervertebral disc space with a subtle areas of\nendplate lucency which was better assessed on prior MR though there does not\nappear to be overt bony destruction, and may represent a Schmorl's node. \nThere are mild multilevel degenerative changes. There is a millimetric\nanterolisthesis of C4 on C5. There are otherwise no osseous lesions.", + "output": "1. There is mild anterolisthesis at C4 upon C5 level, probably degenerative in\nnature, otherwise, unremarkable noncontrast CT examination of the neck.\n2. T1-T2 intervertebral disc space narrowing in location of finding suspicious\nfor osteomyelitis discitis on prior MR. ___ endplate changes are seen at\nthis level without overt cortical destruction." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. There are atherosclerotic calcifications of the\nintracranial internal carotid arteries.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nethmoid air cells. The visualized portion of the remaining paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. Soft tissue density is\nseen in bilateral external auditory canals, likely representing cerumen. The\nvisualized portion of the orbits are unremarkable.\n\nA 1.7 x 0.6 cm fat containing lesion is seen overlying the left side of the\nfrontal bone, likely representing a subgaleal lipoma.", + "output": "No acute intracranial process." + }, + { + "input": "Evaluation for hemorrhage is limited due to recent contrast administration. \nWithin this limitation, there is no evidence of mass, hemorrhage or\ninfarction. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. There is a possible chronic left inferior orbital\nwall blowout fracture. The visualized portion of the orbits are normal.", + "output": "1. No evidence of mass, hemorrhage or infarction.\n2. Imaging somewhat limited due to the presence of intravenous contrast.\n3. Possible chronic left inferior orbital wall blowout fracture." + }, + { + "input": "Dental amalgam streak and beam hardening artifact, and mild motion limits\nstudy. Within these confines:\n\nCT HEAD WITHOUT CONTRAST:\nThere is no definite evidence of no evidence of hemorrhage, edema, mass\neffect, or acute vascular territorial infarction. Right parietal questioned\nminimal hyperdensity suggestive of artifact versus calcification (see 04:26). \nPeriventricular, subcortical, and deep white matter hypodensities are\nnonspecific, but likely sequelae of chronic small vessel ischemic disease in a\npatient of this age. Prominence of the ventricles and sulci and in particular\nthe sylvian fissures bilaterally is consistent with atrophy.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nAn approximately 1 mm left A1 segment probable infundibulum is noted (see\n5:237, 651:16). There is extensive atherosclerotic calcifications along the\ncavernous and supraclinoid internal carotid arteries bilaterally without\nocclusion. The vessels of the circle of ___ and their principal\nintracranial branches appear normal without stenosis, occlusion, or aneurysm\nformation. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is a three vessel aortic arch with moderate atherosclerotic\ncalcifications. The origin of the branch vessels, bilateral common carotid\nand vertebral arteries are patent. The left vertebral artery is dominant. \nMultifocal irregularity and narrowing of the V4 segment of the right vertebral\nartery with at least moderate focal stenosis at the junction with the basilar\nartery is probably related to atherosclerotic disease (___:18).\n\nNote is made of medialized retropharyngeal course of bilateral common and\ninternal carotid arteries there is focal calcified plaque in the left internal\ncarotid artery just distal to the carotid bifurcation however there is no\nappreciable luminal narrowing by NASCET criteria. The carotid and vertebral\narteries and their major branches otherwise appear normal with no evidence of\nstenosis or occlusion. There is no evidence of internal carotid stenosis by\nNASCET criteria.\n\nOTHER:\nEvaluation of the lung parenchyma is limited by extensive respiratory motion\nartifact. Multiple scattered prominent mediastinal lymph nodes do not meet\nimaging criteria for lymphadenopathy. There is no lymphadenopathy by CT size\ncriteria. There are multiple hypodense nodules in the left lobe of the thyroid\ngland, largest measuring 1 cm (5:63).", + "output": "1. Dental amalgam streak and beam hardening artifact, and mild motion limits\nstudy.\n2. No definite evidence of acute intracranial hemorrhage or large territory\ninfarction. Please note MRI of the brain is more sensitive for the detection\nof acute infarct.\n3. Scattered cervical carotid atherosclerotic disease as described, with no\nevidence of internal carotid artery stenosis by NASCET criteria.\n4. Multifocal narrowing of the V4 segment of the right vertebral artery with\nat least moderate focal stenosis at the junction with the basilar artery.\n5. Approximately 1 mm left A1 segment probable infundibulum.\n6. No definite evidence of occlusion, high-grade stenosis, or aneurysm greater\nthan 3 mm involving the circle of ___ or its major tributaries.\n7. Multiple bilateral thyroid nodules, as described. The ___ College of\nRadiology guidelines suggest that in the absence of risk factors for thyroid\ncancer, no further evaluation is recommended." + }, + { + "input": "Images are slightly degraded by motion.\n\nCompared with the prior studies, there are new hyperdense foci along the right\nsylvian fissure measuring 0.8 cm (02:13) and in the left occipital lobe\nmeasuring approximately 1.0 cm (02:14). There is no large territorial\ninfarction.\n\nThe ventricles and sulci are prominent, compatible with age related\ninvolutional change. Subcortical and periventricular white matter\nhypodensities are nonspecific, but likely sequela of chronic small vessel\ndisease. Atherosclerotic vascular calcifications are noted of bilateral\ncavernous portions of internal carotid arteries.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Study is mildly degraded by motion.\n2. New right sylvian fissure and left occipital hyperdense foci since ___, concerning for acute microhemorrhages related to patient's\nhistory of cerebral amyloid angiopathy. Please note that small masses are not\nexcluded on the basis of this examination.\n3. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described.\n\nNOTIFICATION: The above findings were communicated via telephone by Dr.\n___ to Dr. ___ at 03:45 on ___, 3 min after discovery." + }, + { + "input": "Previously seen small foci of hemorrhage are less conspicuous today. There is\nno new hemorrhage. There is no evidence of acute major vascular territorial\ninfarction, edema or mass effect.\n\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Mild bilateral periventricular and subcortical white matter\nhypodensities are nonspecific, but likely reflect a sequela of moderate\nchronic small vessel disease. There is stable chronic cortical infarct in the\nright parietal lobe at the vertex.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Previously seen foci of hemorrhage are less prominent.\n2. There is no new hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are normal in size and configuration. A left\n___ space is again seen (2:9), unchanged.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality or acute fracture." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute hemorrhage, edema, mass effect, or loss of\ngray/white matter differentiation. Ventricles, sulci, and basal cisterns are\nnormal in size a cavum septum pellucidum et vergae is a normal variant.\n\nNo concerning calvarial lesions. Minimal mucosal thickening along the floors\nof the maxillary sinuses. Other paranasal sinuses and mastoid air cells are\nwell aerated. The orbits appear unremarkable.\n\nCTA NECK:\nThere is a 3 vessel aortic arch. Common carotid, cervical internal carotid,\nand vertebral arteries are widely patent. Specifically, no carotid stenosis\nby NASCET criteria. No dissection.\n\nCTA HEAD:\nA curvilinear hypodensity is seen along the lateral margin of the left\ncavernous internal carotid artery (3:222), likely representing a dural\nindentation. Dissection flap is less likely. There is a prominent adjacent\nvein on the other side of the dural indentation.\n\nOtherwise, no evidence for flow-limiting stenosis in the major intracranial\narteries. No evidence for an aneurysm. Dural venous sinuses are patent.\n\nOTHER:\nMultiple prominent cervical lymph nodes are likely secondary to the patient's\nyoung age. The thyroid is unremarkable. Included upper lungs appear\nunremarkable allowing for technique.", + "output": "1. No evidence for acute intracranial hemorrhage or mass effect.\n2. Curvilinear hypodensity along the lateral margin of the left cavernous\ninternal carotid artery likely represents a dural indentation. A dissection\nflap is less likely.\n3. Otherwise unremarkable CTA of the head and neck.\n\nNOTIFICATION: Electronic preliminary report regarding the above findings was\nprovided by Dr. ___ on FRI ___ 12:26 ___." + }, + { + "input": "There is no evidence of infarction, hemorrhage, mass lesion, or edema. The\nventricles and sulci are normal in size and configuration for the patient's\nage. Gray-white matter differentiation is preserved.\n\nSurgical hardware is seen along the anterior wall of the left maxillary sinus,\nassociated with prior left maxillary sinus reconstruction surgery. Patient is\nstatus post left-sided ethmoidectomy and creation of a antral nasal window.\nThere is sclerosis of the lateral wall of the left maxillary sinus which can\nbe seen in the setting of chronic inflammation. Otherwise, the visualized\nportion of the paranasal sinuses, mastoid air cells and middle ear cavities\nare clear. The visualized portion of the orbits are clear.", + "output": "1. No evidence of infarction or hemorrhage." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction.\n\nVentricles and sulci are normal in overall size and configuration. The imaged\nparanasal sinuses are clear. Mastoid air cells and middle ear cavities are\nwell aerated. The bony calvarium is intact.", + "output": "No intracranial hemorrhage or other acute intracranial abnormality." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal for patient age. Minimal calcified\natherosclerosis of the cavernous segments of both internal carotid arteries.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavitiesare well pneumatized. The visualized portion of the orbits are\nnormal.", + "output": "No acute intracranial abnormality" + }, + { + "input": "There is no acute intracranial hemorrhage, edema, or mass effect. Ventricles\nand sulci are age appropriate in size and configuration. Basal cisterns are\npatent. Gray-white matter differentiation is preserved.\n\nOrbits are unremarkable. Visualized paranasal sinuses demonstrate mild\nmucosal thickening within the ethmoidal air cells. Remaining sinuses are\nclear. Note is made of partial opacification of left mastoid air cells. The\nright mastoid air cells are clear. Middle ear cavities are clear. The bony\ncalvarium is intact.", + "output": "No acute intracranial abnormality. Partial opacification of left mastoid air\ncells, correlate with possible inflammatory or infectious process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. There\nis cavum septum pellucidum et vergae, incidental congenital finding. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nPeriventricular and subcortical white matter hypodensities are nonspecific but\nsuggest chronic small vessel ischemic changes.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "1. No acute intracranial process." + }, + { + "input": "Site of primary redness see at the scalp vertex is not covered on this scan. \nExophytic skin lesion left lateral neck at the level of the larynx, measures 4\ncm in diameter, and contains 7 mm raised component. It contacts anterolateral\nmargin of the left sternocleidomastoid muscle.\n\nNo level ___ adenopathy, few scattered subcentimeter lymph nodes. No intra\nparotid, periauricular or suboccipital pathologic lymph nodes.\n\nNo aerodigestive tract mass. Well-circumscribed 1.4 cm lesion left thyroid\nlobe. No salivary gland abnormality. Patent neck vessels. Atherosclerotic\ndisease bilateral proximal ICA, without evidence of significant narrowing. \nVisualized lungs are clear. Mild paranasal sinus disease. Periapical lucency\nleft maxilla tooth ___ represent periapical cyst, granuloma or subclinical\ninfection. Degenerative changes spine. Moderate to severe central canal\nnarrowing C5-C6 level", + "output": "1. Superficial exophytic skin mass left anterior mid neck.\n2. No adenopathy.\n3. 1.4 cm left thyroid lesion, recommendations below.\n4. Periapical lucency tooth 9, see above.\n5. Moderate to severe central canal narrowing C5-C6 level.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or older.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "Large scalp mass at the vertex, nodular and exophytic, measures 4.3 cm by 5.5\ncm in diameter with dominant exophytic component nodule which measures 1.1 cm\nin height and 2.2 cm in diameter.\n\nSeparate, additional 1.6 cm x 1.4 cm by 8 mm in thickness exophytic skin mass\nright vertex, more anterior and separate from the dominant mass above.\n\nBoth masses infiltrate subcutaneous scalp fat, extend to the bone surface. No\nevidence of adjacent bone irregularity to suggest osseous involvement. Patent\nsuperior sagittal sinus.\n\nPosterior left scalp defect may be related to prior surgery.\n\nSerpiginous slightly nodular bilateral suboccipital abnormalities are in\ncontiguity with vessels. 7 mm nodular fullness in the left suboccipital zone\nmay be ectatic vessel versus lymph node, series 11 image 186. Tortuous vessel\nis more likely. Ultrasound could help distinguish between 2 possibilities.\n\n\nThere is no evidence of fracture, infarction, hemorrhage, edema, or\nparenchymal mass. Mild brain parenchymal atrophy. Findings consistent with\nmild chronic small vessel ischemic changes. No intracranial metastasis.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Scalp masses at vertex.\n2. No evidence of bone invasion.\n3. 7 mm left suboccipital nodular fullness, likely tortuous vessel, lymph node\nis less likely." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\n There is no evidence of acute large territorial infarction, hemorrhage,\nedema, or mass effect. Ventricles and sulci are prominent, consistent with\nage-related global parenchymal loss. Subcortical, periventricular and deep\nwhite matter hypodensities are nonspecific, but likely reflect the sequela of\nchronic microangiopathic ischemic disease.\n\nThere is no fracture. The visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The patient is status post\nbilateral lens replacement surgery, otherwise, the visualized portions of the\norbits are normal. The patient is edentulous.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without high-grade stenosis, occlusion, or aneurysm. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThere is 3 vessel aortic arch morphology. There are nonocclusive\natherosclerotic calcifications of the proximal right subclavian artery. \nBilateral carotid and vertebral artery origins are patent.\nThere are atherosclerotic calcifications at the common carotid artery\nbifurcations bilaterally, as well as mild carotid siphon atherosclerotic\ncalcifications. There is no stenosis of the cervical internal carotid\narteries by NASCET criteria.\nThe vertebral arteries are unremarkable.\n\nThere are mild-to-moderate multilevel degenerative changes of the cervical\nspine, worst from C5-C7, including intervertebral disc space narrowing at\nC6-C7 with hip posterior disc osteophyte complex with mild to moderate\nvertebral canal narrowing. There is no acute fracture.\n\nOTHER:\nThe esophagus is patulous and contains a column of fluid, extending to the\nthoracic inlet, consistent with severe reflux. There is a 6 x 9 mm left upper\nlobe solid nodule (301:446). There is a small left pleural effusion. The\nvisualized portion of the lungs are otherwise clear. The visualized portion\nof the thyroid gland is within normal limits. There are multiple prominent\nparatracheal lymph nodes, but there is no lymphadenopathy by CT size criteria.", + "output": "1. No acute intracranial abnormality on noncontrast CT head. Specifically, no\nevidence of acute large territory infarct or intracranial hemorrhage.\n2. Allowing for mild atherosclerotic disease, unremarkable CTA of the head.\n3. Allowing for mild atherosclerotic disease, unremarkable CTA neck. There is\nno stenosis of the cervical internal carotid arteries by NASCET criteria.\n4. Patulous esophagus containing fluid, compatible with severe reflux.\n5. There is a 9 mm left upper lobe pulmonary nodule. Small left pleural\neffusion also identified.\n6. Additional findings as described above.\n\nRECOMMENDATION(S): For incidentally detected single solid pulmonary nodule\nbigger than 8mm, a follow-up CT in 3 months, a PET-CT, or tissue sampling is\nrecommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Prominence of\nventricles and sulci is consistent with age related involutional changes.\n\nThere is mild soft tissue swelling and a skin defect in the left supraorbital\nregion suggestive of laceration. No osseous abnormalities seen. Mild mucosal\nthickening of the ethmoidal air cells and left frontal sinus. Otherwise,\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\norbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Left supraorbital soft tissue swelling." + }, + { + "input": "Trace mucosal thickening with mild narrowing of the bilateral frontal sinus\ndrainage pathways, narrowed proximal bilateral infundibula, otherwise patent\ndrainage pathway and frontal sinuses. These findings have improved since ___.\n\nTrace mucosal thickening bilateral frontal sinuses, mildly narrowed left\ninfundibulum of ostiomeatal unit, patent right side, no fluid.\n\nMild mucosal thickening bilateral ethmoid sinus, similar. Mild mucosal\nthickening left sphenoid sinus, more prominent since prior. Patent right\nsphenoid sinus.\nNarrowed left, patent right sphenoid sinus infundibula..\n\nNo facial soft tissue swelling.\n\nIntact cribriform plates, medial orbital walls. Very beginning of ethmoid air\ncells just above and anterior to the anterior to model arteries. No air cells\nabove posterior model arteries. Nasal septal deviation to the right. Left\nconcha bullosa. Clear nasal cavity. Carotid canals, optic canals are covered\nby bone. No periapical lucencies. Degenerative arthritis bilateral\ntemporomandibular joints, right greater than left. Clear mastoids. \nDegenerative changes cervical spine.", + "output": "1. Mild mucosal thickening paranasal sinuses. No fluid." + }, + { + "input": "There is no evidence of infarction,intracranial hemorrhage,edema,or mass. The\nventricle and sulci and cerebellar are prominent, consistent with global\ncerebral volume loss. Dense dural calcification is noted along the anterior\nfalx.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of acute intracranial process or hemorrhage." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nacute major vascular territorial infarction. Confluent hypodensities in the\nsupratentorial white matter are grossly unchanged, nonspecific but likely\nsequela of chronic small vessel ischemic disease in this age group. Moderate\nage-related global parenchymal volume loss is again seen with prominent\nventricles and sulci.\n\nParanasal sinuses and mastoid air cells are essentially well aerated. The\norbits appear unremarkable.\n\nCT PERFUSION:\nNo perfusion abnormality.\nCBF<39%: 0ml\nTmax>6.0s: 0ml\nMismatch volume: 0ml\nMismatch ratio: none\n\nCTA NECK:\nThere is mild calcified plaque at the origins of the innominate and bilateral\nsubclavian arteries without flow-limiting stenosis. There is mild calcified\nplaque at bilateral internal carotid artery origins without stenosis by NASCET\ncriteria. There is mild irregularity of right greater than left distal\ninternal carotid arteries without flow-limiting stenosis, statistically likely\natherosclerotic in this age group. There is mild focal irregularity/beading\nof the proximal V3 segment of the left vertebral artery at the level of C2 and\nof the distal V3 segment, also statistically likely atherosclerotic in this\nage group. Right vertebral artery appears widely patent.\n\nCTA HEAD:\nThere is calcified plaque within bilateral carotid siphons without evidence\nfor flow-limiting stenosis. There is mild stenosis at the origin of the left\nMCA superior division, images 602: ___. No evidence for flow-limiting\nstenosis in the posterior circulation. No evidence for an aneurysm. Dural\nvenous sinuses are patent.\n\nOTHER:\nThe thyroid is heterogenous with multiple small nodules, up to 1 cm in the\nleft lower pole. No lymphadenopathy by CT criteria.\n\nEvaluation of the included upper lungs is limited by respiratory motion\nartifact. 3 mm subpleural nodule in the left upper lobe on image 4:77. Mild\npleural/parenchymal scarring is noted at the apices.\n\nNo evidence for suspicious bone lesions. Chronic healed fracture of the\npartially visualized left clavicle is noted (04:26). There are degenerative\nchanges in the cervical spine.", + "output": "1. No acute intracranial hemorrhage.\n2. No evidence for acute major vascular territorial infarction on noncontrast\nhead CT or CT perfusion study.\n3. No carotid stenosis by NASCET criteria. Mild irregularity of right greater\nthan left distal internal carotid arteries and V3 segment of the left\nvertebral artery statistically likely atherosclerotic in this age group.\n4. Mild stenosis at the origin of the left MCA superior division, likely\natherosclerotic.\n5. The thyroid is heterogenous with multiple small nodules, up to 1 cm in the\nleft lower pole. ACR guidelines do not recommend sonographic evaluation of\nthyroid nodules smaller than 15 mm in this age group in asymptomatic patients.\n6. 3 mm subpleural pulmonary nodule in the left upper lobe.\nCOMMENT:\nAn addendum to this report may be issued, if necessary, when 3D reformatted\nimages for the head CTA and curved reformatted images for the neck CTA are\nfinalized by the imaging left.\n\nRECOMMENDATION(S):\n1. For incidentally detected nodules smaller than 6 mm in the setting of an\nincomplete chest CT, no CT follow-up is recommended. See the ___ ___\nSociety Guidelines for the Management of Pulmonary Nodules Incidentally\nDetected on CT\" for comments and reference:\n___\n2. Thyroid nodule. No follow up recommended. Absent suspicious imaging\nfeatures, unless there is additional clinical concern, ___ College of\nRadiology guidelines do not recommend further evaluation for incidental\nthyroid nodules less than 1.0 cm in patients under age ___ or less than 1.5 cm\nin patients age ___ or older. Suspicious findings include: Abnormal lymph nodes\n(those displaying enlargement, calcification, cystic components and/or\nincreased enhancement) or invasion of local tissues by the thyroid nodule. \n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "No evidence of acute intracranial hemorrhage, midline shift, mass effect, or\nacute large vascular territorial infarct. There is prominence of the\nventricles and sulci suggestive of involutional changes. Moderate\nhypoattenuation of the periventricular and subcortical white matter is\nnonspecific but may represent sequela of microvascular ischemic changes. Mild\ncalcification of bilateral carotid siphons.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear.", + "output": "1. No acute intracranial process. MRI is more sensitive for the detection of\nacute infarction." + }, + { + "input": "There is no evidence of acute large territorial infarction hemorrhage, edema,\nor mass. Scattered periventricular, subcortical and deep white matter\nhypodensities are nonspecific, but likely reflect the sequela of chronic\nmicrovascular infarction. Dilatation of the ventricles is somewhat out of\nproportion to the degree of sulcal atrophy. Mild atherosclerotic\ncalcifications are demonstrated involving the cavernous carotid arteries.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial hemorrhage or mass effect.\n2. Dilatation of the ventricles appears somewhat out of proportion to the\ndegree of sulcal atrophy. While this could reflect central atrophy, normal\npressure hydrocephalus is not excluded and clinical correlation is\nrecommended." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are prominent compatible with age-appropriate involutional changes.\n\nThere is a small amount of air seen tracking along the left masticator space\nlikely secondary to intravenous catheter manipulation.\n\nThere is a small right frontal soft tissue swelling without evidence of\nunderlying fracture.\n\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\nThe orbits are unremarkable apart from bilateral lens replacements.", + "output": "1. Small right frontal soft tissue swelling without evidence of underlying\nfracture.\n2. No acute intracranial abnormality including no intracranial hemorrhage.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ in ___ ___ at 9:45 Am, 5 minutes after discovery of the\nfindings." + }, + { + "input": "Aero digestive tract:\n\nThere is no mass.\nThere continues to be prominence of the bilateral palatine tonsils, which\ncontain numerous tonsilliths, and a few hypodense areas surrounding the\ntonsilliths perc tracheal only on the right side for example image 79 of\nseries 3. This constellation of findings suggests chronic inflammation. The\nright tonsil is more prominent than the left. No convincing masslike\ncomponent is seen.\n\nNeck lymph nodes:\nAlthough there are a few mildly prominent lymph nodes at level 2A bilaterally,\nby size criteria, there is no adenopathy involving bilateral levels ___.\nThere is no retropharyngeal adenopathy.\n\nExtra nodal tumor spread:\nNot applicable.\n\nDeep neck muscles, masticator space:\nUnremarkable.\n\nBones, skull base:\nThere are no acute osseous findings. There are no suspicious bone lesions.\n\nVessels:\nThe major vascular structures enhance normally.\n\nBrachial Plexus:\nNo abnormality near the brachial plexus.\n\nThyroid, salivary glands:\nThere is no mass.\n\nOther findings:\nThere are no lung nodules.", + "output": "1. Nonspecific enlargement of the palatine tonsils, right greater than left,\nwith features indicating chronic inflammation." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema, or\nmass. The ventricles and sulci are normal in size and configuration. \nQuestion grossly homogeneous intravascular hyperdensity is noted, which may be\nseen in the setting of hemoconcentration. Atherosclerotic vascular\ncalcifications are noted of bilateral vertebral and cavernous portions of\ninternal carotid arteries.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nsphenoid sinus. The remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial process.\n2. Question grossly homogeneous intravascular hyperdensity, which may be seen\nin the setting of hemoconcentration. If clinically indicated, consider\ncorrelation with CBC.\n3. Paranasal sinus disease, as described.\n4. Probable atherosclerotic vascular calcifications, as described.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 04:19 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.\n\nA left subclavian and a left upper extremity venous graft are relatively\nhypodense to the blood pool. This may be artifactual, however the appearance\nwas similar on CT ___. There is extensive left axillary stranding in\nprominence of lymph nodes, which also appears similar to ___.", + "output": "1. No findings to explain the patient's jaw pain. No fluid collection in the\nhead and neck.\n2. Left subclavian graft and a second left upper extremity venous graft are\nnot clearly opacified, this may be artifactual and the appearance is similar\nto ___, but thrombosis can't be excluded. Axillary stranding and\nprominence of lymph nodes centered about the venous grafts are similar\nappearance to ___." + }, + { + "input": "There is no evidence of hemorrhage, edema, or mass effect.\nThe ventricles and sulci are normal in size and configuration and unchanged. \nNo acute skullfracture is identified.\nA sclerotic focus within the right mandibular head likely represents a bone\nisland or fibro-osseous lesion and stable.\nMild mucosal thickening is noted within the left maxillary sinus. Moderate\nethmoidal mucosal thickening.\nThe remainder of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial hemorrhage or mass effect or acute skull fracture.\nMild to moderate ethmoidal, mild left maxillary and minimal left sphenoidal\nmucosal thickening." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThere is an area of expansion in the diploic space extending to the cortex\ninvolving the left parietal bone just posterior to the coronal suture. This\nappears to correspond to the area of abnormality identified on the\nradionuclide bone scan. This area demonstrates very faint reduction in density\ncompared to normal calvarium. There is disruption of the inner table cortex.\nThe bone demonstrates a ground-glass pattern of density reminiscent of fibrous\ndysplasia. There is no thickening of the inner or outer tables as would be\nexpected for Paget's disease. The loss of density would be quite unusual for\nmetastases from prostate cancer. This lesion may be best evaluated by\ncomparison to prior studies if these are available to detect evidence of\nchange over time. An MRI examination may be helpful to determine whether there\nis any soft tissue abnormality associated with the lesion or invasion of the\nadjacent dura.\n\nThere is a right parietal bone osteoma.\n\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\nThe orbits are unremarkable.", + "output": "The lesion identified on the radionuclide bone scan demonstrates faint\nhypodensity involving the diploic space with mild thinning of the outer table\nand disruption of the inner table. The character of bone would be compatible\nwith fibrous dysplasia but the destruction of the inner table is worrisome. \nFurther evaluation should include comparison with prior studies if possible\nand consider an MRI examination to assess soft tissue extending intracranially\nor dural invasion." + }, + { + "input": "Intraventricular hemorrhage identified extending from the right basal ganglia\nto the lateral ventricle and also blood in the third ventricle and left\nlateral ventricle. There is blood seen in the fourth ventricle. There is\ndilatation of the temporal bones indicating no obstructive hydrocephalus.\nOverall no significant change from prior study. Extensive hypodensities in the\nwhite matter indicates small vessel disease.", + "output": "Intraparenchymal and intraventricular hemorrhage. Findings indicating\nhydrocephalus. No change since the previous outside CT examination. ." + }, + { + "input": "Since the previous study a left frontal approach ventricular drain is placed\nwith the tip in the region mild left foraminal narrowing. The ventricular size\nhas remained unchanged. Intraventricular blood is again identified. There is\nno significant change in the appearance of the hemorrhage seen. No new\nhemorrhage. Extensive small vessel disease noted.", + "output": "Interval placement of a left frontal ventricular drain. No new hemorrhage. \nNo change in ventricular size." + }, + { + "input": "A left frontal approach ventriculostomy catheter is identified terminating in\nthe left ventricle in unchanged position. When compared to prior examination,\nthe ventricles appear unchanged in configuration with unchanged\nintraventricular hemorrhage. Again seen is an evolving right basal ganglia\nintraparenchymal hemorrhage with surrounding edema, unchanged. There is no\nshift of normally midline structures. No new hemorrhage or infarction is\nidentified. The basal cisterns are patent. Diffuse white matter hypodensities\nlikely sequela of chronic small vessel disease. There is preservation of\ngray-white matter differentiation.\n\nMucosal thickening is again noted within bilateral maxillary sinuses. The\nremainder of the paranasal sinuses are unremarkable. Bilateral mastoid air\ncells and middle ear cavities are clear.", + "output": "1. Evolving right basal ganglia intraparenchymal hemorrhage without evidence\nof new hemorrhage. No shift of normally midline structures.\n\n2. Left frontal ventriculostomy catheter in unchanged position with stable\nventricular size." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction, mass or midline\nshift. There is no hydrocephalus. Visualized paranasal sinuses and mastoid\nair cells are clear. Periventricular and subcortical white matter\nhypointensities are compatible with chronic small vessel ischemic disease,\nunchanged. Continued encephalomalacia is seen at the site of right basal\nganglia hemorrhage. Left frontal burr hole is again seen. Again seen is the\nground-glass lesion in the left parietal bone measuring 2.2 x 0.9 cm,\nunchanged compared to ___.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,or\nmass effect. Moderate severe periventricular and deep white matter hypodense\nchanges are nonspecific but most likely sequela of microangiopathy. Ex vacuo\ndilatation of the ventricular system.\n\nThere is no evidence of fracture. Evidence of prior left frontal approach\nEVD. Mild mucosal thickening involving the maxillary sinuses. The mastoid\nair cells are clear. Calcification of the vertebral arteries and carotid\nsiphons bilateral. The visualized portion of the orbits are unremarkable.", + "output": "No acute intracranial hemorrhage. No fracture\n\nNo acute large territorial infarction.\n\nModerate severe white matter microangiopathic changes. Please note that this\nmay obscure a small infarct and if clinically indicated MRI may be performed." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are stably prominent reflecting age related\ninvolutional changes. Periventricular and subcortical white matter\nhypodensity is again noted, severe, suggestive of chronic microvascular\nischemic disease. Mild mucosal thickening is noted within the maxillary\nsinuses and ethmoidal air cells. The remainder of the imaged paranasal\nsinuses are well aerated as are the mastoid air cells and middle ear cavities.\nThe bony calvarium is intact aside from a chronic left frontal burr hole.", + "output": "No acute intracranial process. Chronic small vessel disease." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no, hemorrhage, edema, or mass. The ventricles and\nsulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear patent without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear patent with\nno evidence of dissection, stenosis or occlusion. There is no evidence of\ninternal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. There is a 10 mm hypodense\nright lobe thyroid nodule. There is no lymphadenopathy by CT size criteria.", + "output": "1. No intracranial hemorrhage or acute large territorial infarct.\n2. Patent cranial vasculature without significant stenosis, occlusion, or\naneurysm formation.\n3. Patent cervical vasculature without significant stenosis, occlusion, or\ndissection.\n4. 10 mm right thyroid lobe nodule. The ___ College of Radiology\nguidelines suggest that in the absence of risk factors for thyroid cancer, no\nfurther evaluation is recommended." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nMild opacification left ethmoid sinus. Clear mastoids, orbits, bones.", + "output": "No acute intracranial findings. No hemorrhage." + }, + { + "input": "A 4 mm hyperdense focus in the left parietal lobe currently measures 5 mm and\npreviously measured 4 mm 1 day prior and is relatively unchanged accounting\nfor slice selection. This region of hyperdensity remains concerning for\nsubarachnoid hemorrhage. The previously described small left frontotemporal\nsubdural hematoma, has re-distributed and now layers along the left temporal\noccipital region but is stable in maximum depth of 2 mm (series 2, image 14).\nThere is no shift of the midline structures. The ventricles and sulci are\nprominent consistent with age-related atrophy. Confluent periventricular and\nsubcortical white matter hypodensities likely represent the sequela of chronic\nsmall vessel ischemic disease. The basal cisterns are patent.\n\nA left frontal scalp laceration and hematoma is again noted. Left pre orbital\nsoft tissue swelling is also present. The orbits appear normal. No fracture is\nidentified. The paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear.", + "output": "Stable 4 mm hyperdense focus in the left parietal lobe concerning for\nsubarachnoid hemorrhage. Small left subdural hematoma is stable in size. Left\nfrontal scalp laceration and hematoma." + }, + { + "input": "There is a 4 mm hyperdense round focus in the left parietal region. This\nlesion is within the sulcus and given trauma this is concerning for\nsubarachnoid hemorrhage. In addition, there may be a small left frontotemporal\nsubdural hematoma, approximately 2 mm from the inner table. There is no shift\nof midline structures.\n\nThe ventricles and sulci are mildly prominent due to age-related cerebral\natrophy. There is extensive subcortical, deep, and periventricular white\nmatter hypodensities, which are most likely sequela of chronic small vessel\nischemic disease. The basal cisterns appear patent.\n\nLeft frontal scalp laceration and hematoma is noted, associated with left\npreorbital soft tissue swelling. There is no retrobulbar hematoma. No acute\ncalvarial fractures are seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. Atherosclerotic mural calcification of the\nbilateral internal carotid arteries is noted.", + "output": "1. 4mm hyperdense rounded focus in the sulcus overlying the left parietal\nlobe. Given trauma setting this is concerning for subarachnoid hemorrhage. \nFollow-up is recommended.\n2. Probable small left fronto-temporal subdural hematoma.\n3. Left frontal scalp laceration/hematoma and left periorbital soft tissue\nswelling. No retrobulbar hematoma. No acute calvarial fractures." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Prominent ventricles and sulci compatible with age-related\ninvolutional changes. Periventricular white matter hypoattenuation likely\nrepresents chronic small vessel ischemic disease.\n\nThere is mild mucosal thickening of bilateral ethmoid air cells. Remaining\nparanasal sinuses are clear. Mastoid air cells and middle ear cavities are\nwell aerated. The bony calvarium is intact. There are dense vascular\natherosclerotic calcifications of the bilateral carotid siphons.", + "output": "No acute intracranial abnormality. No fractures are identified." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect or infarction. The\nventricles and sulci are normal in size and configuration. The basal cisterns\nappear patent and there is preservation of gray-white matter differentiation.\nNo acute fracture is identified. Mild mucosal thickening in ethmoid air\ncells. Other visualized paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass. The ventricles and sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. Right maxillary mucosal retention cyst is\nidentified. The remaining paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial hemorrhage." + }, + { + "input": "The fracture of the anterior aspect of the right transverse process of the C4\nvertebral body extending to the transverse foramen is again noted, with mild\nassociated prevertebral soft tissue edema, similar to prior exam. The right\nvertebral artery is normal in this area. The carotid and vertebral arteries\nand their major branches are patent with no evidence of stenoses. No evidence\nfor dissection is seen.", + "output": "No vascular abnormalities. Normal right vertebral artery at the level of the\nright C4 transverse process fracture." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nloss of gray/ white matter differentiation. The ventricles, sulci, and basal\ncisterns are normal in size. There is mild calcification within the left\nglobus pallidus.\n\nThere is no evidence of acute calvarial fracture. Visualized paranasal\nsinuses and mastoid air cells are clear. Left frontal sinus is hypoplastic.", + "output": "No evidence for an acute intracranial abnormality.\n\nNOTIFICATION: These findings were discussed with Dr. ___ by Dr. ___\n___ telephone at approximately 1550, ___." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is moderate mucosal thickening of the\nanterior ethmoidal air cells. There is partial opacification of the left\nmastoid air cells. The paranasal sinuses are otherwise clear. The middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No evidence of acute intracranial hemorrhage or fracture.\n2. Partial opacification of the mastoid air cells and anterior ethmoidal air\ncells." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is partial opacification of the\nethmoid air cells. Otherwise, the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass. There\nis prominence of the ventricles and sulci suggestive of involutional changes. \nTwo rounded densities measuring 1.6 cm on the right (02:11) and 1.3 cm on the\nleft (02:13), with peripheral calcifications and abutting the suprasellar\ncistern, are most likely aneurysms, which may be arising from the bilateral\nICA termini. Peripheral hyperdensity within the left aneurysm is most likely\nintraluminal thrombus. Atherosclerotic calcifications of the right distal\nvertebral artery and bilateral carotid siphons are demonstrated.\n\nThere is no evidence of fracture. Partial opacification of the right mastoid\nair cells. Partial opacification of the right maxillary sinus, with air-fluid\nlevel and a minimally aerosolized component. An oval-shaped opacity in the\nleft maxillary sinus may be a mucous retention cyst. Otherwise, the remaining\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavitiesare unremarkable. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute hemorrhage or calvarial fracture.\n2. Approximately 1.6 cm and 1.3 cm bilateral, probable ICA termini aneurysms,\nwhich may be better assessed with dedicated head CTA or MRA.\n3. Partial opacification of the right maxillary sinus, with air-fluid level\nand a minimally aerosolized component, which may be related to recent\nintubation." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. There\nare small chronic infarcts in the medial right thalamus and in the left basal\nganglia. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. There are areas of periventricular and subcortical white\nmatter hypoattenuation that are nonspecific but most likely represent chronic\nsmall vessel disease. Severe calcification is seen at the right vertebral\nartery.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. Patient is status post right lens replacement, with\nstatus post surgical changes for retinal detachment surgery on the left.", + "output": "No evidence of acute intracranial abnormality including hemorrhage.\nSmall probably chronic infarcts in the right thalamus and left basal ganglia." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nacute major vascular territorial infarction. There is unchanged prominence of\nthe ventricles and sulci suggestive of involutional changes. Redemonstrated\nare probable small chronic infarcts in the medial right thalamus and left\nbasal ganglia. Mild periventricular and subcortical white matter\nhypodensities are nonspecific, but likely represent sequela of chronic\nischemic microvascular disease. Dense calcifications are again noted in the\nintracranial right vertebral artery and bilateral carotid siphons.\n\nMild mucosal thickening in the right ethmoid air cells. Mastoid air cells\nappear grossly well-aerated allowing for absence of dedicated bone algorithm\nimages. Status post right lens replacement. Postsurgical changes are again\nnoted in the left globe related to retinal detachment surgery.", + "output": "No evidence for acute intracranial abnormalities. MRI would be more sensitive\nfor an acute infarction, if clinically warranted." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mucosal thickening in the\nbilateral maxillary sinuses, sphenoid sinuses, right frontal sinus, and\nethmoid air cells, and aerosolized secretions in the right maxillary sinus. \nThe visualized portion of the remainder of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. No fracture or acute intracranial process.\n2. Paranasal sinus disease as described." + }, + { + "input": "Since the prior CT of the head obtained of the outside hospital, there has\nbeen significant progression of intraparenchymal hemorrhage in the inferior\ntemporal lobes bilaterally (2:7), left greater than right, along the right\nposterior temporal lobe (02:10), and along the frontal lobes bilaterally, left\ngreater than right (02:15). There is new mass effect upon the frontal horns\nbilaterally, and increase in leftward shift of the midline structures (by 4\nmm). Additionally, there is progression of intraparenchymal hemorrhage in the\nleft occipital lobe (02:15), and development of new subdural blood along the\nfalx superiorly on the right (02:26) and development of new subarachnoid blood\nin the right frontal lobe (02:24). There is no evidence of tonsillar\nherniation.\n\nThere is a large right temporal parietal subgaleal hematoma associated with a\nlongitudinal right temporal bone fracture which exits in the right middle ear.\nOpacification of the right middle ear as well as mastoid air cells is noted.\nOf note, the ossicles of the right ear are not well delineated on this study,\nhowever the orientation of the temporal bone fracture raises concern for\nossicular disruption.\n\nThere is near complete opacification of the sphenoid sinuses, and fluid within\nanterior and posterior ethmoid air cells bilaterally.", + "output": "1. Interval progression of intraparenchymal hemorrhage as noted above.\n2. New mass effect upon the frontal horns bilaterally. No evidence of\ntranstentorial or tonsillar herniation.\n3. New shift of the midline structures to the left by 4 mm.\n4. Right temporal parietal subgaleal hematoma associated with the right\ntemporal bone fracture, terminating in the right middle ear, with concern for\nossicular destruction. If there is further clinical concern, dedicated\ntemporal bone CT can be obtained.\n\nFindings discussed with the Trauma and Neurosurgery teams by Dr. ___ at 645pm\non ___." + }, + { + "input": "There is no significant interval increase in multiple areas of\nintraparenchymal hemorrhage. Specifically, hemorrhage involving the inferior\ntemporal lobes bilaterally, along the posterior temporal lobe, and along the\nfrontal lobes bilaterally left greater than right are largely stable from the\nprior examination without evidence of new hemorrhage. As before, there is mass\neffect upon the frontal horns bilaterally and leftward shift of midline\nstructures by approximately 4 mm, similar to the prior study. Hemorrhage in\nthe left occipital lobe and subdural blood along the falx superiorly is\nstable. There is no evidence of herniation. No evidence of acute infarction.\n\nA large right temporal parietal subgaleal hematoma and right temporal bone\nfracture is again demonstrated and is unchanged. Persistent opacification of\nthe right middle ears and right mastoid air cells is demonstrated, associated\nwith right temporal bone longitudinal fracture. As before, there is near\nopacification of the sphenoid sinus. There is mild mucosal thickening of the\nethmoid air cells.", + "output": "1. No significant change in multiple foci of intraparenchymal hemorrhage as\ndescribed above. Persistent mass effect upon the frontal horns bilaterally\nwithout evidence of tonsillar herniation. Persistent leftward shift of\nnormally midline structures by 4 mm.\n\n2. Unchanged right temporal bone longitudinal fracture associated with\nopacification of the middle of the right mastoid air cells." + }, + { + "input": "There has been no significant interval change to the multiple areas of\nintraparenchymal hemorrhage involving the inferior temporal lobes bilaterally,\nposterior right temporal lobe, and left frontal lobe with adjacent vasogenic\nedema. There is also unchanged subarachnoid hemorrhage in bilateral cerebral\nsulci as well as subdural blood along the falx and bilateral tentorium. There\nis layering of blood within the occipital horns of the lateral ventricles\nbilaterally. No new hemorrhage is identified.\n\nThere is persistent mass affect upon the frontal horns of the lateral\nventricles bilaterally with mild degree of left-to-right subfalcine\nherniation, as before. The ventricles are overall unchanged in size. There is\nno downward herniation.\n\nKnown right temporal bone fracture is again visualized. The right subgaleal\nhematoma has almost completely resolved. There is persistent partial\nopacification of the right mastoid air cells and middle ear cavity. There is\npersistent fluid nearly completely opacifying the large left sphenoid sinus\nand the small right sphenoid sinus, as well as persistent fluid in the ethmoid\nair cells, which may be related to prolonged supine positioning in the\ninpatient setting. Maxillary sinuses are not fully imaged.", + "output": "No significant interval change in multi focal intraparenchymal, subarachnoid,\nintraventricular, as well as subdural hemorrhage, as detailed above. Stable\nmass effect." + }, + { + "input": "A tiny lacunar infarct in the right inferior cerebellar hemisphere is again\nnoted. There is no acute intra-axial or extra-axial hemorrhage, edema, shift\nof normally midline structures, or evidence of acute major vascular\nterritorial infarction. There is periventricular and subcortical white matter\nhypodensity consistent with chronic microvascular ischemic disease. The\nventricles and sulci are normal in overall size and configuration for age. \nBasal cisterns are patent. Paranasal sinuses, mastoid air cells and middle\near cavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process. Small vessel disease.\n\nNOTIFICATION: D/w Dr. ___ (EM Intern)" + }, + { + "input": "Head CT: There is no evidence of hemorrhage, edema, masses, mass effect, or\ninfarction. The ventricles and sulci are normal in caliber and configuration.\nNo fractures are identified.\n\nHead CTA: The intracranial carotid and vertebral arteries and their major\nbranches are patent with no evidence of stenoses, occlusions or aneurysm\nformation. There is atherosclerotic calcification of the cavernous portions of\nthe internal carotid arteries bilaterally. A fetal origin of the left PCA is\nnoted.\n\nNeck CTA: There is is atherosclerotic calcification of the thoracic arch.\nThere is a stent in the right common carotid extending into the proximal right\ninternal carotid artery. There is an intraluminal filling defect within the\nstent consistent with plaque which is resulting in a 53% stenosis. There is\nirregular soft and hard plaque at the left carotid bifurcation with a\nresultant 20% stenosis. There is calcification at the origins of vertebral\narteries with mild narrowing on the right.\n\nThere are shotty superior mediastinal lymph nodes noted. The thyroid is\nunremarkable. There is no significant cervical lymphadenopathy. There are\ndegenerative changes noted in the cervical spine.", + "output": "1. Status post right carotid stenting. Plaque is seen within the right carotid\nstent and results in a 53% in stent stenosis.\n\n2. Irregular plaque at the carotid bifurcation with a resultant 20% stenosis\nof the proximal internal carotid artery.\n\n3. Unremarkable CTA of the head and non-contrast CT of the head." + }, + { + "input": "RIGHT:\n\nThere is fluid within the external auditory canal, increase compared to the\nhead CT from approximately 3 hours earlier. There is unchanged partial\nopacification of the middle ear cavity. The ossicles, scutum , and tegmen are\nintact. Superior semicircular canal dehiscence cannot be excluded in the\nabsence of dedicated Stenvers and ___ reformatted images. There is no\nevidence for enlarged vestibular aqueduct. The facial nerve follows a normal\ncourse through the middle ear. There is no evidence for inner ear dysplasia.\nThere is partial opacification of the mastoid air cells and complete\nopacification of the mastoid antrum, unchanged. No fracture is seen.\n\nLEFT:\n\nThe external auditory canal is patent. The middle ear cavity is clear. The\nossicles, scutum, and tegmen are intact. Superior semicircular canal\ndehiscence cannot be excluded in the absence of dedicated Stenvers and ___\nreformatted images. There is no evidence for enlarged vestibular aqueduct. The\nfacial nerve follows a normal course through the middle ear. There is no\nevidence for inner ear dysplasia. The mastoid air cells are partially\nopacified. No definite fracture line is visualized. However, small foci of\nintracranial air posterior to the mastoid (series 4, images 80, 95, 101), new\ncompared to head CT from approximately 3 hours earlier, are concerning for an\noccult fracture.\n\nOTHER:\n\nThere are foci of extra-axial air in the basal cisterns and suprasellar\ncistern, as well as along the inferior frontal lobes and left inferomedial\ntemporal lobe, new compared to the head CT from approximately 3 hours earlier.\nThe etiology is unclear, as no skullbase fracture is visualized. The\npreceding head CT demonstrated a right parasagittal fracture at the vertex\nextending through the right frontal bone into the right frontal sinus.\n\nThere is a small mucous retention cyst in the partially visualized right\nmaxillary sinus.", + "output": "1. Intracranial, mostly basal pneumocephalus, new compared to the head CT from\napproximately 3 hours earlier. The head CT from approximately 3 hr earlier\ndemonstrates a right parasagittal fracture at the vertex extending through the\nright frontal bone and the right frontal sinus, and disruption of the\nposterior right frontal sinus wall may represent the source of pneumocephalus.\nNo skull base fracture is seen.\n2. New foci of air along the left posterior mastoid and unchanged partial left\nmastoid air cell opacification are concerning for an occult left mastoid\nfracture, but there is no visible fracture line.\n3. Unchanged partial right mastoid air cell opacification and partial right\nmiddle ear cavity opacification, without a visible fracture line.\n4. Increased fluid in the right external auditory canal compared to the head\nCT from approximately 3 hours earlier.\n5. Bilateral superior semicircular canal dehiscence cannot be excluded in the\nabsence of dedicated Stenvers and ___ reformatted images. When these\nimages are produced, an addendum to this report will be issued." + }, + { + "input": "There is a stable right-sided parasagittal curvilinear nondisplaced full\nlength frontal bone fracture involving the anterior and posterior walls of\nthe right frontal sinus. The previously described pneumocephalus is again\nseen.\n\nThere is a mixed density bifrontal subacute subdural hematoma measuring 8 mm\nin maximal thickness (05:23). There is hyperdense subarachnoid hemorrhage\noutlining the sulci of the bilateral frontal lobes which is unchanged from the\n___ study. The left frontal 9 mm x 17 mm hyperdense intraparenchymal\nhematoma is again seen and appears stable.\n\nHowever, there are small new areas of subarachnoid hemorrhage in the\nbitemporal regions not seen in ___ study. New areas of bifrontal\nintraparenchymal hypodensities likely representing edema are also noted. \nAdditionally, there are small dependent hyperdense intraventricular\nhemorrhages seen within the occipital horns of the bilateral lateral\nventricles.\n\nThere is no evidence of acute large territorial infarction, mass, nor midline\nshift. There is symmetric cortical atrophy and prominent sulci and ventricles\nappropriate for age.\n\nThere is mild mucosal thickening of the right maxillary sinus. The frontal,\nethmoid, and bilateral sphenoid sinuses are clear. There is stable moderate\nfluid within the bilateral mastoid air cells, the right external auditory\ncanal, and the right middle ear cavity. However, there are no obvious\nfracture seen within the skull base. The left middle ear cavity is clear.\n\nThe visualized portion of the orbits are unremarkable. Nonspecific facial old\nsubcutaneous hyperdensities may represent dermal calcifications.", + "output": "1. Stable bifrontal subarachnoid hemorrhage with new bitemporal subarachnoid\nhemorrhage.\n2. New small bilateral occipital horn lateral ventricle intraventricular\nhemorrhages.\n3. Mixed density bifrontal subacute subdural hematoma measuring 8 mm in\nmaximum thickness\n4. Bifrontal intraparenchymal vasogenic edema without midline shift.\n5. Stable pneumocephalus\n6. Stable right-sided parasagittal curvilinear nondisplaced full length\nfrontal bone skull fracture with involvement of the anterior and posterior\nwalls of the right frontal sinus." + }, + { + "input": "Mixed density bilateral frontoparietal subdural hematomas are stable from\n___, measuring 7 mm maximally on the right and 6 mm maximally on the\nleft. High-density subdural hemorrhage layering along the left tentorium is\nunchanged in appearance from ___. Bifrontal subarachnoid hemorrhage\nadjacent to the falx is overall unchanged from ___, given slight\nredistribution. Adjacent bifrontal intraparenchymal hypodensities consistent\nwith contusion and small bilateral intraparenchymal hematomas are stable from\n___. Bitemporal intraparenchymal or subarachnoid hemorrhage is less\nprominent than on ___. Bilateral intraventricular hemorrhage in the\noccipital lobes of the lateral ventricles is overall unchanged from ___.\nNo definite new areas of hemorrhage or infarction identified.\n\nThe lateral and third ventricles are slightly larger than on ___ without\nevidence of transependymal CSF flow or temporal horn enlargement. There is no\nmidline shift. The basal cisterns are patent.\n\nNondisplaced right frontal calvarial fracture involves the anterior and\nposterior walls of the right frontal sinus and extends parasagittally along\nthe vertex, extending into the sagittal sinus without evidence of hyperdensity\nto suggest thrombus. Pneumocephalus is stable from ___.\n\nEvaluation of the skullbase is moderately limited by motion. Opacification of\nthe bilateral mastoid air cells appears unchanged from ___. No fracture\nis identified. The orbits appear unremarkable.", + "output": "1. Minimally larger lateral and third ventricles since ___, attention on\nfollow-up is warranted.\n2. Overall stable appearance of intracranial hemorrhage, detailed above,\nwithout definite new areas of hemorrhage or infarct.\n3. Stable appearing nondisplaced calvarial fracture involving the right\nfrontal sinus and extending into the sagittal sinus without evidence of\nsagittal sinus thrombosis. Attention to this area is warranted on follow-up." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass. Enlargement of the ventricles and widening of the sulci are is\ncompatible with age appropriate atrophy. Periventricular, subcortical, and\ndeep white matter hypodensities are compatible with chronic small vessel\ninfarction. Senescent symmetric calcifications of the basal ganglia are noted\nbilaterally. Dense atherosclerotic calcifications of the cavernous carotid\nand distal vertebral arteries are noted.\n\nNo acute osseous abnormalities seen. Aerosolized secretions are demonstrated\nwithin the sphenoid sinuses bilaterally with mild mucosal thickening\ndemonstrated in the ethmoid air cells, findings suggestive of ongoing\ninflammation. The orbits are unremarkable.", + "output": "1. No acute intracranial hemorrhage or mass effect.\n\n2. Aerosolized secretions within the sphenoid sinuses bilaterally may suggest\nacute inflammation.\n\nRECOMMENDATION(S): MRI is more sensitive for the detection of acute\ninfarction." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect.\n\nThere is hyperenhancement and enlargement left parotid gland with minimal\nhaziness of the surrounding fat. No abscess is identified. Limited\nevaluation for ductal stone with IV contrast. But no obvious stone\nidentified. The right parotid gland is unremarkable. The bilateral\nsubmandibular glands enhance symmetrically. There are no pathologically\nenlarged lymph nodes. There are multiple small enhancing nodes in the region\nof the parotid gland, likely reactive. The neck vessels are patent. There is\nfluid within the sphenoid sinus. In addition there is fluid and mild mucosal\nthickening of the visualized ethmoid air cells. There are calcifications of\nthe internal carotid arteries within the siphons bilaterally. There is dense\ncalcification at the carotid bifurcations bilaterally.\n\nImage portions of the lung apices demonstrate severe centrilobular and\nparaseptal emphysema. There is severe atherosclerotic disease of the thoracic\naorta. The thyroid is heterogeneous with small hypodense nodules, all less\nthan 1 cm. There are multilevel degenerative changes of the cervical spine\nmost pronounced at C4/5 where there is disc space narrowing. Mild\nanterolisthesis of C3/4 is likely degenerative.", + "output": "1. Hyperenhancement and enlargement of the left parotid gland, consistent with\nparotitis, no abscess identified. Limited evaluation for sialoadenitis with\nIV contrast, no obvious stone identified.\n2. Severe emphysema." + }, + { + "input": "There is a 25 x 35 x 38 mm hypo dense lesion deforming the anterior margin of\nthe left sternocleidomastoid mastoid muscle at the level of the angle of the\nmandible. There is a thin rim of enhancement surrounding this lesion. The\nlesion elevates and laterally displaces the adjacent parotid gland, but\nappears most likely separate from the gland. Although an abscess would be a\ndiagnostic consideration, there is little evidence of adjacent induration. \nThere is very mild thickening of the platysma muscle with no other evidence of\nfat plane inflammation. No regional adenopathy is detected. Another\npossibility would be a second branchial cleft cyst.\n\nThere are mucous retention cysts or polyps in the maxillary sinuses\nbilaterally. No osseous lesions are detected.\n\nEvaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.", + "output": "1. Mass indenting the left sternocleidomastoid muscle and parotid gland. \nAlthough an abscess is a diagnostic consideration, there is little evidence of\nsurrounding inflammation. A branchial cleft cyst is a more likely\nalternative." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. \nRedemonstration of senescent calcifications in the bilateral basal ganglia. \nUnchanged extent of periventricular and subcortical white matter\nhypodensities, nonspecific but probably reflecting sequela chronic small\nvessel disease. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No acute intracranial findings." + }, + { + "input": "No fractures are identified.\nThere is no evidence of facial swelling or fluid collection.\nBilateral mastoids appear normal.\nThe globes, extraocular muscles, optic nerves, and retrobulbar fat appear\nnormal.\nThe visualized upper aerodigestive tract appears normal.\nThe mandible and temporomandibular joints appear normal.\n\n There is mild mucosal thickening within the frontal sinuses, severe mucosal\nthickening within the ethmoid air cells bilaterally, mild bilateral sphenoid\nsinus mucosal thickening, moderate right and mild left maxillary sinus mucosal\nthickening. There is no bony sclerosis or bony erosions.\n\nIncidentally noted are prominent bilateral (left greater than right) temporal\nsuperficial vessels that are unchanged since ___.", + "output": "1. No evidence orbital cellulitis. Globes appear unremarkable.\n2. Moderate paranasal sinus disease." + }, + { + "input": "There is no evidence of large territorial infarction,acute intracranial\nhemorrhage,edema,or mass. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. Incidental calcifications in the\nbilateral basal ganglia.\n\nThere is no calvarial fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial hemorrhage or mass effect." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Bilateral periventricular and deep white matter\nhypodensities are nonspecific, but most likely related to chronic small vessel\nischemia. Senescent and symmetric calcifications are demonstrated in the\nbilateral basal ganglia.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nbilateral ethmoid air cells. Otherwise, the visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute fracture, territorial infarction,intracranial\nhemorrhage,edema,or mass. Senescent calcifications are again seen in the\nbasal ganglia bilaterally. Periventricular and subcortical white matter\nhypodensities, nonspecific but probably reflect sequela of chronic\nmicroangiopathy There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "No acute intracranial process." + }, + { + "input": "Correlation is made with noncontrast head CT dated the same day, ___.\n\nCTA HEAD:\nImages are significantly degraded by motion artifact. Within these confines:\n\n\nThere are calcifications of the right greater than left cavernous and\nsupraclinoid internal carotid arteries without significant stenosis. Within\nthe limits of this motion degraded study, the vessels of the circle of ___\nand their principal intracranial branches appear patent without definite\nstenosis, occlusion, or aneurysm. The dural venous sinuses are patent.\n\nCTA NECK:\nThe aortic arch demonstrates mild atherosclerotic calcifications. The\nbilateral common carotid artery origins appear within normal limits. There is\na medialized course of the bilateral common carotid arteries (2:104).\n\nThere is calcified plaque formation at the left carotid bifurcation without\nsignificant stenosis of the left internal carotid artery by NASCET criteria. \nThere is atherosclerotic calcified plaque at the right carotid bifurcation and\nproximal right internal carotid artery without significant stenosis by NASCET\ncriteria.\n\nPlease note that evaluation of the vertebral arteries is limited by motion\nartifact. Within these confines: The bilateral vertebral artery origins\nappear normal. The bilateral vertebral arteries are tortuous in course but\nappear patent without significant stenosis or definite dissection.\n\nOTHER:\nEvaluation of the visualized lungs is limited by motion artifact. There is a\nsmall opacity in the superior segment of the left lower lobe (2:13). \nAdditional focus of motion artifact versus ground-glass opacity is noted at\nthe left upper lobe near the apex (2:51). There is a 6 mm hypodense nodule\nwithin the left thyroid lobe, for which no specific follow up is recommended\nin a patient of this age unless otherwise indicated. Increased number of\nsubcentimeter short axis bilateral cervical lymph nodes are noted, likely\nreactive in nature. There are multilevel degenerative changes within the\nvisualized spine.", + "output": "Images are significantly degraded by motion artifact. Within this confine:\n\n1. Head CTA: Grossly patent circle of ___ without definite evidence of\nsignificant stenosis,occlusion,or aneurysm.\n2. Neck CTA: A medialized course of the bilateral common carotid arteries is\nnoted. There is calcified plaque at the bilateral carotid bifurcations and\nproximal internal carotid arteries without significant internal carotid artery\nstenosis on either side by NASCET criteria. Evaluation of the bilateral\nvertebral arteries is limited by motion artifact, but demonstrates grossly\npatent but tortuous bilateral vertebral arteries without definite evidence for\ndissection.\n3. Other: Small patchy opacity within the superior segment of the left lower\nlobe may reflect developing consolidation. Consider dedicated chest imaging,\nif clinically indicated.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nlarge mass. Bilateral basal ganglia calcification is again seen. \nPeriventricular and subcortical white matter hypodensities are nonspecific,\nbut likely represent chronic small vessel ischemic disease. The ventricles and\nsulci are normal in size and configuration. Vascular arteriosclerotic\ncalcifications are visualized in the carotid siphons bilaterally.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. There is bilateral carotid siphon\ncalcification.", + "output": "1. There is no evidence of acute intracranial process, mass or hemorrhage.\n\n2. Periventricular and subcortical areas of low attenuation are nonspecific\nand may represent changes due to chronic microvascular ischemic disease." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles are prominent which may be the result of central\ninvolution. Periventricular white matter hypodensity is noted most consistent\nwith chronic microvascular ischemic disease. Sulcal prominence likely reflect\nage related involutional change. Basal cisterns are patent. Imaged paranasal\nsinuses are well aerated as are the mastoid air cells middle ear cavities. \nBony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of intracranial hemorrhage, edema, or mass effect.\nConfluent hypodensity and suggestion of encephalomalacia is noted in the left\nparieto-occipital region (2:15, 602b:30). The ventricles and sulci are\nprominent, due to age related global atrophy. Extensive subcortical and white\nmatter hypodensities reflect the sequelae of chronic small vessel ischemic\ndisease.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial hemorrhage. Confluent left parieto-occipital hypodensity\nis of indeterminate age, but likely subacute or chronic. MRI is more\nsensitive for the detection of acute ischemia, and could be obtained if\nclinically indicated. Correlation with any outside imaging would also be\nuseful to determine the chronicity of this finding.\n\nNOTIFICATION: The findings were discussed via telephone by Dr. ___ with\nDr. ___ on ___ at 3:45 AM, 5 minutes after discovery of the\nfindings." + }, + { + "input": "There is no acute intracranial hemorrhage, loss of gray/ white matter\ndifferentiation, edema or mass effect. Prominent ventricles, cerebral sulci\nand cerebellar folia likely reflect age related involutional changes. An oval\nhypodensity in the right posterior external capsule may represent a chronic\ninfarct or a large perivascular space. Ill-defined foci of low density in the\nsubcortical, deep, and periventricular white matter of the cerebral\nhemispheres nonspecific, but likely sequela of chronic small vessel ischemic\ndisease in a patient of this age.\n\nNo fracture is identified. The orbits are unremarkable. Mild mucosal\nthickening within the ethmoidal air cells and the left maxillary sinus, and a\nsmall left maxillary sinus mucus retention cyst, are noted. The remainder of\nthe visualized paranasal sinuses middle ear cavities and mastoid air cells are\nclear.", + "output": "No evidence for an acute intracranial abnormality." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. The ventricles and sulci are prominent compatible with global\natrophy, more pronounced involving the cerebellum than the cerebrum. \nPeriventricular and subcortical white matter hypodensities are nonspecific,\nbut likely reflect sequelae of chronic small vessel ischemic disease. There\nis mild right maxillary mucosal thickening. The remaining imaged paranasal\nsinuses are clear. Mastoid air cells and middle ear cavities are well aerated.\nThe bony calvarium is intact.\nA partially empty sella is re- demonstrated. Calcification of the carotid\nsiphons is noted.", + "output": "1. No evidence of acute hemorrhage or fracture.\n2. Diffuse global atrophy more pronounced involving the cerebellum, unchanged." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. There are confluent periventricular and subcortical\nhypodensities, also in the gangliocapsular regions, which may represent small\nvessel ischemic changes.\n\nThere is no depressed calvarial fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavitiesare essentially\nclear. There are bilateral lens replacements.", + "output": "1. No acute intracranial hemorrhage.\n2. Mild to moderate volume loss, probable small vessel ischemic changes." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are age-appropriate. Basilar cisterns are\npatent.\n\nThere is mild ethmoid air cell mucosal thickening. Remaining included\nparanasal sinuses and mastoids are clear. There is a 1 cm soft tissue nodule\nin the left suboccipital region which is unchanged dating back to ___. Skull\nand extracranial soft tissues are otherwise unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Left : The external auditory canal is normal. The middle ear cavity is clear.\nThe ossicles and tegmen are intact. There is no evidence for enlarged\nvestibular aqueduct or superior semicircular canal dehiscence. The facial\nnerve follows a normal course through the middle ear. There is no evidence for\ninner ear dysplasia. The mastoids are clear. No effusion, tympanosclerosis,\notosclerosis.\n\nRight: The external auditory canal is normal. The middle ear cavity is clear.\nThe ossicles and tegmen are intact. There is no evidence for enlarged\nvestibular aqueduct or superior semicircular canal dehiscence. The facial\nnerve follows a normal course through the middle ear. There is no evidence for\ninner ear dysplasia. The mastoids are clear.\n\nOther: Visualized brain and neck soft tissues are normal.", + "output": "1. Normal temporal bones.\n2. No CT evidence of CP angle or IAC mass. MRI IAC exam would be more\nsensitive." + }, + { + "input": "There is no evidence of fracture, acute large territory\ninfarction,hemorrhage,edema,or discrete mass. There is prominence of the\nventricles and sulci suggestive of involutional changes. Periventricular and\nsubcortical white matter hypodensities are nonspecific but likely represent\nsequelae of chronic fracture of the ischemic disease in this age group.\n\nAgain seen is mild thickening of the bilateral ethmoid air cells and inferior\nfrontal sinuses. The visualized portion of the remaining paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The patient is status\npost lens replacement on the left. Otherwise, the visualized portion of the\norbits are normal.", + "output": "No acute intracranial abnormality." + }, + { + "input": "Neck lymph nodes: Adenopathy involving bilateral levels 2 measure up to 1.7 on\nthe right and up to 1.8 on the left. Level 1B adenopathy measure up to 1.7 on\nthe right. Other numerous not enlarged lymph nodes are noted in levels 1A and\n1B bilateral. There is no retropharyngeal adenopathy.\n\nBones, skull base:\nNo concerning osseous lesion is seen.\n\nVessels: Vessels are patent.\n\nThyroid, salivary glands: There is enlargement and hyperemia of the bilateral\nsubmandibular glands, with adjacent soft tissue edema. There is mild\nthickening of the bilateral platysmas muscles. No retropharyngeal edema is\nseen. No drainable fluid collection is seen. Subcutaneous edema tracks along\nthe anterior neck, but does not appear to extend to the chest. The thyroid\ngland is homogeneous.\n\nOther findings: Mild edema in the subcutaneous tissues of the floor of the\nmouth and anterior aspect of the neck with mild thickening of the platysma. \nThe partially imaged paranasal sinuses are clear. Partially imaged upper\nlungs are clear.", + "output": "1. Bilateral enlargement of the submandibular glands consistent with\nsialoadenitis. Reactive bilateral adenopathy at levels 1 and 2. No sialolith\nis noted. No drainable fluid collection. Mild subcutaneous edema tracks\nalong the anterior neck, but does not appear to extend to the chest.\n2. Reactive subcutaneous edema in the floor of the mouth and anterior aspect\nof the neck." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. There\nis prominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is severe mucosal thickening in the ethmoid air cells and left maxillary\nsinus. There is mild mucosal thickening in the right maxillary and bilateral\nsphenoid sinuses. The visualized portion of the mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No acute intracranial abnormality or evidence of mass.\n2. Severe paranasal sinus disease." + }, + { + "input": "There is no evidence of edema, acute intracranial hemorrhage, shift of\nnormally midline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are prominent consistent with age-related\ninvolutional change.\n\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. Multiple calcifications are seen in the partially\nimaged left parotid gland. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. The\nvisualized portion of the orbits are unremarkable. Artifact somewhat limits\nthe evaluation of posterior fossa.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute major vascular territorial infarction,\nhemorrhage, edema, or mass effect. The ventricles and sulci are normal in size\nand configuration.\n\nNo fractures are identified. There is mild mucosal thickening in the\nbilateral maxillary sinuses. Secretions are also noted in the bilateral\nethmoid air cells. Sinus opacification is likely related to recent\nintubation. Frontal and sphenoid sinuses are clear. Mastoid air cells and\nmiddle ear canals are clear bilaterally. Orbits are unremarkable. Trace\nsubgaleal hematoma is noted over the right vertex (3:54). A 6 mm nodular skin\nlesion is also noted at this level.", + "output": "Trace subgaleal hematoma over the right vertex without underlying fracture or\nintracranial hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Evaluation is limited by metallic streak artifact from the coils in the\nposterior fossa. There is edema at in the cerebellum from the known mass. \nThere is a right trans frontal ventriculostomy catheter which terminates\nwithin the foramen of ___. The position is unchanged from the prior study.\nVentricular size is further decreased. There is no acute hemorrhage. There is\nminimal air within the frontal horn of the right lateral ventricle. Basal\ncisterns are patent. No evidence of acute vascular territorial infarction.\nThe ventricles and sulci are normal in size and configuration. There is no\nfracture. The imaged paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear.", + "output": "Unchanged position of ventriculostomy catheter. Ventricular size has\ndecreased further from the prior study. No acute process." + }, + { + "input": "Comparison is made to most recent examination dated 2 days prior. Patient is\nstatus post right frontal approach ventriculostomy catheter. This appears to\nterminate at the 3r ventricle in similar position to prior study. Ventricles\nappear similar in size and configuration when compared to prior study, and\nsmaller compared to more earlier studies. There is interval resolution of\nintraventricular air. Basal cisterns are patent. No extra-axial fluid\ncollections.\n\nEvaluation is limited secondary to metallic streak artifact from coils within\nthe posterior fossa. Allowing for this, no acute hemorrhage, edema, or mass\neffect is identified. Left cerebellar hypodense areas are grossly stable.\nGray-white matter differentiation appears preserved. No acute fracture is\ndetected. Visualized paranasal sinuses are well aerated. Mastoid air cells and\nmiddle ear cavities bilaterally are clear. Carotid siphon vascular\ncalcifications are noted. Along the right frontoparietal convexity, the shunt\nappears to course caudally without interruption. Trace subcutaneous air is\ndecreased in the adjacent soft tissues when compared to prior study.", + "output": "Status post right frontal ventriculostomy catheter in unchanged position when\ncompared to prior study of ___.\nVentricles are similar in size and configuration.\n\nNo acute intracranial abnormality is detected." + }, + { + "input": "There is no substantial change in comparison to the prior study. The right\nfrontal ventriculostomy shunt terminating at about the level of the foramen of\n___ ventricle is unchanged in position.\nThe lateral and ___ ventricles however have diffusely increased in size\ncompared to the prior examination, mild-moderate in extent.\nLeft cerebellar hypodense areas extending into the left side of the pons, are\nagain seen without significant change however assessment limited on\nnoncontrast CT and due to adjacent artifacts.\nThere is no shift of normally midline structures. The basal cisterns are\npatent.\nThere is no acute hemorrhage. Gray-white matter differentiation is preserved.\nPartially imaged paranasal sinuses are clear.", + "output": "Diffuse, mild-moderate increased size of the lateral and ___ ventricles\ndespite little change in the position of the ventriculostomy catheter.\nCorrelate with catheter function and close followup as needed.\nOther details as above." + }, + { + "input": "Right frontal approach external ventricular drain is unchanged in position,\nterminating in the third ventricle. Overall, ventricular size has not\nsignificantly changed since the prior head CT, accounting for differences in\nscanning technique. Basal cisterns are patent and there is no evidence of new\nhemorrhage.\nLeft cerebellar hypodense area extending to the brainstem as before; limited\nassessment due to artifacts adjacent.\nGray-white matter differentiation is maintained. Imaged paranasal sinuses are\nclear.", + "output": "No significant interval change in ventricular size compared to ___,\nhowever still increased ventricular size compared to ___." + }, + { + "input": "Hyperdensity within the posterior fossa on the left is again compatible with\nembolization material from prior AVM treatment. There is persistent\nhypodensity in the left cerebellar hemisphere although now with associated\nvolume loss as opposed to mass effect seen on prior. The fourth ventricle is\nno longer partially effaced and is no longer shifted to the right. There is a\npersistent linear hyperdensity in the posterior fossa on the left (03:11)\nwhich corresponds to draining vein from AVM on prior CT angiogram.\n\nWithin limitation of artifact from the embolization material, there is no\nintra-axial or extra-axial hemorrhage, mass, midline shift, or acute vascular\nterritorial infarct. Gray-white matter differentiation is otherwise preserved.\nRight frontal ventriculostomy catheter is again seen with tip in the third\nventricle. The lateral and third ventricles are stable in configuration\ncompared to ___.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "Right frontal approach ventriculostomy with stable configuration of the\nlateral and third ventricles.\nPost treatment changes within the posterior fossa on the left with interval\ndecrease in mass effect." + }, + { + "input": "CT Head: There are multiple tortuous hyperdensities throughout the left\nposterior fossa, overlying the left cerebellar hemisphere, consistent with\ngiven history of underlying arteriovenous malformation.\n\nThe supratentorial brain parenchyma is unremarkable. There is no evidence of\nhemorrhage, midline shift, mass, mass effect, or acute infarction. The\nventricles, sulci and basal cisterns are normal in caliber and configuration.\nThe paranasal sinuses and mastoid air cells are clear. No fractures are\nidentified.\n\nCTA Head: There is a large tangle of vessels within the left posterior fossa\nand overlying the left cerebellar hemisphere, as well as extending along the\nleft aspect of the pons and midbrain and posteriorly along the posterior\naspect of the left thalamus. The nidus appears to measure approximately 5.1 cm\nTR x 4.3 cm SI x 4.2 cm AP. The bilateral vertebral arteries demonstrate\nrobust enhancement. The left posterior inferior cerebellar artery contributes\nas a feeding vessel. The most distal segment of the left vertebral artery is\nsmaller in caliber, compared to the more proximal segments, indicating\nincreased flow into the left height, and into the arteriovenous malformation.\nOther feeding vessels to the arteriovenous malformation include the left\nanterior inferior cerebellar, left superior cerebellar, as well as from\nbranches of the left external carotid artery (occipital branch). The venous\ndrainage is primarily through the basal vein ___ and into the\ninternal cerebral veins and draining into the straight sinus.\n\nThere is a hypoplastic right A1 segment, with a robust anterior communicating\nartery and left A1 segment. There is adequate opacification of the internal\ncarotid, anterior cerebral, middle cerebral, vertebral, basilar and posterior\ncerebral arteries. There is moderate atherosclerotic calcification of the\nbilateral carotid siphons. The right P1 segment is hypoplastic with a robust\nright posterior communicating arteries giving rise to a right fetal PCA. The\nleft posterior communicating artery is not definitely identified. There is no\nevidence of aneurysm, stenosis or occlusion.", + "output": "1. CTA head demonstrates a large left posterior fossa arteriovenous\nmalformation, measuring approximately 5.1 x 4.3 x 4.2 cm, with feeding vessels\nprimarily from the left the vertebral artery, ___, AICA, as well as from the\nleft external carotid artery branches. Venous drainage is primarily to the\nstraight sinus. For more details on the vascular supply, please refer to the\ncerebral angiogram performed the same date on ___.\n2. No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is mild mucosal thickening of the ethmoid air cells. The remainder of\nthe paranasal sinuses and mastoid air cells clear. Mild dental disease with\nperiapical lucencies. Evidence of tooth extraction in the left mandible.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. Note is\nmade of a hypoplastic right P1 segment which is most likely congenital given\nthe prominent right posterior communicating artery. The dural venous sinuses\nare patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No acute intracranial abnormality.\n2. No intra or extracranial vessel stenosis, occlusion, dissection or aneurysm\nformation.\n3. Mild dental disease with apical lucencies. Mild paranasal sinus disease." + }, + { + "input": "Right IJ central venous catheter terminates at the confluence of the right\ninternal jugular and right subclavian veins.\nThe origins of the arch vessels are patent.\nMinimal calcifications are noted at the right common carotid bifurcation. No\nfocal flow-limiting stenosis or occlusion noted.\nThe vertebral arteries are relatively codominant and patent without focal\nflow-limiting stenosis or occlusion.\nThe cavernous carotid segments are slightly tortuous in course with minimal\ncalcifications.\n\nProminent adenoids and palatine tonsils are noted.\nThe endotracheal tube is approximately 4.4 to 5.1cm above the tracheal\nbifurcation.\nA few small nodes are noted on both sides of the neck, not enlarged by size\ncriteria.\nMild opacification of some of the mastoid air cells, on the right side.\nSoft tissue material in the external auditory canals may relate to cerumen.\n\nNo suspicious osseous lesions are noted. Mildly prominent anterior osteophytes\nnoted in the thoracic spine.\n\nModerate to large nonhemorrhagic right pleural effusion. Scattered bilateral\nareas of ground-glass opacification and interlobular septal thickening likely\nrepresents interstitial edema; however, more confluent areas of opacification,\nparticularly in the left lower lobe may represent superimposed pneumonia.\n\nThe distal cervical internal carotid arteries measure 5.1 mm in diameter on\nthe left and 4.4 mm in diameter on the right. No evidence for dissection is\nseen.", + "output": "Right IJ central venous catheter terminates at the confluence of the right\ninternal jugular and right subclavian veins.\nPatent carotid and vertebral arteries in neck without focal flow-limiting\nstenosis or occlusion.\n\nStatus post intubation with appropriate position of the endotracheal tube\napproximately 4.4-5.1 cm above the carina.\nModerate to large right pleural effusion; parenchymal changes in lungs" + }, + { + "input": "There is no evidence of infarcthemorrhage, edema, or mass effect. Mild\nprominence of the ventricles and sulci is suggestive of age-related\ninvolutional change.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Mild prominence of the ventricles and sulci compatible with the patient's\nage. No evidence of hemorrhage or infarction" + }, + { + "input": "CTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion or aneurysm formation. The dural\nvenous sinuses are patent. There is minimal atherosclerotic calcification\ninvolving the cavernous carotid arteries.\n\nCTA NECK:\nThere is minimal atherosclerotic soft plaque in the left ICA near the\nbifurcation. The carotid and vertebral arteries and their major branches are\notherwise unremarkable with no evidence of stenosis or occlusion. There is no\nevidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Unremarkable head and neck CTA.\n2. No acute intracranial infarct." + }, + { + "input": "Patient is status post left temporoparietal craniotomy and partial resection\nof left temporal lesion with expected postoperative changes, including\npneumocephalus and blood products within the surgical site. Small amount of\nvasogenic edema persists within the left temporoparietal lobe, not\nsignificantly changed since prior exam.\n\nThere is approximately 2 mm left-to-right midline shift. No significant mass\neffect. Ventricles and sulci are normal in size configuration. No\nhydrocephalus or intraventricular blood. Basal cisterns remain patent. \nGray-white matter differentiation is preserved.\n\nThere is no evidence of hemorrhage or infarction. Mild periventricular white\nmatter hypodensities nonspecific, though likely reflect chronic small vessel\nischemic disease.\n\nNo osseous abnormalities identified. The imaged paranasal sinuses, mastoid\nair cells and middle ear cavities are clear. Visualized portions of the\norbits are unremarkable.", + "output": "1. Status post left temporoparietal craniotomy resection and partial resection\nof left temporal lesion with expected postoperative changes.\n2. 2 mm left-to-right midline shift. No significant mass effect. No\nhydrocephalus or intraventricular blood. Basal cisterns remain patent." + }, + { + "input": "Patient is status post left temporal craniectomy and resection of left\ntemporal lobe lesion. Increased vasogenic edema noted within the left\ncerebral hemisphere notably within the left temporal lobe, inferior frontal\nlobe and involving the internal capsule and left periventricular white matter.\nSubtle mass effect is noted on the temporal horn of the left lateral\nventricle. No midline shift or downward herniation. Findings potentially\nconcerning for disease progression. MRI may be performed to further assess. \nThere is no intra-axial or extra-axial hemorrhage. Basal cisterns are patent.\nVentricles appears similar in overall size and configuration. Postsurgical\nchanges along the left temporal bone noted. Paranasal sinuses, mastoid air\ncells and middle ear cavities are well aerated.", + "output": "Increased vasogenic edema in the left frontotemporal lobes as well as the\ninternal capsule and left periventricular white matter is concerning for\ndisease progression. No hemorrhage. Consider MRI to further assess." + }, + { + "input": "There is evidence of edema within the white matter of the left frontotemporal\nlobe and extending into the left internal capsule, similar in appearance to\nprior CT. There is no evidence of infarction or hemorrhage. The ventricles\nappear prominent.\n\nThere is no evidence of fracture. There is mild mucosal thickening within the\nleft maxillary sinus. The remaining visualized portions of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Stable appearance of vasogenic edema secondary to known tumor. No evidence\nof intracranial hemorrhage or mass effect." + }, + { + "input": "Vasogenic edema is seen within the left temporal lobe, centered around a\nheterogeneous, predominately hyperdense mass, which contains several foci of\namorphous high density, which may represent calcium, less likely hemorrhagic\nproducts. Precise measurement of this lesion is difficult in the absence of\nintravenous contrast, but spans approximately 3 x 2.5 cm. Edema in this\nregion results in effacement of sulci. The ventricles are normal in size and\nconfiguration. Basal cisterns are patent. There is mild periventricular\nwhite matter hypodensity, which is compatible with sequela of chronic small\nvessel ischemic disease.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "Ill-defined mass within the left temporal lobe measuring at least 3 x 2.5 cm\nwith associated vasogenic edema. Recommend further evaluation with contrast\nenhanced MRI of the brain.\n\nRECOMMENDATION(S): Recommend further evaluation with contrast enhanced MRI of\nthe brain" + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or acute vascular\nterritorial infarction. The extra-axial CSF spaces, at the vertex and in the\nposterior fossa are prominent related to some degree of diffuse parenchymal\nvolume loss.\nThe basal cisterns are patent. Gray-white matter differentiation is preserved.\n\nNo fracture is identified. The paranasal sinuses are notable for moderate\nmucosal thickening in the left maxillary sinus, mucous retention cyst in the\nright maxillary sinus and mild mucosal thickening of the frontal and ethmoid\nsinuses. Mastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "1. No acute intracranial hemorrhage or mass effect or obvious acute fracture.\n2. Maxillary sinus disease." + }, + { + "input": "There is no acute hemorrhage or mass effect. Gray/white matter\ndifferentiation appears preserved without evidence for a major vascular\nterritorial infarct. Foci of low density in subcortical insular white matter,\nmore extensive on the left than right, as well as in the right superior\nfrontal subcortical white matter (2:22, 601b:42) are nonspecific but likely\nrelated to small vessel ischemic disease. A small well-defined subcortical\nhypodensity in the left superior frontal gyrus, images 2:25 and 601b:55, is\nconsistent with a chronic small vessel infarct. Prominence of the ventricles\nand sulci indicates mild cerebral atrophy\n\nNo concerning bone lesions are seen. There is mild mucosal thickening in the\nright sphenoid sinus. A single right anterior ethmoid air cell is opacified. \nThere is a 3 mm osteoma in the left anterior ethmoid. There is mild mucosal\nthickening in the inferior frontal sinuses bilaterally. Mastoid air cells are\nwell aerated.", + "output": "No acute hemorrhage or mass effect. No evidence of a large major vascular\nterritorial infarction. Multi focal supratentorial white matter hypodensities\nare likely related to small vessel ischemic disease.\n\nRECOMMENDATION(S): Comparison with prior studies would be helpful given the\nhistory of recent cerebrovascular accident. MRI would be more sensitive for\nan acute infarction, if clinically warranted." + }, + { + "input": "There is no evidence of infarction,intracranial hemorrhage,edema,or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. In the craniocervical junction there\nis evidence of lack of fusion of the posterior arch of C1 is consistent with\nanatomical variation.", + "output": "1. Unremarkable head CT, there is no evidence of acute intracranial process\nor hemorrhage.\n\n2. Lack of fusion of the posterior arch of C1 is consistent with anatomical\nvariation" + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci, consistent with involutional changes,\nunchanged.\n\nNo acute fracture is seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. New air in the cavernous sinuses is consistent\nwith intravenous line placement, and is of no clinical significance. The\norbits are unremarkable.", + "output": "No intracranial hemorrhage or other acute intracranial process." + }, + { + "input": "There is increased dilatation of the ventricles, which is more than expected\nfor patient's given age. Given lack of trans-ependymal edema, this finding is\nunlikely to be acute. There is asymmetric inhomogeneity in the frontal horn\nof the right lateral ventricle, which is nonspecific, and a small cystic mass\nis not excluded (602:45). No intracranial hemorrhage is identified. There is\nno midline shift. A focus of gas in mild soft tissue swelling is seen along\nthe right frontal scalp (03:37).\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial hemorrhage. Small focus of gas and soft tissue\nswelling along the right frontal scalp is noted.\n2. There is increased dilatation of the ventricles, which is more than\nexpected for patient's given age and, given lack of transependymal edema, is\nunlikely to be acute and could be secondary to chronic hydrocephalus. Normal\npressure hydrocephalus would be unusual in a patient of this age.\n3. Asymmetric inhomogeneity is seen along the frontal horn of the right\nlateral ventricle, which is nonspecific and a small cystic mass is not\nexcluded.\n\nRECOMMENDATION(S): MRI of the head is recommended for further evaluation." + }, + { + "input": "Small focus of subarachnoid hemorrhage persists within the right sylvian\nfissure (02:16, 601b:54). No other intracranial hemorrhage is identified. \nThere is no shift of the normally midline structures. There is no evidence of\ninfarction, edema or mass. The ventricles and sulci are normal in size and\nconfiguration.\n\nThere is a similar degree of soft tissue swelling and hematoma over the right\nmaxilla and zygomatic process. There is a minimally displaced right orbital\nfloor fracture. There is a minimally impacted right lamina papyracea fracture\nwith herniation of fat into the anterior ethmoid air cells with associated\nblood products within the in right maxillary sinus and anterior ethmoid air\ncells (601b:21). The globes are intact. There is no retrobulbar hematoma.", + "output": "1. Stable isolated focus of right sylvian fissure subarachnoid hemorrhage.\n2. Right orbital floor and lamina papyracea fractures better assessed on\nsame-day CT facial bones." + }, + { + "input": "An ill-defined small area of hyperdensity in the right sylvian fissure is\nnoted (2:16, 601b:64). There is no evidence of large territorial acute\ninfarction, edema, or mass. The ventricles and sulci are normal in size and\nconfiguration.\n\nThere is extensive soft tissue swelling and hematoma overlying the right\nzygomatic process without definite maxillofacial fracture.\n\nThere is a minimally impacted right lamina papyracea fracture with herniation\nof fat into the anterior ethmoidal air cells (3:22, 601b:29). There are\nassociated blood products within the right anterior ethmoidal air cells and\nright maxillary sinus.\n\nThe visualized portion of the mastoid air cells and middle ear cavities are\nclear.", + "output": "1. Small right sylvian fissure subarachnoid hemorrhage.\n2. Minimally impacted right lamina papyracea fracture with fat herniation into\nanterior ethmoidal air cells.\n3. Right zygomatic process hematoma without definite associated fracture.\n4. If concern for additional maxillofacial fractures, consider dedicated\nmaxillofacial CT for further evaluation.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. in person on ___ at 2:00 AM, 1 minutes after discovery\nof the findings." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction, mass or midline\nshift. There is no hydrocephalus. Visualized paranasal sinuses and mastoid\nair cells are clear. There is no fracture. Mild brain atrophy seen. No focal\nabnormal increased inversion was within the brainstem.", + "output": "Mild brain atrophy. No acute abnormalities. No hemorrhage." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, or mass effect. Gray/ white\nmatter differentiation is preserved. Ventricles and sulci are prominent,\nconsistent with age related involutional changes. A chronic infarct is again\nseen in the right corona radiata, extending into the superior aspect of the\nright internal capsule and right putamen. Mild periventricular white matter\nhypodensities are also again seen, likely sequela of chronic small vessel\nischemic disease in this age group.\n\nThere is a left anterior parietal subgaleal hematoma. There is no evidence\nfor a fracture. Visualized portions of the paranasal sinuses and mastoid air\ncells are well aerated.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. Left anterior parietal subgaleal hematoma. No fracture.\n\nNOTIFICATION: No acute intracranial process." + }, + { + "input": "There is a circumscribed low-density focus adjacent to the left atrium of the\nleft lateral ventricle which may represent a chronic infarction (02:15). No\nevidence for acute major vascular territorial infarction, acute hemorrhage,\nedema, or mass effect. Normal size of the ventricles, sulci, and basal\ncisterns.\n\nNo acute osseous abnormalities seen. Visualized paranasal sinuses and mastoid\nair cells appear essentially well aerated. The orbits demonstrate no acute\nabnormalities.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. Probable small chronic infarct in the left periatrial white matter." + }, + { + "input": "There is a region of hypoattenuation in the left basal ganglia centered around\nthe caudate head with loss of gray-white matter differentiation, new from\nprior study dated ___ and concerning for acute site of infarction. \nThere is redemonstration of a circumscribed, hypoattenuating focus adjacent to\nthe left atrium of the left lateral ventricle, unchanged from prior study and\ncompatible with chronic infarct. There is no evidence of hemorrhagic\nconversion. No definite evidence of mass. The ventricles and sulci are normal\nin size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Acute infarct in the left basal ganglia centered at the caudate head. Stable\nappearance of the known chronic infarct in the left periatrial white matter. \nNo acute hemorrhage.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:51 pm, 1 minutes\nafter discovery of the findings." + }, + { + "input": "CTA HEAD:\nNote is again made of the bilateral basal ganglia infarcts.\n\nThere is hypoplasia of the right A1 segment, the proximal anterior cerebral\nartery has a common trunk and there is a late bifurcation. This is a normal\nvariant. There is mild atheromatous calcification of the left cavernous ICA. \nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, . dural venous sinuses are patent.\n3 mm aneurysm is seen arising laterally from the left ICA (2; 202).\n\nCTA NECK:\nThere is mild atheromatous calcification the origin of the great vessels,\nhowever the bilateral carotid and vertebral artery origins are patent. There\nis a small focus of atheromatous calcification in the aortic arch.\nMild atheromatous calcification of the bifurcation of the right common carotid\nartery. There is no evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion.\n\n\n\nOTHER:\nThe visualized portion of the lungs are clear. 6 mm nodule in the left lobe\nof thyroid gland, not requiring follow-up. The visualized portion of the\nthyroid gland is otherwise within normal limits. There is no lymphadenopathy\nby CT size criteria. There is loss of the normal cervical lordosis. There is\nmild cervical spondylosis. There is mild, grade 1 anterolisthesis of C4 on C5\nand C5 on C6.", + "output": "1. Redemonstration of the bilateral basal ganglia infarcts.\n2. Hypoplastic right A1 segment, anterior cerebral artery common trunk with a\nlate bifurcation. This is at normal variant. Patent circle of ___ without\ndefinite evidence of stenosis,or occlusion.\n3. 3 mm aneurysm is seen arising laterally from the left ICA (2; 202).\n4. Patent bilateral cervical carotid and vertebral arteries without definite\nevidence of stenosis, occlusion, or dissection." + }, + { + "input": "There is no evidence of fracture, acute large territory\ninfarction,hemorrhage,edema,or mass. Redemonstration of chronic infarcts\ninvolving the right anterior lentiform nucleus, the left caudate head, in the\nwhite matter adjacent to the trigone of the left lateral ventricle. \nAdditional periventricular and subcortical white matter hypodensities are\nnonspecific but likely sequelae of chronic small vessel ischemic disease. The\nventricles and sulci are normal in size and configuration for age.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. There is a small amount of soft tissue density within\nthe bilateral external auditory canals, which may represent debris. Patient\nis status post left lens surgery. There is small amount of soft tissue\nswelling overlying the left lateral orbital rim with a small focus of air\nwithin the subcutaneous soft tissues (601:23, 2:5), which may represent a soft\ntissue laceration.", + "output": "1. No evidence of acute fracture or large territory infarction.\n2. Chronic infarcts are seen within the right anterior interval nucleus, left\ncaudate head, and in the white matter adjacent to the trigone of the left\nlateral ventricle.\n3. Soft tissue swelling and a focus air within the subcutaneous soft tissues\noverlying the left lateral orbital rim, which may represent a site of tissue\nlaceration." + }, + { + "input": "There is no evidence of fracture, acute infarction,hemorrhage,edema,or mass. \nThere is redemonstration of chronic infarcts involving the bilateral basal\nganglia. Bilateral periventricular and subcortical white matter hypodensities\nare nonspecific but compatible with sequelae of chronic small vessel ischemic\ndisease. The ventricles and sulci are normal in size and configuration for\nage.\n\nThere is a small amount of soft tissue edema and thickening overlying the\nright lateral orbital rim. Small amount debris is again noted within the left\nexternal auditory canal. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The patient is status\npost left lens replacement surgery. Otherwise, the visualized portion of the\norbits are normal.", + "output": "1. No evidence of fracture or hemorrhage.\n2. Chronic bilateral basal ganglia infarcts. No evidence of acute infarction.\n3. Small hematoma overlying the right lateral orbital rim." + }, + { + "input": "There is no evidence of an acute fracture, infarction,hemorrhage,edema, or\nmass. Bilateral basal ganglia chronic infarcts are again noted. \nPeriventricular and subcortical white matter hypodensities are nonspecific but\nlikely sequelae of chronic small vessel ischemic disease. The ventricles and\nsulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. Moderate cerumen is noted, right greater than left. \nThe visualized portion of the orbits are normal.", + "output": "1. There is no evidence of acute intracranial process or hemorrhage.\n\n2. Bilateral basal ganglia chronic infarcts. Periventricular and subcortical\nwhite matter hypodensities are nonspecific but likely sequelae of chronic\nsmall vessel ischemic disease." + }, + { + "input": "There is no evidence of acute hemorrhage mass effect midline shift or\nhydrocephalus. Gray-white matter differentiation is maintained.\n\nPatient has undergone pipeline embolization in the right ophthalmic height. \nThe visualized paranasal sinuses are clear. No skull fracture is seen.", + "output": "No acute intracranial abnormalities are identified." + }, + { + "input": "There is no evidence of large territorial infarct,hemorrhage, edema, or mass\neffect. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality. No mass effect or other evidence of a\nmass." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nLeft maxillary mucosal thickening is improved compared to prior. Asymmetry of\nthe left lamina papyracea suggesting prior insult. The visualized portion of\nthe orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nare patent without marked stenosis, occlusion, or aneurysm formation. \nHypoplasia of the right A1 segment. The dural venous sinuses are patent.\n\nCTA NECK:\nMild calcific atherosclerotic changes at the proximal ICAs, but no stenosis by\nNASCET criteria. The vertebral arteries are patent bilateral.\n\nOTHER:\nThe visualized portion of the lungs are clear. The thyroid is not clearly\nidentified. There is no lymphadenopathy by CT size criteria.", + "output": "No intracranial mass, hemorrhage or large acute territorial infarct.\n\nNo intracranial arterial aneurysm, occlusion or vascular malformation.\n\nMild calcific atherosclerotic changes at the proximal ICAs, but no stenosis by\nNASCET criteria.\n\nThe vertebral arteries are patent bilateral." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema,or definite mass. The\nventricles and sulci are normal in size and configuration. Prominence of the\nposterior fossa extra-axial spaces may represent ___ cisterna magna or a\nsubarachnoid cyst, unchanged from ___.\n\nThere is no acute fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. There is preservation of\ngray-white matter differentiation. The basal cisterns remain patent.\n\nThere is no evidence of fracture. A large mucous retention cyst is noted\nwithin left maxillary sinus. The remainder of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. No evidence for acute intracranial process." + }, + { + "input": "CTA HEAD:\nThere is occlusion of the right V4 segment vertebral artery with\nreconstitution of the short segment prior to its anastomosis with the basilar\nartery via retrograde flow. There is diminished flow within the more proximal\nsecond and third segments of the right vertebral artery.\n\nThere is calcific and noncalcified atherosclerosis with segmental luminal\nnarrowing at the mid left V4 segment vertebral artery (2:216).\n\nLack of vascular enhancement in the distal left posterior cerebral artery,\nsuggestive of partial occlusion or severe narrowing, otherwise, the anterior\ncirculation and the remainder of the posterior circulation are patent without\naneurysm dissection or occlusion. The sinuses and major cerebral veins are\npatent.\n\nThere is loss of the gray-white matter differentiation within the left\noccipital lobe consistent with infarction. The ventricles and extra-axial\nspaces are unremarkable. The orbits, calvarium, and soft tissues are\nunremarkable. There are left maxillary sinus mucous retention cysts.\n\nCTA NECK:\nThere is occlusion of the right V4 segment vertebral artery with\nreconstitution of the short segment prior to its anastomosis with the basilar\nartery via retrograde flow. There is diminished flow within the more proximal\nsecond and third segments of the right vertebral artery. There is streak\nartifact from periarterial veins which obscures the lumen of the right first\nand proximal second segment vertebral arteries.\n\nThere is calcific and noncalcified atherosclerosis with segmental luminal\nnarrowing at the mid left V4 segment vertebral artery (2:216).\n\nThe carotid arteries and their major branches appear normal with no evidence\nof stenosis or occlusion. There is no evidence of internal carotid stenosis by\nNASCET criteria.\n\nOTHER:\nThere are calcified granulomas within the visualized lung apices. The\nvisualized portion of the thyroid gland is within normal limits. There is no\nlymphadenopathy by CT size criteria.", + "output": "1. Occlusion of the right V4 segment vertebral artery with distal retrograde\nfilling. Diminished contrast filling proximal to the occlusion. Obscured\nfirst and proximal second segments of the right vertebral artery due to\nperiarterial venous contrast.\n2. Atherosclerosis with segmental luminal narrowing at the left V4 segment\nvertebral artery.\n3. Infarction of the left occipital cortex. This is better characterized on\ndedicated head MRI performed subsequent to this study.\n4. Patent neck vasculature without carotid stenosis by NASCET criteria." + }, + { + "input": "No acute intracranial hemorrhage. No large territorial infarction. There are\ndiffuse periventricular and subcortical white matter hypodensities as well as\na prominent hypodensity within the left insular subcortical white matter with\npreserved gray-white matter differentiation (series 3, image 19). Findings\nare nonspecific, especially given the lack of relevant prior studies for\ncomparison, however are suggestive of chronic microangiopathy. There are\nage-related involutional changes diffusely. The basal cisterns are patent.\n\nPartial opacification of the frontal sinuses more prominent on the left with\nsome fluid seen within the left anterior ethmoid air cells. The other\nvisualized paranasal sinuses are clear. The mastoid air cells are clear. No\ncalvarial fractures are demonstrated. There is moderate atherosclerotic\ncalcification of the bilateral carotid siphons. The visualized portion of the\norbits are normal.", + "output": "1. No evidence of intracranial hemorrhage or calvarial fracture.\n2. Diffuse periventricular and subcortical white matter hypodensities\nincluding a focal area of hypodensity within the deep insular cortex are\nnonspecific given lack of relevant prior imaging. Findings are suggestive of\nsequela from chronic microangiopathy, however and acute on chronic process\nwould be difficult to exclude in the appropriate context. An MRI would be\nmore sensitive and specific if there is clinical concern." + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass. The ventricles and sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.\n\nThere is a large left frontal scalp hematoma and a small right occipital scalp\nhematoma with soft tissue gas indicating laceration.", + "output": "No acute intracranial process. Large left frontal scalp hematoma and small\nright occipital scalp hematoma. No fracture." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass effect. The ventricles and sulci are prominent, consistent with\nage-related involutional change. There is a small scalp hematoma overlying\nthe left parietal bone.\n\nNo acute fractures are seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear.", + "output": "1. No acute intracranial process.\n2. Small left parietal scalp hematoma." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. There is mild prominence of the ventricle and sulci, suggestive\nof global atrophy. There is periventricular white matter hypo-attenuation,\nwhich is nonspecific but can be seen as sequela of chronic small vessel\nischemic disease.\n\nThere is evidence of prior sinus surgery, unchanged from sinus CT ___. Remaining paranasal sinuses are patent. Mastoid air cells and middle\near cavities are well aerated. The bony calvarium is intact. There are some\natherosclerotic calcifications of the bilateral carotid siphons.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is a\n3.2 cm x 1.8 cm right middle cranial fossa arachnoid cyst that exerts\nmass-effect on the adjacent right temporal lobe. Ventricles and sulci are\nage-appropriate.\n\nThere is no evidence of fracture. There is left maxillary sinus mucosal\nthickening. The visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Right middle cranial fossa arachnoid cyst." + }, + { + "input": "Evaluation is substantially limited by motion artifact even though the images\nwere repeated. Evaluation for subtle hemorrhage is limited, particularly in\nthe subarachnoid and subdural spaces. No clear evidence for parenchymal\nhemorrhage is seen. No gross mass effect is identified. The ventricles and\nbasal cisterns appear age-appropriate.\n\nNo calvarial fracture is seen on motion limited evaluation. There is mild to\nmoderate mucosal thickening in the ethmoid air cells extending into the\nfrontoethmoidal recesses, and mild mucosal thickening in the partially\nvisualized maxillary sinuses.", + "output": "Substantially motion degraded exam. While no definite acute intracranial\nabnormalities are seen, a repeated study is suggested if there is a high\nclinical suspicion for intracranial injury." + }, + { + "input": "There is a 4.0 x 3.2 x 4.9 cm hematoma abutting and partially compressing the\nright internal jugular vein, deep to the sternocleidomastoid muscle, with\nevidence of active bleeding within the lateral aspect of the hematoma (5:145).\nThere is adjacent fat stranding. Although there is venous pooling following\nblush of contrast during the arterial phase, venous contamination during the\narterial phase makes discerning whether this is an arterial or venous bleed\ndifficult. However, there is suggestion of vascular connection, possibly a\nsmall branch, to the external jugular vein (7:135).\n\nThere is atheromatous calcification of the bifurcation of both common carotid\narteries and of the carotid siphons bilaterally. The carotidandvertebral\narteries and their major branches are patent with no evidence of stenoses. No\nevidence for dissection is seen. Note is made of a hypoplastic right A1\nsegment.\n\nBy NASCET criteria, there is no significant stenosis of the ICAs bilaterally.\n\nThere is a small right pleural effusion.\n\nNote is made of a 15 mm x 9 mm right laterally projecting outpouching from the\nesophagus, at the level of the right lobe of the thyroid gland (5:125.\n\nThere are multiple bilateral subcentimeter hypodense nodules within the\nthyroid gland, some of which are partially calcified.\n\nThere is mild cervical spondylosis, most marked at C5-C6, with marked\nreduction in intervertebral disc height. There is 2 mm anterolisthesis of C4\non C5.", + "output": "1. 4.9 cm hematoma underlying the right sternocleidomastoid muscle, abutting\nthe right internal jugular vein, with evidence of active bleeding within.\n2. Mild right-sided pleural effusion.\n3. 15 mm right laterally projecting outpouching/diverticulum from the upper\nesophagus, at the level of the right lobe of the thyroid gland.\n\nNOTIFICATION: Findings were discovered and discussed with ___, MD\nby ___, MD in person at the time of the scan at 20:45 on ___. \nFinal read pending 3D reformats and dedicated review per neuro radiology." + }, + { + "input": "Limited by motion degradation.\n\nThere is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Prominent ventricles and sulci are age appropriate. \nPeriventricular subcortical white matter hypoattenuation likely represent\nchronic small vessel ischemic disease.\n\nThere is mild mucosal thickening in the bilateral ethmoid air cells. \nRemaining paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "Limited by motion degradation. Within these limitations, there is no acute\nintracranial abnormality." + }, + { + "input": "Exam is limited by patient motion.\n\nThere is no evidence of acute infarction,hemorrhage,edema, or mass. A\nwell-defined 1.4 x 0.4 cm (series 601, image 57) hypodensity in the left\nfrontal lobe is new compared with prior, however, otherwise appears chronic in\nnature, likely representing sequela of prior infarct. There is mild\nprominence of the ventricles and sulci suggestive of involutional changes. \nSubcortical and periventricular white matter hypodensities are nonspecific,\nhowever likely represent sequela of chronic small vessel ischemic disease. \nThere are atherosclerotic calcifications in the bilateral cavernous carotids.\n\nThere is no evidence of acute fracture. Subtle chronic deformity of the left\nnasal bone may be due to an old fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "1. Exam is limited by motion. Within these limitations, there is no acute\nintracranial process. Specifically, there is no acute intracranial\nhemorrhage.\n2. A well-defined hypodensity in the left frontal lobe is new compared with\nprior CT head ___, however otherwise appears chronic in nature, likely\nrepresenting sequela of prior infarct." + }, + { + "input": "The study is limited by moderate motion artifacts. Right frontal approach\nventriculostomy catheter terminates in the left lateral ventricle adjacent to\nthe basal ganglia, unchanged. The left thalamus intraparenchymal hematoma has\ndecreased in size measuring approximately 2.6 x 3.4 cm, previously 3.6 x 5.2\ncm. Edema surrounding left thalamic intraparenchymal hematoma extending to\nthe left temporal lobe has worsened with effacement of the paramesencephalic\ncistern is noted, consistent with some degree of uncal herniation. The amount\nof intraventricular hemorrhage has decreased with no residual intraventricular\nblood in the third and fourth ventricles. No definite new intracranial\nhemorrhage given limitation of motion artifacts. Compared to CT from ___ and MR from ___, given technique and modality\ndifferences, the size of the ventricles have slightly increased. No evidence\nof transependymal CSF flow. The configuration and size of the sulci are\nsimilar. No evidence of large territorial infarction, or mass.\n\nThere is no evidence of fracture. The visualized paranasal sinuses\ndemonstrate mild mucosal thickening. There is opacification of bilateral\nmastoid air cell. The visualized portion of the orbits are unremarkable.", + "output": "1. Moderately motion degraded exam.\n2. Interval decrease in size of the intraparenchymal hematoma centered in the\nleft thalamus. Surrounding vasogenic edema extending into the left temporal\nlobe has worsened with effacement of perimesencephalic cisterns and appearance\nof mild uncal herniation.\n3. Interval decreased amount of intraventricular hemorrhage with no residual\nblood noted in third and fourth ventricles. No new intracranial hemorrhage.\n4. Unchanged position of the right frontal approach ventriculostomy catheter\nwith slight interval increase in size of the ventricles.\n5. Additional findings as described above.\n\nNOTIFICATION: The findings were discussed with ___ care NP, Fainty\nby ___, M.D. on the telephone on ___ at 12:10 pm, 2 minutes\nafter discovery of the findings.fanty" + }, + { + "input": "There is been interval placement of a right parietal approach ventriculostomy\ncatheter with the tip seen abutting the septum pellucidum. Small amount of\nright frontal convexity pneumocephalus is likely postprocedural sequela. The\nknown left thalamic intraparenchymal hematoma is difficult to measure but\nappears similar in size compared to the prior exam in ___, with\nslightly increased surrounding edema (02:18). There is effacement of the\nparamesencephalic cistern, consistent with uncal herniation. There is small\namount of intraventricular hemorrhage seen layering in occipital horns of the\nlateral ventricles. Compared to the prior exam from ___, the ventricles\nappear slightly increased in size. There is no evidence of transependymal CSF\nflow. The configuration of the sulci are unchanged. There is no acute major\ninfarct. No definite midline shift. Superficial surgical staples are seen\nalong the right parieto-occipital scalp.\n\nAerated secretions in the left sphenoid sinus are noted. Otherwise, the\nremaining visualized portion of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Interval placement of a right parietal approach ventriculostomy catheter\nwith the tip seen abutting the septum pellucidum.\n2. Compared to the prior exam from ___, the ventricles appear\nslightly increased in size. However, there is no evidence of transependymal\nCSF flow.\n3. The known left thalamic intraparenchymal hematoma appears similar in size\nwith increased surrounding edema since ___. No evidence of acute\nmajor infarct.\n4. Small amount of intraventricular hemorrhages are again seen layering in the\noccipital horns of the lateral ventricles." + }, + { + "input": "Re-demonstrated is a right parietal approach ventriculostomy catheter with tip\nagain abutting the septum pellucidum. There has been near complete resolution\nof right frontal pneumocephalus. The known left thalamic intraparenchymal\nhemorrhage appears grossly unchanged, measuring approximately 3.5 x 2.4 cm. \nSurrounding edema appears stable to slightly decreased compared to ___. There is persistent effacement of the left perimesencephalic cistern,\nconsistent with uncal herniation. There has been interval redistribution and\nevolution of blood products within the occipital horns bilaterally. The\nventricles are overall unchanged in size and remained mildly enlarged. There\nis no large acute vascular territorial infarction or definite midline shift. \nNo new foci of intracranial hemorrhage are identified.\n\nThere is no acute fracture. Aside from aerosolized secretions in the left\nsphenoid sinus, the visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. A right parietal approach ventriculostomy catheter is in unchanged position\nwith persistent mild ventriculomegaly.\n2. Re-demonstration of the known left thalamic intraparenchymal hematoma with\nslight interval decrease in surrounding edema compared to ___. \nHowever, there is persistent effacement of the left perimesencephalic cistern,\nconsistent with uncal herniation.\n3. Interval redistribution and evolution of layering intraventricular\nhemorrhage in the bilateral occipital horns.\n4. No new acute territorial infarction or intracranial hemorrhage." + }, + { + "input": "A known left thalamic intraparenchymal hemorrhage is stable from prior\nmeasuring 2.9 x 1.8 cm in axial diameter with a stable degree of surrounding\nedema. There is persistent effacement of the left perimesencephalic cistern\ncompatible with uncal herniation, similar to prior. Trace blood products are\nnoted within the right occipital horn. The size of the ventricular system is\nenlarged but stable status post placement of a right parietal approach\nventriculostomy catheter. The tip of this catheter again projects over the\nseptum pellucidum. There is no midline shift. No new focus of hemorrhage or\nacute large territorial infarct is noted.\n\nThere is no acute fracture. There is mild thickening of the anterior\nethmoidal air cells. Otherwise, the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Stable left thalamus intraparenchymal hemorrhage with residual blood\nproducts and surrounding edema. Trace blood products in the right occipital\nhorn is stable. No new focus of hemorrhage or acute large territorial\ninfarct.\n2. Persistent effacement of the left perimesencephalic cistern compatible with\nmild uncal herniation. No midline shift.\n3. Enlarged ventricular system is stable status post placement of a right\nparietal approach ventriculostomy catheter." + }, + { + "input": "Redemonstration of a right parietal approach ventriculostomy catheter, with\ntip projecting just to the left of the septum pellucidum in the body of the\nleft lateral ventricle, unchanged. Allowing for differences in patient head\nposition, enlargement of the right lateral ventricle, anterior components of\nthe left lateral ventricle, and mild enlargement of the third ventricle are\nstable. Again seen is a parenchymal hemorrhage involving the left posterior\nthalamus and the posteromedial left temporal lobe, measuring 2.9 x 1.8 cm\n(02:20), unchanged in size from prior study with stable appearance of\nsurrounding vasogenic edema. Unchanged effacement of the left\nperimesencephalic cistern secondary to left uncal herniation. Unchanged\ncompression of the atrium of the left lateral ventricle. Left temporal\noccipital horns are stable in size. There is isodense material layering\nwithin right greater than left occipital horns, unchanged in density on the\nright and decreased in density on the left, consistent with evolution of\nhyperdense hemorrhage seen on earlier CTs. No evidence for new hemorrhage.\n\nMultiple calvarial lucencies are again seen, nonspecific but compatible with\narachnoid granulations. There is moderate left and trace right mastoid air\ncell fluid. There are persistent aerosolized secretions within left greater\nthan right sphenoid sinuses.", + "output": "1. Unchanged left thalamic and left posteromedial temporal intraparenchymal\nhemorrhage with stable associated edema and stable mass effect, including left\nuncal herniation. No evidence for new hemorrhage.\n2. Isodense material within right greater than left occipital horns of the\nlateral ventricles, stable in amount compared to ___ with\ndecreased density compared to prior studies, consistent with evolution of\nhemorrhage. Please note that superimposed infection cannot be excluded on the\nbasis of this exam in the setting of clinical suspicion.\n3. Stable position of the right parietal approach VP shunt catheter. Stable\nsize of the ventricles.\n4. Persistent aerosolized secretions within left greater than right sphenoid\nsinuses and persistent fluid within left greater than right mastoid air cells,\nwhich may be secondary to prolonged supine positioning in the inpatient\nsetting. Please note that superimposed infection cannot be excluded on the\nbasis of this exam in the setting of clinical suspicion." + }, + { + "input": "Patient is status post placement of a right frontal approach ventriculostomy\ncatheter which crosses through the frontal horns and terminates in the left\nbasal ganglia. Small amount of pneumocephalus is noted. Left-sided\nintraparenchymal hemorrhage centered in the region the left thalamus with\nintraventricular extension appears increased in volume in the left lateral\nventricle, occipital horn of the right lateral ventricle as well as within the\nthird ventricle and foramen ___ compared to prior study. Additionally\nis new extension of hemorrhage into the fourth ventricle and through the\nforamina of ___ and ___. Associated edema and mass effect about the\nleft thalamic hemorrhage is grossly unchanged from prior study. There is no\nevidence of acute large territory infarction. The ventricles remain similarly\ndilated. Sulci are stable in size and configuration.\n\nNew right frontal burr hole with postprocedural right frontal scalp soft\ntissue swelling and subcutaneous gas. There is no evidence of fracture. Mild\nmucosal thickening is demonstrated in the bilateral maxillary sinuses, ethmoid\nair cells, and sphenoid sinuses bilaterally. Otherwise the visualized portion\nof the mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Status post placement of right frontal approach ventriculostomy catheter\nwhich terminates in the left basal ganglia.\n2. Redemonstration of intracranial hemorrhage centered in the region of the\nleft thalamus with interval increase in intraventricular extension, which now\ninvolves the fourth ventricle and exits through the foramina of Luschka and\nMagendie. Size of the ventricles is similar to the prior exam." + }, + { + "input": "CTA HEAD:\nPostsurgical changes after right frontal ventriculostomy shunt catheter\nplacement with the tip in the region of the inferior left basal ganglia is\nagain seen. A small amount of pneumocephalus remains.\n\nAgain seen is the intraparenchymal hematoma centered in the left thalamus with\nintraventricular extension, stable configuration of the ventricular system and\nstable 4 mm rightward midline shift.\n\nLimited evaluation of the intracranial vasculature due to poor contrast bolus\ntiming.\nThere are scattered atherosclerotic changes along both cavernous ICAs without\nhigh-grade stenosis. The vessels of the circle of ___ and their principal\nintracranial branches appear grossly patent without stenosis or obvious\naneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nLimited evaluation of the cervical vasculature due to poor contrast bolus\ntiming.\nThere are atherosclerotic changes at both carotid bifurcations. There is no\nevidence of internal carotid stenosis by NASCET criteria.\nSmall atherosclerotic plaque at the origin of left vertebral artery results in\nmild stenosis at its origin.\n\nThe carotidandvertebral arteries and their major branches appear otherwise\nunremarkable with no evidence of high-grade stenosis or occlusion.\n\nOTHER:\nThe patient is intubated with the endotracheal tube terminating just above the\ncarina. There is a small amount of fluid in the upper trachea and\nnasopharynx. Mild mucosal thickening is seen throughout the paranasal\nsinuses.\n\nThyroid is unremarkable. The imaged portion of lung apices is notable for a\n3.2 cm intermediate density right upper lobe mass in close association with a\nright upper lobe pulmonary artery branch vessels with associated\nhyperdense/metallic foci, which could represent a pulmonary artery\npseudoaneurysm status post coiling. The main pulmonary artery is enlarged\nmeasuring up to 4.2 cm suggestive of pulmonary arterial hypertension.", + "output": "1. Postsurgical changes after right frontal ventriculostomy shunt catheter\nplacement with the tip in the region of the inferior left basal ganglia,\nunchanged. Small residual amount of pneumocephalus.\n2. Unchanged left intraparenchymal hematoma centered in the thalamus with\nintraventricular extension but stable configuration of the ventricular system\nand stable 4 mm rightward midline shift.\n3. Limited evaluation of the cervical intracranial vasculature due to poor\ncontrast bolus timing. No evidence of large vessel occlusion, obvious\naneurysm formation or gross abnormal vasculature in the region of the\nintraparenchymal hematoma.\n4. Soft tissue density right upper lobe mass with internal metallic artifact,\ncould represent a treated pulmonary artery pseudoaneurysm given its close\nproximity to the pulmonary artery. Correlation with outside records is\nrecommended.\n5. Main pulmonary artery diameter measuring up to 4.2 cm, suggestive of\npulmonary arterial hypertension.\n\nRECOMMENDATION(S): Soft tissue density right upper lobe mass with internal\nmetallic artifact, could represent a treated pulmonary artery pseudoaneurysm\ngiven its close proximity to the pulmonary artery. Correlation with outside\nrecords is recommended. If clinically indicated, a CT PE study can be\nperformed for further evaluation." + }, + { + "input": "Right frontal approach ventriculostomy catheter is unchanged in position,\nterminating in the region of the left basal ganglia. Small amount of\npneumocephalus overlying the right frontal lobe, expected. Ventricular size\nhas mildly decreased compared to prior.\n\nAcute hemorrhage centered about left thalamus with surrounding edema and\nintraventricular extension into the left lateral ventricle, similar in\ndistribution compared to prior. There is also smaller volume acute hemorrhage\nwithin the right lateral, third, and fourth ventricles, also similar.\n\nEvaluation for new hemorrhage is mildly limited due to the presence of\nintravenous contrast. Within these limitations, no evidence of new\nhemorrhage. No acute territorial infarction or mass. No evidence of midline\nshift.\n\nThere is no evidence of fracture. An NG tube and endotracheal tube are\nvisualized. Opacification of the nasopharynx and oropharynx is likely due to\nintubation. There is mild mucosal thickening of the bilateral maxillary and\nsphenoid sinus with aerosolized secretions. The mastoid air cells and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Right frontal approach ventriculostomy catheter is unchanged, terminating\nin the region of the left basal ganglia. Overall ventricular size has\ndecreased compared to prior.\n2. Unchanged left thalamic hemorrhage with intraventricular extension and\nacute hemorrhage filling the left lateral ventricle, as well as a smaller\nvolume in the right lateral, third, and fourth ventricles." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Normal study." + }, + { + "input": "The carotid and vertebral arteries and their major branches are patent with no\nevidence of stenoses. No evidence for dissection is seen. There is no\nevidence of internal carotid artery stenosis by NASCET criteria.\nThere is soft tissue induration and laceration overlying the right\nsternocleidomastoid muscle with no evidence of deep injury.\n\nThere is a 3 mm subpleural solid nodule in the posterior right upper lobe,\nprobably a benign intrapulmonary lymph node.", + "output": "1. No evidence of vascular injury.\n2. Skin laceration and soft tissue swelling overlying the right\nsternocleidomastoid muscle.\n3. Small right subpleural pulmonary nodule as discussed above.\n\nRECOMMENDATION(S): For an incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient" + }, + { + "input": "There is no intra or extra-axial mass effect, acute hemorrhage or acute large\nterritory infarct. Subtle right parietal encephalomalacia (series 6, image 7)\nis identified. The sulci, ventricles and cisterns are within expected limits\nfor the degree of mild to moderate global cerebral volume loss. There are\nperiventricular and subcortical white matter hypodensities, which are\nnonspecific, but compatible with chronic microangiopathy in a patient of this\nage. Opacification of a few right ethmoid air cells is noted. The remainder\nthe visualized paranasal sinuses are essentially clear. The orbits are\nunremarkable. The mastoid air cells middle ears are well pneumatized and\nclear. No acute osseous abnormality.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nlarge territory infarct or intracranial hemorrhage.\n2. Subtle right parietal encephalomalacia likely sequela of chronic infarct." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nlarge mass. Periventricular and subcortical white matter hypodensities are\nnonspecific, but likely represent chronic small vessel ischemic disease. \nThere is mild prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture. There is scattered opacification of the\nmastoid air cells bilaterally. The visualized portion of the paranasal\nsinuses and middle ear cavities are clear. The orbits are unremarkable. There\nis bilateral carotid siphon and vertebral artery calcification.", + "output": "No acute intracranial process." + }, + { + "input": "This examination is slightly limited due to motion artifact.\n\nThere is no evidence of infarction, hemorrhage, edema, or mass. There is mild\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No evidence of fracture or intracranial hemorrhage." + }, + { + "input": "The examination is severely limited by patient positioning and motion. There\nis no evidence of hemorrhage or infarct. There are extensive periventricular\nwhite matter hypodensities indicative of small vessel disease, and prominence\nof the ventricles and sulci is indicative of involutional change.\n\nThere is no fracture. The imaged paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear.\n\nSuboptimal evaluation of the cervical spine demonstrates severe facet\narthropathy from C3 through C6 on the right.", + "output": "Sequela of chronic small vessel ischemia and involutional change, but no\nevidence of hemorrhage or infarct on this limited CT due to patient\npositioning." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are somewhat enlarged consistent with age related\natrophy. Asymmetric white matter hypodensity seen in the right fronto parietal\nlobe (series 2, image 24 through 27) may be related to an area of prior in Ark\nShin or chronic ischemic disease.\n\nThere is mucosal thickening and mucous retention cyst seen within the right\nmaxillary sinus. There is mild mucosal thickening of the ethmoid air cells.\nThe right the mastoid air cells are well-aerated. The left mastoid air cells\nare not pneumatized.", + "output": "No evidence of acute hemorrhage. Asymmetric white matter hypodensity seen in\nthe right frontoparietal lobe and at the vertex on the right is likely related\nto an area of prior deep watershed infarction or chronic ischemic disease\nhowever it if there is a concern for acute infarction, MRI is more sensitive." + }, + { + "input": "No acute intracranial hemorrhage. No large territory infarction. No evidence\nof edema or underlying mass. The ventricles and sulci are prominent\nconsistent with age-related atrophy. Right frontoparietal encephalomalacia\nsuggests sequela from prior infarction. Old bilateral caudate head lacunar\ninfarcts noted.\n\nThere is no evidence of fracture. There is a right periapical lucency along\nthe maxilla which is similar compared to the prior study (series 3, image 4). \nUnder pneumatization of the left mastoid air cells is unchanged likely\ncongenital, otherwise the visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable. Degenerative changes noted at the temporomandibular\njoints.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is small infarct in the inferolateral left cerebellum, similar to prior,\nlikely late subacute or chronic. There is no evidence of hemorrhage, edema,\nor mass. There are mild-to-moderate chronic small vessel ischemic changes. \nThere is generalized brain parenchymal atrophy, with probably severe atrophy\nof bilateral hippocampus.\n\nMild coastal thickening of the paranasal sinuses. Otherwise, the visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nCervical portion of the right ICA is not opacified. Petrous, cavernous\nsegments of the right ICA are not opacified. Opacification of the right\nparaclinoid and supraclinoid ICA by collateral circulation. Visualize high\nright cervical ICA is of very small caliber, indicating that at there is a\ncomponent of chronic significant right ICA disease, and whether this complete\nocclusion is acute or chronic is indeterminate on this scan. Atherosclerotic\ncalcifications of bilateral cavernous segments IC is is moderate. Mild\nnarrowing of the left cavernous, supraclinoid ICA. Tiny patent left PCOM. \nPatent right PCOM patent A-comm.\nAtherosclerotic calcifications bilateral V4 segments vertebral arteries,\nmildly narrowed left V4 segment.\nMildly decreased arborization of right MCA M2, M3 cortical branches compared\nto the left, no evidence of vessel occlusion.\nOtherwise, the vessels of the circle of ___ and their principal\nintracranial branches appear normal with no evidence of other areas of\nstenosis, occlusion, or aneurysm. The dural venous sinuses are patent.", + "output": "1. Occluded right ICA, with right paraclinoid, supraclinoid reconstitution via\ncollaterals.\n2. Mild atheromatous narrowing left cavernous segment ICA. Decreased\narborization right MCA branches, no evidence of occlusion or acute infarct.\n3. Late subacute to chronic left cerebellar infarct.\n4. Mild-to-moderate chronic small vessel ischemic changes. Brain parenchymal\natrophy, with probably severe hippocampal atrophy.\n\nNOTIFICATION: Preliminary findings were discussed with ___, N.P. By\n___, M.D. on the telephone on ___ at 4:00 pm, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are enlarged compatible with global volume\nloss. The degree of ventricular enlargement is slightly larger than that of\nthe sulci. Cavum septum pellucidum et vergae is again noted. Atherosclerotic\ncalcifications noted within the intracranial ICAs.\n\nIncluded paranasal sinuses and mastoids are essentially clear besides mild\nmucosal thickening throughout the ethmoids and maxillary sinuses. Skull and\nextracranial soft tissues are unremarkable.", + "output": "No acute intracranial process.\nGlobal volume loss. Ventricular enlargement slightly out of proportion to the\nsize of the sulci raising the possibility of normal pressure hydrocephalus,\nunchanged since ___." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, mass, mass effect or\nlarge territorial infarction. The ventricles and sulci are slightly prominent\nin size but normal in configuration, suggest technique which is age\nappropriate. The basilar cisterns are patent, and there is otherwise\npreservation of gray-white matter differentiation.\n\nNo acute fractures identified. Remote fracture is seen involving the right\nlamina papyracea. There is moderate mucosal sinus thickening involving the\nethmoid air cells. The frontal sinuses are clear. The sphenoid sinuses are\nclear. The mastoid air cells, and middle ear cavities are clear. Maxillary\nsinuses are clear.", + "output": "No acute intracranial abnormalities identified. No evidence of an acute\nfracture." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction, mass or midline\nshift. There is no hydrocephalus. There is moderate mucosal thickening in the\nsphenoid and maxillary sinuses, as well as within ethmoid air cells. There is\nno fracture. There is a 0.7 cm lipoma in the left frontal scalp.", + "output": "No evidence of acute intracranial process. Moderate, probably inflammatory\nsinus disease." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. The cerebellum appears atrophic. Cerebral involution is slightly\nage advanced. Mucosal thickening within the paranasal sinuses is most notable\nin the ethmoid air cells. Mastoid air cells and middle ear cavities appear\nwell aerated. The bony calvarium is intact. The bony calvarium is intact.\nThere is a small lipoma in the left frontal scalp.", + "output": "No acute intracranial process. Chronic changes as detailed." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. There are small\nleft posterior parietal and right frontal sub galeal hematoma.\n\nThere is no evidence of acute fracture. There is mucosal thickening in the\nright frontal sinus, ethmoid air cells, sphenoid sinus, and left greater than\nright maxillary sinuses. A deformity of the right lamina papyracea was seen\npreviously. A small left frontal scalp lipoma is unchanged (series 3, image\n33). The orbits are unremarkable.", + "output": "Small right frontal and left posterior parietal subgaleal hematomas. No acute\nintracranial process." + }, + { + "input": "There is no evidence of large vascular territorial infarction, acute\nintracranial hemorrhage, edema, or large mass. The ventricles and sulci are\nnormal in size and configuration.\n\nThe bony calvarium is intact. Small subgaleal hematoma as involving the left\nposterior parietal and right frontal regions are unchanged. A subgaleal\nhematoma at the vertex is more prominent. Mucosal thickening in the right\nfrontal sinus, bilateral maxillary sinuses, and bilateral sphenoid sinuses\nagain noted. Deformity of the right lamina per appreciate was seen previously\nand is unchanged (3:13). A small left frontal scalp lipoma is unchanged\n(3:35). The mastoid air cells and middle ear cavities are well aerated. The\norbits are unremarkable.", + "output": "1. No acute intracranial hemorrhage.\n2. No fracture." + }, + { + "input": "No intra-axial or extra-axial hemorrhage, edema, shift of normally midline\nstructures, or evidence of acute major vascular territorial infarction.\nVentricles and sulci are normal in overall size and configuration.\n\nThere is mucosal thickening of bilateral maxillary sinuses, frontal sinuses,\nand ethmoid air cells. The remaining imaged paranasal sinuses are clear.\nMastoid air cells and middle ear cavities are well aerated. The bony calvarium\nis intact. Soft tissue overlying the right parietal calvarium is unchanged\nand is felt to be chronic. Left frontal scalp lipoma is incidentally noted.", + "output": "No evidence of acute hemorrhage or fracture." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Basilar cisterns are\npatent.\n\nScattered mucosal thickening seen the ethmoid air cells, right frontal sinus,\nand left maxillary sinus. Included paranasal sinuses and mastoids are\notherwise clear. Defect in the right lamina papyracea, potentially from prior\ntrauma is chronic. Skull and extracranial soft tissues are unremarkable\nbesides a small left forehead lipoma..", + "output": "No acute intracranial process." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\n\nThere is mild mucosal thickening of the bilateral ethmoid air cells, bilateral\nfrontal sinuses, and bilateral maxillary sinuses. Defect in the right lamina\npapyracea is unchanged from CT head ___. Mastoid air cells and\nmiddle ear cavities are well aerated. The bony calvarium is intact. Left\nfrontal scalp lipoma is re-demonstrated.", + "output": "No intracranial abnormality including no hemorrhage." + }, + { + "input": "There is no evidence of acute intracranial image, line shift, mass effect, or\nacute large vascular territorial infarct. The ventricles and sulci are normal\nin size and configuration.\n\nSmall subgaleal hematoma just left of midline at the vertex (series 2, image\n24). Incidental 1.9 x 0.6 cm left frontal subgaleal lipoma (series 2, image\n19). A chronic right lamina papyracea fracture is unchanged. There is no\nevidence of acute fracture. Mild relatively diffuse paranasal sinus mucosal\nthickening with aerosolized secretions layering dependently in the right\nmaxillary sinus. The visualized portion of the mastoid air cells and middle\near cavities are clear.", + "output": "No evidence of an acute intracranial abnormality." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci and unremarkable. Basilar cisterns are\npatent.\n\nIncluded paranasal sinuses and mastoids are essentially clear. Skull and\nextracranial soft tissues are unremarkable. Chronic appearing deformity of\nthe nasal bone/frontal process of the maxilla on the left", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction,hemorrhage,edema, or mass. \nEncephalomalacia in the right occipital lobe is consistent with remote\ninfarct, unchanged. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. There are periventricular and subcortical\nhypodensities, which may represent small vessel ischemic changes.\n\nThere is no evidence of fracture. There are small mucous retention cysts in\nthe bilateral ethmoid air cells and in the right maxillary sinus. The\nvisualized portion of the remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. There are bilateral lens replacements. The\nvisualized portion of the orbits are otherwise unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute large territory infarction, hemorrhage, edema,\nor mass. The ventricles and sulci are prominent consistent with age-related\natrophy. Periventricular and subcortical white matter hypodensities are\nnonspecific, but likely reflect sequelae of chronic small vessel ischemic\ndisease.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality, specifically no findings of intracranial\nbleed or mass." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect in the\nbrain. The ventricles and sulci are prominent but proportional, consistent\nwith age related parenchymal volume loss. Periventricular and subcortical\nwhite matter hypodensities most likely represent sequela of chronic\nmicrovascular ischemic disease in a patient of this age.\n\nThere is a mixed density lesion involving the skullbase predominantly of the\nclivus but also extending into the sphenoid wings, which appears expansile on\nreconstructions with areas of possible cortical thinning or breakthrough. The\nlesion may involve the clinoid processes but does not extend into the\npituitary sella or elevated the pituitary. The lesion abuts the posterior\naspect of the bilateral sphenoid sinuses.\n\nSmall air-fluid levels are seen in the bilateral sphenoid and maxillary\nsinuses. The bilateral ethmoid air cells are partially opacified. The mastoid\nair cells and middle ear cavities are clear. The orbits are unremarkable\nexcept to note bilateral lens replacement.", + "output": "1. No evidence of acute intracranial hemorrhage.\n2. Skullbase lesion involving the clivus and sphenoid wings may represent a\nbenign entity such as fibrous dysplasia or hemangioma, although malignancy\nsuch as plasmacytoma or metastasis cannot be excluded. Comparison with prior\noutside imaging would be recommended, if available. If clinically indicated,\nfurther characterization could be considered with non urgent MRI.\n3. Fluid in the bilateral sphenoid and maxillary sinuses." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates prominent bilateral\npalatine tonsils, left greater than right, consistent with tonsilitis. There\nis mild narrowing of the oropharynx at this level, but otherwise the airways\npatent throughout. There is fluid and soft tissue swelling along the\nposterior nasopharynx, most likely due to inflammation. No abscess is seen. \nNo prevertebral soft tissue swelling is identified.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal.Enlarged bilateral\njugulodigastric lymph nodes are most likely reactive. The neck vessels are\npatent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions. No acute fracture or\nmalalignment. There is multilevel moderate degenerative disease of the\ncervical spine. Uncovertebral and facet osteophytes cause moderate canal\nstenosis at C5-6 and C6-7. There is moderate left neural foraminal stenosis\nat C5-6 and C6-7.", + "output": "1. Prominent bilateral palatine tonsils, left greater than right, consistent\nwith tonsillitis. No abscess or retropharyngeal fluid collection.\n2. Soft tissue swelling and fluid along the posterior nasopharynx, most likely\ninflammatory.\n3. Cervical lymphadenopathy, likely reactive.\n4. Multilevel degenerative changes of the cervical spine with moderate canal\nstenosis and left neural foraminal narrowing at C5-6 and C6-7." + }, + { + "input": "Patient is status post SEPS of the previously seen right subdural hematoma\nwith postprocedural pneumocephalus. The collection now measures 7 mm from the\ninner table compared to 21 mm previously, containing a small focus of new\nacute blood products just deep to the skull entry site, as well as layering\nmildly hyperdense fluid, hyperdense fluid, and air. Previously seen sulcal\neffacement has substantially improved with mild right frontal sulcal\neffacement remaining at the level of the pneumocephalus. Previously-seen\nleftward shift of midline structures has nearly resolved. Right lateral and\nthird ventricles have re-expanded. Basal cisterns are not compressed.\n\nChronic infarcts are again seen and they right greater than left basal ganglia\nand adjacent white matter. Ill-defined hypodensities in the periventricular,\ndeep, and subcortical white matter again noted, nonspecific but likely sequela\nof chronic small vessel ischemic disease in this age group. There is mild\nglobal parenchymal volume loss, likely age-related, with mild prominence of\nthe sylvian fissures in some of the sulci.\n\nLeft phthisis bulbi and evidence of right cataract surgery are again noted. \nThere is mild mucosal thickening in the partially imaged maxillary sinuses and\na small mucous retention cyst in the right maxillary sinus. Visualized\nportions of the mastoid air cells are well aerated.", + "output": "Right subdural collection has decreased in size status post drainage with\ndecreased mass effect. There is small focus of new acute blood products\nimmediately deep to the skull entry site, as well as layering mildly\nhyperdense fluid, hypodense fluid, and air within the collection." + }, + { + "input": "The patient is status post SEPS for a right subdural hematoma with significant\ninterval increase in the amount of postprocedural pneumocephalus,\npredominantly along the right frontal convexity. The subdural hemorrhage along\nthe right convexity and measures approximately 4 mm, decreased from 7 mm on\nthe most recent prior study and significantly decreased compared to 21 mm from\n___. Previously seen right sulcal effacement is now minimal.\nThere is no midline shift. A 4 mm subdural hemorrhage along the left parietal\nconvexity is unchanged. No new blood products are seen. The ventricles are\nnow symmetric in configuration. The basal cisterns are normal.\n\nRedemonstrated hypodensities within the bilateral right greater than left\nbasal ganglia and adjacent white matter likely represent chronic infarcts.\nThere are hypodensities in the periventricular, deep, and subcortical white\nmatter which are nonspecific but likely represent sequelae of chronic\nmicroangiopathic ischemic disease. There is slight prominence of the\nventricles and sulci, likely secondary to involutional changes in this age\ngroup.\n\nA small mucous retention cyst is seen in the right maxillary sinus along with\na mild amount of mucosal thickening. The visualized portion of the remaining\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear.\nLeft-sided phthisis bulbi is again noted. The patient is status post lens are\nplacement on the right. The orbits are otherwise unremarkable.", + "output": "1. Continued interval decrease in the size of a right subdural hematoma status\npost drainage. Unchanged small left parietal subdural hemorrhage. No new\nintracranial hemorrhage.\n2. Interval decrease in the amount of right-sided pneumocephalus." + }, + { + "input": "There are cutaneous surgical staples in the right frontal region near the\nvertex overlying the right frontal burr-hole. There is an expected small\namount of right pneumocephalus related to recent stereotactic biopsy. Large\nirregular areas of hypodensity involving the white matter of the bilateral\nfrontal lobes with hypodensity extending across the genu of the corpus\ncallosum is similar to the outside head CT. Bifrontal masses are better\nappreciated on preceding contrast-enhanced MRI. Mild local mass effect with\neffacement of the frontal horns of the bilateral ventricles is unchanged.\nThere is no evidence of infarction or hemorrhage. The ventricles and sulci are\nunchanged in size and configuration. There is no shift of normally midline\nstructures. The basal cisterns appear patent.\n\nNo osseous abnormalities seen. There is partial opacification of the\nbilateral ethmoid air cells and air-fluid levels in the imaged portion of the\nbilateral maxillary sinuses. The remainder of the imaged paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "1. Expected postoperative pneumocephalus status post stereotactic biopsy. No\nacute hemorrhage.\n2. Large bifrontal white matter hypodensities and hypodensity involving the\ngenu of the corpus callosum are similar to the outside head CT.\n3. Bifrontal masses are better appreciated on preceding contrast enhanced MRI." + }, + { + "input": "SOFT TISSUES: There is no stranding, fluid collection, hematoma, or other\nsoft tissue abnormality.\n\nMAXILLOFACIAL BONES: The maxillofacial bones are intact, without fracture.\nThe zygomatico-maxillary complex is intact. The lateral pterygoid plates are\nintact.\n\nMANDIBLE: The mandible is without fracture or temporomandibular joint\ndislocation. The temporomandibular joints are symmetric, without significant\ndegenerative change.\n\nDENTITION: There are no dental fractures.Periapical lucency is identified at\nthe ___ tooth number 3.\n\nSINUSES: Right maxillary sinus is completely opacified. There is small foci\nof hyperintensity within the maxillary sinus, which may represent fungal\ncolonization. No bony erosion is identified. Right anterior ethmoid air\ncells are also opacified. Mucosal thickening is noted the right frontal\nsinus. The ostiomeatal units are obstructed on the right side. The mastoid\nair cells and middle ear cavities are clear.\n\nNOSE: There is no nasal bone fracture. Nasopharyngeal soft tissues are\nunremarkable. There is no nasal septal hematoma.\n\nORBITS: The orbits, including the laminae papyracea, are intact. The globes\nare intact with non-displaced lenses and no intraocular hematoma. There is no\npreseptal soft tissue edema. There is no retrobulbar hematoma or fat\nstranding.\n\nAllowing for imaging technique optimized for the face, the limited included\nis grossly unremarkable. Included portion of brain notable for a mass at the\ncorpus callosum as seen on prior MRI.", + "output": "1. Right maxillary sinus is completely opacified with foci of hyperdensity\nwithin the sinus which may represent fungal colonization. No bony erosion is\nidentified.\n\n2. Periapical lucency is identified at the ___ tooth 3." + }, + { + "input": "Again seen is a large irregular area of hypodensity involving the white matter\nof the bilateral frontal lobes with hypodensity extending across the genu of\nthe corpus callosum, corresponding with the pattern of FLAIR hyperintensity\nseen on prior MR. ___ in the region of the genu of corpus\ncallosum, which corresponds with the enhancing lesion seen on prior MR, is not\nsignificantly changed compared to ___, allowing for differences in\ntechnique. There is stable appearance of minimal effacement of the frontal\nhorn of the right ventricle. The basal cisterns appear similar to prior,\nwithout significant effacement.\nThere is no evidence of fracture. There is opacification of the right\nmaxillary sinus, bilateral ethmoid air cells, slightly worse compared to\nprior. The visualized portion of the other paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Similar appearance of ___ in the genu of the corpus callosum and\nhypodensity in the white matter of the bilateral frontal lobes, compared to\nprior MR on ___, allowing for differences in technique." + }, + { + "input": "Compared to the prior CT of ___ hypodensity throughout the white\nmatter in the bilateral frontal lobes is relatively unchanged. Hypodensity in\nthe genu of the corpus callosum is due to CNS lymphoma treatment. There is no\nacute intracranial hemorrhage identified. The ventricles and sulci are\nstable in size and configuration.\nThere is a right frontal burr hole. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial hemorrhage or new mass effect.\n2. MR is more sensitive for evaluation of intracranial masses." + }, + { + "input": "The paranasal sinuses are normally aerated, with no significant mucosal\nthickening or air-fluid levels identified. There is very minimal mucosal\nthickening in the right maxillary sinus. The ostiomeatal units are patent.\nThe cribriform plates are intact. There is no nasal septal defect. The nasal\nseptum is midline. The lamina papyracea are intact. Again seen is periapical\nlucency surrounding a right maxillary tooth. Limited imaging of the brain\nagain demonstrates bilateral white matter hypodensity extending across the\ncorpus callosum.", + "output": "There is no significant mucosal thickening or air-fluid levels identified in\nthe paranasal sinuses. Minimal mucosal thickening in the right maxillary\nsinus, likely represents the sequela of prior sinus infection seen on the ___ CT of the sinuses." + }, + { + "input": "Since ___ CT, extensive white matter hypodensity in the frontal lobes\nhas increased, consistent with worsening vasogenic edema. Hypodensity in the\ngenu of the corpus callosum correlates with known CNS site of treated\nlymphoma. Difficult to assess interval change in size on this noncontrast CT\nexam though given increase in vasogenic edema and subtle increase in overall\nhypodensity at the genu of the corpus callosum, findings are potentially\nconcerning for tumor progression. No evidence of acute intracranial\nhemorrhage. Partial effacement of the right lateral ventricle is slightly\nincreased with approximately 5 mm of midline shift to the left.\n\nNo acute fracture. Postsurgical right frontal burr hole changes are noted. \nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "Interval increase in extent of the bifrontal vasogenic edema with mass-effect\non the right lateral ventricle and 5 mm leftward midline shift. Tumor size\ncannot be assessed on this noncontrast CT. Consider MRI to further evaluate. \nNo hemorrhage.\n\nRECOMMENDATION(S): Note that MR is more sensitive to evaluate intracranial\nmasses." + }, + { + "input": "Right frontal burr hole and postsurgical changes are unremarkable. Peripheral\nhigh density around the lesion in the left frontal lobe is better evaluated on\nthe MRI from ___. Additional high-density around the left\nventricle is better seen on the MRI from ___. Subtle\nhyperdensity in the right frontal lobe (4:148) may represent a focus of new\nenhancement. However, due to the presence of contrast, the distribution of\ncalcification versus enhancement is difficult to discern. Bifrontal\nhypodensities have substantially improved since ___ and similar to the\nFLAIR signal changes dating back to ___. There is no evidence of\nnew infarction or hemorrhage. The ventricles and sulci are stable in size and\nconfiguration since ___.\n\nNew since prior exam is thickening and stranding of the soft tissue overlying\nthe left globe. The postseptal fat, including intra and extraconal fat are\nunremarkable. The superior ophthalmic vein is normally opacified. The\nextraocular muscles and the optic nerve are symmetric in size when compared to\nthe right. There is no evidence of proptosis. The right globe is\nunremarkable.\n\nPre-existing partial and near complete opacification of the left frontal and\nmaxillary, and ethmoid air cells are persistent. Trace mucosal thickening of\nthe right ethmoid air cells are also stable. The sphenoid sinuses are patent.\nThe visualized portion of the mastoid air cells, and middle ear cavities are\nclear.", + "output": "1. Likely pre-septal cellulitis of the left eye. Less likely orbital\nlymphoma. Follow up clinically to ensure clearance.\n2. Scattered areas of high density, similar in distribution to the enhancing\nareas seen on the MRI from ___. However, there is a possible\narea of enhancement in the right frontal lobe, which may be new since ___. Consider assessment with nonemergent MRI.\n3. Paranasal sinus disease." + }, + { + "input": "Previously seen left orbital preseptal cellulitis is small upper eyelid\nabscess have resolved.\n\nNear complete opacification of the left maxillary sinus with mucosal\nthickening and fluid, mildly improved since prior. Findings consistent with\nacute sinusitis. Mild opacification of the left frontal sinus, with mucosal\nthickening, improved since prior. Mild mucosal thickening of the left ethmoid\nair cells, improved since prior.\nLeft maxillary sinus infundibulum of ostiomeatal unit is narrowed by mucosal\nthickening. Left Haller cell. Left frontal sinus drainage pathway including\ninfundibulum are patent, although, there is mucosal thickening along its path.\n\nMild mucosal thickening at the upper and lower right frontal drainage pathway,\npatent and mildly narrowed infundibulum. Right frontal sinus otherwise\npatent.\n\nMild mucosal thickening right maxillary sinus. Mucosal thickening mildly\nnarrows infundibulum of ostiomeatal units. Fleck of calcification right\nmaxillary antrum, similar. Osseous dehiscence at the left maxillary sinus\nfloor, measuring 2.7 mm, slightly smaller compared with prior, consider\nodontogenic sinusitis. Findings are similar compared to prior..\n\nTrace mucosal thickening right ethmoid sinus.\n\nMild mucosal thickening right sphenoid sinus, new since prior. Sphenoid\nsinuses otherwise clear, sphenoid sinus ostia are patent.\n\nThe cribriform plates are intact. The lamina papyracea are intact. There is\nair above bilateral anterior ethmoidal arteries. Bilateral concha bullosa. \nNasal septum is midline. Clear nasal cavity.\n\nAreas of brain parenchymal calcifications bilateral frontal lobes, left\ncentrum semiovale, areas of low-attenuation volume loss and encephalomalacia,\nsimilar to prior, likely treatment related, refer to prior brain MRI ___. Right frontal burr hole.", + "output": "1. Extensive paranasal sinus disease, worse at left maxillary sinus, with\nacute left maxillary sinusitis. Appearance is improved since prior.\n2. Osseous dehiscence left maxillary sinus floor, suggesting left maxillary\nodontogenic sinusitis.\n3. Left Haller cell. Air cells above bilateral anterior ethmoidal arteries.\n4. Intracranial findings as above, better seen on prior MRI." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci well within the range of normal for a\npatient of this age.\n\nThere is no evidence of fracture. Mild mucosal thickening of the ethmoidal\nair cells and left sphenoid sinus is present. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "Mild paranasal sinus inflammatory changes. Otherwise normal study." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. \nProminence of the ventricles and sulci is consistent with cortical volume\nloss. Minimal subcortical and periventricular white matter hypodensity is\nlikely sequela of chronic small vessel disease.\n\nNo osseous abnormalities seen. Fluid and aerosolized secretions are seen\nwithin the left sphenoid sinus. Remaining visualized paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, ormass effect. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. Opacification of the left sphenoid sinus\nwith aerosolized secretions and mild mucosal thickening of the right sphenoid\nsinus and the ethmoid air cells are unchanged. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are otherwise\nclear. The visualized portion of the orbits are unremarkable. Cavernous\ncarotid and distal vertebral artery atherosclerotic calcifications are noted.", + "output": "No evidence of intracranial hemorrhage or acute infarction." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema,or large mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. There is fluid and aerosolized secretions\nin the left sphenoid sinus; otherwise, the visualized paranasal sinuses and\nmastoid air cells are clear. The middle ear cavities are clear. The frontal\nsinuses are underdeveloped. The visualized portions of the globes and bony\norbits are intact and unremarkable. Carotid siphon calcifications are noted.", + "output": "1. No acute intracranial process.\n2. Fluid and aerosolized secretions in the left sphenoid sinus may reflect\nsinusitis." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. Mild periventricular and subcortical white matter hypodensities are\nnonspecific, but likely reflect the sequela of chronic microvascular\ninfarction. Atherosclerotic calcifications involving the cavernous carotid\narteries are re-demonstrated.\n\nThere is no evidence of acute fracture. Deformities of both nasal bones and\nleft mandibular condyle appear chronic. Probable acute on chronic\ninflammation of the left sphenoid sinus with aerosolized secretions, moderate\nmucosal thickening, and thickening and sclerosis of the sinus walls is\npresent. Mucous retention cyst in the left maxillary sinus is noted. The\nvisualized portion of the remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable apart from bilateral lens replacements.", + "output": "1. No acute intracranial hemorrhage or mass effect. No acute fracture.\n2. Probable acute on chronic sinusitis involving the left sphenoid sinus." + }, + { + "input": "Status post bilateral burr holes and a parietal approach with drains placed\nand terminating along bilateral frontal convexities. There is substantial\npneumocephalus. Large volume subdural hematomas are seen bilaterally, of\nheterogeneous density. Hyperdense areas within the blood products are in a\nsimilar distribution to the prior study. Blood products extend from the\ncalvarium up to 1.5 cm on the right, previously 1.8 cm, and 0.7 cm on the\nleft, previously 1.7 cm. There is a parafalcine hematoma which appears\nunchanged from the prior study. There is persistent midline shift to the\nright, of up to 1.0 cm, previously 1.0 cm. The basal cisterns are patent.\nThere is crowding of the foramen magnum without herniation. There is\nasymmetric effacement of the right lateral ventricle relative to the left as\non prior.\n\nNo intraparenchymal hemorrhage is demonstrated. There is soft tissue swelling\naround the bilateral burr hole approach sites, with surgical staples noted\nbilaterally. No substantial subgaleal hematoma is demonstrated, there is\nlikely trace blood product and subcutaneous emphysema.\n\nNo acute fractures. Severe calcification of the bilateral carotid siphons. \nThe paranasal sinuses and bilateral mastoid air cells are well aerated. The\norbits are within normal limits.", + "output": "1. Status post bilateral burr hole and drain placement. There is persistent\nheterogeneous subdural hemorrhage bilaterally which appears mildly improved\nfrom prior study more substantially on the left. Hyperdense areas within the\nblood products are in a similar distribution to the prior study. There is\nunchanged parafalcine hematoma.\n2. Midline shift measures up to 1.0 cm which is similar to the prior study. \nNo frank herniation, there is some crowding of the foramen magnum.\n3. Postsurgical changes of the scalp at the bilateral burr hole sites without\nlarge subgaleal hematoma. Substantial intracranial pneumocephalus is\npostsurgical." + }, + { + "input": "There are postsurgical changes from right parietal craniotomy and a left\nparietal burr hole. The bilateral subdural drains have been removed. There\nhas been interval decrease in the pneumocephalus along the bilateral cerebral\nconvexities.\n\nThe residual heterogenous subdural hemorrhages along the right cerebral\nconvexity measuring up to 14 mm and along the left cerebral convexity\nmeasuring up to 7 mm are not significantly changed in size. There is\nincreased hyperdensity within the right subdural hemorrhage along the\nparietoccipital region. A small amount of subdural hemorrhage along the falx\nis also not significantly changed. The subdural hemorrhages along the\nbilateral cerebellar hemispheres are better appreciated on prior MRI but\nappear grossly unchanged.\n\nThe leftward midline shift now measures 6 mm at the septum pellucidum,\npreviously 10 mm. There is decreased effacement of the right lateral\nventricle. There is unchanged crowding of the foramen magnum. The basal\ncisterns are patent.\n\nThere is no evidence of acute territorial infarction. There are hypodensities\nin the periventricular white matter, which are nonspecific, but most likely\nrepresent chronic microangiopathic changes. There are atherosclerotic\ncalcifications of the intracranial internal carotid and vertebral arteries.\n\nThere is minimal mucosal thickening in the right maxillary sinus. The\nvisualized portion of the remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Postsurgical changes from right parietal craniotomy and a left parietal\nburr hole with interval removal of the bilateral subdural drains.\n2. New small amount of hyperdensity within the subdural hemorrhage along the\nright parietoccipital region, which may represent acute hemorrhage or\ncontinued evolution of blood products. No significant change in the size of\nthe subdural hemorrhages along the bilateral cerebral convexities, falx and\nbilateral cerebellar hemispheres.\n3. Decreased midline shift, now measuring 6 mm, previously 10 mm. Decreased\neffacement of the right lateral ventricle." + }, + { + "input": "Status post right parietal craniotomy and left parietal burr hole with\nbilateral overlying skin staples, as seen previously. Persistent right\ngreater than left pneumocephalus.\n\nMixed density right convexity extra-axial collection, predominantly hypodense\nwith multiple areas of hyperdensity as well as air, measures up to 14 mm in\nits midportion on image 2:21 and up to 16 mm more superiorly on image 2:23,\nunchanged compared to ___ when measured in the same fashion, without\nevidence for increased hyperdense blood products.\n\nMixed density left convexity extra-axial collection, mostly hypodense with\nsmall amount of hyperdense blood products, measures up to 8 mm on image 2:23\nand up to 13 mm more superiorly on image 2:24, unchanged compared to ___ when measured in the same fashion, without evidence for increased\nhyperdense blood products.\n\nSmall amount of hyperdense subdural blood along the falx, right greater than\nleft, is unchanged in extent with slight dependent redistribution.\n\nUnchanged mild right sulcal effacement. Unchanged mild effacement of the\nright lateral and third ventricles. There is persistent leftward shift of\nmidline structures, difficult to measure accurately date at the level of the\nlateral ventricles due to the normal-variant cavum septum pellucidum et\nvergae, but measuring approximately 5-6 mm, unchanged. Unchanged borderline\nright uncal herniation with effacement of right perimesencephalic cistern\n(02:12). Other basal cisterns are preserved.\n\nMild mucosal thickening is again seen along the floors of bilateral maxillary\nsinuses.", + "output": "Stable mixed density bilateral extra-axial collections, right greater than\nleft, with stable mass effect compared to ___." + }, + { + "input": "Status post right parietal craniotomy and left parietal burr hole with\nbilateral overlying skin staples. There is persistent, though slightly\nimproved, right greater left pneumocephalus.\n\nMixed density right convexity extra-axial collection, predominantly hypodense,\nis stable measuring up to 1.4 cm along its midportion.\n\nMixed density left convexity extra-axial collection,, predominantly hypodense\nas well is similar to slightly improved measuring up to 7 mm along its\nmidportion, previously up to 8 mm.\n\nSmall amount of hyperdense subdural blood is grossly stable.\n\nDiffuse mild right sulcal effacement is unchanged. Partial effacement of the\nright and third ventricles is unchanged as well. Allowing for differences in\npatient positioning, there is slight improvement in leftward midline shift\nmeasuring up to 4 mm, previously up to 5 mm. Borderline right uncal\nherniation may be positional but is unchanged.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Stable mixed density bilateral extra-axial collections, right greater left,\nwith stable mass effect." + }, + { + "input": "Dental and surgical hardware streak artifact limits study.\n\nCT HEAD WITHOUT CONTRAST:\nThe patient is status post bilateral burr hole placement. Postsurgical\nchanges related to right middle meningeal artery embolization is noted. There\nis interval decrease in size of the bilateral subdural collections, with the\nright measuring 1.3 cm in diameter and the left measuring 9 mm in diameter. \nThere is continued decrease of leftward midline shift, now measuring 5 mm. The\ndegree of pneumocephalus is slightly decreased. There is diffuse right\ncerebral sulcal effacement, unchanged.\n\nA small posterior falcine subdural hematoma measures 3 mm in diameter,\nunchanged.\n\nThere is no evidence of acute large territorial infarction ormass. The\nventricles and sulci are grossly stable in size and configuration. A cavum\nseptum pellucidum and vergae is seen. A chronic infarct is seen in the left\nbasal ganglia.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits demonstrate\npostoperative changes.\n\nCTA HEAD:\nAgain, there is occlusion of the right mid V3 segment with reconstitution of\nflow in the distal V3 and V4 segment. Extensive calcified atherosclerotic\nchanges of the V4 segments are seen.\n\nAtherosclerotic changes of the petrous, cavernous and supraclinoid segments of\nthe bilateral internal carotid arteries are seen without significant stenosis.\n\nOtherwise, the vessels of the circle of ___ and their principal\nintracranial branches appear grossly preserved with no evidence of stenosis,\nocclusion,oraneurysm. The dural venous sinuses are grossly patent.", + "output": "1. Dental and surgical hardware streak artifact limits study.\n2. Oval decrease in size of bilateral subdural collections, leftward midline\nshift and agree of pneumocephalus, with residual approximately 5 mm leftward\nmidline shift.\n3. Grossly stable diffuse right cerebral sulcal effacement and small posterior\nfalcine subdural hematoma.\n4. Within limits of study, no definite evidence of acute large territorial\ninfarct.\n5. Occlusion of the right mid V3 segment with reconstitution at its distal V3\nsegment.\n6. Nonocclusive atherosclerotic narrowing of circle of ___ as described.\n7. Otherwise, grossly patent circle of ___ without definite evidence of\nstenosis,occlusion,or aneurysm." + }, + { + "input": "Image quality is severely degraded by poor bolus timing. There is reduced\nopacification of the common and internal carotid arteries bilaterally. Within\nthis limitation, there appears to be calcified plaque at the right common\ncarotid artery bifurcation, probably without stenosis by NASCET criteria. \nThere is no evidence of a stenosis at the proximal left internal carotid\nartery although there is a small amount of calcified plaque. There is dense\ncalcification of the cavernous carotid arteries bilaterally.\nThe vertebral arteries are poorly opacified bilaterally. This is to a far\ngreater extent than the poor opacification of the carotid arteries, suggesting\nthat there may be bilateral vertebral artery disease, rather than simply poor\nopacification due to bolus timing. However, due to the severe reduced\nopacification, it is not possible to better characterize the vertebral\narteries from their origin to the intracranial course. The intracranial\nportions of the vertebral arteries are calcified bilaterally but appear to\nopacify.", + "output": "1. Severely limited study due to poor arterial opacification.\n2. Bilateral largely calcified plaques at the carotid bifurcations, likely\nwithout stenosis by NASCET criteria.\n3. Poor opacification of the vertebral arteries bilaterally. This is likely\npathologic, but poorly characterized due to inadequate arterial opacification." + }, + { + "input": "The patient is status post right parietal craniotomy. Degree of\npneumocephalus has decreased, now with few foci noted along the vertex, and\nsmall amount overlying the right greater than left frontal lobes. Bilateral\nsubdural hematomas are not substantially changed in size, measuring up to 1.3\ncm in maximum thickness on the right and 7 mm in maximal thickness on the\nleft, though with overall decrease in hyperdense component. The ventricles\nand sulci are similar in size and configuration, with mass effect resulting in\npartial effacement of the sulci along the right hemisphere, mild effacement of\nthe right lateral ventricle and 4 mm of leftward midline shift.There is no\nevidence of acute large territorial infarction.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "Stable size of right greater than left subdural collections, though with\noverall decrease in hyperdense component. Similar mass effect, with 4 mm of\nleftward midline shift." + }, + { + "input": "The previously noted right-sided chronic subdural hematoma is decreased in\nsize and measures 10 mm in maximum width compared to 15 mm on the previous\nstudy. The overall size of the hematoma has decreased. There is no acute\nhemorrhage seen. The previously noted small left-sided subdural hematoma has\nconsiderably decreased in size and is essentially resolved. Mild-to-moderate\nbrain atrophy seen. No midline shift or hydrocephalus.", + "output": "1. Considerable decrease in size of right-sided chronic subdural hematoma\nwithout signs of acute hemorrhage.\n2. Considerable root decreased and resolution of left-sided subdural hematoma.\n3. No acute abnormalities." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial process, with no evidence of acute intracranial\nhemorrhage.\n2. Within limits of this noncontrast study, no definite evidence of\nintracranial mass." + }, + { + "input": "There is no evidence of acute large territorial infarct or hemorrhage. There\nappears to be loss of gray-white matter differentiation, concerning for\nhypoxia likely related to recent cardiac arrest. These sulci at the skull\nvertex are not effaced. The frontal horns of the lateral ventricles seem\nsomewhat diminutive, but patent. The basal cisterns remain patent.\n\nNo osseous abnormalities seen. There is mild mucosal thickening of the\nvisualized paranasal sinuses and ethmoid air cells. The mastoid air cells and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No acute intracranial hemorrhage.\n2. Loss of gray-white matter differentiation, concerning for hypoxic ischemic\ninjury, likely related to recent cardiac arrest. Recommend clinical\ncorrelation. If clinically indicated, MRI of the brain may be obtained for\nfurther evaluation.\n3. Mild mucosal thickening of the visualized paranasal sinuses and ethmoid air\ncells is likely related to intubation.\n4. Paranasal sinus disease as described.\n\nRECOMMENDATION(S): Loss of gray-white matter differentiation, concerning for\nhypoxic ischemic injury, likely related to recent cardiac arrest. Recommend\nclinical correlation. If clinically indicated, MRI of the brain may be\nobtained for further evaluation.\n\nNOTIFICATION: These findings were communicated via telephone by Dr. ___\n___ to Dr. ___ at 0200 on ___." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is again seen a small focus of chronic hemorrhage, likely an occult\nvascular malformation, in the left parietal lobe (series 2, image 23)\nunchanged from the prior studies. There is no evidence of\ninfarction,edema,ormass.\nThere are atherosclerotic changes along both cavernous ICAs.\n\nThe ventricles and sulci are age appropriate.\n\nThere is mild mucosal thickening along the ethmoid air cells and in the\nbilateral maxillary sinuses. The remainder of the paranasal sinuses and\nmastoid air cells appear clear. Note is made of bilateral lens replacement\nsurgery. The orbits appear otherwise unremarkable.\n\nAgain seen is a hypodense 2 cm elongated mass in subcutaneous soft tissue of\nthe right posterolateral occipital region (series 2, image 8). This was shown\nto enhance intensely on the brain MR but does not immediately enhance on the\ndynamic CT. This could be potentially ___ lymphatic in nature. \nFurther evaluation is recommended.\n\nCTA HEAD:\nThere are atherosclerotic changes along both cavernous ICAs without high-grade\nstenosis. The vessels of the circle of ___ and their principal\nintracranial branches appear normal without stenosis, occlusion, or aneurysm\nformation. There is no abnormal vascularity in the region of the small focus\nof hyperdensity in the high left parietal lobe.\nThe dural venous sinuses are patent.\n\nCTA NECK:\nNormal 3 vessel aortic arch. There are mild atherosclerotic plaques at both\ncarotid bifurcations but without evidence of internal carotid stenosis by\nNASCET criteria. There are few areas of mild narrowing along the cervical\ncourse of the bilateral vertebral arteries secondary to hypertrophic\ndegenerative changes of the spine (for example series 3, image 112, image 133\nand 134). The carotidandvertebral arteries and their major branches appear\notherwise normal without evidence of dissection or occlusion.\n\nOTHER:\nVisualized portions of the lung demonstrate gravity dependent atelectasis and\nmild emphysematous changes. No suspicious pulmonary nodules. The visualized\nportion of the thyroid gland is within normal limits. There is no\nlymphadenopathy by CT size criteria.\n\nIncidental note is made of likely enchondroma versus bone infarct of the left\nproximal humerus (series 1, image 2) on scout localizer images. Healed\nfracture deformity of the left clavicle and chronic left-sided rib fractures\nare noted.", + "output": "1. Small focus of hyperdensity in the high left parietal lobe without\nassociated abnormal vascularity most likely represents a small cavernoma or\nmineralization from prior hemorrhage and much less likely a micro AVM given\nlack of associated abnormal vessels.\n2. No evidence of acute infarction or intracranial mass on noncontrast head\nCT.\n3. Patent intracranial and cervical vasculature. No evidence of dissection,\nocclusion or aneurysm formation greater than 3 mm.\n4. Areas of mild narrowing along the bilateral vertebral arteries secondary to\nhypertrophic degenerative changes of the spine but without hemodynamically\nsignificant stenosis.\n5. Unchanged mass in the subcutaneous soft tissues of the right posterolateral\noccipital region which shows intense enhancement on the brain MRI but does not\nimmediately enhance on the dynamic CT. Imaging appearance favors a lesion of\nvascular/venolymphatic origin. Close clinical and/or imaging follow-up is\nrecommended.\n6. Additional findings described above.\n\nRECOMMENDATION(S): Subcutaneous soft tissue mass in the right posterolateral\noccipital region showing no immediate enhancement on the dynamic CT but\nintense enhancement on the brain MRI. Close clinical and/or imaging follow-up\nis recommended.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 10:22 into the Department of Radiology\nnon-urgent critical communications system for direct communication to the\nreferring provider." + }, + { + "input": "Tthere are multiple bilateral enlarged level 2 and level 3 lymph nodes with\ninduration of the adjacent tissues. This is far more prominent on the left\nthan right. On the left, these nodes are often confluent in many appear\nnecrotic. There are also left-sided level 5 nodes with similar appearance. \nThis pattern appears most likely infectious.\nThere is a defect in the left axilla after resection of the ___ 14. Tooth. \nThere is local cortical disruption but no other osseous findings to suggest\ninfection. The adjacent soft tissues are only mildly indurated.\nImages of the remainder of the neck demonstrate no other areas suspicious for\ninfection.\nEvaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal.\nThe neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.", + "output": "1. Prominent bilateral infectious-appearing adenopathy, more extensive and\nwith necrosis on the left.\n2. Socket at the site of a dental extraction without imaging findings to\nsuggest osseous involvement with infection." + }, + { + "input": "Left : The external auditory canal is normal. Soft tissue density is seen in\nPrussak's space and around the stapes. The ossicles and tegmen are intact. \nThere is a focal 2 mm defect in the left tympanic membrane. There is no\nevidence for enlarged vestibular aqueduct or superior semicircular canal\ndehiscence. The facial nerve follows a normal course through the middle ear.\nThere is no evidence for inner ear dysplasia. There is fluid-filled\nopacification and sclerosis of the left mastoid air cells.\n\nRight: The external auditory canal is normal. The middle ear cavity is clear.\nThe ossicles and tegmen are intact. There is no evidence for enlarged\nvestibular aqueduct or superior semicircular canal dehiscence. The facial\nnerve follows a normal course through the middle ear. There is no evidence for\ninner ear dysplasia. The mastoids are clear.\n\nOther: Visualized brain and neck soft tissues are normal.", + "output": "1. Soft tissue density in the left Prussak's space and around the stapes which\nmay represent granulation tissue versus cholesteatoma. No evidence of\nossicular erosions or demineralization.\n2. Fluid-filled opacification and mild sclerosis of the left mastoid air cells\nsuggestive of chronic otomastoiditis.\n3. 2 mm focal defect in the left tympanic membrane, consistent with clinical\nhistory of chronic tympanic membrane perforation." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence acute major vascular territory infarction, acute\nhemorrhage, edema, or mass effect. There are chronic bilateral basal ganglia\ninfarcts. Extensive subcortical, deep, and periventricular white matter\nattenuation are nonspecific but likely sequela of chronic small vessel disease\nin this age group. There is prominence of the ventricular system and sulci in\nthe setting of age related involutional changes.\n\nFrontal sinuses are not pneumatized. There is minimal mucosal thickening in\nthe ethmoid air cells and a tiny focus of mucosal thickening in the left\nmaxillary sinus. There is partial bilateral mastoid air cell opacification. \nThe orbits are unremarkable.\n\nCTA HEAD:\nThere are mild atherosclerotic calcifications of the cavernous and\nsupraclinoid ICAs without flow-limiting stenosis. No flow-limiting stenosis\nor aneurysm is seen elsewhere in the intracranial circulation. Right ___\n___ is low-lying and appears to be extradural, a normal variant. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThere is a 3 vessel aortic arch. There is mild mixed plaque in the visualized\nproximal descending aorta. There is mild calcified plaque at the right\nsubclavian artery origin without flow-limiting stenosis. The common and\ninternal carotid arteries are widely patent without internal carotid stenosis\nby NASCET criteria. There are small foci of calcified plaque in bilateral V2\nsegments of the vertebral arteries without flow-limiting stenosis.\n\nOTHER:\nThe visualized portion of the lungs demonstrate mild biapical\npleural/parenchymal scarring. There is an approximately 1 cm peripherally\nenhancing cystic left thyroid nodule. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No evidence for acute intracranial abnormality.\n2. Chronic bilateral basal ganglia infarct. Extensive supratentorial white\nmatter abnormalities are nonspecific but likely sequelae of chronic small\nvessel ischemic disease in this age group.\n3. No evidence for flow-limiting stenosis or dissection in the major arteries\nof the head and neck. No evidence for an intracranial aneurysm.\n4. Approximately 1 cm left thyroid nodule. The ___ College of Radiology\nguidelines suggest that in the absence of risk factors for thyroid cancer, no\nfurther evaluation is recommended." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nlarge territorial infarction. Prominent ventricles and sulci suggest\nage-related involutional changes or atrophy. Subcortical and periventricular\nwhite matter hypodensities, also seen in ___, are consistent with chronic\nsmall vessel ischemic disease. The basal cisterns appear patent and there is\npreservation of gray-white matter differentiation.\n\nThe visualized bony structures are grossly unremarkable. Mucosal thickening of\nthe right sphenoid sinus is seen. Atherosclerotic mural calcification of the\nbilateral internal carotid arteries is noted. Patient is status post \nbilateral lens replacement.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is mild swelling and prominence of palatine tonsils, left greater than\nright, with heterogeneous enhancement but no evidence of a focal fluid\ncollection. Superimposed tonsilliths are seen scattered within the bilateral\npalatine tonsils as well as the right lingual tonsil, likely sequela of prior\ninfections. The remainder of the aerodigestive tract is otherwise\nunremarkable. Parapharyngeal fat is preserved bilaterally. No retropharyngeal\nor prevertebral fluid collection is identified.\n\nThere is very minimal subcutaneous inflammatory stranding overlying the left\nparasymphyseal mandible without evidence of focal collection. No periapical\nlucency is identified in the mandible or maxilla.\n\nThe parotid glands are unremarkable. The left submandibular gland is\nasymmetrically larger relative to the right without evidence of focal mass or\nsurrounding inflammatory changes, likely a normal anatomic variant. There is\nno cervical lymphadenopathy by CT size criteria.\n\nThe thyroid gland is multinodular, unchanged from prior exam.\n\nA right-sided Port-A-Cath is noted. There are multiple centrilobular\nground-glass nodular pulmonary opacities in the visualized left upper lobe,\nunchanged from the chest CT dated ___, which may represent\ninfectious/inflammatory etiology. There are multiple calcified mediastinal and\nleft hilar lymph nodes, compatible with prior granulomatous disease. No\nenlarged lymph nodes is seen in the visualized upper chest.\n\nThere is 2 mm anterolisthesis of C4 on 5 and C7 on T1. Multilevel loss of disc\nheight, most severe at C4-5 through is T1 and T2 is noted. Disc osteophyte\ncomplexes are present at multiple levels, indenting the ventral thecal sac.\nThere is multilevel neural foraminal narrowing by uncovertebral and facet\nosteophytes. There is a large trabeculated lucency of T1 vertebral body, which\nextends to the posterior elements on the right, without expansion of cortical\ndestruction, most consistent with a hemangioma. Congenital nonunion of the\nposterior element of C1 is noted. The right vertebral artery is markedly\ntortuous at C3, invaginating into and remodeling the right lateral aspect of\nthe C3 vertebral body by 1 cm (Series 2, image 33 and series 7, image 38).\n\nIncidentally noted is a hypoplastic non dominant left vertebral artery from\nits origins to the intracranial segments an retropharyngeal course of the\nright extracranial internal carotid artery.\n\nThe middle ear cavities and visualized portions of the mastoid air cells are\nwell pneumatized and clear. There is chronic opacification of the right\nsphenoid sinus demonstrating hyperostotic walls, similar in appearance\nallowing for technical differences to MR ___ of ___. There is\nminimal mucosal thickening of the left maxillary sinus. Bilateral lens\nreplacements are noted. Otherwise the orbits are unremarkable.", + "output": "1. Prominence of the palatine tonsils, left greater than right, compatible\nwith tonsillitis. No evidence for tonsillar, peritonsillar, retropharyngeal or\nother abscess.\n2. Minimal subcutaneous inflammatory stranding overlying the left\nparasymphyseal mandible without evidence of focal collection or periapical\nlucencies in the dentition.\n3. Multiple centrilobular ground-glass nodular pulmonary opacities in the\nvisualized left upper lobe, unchanged from the chest CT dated ___,\nwhich may be infectious or inflammatory. Please correlate clinically.\n4. Multilevel multifactorial changes of the cervical spine as described above\nwith mild anterolisthesis at C4-5 and C7-T1. Likely hemangioma of the T1\nvertebral body and left posterior elements. This may be better evaluated with\ncervical spine MRI, if clinically indicated.\n\nNOTIFICATION: Impression items 1 and 2 were discussed over the telephone by\nDr. ___ with Dr. ___ on ___ at approximately 17:55." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is minimal mucosal thickening of the\nright sphenoid sinus. The visualized portion of the remaining paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is a focal hypodensity in the left putamen that likely represents a\nchronic lacune. There is no evidence of fracture, hemorrhage,edema, mass or\nrecent infarction. The ventricles and sulci are normal in size and\nconfiguration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavitiesare essentially clear. The visualized portion of the orbits are\nnormal.", + "output": "Chronic lacune in the left putamen.\nNo evidence of hemorrhage or recent infarction." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Basilar cisterns are\npatent.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nminimal prominence of the ventricles and sulci suggestive of involutional\nchanges.\n\nThere is no evidence of fracture. Aside from mild mucosal thickening in the\nanterior ethmoidal air cells and the maxillary sinuses, the visualized portion\nof the paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "No acute intra or extra-axial hemorrhage, mass effect, or shift of midline\nstructures is demonstrated. Confluent periventricular, subcortical, and deep\nwhite matter hypodensities are compatible with chronic small vessel ischemic\nchanges. Widening of the sulci and ventricles is compatible with age\nappropriate atrophy. Basal cisterns are patent. Differentiation of the gray\nand white matter is preserved. Atherosclerotic calcifications are seen\ninvolving the cavernous carotid arteries. .\n\nNo acute osseous abnormalities seen. Air-fluid level within a right mastoid\nair cell as well as partial opacification of the left mastoid air cells\nsuggest mild ongoing inflammation. Minimal mucosal thickening is also seen\ninvolving the ethmoid air cells and right maxillary sinus. The middle ear\ncavities a remaining paranasal sinuses are clear. A left scleral band is\nincidentally noted.", + "output": "No acute intracranial hemorrhage or mass effect." + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass. Extensive bilateral periventricular, subcortical and deep white matter\nhypodensities are nonspecific, but likely a sequela of chronic small vessel\nischemic changes. There is prominence of the ventricles and sulci suggestive\nof involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses are clear. Partial opacification of bilateral mastoid air cells. \nMiddle ear cavities are clear. A scleral band is incidentally noted on the\nleft. The visualized portion of the orbits are otherwise unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of territorial infarction,intracranial\nhemorrhage,edema,or mass. There are extensive periventricular and subcortical\nwhite matter hypodensity is a nonspecific finding, however concerning for\nchronic microvascular ischemic disease. Prominence of the ventricles and\nsulci suggest age related involutional change.\n\nThere is no evidence of fracture. There is chronic partial opacification of\nleft mastoid air cells. There is also opacification of the left middle ear\ncavity. Right mastoid air cells, middle ear cavity, and the paranasal sinuses\nare clear.\nThe orbits and globes are remarkable for a scleral band on the left.", + "output": "1. No acute intracranial abnormality.\n2. Chronic findings included involutional change, chronic microvascular\ndisease, and left mastoid and middle ear cavity opacification." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Extensive periventricular and subcortical white matter\nhypodensities are again seen, similar in overall extent compared with prior,\nmost likely due to chronic microvascular ischemic disease. Ventricular\nprominence is stable. Involutional changes are age appropriate. Basal\ncisterns are patent. Imaged paranasal sinuses and mastoid air cells appear\nwell aerated. Right middle ear cavity is well aerated. There is a similar\nappearance of opacity abutting the left middle ear ossicles when compared with\nprior. The bony calvarium is intact.", + "output": "No acute intracranial process. Chronic small vessel disease." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. Extensive\nperiventricular and subcortical white matter hypodensities are nonspecific,\nsimilar to prior, and likely represent sequela from chronic small vessel\nischemic changes. Hypodensities in both thalami are more conspicuous than on\nprior butter consistent with chronic lacunar infarcts. There is prominence of\nthe ventricles and sulci suggestive of global involutional changes.\n\nSmall subcutaneous tissue thickening which is slightly hyperdense in the right\ntemporal scalp is most likely posttraumatic. There is no evidence of\nfracture.\n\nThe visualized portion of the paranasal sinuses,, right middle ear cavity and\nright mastoid air cells are clear. There is partial opacification of the left\nmastoid air cells with surrounding sclerosis. The soft tissue density in the\nleft epitympanum is better appreciated on prior studies with bone reformats. \nThere is a left scleral band. The orbits are otherwise unremarkable.", + "output": "1. No acute intracranial hemorrhage, infarction, edema or mass.\n2. Small acute scalp hematoma overlying the right parietal bone. No calvarial\nfracture." + }, + { + "input": "Soft tissue changes are seen within the left maxillary sinus with thickening\nof the sinus wall indicative of chronic sinusitis. There is a bony defect\nwithin the posterior portion of the sinus which is occupied by soft tissue\nchanges. A small calcific density is seen within the sinus content (03:41)\nwhich may indicate inspissated secretions or fungal colonization. The\ninfundibulum of left ostiomeatal unit is narrowed. A small fluid level is\nidentified. The remaining sinuses are clear. No bony dehiscence identified\nat the anterior cranial fossa. The visualized nasopharynx and orbits are\nunremarkable. Mild prominence of cerebral sulci is seen.", + "output": "1. Chronic left maxillary sinusitis with a fluid level indicating acute\ncomponent." + }, + { + "input": "There is no evidence of fracture, acute large territorial\ninfarction,hemorrhage,edema,or mass. Periventricular and subcortical white\nmatter hypodensity is nonspecific, but likely reflect sequelae of chronic\nsmall vessel ischemic disease. Mildly asymmetric extra-axial space in the\nleft temporal fossa is unchanged, and could reflect an arachnoid cyst or\nencephalomalacia. There is mild prominence of the ventricles and sulci\nsuggestive of involutional changes.\n\nThere is near complete opacification of the left maxillary sinus, with\nsclerotic thickening of the walls and hyperdense components suggestive of\nchronic sinus disease with inspissated secretions or fungal colonization. \nThere are some aerosolized secretions in the right maxillary sinus, which was\nnot seen on ___. The orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction,hemorrhage,edema,or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Normal study." + }, + { + "input": "There is no evidence of infarction, edema, or mass. The ventricles and sulci\nare normal in size and configuration.\n\nThere is mild thickening of the bilateral maxillary sinuses. Otherwise, the\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.\n\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nThere are non calcified, nonobstructive plaques at the origins of the\nbilateral carotid arteries. Otherwise, the carotid and vertebral arteries and\ntheir major branches appear normal with no evidence of stenosis or occlusion.\nthere is no evidence of internal carotid stenosis by NASCET criteria.\n\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Mild atheromatous disease. Otherwise normal study." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nRoughly 31 x 17 mm right frontal intraparenchymal hemorrhage is grossly\nunchanged compared to the prior study given difference of plane. There is\nmild surrounding vasogenic edema. Surrounding areas of right frontal\nsubarachnoid hemorrhage appear unchanged. No new hemorrhage is seen. There\nremains associated mass effect with up to 4 mm of leftward midline shift. \nThere is localized mass effect with effacement of the sulci.\n\nA region of left frontal hypodensity with cortical involvement, ill-defined is\nunchanged (03:20).\n\nThe background ventricles and sulci are normal in size and configuration.\n\nHyperostosis frontalis is noted. There is a moderate mucous retention cyst in\nthe floor of the right maxillary sinus. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are otherwise\nclear. Right maxillary molar periapical lucency is noted (2:192). The\nvisualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is no CTA spot sign to suggest active hemorrhage. No definite vascular\nmalformation is seen.\n\nThere are mild to moderate atherosclerotic calcifications of the bilateral\nintracranial internal carotid arteries without significant narrowing. A\nsmall, nonocclusive filling defect is noted in the M1 segment of the left\nmiddle cerebral artery (2:229). The left A1 segment appears hypoplastic. \nThere is irregularity and mild narrowing of the right A2 segment of the ACA,\nlikely atherosclerotic. The vessels of the circle of ___ and their\nprincipal intracranial branches otherwise appear patent without occlusion, or\naneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nThere are mild atherosclerotic calcifications of a 3 vessel aortic arch. The\nleft vertebral artery is hypoplastic. There are mild atherosclerotic\ncalcifications of the bilateral carotid bifurcations without significant\nnarrowing. The internal carotid arteries are medialized. The carotid and\nvertebral arteries and their major branches appear normal with no evidence of\nstenosis or occlusion. There is no evidence of internal carotid stenosis by\nNASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. There are postsurgical changes\nfrom thyroidectomy. There is no lymphadenopathy by CT size criteria.", + "output": "1. Unchanged right frontal intraparenchymal hemorrhage with surrounding\nvasogenic edema, localized mass effect with up to 4 mm of leftward midline\nshift and right frontal subarachnoid hemorrhage. No new hemorrhage. No\ndefinite underlying vascular malformation is seen. Surveillance\ncontrast-enhanced MR imaging is recommended to resolution in order to exclude\nan underlying occult vascular malformation or possible hemorrhagic lesion.\n2. Unchanged ill-defined region of left frontal hypodensity which may\nrepresent chronic infarct, though remains age indeterminate. Consider further\nevaluation with MR.\n3. Small nonocclusive filling defect due to atherosclerotic disease or a small\nthrombus in the M1 segment of the left MCA as well as mild narrowing of the\nright A2 segment of the ACA. Otherwise patent intracranial arterial\nvasculature without occlusion or aneurysm.\n4. Patent cervical arterial vasculature without significant stenosis,\nocclusion, or dissection.\n\nRECOMMENDATION(S): Further evaluation with contrast enhanced MR examination\nis recommended, which has been ordered at the time of dictation." + }, + { + "input": "Compared with CTA head and neck performed earlier on same day, a right frontal\nintraparenchymal hematoma with surrounding mild edema is not significantly\nchanged allowing for differences in patient positioning, measuring up to 3.1 x\n1.7 cm greatest diameter. Right frontal subarachnoid hemorrhage is stable. \nMass effect with up to 4 mm of leftward midline shift is not significantly\nchanged, as well as right uncal herniation with filling of the right\nprepontine cistern. A ill-defined left frontal hypodensity is again seen,\npossibly representing chronic infarct. There is no new intracranial\nhemorrhage. The ventricles are stable in size.\n\nThere is no evidence of fracture. There is a mucosal retention cyst in the\nright maxillary sinus. The visualized portion of the remainder of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. \nPatient is status post right lens replacement. The visualized portion of the\norbits are otherwise unremarkable.", + "output": "1. No significant change in right frontal intraparenchymal hemorrhage with\nsurrounding mild edema and right frontal subarachnoid hemorrhage allowing for\ndifferences in patient positioning. No new intracranial hemorrhage.\n2. Stable mass effect with up to 4 mm of leftward midline shift and right\nuncal herniation. No tonsillar herniation." + }, + { + "input": "Compared with CT head on ___, a right frontal intraparenchymal\nhematoma is decreased in size and density. There is persistent surrounding\nedema, not significantly changed. Right subarachnoid hemorrhage is less\napparent compared with prior. There has been interval slight decrease in mass\neffect, with leftward midline shift measuring up to 3 mm, compared with 5 mm\npreviously. Effacement of the suprasellar cistern is slightly improved. Left\nfrontal encephalomalacia is again seen.\n\nThere is no evidence of fracture. There is mild mucosal thickening in the\nbilateral maxillary sinuses. The visualized portion of the remainder of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. \nPatient is status post right lens replacement. The visualized portion of the\norbits are otherwise unremarkable.", + "output": "-Interval evolution of a right frontal intraparenchymal hematoma with\nsurrounding edema and right frontal subarachnoid hemorrhage. No new\nintracranial hemorrhage.\n-Slight interval decrease in mass effect, with midline shift measuring up to 3\nmm, compared with 4 mm previously, and slight interval decrease in effacement\nof the suprasellar cistern." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is a dilated arterial structure at the left middle cerebral artery\nbifurcation. This extends into a somewhat tortuous a.m. to branch. The\nanatomy is not typical of a berry aneurysm, and may represent fusiform\ndilatation of the M2 branch. The appearance is unchanged since the comparison\nMR and MRA studies of ___. The remaining\nintracranial arteries appear normal with no other evidence of aneurysm\nformation.\n\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. 4 mm structure at the left middle cerebral artery bifurcation. Its\nconfiguration appears not typical of a berryaneurysm and it may represent\nfusiform dilatation of an M2 branch. The appearance is unchanged since the\nprior head imaging studies.\n2. The head CT, neck CTA, and head CTA are otherwise normal" + }, + { + "input": "CTA HEAD: An aneurysm clip is noted at the left MCA bifurcation with adjacent\nstreak artifact, limiting evaluation of the adjacent vascular structures. \nThere is no evidence of recanalization. Otherwise, the remainder of vessels\nof the circle of ___ and their principal intracranial branches appear\nnormal without stenosis, occlusion or aneurysm formation. The dural venous\nsinuses are patent.\n\nThere is a small left frontal extra-axial collection, measuring 0.8 cm in\ngreatest axial dimension, better evaluated on the subsequently performed\nnoncontrast CT. Mild mass effect on the underlying parenchyma is seen with no\nsignificant midline shift. Left frontotemporal craniotomy changes are seen. \nNew small air-fluid levels are noted in the bilateral maxillary sinuses.\n\nCTA NECK: There is a common origin between the brachiocephalic and left\ncarotid artery. The carotid and vertebral arteries and their major branches\nappear normal with no evidence of stenosis or occlusion. There is no evidence\nof internal carotid stenosis by NASCET criteria.\n\nOTHER:\nCentrilobular emphysema is seen. There is biapical pleural parenchymal\nscarring. There are multiple pleural-based sub cm lung nodules, stable since\n___. The visualized portion of the thyroid gland is within normal limits.\nThere is no lymphadenopathy by CT size criteria. Degenerative changes are\nnoted throughout the cervical spine.", + "output": "1. Small left frontal subdural hematoma, with mild mass effect on the\nunderlying parenchyma, and no midline shift, better visualized on the\nsubsequently performed noncontrast CT of the head.\n2. Status post clipping of a left MCA bifurcation aneurysm with no evidence of\nrecanalization. No new aneurysms.\n3. Patent circle of ___ and vasculature in the neck." + }, + { + "input": "The predominantly hypoattenuating subdural hematoma overlying the left frontal\nand parietal lobes is unchanged. It measures up to 1 cm in thickness. Some\nhyperdense components are seen anterior inferiorly overlying the left frontal\nlobe. There is minimal sulcal effacement but no midline shift. Overall,\nthere has been no significant interval change. Left pterional craniotomy\nchanges are noted for prior left MCA aneurysm clipping.\n\nThere is no new or enlarging hemorrhage, evidence of acute infarct, or\nsignificant mass effect. Basilar cisterns are patent. Included paranasal\nsinuses and mastoids are clear. Besides prior craniotomy, skull extracranial\nsoft tissues are unremarkable.", + "output": "No significant interval change to left frontoparietal subdural hematoma\ncompared to exam from earlier the same day.\nPostoperative changes of prior left MCA aneurysm clipping." + }, + { + "input": "The previously noted left-sided 7 mm subdural collection with mixed density\nwith high density material inferiorly is essentially unchanged. The subdural\nmeasures 7 mm in the maximum great at the level of the upper margin of\nventricles and is unchanged. Previously seen left-sided aneurysm clip is\nagain identified with postsurgical changes. No acute abnormalities are seen.", + "output": "No change in the size and appearance of left-sided subdural collection." + }, + { + "input": "Postoperative changes are seen with aneurysm clipping in the region of the\nleft sylvian fissure. The ventricular size is unchanged. No acute hemorrhage\nis identified. The left-sided subdural hematoma has decreased in size and\nhigh-density material has resolved. Subtle hyperdensity remains in the left\nfrontal region.", + "output": "Resolution of previously seen high density subdural hematoma. Subtle\nextra-axial collection remains. No acute intracranial hemorrhage. No\nventriculomegaly." + }, + { + "input": "There have been no significant changes since the prior study. Again seen are\npostoperative changes after craniotomy and clipping of a left middle cerebral\nartery aneurysm. There is no evidence of hemorrhage or infarction. No masses\nare identified. The ventricles and sulci are mildly prominent in an atrophic\npattern, unchanged. Again seen is a small left frontal extra-axial fluid\ncollection that may be subdural or subarachnoid.\n\nThere is no evidence of fracture. There is minimal mucosal thickening and\nperhaps small amounts of fluid in the ethmoid air cells bilaterally. \nOtherwise, the visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Unchanged appearance after clipping of left middle cerebral artery\naneurysm. Small left frontal fluid collection may be subdural or\nsubarachnoid, but has not enlarged since the prior study. ." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The bilateral submandibular glands are slightly prominent but\nsymmetric without evidence of mass or calcified obstructing duct stone. The\nthyroid gland appears normal. No lymphadenopathy by CT criteria.\n\nThe neck vessels are patent. Atherosclerotic calcifications at the bilateral\norigins of the common carotid arteries are mild. There is moderate-to-severe\natherosclerotic calcification in the left common carotid bifurcation and\nproximal left internal carotid artery (series 6, image 37). There is moderate\natherosclerotic calcification in the right common carotid artery bifurcation\nwith noncalcified thrombus at the bifurcation (series 4, image 32; series 6,\nimage 35).\n\nThe partially visualized paranasal sinuses and mastoid air cells are clear.\n\nThere is mild bilateral paraseptal emphysema at the lung apices. Multiple\nbilateral pulmonary nodules and micronodules are identified on this\nnon-dedicated exam are non-specific (series 4, image 78, 69, 68, 57). Several\nmediastinal lymph nodes are measurable, the largest up to 1 cm in the right\nlower paratracheal station but appears to maintain its normal fatty hilum\n(series 4, image 79).\n\nNo osseous lesions suspicious for malignancy or infection. Multi-level\ndegenerative changes in the cervical spine are most prominent at C4 through C6\nwith loss of intervertebral disc height, sclerosis, osteophytes and\nsubchondral cyst formation. There is minimal retrolisthesis of C4 on C5 and\nC5 on C6, likely related to degenerative change. No prevertebral soft tissue\nswelling.", + "output": "1. No evidence of a salivary gland mass or cervical lymphadenopathy.\n\n2. Moderate-to-severe atherosclerotic calcifications in the bilateral carotid\nbifurcations.\n\n3. Multiple, non-specific bilateral pulmonary nodules on this non-dedicated\nexam for which a dedicated Chest CT is recommended to further evaluate.\n\n4. Multilevel moderate degenerative changes at C4 through C6 with mild\nretrolisthesis.\n\nRECOMMENDATION(S): Dedicated Chest CT to further evaluate pulmonary nodules." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Small chronic appearing right\ncerebellar infarct is noted. Scattered periventricular and subcortical white\nmatter hypodensities are likely sequela of chronic small vessel disease.\nVentricles and sulci are prominent compatible with global volume loss. \nBasilar cisterns are patent.\n\nIncluded paranasal sinuses and mastoids are clear besides partially visualized\nmucosal thickening in the left maxillary sinus. Skull and extracranial soft\ntissues are unremarkable.", + "output": "Global volume loss and white matter changes suggestive of chronic small vessel\ndisease without acute intracranial process." + }, + { + "input": "Streak artifact from bilateral deep brain stimulators slightly limits\nevaluation of surrounding structures.\n\nThere is no evidence of acute major vascular territorial\ninfarction,hemorrhage,edema,or large mass. There is prominence of the\nventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of acute fracture. There is no evidence of hardware\nloosening in the partially imaged upper cervical spine. Minimal mucosal\nthickening of the sphenoid sinuses is noted. Remainder of the visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "No acute intracranial process identified." + }, + { + "input": "There have been no significant changes since the prior study. Again seen are\nbilateral deep brain stimulation devices in place. There is no evidence of\nhemorrhage, edema, masses or infarction. The ventricles and sulci are\nenlarged in a mild atrophic pattern, within the range expected for age.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Imaging is limited by artifacts from deep brain stimulator electrodes.\n2. Within these limitations, no evidence of mass, hemorrhage or infarction." + }, + { + "input": "A rounded cortically based hyperdense lesion measuring approximately 14 x 8\nmm, is noted in the left superior frontal lobe (02:20), with surrounding\nvasogenic edema. A second similar cortically based hyperdense lesion\napproximately 11 mm, located in the right cerebellar cortex (___), is\nassociated with mild vasogenic edema. Given the hyperdense appearance of\nthese 2 lesions, the possibility of intralesional hemorrhage is difficult to\nexclude. However, there is no definite intra-axial or extra-axial hemorrhage,\nshift of normally midline structures, or evidence of acute major vascular\nterritorial infarction. Ventricles and sulci are prominent, suggestive of\nvolume loss. The imaged paranasal sinuses are clear. Mastoid air cells and\nmiddle ear cavities are well aerated. The bony calvarium is intact.", + "output": "2 cortically based hyperdense lesions, 1 in the left frontal lobe and the\nsecond in the right cerebellar cortex concerning for metastatic disease,\nplease refer to same-day outside hospital MRI for further details. Given\nhyperdense appearance, intralesional hemorrhage is impossible to exclude." + }, + { + "input": "There is no evidence of intracranial hemorrhage, acute large territorial\ninfarction, edema,or mass. There is mild prominence of the ventricles and\nsulci suggestive of involutional changes.\n\nFracture of the nasal bone, indeterminate age, likely chronic. Mild mucosal\nthickening of the right sphenoid sinus and right maxillary sinus. Mild\nthickening of the bilateral ethmoid air cells. The visualized portion of the\nremaining paranasal sinuses, mastoid air cells, and middle ear cavities clear.\nPatient is intubated. The visualized portion of the orbits are unremarkable.", + "output": "No acute intracranial findings.\nNasal bone fracture, likely chronic" + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nAero digestive tract: There is no mass.\n\n\nNeck lymph nodes: There is no adenopathy involving bilateral levels ___. \nThere is no retropharyngeal adenopathy.\n\nExtra nodal tumor spread: There are no findings suggestive of extra nodal\nextension.\n\nDeep neck muscles, masticator space: There is no muscle invasion.\n\nBones, skull base:\nThere is no bone involvement.\nThere are no findings suggestive of perineural tumor extension. Jugular\nforamen, carotid canal, pterygopalatine fossa, infraorbital foramen, other\nskull base foramina are not involved. There is partial opacification of the\nbilateral mastoid air cells which is nonspecific. There is partial\nopacification of the right sphenoid sinus with aerosolized material and\nair-fluid level.\n\nVessels: There is no vascular invasion. There is mild narrowing of the right\ncommon carotid artery by smooth mixed type atherosclerosis.\n\nThyroid, salivary glands: There is no mass.\n\nOther findings: There are no lung nodules. There is no evidence of thyroid\nnodules or masses. There is exaggerated lordosis of the cervical spine. \nModerate multilevel changes of the cervical spine include intervertebral disc\nspace narrowing and osteophytosis most pronounced at C5-C6.", + "output": "1. Dental amalgam streak artifact limits study.\n2. No evidence of adenopathy.\n3. Partial opacification of right sphenoid sinus, including air-fluid level,\nwhich may represent sinusitis in the appropriate clinical setting.\n4. Mild right carotid stenosis." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nCT HEAD WITHOUT CONTRAST:\nNo evidence of infarction, hemorrhage, edema, or mass effect. The ventricles\nand sulci are normal in size and configuration.\n\nMucosal thickening of the bilateral maxillary sinuses and right sphenoid sinus\nis mild. The frontal sinuses are hypoplastic. The remaining visualized\nparanasal sinuses are clear. The mastoid air cells and middle ear cavities\nare clear. The orbits are normal.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The right\nA1 segment is attenuated, which can be a normal variant (see 601b:23). The\nbilateral PCOM arteries are also attenuated. The dural venous sinuses are\npatent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe main pulmonary artery is top-normal in size, measuring up to 30 mm, which\ncan be seen with chronic pulmonary hypertension.\n\nDetailed evaluation of the lung apices is limited by respiratory motion\nartifact. Other than atelectasis, the visualized lung apices are clear. The\nvisualized portion of the thyroid gland is within normal limits. Scattered\nsubcentimeter nonspecific lymph nodes are noted throughout the neck\nbilaterally. No lymphadenopathy by CT size criteria.", + "output": "1. Dental amalgam streak artifact limits study.\n2. Top-normal main pulmonary artery which can be seen with chronic pulmonary\nhypertension.\n3. No evidence of acute intracranial hemorrhage.\n4. No evidence ofaneurysm greater than 3 mm, dissection or significant\nluminal narrowing.\n5. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct.\n6. Paranasal sinus disease as described.\n7. Scattered subcentimeter mildly prominent nonspecific lymph nodes throughout\nthe neck as described, which may be reactive in nature, and with no definite\nlymphadenopathy by CT size criteria." + }, + { + "input": "There is evidence of significant diffuse mass effect including marked sulcal\neffacement. Though not well seen, there is apparent effacement of the basilar\ncisterns as well as fullness at the foramen magnum, concerning for some degree\nof central herniation. Diffuse loss of gray-white matter differentiation\nthroughout the brain is compatible with sequelae of anoxic brain injury. \nApparent linear hyperdensity seen along the falx and tentorium, as well as\ndiffusely in the central subarachnoid spaces likely relates to a combination\nof pseudosubarachnoid sign in the setting of diffuse brain edema as well as\npossibly a component of retained/residual IV contrast material from recent\ncardiac catheterization.\n\nThere is no evidence of hemorrhage. The ventricles appear normal in caliber\nand configuration. There is layering material in the right greater than left\nmaxillary sinuses, as well as mucosal thickening in the frontal and sphenoid\nsinuses, as well as the ethmoid air cells. The patient is intubated. The\npatient is status post left lens removal, otherwise the globes and bony orbits\nare unremarkable.", + "output": "1. Sequelae of anoxic brain injury, including diffuse loss of gray-white\nmatter differentiation and marked brain edema with mass-effect, including\nlikely some degree of centra herniation.\n2. Linear hyperdensity along the falx and tentorium likely relates to\ncombination of pseudosubarachnoid sign as well as retained IV contrast\nmaterial from prior catheterization.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 9:33 AM, 10 minutes after discovery of the\nfindings." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, large vascular\nterritory infarction, edema, or mass effect. The ventricles and sulci are\nprominent in size and configuration consistent with age related atrophy. \nSubcortical and periventricular white matter hypodensities are nonspecific but\nsuggest chronic small vessel ischemic changes.\n\nModerate-sized right frontal scalp hematoma without underlying fracture of the\ncalvarium. Mild-to-moderate mucosal thickening of the ethmoid and sphenoid\nsinuses. Moderate atherosclerotic calcifications of the cavernous portions of\nbilateral internal carotid arteries in the V4 segments of bilateral vertebral\narteries are identified. The remaining paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The orbits demonstrates left lens\nreplacement.", + "output": "No acute intracranial process such as hemorrhage or acute large vascular\nterritory infarction. Moderate right frontal scalp hematoma without\nunderlying fracture of the calvarium." + }, + { + "input": "CT HEAD:\nThere is no evidence of hemorrhage, infarction, mass effect, or edema. The\nventricles and sulci are diffusely prominent compatible global parenchymal\nvolume loss.\n\nPeriventricular and subcortical white matter hypodensities are noted, a\nnonspecific finding that most likely represents the sequelae of chronic small\nvessel ischemic disease.\n\nMucosal thickening is seen throughout scattered ethmoid air cells and within\nthe left sphenoid sinus. There is an air-fluid level in the left sphenoid\nsinus. The remainder of the paranasal sinuses, middle ear cavities, and\nmastoid air cells are clear. The orbits are grossly unremarkable bilaterally.\n\n\nCTA HEAD AND NECK:\nThe left vertebral artery originates directly from the aortic arch. Dense\ncalcifications are seen at the aortic arch and at the origin of the great\nvessels.\n\nThe bilateral vertebral arteries demonstrate multiple areas of partially\ncalcified atherosclerotic plaque resulting areas of moderate or even moderate\nto severe stenosis, without focal occlusion.\n\nThe bilateral common carotid arteries are patent. Partially calcified\natherosclerotic plaque is noted involving the bilateral carotid bulbs, left\ngreater than right. This extends into the proximal internal carotid arteries,\nresulting in 50-60% stenosis of the left proximal ICA by NASCET criteria. \nThere is no stenosis of the right ICA by NASCET criteria.\n\nDense calcifications are seen involving the bilateral cavernous internal\ncarotid arteries. Multiple sites of mild-to-moderate vessel narrowing are\nnoted involving the left M1 segment. Mild narrowing also effects the right P1\nsegment and multiple levels. Within the proximal basilar artery, there are\nmultiple sites of focal moderate stenosis. Mild-to-moderate stenosis is seen\ninvolving the distal right M1 branch.\n\nAllowing for this, the intracranial vasculature remains patent without\nocclusion, or aneurysm. The dural venous sinuses are patent.\n\n\nOTHER:\nThe lungs apices are clear bilaterally. The thyroid gland is unremarkable in\nappearance. There is no cervical lymphadenopathy by CT size criteria.", + "output": "1. No evidence of hemorrhage or infarction.\n2. Moderate severe global parenchymal volume loss and evidence of chronic\nsmall vessel ischemic disease.\n3. Multifocal paranasal sinus disease with an air-fluid level in the left\nsphenoid sinus suggesting an acute component.\n4. Multifocal atherosclerosis of the intracranial and cervical vasculature as\ndetailed above, without critical stenosis or large vessel occlusion.\n5. Carotid artery atherosclerosis results in approximately 50-60% stenosis of\nthe left proximal ICA by NASCET criteria." + }, + { + "input": "Head CT: There is no evidence of hemorrhage, edema, masses, mass effect, or\ninfarction. The ventricles and sulci are normal in caliber and configuration.\nNo fractures are identified.\n\nHead and neck CTA: The carotid and vertebral arteries and their major branches\nare patent with no evidence of stenoses. There is no evidence of aneurysm\nformation or other vascular abnormality. There is mild multilevel DJD. There\nis a right lung opacity previously demonstrated in CT abdomen ___.", + "output": "1. The carotid and vertebral arteries and their major branches are patent with\nno evidence of stenosis, aneurysm or other vascular abnormality.\n\n2. There is a right lung opacity previously demonstrated in CT abdomen ___" + }, + { + "input": "CT head:\nWhen compared to the most recent prior ___ head CT, there are new\nhypodensities occupying much of the left occipital lobe spanning an area of\napproximately 6.1 x 3.5 cm on axial images, and a smaller 1 cm hypodensity\nwithin right occipital lobe (02:21). Additionally there is a clustered\nhypodensity within the right cerebellum spanning an area of approximately 2.2\nx 1.6 cm (02:16). These demonstrate loss of normal gray-white matter\ndifferentiation and likely represent new areas of posterior circulation\nischemic infarcts. There is no shift of the normally midline structures or\ndownward herniation.\n\nThere is a new 9 x 3 mm simple fluid collection within the left frontoparietal\nscalp soft tissues and a smaller 9 x 1.5 mm the fluid collection within the\nright parietal scalp soft tissues which may be postoperative in nature.\n\nThere is mucus opacification of the bilateral ethmoid air cells and\nopacification of the left sphenoid sinus demonstrating an air-fluid level. \nMucous retention cysts are noted within the right and left maxillary sinuses. \nThe mastoid air cells and middle ear cavities are clear. The visualized\norbits are unremarkable.\n\nIncidental note is made of an endotracheal tube terminating at the mid\ntrachea. The partially visualized enteric tube courses through the esophagus,\nthe distal tip of which is not imaged in this study.\n\nIncidental note is made of a new C4-C5 anterior fusion hardware and right\nanterior neck - to -upper chest subcutaneous emphysema, likely secondary to\nrecent operation.\n\nMultiple cervical spine fractures are better assessed in the same day CT\ncervical spine.\n\nCT angiography of the neck:\nThere is a abrupt loss of luminal opacification of the right vertebral artery\nbeginning just above the level of C6 vertebral body (3:158) within the\nfractured right C5 transverse process. It remains continuously non-opacified\nupwards to the level of C2, within the transverse foramen (3:212), beyond\nwhich there is luminal re-opacification (3:215). The remainder of the upper\ncervical right vertebral artery remains patent and normal in luminal caliber\nas it enters into foramen magnum (3:245). The intracranial right vertebral\nartery is otherwise patent. The remainder of the cervical vasculature remain\npatent without evidence of severe stenosis, dissection or large aneurysms.\n\nCT angiography of the head:\nPlease note that bolus timing and venous contamination obscures evaluation for\nsmall aneurysms. The intracranial vasculature otherwise demonstrate a normal\nappearance of the arteries of the anterior and posterior circulation without\nstenosis or occlusion or aneurysm greater than 3 mm in size.", + "output": "1. New posterior circulation ischemic infarcts within the left greater than\nright occipital lobe and the right cerebellum. No evidence of hemorrhagic\ntransformation or transtentorial herniation.\n2. Thrombosed right vertebral artery extending from the C5 transverse foramen\nlevel continuously upward to C2. The right vertebral artery is otherwise\nopacified proximally at its origin from the subclavian and distally as it\nenters into the foramen magnum.\n3. New C4-C5 anterior fusion hardware.\n4. Multiple cervical spine fractures are better assessed in the same day CT\ncervical spine.\n5. Other incidental findings as detailed above." + }, + { + "input": "The vasogenic edema associated with left parieto-occipital infarct has\ndecreased in size and now measures 5.4 X 2.7 cm, previously measuring 6.1 x\n3.5 cm on axial imaging. Hypodensities in the right occipital and right\ncerebellar regions have slightly decreased in size. There is a new\nhypodensity within the right basal ganglia which may represent an evolving\nsubacute infarction, (series 2, image 17).\n\nThere is no evidence of hemorrhage. No evidence of mass effect or midline\nshift.\n\nThe ventricles and sulci are normal in size and configuration.\n\nThe subgaleal hematomas along the right parietal bone and left frontoparietal\nregion have resolved. There is no evidence of fracture.\n\nThere is mucosal thickening of the ethmoid, sphenoid, maxillary sinuses\nbilaterally and opacification of the left mastoid air cells, likely due to\nintubation.\n\nThe visualized portion of the orbits are unremarkable.", + "output": "1. New hypodensity in the right basal ganglia, which may represent an evolving\nacute/subacute infarction.\n2. Interval decrease of the edema surrounding the left parieto-occipital,\nright occipital and right cerebellar infarcts.\n3. No evidence of hemorrhagic transformation, new hemorrhage, or significant\nmass effect.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 9:02 pm, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "There is no evidence of acute major infarction,hemorrhage,edema,or mass. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Subcortical and periventricular white matter hypodensities are\nnonspecific but likely represent sequelae of chronic microangiopathic ischemic\ndisease.\n\nThere is opacification of the right sphenoid sinus. Otherwise the imaged\nparanasal sinuses are well aerated. The mastoid air cells and middle ear\ncavities are clear. Bony calvarium is intact.", + "output": "1. Mild small vessel disease.\n2. Complete opacification of the right sphenoid sinus.\n3. No acute hemorrhage or fracture." + }, + { + "input": "CT HEAD:\nThere is no evidence for acute territorial hemorrhage. Large area of\nencephalomalacia in the right parietal/posterior temporal/superior occipital\nlobes is consistent with a chronic infarct, new since ___. Multiple chronic\ninfarcts are seen in the right basal ganglia, with the largest extending from\nthe anterior putamen into the anterior right internal capsule and corona\nradiata. Another chronic infarct is seen centered in the left caudate head. \nA small chronic infarct is also seen along the posterior left putamen. Yet\nanother chronic infarct is seen in the right thalamus. The above-described\nsmaller infarcts were visible on the ___ CT. There also extensive confluent\nhypodensities in the subcortical, deep, and periventricular white matter of\nthe cerebral hemispheres, progressed since the prior CT, likely sequela of\nchronic small vessel ischemic disease in this age group. The above\nabnormalities limit evaluation for an acute major vascular territorial\ninfarction, though no evidence for that is clearly visible.\n\nThere is global cerebral volume loss with enlargement of the ventricles and\nsulci, as well as superimposed ex vacuo enlargement of the right lateral\nventricle secondary to the above described infarctions.\n\nMild mucosal thickening is seen in scattered ethmoid air cells. Mucous\nretention cysts are present in the bilateral maxillary sinuses. Mastoid air\ncells are well aerated. The orbits appear unremarkable.\n\nCTA NECK:\nThere is a 3 vessel aortic arch. There is mild mixed plaque in the aortic\narch and visualized proximal descending aorta, including mild plaque at the\norigins of bilateral common carotid and left subclavian arteries without\nsignificant narrowing. There is mild calcified plaque within bilateral\nproximal internal carotid arteries without stenosis by NASCET criteria. There\nis also mild calcified plaque within bilateral distal cervical internal\ncarotid arteries without stenosis. Distal cervical right internal carotid\nartery forms a loop.\n\nRight vertebral artery is widely patent. V1 segment of the left vertebral\nartery is tortuous with an apparent mild luminal narrowing at the level of its\nloop, images 11:44, ___, but this may not represent a true stenosis.\n\nCTA HEAD:\nCalcified plaque within bilateral carotid siphons causes mild distal\nsupraclinoid luminal narrowing bilaterally. There is severe narrowing of the\nM1 segment of the right MCA with a segment of occlusion in its distal portion\nand diminutive appearance of the M2 through M4 segments appear to be filling\nthrough collaterals. There is also set mild to moderate narrowing of the M1\nsegment of the left middle cerebral artery and scattered foci of mild\nnarrowing in its distal branches.\n\nThere is diffuse irregularity of the basilar artery with foci of mild\nnarrowing. There is a 4.5 x 2.5 mm aneurysm of the basilar artery immediately\ndistal to the bilateral AICA origins, which projects anteriorly from its right\nlateral aspect, images 8:257, 11:32, 960:6. A fetal type origin of the right\nposterior cerebral artery is noted.\n\nDural venous sinuses are patent, with dominance of the right transverse and\nsigmoid sinuses, and of the right internal jugular vein.\n\n\nOTHER:\nThere is soft tissue asymmetry in the right oropharynx in the region of the\nright tonsil. Intraglandular ductal dilatation is noted within bilateral\nsubmandibular glands without evidence for silo lithiasis on limited\nevaluation. No pathologically enlarged cervical lymph nodes. The thyroid\ngland contains numerous bilateral nodules, with the largest in the isthmus\nmeasuring approximately 1.4 cm.", + "output": "1. No acute hemorrhage. Numerous chronic infarctions and extensive presumed\nchronic small vessel ischemic changes in the supratentorial white matter,\nlimiting evaluation for an acute infarction, though no clear evidence for an\nacute major vascular territorial infarction is seen. MRI would be more\nsensitive for an acute infarction, if clinically warranted.\n2. No cervical carotid stenosis by NASCET criteria. V1 segment of the left\nvertebral artery is tortuous with an apparent mild luminal narrowing at the\nlevel of its loop, but this may not represent a true stenosis.\n3. Severe stenosis of the proximal M1 segment of the right MCA with distal\nocclusion. Diminutive distal right MCA branches appear to be supplied by\nextracranial collaterals.\n4. Mild to moderate stenosis of the M1 segment of the left MCA with multifocal\nmild stenosis in its distal branches.\n5. Mild irregular narrowing of the basilar artery. 4.5 x 2.5 mm mid basilar\naneurysm just distal to bilateral AICA origins.\n6. Abnormal soft tissue density in the right oropharynx in the region of the\ntonsil. Malignancy is not excluded.\n7. Multinodular thyroid gland with largest nodule in the isthmus measuring\napproximately 1.4 cm. Recommend thyroid ultrasound for further\ncharacterization.\n\nRECOMMENDATION(S):\n1. Regarding the basilar artery aneurysm, recommend consultation with an\nendovascular neurosurgeon and follow-up CTA or MRA in ___ months, unless\notherwise directed by neuro surgery.\n2. ENT evaluation of the right tonsillar region.\n3. Thyroid nodule. Ultrasound follow up recommended. ___ College of\nRadiology guidelines recommend further evaluation for incidental thyroid\nnodules of 1.0 cm or larger in patients under age ___ or 1.5 cm in patients age\n___ or older, or with suspicious findings. Suspicious findings include:\nAbnormal lymph nodes (those displaying enlargement, calcification, cystic\ncomponents and/or increased enhancement) or invasion of local tissues by the\nthyroid nodule. ___, et al, \"Managing Incidental Thyroid Nodules Detected on\nImaging: White Paper of the ACR Incidental Findings Committee\". J ___\n___ ___ 12:143-150.\n\nNOTIFICATION: The following preliminary report was provided electronically by\nDr. ___ on ___ at 16:23: \"NECT: No acute intracranial\nabnormalities. Large encephalomalacia in the right temporal parietal lobe. \nCTA: There is narrowing of the right MCA at the origin with diminutive\nappearance of the M2 segment. M3 and M4 segments appear to be filling through\ncollaterals. Otherwise, patent circle ___ and its major tributaries. Likely\nfetal origin of right PCA. Unremarkable filling of the major dural venous\nsinuses. Multinodular thyroid gland. This report is provided without 3D and\ncurved reformats. When these images are available, and if additional\ninformation is obtained, then a final report will be generated.\"" + }, + { + "input": "There is a large right-sided chronic infarction extending from the right\ntemporal to the occipital lobe. There is chronic infarction seen within the\nleft parietal lobe. There is evidence of chronic lacunar infarcts\nbilaterally. Hypodensities seen in the subcortical, deep, and periventricular\nwhite matter are likely due to chronic small vessel ischemic disease. No\nevidence of hemorrhage, edema, or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute hemorrhage.\n2. Multiple chronic lacunar infarcts and cortical infarcts, involving the\nright temporoparietal and occipital lobe and left parietal lobe, are seen,\nunchanged since prior study.\n3. Chronic small vessel ischemic disease, unchanged since prior study.\n4. No evidence of fracture." + }, + { + "input": "Areas of encephalomalacia from chronic infarction involving the right temporal\nto occipital lobes and left parietal lobe are again seen. Re-demonstration of\nold bilateral lacunar infarcts. There is no evidence of acute large\nterritorial infarction,hemorrhage,edema,or mass-effect. There is prominence\nof the ventricles and sulci suggestive of atrophy. Mild ex vacuo dilatation\nof the right lateral ventricle is again noted. Extensive subcortical and\nperiventricular white-matter hypodensities are nonspecific, but likely\nrepresent sequela of chronic small vessel disease.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Re-demonstration of chronic lacunar and cortical infarcts and sequela of\nchronic small vessel disease." + }, + { + "input": "Note is made of 2 large territorial infarcts in the right temporoparietal area\nas well as in the right inferior cerebellum, with multiple lacunar infarcts in\nthe basal ganglias, centrum semiovales as well as left cerebellar hemisphere.\n\nCTA HEAD:\nCompared to prior CTA head neck study from ___, there is little\nchange. Re-demonstration of severe narrowing of the M1 segment of the right\nmiddle cerebral artery being occluded proximally. Poor collaterals with no\nrecanalization of distal M2 M3 branches. Again seen is mild to moderate\nnarrowing of the M1 segment of the left middle cerebral artery. The anterior\nand posterior cerebral arteries are patent. The dural venous sinuses are\npatent. Irregularity of the basilar artery is again seen, with a 4 mm aneurysm\nnoted just distal to the bilateral AICA origins appear similar compared to\nprior.\n\nCTA NECK:\nAtherosclerotic changes noted of the aortic arch. Mild dilatation of the\naortic arch, but it is not aneurysmal. Minimal atherosclerotic changes at the\ncarotid bulbs, with no stenosis according to NASCET criteria.\n\nOTHER:\n7 mm nodule in the medial aspect of the left upper lobe. Mild centrilobular\nemphysematous changes. Incompletely imaged possible right hilar lymph nodes. \nMultiple subcentimeter thyroid nodules. There is no lymphadenopathy by CT\nsize criteria.", + "output": "Multiple chronic territorial and lacunar infarcts as described above.\n\nSevere narrowing and occlusion of the proximal right M1 segment with marked\nnarrowing also noted in the left M1 segment. There is flow seen in the distal\nleft M2 and M3 segments but no flow seen in the distal right M2 and M3\nsegments.\n\nThere is no ICA stenosis by NASCET criteria.\n\n4 mm basilar aneurysm appear similar compared to prior.\n\nIncidental finding of a 7 mm pulmonary nodule in the left upper lobe.\n\nRECOMMENDATION(S): For incidentally detected single solid pulmonary nodule\nmeasuring 6 to 8 mm, a CT follow-up in 6 to 12 months is recommended in a\nlow-risk patient, optionally followed by a CT in ___ months. In a high-risk\npatient, a CT follow-up in 6 to 12 months, and a CT in ___ months is\nrecommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" + }, + { + "input": "Chronic infarction in the distribution of right middle cerebral artery\ninvolves the right temporal and parietal lobes with encephalomalacia, not\nsubstantially changed from MRI from ___. Remote infarct of the\nright cerebellar hemisphere is also unchanged. Confluent periventricular and\nsubcortical white matter hypodensities are likely due to chronic small vessel\nischemic disease. More discrete areas of hypodensities in bilateral basal\nganglia and centrum semiovale are likely due to chronic infarcts. There is\ngeneralized cerebral and cerebellar atrophy with prominence of the ventricles.\nHowever, there is no evidence of new acute large territorial infarct or acute\nhemorrhage. Mild atherosclerotic calcifications of the cavernous carotid\narteries are demonstrated.\n\nThere is no evidence of acute fracture, though evaluation is mildly limited\ndue to lack of dedicated bone algorithm. Polypoid mucous retention cyst is\nnoted in the left maxillary sinus. The visualized portion of the remaining\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No evidence of new acute large territory infarct or acute intracranial\nhemorrhage. Please note that MRI would be more sensitive however for the\ndetection of acute infarction.\n2. Remote infarcts involving the right middle cerebral artery territory and\nright cerebellar hemisphere. Chronic lacunar infarcts involving both basal\nganglia and centrum semiovale." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration. Periventricular and\nsubcortical white matter hypodensities are nonspecific but likely related to\nsequelae of chronic microangiopathy. Equivocal accentuation of usual\nhypodense appearance of bilateral temporal occipital white matter.\n\nThere is mild opacification of a posterior right ethmoid air cell. Otherwise,\nthe remainder of the visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are normal.", + "output": "Equivocal occipito-parietal subcortical white matter abnormality. If this were\nconfirmed, posterior reversible encephalopathy syndrome might be a\nconsideration versus leukoencephalopathy due to cocaine or other toxic\nmetabolic effect. However the study is not definitely abnormal.\n\nRECOMMENDATION(S): MR imaging is recommended to assess further if needed\nclinically, preferably with gadolinium if feasible.\n\nNOTIFICATION: Findings and recommendations of final report were discussed\nwith ___ MD at 8:53 pm by telephone on ___." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nMinimal left parietal scalp soft tissue swelling is present (see 7b:65).\n\nThere is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The mastoid air cells, and middle ear cavities\nare clear. The orbits are unremarkable. Minimal bilateral maxillary and\nsphenoid sinus mucosal thickening is present.", + "output": "1. Dental amalgam streak artifact limits study.\n2. No fracture or intracranial hemorrhage.\n3. Minimal left parietal scalp soft tissue swelling.\n4. Minimal paranasal sinus disease as described." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration.\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial abnormalities." + }, + { + "input": "There is no evidence of acute hemorrhage mass effect midline shift or\nhydrocephalus. Gray-white matter differentiation is maintained.\n\nThe visualized paranasal sinuses are clear. No skull fracture is seen.", + "output": "No acute intracranial abnormalities are identified." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or mass\neffect. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. A large scalp hematoma is noted along the\nright vertex (___) and measures up to 3.5 x 1.6 cm. Minimal mucosal\nthickening of the ethmoid air cells. The remainder of the paranasal sinuses\nare clear. The patient is status post right canal down mastoidectomy with\ntrace soft tissue within the mastoid bowl. The right middle ear is clear. \nThe left mastoid air cells middle ears are clear.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nlarge territory infarct or intracranial hemorrhage.\n2. Large right frontal scalp hematoma measuring approximately 3.5 cm in\ngreatest thickness without underlying acute displaced calvarial fracture.\n3. The patient is status post right canal down mastoidectomy with soft tissue\nwithin the mastoid bowl." + }, + { + "input": "There is no evidence of infarction,intracranial hemorrhage,edema,or mass. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges.\n\nThere is no evidence of fracture. Patient is status post right canal down\nmastoidectomy with persistent small amount of soft tissue in the mastoid bowl,\nimproved from prior. The visualized portion of the paranasal sinuses, left\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. There is no evidence of acute intracranial process or hemorrhage.\n2. The patient is status post right canal down mastoidectomy, with soft tissue\nwithin the mastoid bowl, improved from prior." + }, + { + "input": "There is no evidence of fracture, large territorial\ninfarction,hemorrhage,edema,or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. Periventricular and deep white\nmatter hypodensities are nonspecific, but likely sequela of chronic small\nvessel disease.\n\nNo evidence of fracture. Patient is status post right canal down\nmastoidectomy with a small amount of tissue seen in the mastoid bowl, similar\nto slightly decreased from most recent prior exam dated ___. \nParanasal sinuses are clear. Left mastoid air cells are clear. Orbits are\nunremarkable.", + "output": "There is no evidence of acute intracranial process or hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The patient is intubated. Again seen, are\nnumerous bilateral maxillary sinus mucous retention cysts versus polyps. \nThere is a rim calcified polypoid lesion in the anterior right ethmoid air\ncells resulting in erosion of the ethmoid septa. This lesion extends into the\nright frontal sinus superiorly and superior nasal passage inferiorly. There\nis mucosal thickening in the sphenoid sinus and ethmoid air cells. The\nmastoid air cells are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial process.\n2. Polypoid opacification of the right anterior ethmoid air cells causing\nethmoid septa erosion and extending into the frontal sinus and nasal passage,\nas recommended previously, if clinically indicated and further\ncharacterization is needed consider MR imaging or direct visualization.\n\nRECOMMENDATION(S): If clinically indicated, direct visualization or MR\nimaging to further characterize ethmoid sinus findings." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. There is no CT\nevidence of osmotic demyelination syndrome.\n\nThere is no evidence of fracture. There multiple submucosal retention cysts\nin bilateral maxillary, right frontal sinuses. There is ovoid fullness in the\nright ethmoid sinus, stable since prior, causing expansion of the septa,\nextending into the right nasal cavity. There is new fluid in the right\nmaxillary sinus, likely from tube use. Bilateral mastoid air cells, middle\near cavities are patent. The The visualized portion of the orbits are\nunremarkable.", + "output": "1. There are no new intracranial abnormalities.\n2. Polypoid mass in the right ethmoid sinus, nasal cavity stable." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nThere are multiple mucous retention cysts in both maxillary sinuses and right\nfrontal sinus. There is ovoid fullness of the right ethmoid sinus with\nrightward deviation of the nasal septum, unchanged. There is mild mucosal\nthickening the sphenoid sinuses and left ethmoid air cells Mastoid air cells\nand middle ear cavities are well aerated. The bony calvarium is intact.", + "output": "No interval change from head CT ___. No evidence of anoxic brain\ninjury." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nNo fractures. There are multiple (greater than 15) mucous retention cysts or\npolyps in the bilateral maxillary sinuses. There is erosion of the ethmoid\nseptae eye in the right ethmoid sinus and extending into the right frontal\nsinus. This may represent an ethmoid sinus mucocele, one or several polyps, a\nneoplasm or a combination of these factors. If the distinction between polyp\nversus neoplasm and mucocele is clinically significant, magnetic resonance\nimaging may be helpful. There are few small mucous retention cysts/ polyps in\nthe bilateral sphenoid sinuses. The mastoid air cells and middle ear cavities\nare clear. The orbits are unremarkable.", + "output": "1. Normal CT of the brain..\n2. Extensive opacification of the left ethmoid and frontal sinuses with\nerosion of the ethmoid septae deep. This may represent a mucocele, a polyp or\na neoplasm. Further evaluation with direct visualization and perhaps MR\nimaging may be helpful.\n\nRECOMMENDATION(S): Centered or visualization and MR imaging for further\nevaluation of the ethmoid sinus findings\n\nNOTIFICATION: The recommendation of direct visualization and perhaps MR\nimaging for further evaluation of the ethmoid sinus findings was emailed to\nthe Emergency Department QA nurses 10:12 ___ by Dr. ___\n___ upon reviewing the study." + }, + { + "input": "There is no evidence of acute major infarction,hemorrhage,edema,or discrete\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.There is no acute fracture. Mild mucosal thickening is\nnoted in bilateral ethmoid sinuses. The visualized portion of the orbits are\nunremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of an AVM or other significant vascular abnormalities. \nIncidental note is made of a fetal type left PCA and bilateral carotid siphon\ncalcifications. There are no masses within the nasal cavity or sinuses. There\nis minimal mucosal thickening of the bilateral maxillary sinuses and ethmoid\nair cells. The remainder of the paranasal sinuses are well aerated without\nmucosal thickening or fluid. The ostiomeatal units and frontoethmoidal\nrecesses are patent. The cribriform plates are intact. There is no nasal\nseptal defect. There is minimal rightward nasal septum deviation. The anterior\nclinoid processes are not pneumatized. The lamina papyracea are intact. The\nsphenoid sinus septum is mostly midline with insertion upon the sellar floor\nand right optic canal. There is a hypoattenuating bony lesion in the right\nsphenoid bone adjacent to the right foramen rotundum. This lesion is well\ncorticated peripherally with a well corticated traversing vidian nerve canal. \nThe bilateral orbits appear unremarkable, noting bilateral lens replacements.", + "output": "1. No evidence of mass or AVM within the nasal cavity or paranasal sinuses.\n2. Minimal mucosal thickening of the bilateral maxillary sinuses and ethmoid\nair cells.\n3. Hypoattenuating lesion within the right sphenoid bone has a benign\nappearance." + }, + { + "input": "The visualized paranasal sinuses, aside from a minimal ethmoid air cell and\ninferior right maxillary sinus mucosal thickening, are well-pneumatized and\nclear. No additional areas of mucosal thickening are seen. There are no\nair-fluid levels. The drainage pathways including the ostiomeatal units are\npatent bilaterally.\n\nThe cribriform plates are intact. The lamina papyracea are intact. There is\nslight rightward nasal septal deviation with a small spur. There is partial\npneumatization of the right anterior clinoid process.\n\nThe visualized portions of the mastoid air cells and middle ear cavities are\nwell pneumatized and clear. Carotid siphon calcifications are noted. Aside\nfrom bilateral lens extraction, the globes are within normal limits. \nDysconjugate gaze is noted. Absence of the maxillary dentition is noted.\n\nMultiple subcentimeter hyperdense foci in the left parotid gland may represent\nnonobstructing sialoliths (for example see series 4, image 7). No evidence of\nsoft tissue abnormality in the imaged portions of the face.\n\nThere is slight fullness of the right oropharynx soft tissues which is only\npartially visualized on this study (series 4, image 1).", + "output": "1. Mild ethmoid air cell and right maxillary sinus mucosal thickening. No\nair-fluid levels. Patent bilateral drainage pathways.\n2. Partially visualized asymmetric fullness of the right oropharyngeal mucosal\nsoft tissues, as described. Please see concurrently obtained contrast neck CT\nfor further evaluation.\n3. Partial pneumatization of right anterior clinoid process.\n4. Rightward nasal septal deviation with bony spur." + }, + { + "input": "Approximately 7 mm right palatine tonsil hypodensity is noted (see 4:71;\n07:28).\n\nEvaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nNonspecific left parotid gland calcifications are present. Otherwise, the\nsalivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears preserved.There is no lymphadenopathy by\nCT criteria. The neck vessels are patent.\n\nThe imaged portion of the lung apices demonstrate emphysematous changes.There\nare no osseous lesions. Partially imaged is a right anterior chest wall\ncentral catheter. Limited imaging of cervical spine demonstrates multilevel\ndegenerative changes.", + "output": "1. Dental amalgam streak artifact limits study.\n2. 7 mm right palatine tonsil phlegmon versus early abscess.\n3. Within limits of study, no definite evidence of cervical mass or\nlymphadenopathy.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:20 pm, 20 minutes after\ndiscovery of the findings." + }, + { + "input": "Interval increase in size of previously noted right peritonsillar abscess, now\n1.5 cm along its longest axis. There is evidence of downward tracking of\nedema and induration to the piriform sinus.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by CT\ncriteria. The neck vessels are patent.\n\nThe imaged portion of the lung apices show emphysematous changes and there are\nno concerning pulmonary nodules. There are no osseous lesions. Chemotherapy\nport is seen along the right anterior chest wall.", + "output": "1. Interval increase in size of peritonsillar abscess compared to previous\nstudy on ___. Evidence of downward tracking of edema induration to the\npiriform sinus.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 5:21 pm, 5 minutes after discovery\nof the findings." + }, + { + "input": "Seen again is the peritonsillar abscess located in the right nasopharynx. \nThere is been an interval decrease in size to 7.5 mm from 16 mm. There is\nimprovement in mass effect on the airway. The surrounding enhancement has\nalso decreased. Edema involving the tonsillar pillars has decreased.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.", + "output": "1. Interval improvement in size of peritonsillar abscess in the right\nnasopharynx.\n2. Surrounding enhancement indicating inflammation as well as the edema of the\ntonsillar pillars has also decreased." + }, + { + "input": "Interval decrease in size of the previously described right peritonsillar\nabscess, from 8 mm to 3 mm residual abscess or phlegmon (03:26). This is\naccompanied by decreasing surrounding enhancement and airway mass-effect. \nPatent airway.\n\nOtherwise, paranasal sinuses, maxillary sinus, ethmoid sinus, sphenoid sinus,\nmastoid air cells are clear.\n\nA trophic bilateral parotid glands with few punctate foci of calcifications,\nlikely sequela of chronic inflammation, no evidence of acute inflammation, no\nstones within parotid duct. A trophic submandibular glands. The thyroid\ngland appears normal. There is no lymphadenopathy by CT criteria. The neck\nvessels are patent.\n\nRefer to chest CT from today for evaluation of thoracic findings, including\nmultiple tiny lung nodules. Port-A-Cath.. Degenerative changes cervical\nspine.", + "output": "Resolution or near resolution of previously seen right palatine tonsil\nabscess." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nlarge mass. Prominent posterior fossa CSF space is similar to prior. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There are small mucous retention cysts in\nthe maxillary sinuses. The visualized portion of the remainder of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\norbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. No evidence acute intracranial hemorrhage.\n3. Paranasal sinus disease , as described." + }, + { + "input": "There is mucosal thickening in the right sphenoid likely consistent with a\nmucous retention cyst. There is mild mucosal thickening of the anterior\nethmoidal air cells. Otherwise, the paranasal sinuses are normally aerated,\nwith no mucosal thickening or air-fluid levels identified. The ostiomeatal\nunits are patent. The cribriform plates are intact. The lamina papyracea are\nintact.", + "output": "1. Minimal paranasal sinus disease with mucosal thickening in the right\nsphenoid sinus and anterior ethmoidal air cells with possible mucous retention\ncyst in the right sphenoid sinus. No air-fluid levels identified." + }, + { + "input": "There is no evidence of acute large territory infarct, hemorrhage, edema, or\nmass effect. The ventricles and sulci are within expected limits for the\ndegree of mild global cerebral senescent related volume loss.\n\nThere is no evidence of fracture. Re-identified is a small dependent mucus\nretention cyst in the left maxillary sinus. Otherwise, the remainder the\nvisualized paranasal sinuses are clear. The mastoid air cells and middle ears\nare well pneumatized and clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nintracranial hemorrhage." + }, + { + "input": "There is mild mucosal thickening in the maxillary sinuses. No air-fluid\nlevels. The maxillary infundibula and ostiomeatal complexes are patent\nbilaterally. There is mild mucosal thickening in the anterior ethmoid air\ncells and the left frontal sinus. The frontal recess these are clear. There\nare small air-fluid levels in the sphenoid sinuses. The sphenoethmoidal\nrecesses are clear. The middle turbinates are pneumatized, left greater than\nright, without opacification. The nasal cavity is clear. The nasal septum is\nmildly deviated to the right with a superimposed bony spur. The mastoid air\ncells and middle ear cavities are clear.\n\nThe lamina papyracea are intact. Cribriform plates are intact and relatively\nsymmetric. The left fovea ethmoidalis is slightly higher than the right. The\nsphenoid septum inserts onto the floor of the sella. Degenerative changes are\nnoted in the mandibular condyles bilaterally.\n\nAside from bilateral cataract extractions and senile calcifications, the\norbits are unremarkable. This is study is not optimized for evaluation of\nintracranial structures however no gross abnormality is detected.", + "output": "Small air-fluid levels in bilateral sphenoid sinuses and minimal mucosal\nthickening of other sinuses as described above. The paranasal sinuses are\notherwise clear." + }, + { + "input": "When compared to CT chest dated ___, the epiglottis is severely\nenlarged (series 3, image 23 and series 6, image 41), concerning for\nepiglottitis. The bilateral tonsils appear enlarged and edematous (series 3,\nimage 21) without hypodense collection or induration of adjacent fat,\nconcerning for infection versus inflammation.. There is no evidence\nperitonsillar abscess. The posterior wall of the supraglottic region is\nthickened without fluid collection, concerning for infection versus\ninflammation.\n\nThere is a and enlarged left II A lymph node (series 3, image 30) measuring 13\nmm on short axis. There is a enlarged right IIA lymph node (Series 3, image\n32) measuring 11 mm on short axis. These could be reactive versus secondary\nto patient's known myelodysplastic syndrome.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding.There is no thyroid nodules.There is mild mastoid opacification. \nThe paranasal sinuses are otherwise clear.The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.", + "output": "1. Enlarged epiglottis concerning for epiglottitis.\n2. Enlarged and thickened bilateral tonsils and posterior wall of the\nsupraglottic region without fluid collection concerning for infection versus\ninflammation.\n3. Lymphadenopathy of the bilateral the IIA lymph nodes as described above,\nwhich could be reactive versus secondary to patient's known myelodysplastic\nsyndrome.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 2:03 pm, 10 minutes after\ndiscovery of the findings." + }, + { + "input": "Compared to CT neck dated ___, the previously severely enlarged\nepiglottis has significantly improved. The piriform sinus is still narrowed,\nbut better than prior. The previously seen prominent tonsils and posterior\nwall of the supraglottic soft tissue have improved. There is no evidence of\nfluid collection to suggest abscess formation. The previously seen enlarged\ngroup IIA cervical lymphadenopathy have resolved.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal.The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.", + "output": "1. Interval improvement of the previously seen epiglottitis, tonsillar and\nposterior wall of the supraglottic soft tissue inflammation, and cervical\nlymphadenopathy.\n2. No evidence fluid collection to suggest abscess formation." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass effect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Mild periventricular and subcortical white matter\nhypodensities are nonspecific, but compatible with chronic microangiopathy in\na patient of this age.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The patient is\nstatus post bilateral cataract surgery.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nevidence of intracranial hemorrhage, acute large territory infarct or mass\neffect." + }, + { + "input": "Study is mildly degraded by motion. There is no evidence of infarction,\nhemorrhage, edema, or mass. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. Mild periventricular and subcortical\nwhite matter hypodensities are nonspecific, compatible with chronic\nmicroangiopathy. Atherosclerotic vascular calcifications are noted of\nbilateral cavernous portions of internal carotid arteries.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Patient is\nstatus post bilateral lens replacement.", + "output": "1. Study is mildly degraded by motion.\n2. Within limits of study, no acute intracranial abnormality, with no\ndefinite evidence of acute intracranial hemorrhage or acute large territorial\ninfarct. Please note MRI of the brain is more sensitive for the detection of\nacute infarct.\n3. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described." + }, + { + "input": "There is no acute intracranial hemorrhage, acute infarction, edema or mass\neffect. Prominent bifrontal and temporal convexity extra-axial space most\ncompatible with moderate atrophy. Periventricular and subcortical white matter\nhypodensities are nonspecific though likely sequela of chronic small vessel\nischemic disease. There is no shift of normally midline structures. The basal\ncisterns are clear. The gray white matter differentiation appears preserved.\n\nNo fracture is identified. Mild mucosal thickening within the ethmoidal air\ncells and maxillary sinuses bilaterally is noted. The remaining visualized\nparanasal sinuses mastoid air cells and middle ear cavities are clear.\nModerate atherosclerotic calcifications within the carotid site thin\nincidentally noted.", + "output": "No evidence of acute intracranial abnormality." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nA bony excrescence of the left occipital bone (Series 2, image 12), is likely\nan exostosis.\n\nCTA HEAD:\nThere are multifocal bilateral stenoses of the anterior cerebral arteries,\nbilaterally (series 3, image 267). Equivocal irregularity of the distal\nbranches of the middle cerebral arteries, bilaterally (series 3, image 248) is\nalso noted. Otherwise, the vessels of the circle of ___ and their\nprincipal intracranial branches appear normal without stenosis, occlusion, or\naneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nA luminal defect at the origin of the left vertebral artery may also be\nartifactual or represent a moderate stenosis (series 3, image 71). Otherwise,\nthe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\n\nScarring is noted at the lung apices, bilaterally. Evaluation of the lungs is\nlimited by respiratory motion. The thyroid is unremarkable.", + "output": "1. Multifocal, mild narrowing involving the anterior cerebral arteries,\nbilaterally and equivocal multi segmental narrowing involving the middle\ncerebral arteries, bilaterally are suggestive reversible cerebral\nvasoconstriction syndrome.\n2. No intracranial hemorrhage, edema, mass effect or infarction.\n3. Luminal defect at the origin of the left vertebral artery may represent\nartifact or moderate stenosis.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 4:00 pm, 30 minutes after\ndiscovery of the findings.\n\nAn e-mail was sent by Dr. ___ to the ___ QA nurses at 16:00 on ___." + }, + { + "input": "Exam is very limited by artifacts from the leads and from the external metal\nframework. Within this limitation, there is no evidence of hemorrhage. \nBilateral leads for deep brain stimulation are in place. Expected left\nfrontal pneumocephalus from procedure.", + "output": "1. DBS leads in place without evidence of hemorrhage." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are within expected limits in size and configuration.\nThere are mild periventricular and subcortical white matter hypodensities,\nwhich are nonspecific, but compatible with chronic microangiopathy in a\npatient this age.\n\nThe paranasal sinuses are essentially clear allowing for mild mucous retention\ncysts in the maxillary sinus alveolar recesses. The orbits are unremarkable\nmastoid air cells and middle ears are well ties and clear. No acute osseous\nabnormality.\n\nScattered dental caries of the patient's remaining mandibular teeth are noted.\n\nCTA HEAD:\nThere is fetal type origin of the right posterior cerebral artery. The\nvessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThere is apparent moderate narrowing of the left vertebral artery origin,\nalthough this is likely artifactual. Otherwise, the carotid and vertebral\narteries and their major branches appear normal with no evidence of stenosis\nor occlusion. There is no evidence of internal carotid stenosis by NASCET\ncriteria.\n\nOTHER:\nProminent paraseptal and centrilobular emphysematous changes of the lung\napices are identified. Patchy focus of ___ and ground-glass opacity\nof the right lung apex (series 3, image 65) may be secondary to atelectasis\nand not seen on prior examination of ___. In the right upper\nlobe there is a 9 mm nodule with surrounding ground-glass opacity and nodular\n___ opacities as well as smaller nodules measuring up to 3-4 mm\n(series 3, image 31). Calcified pleural plaques are incidentally noted in the\nright, similar to prior examination.", + "output": "1. Unremarkable head and neck CTA. Apparent moderate narrowing of the left\nvertebral artery origin is likely artifactual.\n2. No acute intracranial abnormality on noncontrast head CT. Mild\nperiventricular and subcortical T2/FLAIR white matter hyperintensities are\nnonspecific, but compatible with chronic microangiopathy in a patient of this\nage.\n3. In the right upper lobe there is a 9 mm nodule with surrounding\nground-glass opacity and ___ opacities as well as smaller satellite\nnodules measuring up to 3-4 mm. These are not seen on recent CT chest of ___.\n4. Additional findings as described above.\n\nRECOMMENDATION(S): For incidentally detected multiple solid pulmonary nodules\nbigger than 8mm, a CT follow-up in 3 to 6 months is recommended in a low-risk\npatient, with an optional CT follow-up in 18 to 24 months. In a high-risk\npatient, both a CT follow-up in 3 to 6 months and in 18 to 24 months is\nrecommended.\n\nSee the ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___\n\nAlternatively, if there is higher clinical suspicion, completion CT chest can\nbe performed for more immediate evaluation." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nCT HEAD WITHOUT CONTRAST:\nLeft frontal craniotomy postsurgical changes noted. There is no evidence of\nno evidence of large territorial infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nEvidence of prior left frontal craniotomy. No acute fracture is identified. \nThere is mild mucosal thickening of the left maxillary sinus. Otherwise, the\nremaining visualized portion of the paranasal sinuses and middle ear cavities\nare clear. There is minimal fluid in the right mastoid air cells, nonspecific\nand could be related to intubation. The visualized portion of the orbits are\nunremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThere are short segments of predominantly noncalcified atherosclerotic plaque\nwith peripheral foci of calcification in the proximal right internal carotid\nartery just off the bifurcation. The largest plaque causes approximately 30%\nstenosis of the internal carotid artery by NASCET criteria. Otherwise the\nremaining carotid and vertebral arteries and their major branches appear\nnormal without evidence of stenosis or occlusion. No evidence of dissection.\n\nOTHER:\nThe patient is intubated. An enteric tube is demonstrated within the expected\nlocation. The thyroid appears unremarkable. The visualized portion of the\nbilateral lungs demonstrate consolidation in the dependent portion of the left\nupper lobe (series 3, image 19; 602:6). Additionally, ill-defined right upper\nlobe opacity is noted (see 3:5). There are biapical scarring with scattered\nparaseptal emphysema.\n\nMultilevel degenerative changes are mild. No prevertebral soft tissue\nswelling. Partially visualized minimally displaced right fourth rib fracture\nis noted (see 03:17). Scattered subcentimeter nonspecific lymph nodes are\nnoted throughout the mediastinum and neck bilaterally, without definite\nenlargement by CT size criteria. Soft tissue density is noted within the left\nexternal auditory canal which may represent cerumen.", + "output": "1. Dental amalgam streak artifact limits study.\n2. No acute intracranial process. Please note MRI of the brain is more\nsensitive for the detection of acute infarct.\n3. Approximately 30% stenosis of right internal carotid artery by NASCET\ncriteria.\n4. Otherwise, patent intracranial and cervical carotid and vertebral arteries\nwithout evidence of dissection or aneurysm.\n5. Left greater than right upper lobe consolidation concerning for pneumonia,\naspiration and/or contusion. If clinically indicated, consider correlation\nwith dedicated chest imaging.\n6. Nonspecific subcentimeter lymph nodes as described, which may be reactive.\n7. Partially visualized minimally displaced right fourth rib fracture. If\nclinically indicated, consider dedicated thoracic imaging for further\nevaluation.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:37 am, 2 minutes after discovery\nof the findings.\n\nThe updated findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 2:30 pm, 2 minutes after discovery of\nthe findings." + }, + { + "input": "Chronic left cerebellar infarcts. Chronic infarcts bilateral posterior\ntemporal, occipital lobes. If there is concern for subacute ischemia, brain\nMRI without contrast recommended. Findings consistent with moderate chronic\nsmall vessel ischemic changes. Possible subacute to chronic left centrum\nsemiovale infarcts. Brain parenchymal atrophy. No acute hemorrhage, no\nhydrocephalus.\n\nThere is mild ethmoid sinus opacification and suggestion of either polyp or\nopacified concha bullosa on the left.", + "output": "Chronic infarcts. If there is concern for subacute ischemia, brain MRI\ncommended.\nNo hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration for the patient's\nage.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. There is mild\nsoft tissue swelling in the right periorbital region.", + "output": "Swelling over the right orbit. No evidence of fracture.\nOtherwise normal head CT." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nMotion artifact somewhat limits the image quality.\n\nThere is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of mild age-related atrophy.\n\nThere is no fracture. The visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portions of the\norbits are normal. Dental fillings cause streak artifact, which somewhat\nlimits the interpretation of the images of the level of the teeth.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, or occlusion. At the bifurcation of the P1\nsegment on the right, there is a 2 mm density, which most likely represents an\ninfundibulum or a diminutive PCOM (3:287). The dural venous sinuses are\npatent.\n\nCTA NECK:\nThere is a 3 vessel aortic arch. Bilateral carotid and vertebral artery\norigins are patent.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. The left vertebral artery is slightly\ndominant compared to the right.\n\nThere are mild-to-moderate multilevel degenerative changes of the cervical\nspine, worst at C6 through 7 with intervertebral disc space narrowing,\nanterior and posterior osteophytosis and endplate sclerosis.\n\nOTHER:\nThe visualized portion of the lungs are clear aside from mild biapical pleural\nscarring and mild dependent atelectasis. The esophagus is patulous the\nvisualized portion of the thyroid gland is within normal limits. There is no\nlymphadenopathy by CT size criteria. There is a vagus nerve stimulator on the\nleft, with leads in the appropriate position and battery pack within the left\nprepectoral space.", + "output": "1. No acute intracranial abnormality.\n2. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n3. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection.\n4. Prominence of the ventricles and sulci is consistent with global\nparenchymal atrophy within the expected range for the patient's age.\n5. Mild-to-moderate multilevel cervical spondylosis, as above." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Mild carotid siphon atherosclerotic\ncalcifications are noted. Again noted is prominent posterior nasopharyngeal\nsoft tissue perhaps reflective of lymphoid hyperplasia.", + "output": "No evidence of an acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nlarge territorial infarction. Prominent ventricles and sulci suggest\nage-related involutional changes or atrophy. Subcortical and periventricular\nwhite matter hypodensities are consistent with chronic small vessel ischemic\ndisease, there is a small lacunar ischemic change on the head of the caudate\nnucleus on the left (16:2). The basal cisterns appear patent and there is\npreservation of gray-white matter differentiation.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nbilateral ethmoid air cells. The remainder of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. Atherosclerotic mural\ncalcification of the bilateral internal carotid arteries is noted. The globes\nare unremarkable.", + "output": "1. No evidence of acute intracranial hemorrhage or large vascular territory\ninfarction.\n2. Moderate-severe global cerebral atrophy and evidence of chronic small\nvessel ischemic disease." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute vascular territorial infarct. Scattered subcortical and periventricular\nwhite matter hypodensities are likely sequela of chronic small vessel disease.\nFocal hypodensity in the left caudate head suggests prior lacunar infarct.\nGray-white matter differentiation is preserved. Ventricles and sulci are\nprominent compatible with global volume loss. Dense atherosclerotic\ncalcifications noted within the intracranial ICAs.\n\nIncluded paranasal sinuses and mastoids are essentially clear noting minimal\nopacification of the right mastoid tip, unchanged, and mild mucosal thickening\nin the right sphenoid sinus. Multiple lucencies in the calvarium are are all\nunchanged back to ___. Skull and extracranial soft tissues are unremarkable.", + "output": "No acute intracranial process. Multiple lucent lesions in the calvarium are\nnonaggressive in appearance, and are unchanged from ___." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territorial infarct. Prominence of the\nventricles and sulci is consistent with atrophy. Periventricular and\nsubcortical white matter hypodensities are likely sequelae of chronic small\nvessel disease. Lacune or infarct in the left caudate head is re-\ndemonstrated. The partially imaged paranasal sinuses demonstrate mild mucosal\nthickening in the ethmoid air cells. The maxillary sinuses are essentially\nnot imaged. There is minimal mucosal thickening/fluid in the dependent\nportions of the sphenoid sinuses. The right mastoid air cells are opacified,\nnew since the prior study. The right middle ear cavity is also opacified. No\nacute fracture is seen.", + "output": "No acute intracranial process.\n\nRight otomastoiditis, with opacification of the right mastoid air cells and\nright middle ear cavity, new since ___, without definite septal\ndestruction. No acute fracture seen." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are prominent compatible with global volume\nloss. Mild periventricular white matter hypodensities are likely sequela of\nchronic small vessel disease. Chronic left caudate head lacune is also noted.\nDense atherosclerotic calcifications within the intracranial ICAs is noted.\n\nThere is near complete opacification of the right mastoids and middle ear as\non prior. Hyperostosis of the visualize maxillary sinus wall suggests prior\nchronic inflammation. Other included paranasal sinuses and left mastoids are\nclear. Skull and extracranial soft tissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Evaluation is substantially limited by severe streak artifact secondary\npresence of stereotactic frame and left frontal approach deep brain\nstimulator.\n\nThere has been interval placement of a left frontal approach deep brain\nstimulator, which terminates in the approximate location in the left thalamus.\nOperative changes including the left frontal burr hole and left frontal\npneumocephalus. There is no evidence of large hemorrhage. The ventricles are\ngrossly normal in size and configuration.", + "output": "1. Study is severely limited secondary to streak artifact as described.\n2. Intraoperative images demonstrate interval placement of a left frontal\napproach deep brain stimulator, which terminates in the approximate location\nof the left thalamus." + }, + { + "input": "Two series of images demonstrates the presence of a left deep brain stimulator\nvia a frontal approach and subsequent placement of a right DBS stimulator via\na frontal approach. The DBS stimulators appear to terminate in the expected\nregion of the basal ganglia/subthalamic nucleus bilaterally. Evaluation of\nbrain parenchyma severely degraded by metallic artifact from external\nstereotactic device and the deep brain stimulators. Trace amount of\npostoperative right frontal pneumocephalus is identified. Interval resolution\nof previously seen left frontal pneumocephalus on examination ___.\nNo gross intracranial hemorrhage.", + "output": "1. Interval placement of a right frontal approach deep brain stimulator which\nterminates in the approximate location of the right subthalamic nucleus.\n2. Trace right frontal pneumocephalus. No large intracranial hemorrhage.\n3. Unchanged position of a left trans-frontal deep brain stimulator.\n4. Please note, evaluation the brain parenchyma severely limited secondary to\nmetallic artifact." + }, + { + "input": "Mildly limited study in the setting of hardware artifact from bilateral deep\nbrain stimulator leads. Within this limitation, no evidence of hemorrhage,\nacute infarction, edema, mass, or mass effect. The ventricles and sulci are\nwithin normal limits with respect to size and configuration. The basal\ncisterns are patent. There is no shift of normally midline structures. \nBifrontal approach deep brain stimulator leads appear in grossly appropriate\nposition. Pneumocephalus has resolved. There is no evidence of hemorrhage or\nsignificant edema along the lead tracts. The visualized paranasal sinuses and\nmastoid air cells are clear. The patient is status post bilateral lens\nremoval; otherwise, the globes and bony orbits are intact and unremarkable.", + "output": "No acute intracranial process. No hemorrhage. Bilateral deep brain\nstimulator leads in grossly appropriate position." + }, + { + "input": "Bilateral deep brain stimulators in place ending in the region of the globus\npallidi. There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mucosal thickening in the left\nmaxillary sinus and ethmoid air cells. Remainder of the paranasal sinuses are\nclear. The visualized portion of the orbits are unremarkable. Incidental\nnote is made of a partially empty sella.", + "output": "No acute intracranial process. Bilateral deep brain stimulator leads ending\nin expected position." + }, + { + "input": "Bilateral deep brain stimulator leads are again noted, similar in position. \nThere is secondary streak artifact. Within this limitation, there is no\nintra-axial or extra-axial hemorrhage, mass, midline shift, or acute major\nvascular territorial infarct. Gray-white matter differentiation is preserved.\nVentricles and sulci and unremarkable. Basilar cisterns are patent.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "Bilateral deep brain stimulator leads in stable position with secondary\nartifact. Within this limitation, no evidence of acute intracranial process,\nno hemorrhage." + }, + { + "input": "Bilateral deep brain stimulator devices are again seen with lean is in stable\nposition. There is mild secondary artifact. No visualized intra-axial or\nextra-axial hemorrhage, mass effect, midline shift, or evidence of infarct. \nVentricles and sulci are symmetric and unremarkable.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "Bilateral deep brain stimulator devices, unchanged. Within this limitation,\nno visualized acute intracranial process." + }, + { + "input": "Subtle hyperdensity along the right posterior parietal lobe is best seen on\ncoronal view (401b:72) is unchanged since prior examination. This may rib\nrelated to slightly hyperdense cortex although trace subarachnoid hemorrhage\nis not entirely excluded. No new hemorrhage. There is no evidence of\ninfarction, edema,or mass.\n\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Periventricular, subcortical white matter hypodensities are likely\nsequelae of chronic small vessel ischemic disease.\n\nLeft parietal subgaleal hematoma with evidence of laceration and overlying\nskin staples. No fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable. Calcification the cavernous portions of\ninternal carotid arteries are present.", + "output": "1. Stable small hyperdensity in the posterior right parietal lobe as seen on\nprior. This could be slightly hyperdense cortex although trace subarachnoid\nblood is not entirely excluded.\n2. Chronic changes as described above.\n3. Left parietal subgaleal hematoma with evidence of laceration and overlying\nskin staples." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Normal study." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nRedemonstration of hypodensity in the left parieto-occipital region with\nextension into the left frontal lobe, consistent with the patient's known\nsubacute infarction previously identified on the MRI.\nAreas of hyperdensity along the left parietal gyri (for example series 2,\nimage 26) are again seen and correspond to the previously identified cortical\nlaminar necrosis.\n\nAdditional scattered white matter lesions in the cerebral hemispheres\nbilaterally are nonspecific but suggestive of chronic small vessel ischemic\nchanges.\n\nCalcification of the bilateral basal ganglia are unchanged.\n\nAgain noted is mild generalized parenchymal volume loss which is most likely\nage related. Mild prominence of the ventricular system and extra-axial CSF\nspaces is stable and consistent with the previously mentioned parenchymal\nvolume loss.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation.\nThe dural venous sinuses are patent.\n\nCTA NECK:\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of significant\ninternal carotid stenosis by NASCET criteria.\n\nOTHER:\nThere is gravity dependent atelectasis. No suspicious pulmonary nodules. \nThere are subcentimeter hypodense nodules in the bilateral thyroid lobes, no\nfollow-up is indicated according to current guidelines. There is no\nlymphadenopathy by CT size criteria.", + "output": "1. Redemonstration of the patient's known subacute infarction in the left\nparieto-occipital region with extension into the left frontal lobe and\nevidence of areas of cortical laminar necrosis.\n2. Additional scattered periventricular hypodensities are nonspecific but\nsuggestive of chronic small vessel ischemic changes.\n3. Patent intracranial and cervical vasculature without evidence of stenosis,\nocclusion, dissection or aneurysm formation greater than 3 mm." + }, + { + "input": "Again seen are the 1.8 x 1.9 cm left parietal and 1.7 x 2.0 cm pontine\nhemorrhagic masses, which allowing for technique differences are likely\nunchanged to slightly increased in size. No substantial increase surrounding\nmass effect. The known right thalamic nonhemorrhagic mass is not\nwell-visualized. No definite new intracranial mass identified allowing for\nlimitation of a noncontrast CT. There is no evidence of large territorial\ninfarction,new intracranial hemorrhage,or new edema. The ventricles and sulci\nare normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear.", + "output": "1. Known 1.8 x 1.9 cm left parietal and 1.7 x 2.0 cm pontine hemorrhagic\nmasses, likely unchanged or slightly increased in size given technique\ndifferences. No substantial surrounding mass effect. Known right thalamic\nnonhemorrhagic mass is not well-visualized. No definite new intracranial\nmass.\n2. Otherwise no new intracranial hemorrhage." + }, + { + "input": "Re-demonstrated are several hyperdense lesions compatible with melanoma\nmetastases including one within the left frontoparietal region (series 2,\nimage 21) which measures approximately 1.7 x 1.0 cm, one within the pons which\nmeasures approximately 13 x 7 mm (series 2, image 6), and a 7 mm lesion in the\nright thalamus, all grossly similar to prior MRI exam. Additionally, a 2 mm\npunctate hyperdense focus in the left posterior parietal lobe (02:19) appears\nnew compared to the prior CT, and appears to correspond to a metastasis seen\non prior MRI. Other known metastatic lesions seen on prior MRI are not well\nvisualized on the current CT.\n\nNo additional areas of intracranial hemorrhage. No shift of normally midline\nstructures, vasogenic edema, or acute territorial infarct. The ventricles and\nsulci are normal in configuration and size.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Redemonstration of several hyperdense lesions compatible with known\nmelanoma metastases, as seen on prior MRI, of which the dominant left\nfrontoparietal and pontine lesions demonstrated evidence of prior hemorrhage\non previous exams.\n2. A 2 mm punctate hyperdense focus in the left posterior parietal lobe\nappears new from the previous CT, but was present on the prior MRI, and\ncorresponds to a melanoma metastasis. It is difficult to exclude the presence\nof hemorrhage within this metastasis on the basis of this CT exam, though none\nwas detected in this lesion on the recent MRI.\n3. Other known melanoma metastases seen on MRI are not clearly visualized on\nthe current CT.\n4. No other additional new areas of acute intracranial hemorrhage or vasogenic\nedema identified." + }, + { + "input": "Hemorrhagic or enhancing lesion right thalamus better seen on MRI brain from\ntoday. Indeterminate 0.6 cm lesion C3 vertebral body.\n\nNo aerodigestive tract mass.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. The neck vessels are patent.\n\nRefer to chest CT for thoracic findings from today.", + "output": "1. Right thalamic lesion, refer to brain MRI from today.\n2. No mass or adenopathy in the neck" + }, + { + "input": "There is an wedge-shaped area of parenchymal hypodensity in the left\ncerebellum (2:5 and 601:74), concerning for cytotoxic edema related to an\nacute infarct. No associated mass effect. There is no intra-axial or\nextra-axial hemorrhage or shift of normally midline structures. Prominent\nventricles and sulci are compatible with age-related involutional changes. \nPeriventricular subcortical white matter hypoattenuation is nonspecific but\ncan be seen in chronic small vessel ischemic disease.\n\nThere is mucosal thickening in the bilateral ethmoid air cells. Remaining\nparanasal sinuses are clear. Mastoid air cells and middle ear cavities are\nwell aerated. The bony calvarium is intact. There are moderate\natherosclerotic calcifications within the bilateral carotid siphons", + "output": "1. Wedge-shaped hypodensity in the inferior left cerebellar hemisphere is\nconcerning for acute infarction. MRI can be considered for further\ncharacterization.\n2. No intracranial hemorrhage." + }, + { + "input": "CTA HEAD AND NECK:\nThere is a filling defect in the V4 segment of the left vertebral artery,\nconsistent with intraluminal thrombus (2:183). The spiral configuration of the\nthrombus within the left vertebral artery raises concern for dissection.\nSubtle hypodensity within the more distal basilar may represent propagation of\ndissection versus contrast mixing from the diminished flow within the left\nvertebral artery (2: 213).\n\nThere is mild atherosclerotic calcification in the bilateral cavernous\ncarotids without significant narrowing. The remainder of the vessels of the\ncircle of ___ and their principal intracranial branches appear normal\nwithout stenosis, occlusion, or aneurysm formation. The dural venous sinuses\nare patent.\n\nThere is mild atherosclerotic calcification of the bilateral cavernous\nbifurcations without severe narrowing. The carotidandright vertebral arteries\nand their major branches appear normal with no evidence of stenosis or\nocclusion. There is no evidence of internal carotid stenosis by NASCET\ncriteria.\n\nOTHER:\nThere is fluid in the esophagus.the visualized portion of the lungs are clear.\nThere is a 2.9 x 1.9 cm heterogeneous left thyroid nodule (2:71). There is no\nlymphadenopathy by CT size criteria. There is mild mucosal thickening in the\nethmoid air cells. The remainder of the paranasal sinuses and mastoid air\ncells are clear. Patient is status post bilateral lens replacement. The\norbits are otherwise grossly unremarkable. There are multilevel degenerative\nchanges in the cervical spine.", + "output": "1. Intraluminal thrombus in the V4 segment of the left vertebral artery.\n2. Spiral to configuration of the thrombus within the left vertebral artery\nraises concern for dissection.\n3. Subtle hypodensity within the more distal basilar artery may represent\npropagation of the dissection versus contrast mixing from the diminished flow\nwithin the left vertebral artery.\n4. 2.9 cm heterogeneous left thyroid nodule, for which outpatient thyroid\nultrasound is recommended if clinically indicated.\n5. Fluid within the esophagus. Aspiration precautions are recommended." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThe right internal auditory canal mass with small right cerebellopontine angle\ncomponent is better demonstrated on the prior MRI, though it is faintly\nvisible on image 3:270. No evidence for edema in the adjacent right cerebellar\npeduncle, nor elsewhere in the brain parenchyma. No acute hemorrhage. No\nevidence for an acute major vascular territorial infarct. Mild global\nparenchymal volume loss with mildly prominent ventricles and sulci is again\nseen.\n\nThere is minimal mucosal thickening in the ethmoid air cells. There is a\nlarge 1.3 x 1.0 cm periapical lucency involving the roots ___ 9 and 10, and\nextending to the margin ___ 8, with thinning and possible dehiscence of the\nbuccal cortex the on images 3:226-227. Mastoid air cells are clear. The\norbits are unremarkable.\n\nCTA NECK:\nThere is a 3 vessel aortic arch. There is mild calcified plaque at the great\nvessel origins without associated stenosis. There is also mild calcified\nplaque in the visualized proximal descending aorta.\n\nThere is 2 cm segment of plaque extending from the distal right common carotid\ninto the proximal right internal carotid artery, noncalcified proximally and\ncalcified distally. The noncalcified plaque causes greater than 90% stenosis\nof the right internal carotid artery origin by NASCET criteria.\n\nThere is approximately 1 cm segment of predominantly calcified plaque in the\nproximal left internal carotid artery causing 70-80% stenosis by NASCET\ncriteria.\n\nCalcified plaque at the right vertebral artery origin causes mild-to-moderate\nstenosis. There is also calcified plaque in the distal V1 segment and in the\nV2 segment, without flow-limiting stenosis.\n\nCalcified plaque at the left vertebral artery origin causes moderate to severe\nstenosis. Calcified plaque in the distal V1 segment causes mild stenosis. \nNoncalcified plaque causes short-segment moderate stenosis of the left V2\nsegment at the level of C3. Left V3 segment demonstrates no evidence for\nflow-limiting stenosis.\n\nCTA HEAD:\nThere is mild calcified plaque within bilateral carotid siphons without\nevidence for flow-limiting stenosis. No other evidence for flow-limiting\nstenosis in the major intracranial arteries. No evidence for an aneurysm. \nThe dural venous sinuses are patent.\n\nOTHER:\nThe thyroid is enlarged and heterogenous with multiple bilateral nodules, some\nof which are ill-defined. Right-sided nodule on image 3:99 measures\napproximately 1.6 cm. Left-sided nodule on image 3:101 measures approximately\n2.4 cm. The left lower pole extends into the superior mediastinum. The\ntrachea is slightly deviated to the right. No pathologically enlarged lymph\nnodes by CT criteria. Evaluation of the included upper lungs is limited by\nrespiratory motion artifact; there is mild dependent atelectasis.\n\nThere are degenerative changes in the cervical spine. 8 mm oval sclerotic\nlesion in the right scapular on image 3:110 is nonspecific but compatible with\na bone island.", + "output": "1. 2 cm segment of plaque extending from the distal right common carotid into\nthe proximal right internal carotid artery, noncalcified proximally and\ncalcified distally. The noncalcified plaque causes greater than 90% stenosis\nof the right internal carotid artery origin by NASCET criteria.\n2. Approximately 1 cm segment of predominantly calcified plaque in the\nproximal left internal carotid artery causing 70-80% stenosis by NASCET\ncriteria.\n3. Mild-to-moderate right vertebral artery origin stenosis due to calcified\nplaque.\n4. Moderate to severe left vertebral artery origin stenosis due to calcified\nplaque, with calcified plaque causing mild stenosis of the distal V1 segment\nand noncalcified plaque causing short-segment moderate stenosis of the left V2\nsegment at the level of C3.\n5. No evidence for flow-limiting stenosis in the major intracranial arteries.\n6. Right internal auditory canal mass with a small right cerebral pontine\nangle cistern component is better seen on the ___ MRI.\n7. 1.3 x 1.0 cm periapical lucency involving the roots ___ 9 and 10, and\nextending to the margin ___ 8, with thinning and possible dehiscence of the\nbuccal cortex.\n8. Enlarged thyroid gland, with a left lower pole extending into the superior\nmediastinum, and associated rightward tracheal deviation. Multiple thyroid\nnodules, some ill-defined, measuring up to 2.4 cm.\n\nRECOMMENDATION(S): Thyroid nodule. Ultrasound evaluation recommended if not\npreviously performed elsewhere.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or ___, or with suspicious findings. Suspicious\nfindings include: Abnormal lymph nodes (those displaying enlargement,\ncalcification, cystic components and/or increased enhancement) or invasion of\nlocal tissues by the thyroid nodule. ___, et al, \"Managing Incidental\nThyroid Nodules Detected on Imaging: White Paper of the ACR Incidental\nFindings Committee\". J ___ ___ 12:143-150.\n\nNOTIFICATION: The impression and recommendation above were entered by Dr.\n___ on ___ at 10:57 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." + }, + { + "input": "There is no evidence of large territorial infarction, hemorrhage, edema, or\nmass effect. The ventricles and sulci are normal in size and configuration. No\nosseous abnormalities seen. Minimal thickening is seen of the ethmoid\nsinuses. The mastoid air cells and middle ear cavities are clear. The orbits\nare unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is mild calcific atherosclerosis of the bilateral carotid siphons,\nwithout luminal stenosis. The anterior communicating artery is visualized. \nThe bilateral posterior communicating arteries are not visualized. There are\ncodominant vertebral arteries. The anterior and posterior circulations are\npatent without evidence of occlusion, dissection, aneurysm, or significant\nstenosis. The dural venous sinuses are patent.\n\nThe gray-white matter differentiation is intact without evidence of acute\nterritorial infarct, hemorrhage, mass, or mass effect. The ventricles and\ncortical sulci are normal in caliber and configuration. The orbits,\ncalvarium, and soft tissues are unremarkable. There is mild mucosal\nthickening within the bilateral ethmoid and maxillary sinuses. The mastoid\nair cells and middle ears are clear.", + "output": "1. Patent intracranial vasculature, without evidence of occlusion, dissection,\naneurysm, or significant stenosis.\n2. No acute intracranial abnormality." + }, + { + "input": "Dental amalgam streak artifact and motion limits study.\n\nThere is calcification of the aortic arch. Nonocclusive calcification of\nbilateral subclavian arteries is noted. Punctate nonocclusive calcification\nof the left mid common carotid artery is noted.\n\nThe left internal carotid artery demonstrates a retropharyngeal course.\n\nBy NASCET criteria, there is an approximately 50 percent stenosis of the right\nICA origin (see 02:36) and an approximately 25 percent stenosis of the left\nICA origin (see 303:37) secondary to at least partially calcified plaques.\n\nOtherwise, the carotid and vertebral arteries and their major branches are\npatent with no evidence of stenoses. No definite evidence for dissection is\nseen.\n\nOTHER:\nLimited imaging of cervical demonstrates nonocclusive probable atherosclerotic\ncalcified mass of bilateral cavernous internal carotid artery segments, the\nright vertebral artery distal V3 segment and mid right vertebral artery V4\nsegment. Limited imaging of cervical and upper thoracic spine demonstrates\nmultilevel degenerative changes with at least moderate vertebral canal\nnarrowing at T1-2.", + "output": "1. Dental amalgam streak artifact and motion limits study.\n2. Approximately 50% stenosis of the right internal carotid artery origin and\n25% stenosis of the left internal carotid origin by NASCET criteria as\ndescribed.\n3. Probable atherosclerotic changes of the aortic arch and subclavian arteries\nas described.\n4. Otherwise, patent bilateral cervical carotid and vertebral arteries without\ndefinite evidence of stenosis, occlusion, or dissection.\n5. Limited imaging of circle of ___ suggests nonocclusive probable\natherosclerotic changes as described.\n6. Limited imaging of cervical and upper thoracic spine demonstrates\nmultilevel degenerative changes with at least moderate vertebral canal\nnarrowing at T1-2. If concern for thoracic spinal cord compression, consider\nthoracic spine MRI for further evaluation." + }, + { + "input": "Some patient motion through the inferior more images makes assessment somewhat\nsuboptimal. Given this, no evidence of large acute intracranial hemorrhage,\nmidline shift, mass effect, or acute large vascular territorial infarct. No\nacute fracture is seen. Minimal subcortical and periventricular white matter\nhypodensities are nonspecific, likely the sequelae of chronic small vessel\nischemic disease. There is prominence of the ventricles and sulci suggestive\nof involutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavitiesare essentially clear.", + "output": "1. Some patient motion through the inferior more images makes assessment\nsomewhat suboptimal. Given this, no acute intracranial process seen." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,or\nedema. There is a hypodense lesion in the left frontal lobe, not definitively\nseen on prior MRI dated ___ (04:22). This may represent a chronic\ninfarct. However, a metastatic lesion cannot be definitively excluded in the\nsetting of known malignancy. The ventricles and sulci are normal in size and\nconfiguration.\n\nThere is no evidence of fracture. There is a mild amount of aerosolized fluid\nin the right maxillary sinus. Otherwise, the visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No evidence of intracranial hemorrhage.\n2. Hypodense left frontal lobe lesion, not definitively seen on prior MRI\ndated ___. However, metastasis cannot be excluded in the setting of\nknown malignancy. MRI can be performed as clinically indicated." + }, + { + "input": "There is no evidence of large territory infarction,hemorrhage,edema, or mass\neffect. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality on noncontrast CT head. Specifically no\nacute large territory infarct or intracranial hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Ventricles\nand sulci are mildly prominent consistent with a small amount of involutional\nchange.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nbilateral maxillary sinuses, sphenoid sinuses, and anterior ethmoid air cells.\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is a moderate-sized subgaleal hematoma overlying the left parietal\ncalvarium. There is no evidence of underlying fracture.\n\nThere is a small focus of acute subarachnoid hemorrhage within a right frontal\nsulcus (series 2, image 25). There is also a small amount of subarachnoid\noverlying the left temporal lobe (series 2, image 17, 18) and left parietal\nlobe (series 602, image 68). Finally, there appears to be a parenchymal\nhemorrhage tusion involving the left paramedian cerebellum/cerebellar peduncle\n(series 2, image 10), which measures approximately 1.8 x 1.2 cm in maximum\naxial ___.\n\nThere is no evidence of acute territorial infarctionor mass. Chronic\nappearing lacunar infarct involving the left putamen. There is prominence of\nthe ventricles and sulci suggestive of involutional changes.\n\nPeriapical lucency surrounding the left maxillary canine (series 3, image 7). \nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The patient is status post bilateral lens\nreplacements. Otherwise, the visualized portion of the orbits are\nunremarkable. Degenerative changes seen within the right temporomandibular\njoint.", + "output": "1. Please note no prior examinations are available at the time of this\ndictation.\n2. Parenchymal hemorrhage involving the left paramedian cerebellum/cerebellar\npeduncle measuring up to 1.8 cm.\n3. Scattered foci of acute subarachnoid hemorrhage overlying the right frontal\nand left temporal parietal lobes.\n4. Moderate-sized subgaleal hematoma overlying the left parietal calvarium\nwithout evidence of underlying fracture.\n5. Periapical lucency surrounding the left maxillary canine, which should be\ncorrelated with dental exam for signs of infection." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass effect. The ventricles and sulci are normal in size and\nconfiguration.\n\nThere is no evidence of fracture. There is near complete opacification of\nbilateral ethmoid sinuses and right maxillary sinus. Mucous retention cyst is\nin the left maxillary sinus. Mild mucosal thickening is noted in the frontal\nand sphenoid sinuses. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nintracranial hemorrhage or edema.\n2. Pansinus disease as described above." + }, + { + "input": "There is no evidence of acute large territory infarction, hemorrhage, edema or\nmass. There is preservation gray-white matter differentiation. Basal\ncisterns are patent. Ventricles and sulci are normal in overall size and\nconfiguration.\n\nNo fractures identified. There is complete opacification of the right\nmaxillary sinus with layering fluid densities. There is near complete\nopacification of the anterior and posterior ethmoidal air cells. Large\nleft-sided maxillary sinus mucous retention cyst is noted. An endotracheal\ntube is partially imaged. Fluid is seen within the posterior nasopharynx,\nlikely reflective patient's intubated status. The remaining imaged paranasal\nsinuses are clear, mastoid air cells and middle ear cavities are clear. \nVisualized portions of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormalities, with no evidence of acute large\nterritorial infarction or acute intracranial hemorrhage.\n2. Large left-sided maxillary sinus mucous retention cyst versus polyp.\n3. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nSome of the images have been degraded by patient motion. Within this\nlimitation:\n\nRedemonstration of the acute hemorrhage within the temporal ventricular horn,\nwith possible adjacent intraparenchymal hemorrhage in the left medial temporal\nlobe. There is associated dilatation of the temporal horn of left lateral\nventricle. Allowing for the movement artifact, there is no evidence of\ninfarction, new intracranial hemorrhage,edema,ormass. The ventricles and\nsulci are otherwise normal in size and configuration. There are nonspecific\nbilateral supratentorial white matter hypodensities, which may represent the\nsequelae of microangiopathy.\n\nThere is a mucous retention cyst in the right maxillary sinus and left ethmoid\nair cells. There is mucosal thickening in the left maxillary sinus and\nsphenoid sinus. The visualized portion of the paranasal sinuses, mastoid air\ncells,and middle ear cavities are otherwise clear. The visualized portion of\nthe orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. The dural venous\nsinuses are patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent.\nThere is mild atheromatous calcification at the bifurcations of the common\ncarotid arteries bilaterally and at the origin of the right vertebral artery. \nThere is no evidence of internal carotid stenosis by NASCET criteria. The\ncarotidandvertebral arteries and their major branches appear normal with no\nevidence of stenosis or occlusion.\n\nOTHER:\nThere are mild-to-moderate bilateral pleural effusions, with associated\natelectasis of the upper lobes bilaterally. There is interlobular septal\nthickening in keeping with a degree of pulmonary congestion. There is mild\nbilateral emphysematous change. There are multiple enlarged mediastinal lymph\nnodes up to short axis diameter of 18 mm (right paratracheal). CT chest\nshould be considered for further evaluation.\n\nThere is asymmetry of the base of tongue, which is enlarged on the right side.\nWhilst this may represent asymmetrical tongue base lymphoid tissue, this may\nalso represent a tongue base lesion and referral to ENT, a dedicated CT neck\nand direct visualization is advised, if clinically warranted. There is no\ncervical lymphadenopathy by CT size criteria. The visualized portion of the\nthyroid gland is within normal limits.", + "output": "1. Redemonstration of the acute hemorrhage within the temporal horn of left\nlateral ventricle, with possible adjacent intraparenchymal hemorrhage in the\nleft medial temporal lobe.\n2. Dilatation of the temporal horn of the left lateral ventricle.\n3. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n4. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection.\n5. Mild-to-moderate bilateral pleural effusions, with associated atelectasis\nof the upper lobes bilaterally.\n6. Multiple enlarged mediastinal lymph nodes up to short axis diameter of 18\nmm (right paratracheal). CT chest should be considered for further evaluation.\n7. Nonspecific asymmetry of the base of the toe, which is enlarged on the\nright side. While this may represent asymmetrical tongue base lymphoid tissue,\na tongue base lesion cannot be excluded. A dedicated CT neck and referral to\nENT and direct visualization is suggested if clinically warranted.\n\nRECOMMENDATION(S):\n1. CT chest for further evaluation of the bilateral pleural effusions and\nmediastinal lymphadenopathy.\n2. ENT referral, CT neck and direct visualization, for further assessment of\nthe possible right sided tongue base lesion is suggested if clinically\nwarranted." + }, + { + "input": "When compared to the CT head from ___, there is no significant\nchange. Specifically, there is redemonstration of acute hemorrhage within the\ntemporal horn of the left lateral ventricle with possible adjacent\nintraparenchymal hemorrhage in the left medial temporal lobe. There is no\nevidence of fracture, infarction,hemorrhage,edema, or mass. The ventricles and\nsulci are normal in size and configuration. Periventricular and subcortical\nwhite matter hypodensities are nonspecific but likely sequelae of chronic\nsmall vessel ischemic disease.\n\nSimilar small retention cysts within each maxillary sinus. Very similar\nmucosal thickening with the aerosolized secretions in the left moiety of a\nbipartite sphenoid sinus. Again noted are calcifications along each optic\nnerve.", + "output": "When compared to the CT head from ___, there is no significant\nchange. Specifically, there is redemonstration of acute hemorrhage within the\ntemporal horn of the left lateral ventricle with possible adjacent\nintraparenchymal hemorrhage in the left medial temporal lobe." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Basilar cisterns are\npatent.\n\nIncluded paranasal sinuses and mastoids are clear besides fluid layering\nwithin the left sphenoid sinus. Skull and extracranial soft tissues are\nunremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Gray-white\nmatter differentiation is preserved. The ventricles and sulci are normal in\nsize and configuration.\n\nThere is no evidence of acute fracture. There is persistent layering fluid in\nthe sphenoid sinus. Mucosal thickening of the bilateral ethmoid air cells are\nnoted. The visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial abnormalities.\n2. Mild sinus disease as described above." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of age-related volume loss.\n\nThere is no evidence of fracture. There is mild mucosal thickening in the\nethmoid air cells. Patient is status post apparent bilateral mastoidectomies\nwith soft tissue material seen in the bilateral middle ear cavities. The\nossicles are not visualized on either side. The visualized portion of the\norbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Status post apparent bilateral mastoidectomies." + }, + { + "input": "Images at the vertex are mildly limited by motion artifact. There is no\nevidence for acute hemorrhage, edema, mass effect, or acute major vascular\nterritorial infarction. Periventricular and deep white matter hypodensities\nare again seen, nonspecific but likely sequela of chronic small vessel\nischemic disease in this age group. Age-related parenchymal volume loss with\nprominent ventricles and sulci are also again seen.\n\nThere is no evidence of fracture. There is mild mucosal thickening in the\nleft anterior ethmoid air cells. The patient is status post bilateral canal\nwall down otomastoidectomies. There is indeterminate soft tissue density\nextending from the left external auditory canal into the left mastoidectomy\nbed, presumably debris, similar to ___.", + "output": "No evidence for acute intracranial abnormalities." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass effect. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Periventricular white-matter hypodensities are nonspecific, but may\nbe sequela of chronic ischemic small vessel disease. Few scattered punctate\ncalcifications in the bilateral frontotemporal regions there is similar to\nprior.\n\nThere is no evidence of acute fracture. Partial opacification of the right\nmastoid air cells. Otherwise, the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "No acute intracranial process." + }, + { + "input": "CTA HEAD:\n3 mm anterior communicating artery aneurysm is identified (2:271).\nOtherwise, the vessels of the circle of ___ and their principal\nintracranial branches appear normal without stenosis, occlusion, or other\naneurysm formations. The dural venous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria. Non opacification of left internal jugular vein\nat the upper cervical levels may be secondary to bolus timing.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy. Left\npectoral pacemaker is partially imaged. The patient is status post CABG,\nmultilevel degenerative changes are visualized throughout the cervical spine\nconsistent with narrowing of the intervertebral disc spaces and spondylosis,\nmore significant from C3-C4 through C5-C6 levels, diffuse osteopenic changes\nare visualized in the upper thoracic spine", + "output": "1. Small 3 mm anterior communicating artery aneurysm is identified. No\nadditional aneurysm greater than 4 mm. No thrombosis, dissection or\nflow-limiting stenosis.\n\nNOTIFICATION: The impression above was entered by Dr. ___ on\n___ at 11:46 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider." + }, + { + "input": "A small hypodensity just inferior to the left basal ganglia likely represents\na dilated perivascular space. Otherwise, there is no hemorrhage, acute large\nvascular territorial infarct, or brain edema. The basal cisterns are patent.\nThere is no shift of normally midline structures. Mild prominence of the\nventricles and sulci is compatible with age-related involutional change. \nThere is mild mucosal thickening of the bilateral maxillary sinuses, sphenoid\nsinuses, and ethmoid air cells. The mastoid air cells are clear. There is no\nfracture. There is degenerative change of the left temporomandibular joint.\nThe globes and bony orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, shift of normally\nmidline structures or acute major vascular territorial infarction. Ventricles\nand sulci are slightly prominent, suggesting mild cortical volume loss. The\nbasal cisterns appear patent and there is preservation of gray-white matter\ndifferentiation.\n\nThere is no fracture. There is small amount of mucosal thickening along the\nleft sphenoid sinus and posterior ethmoidal air cells. Otherwise, the\nremaining visualized paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There are bilateral crescentic cerebral convexity extra-axial collections. On\nthe right, the collection is isodense, measuring up to 13 mm in diameter, with\na more hyperdense components measuring up to 11 mm. The extra-axial\ncollection on the left is more hypodense in attenuation and is likely in\nchronic. The ventricles and sulci are normal in size and configuration. No\nevidence of acute infarction or edema.\n\nThere is no evidence of fracture. A mucous retention cyst is seen in the\nright maxillary sinus. Minimal mucosal thickening is seen of the left\nmaxillary sinus. Middle ear cavities and mastoid air cells are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Right convexity subacute subdural hematoma with a hyperdense acute\ncomponent. Left-sided chronic subdural hematoma versus a subdural hygroma. \nComparison with prior would be helpful to evaluate for changes." + }, + { + "input": "Again seen are bilateral crescentic cerebral convexity subdural collections,\nnot significantly changed since the recent examination. The collection on the\nright is isodense, measuring up to 14 mm with a more hyperdense component,\nmeasuring up to 11 mm. The hypodense extra-axial collection on the left\nmeasures up to 14 mm as well, and is likely chronic in nature. The ventricles\nand sulci are unremarkable. There is no evidence of acute large territorial\ninfarction or edema.\n\nThere is no evidence of fracture. Again seen is a mucous retention cyst in\nthe right maxillary sinus. Minimal mucosal thickening is seen the left\nmaxillary sinus. The middle ear cavities and mastoid air cells are clear. \nThe visualized portion of the orbits are unremarkable.", + "output": "1. Unchanged bilateral subdural collections as described above." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Basilar cisterns are\npatent.\n\nMucous retention cysts noted in the right maxillary sinus. Included paranasal\nsinuses and mastoids are otherwise clear. A 2 mm metallic density in the\nsubcutaneous tissues of the left forehead is noted. Skull and extracranial\nsoft tissues are unremarkable. Degenerative changes noted at the\ntemporomandibular joints.", + "output": "No acute intracranial process." + }, + { + "input": "There is re-demonstration of a right frontal approach VP shunt with the tip\nterminating in the third ventricle, unchanged in positioning compared to\nprior. There is no hydrocephalus with ventricles and sulci stable, normal in\nsize and configuration. Cavum septum pellucidum is incidentally noted. There\nis no evidence of infarction, hemorrhage, edema, or mass.\n\nThere is a right frontal burr hole for VP shunt entry otherwise no osseous\nabnormalities are seen. The paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The orbits are unremarkable. Degenerative changes\nnoted at the temporomandibular joints bilaterally.", + "output": "1. No acute intracranial abnormalities, specifically no hydrocephalus.\n2. Stable appearance of right frontal approach VP shunt unchanged in position\ncompared to prior." + }, + { + "input": "A right frontal approach ventriculoperitoneal shunt catheter terminates in\nunchanged position in third ventricle. Ventricular size is unchanged. There\nare no extra-axial fluid collections. There is no hemorrhage along the\ncatheter. No evidence of intracranial hemorrhage, acute infarction, mass, or\nedema.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Right VP shunt in stable position. No hydrocephalus. No acute findings." + }, + { + "input": "Right frontal approach ventriculoperitoneal shunt catheter terminates in the\nthird ventricle. The size and configuration of the ventricles are unchanged\ncompared to prior. Basal cisterns are patent.\n\nThere is no evidence of infarction, hemorrhage, edema, or mass effect. The\nsulci are normal in size and configuration.\n\nNo calvarial fracture identified. The paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The orbits are unremarkable. Degenerative\nchanges noted at the temporomandibular joints, particularly on the left.", + "output": "Right frontal approach ventriculoperitoneal shunt catheter is in unchanged\nposition. Size of ventricles are unchanged. No acute intracranial process." + }, + { + "input": "The patient is status post right trans frontal ventriculostomy catheter\nplacement with tip terminating in the third ventricle, unchanged from prior\nexamination. The size of the ventricles are stable. There is no\nventriculomegaly. Incidental note is made of a cavum septum pellucidum et\nvergae. There is no intra or extra-axial mass effect, acute hemorrhage or\nlarge territory infarct. No acute osseous abnormality. The visualized\nparanasal sinuses are clear. The orbits are unremarkable. The mastoid air\ncells middle ears are pneumatized and clear.", + "output": "1. Stable position of right trans frontal ventriculostomy catheter with tip in\nthe third ventricle.\n2. No ventriculomegaly. Stable size of the ventricles.\n3. No acute intracranial abnormality on noncontrast head CT." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nRight frontal VP shunt in place, tip in the third ventricle, ventricular\nsystem is decompressed, no hydrocephalus. No acute hemorrhage, mass or\ninfarct. Orbits, osseous structures, paranasal sinuses, mastoids are normal.\n\nCTA HEAD:\nSuboptimal contrast bolus moderately compromises exam.\nThe vessels of the circle of ___ and their principal intracranial branches\nappear patent without occlusion. No large aneurysm.. No evidence of abnormal\nvascularity or enlarged vessels to suggest AV fistula. No early filling of\nthe dural venous sinuses to suggest dural AV fistula. No proptosis, normal\nsuperior ophthalmic veins, no asymmetry of the cavernous sinuses.\n\nCTV head:\nPatent dural venous sinuses. No evidence of dural venous sinus thrombosis.", + "output": "1. Technically compromised CTA head.\n2. No evidence of arterial occlusion, aneurysm or vascular malformation.\n3. Patent dural venous sinuses.\n4. VP shunt in place, no hydrocephalus." + }, + { + "input": "Right frontal VP shunt terminates in the third ventricle, unchanged in\nposition as compared to CTA head ___. The ventricles are not\ndilated and grossly unchanged in appearance as compared to ___. \nThere is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction.\n\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. There is no acute fracture. The", + "output": "No acute intracranial abnormality. Specifically, no evidence of hydrocephalus\nand the right frontal approach VP shunt terminates in the third ventricle,\nunchanged in position as compared to CT head ___." + }, + { + "input": "Right frontal VP shunt terminates in the third ventricle, unchanged in\nposition as compared to CT head ___. The ventricles are not\ndilated and are grossly unchanged in appearance as compared to ___.\n\nThere is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. The imaged paranasal sinuses are clear. Mastoid air cells and\nmiddle ear cavities are well aerated. There is no acute fracture.", + "output": "1. No acute intracranial abnormality. Please note that MRI is more sensitive\nfor detection of infarction.\n2. No evidence of hydrocephalus and right frontal approach VP shunt terminates\nin the third ventricle, unchanged from CT head ___." + }, + { + "input": "Patient is status post right frontal approach ventriculoperitoneal shunt\nplacement. The radiopaque portions of the shunt appear intact. The tip of\nthe shunt terminates in the region of the foramen of ___, unchanged. There\nis no ventriculomegaly and ventricular caliber appears similar to multiple\nprior studies. There is no loss of gray-white differentiation to suggest\ninfarction. There is no acute intracranial hemorrhage.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Stable examination without evidence of ventriculomegaly or increasing\nventricular caliber. Unchanged position of the right frontal approach\nventriculoperitoneal shunt." + }, + { + "input": "There is no evidence of large territorial infarction,acute intracranial\nhemorrhage, edema, or mass. Anatomical variation of the ventricular system is\nnoted, consistent with septum cavum pellucidum et vergae, there is no evidence\nof hydrocephalus. Incidental note is made of cavum septum pellucidum and\ncavum vergae.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "There is no evidence of acute intracranial process or hemorrhage." + }, + { + "input": "The patient is status post right frontal approach ventriculostomy, with the\ncatheter terminating in the area of the foramen of ___. There is no\nevidence of acute large territorial infarction, hemorrhage, edema, or mass\neffect. The ventricles are grossly unchanged in size and appearance compared\nto the prior study.\n\nThere is no evidence of acute osseous abnormality. Some extra-calvarial soft\ntissue edema is noted along the course of VP shunt. The visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nThe visualized portion of the orbits are unremarkable.", + "output": "1. Status post right frontal approach ventriculostomy, with the catheter\nterminating in the area of the foramen of ___.\n2. No acute intracranial abnormality.\n3. Grossly stable ventricles compared and ___ prior exam." + }, + { + "input": "VP shunt in place via right frontal burr hole, tip is in the third ventricle,\nsimilar to prior. There is no hydrocephalus. Ventricular size is stable\ncompared to prior. There are no new extra-axial fluid collections. There is\nno evidence of infarction, hemorrhage, edema, or mass.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. There is degenerative arthritis of\nbilateral temporomandibular joints.", + "output": "Stable ventricular size since prior.\nThere is no hemorrhage, or fluid collections" + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass. The ventricles and sulci are normal in size and configuration. There is\npreservation of gray-white matter differentiation. The basal cisterns remain\npatent.\n\nNo acute fracture is seen. Multiple surgical staples overlie the calvarial\nvertex. Mild mucosal thickening is noted within the left maxillary sinus and\nbilateral ethmoid air cells. The remainder of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process. Skin staples at the calvarial vertex." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are are slightly prominent for the patient's age, suggesting mild\ncortical volume loss, however, this finding is nonspecific. The\nperimesencephalic cisterns are patent. No shift of normally midline\nstructures. Gray-white matter differentiation is preserved. There extensive\ndural calcifications.\n\nThere is no evidence of fracture in the calvarium or partially imaged orbits\non this nondedicated exam. There is moderate mucosal thickening of the right\nfrontal sinus, near complete opacification of the anterior of right ethmoidal\nair cells and partial opacification of the posterior right ethmoidal air\ncells. There is minimal partial opacification of the left ethmoidal air\ncells. The incompletely visualized right maxillary sinus appears opacified. \nThe incompletely visualized left maxillary sinus appears grossly clear. The\nleft frontal sinus is clear. The sphenoid sinuses are clear. The mastoid air\ncells and middle ear cavities are clear. The visualized portion of the orbits\nare unremarkable.", + "output": "1. No intracranial hemorrhage.\n2. No definite evidence of a fracture.\n3. Right paranasal sinus opacification. Correlate with focal exam findings,\nand if concerned of the facial bones fracture, a dedicated facial bone CT\ncould be performed." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Age advanced involutional changes again noted. Mild mucosal\nthickening within the ethmoid air cells and right maxillary sinus. Mastoid\nair cells and middle ear cavities are well aerated. The bony calvarium is\nintact.", + "output": "No acute intracranial process. Mild atrophy. Mild sinus disease." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is mild\ngeneralized brain parenchymal atrophy, stable since prior. There is no\nhydrocephalus. The basilar cisterns appear patent.\n\nNo osseous abnormalities seen. There is mild mucosal thickening of the\nparanasal sinuses. Mastoid air cells, and middle ear cavities are clear. The\norbits are unremarkable.", + "output": "1. There are no acute intracranial changes. There are no fractures.\n2. There is mild mucosal thickening of the paranasal sinuses." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No acute intracranial findings.." + }, + { + "input": "Limited study due to motion artifact. There is no evidence of fracture,\ninfarction,hemorrhage,edema, or mass. The ventricles and sulci are normal in\nsize and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "Study is limited due to motion artifact. Within these limitations, no\nevidence of mass, hemorrhage or infarction." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are normal.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. The left posterior\ncommunicating artery is hypoplastic, likely an anatomic variant The dural\nvenous sinuses are patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Normal head CT.\n2. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n3. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection." + }, + { + "input": "There is no evidence of fracture, acute large territory infarction,\nintracranialhemorrhage,edema,or discrete mass. The ventricles and sulci are\nnormal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "No evidence of acute intracranial abnormality. No intracranial hemorrhage\nidentified. If there is continued clinical concern for small microbleeds, can\nconsider MRI for further evaluation." + }, + { + "input": "There is no evidence of fracture, large territorial\ninfarction,hemorrhage,edema,or mass effect. There is prominence of the\nventricles and sulci suggestive of involutional changes. Mild periventricular\nand subcortical white matter hypodensities are nonspecific, but most likely\nsequela of chronic small vessel change.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute major infarction,hemorrhage,edema,or definite\nmass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Study is mildly limited by artifact. No acute intracranial abnormality." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nEncephalomalacia in the right temporal and parietal lobes in keeping with\nprior MCA infarct. There is streak artifact related to prior clipping of\nbasilar tip aneurysm.\n\nNo acute intracranial hemorrhage, infarct, mass or midline shift is seen.\n\nThere is prominence of ventricles and sulci in keeping with age-related\ninvolutional changes. Scattered hypodensities in the subcortical and\nperiventricular white matter, nonspecific, likely secondary to small vessel\nischemic disease.\n\nThe orbits are unremarkable. The visualized paranasal sinuses and mastoid air\ncells are clear. Prior right temporoparietal craniotomy for aneurysm clipping\nis again seen. Otherwise, the osseous structures appear unremarkable.\n\nCTA HEAD:\nThere is mild atherosclerosis involving bilateral cavernous and supraclinoid\nICAs without high-grade stenosis. Also seen is an aneurysm clip in place for a\npreviously known basilar tip aneurysm. No definite aneurysm is seen on\ntoday's study. The left posterior cerebral artery appears unremarkable. The\nright posterior cerebral and posterior communicating artery are not well\nvisualized given the streak artifact from the aneurysm clip. The remaining\nvessels of the circle of ___ appear unremarkable.\n\nThe dural venous sinuses are patent.", + "output": "1. No acute intracranial abnormality.\n2. Mild intracranial atherosclerosis.\n3. Stable aneurysm clip for basilar tip aneurysm. Associated streak artifact\nlimits the evaluation of right PCA and P com as well as the basilar tip. The\nremaining vessels of circle of ___ appear unremarkable." + }, + { + "input": "An area of hypodensity along the superior left cerebellum appears too\nprominent to be explained by a large sulcus alone and may reflect a small\nchronic infarct (___). Smaller hypodense foci in the right cerebellum\n(2:7) and left occipital lobe (02:16) are compatible for prior infarcts,\nsubacute to chronic. A hypodense focus in the anterior limb of the left\ninternal capsule likely corresponds to a prior lacunar infarct (02:12). There\nis no evidence of hemorrhage, edema, or mass. There is prominence of the\nventricles and sulci suggestive of involutional changes. Extensive\nperiventricular and subcortical white matter hypodensities are nonspecific but\nlikely sequelae of chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. Complete opacification of visualized right\nmaxillary sinus. The visualized portion of the remaining paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. Multiple small hypodense foci are concerning for subacute to chronic\ninfarcts, most concerningly in the right cerebellum and left occipital lobe. \nA superior left cerebellar hypodensity is compatible with a chronic infarct. \nGiven the patient's worsening symptoms, MRI could be considered for further\nevaluation.\n2. Ventricular prominence is out of proportion to the overall global atrophy.\n3. Extensive probable chronic small vessel ischemic changes.\n4. Right maxillary sinus disease.\n\nRECOMMENDATION(S): Multiple small hypodense foci are concerning for subacute\nto chronic infarcts, most concerningly in the superior left cerebellum, but\nalso within the right cerebellum and left occipital lobe. Given the patient's\nworsening symptoms, MRI could be considered for further evaluation.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 1:35 AM, less than 5 minutes\nafter discovery of the findings." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nCTA HEAD:\nThere is a left dominant vertebrobasilar system. There is mild narrowing of\nthe bilateral cavernous and supra clinoid internal carotid arteries secondary\nto atherosclerotic calcification. The vessels of the circle of ___ and\ntheir principal intracranial branches otherwise appear patent without\nsignificant stenosis, occlusion, or aneurysm formation. The dural venous\nsinuses are patent.\n\nCTA NECK:\nThere is mild to moderate atherosclerotic calcification along the aortic arch.\nThere is mild atherosclerotic calcification of the origin of the left\nsubclavian artery. There is moderate narrowing at the origin of the left\nvertebral artery secondary to atherosclerotic disease. There is mild\natherosclerotic calcification within the V2 segment of the left vertebral\nartery without significant stenosis. There are mild atherosclerotic\ncalcifications at the carotid bifurcations bilaterally, without significant\ninternal carotid artery stenosis by NASCET criteria. The carotid and\nvertebral arteries and their major branches otherwise appear patent with no\nevidence of significant stenosis or occlusion. There is no evidence of\ninternal carotid stenosis by NASCET criteria.\n\nOTHER:\nThere is mild dependent atelectasis.\n\n7 and 10 mm hypodense right lobe thyroid nodules are noted (2: 70, 78).\n\nThere is a single enlarged right peritracheal mediastinal lymph node measuring\n15 x 11 mm (02:23). Scattered additional mildly prominent cervical lymph\nnodes in the mediastinum and in bilateral cervical chains are not enlarged by\nCT size criteria.\n\nThere is moderate cervical spondylosis with 2 mm anterolisthesis of C3 on C4,\nlikely degenerative.\n\nThere is significant periapical lucencies surrounding ___ tooth 4 with\nanterior cortical disruption, extending to the inferior portion of the right\nmaxillary sinus which is completely opacified. The remainder of the visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear.\n\nLeft greater wing of sphenoid lesion measuring approximately 4 mm lucent\nlesion without definite enhancement, T1 and T2 isointense to minimally\nhyperintense, with well-defined sclerotic margins, no associated soft tissue\ndensity or cortical break through, suggestive of hemangioma (see 2:232 on\ncurrent study, 03:11 on prior noncontrast head CT, and 8:7 and 09:9 on recent\nnoncontrast brain MRI).\n\n Soft tissue densities are noted within bilateral external auditory canals\nwhich may represent cerumen.", + "output": "1. Dental amalgam streak artifact limits study.\n2. Mild narrowing of the bilateral cavernous and supra clinoid internal\ncarotid arteries secondary to atherosclerotic calcification. Otherwise patent\nintracranial vasculature without significant stenosis, occlusion or aneurysm\ngreater than 3 mm.\n3. Moderate narrowing of the origin of the left vertebral artery. Otherwise\npatent cervical vasculature without significant stenosis, occlusion or\ndissection.\n4. Solitary enlarged 15 x 11 mm mediastinal lymph node, of unclear\nsignificance.\n5. Prominent periapical lucency ___ tooth 4 compatible with periodontal\ndisease.\n6. Right maxillary sinus disease.\n7. 7 and 10 mm right thyroid lobe nodules. The ___ College of Radiology\nguidelines suggest that in the absence of risk factors for thyroid cancer, no\nfurther evaluation is recommended." + }, + { + "input": "Compared to multiple same day studies including CT and MRI examinations, no\nsignificant changes are noted. Specifically, there are chronic infarcts in\nthe anterior limb of the left internal capsule, left occipital lobe, and both\ncerebellar hemispheres. There is no evidence of new large territorial\ninfarction. There is no evidence of hemorrhage, edema, or mass. Again seen\nis dilatation of the ventricles out of proportion to the degree of sulcal\nwidening. Marked periventricular and subcortical white matter hypodensities\nare nonspecific but likely the sequelae of chronic small vessel ischemic\ndisease.\n\nThere is no evidence of fracture. Complete opacification of the right\nmaxillary sinus is again seen with sclerosis of the surrounding walls\nsuggestive of chronic inflammation. The visualized portion of the remaining\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality. Specifically, no changes compared to\nmultiple studies performed earlier on the same day.\n2. Chronic infarcts involving the anterior limb of the left internal capsule,\nleft occipital lobe, and bilateral cerebellar hemispheres.\n3. Ventricular prominence is out of proportion to the degree of sulcal atrophy\nwhich raises the possibility of normal pressure hydrocephalus. Clinical\ncorrelation is recommended.\n4. Extensive probable chronic small vessel ischemic changes.\n5. Chronic right maxillary sinus disease." + }, + { + "input": "The study is moderately motion degraded at the skullbase. Within this\nlimitation:\n\nA focus of hyperdensity of the left posteroinferior cerebellar lobe (2:6) may\nbe artifactual, and also appears on the contralateral side, compatible with\nchoroid plexus calcifications extending through the foramina of Luschka. \nOtherwise, there is no definite evidence of acute infarction,hemorrhage,edema,\nor mass effect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular white-matter hypodensities are\nnonspecific, likely sequela of chronic ischemic small vessel disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Within the confines of a motion degraded study:\n\n\n1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nlarge territory infarct or intracranial hemorrhage.\n2. Hyperdense foci adjacent to the brainstem in the posterior fossa are most\ncompatible with choroid plexus calcifications.\n3. No evidence of acute displaced calvarial fracture. Additional findings\ndescribed above." + }, + { + "input": "The blood pool is slightly hyperdense compatible with interval\ncontrast-enhanced CT scan. Hyperdensities within the posterior cranial fossa\nadjacent to the brainstem (2: 6, 7) are consistent with choroid plexus\ncalcifications extending through the foramina of Luschka. There is no\nevidence of large territory infarction,hemorrhage,edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nPeriventricular and deep white matter hypodensities are nonspecific but likely\nrepresents sequela of chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of acute large territory infarction or intracranial hemorrhage.\n2. Previously noted hyperdensities within the posterior cranial fossa are\nconsistent with choroid plexus calcifications." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage, edema,or mass. Subtle\nhypodensity in the right basal ganglia is suggestive of prior/chronic lacunar\ninfarct. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere are a few skin staples overlying the occiput, slightly left of midline. \nThere are a few foci of subjacent subcutaneous emphysema noted. There is no\nevidence of subjacent fracture, nor acute fracture elsewhere. Mild changes of\nhyperostosis frontalis interna are noted. The visualized paranasal sinuses,\nmastoid air cells, and middle ear cavities are well pneumatized and clear. \nAside from bilateral lens removal, the globes visualized portions of the bony\norbits are intact and unremarkable. Carotid siphon calcifications are noted\nbilaterally.", + "output": "1. No acute intracranial process. No hemorrhage.\n2. Staples overlie the left occiput, slightly off midline, with a few foci of\nsubjacent subcutaneous emphysema. Correlate with physical exam findings and\nany recent intervention. No underlying fracture, or evidence of fracture\nelsewhere.\n3. Chronic findings include age-appropriate global involutional change,\nprobable right basal ganglia chronic lacunar infarct, and vascular\ncalcifications." + }, + { + "input": "CT HEAD:\nThere is no evidence for acute hemorrhage, vascular territorial infarction,\nmass effect, or edema. The ventricles and sulci are prominent, compatible with\nage related atrophic changes. A 3-4 mm extra-axial hyperdensity along the\ninferior right posterior fossa, demonstrates possible trace enhancement on CTA\nportion of the examination (series 3, image 198), potentially representing\neither meningioma or calcification\n\nA focal hypodensity in the right basal ganglia likely reflects a chronic\nlacunar infarction. Periventricular and subcortical white matter\nhypodensities are noted, likely the sequelae of chronic small vessel ischemic\ndisease. The basal cisterns remain patent.\n\n The paranasal sinuses, middle ear cavities, and mastoid air cells are clear.\nThe patient is status post bilateral lens resections.. Mild bifrontal\nhyperostosis frontalis interna is noted. Skin closure staples associated with\na small left occipital scalp laceration and subcutaneous emphysema is noted.\n\n\nCTA HEAD AND NECK:\nThe ascending thoracic aorta is mildly dilated measuring up to 4.3 cm. There\nis a 2 vessel aortic arch, with a common origin of the right subclavian and\nbilateral common carotid arteries.\n\nMild calcifications are seen at the left carotid bulb. The common carotid and\nvertebral arteries and their major branches appear patent without high-grade\nstenosis or occlusion. There is no evidence of internal carotid stenosis by\nNASCET criteria.\n\nThere are mild calcifications in the bilateral cavernous internal carotid\narteries. Mild-to-moderate narrowing of the mid basilar artery is present\n(3:218). There is a fetal origin to the left posterior cerebral artery. \nOtherwise, the vessels of the circle of ___ and their principal\nintracranial branches are patent without high-grade stenosis, occlusion, or\naneurysm formation. The dural venous sinuses are patent.\n\n\nOTHER:\nThe lungs apices are clear bilaterally. The thyroid gland is heterogeneous\nincomplete chains multiple nodules, measure up to 1.1 cm on the right. There\nis no cervical lymphadenopathy by CT size criteria.", + "output": "1. No evidence for acute intracranial hemorrhage or vascular territorial\ninfarction.\n2. Chronic findings of global parenchymal volume loss and evidence of\nsmall-vessel ischemic disease.\n3. Mild-to-moderate mild irregular narrowing of the mid basilar artery. \nOtherwise, patent intracranial and cervical vasculature without high-grade\nstenosis, occlusion, or dissection.\n4. Mild dilation of the ascending thoracic aorta measuring up to 4.3 cm.\n5. Heterogeneous thyroid gland containing multiple nodules measuring up to 1.1\ncm.\n6. 2-3 mm extra-axial hyperdensity demonstrating possible postcontrast\nenhancement in the right posterior fossa. This could represent calcification\nversus a very small meningioma.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "There is no evidence of infarction,hemorrhage,edema,or mass. Periventricular\nand sub course white matter hypodensities are unchanged and nonspecific,\nhowever likely represent chronic small vessel ischemic disease. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. Mild polypoid thickening in the right\nmaxillary sinus. Patient has an nasogastric tube. The mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nPlease note, evaluation is limited due to patient motion artifact. Within the\nconfines of the study, there is no evidence of intracranial hemorrhage or\nacute territorial infarction. There is prominence of the ventricles and\nsulci, likely related to age-appropriate diffuse parenchymal loss. There are\nnonspecific periventricular and subcortical white matter hypodensity, likely a\nsequela of mild chronic small vessel ischemic disease. There is mild mucosal\nthickening of the bilateral maxillary sinuses. The bilateral mastoid air\ncells appear clear. Postoperative change right orbit, scleral band in place.\n\nCT PERFUSION:\nThere is no evidence of asymmetric abnormal perfusion to suggest acute\nterritorial infarction.\n\nCTA HEAD:\nThe bilateral anterior cerebral arteries and middle cerebral arteries appear\npatent. There is fetal origin of the left posterior cerebral artery. Right\nP1 segment is small in caliber, patent large caliber right PCOM contributing\nto the right PCA. The bilateral posterior cerebral arteries appear patent. \nThe basilar artery in the bilateral vertebral arteries appear patent. There\nare mild calcifications of the cavernous and clinoid segments of the bilateral\ninternal carotid arteries. The dural venous sinuses appear patent.\n\nCTA NECK:\nThe bilateral vertebral arteries appear patent. Motion artifact degrades\nevaluation of the origin of the left vertebral artery. There is\natherosclerotic disease at the bilateral carotid bifurcation and proximal\ninternal carotid artery resulting in no significant internal carotid artery\nstenosis by NASCET criteria. Mild irregularity of the proximal right common\ncarotid artery is related to patient motion. There is no evidence of\ndissection. There is a 3 vessel aortic arch.\n\nOTHER:\nThere is a dilated main pulmonary artery measuring 3.9 cm. There is a\nnecrotic 2.3 x 1.5 x 1.9 cm left supraclavicular lymphadenopathy (6: 85). The\nthyroid gland appears unremarkable. There is biapical scarring with dependent\natelectasis and areas of interlobular septal thickening, which may be related\nto pulmonary congestion. There are degenerative changes at the C1-C2\narticulation with posterior endplate osteophyte and C5-C6 causing mild spinal\ncanal stenosis. Suggestion of 1.7 cm nodule overlying C7 spinous process,\nworrisome for metastasis series 2, image 120.", + "output": "1. No evidence of intracranial hemorrhage or acute territorial infarction.\n2. No CT perfusion abnormality.\n3. Patency of the major intracranial vasculature without stenosis, occlusion,\nor aneurysm.\n4. Atherosclerotic disease at the bilateral carotid bifurcations without\ninternal carotid artery stenosis by NASCET criteria. Patent bilateral\nvertebral arteries.\n5. Dilated main pulmonary artery, which may be related to pulmonary\nhypertension.\n6. Nonspecific necrotic left supraclavicular lymphadenopathy. Suggestion 1.7\ncm nodule superficial to the C7 spinous process. Findings consistent with\nmetastases given known history of malignancy." + }, + { + "input": "Dental amalgam streak artifact limits study. There is no evidence of\ninfarction, hemorrhage, edema, or mass. There is mild prominence of the\nventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Soft tissue densities are noted within\nbilateral external auditory canals which may represent cerumen.", + "output": "1. Dental amalgam streak artifact limits study.\n2. No acute intracranial process.\n3. No evidence of acute intracranial hemorrhage or fracture.\n4. Mild nonspecific global volume loss." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute infarction,hemorrhage,edema,ormass. Prominence\nof the ventricles and sulci suggestive of involutional changes. \nPeriventricular and subcortical white matter hypodensity is nonspecific, but\nlikely reflect sequelae of chronic small vessel ischemic disease. Punctate\ncalcification in the right cerebellar hemisphere is noted, possibly related to\na remote infarct.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. Incidental\nnote is made of fetal posterior cerebral arteries, and resultant diminutive\nbasilar artery. The dural venous sinuses are patent.\n\nThe intracranial portions of the internal carotid arteries demonstrate dense\natherosclerotic calcification.\n\nCTA NECK:\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThere is a 3 mm left apical nodule. Mild bronchial wall thickening is noted\nin both apical airways, probably related to chronic small airways\ninflammation. The visualized portion of the thyroid gland is within normal\nlimits. There is no lymphadenopathy by CT size criteria. Incidental note is\nmade of calcified anterior mediastinal lymph nodes.", + "output": "1. Unremarkable head and neck CTA.\n2. 3 mm left apical pulmonary nodule. No CT follow-up is recommended in a low\nrisk patient, however an optional CT could be obtained in 12 months in a high\nrisk patient.\n\nRECOMMENDATION(S): For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute intracranial hemorrhage, mass, mass effect or\nlarge territorial infarction. Ventricles and sulci are normal in size and\nconfiguration. There are periventricular and subcortical lucencies, which may\nrepresent small vessel ischemic changes.\n\nNo acute fractures are identified. The visualized paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The globes are unremarkable.\n\nCTA HEAD:\nThere is an abrupt cut off of the origin of the M2 segment of the left MCA\nwith asymmetrically decreased oligemia in the left temporal lobe and left\nfrontal lobe. The remainder of the circle of ___ is unremarkable without\nevidence of stenosis or aneurysm formation. The left vertebral artery is\ndominant. The dural venous sinuses are patent. Note is made of a fetal\norigin of the right PCA.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nVisualized portion lungs demonstrate scarring at apices and mild emphysema. \nThe visualized portion of the thyroid gland is within normal limits. There is\nno lymphadenopathy by CT size criteria. Anterolisthesis of C3 on C4, is\nlikely degenerative in etiology. Posterior osteophytes are seen at C5/C6.", + "output": "1. Dental amalgam streak artifact limits study.\n2. Abrupt cut off at the origin of the M2 segment of the left MCA with\nrelative oligemia left temporal lobe and left frontal lobe.\n3. Patent neck vessels without evidence of stenosis by NASCET criteria.\n4. No evidence of acute intracranial hemorrhage.\n5. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct.\n6. Extensive multilevel degenerative changes of the cervical spine are noted,\nincluding C3 on C4 anterolisthesis. Please note MRI of cervical spine is more\nsensitive for the evaluation of ligamentous injury." + }, + { + "input": "There is no evidence of hemorrhage. There is a hypodensity in loss of gray\nwhite matter differentiation extending from the insular cortex to the anterior\nparietal lobe posteriorly in the posterior frontal lobe anteriorly compatible\nwith evolving left MCA territory stroke. The ventricles and sulci are normal\nin size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of hemorrhage.\n2. Evolving left MCA territory stroke with hypodensity extending from the\nposterior frontal lobe to the anterior parietal lobe." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are prominent, consistent with involutional changes.\n\nNo acute osseous abnormalities seen. The paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. Cerumen is noted in the right external\nauditory canal. Dysconjugate gaze is noted. The orbits are otherwise\nunremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "Motion and overlying hardware artifact limits examination.\n Re-identified is a small subacute to chronic left frontal subdural hematoma\nwhich is unchanged in size in comparison to the most recent prior exam. Also\nre- demonstrated is the acute intraventricular hemorrhage extending from the\nbody of the left lateral ventricle into the third ventricle as well as into\nthe left greater than right occipital horns and into the temporal horn of the\nleft lateral ventricle. The ventricles are grossly unchanged in caliber. \nThere is no evidence of new focus of acute hemorrhage elsewhere, or\nsuperimposed acute large vascular territorial infarction. Anterior left\ntemporal lobe with encephalomalacia is unchanged. The basal cisterns remain\npatent. Approximately 5 mm rightward shift of midline structures is not\nappreciably changed. The cerebellar tonsils are normally positioned. Mild\ngeneral prominence of the ventricles and sulci is consistent with\nage-appropriate global involutional change.\n\nAlso redemonstrated are left frontal craniotomy changes. The previously\ndemonstrated left tibial hematoma is smaller, minimal on the current exam (4,\n27). The visualized paranasal sinuses and mastoid air cells are clear. The\nglobes, aside from bilateral lens removal, are intact and unremarkable. \nNasopharyngeal secretions likely relate to an in situ enteric tube, partially\nvisualized.", + "output": "1. Motion and overlying hardware artifact limits examination.\n2. Grossly stable acute intraventricular hemorrhage and subacute to chronic\nsmall left frontal subdural hematoma.\n3. Mass-effect is unchanged including 5 mm rightward shift of midline\nstructures, and grossly stable ventricles.\n4. Interval decrease of left frontal scalp subgaleal hematoma, now minimal.\n5. Left anterior temporal lobe encephalomalacia." + }, + { + "input": "Overlying hardware artifact limits examination.\n\nThere is stable appearance of the known acute intraventricular hemorrhage\nextending from the body of the left lateral ventricle into the occipital horns\nof the lateral ventricles, left greater than right.\n\nThe previously demonstrated small subacute to chronic appearing left frontal\nsubdural hematoma is also unchanged compared to the earlier same-day exam.\n\nThe previously demonstrated anterior left temporal lobe encephalomalacia is\nstable. There is no evidence of acute major vascular territory infarction. \nMinimal midline shift is unchanged. There is persistence of prominent\nventricles, concerning for early developing obstructive hydrocephalus. \nProminence of the sulci are unchanged. The basilar cisterns remain patent.\n\nRedemonstrated are left frontal craniotomy changes. The visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nCalcifications are noted in the bilateral carotid siphons. Patient is status\npost lens resections. Oral tubes x2 are noted in the oropharynx.", + "output": "1. Overlying hardware artifact limits examination.\n2. Grossly stable intraventricular hemorrhage.\n3. Grossly stable ventriculomegaly.\n4. Grossly stable subacute to chronic left subdural hematoma.\n5. Within limits of study, no definite new intracranial hemorrhage." + }, + { + "input": "Study is moderately limited by streak artifact from hardware.\n\nRe- demonstrated intraventricular hemorrhage appears unchanged in appearance\nextending from the body of the left lateral ventricle into the occipital horns\nbilaterally, left greater than right. Suggestion of subarachnoid hemorrhage\nalong the posterior aspect of the left sylvian fissure (series 3, image 22) is\nunchanged from most recent prior examination, presumably redistribution. No\nevidence of new hemorrhage. Previously demonstrated small subacute to chronic\nappearing left frontal subdural hematoma is also unchanged in appearance\ncompared to the prior study, measuring approximately 9 mm in axial thickness.\n\nAnterior left temporal lobe encephalomalacia is unchanged. No evidence acute\nmajor vascular territory infarction. 5 mm midline shift towards the right is\nalso unchanged. Persistent prominence of the ventricles is not significantly\nchanged compared to the prior study. The imaged paranasal sinuses are clear.\nMastoid air cells and middle ear cavities are well aerated.\nLeft frontal craniotomy changes are again noted.", + "output": "1. Intraventricular hemorrhage appears unchanged in appearance compared to the\nprior study. No evidence of new focus of hemorrhage.\n2. Mild prominence of the ventricles is unchanged compared to the prior study.\n3. Minimal midline shift is unchanged." + }, + { + "input": "There has been interval evolution of the intraventricular hemorrhage extending\nfrom the body of the left lateral ventricle to the occipital horns\nbilaterally. There has been interval evolution of the subarachnoid hemorrhage\nalong the posterior aspect of the left sylvian fissure (03:17). There is no\nevidence of new hemorrhage. Unchanged appearance of previously demonstrated\nsmall subacute to chronic left frontal subdural hematoma. There is persistent\ndilation of the ventricles, notably at the temporal horns, not significantly\nchanged from the prior study.\n\nLeft frontal craniotomy changes are again noted. A 4 mm midline shift towards\nthe right is slightly improved from the prior study. The visualized portion\nof the paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. Interval evolution of intraventricular hemorrhage. No new hemorrhage\ndetected.\n2. Persistent dilation of the ventricles, notably in the temporal horns, not\nsignificantly changed from the prior study.\n3. Small improvement in minimal rightward midline shift." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is hyperdense intraventricular hemorrhage within the lateral ventricles,\nleft greater than right and extending into the temporal horns, in addition to\nthe third ventricle. There is a hyperdense left frontal subdural hematoma,\nmeasuring 0.8 cm from the inner calvarium exerting mass effect on the left\nfrontal lobe. There is 5 mm rightward midline shift, with questionable mild\nenlargement of the ventricles, which may be commensurate with diffuse\nparenchymal volume loss. Anterior left temporal lobe encephalomalacia is\npresent. Patient is status post left frontal craniotomy. There is a small\nleft frontal subgaleal hematoma (03:27). There is partial bilateral sphenoid\nopacification with fluid in the nasopharynx, likely iatrogenic from\nendotracheal tube and enteric tube placement.\n\nCTA HEAD:\nThere are vascular calcifications of the cavernous and clinoid segments of\nbilateral internal carotid arteries with mild bilateral luminal narrowing. \nThere is fetal continuation of the right posterior cerebral artery. \nOtherwise, the principal intracranial vasculature including the circle of\n___ appear patent without stenosis, occlusion, or aneurysm formation. \nThere is a right dominant vertebral artery.\n\nCTA neck:\nThere is calcified and noncalcified plaque of the bilateral distal common\ncarotid arteries and proximal internal carotid arteries, with greater than 75%\nluminal narrowing of the left proximal internal carotid artery and\napproximately 35% narrowing of the proximal right internal carotid artery by\nNASCET criteria. There is moderate aortic arch vascular calcifications with\ndense calcifications at the origin of the left subclavian artery with\nadditional vascular calcifications at the origin of the great vessels. There\nis a right dominant vertebral artery with a hypoplastic left vertebral artery.\n\nOther:\nEndotracheal tube and enteric tube are visualized. The thyroid gland appears\nunremarkable. The left submandibular gland is not well-visualized. There is\nno lymphadenopathy per size criteria. There is biapical pleuroparenchymal\nscarring of the visualized lung apices. There are multilevel degenerative\nchanges of the cervical spine and visualized left glenohumeral joint with\nmultiple loose bodies identified.", + "output": "1. Intraventricular hemorrhage and left frontal subdural hematoma, as above,\nwith 5 mm rightward midline shift.\n2. Left anterior temporal lobe encephalomalacia.\n3. Left frontal sub gluteal hematoma.\n4. Vascular calcifications of the internal carotid arteries. Otherwise, no\nstenosis, occlusion, or aneurysm formation of the intracranial vessels.\n5. Calcified and noncalcified plaque of the bilateral distal common and\nproximal internal carotid arteries, with approximate 75% left internal carotid\nartery stenosis and 35% right internal carotid artery stenosis.\n6. Dense calcifications of the proximal left subclavian artery with\nnonvisualized luminal opacification proximally and is present distally." + }, + { + "input": "Trace intraventricular hemorrhage layers in the posterior horn of the\nbilateral lateral ventricles, unchanged in comparison with ___. There\nis no new or increasing hemorrhage. No evidence of an acute large territorial\ninfarct or mass effect. The sulci, ventricles and cisterns are prominent, but\nwithin expected limits for the degree of moderate to severe cerebral volume\nloss. There is prominence of the temporal horns mesial temporal volume loss\ncompatible with given clinical history of Alzheimer's disease. \nPeriventricular and subcortical white matter hypodensities are nonspecific but\nlikely reflect sequelae of chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No change to the trace bilateral intraventricular hemorrhage layering in\nthe posterior horns of the lateral ventricles. No new or increasing\nhemorrhage." + }, + { + "input": "Head CT: No evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are prominent, compatible with mild age-related involutional\nchanges. Periventricular white matter hypodensities are compatible with\nmoderate chronic small vessel ischemic changes. Overall, little changed from\nthe prior outside hospital head CT dated ___. Fluid is noted\nwithin the right maxillary sinus. No fractures.\n\nHead CTA: There are no intracranial vascular abnormalities. There is no\nevidence of aneurysm, stenosis, or occlusion.\n\nNeck CTA: Multiple rim enhancing fluid collections are seen within the\nposterior soft tissues of left neck. The largest of which is deep to the left\ntrapezius muscle, measuring 1.2 x 2.0 cm in transverse ___ and 3.6 cm\ncraniocaudal ___ extending from C2-C5 (03:172). An additional smaller\nleft paraspinal rim enhancing fluid collection is seen extending from C4-C7\n(3:144). Within the spinal canal at the level of C5-C6, there is a 1.0 x 0.8\ncm area that may represent a posterior intervertebral disc bulge due to the 7\nmm of anterolisthesis at this level, or may be an additional fluid collection\nwithin the spinal canal. There is likely at least moderate spinal canal\nstenosis at this level. MRI is recommended to further evaluate these\ncollections and exclude an epidural abscess. The left lamina of C5 is\ndiscontinuous but relatively well corticated, suggestive of prior trauma or\ndegenerative change rather than acute fracture. Patient is status post fusion\nof C3-C5 with an interbody spacer at C3-C4. Moderate anterolisthesis is seen\nabove and below the fusion levels with severe multilevel facet arthropathy. \nThe carotid and vertebral arteries and their major branches are patent with no\nevidence of stenoses. There is no evidence of internal carotid stenosis by\nNASCET criteria. Emphysema is noted in the partially visualized lung apices.", + "output": "1. Multiple rim enhancing fluid collections within the posterior neck,\nadditional fluid collection within the spinal canal as described concerning\nfor abscess these. MRI is recommended to further evaluate these collections\nand exclude an epidural abscess.\n2. No evidence of infarction, hemorrhage, or mass.\n3. No aneurysm, flow-limiting stenosis, or occlusion.\n4. Moderate multilevel degenerative changes of the cervical spine as described\nabove.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. \n___ on the telephone on ___ at 9:50 AM, 5 minutes after the\ndiscovery of the findings." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema,or mass-effect. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "In the region of the patient's palpable abnormality, there is an enlarged\nlymph node which measures 2.3 cm x 1.6 cm in station 1A, series 4, image 45. \nAdditional cervical lymphadenopathy seen bilaterally, measuring up to 1.2 cm\non the right and 1.3 cm on the left. There is normal enhancement of the\nvessels of the neck. Enlarged mediastinal and supraclavicular lymph-nodes are\nalso identified.\n\nThe thyroid is normal. The visualized apices of lungs are clear. Mild sinus\ndisease is seen. The mastoid air cells, and middle ear cavities are clear. \nThe globes are unremarkable.", + "output": "1. In the region of the patient's palpable abnormality in the right submental\narea, there is an enlarged lymph node which measures 2.2 cm in station 1A.\n\n2. Additional cervical lymphadenopathy, supraclavicular, and mediastinal\nlymph-nodes seen bilaterally, measuring up to 1.2 cm on the right and 1.3 cm\non left.\n\nNote: Although this could be secondary to sarcoidosis, malignancy such as\nlymphoma cannot be excluded." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Basilar cisterns are\npatent.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. Minimal mucosal thickening is seen within\nscattered ethmoid air cells. Otherwise the visualized paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "No evidence of intracranial hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are age appropriate in size and configuration.\n\nThere is no evidence of acute fracture. Mild mucosal thickening of the left\nmaxillary sinus, bilateral ethmoid and sphenoid sinuses. The visualized\nportion of the frontal sinuses, mastoid air cells, and middle ear cavities are\nclear.", + "output": "No acute intracranial abnormality. Specifically, no evidence of acute, large\nterritorial infarction or hemorrhage. If clinically warranted, MRI is more\nsensitive for the detection of acute infarct." + }, + { + "input": "CTA HEAD:\nThere are scattered atherosclerotic calcifications along both cavernous ICAs\nwithout stenosis. The vessels of the circle of ___ and their principal\nintracranial branches appear normal without stenosis, occlusion, or aneurysm\nformation. The left A1 segment is hypoplastic, likely congenital. Probable\nazygos configuration of the ACA, normal anatomic variant. The dural venous\nsinuses are patent.\n\nThere is mild mucosal thickening along the ethmoid air cells as well as in the\nbilateral sphenoid and maxillary sinuses. The mastoid air cells appear clear.\n\nCTA NECK:\nNormal 3 vessel aortic arch. There are atherosclerotic calcifications at both\ncarotid bifurcations but without vidence of internal carotid stenosis by\nNASCET criteria. The carotidandvertebral arteries and their major branches\nappear normal with no evidence of stenosis or occlusion.\nOTHER:\nThere is mild bilateral gravity dependent atelectasis. No suspicious\npulmonary nodules. The visualized portion of the thyroid gland is within\nnormal limits. There is no lymphadenopathy by CT size criteria.", + "output": "1. No significant intracranial abnormality. No evidence of acute infarction,\nhemorrhage or mass.\n2. Patent intracranial and cervical vasculature without evidence of\ndissection, stenosis, occlusion or aneurysm formation greater than 3 mm." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. No evidence acute intracranial hemorrhage." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of hemorrhage, edema, or mass. There is no loss of\ngray-white matter differentiation. There is prominence of the ventricles and\nsulci suggestive of involutional changes. Periventricular white-matter\nhypodensities are nonspecific, but likely reflect chronic microvascular\nischemic disease. Hypodense region in the superior left parietal lobe likely\nreflects a chronic infarct.\n\nMild mucosal thickening of the left maxillary sinus. Partial opacification of\nthe left ethmoid air cells. Partial opacification of the left mastoid air\ncells. Otherwise, the visualized portion of the paranasal sinuses,right\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\ndo not demonstrate stenoses or occlusion. There is a 7 x 11 mm, calcified\naneurysm at the junction of the right V4 segment and basilar artery. The dural\nvenous sinuses are patent. There is calcification of the cavernous, clinoid,\nand supraclinoid segments of the internal carotid arteries bilaterally.\n\nCTA NECK:\nThe carotid and right vertebral arteries and their major branches appear\nnormal with no evidence of stenosis or occlusion. There is no evidence of\ninternal carotid stenosis by NASCET criteria. The left vertebral artery is\nnot visible below the level of C4, with likely retrograde flow in the segments\nabove the level of C4. There is diffuse atherosclerotic disease. Vascular\ncalcification is most pronounced at the carotid bifurcations.\n\nOTHER:\nFocal consolidation at the right apex (5, 32) could reflect pneumonia. \nConsider dedicated chest imaging, if clinically indicated. The visualized\nportion of the thyroid gland is within normal limits. There is no\nlymphadenopathy by CT size criteria. Degenerative changes throughout the\nspine.", + "output": "1. No acute intracranial hemorrhage or loss of gray-white matter\ndifferentiation.\n2. 7 x 11 mm, calcified aneurysm at the junction of the right V4 segment and\nbasilar artery.\n3. Hypoplastic left vertebral artery with retrograde flow with the segments\nabove the level of C4.\n4. Focal consolidation at the right apex could reflect pneumonia. Consider\ndedicated chest imaging for further evaluation, if clinically indicated.\n\nRECOMMENDATION(S): Focal consolidation at the right apex could reflect\npneumonia. Consider dedicated chest imaging for further evaluation, if\nclinically indicated.\n\nNOTIFICATION: Findings were communicated to Dr. ___ by Dr. ___ at\n11:12 AM via telephone and to Dr. ___ by Dr. ___ at 11:20 AM via\ntelephone on ___ within 10 minutes of the discovery of the findings." + }, + { + "input": "Images were slightly limited by motion artifact. There is no evidence of\nlarge territorial infarction, acute intracranial hemorrhage, edema, or mass. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Periventricular and subcortical white matter hypodensities are\nnonspecific, likely sequela of chronic small vessel ischemic disease. \nPreviously described hypodensity in the left parietal lobe is unchanged, and\nlikely relates to chronic infarction.\n\nThere is no evidence of fracture. There is mild mucosal thickening involving\nthe bilateral maxillary sinuses and anterior ethmoidal air cells. The\nvisualized portion of the remaining paranasal sinuses, and middle ear\ncavities are clear. The left mastoid air cells are partially opacified,\nunchanged. The visualized portion of the orbits are unremarkable. A\ncalcified vascular structure at the level of the basilar artery is similar in\nappearance.", + "output": "Compared with the CTA head and neck from earlier today, no significant\ninterval change. No acute intracranial hemorrhage." + }, + { + "input": "Left parietal encephalomalacia and chronic right cerebellar infarct are again\nnoted. There is a chronic right thalamic infarct which is new since ___. \nPeriventricular and subcortical white matter hypodensities are likely sequela\nof chronic small vessel disease. There is no intra-axial or extra-axial\nhemorrhage, mass, midline shift, or acute major vascular territorial infarct.\nGray-white matter differentiation is preserved. Ventricles and sulci and are\nprominent compatible with volume loss. Dense atherosclerotic calcifications\nnoted within the vertebral arteries, basilar artery and intracranial ICAs.\n\nIncluded paranasal sinuses and right mastoids are essentially clear noting\nmild mucosal thickening in the maxillary sinuses. The left mastoids are\npoorly pneumatized and entirely opacified. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process.\nLeft parietal encephalomalacia, chronic right cerebellar infarct and changes\nsuggestive chronic small vessel disease, unchanged. Interval though chronic\nright thalamic lacunar infarct." + }, + { + "input": "There is no evidence of acute major infarction,hemorrhage,edema,or discrete\nmass. The ventricles and sulci are normal in size and configuration for the\npatient's age.\n\nThere is no evidence of fracture. There is extensive thickening in the\nbilateral maxillary sinuses and ethmoid air cells and right sphenoid sinus.\nOtherwise, the visualized portion of the paranasal sinuses, mastoid air cells\nand middle ear cavities are clear. Visualized orbits are unremarkable.\nMetallic density structure is seen in the region of the left ear, likely\nrepresents external jewelry.", + "output": "1. No acute intracranial process.\n2. Extensive paranasal sinus disease as described above." + }, + { + "input": "This exam is motion degraded.\n\nThere is no evidence of large territorial infarction, hemorrhage, edema, or\nmass effect. The ventricles and sulci are normal in size and configuration.\n\nThere is no discernable fracture. There is soft tissue swelling involving the\nleft pinna. Small foci of gas in the periauricular scalp soft tissues raises\npotential concern for subtle injury to the left mastoid air cells. There is\npartial opacification of the left middle ear cavity and minimal opacification\ninvolving the left mastoid air cells. There is extensive paranasal mucosal\nthickening, with near complete opacification of the bilateral maxillary\nsinuses, and moderate mucosal thickening involving ethmoid air cells and\nsphenoid sinuses. There is small fluid in the left middle ear cavity. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Motion degraded examination. No definite acute intracranial abnormality.\n2. Soft tissue swelling at the left pinna with periauricular scalp soft tissue\ngas raising potential concern for subtle injury to the left mastoid air cells.\nSmall amount of fluid in the left middle ear cavity may represent blood. \nPlease correlate clinically." + }, + { + "input": "Left : The external auditory canal is normal. Hyperdense fluid is seen within\nleft middle ear compatible with hemorrhage. The tympanic membrane is\nasymmetrically thickened compared to the right.The epitympanum is opacified\nand the adjacent hyperdensity limits evaluation of the tegmen which however\nappears grossly intact. The ossicles appear intact. There is no evidence for\nenlarged vestibular aqueduct or superior semicircular canal dehiscence. The\nfacial nerve follows a normal course through the middle ear. There is no\nevidence for inner ear dysplasia. The mastoid antrum and habitus at antrum is\nopacified with scattered opacification of a few mastoid air cells. No\ndisplaced temporal bone fracture is identified.\n\nRight: The external auditory canal is normal. The middle ear cavity is clear.\nThe ossicles and tegmen are intact. There is no evidence for enlarged\nvestibular aqueduct or superior semicircular canal dehiscence. The facial\nnerve follows a normal course through the middle ear. There is no evidence for\ninner ear dysplasia. The mastoids are clear.\n\nOther: Subcutaneous emphysema in the left retroauricular region and\nlaceration is identified. Please refer to concurrent CT cervical spine and\nhead for additional details.", + "output": "1. Hyperdense fluid in the left middle ear cavity extending to the mastoid\nantrum and scattered mastoid air cells is compatible with hemorrhage. \nHowever, no displaced temporal bone fracture is identified.\n2. The left tympanic membrane is mildly thickened. Correlation with\nvisualization is recommended.\n3. The left ossicles appear intact. The tegmen tympani appears intact\nalthough evaluation is suboptimal secondary to adjacent hemorrhage product.\n4. Left retroauricular subcutaneous emphysema and laceration." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are prominent, compatible with global involutional\nchange.\n\nNo osseous abnormalities seen. Focal mucosal thickening along the antral\nfloor of the right maxillary sinus overlying a right maxillary tooth root is\nincidentally noted (601b:22), along with a periapical lucency (3:6). There is\nmild mucosal thickening in the ethmoid air cells. The orbits are\nunremarkable. Degenerative changes noted at the temporomandibular joints\nbilaterally.", + "output": "1. No acute intracranial pathology.\n2. Periapical lucency about a partially visualized right maxillary tooth, with\nassociated focal mucosal thickening in the right maxillary sinus, compatible\nwith odontogenic disease." + }, + { + "input": "The patient is status post left parietal craniotomy. There is no evidence of\ninfarction, hemorrhage, edema, or mass. There is mild prominence of the\nventricles and sulci suggestive of involutional changes.\n\nPatient is status post left parietal craniotomy. There is no evidence of\nfracture. There is a meningioma or exostosis adjacent to the inner table of\nthe left frontal calvarium, which is unchanged. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Stable meningioma or exostosis/osteoma adjacent to the inner table of the\nleft frontal calvarium." + }, + { + "input": "CTA NECK:\nThere is a two vessel aortic arch with a common trunk between the innominate\nand the left common carotid artery. There is mixed plaque along the proximal\nleft subclavian artery with minimal luminal narrowing. The ostia of the common\ncarotid and vertebral arteries is widely patent. The vertebral arteries are\nsymmetric in size without evidence of dissection, occlusion, or significant\nstenosis. There is mixed plaque at the carotid bifurcations bilaterally\nwithout significant internal carotid stenosis by NASCET criteria.\n\n\nCTA HEAD:\nThere is minimal plaque along the cavernous carotid arteries without\nsignificant luminal narrowing. The circle of ___ and its major branches do\nnot demonstrate occlusion, stenosis, or aneurysm formation. The right\ntransverse and sigmoid sinuses are dominant. Diminutive appearance of left\ntransverse sinus is likely related to hyperplasia.\n\nOTHER:\nThe thyroid glands mildly heterogeneous without discrete nodules. The parotid\nsalivary glands are unremarkable. There is no lymphadenopathy by CT criteria.\nAn azygos fissure containing the azygos vein is noted in the right upper lobe.\n\nThere is focal outpouching of a subsegmental vascular branch in the right\nupper lobe measuring contrast density. The vessel proximal and distal to the\noutpouching is normal in caliber. This is surrounded by a thin rim of\nparenchymal opacification. There is no consolidation or pleural effusion.", + "output": "1. CTA neck demonstrates common origin of the left common carotid and\ninnominate arteries. There is no evidence of dissection, occlusion, or\nstenosis. No internal carotid artery by NASCET criteria.\n\n2. Unremarkable head CT.\n\n3. Focal outpouching of a subsegmental vascular branch in the right upper\nlobe measuring contrast density could represent an aneurysm of a pulmonary\nartery branch. Further evaluation with a dedicated contrast enhanced chest CT\nis recommended.\n\nRECOMMENDATION(S): Chest CT with contrast.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 3:08 ___, 30 minutes after\ndiscovery of the findings." + }, + { + "input": "Patient is status post left craniotomy. Expected postsurgical pneumocephalus\noverlying the left frontal lobe. No significant blood products identified in\nthe surgical bed. No evidence of infarction, acute intracranial hemorrhage,\nedema, or new mass. No shift of normally midline structures. The basal\ncisterns are patent. The ventricles and sulci are normal in size and\nconfiguration. Incidental note of a probable left frontal calcified meningioma\nis made (4:19).\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "Status post left craniectomy with expected postsurgical pneumocephalus. No\nevidence of infarction, acute intracranial hemorrhage or shift of normally\nmidline structures." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is a 3.6 x 4.8 cm mixed density left frontal intraparenchymal hemorrhage\nresulting in substantial mass effect with partial effacement of the body of\nthe right lateral ventricle and complete obliteration of the occipital and\ntemporal horns and approximately 1 cm shift of normally midline structures to\nthe right. There is extension of hemorrhage into the left lateral ventricle. \nThe third ventricle is not well visualized and likely effaced. The fourth\nventricle contains hyperdense blood which extends inferiorly into the\nquadrigeminal cistern. There is also a hyperdense left subdural hematoma\nlayering along the lateral convexity measuring up to 8 mm from the inner\ntable. Gray-white matter differentiation is preserved.\n\nThere appears to be mild enlargement of the right lateral ventricle,\nparticularly of the temporal horn, raising concern for ventricular entrapment\nand developing hydrocephalus. There is effacement of the bilateral\nperimesencephalic cisterns. No definite large acute territory infarct.\n\nThere is a 7 mm thick right temporal scalp hematoma (series 2, image 25).\n\nThe visualized paranasal sinuses and mastoid air cells are essentially clear. \nThe orbits are unremarkable.\n\nCTA NECK:\nA three vessel aortic arch is demonstrated. There is no significant\natherosclerotic disease along the aortic arch and ostia of branch vessels. \nThe origin of the vertebral arteries and bilateral common carotids is widely\npatent. The carotid and vertebral arteries and their major branches appear\nnormal with no evidence of stenosis or occlusion. There is no evidence of\ninternal carotid stenosis by NASCET criteria.\n\nCTA HEAD:\nThere is complete lack of visualization of the P3 branches of the left\nposterior cerebral artery likely as a result of compression. There is\nshort-segment narrowing of the bilateral A2 segments (series 454, image 1),\nmost prominently of the left, also presumably secondary to mass effect from\nthe hematoma. There is a 1-2 mm medially projecting outpouching of the left\ncavernous internal carotid artery (series 3, image 282) may represent an\ninfundibular origin although a small aneurysm is not entirely excluded. The\ndural venous sinuses are patent.\n\nOTHER:\nThe visualized portion of the lungs are clear. There is a 6 mm hypodense\nnodule in the right lobe of the thyroid gland (3:101) as seen on the prior CT\ntorso of ___. The salivary glands are within normal limits. There is\nno lymphadenopathy by CT size criteria. The endotracheal tube is noted.", + "output": "1. 3.6 x 4.8 cm mixed density left frontal intraparenchymal hemorrhage with\nsubstantial mass effect resulting in partial effacement of the left lateral\nventricle and third ventricles and rightward 1 cm shift of normally midline\nstructures. There is effacement of the bilateral perimesencephalic cisterns,\nconcern for herniation.\n2. The right ventricle demonstrates enlarged temporal horn, concerning for\nentrapment and developing hydrocephalus.\n3. There is extension of hemorrhage into the left lateral ventricle with\nhyperdense blood also seen within the fourth ventricle and the quadrigeminal\nplate cistern.\n4. A hyperdense subdural hematoma along the left lateral convexity measuring\napproximately 8 mm in maximum dimension from the inner table.\n5. Head CTA is notable for complete lack of visualization of the P3 branches\nof the left posterior cerebral artery and partial effacement of the A2 branch\nof the left anterior cerebral artery from extensive mass effect and midline\nshift.\n6. A 1-2 mm outpouching arising from the medial aspect of the left cavernous\ninternal carotid artery may represent an infundibulum of a branch vessel\nhowever a tiny aneurysm cannot be excluded.\n7. Unremarkable neck CTA.\n\nNOTIFICATION: The findings and changes from the wet read, including A2\nsegment attenuation, opacification of the left PCA were discussed with ___\n___, M.D. by ___, on the telephone on ___ at 12:04 ___,\n10 minutes after discovery of the findings." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.There is no evidence of\nfracture. The visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema,or large mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "There is no acute intracranial hemorrhage, acute infarction, edema or mass\neffect. Lacunar infarct within the left basal ganglia are unchanged in\nappearance. Interval lacunar infarct is seen within the right lentiform\nnucleus since ___. Prominent ventricles and sulci are likely reflective of\nage related involutional changes. The basal cisterns are clear. The gray\nwhite matter differentiation appears preserved.\n\nNo fracture is identified. The visualized paranasal sinuses, mastoid air\ncells and middle ear cavities are clear.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are prominent compatible with global volume loss. \nHypodensities in the lentiform nuclei bilaterally may represent chronic\nlacunar infarcts or prominent perivascular spaces. Atherosclerotic\ncalcifications noted within the intracranial ICAs and vertebral arteries\nbilaterally.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute large vascular territory infarction, hemorrhage,\nedema, mass, or mass effect. The ventricles and sulci are prominent,\ncompatible with global parenchymal volume loss. There are dilated\nperivascular spaces in the basal ganglia bilaterally. Small chronic infarct,\nright pons. The visualized paranasal sinuses and mastoids appear clear. \nAside from bilateral lens extraction, the globes and orbits are within normal\nlimits. Carotid siphon calcifications are noted bilaterally.\n\nCT PERFUSION:\n Automated RAPID CT algorithm calculates a volume of 0 mL brain parenchyma\nwith a CBF <30%, as well as volume of 0 mL brain parenchyma with Tmax > 6\nseconds. Subjective review of CBF, CBV, and MTT/T-max maps show no evidence\nof decreased cerebral blood flow, abnormal cerebral blood volume, or prolonged\nmean transit time.\n\nSubjective review of arterial inflow (AIF) and venous outflow (VOF) time\nintensity curves demonstrate normal, expected curves compatible with\nappropriate selection of AIF and VOF regions of interest. There is no\nevidence of significant motion degradation on 3-plane time-translation curves.\nOverall, findings are compatible with technically adequate study, without\nevidence of infarct core or ischemic penumbra.\n\nCTA HEAD:\nThere is a occluded distal right vertebral artery. Flow seen within the very\ndistal right V4 segment, possibly retrograde or collateral flow. Distal left\nvertebral artery calcified, mild luminal narrowing, but patent. Basilar\nartery patent.\n\nConventional bilateral PCA anatomy. Scattered areas of mild luminal narrowing\naffecting the left P1, right P2, PCA segment. There is normal, preserved\nbilateral distal PCA territory runoff.\n\nMedially projecting outpouching measuring 3.4 mm aneurysm right cavernous\nsegment ICA, measuring 2.7 mm neck to apex, 3.2 mm at the neck, 3.4 mm in\nlargest diameter.\n\nThere is 4.8 mm anterolaterally projecting aneurysm from ophthalmic segment of\nthe right intracranial ICA (4:275, measuring 4.8 mm from neck to apex, 4.2 mm\nat the neck. Parent ICA measures 3.3 mm just proximal to the aneurysm, 4.1 mm\njust distal to the aneurysm, with neck parent artery ratio 1.14.\n\nSevere calcification of the cavernous and supraclinoid intracranial ICAs cause\nareas of moderate to severe luminal narrowing bilaterally. Otherwise, the\nremaining portions of the bilateral intracranial internal carotid arteries and\nthe bilateral anterior and middle cerebral arteries are patent with normal\ndistal runoff.\n\nNo large vessel occlusion. Major dural venous sinuses are patent.\n\nCTA NECK:\nMild luminal narrowing, right common carotid artery, due to calcified plaque\ncalcified plaque at the right carotid bulb and proximal right extracranial ICA\n10% luminal narrowing by NASCET criteria (551:15). Remainder of the right\ncervical carotid artery is widely patent.\n\nMild calcified plaque at the left carotid bulb proximal left extracranial ICA\ndoes not cause significant luminal narrowing by NASCET criteria. Mild focal\ncalcified plaque along the distal left extracranial ICA also does not cause\nluminal narrowing.\n\nThe right vertebral artery is occluded at its origin origin throughout the\nneck, not opacified through the V1, V2, V3, and proximal V4 segments.\n\nLeft vertebral artery widely patent throughout the neck.\n\nModerate to severe calcified and noncalcified plaque throughout the aortic\narch. Arch branch vessel origins are mildly diseased but otherwise patent.\n\nOTHER:\nMultiple hypodense thyroid nodules are noted, largest on the right measuring\n18 mm (04:32). Postsurgical changes left parotid gland. No cervical\nadenopathy. Severe cervical spine degenerative changes. No aggressive focal\nosseous lesions identified. Scattered mediastinal lymph nodes are not\npathologically enlarged, possibly reactive. Moderate to severe biapical\nparaseptal and centrilobular emphysema. Patchy opacity in the posterior right\nupper lobe may left pneumonia, aspiration in the appropriate clinical setting.\nDistal airway peribronchial nodularity, partially visualized, medial right\nupper lobe (4:1). 7 mm subpleural ground-glass nodule, right upper lobe\n(04:21). 9 mm enhancing right parotid nodule. Postoperative change left\nparotid gland. Advanced degenerative changes spine.", + "output": "1. No acute intracranial abnormality.\n2. CT perfusion without evidence of ischemic penumbra or infarct core.\n3. There is 4.8 mm anterolaterally projecting right paraophthalmic ICA\naneurysm.\n4. There is 3.4 mm right cavernous segment ICA aneurysm.\n5. Occluded right vertebral artery throughout its course.\n6. Areas of moderate to severe narrowing of the intracranial ICAs due to\ncalcified plaque bilaterally. Mild distal vertebral and PCA narrowing\nbilaterally.\n7. Mild atherosclerotic disease bilateral ICA in the neck.\n8. Chronic right pontine infarct.\n9. 18 mm right thyroid lobe nodule. Recommend ultrasound as below..\n10. Right upper lobe patchy opacity, could reflect pneumonia, sequelae of\naspiration. Partially visualized area of distal peribronchial nodularity,\nnew. Unchanged right upper lobe 9 mm ground-glass nodule. CT chest is\nrecommended for further assessment, as below.\n11. 9 mm right parotid nodule, indeterminate.\n\nRECOMMENDATION(S):\n1. CT chest examination, as there is an invasion of the patient has\nrespiratory symptoms, or as an outpatient on a nonurgent patient if the\npatient is symptomatic, for further evaluation of lung parenchymal\nabnormalities, as above.\n2.\nThyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or older, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150.\n.\n\nNOTIFICATION: The findings and recommendations above were discussed with\n___, M.D. by ___, M.D. on the telephone on ___ at\n3:59 pm, 30 minutes after discovery of the findings." + }, + { + "input": "Hypodensities in left corona radiata and putamen appear minimally larger than\non prior brain MRI, difficult to directly compare given differences in\ntechnique (02:20, 02:19). No intracranial hemorrhage. No significant mass\neffect or midline shift. The ventricles and sulci are prominent compatible\nwith involutional changes. Mild periventricular white matter hypodensities\nare nonspecific but in a distribution suggestive of chronic microangiopathy.No\nosseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No intracranial hemorrhage, midline shift, or new territorial infarct.\n2. Minimally larger subacute infarcts in the left corona radiata and putamen\nsince prior brain MRI, difficult to directly compare given differences in\ntechnique. However, this is likely due to evolution of previously seen\ninfarct." + }, + { + "input": "Study is mildly degraded by motion. There is no evidence of large territory\ninfarction,hemorrhage,edema, or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. There moderate to severe\nhypodensities within the subcortical and periventricular white matter of the\nnonspecific probably represents sequela of microvascular ischemic disease. \nThere is mild calcified atherosclerosis at the bilateral carotid siphons.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nbilateral ethmoid air cells partial with opacification of the left anterior\nand right posterior ethmoid air cells. The visualized portion of the other\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Study is mildly degraded by motion. No acute intracranial process.\n2. Paranasal sinus disease as described above." + }, + { + "input": "Study limited by artifact.\n\nThere is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass effect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. There is questionable prominence of the temporal horns\nand occipital horns. Periventricular and subcortical white matter\nhypodensities are nonspecific but likely sequelae of chronic small vessel\nischemic disease.\n\nThere is no evidence of fracture. Mild mucosal thickening of bilateral\nethmoid air cells. The visualized portion the other paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality on noncontrast CT head.\n2. Questionable increased prominence of the temporal horns and occipital horns\nsuperimposed on generalized involutional change. Clinical correlation with\npatient's dementia status is recommended.\n3. Paranasal sinus disease as described above." + }, + { + "input": "There is no evidence of acute intracranial infarction, hemorrhage, edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. There is\natherosclerotic calcification in the bilateral cavernous carotids.\n\nThere is no evidence of fracture. There is mucosal thickening in the ethmoid\nair cells. The visualized portion of the remainder of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. No evidence of acute intracranial hemorrhage or large territory infarct.\n2. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Age related involutional changes are noted. Minimal\nperiventricular white matter hypodensity suggestive of chronic microvascular\nischemic disease is noted. Faint basal ganglia calcifications are seen. \nImaged paranasal sinuses, mastoid air cells and middle ear cavities appear\nwell aerated. The nasal bones appear intact. There is a small subgaleal\nhematoma at the right posterior vertex. No underlying fracture. Partially\nvisualized left mandibular hardware noted.", + "output": "No acute intracranial hemorrhage or fracture." + }, + { + "input": "There is no evidence of acute territorial infarction,intracranial hemorrhage\nor edema. There is mild enlargement of the pineal gland, measuring 1.3 x 0.9\ncm with cystic internal density and partial anterior calcification, abutting\nthe tectum. It is not clear if there is narrowing of the cerebral aqueduct,\nthere is no evidence of hydrocephalus and the sulci are normal in size and\nconfiguration.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute infarction or hemorrhage.\n2. Cystic appearance and partially calcified pineal gland as described above,\napparently abutting the tectum, it is not clear if the pineal gland is causing\nnarrowing of the cerebral aqueduct. Further evaluation with MRI with\ncontinued follow-up is recommended.\n\nRECOMMENDATION(S): Slightly prominent cystic and partially calcified pineal\ngland as described above, partially evaluated in this exam, it is not clear if\nthe pineal gland is producing narrowing of the cerebral aqueduct, correlation\nwith MRI of the head with and without contrast is recommended for further\ncharacterization." + }, + { + "input": "There is no intracranial hemorrhage, edema, mass effect, or acute vascular\nterritorial infarction. The ventricles and sulci are normal in size and\nconfiguration. Scattered subcortical white matter hypodensities reflect\nchronic small vessel ischemic disease. There is no shift of the normally\nmidline structures.The basal cisterns appear patent and there is preservation\nof the gray-white matter differentiation.\n\nNo fracture or suspicious osseous lesion is identified.The included paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.The orbits are\nunremarkable.", + "output": "No acute intracranial abnormality. Chronic small vessel ischemic changes." + }, + { + "input": "Portions of the frontal bone are out of the field-of-view secondary to\ninability to appropriately position patient due to accentuated kyphosis. \nArtifact within the bilateral frontal lobes limits examination.\n\nImaged brain parenchyma demonstrates no hemorrhage, edema, or mass effect. \nVentricles and sulci are age appropriate in size and configuration. There is\nno shift of normally midline structures. Basal cisterns are patent.\n\nA subgaleal hematoma along the left parietal convexity is noted without an\nunderlying osseous abnormality. The orbits are grossly normal in appearance. \nImaged paranasal sinuses demonstrate moderate mucosal thickening within the\nethmoidal air cells. Minimal mucosal thickening involves the left maxillary\nsinus. Mastoids are underpneumatized. Mastoid air cells and middle ear\ncavities are clear. Note is made of minimally prominent adenoids.", + "output": "Limited study secondary to inability to appropriately position patient due to\naccentuated kyphosis, the frontal bone and frontal lobes suboptimally imaged.\n\nNo acute intracranial abnormality is identified. Small left parietal\nconvexity scalp hematoma without underlying fracture." + }, + { + "input": "Study limited secondary to beam hardening artifact. There is no evidence of\ninfarction, hemorrhage, edema, or mass. The ventricles and sulci are normal in\nsize and configuration.\nThere is no evidence of fracture.\n\nMild mucosal thickening of the anterior and posterior right ethmoid air cells.\nThe visualized portion of the orbits are unremarkable.\n\nNonspecific grossly stable left parietal scalp subcutaneous tissue density in\nwith linear extension to overlying skin surface is again noted (see 02:27 on\ncurrent study, 601b:79 on ___ prior exam, 601b:76 on ___ prior exam while and 02:28 on ___ prior exam).", + "output": "1. No acute intracranial abnormality.\n2. Nonspecific left parietal scalp thickening suggestive of scarring, grossly\nstable compared to ___ prior exam.\n3. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct.\n4. Paranasal sinus disease as described." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is mild\nprominence of the ventricles and sulci suggestive of involutional changes.\nMild periventricular hypodensities are nonspecific, but likely a sequela of\nchronic small vessel disease.\n\nThere is no evidence of fracture. Mild mucosal thickening within the ethmoid\nair cells. There are also secretions within the left maxillary sinus. \nRemainder of the visualized paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable. Atherosclerotic calcifications are noted within the bilateral\nvertebral arteries and cavernous internal carotid arteries.\n\nThere is a small left frontoparietal scalp hematoma (03:56).", + "output": "Left frontoparietal scalp hematoma, without underlying fracture or hemorrhage." + }, + { + "input": "The examination is slightly suboptimal secondary to patient positioning.\n\nThere is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass/mass effect. The ventricles and sulci are normal in size and\nconfiguration.\n\nThere is no evidence of fracture. Aerosolized mucus is noted in the maxillary\nsinuses. The remainder the visualized paranasal sinuses are essentially\nclear. The visualized orbits are unremarkable. The mastoid air cells are\nclear. A left scalp hematoma is essentially unchanged from prior exam.", + "output": "1. No acute intracranial abnormality on noncontrast head CT." + }, + { + "input": "The exam is mildly limited due to artifacts created by patient positioning,\nlowering sensitivity for subtle findings, especially immediately adjacent to\nthe calvarium.\n\nWithin these limits, there is no evidence of acute territorial\ninfarction,hemorrhage,edema,or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes.\n\nThere is no evidence of acute fracture. Left subcutaneous stranding overlying\nthe parietal bone is again noted. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Patient is\nstatus post bilateral lens replacements. Dense calcifications and the\nbilateral vertebral arteries and the carotid siphons are noted.", + "output": "1. Limited study due to artifacts. Within these limits, no large territory\ninfarct or hemorrhage. Evaluation for cortical or extra-axial findings is\nlimited." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema,or discrete mass. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Mild periventricular and subcortical white matter hypodensities are\nnonspecific, however likely due to chronic small vessel ischemic disease.\n\nThere is no evidence of acute fracture. There is small amount of subgaleal\nhematoma overlying the left lateral vertex. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormalities.\n2. Small amount of subgaleal hematoma overlying the left lateral vertex\nwithout underlying fracture." + }, + { + "input": "X per noncontrast, non vascular head CT there is no large hematoma. There is\nan aneurysm clip the left MCA position. There is bifrontal pneumocephalus. \nThere is some subcutaneous fluid under this scalp flap.\n\nUltrasound the right common femoral artery: There is a single noncompressible,\narterial, pulsatile lumen. There is evidence of access of the wire into the\nlumen. Images were saved to the patient's permanent medical record.\n\nLeft common carotid artery: Vessel caliber smooth and regular. There is\nopacification the anterior middle cerebral arteries and their distal\nterritories. There is no residual aneurysm the left MCA. There is filling of\nthe full MCA candelabra with no delayed in filling.. There is cross-filling\nacross the anterior communicating artery and filling the contralateral A 2\nsegment. This is confirmed on the three-dimensional rotational imaging.\n\nUltrasound the right common femoral artery: There is a single noncompressible,\narterial, pulsatile lumen. There is evidence of access of the wire into the\nlumen. Images were saved to the patient's permanent medical record.", + "output": "No residual filling of the previously clipped left MCA aneurysm that was\nunruptured\n\nFilling of the bilateral M2 branches with good distal supply\n\nRECOMMENDATION(S):\n1. Continue to maintain flap with hypertension." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There are bilateral prominent\nlymph nodes at the level IIa and IIb bilaterally, better depicted in the\nsagittal reformations (image 14, series 602b, images 42 and 43, series 202b),\nfor example on the right measuring up to 18 x 8 mm in transverse dimension\n(image 58, series 2), and on the left up to 20 x 13 mm (image 42, series\n602b). The neck vessels are patent and unremarkable.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. The thyroid gland appears unremarkable. There are no\nosseous lesions.", + "output": "1. Bilateral prominent lymph nodes, suggesting lymphadenopathy at the stations\nIIa and IIb bilaterally as described in detail above." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are preserved in size and configuration.\n\nThere is no evidence of fracture. Polypoid mucosal thickening in bilateral\nmaxillary sinuses noted. Visualized portion of the mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\npreserved. Age-indeterminate irregularity of the left anterior nasal bone\nwithout definite associated soft tissue swelling versus volume averaging\nartifact is noted (see 301:19).", + "output": "1. No acute intracranial abnormality.\n2. No evidence acute intracranial hemorrhage or fracture.\n3. Paranasal sinus disease , as described.\n4. Question probable chronic nasal bone deformity versus artifact, as\ndescribed." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThere is mild mucosal thickening in the right maxillary sinus, in a small\nmucous retention cyst along the antral floor of the left maxillary sinus. \nThere are mild periapical lucencies of the maxillary molars. The remaining\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. The principal arteries of the head and neck are patent, with no evidence of\nsignificant stenosis, dissection, or intracranial aneurysm\n2. Mild maxillary sinus disease. Mild periapical lucencies of the maxillary\nmolars are noted. Clinical correlation with odontogenic sinus disease is\nrecommended." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute hemorrhage, edema, mass effect, or loss of\ngray/white matter differentiation. Ventricles, sulci, and basal cisterns are\nnormal in size for age.\n\nMild mucosal thickening is noted within the bilateral maxillary sinuses with a\nmucous retention cyst in the left maxillary sinus. There is also a small\nfocus of mucosal thickening versus secretions in the right anterior ethmoid on\nimage 3:226. Mastoid air cells appear grossly clear allowing for absence of\ndedicated bone algorithm reformatted images. The orbits are noted for\napparent dysconjugate gaze, but it is not known whether the patient size are\nopen during the exam.\n\nCTA NECK:\nThere is a 3 vessel aortic arch. The carotid and vertebral arteries are\nwidely patent without flow-limiting stenosis or dissection. Specifically,\nthere is no internal carotid stenosis by NASCET criteria.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear patent without evidence for flow-limiting stenosis or aneurysm. The\ndural venous sinuses are patent.\n\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. Multiple prominent cervical lymph\nnodes are noted, none of which are pathologically enlarged by CT size\ncriteria.", + "output": "1. No evidence for acute intracranial abnormalities. MRI would be more\nsensitive for an acute infarction or other posterior fossa pathology, if\nclinically warranted.\n2. Unremarkable head and neck CTA." + }, + { + "input": "There has been slight interval increase in size of the left intraparenchymal\nhemorrhage centered around the left lentiform nucleus approximately 5.4 x 3.7\ncm, previously 4.4 x 3.2 cm. No new foci of hemorrhage are identified. There\nis also increased surrounding vasogenic edema, particularly anterior to the\nbleed. This results in approximately 8 mm (previously 4 mm) of rightward\nmidline shift and further effacement of the frontal horn of the left lateral\nventricle and the left suprasellar cistern. There is also early mild downward\nherniation of the cerebellar tonsils. There is mild mucosal thickening in the\nbilateral maxillary, sphenoid and ethmoid sinuses. Mastoid air cells and\nmiddle ear cavities are well aerated. The bony calvarium is intact.", + "output": "1. Interval increase in size in the left intraparenchymal hemorrhage,\nmeasuring approximately 5.4 x 3.7 cm, previously 4.4 x 3.2 cm. No new foci of\nhemorrhage are identified.\n2. Increased vasogenic edema resulting in an increase in rightward midline\nshift, currently 8 mm, previously 4 mm. Additionally, there is further\neffacement of the frontal horn of the left lateral ventricle as well as the\nleft suprasellar cistern.\n3. There is also early mild downward herniation of the cerebellar tonsils.\n4. Mild paranasal sinus disease, as described above." + }, + { + "input": "TUBES AND LINES:\nThe patient is intubated and there is an enteric tube in place. Retained\nfluid within the nasopharynx likely correlates with patient's intubated\nstatus.\n\nCTA HEAD:\nThere is a 5.4 x 3.7 cm intraparenchymal hemorrhage centered in the left\nlentiform nucleus with associated mass effect on and partial effacement of\nleft lateral ventricle and a 9 mm midline shift to the right.\n\nThere are calcifications of the carotid siphons. There is a persistent fetal\norigin of the right PCA. There is evidence of 2 left MCA M 2 segments arising\nfrom the terminal carotid, a normal variant. The vessels of the circle of\n___ and their principal intracranial branches appear normal without\nstenosis, occlusion, or aneurysm formation. The dural venous sinuses are\npatent.\n\nThere is mild mucosal thickening of the maxillary sinuses and moderate mucosal\nthickening of the ethmoid air cells. The frontal sinuses are aplastic.\n\nCTA NECK:\nThere are mild right and moderate left soft plaque and calcified atheromatous\nchanges of the origins of the bilateral ICAs. The carotid and vertebral\narteries and their major branches appear otherwise normal with no evidence of\nstenosis or occlusion. There is no evidence of internal carotid stenosis by\nNASCET criteria.\n\nOTHER:\nThere is mild centrilobular emphysema. The visualized portion of the thyroid\ngland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Redemonstrated intraparenchymal hemorrhage centered within the left\nlentiform nucleus with mass effect on the left lateral ventricle and a 9 mm\nmidline shift to the right.\n2. No evidence of vascular dissection, aneurysm or occlusion of the head neck.\nAt the cervical carotid bifurcations, there are changes due to\narteriosclerotic disease consistent with a combination of soft plaque and\ncalcified plaque material, with no significant ICA stenosis by NASCET\ncriteria." + }, + { + "input": "Re-demonstrated is intraparenchymal hemorrhage centered along the left\nlentiform nucleus measuring approximately 5.7 x 3.4 x 4.3 cm, previously 5.2 x\n3.7 x 5.2 cm. No new foci of hemorrhage are identified. Hypodensity\nsurrounding the hemorrhage is compatible with vasogenic edema, similar in\nextent compared to the prior study. There is approximately 8 mm rightward\nmidline shift, unchanged since the prior study. Persistent effacement of the\nfrontal horn of the left lateral ventricle is unchanged. There is no\nintra-axial or extra-axial hemorrhage, edema, shift of normally midline\nstructures, or evidence of acute major vascular territorial infarction.\nVentricles and sulci are normal in overall size and configuration. The imaged\nparanasal sinuses are clear. Mastoid air cells and middle ear cavities are\nwell aerated. The bony calvarium is intact.", + "output": "1. Intraparenchymal hemorrhage centered along the left lentiform nucleus with\nsurrounding vasogenic edema is slightly decreased in size compared to the\nprior study. No new foci of hemorrhage.\n2. Persistent moderate effacement of the left lateral ventricle and 8 mm\nrightward midline shift." + }, + { + "input": "No interval change in the intraparenchymal hemorrhage along the left lentiform\nnucleus, with surrounding hypodensity likely vasogenic edema, (2: 20). There\nis no interval change in persistent effacement of the left anterior horn of\nthe lateral ventricle, (02:20). Rightward midline shift remains approximately\n8 mm. There is no new intracranial hemorrhage, or infarction.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare well-aerated. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No interval change in the intraparenchymal hemorrhage along the left\nlentiform nucleus.\n2. No interval change in rightward midline shift that measures approximately\n8 mm.\n3. There is no new intracranial hemorrhage or infarction." + }, + { + "input": "Re-demonstrated is a large, approximately 6.7 x 4.2 cm parenchymal hematoma\ninvolving the inferior left frontal lobe and insula, which displaces the basal\nganglia medially. Surrounding edema is also stable. There is stable 9 mm\nrightward shift of midline structures. Partial effacement of the left lateral\nventricle and severe effacement of the third ventricle and not significantly\nchanged. The right lateral ventricle is also stable in size. Suprasellar\ncistern is preserved. Perimesencephalic cistern remains crowded to the same\ndegree. Other basal cisterns are preserved.\n\nFrontal sinuses are not pneumatized. Mild mucosal thickening in the ethmoid,\nsphenoid, and partially visualized maxillary sinuses. Possible trace fluid in\nthe sphenoid sinuses, trace fluid in the mastoid air cells, and fluid in the\nnasopharynx and posterior nasal cavity, which are likely secondary to\nendotracheal and nasogastric intubation.", + "output": "Stable large parenchymal hematoma in the left frontal lobe and insula,\ndisplacing the basal ganglia medially, with stable mass effect." + }, + { + "input": "There is severe generalized cerebral and cerebellar edema with effacement of\nthe sulci as well as basal cisterns. Tonsillar herniation is incompletely\nimaged as evidenced by crowding of the foramen magnum. Prominent ventricles\nfor the degree of cerebral swelling.\n\nThere is no evidence of mass or hemorrhage. There is no evidence of fracture. \nThere is moderate opacification of the paranasal sinuses. The orbits appear\nnormal.", + "output": "Severe cerebral and cerebellar swelling with effacement of the basal cisterns\nand incompletely imaged tonsillar herniation. This is nonspecific but most\nlikely secondary to diffuse hypoxic or ischemic injury.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with\nDr. ___ on the ___ ___ at 9:11 am, 10 minutes after discovery\nof the findings." + }, + { + "input": "No intracranial hemorrhage. Moderate chronic small vessel ischemic changes. \nZone of low attenuation in the left parietal, occipital lobe junction, few\ntiny foci of overlying cortical involvement. Findings are atypical for\nchronic infarct, as 1 would like to see larger area of cortical\nencephalomalacia, further evaluation with MRI without contrast would be\nhelpful. There is a small chronic cortical infarct inferior right parietal\nlobe. No shift of normally midline structures. Bilateral, symmetric\nprominence of the ventricles and sulci indicates cortical volume loss, likely\nage-related. Bilateral cavernous internal carotid calcifications are severe. \nBilateral vertebral artery calcifications are moderate.\n\nIndeterminate 0.9 cm osseous low-attenuation lesion left parietal bone. There\nis symmetric bilateral proptosis, no evidence of orbital mass or enlargement\nof the lacrimal glands. The imaged portions of the paranasal sinuses are\nclear. The mastoid air cells and middle ear cavities are clear. The patient\nis intubated. The partially imaged enteric tube is noted. Bilateral lens\nreplacements.", + "output": "1. No intracranial hemorrhage.\n2. There is a zone of low attenuation at the junction left parietal, occipital\nlobes, indeterminate, possibly chronic infarct, however, there is not as much\ncortical encephalomalacia as 1 would expect to see. MRI brain without\ncontrast would be helpful in further evaluation. There is a small cortical\nchronic infarct right parietal lobe.\n\nRECOMMENDATION(S): MR brain without contrast.\n\nNOTIFICATION: The findings, impression, and recommendation were discussed\nwith ___, M.D. by ___, M.D. on the telephone on ___ at\n7:10 ___, 1 minutes after discovery of the findings." + }, + { + "input": "There is no vascular territorial infarct, hemorrhage or mass effect. The\nventricles, sulci and cisterns are prominent indicative of age related volume\nloss. There are nonspecific periventricular and subcortical white matter\nhypodensities likely reflecting sequela of chronic small vessel ischemic\ndisease.\n\nThere are bilateral lens implants. The paranasal sinuses, mastoid air cells\nand visualized soft tissues are unremarkable.", + "output": "There is no vascular territorial infarct, hemorrhage or mass effect.\n\nNonspecific white matter abnormalities, likely reflecting sequela of chronic\nsmall vessel ischemic disease." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or infarction.\nProminent ventricles and sulci suggests age related involutional changes.\nPeriventricular white matter hypodensities are consistent with small vessel\nischemic disease. The basal cisterns appear patent and there is preservation\nof gray-white matter differentiation.\n\nNo fracture is identified. Mucous retention cyst is seen in the right sphenoid\nsinus. Otherwise, the visualized paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear pre The globes are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is hyperdensity within the left frontal sulci consistent with\nsubarachnoid hemorrhage. There is no evidence of edema or mass effect.\nProminent ventricles and sulci suggest age related atrophy. Periventricular\nwhite matter hypodensities are nonspecific but likely represent sequela of\nchronic small vessel ischemic disease. The basal cisterns appear patent and\nthere is preservation of gray-white matter differentiation.\n\nNo fracture is identified. A soft tissues hematoma overlying the left\nzygomatic arch is noted. There is mucosal thickening of the right sphenoid\nsinus. The remaining visualized paranasal sinuses, mastoid air cells and\nmiddle ear cavities are clear. The globes are unremarkable. Atherosclerotic\nmural calcification of the vertebral and internal carotid arteries is noted.", + "output": "1. Left frontal subarachnoid hemorrhage.\n2. Soft tissue hematoma overlying the left zygomatic arch." + }, + { + "input": "Left frontal subarachnoid hemorrhage (02:14) is re- demonstrated with no\nevidence of interval bleedingventricles and sulci are stable in size and\nconfiguration. There is no shift of normal midline structures. The basal\ncisterns remain patent.\n\nSoft tissue hematoma over the left zygoma is decreased. Again there is mucosal\nthickening in the sphenoid sinuses, right greater than left. The mastoid air\ncells and middle ear cavities remain clear.", + "output": "Stable appearance of left frontal subarachnoid hemorrhage. Slight decrease in\nthe left malar eminence swelling" + }, + { + "input": "Previously noted left frontal subarachnoid hemorrhage has resolved. There is\nno acute intracranial hemorrhage, edema, mass effect, loss of gray/ white\nmatter differentiation, or pathologic extra-axial collection. Again seen are\nmultiple foci of low density in the periventricular, deep, and subcortical\nwhite matter of the cerebral hemispheres, likely sequela of chronic small\nvessel ischemic disease in a patient of this age. The ventricles and sulci are\nmildly prominent due to age-related cerebral atrophy, as before.\n\nPartially visualized hematoma overlying the left malar eminence is smaller\nthan on the prior CT, but has not resolved. There is no fracture. The imaged\nparanasal sinuses and mastoid air cells are well aerated.", + "output": "1. Resolution of left frontal subarachnoid hemorrhage. No evidence for new\nintracranial abnormalities.\n2. Hematoma overlying the left malar eminence has decreased in size, but not\nresolved." + }, + { + "input": "There is no acute intracranial hemorrhage, edema, mass effect, loss of gray/\nwhite matter differentiation, or pathologic extra-axial collection. Extensive\nareas of hypodensity are again seen in the subcortical, deep, and\nperiventricular white matter of the cerebral hemispheres, nonspecific but\nlikely sequela of chronic small vessel ischemic disease in this age group.The\nventricles and sulci are mildly prominent due to age-related parenchymal\nvolume loss, unchanged.\n\nThere is mild irregularity of the lateral wall and floor of the left orbit, as\nwell as of the anterior, medial, and posterolateral walls of the left\nmaxillary sinus, at the site of the fractures seen in ___. Aside\nfrom evidence of bilateral lens replacement, no soft tissue abnormalities seen\nwithin the orbits on noncontrast assessment. Please note that the extraocular\nmovement muscles are not adequately assessed on this exam. The imaged\nportions of the paranasal sinuses demonstrate no fluid in mucosal thickening. \nA small osteoma is again seen in the left anterior ethmoid. Middle ear\ncavities are grossly clear. There is small amount of dependent fluid in\nbilateral mastoid tip air cells.", + "output": "1. No evidence for acute intracranial abnormalities. Stable appearance of the\nbrain compared to ___.\n2. Chronic left orbital and maxillary sinus fractures are again demonstrated. \nExtraocular movement muscles are not optimally assessed.\n3. Small amount of dependent fluid in bilateral mastoid tip air cells." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,or\nmass-effect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and subcortical white-matter\nhypodensities are nonspecific, but likely represent sequela of chronic small\nvessel disease.\n\nThere is no evidence of acute fracture. Old fractures involving the left\norbit and left maxillary sinus are again seen. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized nonosseous portion of the orbits are unremarkable. Calcification\nof the carotid siphons and bilateral vertebral arteries are noted.", + "output": "No acute intracranial abnormality." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass effect. The ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTV HEAD:\nThe dural venous sinuses are patent, without evidence of a filling defect\nconcerning for a thrombus.", + "output": "1. No acute intracranial abnormalities identified.\n2. Unremarkable CTV of the head without evidence of dural venous sinus\nthrombosis." + }, + { + "input": "Head CTA: The anterior cerebral arteries, middle cerebral arteries, and\nposterior cerebral arteries appear normal. The dural venous sinuses appear\npatent. There is no evidence of aneurysm, occlusion, or vascular\nmalformation.\n\nNeck CTA: The aortic arch demonstrates conventional three-vessel branch\nconfiguration. The subclavian arteries appear normal. The origins of the\ngreat vessels are patent. The right vertebral artery is dominant. The\nvertebral arteries are patent throughout their course within the neck. There\nis atherosclerotic plaque at the origins of the bilateral proximal internal\ncarotid arteries measuring approximately 35% stenosis on the right (by NASCET\ncriteria) and approximately 50% stenosis on the left by NASCET criteria. \nThere is no evidence of occlusion or dissection.\n\nThere are biapical pulmonary opacities and septal thickening, likely\nrepresenting edema. The thyroid gland, submandibular glands, and parotid\nglands appear normal. No osseous lesions are seen. There are enlarged\nmediastinal lymph nodes including a pretracheal lymph node which approximately\nmeasures 1 cm in short axis (series 2, image 9). These may be reactive\nalthough are indeterminate. There are several mildly prominent bilateral\ncervical lymph nodes, the largest of which measures approximately 0.7 cm in\nshort axis within level II a (series 2, image 160).", + "output": "1. No evidence of aneurysm, vascular malformation, dissection, or occlusion\nwithin the vasculature of the head and neck.\n2. Atherosclerotic vascular disease including approximately 35% stenosis of\nthe right proximal internal carotid artery 50% stenosis the left proximal\ninternal carotid artery (by NASCET criteria).\n3. Biapical pulmonary opacities and septal thickening suggesting pulmonary\nedema. Recommend clinical correlation and correlation with dedicated chest\nimaging.\n4. Mildly prominent, without being enlarged by CT criteria, mediastinal lymph\nnodes, and to a lesser extent bilateral cervical lymph nodes, may be reactive\nbut indeterminate. Recommend clinical correlation and attention on followup\nimaging.\n\nRECOMMENDATION(S):\n1. Biapical pulmonary opacities and septal thickening suggesting pulmonary\nedema. Recommend clinical correlation and correlation with dedicated chest\nimaging.\n2. Mildly prominent, without being enlarged by CT criteria, mediastinal lymph\nnodes, and to a lesser extent bilateral cervical lymph nodes, may be reactive\nbut indeterminate. Recommend clinical correlation and attention on followup\nimaging." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. There\nis a punctate dural calcification towards the right region (3:40). The\nventricles and sulci are prominent, consistent with age-related global\nparenchymal loss. Periventricular, subcortical, and deep white matter\nhypodensities are nonspecific, but may represent small vessel ischemic\nchanges. There are atherosclerotic vascular calcifications of bilateral V4\nsegments of vertebral arteries and cavernous portions of internal carotid\narteries.\n\nThere is mild thickening of the ethmoidal air cells. The visualized portion\nof the mastoid air cells and middle ear cavities are clear. The visualized\nportion of the orbits are normal.", + "output": "There is no evidence of acute intracranial process or hemorrhage." + }, + { + "input": "There is a large intraparenchymal acute hematoma centered in the left frontal\nlobe spanning approximately 10.2 x 7.6 cm x 6.8 cm, with surrounding edema in\nthe left cerebral hemisphere. There is intraventricular extension of\nhemorrhage with blood in the bilateral lateral ventricles, third ventricle and\nfourth ventricle. There is an additional intraparenchymal hematoma in the\nright parietal lobe spanning 2.4 x 1.9 x 2.6 cm with surrounding edema. There\nis significant mass-effect with effacement of the left cerebral sulci and\nlateral ventricles, left subfalcine herniation, and rightward midline shift\nmeasuring up to 2.3 cm. There is left uncal herniation with effacement of the\nsuprasellar cistern. There is enlargement of the occipital and temporal horns\nof the right lateral ventricle concerning for entrapment. There is\nencephalomalacia in the left cerebellar hemisphere consistent with chronic\ninfarct.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Large intraparenchymal hematoma centered in the left frontal lobe spanning\nup to 10.2 cm with surrounding edema, intraventricular extension of\nhemorrhage, and significant mass-effect including 2.3 cm of rightward midline\nshift, left subfalcine and uncal herniation, effacement of the suprasellar\ncistern, and findings concerning for right ventricular entrapment.\n2. Additional 2.6 cm intraparenchymal hematoma in the right parietal lobe.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\non the telephone on ___ at 2:13 pm, 2 minutes after discovery of the\nfindings." + }, + { + "input": "A bilobed 2.4 x 4.7 cm hyperdense mass in the left basal ganglia is similar in\nsize and degree of surrounding vasogenic edema from the prior CT ___. However, compared to the prior CT there is a greater degree of medial\nmass effect on the uncus (02:12). However, the basilar cisterns still remain\npatent despite subtle narrowing on the left.\n\nThere is no hemorrhage or major vascular territorial infarction. The size and\nconfiguration of the ventricles and sulci are normal. Periventricular and\nsubcortical white matter hypodensities are compatible with small-vessel\nischemic changes. Osseous structures are unremarkable. There is a small mucous\nretention cyst in the right maxillary sinus. The remainder of the visualized\nparanasal sinuses and mastoid air cells are clear. Osseous structures are\nunremarkable.", + "output": "1. Grossly similar appearance of large left basal ganglia mass and surrounding\nvasogenic edema.\n2. The basal cisterns remain patent. However, there is slight medialization\nof the medial left temporal lobe. Close monitoring for signs of impending\nuncal herniation is suggested.\n\nNOTIFICATION: The findings were discussed by Dr. ___ With Dr. \n___ on the telephone on ___ at 1:01 AM, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "There is a focal area of increased density within the previously described\nbasal ganglial the lesion, which likely represents hemorrhage status post\nbrain biopsy. There is a small locule of air seen within the lesion, which is\nexpected in the postoperative period. The overall volume of the lesion has\nincreased since the prior examination with mildly increased surrounding\nvasogenic edema.\n\nThe basal cisterns remain patent. No other significant change from prior\nexamination.", + "output": "Left common basal ganglia lesion has increased in size with with the area of\nhemorrhage within the lesion status post stereotactic biopsy.\n\nNOTIFICATION: These findings were discussed with Dr. ___\ntelephone by Dr. ___ at 14:30 on ___" + }, + { + "input": "The small area of hemorrhage within the left basal ganglia lesion, seen on the\nhead CT done earlier today at 09:17 is unchanged in size and appearance. The\ndensity of the enhancing tumor is decreased from the prior study due to to the\nwashout of contrast.\n\nNo other significant change from the prior examination.", + "output": "Area of hemorrhage within the left basal ganglia lesion is unchanged from the\nprior exam at 09:17 ___.\n\nNOTIFICATION: These findings were discussed with Dr. ___\ntelephone by Dr. ___ at 14:31 on ___." + }, + { + "input": "Again seen is a 2.0 x 1.2 cm area of hemorrhage within the left basal ganglia\nlesion, largely unchanged in size from the prior examination. Effacement of\nthe left lateral ventricle is very minimally improved from the prior study.\nThere is no evidence of new hemorrhage or infarction. There is minimal\npneumocephalus anteriorly, expected in the postoperative stage.\n\nThe basal cisterns are patent.\n\nThe visualized bony structures are grossly unchanged. Again seen is a small\nmucous inclusion cyst in the right maxillary sinus, unchanged from the prior\nstudy. The remainder of the paranasal sinuses and mastoid air cells are\nnormal.\n\nThe globes are unremarkable.", + "output": "2.0 x 1.2 cm area of hemorrhage within the left basal ganglia lesion is\nlargely unchanged from prior examination." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nThere is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are preserved in size and configuration. Right cerebellar probable\nencephalomalacia is noted (see 2: ___.\n\nNo osseous abnormalities seen. Moderate ethmoid sinus disease is noted. Left\nmaxillary sinus mucosal thickening is present. Mastoid air cells, and middle\near cavities are clear. The orbits are preserved.", + "output": "1. Dental amalgam streak artifact limits study.\n2. Within limits of study, no definite evidence of intracranial hemorrhage or\nacute fracture.\n3. Right cerebellar probable chronic infarct. If concern for subacute or\nearly chronic infarct, consider brain MRI for further evaluation.\n4. Paranasal sinus disease , as described." + }, + { + "input": "Moderately limited examination due to motion artifact. Within these\nlimitations:\n\nThere is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is complete opacification of the left\nmaxillary sinus. Otherwise, visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. Moderately limited examination due to motion artifact. Within these\nlimitations, no acute intracranial process.\n2. Complete opacification of left maxillary sinus." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is complete opacification of the left\nmaxillary sinus with high density internal debris, potentially due to chronic\ninspissation versus fungal superinfection. Volume loss in the left maxillary\nsinus is also noted with slight expansion of the left orbit and asymmetric\nleft and of thalamus suggesting silent sinus syndrome. Mild mucosal\nthickening of the anterior ethmoidal air cells noted. The additional\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial process. Specifically, no intracranial hemorrhage.\n2. Complete opacification of the left maxillary sinus with high density\ncentral component suggesting chronic inspissated secretions or potentially\nfungal superinfection. Sinus is small with expansion of the left orbit and\nasymmetric left and of the most suggesting silent sinus syndrome." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No evidence of mass or other acute process. Please note that MRI with\ncontrast would be more sensitive in the detection of a seizure focus." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThere is a bovine aortic arch with common origin for the left common carotid\nartery and right brachiocephalic trunk. The carotid and vertebral arteries and\ntheir major branches appear normal with no evidence of stenosis or occlusion.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Normal head and neck CTA.\n2. Normal CT of the head.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ in person on ___ at 2:50 AM, 5 minutes after discovery of the\nfindings." + }, + { + "input": "Mild patient motion. No evidence of acute major vascular territorial\ninfarction,hemorrhage,edema, or mass. The ventricles and sulci are normal in\nsize and configuration. Atherosclerotic calcifications are seen in both\ncarotid siphons and V4 segments of the vertebral arteries.\n\nThere is no evidence of fracture. Mild mucosal thickening paranasal sinuses. \nClear mastoids. The visualized portion of the orbits are unremarkable. Mild\nanterolisthesis C2-C3, C3-C4, may be degenerative, clinically correlate.", + "output": "No acute findings.\nParanasal sinus disease, as above.\nMild anterolisthesis C2-C3, C3-C4, may be degenerative, consider plain film\nradiographs of the cervical spine if indicated." + }, + { + "input": "Study is degraded by motion. Within these confines:\n\nThere is no evidence of acute infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. Unchanged\natherosclerotic calcifications of the bilateral carotid siphons.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are preserved. An NG tube is partially visualized.", + "output": "1. Study is degraded by motion.\n2. No acute intracranial abnormality.\n3. No acute hemorrhage or mass effect. Please note MRI of the brain is more\nsensitive for the detection of acute infarct." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass affect. \nThe ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThe gray-white matter differentiation is intact without evidence of infarct,\nhemorrhage, mass, or mass effect. The ventricles and extra-axial spaces are\nunremarkable. The orbits and calvarium are normal. There is mild mucosal\nthickening within the left maxillary sinus. There is mild calcification of\nthe cartilaginous external auditory canal bilaterally and the left patent. \nIncidental note is made of a chronic right lamina papyracea fracture with\nherniation of orbital fat. The right medial rectus is unremarkable.\n\nCTA HEAD:\nThere is calcification of the bilateral carotid siphons without severe\nstenosis. The anterior and posterior circulation is patent without evidence\nof occlusion, dissection, significant stenosis, or aneurysm. The bilateral\nposterior communicating arteries are not visualized. There is a left dominant\nvertebral artery.\n\nCTA NECK:\nThere is dense calcific atherosclerosis at the bilateral carotid bulbs and\ninternal carotid arteries resulting in approximately 50% stenosis of the right\nICA and 30% stenosis of the left ICA by NASCET criteria. There is there is a\nleft dominant vertebral artery. There is a 2 vessel aortic arch with a common\norigin of the right brachiocephalic and left common carotid artery. There is\ncalcific atherosclerosis of the aortic arch. There is no evidence of\ndissection, occlusion, or aneurysm.\n\nOTHER:\nThere are sternotomy wires in place. Limited views of the lung apices are\nclear. The thyroid gland is normal. The paravertebral soft tissues are\nunremarkable. There is streak artifact from dental almalgum. There are\nmultilevel degenerative changes of the cervical spine without fracture or\nmalalignment.", + "output": "1. No acute intracranial abnormality.\n2. Patent intracranial and neck vasculature without evidence of dissection,\nocclusion or aneurysms.\n3. Approximately 50% stenosis of the right ICA 30% stenosis of the left ICA by\nNASCET criteria." + }, + { + "input": "Small areas of hypodensity in the left frontal and parietal white matter are\nseen, but better characterized on MR from ___. There are no areas\nof new hemorrhage or large vascular territory infarction. Evolution of\npreviously seen bilateral subdural fluid collection corresponding chronic\nsubdural hematomas is seen. There is no mass effect or midline shift.\n\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. There are areas of periventricular and subcortical white matter\nhypoattenuation that are nonspecific but most likely represent chronic small\nvessel disease.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. Evolution of chronic bilateral subdural hematomas with no evidence of new\nhemorrhage or large infarction.\n2. Small hypodensities in the left frontoparietal white matter correspond with\nchronic infarct and are better characterized on MR from ___." + }, + { + "input": "There is prominence of the right convexity extra-axial spaces more prominent\nover the parietal and frontal lobes, not clearly bridged by vessels which may\nreflect a subdural hygroma. In addition, there is a subtle 2 mm possible\nhyperdense component along the anterior aspect of the inferior frontal lobe\nseen best on the coronal images, example image 601:36. There is no\nmass-effect.\n\nThere is no evidence of acute, large territory infarction,\nfracture,hemorrhage,edema,or mass. Chronic infarct of the superomedial\ncerebellum (2:13, 602:42). There is prominence of the ventricles and sulci\nsuggestive of involutional changes. Periventricular and subcortical white\nmatter hypodensities are nonspecific, likely sequela of chronic ischemic small\nvessel disease.\n\nAn enlarged node adjacent to the right parotid gland measures 1 cm (3:4). The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are normal.", + "output": "Findings suggest a chronic right subdural collection with questionable thin\nless than 2 mm acute component. There is no mass-effect. MRI would verify\nthe finding, and would also help to assess for subtle ischemia if this is of\ncontinued concern.\n\nNOTIFICATION: The findings were discussed with ___ team by ___\n___, M.D. on the telephone on ___ at 10:00 am, 15 minutes after\ndiscovery of the findings." + }, + { + "input": "There is no acute intracranial hemorrhage, edema, mass effect, loss of gray/\nwhite matter differentiation, or pathologic extra-axial collection. The\nventricles, sulci, and basal cisterns are normal in size for age.\n\nThe bones are unremarkable. The imaged paranasal sinuses and mastoid air cells\nare well aerated. The orbits are grossly unremarkable on noncontrast\nassessment.", + "output": "No evidence for acute intracranial abnormalities." + }, + { + "input": "Limited evaluation secondary to streak artifact in extensive oral hardware. \nWithin these limitations, no fluid collection identified. Superficial soft\ntissue fat planes appear preserved.\n\nEvaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect. There is no retropharyngeal edema.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by CT\ncriteria. The neck vessels are patent.\n\nThere is mucosal thickening in the ethmoid air cells with a probable 1.5 x 1.3\ncm retention cyst on the left (series 2, image 12).\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions. There is prominent\nmediastinal adenopathy measuring up to 8 mm, of uncertain significance.", + "output": "1. Although limited by dental hardware streak artifact, no fluid collection or\ninflammatory changes overlying the mandible or maxilla.\n2. Probable 1.5 cm renention cyst in the left ethmoid air cells." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. No mucosal thickening is seen in the\nethmoid air cells and sphenoid sinuses. Otherwise, the remaining visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormalities" + }, + { + "input": "There is no evidence of acute major vascular territorial infarction,\nhemorrhage, edema, or large mass. There is prominence of the ventricles and\nsulci suggestive of involutional changes, age advanced.\n\nThere is no acute fracture. Mild mucosal thickening of the ethmoid air cells\nbilaterally, aerosolized posteriorly on the left. Remainder of the visualized\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Age advanced involutional changes, without fracture or intracranial\nhemorrhage.\n2. Aerosolized secretions in the left posterior ethmoid air cells." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Mild asymmetric enlargement of the left lateral\nventricle compared to the right is similar to the prior exam, without\nhydrocephalus. Mild periventricular and subcortical white matter\nhypodensities are nonspecific, but likely reflect the sequela of chronic\nmicrovascular infarction.\n\nThere is no evidence of acute fracture. Chronic deformity of the right lamina\npapyracea is re-demonstrated. A mucous retention cyst is seen in the left\nmaxillary sinus along with mild mucosal thickening. Mild mucosal thickening\nis also seen within scattered ethmoid air cells. Minimal partial\nopacification of the inferior left mastoid air cells are noted. The\nvisualized portion of the remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is subcutaneous emphysema along the occipital muscle planes at the base\nof the skull, tracking at least into the supraclavicular region on scout\nimage.\n\nThere is no evidence of infarction, hemorrhage, edema,or mass effect. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "1.\n 1. Subcutaneous emphysema along the occipital muscle planes at the base of\nthe skull extending into the upper neck, full extent not imaged. Recommend\nchest xray/imaging of the chest to assess for pneumomediastinum.\n 2. No acute intracranial findings.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 5:44 pm, 1 minutes after\ndiscovery of the findings. Findings and recommendation also discussed with\nDr. ___ by Dr. ___ on 18:15 on ___" + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of acute fracture. There is a small subgaleal hematoma\noverlying the left frontal bone. There is severe mucosal thickening of the\nleft ethmoid air cells and mild on the right. There is a moderate sized\nmucous retention cyst in the right maxillary sinus and a smaller on the left\nmaxillary sinus. The visualized portion of the remaining paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. No acute intracranial abnormalities.\n2. Moderate mucosal thickening." + }, + { + "input": "There is no evidence of large territorial infarction, intracranial\nhemorrhage,edema,or mass. The ventricles and sulci are normal in size and\nconfiguration.\n\nThere is no evidence of fracture. There is partial opacification of the\nethmoid air cells. The remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "There is no evidence of acute intracranial process or hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Hyperdense\nfocus in the right perimesencephalic cistern (2:9) is unchanged from prior,\nbetter evaluated on prior MRI. The ventricles and sulci are normal in size\nand configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process.\nRight ambient cistern nodule, better evaluated on prior MRI." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, mass effect or large\nterritorial infarction.\nA hypodense focus in the left temporal lobe posterior to the insula series 2,\nimage 13 is not confirmed on the repeat sequence and hence could be\nartifactual.\nMildly prominent ventricles and sulci is likely related to age-related\ninvolutional changes.\nThe basilar cisterns are patent common there is otherwise good preservation of\nthe gray-white matter differentiation.\n\nNo acute fracture or suspicious osseous lesion is identified.\nThere is polypoid mucosal thickening of the right maxillary sinus.\nMild mucosal thickening is seen in the left maxillary sinus.\nThe sphenoid sinuses, and the ethmoid sinuses, demonstrate mild to moderate\nmucosal thickening.\nThe mastoid air cells, and middle ear cavities are clear.\nThe globes are unremarkable.", + "output": "No acute intracranial abnormalities identified. Mild to moderate sinus\ndisease.\nCorrelate clinically and if necessary consider MRI if not contraindicated if\nneeded." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nExamination is limited by artifact from coil embolization of left internal\ncarotid artery aneurysm. There is no evidence of of infarction, hemorrhage,\nedema, or mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Areas of minimal periventricular and subcortical white\nmatter hypodensity are in a configuration most suggestive of chronic small\nvessel ischemic disease.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere are moderate atherosclerotic calcifications of the bilateral\nintracranial internal carotid arteries. Superior to the previously coiled\naneurysm, there is a new 12 x 11 mm aneurysm, possibly arising from the left\nM1, or superiorly from the internal carotid artery itself. Inferior to the\nlevel of the coiled aneurysm, there is a aneurysmal dilatation of the supra\nclinoid left internal carotid artery measuring up to 13 x 8 mm (05:229-236). \nThere is also a new 6 mm aneurysm at the distal right M1, proximal to the M2\nbifurcation (5:235). The vessels of the circle of ___ and their principal\nintracranial branches otherwise appear patent without significant stenosis, or\nocclusion The dural venous sinuses are patent.\n\nCTA NECK:\nThere is moderate atherosclerotic calcification of the aortic arch. There is\nmoderate narrowing at the origin of the left subclavian artery. There is\nmoderate narrowing at the origin of the left common carotid artery. There is\nmild narrowing at the origin of the bilateral vertebral arteries. There are\nmild to moderate atherosclerotic calcifications at the bilateral carotid\nbifurcations. There is 30% stenosis of the right internal carotid artery by\nNASCET criteria. There is no significant left internal carotid artery\nstenosis by NASCET criteria. The carotid and vertebral arteries and their\nmajor branches otherwise appear patent with no evidence of occlusionor\ndissection.\n\nOTHER:\nA right apical pulmonary cyst is noted. There is minimal dependent\natelectasis the visualized lung apices are otherwise clear. The visualized\nportion of the thyroid gland is within normal limits. There is no\nlymphadenopathy by CT size criteria.", + "output": "1. No infarct or hemorrhage.\n2. Coil embolization of a previous left internal carotid artery aneurysm.\n3. New 12 x 11 mm aneurysm superior to the previously coiled aneurysm,\npossibly arising from the left M1 segment.\n4. New aneurysmal dilatation of the supra clinoid left internal carotid artery\nmeasuring up to 13 x 8 mm.\n5. New 6 mm aneurysm arising from the right M1 of the MCA, proximal to the M2\nbifurcation.\n6. Otherwise patent intracranial vasculature without significant stenosis or\nocclusion.\n7. Scattered cervical atherosclerotic disease with mild narrowing at the\norigin of the bilateral vertebral arteries, moderate narrowing at the origin\nof the left common carotid artery, moderate narrowing of the origin of the\nleft subclavian artery and 30% stenosis of the right internal carotid artery\nby NASCET criteria.\n8. Otherwise patent cervical vasculature without occlusion or dissection." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\n\nThere is opacification of scattered bilateral ethmoid air cells. The\nremaining imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact. There is a\nsignificant amount of left periorbital soft tissue swelling.", + "output": "No acute intracranial process. Left periorbital soft tissue swelling." + }, + { + "input": "The examination is severely limited by patient motion.\n\nThere is no evidence of acute hemorrhage, edema, or mass effect. Ventricles\nand sulci are stable in size, prominent due to age-related parenchymal volume\nloss.\n\nNo gross osseous abnormalities seen.", + "output": "Severely motion limited examination without clear evidence for acute\nabnormalities." + }, + { + "input": "Please note the study is mildly degraded by motion. There is no evidence of\ninfarction, hemorrhage, edema, or mass. Prominence of the ventricles and sulci\nis indicative of atrophy. There are periventricular and subcortical\nlucencies.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Soft tissue density is noted within\nthe left external auditory canal which may represent cerumen. There is re-\ndemonstration of a at least partially calcified pannus at the anterior atlanto\noccipital junction (see series 401b, image 40). This structure is noted to\nresults in at least moderate spinal canal stenosis.", + "output": "1. Study is mildly degraded by motion.\n2. Within limits of study, no acute intracranial abnormality.\n3. Probable degenerative changes at the visualized portion of anterior atlanto\noccipital junction, resulting in at least moderate spinal canal stenosis. \nRecommend clinical correlation. Allowing for difference in technique, this\nfinding is grossly stable compared to ___ prior head CTs a study. If\nclinically indicated, further evaluation may be obtained via cervical spine\nMRI.\n4. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct." + }, + { + "input": "Study is mildly degraded by motion. No evidence of infarction, hemorrhage,\nedema, or mass. Prominence of the ventricles and sulci indicates age related\nvolume loss. Periventricular and subcortical hypodensities are nonspecific\nand likely sequela of chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Please note that the study is mildly degraded by motion. Within this limit,\nthere is no evidence of acute intracranial hemorrhage." + }, + { + "input": "There is no evidence of acute major infarction,hemorrhage,edema,or definite\nmass. The ventricles and sulci are normal in size and configuration.\n\nThere is no acute fracture. Small amount of aerosolized secretions are seen\nwithin the left sphenoid, otherwise the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Fluid is seen pooling in the\nnasopharynx related to intubation.", + "output": "No acute intracranial hemorrhage or fracture." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The basal\ncisterns are patent. There is no evidence of midline shift. The ventricles\nand sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is partial opacification of the\nmastoid air cells bilaterally. Otherwise, the visualized portion of the\nparanasal sinuses and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "No evidence of acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema,or mass effect. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Mild mucosal thickening and aerosolized\nsecretions within the bilateral ethmoid air cells. Otherwise, the visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. Soft tissue within the bilateral ear canals is likely due to\ncerumen. The visualized portion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is subtle loss of gray-white differentiation of the right insula and\npotentially of the right temporal operculum (series 3A, image 12). Allowing\nfor motion artifact, there is no evidence of intracranial hemorrhage. Sulci,\nventricles cisterns are within expected limits for the patient's age related\nglobal cerebral volume loss. Atherosclerotic calcification of the bilateral\ncavernous internal carotid arteries are noted. The paranasal sinuses are\nclear. The orbits are unremarkable. The mastoid air cells and middle ear\ncavities are well pneumatized and clear.\n\nCTA HEAD:\nThere is abrupt termination of the mid right M1 segment (series 5, image 249)\nwith paucity of distal opacification of the M2 segments. Atherosclerotic\ncalcifications of the bilateral horizontal segments and cavernous segments of\nthe internal carotid arteries are noted. Infundibular origin of the left\nmeningohypophyseal trunk is noted. Otherwise, the ACA, left MCA and their\nmajor branches are unremarkable. The left vertebral artery is dominant. \nOtherwise, the posterior circulation is unremarkable. There is no evidence of\nintracranial aneurysm. The dural venous sinuses are patent.\n\nCTA NECK: There is a normal 3 vessel arch. Mild atherosclerotic\ncalcification of the right brachiocephalic, bilateral common carotid and\nsubclavian artery origins are noted. The left vertebral artery is dominant. \nProminent atherosclerotic calcification of the left vertebral artery origin\nresults in apparent high-grade stenosis, although evaluation is slightly\nmotion degraded (series 5, image 74). The remainder of the left vertebral\nartery is unremarkable to the level of the skullbase. The right vertebral\nartery is diminutive and is likely occluded from its origin to the mid V2\nlevels.\n\nMild atherosclerotic calcification of the right carotid bifurcation does not\nresult in right internal carotid artery stenosis by NASCET criteria. \nAtherosclerotic calcification of left carotid bifurcation results in\napproximately 40% stenosis by NASCET criteria.\n\nOTHER:\nMultiple pulmonary nodules are seen in the bilateral lung apices and include 4\nx 7 mm pulmonary nodule in the left upper lobe (series 5, image 40) and a 8 x\n9 mm pulmonary nodule in the right upper lobe (series 5, image 57). Multiple\nadditional ground-glass and solid pulmonary nodules in the visualized lung\nfields. The visualized portion of the thyroid gland is within normal limits.\nThere is no lymphadenopathy by CT size criteria.", + "output": "1. There is subtle loss of gray-white differentiation of the right insula and\nright temporal operculum, compatible with right MCA distribution infarct.\n2. Abrupt occlusion of the right M1 segment with profound of lack of flow\nwithin the M2 segments.\n3. There is no intracranial aneurysm. The left vertebral artery is dominant.\n4. There is apparent high-grade stenosis of the left vertebral artery at its\norigin on CTA neck. There is apparent occlusion of the diminutive right\nvertebral artery from its origin to the mid V2 segment with thin\nreconstitution of flow.\n5. 40% stenosis of the left proximal cervical internal carotid artery by\nNASCET criteria.\n6. Multiple pulmonary nodules in the visualized lung apices, including a 9 mm\nright upper lobe lesion. Additional ground-glass and solid nodules are\nvisualized. Recommend further evaluation with dedicated chest CT when\nclinically feasible." + }, + { + "input": "Loss of gray-white matter differentiation of the right temporal lobe is now\nmuch more conspicuous and extensive, corresponding to the evolving MCA\nterritory stroke. There is effacement of sulci, consistent with local mass\neffect. No shift of normally midline structures. The perimesencephalic\ncisterns are patent. There is no evidence of hemorrhage or new infarction. \nBilateral and symmetric prominence of the ventricles and remaining sulci is\nlikely related to a age.\n\nNo evidence of fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. Evolution of known right MCA territory stroke with edema causing local\nmass effect, now evident on CT.\n2. No evidence of hemorrhage were new infarction." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nlarge mass. Mild periventricular and subcortical white matter hypodensities\nare nonspecific, but likely represent chronic small vessel ischemic disease.\nThere is mild prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture. There is a small left forehead subcutaneous\nhematoma (02:14). The visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "No fractures are identified.\nThere is a small left forehead subcutaneous hematoma. There is mild left\ninfraorbital facial hematoma. There is mild edema in the subcutaneous tissues\nof the left face.\nThere are trace aerosolized secretions in the left maxillary sinus, but the\nparanasal sinuses are otherwise essentially well aerated.\nThere is no evidence of abnormal fluid collections.\nBilateral mastoids appear normal.\nThe globes, extraocular muscles, optic nerves, and retrobulbar fat appear\nnormal.\nThe visualized upper aerodigestive tract appears normal.\nThe mandible and temporomandibular joints appear normal. Evaluation at the\nlevel of the teeth is somewhat limited by streak artifact from dental\nhardware.", + "output": "1. No fracture.\n2. Left forehead and face hematoma and edema as described." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Overall degree of involutional change is age advanced. \nVentricles are mildly prominent likely due to central atrophy. The imaged\nparanasal sinuses are clear. Postsurgical changes involving the right mastoid\nnoted. The remaining mastoid air cells are well aerated as are the middle ear\ncavities. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nright maxillary sinus and left frontal sinus. The remaining visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute vascular territorial infarction, hemorrhage,\nedema, or mass. There is mild prominence of the ventricles and sulci\nsuggestive of involutional changes. Chronic right superior frontal\nencephalomalacia is noted (series 2:image 23, series 602b:image 36, 601b:image\n40).\n\nThere is no evidence of acute fracture. Deformity of the left lamina\npapyracea is noted (series 3:image 18). The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial process. Chronic right frontal encephalomalacia." + }, + { + "input": "The patient is status post suboccipital craniotomy with expected postsurgical\nsubcutaneous air and pneumocephalus. There are defects of the posterior\noccipital bone and the posterior arch of C1. There is an approximately 2.2 x\n1.6 cm area of hemorrhage in the fourth ventricle extending into the third\nventricle and slightly into the right lateral ventricle.\n\nThere is no definite evidence of acute territorial infarction or large mass. \nChronic right superior frontal encephalomalacia is similar to ___.\nPeriventricular and subcortical white matter hypodensities are nonspecific,\nbut likely represent chronic small vessel ischemic disease. There is mild\nprominence of the ventricles, decreased in size compared to ___.\n\nThere is no evidence of acute traumatic fracture. There is mild mucosal\nthickening in the maxillary sinuses and scattered ethmoid air cells. The\nparanasal sinuses, mastoid air cells, and middle ear cavities are otherwise\nclear. Deformity of the left lamina papyracea is similar to prior.", + "output": "1. Approximately 2.2 x 1.6 cm fourth ventricular hemorrhage in extending into\nthe third ventricle and slightly into the right lateral ventricle.\n2. Postsurgical changes as described above status post suboccipital\ncraniotomy.\n3. Continued mild prominence of ventricles, decreased compared to prior exam.\n4. Please note contrast brain MRI is more sensitive for the evaluation for\nresidual mass." + }, + { + "input": "Study is mildly degraded by motion. The patient is status post suboccipital\ncraniotomy with expected postsurgical subcutaneous air and pneumocephalus. \nThere are defects of the posterior occipital bone and the posterior arch of\nC1. There is an approximately 2.3 x 1.5 cm area of hemorrhage in the fourth\nventricle extending into the third ventricle and slightly into the right\nlateral ventricle. There is trace blood in the occipital horns of the lateral\nventricles bilaterally.\n\nThere is no definite evidence of acute territorial infarction or large mass. \nChronic right superior frontal encephalomalacia is similar to ___.\nPeriventricular and subcortical white matter hypodensities are nonspecific,\nbut likely represent chronic small vessel ischemic disease. There has been\nminimal interval increase in the lateral diameter of the lateral ventricles.\n\nThere is no evidence of acute traumatic fracture. There is mild mucosal\nthickening in the right maxillary sinus and sphenoid sinuses. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare otherwise clear. Deformity of the left lamina papyracea is similar to\nprior. The visualized portion of the orbits are unremarkable. Soft tissue\ndensities are noted within bilateral external auditory canals which may\nrepresent cerumen.", + "output": "1. Study is mildly degraded by motion.\n2. Minimal interval increase in size of the lateral ventricles.\n3. Grossly stable postoperative changes related to patient's fourth\nventricular mass resection, as described.\n\nNOTIFICATION: Critical results were discussed with the ___ care NP\nby ___, M.D. on the telephone on ___ at 6:09 AM, 5 minutes after\ndiscovery of the findings, at which time she was already aware of the\nfindings." + }, + { + "input": "Status post suboccipital craniotomy with expected postoperative changes. \nApproximately 2.1 x 1.5 cm area of hemorrhage in the fourth ventricle is again\nseen and appears slightly smaller to stable compared to prior exam. Compared\nto the prior exam, the ventricular system, and in particular the third\nventricle and temporal horns of the lateral ventricles, appear larger. \nLayering hemorrhage is again seen in the occipital horns of the lateral\nventricles. Transependymal edema around the lateral ventricles is also\nincreased compared to prior exam. The area of right frontal encephalomalacia\nis stable from prior exams. There is no evidence of new hemorrhage.\n\nThere are surgical defects of the posterior occipital bone and arch of C1. \nThere is no evidence of acute traumatic fracture. The left lamina papyracea\ndeformity is stable from prior exam. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Status post suboccipital craniotomy with expected postoperative changes\nwith stable hemorrhage in the fourth ventricle. No evidence of new hemorrhage\n2. Interval increase in size in the lateral and third ventricles with\nincreased transependymal edema concerning for obstructive hydrocephalus,\nprobably secondary to blood products in the fourth ventricle.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:16 AM, 10 minutes after\ndiscovery of the findings." + }, + { + "input": "There is slightly more prominent appearance of hemorrhage in the fourth\nventricle measuring approximately 2.1 x 1.6 cm (previously 2.1 x 1.5 cm).\nCompared to most recent prior exam, enlargement of the ventricular system is\ngrossly stable. Layering hemorrhage in the occipital horns of the lateral\nventricles is also stable. An area of right frontal encephalomalacia is\nstable. There is no evidence of new large territory infarction or new\nhemorrhage.\n\nThe patient is status post suboccipital craniotomy with expected postoperative\nchanges. There is no evidence of acute traumatic fracture. Deformity of the\nleft lamina papyracea is stable from prior exams. The visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nThe visualized portion of the orbits are unremarkable.", + "output": "1. Slightly more prominent appearance of hemorrhage in the fourth ventricle\nwith stable dilation of the ventricular system. No evidence of new hemorrhage." + }, + { + "input": "Evolving postoperative changes related to fourth ventricular mass resection\nand suboccipital craniectomy are again noted. Approximately 2.2 x 1.5 cm area\nof hemorrhage in the fourth ventricle is not significantly changed since\nprior. Trace intraventricular hemorrhage in the occipital horns of the\nlateral ventricles bilaterally, slightly greater on the right, is similar to\nprior. Encephalomalacia in the right frontal lobe is similar to prior. There\nis no evidence of acute territorial infarction or large mass. Grossly stable\nmild ventriculomegaly is again noted.\n\nThe patient is status post bilateral suboccipital craniectomy with expected\npostoperative changes. There is no evidence of acute traumatic fracture. \nDeformity of the left lamina papyracea is similar to prior. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The orbits are unremarkable.", + "output": "1. Evolving postoperative changes related to fourth ventricular mass in\nsuboccipital craniectomy.\n2. Grossly stable approximately 2.2 cm fourth ventricle probable blood\nproducts.\n3. Grossly stable mild ventriculomegaly.\n4. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct." + }, + { + "input": "Patient is status post suboccipital craniotomy with fourth ventricular mass\nresection. A focus of hemorrhage in the fourth ventricle measures\napproximately 1.7 x 1.7 cm, compared with 2.2 x 1.6 cm previously. There has\nbeen interval resolution of intraventricular hemorrhage in the occipital horns\nof the lateral ventricles. Again seen is an area of right frontal\nencephalomalacia. There is no evidence of acute large territorial infarction\nor new intracranial hemorrhage. The ventricles are unchanged in appearance.\n\nA chronic deformity of the left lamina papyracea is again noted. There is no\nevidence of acute fracture. There is mild mucosal thickening in the bilateral\nmaxillary sinuses and ethmoid air cells. The visualized portion of the\nremainder of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Interval slight decrease in size of hemorrhage in the fourth ventricle,\ncurrently measuring up to 1.7 cm, compared with 2.2 cm previously, and\ninterval resolution of intraventricular hemorrhage in the occipital horns of\nthe lateral ventricles, with stable dilation of the ventricular system.\n2. No acute fracture or new intracranial hemorrhage." + }, + { + "input": "The patient is status post suboccipital craniectomy with subcutaneous fluid\nand other postsurgical changes similar to prior. There is a 6 mm focus of\nhemorrhage in the fourth ventricle, which previously measured 1.7 x 1.7 cm. \nRight frontal encephalomalacia is similar to prior. There is no evidence of\nacute territorial infarction or large mass. The ventricles and sulci are\nsimilar to prior in size and configuration.\n\nThere is no evidence of acute fracture. Chronic deformity of the left lamina\npapyracea is similar to prior. There is minimal fluid in the left mastoid air\ncells, similar to prior. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are otherwise clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute traumatic hemorrhage or contusion.\n2. 6 mm focus of residual fourth ventricle postsurgical hemorrhage, which\npreviously measured 1.7 cm." + }, + { + "input": "The patient is status post suboccipital craniectomy with subcutaneous fluid\nand unchanged postsurgical findings. There has been expected evolution of\nblood products previously seen in the fourth ventricle. No new hemorrhage is\nidentified. There is no evidence of acute large territorial infarct, edema,\nor mass effect. Prominence of the ventricles and sulci are unchanged. There\nare mild periventricular white matter hypodensities and encephalomalacia\ninvolving the right frontal lobe, unchanged.\n\nThere is no acute fracture. The paranasal sinuses and middle ear cavities are\nclear. There is a small amount of fluid layering in the posterior left\nmastoid air cells, unchanged in appearance compared to ___. A\nchronic defect of the left lamina papyracea is noted.", + "output": "1. No acute intracranial abnormality.\n2. Status post suboccipital craniectomy with expected evolution of blood\nproducts previously seen in the fourth ventricle." + }, + { + "input": "2 areas of white matter hypodensity within the right frontal lobe (series 400,\nimage 36) may reflect encephalomalacia from prior infarction. There is no\nevidence of acute territorial infarction,hemorrhage, or mass effect. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThe patient is status post midline suboccipital craniectomy and resection of\nthe posterior arch of C1 with adjacent postoperative changes within the\nmidline cerebellum. Chronic appearing deformity of the left lamina papyracea\nwith herniation of fat and displacement of the medial rectus muscle. There is\nno evidence of acute fracture. Soft tissue density within the ear canals\nbilaterally likely represent cerumen. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Otherwise, the\nvisualized portion of the orbits are unremarkable.", + "output": "1. 2 areas of white matter hypodensity within the right frontal lobe which\nlikely reflects encephalomalacia from prior infarctions. Correlation with any\navailable prior examinations is recommended or consider further assessment\nwith MRI.\n2. Status post midline suboccipital craniectomy with adjacent postoperative\nchanges in the midline cerebellum.\n3. Chronic appearing deformity of the left lamina papyracea with herniation of\nfat and displacement of the medial rectus muscle.\n\nRECOMMENDATION(S): Correlation with priors or contrast enhanced brain MRI." + }, + { + "input": "ORBITS AND SOFT TISSUES: There is skin thickening, subcutaneous edema, and\nfat stranding centered over the left orbit. There is no evidence of\nretrobulblar extension or involvement of the left globe. The left retrobulbar\nintraconal fat is clean without evidence of focal fluid collection or\nsubperiosteal abscess. Findings are consistent with preseptal cellulitis. \nThe right globe is normal in appearance.\n\nMAXILLOFACIAL BONES: The maxillofacial bones are intact, without fracture.\nThe zygomatico-maxillary complex is intact. The lateral pterygoid plates are\nintact.\n\nSINUSES: There is mild left paranasal sinus mucosal thickening ; there is\nmild left mastoid sinus polypoid mucosal thickening. Otherwise the imaged\nparanasal sinuses and mastoid air cells are clear.. The ostiomeatal units are\npatent.The middle ear cavities are clear.\n\nNOSE: There is no nasal bone fracture. Nasopharyngeal soft tissues are\nunremarkable. There is no nasal septal hematoma.\n\nAllowing for imaging technique optimized for the face, the limited included\nportion of the brain is grossly unremarkable.", + "output": "Preseptal cellulitis centered over the left orbit. No evidence of retrobulbar\nextension, focal fluid collection, subperiosteal abscess, or other\ncomplication." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. A small area\nof encephalomalacia in the left temporal lobe is unchanged. The ventricles\nand sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute major vascular territorial infarction,\nhemorrhage, edema, or mass. There is a is slightly prominent cisterna magna\nin the posterior fossa, which is considered an anatomical variation,\notherwise, the ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process, specifically, there is no evidence of\nintracranial hemorrhage." + }, + { + "input": "The study is limited by motion artifact. There is no evidence of fracture,\nacute large territorial infarction,intracranial hemorrhage,edema,or mass. \nThere are bilateral periventricular and subcortical white matter\nhypodensities, nonspecific but compatible with sequelae of chronic small\nvessel ischemic disease. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. Mild prominence of the cisterna magna is\nunchanged.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The patient is status post bilateral lens replacement\nsurgery.", + "output": "1. Study is limited by motion artifact.\n2. Within limits of study, no definite evidence of acute intracranial\nhemorrhage. Please note MRI of the brain is more sensitive for the detection\nof acute infarct." + }, + { + "input": "Bilateral cerebral subdural hematomas are re-demonstrated, left greater than\nright, without significant change from prior. The left cerebral subdural\nhematoma contains mixed density material with acute, chronic and subacute\ncomponents and measures up to 26 mm, series 2, image 18, unchanged. There is\nsignificant mass-effect on the left cerebral hemisphere with rightward\nsubfalcine herniation measuring approximately 17 mm, not changed from prior. \nThere is left uncal herniation resulting in partial effacement of the\nsuprasellar cistern though the quadrigeminal and perimesencephalic cisterns\nappear preserved. Also noted, is an acute right cerebral subdural hematoma\nwhich measures 9 mm in maximal thickness, not significantly changed from\nprior. Ventricular size is unchanged. Chronic encephalomalacia in the left\ncerebellum is again seen. No new sites of hemorrhage. Small fluid level in\nthe left maxillary sinus with aerosolized material may reflect acute sinus\ndisease. The bony calvarium is intact.", + "output": "1. Mixed density left cerebral subdural collection measures up to 26 mm with\nsignificant associated mass effect resulting in significant rightward\nsubfalcine herniation measuring 17 mm and left uncal herniation.\n2. Unchanged acute right cerebral subdural hematoma measuring 9 mm." + }, + { + "input": "The patient is status post burr hole and left subdural hematoma evacuation,\nwith a small amount of pneumocephalus at the surgical site and along the left\ncerebral hemisphere. There is a mixed density left subdural collection\nmeasuring up to 0.9 cm in maximum thickness, previously 2.6 cm, with increase\nin hyperdense components suggestive of acute hemorrhage. A right subdural\nhematoma is minimally increased, measuring up to 1.1 cm in maximal thickness,\npreviously 0.9 cm. There is substantial improvement in mass effect, with 7 mm\nof rightward midline shift, previously 17 mm. The degree of rightward\nsubfalcine herniation is also improved and left uncal herniation has resolved.\nThere is no evidence of acute large territorial infarction. Left cerebellar\nencephalomalacia is again seen. There is mild residual effacement of the left\nlateral ventricle, substantially improved.\n\nThere is no evidence of fracture. There is mild opacification of scattered\nbilateral ethmoid air cells and mild mucosal thickening of the right frontal\nsinus and right maxillary sinus. A small amount of aerosolized fluid in the\nleft maxillary sinus is unchanged. The visualized portion of the remaining\nparanasal sinuses, mastoid air cells, and middle ear cavitiesare essentially\nclear. There are bilateral lens replacements.", + "output": "1. Status post left-sided subdural hematoma and evacuation, with substantial\nimprovement in mass effect from bilateral subdural hematomas, now with 7 mm of\nrightward midline shift, previously 17 mm.\n2. The left subdural collection now measures 0.9 cm in maximum thickness,\npreviously 2.6 cm, with relative increase in hyperdense component suggestive\nof acute hemorrhage.\n3. Minimal increase in right subdural hematoma, now measuring up to 1.1 cm in\nmaximum thickness, previously 0.9 cm.\n4. Postsurgical changes including a small amount of pneumocephalus along the\nleft cerebral hemisphere." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. Small mucous retention cyst is seen in the\nfloor of the right maxillary sinus. The visualized portion of the remain\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass. Mild prominence of the ventricles and sulci is consistent with\nage-appropriate involutional changes. Mild subcortical and periventricular\nwhite matter hypodensities are nonspecific, but may reflect the sequela\nchronic microvascular ischemia.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "CTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\n Atherosclerotic changes of the carotid bifurcations are seen with 40%\nnarrowing of the right internal carotid artery and 30% narrowing of the left,\nby NASCET criteria. The vertebral arteries and their major branches appear\nnormal with no evidence of stenosis or occlusion.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No stenosis, occlusion or aneurysm formation of the intracranial arteries.\n2. 40% narrowing of the right proximal internal carotid artery and 30%\nstenosis of the left ICA by NASCET criteria." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Calcification of the the cavernous\nportions of internal carotid arteries are noted.", + "output": "1. No acute intracranial process. Specifically, no intracranial hemorrhage or\nacute large territorial infarction.\n2. Chronic changes as described above." + }, + { + "input": "Severe motion artifact limits full evaluation of the head. However, within\nthese limitations, there is an acute moderate sized subdural bleed, measuring\n2.8 cm wide, as well as subarachnoid hemorrhage in the right frontal,\ntemporal, and parietal lobe sulci. There is associated 0.9 cm leftward shift\nof normally midline structures (2a:18). There is a small subdural hematoma\noverlying the left parietal lobe, measuring 0.5 cm wide, with a small\nsubarachnoid hemorrhage in the left temporal lobe (2a:21) sulci. There is no\nevidence of acute major vascular territorial infarction. Layering fluid and\naerosolized secretions are seen in the bilateral maxillary sinuses and\nbilateral sphenoid sinuses. There is mild mucosal thickening in the bilateral\nethmoid air cells.\n\nAtherosclerotic calcifications are noted in the bilateral carotid siphons. \nMastoid air cells and middle ear cavities are well aerated. Subcutaneous gas\nin the left parietal soft tissues may indicate the region of impact following\npatient's fall. No fracture is identified.", + "output": "1. There is an acute moderate sized subdural and subarachnoid hemorrhage\nlayering in the right frontal, temporal, and parietal region with an\nassociated 0.9 cm leftward shift.\n2. Small acute subdural hematoma overlying the left parietal lobe with a small\nsubarachnoid hemorrhage noted in the left temporal lobe.\n3. Subcutaneous gas in the left parietal scalp may indicate a region of impact\nfollowing patient's fall.\n4. No acute fracture.\n5. Findings concerning for acute sinusitis, as described above.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 1:18 ___, 5 minutes after discovery\nof the findings." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nlarge territorial infarction. Prominent ventricles and sulci suggest\nage-related involutional changes or atrophy.\nThe basal cisterns appear patent and there is preservation of gray-white\nmatter differentiation.\n\nNo fracture is identified. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "The study is mildly limited by streak artifact.\n\nThere is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\nThere is no evidence of fracture. Mucous retention cysts are present in the\nleft maxillary sinus. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavitiesare otherwise clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of hemorrhage or acute infarction.\n\nNOTIFICATION: No evidence of hemorrhage or acute infarction." + }, + { + "input": "CTA head: The gray-white matter differentiation is intact without acute\nterritorial infarct, hemorrhage, mass, or mass effect. The ventricles and\ncortical sulci are normal caliber configuration. The extra-axial spaces are\nunremarkable.\n\nOrbits, soft tissues, and calvarium are unremarkable. There is moderate\nmucosal thickening within the left maxillary sinus. There is partial\nopacification of the bilateral anterior ethmoid sinuses. There is mild\nmucosal thickening within the right maxillary sinus. The mastoid air cells\nand middle ears are clear.\n\nThe bilateral intracranial internal carotid arteries are patent. The anterior\nand bilateral posterior communicating arteries are visualized. There is a\nleft fetal origin and right fetal type origin of the posterior cerebral\narteries. The posterior circulation is diminutive with codominant vertebral\narteries. The anterior and posterior circulations are patent without\nocclusion, dissection, significant stenosis, or aneurysm. There is no\nevidence of vascular malformation. Dural venous sinuses are patent\n\nCTA neck: There is a 3 vessel aortic arch. The subclavian arteries are\npatent. The right carotid artery is patent without significant stenosis by\nNASCET criteria. The left carotid artery is patent without significant\nstenosis by NASCET criteria. The vertebral arteries are patent and\ndemonstrate codominance. There is no evidence vascular occlusion, dissection,\nsignificant stenosis, or aneurysm. There is no evidence of vascular\nmalformation.\n\nThe pharynx, larynx, nasal cavity, and oral cavities are unremarkable. The\ndentition is intact. There is no fracture or osseous lesion. The masticator\nand parapharyngeal spaces are unremarkable. The thyroid and salivary glands\nare unremarkable. There are no suspicious lymph nodes by size or morphology. \nThere is a 3 mm pulmonary nodule at the right lung apex (2:64) and\npleural-parenchymal scarring at the lung apices.", + "output": "1. No acute intracranial abnormality.\n2. Patent intracranial and neck vasculature without occlusion, dissection,\nsignificant stenosis, or aneurysm. No evidence of vascular malformation.\n3. Paranasal sinus disease, as described.\n4. 3 mm right upper lobe pulmonary nodule. If patient has no clinical risk\nfactors then follow-up imaging is not required. If patient has clinical risk\nfactors (smoking history, immunocompromised, or history of malignancy), then\nrecommend follow-up noncontrast CT of the chest in 12 months to document\nstability or resolution of this findings. Of note, these recommendations are\nbased on the ___ guidelines, which apply to the patients\ngreater than ___ years old.\n\nRECOMMENDATION(S): 3 mm right upper lobe pulmonary nodule. If patient has no\nclinical risk factors then follow-up imaging is not required. If patient has\nclinical risk factors (smoking history, immunocompromised, or history of\nmalignancy), then recommend follow-up noncontrast CT of the chest in 12 months\nto but document stability or resolution of this findings. Of note, these\nrecommendations are based on the ___ Society guidelines, which apply to\nthe patients greater than ___ years old, therefore clinical discretion is\nadvised." + }, + { + "input": "The initial scan, series 2, is limited by motion artifact, but the repeated\nscan, series 5, provide good diagnostic quality.\n\nThere is no evidence of acute hemorrhage, edema, mass effect, or loss of\ngray/white matter differentiation. There is no pathologic extra-axial\ncollection. Ventricles, sulci, and basal cisterns are normal in size. \nCerebellar tonsils are normally positioned.\n\nNo concerning bone lesion is seen. There is near complete opacification of\nthe left maxillary sinus, increased compared to ___, with\nunchanged centrally hyperdense material. Mild left maxillary sinus wall\nsclerosis indicates sequela of chronic sinusitis. There is unchanged\nnear-complete opacification of several left anterior ethmoid air cells, but\nthe left frontoethmoidal recess appears patent. There is a small mucous\nretention cyst in the right maxillary sinus, new since ___. \nMiddle ear cavities and mastoid air cells are well aerated. The orbits are\nunremarkable.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. Chronic left maxillary sinusitis is again demonstrated, with increased, now\nnear complete opacification of the left maxillary sinus compared to ___. Persistent hyperdense material within the left maxillary sinus\nis compatible with inspissated secretions or fungal colonization. Also, new\nsmall mucous retention cyst in the right maxillary sinus." + }, + { + "input": "Again is noted left maxillary sinus mucosal thickening with suggested minimal\nhigh density centrally (see 02:22), decreased compared to prior examinations. \nMinimal right maxillary sinus mucosal thickening is noted. The ostiomeatal\nunits are patent. The cribriform plates are intact. There is no nasal septal\ndefect. Minimal rightward nasal septal deviation is noted. The anterior\nclinoid processes are pneumatized. The lamina papyracea are intact. The\nsphenoid sinus septum is midline with insertion upon thesellar floor.\n\nThe patient is noted to edentulous.", + "output": "1. Paranasal sinus disease as described. Question small area of high density\nmaterial within right maxillary sinus mucosal thickening which may represent\nchronic sinusitis or fungal sinusitis.\n2. Minimal rightward nasal septal deviation." + }, + { + "input": "Stable small chronic infarcts is seen at the right superior frontal gyrus,\nright centrum semiovale, stable since ___. Mild chronic small vessel\nischemic changes elsewhere.\n\nThere is no evidence of fracture, acute infarction, hemorrhage, edema, or\nmass. The ventricles and sulci are normal in size and configuration. There\nis no abnormal enhancement on post contrast images. Patent dural venous\nsinuses.\n\nThere is moderate mucosal thickening of the maxillary sinuses with small\nvolume fluid, mild opacification of the ethmoid sinus, worsened since ___, suggestive of acute paranasal sinusitis. Remaining paranasal sinuses\nare clear. Clear mastoid air cells, middle ear cavities. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Stable small chronic infarcts.\n2. Paranasal sinus disease with suggestion of acute sinusitis." + }, + { + "input": "Compared with the outside head CT from earlier today, there has been\nprogression of multi compartmental hemorrhage with increased midline shift and\nevidence of early downward herniation.\n\nThe left frontal intraparenchymal hemorrhage now measures approximately 5.1 x\n4.2 cm. A smaller 5 mm focus of hemorrhage in the superior left frontal lobe\nis unchanged (2:25). Subarachnoid hemorrhage in the right frontal lobe and\nwithin the right sylvian fissure and adjacent to the right temporal lobe is\nunchanged in appearance (___). There is intervally increased subfalcine\nherniation with 16 mm rightward shift of normally midline structures,\npreviously 8 mm (2:17). New intraventricular hemorrhage seen layering\nposteriorly in the occipital horn of the right lateral ventricle. There is\npartial effacement of the suprasellar cistern with left uncal herniation.\n\nNo acute fracture. Surgical staples overlying the right parietal scalp are\nnew. Mild mucosal thickening of the ethmoidal air cells. The visualized\nportion of the remaining paranasal sinuses, and middle ear cavities are\nclear. Partial opacification of the right mastoid air cells.", + "output": "Progressive multi compartment hemorrhage with large left frontal parenchymal\nhemorrhage, extensive bilateral subarachnoid hemorrhage and left cerebral\nsubdural hematoma. Since prior, there is worsening rightward subfalcine\nherniation and left uncal herniation indicative of early downward\ntranstentorial herniation.\n\nNOTIFICATION: The updated findings were communicated via telephone by Dr.\n___ to Dr. ___ at 19:20 on ___, 5 min after discovery." + }, + { + "input": "There is a 3.2 x 2.2 cm area of intraparenchymal hemorrhage within the left\nparietal lobe (series 2, image 20). There is substantial surrounding edema,\nwhich may be vasogenic in etiology based on the extent. Mild-to-moderate mass\neffect including loss of sulci in the left parietal and occipital lobes and\nmass effect on the occipital horn of the left lateral ventricle. No\nmeasurable midline shift. No herniation. There periventricular subcortical\nwhite matter hypodensities, which have the appearance of sequela from chronic\nmicroangiopathy.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. 3.2 x 2.2 cm intraparenchymal hemorrhage within the left parietal lobe with\nsubstantial surrounding edema and mild mass effect including loss of sulci and\ncompression of the occipital horn left lateral ventricle. Underlying mass\ncould be present. No midline shift or herniation." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. Mild predominantly periventricular white matter hypodensities are\nnonspecific, but likely represent the sequela of chronic microvascular\nischemia. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture. Mild anterior subluxation of the right\ntemporomandibular joint is likely positional. Soft tissue within the left ear\ncanal likely represents cerumen. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Mild microvascular ischemic and age-related involutional changes." + }, + { + "input": "New since the prior study are small bilateral subdural fluid collections. \nThese appear similar in density to CSF and are not typical of subdural\nhematomas. They appear to represent subdural hygromas. The etiology of these\nis unclear. They can be seen after lumbar puncture or CNS hypotension\nsyndrome. It is possible they could represent infection-related subdural\neffusions.\n\n\nThere is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal for age in size and configuration.\n\nThere is no evidence of fracture. The mastoid air cells and middle ear\ncavities are opacified bilaterally, a new finding since ___. \nThere are air-fluid levels in multiple left mastoid air cells. This new\nfinding along with the subdural hygromas would suggest infection is the\netiology. There is soft tissue swelling involving the external auditory\ncanals bilaterally, also new since the prior study.\nThe visualized portion of the paranasal sinuses are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. New bilateral subdural hygromas of uncertain etiology.\n2. New mastoid and middle ear opacification.\n3. These findings suggest the subdural fluid collections may be related to\ninfection.\n4. Otherwise unchanged examination with no evidence of hemorrhage, edema or\nmass..\n\nNOTIFICATION: The finding of bilateral subdural hygromas and possible\ninfectious etiology were discussed by telephone by ___ with ___\n___, NP at 3:25pm ___" + }, + { + "input": "There is no evidence of major vascular territory infarction, hemorrhage,\nedema, or mass. The ventricles and sulci are normal in size and configuration.\nBasal cisterns are patent. No fracture is identified. Incidental note is made\nof hyperostosis frontalis interna, unchanged from prior. Aerosolized\nsecretions and fluid level noted within the left sphenoid sinus. Remainder of\nthe visualized paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Left sphenoid sinus disease, appears acute." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nThere is complete opacification of the left maxillary sinus and mild\nopacification of the left sphenoid sinus suggesting an ongoing inflammatory\nprocess. The remaining imaged paranasal sinuses are clear. Mastoid air cells\nand middle ear cavities are well aerated. The bony calvarium is intact with\nunchanged diffuse hyperostosis, and hyperostosis frontalis interna.", + "output": "1. No acute intracranial process or hemorrhage.\n\n2. Opacification of the left maxillary sinus as described above, new since\nthe prior exam." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is a 1.5 x 1.4 cm dense mass in the right suprasellar region, with\ninvolvement of the sella. There is no evidence of no evidence of infarction,\nhemorrhage, or edema. The ventricles and sulci are normal in size and\nconfiguration for age. Areas of periventricular, subcortical and deep white\nmatter hypodensity are in a configuration suggestive of chronic small vessel\nischemic disease. There is right frontal encephalomalacia suggestive of\nchronic infarct (03:20).\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is no enhancement of the dense suprasellar mass, with mass in close\nproximity with the right A1 segment which appears somewhat irregular and a\nright portion of the anterior communicating artery. There are infundibular\norigins of the bilateral posterior cerebral and superior cerebellar arteries\nwith patulous appearance of the basilar tip.The vessels of the circle of\n___ and their principal intracranial branches appear normal without\nstenosis, occlusion, or otherwise definite aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nExamination is mildly limited by motion. There is mild atherosclerotic\ncalcification of the aortic arch. The carotid and vertebral arteries and\ntheir major branches appear normal with no evidence of stenosis or occlusion.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nMild paraseptal emphysema is noted. The visualized lung apices are otherwise\ngrossly clear. The visualized portion of the thyroid gland is within normal\nlimits. There is no lymphadenopathy by CT size criteria.", + "output": "1. 1.5 x 1.4 cm dense right suprasellar mass, without apparent enhancement on\nthe CTA images, in close proximity to the A1 segment of the right anterior\ncerebral artery which appears somewhat irregular, as a results of mass effect\nfrom the mass or possibly denoting aneurysm arising from this area. This\nrepresents either sellar/ suprasellar mass or thrombosed aneurysm. Further\ncharacterization with a gadolinium-enhanced MRI and MRA of the head is\nrecommended.\n2. Otherwise no acute intracranial abnormality.\n3. Chronic right frontal infarct.\n4. Otherwise patent intracranial vasculature without significant stenosis,\nocclusion, or definite other aneurysm.\n5. Patent cervical vasculature without significant stenosis, occlusion, or\ndissection.\n6. Mild paraseptal emphysema.\n\nRECOMMENDATION(S): Further characterization of the suprasellar mass versus\naneurysm with gadolinium enhanced MRI and MRA of the head is recommended." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nA round hyperdense right suprasellar mass measuring 15 x 16 mm, previously 14\nx 15 mm, corresponds to a partially thrombosed aneurysm that is described in\ndetail below. There is no evidence of hemorrhage, edema, mass effect, or\nacute infarction. Ventricles are stable in size and configuration. Mild\nperiventricular and subcortical white matter hypodensities are unchanged from\nprior exam, nonspecific, but compatible with chronic microangiopathy in a\npatient of this age. The visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.\n\nCTA HEAD:\nThere is interval recanalization of previously seen almost completely\nthrombosed saccular aneurysm arising from the distal A1 segment of the right\nanterior cerebral artery with the patent lumen measuring approximately 8 AP x\n12 TV x 14 SI mm (601b:17, 602b:32). The aneurysm has a narrow neck that\napproximately measures 2 mm. Diminutive appearance of the proximal right A1\nsegment is similar to the prior examination. The right A2 segment is well\nopacified.\n\nThe remainder of the vessels of the circle of ___ and their principal\nintracranial branches otherwise appear normal with no evidence of stenosis,\nocclusion, or new aneurysm. The dural venous sinuses are patent.", + "output": "1. Interval recanalization of previously almost completely thrombosed\naneurysm arising from the distal A1 segment of the right anterior cerebral\nartery with the patent lumen measuring 8 x 12 x 14 mm.\n\n2. No evidence of intracranial hemorrhage or infarction.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 14:44 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider.\n\n The findings were discussed with ___, M.D. by ___, M.D. on\nthe telephone on ___ at 3:26 ___, 50 minutes after discovery of the\nfindings." + }, + { + "input": "There is no evidence of acute major vascular territorial\ninfarction,hemorrhage,edema,or mass-effect. There is prominence of the\nventricles and sulci suggestive of involutional changes. Ill-defined\nperiventricular and subcortical white matter hypodensities are nonspecific but\nlikely due to chronic small vessel ischemic disease. Atherosclerotic\ncalcifications are seen in bilateral carotid siphons.\n\nThere is no evidence of acute fracture. A mucous retention cyst versus fluid\nlevel is noted in the left maxillary sinus. Aerosolized secretions are noted\nin the anterior ethmoid air cells. A 6 mm likely osteoma is seen in the\nanterior left ethmoid air cells. Otherwise, the remaining visualized portion\nof the paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The patient is status post bilateral lens resections", + "output": "1. No acute intracranial abnormalities.\n2. Paranasal sinus disease, as above." + }, + { + "input": "Many of the images were repeated due to motion on the initial scan.\n\nThere is no evidence of acute hemorrhage, edema, mass effect, or acute major\nvascular territorial infarction. Periventricular white matter hypodensities\nare again seen, nonspecific but likely sequela of chronic small vessel\nischemic disease in this age group. Mild global parenchymal volume loss is\nagain seen with prominent ventricles and sulci.\n\nThere is no evidence of fracture. Again seen is a 5 mm osteoma in the left\nethmoid air cells. There a right middle ethmoid air cell is opacified. There\nare aerosolized secretions in the left middle ethmoid air cell. There is mild\nmucosal thickening within other anterior ethmoid air cells bilaterally,\nextending into the inferior frontal sinuses. There is also mild mucosal\nthickening within bilateral maxillary sinuses. Mastoid air cells are well\naerated. Status post bilateral cataract surgery.", + "output": "1. No evidence for acute intracranial abnormalities. Stable CT appearance of\nthe brain.\n2. Paranasal sinus disease. Aerosolized secretions in the left ethmoid may\nindicate active inflammation. Please correlate with symptoms." + }, + { + "input": "Motion artifact limits evaluation of the lower portion of the brain. \nOtherwise, there is no evidence of acute hemorrhage, edema, mass effect, or\nacute major vascular territorial infarction. The ventricles and sulci are\nnormal in size and configuration. There are a few hypodensities within the\nsupratentorial white matter bilaterally which are nonspecific but may\nrepresent mild chronic small vessel ischemic disease. Mild age-related global\nparenchymal volume loss is also again seen.\n\nThere is no evidence of fracture. There is a 5 mm osteoma in the left\nanterior ethmoid, which is unchanged compared with previous. There is mild\nmucosal thickening in the maxillary sinuses and anterior ethmoid air cells,\nextending into the frontoethmoidal recesses bilaterally and into the inferior\nleft frontal sinus. Mastoid air cells appear grossly clear.", + "output": "Motion limited exam without evidence for acute intracranial abnormalities." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nPeriventricular and subcortical white matter hypodensities are nonspecific but\nlikely reflect sequelae of chronic microvascular ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. 4\nmm osteoma in the left anterior ethmoid is unchanged compared to the prior\nexam (5:7) . The visualized portion of the orbits are notable for bilateral\nlens replacements.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "There is no evidence of acute large territorial infarction, acute intracranial\nhemorrhage, edema, or mass effect. The ventricles and sulci are normal\nprominent, likely age-related involutional changes. Periventricular and\nsubcortical hypodensities are nonspecific, but likely reflect chronic small\nvessel ischemic changes.\nSoft tissue swelling/small scalp hematoma is seen overlying the right parietal\nregion. No acute fracture is seen. 4 mm osteoma in the left anterior ethmoid\n(03:12) is unchanged. The paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. Status post bilateral lens replacements.", + "output": "1. No acute intracranial process.\n\n2. Right parietal scalp soft tissue swelling/small hematoma without\nunderlying acute fracture ." + }, + { + "input": "No evidence for acute intracranial hemorrhage, edema, mass effect, or acute\nmajor vascular territorial infarction. Periventricular and subcortical white\nmatter hypodensities are nonspecific but unchanged and likely represent\nchronic small vessel ischemic changes. There is mild age-related prominence\nof the ventricles and sulci.\n\n4 mm osteoma in the left anterior ethmoid air cells is unchanged. There is\nmild mucosal thickening in the ethmoid air cells and maxillary sinuses. \nMastoid air cells are well aerated. Patient is status post bilateral lens\nreplacements.", + "output": "No evidence for an acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, or loss of gray/ white matter\ndifferentiation. The ventricles and sulci are normal in size and\nconfiguration. Basal cisterns are normal in size.\n\nNo fracture seen. There is a small amount of fluid and secretions in the left\nsphenoid sinus. There is a small focus of mucosal thickening along the\nanterior wall of the right sphenoid sinus. There is mild mucosal thickening\nin bilateral anterior ethmoid air cells. Mastoid air cells and middle ear\ncavities are well aerated. The orbits are unremarkable.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. Fluid in the left sphenoid sinus. Please correlate clinically whether\nthere a any symptoms of acute sinusitis." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect or\nlarge territorial infarction. The ventricles and sulci are normal in size\nconfiguration. The basal cisterns are patent. Gray-white matter\ndifferentiation is preserved.\n\nThere is no osseous abnormality. The mastoid air cells and middle ear cavities\nare clear. There is mild mucosal thickening in the frontal and sphenoid\nsinuses. There is new complete opacification of numerous bilateral ethmoid air\ncells. There is severe mucosal thickening in the partially imaged right\nmaxillary sinus and mild thickening in the left maxillary sinus. The orbits\nare unremarkable.", + "output": "Notable paranasal sinus disease. No air-fluid levels but significant mucosal\nthickening. No acute intracranial abnormality otherwise demonstrated." + }, + { + "input": "There is encephalomalacia with ex vacuo dilatation in the left occipital lobe,\nlikely from a old infarction. Hypodensity in the right parietal lobe, series\n2, image ___ also be secondary to encephalomalacia from chronic infarction\nhowever adjacent area of edema is concerning for ischemia, particularly in\nlight of patient's symptoms and absence of prior exams. No acute intracranial\nhemorrhage is identified. The basilar cisterns are patent.\n\nNo fractures are seen. The visualized paranasal sinuses the mastoid air cells\nand middle ear cavities are clear. The globes are unremarkable.", + "output": "1. Hypodensity in the right parietal lobe may be secondary to\nencephalomalacia however subtle adjacent areas of edema is concerning for\nischemia. An MRI may be helpful for further evaluation, particularly in light\nof the patient's symptoms and lack of prior exams for comparison. No acute\nintracranial hemorrhage.\n\n2. Encephalomalacia with ex vacuo dilatation in the left occipital lobe is\nlikely secondary to a chronic infarction." + }, + { + "input": "CTA Head and Neck: There is no evidence of large vessel occlusion,\ndissection, or aneurysm > 3 mm. The carotid and vertebral arteries and their\nmajor branches are patent with no evidence of stenoses. The right internal\ncarotid artery measures 9 mm proximally and 4 mm distally. The left internal\ncarotid artery measures 11 mm proximally and 5 mm distally. Moderate\ncentrilobular emphysema is noted. A 3 mm calcified lung nodule is noted in the\nright upper lobe (2:66). The thyroid is unremarkable.", + "output": "No evidence of flow-limiting stenosis in the cervical and intracranial\ninternal carotid and vertebral arteries and their major branches." + }, + { + "input": "Again noted are areas of encephalomalacia in the right parietal and left\noccipital lobes. There is also ex vacuo dilatation of the occipital horn of\nleft lateral ventricle. The ventricles and sulci are prominent, consistent\nwith global atrophy. There is no acute hemorrhage, edema, mass effect or\nshift of normally midline structures. The basal cisterns appear patent. The\norbits and globes are unremarkable. The imaged paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear.", + "output": "No acute intracranial abnormality." + }, + { + "input": "Re-demonstration of encephalomalacia in the right parietal and left occipital\nlobes with ex vacuo dilatation of the left occipital horn. There is no acute\nintracranial hemorrhage, new large vascular territory infarction, edema, or\nmass effect. Basal cisterns are patent. The ventricles and sulci are\nprominent in size and configuration consistent with age related atrophy.\n\nThere is no evidence of fracture. Hardware is noted in the frontal and nasal\nbone, similar to prior. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. No acute intracranial process such as hemorrhage or new large vascular\nterritory infarction.\n2. Re-demonstration of encephalomalacia in the right parietal and left\noccipital lobes from prior infarcts." + }, + { + "input": "There is ventriculomegaly out of proportion to sulcal enlargement. There is\nno evidence of obstructing mass or lesion. These findings may represent normal\npressure hydrocephalus. The basal cisterns are patent. There is no shift of\nnormally midline structures. There is no evidence of hemorrhage, large\nvascular territorial infarct, or brain edema. The visualized paranasal sinuses\nand mastoid air cells are clear. The patient is status post bilateral lens\nremoval. The globes and orbits are otherwise unremarkable. There is no\nevidence of fracture.", + "output": "1. Ventriculomegaly out of proportion to sulcal enlargement. No evidence of\nobstructing mass or lesion. These findings can be seen in the setting of\nnormal pressure hydrocephalus.\n2. No evidence of hemorrhage or large vascular territorial infarct." + }, + { + "input": "Head CTA: There is no evidence of aneurysm, vascular malformation, or\nocclusion within the intracranial vasculature. The anterior cerebral arteries,\nmiddle cerebral arteries, and posterior cerebral arteries appear normal. The\ndural venous sinuses appear patent.\n\nThe prominent ventricular size appears unchanged when compared to prior exam.\n\nThere is a left maxillary sinus mucosal retention cyst.\n\nNeck CTA: There is atherosclerotic plaque within the aortic arch. The origins\nof the great vessels are patent. The aortic arch demonstrates conventional\nthree-vessel branch configuration. The left vertebral artery is dominant. The\nright vertebral artery terminates in a posterior inferior cerebellar artery.\nThere is mild atheromatous irregularity at the origins of the bilateral\nproximal internal carotid arteries without stenosis by NASCET criteria.\n\nThere is biapical pulmonary scarring. The thyroid gland, submandibular glands,\nand parotid glands appear normal. Scattered subcentimeter lymph nodes are\nseen throughout the neck bilaterally, without definite lymphadenopathy by size\ncriteria. No osseous lesions are seen. There is multilevel cervical\nspondylosis.", + "output": "1. No evidence of aneurysm, stenosis, or occlusion within the vasculature of\nthe head and neck\n2. Stable ventriculomegaly, again noted to be out of proportion to the sulci.\nFindings concerning for possible normal pressure hydrocephalus. Recommend\nclinical correlation." + }, + { + "input": "No intra-axial or extra-axial hemorrhage, edema, shift of normally midline\nstructures or evidence of acute major vascular territorial infarction. There\nis ventriculomegaly which appears stable to marginally increased from the\nprior exam with third ventricle measuring 13 mm in transverse dimension,\npreviously 12 mm. No evidence of transependymal CSF migration. Involutional\nchanges are age appropriate. Imaged bony structures are intact. Sinus bases\nare well aerated. Middle ear cavities are well aerated.", + "output": "Ventriculomegaly, stable to marginally increased. No hemorrhage." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere are low-attenuation changes in the posterior left insular region and\nleft temporoparietal region, better demonstrated on the MRI head dated ___, compatible with infarction. A smaller focus of hypoattenuation in the\nleft parietal lobe also corresponds to a known subacute left MCA territory\ninfarct. Subtle hyperdensity in this region likely relates to hemorrhagic\ntransformation, better demonstrated on the prior MRI. No evidence of new\nlarge territorial infarction. No evidence of new intracranial hemorrhage.\n\nThe ventricles remain prominent in size and configuration. No mass effect or\nmidline shift.\n\nThere are small air-fluid levels in the left maxillary and left sphenoid\nsinuses. Ovoid soft tissue densities in the right greater than left orbits are\nbetter assessed on preceding brain MRI. There is mass effect on the right\nmedial rectus muscle.\n\nCTA HEAD:\nModerate nonocclusive calcified and noncalcified atherosclerotic plaques of\nthe cavernous internal carotid arteries bilaterally. There is mild luminal\nirregularity of the left M1 segment, likely due to atherosclerotic disease. \nOtherwise, the vessels of the circle of ___ and their principal\nintracranial demonstrate normal opacification without evidence of occlusion. \nThe dural venous sinuses are patent.\n\nCTA NECK:\nStandard 3 vessel aortic arch with mild to moderate scattered atherosclerotic\ncalcifications and narrowing of the right brachiocephalic artery. Left\nsubclavian artery origin occlusion with reconstitution at the level of the\nleft vertebral artery origin, which is severely stenotic. Mild\natherosclerotic calcifications of the right vertebral artery origin. \nOtherwise, the vertebral arteries demonstrate opacification without evidence\nof occlusion.\n\nThere is approximately ___ stenosis of the proximal right internal carotid\nartery by NASCET criteria due to calcified plaque. There is approximately 10%\nstenosis of the proximal left internal carotid artery by NASCET criteria due\nto calcified and noncalcified plaque otherwise, the common carotid, internal\nand external carotid arteries and their major branches demonstrate\nopacification with no evidence of occlusion.\n\nOTHER:\nThere are small to moderate bilateral pleural effusions with associated\npassive collapse. There is severe emphysematous changes. Left upper lobe and\nto a lesser extent right upper lobe and bilateral superior segment lower lobe\nground-glass opacities are present. There is interlobular septal thickening\nlikely reflecting pulmonary edema.\n\nThe thyroid is heterogeneous in appearance. There are a number of bilateral\nsubcentimeter cervical chain lymph nodes, but otherwise no lymphadenopathy by\nCT size criteria.\n\nThe patient is edentulous. Partially visualized nasoenteric tube. Partially\nvisualized right internal jugular approach port catheter extending into the\nSVC.\n\nMild anterolisthesis of C3 on C4, C4 on C5, and C5 on C6. No suspicious\nosteolytic or osteoblastic lesions.", + "output": "1. Evolving infarction in the posterior left insula and left temporoparietal\nregion. Subtle hyperdensity likely relates to known hemorrhagic\ntransformation.\n2. Occlusion of the left subclavian artery with reconstitution at the level of\nthe left vertebral artery. This is presumably a case of subclavian steal.\n3. Severe stenosis at the origin of the left vertebral artery.\n4. Mild-to-moderate narrowing at the origin of the right brachiocephalic\nartery.\n5. Moderate nonocclusive atherosclerotic calcification of the cavernous ICAs\nbilaterally. Otherwise, patent circle of ___ with no evidence of\nocclusion.\n6. Small to moderate bilateral pleural effusions with associated passive\ncollapse and patchy ground-glass opacities, greatest in the left upper lobe\nalong with interlobular septal edema. The constellation of findings may\nreflect pulmonary edema. A superimposed infectious process is possible in the\nproper clinical setting.\n7. Redemonstration of ovoid shaped densities in the bilateral orbits, right\ngreater than left, with mass effect on the right medial rectus muscle. This\nis better evaluated on the prior MRI dated ___." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no intra or extra-axial mass effect, acute hemorrhage or large\nterritory infarct. Left posterior insula and temporoparietal lobe\nencephalomalacia from prior infarct is visualized. There is also mild\nsuperimposed periventricular and subcortical white matter hypodensities,\nnonspecific, but compatible with chronic microangiopathy in a patient of this\nage. The sulci, ventricles and cisterns are within expected limits for the\ndegree of moderate senescent related global cerebral volume loss. Dependent\nmucosal thickening in the left maxillary sinus is moderate. There is mild\nmucosal thickening of the remainder of the paranasal sinuses. Known right\norbital venous varices or vascular malformations are unchanged resulting in\nstable proptosis of the right globe. The remainder of the orbits are\notherwise unremarkable. The mastoid air cells middle ears are well\npneumatized and clear.\n\nCTA HEAD:\nThere is mild atherosclerotic calcification of the cavernous and paraclinoid\ninternal carotid arteries without significant stenosis. The MCA, ACA and\ntheir major branches are unremarkable without evidence of high-grade stenosis,\nocclusion or aneurysm. The posterior circulation is unremarkable, noting\nright vertebrobasilar dominance. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is mild atherosclerotic calcification of the aortic arch, origins of the\nright brachiocephalic, bilateral common carotid arteries without high-grade\nstenosis. There is occlusion of the left subclavian artery from its origin to\nthe thoracic outlet, with distal reconstitution. Atherosclerotic disease at\nthe origin of the left vertebral artery the results in moderate narrowing. \nThe remainder of the vertebral artery is unremarkable. The dominant right\nvertebral artery is unremarkable.\n\nThe bilateral common carotid arteries are unremarkable. Motion artifact\ndegrades evaluation of the carotid bifurcations. Atherosclerotic\ncalcification of the carotid bifurcations within this confines, is likely\nunchanged from prior examination and results in approximately ___ stenosis\nof the proximal right internal carotid artery and 10% stenosis of the proximal\nleft internal carotid artery by NASCET criteria.\n\nCT PERFUSION:\nCBF greater than 20% is 0 mL.\nT-max greater than 6.0 seconds is 0 mL\nNo mismatch ratio\n\nOTHER:\nCentrilobular emphysematous changes are identified. Patchy airspace opacities\nof the left upper and lower lobe is noted, which may be\ninfectious/inflammatory in etiology. Residual small left pleural effusion. \nNo suspicious osseous lesions. There is no cervical lymphadenopathy by size\ncriteria. The thyroid is unremarkable. The visualized aerodigestive tract is\nwithin expected limits.", + "output": "1. No acute abnormality on noncontrast CT head. Specifically no evidence of\nacute large territory infarct or intracranial hemorrhage. Expected involving\nsequela of left MCA infarct from prior examination.\n2. Allowing for atherosclerotic disease, unremarkable CTA of the head.\n3. No findings suggesting infarct core on perfusion.\n4. Unchanged occlusion of the proximal left subclavian artery with\nreconstitution at the level of the thoracic inlet. Allowing for\natherosclerotic disease, the remainder of the CTA neck is unremarkable. \n___ stenosis of the right cervical internal carotid artery and 10% stenosis\nof the left cervical internal carotid artery by NASCET criteria, unchanged\nfrom prior exam.\n5. Centrilobular emphysema with airspace opacifications of the left upper\nlung, which may represent infectious etiology versus aspiration. A small left\npleural effusion has decreased in size.\n6. Additional findings described above, including unchanged right orbital\nvenous varices or vascular malformations." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is a subtle region of left parietal encephalomalacia in area of prior\ninfarct, with subtle cortical density which may represent cortical laminar\nnecrosis (03:20). There is no evidence of intracranial hemorrhage edema or\nmass effect. There is mild prominence of the ventricles and sulci suggestive\nof involutional changes. Areas of confluent periventricular, subcortical, and\ndeep white matter hypodensity are in a configuration most suggestive of\nchronic small vessel ischemic disease. Small punctate calcification is noted\nin the left temporal region, likely consistent with vascular calcification\n(series 3:17), which apparently is new since ___.\n\nThere is trace mucosal wall thickening in the floor of the left maxillary\nsinus. The remainder of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\nSoft tissue density is noted in the left external auditory canal, likely\ncerumen.\n\nCTA HEAD:\nThere is a left dominant vertebrobasilar system. There is ___ termination of\nthe right vertebral artery. There is normal variant fetal type origin of the\nright posterior cerebral artery. There are mild atherosclerotic\ncalcifications of the bilateral intracranial internal carotid arteries without\nsignificant narrowing. The vessels of the circle of ___ and their\nprincipal intracranial branches otherwise appear patent without significant\nstenosis, occlusion, or aneurysm formation. The dural venous sinuses are\npatent.\n\nCTA NECK:\nThere are mild to moderate atherosclerotic calcifications in the visualized\naortic arch. There are mild to moderate atherosclerotic calcifications at the\norigins of the great vessels, without significant narrowing. The right\nvertebral artery appears diffusely hypoplastic, likely congenital. Scattered\natherosclerotic calcifications are noted along the proximal left vertebral an\nbilateral common carotid arteries without significant narrowing. There are\nsevere atherosclerotic calcifications at the left carotid bifurcation, with\nsevere narrowing of the distal common carotid artery (5:160). There is at\nleast 80% narrowing of the left internal carotid artery at its origin by a\nNASCET criteria, with estimation made difficult by the irregular configuration\nof atherosclerotic plaque. There are moderate atherosclerotic calcifications\nat the right carotid bifurcation producing roughly 40% stenosis of the right\ninternal carotid artery by NASCET criteria. The carotid and vertebral\narteries and their major branches otherwise appear patent with no evidence of\ndissection or occlusion.\n\nOTHER:\nThere is mild centrilobular emphysema. A triangular area of a subpleural\ndensity in the posterolateral aspect of the left upper lobe measuring 12 x 12\nmm has minimally increased in size compared to ___, and appears more\ndense than on that examination. The visualized portion of the lungs are\notherwise clear. The visualized portion of the thyroid gland is within normal\nlimits. There is no lymphadenopathy by CT size criteria. Moderate multilevel\ncervical spondylosis is identified, more significant from C4 through C6\nlevels.", + "output": "1. Subtle region of left parietal encephalomalacia in area of prior infarct\nwith areas of gyriform density which may represent cortical laminar necrosis. \nOtherwise no definite hemorrhage or new large territorial infarct.\n2. 80% stenosis of the left internal carotid artery and 40% stenosis of the\nright internal carotid artery by NASCET criteria.\n3. Severe stenosis of the distal left common carotid artery at the level of\nthe carotid bifurcation.\n4. Otherwise patent cervical arterial vasculature without occlusion, or\ndissection.\n5. Patent intracranial arterial vasculature without significant stenosis,\nocclusion, or aneurysm formation.\n6. Apparent slight interval increase in size and increase of density of a 12 x\n12 mm triangular density in the left upper lobe, though direct comparison is\nprecluded by difference of technique. Short-term follow-up with dedicated\nchest CT examination is advised in 3 months to confirm a real change in size\nand morphology, given background emphysema which increases malignancy risk." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Atherosclerotic\ncalcifications noted within the intracranial ICAs.\n\nMucosal thickening noted in the ethmoid air cells and maxillary sinuses.. \nSkull and extracranial soft tissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Head CT: There is no evidence of hemorrhage, edema, mass effect or\ninfarction. Ventricles and sulci are normal in size and configuration. The\nbasal cisterns appear patent there is preservation of gray-white matter\ndifferentiation. No fracture is identified. There is opacification of the\nright anterior and posterior ethmoidal air cells and opacification of the\nnasal cavity. Otherwise the visualized paranasal sinuses, mastoid air cells\nand middle ear cavities are clear. There is a soft tissue swelling involving\nthe right orbit. There is a Large retro-orbital hematoma re- demonstrated.\n\nIncomplete C-spine: No fracture or malalignment identified. Examination was\nonly performed through the C7 level. No disc intervertebral abnormality seen.\nCT is not able to provide intrathecal detail comparable to MRI but the\nvisualized alkaline of the thecal sac appears unremarkable.", + "output": "1. Right retro-orbital extraconal hematoma. Orbit CT can help for further\nassessment.\n2. Right periorbital soft-tissue swelling.\n3. No evidence of hemorrhage, edema, mass effect or infarction.\n4. No evidence of fracture or acute malalignment of the C-spine." + }, + { + "input": "Within the right parotid gland is a 1.5 x 1.0 cm soft tissue density\ncompatible with enlarged lymph node. This lesion correlates with FDG avid\nlesion on recent PET-CT. Given differences in technique, subtle interval\nchanges in size are difficult. The additional FDG avid node in the right at\nlevel 2 (02:35), is a not pathologically enlarged 1.2 cm long axis lymph node.\nOther scattered non pathologically enlarged nodes are seen bilaterally. The\nleft parotid gland andsubmandibular glands are unremarkable. The thyroid is\nsomewhat heterogeneous but without discrete nodule.\n\nThe included paranasal sinuses and mastoids are clear.\n\nThe somewhat prominent adenoidal tissues noted within the nasopharynx and\nprominent palatine tonsils are noted. The aerodigestive tract is otherwise\nunremarkable.\n\nThe lung apices are clear.\n\nMajor vascular structures in the neck are unremarkable. Included intracranial\nstructures are unremarkable. Osseous structures are unremarkable.", + "output": "Enlarged right-sided intraparotid lymph node compatible with FDG avid lesion\non prior PET-CT. While this could be reactive, recurrent lymphoma is also\npossible.\nPreviously noted FDG avid right level 2 lymph node is not pathologically\nenlarged." + }, + { + "input": "Heterogeneously enhancing 1.4 x 1.1 x 1.6 cm (TRV, AP, SI) right parotid gland\nlesion the is unchanged in size from examination of ___. Previously\ndescribed ___ avid right level 2A node (series 3, image 42) is similar in size\nto prior exam measuring approximately 1 cm in long axis. There is no cervical\nlymphadenopathy by size criteria. The submandibular glands and left parotid\ngland are unremarkable.\n\nProminent adenoids are again seen. The visualized aerodigestive tract is\notherwise unremarkable. The thyroid gland is heterogeneous but without\ndefinitive focal lesion.\n\nThe paranasal sinuses are clear. The visualized orbits are unremarkable. The\nmastoid air cells and middle ear cavities are well pneumatized and clear. \nCervical vessels are patent and unremarkable. Visualized brain parenchyma are\nalso unremarkable. The lung apices are clear. No suspicious blastic or lytic\nosseous lesions.", + "output": "1. Heterogeneously enhancing right parotid 1.4 cm lesion, potentially an intra\nparotid lymph node, is unchanged in size.\n2. There is no cervical lymphadenopathy by size criteria. Previously\ndescribed FDG avid level 2 lymph node is unchanged in appearance." + }, + { + "input": "There is no evidence of fracture, infarction, hemorrhage, edema or mass. The\nventricles and sulci are normal in size and configuration. There is no\nabnormal enhancement on post contrast images. The visualized portion of the\norbits are unremarkable. There is mild opacification of the right mastoid air\ncells, otherwise the sinuses are clear.", + "output": "1. No acute intracranial abnormality.For assessment of the postsurgical and\ninflammatory changes in the region of the right ear please see the CT neck\nfrom the same date." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect.\n\nPostsurgical changes are noted superficial to the right angle of the mandible.\nSkin thickening and superficial soft tissue stranding is noted along the\nposterolateral right periauricular neck. No focal fluid collection is seen. \nOtherwise, the salivary glands enhance normally and are without mass or\nadjacent fat stranding. The thyroid gland appears normal. A submandibular\nlymph node measures up to 1.2 cm. Additional lymph nodes are prominent but\nnot enlarged by CT size criteria. The neck vessels are patent. There is\nminimal opacification of the right mastoid air cells.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions or osseous destruction.", + "output": "1. Inflammatory changes of the superficial soft tissues of the right\nperiauricular head and neck without evidence of focal fluid collection or\ninvolvement of the deep spaces of the neck." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of large territorial\ninfarction,hemorrhage,edema,ormass-effect. The ventricles and sulci are\nage-appropriate. Periventricular and subcortical white-matter hypodensities\nare nonspecific, but likely represent sequela of chronic microangiopathic\ndisease.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. Patient is post right native lens replacement. The\nleft orbit is unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nThere is fetal origin of the left posterior cerebral artery. There is\nmoderate right and mild left calcification the cavernous and clinoid segments\nof the internal carotid arteries.\n\nCTA NECK:\nCalcified atherosclerotic disease at the right carotid bulb results in\nmoderate to severe focal narrowing of the proximal right external carotid\nartery (03:149). The vessel demonstrates normal luminal caliber and good\ncontrast opacification distally. There is mild calcification of the left\ncarotid bulb.\n\nThe other carotidandvertebral arteries and their major branches are patent\nwithout evidence of occlusion, dissection or aneurysm formation. There is no\nevidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe imaged thyroid gland is unremarkable. There is no lymphadenopathy by CT\nsize criteria. Minimal scarring is noted in the bilateral lung apices. The\nesophagus is patulous.", + "output": "1. No acute intracranial process.\n2. Bilateral supratentorial white matter hypodensities are nonspecific, but\nlikely represent sequela of chronic microangiopathic disease.\n3. Patent cerebral vasculature.\n4. Focal moderate to severe narrowing at the origin of the right external\ncarotid artery secondary to calcified atherosclerotic disease. The other\nmajor neck arterial vessels are patent." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Subcortical white matter\nhypodensity in the right frontal lobe is unchanged from prior MRI. Ventricles\nand sulci are unremarkable. Vascular calcifications are noted.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or infarction.\n\nThe ventricles and sulci are normal in size and configuration.\n\nThe basal cisterns appear patent and there is preservation of gray-white\nmatter differentiation.\n\nThe visualized bony structures are grossly unremarkable.\n\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nThe head looks okay and\n\nThe globes are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, mass, mass effect or\nlarge territorial infarction. The basilar cisterns are patent and there is\ngood preservation of the gray-white matter differentiation. The ventricles and\nsulci are normal in size and configuration.\n\nNo acute fracture is identified. The visualized paranasal sinuses, mastoid air\ncells and middle ear cavities are clear. The globes are unremarkable. Note is\nmade of a moderate right periorbital hematoma with a small amount of\nsubcutaneous gas, the eye globes are intact.", + "output": "No acute intracranial abnormalities identified.\n\nRight periorbital hematoma as described above." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are normal.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. Fetal type right\nposterior cerebral artery is noted as well as a short fenestration of the\nproximal basilar artery (3:191), anatomic variants. The dural venous sinuses\nare patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. Debris in the right external auditory canal likely reflects\ncerumen.", + "output": "1. No acute intracranial abnormality.\n2. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n3. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nLarge frontal scalp hematoma, appears significantly increased in size and\ndensity compared to prior CT scan performed ___. There is\nheterogeneous opacification of the bilateral mastoid air cells and ethmoid air\ncells, suggestive of blood products. Please see dedicated maxillofacial for\ndescription of multiple fractures. Right mastoid air cell opacification with\nfluid in the right middle ear. The visualized portion of the bilateral orbits\nare grossly unremarkable.", + "output": "1. No evidence of infarction, hemorrhage, edema, or mass.\n2. Large frontal scalp hematoma, appears significantly increased in size and\ndensity compared to prior CT scan performed ___." + }, + { + "input": "Multiple nasal bone fractures (series 2, images 46-50) as well as bilateral\nmaxillary sinus fractures (series 601, image 46), with almost complete\nopacification of the bilateral maxillary sinuses, sphenoid sinuses, ethmoid\nair cells, and mild thickening of left frontal sinus. Mixed density\nenhancement of the bilateral maxillary sinuses, ethmoid air cells, and\nsphenoid sinuses, are suggestive of blood products. There appears to be\npacking material in the nasal and oral cavities. There is a large frontal\nscalp hematoma. Degenerative disease of the left temporomandibular joint is\nappreciated. Endotracheal tube is partially visualized.\n\nRight mastoid air cell opacification with fluid in the middle ear cavity. \nLeft mastoid air cells and middle ear cavity are clear.\n\nPeriapical lucencies of the left maxilla, are suggestive of periodontal\ndisease.\n\nThe visualized globes, extraocular muscles, optic nerves, and retrobulbar fat\nappear normal.", + "output": "1. The multiple nasal bone and bilateral maxillary sinus fractures with almost\ncomplete opacification of the bilateral maxillary sinuses, sphenoid sinuses,\nand ethmoid air cells, with mixed density enhancement suggestive of blood\nproducts.\n2. Large frontal scalp hematoma.\n3. Right mastoid air cell opacification with fluid in the middle ear cavity.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 6:15 pm, 10 minutes after\ndiscovery of the findings." + }, + { + "input": "Extensive blood and soft tissue changes in the sinuses and frontal soft tissue\nswelling is identified as before. The frontal scalp soft tissue swelling and\nperiorbital soft tissue swelling has decreased.\n\nThere is increased density seen along the right side tentorium better\nvisualized on the current study indicative of a small tentorial subdural\nhematoma. There is mild brain atrophy seen. There is no midline shift or\nhydrocephalus. No evidence of brain edema.", + "output": "1. Small right tentorial subdural hematoma is better appreciated on the\ncurrent study.\n2. No new intracranial axial hemorrhage or brain edema. No signs of\nherniation or midline shift.\n3. Extensive blood and soft tissue changes within the sinuses as before with\ndecreased frontal soft tissue swelling." + }, + { + "input": "Previously seen small right paratentorial subdural hematoma has resolved. \nThere is no new hemorrhage. There is no edema, mass effect, or CT evidence\nfor an acute major vascular territorial infarction. The ventricles and sulci\nare prominent due to mild global parenchymal volume loss. Nonspecific\nperiventricular, deep, and subcortical white matter hypodensities are likely\nsequela of chronic small vessel ischemic disease in this age group.\n\nCompared to ___, previously seen bifrontal subgaleal hematoma and\nright larger than left periorbital/zygomatic hematomas have decreased in size.\nPlease refer to maxillofacial CT performed on the same day regarding the\nfacial fractures, orbits, and paranasal sinus abnormalities. Bilateral middle\near cavities and left mastoid air cells are well aerated. There is persistent\nnear complete opacification of right mastoid air cells compared to ___.", + "output": "1. Resolution of right paratentorial subdural hematoma. No new hemorrhage. \nNo CT evidence for other acute intracranial abnormalities.\n2. Partial improvement in bifrontal subgaleal hematoma and right larger than\nleft periorbital/zygomatic hematomas.\n3. Persistent near complete right mastoid air cell opacification.\n4. Facial fractures, orbits, and paranasal sinuses are better assessed on the\nconcurrent facial bone CT." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. A rounded\nhyperdensity is seen along the falx cerebri, corresponds to an area of\nprobable ossification and was seen on prior MRI. Subcortical and\nperiventricular white matter hypodensities are nonspecific, likely the\nsequelae of chronic small vessel ischemic disease. There is prominence of the\nventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. Mucosal thickening and aerosolized\nsecretions are seen in the left maxillary sinus, the sphenoid sinuses, and the\nethmoid air cells. The visualized portion of the remaining paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. Soft tissue density in\nthe left external auditory canal is likely cerumen. The visualized portion of\nthe orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is a 4\nmm slightly hyperdense colloid cyst at the foramen of ___. Bifrontal\nventricular shunts are visualized. The lateral ventricles appear small, but\ncannot evaluate for stability without prior studies for comparison. No osseous\nabnormalities seen. There is mucosal thickening of the frontal and maxillary\nsinuses. Left mastoid tip is partially opacified. Right mastoids are clear. \nThe orbits are unremarkable. There is superficial soft tissue swelling with\nlaceration over the right parietal region (2:24) without underlying fracture", + "output": "1. No acute intracranial hemorrhage or fracture.\n2. 4mm colloid cyst, and bifrontal ventriculostomy catheters in place.\nVentricles are small in size without prior to evaluate for interval change.\n2. Right parietal scalp soft tissue swelling and laceration without fracture." + }, + { + "input": "Again noted is a small parafalcine hyperdensity in the medial aspect of the\nleft frontal lobe in the area of the suspected subarachnoid hemorrhage (series\n2; image 19). These hyperdensity is overall similar in size and configuration\nwhen compared to the prior study from the day before. There is no significant\nevidence of sulci effacement or mass effect.\nThere is no evidence of large territorial infarction,new hemorrhage,edema,or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses re-demonstrate a small mucous retention cyst in the left maxillary\nsinus, less conspicuous when compared to the previous exam. The mastoid air\ncells and middle ear cavities are clear. The patient is status post bilateral\nlens replacement. The visualized portion of the orbits are unremarkable.", + "output": "1. Redemonstration of the suspected small subarachnoid hemorrhage along the\nmedial aspect of the left frontal lobe without significant interval changes.\n2. No evidence of significant edema or mass effect.\n3. No evidence of large territorial infarction or new hemorrhage." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Basilar cisterns are\npatent.\n\nIncluded paranasal sinuses and mastoids are clear. There is mild right\nperiorbital hematoma without underlying fracture. Skull and extracranial soft\ntissues are otherwise unremarkable.", + "output": "No acute intracranial process.There is a small right periorbital hematoma\nwithout underlying fracture." + }, + { + "input": "Minimal hyperdensity overlying the medial left frontal lobe adjacent to the\nfalx likely represents a tiny amount of extra-axial acute hemorrhage (series\n2, image 22, 23), either subdural or subarachnoid. No other evidence of acute\nhemorrhage.\n\nThere is no evidence of acute territorial infarction,edema,or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. Mucous retention cyst within the left\nmaxillary sinus. Otherwise, the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The patient is status\npost bilateral lens replacements. Otherwise, the visualized portion of the\norbits are unremarkable.", + "output": "Tiny amount of extra-axial acute hemorrhage along the medial left frontal lobe\nadjacent to the falx, either subdural or subarachnoid. No evidence of\nfracture." + }, + { + "input": "Streak artifact from dental amalgam degrades evaluation.\n\nA large left cervical level IV nodal conglomerate measuring roughly 47 x 28 x\n24 mm (5:31, 3:66) has significantly increased as compared the prior\nexamination where a small lymph node in this area previously measured 10 x 6\nmm other scattered cervical lymph nodes do not appear enlarged. A rounded,\nenlarged high right paratracheal mediastinal lymph node appears new measuring\n21 x 16 mm (3: 82). A prominently enlarged subcarinal nodal conglomerate\nextending to the area of the left hilus is incompletely imaged, measuring at\nleast 69 x 23 mm, though is likely increased in size as compared the prior\nstudy.\n\nEvaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. The neck vessels are patent. \nThere is mild mucosal wall thickening in the left maxillary sinus. The right\nmaxillary sinus appears clear. There is periapical lucency surrounding a left\nmaxillary molar. The visualized brain is grossly unremarkable.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions. There are moderate to severe\nmultilevel cervical and upper thoracic degenerative changes with 4 mm\nanterolisthesis of C7 on T1, likely degenerative, and partial bony fusion at\nT1-T2.", + "output": "1. New large left cervical level IV nodal conglomerate collectively measuring\n47 x 28 x 24 mm.\n2. New and progressive mediastinal lymphadenopathy, as described.\n3. Moderate to severe cervical and upper thoracic degenerative changes. This\ncan be further interrogated with dedicated MR, as clinically indicated.\n4. Periapical lucency surrounding a left maxillary molar suggestive of\nperiodontal disease." + }, + { + "input": "Previously seen bulky lymphadenopathy involving left level 4, 5 B chain has\nresolved.\n\n2.5 cm x 1.7 cm cystic, peripherally enhancing right supraclavicular level 4\nmass, slightly decreased compared with PET scan when it measured with 3.1 cm x\n1.5 cm, indeterminate, may represent cystic lymph node versus postprocedural\nchange, such as seroma or lymphocele, if there has been intervention in this\narea. There is 1.6 cm lymph node in this area on CT neck ___.\n\nBulky lower left paratracheal, precarinal adenopathy, measuring 2.5 cm x 1.7\ncm, compared with 3.1 cm by 1.8 cm on PET scan ___, with\ninhomogeneous central areas, findings have significantly worsened since ___ PET scan, on PET scan there was 1.9 cm x 1.6 cm lymph node.\nLeft Port-A-Cath.\n\nEvaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal.The neck vessels are patent.\n\nNo lung nodules. Minimal opacification left mastoids. Chronic fracture left\nzygomatic arch. Minimal mucosal thickening paranasal sinuses, without fluid..\nAdvanced degenerative changes cervical spine, similar. Significant\nanterolisthesis at C7-T1, similar. There are no osseous lesions.", + "output": "1. Previously seen left level 4 adenopathy has resolved since ___.\n2. Worsened upper mediastinal adenopathy since ___.\n3. Cystic right supraclavicular lesion, may represent cystic adenopathy or\npostprocedural change, it is minimally changed since ___, and is\nnew since ___.\n\nRECOMMENDATION(S): Consider chest CT for evaluation of mediastinal\nadenopathy, if indicated." + }, + { + "input": "Interval development of asymmetric enlargement of the left piriform sinus and\nlaryngeal ventricle (series 3, image 141; series 3, image 174). There is\nmedial is a shin of the left vocal cord and arytenoid cartilage. Possible\ndecreased asymmetric size of the left posterior cricoid arytenoid muscles also\nidentified appear overall the findings are compatible with left vocal cord\nparalysis.\n\nNo significant change in size of the enlarged cystic right supraclavicular\nlesion, measuring 1.8 cm AP x 2.6 cm TV. There is otherwise no evidence of\ncervical lymphadenopathy. There has been interval increase in confluent\nmediastinal predominantly left paratracheal lymphadenopathy, which encases the\nundersurface of the aortic arch.. No evidence of mass lesion along the\ntracheoesophageal grooves. No fluid collections. No cervical lymphadenopathy\nby size criteria.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal.The neck vessels are patent. \nThere is a mild amount of nonspecific fluid within the left mastoid air cells\nand trace mucosal thickening of the left maxillary sinus.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules.No definite suspicious osseous lesions. 3-4 mm\nanterolisthesis of 2 C7 on T1 is unchanged from prior examination. Near\ncomplete loss of disc height at C6-C7 and T1-T2 with endplate sclerosis and\nvacuum disc phenomenon is unchanged from prior exam. Moderate to severe loss\nof disc height spanning C4-C5 and C5-C6 is also noted. There is not appear to\nbe critical spinal canal or neural foraminal narrowing.", + "output": "1. Continued worsening of confluent mediastinal lymphadenopathy since ___.\n2. Unchanged cystic right supraclavicular lesion possibly representing cystic\nadenopathy versus is postprocedural change.\n3. Otherwise, no new evidence of cervical lymphadenopathy.\n4. Interval development of findings compatible with left vocal cord paralysis\n(presumably secondary to confluent mediastinal mass). Clinical correlation is\nrecommended. No evidence of abnormal mass lesion along the bilateral tracheal\nsoft dural grooves.\n5. Additional findings described above." + }, + { + "input": "There is no evidence of fracture, infarction, hemorrhage, edema,or mass\neffect. The ventricles and sulci are normal in size and configuration. \nThere is no abnormal enhancement on post contrast images. Major dural venous\nsinuses appear patent.\n\nMucosal thickening of the left maxillary sinus is mild and of the right\nmaxillary sinus is minimal. The visualized portion of the remaining paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No CT evidence of acute intracranial process.\n2. Mild maxillary sinus disease." + }, + { + "input": "Left focal cord paralysis, also seen on prior. Again seen is heterogeneously\nenhancing mediastinal mass situated between trachea, aortic arch, esophagus,\nwith right lateral deviation of the esophagus and trachea. Mass has increased\nin size since ___, it is incompletely covered on this scan,\nsegment covered here measures 6.2 cm x 5.2 cm x 5.5 cm today, compared with\n5.0 cm x 4.9 cm x 4.2 cm on prior. Mild tracheal narrowing, new since prior. \nEsophageal invasion cannot be excluded. Narrowed left mainstem bronchus\nsurrounded by tumor, partially seen. Left Port-A-Cath in place..\n\nEvaluation of the aerodigestive tract in the neck demonstrates no mass and no\nareas of focal mass effect. Stable 6 mm midline nodule abutting anterior\nmargin of the hyoid bone is indeterminate, may represent lymph node or\nthyroglossal duct cyst. Otherwise, no enlarged lymph nodes in the neck.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal.The neck vessels are patent.\n\nRefer to chest CT report from ___ for thoracic findings. There are\nno osseous lesions. Advanced degenerative changes cervical spine,\nanterolisthesis C3-C4, retrolisthesis C4-C5, anterolisthesis C7-T1, stable\nsince prior. Chronic fracture left zygomatic arch.", + "output": "1. Mediastinal mass has increased in size.\n2. Left vocal cord paralysis, stable.\n3. Stable 6 mm level 6 lymph node versus thyroglossal duct cyst." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\npartially visualized left maxillary sinus as well as fluid within a few caudal\nmastoid air cells. The visualized portion of the remaining paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Evaluation of the aerodigestive tract shows prominence/thickening at the level\nof the right vocal cord (02:49). However, this was not seen on the prior CT\nneck which was recently performed on ___, and suggests that this may\nbe physiologic or due to secretions. Mild dependent secretions are seen in\nthe upper thoracic esophagus (2:69). Evaluation of the esophagus beyond the\nlevel is limited due to large surrounding mediastinal adenopathy.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no cervical\nlymphadenopathy by CT criteria. The neck vessels are patent.\n\nNo fractures are identified in the cervical spine. There are mild multilevel\ndegenerative changes with small endplate osteophytes, loss of intervertebral\ndisc space height, and facet joint arthropathy, most pronounced at C6-C7. \nThere is mild anterolisthesis of C7 on T1, which is most likely degenerative.", + "output": "1. No cervical lymphadenopathy.\n2. Extensive mediastinal lymphadenopathy, better assessed on the dedicated on\nthe same day chest CT performed." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. The ventricles and sulci are unchanged in size and configuration.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nleft maxillary sinus. The visualized portion of the remaining paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "1. No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration for age.\n\nThere is no evidence of fracture. There is a tiny mucous retention cyst in\nthe left maxillary sinus. The remainder of the visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "The exam is limited secondary to patient motion artifact. Within these\nlimitations, there is no evidence of acute infarct,hemorrhage, edema, or mass\neffect. The ventricles and sulci are normal in size and configuration.\nThere is no evidence of fracture. Other than mucous retention cyst in the\nbilateral maxillary sinuses, the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "Limited exam secondary to patient motion artifact. Within these limitations,\nno acute intracranial abnormality." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are patent and prominent in keeping with age-related\nvolume loss.\n\nThere are scattered hypodensities in the subcortical and periventricular white\nmatter, nonspecific, likely secondary to small vessel ischemic disease. There\nis intracranial atherosclerotic calcification.\n\nThe orbits are unremarkable. There is minimal mucosal thickening in left\nmaxillary, right frontal and bilateral ethmoid air cells. The mastoid air\ncells are clear.\n\nCTA HEAD:\nThere is dense calcified atherosclerosis involving bilateral cavernous and\nsupraclinoid internal carotid arteries resulting in at least moderate stenosis\nbilaterally.\n\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\n\nIncidentally seen is a 4 vessel arch with separate origin of the left\nvertebral artery from the aortic arch.\n\nThere is atherosclerosis involving the origin of the right brachiocephalic\ntrunk. Also seen is atherosclerosis involving bilateral carotid bifurcations\nwithout any stenosis by NASCET criteria. The carotid and vertebral arteries\nand their major branches appear otherwise unremarkable with no evidence of\nstenosis or occlusion.\n\nOTHER:\n\nThere is minimal paraseptal emphysema in visualized upper lung zones. Also\nseen are prominent mediastinal lymph nodes, for example are right precarinal\nlymph node on image 5:7 measuring 2.5 x 1.2 cm, right pretracheal lymph node\non image 5:18 measuring 1.6 x 1.3 cm. These are indeterminate in etiology but\nstable since the prior CT chest from ___.\n\nThe thyroid gland appears unremarkable. There are mildly prominent sub cm\nbilateral cervical lymph nodes, likely reactive in etiology. There is minimal\natherosclerosis involving the aortic arch.", + "output": "1. No acute intracranial abnormality.\n2. Atherosclerosis involving bilateral cavernous and supraclinoid ICAs\nresulting in at least moderate luminal narrowing.\n3. Mild atherosclerosis involving bilateral carotid bifurcation without any\nstenosis by NASCET criteria.\n4. Slightly prominent mediastinal lymph nodes, stable since ___." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or mass\neffect. Ventricles and sulci are enlarged, consistent with age-related global\natrophy.\n\nThere is no evidence of fracture. There is persistent atherosclerosis\ninvolving the bilateral cavernous and supraclinoid internal carotid arteries. \nThere is mild mucosal thickening of the anterior ethmoid air cells and\nbilateral maxillary sinuses. The visualized portion of the remaining\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. \nPatient is status post bilateral lens replacements.", + "output": "No acute intracranial abnormality." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no intra or extra-axial mass effect, acute hemorrhage or large\nterritory infarct. Minimal periventricular and subcortical white matter\nhypodensities are nonspecific, but compatible with chronic microangiopathy in\na patient this age. There is mild senescent related global cerebral volume\nloss. Atherosclerotic calcification of the internal carotid arteries is\nsimilar to prior exam.\n\nMinimal mucosal thickening of the ethmoid air cells and maxillary sinuses. \nThe orbits are unremarkable noting bilateral lens replacements. The mastoid\nair cells middle ears are well pneumatized and clear. No acute osseous\nabnormality.\n\nCTA HEAD:\nModerate atherosclerotic calcification of the internal carotid arteries are\nre-identified. The bilateral ophthalmic arteries appear unremarkable.\nOtherwise, the ACA, MCA and their major branches are without high-grade\nstenosis, occlusion or aneurysm. The posterior circulation is unremarkable. \nThe dural venous sinuses are patent.\n\nCTA NECK:\nExtensive venous reflux is identified mildly degrading the examination.\n\nMild atherosclerotic calcification of the aortic arch, origins of the right\nbrachiocephalic, left common carotid, and right subclavian arteries are noted.\nThe left vertebral artery arises from the aorta, with mild atherosclerotic\ncalcification at the origin. Otherwise, the vertebral arteries are\nunremarkable. The common carotid and subclavian arteries are unremarkable. \nMild atherosclerotic calcification of the bilateral internal carotid arteries\ndoes not result in stenosis of the proximal cervical internal carotid arteries\nby NASCET criteria.\n\nOTHER:\nAsymmetric fullness of the left piriform sinus is without mass lesion an\nunchanged since ___. Otherwise, the remainder of the aerodigestive tract is\nunremarkable. The thyroid is unremarkable. There is no cervical\nlymphadenopathy by size criteria. Major salivary glands are unremarkable.\n\nParaseptal emphysematous changes is stable from prior examination. Allowing\nfor respiratory motion artifact, no suspicious pulmonary nodules. Mildly\nprominent left paratracheal lymph nodes are unchanged from prior exam.\n\nMild multilevel degenerative changes without evidence of high-grade spinal\ncanal or neural foraminal narrowing. Left-sided cardiac device is noted.", + "output": "1. Moderate atherosclerotic calcification of the intracranial internal carotid\narteries is unchanged from CTA of ___. The ophthalmic arteries appear\nunremarkable. No intracranial aneurysm, high-grade stenosis or occlusion.\n2. Mild atherosclerotic disease of the cervical vessels without stenosis of\nthe cervical internal carotid arteries by NASCET criteria.\n3. No acute intracranial abnormality on noncontrast head CT. Specifically no\nlarge territory infarct or intracranial hemorrhage.\n4. The orbits appear unremarkable without evidence of mass lesion, abnormal\ninflammatory stranding or asymmetry at the apex.\n5. Additional findings described above." + }, + { + "input": "Overlying hardware and venous contrast pooling streak artifact limits\nexamination.\n\nThere is luminal narrowing of the right vertebral artery V2 segment from the\nlevel of the C3 vertebra to the level of the C6 vertebra, concerning for long\nsegment dissection. There is luminal narrowing of the left vertebral artery V2\nsegment at the level of the C5 vertebra, concerning for short segment\ndissection (2:106).\n\nOtherwise the carotid arteries and its major branchesare patent with no\nevidence of stenoses. Bilateral cervical carotid and vertebral artery origins\nare patent. Bilateral subclavian artery origins are patent. The right\nsubclavian artery demonstrates aberrant origin, arising directly from the\naortic arch and crossing posterior to the trachea and esophagus.\n\nOTHER:\nLimited imaging of the chest wall partially demonstrates right sided breast\nimplant. Scattered subcentimeter nonspecific lymph nodes are noted throughout\nthe neck bilaterally, without definite enlargement by CT size criteria.", + "output": "1. Overlying hardware and venous contrast pooling streak artifact limits\nexamination.\n2. Luminal narrowing of the right vertebral artery V2 segment from the level\nof the C3 vertebra to the level of the C6 vertebra, concerning for dissection.\n3. Luminal narrowing of the left vertebral artery V2 segment at the level of\nthe C5 vertebra, concerning for dissection.\n4. Aberrant right subclavian artery origin, which is an anatomic variant.\n5. Otherwise, patent bilateral cervical carotid and vertebral arteries without\ndefinite evidence of stenosis, occlusion, or dissection.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nNo evidence for acute intracranial hemorrhage, edema, mass effect, or acute\nmajor vascular territorial infarction. Normal size of the ventricles, sulci,\nand basal cisterns. No evidence for concerning osseous abnormalities. \nMinimal mucosal thickening and small mucous retention cysts in the maxillary\nsinuses. There is a small mucous retention cyst in the left ethmoid between\nthe middle and posterior air cells on image 3:213. There is a focus of\nmucosal thickening within left frontoethmoidal recess on images 3: 216-222,\nbut the frontal sinus is well-aerated. Middle ear cavities and mastoid air\ncells appear well-aerated. The orbits appear unremarkable.\n\nCTA NECK:\nAberrant right subclavian artery is again noted. Great vessel origins appear\nwidely patent. No carotid dissection or carotid stenosis by NASCET criteria.\n\nOn the prior CTA, there was irregularity and narrowing of the right vertebral\nartery V2 segment between C3 and C5, with corresponding intramural hematoma on\nMRI. Presently, the right V1, V2, and proximal V3 segments are uniformly\nsmall in caliber with smooth luminal contour, demonstrating decrease in\ncaliber of the V1, proximal V2, and proximal V3 segments compared to ___. No significant changes seen in the caliber of the V4 segment\n\nThe focal short-segment narrowing of the V2 segment of the left vertebral\nartery at the C5 level on the prior CTA, corresponding to intramural hematoma\non MRA, has resolved. The left vertebral artery now appears widely patent.\n\nCTA HEAD:\nV4 segments of bilateral vertebral arteries appear widely patent without\nevidence for dissection. Bilateral ___ and bilateral small AICA are\nvisualized. Basilar, bilateral superior cerebellar, and bilateral posterior\ncerebral arteries are patent. No evidence for flow-limiting stenosis in the\nmajor intracranial arteries. No evidence for an aneurysm. Dural venous\nsinuses are patent, with dominance of the right transverse and sigmoid sinuses\nagain demonstrated.\n\nOTHER:\nLeft palatine tonsilliths are again seen consistent with sequela of prior\ninfections. Prominent nonenlarged bilateral level 1A lymph nodes are\nunchanged. No pathologically enlarged lymph nodes by CT criteria. The\nthyroid is unremarkable. Evaluation of the included upper lungs is limited by\nmotion; no concerning abnormalities are identified. Bilateral breast implants\nare again partially imaged. No evidence for suspicious bone lesions.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. Previously seen short-segment narrowing of the V2 segment of the left\nvertebral artery at the C5 level, corresponding to intramural hematoma on the\nprior MRI, has resolved. The left vertebral artery now appears widely patent.\n3. Prior CTA demonstrated irregularity and narrowing of the right vertebral\nartery V 2 segment from C3 through C5, with corresponding intramural hematoma\non MRI. Presently, the right V1, V2, and proximal V3 segments are uniformly\nsmall in caliber with smooth luminal contour, demonstrating decrease in\ncaliber of the V1, proximal V 2, and proximal V3 segments compared to ___. This may reflect persistent, now chronic intramural hematoma with\nslightly diminished flow proximally and distally. If clinically warranted,\nthis may be clarified by neck MRA with axial fat-suppressed T1 weighted\nimages.\n4. No evidence for dissection or flow-limiting stenosis in the major\nintracranial arteries.\n5. Aberrant right subclavian artery is again seen, a normal variant.\n6. Paranasal sinus disease with apparent opacification of the left\nfrontoethmoidal recess though the left frontal sinus is well-aerated." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,intracranial hemorrhage,edema,ormass. The\nventricles and sulci are normal in size and configuration.\n\nSmall bilateral maxillary sinus mucosal retention cysts. Otherwise, the\nvisualized portion of the paranasal sinuses, mastoid air cells,and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation greater than\n3mm. The V4 segments of the vertebral arteries and their major branches appear\npatent, with the left vertebral artery slightly larger than the right. The\ndural venous sinuses are patent, with dominance of the right transverse and\nsigmoid sinuses with respect to the left, stable.\n\nCTA NECK:\nAn aberrant right subclavian artery is again noted.\nBilateral carotid and vertebral artery origins are patent.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThe left vertebral artery appears normal in course and caliber throughout.\nThe right vertebral artery demonstrates increased caliber in comparison to the\nprevious study from ___. The right vertebral artery is slightly\nasymmetrically small with respect to the left. There is still a subtle short\nsegment of focal narrowing at the C2 level best appreciated on the curved\nreformats (image 53 series 854 and verified on the source images, image 164,\nseries 7.\nNo evidence of vascular stenosis or occlusion.\n\n\nOTHER:\nLeft palatine tonsilliths are again seen consistent with sequela of prior\ninfection. Mildly prominent bilateral Level 2A and 1A lymph nodes are again\nseen, grossly unchanged in size and morphology. The thyroid gland appears\nnormal. Images of the lungs are degraded by motion artifact. Bilateral\nbreast implants again partially imaged.", + "output": "1. No acute intracranial abnormality.\n2. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n3. Patent bilateral cervical carotid arteries without evidence of stenosis,\nocclusion, or dissection.\n4. The left vertebral artery mass appears normal in course and caliber\nthroughout.\n5. Right vertebral artery caliber has improved compared to the previous exam,\nbut there is still a short segment of focal narrowing at the C2 level. If\nclinically warranted, MRA could be done to assess for residual chronic\nintramural hematoma." + }, + { + "input": "There is no evidence of infarction, hemorrhage, or edema. There is a 1.6 cm\nhyperdense mass in the right parietal lobe, slightly increased in size from\nthe prior MRI ___ currently measures up to 2.1 cm when measured in\nthe coronal plane, previously 1.5 cm. Calcified left frontal extra-axial mass\nmeasuring 3.2 x 2.8 cm likely representing a meningioma is again seen. \nAdditional meningioma along the left parietal calvarium 02:24) is also\nunchanged. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "A 2.1 cm hyperdense mass in the right parietal lobe. This is likely slightly\nincreased size from the MRI in ___. Hyperdensity could represent\nmineralization from prior treatment or calcification versus hemorrhagic\nhemorrhagic components versus blood products.\nMultiple left-sided hyperdense extra-axial mass is again suggestive of\nmeningiomas as seen on prior MRI.\n\nRECOMMENDATION(S): If further evaluation of brain masses is desired, MRI of\nthe brain should be considered." + }, + { + "input": "1.2 x 1.4 x 1.2 cm hyperdense focus at the gray-white matter junction in the\nright postcentral gyrus is redemonstrated and not significantly changed in\nsize nor appearance since ___. Mild surrounding vasogenic edema without\nmass effect is also stable. Punctate cerebellar bilateral lesions mentioned\non prior MRI are not seen on CT. There is no evidence of infarction or new\nareas of hemorrhage or mass. There is prominence of the ventricles and sulci\nsuggestive of involutional changes.\n\nLeft hyperdense extra-axial mass in the left frontal bone appears measuring 27\nx 31 mm, and a smaller left parietal calvarium extra-axial mass are unchanged\nfrom recent MRI. There is no evidence of fracture. The visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nThe visualized portion of the orbits are unremarkable.", + "output": "1. Unchanged 1.4 cm right postcentral gyrus mass. Although the appearance is\nsimilar to prior CT and MRIs from ___ and ___ 50,019, additional areas of\nintralesional hemorrhage cannot be excluded.\n2. No additional areas of hemorrhage, infarct or masses on current CT. \nPunctate bilateral cerebellar lesions mention on prior MRI are not seen on CT.\n3. Unchanged left frontal and parietal meningiomas." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\n2.4 x 2.1 cm peripherally calcified mass centered along the left tentorial\nleaflet (series 3, image 13) is similar in appearance to prior outside\nhospital MRI of ___, compatible with a meningioma. There is mass\neffect on the midbrain, resulting in hydrocephalus involving the lateral and\nthird ventricles with periventricular hypodensity compatible with\ntransependymal CSF flow. The configuration of ventriculomegaly is also\nsimilar to prior examination. The pre pontine cistern remains patent. The\nfourth ventricle appears unremarkable. There is no evidence of acute large\nterritory infarct or intracranial hemorrhage.\n\nMild mucosal thickening of scattered posterior ethmoid air cells is noted. \nOtherwise, the remainder the paranasal sinuses are clear. The orbits are\nunremarkable. The mastoid air cells middle ears well pneumatized and clear.\nThere is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nCTA HEAD:\nA distal branch of the left posterior cerebral artery closely approximates the\nleft superior aspect of the lesion (series 6, image 61). A small venous\nstructure potentially the basal vein ___ appears anterior to the\nlesion (series 6, image 7). The lesion demonstrates early arterial\nenhancement, compatible with meningioma. The dural venous sinuses appear\ngrossly patent as to the internal cerebral veins, ___ and ___\nsinus.", + "output": "1. 2.4 cm peripherally calcified lesion centered along the left tentorial\nleaflet exerting mass effect on the midbrain resulting in hydrocephalus of\nlateral and third ventricles with evidence of transependymal CSF flow is\nsimilar appearance to outside hospital MRI of ___.\n2. A distal branch of the left posterior cerebral artery closely approximates\nthe left superior aspect of the lesion as does a small venous structure,\npotentially representing the basal vein of ___. No large vessels are\nnoted. The lesion demonstrates early arterial enhancement compatible with\nmeningioma.\n3. No aneurysm or high-grade stenosis of the circle ___." + }, + { + "input": "The patient is status post suboccipital craniectomy, and resection of a\nmeningioma. There is small volume intracranial pneumocephalus. There is a\ntriangular shaped low-attenuation fluid collection at the site of resection\nabutting posterior left tectal plate, vermis, measuring up to 1.8 cm. There\nis a small amount of adjacent high-density material (series 3, image 12),\nwhich likely represents postoperative blood products.\n\nThere is persistent hydrocephalus, which has minimally increased since the MRI\nfrom ___. There is periventricular edema, which has slightly\ndecreased compared to the MR with the same date. There is no evidence of\nacute territorial infarction or mass. Effaced suprasellar cistern,\nperimesencephalic cistern. Minimal left uncal herniation, better seen on\nprior MRI. Effaced pre pontine cistern, foramen magnum, fourth ventricle\nsimilar, with tonsillar herniation to just above C1 level, similar.\n\nThere is no evidence of fracture. There is right occipital bone burr hole. \nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Post meningioma resection with expected postoperative changes.\n2. Triangular-shaped low-attenuation fluid collection at the surgical bed,\nwith tiny volume adjacent extra-axial postoperative blood products.\n3. Persistent hydrocephalus, which has minimally improved. There is stable\nleft uncal, bilateral tonsillar herniation, both stable." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nStatus post suboccipital craniectomy with associated postsurgical changes, a\nsurgical mesh is in place. There is no evidence of fracture. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Status post suboccipital craniectomy with associated postsurgical changes." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute intracranial hemorrhage, infarction, edema,\nmass, or mass effect. The ventricles and sulci are normal in caliber and\nconfiguration.\n\nThere is no evidence of an acute fracture. Mild left nasal septal deviation\nis noted. There is moderate severity mucosal thickening in the left more than\nright maxillary sinuses. There are focal areas of apparent bony defects in\nthe medial maxillary sinus walls (see series 3, images 223 and 224). There is\nalso ethmoid air cell mucosal thickening and trace aerosolized secretions in\nthe sphenoid sinus. Otherwise, the remaining imaged paranasal sinuses, as\nwell as the mastoid air cells and middle ear cavities, are well pneumatized\nand clear. The globes and orbits are unremarkable.\n\nCTA HEAD:\nThere is a fetal-type right PCA, a normal anatomic variant. The right P1 is\ndiminutive but patent. Conventional left PCA anatomy. Otherwise, the\nvertebral basilar and posterior cerebral arteries are patent without\nsignificant stenosis, occlusion, or aneurysm.\n\nSeen arising from the distal left M1 bifurcation is a superiorly and\nanteriorly projecting saccular aneurysm which measures up to 6 mm in diameter\nwithin the aneurysm sac, and 3 mm at the base (see series 602, image 39. \nSmall inferior and anterosuperior distal MCA branches arise directly from the\naneurysm sac (609:39).\n\nOtherwise, the remainder of the anterior circle of ___ vasculature is\npatent without stenosis, occlusion, or additional aneurysm. No arteriovenous\nmalformation is identified. The major dural venous sinuses are grossly\npatent.\n\nCTA NECK:\nPatent bilateral vertebral and carotid arteries in the neck. No ICA stenosis\nby NASCET criteria.\n\nOTHER:\nThe thyroid is unremarkable. There are no pathologically enlarged cervical\nlymph nodes. Imaged salivary glands are unremarkable. Imaged lung apices are\ngrossly clear. No worrisome focal osseous lesions identified.", + "output": "1. Distal left M1 bifurcation anterosuperiorly projecting 6 mm saccular\naneurysm measuring 3 mm at the base, from which arise 2 small distal MCA\nbranches at its superior and inferior aspect.\n2. Remainder of the circle of ___ vasculature is patent without additional\naneurysm, significant stenosis, or occlusion.\n3. Patent bilateral vertebral and carotid arteries in the neck. No ICA\nstenosis by NASCET criteria.\n4. No acute intracranial process by unenhanced head CT. No intracranial\nhemorrhage.\n5. Moderate severity mucosal thickening affecting the left more than right\nmaxillary sinuses, with bony defects in the medial maxillary sinus walls. \nCorrelate with surgical history. CT sinus could be performed for further\nevaluation, if indicated." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is moderate mucosal thickening of the\nbilateral maxillary sinus and bilateral ethmoid air cells, similar to prior MR\nbrain. There is there are aerosolized secretions within the left sphenoid\nsinus. The remainder of the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. No evidence of acute infarction or intra-axial hemorrhage. No CT correlate\nfor findings seen on recent MRI.\n2. Moderate paranasal sinus disease." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nNew, intraparenchymal hemorrhage within the left parietal-occipital region,\nmeasuring approximately 3.8 x 2.7 cm. There is an approximately 1 cm rightward\nshift of normally midline structures, with effacement of the left cerebral\nhemisphere sulci, and mass effect on the left lateral ventricle and basilar\ncisterns. Possible early left uncal herniation. Subarachnoid blood is seen\nwithin the sulci of the left cerebral hemisphere, along with mild subdural\nblood tracking along the falx.\n\nParanasal sinus disease is redemonstrated.\n\nCTA HEAD:\nThe approximately 6 mm saccular aneurysm of the distal left M1 bifurcation is\nagain seen. Mild focal narrowing of the left proximal V4 segment (3:183).\nOtherwise, no evidence of stenosis, occlusion, or aneurysm of the vessels of\nthe circle of ___.\n\nCTA NECK:\nNo evidence of stenosis or occlusion of the carotid or vertebral arteries.", + "output": "1. New intraparenchymal hemorrhage in the left parieto-occipital region\nmeasuring 3.8 x 2.7 cm with midline shift and early uncal herniation. \nSubarachnoid blood is also identified.\n2. No significant change since the previous CT angiography examination. \nPreviously noted left MCA aneurysm is again noted. No new vascular occlusion\nis seen." + }, + { + "input": "Compared to the most recent prior study, the known, left parietooccipital\nhematoma measures approximately 4.0 x 2.9 cm, not significantly changed from\nprior. There is persistent approximately 0.9 cm rightward shift of normally\nmidline structures, with effacement of the left lateral ventricle, sulci of\nthe left cerebral hemisphere, and basilar cisterns. A left subdural\ncollection measures approximately 0.8 cm in greatest axial ___, with\nsubdural blood tracking along the falx and tentorium.\nThere is persistent subarachnoid blood over the left convexity as well as in\nthe sylvian fissures bilaterally, the quadrigeminal cistern and the ambient\ncistern. Probable left uncal herniation appears stable. There is no evidence\nof new hemorrhage. The ventricles are stable in size and configuration.\n\nThere is no evidence of fracture. Moderate mucosal thickening of the\nbilateral maxillary sinuses and anterior ethmoid air cells. Aerosolized\nsecretions are seen within the right maxillary sinus and left sphenoid sinus,\nsimilar to prior. Otherwise, the remainder of the visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No significant change in the known, left parieto-occipital hematoma, with\nsubsequent mass effect, including stable rightward shift of normally midline\nstructures, effacement of the left lateral ventricle, sulci of the left\ncerebral hemisphere, and basilar cisterns. Stable probable left uncal\nherniation. No evidence of new hemorrhage.\n2. Stable left subdural hematoma, with subdural blood tracking along the falx\nand tentorium.\n3. Stable subarachnoid blood interdigitating between sulci of the left\ncerebral hemisphere.\n4. Redemonstrated paranasal sinus disease." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\n\nThe study is limited by motion artifact.\n\nSeen again is the left parietal subdural hematoma the shows an interval\nincrease in size from 8.2 mm to 14 mm. There is increase in right midline\nshift from 9 mm to 14 mm. The parietooccipital intraparenchymal hemorrhage\nremains unchanged in size. There is no evidence of new hemorrhage or acute\ninfarct.\n\nThere is partial opacification of the left maxillary sinus. Otherwise the\nparanasal sinuses and the mastoid air cells are well aerated. The orbits are\nunremarkable.\n\nCTA HEAD:\nThere is evidence of vasospasm of vessels in the circle ___ although no\nevidence of subarachnoid hemorrhage. There is no evidence of occlusion, or\ndissection in the vessels of the circle ___. Aneurysm seen along the left\nM1 bifurcation remains unchanged in size at 6.2 mm.\n\nCTA NECK:\nNo evidence of occlusion, dissection or aneurysm of the internal carotid or\nvertebral arteries.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Interval increase in size of previously seen left parietal subdural\nhematoma from 8.2 mm to 14 mm. There is subsequent increase in right midline\nshift.\n2. Parietooccipital intraparenchymal hemorrhage remains unchanged.\n3. Evidence of vasospasm in the anterior circulation of the circle ___\nalthough no evidence of subarachnoid hemorrhage. This could be related to\nmass effect and increased intracranial pressure.\n4. Aneurysm seen along the left M1 bifurcation remains unchanged in size." + }, + { + "input": "Beam hardening and overlying hardware artifact limits examination.\n\nThere is a new area of hypodensity in the right frontal lobe without changes\nin ventricle effacement versus artist.\n\nGrossly stable left parietoccipital intraparenchymal bleed that remains\nunchanged compared to prior study from ___. There is interval increase\nin the left parietoccipital subdural hematoma from 1.4 cm to 1.8 cm. Question\nincrease in crowding around foramen magnum. Grossly stable approximately 1.3\ncm left to right midline shift is noted.\n\nThere is no evidence of fracture. The visualized portion of the mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are preserved. Bilateral maxillary sinus and ethmoid air cell mucosal\nthickening is present.", + "output": "1. Beam hardening and overlying hardware artifact limits examination.\n2. New area of hypodensity in the right frontal lobe may represent artifact,\nwith differential consideration of acute infarct.\n3. Interval increase in size of left parietoccipital subdural hematoma with\nsubsequent increase in right-sided midline shift.\n4. Question minimal tonsillar herniation versus difference in technique.\n5. Grossly stable left parietoccipital intraparenchymal hemorrhage.\n6. Grossly stable approximately 1.3 cm left right midline shift and\nventricular size.\n7. Within limits of study, no definite new acute intracranial hemorrhage\nidentified" + }, + { + "input": "Left frontal parietal extra-axial hyperdense collection measuring\napproximately 1.8 cm in greatest thickness, compatible with subacute to\nchronic hematoma is overall unchanged in size from prior examination. 4.7 x\n2.7 cm (AP, TRV) left parietooccipital parenchymal hematoma with surrounding\nwhite matter edema pattern is unchanged from prior examination. There is 1.3\ncm rightward midline shift with effacement of the left lateral ventricle. \nRight ventricle size and effacement of the third ventricle is unchanged from\nprior examination. No evidence of interval acute large territory infarct or\nintracranial hemorrhage.\n\nNo acute osseous abnormality. The visualized paranasal sinuses demonstrates\nmoderate mucous retention cyst in the left maxillary sinus and small mucous\nretention cyst in the right maxillary sinus, unchanged from prior examination.\nThe mastoid air cells middle ears are well ties and clear.", + "output": "1. Unchanged left frontal parietal chronic hematoma. Unchanged left\nparietooccipital parenchymal hematoma. No new interval hemorrhage.\n2. Unchanged 1.3 cm rightward midline shift with effacement of the left\nlateral ventricle and third ventricle. Right ventricular size is unchanged.\n3. Additional findings described above." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nCompared with CT head on ___, a 4.8 cm left parieto-occipital\nhematoma with surrounding edema is not significantly changed. A left\nfrontoparietal hypodense subdural collection measures up to 18 mm, not\nsignificantly changed. Mass effect with effacement of the lateral ventricles,\nleft greater than right, and third ventricle, as well as rightward midline\nshift measuring up to 12 mm, is not significantly changed. Right lateral\nventricle is stable in size. No evidence of new intracranial hemorrhage or\ninfarct. Specifically, no subarachnoid hemorrhage visualized.\n\nThere is a mucosal retention cyst in the left maxillary sinus and mucosal\nthickening in the right maxillary sinus. The visualized portion of the\nremainder of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nCompared with ___, there is mild diffuse arterial narrowing in the\nanterior circle of ___, new compared with ___. This is smooth\nand uniform, not a typical appearance of vasospasm. There is a stable 6 mm\naneurysm at the bifurcation of the left MCA M1 segment. The dural venous\nsinuses are patent.", + "output": "1. No significant change in left intraparenchymal and subdural hematomas and\nassociated severe mass effect.\n2. Mild diffuse vascular narrowing, not typical of vasospasm, appears\nunchanged.\n3. Stable 6 mm left MCA aneurysm." + }, + { + "input": "Near complete resolution of the previously seen left frontoparietal\nextra-axial hypodense collection now measuring up to 4 mm in maximum thickness\nfrom previously 18 mm.\nThe previously seen 12 mm rightward midline shift and effacement of the left\nlateral ventricle has resolved.\n\nThere has been interval decrease in size of the left parieto-occipital\nparenchymal hematoma now measuring 2.6 x 2.1 cm (AP X TR) from previously 4.7\nx 2.7 cm.\n\nNo new intracranial abnormalities identified. No interval development of\nacute large territorial infarction or new intracranial hemorrhage.\n\nThere is mild mucosal thickening along the ethmoid air cells and a small\namount of aerosolized mucus is seen in the sphenoid sinuses. The remainder of\nthe visualized paranasal sinuses and mastoid air cells appears clear. \nVisualized portions of the orbit are unremarkable.", + "output": "1. Decrease in size of the left parieto-occipital parenchymal hematoma.\n2. Near complete resolution of the left frontoparietal extra axial, hypodense\ncollection now measuring up to 4 mm in maximum thickness from previously 18\nmm.\n3. Resolution of the previously seen right port midline shift and effacement\nof the left lateral ventricle.\n4. No new intracranial abnormality." + }, + { + "input": "There is mild increased in density of the tentorium. This may be suggestive\nof a small subdural hematoma. However, given this patient's clinical history,\nwith both renal and hepatic failure, there is a possibility this may be due to\ndiffuse hypodensity of the cerebral cortex. There is preservation of\ngray-white differentiation. The ventricles and sulci are normal in size and\nconfiguration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Increase in apparent density of the tentorium consistent with layering\nsmall subdural hematoma versus diffuse hypodensity of the cerebral cortex from\nmetabolic derangement.\n\nNOTIFICATION: The findings were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 3:00 ___, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "Patient is status post bilateral endoscopic sinus surgery with resection of\nthe uncinate processes, ethmoidectomies and middle turbinate resection with\nexpected postoperative changes. There is persistent opacification of the\nright frontal sinus and ethmoidal air cells. The remaining visualized\nparanasal sinuses are unremarkable. The left ostiomeatal unit is patent. The\ncribriform plates are intact. There is no nasal septal defect. The nasal\nseptum is midline. The anterior clinoid processes are not pneumatized. The\nlamina papyracea are intact. Visualized portions of the orbits, including\nthe globes, are unremarkable.", + "output": "1. Status post bilateral endoscopic sinus surgery with resecction of the\nuncinate processes, ethmoidectomies and middle turbinate resection with\nexpected postoperative changes.\n2. Persistent opacification of the right frontal sinus and ethmoid air cells,\nwhich could reflect chronic sinusitis in the proper clinical context.\n3. No abnormality of the bilateral orbits, including the globes, identified. \nIf there is concern regarding the orbits, MR could be performed for further\nevaluation." + }, + { + "input": "There is no evidence of infarction,hemorrhage,edema,or mass effect. Ventricles\nand sulci are prominent consistent with age-related global parenchymal loss. \nPeriventricular white matter hypodensities are nonspecific, but likely\nrepresent sequela of chronic microvascular ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Periventricular white matter hypodensities are nonspecific, but likely\nrepresent sequela of chronic microvascular ischemic disease." + }, + { + "input": "There is no evidence of fracture, acute large territorial\ninfarction,hemorrhage,edema,or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. There are bilateral subcortical\nand periventricular white matter hypodensities, which are nonspecific but most\nlikely represent sequelae of chronic small vessel ischemic disease. There are\natherosclerotic calcifications of the intracranial internal carotid and left\nvertebral arteries.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No evidence of acute intracranial process or mass.\n2. Redemonstration of chronic microangiopathic and involutional changes." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute hemorrhage, edema, or acute major vascular\nterritorial infarction. There are bilateral chronic cerebellar hemispheric\ninfarcts, left larger than right, which are unchanged compared to the ___ head CT. Associated enlargement of the fourth ventricle is\nagain noted. Lateral and third ventricles are normal in size. Cerebral sulci\nare normal in size.\n\nThere is mild mucosal thickening along the floor of the right maxillary sinus.\nThere are periapical lucencies of the right maxillary molars.\n\nCTA HEAD & NECK:\nThis study is suboptimal secondary to insufficient contrast. Within these\nlimitations, the major cervical and intracranial arteries appear patent and\nsimilar in caliber to the prior CT from ___. There is no evidence\nof internal carotid stenosis by NASCET criteria. Evaluation for dissection or\nintracranial aneurysm is technically limited. The dural venous sinuses are\npatent.\n\nOTHER:\nThe visualized portion of the lungs demonstrate atelectasis and emphysematous\nchanges. The patient is status post thyroidectomy. There is no\nlymphadenopathy by CT size criteria. No suspicious bone lesion is seen.", + "output": "1. No acute hemorrhage. No CT evidence for an acute major vascular\nterritorial infarction. Chronic cerebellar infarctions, left larger than\nright, are again demonstrated.\n2. The CTA is suboptimal due to insufficient amount of intravenous contrast,\nas detailed in the technique section. The major cervical and intracranial\narteries appear patent and similar in caliber to the ___ CTA,\nwithout evidence for high-grade stenosis. Evaluation for dissection or\naneurysm is limited.\n3. Right maxillary molar periapical lucencies are again demonstrated, with\nadjacent mucosal thickening along the floor of the right maxillary sinus. \nPlease correlate with signs or symptoms of active dental inflammation.\n\nRECOMMENDATION(S): MRI would be more sensitive for an acute infarction, if\nclinically warranted." + }, + { + "input": "There is no evidence of acute territorial infarction, intracranial hemorrhage,\nintracranial edema, or large mass. Bilateral chronic cerebellar hemispheric\ninfarcts, left larger than right, and enlargement of the fourth ventricle, are\nsimilar to prior. The ventricles and sulci are otherwise normal in size and\nconfiguration.\n\nThere is no evidence of fracture. There is subgaleal hematoma over the left\nfrontotemporal region. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. There is no evidence of acute intracranial process or hemorrhage.\n\n2. Subgaleal hematoma is noted over the left temporal frontal region, with no\nevidence of underlying fracture." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is redemonstration of a large chronic left cerebellar infarct and a\nsmaller chronic right cerebellar infarct, similar to the prior studies. There\nis no evidence of mass, hemorrhage, or recent infarction. The ventricles and\nsulci are normal in caliber and configuration\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear patent and similar in caliber without occlusion, stenosis or aneurysm\nformation. Mild atherosclerotic plaque is noted in the bilateral cavernous\nportions of the ICA. There is fetal origin of the bilateral posterior\ncerebral arteries. The dural venous sinuses are patent.\n\nCTA NECK:\nThe carotidandvertebral arteries and their major branches appear patent and\nsimilar in caliber when compared with prior CT dated ___. There\nare calcified plaques at the proximal left internal carotid artery and in the\nproximal right external carotid artery bilaterally without stenosis. The left\nvertebral artery is dominant. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nCT perfusion: There is a perfusion defect in the left cerebellar hemisphere,\ncorresponding to the area of chronic infarct which is expected.\n\nOTHER:\nThe visualized portion of the lungs are clear. Multiple surgical clips are\nnoted in the thyroid bed. The ocular globes are elongated suggestive of\nbilateral staphyloma. There is no lymphadenopathy by CT size criteria.", + "output": "1. No no evidence of mass, hemorrhage or recent infarction.\n2. Chronic bilateral cerebellar infarctions, larger on the left with\nassociated perfusion defect.\n3. No evidence of vascular stenosis or occlusion." + }, + { + "input": "NECT: No intracranial hemorrhage is identified. There is no mass, mass effect\nor midline shift. Regions of encephalomalacia within both cerebellar\nhemispheres, left greater than right are likely due to prior infarct. The\nventricular system is normal in size and configuration.\n\nMaxillary sinus disease is noted.\n\nHead CTA: There is no evidence of aneurysm formation or other vascular\nabnormality.There is patency of the anterior and posterior ___\ntermination right vertebral artery is noted. The posterior communicating\narteries are prominent with resultant diminutive caliber of the basilar\nartery, unchanged.\n\nCTA neck: The aortic arch demonstrates a normal branching pattern. Both\nvertebral arteries are patent. The right vertebral artery is hypoplastic, as\nnoted previously. The bilateral common carotid, internal carotid and external\ncarotid artery is are patent. Mild atherosclerotic plaque is present at both\ncarotid bulbs, but there is no evidence for dissection or significant stenosis\nby NASCET criteria.\n\nCT perfusion: No perfusion abnormality is detected.", + "output": "No intracranial hemorrhage or mass effect. Unchanged regions of\nencephalomalacia within both cerebellar hemispheres likely due to chronic\ninfarcts.\n\nNo evidence for dissection, occlusion or significant stenosis within the\narterial vasculature of the head and neck. No perfusion abnormality." + }, + { + "input": "Head CT: There is no evidence of hemorrhage, edema, masses, mass effect, or\nevidence for acute infarction. Chronic bilateral cerebellar infarcts are again\nidentified. The ventricles and sulci are normal in caliber and configuration.\nNo fractures are identified.\n\nHead and neck CTA: The carotid and vertebral arteries and their major branches\nare patent with no evidence of stenoses. There is calcified and non calcified\natherosclerotic plaques at both carotid bifurcations without significant\nstenosis by NASCET criteria. The right vertebral artery is hypoplastic and\neffectively terminates as ___. There is no evidence of aneurysm formation or\nother vascular abnormality.\n\nMinimal emphysematous changes are seen at the lung apices. Multiple cervical\nlymph nodes are noted, similar to the previous examination. The patient is\nstatus post thyroidectomy. Bilateral staphylomas are identified.", + "output": "1. Chronic bilateral cerebellar infarcts. No intracranial hemorrhage or mass\neffect.\n2. No significant arterial stenosis, occlusion or evidence for dissection." + }, + { + "input": "Unchanged chronic bilateral cerebellar infarcts. Asymmetric atrophy of the\nright temporalis and visualized portion of the right masticator muscle group\nis unchanged. There is no acute intracranial hemorrhage, acute infarction,\nlarge mass or midline shift. There is no hydrocephalus. The ventricles and\nsulci are normal in size and configuration. The basal cisterns are patent and\nthere is preservation of gray-white matter differentiation. The orbits are\nunremarkable. The visualized paranasal sinuses, middle ear cavities and\nmastoid air cells are clear. There is no fracture.", + "output": "1. No acute intracranial abnormality.\n2. Chronic bilateral cerebellar infarcts.\n3. Chronic, asymmetric atrophy of the right temporalis and visualized right\nmasticator muscle group." + }, + { + "input": "The intracranial ICAs, ACAS, MCAs and their major branches are unremarkable.\nThere is congenital hypoplasia of the right vertebral artery. In addition,\nprominent posterior communicating arteries are noted. Otherwise, the posterior\ncirculation is unremarkable. No flow-limiting stenosis or aneurysm is seen.\n\nEncephalomalacia is again seen within the cerebellar hemispheres, more\nextensive on the left, corresponding to prior infarcts.\n\nMild polypoid mucosal thickening of the maxillary sinuses, left greater than\nright, is noted. The remainder the paranasal sinuses are clear. The orbits are\nunremarkable. The mastoid air cells and middle ear cavities are well\npneumatized and clear.\n\nAtrophy of the right temporalis and masticator muscles is again noted,\nunchanged. Prominent adenoids, palatine and lingual tonsils are unchanged and\nsymmetric.", + "output": "No evidence of flow-limiting stenosis or aneurysm of the intracranial\ncirculation." + }, + { + "input": "Head CT: There is no evidence of hemorrhage. There are chronic cerebellar\ninfarcts, left greater than right, also present on prior CT from ___. There is no mass lesion or positive mass effect. There is ex vacuo\ndilatation of the fourth ventricle due to the cerebellar infarcts. The\nventricles and sulci are otherwise normal in caliber and configuration.\n\nNo fractures are identified. The visualized paranasal sinuses, mastoid air\ncells, and tympanic cavities are clear. The orbits are normal.\n\nHead CTA: The intracranial right vertebral artery is diminutive, unchanged\nfrom prior CTA on ___. The intracranial left vertebral artery is\nnormal. The basilar artery is normal. The superior cerebellar and posterior\ncerebral arteries are normal. The posterior communicating arteries are\nvisualized and are normal.\n\nThe internal carotid arteries are normal. The middle cerebral anterior\ncerebral arteries are normal. The anterior communicating artery region is\nnormal.\n\nThere is no evidence of aneurysm, stenosis or occlusion.\n\nThe major dural venous sinuses are patent.\n\nHead CTP: There are no areas of increased mean transit time, decreased\ncerebral blood flow, or cerebral blood volume to suggest ischemia or infarct. \nThe known large of left cerebellar chronic infarct demonstrates decreased\ncerebral blood volume, consistent with an infarct. The right cerebellar\nchronic infarct is difficult to appreciate on perfusion due to its relatively\nsmall size.\n\nNeck CTA:\nThere is 3 vessel aortic arch anatomy. The aortic arch is normal.\n\nThe right vertebral artery is small in caliber throughout its length. The left\nvertebral artery is normal.\n\nThe carotid arteries and their major branches are patent with no evidence of\nstenoses. There is mild atherosclerosis of the carotid bifurcations but no\ninternal carotid stenosis by NASCET criteria.\n\nThere is fatty atrophy of the right muscles of mastication. No causative\nlesion is identified. Foramen ovale has normal morphology. The thyroid gland\nhas been removed. There are numerous right maxillary dental caries and\nperiapical lucencies.", + "output": "1. No intracranial hemorrhage or evidence of an acute infarct on CT head.\n2. No evidence of ischemia or an acute infarct CT perfusion.\n3. No intracranial arterial occlusion or stenosis on CTA head.\n4. No stenosis of the internal carotid arteries by NASCET criteria.\n5. Diminutive right vertebral artery, likely developmental.\n6. Multiple right maxillary dental caries and periapical lucencies." + }, + { + "input": "No interval change in chronic bilateral cerebellar infarcts with associated\nencephalomalacia, left greater then right. There is no evidence of hemorrhage,\nedema, acute large territorial infarction, or mass. The ventricles and sulci\nare normal in size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable. Stable asymmetric\nenlargement of the left temporalis and masseter muscles.", + "output": "1. No acute intracranial process. Specifically no intracranial hemorrhage.\n2. Chronic bilateral cerebellar infarcts with associated encephalomalacia." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass effect. Again seen are hypodensities in the bilateral cerebellar\nhemispheres, left greater than right, consistent with prior infarcts and\nunchanged compared to ___. The ventricles and sulci are normal in size\nand configuration.\n\nNo osseous abnormalities seen. The visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "Nasopharyngeal tissues are symmetrically enlarged, slightly larger than on ___, without evidence for a focal mass or abscess. The left palatine\ntonsil is slightly larger than the left, abutting the uvula, without evidence\nfor focal mass or abscess, unchanged compared to ___. Left\noropharyngeal wall appears mildly thickened, unchanged. There is no stranding\nin the parapharyngeal fat. There is no peritonsillar abscess. There is no\nretropharyngeal edema or collection.\n\n___ 1 and ___ 3 been partially extracted, with only their roots remaining,\nsurrounded by periapical lucencies. There is no evidence for adjacent soft\ntissue abscess. There is also a large periapical lucency of the ___ 2. These\nfindings are similar to ___. The paranasal sinuses, middle ear\ncavities, mastoid air cells, and pneumatized petrous apices are well-aerated.\n\nEvidence of thyroidectomy is again noted.\n\nScattered nonenlarged intraparotid lymph nodes are unchanged and within normal\nlimits. Submandibular glands appear unremarkable.\n\nEnhancing left level 2 lymph node measures 1.3 x 0.8 cm compared to 1.3 x 0.6\ncm on ___, image 2:33. Asymmetric prominent left level 5a lymph node\nmeasuring 10 mm on image 2:33 and left level 5B lymph node measuring 7 mm on\nimage 2:56 are unchanged since ___. Other symmetric nonenlarged level\n5 lymph nodes are also not significantly changed. Bilateral subcentimeter\nsupraclavicular lymph nodes are also unchanged.\n\nThere is mild calcified plaque in bilateral proximal internal carotid arteries\nwithout stenosis by NASCET criteria. V1 segment of the left vertebral artery\nand the entire non dominant right vertebral artery are not optimally\nevaluated. The remainder of the left vertebral artery appears grossly patent.\nMajor veins of the neck appear grossly patent.\n\nCentrilobular emphysema is noted in the included upper lungs.\n\nThis exam is not technically optimized for evaluation of the included\nintracranial contents. Areas of encephalomalacia are again seen in the\ncerebellar hemispheres, left greater than right.\n\nNo lytic or sclerotic bone lesions suspicious for malignancy are identified.", + "output": "1. Mild symmetric enlargement of the nasopharyngeal soft tissues, slightly\nincreased compared to ___, without evidence for a mass or abscess. \nThis may reflect a nonspecific viral or other infection, given the clinical\nhistory.\n2. Mild asymmetric enlargement of the left palatine tonsil with mild left\noropharyngeal wall thickening are unchanged compared to ___, without\nevidence for a mass, abscess, or adjacent inflammatory change.\n3. Unchanged periapical lucencies ___ 2 and of the partially extracted ___\n1 and ___ 3, without evidence for an adjacent soft tissue abscess. Please\ncorrelate clinically whether active dental infection may be present.\n4. Prominent but not pathologically enlarged cervical and supraclavicular\nlymph nodes are unchanged compared to ___, including the asymmetric\nleft level 5B and 5B lymph nodes.\n5. Emphysema.\n\nRECOMMENDATION(S): Recommend correlation with dental exam regarding the\npresence of any active dental infection." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nRedemonstrated hypodensities in the bilateral cerebellar hemispheres, left\ngreater than right, are consistent with prior infarcts and remain unchanged\ncompared to prior exams.\n\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "CTA HEAD: There is minimal atherosclerotic calcification of the cavernous\ninternal carotid arteries. Diminutive distal right vertebral artery. A\ndominant left vertebral artery is seen. Otherwise, the vessels of the circle\n___ and their principal intracranial branches appear normal without\nstenosis, occlusion or aneurysm formation. The dural venous sinuses are\npatent.\n\nEncephalomalacia in the bilateral cerebellar hemispheres is seen, better\nvisualized on the subsequently performed MRI.\n\nCTA NECK: There is a common origin between the brachiocephalic and left\ncarotid artery. There is minimal atherosclerotic calcification of the carotid\nbulbs. The right vertebral artery is diminutive throughout its course. \nOtherwise, the carotid and vertebral arteries and their major branches appear\nnormal with no evidence of stenosis or occlusion. There is no evidence of\ninternal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.Periapical lucency is noted along multiple right maxillary molars as\nwell as dental caries ___ 1 and 3. The adenoids are mildly prominent,\nwhich may reactive. .", + "output": "1. No evidence of aneurysm greater than 3 mm, dissection or vascular\nmalformation, or significant luminal narrowing.\n2. Essentially unremarkable CTA of the neck noting a congenitally hypoplastic\nright vertebral artery.\n3. Dental disease. Dental consultation is recommended." + }, + { + "input": "CT HEAD:\n\nThere is cystic encephalomalacia within the bilateral cerebellar hemispheres,\nleft greater than right, which is unchanged. There is no acute hemorrhage,\nand no evidence for parenchymal edema or acute major vascular territorial\ninfarction. Lateral and third ventricles, as well as the cerebral sulci, are\nnormal in size. There is ex vacuo enlargement of the fourth ventricle and\nprominence of the basal cisterns due to the cerebellar volume loss.\n\nThere is mild deformity at the posterior aspect of the bilateral globes,\nlikely representing staphylomas. No suspicious calvarial lesion is seen. The\nmastoid air cells and middle ears are clear. There is mild mucosal thickening\nalong the floor of the right maxillary sinus, adjacent to periapical lucencies\ninvolving ___ 1, 2, and 3, as seen on ___. Caries are also again\nseen in ___ 1 and ___ 3.\n\nCTA NECK:\n\nThere is a 2 vessel aortic arch with common origin of the right\nbrachiocephalic and left common carotid arteries. Common carotid and cervical\nright internal carotid artery are widely patent. There is minimal\natherosclerosis at the right external carotid artery origin without stenosis. \nThere is mild calcific atherosclerosis at the left carotid bulb without\nsignificant stenosis by NASCET criteria. The left vertebral artery is\ndominant and widely patent. The right vertebral artery is extremely\ndiminutive, but unchanged comparison to prior study.\n\nCTA HEAD:\n\nThere is mild calcified plaque in bilateral carotid siphons without\nflow-limiting stenosis. No flow-limiting stenosis is seen elsewhere in the\nintracranial circulation, allowing for the diminutive non dominant right\nvertebral artery. There is unchanged patulous appearance of the basilar\nartery tip, likely due to the bilateral fetal type posterior cerebral\narteries, without saccular aneurysm. Major dural venous sinuses appear\npatent.\n\nOTHER:\n\nThere is streak artifact secondary to dental almalgam which obscures adjacent\nstructures. There is chronic lipoatrophy of the right temporalis, masticator,\nand medial pterygoid musculature. The patient is status post thyroidectomy. \nThere are no suspicious lymph nodes by size or morphology.\n\nThere are degenerative changes of the cervical spine.\n\nEvaluation of the included lungs is limited by respiratory motion artifact ;\nno focal abnormalities are identified. The main pulmonary artery is enlarged,\n3.5 cm, indicating pulmonary arterial hypertension.", + "output": "1. Chronic cerebellar infarcts, left greater than right, are again\ndemonstrated. No evidence for acute intracranial abnormalities.\n2. Unchanged appearance of the diminutive non dominant right vertebral artery.\nNo evidence for flow-limiting stenosis in the cervical or major intracranial\narteries.\n3. Unchanged appearance of the patulous basilar tip, likely at least in part\nsecondary to fetal type configuration of bilateral posterior cerebral\narteries, without evidence for a saccular aneurysm.\n4. Periapical lucencies and dental caries involving the right maxillary molars\nare again seen, with the adjacent mucosal thickening along the floor of the\nright maxillary sinus. Recommend correlation with dental exam.\n5. Enlargement of the main pulmonary artery is again noted, indicating\npulmonary arterial hypertension." + }, + { + "input": "Encephalomalacia involving bilateral cerebellar hemispheres appear unchanged\nfrom prior exam. There is no intra-axial or extra-axial hemorrhage, edema,\nshift of normally midline structures, or evidence of acute major vascular\nterritorial infarction. Ventricles and sulci are in stable configuration. \nParanasal sinuses, mastoid air cells and middle ear cavities are well aerated.\nBony calvarium is intact.", + "output": "No acute intracranial process. Chronic encephalomalacia involving the\ncerebellum." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Senescent calcifications are noted within the cerebellum. Age\nrelated involutional changes are present. Ventricles are normal in size. \nBasal cisterns are patent. The imaged paranasal sinuses appear clear aside\nfrom mild opacification of the ethmoidal air cells. The mastoid air cells and\nmiddle ear cavities are clear. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "CTA HEAD:\nWidely patent vertebrobasilar system. Patent bilateral posterior cerebral\narteries with normal distal runoff.\n\nThe bilateral intracranial internal carotid arteries and the bilateral\nanterior and middle cerebral arteries are patent with normal distal runoff.\n\nNo stenosis, occlusion, or aneurysm.\n\nPatent major dural venous sinuses.\n\nCTA NECK:\nThere is mild calcification at the carotid bulbs and cervical ICA origins,\nwithout ICA narrowing by NASCET criteria. The remaining portions of the\nbilateral cervical carotid arteries are widely patent.\n\nDense calcified plaque at the origin of the left vertebral artery causes mild\nluminal narrowing. The remaining left cervical vertebral artery is widely\npatent. The right cervical vertebral is widely patent.\n\nOTHER:\nThe aortic arch and arch branch vessel origins are minimally calcified but\nwidely patent and otherwise unremarkable. There is a left chest cardiac\ndevice with associated dual leads seen to the level of the superior vena cava.\nThere are no pathologically enlarged cervical lymph nodes. Imaged portions of\nthe upper mediastinum are within normal limits. No suspicious pulmonary\nnodule in the partially visualized lung apices. Thyroid is unremarkable.\n\nNote is made of ethmoid air cell mucosal thickening and a small right\nmaxillary sinus mucous retention cyst. The mastoids are clear. No aggressive\nfocal osseous lesions. Moderate cervical spine degenerative changes, worst at\nC5-6 and C6-7.", + "output": "1. Widely patent circle of ___ vasculature. No occlusion, stenosis, or\naneurysm.\n2. Mild calcification at the carotid bulbs and cervical ICA origins\nbilaterally not causing ICA narrowing by NASCET criteria. Mild luminal\nnarrowing of the origin of the left vertebral artery due to calcified plaque. \nRemainder of the bilateral cervical vertebral and carotid arteries are widely\npatent.\n3. Please see separate report for intracranial findings from earlier same-day\nunenhanced head CT." + }, + { + "input": "There is no evidence of fracture, acute large vascular territory\ninfarction,hemorrhage,edema,or mass. Periventricular white matter\nhypodensities are nonspecific, however likely represent sequela of chronic\nsmall vessel ischemic disease. There is mild, age-appropriate prominence of\nthe sulci and ventricles.\n\nAside from mild ethmoid air cell mucosal thickening, the visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nThe visualized portion of the orbits are normal, patient is status post\nbilateral lens surgery.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. \nPeriventricular and subcortical white matter hypodensities are nonspecific but\nlikely sequelae of chronic small vessel ischemic disease. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is a small occipital scalp laceration (series 2, image 18; series 602,\nimage 35). There is no evidence of acute fracture. Status-post endoscopic\nsinus surgery. Since ___, left frontal sinus opacification has\nessentially resolved. Patchy ethmoid air cell opacification is slightly\nincreased, particularly anteriorly on the right. Left sphenoid sinus\nopacification has resolved. There is mild right sphenoid sinus mucosal\nthickening and moderate bilateral maxillary sinus mucosal thickening, noting\natelectasis of the partially imaged maxillary sinuses. There is hyperostosis\nof the walls of multiple sinuses consistent with chronic sinusitis. Bilateral\nlens replacements noted. Moderate carotid siphon and mild V4 segment\ncalcification.", + "output": "1. No evidence of an acute intracranial abnormality.\n2. Small occipital scalp laceration.\n3. Extensive chronic sinusitis." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration. Mild-to-moderate\npatchy bilateral cerebral white matter disease suggest chronic small vessel\nischemic change.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The patient is status post right lens replacement. \nOtherwise, the visualized portion of the orbits are normal.", + "output": "No evidence of acute intracranial abnormality. Mild-to-moderate abnormalities\nin cerebral white matter. These are typical for chronic small vessel ischemic\nchanges in cerebral white matter seen in patients with vascular disease. \nHowever, even though vascular calcification does suggest the presence of\natherosclerotic disease, given relatively young age, other etiologies might be\nconsidered such as demyelinating disorder depending on clinical circumstances." + }, + { + "input": "There is a right temporal subdural hematoma with heterogeneous appearance\nmeasuring approximately 6 cm by 2.5 cm in AP and transverse dimension, causing\neffacement of the sulci, the subdural hematoma is extending along the\ntentorium and subdural region of the right temporal fossa. There is no\nevidence of underlying fracture or soft tissue swelling. Additionally\nadjacent to the subdural hematoma there is small right temporal\nintraparenchymal hematoma measuring approximately 14 mm by 7 mm in transverse\ndimension (5:15). The cerebellar pontine cisterns are preserved with an\nunchanged prominent cisterna magna versus arachnoid cyst, scattered areas of\nlow attenuation in the subcortical periventricular white matter are\nnonspecific and may reflect changes due to small vessel disease, grossly\nunchanged since the prior MRI on ___. On the left cerebral\nhemisphere the sulci are slightly prominent suggesting mild cortical volume\nloss, there is no evidence of hydrocephalus. There is no evidence of large\nterritorial infarct. Vascular calcifications are seen in the carotid siphons\nand distal vertebral arteries. The orbits are unremarkable, the paranasal\nsinuses, middle ear cavities and mastoid air cells are clear.", + "output": "1. Heterogeneous right temporal subdural hematoma measuring approximately 6\ncm x 2.5 cm in AP and transverse dimension, with a small adjacent\nintraparenchymal hematoma in the right temporal lobe measuring approximately\n14 x 7 mm in transverse dimension, there is no significant shifting of the\nnormally midline structures and the perimesencephalic cisterns remain patent. \nThe subdural hematoma is extending along the right tentorium and subdural\nspace of the right temporal fossa.\n\n2. No fractures are identified.\n\n3. Subtle areas of low attenuation in the subcortical and periventricular\nwhite matter are nonspecific and may reflect changes due to small vessel\ndisease.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 4:27 pm, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "Please note that the exam is suboptimal due to significant motion artifact\nwhich limits evaluation of intracranial structures. Within these limitations,\nthere is approximately similar size of a right temporal subdural hematoma\nmeasuring approximately 6.6 x 2.4 cm (02:14), as compared to the earlier CT\nexam. An adjacent intraparenchymal hematoma measures approximately 1.6 x 0.9\ncm, which is similar to the prior exam. No new obvious large acute infarct or\nintracranial hemorrhage is identified. The ventricles and sulci are\nunchanged. No midline shift.\n\nEvaluation of fracture cannot be performed due to motion artifact. There is\nno obvious opacification of the paranasal sinuses or mastoid air cells. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Please note that the exam is suboptimal due to significant motion artifact\nwhich limits evaluation of intracranial structures.\n2. Within these limitations, overall, no significant change in 6.6 x 2.4 cm\nright temporal subdural hematoma compared to prior exam in ___.\n3. A 1.6 x 0.9 cm adjacent intraparenchymal hematoma in the right temporal\nlobe is also unchanged. No obvious large acute infarct." + }, + { + "input": "Interval evolution of blood products within right temporal lobe hematoma. \nInterval decrease of adjacent right temporal subdural hematoma, late subacute\nto chronic today.. No new hemorrhage.\n\nBrain parenchymal atrophy. Findings consistent with moderate chronic small\nvessel ischemic changes. No midline shift. No hydrocephalus.\n\nNo acute fracture. Clear paranasal sinuses, mastoids.", + "output": "Interval improvement, evolution of blood products. No new hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nPeriventricular and subcortical white matter hypodensities are nonspecific,\nbut likely reflect sequelae of chronic small vessel ischemic disease. A\nchronic lacune is seen within the right basal ganglia.\n\nThere is no evidence of fracture. There is complete opacification of the\nbilateral maxillary sinuses with mucosal thickening in the bilateral sphenoid\nand frontal sinuses as well as the ethmoid air cells. There is bony sclerosis\nsurrounding the maxillary and sphenoid sinuses compatible with chronic\ninflammation. The mastoid air cells and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Age related global atrophy and chronic small vessel ischemic disease.\n3. Severe chronic sinus disease as described above." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass. The ventricles and sulci are enlarged suggesting age related atrophy. \nPeriventricular white matter hypodensities are nonspecific but likely sequela\nof chronic small vessel disease.\n\nThere is no evidence of fracture. There is chronic opacification of the\nbilateral maxillary sinuses and anterior ethmoid air cells, with bony\nsclerosis of the wall sinus walls indicative of chronic inflammation. Mild\nmucosal thickening is also seen in the left frontal sinus. The mastoid air\ncells and middle ear cavities are clear. The visualized portion of the orbits\nare unremarkable. Mild atherosclerotic calcifications are seen involving the\ndistal left vertebral and cavernous carotid arteries.", + "output": "1. No acute intracranial process.\n2. Chronic sinus inflammation involving the ethmoid and maxillary sinuses\nbilaterally." + }, + { + "input": "Exam is slightly limited by motion despite numerous attempted repeats.\n\nThere is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Subcortical impaired ventricular white-matter\nhypodensities are nonspecific, however likely represent sequela of chronic\nsmall vessel ischemic disease. Atherosclerotic vascular calcifications are\nnoted of bilateral vertebral and cavernous portions of internal carotid\narteries.\n\nThere is no evidence of fracture. There is mucosal thickening in the\nbilateral maxillary sinuses and ethmoid air cells. Bony sclerosis adjacent to\nbilateral maxillary sinuses is noted. Air-fluid levels are noted in bilateral\nmaxillary sinuses. The visualized portion of the mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable. Soft tissue densities are noted within bilateral external\nauditory canals which may represent cerumen.", + "output": "1. Study is moderately degraded by motion.\n2. Within limits of study, no with acute large territorial infarction or\nhemorrhage.\n3. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct.\n4. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described.\n5. Paranasal sinus disease concerning for acute and chronic sinusitis, as\ndescribed." + }, + { + "input": "Study is mildly degraded by motion. There is no evidence of infarction,\nhemorrhage, edema, or mass. The ventricles and sulci are prominent,\nconsistent with mild atrophy well within normal range for age. There are\nperiventricular and subcortical lucencies, which may represent small vessel\nischemic changes. Atherosclerotic vascular calcifications are noted of\nbilateral vertebral and cavernous portions of internal carotid arteries.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Study is mildly degraded by motion.\n2. Within limits of study, no evidence of large territory acute infarct or\nacute intracranial hemorrhage hemorrhage.\n3. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct.\n4. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema,or large mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. There is small mucous retention cyst in the\nright maxillary sinus. The remaining paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No intracranial hemorrhage or large territorial infarction.\n2. No fracture." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nlarge territorial infarction. Mildly prominent ventricles and sulci suggest\nage-related involutional changes or atrophy. Subcortical and periventricular\nwhite matter hypodensities are consistent with chronic small vessel ischemic\ndisease. The basal cisterns appear patent and there is preservation of\ngray-white matter differentiation.\n\nNo acute fracture is seen. There is complete opacification of the bilateral\nfrontal and partially imaged maxillary sinuses, as well as partial\nopacification of the bilateral ethmoid air cells. Mild mucosal thickening is\nseen within the bilateral sphenoid sinuses. The bilateral mastoid air cells\nand middle ear cavities are clear. Atherosclerotic mural calcification of the\nbilateral internal carotid arteries is noted. The globes are intact.", + "output": "1. No acute intracranial abnormality.\n2. Mild global cerebral atrophy and evidence of chronic small vessel ischemic\ndisease.\n3. Severe sinus disease, as above, largely unchanged from the prior\nexamination." + }, + { + "input": "Prominent of the adenoids and palate tonsils noted. There is asymmetric\nenlargement of the left palate teen tonsil with subtle hypodensity in the\nperitonsillar region consistent with tonsillitis. No drainable fluid\ncollection is seen. Mild associated airway narrowing is noted.\n\nOtherwise the remaining fat planes of the supra and infra hyoid neck\ncompartments are preserved. The aerodigestive tract demonstrates no exophytic\nmucosal mass or focal areas of mass effect. The salivary glands are\nunremarkable. The submandibular soft tissues are within normal limits. There\nis no prevertebral soft tissue swelling.\n\nThere are bilateral prominent level 2A lymph nodes. No lymphadenopathy is\nseen in the remaining nodal levels. The thyroid gland is unremarkable. The\ncervical vessels enhance without evidence of high-grade stenosis or occlusion\nalthough this study is not as optimal as a dedicated CTA.\n\nThe imaged intracranial structures are unremarkable. The imaged lung apices\nare clear. No significant degenerative changes are seen in the cervical\nspine.", + "output": "1. Left tonsillitis with probable phlegmon. No drainable fluid collection.\n\n2. Prominent bilateral level IIa adenopathy is likely reactive. No\nlymphadenopathy is seen in the remaining nodal levels.\n\n3. Hypertrophic adenoid tonsils incidentally noted." + }, + { + "input": "No evidence of acute large territorial infarction, acute intracranial\nhemorrhage, edema, or mass effect. The ventricles and sulci are prominent,\nlikely reflective of age-related volume loss.\n\nNo acute osseous abnormalities. Mild mucosal thickening of the ethmoid air\ncells. Small mucous retention cyst within the right maxillary sinus. The\nparanasal sinuses are otherwise clear. The mastoid air cells, and middle ear\ncavities are clear. Status post bilateral lens replacement.", + "output": "No acute fractures or acute intracranial process." + }, + { + "input": "There is no evidence of acute major territorial infarction, hemorrhage, edema,\nor large mass. The ventricles and sulci are prominent, consistent with age. \nThere is mild periventricular hypodensities, most compatible with the sequelae\nof chronic small vessel disease.\nNo osseous abnormalities seen. There is minimal mucosal thickening in the\nright maxillary sinus. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Motion artifact mildly limits evaluation. There is no evidence of acute,\nlarge territorial infarction, fracture,hemorrhage,edema,or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes\nperiventricular and subcortical white matter hypodensities are nonspecific,\nlikely sequela of chronic ischemic small vessel disease.\n\nSmall mucous retention cyst in the right maxillary sinus. Otherwise, the\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. Aside from bilateral lens replacements and scleral\ncalcifications, the visualized portion of the orbits are normal.", + "output": "No acute intracranial abnormality." + }, + { + "input": "Moderate age-related involutional changes appear stable. Areas of white\nmatter disease suggesting very small prior infarcts and/or chronic ischemic\ndisease appear unchanged. No evidence of acute territorial infarction. No\nevidence of acute intracranial hemorrhage. Gray-white matter distinction\nappears preserved. Similar scleral calcifications and bilateral lens\nreplacements. Partly imaged right maxillary sinus shows mild polypoid mucosal\nthickening as before. Ethmoid sinuses also show similar mild mucosal\nthickening. Otherwise, visualized paranasal sinuses and mastoid air cells\nremain clear. There is no evidence of fracture or bone destruction.", + "output": "No evidence of acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nacute major vascular territorial infarction. Mild periventricular and\nsubcortical white matter hypodensities are nonspecific, likely sequela of\nchronic small vessel ischemia. Global parenchymal volume loss is again seen\nwith prominent ventricles and sulci.\n\nNo evidence for displaced calvarial fracture. Partially visualized right\nmaxillary sinus demonstrates an incompletely imaged small mucous retention\ncyst. There is mild mucosal thickening in the bilateral ethmoid air cells. \nMastoid air cells are well aerated.", + "output": "No evidence for acute intracranial abnormalities." + }, + { + "input": "There is no evidence of acute large territorial infarction, intracranial\nhemorrhage, edema, or significant mass effect.\n\nThere is prominence of the ventricles and sulci suggestive of age-related\ncerebral volume loss. Periventricular and subcortical white matter\nhypodensities are nonspecific, though likely sequelae of chronic small vessel\nischemic disease. Atherosclerotic vascular calcifications are noted of\nbilateral cavernous portions of internal carotid arteries.\n\nNo acute osseous abnormalities seen. Small mucous retention cysts of the\npartially imaged right maxillary sinus. Otherwise, the remaining partially\nimaged paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The orbits demonstrate no acute abnormalities.", + "output": "No acute intracranial process within limitations of this noncontrast study. No\nevidence of intracranial hemorrhage or acute fracture." + }, + { + "input": "A predominantly hypodense extra-axial collection along the left cerebral\nconvexity which measures up to 5 mm and demonstrates several dependent areas\nof intermediate density most likely represents a chronic subdural hemorrhage. \nThere is minimal mass effect on the underlying left cerebral hemisphere with\napproximately 3 mm of rightward midline shift at the level of the septum\npellucidum. There is no subfalcine, uncal or transtentorial herniation.\n\nThere is no evidence of acute territorial infarction or acute intracranial\nhemorrhage.\n\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Mild hypodensities in the periventricular and subcortical white\nmatter are nonspecific but most likely represent chronic microangiopathic\nchanges. There are atherosclerotic calcifications of the intracranial\ninternal carotid and vertebral arteries.\n\nThere is mild mucosal thickening throughout the paranasal sinuses. The\nmastoid air cells, and middle ear cavities are clear. There are bilateral\nlens replacements. There is medial bowing of the right lamina papyracea,\nwhich may be congenital or represent sequela of remote trauma.\n\nNo calvarial fracture is identified. The extracranial soft tissues are\nunremarkable.", + "output": "1. Chronic subdural hemorrhage along the left cerebral hemisphere measuring up\nto 5 mm in thickness and resulting in 3 mm of rightward midline shift.\n2. No acute intracranial hemorrhage or evidence of acute territorial\ninfarction." + }, + { + "input": "A predominantly hypodense extra-axial collection is again visualized along the\nleft cerebral convexity which measures up to 4 mm (series 602: Image 54). \nThere is minimal mass effect on the underlying left cerebral hemisphere with\napproximately 2 mm of rightward midline shift. An acute focus is demonstrated\nalong the vertex, more conspicuous than prior exam which measures 1.2 cm\n(series 602: Image 57). Is no evidence of fracture, large territorial\ninfarction,edema or mass. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. Periventricular deep white matter\nhypodensities are nonspecific, but likely sequela of chronic small vessel\nischemia.\n\nThere is mild mucosal thickening throughout the paranasal sinuses. The\nmastoid air cells, and middle ear cavities are clear.", + "output": "1. Chronic subdural hemorrhage measuring approximately 4 mm in thickness along\nthe left cerebral hemisphere with a hyperdense focus along the vertex which is\nmore conspicuous than prior exam, possibly representing an acute hemorrhagic\ncomponent.\n2. 2 mm of rightward midline shift, similar to prior.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on\n___ at 7:28 pm, 5 minutes after discovery of the findings." + }, + { + "input": "There is no evidence of infarction, new hemorrhage, edema, or mass. The\npredominantly hypodense, extra-axial fluid collection overlying the left\ncerebral convexity is unchanged from previous examination, measuring 7 mm\n(302:44). There is unchanged minimal mass-effect associated with this\ncollection. The previously described 12 mm extra-axial hyperdense focus along\nthe vertex on the left is less conspicuous compared to prior exam, is\nessentially unchanged (302:50). There is a stable rightward midline shift of 2\nmm. The ventricles and sulci are normal in size and configuration.\nSubcortical, periventricular and deep white matter hypodensities are\nnonspecific, but likely reflect the sequela of chronic microangiopathic\nischemic disease.\n\nThere is no fracture. There is mild mucosal thickening of the ethmoid air\ncells. Otherwise, the visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portions of the\norbits are normal.", + "output": "1. Unchanged appearance of the chronic left-sided subdural hemorrhage\nmeasuring 7 mm in thickness with stable 2 mm rightward midline shift.\n2. Similar appearance of the 12 mm extra-axial hyperdense focus along the left\nvertex compared to prior examination, which likely demonstrates an acute\ncomponent of the patient's known subdural hematoma, versus prominent bridging\nvein.\n3. White matter hypodensities are consistent with chronic microangiopathic\nchanges.\n4. Mild paranasal sinus disease." + }, + { + "input": "There is no evidence of large vascular territory infarction, new hemorrhage,\nor edema. The predominantly hypodense, extra-axial fluid collection overlying\nthe left cerebral convexity is unchanged from previous CT, measuring 7 mm and\nmaximum depth (2:24) and exerts minimal mass effect. There is a stable 2 mm\nrightward midline shift. The additional extra-axial hyperdense focus along\nthe left vertex is less conspicuous compared to prior and measures 11 mm\n(303:57), compared to 12 mm from previous. This again may reflect an acute or\nsubacute component of the patient's extra-axial intracranial hemorrhage.\n\nThe ventricles and sulci are prominent, but stable in size and configuration.\nSubcortical, periventricular and deep white matter hypodensities are\nnonspecific, but likely reflect the sequela of chronic microangiopathic\nischemic disease. There is mineralization of the bilateral basal ganglia. \nIntracranial atherosclerotic calcifications.\n\nThere is no fracture. Mild anterior ethmoid air cell mucosal thickening,\notherwise, the visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits\ndemonstrate prior lens surgery and are otherwise normal.", + "output": "1. Unchanged appearance of the 7 mm chronic left-sided subdural hemorrhage\nwith 2 mm of rightward midline shift.\n2. The hyperdense focus along the left vertex is less conspicuous compared to\nprevious and measures 11 mm, likely representing an acute or subacute\ncomponent of extra-axial intracranial hemorrhage.\n3. Prominent sulci and ventricles are consistent with age related global\nparenchymal atrophy, as well as deep white matter changes consistent with\nchronic microangiopathic disease.\n4. Mild paranasal sinus disease." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema,or mass. A\nsubtle 2 mm rightward midline shift is unchanged since the prior study. The\nventricles and sulci are normal for age.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The native lenses have been surgically removed\nbilaterally.", + "output": "1. No evidence of fracture, mass, hemorrhage or infarction.\n2. Two mm rightward midline shift is unchanged." + }, + { + "input": "There is no definite interval change in the curvilinear hyperdensity adjacent\nto inferior fourth ventricle and foramen of Magendie\n\nThere is no evidence of large vascular territory infarction,edema,or mass\neffect. No definite new foci of hemorrhage. There is prominence of the\nventricles and sulci suggestive of involutional changes. Periventricular\nsubcortical white matter hypodensities are nonspecific but suggest chronic\nsmall vessel ischemic changes. Atherosclerotic vascular calcifications are\nnoted of bilateral cavernous portions of internal carotid arteries.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Patient is\nstatus post bilateral lens replacement.", + "output": "1. Grossly stable curvilinear hyperdensity adjacent to inferior fourth\nventricle and foramen of Magendie compared to outside prior noncontrast head\nCT from 7 hours previous. Findings suggestive of vascular calcification, with\ndifferential consideration of small hemorrhage less likely. If available,\nconsider correlation with additional prior imaging. If clinically indicated,\nconsider short-term follow-up imaging for stability.\n2. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described.\n3. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct." + }, + { + "input": "Study is mildly limited by motion artifact. There is no evidence of large\nterritorial infarction,acute intracranial hemorrhage,edema,or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nProminence of the extra-axial spaces overlying the frontal and parietal lobes\ncould reflect the presence of small bilateral subdural hygromas or chronic\nsubdural hematomas. Periventricular and subcortical hypodensities are\nnonspecific but most likely represent sequela of chronic small vessel ischemic\nchanges. Dense atherosclerotic calcifications of the cavernous carotid\narteries are noted with mild atherosclerotic calcifications of the distal left\nvertebral artery seen.\n\nThere is no evidence of acute fracture. There is mild mucosal thickening of\nthe ethmoid air cells and bilateral maxillary sinuses. The remaining\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. \nPatient is status post bilateral lens replacement.", + "output": "1. No acute intracranial hemorrhage or mass effect. No fracture.\n2. Age-appropriate atrophy with chronic small vessel ischemic changes.\n3. Prominence of the extra-axial spaces overlying the frontal and parietal\nlobes could reflect the presence of small and symmetric bilateral subdural\nhygromas or chronic subdural hematomas." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Bilateral periventricular and subcortical white matter\nhypodensities are nonspecific but most likely represent sequela of chronic\nsmall vessel ischemic changes. Atherosclerotic calcifications are seen in the\nbilateral carotid siphons.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Patient is\nstatus post bilateral lens replacement.", + "output": "1. No acute intracranial process. Specifically, no intracranial hemorrhage.\n2. No calvarial fracture." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Prominence of the ventricles and sulci suggest involutional\nchanges. There is also increased CSF density anterior aspect of the right\nmiddle cranial fossa suggesting underlying arachnoid cyst.\n\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact. Punctate calcific\ndensities noted overlying the vertex within the subcutaneous tissues.", + "output": "No acute intracranial process.\nPunctate calcific densities in the subcutaneous tissues overlying the vertex. \nClinical correlation is recommended." + }, + { + "input": "There is no evidence of acute, large territorial\ninfarction,hemorrhage,edema,or mass. The ventricles and sulci are preserved\nin size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are preserved.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is moderate atherosclerotic plaque within the aortic arch and carotid\nsiphons.\n\nThe thyroid gland appears mildly heterogeneous, without a discrete nodule.\n\nThere are no enlarged cervical lymph nodes or definite neck mass on this\nnoncontrast CT. No fluid collection is identified.\n\nThere may be a mildly enlarged precarinal lymph node, incompletely imaged and\na nonspecific finding. The lung apices are clear. There is no aggressive\nbone lesion.", + "output": "1. Please note that the exam is limited due to the lack of intravenous\ncontrast. No enlarged cervical lymph nodes or definite neck mass.\n2. Please refer to concurrent CT chest for additional details." + }, + { + "input": "There are nonenlarged lymph nodes at levels 1 through 5, decreased in size\ncompared to ___. Many of them have also decreased in size compared\nto ___. A left supraclavicular lymph node measures 10 x 6 mm, image\n3:61, compared to 11 x 7 mm in ___ and 25 x 12 mm in ___.\n\nThere is no evidence for an exophytic mucosal mass. Salivary glands appear\nunremarkable. The right thyroid lobe is slightly larger than the left, as\nbefore, without CT evidence for nodules.\n\nMajor cervical vessels are patent. The distal left common carotid artery\nappeared medialized on the ___ CT, on which it coursed medial to the\nupper left thyroid cartilage and indented the posterior pharyngeal wall of the\nlevel of the piriform sinuses. However, it does not appear medialized on the\npresent exam, nor on the ___ exam, coursing lateral to the upper\nleft thyroid cartilage. The clinical significance of this finding is\nuncertain.\n\nEvaluation of the visualized upper lungs is significantly limited by\nrespiratory motion artifact. No enlarged lymph nodes are seen in the included\nportion of the mediastinum. Concurrent chest CT is reported separately.\n\nThere is mild mucosal thickening in the partially visualized left maxillary\nsinus, new compared to ___. A small mucous retention cyst along the\nmedial wall of the right maxillary sinus is smaller than in ___. There\nis small focus of mucosal thickening in a single right anterior ethmoid air\ncell. The ethmoid air cells are partially visualized. Sphenoid sinuses are\nclear. Mastoid air cells are well aerated.\n\nCaries is again noted within ___ #11.\n\nThere are multilevel degenerative changes in the cervical spine. No suspicious\nlytic or sclerotic bone lesions are seen.", + "output": "Progressive decrease in lymphadenopathy compared to ___ and ___." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. There is stable asymmetric size of the thyroid gland, right larger\nthan left, without evidence of nodules. There is no lymphadenopathy by CT\ncriteria. Previously described left supraclavicular lymph node is obscured by\nstreak artifacts from the injected IV contrast. The neck vessels are patent.\n\nConcurrent chest CT is reported separately. There are no osseous lesions. \nMild-to-moderate degenerative changes of the cervical spine is seen, stable\ncompared to prior exam. Dental caries is again seen in ___ 11.\nThe visualized paranasal sinuses, the inner ear and the mastoid air cells are\npatent.\n\nThe left carotid artery is medialized, adjacent to the esophagus. Mild\ndegenerative changes throughout the cervical spine remain unchanged.", + "output": "1. No evidence of lymphadenopathy." + }, + { + "input": "The parotid glands, submandibular glands, and thyroid are unremarkable. There\nis no cervical adenopathy.\n\nThe aerodigestive tract appears normal.\n\nMucous retention cyst is noted in the right maxillary sinus. Other included\nparanasal sinuses and mastoids are clear.\n\nVascular structures in the neck are grossly unremarkable noting a\nretropharyngeal course of the right common carotid artery.\n\nIncluded intracranial structures are grossly unremarkable.\n\nNo focal suspicious osseous lesion identified. Degenerative changes are seen\nin the cervical spine.\n\nCalcified pleural plaques seen at the right upper lung anteriorly. Lung\napices were more fully described on concurrent chest CT.", + "output": "No cervical adenopathy." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are prominent in size and configuration compatible with age related\natrophy.\n\nNo osseous abnormalities seen. There is bilateral mucosal thickening of the\nethmoidal air cells otherwise the visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The orbits are notable for bilateral\nlens replacement.", + "output": "No acute intracranial abnormality." + }, + { + "input": "Study is moderately degraded by motion.\n\nQuestion small left temporal hemorrhagic contusion or subdural hemorrhage,\nversus artifact (see 400:54; 401:72; 05:10).\n\nThere is shift of normally midline structures, or evidence of acute major\nvascular territorial infarction. There is prominence of the ventricles and\nsulci suggestive involutional changes. There are periventricular and\nsubcortical lucencies, which may represent small vessel ischemic changes. \nAtherosclerotic vascular calcifications are noted of bilateral cavernous\nportions of internal carotid arteries.\n\nModerate mucosal thickening of bilateral maxillary sinuses and bilateral\nethmoid air cells. Mild mucosal thickening of bilateral frontal sinuses and\nleft sphenoid sinus. Right middle ear and mastoid air cell partial\nopacification is noted. Soft tissue densities are noted within bilateral\nexternal auditory canals which may represent cerumen.\n\nComplex maxillofacial bone fractures are partially imaged, and are better\nevaluated on recent outside hospital maxillofacial CT.\n\nSubcutaneous air is seen in the deep tissues of the right pterygoid fossa,\naround the and along the prevertebral space and around the right lateral neck\nvessels better evaluated on prior outside hospital imaging.", + "output": "1. Study is moderately degraded by motion.\n2. Question small left temporal intraparenchymal hemorrhage or subdural\nhemorrhage versus artifact.\n3. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct.\n4. Complex maxillofacial bone fractures and associated soft tissue swelling\nare better evaluated on outside hospital maxillofacial CT ___.\n5. Grossly stable retropharyngeal and right suboccipital soft tissue emphysema\ngrossly similar in appearance to prior outside hospital CT from ___.\n6. Paranasal sinus disease and nonspecific right mastoid and middle ear\npartial opacification, as described.\n7. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 2:32 pm, 40 minutes after\ndiscovery of the findings." + }, + { + "input": "The exam is suboptimal due to some patient motion artifact. 9 mm peripheral\nright frontal hyperdensity on series 2, image 19 is felt to be artifactual. \nNo definite acute intracranial hemorrhage is seen elsewhere. There is no\nmidline shift, mass effect, or evidence of acute large vascular territorial\ninfarct. The ventricles and sulci are normal in size and configuration.\n\nNo acute fracture is seen. Mild mucosal thickening is seen of the right\nmaxillary sinus and bilateral ethmoid air cells. The mastoid air cells are\nclear. There is not packed it right posterior maxillary molar.", + "output": "The exam is suboptimal due to some patient motion artifact. 9 mm peripheral\nright frontal hyperdensity on series 2, image ___ be artifactual. No\ndefinite acute intracranial hemorrhage is seen elsewhere. Consider short-term\nfollow-up head CT for further assessment/re-assess right frontal region.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 12:00 am." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. Tiny\nchronic lacunar infarct left caudate head, stable. Mild chronic small vessel\nischemic changes are more prominent. If mild generalized brain parenchymal\natrophy, more prominent since prior.\n\nThere is no evidence of fracture. Volume the visualized portion of the orbits\nare unremarkable. Mild partial opacification of inferior left mastoid air\ncells, with ossification, consistent with contraction from chronic\ninflammation, stable. Small submucosal retention cyst and trace mucosal\nthickening left sphenoid sinus, more prominent since prior. Volume loss left\nmaxillary sinus, similar, with mild mucosal thickening, consistent with\natelectasis from chronic inflammation.", + "output": "No acute intracranial change. No hemorrhage.\nParanasal sinus disease, as above." + }, + { + "input": "No acute intracranial hemorrhage, mass, or cortical infarct. There is subtle\nprogressed bifrontal subcortical and left ganglia capsular hypodensities,\nrepresenting mild chronic ischemic microangiopathic changes, and mild\nincreased prominence of the intra and extra-axial CSF spaces, likely\nrepresenting mild volume loss compared to ___.\n\nGaze towards the right.", + "output": "1. No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. There are\nsmall chronic infarcts, 1 in each side of cerebellum, additional focus\ninvolving anterior limb left internal capsule, stable. There is small focus\nof cortical low-attenuation involving right precentral gyrus, stable since\nprior, with associated atrophy, favoring chronic infarct series 3, image 28. \nJust medial to this, also involving medial right postcentral gyrus, there is\nadditional focus of cortical and subcortical low-attenuation change, similar\nto prior, may represent subacute or chronic infarct, clinically correlate\nseries 3, image 25. There are moderate chronic small vessel ischemic changes,\nstable. There is generalized brain parenchymal atrophy, stable. There is no\nhemorrhage, no evidence of intracranial mass. No hydrocephalus is onto\n\nDiffuse marrow changes of the calvarium may relate to demineralization,\ninfiltrative process cannot be excluded.. There is bilateral complete\nopacification of the middle ear, mastoid air cells, without evidence of bony\nerosion. There is fullness of the posterior nasopharynx, suboptimally seen,\nmay be combination of secretions and prominent mucosa, however, nasopharyngeal\ncarcinoma, lymphoma cannot be excluded, direct visualization recommended. \n___ there is mucosal thickening of the anterior ethmoid air cells. The\nvisualized portion of the remaining paranasal sinuses, are clear. Patient is\nstatus post bilateral lens replacements. Dense calcifications are seen in the\ncarotid siphons.", + "output": "1. No acute intracranial abnormalities. Small chronic infarcts. Chronic\nsmall vessel ischemic changes, generalized brain parenchymal atrophy.\n2. Suggestion of subacute or chronic infarct medial right precentral gyrus.\n3. Complete opacification of the bilateral middle ear and mastoid air cells. \nFullness in the posterior nasopharynx suboptimally seen, may be combination of\nsecretions and prominent mucosa, underlying mass cannot be excluded. Direct\nvisualization is recommended.\n4. Inhomogeneous calvarium, may be due to aggressive demineralization, diffuse\nmarrow infiltrative process, metastases, cannot be excluded.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 11:31 am, 10 minutes after discovery of\nthe findings." + }, + { + "input": "There is no evidence of acute fracture, territorial infarction,intracranial\nhemorrhage,edema,or mass. Subtle periventricular and subcortical white matter\nhypodensities, nonspecific but probably reflect sequela of chronic\nmicroangiopathy The ventricles and sulci are normal in size and configuration\nfor the patient's age.\n\nThere is moderate nasal septum deviation towards the left (series 3, image 9),\nthere is mild asymmetry of the nasal bones on the right (series 3, image 11),\nof uncertain chronicity, please correlate. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. There is no evidence of acute intracranial process or hemorrhage.\n2. No fractures are identified.\n3. Asymmetry of the nasal bones on the right of uncertain chronicity, please\ncorrelate." + }, + { + "input": "Study is mildly degraded by motion.\n\nThere is no evidence of large territorial infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Mild bilateral periventricular white matter\nhypodensities are nonspecific but most likely represent sequela of chronic\nsmall vessel ischemic changes. Atherosclerotic vascular calcifications are\nnoted of bilateral vertebral and cavernous portions of internal carotid\narteries.\n\nThere is no evidence of acute fracture. Chronic right lamina papyracea\nfracture is again noted (see 3:8 on current study and 05:10 on prior exam).. \nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. Patient is status post left lens replacement. \nMinimal right parietal scalp soft tissue swelling is noted (see 02:25).", + "output": "1. Study is mildly degraded by motion.\n2. No acute intracranial abnormality. Please note MRI of the brain is more\nsensitive for the detection of acute infarct.\n3. No evidence acute intracranial hemorrhage or fracture.\n4. Minimal right parietal scalp soft tissue swelling.\n5. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described.\n6. Grossly stable chronic right lamina papyracea fracture compared to ___\nprior exam." + }, + { + "input": "There is no evidence of large territory infarction,hemorrhage,edema,or mass. \nThere is prominence of the ventricles and sulci suggestive global volume loss.\nPunctate foci of hypoattenuation within the right basal ganglia likely\nrepresent virchow ___ spaces or sequela of prior lacunar infarction. Mild\nhypoattenuation of the periventricular and subcortical white matter are\nnonspecific but may represent sequela of prior microvascular ischemic disease.\nMild calcification of the bilateral carotid siphons and right V4 portion of\nthe vertebral artery.\n\nThere is a chronic compression deformity of the right lamina papyracea,\nunchanged when compared to CT head dated ___. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The patient is status post left lens replacement.", + "output": "1. No acute intracranial process." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,or\nmass effect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Mild periventricular white matter hypodensities are\nnoted, sequela of chronic small vessel ischemic disease. Focal hypodensities\nwithin the pons are compatible with prior infarcts. Minimal atherosclerotic\ncalcifications are seen involving the cavernous carotid arteries.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of large territory infarction,hemorrhage,edema,or mass. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Hypodensity within the pons centrally suggestive of a chronic\ninfarct. There is mild attenuation of the periventricular white matter which\nis nonspecific but may represent sequela microvascular disease. There is mild\ncalcified atherosclerosis of the bilateral carotid siphons.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of hemorrhage, infarction, edema, midline shift, or mass\neffect. The ventricles and sulci are normal in caliber and configuration. \nThe basal cisterns are patent. Bilateral senescent basal ganglia\ncalcifications are seen. The visualized paranasal sinuses and mastoid air\ncells are clear. The patient is status post bilateral lens removal, otherwise\nthe globes and bony orbits are unremarkable. Bilateral carotid siphon\ncalcifications are noted.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute large territorial infarct, hemorrhage, edema, or\nmass effect. Prominent ventricles and sulci are suggestive of age-related\ninvolutional changes.\n\nNo osseous abnormalities seen. The visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of intracranial hemorrhage, acute large territorial\ninfarction, edema,or mass. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. Findings consistent with mild chronic\nsmall vessel ischemic change.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute findings." + }, + { + "input": "There is no evidence of intracranial hemorrhage, acute infarction,edema,or\nmass effect. The ventricles and sulci are normal in size and configuration. \nA punctate focus of calcification along a sulcus of the posterior left\nparietal lobe is likely secondary to post infectious change.\n\nThere is no evidence of fracture. There is fluid layering within the right\nmaxillary sinus. The visualized portion of the remaining paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. No evidence of intracranial hemorrhage, fracture, or infarction on\nnoncontrast head CT.\n2. Paranasal sinus disease, as described above.\n3. Additional findings described above." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere are moderate periventricular and subcortical white matter hypodensities,\nnonspecific and likely sequelae of chronic microangiopathy. There is no CT\nevidence of infarction,hemorrhage,edema,ormass. There is prominence of the\ncerebral sulci and ventricles suggestive of age-related involutional changes.\n\nThe visualized portion of the paranasal sinuses demonstrate hyperdense\ninspissated mucus within the sphenoid sinus. There is mild fluid\nopacification of the bilateral mastoid air cells. The remaining paranasal\nsinusesand middle ear cavities are clear. The visualized portion of the orbits\nare unremarkable.\n\nCTA HEAD:\nThere are mild atherosclerotic calcifications of the bilateral internal\ncarotid artery siphons without stenosis. The vessels of the circle of ___\nand their principal intracranial branches otherwise appear patent without\nstenosis, occlusion, or aneurysm formation greater than 3mm. The dural venous\nsinuses are patent.\n\nCTA NECK:\nThere is a linear hypodensity within the lumen of the mid to distal right\ncommon carotid artery (series 6, image 117-127) concerning for possible\ndissection.\n Calcified and noncalcified atherosclerotic plaque is noted along the aortic\narch and origins the right innominate, left subclavian and carotid arteries\nresulting in mild stenosis of the bilateral subclavian arteries. The\nbilateral carotid and vertebral artery origins are patent. There is calcified\nand noncalcified atherosclerotic plaque at the origin of the left vertebral\nartery resulting in 30% stenosis. The left vertebral artery is dominant. The\nright vertebral artery is hypoplastic and terminates in the posterior inferior\ncerebellar artery, a normal anatomic variant.\n There is mixed calcified and noncalcified atherosclerotic plaque at the\nbilateral common carotid artery bifurcations with prominent atherosclerotic\nplaque at the proximal bilateral internal carotid artery resulting in\napproximately 50% stenosis by NASCET criteria.\nOTHER:\nThe visualized portion of the lungs demonstrate bilateral calcified pleural\nplaques with bilateral atelectasis/scarring predominantly in the superior\nsegment of the right lower lobe. Multiple air cysts are seen throughout the\nvisualized lung parenchyma. The visualized portion of the thyroid gland is\nwithin normal limits. There is no lymphadenopathy by CT size criteria.", + "output": "1. Linear hypodensity extending from the mid to distal right common carotid\nartery is concerning for dissection although not definitive.\n2. No evidence of infarction, hemorrhage or other acute intracranial\nabnormality.mass\n3. Patent circle of ___ without definite evidence of stenosis,occlusion,or\naneurysm.\n4. Prominent atherosclerotic plaque of the common carotid, internal carotid\nand left vertebral arteries resulting in approximately 50% stenosis at the\nproximal bilateral internal carotid arteries and 30% stenosis at the origin of\nthe left vertebral artery.\n5. Otherwise patent bilateral cervical carotid and vertebral arteries.\n6. Inspissated mucous in the sphenoid sinus.\n7. Small amount of fluid in the mastoid air cells.\n8. Bilateral calcified pleural plaques with adjacent atelectasis/scarring of\nthe visualized lungs, predominately on the right. This is nonspecific and may\nrepresent asbestos related pleural disease.\n\nNOTIFICATION: The findings were discussed with Dr. ___. by\n___, M.D. on the telephone on ___ at 5:10 pm, 10 minutes\nafter discovery of the findings." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Periventricular and subcortical\nwhite matter hypodensities are likely sequela of chronic small vessel disease.\nVentricles and sulci are unremarkable. Atherosclerotic calcifications noted\nwithin the intracranial ICAs.\n\nThere is a 2.6 x 1.6 cm lobulated density in the right sphenoid sinus which\ndemonstrates areas of central high-density. Included paranasal sinuses and\nmastoids are otherwise essentially clear. Skull and extracranial soft tissues\nare unremarkable.", + "output": "1. No acute intracranial process.\n2. Periventricular and subcortical white matter hypodensities which are likely\nsequela of chronic small vessel disease. If high clinical concern for acute\nstroke, MRI would be more sensitive.\n3. Polypoid density in the sphenoid sinus with some internal high density\ncomponents. While could be just due to underlying sinus disease and retention\ncyst, a solid lesion is not excluded based on this study. Correlation with\nprior imaging may prove useful." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, loss of gray/\nwhite matter differentiation. Ventricles and sulci are age-appropriate. \nMinimal periventricular white matter hypodensity is usually secondary to mild\nchronic small vessel ischemic disease in this age group.\n\nThere is no evidence of fracture. There is mild mucosal thickening in the\nethmoid air cells, frontal sinuses, and partially visualized maxillary\nsinuses. Mastoid air cells are clear. The orbits are unremarkable on\nnoncontrast assessment.", + "output": "No evidence for acute intracranial abnormalities." + }, + { + "input": "No acute fractures are identified.\n\nInferolateral to the right maxilla, there is a high-density subcutaneous fluid\ndensity collection measuring 2.4 x 1.3 cm (2:81) compatible with hematoma. \nThere is also stranding within the subcutaneous tissues inferior to the right\nmaxilla.\n\nThere is mild mucosal thickening in the ethmoid air cells. The ostiomeatal\nunits are patent. Draining channels from the frontal sinuses to the ethmoid\nair cells are patent.\nThe mastoid air cells are clear. The orbits are intact. The mandible and\ntemporomandibular joints appear normal.", + "output": "1. No acute fracture..\n2. Hematoma measuring 2.4 x 1.3 cm inferolateral to the right maxilla, with\nadjacent subcutaneous stranding/swelling." + }, + { + "input": "Streak artifact limits evaluation of pons. Within these confines:\n\nThere is no evidence of territorial infarction,acute hemorrhage,edema,or mass.\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. There are periventricular and subcortical lucencies, which may\nrepresent small vessel ischemic changes.\n\nThere is no evidence of acute fracture. The visualized portion of the mastoid\nair cells, and middle ear cavitiesare grossly clear. The visualized portion\nof the orbits are preserved. Bilateral ethmoid air cell and right frontal\nsinus mucosal thickening is present. Nonspecific numerous punctate foci of\nprobable emphysema are noted throughout the right skullbase soft tissues and\nright temporal soft tissues, which may be intravascular related to vascular\naccess.", + "output": "1. Streak artifact limits evaluation of pons.\n2. No acute intracranial abnormality. Please note MRI of the brain is more\nsensitive for the detection of acute infarct.\n3. Paranasal sinus disease , as described." + }, + { + "input": "There is no evidence of fracture, acute large territory infarction,\nintracranialhemorrhage,edema,or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. Mild periventricular and\nsubcortical white matter hypodensities are nonspecific but compatible with\nchronic small vessel ischemia.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No acute intracranial abnormality.\n2. Involutional and chronic small vessel disease changes." + }, + { + "input": "Imaged intracranial vessels appear normal. The orbits appear normal. The\nimaged paranasal sinuses are well aerated. Mastoid air cells and middle ear\ncavities are clear. Mild bilateral TMJ arthritis is noted. No periapical\nlucency or evidence of odontogenic collection. The airway is patent. The\nepiglottis appears normal. The salivary glands appear symmetric and normal. \nThere is no lymphadenopathy. The thyroid is unremarkable. The lung apices\nare clear. No findings to account for reported neck swelling. Bones appear\nnormal without worrisome lytic or blastic lesion or fracture. Mild\ndegenerative disc disease within the cervical spine is noted with mild loss of\ndisc space and small endplate spurs.", + "output": "No acute findings." + }, + { + "input": "Aero digestive tract:\n\nThere is no mass.\n\nNeck lymph nodes:\nAlthough not pathologically enlarged by size criteria, there are\nasymmetrically prominent rounded lymph nodes on the left at level 5A, for\nexample image 113 of series 4, measuring up to 6 mm.\nThere is no retropharyngeal adenopathy.\n\nExtra nodal tumor spread:\nThere are no findings suggestive of extra nodal extension.\n\nDeep neck muscles, masticator space:\nThere is no muscle invasion.\n\nBones, skull base:\nThere is no bone involvement.\nThere are no findings suggestive of perineural tumor extension.\nJugular foramen, carotid canal,pterygopalatine fossa,infraorbital\nforamen,other skull base foramina are not involved.\n\nVessels:\nThere is no vascular invasion. There is a right chest wall port with IJ\napproach catheter extending into the superior vena cava, not fully included on\nthis exam.\n\nBrachial Plexus:\nThere is no brachial plexus contact or invasion.\n\nThyroid, salivary glands:\nThere is no mass.\n\nOther findings:\nPartially imaged thoracic findings including left upper lobe radiation\nnecrosis and left first rib pathologic fracture as described on dedicated\nthoracic imaging done on previous day. There is mild mucosal thickening in\nthe maxillary sinuses.", + "output": "1. Nonspecific prominent although not pathologically enlarged left level 5A\nlymph node may be reactive.\n2. No definite osseous metastases in the cervical spine, but MRI of the\ncervical spine would be more sensitive, or nuclear medicine bone scan if there\nis concern for more widespread metastatic disease.\n3. Partially imaged thoracic findings including presumed pathologic fracture\nof the left first rib post radiation therapy as well as adjacent pleural\nthickening and likely post radiation changes in the left upper lobe are as\ndescribed and better evaluated on the chest CT from previous day." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or mass\neffect. The ventricles and sulci are normal in size and configuration.\n\nThere is mild soft tissue swelling over the left orbit and frontal bone. \nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear besides\npartially visualized mucosal thickening in the right maxillary sinus. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "No intra-axial or extra-axial hemorrhage, edema, shift of normally midline\nstructures, or evidence of acute major vascular territorial infarction is\nseen. Ventricles are normal in size. Basal cisterns are patent. \nInvolutional changes are age appropriate. The imaged paranasal sinuses are\nwell aerated as are the mastoid air cells and middle ear cavities. The bony\ncalvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of intracranial hemorrhage, acute large territorial\ninfarction, edema,or mass. The ventricles and sulci are within expected\nlimits in size and configuration for age. Minimal periventricular and\nsubcortical hypodensities are nonspecific, though likely sequela of chronic\nsmall vessel ischemic disease.\n\nThere is no evidence of fracture. Mild mucosal thickening of the bilateral\nmaxillary sinuses. The visualized portion of the remaining paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "No evidence of acute intracranial abnormality on noncontrast CT head. \nSpecifically, no acute large territory infarct or intracranial hemorrhage." + }, + { + "input": "Streak artifact from overlying deep brain stimulator leads somewhat limits\nassessment. There is no evidence of acute intracranial hemorrhage, or large\nterritorial infarction. No definite mass or mass effect is demonstrated. The\nventricles and sulci are normal in size and configuration. There is\nredemonstration of bilateral deep brain stimulators terminating in the\nexpected location, and stable from prior.\n\nThere is no evidence of fracture. Multiple sclerotic foci within the\nskullbase including the right occipital condyle, the odontoid process, and the\nclivus appear grossly similar to the prior study. Additional foci are\ndemonstrated at the bilateral mandibular rami and necks (series 601, image\n15). The visualized portion of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Within the limits of a study slightly limited by streak artifact from\noverlying deep brain stimulators, there is no acute intracranial hemorrhage or\nlarge territorial infarction. No definite intracranial mass or mass effect.\n2. Bilateral deep brain stimulators in overall similar location to prior.\n3. Numerous sclerotic foci at the skullbase, cervical spine and mandible are\ngrossly similar to the prior study from ___, concerning for metastatic\ndisease." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nHypodensity in the left basal ganglia is likely sequela of old lacunar\ninfarct. Chronic lacunar infarct also noted in the right caudate head. \nChronic right cerebellar infarct is also noted.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intra cranial hemorrhage. No CT evidence of acute stroke is\nidentified.\n2. Sequela of old lacunar infarct in the left basal ganglia and right caudate\nhead." + }, + { + "input": "The images are partly degraded by motion artifact. Within this limitation,\nthere is no evidence of a territorial infarction, hemorrhage, edema, or mass. \nProminence of the ventricles and sulci is suggestive generalized parenchymal\nvolume loss. Unchanged hypodensity in the left basal ganglia and right\ncaudate head. A chronic right cerebellar infarct was better appreciated on\nthe prior studies.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality or significant interval change since the\nprior head CT." + }, + { + "input": "Compared with CTA head and neck performed earlier on same day, a large left\nparieto-occipital intraparenchymal hematoma with surrounding edema is not\nsignificantly changed in size. Intraventricular extension with blood in the\nleft lateral ventricle is stable. Mass effect on the left lateral ventricle\nstable. The ventricles are stable in size. No evidence of acute infarct or\nnew intracranial hemorrhage. No midline shift. Basal cisterns are patent.\n\nThere is no evidence of fracture. There is mucosal thickening in the\nbilateral maxillary sinuses, right frontal sinus, sphenoid sinuses, and\nbilateral ethmoid air cells, not significantly changed. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Stable large left parieto-occipital intraparenchymal hematoma with\nintraventricular extension.\n2. Stable ventricular size." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is a large, 6.3 x 3.7 cm intraparenchymal hemorrhage in the left\ntemporal lobe with extension into the temporal horn of the left lateral\nventricle, unchanged compared to the exam from 3 hours prior. There is\nminimal, 2 mm rightward midline shift. There is also mild dilatation of the\nleft temporal horn of the lateral ventricle, similar to the study performed 2\nhours prior. The suprasellar cistern remains patent.\n\nThere is no evidence of fracture. There is moderate mucosal thickening of the\nbilateral maxillary sinuses, ethmoid air cells, and sphenoid sinuses. There\nis partial opacification of the bilateral mastoid air cells. The frontal\nsinuses and middle ear cavity is clear. The visualized orbits are\nunremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. No vascular\nabnormality is identified in the region of intraparenchymal hemorrhage. The\ndural venous sinuses are patent.\n\nCTA NECK:\nCalcified atherosclerotic plaque at origin of the right internal carotid\nartery results in mild narrowing. Mild calcifications of the cervical left\ncommon carotid artery do not result in narrowing. Calcification of the\nproximal subclavian artery at the origin of the right vertebral artery likely\nresulting in mild narrowing. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nA solitary bulla is noted in the right lung apex, incompletely evaluated on\nthe current exam. 1The visualized portion of the thyroid gland is\nunremarkable. Scattered prominent cervical lymph nodes do not meet CT size\ncriteria for lymphadenopathy.", + "output": "1. Unchanged 6.3 cm intraparenchymal hemorrhage in the left temporal lobe with\nintraventricular extension and resultant 2 mm rightward midline shift.\n2. No vascular abnormality identified to explain the etiology of the\nhemorrhage.\n3. No internal carotid artery stenosis by NASCET criteria.\n4. Sclerotic calcification and likely mild narrowing of the origin of the\nright vertebral artery." + }, + { + "input": "Middle ear cavities are well aerated bilaterally. There is moderate\nopacification of right mastoid air cells. Left mastoid air cells are well\naerated. Imaged paranasal sinuses are well aerated. No focal organized fluid\ncollections.\n\nEvaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. The neck vessels are patent.\n\nThe imaged portion of the lung apices demonstrate a areas of ground-glass\nopacity which are likely secondary to expiration. No focal pulmonary\nlesions.There are no osseous lesions.\n\nThere are moderate diffuse degenerative changes without high-grade spinal\ncanal or neural foraminal narrowing.", + "output": "Moderate opacification of right mastoid air cells without evidence of bone\ndestruction or middle ear involvement." + }, + { + "input": "Streak artifact from dental amalgam and beam hardening limits assessment of\nthe oropharynx and soft tissues adjacent to the maxilla.\n\nTrace bilateral ethmoid air cell mucosal thickening is present. Otherwise,\nthe paranasal sinuses are well aerated, with no mucosal thickening or\nair-fluid levels identified. The ostiomeatal units are patent.\n\nThe cribriform plates are intact. The lamina papyracea are intact. There is\nminimal leftward nasal septal deviation. Bilateral concha bullosa present. \nThere is no abnormal enhancement on post contrast images.\n\nDiffusely heterogeneous osseous structures is in keeping with history of\nmultiple myeloma. No evidence of acute fracture. The visualized left mastoid\nair cells are clear. There is near complete opacification of the right\nmastoid air cells, which appears stable from neck CT on ___, new\nfrom PET-CT in ___. There is no definite evidence of osteolysis within the\nvisualized portion. Please note, the posterior aspect of both mastoids is not\nincluded in the field of view. No abscess identified in the visualized field.\n\nNonspecific date radiopaque density is noted within the right masticator space\n(see 03:18; 9:5).", + "output": "1. Streak artifact from dental amalgam and beam hardening limits assessment of\nthe oropharynx and soft tissues adjacent to the maxilla.\n2. Nonspecific partial opacification of the right mastoid air cells as seen on\n___ prior neck CT without definite evidence of osteolysis within the\nvisualized portion. No definite evidence of left middle ear cavity fluid.\n3. Within limits of study, no definite peripherally enhancing collection\nidentified. Please note, the posterior aspects of both mastoid air cells are\nnot included in the field of view.\n4. No definite fluid within visualized portion of left mastoid air cells or\nmiddle ear.\n5. Trace ethmoid air cell nonspecific mucosal thickening. Otherwise no\ndefinite evidence of paranasal sinus disease.\n6. Osseous findings as described, compatible with patient's history of\nmultiple myeloma.\n7. Minimal leftward nasal septal deviation.\n8. Bilateral concha bullosa.\n9. Nonspecific date radiopaque density is noted within the right masticator\nspace. Question history of prior surgery." + }, + { + "input": "No evidence of acute large territorial infarction, acute intracranial\nhemorrhage, edema, or mass effect. The ventricles and sulci are mildly\nprominent, likely related to age involutional changes.\n\nNo acute osseous abnormalities. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "The paranasal sinuses are normally pneumatized, with no mucosal thickening or\nair-fluid levels identified. The drainage pathways are patent. Incidental\nnote of right sphenoid cell, and bilateral supraorbital ethmoid air cells.\nThe cribriform plates are intact. The lamina papyracea are intact. Nasal\ncavities is clear. Unchanged left middle turbinate process concha bullosa.\nSoft tissue thickening along anterior aspect of hard palate extending\nposteriorly to oropharynx (2:47, 601:62), correlation with direct\nvisualization is advised.\nInterval improvement in the previously described opacification of the right\nmastoid air cells. Pneumatized petrous apices are clear. Heterogeneous\nosseous structures are again seen, in keeping with history of multiple\nmyeloma. Unchanged punctate radiopaque foreign body identified in the right\nmaxillary space (2:40).\nLimited views of the intracranial structures are unremarkable.", + "output": "1. Paranasal sinuses are essentially clear with no evidence of mucosal\nthickening, and patent drainage pathways.\n2. Nonspecific soft tissue thickening along anterior aspect of hard palate\nextending posteriorly to oropharynx; correlation with direct visualization is\nadvised.\n3. Grossly unchanged heterogeneous osseous structures, in keeping with history\nof multiple myeloma." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are normal.\n\nCTA HEAD:\nThere is moderate calcification causing mild stenosis of the bilateral\ncavernous portions internal carotid arteries.\nOtherwise, the vessels of the circle of ___ and their principal\nintracranial branches appear normal without stenosis, occlusion, or aneurysm. \nThe dural venous sinuses are patent.\n\nCTA NECK:\nImage quality is substantially degraded by artifacts from the shoulders.\nRetropharyngeal course of the bilateral common carotid arteries.\nThere is small calcification left common carotid artery at the carotid\nbifurcation.\nBilateral carotid and vertebral artery origins are patent.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nOtherwise visualization of the bilateral vertebral arteries is difficult given\nsignificant artifact.\nThe carotidand their major branches appear normal with no evidence of stenosis\nor occlusion.\n\n\n\nOTHER:\nThe visualized portion of the lungs are clear. The thyroid gland is enlarged\nand appears nodular. However, images are heavily degraded by artifacts from\nthe shoulders. There may be nodules within the thyroid gland. If further\nevaluation is indicated, thyroid ultrasound may be helpful.. There is no\nlymphadenopathy by CT size criteria.", + "output": "1. Normal head CT.\n2. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n3. Limited evaluation of the neck suggests patent bilateral cervical carotid\narteries without evidence of stenosis, occlusion, or dissection.\n4. Origin of the bilateral vertebral arteries are patent, assessment of the\nremainder of vertebral arteries is extremely limited by artifact\n5. Probable nodular thyroid gland. If further evaluation is indicated,\nconsider elective ultrasound." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are normal in size and configuration.\n\nThere is no fracture. The visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portions of the\norbits are normal.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, shift of midline\nstructures, or acute infarction. The ventricles and sulci are and normal in\nsize and configuration given patient's age. Mild periventricular and\nsubcortical white matter hypodensities are likely sequelae of chronic small\nvessel ischemic disease. The basal cisterns are patent and there is\npreservation gray-white matter differentiation.\n\nNo fracture is seen. There is acute on chronic sinus inflammatory disease\ninvolving the right maxillary sinus and ethmoid air cells with mucosal\nthickening. Within the right maxillary sinus, layering fluid and aerosolized\nsecretions are noted. No osseous erosion is seen. The remaining visualized\nparanasal sinuses, mastoid air cells and middle ear cavities are clear.", + "output": "1. No evidence of hemorrhage or other acute intracranial process.\n\n2. Acute-on-chronic inflammatory disease involving the right maxillary sinus\nand ethmoid air cells." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nloss of gray/ white matter differentiation. Apparent symmetric low attenuation\nwithin the white matter of the bilateral inferior parietal and occipital lobes\nmay be artifactual. The ventricles and sulci are mildly enlarged, indicating\ncerebral atrophy. The basal cisterns are not compressed.\n\nNo fracture is identified. An air-fluid level is seen in the partially\nvisualized right maxillary sinus. Mild mucosal thickening is seen in the\nethmoid air cells. Mastoid air cells and middle ear cavities are clear.", + "output": "1. Apparent symmetric low attenuation within the white matter of the bilateral\ninferior parietal and occipital lobes may be artifactual, but subtle PRES may\nhave a similar appearance. If clinically warranted, MRI may be obtained for\nfurther evaluation.\n2. Fluid within the right maxillary sinus. Please correlate clinically whether\nthe patient has symptoms of acute sinusitis.\n\nNOTIFICATION: The findings and recommendations in impression item 1 were\ndiscussed by Dr. ___ with Dr. ___ on the telephone on ___\nat 1:34 ___, 5 minutes after discovery of the findings." + }, + { + "input": "There is no acute intracranial hemorrhage, edema, mass effect or shift of\nnormally midline structures. The ventricles and sulci are normal in size and\nconfiguration for the patient's age. Subcortical and periventricular white\nmatter hypodensities are consistent with chronic small vessel ischemic\ndisease. Focal hypodensity in the right corona radiata is likely an enlarged\nperivascular space and corresponds to a finding on prior MR. ___ basal\ncisterns appear patent and gray-white matter differentiation is preserved. The\norbits and globes are unremarkable. There is moderate mucosal thickening and\nan air-fluid level in the right maxillary sinus. The remaining imaged\nparanasal sinuses, mastoid air cells, and middle cavities are clear. The bony\ncalvaria appear intact.", + "output": "1. No acute intracranial abnormality.\n2. Right maxillary sinus inflammatory disease with acute component.\n\nNOTIFICATION: Findings were discussed by Dr. ___ with Dr. ___\n(Medicine) by phone at 10:30 a.m. on ___." + }, + { + "input": "The study is limited by motion. Subcortical and periventricular white matter\nhypodensities are consistent with chronic small vessel ischemic disease. There\nis no acute intracranial hemorrhage, edema, mass effect or shift of normally\nmidline structures. The ventricles and sulci are normal in size and\nconfiguration for the patient's age. The basal cisterns appear patent and\ngray-white matter differentiation is preserved. The orbits and globes are\nunremarkable. Again noted is moderate right maxillary sinus inflammatory\ndisease. The remaining imaged paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The calvaria appear intact.", + "output": "1. No acute intracranial abnormality.\n2. Right maxillary sinus inflammatory disease." + }, + { + "input": "Study is degraded by motion and dental streak artifact. There is no evidence\nof infarction, hemorrhage, edema, or mass. There is prominence of the\nventricles and sulci suggestive of involutional changes, greater than expected\nfor age. There are periventricular and subcortical lucencies, which may\nrepresent small vessel ischemic changes.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nethmoid air cells. The visualized portion of the remaining paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are preserved.", + "output": "1. Study is degraded by motion and dental streak artifact.\n2. Within limits of study, no definite evidence of large territorial\ninfarction or intracranial hemorrhage. Please note MRI of the brain is more\nsensitive for the detection of acute infarct.\n3. Global volume loss and probable microangiopathic changes, as described." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. There are\nmild-to-moderate chronic small vessel ischemic changes. There is moderate\nglobal cerebral volume loss, most prominent in the frontal and parietal\nlobes..\n\nThere is no evidence of fracture. Mild opacification right mastoid air cells,\nsimilar to prior. Otherwise, the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "No acute changes.\nModerate cerebral volume loss, there is not temporal lobe dominant." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass effect. \nThe basal cisterns are patent. There is no shift of the normally midline\nstructures. The ventricles and sulci are mildly enlarged, consistent with\ninvolutional changes. A 5 mm circumscribed hypodensity in the right external\ncapsule (3, 15) is consistent with a chronic lacunar infarct versus a dilated\nperivascular (___) space. Scattered bilateral periventricular and\ndeep white matter ill-defined foci of hypodensity are nonspecific however\ncompatible with mild-to-moderate changes of chronic white matter\nmicroangiopathy.\n\nThere is no evidence of fracture. The visualized paranasal sinuses, mastoid\nair cells, and middle ear cavities are well pneumatized and clear. The globes\nand bony orbits are intact and unremarkable.", + "output": "1. No acute intracranial process.\n2. Hypodensity in the right external capsule is consistent with a chronic\nlacunar infarct versus a dilated perivascular (___) space.\n3. Additional findings include age-appropriate global involutional changes and\nmild-to-moderate changes of chronic white matter microangiopathy." + }, + { + "input": "No evidence of acute intracranial hemorrhage. Calcifications noted in the\nbasal ganglia. There is no evidence of acute large territorial\ninfarction,edema,or mass effect. There is prominence of the ventricles and\nsulci suggestive of involutional changes.\n\nMild soft tissue edema overlying the left frontal calvarium without underlying\nfracture. Incidental noting of a 4 mm osteoma of the left frontal calvarium. \nMild mucosal thickening of the right frontal sinus. Mild mucosal thickening\nof the bilateral ethmoid air cells. The visualized maxillary sinuses are\nunremarkable. Partial opacification of the left mastoid air cells. The\nvisualized portion of the right mastoid air cells, and middle ear cavities are\nclear. Vascular calcification of the right vertebral and bilateral internal\ncarotid arteries. Bilateral lens replacement.", + "output": "1. No evidence of acute intracranial hemorrhage.\n2. Left frontal soft tissue edema without underlying fracture." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nThere is extensive loss of the gray-white matter differentiation and oligemia\nin the left MCA and left ACA distributions, consistent with an evolving\ninfarct. There is along the oligemia in the right ACA territory which may\nreflect early ischemic changes. There is also involvement of the left caudate\nnucleus and lentiform nucleus, compatible with infarcts in these territories. \nSulcal effacement in these areas related to cytotoxic edema has worsened, with\nworsening rightward midline shift of 4 mm at the level of the septum\npellucidum. There is mild effacement of the left lateral ventricle. \nHyperdense linear streaks within the involved area are seen.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are preserved. \nEndotracheal and enteric tube are partially visualized.", + "output": "1. Dental amalgam streak artifact limits study.\n2. Evolving infarct involving the large left MCA and ACA territories, with\nworsening cytotoxic edema, sulcal effacement, and 4 mm rightward shift of the\nmidline structures. Hyperdense linear streaks within the involved area may\nrepresent thrombosed vessels, though hemorrhage is not excluded and continued\nimaging follow-up is recommended." + }, + { + "input": "Continued worsening of extensive left hemispheric cytotoxic edema related to\nlarge territory left MCA and ACA infarct, with interval development of\nsubfalcine herniation. Again seen are linear hyperdensities within the\ninvolved left MCA territory, most consistent with thromboses of the left MCA\nand is accentuated by surrounding cytotoxic edema. No evidence of hemorrhagic\ntransformation. 5 mm rightward midline shift, previously 4 mm on the study\nfrom 8 hours prior. Similar appearance of the ventricles with mild effacement\nof the left lateral ventricle. There is evolving oligemia corresponding to\nthe territory of the right ACA, which has progressed compared to the prior\nstudy, concerning for infarction.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. Interval worsening of extensive left hemispheric edema and associated mass\neffect, with development of subfalcine herniation.\n2. Grossly stable linear hyperdensities in the left MCA territory, most\nconsistent with thrombosed vessels, with small adjacent intracranial\nhemorrhage not excluded on the basis examination. Recommend attention on\nfollow-up imaging.\n3. No definite evidence of hemorrhagic transformation.\n\nRECOMMENDATION(S): Grossly stable linear hyperdensities in the left MCA\nterritory, most consistent with thrombosed vessels, with small adjacent\nintracranial hemorrhage not excluded on the basis examination. Recommend\nattention on follow-up imaging.\n\nNOTIFICATION: The wet read findings were discussed with ___, m.D.\nby ___, M.D. on the telephone on ___ at 6:40 am, 2 minutes\nafter discovery of the findings." + }, + { + "input": "Limited exam due to motion degradation. There is no evidence of acute\nintracranial hemorrhage, edema, mass effect, or large territorial infarction. \nThe ventricles and sulci are normal in size and configuration.\nThe basal cisterns appear patent and there is preservation of gray-white\nmatter differentiation.\n\nThere is no acute fracture. Right maxillary sinus is opacified. The remaining\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear.\n\nThe globes are unremarkable.", + "output": "Limited exam due to motion degradation. There is no evidence of acute\nintracranial process. Opacification of right maxillary sinus." + }, + { + "input": "Study is degraded by motion.\n\nPatient is status post left frontal craniotomy and resection of a left frontal\nmass. Postoperative changes including pneumocephalus and edema are seen. \nThere is mass-effect on the anterior horn of the left lateral ventricle and 14\nmm rightward midline shift. Similar to prior exam, the body, posterior horn,\nand temporal horn of the left lateral ventricle appear enlarged.\n\nNo acute large territory infarction or intracranial hemorrhage. The\nvisualized paranasal sinuses, mastoid air cells, and middle ear cavities are\nessentially clear. The orbits are preserved.", + "output": "1. Study is degraded by motion.\n2. Postsurgical changes related to interval left frontal craniotomy and tumor\nresection.\n3. Grossly stable edema and mass effect on anterior horn of the left lateral\nventricle and 14 mm rightward midline shift.\n4. Grossly stable ventriculomegaly as described.\n5. No acute intracranial hemorrhage." + }, + { + "input": "Patient is status post resection of left frontal glioblastoma. There is a 2.3\ncm hyperdensity in the left frontal lobe, consistent with hemorrhage. There\nis adjacent vasogenic edema, which may in part be postsurgical and related to\nthe hemorrhage. There is 15 mm rightward midline shift and subfalcine\nherniation. No evidence of acute fracture. No evidence for acute hemorrhage.\nThe appearance of the ventricles is similar compared to the prior head CT,\nwith the right temple horn possibly slightly more prominent.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "Status post left frontal glioblastoma resection. New left frontal acute\nintraparenchymal hemorrhage; 2.3 cm hyperdensity in the left frontal lobe is\nconsistent with acute intraparenchymal hemorrhage, new since ___. \nRedemonstrated 15 mm rightward midline shift as well as subfalcine herniation,\nand compression of the left frontal horn. The appearance of the ventricles is\ngrossly stable with the right temporal horn possibly slightly more prominent.\n\nNOTIFICATION: The findings were discussed with ___, m.D. by\n___, M.D. on the telephone on ___ at 6:37 pm, 15\nminutes after discovery of the findings." + }, + { + "input": "The left frontal intraparenchymal hematoma measuring 2.2 x 1.2 cm with\nsurrounding edema is unchanged compared to ___. No new\nintracranial hemorrhage identified. Patient is status post resection of left\nfrontal glioblastoma with 4.5 x 3.4 cm resection cavity and adjacent edema\ncausing persistent 12 mm rightward midline shift, dilatation of the occipital\nand temporal horn of the left lateral ventricle, and effacement of the right\nlateral ventricle. There is a 1.7 x 0.9 cm left frontal paramedian\nhypodensity consistent with known satellite nodule seen on prior and better\nevaluated on prior MRI. No additional mass identified. No large territory\ninfarction.\n\nNo acute fracture. The visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are normal.", + "output": "1. Unchanged left frontal intraparenchymal hematoma. No new intracranial\nhemorrhage.\n2. Status post resection of the left frontal glioblastoma with unchanged\npostoperative appearance of the resection cavity and its associated local mass\neffect and rightward midline shift are also unchanged.\n3. Stable ventricular size and configuration including dilated temporal horns\nand effacement of the frontal horn of the left lateral ventricle.\n4. Known left frontal paramedian satellite nodule is better evaluated on prior\nMRIs." + }, + { + "input": "There is no acute intracranial hemorrhage, or midline shift. There is re-\ndemonstration of numerous hypodensities in bilateral cerebellar hemispheres as\nwell as scattered areas in bilateral frontal and parietal lobes and the right\noccipital lobe, more prominent in appearance compared to yesterday's\nexamination. Many of these areas appear to involve both the white matter and\ncortex. There is no hydrocephalus. The the ventricles and sulci are unchanged\nin size and configuration, slightly prominent suggestive of age-related\ninvolutional changes. Dense atherosclerotic calcifications are noted in\nbilateral carotid siphons. The basal cisterns are patent and there is\npreservation of gray-white matter differentiation. The orbits are\nunremarkable. There is again partial opacification of a few of the right-sided\nmastoid air cells. The visualized paranasal sinuses, middle ear cavities and\nmastoid air cells are otherwise clear. There is no fracture.", + "output": "Re- demonstration of numerous hypodense lesions in bilateral cerebral and\ncerebellar hemispheres involving both gray and white matter are slightly more\nevident on today's examination. Given more clear cortical involvement,\nmultiple infarcts are more likely though metastatic lesions remain a\ndifferential consideration. Again, MRI of the brain with and without contrast\nis recommended for further characterization." + }, + { + "input": "SOFT TISSUES: There is no stranding, fluid collection, hematoma, or other\nsoft tissue abnormality.\n\nMAXILLOFACIAL BONES: There is a fracture deformity of the left frontal\nprocess of the maxillary bone (02:51-55). The zygomatico-maxillary complex is\nintact. The lateral pterygoid plates are intact.\n\nMANDIBLE: The mandible is without fracture or temporomandibular joint\ndislocation. The temporomandibular joints are symmetric. Degenerative changes\nare noted bilaterally.\n\nDENTITION: There are no dental fractures. There is no remarkable periodontal\ndisease, periapical lucency, or odontogenic abscess.\n\nSINUSES: There is a mucous retention cyst in the left maxillary sinus, as\nwell as opacification of the left sphenoid sinus. Hyperostosis of the\nsphenoid sinus walls is identified, which may be seen in the setting of\nchronic sinusitis.The ostiomeatal units are patent. The mastoid air cells and\nmiddle ear cavities are clear.\n\nNOSE: There are bilateral nasal bone fractures. Nasopharyngeal soft tissues\nare unremarkable. There is no nasal septal hematoma.\n\nORBITS: The orbits, including the laminae papyracea, are intact. The globes\nare intact with non-displaced lenses and no intraocular hematoma. There is no\npreseptal soft tissue edema. There is no retrobulbar hematoma or fat\nstranding. There are prominent bilateral superior ophthalmic veins, without\nevidence of proptosis or extra-ocular eye muscle enlargement. This is\nnonspecific and may be seen in setting of Valsalva.\n\nAllowing for imaging technique optimized for the face, the limited included\nportion of the brain is grossly unremarkable.", + "output": "1. Bilateral nasal bone fractures and fracture through the left frontal\nprocess of the maxillary bone.\n2. Prominent bilateral superior ophthalmic veins without evidence of orbital\nproptosis or extra-ocular eye muscle enlargement. This is nonspecific and may\nbe seen in setting of Valsalva. Clinical correlation is recommended." + }, + { + "input": "There is extensive subarachnoid hemorrhage in the right sylvian fissure\nextending into the adjacent sulci of the insula, right frontal operculum, if\nand anterior right temporal lobe. There is mild subarachnoid hemorrhage in\nthe left sylvian fissure. No definite parenchymal hemorrhage is seen. These\nfindings are unchanged.\n\nThere is no evidence for parenchymal edema or loss of gray/ white matter\ndifferentiation. Ventricles and basal cisterns are normal in size.\n\nAgain noted is the left scalp hematoma, slightly decreased, extending to the\nleft periorbital region without evidence for intraorbital extension. The\nglobes are intact. No fracture is seen. Fluid are secretions are again seen\nin the the left posterior ethmoid air cell, as well as in the medial aspect of\nthe left sphenoid sinus. There is a small mucous retention cyst in the\npartially visualized right maxillary sinus. Mastoid air cells are grossly\nwell-aerated.", + "output": "1. Stable right greater than left subarachnoid hemorrhage centered in the\nsylvian fissures. No clear evidence for parenchymal hemorrhage is seen on the\npresent or prior CTs.\n2. Left scalp hematoma extending into the left periorbital region has slightly\ndecreased in size. No fracture is seen." + }, + { + "input": "There is no evidence of acute large territorial infarction,acute intracranial\nhemorrhage, edema, or mass. The ventricles and sulci are normal in size and\nconfiguration. The cerebellar tonsils descend approximately 7 mm below the\nforamen magnum (602b:40). There is a possible small pineal cyst measuring 6\nmm (2:13, 602b:42). No prior studies available for comparison.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial hemorrhage. The calvarium is intact.\n\n2. Low lying cerebellar tonsils, approximately 7 mm below the foramen magnum,\ncompatible with the history of Chiari malformation." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are mildly prominent in keeping with mild generalized parenchymal\nvolume loss. Few scattered subcortical and deep white matter hypodensities\nare nonspecific but likely reflect chronic microvascular ischemic change.\n\nNo osseous abnormalities seen. There is mucosal thickening of the sphenoid\nsinuses and of the right maxillary sinus. Otherwise the remaining paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "No acute intracranial abnormality. Mucosal thickening as described above." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Basilar cisterns are\npatent.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or mass\neffect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and deep subcortical white matter\nhypodensities are compatible with moderate chronic small vessel ischemic\nchanges.\n\nThere is no acute fracture. Aside from mild mucosal thickening of the left\nmaxillary sinus in the anterior ethmoidal air cells not thickened at Reading\nout like wrapping hila and a with, the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of acute intracranial process.\n2. Age-related involutional changes and nonspecific white matter hypodensities\nlikely representing the sequelae of chronic small vessel ischemic disease." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nPeriventricular and white matter hypodensities are nonspecific but likely\nsequela of chronic small vessel disease.\n\nThere is no evidence of fracture. There is mild mucosal thickening in the\nmaxillary sinuses and anterior ethmoid air cells. The paranasal sinuses are\notherwise clear. There are calcifications in the cavernous carotid arteries\nbilaterally.", + "output": "No acute intracranial process." + }, + { + "input": "Study is mildly degraded by motion.\n\nAgain is noted small posterior parietal scalp midline soft tissue swelling\n(see 2b:25 on current study and 02:27 on prior exam).\n\nWithin limitations of the study, there is no evidence of infarction,\nhemorrhage, edema, or mass. Bilateral hypodensities in the external capsule,\nleft greater than right appear unchanged from prior study. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nPeriventricular and subcortical white matter hypodensities are nonspecific but\nlikely represent sequelae chronic small vessel ischemic disease. Carotid\nsiphon calcification noted.\n\nThere is no evidence of fracture. Mild mucosal thickening in the and anterior\nethmoid air cells. Otherwise, the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Study is mildly degraded by motion.\n2. No acute intracranial abnormality, with no definite evidence of acute\nintracranial hemorrhage.\n3. Stable age-related involutional changes.\n4. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct.\n5. Grossly stable posterior parietal scalp midline soft tissue swelling." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass effect. \nThere is prominence of the ventricles and sulci suggestive of age-related\nvolume loss. Chronic bilateral subinsular lacunar infarcts are noted (2: 13,\n14). Periventricular and subcortical white matter hypodensities are\nnonspecific, but likely reflect sequela of chronic small vessel disease.\n\nThere is no evidence of fracture. There is moderate mucosal thickening in the\nethmoid air cells and right maxillary sinus. There is moderate to severe\nmucosal thickening and aerosolized secretions in the left maxillary sinus. \nThe visualized portion of the mastoid air cells and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable. Calcification\nof the bilateral carotid siphons are noted.", + "output": "1. No acute intracranial abnormality.\n2. Chronic bilateral subinsular lacunar infarcts.\n3. Paranasal sinus disease, left greater than right." + }, + { + "input": "The previous right posterior parietal approach shunt catheter has been\nremoved. There has been interval placement of a right parietooccipital shunt\ncatheter with tip terminating in the occipital horn of the left lateral\nventricle. The ventricles appear unchanged in size and configuration, with\npersistent prominence of the bilateral occipital horns. There is no evidence\nof acute territorial infarction,hemorrhage, or edema.\n\nExpected postsurgical changes are noted along the right occipital bone with\ntrace pneumocephalus and small amount of subcutaneous edema as well as\nsuperficial skin staples. There is no evidence of acute fracture. The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Interval placement of a right parietooccipital approach shunt catheter\nwith tip terminating in the occipital horn of the left lateral ventricle. The\nventricles remain unchanged in size and configuration compared to ___.\n2. No acute intracranial hemorrhage." + }, + { + "input": "Ventricular drain in place via right parietal burr hole tip may be in the\nbrain parenchymal or just at the roof of the posterior body left lateral\nventricle. Near complete or complete agenesis of the corpus callosum, portion\nof body may be present. Communication of the atria lateral ventricles\nposteriorly, splenium is absent. Probable chronic subdural hygroma along the\nposterior falx on the right side. Minimal intracranial air may be\npostsurgical or from infection. Cerebellar atrophy. No acute infarct, no\nacute hemorrhage. Calcification versus trace subdural hemorrhage along the\nleft tentorium, more apparent. Bilateral temporal lobes partially extend\nthrough the tentorial opening into the perimesencephalic cistern superior\ncerebellar cistern, similar. Minimal opacification paranasal sinuses. Clear\nmastoids.", + "output": "1. Ventricular drain in place, tip may be within brain parenchyma.\n2. Calcification versus trace hemorrhage along the left tentorium cerebelli.\n3. Stable ventricular size.\n4. Remainder as above." + }, + { + "input": "Patient positioning and surgical hardware artifact limits examination.\n\nA right transparietal approach ventriculostomy catheter terminates in the left\natrium. Interval increase in the size of the left temporal horn which now\ndemonstrates increased interventricular air. Interval increase of the\ninterventricular air in the third ventricle, (series 2, image 20). A\ncommunication of the bilateral atria of the lateral ventricles posteriorly is\nagain demonstrated. Near complete or complete agenesis the corpus callosum. \nStable, probable chronic subdural hygroma on the right posterior falx, (series\n2, image 14). Grossly stable hyperdensity along the left tentorium. There is\nno evidence of acute large territory infarction, edema,or mass.\n\nExpected postsurgical changes are noted along the right occipital bone with\ntrace pneumocephalus and a small amount of subcutaneous gas and edema as well\na superficial skin staples.", + "output": "1. Patient positioning and surgical hardware artifact limits examination.\n2. Patient is status post replacement of a right trans parietal approach\nventriculostomy catheter which terminates at the atrium of the left lateral\nventricle with expected postsurgical changes as described above.\n3. Interval increase of in size of the left temporal horn with increased\ninterventricular air within the left temporal horn and third ventricle. \nFindings may reflect postoperative changes and attention is recommended on\nfollow up brain imaging.\n4. No interval change of the hyperdensity along the left tentorium may reflect\nthe transverse sinus. Attention is recommended on follow up if there is\nconcern for hemorrhage.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 1:42 pm, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "The configuration of the ventricles and sulci is unchanged from prior study. \nThere is been redistribution of the pneumocephalus with air now layering in\nthe anterior lateral ventricles and third ventricle, likely due to differences\nin head position during imaging. A right trans parietal approach\nventriculostomy catheter terminates in the left lateral ventricular atrium as\non prior. No acute intracranial hemorrhage or large territorial infarction.\n\nAgenesis of the corpus callosum is congenital. A hypodensity along the right\nposterior falx likely represents a chronic hygroma is unchanged. Relative\n___ along the left posterior cerebral convexity (series 2, image 16)\nslightly less apparent than the prior study from ___.\nPostsurgical changes along the right occiput are unchanged. No substantial\nparanasal sinus disease. The mastoid air cells are clear. The orbits are\nnormal.", + "output": "1. No substantial interval change compared to the prior study. Stable\nventricles and sulci.\n2. Ventricular drain in place and unchanged in position.\n3. No significant change in appearance of the calcification versus trace\nhemorrhage along the left tentorium cerebelli." + }, + { + "input": "Study is degraded by motion and surgical hardware streak artifact.\nAdditionally, beam hardening streak artifact limits evaluations of pons. \nStudy is also limited by patient positioning.\n\nThere as been interval resolution of previously noted intraventricular\npneumocephalus. Findings suggestive of corpus callosum dysgenesis is again\nseen. The ventricles and sulci are grossly stable in size and configuration. \nRight parietal approach ventriculostomy catheter is again seen, with its tip\nagain noted within the body of the left lateral ventricle, grossly unchanged. \nPosterior falx probable hygroma is grossly unchanged.\n\nThere is no evidence of acute large territorial infarction,acute intracranial\nhemorrhage,edema,or mass.\n\nThere is no evidence of fracture. The visualized portion of the mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are preserved. Approximately 8 mm left frontal dural based\ncalcification is noted (602:53; 601:51). While finding may represent dural\ncalcification, calcified meningioma may have a similar appearance. There is\nno definite mass effect on adjacent left frontal lobe. Left sphenoid sinus\nmucosal thickening is present.", + "output": "1. Study limited by motion, surgical hardware streak artifact, patient\npositioning and beam hardening artifact as described.\n2. Grossly stable right parietal approach ventriculostomy catheter.\n3. Interval resolution of previously noted intraventricular pneumocephalus. \nOtherwise, grossly stable ventricular size compared to ___ prior\nexam.\n4. Minimal paranasal sinus disease as described." + }, + { + "input": "There appears to be interval development of a small left subdural low\nattenuation fluid collection measuring 7 mm in maximal thickness overlying the\nleft posterior parietal (series 601, image 73). This is new from ___,\nand this region was not clearly imaged on the prior outside hospital head CT. \nThere is mild mass effect upon the left hemisphere without midline shift.\n\nThere is redemonstration of a right occipital approach VP shunt traversing the\nright occipital lobe with tip terminating into the left lateral ventricle,\nunchanged in position from previous study. There is stable mild dilatation\ninvolving the posterior horn of the left lateral ventricle, third and fourth\nventricle, as seen on most recent prior study. There is redemonstration of\nagenesis of the corpus callosum. There is diffuse bilateral dermal\ncalcification.\n\nNo acute osseous abnormalities seen. The paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The orbits are unremarkable.", + "output": "1. Interval development small subdural hypodense fluid collection overlying\nthe left posterior parietal lobe since ___ which may reflect a chronic\nsubdural hematoma. No acute intracranial hemorrhage or significant mass\neffect.\n2. Stable position of the VP shunt catheter with similar dilatation of the\ninvolving the posterior horn of the left lateral ventricle, third and fourth\nventricles.\n3. Genesis of the corpus callosum." + }, + { + "input": "Right parietal approach ventriculostomy catheter terminates in the left\nlateral ventricle, unchanged. Small, low-density left parietal subdural\ncollection is not significantly changed compared to prior measuring\napproximately 5 mm in maximal thickness. No significant associated mass\neffect or midline shift. There is no evidence of fracture,\ninfarction,hemorrhage,edema, or mass. Agenesis of the corpus callosum is\nnoted. There is stable mild dilation involving the posterior horn of the left\nlateral ventricle.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "Stable low-density left parietal subdural collection. No significant\nassociated mass effect or midline shift." + }, + { + "input": "Again seen is the 7 mm hyperdense focus within the right posterior inferior\ntemporal lobe consistent with intraparenchymal hemorrhage with surrounding\nedema, measuring similar in size to previous, with expected interval evolution\n(2; 18). The trace right supratentorial subdural hematoma is again visualized\nwithout significant interval change (2: 17). There are no new additional foci\nof hemorrhage. There is no evidence of large vascular territorial\ninfarction,or mass. The ventricles and sulci are normal in size and\nconfiguration. The basal cisterns are not compressed. There is no shift of\nnormally midline structures.\n\nAgain seen is foci of air superior to the left orbit (2; 9), unclear if\npneumocephalus.\n\nThe known nondisplaced left maxillary sinus fracture is better visualized on\nprior CT maxillofacial ___. Mild opacification of the left ethmoid\nsinuses and the sphenoid sinus. There is an air-fluid level within the left\nmaxillary sinus, slightly decreased since prior CT head from ___. \nThe visualized portion of the mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. No significant interval change in the small right posterior inferior\ntemporal lobe intraparenchymal hematoma with surrounding edema. No\nsignificant interval change in the trace right supratentorial subdural\nhematoma. No new foci of hemorrhage.\n2. There is a decreased low air-fluid level within the left maxillary sinus\nwith re-demonstration of nondisplaced left maxillary sinus fracture." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. Tiny area of\nincreased signal in the left basal ganglia is due to mineralization, an\nincidental finding (image 11 of series 2).\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere are mild atherosclerotic calcifications of the parasellar internal\ncarotid arteries. There is a small focus of air attenuation adjacent to the\nmedial aspect of the left supraclinoid internal carotid artery likely in the\ncavernous sinus and related to the contrast injection.. The vessels of the\ncircle of ___ and their principal intracranial branches appear normal with\nno evidence of stenosis, occlusion, or aneurysm. The dural venous sinuses are\npatent. Incidental infundibulum is seen at the origin of right posterior\ncommunicating artery.", + "output": "1. No evidence of acute territorial infarction, hemorrhage, or mass lesion.\n2. Mild atherosclerotic calcifications of the parasellar internal carotid\narteries. Otherwise, patent circle of ___ with no evidence of focal\nstenosis, occlusion, or aneurysm formation." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. There\nis prominence of the ventricles and sulci suggestive of involutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "Normal study" + }, + { + "input": "Aero digestive tract:\n\nMildly prominent for age tonsillar pillars are noted. This may reflect\nreactive change.\n\nNeck lymph nodes: Borderline enlarged approximately 1.8 CC x 1.0 AP x 0.7 TRV\ncm left upper jugular chain lymph node may be reactive.\n\nExtra nodal tumor spread:\nThere are no findings suggestive of extra nodal extension.\n\nDeep neck muscles, masticator space:\nThere is no muscle invasion.\n\nBones, skull base: Osteophytic spurring the cervical spine is demonstrated\nwith mild to moderate central canal stenosis and foraminal narrowing most\npronounced at C5-6 and C6-7.\nThere is no bone involvement.\nThere are no findings suggestive of perineural tumor extension.\nJugular foramen, carotid canal,pterygopalatine fossa,infraorbital\nforamen,other skull base foramina are not involved.\n\nVessels: Moderate narrowing of the left proximal cervical internal carotid\narteries seen.\nThere is no vascular invasion.\n\nBrachial Plexus:\nThere is no brachial plexus contact or invasion.\n\nThyroid, salivary glands: An approximately 6.6 CC x4.9 AP x 5.0 TRV cm\nheterogeneous nodule is seen with a few new calcifications and cystic and\nsolid components involving the right thyroid lobe. Substernal component\nextends approximately 2.5 cm below the clavicle, positioned between the\ntrachea and right subclavian and right common carotid. The lesion deviates\nthe trachea approximately 1.5 cm to the left midline. There is mild to\nmoderate airway narrowing most pronounced at thoracic inlet where the caliber\nis diminished to approximately 6 mm. The left thyroid lobe is small.\n\nThe bilateral submandibular gland ducts are dilated to approximately 4 mm\nmaximally. There may be a subcentimeter peripheral left submandibular\ntonsilliths (6; 30) versus tiny calcified lymph nodes. No convincing parotid\nstones are seen. There is partial fatty replacement of the parotid glands. \nThere is no mass.\n\nOther findings: Asymmetric right greater than left apical opacities are\nsimilar demonstrated. Previously described pulmonary nodules are not clearly\nidentified. Mild right and moderate left temporal mandibular joint\nosteoarthritis is seen. Minimal right maxillary sinus and ethmoid air cell\nmural mucosal thickening is demonstrated.", + "output": "1. Heterogeneous right thyroid nodule measuring maximally approximately 6.6 cm\nwith approximately 2.5 cm substernal component and associated mild-to-moderate\nnarrowing and leftward deviation of the trachea. Given its size, if this\nlesion has not been previously evaluated by ultrasound or biopsied, ultrasound\nis recommended to better assess lesion to determine whether biopsy is\nwarranted.\n2. Dilated submandibular gland ducts with a possible left peripheral sialolith\nversus tiny calcified lymph node.\n3. Incompletely imaged right greater than left apical opacities could be\nrelated to scarring but are nonspecific.\n4. Mild right and moderate left temporomandibular osteoarthritis.\n\nRECOMMENDATION(S): 1. Heterogeneous right thyroid nodule measuring maximally\napproximately 6.6 cm with approximately 2.5 cm substernal component and\nassociated mild-to-moderate narrowing and leftward deviation of the trachea.\nGiven its size, if this lesion has not been previously evaluated by ultrasound\nor biopsied, ultrasound is recommended to better assess lesion to determine\nwhether biopsy is warranted.\n\n2. Borderline enlarged approximately 1.8 CC x 1.0 AP x 0.7 TRV cm left upper\njugular chain lymph node may be reactive.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 15:15 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass. The ventricles and sulci are mildly prominent in size compatible with\nage-appropriate atrophy. Mild periventricular and subcortical white matter\nhypodensities are nonspecific, but likely reflect the sequela of chronic\nmicrovascular infarction. Moderate atherosclerotic calcifications of the\ncavernous carotid arteries.\n\nNo fractures identified. Osteomas of the posterior ethmoid air cells are\nnoted. The paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The orbits are notable for bilateral lens replacement.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Normal study. MR may be more sensitive for acute stroke." + }, + { + "input": "There is a redemonstrated left occipital lobe lesion with surrounding\nvasogenic edema, better depicted in the recent MRI of the head dated ___. There is no evidence of acute intracranial hemorrhage.\nThere is no evidence of fracture, territorial infarction, mass effect or\nshifting of the normally midline structures. The ventricles appear normal,\nthe sulci appear slightly prominent towards the left parietal convexity and\ngrossly unchanged (4:20).\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. Redemonstration of left occipital lobe metastatic disease with surrounding\nvasogenic edema, better depicted in the prior MRI of the brain on ___.\n2. There is no evidence of infarction, hemorrhage, or mass-effect\n\nRECOMMENDATION(S): If there is a concern for new metastatic disease,\nrecommend MRI with and without contrast to evaluate for new metastatic lesion." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nMarked bilateral periventricular white matter hypodensities are nonspecific,\nbut likely a sequela of chronic small vessel disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.\n\n Atherosclerotic vascular calcifications are noted of bilateral vertebral and\ncavernous portions of internal carotid arteries.\n\nEvaluation of the soft tissues reveals a focus of left parietal scalp\nthickening with punctate calcification (03:38), which may represent a small\nscalp hematoma or sequela of prior trauma.", + "output": "1. No acute hemorrhage or fracture.\n2. Atrophy and probable chronic small vessel disease.\n3. Nonspecific left parietal scalp thickening with punctate calcification,\nwhich may represent a small contusion or a sequela of prior trauma. Correlate\nclinically with location of head strike.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 8:58 ___, 5 minutes after discovery\nof the findings." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, mass effect, midline\nshift, or mass. The ventricles and sulci are prominent consistent with\natrophy. Confluent periventricular and subcortical white matter hypodensities\nlikely represent the sequela of chronic small vessel ischemic disease.\n\nNo acute fracture is seen. Aerosolized secretions in the paranasal sinuses are\nlikely related to recent intubation The mastoid air cells, and middle ear\ncavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction or hemorrhage. No extra-axial fluid\ncollections are noted. There is slightly more progressed than expected\ncerebral volume loss for age. The basilar cisterns are patent.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. There is prominence of the ventricles and sulci suggestive of volume\nloss. Atherosclerotic calcification of the carotid siphons are noted.\n\nMinimal soft tissue swelling overlies the left parietal bone. There is no\nevidence of fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "No acute intracranial process. Minimal soft tissue swelling overlying the\nleft parietal bone." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are prominent consistent with involutional changes. Minimal\nprominence of extra-axial space overlying right prior occipital junction\ngreater than left, is stable compared to prior exams ___, is most likely secondary to parietal and occipital lobe predominant\natrophy, less likely chronic subdural hygroma.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "Brain parenchymal atrophy is most prominent in the parietal, upper occipital\nlobes and cerebellum." + }, + { + "input": "Age advanced involutional changes are again noted. There is no acute\nintra-axial or extra-axial hemorrhage, edema, shift of normally midline\nstructures, or evidence of acute major vascular territorial infarction. \nImaged paranasal sinuses are well aerated. Mastoid air cells and middle ear\ncavities are also well aerated. The bony calvarium appears intact. Mild soft\ntissue swelling along the right parietal scalp.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of intracranial hemorrhage, infarction,edema, or mass. \nThere is stable prominence of the ventricles and sulci, compatible with\ninvolutional change greater than expected for age.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of intracranial hemorrhage, fracture, or infarction.\n2. Stable appearance of age-advanced involutional change." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are prominent compatible with global volume\nloss. Basilar cisterns are patent.\n\nIncluded paranasal sinuses and left mastoids are clear. Partially opacified\nright mastoid tip is noted. Skull and extracranial soft tissues are\nunremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nAgain noted is parenchymal volume loss, predominantly affecting the sylvian\nfissures, parietal lobes and occipital lobes bilaterally.\n Unchanged prominence of the ventricular system and extra-axial CSF spaces is\nconsistent with the previously mentioned parenchymal volume loss.\n\nThere is no evidence of infarction,hemorrhage,edema,ormass.\nUnchanged mild tonsillar ectopia.\n\nThere is mild mucosal thickening of the ethmoid air cells. The remainder of\nthe paranasal sinuses and mastoid air cells appears clear. The orbits appear\nunremarkable.\n\nCTA HEAD:\nHypoplastic left A1 segment, most likely congenital. The left ACA territories\npredominantly supplied from the contralateral right ICA via a prominent\nanterior communicating artery. There is a prominent left posterior\ncommunicating artery with a hypoplastic P1 segment of left PCA. The vessels\nof the circle of ___ and their principal intracranial branches appear\notherwise normal without stenosis, occlusion, or aneurysm formation. The\ndural venous sinuses are patent.\n\nCTA NECK:\nNormal 3 vessel aortic arch. The carotidandvertebral arteries and their major\nbranches appear normal with no evidence of stenosis or occlusion. There is no\nevidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nMild gravity dependent atelectasis. No suspicious pulmonary nodules. The\nvisualized portion of the thyroid gland is within normal limits. There is no\nlymphadenopathy by CT size criteria.", + "output": "1. No significant intracranial abnormality, no evidence of hemorrhage,\ninfarction or mass.\n2. Unchanged parenchymal volume loss, predominantly affecting the sylvian\nfissures, parietal and occipital lobes bilaterally. Unchanged mild tonsillar\nectopia.\n3. Patent intracranial and cervical vasculature without evidence of vessel\ndissection, occlusion, stenosis or aneurysm." + }, + { + "input": "EEG leads are in place.\n\nThere is no evidence of fracture, infarction,hemorrhage,edema, or mass. A\npunctate density in the right putamen is unchanged since ___ and\nlikely represents a calcification. The ventricles and sulci are normal in\nsize and configuration.\n\nUnchanged left frontal and parietal calvarial osteolytic lesions. The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No acute intracranial findings.\n2. Unchanged left frontal and parietal calvarial lesions." + }, + { + "input": "Unchanged left frontoparietal calvarium osteolytic lesions status post biopsy.\n\nThere is no evidence of large territory infarction, edema, hemorrhage or mass\neffect. Unchanged area of low attenuation in the left parietal subcortical\nwhite matter, nonspecific. There are mild periventricular white matter\nhypodensities, which are also nonspecific, most likely sequela of chronic\nsmall vessel disease. The ventricles and sulci are mildly prominent, likely\nrelated to involutional changes.\n\nThere is no gross evidence of acute fracture. The ethmoid, sphenoid, frontal\nand maxillary sinuses are clear. The middle ear cavities and mastoid air cells\nare unremarkable. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality. Specifically no evidence of\nintracranial hemorrhage.\n2. Relatively stable morphology and extent of known left frontal and parietal\ncalvarium osteolytic lesions." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. There is small area left parietal\nencephalomalacia, unchanged. Ventricles and sulci and unremarkable. Basilar\ncisterns are patent.\n\nIncluded paranasal sinuses and mastoids are clear. Lytic lesions within the\nleft parietal and right frontal calvarium are unchanged, status post biopsies.\nNo new lesion identified.", + "output": "No acute intracranial process, no hemorrhage.\nUnchanged left parietal and left frontal osteolytic lesions in the calvarium\nstatus post biopsy." + }, + { + "input": "Aero digestive tract:\n\nThere is no mass.\nIf there is a mass, please insert field choice -->\n\nNeck lymph nodes:\nThere is no adenopathy involving bilateral levels ___.\nThere is no retropharyngeal adenopathy. There are postoperative changes after\nexcisional biopsy of a left level 5 lymph node present on the prior\nexamination.\n\nExtra nodal tumor spread:\nThere are no findings suggestive of extra nodal extension.\n\nDeep neck muscles, masticator space:\nThere is no muscle invasion.\n\nBones, skull base:\nThere is no bone involvement.\nThere are no findings suggestive of perineural tumor extension.\nJugular foramen, carotid canal,pterygopalatine fossa,infraorbital\nforamen,other skull base foramina are not involved.\n\nVessels:\nThere is no vascular invasion.\n\nBrachial Plexus:\nThere is no brachial plexus contact or invasion.\n\nThyroid, salivary glands:\nThere is a hypodense partially calcified 6 mm right thyroid nodule, unchanged\nsince the prior study.\n\nOther findings:\nThere are no lung nodules.", + "output": "Status post excisional biopsy of left level 5 lymph node.\nNo adenopathy detected." + }, + { + "input": "Aero digestive tract:\n\nThere no mass.\n\nNeck lymph nodes:\nThere is no adenopathy involving bilateral levels ___.\nThere is no retropharyngeal adenopathy.\n\nExtra nodal tumor spread:\nNot applicable.\n\nDeep neck muscles, masticator space:\nThere is no muscle invasion.\n\nBones, skull base:\nThere is soft tissue stranding surrounding the left sternoclavicular joint\nwith rim enhancing fluid collection within the joint space suggestive of\nseptic joint. There is no evidence of bone erosion suggestive of\nosteomyelitis.\n\nVessels:\nThe left vertebral artery is dominant. There are moderate stenosis and\ncalcification involving bilateral cavernous ICA. There is hypoplastic left\ntransverse sinus. There is a partially visualized right Port-A-Cath catheter.\n\n\nBrachial Plexus:\nThere is no brachial plexus contact or invasion.\n\nThyroid, salivary glands:\nThere are stable subcentimeter partially calcified low-attenuation nodules in\nthe right thyroid lobe.\n\nOther findings:\nThere are no lung nodules.", + "output": "Inflammatory changes involving the left sternoclavicular joint with no\nevidence of bone destruction." + }, + { + "input": "There is no evidence of fracture, acute large territory\ninfarction,intracranial hemorrhage,edema,or mass effect. Redemonstration left\nfrontal and left parietal calvarial lytic lesions. White matter hypodensities\ninvolving the left parietal lobe (4:23) and left frontal lobe (4:26) are\nnonspecific and similar in distribution to prior MR. ___ ventricles and sulci\nare normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No evidence of acute large territory infarction or intracranial\nhemorrhage.\n\n2. Redemonstration left frontal and left parietal calvarial lytic lesions." + }, + { + "input": "Exam is mildly limited due to streak artifact.\n\nThere is no evidence of large territorial infarction,hemorrhage,edema,or mass\neffect. White matter hypodensities involving the left parietal lobe and left\nfrontal lobe are nonspecific, and similar in distribution to T2/FLAIR\nhyperintensities from prior MRI, overall unchanged. Ventricles and sulci are\nunchanged and normal in size and configuration.\n\nRedemonstrated left frontal and parietal calvarial lytic lesions, unchanged. \nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No acute intracranial abnormality.\n2. Unchanged left frontal and left parietal calvarial lytic lesions." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding.There is redemonstration of subcentimeter partially calcified\nhypodense nodules in the right thyroid lobe. There is no lymphadenopathy by CT\ncriteria.The neck vessels are patent, noting mild atherosclerotic\ncalcifications at the carotid bifurcations bilaterally.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules.\n\nThere are postsurgical changes of partial resection of the medial head of the\nleft clavicle and debridement at the left sternoclavicular joint. There is a\npartially imaged defect in the mid to left anterior upper chest wall with soft\ntissue fat stranding and without evidence of focal fluid collections.\n\nThere is mild cervical spondylosis, noting osteophytosis and loss of\nintervertebral disc height at C5-C6 and C6-C7.", + "output": "Postsurgical changes of partial resection of the medial head of the left\nclavicle and debridement at the left sternoclavicular joint. Soft tissue\ninflammatory changes in the left anterior chest wall without evidence of focal\nfluid collections." + }, + { + "input": "There is no evidence of an acute hemorrhage or infarct. Hypodensities in the\nleft cerebral hemisphere are noted corresponding to foci of increased T2/FLAIR\nhyperintensity on the MRI from ___, presumably encephalomalacia. \nThe ventricles and sulci are normal in size and configuration. There is\ncalcification of the left vertebral artery.\n\nHeterogeneous left frontal and left parietal calvarial lesions are again\nnoted, unchanged. The visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are normal.", + "output": "1. No acute intracranial abnormality on noncontrast CT head. Specifically no\nintracranial hemorrhage or acute large territory infarct.\n2. Left frontal and parietal calvarial lesions are unchanged from prior exam. \nNo new osseous lesions identified." + }, + { + "input": "There is a soft tissue lesion in the left upper frontal scalp. The scalp soft\ntissue component measures approximately 3.4 x 1.55 x 3.3 cm. There is a\npoorly defined moth-eaten lesion of the underlying calvarium which spans the\nentire thickness of the involving a region measuring approximately 3.3 x 4.3\ncm. In addition, there is underlying dural thickening measuring approximately\n4-5 mm in thickness. There is no edema in the underlying parenchyma. No\nintra-axial or extra-axial hemorrhage is seen. No signs of acute major\ninfarction. Ventricles and sulci are normal in overall size and\nconfiguration. No fracture is seen. The sinuses are clear and the mastoid\nair cells/middle ear cavities are well aerated.", + "output": "Left sided infiltrative/destructive bone lesion involving the frontal bone\nwith associated soft tissue scalp component and underlying dural thickening. \nBiopsy is advised and an MRI may be considered to further assess." + }, + { + "input": "Aero digestive tract: There a possible mass.\n\nThere is a mass in the right nasopharynx with effacement of the fossa of\n___. There is no measurable Masse. However, this lies adjacent to\nthe area of clival involvement demonstrated on the MR examinations. The\nclivus appears normal on this CT study. There is no parapharyngeal,\noropharyngeal, or nasal cavity involvement.\n\nNeck lymph nodes: There is no adenopathy involving bilateral levels ___. \nThere is no retropharyngeal adenopathy.\n\nExtra nodal tumor spread: There are no findings suggestive of extra nodal\nextension.\n\nDeep neck muscles, masticator space: The mass may involve the right longus\ncapitis and medial pterygoid muscles. There is no other evidence of muscle\ninvasion.\n\nBones, skull base:\nThere is no bone involvement demonstrated on the CT scan. However, the right\nside of the clivus was involved on the comparison MR studies.\nThere are no osseous findings suggestive of perineural tumor extension. \nHowever, the location of the nasopharyngeal Mass raises a concern of\nperineural extension. Jugular foramen, carotid canal, pterygopalatine fossa,\ninfraorbital foramen, other skull base foramina are not involved.\n\nVessels: There is no vascular invasion.\n\nBrachial Plexus: There is no brachial plexus contact or invasion.\n\nThyroid, salivary glands: There is no mass.\n\nOther findings: There are no lung nodules.", + "output": "1. Right-sided nasopharyngeal Mass underlying previously demonstrated right\nclivus invasion. The lesion is poorly defined and non measurable but appears\nto involve the right longus capitis and medial pterygoid muscles." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nSubtle periventricular hypodensities in the left frontal and left parietal\nwhite matters correspond with FLAIR/T2 hyperintensities seen on MRI from ___.\n\nMoth eaten appearance of left calvarium with infiltrating lesions are better\nseen on the MRI from ___. There is no evidence of mass effect on\nthe underlying brain parenchyma. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormalities on noncontrast head CT." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration. Chronic left\nparietal infarct, unchanged compared to the prior exam.\n\nMoth-eaten appearance of the left calvarium with infiltrating lesions, similar\nto prior exam. There is no evidence of fracture. The visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavitiesare\nessentially clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Infiltrating left calvarial lesions are unchanged compared to ___." + }, + { + "input": "There is no evidence of acute territorial infarction or intracranial\nhemorrhage.\n\nPeriventricular and subcortical white matter hypodensities corresponding to\nthe T2/FLAIR hyperintensities on prior MRI are unchanged. The ventricles and\nsulci are normal in size and configuration. There are atherosclerotic\ncalcifications of the intracranial internal carotid and vertebral arteries.\n\nMultiple skin markers are seen overlying the calvarium. Multiple\nhypoattenuating infiltrating lesions in the calvarium are not appreciably\nchanged compared to prior exam. There is no evidence of fracture. There is\npartial opacification of the left mastoid air cells. The visualized portion\nof the paranasal sinuses, right mastoid air cells, and bilateral middle ear\ncavitiesare essentially clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial process.\n2. Stable appearance of multiple infiltrating calvarial lesions compared to ___.\n3. Stable appearance of the hypodense lesions in the periventricular and\nsubcortical white matter." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding.There is a 1.2 cm ill-defined hypoattenuating right thyroid nodule\nwith calcification (3:135). There is no lymphadenopathy by CT criteria. The\nneck vessels are patent. A right chest wall Port-A-Cath is partially\nevaluated.\n\nThere is trace mucosal thickening of the right maxillary sinus. Otherwise,\nthe remainder of the visualized paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portions of the globes is\nunremarkable.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules.There is mild multilevel degenerative change of the cervical\nspine. Previously described calvarial and skullbase lesions were better\nassessed on prior MRI brain performed ___. Although this examination\nis not tailored for the evaluation of intracranial structures, no overt\nabnormalities are detected.", + "output": "1. No evidence of lymphadenopathy.\n2. Previously described calvarial and skullbase lesions are better assessed on\nprior MRI brain performed ___.\n3. 1.2 cm ill-defined hypoattenuating right thyroid nodule. No further\nfollow-up is recommended\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or older.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "There is no evidence of acute large territory, infarction, hemorrhage, or\ncerebral edema. The ventricles and sulci are normal in size and\nconfiguration. There is no abnormal enhancement on post contrast images. \nPeriventricular and subcortical white matter hypodensities are nonspecific,\nbut likely reflect sequelae of chronic small vessel ischemic disease.\n\nRedemonstration of low attenuating infiltrating lesions in the calvarium\ninvolving the left frontal and left parietal bone, not significantly changed\nfrom the prior study. Skin staples are seen overlying the left frontal\ncalvarial lesion. The left mastoid air cells are partially fluid filled. \nParanasal sinuses and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "1. No significant change in multiple infiltrating calvarial lesions compared\nto ___.\n2. No acute intracranial process." + }, + { + "input": "There is no evidence of acute large territory infarction,\nintracranialhemorrhage,edema,or discrete mass. The ventricles and sulci are\nnormal in size and configuration. Periventricular and subcortical white\nmatter hypodensities are nonspecific but compatible with chronic small vessel\nischemia.\n\nNo acute fracture. Redemonstration of multiple hypoattenuating infiltrating\ncalvarial lesions, similar to prior. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality, specifically no intracranial hemorrhage\nfollowing biopsy. Unchanged multiple infiltrating calvarial lesions." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThere is a left level 5A lymph node measuring 1.0 cm along the short axis,\npreviously measuring 0.4 cm. It is oval and solid, mildly hyperenhancing.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding.A multinodular goiter is noted..The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions. Multilevel degenerative\nchanges along the cervical spine most prominent at C5-6.\n\nRight chest wall Port-A-Cath is unchanged.", + "output": "Enlarging asymmetrically enlarged left level 5A cervical lymph node, now\nmeasuring 1.0 cm. Node is suspicious regarding potential involvement with\nlymphoma." + }, + { + "input": "No fractures are identified.\nThere is no evidence of facial swelling.\nNo significant mucosal thickening of the paranasal sinuses. The ostiomeatal\nunits are patent bilaterally. There is mild left lower nasal septum deviation\nwith small bone spur formation projecting towards the inferior turbinate\n(05:45). The lamina papyracea is intact. There is mild vascular\ncalcification seen in the carotid siphons.\nThere is no evidence of abnormal fluid collection.\nBilateral mastoids appear normal.\nThe globes, extraocular muscles, optic nerves, and retrobulbar fat appear\nnormal.\nThe visualized upper aerodigestive tract appears normal.\nThe mandible and temporomandibular joints appear normal.\nVascular atherosclerotic calcifications are seen in the carotid siphons\nbilaterally.\nAllowing for the slice selection and technique, limited views of the\nintracranial structures are unremarkable.", + "output": "1. No evidence of acute sinus infection.\n2. Mild nasal septum deviation towards the left as described above." + }, + { + "input": "There is no evidence of recent infarction,hemorrhage,edema,or mass. The\nventricles and sulci are normal in size and configuration.\n\nAgain demonstrated are left frontal and parietal calvarial lesions, not\nappreciably changed compared to the prior examinations. No new osseous lesion\nis identified. The visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavitiesare essentially clear. The visualized portion\nof the orbits are normal.", + "output": "1. No acute intracranial process.\n2. Unchanged left frontal and parietal calvarial lesions. No new osseous\nlesions are identified." + }, + { + "input": "There is no evidence of acute large territory infarction,intracranial\nhemorrhage,edema. The ventricles and sulci are normal in size and\nconfiguration.\n\nLeft frontal and parietal calvarial lesions are not significantly changed. \nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal. \nNasal septal deviation is again noted.", + "output": "1. Unchanged left frontal and parietal calvarial lesions. No evidence of\nacute territorial infarct, intracranial hemorrhage, or significant interval\nchange." + }, + { + "input": "There are periventricular hypodensities along the bilateral anterior horns of\nthe lateral ventricles. Subtle hypodensity is also seen in the right frontal\nwhite matter (02:24). These findings are nonspecific and may reflect sequelae\nof chronic microvascular ischemic disease. No evidence of hemorrhage, edema,\nor mass. Prominence of the ventricles and sulci are likely related to\ninvolutional change.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nleft maxillary sinus. The remainder of the visualized paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "Subtle periventricular and right subcortical white matter hypodensities are\nnonspecific but may reflect the sequelae of chronic microvascular ischemic\ndisease. However, these appear greater than expected for patient's age and\nfurther characterization with MR imaging can be considered to evaluate for\nacute/subacute ischemic change." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\n\nNo fracture is identified. Mild soft tissue swelling along the vertex is\nnoted. Minimal mucosal thickening is noted within the right maxillary sinus. \nThe remaining imaged paranasal sinuses are clear. Mastoid air cells and middle\near cavities are well aerated.", + "output": "No acute intracranial process. Mild soft tissue swelling along the vertex." + }, + { + "input": "There is no evidence of no evidence of infarction, hemorrhage, edema, or\nmass. Prominent ventricles and sulci suggest age related involutional\nchanges. Periventricular white matter hypodensities are consistent with\nchronic small vessel ischemic disease. Atherosclerotic vascular\ncalcifications are noted of bilateral cavernous portions of internal carotid\narteries.\n\nThere is no evidence of fracture. A mucous retention cyst and mucosal\nthickening are seen in the right maxillary sinus. Otherwise, the visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct.\n3. Paranasal sinus disease as described." + }, + { + "input": "There is a re-demonstrated mixed density left subdural collection measuring up\nto 12 mm (02:30) which causes mass effect resulting in a rightward midline\nshift of 4 mm and sulcal effacement, unchanged from prior. There is no\nevidence of acute large territory infarction,new intracranial hemorrhage, or\nmass. The ventricles and sulci are stable in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are notable for bilateral lens replacement.", + "output": "1. Re-demonstrated left subdural mixed density collection measuring up to 12\nmm resulting in rightward midline shift of 4 mm, unchanged from prior.\n2. No acute large territory infarction or new intracranial hemorrhage\nidentified." + }, + { + "input": "Left-sided hypodense subdural in the frontal region is again noted. The extent\nand size of the subdural has decreased. Currently it measures 8 mm in maximum\nwidth in the left frontal region decreased from the previous study when it\nmeasured 12 mm. No acute hemorrhage is seen. Slightly high density membrane\nis seen along the inner aspect. There is no hydrocephalus or midline shift.", + "output": "Left frontal hyperdense subdural measuring 8 mm with high-density membrane\nalong the inner aspect has decreased in size and extent compared with the CT\nof ___. No acute hemorrhage." + }, + { + "input": "Left hemispheric subdural subacute to chronic hematoma is seen. Component\noverlying anterior left frontal lobe is mildly decreased, it measures 7 mm in\nthickness today, compared with 10 mm on ___. Mildly more prominent\nposterior component, measuring 3 mm in thickness at the level of the roof of\nthe lateral ventricles, compared with 1-2 mm on prior, trace component\noverlies left occipital lobe may be from redistribution. No acute blood\nproducts.. No hydrocephalus, no midline shift, no herniation.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Small left hemispheric subacute subdural hematoma, smaller anteriorly,\nslightly larger posteriorly, may be from redistribution. No acute blood\nproducts." + }, + { + "input": "When compared to prior, the left sided subdural hematoma is stable in size\noverlying the left frontal lobe measuring up to 6 mm in thickness. Thinner\nresidual hypodense subdural hematoma seen overlying the parietal lobe, similar\nto prior. There is perhaps slight interval decrease in attenuation,, as\nexpected. No acute hemorrhage identified. No significant mass effect, no\nmidline shift. Gray-white matter differentiation is preserved. Basilar\ncisterns are patent.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Status-post left frontotemporal craniotomy and left temporal lobe lesion\nresection. Extra-axial hemorrhage adjacent to the craniotomy is not\nsignificantly changed. A 1.8 x 1.6 cm hematoma within the left temporal lobe\nresection bed is not significantly changed. No evidence of new intracranial\nhemorrhage. Additional postoperative changes include minimally changed\npneumocephalus. Substantial vasogenic edema involving the left temporal lobe,\nbasal ganglia, inferior frontal lobe is not significantly changed. Effacement\nof the left lateral ventricle is unchanged. 4 mm of midline shift is\nunchanged. Borderline left uncal herniation is stable.\n\n The paranasal sinuses are clear. Partial nonspecific mastoid air cell\nopacification is again noted. The orbits are unremarkable.", + "output": "Status-post left frontotemporal craniotomy and left temporal lobe lesion\nresection with postoperative changes including a small left temporal lobe\nhematoma and small amounts of extra-axial blood which are not significantly\nchanged since 1 day prior." + }, + { + "input": "Status-post left frontotemporal craniotomy and left temporal lobe lesion\nresection. There is a small amount of extra-axial hemorrhage subjacent to the\ncraniotomy. There is a 1.8 x 1.6 cm hematoma within the left temporal lobe\nresection bed. Additional postoperative changes include pneumocephalus and\nsoft tissue emphysema. Substantial vasogenic edema involving the temporal\nlobe, basal ganglia, and inferior left frontal lobe is similar to the\npreoperative examinations. Effacement of the left lateral ventricle is\nimproved. Midline shift is improved, measuring 4 mm and previously measuring\n6 mm. Left uncal herniation has improved.\n\nThe paranasal sinuses are clear. There is nonspecific partial mastoid air\ncell opacification. The middle ear cavities are clear.", + "output": "1. Postsurgical changes from left frontotemporal craniotomy and resection of\nthe left temporal lobe lesion. Postoperative changes include a 1.8 cm\nresection bed hematoma and small amounts of extra-axial hemorrhage along the\ncraniotomy site.\n2. Midline shift, effacement of the left lateral ventricle and left uncal\nherniation are overall improved.\n3. No evidence of acute territorial infarction." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and\nconfiguration. Streak artifact from pipeline embolization material in the\nregion of the right internal carotid artery somewhat limits evaluation. \nMinimal encephalomalacia in the right inferior temporal lobe likely reflect\nhistory of prior aneurysm clipping. Evidence of prior craniotomy along the\nright fronto temporal region.", + "output": "No acute intracranial process. Streak artifact in the region of the right ICA\nfrom recent pipeline embolization." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci and are prominent compatible with global\nvolume loss. Atherosclerotic calcifications noted within the intracranial\nICAs.\n\nPolypoid densities in the nasal cavity suggestive of polyps. Mucous retention\ncysts noted in the right maxillary sinus. Other included paranasal sinuses\nand mastoids are essentially clear.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of acute fracture. There is partial opacification of the\nbilateral ethmoid air cells and frontoethmoid recess on the right. The right\nsphenoid sinus is completely opacified with hyperdense material, suggestive of\nfungal colonization. Otherwise, the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormalities or acute cranial fracture.\n2. Severe, chronic sinusitis with complete opacification of the right sphenoid\nsinus with hyperdense material, which may be due to blood products.. \nClinically correlate." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Prominence of the ventricles and sulci suggest mild parenchymal\ninvolutional changes.\n\nNo suspicious bone lesion is seen. There is mild to moderate mucosal\nthickening in a right anterior ethmoid air cell. Mastoid air cells are well\naerated. The orbits appear unremarkable.", + "output": "No acute hemorrhage or mass effect.\n\nRECOMMENDATION(S): MRI would be more sensitive for intracranial metastatic\ndisease, if clinically warranted." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. There is mild prominence of the ventricles and sulci compatible\nwith age-related involutional changes.\n\nThere is partial opacification of the bilateral ethmoid air cells mild mucosal\nthickening of the right maxillary sinus with a mucous retention cyst in the\nposterior aspect of the right maxillary sinus which is partially visualized. \nMastoid air cells and middle ear cavities are well aerated. The bony calvarium\nis intact.", + "output": "No significant change from CT head ___." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are prominent in size and configuration consistent\nwith age related involutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent. There is a hypoplastic right A1 segment and\nhypoplastic P1 segments bilaterally.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThere is a new 4.9 x 2.5 cm fluid density along the right aspect of the\npericardium ___ of 25 incompletely visualized on the study which may be\nconsistent with either a loculated effusion or pericardial recess. In\naddition, there is a new moderate right pleural effusion.\n\nHeterogeneous left thyroid lobe with multiple lesions, coarse calcification,\nand largest nodule measuring 1.5 x 1.2 cm, for which non-urgent outpatient\nthyroid ultrasound is recommended.\n\nMild multilevel degenerative changes most notable at C5-C6 with loss of disc\nheight, osteophyte formation, endplate sclerosis, and uncovertebral\nhypertrophy.", + "output": "1. Normal head and neck CTA.\n2. No acute intracranial process such as hemorrhage or infarction.\n3. Incompletely visualized 4.9 cm fluid density lesion adjacent to the right\nheart border may represent a loculated effusion or pericardial recess.\n4. Moderate new right pleural effusion.\n5. 1.5 cm thyroid nodule, see below for recommendations.\n\nRECOMMENDATION(S): 1. CT chest.\n2. Nonurgent outpatient thyroid ultrasound.\n\nThyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or older, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150.\n\nNOTIFICATION: The findings were discussed with Dr. ___. by ___,\nM.D. on the telephone on ___ at 1:22 pm, 10 minutes after discovery of\nthe findings." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. Small\nchronic left cerebellar infarct, stable. Brain parenchymal atrophy. Patient\nis intubated.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute findings.\nChronic left cerebellar infarct, stable." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territorial infarct. Prominence of the\nventricles and sulci is consistent with involutional changes. Periventricular\nand subcortical white matter hypodensities are likely sequelae of chronic\nsmall vessel disease. The visualized paranasal sinuses demonstrate partially\nimaged small mucous retention cyst in the right maxillary sinus. The\nremainder of the imaged paranasal sinuses are clear. The mastoid air cells\nare clear. No acute fracture is seen.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema,or mass-effect. \nProminence of the ventricles and sulci is again consistent with involutional\nchanges.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality or evidence of mass effect." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass effect, midline shift,\nor acute major vascular territorial infarct. Gray-white matter differentiation\nis preserved. Ventricles and sulci are prominent compatible with global volume\nloss. Chronic left cerebellar infarct is noted.\n\nIncluded paranasal sinuses and mastoids are clear. Left parietal scalp\nlaceration and soft tissue swelling noted without underlying fracture.", + "output": "Left parietal scalp laceration and swelling without underlying calvarial\nfracture or intracranial hemorrhage." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. \nPeriventricular and subcortical white matter hypodensities are nonspecific,\nbut likely reflect sequelae of chronic small vessel ischemic disease. \nProminence of the ventricles and sulci suggest involutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nModerate atherosclerotic calcification of the cavernous ICAs, with\nmild-to-moderate narrowing on the right, moderate narrowing on the left.\n\nThe left vertebral artery is diminutive. Mild narrowing right P3 segment.\n\nOtherwise, no evidence of intracranial high-grade stenosis or occlusion.\nThe dural venous sinuses are patent.\n\nCTA NECK:\n Moderately atherosclerotic calcification of the right carotid bulb and mild\natherosclerotic calcification of the left carotid bulb noted. There is no\nevidence of internal carotid stenosis by NASCET criteria. Origin narrowing\nright external carotid artery\n\nThe right vertebral artery is patent.\n\nThe left vertebral artery demonstrates complete occlusion from its origin\ninvolving V1, proximal V2 segments. Minimal flow through remainder of the V2\nsegments in the upper neck at C3-4 (3:113). It remains thereafter occluded\nuntil the reconstitution at the left V3 segment (03:38), however it remains\nnarrow in caliber with the V4 segment moderately attenuated, may be from\ndiminished flow or atherosclerotic disease.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Occluded left V1, proximal V2 segments vertebral artery from the origin. \nDiminished flow remainder vertebral artery, small caliber V3, V4 segments.\n2. Intracranial atherosclerotic disease with narrowing.\n3. No acute intracranial findings." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, or mass effect. The\nventricles and sulci are enlarged consistent with age-related atrophy. Subtle\nperiventricular white matter hypodensities suggest chronic small vessel\nischemic disease. No large cortical hypodense area to suggest major\nterritorial infarct, within the limitations of CT.\nVascular calcifications are noted in the cavernous carotid segments on both\nsides.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable. Status post\nbilateral lens replacement.", + "output": "No acute intracranial hemorrhage or mass effect.\nCorrelate clinically to decide on the need for further workup or followup." + }, + { + "input": "Redemonstration of a mixed density subdural hematoma in the left parietal lobe\nwith minimal local mass effect with effacement of the left parietal sulci,\nthat appears unchanged from prior study performed ___. There is no\nsignificant shift in midline structures. There is re-demonstration of\nincreased density along the falx which likely represents parafalcine subdural\nhematomas. Supratentorial subdural hematoma is better visualized in the\ncoronal plane from prior CT performed ___, and appears grossly\nunchanged on today's examination. There is prominence of the ventricles and\nsulci suggestive of involutional changes. There is no evidence of new large\nvascular territory infarct or hemorrhage.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Bilateral lens\nreplacements are once again noted. The remaining visualized portion of the\norbits are unremarkable.", + "output": "1. Redemonstration of a mixed density subdural hematoma in the left parietal\nlobe with minimal local mass effect and effacement of the left parietal sulci,\nwithout significant interval change from prior head CT performed ___.\n2. Parafalcine and tentorial subdural hematomas appear grossly unchanged from\nprior head CT.\n3. No evidence of new large vascular territory infarct or hemorrhage. No\nsignificant shift of midline structures." + }, + { + "input": "Re-demonstration of a mixed density subdural hematoma overlying left parietal\nand temporal lobe, predominantly low density, with minimal local mass effect\nwith effacement of the left parietal and temporal sulci, that appears grossly\nunchanged in thickness from prior study performed ___. High-density\ncomponent seen on prior are less apparent today. There is no significant\nshift of midline structures. There is no significant change of the small\nparafalcine and supratentorial subdural hematomas compared to prior\nexamination. There is prominence of the ventricle and sulci suggestive of\ninvolutional changes. There is no evidence of new large vascular territory\ninfarction or hemorrhage.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Patient is\nstatus post bilateral lens replacements. The remaining visualized portion of\nthe orbits are unremarkable.", + "output": "1. Stable size mixed density subdural hematoma overlying left parietal,\ntemporal lobe. There is no new hemorrhage." + }, + { + "input": "There is no evidence of acute large territory infarction,hemorrhage,edema, or\nmass. There is mild prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific, but likely reflect sequelae of chronic small\nvessel ischemic disease.\n\nThere is no evidence of fracture. There is near complete opacification of the\nbilateral sphenoid sinuses as well as bilateral mucosal thickening of the\nmaxillary sinuses, frontal sinuses, and ethmoidal air cells, which can be seen\nin an intubated patient. The mastoid air cells and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable. Prominent\nbilateral prominent lymph nodes with normal morphology. Nasal and oral\ntracheal tubes are partially evaluated in this exam.", + "output": "There is no evidence of acute intracranial process or hemorrhage.\n\nFindings discussed and reviewed with Dr. ___." + }, + { + "input": "There is no evidence of acute large vascular territorial infarction, acute\nhemorrhage, edema,or mass effect. There is unchanged prominence of the\nventricles and sulci suggestive of involutional changes. Again seen are\nextensive periventricular, deep, and subcortical hypodensities, which may\nrepresent small vessel ischemic changes.\n\nThere is no evidence of fracture. Nasogastric tube is noted. There is\nmoderate amount of fluid, aerosolized secretions, and mild mucosal thickening\nin the left sphenoid sinus, as well as moderate aerosolized secretions and\nmild to moderate polypoid mucosal thickening in the right sphenoid sinus. \nThere is also small amount of fluid in bilateral mastoid air cells. The fluid\nand the aerosolized secretions may be secondary to prolonged supine\npositioning in the inpatient setting. There is also mild mucosal thickening\nin the maxillary, ethmoid, and frontal sinuses.", + "output": "No evidence for an acute intracranial abnormality." + }, + { + "input": "The paranasal sinuses are normally aerated, with no mucosal thickening or\nair-fluid levels identified. A small mucous retention cyst is noted within\nthe left sphenoid sinus (2:41). The ostiomeatal units are patent.\n\nThe cribriform plates are intact. The lamina papyracea are intact. There is\nno abnormal enhancement on post contrast images.\n\nThe partially imaged intracranial structures are unremarkable.", + "output": "Normal appearance of the paranasal sinuses. Specifically, no evidence of\nacute sinusitis." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nA small ill-defined hyperdensity in the interhemispheric fissure anteriorly is\nless conspicuous compared to the prior study (___). Otherwise, there is\nno new intra or extra-axial hemorrhage. Ventricles are stable in size and\nconfiguration and prominence likely represents age related involutional\nchange. There is no edema or mass effect. Gray-white differentiation is\npreserved. Moderately severe mucosal thickening of the left maxillary sinus\nand mild mucosal thickening of the left frontal sinus are noted. The mastoid\nair cells and middle ear cavities are clear. The orbits are unremarkable.\n\n\nCTA NECK:\nThere is a five vessel aortic arch with an aberrant right subclavian artery\ntraversing the midline posterior to the esophagus. The left vertebral artery\nis also originating directly from the arch in close proximity to the left\nsubclavian artery. There is moderate mixed atherosclerotic plaque along the\naortic arch and the ostia of branch vessels without luminal narrowing. The\norigin of the right vertebral artery is tortuous but widely patent. The\ncarotid and vertebral arteries and their major branches appear normal with no\nevidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent. Right fetal PCA configuration noted.\n\n\nOTHER:\nThe visualized portion of the lungs are notable for partially calcified\nbiapical pleural parenchymal scarring. The lungs are otherwise clear. The\nvisualized portion of the thyroid gland is within normal limits. There is no\nlymphadenopathy by CT size criteria.", + "output": "1. A small ill-defined hyperdensity in the interhemispheric fissure anteriorly\nis less conspicuous compared the prior examination and may represent a small\nfocus of evolving subarachnoid hemorrhage. No new hemorrhage or acute\ninfarction.\n2. Unremarkable head and neck CTA, allowing for common anatomic variations,\nsuch as aberrant right subclavian artery." + }, + { + "input": "There is no evidence of acute hemorrhage mass effect midline shift or\nhydrocephalus. Gray-white matter differentiation is maintained. Previously\nseen blood products have resolved. Mild brain atrophy seen.\n\nThe visualized paranasal sinuses are clear. No skull fracture is seen.", + "output": "No acute intracranial abnormalities are identified." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema,or mass effect. There\nis mild prominence of the ventricles and sulci suggestive of involutional\nchanges. Mild subcortical and periventricular white matter hypodensities are\nnonspecific, however likely represent sequela of chronic small vessel ischemic\ndisease. There are atherosclerotic calcifications in the bilateral cavernous\ncarotids.\n\nThere is no evidence of acute fracture. There is mild mucosal thickening in\nthe left maxillary sinus, and partial opacification of the bilateral ethmoid\nair cells, similar to prior. There is mild mucosal thickening and aerosolized\nsecretions in the bilateral frontal sinuses, similar to prior. The visualized\nportion of the remainder of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "No fracture or acute intracranial process." + }, + { + "input": "There is no evidence of acute major infarction,hemorrhage,edema,or large mass.\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Periventricular and subcortical white matter hypodensities are\nnonspecific but likely reflect the sequelae of microvascular ischemic disease.\n\nThere is minimal soft tissue thickening overlying the nasal bridge without\nevidence of an underlying fracture. There is mild mucosal thickening of the\nanterior posterior ethmoid air cells. Minimal mucosal thickening of the left\nmaxillary sinus. The visualized mastoid air cells and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Minimal soft tissue thickening overlying the nasal bridge without evidence\nof an underlying fracture." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. \nPeriventricular white matter hypodensities are nonspecific, likely reflective\nof microvascular ischemic disease. Age-related prominence of ventricles and\nsulci.\n\nThere is no evidence of fracture. Nonspecific persistent mild mucosal\nthickening of the left ethmoid air cells. Nonspecific mild mucosal thickening\nof the left maxillary sinus. Otherwise, the visualized portion of the\nremaining paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are notable for postoperative changes. There\nis extensive calcification of the carotid siphons bilaterally.", + "output": "1. No acute intracranial process.\n2. Age-appropriate atrophic changes." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Mucous retention cysts are seen in the\nright maxillary sinus and right ethmoid air cells. Aerosolized secretions are\nseen in the right sphenoid sinus. The visualized portion of the remaining\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. There is mild\nprominence of the ventricles and sulci compatible with involutional change.\n\nThere is complete opacification of the right maxillary sinus. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare otherwise clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere are trace atherosclerotic calcifications of the bilateral intracranial\ninternal carotid arteries without significant narrowing. There is variant\nfetal type origin of the bilateral posterior cerebral arteries. The vessels\nof the circle of ___ and their principal intracranial branches appear\npatent without significant stenosis, occlusion, or aneurysm formation. The\ndural venous sinuses are patent.\n\nCTA NECK:\nThere are trace atherosclerotic calcifications of the aortic arch. There is a\n3 vessel aortic arch. The carotid and vertebral arteries and their major\nbranches appear patent with no evidence of dissection, stenosis or occlusion.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThere is a punctate calcified granuloma in the left upper lobe. The\nvisualized portion of the lungs are otherwise clear. The visualized portion\nof the thyroid gland is within normal limits. There is no lymphadenopathy by\nCT size criteria.", + "output": "1. No acute intracranial abnormality.\n2. Patent intracranial arterial vasculature without significant stenosis,\nocclusion, or aneurysm.\n3. Patent cervical arterial vasculature without significant stenosis,\nocclusion, or dissection.\n4. Complete opacification of the right maxillary sinus." + }, + { + "input": "Again seen is intraparenchymal hemorrhage involving the left basal ganglia\nmeasuring approximately 3.7 x 2.1 cm with surrounding vasogenic edema, similar\nto prior, with similar degree of intraventricular component filling much of\nthe left lateral ventricle with a small amount of layering hemorrhage in the\noccipital horn of right lateral ventricle. There is also a similar\nsubarachnoid component, most conspicuous along the sylvian fissures, right\ngreater than left. There is similar to slight decrease in rightward midline\nshift, measuring 4 mm, previously 6 mm. There is no evidence of acute large\nterritorial infarction. The ventricles and sulci are stable in size and\nconfiguration. There are periventricular and subcortical hypodensities, which\nmay represent small vessel ischemic changes.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nbilateral maxillary sinuses and ethmoid air cells. The visualized portion of\nthe remaining paranasal sinuses, mastoid air cells, and middle ear cavitiesare\nessentially clear. Nonspecific nasopharyngeal fluid is seen, which may be\nrelated to intubation status. The visualized portion of the orbits are\npreserved. Soft tissue densities are noted within bilateral external auditory\ncanals which may represent cerumen.", + "output": "1. Grossly stable left basal ganglia intraparenchymal hemorrhage with\nintraventricular and subarachnoid components.\n2. Similar to slight decrease degree of rightward midline shift, measuring 4\nmm, previously 6 mm.\n3. Grossly stable ventricular size." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is intraparenchymal hematoma centered in the left caudate head with\ninvolvement of the putamen and extension into the left frontal lobe. There is\nsurrounding edema. There is also intraventricular extension into both lateral\nventricles, left more than right, the third ventricle as well as a trace\namount of blood within the fourth ventricle. Layering blood is also noted in\nthe bilateral occipital horns.\n\nDue to the mass effect of the hematoma and surrounding edema, there is\napproximately 6 mm rightward midline shift. The basal cisterns remain patent.\nThere is no crowding at the level of the foramina magnum.\n\nThere is no evidence of infarction. There is generalized parenchymal volume\nloss, most likely age related. Confluent patchy periventricular hypodensities\nare nonspecific but suggestive of chronic microangiopathy. Questionable trace\namount of subarachnoid hemorrhage in the right temporal and temporoparietal\nsulci (series 2, image 17 and 18).\n\nThere is mild mucosal thickening along the ethmoid air cells, left sphenoid\nsinus and along the floor of the bilateral maxillary sinuses. There is fluid\nin the nasopharynx and oropharynx which is most likely related to intubation. \nThe visualized portion of the mastoid air cells,and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.\nDiffuse periapical lucencies along the remaining maxillary teeth.\n\nCTA HEAD:\nThere are calcified plaque along both carotid siphons but without high-grade\nstenosis. There is focal moderate stenosis at the right P1-P2 junction\n(series 3, image 293) and mild focal stenosis at the proximal left P2 segment\n(series 3, image 287). The vessels of the circle of ___ and their\nprincipal intracranial branches appear otherwise unremarkable without\nhigh-grade stenosis, occlusion, or aneurysm formation.\n\nCTA NECK:\nNormal 3 vessel aortic arch. There are diffuse calcified plaques along the\naortic arch with extension into the great vessels resulting in moderate\nstenosis at the origin of the right subclavian artery. There is\natherosclerotic narrowing of the proximal left subclavian artery, just\nproximal to the origin of the left vertebral artery which results in mild\nstenosis of the left subclavian artery and severe stenosis at the origin of\nthe left vertebral artery. There are atheromatous changes at the origin of\nthe right vertebral artery which result in at least mild stenosis.\nThere are mixed calcified and noncalcified plaque at both carotid\nbifurcations, left more than right with extension into carotid bulb on the\nleft. On the right, this produces approximately 30% stenosis and 20% stenosis\non the left by NASCET criteria.\nOtherwise, the carotidandvertebral arteries and their major branches appear\notherwise normal.\nOTHER:\nThe patient is intubated with the tip of the ET tube terminating approximately\n4.5 cm above the carina. An orogastric tube is in place which is within the\nesophagus and extends beyond the field of few. Mild emphysematous changes are\nnoted in the visualized lung. There are no suspicious pulmonary nodules.\nThere is a 12 cm hypodense left thyroid nodule with peripheral coarse\ncalcification (series 3, image 101). ___ College of Radiology guidelines\ndo not recommend further evaluation for incidental thyroid nodules of this\nsize. There is no lymphadenopathy by CT size criteria.", + "output": "1. Intraparenchymal hematoma centered in the left caudate head with mild\nsurrounding edema and intraventricular extension.\n2. Approximately 6 mm rightward midline shift due to mass effect from the\nhematoma.\n3. Nonspecific confluent, patchy periventricular hypo densities, likely\nsequela of chronic microangiopathy.\n4. Diffuse atheromatous changes of the cervical vasculature resulting in\nmoderate stenosis at the origin of the right and mild stenosis at the origin\nof the left subclavian arteries, severe stenosis at the origin of the left\nvertebral artery and at least mild stenosis at the origin of the right\nvertebral artery.\n5. 30% right and 20% left internal carotid artery stenosis by NASCET criteria.\n6. Moderate focal stenosis at the right P1-P2 junction and focal mild stenosis\nat the proximal left P2 segment.\n7. Otherwise patent cervical and intracranial vasculature without evidence of\ndissection, vessel occlusion or aneurysm formation greater than 3 mm.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "There is a tiny mucosal retention cyst in the left maxillary sinus. The\nparanasal sinuses are otherwise normally aerated, with no mucosal thickening\nor air-fluid levels identified. The ostiomeatal units are patent. There is a\ntiny Haller cell on the right. The cribriform plates are intact. The nasal\nseptum is mildly deviated to the right. The anterior clinoid processes are\nnot pneumatized. The lamina papyracea are intact. The sphenoid sinus septum is\nmidline with insertion upon the sellar floor.", + "output": "1. Small right Haller cell.\n2. Tiny mucosal retention cyst in the left maxillary sinus.\n3. Mild deviation of the nasal septum to the right." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are prominent, suggestive of volume loss. \nThere are periventricular and subcortical hypodensities, which may represent\nsmall vessel ischemic changes. The imaged paranasal sinuses are clear. Mastoid\nair cells and middle ear cavities are well aerated. The bony calvarium is\nintact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction or midline shift.\nThere is no hydrocephalus. There is no edema. There is no fracture. \nProminence of ventricles and sulci are compatible with minor atrophy.\n\nVisualized paranasal sinuses are clear. The right mastoid air cells are\npartially opacified. The left mastoid air cells are clear.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "There is no evidence of fracture, acute large vascular territory\ninfarction,hemorrhage,edema,or mass effect. The ventricles and sulci are\nnormal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is subdural hemorrhage along the falx as well as over the left tentorium\nposteriorly. There is also subarachnoid hemorrhage in the frontal sulci\nanteriorly, similar to prior. Trace hyperdensity along the right medial\nanterior temporal lobe (series 2, image 11) is also unchanged. Overall, there\nhas been some redistribution of blood, but no significant interval increase. \nThere is no evidence of acute territorial infarction or large mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. Small occipital scalp hematoma is noted. \nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavitiesare essentially clear. The orbits are unremarkable. There is\nbilateral carotid siphon calcification.", + "output": "Some redistribution but overall no significant interval increase in subdural\nand subarachnoid hemorrhage." + }, + { + "input": "Prior parafalcine subdural hematoma is no longer visualized. There is no\nintra-axial or extra-axial hemorrhage, mass effect, or midline shift. No\nevidence of acute infarct. Ventricular enlargement out of proportion to the\nsulci is similar in configuration compared to prior.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "Resolution of previously seen subdural and subarachnoid hemorrhage. No acute\nhemorrhage.\nVentricular enlargement out of proportion to degree of sulcal enlargement\nraising the possibility of normal pressure hydrocephalus, to be correlated\nclinically." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of large territory infarction, intracranial\nhemorrhage,edema, mass effect or mass. Prominence of the ventricles and sulci\nare suggestive of involutional changes. There are confluent hypodensities\nwithin the subcortical and periventricular white matter, that are nonspecific\nbut may represent chronic microvascular ischemic disease. There is moderate\ncalcified atherosclerosis at the bilateral carotid siphons.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe P3 segment of the left posterior cerebral artery is not well visualized\nlikely due to suboptimal contrast timing or atherosclerotic disease. The\nother vessels of the circle of ___ and their principal intracranial\nbranches appear normal without stenosis, occlusion, or aneurysm formation. \nThe dural venous sinuses are patent.\n\nCTA NECK:\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\n\nPerfusion:\nCBV > 34% is 4 ml\nCBF less than 30% is 0 mL\nT-max less than 6.0 seconds is 28 ml\n\nDue to suboptimal contrast timing the perfusion data is not optimized in the\nmismatch is infinite.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.\nMultilevel, multifactorial degenerative changes are visualized throughout the\ncervical spine, more significant from C4 through C7 levels.", + "output": "1. Normal head and neck CTA without evidence of internal carotid stenosis by\nNASCET criteria.\n2. No acute intracranial process, specifically no large territorial infarction\nor hemorrhage.\n3. The perfusion data is not optimized due to suboptimal contrast timing.\n4. The P3 segment of the left posterior cerebral artery is not well visualized\nlikely due to suboptimal contrast timing or atherosclerotic disease." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, or acute major\nvascular territorial infarction. Again seen are confluent hypodensities in\nthe periventricular and deep white matter of the cerebral hemispheres, with\nless extensive subcortical involvement, grossly unchanged, nonspecific but\nlikely sequela of chronic small vessel ischemic disease in this age group. \nAlso again seen is a small chronic infarct in the posterior limb of the right\ninternal capsule. There is unchanged mild prominence of the ventricles and\nsulci suggestive of age-related parenchymal involutional changes.\n\nPeriapical lucency and caries ___ 10 are again partially imaged. No other\nconcerning osseous abnormalities seen. There is minimal mucosal thickening in\nthe maxillary sinuses and ethmoid air cells. Mastoid air cells are well\naerated. The orbits appear grossly unremarkable.", + "output": "1. No evidence for acute intracranial abnormalities on noncontrast CT. CTA\nhead and neck was not performed as the patient declined intravenous contrast. \nMRI would be more sensitive for an acute infarction, if clinically warranted.\n2. Periapical lucency and caries ___ 10 are again partially imaged. Please\ncorrelate with dental exam regarding any active inflammation." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nThere is mild mucosal thickening within the left maxillary sinus. Mastoid air\ncells and middle ear cavities are well aerated. The bony calvarium is intact. \nVisualized orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\n\nAerosolized secretions are seen in the left frontal sinus. The remaining\nimaged paranasal sinuses are clear. Mastoid air cells and middle ear cavities\nare well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is a large evolving infarct involving the left parietal and temporal\nlobes and a smaller evolving infarct involving the right parietal lobe. There\nis bilateral effacement of the overlying sulci. There is no shift of midline\nstructures and no evidence of central herniation. There is no hemorrhagic\ntransformation. Size and configuration of the ventricles is unchanged.\n\nThe paranasal sinuses, mastoid air cells and middle ear cavities are clear.\nThere is no fracture. There are atherosclerotic calcifications of the\ncavernous internal carotid arteries.", + "output": "Evolving infarcts involving the inferior divisions of the middle cerebral\narteries bilaterally, larger on the left than right. No hemorrhagic\ntransformation.\n\nNOTIFICATION: The findings were telephoned to Dr. ___ By ___\n___ at 17:09, ___, 2 min after discovery." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. The basal cisterns appear\npatent and there is preservation of gray-white matter differentiation.\n\nNo osseous abnormalities seen. There is mucosal thickening of the left\nmaxillary sinus, ethmoid air cells, as well as the frontal and sphenoid sinus\nwith mild mucosal thickening in the right ethmoid air cells. The mastoid air\ncells and middle ear cavities are clear. The orbits are unremarkable.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect or loss of gray/ white\nmatter differentiation. The ventricles and sulci are normal in size and\nconfiguration. The basal cisterns appear patent.\n\nNo lytic or sclerotic bone lesions are identified. There is mild mucosal\nthickening of the left maxillary sinus and a mucous retention cyst in the\nright sphenoid sinus, similar to ___. Other visualized paranasal\nsinuses, mastoid air cells and middle ear cavities are clear.", + "output": "No evidence of an acute intracranial abnormality. MRI would be more sensitive\nfor sequela of ALL or its treatment, if clinically warranted." + }, + { + "input": "There is no intracranial hemorrhage. There is no evidence of acute infarction.\nThere is no edema, mass-effect, or midline shift. Ventricles and sulci are\nage-appropriate. Basal cisterns are patent and symmetric.\n\nThe osseous structures are normal. There is mild mucosal thickening of the\nleft maxillary sinus and a mucus-retention cyst in the right sphenoid air\ncell, unchanged from ___. The paranasal sinuses are otherwise clear. \nThere are aerosolized secretions in the nasal cavity. The mastoid air cells\nand tympanic cavities are clear. The orbits are normal.", + "output": "No intracranial hemorrhage or other acute intracranial abnormality. No\nfracture.\n\nNOTIFICATION: Findings discussed with Dr. ___ at 1450H on ___." + }, + { + "input": "Left : The external auditory canal is normal. The middle ear cavity is clear.\nThe ossicles and tegmen are intact. There is no evidence for enlarged\nvestibular aqueduct or superior semicircular canal dehiscence. The facial\nnerve follows a normal course through the middle ear. There is no evidence for\ninner ear dysplasia. The mastoids are clear.\n\nRight: The external auditory canal is normal. The middle ear cavity is clear.\nThe ossicles and tegmen are intact. There is no evidence for enlarged\nvestibular aqueduct or superior semicircular canal dehiscence. The facial\nnerve follows a normal course through the middle ear. There is no evidence for\ninner ear dysplasia. The mastoids are clear.\n\nOther: Extensive atherosclerotic calcification of the internal carotid\narteries are identified. Otherwise, visualized brain and neck soft tissues\nare normal. The visualized paranasal sinuses are clear. The orbits are\nunremarkable.", + "output": "1. There is no radiographic evidence of mastoiditis. Unremarkable examination\nof the temporal bones.\n\n2. Visualized brain and soft tissues are unremarkable." + }, + { + "input": "Large left subdural hemorrhage overlying the left cerebral convexity,\nextending along the left falx and layering along the left tentorium appears\nincreased in size from the prior study. Additionally, right-sided subdural\nhematoma along the right frontal temporal convexity and layering along the\nright tentorium has also increased in size in the interval. There is\nincreased mass effect with increased rightward shift of normally midline\nstructures by 13 mm (previously 10 mm). Left frontal and temporal\nsubarachnoid hemorrhage appears slightly increased. Small right superior\nfrontal subarachnoid hemorrhage is new. There is bilateral uncal and\ntonsillar herniation. The ventricles are larger compared to the prior study\nsuggestive of entrapment and obstruction.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Right parietal subgaleal hematoma is\nnoted. Dense atherosclerotic calcifications are seen involving the cavernous\ncarotid arteries.", + "output": "1. Increased bilateral subdural hematomas and increased left frontal temporal\nsubarachnoid hemorrhage with new focus of right frontal subarachnoid\nhemorrhage.\n2. Worsening mass effect with increased right subfalcine herniation as well as\nbilateral uncal and tonsillar herniation.\n3. Increased size of the ventricles suggestive of entrapment and obstruction." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nExtensive soft tissue swelling with locules of gas are consistent with\nmultiple scalp lacerations. Deep laceration along the left frontoparietal\nscalp is present. There is a bone chip along the outer table of the left\nparietal bone (03:38). The inner table is intact at this level. Large right\nfrontoparietal subgaleal hematoma measures 4.4 x 2.3 cm with overlying skin\nstaples. Left mucous retention cyst is noted within left maxillary sinus. \nThe additional visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial process. Specifically, no intracranial hemorrhage.\n2. Extensive soft tissue swelling with locules of gas within the subcutaneous\ntissue consistent with the multiple lacerations.\n3. Deep left frontoparietal laceration with bone chip along outer table of the\nleft parietal bone. Inner table is intact.\n4. Large right frontoparietal subgaleal hematoma measuring 4.4 cm." + }, + { + "input": "There is no hemorrhage, edema, or mass effect. Prominent ventricles and sulci\nlikely reflect age related volume loss. Minimal periventricular white matter\nhypodensities are nonspecific, likely sequela of chronic small vessel\nischemia. Empty sella noted.\n\nThe orbits are unremarkable bilaterally. The calvarium is intact. Moderate\nmucosal thickening involves the ethmoidal air cells with near complete\nopacification. Minimal mucosal thickening involves the frontal sinuses\nbilaterally, sphenoid sinuses, and maxillary sinuses, a mucous retention cyst\nnoted in the right maxillary sinus. Mastoid air cells bilaterally and middle\near cavities are clear. Extensive atherosclerotic calcifications are noted\nwithin the carotid siphons.", + "output": "1. No acute hemorrhage or evidence of fracture.\n2. Left parietal scalp soft tissue swelling.\n3. Paranasal sinus disease as described." + }, + { + "input": "There is no evidence of tumor recurrence. There is no abnormal fluid\ncollection.\nAgain noted is obliteration of the normal fat planes throughout the\nsuperficial soft tissues of the right neck and parotid region, consistent with\nprior right radical neck dissection and post radiation changes. The right\nsternocleidomastoid and jugular vein are surgically absent.\n\nThe visible vessels are all patent. There is atheromatous disease at the left\ncarotid bifurcation, similar compare to prior. Visualized mastoid air cells\nare clear.\n\nThere is mild worsening of the degenerative changes of the spine. Again seen\nare disc space narrowing and anterior and posterior osteophytosis of the C4-7.\nThere is no significant spinal canal narrowing. There is mild neural\nforaminal narrowing at left C3-4, bilateral C4-5, bilateral C5-6 and bilateral\nC6-7, not significantly changed from prior.\n\nLung apices again demonstrate emphysematous changes.", + "output": "1. No evidence of tumor recurrence.\n2. No abnormal fluid collection concerning for abscess.\n3. Stable postsurgical and radiation changes of the right neck.\n4. Stable appearance of atheromatous disease at the left carotid bifurcation." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes, but\nwithin normal range for age. Periventricular, subcortical and deep white\nmatter hypodensities are consistent with chronic small vessel ischemic\ndisease.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of intracranial hemorrhage, edema, or large territorial\ninfarction. Ventricles and sulci are normal in size and configuration. The\nbasal cisterns are not compressed.\n\nNo suspicious calvarial lesion is seen. There is mild mucosal thickening\nalong the floor of the right maxillary sinus. Other paranasal sinuses and\nmastoid air cells are well aerated. The orbits are unremarkable.\n\nCTA NECK:\nThere is a common origin of the innominate and left common carotid arteries, a\nnormal variant. Evaluation of the distal internal carotid arteries is limited\nby motion artifact. Otherwise, the carotid and vertebral arteries and their\nmajor branches appear widely patent without evidence for stenosis or\ndissection. Specifically, there is no evidence of internal carotid stenosis\nby NASCET criteria.\n\nCTA HEAD:\nThere is no evidence for flow-limiting stenosis in the anterior or posterior\ncirculation. There is a medially directed 3 mm outpouching of the paraclinoid\nleft internal carotid artery, compatible with an aneurysm or infundibulum,\nseries 5, image 211. A possible 2 mm outpouching may be seen within the distal\nleft anterior cerebral artery at the bifurcation of the callosal and\npericallosal branches, series 601b, image 26, series 5, image 254. The dural\nvenous sinuses are patent.\n\nOTHER:\n1.2 cm nodule is seen within the right thyroid lobe, series 5, image 75. \nThere is a 0.8 x 0.8 cm nodule contiguous with the posterior margin of the\nlower pole of the right thyroid lobe, series 5, image 64, which demonstrates\nthe same enhancement as the thyroid gland may represent an exophytic nodule. \nThere is a a 2.1 cm x 1.5 cm enhancing mass with central hypoenhancement\ninferior to the left thyroid lobe, series 5 image 45, which is most likely\nseparate from the left thyroid lobe.\n\nVisualized lungs appear clear.", + "output": "1. No acute intracranial abnormalities identified.\n2. 3 mm aneurysm versus infundibulum projecting medially from the paraclinoid\nthe left internal carotid artery.\n3. Possible 2 mm outpouching arising from the distal left anterior cerebral\nartery at the bifurcation of callosal and pericallosal branches, versus\nconfluence of vessels.\n4. Unremarkable CTA of the neck.\n1.2 cm right thyroid nodule. 0.8 cm nodule contiguous with the posterior\nmargin of the lower pole of the right thyroid lobe may also represent a\nthyroid nodule, versus an adjacent lesion.\n5. 2.1 cm lesion with central decreased enhancement inferior to the left\nthyroid lobe, concerning for a necrotic lymph node.\n\nRECOMMENDATION(S): Thyroid/neck ultrasound. Based upon ultrasound results,\nbiopsy of the left thyroid/neck lesion may be considered.\n\nNOTIFICATION:\n1. Presence of the aneurysms and left lower neck mass were communicated to the\nED QA nurse group by Dr. ___ on ___, by email.\n2. The final impression and recommendation above were entered by Dr. ___\n___ on ___ at 08:59 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are prominent, suggestive of volume loss.\n\nThere is mild mucosal thickening in the bilateral ethmoid air cells. The\nremaining imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact. Defect of the right\nlamina papyracea is suggestive old trauma.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territory infarct. Gray-white matter\ndifferentiation is preserved. Prominence of the ventricles and sulci is\nconsistent with involutional change. The visualized paranasal sinuses\ndemonstrate some mucosal thickening in right ethmoid air cells. Minimal\nmucosal thickening in the right sphenoid sinus is seen.. The mastoid air\ncells are clear. No acute fracture is seen. Right lens replacement is\nincidentally noted.", + "output": "No acute intracranial process. No acute intracranial hemorrhage." + }, + { + "input": "There is no evidence of intra or extra-axial mass, acute hemorrhage or\ninfarct. No abnormal enhancement is identified. The sulci, ventricles and\ncisterns are within expected limits for the patient's age. There is mild\nasymmetric hypodensity of the left inferior cerebellar hemisphere (series 4,\nimage 7) which appears to correspond to a prominent sulcus on prior MRI of ___. The visualized paranasal sinuses are essentially clear. The\norbits are unremarkable. The mastoid air cells middle ears are clear. No\nacute osseous abnormality identified.", + "output": "1. No intracranial metastatic disease at this time within confines of a CT\nexamination. MRI, if there are no contraindications would be more sensitive\nfor small lesions." + }, + { + "input": "Again seen is an acute comminuted fracture of the right orbital floor with\ninferior displacement of fracture fragments into the right maxillary sinus and\nherniation of orbital fat and associated extraconal fat stranding (series\n602b: Image 56). No evidence of herniation of the inferior rectus muscle\nthrough the fracture defect.The globes appear intact and there is no\nproptosis. The remaining extraocular muscles, optic nerves, and retrobulbar\nfat appear normal. Right periorbital soft tissue swelling is present along\nwith subcutaneous emphysema seen along the right frontal scalp (series 301:\nImage 21). Radiopaque densities are seen in the subcutaneous tissues of the\nright cheek, possibly foreign bodies, not seen on the prior study from\n___ (301: 55-66). Radiopaque density within the right eyelid is\nunchanged from the previous examination from ___.\n\nThe right maxillary sinus is near completely opacified with high density\nmaterial compatible with blood products. Mild mucosal thickening is seen in\nthe right ethmoid air cells. The remaining visualized paranasal sinuses and\nmastoid air cells appear clear.\n\nNo additional facial bone fractures present.\nThere is no abnormal fluid collection concerning for abscess.\nThe visualized upper aerodigestive tract appears normal. The mandible and\ntemporomandibular joints appear normal. There is increased global atrophy of\nbrain parenchyma, which appears advanced for age.", + "output": "1. Acute comminuted fracture of the right orbital floor with herniation of fat\nand associated fat stranding. No evidence of extraocular muscle herniation.\n2. Near complete opacification of the right maxillary sinus with blood\nproducts.\n3. Radiopaque densities are seen in the subcutaneous tissues of the right\ncheek, possibly foreign bodies, not seen on a prior study from ___. \nRecommend correlation with clinical exam.\n4. Soft tissue swelling and subcutaneous emphysema seen along the right\nperiorbital region and frontal scalp.\n5. Global atrophy of the visualized brain parenchyma, prominent in a patient\nof this age.\n\nRECOMMENDATION(S): Recommend correlation with clinical exam." + }, + { + "input": "There is no evidence of large territorial infarctionhemorrhage, edema, ormass\neffect. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Aside from minimal mucosal thickening of\nthe ethmoid air cells, the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial abnormality." + }, + { + "input": "The carotid and vertebral arteries and their major branches are patent with no\nevidence of stenoses. No evidence for dissection is seen. By NASCET\ncriteria, there is no stenosis of the internal carotid arteries.\n\nThere is a 2.5 cm triangular outpouching at the lateral right cavernous\ninternal carotid artery which appears to have a vessel extending from its tip.\nIncidental note is made of 3 anterior cerebral arteries. There is a 0.4 cm\nvascular irregularity in the left sylvian fissure, series 2, image 236 which\nappears to be venous in etiology.\n\nThere is partial opacification of the ethmoid air cells. Mucosal thickening\nof the left maxillary sinus is seen.", + "output": "1. Normal CTA of the neck with no evidence of vascular injury.\n2. A 2.5 mm triangular outpouching of the lateral right cavernous internal\ncarotid artery with a possible vessel extending from its tip, favored to\nrepresent a infundibulum of the inferolateral trunk, rather than an aneurysm. \nRecommend a follow-up MRI for further evaluation.\n3. A 0.4 cm vascular irregularity in the left sylvian fissure, which is likely\nvenous in etiology, which can also be further evaluated on the MRA.\n\nRECOMMENDATION(S): Follow-up MRA of the brain recommended for further\nevaluation." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nNonspecific periventricular white matter hypodensities most likely represent\nthe sequelae of chronic small vessel ischemic disease.\n\nA 3.8 x 1.7 cm hematoma overlying the anterior right zygomatic arch with\nextensive associated soft tissue stranding and swelling is better assessed on\nconcurrent maxillofacial CT. No fractures are identified. Aside from\nchronic partial opacification of the left mastoid air cells, the visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are notable for bilateral\ncataract surgeries.", + "output": "1. No acute intracranial process.\n2. 3.8 cm hematoma overlying the anterior right zygomatic arch is better\nassessed on concurrent maxillofacial CT.\n3. Stable age related involutional changes and sequelae of chronic small\nvessel ischemic disease." + }, + { + "input": "SOFT TISSUES: A 3.8 x 1.8 cm hematoma overlies the right anterior zygomatic\nprocess with significant associated soft tissue swelling and stranding\nextending from the mandible to the inferior aspect of the orbit. There is no\npostseptal extension.\n\nMAXILLOFACIAL BONES: The maxillofacial bones are intact, without fracture.\nThe zygomatico-maxillary complex is intact. The lateral pterygoid plates are\nintact.\n\nMANDIBLE: The mandible is without fracture or temporomandibular joint\ndislocation. The temporomandibular joints are symmetric, without significant\ndegenerative change.\n\nDENTITION: There are no dental fractures. There is no remarkable periodontal\ndisease, periapical lucency, or odontogenic abscess, however some dental\ncaries are noted, dental consultation is advised.\n\nSINUSES: The paranasal sinuses are intact and clear. The ostiomeatal units\nare patent. Partial opacification of the inferior left mastoid air cells is\nchronic. The middle ear cavities are clear.\n\nNOSE: There is no nasal bone fracture. Nasopharyngeal soft tissues are\nunremarkable. There is no nasal septal hematoma.\n\nORBITS: The orbits, including the laminae papyracea, are intact.The globes\nare intact with no intra-ocular hematoma. Bilateral lenses are surgically\nabsent. There is no retrobulbar hematoma or fat stranding.\n\nAllowing for imaging technique optimized for the face, the limited included\nportion of the brain is grossly unremarkable.", + "output": "3.8 cm hematoma overlying the anterior right zygomatic process with extensive\nassociated soft tissue swelling. No fracture." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nPeriventricular and subcortical white matter hypodensities are nonspecific but\nlikely sequelae of chronic small vessel ischemic disease.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of hemorrhage or acute infarction.\n\n2. No fracture." + }, + { + "input": "There are chronic lacunar infarcts involving the right caudate tail, left\ncaudate head, and right thalamus. No evidence of new, large territorial\ninfarction as gray-white matter differentiation is well preserved. There is no\nevidence of hemorrhage, edema, or mass. Mild periventricular and subcortical\nwhite matter hypodensities are nonspecific but likely sequelae of chronic\nsmall vessel ischemic disease. There is prominence of the ventricles and\nsulci suggestive of involutional changes.\n\nThere is no evidence of fracture. There is mild pansinus mucosal thickening\nwith hyperostosis of the maxillary sinus walls suggesting chronicity. There\nis opacification of the left mastoid air cells and middle ear cavity. No\nevidence of osseous dehiscence. The right mastoid air cells and middle ear\ncavity are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No evidence acute infarction or intracranial hemorrhage.\n2. Opacification of the left mastoid air cells and middle ear cavity\nsuggesting otomastoiditis.\n3. Mild paranasal sinus disease." + }, + { + "input": "CT HEAD:\nThere is an unchanged, right frontal intraparenchymal hematoma spanning\napproximately 4.7 x 3.1 cm in greatest diameter with surrounding vasogenic\nedema. A small amount of subdural blood is noted layering on the adjacent\nright falx. Associated mass effect with sulcal effacement and leftward bowing\nof the anterior falx is not significantly changed. Otherwise, there is no\nsignificant midline shift.\n\nAreas of encephalomalacia in the left frontal and parietal lobes are\nunchanged. There is no evidence of acute large territorial infarction. The\nventricles are stable in size. Basal cisterns are patent.\n\nA mucous retention cyst is noted in the right maxillary sinus. He remainder\nof the paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.\n\n\nCTA HEAD AND NECK:\nThere is a 3 vessel aortic arch with mild calcifications noted at the origin\nof the left subclavian mild calcifications are noted at the left common\ncarotid bulb. The common carotid and vertebral arteries and their major\nbranches appear patent without high-grade stenosis or occlusion. There is no\nevidence of internal carotid stenosis by NASCET criteria.\n\nCalcifications are noted in the bilateral cavernous internal carotid arteries.\nThe vessels of the circle of ___ and their principal intracranial branches\nare patent without high-grade stenosis, occlusion, or aneurysm formation. The\ndural venous sinuses are patent. No CTA spot sign identified.\n\n\nOTHER:\nThe visualized portion of the lungs are clear. There is no lymphadenopathy by\nCT size criteria. Bone island in the right C3 vertebral body and pedicle is\nunchanged from prior examinations dating back to ___.", + "output": "1. Unchanged appearance of a large right frontal intraparenchymal hemorrhage\nwith local mass effect and mild leftward bowing of the anterior falx.\n2. Mild subdural hemorrhage layering along the right anterior falx.\n3. Patent intracranial and neck vasculature without high-grade stenosis,\nocclusion, or aneurysm greater than 3 mm.\n4. No CTA spot sign identified." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute major vascular territory\ninfarction,hemorrhage,edema,ormass. Prominence of the ventricles and sulci\nare compatible with age related global atrophy.\n\nBilateral ethmoid air cell and maxillary sinus mucosal thickening is present. \nThe mastoid air cells,and middle ear cavities are clear. The visualized\nportion of the orbits demonstrate bilateral lens replacement postoperative\nchanges.. Soft tissue densities are noted within bilateral external auditory\ncanals which may represent cerumen.\n\nCTA HEAD:\nThere is fetal origin of the right PCA. There is a punctate left mid V4\nsegment approximately 1 mm outpouching noted (see 3:198; 458:7). Otherwise,\nthe vessels of the circle of ___ and their principal intracranial branches\nappear preserved without stenosis, occlusion, or aneurysm formation. The\ndural venous sinuses are patent.\n\nCTA NECK:\nNonocclusive atherosclerotic calcifications and noncalcified plaque are noted\nalong both carotid artery bifurcations, left greater than right. Nonocclusive\natherosclerotic calcifications are noted at the origins of left common carotid\nartery, the left subclavian artery, and the brachiocephalic trunk. \nAtherosclerotic calcifications are seen at the right vertebral artery origin. \nAtherosclerotic calcifications are noted along the aortic arch. Otherwise,\nthe carotidandvertebral arteries and their major branches appear preserved\nwith no definite evidence of stenosis or occlusion. There is no evidence of\ninternal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs demonstrate biapical scarring, dependent\natelectasis and left upper lobe emphysematous changes.. The visualized\nportion of the thyroid gland is demonstrates approximately 9 mm left thyroid\nnodule (see 3:72).. Scattered subcentimeter nonspecific lymph nodes are noted\nthroughout the neck bilaterally, without definite enlargement by CT size\ncriteria.", + "output": "1. Dental amalgam streak artifact limits study.\n2. No acute intracranial abnormality. Please note MRI of the brain is more\nsensitive for the detection of acute infarct.\n3. Punctate left mid V4 segment 1 mm infundibulum versus aneurysm.\n4. Otherwise, patent circle of ___ without definite evidence of\nstenosis,occlusion,or aneurysm.\n5. Nonocclusive atherosclerotic calcifications and noncalcified plaque are\nseen along both carotid artery bifurcations, without definite moderate or\nsevere stenosis by NASCET criteria.\n6. Additional nonocclusive atherosclerotic changes as described.\n7. Otherwise, patent bilateral cervical carotid and vertebral arteries without\ndefinite evidence of stenosis, occlusion, or dissection.\n8. Approximately 9 mm left thyroid nodule.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 23:11 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." + }, + { + "input": "There is enlargement of the bilateral tonsils, left greater than right with\nmoderate to narrowing of the oropharynx. The airway is patent. In the left\nperitonsillar region there is a 2.2 x 2.4 cm low-density collection which\nalthough is not rim enhancing, is concerning for a developing abscess (series\n2, image 34). A sliver of low-density within the right peritonsillar region\nmeasures approximately 0.5 x 1.9 cm and also likely represents a developing\ncollection (Series 2, image 34). There is no expansion or fluid tracking into\nthe retropharyngeal space.\n\n\nNeck vessels appear grossly patent. Thyroid is unremarkable. There are no\npathologically enlarged cervical chain lymph nodes. Limited views of the\nintracranial structures are normal. Evaluation of the aerodigestive tract\ndemonstrates no exophytic mass, nor areas of focal mass effect. . The\nvisualized salivary glands are unremarkable in appearance. No thyroid mass is\nseen. No bony abnormality is seen.", + "output": "1. 2.2 x 2.4 cm low-density left peritonsillar collection concerning for a\ndeveloping abscess.\n2. 0.5 x 1.9 cm low-density region in the right peritonsillar region, also\nconcerning for a smaller developing phlegmon/ abscess, although is likely too\nsmall for drainage.\n3. Moderate bilateral cervical lymphadenopathy which is likely reactive to\ninfection.\n\nRECOMMENDATION(S): ." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute infarction, hemorrhage, edema, or mass. There\nis focal hypodensity at the right basal ganglia and mid centrum semiovale\nconsistent with remote lacunar infarct. There are subcortical deep and\nperiventricular white matter hyperintensities which are nonspecific but likely\nrepresent sequela of chronic small vessel ischemic disease. There is\nprominence of the ventricles and cortical sulci consistent with volume loss.\n\nThere is mucosal thickening in the ethmoid air cells. There is mucosal\nthickening and fluid in the right maxillary sinus which contains high density\nmaterial. The visualized portion of the mastoid air cells and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nIncidental note is made of the left fetal PCA. The vessels of the circle of\n___ and their principal intracranial branches appear normal without\nstenosis, occlusion or aneurysm formation. The dural venous sinuses are\npatent.\n\nCTA NECK:\nThere is mild atherosclerotic disease at the left carotid bifurcation, and\nmild calcification at the right carotid bifurcation. There is no evidence of\nsignificant stenosis or occlusion of the carotid and vertebral arteries and\ntheir major branches.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. Mild degenerative changes are present cervical spine at C5/C6\nlevel, consistent with spondylosis.", + "output": "1. No acute intracranial abnormality.\n2. Patent intracranial neck vasculature without occlusion, dissection,\nsignificant stenosis, or aneurysm." + }, + { + "input": "Slight soft tissue asymmetry is seen in the region of right lacrimal sac\nregion. Both nasal lacrimal ducts are symmetric in appearance. No bony\nerosion is identified.\n\nVisualized paranasal sinuses are clear with patent drainage pathways of the\nfrontal and maxillary sinuses. No periapicall lucency seen about the teeth in\nthe maxillary region. A small left-sided septal spur is visualized. No bony\ndehiscence is identified. The visualized nasopharynx orbits and brain are\nunremarkable.", + "output": "1. Slight soft tissue asymmetry seen in the region of nasolacrimal sac region.\nNo other significant abnormalities." + }, + { + "input": "This examination is limited due to streak artifact from DBS hardware. \nBilateral DBS leads are in place. Moderate amount of pneumocephalus overlying\nthe frontal lobes bilaterally. The ventricles and sulci are normal in size\nand configuration.\n\nThere is no evidence of fracture. Mild polypoid mucosal thickening within\nfear maxillary sinuses bilaterally. Otherwise, the visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "DBS leads in place. Moderate pneumocephalus overlying the frontal lobes\nbilaterally, expected." + }, + { + "input": "There is re- demonstration of a 1.1 x 1.8 x 1.5 cm(TRV X AP x CC) oval lesion\nwithin the subcutaneous soft tissues in the right preauricular region. There\nis no extension of this mass into the parotid gland.\n\nEvaluation of the aerodigestive tract demonstrates no exophytic mass, nor\nareas of focal mass effect. Evaluation of the cervical lymph chains\ndemonstrate no pathologic lymphadenopathy by imaging criteria. The visualized\nsalivary glands are unremarkable in appearance. No thyroid mass is seen. Neck\nvessels are patent. Upper lung fields are clear. No bony abnormality is seen. \nA mucous retention cyst is seen within the right maxillary sinus.", + "output": "1. 1.1 x 1.8 x 1.5 cm oval lesion within the subcutaneous soft tissues of the\nright preauricular region, which was previously biopsied with results\ncompatible with a pilomatricoma. No extension into the right parotid gland.\n\n2. Right maxillary mucous retention cyst." + }, + { + "input": "There is evidence of chronic volume loss in the right inferior parietal lobe\nwith possible superior occipital involvement, and associated ex vacuo\nenlargement of the right lateral ventricle. There also multiple large areas of\nsubcortical hypodensity involving mainly right frontal, parietal, and temporal\nlobes (with apparent sparing of the insula), and in the left occipital and\ninferior parietal lobes, with associated sulcal effacement, and with\neffacement of gray-white matter differentiation in the right temporal lobe,\nportions of the right parietal lobe, left occipital and left inferior parietal\nlobes, concerning for acute ischemic injury. There are also small nonspecific\nhypodensity in the right lentiform and caudate nuclei, of uncertain\nchronicity.\n\nNo acute hemorrhage is seen. There is no shift of midline structures. Left\nlateral ventricle, third and fourth ventricles are normal in size for age. \nBasal cisterns are not compressed.\n\nNo fracture is identified. There is fluid in the sphenoid sinuses, ethmoid air\ncells, bilateral mastoid air cells and right middle ear cavity, which may be\nsecondary to the endotracheal and nasogastric intubation. The frontal sinuses\nare not pneumatized. The maxilla is edentulous with mottled appearance of the\nalveolar ridge.", + "output": "1. Large areas of subcortical edema in right frontal, parietal, and temporal\nlobes, and in the left occipital and inferior parietal lobes, with sulcal\neffacement and areas of effaced gray/ white matter differentiation, concerning\nfor acute ischemic injury. This could be better assessed by MRI.\n2. Chronic volume loss in the inferior right parietal lobe with possible\noccipital involvement, and associated ex vacuo enlargement of the right\nlateral ventricle.\n3. Small nonspecific hypodensities in the right basal ganglia, of uncertain\nchronicity.\n4. No evidence for acute hemorrhage." + }, + { + "input": "NCCT: There is an acute intraparenchymal hemorrhage in the right thalamus\nmeasuring approximately 2.4 x 2.3 cm with associated surrounding edema and\nmass effect upon the right lateral ventricle (series 3: Image 15). Minimal\nblood present in the occipital horns of the lateral ventricles bilateral. \nEncephalomalacia is also noted in the left peritrigonal/parietal MCA\nterritory, chronic appearing. Increased prominence of ventricles and sulci are\ncompatible with age related global atrophy.\n\nOpacification of the left epitympanum and adjacent mastoid air cells.\n\nCTA HEAD:\nThere is atherosclerotic calcification of the petrous, cavernous, and\nsupraclinoid carotids bilaterally causing mild narrowing. The vessels of the\ncircle ___ and their intracranial branches appear patent without evidence\nof stenosis or occlusion. Small 1 mm infundibulum at the origin of the left\nPCOM from the ICA.\n\nCTA NECK:\nThere is 21% stenosis of the left internal carotid artery and 37% stenosis of\nthe right internal carotid artery by NASCET criteria. There is mild stenosis\nat the origin of the left vertebral artery.\n\nLungs show emphysema and biapical pleural-parenchymal scarring\nProminent adenoids and palatine tonsils, likely reactive. Borderline cervical\nlymph nodes. No suspicious thyroid nodules. Ectopic thyroid nodule noted\nimmediate the inferior to the isthmus.", + "output": "Right thalamic intraparenchymal hemorrhage as described above. No visualized\nunderlying enhancing mass or vascular malformation. Minimal associated\nsubarachnoid blood in the occipital horns of the lateral ventricles.\n\nOpacification of the left epitympanum and mastoid air cells. Infection should\nbe excluded." + }, + { + "input": "There is redemonstration of an intraparenchymal hemorrhage seen in the right\nthalamus measuring 2.4 x 2.2 x 2.8 cm, grossly unchanged since the earlier\nsame day CTA study. There is persistent surrounding edema and mass effect on\nthe right basal ganglia and right lateral ventricle. Chronic encephalomalacia\nis again seen in the left parietal MCA territory. There is prominence of the\nventricles and sulci suggestive of involutional changes. The basilar cisterns\nare patent. There is a small amount of intraventricular hemorrhage layering\nin the occipital horns of the lateral ventricles, right greater than left. \nThere is stable appearance of the ventricles compared to the prior study\nwithout evidence of developing obstructive hydrocephalus. There is no midline\nshift. Atherosclerotic calcifications are seen in the bilateral carotid\nsiphons.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Patient is\nstatus post right lens replacement.", + "output": "Size stable right basal ganglia hemorrhage with new intraventricular extension\nwith small volume blood layering dependently within the occipital horns of the\nlateral ventricle. Ventricular size is unchanged though patient is now at\nrisk for development of obstructive hydrocephalus. Ventriculostomy catheter\nmay be considered.\n\nRECOMMENDATION(S): Close attention is recommended on follow-up studies for\ndeveloping obstructive hydrocephalus.\n\nNOTIFICATION: The findings were discussed with ___ , M.D. by\n___, M.D. on the telephone on ___ at 11:15 pm, 1 minutes after\ndiscussion of findings with attending radiologist." + }, + { + "input": "No evidence of acute infarction,hemorrhage,edema, or mass effect. Scattered\nareas of periventricular hypodensity appear to have some T2/FLAIR signal\nabnormality on prior MRI, likely old insults or sequelae of chronic small\nvessel ischemic disease (e.g. Series 2, image 25, 20). Gray-white matter\ndifferentiation appears preserved. Enlargement of the ventricles including\nthe third, fourth ventricles, temporal horns is out of proportion to the\ndegree of sulci enlargement, similar to prior exams which raises possibility\nof normal pressure hydrocephalus. Cavernous internal carotid artery\ncalcifications are mild.\n\nNo evidence of fracture. Mild mucosal thickening noted within the maxillary\nsinuses. The visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavitiesare otherwise clear. Debris within the left external\nauditory canal is likely cerumen. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No intracranial hemorrhage.\n2. Persistent dilated ventricles out of proportion to sulci, similar to prior\nexam and can be seen with normal pressure hydrocephalus." + }, + { + "input": "Examination is slightly limited due to motion despite repeat scanning.\n\nThere is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles are symmetric and unremarkable.\n\nThere is near complete opacification of the left frontal sinus and partial\nopacification of the ethmoid air cells bilaterally. Included paranasal sinuses\nand mastoids are otherwise clear. Skull and extracranial soft tissues are\nunremarkable.", + "output": "Slightly limited exam by motion without acute intracranial process." + }, + { + "input": "Right frontal sinus, frontal sinus drainage pathway are clear. Left frontal\nsinus is clear. Mild narrowing of the infundibulum left frontal sinus\ndrainage pathway from mucosal thickening or secretions.\n\nModerate secretions, fluid in the right maxillary sinus, mild mucosal\nthickening. Mild narrowing of the infundibulum right maxillary sinus\nostiomeatal unit from mucosal thickening or secretions. Submucosal retention\ncyst left maxillary sinus, with mild secretions. Infundibulum of the left\nmaxillary sinus ostiomeatal unit is obstructed from mucosal thickening and/or\nsecretions. Left infraorbital canal partially protrudes freely into the\nanterior maxillary sinus.\n\nOpacification with mild expansion of the anterior, inferior left ethmoid air\ncell, subtle bowing and associated thinning of the adjacent medial orbital\nwall, findings suggest small mucocele. No destructive changes to suggest\nunderlying aggressive lesion. No obstruction of the adjacent nasolacrimal\nduct. Otherwise, there is trace mucosal thickening bilateral mastoid air\ncells.\n\nSmall osteoma left sphenoid sinus. Mild mucosal thickening anterior wall\nsphenoid sinus. Bilateral sphenoid sinus ostia are patent.\n\nThe cribriform plates are intact. The lamina papyracea are intact. No air\ncells above bilateral anterior ethmoidal arteries. Bilateral optic canals are\ncovered by bone.\nNasal septum is deviated to the right. Clear nasal cavity. Carotid canals\nare covered by bone. No periapical lucencies.", + "output": "1. Moderate paranasal sinus disease, suggestive of acute sinusitis.\n2. Suggestion of small mucocele single anterior left ethmoid air cell." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute large territorial\ninfarction,hemorrhage,edema,ormass effect. The ventricles and sulci are\nnormal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\nIncidental note is made of a subcentimeter osteoma in the left frontal ethmoid\nair cells.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The left\ntransverse sinus is not completely visualized and likely congenitally\nhypoplastic. The dural venous sinuses are otherwise patent.\n\nCTA NECK:\nBovine type aortic arch with common origin of the innominate and right common\ncarotid artery. The carotidandvertebral arteries and their major branches\nappear normal with no evidence of stenosis or occlusion. There is no evidence\nof internal carotid stenosis by NASCET criteria.\n\nIncidental note is made of a 0.7 x 0.7 cm lesion in the right parotid gland\nwhich appears larger than other lymph nodes within the gland and could\nrepresent a small Warthin's tumor.\n\nOTHER:\nThere is a 5 mm nodular opacity within the right upper lobe (series 3, image\n44. The visualized portion of the lungs are clear. The visualized portion of\nthe thyroid gland is within normal limits. There is no lymphadenopathy by CT\nsize criteria.", + "output": "1. Unremarkable CTA of the head and neck. No evidence of vessel dissection,\nocclusion, stenosis or aneurysm formation greater than 3 mm.\n2. No acute large territory infarct on noncontrast head CT.\n3. Incidental 0.7 x 0.7 cm lesion in the right parotid gland, larger than\nexpected for a regular lymph node and possibly a small pleomorphic adenoma or\nWarthin's tumor.\n\nRECOMMENDATION(S): Dedicated right parotid ultrasound on a nonemergent basis\nfor further evaluation of the incidental 0.7 x 0.7 cm lesion in the right\nparotid gland." + }, + { + "input": "There is a lytic lesion in the posterior aspect of the right mastoid bone with\nnonvisualization of the outer cortex and severe thinning and possible\ndehiscence of the inner cortex, measuring 19 x 10 mm (series 3, image 14). \nThere is no definite evidence of an extraosseous soft tissue mass in this\nlocation.\n\nThere is an approximately 16 x 12 mm lytic lesion in the right frontal bone\nwith a ground-glass matrix resulting in severe thinning or dehiscence of the\ninner table (series 3, image 49).\n\nThere is no evidence of hemorrhage, edema, mass effect, or infarction. The\nventricles and sulci are age-appropriate.\n\nThere are a few opacified right mastoid air cells. The paranasal sinuses,\nmastoid air cells, and middle ear cavities are otherwise clear. The orbits\nare unremarkable.", + "output": "1. Lytic lesions involving the posterior aspect of the right mastoid bone and\nright frontal bone as described above, resulting in severe thinning or\ndehiscence of the adjacent cortex. There is no definite extraosseous soft\ntissue mass in this region.\n2. No intracranial abnormality on noncontrast CT head.\n3. Please note that noncontrast head CT is not sensitive for detection of\nsmall brain metastases and MRI should be considered if there is clinical\nsuspicion.\n\nRECOMMENDATION(S): MRI is recommended for confirmation of suspicious osseous\nmetastatic lesions and to assess for intracranial extension. Addition of\naxial postcontrast T1 fat saturated sequences through the head to standard MRI\nbrain protocol is also recommended.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:32 am, 10 minutes after\ndiscovery of the findings." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is 1.5 cm x 1.1 cm lytic lesion involving right parietal bone at the\nvertex, with cortical breakthrough, without definite intracranial or scalp\nextension, similar to prior. Additional 1.8 cm x 0.9 cm lytic lesion\ninvolving posterior, inferior right mastoid bone, abutting is suture with\noccipital bone, similar to prior, without definite disruption of the wall\nadjacent sigmoid sinus. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "Stable 2 osseous lytic lesions consistent with metastases.\nNo new metastatic lesions." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema,or intracranial mass. \nThe ventricles and sulci are normal in size and configuration.\n\nNo significant change in size of a 1.5 cm AP x 1.3 cm TV lytic lesion\ninvolving the right parietal bone near the vertex with evidence of cortical\nbreakthrough of the inner table of the calvarium. Also unchanged is a 1.4 cm\nAP x 1.3 cm TV lytic lesion of the inferior right mastoid bone demonstrating\nouter cortex breakthrough. There are no new metastatic lesions.\n\nThe visualized portion of the paranasal sinuses and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. Unchanged lytic/destructive lesions of the right parietal bone and inferior\nright mastoid bone consistent with osseous metastases.\n2. No new bony metastatic lesions.\n3. No foci of brain edema or hemorrhage." + }, + { + "input": "Again seen, and unchanged, are lytic lesions in the right parietal bone, best\nseen on image 23 of series 4 and a right mastoid bone lytic lesion best seen\non image 27 of series 4. No new lesions are identified. Images of the brain\nappear normal.\nThere is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Unchanged appearance of right mastoid and right parietal bone lytic\nlesions.\n2. No evidence of new lesions." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is a new 4.6 x 2.7 cm (AP, TRV ; series 2, image 22) focus of hemorrhage\ninferior in contiguous to the left sylvian fissure subarachnoid hemorrhage,\nwhich may be parenchymal. The diffuse subarachnoid hemorrhage, or predominant\nwithin the right frontal, parietal, and temporal sulci, is otherwise\nessentially unchanged. The intraparenchymal hematoma in the left basal\nganglia, cerebral peduncle and pons on 02:21, measures 1.4 x 0.7 cm and is new\nfrom the prior examination. There are also small intraparenchymal hematomas,\nmeasuring 0.8 cm in the right frontal lobe and 0.7 cm in the left frontal lobe\non 02:28, slightly more prominent from the prior examination. The lateral\nventricles are effaced, right greater than left, increased from the prior\nexamination. The right frontal subdural hematoma, measuring 5 mm in\nthickness, is unchanged. There is a small amount of intraventricular\nhemorrhage layering within the occipital horns of the lateral ventricles.\n\nThere is a minimally displaced fracture of the right lateral wall of the orbit\n(series 4, image 26) with very minimal periosteal hematoma. No right\nintraconal hemorrhages identified. The bilateral frontal and ethmoid sinuses\nare partially opacified. The left maxillary sinus is partially opacified with\nthickening and sclerosis of its walls.\n\nThe soft tissues overlying the right zygomatic arch are swollen and edematous.\nThere is a small right frontal scalp hematoma.\n\nAn endotracheal tube is partially visualized.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nare patent with no evidence of stenosis,occlusion or aneurysm. The right A1\nsegment is hypoplastic. There is fetal type origin of the left posterior\ncerebral artery. The dural venous sinuses are patent.", + "output": "1. No aneurysms. Patent circle of ___.\n2. Multi compartmental hemorrhage with interval development of a likely right\ntemporal intraparenchymal hematoma, new intraparenchymal hematoma in the left\ncerebral peduncle, and unchanged, diffuse subarachnoid hemorrhage.\n3. Minimally displaced fractures of the right lateral wall of the orbit\nwithout evidence of intraconal hematoma." + }, + { + "input": "There persist a large hemorrhage within the right temporal lobe with\nsurrounding vasogenic edema, not significantly changed in volume relative to\nprior examination. This results in mild mass effect and effacement of the\nright lateral ventricle.\n\nThe remains intraventricular blood which layers within the occipital horns of\nthe lateral ventricles bilaterally. Relative to prior examination,\nsubarachnoid hemorrhage is less conspicuous. There is interval evolution of\nbifrontal and left cerebral peduncle hemorrhages.\n\nNo new hemorrhage is identified. No evidence of cerebral herniation. No\nsignificant shift of normally midline structures. The ventricles and sulci\nare stable in size in configuration.\n\nNear complete opacification of the ethmoidal air cells with air-fluid levels\nnoted within the sphenoid sinuses. Aerosolized secretions are present within\nthe frontal sinuses, progress relative to prior study. Paranasal sinus\nfindings may be related intubation status. Mastoid air cells and middle ear\ncavities bilaterally are clear. Stable right lateral orbital wall fracture is\nagain noted.", + "output": "1. Grossly stable multi-compartmental hemorrhage with stable mass effect, as\ndescribed.\n2. No definite new hemorrhage." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThe large right temporal lobe hematoma is stable in size, minimally less dense\nin appearance. Adjacent edema and mass effect effacing the right lateral\nventricle are essentially unchanged. Small, bifrontal and left cerebral\npeduncular hemorrhages are less dense. Subarachnoid and intraventricular blood\nproducts are stable. No new hemorrhages are identified. Stable right\nminimally displaced lateral orbital fracture is again seen.\n\nThere is mucosal thickening with aerosolized secretions and possible fluid\nlevels throughout the paranasal sinuses, essentially unchanged. The mastoid\nair cells and middle ear cavities are well aerated and clear.\n\nCTA HEAD:\nThere is new mild narrowing of the bilateral super clinoid internal carotid\narteries, right middle cerebral artery, and right anterior cerebral artery in\ncomparison to the CTA performed 1 week prior. The remaining arteries of the\ncircle of ___ and their visualized branches are unremarkable without\nevidence of occlusion, stenosis, or aneurysm formation. The dural venous\nsinuses are patent.", + "output": "1. New narrowing of the bilateral supraclinoid internal carotid arteries,\nright middle cerebral artery, and right anterior cerebral artery, compatible\nwith vasospasm.\n2. Stable intracranial hemorrhages with mild mass-effect as described above. \nNo evidence of new hemorrhage.\n3. Extensive paranasal sinus disease as described above is essentially\nunchanged." + }, + { + "input": "There has been interval evolution in appearance of the large right temporal\nlobe intraparenchymal hemorrhage with extension into the right frontal lobe. \nThere is a similar degree of surrounding vasogenic edema with mild effacement\nof the adjacent sulci and right lateral ventricle. Areas of scattered\nbihemispheric subarachnoid hemorrhage appears less apparent than on prior\nexamination. Again small amount of blood is seen in bilateral occipital horns\nof the lateral ventricles. Previously identified bifrontal and left cerebral\npeduncle hemorrhages are not visualized on current examination.\n\nThere is no new hemorrhage.\n\nThere is no evidence of mass. There is interval decrease mass effect on right\nlateral ventricle, which is now more symmetric with the left lateral\nventricle, without evidence of ventriculomegaly, similar to ___\nprior noncontrast head CT.\n\nStable right minimally displaced lateral orbital fracture is again seen.\n Aerosolized fluid, mainly in the right frontal sinus and sphenoid air cells\nappears slightly increased compared to prior examination and may be related to\nintubation. Again there is moderate left and mild right maxillary sinus\nmucosal wall thickening. Ethmoid air cells appear more well-aerated than\ncompared to the prior exam. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Interval evolution of previously noted multi compartment hemorrhages, as\ndescribed.\n2. No new hemorrhages identified.\n3. Interval mild decrease mass effect right lateral ventricle as described." + }, + { + "input": "There is no acute hemorrhage, edema or shift of normally midline structures.\nThe ventricles and sulci are of normal size and configuration. The gray-white\nmatter differentiation is preserved and there is no evidence for an acute\ninfarction. The basal cisterns are patent.\n\nThere is no fracture. The included paranasal sinuses and mastoid air cells are\nwell-aerated. The imaged lenses and globes are normal.", + "output": "No acute intracranial process." + }, + { + "input": "Both parotids and periauricular regions are unremarkable. There is\nsuperficial or deep neck collections/abscesses.\n\nAero digestive tract: Unremarkable\n\nNeck lymph nodes: There is no adenopathy involving bilateral levels ___. The\nprominent right level 2A lymph node is not pathologically enlarged. There is\nno retropharyngeal adenopathy.\n\nDeep neck muscles, masticator space: Unremarkable\n\nBones, skull base:\nThere is no aggressive osseous lesions.\nThere are no findings suggestive of perineural tumor extension. Jugular\nforamen, carotid canal, pterygopalatine fossa, infraorbital foramen, other\nskull base foramina are not involved.\n\nVessels: Within normal limits.\n\nBrachial Plexus: There is no brachial plexus contact or invasion.\n\nThyroid, salivary glands: There is no mass.\n\nOther findings: There are no lung nodules. There are partially imaged\nfindings from right mastectomy.\n\nLeft Port A cath noted passing through the left brachiocephalic vein and its\ndistal tip is not included.", + "output": "1. Unremarkable CT neck with contrast with no neck abscesses/collections or\nmass lesions. Mildly prominent nonspecific right level 2A lymph node. This\nmay be reactive." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nThere is minimal mucosal thickening within the ethmoidal air cells. Mastoid\nair cells and middle ear cavities are well aerated. The bony calvarium is\nintact. Bilateral nasal bone deformities reflect acute fractures, only\nminimally displace, better assessed on same-day facial bone CT.", + "output": "1. No acute intracranial process.\n2. Minimally displaced bilateral nasal bone fractures." + }, + { + "input": "Dental amalgam streak artifact limits study. Right maxillary and left\nsphenoid sinus mucous retention cysts versus polyps are noted. Bilateral\nethmoid air cell mucosal thickening is present. The ostiomeatal units are\npatent. The cribriform plates are intact. There is no nasal septal defect.\nThere is rightward nasal septal deviation. The anterior clinoid processes are\nnot pneumatized. The lamina papyracea are intact. The sphenoid sinus septum is\nmidline with insertion upon the sellar floor. A left-sided concha bullosa is\npresent.", + "output": "1. Dental amalgam streak artifact limits study.\n2. Paranasal sinus disease as described.\n3. Rightward nasal septal deviation.\n4. Left-sided concha bullosa." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territorial infarct. Prominence of the\nventricles and sulci is consistent with atrophy. Periventricular and\nsubcortical white matter hypodensities are likely sequelae of chronic small\nvessel disease. The visualized paranasal sinuses demonstrate mucosal\nthickening of bilateral ethmoid air cells. There is mild mucosal thickening\nof the right sphenoid sinus and left maxillary sinus.. The mastoid air cells\nare clear. No acute fracture is seen.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect or acute large vascular\nterritory infarction. Prominent ventricles and sulci suggest age related\natrophy. Periventricular white matter hypodensities are nonspecific but likely\nrepresent sequela of chronic small vessel ischemic disease. The basal cisterns\nappear patent and there is preservation of gray-white matter differentiation.\n\nNo fracture is identified. An air-fluid level is seen in the right maxillary\nsinus. The remaining visualized paranasal sinuses, mastoid air cells and\nmiddle ear cavities are clear. The globes are unremarkable. Atherosclerotic\nmural calcification of the vertebral and internal carotid arteries is noted. \nA small left frontal subgaleal hematoma has decreased in size compared to the\nprior.", + "output": "1. No evidence of acute intracranial process.\n2. Air-fluid level in the right maxillary sinus; correlate with symptoms for\nacute sinusitis." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Age related involutional changes are noted. The imaged paranasal\nsinuses are clear. Mastoid air cells and middle ear cavities are well aerated.\nThe bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Diffuse\nperiventricular white matter hypodensities are likely related to small chronic\nvessel disease. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial findings.\n2. Chronic findings from small chronic vessel disease and parenchymal volume\nloss similar to prior." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territory infarct. Gray-white matter\ndifferentiation is preserved. Prominence of the ventricles and other\nextra-axial spaces is consistent with volume loss. The visualized paranasal\nsinuses demonstrate mucosal thickening, opacification of some right ethmoid\nair cells as well as right frontal sinus.. The mastoid air cells are clear. \nNo acute fracture is seen. A left scleral band is noted.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema, or\nmass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\nIncidentally noted benign-appearing right level II lymph node measuring 7 mm\nwithout evidence of matting, extracapsular spread or necrosis.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs demonstrate mild dependent atelectasis. \nThe visualized portion of the thyroid gland is within normal limits. There is\nno lymphadenopathy by CT size criteria.", + "output": "HEAD CT:\nNo acute intracranial pathology.\n\nCTA HEAD AND NECK:\nWithin normal limits.\nNo evidence of atherosclerosis, stenosis or aneurysm formation." + }, + { + "input": "There is no evidence acute intracranial hemorrhage, edema, mass effect or\nlarge territorial infarction. The ventricles and sulci are prominent\ncompatible with age-related atrophy. The basal cisterns are patent.\nGray-white matter differentiation is maintained.\n\nThere is a very small probable left posterior scalp contusion (03:32 and\n602b:66).\nThere is no fracture. There is very mild mucosal thickening in the bilateral\nmaxillary sinuses, sphenoid sinuses and ethmoidal air cells. There also\nminimal aerosolized secretions in the left sphenoid sinus. The mastoid air\ncells and middle ear cavities are clear. There are atherosclerotic\ncalcifications of the cavernous internal carotid arteries and vertebral\narteries.", + "output": "1. No acute intracranial abnormality.\n2. No evidence of fracture. Probable small left posterior scalp contusion.\n3. Mild mucosal thickening in the paranasal sinuses with mild aerosolized\nsecretions in the left sphenoid sinus." + }, + { + "input": "CT head: There is a diffuse hyperdense subarachnoid blood throughout the\nbilateral convexities, right greater than left. There is focal extra-axial\nblood within the anterior right middle cranial fossa measuring 3.0 x 3.5 x 3.3\ncm which demonstrates a discrete lens shaped margin causing mass effect on the\nanterior right temporal lobe (03:18; 6 03:21), which has increased in\ncomparison to prior study. There is a thick extra-axial blood over the right\ncerebral convexity measuring up to 9 mm in depth which is mildly increased in\ncomparison to prior study when it measured 7 mm in depth. There is\nintraventricular hemorrhage probably within the right lateral ventricle but\nalso layering within the left occipital horn lateral ventricle, third\nventricle, and the fourth ventricle. There is effacement of the right lateral\nventricle. The left lower ventricle is asymmetrically enlarged and\ndemonstrates mild periventricular hypodensity. The third and fourth\nventricles are effaced. There is subarachnoid blood within the basal\ncisterns. There is 7 mm of right to left midline shift. The basilar cisterns\nare effaced. The cerebellar tonsils extend inferiorly through the foramen\nmagnum by 1 cm (6 03:32). There is no discrete parenchymal hemorrhage. There\nis mild decrease gray-white matter differentiation within the right temporal\nlobe which may reflect vasogenic edema. There is effacement of the cortical\nsulci.\n\nThere is hyperdense thickening at the right posterior orbit measuring up to 4\nmm in thickness, which has increased, likely representing sub retinal\nhemorrhage. The calvarium is unremarkable. The paranasal sinuses mastoid air\ncells are clear. There is soft tissue particulate in the left external\nauditory canal likely representing cerumen. There is calcification of the\nbilateral intracranial carotid arteries. There is an endotracheal and oral\nenteric tubes in place with fluid layering within the nasopharynx. The soft\ntissues are unremarkable.\n\nCTA head:\nThere is minimal contrast filling of the visualized V2 segment and inferior V3\nsegment vertebral arteries and upper cervical segment carotid arteries. There\nis contrast drainage seen within the posterior superior sagittal, right\ntransverse and sigmoid sinuses and the right internal jugular vein. There is\nno contrast within the intracranial arteries.", + "output": "1. Extensive subarachnoid hemorrhage at the bilateral cerebral convexities,\nright greater than left, with focal masslike hemorrhage at the anterior right\nmiddle cranial fossa causing mass effect on the adjacent structures. Large\nright convexity extra-axial hemorrhage measuring up to 9 mm in depth. The\ndegree of hemorrhage has increased in comparison to prior study. This pattern\nof hemorrhage may be seen with a ruptured right middle cerebral artery\naneurysm. The hemorrhage at the anterior right middle cranial fossa could\nreflect an epidural hematoma given its lens shaped morphology, however this is\nless likely in the absence of a calvarial fracture and the additional sites of\nsubarachnoid hemorrhage.\n2. Worsening mass effect with effacement of the cortical sulci and ventricle,\n7 mm of right to left midline shift, and findings of downward herniation\nincluding effacement of the basilar cisterns and cerebellar tonsillar ectopia.\n3. Right to left midline shift, as described, with effacement of the right\nlateral ventricle, and asymmetric enlargement of the left lateral ventricle\nwith associated periventricular hypodensity which may represent ventricular\nentrapment an and transependymal flow.\n4. Enlarging hyperdensity at the posterior aspect of the right globe, likely\nreflecting a subretinal hemorrhage.\n5. Absent contrast filling of the intracranial arterial vasculature which is\nsuspicious for elevated intracranial pressure given the intracranial\nhemorrhage and findings of mass effect. Less likely, this could reflect early\nphase of contrast." + }, + { + "input": "Large area of hypodensity and loss of gray-white matter differentiation in the\nleft MCA territory. There is acute appearing hemorrhage which appears\ncentered in the left caudate head/basal ganglia with extension into the left\nthalamus and intraventricular extension into the frontal horn of the left\nlateral ventricle as well as the fourth ventricle. Associated mass-effect\ncauses approximately 16 mm of rightward midline shift. There is effacement of\nthe suprasellar and prepontine cistern is with suggestion of left-sided uncal\nherniation.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Endotracheal and enteric tubes are\npartially imaged.", + "output": "1. Large left MCA territory infarct with hemorrhagic transformation associated\nwith subfalcine herniation and approximately 16 mm of the rightward midline\nshift.\n2. Effacement of the suprasellar and prepontine cistern with left uncal\nherniation.\n\nNOTIFICATION: The findings were discussed with ___, N.P. by ___\n___, M.D. on the telephone on ___ at 7:40 am, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is interval increase in size of intraparenchymal hemorrhage centered in\nthe left basal ganglia measuring approximately 2.1 x 2.4 cm previously up to\n1.5 cm with increased extension into the left caudate and medial left temporal\nlobe. There is intraventricular extension into the frontal, body, and\noccipital horns of the left lateral ventricle as well as hemorrhage present in\nthe cerebral aqueduct. Hyperdense left MCA sign (series 2, image 16) and\nhypodense changes involving the left basal ganglia, temporal lobe as well as\noverlying frontal and parietal lobes in the distribution of the left MCA\nsuggesting a large ischemic infarct. Edema results in approximately 4 mm\nrightward midline shift is new from prior.\nSmall mucous retention cyst in the lateral aspect of the left maxillary sinus.\nThe mastoid air cells are clear. The orbits appear normal.\n\nCTA HEAD:\nFilling defect extending from the mid left MCA M1 segment with decreased\nopacification of the M2, M3 and M4 branches on the left. Hypoplastic left A1\nsegment. The ACA vessels are patent. The right MCA is patent. The PCAs and\nbasilar artery are patent. Mild moderate calcific atherosclerotic changes of\nthe carotid siphons bilateral. No aneurysms are seen. The dural venous\nsinuses are patent.\n\nCTA NECK:\nSoft plaque and arteriosclerotic plaque material is consistent with\natherosclerotic changes involving the proximal ICAs bilateral with\napproximately 50% stenosis on the right ICA by NASCET criteria. There is\nminimal stenosis the proximal left ICA with soft plaque material. Mild\ncalcific atherosclerotic changes of the vertebral arteries, however without\nmarked stenosis.\n\nOTHER:\nEndotracheal and feeding tubes are in place. Mild centrilobular pulmonary\nemphysema. No suspicious pulmonary nodules or masses. The visualized portion\nof the thyroid gland is within normal limits. There is no lymphadenopathy by\nCT size criteria.", + "output": "1. Interval increase in size of the intraparenchymal hemorrhage centered in\nthe left basal ganglia as described above with intraventricular extension\nwhich is new.\n\n2. Hyperdense left MCA sign with hypodense changes in the majority of the\ndistribution of the left MCA suggests a large acute left MCA ischemic infarct.\nCorresponding filling defect in the left MCA M1 segment with decreased\nopacification of the M2, M3 and M4 branches on CTA in keeping with occlusion.\n\n3. Atherosclerotic changes involving the proximal ICAs bilateral with\napproximately 50% stenosis of the right ICA and minimal stenosis of the\nproximal left ICA by NASCET criteria. The vertebral arteries are patent.\n\n4. Mild centrilobular pulmonary emphysematous changes. No suspicious\npulmonary nodules or masses.\n\nNOTIFICATION:\n *** ED URGENT ATTENTION ***" + }, + { + "input": "Since prior examination of ___ at 01:06, there is now geographic loss\nof gray-white differentiation of the left frontal, temporal and parietal lobes\n(series 2, image 11 through 23). Hyperdense left MCA sign involving the mid\nto distal MCA through to the proximal M2 segments is identified. There is\nsubtle focus of linear sulcal hyperdensity of the left frontal vertex (series\n2, image 26), which may represent subtle subarachnoid hemorrhage versus\nartifact from sulcal effacement.\n\nContinued minimal interval enlargement of left basal ganglia hemorrhage from\nprior examination. Ventricular extension into the left lateral ventricle,\nthird ventricle and cerebral aqueduct is similar to slightly progressed.\n\nRightward midline shift has minimally progressed now measuring approximately 4\nmm, with mild effacement of the left lateral ventricle.\n\nThe basilar cisterns remain patent. Prominent atherosclerotic calcification\nof the internal carotid arteries are noted. No acute osseous abnormality. \nThe patient is intubated. Small mucous retention cyst in the left maxillary\nsinus and mild mucosal thickening of the ethmoid air cells. The orbits are\nunremarkable. Mastoid air cells middle ears are essentially clear.", + "output": "1. Geographic acute infarct of the left frontal, temporal and parietal lobes\nsince prior examination. Hyperdense left MCA sign corresponds to filling\ndefect noted on prior CTA.\n2. There may be subtle interval enlargement of left basal ganglia hemorrhage. \nVentricular extension as well as hemorrhage in the cerebral aqueduct is\nsimilar to slightly progressed.\n3. Minimally progressed rightward midline shift now measuring approximately 4\nmm. Continued effacement of the left lateral ventricle.\n4. There is minimal linear hyperdensity in the sulci of the left frontal\nvertex, which may represent subtle subarachnoid hemorrhage versus artifact\nfrom sulcal effacement.\n5. Additional findings as described above.\n\nRECOMMENDATION(S): The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 10:18 am, 10 minutes after\ndiscovery of the findings." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass effect. The ventricles and sulci are normal in size and configuration. \nThere are very few subcortical and periventricular white matter hypodensities,\nwhich are nonspecific, but commonly seen in the setting of chronic\nmicroangiopathy in a patient of this age.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality on noncontrast head CT.\n2. MRI is more sensitive for the evaluation of intracranial masses." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nAtherosclerotic calcifications the cavernous carotid arteries noted.\nThere is no evidence of fracture. There is opacification of the bilateral\nethmoid sinuses with fluid in the nasopharynx compatible with intubation. The\nvisualized portion of the remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "No intracranial hemorrhage or mass effect." + }, + { + "input": "Image quality is moderately degraded by streak artifact.\n\nWithin the left frontal lobe, there is a 5 mm round hyperdense lesion with\nslight surrounding edema, which is new in comparison to ___, compatible\nwith hemorrhage. In the context of stage IV cholangiocarcinoma, this does\nraise concern for a hemorrhagic metastatic lesion. No other masses are\nvisualized. There are no other areas of large territorial infarction,\nhemorrhage or edema.\nThe ventricles and sulci are normal in size and configuration.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Image quality mildly degraded by streak artifact.\n2. 5 mm round hyperdense of left frontal lesion, new since ___,\ncompatible with hemorrhage. Given the history of stage IV cholangiocarcinoma,\nthis raises the concern for a hemorrhagic metastatic lesion.\n\nRECOMMENDATION(S): MRI with without contrast is recommended for further\ncharacterization of this lesion. If MRI is contraindicated, a\ncontrast-enhanced head CT may be obtained.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ on the ___ ___ at 1:21 ___, 5 minutes after discovery of\nthe findings." + }, + { + "input": "Previously seen millimetric round hyperdense lesion in the left frontal lobe\nis not significantly changed since prior. There is no evidence of acute\nterritorial infarction, new hemorrhage, edema, or large mass. The ventricles\nand sulci are normal in size and configuration.\n\nNo fracture seen. The imaged portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The imaged portion of the orbits are\nunremarkable.", + "output": "Previously seen millimetric round hyperdense lesion in the left frontal lobe\nis not significantly changed since prior." + }, + { + "input": "There is no acute intra-axial or extra-axial hemorrhage, edema, mass effect,\nor evidence of acute major vascular territorial infarction. Ventricles and\nsulci are age appropriate in size.\n\n1.0 cm oval nodule in the right parietal scalp has soft tissue density,\nconsistent with a nonspecific skin lesion (601:81). No suspicious bone lesion\nis seen. No evidence for a fracture.\n\nThere is small amount of fluid versus dependent mucosal thickening in the\nfrontal sinuses, extending into the frontoethmoidal recesses. There is mild\nmucosal thickening in the ethmoid air cells. There is trace fluid in the\npartially visualized left maxillary sinus. Partially visualized right\nmaxillary sinus appears clear. There is trace fluid in the pterygoid recess\nof the left sphenoid sinus, and mild mucosal thickening in bilateral sphenoid\nsinuses. Mastoid air cells and middle ear cavities are well aerated.", + "output": "1. No intracranial hemorrhage or evidence for other acute intracranial\nabnormalities. No evidence for a fracture.\n2. 1 cm nonspecific oval skin lesion in the right parietal scalp.\n3. Small amount of fluid in the bilateral frontal, left sphenoid, and\npartially visualized left maxillary sinuses. Please correlate clinically\nwhether the patient may have symptoms of acute sinusitis." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere are mild to moderate periventricular and subcortical white matter\nhypodensities. There is no evidence of infarction,hemorrhage,edema,ormass. \nThe ventricles and sulci are age-appropriate.\n\nThere is mucosal thickening within multiple ethmoid air cells. The visualized\nportion of the remaining paranasal sinuses, mastoid air cells,and middle ear\ncavities are clear. The visualized portion of the orbits demonstrates\npseudophakia related cataract surgery.\n\nCTA HEAD:\nThe right A1 segment is not visualized and may be congenitally absent or\nhypoplastic. There are atherosclerotic calcifications of the bilateral\ncavernous portions of the internal carotid arteries resulting in mild stenosis\nof the right cavernous segment. The vessels of the circle of ___ and their\nprincipal intracranial branches appear patent without significant stenosis,\nocclusion, or aneurysm formation greater than 3mm. The dural venous sinuses\nare patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion.\n\n\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No acute intracranial abnormality.\n2. Patent circle of ___ without definite evidence of high-grade\nstenosis,occlusion,or aneurysm. Mild atherosclerotic disease is seen at the\ncavernous carotids and vertebrobasilar artery and vertebrobasilar system.\n3. Clinical history suggests that the patient has a known aneurysm. Since no\naneurysm is identified, correlation with prior imaging would be helpful\n4. Patent bilateral cervical carotid and vertebral arteries without definite\nevidence of stenosis, occlusion, or dissection.\n5. Mild to moderate periventricular and subcortical white matter changes,\nnonspecific and likely sequelae of chronic microvascular ischemic disease.\n6. Minimal paranasal sinus mucosal thickening." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. Subcentimeter hypodensity within the anterior limb of the right and\nleft internal capsule may represent old foci of infarcts versus prominent\nperivascular spaces. The ventricles and sulci are normal in size and\nconfiguration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. Moderate\nchanges of small vessel disease and mild to moderate brain atrophy identified.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is a nonocclusive stenosis of the left M3 segment. The rest of the\ncircle ___ is patent without evidence of aneurysm, occlusion or critical\nstenosis. The dural venous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Nonocclusive stenosis of the left M3 segment.\n2. No evidence of acute infarct or bleed is seen." + }, + { + "input": "NECT:\nThere is diffuse subarachnoid hemorrhage, with blood layering in the\ninterhemispheric fissure, bilateral sylvian fissures and throughout sulci.\nThere is minimal blood in the basilar cisterns. The blood distribution pattern\nis compatible with an anterior communicating artery aneurysm rupture.\nProminence of the lateral and third ventricles are suggestive of possible\ndeveloping hydrocephalus.\n\nThere is partial opacification of the anterior ethmoid air cells. The imaged\nportions of the orbits are unremarkable. The imaged mastoid air cells are\nclear.\n\nCTA HEAD:\nA saccular outpouching of the right anterior communicating artery measures\napproximately 2.0 x 2.4 cm (603b:10, 602b:21, 3:249).\n\nNo additional aneurysms are identified. The vessels of the circle of ___\nare otherwise patent without evidence of stenosis or occlusion.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Diffuse subarachnoid hemorrhage with a distribution pattern compatible with\nanterior communicating artery aneurysm rupture.\n2. Prominence of the lateral and third ventricles are suggestive of possible\ndeveloping hydrocephalus.\n3. 2.0 x 2.4 cm right anterior communicating artery aneurysm.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 4:46 pm, 15 minutes after\ndiscovery of the findings." + }, + { + "input": "Expected postsurgical changes are seen following right frontal craniotomy with\ncoiling of the A-comm aneurysm including pneumocephalus and associated soft\ntissue swelling. There is redemonstration of diffuse bihemispheric\nsubarachnoid and intraventricular hemorrhage as compared to the prior exam in\n___. A left frontal approach ventriculostomy catheter terminates in the\nfrontal horn of the left lateral ventricle. There is no new hemorrhage or\nacute major infarct. There is no midline shift. The basilar cisterns appear\npatent. The ventricles appear prominent but unchanged since ___.\n\nMild mucosal thickening is seen in the maxillary sinuses. There is partial\nopacification of the posterior ethmoid air cells. A mucous retention cyst is\nseen in the right frontal sinus. Otherwise, the mastoid air cells and middle\near cavities appear clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Expected postsurgical changes seen following right frontal craniotomy and\nACOM aneurysm coiling. Otherwise, stable appearance of diffuse bihemispheric\nsubarachnoid and intraventricular hemorrhage without evidence of new\nintracranial hemorrhage or acute major infarct. No midline shift.\n2. A left frontal approach ventriculostomy catheter terminates in the frontal\nhorn of the left lateral ventricle.\n3. Paranasal sinus disease, as above." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is new hypodensity involving the paramedian left frontal lobe extending\nto the corpus callosum (02:15) possibly related to acute infarction. There is\ninterval redistribution and evolution of diffuse subarachnoid hemorrhage\nwithin the anterior interhemispheric fissure, scattered within bilateral\nfrontal and parietal sulci, within the bilateral sylvian fissures, and in the\nsuprasellar cistern. There is trace intraventricular hemorrhage layering\nwithin the occipital horns of bilateral lateral ventricles (02:15), similar to\nthe prior study.\n\nThere is a left frontal approach ventriculostomy shunt catheter, terminating\nslightly adjacent to the frontal horn of the left lateral ventricle (02:16). \nThere is interval decrease in ventriculomegaly with effacement of the frontal\nhorn of the left lateral ventricle with new 4 mm leftward midline shift. \nFinding may be related to over shunting.\n\nAgain seen are postsurgical changes related to right frontal craniotomy with\nslight decrease in right frontal extra-axial fluid collection and scattered\npneumocephalus, with persistent extracranial soft tissue swelling with\nhemorrhage and subcutaneous emphysema. There is moderate opacification of the\nright frontal and bilateral ethmoid air cells, and the left maxillary sinus.\n\nCTA HEAD:\nThe patient is status post clipping of an anterior communicating artery\naneurysm. In comparison with the prior CTA dated ___, there is new\nmild luminal narrowing and irregularity of the right A1 segments of bilateral\nanterior cerebral arteries, possibly from procedure related vasospasm. \nOtherwise, there is no evidence of stenosis, occlusion, or new aneurysm.\n\nCTA NECK:\nThe bilateral common and vertebral arteries appear patent without evidence of\nstenosis, occlusion, or dissection. There is a 3 vessel aortic arch.\n\nOTHER:\nThe visualized lung apices appear clear. There is no evidence of\nlymphadenopathy. The thyroid gland appears unremarkable.", + "output": "1. New hypodensity involving the paramedian left frontal lobe extending to the\ncorpus callosum, possibly related to an acute infarction. Recommend MRI to\nfurther evaluate.\n2. Interval redistribution and evolution of diffuse subarachnoid hemorrhage\nwith stable trace intraventricular hemorrhage.\n3. Unchanged positioning of a left frontal ventriculostomy shunt catheter\nterminating immediately adjacent to the frontal horn of the left lateral\nventricle.\n4. Interval decompression of previously seen ventriculomegaly, with new 4 mm\nleftward midline shift, possibly related to over shunting. Recommend clinical\ncorrelation.\n5. Again seen are postsurgical changes related to right frontal craniotomy, as\nabove.\n6. Status post clipping of an anterior communicating artery aneurysm.\n7. New mild luminal narrowing and irregularity of the A1 segments of\nbilateral anterior cerebral arteries, possibly related to vasospasm.\n8. Unremarkable CTA neck." + }, + { + "input": "Patient is status post left frontal approach ventriculostomy catheter\nplacement, with tip terminating in the frontal horn of the left lateral\nventricle, unchanged from prior exam. However, compared to prior exam, there\nis increased size of the lateral ventricles and the third ventricle, now\nmeasuring 21 mm, previously 12 mm near the foramen of ___. In addition, the\nthird ventricle has also increased in size, now 6 mm, previously 2 mm.\nThere is continued evolution of the hypodensity involving the paramedian left\nfrontal lobe extending to the corpus callosum. There is further\nredistribution and evolution of diffuse subarachnoid hemorrhage in the\nbilateral sylvian fissure, and bilateral frontal and parietal sulci. Overall,\ncompared to prior exam, the subarachnoid hemorrhage has decrease in density. \nBilateral layering hyperintensities in the occipital horns of the lateral\nventricles have decreased in density.\nEvaluation of the skullbase is what limited due to presence of the\nembolization coil and resulting streak artifacts. However, there is no\nevidence of large territory infarct.\nPatient is status post right frontal craniotomy. Small amount of\npneumocephalus persists, decreased from prior exam. Subgaleal swelling along\nthe right frontal craniotomy surgical bed is persistent. Skin staples are in\nplace.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "-Worsening hydrocephalus status post ventriculostomy catheter placement.\n-Interval evolution of diffuse subarachnoid hemorrhage. No new areas of\nhemorrhage or infarction." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\n\nIn comparison to the most recent prior examination of 1 hour prior, there is\ninterval development of hyperdense hemorrhage in the region of previously seen\nparenchymal hypodensity along the anterior horn the left lateral ventricle and\nthe genu of the corpus callosum, concerning for hemorrhagic transformation. \nThe hematoma splays the anterior horns of the lateral ventricles and extends\ninto the ventricular system with hyperdense hemorrhage seen within the\nlateral, third, and fourth ventricles, new from prior. Previously noted\nbilateral subarachnoid hemorrhage is grossly unchanged. A left\nventriculostomy shunt terminates in the anterior horn of the left lateral\nventricle, unchanged in position. The ventricles are slightly more expanded\ncompared to the prior examination and the temporal horns appear more prominent\nbilaterally. There is no shift of normally midline structures. Recent\npostsurgical changes related to right frontal craniotomy and aneurysm clipping\nare again noted.\n\nCTA HEAD:\n\nIrregularity and diffuse narrowing of bilateral A2 segments, new compared to\nprior examination, is suggestive of vasospasm. The circle of ___ and its\nmajor tributaries are otherwise unremarkable.", + "output": "1. Hemorrhagic conversion of previously seen left paramedian frontal infarct\nextending to the corpus callosum with intraventricular extension and presence\nof hyperdense hemorrhage in bilateral lateral, third, and fourth ventricles.\n2. Diffuse enlargement of ventricles.\n3. Interval development of irregularity and narrowing of bilateral A 2\nsegments of the anterior cerebral arteries suggestive of vasospasm. Otherwise\npatent circle of ___.\n4. Expected postsurgical changes of right pterional craniotomy for aneurysm\nclipping.\n\nNOTIFICATION: The findings were discussed with ___ care NP by\n___, M.D. on the telephone on ___ at 4:56 pm, 10 minutes after\ndiscovery of the findings." + }, + { + "input": "Right frontal craniotomy changes are redemonstrated with streak artifact noted\nfrom A-comm coiling. A left frontal approach ventriculostomy catheter is in\nunchanged position with the tip seen in the frontal horn of the right lateral\nventricle. Small amount of pneumocephalus persists along the right frontal\nconvexity. Subgaleal swelling along the right frontal craniotomy surgical bed\nis unchanged. Surgical staples are in place.\n\nThere is mild interval decrease in size of the lateral ventricles compared to\nthe CT exam in ___. Expected redistribution and evolution of the diffuse\nsubarachnoid hemorrhage is seen in the bilateral sylvian fissure, bilateral\nfrontal sulci and bilateral parietal sulci. Intraventricular hemorrhages seen\nin the lateral ventricles, third ventricle, and fourth ventricle are not\nsignificantly changed. There is no evidence of midline shift. There is\ncontinued evolution of the hypodensity involving the paramedian left frontal\nlobe extending to the corpus callosum. No new intracranial hemorrhage or\nlarge acute infarct is identified.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Anterior communicating artery aneurysm coil mass streak artifact limits\nexamination.\n2. Redemonstration of right frontal craniotomy changes with A-comm coiling and\nleft frontal approach ventriculostomy catheter in unchanged position.\n3. Mild interval decrease in the size of lateral ventricles compared to the\nprior study in ___.\n4. Expected redistribution and evolution of the diffuse bilateral subarachnoid\nhemorrhage since ___.\n5. No definite new intracranial hemorrhage or acute large acute infarct." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\n\nIn comparison to the most recent prior examination, bilateral subarachnoid\nhemorrhage, diffuse intraventricular hemorrhage, an a hyperdense parenchymal\nhemorrhage in the region of prior infarction splaying the anterior horns of\nthe lateral ventricles are grossly unchanged. A left frontal approach\nventriculostomy catheter remains in place. Diffuse dilatation of the\nventricles is grossly unchanged. There is no evidence of new hemorrhage. \nThere is no shift of normally midline structures. Post surgical changes\nrelated to treatment of an anterior communicating aneurysm are grossly\nunchanged.\n\nCTA HEAD:\nDiffuse irregularity of the A2 segments of bilateral anterior cerebral\narteries, likely representing vasospasm, is grossly unchanged compared to\nprior examination. The circle ___ is otherwise unremarkable.", + "output": "1. Bilateral subarachnoid, diffuse intraventricular, and anterior paramedian\nintraparenchymal hemorrhages are grossly unchanged compared to prior\nexamination there is no evidence of new hemorrhage.\n2. Diffuse enlargement of the ventricles is stable compared to most recent\nprior examination. Ventriculostomy catheter is in place.\n3. Diffuse irregularity of bilateral A2 segments is grossly unchanged,\nconcerning for vasospasm. Otherwise, patent circle of ___.\n4. Grossly unchanged postsurgical changes of right pterional craniotomy for\nruptured anterior communicating artery treatment." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nPatient is status post right frontal craniotomy with skin staples and\npostsurgical changes, including small pneumocephalus along the right frontal\nconvexity. Patient is status post clipping and coiling of the anterior\ncommunicating artery aneurysm with streak artifacts mildly limiting the\nevaluation. Again seen is bilateral subarachnoid hemorrhage, diffuse\nintraventricular hemorrhage, as well as intraparenchymal hemorrhage in the\nhypodensity involving paramedian frontal lobe extending to the corpus\ncallosum. Status post left frontal ventriculostomy with tip terminating in the\nfrontal horn of the left lateral ventricle, unchanged. Size of the lateral\nventricles, third and the fourth ventricles are overall unchanged in size,\ncontaining blood products.\n\nPolypoid mucous retention cyst is seen in the right frontal sinus. Mild\nmucosal thickening is seen in the left frontal sinus. Otherwise, the\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nAnterior communicating artery clipping and coiling hardware artifacts\nattenuates the left A1 segment on 3D reformats, but the left A1 segment\nappears to be patent on the source image.\nInterval improvement and near complete resolution of vasospasm involving the\nA2 segment of the bilateral anterior cerebral arteries. Patent circle ___\nand its major tributaries.\n\nThe remaining vessels of the circle of ___ and their principal intracranial\nbranches appear normal with no evidence of stenosis, occlusion, or aneurysm.\nThe dural venous sinuses are patent.", + "output": "1. Interval substantial improvement and near complete resolution of vasospasm\ninvolving the A2 segment of the bilateral anterior cerebral arteries.\n2. Status post clipping and coiling of the anterior communicating artery and\npost craniotomy surgical changes along the right frontal lobe. No evidence of\nnew or enlarging hemorrhage or territorial infarction." + }, + { + "input": "Compared to ___, no new or enlarging hemorrhage. As before, the\npatient is status post right frontal craniotomy with skin staples and left\nfrontal approach VP shunt with tip in the left frontal horn. Patient is\nstatus post clipping and coiling of the anterior communicating artery aneurysm\nwith streak artifact mildly limiting the evaluation. Subarachnoid hemorrhage\npersists, but has decreased compared to ___. Intraparenchymal\nhemorrhage involving the paramedian frontal lobe extending to the corpus\ncallosum with surrounding edema is unchanged. There has been interval\ndecrease in intraventricular hemorrhage in the occipital horns and third and\nfourth ventricles. There is no evidence of acute infarction or mass. The\nventricles and sulci are essentially unchanged in size and configuration.\n\nThere is no evidence of fracture. There is mild mucosal thickening in the\nbilateral frontal sinuses with a small mucous retention cyst in the right\nfrontal sinus. Otherwise, the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. Compared to ___, no new or enlarging hemorrhage. No acute\ninfarction.\n2. Interval decrease in degree of subarachnoid and intraventricular\nhemorrhage.\n3. Paramedian frontal lobe intraparenchymal hemorrhage with extension to the\ncorpus callosum is unchanged.\n4. Stable postsurgical changes." + }, + { + "input": "Patient is status post right frontal craniotomy and aneurysm clipping in the\nanterior right suprasellar cistern.\n\nThere has been interval conversion of the left frontal approach EVD to a\nventriculoperitoneal shunt with expected postsurgical changes including\nsubcutaneous emphysema at the site of the VP shunt placement. The radiopaque\nportions of the shunt appear intact. The catheter tip is located in the\nfrontal horn of the left lateral ventricle slightly above the foramen of\n___. There is decreased blood in the occipital horns of the lateral\nventricles. There is decreased blood in the third ventricle. The temporal\nhorns of the lateral ventricles and third ventricle and slightly larger than\non ___.\n\nIntraparenchymal hemorrhage involving the paramedian frontal lobes and\nbilateral genu of the corpus callosum, with surrounding edema, is not\nsignificantly changed since ___. Trace residual subarachnoid\nhemorrhage in the sulci continues to decrease in conspicuity. \nIntraventricular and subarachnoid hemorrhage continues to decrease.\n\nThere is mild mucosal thickening in the inferior right frontal sinus, similar\nto prior. There is trace fluid in bilateral mastoid tip air cells, likely\nsequela of prolonged supine positioning in the inpatient setting.", + "output": "1. Interval conversion of the prior left frontal approach EVD to a left\nfrontal approach ventriculoperitoneal shunt, with tip in the frontal horn of\nleft lateral ventricle slightly above the foramen of ___. Small amount of\nblood in the occipital horns of the lateral ventricles and in the third\nventricle has decreased. Temporal horns of the lateral ventricles in the\nthird ventricles has slightly increased in size.\n2. Unchanged intraparenchymal hemorrhage involving the paramedian frontal\nlobes and bilateral genu of the corpus callosum. Trace residual subarachnoid\nhemorrhage with progressive decrease in conspicuity. No new hemorrhage seen." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nPatient is status post with right frontal craniotomy and clipping and\nembolization of an anterior communicating artery aneurysm. There is unchanged\nhemorrhage in the paramedian frontal lobes extending to the bilateral genu of\nthe corpus callosum with mild surrounding edema. Subarachnoid hemorrhage\nremains barely visible at the left vertex and in the left sylvian fissure. \nPatient is status post left frontal approach ventriculoperitoneal shunt\nplacement with the ventriculostomy tube tip terminating in the frontal horn of\nleft lateral ventricle. Prominence of the lateral and third ventricles is\nunchanged. There is unchanged trace hemorrhage in the occipital horns of\nlateral ventricles. There is no shift of midline structures.\n\nThere is an unchanged mucous retention cyst versus secretions in the right\nfrontal sinus. Mild mucosal thickening is again seen in the ethmoid air cells\nand partially imaged left maxillary sinus. Mastoid air cells are clear.\n\nCTA HEAD:\nStreak artifact from the aneurysm clip mildly limits evaluation of the A1 and\nproximal A2 segments. Evaluation for residual aneurysm filling is limited. \nNo additional aneurysm is seen. Allowing for slight differences in contrast\nbolus timing, the caliber of the major intracranial vessels appears unchanged\nfrom the prior study of ___ without evidence for vasospasm. The\ndural venous sinuses are patent.", + "output": "1. Allowing for slightly different contrast bolus timing compared to ___, there is no evidence of vasospasm.\n2. Unchanged bilateral paramedian frontal lobe intraparenchymal hemorrhage\nextending to the corpus callosum. Unchanged trace intraventricular and\nsubarachnoid hemorrhage." + }, + { + "input": "Patient is post right frontal craniotomy and clipping and embolization of an\nanterior communicating artery aneurysm. Previously described hemorrhage in\nthe paramedian frontal lobes extending to the genu of the corpus callosum with\nmild surrounding edema has evolved, now isodense to the surrounding brain\nparenchyma (2:14). Previously described subarachnoid hemorrhage is no longer\nvisible. The left frontal approach ventriculoperitoneal shunt placement with\ntip terminating in the frontal horn of the lateral ventricle is unchanged in\nposition. Ventricular size is unchanged since the prior study. No evidence\nof large territorial infarction or new intracranial hemorrhage. There is no\nevidence of mass. The ventricles and sulci are normal in size and\nconfiguration.\n\n The visualized portion of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Study degraded by streak artifact from the A-comm coil and clip as well as\nmotion.\n2. Stable left frontal approach ventriculostomy catheter.\n3. Stable ventricular size.\n4. Evolving hemorrhage in the paramedian frontal lobes.\n5. Previously described subarachnoid hemorrhage no longer visible.\n6. Within limits of study, no definite evidence of new intracranial\nhemorrhage." + }, + { + "input": "Left frontal approach ventriculoperitoneal shunt is identified extending into\nthe anterior horn of the left lateral ventricle. Ventricular size is\ndecreased compared to the prior study. Clip is visualized in the region of\nanterior communicating artery. Previously seen evolving blood products in the\nregion of septum pellucidum have resolved. No new hemorrhage is seen. No\nmidline shift is identified.", + "output": "No acute hemorrhage identified. Decrease in ventricular size compared to the\nprior study." + }, + { + "input": "Some patient motion makes assessment somewhat suboptimal. Given this, no\nobvious acute intracranial hemorrhage is seen. There are no findings to\nsuggest midline shift or significant mass effect. No definite acute large\nvascular territorial infarct is prominence of the ventricles and sulci is\nconsistent with involutional changes. Probable right basal gangliar lacunar\ninfarct. The visualized paranasal sinuses demonstrate some opacification left\nsphenoid sinus. The mastoid air cells are clear. No acute fracture is seen.", + "output": "Some patient motion makes the study somewhat suboptimal. Given this, no acute\nintracranial process seen." + }, + { + "input": "Enlargement of the lateral ventricles out of proportion to the sulci is stable\ncompared to the prior study, and similar dating back to ___, slightly\nincreased since ___.\nThere is no evidence of infarction, hemorrhage, or mass. Scattered subcortical\nwhite matter hypodensities likely reflect the sequelae of chronic small vessel\nischemic disease.\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No intracranial hemorrhage.\n2. Enlargement of the lateral ventricles out of proportion to the sulci is\nsimilar since ___, slightly increased since ___. Clinical correlation for\nsigns of normal pressure hydrocephalus is recommended." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nare severely enlarged out of proportion to the sulci, stable from the prior\nstudy. Periventricular white matter hypodensities are nonspecific, but most\nlikely sequela of chronic small vessel disease. The basal cisterns are patent\nand there is preservation of gray-white matter differentiation.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, and middle ear cavities are clear. There opacification of the left\nmastoid air cells. The visualized portion of the orbits are unremarkable. \nAir dense calcifications within the cavernous carotid arteries and vertebral\narteries bilaterally.", + "output": "1. No acute intracranial process.\n2. Enlarged ventricles out of proportion to sulci, unchanged from prior,\nfindings could represent normal pressure hydrocephalus in the appropriate\nclinical setting." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, or mass effect. There is\npersistent severe enlargement of the ventricles out of proportion to the\nsulci, but unchanged since prior study. Mild periventricular white matter\nhypodensities are unchanged, compatible with a combination of sequela of\nchronic small vessel ischemic disease and sequela of ventriculomegaly.\n\nThere is no evidence of fracture. There is unchanged partial opacification of\nthe bilateral mastoid tip air cells. There is partially visualized mild\nmucosal thickening in the included portion of the left maxillary sinus, which\nwas also seen previously.", + "output": "1. Unchanged severe ventriculomegaly out of proportion to the size of the\nsulci, compatible with communicating hydrocephalus in an appropriate clinical\nsetting.\n2. No evidence for new intracranial abnormalities." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is interval evolution of the hypodensity in right pons in keeping with\nan acute infarct as seen on the recent prior MRI.\n\nNo acute intracranial hemorrhage is seen. Again seen are scattered foci of\nhypodensity in the periventricular and subcortical white matter, nonspecific,\nlikely secondary to small vessel ischemic disease.\n\nThe ventricles are dilated out of proportion to the sulci and cisterns raising\nconcern for normal pressure hydrocephalus in the appropriate clinical context.\n\nNo masses, midline shift or edema is seen.\n\nThere is mucosal thickening in bilateral maxillary sinuses, bilateral ethmoid\nair cells. The remaining visualized paranasal sinuses and mastoid air cells\nare clear. The middle ear cavities are clear. The orbits appear\nunremarkable.\n\nCTA HEAD:\nThere is atherosclerosis involving bilateral cavernous carotid and\nsupraclinoid ICAs. Atherosclerosis involving bilateral V4 segments of the\nvertebral artery. The vessels of the circle of ___ and their principal\nintracranial branches appear otherwise unremarkable without stenosis,\nocclusion or aneurysm formation. The dural venous sinuses are patent. \nIncidentally seen is hypoplastic bilateral posterior communicating arteries.\n\n\nCTA NECK:\nThere is a 4 vessel arch with a separate origin of left vertebral artery from\nthe aortic arch with mild luminal narrowing secondary to atherosclerosis.\n\nThere is calcified and soft plaque involving the right carotid bifurcation\ncausing approximately 50% stenosis by NASCET criteria. Also seen is calcified\natherosclerosis involving the right carotid bifurcation without any stenosis\nby NASCET criteria.\n\nThe carotid and vertebral arteries and their major branches appear otherwise\nunremarkable with no evidence ofocclusion.\n\nOTHER:\nThe visualized portion of the lungs are clear. There is a 7 mm nodule in the\nleft lobe of thyroid. There is no lymphadenopathy by CT size criteria. There\nis atherosclerosis involving the aortic arch. Mild degenerative changes are\npresent throughout the cervical spine, more significant at C5/C6 and C6/C7\nlevels.", + "output": "1. Evolving acute infarct in the right pons.\n2. Marked ventriculomegaly out of proportion to the size of the cisterns and\nsulci raising concern for normal pressure hydrocephalus in the appropriate\nclinical context.\n3. Calcified and noncalcified atherosclerotic plaque involving the right\ncarotid bifurcation causing approximately 50% stenosis by NASCET criteria.\n4. Mild atherosclerosis involving the left carotid bifurcation without any\nstenosis by NASCET criteria.\n5. Mild luminal narrowing involving the origin of left vertebral artery from\nthe aortic arch.\n6. Moderate atherosclerosis involving bilateral cavernous carotid and\nsupraclinoid ICAs and V4 segments of bilateral vertebral arteries." + }, + { + "input": "There is no evidence of hemorrhage or mass. Focal hypodensity is again noted\nin the right pons, consistent with evolution of known infarct. Severe\nventriculomegaly is again noted, out of proportion to mild to moderate sulcal\nenlargement.\n The visualized osseous structures are osteopenic. There is no evidence of\nfracture. Mild mucosal thickening of left maxillary sinus is noted. The\nvisualized portion of the mastoid air cells, and middle ear cavities are\nclear.", + "output": "1. Evolving right pontine infarct.\n2. No evidence of hemorrhagic conversion.\n3. Stable ventriculomegaly, again disproportionately prominent relative to\nsulci, which may reflect communicating hydrocephalus in the correct clinical\nsetting.\n4. Paranasal sinus disease as described." + }, + { + "input": "Severe ventriculomegaly is unchanged from the prior examination. No evidence\nof large territorial infarction, acute intracranial hemorrhage, edema, or\nmass. Subcortical and periventricular white matter hypodensities are\nnonspecific, likely sequela of chronic small vessel ischemic disease. A small\nhypodensity in the right pons is unchanged from the prior study. Extensive\natherosclerotic calcifications of the bilateral cavernous internal carotid\narteries are again noted.\n\nThere is no evidence of fracture. There is mucosal thickening involving the\nleft maxillary sinus. Partial opacification of the right-sided mastoid air\ncells again noted. The visualized portion of the middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. Persistent ventriculomegaly, compatible with communicating hydrocephalus. \nThis is unchanged since the prior study on ___.\n\n2. No acute intracranial hemorrhage." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute territorial infarction, intracranial hemorrhage,\nor mass. The ventricles and sulci are age-appropriate. No mass effect or\nmidline shift. Mild patchy periventricular white matter low-attenuation\nchanges are nonspecific, but likely reflect chronic small vessel ischemic\ndisease.\n\nPostsurgical changes of bilateral lens replacement. Minimal mucosal\nthickening of the paranasal sinuses. Surgical clips are noted along the\nbilateral anterior maxillary sinuses. The mastoid air cells and middle ear\ncavities are clear.\n\nCTA HEAD:\nMild nonocclusive atherosclerotic calcifications of the right greater than\nleft cavernous internal carotid arteries. There is opacification of the\nbilateral anterior and middle cerebral arteries. There is persistent fetal\norigin of the right posterior cerebral artery. Opacification of the\nvertebrobasilar system and both posterior cerebral arteries. No focal\nstenosis or occlusion. The dural venous sinuses are patent.\n\nCTA NECK:\nStandard 3 vessel aortic arch. Mild atherosclerotic calcifications of the\nright common carotid artery bifurcation. Otherwise, the common carotid and\ninternal carotid arteries demonstrate opacification without evidence of\nocclusion. There is no evidence of internal carotid stenosis by NASCET\ncriteria.\n\nThere is opacification of the vertebral arteries without evidence of focal\nstenosis or occlusion.\n\nOTHER:\nMild biapical scarring. Mild mosaic attenuation, likely due to air-trapping. \nNo suspicious pulmonary nodules.\n\nThere are a number of bilateral nonenlarged cervical chain lymph nodes, but\notherwise no lymphadenopathy by CT size criteria.\n\nThere is a nonspecific 0.8 cm mildly hyperdense nodule in the left parotid\ntail.\n\nThere are multifocal ill-defined, irregular heterogeneous subcutaneous soft\ntissue attenuation density in the bilateral maxillofacial regions, likely\ncosmetic, less likely inflammatory. Correlate with physical exam and prior\nhistory.\n\nMultilevel degenerative changes of the visualized spine, most pronounced from\nC3-C4 through C6-C7 with multilevel posterior disc osteophyte complexes.\n\nThere are hypertrophic osseous changes along the leftward mandible/left\nmandibular ramus. Surgical material is noted in the bilateral mandibular\nsymphysis. Dental disease.", + "output": "1. No acute intracranial abnormalities.\n2. Patent head and neck vasculature with no evidence of focal stenosis or\nocclusion.\n3. 0.8 cm mildly hyperdense nodule in the left parotid tail is nonspecific. \nWhile this could represent an intraparotid lymph node, benign and malignant\nparotid neoplasms are also possible.\n4. Probable cosmetic injections involving the bilateral maxillofacial regions.\nCorrelate with physical exam and clinical history." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, mass effect or large\nterritorial infarction. The basilar cisterns are patent, and there is\notherwise good preservation of the gray-white matter differentiation. Mild\nprominence of the ventricles and sulci is likely related to age related\ninvolutional changes. Incidental note is made of an empty sella.\n\nNo acute fractures identified. The visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The globes are unremarkable.", + "output": "1. No acute intracranial abnormalities identified." + }, + { + "input": "The study is limited due to patient motion. Within this limitation, there is\nno evidence of infarction,intracranial hemorrhage,edema,or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nleft maxillary sinus. Within the inferior left maxillary sinus, there is an\nunerupted wisdom molar tooth. The remaining visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavitiesare essentially\nclear. Right infraorbital soft tissue swelling is noted, better depicted in\nthe concurrent MRI of the orbits performed on the same date.", + "output": "1. No acute intracranial abnormality within the limitations of a motion\ndegraded study.\n\n2. Right orbital soft tissue swelling is noted, better depicted in the\nconcurrent MRI of the orbits performed on the same date." + }, + { + "input": "There is mild enhancing right infraorbital soft tissue edema. There is no\nevidence of intraconal fat, the eye globes are intact bilaterally.\nThere is a small mucous retention cyst in the left maxillary sinus. Within\nthe inferior left maxillary sinus, there is an unerupted wisdom molar tooth\n(image 36, series 602), also noted on prior MR. ___ paranasal sinuses are\notherwise normally aerated, with no mucosal thickening or air-fluid levels\nidentified. There is mild narrowing of the left ostiomeatal unit at the level\nof the infundibulum with mild underlying mucosal thickening. The cribriform\nplates are intact. The lamina papyracea are intact.", + "output": "Right infraorbital soft tissue edema with mild pattern of enhancement suggest\nmild-to-moderate preseptal orbital cellulitis, no fluid collections are seen, \nthere is no evidence of intraconal fat stranding and the eye globes are intact\nbilaterally." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is redemonstration of a cystic mass measuring 3.4 x 3.7 cm with a\nenhancing nodular component measuring up to 1.5 cm along the right frontal\nlobe with mild regional mass effect on the adjacent brain parenchyma, better\ncharacterized on the prior contrast enhanced MR head. There is no evidence of\ninfarction,hemorrhage,edema,oradditional mass. The ventricles and sulci are\nnormal in size and configuration.\n\nThere is mild mucosal thickening along the inferior right maxillary sinus. \nThe visualized portion of the remaining paranasal sinuses,mastoid air\ncells,and middle ear cavities are clear. The visualized portion of the orbits\nare normal. There is a periapical lucency involving the first right maxillary\nmolar tooth. Multiple bilateral extracranial subcutaneous soft tissue\nstructures are again noted, several of which contain calcifications and most\nlikely representing epidermoid inclusion cyst.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. The dural venous\nsinuses are patent.", + "output": "1. Redemonstrated cystic mass along the right frontal lobe with an enhancing\nnodular component with mild local mass effect on the parenchymal, better\ncharacterized on the prior contrast enhanced MR head.\n2. No acute intracranial process.\n3. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n4. Periodontal disease of the first right maxillary molar tooth with adjacent\nright maxillary sinus mucosal thickening, possibly odontogenic in origin.\n5. Multiple extracranial subcutaneous soft tissue structures, likely epidermal\ninclusion cysts." + }, + { + "input": "Patient is status post right frontal craniotomy for resection of right frontal\nlobe mass with postsurgical changes including pneumocephalus and mild right\nfrontal lobe encephalomalacia.\n\nOtherwise, there is no evidence of acute large territorial infarction, or\nacute intracranial hemorrhage. No significant midline shift is seen.\n\nThe ventricles and sulci are normal in size and configuration.\n\nNo acute fracture is seen. Partially imaged paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The orbits demonstrate no acute\nabnormalities.", + "output": "1. No acute intracranial process within limitations of this noncontrast\nstudy. No evidence of intracranial hemorrhage.\n2. Status post right frontal craniotomy for resection of right frontal lobe\nmass with postsurgical changes, including pneumocephalus." + }, + { + "input": "Patient is status post right frontal craniotomy for resection of previously\nseen enhancing mass and cyst. Encephalomalacia in the anterior right frontal\nlobe at the level of the postoperative bed. There is slight thickened\nappearance of the falx anteriorly (2:19), potentially postoperative though MRI\nwould be more sensitive for detection of residual lesion.\n\nThere is no intracranial hemorrhage. No evidence of infarct. No mass effect.\nVentricles and sulci are within normal limits.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable. Subcutaneous nodules along the scalp near the\nvertex, likely sebaceous cysts.", + "output": "1. No acute intracranial process.\n2. Postoperative changes centered in the right frontal lobe from prior mass\nand cyst resection. Apparent focal thickening along the falx anteriorly,\npotentially postoperative though MRI would be more sensitive for detection of\nresidual/recurrent disease." + }, + { + "input": "When compared to the ___ head CT diffuse cortical atrophy has\nprogressed in the interim. Additionally there is new hypodensity involving\nthe right frontal lobe with ex vacuo dilatation of the adjacent right lateral\nventricle which is consistent with encephalomalacia from prior infarct or\ninjury. There is no evidence of acute large territorial infarction. No\nintracranial hemorrhage. No shift of the normal midline structures. \nSubcortical and periventricular white matter hypodensities likely reflect\nsequela of chronic microvascular ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of acute large territory infarction or acute intracranial\nhemorrhage.\n2. Global cerebral atrophy and right frontal encephalomalacia from prior\ninsult." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema,or large mass. The\nventricles and sulci are normal in size and configuration. Basal cisterns are\npatent. The orbits are unremarkable. There is aerosolized secretions within\nthe left frontal sinus and mild ethmoidal air cell mucosal thickening. \nRemaining imaged paranasal sinuses, bilateral mastoid air cells, and middle\near cavities are clear. Bony calvarium appears intact.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. The ventricles and sulci are normal in size and configuration.\n\nThere is soft tissue swelling overlying the frontal bone without underlying\ncalvarial fracture. The visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "No acute intracranial process, no hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect or\nmidline shift. The cavum septum pellucidum is not identified, and may be\ncongenitally absent. The ventricles and sulci are normal in size and\nconfiguration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Cavum septum pellucidum not identified, may be congenitally absent." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mucosal thickening of the\nbilateral ethmoid air cells, right worse than left and the sphenoid sinus. \nThe visualized portion of the other paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial abnormalities.\n2. Mild sinus disease as described above." + }, + { + "input": "There is no evidence of infarction, acute intracranial hemorrhage hemorrhage,\nor mass. Confluent white matter hypodensities are thought to reflect a\ncomponent of vasogenic edema in the setting of ischemic compromise suggested\nin multiple clinical nodes. The basal cisterns remain patent. There is no\nshift of normally midline structures. The ventricles and sulci are normal in\nsize and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial hemorrhage.\n\n2. Diffuse white matter hypodensities is likely due to hypoxic ischemic\nencephalopathy from polypharmacy overdose, suggested in multiple clinical\nnotes." + }, + { + "input": "Evaluation of the aerodigestive tract is limited by streak artifact from\ndental amalgam, but demonstrates no no areas of focal mass effect. Notably,\nsmall foci of presumably extraluminal air anterior to the endotracheal tube in\nthe soft tissues at the level of the thyroid cartilage likely represents\nsequela of reported traumatic intubation (602b:32, 2:46, 53). Compared with\nthe outside hospital cervical spine CT, the amount of air has decreased. An\nenteric tube courses in the expected region of the esophagus.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. The neck vessels are patent. Incidental note is made of mild\nmucosal thickening in the bilateral maxillary and sphenoid sinuses.\n\nPlease refer to the dedicated CT chest report of the same date for the\nintrathoracic findings. There are no osseous lesions.", + "output": "1. Small foci of air are presumably extraluminal in the soft tissues anterior\nto the endotracheal tube at the level of the thyroid cartilage. These likely\nrepresent sequelae of reported traumatic intubation. However, compared with\nthe CT cervical spine of ___, the amount of air has decreased.\n\n2. Please refer to the dedicated CT chest report of the same date for the\nintrathoracic findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere are patchy to confluent periventricular white matter low-attenuation\nchanges, which are nonspecific, but similar to prior exam. There is no\nevidence of infarction,hemorrhage,edema,ormass. The ventricles and sulci are\nnormal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nNo suspicious pulmonary nodules are evident in the visualized lungs. The\nthyroid is unremarkable. There are a number of nonenlarged bilateral cervical\nchain lymph nodes, but otherwise no lymphadenopathy by CT size criteria.", + "output": "1. Patchy to confluent periventricular white matter low-attenuation changes\nare nonspecific, but similar to prior exam.\n2. No evidence of hemorrhage.\n3. Patent circle of ___ with no evidence of stenosis or aneurysm formation.\n4. Patent neck vasculature with no evidence of stenosis or aneurysm formation." + }, + { + "input": "There is a small mucous retention right maxillary sinus. There is minimal\nmucosal thickening of the right maxillary sinus and ethmoid sinus. Paranasal\nsinuses otherwise clear. Mild narrowing of patent left maxillary sinus\nostiomeatal unit infundibulum. Paranasal sinus ostia otherwise widely patent.\n\nMidline nasal septum, clear nasal cavity. Small right concha bullosa. Intact\ncribriform plates, medial orbital walls. Anterior clinoids not aerated. \nOptic canals, carotid canals are covered by bone. Suboptimally images\nintracranial contents, orbits, upper neck soft tissues are normal.", + "output": "1. Minimal paranasal sinus disease." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\n\nAn area of encephalomalacia in the straight gyrus of the right frontal lobe is\nseen. There is no evidence of acute infarction,acute hemorrhage,\nedema,ormass.There is prominence of the ventricles and sulci suggestive\ninvolutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is mild plaque in the carotid siphons without evidence of narrowing. The\nvessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nA punctate focus of calcified plaque at the right vertebral origin is noted.\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nMild degenerative disease of the cervical spine is noted.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No evidence of aneurysm, occlusion or stenosis.\n2. An area of encephalomalacia in the straight gyrus of the right frontal lobe\nis nonspecific, and probably represent sequela of prior chronic traumatic\ninjury, please correlate." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territory infarct. Gray-white matter\ndifferentiation is preserved. The ventricles and sulci are slightly more\nprominent than expected given patient's age, but similar to prior study. \nThere is no hydrocephalus. The visualized paranasal sinuses demonstrate mild\nmucosal thickening in the bilateral ethmoid air cells. The remainder of the\npartially imaged paranasal sinuses are clear.. The mastoid air cells and\nmiddle air cavities are clear. No acute fracture is seen.", + "output": "No acute intracranial process. Extra-axial spaces are slightly more prominent\nthan expected given patient age, but similar to the prior study." + }, + { + "input": "Study is moderately degraded by motion. Within these confines\n\nQuestion subtle right occipital lobe hypodensity which extends to the gray\nmatter (see 15:16). There is no evidence of hemorrhage or mass.. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Soft tissue densities are noted within\nbilateral external auditory canals which may represent cerumen.", + "output": "1. Study is moderately degraded by motion.\n2. Question subtle right occipital lobe hypodensity, concerning for acute to\nsubacute infarct. Differential considerations include PRES. Recommend\ncorrelation with neurologic exam. If clinically indicated, brain MRI may be\nobtained for further evaluation.\n3. Within limits of study, no definite acute intracranial hemorrhage.\n\nRECOMMENDATION(S): Question subtle right occipital lobe hypodensity,\nconcerning for acute to subacute infarct. Differential considerations include\nPRES. Recommend correlation with neurologic exam. If clinically indicated,\nbrain MRI may be obtained for further evaluation.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\non the ___ ___ at 3:50 AM, 5 minutes after discovery of the\nfindings." + }, + { + "input": "There is no evidence of large territory infarction, hemorrhage, edema, or mass\neffect. The previously seen subtle, vague hypodensity in the right occipital\nlobe is not well appreciated on the current examination. The ventricles and\nsulci are normal in size and configuration.\n1\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality. Previously seen subtle right occipital\nlobe hypodensity is not well appreciated on the current examination." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, or mass. There is prominence\nof the ventricles and sulci suggestive of age-related cerebral volume loss.\nPeriventricular and subcortical white matter hypodensities are nonspecific,\nthough likely sequelae of chronic small vessel ischemic disease.\nAtherosclerotic vascular calcifications are noted of bilateral cavernous\nportions of internal carotid arteries. Hypodensities are visualized in the\nleft ___, left frontal and right frontal as well as basal gangliar\nregion due to infarcts of undetermined age.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. Bilateral hypodensities due to infarct of undetermined age. In absence of\nprior studies, MRI would be helpful for further assessment if clinically\nindicated.\n2. No acute hemorrhage or mass effect." + }, + { + "input": "There is no evidence of infarction,hemorrhage,edema, or mass. The ventricles\nand sulci are normal in size and configuration. There is left frontal scalp\nswelling.\n\nThere is no evidence of fracture. There is fluid in the left maxillary sinus.\nIn the setting of trauma, this would raise the possibility of a fracture. No\nfracture is identified and the fluid appears of lower density than would be\nexpected for hemorrhage. Otherwise, the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Left frontal scalp swelling.\nFluid in the left maxillary sinus with no evidence of fracture.\nOtherwise normal study." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. \nPeriventricular and subcortical white matter hypodensities are nonspecific but\nlikely sequelae of chronic small vessel ischemic disease. There is prominence\nof the ventricles and sulci suggestive of involutional changes.\n\nThere is left facial and periorbital soft tissue swelling. There is no\nevidence of fracture. There is diffuse paranasal sinus mucosal thickening\nwith aerosolized secretions in the left maxillary sinus and ethmoid air cells.\nThe mastoid air cells are clear. The middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable. Severe carotid siphon and\nV4 segment calcifications are noted.", + "output": "1. No evidence of fracture, mass, hemorrhage or infarction.\n2. Paranasal sinus inflammatory changes." + }, + { + "input": "Left cerebellar hypodensity is consistent with old infarction. There is no\nevidence of new large territorial infarction,hemorrhage,edema, or mass. There\nis prominence of the ventricles and sulci suggestive of involutional changes. \nBilateral periventricular and subcortical white matter hypodensities are\nnonspecific but most likely reflect chronic small vessel ischemic changes. \nThere is mild bilateral carotid siphon atherosclerotic calcification.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nethmoid air cells. The remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial process.\n2. Old left cerebellar infarction and chronic small vessel ischemic changes." + }, + { + "input": "There is no evidence of acute intracranial infarction,hemorrhage,edema,or\nmass-effect. Mild prominence of ventricles and sulci is greater than expected\ngiven patient age.\n\nThere is no evidence of fracture. There is apparent slight fat stranding\ninvolving the soft tissues of the nose, possibly related to contusion or\nabrasion. The visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. There is mild rightward anterior nasal\nseptum deviation. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality. Mild prominence of the ventricles and\nsulci is greater than expected given patient age.\n2. Possible contusion or abrasion of the superficial soft tissues of the nose.\nNo acute fracture." + }, + { + "input": "There is no evidence of acute large territory infarction,hemorrhage,edema, or\nmass. There is encephalomalacia of the right frontal and parietal lobes which\nextends to the ipsilateral insular cortex. Additionally there is ex vacuo\ndilatation of the right lateral ventricle. The ventricles and sulci are age\nappropriate. Parafalcine calcifications are again noted. Moderate\nhypodensities of the subcortical and periventricular white matter nonspecific\nbut may represent sequela microvascular ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Metallic\ndensity in the left middle ears presumably in the saccular prosthesis. \nPatient is status post right lens replacement surgery. The partially\nvisualized left orbit is unremarkable.", + "output": "1. No acute intracranial process.\n2. Encephalomalacia at the right parietal lobe extending to the ipsilateral\ninsular cortex is likely sequela of chronic infarction.\n3. Presumable left stapes prosthesis." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Focal right frontal lobe white matter hypodensity\nadjacent to the body of the right lateral ventricle (02:18) correlates with an\nold infarct, as seen on the ___ MR head exam. Mild\natherosclerotic calcifications are noted involving the cavernous carotid\narteries.\n\nThere is no evidence of fracture. Mild mucosal thickening of the ethmoid\nsinuses suggests mild ongoing inflammation. The remainder of the paranasal\nsinuses, the mastoid air cells,and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable except for prior right lens\nresection.", + "output": "1. No acute intracranial hemorrhage or mass effect. Remote right frontal\ninfarct.\n2. Mild ethmoid sinus disease." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territory infarct. Gray-white matter\ndifferentiation is preserved. Mild prominence of the ventricles and sulci is\nconsistent with involutional changes.. The visualized paranasal sinuses\ndemonstrate mucosal thickening of the bilateral ethmoid air cells and minimal\nmucosal thickening of the inferior bilateral maxillary sinuses.. The mastoid\nair cells are clear. No acute fracture is seen. 8 mm coarse calcification in\nthe scalp in the right occipital region/inferior right head, nonspecific, but\nmay be sequela of prior trauma or other nonspecific soft tissue calcification.", + "output": "No acute intracranial process, including no acute intracranial hemorrhage." + }, + { + "input": "There is no evidence of large territory infarction,hemorrhage,edema, or mass\neffect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. There are a few hypodensities within the subcortical\nand periventricular white matter there are nonspecific but may represent\nsequela of chronic microvascular ischemic disease.\n\nThere is no evidence of fracture. There is mild mucosal thickening and\npartial opacification of the right ethmoid sinuses. There is complete\nopacification of the right maxillary sinus with hyperdense material and\ncalcification which may represent inspissated secretions or allergic fungal\nsinusitis. The visualized portion of the other paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear.", + "output": "1. No acute intracranial process. MRI would be more sensitive for detection\nof intracranial metastasis.\n2. The right maxillary sinus is completely opacified with hyperdense material\nand calcification which may represent inspissated secretions or allergic\nfungal sinusitis." + }, + { + "input": "Evaluation of the skullbase is slightly motion degraded. Within these\nconfines:\n\nThere is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass. The ventricles and sulci are normal in size and configuration. Basal\nganglia calcifications are noted bilaterally. Slightly asymmetric\nhypodensities in the subcortical, and periventricular, and deep gray matter\nare slightly progressed ___, particularly on the left. These hypodensities\nare nonspecific but but most likely represent sequelae of chronic small vessel\nischemic disease appear\n\nThere is no evidence of fracture. There is a small left maxillary sinus\nmucous retention cyst or polyp. The visualized portion of the remaining\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality on noncontrast head CT.\n2. Nonspecific periventricular subcortical white matter hypodensities are\nnonspecific, but commonly seen in setting of chronic microangiopathy in a\npatient of this age." + }, + { + "input": "There is no evidence of acute large territorial infarction, intracranial\nhemorrhage, edema, or discrete mass. The ventricles and sulci are normal in\nsize and configuration. Periventricular and subcortical white matter\nhypodensities are nonspecific, though likely sequelae of chronic small vessel\nischemic disease. Carotid siphon calcification noted bilaterally.\n\nNo acute osseous abnormalities seen. The partially imaged paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The orbits demonstrate\nno acute abnormalities.", + "output": "1. No acute intracranial process.\n2. Small vessel disease.\n3. No fracture." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or large\nmass. Chronic lacunar infarct right caudate head, adjacent internal capsule,\nanterior putamen, with mild volume loss of the caudate head, consistent with\nchronic lacunar infarcts. Zone of low-density in the posterior right\nthalamus, consistent with lacunar infarct, of indeterminate age, may be\nsubacute or chronic. Small area of low attenuation right ___ represent\nlacunar infarct, suboptimally evaluated.\nPeriventricular and subcortical white matter hypodensities are nonspecific but\nlikely sequelae of chronic small vessel ischemic disease. The ventricles and\nsulci are normal in size and configuration.\n\nThere is no evidence of fracture. Trace left maxillary sinus mucosal\nthickening. The visualized portion of the remaining paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "Chronic lacunar infarcts, some are chronic. Lacunar infarct of the right\nthalamus may be subacute or chronic, clinically correlate.\nNo noncontrast evidence of intracranial metastasis.\n\nRECOMMENDATION(S): Consider contrast exam if there is high clinical suspicion\nof metastases.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 08:37 into the Department of Radiology\ncritical communications system, and was emailed to the ED QA nurses, for\ndirect communication to the referring provider." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Bilateral\nprominent ventricles and sulci suggest cortical atrophy and are likely\nage-related.\n\nNo osseous abnormalities are seen. The paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n\n2. Age-related cortical atrophy." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect.\n\nThere is soft tissue thickening and fat stranding overlying the left mandible\n(2:43), with an adjacent prominent 1.9 x 0.8 cm submandibular cervical lymph\nnode. No underlying fluid collection detected. Streak artifact from dental\namalgam limits evaluation of the dentition. No obvious periapical lucency\ndetected.\n\nA 0.7 cm hyperdense rounded focus is identified in the left parotid gland\n(601b:39), likely a lymph node. The thyroid gland appears normal. The neck\nvessels are patent.\n\nThe imaged portion of the lung apices exhibit mild emphysematous changes..\nThere are no osseous lesions. Mild mucosal thickening is noted in the left\nmaxillary sinus. A tiny mucous retention cyst is seen in the right maxillary\nsinus.", + "output": "1. Soft tissue thickening and fat stranding overlying the left mandible,\nwithout underlying fluid collection.\n\n2. Streak artifact from dental amalgam limits evaluation of the dentition,\nhowever there is no obvious periapical lucency.\n\n3. 0.7 cm hyperdense focus in the left parotid gland is likely a small lymph\nnode. Follow-up nonemergent MRI could be obtained for further evaluation.\n\n4. Paranasal sinus disease as above.\n\nNOTIFICATION: The above findings were communicated via telephone by Dr.\n___ to Dr. ___ at 22:22 on ___, 5 min after discovery." + }, + { + "input": "Some of the images were repeated due to motion artifact on the initial scan.\n\nThere is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nacute major vascular territorial infarction. Ventricles, sulci, and basal\ncisterns are normal in size. Cerebellar tonsils are normally positioned.\n\nNo evidence for suspicious bone lesions. There is a well corticated defect in\nthe midline posterior arch of C1, images 3:3 and 601:66, likely congenital. \nVisualized paranasal sinuses and mastoid air cells appear grossly\nwell-aerated. The orbits are unremarkable.", + "output": "No evidence for acute intracranial abnormalities or mass effect. MRI would be\nmore sensitive for the detection of intracranial metastatic disease or other\nsource of seizures, if clinically warranted." + }, + { + "input": "The study is slightly degraded by motion. Within the limitation, a\nhyperdensity along the right inferior frontal lobe adjacent to the inner table\nis likely artifactual and less likely to represent hemorrhage, as similar\naffect is seen on the prior study from ___. Subtle hypodensity is seen\nwithin the left frontal lobe. There is no evidence of territorial\ninfarction,acute hemorrhage,edema,or mass. The ventricles and sulci are\nnormal in size and configuration.\n\nA mildly displaced left nasal bone fracture is seen. The visualized portion\nof the paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear.. Otherwise, the visualized portion of the orbits are unremarkable.", + "output": "Subtle hypodensity within the left frontal lobe, remains on both the initial\nand repeat sequences.\n\nMildly displaced left nasal bone fracture, new compared to the prior exam from\n___.\n\nRecommendations:\n\nAn MRI is recommended for further evaluation of an underlying lesion.\n\nNOTIFICATION: Updated findings and recommendations were discussed with Dr. \n___, M.D. by ___, M.D. on the telephone on ___ at 10:06\nam, 10 minutes after discovery of the findings." + }, + { + "input": "There is a 1.0 x 1.2 cm hyperdense focus in the medial right frontal\nextra-axial space, which appears slightly rounded particularly on sagittal\nimaging (602:32). It is difficult to ascertain whether this is artifactual\nfrom overlying calvarium or representing a mass lesion. Of note, there is no\ncorrelate lesion on MRI brain from ___.\n\nThere is no evidence of acute large territorial infarction. No definite\nevidence of intracranial hemorrhage.\n\nThe ventricles and sulci are normal in size and configuration. Basilar\ncisterns are patent.\n\nNo acute fracture is seen. Scattered mild mucosal thickening of the ethmoidal\nair cells. Otherwise, partially imaged paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear.", + "output": "1. 1.2 cm hyperdense focus in medial right frontal extra-axial space may\nrepresent artifact from overlying calvarium, but has a rounded appearance on\nthe sagittal imaging and a mass lesion is not excluded. MRI brain with and\nwithout contrast is recommended for further evaluation.\n2. No acute intracranial process within limitations of this noncontrast\nstudy. No definite evidence of intracranial hemorrhage.\n\nRECOMMENDATION(S): MRI brain with and without contrast" + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nMild mucosal thickening of the left maxillary sinus and ethmoid air cells,\notherwise the visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nnormal.", + "output": "1. Normal study." + }, + { + "input": "There is re-demonstration of a small right frontal parafalcine\nintraparenchymal hemorrhage, measuring up to 6 mm (601:42) similar in size and\nappearance compared to prior study. There is no evidence of acute large\nterritory infarction, edema,or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. Periventricular and subcortical\nwhite matter hypodensities are nonspecific, but likely reflect sequelae of\nchronic small vessel ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Stable small right frontal parafalcine intraparenchymal hemorrhage when\ncompared to the prior study. No new intracranial hemorrhage identified." + }, + { + "input": "There is no hemorrhage, edema, mass effect or infarction. The ventricles and\nsulci are normal in size and configuration. The visualized paranasal sinuses\nand mastoid air cells are clear. There is no acute fracture.", + "output": "Normal study" + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are normal in size and configuration.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Unremarkable CT head." + }, + { + "input": "New hyperdense focus in the right thalamus / posterior limb of the internal\ncapsule since ___ may represent intraparenchymal hemorrhage or dystrophic\ncalcification (Series 2, Image 15). A tiny hypodensity anteriorly is seen,\nbut could be prior lacunar infarct; no definite edema and no circumferential\nedema around this hyperdense focus.\n\nSequelae of prior right external capsule right posterior temporal lobe\ninfarcts are noted. Hypodensity in the left thalamus is compatible with prior\nleft lacunar infarct. Bilateral symmetric, prominent and largely confluent\nperiventricular and subcortical white matter hypodensities are nonspecific but\nare most compatible with sequelae of chronic small vessel ischemic disease. \nBilateral symmetric prominence of the ventricles and sulci suggest cortical\nvolume loss and are similar to the prior exam, likely age related. No shift\nof normally midline structures. No mass-effect. The perimesencephalic\ncisterns are patent. Incidental septum cavum pellucidum et vergae is noted. \nAtherosclerotic calcifications are noted in the basilar artery and bilateral\ninternal carotid and vertebral arteries. Incidental calcification of the\npineal gland is noted and within normal limits.\n\nNo acute osseous process. The incompletely visualized paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. Other than a replaced\nright lens, the orbits are unremarkable.", + "output": "1. New hyperdense focus in the right thalamus / posterior limb of the\ninternal capsule since ___ may represent intraparenchymal hemorrhage or\ndystrophic calcification; short interval follow-up is recommended.\n\n2. Stable sequelae of prior infarcts and chronic small vessel ischemic\ndisease.\n\n3. Stable cortical volume loss.\n\n4. No mass effect." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass effect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. The bilateral symmetric periventricular white matter\nhypodensities likely represent chronic microvascular ischemic disease,\nunchanged from prior exam. There is dense atherosclerotic calcification of\nthe left vertebral artery and the right MCA.\n\nThere is no evidence of fracture. The right frontal sinus is hypoplastic. \nOtherwise, the visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. There has been right lens replacement,\notherwise the visualized portion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality on noncontrast head CT. Specifically no\nintracranial hemorrhage or large territorial infarct." + }, + { + "input": "Overlying hardware streak artifact limits examination. There is no evidence\nof infarction, hemorrhage, edema, or mass. There is prominence of the\nventricles and sulci suggestive of involutional changes, unchanged. \nPeriventricular, subcortical, and deep white matter hypodensities are likely\nsequelae of chronic small vessel ischemic disease and unchanged since prior\nexamination.\n\nThere is no evidence of fracture.\n\nMild mucosal thickening of the ethmoidal air cells and sphenoid sinus are\nnoted. Aerosolized secretions are seen within bilateral maxillary sinuses as\nwell as within the oropharynx. Findings are nonspecific, and may be related\nto intubation status.\n\nThe additional visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. Soft tissue within bilateral external\nauditory canals, right greater than left is most consistent with cerumen. The\nvisualized portion of the orbits are notable for right lens replacement. \nCalcification of the cavernous portions of internal carotid arteries, basilar\nartery, and left vertebral artery are noted.", + "output": "1. Overlying hardware streak artifact limits examination.\n2. No acute intracranial process with no evidence of acute intracranial\nhemorrhage or cerebral edema.\n3. Stable chronic changes as described.\n4. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct." + }, + { + "input": "The carotid and vertebral arteries and their major branches are patent with\nbilateral arteriosclerotic cysts, more significant below the right cervical\ncarotid bifurcation and throughout the left common carotid artery. No\nevidence for dissection is seen. There is opacification of the mastoid air\ncells bilaterally.\n\nNo evidence of a tracheoinnominate fistula. Soft tissue density mass causes\nsignificant tracheal narrowing just above the carina (2, 19). This mass is\nmost likely extrinsic to the trachea, but could reflect blood clot or tumor\nwithin the tracheal lumen.\n\nIncidental note is made of a retropharyngeal course of the internal carotid\narteries, more significant on the left with dense bilateral arteriosclerotic\ncalcifications, causing moderate vascular narrowing, if clinically warranted,\ncorrelation with carotid ultrasound is advised.\n\nThere are no osseous lytic lesions. Small, bilateral, nonhemorrhagic pleural\neffusions with adjacent relaxation atelectasis. Degenerative changes\nthroughout the visualized portions of the cervical and thoracic spine. Focus\nof heterotopic ossification posterior to the spinous processes of C4 and C5\nlikely reflects prior injury.", + "output": "1. Soft tissue density mass causing significant tracheal narrowing just above\nthe carina is of unclear etiology. The differential includes an extrinsic\nsoft tissue tumor, a blood clot within the tracheal lumen, or an endotracheal\ntumor. Recommend comparison with prior imaging, if available, for further\nevaluation.\n2. No evidence of a tracheoinnominate fistula.\n3. No stenoses or dissection in the neck vasculature.\n\nRECOMMENDATION(S): Soft tissue density mass causing significant tracheal\nnarrowing just above the carina is of unclear etiology. The differential\nincludes an extrinsic soft tissue tumor, a blood clot within the tracheal\nlumen, or an endotracheal tumor. Recommend comparison with prior imaging, if\navailable, for further evaluation.\n\nNOTIFICATION: The findings were discussed with Dr. ___ by Dr. ___ on\nthe telephone on ___ at 4:50 ___, 2 minutes after discovery of the\nfindings." + }, + { + "input": "This study is somewhat limited secondary to patient motion artifact. There is\nno evidence of acute infarction, hemorrhage, edema, or mass. Prominent\nventricles and sulci are consistent with age-related involutional change.\nPeriventricular white matter hypodensities are consistent with chronic small\nvessel ischemic disease. No osseous abnormalities seen. The paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "Study is somewhat limited secondary to patient motion artifact. Allowing for\nthis limitation, there is no acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no acute fracture. There are small mucous retention cyst in the\nbilateral maxillary sinuses, and there is mucosal thickening of the bilateral\nethmoid air cells. The mastoid air cells and middle ear cavities are clear. \nThe visualized portion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass. Periventricular, subcortical and deep white matter hyperintensities are\nlikely sequelae of chronic small vessel ischemic disease. There is prominence\nof the ventricles and sulci suggestive of involutional changes.\n\nNo brainstem lesions are identified, within the confines of CT technique.\n\nIncidentally noted incompletely characterize is apparent prominence of the\npituitary gland which measures approximately 1 cm in SI dimension (series\n305b, image 36), larger than would be expected for patient's gender and age.\n\nThere is no evidence of fracture. Mild mucosal thickening of the right\nmaxillary sinus, and posterior right ethmoidal air cells are noted. Small\nright sphenoid mucous retention cyst is noted. The additional visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically, no\nlarge intracranial mass or lesion to explain patient's symptoms.\n2. Apparent enlargement of the pituitary gland, incompletely characterized on\nnoncontrast head CT. Clinical correlation and if indicated and not\ncontraindicated, MRI pituitary with without contrast could be performed for\nfurther evaluation.\n3. Chronic changes as described above.\n4. Of note MR with contrast is more targeted towards the assessment of AV\nmalformation and subtle mass lesions.\n\nRECOMMENDATION(S): Apparent enlargement of the pituitary gland, incompletely\ncharacterized on noncontrast head CT. Clinical correlation and if indicated\nand not contraindicated, MRI pituitary with without contrast could be\nperformed for further evaluation." + }, + { + "input": "There is no evidence of acute major vascular territory\ninfarction,hemorrhage,edema,or effect mass. Enlargement of the pituitary with\na superiorly convex margin is again noted, similar compared to prior exam from\n___. The ventricles and sulci are normal in size and configuration.\n\nSoft tissue swelling and a subgaleal hematoma is seen in the right frontal\nscalp. There is no underlying fracture. There is a mucous retention cyst in\nthe right sphenoid sinus. There is partial opacification in the right\nposterior ethmoid air cells. Otherwise, the remaining visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nPatient is status post lens resections.", + "output": "1. Soft tissue swelling and a subgaleal hematoma is seen in the right frontal\nscalp. Otherwise, no acute intracranial abnormalities.\n2. Mild paranasal sinus disease, as above.\n3. Pituitary gland appears enlarged as seen in ___. Underlying pituitary\nadenoma would be possible." + }, + { + "input": "There is a hairline left temporal bone fracture which extends inferiorly into\nthe squamous portion of the temporal bone, greater wing of the sphenoid,\nsphenoid body and dorsum sella of the sphenoid (03: 7, 8, 17, 30). Equivocal\nfracture line is also seen extending to the petrous portion of the left\ntemporal bone (03: 11). Small locules of subcutaneous emphysema are\ndemonstrated along the fracture line tract.\n\nPunctate foci of intracranial air are seen adjacent to the dorsum sellae\n(03:16). Small high attenuating foci in the right temporal lobe are\nconcerning for intracranial hemorrhage, and measure up to 6 mm (2:10, 602:14).\n\nNo evidence of infarction. The ventricles and sulci are normal in size and\nconfiguration.\n\nHigh attenuating fluid in the bilateral sphenoid sinuses is compatible with\nhemosinus. There is moderate opacification of the left-sided mastoid air\ncells. Bilateral middle ear cavities are clear. The visualized globes are\nunremarkable.", + "output": "1. Hairline left temporal bone fracture with extension into the sphenoid body\nand dorsum sella with associated trace pneumocephalus and small volume\nintraparenchymal hemorrhage in the right temporal lobe.\n2. Equivocal fracture line extending to the petrous portion left temporal\nbone. Further evaluation with temporal bone CT may be considered if\nclinically indicated.\n3. High attenuating fluid in the bilateral sphenoid sinuses is compatible with\nhemorrhage.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 4:01 am, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "Left :\nAgain seen is a nondisplaced fracture through the left temporal calvarium with\nadjacent small volume pneumocephalus, incompletely visualized at its superior\naspect on the current study. The fracture cleft extends inferiorly through\nthe squamous portion of the temporal bone and greater wing of the sphenoid. \nAlthough the sphenoid body fracture is better identified on the prior bone\nalgorithm head CT, fracture clefts through the dorsum sella are again noted,\nwith punctate foci of adjacent pneumocephalus. An additional nondisplaced\nlongitudinal temporal bone fracture cleft component is noted, which appears to\nspare both the otic capsule and carotid canal, exiting at the posterior aspect\nof the left temporomandibular joint. The previously questioned fracture cleft\nextending into the petrous portion of the left temporal bone is not clearly\nidentified on the current study.\n\nThere is partial opacification of left mastoid air cells compatible with acute\nblood products. High attenuation layering fluid within the bilateral sphenoid\nsinuses may reflect acute blood products.\n\nBlood products are noted within the left external auditory canal. A trace\namount of blood is noted within the middle ear cavity adjacent to the inner\naspect of the tympanic membrane. The ossicles appear intact.\n\nThere is no evidence for enlarged vestibular aqueduct or superior semicircular\ncanal dehiscence. The facial nerve follows a normal course through the middle\near. There is no evidence for inner ear dysplasia.\n\n\nRight:\nThe external auditory canal is normal. The middle ear cavity is clear. The\nossicles and tegmen are intact. There is no evidence for enlarged vestibular\naqueduct or superior semicircular canal dehiscence. The facial nerve follows a\nnormal course through the middle ear. There is no evidence for inner ear\ndysplasia. The mastoids are clear.\n\n\nOther:\nSmall foci of intraparenchymal hemorrhage noted within the right temporal lobe\nare better identified on previous CT head.", + "output": "1. Nondisplaced fracture involving the left temporal calvarium with small\nvolume underlying pneumocephalus, with fracture close extending inferiorly\nalong the squamous portion of the temporal bone and greater wing of the\nsphenoid. Although the sphenoid body fracture is better identified on the\nprior bone algorithm head CT, fracture clefts through the dorsum sella are\nagain noted, with punctate foci of adjacent pneumocephalus. An additional\nnondisplaced longitudinal temporal bone fracture cleft component is noted,\nwhich appears to spare both the otic capsule and carotid canal, exiting at the\nposterior aspect of the left temporomandibular joint.\n2. Partial opacification of left mastoid air cells compatible and high\nattenuation layering fluid within the bilateral sphenoid sinuses compatible\nwith acute blood products.\n3. Blood products are noted within the left external auditory canal. A trace\namount of blood is noted within the middle ear cavity adjacent to the inner\naspect of the tympanic membrane. The ossicles appear intact.\n4. Small foci of intraparenchymal hemorrhage noted within the right temporal\nlobe are better identified on previous CT head.\n\nNOTIFICATION:\n The findings were discussed with ___, M.D. by ___, M.D.\non the telephone on ___ at 6:07 am, 5 minutes after discovery of the\nfindings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\n6 mm focus of high density in the right temporal lobe appears stable compared\nto prior and is suspicious for brain contusions. An adjacent 3 mm peripheral\nfocus of high attenuation may represent an additional site of intraparenchymal\nhemorrhage, and was not definitely seen on prior exam. Previously described\nsmall volume pneumocephalus is better evaluated on prior CT head. No evidence\nof infarction. The ventricles are normal in size and configuration. Known\ntemporal bone fractures are better assessed on dedicated temporal bone\nperformed on the same day. Bilateral sphenoid hemosinus is unchanged.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.", + "output": "1. Re-demonstrated are multiple right temporal lobe brain contusions.\n2. No evidence of infarction or masses.\n3. No evidence of arterial dissection.\n4. Temporal bone fractures are better assessed on recent CT scan." + }, + { + "input": "Re demonstrated is an endotracheal tube and enteric tube both in appropriate\nposition. A large hypopharyngeal hematoma, with associated extensive edema\nand swelling of soft tissues of the neck has slightly improved compared to the\nprior exam. Discontinuity of the right thyroid cartilage is suspicious for a\nminimally displaced fracture. Heterogeneous attenuation of the thyroid gland\nis again suspicious for a laceration, particularly in the context of the\npatient's trauma.\n\nThere is no cervical lymphadenopathy. The visualized parotid, and\nsubmandibular glands appear to be unremarkable. Extensive facial fractures\nare re- demonstrated and better characterized on the recent CT of the face\nfrom the prior day.\n\nPleural effusion and adjacent consolidation, likely secondary to atelectasis,\nincreased compared to the prior exam. Extensive bony degenerative changes are\nre- demonstrated.", + "output": "1. Interval improvement in the large hypo pharyngeal hematoma, with\nassociated extensive edema and swelling of the soft tissues.\n\n2. Discontinuity of the right thyroid cartilage is again suspicious for a\nminimally displaced fracture.\n\n3. Heterogeneity of the thyroid gland is concerning for a laceration,\nparticularly context of patient's trauma.\n\n4. New small pleural effusion and atelectasis in the right lung apex.\n\nNOTIFICATION: ___ were d/w Dr. ___ by Dr. ___ by phone at 1p\non the day of the exam by phone." + }, + { + "input": "There is no significant interval change in the left subdural hematoma along\nthe left middle cranial fossa. There is no shift of the midline structures. \nMildly prominent ventricles and sulci is likely related to age related\ninvolutional changes. The extent of the subgaleal hematomas are also\nunchanged compared to the prior exam.\n\nRe demonstrated are multiple facial fractures, including a comminuted fracture\nof the right maxillary sinus involving the right orbital floor and right\nzygomatic arch fracture as well as the right sphenoid fracture, better\nevaluated on the recent facial bone CT from the day prior. There has been\nslight interval increase in fluid opacification involving the sphenoid sinus,\nand left maxillary sinus.", + "output": "1. No significant interval change in the left subdural hematoma along the\nleft middle cranial fossa.\n\n2. Multiple facial fractures, better characterized on the recent facial CT. \nIncreased fluid opacification involving the sphenoid and left maxillary\nsinuses." + }, + { + "input": "There is a small acute left cerebral subdural hematoma along the left temporal\nlobe in the middle cranial fossa (60___: 45-47). Subdural hematoma measures\nup to 7 mm in thickness resulting in no significant mass effect or herniation.\nBasal ganglia calcifications are identified. The basal cisterns are patent. \nLeft posterior scalp hematoma and laceration noted with prominent bifrontal\nsoft tissue swelling and hematoma.\n\nPartially imaged right facial bone fractures are better assessed with\ndedicated CT of the facial bones. Blood is seen within the right maxillary\nsinus with fractures along the right orbital floor.", + "output": "1. Small left cerebral subdural hematoma. No significant mass effect.\n\n2. Multiple right facial fractures partially imaged. Please refer to\nsame-day dedicated facial bone CT for further details.\n\n3. Significant soft tissue swelling and laceration overlying the left\nparietotemporal region and soft tissue swelling in the frontal/ periorbital\nregion.\n\nNOTIFICATION: These findings were communicated via telephone and in person by\nDr. ___ Dr. ___ to Dr. ___ attending, at the time of\ndiscovery." + }, + { + "input": "Compared with the prior CT, the left subdural hematoma along the left middle\ncranial fossa is unchanged (601b:45). There is no shift of normally midline\nstructures. Bilateral basal ganglia calcifications are again seen. No\nretrobulbar hematoma is identified.\n\nPlease refer to the CT maxillofacial and CT C-spine studies from earlier on\nthe same date for description of the sinuses and osseous structures.", + "output": "1. Stable small left subdural hematoma. No midline shift or herniation.\n\n2. Please refer to the dedicated CT maxillofacial and CT C-spine studies from\nearlier on the same date for further findings." + }, + { + "input": "The carotid and vertebral arteries and their major branches are patent with no\nevidence of stenoses. There is mild calcified plaque seen at the carotid\nbifurcations without significant stenosis by NASCET criteria. No evidence for\ndissection is seen.\n\nThe distal right ICA measures 3.8 mm and the distal left ICA measures 3.9 mm.\n\nAn endotracheal tube and a enteric tube are visualized. There is a large\nhypopharyngeal hematoma with associated extensive edema and swelling of the\nsoft tissues of the neck again seen. Discontinuity of the right thyroid\ncartilage again noted and felt suspicious for fracture. There are partially\nvisualized fractures involving the right zygomatic arch and right maxillary\nsinus also again noted. Please see dedicated facial bone CT for further\ninformation. The thyroid gland is again noted to appear heterogeneous in\nattenuation suspicious for laceration given the history of trauma.", + "output": "No evidence of arterial dissection or stenosis. No active extravasation of\ncontrast.\n\nLarge hypo pharyngeal hematoma with associated soft tissue swelling. \nDiscontinuity of the adjacent right thyroid cartilage to suspicious for\nfracture.\n\nHeterogeneous appearance of the right thyroid gland suspicious for a\nlaceration given history of trauma." + }, + { + "input": "There is no acute intracranial hemorrhage, acute infarction, mass or midline\nshift. There is no hydrocephalus. Mild prominence of the sulci and ventricles\nsuggesting mild atrophy is unchanged. Mild periventricular white matter\nhypodensities likely are the sequelae of chronic small vessel ischemic\ndisease. Visualized paranasal sinuses and mastoid air cells are clear. There\nis no fracture.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territory infarct. Prominence of ventricles\nand sulci is slightly greater than expected for patient age, similar to the\nprior study. Subtle periventricular and subcortical white matter\nhypodensities likely sequela of chronic small vessel disease. Slight\nasymmetry of the frontal horns is stable. There is no hydrocephalus. The\nvisualized paranasal sinuses demonstrate minimal mucosal thickening in ethmoid\nair cells. The remainder the partially imaged paranasal sinuses are clear.. \nThe mastoid air cells are clear. No acute fracture is seen.", + "output": "No acute intracranial hemorrhage.\n\nNOTIFICATION:\nNo acute intracranial hemorrhage." + }, + { + "input": "Of note, the study is somewhat limited by motion artifact. There is a small\nnondisplaced transverse acute fracture in the left mastoid portion of the\ntemporal bone and opacification of the left mastoid air cells. The ossicles\nappear grossly in appropriate alignment. Right mastoid air cells are clear.\nComplex fluid is seen layering in the left sphenoid sinuses. There is a\nmoderate subarachnoid hemorrhage seen in the left temporo-frontal parietal\nregion. A small amount of subdural bleed is seen layering along the anterior\nleft falx. It is difficult to exclude a contusion in the bilateral inferior\nfrontal lobes.\n\nThere is no shift of normally midline structures, or evidence of acute major\nvascular territorial infarction. Ventricles and sulci are normal in overall\nsize and configuration.", + "output": "1. Nondisplaced acute transverse fracture in the left mastoid portion of the\ntemporal bone and left mastoid air cell opacification. Moderate left sided\nsubarachnoid hemorrhage, involving the left temporofrontal parietal regions.\n2. Small acute subdural hematoma along the anterior left falx.\n3. It is difficult to exclude a contusion in the bilateral inferior frontal\nlobes.\n\nNOTIFICATION: left temporal cortex." + }, + { + "input": "Since the prior study, there has been interval development of a large left\nhemispheric intraparenchymal hemorrhage spanning approximately 4.8 x 7.0 cm,\nwith extensive surrounding edema and exerting severe mass effect upon adjacent\nstructures. There is approximately 11 mm of rightward midline shift which is\nnew since the prior study. Massive extension of left frontal subarachnoid\nhemorrhage now includes the all of the ventricles as well as the suprasellar\nand quadrigeminal plate cisterns. New smaller foci of subarachnoid and\nintraparenchymal hemorrhage are also noted along the gyrus rectus bilaterally.\nA low-density left frontal subdural collection is also new (03:23), but\nremains hypodense.\n\nSphenoid sinus air-fluid levels and opacification of the nasopharynx is likely\nrelated to intubation. On the left the mastoid air cells remain with partial\nopacification (see roots 03:12), the study is partially limited due to patient\nmotion, however no significant changes are demonstrated the previously noted\nnondisplaced temporal bone fracture involving the left mastoid area.", + "output": "1. Interval development of a large left frontal intraparenchymal hemorrhage\nand widespread extension of subarachnoid hemorrhage since the prior study.\n2. Rightward midline shift of 11 mm.\n3. Grossly unchanged nondisplaced left temporal bone fracture.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with ___\n___ (neuro surgery NP) on the telephoneon ___ at 8:37 ___, 5 minutes\nafter discovery of the findings." + }, + { + "input": "Again seen is an evolving area of intraparenchymal hemorrhage in the left\nhemisphere measuring approximately 6.5 x 4.3 cm with surrounding vasogenic\nedema, previously 7.0 x 4.8 cm, slightly decreased in size. There is\nsignificant mass effect with 12 mm rightward shift of midline structures,\npreviously 10 mm. There is complete effacement of the left lateral ventricle,\nsimilar to before. There is minimal increase in size of the right lateral\nventricle.\n\nThere is an area of intraparenchymal hemorrhage in the inferior right frontal\nlobe that has increased in size since the prior study, now measuring 3.5 x 1.6\ncm, previously 1.0 cm. Other areas of intraparenchymal hemorrhage in the\ninferior bifrontal regions appear more conspicuous since the prior study.\n\nSubarachnoid blood filling the basal cisterns and the third and fourth\nventricles appears much less conspicuous since the prior study. The\nlow-density left frontal subdural collection is also less conspicuous. \nRemaining areas of subarachnoid blood along the cerebral convexities also\nappear less conspicuous since the prior study.\n\nThere is no evidence of fracture. Air-fluid level is seen within the left\nsphenoid sinus, increased since the prior study. Remaining visualized\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Interval increase in size of the intraparenchymal hemorrhage in the\ninferior right frontal lobe measuring 3.5 x 1.6 cm, previously 1.6 cm.\n2. Slight interval decrease in size in the left intraparenchymal hemorrhage. \nPersistent 12 mm rightward shift midline structures.\n3. Interval decrease in the subarachnoid blood within the basal cisterns and\nalong the cerebral convexities.\n4. Minimal increase in size of the right lateral ventricle." + }, + { + "input": "Head CT: No intra or extra-axial mass, acute hemorrhage or infarct. Sulci,\nventricles and cisterns are within expected limits. The gray-white\ndifferentiation is preserved. There is a small mucous retention cyst in the\nleft maxillary sinus. Under pneumatization of the left frontal sinus is noted.\nOtherwise, the visualized paranasal sinuses are essentially clear. The orbits\nare unremarkable. The mastoid air cells and middle ear cavities are well\npneumatized and clear.\n\nHead CTA and CTV: The intracranial ICA, ACA, MCA and their major branches are\nunremarkable. The posterior circulation is also unremarkable, noting a left\ndominant vertebral artery. There are no intracranial aneurysms larger than 2\nmm. There is no evidence of venous sinus or cavernous sinus thrombosis.\n\nNeck CTA: There is a 3 vessel arch. The carotid and vertebral arteries and\ntheir major branches are patent with no evidence of stenoses. There is no\nevidence of internal carotid stenosis by NASCET criteria.\n\nOther: The lung apices are clear. There is no cervical lymphadenopathy by CT\nsize criteria. The aerodigestive tract is unremarkable. Thyroid gland is\nunremarkable. The submandibular and parotid glands are unremarkable. No\nsuspicious osseous abnormalities.", + "output": "1. No evidence of acute intracranial hemorrhage or infarct. Previously noted\npunctate enhancing foci with diffusion-weighted hyperintense signal on MRI\nperformed earlier in the day are too small to be characterized on CT\nexamination.\n2. No evidence of sinus venous thrombosis or cavernous sinus thrombosis.\n3. Unremarkable CTA of the head and neck. No evidence of aneurysms,\ndissection or stenosis." + }, + { + "input": "There is no evidence of infarction,hemorrhage,edema,or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nThere are extensive bilateral periventricular and subcortical white matter\nhypodensities, nonspecific but compatible with sequelae of chronic small\nvessel ischemic disease.\n\nThere is no evidence of fracture. There is moderate mucosal thickening of the\nright sphenoid sinus and right ethmoid air cells. Otherwise, the visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The patient is status post lens replacement surgery. Otherwise,\nthe visualized portion of the orbits are unremarkable.", + "output": "No evidence of mass, hemorrhage or infarction.\nAtrophy." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. The cerebellar tonsils are\nborderline ectopic.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No evidence of infarction, hemorrhage, edema, or mass.\n2. Borderline ectopic cerebellar tonsils.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. \n___ on the telephone on ___ at 4:09 ___, 220 minutes after the\ndiscovery of the findings." + }, + { + "input": "Hyperdense acute intraparenchymal hemorrhage centered in the right basal\nganglia is minimally changed when accounting for differences in measurement\ntechnique from the CT and ___. Surrounding hypodensity, likely edema is\nmild. Left shift of normally midline structures by about 3 mm is perhaps\nminimally increased. Local mass effect and partial effacement of the right\nlateral ventricle is unchanged. No new focal hemorrhage is identified.\n\nThere is no evidence of fracture. There may be mild polypoid mucosal\nthickening of the partially imaged right maxillary sinus. The remaining\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No significant interval change in the acute right basal ganglia\nintraparenchymal hemorrhage since ___ with 3-mm left shift of normally\nmidline structures.\n\n2. No new focal hemorrhage." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is a roughly 3.1 x 2.3 cm acute intraparenchymal hemorrhage centered in\nthe right posterior limb of the internal capsule, splaying the adjacent\nputamen and thalamus with minimal surrounding edema localized mass effect. \nThis appears to be in on identical area to prior intraparenchymal hemorrhage\nseen on prior examination from ___. There is no evidence of no\nevidence of infarction, or mass. The ventricles and sulci are normal in size\nand configuration.\n\nThere is a moderate mucous retention cyst in the right maxillary sinus. The\nremainder of the visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the orbits\nare unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation.\n\nCTV HEAD:\nThe dural venous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. 3.1 x 2.3 cm acute intraparenchymal hemorrhage centered in the right\nposterior limb of the internal capsule with associated localized mass effect,\nin identical location of prior intraparenchymal hemorrhage in ___.\n2. Patent intracranial vasculature. No aneurysm.\n3. Patent dural venous sinuses.\n4. Patent cervical vasculature. No dissection." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear widely\npatent with no evidence of stenosis or occlusion. Minimal atherosclerotic\nchanges in the carotid bulbs, but there is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No significant carotid or vertebral artery stenosis.\n2. No acute intracranial pathology." + }, + { + "input": "The patient is status post left-sided craniotomy for chronic subdural hematoma\ndrainage. Subfalcine herniation has improved. There is a drain present in the\nleft frontotemporal region. In the region of the prior chronic subdural,\nthere is pneumocephalus and an air-fluid level, with blood products. There is\na small hyperdense region within the area of older blood products (02:16),\ndemonstrating newer blood products in the evacuated region, likely secondary\nto drainage placement. Interval decrease in midline shift from 1.6 cm to 0.7\ncm.\n\nCraniotomy screws in place without evidence of ___ fracture. The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable. \nThere are postsurgical changes in the soft tissue of the left posterior head.", + "output": "1. The patient is status post left-sided craniotomy for drainage of chronic\nsubdural. Improvement in subfalcine herniation.\n2. There postoperative changes, including pneumocephalus, and blood products\nof variable age in the area of the evacuated subdural." + }, + { + "input": "The patient is status post left parietal craniotomy for evacuation of a left\nsubdural hematoma. Significant interval decrease in size of left subdural\nhematoma and pneumocephalus, now with a residual 7 mm thick extra-axial fluid\ncollection, with slightly hyperdense material, compatible with a combination\nof cranioplasty material and likely hemorrhage product. Previously seen\nrightward midline shift has resolved. No significant effacement of the\nunderlying brain parenchyma or the ventricles.\n\nThere is no evidence of acute large territory infarct.\n\nThe sulci, ventricles and cisterns are within expected limits for the\npatient's mild senescent related global cerebral volume loss.\n\nThere is moderate mucosal thickening of the left sphenoid sinus and mild\nmucosal thickening of the bilateral frontal sinuses and right sphenoid sinus. \nPartial opacification of multiple ethmoid air cells is noted. The paranasal\nsinus disease has progressed from prior exam. The mastoid air cells and\nmiddle ears are pneumatized and clear. No acute osseous abnormality. The\norbits are unremarkable.", + "output": "1. Significant interval decrease size of left subdural hematoma and\npneumocephalus, now with residual 7 mm thick extra-axial fluid collection with\nslightly hyperdense material compatible with combination cranioplasty material\nand residual hemorrhage product.\n2. No acute intracranial abnormality noncontrast CT head\n3. Interval progression of paranasal sinus disease." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no intra or extra-axial mass effect, acute hemorrhage or large\nterritory infarct. The sulci, ventricles and cisterns are within expected\nlimits for the patient's age. There is unchanged partial empty sella.\n\nThe visualized paranasal sinuses are clear. The orbits are unremarkable.\n\nCTV HEAD:\nThe superior sagittal sinus, the internal cerebral veins, vena ___, straight\nsinus,, bilateral transverse sinuses and sigmoid sinuses as well as visualized\nportions of the internal jugular veins are patent. No evidence of acute\nthrombus identified. An apparent hypodensity along the lateral edge of the\nconfluence of sinuses (series 603, image 17) corresponds to a hypodense focus\non noncontrast head CT (series 2, image 10) and appears to be extraluminal on\nsource images (series 3, image 37) and is not consistent with acute thrombus. \nFurthermore, this hypodensity can be seen on prior CT head of ___.", + "output": "1. No evidence of dural venous sinus thrombosis.\n2. Unremarkable noncontrast CT head. No acute large territory infarct or\nintracranial hemorrhage. Unchanged partial empty sella." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, or loss of\ngray/white matter differentiation. Periventricular, deep, and subcortical\nwhite matter hypodensities are similar to the prior CT, nonspecific but\ncompatible with sequela of chronic small vessel ischemic disease in this age\ngroup. Age-related parenchymal volume loss is again seen with prominent\nventricles and sulci.\n\nThere is no evidence of fracture. There is evidence of left cataract surgery.\nThere are mucous retention cysts and mild mucosal thickening in the partially\nvisualized right maxillary sinus, and partially visualized polypoid mucosal\nthickening and in the included portion of the left maxillary sinus. There is\nmild mucosal thickening in the ethmoid air cells, as well as within the left\nfrontal sinus along the septum. Mastoid air cells and middle ear cavities\nappear grossly well-aerated.", + "output": "1. No evidence for acute intracranial abnormalities. Stable appearance of the\nbrain compared to ___.\n2. Paranasal sinus disease." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nPeriventricular and subcortical white matter hypodensities are nonspecific but\nlikely represent sequela of chronic small vessel ischemic disease and are\nunchanged from prior. More focal hypodensity in the body of the caudate on\nthe right is suggestive of a prior lacunar infarct, also unchanged.\n\nThere is no evidence of fracture. There is mild mucosal thickening in the\nright maxillary sinus. Otherwise, the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are normal.\n\nCTA HEAD:\nA persistent left trigeminal artery ___ type 1) is noted, an anatomic\nvariant. There is an asymmetrically expanded left cavernous sinus with\napparent fusiform dilatation of the left internal carotid artery cavernous\nsegment. Although exact measurement of luminal caliber is difficult on this\nexam secondary to adjacent venous contamination within the cavernous sinus,\nthe tubular enhancement within the left cavernous sinus measures up to\napproximately 7 mm. No dilated veins are noted in the area to suggest\narteriovenous fistula. The intradural segments of the bilateral internal\ncarotid arteries appear normal in course and caliber. The remaining vessels\nof the circle of ___ and their principal intracranial branches appear\nnormal without stenosis, occlusion, or additional aneurysm. The dural venous\nsinuses are patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. An increased number of subcentimeter\nshort axis cervical lymph nodes are seen bilaterally. There is no\nlymphadenopathy by CT size criteria.", + "output": "Head CT:\n\n1. Normal head CT.\n\nHead CTA:\n\n1. Persistent left ___ type 1 trigeminal artery.\n2. Expansion of the left cavernous sinus with apparent fusiform dilatation of\nthe left internal carotid artery cavernous segment. Although exact\nmeasurement of luminal caliber is limited by adjacent venous opacification\nwithin the cavernous sinus, the tubular enhancement within the left cavernous\nsinus measures up to 7 mm. No nearby dilated veins are identified.\n3. An MRA of the head would be helpful to distinguish arterial from venous\nenhancement within the cavernous sinus and to better evaluate the presumed\ncavernous ICA aneurysm.\n4. The intradural segments of the bilateral internal carotid arteries appear\nnormal in course and caliber.\n5. The remaining vessels of the circle of ___, including the intradural\nsegments of the bilateral ICAs, appear normal without stenosis, occlusion, or\nadditional aneurysm.\n\nNeck CTA:\n\n1. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection.\n\nRECOMMENDATION(S):\nAn MRA of the head would be helpful to distinguish arterial from venous\nenhancement within the cavernous sinus and to better evaluate the presumed\ncavernous ICA aneurysm." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. There\nis prominence of the ventricles and sulci suggestive of involutional changes.\n\nA mucous retention cyst is noted within the left maxillary sinus. \nAdditionally, layering fluid is noted within the bilateral maxillary sinuses,\nethmoid air cells, sphenoid sinuses, and there is partial to near complete\nopacification of the bilateral middle ear cavities and mastoid air cells. The\nfrontal sinuses are clear. The visualized portion of the orbits are normal. \nThere appears to be a chronic deformity involving the visualized portions of\nthe right temporomandibular joint (4:4).", + "output": "1. No evidence of infarction or hemorrhage.\n2. Partial to near complete opacification of the bilateral middle ear cavities\nand mastoid air cells, with additional layering fluid within the bilateral\nmaxillary sinuses, ethmoid air cells, sphenoid sinuses.\n3. Chronic deformity is noted involving the right temporomandibular joint." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. There\nis prominence of the ventricles and sulci suggestive of involutional changes. \nNo change in configuration of the cavum septum pellucidum with lateral bowing\nof the leaflets.\n\nThere is continued partial opacification of the sphenoid sinus, left maxillary\nsinus mucous retention cyst, and opacification of the mastoid air cells and\nmiddle ear cavities. The fluid layering in the maxillary sinuses seen\npreviously appears improved. Chronic deformity of the right temporomandibular\njoint is again noted. Support tubes are in place, partially imaged.", + "output": "1. No large acute vascular territory infarct or hemorrhage. Paranasal sinus\ndisease appears improved. Otherwise, no significant change compared to prior" + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass effect.\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Cavum septum pellucidum variant is demonstrated with bowing of the\nleaflets, unchanged from prior.\n\nA left maxillary mucous retention cyst is demonstrated. There is improvement\nof opacification of the right sphenoid sinus. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are normal.", + "output": "Limited study due to motion. No acute intracranial abnormality." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Prominence of the ventricles and sulci are compatible with age\nappropriate global atrophy. Ill-defined periventricular and subcortical white\nmatter hypodensities are nonspecific but likely due to the sequela of chronic\nischemic small vessel changes. Minimal mucosal thickening is seen the left\nmaxillary sinus. Mastoid air cells and middle ear cavities are well aerated.\nThe bony calvarium is intact. There is soft tissue swelling and hematoma\nnoted at the right vertex of the head.", + "output": "No acute intracranial process. Soft tissue swelling and a small hematoma is\nnoted at the right vertex of the head." + }, + { + "input": "Patient is status post right frontal craniotomy for resection of a olfactory\ngroove meningioma. There is associated mild extra-axial blood along the right\nfrontal lobe and in the resection cavity at the inferior right frontal lobe. \nThere is associated pneumocephalus in the bilateral frontal lobe and pockets\nof air in the resection cavity. Again seen is edema within the right frontal\nlobe, similar to prior. There is no midline shift. There is diffuse sulcal\nand bilateral lateral ventricle effacement. No evidence of large territory\ninfarction.\n\nThere is subcutaneous air and swelling of the right frontal scalp along the\ncraniotomy site. The visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. Status post right frontal craniotomy for resection of an olfactory groove\nmeningioma with associated postoperative pneumocephalus, mild extra-axial\nblood, as well as sulcal and lateral ventricle effacement.\n2. No evidence of large territorial infarction." + }, + { + "input": "There is no evidence of large territorial infarction, hemorrhage, edema, or\nmass effect. The ventricles and sulci are normal in size and configuration.\nThere are left-sided basal ganglia calcifications. No osseous abnormalities\nseen. The paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is an acute left frontal subdural hematoma measuring up to 11 mm from\nthe inner table as well as an acute right occipitoparietal subdural hematoma\nmeasuring up to 11 mm from the inner table. There is also subdural blood\nlayering along the falx and the right tentorium cerebelli. There is an old\nlacunar infarct of the right caudate head as well as in the left thalamus.\nProminent ventricles in sulci suggest age related global atrophy. Note is\nmade of cavum septum pellucidum. The basal cisterns appear patent and there\nis preservation of gray-white matter differentiation.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. There has been bilateral lens surgery.", + "output": "1. Acute bilateral subdural hematomas measuring up to 11 mm from the inner\ntable.\n\n2. Old lacunar infarcts in the right caudate head and left thalamus.\n\nNOTIFICATION: Findings were discussed with Dr. ___ by Dr. ___ telephone\nat 8:35 ___ on ___, 10 minutes following discovery." + }, + { + "input": "Expected evolution of blood products within acute left frontal extra-axial\ncollection measuring up to 11 mm (previously 11 mm) from the inner table. \nSubdural blood is seen layering along the falx in the right tentorium\ncerebella measuring up to 10 mm, (previously 10 mm) unchanged since previous\nexamination. An old lacunar infarct in the right caudate head as well as the\nleft thalamus are stable. The ventricles are notable for anatomical\nvariation, consistent septum cavum pellucidum et vergae, and again appear\nprominent as well as the sulci likely consistent with age-related cortical\nvolume loss. The basal cisterns are patent.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are notable for bilateral lens\nreplacement.", + "output": "1. Stable acute right-sided subdural hematoma and left frontal extra-axial\ncollection measuring up to 11 mm from the inner table, unchanged from ___.\n2. Old lacunar infarcts in the right caudate head and left thalamus." + }, + { + "input": "Since head CT from 1 day prior, there has been no significant interval change.\nLeft frontal extra-axial collection measures approximately 11 mm in greatest\nwidth (series 2, image 25), unchanged. Subdural hemorrhage layering along the\nright tentorium, also not largely changed. No new hemorrhage is identified. \nA chronic right caudate head lacunar infarct is again seen. Anatomic\nventricular variant, cavum septum pellucidum, again noted. Prominence of the\nventricles and sulci likely related to cerebral atrophy. The basal cisterns\nremain patent. There is no significant shift of midline structures.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable. There are\ncalcifications of the carotid siphons bilaterally.", + "output": "No interval change to right-sided subdural hematoma and left frontal\nextra-axial collection as compared to CT from 1 day prior. No new areas of\nhemorrhage identified." + }, + { + "input": "Compared to head CT from 1 day prior, there is no significant and interval\nchange in left frontal extra-axial collection and right-sided acute on chronic\nsubdural hematoma layering along the right parietal and occipital convexities\nand the right tentorium. No new hemorrhage seen. No significant shift of\nmidline structures. Ventricles and sulci unchanged in size and configuration.\nMild cerebral atrophy again seen. A right chronic lacunar infarct is\nidentified. Additional hypodensity within the left cerebellum, also\nunchanged.\n\nNo osseous abnormalities seen. Left maxillary mucous retention cysts again\nseen. The paranasal sinuses are otherwise clear. The orbits are\nunremarkable.", + "output": "No significant interval change in right sided subdural hematoma left frontal\nextra-axial collection as compared to 1 day prior. No new areas of hemorrhage\nidentified.\n\nDOSE: CTDI: 53 mGy\nDLP: 1003 mGy-cm" + }, + { + "input": "Again seen are multiple extra-axial fluid collections. The acute on chronic\nright subdural hematoma is again identified layering dependently along the\nright parietal and occipital convexities and the right tentorium, not\nappreciably changed in appearance in comparison to prior study. The smaller\nleft frontal hyperdense extra-axial--likely subdural--hematoma is also\nunchanged in size and appearance since prior study. There are no new foci\nhemorrhage. There is no evidence of acute infarction.\n\nChronic lacunar infarcts in the superior right caudate head and the left\nthalamic head are again seen (series 4, image 20). A hypodensity in the\noccipital lobe posterior to the occipital horn of the left lateral ventricle\nis unchanged from multiple prior studies (series 4, images 14 and 15),\npossibly sequela of prior infarct, age-indeterminant. An additional\nhypodensity in the left cerebellar hemisphere is also stable from multiple\nprior exams (series 4, image 9). Periventricular and subcortical white matter\nhypodensities are compatible with the sequelae of chronic small vessel\nischemia. Mild prominence of the ventricles and sulci is unchanged,\ncompatible with global involutional change. Cavum septum pellucidum is again\nnoted. The paranasal sinuses mastoid air cells are clear. The patient is\nstatus post bilateral lens removal, otherwise the globes and bony orbits are\nunremarkable.", + "output": "1. Stable right parieto-occipital acute on chronic subdural hematoma and left\nfrontal hyperdense extra-axial (likely subdural) hematoma. No new foci of\nhemorrhage or acute infarction.\n2. Chronic lacunar infarcts in the right caudate head, left thalamus, and left\ncerebellar hemisphere.\n3. Stable left occipital hypodensity, possibly representing infarct of\nindeterminate age." + }, + { + "input": "In comparison to the most recent CT on ___, there has been interval\ndecrease in size of the extra-axial hematomas along the right\nparieto-occipital and left frontal lobes. This results in mild sulcal\neffacement and mass effect on the posterior aspect of the right lateral\nventricle, which is unchanged. No shift of midline structures. No new\nhemorrhage. The old lacunar infarct in the left thalamus is re-demonstrated. \nLeft occipital and cerebellar hypodensities are again noted (3: 10,17), which\nmay represent prior infarcts. No evidence of major vascular territory\ninfarction. Unchanged appearance of enlarged ventricles and sulci, suggesting\nparenchymal atrophy. Bilateral periventricular, subcortical and deep white\nmatter hypodensities are non-specific but likely a sequela of chronic small\nvessel ischemic disease.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "Interval decrease in size of extra-axial hematomas along the right\nparieto-occipital and left frontal lobes. No new hemorrhage." + }, + { + "input": "There is no hemorrhage, edema, or mass effect. Ventricles and sulci are age\nappropriate in size and configuration. There is no shift of normally midline\nstructures. Basal cisterns are patent. Gray-white matter differentiation is\npreserved.\n\nThe orbits are unremarkable. Imaged paranasal sinuses, bilateral mastoid air\ncells, and middle ear cavities are clear. Moderate calcifications involve the\ncarotid siphons bilaterally.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute large territory infarction, hemorrhage, edema,\nor mass. The ventricles and sulci are normal in size and configuration.\n\nNo acute osseous abnormalities seen. There is complete opacification of the\nleft maxillary sinus, complete opacification of the right anterior ethmoid air\ncells and near complete opacification of the right frontal sinus, as well as\nmild mucosal thickening of the right maxillary sinus. There is mild\nhyperostosis of the maxillary sinus walls suggestive of chronic inflammation. \nThe mastoid air cells and middle ear cavities are clear. Multiple periapical\nlucencies are noted involving several maxillary teeth suggestive of\nperiodontal disease. The orbits are unremarkable.", + "output": "1. No acute intracranial abnormalities.\n2. Paranasal sinus disease, likely chronic, and most severe in the left\nmaxillary sinus.." + }, + { + "input": "There is no evidence of acute vascular territorial\ninfarction,hemorrhage,edema,or discrete mass. There is prominence of the\nventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. There is soft tissue swelling overlying the\nleft frontal bone and maxilla. There is opacification of the left frontal\nsinus, multiple left ethmoid air cells, in the left maxillary sinus. There is\nmild mucosal thickening of the right maxillary sinus, and several right\nmaxillary air cells. The visualized portion of the remaining paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. There are multiple periapical\nlucencies seen along bilateral maxillary teeth concerning for period.", + "output": "1. No acute intracranial abnormality.\n2. Soft tissue swelling overlying the left frontal bone and maxilla without\nevidence of underlying fracture.\n3. Severe left paranasal sinus disease and mild right paranasal sinus disease.\nPlease refer to same-day CT facial bones for further details." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. Unchanged, complete opacification of the\nleft maxillary sinus, left frontal sinus and the ethmoid air cells on the\nleft. Of note, there is high-density material within the left maxillary sinus\nwhich can be seen with inspissated mucus or fungal colonization. Moderate\nmucosal thickening and a small mucous retention cyst are noted in the right\nmaxillary sinus. The mastoid air cells are clear. A left maxillary molar and\na right maxillary incisor (series 2, image 4) demonstrate periapical\nlucencies, unchanged. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Unchanged extensive paranasal sinus and odontogenic disease. High density\nmaterial within the left maxillary sinus can be seen in the setting of\ninspissated mucus or fungal colonization." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nloss of gray/white matter differentiation.\n\nThere is no evidence of acute fracture.\n\nThere is persistent complete opacification of the left frontal sinus, left\nanterior ethmoid air cells and left maxillary sinus with partial hyperdense\nmaterial, which may represent inspissated mucus or fungal colonization. Left\nostiomeatal unit and left frontoethmoidal recess remain occluded. Moderate to\nsevere opacification of the right maxillary sinus with mucosal thickening and\nmucous retention cysts has increased compared to ___. The right\nostiomeatal unit is narrowed by mucosal thickening but not completely\noccluded. Hyperostosis of the bilateral maxillary sinus walls and of the\nfrontal septum is again noted, indicating sequela of chronic inflammation. \nThere is mild mucosal thickening in the right anterior ethmoid air cells,\nright frontoethmoidal recess, and right frontal sinus.\n\nMultiple bilateral maxillary periapical lucencies are again noted, image 8:1. \nAgain seen is a small defect in the left maxillary sinus floor at the level of\na molar periapical lucency, image 9:33.\n\nMastoid air cells and middle ear cavities are well aerated. The orbits are\nunremarkable on noncontrast CT.", + "output": "1. No acute intracranial process.\n2. Worsening severe paranasal sinus disease. High-density material is again\nseen in the left maxillary sinus, which may represent inspissated mucus or\nfungal colonization, however, there is no evidence of invasion.\n3. Persistent odontogenic disease.\n\nRECOMMENDATION(S):\n1. No evidence for acute intracranial hemorrhage or other acute intracranial\nabnormalities.\n2. Unchanged appearance of chronic left frontal, anterior ethmoid, and\nmaxillary sinusitis, with complete opacification with partially hyperdense\nmaterial, compatible with inspissated secretions versus fungal colonization.\n3. Increased moderate to severe opacification of the right maxillary sinus\nwith mucosal thickening and mucous retention cysts, but no evidence for fluid\nto definitively indicate acute inflammation.\n4. Multiple bilateral maxillary periapical lucencies are again noted, with\nunchanged small defect in the left maxillary sinus floor at the level of a\nmolar periapical lucency. Correlation with dental exam would be needed to\nexclude active infection/inflammation." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nThere is near complete opacification of all paranasal sinuses noted with\nadjacent bony sclerosis, and areas of high density. There is expansion of\nbilateral maxillary sinus infundibula. There is obstruction of bilateral\nostiomeatal complexes. Bilateral superior and middle nasal turbinates are\nsurrounded by soft tissue, with near complete opacification of the mid and\nposterior nasal cavity.\n\nDefect of the right maxillary sinus posterior wall with soft tissue extension\ninto retroantral fat is noted (see 02:32). Evaluation the lamina papyracea\nand cribriform plates are limited secondary to extensive paranasal sinus\ndisease.\n\nLeft globe probable drusen is seen (see 05:122). Soft tissue density is noted\nwithin the right external auditory canal, which may represent cerumen.", + "output": "1. Dental amalgam streak artifact limits study.\n2. Extensive pansinus disease with findings concerning for chronic and/or\nfungal sinusitis, and polyposis.\n3. Focal defect of right maxillary sinus posterior wall with retroantral fat\nsoft tissue extension, concerning for invasive fungal sinusitis, with\ndifferential consideration of chronic wall defect.\n4. Left globe probable drusen. While finding is nonspecific, it may be seen\nin the setting of macular degeneration.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 08:49 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." + }, + { + "input": "Evaluation is limited secondary to artifact and evaluation for small subdural\ncollections is non-diagnostic. Within limitation of the study there is no\nevidence of acute large territorial infarct, edema, hemorrhage or mass. There\nare age-related involutional changes, similar to prior.\n\nThere is no evidence of fracture. There is thickening of the anterior\nethmoidal air cells. The middle ear cavities and mastoid air cells are clear.\nThe orbits are unremarkable.", + "output": "Markedly limited study secondary to artifact. No acute intracranial\nabnormality detected, although evaluation for small subdural collection should\nbe considered non-diagnostic." + }, + { + "input": "There is a hypodensity within the left thalamus compatible with a subacute\ninfarct (see series 2b, image 15). There is suggestion of hypodensity within\nthe mid brain, though evaluation of this area is limited by streak artifact.\nNot clearly assessed (series 2b, image 12).\n\nThere is no acute intracranial hemorrhage or mass effect. Mildly prominent\nventricles and sulci suggest age related global atrophy. Periventricular white\nmatter hypodensities are nonspecific but likely sequelae from chronic small\nvessel ischemic disease. The basal cisterns appear patent and there is\npreservation of gray white matter differentiation.\n\nNo osseous abnormalities seen. There is mucosal thickening and aerosolized\nsecretions within the right maxillary sinus, as well as mucosal thickening in\nthe right maxillary sinus, ethmoid air cells, and the sphenoid sinuses. The\nmastoid air cells and middle ear cavities are clear. The visualized portion of\nthe orbits are preserved.", + "output": "1. Subacute infarct in the left thalamus.\n2. Possible midbrain additional area of subacute infarct, however evaluation\nof this area is limited secondary to streak artifact. Recommend clinical\ncorrelation.\n3. Paranasal sinus disease as described. Correlate clinically with signs of\nacute sinusitis." + }, + { + "input": "Head CTA: Minimal atherosclerotic calcifications of the carotid siphons are\nnoted. Otherwise, the ICA, ACA, MCA and their major branches are unremarkable.\n\nThere is a filling defect of the distal basilar artery, extending to the\nbilateral P1 segments (series 2, image 233 through 245) compatible with\nthrombus, which also severely narrows the origins of the bilateral superior\ncerebellar arteries. There is reconstitution of the posterior cerebral\narteries starting at the mid P1 segments.\n\nThe intracranial vertebral arteries are unremarkable.\n\nUnchanged in appearance from outside CT head is a region of left thalamic\nhypodensity, compatible with acute infarct without evidence of spot sign.\n\nNeck CTA: There is a 3 vessel arch. Atherosclerotic calcification of the\naortic arch is noted. Abscess calcification of the left subclavian artery\norigin is noted. Otherwise, the bilateral common carotid, vertebral and\nsubclavian arteries are unremarkable. Minimal atherosclerotic plaque of the\nleft common carotid artery is noted. There is no cervical internal carotid\nartery stenosis by NASCET criteria. Incidental note is made of retropharyngeal\ncourses of the bilateral cervical internal carotid arteries.\n\nOther: Allowing for respiratory motion artifact, the lung apices are grossly\nclear. The thyroid glands are unremarkable. There is no cervical\nlymphadenopathy by CT size criteria. The submandibular and parotid glands are\nalso unremarkable. The aerodigestive tract is unremarkable.\n\nMultiple mandibular and maxillary dental caries with periapical lucencies are\nnoted. No periodontal abscess. There is polypoid mucosal thickening of the\nmaxillary sinuses as well as mild mucosal thickening of the inferior aspects\nof the frontal sinuses extending to the frontoethmoidal recesses. Mild mucosal\nthickening of the sphenoid sinuses are noted. The orbits are unremarkable. The\nmastoid air cells and middle ear cavities are well pneumatized and clear. No\nsuspicious blastic or lytic osseous lesions.", + "output": "1. Intraluminal filling defect of the distal basilar artery extending to the\ntip and proximal P1 segments, highly concerning for thrombus, with\nreconstitution distally at the level of the mid P1 segments. The superior\ncerebellar arteries are also narrowed at its origins, with distal\nreconstitution.\n2. The remainder of the intracranial circulation demonstrates no evidence of\nstenosis or aneurysm.\n3. Allowing for anatomic variations and atherosclerotic disease, essentially\nunremarkable CTA of the neck.\n4. Unchanged appearance of left thalamic infarct.\n5. Additional findings described above." + }, + { + "input": "There is a 3.5 x 2.0 x 1.7 cm hyperdense lesion with surrounding edema in the\nright cerebellar hemisphere (2:10, 4:54, 5:38). While this may represent an\nintraparenchymal hemorrhage, an underlying hemorrhagic mass is not excluded on\nthe basis of this study. Compared with the outside hospital study of ___, this has enlarged. There is mild mass effect upon the right aspect of\nthe quadrigeminal plate cistern (2:10). There is no shift of normally midline\nstructures. The remaining basal cisterns are patent. Large area of\nencephalomalacia involving the right MCA territory is compatible with known\nold right MCA stroke. Ventricles and sulci are prominent, compatible with age\nrelated volume loss. Periventricular and subcortical white matter\nhypodensities are compatible with chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. Small mucosal retention cyst in the right\nmaxillary sinus, and mild bilateral maxillary sinus mucosal thickening is\npresent. The visualized portion of the remaining paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. 3.5 cm hyperdense lesion with surrounding edema in the right cerebellar\nhemisphere. While this may represent an intraparenchymal hemorrhage, as\nprovided in the history, an underlying hemorrhagic mass is not excluded. \nThere is mild mass effect upon the right aspect of the quadrigeminal plate\ncistern. No shift of normally midline structures. Compared with the outside\nhospital study of ___, this lesion has slightly enlarged.\n\n2. Extensive encephalomalacia involving the right MCA territory, compatible\nwith known prior infarction.\n\nNOTIFICATION: The above findings were communicated via telephone by Dr.\n___ to ___, NP (neurosurgery) at 22:37 on ___, 2 min\nafter discovery. Currently, the patient cannot receive an MRI tonight, as\nthere is not yet clearance for his pacemaker." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Unchanged, periventricular white-matter hypodensities are\nnonspecific, but likely reflect chronic microvascular ischemic changes. \nStable, large area of encephalomalacia involving the right MCA territory is\ncompatible with known, old right MCA stroke. 1.4 x 2.7 cm focal hyperdensity\nin the right cerebellar hemisphere with a surrounding hypodense rim,\nconsistent with edema, appears unchanged and exerts stable, mild mass effect\nupon the right quadrigeminal plate cistern. There is no midline shift.\n\nMucous retention cysts within the right maxillary sinus. Otherwise, the\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nare without stenosis, occlusion, or aneurysm formation. There is\ncalcification of the cavernous and supraclinoid portions of the internal\ncarotid arteries bilaterally. The dural venous sinuses are patent.\n\nCTA NECK:\nStudy is limited by streak artifact from a right-sided pacemaker. The carotid\nand vertebral arteries and their major branches appear patent. There is\nbilateral vertebral artery calcification. There is approximately 50% stenosis\nof the proximal right internal carotid artery just distal to the bifurcation.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. Comminuted, impacted fracture through the left humeral neck.", + "output": "1. Approximately 50% stenosis of the proximal right ICA just distal to the\nbifurcation.\n2. Stable hyperdensity in the right cerebellar hemisphere.\n3. Comminuted, impacted left humeral neck fracture.\n\nNOTIFICATION: The findings were discussed with ___ by ___\non the telephone on ___ at 2:09 ___, 10 minutes after discovery of the\nfindings." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or infarction.\nProminent ventricles and sulci suggests age related involutional changes. \nAreas of hypodensity in cerebral white matter are consistent with small vessel\nischemic disease. An area of encephalomalia in the left caudate suggests a\nprior chronic infarct. The basal cisterns appear patent and there is\npreservation of gray-white matter differentiation.\n\nNo fracture is identified. Aerosolized secretions are seen in the bilateral\nmaxillary sinuses with wall thickening and volume loss suggesting chronic\ninflammatory disease. Mucosal thickening is seen in the ethmoid air cells.\nOtherwise, the visualized paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. Cavernous carotid and vertebral arteries are heavily\ncalcified. A subcutaneous nodule along the right occiput measures 11 x 9 mm\n(2:7).", + "output": "1. No acute intracranial process.\n\n2. Findings consistent with chronic inflammatory disease of maxillary\nsinuses.\n\n3. Enlarged right occipital lymph node.\n\n4. Marked vascular calcification." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\n\nArtifact at the skullbase limits interpretation. Within this limitation,\nthere is no evidence of hemorrhage, edema, mass effect, or acute infarction. \nThere is mild mucosal thickening in the left maxillary sinus. The remaining\nparanasal sinuses are clear. Postsurgical changes related to left\nmastoidectomy are noted. The right mastoid air cells are clear. The orbits\nare unremarkable.\n\n\nCTA NECK:\nThere is a 3 vessel aortic arch. There are mild atherosclerotic\ncalcifications along the aortic arch, but the ostia of branch vessels are\nwidely patent. There is partially calcified atherosclerotic plaque at the\ncarotid bifurcations bilaterally without narrowing. The carotid and vertebral\narteries and their major branches appear normal with no evidence of stenosis\nor occlusion. There is no evidence of internal carotid stenosis by NASCET\ncriteria.\n\nCTA HEAD:\nAtherosclerotic calcifications are seen along the cavernous portion internal\ncarotid arteries bilaterally, left greater than right, without significant\nstenosis. The vessels of the circle of ___ and their principal\nintracranial branches appear normal without stenosis, occlusion, or aneurysm\nformation. The dural venous sinuses are patent.\n\nOTHER:\nEvaluation of the upper lungs is limited by respiratory motion artifact and\nimaging during expiration. Within this limitation, there is no suspicious\npulmonary nodule or consolidation. The thyroid and salivary glands are within\nnormal limits. There is no lymphadenopathy by CT size criteria. Old anterior\nleft second rib fracture is noted.", + "output": "1. No hemorrhage, edema, mass effect or acute infarction.\n\n2. Mixed plaque at the carotid bifurcations bilaterally without stenosis by\nNASCET criteria.\n\n3. Atherosclerotic calcifications along the cavernous portion of the internal\ncarotid arteries bilaterally, left greater than right, without significant\nstenosis. Otherwise, unremarkable head CTA." + }, + { + "input": "There is no evidence of large territorial infarction, acute intracranial\nhemorrhage, edema, or mass. There is prominence of the ventricles and sulci,\nas seen on the prior MRI. Periventricular and white matter hypodensities are\nlikely due to demyelinating plaques described on the prior MR.\n\n___ is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. There is a\nleft-sided prosthetic globe.", + "output": "1. No acute intracranial hemorrhage.\n\n2. Periventricular white matter hypodensities are nonspecific, but likely due\nto demyelinating plaques as described on the prior MR." + }, + { + "input": "There is no evidence of large territorial infarction, hemorrhage, edema, or\nmass. There is stable cortical volume loss, age advanced. Periventricular\nwhite matter hypodensity is most likely represents demyelinating plaques as\nseen on prior examinations. No osseous abnormalities seen. There is mild\nethmoidal sinus mucosal thickening. bony abnormality is noted, unchanged the\nprior examinations. A left-sided prosthetic globe is noted.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of major vascular territorial infarction, hemorrhage,\nedema, or mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Extensive bilateral periventricular and subcortical\nwhite matter hypodensities are nonspecific, but likely a sequela of chronic\nsmall vessel disease.\n\nNo definite acute fracture. Extensive bony irregularities of the frontal and\nethmoidal sinuses with surgical material and fracture fragments demonstrating\nwell corticated margins are noted. There is complete opacification of\nresidual frontal sinuses. The visualized portion of the mastoid air cells,\nand middle ear cavities are clear. There is a prosthetic globe on the left.", + "output": "1. No evidence of acute intracranial hemorrhage.\n2. Findings suggestive of remote frontoethmoidal sinus fracture and subsequent\nrepair. Please note that evaluation for subtle acute fracture is limited\nsecondary to extensive postsurgical change. If clinically indicated, consider\ncorrelation with available prior imaging.\n3. Left orbit prosthetic globe.\n4. Nonspecific complete opacification of residual frontal sinuses.\n5. Atrophy and probable small vessel ischemic changes as described." + }, + { + "input": "There is no evidence of fracture, hemorrhage, edema, mass effect or\ninfarction. The ventricles and sulci are normal in size and configuration.\nThe visualized paranasal sinuses and mastoid air cells are clear.", + "output": "Normal study." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. The ventricles and sulci are mildly prominent consistent with\nage-related involutional changes. Bilateral maxillary nasal retention cysts\nnoted. The remaining imaged paranasal sinuses are clear. Mastoid air cells\nand middle ear cavities are well aerated. The bony calvarium is intact. Mild\nsoft tissue swelling seen overlying the right frontal calvarium.", + "output": "No evidence of acute hemorrhage." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, or acute major\nvascular territorial infarction. Ventricles and sulci are age-appropriate in\nsize.\n\nNo concerning bone lesion is seen. Again seen are small mucous retention\ncysts within the maxillary sinuses.", + "output": "No evidence for an acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute fracture, gross hemorrhage, edema, or definite\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. There is no abnormal enhancement on post contrast\nimages.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\nThe orbits appear unremarkable without retrobulbar hematoma or signs of globe\nrupture.", + "output": "1. Unremarkable left orbit.\n2. No acute intracranial abnormalities, though evaluation for subtle\nintracranial hemorrhage is limited due to presence of intravenous contrast.\n3. No definite intracranial mass. However, evaluation for mass is limited on\nthe current modality. If there is continued clinical concern, obtain head\nMRI." + }, + { + "input": "Skin staples in the anterior neck at the level of the thyroid cartilage is\nnoted. There is subcutaneous emphysema bilaterally, extending along the\nsagittal planes, most prominently seen posterior to the sternocleidomastoid\nmuscle on the right at the level of the thoracic inlet (series 8, image 76)\nand extending to the level of the hyoid bone on the right (series 8, image\n58), compatible with known penetrating injury. There is diffuse subcutaneous\nstranding and edema of the left neck, resulting in mild rightward deviation of\nthe airway without significant narrowed.\n\nThere is contour deformity of the left anterior thyroid cartilage (series 8,\nimage 70), of uncertain chronicity. Otherwise, the vocal cords, laryngeal\nventricles and piriform sinuses are symmetric and unremarkable on limited\nnoncontrast assessed. Salivary glands are also unremarkable on limited\nnoncontrast assessment. Thyroid gland is unremarkable.\n\n The visualized lung apices are clear. There is no suspicious blastic or lytic\nosseous lesions. The partially visualized paranasal sinuses are clear. The\norbits are unremarkable on noncontrast assessment. The mastoid air cells and\nmiddle ear cavities are well pneumatized and clear.", + "output": "1. Sequela of bilateral penetrating injuries and postsurgical changes in the\nanterior neck.\n2. Contour abnormality of the left anterior thyroid cartilage may be\nposttraumatic, but its acuity is uncertain. Otherwise unremarkable appearance\nof the larynx on noncontrast assessment.\n3. The airway is mildly deviated to the right, but not significantly narrowed,\nby edema along the left internal jugular vein and left carotid artery. The\nvessels are not assessed in the absence of intravenous contrast.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 10:00am, at the time of initial\nreading." + }, + { + "input": "There is no evidence of hemorrhage, edema, or mass effect. Gray/white matter\ndifferentiation is preserved. The ventricles and sulci are normal in size.\nNo osseous abnormalities are seen. The visualized paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear.", + "output": "Unremarkable unenhanced CT head without evidence acute intracranial\nabnormalities." + }, + { + "input": "There is no evidence of infarction,hemorrhage,edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nright maxillary sinus and bilateral ethmoid air cells. The visualized portion\nof the remaining paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "Mild paranasal sinus inflammatory changes. Otherwise normal study.." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect or\nlarge territorial infarction. The ventricles and sulci are quite prominent\nsimilar to the prior study suggesting age-related atrophy. Periventricular\nwhite matter hypodensities may reflect chronic microvascular ischemic disease.\nThe basal cisterns are patent. Gray-white matter differentiation is preserved.\n\nThere is no fracture. The included paranasal sinuses, mastoid air cells and\nmiddle ear cavities are clear. There are atherosclerotic calcifications of the\ncavernous internal carotid arteries.", + "output": "There acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, mass, edema or large\nvascular territorial infarction. Prominent ventricles and sulci are likely\nsecondary to age related involutional changes. A hypodensity within the right\ncaudate head reflects a prior lacunar infarct (series 2: Image 16).\n\nNo fracture is identified. The visualized paranasal sinuses, mastoid air\ncells and middle ear cavities are clear. The globes are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. Mild periventricular\nsubcortical white matter hypodensities are nonspecific, but likely reflect\nsequelae of chronic small vessel ischemic disease. The basal cisterns appear\npatent and there is preservation of gray-white matter differentiation.\nNo osseous abnormalities seen. There is mild mucosal thickening in the\nbilateral maxillary sinuses as well as the ethmoid air cells. The remaining\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear.\nAtherosclerotic calcifications of the bilateral carotid siphons are noted.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. Focal hyperdensity in the\nleft temporal lobe likely represents artifact from partial volume averaging\n(3a:5).\n\nNo osseous abnormalities seen. The bilateral mastoid air cells are opacified,\nleft more than right, which is new from the prior study and likely secondary\nto intubation. The orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. New opacification of the bilateral mastoid air cells are likely secondary\nto intubation." + }, + { + "input": "There is no evidence of territorial infarction,intracranial\nhemorrhage,edema,or mass. The ventricles and sulci are normal in size and\nconfiguration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Unremarkable noncontrast head CT, there is no evidence of acute\nintracranial process or hemorrhage." + }, + { + "input": "A surgical drain terminates within a heterogeneous collection which measures\napproximately 3.6 x 3.2 x 3.9 cm, and is felt to correspond to the known\nLudwig's angina. As compared to outside CT, there has been a decrease in the\nsize of the central fluid area with continued extensive edema and swelling. \nEvaluation of the aerodigestive tract is otherwise grossly unremarkable. The\nright submandibular gland is normal. There appears to be a involvement of the\nleft submandibular gland within this collection.\n\nThe neck vessels are patent.\n\nThere are new diffuse ground-glass opacities involving the bilateral lung\napices. The thyroid gland is normal.", + "output": "1. There is a drain at the surgical site and near complete resolution of the\nhypodense fluid component of the abscess. There is extensive surrounding\nedema and tissue induration, similar to the prior examination.\n2. New diffuse ground-glass opacities involving the lung apices bilaterally,\nconcern for a new infectious process in the lungs.\n\nRECOMMENDATION(S): The findings were discussed with Dr. ___. by\n___, M.D. on the telephone on ___ at 6:33 AM, 5 minutes\nafter discovery of the findings." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nThe imaged mastoid air cells and middle ear cavities are well aerated. \nLimited evaluation the nasal bones, but there is no evidence of fracture. \nLeft sphenoid sinus aerated mucosal thickening is present.", + "output": "1. No acute intracranial hemorrhage.\n2. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct.\n3. Paranasal sinus disease as described." + }, + { + "input": "There is a persistent small amount of subarachnoid hemorrhage in the right\nprecentral sulcus and in left superior frontal sulci. Small focus of\nextra-axial hyperdensity along the left frontal convexity on image 3:20\nprobably represents bone related artifact, given its location within an\ninvagination of the inner table, versus another focus of extra-axial, probably\nsubdural hemorrhage. Otherwise, no new hemorrhage is seen. An area of right\nfrontal encephalomalacia is re- demonstrated with mild ex vacuo dilatation of\nthe frontal horn of the right lateral ventricle. The ventricles and sylvian\nfissures are overall mildly prominent, likely due to age-related parenchymal\ninvolutional change.\n\nThere are right post craniectomy and cranioplasty changes and a surgical clip\nsuggesting anterior communicating artery aneurysm clipping. Visualized\nparanasal sinuses and mastoid air cells are grossly well-aerated.", + "output": "Unchanged small amount of subarachnoid hemorrhage in the right precentral\nsulcus and left superior frontal sulci. Small focus of extra-axial\nhyperdensity along the left frontal convexity within an invagination of the\ninner table probably represent bone related artifact, versus another focus of\nextra-axial, probably subdural hemorrhage. Otherwise, no evidence of new\nhemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, or edema. There is prominence\nof the ventricles and sulci suggestive of involutional changes. 6 mm\ncalcified focus at the inner table of the right temporal bone (04:15) could\nrepresent a small bony excrescence or a calcified meningioma, of doubtful\nclinical significance.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "The right maxillary sinus is almost completely opacified. Right maxillary\ndental implants extend into the sinus. The right ostiomeatal complex is\npatent. The left maxillary sinus appears clear. The left ostiomeatal complex\nis patent. There is mild mucosal thickening in the ethmoid air cells\nbilaterally. The sphenoid and frontal sinuses appear clear. The nasal septum\nis deviated to the left with a spur.\n\nThe cribriform plates are intact. The lamina papyracea are intact.", + "output": "1. Near complete opacification of the right maxillary sinus.\n2. Minimal ethmoid sinus mucosal thickening.\n3. No evidence of bone destruction." + }, + { + "input": "There is no acute intracranial hemorrhage, edema, mass effect or loss of gray/\nwhite matter differentiation. The ventricles, basal cisterns, and see sulci\nare normal in size and configuration for the patient's age. All components of\nthe left lateral ventricle a larger than the right, as before, suggesting\ncongenital/developmental etiology. The imaged paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. There is no fracture.", + "output": "No evidence for an acute intracranial abnormality." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nacute major vascular territorial infarction. Ventricles, sulci, and basal\ncisterns are normal in size.\n\nNo evidence for suspicious bone lesions. Paranasal sinuses and mastoid air\ncells are well aerated. The orbits appear unremarkable.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent. There is calcified\nand noncalcified atherosclerotic plaque along the bilateral common carotid\nartery bifurcations and origins of the internal carotid arteries resulting in\napproximately ___ stenosis of the left ICA origin and ___ stenosis of\nthe right ICA origin by NASCET criteria.\n\nSmall focus of calcified plaque is noted along the V4 segment of the left\nvertebral artery without significant narrowing. Right vertebral artery\nappears widely patent.\n\nCTA HEAD:\nThere is an irregular, incompletely occlusive linear filling defect in the\ndistal left transverse sinus extending to the proximal aspect of the sigmoid\nsinus (series 7 images 232-251), concerning for thrombosis. There is a 4 mm\novoid nonocclusive filling defect in the superior sagittal sinus on image\n7:309, which may represent an arachnoid granulation versus a small focus of\nnonocclusive thrombus.\n\nThere are mild atherosclerotic calcifications along the bilateral cavernous\nICA without flow-limiting stenosis. No flow-limiting stenosis is seen\nelsewhere in the major intracranial arteries. No clear evidence for arterial\nirregularity or beading to suggest vasculitis or vasospasm. No evidence for\nan aneurysm or arteriovenous malformation.\n\nCTP:\nCBF <30% volume = 0\nTmax >6.0s volume = 0\nMismatch volume = 0\nMismatch ratio = none\n\nOTHER:\nThere is respiratory motion artifact throughout the lungs, causing mosaic\nattenuation. The visualized portion of the thyroid gland is unremarkable. \nThere is no lymphadenopathy by CT size criteria.", + "output": "1. Irregular, incompletely occlusive filling defect in the distal left\ntransverse sinus extending to the proximal aspect of the left sigmoid sinus,\nconcerning for thrombosis. Additional 4 mm ovoid nonocclusive filling defect\nin the superior sagittal sinus, which may represent an arachnoid granulation\nversus nonocclusive thrombus.\n2. No evidence for intracranial flow-limiting stenosis, vasculitis, vasospasm,\naneurysm, or arteriovenous malformation.\n3. Mild atherosclerosis of bilateral proximal internal carotid arteries with\napproximately ___ stenosis on the left and approximately ___ stenosis on\nthe right by NASCET criteria.\n4. No acute hemorrhage or evidence for an acute major vascular territorial\ninfarction on noncontrast head CT. MRI would be more sensitive for further\nevaluation.\n5. Unremarkable CT perfusion study.\n\nNOTIFICATION: Preliminary report including the concern for left transverse\nsinus thrombosis discussed with ___, M.D. by ___, M.D.\non the telephone on ___ at 11:57 pm, 5 minutes after discovery of the\nfindings. MRI and cerebral angiography were subsequently performed." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is approximately a 6 x 5 cm intraparenchymal hemorrhage in the right\nfrontotemporal parietal lobes with surrounding vasogenic edema, increased in\nsize compared to prior exam. Small amount of subarachnoid hemorrhage in the\nright cerebral hemisphere is unchanged. There is also interval increase of the\nfocal hemorrhage in the right basal ganglia now measuring up to 1.2 cm,\npreviously 7 mm.\n\nThere is associated near complete effacement of the right lateral ventricle\nand approximately 1.2 cm of right-to-left midline shift with subfalcine\nherniation. There is effacement of the right cerebral sulci. There is\ncompensatory dilatation of the occipital horn of the left lateral ventricle.\nThere is minimal effacement of the suprasellar and ambient cisterns.\n\nThere is encephalomalacia in the left frontoparietal lobes and left\ncerebellum. There is partial opacification of the ethmoid sinuses. Mild\nopacification of the right maxillary sinus. Postsurgical changes of bilateral\nlens replacement.\n\nCTA HEAD:\nThere are mild atherosclerotic calcifications of the parasellar internal\ncarotid arteries. There is a bulbous appearance of the terminal right carotid\nartery from which the right A1 and right M1 segments arise. Otherwise, the\nvessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThere is a common origin of the right brachiocephalic and left common carotid\narteries, a normal anatomic variant. There are extensive atherosclerotic\ncalcifications of the aortic arch. Mild-to-moderate atherosclerotic\ncalcifications of the great vessel origins.\n\nThere are mild atherosclerotic calcifications of the common carotids and\ncommon carotid bifurcations. Otherwise, the carotidandvertebral arteries and\ntheir major branches appear normal with no evidence of stenosis or occlusion.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Slight interval increase in theintraparenchymal hemorrhage in the right\nfrontotemporal parietal lobes with surrounding vasogenic edema.\n2. Near complete effacement of the right lateral ventricle and right cerebral\nsulci with approximately 1.2 cm of right-to-left midline shift with subfalcine\nherniation.\n3. Small amount of subarachnoid hemorrhage in the right cerebral hemisphere is\nunchanged.\n4. Mild atherosclerotic calcifications of the parasellar internal carotid\narteries, common carotid arteries, and common carotid bifurcations.\n5. Patent circle of ___ with no evidence of focal stenosis or aneurysm\nformation.\n6. Patent cervical carotid and vertebral arteries with no evidence of focal\nstenosis or aneurysm formation." + }, + { + "input": "There has been interval increase in size of the right temporoparietal\nhemorrhage, now measuring approximately 6.2 x 4.0 cm, previously 5.5 x 4.0 cm.\nThere is continued associated vasogenic edema as well as a subarachnoid\ncomponent along the right hemispheric convexity. The focal hemorrhage in the\nright basal ganglia is similar in size, measuring 1.2 cm. There is increased\nmass effect as evidenced by effacement of the right hemispheric sulci, right\nlateral ventricle, uncal herniation and leftward midline shift of\napproximately 1.7 cm, previously 1.2 cm. There has been slight interval\nincrease in size in the left lateral ventricle, particularly the occipital\nhorn. No new foci of hemorrhage are identified.\n\nRe-demonstrated is encephalomalacia of the left parietal lobe and left\nposterior cerebellum.\n\nThere is no evidence of fracture. There is increased opacification of the\nright maxillary sinus. Otherwise, the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable aside from bilateral lens replacement.", + "output": "1. Interval increase in size in the right temporoparietal hemorrhage now\nmeasuring approximately 6.2 x 4.0 cm, previously 5.5 x 4.0 cm. No new foci of\nhemorrhage are identified. The change in size could also be related to\ndifferences in angulation and slice selection. Can be assessed on further\nfollow-up.\n2. Interval increase in mass effect, now with approximately 1.7 cm of\nleftward midline shift, previously 1.2 cm.\n3. Interval increase in size in the left lateral ventricle.\n\nNOTIFICATION: The findings were discussed with ___, N.P. by\n___, M.D. on the telephone on ___ at 9:45 am, 10 minutes\nafter discovery of the findings." + }, + { + "input": "There is no acute intracranial hemorrhage, acute major vascular territory\ninfarction, or mass effect. The ventricles and sulci are normal in size for\nage. Bifrontal extra-axial spaces and extra-axial spaces in the posterior\nfossa are mildly prominent, indicating parenchymal volume loss. Scattered foci\nof supported white matter hypodensity are nonspecific, most likely sequela\nchronic small vessel ischemic disease in a patient of this age.\n\nNo suspicious lytic or sclerotic bone lesions are seen. There are small mucous\nretention cysts in several bilateral anterior ethmoid air cells. Other\nvisualized paranasal sinuses, middle ear cavities and mastoid air cells are\nclear.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. Scattered foci of supported white matter hypodensity are nonspecific, most\nlikely sequela chronic small vessel ischemic disease in a patient of this age,\nalthough edema from small metastases could have a similar appearance. If\nclinically warranted, MRI with and without contrast could be obtained for\nexclusion of intracranial metastatic disease.\n\nNOTIFICATION: Impression item #2 was discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 11:50 AM. Dr. ___ that\nthe patient mental status returned to baseline with correction of dehydration\nand electrolyte abnormalities." + }, + { + "input": "This exam is limited by motion artifact.\n\nNo evidence of large territorial infarction, hemorrhage, edema, or mass\neffect. Bilateral, symmetric prominence of the ventricles and sulci indicates\ncortical volume loss, similar to the prior exam. Bilateral prominence of the\nextra-axial spaces in the bilateral frontal lobe region and posterior fossa is\nalso consistent with global volume loss, similar to the prior exam. Bilateral\nsymmetric periventricular and subcortical white matter hypodensities are\nnon-specific but similar to the prior exam, likely sequelae of chronic small\nvessel ischemic disease.\n\nNo abnormal enhancement on post contrast images. Cavernous internal carotid\nartery calcifications are moderate on the left.\n\nNo evidence of fracture or lytic osseous lesions. The visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\nThe visualized portion of the orbits are unremarkable.", + "output": "1. No enhancing lesions.\n2. Non-specific stable-appearing white matter hypodensities, likely sequelae\nof chronic small vessel ischemic disease.\n3. Mild cortical atrophy, unchanged." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Prominence of the ventricles and sulci is consistent with\ninvolutional changes. Mild periventricular and subcortical white matter\nhypodensities are most consistent with sequela of chronic small vessel\ndisease.. Partially imaged paranasal sinuses demonstrate opacification of a\nsingle right and left ethmoid air cell. The remainder of the partially imaged\nparanasal sinuses are clear. The mastoid air cells and middle ear cavities\nare clear. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. \nPeriventricular and subcortical white matter hypodensities are nonspecific but\nlikely sequelae of chronic small vessel ischemic disease. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of an acute intracranial abnormality. MRI is more sensitive\nfor detection of intracranial metastases.\n2. Chronic ischemic and involutional changes." + }, + { + "input": "Superficial to the right mandible, there is dermal thickening and stranding in\nthe subcutaneous fat (301:123, 301:25). There is no evidence of drainable\nfluid collection. Right cervical lymph nodes are enlarged and likely\nreactive. For example, measuring 8 mm and 6 mm in short axis (301:130,\n301:123). The adjacent osseous structures appear unremarkable. There does\nnot appear to be a periodontal origin to this process. The patient is\nedentulous.\n\nNo fractures are identified. Visualized paranasal sinuses are well aerated.\nBilateral mastoids appear normal.The globes, extraocular muscles, optic\nnerves, and retrobulbar fat appear normal. The visualized upper aerodigestive\ntract appears normal. The mandible and temporomandibular joints appear\nnormal.", + "output": "Cellulitis involving the right cheek adjacent to the right mandible with\nadjacent reactive lymphadenopathy. No drainable fluid collection. No\nevidence of osseous involvement or periodontal origin.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 7:27 pm, 3 minutes after\ndiscovery of the findings." + }, + { + "input": "There is no evidence of acute large territorial infarction, intracranial\nhemorrhage, edema, or mass.\n\nThere is prominence of the ventricles and sulci suggestive of age-related\ncerebral volume loss. Periventricular and subcortical white matter\nhypodensities are nonspecific, though likely sequelae of chronic small vessel\nischemic disease. Atherosclerotic vascular calcifications are noted of\nbilateral cavernous portions of internal carotid arteries.\n\nNo acute osseous abnormalities seen. There are scattered small mucous\nretention cysts within the inter ethmoid air cells. Otherwise, the partially\nimaged paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The orbits demonstrate no acute abnormalities.", + "output": "No acute intracranial process. No evidence of intracranial hemorrhage or\nfracture." + }, + { + "input": "A small to moderate mucous retention cyst in the inferior left maxillary sinus\nis noted. Minimal mucosal prominence along the right inferior maxillary\nalveolar recess is identified. There is mild mucosal thickening along the\nroof of the right maxillary sinus extending to the infundibulum of the\nostiomeatal unit (series 601b, image 55), which is otherwise patent. The left\ninfundibulum is clear. The frontoethmoidal recesses are clear. The ethmoid\nair cells, frontal sinuses and sphenoid sinuses are clear. The sphenoid sinus\nseptum inserts on the right carotid canal.\n\nThe anterior clinoid processes are not pneumatized. There is minimal leftward\ndeviation of the nasal septum, without perforation. The lamina papyracea and\ncribriform plates are intact. There is a small left concha bullosa. Minimal\nprominence of the adenoids, presumably reactive in nature.\n\nThe visualized orbits are unremarkable. The visualized mastoid air cells and\nmiddle ears are well pneumatized and clear. Although the examination is not\noptimized for such evaluation, visualized brain is grossly unremarkable.", + "output": "1. Small to moderate mucous retention cyst in the inferior left maxillary\nsinus with minimal mucosal prominence along the inferior and superior aspects\nof the right maxillary sinus.\n2. There is mucosal thickening of the right infundibulum of the ostiomeatal\nunit, which is otherwise grossly patent.\n3. The remainder the paranasal sinuses are clear.\n4. Small left concha bullosa and additional anatomic findings described above.\n\nNOTIFICATION: The findings were discussed with Dr. ___, M.D. by\n___, M.D. on the telephone on ___ at 3:29 ___, 2 minutes after\ndiscovery of the findings." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nMild soft tissue swelling is noted overlying the left parietal region (02:22).\nThere is no evidence of fracture. Aside from moderate mucosal thickening of\nthe anterior ethmoidal air cells and mild mucosal thickening of the left\nfrontal sinus, the visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "No acute intracranial process. Left parietal scalp swelling without\nunderlying fracture." + }, + { + "input": "There is no evidence of acute infarction,intracranial hemorrhage,edema,or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No evidence of infarction, intracranial hemorrhage, or other acute\nintracranial process." + }, + { + "input": "There is loss of gray-white differentiation and increasing hypodensity in the\nright frontal and temporal lobes with loss of the insular ribbon which appears\nnew from the prior CT performed 5 hours earlier. There is prominence of the\nventricles and sulci suggestive of involutional changes. Periventricular\nwhite matter hypodensities are nonspecific but likely reflect sequela of\nchronic small vessel ischemic disease. No acute intracranial hemorrhage or\nshift of midline structures is present.\nThere is no evidence of fracture. There is a small osseous exostosis off the\nleft frontal bone. There is mucosal thickening in the bilateral maxillary\nsinuses and bilateral frontal sinuses. The remaining visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nThere are dense atherosclerotic calcifications of the internal carotid\nsiphons.", + "output": "Evolving infarct within the left middle cerebral artery territory. No\nevidence of intracranial hemorrhage." + }, + { + "input": "This study is more limited than the prior studies due to severe motion\nartifact. Compared with the prior CT, there is continued loss of gray-white\ndifferentiation increasing hypodensity in the left frontal and temporal lobes,\nwith loss of differentiation at the insular ribbon, consistent with evolving\nleft MCA infarction. No new acute intracranial hemorrhage is identified.\n\nThere is no evidence of fracture. Re demonstration of a small osseous\nexostosis off the left frontal bone. Sulcal thickening in the bilateral\nmaxillary sinuses and frontal sinuses is unchanged. The visualized portion of\nthe remaining paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. Incidental note is made of a 6 mm left frontal osteoma. The\nvisualized portion of the orbits are unremarkable.", + "output": "-Evolving infarct of the left middle cerebral artery territory. No acute\nintracranial hemorrhage." + }, + { + "input": "No acute intracranial hemorrhage, large acute territorial infarct, mass\neffect, or shift of normally midline structures. Periventricular, subcortical\nand white matter hypodensities bilaterally are nonspecific, but suggest\nchronic microvascular infarction. More focal area of hypoattenuation in the\nleft frontal subcortical white matter measuring 3.3 x 2.1 cm is noted (series\n2, image 18). The basal cisterns are patent.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Periventricular and subcortical white matter hypodensities throughout the\nbrain with a more focal pronounced area in the left frontal lobe. Findings\nmay reflect chronic microvascular angiopathy, but difficult to exclude an\nunderlying mass lesion. Recommend correlation with MRI brain with contrast or\nprevious cross-sectional brain imaging.\n2. No acute intracranial hemorrhage." + }, + { + "input": "Focal hypodensity in the left putamen and left caudate head is consistent with\nknown acute left MCA territory infarct. There is no evidence of hemorrhagic\nconversion. There are no areas of intracranial hemorrhage. There is no mass,\nmass effect or shift of midline structures. The ventricles and sulci are\nnormal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Focal hypodensity in the left putamen and left caudate head consistent with\nknown acute left MCA territory infarct.\n2. No evidence of hemorrhagic conversion." + }, + { + "input": "In the left paramedian parietal lobe, again seen is a 2.8 x 2.5 cm\nheterogeneous mass with surrounding vasogenic edema. Compared to prior CT\nhead dated ___, there is mild interval increase in liquefaction of the\nmass and size of the vasogenic edema. The smaller right parietooccipital\nmass, measuring 2.0 x 2.1 cm, is associated with stable vasogenic edema.\nAltogether, there is stable partial effacement of the occipital horn of the\nleft lateral ventricle and no midline shift. No evidence of new mass or\nhemorrhage. No evidence of hernia.\n\nStable chronic bilateral lacunar infarct. Complete fluid opacification of the\nright maxillary sinus. Near complete fluid opacification of the ethmoid air\ncells and left maxillary sinus. Moderate fluid opacification of the sphenoid\nsinus. The visualized portion of the mastoid air cells, and middle ear\ncavities are clear.", + "output": "1. Increased liquefaction and associated edema of the 2.8 cm left paramedian\nparietal mass.\n2. Stable 2.1 cm right parietooccipital mass and associated edema.\n3. No evidence of midline shift or herniation. No evidence of intracranial\nhemorrhage.\n4. Stable pansinusitis." + }, + { + "input": "There is no evidence of fracture, acute large territory\ninfarction,hemorrhage,edema,or mass. There are severe confluent\nperiventricular and subcortical white matter hypodensities which are\nnonspecific but likely represent chronic sequela of small-vessel ischemic\ndisease. There is age appropriate prominence of the ventricles and sulci\nsuggestive of involutional changes.\n\nDensities within the left external auditory canal are likely cerumen. There\nis mild chronic rightward deviation of the nasal septum. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are normal.", + "output": "No acute intracranial hemorrhage or calvarial fracture." + }, + { + "input": "The paranasal sinuses are clear without evidence of mucosal thickening or\nair-fluid levels. The ostiomeatal units are clear. There are bilateral\nHaller cells which appear to mildly narrow the left infundibulum of the\nostiomeatal unit. The cribriform plates and lamina papyracea are intact. The\nnasal septum is near midline without evidence of perforation. There is\npneumatization of the left middle turbinate lamina.\n\nThe orbits are unremarkable. Although not optimized for such evaluation, the\nvisualized brain parenchyma is unremarkable. The mastoid air cells middle\nears are well pneumatized and clear.", + "output": "1. The paranasal sinuses are clear.\n2. Bilateral Haller cells, which appear to mildly narrow the left infundibulum\nof the ostiomeatal unit.\n3. The nasal septum is near midline without evidence of perforation.\n4. Additional findings as described above." + }, + { + "input": "Head CT: There is no evidence of hemorrhage, edema, masses, mass effect, or\ninfarction. The ventricles and sulci are normal in caliber and configuration.\nNo fractures are identified. There is bilateral maxillary sinus mucosal\nthickening. The orbits and mastoid air cell are unremarkable.\n\nHead CTA: The anterior cerebral arteries, middle cerebral arteries, and\nposterior cerebral arteries are normal. There is no evidence of aneurysm,\nvascular malformation, or occlusion within the intracranial vasculature. The\ndural venous sinuses appear patent. Minimal atherosclerotic irregularities\nare noted along the course of the right internal carotid artery distal petrous\nand proximal cavernous segments.\n\nNeck CTA: The left vertebral artery arises directly from the aortic are. The\norigins of the great vessels are patent. The vertebral arteries are codominant\nand patent throughout their course. There is no evidence of stenosis of either\nproximal internal carotid artery by NASCET criteria.\n\nThe lung apices are unremarkable. There is a tiny hypodense right-sided\nthyroid nodule which is unchanged. The submandibular glands and parotid glands\nappear normal. No osseous lesions are seen.", + "output": "1. No evidence of acute intracranial hemorrhage or mass effect.\n2. No evidence of aneurysm, dissection, or occlusion within the vasculature of\nthe head and neck.\n3. Minimal irregularity of right petrous and cavernous internal carotid artery\nsegments as described, which may represent atherosclerotic changes.\n4. Thyroid nodules as described. Recommend clinical correlation. If clinically\nindicated, further evaluation may be obtained via dedicated thyroid\nultrasound.\n5. Paranasal sinus disease as described." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are patent and prominent in keeping with age-related volume loss.\n\nThe pituitary gland appears grossly unremarkable though CT is not an ideal\ntechnique for evaluation of pituitary microadenoma.\n\nThere is intracranial atherosclerotic calcification. Few scattered foci of\nhypodensity in the periventricular and subcortical white matter, nonspecific,\nlikely secondary to small vessel ischemic changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable noting prior cataract surgeries.", + "output": "1. No definite pituitary lesion identified. No macroadenoma seen (CT is not\nthe ideal technique for evaluation of pituitary microadenoma).\n\n2. No acute intracranial abnormality." + }, + { + "input": "There is no hemorrhage, edema, or mass effect. Prominent ventricles and sulci\nreflect age related volume loss. Periventricular and subcortical white matter\nhypodensities are mild, nonspecific, likely sequela of chronic small vessel\nischemia. Gray-white matter differentiation is preserved. There is no shift\nof normally midline structures. Basal cisterns are patent.\n\nThe orbits are unremarkable. Imaged paranasal sinuses demonstrate mild\nmucosal thickening within the right maxillary sinus. Bilateral mastoid air\ncells and middle ear cavities are clear. Carotid siphon vascular\ncalcifications are moderately severe. The bony calvarium appears intact. \nSclerotic focus in the left parietal bone is unchanged (03:58).", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute large vascular territorial\ninfarction,hemorrhage,edema, or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. Periventricular and subcortical\nwhite matter hypodensities are likely sequela of mild chronic small vessel\nischemic changes. Basilar cisterns are patent.\n\nThere is no evidence of fracture, and a sclerotic focus in the left parietal\nbone is stable (series 4:image 30). The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The patient is\nstatus post bilateral lens replacement.", + "output": "1. No acute intracranial abnormality.\n2. Generalized atrophy and chronic small vessel ischemic changes." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nWithin the right anterior temporal lobe is a round rim enhancing lesion\nmeasuring approximately 4.6 x 3.4 cm and demonstrating surrounding vasogenic\nedema involving the right temporal, right frontal and parietal lobes. There\nis associated mass effect on and near complete effacement of the right lateral\nventricle as well as a 9 mm midline shift to the left. There is no evidence\nof intracranial hemorrhage.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe right anterior cerebral artery appears attenuated throughout its length\nwhich may be congenital versus secondary to mass effect from the right\ntemporal lobe mass. There are bilateral persistent fetal origins of the\nposterior cerebral arteries. The intracranial vertebral arteries and basilar\nartery are diffusely small in caliber, likely congenital. In the right\ntemporal region, the vascular structures are displaced by the mass seen on the\nCT and subsequent MRI. The right middle cerebral artery M1 segment is\nelevated with its branches wraps around the mass. 1 of the branch appears to\nbe attenuated likely secondary to involvement by the tumor. A few irregular\narterials and venous structures are seen at the lateral margin of the mass\n(603:19) related to tumor hypervascularity.\n\nCTA NECK:\nThe right ICA demonstrates a retro pharyngeal course. The carotid and\nvertebral arteries and their major branches appear otherwise normal with no\nevidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria. The left vertebral artery arises from the aorta,\na normal variation.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Right anterior temporal lobe 4.6 cm rim enhancing lesion with surrounding\nvasogenic edema resulting and mass effect on and near complete effacement of\nthe right lateral ventricle as well as a 9 mm midline shift to the left.\n2. Displacement of the right middle cerebral artery branches due to the\ntemporal lobe mass with some of the vascular structures appear focally\nnarrowed which could be due to invasion by the tumor. Slightly increased\nvascularity at the lateral aspect of the mass noted. Attenuated right\nanterior cerebral artery throughout its entire length is possibly secondary\nto mass effect from the right temporal lobe mass.\n3. Normal CTA of the neck.\n4. No evidence of intracranial hemorrhage.\n\nNOTIFICATION: The findings were discussed with ___ M.D. By ___\n___, M.D. on the telephone on ___ at 10:07 pm, 1 minutes after\ndiscovery of the findings." + }, + { + "input": "Patient is status post right craniotomy for temporal lobe lesion resection. \nFluid and air is seen within the surgical cavity. A few hyperdense foci\nlining the surgical cavity are compatible with hemorrhage (___). Mild\n1.0 cm leftward midline shift persists with near complete effacement of the\nright lateral ventricle and third ventricle, unchanged since the prior study. \nPneumocephalus is also seen overlying the right frontal lobe. Soft tissue\nswelling and subcutaneous emphysema overlying the right cerebral convexity are\ncompatible with postsurgical changes. Moderate right cerebral sulcal\neffacement and vasogenic edema persist. The imaged paranasal sinuses are\nclear. Mastoid air cells and middle ear cavities are well aerated.", + "output": "1. Status post right temporal lobe resection with postsurgical changes noted\nas above. The surgical cavity contains fluid, air, and a few small foci of\nhemorrhage lining the cavity.\n2. Mild leftward midline shift and moderate sulcal effacement persist.\n3. Complete effacement of the right lateral ventricle and third ventricle\npersist." + }, + { + "input": "There is no evidence of acute large territory infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Mild bilateral periventricular white matter\nhypodensities are nonspecific but likely reflect chronic sequela of\nsmall-vessel ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Chronic punctate calcifications are\nseen about the skin surface of the scalp.", + "output": "1. No acute large territory infarction or intracranial hemorrhage.\n2. No evidence of intracranial mass within the limitations of unenhanced\nstudy.\n3. Global parenchymal atrophy with probable chronic microangiopathic changes." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific but likely reflect the sequelae of chronic\nmicrovascular ischemic disease.\n\nLarge left frontal subgaleal hematoma measures up to 5.5 x 4.4 cm with a\nseparate hyperdense nodular focus measuring up to 1.3 x 1.4 cm (2:18, 601:32).\nNo underlying fracture is identified. A 7 mm hyperdensity in the region of\nthe right posterior ethmoid air cells likely represents an osteoma (3:4). \nThere is mild mucosal thickening with multiple foci of air within the\nposterior right ethmoid air cells and left sphenoid sinus. The visualized\nmiddle ear cavities and mastoid air cells are clear. The visualized portion\nof the orbits are unremarkable. Mild calcified atherosclerotic calcifications\nof the cavernous carotid arteries are noted.", + "output": "1. No acute intracranial abnormality.\n2. Large left frontal subgaleal hematoma measures up to 5.5 cm. No acute\nfractures identified." + }, + { + "input": "There is no acute intracranial hemorrhage, edema, mass effect, or evidence of\nlarge vascular territorial infarction. The ventricles and sulci are normal in\nsize and configuration. There is no fracture. The imaged paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear.", + "output": "Normal CT of the head." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction, mass or midline\nshift. There is no hydrocephalus. Visualized paranasal sinuses and mastoid\nair cells are clear. There is no fracture.", + "output": "No acute intracranial process. No fracture." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect or infarction. The\nventricles and sulci are slightly more prominent since the study ___\nsuggesting progression of age-related atrophy. Mild periventricular white\nmatter hypodensities may reflect chronic microvascular ischemic disease. The\nbasal cisterns are patent. Gray-white matter differentiation is preserved. As\nbefore there is an enlarged and empty sella turcica. There is no shift of\nnormal midline structures.\n\nThere is no fracture. There is decreased size and opacification of the right\nmaxillary sinus similar to the partially imaged sinus and ___. There is\nmucosal thickening in the left sphenoid sinus. There are atherosclerotic\ncalcifications of the cavernous internal carotid arteries and vertebral\narteries.", + "output": "Progression of global atrophy. No evidence of acute intracranial abnormality." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No acute intracranial findings as sequela of trauma." + }, + { + "input": "There is no evidence of calvarial fracture, acute\ninfarction,hemorrhage,edema,or mass. Arachnoid granulations are noted in the\nright occipital bone posteriorly. There is prominence of the ventricles and\nsulci suggestive of involutional changes. There are subcortical and\nperiventricular white matter hypodensities, nonspecific but compatible with\nsequelae of chronic small vessel ischemic disease.\n\nLeft nasal bone fracture and paranasal sinuses are better evaluated on\ndedicated maxillofacial CT. The mastoid air cells and middle ear cavities are\nclear. The patient is status post bilateral lens replacement surgery. \nOtherwise, the visualized portion of the orbits are normal.", + "output": "1. No acute intracranial process. Specifically, no evidence of intracranial\nhemorrhage.\n2. Please refer to the dedicated maxillofacial CT for description of the\nmaxillofacial structures." + }, + { + "input": "SOFT TISSUES: There is mild soft tissue stranding and skin thickening\noverlying the nose bilaterally, left greater than right. No evidence of soft\ntissue hematoma.\n\nMAXILLOFACIAL BONES: There is an acute, comminuted, depressed fracture of the\nleft nasal bone with adjacent foci of subcutaneous air. There is deviation of\nthe bony nasal septum with possible fracture through the anterior aspect of\nthe nasal septum, without evidence of other fracture or nasal septal hematoma.\nThere is layering fluid within the bilateral maxillary sinuses, as well as\nhigh-density fluid within the left nasal cavity and nasal turbinates, which in\nthe setting of trauma likely represents hemorrhage. The zygomatico-maxillary\ncomplex is intact. The lateral pterygoid plates are intact.\n\nMANDIBLE: The mandible is without fracture or temporomandibular joint\ndislocation. The temporomandibular joints are symmetric, without significant\ndegenerative change.\n\nDENTITION: There are no dental fractures. There is no remarkable periodontal\ndisease, periapical lucency, or odontogenic abscess.\n\nORBITS: The patient is status post bilateral lens replacement surgery. \nOtherwise, the orbits, including the laminae papyracea, are intact. The globes\nare intact. There is no intra-ocular hematoma.There is no preseptal soft\ntissue edema. There is no retrobulbar hematoma or fat stranding.", + "output": "Acute, comminuted, depressed fracture of the left nasal bone with likely mild\nto moderate hemosinus and hemorrhage within the nasal cavity/turbinates. \nDeviation of the bony nasal septum with questionable fracture along the\nanterior aspects. No other evidence of nasal septum fracture or hematoma." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute hemorrhage, edema, mass effect, or loss of\ngray/white matter differentiation. Ventricles, sulci, and basal cisterns are\nnormal in size for age.\n\nThere is mild mucosal thickening within the maxillary sinuses and ethmoid air\ncells. The middle ear cavities and mastoid air cells are clear. The orbits\nare unremarkable.\n\nCTA NECK:\nThere is a common origin of the innominate and left common carotid arteries, a\nnormal variant. The carotid and vertebral arteries and their major branches\nappear normal with no evidence of stenosis or occlusion. There is specifically\nno evidence of internal carotid stenosis by NASCET criteria.\n\nCTA HEAD:\nThe major intracranial arteries appear patent without evidence for\nflow-limiting stenosis or aneurysm formation.\n\nCTV HEAD:\nThe dural venous sinuses are patent.\n\nOTHER:\nThe visualized portion of the lungs are clear. There are bilateral thyroid\nnodules measuring up to 0.7 cm. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. Normal CTA of the head and neck. No evidence dural venous sinus\nthrombosis.\n3. Thyroid nodules measuring up to 0.7 cm.\n\nRECOMMENDATION(S): Thyroid nodules. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___. Suspicious findings\ninclude: Abnormal lymph nodes (those displaying enlargement, calcification,\ncystic components and/or increased enhancement) or invasion of local tissues\nby the thyroid nodule. ___, et al, \"Managing Incidental Thyroid Nodules\nDetected on Imaging: White Paper of the ACR Incidental Findings Committee\". J\n___ ___ 12:143-150." + }, + { + "input": "There is no acute intracranial hemorrhage, edema, mass effect, or evidence of\nlarge vascular territorial infarction. Focal hypodensity in the right basal\nganglia is consistent with an old lacunar infarction. Prominence of the\nventricles and sulci is consistent with age-related involutional changes.\nThere are non-specific periventricular and subcortical white matter\nhypodensities which can be seen in patients with chronic small vessel\nischemia. There is no fracture. There are skull base lucencies. There are\naerosolized and likely inspissated secretions in the right maxillary sinus,\nwhich features hyperostotic, retracted walls. The imaged paranasal sinuses,\nmastoid air cells, and middle ear cavities are otherwise clear.", + "output": "1. No acute intracranial abnormality.\n2. Multiple skull base lucencies, along with the abnormalities seen in the\nrest of the skeleton on the other studies performed on the same day, are\nconcerning for a metastatic process.\n3. Findings consistent with chronic right maxillary sinusitis and atelectasis." + }, + { + "input": "Scout imaging demonstrates postsurgical changes related to lower cervical\nspine ACDF.\n\nThere is no evidence of acute major vascular territorial infarction,\nhemorrhage, edema, or mass. The ventricles and sulci are normal in size and\nconfiguration.\n\nThere is no evidence of fracture. The visualized portion of the mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable. Right maxillary sinus mucous retention cyst versus\npolyp is noted.", + "output": "1. No acute intracranial abnormality.\n2. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct.\n3. Paranasal sinus disease as described." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\n\nThere is no evidence of hemorrhage, edema, mass effect, or acute infarction. \nThe ventricles and sulci are normal in size and configuration. A mucous\nretention cyst in the right maxillary sinus is unchanged.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are otherwise clear. The visualized portion of the orbits are\nunremarkable. A rounded calcification in the scalp is noted at the vertex.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThere is a three vessel aortic arch with no appreciable atherosclerotic\ndisease. The origin of branch vessels, common carotid arteries, and the right\nvertebral artery are widely patent. The streak artifact from spinal hardware\nlimits assessment of the proximal left vertebral artery but appears grossly\npatent. The carotid and vertebral arteries and their major branches appear\nnormal with no evidence of stenosis or occlusion. There is no evidence of\ninternal carotid stenosis by NASCET criteria.\n\nOTHER:\n\nAir extending along the entire length of a nondilated left Stensen's duct from\nthe oral cavity to the intraparotid ducts without inflammatory changes is\nlikely incidental and may reflect a patulous opening.\n\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. Postsurgical changes in the spine are noted.", + "output": "1. No evidence of hemorrhage, edema, mass effect, or acute infarction.\n\n2. Unremarkable head CTA.\n\n3. Unremarkable neck CTA. No internal carotid artery stenosis by NASCET\ncriteria." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The main pulmonary artery is\ndilated. The visualized portion of the thyroid gland is within normal limits.\nThere is no lymphadenopathy by CT size criteria.", + "output": "1. No acute intracranial abnormalities.\n2. Normal head and neck CTA.\n3. The main pulmonary artery is dilated with can be seen in the setting of\npulmonary artery hypertension." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci, advanced for the patient's age, but\nstable compared to prior performed ___.\n\nThere is no evidence of fracture. Trace bilateral ethmoid air cell and\nmaxillary sinus mucosal thickening is present. The visualized portion of the\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are preserved.", + "output": "1. No acute intracranial abnormality.\n2. Mild prominence of the ventricles and sulci is advanced for the patient's\nage but unchanged compared to ___.\n3. Minimal paranasal sinus disease as described." + }, + { + "input": "Dental amalgam and overlying hardware streak artifact limits examination. \nPlease note evaluation for abscess is limited due to lack of administration of\nintravenous contrast.\n\nQuestion nonspecific induration of the right greater than left pre mandibular\nsoft tissues versus artifact is again noted (see 301: 83-111 on current study\nand 3: 43-57).\n\nThere is a small periapical lucency around the root ___ tooth 29 in the\nright mandible (02:52), unchanged from ___.\n\nEvaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nEnlarged appearance of the right submandibular gland with 2 large stones in\nthe gland/proximal duct are unchanged. The left submandibular and bilateral\nparotid glands are preserved. The thyroid gland is preserved. An enlarged\nright level 2A lymph node measuring up to 1.1 cm is noted (see 02:50). \nAdditional scattered scattered subcentimeter nonspecific lymph nodes are noted\nthroughout the neck bilaterally, without definite enlargement by CT size\ncriteria.\n\nRedemonstration of centrilobular emphysematous changes and Pleuroparenchymal\nscarring is noted in the imaged lung apices.There are no suspicious osseous\nlesions.\n\nThere is a moderate mucous retention cyst in the inferior right maxillary\nsinus.", + "output": "1. Dental amalgam and overlying hardware streak artifact limits examination. \nPlease note evaluation for abscess is limited due to lack of administration of\nintravenous contrast.\n2. Within limits of this noncontrast examination, no definite evidence of new\ndental abscesses.\n3. Small periapical lucency around the root ___ tooth 29 in the right\nmandible is unchanged from ___, and likely reflects sequela of\nperiodontal disease.\n4. Enlarged appearance of the right submandibular gland with 2 large stones in\nthe gland/proximal duct are unchanged, again suggestive of submandibular\nsialolithiasis and sialoadenitis.\n5. Nonspecific induration and/or nonvisualization right submandibular gland\nadjacent fat, allowing for difference technique grossly unchanged compared to\n___ prior exam.\n6. Question nonspecific induration of pre mandibular soft tissues as\ndescribed, suggested on ___ prior exam. If not artifactual, finding may\nrepresent scarring, with differential consideration of cellulitis not excluded\non the basis of this examination.\n7. Enlarged right level 2A and additional scattered subcentimeter nonspecific\nlymph nodes are noted throughout the visualized portion of the neck\nbilaterally, without definite enlargement by CT size criteria, which may be\nreactive.\n8. Additional findings as described above.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 11:49 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." + }, + { + "input": "Again seen is a tiny periapical lucency around the root the right mandible ___\ntooth 29 (series 2, image 36), unchanged compared to prior. Diffuse dental\ncaries are noted.\n\nEvaluation of the area of digestive tract demonstrates no masses or areas of\nfocal mass-effect.\n\nAgain seen is enlargement of the right submandibular gland with 2 stones\nmeasuring up to 9 mm within the gland, appearing unchanged compared to prior. \nThere is decreased density of the right submandibular gland compared to the\nleft, and there is heterogeneous enhancement with some overlying soft tissue\nstranding. Soft tissue thickening appears improved compared to the previous\nexamination with no definite focal fluid collection demonstrated. The left\nsubmandibular gland and bilateral parotid glands are preserved. No evidence\nof abscess formation.\n\nThe thyroid gland is unremarkable. An enlarged right level 2A lymph node\nmeasures 0.9 cm, previously measuring 1.1 cm (series 3, image 78). Additional\nscattered subcentimeter nonspecific lymph nodes are noted throughout the neck\nbilaterally, and are not enlarged by size criteria. Again seen are\ncentrilobular emphysematous changes as well as pleuroparenchymal scarring in\nthe imaged lung apices. No suspicious osseous lesions identified.\n\nAgain seen is a mucous retention cyst in the right maxillary sinus.", + "output": "1. Re-demonstrated appearance of enlarged right submandibular gland with 2\nlarge stones and mild surrounding inflammatory changes within the gland. The\nfindings are again suggestive of sialolithiasis and sialoadenitis. No evidence\nof abscess formation. Surrounding inflammatory changes/soft tissue thickening\nappear improved.\n2. Re-demonstrated small periapical lucency around the root of the right\nmandibular ___ tooth 29. Diffuse dental caries are identified." + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass. The ventricles and sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "The exam is mildly limited due to patient motion, particularly within the\nskullbase.\n\nThere is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Mild mucosal thickening is seen within the\nright maxillary sinus (series 3:image 1). The visualized portion of the\nremaining paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "The exam is mildly limited by patient motion. No acute intracranial\nabnormality detected." + }, + { + "input": "There is no evidence of acute large territory infarct,hemorrhage,edema, or\nmass effect. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mild ethmoid air cell mucosal\nthickening. The visualized portion of the remaining paranasal sinuses mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "No evidence of an acute intracranial abnormality on noncontrast head CT." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe right submandibular gland is asymmetrically enlarged compared with the\nleft, with mild surrounding fat stranding. Small surrounding reactive lymph\nnodes are noted. There is a 1.3 x 8.0 cm stone in the proximal right\nsubmandibular duct (3:42). The thyroid gland appears normal. There is no\nlymphadenopathy by CT criteria.\n\nThere is mild mucosal thickening in the right maxillary sinus. Multiple\nperiapical lucencies and dental caries are identified.\n\nThere is mild centrilobular emphysema and biapical scarring. There is a 4 mm\nright upper lobe pulmonary nodule. There are no osseous lesions. The\nvisualized orbits are unremarkable. Although not optimized for such\nevaluation, the visualized brain parenchyma is grossly unremarkable.", + "output": "1. Right submandibular sialolithiasis and sialadenitis. The right sialolith\nin the submandibular duct measures approximately 1.3 cm in greatest dimension.\n2. 4 mm right upper lobe pulmonary nodule, for which no follow-up CT chest is\nrecommended.\n\nRECOMMENDATION(S): For incidentally detected nodules smaller than 6mm in the\nsetting of an incomplete chest CT, no CT follow-up is recommended.\n\nSee the ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Mild prominence of ventricles and sulci is advanced for the\npatient's age.\n\nThere is mild mucosal thickening of the bilateral ethmoid air cells. \nRemaining paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial abnormality." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect. A mucous retention cyst and mucosal thickening is noted in\nthe right maxillary sinus. Multiple dental caries are identified. Periapical\nlucency seen adjacent to right mandibular tooth\n\nThere is heterogeneity and enlargement of the right submandibular gland with\nlarge stones measuring up to 1.3 and 0.8 cm, respectively likely within the\nsubmandibular duct. These stones were present on prior exam.\n\nThe thyroid appears normal. Prominent right cervical chain lymph nodes\nmeasuring up to 8 mm are not enlarged by CT size criteria. The neck vessels\nare patent.\n\nThere is mild scarring and centrilobular emphysema at the lung apices,\nbilaterally. No suspicious pulmonary nodule.There are no acute osseous\nabnormalities. Defect of the inferomedial left orbital wall is compatible\nwith remote prior trauma.", + "output": "Right submandibular sialoadenitis. Two large stones within the proximal\nsubmandibular duct, similar to prior." + }, + { + "input": "Multiple focal areas of hypodensity in the bilateral thalami, corona radiata,\nleft pons, and right insula are unchanged and reflect prior lacunar infarcts. \nHigh density in the pons with indicating old hemorrhage is unchanged. \nPeriventricular subcortical white matter hypodensities are nonspecific and\nlikely sequela of chronic small vessel ischemic disease. There is prominence\nof the ventricles and sulci suggestive involutional changes. There is no\nevidence of recent hemorrhage or infarction.\n\nThere is no evidence of fracture. Mild right maxillary mucosal thickening and\na mucous retention cyst in the left maxillary sign are present. The\nvisualized portion of the remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "Multiple old infarctions and chronic hemorrhage in the pons. No evidence of\nrecent hemorrhage or infarction. ." + }, + { + "input": "Again seen are multifocal areas of periventricular and deep and subcortical\nwhite matter hypodensity in a similar distribution to prior head CT from ___, corresponding to areas of multifocal deep white matter infarcts,\nbetter assessed on MRI from ___. Additionally, chronic pontine\ninfarct with calcification is again seen, unchanged (see 2:8 on current study\nand 2:9 ___ prior noncontrast head CT).\n\nThere is no evidence of acute hemorrhage or acute large vascular territorial\ninfarction. There is no mass effect.\n\nMild prominence of the ventricles and sulci is stable, and compatible with\nage-appropriate global atrophy. Small foci of bilateral basal ganglia and\nthalamic hypodensity likely reflect chronic lacunar infarcts. Hyperdensity in\nthe pons (series 2, image 8) is unchanged in appearance, consistent with prior\npontine hemorrhage. Scattered white matter punctate calcifications likely\nreflect prior microhemorrhage, unchanged in appearance.\n\nThe imaged paranasal sinuses and mastoid air cells are clear. The globes and\nbony orbits are intact. The right lens has been removed. Soft tissue\ndensities are noted within bilateral external auditory canals which may\nrepresent cerumen. Degenerative changes of bilateral temporomandibular joints\nis noted, unchanged.", + "output": "1. No acute hemorrhage or evidence of acute large vascular territory\ninfarction.\n2. Multiple chronic infarcts, atrophy, and probable small vessel ischemic\nchanges as described, grossly stable compared to prior exam.\n3. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct.\n4. Stable bilateral temporomandibular joint disease." + }, + { + "input": "Multifocal areas of periventricular and deep subcortical white matter\nhypodensity are grossly similar to the prior study, previously characterized\nas multiple deep white matter infarctions. Focal areas of hypodensity within\nthe pons (associated with unchanged hyperdensity from chronic hemorrhage\n02:11), and the right basal ganglia (02:18) are stable. There is no evidence\nof interval infarction, acute intracranial hemorrhage, edema, or mass. The\nventricles and sulci are mildly prominent consistent with age related\ninvolutional changes. Scattered punctate calcifications within the cerebrum\nand cerebellum may be due to the sequela of prior neurocysticercosis.\n\nThere is no evidence of fracture. Aside from a small mucous retention cyst\nwithin the left maxillary sinus, the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Nonspecific\nsoft tissue density within the right external auditory canal likely represents\ncerumen. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial hemorrhage or evidence of acute large vascular\nterritory infarction.\n2. Unchanged age related involutional changes and confluent white matter\nhypodensities previously characterized as chronic infarctions." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Enlarged ventricles and sulci suggest global volume loss. \nScattered periventricular and subcortical white matter hypodensities are\nlikely sequela of chronic small vessel disease. More focal hypodensity in the\nleft thalamus suggests prior lacunar infarct. Hyperdense focus likely due to\ncalcification noted within the pons (2:8). These findings are unchanged from\nprior.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process.\nGlobal volume loss and white matter changes changes suggesting chronic small\nvessel disease." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. Incidentally noted bilateral\nbasal ganglia calcification,, right greater than left (___).\n\nNo osseous abnormalities seen. There is mucosal thickening in bilateral\nethmoid air cells and left sphenoid sinus. The paranasal sinuses, mastoid air\ncells, and middle ear cavities are otherwise clear. The orbits are\nunremarkable.", + "output": "1. No acute intracranial abnormality.\n\n2. Incidentally noted bilateral basal ganglia calcification, potentially\nphysiologic. Given patient's young age, metabolic, prior infectious or\ninherited disorders could be considered." + }, + { + "input": "There is no intracranial hemorrhage, edema, mass effect, or acute vascular\nterritorial infarction. The ventricles and sulci are normal in size and\nconfiguration. Mild periventricular and subcortical white matter\nhypodensities likely reflect the sequelae of chronic small vessel ischemic\ndisease. There is no shift of the normally midline structures.The basal\ncisterns appear patent and there is preservation of the gray-white matter\ndifferentiation.\n\nA small left occipital scalp hematoma (03:40) is noted, with no evidence of\nunderlying fracture. Minimal mucosal thickening is noted in the ethmoid air\ncells. Otherwise, the included paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear.The orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Small left occipital scalp hematoma, with no evidence of underlying\nfracture." + }, + { + "input": "Study is limited by motion and dental amalgam artifact.\n\nThere is no evidence of acute infarction,hemorrhage,edema, or mass. Again\nseen is encephalomalacia in the left anterior frontal and temporal lobes and\nright cerebellum. There is prominence of the ventricles and sulci suggestive\nof involutional changes. Subcortical and periventricular white matter\nhypodensities are nonspecific, however likely represent sequela of chronic\nsmall vessel ischemic disease.\n\nPatient is status post right occipital craniectomy. There is no evidence of\nfracture. The visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable. A enteric tube is partially visualized.", + "output": "Study is limited by motion and dental amalgam artifact. Within this\nlimitation, there is no acute intracranial process." + }, + { + "input": "Patient is status post a minimally invasive esophagectomy. A left cervical JP\ndrain abuts the superior suture margin. Inferiorly, it is difficult to\ndetermine the location of the drain, as there is no suture or mucosa abutting\nthe medial margin (2:91). There is no focal fluid collection. There is no\nsubcutaneous air - other than at the site of catheter entry - or leak of oral\ncontrast.\n\nThe intracranial contents are grossly unremarkable. There is no cervical\nlymphadenopathy. The included thyroid is normal. There is left maxillary sinus\nmucosal thickening. Mild degenerative changes are seen in the cervical spine,\nworst at C5-6 and C6-7.", + "output": "1. Status post minimally invasive esophagectomy.\n2. Location of the left cervical JP drain is difficult to determine and may be\nintraluminal. Correlation with output recommended.\n3. No definite focal fluid collection or extravasation of oral contrast\nidentified.\n4. Please refer to concurrently obtained CT of the chest study with accession\n___ for description of chest findings.\n5. Paranasal sinus disease as described.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with the surgical team\nvia telephone on ___ at 8:12 ___, 10 minutes after discovery of the\nfindings." + }, + { + "input": "Study is mildly degraded by motion.\n\nThere is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. Mild mucosal thickening is noted in the\nethmoid air cells and left sphenoid sinus. The mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable. Nasogastric tube is partially visualized.", + "output": "1. Study is mildly degraded by motion.\n2. No acute intracranial abnormality.\n3. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. There is preservation of\ngray-white matter differentiation.\n\nThere is no evidence of fracture. Fluid is seen within the right maxillary\nsinus. The remaining visualized paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Mild paranasal sinus inflammatory changes. Otherwise normal study." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, or loss of\ngray/white matter differentiation. Ventricles, sulci, and basal cisterns are\nnormal in size.\n\nThere is no evidence for a fracture. There are small mucous retention cysts\nin the partially visualized maxillary sinuses and minimal mucosal thickening\nin the anterior ethmoid air cells. Mastoid air cells and middle ear cavities\nare well aerated. The orbits appear unremarkable.", + "output": "No evidence for acute intracranial abnormalities." + }, + { + "input": "There is no evidence of large territorial infarction, hemorrhage, edema, or\nmass effect. There is mild age-related cortical volume loss.\n\nNo definite osseous abnormalities are identified. There is mucosal thickening\ninvolving the frontal, ethmoid, and maxillary sinuses. The middle ear\ncavities and mastoid air cells are clear. The orbits are preserved. Soft\ntissue densities are noted within bilateral external auditory canals which may\nrepresent cerumen.", + "output": "1. No acute intracranial abnormality.\n2. No evidence of acute intracranial hemorrhage or fracture.\n3. Paranasal sinus disease as described.\n4. Please refer to concurrently obtained facial bones and cervical spine CT\nstudies for description of non brain structures." + }, + { + "input": "SOFT TISSUES: There is no stranding, fluid collection, hematoma, or other\nsoft tissue abnormality.\n\nMAXILLOFACIAL BONES: The maxillofacial bones are intact, without fracture.\nThe zygomatico-maxillary complex is intact. The lateral pterygoid plates are\nintact.\n\nMANDIBLE: The mandible is without fracture or temporomandibular joint\ndislocation. The temporomandibular joints are symmetric, without significant\ndegenerative change.\n\nDENTITION: The patient is edentulous.\n\nSINUSES: Mucosal thickening is seen within the bilateral maxillary, ethmoid,\nand frontal sinuses.\n\nNOSE: There is no nasal bone fracture. Nasopharyngeal soft tissues are\nunremarkable. There is no nasal septal hematoma.\n\nORBITS: The orbits, including the laminae papyracea, are intact. The globes\nare intact with non-displaced lenses and no intraocular hematoma. There is no\npreseptal soft tissue edema. There is no retrobulbar hematoma or fat\nstranding.\n\nOTHER: Scattered subcentimeter nonspecific lymph nodes are noted throughout\nthe visualized portion of the neck bilaterally, without definite enlargement\nby CT size criteria. Soft tissue densities are noted within bilateral\nexternal auditory canals which may represent cerumen.", + "output": "1. No acute fracture identified.\n2. Paranasal sinus disease as described.\n3. Please refer to report of concurrently obtained CT cervical spine and CT\nhead for description of non facial bone structures." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is mild\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is minimal inflammatory fat stranding in the right parietal soft tissues\n(601b:86), likely the point of impact. There is no evidence of fracture. \nThere is minimal opacification of a few inferior left mastoid air cells. The\nvisualized portion of the paranasal sinuses, right mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Mild fat stranding in the right parietal scalp, likely traumatic, without\nunderlying fracture.\n\nNOTIFICATION: A wet read was requested and the findings were discussed with\n___, M.D. by ___, M.D. on the telephone on ___ at\n4:42 pm, 5 minutes after discovery of the findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is mild opacification of the mastoid air cells on the left. A small\nmucous retention cyst is noted in the right maxillary sinus and there is mild\nmucosal thickening in the left maxillary sinus.\n\nBilateral patchy thinning of the anterior temporal bones, bilaterally (series\n3, image 279), appears allowing for technical differences unchanged from MR ___.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe V4 segment of the right vertebral artery is mildly diminutive. Carotid\nand vertebral arteries and their major branches appear normal with no evidence\nof stenosis or occlusion. There is no evidence of internal carotid stenosis by\nNASCET criteria.\n\nOTHER:\nEvaluation of the lung apices is severely limited by respiratory motion. No\nlarge pulmonary nodules. The thyroid is unremarkable. There is no\nlymphadenopathy.", + "output": "1. No acute intracranial abnormality. No flow-limiting stenosis, dissection,\nor aneurysm greater than 3 mm.\n2. Patchy, bilateral thinning of the anterior temporal bones, given the\nsymmetry is likely congenital and appears allowing for technical differences\nunchanged from ___." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nSubtle periventricular and subcortical white matter hypodensities are\nnonspecific but likely reflect sequelae of chronic microvascular ischemic\ndisease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. The\nvisualized portion of the orbits are notable for bilateral lens replacements. \nDense atherosclerotic calcifications of the cavernous carotid arteries.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or recent infarction. \nThere is right frontal tissue loss and dilatation of the right frontal horn\nconsistent with prior infarction, unchanged since the MR of ___.\nProminent ventricles and sulci are consistent with age-related involutional\nchanges. Periventricular white matter hypodensities are seen, consistent with\nchronic small vessel ischemic changes. The basal cisterns appear patent and\nthere is preservation of gray-white matter differentiation.\n\nNo fracture is identified. Mucosal thickening is seen in the sphenoid sinus\nand ethmoid air cells. There is fluid in the bilateral mastoid air cells.\nOtherwise, the visualized paranasal sinuses and middle ear cavities are clear.\nThe globes are unremarkable.", + "output": "1. No acute intracranial process.\n\n2. Fluid in the bilateral mastoid air cells.\n\nOld right frontal infarction with no evidence of new hemorrhage or infarction.\n\nNOTIFICATION: Findings were communicated to Dr. ___ at 6:55 p.m. on ___ by phone." + }, + { + "input": "Re-identified is an a 1.3 x 0.9 cm (TRV, AP) left occipital erosive lesion,\nunchanged from CT cervical spine of ___ and progressed it in size\nsince prior CT examination of ___. No additional osseous lesions are\nidentified.\n\nThere is no intra or extra-axial mass effect, acute hemorrhage or territorial\ninfarct. The sulci, ventricles and cisterns are slightly prominent, but\nwithin expected limits given the degree of global cerebral volume loss. Right\nfrontal encephalomalacia is identified. These findings are unchanged from\nexamination of ___.\n\nMild mucosal thickening with mucous retention cysts of the right greater than\nleft maxillary sinuses are noted. The remainder the paranasal sinuses are\nessentially clear. The orbits are unremarkable. Mastoid air cells and middle\near cavities are well pneumatized and clear.", + "output": "1. A 1.3 x 0.9 cm (TRV, AP) left occipital erosive lesion is unchanged from\nrecent CT cervical spine of ___. This has increased in size\nsince prior examination of ___. No additional lesions are\nidentified.\n2. Differential considerations include brown tumor given the patient's history\nof renal failure. However, more worrisome neoplasm is not excluded. \nRecommend further evaluation with nuclear medicine bone scan." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect. There is nonspecific fat stranding, edema and small amount\nof fluid within the retropharyngeal space extending from the nasopharynx to\nthe thyroid cartilage. There is also subcutaneous edema of the neck\ndiffusely, right worse than left. No fluid collections are\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There are multiple prominent\nlymph nodes throughout the neck as well as in the mediastinum (2:94), but none\nof which are pathologically. Multiple dilated vessels are seen in the\nanterior subcutaneous chest wall.\n\nMucosal thickening and retention cysts are seen within the bilateral maxillary\nsinuses. There is mucosal thickening of the ethmoid air cells.\n\nThere is a 4 mm nodule in the left upper lobe (2:69) and a 2 mm nodule in the\nright upper lobe of (2:72), unchanged from prior CT of the cervical spine from\n___ chest CT from ___. Biapical scarring is seen. \nRight-sided brachiocephalic and SVC stent is again noted, unchanged in\nappearance and position since ___. There is a 1.4 cm lucency in the\nposterior left occipital bone, unchanged from ___ and ___. There are sclerotic lesions within C6 and T1 vertebral bodies,\nunchanged from prior exams, potentially indicating bone islands.\n\nEvaluation of the intracranial content is limited, however there are no gross\nabnormalities. Dense calcification of bilateral carotid siphons and aorta are\nnoted.", + "output": "1. Retropharyngeal fat stranding, edema and fluid are nonspecific without\nfocal fluid collection or abscess. Diffuse subcutaneous edema within the\nneck, right worse than left.\n2. Sinus disease as above.\n3. Multiple dilated vessels in the anterior chest wall and status post\nstenting of the right brachiocephalic vein and SVC.\n4. 1.4 cm lucency in the left occipital bone, unchanged." + }, + { + "input": "There is high-grade stenosis of the right brachiocephalic/SVC stent at the\nconfluence of the right subclavian vein, internal jugular vein and anterior\njugular vein (301: 63-68, 306b: ___, unchanged from prior exams dating\nback to at least ___. The superior vena cava portion of the stent is patent\nand demonstrates unremarkable opacification secondary to collaterals.\n\nThe bilateral internal jugular veins from the level of the jugular fossa are\nwidely patent until the lower neck where the internal jugular veins become\nseverely narrowed, with high grade stenosis and are essentially occluded. \nProminent venous collaterals are noted in the lower neck and upper chest.\n\nThe cervical arterial vessels are patent. There are mild aortic\ncalcifications at the origin of great vessels, without narrowing.\n\nRe-identified is a large thyroid pyramidal lobe with a thyroid nodule\ndemonstrating peripheral calcifications, unchanged from prior exam. There is\nno cervical lymphadenopathy by size criteria.", + "output": "1. Severe narrowing of the right brachiocephalic/SVC stents at the confluence\nof the right subclavian vein and internal jugular vein, essentially unchanged\nin appearance from prior examinations. The SVC portion of the stent is patent\nand reconstitutes via prominent surrounding venous collaterals.\n2. The bilateral internal jugular veins from the level of the jugular fossa to\nthe supraclavicular fossa are widely patent. At the level of the lower neck,\nthe internal jugular veins are severely narrowed, but are associated with the\nnumerous prominent venous collaterals.\n3. Re-identified is a prominent thyroid pyramidal node with a thyroid nodule\nand calcifications, similar in appearance to prior examinations dating back to\n___, allowing for technical differences. This could be further evaluated\nwith ultrasound as clinically indicated." + }, + { + "input": "An endotracheal tube is seen entering via as the right nares through the\nnasopharynx with distal tip not evaluated. Similarly a feeding tube is seen\npassing through the left nares through the nasopharynx with distal tip not\nevaluated.\n\nMucosal thickening of the right maxillary sinus and ethmoidal air cells are\nnoted with complete opacification of the right ethmoidal air cells. Interval\nincrease in hyperdense air-fluid levels within bilateral sphenoid sinuses,\nright greater than left with aerosolized secretions within the right sphenoid\nsinus. No definite erosive changes identified. There is partial\nopacification of bilateral mastoid air cells which are partially visualized. \nThe frontal sinuses are clear. Bony sclerosis is noted surrounding the\nsphenoid sinuses, unchanged compared to ___ noncontrast neck CT,\nand new compared to the ___ contrast neck CT.\n\nThe ostiomeatal units are narrowed, right greater than left. The cribriform\nplates are intact. There is no nasal septal defect. The nasal septum is\nmidline. The anterior clinoid processes are not pneumatized. The lamina\npapyracea are intact. The sphenoid sinus septum is multipartite. Fluid is\nseen within bilateral middle ears. Calcification of the cavernous portions of\nthe internal carotid arteries are again noted. Left maxillary tooth\nperiapical lucency is noted (see 2:1, 41b:88, 400b:52).", + "output": "1. Interval progression of paranasal sinus disease concerning for chronic and\nfungal sinusitis and polyposis, as described. Recommend correlation with\nphysical exam, inflammatory markers and ENT examination.\n2. No evidence of sinus abscess.\n3. Endotracheal and enteric nasal tubes partially, evaluated as described.\n4. Findings concerning for periodontal disease as described. Recommend\ncorrelation with dental exam.\n\nRECOMMENDATION(S):\n1. Interval progression of paranasal sinus disease concerning for chronic and\nfungal sinusitis as described. Recommend correlation with physical exam,\ninflammatory markers and ENT examination.\n2. Findings concerning for periodontal disease as described. Recommend\ncorrelation with dental exam." + }, + { + "input": "There is no evidence of hemorrhage, edema, or mass effect. Encephalomalacia\ninvolving the right frontal lobe is unchanged. Gray-white matter\ndifferentiation appears preserved. There is no evidence of acute large\nterritorial infarction. Ventricles and sulci are stable in size and\nconfiguration with slight ex vacuo dilatation involving the frontal horn of\nthe right lateral ventricle. The basal cisterns are patent. There is no\nshift of normally midline structures. Periventricular and scattered white\nmatter hypodensities, particularly a hypodensity involving the right lentiform\nnucleus (03:15) is most likely sequela of chronic small vessel ischemia and\nchronic lacunar infarct.\n\nA 1.4 cm left occipital erosive lesion appears stable relative to prior\nexamination. No new osseous lesion is identified. Relative to examination\ndated ___, there is new opacification of anterior right ethmoidal\nair cells, right frontal sinus, as well as near complete opacification of\nbilateral sphenoid sinuses. Moderate mucosal thickening involves bilateral\nmaxillary sinuses. Mastoid air cells bilaterally are opacified, potentially\nrelated to prolonged supine positioning.", + "output": "1. No evidence of acute intracranial abnormality on noncontrast head CT. \nStable encephalomalacia involving the right frontal lobe with associated ex\nvacuo dilatation of the right lateral ventricle.\n\n2. New sinus disease with near complete opacification of right frontal,\nethmoidal, and sphenoid sinuses from prior CT head of ___ and\nworsened from prior CT sinus of ___.\n\n3. Mastoid air cell opacification likely reflects prolonged supine\npositioning.\n\n4. Stable left occipital lobe osseous lesion. No new lesion is identified. \nIf not already pursued, further evaluation with nuclear medicine bone scan can\nbe considered." + }, + { + "input": "Study is mildly degraded by motion. There is no evidence of intracranial\nhemorrhage. Encephalomalacia involving the right frontal lobe is unchanged. \nVentricular size and configuration are also stable. There is no new large\nterritorial infarction. Periventricular white matter hypodensities\nnonspecific but likely sequela of chronic small vessel disease.\n\nAgain is noted an approximately 1.4 cm well-marginated lytic left occipital\nbone lesion with sclerotic margins, unchanged compared to the ___\nprior exam, and increased in size compared to the ___, and ___ prior exams. No new osseous lesion is identified. There is\nopacification of the ethmoid air cells, right frontal sinus, right maxillary\nsinus with near complete opacification of the bilateral sphenoid sinuses. \nRight maxillary sinus mucous retention cysts versus polyps are noted. \nHyperdensities are noted within the mucosal thickening of the right frontal\nand ethmoid sinuses.\nThere is complete opacification of bilateral mastoid air cells.", + "output": "1. Study is mildly degraded by motion.\n2. No acute intracranial abnormality.\n3. No evidence of acute intracranial hemorrhage.\n4. 1.4 cm left occipital lytic lesion, that is stable compared to ___ prior exam, and slightly increased compared to ___ prior\nexam. Differential considerations again include brown tumor, with other\netiologies not excluded. Again recommend correlation with physical exam and\noncologic history. If clinically indicated, bone scan may be obtained for\nfurther evaluation.\n5. Stable right frontal encephalomalacia.\n6. Paranasal sinus disease concerning for chronic and fungal sinusitis as\ndescribed, which is progressed compared to the ___ prior exam\ncomment which is similar to the ___ prior exam.\n7. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct." + }, + { + "input": "There is no evidence of acute large vascular territorialhemorrhage, edema, or\nmass. There is unchanged encephalomalacia involving the right periventricular\nregion in the right frontal lobe. There is prominence of the ventricles and\nsulci suggestive of involutional changes. Periventricular and subcortical\nwhite matter hypodensities are nonspecific, but likely reflect sequelae of\nchronic small vessel ischemic disease.\n\nThere is no acute fracture. There is unchanged well-marginated 1.5cm lytic\nlesion in the left occipital bone. There is near complete opacification of\nthe bilateral paranasal sinuses, some of which contain aerosolized secretions\nand central hyperdense material, particularly within the sphenoid sinuses. \nThere is also opacification of the bilateral mastoid air cells as well as the\nmiddle ears. The included globes are unremarkable.", + "output": "1. No acute intracranial abnormality. Specifically, there is no evidence for\nintracranial hemorrhage or acute territory infarct. No calvarial fracture.\n2. Unchanged encephalomalacia of the right frontal lobe.\n3. Parenchymal atrophy and chronic small vessel ischemic disease.\n4. 1.4 cm left occipital lytic lesion. Differential again include brown\ntumor. As per previous recommendation, bone scan may be obtained for further\nevaluation if indicated.\n5. Extensive paranasal sinus disease, raising concern for chronic and fungal\nsinusitis." + }, + { + "input": "The bilateral internal jugular veins are patent. Partially visualized dural\nvenous sinuses are patent. Again seen is the occluded left brachiocephalic\nvein. The right brachiocephalic/SVC stent again seen. Compared to ___, there is interval placement of right-sided Port-A-Cath. Fluid density\nsurrounding right subclavian vein, right internal jugular vein, and the SVC is\nmost likely secondary to subclavian plasty from ___. Extensive\nanterior chest wall and lower neck venous collaterals are again seen.\n\nThis exam is not technically optimized for evaluation of the included\narteries. There is mild atherosclerotic plaque in the origin of the right\ninternal carotid artery without evidence for significant stenosis. There is\nnoncalcified plaque in the left internal carotid artery without evidence for\nsignificant stenosis. There is calcified plaque in bilateral carotid siphons.\n\nThe salivary glands appear unremarkable. There is no evidence for an\nexophytic mucosal mass. Multiple cervical lymph nodes are not enlarged by CT\ncriteria. There is a 1.7 x 1.2 cm nodule in the isthmus of the thyroid, last\nevaluated by ultrasound on ___.\n\nThere is partial opacification of the partially visualized bilateral ethmoid\nair cells. There are mucous retention cysts and mucosal thickening in the\nright maxillary sinus. There is mild mucosal thickening in the left maxillary\nsinus. There is polypoid mild-to-moderate mucosal thickening in bilateral\nsphenoid sinuses. This exam is not technically optimized for evaluation of\nthe included brain parenchyma.\n\nThere is a enlarged subcarinal lymph node measuring approximately 1.4 cm,\nsimilar to the ___ chest CT. Multiple nonenlarged paratracheal, AP\nwindow, and prevascular lymph nodes are also noted. There are partially\nvisualized small bilateral pleural effusions. 4 mm pulmonary nodule in the\napical left upper lobe on image 2:59 is stable. Cardiomegaly and coronary\nartery calcifications are again noted.\n\nSmall sclerotic foci are again seen in the included upper thoracic spine,\ncompatible with bone islands. There is a 1.4 x 1.0 cm lesion with\nground-glass density in the left occipital bone, eroding the outer table. It\nmeasured 5 mm on the ___ CT neck and 1.3 x 0.9 cm on the ___ head CT. It most likely represents a brown tumor given the patient's\nhistory, as stated previously.", + "output": "1. Patent bilateral internal jugular veins.\n2. Unchanged occlusion of the left brachiocephalic vein. Right\nbrachiocephalic/SVC stent remains in place with interval placement of right\nPort-A-Cath. Fluid density along the right brachiocephalic vein, right\ninternal jugular vein, and SVC is likely related to the ___\nsubclavian plasty.\n3. 1.7 x 1.2 cm thyroid isthmus nodule, last evaluated by ultrasound on ___.\n4. Unchanged mild mediastinal lymphadenopathy. Stable 4 mm pulmonary nodule\nin the apical left upper lobe.\n5. Slowly increasing ground-glass lesion in the left occipital bone, most\nlikely a brown tumor given the patient's history.\n6. Paranasal sinus disease." + }, + { + "input": "The patient is status post interval removal of an existing right-sided\ntunneled hemodialysis catheter and interval placement of a left internal\njugular vein approach tunneled hemodialysis catheter. The new catheter\ntraverses the left occluded brachiocephalic vein. A small amount thrombus is\nseen within the origin and proximal aspect of the left internal jugular vein,\nmildly more prominent compared to the prior exam. The remainder of the left\ninternal jugular vein is patent. Left axillary, subclavian veins are\nsuboptimally opacified, are probably patent.\n\nA right brachiocephalic/SVC ___ is again noted, with a limb extending into\nthe right internal jugular vein and a limb extending into the right subclavian\nvein. The internal jugular vein component of the ___ is nearly occluded\nwith low level flow centrally seen today. There is nonocclusive thrombus\nwithin the right internal jugular vein above the level of the ___, difficult\nto compare as this area was nearly filled with central catheter on prior exam.\nThere is nonocclusive mild thrombus eccentrically within brachiocephalic\ncomponent of the ___, with flow centrally present on today's exam. Very\ndistal aspect of ___ ___ is difficult to see secondary to artifact from\nmetal and adjacent venous catheter. The right subclavian portion of the ___\nis kinked and narrowed. Very medial right subclavian vein is narrowed,\nlateral margin is of normal caliber with some enhancement, it is suboptimally\nopacified to adequately evaluate. There is stable thickening about right\n___ be postprocedural.\n\nThere are anterior chest, upper mediastinal venous collaterals, similar to\nprior.\n\nThe salivary glands are unremarkable. There is no mucosal exophytic mass. \nThere is calcified plaque in the bilateral carotid siphons. There is no\nevidence of internal carotid artery stenosis by NASCET criteria.\n\nRe demonstrated is a 1.7 x 1.4 cm nodule within the isthmus of the thyroid\ngland, unchanged compared to the prior exam.\n\nA mucous retention cyst is seen within the right maxillary sinus as well as\nmild mucosal sinus thickening. The left maxillary sinus is clear. The\nmastoid air cells, and middle ear cavities are clear. Re demonstrated is a\n1.4 x 1 cm lesion with ground-glass density in the left occipital bone eroding\nthe outer table, unchanged compared to the prior exam.\n\n4 mm left apical lung nodule is unchanged compared to the prior exam.", + "output": "1. No definite flow is seen within the left brachiocephalic vein. Medial\nright subclavian vein is of small caliber, may be from complete or near\ncomplete occlusion, vessel is suboptimally opacified to fully evaluate.\n2. Near complete occlusion of the right internal jugular vein ___, with\ntrickle flow centrally. Above the ___, there is near occlusive thrombus in\nthe lower right internal jugular vein. Right brachiocephalic vein is probably\nmildly narrowed. SVC component of ___ is suboptimally seen, appears patent.\n3. Probable near complete occlusion of left internal jugular vein with areas\nof acute to subacute thrombus at the level of the central line entrance site;\nsome of the appearance may be from suboptimally opacified blood.\n4. Stable 1.7 cm thyroid isthmus nodule.\n5. Re demonstrated is a ground-glass lesion within the left occipital bone,\npossibly a brown tumor, unchanged.\n\nRECOMMENDATION(S): Internal jugular vein ultrasound if indicated\n\nNOTIFICATION:\n The findings were discussed with Dr. ___. by ___, M.D. on\nthe telephone on ___ at 4:06 pm, 10 minutes after discovery of the\nfindings." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Encephalomalacia in the right frontal lobe is again noted. \nVentricles and sulci are prominent, suggestive of volume loss. There are\nperiventricular and subcortical hypodensities, which may represent small\nvessel ischemic changes. More focal hypodensity involving the body of the\ncaudate on the right suggests prior lacune.\n\nThere is at least moderate mucosal thickening of the partially visualized\nright maxillary sinus. The remaining imaged paranasal sinuses are essentially\nclear. Mastoid air cells and middle ear cavities are well aerated. The bony\ncalvarium is intact. A 1.4 cm lytic lesion in the left occipital bone is\nagain noted, unchanged in size and appearance from most recent prior,\npreviously evaluated by bone scan without increased radiotracer uptake.", + "output": "1. No acute intracranial process.\n2. Unchanged 1.4 cm lytic lesion in the left occipital bone." + }, + { + "input": "Evaluation of the cerebellum is suboptimal due to streak artifact despite\nrepeat acquisition. Within this confine: There is no evidence of acute large\nterritorial infarction,hemorrhage,edema, or mass effect. There is prominence\nof the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The left sphenoid sinus is near completely\nopacified. The visualized portion of the remaining paranasal sinuses and\nmiddle ear cavities are clear. The mastoid air cells are underpneumatized\nbilaterally. The visualized portion of the orbits are unremarkable. A\nnasogastric tube and endotracheal tube are partially visualized.", + "output": "No acute intracranial abnormality on noncontrast CT head. Specifically no\nacute large territory infarct or intracranial hemorrhage." + }, + { + "input": "Right nasal tube in place. Mild opacification left sphenoid sinus,\nsignificantly improved since ___, surrounding mild chronic\nperiostitis. Trace mucosal thickening ethmoid, maxillary, frontal sinuses,\npatent ostia. Mild atelectasis right maxillary sinus, from chronic\ninflammation.\nIntact cribriform plate. Anterior clinoid are not aerated. Nasal septal\ndeviation to the right. Mild secretions nasal cavity. Bilateral concha\nbullosa. Otherwise clear nasal cavity. No periapical lucency. Chronic\nfracture nasal bone.. Degenerative changes upper cervical spine.\nVisualized intracranial contents, orbits, upper neck soft tissues are normal.", + "output": "1. Mild paranasal sinus disease, improved since ___." + }, + { + "input": "The patient is status post bilateral maxillary antrostomies with uncinectomies\nand partial ethmoidectomies, as seen on the ___ CT. Bilateral\nmaxillary neo ostia are well-aerated. Maxillary sinuses appear well-aerated.\n\nThere is near complete opacification of bilateral frontal sinuses, progressed\nsince ___, with occlusion of bilateral frontoethmoidal recesses\ncompared to narrowing in ___. There is complete opacification of\nresidual right anterior ethmoid air cells and contiguous nasal cavity. There\nis polypoid mucosal thickening in the left nasal cavity near the left anterior\nethmoidectomy site.\n\nSphenoid sinus ostia have been surgically widened and are well aerated. No\nsignificant mucosal thickening is seen in the right sphenoid sinus. There is\nonly minimal mucosal thickening in the anteromedial aspect of the left\nsphenoid sinus on image 301:28. The sphenoid septum inserts to the left\nmidline.\n\nThere is slight leftward nasal septal deviation, with areas of\ndemineralization of the bony nasal septum. There is demineralization of the\nbones of the anterior skullbase, with portions of the cribriform plates poorly\nvisualized (for example see series 601, image 61), similar to prior. The\nlamina papyracea appears intact bilateral. The sphenoid septum inserts to the\nleft of midline.\n\nCompared to ___, previously seen periapical lucencies ___ 2, 4,\nand 14 are no longer apparent as these appear to have been extracted. No new\nperiapical lucencies are identified in the maxillary dentition.\n\nMiddle ear cavities and mastoid air cells are well aerated. The orbits are\nunremarkable aside from evidence of right cataract surgery. Visualized soft\ntissues of the face and upper neck are unremarkable on noncontrast CT. This\nexam is not technically optimized for evaluation of the included brain\nparenchyma; no concerning abnormalities are identified.", + "output": "1. Status post bilateral maxillary antrostomies with uncinectomies and partial\nethmoidectomies. Patent maxillary neo ostia. Well aerated maxillary sinuses\nand essentially well aerated sphenoid sinuses.\n2. Near-complete opacification of bilateral frontal sinuses with occlusion of\nbilateral frontoethmoidal recesses, progressed compared to ___. \nComplete opacification of residual right anterior ethmoid air cells.\n3. Mild leftward nasal septal deviation.\n4. Demineralization of the anterior cribriform plates, unchanged, difficult to\nassess for dehiscence." + }, + { + "input": "Dental almalgam streak artifact limits study.\n\nCT HEAD WITHOUT CONTRAST:\nThere are chronic infarctions in the right anterior limb of the internal\ncapsule, right putamen, right caudate, and left thalamus. There is\nill-defined hypoattenuation in the posterior limb of the left internal capsule\nand corona radiata, corresponding to the area of restricted diffusion on MRI. \nThere is no evidence of no evidence of hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is mild mucosal thickening in the bilateral ethmoid sinuses. The\nmastoid air cells are clear. The visualized portion of the orbits are\nunremarkable.\n\nCTA HEAD:\nThere is minimal narrowing of the distal right V4 segment at its termination\ninto the basilar artery. Otherwise, the vessels of the circle of ___ and\ntheir principal intracranial branches are patent without stenosis, occlusion\nor aneurysm formation.\n\nCTA NECK:\nThere is a normal 3 vessel branching pattern of the aortic arch. Evaluation\nof the bilateral common carotid arteries is slightly limited due to streak\nartifact related to dense contrast within the left subclavian veins. The\ncarotid and vertebral arteries and their major branches are patent with no\nevidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe 3 mm nodule in the left upper lobe on 7:102 is unchanged from the CT chest\n___ and is considered benign. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Dental almalgam streak artifact limits study.\n2. Minimal atherosclerotic changes, with overall patent circle of ___.\n3. Patent vasculature in the neck with no evidence of internal carotid artery\nstenosis by NASCET criteria.\n4. Acute infarction in the left posterior limb of the internal capsule and\ncorona radiata.\n5. Paranasal sinus disease as described." + }, + { + "input": "No evidence of infarction, hemorrhage, edema, or mass. The ventricles and\nsulci are normal in size and configuration.\n\nNo evidence of fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. Normal study." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Prominent ventricles and sulci are likely secondary age-related\ninvolutional change. Periventricular white matter hypodensities are\nnonspecific but likely sequelae of chronic small vessel ischemic disease. \nThere is mild mucosal thickening in the bilateral ethmoid air cells. Mastoid\nair cells and middle ear cavities are well aerated. The bony calvarium is\nintact. No acute fracture is seen.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. There\nis prominence of the ventricles and sulci suggestive of involutional changes. \nPeriventricular and subcortical white matter hypodensities are nonspecific but\nlikely reflect sequelae of chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Bilateral lens\nreplacements are noted. Atherosclerotic calcifications of the carotid siphons\nare also present.", + "output": "No acute intracranial process. Parenchymal volume loss and chronic small\nvessel ischemic disease." + }, + { + "input": "There is no evidence of acute infarction, intracranial hemorrhage, edema, or\nmass. The ventricles and sulci prominent compatible with involutional changes\nas seen previously. Periventricular white matter hypodensities are\nnonspecific but suggest chronic microangiopathy, stable from prior. Focal\nhypodensity in the left basal ganglial is stable and compatible with a\nprominent vascular space (Virchow ___ space). No acute fracture seen. \nAtherosclerotic vascular calcifications are noted of bilateral cavernous\nportions of internal carotid arteries. The paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The orbits are preserved. Soft\ntissue densities are noted within bilateral external auditory canals which may\nrepresent cerumen.", + "output": "1. No acute intracranial abnormality.\n2. No evidence acute intracranial hemorrhage or fracture.\n3. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. Mild prominence of ventricles and sulci is consistent with\ninvolutional changes. Benign calcifications are seen in the basal ganglia\nbilaterally.\nNo definite acute fracture is seen. There is extensive thickening in left\ngreater than right maxillary sinuses with hyperostotic changes seen in\nmaxillary sinus walls compatible with chronic sinusitis. Thickening is also\nthickening seen in sphenoid sinuses and ethmoidal air cells. There is minimal\nopacification of the right mastoid air cells. The middle ear cavities are\nclear. Soft tissue density in the left external ear canal likely reflects\ncerumen.", + "output": "1. No acute intracranial process.\n2. Extensive paranasal sinus disease as described above." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema,or large mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nAdditionally, there is prominent cerebellar atrophy. Senescent calcifications\nare again seen in the bilateral basal ganglia.\n\nThere is an acute, nondisplaced alveolar ridge fracture about the right\nmaxillary central incisor (03:10, 601:2). The associated tooth is possibly\nchipped as well. Findings of chronic bilateral maxillary sinusitis appear\nsimilar, and are better described on the prior CT. There is new opacification\nof the left sphenoid sinus with inspissated secretions. The ethmoid air cells\nremains significantly opacified throughout. The mastoid air cells and middle\near cavities are remarkable. Soft tissue density in the left external\nauditory canal likely represents cerumen, and appears similar to prior. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Acute, nondisplaced alveolar ridge fracture about the right maxillary\ncentral incisor with possible chipping of the same tooth.\n2. No acute intracranial hemorrhage.\n3. No significant change in chronic, extensive paranasal sinus disease.\nUpdated findings, including acute fracture, discussed with Dr. ___ by\nDr. ___ via telephone at 10:36 pm on ___." + }, + { + "input": "No fractures are identified.\nSubcutaneous tissue swelling is noted at the nose.\nVisualized paranasal sinuses are well aerated. Nasal septum is deviated to\nthe right.\nThere is no evidence of abnormal fluid collections.\nBilateral mastoids appear normal.\nThe globes, extraocular muscles, optic nerves, and retrobulbar fat appear\nnormal.\nThe visualized upper aerodigestive tract appears normal.\nThe mandible and temporomandibular joints appear normal.", + "output": "1. No fracture is identified." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial process." + }, + { + "input": "Examination is limited secondary to patient motion. Within that limitation:\n\nThere is redemonstration of multiple small intraparenchymal, partially\ncalcified hyperdensities consistent with cavernomas, with the full extent\nbetter demonstrated on the MR brain dated ___.\n\nAs before, the lesion involving the right cerebellar peduncle and extending\ninto the right pons demonstrate hyperdensity consistent with recent\nhemorrhage. While direct comparison to the studies dated ___ is\nlimited due to motion artifact obscuring the most anterior aspect, the overall\nsize and morphology appear stable. There is stable partial effacement of the\nright anterior aspect of the fourth ventricle with an unchanged size of the\nthird and lateral ventricles, without supratentorial hydrocephalus. Unchanged\nrightward tenting of the septum pellucidum, likely congenital as there is no\nevidence for mass effect in the left cerebral hemisphere.\n\nThere is a right maxillary sinus mucous retention cyst and minimal mucosal\nthickening in the ethmoid air cells. Mastoid air cells appear grossly\nwell-aerated. There is right concha bullosa. The nasal septum is deviated to\nthe right. A nasogastric tube is partially visualized with associated fluid in\nthe nasopharynx.", + "output": "1. Motion limited exam.\n2. Multiple cavernous malformations are again demonstrated. The largest in\nthe right cerebellar peduncle demonstrates associated hyperdense blood\nproducts, not significantly changed allowing for motion artifact.\n3. Stable mild partial effacement of the right anterior aspect of the fourth\nventricle. No supratentorial hydrocephalus." + }, + { + "input": "Redemonstration of the multiple cavernomas, better evaluated on prior MR\nstudy.\n\nHyperdense material at the cavernoma in the right cerebellar peduncle,\ncompatible with acute hemorrhage products, appears grossly unchanged (2:12). \nLocal mass effects, including partial effacement of the fourth ventricle is\nsimilar. The lateral and third ventricles are unchanged, without evidence of\nobstructive hydrocephalus.\n\nThere is no evidence of fracture, infarction, or edema.\n\nA small mucous retention cyst right maxillary sinus is unchanged. A right\nconcha bullosa is again demonstrated. The right mastoid air cells are\nunderpneumatized. The visualized portion of the middle ear cavities are\nclear. The visualized portion of the orbits are normal.", + "output": "1. No significant change in acute hemorrhage of a cavernoma at the right\ncerebellar peduncle, which exerts local mass effects, including partial\neffacement of the fourth ventricle. No evidence of obstructive hydrocephalus.\n2. Redemonstration of multiple cavernomas, better evaluated on prior MR study." + }, + { + "input": "Dental artifact moderately degrades the study.\n\nEvolving hemorrhage of right cerebellar peduncle effacing the fourth ventricle\nwith re-demonstrated cavernomas, better assessed on head imaging.\n\nTracheostomy is visualized in the trachea with expected swelling and\npostoperative changes anterior to the tracheostomy.\n\nMucosal thickening of the ethmoid air cells is seen. Near complete\nopacification of the right mastoid air cells is seen, unchanged from prior. \nMucous retention cyst is seen in the right maxillary sinus. Right concha\nbullosa is again demonstrated.\n\nEvaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands are grossly without mass or adjacent fat stranding. The\nthyroid gland appears normal.Bilateral cervical lymphadenopathy is seen, with\nthe largest measuring 1.1 cm (2; 40).\n\nPulmonary edema is seen in bilateral lung apices. Moderate degenerative\nchanges are seen along the cervical spine.", + "output": "1. Expected postoperative changes around the tracheostomy with no evidence of\nfluid collection.\n2. Bilateral cervical lymphadenopathy, likely reactive.\n3. Re-demonstrated opacification of the right mastoid air cells, and mild\nparanasal sinus disease." + }, + { + "input": "Redemonstrated are numerous cavernomas, which were better evaluated on prior\nMR brain from ___.\n\nHyperdense focus in the cavernoma located in the right cerebellar peduncle is\ncompatible with acute blood products with mild surrounding edema. Compared to\nprior, there is elongation of the apparent hematoma in an anteroposterior\norientation. Although this may represent evolution of the prior hematoma, the\npossibility of interval bleeding should be considered. Local mass effect\nincluding partial effacement of the fourth ventricle is not substantially\nchanged. The lateral ventricles and third ventricle are normal in\nconfiguration without evidence of obstructive hydrocephalus.\n\nThere is no evidence of infarction, fracture, or edema.\n\nSmall unchanged mucous retention cyst is noted in the right maxillary sinus. \nA right concha bullosa there are demonstrated. The right mastoid air cells\nare congenitally underpneumatized. The visualized portion of the middle ear\ncavities are clear. The visualized portion of the orbits are normal.", + "output": "1. Change in the configuration of the hemorrhagic right pontine lesion with\nextension into the cerebellar peduncle and right cerebellar hemisphere. \nAlthough this may represent evolution of the prior hemorrhage, the possibility\nof interval bleeding should be considered..\n2. Numerous cavernomas better characterized on prior MR." + }, + { + "input": "The density of the hemorrhage centered at the right middle cerebellar peduncle\nhas decreased since prior CT, though the overall size is slightly more\npronounced measuring 3.1 x 2.4 cm, previously 2.6 x 2.1 cm. There is\npersistent mass effect of the hemorrhage in the right middle cerebellar\npeduncle with asymmetry of the fourth ventricle which is displaced to the\nleft. Overall the ventricles are similar in configuration.\n\nThere is no evidence of acute hemorrhage. Areas of high density, some with\ncalcifications, specifically within the midbrain, right frontal lobe and white\nmatter adjacent to the atria of the bilateral lateral ventricles, for example\nare again seen, compatible with cavernomas. These are better characterized on\nprior MRI. Cerebellar volume loss is again noted.\n\nMild mucosal thickening in the right maxillary sinus. Remaining paranasal\nsinuses and mastoids are clear.", + "output": "Interval decrease in density though marginal increase in size of the\nhemorrhage centered in the right middle cerebellar peduncle. Overall similar\nmass effect. Evidence of multifocal cavernomas without acute intracranial\nhemorrhage." + }, + { + "input": "Right cerebellar peduncle hemorrhage is increased in size from prior currently\nmeasures 2.6 x 1.7, previously 1.5 x 1.4 cm. Slightly more prominent left\nfrontal parafalcine hemorrhage.\n\nMultiple small intraparenchymal hyperdensities are unchanged including left\nfrontal lobe, bilateral temporal, left corona radiata.\n\nHyperdensity in the region of the left MCA is unchanged, could represent an\naneurysm or cavernomas given patient's history.\n\nA left frontal hyperdensity with calcification is again seen, could represent\na cavernoma.\n\nThere is no evidence of fracture, infarction. The ventricles and sulci are\nnormal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. Interval increase in size of the right cerebellar peduncle hemorrhage\ncompared to ___.\n2. No evidence of infarction.\n3. Multiple other hyperdense foci, presumed cavernomas, are unchanged since ___" + }, + { + "input": "Again seen is extensive hypodensity involving the left frontoparietal region,\nin the left M2 territory, corresponding to known infarct. Other foci of acute\ninfarction are better evaluated on comparison MRI. There is no evidence of\nhemorrhage.\n\nPostsurgical changes are again seen in the left cerebellum with\nencephalomalacia and evidence of prior craniotomy. The visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nThe visualized portion of the orbits are unremarkable.", + "output": "1. No evidence of hemorrhage. Otherwise stable findings consistent with large\nleft infarct." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThe posterior fossa is notable for stable postsurgical changes of left\noccipital craniotomy and cranioplasty and left cerebellar encephalomalacia. A\nlarge hypodensity in the left parietal lobe with loss of gray-white matter\ndifferentiation reflecting an evolving infarct is no larger compared to the\nprior study of ___ and may even be slightly smaller. There is no\nevidence of hemorrhagic conversion. Additional bilateral confluent\nperiventricular and scattered subcortical white matter hypodensities are\ngrossly unchanged and although nonspecific probably represent sequelae of\nchronic microangiopathy in a patient of this age. The ventricles are stable\nin size and configuration. Prominence of the ventricles and sulci is\nreflective of global atrophy. Aside from effacement of the left parietal\nsulci as a result of edema from an evolving infarction in this region, there\nis no evidence of mass effect or midline shift. There is no evidence of a new\nacute infarct. The paranasal sinuses are clear. The orbits are unremarkable.\n\n\nCTA HEAD:\nNote is made of fetal origin of bilateral posterior cerebral arteries with\ndiminutive P1 segments. Interest dense atherosclerotic disease along the\ncavernous and supra clinoid internal carotid arteries bilaterally without\nocclusion. There is paucity of M3 branches in the region of the infarct. The\nvessels of the circle of ___ and their principal intracranial branches\notherwise appear normal without stenosis, occlusion, or aneurysm formation. \nThe dural venous sinuses are patent.\n\nCTA NECK:\nThere is a three vessel aortic arch with extensive atherosclerotic\ncalcifications particularly along the origin of branch vessels without\nocclusion. Atherosclerotic calcifications extend into the proximal left\ncommon carotid and subclavian arteries which appear patent. The origin of the\nvertebral arteries are patent. The left vertebral artery appears dominant. \nShort segment multifocal calcifications are present along the course of the\nleft vertebral artery dense calcified atherosclerotic disease is also present\nalong the V4 segment of the right vertebral artery resulting in luminal\nnarrowing. There is dense predominantly calcified atherosclerotic disease in\nthe carotid bulbs bilaterally extending into the proximal internal carotid\narteries. There is approximately 60% narrowing of the proximal right internal\ncarotid artery by NASCET criteria. There is less than 30% narrowing of the\nleft internal carotid artery by NASCET criteria.\n\n\nOTHER:\nThe visualized portion of the lungs are notable for moderate centrilobular\nemphysema. The lungs are clear. Several prominent precarinal lymph nodes are\nlikely reactive. The visualized portion of the thyroid gland is within normal\nlimits. There is no lymphadenopathy by CT size criteria.", + "output": "1. Evolving large left parietal infarct without evidence of new acute\ninfarction or hemorrhagic conversion. A stable postsurgical changes of left\noccipital craniotomy and stable encephalomalacia of the left cerebellar\nhemisphere.\n2. Head CTA is notable for paucity of left M3 branch vessels in the region of\nthe infarct without evidence of occlusion or high-grade stenosis in the circle\n___ or its major tributaries.\n3. Neck CTA is notable for approximately 60% narrowing of the proximal right\ninternal carotid artery and 30% narrowing of the proximal left internal\ncarotid artery by NASCET criteria, overall similar to the prior examination.\n4. Extensive atherosclerotic disease along the aortic arch and ostia of branch\nvessels. Multifocal calcified plaque is present along the course of the left\nvertebral artery and heavily calcified plaque along the V4 segment of the\nright vertebral body results in mild to moderate luminal narrowing. Extensive\natherosclerotic disease involving the vessels in the neck, with a combination\nof soft plaque and calcified plaque material and cervical carotid\nbifurcations." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nA hypodensity is seen in the left frontoparietal lobe, concerning for acute\nischemia. There is no evidence of acute intracranial hemorrhage. \nEncephalomalacia within the left cerebellum, is likely secondary to prior\npostsurgical encephalomalacia. Ventricles and sulci are prominent, likely\nsecondary to age related involutional changes. Periventricular and\nsubcortical deep white matter hypodensities are likely related to chronic\nsmall vessel ischemic disease.\n\nThe basilar cisterns are patent. No acute fracture is identified. The\nvisualized paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The globes are unremarkable. No definite soft tissue abnormalities\nare seen.\n\nCTA HEAD:\nExtensive calcifications are seen along the cavernous portion of the internal\ncarotid arteries bilaterally. An abrupt cut off is seen involving the left M3\nportion of the MCA artery, concerning for an acute infarct. Irregularity is\nseen along the left M1 portions of the MCA artery concerning for intracranial\natherosclerotic disease. The right MCA artery is unremarkable. The anterior\ncerebral arteries are normal. The anterior communicating arteries are normal.\nBilateral fetal PCA type morphology is seen. The dural venous sinuses are\npatent.\n\nCTA NECK:\nExtensive atherosclerotic disease is seen involving the vessels of the neck. \nMild stenosis is seen involving the left internal carotid artery by NASCET\ncriteria. At least 50% stenosis is seen involving the right internal carotid\nartery by NASCET criteria. There is a normal three-vessel arch. Extensive\natherosclerotic disease is seen along the vessels of the neck.\n\nOTHER:\nThe visualized apices of the lungs are clear. There is no cervical\nlymphadenopathy. The thyroid is normal. The visualized osseous structures\nare unremarkable.", + "output": "1. Hypodensity in the left frontoparietal region is concerning for acute\nischemia.\n2. Abrupt cut off involving the left middle cerebral artery along the M3\nportion. Remainder of the circle ___ is unremarkable. Extensive\nintracranial atherosclerotic disease is identified.\n3. 50 % stenosis of the right internal carotid artery by NASCET criteria.\n4. Diminutive right vertebral artery, likely congenital.\n5. Postsurgical changes in the left cerebellar hemisphere with overlying\ncraniotomy." + }, + { + "input": "CT HEAD:\nThere is no intra or extra-axial mass effect, acute hemorrhage or large\nterritorial infarct. Periventricular and subcortical moderate confluent white\nmatter hypodensities are nonspecific, but compatible with chronic\nmicroangiopathy in a patient this age. The degree of white matter change may\nobscure superimposed acute infarct and if there is high clinical suspicion,\nMRI, if there no contraindications is recommended.\n\nThe paranasal sinuses are essentially clear. The orbits are unremarkable,\nnoting bilateral lens replacements. The mastoid air cells and middle ears are\nwell pneumatized and clear. No acute osseous abnormality.\n\n\nCTA HEAD:\nMild-to-moderate atherosclerotic calcification of the internal carotid\narteries is noted. The ACA, MCA and their major branches are unremarkable,\nwithout evidence of high-grade stenosis, occlusion or aneurysm. Moderate to\nsevere stenosis of the mid left V4 segment is identified. There is fetal type\norigin of the right posterior cerebral artery. Otherwise, the remainder the\nposterior circulation is unremarkable. The dural venous sinuses appear\npatent.\n\n\nCTA NECK:\nAtherosclerotic calcification at the of the aortic arch results in mild to\nmoderate narrowing at the origin of the left subclavian and mild narrowing at\nthe origin of the right brachiocephalic and left common carotid arteries. \nOtherwise, these vessels along the remainder the course are unremarkable. \nAtherosclerotic calcification of the carotid bifurcations results in\napproximately 40% stenosis of the right and left cervical internal carotid\narteries. Mild to moderate narrowing at the origin of the bilateral vertebral\narteries are also identified. Multifocal atherosclerotic narrowing of the\nvertebral arteries are identified.\n\nPERFUSION:\nCBF less than 30=0 mL,\nTMAX greater than 6 seconds = 0 mL\n\n\nOTHER:\nThe visualized lungs are clear. There is no cervical lymphadenopathy by size\ncriteria. The thyroid demonstrates small hypoattenuating nodules measuring up\nto 5 mm. The visualized aerodigestive tract is grossly unremarkable. No\nsuspicious osteoblastic or lytic lesions.", + "output": "1. No acute large territory infarct or intracranial hemorrhage within confines\nof noncontrast CT technique.\n2. Periventricular and subcortical moderate confluent white matter\nhypodensities are nonspecific, but compatible with chronic microangiopathy in\na patient this age. The degree of white matter change may obscure\nsuperimposed acute infarct and if there is high clinical suspicion, MRI, if\nthere no contraindications is recommended.\n3. Allowing for moderate atherosclerotic calcification of the internal carotid\narteries and along the right mid V4 segment, the remainder of the CTA head is\nunremarkable without other evidence of high-grade stenosis, occlusion or\naneurysm.\n4. Allowing for atherosclerotic disease as described above, unremarkable CTA\nof the neck. There is approximately 40% stenosis of the cervical internal\ncarotid arteries by NASCET criteria.\n5. No findings on rapid CT perfusion to suggest sizable infarct core or\nregions of ischemia.\n6. Thyroid nodules measuring up to 5 mm. Additional findings described above.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or older.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Focal area of encephalomalacia in the left occipital\nlobe compatible with an area of remote infarction. Mild periventricular and\nsubcortical white matter hypodensities are nonspecific, but likely reflect the\nsequela of chronic microvascular infarction. Mild atherosclerotic\ncalcifications are demonstrated within the cavernous carotid arteries.\n\nThere is no evidence of fracture. Aerosolized secretions are noted within a\nright posterior ethmoid air cell which may suggest ongoing inflammation. The\nvisualized portion of the remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial hemorrhage or mass effect. Please note that MRI with\ncontrast is more sensitive for detection of small masses.\n2. Encephalomalacia within the left occipital lobe compatible with chronic\ninfarction." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territory infarct. Gray-white matter\ndifferentiation is preserved. There is no hydrocephalus. The visualized\nparanasal sinuses are clear. The mastoid air cells are clear. No acute\nfracture is seen.", + "output": "No acute intracranial process." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect. No foreign body is identified in the air digestive tract. \nNo evidence of perforation.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions. The thyroid is unremarkable.", + "output": "1. No evidence of foreign body or perforation of the aerodigestive tract." + }, + { + "input": "There is no evidence of territorial infarction, hemorrhage, edema, or mass. \nThe ventricles and sulci are normal in size and configuration for the\npatient's age.\n\nVascular arteriosclerotic calcifications are present the carotid siphons\nbilaterally. There is no evidence of fracture. The visualized portion of the\nparanasal sinuses demonstrate mild mucosal thickening in the ethmoidal air\ncells, slightly more significant on the right (image 5, series 3), mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable. Carotid siphon calcifications are noted.", + "output": "There is no evidence of acute intracranial process or hemorrhage.\n\nMild mucosal thickening is identified in the ethmoidal air cells." + }, + { + "input": "There is a 2.1 AP by 3.7 TV by 3.9 and size cm well-circumscribed lesion deep\nto the left sternocleidomastoid muscle within the lower neck which extends\nsuperiorly to the thyroid cartilage and inferiorly to just below the clavicle.\nThis is just superficial and medial to the internal jugular vein and\nmarginates the left lateral aspect of the thyroid gland. There no visualized\ninternal septations or mural nodularity. There is prominent low attenuation\ncentrally with mild layering hyperdensity likely representing evolving blood\nproducts given appearance on prior neck ultrasound. The extension to the left\nclavical was questionably present on the CT of the chest form ___ but not\nwithin the field of view on the ___ study.\n\nThere is post sinus surgery anatomy with bilateral antrectomies and\nethmoidectomies. There is mucosal thickening of the bilateral maxillary and\nsphenoid sinuses. There is opacification of the right mastoid air cells. The\nvasculature is patent. There is no fracture or malalignment. Limited views\nof the lung apices are clear. The thyroid gland is normal. There is no\nlymphadenopathy.", + "output": "1. Well-circumscribed cystic lesion within anterior left lower neck at the\nlevel of the thyroid gland, just deep to the sternocleidomastoid muscle, which\nextends just below the clavicle, as described. The morphology and location\nfavor a cervical thymic cyst versus a unilocular lymphatic malformation. The\ndifferential includes ___ or ___ branchial cleft cysts, however this is lower\nand more posterior than is typically expected for these entities. This does\nnot have the appearance of an abscess or necrotic node.\n2. Sinus disease, as described." + }, + { + "input": "Right frontal sinus is expanded and measures 34 x 29 mm with thinning of the\nbony walls with markedly thinned or absent bony wall posterior medially and\ninferolaterally. Findings are consistent with a frontal sinus mucocele. The\nleft frontal sinus is hypoplastic and demonstrates opacification. The mucosal\nbulges in the right orbit with slight indentation of the right lobe with mild\nright exophthalmos.\n\nThere is also expansion of the left sphenoid sinus with high-density material\nindicative of inspissated secretions. The bony walls of the left sphenoid\nsinus is thinned and findings are suggestive of left sphenoid sinus mucosal. \nRight sphenoid sinus is clear and appears to have resolution of changes seen\non the previous MRI.\n\nBilateral functional endoscopic sinus surgeries are identified with\nethmoidectomies and uncinectomies. The neo ostia appear patent but there is\nmucosal thickening identified in both maxillary sinuses with high-density\nmaterial within the right maxillary sinus indicative of inspissated secretions\nor fungal infection.", + "output": "1. Right frontal mucosal with thinning of the bony walls of the sinuses with\npossibly markedly thinned or absent bony wall both laterally and medially as\ndescribed.\n2. Left sphenoid mucocele with inspissated secretions or fungal infection due\nto high-density material.\n3. Bilateral functional endoscopic sinus surgeries mucosal thickening and\nhigh-density material due to inspissated secretions or fungal infection within\nthe right maxillary sinus.\n4. If patient has prior outside studies then comparison would be helpful." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Mildly prominent ventricles and sulci is compatible with age\nappropriate atrophy. Basal cisterns are patent. There is preservation of\ngray-white matter differentiation.\n\nNo acute osseous abnormalities are seen. The imaged paranasal sinuses are\nclear. Mastoid air cells and middle ear cavities are well aerated.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nDeep white matter and periventricular hypodensities are nonspecific but likely\nrepresent sequela of chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.\n\nVascular calcifications are dense.", + "output": "1. No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. There is\nprominence of the ventricles and sulci again seen, particularly in the left\nfrontotemporal lobes, demonstrated by asymmetric enlargement of the left\nfrontal and temporal horns of the lateral ventricle. Scattered\nperiventricular and subcortical white matter hypodensities, which are\nnonspecific, already seen on prior MRI. Chronic bilateral subdural hygromas\nare seen. Chronic left cerebellar stroke is seen.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.\n\nCoronary calcifications are noted in both internal carotid arteries\nparticularly at the cavernous segments.", + "output": "1. No acute infarction, hemorrhage edema or mass.\n2. Volume loss is redemonstrated, particularly in the left frontotemporal\nlobes." + }, + { + "input": "Artifact is demonstrated in the area of the right MCA secondary to stent\nassisted coiling of a prior aneurysm. Again seen are right parietal and right\nfrontal watershed infarcts, unchanged.\n\nThere is no evidence of intracranial hemorrhage, edema or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nProminent bifrontal CSF density extra-axial spaces are unchanged, likely\nrelated to atrophy. Periventricular and deep white matter hypodensities are\nnonspecific, but most likely related to chronic small vessel ischemia. \nChronic lacune in the right caudate head is unchanged.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable apart from bilateral lens replacements.", + "output": "1. No acute intracranial abnormality.\n2. Chronic right parietal and right frontal watershed infarcts in this patient\nwho is status post right MCA stent assisted coiling of prior aneurysm." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is mild\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of an acute fracture. The visualized paranasal sinuses\nare well pneumatized and clear. There is partial opacification of the right\nmastoid air cells. The left mastoid air cells are clear. The visualized\nportion of the orbits are unremarkable. Aerosolized secretions are partially\nvisualized within the right aspect of the lower oropharynx near the\nepiglottis.", + "output": "No acute intracranial process." + }, + { + "input": "Overall, there has been interval improvement of the intraventricular\nhemorrhage within the right occipital horn, with minimal residual hemorrhage. \nNo new areas of hemorrhage identified. Prominence of the ventricles is out of\nproportion to the sulci, unchanged compared to the prior exam, and may suggest\nearly hydrocephalus. Periventricular and deep white matter subcortical\nhypodensities are likely secondary to small vessel ischemic disease. The\nbasilar cisterns are patent.\n\nNo acute fractures identified. The visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The globes are unremarkable.", + "output": "1. Overall, interval improvement in the intraventricular hemorrhage, with\nminimal residual hemorrhage within the right occipital horn. No new areas of\nhemorrhage identified.\n\n2. Prominence of the ventricles out of proportion to the sulci is suggestive\nof early hydrocephalus.\n\nNOTIFICATION: ___ were d/w Dr. ___ by Dr. ___ by phone at\n4:55pm on the day of the exam." + }, + { + "input": "There is an area of mild hyperdensity in the right parietal lobe measuring\napproximately 13 mm in diameter. This is surrounded by vasogenic edema. \nAlthough this could be a consequence of a subacute hemorrhage, the subcortical\nand white matter location, rather than cortical center, argues against a\nhemorrhagic contusion. The appearance would be more concerning for a\nneoplasm. The mild hyperdensity would suggest lymphoma, but metastasis or\nglioblastoma could present a similar appearance. An abscess would be\nplausible, but these are usually not hyperdense on noncontrast CT. This would\nbe best evaluated with an MR scan without and with contrast. If the patient\ncannot undergo MR imaging, than a head CT contrast would be helpful\n\nNo other lesions are detected. There is mild prominence of the ventricles and\nsulci in an atrophic pattern.\nThere is no evidence of fracture. Right supraorbital scalp swelling is noted.\nThe patient is status post a left wall down mastoidectomy. Images of this\narea are limited by motion artifact. There appears to be minimal soft tissue\nwithin the mastoidectomy cavity. Otherwise, visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Right parietal mildly hyperdense lesion with surrounding edema. The\ndifferential diagnosis includes evolving hematoma, metastasis, lymphoma or\nglioblastoma. The hyperdensity centrally argues somewhat against an abscess\n2. Right frontal scalp swelling without underlying fracture.\n\nRECOMMENDATION(S): MR with contrast if possible. Otherwise, head CT with\ncontrast.\n\nNOTIFICATION: The revised report suggesting that the right parietal lesion\nmay represent a malignant neoplasm, or less likely abscess as well as\npotentially an evolving hematoma was discussed by telephone with ___ at\n10:40 ___ immediately upon reviewing the images by Dr. ___.\nThe findings were discussed with ___, M.D. by ___, M.D.\non the telephone on ___ at 6:09 am, 10 minutes after discovery of the\nfindings." + }, + { + "input": "No fractures are identified.\nThere is mild right supraorbital soft tissue swelling.\nVisualized paranasal sinuses are well aerated. Mucous retention cyst is noted\nin the floor of the left maxillary sinus.\nThere is no evidence of abnormal fluid collections.\nBilateral mastoids appear normal.\nThe globes, extraocular muscles, optic nerves, and retrobulbar fat appear\nnormal.\nThe visualized upper aerodigestive tract appears normal.\nThe mandible and temporomandibular joints appear normal.", + "output": "No evidence of fracture. Mild right frontal scalp swelling." + }, + { + "input": "There is a thin rim of peripheral enhancement surrounding the right parietal\nlobe hyperdense lesion (2:20, 601b:73). There is relatively mild surrounding\nvasogenic edema. There is no evidence of fracture, infarction, new\nhemorrhagic (within the limitation of a contrast enhanced study) or midline\nshift. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThe visualized portion of the paranasal sinuses are notable for mild mucosal\nthickening of the ethmoid air cells and the right and left maxillary sinuses. \nThe remainder of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. Patient is status post bilateral lens replacement. The\nvisualized portion of the orbits are unremarkable.", + "output": "Thin rim of peripheral enhancement surrounding the small area of central\nhyperdensity within the right parietal lobe may represent a subacute/resolving\nintraparenchymal hematoma. Please note that underlying mass is not excluded\nand continued followup will be necessary. Abscess is also possible though\nconsidered less likely given lack of surrounding edema.\n\nRECOMMENDATION(S): Continued follow-up imaging in ___ months to ensure\nexpected evolution of suspected intraparenchymal hematoma is recommended.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:25 am, 3 minutes after\ndiscovery of the findings." + }, + { + "input": "Patient is status post resection of the known lesion in the right parietal\nbone with postsurgical changes including surgical bed hemorrhage,\npneumocephalus and minimal fluid. Evaluation of the osseous structures and\nthe craniectomy site is limited due to a metallic plate in place and\npostsurgical changes. There is subcutaneous emphysema and postsurgical blood\nproducts in the soft tissues overlying the craniotomy site. There is no\nevidence of intracranial hemorrhage, infarction, edema or intracranial mass. \nMinimal crowding of the gyri in the right parietal lobe is likely due to small\npneumocephalus. The ventricles and sulci are normal in size and\nconfiguration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Status post resection of the right parietal osseous lesion with\npostsurgical changes. No intraparenchymal hemorrhage or infarction." + }, + { + "input": "Patient is status post interval drainage of a right parietal brain abscess\nwith placement of a subdural drainage catheter in the region of previous right\nparietal craniectomy for resection of a calvarial lesion. There is persistent\nedema of the posterior right frontal and right parietal lobes with new trace\nblood products and pneumocephalus in the area of the drained abscess (03:30). \nPreviously seen leftward midline shift has improved, now measuring up to 4 mm,\npreviously 6 mm (03:21). Effacement of the surrounding sulci is unchanged. \nThere is persistent moderate effacement of the body of the right lateral\nventricle. There is unchanged mild dilatation of the occipital horn of the\nright frontal lobe (03:15). There is no subdural hematoma or intraventricular\nblood products.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Expected postoperative appearance following interval drainage of right\nparietal abscess and placement of a subdural drainage catheter with trace\nblood products and pneumocephalus in the abscess cavity.\n2. Leftward midline shift is decreased, now measuring up to 4 mm with\npersistent effacement of the right cerebral sulci and the body of the right\nlateral ventricle." + }, + { + "input": "The craniectomy is identified in the right parietal region. Subtle\nencephalomalacia is seen in this region is hypodensity. This is unchanged\nfrom the MRI of ___. No acute hemorrhage mass effect or new areas\nof hypodensity are seen. No hydrocephalus.", + "output": "Right parietal craniectomy and associated encephalomalacia changes in the\nparietal lobe are identified. No acute abnormalities." + }, + { + "input": "Patient is status post right craniectomy for right-sided skull lesion. The\nadjacent right parietal hypodensity is stable and may represent\nencephalomalacia and unchanged since ___. There is no evidence of\nacute large territorial infarction, intracranial hemorrhage, or mass effect.\n\nThe ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Stable postsurgical changes related to recent right craniectomy. Stable\nright parietal encephalomalacia adjacent to the right craniectomy site.\n2. No evidence of acute intracranial process." + }, + { + "input": "Status post right parietal cranioplasty is new since prior. There is stable\nzone of encephalomalacia in the right parietal lobe, deep to the surgical bed.\nThere is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Interval right parietal cranioplasty.\nStable zone of encephalomalacia right parietal lobe." + }, + { + "input": "The patient is status post right parietal craniectomy. Deep to the\ncraniectomy site there is linear dural enhancement which is most likely\npostsurgical in nature. Small area of encephalomalacia deep to this in the\nright parietal area demonstrates normal expected evolution. No abnormal\nintracranial enhancing lesions. No new masses. The ventricular profile is\nnormal. The dural venous sinuses appear patent. There is no evidence for\nacute large territory infarct or intracranial hemorrhage. The paranasal\nsinuses are clear. The orbits are unremarkable. The mastoid air cells middle\nears are well pneumatized and clear.", + "output": "1. Stable postsurgical changes in the right parietal area. Normal expected\nevolution of the underlying cystic encephalomalacia.\n2. No new masses or abnormal enhancing lesions." + }, + { + "input": "There is a well-defined approximately 2.5 x 1.5 cm lesion identified in the\nright parietal bone with well-defined margins with internal matrix. Subtle\nsoft tissue prominence is seen along the outer aspect of the lesion.\nThe ventricles and extra-axial spaces are normal in size without midline shift\nmass effect seen. No hydrocephalus noted. No brain edema is identified\nadjacent to the lesion.\nThe visualized paranasal sinuses are clear. No skull fracture is seen.", + "output": "Well-circumscribed lesion with internal matrix and expansion could be due to\nhemangioma but given presence of subtle adjacent soft tissues, an aggressive\nlesion could not be completely excluded and further evaluation with MRI of the\nbrain with gadolinium is recommended.\n\nRECOMMENDATION(S): MRI of the brain with gadolinium." + }, + { + "input": "Palatine tonsils are prominent bilaterally with hyperemia and subtle\nheterogeneity without discrete abscess formation. Findings are most suggestive\nof tonsillitis. There is mild, non critical narrowing of the airway. No\nretropharyngral thickening. The salivary glands enhance normally and are\nwithout mass or adjacent fat stranding. The thyroid gland appears normal.\nThere is no lymphadenopathy by CT criteria. The neck vessels are patent. The\nimaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions. Left chest wall port line is\nseen in the left IJ vein, incompletely visualized.", + "output": "Tonsillitis -- no drainable collection." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect.\n\nThe palatine tonsils are enlarged and hyperemic, right worse than left, with\nareas of internal hypodensity likely reflective of phlegmon. No drainable\nfluid collection. The salivary glands enhance normally and are without mass or\nadjacent fat stranding. The thyroid gland appears normal. Bilateral enlarged\nlevel II lymph nodes are likely reactive. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions. There are small mucous\nretention cysts in the right maxillary sinus. There is mild mild mucosal\nthickening in the ethmoid air cells.", + "output": "Palatine tonsillitis, right worse than left, with findings suggestive of\ninternal phlegmon. No drainable fluid collection." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Basilar cisterns are\npatent.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is a mass the left temporal lobe unchanged from the CT on ___.\nThis most likely represents a low-grade neoplasm. There is no evidence of\ninfarction, hemorrhage. The ventricles and sulci are normal in size and\nconfiguration. No osseous abnormalities seen. The paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The orbits are unremarkable.", + "output": "1. Left temporal lobe mass which most likely represents a low-grade neoplasm." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or infarction. Re-\ndemonstrated hypodensity left medial temporal lobe There are expected postop\nsurgical changes including intracranial air. The ventricles and sulci are\nnormal in size and configuration. Staples are noted over the left scalp.\n\n\nThe basal cisterns appear patent and there is preservation of gray-white\nmatter differentiation.\n\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\n\nThe globes are unremarkable.", + "output": "Expected postoperative surgical changes, including pneumocephalus." + }, + { + "input": "Postoperative changes of left temporal mass resection are seen. Hyperdense\ncomponent seen in the postoperative bed compatible with blood products.\nAdjacent foci of air and pneumocephalus overlying the left frontal lobe are\nnoted. Otherwise, there has been no change. There is no evidence of acute\ninfarct, unexpected hemorrhage or midline shift.\n\nIncluded paranasal sinuses and mastoids are clear. Besides post craniotomy\nchanges, extracranial soft tissues are unremarkable.", + "output": "Expected postoperative changes of left temporal lobe mass resection." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction, mass or midline\nshift. Prominence of the ventricles and sulci, particularly within the\nbilateral frontal extra-axial spaces and the right middle cranial fossa are\nlikely secondary to age related involutional changes. Periventricular and deep\ncortical white matter hypodensities are likely related to small vessel\nischemic disease. The basilar cisterns are patent and there is otherwise\npreservation of the gray-white matter differentiation.\n\nNo acute fractures identified. The visualized paranasal sinuses, mastoid air\ncells and middle ear cavities are clear. Right pthisus bulbi with\ncalcifications is unchanged.", + "output": "No acute intracranial abnormalities identified." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territory infarct. Gray-white matter\ndifferentiation is preserved. There is no hydrocephalus. The visualized\nparanasal sinuses are clear. The mastoid air cells are clear. No acute\nfracture is seen.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST: There is no evidence of no evidence of infarction,\nhemorrhage, edema, or mass. The ventricles and sulci are normal in size and\nconfiguration.The visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the orbits\nare unremarkable.\n\nCTA HEAD: The vessels of the circle of ___ and their principal intracranial\nbranches appear normal without stenosis, occlusion or aneurysm formation. \nThere is a hypoplastic right A1 segment, a normal variant. The dural venous\nsinuses are patent.\n\nCTA NECK: There is an aberrant right subclavian artery which courses behind\nthe esophagus. The artery is not dilated. There is common origin of the\nright common carotid in left common carotid arteries (05:29). The vertebral,\ncommon, and internal carotid arteries appear normal without evidence of\nstenosis, aneurysm or dissection. There is no internal carotid stenosis by\nNASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits.", + "output": "1. No evidence of dissection or flow limiting stenosis in the head or neck. \nHypoplastic right A1 segment, a common variant.\n2. Aberrant right subclavian artery coursing behind the esophagus without\naneurysmal dilatation." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nlarge territorial infarction.\n\nThe ventricles and sulci are normal in size and configuration. There is\nsubcortical and periventricular white matter hypodensities, which are most\nlikely sequela of chronic small vessel ischemic disease.\n\nThe basal cisterns appear patent and there is preservation of gray-white\nmatter differentiation.\n\nThe visualized bony structures are grossly unremarkable. Left ethmoid and\nnasal cavity mucosal thickening with tube. The paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The globes are unremarkable.", + "output": "No acute intracranial hemorrhage, mass effect, or large territory infarct.\nIf continued to have clinical concern, MRI is more sensitive and can be\nconsidered if not CI to further evaluate for intracranial changes, etc" + }, + { + "input": "There is no evidence of acute large territorial infarction, acute intracranial\nhemorrhage, edema, or mass. Prominent ventricles and sulci suggest age related\nglobal atrophy. Periventricular and subcortical white matter hypodensities\nare nonspecific, but likely reflect sequelae of chronic small vessel ischemic\ndisease. The basal cisterns appear patent and there is preservation of\ngray-white matter differentiation.\n\nThere is no evidence of fracture oracute osseous abnormalities. There is\nminimal mucosal thickening of the frontoethmoidal recess bilaterally. The\nremaining visualized portion of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable. Atherosclerotic calcifications of the carotid siphons are noted\nbilaterally.", + "output": "1. No acute intracranial abnormality.\n\n2. Parenchymal atrophy and chronic small vessel ischemic disease." + }, + { + "input": "There is no evidence of no evidence of acute territorial infarction, \nhemorrhage, edema, or mass. Prominence of the ventricles and sulci is\ncompatible with generally appropriate age-related atrophy. Periventricular\nand subcortical white matter hypodensity is compatible with the sequelae of\nchronic small vessel ischemic change. There is no abnormal enhancement on\npost contrast images.\n\nThere is no evidence of fracture or osseous abnormality. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial process. No abnormal enhancement on postcontrast\nimages.\n2. Chronic findings including age-appropriate global atrophy and white matter\nchronic small vessel ischemic changes.\n\nRECOMMENDATION(S): No evidence of acute intracranial process or abnormal\nenhancement. However, MRI would be more sensitive for subtle metastatic\ndisease if there are no contraindications." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territorial infarct. Prominence of the\nventricles and sulci is consistent with atrophy. Periventricular and\nsubcortical white matter hypodensities are likely sequelae of chronic small\nvessel disease. The visualized paranasal sinuses demonstrate mucosal\nthickening with possible small amount of fluid in the right maxillary sinus. \nThere is also some opacification of bilateral ethmoid air cells.. The mastoid\nair cells are clear. No acute fracture is seen.", + "output": "No acute intracranial process." + }, + { + "input": "Images were repeated due to motion artifact on the initial scan. There is no\nevidence of acute hemorrhage, edema, or mass effect. Prominent ventricles and\nsulci likely reflect age related age-related parenchymal involutional changes.\nScattered periventricular and deep white matter hypodensities, while\nnonspecific likely reflect sequela of chronic small vessel ischemic disease. \nThere is no shift of normally midline structures. Basal cisterns are patent.\n\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nNo concerning osseous lesion is seen. The orbits are unremarkable.", + "output": "No evidence for acute intracranial abnormalities." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nPeriventricular and subcortical white matter hypodensities are nonspecific but\nlikely sequelae of chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. There is mild left maxillary sinus, ethmoid\nair cell, and left sphenoid sinus mucosal thickening. The visualized portion\nof the paranasal sinuses, mastoid air cells, and middle ear cavities\notherwiseare clear. The visualized portion of the orbits are unremarkable. \nIncidental note is made a cavernous carotid and vertebral artery\ncalcifications.", + "output": "1. No acute intracranial abnormality.\n2. Global atrophy and chronic small vessel ischemic changes.\n3. Paranasal sinus disease." + }, + { + "input": "Deep white matter periventricular hypodensities are nonspecific but likely\nrepresent sequela of chronic small vessel ischemic disease. There is no\nevidence of infarction, hemorrhage, edema, or mass effect. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Mild mucosal thickening is seen within the\nethmoid air cells bilaterally. There is near complete opacification of the\nleft mastoid air cells without osseous destruction as well as opacification of\nthe left middle ear cavity. Partial opacification of the right inferior\nmastoid air cells are also noted with the right middle ear cavity appearing\nclear. The visualized portion of the remaining paranasal sinusesare clear. \nThe visualized portion of the orbits are unremarkable. Soft tissue density in\nthe left external auditory canal likely reflects cerumen.", + "output": "1. No acute intracranial abnormality.\n2. Near complete opacification of the left mastoid air cells and opacification\nof the left middle ear cavity, without evidence of osseous destruction,\nfindings suggestive of acute uncomplicated otomastoiditis." + }, + { + "input": "A right temporoparieto-occipital subdural collection measures approximately\n1.1 cm at its greatest diameter (previously 1.2 cm) and is stable in size\ncompared to the prior examination done today at 08:10 and outside hospital\nexamination. There is no evidence of midline shift. Mild local sulcal\neffacement and mass effect of the right parietal lobe is unchanged. The basal\ncisterns are patent. No large territorial infarction or new area of\nhemorrhage is identified. As before, the ventricles and sulci are somewhat\nprominent for age.\n\nNo fractures are identified. The paranasal sinuses and mastoid air cells are\nclear.", + "output": "1. Stable right temporoparieto-occipital subdural hematoma. No evidence of\nnew hemorrhage or acute territorial infarction." + }, + { + "input": "A subdural hematoma layering along the right parieto-occipital lobe measures\napproximately 1.2 cm at its greatest diameter, stable in size from the prior\nexamination dated ___. Unchanged subtle subdural hematoma\noverlying the left parietal occipital lobe since outside hospital examination\nof ___. There is mild adjacent mass effect without appreciable\nmidline shift, also similar in appearance the prior examination.\n\nThere is no new foci of intracranial hemorrhage. No evidence for large\nvascular territorial infarction. The basal cisterns remain patent. The\nventricles and sulci remain somewhat prominent given the patient's age,\nsimilar to the prior examination.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Stable, moderate right parieto-occipital subdural hematoma. Unchanged trace\nleft parietal occipital subdural hematoma since outside hospital examination\nof ___. No evidence for new intracranial hemorrhage or acute\nvascular territorial infarction." + }, + { + "input": "Previously noted right greater than left subdural hematomas have resolved. \nRight parietal/occipital sulcal effacement has resolved. There is no acute\nintracranial hemorrhage, edema, mass effect, or loss of gray/ white matter\ndifferentiation. The ventricles, sulci, and basal cisterns are mildly\nprominent for age, as seen previously.\n\nNo evidence for a fracture is seen. The partially imaged paranasal sinuses and\nmastoid air cells are well aerated. Partially visualized orbits are\nunremarkable.", + "output": "1. Resolution of right greater than left subdural hematomas and right\nparietal/ occipital sulcal effacement since ___.\n2. No evidence for acute intracranial abnormalities or fractures." + }, + { + "input": "A right temporoparietoccipital subdural collection is seen measuring 1.2 cm,\nstable in size compared to the prior outside hospital same day study, with\nunchanged effacement of adjacent sulci. There is no evidence of midline\nshift. There are prominent ventricles and sulci,, greater than expected for\npatient of this age.\n\nNo fracture is seen. The imaged paranasal sinuses are clear. Mastoid air\ncells and middle ear cavities are well aerated.", + "output": "1. Stable size of right temporoparietoccipital subdural hematoma measuring 1.2\ncm in maximum dimension with unchanged adjacent sulcal effacement. No midline\nshift.\n2. Mildly prominent ventricles and sulci, significantly greater than expected\nfor patient of this age." + }, + { + "input": "SOFT TISSUES: Some foci of air in the right cavernous sinus is seen, which\ncould represent venous air. No inflammatory soft tissue stranding is seen. A\nnasogastric tube and endotracheal tube are seen. Secretions in the\nairway/narrowing are noted.\n\nMAXILLOFACIAL BONES: The maxillofacial bones are intact, without fracture.\nThe zygomatico-maxillary complex is intact. The lateral pterygoid plates are\nintact.\n\nMANDIBLE: The mandible is without fracture or temporomandibular joint\ndislocation.\n\nSINUSES: The paranasal sinuses are intact and clear. The ostiomeatal units\nare patent. The mastoid air cells and middle ear cavities are clear.\n\nNOSE: There is no nasal bone fracture.\n\nORBITS: The orbits, including the laminae papyracea, are intact. The globes\nare intact with non-displaced lenses and no intraocular hematoma. There is no\npreseptal soft tissue edema. There is no retrobulbar hematoma or fat\nstranding.", + "output": "1. No evidence of fracture.\n2. Scattered foci of air within the right cavernous sinus, likely venous air\npossible from IV." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass. \nNonspecific left sub insular and bilateral parietal periventricular\nwhite-matter hypodensities appear unchanged and may represent the sequela of\nchronic small vessel ischemic disease (02:17, 02:13). The ventricles and\nsulci are normal in size and configuration for the patient's age.\n\nNo osseous abnormalities seen. Evidence of prior left maxillary antrostomy is\nnoted. There is minimal mucosal thickening in the left maxillary sinus. \nRemaining paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The orbits are unremarkable. Mild atherosclerotic calcifications of\nthe cavernous carotid arteries are demonstrated.", + "output": "1. No acute intracranial process.\n2. Unchanged hypodensities in the parietal lobes bilaterally and left sub\ninsular region may represent the sequela of chronic microvascular infarction." + }, + { + "input": "The examination is mildly to moderately motion degraded despite repeat\nacquisition. Within this confine:\n\n1.1 cm hyperdensity along the right aspect of the occipital lobe within the\nposterior fossa described in the wet read is an asymmetrically prominent\ntorcula and right sided transverse sinus, a normal anatomic variant. There is\nno evidence of acute large territorial infarction, intracranial hemorrhage,\nedema, or mass effect. The ventricles and sulci are normal in size and\nconfiguration.\n\nNo osseous abnormalities seen. There are mucous retention cysts in the left\nmaxillary sinus. Otherwise, the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. Allowing for motion degradation, unremarkable CT Head without evidence of\nacute large territory infarct or intracranial hemorrhage.\n2. No displaced calvarial fracture.\n3. Hyperdensity in the right aspect of the occipital lobe described in\nresident wet read represents the torcula and right transverse sinus. No\nevidence of abnormal hyperdensity to suggest thrombosis.\n\nNOTIFICATION: The above findings were communicated to the surgical team,\nmoments after the exam was completed." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nAgain noted is a prominent right transverse sinus and torcula, a normal\nanatomic variant.\n\nThere is mucosal thickening in the bilateral ethmoid air cells. Mastoid air\ncells and middle ear cavities are well aerated. There is no displaced\ncalvarial fracture.", + "output": "No acute intracranial process. Again noted is a prominent transverse sinus\nand torcula, a normal anatomic variant." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are prominent, consistent with atrophy. Nonspecific periventricular\nand subcortical white matter hypodensities are slightly progressed compared to\nthe prior exam and are suggestive of chronic microvascular ischemic disease. \nDense vascular arteriosclerotic calcifications are present in the carotid\nsiphons and vertebral arteries.\n\nNo osseous abnormalities seen. The patient is status post bilateral\nuncinectomies. The left maxillary sinus is completely opacified, in the right\nmaxillary sinus is partially opacified. Additionally, the right sphenoid shine\nsinus has moderate mucosal thickening. The frontal sinuses are underdeveloped.\nThe orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Dental almalgam streak artifact limits study. There is no evidence of\ninfarction, hemorrhage, edema, or mass effect. Prominent ventricles and sulci\nare suggestive of age-related involutional change. Periventricular,\nsubcortical, and deep white matter hypodensities are similar in distribution\ncompared to ___, and again likely represent sequela of chronic small\nvessel ischemic disease.\nThere is no evidence of fracture. The patient appears to be status post left\nantrostomy. The bilateral maxillary sinuses and right sphenoid sinus\ndemonstrate mucosal thickening, right greater than left. The other visualized\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. \nThere is periapical lucency involving the maxillary second molars bilaterally,\nsuggestive of periodontal disease. This is unchanged compared to ___. \nThe visualized portion of the orbits are unremarkable. Again noted bilateral\nmaxillary wisdom teeth impacted against roots of suspected maxillary second\nmolars.", + "output": "1. Dental almalgam streak artifact limits study.\n2. No acute hemorrhage or fracture.\n3. Paranasal sinus disease as described." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nThere are calcified and noncalcified plaques of the common carotid arteries,\nworse at the carotid bifurcations resulting in approximately 70% right and 60\n% left proximal internal carotid artery stenosis by NASCET criteria. There is\nmild-to-moderate narrowing of the right vertebral artery at its origin. There\nis calcified plaque at the origin of the left vertebral artery without\nsignificant stenosis.\n\nThere is calcification of the aortic arch and origins of the great vessels\nwith mild narrowing of the proximal right subclavian artery. There is no\nevidence of dissection.\n\nThe visualized lung parenchyma appears grossly clear. There is a 8 mm left\nthyroid nodule. There is no lymphadenopathy per size criteria. Healed left\nproximal first rib fracture is noted (see 2:69).", + "output": "1. Dental amalgam streak artifact limits study.\n2. Extensive calcified and noncalcified plaque of the common carotid arteries\nand at the carotid bifurcations resulting in approximately 70% right and 60%\nleft proximal internal carotid artery stenosis by NASCET criteria.\n3. Mild-to-moderate right vertebral artery narrowing at its origin. Patency\nof the distal vertebral artery.\n4. Limited imaging of posterior fossa circulation demonstrates irregular\nnonocclusive stenosis of right V4 segment of vertebral artery.\n5. 8 mm left thyroid lobe nodule. The ___ College of Radiology\nguidelines suggest that in the absence of risk factors for thyroid cancer, no\nfurther evaluation is recommended." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. There is small chronic lacunar infarct in the left caudate nucleus,\nstable since prior. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. There are severe chronic small vessel\nischemic changes, stable since prior.\n\nThere is no evidence of fracture. There is mucosal thickening of the left\nmaxillary sinus and right sphenoid sinus, with areas of mild chronic\nosteitis.. The visualized portion of the other paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Severe chronic small vessel ischemic changes, generalized parenchymal\natrophy." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Hydrocephalus appears stable or minimally improved. Evolving subarachnoid\nhemorrhage in the bilateral sylvian fissures left occipital lobe,\ninterpeduncular cistern and prepontine cistern is overall stable. Apparent\nslightly increased blood products layering in the bilateral occipital horns of\nthe lateral ventricles may reflect redistribution. No definite new\nintracranial hemorrhage. No CT evidence of acute infarct. Overall stable or\nslightly improved periventricular white matter hypodensities. The visualized\nparanasal sinuses, middle ear, and mastoid air cells are clear.", + "output": "1. Hydrocephalus appears stable or mildly improved.\n2. Overall less prominent, evolving subarachnoid hemorrhage.\n3. Slightly increased layering intraventricular hemorrhage may reflect\nredistribution.\n4. No definite new intracranial hemorrhage or infarct." + }, + { + "input": "Overall stable or slightly improved evolving multicompartmental hemorrhage\nincluding subarachnoid hemorrhage along the bilateral anterior temporal lobes,\nSylvian fissures, interpeduncular, prepontine, premedullary and quadrigeminal\ncisterns, and bilateral occipital lobes and parietal lobes. Hemorrhage\nlayering in the bilateral occipital horns of the lateral ventricles appears\nslightly less prominent which may reflect combination of evolution and\nredistribution. Ventricles are overall stable in size and configuration. \nPeriventricular confluent white matter hypodensities which may suggest mild\ntransependymal CSF appear stable. No definite new intracranial hemorrhage or\nnew infarct. No midline shift.", + "output": "1. No significant increase in the evolving multicompartmental intracranial\nhemorrhage.\n2. No definite new hemorrhage or infarct.\n3. Stable ventricular size." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nContinued decrease of the perimesencephalic subarachnoid hemorrhage. A small\namount of bilateral temporal and parietal subarachnoid hemorrhage remains, not\nsignificantly changed from the most recent prior exam. There is no evidence\nof new intracranial hemorrhage or acute territory infarction.\n\nA small amount of blood layering in the bilateral occipital horns appears\nsimilar to the most recent prior study and is likely due to redistribution.\nThe ventricular system appears stable in size and configuration. There is no\nmidline shift.\n\nThere are diffuse periventricular hypodensities, unchanged from prior and\nlikely representing a sequela of chronic microangiopathy.\n\nThere is mild mucosal thickening in the posterior right ethmoid air cells. \nThe remainder of the paranasal sinuses appears centrally clear. There are\nsmall soft tissue densities in the bilateral external auditory canals, most\nlikely representing cerumen. The visualized portion of the mastoid air\ncells,and middle ear cavities are clear. Again noted is a left eye\nprosthesis. Postsurgical changes after right lens replacement are again\nnoted. The right orbit appears otherwise unremarkable.\n\nCTA HEAD:\nThere are extensive atherosclerotic changes along both carotid siphons\nresulting in focal severe stenosis of the on left cavernous ICA (series 3,\nimage 41 and series 309, image 11) as well as focal moderate stenosis of the\nright cavernous ICA (series 3, image 42 and series 310, image 11).\nThere are mild irregularities along both intradural vertebral arteries, likely\ndue to intracranial atherosclerotic changes.\nThe vessels of the circle of ___ and their principal intracranial branches\nappear otherwise unremarkable with no evidence of stenosis,\nocclusion,oraneurysm.", + "output": "1. Decrease of the perimesencephalic subarachnoid hemorrhage. Stable\nbilateral temporal and parietal subarachnoid hemorrhage and small amount of\nintraventricular blood canal likely due to redistribution.\n2. Stable size and configuration of the ventricular system. No midline shift.\n3. Focal severe stenosis of the left cavernous ICA and focal moderate stenosis\nof the right cavernous ICA.\n4. Otherwise patent intracranial vasculature without evidence of high-grade\nstenosis, vessel occlusion or aneurysm formation greater than 3 mm." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nThere are periventricular and subcortical lucencies, which may represent small\nvessel ischemic changes.\n\nThe visualized portion of the mastoid air cells,and middle ear cavities are\nclear. The visualized portion of the orbits again demonstrate left globe\nprosthesis.. Minimal bilateral ethmoid air cell mucosal thickening is\npresent.\n\nCTA HEAD:\n Nonocclusive severe left and moderate right atherosclerotic narrowing of the\ncavernous and supraclinoid segments of the bilateral internal carotid arteries\nare seen. Nonocclusive atherosclerotic narrowing of the left proximal\ninternal carotid artery petrous segment is again seen (see 03:35 on current\nstudy and 03:32 on prior exam). Grossly stable known nonocclusive\nirregularity of left V4 segment is again seen. Otherwise, the vessels of the\ncircle of ___ and their principal intracranial branches appear grossly\npreserved with no definite evidence of stenosis, occlusion,oraneurysm greater\nthan 3 mm. The dural venous sinuses are grossly patent.\n\nOTHER:\nLimited imaging of the cervical spine on scout imaging again demonstrates\nextensive multilevel cervical spondylosis.", + "output": "1. Interval resolution of previously noted subarachnoid interventricular\nhemorrhage.\n2. No acute intracranial abnormality, no definite evidence acute intracranial\nhemorrhage.\n3. Grossly stable nonocclusive probable atherosclerotic narrowing of circle of\n___ as described.\n4. Otherwise, grossly patent circle of ___ without definite evidence of\nstenosis,occlusion,or aneurysm greater than 3 mm." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is acute subarachnoid hemorrhage on the left seen predominantly within\nleft temporal, frontal, and parietal sulci, the majority of which is seen\nlayering in the dependent aspect of the sylvian fissure on the left, with\nsmaller amounts seen in the anterior left temporal fossa (02:14) along the\nfrontal parafalcine region and left frontal convexity (02:19). No definite\ninterventricular extension identified. No other foci of acute intracranial\nhemorrhage seen. There is no evidence of acute intracranial large vascular\nterritorial infarction, edema, mass, or mass effect. The basal cisterns are\npatent, and there is no shift of the normally midline structures. The\nventricles and sulci are prominent, in keeping with global involutional\nchanges.\n\nThere is no evidence of an acute fracture. Postsurgical changes are seen in\nthe left nasal cavity. The left maxillary sinus is atelectatic or\ncongenitally diminutive. There is mild right maxillary sinus mucosal\nthickening frontal sinuses are well pneumatized and clear. The mastoid air\ncells and middle ear cavities are well pneumatized and clear. Carotid siphon\ncalcifications are noted bilaterally. The patient is status post bilateral\nlens removal; otherwise, the globes and orbits are intact and unremarkable. \nSclerotic changes are visualized in the posterior wall of the left maxillary\nbone, extending towards the maxilla and inferior aspect of the ethmoidal air\ncells, suggesting mild diffuse hyperostosis, the possibility of fibrous\ndysplasia is a consideration.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nPatchy areas of ground-glass in the lung apices likely reflect atelectasis. \nThere is a 5 mm nodule at the right lung apex posteriorly (03:32). There is\nan enlarged and calcified left thyroid lobe which is heterogeneous likely\nreflecting small nodules. There is no cervical lymphadenopathy. No visible\nmediastinal or supraclavicular lymphadenopathy.", + "output": "1. Acute left-sided subarachnoid hemorrhage, with majority blood products seen\nlayering dependently in the sylvian fissure, as well as in the left anterior\ntemporal fossa, with additional smaller volume foci seen along the parafalcine\nleft frontal lobe, left frontal convexity, and left temporoparietal and\nfrontal sulci. Findings are not appreciably changed from outside hospital\nhead CT from ___ performed at 16:08.\n2. Unremarkable CTA head and neck examination without aneurysm, significant\nstenosis, or occlusion.\n3. No evidence of acute intracranial large vascular territorial infarction. \nNo significant mass effect.\n4. Chronic findings include global involutional changes and vascular\ncalcifications.\n5. Incidentally noted 5 mm right apical lung nodule.\n6. Calcified and heterogeneous and enlarged left thyroid lobe, likely\nreflecting nodules.\n\nRECOMMENDATION(S):\n1. Nonurgent/routine thyroid ultrasound if enlarged heterogeneous left thyroid\nlobe is not a previously known/imaged finding.\n2. For incidentally detected single solid pulmonary nodule smaller than 6 mm,\nno CT follow-up is recommended in a low-risk patient, and an optional CT in 12\nmonths is recommended in a high-risk patient.\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" + }, + { + "input": "Previously seen subarachnoid hemorrhage has resolved. No new hemorrhage is\nseen. Mild-to-moderate brain atrophy identified. No acute skull fracture is\nseen. Changes of chronic sinusitis are seen in the left sphenoid sinus with\nsclerotic is CIS at the margin and opacification as before.", + "output": "Resolution of previously seen subarachnoid blood. No new hemorrhage. No\nhydrocephalus." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of large vascular territory infarction, hemorrhage, or\nedema. There is mild age-related involutional changes involving the ventricles\nand sulci.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is minimal tortuosity of the right\nvertebral artery at the transition between the V2 and V3 segments (3:167).\nPatient has a left vertebral artery dominant system. There is no evidence of\ninternal carotid stenosis by NASCET criteria.\n\nOTHER: 7 mm hypodensity in the right thyroid lobe for which no further\nfollow-up is recommended (3:77).", + "output": "1. No significant abnormalities on CT of the head without contrast.\n2. No significant abnormalities on CT angiography of the head.\n3. Slight tortuosity of the right vertebral artery V3 segment could be due to\nfibromuscular dysplasia current no dissection seen. No vascular occlusion. \nNo evidence of high-grade stenosis." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. Partially empty sella again\nnoted.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process. Partially empty sella." + }, + { + "input": "There is chronic appearing left precentral gyrus tissue loss, new since ___. Bilateral cerebellar hypodense areas are likely chronic ischemic\nlacunes. There is no evidence of new infarction, hemorrhage, edema, or mass.\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Periventricular and subcortical white matter hypodensities are\nnonspecific but likely sequelae of chronic small vessel ischemic disease. \nSubcortical white matter calcifications (04:21) may be related to a\ndevelopmental venous anomaly.\n\nAn OG tube is coiled within the oropharynx. There is no evidence of fracture.\nThere are right maxillary and ethmoid air cell mucous retention cysts. The\nother visualized paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable. Cavernous\ncarotid calcifications are noted", + "output": "1. No evidence of hemorrhage, new infarction, or other significant\nintracranial abnormalities.\n2. Chronic left precentral gyrus and bilateral cerebellar hypodensities are\nlikely related to chronic infarctions. Cerebellar hypodensities possibly\nsubacute.\n3. Age-appropriate atrophy and probable chronic small-vessel ischemic changes.\n4. Paranasal sinus disease as described above.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ on the telephoneon ___ at 4:53 ___, approximately 30\nminutes after discovery of the findings." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. There\nis prominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is fluid within the left maxillary sinus with mucosal hypertrophy. \nThere remaining paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. Status post right lens replacement, left lens appears intact.", + "output": "1. No evidence of acute intracranial abnormalities.\n2. Partial opacification of left maxillary sinus." + }, + { + "input": "Dental almalgam streak artifact limits study.\n\nEvaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect. A linear density within the right vallecula measuring\napproximately 1.1 cm is consistent with a foreign body (2:65-68). A tiny\nhyperdensity within the left aspect of the vallecular may represent an\nadditional fragment of the similar foreign body (2:69). There is no evidence\nof perforation or air outside of the oropharynx. No other foreign bodies are\nidentified.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. Mildly prominent bilateral lymph nodes, most pronounced at level\nIIa, that are not enlarged by CT size criteria are noted. The neck vessels are\npatent. Trace fluid is seen within the right anterior ethmoidal air cells\n(02:108). Numerous tonsilliths suggest remote prior infections (2:83). An\napproximately 4 mm right thyroid lobe nodule is noted (see 02:39).\n\nThe imaged portion of the lung apices contain a 4 mm left upper lobe pulmonary\nnodule (02:40). There are no osseous lesions. Moderate multilevel\ndegenerative changes are noted the cervical spine.", + "output": "1. Dental almalgam streak artifact limits study.\n2. Linear density within the right vallecula measuring approximately 1.1 cm\nconsistent with a foreign body, possible tiny foreign body within the left\nvallecula as well. No evidence of perforation.\n3. 4.5 mm left upper lobe pulmonary nodule. The ___ pulmonary\nnodule guidelines suggest for pulmonary nodules greater than 4 mm or less than\n6 mm, 12 month follow-up in low-risk patients, and ___ month follow-up in\nhigh risk patients.\n4. 4 mm right thyroid lobe nodule. The ___ College of Radiology\nguidelines suggest that in the absence of risk factors for thyroid cancer, no\nfurther evaluation is recommended.\n5. Nonspecific prominent bilateral cervical lymph nodes, especially at\nbilateral level IIa, not definitely enlarged by CT size criteria. While\nfindings may be reactive in nature, inflammatory or neoplastic etiologies are\nnot excluded on the basis examination. Recommend attention on followup\nimaging.\n6. Paranasal sinus disease as described.\n\nRECOMMENDATION(S):\n1. 4.5 mm left upper lobe pulmonary nodule. The ___ pulmonary\nnodule guidelines suggest for pulmonary nodules greater than 4 mm or less than\n6 mm, 12 month follow-up in low-risk patients, and ___ month follow-up in\nhigh risk patients.\n2. Nonspecific prominent bilateral cervical lymph nodes, especially at\nbilateral level IIa, not definitely enlarged by CT size criteria. While\nfindings may be reactive in nature, inflammatory or neoplastic etiologies are\nnot excluded on the basis examination. Recommend attention on followup\nimaging.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 4:36 ___, 2 minutes after\ndiscovery of the findings." + }, + { + "input": "Re-demonstrated is extensive encephalomalacia of bilateral frontal lobes, left\ntemporal lobe, and anterior right temporal lobe, similar extent to the prior\nstudy.\nThere is no intra-axial or extra-axial hemorrhage, shift of normally midline\nstructures, or evidence of acute major vascular territorial infarction. \nProminence of the ventricles and sulci suggest involutional changes, similar\nin extent compared to multiple prior studies.. There is a 1.3 cm a frontal\nsinus osteoma. The remaining imaged paranasal sinuses are clear. Mastoid air\ncells and middle ear cavities are well aerated. The bony calvarium is intact.", + "output": "1. No acute intracranial abnormality.\n2. Extensive encephalomalacia of the frontal lobes and temporal lobes, left\ngreater than right, similar in extent compared to multiple prior studies." + }, + { + "input": "Interval placement of a ventriculostomy drain via a left frontal approach,\nwith the tip terminating in body of the left lateral ventricle immediately\nadjacent to the septum pellucidum.\n\nGrossly stable extensive encephalomalacia of bilateral frontal lobes left\ntemporal lobe and anterior right temporal lobe is noted. There is no acute\nintracranial hemorrhage or shift of normally midline structures. There is no\nacute large territory infarction.\n\nThe ventricular system remains prominent, stable from prior.\n\nThe bony calvarium is intact. Again seen is a 1.2 cm frontal sinus osteoma.\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable. Soft tissue densities are noted within bilateral external\nauditory canals which may represent cerumen.", + "output": "1. Interval placement of a ventriculostomy drain via left frontal approach,\nwith the tip terminating in body of the left lateral ventricle immediately\nadjacent to the septum pellucidum.\n2. Grossly stable ventricular size as described.\n3. Chronic left MCA territory infarct." + }, + { + "input": "Left frontal approach ventricular shunt catheter tip is in the right anterior\nhorn across the septum pellucidum slightly changed from the previous study. \nThere is moderate ventriculomegaly which is unchanged from the prior study. \nEncephalomalacia in both frontal and left temporal lobes are unchanged. No\nacute hemorrhage is seen. No periventricular edema is identified.", + "output": "1. Moderate ventriculomegaly which is unchanged from prior study.\n2. The shunt tip appears to be minimally changed compared to the prior study,\nnow across the septum pellucidum to the right side. Clinically correlate.\n3. Unchanged encephalomalacia.\n4. No acute hemorrhage." + }, + { + "input": "There is no evidence of new infarction,hemorrhage, or mass. Allowing for\ndifferences in patient positioning, the previously seen encephalomalacia\ninvolving the bilateral frontal lobes and left anterior temporal lobe is\nunchanged in size and appearance. The ventricles remain prominent but are\nmildly decreased in size. The ventriculostomy catheter via left frontal\napproach is unchanged in position, terminating at the septum pellucidum in the\nbody of the left lateral ventricle.\n\nThere is no evidence of fracture. Again seen is a frontal sinus osteoma,\nunchanged in size. The remaining visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. No evidence of hemorrhage, mass, or new infarct.\n2. No significant change in the previously seen bifrontal and left anterior\ntemporal encephalomalacia.\n3. The ventricle system remain prominent but mildly decreased in size." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema,or mass effect. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Moderate left periorbital swelling", + "output": "No acute intracranial process. Moderate left periorbital swelling is noted." + }, + { + "input": "No fractures are identified.\nThere is moderate left periorbital soft tissue swelling.\nMild mucosal thickening of the anterior ethmoid sinuses and bilateral\nmaxillary sinuses are noted. Visualized remaining paranasal sinuses are well\naerated.\nThere is no evidence of abnormal fluid collections.\nBilateral mastoids appear normal.\nThe globes, extraocular muscles, optic nerves, and retrobulbar fat appear\nnormal.\nThe visualized upper aerodigestive tract appears normal.\nThe mandible and temporomandibular joints appear normal.", + "output": "1. No evidence of fracture. Moderate left periorbital soft tissue swelling\nnoted." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is atheromatous calcification of the carotid siphons bilaterally. The\nvessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. The dural venous\nsinuses are patent.\n\nCTA NECK:\nThere is mild atheromatous calcification of the bifurcation of both common\ncarotid arteries and of the V4 segments of both vertebral arteries. Bilateral\ncarotid and vertebral artery origins are patent.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion.\n\n\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. There is mild cervical spondylosis.", + "output": "1. Bilateral cavernous and supraclinoid internal carotid artery calcification.\nOtherwise normal head CT.\n2. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n3. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Periventricular and subcortical white matter hypodensities are\nnonspecific, but likely reflect sequelae of chronic small vessel ischemic\ndisease. Prominence of the ventricles and sulci suggest involutional changes.\nThere is partially imaged mucosal thickening of the left maxillary sinus and\nbilateral ethmoid air cells.. The remaining partially imaged paranasal\nsinuses are clear. Mastoid air cells and middle ear cavities are well aerated.\nThe bony calvarium is intact. Scalp staples are seen posteriorly.", + "output": "No acute intracranial process." + }, + { + "input": "Study is mildly degraded by motion.\n\nThere is no evidence of intracranial hemorrhage, acute large territorial\ninfarction, edema,or mass. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. Periventricular and subcortical\nhypodensities are nonspecific, though likely sequela of chronic small vessel\nischemic disease. Atherosclerotic vascular calcifications are noted of\nbilateral cavernous portions of internal carotid arteries.\n\nThere is no evidence of fracture. Moderate mucosal thickening of the\nbilateral frontal sinuses and bilateral ethmoid air cells. Mucosal thickening\nof all the paranasal sinuses noted. Partial opacification of the right\nmastoid air cells. Near complete opacification of the left maxillary sinus\nwith areas of high density without definite layering is suggested (see 2:2). \nBony sclerosis surrounding the left maxillary sinus is noted. Nonspecific\nright mastoid fluid is seen. Visualized portion of the middle ear cavities\nare clear. The visualized portion of the orbits demonstrate bilateral globe\npostoperative changes.", + "output": "1. Study is mildly degraded by motion.\n2. No evidence of acute intracranial abnormality.\n3. No definite evidence of acute intracranial hemorrhage or fracture.\n4. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described.\n5. Paranasal sinus disease with findings concerning for chronic and/or fungal\nsinusitis, and nonspecific right mastoid fluid, as described." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, or acute major\nvascular territorial infarction. Mildly prominent due to mild global\nparenchymal volume loss, likely age related. Asymmetric prominence of the\nright parafalcine extra-axial space with fluid density, most likely related to\nvolume loss or involutional changes, though a small subdural effusion may be\nconsidered. There are mild periventricular white matter hypodensities that\nare nonspecific, but most likely represent sequela of mild chronic\nsmall-vessel ischemia.\n\nThere is no evidence of fracture. There is fluid in the left sphenoid sinus,\nwhich may be secondary to prolonged positioning in the inpatient setting. \nThere is trace fluid in the left mastoid tip air cells. The orbits are\nunremarkable.", + "output": "1. No evidence for acute intracranial traumatic injury.\n2. Asymmetric prominence of the right parafalcine extra-axial space with fluid\ndensity, most likely related to volume loss or involutional changes, though a\nsmall subdural effusion may be considered.\n3. Fluid in the left sphenoid sinus and trace fluid in the left mastoid tip\nair cells, most likely secondary to prolonged supine positioning in the\ninpatient setting. However, given the history of septic shock, please\ncorrelate with any associated infectious symptoms." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Prominence of\nthe ventricles and sulci is consistent with age related involutional changes. \nNonspecific subcortical and periventricular white matter hypodensities are\nsuggestive of small vessel ischemic disease.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable. Bilateral lens\nreplacements noted.", + "output": "No acute intracranial process." + }, + { + "input": "Please note repeat scans head were obtained due to substantial patient motion.\nThere is no evidence of large territorial infarction, acute intracranial\nhemorrhage, edema, or mass. Enlarged ventricles and sulci, unchanged from\nprior, compatible with global atrophy. Ex vacuo dilation of the bilateral\ntemporal horns, also seen. Severe periventricular white matter hypodensities\nlikely sequela of chronic small vessel disease. Areas of encephalomalacia\ninvolving the left temporal, right occipital lobes, and right temporal lobes\nunchanged, compatible with prior infarcts. A chronic lacunar infarct on the\nleft is also noted. The basal cisterns are patent and there is preservation\nof gray-white matter differentiation. Atherosclerotic vascular calcifications\nare noted of bilateral vertebral and cavernous portions of internal carotid\narteries.\n\nNo definite acute osseous abnormality seen although bone reconstruction\nseverely limited by motion. Fluid is seen within the left maxillary sinus. \nRemainder of the paranasal sinuses grossly clear. The orbits are\nunremarkable.", + "output": "1. No acute intracranial process.\n2. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described.\n3. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct.\n4. Paranasal sinus disease as described." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Prominence of\nthe ventricles and sulci is indicative of atrophy. There is encephalomalacia\nin the left temporal, right occipital, and right temporal lobes is unchanged,\ncompatible with prior infarcts. Dystrophic calcifications of the basal\nganglia are noted bilaterally. Vertebral artery and carotid siphon\ncalcifications are again noted.\n\nNo fracture. Fluid is noted in the maxillary sinuses bilaterally, sphenoid\nsinuses bilaterally, and the right posterior ethmoid air cell. Partial\nopacification of left mastoid air cells is noted. Right mastoid air cells are\nclear. Bilateral middle ear cavities are clear.", + "output": "1. No acute intracranial abnormality.\n2. Stable encephalomalacia, atrophy, probable small vessel ischemic changes,\nand atherosclerotic vascular disease as described.\n3. Paranasal sinus disease as described." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass. There\nare areas of encephalomalacia in the left temporal, right occipital, and right\ntemporal lobes compatible with prior infarcts. Dystrophic calcifications are\nagain noted in the basal ganglia bilaterally. Prominent ventricles and sulci\nsuggest age related global volume loss. Periventricular and subcortical white\nmatter hypodensities are nonspecific, but likely reflect sequelae of chronic\nsmall vessel ischemic disease.\n\nNo acute fracture is seen. There is mucosal thickening in the bilateral\nmaxillary sinuses with minimal mucosal thickening in the ethmoid air cells. \nThe remaining visualized paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The globes are unremarkable. Dense atherosclerotic\ncalcifications of the carotid siphons and bilateral vertebral arteries are\nnoted.", + "output": "1. No acute intracranial process.\n2. Unchanged areas of encephalomalacia compatible with prior infarcts. \nChronic small vessel ischemic disease." + }, + { + "input": "Scattered foci of acute subarachnoid hemorrhage noted along bilateral cerebral\nhemispheres slightly more conspicuous on the right than left with involvement\npredominately along the bilateral frontotemporal region. Also noted is a right\nsubdural hematoma, acute layering anterior to the right temporal lobe\nmeasuring up to 12 mm and right parafalcine measuring up to 8 mm. There is no\nsignificant mass effect or midline shift. No herniation. Generalized atrophy\nis noted with prominent CSF spaces which appears slightly expanded even\ncompared with a recent CT head performed ___. Chronic\nencephalomalacia in the left temporal and right occipital region noted. Mild\nperiventricular white matter hypodensities consistent with chronic\nmicrovascular ischemic disease. Dystrophic calcifications again noted within\nthe cerebellum and bilateral basal ganglia. Mucosal thickening in the left\nmaxillary sinus and bilateral ethmoidal air cells noted. The mastoid air\ncells are well aerated. Middle ear cavities are also well aerated. Calvarium\nis intact though slightly demineralized. Carotid siphon calcification is\nnoted.", + "output": "1. Scattered foci of subarachnoid and subdural hematoma as detailed above\nwithout significant mass effect or midline shift.\n2. No fracture.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on\nthe ___ ___ at 10:57 AM, 5 minutes after discovery of the\nfindings." + }, + { + "input": "There are scattered areas of bihemispheric acute subarachnoid hemorrhage. A\nfocus of right parietal subarachnoid hemorrhage appears new or more\nconspicuous compared to the prior study (5:19).\n\nRight temporal subdural hematoma measures up to 1.1 cm (5:13), not\nsignificantly changed. There is a right parafalcine hematoma measuring 0.6 cm\n(5:13), previously 0.5 cm.\n\nA small amount of blood products layering within the occipital horns of the\nlateral ventricles has slightly increased.\n\nNo shift of midline structures. No evidence of herniation. There is no\nevidence of acute major vascular territorial infarction. Ventricles and sulci\nare prominent, suggestive of age-related involutional changes. Mild bilateral\nperiventricular and subcortical white matter hypodensities are nonspecific,\nbut likely represent a sequela of chronic small vessel disease.\n\nThere is no evidence of fracture. There is mucosal thickening in the\nbilateral ethmoid air cells and left maxillary sinus. Maxillary sinus walls\nare thickened bilaterally, reflective of chronic sinusitis. Mastoid air cells\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.\n\nA small left frontoparietal scalp hematoma is unchanged (02:28).", + "output": "1. Multiple scattered areas of subarachnoid hemorrhage, with interval\nworsening of right parietal subarachnoid hemorrhage.\n2. Minimally larger right parafalcine subdural hematoma.\n3. Stable right temporal subdural hematoma.\n4. Minimal interval increase intraventricular hemorrhage.\n5. No evidence of midline shift or herniation.\n6. Atrophy and probable chronic small vessel disease.\n7. Paranasal sinus disease as described above.\n8. Stable left frontoparietal scalp hematoma." + }, + { + "input": "Study is substantially degraded by motion, due to difficulty with patient\ncooperation during this examination.\n\nWithin this limitation, there is no significant interval change compared to\nthe prior CT per day earlier.\n\nBihemispheric subarachnoid hemorrhage is unchanged. Known right temporal and\nright parafalcine subdural hematomas are difficult to measure, but appear\ngrossly unchanged. Stable intraventricular hemorrhage. No new hemorrhage. \nNo shift of midline structures or herniation. There is no evidence of\ninfarction. Ventricles and sulci are prominent, suggestive of age-related\ninvolutional changes. Mild bilateral periventricular subcortical white matter\nhypodensities are nonspecific, but likely represent a sequela of chronic small\nvessel disease.\n\nBilateral subdural fluid collections appears somewhat larger than on the prior\nstudy. These are likely subdural hygromas.\n\nThere is no evidence of fracture. Mild mucosal thickening in the bilateral\nethmoid air cells, and aerosolized secretions in the left maxillary sinus. \nMaxillary sinus walls are bilaterally thickened, reflective of chronic\nsinusitis. Mastoid air cells and middle ear cavities are clear. Visualized\norbits are unremarkable. Left frontoparietal scalp hematoma is not\nsignificantly changed.", + "output": "1. Substantially motion limited study.\n2. No significant interval change in subarachnoid, subdural and\nintraventricular hemorrhage. No new hemorrhage.\n3. Stable left frontoparietal scalp hematoma.\n4. Paranasal sinus disease as described above.\n5. Slight enlargement of bilateral subdural hygromas." + }, + { + "input": "Previously noted subarachnoid hemorrhage has resolved. Right posterior\nparafalcine subdural hemorrhage has resolved.\n\nThere are bilateral subdural collections along the convexities, hypodense but\nslightly denser than CSF. Comparison to ___ and ___ is limited\nby motion artifact on the prior exams, as well as differences in patient head\nposition. Even allowing for positional differences, both of these collections\nappear slightly larger, measuring up to 1.4 cm on the right and 1.2 cm on the\nleft on image 3:23. There is minimal dependent hyperdensity within the left\nsubdural collection, not seen on ___ evaluation of this area on\n___ was limited by motion. Due to the underlying cerebral atrophy,\nthere is no significant sulcal effacement despite the interim enlargement of\nthe subdural collections.\n\nLarge area of encephalomalacia is again seen in the left temporal lobe. \nModerate area of encephalomalacia is also again seen in the right occipital\nand posterior temporal lobes. Associated ex vacuo enlargement of the adjacent\nportions of the lateral ventricles is again seen. In addition, there is mild\ndiffuse increase in ventriculomegaly since the prior exam, which may relate to\nprior intraventricular hemorrhage. Intraventricular hemorrhage has resolved.\n\nA small chronic infarction is again seen in the left basal ganglia and\ninternal capsule. Foci of low density are again seen in the periventricular,\ndeep, and subcortical white matter of the cerebral hemispheres, nonspecific\nbut likely sequela of chronic small vessel ischemic disease in this age group.\n\nNo concerning bone lesion is seen. There is new minimal partial opacification\nof left mastoid tip air cells. Polypoid mucosal thickening in the left\nmaxillary sinus is again partially visualized. A mucous retention cyst is\nagain seen in a right posterior ethmoid air cell.", + "output": "1. Resolution of subarachnoid hemorrhage, right posterior parafalcine subdural\nhemorrhage, and intraventricular hemorrhage.\n2. Bilateral subdural collections along the convexities, hypodense but\nslightly denser than CSF, are slightly larger than on ___, but\nwithout significant sulcal effacement given the underlying cerebral atrophy. \nSince on ___ these collections were hypodense and larger than on\nthe presenting exam from ___, they are most consistent with\nhygromas. However, minimal amount of hyperdense blood in the dependent aspect\nof the left subdural collection is new, indicating superimposed recent\nhemorrhage.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at approximately 14:00 into the Department of\nRadiology critical communications system for direct communication to the\nreferring provider." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect or infarction.\nProminent ventricles and sulci suggest age related atrophy. Periventricular\nwhite matter hypodensities are nonspecific but likely represent sequela of\nchronic small vessel ischemic disease. The basal cisterns appear patent and\nthere is preservation of gray-white matter differentiation.\n\nNo fracture is identified. There is mucosal thickening of the bilateral\nmaxillary sinuses. The remaining visualized paranasal sinuses, mastoid air\ncells and middle ear cavities are clear. The globes are unremarkable.\nAtherosclerotic mural calcification of the vertebral and internal carotid\narteries is noted.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect or\nlarge territorial infarction. There is a large area of encephalomalacia\ninvolving the left temporal lobe and the left insula similar in distribution\nto prior MRI. There is ex vacuo dilatation of the left temporal horn of the\nleft lateral ventricle. There is no shift of midline structures. Gray-white\nmatter differentiation is preserved in regions uninvolved by encephalomalacia.\n\nThere is no fracture. The included paranasal sinuses, mastoid air cells and\nmiddle ear cavities are clear. The globes are grossly intact.", + "output": "Encephalomalacia in the left temporal lobe and insula secondary to prior HSV\nencephalitis. No intracranial hemorrhage or other acute intracranial process." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or large\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Calcified atherosclorosis of the bilateral carotid\nsiphons.\n\nThere is no evidence of fracture. Mild mucosal thickening of the bilateral\nethmoid sinuses and sclerosis of left mastoid air cells compare likely\nchronic. The visualized portion of the other paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nNo evidence of acute intracranial hemorrhage. No large territory hypodensity,\nloss of gray-white differentiation, dense vessel sign to suggest new infarct\ndisease. No mass or subsequent mass-effect.\n\nNo acute fractures. The paranasal sinuses, middle ear cavity and mastoid air\ncells are unremarkable.\n\nCTA HEAD:\nThere is a left dominant vertebral artery. The A1 segment of the left\nanterior cerebral artery is congenitally hypoplastic. Otherwise, the ___\n___ and ___ intracranial arterial branches appear grossly\nunremarkable.\n\nThere is atherosclerosis in the bilateral cavernous segments of the internal\ncarotid arteries without the high-grade stenosis.\n\nCTA NECK:\nDiffuse calcified atherosclerotic disease along the aortic arch. Conventional\ncommon carotid and vertebral artery takeoff. There is high-grade stenosis\nsecondary to atherosclerotic plaque at the origins of the bilateral vertebral\narteries (series 13, image 39; series 13, image 38). There is no stenosis of\nthe cervical internal carotid arteries by NASCET criteria. The common carotid\narteries are unremarkable.\n\nOTHER:\nExamination of the lungs is motion degraded. Within this confines: Pulmonary\ninterlobar septal thickening bilaterally, which might be explained by\npatient's poor cardiac status. The thyroid is heterogeneous, without\ndefinitive discrete nodule.. There is no cervical lymphadenopathy by size\ncriteria. The visualized aerodigestive tract is within expected limits.", + "output": "1. No acute intracranial hemorrhage or large territorial infarct.\n2. Allowing for common anatomic variation and mild atherosclerotic disease,\nunremarkable CTA of the head.\n3. There appears to be high-grade stenosis of the bilateral vertebral artery\norigin secondary to noncalcified atherosclerotic plaque.\n4. The remainder the CTA is unremarkable allowing for mild atherosclerotic\ndisease. There is no cervical internal carotid artery stenosis by NASCET\ncriteria.\n5. Additional findings described above." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "Normal study." + }, + { + "input": "Multilobulated hypodense mass is identified measuring 23 x 31 x 41 mm in the\nright upper anterior cervical region, anterior to the sternocleidomastoid and\nright common carotid artery and deep to the platysma muscle. It abuts the\ntail of the right parotid gland as well.\n\nEvaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid appears normal. There is no lymphadenopathy. The neck\nvessels are patent.\n\nMucous retention cyst noted in the left maxillary sinus. Right ethmoids are\npartially opacified.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. Calcified granuloma is noted at the right upper lobe and\nmild apical base scarring seen bilaterally. There are no osseous lesions.", + "output": "Multilobulated hypodense cystic lesion is identified measuring 41 mm in the\nright upper anterior cervical region. Differential considerations include,\nbut not limited to, venolymphatic malformation. Branchial cleft cyst is not\nlikely. No abscess is identified. Nonemergent MRI with contrast is\nrecommended for further evaluation.\n\nRECOMMENDATION(S): Nonemergent MRI neck contrast." + }, + { + "input": "There is minimal soft tissue stranding at the location of the previously\ndemonstrated right neck lesion. There is no evidence of recurrence. There\nare several small level 2 lymph nodes bilaterally. None reach size criteria\nfor malignancy.\n\nEvaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.", + "output": "1. The right neck mass noted on the study of ___ has essentially\ncompletely disappeared. There is a minimal soft tissue stranding in this\nlocation with no evidence of a recurrent lesion.\n2. Minimal bilateral level 2 adenopathy." + }, + { + "input": "Right-sided VP shunt catheter terminates in the left lateral ventricle, near\nthe frontal horn. Atrophy of the medial occipital lobes is noted bilaterally.\nNo evidence of acute intracranial hemorrhage, mass effect, or shift of midline\nstructures. The ventricles appear slightly decompressed. There is likely a\ncavum septum pellucidum. The imaged paranasal sinuses are clear. Mastoid air\ncells and middle ear cavities are well aerated. The bony calvarium is intact.", + "output": "1. Right-sided VP shunt catheter terminates in the left lateral ventricle. No\nevidence of ventriculomegaly.\n2. No acute intracranial process.\n3. Atrophy of medial occipital lobes bilaterally." + }, + { + "input": "Patient is status post VP shunt placement with the proximal tip seen in the\nleft frontal horn of the lateral ventricle. There is no evidence of\ninfarction, hemorrhage, edema, or mass. Again seen are findings of agenesis\nof the corpus callosum.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the o1rbits are unremarkable.", + "output": "1. Status post VP shunt placement with the proximal tip seen in the left\nfrontal horn of the lateral ventricle. No evidence of hemorrhage, new\ninfarction, or hydrocephalus." + }, + { + "input": "There is no evidence of acute hemorrhage mass effect midline shift or\nhydrocephalus. Gray-white matter differentiation is maintained. Mild\nprominence of sulci seen.\n\nThere is no change from prior study.", + "output": "No acute intracranial abnormalities are identified. No change from previous\nstudy." + }, + { + "input": "This examination is partially limited by motion. Evaluation of the\naerodigestive tract demonstrates no definite effacement. There is edema,\nincreased density and air bubbles adjacent to the surgical site anterior to\nthe vertebral bodies of C4 and C5. Evaluation of the cervical lymph chains\ndemonstrate no pathologic lymphadenopathy by imaging criteria. The visualized\nsalivary glands are unremarkable in appearance. A calcified nodule seen in\nthe right lobe of the thyroid. Neck vessels are patent. Upper lung fields are\nrelatively clear.", + "output": "Postoperative i fluid is seen adjacent to the surgical site without large\nhematoma or fluid collection." + }, + { + "input": "There is no evidence of intracranial hemorrhage. There is no mass effect or\nshift of the normally midline structures. The gray-white matter distinction\nappears preserved. There is a small retention cyst in the sphenoid sinus, as\nbefore. Surrounding soft tissue structures are unremarkable. There is no\nevidence of fracture or bone destruction.", + "output": "No evidence of intracranial process or injury." + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass. The ventricles and sulci are normal in size and configuration. The basal\ncisterns appear patent, and there is preservation of gray-white matter\ndifferentiation. No osseous abnormalities seen. The paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction, mass or midline\nshift. There is no hydrocephalus. The ventricles and sulci are enlarged\nconsistent with atrophy. There are mild periventricular white matter\nhypodensities most consistent with sequelae of chronic small vessel ischemic\ndisease. Calcification of the cavernous carotid arteries. Visualized paranasal\nsinuses and mastoid air cells are clear. There is no acute fracture.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute large territory infarction, hemorrhage, edema,\nor mass. The ventricles and sulci are normal in size and configuration.\n\nNo acute osseous abnormalities seen. The paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormalities." + }, + { + "input": "There is no evidence of hemorrhage, edema, or mass effect. The ventricles and\nsulci are normal in size and configuration. There is a periventricular\nhypodensity in the left temporal lobe suggestive of prior infarction. \nFurther, there is an area of hypodensity in the watershed region in the left\ntemporo-occipital lobe. This may represent developing infarction versus\nartifact. Follow-up imaging with MRI versus serial CT exams is recommended.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of acute hemorrhage.\n2. An area of hypodensity is identified in the watershed region of the left\ntemporo-occipital lobe. This may represent developing infarction versus\nartifact. Follow-up imaging with MRI versus serial CT exams is recommended.\n3. Periventricular hypodensity in the left temporal lobe suggestive of prior\ninfarction.\n\nNOTIFICATION: The findings were discussed with ___, P.A. by\n___, M.D. on the telephone on ___ at 3:07 ___, 15 minutes after\ndiscovery of the findings." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. Atherosclerotic\ncalcifications are seen in the bilateral carotid siphons.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of major acute intracranial abnormalities." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are within normal limits. Basilar cisterns\nare patent. Atherosclerotic calcifications seen within the intracranial ICAs.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of large territory infarction, acute intracranial\nhemorrhage, edema, or mass effect. The ventricles and sulci are normal in size\nand configuration for the patient's age. There is no midline shift.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable. Atherosclerotic\nvascular calcifications are noted of bilateral vertebral and cavernous\nportions of internal carotid arteries.", + "output": "No evidence of acute infarct, hemorrhage, or mass effect." + }, + { + "input": "Head CT: There is no evidence of hemorrhage, edema, masses, mass effect, or\ninfarction. The ventricles and sulci are normal in caliber and configuration\nfor patient's age, vascular arteriosclerotic calcifications are seen in the\ncarotid siphons bilaterally. No fractures are identified.\n\nHead and neck CTA: T there is extensive atherosclerotic disease in the carotid\nvessels, involving long segments of the common carotid arteries and cervical\ncarotid bifurcations, previously demonstrated by MRA of the neck,, probably\nrelated with post radiation induced changes. There is no evidence of\ndissection.\n\nThe internal lumen of the left internal carotid artery at the level of the\nbifurcation measures approximately 1.6 mm and distally 2.6 mm., consistent\nwith severe stenosis.\n\nThe internal lumen of the right internal carotid artery in the proximal\nsegment measures 2.2 mm and 4.1 mm distally, consistent with severe stenosis.\n\nThe circle of ___ demonstrates patency of the anterior middle and posterior\ncerebral arteries with no evidence of critical stenosis in the intracranial\nvasculature, apparently the narrowing of the vessels is mainly involving the\nextracranial vasculature. No aneurysms are identified.\n\nBiapical fibrotic changes are visualized in the lung apices. Multilevel\ndegenerative changes are present throughout the cervical spine, more\nsignificant at C3/C4 level.", + "output": "1. No acute intracranial process.\n\n2. Extensive atherosclerotic disease in the carotid vessels, causing severe\nnarrowing of the vessels throughout the common carotid arteries, cervical\ncarotid bifurcations and proximal internal carotid arteries, previously noted\nby MRI of the neck, and probably related with post radiation induced changes." + }, + { + "input": "No evidence of acute infarction,hemorrhage,edema, or mass effect on this\nunenhanced exam. The ventricles and sulci are normal in size and\nconfiguration for the patient's age.\n\nNo evidence of fracture. Mucosal thickening of the right maxillary sinus and\nethmoidal air cells is minimally. The visualized portion of the remaining\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No intracranial hemorrhage or mass effect." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration. Unchanged,\npersistent subcortical and periventricular hypodensities are nonspecific, but\nare likely due to chronic ischemic small vessel disease. Bilateral\narteriosclerotic calcifications are visualized in the carotid siphons.\n\nMild mucosal thickening of the ethmoid sinuses. Otherwise, the visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent. Vascular calcifications of the carotid siphons.\n\nCTA NECK:\nSevere atherosclerotic disease and calcified plaques of the proximal common\ncarotid arteries and near the carotid bifurcation causes complete occlusion of\nthe bilateral common carotid arteries above their origins, with evidence of\nretrograde flow via the posterior circulation and probably from leptomeningeal\nbranches. The vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion.\n\nOTHER:\nBilateral, pleural apical scarring. The visualized portion of the thyroid\ngland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. Multilevel degenerative changes of the cervical spine.", + "output": "1. No evidence of acute hemorrhage, large territorial infarction, or mass.\n2. Severe atherosclerotic disease of the proximal common carotid arteries,\ncausing complete occlusion throughout the cervical segments as described\ndetail above, with evidence of retrograde flow." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration. Benign\ncalcifications of the falx noted.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of large acute infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nNo acute osseous abnormality is seen. Minimal mucosal thickening is seen\nwithin the left maxillary sinus. The remaining paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The orbits are unremarkable.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "Left : The external auditory canal is normal. The middle ear cavity is clear.\nThe ossicles and tegmen are intact. There is no evidence for enlarged\nvestibular aqueduct or superior semicircular canal dehiscence. The facial\nnerve follows a normal course through the middle ear. The pyramidal eminence\nand the facial nerve recess appear unremarkable. There is no evidence for\ninner ear dysplasia. The mastoids are clear.\n\nRight: The external auditory canal is normal. The middle ear cavity is clear.\nThe ossicles and tegmen are intact. There is no evidence for enlarged\nvestibular aqueduct or superior semicircular canal dehiscence. The facial\nnerve follows a normal course through the middle ear. The pyramidal eminence\nand the facial nerve recess appear unremarkable. There is no evidence for\ninner ear dysplasia. The mastoids are clear.\n\nOther: Visualized brain and neck soft tissues are normal. There is a small\nfocal area of ground-glass appearance in the squamous portion of the left\ntemporal bone, just anterior aspect of the left mastoid bone, measuring\napproximately 10 mm (series 8 image 37, series 12, image 123).", + "output": "1. Unremarkable CT of the temporal bone.\n2. Incidental note a 1 cm focal area of ground-glass appearance in the\nsquamous portion of the left temporal bone, just anterior to the left mastoid\nbone. Differential considerations include a small focus of fibrous dysplasia." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema,or mass. There\nis prominence of the ventricles and sulci suggestive of involutional changes.\n\nPartial opacification of the ethmoid air cells, otherwise the visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are normal.", + "output": "1. Mild paranasal sinus inflammatory changes.\n2. Otherwise normal study." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Basilar cisterns are\npatent.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Bilateral periventricular subcortical white matter\nhypodensities are nonspecific but most likely represent sequela of chronic\nsmall vessel ischemic changes. Atherosclerotic calcifications are seen in the\nbilateral carotid siphons.\n\nThere is no evidence of fracture. There is partial opacification of the\nethmoid air cells and right maxillary sinus with aerosolized secretions. The\nremaining paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. There is no evidence of acute intracranial process or hemorrhage.\n2. Paranasal sinus disease as described above." + }, + { + "input": "There is no evidence of enlarged lymph nodes throughout the neck stations, as\nwell as within the axillary and supraclavicular regions. There is no evidence\nof soft tissue mass or fluid collection. There is no abnormality identified\nthroughout the course of the right recurrent laryngeal nerve.\n\nThe nasopharynx, oropharynx, hypopharynx and larynx are unremarkable.\n\nThe right parotid gland and demonstrates a slightly 9 x 7 mm, which hypodense\narea (___), measuring approximately is unchanged compared to prior study of\n___, and may represent a small cyst or lymph node. Otherwise, the\nparotid, submandibular and sublingual glands are within normal limits.\n\nThe thyroid gland demonstrates homogeneous enhancement. The deep tissues of\nthe neck are symmetric.\n\nThe neck vasculature demonstrates moderate calcified and noncalcified plaque,\nparticularly throughout the bilateral common carotid arteries and carotid\nbulbs.\n\nThe visualized paranasal sinuses and mastoid air cells are clear. Visualized\nportions of the brain parenchyma are unremarkable. The orbits are\nunremarkable.\n\nVisualized portions of the brain parenchyma are unremarkable. The orbits are\nunremarkable. The lung apices demonstrate extensive emphysematous changes.\n\nThere are moderate degenerative changes of the cervical spine with\nstraightening of the cervical lordosis and regions of mild to moderate spinal\ncanal stenosis, particularly at C5-C6 and C6-C7.", + "output": "1. No evidence of soft tissue mass, fluid collections or abscess.\n2. Unchanged subcentimeter hypodense focus within the right parotid gland,\ncompared to ___, most consistent with a benign finding such as a\nsmall cyst or lymph node.\n3. Moderate atherosclerosis of the common carotid arteries and carotid bulbs.\n4. Mild to moderate spinal canal stenosis, particularly at C5-C6 and C6-C7.\n5. Extensive emphysematous changes at the lung apices." + }, + { + "input": "There is a nondisplaced fracture through the right lamina of the C5. There is\nan additional nondisplaced fracture through the right inferior articular facet\nof C5 with extension into the C5-C6 facet joint space. The facet joint remains\nwell aligned, and normal cervical alignment is overall maintained. The\nfractures do not involve the right transverse foramen.\n\nThe right vertebral artery is widely patent without evidence for dissection. \nLeft vertebral artery and bilateral cervical carotid arteries are also widely\npatent without evidence for dissection. There is a mild amount of calcified\nplaque at the right carotid bifurcation. There is mixed soft and calcified\nplaque involving the left carotid bifurcation. There is no significant\nstenosis by NASCET criteria. The distal right ICA measures 3.9 mm and the\ndistal left ICA measures 5.2 mm. There is a common origin of the\nbrachiocephalic artery and left common carotid artery, a normal variant.\n\nThe intracranial arteries are partially visualized on this study, but are not\nfully assessed in the absence of dedicated 3D reformations. This particularly\nlimits evaluation for an aneurysm. A hypoplastic A1 segment of the right\nanterior cerebral artery and a fetal left posterior cerebral artery are noted.\nThere is also mild narrowing of the P2 segment of the right posterior cerebral\nartery.\n\nPalatine tonsils are symmetrically prominent. There are multiple periapical\nlucencies noted in the maxilla and mandible. There is mild paraseptal\nemphysema in the visualized upper lungs. There are chronic healed fractures of\nthe left posterolateral fourth and fifth ribs.", + "output": "1. Acute nondisplaced fractures of the right C5 lamina and right C5 inferior\nfacet extending into the right C5-6 facet joint, with preserved normal\nalignment.\n\n2. No evidence of cervical arterial dissection or stenosis.\n\n3. Multiple periapical lucencies are within the maxilla and mandible. Please\ncorrelate clinically whether active dental infection/inflammation may be\npresent.\n\n4. Symmetrically prominent palatine tonsils, unusual for age. Please\ncorrelate clinically whether there has been any recent upper respiratory\ninfection or allergies to explain this finding. If clinically warranted,\ndirect visualization could be considered.\n\n5. Paraseptal emphysema in the imaged upper lungs." + }, + { + "input": "The study is mildly limited by motion artifact.\n\nAgain seen is a hypodense left convexity subdural collection measuring up to\n1.2 cm in diameter (02:21), unchanged since ___. There is a\nsmall amount of relatively hyperdense material layering dependently within the\ncollection, however, this is decreased compared to most recent prior study. \nThere is no evidence of acute territorial infarction,new hemorrhage,edema,or\nmass effect. The ventricles and sulci are mildly prominent, consistent with\nage-related involutional change. Periventricular and subcortical white matter\nhypodensities are nonspecific, but likely represent sequela of chronic\nischemic microvascular disease. Re-demonstrated is encephalomalacia in the\nright frontal lobe.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Re-demonstration of a subacute left convexity subdural hematoma. No acute\nhemorrhage is identified.\n2. Redemonstration of a chronic right frontal lobe infarct." + }, + { + "input": "There is no intra or extra-axial mass effect acute hemorrhage or large\nterritory infarct. The sulci, ventricles and cisterns are within expected\nlimits for the patient's age. Incidental note is made of a partial empty\nsella. The visualized paranasal sinuses are essentially clear. The\nvisualized orbits are unremarkable. The mastoid air cells middle ears are\nwell pneumatized and clear. No acute osseous abnormality.", + "output": "1. No evidence of acute large territory infarct on noncontrast head CT.\n2. If there are no contraindications, MRI would be much more sensitive for\nacute infarct." + }, + { + "input": "There is no evidence of hemorrhage, acute large vascular territorial\ninfarction, or brain edema. There is preservation of gray-white matter\ndifferentiation. The basal cisterns are patent. There is no shift of normally\nmidline structures. The ventricles are normal in caliber and configuration.\nThe visualized paranasal sinuses and mastoid air cells are clear. There is no\nfracture. The globes are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or large mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Normal head CT examination." + }, + { + "input": "Study is degraded by motion and artifact associated with the dental hardware.\n\nCT HEAD WITHOUT CONTRAST:\nThere is left occipital lobe hypodensity likely related to chronic infarction.\nOtherwise, there is no definite evidence of acute territorial infarction or\nintracranial hemorrhage. There is mild diffuse parenchymal volume loss. The\nventricles are normal in size without midline shift. The paranasal sinuses\nand bilateral mastoid air cells appear clear. The patient is status post\nbilateral scleral implants.\n\nCTA HEAD:\nThere is a 1.3 cm distal basilar artery thrombus with stenosis at the origins\nof the bilateral posterior cerebral arteries. There are mild vascular\ncalcifications of the cavernous segments of bilateral internal carotid\narteries. Otherwise, the intracranial vasculature and the major visualized\nbranches appear patent without stenosis, occlusion, or aneurysm. There is a\nleft dominant vertebral artery.\n\nCTA NECK:\nThere is atherosclerotic disease at the bilateral carotid bifurcations\nresulting in approximately 65-70% left and no significant right internal\ncarotid artery stenosis. The aortic arch contains vascular calcifications. \nThere is mild narrowing at the origin of the right vertebral artery. \nOtherwise, the bilateral vertebral arteries appear patent.\n\nOTHER:\nThere is moderate paraseptal and mild centrilobular emphysematous changes. \nThe thyroid gland contains dense calcifications. There is mediastinal\nlymphadenopathy, largest of which measures 2.2 cm within the right lower\nparatracheal region.", + "output": "1. Study is degraded by motion and artifact associated with the dental\nhardware.\n2. Left occipital lobe probable chronic infarction.\n3. No definite evidence of acute territorial infarction or intracranial\nhemorrhage.\n4. Occlusion of the distal basilar artery and origins of the bilateral\nposterior cerebral arteries.\n5. Atherosclerotic disease of the bilateral carotid bifurcations with\napproximately 65-70% left and no significant right internal carotid artery\nstenosis by NASCET criteria.\n6. Mild narrowing at the origin of the right vertebral artery. Patent left\nvertebral artery.\n7. Dense calcifications within bilateral thyroid gland. No evidence of\nthyroid nodule greater than 1.5 cm.\n8. Nonspecific mediastinal lymphadenopathy as described, which may be\nreactive. Recommend correlation with clinical history and follow-up as\nwarranted.\n9. Moderate paraseptal emphysema." + }, + { + "input": "Again seen is hypodensity in the left occipital lobe, overall unchanged from\nprior exam, with no evidence of edema mass effect or hemorrhagic\ntransformation. There is no evidence of acute or new territorial infarction,\notherwise, the ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of acute fracture. There is mucosal thickening of the\nsphenoid sinuses. Otherwise, the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. Stable hypodensity in the left occipital lobe.\n2. No new or enlarging acute infarction or hemorrhage." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nlarge mass. Bilateral basal ganglia and left cerebellar calcifications are\nunchanged since prior. Periventricular and subcortical white matter\nhypodensities are nonspecific, but likely represent chronic small vessel\nischemic disease. There is prominence of the ventricles and sulci suggestive\nof involutional changes.\n\nThere is no evidence of fracture. There is mild mucosal thickening in the\nanterior ethmoid air cells. The visualized portion of the remaining paranasal\nsinuses, mastoid air cells, and middle ear cavities are otherwise clear. The\nvisualized portion of the orbits are unremarkable. There is bilateral carotid\nsiphon and distal vertebral artery calcification.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema, or\nmass. The ventricles and sulci are normal in size and configuration. Mild\ndiffuse periventricular and subcortical white matter hypodensities are\nnonspecific, however likely represent sequelae of chronic microangiopathic\nskin ___ disease.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nethmoid sinuses. The remainder of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The patient is status post bilateral lens\nreplacement. Otherwise, the visualized portion of the orbits are\nunremarkable.", + "output": "1. No evidence of large territorial infarction, intracranial hemorrhage, or\nmass.\n2. The study is performed without IV contrast due to infiltration and\ninability to regain IV access. See above for details." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. There\nis prominence of the ventricles and sulci suggestive of involutional changes. \nThere are a few patchy areas of hypoattenuation in the white matter which are\nnonspecific but likely reflect chronic small vessel disease in this age group.\nAtherosclerotic vascular calcifications are noted involving the intracranial\nsegments of the internal carotid arteries.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal with\nbilateral lens replacements noted..", + "output": "1. No acute intracranial abnormality." + }, + { + "input": "Since the most recent CT, there has been no change in the size or appearance\nof the left subdural hematoma extending approximately 10-11 mm from the inner\ntable with overall hyperintensity with some small areas of hyperdensity.\n\nNo change in the small left temporal subarachnoid hemorrhage, and prominent\nright frontal subarachnoid hemorrhage. There is stable 2 mm leftward shift of\nnormally midline structures. Areas of hypodensity involving the left MCA\nterritory, as well as the bilateral frontal lobes (2: ___ are unchanged\nsince at least ___, but may be sequelae of recent acute infarction. \nThe ventricles are unchanged in configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Compared with the most recent CT, no change in the size or appearance of\nthe hyperdense left subdural hematoma, as well as the right greater than left\nfrontal subarachnoid hemorrhage.\n2. Persistent 2 mm leftward shift of normally midline structures.\n3. Areas of hypodensity involving the left MCA territory and bilateral frontal\nlobes are unchanged compared to ___ outside head CT, and may reflect\nsequelae of recent acute to subacute infarction.\n4. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct." + }, + { + "input": "Left frontoparietal convexity subdural hematoma measuring up to 1.1 cm from\nthe inner table is unchanged from multiple prior studies when measured in\nsimilar planes. Blood products layering along the left tentorium are slightly\ndecreased. Mild effacement of the left lateral ventricle is stable. Foci of\nsubarachnoid hemorrhage with the frontal convexity bilaterally and the\nanterior right frontal lobe are minimally changed from the prior study. \nHypodensities within the left temporal lobe and bilateral medial frontal lobes\nare similar to the prior study and consistent with areas of infarction.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Unchanged left frontoparietal subdural hematoma and bifrontal subarachnoid\nhemorrhages.\n2. Unchanged areas of hypodensity within the left MCA and bilateral ACA\nterritories consistent with subacute to chronic infarctions." + }, + { + "input": "Compared to the previous CT the left-sided subdural hematoma has decreased in\nsize. There has been considerable decrease in frontal component of the\nsubdural hematoma decrease in size of the for parietal component. The\nparietal component measures approximately 10 mm in thickness compared to 19 mm\non the previous study. The hyperdense area seen within the subdural has\nresolved. No acute hemorrhage is seen. The mass effect has decreased. There\nhas been were also evolution of blood products in the left temporal region. \nEncephalomalacia is seen in this region. Mild ex vacuo dilatation of the left\ntemporal horn seen.", + "output": "Decrease in size of previously seen subdural with chronic subdural remaining\nin the left parietal region with maximum thickness of 10 mm. No acute\nhemorrhage." + }, + { + "input": "Left-sided convexal subdural hematoma measures up to 16 mm in diameter,\npreviously approximately 14 mm. It overall appears less dense than on prior. \nAssociated left-sided sulcal effacement appears unchanged. There is no\nmidline shift. Right frontal and bilateral parietal subarachnoid blood is\nagain noted. Hypodensity in the lateral left temporal lobe is also unchanged.\nHypodensity in the anterior inferior right frontal lobe is less clearly\ndelineated on the current exam. There is no new hemorrhage. Ventricles are\nstable in configuration.\n\nIncluded paranasal sinuses and right mastoids are clear besides a right\nethmoid osteoma. Scattered opacification of left mastoid air cells is noted. \nAtherosclerotic calcifications are noted within the intracranial ICAs.", + "output": "Marginal increase in size of the left-sided subdural hematoma which is less\ndense in attenuation without evidence of interval hemorrhage. Bilateral foci\nof subarachnoid hemorrhage as seen on recent prior head CT." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage or acute mass effect. \nThe ventricles and sulci are prominent consistent with age related cortical\nvolume loss. Periventricular white matter hypodensities suggest chronic small\nvessel ischemic disease. Ex vacuo dilatation of the left temporal horn and\nencephalomalacia of the left temporal lobe are re- demonstrated and are\noverall unchanged.\n\nNo acute fracture is seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process. Chronic changes as described above are stable\nfrom ___." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are otherwise normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Normal study." + }, + { + "input": "There is evidence of interim left craniotomy. Left subdural collection has\nmarkedly decreased in size, with a small amount of hyperdense left subdural\nblood remaining. There is mild new left frontal subarachnoid hemorrhage.\nRightward shift of midline structures has decreased, and the left lateral\nventricle and third ventricle have re-expanded. Mild periventricular white\nmatter hypodensities are again noted, likely sequela of chronic small vessel\nischemic disease.\n\nThere is mild mucosal thickening in the maxillary and posterior ethmoid\nsinuses, and an air-fluid level in the left sphenoid sinus. These findings\nmay be related to prolonged supine positioning in the inpatient setting, as\nwell as endotracheal intubation. Other visualized paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear.", + "output": "1. Significant decrease in left frontal subdural hematoma with decreased mass\neffect. Small residual hyperdense subdural blood products.\n2. New small left frontal subarachnoid hemorrhage deep to the preexisting\nsubdural collection." + }, + { + "input": "Since the prior study, there has been no significant interval change in\nappearance of small left frontal subdural hemorrhage, measuring approximately\n4 mm in greatest depth (03:26). A tiny focus of adjacent subarachnoid\nhemorrhage is again noted, but slightly less conspicuous compared to the prior\nstudy (03:22). The degree of local mass effect on the left lateral ventricle\nof is unchanged, and there is no significant shift of normally midline\nstructures. Mild periventricular white matter hypodensities are again noted,\nlikely the sequelae of chronic small vessel ischemic disease. The basal\ncisterns appear patent and there is preservation of the gray-white matter\ndifferentiation.\n\nLeft frontal craniotomy changes are again seen, with a small amount of\npneumocephalus, and soft tissue swelling overlying the craniotomy site. \nMucosal thickening is noted in the ethmoid and sphenoid sinuses, as before.\nOtherwise, the remaining visualized paranasal sinuses, mastoid air cells and\nmiddle ear cavities remain clear.The orbits are unremarkable.", + "output": "No significant interval change in appearance of small left frontal subdural\nhematoma and adjacent left frontal subarachnoid hemorrhage since the prior\nstudy from 5 hr ago." + }, + { + "input": "Re- demonstrated left frontal subdural hematoma, unchanged. Associated\nsubpleural hematoma and left frontal craniotomy noted with minimal\npneumocephalus. There is no shift of midline structures. There is no new area\nof hemorrhage or infarction. The ventricles and sulci are normal in size and\nconfiguration.\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "Stable left frontal subdural hematoma, unchanged from the previous\nexamination." + }, + { + "input": "The patient is status post left frontal parietal craniotomy for evacuation of\na left frontal subdural hemorrhage. There remains an extra-axial hematoma\noverlying the left frontal lobe measuring approximately 4 mm in greatest\nthickness, similar in appearance to prior exams extending from the vertex to\nthe anterior left temporal pole. Again noted is subarachnoid hemorrhage\ninterdigitating within the sulci of the left frontal vertex, slightly improved\nfrom prior exam. Interval resolution of previously noted pneumocephalus. No\nnew intracranial hemorrhages. There remains a subgaleal 1 cm hematoma at the\nsurgical bed, similar in appearance to prior exam, with near-complete\nresolution of subcutaneous emphysema.\n\nThere is suggestion of hypodensity of the left medial temporal cortex and\npotentially the left cerebral peduncle, which may be artifactual from beam\nhardening although this may also represent ischemic injury from the mass\neffect and uncal herniation seen on initial CT of ___. There is no\nsignificant mass effect on the left lateral ventricle nor is there midline\nshift. Again noted is superimposed mild periventricular white matter\nhypodensities, likely sequela of chronic small vessel ischemic disease. The\nbasilar cisterns are patent.\n\nThe paranasal sinuses are clear. The mastoid air cells are clear. The orbits\nare unremarkable.", + "output": "1. No significant interval change in size of small residual left frontal\nextra-axial hematoma. There is resolution of previously seen pneumocephalus. \nLeft frontal subarachnoid hemorrhages are slightly improved from prior exam.\nNo new intra cranial hemorrhage.\n2. There is suggestion of hypodensity within the left medial temporal cortex\nand left cerebral peduncle, which may be artifactual secondary to adjacent\nbeam hardening although this may also represent ischemic injury secondary to\nmass effect from uncal herniation seen on initial CT of ___. Clinical\ncorrelation is recommended. If clinically indicated and there are no\ncontraindications, MRI may yield additional information." + }, + { + "input": "The patient is status post left frontal parietal craniotomy for evacuation of\na left frontal subdural hemorrhage. Compared with previous exam there is\nsignificant interval decrease in size of prior extra-axial hematoma overlying\nthe left frontal lobe, with only trace residual blood products seen in this\nexam. The previously seen subarachnoid hemorrhage has also resolved. There is\nno new intracranial hemorrhage. There is residual scalp swelling as well,\nwhich is unusual given interval from the previous exam and suggests either\nminor trauma or manipulation of the area.\n\nAn equivocal focus of hypodensity of the left medial temporal cortex and\npotentially the left cerebral peduncle (2:11) is not significantly changed\nfrom prior and as previously characterized, may be artifactual from beam\nhardening although this may also represent parenchymal injury from the mass\neffect and uncal herniation seen on initial CT of ___. There is no\nmidline shift. Again noted is superimposed mild periventricular white matter\nhypodensities, likely sequela of chronic small vessel ischemic disease. The\nbasilar cisterns are patent.\n\nThe paranasal sinuses are clear. The mastoid air cells are clear. The orbits\nare unremarkable.", + "output": "1. Significant interval improvement of prior extra-axial hematoma overlying\nthe left frontal lobe with only trace residual blood products. Interval\nresolution of subarachnoid hemorrhage.\n\n2. Unchanged appearance of an equivocal focus of hypodensity of the left\nmedial temporal cortex and potentially the left cerebral peduncle which may be\nartifactual from beam hardening or parenchymal injury secondary to compression\nduring recent episode of uncal herniation." + }, + { + "input": "Status post left-sided craniotomy with postsurgical changes.\nInterval significant resolution of the previously noted left-sided subdural\nhemorrhagic fluid collection compared to the initial CT study of ___.\nNo displacement of the left cerebral hemisphere.\nNo new acute intracranial hemorrhage or mass effect.\n\nThe ventricles, are mildly prominent likely related to developmental or\nrelated to mild parenchymal volume loss.\nPeriventricular hypodense foci are noted adjacent to the frontal horns\nnonspecific in appearance, stable.\nSmall pituitary gland, as before.\nPineal gland and the craniocervical junction regions are unremarkable.\n\nNo suspicious osseous lesions are noted.\nVascular calcifications are noted in the distal vertebral and the cavernous\ncarotid segments on both sides.\n\nMild left maxillary sinus mucosal thickening.\nThe mastoids are clear.\nCardiac pacer, partially noted on the scout image.", + "output": "No new acute intracranial hemorrhage or mass effect.\nLeft-sided craniotomy related changes as before.\nOther details as above" + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territory infarct. Gray-white matter\ndifferentiation is preserved. There is no hydrocephalus. The partially\nimaged paranasal sinuses demonstrate mucosal thickening/mucous retention cyst\nin the left maxillary sinus. There remainder of the partially imaged\nparanasal sinuses are clear. The mastoid air cells are clear. No acute\nfracture is seen.", + "output": "No acute intracranial process." + }, + { + "input": "This examination is moderately limited due to motion artifact. Within these\nlimitations:\n\nThere is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass effect. The ventricles and sulci are normal in size and\nconfiguration.\n\nThere is no evidence of fracture. Mucous retention cyst within the left\nmaxillary sinus. Otherwise, the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.Anterior subluxation at the bilateral\ntemporomandibular joints is likely positional.", + "output": "1. This examination is moderately limited due to motion artifact. Within\nthese limitations, no evidence of acute territorial infarction or intracranial\nhemorrhage on noncontrast head CT.\n2. Anterior subluxation at the bilateral temporomandibular joints is likely\npositional.\n3. Additional findings described above." + }, + { + "input": "There is no hemorrhage, edema, mass, mass effect or large vascular territorial\ninfarction. The ventricles and sulci are normal in size and configuration. \nThere is preservation of grey-white matter differentiation and the basal\ncisterns are patent.\n\nNo fracture is identified. The paranasal sinuses are clear, there is mild\nunder pneumatization of the mastoid air cells.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci and unremarkable. Basilar cisterns are\npatent.\n\nMild mucosal thickening noted in the ethmoid air cells. Included paranasal\nsinuses and mastoids are otherwise clear noting poor pneumatization of the\nmastoids bilaterally. Skull and extracranial soft tissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nThe imaged paranasal sinuses are clear. The diminutive mastoid air cells are\nnot pneumatized. There mild mucosal thickening in the bilateral ethmoid air\ncells and bilateral sphenoid sinuses. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute major vascular territorial\ninfarction,hemorrhage,edema, or mass. The ventricles and sulci are normal in\nsize and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. No evidence acute intracranial hemorrhage or fracture." + }, + { + "input": "There is re- demonstration of a large right frontal subdural hematoma\nmeasuring approximately 1.4cm from the inner table, unchanged since prior\nstudy. Some blood is seen layering along the anterior falx. There is also a\nsmall left frontal subdural hematoma measuring approximately 8 mm from the\ninner table, also unchanged since prior study, and unchanged bilateral frontal\nhemorrhagic contusions, more significant on the right frontal lobe. There is\nright frontal subarachnoid blood layering along the convexities. There may be\na small amount of left frontal subarachnoid hemorrhage as well. Rounded\nhyperdensities within the right temporal lobe could represent some areas of\nintraparenchymal contusion, but unchanged since prior study. Effacement of the\nright cerebral sulci is overall unchanged as well as effacement of the right\nlateral ventricle. There is slight increase in size of the left temporal horn\nwhich now measures 4 mm, previously 2 mm. There is also a 6 mm leftward shift\nof midline structures, not significantly changed since prior study. There is\nno evidence of uncal or transtentorial herniation.\n\nNo fracture is identified. There is mucosal thickening involving the bilateral\nmaxillary and frontal sinuses as well as ethmoid air cells. Patchy\nopacification of the mastoid air cells is likely related to intubation. The\nmiddle ear cavities are clear. The globes are unremarkable.", + "output": "1. No significant interval change to the large right frontal subdural\nhematoma and subarachnoid hemorrhage with effacement of the right lateral\nventricle and a 6 mm leftward shift of midline structures. Unchanged\nbilateral frontal hemorrhagic contusions, more significant on the right\nfrontal lobe. Slight increased in the size of the left temporal horn.\n\n2. Small left frontal subdural hematoma with possibly small amount of left\nfrontal subarachnoid blood.\n\n3. Rounded hyperdensities in the right temporal lobe likely represents\nintraparenchymal contusions, unchanged since prior study." + }, + { + "input": "There is re- demonstration of a large right frontal subdural hematoma\nmeasuring approximately 1.4 cm from the inner table, unchanged since prior\nstudy. Some blood is seen layering along the anterior falx. There is also a\nsmall left frontal subdural hematoma measuring approximately 5 mm from the\ninner table (3:29), also unchanged since prior study. hemorrhagic contusions\nin the bilateral frontal lobes as well as the right temporal lobe, more\nsignificant on the right frontal lobe, are also similar to prior. Minimal\nbilateral frontal subarachnoid blood are re-identified.\nA non displaced left calvarial fracture extending into the roof of the left\norbit is described in detail in concurrent maxillofacial CT with clip number\n___. There is no underlying hemorrhage related to this fracture and no\nevidence of subperiosteal hematoma in the left orbit.\nEffacement of the right cerebral sulci is overall unchanged as well as\neffacement of the right lateral ventricle. A 6 mm leftward shift of midline\nstructures is stable as well. However, there is apparent worsening of\neffacement of the left paramesencephalic cistern (3:17). The remaining basal\ncistern arepatent. No evidence of tonsillar herniation.\nFor detailed assessment of the paranasal sinuses and facial structures please\nrefer to concurrent maxillofacial CT with clip number ___.", + "output": "1. A non displaced left calvarial fracture extending into the roof of the left\norbit is described in detail in concurrent maxillofacial CT with clip number\n___. There is no underlying hemorrhage related to this fracture and no\nevidence of subperiosteal hematoma in the left orbit.\n2. Compared to the previous exam there is worsening of narrowing and\neffacement of the left paramesencephalic cistern, raising concern for\nimpending uncal herniation.\n3. No significant interval change in multiple subdural hematomas and foci of\nparenchymal contusion in the right temporal lobe compared to the previous\nexam.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the\ntelephone on ___ at 5:12 ___, immediately after discovery of the\nfindings." + }, + { + "input": "Allowing for difference in technique, there is no significant interval change\nin large right frontal subdural hematoma with some blood layering along the\nanterior falx. The smaller left frontal subdural hematoma is also stable.\nBifrontal and right temporal lobe hemorrhagic contusion with associated edema\nare again noted and also stable. The bifrontal subarachnoid blood is unchanged\nas well.\n\nThere is redemonstration of the patient's known non displaced left calvarial\nfracture extending into the roof of the left orbit. Effacement of the right\ncerebral sulci and right lateral ventricle are stable. 5 mm leftward midline\nshift is again seen. There is stable effacement of the left paramesencephalic\ncistern (see series 3, image 14). The remaining basal cisterns are patent and\nthere is no evidence of tonsillar herniation. There is stable opacification of\nthe ethmoid air cells and mucosal thickening within bilateral frontal and\nmaxillary sinuses.", + "output": "1. Stable nondisplaced left calvarial fracture extending into the roof of the\nleft orbit. Grossly stable subdural hematomas, subarachnoid hemorrhages and\nparenchymal contusions.\n\n2. No significant change in appearance of the basal cisterns, with minimal\neffacement of left perimesencephalic cistern. The remaining basal cisterns\nare patent.\n\n3. Stable approximately 5 mm right to left midline shift." + }, + { + "input": "Again noted is a right frontotemporal subdural hematoma that extends into the\nanterior falx, stable from most recent NECT. Hemorrhagic contusions within the\ninferior frontal lobes and anterior temporal lobe on the right along with foci\nof subarachnoid hemorrhage and surrounding edema are also stable.\nThere is approximate 6 mm leftward shift of midline structures, not\nsignificantly changed from most recent prior. The left lateral ventricle\nremains entrapped with mild dilatation. The right paramesencephalic cistern\nremains slightly effaced, but unchanged. There is no new focus of hemorrhage.\nThe previously described small left frontal subdural hematoma is stable\n(2:12). Small amount of bifrontal subarachnoid hemorrhage is also unchanged.\n\nFracture through the left calvarial fracture extending to the orbital roof and\nlateral wall is re-demonstrated; however, better assessed on the prior CT\nsinus study.\nSurgical staples are also noted along the left parietal scalp with underlying\nswelling.\nThe globes are intact.\nThere is moderate mucosal thickening in the frontal, sphenoid, and ethmoid air\ncells.\nMild mucosal thickening are also noted in the included portions of the\nmaxillary sinuses.\nFluid is noted in the left mastoid air cells. The middle ear cavities are\nclear.", + "output": "1. Stable right frontoparietal subdural hematoma extending into the anterior\nfalx. Stable small left frontal subdural hematoma.\n2. 6 mm leftward shift of midline structures, mass effect on the right lateral\nventricle, not significantly changed from most recent prior.\n3. Stable bifrontal and right anterior temporal hemorrhagic contusions and\nfoci of subarachnoid hemorrhage. No new focus of hemorrhage.\nCorrelate clinically to decide on the need for further workup with MRI if not\ncontraindicated or close followup.\n4. Left calvarial fracture extending to the orbital roof and lateral wall is\nre-demonstrated; however, better assessed on the prior CT sinus study." + }, + { + "input": "Head CT: Again noted is a right frontal temporal subdural hematoma extending\nto the anterior falx measuring approximately 3 mm in greatest thickness, which\nappears larger size. The subdural hematoma extends past midline to involve the\nanterior aspect of the left frontal lobe. Edema associated with right frontal\nand temporal lobe hemorrhagic contusions appear slightly more prominent when\ncompared to the prior exam. In addition, there appears to be increased\neffacement of the right lateral ventricle although the 6 mm leftward midline\nshift is similar in appearance to the prior exam. Again noted is effacement of\nthe bilateral perimesencephalic cisterns as well as right uncal herniation.\nThere is entrapment of the left lateral ventricle with mild dilatation. No new\nhemorrhages are noted.\n\nEndotracheal and enteric tubes are noted. Diffuse maxillary and mandibular\ndental caries with periapical lucencies and dehiscence of the buccal alveolar\nridges is noted. No new fractures are noted. Known fractures of the left\nfrontal calvarium extending to the left orbital roof and lateral wall is\npoorly visualized on current exam.\n\nMucosal thickening of the paranasal sinuses most prominently seen of the\nfrontal and sphenoid sinuses as well as partial opacification of ethmoid air\ncells is noted. The globes are unremarkable. Trace fluid is seen in the\nbilateral mastoid tips. The middle ear cavities are clear.\n\nSurface electrodes overlying the scalp are noted.\n\nHead CTA: The intracranial arteries appear normal with no evidence of\nstenosis, occlusion, or aneurysm formation. No spot sign is noted. No evidence\nof active extravasation. The right transverse sinus and sigmoid sinus are\ncongenitally diminutive.", + "output": "1. Slightly increased size of right subdural hematoma when compared to the\nprior exam ___.\n2. Minimal increase in an parenchymal edema associated with right frontal and\ntemporal lobe contusions with unchanged 6 mm leftward midline shift. There\nremains effacement of the bilateral perimesencephalic cisterns with mild right\nuncal herniation.\n3. No occlusion or aneurysm of the intracranial circulation.\n4. No enhancing foci noted within hematoma." + }, + { + "input": "The right fronto-temporal subdural hematoma extending to the anterior falx\nappears slightly increased in size since the prior exam. For example the level\nof the lateral ventricles, it measures up to 8 mm in width (2, 18). It\npreviously measured 6 mm. Right frontal and temporal lobe hemorrhagic\ncontusions also appear slightly more prominent with increased surrounding\nedema. As a result, there is increased mass effect with 8 mm of leftward\nshift of the normal midline structures, as compared to 6 mm in the prior exam.\nThere is also increased effacement of the sulci. Effacement of the right\nlateral ventricle appears grossly stable. Again noted is effacement of the\nbilateral perimesencephalic cisterns as well as right uncal herniation,\nsimilar to the prior exam. There is persistent entrapment of the left lateral\nventricle, which is slightly increased in size. The basal cisterns remain\npatent without evidence of downward herniation.\n\nThe left frontal contusion and left frontal subdural hematoma appear grossly\nstable. There is no new foci of hemorrhage. No large vascular territory\ninfarction is identified. There is mucosal thickening in all of the paranasal\nsinuses. Fractures of the left frontal calvarium, left orbital roof, and left\nlateral orbital wall are similar to prior exams. No new fracture is\nidentified. The globes are intact. Opacification of the mastoid air cells is\nnoted. The middle ear cavities are clear. Surgical staples are unchanged\nalong the left posterior scalp.", + "output": "1. Slight interval increase in size of the right fronto-temporal\nintraparenchymal hemorrhagic contusion and right subdural hematoma. Stable\nleft frontal contusion and subdural hematoma. No new hemorrhage.\n2. Increased leftward shift of the normal midline structures, now 8 mm. \nUnchanged effacement of the perimesencephalic cisterns and right uncal\nherniation.\n3. Slight interval increase in size of the entrapped left lateral ventricle.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the\ntelephone on ___ at 11:55 ___, 5 minutes after discovery of the findings." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are normal in size and configuration.\n\nNo acute fracture is seen. There is mild mucosal thickening of scattered\nanterior and posterior ethmoid air cells, otherwise the imaged paranasal\nsinuses and mastoid air cells, and middle ear cavities are clear. The orbits\nare unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "The intracranial carotid arteries, anterior cerebral arteries and middle\ncerebral arteries as well as their major branches are unremarkable. The\nposterior cerebral arteries are not visualized. The left vertebral artery is\ndominant. Otherwise, the posterior circulation is unremarkable. There is no\nevidence of aneurysm formation, stenosis, occlusion or other vascular\nabnormality.\n\nMild mucosal thickening of the maxillary sinuses and both minimal\nopacification of the ethmoid air cells is noted. The orbits are unremarkable.\nThe mastoid air cells and middle ear cavities are clear.", + "output": "1. No evidence of aneurysm, dissection, stenosis or occlusion.\n2. No acute intracranial abnormality.\n3. Paranasal sinus disease as described." + }, + { + "input": "Evaluation is significantly limited secondary to streak artifact from the\nright occipital approach probe and hardware which lies along the right lateral\nand frontal convexity. Within these limitations, there is no evidence of acute\nlarge territorial infarction, hemorrhage, edema, or mass effect. There are\nexpected postsurgical changes, including bifrontal pneumocephalus. Mass effect\nupon the underlying brain results in decrease caliber of the bilateral frontal\nhorns of the ventricles. The basal cisterns remain patent.\n\nThe visualized paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The orbits are unremarkable.", + "output": "1. Status post placement of a right occipital approach probe hardware which\nlies along the right lateral and frontal convexity, limiting evaluation\nsecondary to streak artifact. Within these limitations, no evidence of acute\nhemorrhage.\n2. Expected post procedure changes, including pneumocephalus along the\nbifrontal convexities." + }, + { + "input": "Patient is status post right temporal craniotomy and lobectomy. There is\nexpected post operative pneumocephalus. There is hypodensity filling the\nright temporal lobe as well as small hypodensity filling the extra-axial\nspaces measuring up to 10 mm from the inner table with slight crowding of the\nsubjacent cerebral sulci. Tiny punctate hyperdensity is seen layering\nposteriorly which may reflect small amount of postoperative blood (02:15). \nThere is no abnormal shift of midline structures or downward herniation. The\nventricles and sulci are unchanged in size and configuration. The basal\ncisterns appear patent and there is preservation of gray-white matter\ndifferentiation.\n\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\nThe orbits are unremarkable.", + "output": "Status post right temporal craniotomy and lobectomy with expected\npostoperative changes including pneumocephalus and predominantly hypodense\ncollection filling the right extra-axial space." + }, + { + "input": "Again seen are expected postoperative sequela from prior right temporal\ncraniotomy and lobectomy. There is a small hypodense right-sided extra-axial\nfluid collection, likely subdural, layering along the right frontoparietal\nconvexity, measuring 5 mm from the inner table of the adjacent frontoparietal\ncalvarium. There is no significant mass effect. There is no shift of\nnormally midline structures. The ventricles and sulci are normal in caliber\nand configuration, aside from some minimal ex vacuo dilatation of the temporal\nhorn of the right lateral ventricle. There is no evidence of acute hemorrhage\nor infarction.\n\nThe visualized paranasal sinuses and mastoid air cells are clear. The globes\nand bony orbits are unremarkable. A burr hole is noted in the right occipital\nbone, as on prior.\n\nPost-contrast images do not demonstrate evidence of abnormal enhancement.", + "output": "1. Small (5 mm) residual extra-axial hypodense fluid collection along the\nright frontoparietal convexity, likely a small amount of residual blood\nproducts.\n2. No acute hemorrhage or infarction.\n3. Expected postoperative sequela from prior right temporal craniotomy and\nlobectomy.\n4. No abnormal enhancement following contrast administration." + }, + { + "input": "No evidence of infarction, hemorrhage, edema, or mass effect. The ventricles\nand sulci are normal in size and configuration. The basal cisterns are\npatent.\n\nNo evidence of fracture. Degenerative changes in the bilateral\ntemporomandibular joints are mild. The paranasal sinuses are only partially\nimaged. The frontal sinuses are hypoplastic. The visualized portion of the\nparanasal sinuses are clear. The mastoid air cells and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No mass effect or hemorrhage.\n2. Partially imaged paranasal sinuses are clear." + }, + { + "input": "There is no acute hemorrhage, edema or shift of the normally midline\nstructures. Gray-white matter differentiation is preserved and there is no\nevidence for an acute major vascular territorial infarction. The basal\ncisterns are patent. There is mild mucosal thickening within the ethmoid air\ncells, sphenoid sinuses and maxillary sinuses. Within the left maxillary\nsinus there is partially visualized polypoid mucosal thickening. There is no\nacute fracture.", + "output": "1. No acute intracranial abnormality.\n2. Paranasal sinus disease as described, with possible polypoid mucosal\nthickening within left maxillary sinus. Recommend clinical correlation." + }, + { + "input": "CT HEAD:\nBilateral periventricular white-matter hypodensities are more confluent and\nincreased from the previous examination. Allowing for this, no convincing\nevidence for large vascular territorial infarction is seen.\n\nThere is no evidence for acute intracranial hemorrhage. No mass, mass effect,\nor edema. The ventricles and sulci are age appropriate.\n\n The paranasal sinuses, middle ear cavities, and mastoid air cells are clear.\nThe orbits are grossly unremarkable bilaterally.\n\n\nCTA HEAD AND NECK:\nThere is a normal 3 vessel aortic arch. Atherosclerotic disease,\nmild-to-moderate narrowing right subclavian artery lateral to the first rib. \nModerate origin narrowing left subclavian artery with eccentric soft plaque\n\nMild origin narrowing left vertebral artery. Calcifications are noted along\nthe medial aspects of the bilateral V3 segments causing mild narrowing at the\ntransition of left V3 to V4 segment. Mild calcifications are also seen within\nthe right V4 segment. Otherwise, the vertebral arteries are patent\nbilaterally.\n\nThere are moderate bilateral partially calcified atherosclerotic plaque seen\ninvolving the carotid bulbs. These extend into the proximal internal carotid\narteries, or resulting in approximately 40% stenosis on the left and 30%\nstenosis on the right by NASCET criteria.\n\nMild-to-moderate narrowing right P 2 P3, moderate narrowing left P2 segment\n\nOtherwise, the vessels of the circle of ___ and their principal\nintracranial branches are patent without high-grade stenosis, occlusion, or\naneurysm formation. The dural venous sinuses are patent.\n\n\nOTHER:\nThe lungs apices are clear bilaterally. The thyroid gland is unremarkable in\nappearance. There is no cervical lymphadenopathy by CT size criteria. Images\ncervical spine. Probably moderate central canal narrowing at C4-C5 level.", + "output": "1. Moderately extensive deep white matter confluent low-attenuation changes\nare more apparent or worsened since prior, component is likely from chronic\nsmall vessel ischemic changes.. If there is worsening clinical symptoms,\nconsider brain MRI without contrast, to exclude toxic leukoencephalopathy or\nischemic process.\n2. Less than 50% narrowing bilateral proximal ICA. Origin narrowing left\nvertebral artery.\n3. Intracranial atherosclerotic disease.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 16:56 into the ED dashboard critical\ncommunications system for direct communication to the referring provider." + }, + { + "input": "Patient is status post remote left frontotemporal craniotomy and possible\ncranioplasty with left lateral temporal encephalomalacia, unchanged from ___\n(2:7). There is no evidence of acute hemorrhage, edema, mass effect, or acute\nmajor vascular territorial infarction. There is prominence of the ventricles\nand sulci consistent with involutional changes.\n\nThere is no evidence of suspicious bone lesions. The visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nNonspecific soft tissue density within the left external auditory canal likely\nrepresents cerumen. The visualized portion of the orbits are unremarkable.", + "output": "1. No evidence of acute intracranial abnormalities .\n2. Stable left temporal postsurgical changes.\n\nRECOMMENDATION(S): Consider MRI for further evaluation, given prior history\nof a mass." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nPatient is status post remote left frontotemporal craniotomy and cranioplasty\nwith left temporal encephalomalacia, unchanged from ___. There is no\nevidence of acute large territorial infarction, hemorrhage, edema or mass. \nProminent ventricles and sulci suggest age-related involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation greater than\n3 mm. The dural venous sinuses are patent.\n\nCTA NECK:\nDominant right cerebral artery. The carotid and vertebral arteries are patent\nthrough their cervical course without evidence of occlusion, stenosis,\ndissection or aneurysm formation. Mild calcified plaque at the bilateral\ncarotid bifurcation. There is no evidence of internal carotid stenosis by\nNASCET criteria. The left vertebral artery arises directly from the aorta, a\nnormal variation. Both internal carotid arteries are couurse medially. A\nnormal variation.\n\nOTHER:\nModerate respiratory motion artifact. Within this limitation, there is mild\ncentrilobular emphysema. Otherwise, the remaining visualized lung fields are\nunremarkable. The patulous and circumferentially thickened esophagus is\nunchanged compared to multiple prior studies. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Patent intracranial vasculature without evidence of occlusion, stenosis or\naneurysm formation.\n2. Patent cervical vasculature. Mild calcified plaque at the bilateral\ncarotid bifurcation.\n3. No acute intracranial abnormality. Status post remote left frontotemporal\ncraniotomy neoplastic with stable left temporal encephalomalacia." + }, + { + "input": "There is no evidence of acute territorial infarction,intracranial\nhemorrhage,edema, mass,or mass effect. The ventricles and sulci are normal in\nsize and configuration.\n\nThere is no evidence of fracture. Th the visualized aspect of the maxillary\nsinuses demonstrate mucosal thickening on the right maxillary sinus, there is\nnasal septum deviation towards the left with bony spur formation, mucosal\nthickening is also noted in the ethmoidal air cells and frontoethmoidal\nrecesses, there is partial opacification of the sphenoid sinus in the right\nlateral recess, there is mild opacification of the mastoid air cells on the\nleft left,the middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. There is no evidence of acute intracranial process or hemorrhage, no\nfractures are identified.\n\n2. Paranasal sinus disease and partial opacification of the left mastoid air\ncells." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Normal noncontrast head CT." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. There is moderate mucosal thickening of both\nmaxillary sinuses and mild mucosal thickening involving the left frontal and\nethmoid sinuses bilaterally. The remaining paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process. Sinus disease, detailed above." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. Cerebellar tonsils\nminimally extend below foramen magnum, may represent developmental variant,\nconsider Chiari 1 malformation, findings are better seen on MRI cervical spine\n___. Findings consistent with mild chronic small vessel ischemic\nchanges.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute findings.\nMild cerebellar tonsillar ectopia, stable." + }, + { + "input": "There is no evidence of large vascular territory\ninfarction,hemorrhage,edema,or mass. The ventricles and sulci are\nage-appropriate. Re-demonstrated, is minimal extension of cerebellar tonsils\nat foramen magnum which may represent cerebellar tonsillar ectopia, stable.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute findings.\n2. Stable mild cerebellar tonsil ectopia." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. There is unchanged low laying cerebellar tonsils at the foramen\nmagnum consistent with cerebellar tonsillar ectopia, otherwise, the ventricles\nand sulci are stable in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Unchanged mild cerebellar tonsillar ectopia." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are normal in size and configuration.\n\nA cystic lesion with peripheral calcification is seen, contiguous with a non\nerupted right maxillary molar tooth. The mastoid air cells,and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No acute intracranial abnormality.\n2. Cystic lesion with peripheral calcification, contiguous with a non erupted\nright maxillary molar tooth, likely representing an odontogenic cyst.\n3. No stenosis or occlusion of the circle of ___ arteries.\n4. No stenosis or occlusion of the cervical arteries." + }, + { + "input": "Head CT: The noncontrast head CT demonstrates right frontoparietal\ncalcification and mild mass effect compatible with the patient's known AVM.\nThere is no evidence of hemorrhage or infarction. The ventricles and sulci are\nnormal in caliber and configuration. No fractures are identified.\n\nHead CTA: There is a large right frontoparietal arteriovenous malformation\nwith associated local sulcal effacement. There are multiple enlarged vascular\nstructures in the region of the nidus which appear to be predominantly\nrepresentative of veins. The drainage of the arteriovenous malformation is\npredominantly superficial, mostly into the vein Trolard with possibly some\nminimal subependymal venous drainage. There is no evidence of additional\naneurysm, vascular malformation, or vascular occlusion. The AVM appears\npredominantly unchanged when compared to prior exam.\n\nNeck CTA: The carotid and vertebral arteries and their major branches are\npatent with no evidence of stenoses. There is no evidence of internal carotid\nstenosis by NASCET criteria.", + "output": "1. Unchanged right frontoparietal AVM with predominantly superficial drainage,\nas described." + }, + { + "input": "Right frontoparietal calcified vascular mass consistent with known AVM with\nlarge draining veins is unchanged from ___. No hemorrhage or\ninfarction. The ventricles and sulci are normal in size and configuration. No\nosseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "Right frontoparietal AVM, unchanged from ___. No hemorrhage or CT\nevidence of infarction." + }, + { + "input": "There is no acute intracranial hemorrhage, edema, mass effect or shift of\nnormally midline structures. The ventricles and sulci are prominent.\nAdditionally, the corpus callosum is thinned and the floor of the third\nventricle is flattened. Periventricular white matter hypodensities are in\nkeeping with chronic small vessel ischemic disease. The basal cisterns appear\npatent and gray-white matter differentiation is preserved. The orbits and\nglobes are unremarkable. The imaged paranasal sinuses, mastoid air cells,\nmiddle ear cavities are clear. The bony calvaria appear intact.", + "output": "Ventricular prominence and thinning of the corpus callosum are compatible with\nnormal pressure hydrocephalus, given the provided history. However please note\nthat imaging alone cannot reliably differentiate between on communicating\nhydrocephalus and central atrophy." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Ventricles and\nsulci are appropriate for patient's age.\n\nThere is no evidence of fracture. The visualized portion of the mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable. Minimal left frontal sinus mucosal thickening is\npresent.\n\nThere is extensive subcutaneous emphysema, presumably extending from the\nmediastinum. Soft tissue densities are noted within bilateral external\nauditory canals which may represent cerumen.", + "output": "1. No acute intracranial hemorrhage or fracture.\n2. Extensive subcutaneous emphysema, which may be extending from the\nmediastinum. Recommend clinical correlation.\n\nRECOMMENDATION(S): Extensive subcutaneous emphysema, which may be extending\nfrom the mediastinum. Recommend clinical correlation." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nThere is mild mucosal thickening of the left sphenoid sinus. The remaining\nimaged paranasal sinuses are essentially clear. Mastoid air cells and middle\near cavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 2:21 pm, 1 minutes after\ndiscovery of the findings." + }, + { + "input": "There is no evidence of infarction,intracranial hemorrhage,edema,or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No evidence of acute intracranial process or hemorrhage." + }, + { + "input": "No acute intracranial hemorrhage, edema, mass effect, or acute major vascular\nterritorial infarction. Extensive periventricular, deep, and subcortical\nwhite matter hypodensities are a nonspecific but likely sequela of chronic\nsmall vessel ischemic disease in this age group, with corresponding T2/FLAIR\nhyperintensities on the preceding MRI. No calcifications are seen at the\nsites of numerous small microhemorrhages in the brain parenchyma is seen on\nthe preceding MRI. There is mild global parenchymal volume loss with mild\nprominence of the ventricles and sulci.\n\nThere are multiple lucent lesions in the calvarium, many of which are\ncompatible with arachnoid granulations. However, there is outer table\nthinning associated with a 12 mm elongated left occipital lesion on image 3:14\nand 6 mm rounded left frontal lesion on image 3:45. Left occipital lesion\ndemonstrates intermediate T1 signal, high T2 signal, high signal on gradient\necho images, faint high signal on diffusion tracer images, and no clear\nevidence for contrast enhancement. The left frontal lesion demonstrates high\nT1 signal on the recent brain MRI, indicating a hemangioma or other\nnonaggressive fat containing lesion.\n\nThere is mild mucosal thickening in the ethmoid air cells and minimal mucosal\nthickening in the partially imaged right maxillary sinus. Mastoid air cells\nappear well-aerated. Status post bilateral cataract surgery.", + "output": "1. No acute intracranial hemorrhage. No evidence for other acute intracranial\nabnormalities.\n2. Multiple lucent calvarial lesions are compatible with arachnoid\ngranulations. However, a left occipital bone lesion with indeterminate signal\ncharacteristics on the preceding brain MRI is associated with thinning of the\nouter table, and aggressive etiology cannot be excluded, particularly given\nthe history of breast cancer.\n\nRECOMMENDATION(S): Comparison with prior head imaging to assess stability of\nthe left occipital bone lesion. If clinically warranted, further evaluation\nmay be performed by a nuclear medicine bone scan.\n\nNOTIFICATION: Electronic preliminary report on ___ at 01:49 by\nDr. ___: \"No acute intracranial hemorrhage. No calvarial fractures. No\nlarge territorial infarct. Numerous bilateral periventricular and subcortical\nwhite matter hypodensities are nonspecific and likely correspond with sequela\nof chronic microangiopathy, however without priors for comparison again acute\netiology cannot be completely excluded.\"\n\nDr. ___ text-paged Dr. ___ in the emergency department at 13:05\non ___ regarding the additional findings and recommendations\nrelated to the left occipital bone lesion." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nExtensive periventricular and subcortical white matter hypodensities are\nunchanged and nonspecific, likely reflecting the sequelae of chronic small\nvessel ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. The\nvisualized portion of the orbits are notable for bilateral lens replacement.", + "output": "No evidence of acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass.\nSubcortical and periventricular white matter hypodensities are nonspecific,\nlikely related to chronic small vessel ischemic disease in a patient of this\nage. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Atherosclerotic calcifications are seen along bilateral\ncarotid siphons and distal vertebral arteries.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or acute vascular\nterritorial infarction. Prominent ventricles and sulci likely reflect age\nrelated atrophy. Periventricular white matter hypodensities are nonspecific\nbut likely sequelae of chronic small vessel ischemic disease. The basal\ncisterns are patent. Gray-white matter differentiation is preserved.\n\nNo fracture is identified. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of no evidence of acute major infarction, hemorrhage,\nedema, or large mass. The ventricles and sulci are prominent, compatible with\nage related global involutional change, stable since the prior study. \nScattered periventricular and subcortical white matter hypodensities are\ncompatible with small vessel ischemic disease. Bilateral basal ganglia\ncalcifications are unchanged. Atherosclerotic calcifications within the\nintracranial bilateral vertebral and internal carotid arteries are again\nnoted.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial pathology. Chronic changes, as described above." + }, + { + "input": "Images are degraded by motion. There is no evidence of large territorial\ninfarction, hemorrhage, edema, or mass effect. There is age related cerebral\nvolume loss CT accounting for the widening of the sulci and enlargement of the\nventricles. Hypodensities within the periventricular, subcortical and deep\nwhite matter are compatible with chronic small vessel infarction. \nIntracranial vascular calcifications are noted.\n\nNo acute osseous abnormalities seen. An air-fluid level with aerosolized\nsecretions are seen in the left maxillary sinus. There is mucosal thickening\nof the ethmoidal air cells. Fluid is also seen within the right frontal sinus\nwith aerosolized secretions. The mastoid air cells and middle ear cavities\nare clear.", + "output": "1. No acute intracranial hemorrhage.\n2. Air-fluid levels in the left maxillary sinus and right frontal sinus may be\nseen in acute sinusitis." + }, + { + "input": "There is no evidence of large territorial infarction, hemorrhage, edema, or\nmass effect. Again seen is age related cerebral volume loss with prominence\nof the sulci and ventricles. This is not significantly changed since the\nprior examination. Scattered white matter hypodensities are noted, unchanged\nsince prior examination, and representing the sequela of chronic small vessel\nischemic disease. Intracranial vascular calcifications are noted, unchanged\nsince the prior examination. Basal ganglia calcifications are also again\nnoted.\n\nStable fluid and mucosal thickening is noted within the left maxillary sinus\nsince the most recent examination. Fluid is seen within the right frontal\nsinus is well. The mastoid air cells and middle ear cavities are clear. The\nvisualized portions of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Fluid within the maxillary and frontal sinuses." + }, + { + "input": "The study is mildly limited by motion artifacts. There is no evidence of\nlarge territorial infarction,hemorrhage,edema,or mass. There is prominence of\nthe ventricles and sulci suggestive of involutional changes. Arachnoid cyst\nis again noted in the right middle cranial fossa. Chronic right cerebellar\ninfarct is again noted. Subependymal nodule along the frontal horn of the\nleft lateral ventricle (02:13) was better assessed on prior MRI.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nethmoid air cells. The remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "No acute intracranial process. Other details as above." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, or loss of\ngray/white matter differentiation. Ventricles and sulci within normal limits\nin size. Basal cisterns are preserved.\n\nThere is no evidence of fracture. There is minimal mucosal thickening in the\nethmoid and partially visualized maxillary sinuses. Mastoid air cells are\nwell aerated. The orbits appear unremarkable.", + "output": "No evidence for acute intracranial abnormalities." + }, + { + "input": "There is a 3 vessel aortic arch. There is calcified plaque at the great\nvessel origins and within bilateral proximal subclavian arteries without\nevidence for flow-limiting stenosis. Mixed plaque in the proximal right\ninternal carotid artery causes approximately 30% stenosis by NASCET criteria. \nThere is also mild calcified plaque in the proximal left internal carotid\nartery with approximately 35-40% stenosis by NASCET criteria. There is a\nfocus of calcified plaque mildly narrowing the right vertebral artery origin. \nRemaining course of the right vertebral artery is widely patent. Left\nvertebral artery is widely patent.\n\nThis exam is not technically optimized for evaluation of the included\nintracranial arteries, in the absence of dedicated 3D reformatted images. \nThere is calcified plaque within the partially visualized bilateral carotid\nsiphons without evidence for flow-limiting stenosis. Right ___, right AICA,\nand left ___ complex appear patent.\n\nThe patient is status post extraction ___ 17 with dehiscence of the lingual\ncortex. There is a left sublingual space hematoma measuring 51 x 30 x 24 mm\n(AP by TV by CC). No extravasation from the adjacent lingual or facial\narteries. Streak artifact from dental amalgam limits evaluation of the more\nsuperior oral cavity.\n\nThis exam is not technically optimized for evaluation of the included brain\nparenchyma. No concerning abnormalities are detected on limited assessment. \nPartially visualized orbits are notable for evidence of bilateral cataract\nsurgeries. There are a mucous retention cyst in the right maxillary sinus and\nmild mucosal thickening in the left maxillary sinus. There is partial\nopacification of bilateral mastoid air cells. There is fluid in the\nnasopharynx, likely secondary to the endotracheal tube which has been placed\nvia the left naris.\n\nPartially calcified right lobe thyroid nodule measures 27 x 16 mm in the axial\nplane. Multiple nonenlarged cervical lymph nodes are likely reactive. There\nis subcutaneous edema overlying the bilateral sublingual in left submandibular\nregions.\n\nEvaluation of the included upper lungs is technically limited. No concerning\nabnormalities are identified. Multiple nonenlarged lymph nodes in the\nincluded portion of the mediastinum may be reactive.\n\nSpondylotic changes of the cervical spine are noted.", + "output": "1. Left sublingual space hematoma measuring 51 x 30 x 24 mm, abutting ___ 17\nextraction bed with lingual cortex dehiscence. No evidence for active\nextravasation of contrast from the left lingual or facial arteries.\n2. Mild atherosclerosis. Approximately 30% stenosis of the right ICA by\nNASCET criteria and approximately 35-40% stenosis of the left ICA by NASCET\ncriteria.\n3. 2.7 cm partially calcified right thyroid nodule.\n\nRECOMMENDATION(S): Thyroid nodule. Ultrasound follow up recommended. \n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or ___, or with suspicious findings.\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule. ___, et al, \"Managing\nIncidental Thyroid Nodules Detected on Imaging: White Paper of the ACR\nIncidental Findings Committee\". J ___ ___ 12:143-150." + }, + { + "input": "There is no fracture. The temporomandibular joints are well aligned in closed\nmouth position, without evidence for degenerative remodeling of the articular\nsurfaces. There are mild periodontal lucencies throughout the mandible and\nmaxilla without evidence for focal periapical lucencies.\n\nThe globes are intact. No intraorbital hematoma is seen.\n\nThe paranasal sinuses and ostiomeatal units are well-aerated. The nasal\nseptum is midline. No abnormal soft tissue density in the nasal cavity.\n\nMiddle ear cavities and partially visualized mastoid air cells are clear.\n\nThis exam is not technically optimized for evaluation of the included brain\nparenchyma, but no concerning abnormalities detected.", + "output": "No fracture." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Mild mucosal thickening is seen within the\nmaxillary sinuses. The visualized portion of the remaining paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. No evidence of fracture." + }, + { + "input": "Postoperative changes following a broad left frontoparietal craniotomy for\nresection of an underlying extra-axial mass. Expected postoperative changes\ninclude small scattered amounts of pneumocephalus and subarachnoid hemorrhage.\nFat packing material along a small portion of the superior sagittal sinus. \nPersistent vasogenic edema predominantly in the left frontoparietal white\nmatter. No significant mass effect or midline shift. No CT evidence for\nacute, major vascular territorial infarction.\n\nBackground mild chronic microangiopathic ischemic changes. Persistent smaller\nright cerebellar and right frontoparietal meningiomas are better demonstrated\non recent MR.\n\n___ mucosal thickening lines the paranasal sinuses. Bilateral lens\nreplacements.", + "output": "Postoperative changes following left parietal tumor resection, detailed above." + }, + { + "input": "There is no evidence of territorial infarction, hemorrhage, edema, or mass.\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. There unchanged periventricular and subcortical white matter\nhypodensities, which are nonspecific, but commonly seen with chronic\nmicroangiopathy in a patient of this age. Extensive atherosclerotic\ncalcification of the bilateral internal carotid arteries are noted.\n\nThere is a new prominent calcific density of the right MCA bifurcation (series\n2, image 7), not seen on prior examination of ___. This likely\nrepresents atherosclerotic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. There is no CT evidence for acute territory infarct. No intracranial\nhemorrhage.\n2. When compared to prior exam there is a new prominent calcific density at\nthe right MCA bifurcation, most compatible with atherosclerotic calcification.\n3. Given interval development since prior examination of ___, clinical\ncorrelation with patient's symptoms is recommended. If there no\ncontraindications, MRI MRA brain could be performed for further evaluation.\n\nRECOMMENDATION(S): Given interval development of prominent calcification at\nthe expected location of the right MCA bifurcation since prior examination of\n___, clinical correlation with patient's symptoms is recommended. If there no\ncontraindications, MRI MRA brain could be performed for further evaluation for\nprogressive vascular disease.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\n___ on the telephoneon ___ at 11:31 AM, 2 minutes after discovery of\nthe findings." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,or\nmass-effect. Septum cavum pellucidum et vergae is incidentally noted. No\nhydrocephalus is seen. Gray-white matter differentiation is preserved.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses is notable for a left maxillary sinus mucosal polyp/mild\nmucosal thickening. The remainder of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. No acute intracranial process. No acute fracture seen." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of hemorrhage, edema, mass effect, or\nacute vascular territorial infarction. The ventricles and sulci are\nage-appropriate.\n\nThere is partial opacification of the anterior ethmoid air cells and a mucous\nretention cyst in the right sphenoid sinus. The mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nMultifocal atherosclerotic disease is present along the cavernous and\nparaclinoid internal carotid arteries bilaterally without high-grade narrowing\nor occlusion. The left A1 segment is diminutive and the normal left V2\nsegment is predominantly supplied from the contralateral side, likely\nrepresenting a normal anatomic variant. The vessels of the circle of ___\nand their principal intracranial branches otherwise appear normal without\nstenosis, occlusion, or aneurysm formation. The dural venous sinuses are\npatent.\n\nCTA NECK:\nThere is a three vessel aortic arch with minimal atherosclerotic disease. The\norigin of branch vessels and bilateral common carotid and vertebral arteries\nare patent. There is mild noncalcified plaque at the left carotid bifurcation\nextending into the proximal left internal carotid artery without appreciable\nluminal narrowing. The carotid and vertebral arteries and their major branches\notherwise appear normal with no evidence of stenosis or occlusion. There is no\nevidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nPartially imaged lung parenchyma is notable for biapical scarring and mild\ndependent atelectasis. There are multiple hypodense nodules in the thyroid\ngland bilaterally, largest measuring 1.2 cm (5:92). There is no\nlymphadenopathy by CT size criteria.", + "output": "1. No evidence of hemorrhage, edema, mass effect, or acute infarction.\n2. Unremarkable head and neck CTA aside from scattered atherosclerotic disease\nand anatomic variants as described.\n3. Multiple bilateral thyroid nodules measuring up to 1.2 cm. The ___\nCollege of Radiology guidelines suggest that in the absence of risk factors\nfor thyroid cancer, no further evaluation is recommended." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are normal in size and configuration.\n\nThere is mild mucosal thickening in the ethmoid air cells. The visualized\nportion of the paranasal sinuses, mastoid air cells,and middle ear cavities\nare otherwise clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is atheromatous calcification of the carotid siphons bilateral. There\nis a hypoplastic left A1. The vessels of the circle of ___ and their\nprincipal intracranial branches appear otherwise normal without stenosis,\nocclusion, or aneurysm. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is atheromatous calcification of the bifurcation of the common carotid\narteries bilaterally. Bilateral carotid and vertebral artery origins are\npatent.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion.\n\n\n\nOTHER:\nThere is mild nonspecific ground-glass opacification in the right upper lobe\nposteriorly. There is a 2 mm right upper lobe pulmonary nodule, unchanged\nsince ___. The visualized portion of the lungs are otherwise clear.\nThe visualized portion of the thyroid gland is within normal limits. There is\nno lymphadenopathy by CT size criteria.", + "output": "1. No acute intracranial abnormality.\n2. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n3. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection." + }, + { + "input": "Several tiny, punctate hyperdensities are noted within the parenchyma and may\nrepresent miniscule intraparenchymal hemorrhage versus axonal shearing injury,\nunchanged as compared to the prior examination. There is no large extra-axial\nfluid collection, mass effect, midline shift, or impending downward\nherniation. The ventricles and sulci are normal in size and configuration. The\nbasal cisterns remain patent.\n\nExtensive facial bone fractures are better characterized by recent outside\nhospital maxillofacial CT examination, and include fractures through the left\nmaxilla, left orbit, and left sphenoid bone with a small degree of\npneumocephalus. There is appreciable opacification of the bilateral maxillary\nsinuses, ethmoid air cells, sphenoid sinuses, and left frontal sinus. A\nlaceration is noted anterior lateral to the left zygomatic arch.", + "output": "1. Multiple punctate foci of intraparenchymal hemorrhage versus posttraumatic\ndiffuse axonal injury, without appreciable midline shift or mass effect.\n2. Extensive facial bone fractures, better characterized by recent CT\nmaxillofacial.\n\nNOTE ADDED AT ATTENDING REVIEW: There is no evidence of hemorrhage. The\nhyperdensities noted above are noise, rather than small bleeds.\n\nNOTIFICATION: The finding of no evidence of hemorrhage was discussed by\ntelephone by Dr. ___ with Dr. ___ at 9:50 am on ___." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nPeriventricular white matter hypodensities are nonspecific but likely\nrepresent sequela of chronic small vessel ischemic disease.\nThere is no evidence of fracture. There is mild mucosal thickening in the\nright maxillary sinus. The remaining visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThere is mild right and trace left mucosal wall thickening in the maxillary\nsinuses as well as mild right greater than left mucosal wall thickening of the\nethmoid air cells. There is trace mucosal thickening in the anterior aspect\nof the right sphenoid sinus. The remainder of the visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are otherwise\nclear. The visualized portion of the orbits are unremarkable. Punctate,\nrounded metallic density is seen within the midline forehead soft tissues\n(05:16), corresponding to the susceptibility artifact as seen on prior MR\n___ images.\n\nCTA HEAD:\nThere is normal variant partial fetal type supply of the right posterior\ncerebral artery. The right A1 segment of the ACA is hypoplastic. There is an\nanterior communicating artery fenestration (series 952, image 12) the vessels\nof the circle of ___ and their principal intracranial branches appear\nnormal with no evidence of stenosis, occlusion, or aneurysm. The dural venous\nsinuses are patent.", + "output": "1. No acute intracranial abnormality on noncontrast head CT.\n2. Patent intracranial arterial vasculature without stenosis, occlusion, or\naneurysm formation.\n3. Punctate rounded metallic density of the midline forehead superficial soft\ntissues, corresponding to susceptibility artifact seen on prior MR scout\nimages." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThere are innumerable stones within right submandibular gland, tracking into\nthe very proximal duct. Largest stone measures 1.5 cm. Right submandibular\ngland is atrophic and contains few saccular cystic structures, likely dilated\nducts from obstruction secondary to stone disease.. No adjacent inflammatory\nstranding suggest acute inflammation. No adjacent fluid collections. There\nare no stones within distal submandibular duct.\nLeft submandibular gland, bilateral parotid glands, ducts demonstrate no\nstones, masses or inflammatory changes.\n\nThe thyroid gland appears normal. There is no lymphadenopathy by CT criteria.\nThe neck vessels are patent.\n\nMild paraseptal, centrilobular emphysema in the upper lungs. There are no\nosseous lesions. Degenerative changes spine.", + "output": "1. Right submandibular gland silolithiasis, with atrophic gland and no\nevidence of active inflammation." + }, + { + "input": "This study is severely limited by artifacts from mechanical hardware and\nanatomically by severe scoliosis. In addition, most vessels that would supply\nthe region of interest are below the reliable resolution of CTA. Therefore,\nthe sensitivity is very low for extravasation of blood into the trachea. \nWithin these confines, there is no evidence of frank extravasation, fluid in\nthe trachea, or evidence of an tracheoarterial fistula. The carotid and\nvertebral arteries and their major branches are patent with no evidence of\nstenoses. No evidence for dissection is seen.\n\nBy NASCET criteria, there is no stenosis of the right ICA and no stenosis of\nthe left ICA.\n\n 0.7 cm right thyroid lobe nodule. The ___ College of Radiology\nguidelines suggest that in the absence of risk factors for thyroid cancer, no\nfurther evaluation is recommended.", + "output": "The study is severely limited by artifact from mechanical hardware and\nanatomically by severe scoliosis. Additionally, the sensitivity of CTA for a\ntracheoarterial fistula is notably low. Within these limitations, there is no\nevidence of fluid within the trachea nor a tracheoarterial fistula. The most\nsensitive and anatomically accurate study to perform would be a catheter\nangiogram if the degree of bleeding is sufficient to warrant such." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. There is generalized atrophy. The paranasal sinuses appear well\naerated. The mastoid air cells and middle ear cavities are clear. The bony\ncalvarium is intact.", + "output": "No acute intracranial process. Generalized atrophy." + }, + { + "input": "There is no evidence of territorial infarction, intracranial hemorrhage,\nedema, or discrete mass. Periventricular and subcortical white matter\nhypodensities, nonspecific but probably reflect sequela of chronic\nmicroangiopathy. Prominence of the ventricles and sulci may reflect\nage-related involutional changes.\n\nNo acute fractures are seen. There is scattered mucous in the ethmoidal air\ncells and a mucous retention cyst in the right maxillary sinus. Otherwise,\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\nThe orbits are unremarkable.", + "output": "No acute intracranial findings." + }, + { + "input": "Encephalomalacia in the left temporal occipital region noted with dystrophic\ncalcifications. There are chronic left basal ganglia and right thalamic\nlacunar infarcts. There is also a chronic infarct in the left cerebellar\nhemisphere. Enlarged ventricles and sulci is compatible global volume loss. \nScattered periventricular and subcortical white matter hypodensities are\nlikely sequela of chronic small vessel disease. There is no intra-axial or\nextra-axial hemorrhage, no evidence of acute infarct or mass effect.\n\nIncluded paranasal sinuses and mastoids are essentially clear. Skull and\nextracranial soft tissues are unremarkable.", + "output": "No acute intracranial process, no hemorrhage.\nLeft temporal occipital encephalomalacia, chronic left cerebellar infarct and\nbilateral chronic lacunar infarcts as above." + }, + { + "input": "There is no evidence of hemorrhage, edema, or mass. A chronic lacune \ninvolving the left basal ganglia is new compared to the prior examination. A\ntiny chronic lacunar infarct versus prominent perivascular space is also\npresent in the right insula more inferiorly, unchanged. There is prominence\nof the ventricles and sulci suggestive of involutional changes.\nPeriventricular and subcortical white matter hypodensities are nonspecific but\nlikely sequelae of chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are essentially clear. \nThe visualized portion of the orbits are unremarkable.", + "output": "No evidence of acute infarction or hemorrhage.\nInterval but chronic left basal ganglia infarct." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is a subtle hypodensity in the right thalamus on image 4:12 which\ncorresponds to an acute infarct seen on the recent prior MRI of the head.\n\nThere is no evidence of no evidence of hemorrhage, edema, or mass. The\nventricles and sulci are patent and prominent in keeping with age-related\nvolume loss.\n\nThere is an old lacunar infarct in putamen. Scattered foci of hypodensity in\nthe subcortical and periventricular white matter, nonspecific, likely\nsecondary to small vessel ischemic disease. There is intracranial\natherosclerotic calcification.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable\nnoting prior bilateral cataract surgeries.\n\nThere is soft tissue density in the left external auditory canal, likely\ncerumen.\n\nCTA HEAD:\nThere is focal luminal narrowing involving the basilar artery as seen on image\n___:36, likely secondary to atherosclerosis. Also seen is marked luminal\nnarrowing involving the P1 and P2 segments of the right posterior cerebral\nartery (see 657: 25 and P1 segment of left posterior cerebral artery (see\n657:3). There is a focal stenosis of a proximal M2 branch of the left middle\ncerebral artery. A This is also favored to be secondary to atherosclerosis.\n\nThere is bilateral cavernous carotid artery calcification causing mild\nstenosis.\n\nThe remaining vessels of the circle of ___ and their principal intracranial\nbranches appear unremarkable without occlusion or aneurysm formation. The\ndural venous sinuses are patent.\n\nCTA NECK:\nThere is atherosclerosis involving the left carotid bifurcation causing\napproximately 50% stenosis by NASCET criteria. Also seen is mild\natherosclerosis involving the right carotid bifurcation without any stenosis\nper NASCET criteria.\n\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of occlusion.\n\nOTHER:\nThere is a 4 mm nodule in the right upper lobe on image 5:58. The visualized\nportion of the lungs are otherwise clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Atherosclerosis involving bilateral cavernous carotid arteries, the left\nmiddle cerebral artery, basilar arteries and bilateral posterior cerebral\narteries causing luminal irregularity and narrowing as described above. No\nocclusion or aneurysm is seen.\n2. Atherosclerosis involving the left carotid bifurcation causing\napproximately 50% stenosis by NASCET criteria. Mild atherosclerosis involving\nthe bifurcation of right carotid artery without any stenosis by NASCET\ncriteria.\n3. Subtle hypodensity in the right thalamus corresponding to the acute infarct\nseen on the recent prior MRI. Otherwise, unremarkable CT of the head." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, mass, mass effect or\nlarge territorial infarction. Prominence of the ventricles and sulci are\nlikely related to age related involutional changes. Periventricular and\nsubcortical deep white matter hypodensities are likely related to small vessel\nischemic disease. A lacunar infarct in the left basal ganglia, is unchanged\ncompared to the prior exam. A lacunar infarct in the right thalamus\ndemonstrates expected evolution since prior MRI. Region of encephalomalacia\nin the right occipital lobe (602b:29) is unchanged. The basilar cisterns are\npatent, and there is otherwise good preservation gray-white matter\ndifferentiation.\n\nNo acute fractures identified. The visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The globes are unremarkable. The\npatient is status post bilateral lens replacement surgery.", + "output": "1. No evidence of an acute intracranial hemorrhage.\n2. Chronic changes as above including multiple bilateral lacunar infarcts and\nwhite matter changes likely sequela of chronic small vessel disease." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass. Chronic lacunes are noted in the basal ganglia bilaterally, right\ninternal capsule, and left corona radiata, unchanged. Periventricular,\nsubcortical and deep white matter hypodensities are nonspecific but likely\nrepresent the sequela of chronic small vessel ischemic disease. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nMild atherosclerotic calcifications are seen involving the cavernous carotid\narteries.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is low-density with sulcal effacement within the left occipital lobe and\nmedial temporal lobe, compatible with an acute infarction in the left PCA\ndistribution. There is surrounding edema with effacement of the temporal horn\nof the left lateral ventricle. There is no evidence of hemorrhage.\n\nThere is diffuse parenchymal volume loss with prominence of the ventricles,\nsulci, and cisterns. There are hypodensities within the right thalamus and\nleft centrum semiovale, which may be related to chronic infarction. In\naddition, there is nonspecific periventricular subcortical white matter\nhypodensity, which may be a sequela of chronic small vessel microangiopathy. \nThe paranasal sinuses and bilateral mastoid air cells appear clear. Streak\nartifact related to dental amalgam limits evaluation of the adjacent\nstructures. Patient is status post bilateral lens replacements.\n\nCTA HEAD:\nThere is an abrupt termination of the left P1 segment of the posterior\ncerebral artery (3:253, 464: 1) with decreased arborization of the distal left\nposterior cerebral arteries. There is moderate narrowing of the proximal\nportion of the right superior cerebellar artery (464:1, 3:251). Otherwise,\nthe vessels of the circle of ___ and the principal intracranial branches\nappear patent without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses appear patent.\n\nCTA NECK:\nThere is calcification at the origin of bilateral internal carotid arteries\nresulting in approximately 30% narrowing of the proximal right internal\ncarotid artery and no significant stenosis of the left internal carotid artery\nby NASCET criteria. Otherwise, the bilateral common carotid and vertebral\narteries are patent without stenosis or occlusion.\n\nOTHER:\nThere are multiple nodules identified within the visualized lung apices,\nmeasuring up to 7 x 6 mm within the right upper lobe (03:23), with additional\nsmaller nodules, the larger of which measure 6 x 5 mm within the right upper\nlobe (03:42), and 5 x 5 mm within the left upper lobe (03:12). There are\nvascular calcifications at the aortic arch and origins of the great vessels. \nSternotomy wires are visualized.\n\nThere are multilevel degenerative changes of the visualized cervical spine\nwith anterolisthesis of C3 on C4. There are Posterior endplate osteophytes\nresulting in moderate spinal canal stenosis particularly at C5-C6 and C6-C7,\nwith the endplate osteophytes encroaching into the neural foramina and\ncombined with facet osteophyte result in severe right neural foraminal\nnarrowing at C5-C6 and moderate right neural foraminal narrowing at C6-C7.", + "output": "1. Acute to subacute infarction involving the left PCA distribution. No\nevidence of hemorrhage.\n2. Abrupt termination of the left P1 segment of the posterior cerebral artery\nwith decreased arborization of the distal left posterior cerebral arteries.\n3. Moderate narrowing of the proximal right superior cerebellar artery, with\nreconstitution distally.\n4. Approximately 30% narrowing at the origin of the right internal carotid\nartery. No significant left internal carotid artery stenosis by NASCET\ncriteria.\n5. Multiple bilateral pulmonary nodules within the visualized bilateral lung\napices, measuring up to 7 x 6 mm, which are new when compared with the prior\nCTA dated ___.\n6. Degenerative changes of the cervical spine, with severe right neural\nforaminal narrowing at C5-C6 and moderate right neural foraminal narrowing at\nC6-C7 as a result of endplate and facet osteophytes.\n\nRECOMMENDATION(S): The ___ Society guidelines for pulmonary nodule\nguidelines suggest for pulmonary nodules greater than 6 mm or less than 8 mm,\n___ month follow-up in low-risk patients, and ___ month follow-up in high\nrisk patients.\n\nNOTIFICATION: The findings were discussed with ___ by ___\n___ on the telephone on ___ at 4:12 ___, 3 minutes after discovery of\nthe findings." + }, + { + "input": "Dental amalgam streak artifact and motion, despite repeat exam, limits this\nstudy.\n\nThere is no evidence hemorrhage, edema or mass. Hypodensity within the left\ntemporal and occipital lobes is consistent with encephalomalacia from prior\nleft PCA territory infarct. Additional area of hypodensity in the more\nlateral left temporal lobe (5:9). This area of hypodensity is less clearly\nchronic in nature, additionally is located in the MCA territory. There are\nmultiple bilateral basal ganglia lacunar infarcts, grossly unchanged since\n___.\n\nStable diffuse cortical atrophy and prominent ventricles consistent with\ninvolutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Patient is\nstatus post bilateral lens replacement. The visualized portion of the orbits\nare otherwise unremarkable.", + "output": "1. Limited exam without definite acute intracranial process, no hemorrhage.\n2. Diffuse cortical atrophy and evidence of old left PCA territory infarction.\n3. Additional area of hypodensity in the more lateral left temporal lobe in an\nMCA territory. This is also likely an infarct though age indeterminate. MRI\nwould help date if clinically warranted.\n\nNOTIFICATION: The updated findings were discussed with Dr. ___. by\n___, M.D. on the telephone on ___ at 5:51 pm, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass. \nEncephalomalacia of the right temporal and occipital lobes, and right\ncerebellum are unchanged. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. Extensive bilateral periventricular,\nsubcortical and deep white matter hypodensities are nonspecific, but likely a\nsequela of chronic small vessel disease. Atherosclerotic calcifications are\nnoted within the bilateral carotid siphons.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. A nasogastric\ntube is partially visualized. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial process.\n2. Remote infarction involving the right temporal/occipital lobes and right\ncerebellum." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nPeriapical lucencies are noted at left mandibular molars, ___ 19 and 18.\n\nCTA HEAD:\nThe carotid siphons are moderately calcified. Otherwise, the vessels of the\ncircle of ___ and their principal intracranial branches appear normal\nwithout stenosis, occlusion, or aneurysm formation. The dural venous sinuses\nare patent.\n\nCTA NECK:\nThe right vertebral artery is diminutive relative to the left, likely\ncongenital. Otherwise, the carotid and vertebral arteries and their major\nbranches appear normal with no evidence of stenosis or occlusion. There is no\nevidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nA subsegmental pulmonary embolus (series 3, image 25) extending into multiple\nleft upper lobe subsegmental branches appears new from prior examination. \nPreviously seen pulmonary emboli in the left lower lobe are not imaged on\ntoday's examination. No evidence of pulmonary infarct.\n\nA 5 mm pulmonary nodule in the subpleural right upper lobe (series 3, image\n63) appears unchanged from ___. A 4 mm pulmonary nodule (series 3,\nimage 47) in the right lung apex also appears unchanged.\n\nFocus of nodular scarring in the superior segment of the left lower lobe\n(series 3, image 1) is partially imaged but grossly unchanged.\n\nNumerous thyroid nodules measure up to 1.3 x 1.0 cm.\n\nMultilevel cervical degenerative changes noted.", + "output": "1. New left upper lobe subsegmental pulmonary embolus. Previously seen\npulmonary emboli in the left lung base are not imaged on today's examination.\n2. No evidence of hemorrhage, edema, mass effect or infarction. No high-grade\nstenosis, dissection or aneurysm greater than 3 mm.\n3. Pulmonary nodules at the right lung apex are unchanged from chest CT ___.\n4. Multiple thyroid nodules measure up to 1.3 cm.\n5. Periapical lucencies are noted at left mandibular molars, ___ 19 and 18.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:14 am, 10 minutes after\ndiscovery of the findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of hemorrhage, edema, or mass. Two small round\nhypodensities identified in the right periventricular white matter, which\nlikely reflect lacunar infarcts. No new since the study ___. The\nventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThere is a stenosis at the left vertebral artery origin. The carotid and\nright vertebral arteries and their major branches appear otherwise normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. Unchanged 4 mm triangular\nshaped pulmonary nodule in the right upper lobe. Again seen are multiple\nright thyroid nodules of varying sizes. The largest nodule appears\nheterogeneous with central calcification and measures up to 16 mm in maximum\nAP dimension. There is no lymphadenopathy by CT size criteria.", + "output": "1. New lacunar infarcts in the right periventricular white matter.\n2. Stenosis at the left vertebral artery origin.\n3. Unchanged multiple right thyroid nodules and triangular shaped right\nupper lobe pulmonary nodule." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nAgain identified is the mixed density subdural collection along the left\ncerebral convexity measuring up to 14 mm in maximum thickness, similar to the\nprior outside CT. A small subdural hematoma is again identified along the\nfalx and extending along the right tentorium. There is unchanged 7 mm\nrightward midline shift.\nThere is unchanged effacement of the left lateral ventricle. There is slight\nenlargement of the right temporal horn there is stable effacement of the right\nambient and quadrigeminal cisterns. The fourth ventricle is normal in size.\n\nThere is no intraparenchymal or intraventricular hemorrhage.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The right\nvertebral artery predominantly supplies the right ___ territory, normal\nanatomic variant.\nThe dural venous sinuses are patent.\n\nCTA NECK:\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThere are no suspicious pulmonary nodules. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Unchanged mixed density subdural collection along the left cerebral\nconvexity measuring up to 14 mm with stable 7 mm rightward midline shift and\nunchanged effacement of the left lateral ventricle, right ambient and right\nquadrigeminal cisterns.\n2. Unchanged prominence of right temporal horn likely related to subfalcine\nherniation.\n3. Patent intracranial and cervical vasculature without evidence of vessel\ndissection, stenosis, occlusion or aneurysm formation greater than 3 mm." + }, + { + "input": "A mixed density subdural collection along the left cerebral convexity measures\nup to 1.3 cm in maximal thickness and is unchanged compared to prior. \nUnchanged small subdural hematoma along the falx and right tentorium. \nUnchanged 7 mm rightward midline shift. The right basilar cistern is effaced.\nThere is left-sided uncal herniation. There is unchanged effacement of the\nleft lateral ventricle. The right temporal horn is prominent.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Unchanged mixed density subdural collection along the left cerebral\nconvexity measuring up to 13 mm with 7 mm rightward midline shift.\n2. Unchanged left-sided uncal herniation." + }, + { + "input": "The mixed density, predominantly isodense fluid collection along the left\ncerebral convexity measures up to 1.1 cm in maximal thickness, previously 1.3\ncm. There as also been interval evolution of blood products along the\nanterior falx and right tentorium with minimal residual hyperdense blood\nproducts along the anterior falx. There is mild-to-moderate mass effect on\nthe left cerebral hemisphere with partial effacement of the left lateral\nventricle and approximately 4 mm of left-to-right midline shift, previously 7\nmm. Effacement of the left cerebral sulci persists. Partial effacement of\nthe left suprasellar cistern.\n\nNo evidence of new intracranial hemorrhage. No evidence of large territory\ninfarction.\n\nThe patient is status post embolization of the left middle meningeal artery. \nThe visualized paranasal sinuses, mastoid air cells, and middle ear\ncavitiesare grossly clear.", + "output": "1. Slight decrease and interval redistribution of the left cerebral convexity\nsubdural fluid collection measuring up to 1.1 cm and approximately 4 mm of\nleft-to-right midline shift, slightly improved from prior.\n2. Mild left uncal herniation.\n3. No evidence of new intracranial hemorrhage or large territorial infarction." + }, + { + "input": "Chronic left hemispheric subdural hematoma has decreased since prior and has\nevolved, it measures 0.5 cm maximum thickness today, compared with 1.1 cm on\nprior. No acute hemorrhage.. Post embolization changes left middle meningeal\nartery. No hydrocephalus, acute infarct, midline shift or mass.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Small chronic left hemispheric subdural hematoma, decreased." + }, + { + "input": "Linear hyperdensity in the left skull base in the region of left sphenoid is\ncompatible with provided history of left middle meningeal artery (MMA)\nembolization.\n\nPreviously seen left subdural hematoma is no longer identified. There is no\nevidence of infarction,new area of hemorrhage,parenchymal edema,, extra-axial\ncollection, mass, or mass effect. The ventricles and sulci are preserved in\nsize and configuration.\n\nNo displaced calvarial fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are preserved.", + "output": "1. Interval resolution since ___ of left subdural hematoma.\n2. No evidence of new acute intracranial hemorrhage.\n3. Left MMA embolization postoperative changes." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nNo large vascular territorial infarct is demonstrated. There are patchy areas\nof hypoattenuation in the white matter bilaterally which may reflect chronic\nsmall vessel disease or in the context of the outside imaging reportedly\nshowing small infarcts, could also corresponds to the frontal lobe infarcts. \nThe ventricles and sulci are mildly prominent reflecting volume loss. No\nhemorrhage is demonstrated..\n\nThere is minimal ethmoid air cell mucosal thickening. The visualized portion\nof the paranasal sinuses, mastoid air cells,and middle ear cavities are\notherwise clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe left vertebral artery is slightly dominant, and is partially calcified and\ntortuous in the V4 segment although without significant stenosis demonstrated.\nThere appear to be 2 small vessels arising from the basilar artery on the\nright giving rise to the right superior cerebellar artery, possibly with\nstenosis at the origin of the right superior cerebellar artery. Mild stenosis\nat the origin of the P1 segment of the left posterior cerebral artery. There\nis atherosclerotic calcification of the bilateral intracranial internal\ncarotid arteries predominantly in the cavernous segments with no significant\nstenosis. The vessels of the circle of ___ and their principal intracranial\nbranches otherwise appear patent without stenosis, occlusion, or aneurysm\nformation greater than 3mm. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is variant aortic arch anatomy with Advair and right subclavian artery\nnoted. Mild atherosclerotic calcification of the aortic arch and great vessel\norigins, with no stenosis. The proximal common carotid arteries as well as\nthe proximal subclavian arteries are tortuous with mild scattered\ncalcifications, but there is no stenosis as a result of these findings\nBilateral carotid and vertebral artery origins are patent.\nThe bilateral internal carotid arteries are tortuous in their distal\nextracranial segments, with mild scattered calcified and noncalcified\natheromatous disease causing no internal carotid stenosis by NASCET criteria.\nThe vertebral arteries appear normal with no evidence of stenosis or\nocclusion.\n\n\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. There are multilevel degenerative changes of the spine. Multiple\ndental caries involving the maxillary incisors. Few mild patchy ground-glass\ndensities at the lung apices are nonspecific. Nonspecific enlarged palatine\ntonsils with fluid in the nasopharynx, which may be reactive. Enlarged\nthyroid gland with 19 mm hypodense right thyroid nodule as measured in the\ncoronal plane. There is a partially calcified nodule in the tail of the left\nparotid gland measuring 16 mm", + "output": "1. No large vascular territory infarct or hemorrhage. Hypodensities in the\nwhite matter are noted which can reflect chronic small vessel disease,\nalthough hypodensities in the frontal lobe on the right could correspond to\nsubcortical infarcts given the reported findings on outside imaging, not\navailable for direct comparison.\n2. Patent circle of ___ without definite evidence of stenosis,occlusion,or\naneurysm.\n3. Patent bilateral cervical carotid and vertebral arteries without definite\nevidence of stenosis, occlusion, or dissection.\n4. Partially calcified nodule in the left parotid tail measures 16 mm. \nConsider tissue sampling and ENT consultation.\n5. 19 mm right thyroid nodule for which ultrasound is recommended.\n\nRECOMMENDATION(S): Thyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or older, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150.\n\nLeft parotid nodule - tissue sampling and ENT consultation is suggested." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Periventricular and subcortical white matter hypodensities are\nnonspecific, but likely reflect sequelae of chronic small vessel ischemic\ndisease. Prominence of the ventricles and sulci suggest involutional changes.\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nlarge territory infarct or intracranial hemorrhage.\n2. No acute displaced calvarial fracture." + }, + { + "input": "The patient is status post interval suboccipital craniotomy and resection of a\nmass within the foramen of Magendie. There is expected postoperative change,\nincluding pneumocephalus, and small amount of high-density blood products\nwithin the surgical bed. The bilateral frontal lobes are somewhat effaced by\na pneumocephalus. The ventricles are stable in size. The basal cisterns are\npatent. There is preservation of gray-white matter differentiation. There is\nno evidence of acute infarct.\n\nThe a visualized paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The globes are unremarkable.", + "output": "1. Status post suboccipital craniotomy and resection of a mass within the\nforamen of Magendie, with expected postoperative change, as described above.\n2. No evidence of acute infarct." + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass. The ventricles and sulci are normal in size and configuration. No\nosseous abnormalities seen. There is mild mucosal thickening in the\nvisualized paranasal sinuses. The mastoid air cells and middle ear cavities\nare clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality. Please note, however, that MR is more\nsensitive in the detection of intracranial mass." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.\nThere is no evidence of large vessel occlusion, dissection, or aneurysm. The\ncarotid and vertebral arteries and their major branches are patent with no\nevidence of stenoses. There is a 2 vessel aortic arch noted.\n\nEvaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. The neck vessels are patent.", + "output": "Normal study No evidence of dissection or aneurysm." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nCT HEAD:\nThere is no evidence of acute vascular territorial infarction, hemorrhage,\nedema, or mass. Prominence of ventricles and sulci are unchanged compared to\nexams dating back to ___.\n\nA mucous retention cyst is seen in the left maxillary sinus, and there is\nmucosal thickening seen in scattered ethmoid air cells. The remainder of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\norbits are grossly unremarkable bilaterally.\n\nCTA HEAD:\nThe right A1 segment is not visualized, likely a congenital variant. \nOtherwise, the remaining vessels of the circle of ___ and their principal\nintracranial branches appear patent without stenosis, occlusion, or aneurysm\nformation. The bilateral posterior communicating arteries are patent. The\ndural venous sinuses are patent.\n\nCTA NECK:\nThe right vertebral artery is dominant. Mild atherosclerotic calcifications\nare seen along the carotid bifurcations. There is medialization of the\nbilateral internal carotid arteries. Otherwise, the carotid and vertebral\narteries and their major branches appear grossly patent with no evidence of\nstenosis or occlusion. There is no evidence of internal carotid stenosis by\nNASCET criteria.\n\nOTHER:\nIncidental note is made of a 3 mm pulmonary nodule in the left upper lobe\n(3:4). The remainder of the lungs are otherwise grossly clear. Prominent\ncervical lymph nodes are seen bilaterally, none of which are pathologically\nenlarged by CT size criteria. The thyroid is unremarkable in appearance.", + "output": "1. Dental amalgam streak artifact limits study.\n2. No evidence for acute intracranial hemorrhage or large vascular territorial\ninfarction. Please note MRI of the brain is more sensitive for the detection\nof acute infarct.\n3. Mild atherosclerotic disease involving the bilateral carotid bulbs. \nOtherwise, widely patent intracranial and cervical vasculature without\nhigh-grade stenosis, occlusion, dissection, or aneurysm greater than 3 mm.\n4. Right-sided dominant vertebral basilar system and a hypoplastic right A1\nsegment, likely congenital findings.\n5. Incidental 3 mm pulmonary nodule in the left upper lobe. Please see\nrecommendation lobe.\n6. Nonspecific mildly subcentimeter lymph nodes as described, which may be\nreactive.\n\nRECOMMENDATION(S): For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 12:09 am, 1 minutes after\ndiscovery of the findings." + }, + { + "input": "No evidence of acute large territorial infarction, acute intracranial\nhemorrhage, edema, or mass effect. The ventricles and sulci are normal in\nsize and configuration.\n\nNo acute osseous abnormalities. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. There is no evidence of acute intracranial process or hemorrhage.\n2. No fractures are identified." + }, + { + "input": "There is no evidence of large territorial infarction, hemorrhage, edema, or\nmass effect. The ventricles and sulci are normal in size and configuration. \n___ cisterna magna versus less likely posterior fossa arachnoid cyst.\n\nPlease see report from dedicated CT of the facial bones for bony evaluation. \nRight ___ soft tissue hematoma is seen.", + "output": "No acute intracranial abnormality. ___ cisterna magna versus less likely\nposterior fossa arachnoid cyst.\n\nRight ___ soft tissue hematoma." + }, + { + "input": "There is a left parieto-occipital extra-axial hematoma measuring 8.3 mm,\nstable compared to the prior study on ___. Small locules of gas are\nnoted in the adjacent subcutaneous soft tissues. Additionally, there is a\npossible minimal widening of the left occipitomastoid and left side of the\nlambdoid suture compared to the contralateral side ; questionable fracture in\nOR in close proximity to the suture line.\nSmall Linear increased density along the left side of the anterior falx (Se2:\nIm21) may represent a small subdural hematoma, which was not definitely seen\non the prior CT. No shift of midline structures.\nA small 1.5 x1 0.6 cm slightly round, extra-axial for lesion, in the left\nparasagittal anterior frontal location series 3, image 51; series 601 be,\nimage 63\n\nThe ventricles and sulci are normal in size and configuration. The basal\ncisterns appear patent. The visualized paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The globes are unremarkable.", + "output": "1. Stable left parieto-occipital extra-axial hematoma.\nPossible minimal widening of the left occipitomastoid and left side of the\nlambdoid suture compared to the contralateral side; questionable fracture in\nOR in close proximity to the suture line.\n2. Possible small subdural hematoma along the left anterior falx.\n3. A small 1.5 x1 0.6 cm slightly round, extra-axial for lesion, in the left\nparasagittal anterior frontal location series 3, image 51; series 601 be,\nimage 63 -Can represent a dural based lesion. Limited assessment as\nnoncontrast study.\nConsider evaluation with MRI of the head without and with IV contrast if not\ncontraindicated or post-contrast CT for better assessment ." + }, + { + "input": "There is no evidence of infarction, intracranial hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration. No osseous\nabnormalities seen. There is a left parietal scalp hematoma with no evidence\nof underlying fracture. Fluid is noted within the right maxillary sinus, and\nmucous retention cysts are partially visualized in the left maxillary sinus.\nThe orbits are unremarkable.", + "output": "No acute intracranial process. Left parietal scalp hematoma." + }, + { + "input": "No evidence of infarction, hemorrhage, edema, or mass. Bilateral, mild\nsymmetric prominence of the ventricles and sulci suggest age related\ninvolutional change. Minimal periventricular white matter hypodensities\nsuggest the sequela of chronic microvascular infarction. Bilateral cavernous\ninternal carotid calcifications are mild.\n\nNo evidence of fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are essentially clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No intracranial hemorrhage or evidence of acute infarct. Please note that MRI\nis more sensitive for the detection of acute infarction." + }, + { + "input": "There is no hemorrhage, edema, mass effect, midline shift, or mass. Prominence\nof the ventricles and sulci is indicative of volume loss. Subcortical and\nperiventricular white matter hypodensities are nonspecific, but are likely\nsequela of chronic small vessel ischemic disease. The basal cisterns are\npatent and there is normal gray-white matter differentiation. Mild cavernous\ncarotid calcifications are noted.\n\nNo acute bony abnormalities seen. The paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The orbits are unremarkable. Severe\ndegenerative changes noted at the temporomandibular joints.", + "output": "No acute intracranial abnormality" + }, + { + "input": "There is no evidence of hemorrhage, edema, shift of normally midline\nstructures, or infarction. Periventricular and subcortical white matter\nhypodensities are nonspecific, but likely reflect sequelae of chronic small\nvessel ischemic disease. Prominence of the ventricles and sulci suggest\ninvolutional changes. The imaged paranasal sinuses are clear. Mastoid air\ncells and middle ear cavities are well aerated. Degenerative changes of\nbilateral temporomandibular joints noted.", + "output": "Atrophy. No evidence of mass, hemorrhage or infarction" + }, + { + "input": "There is a 2.1 x 1.7 x 2.6 cm (AP by TRV by SI) lobulated soft tissue mass\ncentered in the posterior right nasal passage extending into the right ethmoid\nair cells. There is no bony erosion. The mass does extend slightly into the\nright pterygopalatine fossa (3:19). There is extension to the right\nnasopharynx posteriorly (2:15). The fossa of ___ is not involved.\n\nThere is mild mucosal thickening in the left greater than right frontal\nsinuses. Mild mucosal thickening is present in the bilateral anterior ethmoid\nair cells. There is mild left maxillary sinus mucosal thickening. The left\nostiomeatal unit is patent. The right maxillary sinus is almost completely\nopacified, and the ostiomeatal unit is opacified. There is mucosal thickening\nin the sphenoid sinus. Paradoxical turn to the right middle turbinate\n(63:601), and small right concha bullosa. There is S-shaped curvature of the\nnasal septum, but the anterior nasal passages appear grossly patent.\n\nThe cribriform plates are intact. The lamina papyracea are intact. The imaged\nportions of the orbits are unremarkable. The imaged intracranial contents are\nunremarkable. The imaged head and neck soft tissues are otherwise\nunremarkable.", + "output": "1. 2.6 cm lobulated mass in the posterior right nasal cavity with extension\ninto the right ethmoid air cells and right pterygopalatine fossa without\nosseous erosion.\n2. Additional paranasal sinus disease as described above." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of acute large territory infarct,\nhemorrhage, edema, or mass effect. The ventricles and sulci are normal in\nsize and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThere is common origin of the right brachiocephalic and left common carotid\narteries, a normal anatomic variation. The carotid and vertebral arteries and\ntheir major branches appear normal with no evidence of stenosis or occlusion.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No evidence of acute intracranial hemorrhage or vascular territorial\ninfarction on noncontrast head CT.\n2. Unremarkable head and neck CTA. Specifically, no evidence for dissection." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of major vascular territory\ninfarction,acute hemorrhage, edema, or mass effect. The ventricles are normal\nin size. There is mild bifrontal sulcal prominence.\n\nThe patient is status post left maxillary antrectomy with opacification of the\nleft maxillary sinus. The right sphenoid sinus is nearly completely\nopacified. The mastoid air cells are clear. The orbits are unremarkable.\n\nCTA NECK:\nThere is a normal 3 vessel branching pattern of the aortic arch. Calcified\nand noncalcified plaque is present in the distal common carotid and proximal\ninternal carotid arteries bilaterally, causing approximately 50% stenosis of\nbilateral proximal internal carotid arteries, including the origins, by NASCET\ncriteria. V1 through V3 segments of bilateral vertebral arteries, including\ntheir origins, are widely patent.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nare patent without flow-limiting stenosisor aneurysm formation. There is\ncalcified plaque in bilateral carotid siphons without flow-limiting stenosis.\nThe major dural venous sinuses are patent.\n\nOTHER:\nMosaic attenuation of the included upper lungs is likely secondary to air\ntrapping, as the shape of the central airways indicates that the patient was\nimaged in expiration. Mild dependent atelectasis is also present. The\nthyroid gland is unremarkable. There is no lymphadenopathy by CT size\ncriteria. There are multilevel degenerative changes in the cervical spine.", + "output": "1. No evidence for acute intracranial abnormalities. No mass effect.\n2. Atherosclerosis causing approximately 50% stenosis of bilateral proximal\ninternal carotid arteries by NASCET criteria.\n3. No evidence for flow-limiting stenosis in the major intracranial arteries.\n\nRECOMMENDATION(S): MRI would be more sensitive for a small intracranial mass,\nif clinically warranted." + }, + { + "input": "A right frontal approach ventricular drain is again noted, terminating in the\nthird ventricle and in unchanged position from prior exam. Acute\nintraparenchymal hemorrhage is again seen in the area of the right globus\npallidus and putamen, unchanged in size from prior exam, measuring 6.0 x 2.9\ncm (previously 6.1 x 3.1 cm). The intraventricular extension of blood products\nin the bilateral lateral ventricles, third ventricle, sylvian aqueduct, and\nfourth ventricle are similar to prior exam. There is a 6 mm leftward midline\nshift, unchanged from prior exam. A new small focus of likely subarachnoid\nblood is seen in a left posterolateral sulcus (2:21, 601b:85), which may\nreflect redistributed blood products.\n\nNo fracture is identified. Opacification of the ethmoid air cells and left\nmaxillary sinus is again noted, similar to prior exam. Otherwise, the\nvisualized paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The globes are unremarkable.", + "output": "1. Stable intraparenchymal hemorrhage in the area of the right globus\npallidus and putamen with intraventricular extension.\n\n2. New small focus of likely subarachnoid blood in a left posterolateral\nsulcus, which may represent redistributed blood products.\n\nNOTIFICATION: These findings were communicated to Dr. ___ at 7:07\np.m. on ___ by phone." + }, + { + "input": "A right frontal approach ventricular drain is again seen terminating and third\nventricle, unchanged in position. There is evolution of blood products within\na previously seen intraparenchymal hemorrhage involving the right putamen and\nglobus pallidus with intraventricular extension of blood products into the\nbilateral lateral ventricles, third ventricle, sylvian aqueduct and fourth\nventricle. The right lateral ventricle appears decompressed by a catheter but\nthe left lateral ventricle is persistently dilated. There is no significant\nchange in the leftward shift of normally midline structures. There is no\nevidence of infarction.\n\nOpacification of the ethmoid air cells and mucosal thickening of the left\nmaxillary sinus is largely unchanged from the prior study. Mastoid air cells\nand middle ear cavities are clear.", + "output": "1. Evolution of blood products in the previously seen intraparenchymal\nhemorrhage involving the right putamen and globus pallidus.\n\n2. Decompression of the right lateral ventricle. Hydrocephalus of the left\nlateral ventricle.\n\n3. No evidence of new hemorrhage or infarction." + }, + { + "input": "Study is moderately degraded by motion. Within these confines:\n\nMild left frontal soft tissue scalp swelling without underlying fracture. No\nevidence of intracranial hemorrhage identified within these limits. There is\nno evidence of large infarct, edema, or mass. The ventricles and sulci are\nnormal in size and configuration. Trace right partial opacification of the\nright mastoid air cells. Otherwise, the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The orbits are grossly preserved. \nApproximately 1.5 x 18 x 14 mm right parasagittal midline vertex scalp\nprobable lipoma is noted (see 601:32; 602:37).", + "output": "1. Moderately limited exam due to motion.\n2. Within limits of study, no evidence of intracranial hemorrhage or\nfracture. If continued concern for acute intracranial hemorrhage, consider\nrepeat study when patient can tolerate exam.\n3. Left frontal soft tissue scalp swelling without definite underlying\nfracture." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThere are few scattered hypodensities in the subcortical and periventricular\nwhite matter, nonspecific, likely secondary to small vessel ischemic disease.\n\nThere is soft tissue density in the right external auditory canal, likely\ncerumen. Direct visualization can be performed as clinically indicated.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nIncidentally seen is dominant right vertebral artery.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Normal head and neck CTA.\n2. No acute intracranial abnormality." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are prominent in size for the patient's age\ncompatible with mild atrophy, but otherwise normal in configuration. The\nimaged paranasal sinuses are clear. Mastoid air cells and middle ear cavities\nare well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process. Mild global atrophy, advanced for age." + }, + { + "input": "There is no evidence of intracranial hemorrhage, acute large territorial\ninfarction, edema,or mass. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. Periventricular and subcortical\nhypodensities are nonspecific, though likely sequela of chronic small vessel\nischemic disease.\n\nThere is no evidence of fracture. There is minimal mucosal thickening of the\nanterior ethmoid air cells extending into the frontoethmoidal recesses, and in\nthe visualized portions of the maxillary sinuses. Middle ear cavities,\nmastoid air cells, and pneumatized petrous apex air cells are well aerated. \nStatus post bilateral cataract surgery.", + "output": "No evidence of acute intracranial abnormalities." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nSmall left parietal subgaleal hematoma and adjacent soft tissue edema. Small\nleft frontal subgaleal hematoma and adjacent soft tissue edema. \nAge-indeterminate nasal bone fractures. Mild paranasal sinus mucosal\nthickening and small mucous retention cysts. The visualized portion of the\norbits are unremarkable.", + "output": "Small left parietal and left frontal subgaleal hematomas. Age-indeterminate\nnasal bone fractures. No evidence of intracranial hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes,\nadvanced for age.\n\nThere is no evidence of fracture. A small mucous retention cyst is\ndemonstrated in the left sphenoid sinus, and minimal mucosal thickening is\nseen in the left maxillary sinus. Otherwise, the visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality. Mild global atrophy, advanced for age." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are patent and prominent in keeping with age-related\nvolume loss.\n\nThere are scattered hypodensities in the subcortical and periventricular white\nmatter, nonspecific, likely secondary to small vessel ischemic disease. There\nis intracranial atherosclerotic calcification.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is atherosclerosis involving bilateral cavernous carotid arteries\ncausing mild stenosis on the left and moderate stenosis on the right. Also\nseen is mild atherosclerosis involving bilateral V4 segments of the vertebral\narteries. The vessels of the circle of ___ and their principal\nintracranial branches appear otherwise unremarkable without stenosis,\nocclusion, or aneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is mild atherosclerosis involving the left carotid bifurcation without\nany stenosis by NASCET criteria. The carotid and vertebral arteries and their\nmajor branches appear otherwise unremarkable with no evidence of stenosis or\nocclusion. There is no evidence of internal carotid stenosis by NASCET\ncriteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. There is heterogeneously\nenlarged thyroid gland with retrosternal extension, likely in keeping with\nmultinodular goiter, grossly unchanged compared to ___ prior exam. There is\nno lymphadenopathy by CT size criteria. Multilevel degenerative changes\ninvolving the visualized cervical spine are noted. There also seen is mild\nectasia of the ascending aorta measuring up to 3.8 cm with atherosclerosis.", + "output": "1. Unremarkable head and neck CTA noting mild atherosclerosis as described\nabove.\n2. No acute intracranial abnormality, with no evidence of acute intracranial\nhemorrhage.\n3. Findings of small vessel ischemic disease in age-related involutional\nchanges.\n4. Ectasia of the ascending aorta measuring up to 3.8 cm, grossly unchanged\ncompared to prior exam.\n5. Multinodular goiter with retrosternal extension, grossly similar compared\nto prior.\n6. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,intracranial hemorrhage,edema,ormass. The\nventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. There is\n___ termination of the right vertebral artery. The dural venous sinuses are\npatent.\n\nCTA NECK:\nThe carotid arteries and their major branches appear normal with no evidence\nof stenosis or occlusion. There is no evidence of internal carotid stenosis by\nNASCET criteria. The left vertebral artery is dominant, the V4 segment of the\nright vertebral artery is hypoplastic likely consistent with anatomical\nvascular variation\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. Mild to moderate multilevel degenerative changes are visualized\nthroughout the cervical spine, more significant at C5-C6 level.", + "output": "1. There is no evidence of acute intracranial process or hemorrhage.\n2. Essentially normal neck CTA.\n3. Multilevel, multifactorial degenerative changes throughout cervical spine,\nmore significant at C5-C6 level." + }, + { + "input": "Streak artifact limits evaluation of pons. There is no evidence of\ninfarction, hemorrhage, edema, or mass. The ventricles and sulci are preserved\nin size and configuration.\n\nSmall left parietal subgaleal hematoma and soft tissue swelling. No\nunderlying fracture. No osseous abnormalities seen. The paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The orbits are\npreserved. Nonspecific prominence of the adenoids is noted, which may be\nwithin normal limits for patient's age.", + "output": "1. Streak artifact limits evaluation of pons.\n2. No acute intracranial abnormality.\n3. Within limits of study, no definite evidence acute intracranial hemorrhage\nor fracture.\n4. Small left parietal subgaleal hematoma." + }, + { + "input": "There is small focus of round hyperdensity within or abutting posterior right\ntemporal lobe, probably intra-axial, series 2, image 12, 13, measuring 0.6 cm,\nbrighter than the vascular pool, indeterminate. MRI brain without and with\ngadolinium recommended in further evaluation. There is no edema, shift of\nnormally midline structures, or evidence of acute major vascular territorial\ninfarction. Normal ventricular, sulcal size. The imaged paranasal sinuses\nare clear. There is chronic bilateral maxillary sinus atelectasis, from\nchronic inflammation. Otherwise, paranasal sinuses, mastoid air cells and\nmiddle ear cavities are well aerated. The bony calvarium is intact.", + "output": "There is subtle hyperdensity involving or abutting posterior right temporal\nlobe, differential considerations include small parenchymal or subarachnoid\nhemorrhage, cavernoma, vein ___ thrombosis, less likely meningioma or\nhemorrhagic mass. MRI brain without and with gadolinium recommended in\nfurther evaluation.\n\nRECOMMENDATION(S):\nMRI brain without and with gadolinium recommended in further evaluation.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 9:33 pm, 15 minutes\nafter discovery of the findings." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, or loss of gray/\nwhite matter differentiation. Postcontrast images demonstrate no evidence for\nan intra-axial or extra-axial enhancing lesion. The ventricles and sulci are\nnormal in size for age.\n\nNo osseous abnormalities are seen. The visualized paranasal sinuses, mastoid\nair cells, and middle ear cavities are grossly well aerated.", + "output": "No evidence for intracranial abnormalities. Please note that MRI, preferably\nwith gadolinium, would be significantly more sensitive for any posterior fossa\npathology, demyelination, or other potential sources of the patient's\nsymptoms." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles are unremarkable. Incidentally noted are basal ganglia\nand dentate nuclei calcifications. Atherosclerotic calcifications noted\nwithin the intracranial ICAs bilaterally.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial\nsoft tissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Overlying hardware streak artifact limits examination.\n\nThere is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of age related involutional\nchanges.\n\nThere is no evidence of fracture. There is extensive paranasal sinus disease\nwith complete opacification of the left sphenoid sinus and mucosal thickening\nand aerosolized secretions in the remaining paranasal sinuses. There is also\nsclerosis involving the paranasal sinuses compatible with a chronic sinusitis.\nQuestion focal hyper density within right maxillary sinus opacification (see\n3:1). The mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Overlying hardware streak artifact limits examination.\n2. No evidence of acute hemorrhage or large territory infarct. Please note\nMRI of the brain is more sensitive for the detection of acute infarct.\n3. Within the limits of this noncontrast study, there is no definite evidence\nof intracranial mass. Please note contrast enhanced brain MRI is more\nsensitive for the evaluation for intracranial mass.\n4. Extensive paranasal sinus disease as described, concerning for acute,\nchronic, and / or fungal sinusitis." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Left periventricular white matter\nhypodensity is somewhat ill-defined but unchanged from prior exam. Gray-white\nmatter differentiation is preserved. Ventricles and sulci are prominent\ncompatible with global volume loss.. Basilar cisterns are patent.\n\nNear complete opacification of the left frontal sinus is noted. Bilateral\nethmoids and right sphenoid sinus are partially opacified. There is bilateral\nmaxillary sinus mucosal thickening with aerosolized debris on the left. Left\nsphenoid sinus is completely opacified. There is sclerosis of the adjacent\nleft frontal, bilateral sphenoid sinus and maxillary sinus walls suggesting\nchronic inflammation. Skull and extracranial soft tissues are unremarkable.", + "output": "No acute intracranial process.\nSinus disease." + }, + { + "input": "There is no evidence of acute major vascular territorial\ninfarction,hemorrhage,edema, or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. Ill-defined periventricular and\nsubcortical white matter hypodensities are nonspecific but likely due to small\nvessel ischemic disease. The basilar cisterns are patent. A more prominent\nleft corona radiata white matter hypodensity is unchanged from prior\nexamination, potentially secondary to prior infarct.\n\nThere is no evidence of fracture. There is near complete opacification of the\nleft sphenoid sinus with aerosolized secretions. There is complete\nopacification of the left sphenoid sinus. Moderate mucosal thickening is seen\nin the right sphenoid sinus and right ethmoid air cells along with aerosolized\nsecretions. Mild mucosal thickening is seen in the maxillary sinuses. There\nis sclerosis of the adjacent left frontal, bilateral sphenoid sinus, and\nmaxillary sinus walls, suggestive of chronic inflammation. The mastoid air\ncells and middle ear cavities are clear. The visualized portion of the orbits\nare unremarkable.", + "output": "1. No evidence of major intracranial abnormalities on noncontrast head CT. \nSpecifically no intracranial hemorrhage or large territory infarct.\n2. Paranasal sinus disease, as above." + }, + { + "input": "There is mild motion artifact limiting evaluation. There is no evidence of\nacute intracranial hemorrhage, edema, mass effect, or acute major vascular\nterritorial infarction. Ventricles and sulci are prominent consistent with\nage-related global parenchymal loss. There are mild periventricular and\nsubcortical hypodensities, which are nonspecific, but likely represent sequela\nof chronic microvascular ischemic disease in this age group.\n\nThere is no evidence of fracture. Mastoid air cells are well aerated.\n\nWall thickening and sclerosis is again seen throughout the paranasal sinuses,\nindicating sequela of chronic sinusitis. Complete opacification of the left\nsphenoid sinus with mildly hyperdense material, as well as mildly hyperdense\nmaterial in the medial portion of left frontal sinus, are unchanged,\ncompatible with inspissated secretions or fungal colonization. In the right\nsphenoid sinus, mild-to-moderate mucosal thickening is stable, but aerosolized\nsecretions are new. There is moderate mucosal thickening and aerosolized\nsecretions within bilateral anterior and posterior ethmoid air cells,\nprogressed on the right and minimally progressed on the left. Moderate\nmucosal thickening within bilateral maxillary sinuses is not adequately\ncompared to the ___ head CT, but appears increased on the right and\nstable on the left compared to the ___ head CT. Aerosolized secretions\nwithin bilateral maxillary sinuses are new. Aerosolized secretions and\nmoderate mucosal thickening in the left frontal sinus are not significantly\nchanged.", + "output": "1. Mildly motion limited exam.\n2. No evidence of acute intracranial abnormalities or calvarial fracture.\n3. Acute on chronic inflammatory changes in the paranasal sinuses with chronic\ndiffuse osseous remodeling. Multifocal progression of sinus disease compared\nto ___, as detailed above." + }, + { + "input": "Foci of dural calcification are seen in the right tentorium. There is no\nevidence of large territory infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration. Mild\natherosclerotic calcifications in the bilateral carotid siphons.\n\nThere is no evidence of fracture. Mild mucosal thickening of the ethmoid air\ncells. Otherwise, the remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute findings." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema,or mass-effect. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of acute fracture. There is mild mucosal thickening\nright maxillary sinus. The visualized portion of the other paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable. A 3.1 x 1.3 cm circumscribed fat containing\nlesion within left occipitalis muscle likely represents an intramuscular\nlipoma (105:18).", + "output": "No acute intracranial abnormality or fracture." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial hemorrhage or shift of normally midline structures." + }, + { + "input": "The vessels of the circle of ___ and their principal intracranial branches\nappear patent with no evidence of flow-limiting stenosis or aneurysm. The\ndural venous sinuses are patent.\n\nThe brain parenchyma is not well assessed with this technique. There is\ncomplete opacification of right posterior ethmoid air cell and mild mucosal\nthickening in other bilateral ethmoid air cells. There is minimal mucosal\nthickening in the maxillary sinuses. Mastoid air cells are well aerated. No\nconcerning bone lesion is seen. The orbits appear unremarkable.", + "output": "Normal head CTA." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass, mass effect, or large\nvascular territory infarction. The ventricles and sulci are normal in size and\nconfiguration. The basal cisterns are patent. There is preservation of\ngray-white matter differentiation.\n\nNo fracture is identified. The visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The soft tissues and orbits are\nunremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Prominent ventricles and sulci are compatible with age-related\ninvolutional change. Confluent periventricular white matter hypoattenuation\nlikely represents chronic small vessel ischemic disease.\n\nThere is mucosal thickening of the bilateral ethmoid air cells. There are\nmultiple mucous retention cysts in the bilateral maxillary sinuses. There is\nminimal mucosal thickening is of the right sphenoid sinus. Soft tissue in the\nbilateral external auditory canals likely represents cerumen. The calvarium\nis intact. There are mild atherosclerotic calcifications of bilateral carotid\nsiphons.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nintracranial hemorrhage or large territory infarct.\n2. Additional findings described above." + }, + { + "input": "There is no evidence of acute territory infarction,hemorrhage,edema, or mass. \nPeriventricular, subcortical and deep white matter hypodensities are\nnonspecific, likely the sequelae of chronic small vessel ischemic disease. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nethmoid air cells. There is minimal mucosal thickening of bilateral sphenoid\nsinuses. Submucosal retention cysts are seen in bilateral maxillary sinuses. \nSoft tissue density seen in bilateral external auditory canals likely\nrepresents cerumen. The visualized portion of the remaining paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "A small scalp hematoma is noted along the left frontal region. There is no\nintra-axial or extra-axial hemorrhage, edema, shift of normally midline\nstructures, or evidence of acute major vascular territorial infarction. \nPeriventricular white matter hypodensities are again seen suggesting chronic\nmicrovascular ischemic disease. Sul age related involutional changes are\nnoted. Ventricles are mildly prominent though unchanged. Small retention\ncyst within the left maxillary sinus are noted. Otherwise the imaged\nparanasal sinuses are well aerated. Mastoid air cells and middle ear cavities\nare clear. Bony calvarium is intact.", + "output": "No acute intracranial process. Small left frontal scalp hematoma. No\nfracture." + }, + { + "input": "There is no evidence of fracture, large territorial\ninfarction,hemorrhage,edema,or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. Periventricular and subcortical\nwhite matter hypodensities are nonspecific but likely sequelae of chronic\nsmall vessel ischemic disease.\n\nThere are mucous retention cysts in the left maxillary sinus. Otherwise, the\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are normal.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of fracture, acute territorial\ninfarction,hemorrhage,edema,or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. Periventricular and subcortical\nwhite-matter hypodensities are nonspecific, but likely represent sequela of\nchronic microangiopathic disease.\n\nSeveral small mucous retention cysts are seen in the left maxillary sinus. \nThe visualized portion of the other paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nnormal.", + "output": "1. No acute intracranial abnormality.\n2. Sequela of chronic microangiopathic disease." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of generalized parenchymal\nvolume loss. Periventricular and subcortical white matter hypodensities are\nnonspecific but likely reflective of chronic microvascular ischemic disease.\n\nNo osseous abnormalities seen. Mucous retention cysts are again noted in the\nleft maxillary sinus. There is mucosal thickening in the ethmoid air cells. \nThe mastoid air cells and middle ear cavities are clear. Soft tissue material\nin the external auditory canals likely reflects cerumen.", + "output": "No acute intracranial abnormality." + }, + { + "input": "Motion limited exam. There is no evidence of fracture, recent territorial\ninfarction,hemorrhage,edema,or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. Periventricular and subcortical\nwhite matter hypodensities are nonspecific, but likely reflect sequelae of\nchronic small vessel ischemic disease.\n\nSeveral mucous retention cysts are noted in the left maxillary sinus. There\nis moderate opacification of the ethmoid air cells. The frontal sinuses are\nwell aerated. The mastoid air cells and middle ear cavities are clear. The\nvisualized portion of the orbits are normal.", + "output": "1. No acute intracranial process. Chronic small vessel disease.\n2. Paranasal sinus disease." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are enlarged in an atrophic pattern. There is\ncalcification of the cavernous carotid arteries bilaterally..\n\nThere is mucosal thickening in the right maxillary sinus and small fluid\ncollections in the maxillary sinuses bilaterally. The patient appears to be\nstatus post endoscopic sinus surgery with antral nasal windows. Visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria. There are minimal calcifications at the origin\nof the right internal carotid artery.\n\nOTHER:\nThere are large bilateral pleural effusions, larger on the right than left. \nThere is no lymphadenopathy by CT size criteria.", + "output": "1. No evidence of mass, hemorrhage or infarction.\n2. Mild paranasal sinus inflammatory changes.\n3. Normal head and neck CTA.\n4. Large bilateral pleural effusions, right greater than left." + }, + { + "input": "There is an evolving acute infarction in the left middle cerebral artery\nterritory, as seen on the preceding MRI, involving the frontal lobe, post\ncentral gyrus, insula, and temporal lobe. There is effacement of the involved\ncerebral sulci and minimal effacement of the left lateral ventricle, but no\nshift of midline structures. Basal cisterns are not compressed. There are\nsmall linear foci of hyperdensity in the left sylvian fissure, images 2:12,\n2:13, and 2:15, likely representing thrombosed vessels. There is also a small\nlinear focus of hyperdensity in the left frontal region, likely located within\na sulcus and also corresponding to a thrombosed blood vessel, rather than\nparenchymal hemorrhagic transformation. Of note, no hemorrhagic transformation\nwas seen on the preceding MRI from 11 hr earlier.\n\nThere is mild mucosal thickening in the visualized portion of the right\nmaxillary sinus. Other visualized paranasal sinuses and mastoid air cells are\nwell aerated.", + "output": "Evolving acute infarction in the left middle cerebral artery territory with\nmild mass effect. Small linear foci of hyperdensity in the sylvian fissure\nand in a left frontal sulcus likely represents thrombosed blood vessels. No\ndefinite parenchymal hemorrhagic transformation is seen, but follow-up is\nrecommended." + }, + { + "input": "Again seen is the large left MCA territorial infarction with sulcal effacement\nand internal thrombosed vessels. This continues to exert mild mass effect on\nthe frontal horn of the right lateral ventricle. However there is no shift of\nnormally midline structures. There is no evidence of hemorrhagic\ntransformation. The basal cisterns are patent. The orbits and globes are\nunremarkable. The imaged paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The bony calvaria appear intact.", + "output": "Evolving left MCA territorial infarction. Stable mild mass effect. No evidence\nof hemorrhagic conversion." + }, + { + "input": "There is a comminuted, depressed and displaced left parietal skull fracture\nwith a few depressed and overriding fragments. A large laceration and\nmultiple foci of subcutaneous and intracranial air noted adjacent to this\nfracture. This fracture line extends till the level of the left mastoid\ninvolvement of the mastoid cannot be completely excluded. However, there is\nno opacification of the left mastoid air cells.\n\nThere is an irregular, comminuted and displaced fracture with some depression\nof the some of the fracture fragments through the frontal bones, on both\nsides, involving both the outer and inner tables.\nA small displaced fragment is noted, in the left frontal sinus and in the\nright superior orbit.\n\n A displaced fracture is noted involving the superior right orbit (601b:20),\nwith angulation of the displaced fracture fragment.\n\nA linear lucency noted in the lateral wall of the right orbit series 3, image\n12, question fracture or vascular groove. New line questionable small\nlucency, at the right lateral pterygoid plate series 3, image 8.\nLimited assessment of the facial fractures on the present study is not\ntargeted.\nSome of these sutures at the skullbase are slightly wider prominent however,\ngiven the young age and non fusion of the sutures, assessment of the\nsignificance is limited.\n\nDiffuse subarachnoid hemorrhage is noted, in addition to intraventricular\nhemorrhage which is predominantly seen within the left lateral ventricle.\n\nThere is approximately 4 mm of rightward midline shift, which is similar to\nthe prior examination performed ___ hr earlier. The basal cisterns remain\ngrossly patent, and there is no evidence of impending downward herniation. \nAir-fluid levels are noted within the bilateral maxillary sinuses, greater and\ndenser on the right-? hemorrhage. There is near complete opacification of the\nbilateral anterior posterior ethmoid air cells and frontal sinuses. Sphenoid\nsinus septations insert anterior to the carotid grooves.\nThe mastoid air cells are clear.\nPneumatization of the petrous apex on the right side.", + "output": "1. Unchanged appearance of a depressed left parietal skull fracture, diffuse\nsubarachnoid hemorrhage, intraventricular hemorrhage, and moderate rightward\nmidline shift. No evidence of impending downward herniation.\n2. Multiple additional skull and facial bone fractures, as above.\n\nNOTE ON ATTENDING REVIEW:\n\nMultifocal subdural hemorrhages noted, along the tentorial leaflets, the\nposterior falx and a small extra-axial component of hemorrhage, epidural or\nsubdural along the left parietal bone under the fracture and questionable at\nthe vertex. Left temporal horn less conspicuous than the right question\nrelated to component of edema and mass effect.\nLeft parietal bone has a maximum depression of approximately 6 mm.\n\nExtensive fracture along the right frontal bone, extends towards the right\nparietal bone, based on scrolling through the axial images series 3, image 32.\nQuestionable subtle fracture versus vascular groove in the right squamous\ntemporal bone series 3, image 16.\n\nGiven the location and appearance of the fractures involving the frontal\nbones, increased predisposition for CSF leak.\n\nLimited assessment of the facial fractures on the present study is not\ntargeted.\nDedicated CT of the face can be considered for better assessment.\n\nSome of these sutures at the skullbase are slightly wider/prominent however,\ngiven the young age and non fusion of the sutures, assessment of the\nsignificance is limited.\n\n\nNOTIFICATION: Findings were conveyed by Dr. ___ to the ___ resident at\n00:45 on ___." + }, + { + "input": "The patient is status post left parietal craniectomy with expected\npostoperative changes including pneumocephalus and hyperdense material\nlayering along the surgical bed. Redemonstrated is diffuse subarachnoid\nhemorrhage, similar in extent allowing for the rearrangement of blood\nproducts. Intraventricular hemorrhage seen predominantly within the left\nlateral ventricle has slightly decreased. Overall midline shift towards the\nright has also decreased slightly, now measuring 3 mm (previously 4 mm).\n\nThe basal cisterns remain grossly patent and there is is no evidence of\nimpending downward herniation. Air-fluid levels are again noted within the\nbilateral maxillary sinuses. There is partial opacification of the bilateral\nanterior and posterior ethmoidal air cells and frontal sinuses. Note also\nmade again of multiple fractures involving the frontal bone, right zygomatic\narch, and superior right orbit.", + "output": "Expected post-craniectomy changes with a relatively unchanged degree of\nsubarachnoid hemorrhage, intraventricular hemorrhage, and rightward midline\nshift. No evidence of impending downward herniation. No foci of new\nhemorrhage.\n\nNOTE ON ATTENDING REVIEW:\n\n1. Subdural hemorrhage along the tentorial leaflets on both sides, left more\nthan right for and the posterior falx is again seen, slightly decreased and\nless dense compared to the recent study. Minimal fluid collection, noted at\nthe craniotomy site, attention on followup.\n\n2. Multiple skull and partly evaluated facial fractures better described on\nthe prior CT study\n\n3. Increased predisposition for CSF leak given the location of the frontal\nbone fractures that needs clinical correlation and if needed MRI if not\ncontra-indicated for better assessment at followup.\n\nPlease see details on clip ___.\n\nRECOMMENDATION(S): Recommend close followup CT Head as needed and CT facial\nbone study for better evaluation of the facial and skullbase/T bones as\nrecommended earlier." + }, + { + "input": "There is been interval placement of a right frontal approach intracranial\nmonitor. Again is noted postsurgical changes related to prior left\nfrontoparietal craniectomy. There is interval increase of bihemispheric edema\nwith new approximately 2 mm right to left midline shift, cerebellar tonsillar\nherniation into the foramen magnum (see 303b:29 on the current exam and\n602b:45 on the most recent prior), and interval extension of left frontal lobe\nthrough craniotomy defect. No definite subfalcine or transtentorial\nherniation is noted. The basilar, pre pontine and suprasellar cisterns are\npatent. The quadrigeminal plate cistern is not well visualized, similar to\nthe most recent prior exam.\n\nThere is new hemorrhage and edema along the corpus callosum (see 302B:38)\nThere is been interval redistribution of left lateral ventricle\nintraventricular hemorrhage. Previously noted subarachnoid hemorrhage is less\nprominent. Left frontal intraparenchymal hemorrhage is again seen, now with\nincreasing adjacent hypodensity compared to most recent prior CT exam. \nEvolving postsurgical changes related to prior left frontoparietal craniectomy\nare noted.\n\nAgain are partially visualize numerous multiple calvarial and facial bone\nfractures, unchanged compared to prior exam. Fractures extending through\nbilateral orbital roofs and frontal sinuses are again noted to be minimally\ndisplaced.", + "output": "1. Interval progression of global edema with suggested increased downward\ndisplacement of cerebellar tonsils as described, with basilar cisterns\nremaining patent.\n2. Grossly stable area of left frontal intraparenchymal hemorrhage with\ninterval increase regional edema and areas concerning for evolving infarct.\n3. Interval increase of global edema with minimal new 2 mm right to left\nmidline shift.\n4. Redemonstration of intraventricular hemorrhage and decreased prominence of\nsubarachnoid hemorrhage relative most recent prior exam.\n5. Evolving postsurgical changes related to left frontoparietal craniectomy.\n6. Redemonstration of calvarial and facial bone fractures. Calvarial\nfractures again raise concern for possible CSF leak. Recommend clinical\ncorrelation. If clinically indicated, facial bone CT may be obtained for\nfurther evaluation of facial bone fractures.\n7. Interval placement of right frontal approach intracranial monitoring\ndevice.\n\nRECOMMENDATION(S): Redemonstration of calvarial and facial bone fractures.\nCalvarial fractures again raise concern for possible CSF leak. Recommend\nclinical correlation. If clinically indicated, facial bone CT may be obtained\nfor further evaluation of facial bone fractures.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 7:05 ___, immediately after discovery of the\nfindings." + }, + { + "input": "There is no evidence of acute large territory infarction,hemorrhage,edema, or\nmass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is partial opacification of the\nsphenoid sinus without evidence of adjacent fracture. There is mild mucosal\nthickening of the ethmoidal air cells. The visualized portion of the mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. No intracranial hemorrhage or other acute intracranial process. No\nevidence of fracture." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage or mass effect. The\nventricles and basal cisterns appear normal. There is mild diffuse brain\nparenchymal volume loss. The orbits, paranasal sinuses, and mastoid air cells\nare unremarkable.", + "output": "No acute intracranial hemorrhage or mass effect." + }, + { + "input": "There is no evidence of large territory infarction, hemorrhage, edema, or mass\neffect. Severe subcortical and periventricular white matter hypodensities are\nnoted, which are nonspecific but can be seen in setting of chronic small\nvessel disease. Ventricles and sulci are symmetric and unremarkable.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality. White matter changes which can be seen in\nsetting of chronic small vessel disease. MRI would be more sensitive for the\ndetection of intracranial metastases." + }, + { + "input": "There is asymmetric diffuse enlargement of the right parotid gland with no\ndistinct mass lesion identified. No surrounding soft tissue stranding is\nseen. No enlargement of ___'s duct or radiodense calculi along the\nexpected course of the duct is seen.\n\nEvaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect.\n\nThe thyroid gland appears normal. There are multiple prominent lymph nodes in\nthe bilateral cervical chains, which maintain their normal reniform shape and\nfatty hilum. The neck vessels are patent.\n\nRetention cysts are noted within the maxillary sinuses. Multiple dental\ncaries are noted. Multiple right-sided maxillary and mandibular periapical\nlucencies are seen.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.", + "output": "1. Newly asymmetric right parotid gland enlargement at site of skin marker,\ncorresponding with patient's palpable abnormality, with no definite focal\nparotid mass or abnormal enhancement and no surrounding inflammatory changes,\ncalculus, ductal enlargement or pathologic lymphadenopathy. Differential\nconsiderations include acute sialadenitis or sialosis, with systemic diseases\nsuch as sarcoidosis or Sjogren's syndrome less likely. Clinical follow up to\nresolution is recommended. If clinically indicated, consider follow-up\nimaging to resolution.\n2. Substantial dental disease as described. Dental consultation is\nrecommended.\n3. Paranasal sinus disease as described.\n\nRECOMMENDATION(S):\n1. Clinical follow up to resolution of right parotid gland enlargement.\n2. Dental consultation." + }, + { + "input": "No evidence of infarction, hemorrhage, edema, or mass. The ventricles and\nsulci are normal in size and configuration.\n\nNo evidence of fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "Normal study. No hemorrhage or mass effect." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThere is no definite mass or asymmetry in the tongue corresponding to FDG\nuptake in the floor of the mouth.\n\nMucous retention cysts are seen in the left maxillary sinus. The patient is\nedentulous.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules.", + "output": "No definite mass or asymmetry corresponding to FDG uptake in the floor of\nmouth. Given PET scan findings, MRI would be helpful in delineating an\ninfiltrating mass which is difficult to discern on CT.\n\nRECOMMENDATION(S): Recommend MRI.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 12:18 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Age related involutional changes are noted. There is a right\nsupraorbital hematoma and soft tissue swelling without underlying fracture. \nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\nThe orbits are unremarkable.", + "output": "Soft tissue swelling and scalp hematoma in the right supraorbital region\nwithout underlying fracture or intracranial hemorrhage." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is increased attenuation of left MCA, M2 portion, (02:12). There is no\nevidence of no evidence of acute hemorrhage, edema, or mass effect. The\nventricles and sulci are prominent consistent with involutional changes which\nare within normal limits patient age.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. There is evidence of right lens replacement surgery,\n(02:12).\n\nCTA HEAD:\nThere is a occlusion of the left MCA, M2 superior portion, (550: 10). There\ncalcified atherosclerotic plaques of the carotid siphons bilaterally. \nOtherwise, the other vessels of the circle of ___ and their principal\nintracranial branches appear normal without stenosis, occlusion, or aneurysm\nformation. The dural venous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs demonstrate diffuse ground-glass\nopacification. The visualized portion of the thyroid gland is within normal\nlimits. There is no lymphadenopathy by CT size criteria. The main pulmonary\nartery is prominent which may suggest pulmonary hypertension. Clinically\ncorrelate.", + "output": "1. There is no evidence of acute hemorrhage, edema or mass effect.\n2. There is a dense MCA sign located at the left MCA, M2 portion.\n3. The CT head confirms an occlusion of the left MCA, M2 superior portion.\n4. There are calcified atherosclerotic plaques of the bilateral carotid\nwithout high-grade stenosis." + }, + { + "input": "There is a new small subarachnoid hemorrhage along the left insular cortex and\nsulci of the left temporal lobe. No evidence of new large acute major\ninfarct. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Ill-defined periventricular and subcortical deep white\nmatter hypodensities are nonspecific but likely due to chronic sequela of\nsmall-vessel ischemic disease. Residual contrast is seen in the vessels of\nthe circle of ___. There is no midline shift.\n\nThere is no evidence of fracture. Mild mucosal thickening is seen in the left\nmaxillary sinus. Otherwise, the remaining visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. A new small subarachnoid hemorrhage is seen along the left insular cortex\nand sulci of the left temporal lobe, likely sequela of recent procedure. No\nlarge acute major infarct.\n2. Residual contrast is also seen in the vessels of the circle of ___.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:40 pm, 1 minutes after discovery\nof the findings." + }, + { + "input": "Patient is status post thrombectomy for a left MCA stroke with hyperdensities\nnoted in the left MCA territory overall appearing less dense and less focal\ncompared to prior, suggestive of contrast staining after mechanical\nthrombectomy. No evidence of new large acute vascular territory infarct. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Periventricular and subcortical white matter hypodensities are\nnonspecific but suggest sequelae of chronic small vessel ischemic changes. \n10, contrast is noted in the circle ___ and its principal intracranial\nbranches. No midline shift.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits demonstrate right lens placement.", + "output": "1. Hyperdensities noted in the left MCA territory appears less dense compared\nto prior, suggestive of contrast staining after mechanical thrombectomy." + }, + { + "input": "Multiple foci of small infarcts were better seen on prior MRI ___.\nFindings consistent with severe chronic small vessel ischemic changes. 5 mm\nnodular focus in the anterosuperior third ventricle, similar to prior, most\nconsistent with colloid cyst. Ventricular system is prominent, including\nthird ventricle, likely on the basis of brain parenchymal atrophy.\n\nThere is no evidence of hemorrhage,edema,or mass. The ventricles and sulci\nare normal in size and configuration.\n\nThere is no evidence of fracture. Trace mucosal thickening paranasal sinuses.\nOtherwise, the visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "Multiple small infarcts were better seen on recent MRI. No hemorrhage.\n\nFindings consistent with 5 mm colloid cyst third ventricle. Prominent\nventricular system is most likely on the basis of atrophy.\n\nFindings consistent with severe chronic small vessel ischemic changes." + }, + { + "input": "Multiple foci of small infarcts were better seen on prior MRI from ___, although hypodensity of the cortex in the area of the left occipital\nlobe appears slightly more conspicuous compared to prior. There are confluent\nhypodensities in the periventricular, subcortical, and deep white matter,\nwhich are nonspecific, but likely represent severe chronic small vessel\nischemic changes. A focal hypodensity within the right frontal lobe, series\n2, image 27 appears more conspicuous compared to the prior exam. Again seen\nis a small, 5 mm nodular focus in the anterior superior third ventricle,\nsimilar to prior, most consistent with colloid cyst. Prominent ventricular\nsystem is unchanged in size. There is no evidence of acute\nhemorrhage,edema,or mass effect.\n\nThere is no evidence of fracture. There is unchanged trace mucosal thickening\nof the anterior ethmoid air cells. The visualized portion of the remaining\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. \nPatient is status post right lens replacement. Otherwise, the visualized\nportions of the orbits are unremarkable.", + "output": "1. Multiple small infarcts were better seen on recent MRI, although\nhypodensity of the cortex in the area of the left occipital lobe and right\nfrontal lobe appears slightly more conspicuous compared to prior. No evidence\nof acute intracranial hemorrhage.\n2. Prominent ventricular system is unchanged in size.\n3. Unchanged 5 mm focus in the anterior superior third ventricle, most\nconsistent with colloid cyst.\n4. Unchanged findings consistent with severe chronic small vessel ischemic\nchanges.\n\nRECOMMENDATION(S): Noncontrast MRI of the head is recommended for further\nevaluation.\n\nNOTIFICATION: The recommendations were discussed with Dr. ___. by\n___, M.D. on the telephone on ___ at 11:10 am, 10 minutes\nafter discovery of the findings." + }, + { + "input": "In the left pons, there is a small focal hypodensity which may represent a\nsubacute to chronic lacunar infarct versus artifact. (See series 2, image 8).\nThere is also a focal lacunar infarct in the posterior limb of the right\ninternal capsule. There is no evidence of acute large territory infarction,\nhemorrhage,edema,or mass. The ventricles and sulci are normal in size and\nconfiguration.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable. Calcifications are noted\nalong the falx cerebri.", + "output": "1. Subacute to chronic lacunar infarct in the left pons versus artifact. \nChronic lacunar infarct in the posterior limb of the right internal capsule. \nMRI is more sensitive in detecting acute ischemia.\n2. No evidence of acute large territory infarction or other acute intracranial\nprocess." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nAgain seen is the old lacunar infarct in the left pons. An additional\nsubcentimeter focus of hypodensity in the posterior limb of the right internal\ncapsule is consistent with a late subacute infarct, previously identified on\nthe MRI.\nThere is no evidence of hemorrhage,edema,ormass.\n\nThe ventricles and sulci are normal in size and configuration.\n\nThere is a small mucous retention cyst in the right maxillary sinus. Mild\nmucosal thickening is also seen along the ethmoid air cells. The remainder of\nthe paranasal sinuses is clear. The mastoid air cells are clear. The orbits\nappear unremarkable.\nNote is made of large calcifications along the falx.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. Small\nbilateral posterior communicating arteries are present.\nThe major dural venous sinuses are patent and are unremarkable.\n\nCTA NECK:\nBovine type aortic arch with common origin of the right innominate and left\ncommon carotid arteries. The carotidandvertebral arteries and their major\nbranches appear normal with no evidence of stenosis or occlusion. There is no\nevidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nAgain noted is a 5.2 x 6.0 cm (AP X TR) hypodense lesion in the posterior\nmediastinum, unchanged from ___ and most likely represents an\nesophageal duplication or mediastinal cyst. Areas of pulmonary scarring and\nemphysematous changes in the right lung are unchanged. The visualized portion\nof the thyroid gland is within normal limits. There is no lymphadenopathy by\nCT size criteria. Mild degenerative changes are visualized throughout the\ncervical spine, with no evidence of significant spinal canal narrowing.", + "output": "1. Late subacute infarcts in the posterior limb of the right internal capsule\nand old lacunar infarct in the left pons, as identified on the same day MRI.\n2. Patent intracranial and cervical vasculature without evidence of\ndissection, stenosis, occlusion or aneurysm formation greater than 3 mm.\n3. Hypodense lesion in the posterior mediastinum, unchanged from ___,\nmost likely represents an esophageal duplication or mediastinal cyst" + }, + { + "input": "Aero digestive tract:\n\nThere is no mass.\n\nNeck lymph nodes:\n2 adjacent left level 4 lymph nodes likely corresponds to those seen on\nultrasound. The more superior node measures 9 mm in short axis, in the\ninferior node measures 11 mm in short axis (5:147, 5:154 respectively). \nInferior to this node is a 6 mm node, at the thoracic inlet (5:70). No\nadditional enlarged lymph nodes are seen. Prominent bilateral level 2\ncervical lymph nodes are not pathologically enlarged by CT size criteria,\npossibly reactive.\nThere is no retropharyngeal adenopathy.\n\nExtra nodal tumor spread:\nThere are no findings suggestive of extra nodal extension.\n\nDeep neck muscles, masticator space:\nThere is no muscle invasion.\n\nBones, skull base:\nThere is no bone involvement.\nThere are no findings suggestive of perineural tumor extension.\nJugular foramen, carotid canal,pterygopalatine fossa,infraorbital\nforamen,other skull base foramina are not involved.\n\nVessels:\nThere is no vascular invasion.\nThe neck vessels are patent.\n\nBrachial Plexus:\nThere is no brachial plexus contact or invasion.\n\nThyroid, salivary glands:\nPartially calcified left thyroid nodule is better evaluated on recent thyroid\nultrasound. The submandibular and parotid glands are unremarkable.\n\nOther findings:\nThere are no lung nodules.", + "output": "1. 6 mm abnormal lymph node at the thoracic inlet.\n2. Redemonstration of 2 abnormal left level 4 cervical lymph nodes, measuring\nup to 11 mm.\n3. Prominent but not enlarged bilateral level 2 cervical lymph nodes are\nnonspecific, possibly reactive. Continued attention on follow-up is\nwarranted." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. Sulci\nand ventricles are appropriate for patient's age. Bilateral periventricular\nsubcortical white matter hypodensities are nonspecific but most likely\nrepresent sequela chronic small vessel ischemic changes. Bilateral carotid\nsiphon calcifications are noted.\n\nThere is mild mucosal thickening of the ethmoid air cells. The remaining\nvisualized paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The patient is status post bilateral lens replacement.", + "output": "1. No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in caliber and configuration.\n\nNo osseous abnormalities seen. There is mild mucosal thickening in the\nmaxillary sinuses. Otherwise, the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "Mild paranasal sinus inflammatory changes.\nOtherwise normal study" + }, + { + "input": "There is no evidence of fracture, acute large territory\ninfarction,hemorrhage,edema,or mass effect. The ventricles and sulci are\nnormal in size and configuration.There is a mucous retention cyst noted within\nthe right maxillary sinus. Otherwise, the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are normal.", + "output": "No acute intracranial abnormality." + }, + { + "input": "Evaluation is limited due to patient body habitus.\n\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are normal in size and configuration.\n\nThere is a right maxillary retention cyst along the medial wall. The\nvisualized portion of 7mastoid air cells,and middle ear cavities are clear.\nThe visualized portion of the orbits are normal.\n\nCTA HEAD:\nThe left A1 segment is hypoplastic. The vessels of the circle of ___ and\ntheir principal intracranial branches appear normal without stenosis,\nocclusion, or aneurysm. The dural venous sinuses are patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No evidence of or hemorrhage.\n2. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n3. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection." + }, + { + "input": "The paranasal sinuses are normally aerated, with no mucosal thickening or\nair-fluid levels identified. The ostiomeatal units are patent. The cribriform\nplates are intact. The lamina papyracea are intact. The nasal septum is\nmidline. There is no bony erosion. The ethmoid roof is higher on the left. \nThe anterior clinoid processes are not pneumatized.\n\nThe orbits are grossly unremarkable. The mastoid air cells and middle ear\ncavities are clear. The brain is grossly unremarkable given low-dose\ntechnique.", + "output": "Normally aerated paranasal sinuses." + }, + { + "input": "There is no evidence of acute major vascular territory\ninfarction,hemorrhage,edema,or discrete mass. There is prominence of the\nventricles and sulci suggestive of involutional changes. Small vessel disease\nis noted, moderate in extent.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormalities.\n2. Moderate small vessel disease." + }, + { + "input": "No evidence of infarction, hemorrhage, edema, or mass effect. The ventricles\nand sulci are normal in size and configuration.\n\nA left vertex subgaleal scalp hematoma is small. There is a small left\nlateral calvarial hematoma and soft tissue swelling. No evidence of fracture.\nLeft frontal sinus is hypoplastic or underpneumatized. The visualized portion\nof the paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. No intracranial hemorrhage.\n2. Left vertex and frontal temporal scalp hematoma.\n3. No evidence of fracture.\n\nNOTIFICATION: The findings and impression were discussed with ___,\nM.D. by ___, M.D. in person on ___ at 9:34 ___, 1 minutes after\ndiscovery of the findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThe patient is status post bicoronal craniotomy for right frontal mass\nresection and sinus surgery with appropriate postsurgical changes including an\nanterior frontal heterogenous extra-axial fluid collection measuring 7.4 x 2.1\ncm, mesh along the inferior ethmoid. (Series 2, image 18), heterogeneous\namorphous calcifications are seen at the surgical bed in the frontal region,\nthe possibility of packing surgical material, versus residual mass are\nconsiderations, correlation with prior exams is advised.\n\nThere is a heterogenous left frontoparietal subdural hematoma with hyperdense\ncomponents that are likely acute hemorrhage that measures 1.3 cm in greatest\ndiameter. There is a mass effect and midline shift that cannot be exactly\nquantified due to postsurgical changes in the anterior fossa.\n\nThe bilateral ethmoid, sphenoid, lamina papyracea and left maxillary sinuses\nare all surgically altered. The bilateral mastoid air cells, middle air canal\nand external auditory canal are within normal limits.\n\n\nCTA HEAD:\nThere is a fetal type configuration of the left PCA. The right PCA\ndemonstrates segmental high-grade stenosis in the proximal portion, (series\n462, image 4).\nThe anterior circulation system does not demonstrate any evidence of\nhigh-grade stenosis, occlusion or aneurysm.\nThe other vessels of the circle of ___ and their principal intracranial\nbranches appear normal without stenosis, occlusion, or aneurysm formation. \nThe dural venous sinuses are patent.\n\nCTA NECK:\nThe carotid and left vertebral arteries and their major branches appear normal\nwith no evidence of stenosis or occlusion. The right vertebral artery\ndemonstrates atherosclerotic plaques at the V2 to V4 portions with no\nhigh-grade stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nPatient is status post CABG and median sternotomy with intact sternal wires.\nThe thyroid is heterogenous with a 0.7 cm thyroid nodule demonstrated in the\nright thyroid lobe. No follow-up is recommended. There is mild scarring at the\nlung apices. Mild degenerative changes are visualized throughout the cervical\nspine as well as diffuse osteopenic changes in the cervical, and upper\nthoracic spine.", + "output": "1. The patient is status post bicoronal craniotomy for right frontal mass\nresection and sinus surgery as described detail above.\n2. Heterogenous left frontoparietal subdural hematoma with hyperdense\ncomponents that are likely acute/subacute hemorrhage that measures 1.3 cm in\ngreatest diameter. There is a mass effect and midline shift that cannot be\nexactly quantified due to postsurgical changes in the anterior fossa.\n3. Heterogeneous amorphous calcifications are seen at the surgical bed in the\nfrontal region, the possibility of packing surgical material, versus residual\nmass are considerations, correlation with prior exams is advised.\n\nRECOMMENDATION(S): Prior CT head or MRI brain examinations may help to\ndetermine the evolution left frontoparietal subdural hematoma and frontal\nextra-axial fluid collection." + }, + { + "input": "Changes from prior bicoronal craniotomy for right frontal mass resection and\nsinus surgery are again noted. A 7.1 x 2.0 cm anterior frontal extra-axial\nfluid collection (02:18) is unchanged. There is marked enhancement of the\nadjacent dura. Heterogeneous calcifications are again seen in the surgical\nbed. High-density along the anterior margin of bilateral frontal lobes is\nstable, may be postsurgical, treatment related or residual calcified tumor.\n\nA left frontoparietal subdural hematoma measuring up to 1.6 cm in thickness\n(02:26), containing mixed density hemorrhage products, is similar.\n\nThere is no evidence of acute large territorial infarction or new acute. The\nventricles and sulci are stable in size and configuration.\n\nSurgical changes to the bilateral ethmoid, sphenoid and left maxillary sinuses\nand bilateral lamina papyracea are again noted. The mastoid air cells and\nmiddle ear cavities are grossly unremarkable. No concerning focal abnormality\nis seen in the orbits.", + "output": "1. The 7.1 cm anterior frontal extra-axial fluid collection is unchanged in\nsize. Adjacent dural enhancement is nonspecific and may be postsurgical. \nHowever, a superimposed infectious process cannot be excluded.\n2. Unchanged left frontal parietal subdural hematoma.\n3. Re-demonstration of heterogeneous calcifications in the frontal surgical\nbed, which may represent postsurgical change, surgical material versus or\nresidual disease.\n4. No new acute intracranial abnormality." + }, + { + "input": "There is unchanged appearance of a 3.0 x 2.0 cm (AP, TRV) left maxillary\npolyp, with extension through a secondary ostium extending into the midline\nnasopharynx to the right choana with second polyp component measuring\napproximately 2.2 x 1.6 cm essentially unchanged from prior CTA of ___.\n\nThere is minimal mucosal thickening along the floor of the right maxillary\nsinus. The remainder of the paranasal sinuses are essentially clear. The\nnasal septum is near midline without perforation. The infundibulum of the\nostiomeatal units are patent. The frontal ethmoidal recesses are clear. The\nsphenoid sinus septum inserts on the sellar floor and the anterior clinoid\nprocesses are not pneumatized. The cribriform plates and lamina papyracea are\nintact.\n\nAlthough not optimized such evaluation, visualized brain parenchyma is grossly\nunremarkable. The orbits are unremarkable. The mastoid air cells and middle\nears are well pneumatized and clear.", + "output": "1. Unchanged appearance of a left maxillary polyp extending through a\nsecondary ostium and the left choana into the nasopharynx with dominant\ncomponents measuring 3 cm and 2.2 cm, most compatible by imaging with an\nantrochoanal polyp. Differential considerations include inverted papilloma.\n2. Additional findings as described above." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. 5 mm dural based calcification is again\nnoted along the left temporal convexity and unchanged. There is no mass\neffect on the subjacent brain parenchyma or evidence of edema. There has been\ninterval resection of the left nasal polyp as well as left maxillary\nantrostomy. Scattered mucous retention cysts are seen within the bilateral\nmaxillary sinuses with minimal mucosal thickening in the ethmoid air cells. \nThe remaining visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. 5 mm dural-based calcification along the left temporal convexity is\nunchanged and likely reflects a calcified dural plaque or small meningioma.\n2. No acute intracranial abnormality.\n3. Status post left nasal polypectomy and left maxillary antrostomy with\nscattered mucous retention cysts in the bilateral maxillary sinuses." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nMild periventricular, subcortical, and deep white matter hypodensities are\nlikely sequelae of chronic small vessel ischemic disease. The ventricles and\nsulci are normal in size and configuration. 0.4 cm (5:270) dural-based\ncalcification along the left frontal convexity is most consistent with a small\nmeningioma or dural calcification.\n\nA large 2.0 x 1.4 cm nasal antrochoanal polyp arising from the left superior\nnasal turbinate and projects into the posterior nasopharynx. Large mucous\nretention cyst in the the left maxillary sinus. The additional visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe right anterior cerebral artery is supplied via the anterior communicating\nartery and left anterior cerebral artery with a congenitally hypoplastic right\nA1 segment. The vessels of the circle of ___ and their principal\nintracranial branches otherwise appear normal without stenosis, occlusion or\naneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nThe left vertebral artery is dominant. The carotid and vertebral arteries and\ntheir major branches appear normal with no evidence of stenosis or occlusion.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are notable for a 0.4 x 0.3 cm left upper\nlobe pulmonary nodule (05:38). The visualized portion of the thyroid gland is\nwithin normal limits. There is no lymphadenopathy by CT size criteria.", + "output": "1. No acute intracranial process. Specifically, no intracranial hemorrhage.\n2. 0.4 cm dural based calcification along left frontal convexity, most\nconsistent with small meningioma or dural calcification.\n3. Large 2 cm antrochoanal polyp arising from left superior nasal turbinate\nand projecting into posterior nasopharynx.\n4. Patent vasculature. No dissection.\n5. 0.4 cm left upper lobe pulmonary nodule. As per ___ criteria if\npatient is low risk no additional follow-up is needed. If high risk recommend\ndedicated CT in ___ year to assess for interval change.\n\nRECOMMENDATION(S): Point 5. There is a 0.4 cm left upper lobe pulmonary\nnodule. As per ___ criteria if patient is low risk no additional\nfollow-up is needed. If high risk recommend dedicated CT in ___ year to assess\nfor interval change." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. There is mild\nprominence of the ventricles and sulci suggestive of involutional change.\n\nThere is mild polypoid mucosal wall thickening in the right greater than left\nmaxillary sinuses and right greater than left ethmoid air cells. The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are otherwise clear. The visualized portion of the orbits are\nunremarkable.\n\nCTA HEAD:\nThere is ___ termination of a hypoplastic left vertebral artery. There is\ntrace atherosclerotic calcification of the V4 segment of the right vertebral\nartery without significant narrowing (5:236). There are mild atherosclerotic\ncalcifications along the bilateral intracranial internal carotid arteries\nwithout significant narrowing. There is a 3 mm wide necked lateral\noutpouching of the cavernous segment of the right internal carotid artery\n(5:266, 653:50) that likely represents atherosclerotic aneurysm. The vessels\nof the circle of ___ and their principal intracranial branches appear\npatent without significant stenosis or occlusion. The dural venous sinuses\nare patent.\n\nCTA NECK:\nThere are trace atherosclerotic calcifications of the aortic arch. There is a\nvariant 2 vessel aortic arch. The left vertebral artery appears hypoplastic. \nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nScattered calcified pleural plaques are noted. The visualized portion of the\nlungs are otherwise clear. The visualized portion of the thyroid gland is\nwithin normal limits. There is no lymphadenopathy by CT size criteria.", + "output": "1. No hemorrhage or infarct.\n2. 3 mm wide necked laterally projecting atherosclerotic aneurysm of the\ncavernous segment of the right internal carotid artery.\n3. Otherwise patent intracranial arterial vasculature without significant\nstenosis or occlusion.\n4. Patent cervical arterial vasculature without significant stenosis,\nocclusion, or dissection." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass effect. The ventricles and sulci are prominent in keeping with\nage-related involutional change. Mild periventricular and subcortical white\nmatter hypodensities are nonspecific, but likely represent sequela of chronic\nischemic microvascular disease. Again seen are multiple punctate\ncalcifications scattered throughout the brain, which are nonspecific, but may\nrepresent sequela of prior infection such as neurocysticercosis\n\nNo acute fractures are seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable aside from\nbilateral lens replacement.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of large acute territorial infarction,intracranial\nhemorrhage,edema,or mass. There is prominence of the ventricles and sulci\nsuggestive of involutional changes, unchanged. Punctate calcifications are\nagain noted throughout the brain. Small area of low attenuation in the left\nfrontal lobe involving the first frontal gyrus is suggestive of small chronic\nischemic event (images 22, 23, series 2), bilateral periventricular and\nsubcortical white matter hypodensities are nonspecific but most likely\nrepresent sequela of chronic small vessel ischemic changes. Bilateral carotid\nsiphon calcifications are noted.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. \nStatus post bilateral lens replacement. An endotracheal tube and an enteric\ntube are noted, partially evaluated in this exam.", + "output": "No evidence of acute intracranial process or hemorrhage. If there is\npersistent concern for infarction or septic emboli, MRI of the brain can\nprovide further assessment." + }, + { + "input": "There is no evidence of acute major territorial infarction, hemorrhage, edema,\nor large mass. Left caudate head hypodensity, stable since ___,\nrepresents a chronic lacune. The ventricles and sulci are prominent,\nconsistent with age. There are confluent periventricular hypodensities, while\nnonspecific likely represent the sequelae of chronic small vessel disease. \nThere is no acute fracture. There is minimal ethmoidal cell mucosal\nthickening. Otherwise the paranasal sinuses are well aerated. The orbits are\nunremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect. The fossa of ___ is unremarkable.\n\nThe salivary glands are without mass or adjacent fat stranding.The thyroid\ngland appears normal.Bilateral cervical lymph nodes remain prominent but are\nnot pathologically enlarged by CT size criteria. Compared to the prior exam,\nthe overall size of these lymph nodes has markedly decreased, favoring a\nreactive process, less likely malignancy. The largest of these prominent\nlymph nodes now are level 1 lymph nodes measuring up to 11 mm in long axis and\na left level 2 lymph node measuring up to 1.6 cm in long axis, all 3 of which\nappear to maintain their normal fatty hila (series 5, image 41, 27).\n\nAsymmetric, mild enlargement of the right lacrimal gland without associated\ncalcification is nonspecific but could be seen with inflammation, neoplasm, or\ninfection in the appropriate clinical situation. Subtle mildly increased fat\nstranding and factual thickening in the right face suggests mild cellulitis as\ndetailed in the CT sinus report from the same day.\n\nNo subcutaneous emphysema or evidence of fluid collections.\n\nA right internal jugular venous catheter tip ends in the SVC-RA junction.\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules.No osseous lesions. Multi-level degenerative changes of the\ncervical spine are noted but difficult to evaluate in the setting of artifact.", + "output": "1. No evidence of fluid collections in the neck.\n2. Subtle mild soft tissue fat stranding and special thickening of the right\nface as above detailed in the CT sinus report from the same day, suggesting\ncellulitis.\n3. Slightly asymmetric enlargement of the right lacrimal gland without\nevidence of associated calcification for which the differential includes\ninflammatory, infectious, and neoplasm. Correlate with clinical assessment.\n4. Persistent prominent bilateral cervical lymph nodes, but markedly decreased\nin size compared to the prior exam as detailed above. These could be\nreactive. Close attention on follow-up is advised given the provided history\nof AML.\n\nRECOMMENDATION(S): Clinical assessment correlate with findings as above." + }, + { + "input": "The right frontal sinus is hypoplastic. Mucosal thickening in the bilateral\nfrontal sinuses is minimal. Several small mucous retention cysts are\nidentified within the right maxillary sinus. Polypoid mucosal thickening of\nthe left maxillary sinus is mild. The sphenoid sinuses and ethmoidal air\ncells are clear. No aerosolized secretions or air-fluid levels are identified\nwithin the sinuses. The retroantral fat planes appear preserved. No evidence\nof sinus wall osseous erosions or dehiscence. The lamina papyracea and\ncribriform plates appear intact. There is partial opacification of several\nleft mastoid air cells.\n\nThere is a right Haller cell. The right ostiomeatal unit is patent. The left\nostiomeatal unit is patent. The bilateral frontal recesses are patent.\n\nThe nasal septum is deviated to the left with a tiny left nasal septal spur\nthat may contact the mucosa of the left nasal turbinate creating focal\nobstruction of the nasal passage at this level (series 6, image 41). The\nbilateral nasal passages are otherwise clear. Nasal mucosal thickening is\nminimal.\n\nThe mastoid air cells and middle ear cavities are clear.\n\nThe imaged upper airway is patent without evidence of mass effect.\n\nThere is nonspecific, asymmetric mild soft tissue stranding as well as\nthickening of the fascia along the right periorbital region extending to the\nright premaxillary and pre mandibular space suggesting cellulitis (e.g. series\n4, image 6, 10, 14, 29, 40). No fluid collections or subcutaneous emphysema\nare identified.\n\nThe right lacrimal gland is asymmetrically expanded and enlarged compared to\nthe left (series 4, image 32, 33, 31). No associated calcifications are\nidentified. The right intraconal orbit and globe is unremarkable. The left\norbit is unremarkable.\n\nNo osseous lesions concerning for malignancy or or infection.\n\nThis exam is not dedicated for imaging of the head. However, limited images\nof the head do not demonstrate midline shift, mass effect, ventriculomegaly,\nor obvious large acute hemorrhage.\n\nPlease refer to the dedicated CT neck report from the same day for description\nof findings in the neck.", + "output": "1. Paranasal sinus disease as above. No specific CT evidence for active\nsinusitis or invasive sinusitis.\n2. Nonspecific asymmetric mild soft tissue fat stranding and thickening of the\nfascia along the right face as above suggesting cellulitis. No subcutaneous\nemphysema or fluid collections.\n3. Nonspecific asymmetric right lacrimal gland enlargement. The differential\ndiagnosis includes inflammatory etiology, non-Hodgkin's lymphoma, benign mixed\nlacrimal tumor, less likely infectious. Correlate with clinical assessment.\n4. Left nasal septal deviation.\n5. Right Haller cell is present.\n6. Please refer to the dedicated CT neck report from the same day." + }, + { + "input": "HEAD CT: There is increased size of a large left frontoparietal scalp\nsubgaleal hematoma, extending across the midline to the right parietal scalp.\nThere is a small right subdural hematoma now apparent along the right parietal\nand right temporal cerebral convexities, which was not visible on the prior CT\nperformed 12 hours earlier. A round focus of hemorrhage in the right parietal\nregion just posterior to the central sulcus (2:19) appears to have \"bloomed\"\nsince the earlier CT, likely representing an evolving hemorrhagic contusion.\nTrace biparietal subarachnoid blood products are noted (2:20).\n\nThere is no evidence of edema, mass effect or shift of normally midline\nstructures. The gray-white matter interface is otherwise preserved without\nevidence of acute major vascular territorial infarct. The ventricles and sulci\nare normal in size and configuration for the patient's age. The basal cisterns\nappear patent. The orbits and globes are unremarkable. The imaged paranasal\nsinuses are partially opacified with multiple air-fluid levels, likely related\nto the intubation and supine positioning. A non - displaced longitudinal\nfracture through the left temporal bone is again seen with partial\nopacification of the left mastoid and middle ear cavity compatible with\nassociated hemorrhage. The right middle ear cavity and mastoid are clear.", + "output": "1. Increased size of large left subgaleal hematoma extending across the\nmidline to the right parietal scalp, with increasing density, likely\nrepresenting additional bleeding.\n\n2. Small, thin right subdural hematoma along the right temporoparietal\nconvexity, was not visible on the CT performed 12 hours earlier.\n\n3. Evolving right parietal hemorrhagic contusion and trace right parietal\nsubarachnoid blood products are more conspicuous on the current examination.\n\n4. Unchanged non-displaced longitudinal left temporal bone fracture with\npartial opacification of the left mastoid and middle ear cavity." + }, + { + "input": "A small parenchymal contusion in the anterior right parietal lobe with mild\nsurrounding edema is stable. There is no new hemorrhage or edema. A new right\nfrontal approach external ventricular drain enters the frontal horn of the\nright lateral ventricle and terminates along the left lateral margin of the\nthird ventricle. The ventricles are normal and stable in size.\n\nA nondisplaced temporal bone fracture is again seen with partial opacification\nof the left mastoid air cells and middle ear cavity. The previously noted\nlarge left frontoparietal scalp subgaleal hematoma is unchanged in appearance.\n\nThere is unchanged complete opacification of the right sphenoid sinus, and\nprogressive near opacification of the bilateral ethmoid air cells. There is\nfluid in the left sphenoid sinus and in the bilateral maxillary sinuses, as\nbefore, with new mild mucosal thickening in the maxillary sinuses. These\nfindings are likely secondary to endotracheal intubation and prolonged supine\npositioning.", + "output": "1. Stable small right parietal hemorrhagic contusion.\n2. Nondisplaced left temporal bone fracture is again noted." + }, + { + "input": "A right frontal approach external ventricular drain has been pulled back\nslightly in the interval, and is now seen terminating in the frontal horn of\nthe right lateral ventricle. A small amount of air is seen in the frontal\nhorn of the right lateral ventricle. The previously seen small parenchymal\ncontusion in the anterior right parietal lobe is unchanged from prior exam. A\nsmall amount of blood is seen in the occipital horn of the right lateral\nventricle, likely due to redistribution. Otherwise, there is no evidence of\nnew hemorrhage, edema, mass effect, or infarction. The ventricles and sulci\nare normal in size and configuration. The basal cisterns appear patent and\nthere is preservation of gray-white matter differentiation.\n\nA nondisplaced left temporal bone fracture with partial opacification of the\nleft mastoid air cells and left middle ear cavity is again seen. Near-complete\nopacification of the sphenoid sinus and ethmoid air cells is again seen.\nMucosal thickening is again seen in the bilateral maxillary sinuses. The\nglobes are unremarkable.", + "output": "1. Interval pull back of the right frontal approach extraventricular drain,\nwhich now terminates in the frontal horn of the right lateral ventricle.\n\n2. Unchanged appearance of anterior parietal lobe parenchymal contusion, with\nsome likely redistributed blood now seen in the occipital horn of the right\nlateral ventricle.\n\n3. Stable appearance of left temporal bone fracture." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or infarction. Blood\nproducts previously seen in the right parietal region are no longer visible on\nthe current study. A large frontal parietal scalp subgaleal hematoma is\nunchanged in size with continued evolution of blood products. The ventricles\nand sulci are normal in size and configuration. The basal cisterns appear\npatent and there is preservation of gray-white matter differentiation.\n\nAgain seen is a nondisplaced longitudinal left temporal bone fracture with\npartial opacification of the left mastoid air cells. A right medial orbital\nfracture, is unchanged in appearance. Near complete opacification of the right\nsphenoid sinus, ethmoid air cells and right maxillary sinus is largely\nunchanged from the prior exam.", + "output": "No evidence of new hemorrhage or acute infarction. Calvarial or orbital\nfractures are largely unchanged from the prior examination. Interval\nresolution of previously described intraventricular blood and right parietal\nhemorrhagic contusion." + }, + { + "input": "There is a large left parietal scalp subgaleal hematoma. There is no\nunderlying fracture or extra axial hematoma. There is a subtle nondisplaced\npredominantly longitudinal fracture through the left temporal bone (3:22,\n302:65). There is a blood within the left mastoid air cells and within the\nleft middle ear (302:55). The ossicles are grossly intact.\n\nThere is no intracranial hemorrhage, major vascular territorial infarction,\nmass, or shift of the normally midline structures. The size and shape of the\nventricles and sulci are normal. The differentiation of grey and white matter\nis preserved. There are secretions within the nasal cavity and blood within\nthe right sphenoid sinus. There is no evidence of central skull base fracture.", + "output": "1. No acute intracranial abnormality.\n\n2. Large left parietal scalp subgaleal hematoma, without underlying fracture.\n.\n\n3. Subtle, non - displaced longitudinal - appearing fracture through the\nmastoid segment of the left temporal bone, with opacification of the left\nmastoid air cells, but clear middle ear cavity, incompletely characterized.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ in\nperson on ___ at 03:00, 0 minutes after discovery of the findings." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or\nmass-effect. The ventricles and sulci are age-appropriate.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no fracture. Mild mucosal thickening of the maxillary sinuses\nbilaterally. The visualized portion of the remaining paranasal sinuses,\nmastoid air cells, and middle ear cavities are otherwise clear. The visualized\nportions of the orbits are normal.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. The dural venous\nsinuses are patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent and there is normal\nthree-vessel aortic arch configuration. The carotid and vertebral arteries\nand their major branches appear normal with no evidence of stenosis or\nocclusion. Incidental note of slightly dominant right vertebral artery.\n\nOTHER:\nThe visualized portion of the lungs are clear. In the area of the thyroid\nbed, there are small hemostatic surgical clips, consistent with prior subtotal\nthyroidectomy. There are multiple prominent cervical lymph nodes bilaterally,\nincluding a 1.2 cm right level IIa cervical lymph node (3:141), which in\nconjunction with prominent palatine and lingual tonsils, are likely reactive.\n\nThere are multiple dense, nonspecific sclerotic foci in the mandible and\nmaxilla. There are multiple dental caries and periapical lucencies.", + "output": "1. No evidence of large territory infarction, hemorrhage or mass.\n2. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n3. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection.\n4. Multiple prominent cervical lymph nodes bilaterally and palatine and\nlingual tonsillar prominence, including a 1.2 cm right level IIa cervical\nlymph node, representing a likely reactive process.\n5. Postsurgical changes to the thyroid.\n6. Multiple dental caries and periapical lucencies which can be correlated\nwith dental exam.\n7. Mild paranasal sinus disease." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nNo evidence for acute intracranial hemorrhage, edema, mass effect, or acute\nmajor vascular territorial infarction. The ventricles, sulci, and basal\ncisterns are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The maxilla is edentulous. Multiple maxillary teeth\nare also absent, as seen previously. Sclerotic foci in the left posterior\nmaxillary alveolar ridge and bilateral mandibular alveolar ridge are\nunchanged. The orbits appear unremarkable.\n\nCTA NECK:\nThere is a 3 vessel aortic arch. Bilateral carotid and vertebral artery\norigins are patent.\nThere is no evidence of internal carotid stenosis by NASCET criteria. There\nis no evidence for flow-limiting vertebral artery stenosis.\n\nCTA HEAD:\nThere is a stable 4 mm AP x 4 mm TV posteriorly/medially oriented aneurysm\narising from the internal carotid artery (602, 14), ophthalmic segment. There\nis no evidence for flow-limiting stenosis in the major intracranial arteries. \nThe dural venous sinuses are patent.\n\nOTHER:\nThere is unchanged prominence of the palatine and lingular tonsils compared to\n___. A right level 2A lymph node measures 1.6 x 1.1 cm compared\nto 1.8 x 1.2 cm on image 3:141, still minimally enlarged but likely reactive.\n\nThe patient is status post left hemithyroidectomy. The right thyroid lobe is\ngrossly unremarkable. There is unchanged hyperdense nodule in the midline\nstrap muscles on image 3:87 which may reflect additional ectopic thyroid\ntissue.\n\nVisualized upper lungs demonstrate no concerning abnormalities allowing for\nmotion artifact and nondedicated technique.\n\nThere are degenerative changes in the cervical spine.", + "output": "1. No evidence of acute intracranial abnormalities. MRI would be more\nsensitive for posterior fossa pathology in the setting of dizziness, if\nclinically warranted.\n2. Stable 4 mm AP x 4 mm posteromedially oriented aneurysm arising from the\nophthalmic segment of the internal carotid artery.\n3. No evidence for flow-limiting stenosis in the major intracranial arteries.\n4. Unremarkable neck CTA.\n5. Status post left hemithyroidectomy. Unremarkable appearance of the right\nthyroid lobe. Unchanged hyperdense nodule in the midline strap muscles, which\nmay reflect additional ectopic thyroid tissue.\n6. Stable prominence of palatine and lingual tonsils. Minimally enlarged\nright level 2A lymph node, slightly decreased in size compared to ___." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nlarge territorial infarction. The ventricles and sulci are normal in size and\nconfiguration. The basal cisterns appear patent and there is preservation of\ngray-white matter differentiation.\nPituitary gland upper limit of normal\nThe visualized bony structures are grossly unremarkable.\nThere is moderate mucosal thickening of the bilateral maxillary sinuses\n(partly included) and bilateral ethmoid air cells. The frontal sinuses, middle\near cavities, and mastoid air cells are clear. The globes are unremarkable.", + "output": "No evidence of acute intracranial hemorrhage or mass effect\nModerate mucosal thickening of the bilateral maxillary sinuses (partly\nincluded) and bilateral ethmoid air cells.\nEnlarged adenoids\nCorrelate clinically" + }, + { + "input": "CT HEAD:\nAgain noted is a mass arising within, enlarging and extending from the sella\nturcica, although this was better appreciated on MR. ___ is no evidence of\ninfarction, hemorrhage or edema. There is mild prominence of the ventricles\nand sulci suggestive of involutional changes.\n\nThere is mild mucosal thickening the bilateral sphenoid sinuses and ethmoid\nair cells. The remaining visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal with no evidence of stenosis, occlusion, or aneurysm. The dural\nvenous sinuses are patent.", + "output": "1. Sellar mass, consistent with a pituitary adenoma.\n2. Normal CTA. No evidence of stenosis, occlusion or aneurysm.\n3. Sinus disease, as described above." + }, + { + "input": "There is a mass expanding the pituitary fossa which measures 2.0 x 1.9 x 2.7\ncm (series 2:8 and series 602:45). There is no intra-axial or extra-axial\nhemorrhage, edema, shift of normally midline structures, or evidence of acute\nmajor vascular territorial infarction. Prominent ventricles and sulci are\nmore than expected given the patient's age.\n\nThere is some mucosal thickening of the bilateral ethmoid air cells. Mastoid\nair cells and middle ear cavities are well aerated. The bony calvarium is\nintact.", + "output": "Soft tissue expanding the pituitary fossa measuring 2.0 x 1.9 x 2.7 cm. MRI\nis recommended for further characterization.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\n___ on the telephone on ___ at 6:36 pm, 5 minutes after discovery of\nthe findings." + }, + { + "input": "HEAD CT: Limited examination due to patient motion. There is no evidence of\nacute intracranial hemorrhage, edema, mass effect or shift of normally midline\nstructures. The gray-white matter interface is preserved without evidence of\nacute major vascular territorial infarct. The ventricles and sulci are normal\nin size and configuration for the patient's age. The basal cisterns appear\npatent. The orbits and globes are unremarkable. A small mucous retention cyst\nis noted in the right maxillary sinus. The remainder of the imaged paranasal\nsinuses, middle ear cavities and mastoid air cells are clear bilaterally. The\nbony calvaria appear intact.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "Patient is status post open reduction internal fixation of multifocal and\ncomminuted bilateral mandibular fractures, the fracture throughout the left\nmandibular ramus demonstrates medial angulation. Within the subcutaneous fat\nimmediately lateral to the masseter muscles (301:39, 602:145) there is mild\nsoft tissue swelling and fat stranding along the mandibular region, slightly\nmore significant on the left with no evidence of fluid collections, there is\nbilateral accessory parotid gland tissue, unchanged since the prior exam.\nMild mucosal thickening of the ethmoid air cells and bilateral maxillary\nsinuses (containing mucous retention cysts) are noted. Unchanged mucosal\nthickening is noted in the anterior aspect of the left sphenoid sinus,\nbilateral Haller cells are present, the ostiomeatal units are patent. The\ncribriform plates are intact. The lamina papyracea are intact. Deformity of\nthe nasal bones remains unchanged, the lamina papyracea appears intact\nbilaterally, the orbits are unremarkable, allowing for the slice selection and\ntechnique, the visualized intracranial structures are unremarkable.", + "output": "1. Postsurgical changes, consistent with fixation and open reduction of\nmultifocal comminuted bilateral mandibular fractures as described above.\n2. Soft tissue swelling and fat stranding is identified along the mandibular\nregion with no evidence of fluid collections." + }, + { + "input": "There is no acute large vascular territorial infarction, hemorrhage, edema or\nmass. Basal cisterns are patent, and there is preservation of gray-white\nmatter differentiation. Mildly prominent ventricles and sulci suggest\nage-related involutional changes.\n\nNo fracture identified. There is extensive mucosal thickening of the\nbilateral anterior and posterior ethmoidal air cells. Mild mucosal thickening\nof the left frontal sinus. Moderate mucosal thickening of the right and mild\nmucosal thickening of the left maxillary sinuses. The remaining imaged\nparanasal sinuses are clear. Middle ear cavities and mastoid air cells are\nunremarkable. A left sided glaucoma device is in place and the lenses have\nbeen resected bilaterally. Moderate calcification of the bilateral carotid\nsiphons.", + "output": "1. No acute intracranial process.\n2. Paranasal sinus disease, as described above." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of new infarction,hemorrhage,edema,ormass. The\nventricles and sulci are normal in size and configuration. An old left\noccipital lobe infarct is seen. A subcentimeter old infarct is seen in the\nright centrum semiovale.\n\nCT PERFUSION ANALYSIS:\nCBF<30% volume: 0 mL\nTmax >6s volue: 0 mL\nMismatch volume: 0mL.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\nA large left-sided posterior maxillary odontogenic cyst is re-demonstrated,\nunchanged.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. There is\nnear complete ___ termination of the left vertebral artery with a hypoplastic\ndistal V4 segment. There is fetal origin of the posterior cerebral arteries. \nThe dural venous sinuses are patent.\n\nCTA NECK:\n Atherosclerotic changes of the right carotid bifurcation is seen. Otherwise,\nthe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. Degenerative changes of the cervical spine are seen.", + "output": "1. No acute infarct or intracranial hemorrhage.\n2. Old left occipital lobe and right centrum semiovale infarcts.\n3. No stenosis or occlusion of the circle of ___ arteries.\n4. No stenosis or occlusion of the cervical arteries." + }, + { + "input": "A focus of encephalomalacia is again seen in the left occipital lobe\ninferiorly as well as the right centrum semiovale. There is no acute\nhemorrhage, edema, shift of normally midline structures, or signs of acute\nmajor infarction. Mild periventricular white matter hypodensity could reflect\nchronic microvascular ischemic disease. Age-appropriate involutional changes\nare noted.\n\nThere is no evidence of fracture. Partial opacification of the left maxillary\nsinus due to a left maxillary bone cyst. Otherwise, remainder of the\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No evidence of acute intracranial hemorrhage, fracture or large territory\ninfarct.\n2. Areas of encephalomalacia involving the right centrum semiovale and left\noccipital lobe appear unchanged." + }, + { + "input": "There is no evidence of large territorial infarction, acute intracranial\nhemorrhage, edema, or mass effect. Encephalomalacia involving the left\nparieto-occipital region is new since ___, but appears chronic. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "1. No acute intracranial hemorrhage.\n\n2. Encephalomalacia involving the left parieto-occipital region is a chronic\nfinding, but is new since the most recent available scan of ___." + }, + { + "input": "CTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nIncidentally seen is fetal origin of bilateral posterior cerebral arteries.\n\nCTA NECK:\nThere is 3 vessel aortic arch. There is atherosclerosis involving the right\ncarotid bifurcation without any stenosis by NASCET criteria. The left carotid\nartery appears unremarkable.\n\nPlease note that the origin of right vertebral artery is not well visualized\nsecondary to streak artifact from the contrast. The bilateral vertebral\narteries are otherwise unremarkable along its entire course. There is no\nevidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. There are mild degenerative changes involving the visualized\ncervical spine.", + "output": "1. Unremarkable CTA of head and neck noting minimal atherosclerosis involving\nright carotid bifurcation." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. Again seen is\nencephalomalacia involving the left parieto-occipital region.\n\nMild mucosal thickening of the left maxillary sinus. There is an unchanged\ncircumscribed lesion posterior inferior to the left maxillary sinus, likely\nrepresenting an odontogenic cyst. Otherwise, the visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent. Incidentally noted fetal origin of the bilateral\nposterior cerebral arteries.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is unchanged mild atherosclerotic\ncalcification involving the right carotid bifurcation without evidence of\nstenosis. There is no evidence of internal carotid stenosis by NASCET\ncriteria.\n\nOTHER:\nRespiratory motion limits evaluation of lungs. Within this limitation, the\nvisualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. There are mild degenerative changes involving the cervical spine.", + "output": "1. No acute intracranial abnormality.\n2. Unremarkable CTA of the head and neck except for stable minimal\natherosclerosis involving the right carotid bifurcation, unchanged dating back\nto ___.\n3. Chronic left occipital infarct.\n4. Hypodensity in the right posterior frontal cortical region and hypodensity\nin the subcortical region correspond with the infarcts seen on subsequent MRI\nof the brain." + }, + { + "input": "There is no evidence of acute major vascular territory\ninfarction,hemorrhage,edema, or mass. The ventricles and sulci are preserved\nin size and configuration. Soft tissue swelling is seen along the right\nparietal scalp (601:91).\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are preserved.", + "output": "1. No acute intracranial abnormality.\n2. No evidence acute intracranial hemorrhage or fracture.\n3. Right parietal scalp soft tissue swelling." + }, + { + "input": "There is no evidence of infarction,intracranial hemorrhage,edema,or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\npartially visualized bilateral maxillary sinuses. The visualized portion of\nthe remaining paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "No evidence of acute intracranial process or hemorrhage." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute intracranial hemorrhage, infarction, edema,\nmass, or mass effect. The ventricles and sulci are normal in caliber and\nconfiguration. There is no evidence for acute fracture. The visualized\nparanasal sinuses, mastoid air cells, and middle ear cavities are well\npneumatized and clear. The globes and orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The left\ntransverse sinus is diminutive but grossly patent. Otherwise, the dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe thyroid is within normal limits. Sever glands are grossly unremarkable. \nNo pathologically enlarged cervical, supraclavicular, or visible mediastinal\nlymph nodes. Lung apices are grossly clear.", + "output": "1. Unremarkable CTA head and neck. Patent circle of ___ and neck\nvasculature.\n2. No acute intracranial process by unenhanced head CT." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size for age. The basal cisterns are patent.\nThere is no evidence of fracture. There is moderate mucosal thickening of the\nethmoid air cells. The remainder of the paranasal sinuses are clear. The\nmastoid air cells and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. No acute intracranial process." + }, + { + "input": "Dental almalgam streak artifact limits study. The left palatine tonsil is\nenlarged, with a ill-defined hypodensity, measuring approximately 2.2 x 1.4\ncm, with at least partial rim enhancement (4:25). Bilateral palatine\ntonsilliths are noted. There is very minimal inflammatory stranding of a left\nparapharyngeal fat (series 4, image 22). The skull-base foramina are\npreserved.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding.There is a 5 mm hypodense right thyroid nodule. There is no\nlymphadenopathy by CT criteria. The neck vessels are patent, with incidental\nnote made of left vertebral artery aortic origin.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no suspicious osseous lesions. The visualized\norbits and paranasal sinuses are unremarkable. The visualized mastoid air\ncells middle ears are well pneumatized and clear. Although not optimized for\nsuch evaluation, the visualized portions the brain is grossly unremarkable.", + "output": "1. Enlargement of the left palatine tonsil, with a ill-defined hypodensity\nmeasuring approximately 2.2 cm with at least partial rim enhancement, likely\nrepresenting phlegmon, however evaluation is limited in the setting of dental\namalgam streak artifact. No definite confluent peripherally enhancing fluid\ncollection is identified. Minimal inflammatory stranding of the adjacent left\nparapharyngeal fat is identified.\n2. A 5 mm hypodense right thyroid nodule does not require further additional\nimaging per ACR guidelines." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect or\nlarge territorial infarction. The ventricles and sulci are mildly prominent\ndue to age related cerebral atrophy. Mild periventricular white matter\nhypodensities are nonspecific but may reflect chronic microvascular ischemic\ndisease in a patient of this age.\n\nThere is no fracture. The mastoid air cells and middle ear cavities are clear.\nMinimal soft tissue in the external auditory canals bilaterally is likely\ncerumen. There is a small mucous retention cyst in the left sphenoid sinus,\nand mild mucosal thickening in the right maxillary sinus and right frontal\nsinus.", + "output": "No evidence of an acute intracranial abnormality." + }, + { + "input": "Again seen is a subdural hematoma, extending along the left convexity with\nmass effect upon the underlying brain parenchyma, now measuring up to 12 mm in\nmaximum thickness on coronal view (601b:49). It is difficult to evaluate\ndifference in this collection compared to the CT sinus from approximately 8 hr\nprior, but appears to be similar on axial view. Rightward shift of normally\nmidline structures is decreased, now measuring 2 mm (01:23, previously 6 mm).\nAgain seen is extension into the temporal horn of the left lateral ventricle,\nand the quadrigeminal plate cistern on the left. A right subdural hematoma\nadjacent to the temporal lobe is increase in size, now measuring 7 mm in\nmaximum thickness (601b:63, previously 4 mm).\n\nNo acute infarction is identified. Other than minimal mucosal thickening\nwithin the right maxillary sinus, the visualized paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. There is no osseous abnormality.", + "output": "1. Increased size of the right subdural hematoma.\n2. The left subdural hematoma is difficult to compare to the CT sinus from\napproximately the 8 hr prior, but appears grossly unchanged, with extension\ninto the left lateral ventricle and quadrigeminal plate cistern.\n3. Rightward shift of normally midline structures is decreased, now measuring\n2 mm (previously 5 mm)." + }, + { + "input": "The left subdural hematoma along the left convexity with mass effect on the\nunderlying brain parenchyma is largely unchanged since the most recent CT\nhead. There is continued extension into the temporal horn of the left lateral\nventricle and quadrigeminal plate cistern on the left. Rightward shift of\nnormally midline structures is approximately 2 mm, unchanged (3a:15). The\nright subdural hematoma adjacent to the temporal lobe is largely unchanged,\nmeasuring 5 mm in maximum thickness (previously 7 mm). No acute infarction\nidentified.\n\nThe left orbital lateral wall cortical irregularity is unchanged. Overlying\nperiorbital soft tissue swelling has somewhat decreased. Paranasal sinuses,\nmastoid air cells, and middle ear cavities are grossly clear.", + "output": "1. No significant change in the left subdural hematoma with mass effect on\nthe underlying brain parenchyma, as described above.\n\n2. Right subdural hematoma is also largely unchanged, and may be slightly\nsmaller." + }, + { + "input": "A 3.9 x 2.2 cm focus of intraparenchymal hemorrhage in the left frontal lobe\nis unchanged in size, however has mildly increased surrounding vasogenic\nedema. Effacement of the frontal horn of the left ventricle is minimally\nincreased. A small amount of subarachnoid blood in the left frontal and\nparietal lobes is noted near the vertex, unchanged (series 2, image 26). \nThere is no intraventricular extension or midline shift. The basal cisterns\nappear patent. No evidence of a large territorial infarction.\n\nHypodensities in the periventricular deep white matter are nonspecific but\nlikely represents sequela of chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Left frontal lobe intraparenchymal hemorrhage is unchanged in size with\nmildly increased surrounding vasogenic edema. Trace left frontal and parietal\nlobe subarachnoid hemorrhage is unchanged. No new focus of hemorrhage or\nacute large territorial infarction." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. There are mild\nchronic small vessel ischemic changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. There are no acute changes." + }, + { + "input": "Dental almalgam streak artifact limits study.\n\nLeft : The external auditory canal is normal. The middle ear cavity is clear.\nThe ossicles and tegmen are intact. There is no evidence for enlarged\nvestibular aqueduct or superior semicircular canal dehiscence. The facial\nnerve follows a normal course through the middle ear. There is no evidence for\ninner ear dysplasia. The mastoids are clear.\n\nRight: The external auditory canal is normal. The middle ear cavity is clear.\nThe ossicles and tegmen are intact. There is no evidence for enlarged\nvestibular aqueduct or superior semicircular canal dehiscence. The facial\nnerve follows a normal course through the middle ear. There is no evidence for\ninner ear dysplasia. The mastoids are clear.\n\nOther: Bilateral cataract extractions are seen. There is atherosclerotic\ncalcification of the cavernous internal carotid arteries.", + "output": "1. Dental almalgam streak artifact limits study.\n2. No evidence of cholesteatoma." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Subcortical, deep and periventricular white-matter\nhypodensities are nonspecific, however likely represent sequela of chronic\nsmall vessel ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No fracture or acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Subcutaneous hyperdensity in the right side\nof the vertex suggests a small subgaleal hematoma (02:25). Minimal mucosal\nthickening within the ethmoid air cells bilaterally. The visualized portion\nof the remaining paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable. Moderate\natherosclerotic calcifications of the cavernous carotid arteries.", + "output": "1. No acute intracranial findings.\n2. Probable small subgaleal hematoma at the right side of the vertex. \nCorrelate with any history of trauma. No fracture." + }, + { + "input": "No intra-axial or extra-axial hemorrhage, edema, shift of normally midline\nstructures, or evidence of acute major vascular territorial infarction. There\nis chronic encephalomalacia in the right frontal lobe compatible with old\ninfarction. There is periventricular white matter hypodensity which reflect\nchronic microvascular ischemic disease. Several small lacune or infarctions\nin bilateral basal ganglia noted. Global involutional changes are noted. \nImaged paranasal sinuses are well aerated. Mastoid air cells and middle ear\ncavities are also well aerated. Bony calvarium is intact.", + "output": "No acute intracranial process. Stigmata of chronic small vessel ischemic\ndisease, basal ganglia lacunar infarctions and chronic right frontal infarct." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. No acute fracture. There is\nmoderate mucosal thickening of the ethmoid air cells and air-fluid level and\naerosolized secretion in the left sphenoid sinus. The remaining paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "1. No acute intracranial hemorrhage or fracture.\n2. Sinus disease, as described." + }, + { + "input": "Vascular coil limits evaluation of the inferior right temporal lobe. Multiple\nhyperdensities are seen in the right frontal and right temporal lobes as well\nas the bilateral cerebellum and along the tentorium which is improved in\nappearance from prior study. Hyperdense material is visualized in the\nposterior horns of the lateral ventricles bilaterally. Subtle hypodensity in\nthe right temporal and right frontal parietal lobes is unchanged in\nappearance. There is no evidence of acute large territory infarction, or new\nintracranial bleed. The basal cisterns are patent. The ventricles are normal\nin caliber.\n\nNo acute osseous abnormalities seen. The paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The orbits are unremarkable.", + "output": "1. Interval decrease in hyperdense material within the right frontal and\ntemporal lobes, bilateral cerebellum, and along the tentorium when compared to\nprior study. Some of the density seen previously was likely due to contrast.\n2. Hyperdense material in the posterior horns of lateral ventricles\nbilaterally that is new from prior study and likely due to redistribution..\n3. Stable subtle hypodensities in the right temporal and frontal lobes.\n4. Increase in size of the ventricles including temporal horns since the\nprevious CT indicating developing hydrocephalus.." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nStreak artifact from right MCA aneurysm coil limits evaluation at adjacent\nlevel. Evolving subarachnoid hemorrhage is noted in the right sylvian fissure\nand right-sided sulci. There is trace left sulcal subarachnoid hemorrhage,\nbarely visible. Subarachnoid hemorrhage within the basilar cisterns and along\nbilateral cerebellar folia have decreased since ___. There is no\nshift of midline structures.\n\nInterval placement of a ventriculostomy catheter terminating in the frontal\nhorn of the right lateral ventricle, with resulting decrease in hydrocephalus.\nBlood products in the occipital horns of the lateral ventricles have slightly\nincreased in extent.\n\nIll-defined hypodensities in the right temporal, parietal, and posterior\nfrontal lobes lobes, and the right insula, appear slightly more conspicuous\ncompared to the prior study, and may represent evolving infarctions. \nPeriventricular white matter hypodensities may be secondary to transependymal\nCSF flow plus/minus chronic small vessel ischemic changes.\n\nThere is a small mucous retention cyst in the left posterior ethmoid, image\n3:40. Other visualized paranasal sinuses are essentially well aerated. Mild\npartial bilateral mastoid air cell opacification cannot be excluded;\nevaluation is limited in the absence of dedicated bone algorithm images.\n\nCTA HEAD:\nStreak artifact from the coil pack in the treated right MCA aneurysm limits\nevaluation for residual aneurysm filling. No new aneurysm is seen.\n\nThere is unchanged mild vasospasm of the M1 segment of the right middle\ncerebral artery and slightly worsen severe vasospasm of the right M2 and M3\nsegments. Mild vasospasm of the distal left M1 segment and left M2/M3 segments\nappears present (though the patient's baseline is not known), not\nsignificantly changed.\n\nUnchanged small caliber of the right A1 segment may be secondary to hypoplasia\nor vasospasm. Left A1 segment and bilateral A2 segments do not appear\nsignificantly changed in caliber.\n\nVertebral arteries are unchanged in caliber with dominance of the right\nvertebral artery again noted. Non dominant left vertebral artery is markedly\nhypoplastic distal to the left ___. There is moderate right posterior\ncerebral artery vasospasm and mild left posterior cerebral artery vasospasm,\nsimilar to prior. Left posterior communicating artery is larger than the\nright, as before, which could be due to more severe vasospasm on the right or\ncongenital factors. Right superior cerebellar artery is slightly smaller than\nthe left and irregular, likely due to vasospasm.\n\nDural venous sinuses are patent.", + "output": "1. Evolving subarachnoid hemorrhage centered in the right sylvian fissure and\nright-sided sulci, with trace residual left sulcal hemorrhage. Decreased\nsubarachnoid hemorrhage in the basal cisterns and along bilateral cerebellar\nfolia.\n2. Status post right frontal approach ventriculostomy placement with partial\nimprovement in hydrocephalus. Slightly increased hemorrhage in the lateral\nventricles, likely due to redistribution.\n3. Hypodensities in the right insula, and right temporal, parietal, and\nposterior frontal lobes are concerning for evolving infarctions.\n4. Unchanged mild right M1 segment vasospasm and increased severe vasospasm of\nthe right M2/M3 segments. Unchanged mild left MCA vasospasm. Unchanged\nmoderate right PCA and mild left PCA vasospasm. Unchanged asymmetry of the\nposterior communicating arteries, which may be secondary to more severe\nvasospasm on the right versus congenital factors. Unchanged mild right\nsuperior cerebellar artery vasospasm." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nRe-demonstration of the ventriculostomy catheter terminating in the frontal\nhorn on the right lateral ventricle with stable hydrocephalus. Again, streak\nartifact of the right MCA aneurysm coil limits evaluation.\n\nThere is continued evolution of the right subarachnoid hemorrhage in the\nsylvian fissure, frontal, parietal, and temporal sulci. There is interval\nresolution of layering hemorrhage in the occipital horns of the lateral\nventricles. There is no new hemorrhage. No midline shift. Significant\nimprovement in hemorrhage in the basal cisterns, which now appear patent.\n\nInterval evolution of infarct in the right MCA distribution with hypodensities\nnoted in the right frontal and temporal lobe consistent with known vasospasm\nof the right MCA. There is an additional hypodensity in the right frontal\nlobe consistent with a subacute infarct, not previously visualized (2; 26).\n\nThe ventricles and sulci are unchanged in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is increased narrowing of the right A1 segment in comparison to CTA head\nfrom ___, concerning for vasospasm (601; 16) and mild increase in\nnarrowing of the right M1 segment. The appearance of the left MCA is similar\nto prior. There is possible mild increase in narrowing of the left A1\nsegment. Bilateral A2 segments are narrowed, similar to prior. There is\nimproved vasospasm of the right MCA segments, most notably the M2 segment and\nmore distal branches. There is improvement in mild spasm of the posterior\ncerebral arteries compared to prior. There is also mild improvement in\nvasospasm of the right superior cerebellar artery. Appearance of the left\nsuperior cerebellar artery is unchanged.\n\nThe dural venous sinuses are patent.", + "output": "1. Interval resolution of layering hemorrhage in the occipital horns. \nContinued evolution of the right subarachnoid hemorrhage without new foci of\nhemorrhage.\n2. More apparent hypodensity in the right frontal lobe consistent with a\nsubacute infarct. Interval evolution of previously seen right MCA\ndistribution hypodensities.\n3. Increased narrowing of the right A1 segment. Mild increase in narrowing of\nright M1. Possible mild increase in narrowing of left A1.\n4. Improved vasospasm in the right M2 and more distal branches. Improved\nvasospasm of bilateral posterior cerebral arteries and the right superior\ncerebellar artery." + }, + { + "input": "Re-demonstrated is a ventriculostomy catheter terminating in the frontal horn\nof the right lateral ventricle. Allowing for differences in patient head\nposition, no definite change in hydrocephalus is seen. Streak artifact from\nthe right MCA coil limits evaluation at adjacent levels. Previously seen\nright sulcal and sylvian fissure subarachnoid hemorrhage is barely visible. \nNo new hemorrhage is seen. Evolving infarcts in the right MCA distribution\nare again noted without evidence for increased mass effect. No shift of\nmidline structures.\n\nPartially visualized paranasal sinuses and mastoid air cells are grossly\nwell-aerated.", + "output": "1. Previously seen right subarachnoid hemorrhage is barely visible. No new\nhemorrhage.\n2. Continued evolution of right MCA territory infarcts without significant\nchange in mass effect.\n3. Stable position of the right frontal EVD. Stable ventriculomegaly allowing\nfor differences in patient head position." + }, + { + "input": "Compared to the earlier same day examination, there has been removal of the\nright frontal ventriculostomy catheter and there is small amount of\nintraventricular air in the frontal horn of the right lateral ventricle,\nlikely from the catheter. Mild lateral and third ventriculomegaly is\nessentially unchanged. There is unchanged focus of right frontal subcortical\nwhite matter hypodensity. Right MCA aneurysm coil is seen with streak\nartifact limiting localized evaluation. Previous identified subarachnoid\nhemorrhage is no longer visible. There is no evidence of new acute large\nterritorial infarction,new hemorrhage, increasing edema,or mass.\n\nThere are changes from right frontal burr hole. There is no evidence of\nfracture. The visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Interval removal of the right frontal ventriculostomy catheter with small\nfocus of air in the right lateral ventricle likely from the catheter, with\nessentially unchanged mild lateral and third ventriculomegaly.\n2. Unchanged small right MCA territory infarct.\n3. No new hemorrhage or new infarct." + }, + { + "input": "There is an evolving infarct seen in the right middle cerebral artery\nterritory. There is coiling in the region of right temporal lobe as before. \nThere is prominence of ventricles and temporal horns unchanged from the prior\nstudy. No acute hemorrhage identified.", + "output": "1. Prominent ventricles including temporal horns unchanged from the previous\nCT of ___.\n2. Evolving right middle cerebral artery infarct.\n3. Coil pack in the right middle cerebral artery temporal region." + }, + { + "input": "Metallic artifact from a right MCA bifurcation aneurysm coil packing results\nin suboptimal evaluation of adjacent structures. Within this confine:\n\nRe-identified is ventriculomegaly, asymmetrically more prominent on the right,\nincreased in size from examination of ___. For example, the\nright frontal horn measured approximately 1.8 cm in greatest transverse\ndimension, now measuring approximately 2.0 cm. In addition, the right\ntemporal horn now measures approximately 1.6 cm, presume measuring\napproximately 9 mm. Periventricular and subcortical white matter\nhypodensities are overall similar to prior examination, nonspecific. Right\nfrontal and temporal operculum encephalomalacia is re-identified.\n\nThere is no acute large territory infarct or new intracranial hemorrhage. \nRight frontal burr hole is noted otherwise no acute osseous abnormality. The\nvisualized paranasal sinuses are essentially clear. The orbits are\nunremarkable. The mastoid air cells and middle ears are well pneumatized and\nclear.", + "output": "1. Increasing ventriculomegaly, asymmetrically prominent on the right compared\nto prior examination of ___. For example, the left frontal horn\nmeasures approximately 2.0 cm in greatest transverse dimension, previously\nmeasuring 1.8 and the right temporal horn now measures approximately 1.6 cm,\npreviously measuring 9 mm.\n2. No acute intracranial hemorrhage or large territory infarct.\n3. Right frontal and temporal lobe encephalomalacia. Sequela of right MCA\naneurysm coil packing is identified.\n\nNOTIFICATION: The findings were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 4:51 pm, 2 minutes after\ndiscovery of the findings." + }, + { + "input": "Dilatation of right greater than left lateral ventricles, and of the third and\nfourth ventricles, is unchanged compared to ___. Streak artifact\nfrom the right MCA bifurcation aneurysm coil pack limits evaluation at the\nadjacent levels. Otherwise, there is no evidence for acute hemorrhage or\nedema. Encephalomalacia/gliosis in the right temporal lobe, insula, and right\nfrontal lobe are stable in extent. Periventricular white matter hypodensity\nis also stable.\n\nRight frontal burr hole is again seen. Partially visualized paranasal sinuses\nare grossly well-aerated. Evaluation of the mastoid air cells is limited in\nthe absence of dedicated bone algorithm images.", + "output": "Stable appearance of the brain 5 compared to ___ with stable\nenlargement of the ventricular system." + }, + { + "input": "Noncontrast head CT:\nSubarachnoid hemorrhage in the right sylvian fissure over the right\nfrontoparietal convexity sulci,, pre pontine cistern, is consistent with\naneurysmal pattern of hemorrhage. There is some associated edema surrounding\nthe area of hemorrhage. Additionally, in the insula and right frontoparietal\noperculum there is an area of hypodensity which may represent edema or\nischemia. The ventricles are mildly dilated, stable, however there is no\nintraventricular hemorrhage. Attention on follow-up for developing\nhydrocephalus. There is no evidence of midline shift or herniation currently.\nThere are bilateral symmetric physiologic calcifications in the basal ganglia.\n\nThe visualized portion the paranasal sinuses, mastoid air cells and middle ear\ncavities are normal. The visualized portion of the orbits is unremarkable. \nNo evidence of fracture. Degenerative changes spine.\n\nHead and neck CTA:\nThere is a lobulated aneurysm at the MCA trifurcation, which is\ninferolaterally directed. It measures 5.6 mm from base to apex, 2.5 mm across\nand 1.3 mm at the neck. This is in the area of subarachnoid hemorrhage seen on\nhead CT.\nThere is moderate to severe vasospasm of the bilateral M2 and M3 segments in\nthe region of the sylvian fissure. The bilateral M1 segment also appears to be\nin mild vasospasm. The A1 segment may be congenitally hypoplastic or in mild\nspasm. Patent right PCOM, with vasospasm more proximally. Patent left PCOM,\nnormal in caliber. There also appears to be mild spasm of the basilar artery\nand the right PCA. There is also a small amount of blood adjacent to the\nbasilar artery. The presence of spasm suggest this is a subacute or acute on\nsubacute bleed.\n\nNormal visualized aorta, origin of great vessels. Bilateral carotid and\nvertebral arteries are patent. Right vertebral artery is dominant. There is\nno ICA narrowing by NASCET criteria.", + "output": "1. Subarachnoid hemorrhage, density in some areas suggests component of\nsubacute hemorrhage. Suggestion of edema the right frontal lobe, anterior\nparietal lobe in basal ganglia. No midline shift or herniation.\n2. Hypodensity in the right insula and frontoparietal operculum concerning for\nischemia.\n3. Mild hydrocephalus. Attention on follow-up for developing hydrocephalus.\n4. Inferolaterally directed lobulated aneurysm at the right MCA trifurcation,\nmeasuring 5.6 mm from base to apex x 2.5 mm across x 1.3 mm at the neck.\n5. Presence of extensive arterial vasospasm suggests this is a subacute or\nacute on subacute bleed. Significant vasospasm of the bilateral right M2 and\nM3 segments. Mild spasm of the bilateral M1, and likely A1, segments. Mild\nspasm the basilar artery and right PCA, proximal right PCOM.\n\nNOTIFICATION: The findings were discussed with Ms. ___. by ___\n___.D. on the telephone on ___ at 10:04 am, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "Hardware artifact from right MCA endovascular intervention is noted, new from\nprior. There is hyperdense material seen in the basilar cisterns as well as\nin the right temporal, frontal, and parietal sulci, as well as within the\nright sylvian fissure. Specifically, hyperdense material is seen within the\nquadrigeminal plate cistern, the interpeduncular cistern, the right more than\nleft ambient cistern, the right more than left sylvian cistern extending into\nthe right sylvian fissure. Additionally, hyperdense material interdigitates\nwithin the folia of the cerebellum bilaterally, with less linear hyperdensity\nwithin the sulci of the right cerebral hemisphere and along the falx and\ntentorium. The amount of hyperdense intracranial material is significantly\nincreased compared with the prior unenhanced head CT of ___.\n\nThere is subtle increased hypodensity involving the right temporal as well as\nthe right frontal parietal cerebrum, as well as the insula, similar to prior\nexam. Given interdigitating hyperdense material in the ipsilateral cerebral\nsulci, assessment of gray-white matter differentiation is difficult. The\nbasal cisterns remain patent. There is no significant shift of the normally\nmidline structures. The ventricles are normal in caliber and configuration.\n\nNo evidence of fracture. The visualized paranasal sinuses, mastoid air cells,\nand middle ear cavities are well pneumatized and clear. The globes and bony\norbits are intact and unremarkable.", + "output": "1. Interval increased since the prior study of ___ at 08:04 in the\namount of subarachnoid hyperdense material centered primarily within the\nbasilar cisterns in the right sylvian fissure, as above. Given the density of\nthe material, much of this likely represents iodinated contrast from recent\nendovascular intervention; however, this limits assessment for interval change\nin the amount of acute subarachnoid blood products.\n2. Subtle hypodensity involving the right insula as well as generally\ninvolving the right temporal and frontoparietal cerebrum, similar in\nappearance to most recent prior exam, may reflect vasogenic edema however\nsuperimposed ischemia is difficult to exclude given this appearance.\n3. New hardware artifact from right MCA endovascular intervention." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are prominent, suggestive of volume loss. \nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\n\nNo acute fracture. The imaged paranasal sinuses are clear. Mastoid air cells\nand middle ear cavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territorial infarct. Prominence of the\nventricles and sulci is consistent with involutional changes. Periventricular\nand subcortical white matter hypodensities are likely sequelae of chronic\nsmall vessel disease. The visualized paranasal sinuses demonstrate mild\nmucosal thickening of the left sphenoid sinus versus small amount of fluid.. \nThe mastoid air cells are clear. No acute fracture is seen.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nThere is patchy hypoattenuation in the subcortical and periventricular white\nmatter which is nonspecific but likely reflects chronic microangiopathy in\nthis age group. There are prominent atherosclerotic calcifications involving\nthe intracranial segments of the internal carotid arteries specially on the\nright, and of the left vertebral artery.\n\nThere is no evidence of fracture. There is partial opacification of the\nsphenoid sinus on the left. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavitiesare otherwise clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territorial infarct. There is prominence of\nthe ventricles and sulci suggestive of involutional changes. There are\nperiventricular and subcortical hypodensities, which may represent small\nvessel ischemic changes.\n\nThere is a focus of subcutaneous air overlying the right supraorbital region,\nwith skin disruption consistent with known laceration. There is no underlying\nfracture. There is mild mucosal thickening of the left sphenoid sinus. The\nmastoid air cells are clear. No acute fracture is seen. There are bilateral\nlens replacements.", + "output": "1. No acute intracranial abnormality.\n2. Subcutaneous air and skin disruption overlying the right supraorbital\nregion is consistent with known laceration. No underlying acute fracture\nseen." + }, + { + "input": "There is no evidence of hemorrhage, edema, shift of normally midline\nstructures, or infarction. Prominent ventricles and sulci are compatible\nwith age-related involutional changes. Subcortical and periventricular white\nmatter hypoattenuation is nonspecific but likely represents chronic small\nvessel ischemic disease.\n\nThere is mucosal thickening of the bilateral ethmoid air cells. The remaining\nparanasal sinuses are clear. The mastoid air cells and middle ear cavities\nare well aerated. The bony calvarium is intact. There are moderate\ncalcifications of the bilateral carotid siphons.", + "output": "1. No of mass, hemorrhage or infarction.\n2. Atrophy." + }, + { + "input": "CTA NECK:\nThere is a 3 vessel aortic arch. Mild calcified plaque is noted at the great\nvessel origins without flow-limiting stenosis. There is mild calcified plaque\nin the proximal right internal carotid artery without stenosis by NASCET\ncriteria. There is no left carotid stenosis by NASCET criteria. There is\ncalcified plaque mildly narrowing the right vertebral artery origin. \nRemaining cervical course of the right vertebral artery is widely patent. \nLeft vertebral artery origin is tortuous without definite stenosis. Remaining\ncervical course of the left vertebral artery is widely patent.\n\nCTA HEAD:\nThere is calcified plaque within bilateral carotid siphons and V4 segment of\nthe right vertebral artery without evidence for flow-limiting stenosis. No\nevidence for flow-limiting stenosis is seen elsewhere in the major\nintracranial arteries. There is 1-2 mm inferiorly projecting outpouching of\nthe supraclinoid left ICA just distal to the left ophthalmic artery origin,\naxial image 2:226, which is not well assessed on reformatted images due to\nproximity to bone. Dural venous sinuses appear patent, with dominance of the\nleft transverse and sigmoid sinuses and the left internal jugular vein.\n\nOTHER:\nThe brain parenchyma is better assessed on the preceding head CT. There are\nsmall mucous retention cyst along the floor of the right maxillary sinus. \nMastoid air cells are well aerated. There is evidence of bilateral cataract\nsurgery.\n\nThere are multiple small areas of nodularity in the thyroid gland, with the\nlargest in the left lobe spanning 8 mm on image 2:74, similar to the ___ chest CT.\n\nEvaluation of the included upper lungs is limited by respiratory motion\nartifact. Partially visualized soft tissue density in the lower lobe of the\nleft lung was previously seen on the ___ chest CT.", + "output": "1. Mild right proximal internal carotid atherosclerosis. No right or left\ncarotid stenosis by NASCET criteria.\n2. Calcified plaque mildly narrowing the right vertebral artery origin.\n3. No evidence for occlusion or flow-limiting stenosis in the major\nintracranial arteries.\n4. Questionable 1-2 mm inferiorly projecting aneurysm of the supraclinoid left\ninternal carotid artery just distal to the left ophthalmic artery origin, not\nwell assessed by CTA due to proximity to bone.\n5. Nodularity in the thyroid gland, up to 8 mm, is again noted.\n6. Partially visualized pulmonary abnormality in the left lower lobe,\npreviously seen on the ___ chest CT, but not adequately reassessed.\n\nRECOMMENDATION(S):\n1. Follow-up brain MRA for better assessment of the questionable tiny left ICA\naneurysm.\n2. Thyroid nodule. No follow up recommended. Absent suspicious imaging\nfeatures, unless there is additional clinical concern, ___ College of\nRadiology guidelines do not recommend further evaluation for incidental\nthyroid nodules less than 1.0 cm in patients under age ___ or less than 1.5 cm\nin patients age ___ or ___. Suspicious findings include: Abnormal lymph nodes\n(those displaying enlargement, calcification, cystic components and/or\nincreased enhancement) or invasion of local tissues by the thyroid nodule. \n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150.\n\nNOTIFICATION: Impression item 4 and recommendations item 1 were emailed to\nthe ED QA nurses list by Dr. ___ at 20:18 on ___." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nProminent sulci and ventricle as consistent with involutional changes are\nunchanged. Again seen is some septum pellucidum and vergae.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nDense atherosclerotic plaques in the bilateral cavernous internal carotid\narteries (series 5, image 262 to 264) are unchanged. Absent right A1 segment\nis again demonstrated. Dense calcification in the right A2 (series 5, image\n285) is also unchanged. Calcification in the left V4 (series 5, image 226) is\nagain noted with the previously seen outpouching anteriorly now calcified. \nAgain seen is extensive atherosclerotic disease throughout the intracranial\narterial system with narrowing and irregularity involving the left carotid\nbifurcation, the right supraclinoid internal carotid artery, the M1 segments\nof the middle cerebral arteries bilaterally, the M2 segments of the middle\ncerebral arteries bilaterally and the A2 segments of the anterior cerebral\narteries bilaterally. These findings are unchanged since the study of ___. Otherwise there is no occlusion, aneurysm, or dissection of\ncircle of ___ and their principal intracranial branches.\n\nCTA NECK:\nA separation of the lumen in the V1 segment of the right vertebral artery\n(series 5, image 128) is again noted without interval change. This identical\nappearance argues in favor of fenestration rather than chronic dissection. \nThere is atherosclerotic plaque at the mid common carotid artery and at the\nbifurcation without stenosis or occlusion, unchanged. Atherosclerotic plaques\nin the mid right common carotid artery and at the bifurcation changed compared\nto prior. There is no evidence of internal carotid stenosis by NASCET\ncriteria. The atherosclerotic plaques in the bilateral subclavian arteries\nand aortic arch is unchanged.\n\nOTHER:\nThe visualized portion of the lungs are clear. The enlarged and\nheterogeneously enhancing enlarged left thyroid is similar to prior. There is\nno lymphadenopathy by CT size criteria.", + "output": "1. No evidence of hemorrhage, infarction, or mass.\n2. Similar appearance of luminal separation of the V1 segment of the right\nvertebral artery compared to ___, favoring fenestration over\ndissection. The right vertebral artery distal to this site is patent.\n3. Severe atherosclerotic calcifications involving the bilateral carotid\nbulbs, bilateral cavernous carotid arteries, and multiple intracranial\narteries described above are similar to prior.\n4. Similar appearance of the heterogeneously enhancing left thyroid." + }, + { + "input": "There is no evidence acute intracranial hemorrhage, edema, mass effect, or\nacute major vascular territorial infarction. There is unchanged prominence of\nthe ventricles and sulci suggestive of involutional changes. Cavum septum\npellucidum et vergae is again noted. Periventricular and subcortical\nhypodensities are nonspecific but grossly unchanged, likely sequela of chronic\nsmall vessel ischemic disease in this age group. Carotid and vertebral artery\ncalcifications are again noted.\n\nNo evidence for acute displaced fracture. Mild mucosal thickening in the\npartially imaged ethmoid air cells. Maxillary sinuses are largely excluded\nfrom the images. Frontal and sphenoid sinuses are well-aerated. Left and\npartially imaged right mastoid air cells are well aerated. The orbits are\npartially imaged. Evidence of bilateral cataract surgery is noted.", + "output": "No evidence for acute intracranial abnormalities." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of hemorrhage, edema, or mass. There is\nfocal hypodensity in the left insular cortex, series 4, image 15, stable in\ncomparison to the prior CT and likely representing a small lacunar infarction.\nThere is a cavum septum pellucidum et vergae. There is prominence of the\nventricles and sulci suggestive involutional changes..\nNear total empty sella\nThe visualized portion of the mastoid air cells, and middle ear cavities are\nclear. Bilateral cataract extractions are seen. Ethmoid sinus mucosal\nthickening is seen.\n\nCTA HEAD:\nThere is dense atherosclerotic calcification of the cavernous internal carotid\narteries. There is absence of the right A1. Dense atherosclerotic\ncalcification of the distal right A2 is seen, series 5, image 277.\nThere is contour irregularity of the bilateral ICA, ___, MCAs, ACAS and PCAs\nand Basilar arteries, with multifocal mild narrowing with adjacent dilation\nand tortuosity consistent with atherosclerotic disease or other vasculopathy.\nThe right vertebral artery terminates as the posterior inferior cerebellar\nartery. Atherosclerotic calcification of the V4 segment of the left vertebral\nartery is seen. There is a 2 mm outpouching from the anterior left V4\nvertebral artery, series 5, image 216. In addition, a 2 mm outpouching from\nthe right A2 artery is seen, also likely representing irregularity secondary\nto atherosclerotic calcification, series 5, image 276. The vessels of the\ncircle of ___ and their principal intracranial branches appear normal\nwithout stenosis, occlusion or aneurysm more than 3mm. The dural venous\nsinuses are patent.\n\nCTA NECK:\n3 vessel arch.\nAtherosclerotic calcification of the aortic arch, branch vessels and bilateral\ncarotid bulbs. There is atherosclerotic calcification of the origin of the\nright subclavian artery. There is focal irregularity with central linear\nfocus in the proximal right vertebral artery, series 5, image 114 and series\n602b, image 53, likely fenestration, though focal dissection can appear\nsimilar; no distal flow limitation. There is atherosclerotic calcification at\nthe origin of the right vertebral artery resulting in moderate stenosis.\nLeft vertebral artery is dominant.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThere is a short segment focal narrowing of the right internal carotid artery\nat the craniocervical junction region better seen on the curved reformations\nseries 659, image 1.\n\n\nOTHER:\nThe visualized portion of the lungs are clear. Heterogeneous multi nodular\nenlarged thyroid gland. There is no lymphadenopathy by CT size criteria. \nThere are multilevel, multifactorial degenerative changes in the cervical\nspine, with mild to moderate canal and moderate to severe foraminal narrowing,\nwith possible deformity on the nerves.\nDegenerative changes throughout the cervical spine.", + "output": "1. Volume loss and chronic microvascular ischemic changes. Otherwise, no\nacute intracranial abnormality on CT. MRI can be considered if not\ncontraindicated.\n2. Contour irregularity, with tortuosity, multifocal narrowing with associated\nfocal dilation seen at multiple levels throughout the intracranial\nvasculature, as described above. This can relate to atherosclerotic disease\nor other vasculopathy, etc.\n3. Small focal irregularity/ defect in the proximal right vertebral artery,\nwhich is favored to represent a fenestration, though focal dissection/filling\ndefect can appear similar. No distal flow limitation.\n4. Focal 2 mm outpouching from the anterior left V4 vertebral artery and right\nA2 anterior cerebral artery, likely representing irregularity of the\nvasculature secondary to atherosclerotic calcification rather than an\naneurysm.\n5. Heterogeneous multi nodular thyroid gland. Ultrasound of the thyroid gland\nis to be considered\n6. 5. C spine degenerative changes\n\nRECOMMENDATION(S): Thyroid ultrasound recommended" + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect.1\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland is heterogeneous with a 6 mm right hypodense\nthyroid nodule (series 2:image 38). There is no lymphadenopathy by CT\ncriteria. The neck vessels are patent, and the bilateral internal carotid\narteries have a retropharyngeal course.\n\nThe imaged portion of the lung apices are clear, and there are no concerning\npulmonary nodules. There are no concerning osseous lesions. There is\nmultilevel moderate to severe degenerative change of the lumbar spine\nincluding mild anterolisthesis of C2 on C3, C3 on C4 and C7 on T1. The\npatient is status post right lens replacement, and the visualized brain is\nwithin normal limits.", + "output": "No abscess or other CT findings to explain the patient's right-sided neck\nsymptoms." + }, + { + "input": "Several images were repeated due to motion artifact on the initial\nacquisition. Evaluation is slightly limited by episodes of the patient's\nhead. There is no evidence of acute hemorrhage, edema, mass effect, or acute\nloss of gray/ white matter differentiation. There is prominence of the\nventricles and sulci suggestive of involutional changes. Subcortical and\nperiventricular white matter hypodensities are nonspecific, however likely\nrepresent sequela of chronic small vessel ischemic disease. There are\natherosclerotic calcifications in the bilateral cavernous carotids.\n\nThere is a left anterior frontal subgaleal hematoma (2:13). There is no\nevidence of fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are essentially well aerated. \nThere is evidence of scleral banding in the partially visualized orbits.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. Left anterior frontal subgaleal hematoma. No fracture." + }, + { + "input": "There is no evidence of fracture, large territorial\ninfarction,hemorrhage,edema,or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. Grossly unchanged\nperiventricular deep white matter hypodensities are nonspecific, but likely\nsequela of chronic small vessel ischemia.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "No evidence of acute intracranial process or hemorrhage." + }, + { + "input": "Postsurgical changes after left craniotomy for encephaloduroarteriosynangiosis\nare noted.\n\nSmall area of hypodensity in the anterior left frontal lobe (series 2, image\n13) is consistent with the previously identified infarct. The gray-white\nmatter differentiation is otherwise preserved.\nSmall hypodensity in the white matter adjacent to the left basal ganglia\n(series 2, image 14) and anteriorly to the right cerebral peduncle (series 2,\nimage 11) most likely represents a perivascular space given the T2\nhyperintensity on the prior MRI.\n\nThere is no evidence of hemorrhage, edema, or mass. The ventricles and sulci\nare normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.\n\nIncompletely imaged swelling of the left eyelid is identified. The globe\nappears normal. The extraconal and intraconal compartments are unremarkable. \nNormal attenuation of the fat without evidence of inflammation. Normal\nappearance of the ocular muscles and optic nerve. No foreign body identified.", + "output": "1. Postsurgical changes after left craniotomy for\nencephaloduroarteriosynangiosis.\n2. Evolving infarct in the left anterior frontal lobe.\n3. Incompletely visualized swelling of the left eyelid without evidence of\norbital inflammation or foreign body." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is a 1.1 cm x 1.5 cm fat-density mass in the right sylvian fissure\nseries 3 image 8. There is a focal hypodensity in the right basal ganglia,\nseries 3, image 9. There is no evidence of no evidence of infarction,\nhemorrhage, or edema. The ventricles and sulci are normal in size and\nconfiguration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is atherosclerotic calcification of the V4 segment of the left vertebral\nartery. Otherwise, the vessels of the circle of ___ and their principal\nintracranial branches appear normal without stenosis, occlusion or aneurysm\nformation. The dural venous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThere is patchy ___ opacity in the right upper lobe, which can be seen\non prior examination. The visualized portion of the thyroid gland is within\nnormal limits. There is no lymphadenopathy by CT size criteria. Soft tissue\ndensity is noted in the left external auditory canal with no evidence of\nerosions, likely representing cerumen. Surgical changes are noted to the left\nmandible. A right maxillary periapical cyst is seen. Multilevel degenerative\nchanges are noted in the cervical spine. There is calcification of the\nsupraspinous ligament. Expansile lesion at the root ___ #7 tooth implant\nwith dehiscence of the labial alveolar surface (series 5, image 224), may\nrepresent reparative granuloma.", + "output": "1. Focal hypodensity in the right basal ganglia which may represent a prior\nlacunar infarct, although age indeterminate. Recommend correlation with MRI\nif clinically suspicious for acute infarct.\n2. Stable 1.5 cm fat density mass in the right sylvian fissure, likely\nrepresenting a lipoma.\n3. No evidence of aneurysm greater than 3 mm, dissection, vascular\nmalformation or significant luminal narrowing.\n4. ___ opacities in the right upper lobe, likely infectious or\ninflammatory process, which may be seen on prior CT of the neck in ___. \nCorrelation with prior history is recommended\n\nRECOMMENDATION(S): Focal hypodensity in the right basal ganglia, which may\nrepresent and lacunar infarct although age indeterminate. Recommend\ncorrelation with MRI if clinically suspicious for acute infarct." + }, + { + "input": "The visualized aerodigestive tract is unremarkable. There is no cervical\nlymphadenopathy by size criteria. The it major salivary glands are\nunremarkable. The thyroid gland is also unremarkable.\n\nOssification of the nuchal ligament at C3 through C6 is unchanged. The\nparaspinal soft tissues are unremarkable without evidence of hematoma. There\nis no CT evidence for epidural hematoma or collection.\n\nThe visualized paranasal sinuses are clear. The mastoid air cells and middle\nears are well pneumatized and clear. No suspicious osseous lesion.\n\nThe right apical scarring with nodular and ___ opacities is similar in\nappearance to prior examination of ___. Otherwise, the remainder\nof the visualized lungs are clear.\n\n Unchanged expansile CT but lucent lesion ___ tooth 7 implant with\nthinning/dehiscence of the buccal alveolar ridge, unchanged from prior\nexamination potentially representing a reparative granuloma.", + "output": "1. On noncontrast examination, no evidence for paraspinal hematoma or epidural\nabnormality. Please note, if there remains concern for epidural collection,\nMRI would be more sensitive.\n2. Additional chronic findings as described above, including right at buccal\n___ and nodular opacities with scarring, similar in appearance to\nprior exams. This may represent sequela of prior infectious process. \nClinical correlation is recommended.\n3. Periapical lucent ___ tooth 7 implant, potentially representing a\nreparative granuloma. Clinical correlation is recommended." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nlarge territorial infarction. There is a focal hypodensity within the right\nparamedian pons, which is possibly from a prior infarct. There is mild\nperiventricular white matter hypodensities, which are most likely sequela of\nchronic small vessel ischemic disease. The ventricles and sulci are mildly\nprominent, appropriate for patient's age. The basal cisterns appear patent and\nthere is preservation of gray-white matter differentiation.\n\nThe visualized bony structures are grossly unremarkable. There is mild mucosal\nthickening of bilateral maxillary sinuses. The mastoid air cells and middle\near cavities are clear. Atherosclerotic mural calcification of the bilateral\ninternal carotid arteries is noted.\n\nThere are bilateral lens replacements. Left scleral buckle is incidentally\nnoted.", + "output": "1. No acute intracranial abnormality.\n2. Mild mucosal thickening of bilateral maxillary sinuses.\n3. Chronic changes as above." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect or\nshift of normally midline structures. The gray-white matter interface is\npreserved without evidence of acute major vascular territorial infarct. The\nventricles and sulci are normal in size and configuration for the patient's\nage. Enlargement of the sella turcica with CSF density likely represents an\nempty or partially empty sella. There is scant atherosclerotic calcification\nof the bilateral carotid siphons. The basal cisterns appear patent. The orbits\nand globes are unremarkable. The imaged paranasal sinuses, middle ear cavities\nand mastoid air cells are clear bilaterally. The bony calvaria appear intact. \nHyperostosis frontalis interna is noted.", + "output": "1. No evidence of acute intracranial process.\n2. Incidentally noted empty or partially empty sella. Recommend clinical\ncorrelation." + }, + { + "input": "CTA Head: The intracranial internal carotid arteries are normal in\nconfiguration. The middle cerebral arteries are patent with normal contrast\nenhancement and branching pattern. The right A1 is dominant and the left A1\nis hypoplastic or aplastic. There is a single anterior cerebral artery\n(azygous ACA) that then separates into two anterior cerebral arteries.\n\nThe vertebral and basilar arteries demonstrate normal enhancement without\nstenosis or occlusion. There is plaque at the V4 segment of the left\nvertebral artery that does not cause stenosis. The posterior cerebral arteries\nhave a normal branching pattern. The posterior communicating arteries are\nvisualized.\n\nThere is no evidence of stenosis, occlusion, aneurysm or arteriovenous\nmalformation.\n\nThe dural venous sinuses and major cerebral veins are patent.\n\nCTA Neck: There is conventional aortic arch anatomy. There is scattered mild\ncalcification of the aortic arch.\n\nThere is mild calcification of the origin of the left subclavian artery. The\nright subclavian artery is normal.\n\nThe right common, internal and external carotid arteries demonstrate no\nevidence of a significant stenosis by NASCET criteria or a dissection.\n\nThe left common, internal and external carotid arteries demonstrate no\nevidence of a significant stenosis by NASCET criteria or a dissection.\n\nThe cervical portions of the vertebral arteries demonstrate normal\nenhancement. There is no evidence of a stenosis or a dissection.\n\nThere is a right palatine tonsil calcification. There is a heterogeneous 2.5 x\n2.1 cm mass of the left thyroid gland, increased in size from 2.1 x 1.7 cm on\nCT from ___. There is a 2.3 x 1.2 cm peripheral left upper lobe\nirregular nodule with multiple air-containing areas that may be dilated\nairspaces or cavitation (series 2, image 30). There is degenerative disease\nof the cervical spine. There is a retention cyst in the left maxillary sinus.\nThere is scattered mucosal thickening of the ethmoid sinuses. There is\ndegenerative joint disease of the spine.", + "output": "1. No steno-occlusive disease, aneurysm, or vascular malformation of the\nintracranial arterial system. Incidentally noted azygous anterior cerebral\nartery, a developmental variant.\n2. No steno-occlusive disease (by NASCET criteria) of the major arterial\nsystem of the neck.\n3. Left thyroid nodule, increased in size to 2.5 cm from 2.1 cm on ___. Ultrasound can be considered for further evaluation as indicated.\n4. Left upper lobe peripheral irregular nodule with dilated airspaces versus\ncavitation. This lesion is suspicious for malignancy. Please refer to the\nsubsequently performed CT chest for further evaluation." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nmass effect, midline shift, or mass. The ventricles and sulci are normal in\nsize and configuration. Subtle areas of low attenuation are seen in the\nsubcortical white matter, which are nonspecific and may represent changes due\nto old vessel disease, better visualized on the prior MRI of the brain.\nHyperostosis frontalis interna is again seen, otherwise, no bony abnormalities\nseen. The paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The orbits are unremarkable.", + "output": "No acute intracranial process. No significant changes since the prior head CT\nexamination on ___." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Bilateral periventricular and subcortical white matter\nhypodensities are nonspecific but most likely reflect sequela of chronic small\nvessel ischemic changes. There are atherosclerotic calcifications in the\nbilateral carotid siphons.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nethmoid air cells. The remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. Patient is status post bilateral lens\nreplacement.", + "output": "1. No acute intracranial process. Chronic small vessel ischemic changes.\n2. No fracture." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. Extensive confluent white matter hypodensities are nonspecific, but\nlikely represent the sequela of chronic microvascular ischemia. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. Aerosolized secretions are seen within the\nleft maxillary sinus. Near complete opacification the right sphenoid sinus. \nMinimal mucosal thickening within the left sphenoid sinus. Soft tissue within\nthe left ear canal likely represents cerumen. The right mastoid air cells are\nunder developed. Otherwise, the visualized portion of the left mastoid air\ncells and bilateral middle ear cavities are clear. The patient is status post\nbilateral lens resections. Otherwise, the visualized portion of the orbits\nare unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Chronic microvascular ischemic and age-related involutional changes." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,intracranial hemorrhage,edema,ormass. The\nventricles and sulci are normal in size and configuration for patient age.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are essentially clear. The visualized portion of the orbits are\nnotable for bilateral lens replacements.\n\nCTA HEAD: Moderate calcific atherosclerotic disease is seen involving the\nbilateral cavernous and paraclinoid segments of the internal carotid arteries.\nOtherwise, the vessels of the circle of ___ and their principal\nintracranial branches appear normal without stenosis, occlusion, or aneurysm\nformation. The dural venous sinuses are patent.\n\nCTA NECK: There is mild calcific and noncalcific atheromatous change involving\nthe origin of the left internal carotid artery without evidence of flow\nlimiting stenosis by NASCET criteria. There is moderate calcific and\nnoncalcific atherosclerotic disease involving the right V4 segment without\nevidence of flow limiting stenosis (3:219). Otherwise, the remainder of the\nbilateral carotid and vertebral arteries and their major branches appear\nnormal without evidence of stenosis or occlusion. No right-sided internal\ncarotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. There is no lymphadenopathy by\nCT size criteria. Mild degenerative changes are visualized throughout the\ncervical spine consistent with narrowing of the intervertebral spaces, and\nanterior osteophytic bridging at C5-C6 level. The patient is status post\nCABG.", + "output": "1. No evidence of acute intracranial process or hemorrhage.\n2. Mild-to-moderate atherosclerotic disease involving the origin of the left\ninternal carotid artery and right V4 segment without evidence of flow-limiting\nstenosis. Otherwise, patent head and neck vasculature." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is prominence of the bifrontal extra-axial spaces. The right frontal\nsubarachnoid hemorrhage is unchanged. No new hemorrhages are identified. \nThere is no evidence of infarction, edema, or mass. The ventricles and sulci\nare normal in size and configuration.\n\nThere is mild mucosal thickening of the right maxillary sinus. The mastoid\nair cells are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nare patent with no evidence of stenosis,occlusion or aneurysm.\n\nCTV HEAD:\nThe dural venous sinuses are patent.", + "output": "1. No aneurysms. Patent circle of ___.\n2. No evidence of dural venous sinus thrombosis.\n3. Unchanged right frontal subarachnoid hemorrhage. No new hemorrhages." + }, + { + "input": "Large right frontal lobe hematoma is unchanged in size currently measuring 5.4\nx 3.2 cm, previously 5.1 x 3.0 cm (02:24). This is associated with mild to\nmoderate surrounding edema and effacement of adjacent sulci, which appears\nslightly worsened. There may be slight increase in shift of midline\nstructures now measuring up to 5 mm (02:19), previously 3-4 mm.\n\nThere continues to be layering hemorrhagic blood products in the right lateral\nventricle (02:19), occipital horn of the right lateral ventricle, and cavum\nvergae. No evidence of ventriculomegaly. The basilar cisterns remain patent.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Unchanged size of a right large right frontal lobe hematoma with\nintraventricular extension, similar to prior exam. The degree of surrounding\nedema pattern has slightly increased as well as local sulcal effacement.\n2. Slight interval increase in midline shift, now measuring 5 mm. Basilar\ncisterns remain patent." + }, + { + "input": "There is expected interval evolution of previously seen right MCA territory\ninfarction and hemorrhagic conversion. The previously large right frontal\nhematoma is is evolving in density with persistent surrounding edema,\ndecreased mass effect, and improved minimal leftward midline shift as compared\nto ___. There is no new infarction or hemorrhage. The ventricles\nand sulci are normal in size and configuration. There is again bifrontal\nhyperostoses of the inner table. Note is made of bilateral basal ganglia\ncalcifications.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Interval evolution of previously seen right MCA territory infarction and\nright frontal hematoma with improvement in surrounding edema, mass effect, and\nmild leftward midline shift since ___. No new infarction or\nhemorrhage." + }, + { + "input": "Again seen is a large right frontal lobe hematoma currently measuring\napproximately 5.1 x 3.0 cm (02:22) with mild to moderate surrounding edema and\neffacement of the adjacent sulci. Compared to the most recent prior exam,\nthere appears to be new layering hemorrhagic blood products in the right\nlateral ventricle (02:18), occipital horn of the right lateral ventricle\n(02:16), and cavum vergae. No evidence of ventriculomegaly. There is\npersistent leftward shift of the midline structures by approximately 3-4 mm.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Unchanged size of a large right frontal lobe hematoma, with new\nintraventricular extension to the right lateral ventricle and cavum verae. No\nevidence of ventriculomegaly.\n2. Stable 3-4 mm midline shift." + }, + { + "input": "There is no evidence of large territory infarction, hemorrhage, edema, or mass\neffect. There is a age-related cortical volume loss. Bilateral basal ganglia\ncalcifications are again noted. Periventricular white matter hypodensities\nare noted, consistent with small vessel ischemic disease.\n\nAgain seen is diffuse sclerosis of the calvarium, possibly related to renal\nosteodystrophy or Paget's disease. The paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality. Stable osseous findings." + }, + { + "input": "The known subdural hematoma overlying the right cerebral convexity has\nminimally increased in size, now measuring up to 10 mm in thickness from the\ninner calvarium, previously 9 mm (2:17 compared with series 2, image 18 on the\noutside hospital study). There is minimal 1 mm, if any, leftward shift of\nnormally midline structures. The basal cisterns remain patent. No new\nintracranial hemorrhage detected. No new loss of gray-white matter\ndifferentiation. Periventricular and subcortical white matter hypodensities\nare nonspecific, but compatible with chronic microangiopathy in a patient of\nthis age. The ventricles are similar in size and configuration. \nCalcification along the falx and tentorium are also unchanged from prior\nexams.\n\nThere is no evidence of fracture. A 2.2 x 1.4 cm subgaleal hematoma in the\nright frontal region is similar in size. Re- demonstration of sclerotic,\nthickened calvarium, unchanged from prior examinations, may be secondary to\nosteodystrophy or Paget's. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable, noting bilateral lens replacements.", + "output": "1. Minimal increase in the thickness of the evolving right subdural hematoma,\nnow measuring up to 10 mm compared with 9 mm previously. Minimal 1 mm, if\nany, leftward shift of normally midline structures. Basal cisterns remain\npatent.\n\n2. 2.2 cm subgaleal hematoma in the right frontal region.\n\n3. Re demonstration of sclerotic, thickened calvarium, as can be seen in\nrenal osteodystrophy or Paget's disease." + }, + { + "input": "Compared to prior, there is no significant change. Right subdural hematoma\noverlying the right cerebral convexity is overall unchanged in size and\ndistribution, measuring up to 9 mm. Minimal midline shift, if any, is also\nunchanged. A tiny focus of hyperdensity measuring along the frontal right\nconvexity (03:24) is likely a an artifact. Prominent sulci and ventricles are\nlikely due to involutional changes. Bilateral scattered subcortical and\nperiventricular hypodensities are nonspecific, though likely due to chronic\nsmall vessel ischemic disease in this age group.\nNo new areas of intraparenchymal hemorrhage or large territory infarct is\nseen.\n\nDiffuse heterogeneously sclerotic appearance of the calvarium is unchanged\nsince ___ and may be due to renal osteodystrophy or Paget's disease. Right\nsubgaleal hematoma has persistent. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Patient is\nstatus post left lens replacement. Dense calcifications of the carotid\nsiphons are noted.", + "output": "1. No significant change since ___. Minimal midline shift if\nany. Stable appearance of the right cerebral convexity subdural hematoma." + }, + { + "input": "Compared with ___, there has been interval increase in size of a\nmixed density, predominantly hypodense, right subdural collection, currently\nmeasuring up to 1.8 cm, compared with 0.9 cm previously (2:13, 601b:48). \nThere is new significant mass effect with effacement of the right lateral\nventricle, 13 mm of leftward midline shift, and subfalcine herniation. Basal\ncisterns are patent.\n\nDiffuse heterogeneity and sclerotic appearance of the calvarium is unchanged,\nand may be due to renal osteodystrophy or Paget's disease. There is no\nevidence of fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. A left lens replacement\nis noted. The visualized portion of the orbits are otherwise unremarkable.", + "output": "Interval significant increase in size of a 1.8 cm mixed density right subdural\ncollection, with new significant mass effect causing effacement of the right\nlateral ventricle, 13 mm of leftward midline shift, and subfalcine herniation.\nBasal cisterns are patent." + }, + { + "input": "There has been interval right frontal craniotomy with evacuation of the\npreviously described right hemispheric subdural hematoma. Expected\npostoperative pneumocephalus is present as well as a right frontal approach\ndrain with the tip extending anteriorly.\n\nA small amount of hyperdense material remains in the right extra-axial space\nand along the tentorial leaflets. There is decreased leftward midline shift,\nnow measuring up to 6 mm. Additionally there is decreased mass effect on the\nright lateral ventricle. There is no new hemorrhage. No evidence of an acute\ninfarct.\n\nUnchanged heterogeneous and thickened calvarium. The paranasal sinuses and\nmastoid air cells are clear.", + "output": "Interval right frontal craniotomy with evacuation of the large right subdural\nhematoma with postoperative changes as described above. Interval decrease in\nthe extent of the leftward midline shift." + }, + { + "input": "The patient is status post right frontal craniotomy for evacuation of a right\nsubdural hematoma. There is a right frontal drain which terminates along the\nanterior frontal convexity with interval decrease in pneumocephalus. There is\na similar amount of right extra-axial fluid. There is stable 6 mm leftward\nshift of midline structures. Hyperdense material continues to seen layering\nalong the tentorium and falx. No new intracranial hemorrhage is noted.\n\nThere is no evidence of fracture. The chronic heterogeneous appearance of the\ncalvarium may be due to renal osteodystrophy or Paget's disease. The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The patient is status post left lens replacement.", + "output": "Interval decrease in pneumocephalus with similar amount of extra-axial fluid\nand leftward shift of midline structures." + }, + { + "input": "The patient is status post right frontal craniotomy for evacuation of a right\nsubdural hematoma. There has been interval removal of the right frontal\ndrain. Since the prior CT scan there is minimal increased size of the right\nextra-axial fluid with evidence of acute hemorrhage. There is unchanged high\ndensity material layering along the falx and tentorial leaflets. Persisting\npneumocephalus. The subdural fluid is causing an unchanged 6 mm leftward\nmidline shift.\n\nThe size of the ventricles is unchanged. No loss of gray-white matter\ndifferentiation is visualized. There is unchanged sulcal effacement along the\nright frontal parietal and temporal lobes.\n\nUnchanged heterogeneous appearance of the calvarium which may be secondary to\nrenal osteodystrophy or Paget's disease. The paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The orbits are unremarkable apart\nfrom a prior left lens replacement.", + "output": "Mild interval increase in size of the right extra-axial fluid collection with\nincreasing hyperdense material within it, consistent with acute/ongoing\nhemorrhage. The degree of 6 mm leftward midline shift is unchanged.\n\nUnchanged subdural hemorrhage along the falx and tentorial leaflets." + }, + { + "input": "Patient is status post right frontal craniotomy\n\nThere has been enlargmeent of a right frontal convexity subdural hematoma\nwhich measures up to 1.1 cm across maximal diameter (03:11), previously\nmeasuring up to 0.9 cm on CT head ___. High-density fluid\nlayering along the falx and tentorial leaflets is minimally changed. There is\n10 mm of leftward midline shift (03:13) increased from ___,\npreviously 6 mm. There is almost complete effacement in the right lateral\nventricle, new from ___ and concerning for subfalcine herniation. \nThere is right uncal hernation, unchanged. The suprasellar and quadrigeminal\nplate cisterns are patent.", + "output": "1. Right frontal subdural hematoma measuring 1.1 cm is increased in size from\nhead CT ___.\n\n2. 10 mm of leftward midline shift with almost complete effacement of the\nright lateral ventricle is new and concerning for subfalcine herniation.\n\n3. Right uncal herniation.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with\n___ NP ___ on the telephone on ___ at 4:16 AM,\n5 minutes after discovery of the findings." + }, + { + "input": "The patient has had prior right craniotomy with expected postsurgical change\nin the overlying soft tissue. The right calvarial subdural hemorrhage\npersists but appears smaller in size, now measuring maximally up to 8 mm on\naxial images, previously 1.1 cm, with substantial decrease in the size of the\ncomponent layering along the right anterior cranial fossa. Associated\nmass-effect with effacement of the adjacent sulci particularly in the right\nfrontal lobe persists, overall unchanged. However, the degree of left shift\nof normally midline structures has improved, now 8 mm compared to 11 mm\npreviously. Partial effacement of the right lateral ventricle also persists\nbut has improved. The size and configuration of the left lateral ventricle is\nminimally changed. Small amount of right parafalcine herniation is overall\nsimilar. The basal cisterns are patent.\n\nSmall amount of hyperdense material layering along the tentorium bilateral and\nthe falx persists but has improved in the interim.\n\nNo evidence of new hemorrhage.\n\nGeneralized thickening of the calvarium with areas of focal sclerosis are\nunchanged and most consistent with secondary hyperparathyroidism, likely from\nrenal insufficiency given history of renal transplant. The visualized portion\nof the paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. Status post right craniotomy with persistent but interval decrease in size\nof a now 8-mm right subdural hemorrhage with persistent but interval decrease\nin associated partial effacement of the right lateral ventricle and 8-mm left\nshift of normally midline structures.\n\n2. Interval decrease in bilateral hyperdense material layering along the\ntentorium and falx.\n\n3. No new hemorrhage.\n\n4. Bony changes of secondary hyperparathyroidism, likely related to history\nof renal insufficiency." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect. A tracheostomy tube terminates 6.3 cm from the carina\n(602b:37). There is a moderate volume of blood products layering within the\nanterior neck (02:52, 57). There is no mass effect on the airway at this\nlevel.\n\nThe salivary glands are without mass or adjacent fat stranding. The thyroid\ngland appears normal. There is no lymphadenopathy by CT criteria. There is\nextensive calcification at the level of the carotid bifurcation bilaterally\n(02:30). A right PICC is partially imaged.\n\nExtensive bilateral upper lobe consolidations are consistent with multifocal\npneumonia or aspiration. There are no osseous lesions. Diffuse low-density\nof the blood pool suggests anemia. Bilateral temporomandibular joint\ndegenerative changes are noted. Degenerative changes noted throughout\ncervical spine.", + "output": "1. Moderate hematoma overlying the trachea in the region of tracheostomy tube.\n2. Airspace opacities in bilateral upper lobes concerning for multifocal\npneumonia or aspiration.\n3. Findings concerning for anemia as described.\n4. Bilateral temporomandibular joint degenerative changes." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territorial infarct. No definite acute\nintracranial hemorrhage is seen. Postsurgical changes are seen in the right\nfrontal region status post craniotomy with subsequent mild dural thickening\nand possible tiny chronic subdural fluid. High density along the tentorium\nbilaterally is felt to represent calcification, as seen on prior studies,\nrather than acute hemorrhage. Slight prominence of the ventricles and sulci\nis consistent with cortical volume loss. The previously seen mass effect on\nthe right lateral ventricle is no longer present. Periventricular,\nsubcortical, and deep white matter hypodensities are nonspecific, but\nconsistent with chronic microvascular ischemic changes.\n\nThe patient's is status post right frontal craniotomy. Unchanged thickening\nof the calvarium consistent with patient's history of renal transplant/renal\ndisease. The paranasal sinuses, mastoid air cells, and middle ear cavities\nare essentially clear.", + "output": "1. No definite acute intracranial hemorrhage. High density along the\ntentorium bilaterally is felt to represent calcification, as seen on prior\nstudies, rather than acute hemorrhage.Sequela of prior subdural hematoma\nstatus post right frontal craniotomy with evacuation and subsequent dural\nthickening along the right cerebral convexity.\n2. Chronic microvascular ischemic changes." + }, + { + "input": "There is no acute hemorrhage, edema, or mass effect. Prominent ventricles and\nsulci reflect age related volume loss. Periventricular white matter\nhypodensity is nonspecific although likely sequela of chronic small vessel\nischemia. Patient is status post right craniotomy with postsurgical changes\nalong the right frontal convexity involving mild dural thickening. \nCalcification of the falx and tentorium bilaterally is stable. Basal cisterns\nare patent. Gray-white matter differentiation is preserved.\n\nThe orbits are unremarkable. Bony calvarium is intact. The imaged paranasal\nsinuses, bilateral mastoid air cells, and middle ear cavities are clear. \nThickening of the calvarium is in keeping with history of renal\ntransplant/renal disease.", + "output": "No acute intracranial abnormality. Right craniotomy postsurgical changes\ninclude dural thickening along the right cerebral convexity. Calcification of\nthe falx and tentorium is unchanged." + }, + { + "input": "Patient is status post right frontal craniotomy with postsurgical changes\nalong the right frontal convexity including dural thickening and\ncalcification. Dural calcifications are also again seen along the falx and\ntentorium.\n\nAllowing for motion artifact, there is evidence for acute hemorrhage, edema,\nmass effect, or acute major vascular territorial infarction. Prominent\nventricles and sulci are compatible with age-related involutional changes. \nConfluent periventricular, deep, subcortical white matter hypodensities are\nnonspecific but likely represent sequelae of chronic small vessel ischemic\ndisease given the patient's age, grossly unchanged. Extensive arterial\ncalcifications are again seen.\n\nDiffuse calvarial thickening and heterogeneity are again seen, likely\nsecondary to hyperparathyroidism in this patient with chronic renal disease.\n\nThere is mild mucosal thickening of the bilateral ethmoid air cells. Mastoid\nair cells are grossly well-aerated.", + "output": "No evidence for acute intracranial abnormalities. No change compared to ___." + }, + { + "input": "Patient is status-post right frontal craniotomy with chronic postsurgical\nchanges including dural thickening and calcification which are unchanged\ncompared to the prior examination. No evidence of new hemorrhage, large\nterritorial infarction, edema, or mass effect. Periventricular and\nsubcortical white matter hypodensities are nonspecific but likely sequelae of\nchronic small vessel ischemic disease. Benign basal ganglia calcifications\nare noted. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nNo evidence of fracture. Diffuse calvarial thickening is again noted,\npossibly related to renal osteodystrophy as documented previously. The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. Patient status-post left lens replacement. The orbits\nare otherwise unremarkable. Severe vertebral and cavernous carotid\ncalcifications are noted. Relative density of the middle cerebral and anterior\ncerebral arteries are unchanged, likely reflecting chronic atherosclerosis.", + "output": "No evidence of mass, hemorrhage or infarction." + }, + { + "input": "New since prior is the parenchymal hemorrhage centered in the right thalamus\nmeasuring 2.9 cm AP x 2.3 cm TRV. There is mild surrounding vasogenic edema. \nFocal midline shift of the septum pellucidum to the left by 4 mm is noted. \nThe basilar cisterns are patent and there is no midline shift elsewhere. \nBlood seen layering within the occipital horns of the lateral ventricles which\nare otherwise stable in configuration. Periventricular and subcortical white\nmatter hypodensities are likely sequela of chronic small vessel disease. No\nadditional i intracranial hemorrhage.\n\nRight parietal craniotomy changes are again noted. Underlying calcification\nin the dura is likely related to prior, chronic subdural hematoma. Diffuse\nsclerotic appearance of the calvarium is again noted. This could be due to\nrenal osteodystrophy and is unchanged dating back to ___.\n\nIncluded paranasal sinuses and mastoids are essentially clear.", + "output": "Acute right thalamic parenchymal hemorrhage with interventricular blood. \nFocal mass effect with 4 mm of leftward midline shift of the septum\npellucidum.\n\nNOTIFICATION: The findings were discussed with Dr, ___, M.D. by ___\n___, M.D. on the telephone on ___ at 8:53 pm, 1 minute after discovery\nof the findings." + }, + { + "input": "Again seen is right thalamic hemorrhage, not significantly changed from prior\nexam. Bilateral lateral ventricular layering hemorrhage in the occipital\nhorns has increased since ___, likely redistribution of prior\nhemorrhage. There is hemorrhage layering along the tentorium. Hyperdense\nmaterial layering at the fourth ventricle is similar compared to prior. There\nis no evidence of new infarction. Periventricular and subcortical\nhypodensities are similar in degree, nonspecific finding given the degree of\nventriculomegaly, which is somewhat out of proportion to sulcal enlargement.\nPatient is status post parietal craniotomy with postsurgical changes. There\nis heterogeneous appearance of the calvarium, unchanged from prior exam. The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable. \nDiffuse calvarial thickening with ground-glass appearance is unchanged from\nprior examinations, which may represent history of renal osteodystrophy or\npotentially fibrous dysplasia.", + "output": "1. Unchanged size of right thalamic hemorrhage. Interval increase in the\namount of layering hemorrhage in the occipital horn of the bilateral lateral\nventricles, presumably due to restriction of prior hemorrhage.\n2. Additional findings described above." + }, + { + "input": "The study is limited by motion artifact.. Again seen is right thalamic\nhemorrhage, not significantly changed allowing for slice selection, with\nassociated leftward bowing of the septum pellucidum. Blood in the occipital\nhorns of the bilateral lateral ventricles has slightly increased since ___. Small amount of blood in the frontal horn of the right ventricle near\nthe foramina ___ is not significantly changed. Trace blood in the fourth\nventricle is unchanged. Dilatation of the lateral and third ventricles has\nincreased compared to ___.\n\nHyperdensity along the falx and bilateral tentorium is unchanged compared to a\nmore remote CT from ___, compatible with calcifications.\n\nConfluent periventricular, deep, and subcortical white matter hypodensities\nare not significantly changed dating back to ___, suggesting chronic\nsmall vessel ischemic changes, although superimposed transependymal CSF flow\nin the setting of current hydrocephalus cannot be excluded. Basal cisterns\nare not compressed.\n\nPatient is status post right craniotomy and multiple burr holes. There is\npersistent thickened and heterogeneous appearance of the calvarium. The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The patient is status post left cataract surgery.", + "output": "1. Motion limited exam.\n2. No significant change in right thalamic hemorrhage.\n3. Slightly increased blood in the occipital horns of lateral ventricles, with\nstable small amount of blood in the right frontal horn and in the fourth\nventricle.\n4. Increased dilatation of the third and lateral ventricles.\n\nNOTIFICATION: The increased hydrocephalus was discussed with ___, M.D.\nby ___, M.D. on the telephone on ___ at 11:30 am." + }, + { + "input": "Study is moderately degraded by motion and hardware streak artifact. Within\nthese confines:\n\nGrossly stable right basal ganglia intraparenchymal hemorrhage in layering\nhemorrhage in the bilateral occipital horns of the lateral ventricles. Within\nlimits of study, no definite new hemorrhage or large territorial infarct is\nnoted. Ventricles are larger than on prior examination with stable\nperiventricular hypodensities. Bilateral temporomandibular joint degenerative\nchanges are noted. Postsurgical changes related to right frontal craniotomy\nis again noted. Atherosclerotic vascular calcifications are noted of\nbilateral vertebral and cavernous portions of internal carotid arteries.", + "output": "1. Study is moderately degraded by motion and hardware streak artifact.\n2. Grossly stable right basal ganglia and interventricular hemorrhage.\n3. Interval ventricular enlargement concerning for developing hydrocephalus.\n4. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct.\n\nNOTIFICATION: The findings were discussed with ___, N.P. by ___,\nM.D. on the telephone on ___ at 8:13 am, 5 minutes after discovery of the\nfindings." + }, + { + "input": "Patient is status post left frontal approach ventriculostomy catheter\nplacement with tip terminating in the third ventricle.\n\nAgain seen is the right basal ganglia the intraparenchymal hemorrhage with\nlayering hemorrhage in the bilateral occipital horns of the lateral\nventricles, overall similar in size and shape compared to prior exam obtained\napproximately 7 hours prior. Of note is periventricular hypodensities, which\nappears to extend into deep cortical white matter, more pronounced on this\nexam compared to prior exam obtained at 05:00, which may represent\ntransependymal flow. Subtle loss of gray-white differentiation in the\noccipital lobes with effacement of sulci is unchanged from prior exam, which\nmay be due to streak artifacts, rather than acute infarcts.\n\nPatient is status post right frontoparietal craniotomy with postsurgical\nchanges. There is diffuse thickening in heterogeneity of the calvarium,\nunchanged from prior exams. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. Study is moderately degraded by motion and beam hardening artifact.\n2. Interval placement of left frontal approach ventriculostomy catheter\nplacement.\n3. Grossly stable ventricles compared to prior exam.\n4. Periventricular hypodensities appear more prominent on the current study,\nwhich may represent worsening transependymal flow.\n5. Question subtle loss of gray-white differentiation in the occipital lobes.\nWhile findings may be secondary to streak artifacts, differential\nconsiderations include edema or infarct. If clinically indicated, consider\nbrain MRI for further evaluation, which is more sensitive for the evaluation\nof acute infarcts. Close attention on follow-up is recommended.\n\nRECOMMENDATION(S): Question subtle loss of gray-white differentiation in the\noccipital lobes. While findings may be secondary to streak artifacts,\ndifferential considerations include edema or infarct. If clinically\nindicated, consider brain MRI for further evaluation, which is more sensitive\nfor the evaluation of acute infarcts. Close attention on follow-up is\nrecommended." + }, + { + "input": "Patient is status post left frontal approach ventriculostomy catheter\nplacement with tip terminating in the cerebral aqueduct or adjacent mid brain\nparenchyma, stable. Compared to prior exam, the overall size of the right\nthalamic hemorrhage is unchanged. Layering blood in the bilateral lateral\nventricles are overall unchanged in size. Again seen is hydrocephalus, with\nminimal decrease in size of the right temporal horn, stable size of the left. \nStable size of the third ventricle, 9 mm.\nAs previously noted, periventricular hypodensities extend into the deep\ncortical white matters are extensive, concerning for transependymal flow\nand/or edema, in addition to sequela of chronic small vessel ischemic disease.\nHowever, loss of gray-white differentiation in the bilateral occipital lobes,\nand at the vertex appears slightly more conspicuous on today's exam. Mild\nbilateral uncal herniation is stable. Patent prepontine cistern, patent\nforamina magnum.\n\nThere is no evidence of acute fracture. Diffusely sclerotic bones at the\ncalvarium are stable. There is mild mucosal thickening in the ethmoidal air\ncells. Otherwise, the visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. Patient is status post left\nlens replacement. Otherwise, the globes are unremarkable. Patient is status\npost intubation.", + "output": "1. Status post left frontal approach ventriculostomy catheter placement,\nunchanged in positioning terminating in the cerebral aqueduct or adjacent mid\nbrain parenchyma.\n2. Interval slight decrease in right lateral ventricle size, otherwise stable\nhydrocephalus. Stable mild uncal herniation bilaterally. Stable intracranial\nhemorrhage. No evidence of new hemorrhage.\n3. More conspicuous hypodensities in the bilateral occipital lobes, vertex,\nmay be a combination of transependymal flow and chronic small vessel ischemic\ndisease, component of artifact from portable scanner is possible. However,\ngiven the patient's history, infarction may be considered. If clinically\nindicated, evaluation with MRI would be more sensitive for detection of\ninfarction.\n\nRECOMMENDATION(S): Consider MRI or conventional CT..\nConsider adjusting ventricular shunt.\n\nNOTIFICATION: The findings were discussed with ___ care, N.P. by\n___, M.D. on the telephone on ___ at 11:38 am, 10 minutes after\ndiscovery of the findings." + }, + { + "input": "There is 3.2 x 2.6 cm acute parenchymal hematoma centered on right thalamus,\nsimilar to prior. Volume of intraventricular hemorrhage within bilateral\noccipital horns has mildly decreased. Stable heart cephalocele, unchanged\nsize of the lateral ventricles, temporal horns, third ventricle. \nIntraventricular drain place, terminating in the midbrain, along anterolateral\nmargin of the cerebral aqueduct image 15, stable, consider adjusting it. \nPatient motion and beam hardening attenuation artifact moderately compromises\nevaluation, decreasing sensitivity in evaluating for potential acute infarcts.\nNo definite large acute infarcts. Falcine, tentorial calcifications are\nstable since ___. Mild bilateral uncal herniation is stable since\nprior.\nThere is no evidence of fracture. Stable extensive osseous calvarial\nsclerosis. Right parietal craniotomy. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "Stable right thalamic hemorrhage, mildly improved intraventricular hemorrhage.\nStable hydrocephalus.\nIntraventricular drain appears to terminate within mid brain parenchyma,\nconsider adjusting it.\nRemainder as above" + }, + { + "input": "The study is severely degraded by motion and hardware streak artifacts. \nWithin these limits, the size of the thalamic hemorrhage on the right appears\ngrossly unchanged as well as layering hyperdensities in the bilateral lateral\nventricles. However, there has been interval increase in the size of the\nlateral ventricles since prior exam from ___. For example, the\nantrum of the right lateral ventricle measures 26 mm, previously 20 mm and the\nleft measures 23 mm, previously 20 mm (02:19). Evaluation for acute\ninfarction is limited due to artifacts. There is no evidence of new or\nenlarging hemorrhage. Patient is status post left frontal approach\nventriculostomy catheter placement with tip stably terminating in the third\nventricle/above the midbrain.\n\nPatient is status post right frontal temple all craniotomy. As previously\nnoted, the calvarium is diffusely thickened and heterogeneous, likely due to\nrenal osteodystrophy. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavitiesare grossly clear as the evaluation\nof the skullbase is heavily limited due to patient motion. The visualized\nportion of the orbits are unremarkable.", + "output": "Severely limited study due to patient motion and hardware artifacts. Within\nthese limits, interval enlargement of bilateral lateral ventricles. \nEvaluation for acute infarction is limited. No evidence of new or enlarging\nhemorrhage." + }, + { + "input": "Study is limited by motion artifact.\n\nPre-existing right thalamic hemorrhage now measures 2.7 x 2.0 cm, mildly\ndecreased compared to 3.1 x 2.3 cm previously, though comparison is limited by\ndifferences in patient head position. Mild surrounding edema is stable. Mild\nleftward shift of midline structures with bowing of the intraventricular\nseptum is grossly unchanged. Small amount of blood in the occipital horns of\nlateral ventricles is stable. The degree of third ventricle compression does\nnot appear changed. No definite change in the size of lateral ventricles is\nseen allowing for differences in patient head position. The left frontal\napproach EVD catheter enters the body of the left lateral ventricle, courses\nthrough the third ventricle, and terminates in the central midbrain,\nunchanged.\n\nThere may be mild mucosal thickening in the ethmoid air cells, but evaluation\nis limited in the absence of dedicated bone algorithm images. There are\nsecretions in the nasopharynx, likely related to endotracheal intubation.", + "output": "1. Mildly motion limited, portable exam.\n2. Stable right thalamic hemorrhage with stable intraventricular extension.\n3. Stable position of the left frontal approach EVD catheter. Allowing for\ndifferences in patient head position, there is no significant change in the\nsize of the ventricles.\n\nNOTIFICATION: The final interpretation was discussed with NP ___ by\n___, M.D. on the telephone on ___ at 10:53 am." + }, + { + "input": "There is 10 x 8 mm hyperdensity in the left vertex, likely present on ___ at the tip of the ventriculostomy (02:27), status post removal of the\ncatheter. Compared to prior on ___, the known right thalamic\nhemorrhage has minimally decreased in size (02:16), now measuring 2.6 x 2.0\ncm. Surrounding edema is persistent, exerting mass effect on the\nintraventricular septum, unchanged from prior exam. Layering hyperdensity\nwithin the atrium of the bilateral lateral ventricles are overall similar\ncompared to prior exam. The size and shape of the ventricles are overall\nsimilar prior exam on ___. The basal cisterns are patent. Extensive\nperiventricular and subcortical white matter hypodensities are nonspecific,\nthough may represent chronic small vessel ischemic disease. While, in the\nsetting of hemorrhage and mild hydrocephalus, transependymal flow is possible.\n\n The visualized portion of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavitiesare grossly clear. The visualized portion of the orbits\nare unremarkable. Diffuse sclerotic changes of the calvarium are again noted,\ngrossly unchanged compared to ___ prior exam.", + "output": "1. Status post removal of the ventriculostomy catheter.\n2. Stable 10 mm hyperdensity in the left vertex.\n3. No new or enlarging intracranial hemorrhage.\n4. Stable right thalamic hemorrhage, minimally decreased in size.\n5. Stable layering hyperdensity in the bilateral lateral ventricles with\nstable ventricular size.\n6. Grossly stable extensive calvarial sclerotic changes compatible with\nhistory of renal osteodystrophy, Paget's disease or fibrous dysplasia, grossly\nsimilar to ___ prior exam." + }, + { + "input": "There is no evidence of large territorial infarction,acute intracranial\nhemorrhage,edema,or mass. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. Periventricular and deep subcortical\nwhite matter hypodensities are nonspecific, but likely sequela of chronic\nsmall vessel ischemic disease.\n\nPatient has had prior right frontotemporal craniotomy, with previous burr\nholes noted in this region, as well as in the left frontal calvarium. The\ncalvarium itself is thickened and sclerotic, with mottled appearance, as can\nbe seen in renal osteodystrophy. There is no evidence of acute calvarial\nfracture. The visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable. Heavy vertebral artery calcifications are incidentally noted.", + "output": "1. No evidence of acute intracranial hemorrhage.\n\n2. Multiple chronic changes, including prior right craniotomy and several\ncalvarial burr holes, as detailed above. Sclerotic bony changes suggesting\nrenal osteodystrophy." + }, + { + "input": "The study is significantly degraded due to motion and beam hardening artifact.\nWithin this limitation, it is difficult to tell whether there may be density\nabnormalities. There is, however, the suggestion of a hyperdense right MCA. \nMuch of the cortex appears hyperdense bilaterally, which may be due to\nartifact, though in the setting of prior contrast administration, this could\nreflect contrast enhancement. There is no shift of normally midline\nstructures. Ventricles and sulci are prominent, suggestive of volume loss. \nThe imaged paranasal sinuses are essentially clear. Mastoid air cells and\nmiddle ear cavities are near completely opacified bilaterally. The patient is\nstatus post right frontotemporal craniotomy, with burr holes in the right\nfrontotemporal and left frontal calvarium.", + "output": "Within the limitation of a study significantly degraded by motion and beam\nhardening artifact, is difficult to assess for density abnormalities. There is\na suggestion of a hyperdense right MCA, and the cortex appears diffusely\nhyperdense bilaterally, which may be due to artifact or reflect enhancement\nfrom prior contrast administration. MR can be performed for further\nevaluation if clinically indicated.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:10 am, 1 minutes\nafter discovery of the findings.\n\nUpdated read was discussed with ___, MD by ___, MD on the\ntelephone on ___ at 11:30am." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThere is moderate mucosal thickening of the ethmoid air cells and left frontal\nsinus. There are surgical clips along the posterior margin of the right\nmaxillary sinus and in the pterygopalatine fossa. The mastoid air cells and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.\n\nCTA HEAD:\nThere are minimal calcifications of the carotid siphons. There is a partial\npersistent fetal origin of the right PCA. The vessels of the circle of ___\nand their principal intracranial branches appear normal without stenosis,\nocclusion, or aneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nThere are mild calcifications at the origin of the left ICA and minimal\ncalcifications of the right vertebral artery V4 segment. The carotid and\nvertebral arteries and their major branches appear otherwise normal with no\nevidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There are multiple enlarged and\nconglomerate mediastinal lymph nodes measuring up to 3.8 x 2.2 cm.", + "output": "1. Normal head and neck CTA.\n2. Multiple enlarged conglomerate mediastinal lymph nodes measuring up to 3.8\nx 2.2 cm likely correlate with the patient's recent diagnosis of sarcoidosis.\n3. Moderate inflammatory changes of the ethmoid air cells and left frontal\nsinus." + }, + { + "input": "There is no evidence of xial hemorrhage, edema, shift of normally midline\nstructures, or infarction. Ventricles and sulci are normal in overall size and\nconfiguration. There is mild mucosal thickening of the left maxillary sinus. \nThere is near complete opacification of bilateral ethmoid air cells and the\nleft frontal sinus. The remaining imaged paranasal sinuses are clear. Mastoid\nair cells and middle ear cavities are well aerated. The bony calvarium is\nintact. There are surgical clips along the posterior margin of the right\nmaxillary sinus and in the pterygoid palatine fossa.", + "output": "No evidence of mass, hemorrhage or infarction. Normal head CT." + }, + { + "input": "There is no evidence of acute large territory infarction, hemorrhage, edema,\nor mass. The ventricles and sulci are normal in size and configuration for the\npatient's age. Incidental note is made of an empty sella, as seen on the MRI\nin ___ (602b:40).\n\nNo acute fracture identified. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of large territory infarction\ninfarction,hemorrhage,edema, or mass effect. The ventricles and sulci are\nprominent, consistent with involutional changes. There is calcified\natherosclerosis at the bilateral carotid siphons.\n\nThere is no evidence of acute fracture. There is minimal mucosal thickening\nof the left maxillary sinus and bilateral ethmoid air cells.. The mastoid air\ncells are clear.", + "output": "No acute intracranial process." + }, + { + "input": "No intra-axial or extra-axial hemorrhage, edema, shift of normally midline\nstructures, or evidence of acute major vascular territorial infarction. \nPeriventricular white matter hypodensity is similar to prior which may in part\nreflect small vessel disease versus multiple sclerosis. Findings appear\ngrossly unchanged allowing for differences in modality when compared with\nprior MRI. Ventricular size is unchanged. Imaged paranasal sinuses, mastoid\nair cells and middle ear cavities are well aerated. The bony calvarium is\nintact.", + "output": "No acute intracranial process. Periventricular white matter hypodensities\nappear grossly unchanged likely related to patient's history of multiple\nsclerosis versus chronic small vessel disease." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are prominent, consistent with volume loss. \nThere are periventricular and subcortical hypodensities, which may represent\nsmall vessel ischemic changes. The imaged paranasal sinuses are clear.\nMastoid air cells and middle ear cavities are well aerated. The bony calvarium\nis intact.", + "output": "No acute intracranial process." + }, + { + "input": "Visualized osseous structures are osteopenic. There is no evidence of acute,\nlarge territorial infarction, fracture,hemorrhage,edema,or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nPeriventricular and subcortical T2 and FLAIR hyperintensities are noted which\nmay represent small vessel ischemic changes. Atherosclerotic vascular\ncalcifications are noted.\n\nA hematoma of the scalp along the right cerebral hemisphere measures\napproximately 8.3 x 0.5 cm, with associated soft tissue swelling. No evidence\nof underlying fracture.\n\nMucous retention cysts of bilateral maxillary sinuses are noted. Visualized\nportion of the mastoid air cells, and middle ear cavities are clear. \nVisualized portion the orbits demonstrate bilateral lens replacement\npostoperative changes.", + "output": "1. Study is limited by diffuse osteopenia.\n2. Within limits of study, no definite evidence of acute intracranial\nhemorrhage or fracture.\n3. Moderately sized hematoma of the scalp along the right cerebral hemisphere,\nwith associated soft tissue swelling.\n4. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described.\n5. Paranasal sinus disease , as described." + }, + { + "input": "Again seen is a 2.0 cm hematoma within the scalp along the right frontal\nconvexity. There is improved surrounding soft tissue swelling when compared\nto the prior exam.\n\nThere is no evidence of fracture, infarction,hemorrhage,edema, or mass. There\nis prominence of the ventricles and sulci suggestive of involutional changes. \nThere is moderate to severe hypodensity of the periventricular and subcortical\nwhite matter likely reflecting chronic microvascular ischemic disease, grossly\nunchanged since ___.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The native lenses have been removed bilaterally.", + "output": "1. No acute intracranial abnormalities.\n2. Redemonstration of a 2 cm hematoma within the scalp along the right frontal\nconvexity with improved surrounding soft tissue swelling.\n3. Involutional changes and white matter disease, grossly unchanged since\n___." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect or acute territorial\ninfarction. Prominent ventricles and sulci are suggestive of age related\nvolume loss. Scattered subcortical white matter hypodensities are likely\nsequela of chronic small vessel ischemic disease. The basal cisterns appear\npatent and there is preservation of gray-white matter differentiation.\n\nThere are no fractures identified. The visualized paranasal sinuses, mastoid\nair cells and middle ear cavities are clear. The globes are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is a new right frontal subarachnoid hemorrhage (series 2, image 14). No\nevidence of mass effect. No evidence of other intracranial hemorrhage. There\nis no evidence of large territorial infarction,edema,or mass. Periventricular\nand subcortical white matter hypodensities are nonspecific but likely sequelae\nof chronic small vessel ischemic disease. There is prominence of the\nventricles and sulci suggestive of involutional changes.\n\nThere is a small left frontal subgaleal hematoma and soft tissue contusion. \nThere is no evidence of fracture. Mild hyperostosis frontalis interna. Trace\nleft maxillary sinus mucosal thickening. The visualized portion of the\nremaining paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. Bilateral lens replacements are noted.", + "output": "Right frontal subarachnoid hemorrhage without evidence of mass effect.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 5:31 am, approximately 10\nminutes after discovery of the findings." + }, + { + "input": "Again seen is a region of subarachnoid hemorrhage within the right frontal\nlobe (02:15). As compared to the prior exam from approximately 5 hours\nearlier, this region is stable size and appearance. There is no evidence of\nmass effect. No new regions of intracranial hemorrhage are identified. There\nis no evidence of acute large territorial infarction. There is no evidence of\nedema or mass lesion. Periventricular and subcortical white matter\nhypodensities are nonspecific but are felt to likely represent the sequelae of\nchronic small vessel ischemic disease. Prominence of the ventricles and sulci\nmay represent this age related involutional changes.\n\nRe-demonstration of left frontal subgaleal hematoma. No evidence of fracture.\nTrace left maxillary sinus thickening. Otherwise the visualized portion of\nthe paranasal sinuses, mastoid air cells and middle ear cavities are clear. \nBilateral lens replacements are again noted.", + "output": "1. Again seen is a region of subarachnoid hemorrhage within the right frontal\nlobe. As compared to the prior exam from approximately 5 hours earlier, this\nregion is stable in size and appearance. There is no evidence of mass effect.\nNo new regions of intracranial hemorrhage are identified." + }, + { + "input": "Similar volume small right frontal subarachnoid hemorrhage without interval\nenlargement (02:10). However, there seems to be slight redistribution into the\nadjacent left frontal extra-axial space (2:8, 601:16). There is no evidence\nof acute large territorial infarction,new hemorrhage,edema,or mass. There is\nprominence of the ventricles and sulci suggestive of age-related cerebral\nvolume loss. Periventricular and subcortical white matter hypodensities are\nnonspecific, though likely sequelae of chronic small vessel ischemic disease.\nAtherosclerotic vascular calcifications are noted of bilateral cavernous\nportions of internal carotid arteries. No evidence of hydrocephalus.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Grossly stable right frontal subarachnoid hemorrhage with slight interval\nredistribution into the left frontal extra-axial space. Continued follow-up\nis recommended.\n2. No new acute intracranial process." + }, + { + "input": "There is no evidence of acute large territorial infarction, intracranial\nhemorrhage, edema, or mass.\n\nThe ventricles and sulci are normal in size and configuration.\n\nThere is mild glabellar swelling medially. None lying fracture. Otherwise,\nno acute osseous abnormalities seen. There is scattered moderate mucosal\nthickening of the paranasal sinuses, excluding the frontal sinuses and most\npronounced in the left maxillary sinus which is nearly completely opacified\nonly partially imaged. The mastoid air cells and middle ear cavities are\nclear bilaterally. The orbits demonstrate no acute abnormalities.", + "output": "No acute intracranial process. No evidence intracranial hemorrhage or\nfracture.\n\nParanasal sinus disease as described above." + }, + { + "input": "There is near complete opacification of the left maxillary sinus with multiple\nareas of high density material which likely represents fungal colonization or\ninspissated secretions. There are similar findings in the right maxillary\nsinus, however approximately 50% opacified. The ethmoid air cells and\nsphenoid sinuses contain scattered mucosal thickening with mixed high-density\nmaterial. The ostiomeatal units, sphenoethmoidal and frontoethmoidal recesses\nare obstructed bilaterally.\n\nNo acute fractures are identified.\nThere is mild glabellar soft tissue stranding.\nThere is no evidence of abnormal fluid collections.\nBilateral mastoids appear normal.\nThe globes, extraocular muscles, optic nerves, and retrobulbar fat appear\nnormal.\nThe visualized upper aerodigestive tract appears normal.\nThe mandible and temporomandibular joints appear normal.", + "output": "1. No acute fractures.\n2. Paranasal sinus disease likely represents fungal colonization or\ninspissated secretions. Of note, bilateral ostiomeatal units, sphenoethmoidal\nand frontoethmoidal recesses are obstructed." + }, + { + "input": "There is mild fat stranding in the left parapharyngeal fat and just deep to\nthe left palatine tonsil without discrete fluid collection or significant\ntonsillar enlargement. No signs of odontogenic abscess or periapical lucency.\nPunctate tonsillith noted in the left palatine tonsil which is not enlarged. \nNo retropharyngeal edema.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal.There is an enlarged left level\n1B lymph node measuring 1.4 cm x 0.8 cm (2; 49). The neck vessels are\npatent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions. There is residual thymic\ntissue noted in the mediastinum.", + "output": "Mild inflammatory fat stranding deep to the left palatine tonsil without\ndiscrete fluid collection. Please correlate clinically." + }, + { + "input": "There is prominence of the ventricles and sulci compatible with global volume\nloss. Focal hypodensities in the cerebellar hemispheres are compatible with\nchronic infarcts. Encephalomalacia in the left frontal lobe is also noted. \nConfluent periventricular and subcortical white matter hypodensities are\nlikely sequela of chronic small vessel disease. There is no intra-axial or\nextra-axial hemorrhage, mass effect, midline shift, or acute major vascular\nterritorial infarct.\n\nIncluded paranasal sinuses and mastoids are clear besides mild mucosal\nthickening in the right sphenoid sinus. Skull and extracranial soft tissues\nare unremarkable.", + "output": "No acute intracranial process, no hemorrhage.\nGlobal volume loss, white matter dense hypodensities which are likely sequela\nof chronic small vessel disease. Bilateral chronic cerebellar infarcts and\nleft frontal encephalomalacia." + }, + { + "input": "There is no evidence of territorial infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Right frontal subgaleal hematoma\nmeasuring approximately 8 mm is noted.", + "output": "1. No acute intracranial abnormality.\n2. A mm thick right frontal subgaleal hematoma without underlying fracture." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction, mass or midline\nshift. There is no hydrocephalus. The ventricles and sulci are mildly\nenlarged consistent with mild atrophy. There are minimal periventricular white\nmatter hypodensities most consistent with sequelae of chronic small vessel\nischemic disease. Mild aerosolized secretions in the sphenoid sinus,\notherwise the visualized paranasal sinuses and mastoid air cells are clear. \nThere is no fracture.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nlarge territorial infarction. All of the ventricles remain mildly enlarged,\nunchanged compared to ___. The sulci and basal\ncisterns remain normal in size.\n\nThe visualized bony structures are grossly unremarkable. The paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The globes are\nunremarkable.", + "output": "1. No evidence of acute intracranial hemorrhage or other acute intracranial\nabnormality.\n2. Stable mild diffuse ventriculomegaly." + }, + { + "input": "There has been interval placement of a right frontal and ventriculoperitoneal\nshunt with the tip ending in the body of the right lateral ventricle.\nPneumocephalus and a small amount of hemorrhage in the occipital horn of the\nright lateral ventricle are likely related to catheter placement. Compared to\nthe prior study the ventricles have mildly decreased in size.\nSoft tissue changes are likely related to the catheter placement. The\ngray-white matter differentiation is preserved. The basal cisterns are patent.\n\nThe paranasal sinuses and middle ear cavities are clear. A few left mastoid\nair cells are opacified. The right mastoid air cells are clear. The orbits are\nunremarkable.", + "output": "Status post right frontal ventriculoperitoneal shunt with the tip ending in\nthe body of the right lateral ventricle. Mild interval improvement in\nventricular dilation. Pneumocephalus and a small amount of hemorrhage in the\noccipital horn of the right lateral ventricle are likely related to catheter\nplacement." + }, + { + "input": "Post OP day 3 post VP shunt, there is decreased intracranial air and decreased\nventricular caliber. The ventricular hemorrhage (right occipital horn) is\nstable. There is no evidence of infarction, edema, or mass. The ventricles and\nsulci are normal in size and configuration.\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "Post ventricular shunt placement, there is reduced intracranial air and stable\nventricular hemorrhage." + }, + { + "input": "Allowing for differences in patient positioning and technique, the caliber of\nthe ventricular system appears relatively stable. A right-sided frontal\napproach ventriculostomy catheter terminates in/ at the lateral margin of the\nbody of the right lateral ventricle, unchanged since prior examination.\nIntraventricular air and pneumocephalus has decreased. Previously seen\nventricular hemorrhage in the right occipital horn has resolved.\nThere is no evidence of new hemorrhage, edema, or obvious infarction.\n\nThere is mild opacification of the left mastoid air cells and minimal mucosal\nthickening of the left maxillary sinus. Otherwise, the remaining visualized\nparanasal sinuses, right mastoid air cells, and middle ear cavities are clear.\nSphenoid sinus minor septation inserts on the right carotid groove.", + "output": "Allowing for differences in patient positioning and technique, the caliber of\nthe ventricular system appears relatively stable with reduced intraventricular\nair and pneumocephalus. Internal hemorrhage has resolved.\nventriculostomy catheter terminates in/ at the lateral margin of the body of\nthe right lateral ventricle, unchanged since prior examination. Correlate\nclinically if this is appropriate." + }, + { + "input": "The right frontal approach ventriculoperitoneal shunt catheter terminates in\nthe lateral margin of the body of the right lateral ventricle, unchanged.\nVentricular size and configuration is stable. Pneumocephalus has resolved.\nThere is no acute intracranial hemorrhage, edema, mass effect, or evidence of\nlarge vascular territorial infarction. There is no fracture. Mild\nopacification of the left mastoid air cells is unchanged. Otherwise, the\nimaged paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear.", + "output": "No evidence of acute intracranial abnormality. Unchanged position of VP shunt\nand stable ventricular size." + }, + { + "input": "Right frontal approach VP shunt catheter follows a similar course to the prior\ncatheter, terminating in the frontal horn of the right lateral ventricle.\nThere is no blood along the course of the catheter within the ventricles.\nThere is a small amount of postprocedural air along the catheter and in the\nfrontal horn of the right lateral ventricle. The ventricles are stable in\nsize. There is no acute hemorrhage or evidence for parenchymal edema.\n\nMild chronic opacification of dependent left mastoid air cells is unchanged\ndating back to the earliest available comparison from ___. There\nis mild mucosal thickening in left ethmoid air cells.", + "output": "Right frontal approach VP shunt catheter terminates in the frontal horn of the\nright lateral ventricle, similar to the prior catheter. Stable size of the\nventricles. No acute hemorrhage or evidence of other complications." + }, + { + "input": "There is a right frontal approach VP shunt catheter again noted and unchanged\nin position with the tip terminating in the frontal horn of the right lateral\nventricle. Previously seen post procedural air along the catheter and within\nthe ventricles has resolved. The ventricles have slightly decreased in size\nwhen compared to prior study. There is no evidence of hemorrhage, extra-axial\ncollection or shift of midline. Normal gray-white matter differentiation is\npreserved.\n\nThe orbits are unremarkable. The paranasal sinuses are clear. There is a small\namount of chronic opacification of the left mastoid air cells unchanged from\nprior study.", + "output": "Right frontal approach VP shunt catheter with tip in the frontal horn of the\nright lateral ventricle. The ventricles have slightly decreased in size when\ncompared to prior study." + }, + { + "input": "Patient is status post a right frontal approach ventriculoperitoneal shunt.\nThe catheter appears to terminate within the frontal horn of the right lateral\nventricle, not significantly changed in position relative to prior CT dated ___. Ventricular size appears decreased, the lateral and third\nventricles are smaller.\n\nNew since study dated ___, there is an intermediate to low density\n6.6 mm left convexity extra-axial fluid collection. Prominent extra-axial\nspace is additionally noted along the right frontal convexity measuring\napproximately 3.5 mm in maximal dimension.\n\nGray-white matter differentiation is preserved. There is no shift of normally\nmidline structures. Basal cisterns are patent.\n\nVisualized paranasal sinuses, right mastoid air cells, and middle ear cavities\nare clear. Partial opacification of left mastoid tip is noted.", + "output": "1. New since prior examination dated ___, there are bilateral\nfrontal convexity low to intermediate density subdural collections may reflect\nchronic hematomas or alternatively hygromas or effusions. No significant mass\neffect.\n2. Status post ventriculoperitoneal shunt placement with shunt tip within the\nfrontal horn of the right lateral ventricle. Relative to prior examination\ndated ___, ventricles are decreased in size.\n\nThese two findings in combination may represent over shunting, to be\ncorrelated clinically.\n\nNOTIFICATION: Findings discussed with Dr. ___ by Dr. ___\ntelephone at 18:30 on ___ at the time findings were discovered. \nNeurosurgery is aware per note in chart." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is a\nright frontal approach ventriculoperitoneal shunt with the catheter tip\nterminating in the frontal horn of the right lateral ventricle. Since the\nexamination dated ___, the bilateral frontal extra-axial collections\nhave resolved. The sulci are normal in size and configuration. There is no\nevidence of fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. No acute findings.\n2. Right frontal approach VP shunt with catheter tip terminating in the\nfrontal horn of the right lateral ventricle." + }, + { + "input": "As before there is a right frontal approach ventriculoperitoneal shunt with\nthe catheter tip terminating in the frontal horn of the right lateral\nventricle. The ventricles are unchanged in size from the prior examination. \nThere is no evidence of acute infarction or intracranial hemorrhage. There is\nno evidence of midline shift.\n\nThe imaged paranasal sinuses are clear. The paranasal sinuses are clear. \nThere is minimal fluid within the left mastoid air cells. The bony calvarium\nis intact.", + "output": "No acute intracranial process. Ventricles are unchanged in size from the\nprior examination in ___" + }, + { + "input": "Right frontal approach shunt catheter tip is projected over the anterior\nportion of the right ventricle. Ventricular size has minimally decreased\ncompared to the prior study and there is no ventriculomegaly seen. Basal\ncisterns are patent. No acute intra or extra-axial hemorrhage is seen.", + "output": "Decrease in ventricular size compared to the previous CT of ___. \nThere is no evidence of ventriculomegaly." + }, + { + "input": "Right frontal approach VP shunt catheter is unchanged in position, with tip\nterminating in the frontal horn of the right lateral ventricle. Ventricular\nsize has decreased compared the ___ examination, with slight asymmetry\nwith the right lateral ventricle smaller than the left.\n\nSenescent calcifications are noted in the basal ganglia. There is no evidence\nof infarction, hemorrhage, edema, or mass. The ventricles and sulci are\nnormal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Stable positioning of a right frontal approach VP shunt catheter, with\ncontinued interval decrease in size of the ventricular system.\n2. No acute intracranial abnormality." + }, + { + "input": "Right frontal approach ventriculostomy catheter terminating at the frontal\nhorn of the right lateral ventricle is stable in position. Asymmetric size of\nthe right lateral ventricle, smaller compared to the left is unchanged from\nprior examination. There is no ventriculomegaly. The sulci, ventricles and\ncisterns are within expected limits for the patient's age. There is no\nevidence of acute large territorial infarct or intracranial hemorrhage. No\nacute fractures. The visualized paranasal sinuses are essentially clear. The\norbits are unremarkable. The mastoid air cells and middle ears are well\npneumatized and clear.", + "output": "1. Unchanged positioning of right frontal approach ventriculostomy catheter\nterminating at the frontal horn of the right lateral ventricle.\n2. The right lateral ventricle is asymmetrically smaller compared to the left,\nunchanged from immediate prior examination of ___. There is no\nventriculomegaly.\n3. No acute intracranial abnormality on noncontrast head CT." + }, + { + "input": "As before there is a right frontal approach ventriculostomy with tip\nterminating in the frontal horn of the right lateral ventricle. The right\nfrontal horn is slightly decreased in size compared to the ___ study.\n\nThere is no evidence of infarction, hemorrhage, edema, or mass effect. \nBilateral basal ganglia calcifications are unchanged.\n\nNo evidence of acute fracture. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No acute intracranial hemorrhage or fracture.\n2. Re-demonstration of a right frontal approach ventriculostomy with tip\nterminating in the frontal horn of the right lateral ventricle, as before. \nHowever, the right frontal horn is slightly decreased in size compared to\n___." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, shift of normally\nmidline structures or acute major vascular territorial infarction. Ventricles\nand sulci are prominent for the patient's age, suggesting mild cortical volume\nloss. The basal cisterns appear patent and there is preservation of\ngray-white matter differentiation.\n\nThere is no fracture. There is mild opacification of left mastoid air cells.\nOtherwise, the remaining visualized paranasal sinuses, right mastoid air\ncells, and middle ear cavities are clear. The globes are unremarkable.", + "output": "1. No acute intracranial abnormality.\n\n2. Prominence of ventricles and sulci.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\non the telephone on ___ at 1:18 ___, 10 minutes after discovery of the\nfindings." + }, + { + "input": "CT Head: There is no intracranial hemorrhage or evidence of acute cortical\ninfarction. There is no extra-axial fluid collection. Gray-white\ndifferentiation is preserved. The lateral, third, and fourth ventricles are\nmildly dilated, unchanged from on ___ and CT on ___.\n\nThe visualized paranasal sinuses are clear. The mastoid air cells are clear.\nThe orbits and soft tissues are unremarkable. There is no displaced calvarial\nfracture.\n\nCTA Head: The intracranial internal carotid arteries are normal in\nconfiguration. The anterior and middle cerebral arteries are patent with\nnormal contrast enhancement and branching pattern. There is a normal anterior\ncommunicating artery complex.\n\nThe vertebral and basilar arteries demonstrate normal enhancement without\nstenosis or occlusion. The posterior cerebral arteries have a normal branching\npattern. The posterior communicating arteries are visualized.\n\nThere is no evidence of stenosis, occlusion, aneurysm or arteriovenous\nmalformation.\n\nThe dural venous sinuses are patent.\n\nCTA Neck: The visualized aortic arch and origins of the great vessels are\nunremarkable.\n\nThere is mild irregularity of the right proximal internal carotid artery but\nno stenosis by NASCET criteria. The right common, internal and external\ncarotid arteries demonstrate no evidence of a significant stenosis by NASCET\ncriteria or a dissection.\n\nThere is mild irregularity of the left proximal internal carotid artery but no\nstenosis by NASCET criteria. The left common, internal and external carotid\narteries demonstrate no evidence of a significant stenosis by NASCET criteria\nor a dissection.\n\nThe cervical portions of the vertebral arteries demonstrate normal\nenhancement. There is no evidence of a stenosis or a dissection.\n\nThe pulmonary veins are prominent. There is a probable bone island in the T4\nvertebral body.", + "output": "1. Normal appearance of the vasculature of the head and neck, without\nsignificant stenosis (by NASCET criteria), dissection, or aneurysm.\n2. No dural venous sinus thrombosis.\n3. No acute territorial infarct, space-occupying lesion, or intracranial\nhemorrhage.\n4. Mild global enlargement of the lateral, third, and fourth ventricles,\nunchanged dating back to CT on ___. When compared with MRI head\nfrom ___, the cerebral aqueduct also appears enlarged. This\npattern suggests extraventricular obstructive hydrocephalus.\n5. Prominence of the pulmonary veins suggesting pulmonary venous congestion." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Age related involutional changes are noted. There is minimal\nperiventricular white matter hypodensity compatible with chronic microvascular\nischemic disease. Ventricles and sulci are normal in overall size and\nconfiguration. The imaged paranasal sinuses are clear. Mastoid air cells and\nmiddle ear cavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "Patient is status post right cerebellar mass resection and right suboccipital\ncraniotomy and cranioplasty. There is widening of right cerebellopontine angle\ncistern as noted in the prior MRI. The edema of the cerebellum is similar as\nbefore. The mass effect on the fourth ventricle is unchanged. No evidence of\nlarge hemorrhage, or large territorial infarction. Postoperative\npneumocephalus is noted as expected.\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "Status post right cerebellar mass resection and right suboccipital craniotomy\nand cranioplasty with expected postsurgical changes." + }, + { + "input": "The patient is status post right cerebellar mass resection and right\nsuboccipital craniotomy and cranioplasty. There has been significant interval\nincrease in extra-axial blood with increased mass effect on the cerebellum and\nextension of the blood superiorly along the tentorium. There is increased\ncrowding of the foramen magnum concerning for early tonsillar herniation. \nThere is complete effacement of the fourth ventricle, as well as the\nquadrigeminal cistern.\n\nThe visualized paranasal sinuses, mastoid air cells and middle ear cavities\nare clear.", + "output": "Significant interval increase in extra-axial blood in the right cerebellar\nresection cavity with increased mass effect on that cerebellar hemisphere and\neffacement of the fourth ventricle, as well as the basal cisterns. The blood\nappears to layer superiorly along the tentorium. Increased crowding of the\nforamen magnum is concerning for early tonsillar herniation.\n\nNOTE ADDED IN ATTENDING REVIEW: As above, there has been marked interval\nchange, with relatively acute, predominantly extra- and some intra-axial\nhemorrhage in the right posterior fossa resection bed. Subdural hemorrhage\nlayers predominantly subjacent to the tentorial leaflets. The combination of\nthe expanding hematoma with worsening edema in the cerebellar, particularly\nthe vermis, results in both upward transtentorial and cerebellar tonsillar\nherniation. Mass effect with virtual-complete effacement of the fourth\nventricle and sylvian aqueduct produces acute obstructive hydrocephalus, with\ndilatation of the lateral ventricular temporal horns, new.\n\nNOTIFICATION: Findings were discussed with Dr. ___ by Dr. ___ by phone\nat 6:50 AM on the day of the study, approximately 1 minute after discovery." + }, + { + "input": "There is an intra-axial, predominantly hypodense, cystic mass within the right\ncerebellum with associated mass effect on the brainstem including effacement\nof the right aspect of the quadrigeminal cistern with mass effect on the\ncerebral aqueduct. Mass demonstrates a large focus of heterogenous enhancement\n-- the overall appearance may represent cystic metastasis, primary glial\ntumor, or hemangioblastoma. There is no evidence of acute intracranial\nhemorrhage. The ventricles are stable in size. Orbits, skull base, and\nparanasal sinuses are unremarkable.\n\nThere is no evidence of aneurysm, hemodynamically significant stenosis, or\nvessel occlusion within the intracranial vasculature. The internal carotid\narteries follow a medialized course. The right anterior inferior cerebral\nartery is engorged and appears to represent the principal supply to the right\ncerebellar mass. Additionally, there appears to be some venous drainage into\nthe transverse sinus from the mass. There is a small focal outpouching of the\nleft vertebral artery (___) which could represent a small pseudoaneurysm.", + "output": "1. Unchanged right cerebellar hemispheric intra-axial mass with heterogenous\nnodular enhancement and mass effect on the quadrigeminal cistern and cerebral\naqueduct, as described.\n2. Engorged right anterior inferior cerebellar artery which appears to be the\nprincipal vascular supply to the cerebellar hemispheric mass.\n3. Incidental small focal outpouching of the V3 segment of the left vertebral\nartery, which may represent a small pseudoaneurysm, perhaps related to\nprevious dissection." + }, + { + "input": "The adenoids the symmetrically enlarged but enhance homogeneously.\n\nThere is severe enlargement of the bilateral palatine tonsils, which contact\neach other in the midline (kissing tonsils), with associated narrowing of the\nairway. The left tonsil is larger than the right and enhances slightly\nheterogeneously. There is no evidence for a fluid collection. Left\nparapharyngeal fat is more effaced than the right.\n\nThe remainder of the aerodigestive tract is patent without evidence of an\nexophytic mass or focal mass effect.\n\nEnlarged bilateral level 2 lymph nodes measure up to 2 cm, likely reactive.\n\nThe parotid and submandibular glands are within normal limits. The thyroid\ngland is unremarkable. The major vessels of the neck are patent.\n\nThe imaged portions of the brain are unremarkable, but this exam is not\ntechnically optimized for evaluation of intracranial structures.\n\nThe visualized paranasal sinuses and mastoid air cells are clear. Bilateral\nundescended maxillary and mandibular third molars are noted.\n\nThe visualized upper lungs are clear.\n\nThere are no concerning bone lesions.", + "output": "1. Severely enlarged palatine tonsils, left larger than right, which contact\neach other with effacement of the airway. The left tonsil enhances\nheterogeneously without evidence for fluid collection. These findings are\nconsistent with tonsillitis.\n2. Symmetrically enlarged adenoids with homogeneous enhancement, which may be\nsecondary to infection or reactive enlargement.\n3. Mild bilateral level 2 lymphadenopathy, presumably reactive.\n\nNOTIFICATION: Preliminary report by a radiology resident stated that there\nmay be a developing abscess in the left tonsil, discrepant from the final\nreport. The patient was discharged from the emergency room with antibiotics\nfor treatment of tonsillitis. No further notification was made to the\nemergency room at the time of final interpretation, as no change in management\nwas expected." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThere is soft tissue swelling overlying the right orbit without underlying or\nother fracture. No osseous abnormalities seen. The paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The globes are intact. No\nretrobulbar hematoma.", + "output": "1. No acute intracranial abnormality.\n2. Soft tissue swelling overlying the right orbit without underlying or other\nfracture." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. The basal cisterns are patent\nand there is preservation of gray-white matter differentiation.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable. An impacted left\nupper molar is partially imaged.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\nThere is no evidence of fracture. There is a minor soft tissue swelling of\nthe right frontal scalp. Trace mucosal thickening of the posterior ethmoid\nair cells is noted, otherwise the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "Minor soft tissue swelling of the right frontal scalp. No evidence of\nfracture or acute intracranial abnormality." + }, + { + "input": "There is an ill-defined area of soft tissue at the site of prior right\nparaesophageal abscess at the level of the thoracic inlet (2:81, 601:39),\ndifficult to measure though with overall decreased in size and with decreased\nmass effect on the adjacent esophagus. The previously seen retropharyngeal\nfluid collection is not appreciated on the current study.\n\nThe visualized lung apices are notable for postsurgical change and a tiny\nright apical pneumothorax.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria, with multiple prominent cervical chain lymph nodes unchanged from\nprior. The neck vessels are patent.\n\nThere are no osseous lesions.", + "output": "1. Decreased size of ill-defined right paraesophageal soft tissue at the site\nof prior abscess.\n2. No residual retropharyngeal fluid collection.\n3. Postsurgical change at the right apex.\n4. Tiny right apical pneumothorax." + }, + { + "input": "The paranasal sinuses are normally aerated, with no mucosal thickening or\nair-fluid levels identified. The ostiomeatal units are patent. The cribriform\nplates are intact. There is no nasal septal defect. The nasal septum is\nmidline. The anterior clinoid processes are not pneumatized. The lamina\npapyracea are intact.\n\nThere is irregularity and subchondral cystic change along the left mandibular\ncondyle and irregularity along the left glenoid fossa that is asymmetric.", + "output": "1. Paranasal sinuses are well aerated and clear.\n\n2. Extensive asymmetric irregularity of the left mandibular condyle and the\nglenoid fossa may represent moderate asymmetric degenerative changes of the\nleft temporomandibular joint however clinical correlation is recommended to\nexclude infection." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent. Atherosclerotic calcifications are seen in the\nbilateral carotid siphons.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. The right vertebral artery is dominant.\nMinimal calcified atherosclerotic disease is noted in the bilateral carotid\nbifurcations without evidence of stenosis. There is no evidence of internal\ncarotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The thyroid gland is\nunremarkable. There is no lymphadenopathy by CT size criteria.", + "output": "1. No evidence of occlusion, stenosis, or aneurysm in the major arteries of\nthe head and neck.\n2. No evidence of infarction, hemorrhage, or mass." + }, + { + "input": "There are multiple enlarged and rounded lymph nodes along the left anterior\ncervical chain. For example a left level 2 lymph node measures 15 x 20 mm\n(series 2, image 36), a heterogeneously enhancing left level 3 lymph node\nmeasures 15 x 20 mm (series 2, image 43), and a left level 4 lymph node\nmeasures 17 x 24 mm (series 2, image 60). A cluster of enlarged left\nsupraclavicular lymph nodes are also noted. Scattered right-sided cervical\nlymph nodes are not enlarged by imaging size criteria.\n\nEvaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect. A few punctate tonsilliths are noted bilaterally, likely\nrepresenting sequelae of prior inflammation.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.", + "output": "Extensive cervical lymphadenopathy predominantly along the left anterior chain\nand left supraclavicular region in combination with enlarged hilar and\nretroperitoneal lymph nodes and numerous hypodensities within the spleen is\nsuspicious for lymphoma." + }, + { + "input": "In comparison to ___ there is decreased size and conspicuity of\nlymphadenopathy along the left anterior cervical chain. For example a left\nlevel 2A lymph node measures 1.7 x 1.2 cm (previously 2 x 1.6 cm) (02:36), a\nheterogeneously enhancing left level 3 lymph node measures 1.7 x 1.2 cm\n(previously 2 x 1.5 cm) (02:45), and a left level 4 lymph node measures 2.1 x\n1.1 cm (previously 2.4 x 1.7 cm) (2:60). A group of enlarged left\nsupraclavicular lymph nodes are unchanged. Subcentimeter right-sided cervical\nlymph nodes are not enlarged by imaging size criteria and are unchanged in\nappearance since prior examination.\n\nEvaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect. Again seen are few punctate bilateral tonsilliths likely\nsequelae of prior inflammation.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal.The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. Few subcentimeter mediastinal lymph nodes are unchanged in\nappearance since prior examination. There are no osseous lesions. Please\ncorrelate with chest CT of the same day for further details.", + "output": "1. Decreased size and conspicuity of left cervical lymphadenopathy with\nunchanged left supraclavicular lymphadenopathy since ___. No new\nlymphadenopathy." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nOverall again is noted lymphadenopathy along the left anterior cervical chain,\nslightly decreased compared to prior exam. For example redemonstrated is an\nenlarged left level 2A lymph node, measuring 1.4 cm AP x 1.1 cm (02:31)\n(previously 1.6 cm AP x 1.2 cm TV). Also again seen is a 1.5 cm AP x 1.2 cm\nTV left level 3 lymph node (02:39), unchanged. Conglomerate left level 4\nlymph nodes do not appear significantly changed allowing for beam hardening\nartifact on the comparison study and measure 1.5 cm AP by 3.4 cm TV (2:61). \nNo significant change in the scattered prominent lymph nodes within the left\nposterior cervical space, which do not meet pathologic size criteria.\n\nEvaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal.The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions. Left maxillary sinus mucous\nretention cyst is noted (see 02:15).", + "output": "1. Dental amalgam streak artifact limits study.\n2. Left anterior cervical chain lymphadenopathy, slightly decreased compared\nto ___ prior exam.\n3. Paranasal sinus disease , as described." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. There is\nage advanced involutional changes with prominence of ventricles and sulci.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormalities.\n2. Involutional changes advanced for age." + }, + { + "input": "1.4 cm cystic/necrotic left level 2A lymph node, slightly decreased in size,\nand more cystic today. Findings are likely treatment related. Other\netiologies, including infection, metastasis from primary squamous cell\ncarcinoma are unlikely unless clinically suspected.\n\nOther previously seen large left level 2, 3, 4, 5 B lymph nodes have\ndrastically decreased, largest lymph node measures 0.6 cm short axis. No new\nleft neck adenopathy.\nSubcentimeter right neck lymph nodes, normal by CT criteria.\nNo retropharyngeal adenopathy.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal.The neck vessels are patent. \nRight Port-A-Cath in place.. Mild paranasal sinus disease.\n\nRefer to chest CT from today for thoracic findings.", + "output": "Improved adenopathy since prior.\nResidual 1.4 cm left level 2 pathologic, cystic lymph node, likely treatment\nrelated.\nNo new adenopathy or mass." + }, + { + "input": "The patient is status post removal of the left-sided deep brain stimulator\nelectrode, with small amount of air along the tract and expected postsurgical\nchanges. There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. A right sided deep\nbrain stimulator electrode is still present.\n\nOther than the postsurgical changes, no osseous abnormalities seen. The\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\norbits are unremarkable.", + "output": "Status post removal of the left-sided deep brain stimulator electrode, with a\nsmall amount of air along the tract. No evidence of new hemorrhage or\ninfarction." + }, + { + "input": "New since prior study is replacement of the left-sided deep brain stimulator\nelectrode, with interval development of a moderate-sized pocket of\npneumocephalus layering in and anti-dependent fashion along the left frontal\ncerebral convexity. The right deep brain stimulator electrode is in unchanged\nposition. Hardware artifact from the stimulator electrodes limits evaluation\nof nearby structures; however, within this limitation there is no evidence of\nhemorrhage, infarction, edema, or mass. The basal cisterns are patent. The\nventricles are normal in caliber and configuration. The visualized paranasal\nsinuses and mastoid air cells are clear. The globes and bony orbits are\nunremarkable.", + "output": "1. Please note study is limited secondary to hardware artifact.\n2. Interval replacement of left-sided deep brain stimulator electrode, with\nnew moderate left pneumocephalus.\n3. Stable position of a right deep brain stimulator electrode.\n4. Within limits of study, no acute intracranial abnormality." + }, + { + "input": "Bilateral, frontal approach deep brain stimulator electrodes are noted in\nunchanged position as compared to the prior examination. There has been\ninterval resolution of the prior left frontal pneumocephalus.\n\nNote that the examination is limited secondary to extensive streak artifact\nfrom the associated hardware. Within this limitation, there is no evidence for\nhemorrhage, mass, edema, or infarction. The ventricles and sulci are mildly\nenlarged, compatible with age related atrophic changes. The basal cisterns\nremain patent.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Limited examination without evidence for acute intracranial process.\n2. Unchanged positioning of bilateral DBS electrodes.\n3. Mild, global age-related cerebral atrophy." + }, + { + "input": "There is no acute intracranial hemorrhage, major vascular territory\ninfarction, edema or mass effect. Ventricles and sulci are prominent,\nsuggestive of atrophy. Bilateral deep brain stimulators are unchanged in\nposition. Associated streak artifact limits the evaluation of adjacent\nstructures.\n\nAtherosclerotic calcifications are noted in the carotid siphons bilaterally.\n\nThere is no evidence of fracture. Minimal mucosal thickening within the\nbilateral ethmoid air cells. Remainder of the visualized paranasal sinuses,\nmastoid air cells and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Unchanged position of bilateral deep brain stimulators." + }, + { + "input": "There is no evidence of acute large territorial infarction, intracranial\nhemorrhage, edema, or discrete mass. The ventricles and sulci are normal in\nsize and configuration. No acute osseous abnormalities seen. Mild mucosal\nthickening of the right maxillary sinus and anterior ethmoid air cells. \nOtherwise, the partially imaged paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits demonstrate no acute abnormalities.", + "output": "No acute intracranial process." + }, + { + "input": "Left palatine tonsil does not appear enlarged, is more prominent compared to\nright, likely related to prior right tonsillectomy, correlate with clinical\nhistory or direct visualization.\n\nOtherwise, evaluation of the aerodigestive tract demonstrates no\nabnormalities.\n\nFew punctate calcifications within left send fibular gland, which appears\natrophic. Salivary glands are otherwise normal.. Thyroid is unremarkable. \nThere is no lymphadenopathy by CT criteria.\n\nThere are atherosclerotic calcifications at the bilateral carotid bulbs. \nThere are multilevel degenerative changes in the cervical spine including mild\nanterolisthesis of C3 on C4. There are no suspicious osseous lesions.\n\nContrast is seen within the distal esophagus related to CT abdomen pelvis\nperformed on same day, consider gastroesophageal reflux.\n\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.", + "output": "1. Asymmetric appearance of palatine tonsils, likely related to prior right\ntonsillectomy, correlate with surgical history or direct visualization..\n2. No adenopathy.." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Brain\nparenchymal atrophy. Findings consistent with mild chronic small vessel\nischemic change. Mild posterior right parietal scalp soft tissue swelling.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial findings.\nRight parietal scalp mild soft tissue swelling." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is an area of right posterior frontal encephalomalacia suggestive of\nchronic infarct (03:25). There is no evidence of no evidence of acute large\nterritorial infarction, hemorrhage, edema, or mass. TThere is prominence of\nthe ventricles and sulci suggestive of involutional changes. Areas of\nconfluent periventricular, subcortical and deep white matter hypodensity are\nin a configuration most suggestive of chronic small vessel ischemic disease. \n.\n\nThere is a tiny mucous retention cyst in the floor of the left maxillary\nsinus. The remainder of the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.\n\nCTA HEAD:\nThere are mild atherosclerotic calcifications in the V4 segments of the\nbilateral vertebral arteries without significant narrowing. There is mild\natherosclerotic calcification of the bilateral intracranial internal carotid\narteries without significant narrowing. There is minimal irregularity of the\nleft M1 segment of the MCA without significant narrowing, likely secondary to\natherosclerotic disease. The vessels of the circle of ___ and their\nprincipal intracranial branches appear patent without significant stenosis,\nocclusion, or aneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is mild calcified and noncalcified atherosclerotic plaque of the aortic\narch. There is variant common origin of the brachiocephalic and left common\ncarotid artery. There is minimal atherosclerotic calcification of the origin\nof the right bilateral vertebral arteries without significant narrowing. \nThere is moderate left and severe right calcified and mainly noncalcified\natherosclerotic plaque of the carotid bifurcations. There is near complete\nocclusion of the right internal carotid artery at its takeoff with a thin wisp\nthe lumen remaining, with likely greater than 90% stenosis (5:104). There is\nno significant left internal carotid artery stenosis by NASCET criteria. The\ncarotid and ertebral arteries and their major branches appear normal with no\nevidence of stenosis, dissection or occlusion.\n\nOTHER:\nThere is severe centrilobular emphysema. Scattered calcified granulomas are\nnoted. The visualized lung apices are otherwise grossly clear. The\nvisualized portion of the thyroid gland is within normal limits. There is no\nlymphadenopathy by CT size criteria.", + "output": "1. Small chronic right posterior frontal infarct.\n2. Otherwise no evidence of acute large territorial infarct or hemorrhage.\n3. Patent intracranial vasculature without significant stenosis, occlusion, or\naneurysm formation.\n4. Moderate left and severe right calcified and mainly noncalcified\natherosclerotic plaques of the carotid bifurcations with near complete\nocclusion of the right internal carotid artery with greater than 90% stenosis.\n5. Otherwise patent cervical vasculature without occlusion, or dissection.\n6. Severe centrilobular emphysema." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nlarge territorial infarction. Prominent ventricles and sulci suggest\nage-related involutional changes or atrophy. The basal cisterns appear patent\nand there is preservation of gray-white matter differentiation.\n\nThere is a nondisplaced right nasal bone fracture of indeterminate age. The\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. \nSurgical hardware is partially imaged at the anterior lateral left maxillary\nsinus. . Atherosclerotic mural calcification of the bilateral internal carotid\narteries is noted. The globes are intact.", + "output": "No acute intracranial abnormality.\nNondisplaced right nasal bone fracture of indeterminate age." + }, + { + "input": "There is no evidence ofhemorrhage, edema, or mass. There is prominence of the\nventricles and sulci suggestive of involutional changes. An area of\nencephalomalacia involving the left cerebellar hemisphere suggests chronic\ninfarction (3:11).\nThere is no evidence of fracture. Trace mucosal thickening of the anterior\nethmoidal air is noted with trace fluid in the right mastoid air cells. The\nvisualized portion of the remaining paranasal sinuses and middle ear cavities\nare otherwise clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Involutional changes and apparent chronic left cerebellar infarction." + }, + { + "input": "Extensive right facial fat stranding and platysmal thickening extending into\nthe anterior superior right neck with skin thickening is demonstrated. No\nfluid collection identified. No definite periapical lucency. The deep neck\nspace fat planes, including the submandibular and masticator spaces, are\npreserved.\n\nEvaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect. There are multiple bilateral palatine tonsilliths.\n\nThe salivary glands enhance normally. No sialoliths. The thyroid gland\nappears normal.A right level IB lymph node measures 1.4 cm and long axis\ndimension, presumably reactive from the adjacent inflammatory process. \nCalcified cervical lymph nodes presumably reflect prior granulomatous disease.\nThe neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. The imaged thoracic aorta is top normal in caliber. There\nare no concerning osseous lesions. Remote left first rib fracture is again\nseen. Imaged aspect of the right globe demonstrates an elongated ovoid\nappearance compatible with a staphyloma.", + "output": "1. Right facial inflammation extending into the right anterior superior neck. \nThe deep neck space fat planes are preserved. No fluid collection.\n2. No definite periapical lucency to suggest an odontogenic source. No\nsialadenitis.\n3. Unchanged bilateral calcified cervical lymph nodes which presumably reflect\nprior granulomatous disease." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect. There are multiple bilateral neck, left greater than\nright, calcified lymph nodes from sequela of prior granulomatous process or\nsequela of chronic infection. There is no neck adenopathy by size criteria. \nNo abnormal fluid collection is identified.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. The neck vessels are patent. Of\nnote, the left PICC line is seen crossing over the confluence of the\nbrachiocephalic veins to terminate in the right brachiocephalic vein.\n\nThe imaged portion of the lung apices are grossly clear. Respiratory motion\nartifact somewhat limits evaluation of pulmonary nodules. There are no\nsuspicious osseous lesions. The visualized skull-base appears normal. There\nis healing or chronic ununited left first rib fracture, stable.", + "output": "1. Multiple bilateral calcified cervical lymph nodes, likely sequela of prior\ngranulomatous process or sequela of chronic infection. There is no neck\nadenopathy.\n2. The left PICC line is seen crossing over the confluence of the\nbrachiocephalics and terminates in the right brachiocephalic vein. Adjustment\nis recommended for optimal positioning." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. Partially empty\nsella.. Posterior nasopharynx probable small cyst.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Partial opacification right concha\nbullosa.", + "output": "No acute intracranial findings." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or infarction.\nProminent ventricles and sulci likely reflect age related atrophy. The basal\ncisterns are patent. Gray-white matter differentiation is preserved.\n\nNo fracture is identified. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. Mild mucosal thickening is noted in the ethmoid\nair cells. The orbits are unremarkable.", + "output": "Normal study." + }, + { + "input": "There is no hemorrhage, acute large vascular territorial infarction, mass,\nedema, or shift of normally midline structures. The basal cisterns are\npatent. Prominence of the ventricles and sulci is compatible with age-related\ninvolutional change. The visualized paranasal sinuses and mastoid air cells\nare clear. Atherosclerotic mural calcifications in the bilateral\nintracranial carotid arteries are seen. The globes and orbits are intact.\nThere is no evidence of acute fracture.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD:\nThere is no evidence for acute hemorrhage, vascular territorial infarction,\nmass effect, or edema. Small chronic infarct right cerebellum, stable since\n___. The ventricles and sulci are prominent. There is gross preservation of\ngray-white matter differentiation.\n\nAerosolized secretions are seen within the left sphenoid sinus. Minimal\nmucosal thickening is seen involving scattered ethmoid air cells. There is\nunder pneumatization versus postsurgical change valve in the left mastoid air\ncells. The remainder of the paranasal sinuses, middle ear cavities, and\nmastoid air cells are clear. The patient is status post bilateral lens\nresections..\n\n\nCTA HEAD AND NECK:\nThere is a normal 3 vessel aortic arch with mild calcifications seen at the\norigins of the great vessels. Moderate calcifications are seen at the origin\nof the left V1 segment. Otherwise, the vertebral arteries are patent without\nhigh-grade stenosis or occlusion.\n\nThe bilateral common carotid arteries are patent. Mild left and moderate\nright calcifications are seen at the bilateral carotid bulbs. There is no\nevidence of internal carotid stenosis by NASCET criteria.\n\nMild calcifications are noted involving the bilateral cavernous internal\ncarotid arteries. Mild luminal irregularity and narrowing is seen involving\nthe right greater than left A1 segments, distal left M1 segment and left P1\nsegment, likely secondary to atherosclerotic disease. The right posterior\ncommunicating arteries open and dominant. The left posterior communicating\nartery is also patent. There is no evidence for high-grade stenosis,\nocclusion, or aneurysm greater than 3 mm.\n\n\nOTHER:\nThere are multiple metallic wires seen throughout the right mandible, likely\npostsurgical. A small punctate focus of hyperdensity in left mandible may\nalso be postsurgical.\n\nMild pulmonary interstitial edema. Innumerable nodules are seen, measuring up\nto 8 mm at the right upper lobe. Several is are solid versus ground-glass,\nand many appear similar as compared to cervical spine CT dated ___.\n\nThe right pulmonary artery is mildly enlarged at 2.6 cm. The thyroid is\nmildly heterogeneous with a 1.0 cm hypodense nodule seen on the left. There\nis no cervical lymphadenopathy by CT size criteria. Degenerative arthritis\nright shoulder. Advanced degenerative changes cervical spine.", + "output": "1. No evidence for acute hemorrhage or acute infarction.\n2. Mild-to-moderate global parenchymal volume loss.\n3. Small chronic right cerebellar infarct.\n4. Multifocal, mild-to-moderate atherosclerotic disease described throughout\nthe intracranial and cervical vasculature. No evidence for high-grade\nstenosis, occlusion, or aneurysm.\n5. Innumerable upper lung ground-glass and solid nodules measuring up to 8 mm,\nmany of which appear similar from ___. Few mildly prominent mediastinal\nlymph nodes, may be reactive.\n6. Mild interstitial pulmonary edema.\n7. 1.0 cm hypodense left thyroid nodule.\n\nRECOMMENDATION(S): For incidentally detected multiple subsolid nodules\nbigger than 6mm, CT follow-up in 3 to 6 months is recommended. Subsequent\nmanagement should be based on the most suspicious nodule(s).\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___\n\n\n\nThyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or older.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "Streak artifact from dental amalgam limits evaluation.\n\nThere is mild leftward deviation of the nasal septum with a bony spur. There\nis minimal mucosal thickening of the ethmoid sinuses. Otherwise, the\nparanasal sinuses are clear, with no significant mucosal thickening or\nair-fluid levels. The ostiomeatal units are patent. The cribriform plates are\nintact. The lamina papyracea are intact. There are no destructive osseous\nchanges. No periapical lucencies are identified in the maxilla mandible.\n\nThe parapharyngeal fat planes are symmetric.\n\nNo focal fluid collections are identified. The parotid and submandibular\nglands are symmetric without evidence of surrounding inflammatory changes. \nThere are a couple nonenlarged level 1B and level 2 lymph nodes. Otherwise,\nno lymphadenopathy by CT size criteria.\n\nThe mastoid air cells and middle ear cavities are clear. The globes are\nintact. The intraconal and extraconal fat planes are maintained.", + "output": "1. No focal or organizing fluid collections to suggest abscess formation. No\nevidence of inflammatory changes.\n2. No periapical lucencies in the maxilla or mandible.\n3. No significant mucosal thickening of the paranasal sinuses." + }, + { + "input": "External marker overlying the left anterolateral neck at the level of the\ncricoid cartilage (series 3, image 51) indicates the patient's region of\npalpable a interest. Deep to the marker and platysmas muscle is a\nnonenhancing fat attenuation 3.6 x 1.6 x 4.2 cm (TRV, AP, SI) well\nencapsulated lesion with a few small vessels coursing through it, compatible\nwith a lipoma. The lesion exerts posterior mass effect on the left\nsternocleidomastoid muscle.\n\nEvaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions. Mild degenerative changes of\nthe cervical spine is most prominent at C3-C4 and C5-C6 where there are small\ncentral protrusions which do not significantly narrow the spinal canal. No\nhigh-grade neural foraminal narrowing.", + "output": "1. Deep to an external marker and platysmas muscle at the left anterolateral\nneck at the level of the cricoid cartilage is a 4.2 cm well encapsulated fatty\nlesion most compatible with a lipoma.\n2. No other mass lesions are identified. The visualized aerodigestive tract\nis unremarkable.\n3. Additional findings as described above." + }, + { + "input": "There is no evidence of acute major infarction,hemorrhage, edema, or large\nmass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Head CT: There is no evidence of hemorrhage, edema, masses, mass effect, or\ninfarction. The ventricles and sulci are prominent likely reflecting\nage-related parenchymal volume loss. There is periventricular and subcortical\nwhite matter low attenuation which is nonspecific but likely on the basis of\nchronic small vessel ischemic disease. No fractures are identified. Patient\nis status post bilateral lens replacement. There is mucosal thickening within\nthe left anterior ethmoid air cells. The remaining paranasal sinuses and\nmastoid air cells are clear. Calcification of the intracranial vasculature is\nnoted. Calcification is seen in the left middle cerebral artery bifurcation.\n\nHead CTA: There is mild-to-moderate narrowing of the distal left cervical/\nproximal petrous portion of the left internal carotid artery. There is a\ncalcification noted along a branch of the left MCA just past the bifurcation. \nThere is no evidence of aneurysm or vascular malformation.\n\nNeck CTA: Patient is status post bilateral carotid endarterectomies. There\nis extensive arthrosclerotic calcification of the aortic arch. There is\nnormal three-vessel takeoff.\n\nThere are changes consistent with history of right side carotid\nendarterectomy. There is calcification along the right common carotid artery\nwith resulting areas of narrowing and irregularity. There is calcification\nalong the right internal carotid artery and at the bifurcation without\nsignificant stenosis on the right. The distal right internal carotid artery\nmeasures 5.0 mm.\n\nThere are calcifications also noted along the left common carotid artery and\ninternal carotid artery as well as postsurgical changes from left carotid\nendarterectomy. There is resulting severe stenosis of the left common carotid\nartery proximal to the bifurcation. There is calcification noted along the\nleft carotid bifurcation without significant stenosis of the left internal\ncarotid artery. The distal left internal carotid artery measures 5.5 mm.\n\nThe bilateral external carotid arteries are occluded proximally with distal\nreconstitution of flow.\n\nThere is calcification of the origins of the vertebral arteries bilaterally\nwith resulting mild to moderate narrowing. However they are patent distally.\nThe left vertebral artery is noted to be dominant.\n\nThere are emphysematous changes seen in the right greater than left lungs. \nThere is an 8 mm nodules seen in the right upper lung which is not clearly\nseen on prior study (series 5, image 43). The soft tissues the neck are\nunremarkable. There degenerative changes in the spine.", + "output": "1. No acute intracranial findings on unenhanced head CT.\n\n2. No evidence of aneurysm or malformation on head CTA. Mild to moderate\nnarrowing of the distal left cervical/early petrous left ICA is noted.\n\n3. Patient is status post bilateral carotid endarterectomies with expected\nsurgical changes. There is moderate narrowing irregularity of the right\ncommon carotid artery and severe stenosis of the left common carotid artery\njust proximal to the bifurcation. The bilateral internal carotid arteries are\npatent without significant stenosis.\n\n4. 8 mm right lung nodule.\n\nRECOMMENDATION(S): 8 mm light lung nodule not previously seen on prior chest\nCT dated ___. Comparison to a more recent prior would be helpful\nto establish stability. If no comparison is available, a dedicated chest CT\nis recommended with a follow-up at 3, 9, and 24 months to establish stability." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere are scattered small radiodense foreign bodies within and overlying the\nsubcutaneous tissues of the left scalp, likely glass. The largest such object\nmeasures up to 9 mm (03:25). There is no evidence of fracture. The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No evidence of acute intracranial process.\n2. Radiodense foreign bodies within the subcutaneous tissues of the left\nfrontal scalp, likely small shards of glass. No associated fracture." + }, + { + "input": "Overlying hardware streak artifact limits examination.\nThere is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\nThere is no definite evidence of calvarial fracture. There is minimal right\nparietal scalp soft tissue swelling at the vertex (see 601:75; 601:76).", + "output": "1. Overlying hardware streak artifact limits examination.\n2. No acute intracranial abnormality.\n3. No evidence acute intracranial hemorrhage or calvarial fracture.\n4. Minimal right parietal scalp soft tissue swelling.\n5. Please see concurrently obtained noncontrast maxillofacial and cervical\nspine CT for description of maxillofacial and cervical spine structures." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nNOSE: Nasopharyngeal soft tissues are unremarkable. There is no definite nasal\nseptal hematoma. There is a nondisplaced, comminuted fracture of the nasal\nbone with overlying soft tissue swelling. There is rightward nasal septal\ndeviation without definite associated fracture. Bilateral concha bullosa\npresent.\n\n SOFT TISSUES: There is no additional stranding,fluid collection,hematoma, or\nother soft tissue abnormality.\n\nMAXILLOFACIAL BONES: The maxillofacial bones are intact, without fracture.\nThe zygomatico-maxillary complex is intact. The lateral pterygoid plates are\nintact.\n\nMANDIBLE: The mandible is without fracture or temporomandibular joint\ndislocation. The temporomandibular joints are symmetric, without significant\ndegenerative change.\n\nDENTITION: There are no dental fractures. There is no remarkable periodontal\ndisease, periapical lucency, or odontogenic abscess.\n\nSINUSES: The paranasal sinuses are intact.Bilateral maxillary sinus, left\nfrontal sinus, bilateral ethmoid air cell, bilateral sphenoid sinus mucosal\nthickening is present. The ostiomeatal units are obstructed.The mastoid air\ncells and middle ear cavities are clear.\n\nORBITS: The orbits, including the laminae papyracea, are intact. The globes\nare intact with non-displaced lenses and no intraocular hematoma. There is no\npreseptal soft tissue edema. There is no retrobulbar hematoma or fat\nstranding.", + "output": "1. Dental amalgam streak artifact limits study.\n2. Nondisplaced, comminuted nasal bone fractures with overlying soft tissue\nswelling.\n3. Rightward nasal septal deviation without definite associated fracture.\n4. Bilateral concha bullosa present.\n5. Paranasal sinus disease, as described.\n6. Please see concurrently obtained noncontrast head CT and cervical spine for\ndescription of cranial and cervical spine structures." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nA 0.9 x 0.6 cm obstructive calculus is identified in the left sublingual\nregion with upstream enlargement of left submandibular duct ___ duct). \nLeft submandibular gland is hyperenhancing, enlarged, and edematous with\nsurrounding fat stranding. The right submandibular gland appears normal. \nBoth parotid glands are unremarkable.\n\nNo lymphadenopathy is present. There is no abscess. The thyroid gland\nappears normal. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.", + "output": "Left submandibular gland sialoadenitis due to obstructing 0.9 x 0.6 cm\nsialolith in ___ duct." + }, + { + "input": "There is no acute hemorrhage mass effect midline shift or hydrocephalus. \nChronic infarcts are seen in the right basal ganglia. Additional hypodensity\nin the right periventricular region also indicates infarcts of undetermined\nage but could be subacute in nature. Mild to moderate brain atrophy seen. \nBone images are unremarkable", + "output": "No acute hemorrhage is seen. Right basal ganglia infarcts are seen likely\nchronic to subacute. Small vessel disease and brain atrophy." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction, mass or midline\nshift. There is no hydrocephalus. Visualized paranasal sinuses and mastoid\nair cells are clear. There is no fracture. There is small contusion over the\nfrontal scalp.", + "output": "Small contusion over the frontal scalp but no acute intracranial abnormality." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is subtle loss of gray-white matter differentiation in a large portion\nof the left frontoparietal lobe, extending into the left temporal lobe.\nAdditionally, there is mild developing encephalomalacia and loss of gray-white\nmatter differentiation in the posterior left frontal and parietal lobes. \nFocal hypodensity is noted in the right caudate head, likely secondary to\nprior lacunar infarction.\n\nThere is no evidence of no evidence of hemorrhage, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThe visualized portion of the middle ear cavities are clear. Periapical\nlucency and dental caries of multiple maxillary and mandibular teeth are seen.\nThere is atelectasis and osteitis of the completely opacified left maxillary\nsinus. Partial opacification of the right mastoid air cells is seen. There\nis debris in the bilateral external auditory canals with no associated\nerosions, likely secondary to cerumen. There is a 1.1 cm lucent lesion in the\nleft greater wing of the sphenoid, series 5, image 180, which contains\n___ unit of -71.\n\nCTA HEAD: The left supra clinoid internal carotid artery is diminutive in\nappearance. There is a 0.4 cm filling defect in the left M1 MCA with very\nfaint distal reconstitution and decreased arborization on the left. There is\na 2 mm outpouching off of the left lateral supra clinoid internal carotid\nartery. There is a 2 cm segment of high-grade narrowing of the distal right\nM1 MCA, just proximal to the bifurcation. The dural venous sinuses are\npatent.\n\nCTA NECK: A dominant right vertebral artery is seen. The carotid and\nvertebral arteries and their major branches appear normal with no evidence of\nstenosis or occlusion. There is no evidence of internal carotid stenosis by\nNASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. There is a 1.0 cm nodule in\nthe right thyroid gland, which requires no further follow-up imaging given the\n___ College of Radiology guidelines. There is no lymphadenopathy by CT\nsize criteria. Multilevel degenerative changes throughout the spine are seen.", + "output": "1. Large left MCA acute infarction with 0.4 cm filling defect, consistent with\nthrombus, in the left M1 MCA with faint distal reconstitution and decreased\narborization. No hemorrhage, mass effect or midline shift.\n2. Subacute infarction in the posterior left frontoparietal lobe.\n3. A 2 mm outpouching off of the left lateral supra clinoid internal carotid\nartery, likely representing a small aneurysm.\n4. A 2 cm segment of high-grade narrowing in the distal right M1 MCA, just\nproximal to the bifurcation.\n5. A 1.1 cm lucent lesion in the left greater wing of the sphenoid which\nappears to contain internal fat within it and may represent an intraosseous\nlipoma. Recommend correlation with the ordered MRI for further evaluation.\n6. Extensive dental disease. Dental consultation is recommended." + }, + { + "input": "Redemonstrated is a large evolving subacute left MCA territory infarct. \nAllowing for differences in technique and head positioning, there appears to\nbe slightly increased mass effect on the affected sulci and the anterior horn\nand body of the left lateral ventricle. There is no significant shift of\nnormally midline structures. Hypodensity in the right caudate head is\ncompatible with an old lacunar infarct. There is no hemorrhage. In the left\nparietal lobe, areas of encephalomalacia appears unchanged.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "1. Large evolving subacute left MCA territory infarct with slightly increased\nedema and mass effect on adjacent sulci and the left lateral ventricle.\n\n2. There is no evidence of hemorrhagic transformation.\n\n3. Unchanged left parietal lobe encephalomalacia." + }, + { + "input": "There is loss of gray-white matter differentiation and significant vasogenic\nedema within the left frontal, parietal, insular, and temporal cortices\nextending into the underlying white matter and left caudate nucleus and\nputamen, corresponding to the left middle cerebral artery territory. There is\nmass effect with sulcal effacement, effacement of the left lateral ventricle,\nand mild 2 mm of left-to-right midline shift. There is no subfalcine or\ndownward herniation. There is no evidence of hemorrhagic conversion.\n\nThere is encephalomalacia at the right frontal operculum and a lacune at the\nright basal ganglia consistent with remote infarcts. There is mineralization\nof the globus paladi. There is no new acute territorial infarct. There is\ncalcification of the intracranial internal carotid arteries.\n\nThe orbits, soft tissues, and calvarium are unremarkable. There is fluid\nopacification of the partially visualized left maxillary sinus with osseous\nwall thickening, consistent with chronicity.", + "output": "1. Evolving left middle cerebral artery territory infarction with unchanged\nsignificant vasogenic edema and mass effect. No evident of hemorrhagic\nconversion. No evidence of subfalcine or downward herniation.\n2. Chronic appearing left maxillary sinus disease." + }, + { + "input": "There is no evidence of fracture, acute large territorial\ninfarction,hemorrhage,edema,or mass. There are mild bilateral subcortical and\nperiventricular white matter hypodensities, nonspecific but compatible with\nsequelae of chronic small vessel ischemic disease. Punctate hypodensity in\nthe left basal ganglia may reflect a chronic lacune or dilated perivascular\nspace (2:15). There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is mild mucosal thickening of the bilateral maxillary sinuses. \nOtherwise, the visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nnormal. Mild atherosclerotic calcifications of the cavernous carotid and left\ndistal vertebral arteries.", + "output": "1. No acute intracranial process. No evidence of intracranial mass or edema.\n2. Chronic microangiopathic and involutional changes." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe right parotid gland is enlarged and diffusely heterogenously enhancing in\ncomparison to the left, (series 2, image 20). There is periparotid fat\nstranding which extends superiorly around adjacent to the right auricle. No\nevidence of calculi in the parotid duct. No right parotid space fluid\ncollections are demonstrated. The constellation of these findings is\nconsistent with parotitis without calculus. The other salivary glands enhance\nnormally and are without mass or adjacent fat stranding. The thyroid gland\nappears normal. There is no lymphadenopathy by CT criteria. A few 6 mm right\ncervical lymph nodes are likely reactive, (series 2, image 33). The neck\nvessels are patent.\n\nSmall left pleural effusion with adjacent compressive atelectasis. Mild right\nposterior atelectasis. The imaged portion of the lung apices are clear and\nthere are no concerning pulmonary nodules or focal consolidation.There are no\nosseous lesions. Soft tissue density is demonstrated in the right external\nauditory canal, nonspecific but may represent cerumen. However, there does\nappear to be mild superficial enhancement, which may represent external\notitis. Direct visualization is advised.", + "output": "1. Findings concerning for right parotiditis without evidence of calculus. No\nparotid space fluid collections.\n2. Soft tissue density in the right external auditory canal is nonspecific,\nlikely cerumen. However, there is associated superficial enhancement, which\nmay represent superimposed otitis externa. Direct visualization is advised.\n3. Small left pleural effusion with adjacent compressive atelectasis." + }, + { + "input": "There is no evidence of fracture, acute territorial\ninfarction,hemorrhage,edema,or mass. Mild subcortical and periventricular\nwhite matter hypodensities are nonspecific, likely the sequelae of chronic\nsmall vessel ischemic disease. There is prominence of the ventricles and\nsulci suggestive of involutional changes. Vascular calcifications are noted\nalong bilateral carotid siphons in the left V4 segment.\n\nThere is mild mucosal thickening of bilateral maxillary sinuses and the\nethmoid air cells. Partially opacified right mastoid tip. The visualized\nportion of the remaining paranasal sinuses, left mastoid air cells, and middle\near cavitiesare clear. The visualized portion of the orbits are normal.", + "output": "1. No acute intracranial process, specifically no evidence of intracranial\nmass within limits of a noncontrast head CT." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. \nSubtle periventricular and subcortical white matter hypodensities are likely\nthe sequela of chronic small vessel ischemic changes. There is prominence of\nthe ventricles and sulci suggestive of involutional changes. Atherosclerotic\ncalcifications are noted in the bilateral ICAs.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "No acute intracranial pathology. Specifically, no evidence of acute\nintracranial hemorrhage." + }, + { + "input": "There is no evidence of fracture, large territory\ninfarction,hemorrhage,edema,or mass effect. There is prominence of the\nventricles and sulci suggestive of involutional changes.\n\nThere is bilateral periventricular hypodensities consistent with chronic small\nvessel ischemic disease that are seen on prior studies dating back to at least\n___.\n\nThere is atherosclerotic calcifications noted of the bilateral carotid siphons\nand vertebral arteries.\n\nThere is mild mucosal thickening of the ethmoid air cells and bilateral\nmaxillary sinuses. Otherwise, the visualized portion of the other paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are normal.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute vascular territory\ninfarction,hemorrhage,edema,ormass. The ventricles and sulci are normal in\nsize and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are normal. \nPostsurgical changes to the mandible and maxilla suggesting ORIF of previous\nmaxillofacial fractures.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. The dural venous\nsinuses are patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion.\n\n\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No acute intracranial abnormality.\n2. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n3. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Basal ganglia calcification is mild. Ventricles and sulci are\nnormal in overall size and configuration. A polyp versus retention cyst is\nnoted within the left maxillary sinus. The remainder of the imaged paranasal\nsinuses, mastoid air cells and middle ear cavities are well aerated. The bony\ncalvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is a 4 x 2.6 cm right temporal lobe hyperdensity with areas of internal\ncalcification that appears contiguous with the right internal carotid artery,\nwith surrounding hypodensity corresponding to edema. Expansion of the sella\nwith 1.4 x 1.1 cm lesion extending into the suprasellar cistern is identified\n(series 2, image 15). Right frontal encephalomalacia (series 2, image 22) is\nidentified.\n\nThere is no evidence of infarction or hemorrhage. There is complete\nopacification of the right maxillary sinus with sclerosis of the maxillary\nwall related to chronic sinusitis. There is near complete opacification of\nbilateral ethmoid sinuses and right sphenoid sinus. Diffuse dental caries and\nperiapical lucencies are identified. The mastoid air cells and orbits are\nunremarkable.\n\nCTA HEAD:\nThere is a partially thrombosed right carotid terminus aneurysm containing\ninternal hyperdensity, as described above, with 5 mm residual contrast\nenhancement at the neck (series 3, image 266). There are moderate vascular\ncalcifications of the cavernous and clinoid segments of bilateral internal\ncarotid arteries. There is a hypoplastic right vertebral artery. The left\nmid V4 segment of the vertebral artery demonstrates mild calcifications with\nmild luminal narrowing.\n\nCTA NECK:\nThere are extensive vascular calcifications at the bilateral carotid\nbifurcations resulting in approximately 60% right and 50% left internal\ncarotid artery stenosis by NASCET criteria. There is a left dominant\nvertebral artery. Otherwise, the vertebral and carotid arteries appear\npatent. There are vascular calcifications of the aortic arch. There are mild\ncalcifications of the proximal left subclavian artery.\n\nOTHER:\nThe thyroid gland appears unremarkable. There is biapical centrilobular\nemphysema. There is subcentimeter mediastinal lymph nodes without evidence of\nlymphadenopathy per size criteria.", + "output": "1. Right temporal lobe hyperdense mass communicating with the right internal\ncarotid artery terminus, compatible with a partially thrombosed giant\naneurysm, with a 5 mm enhancement at the neck.\n2. Vascular calcifications related to atherosclerotic disease with patency of\nthe intracranial vasculature.\n3. Atherosclerotic disease at the carotid bifurcations with approximately 60%\nright and 50% left internal carotid stenosis by NASCET criteria.\n4. Sellar based mass with suprasellar extension measuring at least 1.1 cm. \nThe lesion remodels the sella.\n5. Right frontal encephalomalacia, etiology uncertain, but potentially sequela\nprior trauma or infarct.\n6. Biapical centrilobular emphysema.\n7. Diffuse dental caries and periapical lucencies as well as evidence of\nchronic right maxillary sinusitis is noted. Clinical correlation for\nodontogenic sinusitis is recommended. Additional sinus disease as described\nabove." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is redemonstration of a heterogeneously mildly hyperdense 4.1 cm TV x\n2.8 cm AP mass with areas of internal calcification in the right temporal\nregion, which appears contiguous with the right supraclinoid internal carotid\nartery. In comparison to the prior MRI and CTA dated ___, this is\nconsistent with a thrombosed aneurysm. This appears slightly increased in\nsize compared to prior exam with an increase in peripheral calcification. \nThere is mass effect on the adjacent right temporal lobe.\n\nThere is a heterogeneous mass in the sellar/suprasellar region measuring\napproximately 1.5 cm AP x 2 cm TV. The mass abuts the optic chiasm.\n\nThere is redemonstration of encephalomalacia in the right frontal lobe. There\nis also a moderate size chronic infarction the right cerebellar hemisphere. \nThere is no evidence of recent or hemorrhage. Mild prominence of the\nventricles and sulci is suggestive of involutional changes. There is no\nmidline shift.\n\nThere is complete opacification of the right maxillary sinus and near complete\nopacification of the right ethmoid air cells. There is moderate opacification\nof the right frontal sinus and right frontoethmoidal recess. The mastoid air\ncells and middle ear cavities are clear. The intraorbital contents are\nunremarkable.\n\nCTA HEAD:\nThere are moderate to extensive nonocclusive atherosclerotic calcifications of\nthe cavernous and supraclinoid internal carotid arteries, right greater than\nleft.\n\nThe vast majority of the aneurysm does not demonstrate contrast opacification.\nThere is residual contrast filling at the neck/base of the aneurysm measuring\n6 mm AP x 7 mm TV by 7 mm SI (image 93 of series 3). This appears this\nappears somewhat larger the than on the prior CTA.\n\nThe left vertebral artery is dominant with a smaller caliber right vertebral\nartery. There are moderate nonocclusive atherosclerotic calcifications of the\nleft V4 segment. There is opacification of the vertebrobasilar system and\nboth posterior cerebral arteries. No occlusion.", + "output": "1. Partially thrombosed aneurysm emanating from the right supraclinoid\ninternal carotid artery with mild enlargement of the residual lumen and mild\nenlargement of the thrombosed component.\n2. Redemonstration of a sellar mass extending into the suprasellar cistern\nmass with mass effect on the optic chiasm. This is favored to represent a\npituitary macroadenoma. Consider further evaluation with contrast-enhanced\npituitary MRI.\n3. Moderate to extensive atherosclerotic calcifications of the cavernous\ninternal carotid arteries.\n4. Otherwise, patent head vasculature with no evidence of occlusion.\n5. Unchanged right frontal encephalomalacia.\n6. No evidence of recent infarction or hemorrhage." + }, + { + "input": "Large confluent hypodensity involving the right frontal, parietal, and\ntemporal lobes and right basal ganglia is compatible with known infarction\nbetter characterized on MRI from earlier today, ___. When compared\nto the CT head performed ___, the degree of right cerebral edema\nhas progressed with worsening sulcal effacement particularly notable at the\nvertex. The edema is causing increased mass effect on the right lateral\nventricle and local sulci. There is a 2 mm leftward midline shift.\n\nAdditionally, there is redemonstration of a 3.7 x 2.6 cm ovoid hyperdensity\nwith internal calcifications in the right temporal lobe, compatible with known\nright internal carotid artery aneurysm, which is similar in size and\nappearance compared to CT dated ___.\n\nSimilar to prior, the pituitary gland appears enlarged but is incompletely\ncharacterized on this exam. Chronic infarcts in the right cerebellum are\nunchanged.\n\nThere is no evidence of intracranial hemorrhage.\n\nThere is no evidence of fracture. Mucosal thickening of the ethmoid and\nbilateral sphenoid sinuses. Otherwise, the visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavitiesare essentially\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial hemorrhage.\n2. Redemonstration of right MCA infarction, the degree of right cerebral edema\nand mass effect has increased since ___. 2 mm of leftward midline\nshift however no evidence of subfalcine or uncal herniation..\n3. 3.7 cm right internal carotid artery aneurysm is again seen and unchanged\nin size and appearance compared to prior CT dated ___.\n4. Similar to prior, the pituitary gland appears enlarged but is incompletely\ncharacterized on this exam.\n5. Sinus disease as above." + }, + { + "input": "Study is degraded by motion and overlying hardware artifact.\n\nThere is redemonstration of a large area of confluent hypodensity in the right\nfrontal, parietal, and temporal lobes and right basal ganglia, compatible with\nknown infarction better characterized on MRI dated ___. Compared\nto most recent head CT dated ___, the degree of right cerebral\nedema has slightly increased with increased mass effect on the posterior horn\nof the right lateral ventricle. There is a 3 mm leftward midline shift. \nAdditionally, there is chronic infarction of the right cerebellum again seen.\n\nThere is redemonstration of a 3.2 x 2.8 cm ovoid hyperdensity with internal\ncalcifications, compatible with known right internal carotid artery aneurysm,\nsimilar in size and appearance.\n\n No acute large territory infarction or intracranial hemorrhage noted.\n\nThere is no evidence of fracture. There is mucosal thickening of the right\nmaxillary, ethmoid, and bilateral sphenoid sinuses, which may be related\nintubation status. Asymmetric right maxillary sinus bony sclerosis is again\nnoted, suggestive of chronic sinus disease. The visualized portion of the\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. Study is degraded by motion and overlying hardware artifact.\n2. Minimal progression of right cerebral edema with increased mass effect on\nthe posterior horn of the right lateral ventricle and 3 mm leftward midline\nshift.\n3. Study, grossly stable approximately 3.2 cm right internal carotid artery\naneurysm.\n4. Right cerebellar chronic infarct." + }, + { + "input": "Again seen is a large area of confluent hypodensity in the right frontal,\nparietal, and temporal lobes as well as right insula and basal ganglia,\nconsistent with known infarction which is better characterized on prior MRI\nfrom ___. Compared to the immediate prior there is minimal\nincrease in cerebral edema with mildly worsened mass-effect and 4 mm of\nleftward midline shift, previously 3 mm. Chronic infarction of the right\ncerebellum is similar to prior. No cerebellar tonsillar or subfalcine\nherniation. There is crowding of the uncus, which is edematous, without\ndefinite uncal herniation.\n\nRedemonstration of a 3.4 X 2.5 cm ovoid hyperdensity with internal\ncalcifications compatible with known right internal carotid artery aneurysm,\npreviously measuring 3.2 x 2.8 cm.\n\nNo new large territorial infarct is seen. No evidence of intracranial\nhemorrhage.\n\nThere is no evidence of fracture. Severe mucosal thickening of the ethmoidal\nair cells. Moderate right and mild left maxillary sinus mucosal thickening. \nEndotracheal tube is again partially visualized. The visualized portion of\nthe mastoid air cells. The visualized portion of the orbits are unremarkable.", + "output": "1. Extensive right MCA territory infarction with minimal interval worsening of\nleftward midline shift measuring 4 mm, previously 3 mm.\n2. Grossly unchanged 3.4 cm right internal carotid artery aneurysm.\n3. Chronic right cerebellar infarct." + }, + { + "input": "Redemonstration of a large confluent hypodensity spanning the right frontal,\nparietal, temporal lobes and basal ganglia, consistent with known infarct that\nis better characterized on prior MRI dated ___.\n\nIn comparison to CT head without contrast dated ___, there is\npersistent mass-effect, resulting in an unchanged 4 mm leftward midline shift\nand near complete effacement of the right lateral ventricle. Ventricles and\nsulci are grossly stable in size and configuration compared ___\nprior exam.\n\nRedemonstration of a 3.6 x 2.7 cm ovoid hyperdensity with internal\ncalcifications, compatible with a known right internal carotid artery\naneurysm, previously 3.4 x 2.5 cm.\n\nNo new large territorial infarct or acute intracranial hemorrhage. Chronic\ninfarct to the right cerebellum.\n\nThere is no evidence of fracture. Patient is intubated. Severe mucosal\nthickening of the ethmoid air cells. Moderate to severe right maxillary sinus\nfluid opacification. Moderate mucosal thickening of the left maxillary sinus.\nThe visualized portion of the orbits are preserved.", + "output": "1. Redemonstration of an extensive right MCA territory infarct with unchanged\n4 mm leftward midline shift.\n2. Allowing for differences in measurement techniques, grossly unchanged right\ninternal carotid artery aneurysm, measuring up to 3.6 cm.\n3. No new acute intracranial infarct or hemorrhage.\n4. Chronic right cerebellar infarct." + }, + { + "input": "Patient status post known right middle cerebral artery infarct with evolving\nlarge confluent hypodensity spanning the right frontal, parietal and temporal\nlobes. In comparison to prior, there is slightly decreased hypodensity and\nsmall possible area of hemorrhagic conversion (02:25). There a minimally\ndecreased leftward midline shift, measuring 3 mm (02:24), previously 4 mm with\nunchanged near complete effacement of the right lateral ventricle. The\nventricles and sulci are enlarged, but stable in comparison to the study of ___.\n\nRedemonstration of a 2.6 x 4 cm ovoid hyperdensity with internal\ncalcifications (02:16), previously measuring 3.6 x 2.7 cm, consistent with\nknown right internal carotid artery aneurysm.\n\nUnchanged chronic infarct in the right cerebellum.\n\nThere is no gross evidence of acute fracture. Partially visualized ET tube in\nappropriate position. In comparison to the prior study, slight interval\nincrease in sinus disease involving the bilateral ethmoid air cells, bilateral\nmaxillary sinus disease and left sphenoid sinus. Partial opacification of the\nbilateral frontal sinuses remain unchanged. The middle air cavities are\nunremarkable. The visualized portion of the orbits are unremarkable.", + "output": "1. Redemonstration of evolving extensive right MCA territory infarct with\npossible hemorrhagic conversion versus hyperdensity from cortical laminar\nnecrosis and crowded cortex and slightly decreased 3 mm leftward midline\nshift. No worsening hydrocephalus.\n2. Grossly unchanged right internal carotid artery aneurysm.\n3. Slightly worsening, diffuse sinus disease.\n4. No new large territory intracranial infarct or hemorrhage.\n5. Chronic right cerebellar infarct." + }, + { + "input": "Evolution of previously identified large area of confluent hypodensity in the\nright frontal, parietal, and temporal lobes as well as right insula and basal\nganglia, consistent with known large MCA territory infarction. There is no\nnew intracranial hematoma to suggest hemorrhagic transformation.\n\nEssentially unchanged leftward midline shift by about 5 mm. Redemonstration\nof right perimesencephalic cistern effacement with questionable small uncal\nherniation (series 3, image 17).\n\nChronic infarction of the right cerebellum is similar to prior. No cerebellar\ntonsillar herniation.\n\nEssentially unchanged 3.9 x 2.8 cm ovoid hyperdensity with internal\ncalcifications compatible with known right internal carotid artery aneurysm,\npreviously measuring 3.4 X 2.5 cm. Pipeline stent noted.\n\nNo new large territorial infarct is seen.\n\nComplete opacification of all paranasal sinuses which progressed when compared\nto the previous exam. Endotracheal tube is again partially visualized. \nComplete opacification of both mastoid air cells.", + "output": "1. Evolution of large MCA territory infarction with no imaging signs to\nsuggest hemorrhagic transformation.\n2. Essentially unchanged leftward midline shift by 5 mm as well as\nquestionable small right uncal herniation.\n3. Grossly unchanged 3.4 cm right internal carotid artery aneurysm." + }, + { + "input": "Centered within the right temporal lobe is an 2.6 x 3.6 cm lesion with coarse\ncalcifications. The medial aspect of this lesion is contiguous with a 1 cm\nperipherally calcified outpouching of the right internal carotid artery\n(3:16), the latter consistent with an aneurysm. Therefore, the right temporal\nlesion could represent a giant thrombosed aneurysm. There is surrounding\nvasogenic edema in the right temporal lobe, extending into the right external\ncapsule, subcortical white matter of the right insula, and posterior right\ninternal capsule. The medial right temporal lobe effaces the right ambient\ncistern without significant midbrain deformity.\n\nThere is volume loss with encephalomalacia/gliosis involving the right frontal\noperculum and supraorbital right frontal lobe. There is also a moderate-sized\narea of encephalomalacia/gliosis in the right posterior inferior cerebellar\nhemisphere, most likely chronic infarct (3:6).\n\nA hyperdense soft tissue lesion involving the sella and suprasellar cistern\nabutting the optic chiasm, as seen on the subsequent CTA sagittal/coronal\nreformats. The mass measures 1.6 x 1.0 cm in maximal axial cross-section on\nimage 3:17. On the subsequent CTA, the mass measures 1.7 cm craniocaudad, 1.3\ncm AP, 1.4 cm transverse. There is a curvilinear calcification along the\nmedial aspect of the mass on image 3:17.\n\nThere is no acute hemorrhage. The ventricles are age-appropriate.\n\nThere is a minimally displaced comminuted left nasal bone fracture, partially\nvisualized, chronicity uncertain (04:23, 04:31). There is partially\nvisualized soft tissue swelling over the contralateral right nasal bone\n(04:26). No calvarial fractures are seen.\n\nThere is complete opacification of the right maxillary sinus with partially\nhyperdense material, extending into the ostiomeatal unit. Posterolateral and\nanterior walls of the right maxillary sinus are thickened, and the medial wall\nis partially demineralized, compatible with sequela of chronic inflammation. \nThere is also new complete opacification of right anterior ethmoid air cells\nwith partial demineralization of the adjacent ethmoid septae. Right\nfrontoethmoidal recess is occluded. There is moderate mucosal thickening in\nthe right frontal sinus.\n\nThere is mild mucosal thickening in the left frontal sinus and left\nfrontoethmoidal recess, as well as a combination of opacification and mild\nmucosal thickening in the left anterior ethmoid air cells. There is mild\nmucosal thickening along the medial wall of the left maxillary sinus.\n\nThere is polypoid mucosal thickening/mucous retention cysts in the left\nposterior ethmoid and mild mucosal thickening in the right posterior ethmoid\nwith demineralization of adjacent septa. There is fluid/dependent secretions\nand mucosal thickening moderately opacifying the right sphenoid sinus, and\nmild mucosal thickening in the left sphenoid sinus.\n\nThere are aerosolized secretions in the left concha bullosa. There is a large\nright nasal septal spur and mild rightward nasal septal deviation.\n\nThere are multiple bilateral periapical lucencies in the partially visualized\nmaxillary alveolar ridge, which also demonstrates evidence of numerous dental\nextractions.\n\nThere is trace mucosal thickening in bilateral mastoid air cells.", + "output": "1. 3.6 x 2.6 cm right temporal lesion with coarse calcifications is contiguous\nwith a 1 cm peripherally calcified outpouching of the right internal carotid\nartery, the latter consistent with an aneurysm. Therefore, the entire right\ntemporal lesion could represent a thrombosed giant aneurysm, versus a mass.\n2. Sellar/suprasellar mass abutting the optic chiasm, with a single peripheral\ncurvilinear calcification, could represent a macroadenoma or a\ncraniopharyngioma.\n3. Encephalomalacia/gliosis in the right frontal operculum and supraorbital\nright frontal lobe, which may be secondary to prior infarction or trauma. \nEncephalomalacia/gliosis in the right posterior inferior cerebellar\nhemisphere, likely secondary to prior infarction.\n4. No acute intracranial hemorrhage.\n5. Comminuted left nasal bone fracture, partially visualized, uncertain\nchronicity. Partially visualized soft tissue swelling overlying the\ncontralateral right nasal bone.\n6. Chronic right maxillary and anterior ethmoid sinusitis with complete\nopacification and osseous remodeling, occlusion of the right ostiomeatal unit\nand right frontoethmoidal recess, and mucosal thickening extending into the\nright frontal sinus. Chronic left posterior ethmoid sinusitis. Moderate left\nanterior ethmoid and mild left frontal sinusitis, chronicity uncertain. \nFluid/secretions in the right sphenoid sinus and aerosolized secretions in the\nleft concha bullosa indicate active inflammation.\n7. Numerous bilateral periapical lucencies and evidence of multiple dental\nextractions in the partially visualized maxillary alveolar ridge, raising the\npossibility of odontogenic contribution to etiology of sinusitis.\n\nRECOMMENDATION(S): Combined brain MRI with and without contrast and pituitary\nMRI with and without contrast for better evaluation of the right temporal and\nsellar/suprasellar lesions, unless there are recent prior studies for\ncomparison. CTA of the head/neck has already been performed at the time of\nfinal dictation." + }, + { + "input": "There is no acute intracranial hemorrhage, evidence of acute major vascular\nterritorial infarction, edema or mass effect. The ventricles and sulci are\nslightly prominent likely secondary to age related involutional changes.\nScattered periventricular and subcortical white matter hypodensities likely\nreflect chronic small vessel ischemic disease. The basal cisterns are clear. \nThe gray white matter differentiation appears preserved.\n\nNo fracture is identified. The visualized paranasal sinuses, mastoid air\ncells and middle ear cavities are clear.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is moderate subarachnoid hemorrhage in the right frontal sulci and\nwithin the basal cisterns bilaterally. There is also a subdural hematoma at\nthe right frontal vertex measuring 8 mm, image ___:52, which slightly\ndisplaces the adjacent parenchyma. There is also minimal layering blood\nwithin the occipital horns of the lateral ventricles. The ventricles are\nstable in size compared to ___. There is mild leftward shift of the\nseptum pellucidum. There is no cisternal effacement.\n\nProminent ventricles and sulci suggest age related global parenchyma atrophy. \nExtensive confluent periventricular, deep, and subcortical white matter\nhypodensities are nonspecific, but likely reflect sequelae of chronic small\nvessel ischemic disease.\n\nThere is no fracture. There is minimal mucosal thickening in the anterior\nethmoid air cells. Other visualized paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear.", + "output": "1. Acute subdural hematoma along the right frontal convexity at the vertex, 8\nmm in maximal width, slightly displacing the adjacent brain parenchyma.\n2. Moderate subarachnoid hemorrhage in the right frontal sulci and basal\ncisterns.\n3. Minimal intraventricular hemorrhage." + }, + { + "input": "Moderate subarachnoid hemorrhage in the right frontal sulci has minimally\nincreased compared to approximate 9 hr earlier, for example on image 3:36. \nModerate subarachnoid hemorrhage in the basal cisterns has not significantly\nchanged. Subdural hematoma at the right frontal vertex, which mildly\ndisplaces the adjacent brain parenchyma, appear stable on axial images, though\nits configuration was best demonstrated on the reformatted coronal images of\nthe prior exam. Minimal hemorrhage layering within the occipital horns of the\nleft and right lateral ventricles is also stable. The ventricles are stable\nin size. Extensive confluent hypodensities in the periventricular, deep, and\nsubcortical white matter of the cerebral hemispheres are again seen,\nnonspecific but likely sequela of chronic small vessel ischemic disease in a\npatient of this age.\n\nNo fracture is seen. Minimal mucosal thickening is again seen in the anterior\nethmoid air cells. Other paranasal sinuses and mastoid air cells are well\naerated. Multiple maxillary periapical lucencies are again seen, better\nassessed on the facial bone CT performed earlier on the same day.", + "output": "1. Moderate subarachnoid hemorrhage in the right front sulci appears minimally\nincreased compared to approximately 9 hr earlier. Moderate subarachnoid\nhemorrhage in the basal cisterns is stable.\n2. Right frontal vertex subdural hematoma is stable, with stable mild\ndisplacement of the adjacent brain parenchyma.\n3. Minimal intraventricular hemorrhage is stable." + }, + { + "input": "There is an essentially unchanged degree of moderate subarachnoid hemorrhage\nlayering within the right frontoparietal sulci. Subarachnoid hemorrhage\nwithin the basal cisterns, and a subdural hematoma along the right vertex\ncausing mild local mass effect are also stable. Redemonstrated is a small\namount of layering hemorrhage within the left and right lateral ventricles. \nThe ventricles are stable in size. Periventricular subcortical white matter\nhypodensities are unchanged and likely secondary to chronic small vessel\nischemic disease. There is no evidence of fracture. The paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear.", + "output": "Essentially unchanged appearance of subarachnoid, subdural, and\nintraventricular hemorrhage, as above, as compared to the prior examination\nperformed 9 hr earlier." + }, + { + "input": "There is unchanged moderate subarachnoid hemorrhage layering along the right\nfrontoparietal convexities. The subarachnoid hemorrhage in the basal cisterns\nappear to have decreased slightly in the interim. Intraventricular hemorrhage\nis mostly stable. The right frontal subdural hematoma is unchanged and\nmeasures 9 mm from the inner table in maximum dimension. There appears to be\na new focus of hyperdensity overlying the left parietal lobe measuring\napproximately 8 mm from the inner table (07:23), which could represent a\nanother focus of subdural hemorrhage versus redistribution of the blood\nproducts. There is no shift of midline structures or downward herniation. \nVentricles are stable in size. Gray-white matter differentiation is\npreserved.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. New focus of hyperdensity overlying the left parietal lobe which could\nrepresent a small subdural hematoma measuring 8 mm from the inner table,\nredistribution of the blood products is also a consideration, close follow-up\nin this area is advised.\n\n2. Unchanged appearance of moderate subarachnoid hemorrhage layering along\nthe right frontoparietal convexities as well as the right frontal subdural\nhematoma. Slightly decreased subarachnoid in the basal cisterns. \nIntraventricular hemorrhage is stable.\n\nRECOMMENDATION(S): New focus of hyperdensity overlying the left parietal lobe\nwhich could represent a small subdural hematoma measuring 8 mm from the inner\ntable, redistribution of the blood products is also a consideration, close\nfollow-up with head CT is recommended." + }, + { + "input": "There has been significant interval decrease in appearance of right frontal\nintraparenchymal hemorrhage with surrounding subarachnoid hemorrhage effacing\nthe sulci. Only trace extra-axial hyperdensity remains along the right\nfrontal convexity at the site of prior subdural hematoma (303b:50). The small\nleft parietal convexity hemorrhage has resolved. Only a tiny amount of\nresidual hemorrhagic material layers in the dependent dual horn of the left\nlateral ventricle (03:14), improved since the prior study. There is no new\nfocus of hemorrhage or evidence 6 of acute vascular territorial infarction. \nThere is no midline shift. The ventricles and sulci are unchanged in size and\nmorphology.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. Overall significant interval improvement in multifocal intracranial\nhemorrhage, with resolution of tiny left parietal subdural hematoma and\nnear-complete resolution of right frontal subdural hematoma.\n2. Tiny residual focus of intraventricular hemorrhage in the occipital horn of\nthe left lateral ventricle, also improved." + }, + { + "input": "Previously noted intracranial hemorrhage has resolved, and no new intracranial\nhemorrhage is seen. There is a small focus of low density at the site of the\nprior right frontal parenchymal hemorrhage at the vertex. There also\nconfluent areas of low-density in the subcortical, deep, and periventricular\nwhite matter of the cerebral hemispheres, nonspecific but likely sequela of\nchronic small vessel ischemic disease in a patient of this age. There is also\nstable small focus of encephalomalacia in the right external capsule,\nconsistent with a chronic small vessel infarct. Mild age-related prominence\nof the ventricles and sulci is again noted.\n\nThe bones are unremarkable. The imaged paranasal sinuses and mastoid air cells\nare well aerated.", + "output": "Resolution of intracranial hemorrhage. No evidence for new intracranial\nabnormalities." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is a 6.3 (AP) x 3.5 (TV) x 4.4 (SI) cm hyperdense intraparenchymal\nhemorrhage within the posterior left temporal cortex which demonstrates\ninternal areas of hypodensity suggestive of fluid / fluid levels. There is\nassociated adjacent hypodense edema and mass effect which effaces the atria\nand occipital horn of the left lateral ventricle. There is asymmetric\nprominence of the left temporal horn lateral ventricle concerning for\nentrapment. There is sulcal effacement with, 3 mm of left-to-right midline\nshift without evidence of subfalcine or downward herniation.\n\nThere is extensive periventricular white matter hypodensity, likely\nrepresenting sequela of chronic microangiopathy.\n\nThe orbits, calvarium and soft tissues are unremarkable. Paranasal sinuses\nand mastoid air cells are clear.\n\nCTA HEAD:\nAgain seen is a 6.3 (AP) x 3.5 (TV) x 4.4 (SI) cm hyperdense intraparenchymal\nhemorrhage within the left posterior temporal cortex with curvilinear\npostcontrast enhancement at its posterior lateral margin near the cortical\nsurface measuring 4 mm (4:288), consistent with a CTA spot sign.\n\nThere is calcific atherosclerosis of the bilateral cavernous to communicating\nsegment internal carotid arteries without significant luminal stenosis. The\nanterior circulation is patent without evidence of occlusion, significant\nstenosis, dissection, or aneurysm. There are prominent bilateral posterior\ncommunicating arteries.\n\nThe bilateral vertebral arteries are diminutive with the left vertebral artery\nending in an ___ complex. There is focal calcification at the left\nV3-V4 junction. The right vertebral artery is diminutive with a fusiform\naneurysm at the vertebrobasilar junction measuring 3 mm (4:239). The basilar\nartery is for markedly narrowed and beaded and its appearance with short\nsegments of non filling at its mid to superior aspect.\n\nCTA NECK:\nThere is calcific and noncalcified atherosclerosis at the right carotid\nbifurcation carotid bulb with 40% stenosis at the carotid bulb by NASCET\ncriteria.\n\nThere is calcific atherosclerosis at the left carotid bulb without significant\nluminal stenosis by NASCET criteria.\n\nThe bilateral vertebral arteries are diminutive, but patent along their\ncervical course without evidence of occlusion, stenosis, aneurysm, or\ndissection. There is suggested narrowing and bilateral vertebral artery\norigins.\n\nThere is calcific atherosclerosis of the aortic arch. The visualized lung\napices are clear. The thyroid gland is unremarkable. There is no cervical\nlymphadenopathy by CT criteria. There is a periapical lucency at the right\nmaxillary first molar (04:20 2)", + "output": "1. 6.3 cm left temporoparietal intraparenchymal hemorrhage with central low\ndensity peripheral focus suggestive of active, hyperacute bleeding.\n2. Edema and mass effect related to left temporoparietal hemorrhage with\nconcern for left temporal horn entrapment as described. Recommend clinical\ncorrelation.\n3. While no definite underlying mass identified, please note that underlying\nmass cannot be excluded on the basis examination. Recommend clinical\ncorrelation and imaging followup to resolution. Consider MRI for further\ncharacterization.\n4. Markedly narrowed and beaded appearance of the vertebrobasilar system with\nsegments of absent limited enhancement within mid to superior basilar artery,\nconcerning for occlusion or slow flow.\n5. 3 mm fusiform aneurysm at the inferior basilar artery.\n6. Patent cervical vasculature with atherosclerosis changes of the bilateral\ncarotid bifurcations and bulbs, as described.\n7. Diminutive bilateral cervical vertebral arteries with suggested narrowing\nand bilateral origins.\n8. Periapical lucency at the right maxillary first molar. Recommend follow-up\nwith dentistry.\n\nRECOMMENDATION(S): Periapical lucency at the right maxillary first molar. \nRecommend follow-up with dentistry." + }, + { + "input": "Again demonstrated is a 6.3 x 3.6 cm left posterior temporal intraparenchymal\nhemorrhage with surrounding edema and resultant rightward shift of midline\nstructures measuring 3 mm not significantly increased in size from CTA\nperformed at 16:40 today. No additional hemorrhage or infarction is\nidentified. There is mass effect upon the left lateral ventricle however\nthere is no evidence of herniation and the basal cisterns are patent.\n\n.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No significant change in the size of a 6.3 cm left posterior temporal\nintraparenchymal hemorrhage with surrounding edema. No new hemorrhage or\ninfarction identified.\n2. 3 mm of midline shift is stable from the prior study." + }, + { + "input": "Again seen is a 6.4 x 3.4 cm left posterior temporal intra parenchymal\nhemorrhage with surrounding edema with mild displacement of the medial portion\nof the left temporal lobe on the cistern, minimally increased from prior CT on\n___ (03:12). No additional hemorrhage or infarction is\nidentified. Mild mass effect upon the left lateral ventricle is again\ndemonstrated, unchanged from prior.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No significant change in the size of the 6.4 cm left posterior temporal\nintraparenchymal hemorrhage with surrounding edema. No new hemorrhage or\ninfarction identified.\n2. Medial displacement of the left temporal lobe on the cistern." + }, + { + "input": "Large parenchymal hemorrhage involving the left parietal, occipital, and\nposterior temporal lobes appears stable compared to 1 day earlier, with\nunchanged surrounding edema.Effacement of the posterior components of the left\nlateral ventricle, partial effacement of the third ventricle, and mild\nrightward shift of midline structures are unchanged. Trace blood in the\noccipital horns of the lateral ventricles is unchanged as well. Mild medial\ndisplacement of the left medial temporal lobe, which abuts the midbrain, is\nunchanged. Diffuse supratentorial white matter hypoattenuation is unchanged,\nlikely sequela of chronic small vessel ischemic disease in this age group.\n\nThe bones are unremarkable. The imaged paranasal sinuses and mastoid air cells\nare grossly well aerated.", + "output": "Stable large left parietal/occipital/ posterior temporal hemorrhage with\nstable surrounding edema and stable mass effect." + }, + { + "input": "The study is mildly limited by motion artifact through the posterior fossa and\ninferior temporal lobes.\n\nThe previously seen large intraparenchymal hemorrhage involving the left\nparietal, occipital, and posterior temporal lobes demonstrates decreased size\nand decreased density of blood products since ___. Mild edema persists\nsurrounding the hemorrhage. The occipital horn and atrium of the left lateral\nventricle remain effaced, but the body and frontal horn have re-expanded. The\nthird ventricle has also re-expanded. Rightward shift of midline structures\nhas decreased. Left perimesencephalic cistern has re-expanded.\n\nThere is no new hemorrhage.\n\nAside from the local mass effect related to the above described parenchymal\nhematoma, the ventricles and sulci are prominent due to age-related\nparenchymal volume loss. Diffuse supratentorial white matter hypodensities\nare grossly unchanged, nonspecific but likely sequelae of chronic small vessel\nischemic disease.\n\nNo evidence of an acute fracture. There is mild mucosal thickening of the\nleft maxillary, bilateral ethmoid, and bilateral sphenoid sinuses. Mastoid\nair cells are clear. Visualized orbits are grossly unremarkable.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. Previously demonstrated large left parietal/occipital/posterior temporal\nhematoma has slightly decreased in size and density compared to ___, with decreased mass effect." + }, + { + "input": "Interval evolution of previously seen large left parietal/ occipital/posterior\ntemporal hematoma with interval decrease an hyperdensity/ acute blood, without\ndefinite evidence of new intracranial hemorrhage. There has been some\ninterval volume loss which/ likely evolving encephalomalacia, with possible\nresidual underlying edema in the region, with mild ex vacuo dilatation of the\nleft temporal horn. The left posterior horn is no longer as compressed as on\nthe prior study. Prominence of the ventricles and sulci is consistent with\ncortical volume loss. Periventricular and subcortical white matter\nhypodensities bilaterally are most consistent with sequela of chronic small\nvessel disease. The visualized paranasal sinuses are clear. The mastoid air\ncells are clear. No acute fracture is seen.", + "output": "No definite new intracranial hemorrhage. Interval evolution of previously\nseen large left parietal/occipital/ posterior temporal hematoma with interval\nsignificant decrease in hyperdensity/ acute blood, without definite evidence\nof new intracranial hemorrhage.\nInterval volume loss, likely evolving encephalomalacia in the region, with\nmild ex vacuo dilatation. Residual underlying edema in the region is\npossible, however, there is significantly less mass effect than on the prior\nstudy." + }, + { + "input": "CT head:\nThere is ill-defined isointensity within left posterior temporoparietal cortex\nmeasuring approximately 3.6 cm AP x 1.6 cm TV (02:17), with adjacent\nhypodensity, consistent with an unchanged parenchymal hematoma which is\ndecreased in comparison to ___. There is background extensive\nperiventricular subcortical white matter hypodensity, likely reflecting\nsequela of chronic microangiopathy. There is no CT evidence of acute\nterritorial infarct, hemorrhage, mass, or mass effect. The ventricles are\ndilated, mildly out of proportion to the degree of cortical sulcation\nmeasuring up to 3.8 cm in diameter at the anterior horns which is mildly\nincreased as compared to ___, when it measured 3.3 cm. The\nextra-axial spaces are unremarkable. The orbits, calvarium, and soft tissues\nare unremarkable. The paranasal sinuses and mastoid air cells are clear.\n\nCTA head:\nThere is calcification of the bilateral intracranial internal carotid\narteries, without significant stenosis. The anterior and bilateral posterior\ncommunicating arteries are visualized. There bilateral fetal origin posterior\ncerebral arteries. There is a beaded stenosis anterior circulation consistent\nwith intracranial atherosclerosis, which is most apparent at a short segment\nmild stenosis at the proximal left M1 segment middle cerebral artery. There\nis a hypoplastic left A1 segment.\n\nThe proximal posterior circulation is diminutive with calcification and\nsevere beaded stenosis of the bilateral vertebral arteries and basal artery. \nThe left vertebral artery ends in the posterior inferior cerebellar artery. \nThere is severe stenosis of the right vertebral and basilar artery with\nocclusion or slow flow at the mid to upper basilar artery. The superior basal\nartery and its branches are likely filled via retrograde flow from the\nposterior communicating arteries. There is a 3 mm aneurysm at the junction of\nthe right vertebral artery with the basilar artery (03:222), which is\nunchanged. The dural venous sinuses are patent.\n\nCTA neck:\nThere is 3 vessel aortic arch. The subclavian arteries are patent. There is\natherosclerosis at the right carotid bulb with 40% stenosis by NASCET\ncriteria. There is atherosclerosis at the left carotid bifurcation bulb\nwithout significant stenosis by NASCET criteria. There is a diminutive\nappearance of the bilateral vertebral arteries, which are patent.\n\nThe pharynx, larynx, and nasal cavities are unremarkable. There is torus\npalatini. There is a periapical lucency at the left maxillary central incisor\n(3:190) and the right maxillary first molar (3:192). The masticator\nparapharyngeal spaces are unremarkable. The thyroid and salivary glands are\nunremarkable. There are no suspicious lymph nodes by size or morphology. The\nlung apices are clear. There is with catheter within the left subclavian vein\nextending into the superior vena cava. There are multilevel degenerative\nchanges of the cervical spine without fracture or osseous lesion.", + "output": "1. Continued evolution of a large left parietal occipital posterior temporal\nhematoma with developing encephalomalacia. No new or enlarging hemorrhage.\n2. Moderately dilated ventricles which are mildly out of proportion to the\ndegree of cortical sulcation and mildly increased comparison to ___ CT. Given the interval change, findings may represent hydrocephalus with\ndifferential including central volume loss. Recommend clinical correlation.\n3. Diffuse beaded stenosis of the intracranial vasculature, consistent with\nintracranial atherosclerosis. This is most severe within the vertebral\nbasilar system where there is severe stenosis with occlusion versus slow flow\nat the mid to superior basilar artery. These findings are relatively\nunchanged comparison to prior CTA.\n4. Unchanged 3 mm aneurysm at the right vertebral basilar junction.\n5. Patent neck vasculature with 40% stenosis at the right carotid bulb by\nNASCET criteria.\n6. Periapical lucencies involving the right maxillary central incisor and\nsecond molar tooth. Recommend follow-up with dentistry." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass. There\nis prominence of the ventricles and sulci suggestive of involutional changes.\nThe left parieto-occipital hypodensity with ex vacuo dilation of left lateral\nventricle and posterior horn are consistent with sequela of prior hemorrhage. \nSmall hypodensity in the right basal ganglia is unchanged. Extensive\nperiventricular white matter hypodensities are similar to before and likely\nreflect chronic small vessel disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial hemorrhage.\n2. Sequela of prior left parieto-occipital intraparenchymal hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are prominent, compatible with age related global\natrophy. Scattered periventricular and subcortical white matter hypodensities\nlikely reflect the sequelae of chronic small vessel ischemic disease. \nVascular calcifications of the cavernous carotid arteries are noted.\n\nNo fractures identified. A 9 mm partially calcified scalp nodule along the\nright vertex likely represents a sebaceous cyst (3:54, 601b:59). The paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute major infarction,hemorrhage,edema,or large mass.\nSubcortical and periventricular white matter hypodensities are nonspecific,\nlikely the sequelae of chronic small vessel ischemic disease. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no acute fracture. Degenerative changes are noted at bilateral\ntempomandibular joints. A 1 cm partially calcified scalp lesion at the\nvertex, likely a sebaceous cyst. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. The\nvisualized portion of the orbits show evidence of bilateral lens replacement.", + "output": "No acute intracranial process." + }, + { + "input": "There is no acute intracranial hemorrhage, edema, or mass effect. There is\nencephalomalacia within the left frontal lobe consistent with chronic\ninfarction. There are small basal ganglia lacunar infarcts. There is confluent\nhypodensity within the periventricular white matter which is presumably on the\nbasis of chronic small vessel ischemic disease. The ventricles and sulci are\nprominent which is likely secondary to diffuse brain parenchymal volume loss.\nA cavum septum pellucidum et vergae is incidentally noted.\n\nA subgaleal hematoma over lying in the right parietal bone is identified. No\nunderlying fracture is seen. No fracture is seen elsewhere. Minimal left\nmaxillary sinus mucosal thickening is present. The remaining paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. \nAtherosclerotic calcifications of the carotid siphons and the right vertebral\nartery are present.", + "output": "1. No evidence of acute intracranial process.\n\n2. Chronic changes including left frontal lobe encephalomalacia, small basal\nganglia lacunar infarct, and stigmata of chronic small vessel disease are\nstable." + }, + { + "input": "There is no evidence of acute major territorial infarction, hemorrhage, edema,\nor large mass. Chronic left frontal lobe encephalomalacia, small basal ganglia\nlacunar infarcts, and periventricular white matter hypodensities are again\nseen. Prominence of the ventricles and sulci is suggestive of involutional\nchanges.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No intracranial hemorrhage." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage, edema,\nor mass effect. There is chronic left frontal lobe encephalomalacia and basal\nganglia lacune or infarcts. Periventricular white matter hypodensities are\nagain seen, likely due to chronic small vessel ischemic disease. Incidentally\nagain noted is a cavum septum pellucidum et vergae.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable, noting right lens replacement. \nProminent degenerative pannus of the dens is identified, similar in appearance\nto prior exam, mildly narrowing the craniocervical junction.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nintracranial hemorrhage." + }, + { + "input": "CT Head: The encephalomalacia in the left medial frontal lobe along normally\nanterior cerebral artery distribution is unchanged. The cystic\nencephalomalacia in the left inferior frontal lobe is also unchanged. The\nchronic lacunar infarctions in the right basal ganglia are unchanged. Patchy\nhypoattenuation in the periventricular, subcortical, and deep white matter are\nnonspecific, but likely represent the sequela of chronic small vessel ischemic\ndisease. There is no evidence of acute intracranial hemorrhage, acute\ninfarction, mass effect, midline shift, or extra-axial fluid collection.\n\nThere is a cavum septum pellucidum and cavum et vergae. The ventricles and\nsulci are prominent, related to age-appropriate volume loss.\n\nThere is mild mucosal thickening in the bilateral maxillary sinuses. The\nmastoid air cells are clear. The patient is status post right cataract\nsurgery.\n\nCTA Head:\n\nThere is severe, multifocal stenoses of the left V4 segment and moderate,\nmultifocal stenoses of the right V4 segment. The basilar artery is\nhypoplastic.\n\nThe left mid M1 segment is severely, focally stenotic on 5:238. There is\nmild, focal narrowing of the right distal M1 segment on 5:233. There are\nextensive, severe atherosclerotic calcifications of the bilateral cavernous\nand supra clinoid internal carotid arteries, which are moderately narrowed and\nirregular.\n\nThere are fetal type origins of the posterior cerebral arteries, which are\npatent. The bilateral P1 segments are hypoplastic. There is mild narrowing\nand irregularity of the bilateral A1 and A2 segments. No aneurysms are\nidentified.\n\nCTA Neck:\n\nThere is a normal 3 vessel branching pattern with mild atherosclerotic\ncalcifications of the aortic arch. The left proximal subclavian artery is\nmoderately narrowed by calcified plaque. The origins of the great vessels are\npatent.\n\nAtherosclerotic calcifications mildly narrowed the right distal common carotid\nartery. Calcified and noncalcified plaque cause approximately 75% stenosis of\nthe right proximal internal carotid artery at its bifurcation by NASCET\ncriteria. There is mild calcified plaque along the left distal common and\nleft proximal internal carotid arteries with no evidence of internal carotid\nartery stenosis by NASCET criteria.\n\nThe right vertebral artery, including its origin, is patent.\n\nThe left vertebral artery is is occluded at its origin with a short segment\nnerve reconstitution at C5 and C6 and subsequent reconstitution at C4-C5. The\nreconstituted distal V2 segment demonstrates multi focal, severe stenoses\nthroughout the remainder of its course.\n\nOther: The thyroid gland contains multiple hypodense nodules, the largest\nmeasuring 0.8 cm in the left upper thyroid lobe. The fibrocalcific changes in\nthe lung apices are unchanged from ___. There is no cervical\nlymphadenopathy. There is diffuse osteopenia, and multilevel multifactorial\ndegenerative changes throughout the cervical spine, consistent with anterior\nand posterior spondylosis, more significant from C4/C5 through C6/C7 levels.", + "output": "1. Approximately 75% stenosis of the right proximal internal carotid artery at\nits bifurcation by NASCET criteria.\n2. No evidence of left internal carotid artery stenosis by NASCET criteria.\n3. Occlusion of the left vertebral artery at its origin which short segments\nof reconstitution at the C5 and C6 and eventual reconstitution at C4-C5 with\nsevere, multifocal stenoses throughout the remainder of the left V2 segment.\n4. Severe, multifocal stenoses of the left V4 and mid M1 segments.\n5. No acute intracranial abnormality." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is an approximately 8 x 2 mm focus of hyperdensity in the paracentral\nportion of the cingulate gyrus, image 3:21, which may represent subarachnoid\nhemorrhage.\n\nThere is a large area of encephalomalacia in the medial left frontal and\nanterior parietal lobes, in the left anterior cerebral artery territory. \nThere is a smaller area of encephalomalacia in the inferolateral left frontal\nlobe, which most likely represents a chronic infarct in the left middle\ncerebral artery territory given extension into the anterior limb of left\ninternal capsule, and less likely sequela of prior trauma. There also small\nfoci of low density in the right basal ganglia and adjacent deep white matter,\nmost consistent with small chronic infarcts.\n\nThere is no CT evidence for an acute major vascular territorial infarction. \nPeriventricular white matter hypodensities are likely sequela of chronic small\nvessel ischemic disease in this age group. There is no evidence for edema or\nmass effect. Ventricles and sulci are prominent due to age-related\nparenchymal volume loss. Cavum septum pellucidum et vergae is incidentally\nnoted.\n\nScattered punctate superficial parenchymal or leptomeningeal calcifications\nare seen in the right frontal region and in the left posterior fossa,\nnonspecific but compatible with sequela of prior inflammation.\n\nThere is a right parietal/occipital subgaleal hematoma without evidence for a\ncalvarial fracture. There is also a right frontal supraorbital subgaleal\nhematoma extending into the periorbital region, without evidence for\npostseptal intraorbital extension or associated fracture.\n\nThere is mild mucosal thickening in right greater than left maxillary sinuses\nand in bilateral ethmoid air cells. There is a small mucous retention cyst in\nthe left posterior ethmoid air cell. Mastoid air cells are grossly clear,\nallowing for volume averaging artifact in the absence of dedicated bone\nalgorithm images.\n\nCTA NECK:\nThere is extensive calcified plaque in the aortic arch and visualized distal\nascending aorta, as well as scattered foci of calcified plaque in the\nvisualized proximal descending aorta. There is calcified plaque at the great\nvessel origins without flow-limiting stenosis.\n\nThere is also calcified plaque in the proximal right subclavian artery with an\nat least mild stenosis proximal to right vertebral artery origin. Calcified\nplaque at the right vertebral artery origin causes moderate to severe\nstenosis. There is a small focus of calcified plaque in the distal cervical\nright vertebral artery at C2, without significant stenosis.\n\nThere is extensive calcified plaque in the left subclavian artery proximal and\ndistal to the left vertebral artery origin ; associated stenosis appears to be\ngreater than 50% but is not adequately quantified on this exam. Left\nvertebral artery is occluded from its origin to the level of C4-C5, with\nirregular thready reconstitution distal to C4-C5.\n\nCalcified plaque in the proximal to mid right internal carotid artery causes\ngreater than 90% stenosis by NASCET criteria. There is also calcified plaque\nwithout flow-limiting stenosis in the distal right common carotid artery\n\nMostly calcified plaque in the proximal left internal carotid artery does not\ncause stenosis by NASCET criteria. There is also calcified plaque without\nflow-limiting stenosis in the mid to distal left common carotid artery.\n\nCTA HEAD:\nThere is calcified plaque mildly narrowing bilateral carotid siphons. M1\nsegment of the left middle cerebral artery is diffusely irregular with a\nhigh-grade stenosis in its midportion, as seen on images ___:32 and 651:6. \nThere is also mild stenosis at the junction of the M1 and M2 segments of the\nright middle cerebral artery, images ___:30 and 651:2.\n\nThere is 2 mm fusiform dilatation at the junction of the A1 and A2 segments of\nthe left anterior cerebral artery, images 5:236, 651:21. There is also a 2 mm\nlaterally projecting outpouching of the proximal A2 segment of the right\nanterior cerebral artery, images ___:30 and 651:24, which may represent an\ninfundibulum of a tiny branch vessel, but a tiny aneurysm cannot be excluded. \nDistal to this outpouching, there is short-segment narrowing of the A2\nsegment, presumably atherosclerotic. Irregularity of the more distal\nbilateral anterior cerebral artery branches is presumably atherosclerotic.\n\nThere is calcified plaque in the proximal V4 segment of the right vertebral\nartery causing severe stenosis, with irregularity and diminished caliber of\nthe right vertebral artery distal to the plaque. The right ___ arises distal\nto the stenosis. The V4 segment of the left vertebral artery is small in\ndiffusely irregular, with a tiny focus of calcific plaque noted proximally. \nThe left ___ is visualized. The basilar artery is diffusely narrowed and\ndiffusely irregular. Bilateral AICA and bilateral superior cerebellar\narteries are visualized. P1 segments of bilateral posterior cerebral arteries\nare patent but small, with moderate sized right posterior communicating artery\nand large left posterior communicating artery supplying the P2 segments and\ndistal branches.\n\nCERVICAL SPINE:\n\nThe bones are demineralized. Vertebral body heights are within normal limits.\nNo displaced fracture is seen on limited evaluation, as only sagittal plane\nimages have been reformatted in bone algorithm. There is mild retrolisthesis\nof C3 on C4, of C4 on C5, of C5 on C6, and of C6 on C7. There is no evidence\nfor prevertebral edema, disc space widening, or distraction of the posterior\nelements. There is disc space narrowing from C3-C4 through C6-C7 with\npartially calcified disc protrusions and endplate osteophytes indenting the\nventral thecal sac at these levels. There is extensive multilevel neural\nforaminal narrowing by uncovertebral and facet osteophytes.\n\nOTHER:\n\nThere are multiple thyroid nodules measuring up to 1 cm on the left, image\n302b:38. While the thyroid gland is prominent, there is no associated\ntracheal narrowing.\n\nThere is extensive degenerative remodeling of right greater than left\nsternoclavicular articulations.\n\nThere is pleural/parenchymal scarring at left greater than right lung apices. \nThere is a 4 mm peripheral pulmonary nodule in the posterior right upper lobe,\nimage 5:15. Evaluation of the included upper lungs is otherwise limited by\nrespiratory motion artifact.", + "output": "1. Small focus of hyperdensity in the paracentral portion of the cingulate\ngyrus may represent subarachnoid hemorrhage.\n2. Large chronic infarction in the left anterior cerebral artery territory,\nmoderate-sized chronic infarction in the inferolateral left frontal lobe in\nthe left middle cerebral artery territory, and multiple small chronic\ninfarctions in the right basal ganglia and deep white matter. No CT evidence\nfor an acute major vascular territorial infarction.\n3. Right parietal/occipital subgaleal hematoma and right inferior frontal\nsubgaleal hematoma extending into the periorbital region, without evidence for\nfractures or postseptal intraorbital extension.\n4. At least mild stenosis of the proximal right subclavian artery. Moderate\nto severe stenosis of the right vertebral artery origin, with patency of the\nright vertebral artery distal to its origin. Calcified plaque causing\nhigh-grade stenosis of the proximal right V4 segment.\n5. Apparent greater than 50% stenosis of the proximal and mid left subclavian\nartery, not adequately quantified on this exam. Occlusion of the left\nvertebral artery from its origin to the C4-C5 level, with diffusely irregular,\nsmall-caliber reconstitution from C4-C5 to the basilar artery.\n6. Diffusely narrowed and irregular basilar artery. Bilateral ___, AICA, and\nsuperior cerebellar arteries appear patent. Posterior cerebral arteries\nreceive greater contributions from the posterior communicating arteries than\nfrom the basilar artery.\n7. Calcified plaque causing greater than 90% stenosis of the proximal right\ninternal carotid artery by NASCET criteria.\n8. High-grade stenosis of the M1 segment of the left middle cerebral artery. \nMild stenosis at the junction of M1/M2 segments of the right middle cerebral\nartery. Diffusely irregular A2 segments of the anterior cerebral arteries. \nThese findings are presumably atherosclerotic.\n9. 2 mm laterally projecting infundibulum versus aneurysm of the proximal A2\nsegment of the right anterior cerebral artery.\n10. No evidence for a cervical spine fracture on technically limited\nevaluation. Mild retrolisthesis at C3-C4, C4-C5, C5-C6, and C6-C7 is almost\ncertainly degenerative, though there are no comparison exams to confirm\nchronicity.\n11. Thyroid nodules measuring up to 1 cm. The ___ College of Radiology\nguidelines suggest that in the absence of risk factors for thyroid cancer, no\nfurther evaluation is recommended.\n12. 4 mm pulmonary nodule in the right upper lobe.\n\nRECOMMENDATION(S):\n1. MRI would be more sensitive for an acute infarction, if clinically\nwarranted.\n2. For the 4 mm right upper lobe pulmonary nodule, recommend comparison with\nprior studies to assess stability. In the absence of prior studies,\n___ guidelines suggest follow up chest CT the patient has a\nhistory of smoking or a known primary malignancy, and otherwise no follow up.\n\nNOTIFICATION: Presence of small amount of intracranial hemorrhage, subgaleal\nhematomas without fractures, chronic infarcts, proximal left vertebral artery\nocclusion, and greater than 70% right cervical carotid stenosis were\ncommunicated to the Emergency Department through an electronic wet read by\nRadiology resident Dr. ___. Please see the wet read section regarding the\ntiming of the wet read." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass. Left\nanterior cerebral artery distribution encephalomalacia is noted along with\nleft inferior frontal encephalomalacia. Cavum septum pellucidum et vergae is\nincidentally noted. There is prominence of the ventricles and sulci likely\nreflective of involutional changes.\n\nThere is a right parietal and right frontal subgaleal hematoma (series 2:image\n4, 23). There is no evidence of fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Right frontal and right parietal subgaleal hematomas without underlying\nfracture.\n2. No acute intracranial process. No intracranial hemorrhage." + }, + { + "input": "There is acute hemorrhage partially filling the right lateral ventricle as\nwell as a small amount layering in the occipital horn of the left lateral\nventricle, which are both new compared to the prior CT dated ___. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. The size of the ventricular system is unchanged compared to prior. A\ncavum septum pellucidum et vergae is re- demonstrated.\n\nEncephalomalacia within the left ACA distribution is unchanged, likely due to\nprior infarct. There is also encephalomalacia within the inferior left\nfrontal lobe, also unchanged. There is no evidence of acute territorial\ninfarction, edema, or mass.\n\nA right frontal scalp hematoma is re- demonstrated without evidence of\nunderlying fracture (series 3, image 8). The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.\n\nAtherosclerotic calcification is noted of the vertebral and cavernous carotid\narteries bilaterally.", + "output": "1. Acute hemorrhage partially filling the right lateral ventricle as well as a\nsmall amount layering in the occipital horn of the left lateral ventricle,\nwhich are both new compared to the prior CT dated ___. No\nevidence of hydrocephalus.\n2. Persistent right frontal scalp hematoma without evidence of underlying\nfracture.\n3. Chronic encephalomalacia within the inferior left frontal lobe and along\nthe left ACA distribution, likely due to prior infarct.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 6:47 ___, 1 minute\nafter discovery of the findings." + }, + { + "input": "There is a stable amount of intraventricular hemorrhage seen layering in the\nright lateral ventricle as well as a small amount layering in the left lateral\nventricle. No new intracranial hemorrhage is noted, and the ventricles are\nstable in size and configuration. No acute infarct is noted. Prior left\nanterior cerebral artery territorial and left inferior frontal temporal\nencephalomalacia is again noted. There is prominence of the ventricles and\nsulci suggestive of involutional changes. Cavum septum pellucidum et vergae\nis incidentally noted. There is interval decrease in size of the right\nparietal and right frontal subgaleal hematomas.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Stable intraventricular hemorrhage and ventricle size. No new intracranial\nhemorrhage." + }, + { + "input": "Again seen is a small amount of hemorrhage in the occipital horn and body of\nthe right lateral ventricle. This is considerably less prominent than on the\nprior study. There is no evidence of new hemorrhage. Mild ventricular\ndilatation is unchanged. Chronic left inferior frontal and left anterior\ncerebral artery distribution chronic infarctions are unchanged. There is\nprominence of the ventricles and sulci in an atrophic pattern. Cavum septum\npellucidum is unchanged.\n\nA small right frontal subgaleal hematoma is again noted. There is no\nfracture. There is mucosal thickening of the ethmoid air cells. The mastoid\nair cells and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "Mild interval decreased extent of intraventricular hemorrhage. No evidence of\nnew hemorrhage.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 5:47 AM, 10 minutes after\ndiscovery of the findings." + }, + { + "input": "Intraventricular hemorrhage within the body of the right lateral ventricle and\nthe occipital horns of bilateral lateral ventricles is similar to the earlier\nstudy from ___, but decreased compared to ___. Trace subdural\nhemorrhage along the falx has also decreased in conspicuity, image 3:19. Left\ninferolateral frontal lobe encephalomalacia and left ACA territory\nencephalomalacia are unchanged. Small chronic infarctions in the right basal\nganglia are also unchanged (4: 9, 10). The ventricles and sulci are\nprominent due to age-related parenchymal volume loss. Cavum septum pellucidum\nis noted, a normal anatomic variant.\n\nThere is no evidence of fracture. A small right frontal subgaleal hematoma\nextending to the right supraorbital region is again noted. Mild mucosal\nthickening is probably present in the ethmoid air cells.", + "output": "1. Intraventricular blood products is similar to ___ at 04:15 but\ndecreased compared to ___. No new hemorrhage.\n2. No CT evidence for an acute major vascular territorial infarction. \nMultiple chronic infarctions are again demonstrated.\n\nRECOMMENDATION(S): MRI would be more sensitive for an acute infarction, if\nclinically warranted." + }, + { + "input": "Compared to CT from ___, there has been near-resolution of\nintraventricular hemorrhage within the body of the right lateral ventricle and\nmild interval decrease within the a simple horns of the bilateral lateral\nventricles, with expected evolution of blood products. Trace subdural\nhemorrhage along the falx appears similar to prior study (3:21). Left\ninferolateral frontal lobe and left ACA territorial encephalomalacia are\nunchanged, consistent with prior infarct. Chronic infarcts within the right\nbasal ganglia are unchanged. Prominent ventricles and sulci suggest\nage-related involutional changes. Cavum septum pellucidum, a normal anatomic\nvariant, is noted and appears grossly unchanged.\n\nNo acute large territorial infarction. No new hemorrhage.\n\nNo fracture identified. Small right frontoparietal scalp swelling is mildly\nimproved. Mild mucosal thickening in the bilateral ethmoidal air cells. \nOtherwise, the remaining paranasal sinuses, mastoid air cells and middle ear\ncavities are clear. Visualized portions of the orbits are unremarkable.", + "output": "1. No new acute large territorial infarction. No new hemorrhage. Please note\nthat MRI is more sensitive in detection of acute infarction.\n2. Interval decrease in extent of intraventricular blood products. \nVentricular size and configuration is unchanged.\n3. Encephalomalacia in the left inferolateral frontal lobe and left ACA\nterritory, consistent with old infarct.\n4. Chronic right basal ganglia infarcts, unchanged.\n\nRECOMMENDATION(S): If clinically desired, MRI is more sensitive in detection\nof acute infarcts." + }, + { + "input": "Aero digestive tract: There is no mass. Airway appears patent throughout.\n\nNeck lymph nodes: There has been interval increase in size of bilateral\ncervical lymphadenopathy. The largest lymph node is a heterogeneously\nenhancing left level 5B node and measures 7.0 x 4.9 cm in greatest axial\n___, previously 4.9 x 3.7 cm. Additional enlarged left level 4 node\nmeasures approximately 16 x 19 mm in greatest axial ___, previously 15\nx 19 mm. Enlarged right level 5 nodes measure up to 2.0 x 1.6 cm and 1.8 x\n1.4 cm, previously only 1 of these was demonstrated and measured 1.5 x 1.3 cm.\nA right level 5B 10 mm lymph node posterior to the right clavicle also appears\nnew from the prior PET-CT (3:149). There is no retropharyngeal adenopathy.\n\nExtra nodal tumor spread: There are no findings suggestive of extra nodal\nextension.\n\nDeep neck muscles, masticator space: There is no muscle invasion.\n\nBones, skull base:\nThere is no bone involvement.\nThere are no findings suggestive of perineural tumor extension. Jugular\nforamen, carotid canal, pterygopalatine fossa, infraorbital foramen, other\nskull base foramina are not involved.\n\nVessels: There is no vascular invasion.\n\nBrachial Plexus: There is mass effect by the dominant enlarged left cervical\nnode upon the left brachial plexus without frank invasion.\n\nThyroid, salivary glands: There is no mass.\n\nOther findings: Partially imaged is enlarged right paratracheal lymph node,\nbetter assessed on the same day chest CT. There are no lung nodules.", + "output": "1. Increased size and number of bilateral cervical lymphadenopathy with the\nlargest node being a left level 5B node which measures up to 7.0 x 4.9 cm in\ngreatest axial ___.\n2. Airway is patent throughout without evidence of mass effect." + }, + { + "input": "Streak artifact limits evaluation of pons and midbrain.\n\nThere is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. The There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. There are periventricular and subcortical lucencies,\nwhich may represent small vessel ischemic changes. Atherosclerotic vascular\ncalcifications are noted of bilateral cavernous portions of internal carotid\narteries.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are preserved.", + "output": "1. Streak artifact limits evaluation of pons and midbrain.\n2. No acute intracranial abnormality.\n3. Please note contrast brain MRI is more sensitive for the evaluation of\nintracranial metastatic disease for seizure foci.\n4. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described.\n\nNOTIFICATION: The wet read findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 7:34 am, 10 minutes\nafter discovery of the findings." + }, + { + "input": "Streak artifact from dental amalgam limits evaluation. Streak artifact from\nthe contrast bolus limits evaluation of the aortic arch and great vessel\norigins.\n\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration with no mass effect\nor midline shift. The gray-white matter differentiation is preserved.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. Postsurgical changes of bilateral lens replacement. \nAdditional left globe postsurgical changes are noted.\n\nCT PERFUSION:\nCBF <30% volume is reported as 0 mL. CBV <34% volume is reported as 0 mL. \nT-max > 6.0s volume reported as 0 mL. No perfusion mismatch is identified. \nThe cerebral blood flow and cerebral blood volume appear grossly symmetric.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear preserved without stenosis, occlusion, or aneurysm formation. The\ndural venous sinuses are patent.\n\nCTA NECK:\nThere is slight tortuosity of the right V3 segment. There is also tortuosity\nof the distal left internal carotid artery cervical segment. The carotid and\nvertebral arteries and their major branches appear preserved with no evidence\nof stenosis or occlusion. There is no evidence of internal carotid stenosis by\nNASCET criteria.\n\nOTHER:\n The visualized portion of the lungs are clear. Scattered subcentimeter\nnonspecific lymph nodes are noted throughout the neck bilaterally, without\ndefinite enlargement by CT size criteria.", + "output": "1. Streak artifact from dental amalgam and the contrast bolus limits\nevaluation.\n2. No evidence of acute intracranial hemorrhage, territorial infarction, or\nmass lesion. Please note MRI of the brain is more sensitive for the detection\nof acute infarct.\n3. Patent circle of ___ without focal stenosis, occlusion, or aneurysm\nformation.\n4. Patent cervical vertebral and carotid arteries without focal stenosis,\nocclusion, or aneurysm formation.\n5. No definite perfusion defect identified." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. There is an air-fluid level in the right\nmaxillary sinus. Otherwise, paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Air-fluid level in the right maxillary sinus. Correlate with symptoms of\nacute sinusitis." + }, + { + "input": "There is no evidence of infarction,intracranial hemorrhage,edema,or mass. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Periventricular and subcortical white matter hypodensities are\ndemonstrated, which may represent sequela of chronic microangiopathy. Dense\nvascular arteriosclerotic calcifications are seen in the carotid siphons and\ndistal vertebral arteries bilaterally.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Patient is\nstatus post right lens replacement surgery. There is a slightly hyperdense\n1.5 x 1 cm right parotid gland nodule near the external auditory canal (series\n2, image 4, series 601, image 52).", + "output": "1. There is no evidence of acute intracranial process or hemorrhage.\n\n2. There is a slightly hyperdense 1.5 x 1 cm right parotid gland nodule near\nthe external auditory canal (series 2, image 4, series 601, image 52), given\nthe high attenuation of this nodule an intraparotid mass lesion is a\nconsideration, if clinically warranted, correlation with right parotid\nultrasound is recommended.\n\nRECOMMENDATION(S): There is a 1.5 x 1 cm right parotid gland nodule near the\nexternal auditory canal (series 2, image 4, series 601, image 52). If\nclinically warranted, correlation with ultrasound is recommended in a non\nemergent basis." + }, + { + "input": "While no intravenous contrast was administered for the present study, there is\npersistent intravascular contrast from the chest CT performed approximately 6\nhours prior. However, this is not sufficient to evaluate for an enhancing\nintracranial mass.\n\nThere is no evidence of acute intracranial hemorrhage or mass effect. \nGray/white matter differentiation is preserved. There are confluent as well\nas discrete hypodensities in the periventricular, deep, and, to a lesser\nextent, subcortical white matter of the cerebral hemispheres, which are\nnonspecific, though most likely sequela of chronic small vessel ischemic\ndisease in this age group.\n\nNo evidence for suspicious bone lesions. The orbits are unremarkable on\nnoncontrast CT. Visualized paranasal sinuses and mastoid air cells are\nessentially well aerated. Middle ear cavities are clear.", + "output": "1. No evidence for acute intracranial hemorrhage or mass effect. MRI would be\nmore sensitive for small intracranial metastases, if clinically warranted.\n2. Supratentorial white matter hypodensities are nonspecific but most likely\nsequela of chronic small vessel ischemic disease in this age group. Please\nnote that these may mask small foci of edema related to small metastases." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mild diffuse paranasal sinus\nmucosal thickening. The visualized portion of the mastoid air cells and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No evidence of an acute intracranial abnormality.\n2. Mild paranasal sinus mucosal thickening." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect. The salivary glands enhance normally and are without mass\nor adjacent fat stranding. The deep neck space fat planes are preserved. \nThere is mild, probably reactive level 1 and 2 cervical lymphadenopathy\nmeasuring between 1 and 1.2 cm (series 2, image 54; series 2, image 49; series\n2, image 45).\n\nThe thyroid gland appears normal. The neck vessels are patent.\n\nThere is mild paranasal sinus mucosal thickening.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.", + "output": "Mild, probably reactive cervical lymphadenopathy. Otherwise normal neck CT. \nNo evidence of sialoadenitis, peritonsillar abscess, or other deep neck space\ninfection." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Prominence of\nthe ventricles and sulci is consistent with age-appropriate involutional\nchanges. Nonspecific periventricular white matter hypodensities are\nsuggestive of chronic small vessel ischemic disease. Calcifications of of the\nbasilar artery and carotid siphons are noted.\n\nNo acute fracture is seen. There is mild mucosal thickening of the ethmoidal\nair cells, otherwise the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear..", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute infarction or intracranial hemorrhage. There is\nmild parenchymal volume loss with nonspecific periventricular subcortical\nwhite matter hypodensities, likely sequela of chronic small vessel ischemic\ndisease. There is mild mucosal thickening of bilateral ethmoid air cells. \nThere is rightward nasal septal deviation.\n\nCTA HEAD:\nThere are vascular calcifications of the cavernous and clinoid segments of\nbilateral internal carotid arteries contributing to mild spinal canal\nstenosis. Otherwise, the intracranial vasculature appears patent without\nevidence of stenosis, occlusion, dissection, or aneurysm. There are minimal\nvascular calcifications of the V4 segment of the right vertebral artery. The\ndural venous sinuses appear patent.\n\nCTA NECK:\nThere is atherosclerotic disease at the bilateral carotid bifurcations and\nproximal internal carotid arteries contributing to approximately 60% right and\n70% left internal carotid artery stenosis by NASCET criteria. There is\nmoderate focal stenosis of the distal left common carotid artery (450:17,\n3:128). There are mild vascular calcifications of the aortic arch. There is\ncommon origin of the left common carotid artery and brachiocephalic artery. \nThere are vascular calcifications at the origins of bilateral vertebral\narteries contributing to mild luminal narrowing.\n\nOTHER:\nThe thyroid gland appears unremarkable. There is minimal debris within the\ntracheal lumen. There is dependent atelectasis. There are degenerative\nchanges of the cervical spine. There is no lymphadenopathy per size criteria.\nThe patient is edentulous.", + "output": "1. No evidence of acute infarction or intracranial hemorrhage on noncontrast\nhead CT.\n2. Mild parenchymal volume loss with probable chronic small vessel ischemic\ndisease.\n3. Mild vascular calcifications without stenosis, occlusion, dissection, or\naneurysm.\n4. Atherosclerotic disease at the bilateral carotid bifurcations resulting in\n70% left and 60% right internal carotid stenosis by NASCET criteria.\n5. Moderate focal stenosis of the distal left common carotid artery.\n6. Mild luminal narrowing at the origins of the bilateral vertebral arteries." + }, + { + "input": "NECT: No intracranial hemorrhage is identified. There is no mass, mass effect\nor midline shift. The ventricles, cerebral sulci and cisterns are age\nappropriate.\n\nCTA head: The major intracranial vessels are patent without evidence of\nsignificant stenosis or occlusion. A less than 2 mm outpouching is seen\nprojecting superiorly from the basilar tip which may represent an aneurysm or\ninfundibulum origin of a vessel that is too small to be detected by CTA. No\nother aneurysm or arterial venous malformation is identified. There are\natherosclerotic calcifications involving both carotid siphons.\n\nCTA neck: The aortic arch demonstrates a normal branching pattern. There is\ncalcified and noncalcified plaque at the arch and at the origin of the left\nsubclavian artery causing a mild narrowing.\n\nBoth vertebral arteries are patent. The bilateral common carotid, internal\ncarotid and external carotid arteries are patent.\n\nThe distal cervical internal carotid arteries have a beaded appearance\nsuggesting fibromuscular dysplasia. There is a possible 6 mm outpouching from\nthe affected portion of the right internal carotid artery, and a possible\nshallow outpouching from the affected portion of the left internal carotid\nartery. These findings are difficult to definitively evaluate due to the\ntortuosity of the vessels in this region. There is no evidence for dissection,\nocclusion or significant stenosis by NASCET criteria. An opacity within the\nleft upper lobe is similar to the recent chest CT as is the left second rib\nlesion. Please refer to that report for full detail.", + "output": "1. No evidence of hemorrhage or mass effect.\n2. Atherosclerotic disease of the head and neck without significant stenosis\nor occlusion.\n3. Beaded appearance of the distal cervical internal carotid arteries suggests\nfibromuscular dysplasia. Possible outpouchings from the distal cervical\ninternal carotid arteries, right larger in size than left, may represent\npseudoaneurysms. No evidence for dissection.\n4. Very small basilar tip aneurysm versus infundibulum." + }, + { + "input": "There is no hemorrhage, mass effect or a large hypodense areas to suggest\nacute infarction. The leptomeningeal and parenchymal metastases seen on the\nprior MRI are not clearly visualized on this noncontrast head CT. The\nventricles and sulci are prominent consistent with atrophy. The visualized\nparanasal sinuses, mastoid air cells and middle ear cavities are clear. There\nare no osseous lesions.", + "output": "No hemorrhage or mass effect.\n\n1. Please note MRI is more sensitive for seizure." + }, + { + "input": "There is no acute hemorrhage, edema, mass effect or acute territorial\ninfarction. Leptomeningeal and parenchymal metastases are better visualized on\nthe MRI from ___. The ventricles and sulci are normal in size and\nconfiguration. There is a mucous retention cyst in the left maxillary sinus as\nwell as mucosal thickening within the left ethmoid air cells. Remainder of the\nparanasal sinuses, mastoid air cells and middle ear cavities are clear. There\nis no fracture", + "output": "No acute intracranial process." + }, + { + "input": "There has been interval placement of a right frontal approach EVD which\nterminates in the third ventricle.\n\nThere is intraparenchymal hemorrhage in the right frontal lobe along the right\nventriculostomy drainage catheter tract abutting the vertex which measures 6.9\nx 3.9 cm (series 2:26) which is new as compared to CTA head and neck 3 hours\nprior.\nThere is also a small focus of intraventricular hemorrhage in the right\nlateral ventricle abutting the distal aspect of the EVD, also new from CTA\nhead and neck 3 hours prior. Ventricles and sulci appear unchanged. Again\nnoted is diffuse subarachnoid hemorrhage, predominantly in the sylvian\nfissures and all basal cisterns. There is a small amount of intraventricular\nhemorrhage in the bilateral occipital horns. There is no midline shift.", + "output": "1. Right frontal approach EVD terminates in third ventricle. Ventricles are\nunchanged in appearance as compared to CTA head and neck ___.\n2. Intraparenchymal hemorrhage in right frontal lobe abutting the vertex along\nthe EVD tract measuring 6.9 x 3.9 cm (AP by TV) is new as compared to CTA head\nand neck ___. Small focus of intraventricular hemorrhage in the\nright lateral ventricle is also new.\n3. Diffuse subarachnoid hemorrhage is again noted." + }, + { + "input": "There is re-demonstration of the right frontal approach EVD that terminates in\nthe third ventricle. Ventricles are unchanged in appearance as compared to CT\nhead done 2 hours prior. Re-demonstration of bilateral intraventricular\nhemorrhage that is layering dependently in the occipital horns. Again seen is\na small focus of intraventricular hemorrhage in the right lateral ventricle\nabutting the distal aspect of the EVD (3, 19).\n\nThe parenchymal hemorrhage in the right frontal lobe abutting the vertex along\nthe EVD tract measuring 6.9 x 3.8 cm, is unchanged from prior study. No\nevidence of new hemorrhage. Again noted is diffuse subarachnoid hemorrhage,\npredominantly in the sylvian fissures and all basal cisterns. There is no\nmidline shift.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Re-demonstration of parenchymal hemorrhage in the right frontal lobe\nabutting the vertex along the EVD tract which is unchanged in size from prior\nstudy. Right frontal approach EVD terminates in the third ventricle. No\nmidline shift.\n2. Diffuse subarachnoid hemorrhage is again noted." + }, + { + "input": "Status-post right frontal craniotomy and right frontal lobe intraparenchymal\nhematoma evacuation with significantly decreased hyperdense right frontal lobe\nblood products and expected associated pneumocephalus. A right frontal\napproach ventriculostomy catheter courses into the right lateral ventricle\nwith its tip located in the medial portion of the right lateral ventricle\natrium. Minimal effacement of the right lateral ventricle appears decreased\ncompared to the prior examination. Intraventricular hemorrhage layering in\nthe occipital horns of lateral ventricles is unchanged on the left, more\nprominent on the right. Extensive subarachnoid hemorrhage most prominent in\nthe basilar cisterns and sylvian fissures is not appreciably changed since the\nprior examination. No evidence of new intracranial hemorrhage. No evidence\nof large, territorial infarction. Hydrocephalus is minimally improved. There\nis diffuse cerebral edema, probably similar. Right ICA terminus aneurysm\ncoiling limits evaluation of the basilar cisterns and temporal lobes, uncus\nposition. No tonsillar herniation.\n\nThere is no evidence of fracture. Mild diffuse paranasal sinus mucosal\nthickening. Prominence of the superior ophthalmic veins could reflect\nincreased intracranial pressure, unchanged compared to the initial same day\nCTA. Bilateral lens replacements. Severe carotid siphon and V4 segment\ncalcification.", + "output": "1. Decreased right frontal lobe intraparenchymal hematoma. Minimal effacement\nof the adjacent right lateral ventricle appears slightly improved.\n2. Extensive subarachnoid hemorrhage, similar, mildly worsened intra\nventricular hemorrhage. Cerebral edema, similar. Minimally improved\nhydrocephalus.\n3. A right ventriculostomy catheter tip is located in the proximal atrium of\nthe right lateral ventricle." + }, + { + "input": "Streak artifact from right ICA terminal aneurysmal coil limits diagnostic\nevaluation.\n\nRight frontal approach ventriculostomy drainage catheter terminates in the\nproximal atrium of the right lateral ventricle, unchanged as compared to most\nrecent head CT.\n\nRight frontal intraparenchymal hemorrhage measures 3.9 x 1.9 cm (series 2:20),\nunchanged as compared to most recent head CT. There is local mass effect with\nmild effacement of the frontal horn of the right lateral ventricle, unchanged.\nIntraventricular hemorrhage layering in the occipital horns of lateral\nventricles is unchanged in volume. Subarachnoid hemorrhage appears decreased\nas compared to most recent head CT, specially along the basilar cisterns. \nHydrocephalus is improved. No evidence of large territorial infarction.\n\nThere is mucosal thickening of the bilateral ethmoid air cells and bilateral\nfrontal sinuses. There is no acute fracture. Bilateral lens replacements are\nnoted. Severe carotid siphons and V4 segment calcifications are again noted.", + "output": "1. Mildly decreased subarachnoid hemorrhage as compared to head CT ___ 18:40.\n2. Hydrocephalus is mildly improved.\n3. Stable right frontal intraparenchymal hemorrhage.\n4. Stable intraventricular hemorrhage." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territory infarct. Gray-white matter\ndifferentiation is preserved. Ventricles and sulci are normal in size, shape,\nand position. The visualized paranasal sinuses are clear. The mastoid air\ncells are clear. No acute fracture is seen.", + "output": "No acute intracranial process." + }, + { + "input": "There has been interval increase in size of the right-sided subdural hematoma,\nwhich now extends along the right cerebral convexity posteriorly and\nsuperiorly. Blood is also now seen along the falx and along the right\ntentorium. Subarachnoid blood is seen in the right sylvian fissure. There is\nless prominent scattered subarachnoid hemorrhage that fills the sulci\nbilaterally. There is no evidence of infarction.\n\nThere is no evidence of fracture. There is mucosal thickening in the\nmaxillary sinuses. A mucous retention cyst is seen in the right sphenoid\nsinus. The visualized portion of the mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "Interval increase in size of the subdural hematoma.\nNew mild subarachnoid hemorrhage." + }, + { + "input": "As on the prior exam from ___ and 09:26, there is a relatively\nsmall acute right subdural hematoma which is not appreciably changed compare\nwith the most recent prior study. Although precise comparison of with is\nsomewhat difficult given lack of coronal re-formatted images on the prior, on\nthe current study the width of the acute subdural hematoma on the right\nmeasures up to 10-11 mm in width when measured from the inner table of the\nadjacent calvarium on the current study (302 B, 29). Acute subdural blood\nlayering along the posterior falx is trace, also unchanged (4, 21). There is\nalso suggestion of trace hyperdense layering acute subdural blood along the\ntentorial leaflets, unchanged. A small amount of right acute subarachnoid\nhemorrhage is re- demonstrated in the temporal lobe (4, 12). Hyperdense blood\nis not clearly seen in the right sylvian fissure as on the prior exam.\n\nThere is no new focus of hemorrhage seen elsewhere. There is no evidence of\nsuperimposed acute infarction, edema, or new mass effect. The basal cisterns\nare patent, and there is no shift of the normally midline structures. Aside\nfrom minimal/equivocal right cerebral hemispheric sulcal effacement, the\nventricles and sulci are normal in caliber for age. There is preservation of\ngray-white matter differentiation.\n\nThere is no evidence of fracture. The visualized paranasal sinuses, mastoid\nair cells, and middle ear cavities are well pneumatized and clear. Aside from\nbilateral lens removal, the globes and bony orbits are intact and\nunremarkable.", + "output": "1. No appreciable interval change in the acute subdural hemorrhage.\n2. Trace subarachnoid hemorrhage is similar.\n3. No new acute intracranial process is seen." + }, + { + "input": "The previously noted right subdural hemorrhage and subarachnoid blood products\nhave resolved. Left-sided subdural hygroma/effusion or chronic hematoma has\nalso resolved. No new intracranial hemorrhages. No large territorial\ninfarct. No intracranial masses. Involutional changes of the brain. \nVentricular system is symmetrical. The basal cisterns are patent. The orbits\nappear normal. The paranasal sinuses are clear. No acute osseous\nabnormality. Trabeculated lucent lesions at the vertex most prominently seen\nalong the left posterior parietal lobe and midline frontal lobe are likely\nhemangiomas, unchanged from prior examination.", + "output": "1. Resolution of the intracranial hemorrhage. No new hemorrhage.\n2. No acute intracranial abnormality on noncontrast head CT." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nare normal in size and configuration. No cerebral abnormality. Mild\ngeneralized cerebellar atrophy, can be seen with chronic anti seizure\nmedication use.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute changes." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,intracranial hemorrhage,edema,ormass. The\nventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe right V4 segment appears diminutive and is not very well visualized. The\nvertebrobasilar junction appears unremarkable, likely from retrograde flow. \nBoth PICAs are visualized.\nThe vessels of the circle of ___ and their principal intracranial branches\nappear otherwise unremarkable without stenosis, occlusion, or aneurysm\nformation. The dural venous sinuses are patent.\n\nCTA NECK:\nThe right vertebral artery appears diminutive throughout its cervical course\nwith intermittent visualization and areas suggestive of a larger normal vessel\ncaliber actually seen (series 3, image 160-164), consistent with long segment\ndissection. There is near complete occlusion of the right vertebral artery at\nits V2/V3 segment.\nThe carotidand left vertebral arteries and their major branches appear\nunremarkable with no evidence of stenosis or occlusion. There is no evidence\nof internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.\nMinimal degenerative changes are identified in the cervical spine at the C4-C5\nlevel, consistent with mild spondylosis (series 602, image 37).", + "output": "1. No significant intracranial abnormality. No evidence of acute infarction,\nhemorrhage or mass. If there is persistent clinical concern related with\nacute/subacute ischemic event, correlation with MRI/MRA of the head is\nrecommended.\n2. The right vertebral artery appears diminutive throughout its course with\nintermittent visualization and near complete occlusion at the V2/V3 segment,\nsuggestive of dissection, correlation with MRA of the neck is recommended.\n3. Both PICAs are visualized. The Long segment dissection right ___ likely\nfills from retrograde supply from the contralateral left vertebral artery.\n\nRECOMMENDATION(S): The right vertebral artery appears diminutive throughout\nits course with intermittent visualization and near complete occlusion at the\nV2/V3 segment, suggestive of dissection, correlation with MRA of the neck is\nrecommended.\n\nIf there is persistent clinical concern related with acute/subacute ischemic\nchanges, correlation with MRI/MRA of the head is recommended.\n\nNOTIFICATION: The findings were discovered and discussed with ___,\nM.D. by ___, M.D. on the telephone on ___ at 12:23 pm." + }, + { + "input": "There is increased hypodensity in the right cerebellar tonsil and posterior\ninferior cerebellar hemisphere, which is consistent with an evolving ___\nterritory infarct. There is no evidence of hemorrhagic conversion.\n\nNo new territorial infarction is identified. There is no intracranial\nhemorrhage or intracranial mass.\n\nThe ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Expected evolution of a right ___ territory cerebellar infarct, which is not\nsignificantly changed in size compared to prior MRI. No evidence of\nhemorrhagic conversion." + }, + { + "input": "The right epidural hematoma overlying the right temporal, frontal and parietal\nlobes is increasing in size, now measuring 15 mm in thickness, previously\nmeasuring 5 mm in thickness. There is also increase in midline shift to the\nleft, now measuring 6 mm, previously 3 mm. There is right uncal herniation.\nAgain seen is pneumocephalus. No hydrocephalus.\n\nThere is a fracture of the right temporal bone which extends superiorly into\nthe right parietal bone to the vertex and inferiorly to involve the mastoid\nair cells, foramen magnum, jugular foramen, extends to the right carotid\ncanal. The right-sided ossicles are likely disrupted. There is a fracture\nthrough the sphenoid sinus and pterygoid plates bilaterally. There is a\nfracture of the lateral wall of the right maxillary sinus and medial walls of\nboth maxillary sinuses. Bilateral nasal bone fractures. Air is seen in the\nright and left orbits. Globes appear normal in shape. No retrobulbar\nhematoma. Blood is seen in the maxillary sinuses bilaterally and sphenoid\nsinuses. There is a large right subgaleal hematoma. In the temporal bone\nfracture may have involved labyrinth.", + "output": "Increasing size of right epidural hematoma, now measuring 15 mm in thickness,\npreviously measuring 5 mm at 01:44 on ___. Midline shift of 6\nmm, previously 3 mm. Right uncal herniation.\n\nRight temporal bone fracture extending superiorly to the right parietal bone\ninferiorly to the foramen magnum, with involvement of the right jugular\nforamen and right carotid canal. Recommend CTA and CT the for evaluation of\nvessel integrity.\n\nMultiple facial bone fractures.\n\nLarger right subgaleal hematoma.\n\nNOTIFICATION: These findings were discussed with Dr. ___\n___ by Dr. ___ at 3:20 AM on ___ by telephone at time of\ndiscovery." + }, + { + "input": "Head CT: Interval postoperative changes of right temporal craniotomy with\nevacuation of epidural hematoma. There is marked improvement in overall\nmidline shift and subarachnoid hemorrhage. There is mild asymmetric effacement\nof the sulci within the right cerebral hemisphere compatible with cerebral\nedema. There is no evidence of new intracranial hemorrhage or mass effect. The\npreviously described right temporal bone fractures which extend into the\nforamen magnum and involve the right jugular foramen and right carotid canal\nare unchanged, along with multiple, comminuted facial bone fractures.\nThere is mild asymmetry of the superior ophthalmic veins, left greater than\nright, although the size appears to be within normal limits. There is fluid\nwithin the nasopharynx and bilateral maxillary sinuses.\n\nHead and neck CTA: There is lack of contrast opacification within distal\nright transverse and sigmoid sinus, extending into the jugular foramen, in the\nregion of the associated temporal bone fracture. Overall findings indicate\ntraumatic involvement of the transverse and sigmoid sinus which could indicate\ncompression from traumatic hematoma or thrombus. Just inferior to the jugular\nforamen, the right jugular vein is opacified normally. The timing of the\ncontrast is slightly delayed and and there is suboptimal opacification of the\ninternal carotid arteries which limits evaluation in the region of the\nfracture. Hyperdense material is seen within the upper cervical spine and\nforamen magnum, which could represent residual hemorrhage although this\nappearance may be largely due to epidural venous plexus, given slightly\ndelayed contrast timing.\n\nThe carotid and vertebral arteries within the neck and their major branches\nare patent with no evidence of stenoses. There is no evidence of aneurysm,\narterial dissection, or focal arterial vessel cut off.", + "output": "1. Interval postoperative changes of a right temporal craniotomy with\nevacuation of epidural hematoma and marked improvement of overall midline\nshift and subarachnoid hemorrhage.\n2. Mild asymmetric effacement of sulci within right cerebral hemisphere which\nis compatible with cerebral edema.\n3. Lack of contrast opacification within the distal right transverse and\nsigmoid sinus, in the region of the associated temporal bone fracture,\nsuggesting a compression from traumatic hematoma or thrombus.\n4. Suboptimal evaluation of internal carotid arteries secondary to slightly\ndelayed contrast timing which limits evaluation in the region of the fracture.\n5. Hyperdense material within the foramen magnum and upper cervical spine, the\nappearance of which may be largely due to venous enhancement, given slightly\ndelayed timing.\n\nNOTIFICATION:\n\n1. Findings were discussed with on-call neurosurgery, ___ O, by Dr. ___\n___ telephone at ___ ___." + }, + { + "input": "Postoperative changes of right-sided craniotomy are again seen. There is no\nacute intra-axial or extra-axial hemorrhage. There is no midline shift.\nHypodensity in the anterior right temporal lobe is seen in the region of prior\ncontusion. Elsewhere, gray-white matter differentiation is preserved.\n\nThere is an asymmetric density with calcifications in the subependymal region\nof the atrium of the left lateral ventricle (02:17). This has been present on\nmultiple prior exams and is grossly unchanged. On previous MRI, where included\non the MRA of the neck with contrast, it demonstrated enhancement. On prior\nCT, there are prominent vessels likely enlarged venous structures in this\nregion. This raises possibility of an underlying vascular malformation.\nIntraventricular enhancing mass lesion would also be possible. It is\nsignificantly asymmetric when compared to the right and not thought to be\nnormal choroid plexus.\n\nRight temporal bone fracture is similar to previous exam. There are other\nfacial fractures as well as characterized previously. Mild mucosal thickening\nseen in the right ethmoid air cells. Opacified right mastoids and partially\nopacified left mastoids are noted. Extracranial soft tissues are unremarkable.", + "output": "1. Right temporal bone and facial fractures with postoperative changes of\nright-sided craniotomy. No acute intracranial process.\n2. Partially calcified lesion in the left lateral ventricle as detailed above\nfor which additional imaging including contrast-enhanced MRI and MRA is\nsuggested as differential includes both vascular malformations and enhancing\nmass lesions." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is moderate ethmoid air cell,\nsphenoid sinus, and left maxillary sinus mucosal thickening and partial\nopacification of the right maxillary sinus with maxillary sinus air-fluid\nlevels and scattered aerosolized secretions. The adjacent orbital and\npterygopalatine fossa fat planes are preserved. Mild nonspecific\nopacification of a few dependent right mastoid air cells. The left mastoid\nair cells and bilateral middle ear cavities are clear.", + "output": "1. No evidence of an acute intracranial abnormality.\n2. Diffuse paranasal sinus disease, possible acute sinusitis." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema,or mass-effect. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Prominence of the posterior\nnasopharyngeal soft tissues is similar to the prior exam, reflective of\nadenoidal hypertrophy.", + "output": "Unremarkable head CT." + }, + { + "input": "Previously seen inferior frontal and temporal contusions are controlled.\nHypodensity seen in the inferior frontal region indications involving\nencephalomalacia. Subtle hypodensities in the right temporal region also\nindicates evolving encephalomalacia. No new hemorrhage seen. No mass effect,\nmidline shift esophagus.", + "output": "Evolution of previously seen hemorrhagic contusions with hypodensity seen in\nthe left frontal and temporal region on the right. No new hemorrhage seen." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nNo evidence of acute infarct, hemorrhage, edema, or mass. The patient is\nstatus post right pterional craniotomy, with two aneurysm clips overlying the\nright MCA bifurcation. A hypodensity within the left posterior cerebellum is\nlikely compatible with a subacute to chronic infarct. The ventricles and sulci\nare mildly prominent, suggestive of involutional change.\n\nTrace mucosal thickening of the ethmoid air cells, otherwise the imaged\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nbilateral orbits appear unremarkable.\n\nCTA HEAD:\nEvaluation of the right MCA is limited by streak artifact from aneurysm clips.\nWithin this limitation, there is no definite stenosis, occlusion, or aneurysm\nof the right MCA. A lobulated aneurysm of the left MCA bifurcation superior\ndivision measures approximately 4 mm (2:226). In addition, a second smaller\ninferior division aneurysm measuring approximately 3 mm (series 2, image 225;\nseries 1, image 360) is identified. There is mild narrowing of the left P2\nsegment (2:226), likely secondary to atherosclerotic disease. Otherwise, the\nvessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. The dural venous\nsinuses are patent. Moderate atherosclerotic calcifications of the bilateral\ncarotid siphons.\n\nCTA NECK:\nMild narrowing of the right cervical internal carotid artery (2:179) due to\natherosclerotic disease. Mild, left greater than right, atherosclerotic\ncalcification of the mid bilateral V4 segments. Otherwise, the carotid and\nvertebral arteries and their major branches appear normal with no evidence of\nstenosis or occlusion. Mild atherosclerotic calcifications of the bilateral\ncarotid bulbs. There is no stenosis of the cervical internal carotid arteries\nby NASCET criteria.\n\nOTHER:\nModerate bilateral centrilobular emphysema. Mild, bilateral dependent\natelectasis. Otherwise, the visualized portion of the lungs are clear. The\nvisualized portion of the thyroid gland is within normal limits. There is no\nlymphadenopathy by CT size criteria. No suspicious osseous lesions.", + "output": "1. No evidence of acute hemorrhage or large territorial infarction.\n2. Probable subacute to chronic infarct of the left cerebellum.\n3. Lobulated, approximately 4 mm and 3 mm aneurysms of the left MCA\nbifurcation.\n4. Within the limitations of streak artifact from aneurysm clips, no definite\nstenosis, occlusion, or aneurysm of the right MCA.\n5. Mild narrowing of the left P2 segment, likely secondary to atherosclerotic\ndisease. The remainder of the CTA head is unremarkable.\n6. Mild narrowing of the right cervical internal carotid artery due to\natherosclerotic disease. Otherwise, no evidence of stenosis or occlusion of\nthe carotid or vertebral arteries. No stenosis of the cervical internal\ncarotid arteries by NASCET criteria.\n7. Moderate, bilateral centrilobular emphysema.\n8. Additional findings described above." + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass. The ventricles and sulci are normal in size and configuration. The basal\ncisterns are patent and there is preservation of gray-white matter\ndifferentiation. No osseous abnormalities seen. The paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The orbits are unremarkable. A\nsmall subgaleal hematoma is present over the left parietal bone.", + "output": "No acute intracranial process. Small left parietal subgaleal hematoma." + }, + { + "input": "O intra-axial or extra-axial hemorrhage, edema, shift of normally midline\nstructures, or evidence of acute major vascular territorial infarction. A\nsmall arachnoid cyst is noted in the posterior fossa. There is a coarse\ncalcification along the left tentorial leaflet. Ventricles and sulci appear\nnormal in size. No skull fracture. Mild mucosal thickening is noted within\nthe imaged paranasal sinuses. Mastoid air cells middle ear cavities are well\naerated. The orbits appear grossly unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of large territorial infarction,acute intracranial\nhemorrhage,edema, or mass. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. Diffuse periventricular white matter\nhypodensities are again seen and are nonspecific, but likely sequela of\nchronic small vessel ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No evidence of acute intracranial hemorrhage." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute infarction,hemorrhage,edema,ormass. \nPeriventricular and subcortical white matter hypodensity is nonspecific, but\nlikely reflect sequelae of chronic small vessel ischemic disease. Prominence\nof the ventricles and sulci are suggestive of involutional changes.\n\nThere is mild mucosal thickening of the maxillary sinuses and anterior ethmoid\nair cells. Mastoid air cells are clear. The visualized portion of the orbits\nare normal.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. As before, there is a\nleft dominant vertebrobasilar system with a diminutive V4 segment, discussed\nin detail below. The dural venous sinuses are patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent.\nMild predominantly noncalcified plaque at the origin of the left internal\ncarotid artery does not produce stenosis when calculated using NASCET\ncriteria. Calcified and noncalcified plaque at the left carotid bifurcation\ndoes not result in stenosis by NASCET criteria. The remainder of the cervical\ninternal carotid arteries are patent. As seen on the study from ___, there\nis a large, dominant left vertebral artery without evidence of dissection or\nocclusion. At the C5 level, an uncovertebral osteophyte produces mass effect\non the vessel resulting in minimal narrowing, which was not apparent on ___ (3:113). This is likely chronic, and no definite vascular\ninjury is apparent at this level. As before, the right vertebral artery\nappears to be occluded from the origin, with reconstitution in the V3 segment,\nlikely from a paraspinous collateral vessel (3:184). The vessel remains\ndiminutive until the basilar confluence. Overall, this appearance is\nessentially unchanged dating back to ___.\n\n\nOTHER: There is biapical pleural scarring. Numerous nonenlarged mediastinal\nlymph nodes measuring up to 9 mm are nonspecific, possibly reactive. Cervical\nlymph nodes are not enlarged by CT size criteria. The imaged thyroid is\nnotable only for interdigitating regions of fat, but no focal nodule.", + "output": "1. No acute intracranial process.\n2. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n3. As seen on the study from ___, the right vertebral artery is\nessentially occluded from the origin through the V3 segment where it is\nreconstituted by collateral vessels and likely retrograde flow. This is\nunchanged.\n4. The left vertebral artery is dominant. At the C5 level, it is contacted\nand mildly narrowed by uncovertebral osteophytes which is new in comparison\nwith ___. There is no convincing evidence for vascular injury related to this\nfinding.\n5. No carotid artery stenosis by NASCET criteria." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles are symmetric and unremarkable.\n\nMucosal thickening seen within the ethmoid air cells, right sphenoid sinus and\nleft frontal sinus. There is partially opacified right mastoids. Skull and\nextracranial soft tissues are unremarkable.", + "output": "No acute intracranial process.\n\nNOTIFICATION: Findings discussed with the ordering physician ___ by\nDr. ___ at 15:45 on ___." + }, + { + "input": "Left craniotomy is again seen. There is mild streak artifact from the\noverlying skin staples.Left greater than right pneumocephalus has decreased\nbut not completely resolved. Linear hyperdensity deep to the craniotomy may\nrepresent small amount of blood or dural thickening. The frontal component of\nthe left subdural collection contains hypodense fluid and is slightly smaller\nthan on the prior exam, measuring 11 mm in maximal depth on image 2:25. The\nparietal/ occipital component of the left subdural collection is stable in\nsize, 7 mm in maximal depth on image 2:21, and it contains layering blood and\nhypodense fluid. Hyperdense blood along the right posterior falx and right\ntentorium is stable.\n\nThere is a new right frontal/ temporal hypodense subdural collection,\nconsistent with a hygroma, measuring 9 mm in maximal depth on image 2:26.\n\nRightward shift of midline structures has resolved. Effacement of the left\nlateral ventricle has improved but not resolved. The third ventricle has\nre-expanded. Basal cisterns are not compressed. Nonspecific foci of low\ndensity are again seen in the periventricular and subcortical white matter of\nthe cerebral hemispheres, most likely chronic small vessel ischemic changes.\n\nEndotracheal and orogastric tubes are noted. There is mild mucosal thickening\nin bilateral sphenoid sinuses and left posterior ethmoid air cells, as well as\nmild partial bilateral mastoid air cell opacification.", + "output": "1. Decreased left greater than right pneumocephalus.\n2. Slightly decreased frontal component of the left subdural collection, which\nnow contains hypodense fluid. Stable parietal/occipital component of the left\nsubdural collection, which now contains layering blood and fluid.\n3. New right frontal/ temporal subdural hygroma.\n4. Decreased overall mass effect with resolution of rightward shift of midline\nstructures, re-expansion of the third ventricle, and decreased effacement of\nthe left lateral ventricle." + }, + { + "input": "Since the prior study, there has been interval development of A wedge-shaped\nconfluent hypodensitY in the right parietal lobe (02:27), as well as a smaller\narea in the right occipital lobe (02:14), both of which extend to the cortical\nsurface, and obscure the normal gray-white matter junction, compatible with\nprior infarcts. A more focal hypodensity in the right caudate head (02:17)\nlikely represents a lacunar infarct, and was present previously.\n\nPostsurgical changes related to prior left craniotomy are again seen, with\nimproved degree of pneumocephalus compared to the prior study. Bilateral\nsubdural collections of mixed density, left greater than right are unchanged,\nmeasuring 10 mm on the left, and 8 mm on the right in maximal thickness. A\nsmall parietal/ occipital component of the left subdural collection is again\nnoted, with perhaps slight decrease in overall size, measuring 5 mm (02:21),\npreviously 7 mm. The previously seen subdural hemorrhage along the right falx\ncerebri and tentorial leaflet has improved, measuring 4 mm in maximal\nthickness (401 B:78). There is no shift of the normally midline structures.\nSize of the ventricles is unchanged compared to the prior study, with\npersistent enlargement of the right lateral ventricle compared to the left.\nDense atherosclerotic calcifications are present in the intradural portions of\nthe bilateral vertebral arteries, as well as in the cavernous carotid arteries\nbilaterally. Scattered opacification of the bilateral inferior mastoid air\ncells is noted. There is also mucosal thickening in the bilateral sphenoid\nsinuses, left greater than right posterior ethmoid air cells, and minimal\nmucosal thickening of the bilateral maxillary sinuses.", + "output": "1. Right parietal and occipital lesions are most likely subacute infarctions\nand are new since the prior study from ___. MRI may be helpful for\nfurther characterization.\n2. Postsurgical changes related to prior left craniotomy, as described above,\nwith similar appearance of bifrontal and left parietal subdural collections\nand improved right parafalcine/tentorial subdural hemorrhage.\n\nNOTIFICATION: The findings were discussed via telephone by Dr. ___ with\nDr. ___ resident) on ___ at 4:46 ___, 2 minutes after discovery\nof the findings." + }, + { + "input": "Compared to prior exam, the right parietal infarct appears heterogenous,\nsuggesting petechial hemorraghic changes. The size of the right parietal\ninfarct is unchanged. Previously seen bilateral subdural collections are\nunchanged. The ventricles and sulci are unchanged in size and configuration.\nPeriventricular white matter changes are likely due to small vessel disease.\nScattered mucosal thickening in the paranasal sinuses as well as scattered\nopacification of the mastoid air cells are not significantly changed. The\norbits are unremarkable.", + "output": "Compared to prior exam, the right parietal infarct appears heterogenous,\nsuggesting petechial hemorraghic changes. Otherwise, there are no significant\nchanges.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with NP ___\n___ on the telephone on ___ at 11:42 AM, 3 minutes after discovery\nof the findings." + }, + { + "input": "The study is limited by patient motion. Additionally, the vertex is not\nincluded on the current study.\n\nWithin these limitations, there is no evidence of acute territorial\ninfarction, hemorrhage, edema, or mass. The ventricles and sulci are\nprominent, consistent with age-related involutional change. Periventricular\nand subcortical white matter hypodensities are nonspecific, but likely reflect\nthe sequela of chronic microvascular infarction.\n\nNo acute fractures are seen. There is thinning of the biparietal bones,\nunchanged. There is partial opacification of the bilateral mastoid air cells.\nAdditionally, there is near complete opacification of the right maxillary\nsinus and mild mucosal thickening in the bilateral ethmoid air cells. \nOtherwise, the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The orbits are unremarkable.", + "output": "1. Limited exam due to patient motion and portions of the vertex were excluded\nfrom the study.\n2. Within these limitations, there is no acute intracranial process.\n3. Paranasal sinus disease, as above." + }, + { + "input": "An area of hypodensity with corresponding loss of gray-white matter\ndifferentiation within the right MCA territory distribution is consistent with\nrecent right MCA territory infarct. High-density material within the M2\nsegment of the right MCA (2:13) may represent a hyperdense clot, and appears\nsimilar to prior. No evidence of intracranial hemorrhage or shift of the\nnormally midline structures. The basal cisterns appear patent. Prominent\nventricles and sulci are consistent with age-related involutional change. \nThere is extensive calcification of the right petrous and cavernous carotid\narteries.\n\nNo fracture is identified. Mucosal thickening and fluid is seen within\nbilateral anterior mastoid air cells in the nasopharynx. Remaining visualized\nparanasal sinuses, mastoid air cells, and middle ear cavities appear clear. \nThe globes are unremarkable.", + "output": "1. Hypodensity and loss of gray-white matter differentiation within the right\nMCA territory is consistent recent right MCA territory infarct. No evidence\nof hemorrhagic transformation or herniation." + }, + { + "input": "Again seen is an evolving, large right middle and posterior cerebral artery\nterritorial infarct involving the right frontal, parietal, temporal and\noccipital lobes, more hypodense compared to the prior CT. Within this\nhypodensity, there are linear hypodensities, likely reflecting thrombosed\nvessels. In addition, there is hyperdensity within the region of right\nputamen and caudate head, corresponding with the area of hemorrhage seen on\nprior MR. ___ to the prior exams, there is significant mass effect due to\nedema, effacing the right frontal and occipital horns of the right ventricle\nand resulting in a 7 mm midline shift. Compared to the prior, there is\ncomplete effacement of the sulci. The mass effect on the ventricles and sulci\nare not as prominent, due to underlying age-related involutional changes. \nThere is bilateral low-density subdural fluid collection, left greater than\nright, slightly increased from prior and now measuring up to 7 mm on the left.\nThe basal cisterns are patent.\n\nThere is no evidence of fracture. There is fluid layering in the sphenoid\nsinuses, clear due to supine positioning. Mucosal thickening is seen in the\nmaxillary sinuses bilaterally. The visualized portion of the other paranasal\nsinuses, mastoid air cells, and middle ear cavities are grossly clear. The\nvisualized portion of the orbits are unremarkable. ETT is seen. Dense\nvascular calcifications are seen in the vertebral arteries and cavernous\nportions of the carotid arteries bilaterally. There is evidence of left lens\nreplacement.", + "output": "1. Large infarct in the middle cerebral and posterior cerebral artery\ndistribution with superimposed hemorrhage in the right putaminal and caudate\nhead. There is significantly increased mass effect on the lateral ventricles\ncompared to the prior. There is a right sided sulci are now completely\neffaced. There is a 7 mm midline shift. The basal cisterns are patent.\n2. Bilateral low-density subdural fluid collection, slightly increased from\nprior measuring up to 7 mm on the left.\n3. Dense vascular calcifications in the bilateral vertebral arteries and\ncavernous portion of the carotid arteries bilaterally.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\non the ___ ___ at 10:22 AM, 5 minutes after discovery of the\nfindings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is hyperdensity in the superior right frontal lobe on image 2:24,\nunchanged in appearance compared to the recent prior head CT.\n\nThere is no evidence of infarction, edema, or mass. The ventricles and sulci\nare patent and prominent in keeping with age-related volume loss.\n\nThere are scattered hypodensities in the subcortical and periventricular white\nmatter, nonspecific, likely secondary to small vessel ischemic disease. There\nis atherosclerosis involving bilateral cavernous carotid arteries.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. There is prosthetic left globe.\n\nCTA HEAD:\nThere is nonocclusive atherosclerosis involving bilateral cavernous and\nsupraclinoid internal carotid arteries. The vessels of the circle of ___\nand their principal intracranial branches are otherwise patent with no\nevidence of stenosis, occlusion, or aneurysm. The dural venous sinuses are\npatent.", + "output": "1. Stable right frontal intraparenchymal versus subarachnoid hemorrhage.\n2. No new hemorrhage or acute infarct.\n3. No evidence ofaneurysm greater than 3 mm, dissection or significant\nluminal narrowing.\n4. Nonocclusive atherosclerotic changes of bilateral cavernous and\nsupraclinoid internal carotid arteries." + }, + { + "input": "There is stable hyperdensity in the superior right frontal lobe, subarachnoid\nversus intraparenchymal hemorrhage. No new hemorrhage is seen.\n\nThere is no evidence of infarction, edema, or mass. The ventricles and sulci\nare normal in size and configuration.\n\nThere are scattered hypodensities in the periventricular and subcortical white\nmatter, nonspecific, likely secondary to small vessel ischemic disease. There\nis atherosclerotic calcification involving bilateral cavernous carotid\narteries.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. There is left\nocular prostheses. The right orbit is unremarkable.", + "output": "1. Stable superior right frontal hemorrhage, subarachnoid versus\nintraparenchymal. No new hemorrhage is seen.\n2. Findings of small vessel ischemic disease." + }, + { + "input": "Patient is status post resection of large sellar/suprasellar mass the a left\nfrontal craniotomy. There are expected postoperative changes including\nsubgaleal gas in the frontal scalp bilaterally and scalp edema there is\nmoderate pneumocephalus along the bilateral frontal convexities, left greater\nthan right, and a small loculated gas anterior to the pons.\n\nThere is a small amount of mixed density hemorrhage layering along the left\nfrontal and left temporal convexities. Right frontal approach ventriculostomy\ncatheter terminates in the frontal horn of the right lateral ventricle. The\nright lateral ventricle has decreased in size. There is a trace amount of\nhemorrhage layering in the occipital horn of the right lateral.\n\nThere is fluid in the suprasellar region and new partial pneumatization of the\nsphenoid sinus after tumor resection. Some hyperdense expansile soft tissue\nmeasuring approximately 3.5 x 2.3 cm remains in the sella and suprasellar\nregions, likely residual tumor. There is no evidence of large territorial\ninfarction.", + "output": "1. Postoperative changes as detailed above status post debulking of large\nsellar/suprasellar mass. At least 3.5 x 2.3 cm residual tumor in the sellar\nand suprasellar region.\n2. Moderate pneumocephalus and trace extra-axial hemorrhage along the left\nfrontal and temporal convexities.\n3. Right frontal approach ventriculostomy catheter in place with interval\ndecreased size of the right lateral ventricle." + }, + { + "input": "Patient is status post suprasellar mass resection. A 1.6 x 0.8 x 1.3 cm cm\nhemorrhage is again present at the site of the mass and remains relatively\nstable. Small amount of intraventricular hemorrhage layering in the right\noccipital horn is stable. There are stable small subdural hematomas.\n\nFocal hypodensities involving the bilateral basal ganglia, left frontal lobe\nand corpus callosum correspond to acute infarcts seen on most recent brain MRI\nfrom ___. Acute infarcts involving the left occipital lobe are\nbetter assessed on prior dedicated MRI. Focal hypodensity with surrounding\nhigh attenuation material in the right frontal lobe relates to the course of\nthe previously positioned ventricular drain and appears stable. \nPneumocephalus is improved. There is redemonstration of a residual mass like\narea in the suprasellar region, which is felt to correspond to the residual\nenhancing suprasellar mass seen on prior dedicated MRI.\n\nThere is no new definite area of hemorrhage or large acute territorial\ninfarction. Ventricles are stable in size as compared to prior MRI.\n\nExpected postoperative changes are present from bifrontal craniotomies with\nassociated bifrontal subgaleal hematomas and air-fluid levels. Fluid/mucosal\nthickening is present in the left frontal sinus, sphenoid sinuses and\nposterior ethmoidal air cells. The middle ear cavities are clear. A small\namount of fluid is present in the right mastoid air cells. The globes are\nunremarkable.", + "output": "1. No new area of focal hemorrhage or acute large territorial infarction. \nPlease note MRI of the brain is more sensitive for the detection of acute\ninfarct.\n2. Known infarcts involving the bilateral basal ganglia, left frontal lobe,\ncorpus callosum and left occipital lobe are better assessed on prior dedicated\nMRI.\n3. Stable hemorrhage at site of parasellar mass resection.\n4. Stable small bilateral subdural hematomas and intraventricular hemorrhage\nas described.\n5. Redemonstration of of a mass like area in the suprasellar region which is\nfelt to correspond to the residual enhancing suprasellar mass seen on prior\ndedicated MRI." + }, + { + "input": "Postsurgical changes related suprasellar mass resection are again noted. The\npreviously described hemorrhage at the site of the mass appears grossly\nunchanged in size, however is decreased in density over the interval. \nRedemonstrated is a focal mass like area in the suprasellar region, which is\nfelt to correspond to the residual enhancing suprasellar mass on prior MRI. \nHemorrhage layering within the occipital horn of the right lateral ventricle\nhas decreased over the interval. Small subdural hematomas also appear grossly\nunchanged, allowing for differences in technique.\n\nFocal hypodensities involving the bilateral basal ganglia, left frontal lobe,\nand corpus callosum corresponds the acute infarcts, and appear grossly stable.\nLeft occipital lobe infarct is better assessed on recent prior MRI. Changes\nrelated to prior right frontal approach ventriculostomy catheter appear\nsimilar to prior.\n\nNo definite evidence of acute infarct or intracranial hemorrhage. The\nconfiguration of the ventricles and sulci appears stable.\n\nPostoperative changes are present from bifrontal craniotomies with associated\nbifrontal subgaleal hematomas and a small amount of residual subcutaneous air.\nAllowing for differences in technique, subtalar collections are stable to\nslightly increased compared to prior exam.\n\nFluid and mucosal thickening are seen in the left frontal sinus, sphenoid\nsinus, and posterior ethmoid air cells. The middle ear cavities are clear. \nThe globes are unremarkable.", + "output": "1. Evolving postsurgical changes related to bifrontal craniotomies with stable\nto slightly increased bifrontal subgaleal collections.\n2. No new area of focal intracranial hemorrhage or acute large vascular\nterritorial infarction.\n3. Interval evolution of known hemorrhage at the site of parasellar mass\nresection.\n4. Grossly stable small bilateral subdural hematomas.\n5. Slight interval decrease in layering hemorrhage within the occipital horn\nof the right lateral ventricle.\n6. Known infarcts involving the bilateral basal ganglia, left frontal lobe,\ncorpus callosum, and left occipital lobe are better assessed on recent MR of\nthe brain." + }, + { + "input": "Patient is post bifrontal craniotomy and suprasellar mass resection. Residual\nhyperdense suprasellar mass appears similar to before. Surrounding\nencephalomalacia and hypodensity in the suprasellar region and left frontal\nlobe appear increasingly hypodense, likely reflecting interval evolution of\npostsurgical changes. Small left frontal subdural hematoma is stable. Right\nfrontal encephalomalacia is unchanged.\n\nThe ventricles are diffusely larger compared to ___. For example, the\nwidth of the third ventricle in between the thalamus measures 5 mm (previously\n2 mm).\n\nThere is no evidence of fracture. There is persistent opacification of left\nfrontal sinus. The visualized portion of the orbits are unremarkable.", + "output": "1. The ventricles are larger compared to ___ which may reflect developing\ncommunicating hydrocephalus.\n2. Interval evolution of post surgical changes.\n3. Residual suprasellar mass is stable.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 4:20 AM, 5 minutes after discovery of\nthe findings." + }, + { + "input": "There is a large isodense extra-axial fluid collection overlying the right\nfrontal lobe, crossing suture lines, likely indicating this is a subdural\nhematoma. The subdural hematoma measures up to 1.8 cm in thickness. Hyperdense\ncomponents are seen more superiorly in the collection. There is significant\nlocal sulcal effacement and shift of the normally midline structures by 10 mm\ntowards the left. Additionally, there is effacement of the right lateral\nventricle. The suprasellar cisterns are effaced. There is mild asymmetry of\nthe ambient cisterns, without frank uncal herniation. The gray-white\ndifferentiation is preserved.\n\nHardware from prior left parietal burr holes is noted. No fractures seen. The\nvisualized paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear.", + "output": "Large right frontal subdural hematoma which demonstrates different densities,\nlikely acute/subacute. Significant mass-effect with local sulcal effacement,\nleftward shift of the midline structures by 10 mm, and effacement of the\nsuprasellar cisterns.\n\nNOTIFICATION: These findings were relayed to Dr. ___ by Dr. ___\ntelephone at 22:50 upon discovery." + }, + { + "input": "The patient is status post right frontal craniotomy for evacuation of subdural\nhematoma, with expected postoperative pneumocephalus and a small amount of\nmixed density extra-axial fluid, likely residual blood products. There is\nsubstantial improvement in the sulcal effacement and shift of the midline\nstructures, now measuring 4 mm towards the left. There is still partial\neffacement of the right lateral ventricle. The appearance of the suprasellar\ncistern is improved since the prior study, not completely normal. There is no\nnew hemorrhage or territorial infarction. Gray-white matter differentiation is\npreserved.\nExpected postoperative changes in the scalp of the right frontotemporal\nconvexity. Patent visualized paranasal sinuses.", + "output": "1. Status post right frontal craniotomy for evacuation of subdural hematoma\nwith improvement in midline shift and sulcal effacement, as well as appearance\nof the basal cisterns. No area of new hemorrhage or territorial infarction.\n2. Expected postoperative changes in the scalp, calvarium, and with regards\nto pneumocephalus." + }, + { + "input": "Since the prior study from ___, there has been complete interval\nresolution of postoperative pneumocephalus along the right frontal convexity,\nat the site of prior subdural hematoma evacuation. There is no intracranial\nhemorrhage, infarction, edema, or mass. The ventricles and sulci are normal in\nsize and configuration.\n\nPostsurgical changes related to prior right frontal craniotomy are again noted\nas well as left frontal and parietal burr holes. Otherwise, no osseous\nabnormalities seen. The paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The orbits are unremarkable.", + "output": "1. Complete interval resolution of postoperative pneumocephalus related to\nprior right frontal craniotomy for subdural evacuation.\n2. No intracranial hemorrhage or other acute pathology is present." + }, + { + "input": "SOFT TISSUES:\nAnterolateral to the left mandible, there is subcutaneous emphysema and\nstranding with extension to the lateral wall of the left maxillary sinus.\n\nMAXILLOFACIAL BONES: Multiple, mildly displaced fractures are noted through\nthe maxillofacial bones, fractures through the anterior, lateral, and inferior\nwalls of the left maxillary sinus. Multiple additional displaced fractures\nare seen through the left zygomatic arch, including a fracture through the\nposterior zygomatic arch extending into the left temporomandibular joint\n(2:62). The lateral pterygoid plates are intact.\n\nMANDIBLE: The mandible is without fracture or temporomandibular joint\ndislocation. The temporomandibular joints are symmetric, without significant\ndegenerative change.\n\nDENTITION: There are no dental fractures. There is no remarkable periodontal\ndisease, periapical lucency, or odontogenic abscess.\n\nSINUSES: Multiple fractures through the left maxillary sinus are noted, as\npreviously described. Air-fluid levels seen within the left maxillary sinus. \nThe remainder of the paranasal sinuses are intact and clear. The ostiomeatal\nunits are patent. The mastoid air cells and middle ear cavities are clear.\n\nNOSE: There is no nasal bone fracture. Nasopharyngeal soft tissues are\nunremarkable. There is no nasal septal hematoma.\n\nORBITS: Extensive left maxillary fractures involve the inferior left orbital\nfloor without evidence of inferior rectus muscle entrapment. The orbits,\nincluding the laminae papyracea, are otherwise intact. The globes are intact\nwith non-displaced lenses and no intraocular hematoma. There is no preseptal\nsoft tissue edema. There is no retrobulbar hematoma or fat stranding.\n\nAllowing for imaging technique optimized for the face, the limited included\nportion of the brain is grossly unremarkable.", + "output": "1. Multiple in displaced fractures through the lateral and posterior aspects\nof the zygomatic process of the left temporal bone with extension into the\nleft temporomandibular joint.\n2. Comminuted, displaced fractures involving the anterior, lateral, and\nposterior walls of the left maxillary sinus, with extension through the left\norbital floor. No evidence of inferior rectus muscle entrapment." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThe patient is status post bilateral craniotomies. There is no evidence of\nacute hemorrhage, edema, mass effect, loss of gray/ white matter\ndifferentiation, or pathologic extra-axial collection. Ventricles, sulci, and\nbasal cisterns are normal in size.\n\nLeft zygomaticomaxillary complex fractures are again seen, similar to the\nfacial bone CT performed earlier on the same day. These include left orbital\nfloor and left maxillary sinus wall fractures with fluid in the left maxillary\nsinus, and a comminuted fracture of the left zygomatic arch. The zygomatic\narch fracture extends into the glenoid fossa of the left temporomandibular\njoint, and into the sphenozygomatic suture. The overlying soft tissue\nswelling has decreased with interval resolution of the subcutaneous gas,\npreviously overlying the left maxilla and masticator muscle. The\ntemporomandibular joints are well aligned in closed mouth position.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal with no evidence of stenosis, occlusion, or aneurysm. A 1 mm\ntriangular-shaped outpouching at the origin of the right posterior\ncommunicating artery and a 2 mm triangular-shaped outpouching at the origin of\nthe left posterior communicating artery represent infundibuli. There is also\nan infundibulum at the right superior cerebellar artery origin.\n\nThe dural venous sinuses are patent.", + "output": "1. Normal head CTA.\n2. No evidence for acute intracranial abnormalities.\n3. Left maxillofacial fractures are again noted, assessed in detail on the\npreceding facial bone CT." + }, + { + "input": "There is an acute left frontal subdural hematoma measuring up to 7 mm in\nmaximal thickness. There is no evidence of midline shift or herniation. The\nventricles and sulci are normal in size and configuration.\n\nThey are bilateral frontal and parietal craniotomy. There is a right frontal\nburr hole visualized. The paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The orbits are unremarkable.", + "output": "Acute left frontal subdural hematoma with no evidence of midline shift or\nherniation." + }, + { + "input": "Small left frontal subdural hemorrhagic collection measures up to 7 mm which\nis not significantly changed. The collection now appears more heterogeneous,\nbut hyperdense parts have partly resolved. This change is thought to reflect\nappropriate evolution of the previously noted acute layering hemorrhage\nwithout change in size. Mild flattening of the adjacent anterior left frontal\nlobe appears very similar. Very small right frontal subdural hematoma\nmeasuring only 2 mm in width (2:13) is unchanged. There is no shift of\nnormally midline structures or hydrocephalus. Surrounding soft tissue\nstructures are unremarkable. Minimal mucosal thickening among ethmoid air\ncells, as before. Mastoid air cells appear clear. Bilateral craniotomy sites\nappear unchanged.", + "output": "Evolving attenuation of small left anterior frontal subdural hemorrhage with\ndecrease in hyperdense components; no change in overall size. Trace right\nfrontal subdural hematoma appears unchanged. No definite new hemorrhage." + }, + { + "input": "Again seen small left frontal subdural hemorrhagic collection measuring up to\n7 mm, not significantly changed from prior exam. The collection again appears\nheterogeneous similar to prior exam. Mild flattening of the adjacent anterior\nleft frontal lobe appears similar. Tiny right frontal subdural hematoma\nmeasuring approximately 2 mm is unchanged. There is no shift of normally\nmidline structures or hydrocephalus. Surrounding soft tissue structures are\nunremarkable. Minimal mucosal thickening among the ethmoid air cells, as\nbefore. Mastoid air cells are clear. Bilateral craniotomy sites appear\nunchanged. Right petrous apex effusion, unchanged compared to the prior exam.\n\nThere is no acute hemorrhage or large territorial infarction.", + "output": "Overall unchanged appearance of small left anterior frontal subdural hematoma\nand right frontal subdural hematoma compared to most recent exam dated ___. No new hemorrhage." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema,or mass effect. \nThere has been interval resolution of the previously visualized small\nbilateral frontal subdural hematomas. Redemonstration of bilateral craniotomy\nsites, similar appearance. The ventricles and sulci are normal in size and\nconfiguration.\n\nMild mucosal thickening is noted involving the ethmoid air cells. The\nremainder of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are normal.", + "output": "Chronic postoperative findings, unchanged.\nOtherwise normal study." + }, + { + "input": "Limited examination due to patient motion resulting in obscuration of the\nvertex.. There is no evidence of acute fracture,acute intracranial\nhemorrhage,edema,or mass effect. There is a mild, chronic deformity of the\nleft zygomatic arch. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. There is moderate periventricular\nhypodensity likely representing chronic microvascular ischemic disease.\n\nThere is mild mucosal thickening of the bilateral maxillary sinuses and\nethmoid air cells. The mastoid air cells and middle ear cavities are clear. \nThe native lenses have been surgically removed bilaterally.", + "output": "1. Limited examination due to motion. Within this limitation, there are no\nacute intracranial abnormalities." + }, + { + "input": "Markedly limited examination secondary to patient motion and related artifact.\nWithin that limitation there is no evidence of acute large territorial\ninfarction, intracranial hemorrhage, edema or shift of normal midline\nstructures. There is severe parenchymal atrophy evidence by enlargement of\nthe ventricular system and extra-axial spaces, similar appearance from prior. \nPeriventricular and subcortical white matter hypodensities are nonspecific but\nlikely reflect the sequelae of chronic small vessel ischemic disease in a\npatient of this age.\n\nThere is no definite evidence of fracture. There is mild thickening of the\nanterior ethmoidal air cells. The visualized paranasal sinuses, mastoid air\ncells and middle ear cavities are otherwise clear. Visualized orbits are\nnotable for bilateral lens replacements.", + "output": "1. Limited examination secondary to patient motion. Within that limitation\nthere is no evidence of acute intracranial process.\n2. Severe parenchymal atrophy. Probable chronic small vessel ischemic\ndisease." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or infarction.\n\nThe ventricles and sulci are normal in size and configuration.\n\nThe basal cisterns appear patent and there is preservation of gray-white\nmatter differentiation.\n\nThere is minimal asymmetry in the right parietal bone, probably from prior\nremote trauma, please correlate clinically, otherwise, the visualized bony\nstructures are grossly unremarkable.\n\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\n\nThe globes are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no acute hemorrhage, edema or shift of the normally midline\nstructures. The ventricles and sulci are of normal size and configuration for\nage. There is no evidence for an acute vascular territorial infarction. White\nmatter hypodensities, while nonspecific, are presumably sequela from chronic\nsmall vessel ischemic disease (02:20).\n\nThere is no acute fracture. A chronic appearing left nasal bone deformity is\nnoted. The included paranasal sinuses and mastoid air cells are well-aerated.", + "output": "No acute intracranial abnormality.\n\nNOTE ON ATTENDING REVIEW:\n\nAcute comminuted/overriding fracture involving the right side of mandible- at\nthe junction of head and ramus, similar to the prior study of ___, partly\nincluded (se 3, im 1, 2) and likely new since ___.\nConsider maxillofacial consult and CT face as needed.\nDeformity of right parietal bone and a few lucent lines representing vascular\ngrooves, stable.\nNo acute skull fracture.\n\nD/w Dr. ___ by Dr. ___ phone on ___ at 8.30am soon after\nreview." + }, + { + "input": "There is no evidence of infarction,hemorrhage,edema, or mass. The ventricles\nand sulci appear normal in caliber and configuration.\n\nThere is no evidence of acute fracture. Well corticated nasal bone fragment\nlikely represents prior trauma. There is a chronic deformity of the right\nparietal bone due to old fracture. There is small subgaleal hematoma\noverlying the left frontal calvarium. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.\nThere is thickening of the skin and loss of normal subcutaneous fat adjacent\nto the left malar eminence. This may represent an old scar. However, is\nincompletely visualized and correlation with clinical evaluation is\nrecommended.", + "output": "1. No acute intracranial abnormalities.\n2. Small left frontal subgaleal hematoma.\n3. Chronic right parietal bone depressed fracture.\n4. Possible left facial scar, but clinical correlation is recommended to\nexclude a more aggressive etiology.\n\nRECOMMENDATION(S): Clinical of evaluation of left facial finding, possible\nscar.\n\nNOTIFICATION: The finding of possible left facial scar, incompletely\nevaluated, was reported in the radiology department non urgent critical\nimaging findings system ___ 09:53 immediately upon reviewing the\nimages." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Normal study." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute abnormalities. Mild age inappropriate prominence of sulci." + }, + { + "input": "No evidence of infarction, hemorrhage, edema, or mass effect. The ventricles\nand sulci are normal in size and configuration. Scattered intracranial\ncalcifications in the sulci are likely sequelae of prior infection.\n\nNo evidence of fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. No evidence of ventriculomegaly or mass effect.\n2. Bilateral intracranial calcifications are likely sequelae of prior\ninfection.\n3. No hemorrhage." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. There\nis prominence of the ventricles and sulci suggestive of involutional changes. \nMild hypoattenuation of the periventricular and subcortical white matter is\nnonspecific but may represent sequela of microvascular ischemic disease. Mild\ncalcified atherosclerosis of the bilateral carotid siphons is demonstrated.\n\nMild mucosal thickening of the bilateral ethmoid air cells and right maxillary\nsinus. The visualized portion of the other paranasal sinuses, right mastoid\nair cells, and middle ear cavities are clear. There is partial opacification\nof the left mastoid air cells. The visualized portion of the orbits are\nnormal. ___ tooth 8. Demonstrates broad bone loss surrounding the root and\nis angulated posteriorly recommend correlation with direct inspection.\n\nEndotracheal and orogastric tube are demonstrated within the upper aero\ndigestive tract.", + "output": "No evidence of mass, hemorrhage or infarction.\nIdentify ___ disease involving the ___ tooth 8." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage or mass effect. The\nventricles and basal cisterns appear normal. There is no midline shift or\nhydrocephalus.\n\nThe orbits, skull base, and paranasal sinuses appear unremarkable. There is no\nevidence of acute calvarial fracture.", + "output": "No acute intracranial abnormality.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\nby telephone on ___ at 11:29 AM, 5 minutes after discovery of the\nfindings." + }, + { + "input": "There is no evidence of hemorrhage, edema, shift of normally midline\nstructures, or infarction. Ventricles and sulci are normal in overall size and\nconfiguration. There is mild mucosal thickening of the bilateral ethmoid air\ncells and bilateral maxillary sinuses with a mucous retention cyst noted in\nthe left maxillary sinus. The nasal septum is deviated to the right. Mastoid\nair cells and middle ear cavities are well aerated. The bony calvarium is\nintact.", + "output": "Minimal paranasal sinus inflammatory changes. Otherwise normal study." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema,or discrete mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No evidence of fracture or intracranial hemorrhage." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or mass.\nThe ventricles and sulci are normal in size and configuration. Mild right\nforehead soft tissue swelling.\n\nThere is no evidence of fracture. Moderate opacification right, mild\nopacification left mastoid air cells with areas of ossification, consistent\nwith contraction from chronic inflammation. Clear middle ear cavities. Mild\nsphenoid sinus opacification. Few indeterminate small lucent calvarial\nlesions, statistically likely represent benign hemangiomas in the absence of\nhistory of malignancy.", + "output": "1. No acute intracranial process.\n2. Mild forehead soft tissue swelling.\n3. Chronic mastoid inflammatory changes." + }, + { + "input": "There is no evidence of large territorial infarction, hemorrhage, edema, or\nmass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mucosal thickening of bilateral\nmaxillary and frontal sinuses, as well as bilateral ethmoid air cells. The\nvisualized portion of the mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Paranasal sinus disease as described." + }, + { + "input": "There is no evidence of acute large territory infarction, hemorrhage, edema,\nor mass. Focal hypodensities in the bilateral basal ganglia likely represent\ndilated perivascular spaces or chronic lacunar\ninfarcts. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular, deep white matter, and subcortical\nwhite matter hypodensities are nonspecific, but likely chronic sequela of\nsmall-vessel ischemic disease.\n\nThere is no evidence of fracture. The calvarium is diffusely demineralized.\nNear the vertex of the cranium, there are at least 3 focal sclerotic lesions\nmeasuring up to 1.1 cm (03: 50, 54, 56). The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable. Posterior cervical spinal\nfusion hardware is partially visualized.", + "output": "1. No acute intracranial process.\n2. Bilateral basal ganglia hypodensities likely represent dilated perivascular\nspaces or chronic lacunar infarcts.\n3. Global involutional changes and probable sequela of chronic small vessel\nischemic disease.\n4. At least 3 focal sclerotic lesions near the vertex of the cranium are\nnonspecific but could represent bone islands, but if the patient has a history\nof malignancy, metastatic disease is not excluded. Clinical correlation is\nrecommended and if needed, bone scan may be obtained for further evaluation." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction, mass or midline\nshift. There is no hydrocephalus. A 9 mm hypodensity in the left caudate head\nis consistent with a lacunar infarction which appears chronic. Visualized\nparanasal sinuses and mastoid air cells are clear. There is no fracture.", + "output": "No acute intracranial process. Chronic appearing lacunar infarct in the left\ncaudate head." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are prominent, indicative of age-related involutional change.\nPeriventricular and subcortical white matter hypodensities are nonspecific but\nlikely reflect the sequelae of chronic microvascular ischemic disease.\n\nCTA HEAD: The examination is severely motion degraded. Within these confines:\nThere is moderate to severe focal narrowing of the basilar artery, may be\nexaggerated in setting of motion degradation (602:29). Otherwise, the\nremainder of the more central vessels of the circle of ___ and their\nprincipal intracranial branches appear patent without evidence of\nflow-limiting stenosis, occlusion, or aneurysm formation, in the setting of a\nmotion limited exam. There is a thin linear hypodensity in the left transverse\nsinus, which does not have the typical imaging appearance of arachnoid\ngranulation tissue (3:212). Findings may suggest a nonocclusive dural venous\nsinus thrombus.\n\nCTA NECK: Moderate calcification of the right carotid bulb. Dominant right\nvertebral artery system. Otherwise no evidence of flow-limiting stenosis or\nocclusion of the visualized carotid and vertebral arteries.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. Multilevel, multifactorial degenerative changes are visualized\nthroughout the cervical spine consistent with spondylosis and articular joint\nfacet hypertrophy, causing narrowing of the right neural foramen at C3-C4, on\nthe left at C5-C6 level.", + "output": "1. There is no evidence of acute intracranial process or hemorrhage.\n\n2. There is moderate to severe focal narrowing of the basilar artery, may be\nexaggerated in setting of motion degradation.\n\n3. Thin linear hypodensity in the left transverse sinus, which does not have\nthe typical imaging appearance of arachnoid granulation tissue (3:212).\nFindings may suggest a nonocclusive dural venous sinus thrombus.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 8:38 pm, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute, large territorial\ninfarction,hemorrhage,edema,ormass-effect. Ventricles and sulci are\nprominent, consistent with age-related global parenchymal loss. \nPeriventricular, subcortical, and deep white matter hypodensities are\nnonspecific, but likely represent sequela of chronic microvascular ischemic\ndisease.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe left vertebral artery terminates into of the left ___. The right\nvertebral artery is patent distally, terminating into the basilar artery. \nThere is a moderate focal basilar artery change in caliber/narrowing (series\n4; image 235), which appears similar compared to prior and may be due to\nvessel tortuosity. Fetal PCA is noted on the left. There are moderate\ncalcifications of the bilateral internal carotid siphons. Otherwise, there is\nocclusion or aneurysm of the major vessels of the circle of ___.\n\nAgain seen in the left transverse sinus is a linear filling defect, which does\nnot have the appearance typical of an arachnoid granulation (series 4; image\n247), which appears similar compared to prior. No restricted diffusion to\nsuggest acute thrombosis of the dural venous sinus. Findings are likely due\nto volume averaging from adjacent vein versus chronic nonocclusive dural\nvenous thrombosis.\n\nCTA NECK:\nThere is moderate calcification of the aortic arch and takeoff of the great\nvessels of the neck. Bilateral carotid and vertebral artery origins remain\npatent. There is mild-to-moderate calcification of the right carotid bulb and\nproximal internal carotid artery, causing less than 30% stenosis by NASCET\ncriteria. No evidence of left internal carotid stenosis by NASCET criteria.\n\nThe proximal carotidandvertebral arteries and their major branches appear\nnormal with no evidence of stenosis or occlusion.\n\nCT perfusion: Increased mean transit time seen diffusely through both\nhemispheres in the setting of poor contrast bolus injection is likely\nartifactual.\n\nOTHER:\nVisualized lung show a calcified granuloma in the right upper lobe (series 4;\nimage 86). There are mild peribronchovascular ___ opacities, in the\nbilateral upper lobes, which may represent an element of\ninfection/inflammation. No frank consolidations or concerning nodules in the\nvisualized upper lung fields. The visualized portion of the thyroid gland is\nwithin normal limits. There is no lymphadenopathy by CT size criteria. \nProminent left axillary lymph nodes, which are not frankly enlarged by CT size\ncriteria, are normal in morphology.", + "output": "1. Unchanged linear filling defect in the left transverse sinus, which is not\nthe typical appearance of arachnoid granulation. This finding likely\nrepresents volume averaging from adjacent vein versus chronic nonocclusive\ndural venous sinus thrombosis. No restricted diffusion on subsequent MRI to\nsuggest acute thrombosis of dural venous sinus.\n2. Moderate focal basilar artery change in caliber/narrowing, which appears\nsimilar compared to prior, likely due to atherosclerosis. Overall, no\nocclusion or aneurysm of the major vessels of the head and neck. \nMild-to-moderate atherosclerotic disease of the major vessels of the head\nneck.\n3. Peribronchovascular ___ opacities in the bilateral upper lobes may\nrepresent element of infection/inflammation. No frank consolidations or\nconcerning nodules in the visualized lung fields.\n4. Nondiagnostic CT perfusion with diffusely increased mean transit time\nthroughout both hemispheres, in the setting of poor contrast bolus injection,\nlikely artifactual." + }, + { + "input": "A right cerebral subdural hematoma is again seen measuring up to 8 mm in\nmaximal thickness exerting mass effect upon the right cerebral hemisphere and\nwithout significant increase in size from CT performed 4 hr ago. However,\nthere is interval increase in size of a left cerebral subdural hematoma which\nappears heterogeneous which raises concern for hyperacute bleeding. A left\nparafalcine component measures up to 14 mm. There is mass-effect on the left\ncerebral hemisphere. Tracking of subdural hematoma along the left tentorial\nleaflet is also noted. There is no significant midline shift or evidence of\ndownward herniation. Small vessel disease is again noted. No intra-axial\nhemorrhage is seen. There is no definite calvarial fracture. Opacification\nof left mastoid air cells and left middle ear cavity again noted. Paranasal\nsinus disease is re- demonstrated. Minimal opacification of right inferior\nmastoid air cells also noted. Left posterior scalp hematoma is noted with\ntiny loculates of gas suggesting laceration.", + "output": "1. Bilateral cerebral subdural hematomas, increased on the left with\nsuggestion of hyperacute bleeding. No significant mass-effect, shift of\nmidline structures, or evidence of downward herniation. Close follow-up\nrecommended.\n2. No definite fracture.\n3. Sinus disease with left mastoid air cell and middle ear opacification." + }, + { + "input": "Compared to ___ at 21:29, no new or enlarging hemorrhage. Again\nseen is subdural hematoma tracking along the left aspect the falx and left\ntentorium cerebelli. The hematoma measures 1.0 cm in greatest dimension,\npreviously 1.1 cm (___). Unchanged right frontal subdural hematoma. No\nassociated subarachnoid hemorrhage. Unchanged minimal right to left midline\nshift. Basal cisterns are patent. Unchanged extensive periventricular and\nsubcortical white matter hypodensity, which is nonspecific, but likely\nrepresents chronic microvascular ischemic changes. No evidence of infarction\nor mass. The ventricles and sulci are prominent, consistent with involutional\nchanges.\n\nNo fractures. Unchanged left parietal subgaleal hematoma and extensive\nmucosal thickening in the bilateral maxillary sinuses, ethmoid air cells and\nsphenoid sinuses. Unchanged opacification of the left mastoid air cells. The\npatient is status post bilateral lens replacements.", + "output": "1. Compared to ___ at 21:29, no new or enlarging hemorrhage.\n2. Unchanged subdural hematomas tracking along the left aspect of the falx and\nalong the left tentorium cerebelli. Unchanged right convexity subdural\nhematoma. Unchanged minimal right to left midline shift.\n3. Unchanged paranasal sinus and left mastoid opacification, as described\nabove." + }, + { + "input": "When compared to prior examination of ___, expected evolution and\ndecreased size of left parafalcine subdural hematoma, now measuring\napproximately 3-4 mm in greatest thickness, which is now predominantly hypo\ndense. Left tentorium subdural hematoma has resolved there is also expected\nevolution of right hemispheric subdural hematoma, now all also predominately\nhypodense, measuring up to 7 mm in greatest thickness, with a more loculated\nhypodense component along the right posterior parietal lobe (series 2, image\n15) that was not seen on prior examination, presumably secondary to\nredistribution. No new acute hemorrhage. There is minimal 2 mm leftward\nmidline shift, improved from prior examination.\n\nThere is no acute large territory infarct. Periventricular and subcortical\nwhite matter hypodensities are similar appearance to prior exam some which are\nconfluent, nonspecific, but compatible with chronic microangiopathy in a\npatient of this age. The sulci, ventricles and cisterns are within expected\nlimits for the patient's age, allowing for mild mass effect from the right\nhemispheric subdural hematoma. Unchanged complete opacification of the left\nmastoid air cells and middle years. Aerosolized moderate mucosal thickening\nof the bilateral maxillary sinuses with partial opacification of multiple\nethmoid air cells and aerosolized debris within the sphenoid and inferior\nfrontal sinuses have progressed from prior examination. The orbits are\nunremarkable noting bilateral lens replacements.", + "output": "-Expected interval evolution of previously described left parafalcine and\ntentorial subdural hematoma, with residual left parafalcine hypodense subacute\nto chronic hematoma measuring approximately 3-4 mm in greatest thickness.\n-Expected evolution and redistribution of right hemispheric subdural hematoma,\nwhich is now hypodense, measuring up to 7 mm in greatest thickness.\n-Worsening paranasal sinus disease as described above. Unchanged left mastoid\nand middle ear opacification.\n-No new hemorrhage or acute large territory infarct. Additional findings as\ndescribed above." + }, + { + "input": "CT HEAD: There is no acute intra-axial or extra-axial hemorrhage, major\nvascular infarction, mass or midline shift. Gray-white matter differentiation\nis preserved. Ventricles and sulci are symmetric and unremarkable.\n\nVisualized paranasal sinuses and mastoid air cells are clear. The skull and\nextracranial soft tissues are unremarkable.\n\nCTA NECK: There is a 3 vessel aortic arch. The common carotid and internal\ncarotid arteries appear normal without evidence of dissection occlusion or\nsignificant stenosis. The minimum diameter of the proximal right ICA is 7.5 mm\nand the distal right ICA has a maximum diameter of 3.5 m the m. minimum\ndiameter of the proximal left ICA is 7.0 mm and distal left ICA minimum\ndiameter is 4.0 mm. The vertebral arteries appear normal and are codominant.\n\nThere is scattered bilateral cervical lymph nodes which are not pathologically\nenlarged. At the posterior margin of the right lobe of the thyroid is a 1.4 AP\nx 1.0 TRV x approximately 2.8 cm cc nodule.\n\nCTA HEAD: Intracranial ICAs, MCAs, ACAS and anterior communicating artery are\nunremarkable. The vertebral arteries, basilar artery, and PCAs appear normal.\nPosterior communicating arteries are not definitively identified on either\nside. There is no evidence of aneurysm, stenosis or occlusion.", + "output": "1. Unremarkable unenhanced head CT.\n\n2, Unremarkable CTA of the head and neck.\n\n3. Nodular soft tissue at the posterior aspect of the right lobe of the\nthyroid could potentially be arising from a parathyroid gland and represent an\nadenoma or the from the thyroid itself. Dedicated ultrasound and correlation\nwith lab values is suggested to further characterize." + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes, age advanced. No acute skull fracture. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "No significant interval change in multicompartmental left-sided acute\nintracranial hemorrhage: subarachnoid hemorrhage in the perimesencephalic,\nquadrigeminal plate, and cerebellopontine angle cisterns (series 2, image 11),\nsubarachnoid hemorrhage in the left temp sulci, small parenchymal hematoma in\nthe left temporal lobe with mild surrounding edema (series 2, image 7; series\n601b, image 48), and small foci of subdural hemorrhage along the left frontal\nand temporal convexity (series 2, image 17, image 11). No new hemorrhage is\nseen.\n\nA hypodense subdural collection along the right convexity measuring 6 mm in\nshort axis on axial images (series 2, image 16), and a smaller hypodense\ncollection at the left parietal vertex measuring 9 mm (series 2, image 23) are\nstable compared to the CT from earlier on the same day, but new from ___, compatible with chronic hematomas or subdural hygromas. There is no\nsignificant sulcal effacement due to underlying parenchymal volume loss with\nmild associated prominence of the ventricles and sulci, similar to prior.\n\nThere is no shift of midline structures. There is no herniation.\n\nThere is mild right parietal subgaleal soft tissue swelling, series 3, image\n47. No evidence of a fracture. There is minimal mucosal thickening in the\nright sphenoid sinus. Other visualized paranasal sinuses and mastoid air\ncells are well aerated. The orbits appear unremarkable.", + "output": "1. Unchanged left subarachnoid hemorrhage in the sulci and basal cisterns.\n2. Unchanged small left temporal parenchymal hematoma with mild surrounding\nedema, likely a contusion.\n3. Unchanged small left frontal and temporal acute subdural hematoma.\n4. Small hypodense subdural collection along the right convexity and a smaller\nhypodense subdural collection at the left parietal vertex are stable compared\nto the CT from 2 hr earlier, but new compared to ___, compatible with\neither subdural hygromas or chronic subdural hematomas.\n5. Mild right parietal subgaleal soft tissue swelling. No fracture." + }, + { + "input": "There is incompletely visualized dilatation of the distal cervical right\ninternal carotid artery with associated calcified plaque, measuring 8 mm in\ndiameter on image 2:2. Distal to the dilatation, the distal cervical right\ninternal carotid artery is tortuous but normal in caliber.\n\nThere is extensive calcified plaque in bilateral carotid siphons with mild\nnarrowing on the right. Anterior cerebral and middle cerebral arteries appear\npatent. There is no evidence for flow-limiting stenosis in the posterior\ncirculation. The right posterior cerebral artery receives approximately equal\ncontributions from the basilar artery and right posterior communicating\nartery. The left posterior cerebral artery receives only slightly greater\ncontribution from the basilar artery than from the left posterior\ncommunicating artery. There are infundibula at bilateral posterior\ncommunicating artery origins, both seen on image 2:78. There is also a 1 mm\ninferiorly projecting aneurysm versus infundibulum of a tiny branch vessel in\nthe left internal carotid artery just proximal to the posterior communicating\nartery origin, seen on image 603b:32. Final interpretation is pending 3D\nreformatted images.\n\nDural venous sinuses appear patent.\n\nThe known intracranial hemorrhage in the brain parenchyma are better assessed\non the preceding noncontrast head CT. A small hypodense right subdural\ncollection along the right convexity, and a smaller hypodense left parietal\nsubdural collection, are again seen, similar to the preceding noncontrast head\nCT from the same day, but new compared to ___, compatible with\nhygromas or a chronic subdural hematomas.\n\nThere is periodontal lucency ___ 4 which is status post dental implant, as\nwell as periodontal lucency ___ 5. There is mild mucosal thickening along\nthe floors of the maxillary sinuses. Other paranasal sinuses and mastoid air\ncells appear well-aerated. The orbits appear unremarkable. No concerning\nbone lesion is seen.", + "output": "1. 1 mm inferiorly projecting aneurysm versus infundibulum of a tiny branch\nvessel is in the left internal carotid artery just proximal to the left\nposterior communicating artery origin.\n2. Infundibula at bilateral posterior communicating artery origins.\n3. Atherosclerosis of bilateral siphons with mild luminal narrowing on the\nright.\n4. Incompletely visualized dilatation of the distal cervical right internal\ncarotid artery, measuring at least 8 mm.\n5. The known intracranial hemorrhage is better assessed on the noncontrast\nhead CT from earlier on the same day.\n6. Bilateral hypodense subdural collections, right larger than left, are\nstable compared to the head CT from earlier on the same day, but new compared\nto ___, compatible with hygromas or chronic hematomas.\n7. Periodontal lucency ___ 4 which is s/p dental implant, and periodontal\nlucency ___ 5." + }, + { + "input": "Interval decrease in the extent of multicompartment left-sided intracranial\nhemorrhage consistent with expected evolution of blood products. Minimally\nincreased thickening of the posterior falx most likely represents\nredistribution (03:28). Hypodense subdural collections are seen bilaterally,\nunchanged along the right frontal convexity (03:19) and adjacent to the right\ncerebellar hemisphere (03:12), and increased along the left cerebellar\nhemisphere, again likely due to redistribution (03:30). Minimal vasogenic\nedema is noted surrounding the intraparenchymal hemorrhage in the left\ntemporal lobe (03:12), similar to the prior study.\n\nThere is no evidence of acute vascular territory infarction or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Interval evolution of multicompartment intracranial hemorrhage with\nexpected redistribution of blood products, as described.\n2. No evidence for new hemorrhage or large territorial infarction." + }, + { + "input": "Previously noted left temporal parenchymal hemorrhage, left subdural hematoma,\nand subarachnoid hemorrhage have resolved. Previously noted bilateral\nhypodense subdural collections have also resolved. There is no new\nhemorrhage. There is no edema or mass effect. Ventricles and sulci are\nprominent due to parenchymal volume loss, with re-expansion of the left-sided\nsulci since ___. Prominent extra-axial spaces in the nondependent\nportions of bilateral middle cranial fossa and right posterior fossa are\nsimilar to ___. These may be secondary to parenchymal volume loss,\nbut an arachnoid cyst in the left middle cranial fossa cannot be excluded.\n\nVisualized bones appear unremarkable. The imaged paranasal sinuses and mastoid\nair cells are well aerated.", + "output": "Resolution of intracranial hemorrhage and bilateral hypodense subdural\ncollections since ___. No evidence for new intracranial\nabnormalities." + }, + { + "input": "There is possible loss of gray-white matter differentiation in the left\nparasagittal parietooccipital lobe (series 3, images ___. There is no\nevidence of fracture,hemorrhage,midline shiftor mass-effect. The ventricles\nand sulci are normal in size and configuration. There are periventricular and\nsubcortical white matter hypodensities, nonspecific but likely sequelae of\nchronic small vessel ischemic disease in this age group.\n\nThere are postsurgical changes related to a right vitrectomy with silicone oil\ninjection of the right ocular globe with diffuse vitreous hyperdensity of the\nright ocular globe measuring 47 Hounsfield units in attenuation. The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are normal.", + "output": "1. Subtle loss of gray-white matter differentiation in the left parasagittal\nparietooccipital lobe concerning for acute infarction or possibly artifact. \nMR head is recommended to evaluate for possible infarction. No intracranial\nhemorrhage or midline shift.\n2. Diffuse vitreous hyperdensity within the right ocular globe may be related\nto recent postsurgical changes from silicone oil injection with superimposed\nhemorrhage not excluded. Evaluation by ophthalmology is recommended.\n3. Periventricular and subcortical white matter hypodensities, nonspecific but\nlikely related to chronic small vessel ischemic disease in this age group.\n\nRECOMMENDATION(S): MR head without contrast to evaluate for possible\ninfarction in the left parietooccipital region.\n\nEvaluation by ophthalmology for diffuse which is hyperdensity in the right\nocular globe, possibly related to recent postsurgical changes from silicone\noil injection with superimposed hemorrhage not excluded.\n\nNOTIFICATION: The findings were discussed with ___, N.P. by ___\n___, M.D. on the telephone on ___ at 5:10 pm, 10 minutes after\ndiscovery of the findings." + }, + { + "input": "The previously demonstrated hypodensity within the left parietooccipital lobe\nis not visualized on the current study. No evidence of large territorial\ninfarct. No acute intracranial hemorrhage. No substantial midline shift or\nevidence of intracranial edema. Periventricular and subcortical white matter\nhypodensities are moderate and while nonspecific likely reflect sequela from\nchronic microangiopathy.\nInterval increase in irregular density in the right globe compared to the\nprior study. These are likely related to the prior procedure of a right\nvitrectomy with silicone oil injection. The globe fluid measures 68\nHounsfield units in attenuation, previously 47. No substantial paranasal\nsinus disease.", + "output": "1. The previously demonstrated hypodensity within the left parietooccipital\nlobe is not visualized on the current study. No evidence of acute\nintracranial hemorrhage or large territorial infarction.\n2. Continued increase in density within the right lobe compared to the prior\nstudy. This could be related to the recent postsurgical changes from the\nsilicone injection however overlying hemorrhage is difficult to exclude. \nRecommend correlation with procedure and evaluation by ophthalmology if\nclinically warranted." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Prominence of the sulci and ventricles is compatible with age\nappropriate atrophy. There are periventricular, subcortical and deep white\nmatter hypodensities which are nonspecific but likely represent the sequela of\nchronic small vessel ischemic disease. Atherosclerotic calcifications of the\nbilateral carotid siphons are noted. 7 mm extra-axial calcified lesion along\nthe inner table of the left frontal bone (03:35) and 4 mm calcified\nextra-axial lesion within the anterior aspect of the right middle cranial\nfossa (03:10) may reflect calcified meningiomas. There is focal calcification\nof the right tentorium (601b:79).\n\nThere is extensive opacification of the bilateral maxillary sinuses, bilateral\nethmoid air cells, and right greater than left bilateral sphenoid sinuses. \nThere is moderate mucosal thickening of bilateral frontal sinuses. Mastoid air\ncells and middle ear cavities are well aerated. The bony calvarium is intact. \nRight lateral periorbital soft tissue swelling is noted. Visualized aspect of\nthe globes appear unremarkable apart from bilateral lens replacement surgery.", + "output": "1. No evidence of intracranial hemorrhage or mass effect.\n2. Right lateral periorbital hematoma without fracture.\n3. Chronic microvascular infarction.\n4. 2 subcentimeter extra-axial calcifications, 1 within the anterior aspect\nof the right middle cranial fossa, and the other adjacent to left frontal\nlobe, possible small calcified meningiomas.\n5. Pan sinus disease." + }, + { + "input": "There is no evidence of acute major vascular territorial\ninfarction,hemorrhage,edema, or mass effect. There is prominence of the\nventricles and sulci greater than expected for patient's given age. Small\nhypodensities in the right basal ganglia may represent chronic lacunar\ninfarcts. Ill-defined periventricular and subcortical white matter\nhypodensities are nonspecific but likely secondary to chronic sequela of\nsmall-vessel ischemic disease.\n\nThere is no evidence of fracture. The right maxillary sinus is completely\nopacified with mild reactive thickening of the adjacent bone suggestive of\nchronic sinusitis. There is partial opacification of the right anterior\nethmoid air cells. Otherwise, the remaining visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormalities on noncontrast head CT. Specifically,\nno evidence of acute large infarct or intracranial hemorrhage.\n2. Chronic lacunar infarcts in the right basal ganglia.\n3. Chronic right sinusitis, as above." + }, + { + "input": "Study is degraded by motion.\n\nThere is no evidence of acute large territory infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Atherosclerotic vascular calcifications are noted. \nThere are periventricular and subcortical lucencies, which may represent small\nvessel ischemic changes.\n\nThere is no evidence of acute fracture. Again seen is a completely opacified\nright maxillary sinus with thickening of the adjacent bone, and areas of\nsuggested high density within the right maxillary sinus mucosal thickening. \nThere is also again suggested expansion of the right maxillary sinus\ninfundibulum.\n\nRight petrous apex lucency compatible with patient's known right petrous apex\ncholesterol granuloma is again seen (see 3:8 on current study, 3:6; 11:6 on ___ prior brain MRI and 07:17 on ___ noncontrast head CT).\n\nOtherwise the remaining visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. Study is degraded by motion.\n2. No acute intracranial abnormality.\n3. No evidence acute intracranial hemorrhage or fracture.\n4. Paranasal sinus disease with findings concerning for right maxillary sinus\nmucocele and/or antrochoanal polyp, as described.\n5. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described." + }, + { + "input": "There is no evidence of acute large territory infarct,hemorrhage,edema, or\nmass effect. The sulci, ventricles and cisterns are within expected limits\nfor the patient's age.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality within confines of noncontrast head CT. \nSpecifically no large territory infarct or intracranial hemorrhage.\n2. Given the patient's clinical history, MRI would be more sensitive for\nsubtle findings of encephalopathy, if there are no contraindications." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Study is moderately degraded by motion. There is no evidence of infarction,\nhemorrhage, edema, or mass. Absence of the corpus callosum and a Dandy-Walker\nvariant are again noted. There is no evidence of fracture. There is mucosal\nthickening in the ethmoid air cells and mucous retention cysts in the sphenoid\nand maxillary sinuses. The mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. Study is moderately degraded by motion.\n2. Within limits of examination, no acute intracranial abnormality.\n3. Multiple stable congenital abnormalities as described, compared to prior\nhead CT of ___.\n4. Paranasal sinus disease as described.\n5. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Bilateral basal ganglia calcifications are noted. Ventricles and\nsulci are normal in overall size and configuration. The imaged paranasal\nsinuses are clear. Mastoid air cells and middle ear cavities are well aerated.\nThe bony calvarium is intact. Severe bilateral TMJ arthritis noted.", + "output": "No acute intracranial process." + }, + { + "input": "There is an acute nondisplaced fracture of the right occipital bone (03:31)\nwith thin adjacent epidural hematoma overlying the upright occipital region,\nintermixed with air. Maximal thickness of the hematoma is 5 mm (02:15). \nThere is mild mass effect upon the occipital convexity. Additionally, there\nis subarachnoid blood in the right frontal lobe (series 2 images 13 through 17\nand series 601b: 48, 50, 58).\n\nThe occipital bone fracture extends inferiorly involving the right temporal\nbone, exiting at the posterior wall of the right temporomandibular joint\n(3:8). There is partial opacification of right mastoid air cells and the\nmiddle ear cavity, but no gross evidence of ossicular chain disruption. The\nremainder of the calvarium is intact. Basal cisterns are patent.\n\nAmong the several foci of air noted is a collection seen on series 2, images 9\nand 10 within or adjacent to the right sigmoid sinus. If these are adjacent\nto the sinus, they may simply reflect further air arising from the mastoid\nbone fracture. However, if within the sinus, they would imply sinus\nthrombosis. This may be better evaluated with MR imaging.\n\nMild fluid in the right maxillary sinus, otherwise the paranasal sinuses are\nclear. Moderate right occipital scalp hematoma.", + "output": "1. Right occipital bone fracture extending into the right temporal bone,\nexiting out the posterior wall of the right temporomandibular joint.\n2. Right occipital extra-axial fluid collection in close proximity to the\nskull fracture raising suspicion for epidural hematoma, however is currently 5\nmm in maximal thickness with minimal adjacent mass effect.\n3. Foci of subarachnoid hemorrhage in the right frontal lobe.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 6:34 am, 1 minutes after\ndiscovery of the findings.\nThe finding of possible right sigmoid sinus thrombosis was discussed by\ntelephone by Dr. ___ with Elysia ___ at 11:10 am ___,\nimmediately upon reviewing the images." + }, + { + "input": "Again visualized is the nondisplaced fracture of the right occipital bone\nextending inferiorly to the right temporal bone exiting at the posterior wall\nof the right temporal mandibular joint with a thin epidural hematoma\nintermixed with air with maximal thickness of 5 mm, unchanged compared to\nprior and with mass effect on the right occipital convexity. There is\nminimally increased air within the epidural hematoma. Subarachnoid hemorrhage\nis again seen in the right frontal region (302 B; 48), similar to prior. No\nnew foci of hemorrhage is noted.\n\nThere is no evidence of large vascular territorial infarction or mass. The\nventricles and sulci are normal in size and configuration. Basal cisterns\nremain patent.\n\nAir is again noted in and adjacent to the right sigmoid sinus, similar to\nprior.\n\nAerosolized secretions are noted in the right maxillary sinus. Again noted is\nthe partial opacification of the right mastoid air cells and the right middle\near cavity, similar to prior. Otherwise, the visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable. Again visualized is a\nright occipital scalp hematoma. Prominent subcutaneous emphysema within the\nright masticator space is also unchanged.", + "output": "1. No significant interval change.\n2. Right occipital extra-axial fluid collection intermixed with air adjacent\nto the skull fracture again measures 5 mm in maximal thickness with minimal\nmass effect.\n3. No significant changes subarachnoid hemorrhage in the right frontal lobe.\n4. Right occipital scalp hematoma unchanged.\n5. Foci of air adjacent to the right sigmoid sinus again noted and appear\nunchanged.\n6. Aerosolized secretions in the right maxillary sinus." + }, + { + "input": "A known right frontal subarachnoid hemorrhage is better evaluated on same day\nnoncontrast head CT. A right parietal fracture extending from the right\nlambdoid suture into the right temporal bone is unchanged since the prior\nexamination. An adjacent extra-axial fluid collection with locules of\ninternal gas measuring 4 mm from the inner table and extending from the right\noccipital region inferiorly and laterally to the sigmoid sinus likely reflects\nan epidural hematoma which is anteriorly displacing the right transverse and\nproximal sigmoid sinuses. Few small foci of extra-axial pneumocephalus are\nsimilar. No evidence of adjacent transverse or sigmoid sinus thrombosis. The\nremaining dural venous sinuses are patent. The right mastoid air cells and\nmiddle ear cavity remain partially opacified. Subcutaneous emphysema in the\nright parapharyngeal space. There is mild mucosal thickening of the ethmoid\nair cells, sphenoid sinuses, and maxillary sinuses, with some secretions,\nfluid in the right maxillary sinus.. Visualized carotid, vertebral arteries\nand their intracranial branches appear patent", + "output": "1. Unchanged small epidural hematoma with internal locules of gas anteriorly\ndisplacing the right transverse and sigmoid sinuses. No evidence of dural\nvenous sinus thrombosis.\n2. Unchanged fractures. Please see same day temporal bone CT for further\nevaluation of the fracture." + }, + { + "input": "Left : The external auditory canal is partially opacified, likely from\ncerumen. The middle ear cavity is clear. The ossicles and tegmen are intact. \nThere is no evidence for enlarged vestibular aqueduct or superior semicircular\ncanal dehiscence. The facial nerve follows a normal course through the middle\near. There is no evidence for inner ear dysplasia. The mastoids are clear.\n\nRight: There is a longitudinal fracture of the right temporal bone, extending\nthrough the mastoid segment in oblique plane from the level of the groove for\nthe distal transverse/upper sigmoid sinus junction, extending into the\nposterior margin of right condylar fossa at temporomandibular joint, with\ninvolvement of the anterior wall, roof, floor of the right external artery\ncanal.. There is diastases at the articulation of the malleus and incus,\nsuggesting joint violation, clinically correlate for conductive hearing loss. \nThere is no CT evidence of vesicular chain fracture. There is moderate\nopacification of the right mastoid air cells, right middle ear cavity,\nincluding epitympanum, mesotympanum, hypotympanum.. There is no definite\nfracture extension into the inner ear, petrous apex. There few small\nintracranial, extra-axial air bubbles abutting the right temporal bone,\noccipital bone,, transverse sinus mildly less apparent compared with earlier\ntoday. There is moderate soft tissue swelling overlying scalp, mastoid bone\nalong the plane of the fracture.\nThe facial nerve follows a normal course through the middle ear, without\ndefinite evidence fracture plane extending through the expected course of the\nfacial nerve.. There is no evidence for inner ear dysplasia.\n\nOther: There is subtle nondisplaced lucency involving lateral wall of the\nright sphenoid sinus, which trace fluid within it series 301, image 69-90, may\nrepresent subtle fracture. This fracture may extend along the medial margin\nof the horizontal portion petrous segment ICA. There is motion artifact\nversus fractures through bilateral posterior rami of the mandibles, this area\nsuboptimally seen.. There is soft tissue air medial to the right parotid\ngland extending into the right parapharyngeal space, secondary to the temporal\ntemporal bone fracture. There is partial opacification of the right maxillary\nsinus, stable since prior. Small focus of hemorrhagic contusion on the floor\nof the right temporal bone, mild adjacent edema. Stable small focus of\nextra-axial hemorrhage near the fracture plane, measuring 0.4 cm in maximum\ndiameter..", + "output": "1. There is longitudinal fracture through the right temporal bone, violating\nroof of the junction of right transverse, sigmoid sinuses, and extending into\nthe right condylar fossa, external auditory canal.\n2. Mild subluxation at the articulation of right malleus, incus, clinically\ncorrelate for conductive hearing loss.\n3. Suggestion of nondisplaced, hairline fracture of the right wall sphenoid\nsinus, possibly extending into the medial margin horizontal petrous segment\nICA canal. Adjacent ICA appears patent. Consider intracranial MRA for\nfurther evaluation of the carotid arteries.\n4. Motion artifact versus fracture of the bilateral posterior mandibular rami,\nif there is pain, mandible CT may be helpful in further evaluation.\n5. Small focus of hemorrhagic contusion on the floor of the right temporal\nbone, mild adjacent edema. Stable small focus of extra-axial hemorrhage near\nthe fracture plane, with less prominent foci of pneumocephalus." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, mass, mass effect or\nlarge territorial infarction. The previously noted right occipital\nextra-axial hemorrhage and pneumocephalus have resolved. There is no definite\nevidence of new acute intracranial hemorrhage. Ventricles and sulci are age\nappropriate. There is no evidence of acute large territory infarct.\n\nRe-demonstrated is a nondisplaced, longitudinal fracture extending from the\nright occipital bone into the right temporal bone, with extension into the\nposterior wall of the right condylar fossa, better evaluated on the prior\ntemporal bone CT from ___. There has been interval resolution of\npreviously noted right middle ear opacification, and near complete resolution\nof previously noted right mastoid air cell opacification.\n\nA mucous retention cyst is seen within the right maxillary sinus. Mild\nmucosal sinus thickening is seen involving the left maxillary sinus. Mild\nmucosal sinus disease is seen involving the ethmoid air cells. The sphenoid\nsinuses and frontal sinuses are clear. The left mastoid air cells and middle\near cavities are clear.", + "output": "1. Interval resolution of previously noted right occipital extra-axial\nhemorrhage and pneumocephalus.\n2. No definite evidence of new acute intracranial hemorrhage.\n3. Stable nondisplaced right occipital bone fracture with extension into the\nright temporal bone and posterior wall of the right temporomandibular joint\nwith interval resolution of previously noted right middle ear opacification\nand near complete resolution right mastoid fluid.\n4. Paranasal sinus disease , as described." + }, + { + "input": "No acute intracranial infarct, hemorrhage, edema, or mass-effect. No\nsignificant change in the size and configuration of ventricles and sulci. The\nperimesencephalic cisterns are patent. No shift of normally midline\nstructures. The sella appears slightly prominent, unchanged from the prior\nexam.\n\nNo fracture. Dural calcifications are again seen. Polypoid mucosal\nthickening of the bilateral maxillary sinuses is again noted. There is mild\nmucosal thickening of the bilateral frontal sinuses, greater on the left. \nThere is mild mucosal thickening of the bilateral ethmoid sinuses. The\nsphenoid sinuses are clear. The mastoid air cells and middle ear cavities are\nclear. The orbits are unremarkable.", + "output": "1. No acute intracranial abnormality including no intracranial hemorrhage.\n2. No fracture.\n3. Paranasal sinus disease as above." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere are postsurgical changes following right parietal craniotomy and tumor\nresection. There is continued extent vasogenic edema in the right parietal\nlobe consistent with the presence of the no metastatic lesions. Some of the\nlesions appear hyperdense and are again demonstrated, for example in the\nsuperior right frontal lobe on image 31 of series 2. However, these findings\nare better assessed on the preceding MRI. Extra-axial fluid and gas is noted\nin keeping with recent postoperative status. There continues to be leftward\nmidline shift which measures approximately 6 mm. A few punctate\nhyperdensities in the right frontal lobe may reflect a small volume of\nhemorrhage, or could be related to the underlying known metastatic disease.\n\nPostsurgical changes to the calvarium. Orbits are unremarkable. Mucosal\nthickening in the sphenoid sinus. The visualized paranasal sinuses and\nmastoid air cells are otherwise clear.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear patent without stenosis, occlusion, or aneurysm formation greater than\n3mm. Atherosclerotic vascular calcifications are noted involving the carotid\nsiphons. The dural venous sinuses are patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion.\n\n\n\nOTHER:\nOn the scout images, there is a right lung mass measuring up to 3.5 cm. This\ncorresponds to the right upper lobe/perihilar masses described on the\npreceding chest CT.", + "output": "1. Postsurgical changes following right craniotomy and Masse resection with\ncontinued extensive vasogenic edema throughout the right hemisphere and\napproximately 6 mm leftward midline shift. In the context of the extending\nunderlying edema, MRI would be preferable to assess for ischemic changes.\n2. There are hyperdensities most prominent in the right frontal lobe,\nplacement which appears to correspond to no metastatic lesions better assessed\nby previous MRI, although some could also reflect minimal petechial\nhemorrhage.\n3. Patent circle of ___ without definite evidence of stenosis,occlusion,or\naneurysm.\n4. Right lung mass on the scout images, as described on the previous chest CT\nfrom ___." + }, + { + "input": "The patient is status post right craniotomy and mass resection with\nredemonstration of extensive vasogenic edema throughout the right cerebral\nhemisphere with approximately 5 mm of right-to-left midline shift and partial\neffacement of the right lateral ventricle, not substantially changed compared\nto prior study. A mild amount of pneumocephalus is again seen near the\ncraniotomy site and along the left frontal lobe, left cerebral hemisphere, and\nvertex, mildly decreased from prior study. Minimal, barely detectable,\nhemorrhage at the operative site appears unchanged. A rounded hyperdensity in\nthe left frontal lobe near the vertex is unchanged and corresponds to a known\nmetastatic lesion better assessed on prior MRI (02:29).\n\nThe patient is status post craniotomy. Otherwise, there is no evidence of\nfracture. The visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "Stable postsurgical changes status post right craniotomy and mass resection\nwith persistent vasogenic edema throughout the right cerebral hemisphere and\napproximately 5 mm of leftward midline shift. No definite short-term change." + }, + { + "input": "Moderate prominence of sulci indicate predominantly cortical brain atrophy. \nHypodensities in the white matter extent from periventricular to the\nsubcortical region indicating severe changes of small vessel disease. There\nis no significant temporal horn dilatation to suggest hippocampal atrophy. \nThere is no hemorrhage or midline shift. There is no evidence of\nhydrocephalus. Bone images are unremarkable. The visualized paranasal\nsinuses are clear.", + "output": "Moderate predominantly cortical brain atrophy with severe changes of small\nvessel disease. No evidence of mass effect or hydrocephalus. No evidence of\nmedial temporal atrophy." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nSubcortical and periventricular white matter hypodensities are nonspecific,\nhowever likely represent sequela of chronic small vessel ischemic disease. \nThere are vascular calcifications in the bilateral cavernous carotids.\n\nThere is no evidence of fracture. There is minimal mucosal thickening in the\nvisualized portions of the bilateral maxillary sinus and ethmoid air cells. \nThe visualized portion of the mastoid air cellsand middle ear cavities are\nclear. Patient is status post left lens replacement.", + "output": "1. No acute intracranial abnormality.\n2. No evidence acute intracranial hemorrhage or fracture.\n3. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described.\n4. Paranasal sinus disease , as described." + }, + { + "input": "Post frontal craniotomy with stable appearance of postsurgical changes within\nthe bifrontal extra-axial space. There is no significant change in the right\nfrontal intraparenchymal hematoma from ___. Pneumocephalus and air\nwithin the ventricles overall stable. There is a trace amount of\ninterventricular hemorrhage in the occipital horn of the left lateral\nventricle, unchanged from ___. Ventricles are overall unchanged size\nand configuration from ___. There is no significant midline shift and\nthe basal cisterns are patent. Previous fractures identified, overall\nunchanged.", + "output": "No significant interval change from prior examination of ___." + }, + { + "input": "Extensive postsurgical changes and facial fractures with opacification and\nblood within the sinuses again seen. Small amount of blood. Air is within the\nventricles. Frontal extra-axial collection is unchanged. No acute\nabnormalities are seen. A small amount of subarachnoid blood is also\nidentified.", + "output": "No acute intracranial abnormalities are identified. No change from previous\nstudy in extensive posttraumatic postsurgical changes an extra-axial frontal\ncollection." + }, + { + "input": "Non-contrast Head CT:\nThere is redemonstration of bifrontal subdural hematoma, with slight interval\ndecrease in density and size, now measuring 9 mm (previously 11 mm), with near\ncomplete resolution of intracranial pneumocephalus. There is a decrease in\nsubarachnoid hemorrhage along the bifrontal sulci. The previously seen\nintraventricular hemorrhage within the occipital horn of the left lateral\nventricle appears to have resolved.\n\nThere is no new intraparenchymal hemorrhage or evidence of a large territorial\ninfarction. There is no midline shift.\n\nPatient is status post cortical plate fixation across complex bifrontal\nfractures extending into the frontal sinuses, with additional fractures noted\nwithin the nasal bone, bilateral medial and lateral orbital walls, anterior\nand posterior walls of the maxillary sinuses, bilateral pterygoid plates,\nright inferior orbital wall, and left paramedian clivus possibly extending\ninto the posterior margin of the left carotid canal and right occipital bone,\nas more detailed on the prior studies.\n\nFluid in the mastoid air cells is new and probably from prolonged dependent\npositioning. However, there is new opacification of the right middle ear\ncavity with questionable defect in the temporal bone concerning for temporal\nbone fracture (series 3, image 227, 228, 225). The ossicles of the right ear\nare incompletely imaged but appear grossly unremarkable on this nondedicated\nexam. Recommend dedicated temporal bone CT to further evaluate.\n\nCTA Head: There is a fracture of the left paramedian clivus possibly\nextending into the posterior margin of the left carotid canal. There is no\ndefinite evidence of stenosis, occlusion, or dissection. Major central dural\nvenous sinuses appear patent.\n\nCTA Neck: The cervical vertebral and carotid arteries are widely patent,\nnormal in caliber without evidence of stenosis or dissection.\n\nOTHER:\nThe patient is intubated/tracheostomy. Aerosolized secretions are seen along\nthe endotracheal tube in the upper trachea. Secretions are also allow in the\nesophagus, placing the patient at risk for aspiration. There is a small\nnodule within the for right thyroid gland measuring 7 x 5 mm.", + "output": "1. Numerous facial, calvarial, skullbase fractures, as detailed above. New\nopacification within the right middle ear cavity with questionable defect in\nthe temporal bone, as described above. Possibility of a right temporal bone\nfracture is not entirely excluded. Dedicated temporal bone CT is recommended\nto further assess.\n2. Fracture of the left paramedian clivus possibly extending into the\nposterior margin of the left carotid canal as previously described. There is\nno definite evidence of stenosis, occlusion, or dissection.\n3. Slight decrease in bifrontal subdural hematoma and scattered subarachnoid\nhemorrhage, without new intraparenchymal hemorrhage. No large territorial\ninfarction." + }, + { + "input": "Patient is status post interval cortical plate and screw fixation of the\nbilateral maxillary sinus fractures (ORIF). There is interval improvement in\nalignment of the maxillary sinus fractures previously seen, with improved\noverlapping segments on the left lateral wall of the maxillary sinus with\npersistent diastasis by approximately 2 mm. There is slight interval increase\nin near complete opacification of bilateral maxillary sinuses.\n\nAgain seen is plate fixation across complex bifrontal bone fractures extending\ninto the frontal sinuses. There is interval decrease in pneumocephalus with\nnear complete opacification of the frontal sinuses when compared with the\nprior study. There is lack of continuity of the posterior wall of the\nbifrontal sinus, which is likely postsurgical, with adjacent sinus packing\nmaterial.\n\nAgain seen are fractures involving the nasal bones and medial wall of\nbilateral orbits. There is interval improvement in aeration of the nasal\nsinus when compared with the prior study. Fractures of the lateral orbital\nwalls and bilateral cerebral plates appear unchanged. The fractures of the\ninferior orbital walls previously described are also unchanged.\n\nThere is an unchanged fracture involving the left paramedian clivus, extending\nalong the posterior margin of the left carotid canal. Again seen is a\nhairline fracture of the right occipital bone and left zygomatic arch.\n\nIn comparison with the prior study, there is interval increase in\nopacification of the right mastoid air cells and right middle ear cavity with\nquestionable osseous defect within the right temporal bone, better seen on CTA\ndated the same.\n\nThere is decrease in soft tissue swelling. There is interval decrease in\nbifrontal subdural hematoma, subarachnoid hemorrhage, and intraventricular\nhemorrhage previously seen appear please refer to recent CT report for\nadditional details. Patient is status post extubation with removal of the\nnasoenteric tube.", + "output": "1. Status post interval fixation of bilateral maxillary sinus fractures with\nimproved alignment, as described above.\n2. Interval increase in opacification of the right mastoid air cells and right\nmiddle ear cavity, with questionable osseous defect within the right temporal\nbone, better depicted on recent CTA dated the same. Dedicated temporal bone\nCT is recommended to further assess.\n3. Extensive facial fractures as described above with redemonstration of plate\nfixation of bifrontal bone and frontal sinus fractures again seen. Lack of\ncontiguity of the few areas of the posterior wall of the bifrontal sinuses,\nlikely postsurgical. As previously described, clinical follow-up is\nrecommended to exclude development of infection.\n\nRECOMMENDATION(S): Point 2. Correlation with temporal bone CT is recommended\nfor further characterization and rule out right temporal bone fracture." + }, + { + "input": "There is partial visualization of plate fixation of the anterior maxillary\nsinus walls.\n\nAgain visualized is plate fixation across the complex comminuted bifrontal\ncalvarial fracture with extension into the frontal sinuses, appearing similar\nto the prior examination. Fixation hardware is seen over the bilateral\norbital roof fractures. Nondisplaced comminuted left and nondisplaced right\nlateral orbital wall fractures are again identified, unchanged. Associated\npacking material is seen in the bilateral frontal sinuses.\n\nNondisplaced fracture of the left paramedian clivus is unchanged.\n\nHairline fracture of the left zygomatic arch is unchanged.\n\nAdditional hairline fracture of the right occipital calvarium, extending\nobliquely into the right temporal bone minimally, is unchanged.\n\nRight greater than left bifrontal encephalomalacia is seen, likely the result\nof trauma. There is no evidence of acute large territorial\ninfarction,hemorrhage,edema, or mass. The ventricles and sulci are normal in\nsize and configuration.", + "output": "1. No acute intracranial abnormality.\n2. Areas of bifrontal encephalomalacia, likely traumatic.\n3. Extensive facial fractures with multiple areas of hardware fixation, as\ndescribed, grossly unchanged compared the prior study.\n4. Unchanged hairline right occipital calvarial fracture with minimal\nextension into the temporal bone." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\n\nSevere traumatic injury is seen involving the head and skull base. Acute\nsubarachnoid hemorrhage is seen overlying the right frontal lobe, with\nevidence of bifrontal pneumocephalus and local mass effect, not significantly\nchanged compared to the prior exam. Intraventricular air is also seen. A\nsmall posterior right parieto-occipital extra-axial hematoma is seen,\nprogressed compared to the prior exam, measuring 0.8 cm in maximum thickness. \nTrace acute subdural hemorrhage overlying bilateral frontal, temporal lobes\nstable. Small amount of subdural hematoma along the falx and tentorium is\nalso seen, slightly increased compared to the prior exam. Possible small\nintraparenchymal hemorrhage within the right cerebellum is seen versus\nartifact. There is no evidence of significant midline shift.\n\nMultiple traumatic skull fractures are seen. For example, a comminuted\nfrontal bone fracture seen, displaced, extending inferiorly into the right\nfrontal sinus. Right frontal bone fracture is displaced intracranial by 0.5\ncm,or by width of the the calvarium. The frontal bone fracture has horizontal\ncomponent extending into left frontal sinus. Additional minimally displaced\nfractures are seen along the anterior and posterior walls of the bilateral\nmaxillary sinus, with evidence of hemorrhage within the sinuses. Mildly\ncomminuted fractures are seen involving the bilateral lamina papyracea. There\nare fractures of the bilateral lateral orbital walls. There is small area of\nextraconal hemorrhage involving right orbit superiorly. There is a fracture\nof the right inferior orbital wall, involving infraorbital foramen. There is\na vertical fracture of the left paramedian clivus, extending into the\npetroclival synchondrosis. There is subtle nondisplaced fracture of the right\na occipital bone series 106b, image 39. The by\nThe zygomatic arch bilaterally appears to be intact. The visualized portion\nof the mandible is unremarkable. There is no evidence of mandibular\ndislocation. Possible nondisplaced fractures are seen within the medial and\nlateral pterygoid plates bilaterally. No fluid is seen within the mastoid air\ncells. The middle ear cavities appear to be grossly unremarkable. A large\nsubgaleal hematoma is seen at the vertex. Minimally displaced fracture of the\nnasal bone is seen.\n\nCTA HEAD:\nThe posterior circulation is preserved. Note is made of fetal origin of the\nleft PCA. There is asymmetric early enhancement of the left cavernous sinus. \nLeft internal carotid artery and left middle cerebral artery appear to be\nunremarkable. The bilateral A1 segments of the anterior cerebral arteries,\nand distal anterior cerebral arteries appear to be unremarkable. The right\nmiddle cerebral artery is normal.\n\nCTA NECK:\nThere is a small non-occlusive filling defect of left external carotid artery\njust distal to its origin, series 5, image 165. There is long segment of mild\nnarrowing of right ICA mid cervical segment.\nOtherwise, carotid and vertebral arteries and their major branches appear\nnormal with no evidence of stenosis or occlusion. There is no evidence of\nproximal internal carotid stenosis by NASCET criteria.\n\nOTHER:\nA focal pleural-based consolidation is seen in the posterior aspect of the\nright upper lobe, series 5, image 22 measuring 1.1 cm x 1.4 cm. Additionally,\nthere is area ground-glass opacity and micro nodularity in the visualized left\nlower ___ represent a the pneumonitis or aspiration, is only partially\nseen. There is no cervical lymphadenopathy. Incidental note is made of a 1\ncm hypodense nodule within the right thyroid lobe.", + "output": "1. Extensive pneumocephalus with severe traumatic skull and facial fractures,\nas described above. Hemorrhage is seen within the visualized paranasal\nsinuses sequelae of patient's fractures. Middle ear cavities and mastoid air\ncells are unremarkable.\n2. There is long segment of mild narrowing involving the mid cervical ICA,\nindeterminate, fat-suppressed axial T1 images of the neck would be helpful to\nexclude ICA dissection. There is a small non-occlusive filling defect of left\nexternal carotid artery just distal to its origin, may be from posttraumatic\ninjury.\n3. Asymmetric early enhancement of the left cavernous sinus raises concern for\npossible internal carotid artery injury and left cavernous carotid fistula.\n4. Mild interval increase in the right parieto-occipital extra-axial hematoma\ncompared to the prior exam. Stable right frontal subarachnoid hemorrhage. \nSlight interval increase in the subdural hematoma along the falx and\ntentorium.\n5. Partially seen is area of infiltrate in the left lower lobe, consider\npneumonia, aspiration.\n\nRECOMMENDATION(S): Axial fat-suppressed T1 MRI images of the neck.\n\nNOTIFICATION: Updated findings were discussed with Dr. ___. by\n___, M.D. on the telephone on ___ at 1:30 ___, 20 minutes after\ndiscovery of the findings." + }, + { + "input": "An extensive amount of pneumocephalus is present as well as an unchanged right\nfrontal contusion, not significantly changed. Scattered and grossly unchanged\nsubarachnoid blood is noted as well as an element of subdural hemorrhage\ntracking along the falx and tentorium. New hemorrhages noted in the occipital\nhorns of the lateral ventricles as well as a small amount within the\nsuprasellar and pre pontine cisterns. A right parietal epidural hematoma is\nprobably unchanged when compared to the most recent prior imaging and measures\nup to 1.1 cm in thickness at the right vertex (___).\n\nNo midline shift or herniation. The basal cisterns remain patent.\n\nThe anterior horns of the lateral ventricles are distended with gas however\nthere is no evidence of hydrocephalus otherwise.\n\nThere has been interval craniotomy for the known multiple of depressed skull\nfractures. Again present are multiple facial bone and skullbase fractures. \nFluid and blood are present throughout the paranasal sinuses.", + "output": "Intra and extra-axial hemorrhage as described above, likely re-distributing in\ncomparison to the prior images. No new hemorrhage identified. Extensive\npneumocephalus." + }, + { + "input": "The patient is status post bifrontal ORIF with multiple fixations and surgical\nmesh for stabilization of frontal bone fractures. There is expected evolution\nof postoperative changes. Redistribution of the diffuse and bifrontal\npneumocephalus which were present preoperatively. Unchanged amount of air in\nthe frontal horns of lateral ventricles bilaterally, without evidence of\nhydrocephalus. The right posterior frontoparietal subdural hematoma is\nunchanged. The subdural hemorrhage tracking along the falx and tentorium is\nunchanged. Expected evolution of right frontal contusion and scattered\nsubarachnoid hemorrhages. Minimal layering of blood within the occipital\nhorns of the lateral ventricles bilaterally is unchanged. There is no\nevidence new or enlarging hemorrhage. No evidence of infarction.\n\nThere are multiple stable skullbase fractures which are unchanged, please\nrefer to prior CTA for full description. The visualized portion of the\nparanasal sinuses demonstrate fluid and hemorrhage, unchanged from prior\nstudies. Other than the known facial fractures mentioned, the visualized\nportion of the orbits are unremarkable.", + "output": "1. Expected evolution of postoperative changes status post bifrontal ORIF.\n2. Unchanged volume of right frontoparietal extra-axial hematoma.\n3. Expected evolution of right frontal contusion and scattered subarachnoid\nhemorrhages.\n4. No new or enlarging hemorrhage.\n5. Unchanged skullbase fractures." + }, + { + "input": "There is no evidence of large territory infarction,hemorrhage,edema, or mass. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. There is mild atherosclerotic calcification in the bilateral carotid\nsiphons.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nethmoid air cells. The remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. Patient is status post bilateral lens\nreplacement.", + "output": "No intracranial hemorrhage, large territorial infarction, or mass." + }, + { + "input": "CTA HEAD: Proximal intracranial left ICA is occluded with recannulization at\nthe level of the supraclinoid ICA. Left hypoplastic A1 segment. Left M3 and M4\nsegments are less robust. The left M1 segment is patent. The remaining\nvisualized portion of the circle of ___ and its branches appear patent\nwithout evidence of stenosis, occlusion, or aneurysm. The dural venous sinuses\nare patent.\n\nCTA NECK:\nThere is some opacification of the proximal left common carotid artery with\nocclusion approximately 3 cm from its origin. Occluded left ICA in the neck,\nskull base, and cavernous segment. The left supraclinoid ICA is reconstituted.\nThere is mild origin narrowing of the right CCA and ICA. The vertebral\narteries are patent.\n\nVisualization of few small air bubbles in left face, parotid gland, cavernous\nsinus (series 2, image 182 and 226), which likely represents air in the venous\nsinus after contrasts injection, seen not uncommonly in the absence of\ninfectious symptoms. If there is clinical concern, follow-up head CT can be\nobtained for evaluation of resolution.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. Posterior longitudinal ligament is ossified at C4-C5, with moderate\nspinal canal stenosis.\n\nVisualization of a few small air bubbles in the left face, parotid gland,\ncavernous sinus, which likely represents air in the venous sinus after\ncontrast injection, seen not uncommonly in the absence of infectious symptoms.", + "output": "1. Left common carotid artery occlusion approximately 3 cm from its origin\nwith occlusion of the left ICA in the neck, skullbase, and cavernous segment. \nThe left supraclinoid ICA is reconstituted.\n2. Decreased arborization of the left M3 and M4 segments compared to the\nright." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nA focus of hypoattenuation within the left frontal lobe correlating with the\ninfarcts described on the MRI head study performed on ___. \nSuperimposed mild periventricular white-matter hypodensities are nonspecific\nbut compatible with chronic small vessel disease. There is no evidence of\nacute hemorrhage, edema or mass. There is mild diffuse prominence of the\nventricles and cerebral sulci compatible with age related involutional\nchanges.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA NECK:\nThere is complete occlusion of the left common carotid artery and left\ncervical internal carotid artery with reconstitution at the level of the left\nsupraclinoid ICA. Calcified of atheromatous changes of the origin of the\nright ICA results in less than 50% stenosis.\n\nCTA HEAD:\nThere is complete occlusion of the left carotid siphon with reconstitution at\nthe level of the supraclinoid ICA, as above. There are atherosclerotic\ncalcifications of the carotid siphons. As before, there is decreased\narborization of the left MCA M3 and M4 segments. The remaining vessels of the\ncircle of ___ and their principal intracranial branches appear otherwise\nnormal without stenosis, occlusion, or aneurysm formation. The dural venous\nsinuses are patent.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Focus of hypoattenuation within the left frontal lobe correlating with the\ninfarcts described on the MRI head study performed on ___.\n2. Complete occlusion of the left common carotid and left cervical ICA artery\nwith reconstitution at the level of the left supraclinoid ICA.\n3. Redemonstrated decreased arborization of the left MCA M3 and M4 segments.\n4. No evidence for aneurysm.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 9:31 pm, 5 minutes after discovery\nof the findings." + }, + { + "input": "Seen again are multiple enlarged peripherally enhancing cervical lymph nodes\nat the 2A/B level. There is adjacent stranding of the adjacent soft tissues\nthat extends inferiorly down to the chest. The largest on the right measures\n2.0 x 2.8 cm, previously 2.5 x 2.6 cm in the largest on the left measuring 3.0\nx 3.8 cm, previously 2.7 x 3.7 cm. Multiple other enlarged nodes are seen\nalong the cervical chain down to the supraclavicular level left greater than\nright. The overall appearance of the lymphadenopathy is unchanged since prior\nstudy.\n\nPatient is status post tracheal stenting at the level of the thyroid. Thyroid\nremains diffusely enlarged. The stent remains patent and in place. There is\ninterval increase in retropharyngeal edema seen from levels C2 through 7.\n\nThe neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.", + "output": "1. Significantly increased retropharyngeal edema seen from levels C2 through\nC7.\n2. Tracheal stent is at the level of the thyroid and remains patent.\n3. No evidence of new tracheoesophageal masses. Previously seen\nlymphadenopathy demonstrates no interval growth.\n4. Persistent fat stranding from the mandible extending down to the upper\nchest." + }, + { + "input": "Aero digestive tract:\nSymmetrical thickening in the subglottic larynx, similar to prior, may be\ninflammatory or from tumor infiltration. Severe airway narrowing at the\noropharynx, larynx. Supraglottic laryngeal edema has improved, there may be\nresidual stenosis. Mild diffuse sclerosis anterior thyroid cartilage on both\nsides, similar to prior. More sclerotic appearance of the anterior cricoid\ncartilage, may be posttreatment change or from tumor infiltration.\nTracheostomy. The tracheostomy appears grossly appropriately positioned to\nthe level of the upper thoracic trachea, scattered secretions surrounding the\ntube.\n\n\nNeck lymph nodes:\nLeft neck:\nMarkedly improved bilateral neck adenopathy compared with ___.\nLargest left level 2A lymph node today measures 3.1 cm, compared with 3.8 cm\non prior. Other pathologic level ___ lymph nodes have mildly improved.\n\nRight neck:\nDecreased level ___ adenopathy. Largest level 2A lymph node measures 1.4 cm\ntoday, compared with 2.9 cm on prior. Other lymph nodes have mildly\ndecreased.\n\nRetropharynx:\nDecreased retropharyngeal adenopathy, largest lymph node measures 1.2 cm\ntoday, compared with 1.7 cm on prior.\n\nExtra nodal tumor spread:\nMany pathologic lymph nodes have poor defined margins R inhomogeneous\ncentrally, likely external extension.\n\nDeep neck muscles, masticator space:\nThere is no muscle invasion.\n\nBones, skull base:\nThere is no bone involvement.\nNo aggressive focal osseous lesions.\nThere are no findings suggestive of perineural tumor extension. Jugular\nforamen, carotid canal, pterygopalatine fossa, infraorbital foramen, other\nskull base foramina are not involved.\n\nThere are periapical lucencies involving multiple right mandibular teeth,\nincluding right mandibular premolar (07:29) (also see series 6, images 12,\n16).\n\nVessels:\nNeck vessels are poorly opacified and not well visualized on this exam,\nparticularly the internal jugular veins; grossly. Patency of the bilateral\ninternal jugular vein cannot be established in the mid neck.\nPreviously seen enhancing soft tissue there was marginating and extending into\nthe carotid space bilaterally is less prominent.\n\nBrachial Plexus:\nNo obvious involvement or invasion of the brachial plexus.\n\nThyroid, salivary glands:\nAgain seen is an infiltrative, slightly hypoenhancing mass expanding the\nthyroid gland, wrapping circumferentially around the trachea and abutting and\nlikely involving the anterior 180 degrees of the esophageal wall, inseparable\nfrom it (for example see series 3, image 59), in aggregate measuring up to 4.6\nx 4.7 x 3.9 cm (SI by TV by AP) (6:41 and 3:58). This is not appreciably\nchanged compared with the prior MRI. Obliterated fat plane between the\nthyroid mass and strap muscles, sulfa ___, prevertebral muscles.\n\nOther findings:\nThere is a 4 mm nodule in the right upper lobe at the lung apex (3:66). This\nis unchanged compared with prior CT from ___. For further details\nof this and additional intrathoracic findings, please see separate report for\nfindings from same-day CT chest. Areas of sclerosis bilateral mandible,\nextensive dental disease, cavities, periapical lucencies. Right mandibular\nsclerosis is likely reactive, may be sclerosing osteitis, no destruction, new\nbone formation or sequestration to suggest osteomyelitis. Moderate mucosal\nthickening bilateral maxillary sinuses\n\nImaged base of the brain is unremarkable. Mucous retention cysts and mild\nmucosal thickening is seen within the maxillary sinuses bilaterally. \nRemaining visualized paranasal sinuses, mastoids, middle ear cavities appear\nclear. Visualized portions of the globes and orbits appear unremarkable.", + "output": "1. Improved bilateral neck adenopathy.\n2. Similar thyroid bed mass, involvement as above.\n3. Wall thickening subglottic larynx, may be reactive or from tumor, similar.\n4. Patency of the bilateral internal jugular veins cannot be established. \nTumor involvement of bilateral carotid spaces has improved.\n5. Glottic, supraglottic airway narrowing.\n6. Narrowed oropharynx.\n7. Dental disease, cavities, periapical lucencies, dental consult recommended.\n8. Refer to chest CT from today for thoracic findings." + }, + { + "input": "Aero digestive tract:\n\nPersistent subglottic, proximal tracheal thickening, may represent tumor\ninfiltration, edema or combination, similar.\nDiffuse sclerosis of the anterior thyroid cartilage and anterior cricoid\ncartilage are similar to prior exam, may be post treatment changes or tumor\ninfiltration (03:48, 55).\n\nTracheostomy positioning is unchanged with persistent surrounding secretions\nand tracheal narrowing (3:65).\n\nNeck lymph nodes:\nLeft:\nExtensive left neck level 1, 2, 3, 4, 5 adenopathy.. Largest level 2 lymph\nnode measures 2.7 cm x 2.2 cm, compared with 3.2 cm x 2.4 cm on prior. Few\nadditional lymph nodes have mildly decreased,, example including 1.3 cm level\n2 B lymph node series 3, image 27, compared with 1.5 cm on prior.\n\nRight:\nExtensive right level 1, 2, 3 adenopathy. Few lymph nodes have mildly\ndecreased in size, including 1.2 cm level 2A lymph node, compared with 1.6 cm\non prior.\n\nPathologic right retropharyngeal lymph node, similar to mildly decreased..\n\nLarge confluent level 6, 7 adenopathy about trachea, similar.\n\nExtra nodal tumor spread: As previously noted, the margins of the pathological\nlymph nodes are indistinct with central necrosis, likely representing external\nextension.\n\nDeep neck muscles, masticator space: There is no muscle invasion.\n\nBones, skull base:\nThere is no bone involvement.\nThere are no findings suggestive of perineural tumor extension. Jugular\nforamen, carotid canal, pterygopalatine fossa, infraorbital foramen, other\nskull base foramina are not involved.\n\nPreviously noted multiple right mandibular teeth periapical lucency are again\nnoted (07:37, 35 and 34).\n\nVessels: As previously, bilateral internal jugular veins are not definitively\nidentified with multiple collaterals and enlargement of the external jugular\nveins. There is stable, persistent soft tissue density surrounding the\ncarotid space, without mass effect.\n\nBrachial Plexus: There is no brachial plexus contact or invasion.\n\nThyroid, salivary glands: Pre-existing infiltrative, slightly hypoenhancing\nmass expanding the thyroid gland is overall similar to prior exam. Mass\nencases the trachea and the anterior half of the esophageal wall as\npreviously. No fat plane between the trachea, esophageal wall and the thyroid\nmass is identified. Similarly, no fat plane is identified between the strap\nmuscles in the prevertebral muscles and the thyroid mass. Due to the\ninfiltrative nature of thyroid gland, measurement is difficult. However, the\nhypoenhancing component measures up to 3.2 cm, previously 3.9 cm in the AP\ndimension (4:174).\n\nOther findings: Please refer to the dedicated CT chest report from the same\nday for details on intrathoracic findings, including the stable 3 mm right\napical pulmonary nodule (3:71). Likely reactive sclerosis of the right\nmandible due to dental caries is stable. Mucous attention cysts in the\nbilateral maxillary sinuses are again seen.", + "output": "1. Extensive bilateral neck adenopathy, mildly decreased.\n2. Similar thyroid mass, possible invasion of trachea, esophagus, similar.\n3. Likely chronic thrombosis of the internal jugular veins.\n4. Dental disease, reactive mandibular sclerosis.\n5. Status post tracheostomy with persistent severe airway stenosis..\n6. Refer to chest CT report from today for thoracic findings." + }, + { + "input": "Aero digestive tract: There is no mass.\n\nNeck lymph nodes:\nRight neck:\nMildly enlarged right level 2, 3 lymph nodes, stable, largest 1.7 cm.\nStable level 1 lymph nodes.\nNo new adenopathy.\n\nLeft neck:\nStable level 1 lymph nodes.\n3.7 cm left level 2A lymph node, decreased compared to 4.4 cm on prior. 1.5\ncm addition level 2A lymph node, compared with 1.6 on prior. Additional\nsimilar level 2 lymph nodes.\nMultiple enlarged level 3 lymph nodes, largest 1.2 cm, it measured 1.5 cm on\nprior.\nStable level 4, 5 adenopathy, largest 1.6 cm.\n\nSimilar retropharyngeal adenopathy.\n\nExtra nodal tumor spread: There are no findings suggestive of extra nodal\nextension.\n\nDeep neck muscles, masticator space: There is no muscle invasion.\n\nBones, skull base:\nThere is no bone involvement.\nThere are no findings suggestive of perineural tumor extension. Jugular\nforamen, carotid canal, pterygopalatine fossa, infraorbital foramen, other\nskull base foramina are not involved.\n\nVessels: There is no vascular invasion. Stable chronic occlusion right or\njugular vein at the level of adenopathy.\nBrachial Plexus: There is no brachial plexus contact or invasion.\n\nThyroid, salivary glands: Thyroid mass measuring 6.3 cm x 5.0 cm x 5.2 cm\ntoday, compared with 6.7 cm x 4.6 cm x 5.5 cm on prior, about the same. \nInfiltration of the soft tissues between the mass and trachea, esophagus,\nlaryngeal cartilage, similar. Similar sclerosis of the anterior thyroid,\ncricoid cartilage may represent tumor involvement or posttreatment change,\nsimilar.. Probable tracheal invasion with soft tissue rind within the trachea\nproximally, which may represent tumor invasion or inflammatory change or\ncombination.\n\nOther findings: Tracheostomy. Refer to chest CT report from today for\nthoracic findings. Paranasal sinus disease.. Trace opacification right\nmastoids. Stable small focus of sclerosis right condylar head. Dental\ndisease, chronic sclerosis right mandible, stable, without periosteal\nreaction, bone sequestrum or inflammatory changes in the soft tissues.", + "output": "1. Stable locally invasive thyroid mass. Stable right neck adenopathy. \nMildly decreased left neck adenopathy." + }, + { + "input": "Aero digestive tract: There is no mass.\n\nNeck lymph nodes:\n\nRight neck:\nMildly enlarged right level 2 and level 3 lymph nodes are slightly decreased\nin size, the largest now 1.6 cm. Right level 1 lymph nodes are stable.\n\nLeft neck:\n2.7 cm left level IIa lymph node is stable to slightly decreased in size is\nmeasured using similar technique. Multiple addition left level 2A and 2B\nlymph nodes are also stable. Multiple enlarged left level 3 lymph nodes,\nlargest approximately 1.4 cm, stable with using similar measurement technique.\nLeft level 4 and level 5 lymphadenopathy appears similar to the previous exam.\nSimilar appearance of retropharyngeal left adenopathy.\n\nExtra nodal tumor spread: There are no findings suggestive of extra nodal\nextension.\n\nDeep neck muscles, masticator space: There is no muscle invasion.\n\nBones, skull base:\nThere is no bone involvement.\nThere are no findings suggestive of perineural tumor extension. Jugular\nforamen, carotid canal, pterygopalatine fossa, infraorbital foramen, other\nskull base foramina are not involved.\nMultiple dental caries and periapical lucencies.\n\nVessels: There is no vascular invasion.\n\nBrachial Plexus: There is no brachial plexus contact or invasion.\n\nThyroid, salivary glands: Thyroid mass infiltrating the soft tissues between\nthe mass and trachea again demonstrated with potential involvement of the\nesophagus and laryngeal cartilages. It measures approximately 6.2 by 5.2 by\n5.7 cm and is similar to previous examination if using similar technique. \nSimilar sclerotic appearance of the anterior thyroid cartilage. Similar\nappearance of sclerosis involving the anterior cricoid cartilage. This could\nreflect either tumor involvement or post treatment change. There is likely\ntracheal invasion with soft tissue again seen in the trachea.\n\nOther findings: Tracheostomy tube is in place. Please refer to the separate\nchest CT for thoracic findings. Paranasal sinus disease again demonstrated\nmucosal thickening and mucous retention cysts in the maxillary sinuses, and a\nsmall amount of fluid in the inferior right mastoid air cells. Is chronic\nsclerotic focus in the right mandible is again seen without change.", + "output": "1. Accounting for technical factors, there is no definite change in the\nlocally invasive thyroid mass or cervical lymphadenopathy." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is a large area of low attenuation within the left parietal lobe with\nsulcal effacement and loss of gray-white matter differentiation, consistent\nwith an acute to subacute infarct. No intracranial hemorrhage is identified.\n\nThe ventricles, sulci, and cisterns otherwise appear normal.\n\nThere is a dysconjugate gaze.\n\nThe paranasal sinuses, middle ear cavities, and mastoid air cells are clear.\n\nCTA HEAD:\nThere is diminished flow within the left A1 segment and a left posterior\ncommunicating artery. The left A2 segment is filled by a patent anterior\ncommunicating artery. The left M1 segment is occluded. There is mild\ncollateral flow within the vascular territory of the left middle cerebral\nartery.\n\nModerate atherosclerotic plaque within the bilateral intracranial internal\ncarotid arteries, with areas of mild narrowing of the patent right internal\ncarotid artery. The anterior cerebral arteries and right middle cerebral\nartery are otherwise patent, without stenosis.\n\nThe posterior cerebral arteries are patent, without stenosis. The posterior\ncommunicating arteries are patent.\n\nThere is moderate atherosclerotic plaque within the V4 segments of the\nbilateral vertebral arteries, without occlusion. Please note that the\nproximal V4 segments are difficult to evaluate due to beam hardening artifact\nrelated to dental hardware. The basilar artery is patent, without stenosis.\n\nNo aneurysm or high-flow vascular malformation is identified.\n\nCTA NECK:\nThere is mild atherosclerotic plaque within the aortic arch. The left\nvertebral artery is derived from the aortic arch.\n\nThere is mild atheromatous plaque within the right common carotid artery. \nThere is mild atheromatous and atherosclerotic plaque within the right\ninternal carotid artery, with less than 50% stenosis by NASCET criteria.\n\nThere is mild atheromatous plaque within the left common carotid artery. \nThere is moderate atheromatous and atherosclerotic plaque within the proximal\nleft internal carotid artery. The left extracranial and intracranial internal\ncarotid artery is completely occluded.\n\nThere is mild atheromatous atherosclerotic plaque within the extracranial\nvertebral arteries, with areas of mild narrowing.\n\nCT PERFUSION:\nThe CT perfusion images are nondiagnostic due to suboptimal contrast bolus\ntiming.\n\nOTHER:\nNo enlarged cervical lymph nodes are identified.", + "output": "1. Left extracranial and intracranial internal carotid artery occlusion, and\nocclusion of the left M1 segment. There is mild collateral flow within the\nvascular territory of the left middle cerebral artery. Loss of gray-white\nmatter differentiation and sulcal effacement within the left parietal lobe is\nconsistent with a large acute to subacute infarct. No evidence of hemorrhagic\ntransformation. Please note that the CT perfusion images are nondiagnostic\ndue to suboptimal bolus timing.\n2. Moderate intracranial atherosclerosis.\n3. Moderate extracranial atherosclerosis, with less than 50% stenosis within\nthe right internal carotid artery. The left internal carotid artery cannot be\nevaluated with NASCET criteria due to the proximal occlusion. The vertebral\narteries are patent.\n\nNOTIFICATION: ** ED URGENT ATTENTION ***" + }, + { + "input": "Patient is status post C4-C5 corpectomy with bone graft material in place and\nanterior spinal fusion spanning C3 through C6. Hardware appears in similar\npositioning when compared to prior without evidence of loosening or fracture.\n\nThe parotid glands, submandibular glands, and thyroid are unremarkable.\nSurgical clips posterior to the right lobe of the thyroid are compatible with\nprior parathyroidectomy.\n\nThere is a cluster of lymph nodes on the left at level 5 (03:36). They are\nborderline in size measuring up to 11 mm in long axis and there is adjacent\nstranding of the fat. Other scattered subcentimeter cervical lymph nodes are\nseen bilaterally, none of which meet size criteria for pathologic enlargement.\n\nAerodigestive tract is unremarkable besides prominent adenoidal tissue in the\nnasopharynx.\n\nLarge mucous retention cysts seen within the maxillary sinuses bilaterally.\nThe mastoids and other included paranasal sinuses are clear.\n\nIncluded portion of the brain is unremarkable.\n\nLung apices are clear.", + "output": "Borderline enlarged left level 5 lymph nodes with adjacent stranding, the\nexact etiology of is uncertain, potentially reactive. No focal collection\nidentified. These could be reactive however clinical correlation is suggested." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass, mass effect, or large\nvascular territory infarction. There are postsurgical changes and subtle\nencephalomalacia in the left temporal lobe with associated ex vacuo dilatation\nof the temporal horn of the left lateral ventricle (4, 12) in the area of the\nprior AVM resection. The ventricles and sulci are otherwise normal in size\nand configuration. The basal cisterns are patent. There is preservation of\ngray-white matter differentiation.\n\nPostsurgical changes are noted in the left temporal and parietal bone from a\nprior craniectomy. No fracture is identified. The visualized paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The soft\ntissues are unremarkable.", + "output": "No acute intracranial abnormality; specifically, no evidence of hemorrhage." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\n\nHyperdense material is noted in the posterior left temporal lobe. Surrounding\nencephalomalacia is slightly more hypodense compared to ___. Ex vacuo\ndilation of left lateral ventricle posterior horn is noted.\nThere is no evidence of acute infarction, hemorrhage, edema, or mass.\n\nLeft temporal craniotomy is noted. No subcutaneous tissue fluid collection or\nfat stranding is identified around the craniotomy site. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nNo evidence of residual or recurrent AVM is identified.\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal with no evidence of stenosis, occlusion, or aneurysm. The dural\nvenous sinuses are patent.", + "output": "1. Interval evolution of posttreatment left temporal encephalomalacia since\n___. No residual or recurrent AVM is identified.\n2. No subcutaneous fluid collection or inflammation is identified around the\nleft temporal craniotomy." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute infarction, intracranial hemorrhage, or edema. \nThe ventricles are normal in size and configuration. The visualized paranasal\nsinuses and bilateral mastoid air cells appear clear. Incidental note is made\nof osteomas along the left frontal calvarium (3: 233, 248). Given the lack of\nenhancement on the prior contrast enhanced study, these are unlikely represent\ncalcified meningiomas.\n\nCTA HEAD:\nThere is a hypoplastic right A1 segment of the anterior cerebral artery, a\ncongenital variant. There is mild narrowing of the supraclinoid right\ninternal carotid artery (3: 215). Otherwise, the intracranial vasculature\nappears patent without stenosis, occlusion, or aneurysm. The dural venous\nsinuses appear patent.\n\nCTA NECK:\nThere is common origin of the left carotid artery and brachiocephalic artery. \nThe bilateral common carotid arteries and internal carotid arteries appear\npatent without internal carotid stenosis by NASCET criteria. The bilateral\nvertebral arteries appear patent.\n\nOTHER:\nThere is no lymphadenopathy per size criteria. Streak artifact related to\ndental amalgam obscures visualization of adjacent structures. The visualized\nlung apices appear clear.", + "output": "1. No evidence of acute infarction or intracranial hemorrhage.\n2. Mild luminal narrowing of the supraclinoid right internal carotid artery. \nOtherwise, patency of the intracranial vasculature.\n3. Patency of the cervical vessels without internal carotid stenosis by NASCET\ncriteria." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Age related involutional changes are noted. Ventricles are\nnormal in size. Sulcal prominence reflects age related involutional changes. \nBasal cisterns are patent. Imaged paranasal sinuses, mastoid air cells and\nmiddle ear cavities are clear. Carotid siphon calcification noted. The bony\ncalvarium is intact", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Normal study." + }, + { + "input": "There is a laceration and subgaleal hematoma in the left frontal supraorbital\nregion. There is no evidence of intracranial hemorrhage, edema, shift of\nnormally midline structures, or infarction. Ventricles and sulci are normal in\noverall size and configuration.\n\nThere is mild mucosal thickening in the left maxillary and bilateral ethmoid\nair cells. Mastoid air cells and middle ear cavities are well aerated. The\nbony calvarium is intact.", + "output": "1. No acute intracranial abnormality or fracture.\n2. Soft tissue laceration subgaleal hematoma in the left frontal supra-\norbital region." + }, + { + "input": "There is a mildly depressed fracture of the anterior wall of the left maxilla\n(02:57), there is mildly displaced left nasal bone fracture (02:49). There is\nsignificant soft tissue swelling with foci of air in the left maxilla. There\nis a subgaleal hematoma and laceration in the left frontal region.\nThere is partial opacification of the left maxillary sinus with an air-fluid\nlevel and mild mucosal thickening in the bilateral ethmoid air cells.\nThere are multiple screws in the left mandible, presumably due to prior\ninjury.\nThere is bone destruction at the root of a right mandibular incisor with\nsclerosis of the surrounding mandible. These findings suggest chronic\ninfection.\nBilateral mastoids appear normal.\nThe globes, extraocular muscles, optic nerves, and retrobulbar fat appear\nnormal.\nThe visualized upper aerodigestive tract appears normal.\nThe mandible and temporomandibular joints appear normal.", + "output": "1. Mildly displaced fractures of the anterior wall the left maxilla and left\nnasal bone.\n2. Significant soft tissue swelling in the left maxilla and left supraorbital\nregion. Base of a right mandibular incisor and sclerosis suggesting chronic\ninfection." + }, + { + "input": "There is no evidence of acute major vascular territory\ninfarction,hemorrhage,edema,or large mass. The ventricles and sulci are\nnormal in size and configuration.\n\nThere is no evidence of fracture. Minimal mucosal thickening is seen in the\nleft maxillary sinus. Otherwise, the remaining visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial abnormalities." + }, + { + "input": "There is a large superficial hematoma overlying the left parietal skull\nprobably with a subgaleal component. This also apparently involves a\nlaceration with small quantities of visible gas in soft tissues. There is no\nevidence of intracranial hemorrhage. There is mild subcortical white matter\nhypodensity in the right parietal lobe as well as in the deep white matter of\nthe left frontal lobe which is commonly due to chronic small vessel ischemic\nchange. The ventricles, cisterns, and sulci are unremarkable. There is no\nhydrocephalus. Motion artifact limits assessment of the study to some extent\nbut no fracture is identified. Left mastoid air cells are underpneumatized.\nCavernous carotid calcifications are present.", + "output": "No evidence of acute intracranial process or injury." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass. There is\nmild prominence of the ventricles and sulci suggestive of involutional\nchanges. Subtle periventricular and subcortical white matter hypodensities\nlikely relate to chronic small vessel ischemic disease. Chronic infarctions\nare seen within the left cerebellar hemisphere, unchanged from ___. There is\npreservation of gray-white matter differentiation. The basal cisterns remain\npatent.\n\nThere is no evidence of acute fracture. A mucous retention cyst is noted\nwithin the right frontal sinus. The remainder of the visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nMinimal atherosclerotic are seen within the bilateral cavernous carotid\narteries. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Mild global cerebral atrophy and evidence of chronic small vessel ischemic\ndisease and remote left cerebellar infarcts." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass affect. \nPeriventricular and subcortical white matter hypodensities are nonspecific but\nlikely sequelae of chronic small vessel ischemic disease. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nPrior left basal ganglia lacunar infarct versus prominent perivascular spaces\nare noted. Calcifications overlying the right occipital lobe (401:35) could\nbe dural calcification though underlying small meningioma measuring up to 3 mm\nin thickness is not entirely excluded.\n\nThere is no evidence of fracture. Bilateral expansile petrous apex lesions\nare unchanged since ___, and most likely arachnoid granulations. \nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No evidence of an acute intracranial abnormality.\n2. Chronic atrophy and microangiopathy.\n3. Calcifications overlying the right occipital lobe, potentially dural based\ncalcifications though small meningiomas are possible, unchanged since ___." + }, + { + "input": "Head CT: There is no evidence of hemorrhage, edema, infarction, mass or\nmidline shift. There is no hydrocephalus. Visualized paranasal sinuses and\nmastoid air cells are clear. There is no evidence of fracture.\n\nHead CTA: There is a 9mm basilar tip aneurysm. This involves the origins of\nthe posterior cerebral arteries but appears to spare the origins of the\nsuperior cerebellar arteries. There is an outpouching at the bifurcation of\nan M2 branch of the fight middle cerebral artery, that measures less than 2mm.\nThis may be an infundibulum, but it is too small to reliably characterize.\n\nOtherwise, the intracranial arteries appear normal with no further evidence of\naneurysm formation. There is no evidence of stenosis or occlusion", + "output": "Nine mm basilar tip aneurysm involving the origins of the posterior cerebral\narteries bilaterally.\nThe less than 2 mm outpouching at the branch point of a right middle cerebral\nartery and 2 the superior division of the vessel. This may represent an\ninfundibulum or tiny aneurysm.\nNo evidence of arterial stenosis or occlusion." + }, + { + "input": "Right frontal sinus is not pneumatized. The frontal sinuses and\nfrontoethmoidal junctions are clear. Right concha bullosa.\nThe cribriform plates are intact. The lamina papyracea are intact.\n\nThe sphenoid sinuses are clear, clear ostia. Clear ethmoid air cells.\n\nMild mucosal thickening left maxillary sinus. Trace mucosal thickening right\nmaxillary sinus floor. Note is made of bilateral small Haller air cells. \nMild mucosal thickening along the bilateral ostiomeatal infundibula without\nobstruction of the maxillary sinuses..\n\nThe nasal septum is intact, with mild leftward deviation. Clear nasal cavity.\nThe carotid canals and optic nerve canals are covered by bone. The medial\norbital walls are intact. Clear mastoids, middle ears. No periapical\nlucencies.\n\nLimited evaluation of the brain shows no abnormalities.. The orbits are\nnormal.", + "output": "1. Mild mucosal thickening maxillary sinus." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. There is mild opacification of the right\nposterior ethmoid air cells. The remaining visualized paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is mild opacification of the posterior right ethmoid air cells. The\nparanasal sinuses are otherwise normally aerated, with no mucosal thickening\nor air-fluid levels identified. The ostiomeatal units are patent. The\ncribriform plates are intact. The lamina papyracea are intact.\n\nNo periapical lucencies are seen surrounding the visualized maxillary teeth. \nVascular structures appear patent. No areas of abnormal enhancement are\nvisualized. No fluid collections are seen.", + "output": "Mild opacification of the posterior right ethmoid air cells which may suggest\nmild ongoing inflammation. Otherwise, paranasal sinuses are clear." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territory infarct. Gray-white matter\ndifferentiation is preserved. There is no hydrocephalus. The visualized\nparanasal sinuses show mild mucosal thickening in the bilateral ethmoid air\ncells. There is minimal mucosal thickening in the partially imaged maxillary\nsinuses. The sphenoid sinuses are underpneumatized.. The mastoid air cells\nare clear. No acute fracture is seen. A possible small calcified left\nfrontal meningioma is re- demonstrated, similar in appearance and present\nsince at least ___.", + "output": "No acute intracranial process." + }, + { + "input": "No evidence of acute large territorial infarction, acute intracranial\nhemorrhage, edema, or mass effect. The ventricles and sulci are normal in\nsize and configuration. Redemonstration of a possible dural calcification\nversus left frontal meningioma, unchanged.\n\nNo acute osseous abnormalities. Trace mucosal thickening of the bilateral\nethmoid air cells. The remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process or hemorrhage." + }, + { + "input": "Small well circumscribed lucency along the inner margin of the calvarium\ninferior right parietal bone corresponds to abnormality in skeletal survey, is\nbenign, may represent arachnoid granulation.. There are no worrisome skeletal\nlesions. There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No worrisome osseous lesions." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. The ventricles and sulci are normal in size and configuration for\npatient age.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of intracranial hemorrhage, mass, mass effect or shifting\nof the normally midline structures, there is no evidence of acute territorial\ninfarct. Sequela of chronic ischemic changes are visualized in the\nsubcortical and periventricular white matter and along the caudate nucleus on\nthe right, causing asymmetry of the frontal ventricular horn, the ventricles\nand sulci are prominent suggesting cortical volume loss, likely age related\nand involutional in nature. Periventricular and subcortical white matter\nhypodensities are nonspecific, but likely reflect sequelae of chronic small\nvessel ischemic disease. Dense vascular arteriosclerotic calcifications are\nseen in the vertebral and carotid arteries, the orbits are unremarkable, the\nimaged paranasal sinuses are clear. Mastoid air cells and middle ear cavities\nare well aerated. The bony calvarium is intact.", + "output": "1. There is no evidence of acute intracranial process or hemorrhage.\n\n2. Sequela of chronic ischemic changes involving the body of the caudate\nnucleus on the right causing asymmetry of the lateral ventricle, confluent\nareas of low attenuation in the subcortical and periventricular white matter\nare nonspecific and may reflect changes due to small vessel disease.\n\n3. Vascular arteriosclerotic calcifications identified in the vertebral and\ncarotid arteries." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction or midline shift.\nThere is no hydrocephalus. There is no edema. There is no fracture.Visualized\nparanasal sinuses and mastoid air cells are clear.", + "output": "Unremarkable unenhanced head CT" + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\n\nThere is no evidence of infarction,hemorrhage,edema,ormass. Incidentally\nnoted is a partially empty sella. The ventricles and sulci are normal in size\nand configuration.\n\nThere is mild mucosal thickening of the left maxillary sinus and posterior\nleft ethmoid air cell. The remainder of the visualized paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.\n\nCTA HEAD: Fetal-type left PCA is noted. The vessels of the circle of ___\nand their principal intracranial branches appear normal without stenosis,\nocclusion, or aneurysm formation greater than 3mm. The dural venous sinuses\nare patent.\n\nCTA NECK: Bilateral carotid and vertebral artery origins are patent. There is\nno evidence of internal carotid stenosis by NASCET criteria. The carotid and\nvertebral arteries and their major branches appear normal without evidence of\nstenosis or occlusion.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No evidence of mass, hemorrhage or infarction.\n2. Incidentally noted partially empty sella.\n3. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n4. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection." + }, + { + "input": "There is no evidence of acute large territorial infarction, acute intracranial\nhemorrhage, edema, or mass effect. The ventricles and sulci are normal in\nsize and configuration. No osseous abnormalities seen. Mild mucosal\nthickening of the left ethmoid air cells. Moderate mucous retention cyst in\nthe left maxillary sinus. The remaining paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,intracranial hemorrhage,edema,ormass. The\nventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are normal.\n\nCTA HEAD:\nThere is fetal type configuration of the left posterior cerebral artery. The\nvessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. The dural venous\nsinuses are patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent. There is\nretropharyngeal course of bilateral common carotid and cervical internal\ncarotid arteries.\n\nThere is no evidence of internal carotid stenosis by NASCET criteria.\n\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.\n\nThere are grossly unchanged mild moderate multilevel degenerative changes of\nthe cervical spine, more significant at C5-C6 level.", + "output": "1. No evidence of large territory infarction or intracranial hemorrhage.\n2. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm\nlarger than 3 mm in size.\n3. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection." + }, + { + "input": "There has been no significant interval change in the large right caudate and\nthalamic hemorrhage, with extension into the bilateral lateral ventricles,\nthird ventricle, fourth ventricle, and foramen magnum. The ventricular system\nappears diffusely dilated, similar to the prior study. There is a small amount\nof right frontoparietal subarachnoid hemorrhage (2:23). There approximately 6\nmm of leftward shift of the normally midline structures, which is similar to\nprior.\n\nNo osseous abnormalities seen. Fluid is seen in the nasopharynx and\noropharynx, which is likely related to intubation status. The paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "1. No significant interval change in the large right caudate and thalamic\nhemorrhage, with extension into the bilateral lateral ventricles, third\nventricle, fourth ventricle, and foramen magnum.\n\n2. The ventricular system appears diffusely dilated, similar to the prior\nstudy.\n\n3. Small amount of right frontoparietal subarachnoid hemorrhage.\n\n4. Grossly stable leftward shift of the normally midline structures." + }, + { + "input": "There has been interval placement of a left frontal approach EVD, traversing\nthe anterior horn of the left lateral ventricle with its tip terminating\napproximately midline at the septum pellucidum. There is associated new small\namount of intraparenchymal hemorrhage along the EVD track in the left frontal\nlobe, pneumocephalus, and air in the left anterior ventricular horn. \nPersistent, moderate, diffuse dilatation of the ventricular system is perhaps\nslightly decreased after placement of the EVD drain, most appreciably in areas\nnot filled with blood clot - the bilateral temporal horns and left anterior\nventricular horn. The large right intraparenchymal basal ganglia and thalamic\nhemorrhage with intraventricular extension filling nearly the entire right\nlateral horn, most of the right temporal bone, left posterior horn, third\nventricle, fourth ventricle, and foramen magnum, are overall unchanged when\naccounting for expected redistribution of blood products. Surrounding\nhypodensity, most compatible with vasogenic edema, is also overall stable.\nThere is approximately 5 mm of leftward shift of normally midline structures\nthat is not appreciably changed (6 mm previously). Small hyperdense\nsubarachnoid hemorrhage in the right frontoparietal region is grossly stable\nwhen accounting for redistribution. The ambien and suprasellar cisterns are\nstable in appearance. Encephalomalacia in the right frontoparietal region is\nchronic and suggests sequelae of prior infarct.\n\nThere is moderate, polypoid mucosal thickening in the left sphenoid sinus.\nOtherwise, the incompletely visualized paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The orbits are unremarkable.", + "output": "1. Newly placed EVD terminates near the septum pellucidum with associated\nmild pneumocephalus, pneumoventricle, and hemorrhage near the track.\n\n2. Mild decrease in ventricular size after EVD placement.\n\n3. Otherwise, overall stable large intracranial hemorrhage with stable mass\neffect as above." + }, + { + "input": "A well-circumscribed hypodense lesion is identified in the medulla measuring\n1.5 (AP) x 1.5 (TV) x 2.0 (SI) cm, causing mild expansion as demonstrated on\nthe sagittal reformation (image 43, series 401b). There is no evidence of\ninfarction, hemorrhage, or edema. There is prominence of the ventricles and\nsulci suggestive of involutional changes. Periventricular white matter\nhypodensities likely reflect sequela of chronic small vessel disease. Dense\nvascular arteriosclerotic calcifications are present in the carotid siphons\nbilaterally.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. A 2.0 cm mass is identified in the medulla. Consider MRI of the cervical\nspine with and without contrast for further evaluation.\n\nRECOMMENDATION(S): Partially evaluated hypodense lesion in the medulla\noblongata as described above, correlation with MRI of the cervical spine with\nand without contrast is recommended for further characterization.\n\nNOTIFICATION: The primary team ___, MD), was aware of these\nfindings and recommendations at the time of this interpretation." + }, + { + "input": "1.7 x 1.6 cm well-circumscribed hypodense lesion in the medulla is similar to\nprior. There is no evidence of acute territorial infarction or hemorrhage. \nPeriventricular and subcortical white matter hypodensities are nonspecific,\nbut likely represent chronic small vessel ischemic disease. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1.7 cm medullary lesion is similar to prior. No significant changes are\ndemonstrated in comparison with the prior head CT.\n\nRECOMMENDATION(S): MRI of the cervical spine with and without contrast is\nrecommended for further characterization." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\n\nA 16 x 17 mm hypodense lesion at the craniocervical junction which is expanded\nis better evaluated on the recent contrast-enhanced MRI of ___. There\nis no hemorrhage or acute infarction. Ventricles and sulci are stable and\nprominent likely reflective of global atrophy. Periventricular and\nsubcortical white matter hypodensities are nonspecific but likely sequelae of\nchronic small vessel ischemic disease.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. Bilateral cataract extractions noted.\n\nCTA HEAD:\nThere are dense calcifications along the cavernous and supraclinoid portions\nof the internal carotid arteries bilaterally with mild stenosis. There is\nmild diffuse narrowing of the basilar artery, likely due to atherosclerosis. \nA bulbous appearance of the tip of the basilar tip could be accentuated by the\nmore proximal narrowing. P1 branches of the PCAs are seen to arise from the\ntip noting fetal type bilateral PCAs. The vessels of the circle of ___ and\ntheir principal intracranial branches otherwise appear normal with no evidence\nof stenosis, occlusion, or aneurysm. The dural venous sinuses are patent.", + "output": "1. Hypodense lesion in the craniocervical junction is better evaluated on the\nrecent MRI from ___. No hemorrhage or acute infarction.\n\n2. Atherosclerotic calcifications in the cavernous and supraclinoid ICAs\nbilaterally without significant stenosis. Mild narrowing of the basilar\nartery, likely due to atherosclerosis. Otherwise unremarkable head CTA." + }, + { + "input": "New fixation plate, posterior scalp subcutaneous emphysema and right posterior\nfossa pneumocephalus extending into the foramen magnum are consistent with\npostoperative changes from right suboccipital craniotomy with right cerebellar\ntumor resection. The 3.6 x 2.5 cm hypodense area within the right cerebellar\nhemisphere adjacent to the surgical bed is likely postoperative in nature\n(03:11). There is persistent mild-to-moderate mass effect on the fourth\nventricle which is similar to the most recent ___ head MR however\nthere is no evidence obstructive hydrocephalus. There is no acute\nintraparenchymal hemorrhage. There is no acute large territorial infarction. \nThere is no shift of the midline structures.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Status post right suboccipital craniotomy and resection of right cerebellar\nmass, with postoperative changes including right cerebellar edema and\npneumocephalus at the surgical bed. Given the wedge-shaped appearance of the\nright cerebellar hypodensity, a superior cerebellar arterial infarct should\nalso be considered and close attention on follow-up imaging is recommended.\n2. No evidence of intraparenchymal hemorrhage.\n3. Persistent mild-to-moderate mass effect on the fourth ventricle is similar\nto most recent ___ head MR, without evidence of obstructive\nhydrocephalus.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 6:52 pm, 2 minutes after\ndiscovery of the findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is a hyperdense 5 mm round lesion in the middle cerebellar peduncle\nwhich demonstrates small punctate calcifications and most likely represents a\nsmall cavernoma. There is no surrounding edema.\n\nArea of hyperdensity in the medulla (series 2, image 6) and inferior left\ncerebellar hemisphere (series 2, image 8) is consistent with hemorrhage. \nMinimal surrounding edema.\n\nAt the level of the right cerebral peduncle, there is a 8.5 mm round focus of\nhyperdensity, compatible with a bleed in the midbrain. Minimal surrounding\nedema.\n\nAreas of intraparenchymal hemorrhage are noted in the left parietal lobe,\nperiventricular and within the white matter (series 2, image 22 and 24).\n\nSize and configuration of the ventricles and sulci is within normal limits. \nNo evidence of acute infarction.\n\nMild mucosal thickening in the left frontal sinus and ethmoid air cells. \nThere is a mucous retention cyst and mild mucosal thickening along the floor\nof both maxillary sinuses, left greater than right. The mastoid air cells are\nclear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. There is a\n1.5 mm infundibulum at the origin of the left posterior communicating artery. \nNote is made of mild ectasia of the proximal basilar artery. The dural venous\nsinuses are patent.\n\nCTA NECK:\nNormal 3 vessel aortic arch. The carotid and vertebral arteries and their\nmajor branches appear normal with no evidence of stenosis or occlusion. There\nis no evidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nMild gravity dependent atelectasis. The visualized portion of the lungs are\notherwise clear. The visualized portion of the thyroid gland is within normal\nlimits. There is no lymphadenopathy by CT size criteria. There appear to be\npostsurgical changes in the region of the right parotid gland with the gland\nbeing likely surgically absent.", + "output": "1. Small foci of hemorrhage in the inferior left cerebellar hemisphere,\nmedulla, right cerebral peduncle of the midbrain and left parietal lobe. No\nevidence of acute infarction, hydrocephalus or mass effect.\n2. Subcentimeter cavernoma in the right middle cerebellar peduncle.\n3. Patent cervical and intracranial vasculature without evidence of stenosis,\nocclusion or aneurysm formation.\n4. Paranasal sinus disease as described above." + }, + { + "input": "There is re-demonstration of a rounded hyperdensity in the middle cerebellar\npeduncle with associated punctate calcification likely representing a small\ncavernoma, unchanged from prior. Again seen are multiple focal intracranial\nhemorrhages are re-demonstrated in the medulla (2:8), in the inferior left\nhemisphere (02:10), and right cerebral peduncle (02:18) all of which have\nminimal associated surrounding edema, and are unchanged from prior. Additional\nintraparenchymal hemorrhage in left parietal lobe and left periventricular\nwhite matter are re-demonstrated and unchanged (2:23 and 2:27).\n\nThere is no evidence of acute large territory infarction,or new intracranial\nhemorrhage. The ventricles and sulci are stable in size and configuration.\n\nThere is no evidence of fracture. Bilateral maxillary sinus mucous retention\ncysts are re-demonstrated and unchanged. Otherwise the visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nThe visualized portion of the orbits are unremarkable.", + "output": "1. Multiple small foci of hemorrhage in the inferior left cerebellar\nhemisphere, medulla, right cerebral peduncle, and left parietal lobe, all of\nwhich are unchanged from prior study and results in no appreciable mass\neffect, likely representing multiple cavernous malformations.\n2. No new intracranial hemorrhage or acute large territory infarction\nidentified." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, shift of normally\nmidline structures or acute major vascular territorial infarction. Prominence\nof ventricles and sulci and extra-axial CSF space is consistent with age\nrelated involutional changes. The basal cisterns appear patent and there is\npreservation of gray-white matter differentiation.\n\nThere is no fracture. There is mucosal thickening of the ethmoidal air cells.\nSmall amount of fluid seen in the right maxillary sinus. Otherwise, the\nremaining visualized paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Prominence of\nthe ventricles and sulci is indicative of involutional change.\n\nNo osseous abnormalities seen. Vascular arteriosclerotic calcifications are\nvisualized in the carotid siphons bilaterally. The paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The orbits are unremarkable.", + "output": "Sequela of involutional change but no acute pathology." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. There\nis minimal periventricular and subcortical white matter hypodensity, which is\nnonspecific, but likely represents chronic microvascular ischemic changes. \nThe ventricles and sulci are prominent, consistent with involutional changes.\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable. There are\ndegenerative changes in the partially imaged cervical spine.", + "output": "No acute intracranial abnormality.\n\nInvolutional changes and minimal likely chronic microvascular ischemic change." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Mild periventricular, subcortical and deep white matter\nhypodensities are nonspecific, but likely reflect the sequela of chronic\nmicrovascular infarction. Mild atherosclerotic calcifications of the\ncavernous carotid arteries are noted bilaterally.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality. No acute fracture." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema,or mass effect. The\nventricles and sulci are age appropriate.\n\nThere is no evidence of fracture. Mild mucosal thickening of the left\nmaxillary sinus. The visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute large territorial infarction, intracranial\nhemorrhage, edema, or mass.\n\nThere is prominence of the ventricles and sulci suggestive of age-related\ncerebral volume loss. Periventricular and subcortical white matter\nhypodensities are nonspecific, though likely sequelae of chronic small vessel\nischemic disease. Atherosclerotic vascular calcifications are noted of\nbilateral vertebral and cavernous portions of internal carotid arteries.\n\nMild swelling overlying the right frontal scalp with likely small subgaleal\nhematoma. Otherwise, no acute osseous abnormalities seen. The partially\nimaged paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The orbits demonstrate no acute abnormalities.", + "output": "Mild right frontal scalp swelling with likely small subgaleal hematoma. No\nunderlying fracture. No acute fractures otherwise.\n\nNo acute intracranial process. No evidence intracranial hemorrhage." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or mass\neffect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is an acute, comminuted, depressed fracture of the right zygomatic arch.\nMinimally displaced fractures are noted of the anterior and posterior walls of\nthe right maxillary sinus. There is an acute fracture line through the right\nlateral orbital wall (series 3; images 1, 2, and 11). Additionally,\ncomminuted fracture through the right orbital floor is seen with no evidence\nfor extraocular muscular herniation. There is small amount of soft tissue gas\nadjacent to the fracture site and the fracture fragment is minimally displaced\ninto the right maxillary sinus. Mildly displaced right nasal bone fracture is\npresent. There is associated right periorbital soft tissue swelling with\ninfraorbital, pre maxillary, and right facial subcutaneous emphysema.\n\nThere is resultant air-fluid level with high-density material in the right\nmaxillary sinus, likely hemosinus. There is mild mucosal thickening of the\nanterior ethmoid air cells and minimal mucosal thickening of the left\nmaxillary sinus. Visualized globes intact.\nSmall amount of subgaleal hematoma is seen overlying the left parietal bone.", + "output": "1. Small left parietal scalp subgaleal hematoma. No acute fracture.\n2. No acute intracranial hemorrhage or mass effect.\n3. Fractures of the right orbit, zygomatic arch, maxillary sinus, and nasal\nbone with surrounding soft tissue swelling and subcutaneous emphysema. \nAssociated right maxillary hemosinus. Please see subsequent CT sinus for\nfurther details." + }, + { + "input": "A comminuted, mildly depressed fracture of the right zygomatic arch is\npresent. There are minimally displaced fractures of the anterior and\nposterior walls of the right maxillary sinus. Underlying opacification of the\nright maxillary sinus is consistent with resultant hemosinus. Minimally\ndisplaced fracture of the right nasal bone is noted. There is also\nsurrounding soft tissue stranding and subcutaneous air in the soft tissues in\nthis region.\n\nComminuted fracture through the right orbital floor with adjacent soft tissue\ngas and mild inferior displacement of the fracture fragment into the right\nmaxillary sinus is noted. No herniation of extra ocular musculature is\npresent. There is an additional fracture of the lateral wall of the right\norbit.\n\nPterygoid plates appear intact bilaterally. Lamina papyracea appear intact\nbilaterally.\n\nThere is mild mucosal thickening of the left maxillary sinus as well as the\nbilateral anterior ethmoid air cells. There is a mucous retention cyst in the\nsphenoid sinus. Bilateral mastoids and middle ear cavities are clear.\n\nThere are no abnormal fluid collections. There is soft tissue swelling\noverlying the right orbit with the globes appearing intact. There is a small\namount of soft tissue density in the inferior retro-orbital fat, which may\nrepresent a small orbital hematoma in the floor of the right orbit. Inferior\nrectus muscle shows no signs of entrapment. Globes intact.\n\nThe visualized upper aerodigestive tract appears normal. The mandible and\ntemporomandibular joints appear normal.", + "output": "1. Multiple right-sided facial fractures including involvement of the right\nzygomaticomaxillary complex, lateral wall and floor of the right orbit, and\nright nasal bone. There is resultant right-sided hemosinus.\n2. Small right orbital hematoma adjacent to the right orbital floor fracture. \nInferior rectus muscle shows no signs of inferior herniation or entrapment." + }, + { + "input": "No acute intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. A stable focus of hypodensity in the right centrum ovale is again\nnoted, better characterized on prior MRI as a demyelinating lesion there is no\nevidence of acute fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable. Mild calcifications of the bilateral carotid\nsiphons are noted. Severe right TMJ arthritis noted peer", + "output": "-No acute intracranial abnormalities.\n-Stable focal areas of white matter hypodensity, likely corresponding to\ndemyelinating lesions seen on prior MRI." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. \nPeriventricular and subcortical white matter hypodensities are unchanged. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Severe right temporomandibular joint\ndegenerative changes are unchanged. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Carotid siphon calcifications are\nnoted. Bilateral temporomandibular joint degenerative changes are noted.", + "output": "1. No evidence of an acute intracranial hemorrhage or fracture.\n2. Grossly stable white matter hypodensities compatible with patient's known\nhistory of multiple sclerosis." + }, + { + "input": "The carotid and vertebral arteries and their major branches are patent with no\nevidence of stenoses. No evidence for dissection, aneurysm, or pseudoaneurysm\nis seen. There is mild atherosclerotic calcification at the origin of the left\nsubclavian artery. The left vertebral artery is dominant. Incidental note is\nmade of a common origin of the left common carotid and innominate arteries. \nIncidental note is made of bilateral fetal type posterior cerebral arteries. \nThe left transverse sinus is hypoplastic. Carotid siphon vascular\ncalcifications are noted.\n\nNo neck hematoma or laceration visualized. No subcutaneous emphysema. The\ncartilaginous structures appear heterogeneous, but without discrete fracture\nidentified. There is a prominent tonsillith in the right palatine tonsil. \nThe aerodigestive tract is patent without evidence of narrowing. There is a\nprominent rightward nasal septum spur.\n\nMinimal anterolisthesis of C7 on T1 is unchanged. There is mild multilevel\ndegenerative changes with mild spinal canal narrowing at C4-C5 and C5-C6. \nThere is moderate right and mild left neural foraminal narrowing at C5-C6.", + "output": "1. No evidence of hematoma or major neck vessel injury. Patency of the\ncervical vessels without stenosis or dissection.\n2. No evidence of a discrete fracture, accounting for heterogeneous appearance\nof the cartilaginous structure from osteopenia. If clinically warranted, MRI\nis a more sensitive means for further evaluation, especially for underlying\nligamentous injury.\n3. No subcutaneous emphysema to suggest tracheal fracture.\n4. Minimal anterolisthesis of C7 on T1, unchanged.\n5. Multilevel cervical spondylosis with mild spinal canal narrowing at C4-C5\nand C5-C6." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. White matter\nhypodensities compatible with patient's known history of multiple sclerosis\nare unchanged. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute, large territorial\ninfarction,hemorrhage,edema,or mass. Multiple white matter hypodensities\nconsistent with patient's known history of multiple sclerosis are better\nassessed on prior MRI. There is prominence of the ventricles and sulci\nsuggestive of involutional changes.\n\nThere is no evidence of fracture. Small mucous retention cyst of the right\nsphenoid sinus. Otherwise, the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. Aside from scleral\ncalcifications, the visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Multiple white matter hypodensities consistent with patient's known history\nof multiple sclerosis are better assessed on prior MRI." + }, + { + "input": "There is no evidence of large territorial infarction, hemorrhage, edema, or\nmass effect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. White matter hypodensities are consistent the patient's\nhistory of multiple sclerosis as well as chronic changes due to microvascular\nischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality." + }, + { + "input": "There is a right parietal scalp hematoma and laceration with subcutaneous\nemphysema. No evidence of underlying fracture.\n\nThere is an acute left frontal subdural hematoma measuring 6 mm in maximal\nthickness, not substantially changed compared to prior (series 2, image 10). \nThere is a small focus of subdural hemorrhage along the left anterior falx\n(series 2, image 19), also unchanged. A hyperdense focus within the sulci of\nthe right parietal lobe appears to reflect an additional focus of subarachnoid\nhemorrhage (series 2, image 22), not definitively seen on the prior. There is\nno evidence of acute territorial infarction,edema, or mass. There is mild\nprominence of the ventricles and sulci suggestive of involutional changes. \nMild periventricular and subcortical white matter hypodensities are\nnonspecific, but likely reflect the sequela of chronic microvascular\ninfarction.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable. Lucent slightly expansile ovoid lesion within the right\nparietal bone (03:24) appears nonaggressive, possibly an area of fibrous\ndysplasia.", + "output": "1. Unchanged acute left frontal subdural hematoma measuring up to 6 mm. Small\nfocus of subdural hemorrhage along the left anterior falx is also unchanged.\n2. Hyperdense focus within a right parietal lobe sulcus is compatible with an\nadditional focus of subarachnoid hemorrhage, which was not definitively seen\non the prior examination.\n3. Right parietal scalp laceration and hematoma without evidence of underlying\nfracture." + }, + { + "input": "Again seen is an extra-axial hyperdensity along the left frontal lobe\nconsistent with a subdural hematoma measuring up to 5 mm in maximal thickness,\nnot substantially changed compared to the prior study (3:8). There is no\nevidence of midline shift. Again seen is the small focus of subdural\nhemorrhage along the left anterior falx, also unchanged (03:18). Previously\nseen hyperdense focus within the sulci of the right parietal lobe reflecting a\nfocus of subarachnoid hemorrhage is slightly less conspicuous compared to the\nprior study (03:22). Mild prominence of the ventricles and sulci suggest\ninvolutional changes. Mild periventricular and subcortical white matter\nhypodensities are nonspecific, but likely reflect sequelae of chronic small\nvessel ischemic disease.\n\nRight parietal scalp hematoma with laceration and subcutaneous emphysema is\nagain noted without underlying fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Left frontal subdural hematoma measuring up to 5 mm, not significantly\nchanged compared to the prior study.\n2. No evidence of midline shift.\n3. Small left anterior falx subdural hemorrhage and punctate right parietal\nsubarachnoid hemorrhage, unchanged.\n4. Right parietal scalp hematoma with laceration and subcutaneous emphysema\nwithout underlying fracture." + }, + { + "input": "There is interval decrease in the size of the known left frontal subdural\nhematoma, with minimal residual noted in the left frontal convexity. \nSimilarly, there has been expected interval evolution of the known anterior\nfalx subdural hematoma with minimal residual seen on today's exam. The\npreviously described hyperdense foci within the sulci of the right parietal\nlobe is not well seen on today's study. There is no evidence of\ninfarction,new hemorrhage, edema, or mass effect. There is prominence of the\nventricles and sulci suggestive of involutional changes.\n\nAgain seen is a right parietal scalp hematoma with subcutaneous emphysema. No\nevidence of acute fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. Interval decrease in the size of the known left frontal subdural hematoma\nand anterior falx bleed since prior exam in ___. There is no evidence\nof new hemorrhage or of infarction.\n2. Stable appearance of a known right parietal scalp hematoma." + }, + { + "input": "Previously noted left frontal subdural hematoma and small anterior falx\nsubdural hematoma have completely resolved. There is no evidence of acute\nlarge territorialnew hemorrhage edema, or mass. The ventricles and sulci are\nnormal in size and configuration. Focal areas of scattered white matter\nhypodensity correspond to demyelinating lesions, previously characterized on\nMR. ___ vascular calcifications are noted of the bilateral carotid siphons.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Complete resolution of left frontal and anterior falx subdural hematomas.\n2. No acute intracranial abnormality including new hemorrhage or acute large\nterritorial infarct.\n3. Focal areas of white matter hypodensity corresponding to demyelinating\nlesions as previously seen on MR." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute infarction, intracranial hemorrhage, edema, or\nmass. The ventricles and sulci are normal in size and configuration. Small 3\nmm round calcification in the left parietal area. Less well-circumscribed\nsmall areas of calcification in the posterior left centrum semiovale (series\n2, image 19) and right temporal area (series 2, image 12 that 14). No\nabnormal enhancement.\n\nModerate mucosal thickening involving the paranasal sinuses, but no air-fluid\nlevels or aerated secretions. Evidence of prior right ocular enucleation and\nright facial reconstruction for retinoblastoma according to history. Coarse\nappearance of the right orbit and facial bones are most likely secondary to\nradiation. Evidence of extensive right facial and radical right neck\ndissection.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nare patent without marked stenosis, occlusion, or aneurysm formation. \nHypoplastic appearance of the left A1 segment. The dural venous sinuses are\npatent.\n\nCTA NECK:\nExtensive calcific atherosclerotic changes of the right carotid bulb as well\nas surrounding surgical clips result in beam hardening artifact making the\nproximal right ICA difficult to assess, but there appears to be at least 75%\nstenosis. Please note that complete occlusion cannot be excluded and if\nclinically indicated angiography may be performed to better assess this. Mild\ncalcific atherosclerotic changes of the left proximal ICA but no left ICA\nstenosis by NASCET criteria. The vertebral arteries are patent bilateral.\n\nOTHER:\nGround-glass opacification in the visualized upper lobes with some more\nconfluent peribronchovascular soft tissue opacification is nonspecific and\nafter treatment of the acute condition the lungs could be reassessed. The\nlargest nodule/airspace opacification in the left upper lobe measures 7 mm in\ndiameter. Evidence of prior thyroidectomy. 2 cm predominantly soft tissue\nand 1.8 cm partially calcified soft tissue mass present in the left parotid\nsuperficial lobe. Mildly enlarged left supraclavicular lymph nodes measuring\nup to 12 mm diameter.", + "output": "1. No evidence of intracranial mass, hemorrhage or acute infarct.\n\n2. Multiple parenchymal calcifications is nonspecific, but almost certainly\nbenign and do not demonstrate any enhancement postcontrast.\n\n3. Evidence of prior right ocular enucleation and right facial reconstruction\nfor retinoblastoma according to history. Coarse appearance of the right orbit\nand facial bones most likely secondary to radiation. Evidence of right radical\nneck dissection. Prior thyroidectomy.\n\n4. There is no intracranial arterial aneurysm, occlusion or marked stenosis.\n\n5. Extensive calcific atherosclerotic changes of the right carotid bulb as\nwell as surrounding surgical clips result in beam hardening artifact making\nthe proximal right ICA difficult to assess, but there appears to be at least\n75% stenosis. Please note that complete occlusion cannot be excluded and if\nclinically indicated angiography may be performed to better assess this.\n\n6. No left proximal ICA stenosis by NASCET criteria. The vertebral arteries\nare patent bilateral.\n\n7. Nonspecific ground-glass opacification of the lungs is nonspecific and may\nbe secondary to edema or infection/inflammation. The largest nodule in the\nleft upper lobe measures up to 7 mm diameter. ___ guidelines may be\nfollowed if clinically indicated otherwise reimaging after this acute episode\nmay be performed.\n\n8. Two left parotid soft tissue nodules (1 is partially calcified) which has\na suspicious appearance and correlation with ultrasound +/-histology is\nadvised.\n\nRECOMMENDATION(S): For incidentally detected multiple solid pulmonary nodules\nmeasuring 6 to 8mm, a CT follow-up in 3 to 6 months is recommended in a\nlow-risk patient, with an optional CT follow-up in 18 to 24 months. In a\nhigh-risk patient, both a CT follow-up in 3 to 6 months and in 18 to 24 months\nis recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. The ventricles and sulci are normal in size and configuration. A 3 mm\nround calcification in the left parietal area is unchanged in appearance. \nThere are bilateral smaller calcifications within both parietal lobes, also\nunchanged from prior. Postsurgical and post radiation changes are seen again\nin the right orbit, consistent with history of retinoblastoma. The left orbit\nis within normal limits.\n\nThere is no evidence of fracture. The right maxillary sinus is mildly\nthickened. Otherwise the visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavitiesare remarkable.", + "output": "1. No acute intracranial infarction or hemorrhage. No acute fractures.\n2. Similar appearance of postsurgical and post radiation changes to the right\norbit." + }, + { + "input": "Left parotid gland:\nThere are 2 left parotid gland masses. There is 2.5 cm x 1.6 cm x 1.7 cm\nenhancing mass within anterior aspect superficial lobe left parotid gland,\nextending up to the junction with the deep lobe, with punctate areas of\ninternal calcification, and peripheral irregular margins and micro\nlobulations. Mass is stable since ___. Plane between the tumor and\nthe mandible is preserved. Facial vein is not occluded. No definite\nperineural tumor extension. Left stylomastoid foramen fat pad is preserved,\nand facial nerve similar in size compared with right side. V3 nerve branches\nare normal, no definite perineural tumor.\n\nThe additional less well seen 1.9 cm round lower density mass within superior\naspect superficial lobe left parotid gland, involving pre-auricular segment of\nthe gland, stable.\n\nRight parotid gland:\n1.0 cm right parotid tail nodule, similar to prior.\n\nAero digestive tract:\n\nThere asymmetric fullness of the left palatine tonsil.\n\nThere is asymmetric fullness of the left hypopharynx measuring 1.5 cm x 1.3 cm\nx 1.8 cm, at the level of the superior piriform sinus and just above it,,\npartial aeration of the posterior left paralaryngeal space. Thickened left\naryepiglottic fold. Stable cartilage appearance since priors. Narrow extra\nlaryngeal abnormality. Normal carotid space. Direct visualization\nrecommended to exclude neoplasm. Paramedian position of the left true vocal\ncord, suggestive of vocal cord paralysis. Normal prevertebral muscles, bones.\n\n\nNeck lymph nodes:\nRight neck dissection, resection of sternocleidomastoid.\n2 indeterminate right level 5 B lymph nodes measuring 1.1 cm, 0.6 cm, stable\nsince ___, ___ chest ___..\n1 cm left level 4 lymph node series 3, image 43, stable. Additional enlarged\nleft level 4, L5 be multiple lymph nodes, largest measures 1.5 cm, mildly\nincreased since ___.\nFew subcentimeter level 6 lymph nodes, largest measures 7 mm, stable since ___, not well seen in ___ secondary to artifact. Few subcentimeter\nmediastinal lymph nodes, similar.\nThere is no retropharyngeal adenopathy.\n\n\nExtra nodal tumor spread:\n\nThere are no findings suggestive of extra nodal extension.\n\n\nDeep neck muscles, masticator space:\n\nThere is no muscle invasion.\n\n\nBones, skull base:\n\nThere is no bone involvement.\nThere are no findings suggestive of perineural tumor extension. Jugular\nforamen, carotid canal, pterygopalatine fossa, infraorbital foramen, other\nskull base foramina are not involved.\nPostsurgical changes Right orbit, with right orbital exoneration, metallic\nclips, chronic fracture right zygomatic arch, atelectasis right maxillary\nsinus. Chronic fracture right mandible.\n\n\nVessels:\n\nThere is no vascular invasion.\n\n\nBrachial Plexus:\n\nThere is no brachial plexus contact or invasion.\n\n\nThyroid, salivary glands:\n\nThere is no mass.\n\n\nOther findings:\n\nThere are no lung nodules.", + "output": "1. 2 left parotid masses, similar since prior. Larger of the 2 masses\nappears malignant.\n2. Asymmetric soft tissue fullness left hypopharynx, malignancy should be\nexcluded, direct visualization recommended. Possible left vocal cord\nparalysis.\n3. Asymmetric mild prominence of the left palatine tonsil, possibly from\nright tonsillectomy, correlate with surgical history, or direct visualization.\n4. Adenopathy left level 4, 5 B.\n5. There are 2 indeterminate enlarged right level 5 B lymph nodes.\n6. Indeterminate 1 cm right parotid tail nodule.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 16:19 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." + }, + { + "input": "Re-identified are 2 left parotid masses. More superior lesion is less\nwell-defined and demonstrates less avid enhancement compared to the second\ndominant lesion, measuring approximately 1.5 x 1.4 by 1.4 cm (AP, TRV, SI;\nseries 2, image 20) along the superior aspect of the left superficial lobe. \nThe dominant more solid lesion demonstrating coarse speckled calcifications\nand measures approximately 2.0 x 1.8 x 2.6 cm (AP, TRV, SI; series 2, image\n25). Although there is no definite perineural spread, there does appear to be\nminimally increased curvilinear enhancement along the left stylomastoid either\ntunnel (series 2, image 20), which appears unchanged.\n\nThere is no evidence of intracranial perineural spread. The skull-base\nforamina, including the bilateral stylomastoid foramina appear intact.\n\nThe right parotid gland is partially resected and unchanged from prior\nexamination. A 1 cm right parotid tail lesion (series 2, image 21) is\nunchanged. The left submandibular gland appears unremarkable.\n\nThere are enlarged left level 4 and 5 lymph nodes, unchanged since examination\nof ___ as well as stable prominent right level 5 B lymph nodes.\nThe patient is status post remote right face and neck dissection/resection\nwith right enucleation, resection of the right submandibular gland, and likely\nsternocleidomastoid muscle, with muscular cutaneous flap reconstruction. \nThere appears to be right-sided lymph node dissection. Overall the\npostsurgical changes are stable from prior examination.\n\nAsymmetric fullness of the left hypopharynx, including effacement of the left\npiriform sinus is unchanged from prior examinations. Calcification of the\nthyroid and cricoid cartilages are unchanged.\n\nThe cervical vessels appear patent. The visualized lungs appear unremarkable,\nallowing for respiratory motion artifact and atelectasis. No suspicious\nosseous lesion.", + "output": "1. 2 left parotid masses, with dominant more solidly enhancing lesion\nmeasuring up to 2.6 cm, unchanged from prior examination. Although no\ndefinite evidence of perineural spread, there is curvilinear enhancement along\nthe left submandibular tunnel for close attention is recommended.\n2. Unchanged 1 cm right parotid tail lesion.\n3. Unchanged left level 4 and 5B as well as right level 5B cervical\nlymphadenopathy, unchanged since examination of ___. No new cervical\nlymphadenopathy.\n4. Remote right-sided muscular cutaneous flap reconstruction and neck\ndissection appears unchanged from prior exam.\n5. Additional findings described above." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nThere is mild mucosal thickening in the left maxillary sinus. Mastoid air\ncells and middle ear cavities are well aerated. The bony calvarium is intact.\nA chronic left lamina papyracea deformity is noted.", + "output": "No acute intracranial process." + }, + { + "input": "Bone related artifacts limit evaluation of the brain stem.\n\nThere is a question nonspecific area of hypodensity in the left cerebellar\nhemisphere (2:7) without mass effect. There is no evidence of acute\nintracranial hemorrhage. The ventricles and sulci are normal in size and\nconfiguration. The basal cisterns appear patent. A fluid density structure is\nnoted posterior to the cerebellum to the right of midline with mild remodeling\nof the cerebellum, likely an arachnoid cyst.\n\nThe visualized bony structures are grossly unremarkable. There is mild mucosal\nthickening of the bilateral ethmoid air cells. Other visualized paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The globes are\nunremarkable.", + "output": "1. Questionable nonspecific area of hypodensity in the left cerebellar\nhemisphere without mass effect, versus artifact. MRI is suggested for better\nevaluation.\n2. No acute hemorrhage." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nModerate severe periventricular and deep white matter hypodense changes are\nnonspecific, but most likely sequela of microangiopathy. Please note that\nthis may obscure small acute infarcts. Allowing for this, there is no\nevidence of infarction or hemorrhage. Generalized cerebral atrophy. \nCalcified right globe. Small mucous retention cyst in the medial aspect of\nthe right maxillary sinus. Mastoid air cells are clear.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nare patent without marked stenosis, occlusion, or aneurysm formation. \nHypoplastic right A1 segment. The dural venous sinuses are patent.\n\nCTA NECK:\nMild calcific atherosclerotic changes at the proximal ICAs, but there is no\nstenosis according to NASCET criteria. The vertebral arteries are patent. \nModerate calcific atherosclerotic changes of the aortic arch and great\nvessels.\n\nOTHER:\nWell-circumscribed soft tissue nodule in relation to the thyrohyoid interval\nmeasuring 31 x 18 mm in the sagittal plane. Although this nodule measures 65\n___ (Native thyroid tissue measuring 112 ___ it is most likely of thyroid\norigin. It is unchanged compared to prior CT C spine done ___\nsuggesting that this is a benign lesion.\nModerate bilateral pleural effusions. The visualized portion of the thyroid\ngland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "Moderate severe white matter microangiopathic changes. Please note that this\nmay obscure small acute infarct and MRI may be performed if clinically\nindicated.\n\nNo hemorrhage.\n\nGeneralized cerebral atrophy.\n\nNo intracranial arterial aneurysm or occlusion.\n\nMild calcific atherosclerotic changes of the proximal ICAs, but there is no\nstenosis by NASCET criteria. The vertebral arteries are patent.\nModerate calcific atherosclerotic changes of the aortic arch and proximal\ngreat vessels.\n\nWell-circumscribed soft tissue nodule in relation to the thyrohyoid interval\nmeasuring 31 x 18 mm in the sagittal plane. This nodule is most likely of\nthyroid origin and unchanged compared to prior CT C spine done ___ suggesting that it is a benign lesion." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of hemorrhage or infarction. There are confluent white\nmatter hypodensities, which likely represent chronic microvascular ischemic\ndisease and may obscure small acute infarction.\n\nSmall mucous retention cyst present in the right maxillary sinus. The mastoid\nair cells are clear. Calcified right globe.\n\nCTA HEAD:\nCalcific atherosclerotic changes of the carotid siphons bilateral, but no\nmarked stenosis. The vessels of the circle of ___ and their principal\nintracranial branches appear normal with no evidence of stenosis, occlusion,\nor aneurysm. The dural venous sinuses are patent.", + "output": "Confluent fluid white matter hypodensities, which likely represent chronic\nmicrovascular ischemic disease. Please note that the white matter\nhypodensities may obscure small infarcts and MRI would be far more sensitive\nfor detecting small infarctions..\n\nNo evidence of hemorrhage.\n\nNormal CTA." + }, + { + "input": "Again seen is left thalamic hemorrhage extending into the lateral ventricles,\ngreater on the left than right, third ventricle and fourth ventricle, not\nsignificantly changed in appearance compared to same day earlier study.\n\nThere is no evidence of infarction,new hemorrhage,edema,or mass effect. There\nis no midline shift. The basal cisterns are patent.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Left thalamic hematoma with intraventricular extension, unchanged.\n2. No new hemorrhage." + }, + { + "input": "Redemonstrated left thalamic intraparenchymal hemorrhage with surrounding\nedema measures approximately 2.4 x 1.7 cm, stable from prior MRI and head CT\nfrom earlier today. Intraventricular extension with high-density blood\nthroughout the left lateral ventricle and occipital horn of the right lateral\nventricle, third ventricle, and fourth ventricle are again seen overall stable\nfrom prior examination. The ventricles are stable in size and configuration. \nNo new hemorrhage or infarct is identified. There is no midline shift. Basal\ncisterns are widely patent. No acute fracture is seen. Paranasal sinuses and\nmastoid air cells are clear. The orbits are unremarkable.", + "output": "Stable left thalamic intraparenchymal hemorrhage, surrounding edema, and\nintraventricular hemorrhage. No new hemorrhage or hydrocephalus." + }, + { + "input": "There is no evidence of acute infarctionhemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nPeriventricular white matter hypodensities are nonspecific but likely reflect\nsequela of chronic small vessel ischemic disease.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process. Of note, MRI would be more sensitive for\ndetection of acute ischemia." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,or\nmass effect. There is prominence of the ventricles and sulci consistent with\nage-related global atrophy, mildly progressed compared to ___. \nPeriventricular, subcortical, and deep white matter hypodensities are\nnonspecific, but likely reflect sequelae of chronic microvascular ischemic\ndisease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Prominence of ventricles and sulci consistent with age related global\natrophy has progressed since ___. White matter hypodensities, likely\nreflecting sequela of chronic microvascular ischemic disease." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. There is high-density skin thickening along\nthe occipital region which given the provided clinical history, likely\nreflects a hematoma. The paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The orbits are unremarkable.", + "output": "1. No acute intracranial abnormality. No calvarial fracture.\n\n2. High-density skin thickening along the occipital region, likely reflective\nof a hematoma." + }, + { + "input": "A right frontal approach Ommaya reservoir has been placed. The catheter\nterminates in the inferior left lateral ventricle frontal horn, just below the\nlevel of the caudate nucleus. Ventricular size is stable compared to the\nprevious MRI.\n\nHypoattenuation in the right temporoparietal lesion subjacent to the\ncraniotomy site is noted, consistent with the known treatment site in context\nof the underlying glioblastoma, the tumor itself is not assessed well on this\nunenhanced CT.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. Interval placement of right frontal approach Ommaya reservoir. The\ncatheter tip terminates in the inferior left lateral ventricle frontal horn,\njust below the level of the caudate nucleus.\n2. Postsurgical changes from right temporoparietal tumor resection, with the\nfindings related to tumor better assessed on previous brain MRI. No new\nmass-effect." + }, + { + "input": "Correlation was made with the GRE images of previous MRI study.\n\nThe previously seen shunt catheter in the right frontal region has been\nremoved. Pneumocephalus and air along the shunt tract are identified. No\nhemorrhage is seen.\n\nOtherwise, there is no change in right parieto-occipital hypodensity and\nvolume loss. Ventricles are slightly prominent as before. There is no\nhemorrhage.", + "output": "1. Status post remote of right frontal catheter. Pneumocephalus and air along\nthe tract with a small amount of air within the ventricles identified as\nexpected.\n2. No hemorrhage.\n3. Overall unchanged appearance compared to the previous MRI study." + }, + { + "input": "There is no evidence of fracture, acute infarction,or hemorrhage.\nPreviously seen pneumocephalus has resolved. Patient is status post prior\nright parietal craniotomy for underlying resection in the right temporal lobe.\nAdjacent white matter hypodensity with volume loss is also likely post\ntreatment related.\n\nEnhancing lesions seen on prior MRI are not clearly delineated by this CT. \nThere is however suggestion of a 1.8 cm masslike lesion in the anterior right\ntemporal lobe (2:13, 14 and 602:24). Ill-defined parenchyma more anteriorly\nin the right temporal lobe is also noted, this was in the area of previously\nseen enhancing lesion on prior MRI.\n\nMild soft tissue swelling overlying the right frontal bone in the region of\ncraniotomy. Redemonstration of changes following right-sided craniotomy. The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are normal.", + "output": "1. Suggestion of a masslike lesion in the anterior right temporal lobe which\nshould be further characterized by MRI.\n2. MRI would also be better for re-evaluation of previously seen enhancing\nlesions identified on prior MRI, not clearly delineated on the current exam.\n3. Redemonstration of changes following right-sided craniotomy. Resolved\npneumocephalus.\n\nNOTIFICATION: The updated findings were discussed with ___, M.D.\nby ___, M.D. on the telephone on ___ at 8:20 pm, 4 minutes\nafter discovery of the findings." + }, + { + "input": "Patient is status post right parietal craniotomy with postoperative changes\nrelated to resection in the right temporal lobe redemonstrated. No evidence\nfor intracranial hemorrhage, large territorial infarction or midline shift. \nHypodense area in the left frontal inferior region measuring approximately 2.0\ncm corresponds to known lesion with vasogenic edema is better characterized on\nprior MRI. Additional known enhancing lesions throughout the supratentorial\nand infratentorial brain are better visualized on prior MRI, with ill-defined\nareas of hypoattenuation in the right temporal lobe, left cerebellum, left\nthalamus and midbrain corresponding to these known lesions. Edema in the\ninferior right frontal lobe appears progressed compared to MR from ___. \nThere is unchanged mild dilatation of the ventricular system.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No evidence for acute intracranial hemorrhage or acute large territorial\ninfarct.\n2. Increased edema in the inferior right frontal lobe when compared to the\nprior MRI from ___.\n3. Additional hypodense areas within the left frontal lobe, left cerebellum,\nright temporal lobe, left thalamus and left midbrain correspond to known\nlesions, better evaluated on prior MRI." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, mass, mass effect or\nlarge territorial infarction. 0.9 cm pineal cyst, with coarse rim\ncalcifications and internal hyperdense layering fluid is unchanged compared to\nthe prior exam. There is no evidence of hydrocephalus. The ventricles and\nsulci are normal in size and configuration. The basilar cisterns are patent\nand there is otherwise good preservation gray-white matter differentiation.\n\nNo acute fractures identified. The visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The globes are unremarkable.", + "output": "No acute intracranial abnormality is identified. Unchanged 0.9 cm pineal cyst\nwith coarse rim calcifications." + }, + { + "input": "There is no evidence of infarction,intracranial hemorrhage,edema,or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Trace fluid is noted in the sphenoid sinus.\nOtherwise, the visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. Postoperative changes are seen in the left\norbit. The right orbit is unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "No evidence of acute major infarction, hemorrhage, edema, or large mass.\nBilateral, symmetric prominence of the ventricles sulci, including the\ntemporal horns is overall similar or perhaps slightly progressed since ___,\nconsistent with cortical atrophy, age-related. No shift of normally midline\nstructures. Chronic periventricular white matter hypodensities are overall\nunchanged and may represent sequelae of chronic small vessel ischemic disease.\nGray-white matter differentiation appears preserved.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Changes secondary to post-sella\nsurgery for pituitary lesion.", + "output": "1. No large territorial infarct or hemorrhage.\n2. Cortical atrophy, appears slightly progressed since ___.\n3. Changes suggestive of sequelae of chronic small vessel ischemic disease,\nsimilar the prior exam." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass. The ventricles and sulci are mildly enlarged suggesting age related\natrophy. Mild periventricular and subcortical white matter hypodensities are\nnonspecific but likely sequela of chronic small vessel disease. Expansion of\nthe sella is compatible with postoperative changes, as seen previously.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. There are cavernous carotid\ncalcifications bilaterally.", + "output": "No acute intracranial process." + }, + { + "input": "The known multiple small acute infarctions involving the left corona radiata,\ndemonstrated on the preceding MRI, are not well seen on the present CT. \nHypodensities in the present CT in the left corona radiata, as well as\nelsewhere in the periventricular, deep, and subcortical white matter of the\ncerebral hemispheres, correspond to chronic findings on the preceding MRI. \nChronic infarctions in the right lentiform and caudate nuclei are again noted.\nThere is no acute hemorrhage or edema. Age-related prominence of the\nventricles and sulci is again noted.\n\nNo suspicious bone lesion is. There is mild mucosal thickening in the ethmoid\nair cells and sphenoid sinuses, and minimal mucosal thickening in the\npartially visualized maxillary sinuses. Frontal sinuses are not pneumatized. \nMastoid air cells and middle ear cavities are well aerated. There is evidence\nof bilateral cataract surgery.", + "output": "1. The known small acute infarctions, demonstrated on the preceding MRI are\nnot well seen on the present CT.\n\n2. No acute hemorrhage or mass effect.\n\n3. Chronic infarctions in the right caudate and lentiform nucleus. \nSupratentorial white matter hypodensities, demonstrated to be chronic on the\npreceding MRI, nonspecific but likely sequela of chronic small vessel ischemic\ndisease in this age group." + }, + { + "input": "Again seen are subtle areas of hypodensity in the left corona radiata\ncorresponding to areas of acute infarct detected on the prior MRI, which is\nsuperimposed upon the background of chronic small vessel ischemic changes\nthroughout the supratentorial white matter. There is no evidence of acute\nhemorrhage. There is no mass effect. Chronic infarcts in the right caudate\nand lentiform nuclei, as well as the left lentiform nucleus, are unchanged. \nProminence of the ventricles and sulci due to age-related parenchymal volume\nloss is unchanged.\n\nNo suspicious bone lesion is seen. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Bilateral lens\nreplacements are noted.", + "output": "1. No significant change in the subacute infarcts within the left corona\nradiata, which is superimposed upon the background of chronic small vessel\nischemic changes throughout the supratentorial white matter. No mass effect\nor acute hemorrhage.\n2. Chronic infarcts at the right caudate and bilateral lentiform nuclei." + }, + { + "input": "Hypodensities along the left corona radiata and bilateral basal ganglia are\nconsistent with known chronic infarction. There is background periventricular\nsubcortical white matter hypodensities most likely represent chronic small\nvessel ischemic changes. There is no evidence of new large territorial\ninfarction,hemorrhage,edema, or mass effect. There is prominence of the\nventricles and sulci suggestive of involutional changes, unchanged. Bilateral\ncarotid siphon calcifications are noted.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Bilateral lens\nreplacement. Otherwise the orbits unremarkable.", + "output": "1. No acute intracranial abnormality on noncontrast CT head. Specifically no\nacute large territory infarct or intracranial hemorrhage. No intracranial\nmass effect.\n2. Sequela of chronic infarcts and small vessel ischemic disease are unchanged\nin appearance from examination of ___.\n3. Additional findings described above." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is a sequela of prior infarction in the right basal ganglia, unchanged. \nAdditional periventricular hypodensities are nonspecific but similar to prior\nand suggestive of chronic small vessel ischemic changes. Punctate focus of\ncalcification in the left basal ganglia.\nThere is no evidence of infarction,hemorrhage,edema,ormass.\n\nThe ventricles and sulci are age appropriate.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere are atherosclerotic changes along both cavernous ICAs. Mild-to-moderate\nnarrowing bilateral paraclinoid, supraclinoid ICA. There is a laterally\nprojected 3 mm aneurysm arising from the cavernous right internal carotid\nartery, unchanged (series 3, image 214). Additional 2 mm triangular\nirregularity of the left cavernous internal carotid artery may represent an\nadditional small aneurysm or infundibulum (series 3, image 210).\n\nMultifocal severe stenoses of the left M1 segment (series 3, image 225, 229),\nlikely due to noncalcified atherosclerotic plaque, progressed compared prior.\nThere appears to be abrupt cutoff of a left M2 branch (series 3, image 224),\nunchanged. Remaining distal MCA branches appear patent. Additional areas of\nmoderate narrowing bilateral M2, M3 segments, A2, A3 ACA segments, similar.\n\nThe vertebrobasilar junction is unremarkable.\nThe bilateral PCAs appear extremely diminutive and irregular, right greater\nthan left with several focal areas of severe stenoses. There is a short\nsegment of a right P3 branch that is not visualized, however the distal artery\nappears patent (series 3, image 233).\n\nThe dural venous sinuses are patent.\n\nCTA NECK:\nNormal 3 vessel takeoff. Moderate atherosclerotic calcifications of the\naortic arch and at the origin of the great vessels. Moderate narrowing at the\norigin of the vertebral arteries bilaterally due to atherosclerotic changes\n(series 3, image 62, 64).\n\nThere are atherosclerotic changes at both carotid bifurcations without ICA\nstenosis by NASCET criteria.\nUnchanged retropharyngeal course of the left ICA. Vessel wall irregularities\nof the mid to distal left ICA are again noted and is consistent with\nfibromuscular dysplasia.\nThe cervical course of both vertebral arteries and ICAs is otherwise\nunremarkable.\n\nOTHER:\nNo suspicious pulmonary nodules. The visualized portion of the thyroid gland\nis within normal limits. There is no lymphadenopathy by CT size criteria.", + "output": "1. No acute intracranial findings.\n2. Chronic infarct right basal ganglia.\n3. Severe chronic small vessel ischemic changes.\n4. Extensive intracranial atherosclerotic changes, areas of severe narrowing\nanterior, posterior circulation, mildly worsened at left M1.\n5. Unchanged 3 mm aneurysm arising from the right cavernous ICA.\n6. A 2 mm triangular irregularity along the left cavernous ICA may represent\nan additional small aneurysm versus infundibulum.\n7. Left high cervical ICA fibromuscular dysplasia.\n8. Moderate narrowing origin bilateral bilateral vertebral arteries, similar." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass.\n\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation.\nThe dural venous sinuses are patent.\n\nCT PERFUSION:\nLimited evaluation of the perfusion information due to small arterial contrast\npeak (series 301, image 9).\n\nCBF <30% volume: 0 mL\nTmax >6.0s volume: 17 mL with areas of abnormal perfusion predominantly in the\nleft gyrus rectus and left anterior temporal lobe, which are most likely\nartifactual.\nMismatch volume: 17 mL.\n\nCTA NECK:\nThere is some motion artifact along the cervical vasculature. However, the\ncarotidandvertebral arteries and their major branches appear normal with no\nevidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nNo suspicious pulmonary nodules. The visualized portion of the thyroid gland\nis within normal limits. There is no lymphadenopathy by CT size criteria. \nLimited evaluation of the cervical spine is limited due to patient motion\nmainly at C6-C7 level.", + "output": "1. No evidence of acute infarction, hemorrhage or intracranial mass.\n2. Limited evaluation of the perfusion information due to smaller ___\ncontrast peak. Increased T-max predominantly in the left gyrus rectus and\nleft anterior temporal lobe is most likely artifactual.\n3. Patent intracranial and cervical vasculature without evidence of\ndissection, stenosis, vessel occlusion or aneurysm formation greater than 3\nmm." + }, + { + "input": "There is no evidence of fracture, acute territorial\ninfarction,hemorrhage,edema,or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes.\n\nMild mucosal thickening within a right ethmoid air cell. The visualized\nportion of the remaining paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are normal. Mild\natherosclerotic calcifications of the cavernous carotid arteries.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are enlarged for the patient's age suggesting cerebral\natrophy. Mild cerebellar atrophy is also noted. The basal cisterns are\npatent and there is preservation of gray-white matter differentiation.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "A left frontoparietal predominately hypodense subdural collection is again\nseen, measuring up to 8 mm, grossly unchanged from prior study on ___, consistent with a known subacute to chronic is subdural hematoma. There\nis minimal mass effect without significant midline shift. Basal cisterns are\npatent.\n\nThere is no new intra-axial or extra-axial hemorrhage, edema, or evidence of\nacute major vascular territorial infarction. Ventricles and sulci are normal\nin overall size and configuration.\n\nNo fracture seen. The imaged paranasal sinuses are clear. Mastoid air cells\nand middle ear cavities are well aerated.", + "output": "Stable left frontoparietal subdural hematoma without significant midline\nshift.\n\nNo new hemorrhage or infarction." + }, + { + "input": "The left frontoparietal predominately iso to hypoattenuating subdural hematoma\nis grossly unchanged. There is no significant mass effect or new\nhyperattenuating components to suggest interval hemorrhage. There is no mass,\nmidline shift, or acute major vascular territorial infarct. Gray-white matter\ndifferentiation is preserved. Ventricles and sulci and unremarkable. Basilar\ncisterns are patent.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "Unchanged appearance of left frontoparietal subdural hematoma without evidence\nof interval hemorrhage since 3 days prior." + }, + { + "input": "Re-identified is a left frontal subdural hematoma measuring up to 1.1 cm in\ngreatest thickness, in appears to be smaller from prior examination, but\nincreased in size since examination of ___. The hematoma appears\npredominately hypo attenuating to the brain parenchyma compatible with\nsubacute hemorrhage. There is mild mass effect on the left frontal lobe\nwithout significant midline shift. No new hemorrhages are identified.\n\nThere is no acute territorial infarct. The sulci, ventricles and cisterns are\nunchanged from prior exam. The paranasal sinuses are clear. The orbits are\nunremarkable. The mastoid air cells are clear. No acute osseous abnormality.", + "output": "1. Re-identified is a left frontal sub acute subdural hematoma measuring up to\n1.1 cm in greatest thickness, which appears to be slightly smaller from prior\nexamination.\n2. No new hemorrhages. No acute territorial infarct." + }, + { + "input": "There is persistent prominence of the ventricles and sulci, consistent with\ninvolutional changes, more advanced than expected given patient age, grossly\nstable since the prior studies. Previously seen left frontal subdural\nhematoma has resolved in the interval. No acute intracranial hemorrhage is\nseen. There is no evidence of midline shift, new mass effect, or acute large\nvascular territorial infarct. Gray-white matter differentiation is preserved.\nThe visualized paranasal sinuses are clear. The mastoid air cells are clear. \nNo acute fracture is seen.", + "output": "No acute intracranial process. Previously seen left frontal subdural hematoma\nhas resolved in the interval. No acute intracranial hemorrhage." + }, + { + "input": "Patient is status post plating of the left inferior orbit. A comminuted\nfracture of the inferior orbital wall is partially visualized. The orbital\nfloor is intact without herniation of intraorbital contacts into the maxillary\nsinus. There is mixed density fluid within the maxillary sinus consistent\nwith recent surgery. No proptosis or intraorbital hematoma. Minimal air\nalong the orbit medially and laterally is consistent with recent surgery. The\nleft globe is appropriately shaped. The right orbit is normal.\n\nRedemonstration of a comminuted and minimally displaced fracture of the nasal\nbone bilaterally.\n\nMildly displaced fracture of the lamina papyracea along the left medial\norbital wall (series 3, image 125; series 6, image 59) with minimal inward\ndisplacement persists and is not substantially changed from prior study. The\ninferior wall plating partially covers the inferior aspect lamina papyracea.\n\nThe right maxillary, ethmoid and sphenoid air cells are appropriately aerated.\nThe visualized mastoid air cells and auditory canals are normal. The\nposterior left maxillary molar is cracked, as on the prior study (series 6,\nimage 61)\nThere is no evidence of abnormal fluid collections.\nThe visualized upper aerodigestive tract appears normal.\nThe mandible and temporomandibular joints appear normal.", + "output": "1. Status post surgical repair of the inferior orbital fracture. The inferior\norbital wall appears intact without inferior herniation. No retrobulbar\nhematoma or proptosis. Minimal postsurgical changes within the orbit as\nexpected post operatively. Air-fluid level containing blood in the left\nmaxillary sinus is likely postsurgical.\n2. Persistent minimally displaced fracture of the left-sided lamina papyracea\nnot substantially changed from the prior study.\n3. Minimally-displaced comminuted fracture of the nasal bone bilaterally." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. There is a punctate\ncalcification in the left sylvian fissure.\n\nThere is mild soft tissue swelling over the left lateral periorbital region\n(601b:29). There is no evidence of fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No fracture or acute intracranial process. Mild left lateral periorbital\nswelling without underlying fracture." + }, + { + "input": "Evaluation is moderately limited by motion. There is no gross evidence of\nacute large territory infarction, acute intracranial hemorrhage, edema, or\nmass effect. The ventricles and sulci are normal in size and configuration.\n\nNo acute fracture is identified. Mucosal thickening and mucous retention cyst\nnoted in the left maxillary sinus. The remaining paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. There is small left periorbital\nsoft tissue swelling/hematoma without acute fracture seen.", + "output": "Moderately limited by patient motion. Given this, no acute intracranial\nprocess.\n\nSmall left periorbital soft tissue swelling/hematoma." + }, + { + "input": "There is no evidence of acute large territory infarction,intracranial\nhemorrhage,edema,or mass. The ventricles and sulci are normal in size and\nconfiguration.\n\nNo calvarial fracture. An endotracheal tube is partially imaged. Secretions\nare present dependently in the posterior nasopharynx. The ethmoidal air cells\nand paranasal sinuses are clear. The middle ear cavities are clear. There is\nminimal opacification of few mastoid air cells.", + "output": "1. No acute intracranial process." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Hypodensity within the cerebellar\nvermis likely reflects patient's recent stroke. There is no associated\nhemorrhage. Ventricles and sulci are unremarkable besides cavum septum\npellucidum. Basilar cisterns are patent.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "Hypodensity in the cerebellar vermis compatible with patient's history. No\nevidence of hemorrhagic transformation or other acute intracranial process." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or\nintracranial mass-effect. There is prominence of the ventricles and sulci\nsuggestive of atrophy. Periventricular white-matter hypodensities are\nnonspecific, but likely represent sequela of chronic small vessel ischemic\ndisease.\n\nThe right maxillary sinus and ethmoid air cells are completely opacified with\nheterogeneously high-density material, which measures blood density. This\nmaterial protrudes through the medial right maxillary wall (04:16). There\ndoes not appear to be any direct extension into the adjacent right orbit.\n\nThere is a thick rim of material measuring simple fluid density along the\nright lateral calvarium, measuring up to 1.5 cm in thickness. This material\nextends to the right orbit (04:21).\n\nThere is no evidence of acute fracture. The mastoid air cellsand middle ear\ncavities are clear. The left orbit is unremarkable.\n\nA lipoma is noted over the left forehead.\n\nDiffuse periapical lucencies and dental caries identified, there is erosion of\nthe right maxillary labial alveolar ridge associated with ___ teeth number 7\nand 8.", + "output": "1. No acute intracranial abnormality on noncontrast head CT.\n2. Expansile hemorrhage-containing material completely opacifies the right\nmaxillary sinus and ethmoid air cells, and protrudes through the medial right\nmaxillary wall. Differential considerations include severe acute sinusitis\n(including fungal etiology). An underlying mass lesion cannot be excluded.\n3. Large thick rim of material tracking along the right lateral calvarium,\nmeasuring up to 1.5 cm in thickness, and extending to the right orbit. \nFindings are nonspecific, but may be related to patient's known varicella\nzoster infection.\n4. Additional findings as described above." + }, + { + "input": "Age related involutional changes are noted. There is no acute hemorrhage,\nedema, shift of normally midline structures, or evidence of acute major\nvascular territorial infarction. Ventricles are stably prominent. Mild\nperiventricular white matter hypodensity is most consistent with chronic small\nvessel disease. Basal cisterns are patent. Paranasal sinuses are well\naerated as are the mastoid air cells are cavities. Bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute large territorial infarction, intracranial\nhemorrhage, edema, or mass.\n\nThere is prominence of the ventricles and sulci suggestive of age-related\ncerebral volume loss. Periventricular and subcortical white matter\nhypodensities are nonspecific, though likely sequelae of chronic small vessel\nischemic disease. Atherosclerotic vascular calcifications are noted of\nbilateral vertebral and cavernous portions of internal carotid arteries.\n\nNo acute osseous abnormalities seen. The partially imaged paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The orbits demonstrate\nno acute abnormalities.", + "output": "No evidence of acute intracranial process. No evidence of intracranial\nhemorrhage or fracture." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction, mass or midline\nshift. There is no hydrocephalus. The ventricles and sulci are prominent\nconsistent with age-related involution. Visualized paranasal sinuses and\nmastoid air cells are clear. There is no fracture. Small left parietal\nsubgaleal hematoma.", + "output": "No acute intracranial process. Small left parietal subgaleal hematoma." + }, + { + "input": "There is no hemorrhage, edema, mass effect, midline shift, or mass. Mild\nprominence of the ventricles is indicative of atrophy, likely age related and\ninvolutional in nature. The basal cisterns are patent and there is normal\ngray-white matter differentiation. Subtle areas of low attenuation in the\nsubcortical white matter are nonspecific and may represent changes due to\nsmall vessel disease. Dense vascular atherosclerotic calcifications are\npresent in the carotid siphons and bilateral vertebral arteries.\nNo bony abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No significant intracranial abnormality. No evidence of fracture or scalp\nhematoma." + }, + { + "input": "The patient has a tracheostomy in satisfactory position. Gaseous distention\nis noted in the esophagus, but with no exophytic mucosal lesion. Artifact\nfrom dental hardware limits assessment at the level of the oropharynx.\nAlthough this study is limited by the absence of intravenous contrast, there\nis no evidence of a peritonsillar or retropharyngeal abscess. However, there\nis a 2.3 x 2.3 2.1 cm soft tissue-density lesion posterior to the left\nclavicle just above the subclavian vein (7:37). No lesion is appreciated in\nthis location on prior CT. There are no pathologically enlarged cervical\nlymph nodes by size criteria. The thyroid and major salivary glands are\nunremarkable.\n\nAllowing for helical acquisition, reconstruction however dome, and section\nthickness, the included portions of the brain are unremarkable. Pulmonary\nopacities and thoracic vertebral compression fractures are described in a\nseparate report .", + "output": "1. Limited study masses of intravenous contrast, but no evidence of\nretropharyngeal or peritonsillar abscess.\n2. 2.3 cm lesion posterior to the left clavicle. This could represent\nhemorrhage if a subclavian line was attempted. Consider further evaluation of\nthis finding on ultrasound.\n3. Pulmonary opacities and thoracic vertebral body compression deformities are\ndescribed in a separate report." + }, + { + "input": "There is no intra or extra-axial mass effect, acute hemorrhage or territorial\ninfarct. Sulci, ventricles and cisterns are within expected limits for the\npatient's age related global cerebral volume loss and stable. Prominent\natherosclerotic calcification of the cavernous internal carotid arteries and\nvertebral arteries. There are periventricular subcortical white matter\nhypodensities, also unchanged from prior exam and nonspecific, most commonly\nseen in setting of chronic microangiopathy in a patient of this age. The\nparanasal sinuses are clear. The orbits are unremarkable. The mastoid air\ncells middle ear cavities are well pneumatized and clear. No skull fractures.\nSurgical clips are seen in the bilateral pre-auricular regions.", + "output": "1. No evidence of intracranial hemorrhage. No acute territory infarct.\n2. No skull fractures." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is a of focal hypodensity in the right centrum semiovale extending into\nthe right basal ganglia, which corresponds to or prominent perivascular space\non prior MRI.\n\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is a 6 mm aneurysm in the distal segment of the left posterior cerebral\nartery seen on image 5:258. The vessels of the circle of ___ and their\nprincipal intracranial branches appear normal without stenosis, occlusion or\naneurysm formation. The dural venous sinuses are patent.\n\nThere is another 5 mm aneurysm in the left occipital lobe associated with a\ntangle of vessels as seen on image 5:252. There are prominent veins origin 18\nfrom the aneurysm draining into the left transverse sinus. This possibly is\nan arteriovenous malformation.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThere is a calcified granuloma in the left upper lobe on image 5:66. The\nremaining visualized portion of the lungs are clear. The visualized portion\nof the thyroid gland is within normal limits. There is no lymphadenopathy by\nCT size criteria.", + "output": "1. 6 mm aneurysm in the distal left posterior cerebral artery.\n2. 5 mm aneurysm in the left occipital lobe associated with a surrounding\ntangle of vessels, likely an arteriovenous malformation.\n3. Unremarkable CTA of the neck.\n4. No acute intracranial abnormality." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThe patient is status post embolization of a left occipital arteriovenous\nmalformation with subsequent midline occipital and suboccipital craniotomy for\nresection of the left occipital arteriovenous malformation. Multiple surgical\nclips and hyperdense embolization material are located within the left\noccipital postoperative bed.\n\nThe chronic lacunar infarction in the right basal ganglia and corona radiata\nis unchanged. There is no evidence of acute infarction, hemorrhage, edema, or\nmass. The ventricles are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe patient is status post embolization of a left occipital arteriovenous\nmalformation with subsequent midline occipital and suboccipital craniotomy for\nresection of a left occipital arteriovenous malformation. A 2 mm aneurysm of\nthe left distal posterior cerebral artery on 8:72 has decreased in size,\npreviously measuring 6 mm. There are no tangle of vessels in the\npostoperative bed of the left occipital lobe. A thin, linear filling defect\nwithin the left V3 segment on 08:14 is new from the prior examinations. The\nremainder of the vessels of the circle ___ are patent without evidence of\nstenosis or occlusion.", + "output": "1. Postsurgical changes status post resection of a left occipital\narteriovenous malformation with interval decrease in the size of a 2 mm\naneurysm of the left distal posterior cerebral artery.\n2. No new aneurysms.\n3. New, focal dissection of the left V3 segment. This appears to be a chronic\ndissection.\n4. No acute intracranial abnormality.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 16:19 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThe patient is status post embolization of a left occipital arteriovenous\nmalformation and occipital/suboccipital craniotomy for resection of a left\noccipital arteriovenous malformation. Re demonstrated are surgical hyperdense\nembolization material within the left occipital operative bed with surrounding\nencephalomalacia/gliosis. Chronic infarction within the right basal ganglia\nand corona radiata, is unchanged compared to the prior exam. There is no\nevidence of acute intracranial hemorrhage or acute major vascular territorial\ninfarction.\n\nThere is minimal mucosal thickening in the ethmoid air cells. Mastoid air\ncells and middle ear cavities are well aerated. The orbits appear\nunremarkable.\n\nCTA NECK:\nThere is a 3 vessel aortic arch. The common carotid and cervical internal\ncarotid arteries are patent without stenosis by NASCET criteria. Right\nvertebral artery is widely patent. There is a thin linear filling defect in\nthe V3 segment of the left vertebral artery, unchanged since ___ but\nnew compared to ___, consistent with dissection. V1 and V2\nsegments of the left vertebral artery are widely patent.\n\nCTA HEAD:\nV4 segments of bilateral vertebral arteries appear widely patent. The basilar\nartery appears widely patent. The right ___, right AICA, and left AICA/ ___\ncomplex are again seen. Bilateral superior cerebellar arteries and right\nposterior cerebral artery appear patent. Short-segment occlusion involving\nthe proximal P2 segment of the left posterior cerebral artery is new compared\nto ___ (5:261). A tiny 1 mm aneurysm of the distal left posterior\ncerebral artery, image 5:260, measured 2 mm on ___. There is no\ntangle of vessels within the postoperative bed of the left occipital lobe. No\nnew aneurysm is identified.\n\nThere is no evidence for flow-limiting stenosis or aneurysm in the anterior\ncirculation.\n\nDural venous sinuses appear patent.\n\nOTHER:\nThere are degenerative changes in the cervical spine. The visualized portion\nof the lungs are clear. The thyroid gland is unremarkable.", + "output": "1. Stable post treatment changes in the left occipital lobe status post AVM\nembolization and resection. No evidence for acute intracranial abnormalities.\n2. Dissection of the V3 segment of the left vertebral artery is unchanged\ncompared to ___ but new compared to ___.\n3. New short-segment occlusion of the proximal P2 segment of the left\nposterior cerebral artery compared to ___ with distal reconstitution.\n4. Decreased size of the distal left posterior cerebral artery aneurysm, now 1\nmm.\n\nNOTIFICATION: The findings were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 9:22 AM, 10 minutes after\ndiscovery of the findings." + }, + { + "input": "In the suprasellar cistern is a 1.0 x 2.2 x 1.5 cm slightly heterogeneous\nhyperdense focus with extension into the right ambient cistern consistent with\nacute hemorrhage. There is no appreciable mass effect. The ventricles and\nsulci are normal in size and configuration for the patient's age. There is no\nevidence of infarction, edema, or mass. The ventricles and sulci are normal in\nsize and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. Hyperdense collection consistent with acute hemorrhage in the suprasellar\ncistern, with extension into the right ambient cistern. No appreciable mass\neffect or evidence of hydrocephalus.\n2. Please note that MR is more sensitive in the detection of intracranial\nmasses.\nNOTE ON ATTENDING REVIEW:\n\nThe above mentioned slightly heterogeneous hyperdense focus, in the\nsuprasellar location predominantly in the hypothalamus, with extension towards\nthe right side, can represent a mass lesion (primary or metastatic) with\nheterogeneous cellular component or some hemorrhage within or cyst with dense\ncontents rather than pure hemorrhage itself.\nThe optic chiasm is not well seen on the present study with likely mass effect\nby the focus.\nCorrelate with ophthalmologic examination.\nThere is displacement of the adjacent vessels, better seen on the subsequent\nCT angiogram study.\nFurther workup with MRI of the head without and with IV contrast if not\ncontraindicated and further systemic workup as needed.\nD/w ___ by Dr. ___ phone ___ at 7.30pm." + }, + { + "input": "Head CTA: There are no intracranial vascular abnormalities. There is no\nevidence of aneurysm, stenosis or occlusion.", + "output": "Unremarkable CTA of head without evidence of aneurysm, malformation, or\nocclusion." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is mild left periorbital soft tissue swelling. There is no evidence of\nfracture. There is mild mucosal thickening in the right sphenoid sinus and\nethmoid air cells. The visualized portion of the remainder of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Mild left periorbital soft tissue swelling, with no underlying fracture.\n2. No acute intracranial process.\n3. Paranasal sinus disease as described." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes\nwhich has slightly progressed since ___ and most consistent with age-related\nchanges. No evidence of transependymal flow.\n\nThere is no evidence of fracture. Minimal mucosal thickening of the right\nfrontal sinus noted. The additional visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial process. Specifically, no intracranial hemorrhage.\n2. Mild progression of ventricular and sulcal prominence is most consistent\nwith age-related changes." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes and\nunchanged since ___.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "1. No acute intracranial process." + }, + { + "input": "There is a moderate amount of soft tissue swelling overlying the frontal bone\nextending to the left periorbital region and to the bridge of the nose. There\nare multiple foci of subcutaneous air overlying the nose, compatible with a\nsmall skin laceration. Bilateral nasal bone fractures are visualized. There\nis also a displaced fracture of the bony nasal septum. No other fractures are\nseen. Partial opacification of the nasopharynx with aerosolized secretions.\n\nThere is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. Moderate predominantly periventricular white matter hypodensities are\nnonspecific, but likely represent the sequela of chronic microvascular\nischemia. There is prominence of the ventricles out of proportion to the\nsulci, not significantly changed compared to ___.\n\nSmall amount of aerosolized secretions within the right sphenoid sinus. \nOtherwise, the visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The patient is status post bilateral lens\nresections. Bilateral senile scleral calcifications are identified.", + "output": "1. Bilateral nasal bone fractures. Displaced fracture of the bony nasal\nseptum. Moderate overlying soft tissue swelling/laceration extending to the\nleft periorbital region.\n2. No evidence of calvarial fracture or intracranial hemorrhage." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Mild ventricular prominence is unchanged. Periventricular white\nmatter hypodensities most compatible chronic microvascular ischemic disease. \nOrbits are unremarkable bilaterally. Imaged paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. Minimal calcifications involve the\ncarotid siphons bilaterally. The bony calvarium appears intact.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Diffuse sulcal prominence is consistent with age advanced\ninvolutional change.. Mild mucosal thickening is noted within the bilateral\nmaxillary and left sphenoid sinus, otherwise the imaged paranasal sinuses are\nwell aerated. Mastoid air cells and middle ear cavities are well aerated. The\nbony calvarium is intact.", + "output": "No acute sequelae of trauma. Age advanced involutional changes." + }, + { + "input": "CT head shows no evidence of hemorrhage, or loss of gray-white matter\ndifferentiation. No midline shift or hydrocephalus seen.\n\nCT angiography of the neck shows normal appearance of the carotid and\nvertebral arteries without stenosis or occlusion or dissection. A small\nprotuberance of the posterior aspect of the right vertebral artery at C1 level\n(3:199) appears to be due to origin of a vascular structure which is confirmed\non the maximum intensity projection images.\n\nCT angiography of the head shows normal appearance of the arteries of the\nanterior and posterior circulation without stenosis or occlusion or aneurysm\ngreater than 3 mm in size. There is a hypoplastic A1 segment of the left\nanterior cerebral artery, a normal variation.", + "output": "No significant abnormalities on CT of the head without contrast. No\nsignificant abnormalities on CT angiography of the head and neck." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nThere is mild mucosal thickening in the bilateral ethmoid air cells and a\nmucous retention cyst in the left sphenoid sinus. Mastoid air cells and\nmiddle ear cavities are well aerated. The bony calvarium is intact. Note is\nmade of scleral calcification along the posterior margins of the left globe,\nunchanged from examination of ___.", + "output": "1. No acute intracranial contrast head CT.\n2. Chronic left globe posterior scleral calcification." + }, + { + "input": "Head CT: Loss of gray-white matter differentiation is again noted in the\nright frontal, parietal, and temporal lobes in the right MCA territory\nconsistent with known acute infarct. A dense MCA sign is noted. There is no\nevidence of hemorrhagic transformation. The ventricles and sulci are stable in\nsize and configuration. There is no shift of midline. There is no extra-axial\ncollection. The orbits are unremarkable. There is no evidence of fracture.\nThere is mucosal thickening in the ethmoid air cells and maxillary sinuses\nwith aerosolized secretions also noted in the right maxillary sinus. A\nsuperimposed right maxillary sinus mucous retention cyst is noted. The mastoid\nair cells are clear.\n\nHead CTA: There is abrupt occlusion of the M1 segment of the right MCA. The\nleft MCA, PCAs, and posterior circulation are within normal limits without\nfurther stenosis, aneurysm, or vascular malformation.\n\nNeck CTA: There is mild arthrosclerotic calcification of the aortic arch.\nThere is a normal three-vessel takeoff from the aortic arch. The carotid and\nvertebral arteries and their major branches are patent with no evidence of\nstenoses. There is no evidence of internal carotid stenosis by NASCET\ncriteria. The vertebral artery is dominant.\n\nAn endotracheal tube and nasogastric tube are noted. Prominent bilateral\ncervical lymph nodes are noted. The salivary glands are normal in appearance.\nThe thyroid gland enhances normally. There are degenerative changes noted in\nthe cervical spine. Left greater than right pleural parenchymal apical\nscarring is noted. There are also bibasilar opacities node in lung fields\nwhich may represent atelectasis versus aspiration. There are prominent\nmediastinal lymph nodes noted which may be reactive.", + "output": "1. No significant interval change in right frontal, parietal, and temporal\nlobe MCA territory infarction. A dense MCA sign is noted. No evidence of\nhemorrhagic transformation.\n\n2. Abrupt occlusion of the M1 segment of the right MCA.\n\n3. Unremarkable CTA of the neck without evidence of internal carotid stenosis\nby NASCET criteria." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nAgain demonstrated is an intraparenchymal hemorrhage within the left side of\nthe cerebellum, measuring 3.7 x 1.2 cm in the coronal plane (series 601; image\n78), unchanged compared to prior examination from 3 hours prior. \nAdditionally, there is density along the tentorium cerebelli, unchanged. In\nthe superior aspect of the left side of the cerebellum, there is some\nsuggestion of possible small subarachnoid component. Question grossly stable\nminimal mass-effect on fourth ventricle without definite fourth ventricular\ncollapse. Subtle hypodensities in the left basal ganglia are suggestive of\nprior lacunar infarcts and/or microangiopathic changes. There is no\nsuggestion of large territorial acute infarction. Ventricles and sulci are\nstable without definite evidence of ventriculomegaly\n\nAgain seen is an linear, nondisplaced fracture along the left aspect of the\noccipital bone, with extension to the level of the lateral mass of C1. \nFracture line does not extend across major vascular territory. Overlying\nbilateral occipital scalp soft tissue swelling and subgaleal hematoma is again\nnoted. The right paranasal sinus demonstrates mucosal thickening with areas\nof high density. Left maxillary sinus mucosal thickening is present.\n\n The visualized portion of the mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are preserved.", + "output": "1. Dental amalgam streak artifact limits study.\n2. Stable left cerebellum intraparenchymal hemorrhage.\n3. Stable tentorium cerebelli layering subdural and small subarachnoid\nhemorrhage.\n4. Stable ventricles with no definite evidence of ventriculomegaly.\n5. Stable nondisplaced left occipital bone fracture.\n6. Evolving bilateral occipital scalp soft tissue swelling and subgaleal\nhematoma.\n7. Question grossly stable minimal mass effect on fourth ventricle, without\ndefinite evidence of fourth ventricular collapse or ventriculomegaly.\n8. Paranasal sinus disease with questioned blood products versus chronic\nand/or fungal sinusitis within right maxillary sinus, as described. If\nconcern for occult maxillofacial fracture, consider dedicated maxillofacial CT\nfor further evaluation." + }, + { + "input": "Dental amalgam streak artifact limits study.\nPatient is status post suboccipital craniotomy with evacuation of left\ncerebellar intracranial hemorrhage and placement of drain with expected\npostoperative pneumocephalus. In the region of previously seen hematoma,\nthere is minimal residual hyperdensity. There is postoperative air and edema\nwith minimal decrease in mass effect compared to prior. Ventricular size has\nslightly decreased compared to prior. There is persistent subdural hematoma\nlayering on the tentorium. There is stable hypodensity in the left basal\nganglia, suggestive of prior lacunar infarct.\n\nQuestion new left frontal punctate blood products vs artifact (see ___.\n\nThere is no evidence of fracture. Again seen is mucosal thickening of the\nright maxillary sinus and bilateral anterior ethmoid air cells as well as the\nfrontal sinuses. Again, minimal hyperdensity is noted within the right\nmaxillary sinus mucosal thickening. The visualized portion of the remaining\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are preserved.", + "output": "1. Dental amalgam streak artifact limits study.\n2. Postoperative changes related to interval suboccipital craniotomy, left\ncerebellar hemorrhage evacuation and drain placement.\n3. Interval decrease in mass effect with minimal decrease in ventricular size.\n4. Grossly stable tentorium layering subdural hematoma.\n5. Question new left frontal punctate blood products vs artifact. Recommend\nattention on follow up imaging.\n6. Grossly stable paranasal sinus findings as described, with right maxillary\nsinus mucosal thickening hyperdensity which may represent, which may represent\nblood products and/or chronic or fungal sinusitis.\n\nRECOMMENDATION(S): Question new left frontal punctate blood products vs\nartifact. Recommend attention on follow up imaging." + }, + { + "input": "Status post left suboccipital craniotomy with grossly stable postsurgical\nchanges except for slight interval decrease in associated pneumocephalus. \nLeft cerebellar drain is not fully imaged, but in unchanged position\napproximately. Subdural hematoma along the tentorium is less conspicuous\ncompared to the prior exam. Small additional focus of subarachnoid or\nsubdural hemorrhage along the left temporal lobe is also slightly less\nconspicuous compared to prior (03:13). There is no evidence of new\nhemorrhage. Size of the ventricles and sulci is unchanged, and mildly\nprominent likely related to age-related involutional changes. Chronic left\nbasal ganglia lacunar infarct is noted.\n\nNo osseous abnormalities seen. There is almost complete opacification of the\nright maxillary sinus and moderate mucosal thickening of the left maxillary\nsinus. There is almost complete opacification of the right frontal sinus and\nmucosal thickening of the ethmoidal air cells. Mastoid ascites and middle ear\ncavities are clear. Orbits are unremarkable.", + "output": "1. Stable postsurgical changes status post left suboccipital craniotomy. Less\nconspicuous appearance of subdural hematoma along the tentorium. No evidence\nof new hemorrhage.\n2. Unchanged, significant paranasal sinus disease as described above." + }, + { + "input": "Status post left suboccipital craniotomy. No new hemorrhage or large\nterritorial infarction. Interval removal of a left cerebellar drain. Evolving\npostoperative changes with interval decrease in surgical site pneumocephalus. \nA tentorial subdural hematoma is less conspicuous compared to prior.\nAdditional hyperdense foci representing either subarachnoid or subdural\nhemorrhage near the left temporal lobe are unchanged from prior. Chronic left\nbasal ganglia infarct is unchanged.\n\nThere is no evidence of acute fracture. The right maxillary sinus is\nthickened in nearly completely opacified. There is moderate thickening of the\nbilateral ethmoid air cells. The bilateral mastoid air cells are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Evolving postsurgical changes after a left suboccipital craniotomy for\nhemorrhage evacuation with interval removal of a left cerebellar drain. No\nevidence of new bleeding or large territorial infarction.\n2. Tentorial subdural hematoma is less conspicuous than on prior.\n3. hyperdense foci near the left temporal lobe are unchanged, representing\neither subarachnoid or subdural hematoma." + }, + { + "input": "Left posterior fossa craniectomy is identified. Hypodensities secondary to\nencephalomalacia is seen but no acute blood products are seen. Previously\nnoted subtle blood products on MRI are not apparent. Hypodensities in the\nwhite matter predominantly on the left are again seen. There is no\nhydrocephalus or midline shift.", + "output": "1. Resolution of previously seen immediate postoperative changes in the left\nposterior fossa.\n2. Hypodensity in the left cerebellum likely due to encephalomalacia.\n3. No acute hemorrhage." + }, + { + "input": "The patient is status post left suboccipital craniectomy. There is no acute\nhemorrhage. Focal hypodensity in the posterior inferior left cerebellar\nhemisphere adjacent to the craniectomy is better defined than on ___,\nindicating expected evolution of parenchymal loss related to the prior\nhemorrhage and surgery. There is a persistent hypodense extra-axial fluid\nlateral to the left cerebellum. There is also a 3.0 x 2.7 cm fluid collection\nin the suboccipital soft tissues overlying the craniectomy, which is better\ndefined and more homogeneous compared to ___, though only minimally\nincreased in size.\n\nThe ventricles are stable in size. Small periventricular and deep white\nmatter hypodensities are nonspecific but likely sequela of chronic small\nvessel ischemic disease in this age group. Oval hypodense lesion along the\nposterior inferior left putamen on image 2:11 corresponds to a prominent\nVirchow ___ space on the prior MRI.\n\nThere is persistent moderate mucosal thickening in the partially visualized\nright maxillary sinus with interim resolution of superimposed fluid. Mastoid\nair cells appear grossly well-aerated allowing for absence of dedicated bone\nalgorithm images.", + "output": "1. Status post left suboccipital craniectomy. 3.0 x 2.7 cm fluid collection\nin the overlying suboccipital soft tissues is better defined and more\nhomogeneous compared to ___, the only minimally increased in size. A\npseudomeningocele cannot be excluded.\n2. Stable hypodense extra-axial fluid lateral to the left cerebellum.\n3. Expected evolution of small focal hypodensity in the posterior inferior\nleft cerebellar hemisphere, consistent with parenchymal loss related to the\nprior hemorrhage in surgery.\n4. No acute hemorrhage.\n5. Right maxillary sinus disease." + }, + { + "input": "Patient is status post left suboccipital craniectomy with a punctate focus of\nhyperdensity in the posterior left inferior cerebellar hemisphere measuring up\nto 5 mm is suspicious for acute hemorrhage (2:4). A 3.2 x 2.3 cm\nheterogeneous fluid collection in the suboccipital soft tissues overlying the\ncraniectomy does not appear substantially changed in size compared to\n___ (2:1).\n\nOtherwise, there is no evidence of large territory infarction, hemorrhage,\nedema, or mass. Small periventricular and deep white matter hypodensities are\nnonspecific but likely reflect the sequelae of chronic small vessel ischemic\ndisease. The ventricles are stable in size.\n\nA subgaleal hematoma measures 2.9 x 1.1 cm at the posterior vertex (___). \nNo other evidence of acute fracture. There is near complete opacification of\nthe right maxillary sinus. The mastoid air cells and middle ear cavities are\nclear. The visualized portions of the orbits are unremarkable.", + "output": "1. Status post left occipital craniectomy with new 5 mm focus of hyperdensity\nin the posterior inferior cerebellar hemisphere suspicious for contained acute\nhemorrhage or chronic blood products from prior hemorrhage. This may be\nre-evaluated with short-term CT head follow-up.\n2. Subgaleal hematoma measures up to 2.9 cm at the posterior vertex." + }, + { + "input": "The patient is status post left suboccipital craniectomy for decompression,\nunchanged from prior examination. A left parasagittal occipital fracture is\nunchanged. No new osseous fractures are identified.\n\nInterval resolution of previously described posterior inferior cerebellar\nhemisphere hemorrhage. No acute hemorrhage. Left inferior cerebellar\nencephalomalacia is expected. There is no evidence of acute large territory\ninfarct. Allowing for postsurgical and posttraumatic findings, the sulci,\nventricles and cisterns are within expected limits for the degree of mild\nsenescent related global cerebral volume loss. Periventricular and\nsubcortical white matter hypodensities are nonspecific, but compatible with\nchronic microangiopathy in a patient of this age.\n\nA residual 3.4 cm fluid collection inferior to the craniotomy site is similar\nin size to prior exam.\n\nThere is apparent right maxillary sinus atelectasis with mucosal thickening\nand sclerosis of the walls compatible with chronic sinusitis. The remainder\nthe visualized paranasal sinuses are essentially clear. The mastoid air cells\nmiddle ears well pneumatized and clear. The orbits are unremarkable noting\nbilateral lens replacements.", + "output": "1. No evidence of new intracranial hemorrhage. No acute large territory\ninfarct or intracranial mass effect.\n2. Resolution of previously seen left inferior cerebellar hemorrhage.\n3. Re-identified is left occipital skull fracture. No new fractures.\n4. Unchanged size of a subcutaneous fluid collection inferior to the\ncraniotomy, which may represent a pseudomeningocele versus seroma.\n5. Additional findings as described above." + }, + { + "input": "Postoperative changes of left-sided suboccipital craniectomy are again noted. \nUnderlying encephalomalacia is similar as well as prominent extra-axial CSF\ndensity overlying the left cerebellar hemisphere. Scattered periventricular\nand subcortical white matter hypodensities are nonspecific though commonly due\nto chronic small vessel disease. There is no intracranial hemorrhage, mass\neffect, or midline shift. Ventricles and sulci are stable in configuration. \nDense atherosclerotic calcifications noted within the intracranial ICAs and\nvertebral arteries.\n\nSinus disease is noted with mucosal thickening throughout the maxillary\nsinuses, sphenoid sinuses, ethmoid air cells and frontal sinuses. \nHigh-density material centrally within the right maxillary sinus could be due\nto inspissated secretions though fungal superinfection would be possible. \nRight posterior parietal scalp swelling is noted without underlying acute\nfracture. Chronic nondisplaced left parieto-occipital calvarial fracture is\nagain noted. The skull and extracranial soft tissues are otherwise\nunremarkable.", + "output": "No acute intracranial process.\nRight posterior parietal scalp swelling without underlying acute fracture.\nPostoperative changes and chronic nondisplaced left calvarial fracture.\nSinus disease." + }, + { + "input": "There is no acute intracranial hemorrhage, acute infarction, mass or midline\nshift. The ventricles and sulci are enlarged for the patient's age consistent\nwith atrophy. There is partial opacification of the right mastoid air cells,\nthe visualized paranasal sinuses are clear. There is no fracture.", + "output": "No acute intracranial process.\n\nVentricles and sulci are enlarged for the patient's age consistent with\natrophy." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is a left parietal and temporal lobe hematoma, measuring 7.6 x 3.3 cm,\nwhich is unchanged from the recent outside CT head. There is surrounding\nhypodensity and cerebral edema, with 4 mm rightward midline shift, similar to\nthe prior study, with suggestion of a left sided uncal herniation (03:13). \nThere is no evidence of new hemorrhage or infarction. There is mucosal\nthickening of bilateral ethmoid, maxillary, and sphenoid sinuses with a left\nmaxillary mucosal retention cyst. There is diffuse osteopenia. The bilateral\nmastoid air cells appear clear.\n\nCTA HEAD:\nThere is no evidence of vascular malformation or aneurysm formation. The\nvisualized principal intracranial branches, including the circle of ___\nappear patent without stenosis or occlusion. There is fetal continuation of\nthe right posterior cerebral artery. The visualized dural venous sinuses\nappear patent.\n\nCTA NECK:\nThere is mild calcified and noncalcified plaque at the carotid bifurcations,\nwithout internal carotid artery stenosis by NASCET criteria. There is mild\nmass effect of the left V1 segment by uncovertebral joint hypertrophy (5:124).\nThere is no evidence of significant stenosis, occlusion, or dissection.\n\nOTHER:\nMotion artifact limits evaluation of the lung apices. There is no definite\nfocal abnormality within the lung apices. There are subcentimeter lymph nodes\nwithout lymphadenopathy per size criteria. Streak artifact related to dental\namalgam limits evaluation of adjacent structures. The thyroid gland appears\nunremarkable. There are multilevel degenerative changes of the cervical\nspine.", + "output": "1. Left parietal and temporal lobe hematoma, with surrounding hypodensity and\ncerebral edema, and 4 mm rightward midline shift, similar to the recent\noutside head CT with left-sided uncal herniation.\n2. No evidence of vascular malformation. No stenosis, occlusion, or aneurysm\nformation.\n3. Paranasal sinus disease, as above." + }, + { + "input": "There is a large acute left temporal and parietal lobe hematoma with\nsurrounding edema, which is unchanged in size, measuring 6.6 x 3.5 cm in\nmaximum axial ___ on today's examination. There is no evidence of new\nhemorrhage.\n\nPersistent complete effacement of the occipital horn of the left lateral\nventricle. Effacement of the left frontal horn may have slightly progressed. \nPersistent asymmetric dilatation of the left temporal horn. Left-to-right\nmidline shift has also increased, currently measuring 6 mm, previously\nmeasuring 4 mm. The medial left temporal lobe is again seen displaced into\nthe cistern but without evidence of transtentorial herniation. This is\nunchanged. There is no evidence of infarction.\n\nThere is no evidence of fracture. Mild mucosal thickening involving the\nbilateral ethmoid, sphenoid, and left maxillary sinuses. Otherwise, the\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Unchanged acute left temporal and parietal lobe hematoma with surrounding\nedema measuring up to 6.6 cm. No evidence of new hemorrhage.\n2. Increasing left-to-right midline shift, currently measuring 6 mm.\n3. Unchanged complete effacement of the left occipital horn with asymmetric\ndilatation of the left temporal horn. Effacement of the left frontal horn may\nhave slightly progressed.\n4. Unchanged medial displacement of the left uncus without transtentorial\nherniation." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect. No evidence of pharyngeal or retropharyngeal abscess or\nfluid collection. There is no prevertebral soft tissue swelling.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. The neck vessels are patent.\n\nMotion artifact limits evaluation of the lung apices, but no gross\nabnormalities are detected. There are no osseous lesions. Mild degenerative\nchanges are seen in the cervical spine.", + "output": "No evidence of pharyngeal or retropharyngeal abscess or fluid collection." + }, + { + "input": "The intraparenchymal hemorrhage involving the left parietal and temporal\nlobes, previously measuring 6.6 x 3.5 cm, has decreased in density and size,\nnow measuring 5.1 x 2.5 cm. There has been interval mild decrease in\nattenuation. Edema surrounding hematoma has mildly improved. Extensive\nlow-attenuation change surrounding hematoma persists, extending into left\ncorona radiata, posterior limb left internal capsule, posterior left external\ncapsule, posterior sub insula and left operculum, anterior temporal lobe. \nContinued follow-up recommended to exclude complete resolution of above\nfindings and exclude underlying neoplasm.\n\nLocal mass effect has improved. Sulcal effacement has improved. 5 mm midline\nshift to the right has improved, previously 6 mm. The previously completely\neffaced occipital horn of the left lateral ventricle has improved. \nEffacement of the frontal horn of the left lateral ventricle has also\nimproved. Asymmetric dilatation of the temporal horn of the left lateral\nventricle is less prominent. The remainder of the ventricular system is\nclear.\n\nThere is no evidence of fracture. There are few submucosal retention cysts in\nthe maxillary sinuses. Otherwise, the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Interval mild improvement of left temporal, parietal lobe intraparenchymal\nhematoma, decreased surrounding edema, left hemispheric mass effect. \nSignificant low-attenuation change remains about hematoma. Continued\nfollow-up recommended to document complete resolution of the findings and\nexclude underlying neoplasm." + }, + { + "input": "Compared to the most recent study from ___, there has been interval\nresolution in the left parietal temporal intraparenchymal hemorrhage. There\nis no new hemorrhage identified. There is now hypodensity involving the left\ntemporal parietal region extending to the cortex which likely reflect evolving\ninfarct. There is no new large vascular territorial infarction, shift of\nnormally midline structures, or mass effect. The ventricles and sulci are\nstable in size and configuration.\n\nThere is no evidence of fracture. There is mild mucosal thickening in the\nleft maxillary sinus. The remaining visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Interval resolution of left temporal parietal intraparenchymal hemorrhage. \nResidual hypodensity in this area likely corresponds to evolving infarct. No\nnew hemorrhage." + }, + { + "input": "Study is mildly degraded by motion. There is no evidence of acute\nintracranial infarction,hemorrhage,edema,or mass-effect. There is prominence\nof the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. No fracture." + }, + { + "input": "Some patient motion degrades the inferior most images. There is no evidence\nof acute intracranial hemorrhage, midline shift, mass effect, or acute large\nvascular territorial infarct. Prominence of the ventricles and sulci is\nconsistent with atrophy. Periventricular and subcortical white matter\nhypodensities are likely sequelae of chronic small vessel disease. The\nvisualized paranasal sinuses are clear. There is opacification of the right\ngreater than left bilateral mastoid air cells without acute fracture seen. \nCorrelate with inflammatory/infectious process. There is a left frontal scalp\nhematoma.", + "output": "No acute intracranial process. Left frontal scalp hematoma without fracture\nseen.\n\nOpacification of the bilateral, right greater than left, mastoid air cells\nwithout fracture seen. Correlate with possible inflammatory or infectious\nprocess." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThere is a large soft tissue hematoma overlying the left frontal bone. There\nis no evidence of fracture. There is mild mucosal thickening in in the\nbilateral maxillary sinuses, ethmoid air cells and sphenoid sinus. There are\nsmall mucous retention cysts in the bilateral maxillary sinuses. The mastoid\nair cells and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "No acute intracranial process. Large soft tissue hematoma overlying the left\nfrontal bone." + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass.The ventricles and sulci are normal in size for the patient's age. \nConfluent subcortical and periventricular white matter hypodensities are\nnonspecific but likely sequela of chronic small vessel disease. A focal area\nof hypodensity in the right putaminal likely represents a chronic lacune\nversus dilated perivascular space.\n\nThere is no evidence of fracture. A left ocular prosthesis is noted. There\nis mild mucosal thickening in the right maxillary sinus and ethmoid air cells.\nParanasal sinuses are otherwise clear.", + "output": "No acute intracranial process." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. There are scattered periventricular\nand subcortical white matter hypodensities, likely sequela of chronic small\nvessel disease. Ventricles and sulci are age-appropriate.\n\nIncluded paranasal sinuses and mastoids are essentially clear. Skull and\nextracranial soft tissues are unremarkable. Left globe prosthesis is noted.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST: There is no hemorrhage, edema, mass, mass effect,\nor large territorial infarction. The ventricles sulci are age appropriate.\nPeriventricular white matter changes are compatible with chronic small vessel\ndisease. The basal cisterns are patent. The imaged paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. No fracture is identified.\n\nCTA HEAD: An anteriorly directed anterior communicating artery aneurysm\nmeasuring 9 x 7 mm is re-identified and not significantly changed compared\nwith prior CTA from ___ although comparison is limited as no 3D\nreconstruction images are available from that study. At the left\nposterolateral aspect of the larger aneurysmal sac there is a left lateral\ndirected smaller outpouching measuring 2 mm (series 11, image 76) which is\nalso unchanged in appearance compared with prior exam.\n\nNo other aneurysm is identified. The vertebral and basilar arteries are\nunremarkable, without stenosis, dissection or aneurysm. The petrosal and\nsupraclinoid portions of the ICA's are unremarkable, with minimal\natherosclerotic calcifications at the siphons but no stenosis or aneurysm. \nThere is a right fetal PCA, a common anatomic variant. The dural venous\nsinuses are patent.", + "output": "1. Anterior communicating artery aneurysm measuring 9 x 7 mm is unchanged in\nsize or configuration compared to prior CTA from ___ allowing for\nlimitations of the prior study for which no 3D reconstruction are available. \nA 2 mm outpouching originating from the left aspect of the base of the larger\nsac is also unchanged.\n\n2. Otherwise unremarkable head CTA. A right fetal PCA is a common anatomic\nvariant.\n\n3. No evidence of infarction or mass." + }, + { + "input": "Patient is status post recent anterior communicating artery aneurysm clipping.\nA right frontal approach craniotomy is identified with pneumocephalus along\nthe bilateral frontal convexities, right greater than left. A clip is\nidentified in the region of the anterior communicating artery with an adjacent\n1.2 x 2.2 cm hypodensity within the right frontal lobe. When compared to prior\nstudy dated ___, ventricles and sulci appear similar in size and\nconfiguration. There is no shift of normally midline structures. Basal\ncisterns are patent. There is preservation of gray-white matter\ndifferentiation. No acute hemorrhage, edema, or large territorial infarction\nis detected.", + "output": "Status post anterior communicating artery aneurysm clipping with expected\npostoperative changes. No new hemorrhage or mass effect. 1.2 x 2.2 cm\nhypodensity to the right of the aneurysm clip within the frontal lobe noted. \nThis may be related to ischemia or postoperative change." + }, + { + "input": "Patient is status post anterior communicating artery aneurysm clipping. A\nright frontal approach craniotomy is identified with expected pneumocephalus\nalong bilateral frontal convexities. Adjacent to the anterior communicating\nartery within the right frontal lobe, there is an evolving infarction. No\nevidence of new hemorrhage. The basal cisterns are patent. Ventricles and\nsulci are stable in size and configuration. Previously seen subcortical\nscattered white matter hypodensities likely sequela of chronic small vessel\nischemic disease. Gray-white matter differentiation appears preserved. There\nis no shift of normally midline structures.\n\nEthmoidal cell mucosal thickening is noted. Remainder of the visualized\nparanasal sinuses, mastoid air cells and middle ear cavities are clear.", + "output": "Status post recent anterior communicating artery aneurysm clipping with no new\nhemorrhage or mass effect. Evolving infarction adjacent to the clip." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are prominent in size and configuration consistent atrophy, greater\nthan expected for age. Nonspecific periventricular subcortical white matter\nhypodensities suggest chronic small vessel ischemic changes.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable. There is likely\ncongenital nonunion of the posterior arch of C1.", + "output": "No acute intracranial process such as hemorrhage or large vascular territory\ninfarction. No fracture. Atrophy of ventricles and sulci greater than\nexpected for age." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nMotion artifact degrades the diagnostic quality of the study at the vertex. \nWithin this confine: No acute intracranial hemorrhage or large territorial\ninfarct. Periventricular hypointense lesions are identified, in keeping with\nhistory of MS. ___ brain changes out of proportion for age most\nlikely secondary to the patient's known diagnosis of MS.\n\n___ lesion in the left frontal bone appear similar compared to prior. \nHyperostosis frontalis interna. The paranasal sinuses are clear.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches are patent. Mild\ncalcific atherosclerotic changes at the left carotid bulb. There is no\nevidence of significant internal carotid stenosis by NASCET criteria.\n\nOTHER:\nBiapical pleural-parenchymal scarring. There are multiple pulmonary nodules\nmeasuring up to 3 mm in the bilateral visualized lung apices (e.g. series 3,\nimage 25). Retained secretions present in the trachea and left main bronchus.\nThe visualized portion of the thyroid gland is within normal limits. There is\nno lymphadenopathy by CT size criteria.", + "output": "1. No acute intracranial hemorrhage or large territorial infarct.\n2. Periventricular hypointense lesions as well as early involutional brain\nchanges in keeping with the patient's history of MS.\n3. No internal carotid artery stenosis by NASCET criteria.\n4. No intracranial aneurysms or significant stenosis.\n5. Multiple pulmonary nodules measuring up to 3 mm, potentially inflammatory\nor infectious, with retained secretions in the trachea and left mainstem\nbronchus. However, clinical correlation is recommended and follow-up chest CT\nin 12 months per ___ society recommendations.\n\nRECOMMENDATION(S): For incidentally detected multiple solid pulmonary nodules\nsmaller than 6mm, no CT follow-up is recommended in a low-risk patient, and an\noptional CT follow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are enlarged given the patient's age.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Involutional changes are advanced for age however there is no evidence of\nacute hemorrhage or territorial infarction. MRI is more sensitive for the\ndetection of acute infarction." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect. No loss of\ngray/white matter differentiation is seen allowing for volume averaging with a\nprominent right from sulcus on axial image 2:17, better assessed on coronal\nreformatted images. There is a small hypodensity with volume loss in the left\nsplenium of the corpus callosum on image 2:17, compatible with a chronic\ninfarct or other insult. More ill-defined periventricular, deep and\nsubcortical white matter hypodensities are nonspecific but likely sequelae of\nchronic small vessel ischemic disease in this age. There is prominence of the\nventricles and sulci suggestive of involutional changes. Incidental note is\nmade of a persistent cavum septum pellucidum et vergae.\n\nThere is no evidence of fracture. There is a small mucous retention cyst in\nthe left maxillary sinus. There is rightward deviation of the partially\nvisualized upper nasal septum. Mastoid air cells are well aerated.", + "output": "1. No evidence of an acute intracranial abnormality. MRI would be more\nsensitive for an acute infarction, if clinically warranted.\n2. Small chronic infarct versus sequela of another chronic insult in the left\nsplenium of the corpus callosum.\n3. Ill-defined supratentorial white matter hypodensities are nonspecific but\nlikely sequela of chronic small vessel ischemic disease in this age group." + }, + { + "input": "CTA HEAD:\nThere is moderate irregularity of the bilateral carotid siphons with several\nsmall outpouchings. There is moderate narrowing within the supraclinoid\nsegment of the right internal carotid artery due to atherosclerotic plaque. \nThe vertebral arteries, basilar artery, and vessels of the circle of ___\nand major branches are patent without stenosis.\n\nNo aneurysm or vascular malformation is identified.\n\nCTA NECK:\nThere is mild atherosclerotic plaque within the bilateral internal carotid\narteries, with less than 20% stenosis by NASCET criteria. There is moderate\nnarrowing of the left vertebral artery at its origin. The extracranial\nvertebral arteries otherwise appear normal.\n\nOTHER:\nIncidental note is made of a left cervical rib. There is moderate\ndegenerative change within the cervical spine, without high-grade spinal canal\nnarrowing.\n\nThere are no enlarged cervical lymph nodes. Ground-glass opacity within the\ndependent lung apices likely reflects atelectasis. The thyroid is\nunremarkable. The visualized aerodigestive tract is within expected limits.", + "output": "1. Moderate atherosclerotic plaque within the carotid siphons, with moderate\nnarrowing of the supraclinoid segment of the right internal carotid artery. \nNo large vessel occlusion or aneurysm is identified.\n2. Mild extracranial atherosclerosis, without significant internal carotid\nartery stenosis. There is moderate stenosis of the origin of the left\nvertebral artery.\n3. Additional findings described above." + }, + { + "input": "There is asymmetric fat stranding adjacent to body of the mandible on the left\nwith associated thickening of the platysma. Periapical lucency seen adjacent\nto the root ___ tooth number 18, which shows evidence of prior root canal. \nThere is sclerosis of the adjacent mandible suggesting chronic inflammation. \nNo cortical breakthrough or drainable fluid collection is noted.\n\nThe parotid glands, submandibular glands, and thyroid are unremarkable. There\nis no cervical adenopathy.\n\nAerodigestive tract is unremarkable.\n\nMucosal thickening is noted in the maxillary and sphenoid sinuses and ethmoid\nair cells.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.\n\nIncidentally noted is a right cerebellar developmental venous anomaly, a\nnormal variant.", + "output": "1. Soft tissue stranding surrounding the body of the mandible on the left\nwhich is likely attributable to periapical disease ___ tooth 18. No\ndrainable collection.\n2. Patient experienced an IV contrast reaction. Please see OMR for details.\n\nNOTIFICATION: Updated wet read results were discussed with Dr. ___,\nMD by ___, MD at approximately 730 pm via telephone." + }, + { + "input": "Focal hypodensity within the right frontal lobe is most consistent with\nencephalomalacia from prior known intraparenchymal hemorrhage. There is no new\nevidence of intracranial hemorrhage, edema, mass effect, shift of normally\nmidline structures or acute major vascular territorial infarction. Prominence\nof ventricles and sulci is consistent with age related involutional changes.\nPeriventricular white matter hypodensities are likely the sequela of chronic\nsmall vessel ischemic disease. Focal hypodensity in the right thalamus is\nconsistent with an old lacunar infarct. The basal cisterns appear patent and\nthere is otherwise preservation of gray-white matter differentiation.\n\nThere is no fracture. The visualized paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. A left frontoethmoidal osteoma is again seen.", + "output": "No acute intracranial abnormality." + }, + { + "input": "Study is mildly degraded by motion.\n\nThere is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. Right frontal hypodensity and left parietal hypodensity associated\nwith focal ex vacuo dilatation of the adjacent lateral ventricles are\nconsistent with encephalomalacia from prior ischemia. There is prominence of\nthe ventricles and sulci suggestive of involutional changes. Atherosclerotic\nvascular calcifications are noted of bilateral cavernous portions of internal\ncarotid arteries.\n\nThere is no evidence of fracture. The visualized portion of the mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits demonstrate left lens replacement postoperative changes. Bilateral\nmaxillary sinus and ethmoid air cell mucosal thickening is present. Air cell\neyes mucosal thickening is seen in the right frontal and bilateral sphenoid\nsinuses.", + "output": "1. Study is mildly degraded by motion.\n2. No acute intracranial abnormality.\n3. Within limits of study, no definite evidence of acute intracranial\nhemorrhage or fracture.\n4. Right frontal and left parietal probable chronic infarcts.\n5. Paranasal sinus disease , as described." + }, + { + "input": "Streak artifact limits evaluation of posterior fossa and brainstem. Within\nthese confines:\n\nThere is no evidence of fracture, infarction, hemorrhage, edema, or mass. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. There are periventricular and subcortical lucencies, which may\nrepresent small vessel ischemic changes. There is no abnormal enhancement.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are preserved.", + "output": "Within limits of study, no definite evidence of enhancing intracranial mass\nidentified. If continued concern for intracranial metastatic disease,\nconsider wide bore MRI for further evaluation." + }, + { + "input": "There is no evidence of large territory infarction, hemorrhage, edema, or\ndefinite mass. Age advanced involutional changes are noted. Encephalomalacia\nis noted within the right inferior anterior temporal lobe likely sequelae of\nprior contusion. Areas of basal ganglia calcification noted.\nNo acute fracture seen. Postsurgical changes involving the right\nfrontotemporal calvarium are noted. There is mild mucosal thickening in the\nethmoid sinuses. The remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Age advanced involutional changes with chronic encephalomalacia in the\nright inferior anterior temporal lobe." + }, + { + "input": "Head CT: There is no evidence of hemorrhage, edema, mass, mass effect, or\ninfarction. The ventricles and sulci are normal in size and configuration. No\nfracture is identified.\n\nBilateral maxillary sinus mucus-retention cysts are seen.\n\nMultiple parotid masses are again noted on the right and appear slightly\nincrease in size. Inferior-posterior right parotid mass measures approximately\n1.8 cm x 1.8 cm (previously 1.7 cm x 1.7 cm) and more anterior-superior right\nparotid mass measures approximately 2.0 cm x 1.6 cm (previously 2.0 cm x 1.4\ncm). These findings are presumably on the basis of patient's reported history\nof Langerhans cell histiocytosis. There has been interval removal and/or\ntreatment of previously seen masses within the left parotid gland. Multiple\nprominent although not pathologically enlarged submandibular lymph nodes are\nnoted.\n\nHead/neck CTA: There is no evidence of aneurysm, vascular malformation, or\nhemodynamically significant stenosis within the intracranial vasculature. The\nbasilar summit is \"patulous\" with infundibular origins of multiple vessels\nincluding the left PCA although there is no evidence of aneurysm larger than 2\nmm.\n\nThe left vertebral artery is dominant. There is no evidence of\nhemodynamically significant stenosis within internal carotid arteries or\nvertebral arteries.", + "output": "1. No acute intracranial hemorrhage or mass effect.\n2. No evidence of vascular malformation, aneurysm, or hemodynamically\nsignificant stenosis within the head or neck.\n3. \"Patulous\" basilar summit with multiple infundibular origins, including\nthat of the left posterior cerebral artery, representing variant anatomy.\n4. Slight interval increase in size of right parotid masses, status post\ninterval removal and/or treatment of previously described left parotid masses,\nwhich represent apparently biopsy-proven Langerhans cell histiocytosis (LCH);\ncorrelate with more detailed clinical information." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are prominent, consistent global cerebral volume loss.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. A\nhypoplastic left P1 segment is seen. The dural venous sinuses are patent.\n\nCTA NECK:\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nA 3 mm nodule is seen in the right upper lobe, unchanged. Several soft tissue\nlesions are seen within the right parotid gland largest close at the inferior\naspect of the gland measures approximately 21 x 18 mm is minimally increased\nin size. The previously seen lesion in the upper anterior portion of the\ngland is slightly smaller in size. Several other smaller lesions are\nvisualized which could be due to prominent lymph nodes. The lesions seen\nwithin the left parotid gland on the neck CT of ___ are no longer\nvisible. The visualized portion of the thyroid gland is within normal limits.\nThere is no lymphadenopathy by CT size criteria.", + "output": "1. No acute intracranial abnormality.\n2. Unremarkable CTA of the head and neck.\n3. 3 mm nodule in the right upper lobe is unchanged from the CT dated ___.\n4. Several soft tissue lesions are seen in the right parotid gland 1 at the\ninferior aspect has slightly increased in size but as lesion in the anterior\nsuperior portion has slightly decreased in size. Could represent prominent\nlymph node or mass lesion. Previously seen left-sided parotid lesions are no\nlonger visible. Further evaluation can be obtained with neck MRI and/or\nultrasound-guided biopsy as clinically indicated." + }, + { + "input": "Head CT: There is no evidence of hemorrhage, edema, masses, mass effect, or\ninfarction. The ventricles and sulci are normal in caliber and configuration.\nNo fractures are identified.\n\nHead and neck CTA: The carotid and vertebral arteries and their major branches\nare patent with no evidence of stenoses. The distal cervical internal carotid\narteries measure 4 mm in diameter on the left and 4 mm in diameter on the\nright. There is no evidence of aneurysm formation or other vascular\nabnormality.", + "output": "Significant abnormalities are seen on CT angiography of the head and neck. No\nevidence of occlussion stenosis or dissection. No evidence of aneurysm greater\nthan 3 mm in size." + }, + { + "input": "There is no evidence of major vascular territorial infarct, hemorrhage, edema,\nor mass. There is hypodensity in the left paramedian, ventral pons (2:9). \nWhile this may be due to artifact due to location in the posterior fossa,\nunderlying subacute infarct or other abnormality would be possible. \nGray-white matter differentiation is preserved. The ventricles and sulci are\nnormal in size and configuration.\n\nNo osseous abnormalities seen. Mild mucosal thickening is seen within the\nanterior ethmoidal air cells bilateral maxillary sinuses. Inspissated\nsecretions in the nasopharynx are likely related to intubation. The mastoid\nair cells and middle ear cavities are clear. The orbits are unremarkable.", + "output": "Focal hypodensity in the left ventrolateral pons, potentially due to subacute\ninfarct or potentially artifact. Otherwise, unremarkable head CT.\n\nRECOMMENDATION(S): MR could help clarify vs short interval followup with CT.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. \n___ on the telephone on ___ at 9:37 ___, 10 minutes after the\ndiscovery of the findings." + }, + { + "input": "There is no evidence of major vascular territory infarction, hemorrhage,\nedema, or mass. There is beam hardening artifact through the pons, and\ntherefore the previously described questionable hypodensity within the ventral\npons is not well evaluated on the current study. However, no gross\nabnormalities are identified. The ventricles and sulci are normal in size and\nconfiguration.\n\nNo osseous abnormalities seen. There is mucosal thickening within all\nvisualized paranasal sinuses. Partial opacification of the left mastoid air\ncells is noted. Right mastoid air cells are clear. The orbits are\nunremarkable.", + "output": "Previously described questionable hypodensity within the ventral pons not well\nevaluated on the current study again due to beam hardening artifact. However,\nno gross abnormalities are identified. No evidence of major vascular\nterritory infarction." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass effect.\nThe ventricles and sulci are normal in size and configuration for age. Focal\nhyperdensities in the left basal ganglia and anterior limb of the internal\ncapsule are chronic and consistent with mineralization of blood products as\ndemonstrated on recent MRI. Known cerebellar metastasis seen on MRI are not\nclearly seen on this CT exam.\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No acute intra-cranial process. If clinical concern is high, further\nevaluation with MRI could be performed, particularly to evaluate the posterior\nfossa.\n\n2. Calcified blood products in the left anterior limb of the internal capsule\nand basal ganglia are chronic from prior infarct.\n\n3. Cerebellar lesions seen on prior MRI are not clearly visualized on CT." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass. Focal\nhyperdensities in the left basal ganglia and anterior limb of the internal\ncapsule are unchanged and consistent with mineralization of blood products\nfrom prior infarct as previously seen on MRI. Known cerebellar metastases are\nnot clearly appreciated on CT. Mild prominence of the ventricles and sulci\nsuggest age related global atrophy. Periventricular white matter hypodensities\nare nonspecific, but likely reflect sequelae from chronic small vessel\nischemic disease. The basal cisterns appear patent and there is preservation\nof gray-white matter differentiation.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No evidence of acute intracranial process.\n\n2. Unchanged calcified blood products in the left anterior limb of the\ninternal capsule and basal ganglia from prior infarct.\n\n3. Known cerebellar metastases are not well appreciated on CT exam. There is\nhigh clinical suspicion for acute process, a MRI may be obtained." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized paranasal sinuses\ndemonstrate aerosolized layering secretions, as well as mild mucosal\nthickening within the maxillary sinuses bilaterally, likely related to\nintubation. The visualized mastoid air cells and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "Normal CT of the brain. Aerosolized layering secretions in the visualized\nparanasal sinuses is likely related to intubation." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\nThere is no evidence of fracture. There is mild mucosal thickening in the\nleft maxillary sinus and sphenoid sinuses. In addition, there is fluid within\nthe bilateral mastoid air cells, increased from ___. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of intracranial hemorrhage.\n2. Sinus disease, as described above." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The brain is\natrophic. The ventricles are within normal limits.\nThere is no evidence of fracture. There is mucosal thickening of the right\nfrontal and sphenoid sinuses with air-fluid level. There is mucosal\nthickening of the bilateral maxillary sinuses and probable air-fluid level in\nthe right maxillary sinus. There is partial opacification of the mastoid air\ncells. The remaining paranasal sinuses and middle ear cavities are clear. \nThe visualized portion of the orbits are unremarkable.", + "output": "1. No evidence of hemorrhage, infarction, mass, or edema.\n2. Paranasal sinus disease as described above." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is mild\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. Punctate vascular arteriosclerotic\ncalcifications are present the carotid siphons bilaterally. There is mucosal\nthickening in the bilateral maxillary sinuses, ethmoid air cells, and frontal\nsinuses with aerosolized secretions and fluid layering in the bilateral\nsphenoid sinuses. There is also partial opacification of the bilateral\nmastoid air cells, as before. The visualized portion of the orbits are\nunremarkable. A nasal tube is partially visualized.", + "output": "1. No acute intracranial process.\n2. Extensive paranasal sinus disease as described above." + }, + { + "input": "Ventriculostomy catheter hardware streak artifact limits examination.\n\nThere is no evidence of acute infarction,hemorrhage,edema, or mass. Degree of\nventriculomegaly is grossly stable when compared to ___, status\npost left frontal approach ventriculostomy catheter placement with tip in the\nright lateral ventricle, unchanged.\n\nMild periventricular and subcortical white matter hypodensities are likely due\nto chronic small vessel ischemic disease. More discrete focus of white matter\nhypodensity along the catheter track and right vertex are similar to prior\nexam in ___.\n\nThere is no evidence of acute fracture. Bifrontal supraorbital scalp and\nright periorbital soft tissue swelling is present. Grossly stable right\nfrontal parasagittal soft tissue calcified probable sebaceous cysts are again\nnoted (see 3:62).", + "output": "1. Ventriculostomy catheter hardware streak artifact limits examination.\n2. No acute intracranial abnormality.\n3. Within limits of study, no evidence acute intracranial hemorrhage or acute\nfracture.\n4. Bifrontal supraorbital and right periorbital scalp soft tissue swelling.\n5. Overall stable degree of ventriculomegaly compared to ___, with stable\npositioning of the left frontal approach ventriculostomy catheter.\n6. Similar areas of hypodensities along the catheter tract and at the right\nvertex.\n7. Please see concurrently obtained maxillofacial CT for description of\nmaxillofacial structures.\n8. Grossly stable right frontal parasagittal scalp probable sebaceous cysts,\nas described." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nLeft mandibular condyle probable bone island is noted (see 02:57). Right\nfrontal osteoma measures 4 mm. There is medialization of the right internal\ncarotid artery. Scattered subcentimeter nonspecific lymph nodes are noted\nthroughout the visualized portion of the neck bilaterally, without definite\nenlargement by CT size criteria.\n\nRight periorbital and bifrontal supraorbital scalp soft tissue swelling is\nnoted.\n\nThere is mild mucosal thickening of the anterior ethmoid air cells and left\nmaxillary sinus. Otherwise, the remaining paranasal sinuses are aerated. The\nimaged mastoid air cells and middle ear are preserved.\nThere is no evidence of abnormal fluid collections.\n\nBilateral mastoids appear preserved.\nThe globes, extraocular muscles, optic nerves, and retrobulbar fat appear\npreserved.\n\nThe visualized upper aerodigestive tract appears preserved.\nThe mandible and temporomandibular joints appear preserved. Atherosclerotic\nvascular calcifications are seen in bilateral carotid bifurcations.\n\nLimited imaging of the teeth demonstrates left maxillary first premolar\nperiapical lucency is noted. There is sigmoid nasal septal deviation with\nleftward bony spur.", + "output": "1. Dental amalgam streak artifact limits study.\n2. No definite evidence of fracture.\n3. Right periorbital and bifrontal supraorbital scalp soft tissue swelling.\n4. Minimal paranasal sinus disease, as described.\n5. Nonspecific subcentimeter lymph nodes as described, which may be reactive.\n6. 4 mm right frontal sinus osteoma.\n7. Left maxillary first premolar periodontal disease.\n8. Sigmoid nasal septal deviation with leftward bony spur.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 10:19 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. There is an ossified extra-axial lesion measuring approximately\n3.7 x 0.8 x 3.5 cm along the inner table of the right parietal calvarium best\nseen on series 601B image 48. This lesion most likely represents an\nintraosseous meningioma. No adjacent edema or significant mass effect is seen.\nVentricles and sulci are normal in overall size and configuration. The imaged\nparanasal sinuses are clear. Mastoid air cells and middle ear cavities are\nwell aerated. No fracture.", + "output": "No acute hemorrhage. Ossified extra-axial lesion along the right parietal bone\nlikely represents an intraosseous meningioma." + }, + { + "input": "There is no evidence of large territory infarction,hemorrhage,edema, or mass. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Periventricular and subcortical white matter hypodensities are\nnonspecific but likely represent sequela of chronic small vessel ischemic\nchanges. Atherosclerotic vascular calcifications are noted of bilateral\nvertebral and cavernous portions of internal carotid arteries.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nanterior ethmoid air cells and bilateral maxillary sinuses. The visualized\nportion of the mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits demonstrate bilateral lens replacement\npostoperative changes. .", + "output": "1. No large territory infarction or acute intracranial hemorrhage.\n2. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct and for evaluation of seizure foci.\n3. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described.\n4. Paranasal sinus disease , as described." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. Mild calcified\natherosclerosis involves the bilateral carotid siphons.\n\nThere is soft tissue swelling and gas overlying the right frontal lobe which\nmay represent a laceration. No underlying fracture. There is no evidence of\nfracture. The visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial process.\n2. Right frontal scalp laceration and soft tissue swelling. No underlying\nfracture." + }, + { + "input": "There is a large right frontal intraparenchymal hemorrhage encompassing the\nmajority of the anterior right frontal lobe measuring up to 6.5 x 5.4 x 6.5 cm\n(02:10), with extension into the ventricles, with blood products filling\nnearly the entire right lateral ventricle, left lateral ventricle, third and\nfourth ventricles. There is 13 mm of leftward midline shift, with evidence of\nsubfalcine herniation. Concern for early uncal herniation. The left lateral\nventricle appears relatively dilated, worrisome for evolving hydrocephalus. \nThe right lateral ventricle is compressed. There is significant subcortical\nwhite matter hypodensity in the occipital cortex, which could be related to\nextensive small vessel ischemic change or transependymal flow related to\nhydrocephalus.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Large intraparenchymal hemorrhage involving the right frontal lobe,\nmeasuring approximately 6.5 cm, with extension into the ventricles, and 13 mm\nof leftward midline shift with evidence of subfalcine herniation concern for\nearly uncal herniation. There is relative dilation of the left temporal horns\nof the lateral ventricles, which could be suggestive of developing\nhydrocephalus/entrapment.\n2. Extensive hypodensity in the suboccipital white matter could be related to\nextensive small vessel ischemic changes versus transependymal flow related\nhydrocephalus.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. in person on ___ at 6:13 pm, 2 minutes after discovery of the\nfindings." + }, + { + "input": "CT Head: There is interval increase in the extra-axial hyperdensity along the\nleft cerebral convexity, now with a more crescentic shaped of the left\ntemporal convexity hematoma, measuring 8 mm in depth, most consistent with an\nepidural hematoma. There are also other crescentic or globular hyperdensities\nin the left frontal convexity and at the vertex (2:29 and 2:34). There is also\nhyperdensity along the sulci of the left frontal, temporal and parietal lobes,\nconsistent with subarachnoid hemorrhage. There is mild mass effect on the\nadjacent brain parenchyma epidural hematoma.\n\nThere is no midline shift, intraparenchymal mass or acute infarction. The\nbasilar cisterns are adequately patent, without evidence of uncal herniation.\nAgain noted is a nondisplaced fracture of the right temporal bone. Hyperdense\nair-fluid level is seen within the right sphenoid sinus, consistent with\nhemorrhage.\n\nCTA Head: There is adequate opacification of the internal carotid, anterior\ncerebral, middle cerebral, vertebral, basilar and posterior cerebral arteries.\nThere is no extravasation identified in the internal carotid arteries. There\nis mild atherosclerotic calcification of the bilateral carotid siphons. The\nanterior communicating artery is well visualized, with partial fenestration\nidentified, but no evidence of aneurysm. The right vertebral artery is\ndominant. The posterior communicating arteries are not clearly visualized.\nThere is no evidence of aneurysm formation, occlusion, dissection or vascular\nmalformation.\n\nThere is adequate opacification of the dural venous sinuses, without evidence\nof extravasation, vascular injury or thrombosis.", + "output": "1. Interval increase in extra-axial hyperdensities along the left cerebral\nconvexity and witihin the sulci of the left cerebral hemisphere, as described\nabove, consistent with small epidural hematoma, as well as subarachnoid\nhemorrhage. The epidural hematoma measures up to 8 mm in thickness, with only\nminimal mass effect on the subjacent brain parenchyma.\n2. Non-displaced fracture of the right temporal bone is again visualized, with\nhyperdense fluid ___ the right sphenoid air cell, consistent with hemorrhage.\n3. CTA of the head shows no evidence of extravasation (\"spot sign\"), vascular\ninjury or pseudoaneurysm or aneurysm larger than 2 mm." + }, + { + "input": "Previously seen subarachnoid hemorrhage is no longer visualized. There is a\nsmall low-density subdural collection best seen at the vertex overlying the\nleft frontoparietal region (12;40-60) measuring up to 4 mm. There is no\nsignificant mass effect, there is no midline shift. There is no acute\nhemorrhage. Ventricles and sulci are symmetric and unremarkable. Gray-white\nmatter differentiation is preserved.\n\nKnown right temporal bone and skullbase fractures are better characterized by\nprior exam. The skull and extracranial soft tissues are otherwise\nunremarkable. Included paranasal sinuses and mastoids are clear. Defect in the\nright lamina papyracea is chronic. Lack of fusion of the posterior arch of C1\nas well as congenital fusion of C1 to the skullbase is again noted.", + "output": "Trace low-density subdural fluid collection overlying the left frontoparietal\nregion at the vertex without significant mass effect. No acute hemorrhage." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect.\n\nThe right parotid gland is hyperemic and edematous with surrounding fat\nstranding and a small amount of free fluid extending inferiorly from the\nparotid gland. There is mild thickening of the right platysma muscle, likely\nreactive. There is no sialolith identified. No fluid collection. The\nsalivary glands otherwise enhance normally and are without mass or adjacent\nfat stranding. The thyroid gland appears normal. There is no lymphadenopathy\nby CT criteria. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.", + "output": "Acute right parotitis without evidence of obstructing sialolith." + }, + { + "input": "Again again seen is hypodensity in the right cerebellar hemisphere. This\nappears unchanged since the prior study head CT. This underlies a scalp\nhematoma. Although this finding could be the result of a contusion, the\nimaging findings are not sufficient to come to that conclusion. A cerebellar\nhemisphere infarction or a mass with surrounding edema could produce similar\nfindings.\n\nThere is no evidence of intracranial hemorrhage and there are no findings\nsuggesting infarction elsewhere. No fractures are identified. The ventricles\nand sulci are prominent, consistent with age related volume loss.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable. Soft tissue\nswelling overlying the right occiput is unchanged.", + "output": "The unchanged right cerebellar hemisphere hypodensity as discussed above. This\nmay be represent a contusion associated with recent trauma. However, other\ndiagnostic possibilities, such as mass and infarction, should be considered." + }, + { + "input": "Patient is status post frontal craniotomy and resection of meningioma\npreviously characterized on MRI head ___. There is expected\npneumocephalus. There is a small amount of intraparenchymal hemorrhage near\nthe vertex at the site of the resection bed (02:23). There is no midline\nshift. Ventricles and sulci are normal. Basal cisterns are patent.\n\nThere is minimal mucosal thickening of the bilateral ethmoid air cells. \nRemaining paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are patent.", + "output": "Small amount of intraparenchymal hemorrhage in the vertex of the site of\nmeningioma resection bed and expected postoperative changes." + }, + { + "input": "The study is slightly motion limited even though the images were repeated.\n\nAgain seen is an unchanged left subdural hematoma along the left falx\nmeasuring 8 mm in greatest dimension, along the left tentorium, and along the\nleft convexity measuring 5 mm along the left frontal lobe on image 5:22. \nThere is mass effect with 4 mm of rightward shift of normally midline\nstructures, unchanged from prior. Previously noted trace hemorrhage in the\noccipital horns of the lateral ventricles has decreased on the right and\nresolved on the left. Trace hemorrhage in the third ventricle persists. No\nnew hemorrhage is identified. No evidence of large vascular territory\ninfarction with infarction. Unchanged prominence of the ventricles and is\ncompatible with age-related parenchymal volume loss, though the patient's\nbaseline is not known. The basal cisterns remain patent. Periventricular,\ndeep, and subcortical white matter hypodensities are again noted, nonspecific\nbut likely sequela of chronic small vessel ischemic disease in this age group.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses are well aerated. The mastoid air cells, pneumatized left petrous\napex, partially pneumatized right petrous apex, and middle ear cavities are\nclear. Evidence of right cataract surgery in bilateral scleral banding is\nagain seen.", + "output": "1. Mildly motion limited exam.\n2. Stable left subdural hematoma along the left cerebral convexity, left falx\nand left tentorium. Unchanged 4 mm of rightward shift of normally midline\nstructures.\n3. Trace intraventricular hemorrhage has decreased.\n4. No new hemorrhage." + }, + { + "input": "This examination is motion degraded. Again seen is extensive left subdural\nhemorrhage along the left falx, tentorium and convexity, unchanged in\ndiameter, measuring up to 8 mm in greatest dimension along the falx. There is\nmild mass effect with the approximately 4 mm of rightward shift of midline\nstructures, unchanged since prior. Trace hemorrhage within the occipital\nhorns of the lateral ventricles is no longer appreciated minimal hemorrhage in\nthe third ventricle persists. There is stable prominence of the ventricles\nand sulci, are consistent with likely age-related cerebral volume loss. The\nbasilar cisterns are patent. Periventricular white matter hypodensities are\nmost consistent with small vessel ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unchanged.", + "output": "1. Motion degraded study. Unchanged left subdural hematoma as described above\nwith mild midline shift. There is no ventriculomegaly." + }, + { + "input": "The left-sided subdural hematoma along the the left convexity, the left aspect\nof the falx, and the left tentorium is unchanged from the prior study\nmeasuring up to 9 mm along the falx (02:26) and 5 mm along the inner table at\nthe level of the temporal lobe (02:19). Trace hemorrhage in the occipital\nhorns of lateral ventricles and in the third ventricle is stable. Trace blood\nis no seen in the region of the the ventricular aqueduct on image 2:13,\nindicating were distributed. There is no new hemorrhage. There is unchanged\n4 mm rightward shift of midline structures. Prominence of the ventricles is\nlikely secondary to age-related parenchymal volume loss, though the patient's\nbaseline is not known. There is no loss gray-white differentiation to suggest\nacute infarction. Periventricular, deep, and subcortical white matter\nhypodensities are nonspecific but likely sequela of chronic small vessel\nischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses are well aerated. Mastoid air cells, pneumatized left petrous apex,\npartially pneumatized right petrous apex, and the middle ear cavities are\nclear. There is evidence of right cataract surgery in bilateral scleral\nbanding.", + "output": "1. Unchanged subdural hematoma along the left convexity, left falx, and left\ntentorium compared to approximately 6.5 hours earlier. Unchanged 4 mm\nrightward shift of midline structures.\n2. Unchanged minimal intraventricular hemorrhage.\n3. No evidence for new intracranial abnormalities." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nHypodensity and loss of gray-white matter differentiation in the distribution\nof the left posterior cerebral artery involving the left medial posterior\ntemporal and left occipital lobes indicates an acute-subacute infarction. \nThere is no evidence of hemorrhagic transformation.\n\nThere are chronic infarcts in the right frontal and right occipital lobes. \nMild generalized cerebral atrophy.\n\nMild mucosal thickening involving the paranasal sinuses. Under pneumatization\nof the left mastoid bone. The visualized portion of the orbits are\nunremarkable.\n\nCTA HEAD:\nModerate calcific atherosclerotic changes of the carotid siphons bilateral. \nThe vessels of the circle of ___ and their principal intracranial branches\nare patent without marked stenosis, occlusion, or aneurysm formation. The\ndural venous sinuses are patent.\n\nCTA NECK:\nModerate atherosclerotic changes at the distal common carotid arteries is and\ncarotid bulbs bilateral (left more than right) with minimal (10%) proximal\ninternal carotid artery stenosis on the left by NASCET criteria and no ICA\nstenosis on the right by NASCET criteria. Complete occlusion of the origin of\nthe right vertebral artery with poor opacification again seen in the mid V2\nsegment. opacification of the V2, V3 and V4 segments of the right vertebral\nartery may be due to retrograde flow from the basilar artery. The left\nvertebral artery is widely patent.\n\nOTHER:\nMild septal thickening in the lung apices. Multiple mildly enlarged\nmediastinal lymph nodes and if clinically indicated dedicated chest imaging\nmay be performed. Suspected small bilateral pleural effusions. Ground-glass\nopacity measuring 5 mm in the right upper lobe (series 3, image 33) is\nnonsuspicious. The visualized portion of the thyroid gland is within normal\nlimits. There is no lymphadenopathy by CT size criteria. Spondylotic changes\nof the cervical spine. No acute vertebral body fractures. Left C6-7\nparacentral disc osteophyte complex results in mild moderate spinal canal\nnarrowing.", + "output": "Acute-subacute left posterior cerebral artery distribution infarction with no\nevidence of hemorrhage.\n\nNo intracranial arterial occlusion, marked stenosis or aneurysm formation.\n\nModerate atherosclerotic changes of the distal CCA and proximal ICAs with\napproximately 10% stenosis of the proximal left ICA by NASCET criteria. No\nright ICA stenosis by NASCET criteria.\n\nComplete occlusion of the origin of the right vertebral artery with poor\nopacification again seen in the mid V2 segment. Opacification of the more\ndistal right vertebral artery apparently arises via retrograde flow from the\nbasilar artery.\nThe left vertebral artery is widely patent.\n\nSuspected small bilateral pleural effusions and mild septal thickening in the\nlung apices may suggest pulmonary edema and cardiac decompensation.\nMildly enlarged mediastinal lymph nodes is nonspecific and may be secondary to\ncongestion or may be pathological due to a different etiology and if\nclinically indicated dedicated chest imaging may be performed.\n\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 10h23 am, 5 minutes after discovery of\nthe findings." + }, + { + "input": "There is no evidence of acute large territorial infarctionhemorrhage,edema,or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, and mastoid air cells, are clear. There is near complete soft tissue\ndensity opacification of the left external auditory with no definite middle\near involvement. Punctate tissue densities are also noted in the left\nexternal auditory canal. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No evidence of acute intracranial abnormality. Specifically, no large\nterritorial infarction, hemorrhage, or calvarial fracture.\n2. Soft tissue densities in the bilateral external auditory canals with near\ncomplete opacification of the left canal. This is probably related to cerumen\nalthough the result can be correlated with physical findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are normal.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. The dural venous\nsinuses are patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion.\n\n\n\nOTHER:\nNo suspicious lung nodules. The visualized portion of the thyroid gland is\nwithin normal limits. There is no lymphadenopathy by CT size criteria.", + "output": "1. Normal head CT.\n2. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n3. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. There is focus of\nchronic encephalomalacia involving anterior basal left frontal lobe,\nconsistent with prior trauma.\n\nSubtle fracture of the nasal bone on the left, likely chronic, clinically\ncorrelate. Degenerative changes right temporomandibular joint. Mild\nopacification the paranasal sinuses, likely related to intubation. Otherwise,\nthe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. Scratched patient is intubated. Postoperative\nchanges left orbit with scleral buckle. Secretions in the nasopharynx,\noropharynx.", + "output": "No acute intracranial findings." + }, + { + "input": "There is no evidence of infarction,hemorrhage,edema, or mass. There is\nprominence of the ventricles and sulci suggestive of age-related involutional\nchanges. Again seen is a focus of encephalomalacia involving the anterior\nbasal left frontal lobe which may reflect the sequela of prior trauma.\n\nAgain seen is a fracture of left nasal bone which is felt to be chronic in\netiology. Otherwise there is no evidence of fracture. There has been\ninterval development of mucosal thickening within right maxillary sinus,\nethmoid air cells and sphenoid sinuses which may be the sequelae of\nintubation. The visualized portion of the mastoid air cells, and middle ear\ncavities are clear. Postoperative changes of the left orbit are seen with a\nscleral buckle, otherwise the visualized portion of the orbits are\nunremarkable. Incidental note is made of a nasointestinal tube.", + "output": "1. No acute intracranial findings. As compared to the prior there is no\nevidence of intraparenchymal swelling or loss of gray-white matter\ndifferentiation." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nlarge territorial infarction.\n\n\nProminent ventricles and sulci suggest age-related involutional changes or\natrophy. Subcortical and periventricular white matter hypodensities are\nconsistent with chronic small vessel ischemic disease.\n\nThe basal cisterns appear patent and there is preservation of gray-white\nmatter differentiation.\n\nThe visualized bony structures are grossly unremarkable. The paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.\n\nAtherosclerotic mural calcification of the vertebral and internal carotid\narteries is noted.\n\nThe globes are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Moderate mucosal thickening involves the left maxillary sinus with aerosolized\nsecretions present and an air-fluid level. Patient is status post bilateral\nantrectomies. Wall thickening and sclerosis of the left maxillary wall\nsuggests a history of chronic sinusitis. There is rightward deviation of the\nnasal septum. A small spur projects to the left (601b:64) and measures 2.5\nmm. Minimal mucosal thickening involves the anterior ethmoidal air cells. The\nsphenoid sinuses an frontal sinuses are clear. Bilateral mastoid air cells\nare clear. Middle ear cavities are unremarkable.\n\nThe right ostiomeatal unit is patent. Mucosal thickening obstructs the left\nostiomeatal unit.\n\nThe cribriform plates are intact. The anterior clinoid processes not\npneumatized. The lamina papyracea are intact.\n\nBilateral parotid glands and submandibular salivary glands are unremarkable.\n\nWithin the left orbit in an intraconal well defined oval 6 x 10 mm\nhyperdensity (02:48). The remainder of the orbit is unremarkable. The right\norbit is normal.\n\nWithin the right mandible is an impacted molar tooth (2: 103) which is\nassociated with a approximately 10 x 9 mm hypodense cyst. Probable cortical\nlucency along the medial and posterior mandible suggest osseous destruction,\nthough this area is not well assessed due to artifact from dental amalgam. In\nclose proximity is asymmetric soft tissue density and stranding with\nobscuration of normal fat planes along the medial aspect of the posterior\nmandible. Findings are worrisome for phlegmon. Inferiorly, a more centrally\nhypodense area measures approximately 1.3 cm (2:122), possibly early abscess\nformation formation. Prominent right submandibular of lymph nodes are likely\nreactive.\n\nThe imaged brain appears unremarkable. The major vascular structures appear\npatent.", + "output": "1. Impacted right mandible molar tooth associated with a cystic structure\npossibly reflective of an odontogenic keratocyst or alternatively a\ndentigerous cyst, with probable adjacent cortical lucency of the medial\nposterior mandible and surrounding asymmetric soft tissue density, stranding,\nand obliteration of normal fat planes involving the soft tissues medial to the\nposterior aspect of the right mandible. Inferiorly a more centrally hypodense\nlesion measures approximately 1.3 cm. Findings are likely reflective of\nphlegmon and possibly early abscess formation.\n2. Ovoid hyperdensity within the medial left intraconal region is felt likely\nto reflect a hemangioma which can be further assessed by MR.\n3. Status post bilateral antrectomies with moderate mucosal thickening and\nair-fluid level within the left maxillary sinus suggestive of acute on chronic\nsinusitis.\n\nRECOMMENDATION(S): MRI of the orbit can be obtained for further assessment.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\non the ___ ___ at 4:49 ___, 15 minutes after discovery of the\nfindings." + }, + { + "input": "There is no evidence of fracture. There is no evidence of acute major\ninfarction, hemorrhage, edema,or large mass. The ventricles and sulci are\nnormal in size and configuration. There is no abnormal enhancement on post\ncontrast images.\n\nThere is mild mucosal thickening of the anterior ethmoid air cells, and left\nmaxillary sinus. The visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the orbits\nare unremarkable.", + "output": "1. No acute intracranial abnormalities.\n2. Sinus disease as above." + }, + { + "input": "As on recent prior CT, there is ongoing soft tissue abnormality in the right\nperimandibular region adjacent to the right mandibular body and ramus. Again\nseen, is a heterogeneous inflammatory process containing subtle central\nhypodensity best seen on series 601B, image 30, measuring approximately 2.7 x\n2.4 cm. This findings is most compatible with phlegmon or developing abscess.\nThere is no clear enhancing rim to suggest a well-formed abscess. No\nperiapical lucency. The right mandibular wisdom tooth has been removed. \nThere is no extension to the retro pharyngeal or parapharyngeal space.\n\nSmall left thyroid hypodensity measures 7 mm. Salivary glands appear normal. \nAirways widely patent. Superior mediastinum appears normal. Lung apices are\nclear. Paranasal sinuses notable for mucosal thickening of the left maxillary\nsinus. Mastoid air cells and middle ear cavities are well aerated. Imaged\nintracranial structures appear grossly unremarkable.\n\nModerate degenerative changes of the cervical spine is noted with mild\nvertebral body height loss, disc space narrowing, large anterior and posterior\nosteophytosis, and central disc protrusion, worse at C5, and C6. There is a 4\nmm anterolisthesis of C3 over C4 and 3 mm retrolisthesis of C5 over C6. These\ndegenerative changes result in moderate to severe spinal canal narrowing and\nmoderate to severe right neural foraminal narrowing and moderate mild neural\nforaminal narrowing at C4-5, C5-6 and C6-7.", + "output": "1. Right submandibular phlegmonous process measuring 2.4 x 1.8 x 2.7 cm.\n2. Degenerative changes of the cervical spine as noted above." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Prominent\nventricles and sulci are likely sequela of age related involutional changes.\n\nNo fracture is seen. The paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The orbits are unremarkable. Bilateral carotid siphon\ncalcifications are noted.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema,or mass.\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Periventricular, subcortical and deep white matter hypodensities are\nnonspecific, but likely reflect the sequela of chronic microvascular\ninfarction.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Mild atherosclerotic calcifications\nof the cavernous carotid arteries are present.", + "output": "No acute intracranial process." + }, + { + "input": "There is hyperdensity along the posterior falx extending to the left tentorial\nleaflet. There is a focus of subarachnoid hemorrhage in the left occipital\nparietal region. There is no evidence of acute large territory infarction,\nedema,or mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is a large right occipital parietal scalp hematoma and overlying\nlaceration. There is no evidence of fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Small posterior falx subdural hematoma extending to the tentorium and\nadjacent small subarachnoid hemorrhage.\n2. Large right occipital parietal scalp hematoma without fracture.\n\nNOTIFICATION: Discussed with night resident who accompanied the patient to\nthe ED." + }, + { + "input": "In comparison to prior exam there has been significant interval accumulation\nof hyperdense blood products along the posterior falx extending along the left\ntentorial leaflet. Blood is seen to involve the anterior falx as well. A\nfocus subarachnoid hemorrhage in the left occipital parietal region is\nincreased from prior. There is new subarachnoid hemorrhage involving the\nposterior left parietal lobe and overlying the left frontal lobe (03:20). \nThere is a suggestion of foci of subarachnoid blood in the posterior right\nparietal lobe (03:19). There is no acute large territorial infarction. The\nventricles and sulci are otherwise unchanged in appearance. There is no\nmidline shift. Basal cisterns appear patent.\n\nA right occipital parietal scalp hematoma is similar appearance to the prior. \nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "Interval increase in size of a posterior falx subdural hematoma extending to\nthe tentorium and now the anterior falx. There has been interval increase in\nthe degree of posterior left parietal subarachnoid hemorrhage as well as new\nleft frontal lobe and possibly posterior right parietal lobe subarachnoid\nhemorrhage. No midline shift.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:41 am, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "Prominent subdural hemorrhage along the superior falx and left tentorial\nleaflet is not significantly changed. Several areas of subarachnoid\nhemorrhage in the right frontal and temporal lobes are new or increased in\nprominence. Multiple areas subarachnoid hemorrhage are again seen involving\nthe left frontal and temporal lobes.\n\nThere is no evidence of acute large territorial ischemic infarction or mass\neffect. There is prominence of the ventricles and sulci suggestive of\natrophy.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable. A right occipital scalp\nhematoma is smaller.", + "output": "1. Prominent subdural hemorrhage along the superior falx and left tentorial\nleaflet and multiple areas of subarachnoid hemorrhage involving in the left\nfrontal and temporal lobes are not significantly changed.\n2. Several areas of subarachnoid hemorrhage in the right frontal and temporal\nlobes are new or increased in prominence.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 12:15 pm, 5 minutes after discovery\nof the findings." + }, + { + "input": "Redemonstration of prominent subdural hemorrhage along the superior falx and\nleft tentorium, minimally decreased in size compared to prior study. Several\nareas of subarachnoid hemorrhage in the bilateral frontal and temporal lobes\nappear slightly less conspicuous than on prior study. No evidence of\ninfarction or new intracranial hemorrhage. There is prominence of the\nventricles and sulci suggestive of involutional changes.\n\nA large right parietal subgaleal hematoma appears significantly increased in\nsize compared to prior study, now measuring up to 1.6 cm. There is no\nevidence of fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. No evidence of infarction or new intracranial hemorrhage.\n2. Redemonstration of prominent subdural hemorrhage along the superior falx\nand left tentorial membrane, minimally decreased in size compared to prior\nstudy.\n3. Several areas of subarachnoid hemorrhage in the bilateral frontal and\ntemporal lobes appear slightly less conspicuous than on prior study.\n4. Large right parietal subgaleal hematoma appears significantly increased in\nsize compared to prior study, now measuring up to 1.6 cm." + }, + { + "input": "CT Head: The ventricles, sulci and cisterns are age-appropriate. There is no\nmass-effect, midline shift, or space-occupying lesion. There is no hemorrhage\nor extra-axial fluid collection. There is no acute territorial infarct.\n\nThere is partial opacification of the left sphenoid sinus with mucosal\nthickening and aerosolized secretions. The visualized paranasal sinuses are\notherwise clear. The mastoid air cells are clear. The orbits and soft tissues\nare unremarkable. There is no displaced calvarial fracture.\n\nCTA Head: The intracranial internal carotid arteries are normal in\nconfiguration. The anterior and middle cerebral arteries are patent with\nnormal contrast enhancement and branching pattern. There is a normal anterior\ncommunicating artery complex.\n\nThe vertebral and basilar arteries demonstrate normal enhancement without\nstenosis or occlusion. The posterior cerebral arteries have a normal branching\npattern. The posterior communicating arteries are visualized.\n\nThere is no evidence of stenosis, occlusion, aneurysm or arteriovenous\nmalformation.\n\nThe dural venous sinuses and major cerebral veins are patent.\n\nCT head perfusion: There is no abnormality of mean transit time, blood flow,\nor blood volume to suggest cerebral ischemia or infarct.\n\nCTA Neck: There is four-vessel aortic arch anatomy with separate origins of\nthe brachiocephalic artery, left common carotid artery, left vertebral artery,\nand left subclavian artery. The origins are widely patent with no stenosis.\n\nThe right common, internal and external carotid arteries are normal in\nappearance. There is no evidence of a significant stenosis by NASCET criteria\nor a dissection.\n\nThe left common, internal and external carotid arteries are normal in\nappearance. There is no evidence of a significant stenosis by NASCET criteria\nor a dissection.\n\nThe cervical portions of the vertebral arteries demonstrate normal\nenhancement. There is no evidence of a stenosis or a dissection.", + "output": "1. Normal appearance of the major arterial vasculature of the head, without\nstenosis, dissection, or aneurysm.\n2. No stenosis by NASCET criteria or dissection of the major arterial\nvasculature of the neck.\n3. No acute territorial infarct, space-occupying lesion, or intracranial\nhemorrhage.\n4. Normal CT perfusion with no evidence of cerebral ischemia or infarct." + }, + { + "input": "Small focal white matter hyperdensity near the left frontoparietal vertexbest\nseen on series 601 image 61. While the possibility of parenchymal hemorrhage\nis considered, more favored etiology is that of avascular normally including\ncavernoma. Otherwise, no findings concerning for hemorrhage. No mass effect,\nedema, or evidence of acute major vascular territorial infarction. The\nventricles and sulci are within normal limits for age.\n\nSuperficial hematoma/contusion spans approximately 3.4 x 1.3 cm along the\nright zygoma. No acute fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are normal.", + "output": "1. Small focal white matter hyperdensity near the left frontoparietal vertex;\nthe appearance of which favors a cavernoma rather than acute hemorrhage. A\nfollow-up head CT may be obtained to ensure stability.\n2. Right facial hematoma/contusion.\n3. Please refer to the separate report of the maxillofacial CT for\ncharacterization of the facial bones.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___,\nM.D. in person on ___ at 10:00 pm, 0 minutes after discovery of the\nfindings." + }, + { + "input": "No acute infarction, hemorrhage, edema, or mass effect. Right parietal\nencephalomalacia from prior hemorrhage is demonstrated with associated ex\nvacuo dilatation the posterior body and trigone of the right lateral\nventricle. Bilateral subcortical and periventricular white matter\nhypodensities are nonspecific but likely represent sequela of chronic small\nvessel ischemic disease and are similar to prior CT and MRI exams.\nCalcification of the posterior falx is noted. The perimesencephalic cisterns\nare patent.\n\nNo fracture. The partially visualized paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No acute intracranial abnormality, including no intracranial hemorrhage.\n\n2. Right parietal encephalomalacia." + }, + { + "input": "There is no evidence of acute major vascular territorial infarction,\nhemorrhage, edema, or mass effect. The ventricles and sulci are normal in\nsize and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "No acute intracranial process." + }, + { + "input": "Redemonstrated are the bilateral intraventricular hemorrhages in the lateral\nventricles and third ventricle, which appears stable as compared to prior exam\nfrom ___. There is dependent hyperdensity fluid layering in the\ntrigone of the lateral ventricles, right greater than left. The third\nventricle continues to be filled with blood. The left thalamic hemorrhage is\nrelatively unchanged compared to prior imaging. Ventriculostomy catheter is\nagain visualized approaching the foramen of ___. There is no obvious\nmidline shift or mass effect. There are no new bleeds or infarcts.\n\nThe ventricles remain dilated bilaterally but appear stable in comparison to\nprevious imaging.\n\nA mucoid retention cyst or polyp is seen in the lateral wall of the right\nmaxillary sinus. The left maxillary sinus appears clear. Ethmoid sinuses\nappear clear. There is mild opacification of the dependent left mastoid air\ncells. Sutures are seen overlying the soft tissues of the right frontal\nskull. The orbits are unremarkable.", + "output": "1. Stable known bilateral intraventricular hemorrhages in the lateral\nventricles and third ventricles. The third ventricle continues to be filled\nwith blood and dependent fluid layering is again seen in the trigone of the\nlateral ventricles, right greater than left.\n2. The left thalamic hemorrhage is relatively unchanged compared to prior\nimaging.\n3. Stable positioning of the ventriculostomy catheter. The ventricle size has\nslightly decreased compared to the prior study.\n4. No new bleeds or infarcts." + }, + { + "input": "Interval improvement in the known bilateral intraventricular hemorrhages in\nthe lateral ventricles with redemonstrated dependent hyperdensity fluid\nlayering in the trigone of the lateral ventricles, right greater than left.\nThe left thalamic hemorrhage appears to be stable as compared to prior\nimaging, without obvious extension. Ventriculostomy catheter is again\nvisualized approaching the foramen of ___. There is no obvious midline\nshift or mass effect. There are no new bleeds or infarcts. The basilar\ncisterns appear patent. Partially empty sella is unchanged from prior\nimaging.\n\nThe previously noted bilateral dilatation of the lateral ventricles appears\nvastly improved as compared to prior imaging from ___.\n\nA mucoid retention cyst or polyp is seen in the lateral wall of the right\nmaxillary sinus. The left maxillary sinus appears clear. Ethmoid and\nsphenoid sinuses appear clear. There is mild opacification of the bilateral\nmastoid air cells. Sutures are seen overlying the soft tissues of the right\nfrontal skull. The orbits are unremarkable.", + "output": "1. Interval improvement in the bilateral intraventricular hemorrhages with\nresolution of previously noted hydrocephalus.\n2. The known left thalamic hemorrhage appears stable as compared to prior\nimaging from ___.\n3. No new bleeds or infarcts." + }, + { + "input": "Stable appearance of the known bilateral intraventricular hemorrhages in the\nlateral ventricles with redemonstrated dependent hyperdensity fluid layering\nin the trigone of the lateral ventricles, right greater than left. The left\nthalamic hemorrhage appears to be stable as compared to earlier imaging from\n___, without obvious extension. Ventriculostomy catheter is again\nvisualized approaching the foramen of ___. There is no obvious midline shift\nor mass effect. There are no new bleeds or infarcts. The basilar cisterns\nappear patent. Partially empty sella is unchanged from prior imaging.\n\nThe left lateral ventricle is somewhat compressed due to local mass effect\nfrom the left thalamic hemorrhage, but remains stable compared to earlier\nimaging from ___.\n\nThe ethmoid, maxillary, frontal, and sphenoid sinuses appear clear. There is\nmild opacification of the bilateral mastoid air cells. There is expected soft\ntissue swelling and emphysema at the site of catheter entrance. The orbits\nare unremarkable.", + "output": "1. Stable appearance of the bilateral intraventricular hemorrhages with\nresolution of previously noted hydrocephalus.\n2. The known left thalamic hemorrhage appears stable as compared to prior\nimaging from ___.\n3. No new bleeds or infarcts." + }, + { + "input": "The study is limited by motion artifact.\n\nThere is no significant interval change the left thalamic hemorrhage. \nHemorrhage in the lateral ventricles, more extensive on the right than left,\nis unchanged allowing for positional differences. No new hemorrhage or edema\nis identified. There is no evidence of downward herniation. A right frontal\napproach ventriculostomy catheter terminates near the right foramen of ___,\nas before. The ventricles are unchanged in size without hydrocephalus. The\nbasal cisterns remain patent. A expanded partially empty sella is again\nnoted.\n\nNo osseous abnormalities seen. The partially visualized paranasal sinuses are\nclear. There is fluid partially opacifying the left mastoid air cells, which\nmay be secondary to prolonged supine positioning in the inpatient setting.", + "output": "No significant change compared to 1 day earlier." + }, + { + "input": "The patient remains status post a right frontal approach ventriculostomy\ncatheter terminating in the vicinity of the right foramen of ___. A large\nleft thalamic hemorrhage is unchanged. Similarly, intraventricular hemorrhage\nis noted within the bilateral posterior horns, also unchanged. No new focus\nof hemorrhage is identified. The basal cisterns remain patent, and there is\nno evidence of downward herniation. The sella is partially empty and\nexpanded, also unchanged.\n\n The ventricles and sulci are normal in size and configuration.\nThere is no evidence of fracture. The left mastoid air cells are partially\nopacified, unchanged. The remainder of the paranasal sinuses, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Stable appearance of left thalamic and bilateral intraventricular\nhemorrhage. No new hemorrhage is identified.\n2. Unchanged position of the right frontal approach VP shunt catheter." + }, + { + "input": "A right frontal approach intraventricular catheter remains in stable position\ntraversing the right frontal horn and terminating near the right foramen of\n___. Ventricular size is stable. Incidental cavum septum pellucidum.\n\nEvolution of the patient's previously described left thymic hemorrhage, which\nmeasures up to 18 mm today, compared with 22 mm previously. Intraventricular\nhemorrhage layering in both occipital horns persists, but has decreased\nslightly. There is no new or enlarging hemorrhage. There is no CT evidence\nfor acute, major vascular territorial infarction. The patient's known\narteriovenous malformation is partially visualized in the quadrigeminal plate\ncistern.\n\nIncidental partially empty sella. Mild, generalized volume loss. Right\nfacial subcutaneous edema.", + "output": "1. Unchanged position of right frontal approach ventriculoperitoneal shunt\ncatheter. No significant change in ventricular size.\n2. No acute intracranial pathology. Interval evolution of left thalamic\nparenchymal and bilateral occipital intraventricular hemorrhage." + }, + { + "input": "Right frontal approach ventriculostomy catheter is unchanged in position, and\nterminates at the foramen of ___. Ventricular size is stable. Incidentally\nnoted cavum septum pellucidum.\n\nIn comparison to the most recent CT performed on ___, there has\nbeen expected evolution in the left thalamic hemorrhage which currently\nmeasures 1.5 x 1.8 cm. Known intraventricular hemorrhage may be partially\nvisualized in the occipital horn of the left lateral ventricle (2a:20). No\nnew intracranial hemorrhage.\n\nThere is no evidence of infarction. Partially empty sella is incidentally\nnoted.\n\nNo fracture is identified. A mucous retention cyst is seen in the right\nmaxillary sinus. Minimal mucosal thickening in the ethmoid air cells\nbilaterally. Remainder of the visualized paranasal sinuses are clear. \nPartial opacification of the posterior mastoid air cells bilaterally. Middle\near cavities are clear. Orbits are unremarkable.", + "output": "Overall unchanged appearance of approximately 1.5 x 1.8 cm left thalamic\nhemorrhage. Minimal intraventricular hemorrhage re-demonstrated, with stable\nventricular size. No evidence of new hemorrhage." + }, + { + "input": "Again seen is a left thalamic intraparenchymal hemorrhage, decreased in size\nand now measuring 0.9 x 1.6 cm (303b: 19, previously 1.5 x 1.8 cm). There is\nminimal, if any, residual intraventricular blood within the occipital horn of\nthe left lateral ventricle. No new focus of hemorrhage is identified.\n\nA right frontal approach ventricular drain terminating at approximately the\nforamen ___ is unchanged compared to prior CT. The ventricles are\nslightly decreased in size, measuring 1.3 cm at the level of the caudate heads\n(previously 1.7 cm). Rightward shift of normally midline structures is also\ndecreased, now measuring 5 mm (303b: 19, previously 8 mm).\n\nThere is no evidence of acute infarct. There is no evidence of fracture. A\nmucous retention cyst is again seen in the right max sinus. The other\nvisualized paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable. Incidental\nnote is made of stable partial empty sella unchanged from prior exams dating\nback to ___.", + "output": "1. No new focus of hemorrhage identified. Decreased size of a left thalamic\nintraparenchymal hematoma, with minimal, if any, residual intraventricular\nblood within the left lateral ventricle.\n2. Slight decrease in ventricular size and rightward shift of normally midline\nstructures. Unchanged position of a right frontal approach ventricular drain." + }, + { + "input": "A right frontal approach ventriculostomy catheter terminating at approximately\nthe foramen ___ is unchanged in position. Ventricles are unchanged in\nsize and configuration. High density blood in the left thalamus has near\ncompletely resolved. Minimal residual high density in this region may\nrepresent calcification. No new hemorrhage is seen. There is minimal shift\nof midline structures to the right by 2 mm. Low-density involving the left\nthalamus a represent underlying vascular malformation. The basal cisterns are\npatent and there is preservation of gray-white matter differentiation. There\nis no acute fracture. The paranasal sinuses are clear. The globes are\nunremarkable.", + "output": "1. Near complete resolution of high density hemorrhage within the left\nthalamus. Residual high density in this region may represent calcification. \nNo new hemorrhage identified.\n2. Low density involving the left thalamus may represent underlying AVM.\n3. Unchanged position of right frontal approach ventriculostomy catheter" + }, + { + "input": "Right frontal approach VP shunt is identified with extending to the anterior\nhorn of the right lateral ventricle. The ventricular size is further decrease\nin ventricles are now small in size. No hemorrhage is seen. Temporal horns\nare not dilated. Basal cisterns are patent.", + "output": "Further decrease in ventricular size since the previous CT. The ventricles\nare small and slit-like. Clinical correlation recommended." + }, + { + "input": "Significant metallic artifact from coils material severely limits examination.\nLeft parenchymal hyperdensity is seen in the region of the left temporal lobe\nwith hyperdensity seen within the left lateral ventricle, and to a lesser\nextent in the right lateral ventricle, as well. This may partially represent\ncontrast material, though hemorrhage may also be present. Punctate\nhyperdensity is seen in the region of the right occipital lobe (03:23) and may\nrepresent small focal hemorrhage. The basilar cisterns are not well assessed.\nA right frontal EVD is seen, terminating near the foramen of ___.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Significant metallic artifact from coils material severely limits study. \nHyperdense material, both parenchymal and intraventricular, is noted, and to\nsome extent, represents contrast material. Hemorrhage may also be present. \nFollow-up examinations can be obtained for further evaluation." + }, + { + "input": "No significant interval change. Substantial artifact from the embolization\nwith coils material limits detailed evaluation of the parenchyma. Within this\nlimitation, hyperdense, dependent material in the bilateral lateral ventricle\noccipital horns and body of the left ventricle is likely intraventricular\nhemorrhage, in addition to choroid plexus, similar to the prior exam. The\npunctate hyperdense focus in the right occipital lobe on the prior exam may\nstill be present but is less conspicuous secondary to streak artifact (series\n2, image 20). The course and placement of a right frontal approach extradural\nventricular catheter appears unchanged. The overall size and configuration of\nthe ventricles and sulci are unchanged.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "No significant interval change. Lateral intraventricular hemorrhage is\nunchanged." + }, + { + "input": "Substantial artifact from the embolization material limits detailed evaluation\nof the parenchyma. Within this limitation, hyperdense material in the\noccipital horn and body of the left lateral ventricle is likely\nintraventricular hemorrhage, in addition to choroid plexus, similar to the\nprior exam. The course and placement of a right frontal approach ventricular\ncatheter appears unchanged. The overall size and configuration of the\nventricles and sulci are unchanged.\n\nNo acute fracture seen. The imaged portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The imaged portion of the orbits\nare unremarkable.", + "output": "Previously seen intraventricular hemorrhage in the occipital horn of the right\nlateral ventricle is not definitively seen on this exam. Otherwise no\nsignificant change since earlier today at 06:21." + }, + { + "input": "Substantial streak artifact from the embolization collaterals markedly limited\nevaluation of the parenchyma. Within this confines, hyperdense layering\nmaterial in the bilateral occipital horns of the lateral ventricles and body\nof the left lateral ventricle is consistent with intraventricular hemorrhage,\nsimilar in size, if not smaller from the prior exam. Dilation of the lateral\nventricles may be minimally increased since the earlier exam on ___ but is\ndifficult accurately assess since the angulation is different. A right\nfrontal-approach external ventricular catheter drain appears to be similarly\npositioned, although the position of the tip is difficult to precisely assess\nwith the streak artifact. Hypodensities in the right frontal lobe surrounding\nthe course of the external drain is overall similar. No shift of normally\nmidline structures.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Exam markedly limited by streak artifact from the embolization material. \nBilateral, left greater than right intraventricular hemorrhages have not\nincreased. Persistent dilation of the bilateral ventricles, which may have\nslightly increased if at all, with overall similar position of the right\nexternal ventricular drain.\n2. No evidence of large territorial infarct." + }, + { + "input": "A right frontal approach ventriculostomy catheter tip ends in the region of\nthe foramen ___ at the midline and appears to be perhaps slightly\nadvanced since the prior exam. Substantial streak artifact from the\nembolization material again markedly limits detailed evaluation of the brain\nparenchyma and ventricles. Within this limitation, the overall size of the\nlateral ventricles appears slightly decreased compared to the prior exam. \nHowever, hyperdense material within both lateral ventricles, more so on the\nleft, appears to is increased from the prior exam, reflecting either\nredistribution of blood products or interval small amounts of hemorrhage,\nperhaps related to readjustment of the catheter. Otherwise, no significant\ninterval change.", + "output": "Markedly limited exam from artifact from embolization material, but interval\ndecrease in ventricle size with apparent increased small amounts of hemorrhage\nperhaps from readjustment of the ventriculostomy catheter versus redistributed\nhemorrhage.\n\nRECOMMENDATION(S): Close interval follow-up." + }, + { + "input": "Prior right frontal approach VP shunt catheter has been replaced by a right\nfrontal approach extraventricular drain, which terminates in the frontal horn\nof the right lateral ventricle. Degree and distribution of intraventricular\nhemorrhage, as well as the size of the ventricles, appear unchanged allowing\nfor the extensive streak artifact from embolization material related to the\ntreated vein ___ malformation. No acute hemorrhage is seen along the\nright frontal course of the new extraventricular drain. Where not obscured by\nstreak artifact, no parenchymal edema is seen. Partially visualized paranasal\nsinuses and mastoid air cells appear clear.", + "output": "The new right frontal approach extraventricular drain terminates in the\nfrontal horn of the right lateral ventricle. Intraventricular hemorrhage and\nventricular size appear unchanged allowing for the extensive streak artifact." + }, + { + "input": "Right frontal approach external ventricular drain terminates in the right\nfrontal horn. Left basal ganglia hemorrhage with intraventricular extension\nis similar in distribution and size. There is no relevant change in\nventricular size. Basal cisterns are patent. No evidence of new intracranial\nhemorrhage. No hemorrhage along the external ventricular drain. Embolization\ncoils and associated artifact are again seen.\n\nNo relevant changes in the right frontal burr hole defect.", + "output": "Stable left thalamic hemorrhage with intraventricular extension status post\nright frontal approach external ventricular drain." + }, + { + "input": "Embolization material in the region of the ___ severely limits\nevaluation of the surrounding brain parenchyma. Within these confines:\n\nRight frontal approach external ventricular drain again terminates in the\nright frontal horn. Surrounding brain edema pattern along the ventriculostomy\ntract has in decreased from prior examination. There is no hemorrhage along\nthe drain tract. Intraventricular hemorrhage predominantly in the body of the\nleft lateral ventricle, also seen in the left temporal and occipital horns,\nand a similar distribution to the prior study. Since the prior study, there\nhas been interval increase in ventricular size, particularly of the left\nfrontal horn, previously 8 mm, now 11 mm (04:19).\nNo evidence of new hemorrhage.", + "output": "1. Stable intraventricular hemorrhage, with increase in ventricular size,\nhowever no evidence of new hemorrhage.\n2. Stable position of right frontal approach external ventricular drain. \nThere is apparent increased surrounding brain edema along the tract without\nevidence of hemorrhagic transformation." + }, + { + "input": "Embolization material in the region of the ___ severely limits study. \nWithin these confines:\n\nRight frontal ventriculostomy tube terminates within the right lateral\nventricle, unchanged. Edema along the tract is unchanged with no new\nhemorrhage.\n\nLimited assessment of left lateral ventricle intraventricular hemorrhage is\nsimilar without evidence for worsening hemorrhage. The temporal horn of the\nleft lateral ventricle is increased compared with the prior study (03:15). \nThe frontal horn of the left right lateral ventricle appears increased\nmeasuring up to 12 mm, compared with 6 mm previously (03:25). The temporal\nhorn of the right lateral ventricle is significantly increased compared with ___ (03:20 compared with 03:14 on the previous study), difficult to\ncompare with ___ due to streak artifact. The basal cisterns appear\npatent. No definite new subarachnoid or subdural hemorrhage is identified.", + "output": "1. AVM embolization material streak artifact severely limits study.\n2. Interval increase in size of the bilateral lateral ventricles, particularly\nthe frontal and temporal horns on the right and the temporal horn on the left.\nThe basal cisterns appear patent. Evaluation of this region is limited due to\nsignificant streak artifact.\n3. Grossly stable positioning of right frontal ventriculostomy with associated\nparenchymal edema along the tract.\n4. Grossly stable left lateral ventricle intraventricular hemorrhage.\n5. No definite new hemorrhage, midline shift, or edema.\n\nRECOMMENDATION(S): The findings were discussed with ___, N.P. by\n___, M.D. on the telephone on ___ at 3:56 ___, 5 minutes\nafter discovery of the findings." + }, + { + "input": "Embolization material in the region of the vein ___ severely limits the\nstudy. The right frontal approach ventriculostomy to again is seen\nterminating within the right lateral ventricle in unchanged position in the\nfrontal horn. There is new and pneumocephalus within the right lateral\nventricle (04:16). There is grossly stable appearance of dilatation of the\nlateral ventricles there is roughly stable appearance of the hemorrhage in the\nleft lateral ventricle. The basal cisterns appear patent. There is no\ndefinite new hemorrhage.", + "output": "1. AVM embolization material causes streak artifact severely limiting the\nstudy.\n2. Stable appearance of left lateral ventricle intraventricular hemorrhage.\n3. Roughly stable size of dilated lateral ventricles.\n4. Stable positioning of right frontal approach ventriculostomy catheter\nterminating in the right lateral ventricle frontal horn. New pneumocephalus\nwithin the right lateral ventricle." + }, + { + "input": "As on prior exam, artifact in the region of the vein ___ from\nembolization material severely limits the current study. Within limitation,\nthe right frontal approach ventriculostomy catheter is re-identified with a\nsimilar course to prior, terminating in a similar position in the right\nlateral ventricle. There has been a significant interval increase in the\ncaliber of the lateral ventricles, currently measuring 4.7 cm at the level of\nthe catheter entry into the right lateral ventricle (series 3, image 21),\ncompared with 3.7 cm previously at this level on ___, along with more\nmarked dilation of the temporal horns of the lateral ventricles (for example\nsee series 3, image 9). There is been an interval decrease in the amount of\nacute blood products seen layering in the occipital horn of the left lateral\nventricle (series 3, image 14). No new hemorrhage is identified. There has\nbeen interval resolution of trace right sided pneumocephalus. Within\nlimitation, there is no evidence of infarction. The basal cisterns are\npatent. There is no apparent shift of normally midline structures. The\nimaged paranasal sinuses and mastoid air cells are clear. The globes and bony\norbits are intact and unremarkable.", + "output": "1. Interval worsening of severe hydrocephalus.\n2. Stable configuration of the right frontal approach ventriculostomy\ncatheter, again seen terminating in the right lateral ventricle.\n3. Decreased acute blood products layering dependently in the occipital horn\nof the left lateral ventricle. No definite new hemorrhage seen, although\nstudy is significantly limited by extensive streak artifact for embolization\nmaterial near the vein of ___.\n\nNOTIFICATION: The findings were discussed with ___, N.P. by\n___, M.D. on the telephone on ___ at 3:56 ___, 10 minutes\nafter discovery of the findings." + }, + { + "input": "Artifact from prior embolization limits the current study.\n\nAgain seen is a right frontal ventriculostomy catheter terminating in the\nright lateral ventricle, similar in course to prior. The lateral ventricles\nmay have slightly decreased in size compared to prior study. There may be a\nslight increase or redistribution of blood products in the occipital horn of\nthe left lateral ventricle. No new areas of hemorrhage. There is no evidence\nof infarction. The basal cisterns are patent. There is no midline shift.\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Persistent acute hydrocephalus, perhaps slightly decreased since prior\nstudy.\n2. Slight increase or we distribution of the previously seen blood products\nin the occipital horn of the left lateral ventricle. No new areas of\nhemorrhage." + }, + { + "input": "Limited evaluation of the brain parenchyma secondary to significant streak\nartifact from presumed coils from prior AVM intervention.\n\nA right frontal approach ventriculoperitoneal shunt terminates in the frontal\nhorn of the right lateral ventricle. There is no evidence of infarction,\nhemorrhage or mass. The ventricles are moderately enlarged, of unknown\nchronicity given lack of prior examinations for comparison.\n\nNo osseous abnormalities seen. There is mild mucosal thickening of the\nposterior ethmoidal air cells. There is mild opacification of the left\nmastoid air cells. The remaining paranasal sinuses, right mastoid air cells,\nand middle ear cavities are clear. The orbits are unremarkable.", + "output": "Limited examination secondary to streak artifact from presumed coils from\nprior AVM intervention. Moderate enlargement of the ventricles is of unknown\nchronicity given lack of prior examinations for comparison. Otherwise, no\nacute intracranial abnormalities identified." + }, + { + "input": "Severe streak artifact from the known prior embolization coils, exacerbated by\nincreased patient head rotation, severely limits this study, rendering this\nstudy almost nondiagnostic.\n\nThe known right ventriculostomy catheter appears unchanged in course. The\nlateral ventricles are not visualized. Additionally, the occipital horns of\nthe lateral ventricles are not visualized. There is apparent decrease size of\nthe visualized left temporal horn (series 4, image 9) when compared to prior\nexamination. No evidence of effacement of the visualized basal cisterns. No\nevidence of new hemorrhage on these limited images.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "Severe streak artifact from the known prior embolization coils, exacerbated by\nincreased patient head rotation, severely limits this study, rendering this\nstudy nearly nondiagnostic.\n\n1. No apparent change in the course of the right ventriculostomy catheter. \nThe visualized left temporal horn appears significantly decreased in size from\nprior examination (series 4, image 9) when compared to examination of ___ on series 3, image 18). The lateral ventricles are not visualized. \nRepeat examination is recommended.\n\n2. No evidence of new hemorrhage." + }, + { + "input": "There is no significant interval change. Multiple artifacts limit the\nevaluation. The ventricular size is unchanged. Right frontal shunt catheter\ntip is in the anterior horn of the right lateral ventricle. Surrounding\nhypodensity in the right frontal lobe is unchanged. Temporal horns are not\nenlarged. Basal cisterns are patent.", + "output": "No evidence of hydrocephalus or hemorrhage within the limitations of metallic\nartifacts" + }, + { + "input": "There is an approximately 2.8 x 2.1 cm area of intraparenchymal hemorrhage\ncentered in the left thalamus with intraventricular extension of hemorrhage\ninto all of the ventricles. The lateral ventricles are dilated and there is\n8 mm of shift to the right of normally midline structures. There is no\nevidence of acute large territorial infarction. The basal cisterns are patent.\n\nIncidental note is made of a partially empty sella. There is no evidence of\nfracture. There is a mucous retention cyst in the right maxillary sinus. The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are otherwise clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Left thalamic intraparenchymal hemorrhage with intraventricular extension\nand dilatation of the supratentorial ventricles.\n2. 8 mm of rightward shift of normally midline structures." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nSince the recent CT performed earlier on the same date, there has been\ninterval placement of a right frontal approach ventriculostomy catheter which\nterminates near the lateral part of the frontal horn of the right lateral\nventricle. Small amount of blood products is seen along the tract (3:13). \nVentricles remain enlarged, but grossly similar in size compared to the prior\nstudy.\n\nAgain noted is a large intraparenchymal hemorrhage centered within the left\nthalamus that measures approximately 2.9 x 2.2 cm. There is extensive\nintraventricular extension with hemorrhage noted throughout all visualized\nventricles. Otherwise no new foci of intraparenchymal hemorrhage. No\nevidence of acute major vascular territorial infarction.\n\nIncidentally noted is a partially empty sella.\n\nMucous retention cyst is noted in the right maxillary sinus. Remainder of the\nvisualized paranasal sinuses, mastoid air cells and middle ear canals are\nclear. Orbits are unremarkable.\n\nCTA HEAD:\nThe ACAS and MCAs are normal bilaterally, without evidence of stenosis or\naneurysm formation.\n\nThere are multiple engorged arterial structures and veins, including a\nprominent left PCA, that appears to be located in the quadrigeminal cistern\n(603b:35) although exact location is difficult to accurately discern. \nTherefore, it is unclear if a true nidus is present. This is most likely the\nsource of patient's hemorrhage.\n\nCTA NECK:\nAtherosclerotic calcifications are noted at the proximal internal carotid\narteries bilaterally, resulting in mild ICA stenosis on the right. Remainder\nof the internal carotid arteries are patent bilaterally. The vertebral\narteries and their major branches appear normal with no evidence of stenosis\nor occlusion.\n\nOTHER:\nThe patient is intubated. An enteric tube is partially visualized within the\nesophagus. The main pulmonary artery measures up to 4.1 cm in diameter (5:4),\nsuggestive of underlying pulmonary arterial hypertension. There is\nconsolidation in the left upper lobe, which has the appearance of atelectasis.\nThyroid gland is heterogeneous in appearance, but no discrete nodules\nidentified. There is no lymphadenopathy by CT size criteria.", + "output": "1. Prominent arteries and veins in what appears to be the quadrigeminal\ncistern, suggesting either an arteriovenous malformation or arteriovenous\nfistula. This can be better assessed with cerebral angiogram.\n2. Resulting large left thalamic intraparenchymal hemorrhage is overall\nsimilar in appearance compared to the prior study performed earlier on the\nsame date. Extensive intraventricular hemorrhage is unchanged.\n3. Interval placement of a right frontal approach ventriculostomy catheter,\nterminating near the lateral frontal horn of the right lateral ventricle. \nOverall similar extent of obstructive hydrocephalus.\n4. Enlarged pulmonary artery measuring up to 4.1 cm in diameter, suggestive\nof underlying pulmonary arterial hypertension.\n\nRECOMMENDATION(S): Further evaluation with cerebral angiogram." + }, + { + "input": "Allowing for differences in head position, there has been no significant\ninterval change in size of the large left thalamic intraparenchymal\nhemorrhage, which measures approximately 2.9 x 2 cm. Intraventricular\nextension of hemorrhage is seen within all the ventricles. Subarachnoid\nredistribution is most notable along the right frontal lobe. Patient is\nstatus post placement of a right frontal approach ventriculostomy catheter,\nwhich ends in the frontal horn of the right lateral ventricle. Blood products\nare seen along the ventriculostomy catheter tract. The lateral ventricles\nremain dilated, although direct comparison of ventricular size is difficult\ngiven differences in head position. Rightward shift of the normally midline\nstructures is grossly unchanged. The basal cisterns appear patent. \nIncidental note is made of a partially empty sella.\n\nNo fracture. A mucous retention cyst is seen within the right maxillary\nsinus. Remaining visualized paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The globes are unremarkable.", + "output": "1. Allowing for differences in head position, there has been no significant\ninterval change in the size of the large left thalamic intraparenchymal\nhemorrhage. There is intraventricular extension of hemorrhage into all the\nventricles. Subarachnoid redistribution is most notable along the right\nfrontal lobe. No new foci of hemorrhage.\n2. Status post placement of a right frontal approach ventriculostomy catheter,\nwith blood products seen along catheter tract. The catheter ends in the\nfrontal horn of the right lateral ventricle. Ventricular size appears grossly\nunchanged, allowing for differences in head position. Basal cisterns are\npatent." + }, + { + "input": "A frontal approach ventriculostomy catheter ends in the frontal horn of the\nright lateral ventricle, unchanged. Ventricular size has decreased now\nmeasuring approximately 2.1 cm along the frontal horns. There remains\nextensive intraventricular hemorrhage which has redistributed with more now\nlocated in the occipital horns of the bilateral lateral ventricles. \nIntraventricular hemorrhage is still seen extending into the fourth ventricle\nand suprasellar cistern. Although the basilar cisterns remain patent. There\nis minimal high density along the proximal ventriculostomy catheter site\nlikely representing a small amount of blood (series 601b, image 42),\nunchanged. In addition, subarachnoid blood most pronounced in the right\nfrontal lobe is also unchanged. There is no significant shift of midline\nstructures. No new areas of hemorrhage are identified.\n\nThere is no acute osseous abnormality. Mucosal thickening is seen in the\nright maxillary sinus, unchanged. The remainder of the paranasal sinuses are\nclear. The globes are unremarkable.", + "output": "1. Right frontal approach ventriculostomy catheter unchanged in position with\ninterval decrease in ventricular size compared to prior CT. Small amount of\nhemorrhage along the catheter track is unchanged.\n2. Redistribution of an of a extensive intraventricular hemorrhage and\nsubarachnoid hemorrhage since prior. No new areas of hemorrhage identified." + }, + { + "input": "A frontal approach ventriculostomy catheter ends in the frontal horn of the\nright lateral ventricle. Re-demonstrated are the extensive bilateral\nintraventricular hemorrhages in the lateral ventricles, third ventricle, and\nsuprasellar cistern with dependent layering.\n\nThere has been interval development of hydrocephalus in the lateral ventricles\nwith increased dilation of ventricular size from previously measured 2.1 cm to\n5 cm. Both the third ventricle and the bilateral temporal horns of the\nlateral ventricles appear more prominent than seen on prior exam from ___, further indicating dilatation. There is effacement of the sulci\ndiffusely surrounding the lateral ventricles. There is some interval\nimprovement of the intraventricular hemorrhage in the fourth ventricle. There\nare no new bleeds or infarcts.\n\nA burr hole is visualized in the right frontal skull. The visualized portion\nof the paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. Interval increase in lateral ventricular size from previously measured 2.1\ncm to 5 cm, with concern for developing hydrocephalus.\n2. Redemonstrated extensive bilateral intraventricular hemorrhages in the\nlateral ventricles, third ventricle, suprasellar cistern with dependent\nlayering. No new bleeds or infarcts seen.\n3. Interval improvement in intraventricular hemorrhage in the fourth\nventricle.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\n___ on the telephone on ___ at 2:03 ___, 8 minutes after discovery\nof the findings." + }, + { + "input": "There has been interval repositioning of the right frontal approach\nventriculostomy catheter, which now terminates near the right foramen of\n___. Small amount of blood products along the course of the catheter are\nunchanged. The third ventricle remains dilated and filled with hemorrhage,\nwithout change. The lateral ventricles are minimally larger. Blood within\nthe lateral ventricles, right greater than left, is unchanged. Left thalamic\nhemorrhage is also stable. No new foci of hemorrhage are identified. Diffuse\nsulcal effacement and mild effacement of the basal cisterns are unchanged No\nCT evidence for an acute major vascular territorial infarction is seen.\n\nThere is trace fluid in the dependent left mastoid air cells, likely secondary\nto prolonged supine positioning in the inpatient setting. Right mastoid air\ncells and the partially included paranasal sinuses are grossly well-aerated.", + "output": "1. The right frontal approach EVD catheter now terminates near the right\nforamen of ___. The third ventricle remains dilated and filled with blood. \nThe lateral ventricles have slightly increased in size, with unchanged blood\nproducts.\n2. Stable left thalamic hemorrhage.\n3. Persistent diffuse sulcal effacement and mild effacement of the basal\ncisterns.\n\nNOTIFICATION: Wet read findings were discussed with Dr. ___ by Dr. ___\ntelephone at 19:25 on ___, 5 min after discovery." + }, + { + "input": "Compared with the CT from 7 hr earlier, there has been no change in the\nposition of the right frontal approach ventriculostomy catheter, which\nterminates near the right foramen of ___. The third ventricle remains\ndistended and filled with blood, unchanged. Dilatation of the lateral\nventricles is also unchanged, and blood within the right greater than left\nlateral ventricles is likewise unchanged. Left thalamic hemorrhage is stable.\nDiffuse sulcal effacement and mild effacement of the basal cisterns is\nunchanged. No acute major vascular territorial infarction is seen. \nCerebellar tonsils are normally positioned.\n\nThere is a partially visualized mucous retention cyst in the lower portion of\nthe right maxillary sinus, not included in the field of view of the prior\nscan. A left posterior ethmoid air cell is almost completely opacified,\nunchanged. There is trace fluid in the left mastoid air cells, unchanged,\nlikely secondary to prolonged supine positioning in the inpatient setting.", + "output": "Left thalamic hemorrhage, intraventricular hemorrhage, ventricular dilatation,\nand position of the intraventricular drain are unchanged compared to 7 hr\nearlier.\n\nNOTIFICATION: The above findings were communicated via telephone by Dr.\n___ to ___ from Neurosurgery at 02:08, immediately after discovery." + }, + { + "input": "Comparison to the most recent CT from approximately 14 hr earlier is limited\nby differences in patient head position. No definite change in dilatation of\nthe lateral and third ventricles is seen. The third ventricle remains filled\nwith blood. Blood in the right greater than left lateral ventricles has not\nsignificantly changed. Right frontal approach EVD catheter terminates near\nthe right foramen of ___, as before. Minimal blood products and\npneumocephalus along the right frontal path of the catheter are unchanged.\n\nLeft thalamic hemorrhage with mild surrounding edema is unchanged. No new\nhemorrhage or edema is seen.\n\nSmall amount of fluid in the dependent left mastoid air cells is again seen. \nFluid in the nasopharynx has increased, now extending into the posterior nasal\ncavity. These findings are likely secondary to prolonged supine positioning in\nthe inpatient setting.", + "output": "1. Unchanged appearance of intraventricular hemorrhage and hydrocephalus. \nStable position of the EVD catheter.\n2. Unchanged left thalamic hemorrhage." + }, + { + "input": "Head CT: An intraparenchymal hemorrhage is again seen in the left frontal\nlobe measuring approximately 7.6 x 5.1 cm, similar to prior exam. Blood is\nseen extending into the occipital horns of the bilateral lateral ventricles\nand the third ventricle, similar to prior exam. Extension of blood products\nis again seen into the subarachnoid space, best visualized in the sulci of the\nright cerebral hemisphere. The sulci of the left cerebral hemisphere are\ncompletely effaced by edema associated with intraparenchymal bleed, similar to\nprior exam. There is 5 mm of rightward midline shift and effacement of the\nfrontal horns of the bilateral lateral ventricles, unchanged from prior exam. \nThe basal cisterns appear patent. No fractures are identified.\n\nHead CTA: There is a 5 mm aneurysm at the bifurcation of the left internal\ncarotid artery. There are no other intracranial vascular abnormalities.\n\nNeck CTA: The carotid and vertebral arteries and their major branches are\npatent with no evidence of stenoses. There is no evidence of internal carotid\nstenosis by NASCET criteria. Opacities with air bronchograms are seen in the\nbilateral lung apices, concerning for bilateral pneumonia.", + "output": "1. Intraparenchymal hemorrhage and left frontal lobe with extension into the\nventricles and subarachnoid space, similar to prior exam.\n\n2. Edema in the left cerebral hemisphere with effacement of the frontal horns\nof the bilateral lateral ventricles and 5 mm midline shift, similar to prior\nexam.\n\n3. 5 mm aneurysm at the bifurcation of the left internal carotid artery.\n\n4. Opacities with air bronchograms in the bilateral lung apices, concerning\nfor bilateral pneumonia." + }, + { + "input": "Head CT: Postsurgical changes following left frontotemporal craniotomy with\nhematoma evacuation and left ICA aneurysm clipping are present, with a small\namount of frontal pneumocephalus, but no significant change in local mass\neffect or shift of the normally midline structures. Subarachnoid hemorrhage\nalong the right parieto-occipital cortical convexity, as well in the third\nventricle, and layering in the occipital horns of the lateral ventricles is\nunchanged. There is no interval change in ventricular size. No new area of\nhemorrhage is identified. There is no evidence of acute infarction.\n\nHead CTA: There is no evidence of vasospasm or vessel occlusion.", + "output": "1. Extensive postoperative change related to left temporal craniotomy for\nhematoma evacuation and left ICA aneurysm clipping.\n2. No change in mass effect or extensive subarachnoid hemorrhage since the\nprior study.\n3. No evidence of vasospasm or vessel occlusion in the principal intracranial\narteries." + }, + { + "input": "Postsurgical changes from left frontotemporal craniotomy and left ICA aneurysm\nclipping are again noted. There has been interval decrease in pneumocephalus.\nThe amount of residual intraparenchymal hemorrhage in the left frontal lobe is\nunchanged, as is surrounding edema. There is persistent 6 mm rightward shift\nof midline structures. Subarachnoid blood along the right parietoccipital\nconvexity is stable. Blood is again seen in the occipital horns of the\nlateral ventricles, slightly decreased on the right but stable on the left,\nand in the anterior body of the left lateral ventricle. The ventricles are\noverall stable in size. No new hemorrhage is seen.\n\nThere is mild mucosal thickening of the sphenoid sinuses and partially\nvisualized maxillary sinuses. Aerosolized secretions in the left sphenoid\nsinus and layering fluid in bilateral mastoid air cells are likely secondary\nto endotracheal intubation.", + "output": "Interval decrease in pneumocephalus. Stable left front intraparenchymal\nhemorrhage and right subarachnoid hemorrhage. Slightly decreased\nintraventricular blood." + }, + { + "input": "Head CT: Again noted are postsurgical changes of left pterional craniotomy\nand left middle cerebral artery aneurysm clipping. Postoperative\npneumocephalus has decreased. Hemorrhage and surrounding edema in the left\nfrontal lobe are unchanged from CT on ___. Compression of the left\nfrontal horn 5-6 mm rightward midline shift are unchanged. The ventricles are\nstable in size. There has been a decrease in the amount of intraventricular\nhemorrhage within the left lateral ventricle and bilateral occipital horns. \nScattered subarachnoid hemorrhage in the cerebral hemispheres is not\nsignificantly changed.\n\nThere is mild debris in the ethmoid and sphenoid sinuses. There is mild\nmucosal thickening of the maxillary sinuses. There is moderate fluid in the\nmastoid air cells bilaterally.\n\nHead CTA: Metallic artifact from an aneurysm clip limits evaluation of the\nleft proximal middle cerebral artery. There is narrowing of the M1 segments\nof both middle cerebral arteries and A1 and A2 segments of both anterior\ncerebral arteries, consistent with a vasospasm. This is new from CTA on ___. There is no vessel cut off.\n\nThe V4 segments of the vertebral arteries and superior cerebellar arteries\nalso appear thin in caliber, although this is unchanged from initial CTA on ___.", + "output": "1. Narrowing and irregularity of the M1 segment of the left middle cerebral\nartery and A1 and A2 segments of both anterior cerebral arteries, consistent\nwith vasospasm. This is new from prior CTA on ___.\n2. No evidence of an acute infarct.\n3. Stable left frontal lobe hematoma and scattered subarachnoid hemorrhage. \nIntraventricular hemorrhage demonstrates expected evolution with decreased\nhyperdense clot in the ventricles. Stable ventricle size.\n4. Postsurgical changes of ICA terminus aneurysm clipping." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Mild prominence of the ventricles and sulci is consistent with\nage related changes. The imaged paranasal sinuses are clear. Mastoid air\ncells and middle ear cavities are well aerated. The bony calvarium is intact.\nSoft tissue swelling and hematoma within the right parietal scalp is noted.", + "output": "Soft tissue swelling overlying the right parietal scalp. No evidence of\nacute fracture or intracranial hemorrhage." + }, + { + "input": "Noncontrast. Head CT shows extensive subcortical white matter changes\npredominantly in the left hemisphere, and small areas of low attenuation\nsuggesting a combination of chronic lacunar ischemic changes and small vessel\ndisease. There is no evidence of acute intracranial hemorrhage. Moderate to\nsevere brain atrophy. Dense vascular arteriosclerotic calcifications are seen\nin the carotid siphons, vertebral and basilar arteries. The paranasal sinuses\nare clear, however tear is minimal mucosal thickening on the left maxillary\nsinus with atelectatic configuration, suggestive of chronic sinusitis.\n\nCTA of the head and neck.\n\nLow attenuation is noted in the area of the left ventricle, probably\nconsistent with thickened myocardium, measuring 6 cm in transverse dimension,\ncorrelation with CT of the chest is advised. The patient is status post CABG,\narteriosclerotic calcifications are seen in the aortic arch. The origin of the\ncommon carotid arteries appears patent.\n\nOn the curved reformations the inner lumen of the right internal carotid\nartery at the level of the bifurcation measures approximately 6.7 mm, and\ndistally 3.6 mm, with no evidence of significant stenosis.\n\nThe left cervical carotid bifurcation is notable for small normal of\nconcentric plaque and soft plaque material, the inner lumen measures\napproximately 5.4 mm and distally 4.8 mm with no evidence of significant\nstenosis.\n\nThere is narrowing of the origin of the right vertebral artery with a small\ncalcified plaque (image 1, series 458), additionally tandem plaques are\nvisualized at the level of the V3 segment.\n\nThe left vertebral artery demonstrates small punctate calcification at the V2\nlevel, and significant narrowing of the V3 segment and probable occlusion at\nthe vertebrobasilar junction ___ termination.\n\nThe intracranial circulation demonstrates segmental narrowing throughout the\nbasilar artery with poststenotic dilatation in the mid segment of the basilar\nartery and bellow the basilar bifurcation.\n\nThere is dolichoectetic aneurysm of the supraclinoid left internal carotid\nartery. Extensive atherosclerotic disease of the intracranial vasculature is\nalso seen with irregularity of the middle cerebral arteries and basilar\nartery. There is a focal outpouching of the mid basilar artery indicates\ndolichoectasia.\n\nMultilevel degenerative changes are present throughout the cervical spine,\nmore severe from C3/C4 through C6/7 levels.", + "output": "1. Extensive areas of low attenuation are demonstrated in the subcortical and\nperiventricular white matter, which are nonspecific and may represent changes\ndue to small vessel disease, additionally lacunar ischemic changes are\npresent, prominent ventricles and sulci suggest atrophy.\n\n2. Dolichoectetic aneurysm of the supraclinoid left internal carotid artery.\nExtensive atherosclerotic disease of the intracranial vasculature is also seen\nwith irregularity of the middle cerebral arteries and basilar artery. There is\na focal outpouching of the mid basilar artery indicates dolichoectasia.\n\n3. In the partially visualized chest an approximately 6 cm hypodensity\nadjacent to the left side of the heart is incompletely evaluated. This could\nrepresent a pericardial cyst or a mass. Chest CT scan help for further\nassessment.\n\nCOMMUNICATION: These findings were communicated via phone call to Dr.\n___ by Dr. ___ on ___ at 10:10 a.m. after the 3D\nrendering reconstructions were completed.\n\nA preliminary report was provided by Dr. ___ on ___." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The previously\ncharacterized right inferior cerebellar infarcts are better evaluated on prior\nMR head performed on ___. The ventricles and sulci are stable in\nsize and configuration.\n\nA small mucous retention cyst is re-demonstrated in the left maxillary sinus. \nThere is moderate mucosal thickening of the left sphenoid sinus. Otherwise,\nthe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid arteries and their major branches appear normal with no evidence\nof stenosis or occlusion. There is no evidence of internal carotid stenosis by\nNASCET criteria.\n\nSimilar to prior exam dated ___, the left vertebral artery is\ndominant. Again the right vertebral artery is small in caliber from its\norigin including the V1 and V2 portions. There is redemonstration of severe\nnarrowing and irregularity of the V3 segment of the right vertebral artery\nwith loss of opacification of the V4 segment, similar to prior exam, with\nretrograde filling distally. The findings are unchanged compared to prior\nexam. When compared to the prior MRI brain, there is high signal within the\nvisualized right vertebral artery to the mid V4 segment compatible with\nthrombosis.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Unchanged severe narrowing and irregularity of the V3 segment of the right\nvertebral artery with loss of opacification of the right V4 segment. There is\nretrograde filling of the right V4 segment. Findings remain consistent with\nsevere stenosis or thrombosis.\n2. Patent cervical carotid vasculature.\n3. Otherwise, patent circle of ___ with no other evidence of stenosis or\naneurysm formation.\n4. No evidence of infarction or hemorrhage." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles and\nsulci are normal in size and configuration.\n\nA small mucous retention cyst is demonstrated in the left maxillary sinus. \nOtherwise, the visualized portion of the paranasal sinuses, mastoid air\ncells,and middle ear cavities are clear. The visualized portion of the orbits\nare unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nAsymmetry of the vertebral arteries with left dominance is present. The right\nvertebral artery begins to slightly narrow as it enters the transverse foramen\nof C2 and becomes irregular and severely narrowed from the proximal V3 segment\nand distally to the origin of the right V4 segment where it does not opacify,\nexcept for the distal 4 mm which appears to fill in a retrograde fashion. The\nbasilar and posterior cerebral arteries are patent. These findings are highly\nsuspicious for right vertebral artery dissection with thrombosis resulting\nocclusion of the right V4 segment.\nOtherwise, the carotidandleft vertebral arteries and their major branches\nappear normal with no evidence of stenosis or occlusion. There is no evidence\nof internal carotid stenosis by NASCET criteria.\n\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Severe narrowing and irregularity of the V3 segment of the right vertebral\nartery with lost of intraluminal opacification of the V4 segment, except for\nretrograde filling distally, consistent with right vertebral artery\ndissection. The basilar and posterior cerebral arteries are patent.\n2. No evidence of intracranial hemorrhage, infarction, or mass." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nThere is calcification of the cavernous and supraclinoid internal carotid\narteries bilaterally as well as the intracranial vertebral arteries.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. There is\nbilateral exophthalmos with enlargement of the extra-ocular muscles most\ncharacteristic of thyroid eye disease. There is prominence of the superior\nophthalmic veins bilaterally. Patient is status post left lens replacement.\nNote is made of a 15 x 0.8 cm polyp along the left lateral aspect of the\nposterior vomer (2:6)", + "output": "No evidence of mass, hemorrhage or infarction.\nFindings suggesting thyroid eye disease.\nLeft nasal polyp." + }, + { + "input": "There is no evidence of fracture, infarction, hemorrhage, edema, or mass. \nThe ventricles and sulci are normal in size and configuration. There is no\nabnormal enhancement on post contrast images.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No CT evidence of metastases." + }, + { + "input": "The study is mildly limited by motion. there is no evidence of infarction,\nhemorrhage, edema,or definite mass. The ventricles and sulci are normal in\nsize and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no vascular territorial infarct, hemorrhage, mass effect, or\nabnormally enhancing lesion. There is lacunar infarct within the right\noccipital lobe. The ventricles, sulci and cisterns are appropriate for age.\n\nThere are no lytic or blastic lesions. The orbits, paranasal sinuses, and\nmastoid air cells are unremarkable.", + "output": "There is no evidence of metastatic disease by CT imaging." + }, + { + "input": "The aerodigestive tract is within normal limits, and without abnormal\nenhancement. The parapharyngeal fat is preserved. There is no discrete mass.\nNumerous enlarged and centrally necrotic lymph nodes are seen bilaterally in\nlevels III, IV and V. Diffuse mediastinal lymphadenopathy is better evaluated\non subsequent CT chest.\n\nBilateral parotid glands, submandibular glands and sublingual glands appear\nnormal. 6 mm right thyroid nodule is of doubtful clinical significance. \nMajor cervical vessels enhance normally.\n\nThe patient has had discectomy, anterior and interbody fusion at C4-5 and\nC6-7.", + "output": "Centrally necrotic cervical lymphadenopathy without a discrete primary\nmalignancy." + }, + { + "input": "Multiple foci of hypodensity involving the right post central gyrus, left\nfrontal lobe, left occipital lobe, and anterior right frontal lobe, as well as\nthe right cerebellar hemisphere, midbrain, and pons, correspond to edema\nsurrounding metastatic lesions on recent MR from ___. There is no\nnew focus of hypodensity to suggest acute infarct. No acute hemorrhage or\nmass effect is identified. Prominent ventricles and sulci are suggestive of\nage-related involutional change.\nThere is no evidence of fracture. There is a small mucous retention cyst in\nthe right sphenoid sinus. The other visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. No acute intracranial abnormality. Specifically, no acute hemorrhage or\nfracture.\n2. Multiple foci of hypodensity correspond to edema at related to multiple\nmetastatic lesions, better evaluated on MR from ___. No new focus\nof hyperdensity identified." + }, + { + "input": "There is no evidence of no evidence of infarction, hemorrhage, edema, or\nmass. The ventricles and sulci are normal in size and configuration. There is\npreservation of gray-white matter differentiation. The basal cisterns remain\npatent.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Unremarkable nonenhanced CT examination of the head.\n\nNOTIFICATION: Findings were conveyed by Dr. ___ to Dr. ___\ntelephone at 15:49 on ___." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, or acute major\nvascular territorial infarction. There is moderate prominence of the\nventricles and sulci suggestive of age-related involutional changes. \nModerately extensive periventricular, deep, and subcortical white matter\nhypodensities are nonspecific but likely reflect chronic small vessel disease.\nPunctate calcification is noted in right cerebellar hemisphere, compatible\nwith sequela of prior inflammation or trauma.\n\nThere is no evidence of fracture. There is mild mucosal thickening in the\nethmoid air cells. Moderate partial opacification of right mastoid air cells\nare noted. The patient is status post bilateral cataract surgery.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. Supratentorial white matter hypodensities are nonspecific but likely\nsequela of chronic small vessel ischemic disease in this age group.\n3. Moderate partial right mastoid air cell opacification." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Basilar cisterns are\npatent.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Bilateral maxillary, frontal sinuses and ethmoid air cell mucosal thickening\nis present. Left maxillary sinus mucous retention cyst versus polyp is\npresent. The ostiomeatal units are patent. The cribriform plates are intact.\nThere is no nasal septal defect. Leftward nasal septal deviation is present. \nBilateral concha bullosa noted. The anterior clinoid processes are not\npneumatized. The lamina papyracea are intact. The sphenoid sinus septum is\nmidline with insertion upon thesellar floor.\n\nLimited imaging of the brain demonstrates prominence of ventricles and sulci\nsuggestive of involutional changes. Atherosclerotic vascular calcifications\nare noted of bilateral cavernous portions of internal carotid arteries.", + "output": "1. Paranasal sinus disease as described.\n2. Leftward nasal septal deviation.\n3. Bilateral concha bullosa." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass. The ventricles and sulci are prominent, consistent with involutional\nchanges. Mild periventricular and subcortical white matter hypodensities are\nnonspecific but likely reflect the sequela of chronic microvascular\ninfarction.\n\nNo osseous abnormalities seen. There is a mucous retention cyst in the left\nmaxillary sinus. There is minimal mucosal thickening in the left maxillary\nsinus. Again seen are bilateral concha bullosa. The paranasal sinuses,\nmastoid air cells, and middle ear cavities are otherwise clear. Incidentally\nnoted bilateral scleral plaques. Mild atherosclerotic calcifications noted\nwithin the cavernous carotid arteries.", + "output": "No acute intracranial abnormality. No fractures." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, mass, mass effect or\nshifting of the normally midline structures. The ventricles and sulci are\nprominent suggesting cortical volume loss, likely age related and involutional\nnature. Periventricular and subcortical white matter hypodensities are\nnonspecific, likely sequela of chronic ischemic small vessel disease. \nPunctate vascular atherosclerotic calcifications are seen in the carotid\nsiphons bilaterally.\n\nThere is no evidence of fracture. Mild mucosal thickening of the ethmoid air\ncells and bilateral maxillary sinuses. Otherwise, the visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nSoft tissue within the left external auditory canal likely reflects cerumen. \nAside from scleral calcifications and a left lens replacement, the visualized\nportion of the orbits are unremarkable.", + "output": "1. There is no evidence of acute intracranial process or hemorrhage.\n\n2. Subcortical and periventricular areas of low attenuation are nonspecific\nand may reflect changes due to chronic small vessel disease." + }, + { + "input": "No evidence for large territorial infarction, hemorrhage, mass effect or\nmidline shift. The ventricles and sulci are prominent, consistent with age\nrelated involutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific but likely sequelae of chronic small vessel\nischemic disease.\n\nThere is a mucous retention cyst redemonstrated in the left maxillary sinus. \nOtherwise, the paranasal sinuses are clear. Patient is status post left lens\nreplacement.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are enlarged consistent with age related atrophy. \nPeriventricular and deep subcortical white matter hypodensities suggest\nchronic small vessel ischemic disease. The basal cisterns are patent.\nThere is no evidence of fracture. There is irregularity and chronic appearing\nfracture of the left lamina papyracea, similar in appearance to ___. There\nis mucosal thickening and fluid seen within the left maxillary sinus. There\nis sclerosis of the maxillary sinus walls bilaterally and the patient is\nstatus post endoscopic sinus surgery on the left. The globes are\nunremarkable.", + "output": "1. No acute intracranial process. Periventricular and deep subcortical white\nmatter hypodensities suggest chronic small vessel ischemic disease. If there\nis clinical concern for acute infarction, MRI is more sensitive.\n2. Chronic appearing deformity of the left lamina papyracea consistent with\nprior injury." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nNonspecific periventricular and deep subcortical white matter hypodensities\nmost likely represent moderate chronic small vessel ischemic disease.\n\nA chronic left orbital medial wall blowout fracture is unchanged from the\nprior study (3:9). Moderate to severe mucosal thickening of the left\nmaxillary sinus with mild mucosal thickening of the right maxillary sinus,\nsphenoid sinus, and anterior ethmoidal air cells is similar to the prior\nstudy. The visualized portion of the mastoid air cells and middle ear\ncavities are clear. Nonspecific soft tissue density in the external auditory\ncanals bilaterally likely represents cerumen. The visualized portion of the\norbits are unremarkable.", + "output": "1. No evidence of hemorrhage or infarction.\n2. Age-related involutional changes and nonspecific white matter hypodensities\nsuggesting moderate chronic small vessel ischemic disease." + }, + { + "input": "CTA NECK:\nThe right brachiocephalic and left common carotid arteries share a common\norigin, a normal anatomic variant. Moderate atherosclerotic calcifications\ninvolve the past the aortic arch. There are mild atherosclerotic\ncalcifications of the origins of the great vessels without stenosis.\n\nCalcified and noncalcified plaque cause mild, diffuse narrowing and\nirregularity throughout both common carotid arteries, which remain patent. \nThere is mild plaque without stenosis in the proximal left external carotid\nartery.\n\nCalcified and noncalcified plaque involves the right carotid bifurcation and\nproximal right internal carotid artery without evidence of stenosis by NASCET\ncriteria.\n\nCalcified and noncalcified plaque cause approximately 25% stenosis by NASCET\ncriteria of the left proximal internal carotid artery, slightly distal to the\nbifurcation.\n\nBoth cervical internal carotid arteries have a retropharyngeal course.\n\nThere are atherosclerotic calcifications at the origin of the right vertebral\nartery without stenosis. The right vertebral artery is dominant. There are\nscattered atherosclerotic calcifications throughout the course of the right\nvertebral artery without stenosis.\n\nCalcified and noncalcified plaque cause severe stenosis of the origin and left\nproximal V1 segment. There is moderate narrowing and irregularity of the left\nV2 segment secondary to atherosclerotic disease, with mild to moderate\nshort-segment focal stenoses at C5 and at C3.\n\nCTA HEAD:\nCalcified and noncalcified plaque cause moderate narrowing and irregularity of\nthe left petrous internal carotid artery on 2:225. The right petrous and\nbilateral cavernous internal carotid arteries are patent without evidence of\nstenosis or occlusion. Atherosclerotic calcifications cause mild-to-moderate\nstenosis of the bilateral supra clinoid internal carotid arteries, left\ngreater than right. There is mild narrowing and irregularity of the left\ndistal M1 segment. The right middle cerebral, left anterior cerebral,\nbilateral posterior cerebral, and basilar arteries are patent without evidence\nof stenosis or occlusion. The right A1 and A2 segments are patent. There is\nmild narrowing and irregularity of the right A3 segment.\n\nThe left V3 segment is mild-to-moderately narrowed and irregular secondary to\natherosclerotic disease. There is diffuse irregularity and moderate narrowing\nof the left V4 segment. The right proximal V4 segment demonstrates mild\ncalcifications without stenosis. Bilateral ___, AICA, and superior\ncerebellar arteries are visualized. Basilar and posterior cerebral arteries\ndemonstrate no flow-limiting stenosis.\n\nNo aneurysms are identified.\n\nOTHER:\nThere is minimal paraseptal emphysema at the right lung apex. Dependent\nground-glass densities in bilateral included upper lungs are compatible with\natelectasis. There is a spiculated subpleural nodular density in the left\nupper lobe measuring 9 x 4 mm on images 2:33-34, new compared to CT chest from\n___.\n\nA lobulated 2.6 x 3.6 x 4.5 cm hypodense nodule arising from the left thyroid\nlobe and isthmus, containing scattered calcifications, extends substernally\ninto the superior mediastinum. The right thyroid lobe is heterogeneous and\ncontains multiple small hypodense nodules. There is no lymphadenopathy by CT\nsize criteria.\n\nChronic, healed fractures of the right lateral second and third ribs are\nnoted. Multilevel degenerative changes of the cervical spine are noted.\n\nModerate mucosal thickening in the left maxillary sinus and mild mucosal\nthickening in the right maxillary sinus with thickening of the walls of the\nmaxillary sinuses, left greater than right, are unchanged from ___. Left greater than right maxillary sinus walls are thickened, indicating\nsequela of chronic sinusitis. A defect within the nasal septum is unchanged.\nThere are severe degenerative changes of the right temporomandibular joint.\nThe chronic there is also mild mucosal thickening in the left anterior ethmoid\nair cells and a small mucous retention cyst in the right sphenoid sinus. \nMastoid air cells are well aerated.\n\nLeft lamina papyracea chronic fracture is again noted. The patient is status\npost bilateral cataract surgery.", + "output": "1. Approximately 25% stenosis of the left proximal internal carotid artery by\nNASCET criteria.\n2. No evidence of right internal carotid artery stenosis by NASCET criteria.\n3. Severe stenosis of the origin of the left vertebral artery and left\nproximal V1 segment. Diffuse regularity and moderate narrowing of the V2\nsegment of the left vertebral artery, with short-segment moderate to severe\nfocal stenoses at C3 and C5. Diffuse irregularity of the left V3 and V4\nsegments with mild to moderately V3 and moderate V4 segment narrowing.\n4. Intracranial atherosclerotic disease causing moderate narrowing of the left\npetrous internal carotid artery, and mild-to-moderate narrowing of the\nbilateral supra clinoid internal carotid arteries, and mild narrowing of the\nleft distal M1 segment appears\n5. Multinodular goiter with a 4.5 cm dominant nodule extending from the left\nlobe and isthmus substernally into the superior mediastinum.\n6. 9 x 4 mm spiculated left upper lobe pulmonary nodule is new compared to CT\nchest from ___.\n\nRECOMMENDATION(S):\n1. Thyroid ultrasound is recommended according to the ACR guidelines, if not\npreviously performed elsewhere.\n2. Chest CT is recommended for comprehensive evaluation of the lungs.\n\nNOTIFICATION: The new pulmonary nodule and the recommendation for chest CT\nwere discussed with ___, M.D. by ___, M.D. on the\ntelephone on ___ at 9:40 AM, 10 minutes after discovery of the findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute intracranial hemorrhage, mass, mass effect or\nlarge territorial infarction. Periventricular and deep subcortical white\nmatter hypodensities are likely secondary to chronic small vessel ischemic\ndisease. A focal area of hypodensity within the right frontal lobe, series 3\nimage 17 is likely sequelae of a prior infarct. Mild prominence of ventricles\nand sulci is likely related to age related involutional changes.\n\nThere is moderate mucosal sinus thickening involving the left maxillary sinus.\nThe right maxillary sinus ethmoid air cells and frontal sinuses are clear. \nMinimal opacification is seen involving the left ethmoid air cells. Chronic\nleft medial orbital blowout fracture is overall similar to the prior exam\ngiven differences in acquisition technique. The patient is status post\nbilateral lens replacement surgery.\n\nCTA HEAD:\nExtensive calcifications are seen throughout the carotid siphons. Otherwise,\nthe vessels of the circle of ___ are unremarkable. There is no evidence of\nflow limiting stenosis or aneurysm. The posterior circulation appears to be\nwell preserved. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is a normal three-vessel arch. Moderate atherosclerotic disease is seen\nat the origins of the great vessels. Medialization a retropharyngeal course\nof the internal carotid arteries is seen. Mild-to-moderate atherosclerotic\ndisease is seen involving the left common and internal carotid arteries\nhowever without evidence of significant flow limiting stenosis. The right\ninternal carotid artery demonstrates at least 36% stenosis by NASCET criteria.\nThe origin of the left vertebral artery is occluded however appears to\nreconstitute at the level of C7/T1. The remainder of the course of the left\nvertebral artery is mildly diminutive in beaded likely secondary to\natherosclerotic disease. The V3 and V4 segment of the left vertebral artery\nalso is attenuated secondary to atherosclerotic disease. The right vertebral\nartery is dominant. Mild atherosclerotic disease is seen involving the right\nvertebral artery. The origin of the right vertebral artery is patent.\n\nOTHER:\nWithin the right upper lobe, it a minimally spiculated 1.4 x 1.1 cm nodule is\nseen, increased in size compared to the prior chest CT from ___ at\nwhich time this measured up to 0.9 cm. Left upper lobe nodule measures 6 mm x\n6 mm, unchanged compared to the prior CTA from ___ however was not\nseen on the prior chest CT from ___. Lobulated 2.5 x 4.3 cm\nhypodense nodule arising from the left thyroid lobe and isthmus with internal\nscattered calcifications extend substernally into superior mediastinum overall\nunchanged compared to the prior exam. Multiple small hypodense nodules of the\nright thyroid lobe are re- demonstrated.", + "output": "1. No definite evidence of an acute intracranial process however if there is\nfurther clinical concern for a acute stroke, an MRI may be more sensitive.\n2. Patent circle of ___.\n3. At least 36% stenosis of the right internal carotid artery by NASCET\ncriteria.\n4. Interval increase in size of a spiculated 1.4 cm right upper lobe nodule\ncompared to the prior chest CT from ___. A biopsy or PET-CT is\nrecommended to exclude malignancy.\n5. Unchanged left upper lobe 6 mm nodule.\n6. 4.3 cm dominant nodule in in unchanged multi nodular goiter extending from\nthe left lobe and isthmus of the thyroid substernally into the superior\nmediastinum. Thyroid ultrasound is recommended for further evaluation.\n7. Stable appearance of the severely stenotic origin of the left vertebral\nartery with diffuse irregularity and moderate narrowing of the V2 segment as\nwell as short segment moderate to severe focal stenoses at C3 and C 5. \nAttenuation of the V3 and V4 segments likely secondary to atherosclerotic\ndisease is also unchanged compared to the prior exam.\n\nRECOMMENDATION(S): 1. If there is further clinical concern for stroke, an\nMRI may be more helpful for further evaluation.\n2. Biopsy or PET-CT of right upper lobe spiculated lung nodule to exclude\nmalignancy.\n3. Thyroid ultrasound for further evaluation of large multinodular goiter to\nexclude malignancy." + }, + { + "input": "No hemorrhage, infarct, edema, or mass effect. Bilateral periventricular,\ndeep, subcortical white matter hypodensities are nonspecific but unchanged,\nlikely sequelae of chronic small vessel ischemic disease. Basal ganglia\ncalcifications are normal for the patient's age. Bilateral, symmetric\nprominence of the ventricles and sulci indicate cortical volume loss, likely\nage-related, unchanged.\n\nNo fracture. Left maxillary sinus is partially imaged with mucosal thickening\nand possibly aerosolized secretions suggesting component active sinusitis. \nHyperostosis of the maxillary sinus walls indicates a component of chronic\nsinusitis. Mucosal thickening of the right maxillary sinus is mild. The left\nostiomeatal unit at the level of the infundibulum is opacified. Deformity of\nthe left lamina papyracea appears chronic, unchanged. The orbits are\nunremarkable other than bilateral lens replacements. The remaining partially\nimaged paranasal sinuses and mastoid air cells are clear. The middle ear\ncavities are clear.", + "output": "1. No acute hemorrhage or fracture.\n2. Sequelae of chronic small vessel ischemic disease, unchanged.\n3. Cortical atrophy.\n4. Left predominant chronic sinusitis with possible active component.\n5. Chronic deformity of left lamina papyracea, unchanged." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass. Prominence of the ventricles and sulci appears unchanged and compatible\nwith age appropriate atrophy. Mild periventricular, subcortical, and deep\nwhite matter hypodensities remain nonspecific, but likely reflect the sequela\nof chronic microvascular infarction. Dense atherosclerotic calcifications are\nnoted involving the cavernous carotid arteries.\n\nThere is no evidence of acute fracture. Remote deformity of the left lamina\npapyracea is again noted. Hyperostosis of both maxillary sinus walls, more so\non the left, with mild mucosal thickening is likely related to chronic sinus\ninflammation. There is mild mucosal thickening within the right sphenoid\nsinus, and partial opacification of the right mastoid air cells, findings\nsuggestive of ongoing inflammation. The visualized portion of the remaining\nparanasal sinuses, left mastoid air cells, and middle ear cavities are clear. \nThe visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial hemorrhage or mass effect.\n2. Chronic small vessel ischemic changes.\n3. Mild paranasal sinus disease and partial opacification of the right mastoid\nair cells, findings which may suggest ongoing inflammation." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci are suggestive ofmoderate age-related\natrophy. Moderateperiventricular and subcortical white matter hypodensities\nare nonspecific, though likely sequelae of chronic small vessel ischemic\ndisease. There are several periventricular hypodensities similar to the\ndensity of CSF, reflective of likely small remote lacunar infarcts.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Unchanged moderate age-related atrophy and chronic small vessel ischemic\nchanges as described." + }, + { + "input": "Left peritonsillar swelling but no definite drainable fluid collection. Left\npalatine tonsillar swelling bulges into the oropharnyx and oral cavity. \nRetropharyngeal soft tissues are mildly thickened with thin ___ of low\ndensity posterior to thickened mucosa suggesting edema or ill-defined fluid\ncontent. Multiple prominent left-sided cervical lymph nodes are noted in\nprobably reactive. Mild to moderate soft tissue thickening tracks inferiorly\ninto left piriform sinus and intrudes slightly into the left supraglottic\narea. No radiopaque foreign body is identified. The cervical vasculature is\npatent. The visualized salivary glands are unremarkable. There is mild\nmucosal thickening of the right maxillary sinus. There is mild mucosal\nthickening as well as polypoid thickening of the left maxillary sinus. The\nremaining paranasal sinuses are clear. The mastoid air cells are clear. No\nacute osseous abnormality. No acute odontogenic process. No thyroid mass.\nThe visualized upper lungs are clear.", + "output": "Marked left peritonsillar swelling with soft tissue thickening tracking into\nthe left piriform sinus and with thickening and ill-defined retropharygneal\nsoft tissue thickening or fluid. Associated reactive left cervical lymph\nnodes." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal given age.\n\nThere is partial opacification of the bilateral left worse than right\nposterior ethmoid air cells. Remaining paranasal sinuses are clear. Mastoid\nair cells and middle ear cavities are well aerated. The bony calvarium is\nintact.", + "output": "No acute intracranial abnormality" + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nA diffuse heterogeneous and mottled appearance of the bones is consistent with\na reported history of multiple myeloma.. The paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality.\n\nMottled appearance of the calvarium, in keeping with known multiple myeloma." + }, + { + "input": "There is no evidence of acute territorial infarction, intracranial hemorrhage\nor intracranial mass.\n\nThe ventricles and sulci are normal in size and configuration.\n\nThere is mild mucosal thickening of the left sphenoid sinus and ethmoid air\ncells. The visualized portion of the remaining paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are normal.\n\nThere are multiple small lytic lesions in the calvarium, which are consistent\nwith multiple myeloma. The extracranial soft tissues are unremarkable. No\ncalvarial fracture is identified.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Mild periventricular white matter hypodensities consistent with\nchronic small vessel ischemic changes. Mildly prominent ventricles and sulci\nconsistent with age-related involutional changes.\n\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. Mild mucosal thickening of the ethmoidal air\ncells and left maxillary sinus. The mastoid air cells, and middle ear\ncavities are clear. The orbits suggest dysconjugate gaze versus volume\naveraging artifact.", + "output": "1. No acute intracranial abnormality.\n2. No evidence acute intracranial hemorrhage or fracture.\n3. Minimal nonspecific dysconjugate gaze versus volume averaging artifact.\n4. Paranasal sinus disease , as described." + }, + { + "input": "Head CT: There has been interval placement of a right frontal approach\nventriculostomy catheter. The tip of the catheter is in the left lateral\nventricle. There is increased blood in the ventricles as well as increased\nblood within the corpus callosum. Right greater than left subarachnoid\nhemorrhage is again noted and not significantly changed. The orbits are\nunremarkable. The paranasal sinuses and mastoid air cells are clear. The\ncalvarium and skullbase are intact appear the\n\nHead CTA: There is an unchanged 4 x 5 mm aneurysm of the anterior\ncommunicating artery. There is a hypoplastic left A1 segment. The main\nintracranial arteries are unremarkable without evidence of stenosis or\nocclusion.\n\nNeck CTA: There is calcification of the carotid bifurcations bilaterally.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\n\nThe thyroid gland is heterogeneous. Lung apices are clear. There are\ndegenerative changes in the spine.", + "output": "1. Interval placement of right frontal ventriculostomy catheter with tip in\nthe left lateral ventricle. There has been interval increase in\ninterventricular blood and blood within the corpus callosum. Subarachnoid\nhemorrhage appears unchanged.\n\n2. Unchanged 4 x 5 mm aneurysm of the anterior communicating artery." + }, + { + "input": "Intraventricular hemorrhage is more prominent compared with the prior exam,\nmost likely due to redistribution and placement of a VP shunt, with expected\ndecrease in mild ventriculomegaly. Diffuse areas of subarachnoid hemorrhage\nare essentially unchanged, with a few scattered areas that are more prominent\n(left frontoparietal (03:21), right frontal (03:21), right occipital (03:17)),\nlikely due to redistribution. No definite new subarachnoid or intraparenchymal\nhemorrhage. A small air-fluid level in the right maxillary sinus can be normal\nin the setting of an NG tube. The orbits are unremarkable.", + "output": "1. More prominent intraventricular hemorrhage likely due to redistribution and\nplacement of a VP shunt.\n2. Essentially unchanged diffuse subarachnoid hemorrhage." + }, + { + "input": "Head CT: Previously seen subarachnoid and intraventricular hemorrhage\ncontinues to redistribute without evidence of new bleeding. Ventriculomegaly\nis now mild, improved following placement of ventricular shunt. No fractures\nare identified.\n\nHead CTA: The left A1 segment caliber may be decreased compared with the prior\nstudy, however streak artifact from the adjacent coil severely limits this\nassessment (6:68). Distal flow is preserved and no other areas suggestive of\nvasospasm are identified. Assessment of the coiled aneurysm is significantly\nlimited by streak artifact. The densities surrounding the coil more closely\nmatch blood pool than metal, which may represent residual aneurysm lumen,\nalthough this may be entirely artifactual (6:71, 602b:19). If further\nassessment for residual aneurysm lumen is indicated, angiography or MRI would\nbe most useful. No new aneurysms or foci of hemorrhage are identified.", + "output": "1. Possible mild vasospasm of the left A1 segment, limited by adjacent streak\nartifact.\n2. Possible residual aneurysm lumen, also significantly limited by adjacent\nstreak artifact, angiography or MRI in would be best to assess for residual\nlumen if clinically warranted.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 6:49 ___, 49 minutes after the\ndiscovery of the findings." + }, + { + "input": "Head CT: Right trans frontal ventriculostomy shunt catheter, its tip\nterminating in the body of the left lateral ventricle is stable from prior\nexam. Beam hardening artifact from the A-comm aneurysm coil packing limits\nevaluation of the surrounding regions. However, there has been interval\ndecrease in extent of subarachnoid and intraventricular hemorrhages when\ncompared to examination of ___. There is no evidence of acute\ninfarct. Periventricular and subcortical white matter hypodensities are stable\nfrom prior exam, likely representing small vessel ischemic disease. There is\nno hydrocephalus. The basilar cisterns are patent.\n\nThe paranasal sinuses are essentially clear. Nasogastric and endotracheal\ntubes are noted. The orbits are unremarkable. The mastoid air cells and middle\near cavities are well pneumatized and clear. Patient is status post lens\nreplacements otherwise the orbits are unremarkable.\n\nHead CTA: As noted above, the patient is status post coiling of an A-comm\naneurysm. No aneurysms larger than 3 mm is noted. There is no evidence of\nconclusion. Again noted is bilateral A1 segment narrowing essentially\nunchanged in appearance from prior exams. Mild irregularity of the\npericallosal and close or marginal arteries are noted, unchanged dating back\nto examination of ___, (series 755, image 9) and not seen on\noriginal CTA of ___.", + "output": "1. Right trans frontal ventriculostomy shunt catheter is stable.\n2. Allowing for artifact from anterior communicating artery aneurysm coil\npacking, there is interval decrease in extent of subarachnoid and\nintraventricular hemorrhages.\n3. No acute infarct or new hemorrhages.\n4. Persistent narrowing of the bilateral A1 segments, which may represent mild\npersistent vasospasm.\n5. Mild irregularity of the callosum marginal and pericallosal arteries are\nnoted, unchanged since exam ___, which may also represent very\nmild vasospasm." + }, + { + "input": "Mild ventriculomegaly is mildly increased (with mild increase in the size of\nthe frontal and temporal horns compared to prio CTA; however, the gantry\nangulation is different for these studies and hence, slightly limited\ncomparison), however, not significantly changed from the prior study after\nclamping of the EVD.\nSubarachnoid and intraventricular hemorrhage decreased compared with the\nprior study.\nChronic appearing cortical infarction of the right frontal lobe is unchanged\ndating back to ___.\n\nNo osseous abnormalities seen.\nMild mucosal thickening is seen within the sphenoid sinus, and the left\nmastoid air cells are partially opacified.\nThe orbits are unremarkable.", + "output": "1. Mild ventriculomegaly, mildly increased compared to CTA study of ___\nthough not significant after clamping of the EVD. Limtied comparison due to\ntechnical differences.\n2. Correlate clinically and close followup as needed\n3. Interval decrease in extent of subarachnoid and intraventricular\nhemorrhage." + }, + { + "input": "Beam hardening artifact from an A-comm aneurysmal coil limits evaluation\nslightly.\n\nA right frontal approach ventriculostomy catheter is seen with the tip\nterminating in the body of the left lateral ventricle, and appears unchanged\nin position as compared to the prior study.\n\nAlthough direct comparison is difficult in the setting of differences in head\nposition, there is no significant interval change in the size of the bilateral\nlateral ventricles, which remain mildly enlarged.\n\nSubarachnoid and intraventricular hemorrhagic products continued to decrease\nas compared to the prior study. No new foci of hemorrhage are identified.\n\nThe mastoid air cells, middle ear cavities, and visualized paranasal sinuses\nare clear. The globes are unremarkable.", + "output": "1. Mild persistent ventriculomegaly, grossly stable from the prior study,\nalthough direct comparison is difficult given technical differences.\n\n2. Interval decrease in extent of subarachnoid and intraventricular\nhemorrhage." + }, + { + "input": "No acute intracranial hemorrhage, mass effect, shift of normally midline\nstructures.\nCoiled anterior communicating artery aneurysm is noted, with artifacts from\nthe coils, limiting assessment of the adjacent structures.\nThere is interval removal of the ventricular catheter, with increased size of\nthe lateral and the third ventricles compared to the recent study of ___.\nNow, there is moderate dilation of the lateral and the third ventricles,\nsimilar to the initial study of ___, and may relate to diffuse\nparenchymal volume loss or developing hydrocephalus.\nThere are periventricular and subcortical white matter hypodense foci,\nconfluent and discrete in the frontal and the parietal lobes on both sides,\nlikely nonspecific in appearance and also seen on the initial study.\nSmall hypodense focus is noted in the right thalamus/ adjacent part of the\ninternal capsule, similar to the prior study.\nNo suspicious osseous lesions are noted.\nThere is fluid in the left mastoid air cells.\nSphenoid sinus septation inserts towards the right carotid groove.", + "output": "Interval removal of the ventricular catheter, with moderate dilation and \nincrease in the size of the lateral and third ventricles, which can relate to\nbaseline parenchymal volume loss or developing hydrocephalus.\nCorrelate clinically to decide on the need for further workup or followup.\nNo new acute intracranial hemorrhage or mass effect.\nFluid in the left mastoid air cells.\nOther details as above." + }, + { + "input": "Patient is status post coiling of a A-comm aneurysm with significant beam\nhardening artifact at the skullbase and inferior brain. There has been\ninterval placement of a right frontal approach VP shunt terminating in the\nfrontal horn of the right lateral ventricle. The ventricle size is unchanged\ncompared to study from ___. There is no evidence of acute\ninfarction, hemorrhage, edema, or mass. Periventricular and subcortical white\nmatter hypodensities are nonspecific, but likely sequelae of chronic small\nvessel ischemic disease. A hypodensity is again seen within the right\nthalamus, likely an old lacunar infarct. The basal cisterns appear patent and\nthere is preservation of gray-white matter differentiation.\n\nNo osseous abnormalities seen. There is partial opacification of the right and\ncomplete opacification of the left mastoid air cells, likely related to prior\nintubation. The paranasal sinuses and middle ear cavities are clear. The\norbits are unremarkable.", + "output": "Status post placement of a right frontal approach VP shunt without significant\nchange in ventricle size since ___. No new hemorrhage." + }, + { + "input": "Right frontal approach VP shunt catheter enters the right lateral ventricle\nand terminates at the septum pellucidum, unchanged. The ventricles are\nunchanged in size compared to ___ (allowing for differences in\npositioning) and ___.\n\nA coil pack within the treated anterior communicating artery aneurysm is again\nseen, with associated streak artifact limiting evaluation at adjacent levels.\nThere is no evidence for acute hemorrhage or edema. Extensive areas of low\ndensity in the periventricular, deep, and subcortical white matter are again\nseen, likely sequela of chronic small vessel ischemic disease in a patient of\nthis age. Linear hypodensity along the path of the intraventricular catheter\nis unchanged compared to ___. A small focus of encephalomalacia in the\nposterior right frontal lobe is unchanged compared to the earliest available\nCT from ___, likely sequela of a prior small infarct.\n\nRight frontal burr hole is again seen. The imaged paranasal sinuses are well\naerated. Left mastoid air cells are partially opacified, similar to ___.", + "output": "Stable position of the right frontal approach VP shunt catheter. Stable size\nof the ventricles compared to ___ and ___. No evidence for\nacute abnormalities." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nlarge territorial infarction. The ventricles and sulci are normal in size and\nconfiguration. The basal cisterns appear patent and there is preservation of\ngray-white matter differentiation.\n\nNo acute fracture is seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The globes are intact.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute major infarction,hemorrhage,edema,or discrete\nmass. Periventricular and subcortical white matter hypodensities are\nnonspecific, probably represent sequela chronic small vessel disease. There\nis prominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute major infarction,hemorrhage,edema,or discrete\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Multiple hypodense lesion periventricular white matter\nare sequela of chronic small vessel ischemic disease. There is calcified\natherosclerosis at the cavernous portions of the bilateral carotid arteries.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "No evidence for acute intracranial hemorrhage, edema, mass effect, or loss of\ngray/white matter differentiation. Normal size of the ventricles, sulci, and\nbasal cisterns. Normal position of the cerebellar tonsils.\n\nThere is a small left frontal subgaleal hematoma extending to the left medial\nsupraorbital region. No evidence for intraorbital extension of hematoma. No\nevidence for a fracture in the calvarium, orbital walls, or other partially\nimaged upper facial bones.\nThere is polypoid mucosal thickening in the right frontoethmoidal recess\nextending into the inferior right frontal sinus. There is mild mucosal\nthickening and bilateral anterior ethmoid air cells. There is minimal mucosal\nthickening along the anterior wall of the right sphenoid sinus. Mastoid air\ncells and middle ear cavities are well aerated.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. Small left frontal subgaleal hematoma extending into the medial left\nsupraorbital region. No evidence for intraorbital extension or hematoma. No\nevidence for calvarial or orbital wall fracture." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nloss of gray/white matter differentiation. Ventricles, sulci, and basal\ncisterns are normal in size for age.\n\nThere is no evidence for a fracture or suspicious bone lesion. There is\nrightward deviation of the nasal septum with a small right nasal septal spur. \nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The orbits appear unremarkable on noncontrast CT.", + "output": "No evidence for acute intracranial hemorrhage or other acute intracranial\nabnormalities." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nBilateral basal ganglia calcifications are small.\n\nThere is no evidence of fracture. Mucosal thickening of the bilateral\nethmoidal air cells is mild-to-moderate. There is also mild mucosal\nthickening of the bilateral sphenoid sinuses and frontal sinus. The\nvisualized portion of the remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "No evidence of hemorrhage, infarct or fracture." + }, + { + "input": "CT HEAD: [ There is no hemorrhage, major vascular territory infarction, or\nmidline shift. Gray-white matter differentiation is preserved. Ventricles and\nsulci are symmetric and unremarkable.\n\nVisualized paranasal sinuses and mastoid air cells are clear.\n\nThere is a 4.6 x 1.3 x 0.8 cm extra-axial mass ventral to the brainstem and\nextending into the upper cervical spine posterior to the dense. There are\nprominent erosions within C1 at the insertion of the transverse ligament.\nThere is no evidence of osseous destruction of the dens.\n\nCTA HEAD: [] There is mild calcified plaque of the cavernous segments of the\nICAs. The anterior, and middle cerebral arteries are unremarkable. The\nposterior communicating arteries are not identified. There is a hypoplastic\nleft vertebral artery. The posterior circulation is otherwise unremarkable.", + "output": "No infarct, or hemorrhage on non contrast head CT.\n\nExtra-axial mass ventral to the brainstem and extending into the upper\ncervical spine may represent pannus. However, recommend further evaluation\nwith a cervical MRI with the following protocol: Field-of-view extending from\nthe sella to the C3 level with axial and sagittal T2, sagittal T2 ideal, axial\nT1 precontrast, sagittal T1 precontrast, axial T1 post contrast and sagittal\nT1 post contrast.\n\nUnremarkable head CTA without evidence of an aneurysm, stenosis or other\nvascular abnormality." + }, + { + "input": "HEAD CT: There is no evidence of acute intracranial hemorrhage, edema, mass\neffect or shift of normally midline structures. Mild periventricular white\nmatter hypodensities are compatible with sequela of chronic microvascular\nischemic disease. The gray-white matter interface is otherwise preserved\nwithout evidence of acute major vascular territorial infarct. The ventricles\nand sulci are prominent, consistent with age related parenchymal volume loss.\nThere is no evidence of hydrocephalus. The basal cisterns appear patent. The\norbits and globes are unremarkable. The imaged paranasal sinuses, middle ear\ncavities and mastoid air cells are clear bilaterally. The bony calvaria appear\nintact. Orthopedic hardware is partially imaged in the posterior upper\ncervical spine.", + "output": "No evidence of acute hemorrhage or major vascular territorial infarct." + }, + { + "input": "There is no evidence of acute large territory infarction,hemorrhage,edema, or\nmass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. Mild subcortical\nwhite matter hypodensities are nonspecific, however likely related to chronic\nsmall vessel disease.\n\nThere is no evidence of fracture. Unchanged 2.4 x 0.8 cm ovoid, sclerotic\nstructure arising from the inner table of the squamous portion of the left\ntemporal bone, which could represent an ossified meningioma or ossified dural\nplaque. The visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The lenses have been rib suspected. \nOtherwise, the visualized portion of the orbits are unremarkable.", + "output": "No evidence of hemorrhage, mass, fracture or infarction.." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, or\nedema. Prominent ventricles and sulci are associated with age related\ninvolutional change. There are areas of periventricular and subcortical white\nmatter hypoattenuation that are nonspecific but most likely represent chronic\nsmall vessel disease.\n\nThere is a grossly unchanged 2.5 x 0.9 cm ovoid sclerotic structure in the\ninner table of the squamous portion of the left temporal bone, which could\nrepresent an ossified meningioma or ossified dural plaque. The paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The patient is\nstatus post bilateral lens replacements.", + "output": "No evidence of acute intracranial abnormality including hemorrhage or\ncalvarial fracture." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. There is mild prominence of the ventricles and sulci suggestive of\ninvolutional changes. Faint periventricular white matter hypodensities are\nnonspecific but likely reflect the sequelae of chronic small vessel ischemic\ndisease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Bilateral lens\nreplacements are identified.", + "output": "1. No acute intracranial process.\n2. Mild age related involutional changes." + }, + { + "input": "There is no evidence of acute intracranial infarction,hemorrhage,edema,or mass\neffect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and deep subcortical white matter\nhypodensities suggest chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. A 2.5 x 0.7 cm ovoid, calcified\nstructure along the left temporal bone likely reflects a ossified meningioma\nor osteoma and is unchanged from ___.", + "output": "1. No acute intracranial process." + }, + { + "input": "There is no evidence of large territorial infarction, acute intracranial\nhemorrhage, edema, ornew mass. Mild prominence of ventricles and sulci is\nconsistent with age-related cortical volume loss. Periventricular,\nsubcortical and deep white matter hypodensities are likely sequelae of chronic\nsmall vessel ischemic disease. A ___ cisterna magna is again noted.\n\nNo acute osseous abnormalities seen. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are notable for bilateral lens replacement and a 0.6 x\n0.7 cm (03:15) (previously 0.7 x 0.5 cm) soft tissue lesion along the right\nsuperior rectus muscle. Calcification of bilateral cavernous portions of\ninternal carotid arteries is present.", + "output": "1. No acute intracranial process. Specifically no intracranial hemorrhage.\n2. 0.7 cm soft tissue lesion along right superior rectus muscle which is\nsimilar to ___ MR with differences likely related to imaging\nmodalities. On the previous MRI, this was thought to reflect either an\norbital hemangioma or venolymphatic malformation." + }, + { + "input": "There is no evidence of large territorial infarction, hemorrhage, edema, or\nmass effect. There is mild age related volume loss. Intracranial vascular\ncalcifications are noted.\n\nNo acute fracture is seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. Again noted is a soft tissue abnormality along\nthe right superior rectus muscle, which was previously felt to be a\nvenolymphatic malformation or orbital hemangioma. The patient is edentulous.", + "output": "1. No evidence of mass effect, given the limitations of a noncontrast\nenhanced examination. MRI is more sensitive in evaluating for metastatic\nlesions and can be considered if there is persistent clinical concern." + }, + { + "input": "There is no evidence of infarction, hemorrhage, or edema. There is a 10 x 7 mm\nsoft lesion medial to the right superior rectus muscle (series 3:image 11),\nwhich likely corresponds to the right orbital lesion seen on the ___\nbrain MRI (series 3, image 13 on the prior exam). The ventricles and sulci are\nnormal in size and configuration for age.\n\nNo osseous abnormalities seen, and there is no fracture. The mastoid air\ncells, and middle ear cavities are clear. The orbits are intact. Minimal\nbilateral maxillary sinus mucosal thickening is noted.", + "output": "1. No intracranial hemorrhage.\n2. Approximately 10 mm soft tissue lesion medial to the right superior rectus\nmuscle is better assessed on the prior dedicated orbits MRI.\n3. Paranasal sinus disease as described.\n\nRECOMMENDATION(S): The findings were discussed by Dr. ___ with ___ on\nthe telephone on ___ at 10:51 AM, 5 minutes after wet read request." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Prominent\nventricles and sulci are consistent with age-related involutional changes.\n\nNo osseous abnormality is seen. Mild mucosal thickening is seen within the\nbilateral maxillary sinuses. The other visualized paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. A soft tissue lesion measuring\n8 x 8 mm adjacent to the right superior rectus muscle (02:11) is again seen\nand unchanged.", + "output": "1. No evidence of mass effect or acute intracranial hemorrhage.\n2. Grossly stable soft tissue lesion adjacent to the right superior rectus\nmuscle.\n3. Unchanged age-related involutional changes and mild sinus disease.\n4. Within limits of this noncontrast exam, no definite intracranial mass\nidentified. Please note MRI of the brain with contrast is more sensitive for\nthe evaluation of intracranial metastatic disease." + }, + { + "input": "There is no acute intracranial hemorrhage, acute infarction, mass effect or\nmidline shift. There is no hydrocephalus. There is no edema. Global atrophy is\nnoted with increase in the size of the ventricles as well as sulci. Scattered\nwhite-matter hypodensities are most likely the sequelae of chronic small\nvessel ischemic disease.\n\nVisualized paranasal sinuses and mastoid air cells are clear aside from a\nsmall mucous retention cyst in the maxillary sinus. Subgaleal hematoma is\nnoted over the left frontal bone without underlying fracture.", + "output": "No evidence of acute intracranial hemorrhage." + }, + { + "input": "The frontal sinuses are non pneumatized.\n\nThere is mild mucosal thickening in some of the ethmoid air cells.\n\nThere is moderate mucosal thickening of the right maxillary sinus with\naerosolized secretions. A small mucous retention cyst is seen maxillary\nsinus. The bilateral maxillary infundibula are patent. Bilateral accessory\nmaxillary ostia are seen draining into the bilateral inferior meati.\n\nThere is moderate mucosal thickening of the sphenoid sinuses with aerosolized\nsecretions. There is mild narrowing of the sphenoid ethmoidal recesses and\nsphenoid ostia. The intersphenoid septum inserts to the left of midline, on\nthe bone covering the left ICA.\n\nThe cribriform plates are intact. The lamina papyracea are intact. There is\nmoderate rightward deviation of the nasal septum with a bony spur.\n\nThe visualized brain is unremarkable.", + "output": "1. Acute mild to moderate ethmoid, maxillary and sphenoid sinus disease.\n2. Left-sided septal spur." + }, + { + "input": "Improvement since prior. Previously seen right maxillary sinus fluid has\nnearly resolved, there is trace residual. Resolved previously seen sphenoid\nsinus fluid. Nearly resolved previously seen ethmoid sinus mucosal\nthickening, trace residual.\n\nClear left maxillary sinus. Accessory ostia bilateral maxillary sinus medial\nwalls, partially obscured by inferior turbinates. Clear sphenoid sinus. \nPatent maxillary, sphenoid sinus ostia. Frontal sinuses are hypoplastic.\n\nNasal septal deviation to the right. Nasal spur projects into the left nasal\ncavity posteriorly. Intact cribriform plates, left side slightly deeper. \nIntact medial orbital walls. Right carotid canal is thin or partially\ndehiscent anteriorly. Left carotid canal, bilateral optic canals are covered\nby bone. Postoperative changes maxillary teeth, no periapical lucencies. \nSymmetric prominence bilateral extraocular muscles, likely normal in the\nabsence of thyroid disease. No proptosis. Probable prominent prevascular\nspace inferior left basal ganglia. Upper neck soft tissues are normal.", + "output": "1. Near resolution of previously seen paranasal sinus disease.\n2. Mildly prominent extraocular muscles, consider thyroid disease." + }, + { + "input": "There is no acute hemorrhage. Again seen is a fluid collection in the right\ncerebellum, slightly increased in size compared to the prior study, now\nmeasuring 5.0 x 3.0 cm, as compared to 5.1 x 2.4 cm previously. There is\nslight increase in effacement of the fourth ventricle, and degree of\neffacement of the basal, including quadrigeminal plate cistern is indicative\nof mild upward transtentorial herniation. Compression of the cerebellum, pons,\nand medulla remains similar. Mild to moderate hydrocephalus of the\nsupratentorial ventricles is slightly increased.\n\nOld bilateral occipital infarcts are again seen.\n\nThere is no fracture. Near complete opacification the right maxillary sinus is\nnoted. Partial opacification of the left maxillary sinus, ethmoid air cells,\nand right sphenoid sinus is present. Polypoid mucosal thickening of the right\nfrontal sinus remains. The globes are unremarkable.", + "output": "1. No acute hemorrhage.\n\n2. Slight interval increase in size of the right cerebellar hemispheric fluid\ncollection with corresponding slight increase in degree of effacement of the\nfourth ventricle and mild to moderate obstructive hydrocephalus." + }, + { + "input": "There has been an interval right occipital craniectomy with decompression of\nthe right occipital fluid collection. Expected postoperative changes include a\nlinear hyperdensity in the postsurgical site, which may represent blood\nproducts. A small amount of pneumocephalus is present in the post operative\nbed and layering over the frontal lobes bilaterally, and also present\noverlying the sylvian fissures. The degree of hydrocephalus has remained\nstable since the most recent prior study, mild to moderate. Effacement of the\nfourth ventricle, however, is improved. There is no evidence of new large\nvascular territory infarct. Evidence of prior bilateral occipital infarcts is\nagain seen. There is no fracture. Partial opacification of the right\nmaxillary sinus, ethmoid air cells, and sphenoid sinuses is seen. The mastoid\nair cells and middle ear cavities remain clear. The globes are unremarkable.", + "output": "Expected postoperative changes after right occipital decompressive\ncraniectomy, including blood products in the surgical bed. There has been\ninterval improvement in the effacement of the fourth ventricle. Mild to\nmoderate hydrocephalus remains stable." + }, + { + "input": "Again seen is the right frontal approach EVD terminating along the lateral\nmargin of the body of the right lateral ventricle. The third ventricle and the\ntemporal horns of the bilateral lateral ventricles appears to be slightly\nincreased in size from prior exam. Trace blood in the occipital horns of the\nlateral ventricles is new.\n\nSuboccipital craniectomy is again seen, predominantly right-sided. Fluid is\nseen extending from the right cerebellar surgical bed through the craniectomy\nsite and into the soft tissues of the scalp, similar to prior exam. The blood\nin the surgical bed has resolved. Some air is still seen in the surgical bed\nand at the right vertex, decreased in extent. Bilateral occipital/parietal\nchronic infarcts are again noted. There is no evidence of new acute\nhemorrhage, edema, or mass effect.\n\nMucous retention cysts are again seen in the maxillary sinuses and the right\nfrontal sinus.", + "output": "1. Slight enlargement of the third ventricle and the temporal horns of the\nlateral ventricles compared to ___. New trace blood within the\noccipital horns of the lateral ventricles.\n\n2. Resolution of blood products in the right cerebellar surgical bed. \nPersistent fluid collection extending from the right cerebellar surgical bed\nthrough the suboccipital craniectomy defect into the soft tissues of the\nscalp." + }, + { + "input": "There are postoperative changes status post right suboccipital craniotomy. A\nfluid collection in the soft tissues likely representing pseudomeningocele has\nslightly decreased in size. There is a fluid collection along the right CP\nangle cistern which appears larger compared to the prior study. Cystic cavity\nin the right cerebellum has shrunk. Encephalomalacia in bilateral occipital\nand parietal lobes in the right frontal lobe is unchanged. Previously noted\nright frontal approach ventricular catheter has been removed. Ventricles are\nslightly decreased in size.", + "output": "Postsurgical changes in the right cerebellum with slight decrease in\npostoperative fluid collection. Previously noted cystic cavity in the right\ncerebellum is not as evident and may have shrunk.\n\n\n\nSlight interval decrease in ventricular size." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass.\nAgain identified is the cystic encephalomalacia in the left frontoparietal\nlobe unchanged from prior and consistent with the patient's known congenital\nlesion.\n\nThe ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence acute hemorrhage, infarction or intracranial mass.\n2. No acute fracture.\n3. Stable cystic encephalomalacia in the left frontoparietal lobe and\nconsistent with the patient's known congenital lesion." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema,or large mass. Left\nfrontoparietal cystic encephalomalacia is unchanged from prior. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mild opacification of the ethmoid\nair cells; the visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavitiesare otherwise clear. The visualized portion of the\norbits are unremarkable.", + "output": "No acute intracranial process. Stable left frontoparietal cystic\nencephalomalacia." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. Atherosclerotic\ncalcifications of the proximal vertebral arteries.\n\nThere is no evidence of fracture. Under pneumatization of the right mastoid\nair cells. Otherwise, the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable. Extensive atherosclerotic calcifications of\nthe cavernous carotid and distal vertebral arteries are noted.", + "output": "No acute intracranial abnormality. No acute hemorrhage or calvarial fracture." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Dense calcification of the carotid\nsiphons is noted.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "There is no evidence of territory infarction,acute hemorrhage,edema,or mass. \nThe ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. There is a partially imaged\nnasogastric tube.", + "output": "No evidence of fracture or acute intracranial process." + }, + { + "input": "There is redemonstration of the left frontal extra-axial hyperdense fluid\ncollection, similar in appearance to prior study and measuring up to 1.5 cm in\ngreatest axial diameter (03:21). Stable appearance of bifrontal, right\ngreater than left hypodense subdural fluid collections, unchanged. \nHypodensity within the right basal ganglia extending to the centrum semiovale,\nand focal hypodensity within the left cerebellar hemisphere, both unchanged in\nconsistent with chronic infarcts. Mild sulcal effacement in the left frontal\nlobe and mild effacement of the left frontal horn of the lateral ventricle\nremains unchanged. Minimal rightward shift of midline structures measures 2\nmm, unchanged from prior study. The basal cisterns remain well preserved.\n\nThere is no evidence of new hemorrhage or infarction. There is mild\nprominence of the ventricles and sulci suggestive of involutional changes. \nPeriventricular and subcortical hypodensities are nonspecific, though likely\nsequela of chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. Mild mucosal thickening of the bilateral\nethmoid air cells. The visualized portion of the remaining paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits demonstrate bilateral lens replacement, otherwise unremarkable.", + "output": "1. Overall similar appearance to prior study, with stable appearance of a 1.5\ncm left frontal extra-axial hematoma and bilateral right greater than left\nsubdural fluid collections.\n2. Minimal 2 mm rightward shift of midline structures, unchanged from prior\nstudy.\n3. No evidence of new foci of intracranial hemorrhage or infarction." + }, + { + "input": "There is a 1.4 cm extra-axial hematoma, which is lentiform in shape. \nAdditionally, there is chronic subdural blood/hygroma or effusion along the\nbilateral cerebral convexity, which measures approximately 6 mm in thickness. \nThese findings are unchanged compared to most recent prior. Hypodensity in\nthe right basal ganglia extending to the centrum semiovale is compatible with\nremote infarct. Left cerebellar chronic lacunar infarct is also noted. There\nis no evidence of acute, large territorial infarction, edema,or mass effect. \nNo midline shift is appreciated.. Ventricles and sulci are prominent,\nconsistent with age-related global parenchymal loss. Periventricular,\nsubcortical, and deep white matter hypodensities are nonspecific, but likely\nrepresent sequela of chronic microvascular ischemic disease.\n\nThere is no evidence of fracture. There is moderate mucosal thickening of the\nethmoid air cells, left greater than right and the left frontal sinus. Mild\nmucosal thickening is seen in the bilateral maxillary sinuses, left greater\nthan right. The visualized portion of the remaining paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. Patient is status post\nbilateral lens resections.", + "output": "1. 1.4 cm extra-axial hematoma, unchanged in size. Additional bilateral\nsubdural hygromas or effusion/chronic hematomas measuring up to 6 mm are also\nnoted. No significant mass effect. Findings are unchanged compared to most\nrecent prior.\n2. Global parenchymal loss and likely sequela of chronic microvascular\nischemic disease. Chronic right basal ganglia to centrum semiovale infarct\nand left inferior cerebellar lacunar infarct.\n3. Paranasal sinus disease, as above." + }, + { + "input": "Redemonstration of the left frontal extra-axial hyperdense fluid collection\nmeasuring up to 1.5 cm in greatest axis, similar to prior. Redemonstration of\nbifrontal, right greater than left hypodense subdural fluid collection, likely\nchronic subdural blood versus hygroma, similar to prior. Hypodensity of the\nright basal ganglia extending to the centrum semiovale is similar to prior. \nLeft cerebellar hypodensity consistent with prior infarct is again\ndemonstrated. There is no midline shift. Local mass effect with mild\neffacement of the sulci and left frontal lateral ventricle is similar to\nprior. No new foci of hemorrhage. No large vascular territory infarction. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Periventricular and subcortical white matter hypodensities are\nnonspecific but can suggest chronic small vessel ischemic changes.\n\nThere is no evidence of fracture. Moderate mucosal thickening in the frontal\nsinuses and ethmoid sinuses are again seen, similar to prior. The visualized\nportion of the remaining paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits demonstrate\nbilateral lens replacement.", + "output": "1. Stable 1.5 cm left frontal extra-axial hematoma, similar to prior. \nRedemonstration of bilateral right greater than left subdural fluid\ncollection, similar to prior. No new foci of hemorrhage." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is interval placement of right frontal approach ventriculoperitoneal\nshunt catheter with its tip near the septum pellucidum in the frontal horn of\nright lateral ventricle. There is associated new right frontal convexity\npneumocephalus. There is minimal interval decrease in the size of the\nventricles now measuring 3.6 cm, previously 3.8 cm. There is stable\nhypodensities in the periventricular white matter in keeping with\ntransependymal flow of CSF.\n\nThere is an ill-defined hypo enhancing lesion in the region of the pineal\ngland measuring approximately 2.9 x 4.1 cm causing effacement of the\nquadrigeminal plate cistern corresponding to the previously seen\nheterogeneously enhancing pineal mass.\n\nThere is no evidence of infarction or hemorrhage. No midline shift is seen.\n\nThe visualized portion of the paranasal sinuses,mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal with no evidence of stenosis,occlusion or aneurysm. The dural\nvenous sinuses are patent. There are several prominent vascular structures\nlikely veins (601 B: 16) extending from the mass to the adjacent venous\nsinuses.", + "output": "1. Interval placement of right frontal approach ventriculostomy catheter with\nminimal interval decrease in the size of the ventricles. Stable\ntransependymal flow of CSF.\n2. Ill-defined heterogeneous pineal gland mass. Possible differential\ndiagnosis includes germinoma versus pineoblastoma.\n3. Prominent venous structures are identified from the mass extending to\nadjacent venous sinuses. No enlarged arterial structures are seen." + }, + { + "input": "Right frontal approach ventriculostomy shunt catheter is unchanged in\nposition. Minimal pneumocephalus along the right frontal convexity is\ndecreased from ___. The ventricles are decreased in size from ___. Periventricular hypodensities are less apparent on the current\nexamination consistent with significantly decreased transependymal flow of\nCSF. New small hyperdensity is noted within the third ventricle (see 03:14).\n\nAs before in ill-defined hypoenhancing lesion in the region of the pineal\ngland is unchanged in size in shows persistent effacement of the quadrigeminal\nplate cistern, however the degree of effacement has decreased from the prior\nexamination.\n\nThere is no evidence of acute hemorrhage or infarction. No midline shift is\nidentified.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells and middle\near cavities are clear. The orbits are unremarkable.", + "output": "1. Marked decreased size of the lateral ventricles as well as decreased\neffacement of the quadrigeminal plate cistern compared to the prior\nexamination. Transependymal flow of CSF has also greatly improved.\n2. New small hyperdensity in third ventricle suggestive of small\nintraventricular hemorrhage.\n3. No evidence of acute infarction.\n4. Ill-defined heterogeneous pineal gland mass is stable in size.\n\nNOTIFICATION: The findings were discussed by Dr. ___ With Dr.\n___ on the telephoneon ___ at 10:09 ___, 10 minutes after\ndiscovery of the findings." + }, + { + "input": "A right frontal approach ventriculoperitoneal shunt catheter is again noted,\nwith the tip terminating in unchanged position at the level of the foramen of\n___. Expected postprocedural pneumocephalus is noted. Previously seen\nhyperdensity within the third ventricle is less prominent on the current\nexamination, likely reflective resolving blood products. Again noted is an\nill-defined, hypodense lesion in the region of the pineal gland, demonstrating\npersistent effacement of the quadrigeminal plate cistern. Small hyperdensity\nwithin the right and left lateral ventricles appears to have been present on\nprior examination as well (03:18).\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Status post right ventriculoperitoneal shunt placement.\n2. Evolving blood products within the third ventricle. Small persistent\nhyperdensity within the right lateral ventricle.\n3. The region of the pineal tumor the slightly hypodense on the current study." + }, + { + "input": "A VP shunt terminates in the region of the foramen of ___. An ill-defined\nhypodense lesion in midline at the site of previously seen pineal mass. The\nhypodensity within the lesion is new since the earlier CT of ___\nbut unchanged from ___ and could be due to tumor necrosis or\ninfarction. There is also a hypodensity seen within the region of the corpus\ncallosum series 3, image 16 which although unchanged from the earlier\nexamination of ___ is better visualized on the current study and\nextends superiorly in the midline. The ventricles are smaller than seen on\nthe previous study. A small amount of blood products are seen inferiorly in\nthe third ventricle which due to redistribution of previously seen blood\nproducts . There is no definite new hemorrhage identified.", + "output": "1. Hypodensity in the region of previously seen tumor as well as in the\nmidline involving the genu and anterior portion of corpus callosum could be\nrelated to ischemic changes . Further evaluation with MRI of the brain is\nrecommended.\n2. The ventricular size is decreased compared to the prior study.\n3. There is redistribution of blood products in the third ventricle but no\ndefinite new hemorrhage seen.\n\nRECOMMENDATION(S): MRI with gadolinium.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\n___ on the telephoneon ___ at 4:45 ___, 3 minutes after discovery of\nthe findings." + }, + { + "input": "Since the prior MRI and head CT, there has developed been development of acute\nhydrocephalus. The right trans frontal approach ventricular drainage catheter\nis unchanged in location, terminating in the right frontal horn.\nThe heterogeneous, hypodense mass centered on the midbrain measures\napproximately 6.0 x 3.2 cm (02:13), previously 5.5 x 3.2 cm on ___. There is no evidence of acute intracranial hemorrhage or shift of the\nmidline structures. The suprasellar and quadrigeminal plate cisterns are\npatent.\nAside from the right frontal and occipital calvarial defects from prior\nintervention, the bony calvarium is intact. The imaged portion of the\nventricular drainage catheter is intact.\nThe imaged paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear.", + "output": "1. Compared to prior cranial imaging from ___, development of acute\nhydrocephalus, however unchanged position of the right transfrontal approach\nventricular drainage catheter.\n2. Heterogeneous mass centered on the midbrain appears to have increased in\nsize, now measuring 6.0 x 3.2 cm, previously 5.5 x 3.2 cm.\n3. No evidence of acute intracranial hemorrhage.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 4:08 ___, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "Since the prior examination, there has been placement of a left-sided trans\nfrontal approach ventricular drainage catheter. This terminates in the left\nfrontal horn. Again seen is a large, heterogeneous midbrain mass, unchanged\nsince the prior examination. No definite acute hemorrhage or midline shift is\nidentified. There is improvement in the degree of hydrocephalus in comparison\nto the most recent prior.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Status post placement of a left trans frontal ventricular drainage\ncatheter. Right-sided drainage catheter remains in stable position. \nImprovement in degree of hydrocephalus since the most recent comparison.\n2. Stable mass centered on the mid brain." + }, + { + "input": "Surgical hardware streak artifact limits examination. The patient has\nbifrontal approach ventriculostomy catheters, terminating in the frontal horns\nbilaterally. Location of the catheters is unchanged from the prior CT dated\n___. The heterogeneous midbrain mass is grossly stable. There is no\ndefinite new hemorrhage. The suprasellar cistern is again grossly preserved. \nCSF space around the brainstem is preserved. Ventricular size is minimally\ndecreased since ___, particularly the temporal horns. Previously seen\nhyperdense focus in the right occipital horn is no longer seen. No evidence\nof large territorial infarct.", + "output": "1. Surgical hardware streak artifact limits examination.\n2. Minimal interval decrease in ventricular size compared to ___.\n3. Stable position of bifrontal approach ventricular drainage catheters.\n4. Grossly stable mass centered in pineal region with mass effect on midbrain\nand third ventricle.\n5. No evidence of acute intracranial hemorrhage.\n6. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct." + }, + { + "input": "Hypodensity compatible with peripherally enhancing mass centered in the region\nof pineal gland compatible with patient's GBM is again noted. Overall, the\nsize of the predominately hypodense lesion appears slightly smaller measuring\napproximately 5.5 cm AP x 3.1 cm TRV, previously 6.0 by 3.7 cm on prior. The\ndegree of surrounding hypodensity most extensively in the thalami seen on\nprior has essentially resolved. Bifrontal approach ventriculostomy catheters\nwith tips in the frontal horns of the lateral ventricles are unchanged. \nConfiguration of the ventricles is stable. Calcific density seen within the\nmass lesion. There is no evidence of acute intracranial hemorrhage.", + "output": "Stable ventricular size, no evidence of hydrocephalus.\nHeterogeneous mass centered at the pineal gland compatible with patient's\nknown GBM appears smaller. Significantly decreased surrounding edema when\ncompared to previous exam." + }, + { + "input": "Subtle periapical lucency is noted around the right second mandibular molar\nwith 4 mm thick soft tissue density tracking adjacent on the lingual surface\nof the mandible (03:33), measuring 1.5 cm in AP dimension. Without IV contrast\nan abscess cannot be excluded. Soft tissue stranding inferior and to the right\nof the mandibular body and in the submental region with thickening of the\nplatysma is also noted. Reactive cervical lymphadenopathy is also appreciated.\nPartially imaged maxillary and sphenoid sinuses are clear. The mastoid air\ncells and middle ear cavities are also clear.\n\nThe aerodigestive tract is clear without exophytic mucosal mass or area of\nfocal mass effect.\n\nThe left lobe of the thyroid gland is enlarged with a hypodense nodule\nmeasuring 9 x 9 mm. Inferiorly in the left lobe, there is an indistinct\nhypodensity, not clearly a nodule. Within the right lobe, there is a 6 mm\nhypodense nodule. The submandibular and parotid glands are normal\nbilaterally.\n\nThe visualized lung apices are clear.\n\nThe cervical spine demonstrates mild degenerative changes characterized by\nendplate osteophyte formation at C5-6 and C6-7.", + "output": "1. Subtle periapical lucency around the right second mandibular molar with\nsoft tissue density along the lingual surface of the mandible. Without\nintravenous contrast, an abscess cannot be excluded. Reactive soft tissue\nstranding inferior to the mandibular body and submental region.\n2. Multi nodular thyroid can be further evaluated via a nonemergent\nultrasound. Correlation with thyroid function tests is recommended.\n\nNOTIFICATION: The updated wet reading was provided to Dr. ___ by Dr.\n___ telephone at 18:15 on ___." + }, + { + "input": "There is no evidence of recent territorial infarction,hemorrhage,edema,or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific, but likely reflect sequelae of chronic small\nvessel ischemic disease.\n\nNo calvarial fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are normal.", + "output": "1. No acute intracranial abnormality." + }, + { + "input": "A large scalp hematoma is noted overlying the left frontal bone. There is no\nacute fracture identified. Redemonstrated is a ventriculoperitoneal shunt\ncatheter with the tip terminating in the right foramen of ___. There is no\nevidence of infarction, hemorrhage, edema, or mass. The ventricles and sulci\nare mildly prominent, compatible with age related involutional changes. There\nis preservation of gray-white matter differentiation. The basal cisterns\nremain patent.\n\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\nThe orbits are unremarkable.", + "output": "1. No evidence of acute intracranial process.\n2. Large right frontal scalp hematoma without underlying fracture.\n3. Intact ventriculoperitoneal shunt, unchanged in position as compared to the\nprior examination.\n\nNOTIFICATION: Findings were conveyed by Dr. ___ to the ACS resident at\n05:30 on ___." + }, + { + "input": "A 0.9 x 0.5 cm (02:30) intraparenchymal hemorrhage is seen within the left\nfrontal lobe. A diffuse pseudo subarachnoid sign is seen throughout the brain\nparenchyma consistent with diffuse cerebral edema. No shift of midline\nstructures. There is mass effect with complete effacement of the frontal horns\nof the lateral ventricles, left greater than right. The quadrigeminal plate\ncistern is effaced worrisome for a central herniation.\n\nNo osseous abnormalities seen. Air-fluid levels are seen within the sphenoid\nsinuses with moderate mucosal thickening of bilateral maxillary sinuses and\nethmoidal air cells. Fluid is seen within the oropharynx. The additional\nvisualized paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The orbits are unremarkable. An endotracheal tube and enteric feeding\ntube are incompletely evaluated.", + "output": "1. Diffuse cerebral edema with pseudo subarachnoid sign and findings\nworrisome for central herniation.\n2. 0.9 cm intraparenchymal hemorrhage within left frontal lobe.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 12:56 ___, 5 minutes after discovery of the\nfindings." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Basilar cisterns are\npatent.\n\nThere is a left orbital floor blow-out fracture (401b:29). There is some\ninferior and medial displacement of the major fracture fragment and herniation\nof fat into the maxillary sinus. Fracture line traverses the infraorbital\ncanal. There is also slight rounded configuration of the inferior rectus\nmuscle. Air and mild stranding seen in the retro-orbital, intraconal fat\nwithout frank hematoma. There is mild left-sided proptosis. Subcutaneous gas\nseen in the periorbital region as well.\n\nEthmoids are partially opacified bilaterally. Evaluation of the lamina\npapyracea is limited secondary to motion despite repeat acquisition. Mucosal\nthickening seen in the maxillary sinuses. Mucosal thickening noted in the\nleft frontal sinus and included sphenoid sinus. The mastoids are clear.", + "output": "No acute intracranial process.\nLeft orbital floor blow-out fracture with herniation of the fat into the\nmaxillary sinus. Mild left-sided proptosis with retro-orbital air and\nstranding without large hematoma. Rounded configuration of the inferior\nrectus muscle for which clinical correlation regarding the possibility of\nentrapment is suggested." + }, + { + "input": "Patient is status-post left occipital craniectomy for reported resection of a\nmetastatic lesion. The lateral margin of the adjacent left cerebellar\nhemisphere slightly protrudes through the craniectomy defect, unchanged\ncompared to the prior examination. The involved/adjacent portion of\ncerebellum demonstrates hypoattenuation corresponding to areas which were\nFLAIR hyperintense on recent MRI, concerning for infarction. Within/adjacent\nto the resection bed, there is a 5.7 x 3.5 cm bilobed fluid collection with\ninternal locules of gas, probably slightly enlarged since the prior MRI when\nattempting to account for differences in imaging plane. Venous sinus\nthrombosis identified on the MRI is not appreciated on this noncontrast\nexamination.\n\nThere is no evidence of new large territorial infarction or intracranial\nhemorrhage. The ventricles and supratentorial sulci are normal in size and\nconfiguration.\n\nThere is persistent patchy opacification of the left mastoid air cells. The\nmiddle ear cavities are clear. There is mild mucosal thickening of the\nmaxillary sinuses and ethmoid air cells. The remaining paranasal sinuses are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. Allowing for differences in imaging plane, a bilobed fluid collection\nadjacent to the left occipital craniectomy is probably slightly enlarged and\nremains concerning for abscess, though evaluation specifically for infection\nlimited in the setting in the absence of intravenous contrast.\n2. The cerebellum adjacent to left occipital craniectomy demonstrates slight\nhypoattenuation, slightly protrudes through the craniectomy defect, unchanged,\nand remains concerning for infarction.\n3. Venous sinus thrombosis identified on the MRI is not appreciated on this\nnoncontrast examination." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass. Postoperative changes in the left suboccipital region with left\ncerebellar encephalomalacia is again seen. Bilobed fluid collection measuring\nup to 5.3 x 1.8 cm within and adjacent to the resection bed appears smaller\ncompared to the prior exam. Locules of gas are no longer seen within the\ncollection. Mild prominence of the ventricles and sulci is consistent with\nage-appropriate involutional changes.\n\nNo acute fractures are seen. Visualized paranasal sinuses are clear. There\nis partial opacification of left mastoid air cells, as seen previously. The\nmiddle ear cavities are clear. Orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Status post left suboccipital craniectomy with unchanged appearance of\nencephalomalacia in the left cerebellar hemisphere. Interval decrease in size\nof fluid collection measuring up to 5.3 cm within and adjacent to the\nresection cavity." + }, + { + "input": "There is a punctate calcification surrounded by hypodensity in the left corona\nradiata, which corresponds to the previously seen metastatic lesion. The\npatient is status post left occipital craniotomy. There is no evidence of\nacute territorial infarction, hemorrhage or mass effect. The known right\ninternal auditory canal mass is better appreciated on the prior MRI. The\nventricles and sulci are normal in size and configuration.\n\nNo acute fractures are seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear.", + "output": "1. No acute intracranial process.\n2. Postsurgical changes related to left cerebellar mass resection.\n3. The known metastatic lesions and right internal auditory canal mass are\nbetter appreciated on prior MR." + }, + { + "input": "Posttreatment changes left vertex, with zone of edema surrounding lesion the\ncentrum semiovale, similar to prior MRI.. Postsurgical, posttreatment changes\nposterior fossa, left occipital craniectomy, encephalomalacia left cerebellum,\nsimilar. Meningocele fluid signal through the craniectomy defect, stable. No\nhydrocephalus, no hemorrhage. No evidence of acute infarct. Advanced\ncerebellar atrophy. Mild generalized cerebral atrophy.\nMild opacification left mastoids. No osseous lesions. Clear paranasal\nsinuses.", + "output": "Stable findings in the posterior fossa.\nStable edema left centrum semiovale surrounding lesion better seen on prior\nMR." + }, + { + "input": "Evaluation is mildly limited by motion. There is left frontal hypodensity\nextending to the cortex. The adjacent sulci are not effaced. These findings\nsuggest chronic tissue loss, likely due to prior infarction or contusion. \nThere is extensive tissue loss in the left putaminal extending into the left\ncaudate head with ex vacuo dilatation of the frontal horn of left lateral\nventricle. These suggest old infarction or a prior putaminal hematoma. The\nventricles and sulci are prominent consistent with atrophy. There is no\nevidence of recent infarction or hemorrhage.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. Evaluation is mildly limited by motion. There is no evidence of recent\ninfarction or hemorrhage.\n2. Extensive left frontal lobe tissue loss likely due to prior infarction or\ncontusion.\n3. Tissue loss in the left putaminal and caudate head likely due to chronic\nlacune or infarction or old hematoma." + }, + { + "input": "There is no acute intracranial hemorrhage, edema, mass effect, or evidence of\nlarge vascular territorial infarction. The ventricles and sulci are normal in\nsize and configuration. There is no fracture. The imaged paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear.", + "output": "No evidence of acute intracranial abnormality." + }, + { + "input": "Head CTA: A single atherosclerotic calcification of the left paraclinoid ICA\nis noted. Otherwise, the intracranial internal carotid artery, anterior\ncerebral artery and middle cerebral arteries and their major branches are\nunremarkable. The right vertebral artery is mildly dominant. Otherwise, the\nvertebral arteries, basilar arteries and posterior cerebral arteries are\nunremarkable. There is no intracranial aneurysm larger than 2 mm. The dural\nvenous sinuses are patent.\n\nOther: Although not optimized for evaluation of the brain parenchyma,\nvisualized brain is unremarkable. Sulci, ventricles, cisterns are within\nexpected limits. The paranasal sinuses are clear. The mastoid air cells and\nmiddle ear cavities are well pneumatized and clear. The orbits are\nunremarkable. Pl. See recent CT head study.\n\nNeck CTA:\n\nThere is a normal 3 vessel arch. The contour, course and caliber of the left\ndominant vertebral artery is unremarkable from their origins to level of the\nskullbase. The common carotid arteries are unremarkable. There is a\nretropharyngeal course of the right internal carotid artery. No significant\nstenosis of the extracranial internal carotid artery by NASCET criteria.\n\nOther:\nThe lung apices are clear. The thyroid glands are unremarkable.\nMildly prominent level 2 nodes. There is no cervical lymphadenopathy by CT\nsize criteria.\n\nThere is mild soft tissue asymmetry at the level of the right palatine and\nlingual tonsils effacing the right vallecula. This may be in part secondary to\nmass effect from a retropharyngeal course of the right internal carotid artery\nas well as mucus secretion. However, soft tissue lesion is not entirely\nexcluded.\n\nThe remainder of the aerodigestive tract is unremarkable. In the parotid\nglands are prominent and slightly fatty replaced but otherwise unremarkable.\nThe submandibular glands are also unremarkable. The masticator space, buccal\nspace and pterygopalatine fossa are unremarkable.\n\nMultilevel cervical spondylosis is noted without suspicious blastic or lytic\nosseous lesions. Facet and uncovertebral degenerative changes are noted on\nthe left side at C4-5 level, causing moderate to severe left foraminal\nnarrowing. Series 2, image 145", + "output": "1. There is no intracranial aneurysm. No significant steno-occlusive disease\nof the circle ___.\n2. Incidental note is made of a retropharyngeal course of the right\nextracranial internal carotid artery. Otherwise, essentially unremarkable CTA\nof the neck without evidence of dissection or significant steno-occlusive\ndisease.\n3. There is asymmetric prominence of the right oropharynx, with effacement of\nthe right vallecula. This may be due in part to mass effect from the\nretropharyngeal right internal carotid artery as well as mucous secretions\nhowever soft tissue lesion is not entirely excluded. If there is clinical\nconcern, direct visualization is recommended.\n4. MRI if not contraindicated can be Considered if there is continued clinical\nconcern for infarction/ ischemia.\n5. Multilevel cervical spondylosis is noted without suspicious blastic or\nlytic osseous lesions. Facet and uncovertebral degenerative changes are noted\non the left side at C4-5 level, causing moderate to severe left foraminal\nnarrowing." + }, + { + "input": "There is a left subdural hematoma which layers along the left tentorium and\nmeasures up to 5 mm in maximum dimension (series 3, image 15). An additional\nfocus of extra-axial blood is seen along the left operculum (series 3, image\n21). There is no evidence for large acute territorial infarction. Prominence\nof ventricles and sulci is consistent with age related involutional changes. \nPeriventricular white matter hypodensities are likely the sequela of chronic\nsmall vessel ischemic disease.\n\nThere is moderate to severe mucosal thickening of the frontal sinuses,\nethmoidal air cells and bilateral maxillary sinuses, worse in the right\nmaxillary sinus. The mastoid air cells and middle ear cavities are clear. \nSmall amount of fluid is layering in the sphenoid sinuses bilaterally. Globes\nare unremarkable.", + "output": "1. Left subdural hematoma layering along the left tentorium, measuring 5 mm in\nmaximum dimension with an additional focus of extra-axial blood seen in the\nleft operculum. There is no evidence of significant mass effect or shifting\nof the normally midline structures. No images seen on PACS for comparison." + }, + { + "input": "There is no intra or extra-axial hemorrhage, mass effect, or shift of normally\nmidline structures. The previously described, scattered small amounts of\nintra and extra-axial hemorrhage predominating in the left cerebral hemisphere\nhave resolved. A few isolated punctate foci of parenchymal calcification are\nnonspecific, but most consistent with a remote intracranial infection. There\nis mild low attenuation in the periventricular white matter which is\nnonspecific, but likely relate to chronic microangiopathic ischemia given the\npatient's age. There is no CT evidence for acute, major vascular territorial\ninfarction. Carotid siphons are densely calcified.\n\nMild paranasal sinus mucosal thickening and fluid, improved from prior.", + "output": "1. No acute intracranial pathology.\n2. Interval resolution of multifocal intracranial hemorrhage." + }, + { + "input": "Patient is status post temporal-occipital craniectomy for resection of a right\ncerebellopontine angle vestibular schwannoma. There is expected post\noperative pneumocephalus. There is a small amount of bifrontal low density\nsubdural fluid. There is a small amount of subdural blood layering along the\nposterior portion of the craniectomy site as well as the right tentorium\ncerebelli. A tiny amount of hemorrhage is also seen at the resection cavity. \nThere is no abnormal shift of midline structures or downward herniation.\n\nPost surgical changes from the craniectomy are present on the right skull. \nScattered mucous retention cysts and mucosal thickening are seen in the\nmaxillary, sphenoid, and ethmoid air cells. There is partial opacification of\nthe right posterior arm mastoid air cells. The middle ear cavities are\ngrossly clear.", + "output": "Status post right temporal-occipital craniectomy for resection of a CPA angle\nvestibular schwannoma with expected postoperative changes. Tiny amount of\nacute blood within the resection cavity and along the posterior craniectomy\nsite as well as along the right tentorium cerebelli." + }, + { + "input": "The patient is status post a right temporal occipital craniotomy, with the\nexpected postsurgical findings, including bifrontal pneumocephalus and small\nlocules of air at the surgical site. Pneumocephalus along the skullbase is\ndecreased compared to the day prior. Material at the surgical site is similar\nin density to fat, and likely reflects surgical packing material. A small\namount of blood at the surgical site, as well as layering along the right\ntentorium, is unchanged. There is no evidence of infarction, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\nAgain seen is mild mucosal thickening of the bilateral maxillary and sphenoid\nsinuses. The visualized portion of the orbits are unremarkable.", + "output": "1. Status post right temporal occipital craniotomy, with the expected\npostsurgical findings as described above. Decreased skullbase pneumocephalus.\nBifrontal pneumocephalus is unchanged.\n2. Small amount of blood at the surgical site, as well as blood layering along\nthe right tentorium, is unchanged." + }, + { + "input": "Limited study due to persistent motion artifact despite multiple acquisitions.\n\nThere is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nlarge territorial infarction. The ventricles and sulci are normal in size and\nconfiguration. The basal cisterns appear patent.\n\nThe patient has a perforated nasal septum, otherwise the paranasal sinuses,\nmastoid air cells, and middle ear cavities are grossly clear.\n\nThe globes are unremarkable.", + "output": "Study is limited due to persistent motion artifact despite multiple\nacquisitions.\n\n1. No visualized acute intracranial process.\n\n2. Perforated nasal septum." + }, + { + "input": "Mild motion artifact is present.\n\nSmall subdural hematoma along the left convexity is stable in size. Minimal\namount of left frontal subarachnoid hemorrhage has slightly increased compared\nto the earlier exam. There is no evidence for parenchymal or intraventricular\nhemorrhage. There is no evidence for parenchymal edema or loss of gray/ white\nmatter differentiation. Ventricles and sulci are normal in size for age. The\nbasal cisterns are not compressed.\n\nLeft parietal subgaleal hematoma is again seen, with evidence of interim\nrepair of the overlying laceration. No fracture is seen. A mucous retention\ncyst is again noted in the left maxillary sinus. Mild mucosal thickening is\nagain seen in the left anterior ethmoid air cells. Mastoid air cells are well\naerated.", + "output": "1. Stable small left subdural hematoma.\n2. Minimal amount of left frontal subarachnoid hemorrhage has slightly\nincreased in size." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Minimal\nperiventricular and subcortical white matter hypodensities are nonspecific but\nlikely sequelae of chronic small vessel ischemic disease. The ventricles and\nsulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No evidence of an acute intracranial abnormality." + }, + { + "input": "There is no evidence of fracture, acute major infarction,hemorrhage,edema,or\ndiscrete mass. The ventricles and sulci are normal in size and configuration.\nModerate calcifications are seen of bilateral cavernous carotid arteries.\n\nNo evidence of calvarial fracture. There is a small mucous retention cyst in\nthe right sphenoid sinus. The visualized portion of the remaining paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits demonstrate right lens replacement.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute large territory infarction, hemorrhage, edema,\nor mass. The ventricles and sulci are normal in size and configuration.\n\nNo acute fracture visualized. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are preserved.", + "output": "1. No acute intracranial abnormality.\n2. No evidence acute intracranial hemorrhage or fracture." + }, + { + "input": "The carotid and vertebral arteries and their major branches are patent with no\nevidence of stenoses.\n\nThere is mild atherosclerotic calcifications of the aortic arch, the\nbifurcation of the bilateral common carotid arteries (for example image 16,\nseries 602b and image 28, series 601b), and the visible portions of the\nbilateral cavernous carotid arteries. However, the vessels of the neck are\npatent and there is no evidence of significant stenosis or vascular occlusion\naccording with the NASCET criteria. No evidence for dissection is seen.\n\nThere is moderate to severe degenerative disease of the cervical spine with\nsclerosis and osteophytes.\n\nThe imaged portion of the lung apices are notable for biapical peripheral\nsubpleural ground-glass opacities. A 8 mm x 1 cm round spiculated nodule is\nseen within the posterior right upper lung region. Adjacent to this nodule is\nanother small 5 mm x 5 mm spiculated round nodule in the posterior portion of\nthe right upper lung (2:21). There is a 4 mm x 4 mm hypodense round nodule\nwithin the left lobe of the thyroid gland (2:65). A 1 cm diameter mediastinal\nlymph node (02:19) is also noted. There are no osseous lesions. The bony\nstructures are notable for unchanged nondisplaced odontoid fracture, better\ndepicted in the prior CT of the cervical spine dated ___. There is\nan unchanged spinous process fracture at the level of C5.", + "output": "1. Vascular arteriosclerotic calcifications identified in the aortic arch and\ncommon carotid arteries, with no evidence of stenoses.\n2. Unchanged odontoid process fracture, previously demonstrated on ___. Unchanged fracture at C5 spinous process. There is moderate to severe\ndegenerative disease of the cervical spine with sclerosis and osteophytes.\n3. A 8 mm x 1 cm round spiculated nodule is seen within the posterior right\nupper lung region. Adjacent to this nodule is another small 5 mm x 5 mm\nspiculated round nodule in the posterior portion of the right upper lung\n(2:21). There is a 4 mm x 4 mm hypodense round nodule within the left lobe of\nthe thyroid gland (2:65). A 1 cm diameter mediastinal lymph node (02:19) is\nalso noted." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nBilateral periventricular and deep white matter hypodensity is nonspecific\nhowever consistent with sequelae of chronic small vessel ischemia.\n\nMinimal soft tissue swelling overlies the left aspect of the frontal bone\nwithout underlying fracture (3, 42). The visualized portion of the paranasal\nsinuses,the mastoid air cells are notable for bilateral mucosal thickening,\nmore significant on the left, and leftmiddle ear opacity, suggesting an\nongoing inflammatory process. The globes and bony orbits are intact. \nExtensive carotid siphon calcifications are noted.", + "output": "1. Minimal soft tissue swelling overlying the left aspect of the frontal bone\nwithout fracture. No acute intracranial process.\n2. Chronic findings including vascular calcifications, global involutional\nchange, and chronic white matter microangiopathy.\n3. Mucosal thickening identified in the mastoid air cells bilaterally, more\nsignificant on the left, including left middle ear opacification." + }, + { + "input": "There is mild mucosal thickening of the inferior frontal sinuses, with minimal\nmucosal thickening of the right frontoethmoidal recess and aerosolized\nopacification of the left frontoethmoidal recess. Moderate mucosal thickening\nof the bilateral ethmoid air cells is identified. There is opacification of\nthe bilateral sphenoid ostia. Aerosolized mucus and dependent fluid is seen\nin the left sphenoid sinus. Mild left-greater-than-right aerosolized mucosal\nthickening in the maxillary sinuses is noted. Aerosolized near complete\nopacification of the nasal cavity and nasopharynx is noted. The bilateral\ninfundibulum of the ostiomeatal units are opacified. There are bilateral\nopacified Haller cells.\n\nThere is leftward deviation of the nasal septum without definitive septal\nperforation however assessment is suboptimal due to surrounding soft tissue\nopacification. The cribriform plates and lamina papyracea appear intact. The\norbits are unremarkable. The visualized skull-base foramina are unremarkable.\nAlthough not optimized for such evaluation, the visualized brain parenchyma is\nunremarkable. A single punctate right parotid sialolith (series 2, image 48)\nis noted. Otherwise, the parotid and submandibular glands are unremarkable.\n\nThere is mild opacification of the left middle ear. The right middle ear and\nvisualized bilateral mastoid air cells are grossly clear.", + "output": "1. Left greater than right paranasal sinus disease as described above, with\naerosolized opacification of the left frontal ethmoidal recess,\nleft-greater-than-right mucosal thickening in the maxillary sinuses,\naerosolized mucosal thickening in the left sphenoid sinus. Bilateral mastoid\nair cell mucosal thickening is also noted.\n2. The bilateral infundibulum are opacified.\n3. Aerosolized opacification of the nasal cavity and nasopharynx.\n4. Clinical correlation for acute inflammatory process is recommended.\n5. Additional findings as described above." + }, + { + "input": "Portable study is limited due to surrounding external wires and artifact at\nthe interface of the brain and calvarium. Within these confines: There is no\nevidence of intracranial hemorrhage, acute large territorial\ninfarction,edema,or mass effect. There is prominence of the ventricles and\nsulci, suggestive of age-appropriate involutional changes. Periventricular\nand subcortical hypodensities are nonspecific, though likely represent sequela\nof chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. The patient is intubated. There is a small\nmucous retention cyst within the right maxillary sinus. There is mild mucosal\nthickening of the bilateral ethmoid air cells. The visualized portion of the\nremaining paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. No evidence of intracranial hemorrhage or acute intracranial abnormality\nwithin technical limits of the examination." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute large territorial infarction or acute\nintracranial hemorrhage. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. There are periventricular and subcortical\nlucencies, which may represent small vessel ischemic changes. \nEncephalomalacia within the right occipital lobe compatible with patient's\nknown right occipital infarct is noted. Atherosclerotic vascular\ncalcifications are noted.\n\nThe middle ear cavities are clear. The visualized portion of the orbits are\npreserved. There is partial opacification of bilateral mastoid air cells. \nBilateral maxillary sinus mucosal thickening is present. There is\npneumatization of bilateral anterior clinoid processes. Bilateral concha\nbullosa are noted. Minimal rightward nasal septal deviation is present.\n\nCTA HEAD:\nPatient's known sellar mass with suggested thinning of the sella, superior\nextension with mass effect on the overlying optic chiasm and lateral\ndisplacement of bilateral internal carotid artery cavernous segments is again\nseen.\n\nThe left PCA demonstrates fetal origin. The vessels of the circle of ___\nand their principal intracranial branches appear preserved with no evidence of\nstenosis, occlusion,oraneurysm.", + "output": "1. No acute intracranial abnormality.\n2. Global volume loss and probable microangiopathic changes as described with\nright occipital encephalomalacia compatible with patient's known right\noccipital infarct.\n3. Redemonstration of patient's known sellar mass as described, better\nevaluated on ___ contrast pituitary MRI.\n4. Grossly patent circle of ___ without definite evidence of\nstenosis,occlusion,or aneurysm.\n5. Paranasal sinus disease and nonspecific mastoid fluid, as described.\n6. Pneumatization of bilateral anterior clinoid processes.\n7. Bilateral concha bullosa.\n8. Minimal rightward nasal septal deviation." + }, + { + "input": "The patient is status post transsphenoidal pituitary adenoma resection. There\nis hyperdensity in the sphenoid sinuses (2; 13), which could represent\nhemorrhage product. There is no evidence of acute fracture, infarction,\nedema, or mass effect. No evidence of intracranial hemorrhage. The\nventricles and sulci are within expected limits in size and configuration.\n\nNear complete opacification of the ethmoid air cells and sphenoid sinuses is\nseen. Mucosal thickening of the left maxillary sinuses is seen. The\nvisualized portion of the mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are normal.", + "output": "1. Hyperdensity in the sphenoid sinuses may represent hemorrhage product. \nThere is no evidence of intracranial hemorrhage.\n2. Expected postsurgical changes after transsphenoidal pituitary adenoma\nresection.\n3. Near complete opacification of the ethmoid and sphenoid sinuses.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 2:39 pm, 5 minutes after discovery\nof the findings." + }, + { + "input": "Pre-existing left cerebral subdural hematoma measuring 6 mm along the left\ncerebellar convexity is grossly unchanged from prior exam. Scattered areas of\nsubarachnoid hemorrhage are also stable. Pre-existing areas of\nintraparenchymal hemorrhage/contusion in the left frontal lobe is grossly\nsimilar in appearance. Focus of hyperdensity within the right frontal lobe is\nunchanged, likely representing sequela of contusion (02:15). Small amount of\nlow-density extra-axial fluid overlying the right frontal lobe is grossly\nsimilar in size. The ventricles and sulci are unchanged in size and\nconfiguration although there is a small amount of new hemorrhage within the\noccipital horns of both lateral ventricles. There is no evidence of enlarging\nintracranial hemorrhage or large territory infarct.\n\nComplex fracture involving the frontal sinus, left orbital roof, ethmoid air\ncells and medial left orbital wall are grossly unchanged. Blood products\nwithin the paranasal sinuses are grossly similar in amount with aerosolized\ndebris within. Nasal bone fractures are similar in configuration. Soft\ntissue swelling overlying the left malar eminence and right vertex are\nsimilar.", + "output": "1. Stable left subdural hematoma measuring 6 mm, scattered subarachnoid\nhemorrhage and intraparenchymal hemorrhage/contusion in the left frontal lobe.\nSmall amount of new intraventricular hemorrhage is likely secondary to\nredistribution. No new large territorial infarct or enlarging intracranial\nhemorrhage.\n2. Partial imaging of the complex facial fracture, previously described on\ndedicated CT sinus from the same day." + }, + { + "input": "There is little changed compared to the recent prior examination from ___. Again seen is a complex, comminuted fracture of the left\nfrontal calvarium extending into the left frontal sinus and left superior and\nmedial orbit, crossing midline into the right frontal sinus. Posteriorly,\nthere is a maximum of 2 mm step-off of the inner table. There is lateral\ndisplacement of the left lamina papyracea fracture by roughly 7 mm extending\ninto the orbit with small associated hematoma. Additionally, the fracture\nline extends more inferiorly into the left ethmoid air cells. There is also\nmildly comminuted fracture involving the posterior wall of the left maxillary\nsinus and the lateral anterior wall extending into the orbital floor. There\nis also a mildly displaced fracture of the left zygomatic process with roughly\n3 mm step-off. There is also a comminuted fracture of the left sphenoid bone,\ncausing mild narrowing of the left optic canal, and extending into the lateral\nwall of the left sphenoid sinus. The left pterygoid plate is involved. There\nis also a subtle oblique nondisplaced fracture of the right greater sphenoid\nwing extending into the squamous portion of the right temporal bone, unchanged\n(301:47).\nAssociated facial swelling in the areas of fracture appears similar to the\nprior study. There is some chronic appearing deformity of the nasal bone\nsuggesting old fracture in this area.\nLayering hemorrhagic fluid is noted in the left maxillary sinus associated\nwith fracture. There is mild mucosal wall thickening and layering hemorrhage\nin the right maxillary sinus as well. There is also layering hemorrhage in\nopacification of the sphenoid air cells, ethmoid air cells, and bilateral\nfrontal sinuses.\nThere is otherwise no evidence of abnormal fluid collections.\nBilateral mastoids are well aerated.\nThe globes are intact bilaterally. There has been interval increase of left\norbital roof hematoma slightly displacing the globe and superior rectus muscle\ninferiorly. Left frontal hemorrhagic contusion is partially assessed and\nthere is a small amount of subdural hemorrhage in this area, which appears\nslightly decreased compared the prior examination and the subarachnoid\nhemorrhagic component in this area is no longer well seen.\nThe visualized upper aerodigestive tract appears normal.\nThe mandible and temporomandibular joints appear intact hardware from prior\nleft mandibular fixation is seen..", + "output": "1. Complex left-sided facial fractures in a LeFort 3 pattern, as described in\ndetail above, unchanged compared to ___. The only significant\ninterval changes increasing orbital hematoma superiorly, which inferiorly\ndisplaces the globe and superior rectus muscle.\n2. Unchanged nondisplaced fracture of the right greater sphenoid wing\nextending into the squamous portion of the right temporal bone.\n3. Interval evolution of a left frontal hemorrhagic contusion, with decrease\nof the adjacent sliver of subdural hemorrhage, with the subarachnoid component\nno longer well seen.\n4. Associated hemorrhagic opacification of the paranasal sinuses." + }, + { + "input": "Previously seen left cerebral subdural hematoma measures approximately 6 mm in\ngreatest axial thickness, similar to the prior study. Scattered areas of\nsubarachnoid hemorrhage are less well visualized compared to the prior study. \nHypodensities are seen along bilateral frontal lobes, left temporal lobe, and\nright parietal lobe (02:15, 02:21, 02:23) compatible with edema in the setting\nof contusion. The left frontal contusion is hemorrhagic. Previously seen\nminimal hemorrhage within the occipital horns of the lateral ventricles are\nnot well seen on the current study. Ventricles and sulci are stable. There\nis no shift of normally midline structures, or evidence of acute major\nvascular territorial infarction. Mastoid air cells and middle ear cavities\nare well aerated.\nComplex facial and intracranial fractures better evaluated on maxillofacial CT\nfrom earlier the same day. Associated hemorrhagic opacification of the\nparanasal sinus sinuses persistent.", + "output": "1. Left subdural hematoma measuring approximately 6 mm in greatest axial\nthickness, not significantly changed compared to the prior study.\n2. Previously seen scattered areas of subarachnoid hemorrhage are less\nprominent since the prior study, likely redistributed.\n3. Increased hypodensities along bilateral frontal lobes, left greater than\nright, left temporal lobe and right parietal lobe compatible with increased\nedema representing evolving contusions.\n4. Complex facial and calvarial fractures better evaluated on the concurrent\nmaxillofacial CT." + }, + { + "input": "Complex, comminuted facial fracture involving the left frontal sinus extending\ninto the left frontal calvarium with approximately 10 mm depression of the\ninferior left frontal calvarium and fracture extending into the superior\norbital rim and the left lamina papyracea, overall unchanged from prior exam. \nRemaining complex facial fracture seen on the prior exam also is grossly\nunchanged in configuration, consistent with LeFort 3 pattern.\nHowever, new since ___ is a large collection of air abutting the\nleft frontal calvarial depression, extending into the left frontal lobe\nmeasuring approximately 2.7 x 1.8 cm, surrounded by mild parenchymal\nhypodensity. The layering air-fluid level within the fractured left frontal\nsinus persistently measures low-density. Pre-existing small amount of\nsubdural hemorrhage is not seen on today's exam, possibly obscured by the new\npneumocephalus and edema, though interval evolution of blood products is also\nlikely. There is no evidence of new or enlarging hemorrhage.\n\nNear complete opacification of the paranasal sinuses are grossly stable from\nprior exam with persistent hyper dense material within the sphenoid sinuses,\nlikely due to hemorrhage in the setting of the comminuted fracture.\n\nThe visualized portion of the orbits are unremarkable.", + "output": "1. New left frontal lobe pneumocephalus measuring approximately 2.7 x 1.8 cm\nsurrounded by mild parenchymal edema in the setting of complex facial and\ncalvarial fracture with fracture lines extending into the sinuses, concerning\nfor communication and CSF leak. Close clinical follow-up is recommended for\ndevelopment of intracranial infection and/or infarction related to mass\neffect, and obtain repeat head CT or MRI as needed.\n2. Complex facial and calvarial fracture, not substantially changed since ___. Please refer to the sinus CT for details.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 10:37 am, 10 minutes after\ndiscovery of the findings." + }, + { + "input": "There is 3 cm parenchymal hematoma in anterior basal left frontal lobe, with\nsurrounding moderate edema which has developed since ___. \nAdjacent parenchymal air has mildly improved. There are again seen extensive\nfacial fractures, extending to involve left frontal bone, left frontal sinus,\nwith interval surgical fixation of the left orbital roof, left frontal bone,\nleft lateral orbital wall, left zygomatic arch with hardware in place. \nSuggestion of left frontal duraplasty, surgical packing in the extradural\nspace anterior left cranial fossa.\n\nFracture does involve sphenoid roof, planum sphenoidale, which is depressed,\nand there is extension anteriorly into the cribriform plate. Patient may be\nat risk for CSF leak.\n\nExtensive opacification of the paranasal sinuses, nasal cavity, also present\non prior,. Scalp, facial soft tissue swelling. Incomplete fusion posterior\nC1 arch.", + "output": "1. New acute 3 cm left anterior basal frontal lobe hematoma.\n2. Extensive facial fractures, interval postoperative changes. Patient may be\nat risk for CSF leak.\n\nNOTIFICATION: findings were discussed with PA ___, by ___\n___ M.D. on the telephone on ___ at 10:12 am, 5 minutes after\ndiscovery of the findings.." + }, + { + "input": "Postoperative changes left frontal lobe, with surgical packing material, small\nvolume of extra-axial blood products and pneumocephalus.\nInterval development of an area of approximately 3 cm of intraparenchymal\nhemorrhage with surrounding moderate edema is seen in the adjacent anterior\nbasal left frontal lobe. There few air bubbles within area of hematoma,\noverall intraparenchymal air has decreased since ___. This region\nis seen exerting mass effect on the anterior horn of the left lateral\nventricle. There is associated approximately 5 mm rightward midline shift.\nThere is no evidence of associated intraventricular hemorrhage. Along the\nleft convexity there is unchanged appearance a small hypodense fluid\ncollection exerting mass effect on the sulci within this region which may\nrepresent a hygroma or chronic subdural effusion. Effaced perimesencephalic\ncisterns, minimal left uncal herniation.\n\nThe patient is status post craniectomy with frontal sinus floor fixation. \nInterval postoperative changes, fractures as seen before. Opacification of\nthe paranasal sinuses. The visualized portion of the mastoid air cells and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable. There is prominent soft tissue swelling over the postsurgical\nregion and left temporal lobe region.", + "output": "1. Interval development of a 3 cm parenchymal hematoma within anterior left\nbasal frontal lobe since ___, similar compared with sinus CT ___, moderate surrounding edema. Adjacent parenchymal air has\nimproved. Follow-up recommended. There is 5 mm rightward midline shift. \nEffaced perimesencephalic cisterns, minimal left uncal herniation.\n2. Interval postsurgical changes, fractures as seen before.\n3. Along the left convexity there is unchanged appearance a hypodense fluid\ncollection exerting mass effect on the sulci within this region which may\nrepresent a hygroma or chronic subdural effusion.\n\nRECOMMENDATION(S): Follow-up head CT\n\nNOTIFICATION: The findings were discussed with PA ___, by\n___ M.D. on the telephone on ___ at 10:12 am, 5 minutes\nafter discovery of the findings.." + }, + { + "input": "The patient is status post frontal craniectomy, with frontal sinus floor\nfixation. Again noted is focal pneumocephalus, packing material, and small\nvolume of extra-axial blood products. In intraparenchymal hematoma in the\nleft frontal lobe is not significantly changed, measuring approximately 3 cm. \nThere has been an increase in surrounding vasogenic edema, with slightly\nincreased effacement of the anterior horn, body, and posterior horn of the\nleft lateral ventricle, and similar degree of rightward shift of midline\nstructures measuring 5 mm. Effacement basal cisterns and minimal left uncal\nherniation is again seen, not significantly changed when allowing for\ndifferences in technique. Again noted is a hypodense collection overlying the\nleft cerebellum, unchanged in appearance. No new hemorrhage is identified. \nUnchanged moderate bilateral opacification of the maxillary and frontal\nsinuses and significant opacification of the bilateral sphenoid sinuses and\nethmoid air cells. Secretions in the nasopharynx are consistent with history\nof intubation.. Mastoid air cells and middle ear cavities are well aerated. \nMultiple facial fractures are again seen.", + "output": "1. Postoperative changes status post craniectomy and frontal sinus for\nfixation, with stable 3 cm intraparenchymal blood products in the anterior\nleft frontal lobe, with slightly increase in vasogenic edema scratch. No\nsignificant change in degree rightward midline shift and left uncal herniation\nwhen accounting for differences in technique.\n2. Unchanged widened CSF space overlying the left cerebellum." + }, + { + "input": "Patient is status post left frontal craniectomy with the placement of packing\nmaterial with frontal sinus floor fixation. Again seen is a small volume of\nextra-axial blood products and focal areas of pneumocephalus. The previously\nseen intraparenchymal hematoma in the left frontal lobe is not significantly\nchanged, today measuring 2.5 cm. However, the degree of surrounding vasogenic\nedema is increased from the prior exam with associated effacement of the\nanterior horn of the left lateral ventricle. The degree of rightward midline\nshift is increased measuring 9.2 mm (previously approximately 6mm). There is\nmild unchanged subfalcine herniation. There has been interval increase in the\nhypodense fluid collection along the left convexity exerting mass effect on\nthe sulci within this region and may represent a hygroma or chronic subdural\neffusion. There is no area of new focal hemorrhage or infarction. Again noted\nis a hypodense collection overlying the left cerebellum, unchanged in\nappearance.\n\nPatient is status post craniectomy with frontal sinus floor fixation. \nFractures as seen before. Moderate bilateral opacification of the maxillary\nand frontal sinuses again seen. Significant opacification of the bilateral\nsphenoid and ethmoid air cells is also again seen. The mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.Prominent soft tissue swelling over the postsurgical region and\nleft temporal region.", + "output": "1. The previously seen intraparenchymal hematoma in the left frontal lobe is\nnot significantly changed, today measuring 2.5 cm. However, the degree of\nsurrounding vasogenic edema is increased from the prior exam with associated\neffacement of the anterior horn of the left lateral ventricle. The degree of\nrightward midline shift is increased measuring 9.2 mm (previously\napproximately 6 mm). There is mild unchanged subfalcine herniation.\n2. There has been interval increase in the hypodense fluid collection along\nthe left convexity exerting mass effect on the sulci within this region and\nmay represent a hygroma or chronic subdural effusion.\n3. There is no area of new focal hemorrhage or infarction.\n4. Patient is status post craniectomy with frontal sinus floor fixation.\nModerate bilateral opacification of the maxillary and frontal sinuses again\nseen. Significant opacification of the bilateral sphenoid and ethmoid air\ncells is also again seen.\n\nNOTIFICATION: The findings were discussed with ___ PA by ___\n___, M.D. on the telephone on ___ at 11:17 am, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "Patient is status post left frontal craniectomy with placement of packing\nmaterial and left frontal floor fixation. There remains to be foci of\npneumocephalus in the extra-axial space as well as in the subcutaneous soft\ntissues not significantly changed since ___. There is\nre-demonstration of the left frontal intraparenchymal hematoma measuring up to\n2.9 cm, similar to prior. There is a small amount of decrease in the amount\nof vasogenic edema surrounding the hematoma with persistent effacement of the\nfrontal horn of the left lateral ventricle. The degree of rightward midline\nshift again measures 1.0 cm, similar to prior. There is mild unchanged\nsubfalcine herniation. There is mild interval increase in the hypodense fluid\ncollection along the left frontal convexity exerting mass effect on the sulci\n(5; 22) measuring up to 1.1 cm in greatest thickness and again may represent\nan evolving subdural fluid collection or subdural hygroma. There is no new\nfocal hemorrhage or large vascular territory infarction. The fluid collection\nadjacent to the left cerebellum of CSF attenuation is likely an arachnoid\ncyst.\n\nPatient's numerous calvarial and facial fractures are again demonstrated with\nfixation of the left zygoma fracture, frontal sinus fractures. Overall\nappearance of facial fractures are similar to prior. There is mild bilateral\nmucosal thickening in the maxillary sinuses. Hypodense material is noted\nwithin the sphenoid sinus and ethmoid sinuses as well as the frontal sinuses,\nsimilar to prior. Bilateral orbits appear unremarkable.", + "output": "1. Patient status post left frontal craniectomy and postsurgical changes are\nnoted including pneumocephalus, similar to prior. The left frontal\nintraparenchymal hematoma is unchanged compared to prior but there appears to\nbe slightly decreased surrounding vasogenic edema.\n2. 1.0 cm rightward midline shift and subfalcine herniation is unchanged. \nThere is persistent effacement of the left lateral ventricle frontal horns.\n3. There appears to be slight interval increase in the subdural collection\nalong the left frontal convexity compared to prior with persistent effacement\nof the sulci.\n4. No new intracranial hemorrhage." + }, + { + "input": "The patient is status post left frontal craniotomy with placement of packing\nmaterial along the left anterior cranial fossa. Re-demonstrated is\npneumocephalus in the extra-axial space as well as in the soft tissues\nadjacent to the surgical bed. A left frontal lobe intraparenchymal hematoma\nmeasuring up to 2.4 cm is again seen with associated surrounding vasogenic\nedema, similar in size as compared to the prior exam. The degree of\neffacement of the frontal horn of the left lateral ventricle remains\nunchanged. The right ventricle lateral ventricle is unchanged in appearance.\nThe degree of rightward midline shift measures approximately 9 mm, similar to\nprior. The hypodense fluid collection along the left convexity continues to\nexert mass effect on the sulci within this region (02:25) and appears stable\nin appearance. Again, this evidence fluid collection may represent an\nevolving subdural hematoma or hygroma. No new areas of hemorrhage are\nidentified. No evidence of interval large territorial infarction. The\npreviously seen hypodense fluid collection adjacent to the cerebellum on the\nleft is felt to represent an arachnoid cyst versus ___ cisterna magna.\n\nRe-demonstration of patient's numerous calvarial and facial fractures. \nPostsurgical craniotomy defect is again seen in the left frontal bone. The\npatient is status post fixation of a left zygoma fracture and frontal sinus\nfracture. Mild bilateral maxillary sinus mucosal thickening is seen. \nAerosolized debris is noted within the sphenoid sinus, ethmoid sinus and\nfrontal sinus similar in appearance to the prior. The mastoid air cells and\nmiddle ear cavities are clear.", + "output": "1. Patient is status post left frontal craniotomy with associated postsurgical\nchanges noted including pneumocephalus, similar to the prior exam.\n2. The previously seen left frontal intraparenchymal hematoma with associated\nvasogenic edema is unchanged as compared to the prior study. Re-demonstrated\nare approximately 9 mm rightward midline shift.\n3. Unchanged persistent effacement of the frontal horn of the left lateral\nventricle.\n4. Interval stability in the subdural collection along the left convexity\nwhich is felt to likely represent a subdural hematoma or hygroma.\n5. No evidence of interval intracranial hemorrhage or large territory\ninfarction." + }, + { + "input": "There is a left cerebral subdural hematoma which is seen wrapping around the\nleft cerebral convexity and is most conspicuous on series 601, image 55\nmeasuring to 6 mm in maximal thickness. Scattered foci of subarachnoid\nhemorrhage can be seen, for example adjacent to the left inferior frontal\nlobe. There is small volume pneumocephalus. No intraventricular hemorrhage. \nOn series 2 image 18 in the left frontal lobe there is a small focus of\nparenchymal contusion versus subarachnoid hemorrhage. Ventricles are normal\nin size. The basal cisterns are patent. No significant mass effect or\nmidline shift.\n\nNo shift of normally midline structures. No evidence of acute major vascular\nterritorial infarction. Ventricles are normal in size, although the sulci are\nslightly more prominent than expected for patient's age.\n\nPlease refer to same-day facial bone CT for detailed description of the facial\nbone fractures. The mastoid air cells and middle ear cavities are well\naerated. Mixed density fluid within the maxillary and sphenoid sinuses noted.\nLeft preseptal and periorbital soft tissue swelling is noted. A right\nsphenoid fracture extends to the left orbital roof. Fracture involving the\nleft frontal sinus involves both inner and outer table. Further details on\nsame-day facial bone CTs.", + "output": "1. Left cerebral subdural hematoma measuring up to 6 mm. Scattered mild\nsubarachnoid hemorrhage, possible trace contusion in the left inferior frontal\nlobe. No midline shift or significant mass effect.\n2. Numerous facial fractures partially visualized, to be described in complete\ndetail on same-day facial bone CT exam.\n\nNOTIFICATION: The findings were discussed with the trauma surgery team by\n___, M.D. in person on ___ at 10:45 am, 1 minute after discovery\nof the findings." + }, + { + "input": "Again seen are postoperative changes after left frontal craniotomy and repair\nof complex frontal bone fractures. Again seen is fat packing overlying the\nleft frontal lobe. There is evolution of left frontal lobe tissue loss and\nhemorrhage since the prior study. There is no evidence of new hemorrhage. \nThere is no evidence of infarction. Again seen is prominence of the\nventricles and sulci in a marked atrophic pattern for a patient of this age.\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "Evolving posttraumatic changes in the left frontal lobe.\nNo evidence of infarction or new hemorrhage.\nAtrophy" + }, + { + "input": "Postoperative changes. Left frontal bone metal plate in place, extradural fat\npacking. Encephalomalacia anterior basal left frontal lobe, right gyrus\nrectus, similar. Small focus of chronic encephalomalacia anterior tip left\ntemporal lobe, stable. Bifrontal atrophy, similar.\n\nThere is no evidence of new infarction,hemorrhage,edema, or mass.\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable. Metal plate across left zygomatic arch. Chronic nasal bone\nfracture.", + "output": "Stable exam. Postoperative changes. Encephalomalacia frontal, anterior left\ntemporal lobes, likely posttraumatic." + }, + { + "input": "There is no evidence of territorial infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration. There is no\nevidence of fracture. There is a partially visualized mucous retention cyst\nin the left maxillary sinus. There is mild mucosal thickening of the\nbilateral ethmoid air cells. The other visualized paranasal sinuses, mastoid\nair cells and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "No acute intracranial process on noncontrast head CT." + }, + { + "input": "There is a large region of encephalomalacia in the right frontoparietal and\ntemporal lobes consistent with chronic infarct in the distribution of the\nright MCA. There is no evidence of acute hemorrhage,edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nSubcortical and periventricular white matter hypodensities are nonspecific,\nhowever likely represent sequela of chronic small vessel ischemic disease. \nIncidental note is made of right basal ganglia calcifications. There are\ndense calcifications in the bilateral cavernous carotids and vertebral\narteries.\n\nThere is no evidence of fracture. There is a small mucosal retention cysts in\nthe right maxillary sinus. The visualized portion of the remainder paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process. Specifically, no acute intracranial\nhemorrhage." + }, + { + "input": "There is loss of the gray-white matter differentiation in the right\ntemporoparietal region and posterior right insula with associated sulcal\neffacement. There is no intra-axial or extra-axial hemorrhage, mass, or\nmidline shift. Scattered periventricular and subcortical white matter\nhypodensities are likely sequela of chronic small vessel disease. Chronic\nleft cerebellar infarct is noted. Ventricles and sulci are prominent\ncompatible with global volume loss. Basilar cisterns are patent. Dense\natherosclerotic calcifications noted within the vertebral arteries and\nintracranial ICAs.\n\nIncluded paranasal sinuses and mastoids are the centrally clear. Skull and\nextracranial soft tissues are unremarkable.", + "output": "Right MCA territory acute infarct. No intracranial hemorrhage.\n\nNOTIFICATION: Findings discussed with Dr. ___ by Dr. ___ the phone\nat 14:25\n1 minute after time of discovery." + }, + { + "input": "CTA HEAD:\nThere is relative paucity of blood vessels in the distal branches of the right\nmiddle cerebral artery. No abrupt change in vessel caliber is detected\ndistally in the area.\nThe vessels of the circle of ___ and its principal tributaries are patent\nwithout significant stenosis, occlusion or aneurysm greater than 3 mm.\nInfundibular origins of the left posterior communicating artery and right\nsuperior cerebellar artery and seen.\nThe basilar artery is calcified and tortuous.\nCalcification of the carotid siphons bilaterally is seen.\nThere is non filling of the V4 segment of the left vertebral artery. The\ndural venous sinuses are patent.\nThe left vertebral artery is hypoplastic from the origin to the visualized\ndistal segments. Left foramen transversarium are smaller compared to the\nright. These findings are compatible with congenital variant of diminutive\nleft vertebral artery.\nThere is calcification at the carotid bifurcations bilaterally.\n\nOTHER:\nAgain seen is a loss of gray-white matter differentiation in the right\ntemporal parietal region and posterior right insula. There is associated\nsulcal effacement. There is no intra-axial or extra-axial hemorrhage, mass or\nmidline shift. A chronic left cerebellar infarct is seen. Ventricles and sulci\nare prominent due to age-related involution. Periventricular, subcortical\nwhite matter hypodensities are consistent with chronic small vessel ischemic\ndisease.\n\nThere is a small mucosal retention cyst in the right maxillary sinus. There\nis mild mucosal thickening at the ethmoidal air cells. There is a 2 mm osteoma\nin the frontal sinus. The visualized portion of the paranasal sinuses,mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.\n\nPerfusion:\nThere is matching areas of decreased blood flow, decreased blood volume and\nincreased mean transit time in the M5/M6 area of the right middle cerebral\nartery, corresponding with the previously seen area of right temporoparietal\nand posterior right insular infarct on the noncontrast CT.", + "output": "1. Acute infarct of the right middle cerebral artery territory with relative\npaucity of blood vessels in M5/M6 of the right middle cerebral artery and\ndecrease perfusion to the area. No definite occlusion of the arteries are\nseen.\n2. Patent vessels of the circle of ___ and its principal tributaries\nwithout significant.\n3. Hypoplastic left vertebral artery, likely congenital variant. The left V4\nsegment non-filling is likely in combination with extensive atherosclerotic\ndisease and chronic." + }, + { + "input": "There is progressive loss of gray-white matter differentiation in the right\ntemporal parietal region and posterior right insula with associated sulcal\neffacement. Compared to the prior exam, the area of hypodensity is more\nsharply demarcated. However, there is no significant change in the\ndistribution or size of the hypodensity. There is no midline shift. A small\nfocus of hyperdensity is seen within the sylvian sulcus on the right, possibly\nrepresenting a residual contrast or a clot in the distal right the size the\nmorphology of the lateral middle cerebral artery versus atherosclerotic\ncalcification. The size and morphology of the ventricles are similar to the\nprior exam. The basal cisterns are patent. Hypodensities in the\nperiventricular, subcortical and deep white matter are consistent with small\nvessel ischemic disease. Tortuous and calcified and basilar artery is again\nseen. Vascular calcifications are seen in the vertebral arteries and within\nthe carotid siphons.\nNo new areas of territory artery infarcts or hemorrhages are seen.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are mostly clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Continued evolution of known right inferior middle cerebral artery\nterritory infarct. No changed in ventricles, no eye midline shift, unknown\nmass effect.\n2. No acute intracranial abnormalities." + }, + { + "input": "There has been interval evolution of the previously noted right middle\ncerebral artery CVA, now in the subacute stage. No new large vascular\nterritorial infarction, hemorrhage, edema, or mass is seen. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nPeriventricular, deep and subcortical white matter hypodensities are\nnonspecific but likely sequela of chronic small vessel ischemic changes. \nExtensive vascular calcifications are noted as before.\nThere is no evidence of fracture. Small amount of fluid in the left mastoid\nair cells inferiorly.\nThe visualized portion of the orbits are unremarkable.\nThere is diffuse demineralization of the bones.", + "output": "1. No acute intracranial hemorrhage or mass effect or acute fracture\n2. Continued evolution of the known right middle cerebral artery territorial\ninfarction." + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or\nlargemass. Again seen aneurysmal clipping in the left parietal region from\nprior intracranial hemorrhage from AVM. There is similar appearance of\nencephalomalacia around the aneurysm clip and involving the left parietal lobe\nwith ex vacuo dilatation of the left lateral ventricle. There is prominence\nof the ventricles and sulci suggestive of involutional changes. \nPeriventricular and subcortical hypodensities are nonspecific and likely are\nsequela of chronic small-vessel ischemic disease. There is no acute fracture.\nThe left parietal craniotomy site is unchanged. There are small mucous\nretention cyst in the left maxillary sinus and right ethmoid air cells. The\nright frontal sinus is underpneumatized. The visualized portion of the other\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormalities.\n2. Stable appearance of left parietal encephalomalacia status post aneurysm\nclipping." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Prominence of\nthe ventricles and sulci is consistent with age related involutional changes. \nPeriventricular white matter hypodensities are suggestive of chronic small\nvessel ischemic disease. Calcifications of bilateral carotid siphons are\nnoted.\n\nNo osseous abnormalities seen. The paranasal sinuses and middle ear cavities\nare clear. The orbits are unremarkable. There is partial opacification of the\ninferior right mastoid air cells. Right-sided lens replacement is noted.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute vascular territorial infarction, hemorrhage,\nedema, or mass. The ventricles and sulci are normal in size and\nconfiguration.There is no evidence of fracture. Aerosolized secretions are\nnoted in the left sphenoid sinus along with moderate mucosal thickening. The\nvisualized portions of the other paranasal sinuses, mastoid air cells and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial process.\n2. Aerosolized secretions and moderate mucosal thickening in the left sphenoid\nsinus. Recommend clinical correlation for possible acute sinusitis." + }, + { + "input": "There is a right frontal parafalcine high density measuring approximately 1.1\nx 0.6 cm, along the falx, most likely representing a calcified meningioma.\nOtherwise, there is no evidence of acute intracranial hemorrhage, midline\nshift, mass effect, or acute large vascular territory infarct. Gray-white\nmatter differentiation is preserved. Prominence of the ventricles and sulci\nis consistent with global atrophy. Periventricular and subcortical white\nmatter hypodensities bilaterally likely represent sequelae of chronic small\nvessel ischemic disease. There is no hydrocephalus. The visualized paranasal\nsinuses are clear. The mastoid air cells are clear. No acute fracture is\nseen.", + "output": "Right frontal parafalcine high density measuring ~ 1.1 x 0.6 cm, along the\nfalx, most likely represents a calcified meningioma. Otherwise, no acute\nintracranial process seen. Chronic changes." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nNo acute intracranial hemorrhage. No large territorial infarction. No mass\neffect or midline shift. No acute fractures. The paranasal sinuses, mastoid\nair cells, middle ear cavities are unremarkable\n\nCTA HEAD:\nPatient has a left dominant vertebrobasilar system. The V4 segment of the\nright vertebral artery is diminutive, a normal variant. There is diffuse\nnarrowing of the A1 segment of the right ACA, a normal variant. Otherwise,\nthe circle of ___ and its intracranial major branches appear grossly\npatent. There is no aneurysm greater than 3 mm.\n\nCTA NECK:\nRe-identified is left dominant vertebrobasilar system. Trace atherosclerotic\ncalcification of the aortic arch, right brachiocephalic and right carotid\nbifurcation is identified. Otherwise, the common carotid, right\nbrachiocephalic, bilateral subclavian, vertebral and internal carotid arteries\nare unremarkable. There is no stenosis of the cervical internal carotid\narteries by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. Visualized aerodigestive tract is unremarkable.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nacute large territory infarct or intracranial hemorrhage.\n2. Allowing for common anatomic variation, unremarkable CTA of the head.\n3. Allowing for trace atherosclerotic disease, unremarkable CTA of the neck. \nNo stenosis of the cervical internal carotid arteries by NASCET criteria.\n4. Additional findings as described above." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nPatient is status post clipping of left supraclinoid ICA aneurysm with\nassociated streak artifact limiting the evaluation. There is no evidence of\nno evidence of infarction, hemorrhage, edema, or mass. The ventricles and\nsulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nStreak artifact related to prior clipping of right supraclinoid ICA aneurysm\nsomewhat limiting the evaluation. The remaining vessels of the circle of\n___ and their principal intracranial branches appear normal without\nstenosis, occlusion or aneurysm formation. The dural venous sinuses are\npatent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThere is mild biapical parenchymal scarring. In addition, there is a 3 mm\nsubpleural right apical pulmonary nodule (series 5, image 44), likely\natelectasis. The visualized portion of the thyroid gland is within normal\nlimits. There is no lymphadenopathy by CT size criteria.", + "output": "1. Prior clipping of left supraclinoid ICA aneurysm with associated streak\nartifact.\n2. No acute intracranial abnormality, specifically no acute intracranial\nhemorrhage.\n3. 3 mm right apical subpleural pulmonary nodule, likely atelectasis with\nbiapical pleural-parenchymal scarring.\n\nRECOMMENDATION(S): Point 3: If the patient has no known risk factors such as\nsmoking, no further evaluation is recommended for the pulmonary nodule. If\nthe patient does have a history of smoking and other risk factors CT of chest\nmay be performed for further evaluation in 12 months per ___\nrecommendations." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or mass\neffect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture. Mild paranasal sinus disease. Otherwise,\nthe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The patient is status post bilateral lens\nreplacement.", + "output": "1. No acute intracranial abnormality." + }, + { + "input": "No fractures are identified.\nThere is no evidence of significant facial swelling.\nMucous retention cyst is noted in the left maxillary sinus. Small amount of\naerosolized mucus is noted in the left sphenoid sinus. There is no evidence\nof abnormal fluid collections.\nBilateral mastoids appear unremarkable.\nThe globes, extraocular muscles, optic nerves, and retrobulbar fat appear\nunremarkable.\nThe visualized upper aerodigestive tract appears unremarkable.\nThe mandible and temporomandibular joints appear unremarkable. Degenerative\nchanges upper visualized spine.", + "output": "1. No fracture is identified.\n2. Mild paranasal sinus disease." + }, + { + "input": "Please note that this study is markedly limited by motion artifact. Within the\nlimitations of this study, there is no evidence of an acute large territorial\ninfarction,hemorrhage,edema, or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Please note that this study is markedly limited by motion artifact. Within\nthe limitations of this study there is no evidence of an acute intra-axial\nbleed." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass.\n\nThe ventricles and sulci are normal in size and configuration.\n\nThere is fluid in the ___ and oropharynx, most likely related to intubation. \nThere is a small amount of fluid in the left sphenoid sinus. The remainder of\nthe paranasal sinuses appears clear. The visualized portion of the mastoid\nair cells,and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.\n\nCT PERFUSION:\nSymmetric mismatch in the bilateral occipital lobes is felt to be artifactual\nin nature. No definite evidence of perfusional abnormality.\n\nCTA HEAD:\nThere are mild atherosclerotic changes along both carotid siphons without\nhigh-grade stenosis. Note is made of a 3 mm saccular outpouching along the\nleft ICA ophthalmic segment (series 4, image 232) which could represent a\nsmall ophthalmic artery versus carotid cave aneurysm. There is a small infant\ntibial Um at the origin of the right foot tonic artery (series 4, image 230).\n\nThe vessels of the circle of ___ and their principal intracranial branches\nappear otherwise unremarkable without evidence of stenosis or vessel\nocclusion. A small right posterior communicating artery is visualized. The\ndural venous sinuses are patent.\n\nCTA NECK:\nNormal 3 vessel aortic arch. There are mild atherosclerotic changes along the\naortic arch with extension into the great vessels but without significant\nstenosis. There are mild atherosclerotic changes along both carotid\nbifurcations but without evidence of internal carotid stenosis by NASCET\ncriteria.\n\nThere is atherosclerotic plaque at the origin of the right vertebral artery\nwhich results in at least mild stenosis. The origin of the left vertebral\nartery is unremarkable. Note is made of a short segment caliber change in the\ndistal V2 segment of the right vertebral artery (series 4, image 126) which\nmost likely reflect narrowing due to a noncalcified atherosclerotic plaque,\nhowever, a small focal dissection is not entirely excluded. The remainder of\nthe cervical vertebral arteries is unremarkable.\n\nOTHER: The patient is intubated and the ET tube terminates a couple cm above\nthe carina. Small amount of fluid is seen in the trachea, most likely due to\nintubation. There is a large consolidation in the posterior left upper lobe\nwhich may represent pneumonia or aspiration in the setting of altered mental\nstatus. The visualized portion of the thyroid gland is within normal limits.\nThere is no lymphadenopathy by CT size criteria.", + "output": "1. No evidence of acute infarction, hemorrhage or intracranial mass.\n2. Most likely artifactual symmetric perfusion mismatch involving the\nbilateral occipital lobes.\n3. Saccular 3 mm left ophthalmic artery versus carotid cave aneurysm.\n4. Short-segment caliber change in the distal V2 segment of the right\nvertebral artery, most likely related to a noncalcified atherosclerotic\nplaque, however, a small focal dissection is not entirely excluded.\n5. Atherosclerotic plaque at the origin of the right vertebral artery,\nresulting in at least mild stenosis.\n6. Otherwise patent cervical intracranial vasculature without evidence of\nstenosis or occlusion.\n\nRECOMMENDATION(S): Saccular 3 mm left ophthalmic artery versus carotid cave\naneurysm, neurosurgical consultation is suggested." + }, + { + "input": "There is no evidence of fracture, acute large territory\ninfarction,hemorrhage,edema,or mass. The ventricles and sulci are normal in\nsize and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "No acute intracranial hemorrhage or calvarial fracture." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema,or large mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process. No evidence of intracranial hemorrhage or\nfracture. Note that MRI is a more sensitive study for intracranial masses." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nSubtle subcortical areas of low attenuation are nonspecific and may reflect\nchanges due to chronic small vessel disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. An enteric tube is partially\nvisualized coursing from the left nare into the nasopharynx.", + "output": "There is no evidence of acute intracranial process or hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass.\n\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. There are a few scattered hypodensities in the periventricular and\nsubcortical white matter, which are nonspecific, but most likely represent\nchronic microangiopathic changes.\n\nThere is a left nasogastric tube in place. A small amount of layering\nsecretions are noted within the pharynx. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear.\n\nNo acute fracture is identified. There is a chronic right orbital floor\nfracture with herniation of the extraconal fat but no evidence of entrapment. \nThe left orbit is otherwise unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no acute intracranial hemorrhage, cerebral edema or major vascular\nterritory infarction. Ventricles and sulci are prominent, which has remained\nstable since ___ and probably due to age-related volume loss. Basal cisterns\nare patent. Gray-white matter differentiation is preserved.\n\nNo fractures are identified. Visualized paranasal sinuses are clear. Bilateral\nmastoid air cells and middle ear canals are clear. Bilateral orbits are\nunremarkable.", + "output": "No acute intracranial process. Specifically, there is no acute hemorrhage." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass. The ventricles and sulci are normal in size and configuration. There\nare low-lying cerebellar tonsils and crowding of the foramen magnum, with no\nevidence of ventriculomegaly. The pituitary is small, nonspecific, but\ntypically smaller than would be expected for a female patient of this age,\npotentially representing sequela of increased intracranial pressure.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Low-lying cerebellar tonsils and crowding of the foramen magnum, compatible\nwith given history of Chiari malformation.\n2. There is no evidence of ventriculomegaly.\n3. The pituitary gland is smaller than would be typically expected for a\nfemale patient of this age, a nonspecific finding. This could potentially\nrepresent sequela of crease intracranial pressure, although certainly\nnonspecific.\n4. Otherwise, no acute intracranial abnormality on noncontrast head CT." + }, + { + "input": "Areas of low-density in the anteromedial bilateral basal frontal lobes,\nanterior right temporal lobe appear chronic, likely related to posttraumatic\nencephalomalacia. Chronic infarct left middle frontal gyrus extending into\nthe frontal operculum. Small probably chronic right cerebellar infarct.\nThere is no evidence of acute major vascular territory\ninfarction,hemorrhage,edema, or mass. Mild chronic small vessel ischemic\nchanges. Generalized brain parenchymal atrophy.\n\nThere is no evidence of fracture. Minimal mucosal thickening is noted in the\nleft maxillary sinus. Mild paranasal sinus disease in the ethmoid sinuses\notherwise, the remaining visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. No acute intracranial abnormalities.\n2. Chronic infarcts right cerebellum, left frontal lobe. Chronic\nencephalomalacia anterior bilateral frontal and anterior right temporal lobes,\nlikely posttraumatic.\n3. Brain parenchymal atrophy." + }, + { + "input": "There is anterior dislocation of the 2 central maxillary incisors ___ 8 and\n9) with a fracture through the crown of right central maxillary incisor tooth\n___ 8). There is associated mildly displaced fracture through the dental\nalveoli and alveolar process of these maxillary central incisor teeth.\n\nThere is a minimally displaced fracture of the left nasal bone and anterior\nbony nasal septum (02:44). There is high-density material within the nasal\npassages suggestive of blood.\n\nThere is partial opacification of the ethmoid sinuses. Maxillary, sphenoid\nand mastoid air cells are intact with only minimal mucosal thickening noted in\nthe maxillary sinuses.. The globes, extraocular muscles, optic nerves, and\nretrobulbar fat appear normal. The mandible and temporomandibular joints\nappear normal.", + "output": "1. Anterior dislocation of the 2 maxillary central incisors ___ 8 and 9) with\nassociated fracture through the dental alveoli and alveolar process of these\nmaxillary central incisor teeth.\n2. Fracture through the crown of the right central incisor maxillary tooth.\n3. Minimally displaced fracture of the left nasal bone and anterior bony nasal\nseptum. Associated blood within the nasal passages." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\n\nParanasal sinuses are better assessed on dedicated facial bone CT performed\nsubsequently. Mastoid air cells and middle ear cavities are well aerated. The\nbony calvarium is intact.", + "output": "No acute intracranial process. Please see dedicated maxillofacial CT for\nfacial findings." + }, + { + "input": "Study is mildly degraded by streak artifact emanating from dental amalgam and\nposterior stimulator at the occiput.\n\nThere is a small amount of subarachnoid blood within the sulci in the left\nposterior parietal region (2:18, 601:70, 602:63). No evidence of additional\nhemorrhage, acute large territorial infarction, edema,or mass. The ventricles\nand sulci are normal in size and configuration. There is a small subgaleal\nhematoma in the left frontal region measuring up to 5 mm (02:20).\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Nerve stimulator device leads\nterminate over the bilateral occipital scalp.", + "output": "1. Small amount of subarachnoid blood within the left posterior parietal\nsulci.\n2. Left frontal subgaleal hematoma measuring up to 5 mm.\n3. No evidence of fracture.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at approximately 09:30 pm,\napproximately 5 minutes after discovery of the findings." + }, + { + "input": "Previously identified subarachnoid blood not demonstrated on this scan. There\nis no evidence of infarction, edema, or mass. The ventricles and sulci are\nnormal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. A neural stimulation device lies\nwithin the subcutaneous tissues overlying the occiput, with streak artifact\nthat somewhat limits evaluation of the posterior occipital lobes bilaterally. \nEft forehead soft tissue swelling, improved.", + "output": "1. No definite intracranial hemorrhage..\n2. Left forehead soft tissue swelling.\n3. No evidence of fracture.\n4. Evaluation of occiput is limited secondary to streak artifact." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nMinimal mucosal thickening in the right frontal sinus. Incidentally noted\nright concha bullosa. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are otherwise clear. The visualized\nportion of the orbits are unremarkable.\n\nCTA HEAD:\nAs before, the right A1 segment is attenuated but patent. No significant\nchange in a 0.3 cm anterior communicating artery aneurysm at the junction with\nthe left ACA (___). Again seen is early venous filling secondary to an\nunchanged developmental venous anomaly in the right cerebral hemisphere\n(___). The vessels of the circle of ___ and their principal intracranial\nbranches otherwise appear normal with no evidence of stenosis, occlusion, or\naneurysm. The dural venous sinuses are patent.", + "output": "1. Unchanged 0.3 cm anterior communicating artery aneurysm at the junction\nwith the left ACA.\n2. Unchanged right cerebral hemisphere developmental venous anomaly.\n3. No evidence of infarction, hemorrhage, edema or mass." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThere is mild mucosal wall thickening in the left frontal ethmoidal recess and\na small amount of aerosolized fluid in the right frontoethmoidal recess. The\nremainder of the visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the orbits\nare unremarkable.\n\nCTA HEAD:\nThere is normal variant fetal type origin of the bilateral posterior cerebral\narteries with hypoplastic vertebral and basilar arteries. 3 mm anterior\ncommunicating artery aneurysm is unchanged (03:58, 601b:12). The right A1\nsegment of the ACA is hypoplastic. A right temporal developmental venous\nanomaly is unchanged. The vessels of the circle of ___ and their principal\nintracranial branches otherwise appear patent with no evidence of stenosis,\nocclusion, or new aneurysm. The dural venous sinuses are patent.", + "output": "1. No hemorrhage or infarct.\n2. Stable 3 mm anterior communicating artery aneurysm.\n3. Patent intracranial arterial vasculature without stenosis, occlusion, or\nnew aneurysm.\n4. Unchanged right temporal developmental venous anomaly." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nPatient is status post left frontal craniotomy and clipping of known anterior\ncommunicating artery aneurysm with postoperative pneumocephalus, subcutaneous\nhemorrhage and air. There is no midline shift. There is no evidence of new\nhemorrhage, infarction, or mass.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nArtifact secondary to aneurysm clips limits diagnostic evaluation. The\npreviously patent A2 segment of the right ACA is occluded or severely stenotic\nat its origin. The remaining A2 segment immediately distal to the\nocclusion/severe stenosis is seen but smaller in caliber compared to ___, which is most likely filled by distal collateral vessels. The\nleft A1 and A2 are normal. There is no additional stenosis, occlusion,\ndissection, or aneurysm identified. There is bilateral normal variant fetal\ntype origin of the posterior cerebral arteries. The dural venous sinuses are\npatent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Status post left frontal craniotomy and clipping of anterior communicating\nartery aneurysm with expected postoperative changes.\n2. No evidence of new hemorrhage or of infarction.\n3. Occluded or severely stenotic right A2 at its origin arising from anterior\ncommunicating artery. Right A2 segment immediately distal to the\noccluded/severely stenotic segment is most likely filled by distal collateral.\nNormal left A1 and A2." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is new hypodensity within the right paramedian frontal lobe extending to\nthe genu of the corpus callosum and the right frontal vertex, compatible with\nsubacute infarction.\n\nPostsurgical changes are seen related to left frontal craniotomy with interval\nincrease in overlying soft tissue swelling and extra cranial fluid collection\nwith increase in subcutaneous hemorrhage and edema extending along the left\nperiorbital region, left maxilla, left frontal and temporal scalp. There is\ninterval decrease in left frontal extra-axial pneumocephalus there is no\nsignificant change in size of the ventricles. There is no midline shift. The\nparanasal sinuses and bilateral mastoid air cells appear clear.\n\nCTA HEAD:\nIn comparison with the recent CTA dated ___, there is increased\nluminal narrowing and irregularity of the left A1 segment and likely proximal\nright A2 segments of the anterior cerebral artery, bilateral M1 segments of\nthe middle cerebral artery, and supraclinoid right ICA. These findings are\nsuggestive of vasospasm. There is hypoplastic right A1 segment of the\nanterior cerebral artery similar to the prior study. The proximal portion of\nthe right A2 branch fills slightly better than on the prior CTA. There is\nmild artifact related to left ACA metallic clip.", + "output": "1. New subacute infarction involving the right paramedian frontal lobe\nextending to the genu of the corpus callosum.\n2. Luminal irregularity and narrowing of multiple intracranial vessels, which\nis new from ___, and is consistent with vasospasm.\n3. Postsurgical changes related to left frontal craniotomy with increase in\nsubcutaneous hemorrhage and extensive soft tissue swelling and edema.\n\nNOTIFICATION: The findings were discussed with ___, PA by ___\n___, M.D. on the telephone on ___ at 8:05 pm, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "There is no evidence of acute hemorrhage mass effect midline shift or\nhydrocephalus. Gray-white matter differentiation is maintained. Mild brain\natrophy seen and mild changes of small vessel disease identified.\n\nThe visualized paranasal sinuses are clear. No skull fracture is seen.", + "output": "No acute intracranial abnormalities are identified. Mild brain atrophy\nwithout medial temporal atrophy. Mild small vessel disease. No significant\nchange from previous study." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass. There\nis commensurate prominence of the ventricles, sulci, and cisterns consistent\nwith generalized parenchymal volume loss. This is unchanged from CT on ___. There are patchy hypodensities in the subcortical and periventricular\nwhite matter, also unchanged from prior CT on ___ and consistent with\nchronic small vessel ischemic disease.\n\nThere are chronic nasal bone fractures, unchanged from prior CT. The osseous\nstructures are otherwise normal. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No evidence of hemorrhage, acute infarct, or mass lesion.\n2. Mild generalized parenchymal volume loss, unchanged from CT on ___.\n\n***********reviewed with Dr. ___\n\n___: Preliminary findings were discussed by Dr. ___\nof radiology with Dr. ___ at approximately 15:00 ___." + }, + { + "input": "Head CT: There is no evidence of hemorrhage, edema, masses, mass effect, or\ninfarction. Sulci, ventricles and cisterns are within expected limits for the\ndegree of age-appropriate global cerebral volume loss. Patchy subcortical and\nperiventricular white matter hypodensities are noted, unchanged from prior\nexam, which are nonspecific, but commonly seen in setting of small vessel\nischemic disease. No fractures are noted. Mild mucosal thickening and mucous\nretention cysts of the bilateral maxillary sinuses are noted. Mild\nopacification of ethmoid air cells are also seen with a very small mucous\nretention cyst in the right sphenoid sinus. The orbits are unremarkable. The\nmastoid air cells middle ear cavities are well pneumatized and clear.\n\nHead CTA: Mild atherosclerotic calcification of the left supraclinoid ICA is\nnoted. Otherwise, the intracranial ICA, ACA, MCA and their major branches are\nunremarkable. Incidental note is made of a fetal origin of right posterior\ncerebral artery. The basilar artery is unremarkable. There is mild focal\nnarrowing of the mid V4 segment, which may represent noncalcified\natherosclerotic plaque. There are no intracranial vascular abnormalities.\nThere is no evidence of aneurysm larger than 3 mm. The dural venous sinuses\nare patent.\n\nNeck CTA: There is a normal 3 vessel arch. The carotid and vertebral arteries\nand their major branches are patent with no evidence of stenoses. There is no\nevidence of internal carotid stenosis by NASCET criteria.\n\nOther: The thyroid gland is unremarkable. The lung apices are also clear. No\ncervical lymphadenopathy by CT size criteria. There is prominence of the\npalatine tonsils which also demonstrate multiple tonsilliths. Otherwise, the\nremainder of the aerodigestive tract is unremarkable.", + "output": "1. No evidence of intracranial hemorrhage or mass.\n2. Nonspecific white matter hypodensities, compatible with small vessel\nischemic disease in a patient of this age.\n3. Allowing for anatomic variation, essentially unremarkable MRA of the neck\nand head." + }, + { + "input": "A linear streak of hyperdensity at the left lateral convexity (02:25) may\nrepresent small subarachnoid hemorrhage or artifact. There is concern for\nearly diffuse cerebral edema. There is no evidence of acute infarction,or\nmass effect.\n\nMultiple fractures are seen involving all walls of the left maxillary sinus,\nthe medial, lateral and floor of the left orbit, the left zygomatic arch, and\nthe squamous portion of the left temporal bone (3:33). There is no evidence\nof left extraocular muscle entrapment. Foci of gas are seen tracking into the\ninferior left orbit. Soft tissue density material in the superior left orbit\nlikely represent small hematoma. There is opacity of the bilateral mastoid\nair cells, concerning for fractures of the petrous portions of the bilateral\ntemporal bones. No discrete fracture lines are seen involving the carotid\ncanals. Foci of gas are seen tracking into the inferior left orbit\n\nThere is also fracture seen at the base of the left pterygoid plate.\n\nThere is diffuse opacity of the left maxillary sinus, bilateral sphenoid\nsinuses and opacification of bilateral ethmoid air cells. Aerosolized\nsecretions are seen in the right maxillary sinus as well as a mucous retention\ncyst.\n\nSoft tissue density material in the superior left orbit likely represents a\nsmall hematoma.\nSubcutaneous gas is seen involving the left face and left orbit as well as\nextensive soft tissue swelling and hematoma along the lateral left head and\nface. There is also subgaleal hematoma along the posterior vertex\nbilaterally.", + "output": "1. Linear streak of hyperdensity at the left lateral convexity may represent a\nsmall subarachnoid hemorrhage or artifact.\n2. Concern for early diffuse cerebral edema.\n3. Multiple fractures involving the left face and bilateral temporal bones, as\ndetailed above. Fracture of the base of the left pterygoid plate. See\ndedicated maxillofacial CT for further assessment.\n4. Small hematoma in the superior left orbit. Foci of gas seen tracking into\nthe inferior left orbit.\n5. Subcutaneous gas involving the left face and orbit.\n6.\n\nNOTIFICATION: Updated wet read discussed with ___ ___ on the phone on\n___ at 19:24." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass or infarction. The ventricles\nand sulci are normal in size and configuration.\n\nExtensive maxillofacial fractures involving the left zygomaticomaxillary\ncomplex, orbit, lamina papyracea and temporal bones were completely described\non ___. There has been an interval decrease in the degree of soft\ntissue swelling over the left face. There is partial opacification of the\nleft maxillary sinus with hypodense material. Hyperdense material, presumably\nblood products, fills the left anterior ethmoid air cells and partially fills\nthe sphenoid sinuses. There is partial opacification of the bilateral mastoid\nair cells.", + "output": "1. No evidence of hemorrhage or infarction.\n2. Extensive left maxillofacial fractures and temporal bone fractures as\npreviously described on ___.\n3. Interval reduction in soft tissue swelling about the left face." + }, + { + "input": "Left :\nThere is a fracture of the squamous portion of the left temporal bone at the\njunction with the mastoid portion that is depressed by about 2 mm (302:149). \nThe mastoid air cells are partially opacified, however a discrete fracture\nthrough the mastoid portion of the temporal bone is not seen. The otic\ncapsule is intact.\n\nThe external auditory canal is normal. The middle ear cavity is clear. The\nossicles and tegmen are intact. There is no evidence for enlarged vestibular\naqueduct or superior semicircular canal dehiscence. The facial nerve follows a\nnormal course through the middle ear. There is no evidence for inner ear\ndysplasia.\n\nRight:\nThere is opacification of the mastoid air cells. A transversely oriented\nfracture extends through the temporal bone to the external auditory canal (for\nexample 301:145). The otic capsule is spared.\n\nThe external auditory canal is normal. The middle ear cavity is clear. The\nossicles and tegmen are intact. There is no evidence for enlarged vestibular\naqueduct or superior semicircular canal dehiscence. The facial nerve follows a\nnormal course through the middle ear. There is no evidence for inner ear\ndysplasia.\n\nOther: Extensive maxillofacial fractures, primarily involving the left\nzygomaticomaxillary complex and left lamina papyracea were previously\nevaluated on prior head and maxillofacial CTs from ___ and ___. There remains partial opacification of the left maxillary sinus, left\nanterior ethmoid air cells and sphenoid sinuses.", + "output": "1. Transversely oriented right temporal bone fracture through the mastoid\nportion that spares the otic capsule.\n2. Fracture of the squamous portion of the left temporal bone at the junction\nwith the mastoid portion with 2 mm of depression.\n3. Extensive maxillofacial fractures primarily involving the left\nzygomaticomaxillary complex and lamina papyracea were previously evaluated on\n___ maxillofacial CT.\n4. Paranasal sinus opacification as described above." + }, + { + "input": "Non-contrast Head CT: There is no evidence of acute intracranial hemorrhage,\nedema, masses, mass effect, or major vascular territory infarction. The\nventricles and sulci are prominent, likely due to age-related volume loss. \nExtensive bilateral periventricular, subcortical and deep white matter\nhypodensities are nonspecific, but probably due to chronic small vessel\nischemic disease. No fractures are identified. The orbits are unremarkable. \nThere are nodular soft tissue densities in the posterior scalp with some\ninternal calcifications (4:206), that likely represent sebaceous cysts.\n\nCT perfusion: There is symmetrical apparent increase in the mean transit time\n(MTT) that is most notable in the cerebellar hemispheres and temporal lobes\nbilaterally (___), which may be artifactual. There are no focal\nterritorial perfusion abnormalities to suggest ischemia.\n\nHead and neck CTA: The anterior and middle cerebral arteries are patent,\nwithout evidence of aneurysm, stenosis or occlusion. There are scattered\nareas of wall irregularity and mild outpouchings within the bilateral\nintracranial internal carotid arteries, most notably on the left (4:217),\nlikely representing dolichoectasia.\n\n There is a normal 3-vessel arch. There is mild intraluminal narrowing of the\ndistal innominate artery (4:39) which may be due to noncalcified plaque. The\ncarotid arteries are patent without evidence of internal carotid stenosis by\nNASCET criteria. Dense atherosclerotic calcifications are noted at the\nbilateral carotid bifurcations. There is vessel wall irregularity along the\nright internal carotid artery (602b:35), may represent atherosclerotic disease\nor fibromuscular dysplasia. The vertebrobasilar system is markedly tortuous,\nbut patent. There is markedly dilated fusiform dolichoectasia of the basilar\nartery, measuring up to 1.6 cm in maximum diameter (602b:44). There are\nscattered areas of apparent filling defects along the peripheral wall of the\nbasilar artery (4:199), with no definite correlate on the coronal and sagittal\nreformats and may represent volume averaging. No evidence of dissection.\n\nMultilevel degenerative changes are seen within the cervical spine. The right\nthyroid lobe appears enlarged, and contains an 8 mm hypodense nodule with\nperipheral enhancement (4:57). The left thyroid lobe is not visualized. \nVisualized upper lung zones are clear. The partially visualized esophagus\nappears dilated and contains intraluminal fluid (4:8).", + "output": "1. Noncontrast CT head: No acute intracranial hemorrhage or loss of\ngray-white matter differentiation.\n2. CT Perfusion: Symmetric increase in MTT predominantly in both cerebellar\nhemispheres and temporal lobes, which may be artifactual and less likely due\nto ischemia. No focal vascular territory perfusion abnormalities.\n3. CTA Head: Markedly tortuous vertebrobasilar system with fusiform\ndolichoectasia of the basilar artery measuring up to 1.6cm in diameter. No\nhigh grade stenosis or evidence of dissection. Additional sites of\ndolichoectasia within the intracranial internal carotid arteries,\npredominantly on the left.\n4. Irregularity along the wall of the right internal carotid artery may\nrepresent atherosclerotic disease or fibromuscular dysplasia.\n5. 8 mm peripherally nodule in the right thyroid lobe.\n6. Partially visualized esophagus appears dilated and contains intraluminal\nfluid.\n\nRECOMMENDATION(S): A non-urgent thyroid ultrasound could be obtained for\nfurther evaluation of the thyroid nodule if clinically warranted.\n\nNOTIFICATION: Final results/changes to initial wet read were discussed with\nDr. ___ by Dr. ___ ___ at 5:02PM." + }, + { + "input": "This study is severely degraded by streak artifact and motion. Since the\nprior CTA performed on ___, the patient has been intubated.\n\nWithin the limitations of this study, there is no definite evidence of acute\nintracranial hemorrhage, major vascular territory infarction, edema or mass\neffect. The ventricles and sulci are prominent, likely due to age-related\nvolume loss. Bilateral periventricular, subcortical and deep white matter\nhypodensities are nonspecific, that may represent a sequela of chronic small\nvessel ischemic disease. Again noted is dolichoectasia of the basilar artery,\nmeasuring up to 1.7 cm in greatest dimension (2:15). Calcifications are noted\nwithin the cavernous internal carotid arteries bilaterally.\n\nNo osseous abnormalities seen. There is mild mucosal thickening within the\nethmoid air cells. Remainder of the paranasal sinuses, mastoid air cells and\nmiddle ear canals are clear. The orbits are unremarkable. Two nodular\ndensities within the posterior occipital scalp, one of which is calcified\n(2:15), likely represent sebaceous cysts.", + "output": "1. Study severely degraded by streak artifact and motion.\n2. Within the limitations of this study, no definite evidence of acute\nintracranial hemorrhage or vascular territory infarction.\n3. Basilar artery dolichoectasia, measuring up to 1.7 cm in AP diameter.\n4. Stable bilateral occipital scalp probable sebaceous cyst as described." + }, + { + "input": "There is interval decrease in size of the previously noted right\ntemporoparietal subdural hemorrhage currently measuring 6 mm in maximal\ndiameter (previously 8 mm).\n\nMultiple punctate contusion hemorrhages are again noted with the largest\nbleeds present in the high right frontal (series 2, image 31), posterior high\nleft frontal (series 2, image 29) right frontal operculum (series 2, image\n21), and right postcentral gyrus (series 2, image 28 and 30). These\nhemorrhages demonstrate normal expected evolution of slight increase in\nsurrounding vasogenic edema.\n\nThere is no midline shift. The ventricular profile is unchanged. No large\nacute territorial infarct. Periventricular hypodense changes are most likely\nsequela of microangiopathy. The paranasal sinuses are essentially clear. The\nmastoid air cells are clear. Right parietal extracranial soft tissue swelling\nwith no underlying fracture.", + "output": "1. Interval decrease in size of the right temporoparietal subdural hemorrhage\nas described above compatible with redistribution.\n2. Normal evolution of the multiple intraparenchymal contusion hemorrhages\nwith mild increase in surrounding vasogenic edema.\n3. No evidence of acute large territory infarct. Additional findings\ndescribed above." + }, + { + "input": "Artifact associated with dental amalgam limits evaluation of the inferior\nfrontal lobes and inferior temporal lobes.\n\nThere is a punctate focus of slow diffusion in the left occipital lobe\n(06:16). The there is no definite correlate on T2 weighted imaging. There is\na focus measuring 1.2 x 0.8 cm in the right occipital lobe (15:88) which\nmatches the signal characteristics of CSF on all sequences, without associated\nslow diffusion or enhancement. There is a punctate focus of susceptibility in\nthe right occipital lobe, noted on gradient echo sequences, which corresponds\nto the punctate calcification noted on outside hospital CT head ___. There is no mass effect or midline shift.. There is no hemorrhage. \nVentricles and sulci are normal in size given the patient's age. There are\nsubcortical and periventricular foci of high signal on T2/FLAIR sequences,\nlikely representing chronic small vessel ischemic disease.\n\nA 5 mm aneurysm is incidentally noted at the right M1 M2 bifurcation, series\n15, image 75.", + "output": "1. A punctate focus of slow diffusion in the left occipital lobe, without\ndefinite correlate on T2 weighted imaging, likely representing acute/the early\nsubacute infarct.\n2. Right occipital cyst measuring up to 1.2 cm without associated edema or\nrestricted diffusion. Given its location, this likely represents an\nporencephalic cyst as opposed to an ependymal cyst as a clear connection with\nthe ventricle is not discerned, a benign entity.\n3. 5 mm aneurysm incidentally noted at the right M1/M2 bifurcation.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\n___ on the telephone on ___ at 2:52 pm, 5 minutes after discovery\nof the findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles and\nsulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The patient is status post bilateral lens resections.\nOtherwise, the visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is a 5 mm saccular aneurysm at the right MCA bifurcation (series 3,\nimage 245). There are moderate atherosclerotic calcifications of the\ncavernous carotid arteries bilaterally with mild narrowing. Otherwise, the\nvessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis or occlusion. The dural venous sinuses are\npatent.\n\nCTA NECK:\nNormal 3 vessel takeoff. Mild atherosclerotic calcifications of the aortic\narch. Moderate atherosclerotic calcifications of the carotid bifurcations\nbilaterally. 20% narrowing of the proximal right internal carotid artery by\nNASCET criteria due to calcified plaque. No narrowing of the left internal\ncarotid artery by NASCET criteria. The right vertebral artery is diminutive\ncompared to the left, congenital. Otherwise, the carotid and vertebral\narteries and their major branches appear normal with no evidence of occlusion.\n\nOTHER:\nThe visualized portion of the lungs are clear. 3 mm hypodense nodule within\nthe right lobe of the thyroid. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No acute intracranial abnormalities.\n2. No evidence of large vessel occlusion or high-grade stenosis.\n3. 5 mm saccular aneurysm arising from the right MCA bifurcation.\n4. 20% narrowing of the proximal right internal carotid artery by NASCET\ncriteria due to calcified plaque. No left internal carotid artery stenosis by\nNASCET criteria.\n5. 3 mm hypodense nodule within the right lobe of the thyroid.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "CT HEAD:\nThere is no evidence for acute hemorrhage, vascular territorial infarction,\nmass effect, or edema. The ventricles and sulci are normal in size and\nappearance.\n\nThe paranasal sinuses, middle ear cavities, and mastoid air cells are clear.\nThe orbits are grossly unremarkable bilaterally.\n\nCTA HEAD AND NECK:\nThere is a 3 vessel aortic arch identified. The vertebrobasilar system is\nleft-sided dominant, with a diminutive right-sided vertebral artery seen\nthroughout its course. This is likely a chronic finding. The right V4\nsegment appears to terminate at the ___. The left vertebral artery is widely\npatent.\n\nThe bilateral common carotid arteries are patent. There is no evidence of\ninternal carotid stenosis by NASCET criteria.\n\nThe intracranial vasculature is grossly patent without high-grade stenosis,\nocclusion, or aneurysm greater than 3 mm. The dural venous sinuses are patent.\n\nOTHER:\nThe lungs apices are clear bilaterally. The thyroid gland is unremarkable in\nappearance. Multiple prominent bilateral cervical lymph nodes are noted, none\nof which are pathologically enlarged by CT size criteria.", + "output": "1. No evidence for acute intracranial process or hemorrhage.\n2. Left-sided dominant vertebrobasilar system with a diminutive right\nvertebral artery terminating in the right ___. Although this appears\nchronic, recommend correlation with prior imaging, if available, to establish\nthe chronicity of this finding.\n3. Otherwise widely patent intracranial and cervical vasculature.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 4:36 am, 1 minutes after\ndiscovery of the findings." + }, + { + "input": "Re-demonstration of left intraparenchymal hemorrhage involving the basal\nganglia as well as the external capsule, unchanged in size from ___ head\nCT. No significant midline shift identified. The ventricles and sulci are\nprominent consistent with mild atrophic changes, well within normal limits for\nage. Periventricular, subcortical, and deep white matter hypodensities\nsuggestive of chronic microvascular ischemic disease. Atherosclerotic\nvascular calcifications are noted of bilateral vertebral and cavernous\nportions of internal carotid arteries.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Soft tissue density is noted within\nthe left external auditory canal which may represent cerumen.", + "output": "1. Grossly stable left basal ganglia and external capsule intraparenchymal\nhemorrhage, with no definite midline shift. While finding may be hypertensive\nin etiology, underlying mass is not excluded. Recommend follow-up imaging to\nresolution. If clinically warranted, a contrast-enhanced brain MRI can be\nperformed for further characterization.\n2. Atrophic changes and chronic microvascular ischemic disease." + }, + { + "input": "There are extensive white matter hypodensities in periventricular and\nsubcortical distribution, likely corresponding with findings previously\ndescribed as chronic small vessel ischemic disease or possibly demyelinating\nlesions and progressed since ___. Due to above-mentioned white matter\nchanges, evaluation for acute infarction is mildly limited. Within these\nlimits, there is no evidence of acute infarction,hemorrhage,edema, or mass. \nHypodensity in the left thalamus with volume loss and surrounding relatively\nhigh density corresponds with area of prior blood products/mineralization on\n___. Previously noted pontine lesion is difficult to evaluate on\nthe current modality. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. Small appearance of the left cerebral\npeduncle is compatible with wallerian degeneration better seen on remote prior\nMR.\n\n___ is no evidence of acute fracture. Mild mucosal thickening of the right\nmaxillary sinus and ethmoid air cells are noted. The visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nThe visualized portion of the orbits are unremarkable.", + "output": "1. No acute infarction or hemorrhage within the limits of the exam due to\nextensive white matter hypodensities in periventricular and subcortical\ndistribution, which appears to have progressed significantly since ___. This\nwas previously thought to be chronic small vessel ischemic disease or possibly\ndemyelinating lesion.\n2. Changes in the left thalamus, corresponding with the area of prior blood\nproducts on ___, thought to be related to amyloid angiopathy or\nhypertensive hemorrhages. Other lesions seen on ___ are not well evaluated\non the current modality." + }, + { + "input": "Left parietooccipital encephalomalacia is again noted. Periventricular and\nwhite matter hypodensities are again noted, likely sequela of chronic small\nvessel disease. Prominence of the ventricles and sulci is compatible global\nvolume loss. There is no acute hemorrhage, mass effect, or evidence of acute\ninfarct.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "No evidence for acute intracranial hemorrhage, edema, or mass effect. A\nchronic infarct is again seen in the left inferior parietal and superior\noccipital lobes. Extensive periventricular, deep, and subcortical white\nmatter hypodensities are grossly unchanged, nonspecific but likely sequela of\nchronic small vessel ischemic in this age group.\n\nModerate ventriculomegaly is commensurate with enlargement of the sylvian\nfissures and sulci, likely due to global parenchymal volume loss, which is\nsimilar to the ___ CT, minimally progressed compared to the ___ CT, and more notably progressed compared to the ___ CT.\n\nNo concern osseous abnormalities seen. There is a small mucous retention cyst\nin the left sphenoid sinus. Mastoid air cells are well aerated. The orbits\nappear grossly unremarkable on noncontrast CT.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. Chronic left parietal/occipital infarct is again demonstrated.\n3. Moderate ventriculomegaly is commensurate with enlargement of the sylvian\nfissures and sulci, likely due to global parenchymal volume loss, which is\nsimilar to the ___ CT, minimally progressed compared to the ___ CT, and more notably progressed compared to the ___ CT.\nCOMMENT:\nWhile there is no specific imaging evidence to suggest communicating\nhydrocephalus, please note that this would be a clinically based diagnosis." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles are symmetric. The sulci are prominent, consistent with mild\ncortical atrophy. There are moderate scattered periventricular and\nsubcortical white matter hypodensities, which are nonspecific, but likely\nrepresent chronic microvascular ischemic changes.\n\nThere is no evidence of fracture. Hypoplastic left frontal sinus. There is a\nleft maxillary sinus mucous retention cyst. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are otherwise\nclear. Status post bilateral lens replacement.", + "output": "1. No acute intracranial abnormality.\n2. Mild cortical atrophy. There are scattered periventricular and subcortical\nwhite matter hypodensities, which are nonspecific, but likely represent\nmoderate chronic microvascular ischemic changes." + }, + { + "input": "There is no evidence of acute infarct, hemorrhage, or new edema. A 4.1 x 3 cm\nrim calcified hyperdense right posterior parietal parasagittal lesion is\nunchanged in size from ___ with a small amount of adjacent edema, as seen on\nthe previous MRI. A smaller 0.9 x 0.9 cm dural-based calcified lesion within\nthe right posterior petrosal surface, and a 1.2 x 0.8 cm partially calcified\nlesion seen posteriorly adjacent to the right transverse sinus are also stable\nfrom ___. As before, these lesions are most consistent with meningiomas.\n\nProminence of the ventricles and sulci is consistent with age-related\ninvolutional change. Mild periventricular and deep subcortical white matter\nhypodensities are consistent with sequela of chronic small vessel ischemic\ndisease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. No significant interval change in the known right posterior parietal\nparasagittal mass lesion, dural-based calcified mass lesion along the right\nposterior petrosal surface, and the partially calcified mass lesion adjacent\nto the right transverse sinus, as compared to ___. Again, these likely\nrepresent meningiomas." + }, + { + "input": "There is no evidence of large territorial infarction, hemorrhage, edema, or\nmass effect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific but likely sequelae of chronic small vessel\nischemic disease.\n\nThere is no evidence of fracture. There is a right maxillary sinus mucous\nretention cyst and mucosal thickening with aerosolized secretions in the left\nsphenoid sinus. The visualized portion of the remaining paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nintracranial hemorrhage.\n2. Global atrophy appropriate for age and chronic small vessel ischemic\nchanges.\n3. Paranasal sinus disease." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or infarction. The\nventricles and sulci are normal in size and configuration. There is no\nfracture. The imaged paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear.", + "output": "Normal study." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "Normal CT head." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Basal ganglia and dentate nuclei calcifications are noted. \nVentricles and sulci are unremarkable. Atherosclerotic calcifications noted\nwithin the intracranial ICAs.\n\nThere is a defect in the left lamina papyracea which may be sequela of prior\ntrauma, unchanged from prior MRI. Mucosal thickening noted within the\nleft-sided ethmoid air cells. Remaining paranasal sinuses and mastoids are\nclear. Numerous lucent lesions seen in the visualized osseous structures,\nmost notable in the clivus, compatible with patient's history of myeloma.", + "output": "No acute intracranial process, no hemorrhage.\nMultiple lytic lesions in the osseous structures compatible with patient's\nknown myeloma." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of acute fracture. Mild mucosal thickening of the\nethmoid air cells. Otherwise the remainder of the visualized portions of the\nparanasal sinuses, mastoid air cells, and middle ear cavitiesare clear.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of fracture, acute large territory\ninfarction,hemorrhage,edema,or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. Periventricular and subcortical\nwhite matter hypodensities are nonspecific but compatible with chronic small\nvessel ischemia. Atherosclerotic calcification is noted involving the carotid\nsiphons and left vertebral artery.\n\nMinimal mucosal thickening in the maxillary sinuses and small mucous retention\ncyst in the left maxillary sinus, partially imaged. Mucosal thickening and\nretention cyst in the sphenoid sinus. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare otherwise clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "The right palatine tonsil is enlarged compared to the left compatible with\ntonsillitis. Ill-defined hypodensity in the right peritonsillar region with\nmild peripheral enhancement measures approximately 1.6 x 1.4 x 2.1 cm (series\n601b, image 33; series 2, image 31 ; series 602b, image 20) and is consistent\nwith phlegmon with developing/early abscess formation. Surrounding soft\ntissue edema and fat stranding is extensive with slight displacement of the\nuvula towards the left and moderate effacement of the right oropharynx. From\nthe cranial caudal aspect, the degree of soft tissue swelling extends from\njust above the uvula to the base of the nasopharynx. No evidence of\nretropharyngeal abscess. No soft tissue gas.\n\nThe neck vessels are patent.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal.\n\nEnlarged bilateral cervical chain lymph nodes are likely reactive.\n\nPeriapical lucencies surrounding the right maxillary second molar tooth is\nconsistent with periodontal disease (series 2, image 27 ; series 602b, image\n20). No clear evidence of cortical breakthrough.\n\nPolypoid mucosal thickening of the right maxillary sinus is moderate. The\nremaining imaged paranasal sinuses are clear. The nasal septum is slightly\ndeviated to the left.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules.No osseous lesions or fracture.", + "output": "1. Right palatine tonsillitis with moderate to severe right peritonsillar\nsoft tissue swelling and stranding and 1.6 x 1.4 x 2.1 cm area of phlegmon and\nearly developing abscess formation. This causes narrowing of the right\noropharynx but the airway remains patent. No soft tissue gas.\n2. Reactive bilateral cervical lymphadenopathy.\n3. Patent neck vessels.\n4. Right second maxillary molar tooth periodontal disease.\n5. Right maxillary sinus disease." + }, + { + "input": "There is no hemorrhage, edema, mass effect, midline shift, or mass. The\nventricles and sulci are normal in size and configuration. The basal cisterns\nare patent and there is normal gray-white matter differentiation. No fracture.\nSoft tissue calcifications in the face bilaterally are sequela of prior trauma\nper examination of the patient. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "Left frontal scalp soft tissue swelling is noted (see 02:14). There is no\nevidence of large territorial infarction, hemorrhage, edema, or mass effect. \nThere are periventricular and subcortical lucencies, which may represent small\nvessel ischemic changes. There is evidence of prior lacunar infarct and age\nrelated cerebral volume loss. Atherosclerotic vascular calcifications are\nnoted of bilateral cavernous portions of internal carotid arteries.\n\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\nThe orbits are unremarkable. The visualized osseous structures are\nosteopenic. Postsurgical changes from prior right maxillary sinus fracture\nrepair are noted. A chronic medial displaced right zygomatic arch fracture is\nagain noted (see 03:16 on the current study and 3:5 on the prior exam). A\nstable right sphenoid bone fracture is noted (see 03:20 on current exam in 3:8\non prior exam).", + "output": "1. Left frontal scalp soft tissue swelling.\n2. No acute intracranial abnormality.\n3. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described.\n4. Chronic facial bone fractures as described." + }, + { + "input": "There is no evidence of fracture, acute territorial\ninfarction,hemorrhage,edema,or mass effect. There is prominence of the\nventricles and sulci suggestive of involutional changes. Periventricular and\nsubcortical white matter hypodensities are nonspecific but can suggest chronic\nsmall vessel ischemic changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. Patient is status post bilateral lens replacements.\nThe visualized portion of the orbits are otherwise unremarkable.", + "output": "1. No acute intracranial process." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Mild periventricular white\nmatter hypodensities are likely sequela of chronic small vessel disease.\n\nIncluded paranasal sinuses and mastoids are essentially clear besides mild\nmucosal thickening in the anterior ethmoid air cells. Skull and extracranial\nsoft tissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "The parotid glands, submandibular glands, and thyroid are unremarkable. There\nis no cervical adenopathy. Prominenct, borderline enlarged level 2 lymph\nnodes noted on the left.\n\nThe aerodigestive tract appears normal. There is no retropharyngeal abscess\nor other evidence of inflammation. Included paranasal sinuses and mastoids\nare clear.\n\nAlthough not performed as a CT angiogram, there is relative narrowing of the\nleft vertebral artery with respect to its size at its origin and proximal\naspect. The caliber narrowing is relatively abrupt at the C7 level with more\neccentric narrowing with a flattened appearance at the C3-4 level. Distally,\nthe vessel appears larger in size. Vascular structures are otherwise notable\nfor an aberrant, retroesophageal right subclavian artery.\n\nIncluded intracranial structures appear normal.\n\nNo focal suspicious osseous lesion identified.\n\nLung apices are clear.", + "output": "Although not performed as a CT angiogram, relative caliber narrowing in the\nleft vertebral artery raises concern for dissection. No additional findings\nin the neck to explain patient's symptoms.\n\nRECOMMENDATIONS: MRA of the neck is suggested for further characterization.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:28 ___, 2 minutes after\ndiscovery of the findings." + }, + { + "input": "There is no hemorrhage, edema, mass, mass effect or large vascular territorial\ninfarction. The ventricles and sulci are normal in size and configuration. \nThere is preservation of grey-white matter differentiation and the basal\ncisterns are patent.\n\nNo fracture is identified. Minimal mucosal thickening is seen in the right\nmaxillary sinus. The remaining paranasal sinuses, mastoid air cell and middle\near cavities are clear.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "There is no evidence of acute large territory infarction, hemorrhage, edema,\nor mass effect. The ventricles and sulci are normal in size and\nconfiguration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormalities." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nPeriventricular and subcortical white matter hypodensities are nonspecific,\nhowever likely due to chronic small vessel ischemic disease in this age group.\nPreviously noted bilateral caudate lacunar infarcts are stable.\n\nThere is no evidence of acute fracture. A 1.2 cm lesion in the right frontal\nbone with central sclerotic focus surrounded by lucency is stable. \nDegenerative changes of the right temporomandibular joint is noted. The left\nmastoid air cells are underpneumatized. Previously noted opacification of the\nleft maxillary sinus has resolved. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Patient is\nstatus post bilateral lens replacements. Otherwise, the visualized portion of\nthe orbits are unremarkable.", + "output": "No acute intracranial abnormalities." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Mild periventricular and subcortical white matter hypodensities\nlikely reflect chronic microvascular ischemic disease. Ventricles and sulci\nare normal in overall size and configuration. The imaged paranasal sinuses are\nclear. Mastoid air cells and middle ear cavities are well aerated. Burrholes\nin the left frontal and parietal bone is new from prior.", + "output": "No acute intracranial process. Mild small vessel disease." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, or\nedema. A CSF density extra-axial structure in the posterior right parietal\nlobe measuring approximately 2.7 x 2.5 cm with localized mass effect is\nconsistent with an arachnoid cyst. No shift of normally midline structures. \nThere is age-appropriate prominence of the ventricles and sulci are consistent\nwith involutional changes. Mild periventricular and subcortical white matter\nhypodensities are nonspecific, but suggestive of chronic small vessel ischemic\ndisease.\n\nThere is an osteoma of the left frontal sinus. No acute fracture is seen. \nThere is mild mucosal thickening of the ethmoidal air cells and right\nmaxillary sinus. There is probable nasal polyposis. Bilateral pneumatized\nclinoid processes are incidentally noted. Otherwise the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "No acute intracranial process" + }, + { + "input": "There is no evidence of acute large territory infarction, hemorrhage, edema,\nor mass. The ventricles and sulci are prominent compatible with age related\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific, but likely reflect sequelae of chronic small\nvessel ischemic disease.\n\nNo acute osseous abnormalities seen. Patient is status post bilateral\nethmoidectomies and maxillary antrostomies. There is re-demonstration of\ncomplete opacification of the right sphenoid sinus with hyperdense material\nand surrounding osseous sclerosis, not changed from the prior study. There is\nmild-to-moderate right maxillary sinus mucosal thickening with adjacent bony\nsclerosis that has increased from prior. Moderate mucosal thickening is seen\nwithin the ethmoid sinuses bilaterally, and there is partial opacification of\nthe right mastoid air cells. The left mastoid air cells and middle ear\ncavities are clear. The orbits are unremarkable apart from bilateral lens\nresections.", + "output": "1. No acute intracranial abnormalities including no evidence of intracranial\nbleed.\n2. Chronic sinus disease of the right maxillary sinus and the right sphenoid\nsinus which contains hyperdense components possibly reflective of inspissated\nmucus or fungal colonization." + }, + { + "input": "There is no evidence of acute intracranial infarction,hemorrhage,edema, or\nmass effect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Subcortical and periventricular white matter\nhypodensities are nonspecific, however likely represent sequela of chronic\nsmall vessel ischemic disease.\n\nThere is no evidence of acute fracture. Patient is status post bilateral\nethmoidectomies and maxillary antrostomies. Complete opacification of the\nright sphenoid sinus with hyperdense material and surrounding osseous\nsclerosis is similar to prior, and consistent with chronic sinus disease. \nMucosal thickening in the bilateral maxillary sinuses, right greater than\nleft, with hyperostosis of the right maxillary sinus wall, and mucosal\nthickening in the ethmoid air cells, is similar to prior. There is partial\nopacification of the right mastoid air cells, unchanged. The visualized\nportion of the remainder of the paranasal sinuses, left mastoid air cells, and\nmiddle ear cavities are clear. Patient is status post bilateral lens\nreplacement.", + "output": "1. No fracture or acute intracranial process.\n2. Chronic sinus disease as described." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema, or\nmass. Periventricular and subcortical white matter hypodensities are\nnonspecific but likely sequelae of chronic small vessel ischemic disease. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges.\n\nThere is a left frontal region laceration with adjacent inflammation/small\nhematoma near the superolateral orbital rim. There is no evidence of\nfracture. Patient is status-post endoscopic sinus surgery. Moderate right\nmaxillary sinus mucosal thickening appears increased since ___. \nComplete opacification of the right sphenoid sinus with centrally\nhyperattenuating secretions is unchanged. Calcification and hyperattenuating\nsecretions suggest secretion inspissation or fungal colonization. \nOpacification of the right frontal sinus extending into the frontoethmoid\nrecess is slightly increased. Patchy mucosal thickening of the remaining\nethmoid air cells and mild mucosal thickening of the left maxillary sinus are\nminimally changed. Mild opacification of dependent right mastoid air cells is\nunchanged. The middle ear cavities are clear. Bilateral scleral buckles are\nnoted.", + "output": "1. Left frontal region laceration. No evidence of fracture or intracranial\nhemorrhage.\n2. Chronic sinus disease. Calcification and hyperattenuating secretions\nsuggest secretion inspissation or fungal colonization." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema,or mass effect. There\nis prominence of the ventricles and sulci suggestive of involutional changes. \nPeriventricular deep white matter hypodensities are nonspecific but likely\nrepresent sequela of chronic small vessel ischemic disease. Chronic infarct\nis noted in the left basal ganglia.\n\nThere is no evidence of fracture. The patient is status post nasal sinus\nsurgery with persistent, hyperdense complete opacification of the sphenoid\nsinus, which demonstrates bony thickening, suggesting chronic inflammation. \nThere is moderate mucosal thickening in the right maxillary sinus and ethmoid\nair cells. There is minimal opacification of the mastoid air cells on the\nright.", + "output": "1. No acute intracranial abnormality.\n2. Chronic sinus disease, including unchanged hyperdense opacification of the\nsphenoid sinus, which can be seen in the setting of fungal infection or\ninspissated secretions." + }, + { + "input": "There is no evidence of acute infarct, hemorrhage, edema, or mass effect. A\nchronic lacunar infarct versus prominent perivascular space in the left\nputamen is unchanged dating back to ___ and MRI of the brain dated ___. Prominent ventricles and sulci are suggestive of age-related\ninvolutional change.\n\nThere is no fracture. There is evidence of prior bilateral ethmoidectomy,\nuncinectomy and turbinectomy, with the expected postsurgical changes. The\nleft sphenoid sinus is completely opacified. There is mild mucosal thickening\nof the remaining paranasal sinuses. The mastoid air cells and middle ear\ncavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality. Paranasal sinus disease as described above." + }, + { + "input": "There is no acute hemorrhage, edema, mass, or mass effect or large infarction.\nA hypodensity in the region of the left putamen is unchanged in comparison to\nmultiple prior studies, possibly a chronic lacunar infarct or a dilated\nperivascular (Virchow ___ space. Mild-moderate prominence of the\nventricles and sulci is stable, consistent with age-appropriate global\ninvolutional change.\n\nThere is no evidence of acute fracture. The patient is status post bilateral\nethmoidectomy, uncinectomy, and turbinectomy, with stable postsurgical\nchanges. The right side of sphenoid sinus is completely opacified, as on\nprior. There is ethmoid air cell mucosal thickening. There is minimal\nsclerotic thickening of the wall of the right maxillary sinus, along with mild\nmucosal thickening, indicative of chronic sinusitis. Partial right mastoid\nair cell opacification is stable from prior. Soft tissue density material in\nthe bilateral external auditory canals is likely cerumen. The left mastoid\nair cells are clear. The patient is status post bilateral lens removal;\notherwise, the globes and bony orbits are unremarkable.", + "output": "1. No acute intracranial hemorrhage or mass effect or acute fracture\n2. Stable findings regarding postsurgical changes and chronic sinus disease,\nas detailed above." + }, + { + "input": "There is no evidence of large territorial infarction, hemorrhage, edema, or\nmass. There is an unchanged dilated CSF space or chronic lacunar infarct in\nthe region of the left putamen. The periventricular white matter\nhypodensities are nonspecific, but likely represent the sequela of chronic\nmicrovascular ischemic disease. There is prominence of the ventricles and\nsulci suggestive of involutional changes.\n\nThere is no evidence of acute fracture. The patient is status post bilateral\nfiberoptic endoscopic sinus surgery. There is complete opacification of the\nright sphenoid sinus. There is mild mucosal thickening involving the\nmaxillary and ethmoid sinuses bilaterally. The visualized portion of the\nmastoid air cells and middle ear cavities are clear. The patient is status\npost bilateral lens resections. There is a partially imaged 9 x 7 mm round\nright intraorbital soft tissue nodule adjacent to the lateral wall, which was\npresent in ___, but may have slightly increased in size.", + "output": "1. No evidence of acute intracranial process.\n2. Partially imaged 9 mm round soft tissue nodule within the right lateral\norbit, of doubtful clinical significance considering the patient's age, which\nmay have increased in size since ___. If of clinical concern, considering\nthe patient's age, orbital MRI may be obtained on an outpatient basis for\nfurther assessment." + }, + { + "input": "There is no evidence of intracranial hemorrhage, edema, or mass. The\nventricles and sulci are prominent, normal for age. Hypodensity in the left\ninsula is unchanged from ___, is consistent with prominent perivascular\nspace.\n\nPost functional endoscopic sinus surgery with unchanged trace mucosal\nthickening throughout its paranasal sinuses. Complete opacification of the\nsphenoid sinus is stable from ___ but higher density now measuring 69 ___. \nScleral plaques are noted bilaterally. Sclerosis of the sphenoid sinus walls\nsuggests chronic inflammation. No abnormality concerning for orbital injury. \nPreviously described soft tissue nodule in the right lateral orbit is not seen\non this examination.", + "output": "No fracture or intracranial hemorrhage. Chronic sinus disease with stable\npostsurgical changes since ___." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass. The deep, periventricular, white matter hypodensities are nonspecific\nand likely represents sequela of chronic microvascular disease. There is\ncortical atrophy and prominence of the ventricles and sulci are suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture.\n\nThere is mild mucosal thickening of the right maxillary sinus. There is\ncomplete opacification and wall sclerosis of the right sphenoid sinus\nunchanged from the ___ study and is consistent with patient's\nhistory of chronic sinus disease. Otherwise, the visualized portion of the\nremainder of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. Postsurgical changes related to prior bilateral cataract surgery\nare noted. The visualized portion of the orbits are otherwise unremarkable.", + "output": "1. No evidence of acute territorial infarct, hemorrhage, edema, or mass.\n2. Stable chronic sinus disease particular in the right sphenoid sinus." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of acute fracture. There is nonspecific hyperostosis of\nthe outer table of the frontal calvarium near the vertex (___). The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable. \nDense carotid siphon calcifications are noted.", + "output": "No acute intracranial abnormalities." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is redemonstration of diffuse subarachnoid hemorrhage within the\nbilateral cerebral sulci, bilateral sylvian fissures, along the\ninterhemispheric fissure, tentorium and within the cisterna magna. There is a\nfocal hyperdense focus in the right suprasellar cistern,, similar to the prior\nstudy. There is mild enlargement of the ventricular system and effacement of\nthe cerebral sulci. There is no definite evidence of infarction,ormass. The\nventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are normal.\n\nCTA HEAD:\nThere is a 3 x 3 mm focal outpouching at the origin of the right posterior\ncommunicating artery pointing laterally compatible with an aneurysm. There\nis mild narrowing at the of the proximal M1 segment and distal M2 segments. \nThe right A1 segment is small in caliber. The vessels of the circle of ___\nand their principal intracranial branches appear normal without stenosis,\nocclusion, or aneurysm. The dural venous sinuses are patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion.\n\n\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. 3 x 3 mm right posterior communicating artery aneurysm with evidence of\nrupture.\n2. Similar diffuse bilateral subarachnoid hemorrhage predominantly within the\nsuprasellar cistern, bilateral sylvian fissures, ___ cisterna magna and along\nthe tentorium\n3. Otherwise patent circle of ___ without evidence of stenosis,occlusion,or\nother aneurysm.\n\n1. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection." + }, + { + "input": "The patient is post coiling of a right internal carotid artery aneurysm. \nHyperdensities throughout the brain may reflect residual contrast staining\nfrom administered contrast material. Despite this, disuse subarachnoid\nhemorrhage is seen within the sylvian fissures, and the region of the\nsuprasellar cistern and within the lateral ventricles and third ventricle. The\nintraventricular hemorrhage has redistributed with more hyperdense material\nwithin the third ventricle than in the lateral ventricles as seen previously. \nThe ventricular size has somewhat increased since prior most notable in the\ntemporal horns of the lateral ventricles as well as the size of the third\nventricle. Hemorrhage is also seen within the cisterna magna.\n\nThere is no acute intraparenchymal hemorrhage, midline shift or evidence of\nherniation. There is no acute osseous abnormality. The paranasal sinuses,\nmastoid air cells and middle ear cavities are clear.", + "output": "Interval coiling of a right ICA aneurysm. Interval redistribution of\nsubarachnoid hemorrhage as described above. Diffusely increased hyperdense\nmaterial throughout the subarachnoid space may also reflect contrast staining\nfrom recent contrast administration.\n\nSlight interval increase in ventricular size most notably involving the third\nventricle and temporal horns of the lateral ventricles." + }, + { + "input": "Status post right frontal burr hole with placement of a right frontal\nventriculostomy catheter which appears to terminate in the left lateral\nventricle. Postsurgical changes related to a right internal carotid artery\naneurysm coil is again demonstrated and limits evaluation of the brain\nparenchyma at that level. Diffuse subarachnoid hemorrhage appears slightly\nless conspicuous compared to the prior examination, although likely similar in\nextent and configuration. Intraventricular hemorrhagic blood products in the\nthird and lateral ventricles is not likely changed, allowing for differences\ndue to redistribution. Prominence of the lateral ventricles, third ventricle,\nand temple horns of the bilateral lateral ventricles is not appreciably\nchanged compared to ___. Otherwise, no new areas of\nintracranial hemorrhage or recent infarction. No midline shift.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavitiesare essentially clear. The visualized portion of the orbits are\nnormal.", + "output": "1. Status post right frontal ventriculostomy catheter placement terminating in\nthe left lateral ventricle. No significant change in size of the lateral or\nthird ventricles.\n2. Diffuse subarachnoid blood products appears slightly less conspicuous\ncompared to the prior examination, although likely unchanged.\n3. Stable intraventricular hemorrhagic blood products. No new areas of\nintracranial hemorrhage or infarction.\n4. Status post right ICA aneurysm coiling." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is stable right ventriculostomy catheter with the tip terminating near\nthe foramina of ___. There is no significant change of the hydrocephalus.. \nThere is redistribution of diffuse subarachnoid hemorrhage with associated\npersistent sulcal effacement. There is no evidence of new hemorrhage or acute\ninfarct.\n\nCTA HEAD: Patient is status post coil embolization of the right posterior\ncommunicating artery aneurysm, with streak artifact limiting the evaluation of\nthe adjacent structures. The intracranial ICA are widely patent. There is\nasymmetric irregularity and narrowing of the right MCA artery and its distal\nbranches, slightly more pronounced compared to prior CT. The left MCA is\nunremarkable. The right A1 segment is hypoplastic. Otherwise the bilateral\nACA appear unremarkable. The basilar artery, bilateral PCA, and the bilateral\nintradural vertebral arteries are unremarkable. The dural venous sinuses are\npatent.", + "output": "1. No acute intracranial findings. Redistribution of diffuse subarachnoid\nhemorrhage with persistent diffuse sulcal effacement. No new hemorrhage is\nidentified.\n2. Slightly more pronounced asymmetric irregularity and narrowing of the right\nMCA artery and its distal branches raises concern for vasospasm.\n3. Possible subtle 3 mm aneurysm is seen arising from the left paraclinoid ICA\n(3; 72)\n4. Additional findings as described above." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute infarction, new hemorrhage, edema, or mass.\n\nThere has been interval removal of the extraventricular drain with right\nfrontal approach, and a hypodense track is seen along its previous course.\nThere has been interval placement of a ventricular drain from right\nposterolateral approach, the drain is seen terminating adjacent to the frontal\nhorn of the left lateral ventricle. There is unchanged effacement of the\nsulci, likely secondary to subarachnoid blood products, without evidence of\nnew hemorrhage. Residual blood is seen in the ventricles. There has been no\ninterval change in the size of the ventricles.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are normal.\n\nCTA HEAD:\nThe study is limited secondary to presence of aneurysm coils and resulting\nartifact. This particularly limits visualization of the right middle cerebral\nartery. Within this limitation, there appears to be marked narrowing and\nirregularity of the vessel, new since the study of ___ and worrisome\nfor vasospasm. Otherwise, the visualized vessels of the circle of ___ and\ntheir principal intracranial branches appear normal with no evidence of\nstenosis, occlusion,oraneurysm. The dural venous sinuses are patent.", + "output": "1. Limited study due to artifact from the aneurysm coil. There appears to be\nright middle cerebral artery vasospasm.\n2. Interval removal of the extraventricular drain with right frontal approach,\nand placement of a ventricular drain from right posterolateral approach." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is redemonstration of a ventricular drain via right posterolateral\napproach. The drain is in similar position when compared to prior CT.\nThere is no evidence of infarction, no new hemorrhage, or mass. There is a\nsmall, unchanged region of hyperdensity in the ghost track of a prior\nventricular drain, likely representing residual blood products.\nVentriculomegaly has mildly improved. The degree of generalized edema has\ndecreased.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are normal.\n\nCTA HEAD:\nRedemonstration of PCOM aneurysm coils. Artifact from these coils limits\nevaluation of nearby vessels.\n\nThe right M1 segment has a persistent beaded appearance, similar in appearance\nto prior CTA, however the right M2 segments do appear to have decreased\ncaliber in comparison to prior CTA. The bilateral A1 segments,P2 and P3\nsegments have a slightly more narrowed appearance, as does the basilar artery.\nThese findings raise concern for worsening vasospasm.\n\nTwo small outpouchings, measuring 1-2 mm in the left supraclinoid ICA may\nrepresent small infundibula, however small aneurysms are not excluded.\n\nThe dural venous sinuses are patent.", + "output": "1. Interval mild increased narrowing of the bilateral A1 segments, P2\nsegments, P3 segments, left M2 segments and persistent right M1 segment\nnarrowing with beaded appearance are concerning for mildly progressed\nvasospasm. The basilar artery has a similar narrowed appearance.\n2. Interval mild decrease in ventriculomegaly, and generalized edema.\n3. Other findings as above.\n\nNOTIFICATION: The findings were discussed with ___, by ___\n___, M.D. on the telephone on ___ at 5:10 pm, 10 minutes after\ndiscovery of the findings." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.There is no evidence of\nfracture. The visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "No acute intracranial abnormalities. ." + }, + { + "input": "HEAD CT: There is no evidence of acute intracranial hemorrhage, edema, mass\neffect or shift of normally midline structures. The gray-white matter\ninterface is preserved without evidence of acute major vascular territorial\ninfarct. The ventricles and sulci are normal in size and configuration for the\npatient's age. Cavum septum pellucidum et vergae is incidentally noted. The\nbasal cisterns appear patent. The orbits and globes are unremarkable. Mild\nmucosal thickening is seen in the right maxillary sinus and right sphenoid\nsinus. The remainder of the imaged paranasal sinuses, middle ear cavities and\nmastoid air cells are clear bilaterally. The bony calvaria appear intact.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "Head CT: There is no evidence of hemorrhage, edema, masses, mass effect, or\nacute infarction. There is brain parenchymal volume loss and confluent\nsubcortical white matter hypodensity which is presumably on the basis of\nsequelae of chronic small vessel ischemic disease. The orbits and skull base\nare unremarkable. There is right maxillary sinus disease with hyperdense\nmucosal thickening which could represent inspissated secretions or fungal\ninfection.\n\nHead and neck CTA: There is scattered atheromatous calcified plaque with\napproximately 50% narrowing of the proximal left subclavian artery. There is\natheromatous narrowing at the bilateral carotid bifurcations and proximal\ninternal carotid arteries, left greater than right, though without evidence of\nhemodynamically significant stenosis or pathologic large vessel occlusion\nwithin the neck. There is no evidence of dissection. The vertebral arteries\nare codominant.\n\nThere are atheromatous calcifications within the cavernous internal carotid\narteries without hemodynamically significant stenosis. There is no evidence of\naneurysm, vascular malformation, or hemodynamically significant stenosis\nwithin the intracranial vasculature.\n\nThere is mild biapical pulmonary scarring. The lung apices are otherwise\nunremarkable. The patient is edentulous.", + "output": "1. No evidence of acute intracranial hemorrhage or mass effect.\n2. Brain parenchymal volume loss and sequelae of chronic small vessel ischemic\ndisease.\n3. Scattered atheromatous vascular disease with approximately 50% narrowing of\nthe proximal left subclavian artery.\n4. No evidence of pathologic large vessel occlusion, aneurysm, or\nhemodynamically significant stenosis within the head or neck.\n5. Right maxillary sinus disease with hyperdense mucosal thickening which\ncould represent inspissated secretions or fungal infection.\n6. This report is provided without 3D and curved reformats. When these\nimages are available, and if additional information is obtained, then an\naddendum may be given to this report." + }, + { + "input": "Images are slightly motion degraded. Allowing for this, there is no evidence\nof fracture, infarction, hemorrhage, edema, or mass effect. Prominent\nventricles and sulci reflect age related volume loss. Periventricular,\nsubcortical and deep white matter scattered hypodensities are nonspecific\nthough likely sequela of chronic small vessel ischemia, stable relative to\nexamination dated ___. There is no shift of normally midline\nstructures. Basal cisterns are patent.\n\nOrbits are unremarkable. Mucous retention cysts within the right maxillary\nsinus is slightly of higher density which may reflect inspissated secretions\nor alternatively sequela of focal infection. Mastoid air cells and middle ear\ncavities are clear. Significant atherosclerotic calcifications involve the\ncarotid siphon. The calvarium appears intact. Scalp soft tissues are\notherwise unremarkable.", + "output": "No evidence of hemorrhage, fracture or infarction Volume loss and likely\nsequela of chronic small vessel ischemia is unchanged.\n\nHigh density mucous retention cyst within the right maxillary sinus is likely\ninspissated secretions though fungal infection cannot be entirely excluded,\npresent on examination dated ___." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, acute large vascular territorial infarct. Prominence of the\nventricles and sulci is is again seen, consistent with cortical volume loss. \nPeriventricular and subcortical white matter hypodensities are most likely the\nsequela of chronic small vessel disease. There is no midline shift. The\nbasal cisterns are patent.\n\nThe orbits are unremarkable. Mucosal thickening and a mucous retention cyst\nare seen in the right maxillary sinus. The remainder of the paranasal sinuses\nare clear. The mastoid air cells and middle ear cavities are clear. No acute\nfracture is seen.", + "output": "-No acute intracranial process. MRI is more sensitive in detecting acute\nischemia." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nExtensive periventricular and subcortical white matter hypodensities are\nnonspecific but likely sequelae of chronic small vessel ischemic disease.\n\nThere is a left frontal subgaleal hematoma. There is no evidence of fracture.\nRight maxillary sinus mucosal thickening and a large mucous retention cyst are\nagain noted. The visualized portion of the remaining paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable. Carotid siphon calcifications are noted.", + "output": "1. No evidence of hemorrhage or infarction.\n2. Left frontal subgaleal hematoma without underlying fracture.\n3. Right maxillary sinus mucosal thickening and a large mucous retention cyst\nare again noted." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nLeft parieto-occipital encephalomalacia and left posterior frontal\nencephalomalacia are compatible with chronic infarcts. There is no evidence\nof acute large territorial infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nAreas of confluent periventricular, subcortical and deep white matter\nhypodensity are in a configuration suggestive of chronic small vessel ischemic\nchange.\n\nThere is a large mucous retention cyst in the right maxillary sinus, with mild\nmucosal wall thickening in the inferior aspects of the bilateral maxillary\nsinuses. The remainder of the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.\n\nCTA HEAD:\nThere is mild narrowing in the V4 segment of the right vertebral artery,\nlikely secondary to atherosclerotic disease. There are mild calcifications in\nthe bilateral intracranial internal carotid arteries, without significant\nstenosis. There is variant fetal type origin of the right posterior cerebral\nartery and partial fetal type origin of the left posterior cerebral artery. \nAnterior communicating artery is demonstrated. There is minimal irregularity\nof the M1 segment of the left MCA, likely secondary to atherosclerotic\ndisease. The vessels of the circle of ___ and their principal intracranial\nbranches otherwise appear patent without significant stenosis, occlusion, or\naneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is mild atherosclerotic calcification in the aortic arch. \nCalcifications are noted in the visualized portion of the left main coronary\nartery. There are minimal atherosclerotic calcifications at the origin of the\nbrachiocephalic artery. There is punctate atherosclerotic calcification the\nproximal right vertebral artery without significant associated narrowing. \nThere is mild atherosclerotic calcification at the bilateral carotid\nbifurcations without significant stenosis. The carotid and vertebral arteries\nand their major branches otherwise appear patent with no evidence of\nsignificant stenosis or occlusion or dissection. There is no evidence of\ninternal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. There is severe multilevel degenerative changes, consistent with\ncervical spondylosis and narrowing of the intervertebral disc spaces, more\nsignificant at C5/C6 and C6/C7 levels.", + "output": "1. No acute intracranial abnormality.\n2. Chronic left posterior frontal and parietal occipital infarcts.\n3. Prominent global atrophy and chronic small vessel ischemia.\n4. Mild intracranial atherosclerotic disease, as described. Otherwise patent\nintracranial vasculature without significant stenosis, occlusion, or aneurysm.\n5. Mild cervical atherosclerotic disease, as described. Otherwise patent\ncervical vasculature without significant stenosis, occlusion, or dissection." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nconfluent subcortical, periventricular, and deep white matter hypodensity,\nwhich is nonspecific, but likely represents chronic microvascular ischemic\nchanges. The ventricles and sulci are prominent, consistent with\nage-appropriate involutional changes.\n\nNo osseous abnormalities seen. Again seen is a large right maxillary sinus\nmucous retention cyst/polyp. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. Status post bilateral lens replacements. \nAtherosclerotic calcifications are demonstrated in both cavernous carotid\narteries.", + "output": "1. No acute intracranial abnormality. No fractures.\n2. Compared to ___, no significant change in extensive chronic\nmicrovascular ischemic changes and involutional changes." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are prominent, suggestive of volume loss. \nThere are confluent periventricular and subcortical hypodensities, which may\nrepresent small vessel ischemic changes, similar to prior. There is severe\nmucosal thickening of the right maxillary sinus. The remaining imaged\nparanasal sinuses are clear. Mastoid air cells and middle ear cavities are\nwell aerated. The bony calvarium is intact.", + "output": "1. No acute intracranial process or acute fracture.\n2. Similar appearance of extensive periventricular and subcortical white\nmatter hypodensities, likely reflecting chronic small-vessel ischemic changes.\n3. Near complete opacification of the visualized right maxillary sinus." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territory infarct. Gray-white matter\ndifferentiation is preserved. There is no hydrocephalus. The visualized\nparanasal sinuses demonstrate mucosal thickening and aerosolized secretions in\nthe partially imaged right maxillary sinus. The remainder the partially\nimaged paranasal sinuses are clear.. The mastoid air cells are clear. Right\nposterior parietal subgaleal hematoma with overlying scalp laceration is seen.\nNo acute fracture is seen.", + "output": "No acute intracranial process.\n\nRight posterior parietal subgaleal hematoma and associated scalp laceration. \nNo acute fracture seen." + }, + { + "input": "Streak artifact from seizure monitoring electrodes over the skull slightly\nlimits evaluation, particularly in the posterior fossa.\n\nThere is a small hyperdense focus in the right quadrigeminal plate cistern,\nimages ___, suggesting subarachnoid blood. Evaluation for sulcal\nsubarachnoid blood is limited by streak artifact from the electrodes. There is\nno evidence for parenchymal edema in the supratentorial compartment. The\nventricles and sulci are normal in size and configuration. Basal cisterns do\nnot appear compressed.\n\nNo fracture is seen. Fluid in the ethmoid and sphenoid sinuses may be related\nto endotracheal intubation and/or prolonged supine positioning. There is mild\nmucosal thickening in the right frontal sinus. Mastoid air cells are grossly\nwell aerated.", + "output": "1. Small amount of subarachnoid hemorrhage in the right quadrigeminal plate\ncistern.\n2. Evaluation for sulcal subarachnoid hemorrhage, as well as evaluation of the\nposterior fossa, is limited by streak artifact from the seizure monitoring\nelectrodes.\n\nNOTIFICATION: Results were discussed over the telephone by Dr. ___ Dr.\n___ at 09:54 on ___, 5 min after the results were\ndiscovered." + }, + { + "input": "Since the prior study, the globular hyperdensity within the right ambient\ncistern is unchanged and does not appear to represent subarachnoid blood. The\ndensity of the material is roughly 60 ___, and this may represent a thrombosed\naneurysm, a small mass lesion such as a meningioma or schwannoma, or less\nlikely a dermoid.\n\nNo new hemorrhage is identified. There is no shift of the normal in midline\nstructures and aortic matter differentiation is normal.\n\nNo fracture is seen. There is minimal mucosal thickening of the bilateral\nmaxillary sinuses and fluid within the sphenoid and ethmoid air cells,\nbilaterally. The mastoid air cells are clear.", + "output": "1. No significant interval change in the small, round hyperdensity within the\nright ambient cistern, which does not appear to be subarachnoid blood and may\nrepresent a thrombosed aneurysm, a mass lesion such as a meningioma or\nschwannoma, or less likely, a dermoid. Further evaluation can be performed\nwith enhanced MRI on a non-emergent basis, after the resolution of acute\nmedical issues.\n2. Fluid within the paranasal sinuses, likely related to recent intubation and\nsupine positioning." + }, + { + "input": "Images are limited by streak artifact from dental amalgam. There is no\nevidence of infarction, hemorrhage, edema, or mass. There is prominence of\nthe ventricles and sulci suggestive of involutional changes. Periventricular\nwhite matter hypodensities are nonspecific, but likely sequela of chronic\nsmall vessel ischemic disease.\n\nThere is no evidence of fracture. Multiple punctate hyperdensities are\nidentified in the soft tissues of the scalp, at the vertex (3:65), and in the\nfrontal region (3:51). A left occipital lipoma is noted (3:19). The\nvisualized portion of the mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable. Bilateral\nmaxillary and and frontal, and right sphenoid sinus mucosal thickening is\npresent.", + "output": "1. Dental amalgam streak artifact limits study.\n2. No evidence of acute intracranial hemorrhage or calvarial fracture.\n3. Multiple punctate hyperdensities in the soft tissues overlying the scalp at\nthe vertex in in the frontal region. Differential considerations included\nforeign body versus dermal calcifications. Recommend correlation with direct\nexamination.\n4. 2.1 cm left occipital scalp lipoma.\n5. Paranasal sinus disease as described.\n\nNOTIFICATION: The above findings were communicated via telephone by Dr.\n___ to Dr. ___ at 10:45 on ___, 1 min after discovery." + }, + { + "input": "This examination is severely limited by motion artifact. Within these\nlimitations, there is no evidence of large territorial infarction,gross\nhemorrhage, edema, or mass. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. Periventricular and subcortical white\nmatter hypodensities are nonspecific, but likely reflect the sequela of\nchronic microvascular infarction.\n\nThere is no gross evidence of fracture. Mild mucosal thickening involving the\nleft frontal and bilateral ethmoid sinuses. Otherwise, the visualized portion\nof the paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. Status post bilateral lens resections. Left occipital scalp lipoma is\nre- demonstrated.", + "output": "Severely limited examination due to motion artifact. Within these limitations\nno evidence of fracture or intracranial hemorrhage." + }, + { + "input": "Question small right parietal scalp soft tissue swelling (see 03:47). Again\nseen is a hypodense region in the right frontal lobe corresponding to a remote\nright ACA territory infarct. The triangular intermediate density abutting the\nleft anterior falx (02:22) is also unchanged since ___. There is no evidence\nof acute infarct, hemorrhage, mass, or edema. There is stable prominence of\nthe ventricles and sulci suggestive involutional changes. Basal cisterns are\npatent.\n\nLeft frontal and parietal burr holes are again noted. There is no evidence of\nfracture. The visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable. Intra cerumen", + "output": "1. Question small right parietal scalp soft tissue swelling without definite\nevidence of fracture.\n2. Chronic right frontal lobe infarct.\n3. No acute intracranial abnormality, with no evidence of acute hemorrhage.\n4. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct." + }, + { + "input": "There is no evidence of hemorrhage, edema, or mass. There is low density of\nthe inferior right frontal lobe parenchyma which represents prior chronic\ninfarction or contusion (03:11). There is no evidence of recent infarction. \nA triangular density abutting the left aspect of the anterior falx cerebri is\nstable since ___ and likely represents a prominent cortical vein (03:22). \nThere is intermediate density in the left inferior frontal extra-axial\nsubdural space, however this is been present since ___ and likely\nrepresents a small meningioma (03:14).\n\nThere is prominence of the ventricles and sulci suggestive of age-related\ncerebral volume loss. Periventricular and subcortical white matter\nhypodensities are nonspecific, though likely sequelae of chronic small vessel\nischemic disease. Atherosclerotic vascular calcifications are noted of\nvertebral and cavernous portions of internal carotid arteries.\n\nThere left frontal and parietal burr holes. Otherwise, no osseous\nabnormalities seen. The paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The orbits are unremarkable. There is impacted cerumen in\nthe bilateral external auditory canals.", + "output": "No acute intracranial process. No evidence of mass, hemorrhage or recent\ninfarction.\nInferior right frontal tissue loss that may represent chronic contusion or\ninfarction." + }, + { + "input": "Aero digestive tract: There is no mass.\n\nNeck lymph nodes: There is no adenopathy involving bilateral levels ___. \nThere is no retropharyngeal adenopathy.\n\nExtra nodal tumor spread: There are no findings suggestive of extra nodal\nextension.\n\nDeep neck muscles, masticator space: There is no muscle invasion.\n\nBones, skull base:\nThere is no bone involvement.\nThere are no findings suggestive of perineural tumor extension. Jugular\nforamen, carotid canal, pterygopalatine fossa, infraorbital foramen, other\nskull base foramina are not involved.\n\nVessels: There is no vascular invasion.\n\nBrachial Plexus: There is no brachial plexus contact or invasion.\n\nThyroid, salivary glands: There is no mass.\n\nOther findings: There are no lung nodules.", + "output": "1. No mass or significant lymphadenopathy are seen in the neck." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territory infarct. Gray-white matter\ndifferentiation is preserved. Mild prominence of the ventricles and sulci is\nre- demonstrated, suggesting cortical volume loss, slightly more prominent\nthan expected in a patient of this age. The visualized paranasal sinuses are\nclear. The majority of the left mastoid air cells are opacified, new since\nthe prior study from ___. The left middle ear cavity is also\nopacified. No definite left mastoid septal destruction is seen. No obvious\nnasalpharyngeal mass is identified.", + "output": "No acute intracranial process.\n\nOpacification of the left mastoid air cells and left middle air cavity\nworrisome for otomastoiditis. Correlate clinically." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture. Mild mucosal thickening is seen within the\nleft sphenoid sinus with moderate mucosal thickening and aerosolized\nsecretions noted in the frontal sinuses bilaterally and left frontal ethmoidal\nrecess, findings suggestive of ongoing inflammation. The visualized portion\nof the remaining paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Mild paranasal sinus disease." + }, + { + "input": "No significant change from the prior exam. No evidence of acute infarction,\nhemorrhage, edema, or mass effect. Slight bilateral prominence of the\nventricles and sulci, suggests cortical atrophy, overall unchanged from the\nprior exam. No shift of normally midline structures. Perimesencephalic\ncisterns are patent.\n\nNo fracture. There is mild mucosal thickening of the left sphenoid sinus.\nOtherwise, the incompletely visualized remaining paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No acute intracranial process including no hemorrhage.\n2. No fracture." + }, + { + "input": "No acute intracranial hemorrhage. There is no evidence of large vascular\nterritory infarction, edema, or mass effect or midline shift. The ventricles\nand sulci are normal in size and configuration.\n\nLarge right frontoparietal scalp hematoma with soft tissue swelling and\nmultiple radiopaque foreign bodies and soft tissue gas. No acute fracture of\nthe calvarium. Partially visualized large osseous excrescence from the inner\naspect of the posterior upper mandible, better seen on CT spine, consistent\nwith an exostosis. Linear lucency in the right anterior arch of the C1\nvertebra is concerning for an acute fracture. Mild mucosal thickening of\nbilateral maxillary sinuses. The remaining paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The orbits are unremarkable.\n\nEnlarged posterior nasopharyngeal soft tissue may represent adenoidal\nhypertrophy, however is more than expected for age.", + "output": "1. No acute intracranial hemorrhage.\n2. Large right frontoparietal scalp hematoma with multiple radiopaque foreign\nbodies in the soft tissue without underlying acute fracture of the calvarium.\n3. Linear lucency in the right anterior arch of C1 consistent with acute\nfracture.\n4. Enlarged posterior nasopharyngeal soft tissue, may represent adenoidal\nhypertrophy but more than expected for age, and correlation with direct\nvisualization is recommended." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is a large late acute/subacute right MCA territory infarction with\nhemorrhagic transformation in the region of the right basal ganglia. The\nhemorrhage measures approximately 5.2 x 3.4 cm. Hemorrhage and edema result\nin extensive mass effect, completely effacing the body and frontal horn of the\nright lateral ventricle and approximately 8 mm shift of normally midline\nstructures to the left (series 2, image 23). These are unchanged compared to\nprior examination. There is no evidence of new hemorrhage or increased mass\neffect. The basal cisterns are patent.\n\nLeft frontal scalp swelling and hematoma are noted. There is no fracture. \nThere is extensive opacification of bilateral mastoid air cells. Mucosal\nthickening is also seen in the frontal sinuses, left greater than right. \nThere is mild mucosal thickening in the right sphenoid sinus. The mastoid air\ncells and middle ear cavities are clear.\n\n\nCTA HEAD:\nThere is abrupt cut off of the distal M1 segment of the right middle cerebral\nartery with markedly diminished flow in the more distal right MCA branches,\nlikely through collaterals (series 603b, image 26). The remaining vessels of\nthe circle of ___ and their principal intracranial branches appear normal\nwithout stenosis, occlusion, or aneurysm formation. The dural venous sinuses\nare patent.\n\nCTA NECK:\nThere is a 3 vessel aortic arch with mild calcified atherosclerotic disease. \nThe branch vessels and origins of the common carotid and vertebral arteries\nare patent bilaterally. There is calcified plaque at the carotid bifurcation.\nThis does not result in significant narrowing of the internal carotid arteries\nby NASCET criteria. The extracranial carotid and vertebral arteries are\npatent without evidence of stenosis or dissection.\n\nOTHER:\nThe partially imaged upper lungs are notable for heterogeneous opacification\nof bilateral apices which may represent scarring. Evaluation of the lung\nparenchyma is limited by respiratory motion artifact however there is no\nevidence of consolidation or suspicious pulmonary nodules. Additional\nground-glass and wispy opacities along the dependent portion of the lungs\nprobably represent atelectasis. the visualized portion of the thyroid gland is\nwithin normal limits. There is no lymphadenopathy by CT size criteria.", + "output": "1. Large left acute/subacute MCA territory infarct with hemorrhagic\ntransformation and extensive mass effect on the right lateral ventricle and 8\nmm shift of normally midline structures to the left as described above.\n2. Abrupt cut off of the distal M1 segment of the right middle cerebral artery\nwith markedly diminished flow in the more distal right MCA branches.\n3. Unremarkable neck CTA aside from moderate atherosclerotic calcifications at\nthe carotid bifurcations. There is no internal carotid artery stenosis by\nNASCET criteria." + }, + { + "input": "Large right MCA territory infarct is again seen and not significantly changed\ncompared to prior exam. There is stable associated subfalcine herniation and\nleftward midline shift measuring 11 mm. The right lateral ventricle continues\nto be effaced. There is no significant change of hemorrhagic area in the\nright basal ganglia within this infarction measuring approximately 3.3 x 5.6\ncm. No areas of new hemorrhage are identified. Previously noted right uncal\nherniation is less apparent on this exam.\n\nThere is increased prominence of the left temporal subgaleal hematoma. There\nis no evidence of fracture. There is opacification the posterior ethmoidal\nair cells bilaterally, and mild mucosal thickening of a left frontal sinus,\notherwise the visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Stable large right MCA territory infarct with stable hemorrhagic component.\nNo significant change in associated midline shift." + }, + { + "input": "Large right MCA territory infarct is stable from prior with stable mass effect\neffacing the right lateral ventricle and leftward midline shift measuring\napproximately 11 mm. No significant change in area of basal ganglia\nhemorrhage within the infarct measuring approximately 2.8 x 5.6 cm. No new\nareas of hemorrhage are identified.\n\nLeft temporal soft tissue swelling is again noted. There is no evidence of\nfracture. There is opacification of posterior ethmoid air cells. There is\nmild mucosal thickening of the left frontal sinus. Otherwise the visualized\nparanasal sinuses and mastoid air cells are clear. Visualized portions of the\norbits are unremarkable.", + "output": "No significant change in large right MCA territory infarct with stable\nhemorrhagic component and stable mass effect." + }, + { + "input": "Re-demonstrated is a large right MCA territory hemorrhagic infarct causing\neffacement of the sulci and the right lateral ventricle. There is 12 mm\nmidline shift towards the left, unchanged when compared to the prior study.\nThe infarct appears slightly more hypodense compatible with evolution of the\ninfarct. The hemorrhage within the infarct centered within the right basal\nganglia is not significantly changed in size or appearance. No hydrocephalus.\n\nThere is mild mucosal thickening of the right maxillary sinus, bilateral\nsphenoid sinuses, bilateral ethmoid air cells, and left frontal cells. The\nremaining imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "1. Evolving large right MCA territory infarct. Hemorrhage within the infarct\ncentered within the basal ganglia is not significantly changed compared to the\nprior study.\n2. Effacement of the sulci and the right lateral ventricle as well as leftward\nmidline shift, unchanged when compared to the prior study." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is a hemorrhage in the left globus pallidus and putamen with involvement\nof the genu and posterior limb of the internal capsule. This is associated\nwith perifocal edema and mass effect on the frontal horn of the left lateral\nventricle. There is no evidence of subarachnoid hemorrhage.\nAgain seen is a large coil mass in the expected location of the proximal\nsupraclinoid left internal carotid artery. Artifact from the mass severely\nlimits imaging at these levels.\nThere is no evidence of infarction, other hemorrhage, or mass. There is\nprominence of the sulci in an atrophic pattern. There is periventricular\nwhite matter hypodensity perhaps related to chronic small vessel ischemia..\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The lenses have been removed. Imaging of the orbits\nis limited by artifacts from the coil pack. However, no other abnormalities\nare detected in the orbits.\n\nCTA HEAD:\nDistal to the coil pack, the intracranial arteries appear normal with no\nevidence of anterior circulation stenosis or occlusion.\nThere is mild irregular narrowing of the basilar artery. This area is largely\nobscured by artifact from the coil pack and it is uncertain whether there is a\ntrue abnormality of the basilar artery.\nThe left vertebral artery is dominant. The right vertebral artery is\nhypoplastic and appears to give nearly all of its flow to an early branching\nposterior inferior cerebellar artery. There is a faint possible twin egg of\nthe right vertebral artery that continues distally to join the left vertebral\nartery at the vertebrobasilar junction.\n The dural venous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There are calcified atheromatous\nplaques at the common carotid artery bifurcations and proximal internal\ncarotid arteries without stenosis. The right vertebral artery is hypoplastic\nthroughout its course.\nThere are atherosclerotic calcifications throughout the aortic arch and\ninvolving the origins of the great vessels. There is no evidence of internal\ncarotid stenosis by NASCET criteria.\n\nOTHER:\n___ appearance and ground glass opacities in the lung apices\nbilaterally may be a consequence of infection or aspiration.. The visualized\nportion of the thyroid gland is within normal limits. There is no\nlymphadenopathy by CT size criteria.", + "output": "1. With left globus pallidus and putaminal hematoma with surrounding edema and\nmass-effect on the adjacent left lateral ventricle.\n2. Coil pack in place appears unchanged since ___, although artifact from the\ncoils obscures imaging at this level.\n3. No evidence of aneurysm or arteriovenous malformation.\n4. No evidence of infarction.\n5. Pulmonary apex findings suggest infection or aspiration." + }, + { + "input": "Left : A small amount of cerumen is noted in the left external auditory canal.\nThe external auditory canal is otherwise normal. The middle ear cavity is\nclear. The ossicles and tegmen are intact. Prussak's space is clear. The\nscutum is preserved. There is no evidence for enlarged vestibular aqueduct or\nsuperior semicircular canal dehiscence. The facial nerve follows a normal\ncourse through the middle ear. There is no evidence for inner ear dysplasia.\nThe mastoids are clear.\n\nRight: The external auditory canal is normal. The middle ear cavity is clear.\nThe ossicles and tegmen are intact. Prussak's space is clear. The scutum is\npreserved. There is no evidence for enlarged vestibular aqueduct or superior\nsemicircular canal dehiscence. The facial nerve follows a normal course\nthrough the middle ear. There is no evidence for inner ear dysplasia. The\nmastoids are clear.\n\nOther: There is no cerebellopontine angle mass. The visualized portion of\nthe ventricles and sulci are prominent suggestive of age-related atrophy. \nAtherosclerotic calcifications are noted in the carotid siphons. Visualized\nbrain and neck soft tissues are otherwise normal. A moderate mucous retention\ncyst is noted in the left maxillary sinus.", + "output": "1. Normal temporal bone CT.\n2. No cerebellopontine angle mass." + }, + { + "input": "There is no evidence of infarction,hemorrhage,edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormalities." + }, + { + "input": "Study is markedly limited by streak artifact from bilateral deep brain\nstimulators which terminate in the bilateral mid brain. Within this\nlimitation, there is no evidence of acute large territory\ninfarction,hemorrhage,edema,or discrete mass. There is prominence of the\nventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Markedly limited study due to streak artifact from bilateral deep brain\nstimulators. Within this limitation, no acute large territory infarction or\nintracranial hemorrhage.\n2. Global involutional changes." + }, + { + "input": "There is extensive, severe lymphadenopathy, most prominent in the bilateral\nsupraclavicular regions and superior mediastinum. This effaces the right\nsubclavian, left subclavian, left internal jugular and brachiocephalic veins. \nMarked effacement of the superior vena cava is better demonstrated on the CT\nthorax performed at the same time. Small veins are densly opacified with\ncontrast, due to the more central venous narrowing. The lymphadenopathy is low\ndensity, and surrounds the trachea and anterior aspect of the esophagus. \nSuperiorly, the lymphadenopathy extends to the level of the hyoid bone.\n\nThere is a lucent appearance with slightly thick trabeculae within in the left\nside of the sphenoid ( se 2, im10)which may represent a hemangioma; however,\ncorrelation with bone scan can be helpful to exclude more aggressive etiology.", + "output": "1. Marked, confluent adenopathy extending from the lower neck into the\nsuperior mediastinum with displacement and compression of normal structures,\nparticularly the SVC and left IJ. \n\nPlease see the dictation for the separately read thoracic CT.\n\nThe findings were discussed with Dr. ___, at 2 p.m. on\n___.\n\n2. Lucent appearance of the left side of sphenoid with slightly thick\ntrabeculae within- ? hemangioma; correlate with bone scan to exclude more\naggressive etiology." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nHypodensities in the right basal ganglia region and corona radiata correspond\nto the acute/subacute infarct previously identified on MRI. Additional\nhypodensities in the left basal ganglia and corona radiata most likely reflect\nold lacunar infarcts.\nPeriventricular hypodensities are nonspecific but likely sequela chronic small\nvessel ischemic changes.\nThere is no intracranial hemorrhage or mass.\n\nThe ventricular system and extra-axial CSF spaces are age-appropriate. Mild\ngeneralized parenchymal volume loss is most likely age related.\n\nThere is mild mucosal thickening along the ethmoid air cells. The remainder\nof the paranasal sinuses and mastoid air cells are clear. Note is made of\nbilateral lens replacement surgery. The orbits appear otherwise unremarkable.\n\nCTA HEAD:\nThere are mild atherosclerotic changes along both cavernous ICAs without\nhigh-grade stenosis. Note is made of a prominent right posterior\ncommunicating artery, a normal anatomic variant.\nAtherosclerotic changes along the left P2 segment resulting in areas of severe\nstenoses (series 3, image 255 and series 311, image 4; series 3, image 261).\nThe vessels of the circle of ___ and their principal intracranial branches\nappear otherwise unremarkable without high-grade stenosis, occlusion, or\naneurysm formation.\nThe dural venous sinuses are patent.\n\nCTA NECK:\nNormal three vessel aortic arch. There are atherosclerotic changes at the\nright carotid bifurcation resulting in less than 50% short-segment stenosis of\nthe proximal right ICA by NASCET criteria. The left carotid bifurcation is\nunremarkable with no evidence of internal carotid stenosis by NASCET criteria.\n\nThere is atherosclerotic plaque at the origin of the left vertebral artery\nresulting in mild stenosis. The right vertebral artery origin is\nunremarkable. There is multilevel remodeling of the vertebral arteries along\ntheir cervical course secondary to hypertrophic degenerative changes of the\ncervical spine. No evidence of dissection.\n\nOTHER:\nThere is gravity dependent atelectasis. There are several small right upper\nlobe pulmonary nodules measuring up to 3 mm (series 3, image 21, 22 and 49). \nThe thyroid gland appears multinodular with a dominant 6 mm hypodense nodule\nin the right thyroid lobe. There is no lymphadenopathy by CT size criteria.", + "output": "1. Right basal ganglia and corona radiata hypodensities corresponding to the\nacute/subacute infarcts seen on the most recent prior MRI of the head.\n2. Additional old lacunar infarcts in the left basal ganglia and corona\nradiata, and evidence of chronic small vessel ischemic changes.\n3. Intracranial atherosclerotic changes along the P2 segment of the left\nposterior cerebral artery resulting in areas of severe stenosis.\n4. Mild, short-segment stenosis of the proximal right ICA by NASCET criteria. \nMild left vertebral artery origin stenosis.\n5. Scattered 3 mm right upper lobe pulmonary nodules. Please see\nrecommendations below.\n\nRECOMMENDATION(S): For incidentally detected multiple solid pulmonary nodules\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT follow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mucosal thickening in the right\nsphenoid sinus as well as the bilateral ethmoid air cells. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare otherwise clear. The visualized portion of the orbits are unremarkable.", + "output": "No acute intracranial process. Please note MRI is more sensitive for\ndetection of subtle intracranial lesions." + }, + { + "input": "Gray-white matter differentiation is maintained. There is no evidence of\nhemorrhage, edema or mass. The ventricles and sulci are normal in size and\nconfiguration. There is no abnormal enhancement on post contrast images. \nThere are 2 rounded peripherally calcified nodules in the fourth ventricle\nmeasuring approximately 6 mm each. These do not demonstrate definitive\npostcontrast enhancement on CTA or CTV sequences.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\n The vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation.\n\nCTV HEAD:\nThe dural venous sinuses are patent. There is no evidence of sinus\nthrombosis.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nlarge territory infarct or intracranial hemorrhage. No intracranial mass\neffect.\n2. There are 2 peripherally calcified nodules in the fourth ventricle\nmeasuring approximately 6 mm each, without definitive postcontrast enhancement\non CTA or CTV sequences. These are nonspecific, and could represent fourth\nventricular xanthogranulomas, however these are rare. Recommend further\nevaluation with contrast enhanced MRI brain.\n3. Unremarkable CTA and CTV of the head.\n\nNOTIFICATION: Impression 2 was not discussed in initial wet read. This was\nentered into the ED quality assurance nurse email to be communicated to the\npatient's PCP by ___ on ___ at 15:00." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nInterval resolution of prepontine subarachnoid hemorrhage. There is no intra\nor extra-axial mass effect, acute hemorrhage or large territory infarct. The\nsulci, ventricles and cisterns are within expected limits for the patient's\nage. The paranasal sinuses are essentially clear. The orbits are\nunremarkable. The mastoid air cells middle ears are well pneumatized and\nclear.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal with no evidence of stenosis, occlusion,oraneurysm. The dural\nvenous sinuses are patent.", + "output": "1. Interval resolution of previous seen prepontine subarachnoid hemorrhage. \nNo acute intracranial hemorrhage identified.\n2. No acute intracranial abnormality on noncontrast head CT.\n3. Unremarkable CTA of the head without evidence of aneurysm or vascular\nmalformation." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nMucous retention cyst left maxillary sinus. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are normal. Low-density material within the\nright external canal is favored to consistent with cerumen.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass. The ventricles and sulci are mildly prominent, consistent with age\nrelated involutional changes.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nThere is mucosal thickening within the paranasal sinuses most notable in the\nethmoid and left maxillary. Mastoid air cells and middle ear cavities are\nwell aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "Overall, there has been interval progression of the large right cerebral\ninfarction secondary to a MCA territorial infarction with interval increase in\nthe cytotoxic edema extending to the right temporal lobe. There is no\nsignificant interval change in the size of the right frontal parenchymal\nhemorrhage. There is evidence of intraventricular hemorrhage along the\noccipital horns of the lateral ventricles. The basilar cisterns are patent. \nNo acute fractures identified. The visualized paranasal sinuses the mastoid\nair cells and middle ear cavities are clear. The globes are unremarkable.", + "output": "1. Interval progression of the large right cerebral infarction secondary to\nMCA occlusion. Interval increase in edema with extension to the right\ntemporal lobe.\n2. No significant interval change in the right frontal hemorrhage. Note is\nmade of intraventricular hemorrhage within the occipital horns of the lateral\nventricles." + }, + { + "input": "Large infarction involving essentially the entire right middle cerebral artery\nterritory demonstrates continued evolution. Blood products within the right\nfrontal lobe have slightly decreased in extent and density. There is stable\nmass effect with stable mild leftward shift of midline structures and stable\npartial effacement of the right lateral ventricle. Third ventricle is slightly\ndisplaced to the left and minimally effaced, unchanged. Left lateral ventricle\nis not dilated and stable in size. There is no uncal herniation.\n\nThe bones are unremarkable. There is a small mucous retention cyst in the\nleft ethmoid sinus. Other imaged paranasal sinuses and mastoid air cells are\nwell aerated.", + "output": "Expected evolution of the large infarction involving essentially the entire\nright middle cerebral artery territory. Expected evolution of blood products\nin the right frontal lobe. No evidence for new intracranial abnormalities." + }, + { + "input": "Evolution of right MCA infarct. Evolution of right frontal lobe in hematoma.\nPersistent interventricular hemorrhage and the left occipital horn of the left\nlateral ventricle. All mass effect present with leftward shift of midline\nstructures, narrowing of sulci and effacement of right lateral ventricle\nunchanged from previous study.\n\nThe basal cisterns appear patent and there is preservation of gray-white\nmatter differentiation.\n\nThe visualized bony structures are grossly unremarkable. There is a mucous\nretention cyst in the left ethmoid sinus, otherwise the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear.\n\nThe globes are unremarkable.", + "output": "1. Continued evolution of right MCA infarction and right frontal lobe hematoma\nwith unchanged mass effect and leftward shift of the midline structures." + }, + { + "input": "There is a large area hypodensity in the distribution of the right MCA,\nconsistent with known right MCA infarct, unchanged from prior examination.\nLarge right hyperdensity in the right frontal lobe consistent with evolution\nof known hematoma, not significantly changed from prior examination. There is\na persistent small foci of hyperdense material in the occipital horn of the\nleft lateral ventricle consistent with blood, unchanged from prior\nexamination. There is a small amount of leftward shift of midline structures,\nnarrowing of sulci and effacement of the right lateral ventricle, which are\nunchanged from previous study.\n\nThe basal cisterns appear patent.\n\nThe visualized bony structures are grossly unremarkable. A mucous retention\ncyst is noted in the left posterior ethmoid sinus, otherwise the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.\n\nThe globes are unremarkable.", + "output": "1. No significant interval change of the large right MCA infarct and right\nfrontal hematoma." + }, + { + "input": "In comparison to the previous study, there is no increased hemorrhage, mass\neffect or infarction. There is an extensive infarction in the distribution of\nthe right MCA with some involvement of the right ACA with hemorrhagic\nconversion consistent with known stroke and unchanged significantly from the\nprevious examination. There is mild leftward shift of midline structures which\nis not worse than in the previous examination. There is a small amount of\nblood noted in the occipital horn of the left lateral ventricle. The\nventricles are normal in size and there is mild prominence of the sulci\nconsistent with normal age-related involution in atrophy.\n\nThe basal cisterns appear patent and there is preservation of gray-white\nmatter differentiation.\n\nThe visualized bony structures are grossly unremarkable. The paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.\n\nThe globes are unremarkable.", + "output": "There is no worsening of hemorrhage, mass effect or infarction in comparison\nto the previous examination." + }, + { + "input": "CTA HEAD: [] The right frontal lobe hemorrhage is better appreciated on the\nnoncontrast head CT, but grossly unchanged in size and configuration. There is\na 7 mm ring-enhancing lesion within the left Corona radiata (series 3, image\n303).\n\nThere is calcification of the carotid siphons without evidence of significant\nstenosis. There is there is occlusion of the distal M1 segment of the right\nMCA with some reconstitution of the M3 branches. The anterior and left middle\ncerebral arteries are unremarkable. There is a fetal type right PCA with a\nhypoplastic P1 segment. The right vertebral artery is hypoplastic.\n\nCTA NECK: There is calcified plaque at the carotid bifurcations bilaterally\nwithout evidence of significant stenosis based on NASCET criteria. The right\nvertebral artery is hypoplastic. The vertebral arteries are otherwise\nunremarkable.\n\nThere is extensive bilateral cervical, supraclavicular, and mediastinal\nlymphadenopathy. The largest left level II node measures 3 x 1.4 cm. There is\nnarrowing of the left pulmonary artery due to hilar soft tissue mass. There\nis a possible right lower lobe 2cm nodule.\n\nThe thyroid gland is heterogeneously dense, but without a discrete nodule.\n\nThere is a moderate left pleural effusion.", + "output": "This is a preliminary interpretation is the 3D reconstructions are not yet\navailable.\n\nThere is occlusion of the distal M1 segment of the right MCA with\nreconstitution of some of the M3 branches.\n\nExtensive cervical, supraclavicular and mediastinal lymphadenopathy. There is\nnarrowing of the left pulmonary artery due to hilar soft tissue mass. \nFindings could related to metastatic disease possibly from lung cancer. Other\nmalignancies such as lymphoma and leukemia are possible but less likely given\nleft hilar mass. Atypical infections not completely excluded. Recommend a\nChest CT for further evaluation.\n\nUnchanged right frontal lobe hemorrhage." + }, + { + "input": "Stable appearance of hemorrhage in the anterior right frontal lobe with\ncontinued evolution of the right middle cerebral artery territory infarct. A\nsecond rounded hyperdense lesion seen in the left frontal lobe with minimal\nsurrounding edema (02:20) dense on the prior CT. This change may reflect a\nsmall amount of hemorrhage. As discussed on the MRI examination, this may\nrepresent a neoplasm, or the possibility of a septic embolus-less likely given\nthe white-matter location of the lesion. . Subarachnoid hemorrhage overlying\nthe right frontal convexity is not significantly changed. There is no\nsignificant shift of normally midline structures. The ventricles are normal in\nsize and configuration. The basal cisterns appear patent.\n\nNo fracture is identified. The visualized paranasal sinuses, mastoid air cells\nand middle ear cavities are clear. The globes are unremarkable.", + "output": "1. Stable appearance right frontal intraparenchymal hemorrhage and overlying\nright subarachnoid hemorrhage.\n2. Continued evolution of the right MCA territory infarct.\n3. Smaller hyperdense lesion in the left frontal lobe with surrounding edema\nconcerning for metastasis.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 6:45 AM, 5 minutes after discovery of the\nfindings." + }, + { + "input": "Again seen is right frontal intraparenchymal hemorrhage, not significantly\nchanged from the CT of 1 day prior, with stable adjacent right frontal\nsubarachnoid hemorrhage. Small amount of intraventricular hemorrhage layering\nin the occipital horn of the left lateral ventricle is also stable. There is\ncontinued evolution of the right MCA territory infarct with increasing edema\ncausing increased effacement of the right lateral ventricle and minimal new\nleftward shift of the anterior falx. The left lateral ventricle remains\nnormal in size. The basal cisterns remain patent. No new large vascular\nterritory infarct is identified.\n\nThere is a stable small area of mild vasogenic edema in the left frontal\ncentrum semiovale, surrounding a lesion with a faintly hyperdense rim, which\ncorresponds to the rim enhancing lesion on the preceding MRI.\n\nNo lytic or sclerotic bone lesions suspicious for malignancy are identified.\nThe visualized paranasal sinuses, mastoid air cells and middle ear cavities\nare clear.", + "output": "1. Stable appearance of the right frontal interparenchymal hemorrhage with\noverlying subarachnoid hemorrhage. Stable hemorrhage in the left lateral\nventricle.\n2. Continued evolution the right MCA territory infarct with slightly increased\nedema and minimally increased mass effect.\n3. Vasogenic edema related to a rim enhancing lesion in the left frontal\ncentrum semiovale is again noted, concerning for a metastasis." + }, + { + "input": "There is an acute intraparenchymal hemorrhage centered in the region of the\nright basal ganglia and internal capsule spanning approximately 2.9 x 1.6 x\n3.0 cm with surrounding edema (2:18). Hemorrhage appears to extend superiorly\nand medially along the ependymal surface of the right lateral ventricle though\nthere is no discrete intraventricular blood products (2:20). There is no\nmidline shift. There is prominence of the ventricles and sulci consistent\nwith age related involutional changes. Subcortical and periventricular\nhypodensities are nonspecific, however likely represent sequela of chronic\nsmall vessel ischemic disease.\n\nThere is no evidence of fracture. There is minimal mucosal thickening in the\nbilateral maxillary sinuses. The visualized portion of the remainder of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. \nPatient is status post right lens replacement. The visualized portion of the\norbits are unremarkable.", + "output": "Acute intraparenchymal hemorrhage centered in the region of the right basal\nganglia and internal capsule spanning up to 3.0 cm with surrounding edema. No\nmidline shift." + }, + { + "input": "Bilateral iso to hyperdense thin symmetric subdural hematomas are noted\noverlying the frontoparietal convexities bilaterally, both measuring up to 4\nmm in diameter (2:15), likely acute-to-subacute in nature. Punctate\nintraparenchymal hemorrhagic focus within the right frontal lobe likely\nreflects a small hemorrhagic contusion (02:21). There is a small amount of\nintraventricular blood within occipital horns bilaterally, right greater than\nleft (2:16). No hydrocephalus. No shift of normally midline structures. \nBasal cisterns are patent.\n\nHyperdensity of the venous sinuses likely reflects recent intravenous contrast\nadministration.\n\nRight frontoparietal scalp hematoma is noted as well as a laceration within\nthe right frontal scalp (03:50). No fracture identified. Moderate mucosal\nthickening of the anterior and posterior ethmoidal air cells and mild mucosal\nthickening of the maxillary and sphenoid sinuses is noted. Mastoid air cells\nand middle ear cavities are well aerated. Visualized portions of the orbits\nare unremarkable. Fluid within the nasopharynx likely reflects recent\nintubation.", + "output": "1. Bilateral frontoparietal thin subdural hematomas, measuring up to 4 mm in\ndiameter, likely acute-to-subacute. No midline shift. Basal cisterns are\npatent.\n2. Punctate intraparenchymal hemorrhage within the right frontal lobe.\n3. Intraventricular blood in both occipital horns, right greater than left. \nNo evidence of hydrocephalus.\n4. Small right frontoparietal scalp hematoma and right frontal scalp\nlaceration." + }, + { + "input": "Head CT: There is no evidence of hemorrhage, edema, masses, mass effect, or\ninfarction. The ventricles and sulci are normal in caliber and configuration.\nNo fractures are identified. There is hypodensity along the corpus callosum\nthat likely represents a lipoma.\n\nHead CTA: There is severe narrowing of the right internal carotid artery in\nthe carotid canal, cavernous sinus, and supraclinoid segments. The left ICA\nand its major intracranial branches appear normal. The right vertebral artery\nis dominant and the left vertebral contributes nearly all its flow to the\n___.\n\nNeck CTA: There is apparent occlusion of the right internal carotid artery at\nits origin with reconstitution in the carotid canal. There is severe\nnarrowing of the ICA in the carotid canal, the cavernous sinus, and the\nsupraclinoid segment. There is a stenosis of the left internal carotid artery\nat its origin. It measures approximately 65% stenosis by NASCET criteria, but\nlimitations in opacification and surrounding calcified plaque limit confidence\nin this measurement.\n\nThe vertebral arteries appear normal.", + "output": "Occlusion of the right internal carotid artery at its origin. Reconstitution\nof the right internal carotid artery in the carotid canal, but with severe\nnarrowing.\n\nApproximately 65% stenosis at the origin of the left internal carotid artery,\nbut confidence in this measurement is limited by the technical quality of the\nexamination.\n\nDominant right vertebral artery. The left vertebral artery contributes nearly\nall its flow to the posterior inferior cerebellar artery.\n\nNo other intracranial arterial abnormalities detected." + }, + { + "input": "Head CT: The study is moderately degraded by motion. In the context of these\nlimitations, there is no evidence of acute intracranial hemorrhage, mass, mass\neffect, or large territorial infarction. Periventricular and deep subcortical\nwhite matter hypodensities are likely sequelae of chronic small vessel\nischemic disease. Mild prominence of the ventricles and sulci is likely\nrelated to age related involutional changes. The basilar cisterns are patent,\nand there is otherwise good preservation gray-white matter differentiation.\n\nNo acute fractures are identified. Air-fluid levels are seen within the\nmaxillary sinuses bilaterally. Severe sinus disease is seen involving the\nethmoid air cells and right sphenoid sinus. Mild sinus disease is seen\ninvolving the frontal sinuses and left sphenoid sinus. The mastoid air cells,\nand middle ear cavities are clear. The patient is status post lens\nreplacement surgery on the left. The right globe is unremarkable.\n\nCTA neck: Re demonstrated is complete occlusion of the right internal carotid\nartery at the origin with reconstitution at the level of the carotid canal. \nThe patient is status post left the common/internal carotid artery stenting. \nFlow is seen across lumen of the stent, and although stent patency is\ndifficult to evaluate on CT there appears to be at least 75% stenosis of the\nlumen of the stent. The right vertebral artery is dominant, with a\nhypoplastic V4 segment of the left vertebral artery. The vertebral arteries\nbilaterally are otherwise unremarkable.\n\nCTA head: The left internal carotid artery demonstrates moderate\natherosclerotic disease however is otherwise unremarkable. The left MCA and\nbilateral ACA demonstrate normal flow. Incidental note is made of a 2 mm\noutpouching, likely at the right A1/A-comm junction (series 3, image 263),\nwhich may represent an infundibulum although a small aneurysm is not entirely\nexcluded. The cavernous segment of the right internal carotid artery\ndemonstrates diminutive flow likely secondary to reconstitution of flow from\nthe left across the anterior communicating artery. Appropriate reconstituted\nflow is seen within the right middle cerebral artery. The posterior\ncirculation is well preserved.\n\nPunctate calcifications are noted in the thyroid glands, unchanged from prior\nexam, which appear diminutive but stable. There is no cervical\nlymphadenopathy. Note is made of bibasilar consolidations, likely secondary\nto atelectasis.", + "output": "1. Evaluation of flow through the left common/internal carotid artery stent is\nlimited on CT however there appears to be at least 75% stenosis of the lumen. \nAs noted on prior examination, occlusion of the right internal carotid artery.\n2. No acute intracranial abnormalities identified.\n3. Incidental note is made of a 2 mm outpouching at the right A1/A-comm\njunction, which may represent an infundibulum, although a small aneurysm is\nnot entirely excluded.\n4. Congenitally hypoplastic V4 segment of the left vertebral artery, and\ndominant right vertebral artery, is noted." + }, + { + "input": "There is no evidence of infarction, hemorrhage,or edema. Nasal tube is present\non the right.\nThe ventricles appear prominent for given age of patient. There is no evidence\nof midline shift or mass effect.\n\nThere is no evidence of fracture. Calcifications are seen bilaterally in the\nsupraclinoid and cavernous segments of the bilateral ICA. There is mucosal\nthickening of the right maxillary, ethmoid, and sphenoid sinuses. The\nbilateral frontal sinuses are clear. The mastoid air cells are opacified\nbilaterally. The visualized portion of the orbits are unremarkable.", + "output": "1. No evidence of hemorrhage, infarct, or fractures.\n2. Nasal tube is present on the right.\n3. Ventricles appear prominent for given age of patient.\n4. Atherosclerotic calcifications are visualized in the bilateral ICA." + }, + { + "input": "Left parietal subgaleal hematoma near the vertex. There is no evidence of\ninfarction, hemorrhage, edema, or mass. The ventricles and sulci are normal in\nsize and configuration.\n\nNo fracture. The paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The orbits are unremarkable.", + "output": "1. Left parietal subgaleal hematoma.\n2. No fracture or intracranial hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.\n\nNo significant interval change in the small left occipital scalp hematoma.", + "output": "1. No significant interval change in the small left occipital scalp hematoma.\n2. No subdural hematoma seen." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute large territory infarct,hemorrhage,edema,ormass\neffect. There are few multifocal periventricular and deep white matter\nhypodensities of indeterminate age; nonspecific and could be related to\nchronic small vessel disease. The ventricles and sulci are within expected\nlimits in size and configuration.\n\nMucosal thickening involving bilateral maxillary sinuses and ethmoid air\ncells. Paranasal sinuses and mastoid air cells otherwise are essentially\nclear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm.\n\nThere is a hypodensity at left jugular bulb (series 3, image 222); this\nappearance could be related to incomplete filling of left internal jugular\nvein. Absence of underlying expansion make jugular venous thrombosis is less\nlikely consideration.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent. Atherosclerotic\ncalcifications noted at bilateral internal carotid arteries origin.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear patent with\nno evidence of stenosis or occlusion.\n\nOTHER:\nNo suspicious lung nodules. Calcified granuloma at right upper lobe. The\nvisualized portion of the thyroid gland is within normal limits. There is no\nlymphadenopathy by CT size criteria. Mucous retention cysts are seen in the\nlingual tonsils. In addition, there is a small presumed 4 mm mucous retention\ncyst in the left lingula (series 3, image 127). The remainder of the\naerodigestive tract is grossly unremarkable.", + "output": "1. No acute intracranial hemorrhage or large territorial infarction\nnoncontrast CT head.\n2. Hypodensity at left jugular bulb (series 3, image 222); this appearance is\nmost likely related to incomplete filling of left internal jugular vein.\n3. Patent circle of ___ without evidence of high-grade\nstenosis,occlusion,or aneurysm.\n4. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection.\n5. Apparent mucous retention cysts are seen in the bilateral lingual tonsils\nand left follicular.\n6. Additional findings described above." + }, + { + "input": "There is a common origin of the right brachiocephalic and left common carotid\narteries. Calcified and noncalcified plaque is present at the aortic arch and\nthe origins of the great vessels without significant stenosis. There is\ncalcified atherosclerotic plaques at the origins of both vertebral arteries,\ncausing a mild narrowing on the right and a severe narrowing on the left. The\nseverity of the stenosis at the origin of the left vertebral artery is\ndifficult estimate given the small caliber of the vessel and the degree of\ncalcification. Both vertebral arteries are otherwise patent along their\ncourses. The left vertebral artery is hypoplastic.\n\nBoth common carotid arteries are patent, though calcified plaque is seen\nintermittently along the courses of both common carotid arteries, left greater\nthan right.\n\nThere is calcified and noncalcified atherosclerotic plaque at the carotid\nbulbs and involving the proximal internal carotid arteries, left greater than\nright. By NASCET criteria, this causes an approximate 50% stenosis of the\nproximal right internal carotid artery with a minimal residual lumen of 2.1\nmm. There is an approximate 15% narrowing of the proximal left internal\ncarotid artery with a minimal residual lumen of 4.1 mm. The distal left\ncommon carotid artery demonstrates 60% narrowing with a minimal residual lumen\nof 1.8 mm.\n\nCalcified atherosclerotic plaque involving both intracranial internal carotid\narteries is incompletely visualized.\n\nThe lung apices are clear.\n\nThere is extensive cervical spine degenerative disease with a focal kyphosis\nand partial congenital or acquired fusion of C5 and C6.", + "output": "Atherosclerotic disease with an approximate 50% diameter stenosis of the\nproximal right internal carotid artery and a 60% diameter stenosis of the\ndistal left common carotid artery. The proximal left common carotid artery is\nonly slightly narrowed. There is mild narrowing at the origin of the right\nvertebral artery and high-grade stenosis at the origin of the left vertebral\nartery." + }, + { + "input": "CT HEAD:\nThere is no evidence for acute hemorrhage, vascular territorial infarction,\nmass effect, or edema. The ventricles and sulci are normal in size and\nappearance.\n\n The paranasal sinuses, middle ear cavities, and mastoid air cells are clear.\nThe orbits are grossly unremarkable bilaterally.\n\n\nCTA HEAD AND NECK:\nThere is a normal 3 vessel aortic arch identified. The vertebral arteries are\npatent without high-grade stenosis or occlusion.\n\nThe bilateral common carotid arteries are patent. There is no evidence of\ninternal carotid stenosis by NASCET criteria.\n\nThe intracranial vasculature is grossly patent without high-grade stenosis,\nocclusion, or aneurysm greater than 3 mm. The dural venous sinuses are patent.\n\n\nOTHER:\nThe lungs apices are clear bilaterally. A 1.5 cm irregular thyroid nodule\nwithin the right thyroid lobe is noted, better characterized on recent thyroid\nultrasound examination. Multiple prominent bilateral cervical lymph nodes are\nseen, none of which are pathologically enlarged by CT size criteria.", + "output": "1. No evidence for acute intracranial hemorrhage or vascular territorial\ninfarction.\n2. No CTA evidence for a dural arteriovenous fistula.\n3. Grossly patent intracranial and cervical vasculature without high-grade\nstenosis or vessel occlusion.\n4. 1.5 cm irregular right thyroid nodule, better characterized on prior\nthyroid ultrasound." + }, + { + "input": "There is no evidence of hemorrhage, infarction, edema, mass, or mass effect. \nThere is preservation of gray-white matter differentiation. Prominence of the\nventricles and sulci is compatible with age related involutional change. Mild\nperiventricular white matter hypodensity is compatible with the sequelae of\nchronic small vessel ischemia.\n\nThe visualized paranasal sinuses and mastoid air cells are clear. The patient\nis status post bilateral lens removal, otherwise the globes and bony orbits\nare unremarkable. Bilateral carotid siphon calcifications are noted. Also\nnoted is hyperostosis frontalis interna in addition to multiple foci of dural\ncalcifications along the falx.", + "output": "1. No acute intracranial process.\n2. Chronic findings including age appropriate global atrophy, vascular\ncalcifications, and white matter small vessel ischemic changes." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nThere are patchy periventricular and subcortical hypodensities. This is a\nnonspecific finding and most likely represents small vessel ischemic gliotic\nchange in a patient of this age.\n\nThere is no evidence of fracture. There is partial opacification of the\nanterior ethmoidal air cells and left frontal sinus, likely related to\nintubation in the presence of an nasoenteric tube. Vascular calcification is\nevident. The visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavitiesare otherwise clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. No evidence of acute intracranial process.\n2. Age related involutional changes. Patchy periventricular and subcortical\nhypodensities, likely small vessel ischemic gliotic change." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. There is preservation of\ngray-white matter differentiation. The basal cisterns remain patent.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial hemorrhage." + }, + { + "input": "There is no evidence of acute large territorial infarction, intracranial\nhemorrhage, edema, or significant mass effect.\n\nThere is prominence of the ventricles and sulci suggestive of age-related\ncerebral volume loss. There are hypodensities in the subinsular white matter\nwhich are fairly low-density which likely represents chronic small vessel\nischemic disease. The left insular gray-white matter differentiation is\npreserved.\n\nNo acute osseous abnormalities seen. Partially imaged paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The orbits demonstrate\nno acute abnormalities.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major infarction. Periventricular\nwhite matter hypodensities are not significantly changed and most likely\nreflect chronic microvascular ischemic disease. There are age related\ninvolutional changes. The imaged paranasal sinuses are well aerated as are\nthe mastoid air cells and middle ear cavities. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is a 1 cm intraparenchymal hemorrhage in the right parieto-occipital\nlobe (02:28), and 0.5 cm right frontal intraparenchymal hemorrhage (02:29),\nconsistent with contusions. Hyperdensity in the right sylvian fissure (series\n2, image 16) likely represents a small subarachnoid hemorrhage. Layering\nhemorrhage within the occipital horn of the right lateral ventricle. No shift\nof midline structures.\n\nNo evidence of acute major vascular territory infarction. The sulci,\nventricles cisterns are prominent, but within expected limits for the degree\nof patient's senescent related global cerebral volume loss. Atherosclerotic\ncalcification of the dominant left vertebral artery and of the bilateral\ncavernous internal carotid arteries are identified.\n\nThere is no evidence of fracture. Mild mucosal thickening of the left\nmaxillary, bilateral inferior frontal sinuses and frontal ethmoidal recess is\nidentified. Otherwise, the remainder of the visualized paranasal sinuses are\nclear. The mastoid air cells and middle ears are well pneumatized and clear. \nSoft tissue density in the bilateral external auditory canals are without\nerosion, likely representing cerumen.\n\nLarge scalp hematoma/laceration with subcutaneous emphysema measuring\napproximately 1.7 cm in greatest thickness along the right parietal vertex.", + "output": "1. Right-sided hemorrhagic contusions, 0.5 cm in the right frontal lobe, and 1\ncm in the frontoparietal lobe.\n2. Small amount hemorrhage in the right lateral ventricle. Trace subarachnoid\nhemorrhage in the right sylvian fissure.\n3. Large scalp hematoma/laceration along the right vertex, without evidence of\nunderlying fracture.\n\nNOTIFICATION: The additional finding of right sylvian fissure subarachnoid\nhemorrhage was discussed with Dr. ___. by ___, M.D. on the\ntelephone on ___ at 8:46 AM, 15 minutes after discovery of the findings." + }, + { + "input": "A 5-mm hyperdense intraparenchymal hemorrhage in the right frontal lobe is\nunchanged (series 3, image 24). An 1.3 x 0.9-cm acute intraparenchymal\nhemorrhage in the right parietal-occipital lobe appears minimally larger even\nfor differences in angulation between exams, previously 1 x 0.8 cm (series 3,\nimage 37). Surrounding small amount of hypodensity may reflect edema. \nSerpiginous, hyperdensity in the sylvian fissure corresponding the\nsubarachnoid hemorrhage is slightly more prominent and may reflect\nredistribution of blood products or interval small amount of hemorrhage\n(series 3, image 28, 23). Small amount of intraventricular hemorrhage\nlayering in the right lateral ventricle occipital horn is overall unchanged\n(series 3, image 24). Tiny focus of intraventricular hemorrhage layering in\nthe left lateral ventricle and occipital horn is more conspicuous (series 3,\nimage 22). No evidence of new intraparenchymal focal hemorrhage. No shift of\nnormally midline structures. Bilateral, symmetric mild prominence of the\nventricles and sulci is nonspecific, and may suggest cortical volume loss,\nunchanged. Bilateral vertebral artery and cavernous internal carotid artery\ncalcifications are moderate.\n\nRight posterior scalp laceration and hematoma has markedly decreased (Series\n3, image 35). No evidence of fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are essentially\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. Minimal interval increase in the right parietal occipital lobe\nintraparenchymal hemorrhage, now 1.3 x 0.9 cm, previously 1 x 0.8 cm. \nRedistribution of known right sylvian fissure subarachnoid hemorrhage.\n2. Overall similar 5-mm right frontal lobe intraparenchymal hemorrhage and\nsmall/tiny intraventricular hemorrhage.\n3. No new focal intraparenchymal hemorrhage.\n4. Evolution of previously noted right posterior scalp hematoma and\nlaceration.\n\nNOTIFICATION: The findings and impression were discussed with ___, M.D.\nby ___, M.D. on the telephone on ___ at 9:40 AM, 1 minutes\nafter discovery of the findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\n\nApproximately 1 cm hemorrhage in the subcortical white matter of the right\nprecentral gyrus at the vertex and approximately 0.3 cm hemorrhage in the\nsubcortical white matter of the superior right frontal gyrus, both seen on\nimage 2:29, appear slightly smaller than on ___. Mild surrounding\nedema persists. They are compatible with hemorrhagic contusions or diffuse\naxonal injury.\n\nMild subarachnoid hemorrhage in the right sulci has decreased. Mild hemorrhage\nin the occipital horns of the lateral ventricles is stable in size with\ndecreased density. Mild prominence of the ventricles is stable and compatible\nwith age-related parenchymal volume loss.\n\nThere is no evidence for a calvarial fracture. There appears to be a\nnondisplaced fracture of the anterior process of the maxilla, image 3:203,\nsimilar to ___.\n\nThere is mild mucosal thickening in the inferior frontal sinuses. There is\nminimal mucosal thickening along the anterior walls of the sphenoid sinuses\nand along the floor of the left maxillary sinus. Mastoid air cells and middle\near cavities are well aerated. Soft tissue density in bilateral external\nauditory canals suggest cerumen. The orbits are unremarkable.\n\nCTA NECK:\n\nThere is common origin of the brachiocephalic and left common carotid\narteries, a normal variant. There is no evidence for arterial dissection. \nBilateral common carotid arteries are widely patent. Right internal carotid\nartery is widely patent without stenosis by NASCET criteria. There is mild\ncalcified plaque at the origin of the right external carotid artery. There is\nmild calcified plaque in the proximal left internal carotid artery without\nstenosis by NASCET criteria. Left vertebral artery is dominant. V1 through\nV3 segments of bilateral vertebral arteries are widely patent.\n\nCTA HEAD:\n\nThere is no evidence for arterial dissection or intracranial aneurysm. There\nis mild calcified plaque in bilateral carotid siphons and in the V4 segments\nof bilateral vertebral arteries without flow-limiting stenosis. There is no\nevidence for flow-limiting stenosis elsewhere in the intracranial circulation.\nLeft ___ is low-lying and extradural, a normal variant. Nondominant\nright vertebral artery is hypoplastic distal to right ___. Major\ndural venous sinuses appear patent.\n\nOTHER:\nEvaluation of the included upper lungs is limited by respiratory motion\nartifact. The thyroid gland is grossly unremarkable. There are degenerative\nchanges in the cervical spine, as seen on the recent cervical spine MRI.", + "output": "1. Two right superior frontal subcortical white matter hemorrhages with mild\nsurrounding edema at have decreased in size, compatible with hemorrhagic\ncontusions are diffuse axonal injury. Mild right subarachnoid hemorrhage and\nminimal bilateral intraventricular hemorrhage is also decreasing.\n2. Nondisplaced fracture of the anterior process of the maxilla, similar to ___.\n3. CTA of the head and neck demonstrates no evidence for arterial dissection\nor flow-limiting stenosis." + }, + { + "input": "Right parieto-occipital intraparenchymal hemorrhage measures 1.2 (AP) x 0.8\n(TV) cm , stable from before. Subarachnoid hemorrhage in the right parietal\nand left superior parietal regions also appear similar to before. Small\nintraventricular hemorrhage layers along the bilateral lateral ventricle\nposterior horns. No new hemorrhage is identified. The ventricles and sulci\nare unchanged in size and configuration.\n\nPreviously noted maxillary fracture is not included in current examination. \nNo definite fracture identified The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Stable right parietal occipital lobe intraparenchymal hemorrhage.\n2. Stable subarachnoid hemorrhage in the right parietal and left superior\nparietal regions.\n3. Stable intraventricular hemorrhage as described.\n4. No evidence of new intracranial hemorrhage." + }, + { + "input": "The known right parieto-occipital intraparenchymal hemorrhage is unchanged in\nsize, measuring 1.2 x 0.7 cm (2:28). Subarachnoid hemorrhage in the right\nparietal and left superior parietal regions are also similar to before. \nAgain, a small amount of layering intraventricular hemorrhage in the bilateral\noccipital horns of the lateral ventricle is unchanged. No new intracranial\nhemorrhage detected. The ventricles and sulci are stable in size and\nconfiguration since the prior study.\n\n\nNo new osseous abnormality. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. Stable 1.2 x 0.7 cm right parieto-occipital intraparenchymal hemorrhage\nsince the prior study.\n\n2. Stable small bilateral subarachnoid hemorrhages.\n\n3. Stable intraventricular hemorrhage.\n\n4. No new intracranial hemorrhage." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, loss of gray/\nwhite matter differentiation, or pathologic extra-axial collection. Scattered\nfoci of low density in the periventricular and deep white matter are\nnonspecific but likely sequela of chronic small vessel ischemic disease in\nthis age group. Ventricles and sulci are prominent due to parenchymal volume\nloss. Incidental note is again made of ___ cisterna magna, a normal\nvariant.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No evidence for acute intracranial abnormalities" + }, + { + "input": "Please note that images are significantly degraded secondary to motion\nartifact. Within these confines:\n\nCT HEAD WITHOUT CONTRAST:\nWithin the confines imposed by motion artifact, there is no evidence of acute\nterritorial infarction,intracranial hemorrhage,edema,mass or significant mass\neffect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. There are periventricular and subcortical hypodensities,\nwhich are nonspecific but compatible with small vessel ischemic changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are normal,\nnoting bilateral lens replacements.\n\nCTA HEAD:\nCTA images of the head are significantly degraded by motion artifact, limiting\nevaluation.\n\nThere are atherosclerotic calcifications involving the bilateral carotid\nsiphons, although evaluation for stenosis is limited by motion artifact.\n\nThere is an anteriorly oriented saccular aneurysm of the anterior\ncommunicating artery measuring 5 mm in height with a 2.7 mm wide neck (4:301).\nSubject to the limitations imposed by motion artifact, the remaining vessels\nof the circle of ___ and their principal intracranial branches appear\nnormal without stenosis, occlusion, or aneurysm. The dural venous sinuses are\npatent.\n\nCTA NECK:\nThere are moderate atherosclerotic calcifications noted at the aortic arch and\norigins of the great vessels, with prominent atherosclerotic calcifications at\nthe origin of an aberrant right subclavian artery.\n\nThe bilateral common carotid arteries arise from the aortic arch. There are\nmoderate atherosclerotic calcifications of the bilateral common carotid\narteries. There are prominent atherosclerotic calcifications at the bilateral\ncarotid bifurcations with 50-60% stenosis of the right proximal internal\ncarotid artery and ___ stenosis of the left proximal internal carotid\nartery by NASCET criteria. Calcifications are additionally noted within the\ndistal cervical internal carotid arteries bilaterally, left greater than\nright.\n\nThere are calcifications at the bilateral vertebral artery origins with\nprobable mild stenosis. The remaining portions of the bilateral vertebral\narteries appear patent, normal in course and caliber. A punctate\ncalcifications noted within the right vertebral artery V4 segment without\nstenosis.\n\nNo evidence of vertebral or carotid dissection.\n\nOTHER:\n\n-Evaluation of the upper thorax is limited by motion artifact, however median\nsternotomy wires and mediastinal surgical clips are noted. There is a patchy\nconsolidation within the right middle lobe compatible with pneumonia.\nThe patient is status post CABG.\n-The thyroid gland demonstrates a heterogeneous appearance, with bilateral\nhypodense nodules measuring up to 1.7 x 0.6 cm on the left, for which\nultrasound follow-up may be obtained.\n-There is no lymphadenopathy by CT size criteria.", + "output": "Please note that images are significantly degraded secondary to motion\nartifact. Within these confines:\n\n1. Head CT: Within the limitations imposed by motion artifact, there is no\ndefinite acute territorial infarct, intracranial hemorrhage, mass or mass\neffect. There are diffuse involutional changes as well as\nperiventricular/subcortical hypodensities, which are nonspecific but\ncompatible with small vessel ischemic changes.\n2. Head CTA: There is an anteriorly oriented saccular aneurysm of the anterior\ncommunicating artery measuring 5 mm in height and 2.7 mm at its neck. Subject\nto the limitations imposed by motion artifact, the circle of ___ otherwise\ndemonstrates no definite stenosis,occlusion,or aneurysm. There are prominent\ncalcifications of the bilateral carotid siphons.\n3. Neck CTA: Prominent atherosclerotic plaque formation at the aortic arch and\nthe origins of the great vessels, including at the origin of an aberrant right\nsubclavian artery. There is atherosclerotic plaque at the bilateral vertebral\nartery origins with probable mild stenosis, although the bilateral vertebral\narteries otherwise appear normal in course and caliber. There are prominent\ncalcifications at the bilateral carotid bifurcations with 50-60% right and\n___ left proximal internal carotid artery stenosis by NASCET criteria.\n4. Lungs: Patchy consolidation within the right middle lobe compatible with\npneumonia.\n5. Thyroid: Heterogeneous appearing thyroid gland with multiple bilateral\nnodules, measuring up to 1.7 cm on the left, for which ultrasound follow-up\nmay be obtained, as per ACR guidelines provided below.\n\nRECOMMENDATION(S): Thyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or ___, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr. ___\n___ on ___ at 15:54 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Mild bilateral carotid siphon\ncalcifications are noted.", + "output": "No acute intracranial process. No hemorrhage." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute large territory infarction, hemorrhage, edema,\nor mass. The ventricles and sulci are prominent compatible with age-related\ninvolutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nPunctate vascular arteriosclerotic calcifications are visualized in the\ncarotid siphons bilaterally, however, the vessels of the circle of ___ and\ntheir principal intracranial branches appear patent l without stenosis,\nocclusion, or aneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nAtherosclerotic calcifications are visualized within the bilateral bulbs and\ncarotid side with no substantial stenosis or occlusion identified. The\nvertebral arteries and their major branches appear normal with no evidence of\nstenosis or occlusion. There is no evidence of internal carotid stenosis by\nNASCET criteria. Motion artifacts are visualized in the ascending aorta\n(image 1, series 3), partially evaluated in this exam, if clinically\nwarranted, correlation with CTA of the chest is recommended.\n\nOTHER:\nBilateral scarring is visualized the lung apices. The visualized portion of\nthe thyroid gland is prominent though otherwise within normal limits. There\nis no lymphadenopathy by CT size criteria.", + "output": "1. No acute intracranial abnormality identified.\n2. No focal stenosis, occlusion, or aneurysm formation identified within the\nhead or neck.\n\nRECOMMENDATION(S): Motion artifacts are visualized in the ascending aorta\n(image 1, series 3), if clinically warranted, correlation with CT of the chest\nis recommended." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration for patient's age.\n\nThere is no evidence of fracture. There is mild opacification of the ethmoid\nsinuses. Otherwise, the visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "No acute intracranial process. Please note evaluation of aneurysm is limited\ndue to lack of IV contrasts." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of large territorial infarction,\nhemorrhage, edema, or mass. The ventricles and sulci are normal in size and\nconfiguration for the patient's age. Periventricular and subcortical\nhypodensities are most likely sequelae of chronic small vessel ischemic\nchanges.\n\nThere is minimal mucosal thickening of the ethmoid air cells. The remaining\nparanasal sinuses and middle ear cavities are clear. There is minimal fluid\nin the bilateral mastoid air cells. The visualized portion of the orbits are\nunremarkable.\n\nCTA HEAD:\nThere is no evidence of aneurysm. There is a 2 mm infundibulum of the origin\nof the right posterior communicating artery (series 7, image 317). Otherwise\nthe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. There is\nminimal atherosclerotic calcification in the left cavernous internal carotid\nartery without stenosis. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is minimal atherosclerotic calcification in the left proximal internal\ncarotid artery without stenosis. Atherosclerotic calcification in the left V4\ndoes not cause narrowing. The remaining carotid and vertebral arteries and\ntheir major branches appear normal with no evidence of stenosis or occlusion.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nLimited evaluation of the lungs demonstrate multiple cavitary lesions\nbilaterally, bilateral pleural effusion, chest tube on the right associated\npneumothorax. Please see separate dictation performed on ___ at\n01:49 for detailed evaluation of the chest. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. Limited evaluation of the cervical spine demonstrates multilevel\ndegenerative changes most severe at C4-5 without fracture. Mild\nretrolisthesis C4 over C5 is presumably due to degenerative process.", + "output": "1. No evidence of hemorrhage, large territorial infarct, or mass.\n2. No evidence of aneurysm.\n3. 2 mm infundibulum of the origin of the right posterior communicating\nartery.\n4. No flow-limiting stenosis, occlusion, or dissection of the intracranial and\ncervical vascular structures.\n5. Minimal atherosclerotic calcification in the left cavernous internal\ncarotid artery and left proximal internal carotid artery without stenosis.\n6. Please see separate dictation performed on the same day for detailed\nevaluation of the chest." + }, + { + "input": "Focal hypodensities in the right corona radiata, right caudate and posterior\nright putamen correspond to areas of restricted diffusion on prior MR, are\nbetter seen compared with comparisons CT, suggestive of evolving punctate\nearly subacute infarcts (2:16, 2:17, 02:24). No definite new hypodensities or\nacute infarcts are seen. No parenchymal hematoma. Small focus of new\nsubarachnoid hemorrhage overlies left middle frontal gyrus series 2 images\n___. Ventricles are unchanged in size and configuration. No midline shift.\nBasal cisterns are patent. No acute osseous abnormalities seen. The\nparanasal sinuses are clear.", + "output": "There stable small punctate early subacute infarcts, as seen on MRI ___.\nThere is new trace subarachnoid hemorrhage overlying left frontal lobe\n\nNOTIFICATION: The findings were discussed with ___ NP by ___\n___, M.D. on the telephone on ___ at 3:21 pm, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "Again seen is small volume subarachnoid hemorrhage overlying left frontal\nlobe, probably middle frontal gyrus, series 3, image 24, stable since prior. \nNo interval new hemorrhage. No parenchymal hemorrhage. Stable small early\nsubacute infarcts as seen today. There are no new acute infarcts. There is\nno evidence of mass. The ventricles and sulci are normal in size and\nconfiguration.\n\nThere is no evidence of fracture. There is minimal opacification of the\nbilateral mastoid air cells. Otherwise, the visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "Stable trace subarachnoid hemorrhage overlying the frontal lobe.\nNo parenchymal hemorrhage.\nStable few punctate foci of early subacute infarcts.\nNo new abnormalities." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration. Few scattered\nsubcortical hypodensities are nonspecific, however likely represent sequela of\nchronic small vessel ischemic disease.\n\nThere is minimal mucosal thickening in the ethmoid air cells. The visualized\nportion of the remainder of the paranasal sinusesand middle ear cavities are\nclear. The mastoid air cells are partially occluded, similar to prior. The\nvisualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. Again seen\nis a 2 mm infundibulum at the origin of the right posterior communicating\nartery. There is minimal atherosclerotic calcification in the left cavernous\ninternal carotid, without significant stenosis. The dural venous sinuses are\npatent.\n\nCTA NECK:\nThere is minimal atherosclerotic calcification in the left proximal internal\ncarotid artery, without significant stenosis. Small amount of atherosclerotic\ncalcification left V4 segment does not cause significant narrowing. The\nremaining carotidand vertebral arteries and their major branches appear normal\nwith no evidence of stenosis or occlusion. There is no evidence of internal\ncarotid stenosis by NASCET criteria.\n\nOTHER:\nPlease see separate CT chest dictation for intrathoracic findings.", + "output": "-No evidence of mycotic aneurysm.\n-Please see separate dictation performed on same day for detailed evaluation\nof the chest." + }, + { + "input": "There is no evidence of large territorial infarction,acute intracranial\nhemorrhage,edema,or mass. The ventricles and sulci are normal in size and\nconfiguration.\n\nThere is no evidence of fracture. There is minimal mucosal thickening in the\nethmoidal air cells. The visualized portion of the remaining paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "No evidence of acute intracranial hemorrhage or large vascular territorial\ninfarction." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Partially empty sella again\nnoted.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute territorial infarction or intracranial\nhemorrhage. The ventricles and sulci are normal in size and configuration\nwith no mass effect or midline shift. No mass lesions or extra-axial fluid\ncollections are evident.\n\nThe right maxillary sinus is hypoplastic. Otherwise, the visualized portions\nof the paranasal sinuses are clear. The mastoid air cells are clear. The\nintraorbital contents are unremarkable.\n\nCTA HEAD:\nThe intracranial internal carotid arteries, bilateral A1 and A2 segments, and\nbilateral M1 and M2 segments demonstrate normal contrast opacification without\nevidence of focal stenosis, occlusion, or aneurysm formation. Tiny right\nintradural vertebral artery is seen. Intradural component of left vertebral\nartery is not identified.\nThere are persistent fetal origins of the bilateral posterior cerebral\narteries. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is a 4 mm focal outpouching projecting medially along the right cervical\ninternal carotid artery at the level of the dens tip, likely pseudoaneurysm\n(image 179 of series 3).\n\nThe right vertebral artery is markedly small throughout its course. The left\nvertebral artery is not visualized along its cervical course. Findings may be\nin part congenital in etiology. The transverse foramina are small\nbilaterally.\n\nOtherwise, the carotid and their major branches appear normal with no evidence\nof stenosis or occlusion. There is no evidence of internal carotid stenosis by\nNASCET criteria.\n\nOTHER:\nNo suspicious pulmonary nodules are evident. The thyroid gland is\nheterogeneous in appearance, likely secondary to low-density nodules and\nartifact from the contrast bolus. There is no lymphadenopathy by CT size\ncriteria.\n\nThere are postsurgical changes of C4-C5 ACDF with an interbody spacer. There\nare degenerative changes at C5-C6 with moderate intervertebral disc space\nnarrowing and hypertrophic endplate changes.", + "output": "1. No evidence of acute territorial infarction or intracranial hemorrhage.\n2. No evidence of focal stenosis, occlusion, or aneurysm formation in the\nhead.\n3. Focal 4 mm pseudoaneurysm projecting medially along the right cervical\ninternal carotid artery at the level of the dens tip.\n4. No evidence of internal carotid artery stenosis by NASCET criteria.\n5. Markedly small caliber right vertebral artery, likely in part congenital. \nBilateral transverse foramina are extremely small. Left vertebral artery is\nnot clearly delineated, potentially due to its small size. Occlusion is not\nexcluded.\n6. Expected so postoperative changes of anterior cervical discectomy and\nfusion at C4-C5." + }, + { + "input": "Venous contrast pooling, C4-5 ACDF hardware and dental amalgam streak artifact\nand patient body habitus limits examination.\n\nStreak artifact limits evaluation of right vertebral artery mid V2 segment. \nThe left vertebral artery is again not visualized on the current examination. \nThe right vertebral artery is again diminutive in its entire course. \nBilateral transverse foramina are again noted to be small, which with support\nthe presence of congenitally small vertebral arteries.\n\nGrossly stable right cervical internal carotid artery approximately 4 mm\npseudoaneurysm is again seen (see 3:210 on current study and 3:178 on prior\nexam). Minimal nonocclusive atherosclerotic calcifications of the left\ninternal carotid artery origin is again seen. By NASCET criteria, there is no\ndefinite moderate or high-grade stenosis of the left or right ICA.\n\nOtherwise, the carotidandvertebral arteries and their major branches are\ngrossly patent with no evidence of stenoses. No evidence for new dissection\nis seen.\n\n OTHER:\nVisualized portion lung apices are grossly clear. Evaluation of the thyroid\ngland is limited secondary to streak artifact. Scattered subcentimeter\nnonspecific lymph nodes are noted throughout the neck bilaterally, without\ndefinite enlargement by CT size criteria.", + "output": "1. Venous contrast pooling, C4-5 ACDF hardware and dental amalgam streak\nartifact and patient body habitus limits examination.\n2. Grossly stable right cervical internal carotid artery approximately 4 mm\npseudoaneurysm as described.\n3. Left vertebral artery is again not visualized.\n4. Streak artifact limits evaluation of mid right vertebral artery V2 segment.\n5. Grossly stable diminutive right vertebral artery.\n6. Otherwise, grossly patent bilateral cervical carotid and vertebral arteries\nwithout definite evidence of stenosis or occlusion." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration. Bilateral\nbasal ganglia calcifications are again noted.\n\nThere is mucosal thickening involving the left maxillary sinus the remaining\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The patient is status post bilateral lens replacements.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. Heavy\natherosclerotic calcifications of the left petrous carotid and the bilateral\ncavernous and supraclinoid carotid arteries are identified. Incidental note\nis made of right fetal type and left fetal origin PCAs with diminutive right\nP1 segment. There is also hypoplastic left A1 segment of the anterior\ncerebral artery, a normal variant. Calcification is seen in the right V4\nportion of the vertebral artery. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is normal three-vessel arch configuration. Calcifications of the aortic\narch are mild. There are heavy calcifications extending into the origin of\nthe left subclavian artery. There is approximately 70-80% stenosis the left\nproximal internal carotid artery at the bifurcation (3:139) by NASCET\ncriteria. On the right, there is approximately 20% stenosis of the proximal\ninternal carotid artery at the bifurcation. The vertebral arteries are patent\nbilaterally with a dominant right vertebral artery. There is no evidence\ndissection.\n\nOTHER:\nThe visualized portion of the lungs demonstrate areas of atelectasis and\nbiapical scarring. The visualized portion of the thyroid gland is within\nnormal limits. Scattered prominent cervical and supraclavicular lymph nodes\nare identified but these are not enlarged by CT size criteria.", + "output": "1. No acute intracranial process.\n2. Approximately 70-80% stenosis of the left proximal internal carotid artery\nat the bifurcation.\n3. Approximately 20% stenosis of the right proximal internal carotid artery at\nthe bifurcation.\n4. Remaining carotid and vertebral arteries are patent as described above.\n5. Vascular calcification involving intracranial carotid arteries without\nsignificant stenosis." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction.\n___ cisterna magna versus arachnoid cyst noted posterior to the cerebellum. \nVentricles and sulci are normal in overall size and configuration.\n\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No evidence acute hemorrhage or fracture." + }, + { + "input": "CTA HEAD:\nStudy somewhat limited by streak artifact from dental hardware. The vessels\nof the circle of ___ and their principal intracranial branches appear\nnormal without stenosis, occlusion, or aneurysm formation. The dural venous\nsinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis, occlusion, or dissection. There is no evidence of\ninternal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. There are multiple small\nsubcentimeter nodules in both lobes of the thyroid, with dominant lesion\nmeasuring approximately 9 mm in the left for which no further follow-up is\nrecommended by current ACR guidelines for incidentally noted thyroid nodules.\nThere is no lymphadenopathy by CT size criteria. There are multilevel\ndegenerative changes in the spine.", + "output": "1. No evidence of vertebral artery dissection.\n2. Unremarkable CTA of the neck and head." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,or\nmass effect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular white-matter hypodensities are\nnonspecific, but likely represent sequela of chronic small vessel disease.\n\nThere is no evidence of fracture. There is small mucous in the left frontal\nsinus. There is moderate mucosal thickening in the bilateral maxillary\nsinuses and ethmoid air cells. The visualized portion of the mastoid air\ncells and middle ear cavities are clear. The visualized portion of the orbits\nare unremarkable.", + "output": "No acute intracranial abnormality or fracture." + }, + { + "input": "There is no evidence of acute major infarction,hemorrhage,edema,or discrete\nmass. Periventricular and subcortical white matter hypodensities are\nnonspecific but likely sequelae of chronic small vessel ischemic disease. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges.\n\nThere is no evidence of fracture. There is mucosal thickening within the\nparanasal sinuses as well as partial opacification of the ethmoid air cells. \nThe mastoid air cells, middle ear, and maxillary sinuses are not visualized on\ncurrent exam. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Moderate paranasal sinus mucosal thickening.\n3. Mild small vessel disease." + }, + { + "input": "Study is mildly degraded by motion and streak artifact related to dental\nhardware.\n\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, mass effect, or midline\nshift. There is mild parenchymal volume loss with prominence of the\nventricles and sulci. There are nonspecific periventricular and subcortical\nwhite matter hypodensities, likely sequela of chronic small vessel ischemic\ndisease. There is mild bilateral ethmoid air cell mucosal thickening and left\nfrontal sinus opacification with inspissated secretions. There is right\nethmoid air cell hyperdensity, which may represent inspissated secretions or\nfungal colonization.\n\nCTA HEAD:\nThe intracranial vasculature appears patent without evidence of stenosis,\nocclusion, or aneurysm. The dural venous sinuses appear patent.\n\nCTA NECK:\nThere is atherosclerotic disease of the bilateral carotid bifurcations without\ninternal carotid artery stenosis by NASCET criteria. The bilateral vertebral\narteries appear patent. There is no evidence of dissection.\n\nOTHER:\nThe thyroid gland appears unremarkable. The visualized lung apices appear\nclear. There is no lymphadenopathy per size criteria.", + "output": "1. No evidence of acute large territorial infarction, acute intracranial\nhemorrhage, or edema. Please note MRI of the brain is more sensitive for the\ndetection of acute infarct.\n2. Mild parenchymal volume loss with probable chronic small vessel ischemic\ndisease.\n3. Patent circle of ___ without definite evidence of aneurysm, dissection,\nstenosis or occlusion.\n4. Atherosclerotic disease at the carotid bifurcations without internal\ncarotid stenosis by NASCET criteria.\n5. Paranasal sinus disease , as described." + }, + { + "input": "There is no evidence of acute territory infarction,hemorrhage,edema, or mass. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Mild periventricular and subcorticalwhite matter hypodensities are\nnonspecific, but likely reflect the sequela of chronic microvascular\ninfarction.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "Of note, the superior most portion of the skull is not included on the current\nstudy; repeat scanning due to patient motion. There is no evidence of acute\nterritorial infarction, hemorrhage, edema, or mass effect. The ventricles and\nsulci are mildly prominent keeping with age-related involutional change. Mild\nperiventricular and subcortical white matter hypodensities are nonspecific,\nbut likely represent sequela of chronic ischemic microvascular disease. A\nchronic lacunar infarct in the left corona radiata is noted.\n\nNo acute fracture is seen. Aside from minimal mucosal thickening in the\nbilateral ethmoid air cells, the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear.", + "output": "1. No acute intracranial process.\n2. Evidence of chronic age-related involutional change and small vessel\nischemic disease." + }, + { + "input": "There is no evidence of acute major infarction,hemorrhage,edema,or discrete\nmass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Mild ethmoid air cell mucosal thickening. \nThe visualized portion of the remaining paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass.\n\nThere is prominence of the ventricles and sulci suggestive of atrophy\nappropriate to age. . Atherosclerotic vascular calcifications are noted of\nbilateral cavernous portions of internal carotid arteries.\n\nNo osseous abnormalities seen. There is complete opacification of a right\nposterior ethmoidal air cell with intermediate density material which may\nrepresent inspissated secretions. No evidence of underlying fracture. There\nis mild mucosal thickening of the right anterior ethmoidal air cells and\nbilateral maxillary sinuses. Otherwise, the remaining partially imaged\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\norbits demonstrate no acute abnormalities.", + "output": "1. No evidence of hemorrhage or fracture.\n2. Paranasal sinus inflammatory disease." + }, + { + "input": "In spite of differences in technique (with the current exam being essentially\ncontrast-enhanced from recent IV contrast bolus), the diffuse right-sided\nsubarachnoid hemorrhage involving the entire right cerebral hemisphere appears\nincreased compared with the prior study. Foci of left frontal and parietal\nsubarachnoid hemorrhage is now noted.\n\nRight-sided cerebral subdural hematoma has also significantly increased in\nsize and extent. Majority of the hematoma measures approximately 6 mm in\nthickness. There is now a larger more biconvex component of this hematoma\noverlying the right parietal lobe measuring up to 1.6 cm in thickness (03:34).\nGiven presence of overlying parietal skull fracture and appearance there is\npossibility of an epidural hematoma.\n\nPredominant low-density extra-axial collection overlying the left cerebral\nhemisphere with more high density seen dependently compatible subdural\nhematoma.\n\nThe ventricles appear similar in configuration. There is no herniation or\nsignificant midline shift.\n\nHigh-density in the anterior inferior frontal lobes bilaterally is likely in\npart due to subarachnoid blood in the possibly subdural although underlying\ncontusions are suspected.\n\nA nondisplaced skull fracture extends from the right parietal vertex at the\nright of midline (602a:88), anteriorly and inferiorly into the superior aspect\nof the temporal bone and sphenoid bone (602 a: 37). A large overlying\nsubgaleal hematoma has increased compared with the prior study. Inspissated\nsecretions in the oropharynx is likely related to intubation.", + "output": "1. Interval increase in size of diffuse right-sided subarachnoid hemorrhage\nand more conspicuous left subarachnoid hemorrhage.\n2. Bilateral anterior inferior frontal lobe hemorrhage likely in part\nsubarachnoid and subdural although underlying contusions are also suspected.\n3. Interval increase of the right convex all subdural hematoma and now\nsubdural blood seen in the pre pontine region. Larger more by convex region\nunderlying a right parietal scalp fracture which could represent an epidural\ncomponent.\n4. Thin left-sided subdural hematoma.\n5. Interval increase size of large subgaleal hematoma overlying a nondisplaced\nright-sided calvarial fracture.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. \n___ in person on ___ at 7:45 ___, 5 minutes after the\ndiscovery of the findings. Adjusted wet read also discussed by Dr. ___\nwith Dr. ___ at 10pm on ___." + }, + { + "input": "The quadrigeminal plate cisterns have obliterated bilaterally, since the\ninterval exam, suggesting central herniation.\n\nRight parietal/temporal convexity subdural hematoma measures 10 mm in maximal\ncoronal dimension (602:72), slightly increased from prior.\n\nSubdural hematoma additionally involves the right tentorial leaflet.\n\nDiffuse subarachnoid hemorrhage is predominately located in the right sylvian\nfissure and bilateral cerebral convexities.\n\nRight scalp hematoma and soft tissue swelling is again seen. A minimally\ndisplaced fracture in spanning the right frontal, parietal, and temporal bone\nis again seen. Question thinning versus partially depressed right parietal\nbone along course of right skull fracture (see 4:65, 602 80:71, 6038:62). The\nmastoid air cells and paranasal sinuses are aerated.", + "output": "1. Interval increase in mass effect obliterating bilateral quadrigeminal plate\ncisterns, suggesting central herniation.\n2. Minimally increased right subdural and diffuse subarachnoid hemorrhage.\n3. Minimally displaced right frontotemporal parietal fracture with overlying\nsoft tissue swelling and subgaleal hematoma.\n4. Question thinning versus partially depressed right parietal bone along\ncourse of right skull fracture. Recommend clinical correlation and attention\non followup imaging.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the\ntelephone on ___ at 9:07 AM, 5 minutes after discovery of the findings." + }, + { + "input": "The quadrigeminal plate and suprasellar cisterns are again effaced bilaterally\nwithout significant change from prior examination which remain concerning for\ncentral herniation.\n\nThe right parietal subdural hematoma tracking along the falx and right\ntentorial leaflet is unchanged.\n\nDiffuse subarachnoid hemorrhage lines the right sylvian fissure and bilateral\nparietal sulci.\n\nThe right scalp hematoma with soft tissue swelling and minimally displaced\nunderlying calvarium fracture appear unchanged.\n\nThere is grossly stable bifrontal parenchymal hemorrhages. Stable bifrontal\nhemorrhagic contusions are again seen. The ventricles and sulci are stable in\nsize and configuration.", + "output": "1. Stable mass-effect effacing the bilateral quadrigeminal plate cisterns,\nagain suggesting central herniation.\n2. Grossly stable right hemispheric subdural hematoma, intraparenchymal\nhemorrhages, and diffuse subarachnoid hemorrhage as described.\n3. Stable minimally displaced right temporoparietal fracture with overlying\nsoft tissue swelling and subgaleal hematoma.\n\nRECOMMENDATION(S): Recommend clinical correlation and attention on followup\nimaging." + }, + { + "input": "There is no significant change in extensive bilateral subarachnoid hemorrhage,\nand bilateral frontal intraparenchymal contusions. Subdural hemorrhage along\nthe bilateral parietal convexities and tracking along the falx and tentorium\nremain stable. Subdural component over the cerebellum bilaterally is stable. \nThere is no shift of midline structures. Size and configuration of the\nlateral ventricles is stable. The basal cisterns appear more normal in size,\nless effaced\n\nRight scalp hematoma with minimally displaced calvarial fracture is re-\ndemonstrated. Aside from minimal mucosal thickening the partially visualized\nparanasal sinuses, mastoid air cells and middle ear cavities are clear.", + "output": "1. No appreciable change in bilateral intracranial multi-compartment\nhemorrhages as detailed above.\n2. Effacement of the basal cisterns appears improved\n3. Unchanged right calvarial fracture with overlying scalp hematoma." + }, + { + "input": "There has been mild redistribution of diffuse subarachnoid hemorrhage seen\nmainly along the right frontal, bilateral parietal and bilateral occipital\nlobes overall volume of subarachnoid hemorrhage appears similar to the prior\nexam. There has been expected interval evolution in appearance of bilateral\nfrontal the hemorrhagic contusions. Small bilateral parietal subdural\nhematoma is which tracks along the falx and tentorium is unchanged. \nVentricles appear smaller than on prior examination with interval prominence\nof the bilateral frontal subarachnoid spaces. Small amount of blood product\nlayering within the occipital horns of the lateral ventricles. There is no\nshift of normally midline structures.\nRe- demonstration of right frontoparietal scalp hematoma with underlying\nminimally displaced fracture. . Mild mucosal wall thickening of the left\nsphenoid air cell with some fluid layering bilateral sphenoid sinuses and some\nthickening in the posterior ethmoid air cells. Partial opacification of\nbilateral mastoid air cells. Middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Mild redistribution and expected evolution appearance of multi\ncompartmental bilateral intracranial hemorrhage, as above.\n2. Right frontoparietal scalp hematoma with underlying minimally displaced\nfracture, unchanged." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and\nconfiguration. The basal cisterns are patent. There is left supraorbital\nsoft tissue swelling. There is mild mucosal thickening within the ethmoidal\nair cells. Otherwise the paranasal sinuses are well aerated. The mastoid air\ncells and middle ear cavities are clear. The bony calvarium is intact.", + "output": "No acute intracranial process. Left supraorbital soft tissue swelling without\nunderlying fracture." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Mucous retention cysts are seen in the\nmaxillary sinuses bilaterally, left greater than right. The remainder the\nvisualized sinuses are unremarkable. The mastoid air cells and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable. \nMild soft tissue stranding is seen over the left supra orbital region, however\nno underlying fractures are seen.", + "output": "Soft tissue stranding over the left supraorbital region. No underlying\nfractures identified. No acute intracranial abnormalities identified." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nlarge territorial infarction. The ventricles and sulci are normal in size and\nconfiguration. Cerebellar tonsillar ectopia previously seen on MRI from ___ appears unchanged.\nThe basal cisterns appear patent and there is preservation of gray-white\nmatter differentiation.\nThe visualized bony structures are grossly unremarkable. The paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.\nThe globes are unremarkable.", + "output": "No evidence of acute intracranial process. Cerebellar tonsillar ectopia\npreviously seen on MRI from ___ appears unchanged." + }, + { + "input": "No evidence for an exophytic mucosal mass. No cervical lymphadenopathy. \nUnremarkable appearance of the salivary glands and of the thyroid gland.\n\nMultiple expansile lytic lesions are again seen in the cervical spine with\nmultiloculated cystic components. The largest lesion is centered in the left\naspect of the C6 and C7 vertebral bodies and corresponding left posterior\nelements. The lesion extends into the left anterior paravertebral space,\nexpanding the muscles, displacing the left vertebral artery anteriorly and\nmedially, and severely narrowing the left internal jugular vein. The left\ninternal jugular vein is patent above and below the level of the lesion. \nEpidural and neural foraminal extension of this lesion is better assessed on\nthe preceding MRI.\n\nAlso again seen are the expansile lytic lesion in the left lateral mass of C1\neroding into the left transverse foramina and abutting the left vertebral\nartery, expansile lytic lesion involving the base of C3 process and bilateral\nlaminae, lytic lesion occupying most of the C4 vertebral body with erosion\ninto the epidural space as seen on the prior MRI, expansile lytic lesion\ncentered in the right lamina of C5, lytic lesion in the right C7 vertebral\nbody eroding the posterior endplate. The full extent of disease is better\nassessed on the preceding MRI.\n\nThere are expansile lytic lesions in the right first and second ribs; the ribs\nare more fully assessed on the concurrent CT chest. The lungs and mediastinum\nare also better assessed on the concurrent CT chest.\n\nC5 vertebral body is sclerotic without loss of height, with chronic appearance\non the preceding MRI.\n\nVisualized brain parenchyma is better assessed on the MRI from 1 day prior. \nAgain seen a chronic infarct in the right posterior inferior cerebellar\nhemisphere.", + "output": "1. Numerous expansile lytic lesions in the cervical spine and visualized right\nupper ribs, consistent with malignancy, are again demonstrated.\n2. The large lytic lesion centered in the left C6 and C7 vertebral bodies and\ncorresponding left posterior elements extends into the left anterior\nparavertebral space, expanding the muscles, displacing the left vertebral\nartery anteriorly and medially, and severely narrowing the left internal\njugular vein.\n3. The lytic lesion in the left lateral mass of C1 extends into the transverse\nforamina and abuts the left vertebral artery.\n4. No cervical lymphadenopathy. No evidence for a primary soft tissue\nmalignancy in the neck." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Punctate\nhypodensity in the right basal ganglia (series 2, image 12) was likely present\non the previous head CT from ___ (series 2, image 12). But given\nthe difference in slice cuts, not as clearly visualized as on today's exam.\n\nThe ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.\n\nAtherosclerotic plaques are noted along both V4 segments and along both\ncarotid siphons.", + "output": "1. No acute intracranial abnormality.\n2. No mass effect or hydrocephalus." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,or\nmass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "The study is limited by patient motion, despite repeated attempts. There is\nno evidence of gross hemorrhage or infarct. Ventricles and sulci are\nunchanged from ___. No evidence of new mass.\n\nNo fracture or scalp hematoma. Aside from minimal mucosal thickening of the\nleft maxillary sinus, imaged paranasal sinuses are clear.", + "output": "Limited, nondiagnostic study secondary to patient motion despite repeated\nattempts. No visualize gross pathology." + }, + { + "input": "This study is limited in part by motion artifact. There is no evidence of\ninfarction or intracranial hemorrhage. The ventricles and sulci are prominent,\nconsistent with age related volume loss. Mild periventricular white matter\nhypodensities are nonspecific but likely sequela of chronic small vessel\nischemic disease. The basal cisterns are patent.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "This study is limited in part by motion artifact. However, no acute\nintracranial process seen." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass effect. \nThe ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is minimal right maxillary sinus\nmucosal thickening. The visualized portion of the remaining paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality on noncontrast head CT." + }, + { + "input": "Aero digestive tract:\n\nThere is left base of tongue mass, measuring 3.5 cm x 2.7 cm by 2.2 cm.. \nTumor thickness is 3.5 cm. Probable associated ulcer. Tumor extends pretty\ndeep, with involvement of posterior margin left genioglossus, left hyoglossus.\nTumor extends to midline, and possibly slightly across midline at the level of\nposterior genioglossus series 3, image 41, 42. Mucosal thickening and\nsubmucosal fullness extends into the upper left locule a.. No definite pre\nepiglottic space involvement. Thickening of the left glossal tonsillar\nsulcus, probable involvement of the posterior, left lateral wall oropharynx. \nSublingual space involvement with encasement, narrowing of the lingual artery.\nNo definite submandibular spacer gland involvement.\n\nThere is no parapharyngeal, nasopharyngeal, retropharyngeal, pterygoid or\npre-epiglottic involvement. Tumor abuts superior margin left hyoid bone,\nabuts digastric muscle, no definite erosion or invasion.\n\nNeck lymph nodes:\n\nThere is no adenopathy involving bilateral levels ___.\nThere is no retropharyngeal adenopathy.\n\n\nExtra nodal tumor spread:\n\nThere are no findings suggestive of extra nodal extension.\n\n\nDeep neck muscles, masticator space:\n\nThere is no muscle invasion.\n\nBones, skull base:\n\nThere is no bone involvement.\nThere are no findings suggestive of perineural tumor extension. Jugular\nforamen, carotid canal, pterygopalatine fossa, infraorbital foramen, other\nskull base foramina are not involved.\n\n\nVessels:\n\nThere is no vascular invasion.\n\n\nBrachial Plexus:\n\nThere is no brachial plexus contact or invasion.\n\n\nThyroid, salivary glands:\n\nThere is no mass.\n\n\nOther findings:\n\nThere are no lung nodules. Mild mucosal thickening paranasal sinuses.", + "output": "1. 3.5 cm left base of tongue mass, sublingual space, extrinsic tongue\nmuscle, vallecular involvement. Tumor probably crosses midline.\n2. No adenopathy." + }, + { + "input": "Aero digestive tract: Postradiation changes. 1.9 cm x 1.0 cm x 0.7 cm area of\nmild fullness at the left base of tongue, with linear peripheral enhancement,\nat the site of previously treated cancer. Findings may represent\nposttreatment change versus residual tumor. Most of the abnormalities deep,\nwith some extension superficially. This is best seen sagittal image 42,\ncoronal image 38, axial image 39-42. Consider PET scan now; or short-term\nfollow-up CT in 3 months.\n\nNeck lymph nodes: There is no adenopathy involving bilateral levels ___. \nThere is no retropharyngeal adenopathy.\n\nExtra nodal tumor spread: There are no findings suggestive of extra nodal\nextension.\n\nDeep neck muscles, masticator space: There is no muscle invasion.\n\nBones, skull base:\nThere is no bone involvement.\nThere are no findings suggestive of perineural tumor extension. Jugular\nforamen, carotid canal, pterygopalatine fossa, infraorbital foramen, other\nskull base foramina are not involved.\n\nVessels: There is no vascular invasion.\n\nBrachial Plexus: There is no brachial plexus contact or invasion.\n\nThyroid, salivary glands: There is no mass.\n\nOther findings: There are no lung nodules.", + "output": "1. Left base of tongue discrete, deep mildly enhancing abnormality at the\nsite of previously treated cancer - NIRADS 2B category. Recommend PET scan\nnow, or follow-up CT scan in 3 months.\n2. No adenopathy." + }, + { + "input": "At the left base of the tongue, there is an ill-defined 1.7 x 1.3 cm low\nattenuating area with locules of gas, likely representing posttreatment\nchanges. No organized or walled-off collection is identified.\n\nThere is skin thickening, subcutaneous edema and fascial thickening of the\nupper neck as well as thickening and edema of the upper aerodigestive tract ,\nconsistent with postradiation changes.\n\nThe submandibular glands are overall decreased in size with heterogeneous\nenhancement, which most likely represents post treatment changes. The parotid\nglands are normal in appearance.\n\nThe thyroid gland appears normal. There is no lymphadenopathy by CT criteria.\nThe neck vessels are patent. Mild mucosal thickening of the right maxillary\nsinus.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.", + "output": "Posttreatment changes at the left tongue base, as above. Superimposed\ninfection cannot be excluded by imaging, however there is no organized or\nwalled-off collection." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nlarge territorial infarction. Intra-ventricular air is seen in the left\nfrontal ventricular horn, expected after removal of Ommaya reservoir. There is\nno evidence of hydrocephalus. The basal cisterns appear patent and there is\npreservation of gray-white matter differentiation.\n\nPatient is status post right frontal bone burr hole. The paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The globes are\nunremarkable.", + "output": "Expected postsurgical changes as noted above. No evidence of acute\nintracranial bleed." + }, + { + "input": "There is no evidence of acute large territorial infarction, intracranial\nhemorrhage, edema, or mass within limitations of this noncontrast study. \nThere is a region of relative low-density in the right frontal periventricular\nregion which may represent encephalomalacia from prior ventriculostomy tract.\n\nThe ventricles and sulci are normal in size and configuration.\n\nNo acute osseous abnormalities seen. There is a right frontal burr hole\ncalvarial defect. The partially imaged paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The orbits demonstrate no acute\nabnormalities.", + "output": "No acute intracranial process. No evidence intracranial mass within\nlimitations of this noncontrast study. Please note, MRI is more sensitive for\nevaluation of intracranial masses." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass.\nThere is a small focus of hypodensity in the right anterior frontal lobe\n(series 5, image 28) which corresponds to a T2/FLAIR hyperintense patchy\nlesion on the prior MRI from ___, likely reflecting chronic small\nvessel ischemic changes.\n\nThe ventricles and sulci are normal in size and configuration.\n\nThere is mild mucosal thickening in the maxillary sinuses. The remainder of\nthe paranasal sinuses and mastoid air cells appears clear. The orbits appear\nunremarkable.\n\nCTA HEAD:\nThere are very mild atherosclerotic changes along both cavernous ICAs without\nhigh-grade stenosis. The anterior circulation is otherwise unremarkable. The\nbilateral V4 segments, vertebrobasilar junction and posterior circulation are\nunremarkable.\nThe dural venous sinuses are patent.\n\nCTA NECK:\nNormal 3 vessel aortic arch. There are mild atherosclerotic changes at the\nleft carotid bifurcation with short segment severe narrowing at the origin of\nleft external carotid artery. There is approximately 15% stenosis of the\nproximal left ICA by NASCET criteria. The right carotid bifurcation and the\nremainder of the cervical ICAs is unremarkable.\n\nThere is an atherosclerotic plaque at the origin of the left vertebral artery\nresulting in mild-to-moderate stenosis. The origin of the right vertebral\nartery in the cervical course of both vertebral arteries is unremarkable. The\ncarotidandvertebral arteries and their major branches appear normal with no\nevidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nLimited evaluation of the visualized lungs due to motion artifact. No\ndefinitive suspicious pulmonary nodules identified. The visualized portion of\nthe thyroid gland is within normal limits. There is no lymphadenopathy by CT\nsize criteria.", + "output": "1. No evidence of acute infarction, hemorrhage or intracranial mass.\n2. Approximately 15% stenosis of the proximal left ICA by NASCET criteria.\nThere is severe narrowing at the origin of the left external carotid artery. \nmild-to-moderate stenosis at the origin of the left vertebral artery.\n3. Otherwise patent cervical and intracranial vasculature. No evidence of\nvessel dissection, occlusion or aneurysm formation." + }, + { + "input": "Head CT: There is no evidence of hemorrhage midline shift or hydrocephalus. \nThere is loss of gray-white matter differentiation in the left posterior\nfrontal and anterior parietal lobe regions indicative of an acute infarct. \nThere is brain atrophy and small vessel disease.\n\nCTA neck:. Vascular calcifications are seen at the carotid bifurcations and\ngreat vessels at the thoracic inlet. No vascular occlusion or high-grade\nstenosis is identified involving the carotid or vertebral arteries.\n\nCTA head: There are filling defects in the posterior sylvian branches of the\nleft middle cerebral artery indicated intrinsic emboli. There is an\napproximately 2 mm broad-based aneurysm seen at the left middle cerebral\nartery bifurcation. Otherwise, no vascular abnormalities are seen.", + "output": "CT head shows signs of an acute left posterior frontal infarct. Spleen\ndefects are identified in the posterior sylvian branches of the left middle\ncerebral artery indicative of emboli. 2 mm broad-based aneurysm at the left\nmiddle cerebral artery bifurcation.\n\n This report is provided without 3D and curved reformats. When these images\nare available, and if additional information is obtained, then an addendum may\nbe given to this report." + }, + { + "input": "There is a large region of encephalomalacia in the left temporoparietal\nregion, sequela of prior infarct. Ex vacuo dilatation of the ventricles is\nsecondary to volume loss. Mild periventricular white matter hypodensities are\nnoted, likely a sequela of chronic small vessel ischemia. The basal cisterns\nare patent and there is no evidence of hemorrhage or acute infarction.\nNo osseous abnormalities. Imaged paranasal sinuses are clear.", + "output": "Encephalomalacia in the left temporoparietal region, evolution of prior left\nMCA territory infarct, however no evidence of new infarct or intracranial\nhemorrhage." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, mass effect or acute\nlarge territorial infarction. Re demonstrated is a large region of\nencephalomalacia within the left temporoparietal region, sequela of a prior\nleft MCA territory infarct. There is ex vacuo dilatation secondary to volume\nloss. Periventricular and deep subcortical white matter hypodensities are\nlikely secondary to small vessel ischemic disease. The basilar cisterns are\npatent.\n\nNo acute fractures identified. Mild mucosal thickening is seen involving the\nmaxillary sinuses, and ethmoid air cells. The frontal sinuses are clear. The\nmastoid air cells, and middle ear cavities are clear. The globes are\nunremarkable.", + "output": "1. No acute intracranial abnormalities identified. Stable encephalomalacia in\nthe left temporoparietal region, secondary to a prior left MCA territory\ninfarction." + }, + { + "input": "Encephalomalacia from prior left middle cerebral artery territory infarction\ninvolving the left parietal and temporal lobes with minimal ex vacuo\ndilatation of the temporal horn of the left lateral ventricle is unchanged the\nprior study. There is no evidence of acute vascular territory infarction,\nhemorrhage, edema, or mass. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. Periventricular and subcortical white\nmatter hypodensities are nonspecific, but likely the sequela of chronic\nmicrovascular infarction. Atherosclerotic calcifications are demonstrated\nwithin the cavernous carotid arteries.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Study is moderately limited by patient motion.\n2. No acute intracranial process.\n3. Unchanged encephalomalacia of the left temporoparietal lobes related to\nprior infarction." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. Mild periventricular white\nmatter hypodensities are likely the sequela of chronic small vessel ischemic\ndisease.\n\nNo osseous abnormalities seen. There is mild amount of mucosal thickening in\nthe ethmoidal air cells on the right and the sphenoid sinus. The remaining\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\norbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute large territory\ninfarction,hemorrhage,edema,ormass. The ventricles and sulci are normal in\nsize and configuration. There is no midline shift. Periventricular and\nsubcortical white matter hypodensities are nonspecific but likely sequelae of\nchronic small vessel ischemic disease.\n\nThere is mild thickening of bilateral maxillary sinuses with aura left worse\nthan the right. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD and NECK:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, or occlusion. There is a 2 mm infundibulum\nprojecting off the supraclinoid right ICA (4:265), no aneurysms larger than 3\nmm in size are seen. The dural venous sinuses are patent. The\ncarotidandvertebral arteries and their major branches appear normal with no\nevidence of stenosis or occlusion. There is a dominant left vertebral artery\nsystem. Mild calcification of the left vertebral artery (4; 227). The\nascending aorta is distended and measures 5 cm (4; 1). A 2 mm infundibulum is\nseen projecting off the supraclinoid right ICA (4; 265). There is no evidence\nof internal carotid stenosis by NASCET criteria.\n\nHead CT CT perfusion:\nCBF < 30% volume: 0 mL.\nT-max > 6.0 seconds volume: 0 mL\nMismatch volume: 0 mL.\nMismatch ratio: None.\n\nOTHER:\nA 4 mm calcified granuloma is seen in the right upper lobe (4; 7). Otherwise,\nthe visualized portion of the lungs are clear. Patient is status post\nthyroidectomy. There is no lymphadenopathy by CT size criteria. Mild\nmultilevel degenerative changes noted in the cervical spine.", + "output": "1. There is no evidence of acute intracranial process or hemorrhage..\n2. There is a 2 mm infundibulum projecting off the supraclinoid right ICA.\n3. The ascending aorta is partially evaluated however is distended and\nmeasures 5 cm.\n4. No perfusion abnormalities were detected on the ischemia view rapid\nperfusion analysis." + }, + { + "input": "There is no acute hemorrhage, edema, mass effect or acute large vascular\nterritorial infarction. The ventricles and sulci are normal in size and\nconfiguration. The basal cisterns appear patent and there is preservation of\ngray-white matter differentiation.\n\nNo fracture is identified. The mastoid air cells and middle ear cavities are\nclear. There is fluid layering within the sphenoid sinuses. The globes are\nunremarkable.", + "output": "1. No acute intracranial process.\n\n2. Fluid layering in the sphenoid sinuses." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nExtensive vasogenic edema within the right frontal lobe, is consistent with\npatient's known rim enhancing mass, with mass effect on the frontal horn of\nthe right lateral ventricle. Hypodensity within the left frontal lobe, is\nlikely secondary to prior posttreatment changes/ chronic infarct. Additional\nperiventricular and deep subcortical white matter hypodensities are likely\nsequelae of chronic small vessel ischemic disease. There is no evidence acute\nintracranial hemorrhage.\nPostsurgical frontal bone calvarial defects are seen. There is no evidence of\nacute fracture. The visualized paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The globes are unremarkable.\n\nCTA HEAD: The vertebral arteries are normal. The posterior circulation is\nwell preserved. The left internal carotid and middle cerebral arteries are\nunremarkable. Note is made of a diminutive A1 segment of the left anterior\ncerebral artery, with a fenestrated right A1 segment and anterior\ncommunicating artery. The right internal carotid artery is normal. The right\nMCA appears to be unremarkable. The A1 segment of the right anterior cerebral\nartery and distal right anterior cerebral artery are unremarkable.", + "output": "1. Extensive vasogenic edema consistent with patient's known rim enhancing\nmass within the right frontal lobe. No acute intracranial hemorrhage.\n\n2. Unremarkable CTA of the head without evidence of stenosis or aneurysm. \nNote is made of a diminutive left A1 segment as well as a small fenestration\nof the right A1 segment/A-comm. No evidence of large arterial feeders to the\nlesion." + }, + { + "input": "Stereotactic halo device is seen in place. The left anterior screw of the\nstereotactic device extends through inner table of the right pterion. A again\nseen is a rim enhancing lesion in the right frontal lobe measuring\napproximately 2.3 cm in maximal axial diameter with surrounding vasogenic\nedema in the right frontal lobe causing mild sulcal effacement without midline\nshift. The basal cisterns appear patent. There is no evidence of hemorrhage.\nAn area of encephalomalacia in the left frontal lobe may represent chronic\ninfarct.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Unchanged appearance of rim enhancing right frontal mass with associated\nedema. No hemorrhage or evidence of significant mass effect.\n2. Stereotactic device is in place." + }, + { + "input": "The patient is status post stereotactic brain biopsy. Approximately 3.2 x 2.4\ncm right frontal mass with surrounding edema now demonstrates a thicker rim. \nThere is an approximately 3 mm focus of hyperdensity in the rim of the mass. \nMild right frontal sulcal effacement is similar to earlier today. There is no\nevidence of acute territorial infarction. Encephalomalacia in the left\nfrontal lobe, corpus callosum is similar to prior. Areas of calcifications\nare seen in the inferior left basal ganglia, anteromedial left temporal lobe. \nThe ventricles and sulci are similar to earlier today in size and\nconfiguration.\n\nThere is no evidence of fracture. Postoperative changes from prior frontal\ncraniotomy are seen with few burr holes. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\norbits are unremarkable.", + "output": "1. The right frontal mass now demonstrates a thicker rim, likely due to\nprevious injection of contrast. Approximately 3 mm focus of hyperdensity in\nthe rim of the mass, likely represents hemorrhage due to biopsy." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territory infarct. Gray-white matter\ndifferentiation is preserved. There is no hydrocephalus. There is a possible\n7 mm calcified meningioma versus osteoma in the right frontal region on series\n3, image 46. No adjacent edema is seen. The visualized paranasal sinuses\ndemonstrate mucosal thickening of the partially right ethmoid air cells and\nthe maxillary sinuses. The right frontal sinus is completely opacified. There\nis minimal mucosal thickening of the left sphenoid sinus. The mastoid air\ncells are clear. No acute fracture is seen.. The mastoid air cells are clear.\nNo acute fracture is seen.", + "output": "No acute intracranial process. Please note that MRI is more sensitive in\ndetecting acute ischemia.\n\nSinus disease, as above, including complete opacification of the right\nfrontal sinus.\n\nPossible 7 mm calcified meningioma versus osteoma in the right frontal region.\nNo adjacent edema." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.\n\nThere appears to be an os odontoideum or old odontoid fracture. There is\nposterior subluxation of the anterior arch of C1 with respect to the body of\nC2 is seen on the lateral scout view. The remainder of the odontoid and its\nrelationship to the C2 vertebral body are not included on this study. \nMechanical stability at this level cannot be assessed. Recommend a CT of the\ncervical spine for further evaluation.", + "output": "1. No acute intracranial abnormality.\n\nRECOMMENDATION(S): CT cervical spine for further evaluation of the possible\nodontoideum versus chronic odontoid fracture.\n\nNOTIFICATION: The finding of possible odontoid TM versus old odontoid\nfracture and recommendation fully cervical spine CT was discussed by telephone\nby Dr. ___ Dr. ___ at 11:40 ___" + }, + { + "input": "There is no evidence of acute major infarction,hemorrhage,edema,or discrete\nmass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mild mucosal thickening in the\nethmoid sinuses. Otherwise, the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable. Calcification of the falx cerebri is noted.", + "output": "No acute intracranial process. No evidence of fracture." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, mass effect, midline\nshift.\nThe ventricles and sulci are normal in size and configuration.\nNo bony abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. Small right posterior scalp hematoma. The\ncavernous portion of the internal carotid arteries are calcified.\nSlightly prominent posterior outlines of globes-? Myopia/staphyloma; small\nfoci optic nerve heads can relate to drusen.", + "output": "No acute intracranial hemorrhage or mass effect.\nNo acute fracture. Small right posterior scalp hematoma." + }, + { + "input": "Study is slightly limited by motion. Allowing for this, there is no evidence\nof acute large territorial infarction, hemorrhage, edema, mass effect, midline\nshift, or mass. The ventricles and sulci are normal in size and configuration.\nNo bony abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.\nAtherosclerotic calcifications of the cavernous carotid arteries and distal\nright vertebral artery are re- demonstrated.", + "output": "Slightly suboptimal study due to patient motion. No acute intracranial\nprocess." + }, + { + "input": "There is no hemorrhage, edema, or mass effect. Ventricles and sulci are age\nappropriate in size and configuration. There is no shift of normally midline\nstructures. Basal cisterns are patent. Gray-white matter differentiation is\npreserved.\n\nThe orbits are unremarkable. The bony calvarium appears intact. Imaged\nparanasal sinuses, bilateral mastoid air cells, and middle ear cavities are\nclear.", + "output": "Normal study." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no exophytic mass, and no\nareas of focal mass effect.\n\nThe parotid, sublingual, and submandibular salivary glands enhance normally\nand are without mass or adjacent fat stranding. There is no cervical or\nsupraclavicular lymphadenopathy by CT size criteria. The neck vessels are\npatent.\n\nThe visualized parts of the brain are unremarkable. The visualized paranasal\nsinuses are clear.\n\nThere has been prior bilateral cataract surgery. The visualized orbits are\notherwise unremarkable.\n\nIncidentally seen is multilevel degenerative disease involving the cervical\nspine with moderate to severe neural foramen narrowing and mild-to-moderate\nspinal canal narrowing at C4-C5 and C5-C6.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are surgical clips in the left axilla, likely\nrelated to prior lymph node dissection.", + "output": "1. No focal neck mass is seen or evidence of abnormal enhancement." + }, + { + "input": "There is no evidence of acute infarct,hemorrhage, edema, or mass effect.\nProminent ventricles and sulci are suggestive of age-related involutional\nchange.\nThere is no evidence of fracture. There is minimal aerosolized secretions in\nthe right sphenoid sinus. The other visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. Focal elongation of the posterior\nright globe is new compared to ___, possibly representing a\nstaphyloma.", + "output": "No acute intracranial abnormality. Minimal aerosolized secretions in the\nright sphenoid sinus." + }, + { + "input": "There is no evidence of acute major vascular territorial\ninfarction,hemorrhage,edema,or intracranial mass. The ventricles and sulci\nare normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "There is no evidence of acute intracranial process or hemorrhage." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration. Note is made of\nlipoma of the corpus callosum and bilateral basal ganglia calcifications. The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The left\nposterior cerebral artery demonstrates fetal origin with patency of the left\nposterior communicating artery, there is hypoplasia of the P1 segment on the\nleft, which is an anatomical vascular variation. The dural venous sinuses are\npatent.\n\nCTA NECK:\nThe origin of the supraaortic vessels is normal, dense vascular\narteriosclerotic calcifications are visualized at the cervical carotid\nbifurcations, on the right there is no evidence of critical stenosis, however\na combination of soft plaque and calcified plaque material is identified (for\nexample image 154, series 3). On the left cervical carotid bifurcations dense\narteriosclerotic calcification is present, causing mild narrowing at the\norigin of the left internal carotid artery, if clinically warranted,\ncorrelation with carotid ultrasound is recommended.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Lipoma of the corpus callosum as described above.\n\n2. Essentially normal CTA of the head with no evidence of flow stenotic\nlesions or aneurysms.\n\n3. Arteriosclerotic calcifications are visualized in the cervical carotid\nbifurcations bilaterally, with no evidence of critical stenosis, however if\nclinically warranted, correlation with carotid ultrasound is recommended for\nfurther characterization.\n\nRECOMMENDATION(S): Bilateral arteriosclerotic disease at the cervical carotid\nbifurcations, with no evidence of critical or significant stenosis, if\nclinically warranted, correlation with carotid ultrasound is recommended." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are stable in size and configuration with no mass effect\nor midline shift. A lipoma of the corpus callosum is unchanged compared to\nprior exam. Redemonstration of bilateral basal ganglia calcifications.\n\nThe visualized paranasal sinuses and mastoid air cells are clear.\n\nCT PERFUSION:\nEvaluation of the perfusion images demonstrates no definite mismatch. The\ncerebral blood flow appears grossly symmetric.\n\nCTA HEAD:\nThere are nonocclusive calcifications of the parasellar internal carotid\narteries and the left mid V4 segment. Otherwise the vessels of the circle of\n___ and their principal intracranial branches appear preserved without\nstenosis, occlusion, or aneurysm formation. There is fetal origin of the left\nposterior cerebral artery. The dural venous sinuses are patent.\n\nCTA NECK:\nThere mild-to-moderate calcified and noncalcified atherosclerotic plaques of\nthe aortic arch. There are nonocclusive atherosclerotic calcifications at the\norigin of bilateral subclavian and the left vertebral artery. The carotid and\nvertebral arteries and their major branches appear preserved with no evidence\nof stenosis or occlusion. There are nonocclusive calcifications at the common\ncarotid bifurcations. There is no evidence of internal carotid stenosis by\nNASCET criteria.\n\nOTHER:\nIrregular opacities within the dependent portions of the upper lung zones\nlikely represent atelectasis. The visualized portion of the thyroid gland is\npreserved. Scattered subcentimeter nonspecific lymph nodes are noted\nthroughout the neck bilaterally, without definite enlargement by CT size\ncriteria. Grossly stable multilevel cervical spondylosis is again noted (see\n602:35 on current study and 603:29 on prior CTA).", + "output": "1. No evidence of acute intracranial hemorrhage, territorial infarction, or\nmass lesion. Please note MRI of the brain is more sensitive for the detection\nof acute infarct.\n2. Unchanged lipoma of the corpus callosum.\n3. Atherosclerotic nonocclusive calcifications of circle ___ as described. \nOtherwise, patent circle of ___ without definite evidence of stenosis,\nocclusion, or aneurysm.\n4. Cervical carotid and vertebral artery nonocclusive calcifications as\ndescribed. Otherwise, patent cervical vertebral arteries without focal\nstenosis, occlusion, or dissection.\n5. No definite evidence of cerebral perfusion defect." + }, + { + "input": "Study is limited secondary to patient positioning. There is no evidence of\ninfarction, hemorrhage, edema, or mass. The ventricles and sulci are normal\nin size and configuration.\n\nThere is no evidence of fracture. There is fluid in the bilateral mastoid air\ncells. Minimal right maxillary sinus mucosal thickening is noted. There is\ndebris versus surgical material within the right external auditory canal. \nMinimal soft tissue density within the left external auditory canal may\nrepresent cerumen. The visualized portion of the orbits are preserved.", + "output": "1. Study is limited secondary to patient positioning.\n2. Within limits of study, no definite evidence of acute intracranial\nhemorrhage or large territorial infarct.\n3. Within limits of study, no definite evidence of fracture.\n4. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct.\n5. Nonspecific right external auditory canal debris versus surgical material.\n6. Nonspecific bilateral mastoid fluid." + }, + { + "input": "There is a large late acute to early subacute infarctions in the right MCA\nterritory, with overlying mild to moderate subarachnoid hemorrhage with\nextension into the right lateral and third ventricles. There is mass effect\nwith effacement of the right lateral, third, and fourth ventricle, approximate\n1.2 cm leftward shift of midline structures, right uncal herniation,\neffacement of basal cisterns, and likely cerebellar tonsillar herniation. \nThere is entrapment of the left lateral ventricle with enlargement of the\ntemporal and occipital horns of the lateral ventricle, and diffuse edema in\nthe left cerebral hemisphere.\n\nNo concerning osseous abnormalities seen. Fluid in the paranasal sinuses and\nmastoid air cells is likely secondary to endotracheal intubation.", + "output": "1. Large late acute to early subacute MCA infarct. Mild-to-moderate adjacent\nsubarachnoid hemorrhage with intraventricular extension.\n2. Extensive mass effect with effacement of the right lateral, third and\nfourth ventricles, entrapment of the left lateral ventricle, leftward shift of\nsupratentorial midline structures, left hemispheric cerebral edema, right\nuncal herniation, effacement of basal cisterns, and likely cerebellar\ntonsillar herniation.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 10:04 am, 5\nminutes after discovery of the findings." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No significant intracranial abnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Examination is limited by dental amalgam streak artifact.\n\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThere are moderate-size mucous retention cysts in the left maxillary sinus. \nThe remainder of the visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the orbits\nare unremarkable.\n\nCTA HEAD:\nThere is ___ termination of the hypoplastic right vertebral artery. There is\nvariant fetal type origin of the bilateral posterior cerebral arteries. The\nvessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe right vertebral artery is hypoplastic though grossly patent. The carotid\nand vertebral arteries and their major branches appear patent with no evidence\nof significant stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. There is an 8 mm hypodense\nright lobe thyroid nodule. There is no lymphadenopathy by CT size criteria. \nNumerous dermal calcifications are noted throughout the face.", + "output": "1. Examination is limited by dental amalgam streak artifact.\n2. No acute intracranial abnormality including large acute territorial infarct\nor hemorrhage.\n3. Patent cervical vasculature without significant stenosis, occlusion or\ndissection.\n4. Patent intracranial vasculature without significant stenosis, occlusion or\naneurysm.\n5. Paranasal sinus disease as described.\n6. 8 mm right thyroid lobe nodule. The ___ College of Radiology\nguidelines suggest that in the absence of risk factors for thyroid cancer, no\nfurther evaluation is recommended." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, or acute major\nvascular territorial infarction. Prominence of the ventricles, sylvian\nfissures, sulci, and posterior fossa extra-axial spaces suggests global\nparenchymal volume loss. The callosal angle measures 88 degrees (normal\n100-120).\n\nThere is mild frontal subgaleal hematoma extending inferiorly over the right\nfrontal sinus and over the right nasal bone. There is no evidence of\nfracture. The globes are intact. No evidence for intraorbital hematoma. \nPartially visualized paranasal sinuses are essentially well aerated. Mastoid\nair cells and middle ear cavities are well aerated.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. Mild right frontal subgaleal hematoma extending inferiorly over the right\nfrontal sinus and right nasal bone, without evidence for a fracture.\nCOMMENTS ON ATTENDING REVIEW:\nProminent ventricles and sulci are likely secondary to global parenchymal\nvolume loss. Callosal angle is noted to be slightly low in the preliminary\nreport. If there is any clinical concern for communicating normal pressure\nhydrocephalus based on the patient's symptoms, then MRI could be pursued for\nmore accurate measurement of the callosal angle." + }, + { + "input": "Study is moderately motion degraded. There is early termination of the exam\nand the vertex is not imaged. Within these limitations:\n\nThere is a large left frontotemporal intraparenchymal hemorrhage with\nsurrounding vasogenic edema causing rightward midline shift of at least 7 mm\n(02:16, 20). The left lateral ventricle is nearly completely effaced. There\nis a left frontoparietal subdural hematoma (02:23) and subarachnoid hemorrhage\nin the right sulci/sylvian fissure which is likely extension from the left\nintraparenchymal hemorrhage (02:18). No evidence of hydrocephalus. No\nintraventricular extension seen within limitations of study. The visualized\nbasilar cisterns are patent without evidence of bleed. There is no evidence\nof acute infarction or mass visualized.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear within the\nlimitations of the study. The visualized portion of the orbits are\nunremarkable.", + "output": "Study is severely limited due to significant motion artifact and early\ntermination. The vertex is not imaged. However, within these limitations:\n\n1. Large left frontotemporal intraparenchymal hemorrhage with 7 mm rightward\nmidline shift, grossly unchanged.\n2. Right hemispheric subarachnoid hemorrhage and left frontoparietal subdural\nhemorrhage likely extension from left intraparenchymal hemorrhage, grossly\nunchanged." + }, + { + "input": "Again demonstrated, is a large left frontotemporal intraparenchymal hemorrhage\nwith surrounding vasogenic edema causing rightward midline shift of at least 9\nmm and mild subfalcine herniation, unchanged. There is left uncal herniation,\nunchanged (2:13, 400:40). The left lateral ventricle is nearly completely\neffaced. There is a left frontoparietal subdural hematoma and subarachnoid\nhemorrhage in the right hemispheric sulci/sylvian fissure which are likely\nextension from the left intraparenchymal hemorrhage. Left frontal parietal\nsubdural hematoma measuring up to 8 mm in greatest thickness and subdural\nhematoma layering along the falx are also unchanged. Hemorrhage in the left\nprepontine cistern and interdigitating within the left inferior cerebellar\nhemisphere folia are stable. No evidence of hydrocephalus. No\nintraventricular extension.\n\nThere is no evidence of acute large territorial infarction.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Re-demonstration of large left frontotemporal intraparenchymal hemorrhage\nwith rightward midline shift with left frontal subfalcine herniation and left\nuncal herniation, unchanged.\n2. Multi compartment hemorrhage, including left subdural hematoma and right\nsubarachnoid hemorrhage likely extension from left intraparenchymal hemorrhage\nare unchanged." + }, + { + "input": "The patient is status post left frontoparietal craniectomy for left\nfrontotemporal lobe parenchymal hematoma evacuation and decompression since\nexamination of 5 hours prior. A subdural drain is identified. There is now a\npostoperative extra-axial hemorrhage/blood product measuring approximately 2.3\ncm in greatest thickness along the left frontal parietal convexity as well as\nexpected pneumocephalus within the left anterior middle cranial fossa and\ntemporal lobe. Subdural hemorrhage along the falx is more conspicuous when\ncompared to prior examination.\n\nThere remains parenchymal hemorrhage product is along the left frontal lobe\nand temporal lobe with associated white matter edema pattern. Subarachnoid\nhemorrhage along the right frontal and parietal convexity has increased in\nconspicuity. Subarachnoid hemorrhage along the left pre pontine cistern and\ncerebellar hemisphere is re-identified.\n\nThere is 1.1 cm rightward midline shift with effacement of the left lateral\nventricle, overall similar to prior examination. The right lateral ventricle\ntemporal horn may be slightly increased in prominence although this may be\nartifactual secondary to patient positioning. Left frontal subfalcine\nherniation and left uncal herniation is re-identified. Effacement of the left\nperimesencephalic cistern is re-identified.\n\nVisualized paranasal sinuses are essentially clear. The orbits are\nunremarkable. Mastoid air cells and middle ears are well pneumatized and\nclear.", + "output": "1. The patient is status post left frontoparietal craniectomy for left\nfrontoparietal lobe parenchymal and subdural hematoma evacuation and\ndecompression.\n2. There is mild interval worsening rightward midline shift now measuring\napproximately 1.1 cm previously measuring 8 and 9 mm. There remains\nsubfalcine and left uncal herniation.\n3. There is new postoperative extra-axial left convexity hematoma measuring up\nto 2.3 cm in greatest thickness. Increased prominence parafalcine subdural\nhematoma and diffuse right subarachnoid hemorrhages.\n4. Additional multi compartment hemorrhages and findings as described above." + }, + { + "input": "Patient is status post left frontoparietal craniectomy and left frontotemporal\nparenchymal hematoma evacuation and decompression. Again seen is a drain in\nthe left subdural space terminating adjacent to the left temporal lobe. Again\nseen is a left extra-axial hyperdense fluid collection compatible with\npostoperative hemorrhage measuring approximately 2.3 cm in greatest axial\nthickness overlying the left frontoparietal lobe, not significantly changed\nsince the prior study subdural hemorrhage in the region of the falx is appears\nsimilar to the prior study. Expected pneumocephalus is not significantly\nchanged compared to the prior study.\nIntraparenchymal hemorrhage predominantly in the left frontal lobe and left\ntemporal lobe with associated edema is not significantly changed compared to\nthe prior study. Subarachnoid hemorrhage along the right frontal and parietal\nlobes are also unchanged.. Hemorrhage in the region of the left prepontine\ncistern is also not significantly changed.\n1.5 cm rightward midline shift, previously 1.1 cm, with near complete\neffacement of the left lateral ventricle does not appear significantly changed\ncompared to the prior study. There is persistent left subfalcine herniation\nand uncal herniation.\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated.", + "output": "1. The status post left frontoparietal craniectomy for evacuation of a left\nfrontotemporal parenchymal and left subdural hematoma.\n2. The postoperative extra-axial left hematoma measuring up to 2.3 cm in\ngreatest axial thickness appears unchanged compared to the prior study.\n3. Overall rightward midline shift appears mildly increased with persistent\nnear complete effacement of the right left lateral ventricle.\n4. There is persistent subfalcine and uncal herniation on the left, similar in\nextent to the prior study.\n5. Intraparenchymal, subarachnoid, and subdural hemorrhage, not significantly\nchanged compared to the prior study." + }, + { + "input": "There is a 4.7 x 1.8 cm mixed density extra-axial collection in the left\nfrontal cranioplasty surgical resection bed containing centrally hyperdense\nmaterial surrounded by more relatively hypodense fluid likely reflecting a\ncontracting extra-axial hematoma present on CT from ___ (02:20,\n19, 18). On postcontrast study the dura adjacent to this collection is\nthickened with hyper enhancement (03:18) which may be due to postsurgical\nchanges and less likely secondary to superinfection. There is hypodensity in\nthe left frontal temporal gyri, reflecting chronic blood products and\nencephalomalacia (03:10). Interval development of a right hemispheric\nsubdural low-density fluid collection measuring 1.4 cm from the inner table of\nthe calvarium, likely representing a subdural hygroma and less likely chronic\nsubdural hematoma (02:20). Rightward midline shift has significantly improved\nin the interim now measuring approximately 6 mm, previously 15 mm. No\nevidence of subfalcine or uncal herniation. There remains mild-to-moderate\nmass effect on the left lateral ventricle. The basilar cisterns are patent.\n\nCalvarial defect from left frontal cranioplasty is visualized. Otherwise, no\nevidence of acute fracture. There is no abnormal intraparenchymal enhancement\non post contrast imaging.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Left frontal mixed density fluid collection likely represents retracting\nextra-axial hematoma from ___. Underlying enhancement of the dura\nsurrounding is likely postoperative, however a superimposed infection cannot\nbe definitively excluded, though considered less likely. No discrete abscess\nidentified.\n2. No evidence of new intracranial hemorrhage.\n3. Right subdural collection likely a subdural hygroma and less likely chronic\nsubdural hematoma." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nThere has been interval improvement of the right hemispheric subdural\nhypodense fluid collection, now measuring approximately 2 mm from the inner\ntable (previously 14 mm). The mixed density extra-axial collection in the\nleft frontal cranioplasty surgical bed demonstrates a conspicuous high\nattenuation rim with a relative more hypodense center compared to the prior\nstudy. Post-contrast enhancement of the dura adjacent to the collection is\noverall unchanged when compared to the prior study, without extension into the\nparenchyma.\n\nAgain noted is evolution of the left temporal hypodensity suggestive of\nencephalomalacia.\nThere has been interval decreased mass effect, now with more prominent lateral\nventricles and a left to right shift of normally midline structures of\napproximately 4 mm (previously 5.7 mm).\n\nIn the left cerebellar hemisphere there is a hyperdensity not seen on the\nprior study with surrounding hypodensity. There is no evidence of significant\nmass effect in the cerebellum.\n\nAgain noted is a calvarial defect from the left frontal cranioplasty with\nadjacent tissue edema. Otherwise, there is no evidence of fracture.\n\nThe visualized portion of the paranasal sinuses demonstrate mild opacification\nof the mastoid air cells bilaterally. The middle ear cavities are clear. \nLimited imaging of the orbits demonstrate dysconjugate gaze, not definitely\nseen on prior exam (see 02: ___.", + "output": "1. Dental amalgam streak artifact limits study.\n2. Postsurgical changes related to left frontal craniectomy.\n3. New left cerebellar hyperdensity suggestive of intraparenchymal hemorrhage\nwithout significant cerebellar mass effect.\n4. Evolution of the extra-axial left frontal fluid collection, probably\nrepresenting a retracting hematoma, however, infection cannot be excluded. \nRecommend attention on follow-up imaging. Please note MRI of the brain is\nmore sensitive for the evaluation of intracranial abscesses.\n5. Interval improvement of the right subdural collection and mass effect with\ndecreased left to right shift compared to prior study.\n\nRECOMMENDATION(S): Evolution of the extra-axial left frontal fluid\ncollection, probably representing a retracting hematoma, however, infection\ncannot be excluded. Recommend attention on follow-up imaging. Please note MRI\nof the brain is more sensitive for the evaluation of intracranial abscesses.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 6:54 pm, 40 minutes after\ndiscovery of the findings." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territorial infarct. There is prominence of\nthe ventricles and sulci suggestive of involutional changes. Nonspecific\nperiventricular and deep subcortical white matter hypodensities most likely\nrepresent moderate chronic small vessel ischemic disease.\n\nThere is no evidence of acute fracture. A partially calcified soft tissue\ndensity lesion the vertex likely represents a sebaceous cyst measuring up to\n1.5 x 1.6 x 1.1 cm (2:28, 601:45). Aside from mild mucosal thickening the\nanterior ethmoidal air cells, the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable. Aerosolized secretions are partially imaged\nin the upper nasopharynx.", + "output": "1. No evidence of acute intracranial process.\n2. Marked ventriculomegaly is suggestive of age advanced involutional changes.\nWorsening hydrocephalus is difficult to exclude without prior studies, however\nthere does not appear to be significant sulcal effacement.\n3. Nonspecific white matter hypodensities likely represent the sequelae of\nmoderate chronic small vessel ischemic disease." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes,\nthough degree of ventriculomegaly is slightly out of proportion to sulcal\nenlargement. Periventricular and subcortical white matter hypodensities are\nnonspecific, however likely due to chronic small vessel ischemic disease. \nMore focal areas of hypodensity in bilateral basal ganglia and corona radiata\nare stable from ___.\n\nThere is no evidence of acute fracture. Small amount of mucosal thickening of\nthe anterior ethmoid air cells and layering fluid within the sphenoid sinuses\nare new since ___. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Multiple EEG leads are noted on the\nskin.", + "output": "1. No acute intracranial abnormalities.\n2. Stable mild ventriculomegaly." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territory infarct. Gray-white matter\ndifferentiation is preserved. There is no hydrocephalus. The visualized\nparanasal sinuses are clear. The mastoid air cells are clear. No acute\nfracture is seen.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass effect. The ventricles and sulci are normal in size and configuration.\n\nNo acute fractures are seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are essentially clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Head CT: The known ill-defined right parietal mass with central necrosis is\nidentified and demonstrates significant surrounding vasogenic edema and mass\neffect on the underlying brain parenchyma, with 3 mm leftward shift of\nnormally midline structures (3:20 and 21). No acute hemorrhage or infarct is\nidentified. No osseous abnormality identified. There is no evidence of\nhemorrhage, edema, masses, mass effect, or infarction. The ventricles and\nsulci are normal in caliber and configuration. No fractures are identified.\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are normal.\nThe orbits are unremarkable.\n\nHead CTA: Multiple irregular, ill-defined vessels are identified within the\nmass, consistent with tumor vessels. Vessels in the anterior and superior\naspect of the mass appear to be venous in nature, draining into the right vein\nof ___. The bilateral PCAs are symmetric. No aneurysm greater than 3 mm,\nstenosis, or occlusion is identified.", + "output": "1. Multiple irregular, ill-defined tumor vessels displacing normal\nparenchymal vasculature, as described above. Many of these appear to be\nvenous in nature, draining into the right vein of ___.\n\n2. No aneurysm greater than 3 mm, stenosis, or occlusion is identified.\n\n3. Right parietal mass with central necrosis, surrounding vasogenic edema,\nand 3 mm leftward shift of normally midline structures, as described above." + }, + { + "input": "Since the prior exam, the patient has under gone a right parietal craniectomy\nfor resection of the known right parietal mass. There are postsurgical changes\nin the resection cavity with a focal pneumocephalus and some high density\nmaterial. This may represent hemorrhage or surgical material. Additionally,\nthere is pneumocephalus layering along the right frontal convexity as well as\nadjacent to the craniotomy site. There appears to also be a small amount of\nsubarachnoid hemorrhage around the surgical site. There is edema throughout\nthe right hemisphere with effacement of the sulci. There is approximately 5 mm\nof leftward shift of the normal midline structures. The left lateral ventricle\nis compressed with persistent entrapment of the temporal horn. Allowing for\nchanges in modality and positioning, the amount of leftward shift and\nentrapment are grossly similar. The basal cisterns are patent.\n\nThe visualized paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. Other than postsurgical changes in the soft tissues above the\nsurgical site, the soft tissues and orbits are unremarkable.", + "output": "1. Interval postsurgical changes related to right parietal mass resection as\ndescribed.\n2. There is edema surrounding the resection cavity with persistent leftward\nshift of the normal midline structures and entrapment of the temporal horn of\nthe right lateral ventricle, which is similar to the preoperative exams.\n\nRECOMMENDATION(S): RE 2: Recommend clinical correlation and attention on\nfollowup imaging ." + }, + { + "input": "No acute intracranial hemorrhage. There is a rounded predominantly hypodense,\narea with a small focus of pneumocephalus in the region of prior right\nparietal resection without a hyperdense rim that is probably postsurgical\nchange. This appears to be distinct from the occipital horn of the right\nlateral ventricle. There is persistent edema and sulcal effacement in the\nright hemisphere, mostly in the parietal region. Residual tumor cannot be\ndefinitely excluded. There is persistent partial-to-complete effacement of\nthe right lateral ventricle; the occipital horn is not clearly seen. There\nhas been slight interval decrease in the degree of leftward shift of normally\nmidline structures, now approximately 4 mm compared to 6 mm previously. The\nperimesencephalic cisterns are patent.\n\nPost right craniotomy changes in the calvarium are overall unchanged. The\nincompletely visualized paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The orbits are unremarkable.", + "output": "1. No acute intracranial hemorrhage.\n\n2. Predominantly hypodense, rounded area with a small focus of pneumocephalus\nin the area of prior right parietal resection may represent post-surgical\nchange; however, residual tumor or infection cannot be excluded. MR is\nrecommended for further evaluation if clinical concern is high. Continued\nfollow-up. This recommendation was discussed with Dr. ___ at 420 pm.\n\n3. Persistent edema with sulcal and right lateral ventricle effacement in the\nright hemisphere. Slight interval decrease in the degree of leftward shift." + }, + { + "input": "There is no acute intra or extra-axial hemorrhage mass effect midline shift or\nhydrocephalus. The ventricles and extra-axial spaces are normal in size.\nThere are no areas of brain edema seen. Vascular calcifications are seen. No\nbony abnormality is identified.", + "output": "No acute abnormalities. No evidence of brain edema. MRI can L4 assessment of\nmetastatic disease if clinically indicated." + }, + { + "input": "There is no evidence of hemorrhage, infarct, mass or edema, or shift of\nnormally midline structures. The basal cisterns are patent. There is unchanged\nventricular and sulcal enlargement, normal for this patient's age. There is\nminimal bilateral maxillary sinus, ethmoid air cell, sphenoid sinus mucosal\nthickening. The mastoid air cells are clear. The nasopharynx is filled with\nfluid; this may be due to intubation, clinically correlate. Again noted are\natherosclerotic mural calcifications of the bilateral supraclinoid ICAs.", + "output": "No evidence of hemorrhage, infarct, or mass or edema." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or infarction. The\nventricles and sulci are normal in size and configuration. The basal cisterns\nappear patent and there is preservation of gray-white matter differentiation.\nNo fracture is identified. The visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The globes are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Of note, MRI is more sensitive for the detection of soft tissue masses and\nmetastatic disease. Allowing for this, there is no evidence of mass, mass\neffect, or abnormal enhancement to suggest metastatic disease. There is no\nevidence of recent infarction, hemorrhage, or edema. Hypodensities within the\nexternal capsules bilaterally are most likely prominent perivascular spaces or\nchronic lacunar infarctions. The ventricles and sulci are prominent,\ncompatible with mild age-related involutional changes. Periventricular white\nmatter hypodensities are compatible with mild chronic small vessel ischemic\nchanges. No osseous abnormalities seen. Small mucosal retention cysts are\nnoted in bilateral maxillary sinuses. The paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No evidence of abnormal enhancement to suggest metastatic disease.\n2. Mild age-related involutional changes and mild chronic small vessel\nischemic changes." + }, + { + "input": "The image quality is mildly degraded by patient movement, particularly in the\nposterior fossa. There is no evidence of infarction, hemorrhage, edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific, but most likely represent sequelae of chronic\nsmall vessel ischemic disease. Hypodensities within the bilateral external\ncapsules are likely reflective of prominent Virchow ___ spaces or chronic\nlacunar infarcts.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Stable age related involutional and chronic small vessel ischemic changes." + }, + { + "input": "There is a minimally displaced, comminuted fracture of the right C7 transverse\nprocess with extension into the right pedicle and superior articular facet.\nThere is also a nondisplaced fracture through the superior articular facet at\nright C5.\n\nThe left vertebral artery is dominant. The right vertebral artery is the\ndiminutive throughout its course. There is opacification of the right\nvertebral artery, extending from the origin of the of V2 segment (___), at\nthe level of the C6. Absent opacification is seen through the C3 vertebral\nbody level. There is reconstitution of contrast superior to the C3 level. The\nremainder of the right vertebral artery segments demonstrate opacification.\nThe most distal segment of the right vertebral artery is hypoplastic, likely\non a congenital basis.\n\nThere is a left-sided aortic arch with common origin of the left common\ncarotid and brachiocephalic trunk, a congenital variant.\n\nOtherwise, the carotid and left vertebral arteries and their major branches\nare patent with no evidence of stenoses. There is moderate calcified\natherosclerotic disease involving the bilateral carotid siphons. No evidence\nfor dissection of the carotid arteries is seen.\n\nRight internal carotid artery (minimal dimension in mm):\n\nProximal: 10.0\n\nDistal: 5.0\n\nLeft internal carotid artery (minimal dimension in mm):\n\nProximal: 10.5\n\nDistal: 5.0\n\nAdditional findings: There is moderate mucosal thickening of the maxillary\nsinuses with retention cyst in the left maxillary sinus, as well as moderate\nmucosal thickening of the ethmoid air cells. Mild mucosal thickening seen in\nthe left frontal sinuses and bilateral sphenoid sinuses. The mastoid air cells\nare clear. The visualized lung apices are clear. Visualized portions of the\nbrain parenchymal are unremarkable. The orbits and soft tissues are within\nnormal limits. There is no evidence of enlarged lymph nodes by CT criteria.", + "output": "1. Minimally displaced fracture of the right C7 transverse process with\nextension into the right pedicle and superior articular facet. Nondisplaced\nfracture through the superior articular facet at right C5 is also identified.\n\n2. Complete occlusion of the right vertebral artery V2 segment, from the level\nof C6 through the level of C3 vertebral bodies, in the setting of the\ndescribed right-sided cervical spine fractures. There is reconstitution of\nflow superior to the C3 level. Findings are suggestive of occlusion secondary\nto traumatic etiology and vascular injury. Other vessels show no evidence of\nvascular injury or stenosis.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the\ntelephone on ___ at 12:20, at the time of discovery of the findings." + }, + { + "input": "CT NECK: There has been complete interval healing of the previously noted\nfractures in the right articular processes of C5 and C7, with bony bridging\nresulting in total repair of the previously seen fracture lines and cortical\ndisruption. Multifactorial multilevel degenerative changes of the cervical\nspine are again seen, more prominent at C4-5 and C5-6, with loss of disc\nheight, disc bulge and bilateral neural foramina narrowing at C4-C5. Although\nthere is no apparent significant spinal canal stenosis, CT is suboptimal for\nevaluation of the thecal sac compared to MR.\n\n___ aerodigestive tract is unremarkable. The parotid, submaxillary and\nsublingual glands are within normal limits. There is no peritonsillar fluid\ncollection or prevertebral soft tissue swelling. There is no enhancing mass or\ndisplacement of fat planes in the supra or infrahyoid compartments of the\nneck. The thyroid gland is unremarkable and scattered lymph nodes are not\nenlarged by CT size criteria.\n\nThere is moderate mucosal thickening of the maxillary sinuses with retention\ncyst in the left maxillary sinus, as well as moderate\nmucosal thickening of the ethmoid air cells, unchanged from prior. The mastoid\nair cells are clear. The visualized lung apices are clear. Visualized portions\nof the brain parenchymal are unremarkable.\n\nCTA NECK: The left vertebral artery is dominant. Compared to the previous\nCTA, there has been recovery of flow throughuot the developmentally diminutive\nright vertebral artery, with a single focus of partial narrowing of its lumen\nat the level of C4-C5 (2:142) with immediate reconstitution of flow. Normal\nopacification and uniformity of caliber is seen throughout the remainder of\nits course.\n\nThere is a left-sided aortic arch with common origin of the left common\ncarotid and brachiocephalic trunk, a congenital variant.\nOtherwise, the carotid and left vertebral arteries and their major branches\nare patent with no evidence of stenoses, dissection or aneurysm.", + "output": "1. Compared to the previous CTA there has been recovery of flow throughout\nthe developmentally hypoplastic right vertebral artery, with a residual\nnarrowing of its lumen at the level of C4-C5 with immediate reconstitution of\nflow. Normal opacification and uniformity of caliber is seen throughout the\nremainder of its course.\n\n2. Interval healing of the previously noted fractures in the right articular\nprocesses of C5 and C7.\n\n3. Multifactorial multilevel degenerative changes of the cervical spine are\nmore prominent at C4-C5 and C5-C6." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of hemorrhage, edema, or mass effect. The ventricles and\nsulci are normal in size and configuration. White matter hypodensities are\nnonspecific, but likely represent sequela of mild to moderate chronic\nmicrovascular ischemic disease. However, if there is continued clinical\nconcern for acute infarct, MRI is recommended. Extra-axial 1.2 cm parafalcine\nnodule at the left vertex is most consistent with meningioma.\n\nThere are mucous retention cysts in the bilateral maxillary sinuses. \nCongenital aplasia of the right frontal sinus is noted. The remaining\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is mild-to-moderate narrowing of the left cavernous internal carotid\nartery and mild narrowing of the right cavernous internal carotid artery.\nThere is moderate left M1 narrowing. There is also mild narrowing of the left\nvertebral artery in the V4 segment. There is 1.0 mm central filling defect at\nthe right A2 segment axial image 252, with good flow around this abnormality,\nand mild widening of the vessel on either side, findings likely represent\nfenestrated vessel; embolus as less likely as it would probably not causes\nmild overall vessel enlargement.\nPatent large caliber bilateral PCOM. Basilar artery is diminutive in size\nThe dural venous sinuses are patent.\n\nThere is also a large aneurysm at the right MCA trifurcation which measures\n9.2 mm across, 6.1 mm base to apex, and 2.1 mm at the neck.\n\nCTA NECK:\nPostsurgical changes and subcutaneous air are noted s about right carotid\nbifurcation. Areas of wall irregularity of the distal CCA axial image 133 is\nlikely postsurgical, there is no evidence of adjacent hematoma or contrast\nextravasation; there is no preoperative imaging.\nApproximately 1.5 cm distal to the bifurcation of the right common carotid\nartery there is approximately 60% stenosis of the right internal carotid\nartery by NASCET criteria. Given its irregularity, this could represent\nintramural thrombus or residual plaque following right endarterectomy. No\nevidence of more distal occlusion. Significant narrowing at the origin of the\nproximal left external carotid artery, with linear central opacity within the\nvessel, which may represent intraluminal thrombus versus plaque extension.\n\nThere is also mild, approximately 30% by NASCET criteria, narrowing of the\nleft proximal ICA due to atherosclerosis. There is also moderate to severe\nnarrowing of the left subclavian artery just proximal to the take-off of the\nvertebral artery.\nThere is no significant narrowing of the vertebral arteries.\nThe right jugular vein does not opacify at the surgical level, well which\ncould reflect a flow disturbance or DVT. Clinical correlation is recommended.\n\nOTHER:\nAside from dependent atelectasis, the visualized portion of the lungs are\nclear. There is no lymphadenopathy by CT size criteria. Benign intramuscular\nlipoma posterior right neck dd measures 3 cm. Advanced degenerative changes\nspine, demineralization.", + "output": "1. If there is concern for acute infarct, MRI is recommended.\n2. Intracranial atherosclerotic disease, as above.\n3. 1.0 mm filling defect at the right A2 segment, vessel at this level is\nmildly enlarged, findings more likely to represent fenestrated vessel than\nembolus, clinically correlate, consider MRI brain if clinically indicated.\n4. Large aneurysm of the right MCA trifurcation which measures 9.2 mm across\nby 6.1 mm from base to apex and 2.1 mm at the neck.\n5. 60% stenosis of the right internal carotid artery 1.5 cm distal to the\nbifurcation. Luminal irregularity, nodularity peripherally involving right\nCCA bifurcation, proximal ICA may represent intra mural thrombus or residual\nplaque following right endarterectomy..\n6. Approximately 30% stenosis of the left proximal ICA due to atherosclerosis.\n7. Moderate to severe narrowing of the left subclavian artery just proximal to\nthe vertebral artery takeoff.\n8. The right jugular vein is not opacified well, which could reflect a flow\ndisturbance or DVT. Clinical correlation is recommended, consider ultrasound\nif indicated.\n9. 1.2 cm probable meningioma at the vertex.\n\nRECOMMENDATION(S): MRI brain without contrast if indicated\nRight jugular vein ultrasound if indicated\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 2:28 pm, 5 minutes\nafter discovery of the findings." + }, + { + "input": "Re-demonstrated is a large right MCA infarct with associated parenchymal\nhemorrhage involving the right frontal lobe. Right parieto-occipital\nhypodensity likely represents an infarct in the MCA-PCA watershed territory. \nAdditional area of hypodensity in the right temporal lobe compatible with an\narea of embolic infarct, both of which are better appreciated on the prior MR.\n___ is no evidence of new acute territorial infarct or new foci of\nhemorrhage. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. There is no evidence of midline shift. The basal\ncisterns remain patent.\n\nAgain, extra-axial left anterior parafalcine lesion measuring approximately 7\nmm x 7 mm is noted. This is better appreciated on the prior MR and likely\nrepresents a meningioma. Diffuse periventricular and subcortical white matter\nhypodensities are nonspecific, but likely represent sequela of chronic\nischemic microvascular disease.\n\nThere is no evidence of fracture. Bilateral sphenoid sinus air-fluid levels\nare noted. Mucous retention cysts in the bilateral maxillary sinuses are\nunchanged. The visualized portion of the mastoid air cells and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Re-demonstration of a large right MCA infarct with associated parenchymal\nhemorrhage involving the right frontal lobe, unchanged. No evidence of\nmidline shift or herniation.\n2. Right parietal occipital and right temporal lobe hypodensities are better\nappreciated on the prior MR and likely represent areas of embolic infarct.\n3. No additional foci of hemorrhage or new infarcts noted when compared to the\nprior study.\n4. Left anterior parafalcine lesion likely represents a meningioma, unchanged.\n5. Evidence of chronic ischemic microvascular disease.\n6. Unchanged paranasal sinus disease, as described above." + }, + { + "input": "There is enlargement of the bilateral palatine tonsils which are heterogeneous\nand in a \"kissing\" appearance compatible with tonsillitis. At the periphery\nof the left tonsil, there is a hypodense area which measures approximately 2.0\nx 1.0 cm (2:30) without a discrete peripheral enhancement. This likely\nreflects organizing collection. There is also slight enlargement of the\nbilateral lingual tonsils, left greater than right.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid appears normal. There are enlarged bilateral cervical\nchain lymph nodes measuring up to 2.2 cm long axis (02:36), likely reactive.\nThe neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.", + "output": "1. Enlarged, heterogeneous and \"kissing\" palatine tonsils compatible with\nacute tonsillitis. 2.0 x 1.0cm hypodense area at the periphery of the left\ntonsil is concerning for a peritonsillar organizing collection although no\ndiscrete rind of enhancement is identified at this time.\n\n2. Bilateral cervical chain lymphadenopathy, likely reactive." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The mastoid air cells, and middle ear cavities\nare clear. The orbits are unremarkable. There is near complete opacification\nof the visualized right maxillary sinus, likely secondary to extensive sinus\ndisease.", + "output": "No acute intracranial hemorrhage identified. Extensive sinus disease\ninvolving the right maxillary sinus." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is a fracture through the pedicles of C2 bilaterally, better evaluated\non the CT C-spine with the same date. No other fractures are identified. The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "Bilateral C2 pedicle fractures in a hangman's fracture distribution.\nThe study is otherwise normal" + }, + { + "input": "Cervical spine fractures, which are better assessed on the preceding cervical\nspine CT, are again demonstrated. There is a nondisplaced fracture of the\nright superior facet of C7, extending into the C6-C7 facet joint with\npreserved alignment. There are fractures of bilateral C2 pedicles and pars\ninterarticularis. The right C2 fracture is comminuted with a tiny free\nfragment on image 2:162, with an up to 7 mm gap between the main fracture\nfragments, causing disruption of the right C2-C3 facet joint with perched\nfacet morphology. The left C2 fracture is comminuted with a small free\nfragment in the left anterior epidural space on image 2:156, and with up to 4\nmm gap between the main fracture fragments which slightly compromises the left\nC2-C3 facet joint. The fracture extends into the left C2 vertebral foramen. \nThere is a 2 mm anterolisthesis of C2 on C3 without angulation. C2-C3 disc\nspace is mildly narrowed. There is a punctate fracture fragment of the C3\nsuperior posterior endplate.\n\n\nThere is a common origin of the innominate and left common carotid arteries, a\nnormal variant. The left vertebral artery arises directly from the aortic\narch, an other normal-variant. The left vertebral artery is dominant. Curved\nreformatted images demonstrate mild web-like narrowing of the left vertebral\nartery in the disrupted C2 vertebral foramen, concerning for focal injury, but\nthis could be in part artifactual as it also corresponds to a turn in this\nvessel. The non dominant right vertebral artery appears widely patent without\nevidence for dissection.\n\nBilateral common carotid and cervical internal carotid arteries are widely\npatent without evidence for dissection, atherosclerosis, or stenosis by NASCET\ncriteria.\n\nThis exam is not technically optimized for evaluation of the included\nintracranial contents. The brain parenchyma was better assessed by a\npreceding dedicated head CT. There is no cervical lymphadenopathy. The\nthyroid gland is unremarkable. There is partially visualize residual thymic\ntissue in the anterior mediastinum. Visualized upper lungs are clear.", + "output": "1. Nondisplaced right superior facet fracture at C7 extending into the C6-C7\nfacet joint without disruption.\n2. Bilateral comminuted displaced fractures of C2 posterior elements,\ndisrupting the right C2-C3 facet joint with perched facet morphology, slightly\ndisrupting the left C2-C3 facet joint, and extending into the left C2\nvertebral foramen. Associated 2 mm anterolisthesis of C2 on C3 with a\npunctate fracture fragment of the C3 superior posterior endplate.\n3. Mild web-like narrowing of the left vertebral artery in the disrupted C2\nvertebral foramen is concerning for focal injury, though this could in part be\nartifactual as it corresponds to a turn in this vessel. Right vertebral and\nbilateral cervical carotid arteries appear normal without evidence for\ndissection.\n\nNOTIFICATION: The findings were discussed with ___, P.A. by ___\n___, M.D. on the telephone on ___ at 9:51 AM, 2 minutes after\ndiscovery of the findings." + }, + { + "input": "Streak artifact related to dental amalgam limits evaluation.\n\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or midline shift. \nThere is diffuse parenchymal volume loss with nonspecific periventricular\nsubcortical hypodensities, likely a sequela of chronic small vessel\nmicroangiopathy. There is mild bilateral maxillary and ethmoid sinus mucosal\nthickening. The bilateral mastoid air cells appear clear.\n\nCTA HEAD:\nThere is a hypoplastic right A1 anterior cerebral artery. There are moderate\nbilateral cavernous internal carotid artery vascular calcifications. There is\na right dominant vertebral artery. Otherwise, there is no evidence of\nstenosis, occlusion, or aneurysm formation.\n\nCTA NECK:\nStreak artifact related to dental amalgam significantly limits evaluation\nresulting in apparent hypodensity within the left vertebral artery (5:210). \nThere is apparent moderate narrowing of the left distal V2 segment (5:215),\ndifficult to further assess due to streak artifact. There is moderate\nnarrowing of proximal V2 segment of the left vertebral artery (5:154). There\nis focal right V3 segment vascular calcification. There is moderate\ncircumferential noncalcified plaque of bilateral common carotid arteries and\nmoderate-to-severe calcified and noncalcified plaque at the carotid\nbifurcations with approximately 50% left and no significant right internal\ncarotid artery stenosis by NASCET criteria.\n\nOTHER:\nThere is a 5 mm right upper lobe pulmonary nodule with additional smaller\nnodules measuring 3-4 mm posteriorly (05:57). The thyroid gland appears\nunremarkable. There is no lymphadenopathy per size criteria.", + "output": "1. Streak artifact related to dental amalgam limits evaluation\n2. No evidence of infarction, hemorrhage, or edema. Please note MRI of the\nbrain is more sensitive for the detection of acute infarct.\n3. No evidence of stenosis, occlusion, or aneurysm formation of the\nintracranial vasculature.\n4. Left distal V2 vertebral artery apparent hypodensity (5: 215), which may be\nrelated to streak artifact although moderate luminal narrowing is not\nexcluded. Additional focal proximal left V2 segment vertebral artery moderate\nluminal narrowing.\n5. Extensive predominantly noncalcified atherosclerotic plaque of the\nbilateral carotid arteries and carotid bifurcations with approximately 50%\nleft and no significant right internal carotid artery stenosis by NASCET\ncriteria.\n6. Multiple right upper lobe pulmonary nodules measuring up to 5 mm. The\n___ Society guidelines for pulmonary nodule guidelines suggest for\npulmonary nodules greater than 4 mm or less than 6mm, 12 month follow-up in\nlow-risk patients, and ___ month follow-up in high risk patients." + }, + { + "input": "Vascular arteriosclerotic calcifications are seen in the aortic arch, as well\nas the left common carotid artery, the brachiocephalic trunk demonstrate\nstenosis with calcified plaque material (series 601, image 41), grossly\nunchanged since the prior examination dated ___.\n\nThe cervical carotid bifurcations demonstrate a combination of calcified\nplaque and soft plaque material with no evidence of significant stenosis on\nthe right by NASCET criteria., There is approximately 54% of stenosis at the\nleft carotid bifurcation related with a combination of calcified and soft\nplaque material.\nBoth vertebral arteries are patent throughout with no evidence of stenosis.\n\nMultilevel degenerative changes throughout the cervical spine remain grossly\nunchanged consistent with anterior and posterior spondylosis and narrowing of\nthe intervertebral disc spaces, more significant from C3-C4 through C6-C7\nlevels.\n\nUnchanged 5 mm right upper lobe pulmonary nodule with additional smaller\nnodules measuring approximately 3-4 mm (series 2, image 49).\n\nThe thyroid gland appears unremarkable, there is no evidence of\nlymphadenopathy. Limited views of the intracranial structures demonstrate\nmucosal thickening on the left maxillary sinus.", + "output": "1. Approximately 54% of stenosis by NASCET criteria is identified at the right\ncarotid cervical bifurcation as described detail above related with a\ncombination of soft and calcified plaque material\n2. No significant stenosis is identified at the right cervical bifurcation by\nNASCET criteria.\n3. Arteriosclerotic disease identified in the aortic arch, supra-aortic\nvessels with unchanged stenosis at the brachiocephalic trunk.\n4. Unchanged 5 mm right upper lobe pulmonary nodule with additional smaller\nnodules measuring approximately 3-4 mm (series 2, image 49).\n\nRECOMMENDATION(S): Multiple right upper lobe pulmonary nodules measuring up\nto 5 mm. The\n___ Society guidelines for pulmonary nodule guidelines suggest for\npulmonary nodules greater than 4 mm or less than 6mm, 12 month follow-up in\nlow-risk patients, and ___ month follow-up in high risk patients." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nRight maxillary sinus and posterior ethmoid air cell mucous retention cysts\nare noted. Minimal bilateral maxillary sinus and ethmoid air cell mucosal\nthickening is present. Otherwise, the paranasal sinuses are normally aerated,\nwith no mucosal thickening or air-fluid levels identified. The ostiomeatal\nunits are patent. The cribriform plates are intact. The lamina papyracea are\nintact.\n\nBilateral anterior clinoid processes are partially pneumatized. Leftward\nnasal septal deviation with bony spur which contacts the left inferior nasal\nturbinate is noted (601:54). Bilateral concha bullosa present (601:62). \nSmall bilateral Haller cells are noted (see 601:60).\n\nAtherosclerotic vascular calcifications are noted of bilateral cavernous\nportions of internal carotid arteries.", + "output": "1. Dental amalgam streak artifact limits study.\n2. Minimal paranasal sinus disease as described.\n3. Leftward nasal septal deviation with bony spur which contacts left inferior\nnasal turbinate.\n4. Bilateral partially pneumatized anterior clinoid processes.\n5. Bilateral concha bullosa.\n6. Small bilateral Haller cells." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No fracture or acute intracranial process." + }, + { + "input": "There is no evidence of acute large territorial infarction,acute intracranial\nhemorrhage,edema,or mass. There is prominence of the ventricles and sulci\nsuggestive of age-related volume loss. Periventricular and subcortical white\nmatter hypodensities are nonspecific but likely represent sequelae chronic\nsmall vessel ischemic disease. Carotid siphon atherosclerotic calcifications\nare noted.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nleft maxillary and bilateral anterior ethmoid air cells. The other imaged\nparanasal sinuses, middle ear cavities and mastoid air cells are clear. The\npatient is status post right lens replacement, otherwise the visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of large territory infarction,hemorrhage,edema,or mass. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Bilateral carotid siphon calcifications are noted.\n\nNo fracture. The visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are normal.", + "output": "1. No acute intracranial process. Please note that MRI is more sensitive for\nevaluation of intracranial masses." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of new infarction,hemorrhage,edema,ormass. An old\ninfarct is seen in the right cerebellar hemisphere. The ventricles and sulci\nare normal in size and configuration.\n\nThere is moderate mucosal thickening of the left sphenoid and right maxillary\nsinuses. Trace fluid is seen in the bilateral mastoid air cells.. The\nvisualized portion of the orbits are unremarkable.\n\n\nCTA HEAD:\n Atherosclerotic changes of the cavernous and supraclinoid segments of the\nbilateral internal carotid arteries are seen without stenosis. A\ndolichoectatic vertebrobasilar system is seen.\n\nOtherwise, the vessels of the circle of ___ and their principal\nintracranial branches appear normal without stenosis, occlusion, or aneurysm\nformation. The dural venous sinuses are patent.\n\n\nCTA NECK:\nAn ectatic aortic arch is seen with an aberrant right subclavian artery.\n\nAtherosclerotic changes of the carotid bifurcations are seen without extent of\nthe internal carotid arteries, by NASCET criteria. The vertebral arteries\nappear normal with no evidence of stenosis or occlusion.\n\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. Degenerative changes of the cervical spine are seen.", + "output": "1. No evidence of hemorrhage or recent infarction.\n2. Chronic right cerebellar hemisphere infarction peer\n3. Trace bilateral mastoid effusions.\n4. Atherosclerotic changes of the circle of ___ and cervical vessels\nwithout stenosis or occlusion.\n5. Ectatic aortic arch with an aberrant right subclavian artery." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are patent and prominent in keeping with age-related\nvolume loss.\n\nIntracranial atherosclerotic calcification. Scattered hypodensities in the\nperiventricular, subcortical and deep white matter, nonspecific, likely\nsecondary to small vessel ischemic changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable\nnoting prior bilateral cataract surgeries. .\n\n\nCTA HEAD:\nThere is a 4 mm saccular aneurysm arising from the region of the anterior\ncommunicating artery, which measures approximately 3 mm at the base (series\n601b, image 27, as well as series 5, image 289). The right A1 segment is\nhypoplastic or absent. There are scattered areas of intracranial\natherosclerotic calcification, especially involving the V4 segments of left\nvertebral artery and bilateral cavernous carotid arteries. The remaining\nvessels of the circle of ___ and their principal intracranial branches are\notherwise unremarkable. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is calcification of bilateral carotid bifurcations extending into the\nproximal internal carotid arteries. There is no stenosis by NASCET criteria. \nAlso seen is tight stenosis at the origin of right vertebral artery secondary\nto atherosclerosis as seen on image 13 of the curved reformats. High-grade\nstenosis at the origin of left vertebral artery secondary to atherosclerotic\ncalcification (image 3 of curved reformats).\n\nOTHER:\nExtensive centrilobular emphysema in bilateral upper lung zones. Atelectasis\nin the right upper lobe with a calcified pleural-based nodule in the left\nupper lobe on image 5:5 measuring 14 x7 mm. The right apical\npleural-parenchymal scarring. The visualized portion of the thyroid gland is\nwithin normal limits. There is no lymphadenopathy by CT size criteria. \nAtherosclerotic aortic arch calcification.\n\nEndotracheal tube terminates 2 cm above the carina. Enteric tube is partially\nvisualized.", + "output": "1. No acute intracranial abnormality.\n2. 4 mm aneurysm involving the anterior communicating artery.\n3. Atherosclerotic calcification of intracranial and neck vasculature without\nstenosis of bilateral internal carotid arteries near the bifurcation.\n4. Tight stenosis of bilateral vertebral arteries near its origin." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or acute major\nvascular territorial infarction. Ventricles are normal in size for age.\nUnchanged prominence of the sylvian fissures is age-related. Mild\nperiventricular white matter hypodensities are likely the sequela of mild\nchronic small vessel ischemic disease, grossly unchanged. The basal cisterns\nare not compressed.\n\nThere is no fracture. There is minimal mucosal thickening of left maxillary\nsinus and the anterior ethmoid air cells. Mastoid air cell are clear.", + "output": "No evidence for acute intracranial abnormalities." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nPeriventricular white matter hypodensities are compatible with mild chronic\nsmall vessel ischemic changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Study is mildly degraded by motion. There is no evidence of infarction,\nhemorrhage, edema, or mass. There mild is prominence of the ventricles and\nsulci suggestive of involutional changes, however the ventricles are unchanged\nin size compared with prior. Scattered periventricular white-matter\nhypodensities are nonspecific, however likely represent sequela of chronic\nsmall vessel ischemic disease. Atherosclerotic vascular calcifications are\nnoted of bilateral cavernous portions of internal carotid arteries.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Soft tissue density is noted within\nthe right external auditory canal which may represent cerumen.", + "output": "1. Study is mildly degraded by motion.\n2. No evidence of acute intracranial hemorrhage.\n3. No definite ventriculomegaly.\n4. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described.\n5. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute intracranial hemorrhage, mass, mass effect or\nlarge territorial infarction. Ventricles and sulci are age-appropriate. The\nbasilar cisterns are patent, and there is otherwise good preservation\ngray-white matter differentiation.\n\nNo acute fracture is identified. The visualized paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The globes are unremarkable.\n\nCTA HEAD:\nThe vertebral arteries bilaterally are unremarkable. There is a fetal type\nconfiguration of the left posterior cerebral artery. The right posterior\ncerebral artery is unremarkable. Mild-to-moderate atherosclerotic disease is\nseen along the cavernous segment of the left internal carotid artery. The\nleft MCA, and ACA appear to be unremarkable. Mild atherosclerotic disease is\nseen along the cavernous segment of the right internal carotid artery. The\nright MCA, and right ACA are unremarkable. The dural venous sinuses are\npatent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nSevere consolidations are seen within the right lung apices. The left lung is\nclear. The thyroid is normal. There is no cervical lymphadenopathy. A\nnondisplaced fracture is seen along the inferior aspect of the glenoid lip,\nincompletely evaluated on this exam, but previously evaluated. Furthermore,\nextensive right humeral head osteophytosis, joint space narrowing and glenoid\ndegenerative changes are seen.", + "output": "1. No acute intracranial abnormalities identified.\n2. Unremarkable CTA of the head without evidence of significant stenosis or\naneurysm. Moderate intracranial atherosclerotic disease.\n3. Unremarkable CTA of the neck, without evidence of internal carotid artery\nstenosis by NASCET criteria.\n4. Severe extensive right lung parenchymal opacities likely secondary to\natelectasis and consolidations which may be secondary to a infectious process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. There\nis prominence of the ventricles and sulci suggestive of involutional changes. \nNonspecific periventricular subcortical hypodensities suggest chronic small\nvessel ischemic changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Dense bilateral cavernous internal\ncarotid artery calcifications are noted.", + "output": "1. No acute intracranial process" + }, + { + "input": "There is no evidence of infarction,hemorrhage,edema, or mass. Bilateral\nperiventricular subcortical white matter hypodensities are nonspecific but\nmost likely represent sequela of chronic small vessel ischemic changes.\n\nThere is mild mucosal thickening of the ethmoid air cells. The remaining\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nMild periventricular and subcortical white matter hypodensities are\nnonspecific, but most likely represent sequela of chronic small vessel\nischemic disease in this age group.\n\nThere is no evidence of acute fracture. There is mild thickening of the\nethmoid air cell mucosal lining. Otherwise, the visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial abnormalities." + }, + { + "input": "Motion limited study. Within the limitation of the study, there is no\nevidence of large acute territorial infarction,hemorrhage,edema,or mass. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Mild subcortical and periventricular white matter hypodensities are\nnonspecific but may represent chronic small-vessel ischemic disease. Mild\ncalcified atherosclerosis at the cavernous portions of bilateral carotid\narteries.\n\nThere is no evidence of fracture. Hyperostosis frontalis interna is\nre-demonstrated. The visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "Slightly motion limited exam. No acute intracranial abnormalities\ndemonstrated." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass.\nThere are nonspecific periventricular hypodensities, likely a sequela of\nchronic microangiopathy.\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\nIncidental note is made of hyperostosis frontalis interna, a benign process in\nthis patient's age group.\n\nCTA HEAD:\nThere are mild atherosclerotic changes along both carotid bifurcations but\nwithout significant stenosis. The right intradural vertebral artery\npredominantly supplies the right ___ territory, normal anatomic variant. \nNote is made of a fetal left PCA, normal anatomic variant. The vessels of the\ncircle of ___ and their principal intracranial branches appear otherwise\nunremarkable without stenosis, occlusion, or aneurysm formation.\nThe dural venous sinuses are patent.\n\nCTA NECK:\nNormal 3 vessel aortic arch. Limited evaluation of the distal V1 and proximal\nV2 segments of the right vertebral artery due to streak artifact from\ncontrasts material in adjacent venous structures. The carotidandvertebral\narteries and their major branches appear otherwise unremarkable with no\nevidence of stenosis or occlusion.\nThere are mild atherosclerotic changes along both common carotid bifurcations\nwhich result in less than 20% focal stenosis at the origin of the left ICA by\nNASCET criteria. The remainder of the cervical ICAs is unremarkable. No\nstenosis of the right ICA by NASCET criteria.\n\nOTHER:\nThere is mild gravity dependent atelectasis. Evaluation of the visualized\nlung is limited due to motion artifact no obvious abnormality is identified. \nThe visualized portion of the thyroid gland is within normal limits. There is\nno lymphadenopathy by CT size criteria.", + "output": "1. No acute finding.\n2. Stable chronic small vessel ischemic change.\n3. Less than 20% focal stenosis at the origin of the left ICA.\n4. Otherwise patent intracranial and cervical vasculature." + }, + { + "input": "The study is mildly motion degraded.\n\nThere is no evidence of acute large territorial infarction,hemorrhage,edema,or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific, but likely reflect sequelae of chronic small\nvessel ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of a cute large territory infarction,\nintracranialhemorrhage,edema,or discrete mass. There is prominence of the\nventricles and sulci suggestive of involutional changes. Periventricular and\nsubcortical white matter hypodensities are nonspecific but compatible with\nchronic small vessel ischemia.\n\nThere is no evidence of fracture. Scattered opacified mastoid air cells seen\nbilaterally. Otherwise, the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavitiesare essentially clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Chronic changes as above." + }, + { + "input": "There is no evidence of fracture, acute territorial\ninfarction,hemorrhage,edema,or mass effect. There is prominence of the\nventricles and sulci suggestive of involutional changes. Mild periventricular\nand subcortical white matter hypodensities are nonspecific, but likely\nrepresent sequela of chronic ischemic microvascular disease. There are mild\natherosclerotic calcifications in the bilateral intracranial internal carotid\narteries.\n\nAside from scattered mastoid air cell opacification bilaterally, the\nvisualized portion of the paranasal sinuses and middle ear cavities are clear.\nThe visualized portion of the orbits are normal.", + "output": "No acute intracranial process." + }, + { + "input": "Ventricles, cisterns and sulci appear stable. There is no mass effect,\nhydrocephalus or shift of normally midline structures. Minimal patchy areas\nof subcortical frontal white matter disease suggest chronic small vessel\nischemic change in this age group, which is stable. There is no evidence of\nintracranial hemorrhage. Gray-white matter distinction appears preserved. \nSurrounding soft tissue structures are unremarkable. Visualized paranasal\nsinuses appear clear. Minimal bilateral mastoid fluid. No evidence of\nfracture or bone destruction.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal for age. There is mild hypodensity of the\nperiventricular and subcortical white matter, nonspecific but likely\nrepresenting chronic microvascular ischemic disease.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. White matter hypodensities suggesting chronic small vessel ischemia.\n2. Otherwise normal study." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. There\nis redemonstration of periventricular and deep white matter hypodensity,\nsuggestive of chronic small vessel ischemic disease. 11 The ventricles and\nsulci are normal in size and configuration. There is hyperostosis frontalis.\n\nThere is trace opacification of the right mastoid air cells. The left mastoid\nair cells are clear. 99The visualized portion of the paranasal sinuses, are\nclear. The visualized portion of the orbits are normal.", + "output": "1. Findings suggestive of chronic small vessel ischemic disease.\n2. No acute intracranial hemorrhage or territorial infarction within confines\nof noncontrast CT head technique." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute large vascular territory infarct, hemorrhage,\nedema, mass, or mass effect.\n\nFindings consistent with moderate chronic small vessel ischemic changes. Few\nprobable small chronic deep white matter, right basal ganglia infarcts.\nVentricles and sulci are normal in caliber and configuration.\n\nNo displaced calvarial fracture. Mucous retention cyst is seen in the left\nmaxillary sinus. Remaining visualized paranasal sinuses, mastoids, middle ear\ncavities are clear. Globes and orbits are unremarkable aside from small left\nscleral calcification. Carotid siphon calcifications are noted bilaterally.\n\nCT PERFUSION:\n Automated RAPID CT algorithm calculates a volume of 0 mL brain parenchyma\nwith a CBF <30%, as well as volume of 5 mL brain parenchyma with Tmax > 6\nseconds, the latter of which is limited to the bilateral inferior frontal\nlobes, likely artifact. Subjective review of CBF, CBV, and MTT/T-max maps\nshow no evidence of decreased cerebral blood flow, or abnormal cerebral blood\nvolume. There is a large area of mildly prolonged mean transit time in the\nright parieto-occipital region, however similar areas are also seen in the\nleft centrum semiovale.\n\nSubjective review of arterial inflow (AIF) and venous outflow (VOF) time\nintensity curves demonstrate normal, expected curves compatible with\nappropriate selection of AIF and VOF regions of interest. There is no mild\nmotion degradation on 3-plane time-translation curves.\n\nOverall, findings are compatible with technically adequate study, without\nevidence of infarct core or ischemic penumbra, however suggestive of an area\nof mild, compensated hypoperfusion in the right frontoparietal regions.\n\nCTA HEAD:\nMild narrowing P2 segment left PCA. Otherwise, widely patent vertebrobasilar\nsystem. Patent bilateral posterior cerebral arteries with normal distal\nrunoff.\n\nMild calcification of the carotid siphons causing mild luminal narrowing. \nThere is a 2 mm outpouching arising from the lateral aspect of the cavernous\nintracranial ICA, likely a small infundibulum (4:236). Moderate narrowing\nright M2 segment. Otherwise, the remaining portions of the bilateral\nintracranial internal carotid arteries and the bilateral anterior and middle\ncerebral arteries are patent with normal distal runoff.\n\n Major dural venous sinuses appear patent.\n\nCTA NECK:\nCalcified plaque at the origin of the right cervical ICA causes 50% luminal\nnarrowing by NASCET criteria (553:60). Cervical ICA distal to this is\ntortuous and in areas, redundant, however otherwise widely patent.\n\nMild calcified plaque at the origin of the left cervical ICA does not cause\nluminal narrowing by NASCET criteria.\n\nThe proximal (V1 segment) left vertebral artery involving the origin is\nmoderately narrowed by calcified plaque and tortuous, otherwise patent\n(52:10).\n\nMild origin narrowing right vertebral artery.\n\nMild calcified plaque without significant luminal narrowing at the origin of\nthe left common carotid artery at the aortic arch.\n\nRemainder of the bilateral cervical vertebral appear patent.\n\nMild narrowing proximal right subclavian artery. Mild narrowing proximal left\nsubclavian artery. Mild aortic arch and aortic arch branch vessel origin\ncalcification. Arch branch vessels remain patent.\n\nOTHER:\nTonsilliths are noted on the left. 2.2 cm right thyroid lobe nodule is noted.\nNo pathologic cervical adenopathy. There are several small periapical\nlucencies involving the left maxillary teeth as well as dehiscence of the\nbuccal alveolar ridge suggestive of periodontal disease. Otherwise, no\nadditional aggressive focal osseous lesions. 2 mm pulmonary nodule, right\nlung apex (4:88).", + "output": "1. No acute intracranial abnormality.\n2. CT perfusion without evidence of infarct core or ischemic penumbra.\n3. Mild luminal narrowing of the carotid siphons bilaterally. Moderate\nnarrowing right M2 segment MCA, and mild left PCA P2 segment..\n4. 50% luminal narrowing, proximal right ICA. Origin narrowing bilateral\nvertebral arteries. Areas of mild luminal narrowing, left cervical ICA.\n5. 2 mm pulmonary nodule, right lung apex. Recommendation below.\n6. 22 mm right thyroid lobe nodule. Recommend ultrasound.\n7. Small periapical lucencies involving the left maxillary teeth as well as\ndehiscence of the buccal alveolar ridge suggestive of periodontal disease. \nCorrelate with routine dental examination.\n\nRECOMMENDATION(S):\n1. Outpatient thyroid ultrasound, if not previously performed.\n2. For incidentally detected nodules smaller than 6mm in the setting of an\nincomplete chest CT, no CT follow-up is recommended. See the ___ ___\nSociety Guidelines for the Management of Pulmonary Nodules Incidentally\nDetected on CT\" for comments and reference:\n___" + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nMild patchy white matter hypoattenuation is compatible with chronic small\nvessel ischemic disease given the patient's age. Prominence of the ventricles\nand cerebral sulci are compatible with age related involutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere are calcifications of the carotid siphons. There is a 2 mm posteriorly\noriented infundibulum at the right carotid terminus (3:233, 603:16, ___.\nThere is a small 1-2 mm infundibulum at the origin of the right posterior\ncommunicating artery. The vessels of the circle of ___ and their principal\nintracranial branches appear otherwise normal without stenosis, occlusion, or\naneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThere is a 6 mm sub solid pulmonary nodule within the right upper lobe\n(03:52). The visualized portion of the thyroid gland is within normal limits.\nThere is no lymphadenopathy by CT size criteria.", + "output": "1. Right carotid terminus 2 mm infundibulum.\n2. No evidence of dissection or occlusion of the head neck. No significant\nICA stenosis by NASCET criteria.\n3. Mild white matter chronic small vessel ischemic disease.\n4. Parenchymal involutional changes, likely age related." + }, + { + "input": "There is no evidence of infarction,hemorrhage,edema,or mass. There is a focus\nof right frontal white matter hypodensity best seen on image 16 of series 2. \nThis is of uncertain clinical significance and is potentially related to\nchronic small vessel ischemia. If further evaluation is indicated, an MR\nexamination should be considered. The ventricles and sulci are normal in size\nand configuration. There are punctate bilateral basal ganglia calcifications.\nAtherosclerotic calcifications are seen in the bilateral carotid siphons.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of fracture, hemorrhage or infarction.\n2. Focus of right frontal white matter hypodensity as discussed above.\\" + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are prominent, suggestive of involutional changes. Again\ndemonstrated is a hypodensity in the right frontal white matter, which does\nnot appear substantially changed in size compared to ___, likely\nreflects the sequelae of chronic small vessel ischemia (02:21). Additional\nareas of periventricular white matter hypodensity are nonspecific and likely\nreflect the sequelae of chronic microvascular ischemic disease.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are notable for a\nleft lens replacement.\n\nCTA HEAD:\nThere is moderate atherosclerotic disease involving the bilateral carotid\nsiphons. Otherwise, the vessels of the circle of ___ and their principal\nintracranial branches appear normal without evidence of stenosis, occlusion,\nor aneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nNormal three vessel aortic arch anatomy is demonstrated. Mild-to-moderate soft\nand calcific atherosclerotic plaque is seen involving the aortic arch and head\nneck vessels. There is approximately 26% right internal carotid artery\nstenosis by NASCET criteria. There is no evidence of significant left\ninternal carotid stenosis by NASCET criteria. Otherwise, the carotid\nvertebral arteries and their major branches appear normal without evidence of\nhigh-grade stenosis or occlusion.\n\nOTHER:\nThere is a 4 mm solid-appearing left apical pulmonary nodule (3:86). The\nright thyroid lobe is enlarged with an ill-defined hypodensity with scattered\ninternal calcifications. This measures up to 1.9 x 2.5 cm (3:92). There is\nno lymphadenopathy by CT size criteria. Multilevel degenerative changes of\nthe cervical spine including facet arthropathy and osteophytosis is noted. No\nacute fractures are identified.", + "output": "1. No acute intracranial abnormality.\n2. The head and neck vessels are grossly patent without evidence of occlusion\nor aneurysm formation. There is 26% right internal carotid artery stenosis by\nNASCET criteria.\n3. 2.5 cm ill-defined right thyroid lobe hypodensity, for which additional\nevaluation with dedicated thyroid ultrasound is recommended.\n4. Incidental 4 mm left apical pulmonary nodule. Please refer to ___\ncriteria below for follow-up recommendations.\n\nRECOMMENDATION(S): 1. Thyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or ___, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150.\n\n\n2. For incidentally detected single solid pulmonary nodule smaller than 6 mm,\nno CT follow-up is recommended in a low-risk patient, and an optional CT in 12\nmonths is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No evidence of infarction, hemorrhage, edema, or mass." + }, + { + "input": "Again, there is a small amount of bilateral subarachnoid hemorrhage,\npredominately in the bilateral frontal and temporal lobes. There is also\nsmall amount hemorrhage along the septum pellucidum (02:18) which is\nunchanged. Allowing for changes in technique, the amount of hemorrhage is\nsimilar. No new hemorrhage is identified. There is no evidence of significant\nmass effect. The ventricles and sulci are prominent, consistent with age\nrelated volume loss. They are unchanged in size from the prior exam. There is\nno evidence of hydrocephalus. The basal cisterns are patent. No large vascular\nterritory infarction is identified. Gray-white matter differentiation is\npreserved.\n\nNo fracture is identified. There is a small amount of mucosal thickening in\nthe sphenoid sinus. The remainder of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The soft tissue hematoma is noted over the\nright orbit with a small amount of subcutaneous air, consistent with a\nlaceration. There is no stranding in the retrobulbar are space. The orbits and\nsoft tissues are otherwise unremarkable. Degenerative changes noted at the\nleft temporomandibular joint.", + "output": "No significant change in the appearance of the small bilateral subarachnoid\nhemorrhages." + }, + { + "input": "There is no new hemorrhage. No change in the small bilateral subarachnoid\nhemorrhages that are predominantly in the frontal and temporal lobes from the\nearlier exam on ___. The small focus of hemorrhage along the septum\npellucidum is also unchanged. There is no significant mass effect or midline\nshift. The basal and quadrigeminal cisterns remain patent without effacement. \nEnlarged ventricles and diffuse prominence of sulci suggest cortical atrophy\nthat is likely age-related. The grey-white matter differentiation is\npreserved.\n\nThere is no fracture. The soft tissue hematoma with small focus of air,\ncompatible with a laceration, overlying the right orbit is unchanged. Fluid or\nmucosal thickening in the left sphenoid sinus is unchanged. The remaining\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\norbits are unremarkable.", + "output": "1. No interval change in small bilateral subarachnoid hemorrhages.\n\n2. No new hemorrhage.\n\n3. Stable soft tissue hematoma overlying the right orbit.\n\n4. Cortical atrophy." + }, + { + "input": "There has been interval resolution of the subarachnoid blood layering along\nthe bilateral frontal and temporal convexities. There is residual small focus\nof hyperdensity within the occipital horn of the left lateral ventricle,\ndecreased in size compared to the prior CT from approximately 5 weeks earlier.\nThe ventricles are stable in size, prominent secondary to parenchymal\ninvolutional change. No new hemorrhage is identified. There is no evidence for\na large vascular territorial infarction. Periventricular and subcortical white\nmatter hypodensities are unchanged in nonspecific, but likely reflect sequelae\nof chronic small vessel ischemic disease. The basal cisterns appear patent.\n\nNo acute osseous abnormalities seen. The visualized paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear.", + "output": "1. Interval resolution of subarachnoid hemorrhage.\n2. Small residual focus of hyperdensity within the occipital horn of the left\nlateral ventricle, decreased compared to approximately 5 weeks earlier. \nIncomplete resolution of hemorrhage over this time period is unusual. Either\nrecurrent hemorrhage, or an underlying ventricular or ependymal abnormality is\nnot excluded.\n\nRECOMMENDATION(S): Recommend continued CT follow up. MRI with/without\ncontrast could be considered to exclude an underlying ventricular or ependymal\nabnormality." + }, + { + "input": "There is an acute intraparenchymal hemorrhage in the right frontal lobe\nmeasuring 1.1 x 0.8 x 0.4 cm (2:9 and 601:28) with mild surrounding edema,\nstable since ___. Additional punctate foci of hemorrhage in the\nsubcortical and deep white matter, example series 2 image 25, image 19,\nsuggestive of diffuse axonal injury, stable. There is no evidence of acute\nmajor territorial infarction. No evidence of midline shift. The ventricles\nand sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Acute 1.1 cm parenchymal hemorrhage anterior basal right frontal lobe.\n2. Stable punctate foci of hemorrhage elsewhere, distribution is suggestive of\ndiffuse axonal injury.\n3. No new hemorrhage." + }, + { + "input": "There is no evidence of intracranial hemorrhage. There is no mass effect,\nhydrocephalus or shift of the normally midline structures. A calcified\nmeningioma, which measures up to 19 x 10 mm in axial ___, is located\nalong the right frontal convexity, unchanged without mass effect. Gray-white\nmatter distinction appears preserved. Ventricles, cisterns, and sulci appear\nunchanged. Surrounding soft tissue structures are unremarkable. The\nvisualized paranasal sinuses and mastoid air cells appear clear. Cavernous\ncarotid and vertebral arteries appear calcified. There has been no\nsignificant change.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is partial fetal type origin of the bilateral posterior cerebral\narteries. The vessels of the circle of ___ and their principal\nintracranial branches appear patent without stenosis, occlusion, or aneurysm\nformation. The dural venous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear patent with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No acute intracranial abnormality.\n2. Patent cervical vasculature without significant stenosis, occlusion, or\ndissection.\n3. Patent intracranial vasculature without significant stenosis, occlusion, or\naneurysm." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of large territorial infarction, acute intracranial\nhemorrhage,edema, or mass. The ventricles and sulci are mildly prominent in\nsize compatible with mild atrophy, slightly advanced for the patient's age.\n\nNo acute calvarial fracture identified. There is complete opacification of\nthe left maxillary sinus with surrounding osseous sclerosis suggestive of\nchronic sinus disease, and moderate mucosal thickening of the left ethmoidal\nair cells. Soft tissue laceration is identified overlying the left frontal\narea (3:34). The visualized portion of the remaining paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. No acute calvarial fracture or intracranial hemorrhage is identified.\n\n2. Soft tissue laceration overlying the left frontal bone.\n\n3. Paranasal sinus disease as described above.\n\n4. Mild atrophy, advanced for stated age.\n\nNOTIFICATION: The above findings were communicated in person by Dr. ___\nto Dr. ___ the trauma surgery team at 20:25 on ___, 1 min\nafter discovery." + }, + { + "input": "SOFT TISSUES: There is no stranding, fluid collection, hematoma, or other\nsoft tissue abnormality.\n\nMAXILLOFACIAL BONES: The maxillofacial bones are intact, without fracture.\nThe zygomatico-maxillary complex is intact. The lateral pterygoid plates are\nintact.\n\nMANDIBLE: The mandible is without fracture or temporomandibular joint\ndislocation. The temporomandibular joints are symmetric, without significant\ndegenerative change.\n\nSINUSES: There is hyper enhancing mucosa and marked circumferential mucosal\nthickening of the left maxillary sinus with an air-fluid level. There is\nsurrounding sclerosis and hypertrophy of the left maxillary sinus walls. \nMarked mucosal thickening and hyper enhancement are present within the left\nethmoidal air cells (3:43). The mastoid air cells and middle ear cavities\nare clear.\n\nNOSE: There is no nasal bone fracture. Nasopharyngeal soft tissues are\nunremarkable. There is no nasal septal hematoma.\n\nORBITS: The orbits are intact. No evidence of fracture.", + "output": "1. No evidence of acute facial fracture.\n\n2. Hyper enhancing mucosa and severe mucosal thickening with air-fluid level\nin the left maxillary sinus which demonstrates sclerotic and hypertrophied\nwalls. Marked mucosal thickening and hyperenhancement within left ethmoidal\nair cells. Findings compatible with acute on chronic sinusitis.\n\nNOTIFICATION: The above findings were communicated by Dr. ___ to Dr.\n___ the surgery trauma team at 21:10 on ___, 1 min after\ndiscovery." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nTwo adjacent hypodensities in the posterior left occipital lobe (series 2,\nimage 14) measuring approximately 0.7 x 1.2 cm and 3.2 x 2.1 cm, appears\nunchanged in size and extent from the outside hospital CT from the same date. \nThere are again two small punctate hyperdense foci centered within the larger\nareas of hypodensity.\n\nThere are bilateral areas of convexity subarachnoid hemorrhage in the left and\nright frontal lobes (series 2, image ___ near the vertex, not significantly\nchanged from prior examination.\n\n\nCTA HEAD:\nMild narrowing right P 2 segment.\nThere are regularity is at the bilateral M 2, M3 MCA segments, which may be\nsecondary to beam hardening attenuation artifact and mild motion. Multivessel\nnarrowing cannot be excluded.\n\nOtherwise, the vessels of the circle of ___ and their principal\nintracranial branches appear normal without stenosis, occlusion, or aneurysm\nformation. The dural venous sinuses are patent.\n\nThere is no evidence of abnormal enhancement at the site of the hypodensities\nin the left occipital lobe.\n\nCTA NECK:\nThe V4 segment of the right vertebral artery is mildly diminutive. \nHeterogeneous flow in the petrous portion of the carotid arteries, bilaterally\nand symmetrically, likely represents artifact (series 3, image 233). \nOtherwise, the carotid and vertebral arteries and their major branches appear\nnormal with no evidence of stenosis or occlusion. There is no evidence of\ninternal carotid stenosis by NASCET criteria.\n\nOTHER:\nEvaluation of the lungs is severely limited by motion. The thyroid is\nunremarkable.", + "output": "1. Two occipital hypodensities are suggestive of subacute infarcts, with small\narea of microhemorrhage, stable.. Exclude emboli, and infection in this\nclinical setting.\n2. Bilateral upper convexity subarachnoid hemorrhage, non-aneurysmal pattern.\n3. Normal CTA neck.\n4. Mild narrowing right P 2 segment. Bilateral m 2, M3 MCA irregularity may\nbe from artifact or multivessel narrowing.\n5. Consider vasospasm, vasculopathy, including RCVS.\n\n\nRECOMMENDATION(S):\nConsider MRI with and without contrast for further evaluation." + }, + { + "input": "There is re-demonstration of diffuse bilateral super and infratentorial\ninfarcts, several of which have associated blood products compatible with\nhemorrhagic infarct for example a right frontal lobe infarct (02:17) as well\nas a left occipital lobe infarct (02:13) both of which have associated\nsurrounding vasogenic edema which is slightly increased in size when compared\nwith MR of ___ though the hemorrhagic components remain similar. \nRe-demonstrated bilateral subarachnoid hemorrhage is grossly unchanged from\nprior study. No new intracranial hemorrhage is identified. The ventricles\nand sulci are otherwise stable in size and configuration. No midline shift is\nidentified. The basal cisterns are patent.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Diffuse bilateral supratentorial and infratentorial infarcts, some of which\nhave hemorrhagic infarct components. Surrounding edema have slightly\nincreased in size from prior study though the hemorrhagic components appear\nsimilar.\n2. Stable bilateral subarachnoid hemorrhage.\n3. No new intracranial hemorrhage identified.\n4. Additional findings described above." + }, + { + "input": "Diffuse bilateral supra and infratentorial areas of parenchymal hypodensities\ncompatible with a multiple septic embolic infarcts are re-demonstrated, some\nof which demonstrate hemorrhagic transformation, for example within the left\noccipital lobe (03:14). The evidence blood within the left occipital lobe\nhemorrhagic infarct appear less conspicuous today compatible with expected\nevolution of blood products. When compared to the most recent prior ___ head CT, there are no new areas of ischemic infarcts, however the\nparenchymal edema surrounding the more lateral left occipital area has\nincreased since prior, now measuring 3.2 cm in the left occipital lobe,\npreviously measuring 2.5 cm (03:14). There is persistent effacement of the\nsulci adjacent to the involved areas of the infarct. Small bilateral\nsubarachnoid hemorrhages are re-demonstrated and similar to prior. There is no\nmidline shift or downward herniation.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No new areas of ischemic infarct, however there has been interval increase\nin the size of the edema, particularly in the left occipital lobe as described\nabove.\n2. No midline shift.\n3. Unchanged bilateral subarachnoid hemorrhages. No new areas of hemorrhage." + }, + { + "input": "Head CT:\n\nThere is no evidence of hemorrhage, edema, mass effect, or acute major\nvascular territorial infarction. The ventricles and sulci are normal in size\nand configuration.\n\nThere is a 16 mm oval high density lesion seen in the left occipital scalp\nextending to the skin surface (series 3, image 16), most likely a sebaceous\ncyst, which measured 8 mm in ___. There is bilateral internal fixation\nhardware within the anterior bilateral maxilla and mandibular angles. The\nparanasal sinuses are clear. The mastoid air cells are clear.\n\nHead CTA:\n\nThere is a 12 mm CC x 11 mm AP x 10 mm TV aneurysm of the left internal\ncarotid artery, which appears to arise from the cavernous segment, projecting\nposteriorly, laterally, as well as above and below its neck. It has increased\nin size compared to prior study when it measured approximately 7 mm in\ngreatest dimension. The remainder of the intracranial carotid and vertebral\narteries and their major branches are patent with no evidence of stenoses,\nocclusions or new aneurysm formation.\n\nNeck CTA:\n\nThere is mild arthrosclerotic calcification of the aortic arch with a normal 3\nvessel takeoff. Imaging of the neck reveals no evidence of arterial stenosis\nor occlusion. There is no evidence of internal carotid artery stenosis by\nNASCET criteria. The distal right internal carotid artery measures 4.3 mm,\nand the distal left internal carotid artery measures 4.6 mm. Bilateral\nvertebral arteries form loops within C2 transverse foramina.\n\nOther:\n\nThere are bilateral subcentimeter thyroid nodules noted. There is minimal\nright greater than left pleural/parenchymal scarring in the imaged upper\nlungs. There is paraseptal emphysema in the visualized upper lobes. There is a\n3.5 mm subpleural nodule in the apical right upper lobe (series 5, image 50)\nwhich is stable dating back ___, and which does not require follow up.\nThere are degenerative changes in the cervical spine without suspicious\nosseous lesion identified.", + "output": "1. No acute hemorrhage and no evidence for other acute intracranial\nabnormalities.\n2. 16 mm oval lesion in the left occipital scalp extending to the skin\nsurface, likely a sebaceous cyst, has increased in size since ___. Please\ncorrelate with physical exam.\n3. Left ICA aneurysm, 12 mm CC x 11 mm AP x 10 mm TV compared to 7 mm in ___,\nwhich appears appears to arise from the cavernous segment, although this would\nbe better assessed by conventional angiogram.\n4. No evidence for flow-limiting stenosis in the cervical arteries.\n5. Bilateral subcentimeter thyroid nodules.\n\nRECOMMENDATION(S):\n\n1. Conventional cerebral angiography would better assess the neck of the left\nICA aneurysm.\n2. Thyroid ultrasound is recommended for evaluation of bilateral thyroid\nnodules, if not previously performed elsewhere." + }, + { + "input": "Head CT: There is no evidence of hemorrhage, edema, masses, mass effect, or\ninfarction. The ventricles and sulci are normal in caliber and configuration.\nNo fractures are identified.\n\nHead CTA: 11 mm left internal carotid artery aneurysm is unchanged when\ncompared to prior exam. The anterior cerebral arteries, middle cerebral\narteries, and posterior cerebral arteries appear normal. There is no evidence\nof vascular occlusion. The dural venous sinuses appear patent.\n\nNeck CTA: The carotid and vertebral arteries and their major branches are\npatent with no evidence of stenoses. There is atherosclerotic vascular disease\nwithin the aortic arch. The left vertebral artery is dominant. There is no\nevidence of internal carotid stenosis by NASCET criteria.\n\nThe lung apices are unremarkable. There are multiple hypodense thyroid nodules\nwhich are unchanged from prior exam. The submandibular glands and parotid\nglands appear normal.", + "output": "1. Unchanged 11 mm aneurysm of the left supraclinoid internal carotid artery.\n2. No evidence of hemorrhage.\n3. No evidence of vascular stenosis or occlusion." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territory infarct. Gray-white matter\ndifferentiation is preserved. Evidence of known left ICA aneurysm is again\nseen, better assessed on preceeding CTA. The visualized paranasal sinuses are\nclear. The mastoid air cells are clear. No acute fracture is seen. Again\nseen is a post. Left-sided scout, likely a sebaceous cyst", + "output": "No acute intracranial process. Known left ICA aneurysm, better assessed on\npreceeding CTA." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Patient is\nstatus post type pipeline stent of the left internal carotid artery. The\nventricles and sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. 15 x 4 mm nodule in the left posterior scalp\nlikely represents a sebaceous cyst. The orbits are unremarkable.", + "output": "Status post left internal carotid artery pipeline stent without evidence of\ninfarction or hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or infarction.\n\nThe ventricles and sulci are enlarged consistent with age-related atrophy.\nPeriventricular white matter hypodensities are suggestive of chronic small\nvessel ischemic disease.\n\nThe basal cisterns appear patent and there is preservation of gray-white\nmatter differentiation.\n\nThe visualized bony structures are grossly unremarkable.\n\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\n\nThe globes are unremarkable.", + "output": "No evidence of hemorrhage or acute territorial infarction." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nMild periventricular and subcortical white matter hypodensities are\nnonspecific, however likely due to chronic small vessel ischemic disease in\nthis age group. Focal hypodensity in the posterior left corona radiata likely\ncorresponds with T2/FLAIR hyperintensities seen on prior MRI from ___.\n\nThere is no evidence of acute fracture. Mild mucosal thickening of the\nbilateral maxillary sinuses are noted. The visualized portion of the\nremaining paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. Patient is status post bilateral lens replacements. Otherwise, the\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial abnormalities. MRI would be more sensitive for\ndetection of small mass." + }, + { + "input": "The study is moderately limited by motion artifact. A hypodensity in the\nsubcortical white matter of the left parietal lobe is again noted without\ninterval changes compared to prior CT from ___, corresponding to the\nT2/FLAIR hyperintensities seen on prior MRI. There is no evidence of large\nterritorial infarction,hemorrhage,edema, or mass. There is prominence of the\nventricles and sulci suggestive of involutional changes, similar to prior\nstudies. Bilateral periventricular subcortical white matter hypodensities are\nnonspecific but most likely represent sequela of chronic small vessel ischemic\nchanges.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. The\npatient is status post bilateral lens replacement. Otherwise the orbits are\nunremarkable.", + "output": "1. No acute intracranial process.\n2. No calvarial fractures." + }, + { + "input": "There is no evidence of acute intracranial infarction,hemorrhage,edema, or\nmass effect. There is mild prominence of the ventricles and sulci suggestive\nof age-appropriate involutional changes. There is minimal subcortical and\nperiventricular white matter hypodensities, nonspecific but compatible with\nsequelae of chronic small vessel ischemic disease.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial process. Please note that MRI is more sensitive in\ndetecting small intracranial lesions." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is mild\nprominence of the ventricles and sulci not out of proportion to patient's age.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "In the left parietal lobe is a hypodense region measuring approximately 3.9 x\n2.9 cm surrounded by a region of increased density that blends in with the\nsurrounding cortex and causes effacement of the surrounding sulci. This is\nconcerning for an underlying brain mass. In addition there is a hyperdense\nlesion in the right parietal periventricular white matter measuring\napproximately 2.0 X 1.1 cm that may be calcific versus hemorrhagic. There is\nsurrounding hypodensity of the white matter which may represent vasogenic\nedema versus prior infarct/ischemic changes. Evidence of significant mass\neffect or midline shift. Another suspected lesion is adjacent to the frontal\nhorn of the right lateral ventricle measuring 1.1 cm with a rim of slightly\nincreased density (02:47).\n\nEncephalomalacia centered in the right parietal lobe and insula suggestive of\nprior infarct. No evidence of acute large territory infarct. There is\nprominence of the ventricle size and sulci consistent with age-related\ninvolutional changes. The occipital horn of the right ventricle appears to be\ninvoluted or effaced by the suspected mass.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Suspected mixed density lesion with central hypodensity in the left\nparietal lobe measuring approximately 3.9 x 2.9 cm with effacement of the\nsurrounding sulci.\n2. Hyperdense lesion in the right parietal periventricular white matter\nmeasuring approximately 2.0 x 1.1 cm may be either calcific or hemorrhagic.\n3. A third mass adjacent to the frontal horn of the right ventricle measuring\n1.1 cm.\n4. Right-sided encephalomalacia presumably from previous infarction.\n5. No evidence of acute large territory infarct.\n\nRECOMMENDATION(S): MR brain is recommended for further evaluation." + }, + { + "input": "Head CT: There is no intra or extra-axial mass effect, acute hemorrhage or\ninfarct. The gray-white differentiation is preserved. Sulci, ventricles and\ncisterns are within expected limits for the patient's age. These paranasal\nsinuses are essentially clear. The orbits are unremarkable. The mastoid air\ncells matter cavities are clear. There is suggestion of a high riding left\njugular bulb.\n\nHead CTA: Very minimal atherosclerotic calcification of the right carotid\nsiphon is noted. The left A1 segment is slightly hypoplastic relative to the\nright. Otherwise, the ICA, ACA, MCA and their major branches are unremarkable.\nThe right posterior communicating artery is not visualized. There is a minimal\n1 mm posterior outpouching of the right carotid terminus (series 5, image 284)\nalmost certainly representing a infundibulum. The posterior circulation is\notherwise unremarkable. There is no evidence of stenosis or occlusion. No\naneurysm larger than 2 mm. The dural venous sinuses are patent.\n\nNeck CTA: There is a 3 vessel arch. The origins of the brachiocephalic,\ncommon carotid, and subclavian arteries are unremarkable. The carotid and\nvertebral arteries and their major branches are patent with no evidence of\nstenoses. The vertebral arteries are codominant. There is no evidence of\ninternal carotid stenosis by NASCET criteria.\n\nOther: Very minimal biapical pleural-parenchymal scarring. Otherwise the lung\napices are clear. The aerodigestive tract is unremarkable. There is a\nenhancing left thyroid nodule measuring approximately 9 mm. There is no\ncervical lymphadenopathy by size criteria. The submandibular and parotid\nglands are unremarkable. There are no suspicious blastic or lytic osseous\nlesions.", + "output": "1. Suggestion of a 1 mm outpouching of the right supraclinoid carotid likely \nan infundibulum. No definite aneurysm.\n2. Otherwise, there is no stenosis, occlusion or other abnormality of the\ncervical arterial vessels or the circle of ___.\n3. There is an enhancing 9 mm left thyroid nodule. This may further evaluate\nwith ultrasound if clinically indicated." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Age related involutional changes are again noted with\nperiventricular hypodensity consistent with chronic microvascular ischemic\ndisease. The ventricles appear stably prominent. Basilar cisterns appear\npatent. Extensive anterior and posterior circulation atherosclerosis is noted.\nMucosal thickening is seen within the left maxillary sinus. The remainder of\nthe imaged paranasal sinuses, mastoid air cells and middle ear cavities appear\nwell aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, mass, mass effect or\nlarge territorial infarction. The ventricles and sulci are normal in size and\nconfiguration. The basilar cisterns are patent, and there is otherwise good\npreservation of the gray-white matter differentiation.\n\nNo acute fractures identified. The visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. Note is made of an empty sella.", + "output": "1. No acute intracranial abnormalities identified.\n\n2. Note is made of an empty sella." + }, + { + "input": "There is no evidence of large territorial infarction, acute intracranial\nhemorrhage, edema, or mass. The ventricles and sulci or are normal in size\nand configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "The patient is status post craniotomy and tumor resection, with the expected\npostsurgical changes including pneumocephalus at the surgical site and along\nthe bifrontal convexities. Hypodensity of the bilateral occipital and\nposterior parietal lobes likely represents cytotoxic edema. There is no\nevidence of acute large territorial infarct, although without prior CT imaging\navailable for comparison, is difficult to evaluate for small foci of infarct\nnear the surgical bed. There is no large hemorrhage. The ventricles and basal\ncisterns are patent.\n\nMucous retention cysts are seen in the bilateral maxillary sinuses. The other\nvisualized paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The orbits are unremarkable.", + "output": "1. Status post craniotomy and tumor resection, with the expected postsurgical\nchanges as described above. No large hemorrhage is identified.\n2. Hypodensity of the bilateral occipital and posterior parietal lobes likely\nrepresent edema." + }, + { + "input": "There is no evidence of acute hemorrhage mass effect midline shift or\nhydrocephalus. Gray-white matter differentiation is maintained. The cerebral\nsulci are not clearly seen. However, basal cisterns are patent.\n\nMild mucosal thickening in partially visualized maxillary sinuses. . No skull\nfracture is seen. Note is made of bilateral parotid calcifications.", + "output": "No acute intracranial abnormalities are identified. Paucity of cerebral sulci\nlikely due to patient's young age. No definite signs of brain edema on CT." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. Mucosal thickening is noted in the bilateral\nmaxillary sinuses, sphenoid sinuses and ethmoid air cells along with\naerosolized secretions seen in the bilateral sphenoid sinuses. Postsurgical\nchanges related to bilateral antrostomies are noted. The orbits are\nunremarkable. Bile parotid glands again demonstrated. Heterogeneous appearance\nwith multiple punctate calcifications.", + "output": "1. No acute intracranial abnormality.\n2. Paranasal sinus disease as described.\n3. Redemonstration of bilateral parotid gland heterogeneity in the with\nmultiple punctate calcifications. Findings are nonspecific, with differential\nconsiderations including chronic parotitis, benign lymphoepithelial lesions of\nHIV, with juvenile Sjogren's disease less likely. Recommend clinical\ncorrelation." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. A 6 mm hypodense nodule is incidentally detected in the right\nthyroid gland and is without suspicious features. Borderline level II lymph\nnodes bilaterally are present, likely reactive. The neck vessels are patent.\n\nThere are no concerning pulmonary nodules or masses in the visualized upper\nlungs. There are no osseous lesions. Polypoid mucosal thickening of the\ninferior left maxillary sinus is noted.", + "output": "1. No peritonsillar abscess or tonsillar enlargement.\n2. Borderline enlarged level II lymph nodes bilaterally, which may be\nreactive." + }, + { + "input": "There is an ossification in the right maxillary sinus near the ostiomeatal\ncomplex, but with no evidence of obstruction. The maxillary sinuses, and\nsphenoid sinuses are clear. Minimal mucosal thickening is seen involving the\nethmoid air cells. The frontal sinuses are clear. The mastoid air cells, and\nmiddle ear cavities are clear.\n\nVisualization of the intracranial structures is limited, however no gross\nabnormalities are identified. The globes are unremarkable.", + "output": "1. No evidence of sinusitis. Mild mucosal thickening is seen involving the\nethmoid air cells. Right maxillary sinus osteoma" + }, + { + "input": "There is a small to moderate mucous retention cyst in the right sphenoid\nsinus, new since prior. There is a small mucous retention cyst in 1 of the\nposterior ethmoid air cells, similar to prior. There is mucosal thickening\nnear the ostiomeatal unit right maxillary sinus adjacent to the ossification. \nThe paranasal sinuses are otherwise normally aerated, with no mucosal\nthickening or air-fluid levels identified. There is an ossification in the\nright maxillary sinus near the ostiomeatal complex, without evidence of\nobstruction, as on prior. The ostiomeatal units are patent. The cribriform\nplates are intact. There is no nasal septal defect. The anterior clinoid\nprocesses are not pneumatized. The lamina papyracea are intact.", + "output": "Mucous retention cysts and minimal mucosal thickening as described above. No\nfluid levels or aerosolized secretions." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass/mass effect. There is prominence of the ventricles and sulci\nsuggestive of involutional changes.\n\nThere is no evidence of fracture. There is minimal mucosal thickening/ fluid\nin the right sphenoid sinus which appears new from CT of ___. The\nremaining visualized portion of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nintracranial hemorrhage.\n2. Minimal mucosal thickening/fluid within the right sphenoid sinus. \nCorrelate with any symptoms of sinusitis." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Normal study. No hemorrhage." + }, + { + "input": "There are amorphous calcifications in the midline and just to the left of\nmidline at the superior fibers of the longus coli muscle tendon, just inferior\nto the anterior C1 ring (602:46, 601:42), with associated edema of the\nadjacent prevertebral soft tissues, denoted by hypodensity extending from the\nlevel of C2 through the inferior endplate of C4 (602:44). Findings are\ncompatible with acute calcific tendinitis of the longus coli muscle. There is\nno evidence of drainable fluid collection concerning for abscess. There is no\nmass effect upon the aerodigestive tract.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid appears normal. There is no lymphadenopathy by CT\ncriteria. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.\n\nThere is a small air-fluid level in the right maxillary sinus. The imaged\nmastoid air cells are clear.", + "output": "1. Amorphous calcifications of the superior fibers of the longus coli muscle\ntendon, with associated edema of the prevertebral soft tissues from C2 through\nC4, compatible with acute calcific tendinitis of the longus coli muscle.\n\n2. No drainable fluid collection concerning for retropharyngeal abscess.\n\n3. Incidental mild paranasal sinus disease.\n\nNOTIFICATION: The above findings were communicated via telephone by Dr.\n___ to Dr. ___ at 20:45 on ___, 5 minutes after discovery." + }, + { + "input": "There is no evidence of acute vascular territorial\ninfarction,hemorrhage,edema, or mass. Mild subcortical periventricular white\nmatter hypodensities are nonspecific, and may be a sequelae of chronic small\nvessel ischemic disease. The ventricles and sulci are normal in size and\nconfiguration.\n\nThere is no evidence of fracture. There is soft tissue swelling/small\nsubgaleal hematoma overlying the left occipital and parietal bones. There is\nmild mucosal thickening of the ethmoid air cells. The visualized portion of\nthe remaining paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial process. Soft tissue swelling/small subgaleal\nhematoma overlying the left parietal occipital regions without underlying\nacute fracture." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass. The ventricles and sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. Small mucous retention cyst in the left\nmaxillary sinus. The remainder of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute large vascular territorial infarction,\nhemorrhage, edema, or mass. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. There is small probably chronic lacunar\ninfarct right thalamus.\n\nThere is no evidence of fracture. There is asymmetric soft tissue swelling at\nthe left temporal, right parietal scalp. There is partial opacification of\nthe visualized paranasal sinuses, with fluid in the sphenoid sinus, left\nmaxillary sinus. There are degenerative changes of bilateral\ntemporomandibular joints, more prominent on the right. Minimal opacification\nof the left mastoid air cells is noted. These findings may be due to\nprolonged intubation. Patient is status post bilateral lens replacements. \nAtherosclerotic calcifications of the carotid siphons are noted bilaterally.", + "output": "1. No acute intracranial process.\n2. Air-fluid levels and mucosal thickening throughout the paranasal sinuses,\nlikely due to prolonged intubation." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass effect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular, subcortical, and deep white matter\nhyperdensities are suggestive of chronic small vessel disease.\n\nNo evidence of acute fracture. The visualized paranasal sinuses are\nessentially clear. Fluid opacification of the mastoid air cells is compatible\nwith intubation.", + "output": "1. No evidence of acute large territorial infarction or hemorrhage.\nChronic involutional and microvascular changes.\n2. If there remains high clinical suspicion, and there no contraindications,\nMRI would be more sensitive for subtle lesions." + }, + { + "input": "There is a subtle apparent region of asymmetric white matter hypodensity of\nthe left coronal radiata (series 3, image 21) not clearly visualized on prior\nexamination of ___, potentially representing sequela of subtle\ninfarct versus artifact from patient positioning. However, this finding is\nequivocal and follow-up with MRI or serial CT examinations is recommended, if\nthere is high clinical suspicion. Otherwise, there is no evidence for large\nacute territory infarct or loss of gray-white differentiation. No evidence\nfor acute hemorrhage.\n\nThere is no evidence of fracture. There is mucosal thickening noted in the\nbilateral sphenoid sinuses. There is also opacification of the bilateral\nmastoid air cells and middle ear cavities noted. Fluid in the nasopharynx is\nidentified, but compatible with sequela of intubation. The visualized portion\nof the remaining paranasal sinuses are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. Area of apparent asymmetric developing hypodensity in the left corona\nradiata area, which may represent subtle regions of ischemia/infarct versus\nartifact. As this is equivocal, if there are no contraindications in\nclinically indicated, MRI or serial CT examinations is recommended for further\ncharacterization. No acute hemorrhage is identified.\n2. There is mucosal thickening noted in the bilateral sphenoid sinuses. There\nis opacification the bilateral mastoid air cells and middle ear cavities." + }, + { + "input": "Again demonstrated are bilateral inferior cerebellar hemisphere infarctions,\nunchanged. Heterogeneous areas of high-density within the cerebellum,\ncorresponds to areas of hemorrhage as seen on prior MRI, and is stable\ncompared to prior head CT performed ___. There is persistent minimal\neffacement of the fourth ventricle. Ventricular size is unchanged compared to\nprior study. There is mild crowding at the foramen magnum, which is grossly\nunchanged from prior exam. There is no evidence of new hemorrhage or\ninfarction. There is no evidence of hydrocephalus.\n\nThere is no evidence of fracture. Mild mucosal thickening of the right\nmaxillary sinus. The remaining visualized portion the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. No interval change from prior head CT demonstrating bilateral cerebellar\nhemispheric infarctions with small amounts of hemorrhage." + }, + { + "input": "Again seen is hypodensity in the bilateral cerebellar hemispheres, left\ngreater than right, overall not significantly changed compared with prior MRI.\nHemorrhage in the left inferior cerebellum is not significantly changed. Mild\neffacement of the fourth ventricle is similar to prior. The ventricles are\nstable in size. Crowding at the foramen magnum is unchanged. No evidence of\nnew intracranial hemorrhage or acute large territorial infarction.\n\nThere is no evidence of fracture. There is mild mucosal thickening in the\nleft maxillary sinus and ethmoid air cells. The visualized portion of the\nremainder of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No significant change in bilateral cerebellar hemispheric infarctions with\nsmall amount of hemorrhage.\n2. The ventricles are stable in size, with effacement of the fourth ventricle." + }, + { + "input": "There is no acute hemorrhage or evidence for an acute major vascular\nterritorial infarction. There is unchanged linear hypodensity in the left\ncerebellar hemisphere image 2:7. Bilateral subcortical insular white matter\nhypodensities are also unchanged and nonspecific, but likely secondary to\nchronic small vessel ischemic changes.\n\nNo acute osseous abnormalities seen. There is small amount of fluid and\nmoderate polypoid mucosal thickening plus/minus mucous retention cyst in the\npartially visualized right maxillary sinus. There is mild mucosal thickening\nplus/minus small mucous retention cysts in the partially visualized left\nmaxillary sinus. There is mild mucosal thickening in the frontoethmoidal\nrecesses and anterior ethmoid air cells. Partially visualized mastoid air\ncells appear clear.", + "output": "1. No acute hemorrhage.\n2. Unchanged linear hypodensity in the left cerebellar hemisphere. Please\nrefer to the ___ MRI report for further detail." + }, + { + "input": "Large hypodense regions involving the left greater than right cerebellar\nhemisphere scratch as well as the cerebellar tonsils are again visualized. \nHeterogeneous areas of high signal intensity within this cerebellum likely\nreflects hemorrhage as seen on the prior MRI however there may be increased\nhemorrhage involving the inferior right cerebellum (2:4, 6). There is\npersisting minimal effacement of the fourth ventricle however the ventricular\nsize is unchanged. There is minimally increased mass effect and edema as\nevidenced by mild crowding at the foramina magnum.\n\nNo acute supra tentorial abnormalities identified. There is mild mucosal\nthickening of the right maxillary sinus and several ethmoid air cells.", + "output": "Known cerebellar infarcts with hemorrhagic transformation, likely mildly\nincreased in extent in the right inferior cerebellum. Mildly increased edema\nwithin the cerebellum and crowding at the foramina magnum however the fourth\nventricle and foramen of Magendie remain patent with no supratentorial\nhydrocephalus. No acute supratentorial abnormality identified." + }, + { + "input": "There is no acute intracranial hemorrhage, edema, mass effect or acute\ninfarction. A right choroid plexus cyst is noted. CSF containing space in the\nposterior fossa is most compatible with an arachnoid cyst. The ventricles and\nsulci are normal in size and configuration. The visualized paranasal sinuses\nand mastoid air cells are clear. There is no acute fracture.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. Atherosclerotic\nvascular calcifications are noted of bilateral cavernous portions of internal\ncarotid arteries. There is prominence of the retrocerebellar CSF space,\nrepresenting either arachnoid cyst ___ cisterna magna.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Soft tissue density is noted within\nthe right external auditory canal which may represent cerumen.", + "output": "1. No acute intracranial abnormality.\n2. Stable prominence of the retrocerebellar CSF space representing either ___\ncisterna magna or arachnoid cyst." + }, + { + "input": "The patient is status post bilateral antrostomies, superior and middle\nturbinectomies and partial left inferior turbinectomy with ethmoidectomies. \nThere is residual mucosal thickening in the ethmoid air cell cavity and\nmaxillary sinuses. A persistent mucous retention cyst is noted in a posterior\nsuperior left maxillary sinus, similar appearance to examination of ___. \nMild mucosal thickening of the residual frontal ethmoidal recess is\nidentified. Unchanged left frontal sinus osteoma. The sphenoid sinus is\nessentially clear. The sphenoid sinus septum inserts on the left carotid\ncanal. The anterior clinoid processes are not pneumatized. The cribriform\nplates and lamina papyracea are intact.\n\nThe visualized orbits are unremarkable. The mastoid air cells middle ears are\nwell pneumatized and clear.\n\nAlthough the examination is not optimized for such evaluation, visualized\nbrain is grossly unremarkable.", + "output": "1. Status post remote bilateral antrostomies, superior and middle\nturbinectomies, partial left inferior turbinectomy and ethmoidectomies.\n2. Mild mucosal thickening in the ethmoid air cell cavity and maxillary\nsinuses. Unchanged persistent mucous retention cyst in the superior left\nmaxillary sinus.\n3. Additional findings as described above." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Moderate to\nsevere periventricular and subcortical white matter hypodensities are\nnonspecific but likely sequelae of chronic small vessel ischemic disease. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges.\n\nThere is no evidence of fracture. There is moderate mucosal thickening of the\npartially imaged paranasal sinuses with evidence of prior endoscopic sinus\nsurgery. There is a new small air-fluid level in the sphenoid sinus. The\nvisualized portion of the orbits are unremarkable. Mild bilateral carotid\nsiphon calcification.", + "output": "1. No evidence of mass, hemorrhage or infarction.\n2. Mild global atrophy with moderate to severe probable chronic small vessel\nischemic changes.\n3. Paranasal sinus disease status-post endoscopic sinus surgery including a\nnew air-fluid level in the sphenoid sinus raising the possibility of acute\nsinusitis." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nRight superior parietal periventricular hypodensity is nonspecific (03:27).\n\nThere is no evidence of fracture. Patient is status post left canal wall down\nmastoidectomy. The visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "No acute intracranial process. Nonspecific periventricular white matter\nhypodensity in the right parietal lobe." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema or mass effect. A\nhyperdense focus containing calcification is seen abutting the left lateral\nventricle appears too dense to represent acute hemorrhage and likely\nrepresents calcification (2: 19; 601b:47), possibly related to prior infection\nor a cavernous malformation. The ventricles and sulci are prominent,\ncompatible with moderate age-related involutional changes. Periventricular\nand deep subcortical white matter hypodensities are compatible with moderate\nchronic small vessel ischemic changes.\n\nNo osseous abnormalities seen. Soft tissue swelling overlying the right\noccipital/ parietal area is noted (601b:86) without underlying calvarial\nfracture. The paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Hyperdense focus abutting the left lateral ventricle most likely represents\ncalcification, possibly related to prior infectious process or a cavernous\nmalformation.\n3. Moderate volume loss and moderate chronic small vessel ischemic changes." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThere are extensive hypodensities in the subcortical and periventricular white\nmatter, nonspecific, likely secondary to small vessel ischemic disease. There\nis chronic infarct related encephalomalacia in the right cerebellar\nhemisphere.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is mild atherosclerosis involving bilateral cavernous carotid arteries. \nThe vessels of the circle of ___ and their principal intracranial branches\nappear otherwise unremarkable without stenosis, occlusion, or aneurysm\nformation. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is a 2 vessel aortic arch with common origin for the right\nbrachiocephalic trunk and left common carotid artery. There is minimal\natherosclerosis involving the right carotid bifurcation without any stenosis\nby NASCET criteria. The carotid and vertebral arteries and their major\nbranches appear otherwise under with no evidence of stenosis or occlusion.\n\nOTHER:\nEvaluation of the lungs is limited secondary to motion artifact. Bilateral\nemphysematous changes are noted. The thyroid gland is enlarged and\nheterogeneous with multiple nodules, the largest measuring 5 mm. There is no\nlymphadenopathy by CT size criteria. Degenerative disease involving the\nvisualized cervical spine. There is atherosclerosis involving the origin of\ngreat vessels. There is mildly prominent adenoids.", + "output": "1. Minimal right carotid bifurcation atherosclerotic changes without definite\nstenosis by NASCET criteria.\n2. No evidence of acute intracranial hemorrhage.\n3. No evidence ofaneurysm greater than 3 mm, dissection or significant\nluminal narrowing.\n4. Evaluation for acute infarct is limited given the extensive small vessel\nischemic disease. Please note MRI of the brain is more sensitive for the\ndetection of acute infarct.\n5. Findings of small vessel ischemic disease and chronic right cerebellar\ninfarct.\n6. Multiple bilateral subcentimeter nonspecific thyroid lymph nodes. The\n___ College of Radiology guidelines suggest that in the absence of risk\nfactors for thyroid cancer, no further evaluation is recommended." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect or acute large vascular\nterritory infarction. A hypodensity in the right internal capsule is\nunchanged from prior consistent with an old lacunar infarct. Prominent\nventricles and sulci suggest age related atrophy. Periventricular white matter\nhypodensities are nonspecific but likely represent sequela of chronic small\nvessel ischemic disease. The basal cisterns appear patent and there is\npreservation of gray-white matter differentiation.\n\nNo fracture is identified. The visualized paranasal sinuses, mastoid air cells\nand middle ear cavities are clear. The globes are unremarkable.\nAtherosclerotic mural calcification of the vertebral and internal carotid\narteries is noted.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of acute infarction, hemorrhage,or edema. \nThere is no evidence of midline shift or mass effect. The small hypodensity\nin the right internal capsule is unchanged from prior exam in ___ and\nconsistent with an old lacunar infarct.\n\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe major intracranial artery vessels appear patent without stenosis or\nocclusion. The right A1 segment appears hypoplastic. The left MCA appears\nslightly bulbous at the origin bifurcation. There is some narrowing of the\nbasilar artery and V4 segment of the left vertebral artery consistent with\natherosclerotic disease. Atherosclerotic calcifications are seen in the\nbilateral carotid siphons. The dural venous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria. Atherosclerotic calcifications are seen at the\nbilateral origins of the vertebral arteries and bifurcations of the bilateral\ncarotid arteries.\n\nOTHER:\nThere are bilateral pleural effusions in the lungs, right greater than left. \nA pacemaker is visualized in the left chest wall. The visualized portion of\nthe thyroid gland is within normal limits. There is no lymphadenopathy by CT\nsize criteria. Diffuse osteopenia is noted. Moderate multilevel degenerative\nchanges.", + "output": "1. The major intracranial artery vessels are patent without stenosis,\nocclusion, or aneurysm. There is some narrowing of the basilar artery and V4\nsegment of the left vertebral artery consistent with atherosclerotic disease.\n2. The carotid and vertebral arteries appear patent without stenosis or\nocclusion.\n3. Evidence of right internal capsule old lacunar infarct, unchanged from\nprior exam in ___.\n4. Bilateral pleural effusions are present in the lungs, right greater than\nleft." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage,or edema. There is no\nevidence of midline shift or mass effect. There is a hypodensity in the right\ninternal capsule which is unchanged from prior imaging in ___ and\nconsistent with an old lacunar infarct.\n\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Periventricular white matter hypodensities are nonspecific but\nlikely represent a sequela of chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of acute hemorrhage, infarct or fractures.\n2. A small hypodensity in the right internal capsule likely represents an old\nlacunar infarct.\n3. Prominence of ventricles are visualized, suggestive of involutional\nchanges, along with evidence of chronic ischemic small vessel changes." + }, + { + "input": "NECT: 1.9 x 0.8 cm hypodensity in the brainstem is most concerning for\nhemorrhage. No other intracranial hemorrhage is noted. No territorial infarct\n\nCTA:\nPatent circle ___ and its major tributaries without occlusion, significant\nstenosis or aneurysm. No evidence of acute extravasation in the brainstem.\nPatent neck vessels without dissection or occlusion. Extensive carotid bulb\ncalcification. Mild atherosclerotic disease and calcification seen in the\nneck vessels. Mild atherosclerotic disease seen in the intracranial vessels\naffecting the basilar artery and middle cerebral arteries. Thirds of\nhigh-grade stenosis.\n\nThere is a calcified granuloma in the right upper lobe (3:60).", + "output": "1. Pontine hemorrhage.\n2. No abnormalities on CT angiography except for mild atherosclerotic disease.\nNo evidence of high-grade stenosis or abnormal vascular structures.\n." + }, + { + "input": "There has been interval increase in the size of the brainstem hemorrhage, now\nmeasuring 2.5 x 1.8 cm, previously 1.9 x 0.8 cm. Small amount of hemorrhage\nwithin the fourth ventricle is also new. The ventricles and sulci are overall\nstable in size and configuration. Extensive periventricular and subcortical\nwhite matter hypodensities are nonspecific, however likely due to chronic\nsmall vessel ischemic disease in this age group.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. \nPatient is status post right lens placement. Otherwise, the visualized\nportion of the orbits are unremarkable. Moderate calcifications are noted in\nthe bilateral carotid siphons.", + "output": "Interval increase in brainstem hemorrhage, now measuring 2.5 x 1.8 cm with\nsmall amount of new hemorrhage within the fourth ventricle. No evidence of\nhydrocephalus.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 8:47 pm, 10 minutes after\ndiscovery of the findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST: There is no evidence of no evidence of infarction,\nhemorrhage, edema, or mass. The ventricles and sulci are normal in size and\nconfiguration. The visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the orbits\nare unremarkable. There are periapical lucencies surrounding the two right\nposterior most maxillary teeth (5:191 and 603b:19).\n\nCTA HEAD: The vessels of the circle of ___ and their principal intracranial\nbranches appear normal without stenosis, occlusion or aneurysm formation. \nIncidentally, there is fetal origin of the right PCA (5:253). The dural\nvenous sinuses are patent.\n\nCTA NECK: The carotid and vertebral arteries and their major branches appear\nnormal with no evidence of stenosis or occlusion. There is no evidence of\ninternal carotid stenosis by NASCET criteria.\n\nOTHER: Although evaluation is limited by respiratory motion artifact there is\nan apparent 3 mm nodule in the left upper lobe (05:46). There are moderate\nsized right apical bulla. The thyroid appears grossly normal. There is no\ncervical lymphadenopathy. The submandibular and parotid glands are\nunremarkable.", + "output": "1. Normal appearance of the major arterial structures in the head and neck. \nNo evidence of aneurysm or flow-limiting stenosis. No evidence of large\nterritorial infarction.\n2. Periapical lucencies about the two right posterior most maxillary teeth.\n3. Possible 3 mm left upper lobe nodule warrants no additional followup if\nthere are no risk factors for lung malignancy such as smoking. If risk\nfactors exist then followup chest CT in ___ year is recommended." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, mass, mass effect or\nlarge territorial infarction. The ventricles and sulci are normal in size and\nconfiguration. The basilar cisterns are patent, and there is otherwise good\npreservation gray-white matter differentiation.\n\nNo acute fractures identified. The visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The globes are unremarkable.", + "output": "1. No acute intracranial abnormalities identified." + }, + { + "input": "There is enlargement of the bilateral palatine tonsils with moderate\npharyngeal/retropharyngeal edema. There is no evidence of discrete abscesses.\nThere are mildly prominent cervical lymph nodes, right greater than left,\nwhich are likely reactive in etiology. Evaluation of the aerodigestive tract\ndemonstrates no mass and no areas of focal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland is enlarged and demonstrates a subcentimeter\nnodule in the left thyroid lobe and two adjacent rim calcified nodules in the\nright thyroid lobe. There is no lymphadenopathy by CT criteria. The neck\nvessels are patent. There is prominence of the right internal jugular vein\nwithout evidence of associated pathology.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.\n\nThere is inflammation of the right inferior turbinate with small the coast\nretention cysts in the bilateral maxillary sinuses. Otherwise, the remaining\nparanasal sinuses, middle ear cavities and bilateral mastoid air cells are\nclear.", + "output": "1. No evidence of abscess. Enlargement of the bilateral palatine tonsils,\nmoderate pharyngeal edema and likely reactive cervical lymph nodes likely\nrepresents acute tonsillitis/pharyngitis.\n2. Prominence of the right internal jugular vein without evidence of\nassociated pathology.\n3. Bilateral subcentimeter thyroid nodules. The ___ College of Radiology\nguidelines suggest that in the absence of risk factors for thyroid cancer, no\nfurther evaluation is recommended.\n4. Mild paranasal sinus disease as described above." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Mucous retention cysts are seen within the\nbile maxillary sinuses. There is also a minimal mucosal thickening in the\nfrontoethmoidal recess bilaterally. The remaining visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality, with no evidence of acute intracranial\nhemorrhage or fracture.\n2. Paranasal sinus disease as described." + }, + { + "input": "There is no facial bone fracture. Pterygoid plates are intact. There is no\nmandibular fracture and the temporomandibular joints are anatomically aligned.\nThe orbits are intact. The globes and extra-ocular muscles are unremarkable. \nThere is no orbital hematoma.\n\nIncluded paranasal sinuses are clear. Included extracranial soft tissues are\nunremarkable.\nThere is approximately 8 mm depression of the inferior orbital wall with\nfree-floating fragment measuring approximately 1.1 cm. There is mildly\ncomminuted fracture of the left uncinate process (2:42, 601b:50). Small\namount intra orbital fat is seen between the fracture fragment in the intact\ninferior orbital wall.\nThere is mild facial swelling, especially over the left eye.\nThe left ostiomeatal unit is partially opacified. There is hyperdense\nair-fluid level within the left maxillary sinus. The remaining paranasal\nsinuses are clear.\nThe inferior rectus muscle is mildly expanded and is inferiorly displaced\nrelative to the optic nerve when compared to the contralateral side.", + "output": "1. Comminuted fracture of the inferior orbital wall with 8 mm depression of\nthe free-floating fragment as well as comminuted fracture of the left uncinate\nprocess, partially opacifying the left ostiomeatal unit.\n\n2. Asymmetric edema of the inferior rectus muscle and mild herniation of the\nintraorbital fat into the maxillary sinus. Intermittent entrapment of the\nmuscle cannot be excluded on the current imaging.\n\n3. Hyperdense air-fluid level within the maxillary sinus, concerning for\nhemorrhage.\n\nRECOMMENDATION(S): None.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___,\nM.D. in person on ___ at 9:38 am, 2 minutes after discovery of the\nfindings." + }, + { + "input": "Evaluation at the skullbase is limited due to patient motion and streak\nartifact. There is no evidence of acute infarction,hemorrhage,edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Evaluation at the skullbase is limited due to motion and streak artifacts.\nWithin these limits, no acute infarction or hemorrhage. No acute fracture." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Mildly\nprominent ventricles and sulci are somewhat age advanced.\n\nThere is no evidence of fracture. A small subgaleal hematoma is present at\nthe vertex. The visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "No acute intracranial process. Small subgaleal hematoma at the vertex." + }, + { + "input": "Evaluation of the posterior fossa and inferior frontal and temporal lobes is\nlimited by motion artifact. Within these limitations, there is no evidence of\ninfarction, hemorrhage, edema, or mass. The ventricles and sulci remain\nprominent in size for the patient's age but otherwise normal in configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "Slightly motion limited exam. Within these limitations, no evidence of acute\nintracranial process. Mild atrophy, advanced for age." + }, + { + "input": "There is mild periapical lucency associated with ___ tooth number 30 (series\n4, image 51) without evidence of cortical dehiscence. Additional periapical\nlucency associated with ___ tooth number 31 which demonstrates filling\nmaterial with cortical dehiscence of the lingual alveolar ridge (series 4,\nimage 49) is noted without aggressive appearance (series 4, image 49).\n\nThere is mild mucosal thickening along the bilateral maxillary sinus inferior\nalveolar recess. Wise, the remainder the visualized paranasal sinuses are\nclear. The frontal sinuses are not pneumatized. There is minimal leftward\ndeviation of the nasal septum without perforation. There is a small leftward\nprojecting spur. The ostiomeatal units are patent. The cribriform plates are\nintact. The lamina papyracea are intact. The skull-base foramina appear\nintact.\n\nThe examination is not optimized for evaluation of the brain parenchyma,\nhowever within this confine, visualized brain is grossly unremarkable. There\nare bilateral lens replacement otherwise orbits are unremarkable. The\nvisualized aerodigestive tract is grossly unremarkable.", + "output": "1. Periapical lucency ___ tooth number 30 is identified. An additional\nperiapical lucency ___ tooth number 31 with dehiscence of the lingual\nalveolar ridge is also identified. Given lack of aggressive features these\nmay represent radicular cyst/granulomas. Dental examination is recommended." + }, + { + "input": "There is an acute intraparenchymal hemorrhage at the right insular cortex\nmeasuring approximately 14 x 16 x 18 mm, with minimal surrounding edema. No\nsignificant mass effect. No large territorial infarction. The ventricles and\nsulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Acute focus of parenchymal hemorrhage at the right insular cortex measuring 18\nmm in maximal dimension with mild surrounding edema." + }, + { + "input": "Exam is mildly motion degraded. There is no intra-axial or extra-axial\nhemorrhage, mass, midline shift, or acute major vascular territorial infarct.\nGray-white matter differentiation is preserved. Ventricles and sulci are\nwithin normal limits.\nScattered opacification noted within the ethmoid air cells with mucosal\nthickening also noted in the maxillary sinuses and sphenoid sinuses. Skull\nand extracranial soft tissues are unremarkable.", + "output": "Mildly motion degraded exam without acute intracranial process." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\n The frontal recesses are patent. There is mild mucosal thickening along the\nfloor of the maxillary sinuses. There is a small mucous retention cyst along\nthe superior wall of the left maxillary sinus (601:60). There is mild mucosal\nthickening along the posterior sphenoid sinus. There are no air-fluid levels.\nThe ostiomeatal units are patent bilaterally.\n\nThe cribriform plates are intact. The lamina papyracea are intact. The\nsphenoid sinus septum inserts to the right of midline on the right lateral\nwall of the sphenoid sinus. The carotid canals appear well-covered by bone. \nThere is leftward nasal septal deviation with a spur contacting the left\ninferior turbinate. Bilateral Haller cells are present.", + "output": "1. Dental amalgam streak artifact limits study.\n2. Paranasal sinus disease, as described.\n3. Leftward nasal septal deviation with bony spur contacting the left inferior\nturbinate.\n4. Bilateral Haller cells." + }, + { + "input": "The patient is status post evacuation of a right subdural hematoma. A vertex\napproach extra-axial catheter. Small amount of hyperdense material likely\nrepresenting acute blood products from recent intervention overlying the right\ncerebral hemisphere. The subdural collection measures up to 1.6 cm in maximal\nthickness, with hyperdense component measures 9 mm in thickness near vertex,\nand extends along the anterolateral right frontal lobe.. Small amount of air\ntracks along the falx. There is also a small amount of air overlying the left\nfrontal lobe. There are 7 mm of leftward shift of midline structures,\npreviously 10 mm. The right ventricle is mildly effaced.. Decreased right\nuncal herniation. Scalp catheter in place.\n\nThe patient is status post right frontal craniotomy, with expected\npostsurgical changes. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "Interval subdural hematoma evacuation. Small volume of acute subdural blood\nproducts. Decreased midline shift." + }, + { + "input": "Patient is status post right frontal craniotomy for evacuation of a subdural\nhematoma, with interval removal of a right-sided subdural drain and resolution\nof pneumocephalus. A right frontoparietal subdural hematoma is decreased in\nthickness, currently measuring up to 8 mm in thickness compared with 16 mm\npreviously. The collection remains predominantly hyperdense, however the\nhyperdense components are slightly less dense than on prior. There has been\ninterval improvement in associated mass effect including effacement of the\nadjacent sulci and lateral ventricles as well as leftward midline shift,\ncurrently measuring up to 4 mm, compared with 7 mm previously. No new\nintracranial hemorrhage or evidence of acute large territorial infarction. \nBasal cisterns are patent.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Interval decrease in size of a right cerebral convexity subdural hematoma,\nwith interval improvement in associated mass effect including leftward midline\nshift, currently measuring up to 4 mm compared with 7 mm previously.\n2. No new intracranial hemorrhage or evidence of acute large territory\ninfarction." + }, + { + "input": "There are postoperative changes from prior right frontal and pterional\ncraniotomy.\n\nPreviously demonstrated 8 mm right frontal extra-axial fluid has resolved. \nThere is minimal residual right frontal dural thickening subjacent to the\ncraniotomy.\n\nThere is no evidence of infarction, hemorrhage, new extra-axial collection,\nmass, or mass effect. Prior mass effect, including midline shift, has\nresolved.\n\nThe ventricles and sulci are prominent, compatible with global parenchymal\nvolume loss, unchanged.\n\n The visualized paranasal sinuses and mastoids appear clear.\n\nThe globes and orbits are unremarkable.", + "output": "1. Interval resolution of right frontal extra-axial collection and associated\nmass effect.\n2. Minimal postsurgical right frontal dural thickening subjacent to the\ncraniotomy.\n3. No new acute intracranial abnormality.\n4. Global parenchymal volume loss." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or infarction.The\nventricles and sulci are normal in size and configuration. The basal cisterns\nappear patent and there is preservation of gray-white matter differentiation.\nThe visualized bony structures are grossly unremarkable.\n\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\n\nThere is bilateral, symmetric proptosis of the globes. No orbital mass is\nseen.", + "output": "No acute intracranial process. Bilateral symmetric proptosis of the globes.No\norbital mass is seen." + }, + { + "input": "Study is mildly degraded by motion.\nThere is no significant change from the exam performed on the day prior. \nThere is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are mostly clear. The\nvisualized portion of the orbits are unremarkable. Vascular calcification is\nseen in the vertebral artery bilaterally.", + "output": "1. Study is mildly degraded by motion. Within this limitation, the study\nappears normal." + }, + { + "input": "Chronic right MCA infarct, involving right frontal lobe, insula, basal\nganglia. Chronic infarcts bilateral cerebellum. There is associated ex vacuo\ndilatation of the right lateral ventricle.\n\nThere are severe chronic small vessel ischemic changes bilaterally. \nSuggestion of gray-white matter differentiation loss involving areas of left\nfrontal lobe cortex, consider acute ischemia if clinically appropriate. Brain\nMRI would be helpful in further evaluation if indicated.\n\nThere is no evidence of acute intracranial hemorrhage,edema,or mass. \nExtensive brain parenchymal atrophy.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Suggestion of gray-white matter differentiation loss in the left frontal\nlobe, consider acute infarct.\n\n2. Chronic right hemispheric, right basal ganglia and cerebellar infarct.\n\n3. Severe chronic small vessel ischemic changes. Generalized brain\nparenchymal atrophy.\n\nRECOMMENDATION(S): Brain MRI without contrast, if indicated.\n\nNOTIFICATION: The updated impression and recommendations were communicated\nvia telephone by Dr. ___ to Dr. ___ at 11:15 on ___, 10 min\nafter discovery." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nEncephalomalacia in the right cerebral hemisphere in the distribution of the\nright MCA is again noted in keeping with prior right MCA infarct. Associated\nex vacuo dilatation of the right lateral ventricle. Chronic infarct also\nnoted in the left inferior cerebellar hemisphere and smaller chronic infarct\nin the superior aspect of the right cerebellar hemisphere. There is no\nintracranial mass. No hemorrhage. No evidence of recent infarction.\n\nMild mucosal thickening involving the paranasal sinuses. The visualized\nportion of the orbits are unremarkable.\n\nCTA HEAD:\nModerate to severe calcific atherosclerotic changes of the right carotid\nsiphon with suspected moderate stenosis. The right MCA appear decreased in\nsize compared to the left, but this may be secondary to the large prior right\nMCA infarct. Occluded or hypoplastic A1 segment of the right ACA. Moderate\ncalcific atherosclerotic changes of the left carotid siphon, but no marked\nstenosis. Mild to moderate stenosis of the proximal left MCA M1 segment. \nFetal type origin of the right PCA. Multiple narrowings involving the PCAs\nwith a moderate to severe narrowing in the P 2 segment of the left PCA with\ndecreased arborization of the P3 and P4 segments on the left. Multiple\nmild-to-moderate narrowings involving the intracranial vertebral arteries\nbilateral. No intracranial aneurysm. The dural venous sinuses are patent.\n\nCTA NECK:\nMild calcific atherosclerotic changes at the origins of the ICAs bilateral,\nbut no stenosis according to NASCET criteria. Moderate narrowing at the\norigin of the right vertebral artery. The rest of the right vertebral artery\nis patent. The left vertebral artery is patent. The vertebral arteries\nappear codominant.\n\nOTHER:\nMotion artifact obscures the pulmonary parenchyma, large suspicious pulmonary\nnodule mass. Nonsuspicious thyroid nodules. There is no lymphadenopathy by\nCT size criteria. Left prepectoral pacemaker CTA. Degenerative changes of\nthe cervical spine", + "output": "Multiple chronic infarcts the largest in the right cerebral hemisphere in the\ndistribution of the right MCA as well as in the inferior left cerebellar\nhemisphere and superior aspect of the right cerebellar hemisphere.\n\nNo evidence of mass, hemorrhage, or recent infarction.\n\nExtensive mild to moderate atherosclerotic changes involving the intracranial\narteries. Decreased caliber of the right MCA is thought to be due 2 prior\nright MCA infarct and decreased metabolic demand.\n\nNo intracranial arterial aneurysm.\n\nMild calcific atherosclerotic changes at the origins of the ICAs bilateral,\nbut there is no stenosis according to NASCET criteria.\n\nModerate narrowing at the origin of the right vertebral artery. The rest of\nthe right vertebral artery is patent. The left vertebral artery is patent. \nThe vertebral arteries appear codominant." + }, + { + "input": "Re-demonstrated is encephalomalacia in the right frontal, parietal, and\ntemporal lobes with ex vacuo dilatation of the right lateral ventricle\ncompatible with chronic right middle cerebral artery territorial infarct. \nFocal hypodensities within the left inferior cerebellum and right superior\ncerebellum are compatible with areas of remote infarction. Periventricular,\nsubcortical and deep white matter hypodensities are nonspecific, but likely\nreflect the sequela of chronic microvascular infarction. There is no evidence\nof acute territorial infarct,hemorrhage,edema,or mass. There is prominence of\nthe ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Extensive atherosclerotic\ncalcifications of the cavernous carotid arteries are noted. Mild\natherosclerotic calcifications of the distal vertebral arteries are seen.", + "output": "1. No acute intracranial hemorrhage or mass effect.\n2. Chronic infarcts involving the right middle cerebral artery territory and\nboth cerebellar hemispheres.\n3. Chronic microvascular infarction." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Again seen is encephalomalacia within the right\nfrontal, parietal and temporal lobes with ex vacuo dilatation of the right\nlateral ventricle relative to the left, consistent with reported history of\nright middle cerebral artery infarction. Again seen are hypodensities within\nthe left inferior cerebellum and right inferior cerebellum, consistent with\nchronic infarction. There is extensive periventricular and subcortical white\nmatter hypodensity, which is nonspecific, but likely represents chronic\nmicrovascular ischemic changes. Again seen are extensive calcifications of\nthe bilateral carotid siphons. There is mild calcification of the V4 segments\nof the bilateral vertebral arteries.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically, no\nevidence of intracranial hemorrhage.\n2. Stable sequelae of prior infarctions, as described above." + }, + { + "input": "There is chronic infarction of the right frontoparietal region with ex vacuo\ndilatation of the right lateral ventricle and wallerian degeneration along the\nright cortical spinal tract. There is a chronic infarction of the left\ncerebellar hemisphere and the right cerebellar hemisphere as well. There is\nno evidence of large territorial infarction, hemorrhage, edema, or mass\neffect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. There are multiple hypodense lesions within\nperiventricular and subcortical white matter likely sequela small vessel\nischemic disease.\n\nThere is a punctate focus of hyperdensity on the postcontrast exam in the\nright frontal lobe (09:21) correlates with a cortical vessel seen on prior\nCTA.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. Patient is status post bilateral lens replacements.", + "output": "1. No acute intracranial abnormality, no hemorrhage. No evidence of\nintracranial metastasis.\n2. Stable sequela of prior infarctions as described above." + }, + { + "input": "There is no evidence of acute territorial infarction, intracranial hemorrhage\nor intracranial mass.\n\nThere is unchanged encephalomalacia of the right frontal and parietal lobes,\nand bilateral cerebellar hemispheres related to remote infarcts. There is\nex-vacuo dilatation of the right lateral ventricle. Wallerian degeneration is\nseen along the right cortical spinal tract. Moderate to severe confluent\nperiventricular and subcortical white matter hypodensities, are nonspecific\nbut most likely represent sequela from chronic microangiopathic changes. \nAtherosclerotic calcifications are noted of the intracranial segments of the\ninternal carotid and vertebral arteries.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. There are\nbilateral lens replacements. The visualized portion of the orbits are\notherwise unremarkable.", + "output": "1. No evidence of acute large vascular territorial infarction, intracranial\nhemorrhage or large intracranial mass.\n2. Chronic changes related to remote infarcts and small vessel disease, as\ndetailed above." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of acute major vascular territorial\ninfarction, hemorrhage, edema, or mass effect. Patchy and confluent\nhypoattenuation in the supratentorial white matter is nonspecific, but may\nrepresent the sequela of chronic small vessel ischemic disease. The\nventricles and sulci are enlarged due to age-related parenchymal volume loss.\n\nThere is minimal mucosal thickening in the right maxillary sinus and a small\nmucous retention cyst in the left maxillary sinus. There are large periapical\nlucencies ___ 14, and small periapical lucencies ___ 13 and 15. There\nis mild mucosal thickening in bilateral inferior frontal sinuses with apparent\nocclusion of the frontoethmoidal recesses. There is a 0.9 x 0.7 cm osteoma in\nthe right frontal sinus. Mastoid air cells are well aerated. The patient is\nstatus post bilateral cataract surgery.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without evidence for flow-limiting stenosis or aneurysm\nformation. There are moderate atherosclerotic calcifications of the cavernous\nand supra clinoid internal carotid arteries without flow-limiting stenosis. \nThe major dural venous sinuses are patent.\n\nCTA NECK:\nThe right brachiocephalic and left common carotid arteries share a common\norigin, a normal anatomic variant. Proximal common carotid arteries are\nmedialized, coursing posterior to the thyroid gland. There is mild calcified\nand noncalcified plaque at the aortic arch and in the proximal right internal\ncarotid artery. There is no internal carotid stenosis by NASCET criteria. \nLeft vertebral artery is widely patent. The short-segment mild narrowing of\nthe right vertebral artery at C5 is unchanged and is likely related to an\nadjacent endplate osteophyte.\n\nOTHER:\nThe visualized portion of the lungs are clear. The thyroid gland appears\nheterogeneous, but evaluation is limited by streak artifact from the shoulder\ngirdles and monitoring leads overlying the patient's chest. There is no\nlymphadenopathy by CT size criteria. The 3 mm anterolisthesis of C3 on C4 and\n3 mm retrolisthesis of C5 on C6 are unchanged. There are other multilevel\ndegenerative changes of the cervical spine, including moderate to severe\nspinal canal stenosis at C6-7.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. No evidence for flow-limiting stenosis in the major cervical or\nintracranial arteries. Mild short-segment narrowing of the right vertebral\nartery at the level of C5 is unchanged and likely related to an adjacent\nendplate osteophytes.\n3. Multiple periapical lucencies in the left maxilla. Please correlate with\ndental exam whether active inflammation or infection may be present.\n4. Multilevel cervical degenerative disease with moderate to severe spinal\ncanal stenosis at C6-7.\n\nRECOMMENDATION(S): MRI would be more sensitive for an acute infarction, if\nclinically warranted." + }, + { + "input": "There is a right frontal subgaleal hematoma.\n\nThere is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\n\nThere is mild mucosal thickening of the bilateral ethmoid air cells, bilateral\nmaxillary frontal sinuses, and left sphenoid sinus. Mastoid air cells and\nmiddle ear cavities are well aerated. The bony calvarium is intact.", + "output": "1. Right subgaleal hematoma.\n2. No acute intracranial hemorrhage, fracture, or other acute intracranial\nabnormality." + }, + { + "input": "This study is severely limited by hardware artifact. Patient is status post a\nright and left frontal approach DBS placement. Postoperative frontal\npneumocephalus is noted.\n\nWithin the severe limitations of hardware artifact, there is no evidence of\nlarge hemorrhage seen.", + "output": "1. Postoperative frontal pneumocephalus is noted.\n2. Within the severe limitations of hardware artifact, there is no evidence of\nlarge hemorrhage seen." + }, + { + "input": "The study is limited by surgical hardware artifact.\n\nPostsurgical changes related to recent bilateral DBS leads placement,\nincluding the peripherally located pneumocephalus, are noted. Bilateral lead\ntips are seen terminating at the bilateral subthalamic regions. Within the\nlimits of this study, there is no evidence of acute large territorial\ninfarction, hemorrhage, edema, nor mass. The ventricles and sulci are normal\nin size and configuration.\n\nThere is no evidence of fracture.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. The study is limited by surgical hardware artifact.\n2. Within the limits of this study, there is no evidence of acute large\nterritorial infarction, hemorrhage, edema, nor mass.\n3. The patient is status post DBS leads placement, with the tips terminating\nat the bilateral subthalamic regions." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor discrete mass. The ventricles and sulci are somewhat prominent given the\npatient's age, compatible with age-advanced involutional changes.\n\nThere is no evidence of fracture. With the exception of mild mucosal\nthickening of the anterior ethmoid air cells, the visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Age-advanced involutional changes." + }, + { + "input": "CTA NECK:\n\nThere is moderate atherosclerotic disease along the aortic arch. The\ninnominate artery appears normal in caliber without luminal irregularity.\n\nThere is calcified plaque mildly narrowing the origin and proximal course of\nthe left subclavian artery. There is also mild calcified plaque in the\nproximal right subclavian artery without significant narrowing.\n\nThe origin, V1 and proximal V2 segments of the left vertebral artery are not\nidentified and likely occluded. There is reconstitution of flow in the left\nV2 segment at the level of the C5 vertebral body with multifocal areas of\nirregularity and narrowing more distally as a result of atherosclerotic\ndisease. The V3 and V4 segments of the left vertebral artery are patent. The\nleft V4 segment is small and the basilar artery is predominantly supplied by\nthe dominant right vertebral artery. The dominant right vertebral artery is\nwidely patent.\n\nThe common carotid arteries are within normal limits. There is mixed\ncalcified and soft plaque at the carotid bifurcations extending into the\nproximal portion of the internal carotid arteries bilaterally. This results\nin approximately 25% narrowing of the proximal right internal carotid artery\nand no significant narrowing of the proximal left internal carotid artery by\nNASCET criteria.\n\nThere is a 7 x 9 mm anteromedially directed pseudoaneurysm or penetrating\natherosclerotic ulcer arising from the distal cervical right internal carotid\nartery (series 2, image 218). There is also a partially calcified medially\ndirected pseudoaneurysm or penetrating atherosclerotic ulcer arising from the\ndistal cervical left internal carotid artery measuring 7 x 7 mm (series 2,\nimage 201).\n\nOTHER:\n\nThe mastoid air cells are partially opacified bilaterally. There is extensive\nopacification of partially imaged sphenoid sinuses. This may be secondary to\nprolonged supine positioning in the inpatient setting. There is also mucosal\nthickening and mucous retention cysts in the partially included maxillary\nsinuses.\n\nThere are degenerative changes in the cervical spine.\n\nThe patient is status post tracheostomy and right thoracotomy. Intrathoracic\nfindings are described in the concurrent chest CTA report.", + "output": "1. No evidence for a trachea-innominate fistula.\n2. Occlusion of the origin, V1, and proximal V2 segments of the non dominant\nleft vertebral artery with reconstitution of flow in the mid V2 segment and\nmultiple focal irregularities more distally, compatible with sequela of\natherosclerosis. The left V3 and V4 segments are patent.\n3. Mild atherosclerotic stenosis of the proximal left subclavian artery.\n4. Atherosclerotic disease at the carotid bifurcations extending into the\nproximal internal carotid arteries results in approximately 25% luminal\nnarrowing of the right and no significant narrowing of the left internal\ncarotid artery by NASCET criteria.\n5. Bilateral medially directed distal cervical internal carotid artery\npseudoaneurysms or penetrating atherosclerotic ulcers measuring approximately\n7 x 9 mm on the right and 7 x 7 mm on the left.\n6. Paranasal sinus abnormalities are partially visualized and could be\nsecondary to prolonged positioning in the inpatient setting, though\nsuperimposed infection cannot be excluded on the basis of imaging.\n7. Please refer to concurrent dedicated chest CTA for full description of\nintrathoracic abnormalities.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 1:12 pm, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nProminence of ventricles and sulci likely reflect involutional changes. \nPeriventricular and subcortical white matter hypodensities likely reflect\nchronic ischemic vessel disease.\nThere is near complete opacification of left sphenoid sinus. The visualized\nportion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is focal stenosis of basilar artery origin (3: 200).\nDistal left vertebral artery V4 segment is narrowed (03:197). Hypoplastic\nright vertebral artery terminates into right ___, normal variant.\n\nThe vessels of the circle of ___ and their principal intracranial branches\nare patent. The dural venous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n0.6 segment left subclavian artery (3:69) is nonenhancing, possibly due to\nartifact, however stenosis cannot be ruled out.\n\nOTHER:\nThe visualized portion of the lungs are clear. Multiple coarse calcifications\nare noted in the thyroid. There is no lymphadenopathy by CT size criteria.", + "output": "1. Focal stenosis of basilar artery origin is identified. Distal left\nvertebral artery V4 segment is narrowed. Hypoplastic right vertebral artery\nterminates into right ___.\n2. 0.6 segment left subclavian artery is nonenhancing, possibly due to\nartifact, however stenosis cannot be ruled out." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or mass\neffect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are essentially stable since the recent comparison, and most\ncompatible with small vessel ischemic disease. Atherosclerotic vascular\ncalcifications are noted of bilateral vertebral and cavernous portions of\ninternal carotid arteries.\n\nThere is no evidence of fracture. There is near complete opacification of the\nleft sphenoid sinus with areas of high density and suggested adjacent bony\nsclerosis (see 2:4). Right anterior ethmoid air cell probable osteoma is\nnoted (see 03:14). The right sphenoid sinus demonstrates an air-fluid level. \nMinimal bilateral ethmoid air cell mucosal thickening is present. The left\nmastoid air cells are hypoplastic and the noted air cells are completely\nopacified. There is complete opacification of the left epitympanum with fluid\nsurrounding the ossicles, unchanged.", + "output": "1. No acute intracranial abnormality. Please note MRI of the brain is more\nsensitive for the detection of acute infarct.\n2. No evidence acute intracranial hemorrhage or fracture.\n3. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described.\n4. Completely opacified hypoplastic left mastoid air cells, unchanged.\n5. Nonspecific complete opacification of left epitympanum, unchanged. If\nconcern for cholesteatoma or ossicular erosion, consider dedicated temporal\nbone CT for further evaluation.\n6. Paranasal sinus disease with findings concerning for acute, chronic and/or\nfungal sinusitis, as described.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 10:11 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Periventricular and subcortical\nwhite matter hypodensities are likely sequela of chronic small vessel disease.\nVentricles and sulci are prominent compatible with global volume loss. \nProminent retrocerebellar CSF is likely an arachnoid cyst.. Basilar cisterns\nare patent.\n\nAerosolized debris is noted within the left sphenoid sinus. A 3 mm right\nethmoid air cell osteoma is noted. The left mastoids are poorly pneumatized\nand there is opacification of the epitympanum. Included paranasal sinuses and\nright mastoids are otherwise essentially clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Minimal periventricular white matter hypodensity is consistent\nwith chronic microvascular ischemic disease. Age appropriate involutional\nchanges are noted. A focal area of extra-axial calcification is seen along the\nleft middle cranial fossa of unclear etiology, though of doubtful clinical\nsignificance. Ventricles and sulci are normal in overall size and\nconfiguration. The imaged paranasal sinuses are clear. Mastoid air cells and\nmiddle ear cavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass lesion. There\nis diffuse parenchymal volume loss with commensurate prominence of the\nventricles and sulci. There are nonspecific periventricular subcortical\nhypodensities, likely a sequela of chronic small vessel microangiopathy. The\nbasilar cisterns appear patent. There is mild mucosal thickening of the\nethmoid air cells. The mastoid air cells appear partially opacified. There\nis no displaced calvarial fracture.\n\nCTA HEAD:\nThere is a 3 mm aneurysm arising from the supraclinoid segment of the right\ninternal carotid artery projecting inferiorly (603b:36, 5:252). Otherwise,\nthe circle of ___ and the major intracranial branches appear patent without\nsignificant stenosis, occlusion, or other aneurysms. The dural sinuses appear\npatent.\n\nCTA NECK:\nBilateral internal carotid arteries appear patent without significant stenosis\nor occlusion by NASCET criteria. Bilateral vertebral arteries appear patent. \nThere are mild vascular calcifications of the aortic arch.\n\nOTHER:\nThe visualized portions of the lungs and thyroid gland appear unremarkable. \nThere are degenerative changes of the cervical spine. There is narrowing of\nthe oropharynx secondary to prominent palatine tonsils. Small calcific foci\nare seen within the palatine tonsils, suggestive of tonsilliths.", + "output": "1. No evidence of infarction, hemorrhage, edema, or mass lesion. Mild\nparenchymal volume loss with nonspecific periventricular and subcortical white\nmatter hypodensities, likely chronic small vessel microangiopathy.\n2. Aneurysm arising from the supraclinoid segment of the right internal\ncarotid artery measuring 3 mm.\n3. No significant stenosis, dissection, or occlusion.\n4. Narrowing of the oropharynx secondary to prominent palatine tonsils with\npunctate tonsilliths." + }, + { + "input": "No evidence for acute intracranial hemorrhage, edema, mass effect, or loss of\ngray/white matter differentiation. ___ cisterna magna is a normal variant. \nSlight prominence of other extra-axial spaces, unexpected for the patient's\nage, indicates mild degree of global parenchymal volume loss. The ventricles\nare normal in size.\n\nThere is no evidence of fracture. There is mild mucosal thickening in the\nethmoid air cells, inferior frontal sinuses, sphenoid sinuses, and partially\nvisualized maxillary sinuses. Right mastoid air cells and partially\nvisualized left mastoid air cells appear clear.", + "output": "No evidence for acute intracranial abnormalities." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass.\nSubcortical and periventricular white matter hypodensities are noted and\nappear similar to the FLAIR hyperintensities seen on prior MR, and are likely\nthe sequela of chronic small vessel ischemic disease. No small chronic right\ncerebellar infarct is again noted. There is mild prominence of the ventricles\nand sulci suggestive of involutional changes. Atherosclerotic calcifications\nare seen along bilateral carotid siphons.\n\nThere is no evidence of fracture. Submucosal retention cysts are seen in the\nethmoid air cells. The visualized portion of the remaining paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits show bilateral lens replacement.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, shift of normally\nmidline structures or acute major vascular territorial infarction. Ventricles\nand sulci are normal in size and configuration. Mild periventricular white\nmatter hypodensities are likely the sequela of chronic small vessel ischemic\ndisease. The basal cisterns appear patent and there is preservation of\ngray-white matter differentiation.\n\nThere is no fracture. There is moderate mucosal thickening of the ethmoidal\nair cells. Otherwise, the remaining visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The globes are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "HEAD CT: There is some patient motion on a few images. There is no evidence\nof acute intracranial hemorrhage, edema, mass effect or shift of normally\nmidline structures. Periventricular white matter hypodensities most likely\nrepresent sequela of chronic microvascular ischemic disease in a patient of\nthis age and appear unchanged from the prior study. The gray-white matter\ninterface is otherwise preserved without evidence of acute major vascular\nterritorial infarct. The ventricles and sulci are normal in size and\nconfiguration for the patient's age. The basal cisterns appear patent. The\nimaged paranasal sinuses, middle ear cavities and mastoid air cells are clear\nbilaterally. The bony calvaria appear intact.", + "output": "Some patient motion on a few images. No evidence of acute intracranial\nprocess." + }, + { + "input": "The right posterior approach ventriculoperitoneal shunt terminates in the\noccipital horn of the right lateral ventricle. The lateral and third\nventricles are diffusely enlarged, somewhat out of proportion to the\nsurrounding sulci. Trace periventricular hypodensities are nonspecific and\ncould represent mild transependymal CSF migration or chronic microvascular\nischemic changes. No intracranial hemorrhage, mass, or large territorial\ninfarct is seen.\n\nNo osseous abnormalities seen. Other than partial opacification of the left\nmaxillary sinus, the remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable except for scleral\nplaques.", + "output": "1. Findings could suggest hydrocephalus. Prior imaging for comparison would\nbe helpful.\n2. Right posterior approach ventriculoperitoneal shunt terminates in the\noccipital horn of the right lateral ventricle.\n3. No intracranial hemorrhage or large vascular territory infarct.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 6:52 pm, 2 minutes after\ndiscovery of the findings." + }, + { + "input": "Please note that noncontrast head CT is not sensitive for evaluation of small\nintracranial lesions. Within this limitation, there is no evidence of edema,\nmass, or mass effect. There is no intracranial hemorrhage. Gray-white matter\ndifferentiation is preserved. Diffuse prominence of the ventricles and sulci\nis in keeping with age related involutional changes. The paranasal sinuses\nare clear. The orbits are notable for bilateral cataract extractions. No\nsuspicious osseous lesions identified. Osteoid integrated dental implants are\nnoted.", + "output": "1. No evidence of metastatic disease within limitations of a noncontrast head\nCT. No acute intracranial abnormality.\n2. Age related involutional changes." + }, + { + "input": "There is no evidence of fracture, infarction, hemorrhage, edema, or mass. \nGeneralized brain parenchymal atrophy, with frontal lobe predominance, stable\nsince prior.. No significant hippocampus atrophy on either side. There is no\nabnormal enhancement on post contrast images. No metastasis.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No metastases." + }, + { + "input": "There is no evidence of acute large territorial infarction, intracranial\nhemorrhage, edema, or mass.\n\nThere is prominence of the ventricles and sulci suggestive of age-related\ncerebral volume loss.\n\nNo acute osseous abnormalities seen. The partially imaged paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The orbits demonstrate\nno acute abnormalities.", + "output": "No acute intracranial process. Please note MRI is more specific for\nevaluation of ischemia." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Incidental\nnote is made of focal bony defects of the bilateral lamina papyracea with\nherniation of intraorbital fat, likely related to prior fractures. The\nbilateral medial rectus muscles are intact. The visualized portion of the\norbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is minimal soft tissue swelling over the right frontal bone. There is\nno evidence of fracture. There is a right nasal polyp. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "No acute intracranial process. Please note that MRI is more sensitive for the\ndetection of acute infarction." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territory infarct. Gray-white matter\ndifferentiation is preserved. There is no hydrocephalus. The visualized\nparanasal sinuses demonstrate minimal mucosal thickening in right frontal\nsinus. There is also partially imaged minimal mucosal thickening in the\nbilateral maxillary sinuses which also contain small mucous retention cysts. \nRight nasal polyp is re-demonstrated. The mastoid air cells are clear. No\nacute fracture is seen.", + "output": "No acute intracranial process." + }, + { + "input": "The gray-white matter differentiation is intact without evidence of acute\nterritorial infarct, hemorrhage, mass, or mass effect. The ventricles and\ncortical sulci are mildly prominent. The extra-axial spaces are unremarkable.\n\nThe orbits, calvarium, and soft tissues are unremarkable. The visualized\nparanasal sinuses and mastoid air cells are clear.", + "output": "Unremarkable head CT without CT evidence of metastases. Please note contrast\nenhanced MRI of the brain is more sensitive for the evaluation of intracranial\nmetastatic disease." + }, + { + "input": "There is no evidence of fracture, infarction, hemorrhage, edema, or mass. \nThere is mild prominence of the ventricles and sulci suggestive of\ninvolutional changes. There is no abnormal enhancement on post contrast\nimages.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "No evidence of intracranial metastatic disease or abnormal enhancement.\n\nRECOMMENDATION(S): Please note that gadolinium enhanced MR is more sensitive\nfor the detection of metastatic lesions, if amenable." + }, + { + "input": "There is prominence of the soft palate, (series 602b, image 32), which may\nrepresent underlying mass lesion versus physiologic swallowing. The adenoids\nand palatine tonsils appear unremarkable.\n\nThere appears to be thickening of the aryepiglottic folds as well as an\nenhancing 1.9 x 1.8 x 1.8 cm (AP, TRV, SI) lesion of the midline and right\nhypopharynx and laryngeal vestibule (series 2, image 47; series 601b, image\n37). The right piriform sinus is asymmetrically prominent relative to the\nleft. This enhancing lesion extends down to the level of the supraglottis\n(series 2, image 51).\n\nThere may also be thickening of the glottis itself (series 2, image 55)\nmeasuring approximately 1.9 x 1.6 cm (AP, TRV), with effacement of the\ninferior aspect of the left piriform sinus.\n\nInferiorly, there is a right paraesophageal 2.4 x 1.7 cm enhancing mass\n(series 2, image 74) which may represent a paraesophageal lymph node with\nleftward displacement and effacement of the esophagus with loss of the\nintervening fat plane, which can be seen on prior CT chest of ___.\n\nThere are multiple pulmonary nodules in the visualized right and left lung\napices, measuring up to 6 mm, better evaluated on concurrent CT chest. There\nis also a 1.5 cm necrotic left hilar lymphadenopathy (series 2, image 102)\nunchanged from prior exam.\n\nMultiple lytic osseous lesions of the cervical and visualized thoracic spine,\nwith dominant lesion in the C4 vertebral body measuring up to 1.3 cm,\ncompatible with osseous metastatic disease. Lytic osseous lesions are also\nvisualized in the the sternum and ribs. There is no clear evidence for acute\npathologic fracture. Multilevel degenerative changes, including\nintervertebral osteophytes, disc bulges and loss of intervertebral disc height\nis identified. This is most prominent at C4-C5 and C5-C6 where there is at\nleast moderate spinal canal narrowing and moderate to severe bilateral neural\nforaminal narrowing.\n\nThe cervical vessels are patent. The major salivary glands are unremarkable. \nThe visualized orbits are unremarkable. Visualized brain parenchyma is\ngrossly unremarkable.", + "output": "1. Heterogeneous enhancing soft tissue lesions centered in the midline and\nright hypopharynx and laryngeal vestibule measuring approximately 1.9 cm in\ngreatest dimension, suspicious for metastatic disease.\n2. There is also thickening of the glottis measuring a conglomerate 1.9 cm,\nwith apparent effacement of the inferior aspect of the left piriform sinus. \nDirect visualization is recommended for further evaluation.\n3. There is thickening of the soft palate, which likely represents physiologic\nswallowing, however direct visualization is also recommended to exclude\nunderlying lesion.\n4. Right paraesophageal abnormal lymph node with obliteration of the\nintervening fat plane of the esophagus and left necrotic hilar lymph node is\nsimilar to prior examination.\n5. Diffuse osseous lesions are compatible with metastatic disease, as\ndescribed above.\n6. Multiple bilateral apical pulmonary nodules, better evaluated on concurrent\nCT chest.\n\nRECOMMENDATION(S): Recommend direct visualization of the above findings.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 6:10 ___, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect. The right pyriform sinus is smaller than left and there is\nslight fullness in this region. This appears to be secondary to a medially\nplaced right internal carotid artery the retropharyngeal region (3:61).\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.", + "output": "1. No concerning lesions identified. No evidence of lymphadenopathy.\n2. Slight fullness in the region of right pyriform sinus appears to be due to\nmedialized right internal carotid artery." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. There are chronic bilateral lacunar infarcts. Prominent\nventricles and sulci compatible with age-related involutional changes. \nPeriventricular subcortical white matter hypoattenuation likely represents\nchronic small vessel ischemic disease.\n\nThere is a tiny right frontal subgaleal hematoma (series 3: Image 41) without\nunderlying fracture or fracture elsewhere. There is mild mucosal thickening\nof bilateral ethmoid air cells, small mucous retention cyst identified in the\nleft maxillary sinus. Remaining paranasal sinuses are clear. Mastoid air\ncells and middle ear cavities are well aerated. The bony calvarium is intact.", + "output": "Tiny right frontal subgaleal hematoma without underlying fracture or fracture\nelsewhere. No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute major vascular territory\ninfarction,hemorrhage,edema, or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. Atherosclerotic calcifications\nare seen in the left carotid siphon. Ill-defined periventricular and\nsubcortical white matter hypodensities are nonspecific but likely due to\nchronic sequela of small-vessel ischemic disease. Hypodensities in the\nbilateral basal ganglia and left insula are compatible with old lacunar\ninfarcts.\n\nA 6 mm thick left occipital subgaleal hematoma. There is no evidence of acute\ndisplaced calvarial fracture. Mucous retention cyst is seen in the left\nmaxillary sinus. Otherwise, the remaining visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The patient is\nstatus post lens resections.", + "output": "1. No acute intracranial abnormalities on noncontrast head CT. Specifically\nno intracranial hemorrhage or large territory infarct.\n2. Bilateral chronic lacunar infarcts.\n3. 6 mm thick left occipital scalp hematoma without acute displaced calvarial\nfracture." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or mass.\nHypodensities in the bilateral basal ganglia are similar to prior, suggestive\nof remote lacunar infarcts. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. There are periventricular and subcortical\nhypodensities, which may represent small vessel ischemic changes.\n\nThere is a posterior midline scalp hematoma measuring approximately 6 mm in\nmaximum thickness, without evidence of underlying fracture. There is a left\nmaxillary mucous retention cyst. Minimal mucosal thickening is seen within\nthe ethmoid air cells bilaterally. The visualized portion of the remaining\nparanasal sinuses, mastoid air cells, and middle ear cavitiesare otherwise\nessentially clear. There are bilateral lens replacements.", + "output": "1. Posterior midline scalp hematoma measuring approximately 6 mm in maximum\nthickness, without evidence of underlying fracture.\n2. No acute intracranial abnormality otherwise detected." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Subcortical white matter\nhypodensities are again seen, likely sequela of chronic small vessel disease\nas well as suspected prominent perivascular spaces. Additionally chronic\nlacunar infarcts noted along the posterior limbs of the internal capsules.. \nVentricles and sulci are prominent compatible with volume loss.\n\nIncluded paranasal sinuses and mastoids are clear noting a right frontal sinus\nosteoma and a left maxillary sinus mucous retention cyst. Skull and\nextracranial soft tissues are unremarkable.", + "output": "No acute intracranial process. No hemorrhage." + }, + { + "input": "Study is mildly degraded by motion.\n\nThe has been no interval change in the maximal dimension of the right subdural\nhematoma that extends along the frontal, parietal, temporal and occipital\nlobes. There is a leftward shift of 5.0 mm, (02:21) which has decreased when\ncompared to previously measured which shift of 8.5 mm. There is an interval\nincrease in the left subdural hematoma which measures 1.2 cm and the\npreviously measured 6.9 mm at maximum a dimension. There is soft tissue\nswelling of the right occiput.\n\nThere is no evidence of fracture. There is partial opacification of right\nmastoid air cells. The visualized portion of the paranasal sinuses, and\nmiddle ear cavities are clear. The right orbit demonstrate lens replacement\npostsurgical changes. Evolving left parietal scalp soft tissue swelling and\nsubgaleal hematoma is noted. Soft tissue densities are noted within bilateral\nexternal auditory canals which may represent cerumen.", + "output": "1. Study is mildly degraded by motion.\n2. Interval increase in left acute subdural hematoma from 6.9 mm to 1.2 cm.\n3. Decrease in leftward shift from 8.5 mm 5.0 mm, with patent basilar\ncisterns.\n4. Grossly stable right subacute on chronic subdural hematoma.\n5. Evolving left parietal scalp soft tissue swelling and subgaleal hematoma.\n6. Nonspecific partial opacification of right and mastoid air cells.\n\nNOTIFICATION: The findings were discussed with ___, N.P. By ___\n___, M.D. on the telephone on ___ at 12:20 pm, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "Right subdural hematoma that extends along the frontal, parietal, temporal,\nand occipital lobes is unchanged to slightly decreased in size compared to\nprior. There is persistent right-to-left midline shift, also unchanged\nmeasuring approximately 6 mm (series 2; image 20). The left subdural hematoma\nis unchanged compared to prior measuring 1.2 cm. Soft tissue swelling of the\nright occiput is slightly improved compared to prior. Evolving left parietal\nscalp soft tissue swelling and subgaleal hematoma are unchanged. The\nventricles are unchanged in size and configuration.\n\nThere is no evidence of fracture. Again seen is partial opacification of the\nright mastoid air cells. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. Patient is status post\nright orbit lens replacement. Soft tissue densities within the bilateral\nexternal auditory canals are unchanged and may represent cerumen.", + "output": "Grossly unchanged left acute subdural hematoma and unchanged to slight\ndecrease in size of right subacute on chronic subdural hematoma with\nunchanged, approximately 6 mm, right-to-left midline shift. Ventricles are\nunchanged in size and configuration." + }, + { + "input": "Bilateral subdural hematomas are stable in size compared to 1 day ago. Right\nsubdural hematoma measures 1.6 cm in thickness (02:26). Left subdural\nhematoma measures 1.2 cm in thickness (02:23). Left subdural hematoma is more\nhyperdense compared to the right, similar to before. Leftward midline shift\nby 5 mm is unchanged. No new hemorrhage is identified.\nThe ventricles and sulci are stable in size and configuration.\n\nThere is no evidence of fracture. There is under pneumatization of right\nmastoid air cells. Ligamentous thickening at the cervical junction causes\nsevere spinal canal narrowing and spinal cord narrowing, similar to before.", + "output": "1. Bilateral subdural hematomas and leftward midline shift are stable compared\nto 1 day ago.\n2. Ligamentous thickening at the cervical junction causes severe spinal canal\nnarrowing and spinal cord narrowing, similar to before." + }, + { + "input": "There has been interval evacuation of a right subdural hematoma with a\ncatheter terminating in the right subdural space. Postsurgical air is seen in\nthe right subdural space. A previously seen hyperdense left subdural hematoma\nmeasuring 12 mm in greatest axial thickness is unchanged since the prior\nstudy. No evidence for of new hemorrhage. There is minimal midline shift,\nimproved since the prior study. Ventricles and sulci are stable in overall\nsize and configuration. The imaged paranasal sinuses are clear. The right\nmastoid air cells are underpneumatized. The left mastoid air cells and middle\near cavities are well aerated.", + "output": "1. Interval evacuation of right subdural hematoma with postsurgical changes\nnoted.\n2. Acute left subdural hematoma is unchanged since the prior study.\n3. Minimal midline shift is improved since the prior study." + }, + { + "input": "The patient is status post right craniotomy with a right subdural drain. \nPneumocephalus has decreased. Trace hyperdense extra-axial blood products\nremain. Mixed density left subdural hematoma is unchanged in size, with\nunchanged adjacent left parietal and occipital sulcal effacement, and with\nunchanged trace extension along the falx and left tentorium. 2-3 mm leftward\nshift of midline structures is unchanged. Underlying age-related global\nparenchymal volume loss is again noted. Re-demonstrated are confluent\nhypodensities in the subcortical and periventricular white matter that are\nnonspecific but likely due to microangiopathic disease, (02:18).\n\nThe right mastoid is underpneumatized and partially opacified, similar to\nprior.", + "output": "1. Status post right subdural hematoma evacuation with decreased\npneumocephalus compared to 1 day earlier, and trace residual hyperdense\nextra-axial blood products.\n2. Stable left subdural hematoma.\n3. Stable mass effect." + }, + { + "input": "Status post removal of the right subdural drain, there is interval\nre-accumulation of the right frontoparietal convexity fluid measuring low\ndensity on Houn___ units (likely CSF) resulting in interval 5 mm leftward\nmidline shift, previously measuring 1 mm. This fluid collection measures 1.3\ncm in maximum thickness.. A right frontal pneumocephalus is noted. The known\nleft convexity layering acute on chronic subdural collection is unchanged,\nmeasuring 1.1 cm in maximum thickness (02:19). Post right frontal craniotomy\nchanges are again noted.\n\nThere is no evidence of acute large territorial infarction intraparenchymal\nhemorrhage, edema,or mass. There is no downward herniation the ventricles and\nsulci are normal in size and configuration. The deep, subcortical\nperiventricular white matter hypodensities are nonspecific and likely\nrepresent sequela of chronic melasma changes.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nethmoid air cells. The remainder of the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Status post removal of the right subdural drain, there is interval\nreaccumulation of the right frontoparietal convexity fluid (likely CSF)\nresulting in interval 5 mm leftward midline shift without downward herniation.\nThis fluid collection measures 1.3 cm in maximum thickness.\n2. Unchanged left convexity acute on chronic subdural hematoma.\n3. Persistent right pneumocephalus.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 5:50 am, 1 minutes after\ndiscovery of the findings." + }, + { + "input": "Interval placement of a left frontal approach subdural drain is visualized and\nterminates in the left subdural space with interval decrease in subdural fluid\ncollections now measuring 13 mm, previously measuring 21 mm. There is\npostoperative pneumocephalus, and a small amount of dense material is\nvisualized adjacent to the drain site likely representing acute blood products\n(03:35). There is re-demonstration of a left convexity layering acute on\nchronic subdural collection that is grossly unchanged in appearance measuring\nup to 1.8 cm (03:34), unchanged in size from prior.\n\nThere is no evidence of infarction or mass. The ventricles and sulci are\nstable in size and configuration. Periventricular and subcortical white matter\nhypodensities are nonspecific, but likely reflect sequelae of chronic small\nvessel ischemic disease.\n\nA left frontal burr hole and right posterior parietal burr hole are unchanged\nin appearance. There is no evidence of fracture. The visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nThe visualized portion of the orbits are unremarkable.", + "output": "1. Status post placement of left frontal approach subdural drain with interval\ndecrease in size of subdural collection though high-density products are\nvisualized adjacent to drain terminus.\n2. Grossly unchanged left convexity acute on chronic subdural hematoma.\n\nNOTIFICATION: The findings were discussed with ___, N.P. by\n___, M.D. on the telephone on ___ at 3:38 pm." + }, + { + "input": "There is interval evolution of postoperative changes status post left\ncraniotomy and multi compartment intracranial hemorrhages/subdural fluid\ncollections. Similar volume/degree of bilateral mixed density subdural\nhematomas and left superior frontal subarachnoid hemorrhage, without evidence\nof new hemorrhage. A left frontal subdural drain is again visualized.\n\nThere is no evidence of infarction or new hemorrhage. The ventricles and\nsulci are unchanged configuration.\n\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\nThe orbits are unremarkable.", + "output": "Expected evolution of postoperative changes status post left craniotomy and\nmulti compartment intracranial hemorrhages, without significant change. No\nevidence of new hemorrhage or mass effect." + }, + { + "input": "Since the prior examination, a left trans frontal subdural drain has been\nremoved. Interval decrease size of bilateral subdural mixed age hematomas,\nmeasuring up to 1.2 cm on the right and 0.9 cm on the left. No evidence of\nnew hemorrhage. No acute large territory infarct. The sulci, ventricles and\ncisterns are within expected limits for the patient's age. No acute osseous\nabnormality. The visualized orbits are unremarkable, noting right lens\nreplacement. The visualized paranasal sinuses are essentially clear. The\nmastoid air cells and middle ears appear clear. Bilateral burr holes are\nre-identified.", + "output": "1. Interval decrease size of bilateral cerebral hemispheric subdural mixed\naged hematomas, measuring up to 1.2 cm on the right and 0.9 cm on the left.\n2. No new hemorrhage. No acute large territory infarct.\n3. Additional findings as described above." + }, + { + "input": "Left frontal and bilateral parietal burr holes. Trace residual biparietal\nsubdural hematomas, measures 2-3 mm on each side, significantly improved since\nprior. No new hemorrhage. Stable low-density change surrounding bilateral\noccipital horns, left greater than right, preserved overlying cortex.\n\nSevere central canal narrowing at C1 level secondary to degenerative changes\nat C1-C2 ligamentous thickening, stable since CT cervical spine ___. This causes cord compression.\n\nNo evidence of new hemorrhage, acute infarct or mass. Brain parenchymal\natrophy. Findings consistent with probably moderate chronic small vessel\nischemic changes. Postsurgical changes. Minimal midline shift to the left,\nstable.\n\nPartial opacification inferior right mastoids, consistent with contraction\nfrom chronic inflammation. Clear left mastoids, paranasal sinuses.", + "output": "Severe central canal narrowing C1 level, with cord compression, similar.\nTrace bihemispheric chronic subdural hematomas, nearly resolved.\nLow-density change about bilateral occipital horns, left greater than right,\nmay represent periventricular edema, stable.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 09:20 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or infarction. The\nventricles and sulci are normal in size and configuration. The basal cisterns\nappear patent and there is preservation of gray-white matter differentiation.\nLeft frontal subcortical hypodensities unchanged and could reflect small\nvessel ischemic changes.\nNo fracture is identified. The visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The globes are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Focal hypodensity in the right temporal lobe appearing to involve the cortex\n(___) is nonspecific, difficult to fully characterize.\n\nThere is a focus of probable encephalomalacia in the right frontal lobe\n(302:55), likely sequelae of remote/chronic infarction.\n\nThere is similar hypodensity in the inferior right frontal lobe near the\nskullbase which may relate to encephalomalacia, however is difficult to fully\ncharacterize (302:94).\n\nThe ventricles and sulci are prominent, compatible with global parenchymal\nvolume loss.\n\nBilateral periventricular and deep white matter hypodense foci are\nnon-specific, but compatible with moderate changes of chronic white matter\nmicroangiopathy.\n\nThe visualized paranasal sinuses and mastoids appear clear.\n\nThe globes and orbits are unremarkable. A tube is seen in the left nasal\ncavity, entering the nasopharynx.", + "output": "1. Hypodensities in the right temporal lobe and inferior right frontal lobe\nnear the skullbase are difficult to fully characterize on this study. \nAlthough they may relate to encephalomalacia from prior trauma or\nchronic/remote infarction, subacute/acute ischemia or vasogenic edema could\nalso produce this appearance. MR head without contrast is recommended for\nfurther evaluation.\n2. No acute intracranial hemorrhage.\n3. Additional separate focus of probable right frontal encephalomalacia,\nlikely sequelae of remote/chronic infarct.\n4. Chronic findings include global parenchymal volume loss and moderate\nchanges of chronic white matter microangiopathy.\n\nRECOMMENDATION(S): MR head without contrast." + }, + { + "input": "Chronic infarct in the right frontal and right temporal lobes, better\ncharacterized on the interval MR of ___, appears similar to the\nprior CT. Periventricular and subcortical white matter hypodensities elsewhere\nare unchanged, likely sequela of chronic small vessel ischemic disease. No\nevidence of acute large territory infarction, although MRI would be more\nsensitive for this evaluation. No acute intracranial hemorrhage.\n\nCTA HEAD:\nDiminutive right A1 ACA is patent. The right AICA is not well seen near the\ntakeoff of the basilar artery but appears patent distally. Otherwise, the\nvessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe origin of the right vertebral artery is not well seen, likely due to\ncontrast timing. Otherwise, the carotidandvertebral arteries and their major\nbranches appear normal with no evidence of critical stenosis or occlusion.\n\nOTHER:\nExtensive pulmonary opacities with interstitial thickening likely due to\npulmonary edema, although infectious or inflammatory causes cannot be\nexcluded. Large right pleural effusion and small left pleural effusion.", + "output": "1. Chronic right frontal of infarct and small vessel disease not significantly\nchanged since the MRI of ___. No acute hemorrhage.\n2. No evidence of vascular occlusion stenosis or an aneurysm greater than 3 mm\nin size in the circle of ___ on CT angiography of the head. Hypoplastic\nright A1 segment is incidentally noted.\n3. Normal CT of the neck." + }, + { + "input": "There is mild mucosal thickening of the right maxillary sinus, trace mucosal\nthickening of the left maxillary sinus, moderate mucosal thickening of the\nsphenoid sinuses, moderate mucosal thickening of the right frontal sinus and\nscattered mucosal thickening of the ethmoidal air cells. The ostiomeatal\nunits are patent. The cribriform plates are intact. The lamina papyracea are\nintact.\n\nThe orbits demonstrate no evidence of acute abnormalities.", + "output": "1. No evidence of acute orbital abnormalities. Specifically, no evidence of\npreseptal or postseptal orbital cellulitis.\n2. Mild-to-moderate mucosal thickening of the paranasal sinuses as described\nabove." + }, + { + "input": "There is no evidence of acute large territory infarction,hemorrhage,edema,or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture. Dental hardware partially protrude into the\nbilateral maxillary sinuses. Otherwise, the visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are normal.", + "output": "1. No acute intracranial hemorrhage or calvarial fracture.\n2. No intracranial lesions within the limitations of an unenhanced scan. If\nthere is persistent concern for metastatic disease, MRI is the study of\nchoice." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass effect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. There are periventricular and subcortical hypodensities,\nwhich may represent small vessel ischemic changes.\n\nThere is no evidence of fracture. There is minimal mucosal thickening of the\nright ethmoid air cells. The visualized portion of the remaining paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. \nThere are bilateral lens replacements. The visualized portion of the orbits\nare otherwise unremarkable.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nlarge territory infarct or intracranial hemorrhage.\n2. No acute displaced calvarial fracture." + }, + { + "input": "There is no evidence of acute infarction, intracranial hemorrhage,edema,or\nmass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of acute fracture. There is moderate mucosal thickening\nof the ethmoid air cells with partial opacification. The visualized portion\nof the paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. There is no evidence of acute intracranial process or hemorrhage.\n2. Moderate sinus disease." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is mild\ngrossly stable prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture. There is calcification of the left V4\nartery (2:4). There is mild mucosal thickening of the right maxillary sinus\nand bilateral ethmoid air cells. The visualized portions of the mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are preserved.", + "output": "1. No acute intracranial abnormality.\n2. Please note contrast brain MRI is more sensitive for the evaluation for\nintracranial metastatic disease.\n3. Paranasal sinus disease , as described." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is unchanged appearance of a punctate 5 mm focus of hyperattenuation in\nthe left frontal cortex abutting the falx cerebri, consistent with tiny\nintraparenchymal hemorrhage (series 2: Image 22).\n\nAgain question patchy hyperdensity overlying left parietal lobe (see 2: ___\non current study and 03: ___ on ___ prior exam). A similar\npatchy hyperdensity is noted overlying the right parietal lobe (see 2: ___\non current study and 3: ___ on ___ prior exam).\n\nThere is asymmetric prominence of the extra-axial space overlying the right\nfrontal lobe, grossly unchanged compared to ___ prior exam, and not\ndefinitely seen on ___ prior exam. Question medial displacement of\ncortical vein within right frontal extra-axial space (see 601:20).\n\nThere is no new large acute major infarct or new acute intracranial\nhemorrhage.\n\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. The basilar cisterns appear patent. There is no midline shift.\n\nThere is no evidence of fracture. Again seen is a subgaleal hematoma along the\nleft frontal supraorbital scalp. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Postsurgical\nchanges related to right globe lens replacement is noted. Left globe is\npreserved.", + "output": "1. Unchanged 5 mm focus of intraparenchymal hemorrhage seen in the left\nfrontal cortex abutting the falx cerebri as compared to recent CT head from\n___.\n2. Question biparietal subarachnoid hemorrhage versus artifact, grossly\nunchanged compared to ___ prior exam.\n3. Asymmetric right extra-axial space prominence grossly stable compared to ___ prior exam, and new compared to ___ prior exam, with\nsuggested medial displacement of cortical veins concerning for chronic\nsubdural hemorrhage or subdural hygroma, with differential consideration of\nsymmetric volume loss. If clinically indicated, consider MRI brain for\nfurther evaluation.\n4. No evidence of new large acute infarct or intracranial hemorrhage.\n5. Evolving left frontal supraorbital scalp soft tissue swelling and subgaleal\nhematoma." + }, + { + "input": "There is no evidence of acute territory infarction, hemorrhage, edema, or mass\neffect. The ventricles and sulci are normal in size and configuration.\nMild soft tissue prominence overlying the parietal vertex may represent a\nsmall scalp hematoma. There is no evidence of fracture. The visualized\nportion of the paranasal sinuses are notable for mild to moderate mucosal\nthickening of the maxillary and ethmoid sinuses. The mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No evidence of intracranial hemorrhage or large territorial infarction.\n\n2. No skull fracture." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is an ill-defined area of hypodensity with subtle gray-white matter\ndifferentiation loss in the right medial occipital lobe and posterior temporal\nlobe (02:12), corresponding to infarct on subsequent MR examination. There\nare additional ill-defined hypodensities in the left frontal corona radiata\nand centrum semiovale, also corresponding to infarct on subsequent MR. ___\nother areas of smaller infarct as seen on the subsequent MR are without\ndefinite CT correlate.\n\nThere is no evidence of hemorrhage, or large mass. The ventricles and sulci\nare normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is abrupt loss of opacification at the distal P2 segment of the right\nPCA (3:260 ___. The remainder of the vessels of the circle of ___ and\ntheir principal intracranial branches appear patent without stenosis,\nadditional areas of occlusion, or aneurysm formation. The dural venous\nsinuses are patent.\n\nCTA NECK:\nThere is a variant 2 vessel aortic arch. The right vertebral artery is\nsomewhat hypoplastic. The carotid and vertebral arteries and their major\nbranches are patent with no evidence of dissection, stenosis or occlusion.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThere are diffuse, ill-defined areas of somewhat nodular consolidation in the\nbilateral lung apices, as seen on the recent prior outside hospital CT\nexamination, likely progressed, given apparent increased involvement of the\nlung apices. A small right-sided pleural effusion is partially visualized. \nThere also appears to be a component of ground-glass densities with\ninterlobular septal thickening. The visualized portion of the thyroid gland\nis within normal limits. There is no lymphadenopathy by CT size criteria. \nThere is stranding of the subcutaneous fat, likely representing a component of\nvolume overload. In addition, asymmetric effacement of the left vallecula may\nbe secondary to secretions. The remainder of the visualized aerodigestive\ntract is grossly unremarkable. Patient's osseous lesions.", + "output": "1. Subtle areas of hypodensity in the right medial occipital/posterior\ntemporal lobes as well as in the left frontal corona radiata and centrum\nsemiovale, corresponding to late acute to early subacute infarcts on\nsubsequent MR examination. Other, smaller areas of infarct as described on\nthe subsequent MR examination, are without clear CT correlate.\n2. No hemorrhage.\n3. Occlusion of the distal P2 segment of the right posterior cerebral artery,\nsupplying the area of the large right medial occipital/posterior temporal\ninfarct. This is likely embolic, given history.\n4. Remainder of the intracranial arterial vasculature is patent without\nsignificant stenosis, additional areas of occlusion, or aneurysm formation.\n5. Patent cervical arterial vasculature without significant stenosis,\nocclusion, or dissection.\n6. Worsening multifocal consolidations of the visualized lung apices, with\nsmall pleural effusion and suggestion of ground-glass opacities and\ninterlobular septal thickening. These findings are most concerning for\nmultifocal pneumonia, with possible component of pulmonary edema.\n7. Asymmetric effacement of the left vallecula, potentially representing\nsecretions. Clinical correlation is recommended.\n\nNOTIFICATION: Neurology service was aware of the findings, including\nocclusion of the P2 segment of the right PCA, at time of dictation." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\nThere is no evidence of fracture. There is mucosal thickening in the left\nfrontal sinus, sphenoid sinus and ethmoid air cells. There is a small mucous\nretention cyst in the right maxillary sinus and a large mucous retention cyst\nin the left maxillary sinus. The mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable. Small\nright frontal scalp hematoma. There is a small displaced fracture of the\nright orbital rim (series 3 images 17 and 18).", + "output": "1. No acute intracranial process.\n2. Small right frontal scalp hematoma.\n3. There is a small displaced fracture of the right orbital rim (series 3\nimages 17 and 18).\n\nNOTIFICATION: Change to wet read communicated to Dr. ___ by Dr.\n___ ___ at 09:43 5 minutes after the discovery." + }, + { + "input": "There has been no significant interval change in size of the right sided\nsubdural hematoma. No new foci of hemorrhage are identified. This continues to\nresults in mild effacement of the adjacent sulci and 3 mm of leftward shift of\nthe normally midline structures.\n\nProminent ventricles and sulci are consistent with age-related involutional\nchange. Periventricular and deep subcortical white matter hypodensities are\nconsistent with chronic small vessel ischemic disease. The basal cisterns\nappear patent and there is preservation of gray-white matter differentiation.\n\nNo fracture is identified. Fluid and aerosolized secretions are seen in\nsphenoid sinuses and left maxillary sinus. There is sinus mucosal thickening\nin the bilateral maxillary sinuses, multiple anterior ethmoid air cells, and\nthe sphenoid sinuses. The globes are unremarkable.", + "output": "1. No significant interval change in the size of the right sided subdural\nhematoma, which continues to result in mild effacement of the adjacent sulci\nand 3 mm of leftward shift of the normally midline structures.\n\n2. No new foci of hemorrhage are identified." + }, + { + "input": "No significant interval change in the right subdural hematoma overlying the\nright frontal and parietal lobes since ___. There is no new hemorrhage. \nThere is no associated hydrocephalus, midline shift, or fracture.\n\nCentral white matter hypodensities bilaterally are most consistent with\nchronic small vessels disease. Bilateral cortical atrophy is demonstrated.\n\nNo osseous abnormalities seen. Fluid in the paranasal sinuses bilaterally are\nwithin normal limits. The mastoid air cells and middle ear cavities are clear.\nThe orbits are unremarkable.", + "output": "No significant interval change since ___ in the right subdural hematoma." + }, + { + "input": "There is diffuse cerebral edema with loss of the sulci, loss of gray-white\nmatter differentiation diffusely. Relative high density of the blood pool\ncompatible with recent contrast administration and the pseudo subarachnoid\nhemorrhage sign in diffuse cerebral edema. More focal hypodensities in the\nleft basal ganglia suggestive chronic lacunar infarcts in additional white\nmatter hypodensities which could be from prior chronic ___ vessel disease. \nVentricles appear ___ for patient's age. Additionally, there is mild\ncrowding at the suprasellar cistern; however, they remain patent and without\nevidence of frank herniation.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. Diffuse cerebral edema with diffuse loss of sulci and gray-white matter\ndifferentiation. No frank herniation identified.\n2. No intracranial hemorrhage identified.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:32 pm, 10 minutes after\ndiscovery of the findings." + }, + { + "input": "Exam is somewhat motion limited. There is no evidence of infarction,\nhemorrhage, edema, or mass. Prominence of the ventricles and sulci is\nconsistent with age appropriate involutional changes.\n\nThere is a small subcutaneous hematoma in the supraorbital right frontal\nregion. No acute fracture is seen. The paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear.", + "output": "1. Motion limited exam. Within these limitations, no evidence of acute\nintracranial process.\n2. Small right supraorbital subcutaneous hematoma." + }, + { + "input": "The study is slightly motion degraded. Within this confine: There is no\nevidence of large territorial infarction,hemorrhage,edema, or mass effect. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Bilateral periventricular white matter hypodensities are nonspecific\nbut most likely represent sequela of chronic small vessel ischemic changes. \nAtherosclerotic calcifications are seen in the bilateral carotid siphons.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nethmoid air cells and bilateral maxillary sinuses. The material within the\nleft maxillary sinus is aerosolized. The remaining visualized portions of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\npatient is status post bilateral lens replacement.", + "output": "1. On slightly motion degraded examination, no evidence of acute large\nterritory infarct or intracranial hemorrhage on noncontrast head CT. No\nintracranial mass effect.\n2. If there are no contraindications, MRI would be more sensitive for sequela\nand etiology of seizure.\n3. Aerosolized mucous in the left maxillary sinus, potentially representing\nacute sinusitis. Clinical correlation is recommended." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nlarge territorial infarction. Prominent ventricles and sulci suggest mild\natrophy. Mild subcortical and periventricular white matter hypodensities are\nconsistent with chronic small vessel ischemic disease.The basal cisterns\nappear patent and there is preservation of gray-white matter differentiation.\nThe visualized bony structures are grossly unremarkable. A small air-fluid\nlevel is noted in the left maxillary sinus, otherwise the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. There is a small\nosteoma in a left ethmoid aircell. The globes are unremarkable.", + "output": "1. No acute intracranial process.\n2. Mild atrophy and small vessel disease.\n3. Left maxillary sinus disease, appears acute." + }, + { + "input": "Minimal mucosal thickening is noted in the bilateral maxillary and right\nsphenoid sinuses. The remainder of the visualized paranasal sinuses, middle\near cavities, and mastoid air cells are well aerated and clear.\n\nThere is minimal mucosal thickening narrowing on the right infundibulum,\nhowever, the ostiomeatal units are patent, bilaterally. The cribriform\nplates are intact. The anterior clinoid processes are not pneumatized.\n\nThe lamina papyracea are intact. The nasal septum is mildly deviated towards\nthe left. Nasal passages are clear. No convincing periapical lucency is\nidentified.\n\nThe orbits are grossly unremarkable, bilaterally. Limited evaluation of the\nintracranial contents appears within normal limits.", + "output": "1. Mild multifocal sinus disease, as detailed above.\n2. Patent ostiomeatal complexes, bilaterally." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nLoss of gray-white matter involving the left insular cortex concerning for\nacute left MCA infarct (series 2, image 16). Hyperintense foci involving the\nleft frontoparietal cortex, right corona radiata and right parietal cortex\ncould suggest ischemic small vessel disease, however vasogenic edema and\nunderlying mass cannot be completely excluded. Additional areas of cortical\nhigh attenuation involving the left frontal, right occipital, right frontal\ncortex could suggest hemorrhagic changes, although underlying mass cannot be\nexcluded (series 2, image 21, 13, and 25).\n\nMucosal thickening of the left maxillary sinus as well as opacification of the\nleft mastoid air cells. The orbits are unremarkable.\n\nCT PERFUSION: RAPID perfusion maps demonstrate increase T-max and MTT time,\nconcerning for large left MCA occlusion.\nCBF<30% volume: 0mL\nTmax:>6.0s volume: 104mL\nMismatch volume: 104 mL", + "output": "1. Acute left MCA infarction with increased mismatch volume.\n2. Multiple hyperintense foci may represent hemorrhage or underlying mass and\nMR is recommended for further evaluation. Additionally, areas of low\nattenuation may suggest ischemic small vessel disease or vasogenic edema from\nunderlying mass.\n\nRECOMMENDATION(S): Correlation with MRI of the brain is recommended." + }, + { + "input": "There is no evidence of infarction, edema, or mass. A focus of hyperdensity\nadjacent to the right postcentral gyrus (02:25, 400b:71, 401b:29) may\nrepresent a focus of subarachnoid blood. Previously seen subarachnoid blood\nin the right occipital lobe is no longer appreciated. The ventricles and\nsulci are normal in size and configuration for the patient's age.\n\nA left orbital floor fracture with herniation of fat is again seen. There is\nimprovement of mucosal thickening and fluid layering within the left maxillary\nsinus and ethmoid air cells compared to ___. A mucous retention\ncyst in the right maxillary sinus and mild mucosal thickening of the left\nmaxillary sinus are unchanged. The mastoid air cells, and middle ear cavities\nare clear.", + "output": "1. Small focus of subarachnoid blood adjacent to the right postcentral gyrus,\nnew compared to ___. Subarachnoid blood seen along the occipital\nlobe previously is no longer appreciated. There is no evidence of new\nhemorrhage\n2. Redemonstration of a left orbital floor fracture with herniation of fat but\nno involvement of the inferior rectus muscle. Improved mucosal thickening and\nfluid opacification of the left maxillary sinus." + }, + { + "input": "There is soft tissue density surrounding the common carotid artery, from the\nlevel of the inferior aspect of the left lobe of the thyroid, to the carotid\nbifurcation. No stenosis, occlusion or dissection flap is identified within\nthe vessel. Findings may represent a pericarotid hematoma. It is difficult\nto determine if some of the hematoma is within the wall of the vessel. The\ncarotidandvertebral arteries and their major branches are patent with no\nevidence of stenoses, and appear otherwise unremarkable. No evidence for\ndissection is seen. Note is made of a fetal origin of the left posterior\ncerebral artery. By NASCET criteria, there is no stenosis of the right and\nleft ICA.\n\nThere is mild stranding within the subcutaneous fat in the lower anterior\nneck, which may be secondary to trauma.\n\nThere is mild cervical spondylosis and multilevel facet joint arthropathy.", + "output": "1. Soft tissue density surrounding the left common carotid artery, from the\nlevel of the inferior aspect of the left lobe of the thyroid gland, to the\ncarotid bifurcation. No stenosis, occlusion or dissection. Findings may\nrepresent a pericarotid hematoma. It is difficult to determine if some of the\nhematoma is within the wall of the vessel. No extravasation of contrast.\n2. The carotid and vertebral vessels are otherwise unremarkable." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Diminutive\nappearance of the ventricles and minimal sulcal effacement could suggest early\nglobal cerebral swelling. Gray-white matter differentiation is preserved. \nThe basal cisterns are patent. Periventricular white matter hypodensities\nlikely reflect sequela of chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. There is opacification of some anterior\nethmoidal air cells and mucosal thickening of the sphenoid sinus bilaterally,\notherwise visualized portion of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Suggestion of early global cerebral swelling. No evidence of hemorrhage or\ninfarction." + }, + { + "input": "The study is slightly limited due to patient positioning. Allowing for this,\nthere is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. Intracranial\nfindings are stable compared with brain MRI from earlier today, and CT from\nyesterday. No herniation.\n\nThere is no evidence of fracture. An enteric tube is partially visualized at\nthe nasopharynx. Patient is status post prior right sinus surgery. There is\nmoderate paranasal sinus opacification, likely due to intubation. Mastoid air\ncells and middle ear cavities are clear. The visualized portion of the orbits\nare unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nHemorrhage centered within the left basal ganglia measures approximately 2.1\ncm x 2.5 cm, with extension into the left lateral ventricle, appears overall\nunchanged compared to the prior exam performed at 16:28 on the same day. No\ndefinite new hemorrhage is identified. There is no evidence of acute\nintracranial infarction. The basilar cisterns are patent.\n\nMild mucosal thickening of the ethmoid air cells and sphenoid sinus as well as\nmild mucosal thickening of the maxillary sinuses is noted. Hyperostotic walls\nof the sphenoid and maxillary sinuses likely sequela of chronic sinusitis. \nThe mastoid air cells, and middle ear cavities are clear. The globes are\nunremarkable. Fluid within the nasopharynx and oropharynx, is likely sequelae\nof patient's intubation. Nasal bone deformities, may be sequelae of prior\nchronic fractures. Patient is status post prior maxillary and mandibular\ntooth extractions.\n\nCTA HEAD:\nThe left vertebral artery is diminutive. The right vertebral artery is\ndominant. The basilar artery is unremarkable. The PCAs bilaterally are\nunremarkable. The cavernous segment of the left internal carotid artery\ndemonstrates mild calcifications otherwise demonstrates appropriate\nopacification. The left MCA and distal branches are unremarkable. The right\nMCA and distal branches are normal. The cavernous segment of the right\ninternal carotid artery is normal. The anterior cerebral arteries are\nunremarkable. The dural venous sinuses are patent.\n\nCTA NECK:\nThe left vertebral artery is asymmetrically diminutive. The right vertebral\nartery is dominant. Flow is seen within the cervical portions vertebral\narteries bilaterally. The origins of the common carotid arteries bilaterally\nare unremarkable. There is no evidence of internal carotid artery stenosis by\nNASCET criteria.\n\nOTHER:\nAside for mild paraseptal emphysema at the lung apices, no concerning\npulmonary nodules are seen. Mild ground-glass density along the medial aspect\nof the superior segment of the right lower lobe, series 5, image 9, spans\napproximately 2.3 cm and may be inflammatory in etiology. Mildly prominent\nmediastinal lymph nodes are seen. The visualized portion of the thyroid gland\nis within normal limits. Left-sided cervical lymphadenopathy is seen, for\nexample a 1.3 cm x 1.2 cm left level IIa lymph node, is seen series 5, image\n176. An intra parotid left enhancing lymph node measures 1.1 cm x 1.7 cm,\nseries 5, image 184.", + "output": "1. Stable hemorrhage centered within the left basal ganglia and extension to\nthe left lateral ventricle compared to the prior exam performed at 16:28 on\nthe same day.\n2. Unremarkable CTA of the head without evidence of aneurysm or stenosis. No\nvascular malformation or a spot sign.\n3. Unremarkable CTA of the neck without evidence of internal carotid artery\nstenosis by NASCET criteria.\n4. Cervical lymphadenopathy, left greater than right, may be reactive in\netiology.\n5. Enhancing 1.1 cm left intra parotid lesion, may also be secondary to a\nreactive lymph node.\n6. Mild ground-glass density along the medial aspect of the superior segment\nof the right lower ___ be secondary to inflammatory changes/aspiration." + }, + { + "input": "Study is moderately degraded by motion.\n\nAllowing for slight differences in head position, there has been no\nsignificant interval change in size of the known left basal gangliar\nhemorrhage, with extension into the left lateral ventricle. The ventricles\nare grossly stable in size. No new foci of hemorrhage are identified. Left\nfrontal periventricular hypodensity is unchanged, and may represent edema\nassociated with the hemorrhage, or sequela of chronic infarct (3a:16). 3 mm\ngrossly stable right to left midline shift is again noted.\n\nThere is no evidence of fracture. Mucosal thickening is seen within the\nbilateral sphenoid sinuses, the right maxillary sinus, and scattered anterior\nposterior ethmoid air cells. The globes are unremarkable.", + "output": "1. Study is moderately degraded by motion.\n2. Grossly stable left basal ganglia hemorrhage with left lateral\nintraventricular extension and 3 mm right to left midline shift.\n3. Within limits of study, no new foci of hemorrhage.\n4. Stable left frontal periventricular hypodensity may represent edema\nassociated with the hemorrhage, or sequela of chronic infarct." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass effect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific but suggest chronic small vessel ischemic\nchanges.\n\nThere is no evidence of fracture. Trace sclerosis and opacification of the\nbilateral mastoid tips. Otherwise, the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nintracranial hemorrhage or large territory infarct.\n2. Additional findings as described above." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nConfluent periventricular and subcortical white matter hypodensities are\nnonspecific, would be compatible with chronic small vessel disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, and middle ear cavities are clear. Partial opacification of the left\nmastoid air cells. The visualized portion of the orbits are unremarkable.", + "output": "1. No no evidence of fracture, mass, hemorrhage or infarction.\n2. Confluent periventricular and subcortical white matter hypodensities are\nnonspecific, would be compatible with chronic small vessel disease." + }, + { + "input": "There is no evidence of large acute territorial infarction,hemorrhage,edema,\nor mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific, but likely reflect the sequela of chronic\nmicrovascular infarction.\n\nSoft tissue swelling with subcutaneous gas compatible with laceration is seen\noverlying the midline frontal bones. There is no evidence of fracture. \nPartial opacification of the inferior left mastoid air cells. The visualized\nportion of the remaining paranasal sinuses, right mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Midline frontal laceration and soft tissue swelling without underlying\nacute fracture.\n2. No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute large territorial infarction, acute intracranial\nhemorrhage, edema, or mass effect. The ventricles and sulci are prominent in\nsize and configuration, likely reflective of age involutional changes. \nPeriventricular and subcortical hypodensities are nonspecific, but likely\nreflect chronic small vessel ischemic changes.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nExamination is moderately degraded due to timing of the contrast bolus and\nartifact.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without focal stenosis or aneurysm formation although evaluation\nis limited due to contrast timing. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is a common origin of the right brachiocephalic and left common carotid\narteries, a normal anatomic variant. Examination is moderately degraded due\nto timing of the contrast bolus and limited visualization of the neck\nvasculature. Within limitations, the carotidandvertebral arteries and their\nmajor branches appear normal with no evidence of stenosis or occlusion. There\nis no evidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.\n\nThere is enlargement of the central pulmonary arteries. The main pulmonary\nartery measures up to 3.2 cm.", + "output": "1. Examination is moderately degraded by timing of the contrast bolus.\n2. No evidence of infarction or hemorrhage.\n3. Within limitations, patent circle of ___ and neck vasculature with no\nevidence of focal stenosis or aneurysm formation." + }, + { + "input": "Minimal 3 mm right subdural hematoma overlying the parietal convexity is\nsubtly re- demonstrated, causing minimal local mass effect. There is minimal\nsubarachnoid hemorrhage, layering over several frontal sulci. The basal\ncisterns are widely patent. There is no new hemorrhage. Periventricular\nconfluent hypodensities, are nonspecific but are statistically most likely due\nto chronic small vessel disease. The ventricles and sulci are prominent,\nconsistent with age related atrophy. The patient is status post bilateral\nlens replacement.", + "output": "1. Minimally increased right subdural hematoma overlying the temporal/parietal\nconvexity, causing only local mass effect.\n2. Trace subarachnoid hemorrhage layering in frontal sulci.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 8:10 ___, 5 minutes after discovery of the\nfindings." + }, + { + "input": "There is essentially near-complete resolution of the previously seen right\ntemporal convexity subdural hematoma now measuring less than 1 mm in thickness\n(series 3, image 10) and resolution of minimal right frontal subarachnoid\nhemorrhage.\n\nThere is no evidence of acute infarction, hemorrhage, edema, or mass. The\nventricles and sulci are patent and prominent in keeping with age-related\nvolume loss.\n\nExtensive areas of hypodensity in the periventricular, subcortical and deep\nwhite matter, nonspecific, likely secondary to small vessel ischemic changes. \nThere is intracranial atherosclerotic calcification.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable noting prior bilateral cataract\nsurgeries.", + "output": "1. Essentially near-complete resolution of previously seen subdural\nhemorrhage. Complete resolution of previously seen subarachnoid hemorrhage. \nNo acute intracranial abnormality.\n\n2. Changes secondary to small vessel ischemic disease." + }, + { + "input": "There is no evidence of intracranial hemorrhage. There is no mass effect,\nhydrocephalus or shift of the normally midline structures. Ventricles, sulci,\nand cisterns are all prominent suggesting mild to moderate age-related\ninvolutional change. The is a confluent area of white matter hypodensity in\nthe anterior right frontal lobe with overlying cortical defect. Elsewhere\ngray-white matter distinction appears preserved. Calcifications are noted\nalong cavernous carotid and vertebral arteries, and there are few\ncalcifications along the frontal lobes; often these can be attributed to prior\nexposure to neurocystercercosis. Surrounding soft tissue structures are\nunremarkable. Partly visualized maxillary sinuses are almost fully opacified\nwith bony wall thickening and sclerosis suggesting chronicity to paranasal\nsinus inflammation. In addition there is moderate ethmoid opacification,\ngreater on the right than left, although sphenoid and frontal sinuses appear\nessentially clear. Mastoid air cells appear clear. No fracture is\nidentified.", + "output": "1. No evidence of acute intracranial injury.\n\n2. Region of white matter hypodensity in cortical loss suggesting prior\ninfarct in the right frontal lobe, possibly late subacute but more likely\nolder. If this may indicate an ongoing clinical or recent clinical process MR\nmay be helpful.\n\n3. Opacification of maxillary sinuses with findings suggesting chronicity\nalthough acute on chronic inflammation or infection is not excluded by this\nstudy." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Metallic hardware is noted within the left\nfrontal scalp likely related to prior surgical intervention. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "No evidence of intracranial hemorrhage." + }, + { + "input": "There is no evidence of acute hemorrhage mass effect midline shift or\nhydrocephalus. Gray-white matter differentiation is maintained.\n\nThe visualized paranasal sinuses are clear. No skull fracture is seen.", + "output": "No significant intracranial abnormalities on head CT without contrast." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass effect. The ventricles and sulci are normal in size and configuration.\nNo osseous abnormalities seen. There is mild mucosal thickening within the\nimaged portions of the maxillary sinuses and mild left-sided ethmoidal air\ncell opacification. The mastoid air cells and middle ear cavities are well\naerated. The orbits are unremarkable.", + "output": "No acute intracranial process. Mild sinus mucosal thickening." + }, + { + "input": "There is no evidence of acute major vascular territory\ninfarction,hemorrhage,edema, or mass. The ventricles and sulci are normal in\nsize and configuration.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormalities." + }, + { + "input": "CTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "Normal head and neck CTA." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no exophytic mass, nor\nareas of focal mass effect. Evaluation of the cervical lymph chains\ndemonstrate no pathologic lymphadenopathy by imaging criteria. The visualized\nsalivary glands are unremarkable in appearance. Within the right thyroid lob\ninferiorly, there is a 6 x 6 mm nodule noted as well as a 6 x 3 mm nodule\nwithin the isthmus (2:68) . Neck vessels are patent. Note is made of a common\norigin of the right and left common carotid arteries. At the level of the\nleft clavicular head, the left brachiocephalic vein becomes narrowed. Upper\nlung fields are clear. No suspicious lytic or blastic lesion is identified. \nMultilevel degenerative changes are noted most prominent at the C5-C6 level\nwith disc space narrowing and mild retrolisthesis of C5 on C6 thought\ndegenerative in nature. Partially imaged sternum demonstrates an intact\nsternotomy wire. Note is also made of right posterior ethmoidal cell\nopacification. Remainder of the visualized paranasal sinuses are well\naerated.", + "output": "1. Status post recent laryngoscopy and esophagoscopy with cricopharyngeus\nBotox injection and balloon dilatation without evidence of a complication. No\nmediastinal air or retropharyngeal collection is identified.\n2. Multinodular thyroid again noted. Correlation with labs and ultrasound on\na nonemergent basis can be performed for further evaluation if clinically\nindicated.\n3. Narrowing of the left brachiocephalic vein as it crosses posterior to the\nleft clavicular head.\n\nNOTIFICATION: Discussed with ENT fellow by Dr. ___ telephone at 19:15\non ___ at the time study was reviewed." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nMucous retention cyst of the right maxillary sinus. Otherwise, the visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria. There is no evidence of vertebral artery\ndissection.\n\nOTHER:\nEvaluation of the lung parenchyma is limited by respiratory motion. Within\nthis limitation, there is mild, bilateral dependent atelectasis. The\nvisualized portion of the thyroid gland is within normal limits. There is no\nlymphadenopathy by CT size criteria.", + "output": "1. No evidence of vertebral artery dissection. No occlusion or stenosis of\nthe carotid or vertebral arteries.\n2. No acute hemorrhage or large territorial infarction.\n3. No stenosis, occlusion, or aneurysm formation of the intracranial\nvasculature." + }, + { + "input": "There is no evidence of acute large territory infarction,intracranial\nhemorrhage,edema,or discrete mass. There is prominence of the ventricles\nsulci suggestive of involutional changes. Periventricular and subcortical\nwhite matter hypodensities are nonspecific but compatible with chronic small\nvessel ischemia.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute large territory infarction, intracranial\nhemorrhage,edema,or discrete mass. There is prominence of the ventricles and\nsulci suggestive of involutional changes, advanced for age. Periventricular\nand subcortical white matter hypodensities are nonspecific but compatible with\nchronic small vessel ischemia.\n\nThere is no evidence of fracture. Mild mucosal thickening and a mucous\nretention cyst in the right maxillary sinus. Otherwise, the visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Chronic small vessel disease and involutional changes, advanced for age." + }, + { + "input": "There is no evidence of acute fracture, infarction,hemorrhage,edema, or mass. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges, greater than expected for age. Periventricular and subcortical white\nmatter hypodensities are nonspecific but likely represent sequelae of chronic\nmicroangiopathic ischemic disease.\n\nMultiple screws are seen transfixing a prior left zygomatic process fracture. \nA small focus of soft tissue swelling and punctate subcutaneous emphysema is\nseen along the left frontal convexity.\n\nThere is near complete opacification of the partially imaged bilateral\nmaxillary sinuses with hyperdense components. The lateral wall of the right\nmaxillary sinus appears to be slightly deformed. The right nasal bone also\ndemonstrates mild deformity. There is discontinuity and deformity involving\nthe right lamina papyracea. Mild irregularity is seen involving the right\nnasal bone. Irregularity and lucency within the right orbital floor (601; 27)\nis suggestive of a nondisplaced orbital floor fracture.\n\nThere is partial opacification of the ethmoid air cells. There is slight\nmucosal thickening of the frontal sinuses. The sphenoid sinus is clear. The\nvisualized portion of the mastoid air cells, and middle ear cavities are\nclear.", + "output": "1. No acute intracranial abnormality.\n2. Deformity involving the lateral wall of the right maxillary sinus, right\nlamina papyracea and right nasal bones, represent fractures of indeterminate\nchronicity. Additionally, lucency along the right orbital floor is suggestive\nof a nondisplaced orbital floor fracture. Dedicated CT of the facial bones is\nrecommended for further characterization.\n3. Hyperdense opacification of the right maxillary sinus. Intra sinus blood\nproducts cannot be excluded.\n4. Soft tissue swelling along the left frontal bone.\n5. Chronic left zygomatic process fracture status post screw fixation.\n6. Sinus disease as above.\n\nRECOMMENDATION(S): Dedicated CT of the facial bones.\n\nNOTIFICATION: The findings were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 2:46 pm, 10 minutes after\ndiscovery of the findings." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or large mass. The\nventricles and sulci are prominent, consistent with involutional changes. \nThere is periventricular and subcortical white matter hypodensity, which is\nnonspecific, but likely represents chronic microvascular ischemic changes.\n\nNo osseous abnormalities seen. There is minimal anterior ethmoidal air cell\nmucosal thickening. The paranasal sinuses, mastoid air cells, and middle ear\ncavities are otherwise clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nA subtle hypodensity and loss of gray-white matter differentiation in the\ndistribution of the left MCA is less prominent than on CT head on ___. Again seen is old left occipital infarct, with associated ex vacuo\ndilatation of the occipital horn of the left lateral ventricle. Scattered\nsubcortical and periventricular hypodensities are nonspecific, however likely\nrepresent sequela of chronic small vessel ischemic disease. There is no\nevidence of acute hemorrhage, edema, or mass.\n\nThe visualized portion of the paranasal sinuses,mastoid air cells, and middle\near cavities are clear. There is bilateral lens replacement.\n\nCTA HEAD:\nThere are bilateral cavernous carotid calcifications without significant\nnarrowing. A previously seen distal left MCA branch displaying abrupt cutoff\non CTA head on ___ is now opacified (6:95). There is narrowing\nand irregularity of the P2 segment of the left posterior cerebral artery,\nlikely due to atheromatous disease. Otherwise, the vessels of the circle of\n___ and their principal intracranial branches appear normal with no\nevidence of stenosis, occlusion or aneurysm. The dural venous sinuses are\npatent.", + "output": "1. No evidence of hemorrhage.\n2. Hypodensity and loss of gray-white matter differentiation and distribution\nof the left MCA is less prominent than on CT head on ___. This\nreflects evolving infarction in this distribution.\n3. Previously seen distal left MCA branch displaying abrupt cut off on CTA on\n___ is now opacified." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is subtle hypodensity in the left frontoparietal and temporal operculum\nwith suspected loss of gray-white differentiation in keeping with an acute\ninfarct as seen on image 4: ___.\n\nAlso seen is encephalomalacia in the left occipital lobe with expected\ndilatation of the left lateral ventricle in keeping with chronic infarct.\n\nThere is linear hyperdensity in the left parietal lobe on image 4:20, either\nsecondary to thrombus in the vessel or secondary to apposition of the cortices\ngiven the underlying edema.\n\nThere is no evidence of acute hemorrhage, edema or mass effect. No midline\nshift is seen. The ventricles, sulci and cisterns are patent and prominent in\nkeeping with age-related volume loss.\n\nThere are scattered foci of hypodensity in the periventricular, subcortical\nand deep white matter, nonspecific, likely secondary to small vessel ischemic\ndisease. There is intracranial atherosclerotic calcification.\n\nThe orbits are unremarkable noting prior bilateral cataract surgeries. The\nvisualized paranasal sinuses, mastoid air cells and middle ear cavities are\nclear.\n\nCTA HEAD:\nThere is an abrupt cut off involving one of the cortical distal left MCA\nbranch as seen on image 06:10. Also seen is atherosclerosis involving\nbilateral cavernous internal carotid arteries without significant narrowing. \nThe remaining vessels of the circle of ___ and their principal intracranial\nbranches appear unremarkable with no evidence of stenosis, occlusion or\naneurysm. The dural venous sinuses are patent.", + "output": "1. Findings suspicious for acute infarct involving the left frontoparietal and\ntemporal operculum in the left MCA distribution.\n2. Abrupt cut off of a cortical branch of left MCA. Otherwise, unremarkable\nCTA of the head." + }, + { + "input": "There is significant encephalomalacia in the inferior frontal and temporal\nlobes likely sequelae of prior trauma. There is no acute hemorrhage. No edema\nor shift of midline structures. Basilar cisterns are patent. Ventricles and\nsulci are normal in overall configuration. Imaged paranasal sinuses, mastoid\nair cells and middle ear cavities are well aerated. Bony calvarium is intact.", + "output": "Significant bifrontal and bitemporal encephalomalacia, likely the sequelae of\nprior contusion. No acute hemorrhage." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nlarge mass. Calcified pineal lesion is re- demonstrated, unchanged in\nappearance and similar in size measuring up to 1.5 cm. Mild periventricular\nand subcortical white matter hypodensities are nonspecific, but likely\nrepresent chronic small vessel ischemic disease. Mild prominence of the\nventricles and sulci is suggestive of involutional changes.\n\nNo fracture seen. The paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. There is mild right periorbital swelling. Globes are\nintact and there is no evidence of retrobulbar hematoma. There is mild\ncalcification of the carotid siphons bilaterally and the distal right\nvertebral artery.", + "output": "Mild right periorbital swelling. No acute intracranial process." + }, + { + "input": "Left hemicraniectomy is again seen. Previously noted left subdural drain has\nbeen removed. There is decreased air and increased hyperdensity in the\nhemicraniectomy defect, suggesting increased blood products. There is mild\nherniation of the brain parenchyma through the hemicraniectomy defect, which\nwas not clearly seen on ___, but comparison is limited by the tilt of\nthe patient's head on the present exam. Allowing for differences in patient\npositioning, mild rightward shift of midline structures and partial effacement\nof the left lateral ventricle are unchanged. There is persistent edema and\ntrace blood at the site of the left temporal hemorrhagic contusion, where\nblood products have been resected. Large left and small right inferior frontal\nhemorrhagic contusions are stable allowing for differences in patient\nposition. No new parenchymal edema is seen. Basal cisterns are stable in size.\n\nRight occipital bone fracture extending to the right occipital condyle is\nagain seen. A mucous retention cyst is again seen in the left sphenoid sinus.\nFluid in the right sphenoid sinus and left ethmoid air cells is new, likely\nrelated to prolonged supine positioning.", + "output": "1. Increased extra-axial hyperdensity in the left hemicraniectomy defect,\nsuggesting increased blood products.\n2. Mild herniation of the brain parenchyma through the left hemicraniectomy\ndefect appears new compared to ___, but comparison is limited by\ndifferences in patient positioning.\n3. Stable mild rightward shift of midline structures and partial effacement of\nthe left lateral ventricle.\n4. Stable large left and small right inferior frontal hemorrhagic contusions.\n5. Right occipital bone fracture extending to the right occipital condyle is\nagain seen." + }, + { + "input": "Left-sided craniectomy is identified. The previously seen blood products and\nsoft tissue swelling has resolved. There is a small extra-axial CSF\ncollection seen at the convexity likely widening of the subarachnoid space. . \nThere is no acute hemorrhage midline shift or hydrocephalus. Visualized\nparanasal sinuses are clear.", + "output": "Left-sided craniectomy is identified. Previously seen soft tissue changes have\nresolved. No acute abnormalities." + }, + { + "input": "The patient is status post left hemicraniectomy and evacuation of blood\nproducts, with the expected postsurgical changes and pneumocephalus seen.\nHypodensity is noted at the site of the prior bleed. Frontal contusions are\nseen, similar prior exam. There has been interval decrease in midline shift,\nwhich now measures 5 mm rightward (previously 11 mm). Effacement of the left\nlateral ventricle has improved from prior exam. There is no evidence of new\nacute hemorrhage, edema, mass effect, or infarction.\n\nA nondisplaced fracture of the right occipital bone including the right\noccipital condyle is again seen. A mucous retention cyst is seen in the left\nsphenoid sinus. Otherwise, the visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The globes are unremarkable.", + "output": "1. Expected postsurgical changes status post left hemicraniectomy, with\ninterval improvement of midline shift and effacement of left lateral\nventricle.\n\n2. Nondisplaced fracture of the right occipital bone, unchanged from prior\nexam." + }, + { + "input": "There are postsurgical changes of right craniotomy for clipping of a posterior\ncommunicating artery aneurysm with expected pneumocephalus and a small amount\nof mixed density extra-axial collection along the craniotomy margin. There is\nno shift of normally midline structures. Evaluation of the skullbase is\nseverely limited by extensive artifact from the clip. Within this limitation,\nthere is no evidence of hemorrhage or infarction. The ventricles and sulci\nare normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are essentially clear. \nThe visualized portion of the orbits are unremarkable.", + "output": "1. Expected postsurgical changes of right craniotomy for clipping of a\nposterior communicating artery aneurysm.\n\n2. No evidence of hemorrhage or infarction within limitations of extensive\nartifact created by the clip." + }, + { + "input": "Venous contrast pooling, surgical hardwareanddental amalgam streak\nartifactandpatient body habitus limits study.\n\nCT HEAD WITHOUT CONTRAST:\n\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere are mild atherosclerotic plaque involving the bilateral cavernous and\ncommunicating segment of the bilateral ICAs, without flow limiting narrowing. \nThere are moderate atherosclerotic calcifications involving the intracranial\nV4 segments of the bilateral vertebral arteries, more pronounced on the right.\nThe middle, anterior, and posterior cerebral artery are unremarkable. The\nthere remainder of the vessels of the circle of ___ and their principal\nintracranial branches appear normal without stenosis, occlusion, or aneurysm\nformation. The dural venous sinuses are patent.\n\nCTA NECK:\nNonocclusive narrowing of bilateral vertebral artery origins by\natherosclerotic plaque noted. Bilateral common carotid artery origins are\npatent. The right vertebral artery is dominant, the left vertebral artery is\ndiminutive.\n\nThe left V1 segment demonstrates nonocclusive atherosclerotic calcification\n(see 3:6). The proximal left V 2 segment demonstrates nonocclusive\natherosclerotic calcification (see 03:25). Streak artifact limits evaluation\nright proximal V3 segment. Right mid V2 segment nonocclusive atherosclerotic\ncalcification is present (see 3:141). Right V1 segment nonocclusive\natherosclerotic calcification is noted (see 3:96).\n\nNonocclusive atherosclerotic calcifications of bilateral common carotid\narteries is noted.\n\n There is calcified atherosclerotic plaque with 30% narrowing of the proximal\nleft ICA near the bifurcation. There is mild atherosclerotic plaque without\nsignificant flow limiting stenosis involving the proximal right ICA near the\nbifurcation. There is extensive probable atherosclerotic narrowing of\nbilateral proximal external carotid arteries. The bilateral cervical segments\nof the vertebral arteries are patent.\n\nOTHER:\nLimited evaluation of the lung abscess is due to motion artifact, otherwise no\ngross abnormality identified. Patulous cervical esophagus is noted. The\nthyroid gland is preserved. There is no lymphadenopathy by CT size criteria.", + "output": "1. Venous contrast pooling, surgical hardwareanddental amalgam streak\nartifactandpatient body habitus limits study.\n2. No acute intracranial abnormality, specifically no evidence of an acute\ninfarct. Please note MRI of the brain is more sensitive for the detection of\nacute infarct.\n3. Nonocclusive probable atherosclerotic narrowing of circle of ___ as\ndescribed.\n4. Otherwise, grossly patent circle of ___ without definite evidence of\nstenosis,occlusion,or aneurysm greater than 3 mm.\n5. Calcified atherosclerotic plaque with 30% narrowing of the proximal left\nICA near the bifurcation.\n6. Extensive atherosclerotic narrowing of bilateral proximal external carotid\narteries.\n7. Additional nonocclusive narrowing of bilateral cervical common carotid and\nvertebral arteries as described.\n8. Otherwise, grossly patent bilateral cervical carotid and vertebral arteries\nwithout definite evidence of stenosis, occlusion, or dissection." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. There are\nnonspecific bilateral supratentorial white matter hypodensities, which may\nrepresent the sequelae of chronic microangiopathy. The ventricles and sulci\nare normal in size and configuration. There is calcification projected over\nthe right parietal region (2:26) which could be secondary to a dural\ncalcification or a heavily calcified incidental meningioma without mass effect\non the adjacent brain.\n\nThere is mild mucosal thickening in the right maxillary sinus. The visualized\nportion of the paranasal sinuses, mastoid air cells,and middle ear cavities\nare otherwise clear. The visualized portion of the orbits are normal.\n\nCTA HEAD:\nThere is atheromatous calcification of the carotid siphons bilaterally. The\nvessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. The dural venous\nsinuses are patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent.\nThere is atheromatous calcification of the carotid bulbs bilaterally. There\nis no evidence of internal carotid stenosis by NASCET criteria. The proximal\ninternal carotid arteries are noted to take a retropharyngeal course\nbilaterally.\nThe carotidandvertebral arteries and their major branches appear otherwise\nnormal with no evidence of stenosis or occlusion. There is mild to moderate\nfocal stenosis of the proximal aspect of the left subclavian artery secondary\nto atheroma.\n\n\n\nOTHER:\nThere is redemonstration of the fracture to the base of the dens, which is\nunchanged compared to prior, with 3 mm anterior displacement of the dens\nrelative to the body of C2. C4-C7 anterior fusion with interbody spacers\nnoted. There is multilevel facet joint arthropathy. The visualized portion\nof the lungs are clear. The visualized portion of the thyroid gland is within\nnormal limits. There is no lymphadenopathy by CT size criteria.", + "output": "1. No acute intracranial abnormality is identified.\n2. Nonspecific bilateral supratentorial white matter hypodensities, which may\nrepresent the sequelae of chronic microangiopathy\n3. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n4. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection.\n5. Mild to moderate focal stenosis of the proximal aspect of the left\nsubclavian artery secondary to atheroma.\n6. Redemonstration of the fracture to the base of the dens, which is unchanged\ncompared to prior, with 3 mm anterior displacement of the dens relative to the\nbody of C2. No adjacent vascular injuries identified." + }, + { + "input": "Streak artifact from an embolization coil limits evaluation of adjacent\nstructures. Within these confines, there is no evidence of acute, large\nterritorial infarction, fracture,hemorrhage,edema,or mass. A punctate\nhyperdensity within the left temporal lobe (4:12) may reflect a small\ncalcification. There is mild prominence of the ventricles and sulci\nsuggestive of involutional changes. Evidence of stent mediated coil\nembolization of a left paraclinoid internal carotid artery aneurysm.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "No acute intracranial abnormality.\nMRI is more sensitive for the detection of metastatic disease if this is of\nclinical concern." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "Right frontal lobe small foci of hypoattenuation corresponds to an area of\nacute/early subacute infarction identified on MRI 2 days prior. Additional\nsmaller infarcts are better evaluated on MRI. No evidence of new, large\nterritorial infarction. No evidence of hemorrhagic conversion. The ventricles\nand sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is trace ethmoid air cell mucosal\nthickening. The visualized portion of the remaining paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "No evidence of new infarct or hemorrhage..\nAgain seen are small foci of acute/early subacute infarcts in the right\nfrontal lobe, other small foci were better seen on prior MRI." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nA few small hypodensities involving the high right frontal lobe correlate with\nthe foci of high signal on diffusion-weighted imaging on the recent MRI head\nstudy. No clear evidence of corresponding low signal on the ADC map suggests\ninfarcts of subacute chronicity. There is no evidence of no evidence of\nhemorrhage, edema, or mass. The ventricles and sulci are normal in size and\nconfiguration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere are calcified atheromatous changes of the carotid siphons. There is a\npersistent origin of the left PCA. The vessels of the circle of ___ and\ntheir principal intracranial branches appear otherwise normal without\nstenosis, occlusion, or aneurysm formation. The dural venous sinuses are\npatent.\n\nCTA NECK:\nThere are calcified atheromatous changes of the proximal right ICA resulting\nin approximately 50% stenosis by NASCET criteria. Just superior to this is a\n2 mm focal outpouching arising from the posterior aspect of the proximal right\nICA that is suspicious for a penetrating atherosclerotic ulcer. There are\nmild calcified atheromatous changes of proximal left ICA. The common carotid\narteries and vertebral arteries are unremarkable.\n\nOTHER:\nThe visualized portion of the lungs demonstrate mild ground-glass attenuation\npossibly relating to poor inspiration. The visualized portion of the thyroid\ngland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Redemonstrated few small right frontal hypodensities likely representing\nacute to subacute infarcts better evaluated on the recent MRI head study.\n2. Evidence of a 2 mm penetrating atherosclerotic ulcer arising from the\nposterior aspect of the proximal right ICA. Approximately 50% narrowing of\nthe proximal right internal carotid artery.\n3. No CTA evidence of arterial dissection, aneurysm or high-grade stenosis.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:59 am, 20 minutes after\ndiscovery of the findings." + }, + { + "input": "CT HEAD:\nNo acute large territory infarct, hemorrhage, or mass seen on the noncontrast\nportion of the study.\n\nCTA HEAD:\nThere is atherosclerotic calcification in the bilateral cavernous carotids\nwithout severe narrowing. The vessels of the circle of ___ and their\nprincipal intracranial branches are patent. The dural venous sinuses are\npatent.\n\nCTA NECK:\nThere is mixed calcified and noncalcified atherosclerotic plaque in the\nbilateral internal carotid arteries at the bifurcations, however the carotid\nand vertebral arteries are patent. There is approximately 25% stenosis of the\norigin of right internal carotid artery by an noncalcified plaque.\n\nOther: The thyroid is heterogeneous with multiple small hypodense nodules\nmeasuring up to 8 mm.\n Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or older.", + "output": "1. No acute intracranial abnormalities on head CT without contrast.\n2. Mild atherosclerotic disease on the CT angiography of the head neck without\nocclusion or high-grade stenosis." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. Mild periventricular white matter hypodensities are nonspecific, but\nlikely represent the sequela of chronic microvascular ischemia. There is mild\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. Partial opacification of the right mastoid\nair cells. The visualized portion of the paranasal sinuses, left mastoid air\ncells, and middle ear cavitiesare essentially clear. Nasal septal perforation\nis noted. The patient is status post bilateral lens resections. Degenerative\nchanges within the temporomandibular joints bilaterally.", + "output": "No evidence of fracture or intracranial hemorrhage." + }, + { + "input": "There is no evidence of fracture, infarction, hemorrhage, edema,or mass. The\nventricles and sulci are normal in size and configuration. There is no\nabnormal enhancement on post contrast images.\n\nThere is partial opacification of the ethmoid air cells and there is a\nretention cyst in the left sphenoid sinus. Otherwise, the visualized portion\nof the paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. Mild paranasal sinus inflammatory changes. Otherwise normal study." + }, + { + "input": "There is no evidence of intracranial hemorrhage, infarction, edema, or mass. \nThere is prominence of the ventricles and sulci, compatible with age related\ninvolutional changes. Dense atherosclerotic calcifications are noted at the\nbilateral carotid siphons and vertebral arteries.\n\nThere is no evidence of fracture. There is mild mucosal thickening the\nbilateral maxillary sinuses, ethmoid air cells, and sphenoid sinuses. The\nvisualized portion of the remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No evidence of intracranial hemorrhage, fracture, or infarction.\n2. Mild paranasal sinus disease, as described above." + }, + { + "input": "Scattered small cervical lymph nodes are present, none of which are enlarged\nby CT criteria. No neck mass is identified. The previously seen right level 5\nlymph node and right axillary mass which were noted to be metabolically active\non the PET scan are no longer visualized.\n\nThe bilateral parotid glands, submandibular glands, sublingual spaces and the\nthyroid\n\ngland are normal. The uvula slightly deviated to the left. Structures of the\nnasopharynx, oropharynx and hypopharynx are otherwise symmetric and\nunremarkable.\n\nAtherosclerotic disease is noted at the aortic arch. The visualized upper\nlobes are clear. There are multilevel cervical spine degenerative changes.", + "output": "No pathologically enlarged adenopathy or neck mass." + }, + { + "input": "The aerodigestive tract is unremarkable. The infratemporal fossa and the\npterygopalatine fossa are unremarkable. The parotid and submandibular glands\nare also unremarkable. There is no cervical lymphadenopathy. No axillary\nlymphadenopathy.\n\nExtensive vascular atherosclerotic calcification of the aortic arch is noted.\nOtherwise, the visualized course of the brachiocephalic vessels are\nunremarkable. Atherosclerotic calcification of the carotid siphons are noted,\nunchanged from prior exam. Visualized brain is unremarkable.\n\nMild mucosal thickening of the maxillary sinuses. Otherwise remainder of the\nvisualized paranasal sinuses are clear. Visualized portions of the orbits are\nunremarkable. The mastoid air cells and middle ear cavities are well\npneumatized and clear.\n\nThere is straightening of the normal cervical lordosis as well as multilevel\ndegenerative changes, including anterior marginal osteophytes and posterior\ndisk osteophyte complexes. There is loss of disc height at C4-5 through C7-T1,\nunchanged in appearance from prior exam. No acute osseous abnormalities.\n\nThe lung apices are clear.", + "output": "1. No evidence of recurrent disease. No cervical lymphadenopathy by size\ncriteria.\n2. Chronic changes as described above." + }, + { + "input": "CT head: There is a large extra-axial left frontal mass, causing significant\nmass effect and effacement of the sulci, causing deviation and shifting of the\nnormally midline structures towards the right ~ 15 mm and producing effacement\nof the perimesencephalic cisterns and left lateral and ___ ventricles. There\nis also a prominent right temporal ventriclar horn probably with\ntransependymal migration of CSF, suggestive of developing hydrocephalus. The\nbone structures are unremarkable.\n\nCTA of the head: Both vertebral arteries as well as the vertebrobasilar system\nare patent. There is significant deviation of the left medial inferiorly and\ndeviation anterior cerebral arteries towards the right, related with the mass\neffect. No aneuryms greater than 3 mm are seen. Hypoplasia of the A1 segment\non the right is appreciated. The posterior circulation appears unremarkable\nwith dominance of the left vertebral artery.", + "output": "1. Large extra-axial left frontal mass with heterogeneous enhancement and\napparently increased vascularity, likely consistent with a meningioma, causing\nsignificant mass effect, midline shifting and effacement of the\nperimesencephalic cisterns as described in detail above.\n\n2. There is mass effect in the anterior and left middle cerebral arteries\narteries from mass effect with no evidence of vascular occlusion, no aneurysms\nare identified." + }, + { + "input": "The patient is status post left frontotemporal craniotomy for resection of a\nleft frontal lobe lesion. Postoperative changes, including a significant\namount of pneumocephalus in the postoperative bed as well as edema, is noted.\nA small amount of hyperdensity in the postsurgical bed likely represents blood\nproducts. Coils are seen along the inferior aspect of the postoperative bed\nis consistent with recent coil embolization. There is mass effect on the\nfrontal horn of the right lateral ventricle as well as 10 mm of midline shift.\nThe perimesencephalic cisterns, suprasellar cistern, and third ventricle are\neffaced. The visualized paranasal sinuses, mastoid air cells, middle ear\ncavities are clear.", + "output": "Status post left frontotemporal craniotomy with postsurgical changes, causing\nsignificant mass effect on basal cisterns and 10 mm of midline shift.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the\ntelephone on ___ at 8:34 ___." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass effect. The\nventricles and sulci are age appropriate in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are normal,\nhowever the patient is status post bilateral lens replacement.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear unremarkable without stenosis, occlusion, or aneurysm. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe bilateral carotid artery and right vertebral artery origins are patent.\nThe left vertebral artery has mild/moderate stenosis at its origin. There is\nno stenosis of the cervical internal carotid arteries by NASCET criteria. The\ncarotidandvertebral arteries and their major branches appear unremarkable with\nno evidence of stenosis or occlusion.\n\nOTHER:\nThere is soft tissue density within the mediastinum, as well as mediastinal\nlymph nodes, CT of the chest is recommended for further evaluation (3:22). \nOtherwise, there is no cervical lymphadenopathy by size criteria. Visualized\naerodigestive tract is unremarkable\n\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits.", + "output": "1. No evidence of acute intracranial abnormality on non-contrast head CT.\n2. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n3. Patent bilateral cervical carotid and vertebral arteries without evidence\nof high-grade stenosis, occlusion,or dissection.\n4. Soft tissue density within the mediastinum accompanied by prominent\nmediastinal lymph nodes are noted. CT of the chest is recommended to further\nevaluate.\n\nRECOMMENDATION(S): CT of the chest is recommended to further evaluate\nmediastinal lymphadenopathy and soft tissue density.\n\nNOTIFICATION: The findings were discussed with ___, by ___\n___, M.D. on the telephone on ___ at 3:38 pm, 10 minutes after\ndiscovery of the findings." + }, + { + "input": "CT Head: There is a focal hyperdensity in the periventricular white matter of\nthe right frontal lobe, measuring approximately 1.2 cm AP x 1.1 cm TR. This\nhyperdensity demonstrates a focal calcification within it. No other evidence\nof focal parenchymal abnormality. There is no evidence of midline shift, mass,\nmass effect, or acute infarction. The ventricles and sulci are slightly\nprominent, consistent with generalized cerebral atrophy . The basal cisterns\nare normal in size and configuration. No fractures are identified.\n\nCTA Head: There is a prominent draining vein within the right frontotemporal\nregion, lateral to the region of the described hyperdense lesion in the\nperiventricular white matter of the right frontal lobe, consistent with a\ndevelopmental venous anomaly. There is no evidence of discrete vascular nidus\nto suggest true arteriovenous malformation. Prominence of the bilateral basal\nveins ___ is noted.\n\nThere is adequate opacification of the internal carotid, anterior cerebral,\nmiddle cerebral, vertebral, basilar and posterior cerebral arteries. There is\ntortuosity of the left internal carotid carotid. There is mild atherosclerotic\ncalcification of both carotid siphons. The right A1 segment is hypoplastic.\nThe anterior communicating artery is well visualized. The vertebral arteries\nare codominant. The posterior communicating arteries are well visualized.\nThere is a \"patulous\" basilar summit, a common variant. There is no evidence\nof aneurysm larger than 2 mm , stenosis, occlusion, or dissection.\n\nCTA Neck: There is a left-sided aortic arch with conventional origin of the\nmajor branch vessels insert. There is adequate opacification of the bilateral\ncommon carotid, internal carotid and vertebral arteries, without high-grade\nnarrowing. There is mild to moderate diffuse atherosclerotic calcification,\nparticularly at the carotid bulbs. The vertebral arteries are codominant with\ntortuosity at their origins. There is no evidence of significant stenosis at\nthe origins or throughout the course of these vessels.\n\nRight internal carotid artery (minimal dimension in mm):\n\nProximal: 6.5\n\nDistal: 4.0.\n\nLeft internal carotid artery (minimal dimension in mm):\n\nProximal: 9.5\n\nDistal: 5.0\n\nAdditional findings: There is mild mucosal thickening of the ethmoid air\ncells. Otherwise, the paranasal sinuses and mastoid air cells are clear. The\nnasopharynx, oropharynx, hypopharynx and larynx are unremarkable. The thyroid\ngland demonstrates homogeneous density. There is no evidence of enlarged lymph\nnodes by CT criteria. The visualized lung apices demonstrate small layering\neffusions with subjacent atelectasis. There moderate degenerative changes of\nthe cervical spine. There are postsurgical changes in the orbits, with a right\norbital prosthesis (confirmed by history on OMR).", + "output": "1. Focal hyperdense lesion in the periventricular white matter of the right\nfrontal lobe with a punctate focus of calcification, an appearance most\nconsistent with cavernous malformation. No evidence of acute intracranial\nprocess. Further characterization with MRI may be helpful, if not already\nperformed, elsewhere.\n2. CTA of the head shows a large developmental venous anomaly (DVA), adjacent\nto the described cavernous malformation and extending within the right frontal\nand right temporal lobes and into the sylvian fissure.\n3. No evidence of stenosis, dissection or aneurysm.\n4. CTA Neck demonstrates mild diffuse atherosclerotic disease without evidence\nof stenosis, dissection or pseudoaneurysm. There is no stenosis of internal\ncarotid arteries by NASCET criteria.\n5. Small layering effusions with subjacent atelectasis.\n6. Moderate degenerative disease of the cervical spine." + }, + { + "input": "There is no evidence of fracture, acute large vascular territory\ninfarction,intracranial hemorrhage,edema,or mass. The ventricles and sulci\nare normal in size and configuration.\n\nThere is mild mucosal thickening in the lateral wall of the right maxillary\nsinus, no air-fluid levels are seen, mild mucosal thickening is noted in the\nethmoidal air cells and frontoethmoidal recesses, the sphenoid sinus appears\nnormally pneumatized. The mastoid air cells and middle ear cavities are\nclear. The orbits are unremarkable.", + "output": "There is no evidence of acute intracranial process or hemorrhage." + }, + { + "input": "CTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. The dural venous\nsinuses are patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. However, there is mild calcified and\nnoncalcified atherosclerosis of the common carotid arteries, proximal left\ninternal carotid artery, and bilateral carotid artery siphons.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is grossly unremarkable. There is no lymphadenopathy by CT size\ncriteria. Mild mucosal thickening noted in the maxillary sinuses. Azygos\nfissure is incidentally noted.", + "output": "1. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n2. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection." + }, + { + "input": "There is hypodensity involving the right parietal lobe involving the\npostcentral gyrus (02:23) with additional smaller region in the precentral\ngyrus as well. There is also hypodensity at the right paramedian pons\n(02:11). Other scattered predominantly subcortical white matter hypodensities\nare likely sequela of chronic small vessel disease. There is no intra-axial\nor extra-axial hemorrhage, mass, or midline shift. Ventricles and sulci and\nunremarkable. Basilar cisterns are patent.\n\nIncluded paranasal sinuses and mastoids are essentially clear. Skull and\nextracranial soft tissues are unremarkable.", + "output": "Subacute right parietal infarct.\nAdditional hypodensities in the pons on the right and subcortical white\nmatter, likely sequela of chronic small vessel disease\n\nNOTIFICATION: Findings discussed by Dr. ___ with Dr. ___ the\nphone 4 minutes after time of discovery at 14:10 on ___." + }, + { + "input": "Right frontal convexal enhancing mass lesion measuring approximately 2 x 2 cm\nwith associated vasogenic edema and subsequent right-sided sulcal effacement\nis again seen. There is partial effacement of the right lateral ventricle.\nFocal subfalcine herniation of the cingulate gyrus is seen to cross midline,\nsimilar to prior. Less significant midline shift inferiorly, at the level of\nthe third ventricle, measures approximately 3mm to the left, and appears\nsimilar to prior. No new lesion or other enhancing lesion.\n\nThere is no evidence of infarction or hemorrhage. The ventricles and sulci are\notherwise normal in size and configuration. No new enhancing lesion\nidentified.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. There is a tiny high density structure at the\nmedial aspect of the left orbit, likely metal. The orbits are otherwise\nunremarkable.", + "output": "Right frontal convexal enhanced mass lesion with associated vasogenic edema\nand mass effect, including subfalcine herniation of the cingulate gyrus, is\nsimilar to prior exam." + }, + { + "input": "Extra-axial, right frontal parafalcine mass abuts the superior sagittal sinus\nwithout evidence for sinus narrowing. Allowing for differences in technique,\nthis mass and associated significant vasogenic edema are unchanged from 2 days\nprior. Leftward shift of midline structures and effacement of the right\nlateral ventricle are unchanged from 2 days prior. Evaluation for acute blood\nproducts is limited in the absence of a precontrast scan.\n\nNo lytic or sclerotic bone lesions are seen. The included paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear.", + "output": "Right frontal parafalcine mass and associated edema are not significantly\nchanged from 2 days prior. The extensive edema associated with the mass is\nnot typical for a meningioma, and aggressive etiology is suspected." + }, + { + "input": "Head CT: There is a 2.6 x 2.1 x 1.8 cm (AP x TV x SI) mass in the right\nfrontal extra-axial region along the inner table of the right frontal\ncalvarium. The mass is isodense to brain on unenhanced CT and demonstrates a\nsmall area of hyperdensity to brain within the medial aspect, consistent with\nblood products or calcification. No lucency or hyperostosis is appreciated in\nthe adjacent bone. The mass enhances somewhat heterogeneously on post-contrast\nimages within area of low-density in the anterolateral aspect of the mass\n(series 3, image 328). There is a very large amount of vasogenic edema\nthroughout the right frontal and anterior parietal lobes.\n\nThe right maxillary sinus is atelectatic with mucosal thickening and sclerosis\nof its walls. The paranasal sinuses are otherwise clear. The mastoid air cells\nand middle ear cavities are clear. The orbits are normal.\n\nHead CTA: The intracranial carotid and vertebral arteries and their major\nbranches are patent. The A1 segment of the right anterior cerebral artery is\nhypoplastic. There is no evidence of aneurysm, stenosis or occlusion.\n\nThe right frontal dural-based mass is in close proximity to the anterior\naspect of the superior sagittal sinus, although the superior sagittal sinus\nremains normal in caliber and patent. The major dural venous sinuses are\npatent.\n\nNeck CTA: The carotid and vertebral arteries and their major branches are\npatent with no evidence of stenoses. There is no evidence of internal carotid\nstenosis by NASCET criteria. The left vertebral artery appears to arise from,\nor in very close proximity to, the brachiocephalic artery.\n\nThere is a 9 mm nodule with spiculated margins in the right upper lobe (series\n3, image 32). There are dependent changes in the visualized lung apices. There\nis a somewhat more focal area of ground-glass opacity in the superior segment\nof the right lower lobe (series 3 image 12) that measures 1.5 cm, although\nthis appears to be just a more focal area of dependent change. There is a\nrounded 6 mm lucency in the left lamina of T5 (series 3, image 8). There is\nmediastinal lymphadenopathy.", + "output": "1. Right frontal 2.6 cm extra-axial mass with large surrounding vasogenic\nedema. Please refer to subsequently performed MRI for further\ncharacterization.\n2. Right upper lobe 9 mm spiculated nodule (series 3, image 32) with\nmediastinal lymphadenopathy. This is suspicious for a primary lung malignancy.\n3. 6 mm lucency within the left lamina of T5 (series 3, image 8). It is\nuncertain whether this is a lytic metastasis or a benign lesion.\n\nNOTIFICATION: Impression point 2 was discussed by Dr. ___ of\nradiology with Dr. ___ at 12:50 ___." + }, + { + "input": "Venous contrast pooling, surgical hardwareanddental amalgam streak artifactand\npatient body habitus limits study.\n\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. Loss of\ngray-white differentiation in the left insula, consistent with left MCA\ninfarct. Periventricular and subcortical white matter hypo density is\nnonspecific but suggestive of small vessel ischemic changes. There prominence\nof the ventricles and sulci suggestive of involutional change.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are normal.\n\nCTA HEAD:\nThere occlusion of the left superior M2 division with distal reconstitution\n(4:280). Additionally, the intracranial portion of the left internal carotid\nartery has a diminutive appearance, likely related to near occlusion\nproximally (described below). The vessels of the circle of well as in the\nmajor branches are otherwise patent without evidence of stenosis, occlusion or\naneurysm.\n\nCTA NECK:\nStreak artifact limits evaluation of right mid V2 segment (see 04:146). \nNonocclusive atherosclerotic calcification narrows the left vertebral artery\norigin. Nonocclusive noncalcified probable atherosclerotic plaque narrows\norigin right vertebral artery. There is severe stenosis at the origin of left\nsubclavian artery. Otherwise, bilateral common carotid and right subclavian\nartery origins are patent.\n\nThere is severe calcified and noncalcified plaque at the left carotid\nbifurcation, which results in near occlusion of the left internal carotid\nartery. Distally, there remains critical stenosis of the extracranial left\ninternal carotid artery, with reconstitution in the petrous portion, although\nthis may also be related to retrograde flow from collaterals (4:258).\n\nThere is also severe calcified and noncalcified atherosclerotic plaque at the\nright carotid bifurcation, with approximately 60% stenosis of the proximal\nright internal carotid artery by NASCET criteria. Additionally, there is also\na probable focal chronic dissection (4:179). The remainder of the right\ninternal carotid artery is patent, although there is moderate atherosclerotic\nplaque in the cavernous and supraclinoid segments.\n\nOtherwise, the vertebral arteries are patent bilaterally.\n\nCT PERFUSION: Are limited by artifact.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits.\n\nApproximately 1.3 cm mediastinal lymph node is seen (see 04:15). Scattered\nsubcentimeter nonspecific lymph nodes are noted throughout the neck\nbilaterally, without definite enlargement by CT size criteria.", + "output": "1. Limited study as described.\n2. Loss of gray-white differentiation in the left insula, compatible with\nacute left MCA infarct.\n3. No acute intracranial hemorrhage.\n4. Occlusion of the left superior M2 middle cerebral artery division with\ndistal reconstitution.\n5. High-grade stenosis of the majority of the left internal carotid artery\nfrom the origin, as described.\n6. Approximately 60% stenosis of the right internal carotid artery at its\norigin, with probable focal chronic dissection.\n7. Severe stenosis of the origin of the left subclavian artery.\n8. Artifact limits evaluation perfusion imaging.\n9. Additional findings as described above." + }, + { + "input": "There has been interval evolution of a left MCA territory infarction with\nhypodensity involving the left temporal, frontoparietal lobes and insula. \nThere is no evidence of acute intracranial hemorrhage. There is no evidence\nof fractureor mass. The ventricles and sulci are normal in size and\nconfiguration.\n\nA mucous retention cyst is seen in a left anterior ethmoid air cell. The\nvisualized portion of the remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nnormal.", + "output": "1. Interval evolution of a left MCA territorial infarct. No acute\nintracranial hemorrhage." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nEvolving subacute left MCA infarct is redemonstrated. No intracranial\nhemorrhage or significant mass effect. Ventricles and sulci are normal in\nsize and configuration. Periventricular and subcortical white matter\nhypodensity is nonspecific, but likely reflect sequelae of chronic small\nvessel ischemic disease.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are normal.\n\nCTA HEAD:\nThere is persistent occlusion of the inferior left M2 branch (309:6). The\nremainder of the vessels of the circle of ___ and their major branches are\npatent. No aneurysm. Improved luminal diameter of the intracranial left\ninternal carotid artery compared to ___.\n\nCTA NECK:\n\nRedemonstration of near occlusion at the origin of the left common carotid\nartery. There is focal dissection along the proximal left internal carotid\nartery, extending approximately 2 cm. Previously, the focal dissection was\nnot well visualized. The lumen of the distal left internal carotid artery is\nlikely moderately narrowed, but the caliber is significantly improved compared\nto ___.\n\nApproximately 60% stenosis of the right internal carotid artery at its origin\nwith likely focal chronic dissection is unchanged.\n\nBoth vertebral arteries remain patent throughout. As before, the there is\nsevere stenosis at the origin of the left subclavian artery.\n\n\nOTHER:\nThe imaged lung apices are clear. Thyroid gland is unremarkable. Cervical\nlymph nodes are not enlarged by CT size criteria. Multiple nonspecific\nmediastinal lymph nodes are unchanged, likely reactive. No aggressive osseous\nlesions. Multilevel degenerative changes of the cervical spine.", + "output": "1. Continued evolution of the left MCA territory infarct. No hemorrhage.\n2. Persistent occlusion of the left inferior M2 middle cerebral artery\ndivision.\n3. 2 cm dissection of the proximal left internal carotid artery is new\ncompared to the prior study.\n4. Improved luminal patency of the left internal carotid artery.\n5. Unchanged 60% stenosis and likely chronic dissection of the proximal right\ninternal carotid artery.\n\nNOTIFICATION: Updated findings were discussed with ___.\nby ___, M.D. on the telephone on ___ at 2:50 pm, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nA small bone island is seen in the left frontal bone. The paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. Incidental note is\nmade of ___ cisterna magna, an anatomic variant.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\n\nNo osseous abnormalities identified. The imaged paranasal sinuses are clear.\nMastoid air cells and middle ear cavities are well aerated. Visualized\nportions of the orbits are unremarkable.", + "output": "No acute intracranial abnormalities. Specifically, no intracranial\nhemorrhage." + }, + { + "input": "CTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe orbits are unremarkable. The paranasal sinuses and mastoid air cells are\nclear. Within the limits of respiratory motion, the lungs are clear. The\nvisualized portion of the thyroid gland is within normal limits. A 1.5 cm\nhypodense nodule is seen within the left thyroid lobe. Mild degenerative\nchanges of the cervical spine are noted.", + "output": "1. No flow limiting stenosis, thrombosis, dissection, or aneurysm of the\ncarotid arteries, vertebral arteries, vessels of the circle ___ and their\nprincipal intracranial branches.\n2. Patent dural venous sinuses.\n3. 1.5 cm hypodense nodule in the left thyroid lobe. Recommend further\nevaluation with thyroid ultrasound.\n\nRECOMMENDATION(S): Thyroid ultrasound." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,intracranial hemorrhage,edema,ormass. The\nventricles and sulci are age-appropriate in size and configuration. There is\nstable chronic infarct in the left cerebral hemisphere.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are normal.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. The dural venous\nsinuses are patent.\n\nCTA NECK:\nThree-vessel conventional branching of the aortic arch is demonstrated. \nBilateral carotid and vertebral artery origins are patent.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion.\n\nOTHER:\nThe visualized portion of the lungs are clear. Bilateral hypodense thyroid\nnodules, unchanged since prior CTA and thyroid ultrasound. Otherwise the\nvisualized portion of the thyroid gland is within normal limits. There is no\nlymphadenopathy by CT size criteria. Mild degenerative changes are visualized\nthroughout the cervical spine consistent with mild spondylosis from C3-C4\nthrough C5-C6 levels.", + "output": "1. No evidence of an acute infarct, intracranial mass, or hemorrhage.\n2. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n3. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection.\n4. Grossly unchanged bilateral hypodense thyroid nodules." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Bilateral basal ganglia calcifications are seen. Ventricles and\nsulci are normal in overall size and configuration for age.\n\nA small subgaleal hematoma is seen in the left occipital scalp with punctate\nfocus of gas compatible with a laceration. No evidence of acute fracture. \nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact. Patient is status\npost bilateral lens replacements and left scleral buckle.", + "output": "1. Small left occipital subgaleal hematoma and laceration without evidence of\nacute fracture.\n2. No evidence of intracranial hemorrhage or mass effect." + }, + { + "input": "There is complete opacification of the left maxillary sinus, with enhancing\nmucosa, consistent with acute sinusitis. The medial root and base of a left\nposterior molar tooth is absent, and there are multiple small bony fragments\nalong the inferolateral aspect of the left maxilla at this level (2:87,\n05:56).\n\n___ 15 has roots within the maxillary ridge, but no crown component is left. \n___ 16 has apparently been removed, probably in the fairly recent past.\n___ 17 has been removed with minimal retained component along the roots. Outer\ncortex of right mandible overlying the site of tooth ___ 29, which has a\nmetallic filling along its crown, appears effaced with full thickness erosion\nof the bone.\n\nEvaluation of the surrounding soft tissue is limited due to streak artifact,\nthough no drainable fluid collections identified.\n\nThere is also moderate opacification of the anterior left ethmoid air cells\nand mild opacification of the anterior right ethmoid air cells. There is mild\nmucosal thickening of the left frontal sinus. The ostiomeatal unit on the\nleft is opacified. The ostiomeatal unit on the right is patent. The\ncribriform plates are intact. The lamina papyracea are intact.\n\nIncidental note made of metallic artifact associated with the aneurysm coils\nalong the left suprasellar region probably to treat a left posterior\ncommunicating artery aneurysm but not entirely assessed with this technique. \nMild age-related involutional changes are apparent in along visualized\nintracranial contents.", + "output": "1. Findings consistent with acute left maxillary sinusitis, in communication\nwith a periapical lucency around a partially intact left maxillary molar tooth\nwith fragmentation of the surrounding bone. Findings should be correlated\nwith the recent dental procedure and the timing of that procedure, as these\nfindings may represent acute sinusitis of odontogenic origin.\n2. Evaluation of the surrounding soft tissues limited due to streak artifact\nfrom dental amalgam, though no drainable fluid collections are identified.\n3. Opacification is also noted in the anterior left ethmoidal air cells. Mild\nmucosal thickening of the left\n\nNOTIFICATION: The findings were discussed with the referring physician by\n___, M.D. on the telephone on ___ at 5:33 pm." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is loss of the insular ribbon and mild hypodensity involving the left\nanterior insular region (series 2, image 18 and 19). No evidence of acute\nhemorrhage or intracranial mass.\nPeriventricular hypodensities are nonspecific but unchanged and likely sequela\nof chronic small vessel ischemic changes. Focal hypodensity in the right\ncentrum semiovale most likely reflects an old lacunar infarct (series 2, image\n23).\n\nPost interventional changes after coil embolization of a left posterior\ncommunicating artery aneurysm are again noted. Recanalization at the base of\nthe aneurysm is better identified on the cerebral angiogram.\n\nThere is mild generalized parenchymal volume loss, most likely age related. \nMild prominence of the ventricular system and extra-axial CSF spaces\nconsistent with the previously mentioned parenchymal volume loss.\nPeriventricular hypodensities are nonspecific but suggestive of chronic small\nvessel ischemic changes.\n\nThere is mild mucosal thickening along the left frontal sinus, partial\nopacification of the ethmoid air cells and complete opacification of the left\nmaxillary sinus with sclerotic changes along the maxillary walls. Hyperdense\nmucous may reflect inspissated secretions or chronic fungal colonization.\nDefect in the left maxilla corresponds to extracted maxillary tooth with areas\nof very demineralized or dehiscent bone at the maxillary antrum floor,\nsuggestive of odontogenic sinusitis. Left pre antral, retro antral, buccal\nspace inflammatory changes, consistent with infection. No orbital extension.\n\nThere is soft tissue in the left retromaxillary fat pad (series 2, image 9 and\n10).\nIncidental note is made of a torus ___.\n\n\nCTA HEAD:\nThere are atherosclerotic changes along both cavernous ICAs without high-grade\nstenosis.\nThere is abrupt cut of the distal left MCA M1 segment (series 4, image\n262-263).\nBilateral PCA evaluation is limited secondary to metal artifact from aneurysm\ncoils.\nRight M3 branch narrowing.\nThe vessels of the circle of ___ and their principal intracranial branches\nappear otherwise unremarkable without stenosis, occlusion, or aneurysm\nformation.\nThe dural venous sinuses are patent.\n\nCT PERFUSION:\nEvaluation of the CT perfusion images is slightly limited given a small peak\nof the anterior contrast bolus curve (series 301, image 9).\nCBF<30% volume: 6 mL, Tmax> 6.0s volume: 233 mL, mismatch volume: 229 mL.\nThere is increased T max in the left MCA territory. T-max greater than 8\nseconds 192 mL. T-max greater than 10 seconds 167 mL.\nSome mild decreased cerebral blood volume and flow is seen along the anterior\nleft MCA territory.\n\nCTA MIPS:\nThere is decreased gray-white matter differentiation in the left frontal lobe\nnear the expected Broca's area, left insula, left M 5, and probably left M 2\nand M3 MCA territories.\n\nCollaterals:\nLeft MCA collaterals at level of sylvian fissure and over left hemispheres is\nless than 50% of contralateral side.\n\nCTA NECK:\nBovine type aortic arch. Small atherosclerotic plaque at the origin of the\nright vertebral artery results in mild narrowing of its origin. The cervical\ncourse of both vertebral arteries is otherwise unremarkable.\n\nThere are minimal atherosclerotic changes at both carotid bifurcations without\nevidence of internal carotid stenosis by NASCET criteria.\nThe carotid arteries and cervical ICAs are otherwise unremarkable.\n\nOTHER:\nThere is gravity dependent atelectasis. The visualized portion of the thyroid\ngland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. Suggestion of pulmonary artery hypertension.", + "output": "1. Distal left M1 occlusion with a mismatch volume of 229 mL.\n2. Left MCA collaterals less than 50% compared to right side.\n3. Calculated CBF < 30% is 6 mm. Much greater area of infarct is seen on CTA\nMIPS images involving left insula, M1, M 5; and probably M2, M3 territories.\n4. Findings consistent with severe chronic small vessel ischemic changes. \nProbable chronic small infarct right centrum semiovale.\n5. Left PCOM aneurysm embolization, with recanalization at the aneurysm base.\n6. Complete opacification left maxillary sinus, suggestion of odontogenic\nsinusitis. Chronic surrounding periostitis. Pre antral, retro antral,\npterygopalatine space, buccal space inflammatory change consistent with\ninfection..\n7. Chronic small vessel ischemic changes intracranially.\n8. Otherwise, mild atherosclerotic changes neck, intracranially..\n9. Suggestion of pulmonary artery hypertension.\n\nNOTIFICATION: The patient has already been evaluated by OMFS and\nOtolaryngology at the time of the final report.\n\nNOTIFICATION SECTION The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 6:19 pm, 5 minutes\nafter discovery of the findings." + }, + { + "input": "Loss of gray differentiation in the left frontal lobe and subinsular cortex is\nconsistent with infarction. Gray-white differentiation in the remaining brain\nparenchyma is preserved. No evidence intracranial hemorrhage or mass. There\nis prominence of the ventricles and sulci suggestive of involutional changes,\nunchanged. Bilateral periventricular subcortical white matter hypodensities\nare nonspecific but most likely represent sequela of chronic small vessel\nischemic changes. Left PCOM aneurysm coil is noted. Bilateral carotid siphon\ncalcifications are noted.\n\nThere is no evidence of fracture. There is opacification of the left\nmaxillary sinus, left ethmoid air cells, and left frontal sinus. Osseous\nsclerosis of left maxillary sinus suggest chronic inflammatory changes.\n\nThere is dehiscence of the lateral left maxillary sinus wall (series 3, image\n3) with soft tissue thickening and enhancement involving the left buccal\nspace, extending posteriorly through the retro antral fat pad to the left\npterygopalatine fossa.\n\nThe remaining paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. Status post bilateral lens replacement. Otherwise the orbits are\nunremarkable.", + "output": "1. Loss of gray-white differentiation in the left frontal lobe and left sub\ninsular cortex, consistent with infarction.\n2. No intracranial hemorrhage.\n3. Paranasal sinus disease with chronic inflammatory changes in the left\nmaxillary sinus.\n4. Dehiscence of the left maxillary sinus wall with inflammatory soft tissue\nin the left buccal space, extending to the pterygopalatine fossa. Clinical\ncorrelation and correlation with prior imaging if available is recommended to\ndocument stability of the finding as this could result in intracranial\nextension of infectious process.\n5. Additional findings described above." + }, + { + "input": "There is no evidence of acute territorial infarction,acute intracranial\nhemorrhage,edema,or mass. Periventricular, deep, and subcortical white matter\nhypodensities are nonspecific, likely sequela of chronic small vessel ischemic\ndisease.\n\nThere is no evidence of calvarial fracture. Patient has had prior coiling of\nthe left posterior communicating artery aneurysm, with subsequent streak\nartifact limiting evaluation of adjacent structures. The visualized portion\nof the paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "No acute intracranial hemorrhage or mass effect. No acute fracture." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Brain\nparenchymal atrophy. Findings consistent with severe chronic small vessel\nischemic changes, similar. Probable chronic lacunar infarct left caudate\nhead, similar. Probable small chronic lacunar infarcts centrum semiovale,\nsimilar. If\n\nThere is no evidence of fracture. Left parasellar aneurysm coils. Near\ncomplete opacification of the left maxillary sinus and anterior left ethmoid\nair cells with moderate thickening of the left frontal sinus, new since prior,\nconsistent with acute sinusitis, with component of underlying chronic mild\nmaxillary periostitis.. Degenerative arthritis temporomandibular joints.. \nThe other visualized portions of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Findings consistent with acute paranasal sinusitis.\n2. No acute intracranial findings.\n3. Brain parenchymal atrophy, severe chronic small vessel ischemic changes,\nsmall chronic lacunar infarcts." + }, + { + "input": "A rounded, lucent centered 6 mm hyperdense focus in the medial left occipital\nlobe (series 2, image 12) is centered at site of prior hemorrhagic metastasis\nseen on ___ CT, possibly residual calcification. Difficult to exclude\na small focus of underlying hemorrhage. Elsewhere, there is no evidence of\nhemorrhage. There is preservation of gray-white matter differentiation. \nHypodensity in the right frontal lobe near the vertex may reflect edema from a\nnonvisualized metastasis in this region (series 2, image 22). No mass is\ndefinitively visualized; these were better evaluated on prior MR examinations.\nPeriventricular and deep white matter hypodensity may represent sequelae of\nchronic small vessel ischemic change. Mild prominence of the ventricles and\nsulci is consistent with age-appropriate global atrophy. The basal cisterns\nare patent. There is no shift of normally midline structures. The imaged\nparanasal sinuses and mastoid air cells are clear. The partially imaged\nglobes and bony orbits are intact and unremarkable.", + "output": "1. 6 mm hyperdense focus in the medial left occipital lobe may reflect\ncalcification from previously imaged hemorrhagic metastasis at this location. \nDifficult to exclude trace underlying hemorrhage. Otherwise, no hemorrhage. \nNo evidence of acute infarction.\n2. Edema in the right frontal lobe near the vertex is likely related to known\nmultifocal supratentorial metastases, not definitively visualized on this\nexamination, better evaluated on prior MRI. No mass-effect." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. A\nsmall hyperdense focus adjacent to the occipital horn of the left lateral\nventricle is unchanged. The ventricles and sulci are normal in size and\nconfiguration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of intracranial hemorrhage or infarction. No areas of brain\nedema identified.\n\n2. Please note that noncontrast head CT is not sensitive for detection of\nsubtle intracranial masses, especially given prior history of brain\nmetastases, MRI should be considered for further evaluation if clinically\nindicated." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Symmetric\nenlargement of left lateral ventricle occipital horn is unchanged. A small\nfocus of hyperdensity compatible with calcification adjacent to the left\nlateral ventricle occipital horn is also unchanged. Prominence of sulci and\nventricles are likely reflective of involutional changes. Periventricular and\nsubcortical deep white matter hypodensities are similar to before. Right\nfrontal encephalomalacia is also unchanged (02:26).\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process. If there is clinical concern for subtle mass,\nconsider MRI for better evaluation." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass/mass-effect. Symmetric enlargement of the left lateral ventricle\noccipital horn is unchanged. A small focus of hyperdensity adjacent to the\nleft ventricle occipital horn is unchanged dating back to at least ___, in the region of a known prior hemorrhagic mass. Extensive\nperiventricular white matter hypodensities are nonspecific but likely sequela\nof chronic small vessel disease. Right frontal encephalomalacia is unchanged.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial anomaly noncontrast head CT. If there is concern for\nsubtle brain mass, consider MRI, if there are no contraindications." + }, + { + "input": "Again seen, are multiple hyperdense intracranial lesions with extensive\nsurrounding vasogenic edema, better characterized on prior MRI from ___. The largest lesion is seen within the left occipital lobe measuring\n4.8x2.9 cm lesion. Correlation with MRI shows negative susceptibility on\ngradient echo compatible with multiple stages of hemorrhage within this lesion\nand multiple smaller lesions seen throughout the brain.\nThere is no evidence of major acute territorial infarction.\nThere is persistent compression of the right lateral ventricle and loss of the\noccipital horn of the left lateral ventricle due to edema.\nThere is no appreciable midline shift or herniation.\n\nNo osseous abnormalities seen.\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\nThe orbits are unremarkable.", + "output": "Multiple hyperdense lesions seen throughout the brain, some of which show\nhemorrhage not significantly changed from the prior MRI done on ___.\nThese lesions are most consistent with multiple metastatic foci in the setting\nof a newly discovered lungs mass, characterized on chest CT from ___." + }, + { + "input": "There is no evidence of acute large infarction, acute intracranial hemorrhage,\nedema, or mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Several white matter hypodensities adjacent to the\noccipital horn of the left lateral ventricle (2:15, 18), in the left posterior\nparietal lobe (2:21), and within the left cerebellar hemisphere are likely\nsequela of chronic infarction. Smaller periventricular white matter\nhypodensities are likely the sequela of chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. Mild right maxillary sinus mucosal\nthickening suggests mild ongoing inflammation. The visualized portion of the\nremaining paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable. \nAtherosclerotic calcifications are noted involving the cavernous carotid and\ndistal right vertebral arteries.", + "output": "No acute intracranial hemorrhage detected. Multifocal areas of chronic\ninfarction." + }, + { + "input": "New since prior exam, there is blood products centered around the left frontal\nextra-axial space, with moderate amount of subarachnoid hemorrhage along the\nbilateral frontal gyri. Left subdural hemorrhage measures 10 mm along the\nanterior falx and 2 mm along the left frontal calvarium. Small amount of\nbladder products are also seen along the bilateral sylvian fissures. Layering\nblood products are noted in bilateral posterior horns of the lateral\nventricles, which are dilated when compared to prior exam on ___. \nTiny specks of blood products are noted within the hypodense left frontal\nlobe. Edematous left frontal lobe exerts mass effect on the frontal horn of\nleft lateral ventricle, the possibility of acute/subacute ischemic changes is\na consideration. In addition to the lateral ventricles, the third and fourth\nventricles are also mildly dilated.\nChronic infarct of the left parietal lobe is again seen.\n\nThere is no evidence of acute fracture. There is mild mucosal thickening of\nthe ethmoid air cells with trace fluid in the bilateral sphenoid and right\nmaxillary sinuses. Otherwise, the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Left subdural, bilateral subarachnoid hemorrhage in the frontal and\ntemporal gyri, and tiny specks of intraparenchymal hemorrhage in the left\nfrontal lobe within a larger area of left inter lobe hypodensity. The\nfindings may suggest hemorrhagic transformation of left frontal lobe infarct\nand/or rupture of ACA/anterior communicating artery aneurysm. If clinically\nrelevant, consider obtaining CTA of the head.\n2. Chronic infarct of the left parietal lobe.\n3. New hydrocephalus.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 2:42 am, 2 minutes after\ndiscovery of the findings." + }, + { + "input": "CT angiography of the neck shows normal appearance of the carotid and\nvertebral arteries without stenosis or occlusion or dissection. Mild\natherosclerotic calcifications are seen.\n\nCT angiography of the head shows a bilobed irregular configuration 4 mm\naneurysm at the anterior communicating artery pointing superiorly. There is\nhypoplastic A1 segment of the right anterior cerebral artery. No other\ndistinct aneurysms are identified. No vascular occlusion or stenosis is seen.", + "output": "CT angiography demonstrates a bilobed irregular-shaped aneurysm at the\nanterior communicating artery. Hypoplastic A1 segment of the right anterior\ncerebral artery noted. Vascular calcification seen without high-grade\nstenosis or occlusion." + }, + { + "input": "X per CT prior to procedure: Newly placed right frontal EVD terminates in the\nright lateral ventricle. There is no evidence of hemorrhage along the tract.\nSmall amount of pneumocephalus adjacent to the burr hole for the EVD. Again\nnoted subarachnoid hemorrhage. And intraparenchymal hemorrhage primarily in\nthe left frontal lobe surrounded by hypodensity concerning for ischemic stroke\nversus edema.\n\n Ultrasound the right common femoral artery: There is a single\nnoncompressible, arterial, pulsatile lumen. There is evidence of access of\nthe wire into the lumen. Images were saved to the patient's permanent medical\nrecord.\n\nLeft internal carotid artery: There is no evidence of carotid stenosis\ncervical region based on roadmap images and NASCET criteria. There is\nopacification the anterior and middle cerebral arteries and their distal\nterritories. There is cross-filling across the anterior communicating artery\nand filling of the contralateral A 2 segment. There is an area of extreme\nvasospasm at the origin of the right A 2 segment that is consistent with a\nstring sign. There is an aneurysm approximately 4.5 mm that arises from the\nanterior communicating artery. It is try lobe. And extends with different\nlobes off opposite side of the anterior communicating artery. This anatomy is\nconfirmed on the three-dimensional rotational imaging. The origin of the left\nartery of heubner is associated with the neck of the aneurysm.\n\nLeft internal carotid artery after balloon assisted coil placement: The\nanterior lobe the aneurysm has coils in place. The additional lobe appears\nlarger in size. There is no active extravasation. There is no vessel\ndropout. The Vasa spasm persists in the right A2: There is a new small bleb\nadjacent to the left A2 origin that may represent pseudoaneurysm.\n\nLeft internal carotid artery after partial coiling: There is active\nextravasation noted.\n\nLeft internal carotid artery after coiling completion: There is no residual\nfilling of the previously identified anterior communicating artery aneurysm. \nThere are coils within the anterior communicating artery but there is\npersistent filling the bilateral A2 segments. The right A2 continues to have\nspasm at the origin. There is good opacification distal. The filling is\nsomewhat slowed compared to previously specifically on the left A 2. But\nthere is filling. Three-dimensional rotational imaging confirms no residual\nfilling of the previously identified aneurysm with no active extravasation and\ncoil in the parent artery.\n\nRight common femoral artery: Arteriotomy is above the bifurcation. There is\ngood distal runoff. There is no evidence of dissection. Vessel caliber\nappropriate for closure device.\n\nX per head CT post procedure: Again noted subarachnoid hemorrhage. There is\ncoil artifact at the anterior communicating artery. There is increase in\ninterventricular hemorrhage. There is new hemorrhage layering on the\ntentorium. There is increase in the intraparenchymal component with contrast\npresent in the left frontal lobe. External ventricular drain continues to\ntraverse and terminate in the right lateral ventricle.", + "output": "Balloon assisted coiling of the ruptured anterior communicating artery\naneurysm complicated by intraprocedural rupture. Coils do fill the parent\nartery. ___ 1.\n\nRECOMMENDATION(S):\n1. Start aspirin 325 mg and keep blood pressure above 130 in light of coils in\nthe parent artery." + }, + { + "input": "Artifact from embolization coils in the region of the anterior communicating\nartery limit evaluation.\n\nThere has been interval placement of a right frontal approach ventriculostomy\ndrain, which terminates near the foramen of ___. Small volume right frontal\npneumocephalus is likely postprocedural.\n\nSubdural hematoma seen along the left aspect of the anterior falx, measuring\nup to 1.2 cm in thickness, and along the left frontal lateral convexity is\nmildly bigger. There is increased subarachnoid hemorrhage involving the\nbilateral frontal and parietal lobes. There is markedly increased hemorrhage\nin the ventricles, with the left lateral and fourth ventricles. The left\nfrontal lobe hematoma with surrounding edema is also larger.\n\nThere is no evidence of infarction. No midline shift. Moderate hydrocephalus\npersists but is stable.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Interval increase in size and extent of left frontal subdural hemorrhage,\nbilateral subarachnoid and intraventricular hemorrhage, and left frontal\nintraparenchymal hemorrhage, as detailed above.\n2. New right frontal approach ventriculostomy drain terminates near the\nforamen of ___. Status post coiling of anterior communicating artery\naneurysm.\n3. Similar degree of hydrocephalus." + }, + { + "input": "Streak artifact from the coil pack in the treated anterior communicating\nartery aneurysm limits evaluation at adjacent levels.\n\nDiffuse subarachnoid hemorrhage is most extensive in the anterior\ninterhemispheric fissure, left medial frontal sulci, and along the left\nfrontal pole, similar to prior. There is also bilateral sulcal and basal\ncistern subarachnoid hemorrhage, similar to prior. Left frontal parenchymal\nhemorrhage appears slightly less extensive. Extensive left frontal edema\nparenchymal persists.\n\nLeft convexity subdural hematoma demonstrates slight gravity-related\nredistribution, with a slightly more prominent component along the occipital\npole on image 2:19, but overall no significant change in volume.\n\nModerate effacement of the frontal horn of the left lateral ventricle is\nstable. There is stable amount of blood in the occipital horns of the lateral\nventricles and fourth ventricle, with slightly decreased to stable blood in\nthe third ventricle. Right frontal approach ventriculostomy catheter is\nunchanged in position, terminating near the foramien ___. There has been\npartial improvement in the dilatation of the lateral and third ventricles.\n\nMinimal 2 mm rightward shift of midline structures is stable allowing for\ndifferences in patient positioning.\n\nThere is mild fluid and mucosal thickening in the sphenoid sinuses, as well as\ntrace fluid in the maxillary sinuses, and foci of mucosal thickening in the\nmaxillary and ethmoid sinuses.", + "output": "1. No significant change in extensive bilateral subarachnoid hemorrhage.\n2. Slightly decreased left frontal parenchymal hemorrhage with stable\nsurrounding edema.\n3. Stable left convexity subdural hematoma with slight redistribution.\n4. Minimally decreased intraventricular hemorrhage. Partial improvement in\nhydrocephalus. Stable position of the right frontal approach ventriculostomy\ncatheter.\n5. Stable minimal 2 mm shift of midline structures." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nA right transfrontal ventricular shunt catheter is re-demonstrated,\nterminating within the foramina ___. Resolved hydrocephalus. Stable\nintraventricular hemorrhage.\n\nA large focus of intraparenchymal hematoma is seen in the left frontal lobe\nmeasuring 6.2 x 2.7 cm with stable surrounding edema, stable,, effacing the\nleft frontal horn.\n\nSubarachnoid hemorrhagic products are seen along the anterior and high\nparasagittal frontal lobes, the bilateral sylvian fissures and along the\nbilateral temporal and bilateral parietal lobes. These appear similar.\n\nA subdural hematoma is seen along the left frontoparietal convexity, measuring\nup to 5 mm in maximal diameter, previously measuring 2 mm. Small subdural\nhematoma is seen along the left parietal region, measuring up to 7 mm in\nmaximal diameter, unchanged.\n\nMinimal midline shift. Patent foramen magnum.\n\nMild opacification paranasal sinuses, likely from intubation. Trace\nopacification mastoids. The visualized portion of the orbits are\nunremarkable.\n\nCTA HEAD:\nThe patient is post coiling of a known anterior communicating artery aneurysm.\nEvaluation for residual aneurysm is difficult due to streak artifact. The\ndistal anterior cerebral arteries are patent.\n\nMild narrowing left M3 sylvian branch, mildly worsened. Improved flow with\nthe proximal right A2 segment. Mild narrowing left pericallosal, callosum\nmarginal branches, likely from vasospasm, new since prior.\n\nA hypoplastic right A1 segment is seen. Evaluation of PCAs compromised\nsecondary to artifact from aneurysm coiling, vessels are patent. There is\nextensive calcified atherosclerotic change of the bilateral intracranial\ninternal carotid arteries without significant stenosis. The bilateral middle\ncerebral posterior cerebral arteries are patent.\n\nMild narrowing of the distal left vertebral artery. There is calcified\natherosclerotic change of the right vertebral artery without significant\nstenosis.\n\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal with no evidence of stenosis, occlusion, or aneurysm. The dural\nvenous sinuses are patent.\n\nNasogastric and endotracheal tubes are partially visualized. Pneumocephalus\nis nearly resolved.", + "output": "1. New mild vasospasm left distal ACA branches. Mildly worsened vasospasm\nleft M3 branch. Artifact at the level of bilateral PCA, there may be\nunderlying vasospasm, stable.\n2. A-comm aneurysm coiling..\n3. No new subarachnoid hemorrhage. Left frontal lobe parenchymal,\nintraventricular, subarachnoid hemorrhage, stable.\n4. Minimal worsening of small subdural hemorrhage.\n5. Resolved hydrocephalus.\n6. Minimal midline shift." + }, + { + "input": "Again demonstrated streak artifact from the coil pack in the anterior\ncommunicating artery aneurysm at adjacent levels.\n\nInterval increase in the size of the ventricular system including the lateral,\nthird and fourth ventricles when compared to most recent prior dated ___. Interval decrease in the blood products in the occipital horns, lateral\nventricles and fourth ventricle. Stable bilateral effacement of the frontal\nhorns, left worse than right.\n\n\nDiffuse subarachnoid hemorrhages most extensive in the anterior\ninterhemispheric fissure, left medial frontal sulci and along the left frontal\npole similar to the relatively unchanged from prior. There are bilateral\nfocal and basal cistern subarachnoid hemorrhage mildly decreased from prior. \nThe left frontal parenchymal hemorrhage appears less extensive, however the\nassociated frontal edema persists.\n\nRelatively unchanged left convexity subdural hematoma which has been\nredistribution regularity. The occipital component of the aforementioned\nsubdural hematoma is also relatively unchanged, (series 2, image 16).\n\nThe right frontal approach ventriculostomy catheter is unchanged in position,\nterminating near the foramen of ___.\n\nThere has been interval resolution of midline shift.\n\nMild fluid and mucosal thickening in the sphenoid sinuses as well as trace\nfluid in the maxillary sinuses and foci of mucosal thickening of the maxillary\nand ethmoid sinuses. There is partial opacification of the left mastoid air\ncells which could be due to positioning however infection or inflammation\ncannot be excluded.", + "output": "1. Interval increase in the size of lateral, third and fourth ventricles.\n2. Relatively unchanged extensive bilateral subarachnoid hemorrhages.\n3. Slightly decreased left frontal parenchymal hemorrhage with stable\nsurrounding edema without evidence of new hemorrhage or large territorial\ninfarction.\n4. Relatively unchanged left convexity subdural hematoma likely redistributed\nby gravity.\n5. New partial opacification of the left mastoid air cells likely due to\npositioning however infection or inflammation cannot be excluded." + }, + { + "input": "There is a right transfrontal approach ventricular shunt catheter which\nterminates near the right foramen of ___, unchanged. In comparison ___ and ___, there has been continued enlargement of the ventricular\nsystem including the lateral, third, and probably also fourth ventricles. \nThere is stable small amount of blood in the occipital horns of lateral\nventricles.\n\nThe patient is status post coiling of anterior communicating artery aneurysm. \nStreak artifact from the embolization coils somewhat limits evaluation at\nadjacent levels. No significant change in subarachnoid hemorrhage compared to\n1 day prior, most concentrated in the medial left frontal sulci. Small\nisodense left convexity subdural hematoma is also stable compared to 1 day\nprior. Large left anterior frontal area of edema is unchanged with slowly\ndecreasing amount of hemorrhage.\n\nUnchanged chronic left occipital/parietal infarct dating back to ___.\n\nFluid in the sphenoid sinuses, nasopharynx, and mastoid air cells may be\nrelated to prolonged supine positioning in the inpatient setting, as well as\nnasogastric intubation. Also mild mucosal thickening in the partially\nvisualized maxillary sinuses.", + "output": "1. Continued enlargement of the ventricular system compared to ___\nand ___. Stable small amount of intraventricular hemorrhage.\n2. Stable subarachnoid hemorrhage.\n3. Stable small isodense left convexity subdural hematoma.\n4. Persistent large area of left anterior frontal edema with decreasing\nparenchymal hemorrhage.\n5. Unchanged chronic left occipital/parietal infarct dating back to ___.\n\nNOTIFICATION: The findings, including the increased ventricular size, were\ndiscussed with ___ RN on behalf of the neurosurgical team by ___\n___, M.D. on the telephone on ___ at 12:44 pm, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "Head CT without contrast was performed on ___ at 13:38. It was not\nread as of ___. Report is been generated at 13:40 ___\n\nMild intraventricular hemorrhage, improved since prior. Moderate\nhydrocephalus,, mildly worsened since prior. A-comm aneurysm coiling. Left\nanterior paramedian frontal lobe parenchymal hematoma is slightly decreased,\nsurrounding edema. Extensive areas of subacute infarcts involving bilateral\nhemispheres stable, better seen on MRI. Small subdural hematoma, similar. \nBihemispheric subarachnoid hemorrhage, mildly less prominent. Stable\npartially effaced suprasellar cistern partially effaced perimesencephalic\ncisterns, stable. Patent prepontine cistern, patent foramina magnum.\nPatient is intubated.. Mild bilateral proptosis. Right parietal burr hole\nfrom prior intraventricular drain. Opacified mastoids, mild opacification\nparanasal sinuses, likely from intubation.", + "output": "Moderate hydrocephalus, mildly worsened.\nExtensive subacute infarcts, similar. Mildly decreased left frontal lobe\nparenchymal hematoma. Mildly decreased intraventricular hemorrhage. Less\nprominent subarachnoid hemorrhage. Small stable subdural hemorrhage." + }, + { + "input": "Streak artifact from the patient's necklace limits evaluation of the\nskullbase.\n\nThere is no evidence of acute hemorrhage, edema, mass effect, or loss of\ngray/white matter differentiation. Ventricles, sulci, and basal cisterns are\nnormal in size for age.\n\nThere is no evidence of fracture. The orbits appear unremarkable. There is\nmild mucosal thickening and scattered mucous retention cysts in the ethmoid\nair cells. There is minimal mucosal thickening in the partially visualized\nmaxillary sinuses and along the anterior walls of the sphenoid sinuses. \nMastoid air cells are well aerated.", + "output": "No evidence for acute intracranial abnormalities." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThe left frontal lobe encephalomalacia with associated ex vacuo dilatation of\nthe frontal horn of the left lateral ventricle is unchanged. There is\nencephalomalacia of the right occipital lobe with associated ex vacuo\ndilatation of the occipital horn of the right lateral ventricle. There is no\nhemorrhage, mass effect, midline shift, or extra-axial fluid collection.\n\nA 1.7 x 1.1 cm rounded, extra-axial, hyperdense mass in the left parietal lobe\nis unchanged in size from the MRI head ___ and is associated with\nfocal hyperostosis of the adjacent left parietal calvarium (image 17, series\n2).\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe right distal M1 segment is occluded on 4:229 with reconstitution of the\nproximal M2 segments, new from the prior examination. The bilateral anterior\ncerebral, posterior cerebral, intracranial internal carotid arteries, and left\nmiddle cerebral artery are patent. No aneurysms are identified. There is\nfetal origin of the left posterior cerebral artery. The intradural vertebral\nand basilar arteries are patent.\n\nCTA NECK:\nThe left common carotid and right brachiocephalic arteries share a common\norigin, a normal anatomic variant. The bilateral common, internal, and\nexternal carotid arteries are patent. There is no evidence of internal\ncarotid artery stenosis by NASCET criteria. The bilateral cervical internal\ncarotid arteries have a retropharyngeal course. The left vertebral artery\ndirectly originates from the aortic arch. Both vertebral arteries, including\ntheir origins, are patent throughout their course.\n\nCT PERFUSION:\nThere is increased mean transit time and decreased cerebral blood flow in the\nright MCA distribution. Cerebral blood volume in the right MCA distribution\nis normal.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. There are multilevel degenerative changes of the cervical spine\nfrom C4-C7.", + "output": "1. New occlusion of the distal right M1 segment with reconstitution of the\nright proximal M2 segments with increased mean transit time, decreased\ncerebral blood flow, and normal cerebral blood volume in the right MCA\ndistribution, indicative of ischemic penumbra.\n2. Patient vasculature in the neck with no evidence of internal carotid artery\nstenosis by NASCET criteria.\n3. Chronic infarctions in the left frontal and right occipital lobes.\n4. Unchanged, rounded, extra-axial mass in the left parietal lobe with\nhyperostosis of the adjacent calvarium, suggestive of meningioma, correlation\nwith MRI of the head with contrast is advised for further characterization.\n\nRECOMMENDATION(S): Point 4. Unchanged, rounded, extra-axial mass in the left\nparietal lobe with hyperostosis of the adjacent calvarium, likely representing\na meningioma, correlation with MRI of the head with contrast is recommended\nfor further characterization." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is a new area of subtle hypodensity in the right putaminal and\nsubinsular white matter compared with prior CT on ___, consistent\nwith the acute infarction seen on MRI performed on same day. There is stable\nencephalomalacia of the left frontal and right occipital lobes consistent with\nchronic infarct. There is a stable left meningioma. No evidence of hemorrhage.\nThe visualized portion of the paranasal sinuses,mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is occlusion or severe stenosis at the right MCA bifurcation (702:16).\nThere is no filling of the proximal superior division of the right MCA,\nhowever there is better distal filling of the superior division in the sylvian\nfissure, suggestive of collateral flow. The remainder of the intracranial\nvessels appear patent with no evidence of stenosis or aneurysm formation.", + "output": "1. Occlusion or severe stenosis at the right MCA bifurcation, with no filling\nof the proximal superior division of the right MCA, but with distal filling of\nthe superior division in the sylvian fissure, suggestive of collateral flow.\n2. New subtle hypodensity in the right putaminal and subinsular white matter\ncompared with prior CT head on ___ and consistent with acute\ninfarction seen on MRI performed on same day." + }, + { + "input": "There has been interval evolution and progression of hypodensity in the right\nMCA distribution with loss of gray-white differentiation of the overlying\ninsular cortex, with hypodensity extending into the right deep white matter\ninto the right centrum semiovale (series 3, image 21), centered lateral to the\nright putamen (series 3, image 16), consistent with evolving right MCA\ninfarction. There is no evidence of hemorrhage.\nThere is no evidence of a new or acute infarction elsewhere. Re-identified\nare foci of encephalomalacia involving the right cerebellar hemisphere, the\nright occipital lobe, as well as the left frontal lobe. Again seen is the\nrounded, extra-axial mass in the left parietal lobe with hyperostosis of the\nadjacent calvarium (series 3, image 23), unchanged in appearance.\n\nThe basal cisterns are patent. There is no shift of normally midline\nstructures. The ventricles and sulci are stable in caliber and configuration,\nwithin normal limits. The visualized paranasal sinuses and mastoid air cells\nare clear. Globes are intact and unremarkable.", + "output": "1. Expected interval evolution of findings associated with known right MCA\nterritory infarction. No hemorrhage. No new acute infarction elsewhere.\n2. Stable foci of encephalomalacia involving the right cerebellar hemisphere,\nright occipital lobe, and left frontal lobe.\n3. Stable appearance of a rounded, extra-axial mass in the left parietal lobe\nwith hyperostosis of the adjacent calvarium, suggestive of meningioma, better\nassessed on recent MRI.\n\nRECOMMENDATION(S): If there is clinical concern for new areas of acute\nischemia, correlation with MRI of the brain is recommended." + }, + { + "input": "There is no acute intracranial hemorrhage. There is no evidence for edema,\nmass effect, loss of gray/ white matter differentiation, or pathologic\nextra-axial collection. Ventricles, basal cisterns, and cerebral sulci are\nnormal in size.\n\nThere is a large right supraorbital and periorbital hematoma without evidence\nfor intraorbital extension. The globes appear intact. There is no calvarial\nfracture. Concurrent facial bone CT is reported separately.\n\nThere is fluid in one of the right middle ethmoid air cells. There is a mucous\nretention cyst in the left frontal sinus. Maxillary sinuses are not fully\nincluded on the images; please refer to the concurrent facial bone CT. Mastoid\nair cells and middle ear cavities, as well as partial pneumatized petrous\napices, are well-aerated.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. Large right supraorbital and periorbital hematoma without evidence for\nintraorbital extension. No calvarial fracture. Concurrent facial bone CT is\nreported separately." + }, + { + "input": "No evidence of acute territorial infarction, hemorrhage, oredema. The\nventricles and sulci are normal in size and configuration. An extraaxial\nCSF-density region in the left posterior fossa with associated relative\nasymmetric size of the left cerebellar hemisphere may represent an arachnoid\ncyst. No shift of normally midline structures. Grey-white matter\ndifferentiation appears preserved. Incidental cavum interpositum is a normal\nvariant.\n\nNo evidence of fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.\n\nSubcutaneous induration in the posterior scalp may represent scarring (series\n602b, image 45).", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically, no\nintracranial hemorrhage.\n2. Extra-axial CSF of the posterior left posterior fossa may represent an\narachnoid cyst with apparent mild mass effect on the left cerebellar\nhemisphere.\n3. If there remains concern for aneurysm or dissection, CTA of the head and\nneck may yield additional information." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no acute hemorrhage, edema, mass effect, loss of gray/ white matter\ndifferentiation, or pathologic extra-axial collection. Prominent\nretrocerebellar fluid signal intensity, slightly centric to the left, most\nlikely represents a normal-variant ___ cisterna magna, and less likely an\narachnoid cyst. Other basal cisterns, ventricles, and cerebral sulci are\nnormal in size for age.\n\nParanasal sinuses and mastoid air cells are well aerated. The orbits are\nunremarkable.\n\nCTA NECK:\nThere is a 3 vessel aortic arch. The common carotid and vertebral arteries\nare widely patent without evidence for flow-limiting stenosis. There is no\nevidence of internal carotid stenosis by NASCET criteria. There is no\nevidence for dissection.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear patent without flow-limiting stenosis, dissection, or aneurysm. A1\nsegment of the right anterior cerebral artery is hypoplastic, a normal\nvariant. Fetal type configuration of the right posterior cerebral artery is\nalso a normal variant. The dural venous sinuses are patent.\n\nOTHER:\nThe visualized portion of the lungs are clear allowing for respiratory motion\nartifact. The thyroid gland appears grossly homogeneous. The adenoids are\nsymmetrically enlarged. The tonsils are unremarkable. Multiple nonenlarged\ncervical lymph nodes are likely related to the patient's young age.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. Normal CTA of the head and neck.\n3. Enlarged adenoids. Please correlate clinically." + }, + { + "input": "There is no acute large vascular territorial infarction, hemorrhage, edema or\nmass. Prominent ventricles and sulci suggest age-related involutional\nchanges. Chronic infarcts in the left cerebellar hemisphere noted. \nSubcortical white matter hypodensity in left frontal lobe is unchanged.\n\nNo fracture identified. The imaged paranasal sinuses are clear. Mastoid air\ncells and middle ear cavities are well aerated. Moderate atherosclerotic\ncalcification of the bilateral carotid siphons.", + "output": "1. No acute intracranial process.\n2. Chronic changes, including related cortical atrophy and left cerebellar\ninfarct." + }, + { + "input": "There is no evidence of vascular territory acute infarction, hemorrhage,\nedema, or mass. There is advanced generalized brain parenchymal atrophy,\nprominently involving temporal lobes, stable. There is small chronic infarcts\ninvolving left cerebellum, stable since prior. There is tiny chronic cortical\ninfarct at left superior frontal sulcus, stable. Mildly prominent symmetric\nextra-axial space overlying bilateral frontal lobes, may be from atrophy or\nchronic hygromas. There are mild chronic small vessel ischemic changes. No\nacute osseous abnormalities seen. The paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The orbits are unremarkable. Periodontal\ndisease.", + "output": "No acute intracranial process.\nFew small chronic infarcts are stable.\nAdvanced generalized brain parenchymal atrophy." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nProminence of extra-axial space in the frontal region likely due to atrophy.\n\nThere is no evidence of fracture. Mild partial opacification of anterior left\nethmoid air cells is noted. Otherwise paranasal sinuses are clear. Middle\near cavities and mastoid air cells are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Partial opacification of anterior left ethmoid air cells is mild." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or mass\neffect. Mild increased density within the right superior sulcus at the right\nvertex (series 4; image 28) may be artifactual secondary to volume averaging,\nhowever given the patient's trauma history, subtle subarachnoid hemorrhage\ncannot be excluded. Prominence of the bifrontal extra-axial spaces compatible\nwith senescent related cerebral volume loss. Ventricles and sulci are overall\nprominent, consistent with involutional changes.\n\nThere is no evidence of fracture. There is moderate mucosal thickening of the\nanterior ethmoid air cells. There is mild mucosal thickening the bilateral\nmaxillary sinuses. Partial opacification is noted of the mastoid air cells\nbilaterally. Middle ear cavities are essentially clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Mild increased linear hyperdensity, apparently sulcal, at the right vertex.\nWhile this could be artifactual secondary to volume averaging, given the\npatient's clinical history, small subarachnoid hemorrhage is not excluded. \nRecommend short-term follow-up to document resolution or stability.\n2. Prominence of the bifrontal extra-axial spaces as well as prominence of the\nventricles and sulci are consistent with involutional changes.\n3. Paranasal sinus disease, as above.\n\nRECOMMENDATION(S): Repeat CT head without contrast in ___ hours to document\nstability/resolution of impression 1.\n\nNOTIFICATION: The changes documented in impression 1 and recommendations from\nthe wet read discussed with Dr. ___, M.D. by ___, M.D. on\nthe telephone on ___ at 8:12 am, 5 minutes after discovery of the\nfindings." + }, + { + "input": "Decreased conspicuity in the previously described region of increased density\nwithin the right superior sulcus at the right vertex, suggestive of artifact\nfrom volume averaging. There is no evidence of infarction, hemorrhage, edema,\nor mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. A focus of rounded hyperdensity in the left cerebellar\nhemisphere (series 2, image 7) not clearly seen on prior examinations, felt to\nbe most likely artifactual.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Decreased conspicuity of previously described sulcal hyperdensity in the\nright frontal vertex, suggesting the finding is artifactual from volume\naveraging.\n2. Rounded focus of hypodensity in the left cerebellar hemisphere, not seen on\nprior examinations. This is felt to be likely artifactual on the current\nexamination. However, if there remains clinical concern for hemorrhage,\nrepeat examination could be performed to document stability.\n3. Additional findings described above." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Redemonstration of a focus slightly increased density\nin the left cerebellar hemisphere (series 3, image 5), which is less apparent\ncompared to prior.\n\nThere is no evidence of fracture. The bilateral mastoid air cells are\npartially opacified, a nonspecific finding. The visualized portion of the\nparanasal sinuses, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "No large territorial infarct or hemorrhage." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. There is\nre-demonstration of a focus increased density in the left cerebellar\nhemisphere which is more conspicuous and appears slightly increased in size\ncompared to prior (5; 5). There is prominence of the ventricles and sulci\nsuggestive of involutional changes.\n\nThere is no evidence of fracture. There is complete opacification of the\nright and near complete opacification of the left mastoid air cells and middle\near cavities, which has progressed compared to prior. The visualized portion\nof the paranasal sinuses are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Focal hyperdensity in the left cerebellar hemisphere which appears more\nconspicuous and slightly increased in size compared to prior, this may be\nartifactual or represent a small focus of hemorrhage. If this is of clinical\nconcern recommend repeat examination for further evaluation." + }, + { + "input": "A 9 mm hyperdense focus in the left cerebellar hemisphere is unchanged (04:13)\nfrom ___, but slightly larger than ___.\n\nThere is no evidence of acute large territorial infarction,new areas of\nhemorrhage,edema,or mass effect. There is prominence of the ventricles and\nsulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses are clear. There is persistent near-complete opacification of the\nbilateral middle ear cavities and mastoid air cells. The visualized portion\nof the orbits are unremarkable.", + "output": "1. 9 mm hyperdense focus in the left cerebellar hemisphere is unchanged from 1\nday prior study.\n2. Persistent opacification of the bilateral middle ear cavities and mastoid\nair cells is nonspecific, and may be related to patient's recent extended\nintubation." + }, + { + "input": "6 mm focus of hyperdensity in the inferomedial left cerebellum, most\nconsistent hemorrhage, with mild surrounding edema stable since ___,\nmore prominent since ___. In ___ was hyperdense as\nwell.\n\nThere is no evidence of infarction,,or mass. Brain parenchymal atrophy. \nBifrontal prominent extra-axial space, may represent chronic subdural hygromas\nor chronic hematomas, stable. No acute extra-axial hemorrhage.\n\nComplete opacification bilateral mastoids, middle ears, likely from\nintubation, stable since ___. Clear paranasal sinuses, normal\nbones.", + "output": "6 mm focus of hemorrhage inferior left cerebellum, stable since ___,\nlarger since ___. Differential considerations include bland\nhemorrhage, or hemorrhage within underlying lesion, including cavernoma or\nmetastasis. Brain MRI recommended.\n\nRECOMMENDATION(S): Brain MRI." + }, + { + "input": "The images are somewhat degraded by motion artifact. However, there is a\nfocus of hyperdensity in a left posterior temporal sulcus (series 2, image\n15). This finding suggests a small focus of subarachnoid hemorrhage. Consider\na repeat examination to confirm this finding and exclude progressive\nhemorrhage.\n\nThere are periventricular and subcortical white matter hypodensities. \nAlthough nonspecific, these are often attributed to chronic small vessel\nischemia. There is no evidence of other hemorrhage, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nThis has progressed slightly since the study of ___\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Possible area of left posterior temporal subarachnoid hemorrhage. \nRecommend repeat CT to confirm this finding and exclude progressive bleeding. \nAreas of hypodensity are identified in the white matter in the bilateral\noccipital regions, more pronounced on the right side than left. Findings may\nreflect subacute infarct or small vessel disease. Consider MRI for further\nevaluation.\n\nRECOMMENDATION(S): Follow-up CT scan to confirm the small area of left\nposterior temporal subarachnoid hemorrhage and exclude further bleeding.\n\nNOTIFICATION: The finding of possible left posterior temporal subarachnoid\nhemorrhage was discussed by Dr. ___ by telephone with Dr. ___ at 12:10\n___, immediately upon reviewing the images." + }, + { + "input": "Since the prior examination, there has been no significant interval change in\nappearance of a small hyperdense focus in the posterior left temporal lobe\n(03:19). There is apparent increased conspicuity of white matter hypodensity\nunderlying the presumed hemorrhage, which may represent increasing reactive\nedema versus evolving infarct (series 3, image 20). No new foci of\nintracranial hemorrhage are identified. There is unchanged appearance of\nprominent scattered periventricular and subcortical white matter\nhypodensities. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture or acute osseous abnormality. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Stable appearance of presumed small focus of left posterior temporal\nsubarachnoid hemorrhage compared to the prior head CT from ___ at 04:41.\n2. There is apparent increased white matter hypodensity underlying the\npresumed subarachnoid hemorrhage, which may represent increasing reactive\nedema versus sequela of evolving infarct. This could be further evaluated\nwith MRI, if there are no contraindications.\n3. No new foci of intracranial hemorrhage are identified.\n\nRECOMMENDATION(S): Further evaluation with contrast-enhanced MRI if there are\nno contraindications, is recommended.\n\nNOTIFICATION: The additional impression point #2 of increasing white matter\nhypodensity underlying the presumed subarachnoid hemorrhage were discussed\nwith Dr. ___, M.D. by ___, M.D. on the telephone on\n___ at 8:10 AM, 2 minutes after discovery of the findings." + }, + { + "input": "Slightly limited evaluation due to motion degradation.\n\nLeft : Soft tissue with aerosolized secretions are seen within the external\nauditory canal with extension into the middle ear cavity and internal auditory\ncanal. The ossiclesare intact. There is no evidence for enlarged vestibular\naqueduct or superior semicircular canal dehiscence. The facial nerve follows a\nnormal course through the middle ear. There is no evidence for inner ear\ndysplasia. There is new partial opacification of the left mastoid air cells\nwith air-fluid levels. There is apparent thinning of the superior aspect of\nthe left temporal bone and tegmen tympani just overlying the opacified left\nmastoid air cells (609a: 97-108). No pneumocephalus. No coalescing mastoid\nair cells. No adjacent soft tissue edema or fluid collection. No\nsubcutaneous emphysema.\n\nRight: Soft tissue with aerosolized secretions are seen within the external\nauditory canal with extension into the middle ear cavity and internal auditory\ncanal. The ossiclesare intact. There is no evidence for enlarged vestibular\naqueduct or superior semicircular canal dehiscence. The facial nerve follows a\nnormal course through the middle ear. There is no evidence for inner ear\ndysplasia. There is new partial opacification the right mastoid air cells with\nair-fluid levels. No thinning of the superior aspect of left temporal bone or\ntegmen tympani identified. No coalescing mastoid air cells. No adjacent soft\ntissue edema or fluid collection. No subcutaneous emphysema.\n\nOther: Aerosolized secretions within the posterior left ethmoidal air cells. \nThe additional visualized paranasal sinuses are clear. Visualized brain and\nneck soft tissues are normal. Severe calcification of the cavernous portion\nof the internal carotid artery is noted.", + "output": "1. Findings worrisome for acute bilateral otomastoiditis with bilateral otitis\nexterna.\n2. Apparent thinning of left temporal bone and tegmen tympani overlying\nopacified left mastoid air cells is suspicious for subtle erosion or\ndehiscence and epidural involvement cannot be excluded.\n3. Acute sinus disease.\n\nRECOMMENDATION(S): Recommend contrast enhanced temporal bone CT for further\nevaluation. If patient is unable to obtain a contrast CT, a dedicated MR can\nbe obtained.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:14 pm, 15 minutes after\ndiscovery of the findings." + }, + { + "input": "There is no evidence of fracture, hemorrhage, edema, mass effect or\ninfarction. The ventricles and sulci are normal in size and configuration.\nThere is mild mucosal thickening of ethmoid air cells. The remainder of the\nparanasal sinuses, mastoid air cells and middle ear cavities are clear.", + "output": "Minimal ethmoid sinus mucosal thickening. Otherwise normal study. ." + }, + { + "input": "The patient is status post intubation with the tip of the endotracheal tube\nterminating in the lower thoracic trachea, approximately 3 cm above the\ncarina. A nasogastric tube is incompletely imaged. The distal trachea\ncontains secretions but appears otherwise widely patent. Fluid opacification\nof the nasopharynx and oral pharynx is compatible with sequela of intubation\nwithin the confines of post intubation, no mass lesions are noted within the\naerodigestive track.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. Small calcifications in the right parotid gland may represent\nnonobstructive sialoliths. The thyroid enlarged and heterogeneous, similar in\nappearance as compared to the prior examination dated ___. Numerous\nprominent bilateral cervical, supraclavicular, and mediastinal lymph nodes are\nnoted, none of which are pathologically enlarged by CT size criteria. The neck\nvessels are patent.\n\nThe imaged portion of the lung apices demonstrate postsurgical changes and a\nfiducial marker on the left. The degree of left biapical this atelectasis and\npulmonary nodules appears slightly more confluent and enlarged when compared\nto prior examination of ___. There are new left biapical pulmonary\nnodules (series 2, image 77), the largest which measures conglomerate 1.1 x\n0.6 cm. The remainder of the visualized bilateral pulmonary nodules are\ngrossly stable.\n\nThere are no osseous lesions.", + "output": "1. Status post intubation with with a widely patent lower trachea containing\nminimal secretions. Within the confines of intubated examination, no mass\nlesions within the aerodigestive tract is identified. There is no cervical\nlymphadenopathy by size criteria.\n2. Left upper lobe posttreatment changes related to prior lung cancer. There\nare a number left biapical pulmonary nodules not seen on prior exam, the\nlargest which measures approximately 1.1 cm in greatest dimension (series 2,\nimage 77). Additional bilateral pulmonary nodules are similar to the prior\nexamination.\n3. There is increased left biapical atelectasis and scarring.\n4. Multinodular thyroid, similar in appearance to prior exam.\n\nRECOMMENDATION(S): Recommend CT chest for further evaluation of impression 2\nand 3." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass, and no areas of\nmass effect. The vocal cords appear adducted, but the airway is patent.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. Small calcifications in the right parotid gland may represent\nnonobstructive sialoliths, similar to prior. Enlarged, heterogeneous thyroid\nis similar to prior. There are no pathologically enlarged lymph nodes. The\nneck vessels are patent. There are extensive changes of cervical spine\ndegenerative disc disease.\n\nThe imaged portion of the lung apices again demonstrate postsurgical changes\nand a fiducial marker on the left. Biapical pulmonary nodules, including the\nlargest conglomerate on the left are similar to prior. There are no osseous\nlesions.", + "output": "No mass or mass-effect identified along the aerodigestive tract. The vocal\ncords are symmetrically adducted." + }, + { + "input": "Within the limitations of a noncontrast examination, evaluation of the\naerodigestive tract demonstrates no obvious mass. The tracheostomy tube\nballoon is inflated in the suprasternal soft tissues, and the tip is just at\nthe anterior left edge of the trachea, but is not fully within the trachea. \nThere is minimal communication between the tracheostomy tube lumen and the\ntrachea. The vocal cords appear adducted, as on prior. No definite airway\nobstruction. There is edema in the soft tissues surrounding the thyroid. \nThere are secretions in the nasopharynx.\n\nThe salivary glands are without large mass or adjacent fat stranding. Small\ncalcifications in the right parotid gland may represent nonobstructive\nsialoliths, similar to prior. Enlarged, heterogeneous thyroid is similar to\nprior. There are scattered mediastinal lymph nodes without lymphadenopathy\nby CT criteria.\n\nThe imaged portion of the lung apices again demonstrate postsurgical changes\nand a fiducial marker on the left. Biapical pulmonary nodules, including the\nlargest conglomerate on the left are similar to prior. There is complete\nopacification of the posterior portion of the right lung, likely a combination\nof consolidation, pleural effusion, and atelectasis. There are no concerning\nosseous lesions. Degenerative changes in the imaged cervical spine are\nsimilar to prior. Right subclavian venous line and nasoenteric tube are\npartially imaged.", + "output": "1. The tracheostomy tube balloon is inflated in the suprasternal soft tissues,\nand the tip is just at the anterior left edge of the trachea, but is not fully\nwithin the trachea. There is minimal communication between the tracheostomy\ntube lumen and the trachea. Repositioning is recommended. Dr.\n2. Within the limitations of a noncontrast examination, no obvious airway mass\nis identified.\n3. The vocal cords appear adducted, as on prior.\n4. No definite airway obstruction.\n5. Right lung pneumonia, pleural effusion, and atelectasis are partially\nimaged." + }, + { + "input": "At the level of the of the left epiglottic vallecula, there is a 2.0 x 1.1 x\n1.9 cm (TRV x AP x CC) well-circumscribed cystic lesion compatible with a\nvallecular cyst. There are no nodular components or peripheral thickening. \nNo extension into the pre epiglottic space or tongue base. The epiglottis is\nslightly displaced posteriorly but there is no evidence of laryngeal inlet\nobstruction. There is no internal enhancement within this lesion. No\nadditional mass is present along the aerodigestive tract. There is some\nmotion through with the larynx. There is asymmetric enlargement of left\nlaryngeal ventricle, suggestion of atrophy of left true vocal cord, and mild\nparamedial position of left arytenoid cartilage, aryepiglottic fold. \nAsymmetric prominence of the left piriform sinus. Constellation of findings\nsuggest left vocal cord paralysis. Larynx was not well seen on prior exam\nsecondary to endotracheal tube position and motion.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland is heterogeneous and contains scattered sub\ncentimeter nodules. There is no lymphadenopathy by CT criteria. The neck\nvessels are patent. Mild degenerative changes of the cervical spine.\n\nThe imaged portion of the lung apices are demonstrate centrilobular\nemphysematous changes. No concerning pulmonary nodules are identified. There\nare no osseous lesions. Mild degenerative changes in the cervical spine are\nnoted, most prominent at C5-C6 level.", + "output": "1. 2.0 cm low-attenuation round cystic lesion consistent with a vallecular\ncyst. Mild airway narrowing at the level of vallecula.\n\n2. Suggestion of left vocal cord paralysis.\n3. Heterogeneous thyroid with scattered sub centimeter nodules. The ___\nCollege of Radiation guidelines suggest that in the absence of risk factors\nfor thyroid cancer, no further evaluation is recommended." + }, + { + "input": "Patient is status post left parietal craniotomy for resection of the left\nparietal mass. There is postoperative pneumocephalus and subcutaneous\nswelling and air. There is fluid and air in the resection cavity. There is\npostoperative blood adjacent to the resection cavity (Series 2, image 24). \nExtensive edema involving the left frontal, parietal, occipital, and temporal\nhorns is grossly unchanged. There is decreased effacement of the left lateral\nventricle. The sulcal effacement of the left cerebral hemisphere remain\nsimilar. Rightward midline shift has improved measuring 6 mm, previously\napproximately 10 mm. There is no evidence additional hemorrhage or acute\nlarge territory infarct.\n\n\nThere is no evidence of fracture allowing for postoperative findings. There\nis partial opacification of the sphenoid sinus with air-fluid level. The\nremaining paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. Status post left parietal craniotomy for resection of the left parietal\nmass with postoperative pneumocephalus, subcutaneous swelling and air, and\npostsurgical blood product adjacent to the resection cavity.\n2. Extensive brain edema with improved left lateral ventricular effacement and\nrightward midline shift. The swelling of the left cerebral hemisphere remain\nsimilar." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\n\nThere is expected postsurgical changes with surrounding edema status post\npartial resection of left parietal GBM. There is calcification in the\nsurgical that, unchanged. Periventricular hypodensity most likely related to\na combination of chronic ischemia and post treatment changes. There is no\nevidence of infarction,hemorrhage,edema,ormass. The ventricles and sulci are\nnormal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCT PERFUSION:\nIncreased mean transit time in left parietal region consistent with expected\nsurgical changes. No sign of infarct.\nCBF <30% volume: 0 mL\nMismatch volume: 10 mL\nMismatch ratio: Infinite\nTmax >6.0 s volume: 10 mL\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nDiffuse mild atherosclerotic disease. The carotidandvertebral arteries and\ntheir major branches appear normal with no evidence of stenosis or occlusion.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Expected postsurgical changes status post partial resection of left\nparietal GBM.\n2. No sign of infarct on CT perfusion. Increased mean transit time in the\nleft parietal region consistent with expected surgical changes.\n3. Patent circle of ___ without evidence of stenosis, occlusion, or\naneurysm formation.\n4. Diffuse mild atherosclerotic disease with patent carotid and vertebral\narteries. No evidence of internal carotid stenosis by NASCET criteria." + }, + { + "input": "There is a new approximately 1.1 cm probably intraparenchymal, possibly\nsubarachnoid hematoma in the posterior left frontal lobe (series 2, image 20;\nseries 601, image 69); series 602, image 70). No significant mass effect. No\nmidline shift. Adjacent left frontoparietal posttreatment changes from\ncraniotomy and glioblastoma multiforme resection and radiation are not\nsignificantly changed with an underlying dystrophic calcification.\n\nNo evidence of other intracranial hemorrhage. No evidence of acute/subacute\nlarge territorial infarction. Periventricular and subcortical white matter\nhypodensities are nonspecific but likely sequelae of chronic small vessel\nischemic disease. The ventricles and sulci are enlarged, consistent with\nchronic involutional change. Benign globus pallidus calcifications are seen.\n\nThere is no evidence of fracture. There is partial opacification and\naerosolized secretions in the paranasal sinuses. The mastoid air cells and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable. There are severe carotid siphon and moderate V4 segment\ncalcifications.", + "output": "1. Acute, approximately 1.1 cm, probably intraparenchymal, possibly\nsubarachnoid hematoma in the posterior left frontal lobe. No significant mass\neffect.\n2. Posttreatment changes adjacent to the acute hematoma are otherwise stable.\n3. Paranasal sinus disease including aerosolized secretions raising the\npossibility of acute sinusitis.\n\nNOTIFICATION: The findings were discussed with ___, M.D. By\n___, M.D. on the telephone on ___ at 5:49 am, approximately 5\nminutes after discovery of the findings." + }, + { + "input": "Stable left posterior frontal 1.1 cm probably intraparenchymal possibly\nintraparenchymal hematoma (03:25) with trace adjacent subarachnoid hemorrhage.\nNo new intracranial hemorrhage. No significant mass effect or midline shift. \nThe ventricles and sulci appear overall stable. Periventricular white matter\nhypodensities are similarly stable. Postsurgical changes from left craniotomy\nredemonstrated and not significantly changed. Patent basal cisterns. \nModerate sphenoid sinus mucosal thickening and fluid, stable. The remaining\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. No acute orbital injury.", + "output": "1. No significant interval change.\n2. Stable left frontal probably intraparenchymal hematoma with trace adjacent\nsubarachnoid hemorrhage. No significant mass effect. No new hemorrhage.\n3. Sinus disease as described." + }, + { + "input": "The carotid and vertebral arteries and their major branches are patent with no\nevidence of stenoses. No evidence for dissection is seen.\n\nThere is no evidence of carotid stenosis by NASCET criteria. The visualized\napices of lungs are clear. The thyroid is normal. There is no evidence\nof cervical lymphadenopathy. Minimal degenerative changes are seen in the\ncervical spine, more significant at C3/C4 consistent with mild spondylosis. \nThere is no evidence of spinal canal narrowing", + "output": "1. Patent vessels of the neck. No acute abnormalities identified." + }, + { + "input": "There is no evidence of acute hemorrhage mass effect midline shift or\nhydrocephalus. Gray-white matter differentiation is maintained. The\nventricles and sulci are normal in size.\n\nThe visualized paranasal sinuses are clear. No skull fracture is seen.", + "output": "No acute intracranial abnormalities are identified." + }, + { + "input": "There is no evidence of fracture, infarction, hemorrhage, edema, or mass. \nThe ventricles and sulci are normal in size and configuration. There is no\nabnormal enhancement on post contrast images.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Normal exam. No mass." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, intracranial hemorrhage,\nedema, or mass. The ventricles and sulci are normal in size and\nconfiguration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. Incidental note is made of a 3\nmm nodule within the right lobe of the thyroid. There is no lymphadenopathy\nby CT size criteria.", + "output": "1. Essentially normal head and neck CTA.\n\n2. Incidental note is made of a 3 mm nodule within the right lobe of the\nthyroid.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or older.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Atherosclerotic mural calcification of the distal\nvertebral and cavernous carotid arteries is noted. Mild periventricular and\ndeep white matter hypodensities are compatible with chronic small vessel\ninfarction. A chronic appearing right thalamic lacune is also unchanged.\nThere is no evidence of fracture. There is moderate mucosal thickening of the\nleft maxillary sinus and there is minimal thickening of the ethmoid air cells,\nfindings which suggest ongoing sinus inflammation. The mastoid air cells and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable. There is a sclerotic focus in the right frontal bone, which is\nunchanged, likely a bone island.", + "output": "No acute intracranial process. Mild to moderate sinus disease as described\nabove." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThere is prominence of the ventricles and sulci suggestive involutional\nchanges. Periventricular white matter hypodensities are consistent with\nchronic small vessel ischemic disease. There is a chronic appearing lacunar\ninfarction in the right thalamus. Atherosclerotic vascular calcifications are\nnoted of bilateral cavernous portions of internal carotid arteries.\n\nThe visualized portion of the mastoid air cells, and middle ear cavities are\nclear. Bilateral cataract extractions are seen. There is mucosal thickening\nand partial opacification of the frontal in the ethmoid sinuses. Mucosal\nthickening and hyperdense material seen in the left maxillary sinus, likely\nsecondary to inspissated mucus.\n\nCTA HEAD: Atherosclerotic calcification of the cavernous internal carotid\narteries is seen. There is focal narrowing and irregularity of the distal\nright M1 branch, prior to the bifurcation (see 4:262). There is a short\nsegment filling defect in the left distal M2 proximal M3 branch, series 4,\nimage 289 and series 603b, image 55 which appears to reconstitutes distally. \nOtherwise, the remainder of the vessels of the circle of ___ and their\nprincipal intracranial branches appear normal without stenosis, occlusion or\naneurysm formation. The dural venous sinuses are patent. Right fetal origin\nPCA is noted.\n\nCTA NECK: The ascending thoracic aorta is enlarged measuring 4.8 cm. There\nis atherosclerotic calcification of the aortic arch and branch vessels. There\nis atherosclerotic calcification of the carotid bulbs. The remainder of the\ncarotid and vertebral arteries and their major branches appear normal with no\nevidence of stenosis or occlusion. There is no stenosis of the internal\ncarotid arteries by NASCET criteria.\n\nCT PERFUSION: There is no definite perfusion abnormality identified. \nApparent increased perfusion on blood flow and blood volume sequences, image\n11 is likely artifactual and represents vascular flow given decreased mean\ntransit time at this site.\n\nOTHER:\nThere is centrilobular emphysema. Multiple subpleural air cysts are seen. \nThe visualized portion of the thyroid gland is within normal limits. There is\na partially calcified 2.3 cm right paratracheal mass, likely representing\ncalcified lymphadenopathy. Degenerative changes are noted throughout the\ncervical spine. Median sternotomy wires are partially visualized.", + "output": "1. Short segment filling defect of distal left M2 and proximal left M3\nbranches.\n2. Focal short segment narrowing and irregularity of the distal right M1 MCA\nbranch, prior to the bifurcation, likely secondary to atherosclerotic\ncalcification.\n3. No acute intracranial hemorrhage.\n4. No definite perfusion abnormality. Please note MRI of the brain is more\nsensitive for the detection of acute infarct.\n5. 4.8 cm ascending thoracic aortic aneurysm.\n6. Paranasal sinus disease as described.\n7. Extensive emphysematous changes as described.\n8. Nonspecific 2.3 cm right paratracheal mass, which may represent calcified\nlymphadenopathy." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. Mucous retention cysts and mild thickening\nof the anterior ethmoidal air cells and maxillary sinuses bilaterally are\nnoted. The visualized portion of the mastoid air cells, and middle ear\ncavities are clear. Extensive hyperdense blood products are seen within the\nposterior chamber of the left orbit. The globe appears normal in overall\nshape. The right orbit is notable for a lens replacement.", + "output": "1. New left orbital posterior chamber hemorrhage.\n2. No evidence of acute intracranial hemorrhage or fracture.\n3. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct.\n4. Paranasal sinus disease , as described." + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass. The ventricles and sulci are normal in size and configuration.\nNonspecific periventricular and deep subcortical white matter hypodensities\nmost likely represent mild chronic small vessel ischemic disease.\n\nThere is no acute fracture. Aside from moderate mucosal thickening of the\nanterior ethmoidal air cells, the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Nonspecific periventricular and deep subcortical white matter hypodensities\nlikely represent the sequelae of mild chronic small vessel ischemic disease." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. \nPeriventricular and subcortical white matter hypodensities are nonspecific but\nlikely sequelae of chronic small vessel ischemic disease. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is an apparent left parietal subgaleal hematoma with overlying\nsubcutaneous fat stranding suggesting recent blunt trauma with soft tissue\ncontusion. There is no evidence of fracture. There is a chronic appearing\ndeformity of the left mandibular condyle with adjacent well corticated ossific\ndensity suggesting prior fracture. There is mild leftward nasal septum\ndeviation. The visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable. Moderate carotid siphon calcifications are noted.", + "output": "No evidence of an acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territorial infarct. Mild prominence of the\nventricles and sulci is consistent with involutional changes. Periventricular\nand subcortical white matter hypodensities are likely sequelae of chronic\nsmall vessel disease. Bifrontal subcortical white matter hypodensities are\nsimilar compared to prior CT from ___. The visualized paranasal\nsinuses demonstrate mild mucosal thickening of ethmoid air cells.. The\nmastoid air cells are clear. No acute fracture is seen.", + "output": "No acute intracranial process." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect. Previously seen soft tissue edema involving the left neck\nhas decreased in size.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. The neck vessels are patent. There is diffuse osteopenia. \nHeterogeneous cervical spine is noted with mild multilevel degenerative\nchanges consistent with mild anterior and posterior spondylosis.\n\nPlease refer to same-day CT chest for thoracic findings.", + "output": "1. Previously seen left neck subcutaneous edema has decreased in size. No\nevidence of free air to suggest esophageal perforation.\n2. Heterogeneous cervical spine density is likely due to degenerative changes\nhowever clinical correlation is advised." + }, + { + "input": "The parotid glands, submandibular glands are unremarkable. Small nodule in\nthe right thyroid lobe measures up to 6 mm. Otherwise, the thyroid is\nunremarkable. There is no cervical adenopathy.\n\nThe aerodigestive tract appears normal. Included paranasal sinuses and\nmastoids are clear.\n\nVascular structures in the neck are grossly unremarkable.\n\nIncluded intracranial structures appear normal.\n\nMultilevel degenerative changes without focal suspicious osseous lesion\nidentified.\n\nPartially imaged right perifissural densities are likely atelectatic.", + "output": "No signs of aerodigestive obstruction, mass, or lymphadenopathy." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,or\nmass-effect. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of acute fracture. The 5 mm osseous structure within a\nleft ethmoid air may represent an osteoma. The remainder of the visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No evidence of acute intracranial process." + }, + { + "input": "Again seen is a small right subdural hematoma measuring approximately 3 mm,\nunchanged since the prior study. There is a small amount of left subarachnoid\nhemorrhage (2:17 and 18), new since the prior study. There is no edema, shift\nof normally midline structures, or evidence of acute major vascular\nterritorial infarction. Periventricular and subcortical white matter\nhypodensities are nonspecific, but likely reflect sequelae of chronic small\nvessel ischemic disease. Prominence of the ventricles and sulci suggest\ninvolutional changes. The imaged paranasal sinuses are clear. Mastoid air\ncells and middle ear cavities are well aerated. The bony calvarium is intact.\n\nAgain seen is a hematoma overlying the right frontoparietal scalp, slightly\nincreased since the prior study.", + "output": "1. There is a small right subdural hematoma, unchanged since the prior study.\n2. Small amount of left subarachnoid hemorrhage, new since the prior study.\n3. Hematoma overlying the right frontoparietal scalp, slightly increased since\nthe prior study.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 3:01 pm, 15 minutes after\ndiscovery of the findings." + }, + { + "input": "Again seen, is a small acute cerebral subdural hematoma along the right\nparietal vertex, less conspicuous than on the prior study, measuring\napproximately 2 mm in axial thickness. Small focus of extra-axial\nhyperdensity along the left posterior frontal lobe is again seen and may\nrepresent a focus of subarachnoid hemorrhage (02:14), unchanged. No new areas\nof hemorrhage. No significant mass effect, midline shift. No evidence of\nacute major vascular territorial infarction. Periventricular and subcortical\nwhite matter hypodensities are nonspecific, but likely reflect sequela of\nchronic small vessel ischemic disease. Prominence of the ventricles and sulci\nsuggest involutional changes. The imaged paranasal sinuses are clear. Mastoid\nair cells and middle ear cavities are well aerated. The bony calvarium is\nintact.\nAgain seen is a subgaleal hematoma overlying the right frontoparietal scalp.", + "output": "Unchanged tiny (~2mm) right cerebral subdural hematoma and possible trace left\nposterior frontal subarachnoid hemorrhage. Right-sided subgaleal hematoma\nunchanged." + }, + { + "input": "Patient's head position within the scanner slightly limits direct comparison\nwith the prior study.\n\nCompared to ___, the previously seen hyperdense extra-axial fluid\ncollection along the right parietal lobe is no longer visualized. Apparent\nsmall left holohemispheric extra-axial hypodensity (___) may be artifactual\nsecondary to head positioning.\n\nThere is a small amount of right posterior parietal lobe subarachnoid\nhemorrhage, which is more conspicuous on this study (___). In retrospect,\nthis was likely present on the prior study, although not described. A\npreviously seen tiny focus of left lateral parietal lobe subarachnoid\nhemorrhage is unchanged (___).\n\nThere is no evidence of acute large territorial infarction, new hemorrhage,\nedema, or mass. The ventricles and sulci are prominent, consistent with\ninvolutional changes. There is extensive periventricular and subcortical\nAgain seen is a large right posterior subgaleal hematoma. No osseous\nabnormalities seen. The paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The patient is status post left lens replacement.", + "output": "Patient's head position within the scanner is slightly limits direct\ncomparison with the prior study.\n\n1. Compared to ___, the previously seen hyperdense extra-axial\nfluid collection along the right parietal lobe is no longer visualized.\nApparent small left holohemispheric extra-axial hypodensity (___) is possibly\nartifactual secondary to head positioning.\n2. Unchanged small volume of subarachnoid hemorrhage adjacent to the right\nparietal and left parietal lobes.\n3. No evidence of acute large territorial infarction, new hemorrhage, edema or\nmass." + }, + { + "input": "Head CT: There is no evidence of acute intracranial hemorrhage. Areas of\nchronic ischemia are unchanged in both cerebral hemispheres, more significant\nat the frontal regions, prominent ventricles and sulci are present, suggesting\ncortical volume loss. Punctate artery scattered calcifications are noted in\nthe carotid siphons bilaterally. The soft tissues and bony structures are\nunremarkable.\n\nCT perfusion demonstrates mild increase mean transit time and decreased flow\nalong the left anterior cerebral artery vascular territory , suggestive of\nischemia, correlation with MRI of the brain is advised.\n\nCTA of the head the anterior circulation appears patent with areas of\nsegmental narrowing in the middle cerebral arteries, more significant on the\nleft, both posterior communicating arteries are patent. The posterior\ncirculation is notable for narrowing of the mid segment of the basilar are\nartery, apparently with interval progression since the prior CTA dated ___, the V4 segment appears slightly more narrowed. The neck vessels are\nunchanged with patency of the common carotid arteries as well as a cervical\ncarotid bifurcations with no evidence of stenosis\n\n.", + "output": "There is no evidence of acute intracranial hemorrhage. Low attenuation areas\nappear unchanged in the subcortical white matter, more significant in the\nfrontal lobes.\n\nThe CT and profusion demonstrate some mild increased mean transit time\ndecreased flow along the left anterior cerebral artery vascular territory,\nsuggestive of ischemia, correlation with MRI of the head is recommended.\n\nSignificant stenosis is re- demonstrated in the mid segment of the basilar\nartery with interval progression and also more narrowing in the V4 segment of\nthe left vertebral artery. Both common carotid arteries are patent with no\nflow limiting stenosis." + }, + { + "input": "Again seen are hypodense foci in the left paramedial frontal lobe, as well as\nthe left cingulate gyrus consistent with evolving acute infarction in the left\nACA distribution. Bilateral foci of subarachnoid hemorrhage are similar in\nappearance to the prior examination. Intraventricular hemorrhage layering\ndependently within the occipital horns is again seen and minimally decreased\nfrom the prior study. The ventricles and sulci are largely unchanged. The\nbasal cisterns appear patent. Areas of previously described encephalomalacia\nare unchanged.\n\nThere is no shift of normally midline structures. No acute fractures are\nidentified. The visualized mastoid air cells and paranasal sinuses are\nunchanged and clear.", + "output": "Evolving infarct in the region of the left ACA, with no evidence of new\nhemorrhage or new infarction." + }, + { + "input": "There is no acute intracranial hemorrhage or pathologic extra-axial\ncollection. There is no evidence for loss of gray/ white matter\ndifferentiation or parenchymal edema. Age-related calcifications are\nincidentally noted in the basal ganglia. Lateral and third ventricles, as well\nas cerebral sulci, are normal in size. Fourth ventricle appears slightly small\nfor age, and the cerebellar tonsils appear slightly crowded in the foramen\nmagnum, though they do not appear to extend significantly below the foramen\nmagnum.\n\nNo fracture is seen. The partially imaged paranasal sinuses and mastoid air\ncells are well aerated.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. Apparent slight crowding of the cerebral tonsils on the foramen magnum,\nwithout evidence for significant extent below the foramen magnum. The fourth\nventricle appears slightly small for age, without supratentorial\nhydrocephalus.\n\nRECOMMENDATION(S): MRI could be obtained for better assessment of the\nposterior fossa.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at approximately 17:00 into the Department of\nRadiology critical communications system for direct communication to the\nreferring provider." + }, + { + "input": "There is diffuse cerebral edema with loss of gray-white matter differentiation\nat the level of the cortex and deep nuclei, near complete effacement of the\nventricles, complete effacement of the basilar cisterns. There is complete\neffacement of the foramina magnum, with probable tonsillar herniation. No\nevidence of hemorrhage.\n\nThere is no evidence of fracture. Extensive opacification of the paranasal\nsinuses, presumably from intubation, fluid in the nasopharynx. The visualized\nportion of the mastoid air cells and middle ear cavities are clear. Bilateral\nproptosis.", + "output": "Extensive cerebral edema with near complete loss of gray-white matter\ndifferentiation, highly suggestive of diffuse anoxic injury. Consider brain\nMRI if indicated.\nSlit-like ventricles, effaced basilar cisterns, probable tonsillar herniation.\n\nRECOMMENDATION(S): Brain MRI if indicated.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 2:54 pm, 1 minutes after discovery of the\nfindings." + }, + { + "input": "There is no hemorrhage, acute large vascular territorial infarct, or brain\nedema. There is no shift of normally midline structures. The basal cisterns\nare patent. Prominence of the ventricles and sulci is compatible with\nage-related involutional change. Periventricular white matter hypodensities\nare likely the sequelae of chronic small vessel ischemia. Bilateral\nintracranial carotid artery calcifications are seen. There is minimal mucosal\nthickening of the imaged paranasal sinuses including the ethmoid air cells and\nsphenoid sinuses. The bilateral mastoid air cells are clear. The globes and\nbony orbits are intact. There is no fracture or soft tissue swelling.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are normal in size and configuration.\n\nThere are multiple facial fractures. There are bilateral nasal bone\nfractures, with a tiny bone fragment displaced anteriorly (3:22, 23). There\nis a possible nondisplaced fracture of the nasal septum. There is a fracture\nof the left frontal process of the maxilla (3:13, 601b:15). An additional\nfracture of the left anterior maxillary wall extends to the left inferior\norbital floor, with small foci of air seen in the inferior left orbit, without\ndisplacement of the bony fragments of the inferior orbital wall, herniation of\norbital contents or extraocular muscle entrapment (3:17, 601b:16). There is a\nfracture of the medial orbital wall extending anteriorly and possibly\ninvolving the left frontal sinus (303b:17).\n\nThere is high density fluid filling the bilateral maxillary sinuses, frontal\nsinuses and ethmoid air cells, consistent with blood. The visualized portion\nof the mastoid air cells, and middle ear cavities are clear. There is soft\ntissue swelling overlying the left orbit, however the orbits are intact\n(3:21). There is no retrobulbar hematoma.", + "output": "1. Multiple facial fractures involving the bilateral nasal bones, left frontal\nprocess of the maxilla, anterior left maxillary wall, inferior left orbital\nwall, medial left orbital wall with possible extension to the frontal sinus,\nwithout evidence of herniation of left orbital contents or extraocular muscle\nentrapment.\n2. High density material in the bilateral maxillary sinuses, ethmoid air cells\nand frontal sinuses is compatible with blood.\n3. No intracranial hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Normal study." + }, + { + "input": "There is diffuse subarachnoid hemorrhage with intraventricular blood and\nenlarged lateral and third ventricles worrisome for hydrocephalus. No\nintraparenchymal hemorrhage. There is a triangular appearance to bilateral\ncerebellar tonsils worrisome for impending central herniation. There is\ndiffuse sulcal effacement, raising concern for cerebral edema.\n\nNo evidence of infarction or mass. An unstable C2 fracture is noted with at\nleast 3 distinct fracture points. A 0.3 cm radiopacity is seen along the\nfractured right C2 ring consistent with bullet fragment. No additional\nfracture. Aerosolized secretions within bilateral maxillary sinuses and\nethmoidal air cells are noted. The additional visualized portions of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable. Soft tissue swelling along\nthe right scalp is noted. Punctate radiopacities along the right posterior\nscalp is most consistent with fragments from bullet track.", + "output": "1. Triangular appearance to bilateral cerebellar tonsils is worrisome for\nimpending central herniation. Although the patient is young, there is\napparent diffuse sulcal effacement raising concern for cerebral edema.\n2. Diffuse subarachnoid hemorrhage.\n3. Intraventricular blood with ventriculomegaly worrisome for hydrocephalus.\n4. Unstable C2 burst fracture with bullet fragment adjacent to right lateral\naspect of C2 ring.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 12:35 AM, 5 minutes after discovery of the\nfindings. Of note at time of conversation patient had expired." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Prominence of the ventricles and sulci suggest involutional\nchanges. Periventricular white matter hypodensities are nonspecific, but\nlikely reflect sequelae of chronic small vessel ischemic disease.\n\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact. Multifocal\ncalcifications noted in the scalp. Extensive degenerative changes noted at\nthe left temporomandibular joint.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or mass\neffect. Ventricles and sulci are prominent consistent with age related global\natrophy. Periventricular, subcortical, and deep white matter hypodensities\nare nonspecific, but likely represent sequela of chronic microvascular\nischemic disease. Bilateral basal ganglia calcifications are noted.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. 5 mm osteoma\nis seen in the posterior right ethmoid air cells. Patient is status post\nbilateral lens replacements.", + "output": "1. No acute intracranial abnormality.\n2. Age-related global atrophy and likely sequela of chronic microvascular\nischemic disease, similar to prior." + }, + { + "input": "Laceration is noted involving the right frontal scalp. There is no evidence\nof fracture, acute territorial infarction,hemorrhage,edema,or mass. The\nventricles and sulci are prominent, likely related involutional changes,\nsimilar to prior. Periventricular and subcortical white matter hypodensities\nare nonspecific but likely sequelae of chronic small vessel ischemic disease. \nAgain noted bilateral basal ganglia calcifications (2:13).\n\nAn osteoma is seen within a right posterior ethmoid air cell. The visualized\nportion of the remaining paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. Patient status post bilateral lens replacements.", + "output": "1. Right frontal scalp laceration. No acute fracture.\n2. No acute intracranial abnormality otherwise detected." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. There is preservation of\ngray-white matter differentiation. The basal cisterns remain patent.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial hemorrhage." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or mass.\nThere is mild prominence of the ventricles and sulci suggestive of\ninvolutional changes. There are few periventricular and subcortical lucencies,\nwhich may represent small vessel ischemic changes.\n\nThere is no evidence of fracture. There is mild to moderate mucosal\nthickening of the right maxillary sinus and ethmoidal air cells. Left\nsphenoid sinus air-fluid level seen. Bony sclerosis adjacent to bilateral\nsphenoid sinuses noted. The mastoid air cells are clear. The visualized\nportion of the orbits are preserved.", + "output": "1. No evidence of acute intracranial hemorrhage.\n2. Paranasal sinus disease with findings suggestive of acute and chronic\nsinusitis, as described." + }, + { + "input": "Note, the study is suboptimal due to motion artifact which limits evaluation\nof intracranial structures. Within these limitations, there is no evidence of\nlarge acute major vascular territory infarction,obvious hemorrhage,edema,or\nlarge mass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Mild mucosal thickening is seen in the\nanterior ethmoid air cells. Otherwise, the remaining visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nThe visualized portion of the orbits are unremarkable.", + "output": "Of note, the study is suboptimal due to motion artifact which limits\nevaluation of intracranial structures. Within these limitations, no obvious\nintracranial hemorrhage or fractures identified." + }, + { + "input": "There is no evidence of acute major infarction,hemorrhage,edema,or discrete\nmass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. There is under\npneumatization of right mastoid air cells. The visualized portion of the\norbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "The previously seen hyperdense focus in a left temperoparietal sulcus is less\napparent on this exam (03:21). There is no evidence of acute infarct, edema\nor mass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is single opacified posterior left\nethmoid air cell, underlying skull base appears intact. There is minimal\nmucosal thickening of the right maxillary sinus and anterior sphenoid sinus. \nOtherwise, the visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "No evidence of hemorrhage today. No acute findings intracranially.\nMild paranasal sinus disease." + }, + { + "input": "Somewhat motion degraded at the skull base. Within this limitation, there is\nno evidence of infarction, hemorrhage, edema, or mass. The ventricles and\nsulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Somewhat motion degraded study. Within this limitation, no acute intracranial\nprocess." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are patent and prominent in keeping with age-related volume loss.\n\nThere are few foci of hypodensity in the periventricular, subcortical and deep\nwhite matter, nonspecific, likely secondary to small vessel ischemic changes. \nThere is intracranial atherosclerotic calcification.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Please note MRI of the brain with contrast is more sensitive for the\nevaluation of intracranial metastatic disease and for evaluation of acute\ninfarct." + }, + { + "input": "There is no evidence of territorial infarction,intracranial\nhemorrhage,edema,or mass. The ventricles and sulci are normal in size and\nconfiguration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "There is no evidence of acute intracranial process or hemorrhage." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute infarction,hemorrhage,edema,ormass. Hypodensity\nin the anterior limb of the right internal capsule and right basal ganglia\nappears stable and likely reflects chronic lacunar infarct. There is mild\nprominence of the bilateral sulci compatible with atrophic changes.\n\nThe visualized portion of the paranasal sinuses and middle ear cavities are\nclear. Small right mastoid effusion noted. Status post bilateral lens\nreplacement.\n\nCTA HEAD:\nThere is fetal origin of the right PCA, a common normal variant. The vessels\nof the circle of ___ and their principal intracranial branches appear\nnormal without stenosis, occlusion, or aneurysm formation. The dural venous\nsinuses are patent. There is early asymmetric filling of the right cavernous\nsinus, unchanged compared to the prior exam from ___ however raises\nconcern for a carotid cavernous fistula.\n\nCTA NECK:\nThere is moderate calcified plaque formation at the left carotid bifurcation\nextending into the proximal left internal carotid artery, with resulting 35%\nstenosis of the left internal carotid artery by NASCET criteria.\nThe right common carotid artery is tortuous in course but normal in contour. \nThere is calcified plaque formation at the proximal right internal carotid\nwith significant stenosis by NASCET criteria.\n\nThe bilateral vertebral arteries are tortuous in course but grossly normal in\ncontour. Trace atherosclerotic calcification within the left vertebral artery\nV4 segment.\n\nOTHER:\nVisualized portions of the lungs demonstrate dependent atelectasis\nbilaterally, most prominent at the posterior right upper lobe. the visualized\nportion of the thyroid gland is within normal limits. An increased number of\nnonenlarged bilateral cervical lymph nodes are seen. There is no\nlymphadenopathy by CT size criteria.", + "output": "-Head CT: No acute infarct or acute intracranial hemorrhage. Unchanged small\nchronic infarct involving the right internal capsule.\n-CTA head: There is early asymmetric filling of the right cavernous sinus,\nunchanged compared to the prior exam from ___ however raises concern\nfor a carotid cavernous fistula. No evidence of aneurysm or significant\nstenosis.\n-CTA neck: Calcified plaque at the bilateral carotid bifurcations with\napproximately 35% left and no significant right internal carotid artery\nstenosis by NASCET criteria.\n\nRECOMMENDATION(S): Neurosurgical vascular consult is recommended for further\nevaluation.\n\nNOTIFICATION: Updated findings and recommendations were discussed with Dr. \n___, M.D. by ___, M.D. on the telephone on ___ at\n6:04 pm, 10 minutes after discovery of the findings." + }, + { + "input": "The study is limited by motion.\n\nThere is no evidence of acute large territory infarction,hemorrhage,edema, or\nmass. There is a focal hypodensity in the area of the anterior limb of the\nright internal capsule likely representing chronic infarct. The ventricles\nand sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nright paranasal sinus. Otherwise the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Focal hypodensity in the anterior limb of the right internal capsule\nconsistent with chronic infarct." + }, + { + "input": "Partially limited examination due to patient motion, within the limits of the\nexamination, there is no evidence of intracranial hemorrhageor mass. New\nvague right frontal hypodensity suggests loss of gray-white differentiation\n(04:19 through 22). Other periventricular and subcortical white matter\nhypodensities appear stable. The ventricles and sulci are unchanged. \nPeriventricular white matter and subcortical white matter hypodensities are\nnonspecific, overall stable from prior. There is no evidence of fracture. \nThere is unchanged hyperostosis frontalis interna. Moderate ethmoid and right\nmaxillary sinus mucosal thickening. The remaining visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Motion limited exam.\n2. New vague right frontal hypodensity with suggestion of loss of gray-white\ndifferentiation raises concern for an acute infarct. MRI recommended to\nfurther assess.\n3. No intracranial hemorrhage.\n4. No midline shift. Patent basal cisterns.\n5. Sinus disease, as described\n\nRECOMMENDATION(S): Brain MRI.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 2:49 pm, 5 minutes after discovery\nof the findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nBand like hypodensity in the right frontal lobe (images ___ is unchanged\nfrom prior represents an age-indeterminate infarction. There is no evidence\nof acute intracranial hemorrhage.\n\nThe ventricles and sulci are stable in size and configuration. No mass effect\nor midline shift. Findings of chronic small vessel ischemic disease.\n\nMild mucosal thickening of the right maxillary and ethmoid sinuses. Moderate\nmucosal thickening of the sphenoid sinuses. Postsurgical changes of bilateral\nlens replacement. Moderate opacification of the right mastoid air cells.\n\nCTA HEAD:\nMinimal atherosclerotic calcifications of the cavernous internal carotid\narteries. Focal nonocclusive atherosclerotic calcification in the right A2\nsegment distally (image 337 of series 7). Otherwise, there is opacification\nof the bilateral A1 and A2 segments, bilateral M1 and M2 segments without\nocclusion. There is persistent fetal origin of the right posterior cerebral\nartery. Intracranial right V4 segment becomes diminutive in caliber after the\ntakeoff of the right ___. Opacification of the vertebrobasilar system and\nboth posterior cerebral arteries. No occlusion.\n\nCTA NECK:\nStandard 3 vessel aortic arch with scattered atherosclerotic calcifications of\nthe aortic arch. The common carotid and internal carotid arteries are\ntortuous in appearance and contain multifocal atherosclerotic calcifications. \nThe common carotid and internal carotid arteries take a retropharyngeal\ncourse. Bilateral atherosclerotic calcifications of the carotid bulbs. \nApproximately 30% stenosis left ICA origin by NASCET criteria. No significant\nright internal carotid artery stenosis by NASCET criteria.\n\nThe right vertebral artery is diminutive in appearance with a slightly larger\ncaliber left vertebral artery. Focal serpiginous area of contrast in the\nright transverse foramen (image 141-146 of series 7) likely represents very\ntortuous vessel. Focal nonocclusive atherosclerotic calcifications of the\nleft V4 segment. Otherwise there is opacification of the bilateral vertebral\narteries with no evidence of occlusion.\n\nOTHER:\nBand like opacities in the right apex likely represent atelectasis and/or\nscarring. Mild biapical scarring. Secretions are present within the trachea.\nPartially visualized nasoenteric tube.\n\nThyroid appears atrophic and heterogeneous in appearance, containing\nlow-density nodules.\n\nThere are multiple subcentimeter bilateral cervical chain lymph nodes, but\notherwise no lymphadenopathy by size criteria.\n\nMultilevel degenerative changes of the cervical spine, most pronounced at\nC4-C5 and C5-C6 with disc osteophyte complexes.", + "output": "1. Chronic infarct right basal ganglia, internal capsule..\n2. No evidence of acute intracranial hemorrhage.\n3. Chronic small vessel ischemic disease.\n4. 30% stenosis left ICA origin.. Mild narrowing proximal right vertebral\nartery. Patent intracranial vasculature." + }, + { + "input": "Again demonstrated is a hypodensity in the anterior limb of the right internal\ncapsule, basal ganglia, similar to multiple prior examinations, likely\nreflecting a chronic infarction. There is no evidence of large vascular\nterritory infarction,hemorrhage,edema, or mass. The ventricles and sulci are\nnormal in size and configuration.\n\nThere is no evidence of fracture. Mild opacification paranasal sinuses,\nmoderate opacification right mastoids, likely from intubation.", + "output": "1. No acute intracranial abnormality.\n2. Chronic lacunar infarcts, chronic small vessel ischemic change" + }, + { + "input": "There is a right parietal and temporal intraparenchymal hemorrhage, with acute\nsubdural hematoma extension along the right hemispheric convexity and into the\nright parafalcine and along the right tentorium. The right convexity subdural\nhematoma measures approximately 1.1 cm in maximal thickness (02:17). There is\nresultant 5-7 mm leftward midline shift. There is minimal leftward subfalcine\nherniation. No evidence of uncal herniation or downward transtentorial\nherniation.\n\nThere are small scattered left sulcal subarachnoid hemorrhages along the\nfrontoparietal vertex (___) as well as within the interpeduncular cistern.\n\nThere is no evidence of acute large territorial infarction.\n\nThere is prominence of the ventricles and sulci suggestive of age-related\ncerebral volume loss. No evidence of hydrocephalus or trapped ventricle.\n\nThere is a moderate to large left parietal soft tissue subgaleal swelling and\nhematoma with a focal laceration. There is a mildly displaced fracture of the\nleft lateral orbital wall (03:17) and a nondisplaced fracture of the left\nzygomatic arch (3: 8). There is hematoma tracking along the left masseter\nmuscle adjacent to the left mandibular condyles (3:1). There is asymmetric\nmild left periorbital swelling.\n\nThere is a mixed sclerotic/lytic appearance of the left sphenoid wing which\nmay represent a site of metastasis, considering reported history of lung\ncancer. There is asymmetric hyperdense thickening of the left temporalis\nmuscle superiorly which likely reflects hematoma tracking from the left\nparietal subgaleal hematoma (03:18).\n\nThere are simple density secretions in the nasopharynx. There is trace fluid\nin left maxillary sinus. There are small bilateral mucous retention cysts in\nthe bilateral maxillary sinus. There is high-density layering fluid in left\nsphenoid sinus, which may represent hemosinus, however there are no definite\nadjacent fractures of the sinus walls. There are scattered mucous retention\ncysts and mild mucosal thickening of the ethmoidal air cells. The mastoid air\ncells and middle ear cavities are clear. There low-density secretions in the\nnasopharynx.", + "output": "1. Right parietal and temporal intraparenchymal hemorrhages with acute\nsubdural hematoma extension along the right hemispheric convexity and\nextending along the right falx cerebri and right tentorium. Mild 7 mm\nleftward shift of normally midline structures.\n2. Small foci of subarachnoid hemorrhage along left vertex sulci and\ninterpeduncular cistern.\n3. Acute minimally displaced left lateral orbital fracture. No definite\nevidence of orbital hematoma.\n4. Acute nondisplaced left zygomatic arch fracture.\n5. Left posterior scalp laceration with subgaleal swelling/hematoma and\nextension of blood tracking along the left temporalis and left masseter\nmuscles.\n6. Heterogeneous sclerotic/lytic appearance of left sphenoid wing may\nrepresent a site of metastasis given reported history of lung cancer. \nCorrelation with prior imaging and bone scan, if needed, may be helpful.\n\nNOTIFICATION: The findings were discussed with the Emergency Team, by\n___, M.D. in person on ___ at 7:15 pm, at the time of\ndiscovery of the findings." + }, + { + "input": "There is unchanged appearance of a right temporoparietal intraparenchymal\nhematoma measuring 3.8 x 2.7 cm, within acute subdural hematoma extending\nalong the right convexity measuring up to 9 mm (02:24). The subdural\ncomponent extends into the right parafalcine and right tentorium. There is\nmild 5 mm leftward midline shift, unchanged, with mass effect on the right\nlateral ventricle. A small amount of subarachnoid hemorrhage seen along the\nleft frontoparietal vertex and interpeduncular cistern are both unchanged. A\nleft parietal subgaleal hematoma and left periorbital swelling is unchanged.\nThere is no uncal herniation or subfalcine herniation. No evidence of large\nacute infarct or new intracranial hemorrhage. Prominence of ventricles and\nsulci are compatible with age related involutional changes.\n\nA non-displaced fracture of the left zygomatic arch is less conspicuous on the\ncurrent exam, and was better seen on the prior same day study. Similarly,\npreviously described heterogeneous sclerotic/lytic appearance of the left\nsphenoid wing is better seen on the same-day prior study. Small amount of\nsecretions are noted in the left maxillary sinus. There are small bilateral\nmucous retention cysts in the right sphenoid and both maxillary sinuses. \nSmall amount of layering fluid in the left sphenoid sinus is unchanged. There\nis mild mucosal thickening along the ethmoid air cells. The mastoid air cells\nand middle ear cavities appear clear. The visualized portion of the orbits\nare unremarkable. An ETT is partially visualized.", + "output": "1. Overall, unchanged appearance of a 3.8 cm right temporoparietal\nintraparenchymal hematoma with acute subdural component measuring up to 9 mm\nand extending into the right parafalcine and right tentorium as compared to\nearlier same day prior study. No major acute infarct.\n2. Persistent mild 5 mm leftward midline shift with mass effect on the right\nlateral ventricle.\n3. Small amount of subarachnoid hemorrhage is unchanged in the left frontal\nparietal vertex and interpeducular cistern.\n4. Previously seen nondisplaced fracture of the left zygomatic arch is less\nconspicuous on current study and was better seen on the prior same-day exam.\n5. Unchanged left parietal subgaleal hematoma and left periorbital swelling" + }, + { + "input": "There is a 3.7 x 2.7 cm right temporoparietal intraparenchymal hematoma stable\nfrom prior.\n\nSlightly more superiorly there is a 1.6 x 1.2 cm additional site of\nintraparenchymal hematoma, stable.\n\nThere is a mixed density right extra-axial curvilinear collection compatible\nwith a acute subdural hematoma measuring up to 8 mm, stable prior.\n\nSubdural blood products are also noted along the falx cerebri as well as the \nright tentorial leaflet.\n\nThere is subarachnoid hemorrhage involving the left frontoparietal vertex,\nstable to minimally increased from prior.\n\nSubarachnoid hemorrhage in the interpeduncular cistern is stable.\n\nThere is also an unchanged 3 mm subdural hematoma overlying the left parietal\nbone which appears slightly more hyperdense from prior (02:23).\n\nThere is stable 4 mm leftward midline shift. No uncal herniation. Basilar\nand perimesencephalic cisterns appear patent. The ventricles sulci grossly\nstable.\n\nLeft parietal subgaleal hematoma is stable. There is a nondisplaced fracture\nof the left zygomatic arch. Secretions are seen in the left greater than\nright sphenoid sinus. Mucous retention cysts are seen in the left maxillary\nsinus. Patient is status post bilateral lens replacements.", + "output": "1. Stable temporoparietal intraparenchymal hematomas.\n2. Stable acute right subdural hematoma. In addition, blood products are seen\nto extend into the falx cerebri as well as the right tentorial leaflet.\n3. Stable 4 mm leftward midline shift. Stable ventricular size.\n4. Stable 3 mm left parietal subdural hematoma, denser than on prior\nsuggesting an ongoing acute component.\n5. Subarachnoid blood in the left frontoparietal vertex is stable to minimally\nincreased from prior.\n6. Left zygomatic arch nondisplaced fracture." + }, + { + "input": "There is no evidence of acute vascular territorial infarction, intracranial\nhemorrhage, edema, or mass effect. There is prominence of the ventricles and\nsulci suggestive of involutional changes. Small old lacunar infarct is noted\nin the head of the right caudate.\n\nThere is no evidence of fracture. Minimal mucosal thickening is seen in the\nright sphenoid sinus. The remainder of the partially imaged paranasal sinuses\nare clear. The mastoid air cells and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.\n\nThere is a small to moderate left frontal scalp hematoma (03:41). Mild soft\ntissue swelling is also noted along the forehead.", + "output": "Small to moderate left frontal scalp hematoma, without underlying fracture or\nacute intracranial hemorrhage." + }, + { + "input": "Note, mild-to-moderate motion artifact limits evaluation of intracranial\nstructures. A punctate focus of hyperdensity along the left frontal lobe\nlikely is artifactual (series 2: Image 9). There is no evidence of acute\nmajor vascular territorial infarction, definite intracranial\nhemorrhage,edema,or mass. There is prominence of the ventricles and sulci\nsuggestive of involutional changes, which is greater than expected for\npatient's stated age. There is mild hyperostosis along the inner table of the\nbifrontal calvarium. A moderate subgaleal hematoma is seen along the right\nocciput.\n\nThere is no evidence of fracture. Mild mucosal thickening is seen along the\nright sphenoid and left frontal sinus with opacification of the left frontal\nethmoidal recess. Otherwise, the remaining visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable. Small amount of cerumen is\nnoted in the right external auditory canal.", + "output": "1. A moderate subgaleal hematoma seen along the right occiput. A punctate\nfocus of hyperdensity along the left frontal lobe likely represents artifact. \nNo definite intracranial hemorrhage or fracture is identified.\n2. Mildly increased prominence of ventricles and sulci, greater than expected\nfor patient's stated age. Please correlate with risk fractures.\n3. Paranasal sinus disease, as above." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. There is a small hypodensity inferior to the left basal ganglia\nwhich likely represents a prominent VR space. Subtle right basal ganglia\ncalcifications are present. Ventricles and sulci are normal in overall size\nand configuration. The imaged paranasal sinuses are clear. Mastoid air cells\nand middle ear cavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, shift of normally\nmidline structures or acute major vascular territorial infarction. Enlarged\nventricles and sulci is consistent with age related involutional changes.\nPeriventricular white matter hypodensities are likely the sequela of chronic\nsmall vessel ischemic disease. The basal cisterns appear patent and there is\npreservation of gray-white matter differentiation.\n\nThere is a small amount of subgaleal hematoma overlying the right parietal\nbone with no underlying fracture identified. There is mild mucosal thickening\nof the ethmoidal air cells and minimal mucosal thickening in the right\nmaxillary sinus. Otherwise, the remaining visualized paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. There are calcified\ndensities in the subcutaneous fat. The globes are unremarkable.", + "output": "1. Small amount of subgaleal hematoma overlying the right parietal bone with\nno underlying fracture identified.\n2. No evidence of acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nPeriventricular and subcortical white matter hypodensities are consistent with\nchronic small-vessel ischemic disease.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. There is evidence of right lens\nreplacement. Dense calcifications in the carotid siphons are noted\nbilaterally. Diffuse punctate subcutaneous calcifications in the scalp is\nagain noted. Mild subcutaneous stranding is noted over the left zygoma.", + "output": "No acute intracranial abnormalities." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territorial infarct. Prominence of the\nventricles and sulci is consistent with cortical volume loss. Periventricular\nand subcortical white matter hypodensities are likely sequelae of chronic\nsmall vessel disease. The visualized paranasal sinuses demonstrate minimal\nmucosal thickening in right ethmoid air cell.. The mastoid air cells are\nclear. No acute fracture is seen. Internal carotid artery calcifications are\nseen along the cavernous portions.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is minimal mucosal thickening in the\nethmoid air cells. The visualized portion of the remainder of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Patient is\nstatus post bilateral lens replacement. The visualized portion of the orbits\nare otherwise unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of fracture, acute territorial\ninfarction,hemorrhage,edema,or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. Calcifications of the cavernous\nportions of bilateral carotid arteries are noted.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal. \nBilateral lens replacements are noted.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration. There is mild\nmucosal thickening of the left maxillary sinus, right sphenoid sinus, and\nanterior ethmoid air cells. The remaining paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the orbits\nare unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nare within normal limits without stenosis, occlusion or aneurysm formation. \nIncidental a left posterior communicating artery is visualized. A right\nposterior communicating artery is not visualized. A right SCA infundibulum is\nnoted. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is common origin of the left common carotid artery and right\nbrachiocephalic artery, as well as direct origin of the left vertebral artery\nfrom the aortic arch, all developmental variants. The principal arteries of\nthe neck are patent throughout their course, with no evidence of stenosis or\nocclusion. There is no internal carotid stenosis by NASCET criteria.\n\nOTHER:\nBilateral calcified tonsilliths are noted (5:173, 169). The visualized\nportion of the lungs are clear. The visualized portion of the thyroid gland\nis limited by streak artifact. There is suggestion of an approximately 3 mm\nright thyroid gland nodule (see 5:83). There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No acute intracranial pathology.\n2. The principal arteries of the head and neck are patent, with no evidence of\nstenosis, occlusion, dissection or aneurysmal formation.\n3. Mild paranasal sinus mucosal thickening.\n4. Suggested 3 mm right thyroid gland nodule versus artifact. Recommend\nclinical correlation. If clinically indicated, consider thyroid ultrasound\nfor further evaluation.\n\nRECOMMENDATION(S): Suggested 3 mm right thyroid gland nodule versus artifact.\nRecommend clinical correlation. If clinically indicated, consider thyroid\nultrasound for further evaluation." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration\ngiven age.\n\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial abnormality." + }, + { + "input": "Again seen are small amounts of left frontal subarachnoid hemorrhage. No new\nhemorrhages identified.. There is no evidence infarction. Prominence of the\nventricle and sulci is compatible with age related involutional changes. The\nbasilar cisterns appear patent.\n\nThere is a small amount of air inferiorly in the right orbit. This, along\nwith hyperdense fluid in the maxillary sinus suggests an orbital floor\nfracture, although the fracture itself is not identified on this study. \nOtherwise, the remaining visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "Unchanged small amount of left frontal subarachnoid hemorrhage. No new\nhemorrhage is identified.\nNo evidence of infarction mass effect or edema.\nFindings suggesting right orbital floor fracture with right maxillary sinus\nhemorrhage.\n\nNOTIFICATION: The findings of right intraorbital air and hyperdense fluid in\nthe right maxillary sinus suggesting an orbital floor fracture entered in the\nRadiology department non urgent critical imaging findings system 10:30 ___ immediately upon reviewing the images by D. Hackney." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nlarge mass. Punctate calcification is noted in the left basal ganglia\n(02:10). The ventricles and sulci are normal in size and configuration.\n\nNo fracture seen. The paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The orbits are unremarkable.", + "output": "NORMAL STUDY." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Basilar cisterns are\npatent.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "CT head shows no evidence of hemorrhage, or loss of gray-white matter\ndifferentiation. No midline shift or hydrocephalus seen.\n\nCT angiography of the neck shows normal appearance of the carotid and\nvertebral arteries without stenosis or occlusion or dissection.\n\nCT angiography of the head shows normal appearance of the arteries of the\nanterior and posterior circulation without stenosis or occlusion or aneurysm\ngreater than 3 mm in size.", + "output": "No significant abnormalities on CT of the head without contrast. No\nsignificant abnormalities on CT angiography of the head and neck." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction or midline shift.\nThere is no hydrocephalus. Visualized paranasal sinuses and mastoid air cells\nare clear. There is no fracture. There are no areas of brain edema.\nFollowing contrast administration no abnormal enhancement is seen. No\nevidence of brain atrophy seen.", + "output": "Unremarkable enhanced and unenhanced head CT" + }, + { + "input": "Again seen is right-sided subdural hematoma tracking along the right\nconvexity, falx, and tentorium measuring up to 5 mm in the thickest portion at\nthe right frontal lobe on coronal images. Left frontal subdural hematoma\nmeasuring up to 3 mm on axial images is also noted. When compared to ___, the subdural hematomas appear less prominent. 9 mm\nintraparenchymal hematoma in the inferior left frontal lobe is stable with\nminimal surrounding edema. Right temporal lobe subarachnoid hemorrhage is\nnoted. Layering blood in the occipital horns of the bilateral lateral\nventricles is consistent with redistribution of subarachnoid blood. No new\nintracranial hemorrhage. 3 mm midline shift toward the left is unchanged. \nMild asymmetric effacement of the left lateral ventricle is grossly stable. \nOtherwise, prominent sulci and ventricles are likely due to involutional\nchanges, unchanged. There is no evidence of large territorial infarction,\nedema,or mass. Bilateral periventricular white matter hypodensities are\nnonspecific but most likely representing sequela of chronic small vessel\nischemic changes. There is there are atherosclerotic calcification in the\nbilateral carotid siphons and distal vertebral arteries.\n\nThere is no evidence of fracture. Soft tissue swelling adjacent to the left\nparietal bone is unchanged. There is mild mucosal thickening of the ethmoid\nair cells. The remaining paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Overall slightly less prominent right-sided and left frontal subdural\nhematoma. Stable inferior left frontal intraparenchymal hemorrhage. Right\ntemporal subarachnoid hemorrhage with layering blood in the occipital horns of\nthe bilateral lateral ventricles consistent with redistribution of\nsubarachnoid blood. No new intracranial hemorrhage.\n2. Stable mass effect with 3 mm midline shift and effacement of the left\nlateral ventricle." + }, + { + "input": "There is no evidence of acute large territory infarction, hemorrhage, edema,\nor mass. The ventricles and sulci are prominent compatible with age-related\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific, but likely reflect sequelae of chronic small\nvessel ischemic disease.\n\nNo fractures are identified. Aerosolized secretions are visualized in the\nright sphenoid sinus with additional mucosal thickening of the bilateral\nethmoidal air cells. Otherwise the visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction,hemorrhage,edema,or mass. Involutional\nchanges are unchanged. Multiple foci of air are noted in the region of right\ncavernous sinus (series 3, image 15 and 17). No no fractures are identified.\n\nThere is mucosal thickening on opacifications of the ethmoid air cells and\nright sphenoid sinuses. The remaining visualized paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are normal.", + "output": "1. No evidence of fracture, mass, hemorrhage or infarction hemorrhage.\n2. Foci of air in the right cavernous sinus.\n3. Paranasal sinus inflammatory changes.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 2:24 pm, 2 minutes after discovery\nof the findings." + }, + { + "input": "No fractures are identified.\nThere is redemonstration of multiple punctate foci of gas within the right\ncavernous sinus (2:25 and 2:26), right extraconal fat (2:27), and right\ninfratemporal fossa (2:16), not substantially changed from prior study dated 3\nhours prior, likely within venous structures.\n\nThere is moderate amount of fluid with aerosolized secretions within the right\nsphenoid sinus. There is minimal mucosal thickening of the left maxillary\nsinus and bilateral ethmoid air cells. Otherwise, the remaining paranasal\nsinuses are clear. There is no evidence of abnormal fluid collections.\nBilateral mastoids appear normal.\nThe globes, extraocular muscles, optic nerves, and retrobulbar fat appear\nnormal.\nThe visualized upper aerodigestive tract appears normal.\nThe mandible and temporomandibular joints appear normal.\nHeterogeneous hypodense material within the bilateral external auditory canals\nlikely represents cerumen/debris.", + "output": "1. Redemonstration of multiple punctate foci of air within the right cavernous\nsinus, right extraconal fat, and right infratemporal fossa, not substantially\nchanged from prior study dated 3 hours prior and likely within venous\nstructures, potentially from intravenous catheter placement or manipulation.\n2. No evidence of acute fracture.\n3. Moderate paranasal sinus disease involving the right sphenoid sinus and\nbilateral ethmoid air cells without definite evidence of osseous erosion." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or infarction.\nProminent ventricles and sulci suggest age related involutional changes. The\narea of encephalomalacia in the right parietal lobe similar to prior exam. \nThe basal cisterns appear patent and there is preservation of gray-white\nmatter differentiation. There is a small 8 mm fusiform aneurysm in the left\nvertebral artery (2:7), which appears grossly stable from multiple priors\ndating back to ___.\n\nNo fracture is identified. The visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The globes are unremarkable.", + "output": "1. No acute intracranial process.\n\n2. Small 8 mm fusiform aneurysm in the left vertebral artery (2:7), which has\nbeen stable from multiple priors back to ___. Recommend clinical\ncorrelation." + }, + { + "input": "A large focus of encephalomalacia is seen in the right posterior convexity\nlikely the result of a chronic infarction. There is no evidence of acute\nintracranial hemorrhage, mass, mass effect or acute infarction.\nPeriventricular and white matter hypodensities are likely secondary to age\nrelated small vessel ischemic disease. The basilar cisterns are patent, and\nthere is otherwise good preservation of the gray-white matter differentiation.\n\nThere is moderate mucosal sinus thickening involving the ethmoid air cells.\nThe left maxillary sinus demonstrates mild mucosal thickening. The sphenoid\nsinus is clear. No acute fractures identified. The globes are unremarkable.", + "output": "Encephalomalacia in the right posterior cerebrum. Mild small vessel disease.\nNo acute intracranial process." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass.\nEncephalomalacia in the right parietal lobe is similar to the prior exam. \nVentricles and sulci are stable in size and configuration.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute large territorial infarction,acute intracranial\nhemorrhage,edema, or mass. Encephalomalacia of the right parietal lobe is\nunchanged. The ventricles and sulci are also unchanged in size and\nconfiguration. Basal cisterns are patent.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No change since the study from 1 day earlier. The basal cisterns are patent\nwithout evidence of herniation." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of acute infarction, hemorrhage, edema, or\nmass. The encephalomalacia of the right parietal lobe with ex vacuo\ndilatation of the body and trigone of the right lateral ventricle is\nunchanged.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The patient is status post right cataract surgery.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nare patent without stenosis,stenosis or occlusion. The 8 mm focal aneurysmal\ndilatation of the left mid V4 segment is unchanged in size from the prior\nexamination. There is a of rim of calcifications along the lateral margin of\nthis aneurysm. No new aneurysms are identified. The dural venous sinuses are\npatent.\n\nCTA NECK:\nThe right brachiocephalic and left common carotid arteries share a common\norigin, a normal anatomic variant. The origins of the great vessels are\npatent. Mild atherosclerotic calcifications involve the aortic arch.\n\nThe right common and external carotid arteries are patent. The right internal\ncarotid artery is patent with no evidence of stenosis by NASCET criteria.\n\nThe left common and external carotid arteries are patent. Mild\natherosclerotic calcifications involve the left internal carotid artery at its\nbifurcation without evidence of stenosis by NASCET criteria.\n\nBoth vertebral arteries, including their origins, are patent.\n\nOTHER:\nPatchy, dependent ground-glass densities likely represent atelectasis. There\nis a calcified granuloma in the right lower lobe. The visualized portion of\nthe thyroid gland is within normal limits. There is no lymphadenopathy by CT\nsize criteria. There are severe multilevel degenerative changes of the\ncervical spine.", + "output": "1. Unchanged 8 mm aneurysm of the left mid V4 segment. No new aneurysms.\n2. Patent vasculature in the neck with no evidence of internal carotid artery\nstenosis by NASCET criteria.\n3. No acute intracranial abnormality.\n4. Unchanged encephalomalacia of the right parietal lobe." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass or recent infarction. \nEncephalomalacia in the right parietal lobe is unchanged. Mild\nperiventricular white matter hypodensities are nonspecific, but likely reflect\na sequela of chronic small vessel disease. There is prominence of the\nventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. There has been\nprior lens replacement on the right. Visualized portion of the orbits are\notherwise unremarkable.", + "output": "No evidence of mass, hemorrhage or recent infarction." + }, + { + "input": "There is right occipital and parietal lobe encephalomalacia, which appears\nstable compared to prior head CT from ___. Chronic infarct within the left\npons appears stable. There is no evidence of new infarction,hemorrhage,edema,\nor mass. Subcortical, periventricular, and deep white matter hypodensities\nare nonspecific, but likely represent chronic microangiopathic disease in a\nperson of this age. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. There is vascular calcification seen in\nthe V4 segment of the left vertebral artery and bilateral cavernous internal\ncarotid arteries.\n\nThere is no evidence of fracture. There is mild thickening of the ethmoid air\ncells. The visualized portion of the remaining paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits demonstrate right-sided lens replacement.", + "output": "1. Stable parietal lobe encephalomalacia and chronic left pons infarction.\n2. White matter hypodensities are nonspecific but likely represent chronic\nmicroangiopathic disease.\n3. Additional stable findings as described above.\n4. No evidence of hemorrhage or recent infarction." + }, + { + "input": "There is no evidence of new large infarction, hemorrhage, edema, or mass. The\nventricles and sulci are unchanged. Right PCA territory encephalomalacia\nappears similar to prior.\n\nNo acute fracture. Interval increased partial calcification of both mastoid\nair cells and layering fluid in the sphenoid sinus may be due to prolonged\nsupine positioning or nasal intubation, nonspecific.", + "output": "1. No intracranial hemorrhage or evidence of new infarct. MRI would be more\nsensitive for assessment of acute infarct.\n2. Stable right PCA encephalomalacia.\n3. Increased partial opacification of mastoid air cells, nonspecific." + }, + { + "input": "Study is moderately degraded by motion. Within these confines:\n\nThere is a known large region of right parieto-occipital encephalomalacia with\nex vacuo dilatation of the posterior horn of the right ventricle secondary to\nchronic infarct. Otherwise, there is no evidence of acute large territorial\ninfarction,acute intracranial hemorrhage,edema,or mass. There is prominence\nof the ventricles and sulci suggestive involutional changes. There are\nperiventricular and subcortical lucencies, which may represent small vessel\nischemic changes. Atherosclerotic vascular calcifications are noted of\nbilateral vertebral and cavernous portions of internal carotid arteries.\n\nThere is no evidence of fracture. Allowing for limitations due to motion,\nthere is fluid density within the left middle ear canal surrounding the inner\near ossicles and partial opacification of the bilateral mastoid air cells. \nThe visualized portion of the paranasal sinuses are grossly clear. The\nvisualized portion of the orbits are unremarkable. Soft tissue densities are\nnoted within bilateral external auditory canals which may represent cerumen.\n\nRight globe radiopaque foreign body is again noted, grossly unchanged (see\n02:16 on ___ prior exam and 2:8 on ___ prior exam). \nLimited imaging of the globes again demonstrate prominence of the superior\nophthalmic veins bilaterally, grossly unchanged compared to ___ and\n___ prior exams, not definitely seen on ___ prior exam.", + "output": "1. Study is moderately degraded by motion.\n2. No evidence of acute infarction, intracranial hemorrhage or fracture.\n3. Fluid density in left middle ear canal and partial opacification of the\nbilateral mastoid air cells are nonspecific, and may be related to prolonged\nsupine positioning or recent intubated status, with differential consideration\nof cholesteatoma not excluded on the basis of this examination. If clinically\nindicated, consider dedicated temporal bone CT for further evaluation.\n4. Chronic right occipital infarct.\n5. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described.\n6. Grossly stable nonspecific right globe radiopaque foreign body, grossly\nunchanged compared to ___ prior exam).\n7. Limited imaging of orbits again suggests prominence of superior ophthalmic\nveins, grossly similar to ___ prior exam, but\nnew compared to ___ prior exam. Differential considerations include\ncarotid cavernous fistula, a pelvic vein varix, increased intracranial\npressure, Graves disease, and orbital pseudotumor. Recommend correlation with\nclinical history and neurologic exam. If clinically indicated, consider head\nCTA for further evaluation.\n\nRECOMMENDATION(S): Limited imaging of orbits again suggests prominence of\nsuperior ophthalmic veins, grossly similar to ___ prior exam, but new compared to ___ prior exam. Differential\nconsiderations include carotid cavernous fistula, a pelvic vein varix,\nincreased intracranial pressure, Graves disease, and orbital pseudotumor. \nRecommend correlation with clinical history and neurologic exam. If clinically\nindicated, consider head CTA for further evaluation.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 20:54 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass. The ventricles and sulci are normal in size and configuration. There\nare multiple chronic lacunar infarcts in the basal ganglia bilaterally, right\ninternal capsule, right corona radiata and left external capsule (series 2,\nimage 21, 17, 16, 14).\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Multiple chronic lacunar infarcts within both basal ganglia, right internal\ncapsule, right corona radiata, and left external capsule." + }, + { + "input": "There is no evidence of acute large territorial infarction, intracranial\nhemorrhage, edema, or mass.\n\nThe ventricles and sulci are normal in size and configuration.\n\nNo acute osseous abnormalities seen. The partially imaged paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The orbits demonstrate\nno acute abnormalities.", + "output": "No acute intracranial process within limitations of this noncontrast study." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormalities." + }, + { + "input": "Exam is somewhat limited at the vertex secondary to motion. Again seen is\nsmall subdural hematoma overlying the left frontal and parietal lobes. The\nportion of the subdural hematoma at the vertex is partially obscured by motion\nbut is not grossly changed. There may be superimposed left inferior frontal\nlobe contusion best seen on the coronal images.\n\nThere is nondisplaced right parietotemporal skull fracture. Small associated\n6 mm epidural hematoma seen in the right middle cranial fossa (2 a: 10)\noverlying the right temporal lobe.\n\nNew from prior is subarachnoid blood centered in the left sylvian fissure. \nSmall amount of blood also seen layering within the interpeduncular cistern.\n\nThere is no acute infarct or significant mass effect or midline shift.\n\nThere is no other fracture identified. Paranasal sinuses and mastoids are\nclear. Right parietal scalp hematoma is noted.", + "output": "1. No significant interval change of left frontoparietal subdural hematoma,\nright temporoparietal nondisplaced fracture with associated 6 mm right middle\ncranial fossa epidural hematoma.\n2. Newly apparent left sylvian fissure subarachnoid blood with hemorrhage\nlayering within the interpeduncular cistern.\n3. Possible left inferior frontal contusion." + }, + { + "input": "6 mm epidural hematoma in the right middle cranial fossa, deep to the right\nparietal/temporal bone fracture, is stable.\n\nThin subdural hematoma overlying the left convexity is stable.\n\nLeft inferior frontal lobe hemorrhagic contusion with mild surrounding edema\nare stable in extent, though the edema is more conspicuous with decreased\ndensity, as expected over time.\n\nPreviously noted subarachnoid blood in the left sylvian fissure is less\napparent on the current study.\n\nNo new hemorrhage or edema are detected. Ventricles and sulci are stable in\nsize. Basal cisterns are not effaced. Cerebellar tonsils are normally\npositioned.\n\nThere is mild mucosal thickening in the ethmoid air cells. Other included\nparanasal sinuses are clear. Middle ear cavities, left mastoid air cells, and\npartially included right mastoid air cells are clear.", + "output": "1. Right middle cranial fossa epidural hematoma deep to the right\nparietal/temporal bone fracture, thin left convexity subdural hematoma, and\nhemorrhagic contusion within the inferior left frontal lobe are stable.\n2. Previously noted left sylvian fissure subarachnoid blood is less apparent." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction or midline shift.\nThere is no hydrocephalus. There is no edema. Visualized paranasal sinuses and\nmastoid air cells are clear. Debris in each external auditory canal suggests\ncerumen. There is no fracture.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "There is no evidence of fracture, hemorrhage, edema, mass effect, or\ninfarction. The ventricles and sulci are normal in size and configuration.\nThe imaged paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear.", + "output": "Normal CT of the head." + }, + { + "input": "There is no acute intracranial hemorrhage, edema, mass effect, or evidence of\nlarge vascular territorial infarction. The ventricles and sulci are normal in\nsize and configuration.\n\nThere is no fracture. The imaged paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. There is debris in the bilateral external\nauditory canals, likely cerumen", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute large territory infarction,hemorrhage,edema,or\nmass. There is prominence of the ventricles and sulci suggestive of global\nvolume loss. Moderate hypoattenuation of the periventricular and subcortical\nwhite matter is nonspecific but may represent sequela of chronic microvascular\nischemic disease. Moderate calcified atherosclerosis is demonstrated within\nthe bilateral carotid siphons.\n\nNo acute fracture. Mild mucosal thickening of the bilateral ethmoid air\ncells. Small air-fluid levels are noted in the partially imaged maxillary\nsinuses bilaterally. The visualized portion of the other paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable except for bilateral lens replacements.", + "output": "1. No acute intracranial process.\n2. Paranasal sinus disease." + }, + { + "input": "Pituitary fossa is enlarged. This is unchanged from previous MRI study and\nrelated to postoperative empty sella. There is a calcific density at the\nposterosuperior aspect of the nasal passage (5:78) which communicates and\nextends to the sphenoid sinus. The superior right side of the nasal passage\nis obliterated. The calcific density also contacts with the right middle\nturbinates. The calcification appears to be related to prior sphenoid sinus\nsurgery with calcification of previously placed fat graft. There is\nthickening of the sphenoid sinus walls indicative of chronic macro sphenoid\nsinus inflammatory changes.\n\nMucosal thickening is seen near the infundibulum of both ostiomeatal units\nwhich are slightly narrowed left greater than right side. Haller cells are\nalso seen near the infundibulum bilaterally. The frontal sinuses and anterior\nethmoidal air cells are clear.", + "output": "1. Findings suggestive of chronic sphenoid sinus inflammatory changes with a\ncalcific density protruding into the superior nasal passage and contacting the\nright middle turbinate likely related to previous sella surgery and\ncalcification of the fat graft.\n2. Mild mucosal changes at maxillary sinus.\n3. No fluid levels or aerosolized secretions." + }, + { + "input": "There is no evidence of acute hemorrhage mass effect midline shift or\nhydrocephalus. Gray-white matter differentiation is maintained.\n\nThe visualized paranasal sinuses are clear. No skull fracture is seen.", + "output": "No acute intracranial abnormalities are identified." + }, + { + "input": "There is new hypoattenuation and loss of gray-white matter differentiation in\nthe right frontal operculum concerning for late acute to subacute infarct. \nThere is also a hypodensity of the right paracentral lobule, which may also\nrepresent late acute to subacute infarct, however did demonstrate prominent\nFLAIR hyperintense signal on prior examination of ___. No\nevidence of intracranial hemorrhage or mass effect. Scattered subcortical\nwhite matter hypoattenuation is similar to foci of FLAIR hyperintensity on\nbrain MRI obtained ___ year prior. Hypoattenuation in the pons is felt to be\nartifactual. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mild hyperostosis frontalis\ninterna. The visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Probable late acute to subacute infarction of the right frontal operculum. \nAdditional hypodensity of the right paracentral lobule is also concerning for\nlate acute to subacute infarct, although this region did demonstrate similar\nFLAIR hyperintense signal on prior examination of ___ allowing for technical\ndifferences. No evidence of hemorrhage or mass effect.\n2. Scattered subcortical white matter hypoattenuation is similar to the prior\nMRI with differential considerations including chronic migraine headaches,\ndemyelinating disease, or sequela of prior inflammatory/infectious etiology or\nvasculitis.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 2:17 pm, less than 5\nminutes after discovery of the findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nHypodense changes in the right insular cortex/operculum and high right\nfrontoparietal areas are better seen on prior non contrasted CT head. The\nventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Hypodense changes in the right insular cortex/operculum and high right\nfrontoparietal areas suggesting late acute to subacute infarct is better seen\non prior CT.\n2. No intracranial aneurysms, stenosis or features of vasospasm.\n3. No significant stenosis of the carotid arteries by NASCET criteria." + }, + { + "input": "There is no evidence of acute major vascular territorial infarction,\nhemorrhage, edema, or mass. The ventricles and sulci are normal in size and\nconfiguration. Volume loss of the cerebellum is again noted.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of new hemorrhage. There is redistribution of the trace\namounts of subarachnoid hemorrhage 5 previously. There is stable appearance\nof a tiny focus of subarachnoid hemorrhage seen along the left temporal cortex\nas compared to the same-day CT head exam (series 2: Image 13). A tiny focus of\nsubarachnoid hemorrhage in the left frontal lobe is also unchanged (series 2:\nImage 14). There is no evidence of infarction. The ventricles and sulci are\nnormal in size and configuration. Atherosclerotic calcifications are noted at\nthe bilateral carotid siphons.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Subgaleal hematoma is noted along the\nright occipital scalp, similar in size and appearance compared to same day\nearlier CT exam.", + "output": "1. Redistribution of subarachnoid hemorrhage since the prior study of ___ with no evidence of new hemorrhage.\n2. Subgaleal hematoma is redemonstrated along the right occipital scalp." + }, + { + "input": "CTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nAtherosclerotic calcification at its origin causes mild stenosis of the right\nvertebral artery which otherwise appears patent. There is atherosclerotic\ncalcification at the proximal left internal carotid artery without evidence of\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. Right occipital subgaleal hematoma is again noted. Right\nfrontoparietal subarachnoid hemorrhage is better evaluated on recent head CT.", + "output": "Mild atherosclerotic disease involving the origin of the right vertebral\nartery and proximal left internal carotid artery. No evidence of aneurysm." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There are a number of enlarged,\nlikely reactive cervical lymph nodes, measuring up to 1.1 cm in short axis. \nThe neck vessels are patent. The right tonsil is asymmetrically enlarged in\ncomparison to the right, with effacement of the oropharynx. There are central\nareas of hypodensity with possible suggestion of rim enhancement, though no\ndefinite collection is identified. No peritonsillar component is identified.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.", + "output": "1. Asymmetric enlargement of the right tonsil with hypodensity is indicative\nof acute tonsillitis without definite collection identified in the\nperitonsillar region." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of hemorrhage, edema, or mass. The ventricles and sulci\nare normal in size and configuration. An old infarct is seen in the left\ncorona radiata. There is no evidence of recent infarction.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. An aplastic\nright A1 segment is seen. The dural venous sinuses are patent.\n\nCTA NECK:\n Atherosclerotic changes of the carotid bifurcations are seen without stenosis\nof the internal carotid arteries by NASCET criteria. The vertebral arteries\nand their major branches appear normal with no evidence of stenosis or\nocclusion. The ascending segment of the thoracic aorta is aneurysmal,\nmeasuring 4.2 cm. A 2 vessel arch is seen.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. Sternotomy wires are seen.", + "output": "1. No significant narrowing of the circle of ___ arteries and of the\ninternal carotid arteries, by NASCET criteria.\n2. Old infarct in the left corona radiata.\n3. Aneurysmal ascending thoracic aorta.\n4. No evidence of hemorrhage or recent infarction." + }, + { + "input": "There is no hemorrhage, edema, mass effect, shift in midline structures, or\nacute infarction. The ventricles and sulci are normal in size and\nconfiguration. No small vessel ischemic disease. The basal cisterns are patent\nand there is preservation of gray-white matter differentiation.\n\n\n\nNo fracture seen. No extra-axial fluid collection. The visualized paranasal\nsinuses, mastoid air cells and middle ear cavities are clear. The globes are\nunremarkable. The left sylvian fissure appears slightly wider than right.", + "output": "Negative head CT. Specifically no evidence of hydrocephalus." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci, which is greater than expected for\nage.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality.\nBrain parenchymal atrophy, greater than expected for age." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Prominence of\nthe ventricles and sulci is slightly greater than expected for age.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "Head CT: A right frontal 6 x 5.1 cm parenchymal hematoma and a smaller left\nfrontal parenchymal hemorrhage, diffuse intraventricular hemorrhage involving\nthe lateral, third and fourth ventricles and bifrontal subarachnoid hemorrhage\nis identified. Surrounding right frontal vasogenic edema pattern and 1 cm\nleftward midline shift anteriorly is noted, resulting in edema of the left\nmedial frontal lobe. There is mild uncal herniation, effacement of the basilar\ncisterns and crowding of the foramen magnum, with low lying cerebellar\ntonsils. Enlargement of the ventricles is greater than would be expected for\nthe cerebral volume, concerning for developing hydrocephalus. The paranasal\nsinuses are clear. The orbits are unremarkable. The mastoid air cells and\nmiddle ear cavities are well pneumatized clear.\n\nHead CTA: There is a bilobed 9 x 6 mm anterior communicating artery aneurysm.\nNarrowing of the right A1 and M1 segments relative to the contralateral side,\nis concerning for vasospasm in the appropriate clinical setting. There is\ntapered narrowing of the bilateral V4 segments with narrowing of the mid to\ndistal basilar artery. Incidental note is made of a patulous basilar tip\nmeasuring 5mm. The posterior communicating arteries are noted. Otherwise, the\nposterior cerebral arteries are unremarkable.", + "output": "1. 6 cm right frontal and smaller left frontal parenchymal hemorrhage with\ndiffuse intraventricular and subarachnoid hemorrhages are noted.\n2. A 1 cm leftward midline shift with uncal herniation, effacement of the\nbasilar cisterns and crowding of the foramen magnum with low lying cerebellar\ntonsils.\n3. Prominent ventricles , greater than would be expected for the cerebral\nvolume concerning for developing hydrocephalus. Clinical correlation is\nrecommended.\n4. A 9 mm bilobed anterior communicating artery aneurysm, likely ruptured\ngiven the hemorrhage.\n5. Narrowing of the right A1 and M1 segments relative to the contralateral\nside may either represent vasospasm in the appropriate clinical setting.\nBilateral tapered narrowing of the V4 segments as well as of the mid to distal\nbasilar artery is also noted. Clinical correlation is recommended.\nPlease note, at the time of this dictation, the patient has already undergone\non interventional cerebral angiogram and aneurysm coil packing." + }, + { + "input": "A left frontal approach external ventricular drain is now demonstrated\ntraversing the left frontal lobe, left anterior horn of the lateral ventricle,\nand terminating near the midline in the approximate region of the foramen of\n___.\n\nDiffuse hyperdense acute subarachnoid hemorrhage is re-demonstrated.\nA large right frontal acute intraparenchymal hemorrhage with extensive\nintraventricular extension to the lateral, third, and fourth ventricles is\nperhaps minimally increased to unchanged from the exam 2 hours ago.\nSurrounding hypodensity compatible with edema is overall unchanged. There is\nexpected redistribution of blood products in the ventricles with layering of\nblood in the dependent portions. Prominence of the temporal horns appears\nslightly increased from the prior exam. Dilatation of the third and fourth\nventricles but not the lateral ventricular body, anterior horn, and occipital\nhorns is stable. Mass effect and leftward shift of normally midline\nstructures is overall stable. Diffuse hypodensity overall of the parenchyma\nwith diffuse sulcal effacement is compatible with mass effect and diffuse\nedema, which appears overall unchanged. There is slight uncal herniation and\nslight low-lying tonsils also appear unchanged overall. Slight partial\nsymmetric effacement of the quadrigeminal cistern is overall unchanged. No\npneumocephalus.\n\nThe incompletely visualized paranasal sinuses, mastoid air cells, and middle\near cavities are clear.", + "output": "1. Newly placed left frontal approach EVD terminates in the region of the\nforamen of ___. Prominence of the temporal horns appears slightly increased\nfrom the prior exam concerning for evolving hydrocephalus.\n\n2. Grossly stable, or minimally increased, large right frontal acute\nintraparenchymal hemorrhage and subarachnoid hemorrhage with extensive\nintraventricular extension and associated edema, midline shift and slight\nuncal herniation.\n\n3. Stable low-lying tonsils, possibly from downward herniation in the setting\nof acute intracranial hemorrhage, or Chiari malformation.\n\n4. Otherwise, no significant interval change, and findings as above." + }, + { + "input": "Head CT: The patient is status post right frontal craniotomy and hematoma\nevacuation since the prior examination. There has been a reduction and right\nfrontal mass effect associated with the evacuation. Again seen is hemorrhage\nfilling the ventricular system. The lateral ventricles are somewhat larger on\nthe current examination than on the prior study of ___.\nThe patient is status post coiling of an anterior communicating artery\naneurysm. Artifact from the coils prevents evaluation of the adjacent brain\nfor possible infarction. However, there is reduced gray-white contrast on\nimaging remote from the coil artifacts. This is worrisome for global hypoxia\nand ischemia. No new hemorrhage is identified.\n\nHead CTA: Images in the vicinity of the aneurysm coil are severely degraded\nby artifact. There is a continued appearance of opacification of the base of\nthe aneurysm, unchanged from the arteriogram of ___. It is not possible\nto further characterize this region due to artifact from the aneurysm coils.\nAgain seen is marked attenuation of the right middle cerebral artery, likely\ndue to vasospasm. This appears overall similar to the prior CT a examination.\nHowever, the left middle cerebral artery appears far smaller than on the prior\nstudy, suggesting left-sided vasospasm, new since the prior CTA.\n\nThe anterior cerebral arteries are narrowed bilaterally suggesting this\nvasospasm.\n\nThere is narrowing of the supra clinoid right internal carotid artery, also\nlikely due to vasospasm. There is non visualization of the right posterior\ncerebral artery, a new finding since the prior CTA. There is irregularity of\nthe distal cervical internal carotid arteries bilaterally, not seen on the\nprior catheter arteriogram. These may represent extracranial procedure-related\nvasospasm.\nAgain seen is narrowing of the basilar artery, worrisome for vasospasm, but\nunchanged since the prior study.", + "output": "Status post coiling of anterior communicating artery aneurysm with evidence of\nresidual patent lumen at the aneurysm base.\nStatus post evacuation of a right frontal hematoma with reduction in right\nfrontal mass effect.\nNonvisualization of the right posterior cerebral artery.\nApparent spasm involving the supra clinoid right internal carotid artery and\nthe middle and anterior cerebral arteries bilaterally.\nPossible loss of gray-white differentiation supratentorially bilaterally,\nworrisome for global hypoxia and ischemia." + }, + { + "input": "There is no evidence of acute large territory infarction,intracranial\nhemorrhage,edema,or discrete mass. Ventricles and sulci are age-appropriate. \nA few scattered subcortical white matter hypodensities are likely sequela of\nchronic small vessel disease.\n\nThere is no evidence of fracture. Mucosal thickening of the left sphenoid\nsinus. Hyperostosis of the walls suggest component of chronic inflammation. \nOtherwise, the visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. There is mild mucosal thickening of the\nethmoid and sphenoid sinuses. Partial opacification of the bilateral\nmaxillary sinuses (with air-fluid levels), right mastoid air cells, and right\nmiddle ear cavity are nonspecific and also present in ___. The left mastoid\nair cells and left middle ear cavity are clear. The orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Sinus disease." + }, + { + "input": "Dental amalgam streak artifact limits study. Study is mildly degraded by\nmotion and streak artifact related to dental hardware.\n\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles are normal in size. There is moderate bilateral maxillary sinuses\nopacification with air-fluid level and partial right sphenoid sinus mucosal\nthickening.\n\nCTA HEAD:\nThe intracranial vasculature appears patent without evidence of stenosis,\nocclusion, dissection, or aneurysm. The dural venous sinuses appear patent\nwith a hypoplastic left transverse sinus.\n\nCTA NECK:\nThe bilateral common carotid arteries appear patent. There is no internal\ncarotid artery stenosis by NASCET criteria. The bilateral vertebral arteries\nappear patent. The origins of the great vessels appear unremarkable. There\nis no evidence of dissection.\n\nOTHER:\nThe thyroid gland appears unremarkable. The visualized lung apices appear\nclear. There is no lymphadenopathy per size criteria.", + "output": "1. Dental amalgam streak artifact and motion limits study.\n2. No evidence of acute intracranial hemorrhage or acute large territorial\ninfarct. Please note MRI of the brain is more sensitive for the detection of\nacute infarct.\n3. No evidence ofaneurysm greater than 3 mm, dissection orsignificant luminal\nnarrowing.\n4. Paranasal sinus disease with suggestion of acute bilateral maxillary\nsinusitis and nonspecific right mastoid." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nNo intracranial hemorrhage or mass. Relative fullness of the brain with\ndecreased cortical sulcation, but there is preserved gray-white matter\ndifferentiation. Slit-like appearance of the ventricles is nonspecific.\nNo significant tortuosity of the optic nerves. Partially empty sella.\nMinimal aerosolized secretions present in the right maxillary sinus. Minimal\nmucosal thickening in the left sphenoid sinus. The mastoid air cells are\nclear.\n\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. Small\ninfundibulum at the origin of the right PCA. The dural venous sinuses are\npatent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nDecreased image quality of the lower neck and upper mediastinal structures due\nto overlying tissue. The visualized portion of the lungs are clear. The\nvisualized portion of the thyroid gland is within normal limits. There is no\nlymphadenopathy by CT size criteria.", + "output": "Essentially normal head and neck CTA. No aneurysm. No dissection. A tiny\ninfundibulum is seen at the origin of right posterior communicating artery.\n\nNo intracranial mass or hemorrhage.\n\nNo significant stenosis of the internal carotid arteries by NASCET criteria.\n\nIf the headaches are chronic in nature intracranial hypertension (relative\nfullness of the brain with slit-like ventricles and a partially empty sella)\ncould be considered in the correct clinical setting, although the imaging\nfindings are not classic/specific for this." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass. Global age-related mild atrophy is seen. Periventricular and\nsubcortical mild white matter hypodensities are nonspecific, but likely\nreflect the sequela of chronic microvascular infarction. Cavernous carotid\natherosclerotic calcifications are seen bilaterally.\n\nNo osseous abnormalities seen. There is partial opacification of the left\nsphenoid sinus. Otherwise the remaining paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process identified." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nThe nasal septum is deviated to the right by 3 mm.\n\nThere is no masses in the nasal passages. The nasal passages are patent.\n\n Postsurgical change related to prior FESS are noted. Bilateral maxillary\nsinus mucosal thickening is present. There is mild mucosal thickening\ninvolving the left anterior ethmoid air cells.\n\nThere is mucosal thickening of the left frontal sinus. There is soft tissue\nopacification of the proximal left frontal sinus drainage pathway. The right\nfrontal sinus is clear. The right frontal sinus drainage pathway is clear.\n\nThe sphenoid sinuses are clear. The sphenoid ethmoid recesses are clear.\n\nThe lamina papyracea are intact. The cribriform plates and bilateral fovea\nethmoidalis are grossly intact, with nonspecific areas of minimal\ndiscontinuity noted, without definite opacification of adjacent olfactory\nrecess or ethmoid air cell opacification (see 601:58-61).\n\nThe Crista galli is not pneumatized. The anterior clinoid processes are not\npneumatized.\n\n Left temporomandibular joint degenerative changes are noted. The mastoid air\ncells are clear.", + "output": "1. Dental amalgam streak artifact limits study.\n2. Postsurgical change related to prior FESS are noted.\n3. Left frontal left ethmoid sinus paranasal sinus disease as described.\n4. Grossly preserved bilateral cribriform plates and fovea ethmoidalis, with\nnonspecific areas of lucency without definite adjacent sinus opacification. \nWhile findings may represent nutrient vessels, or areas demineralization,\ndifferential considerations include focal areas of dehiscence. If continued\nconcern for CSF leak or encephalocele, consider dedicated skullbase MRI for\nfurther evaluation.\n5. Left temporomandibular joint degenerative changes.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 23:55 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." + }, + { + "input": "Head CT: There is no evidence of hemorrhage, edema, masses, mass effect, or\ninfarction. The ventricles and sulci are normal in caliber and configuration.\nNo fractures are identified.\n\nHead and neck CTA: The carotid and vertebral arteries and their major branches\nare patent with no evidence of stenoses. The distal cervical internal carotid\narteries measure 4.3 mm in diameter on the left and 4.9 mm in diameter on the\nright. There is no evidence of aneurysm formation or other vascular\nabnormality.", + "output": "Normal Study" + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, mass effect, midline\nshift, or mass. The ventricles and sulci are prominent consistent with\nage-related atrophy. Confluent periventricular and subcortical white matter\nhypodensities likely represent the sequela of chronic small vessel ischemic\ndisease.\nNo bony abnormalities seen. A few ethmoid air cells are opacified. The\nmaxillary and sphenoid sinuses are clear. Sphenoid sinus septation inserts on\nthe left carotid groove. The mastoid air cells are clear. There is evidence of\nprior orbital surgery.", + "output": "No acute intracranial hemorrhage or mass effect.\nNonspecific cerebral white matter hypodense foci.\nMild ethmoidal mucosal thickening.\n\nCorrelate clinically to decide on the need for further workup or followup." + }, + { + "input": "CT Head not performed on this study as done before.\n\nHead CTA: The intracranial carotid and vertebral arteries and their major\nbranches are patent with no evidence of stenoses, occlusions or aneurysm\nformation.\nThere is a fetal type right PCA. Minimal prominence at the origins of the\nposterior communicating arteries, right more than left, can relate to\ntortuosity or tiny infundibulum.\nA tiny of 2.6 mm focal prominence at the right middle cerebral artery one of\nthe M2 branches - series 2, image 267, similar to the prior study.\nThere is mild calcification of the cavernous portions of the internal carotid\nartery bilaterally without stenosis.\nLeft transverse sinus is diminutive.\n\nNeck CTA: Imaging of the neck reveals no evidence of arterial stenosis or\nocclusion. There is no evidence of internal carotid artery stenosis by NASCET\ncriteria.\nThere is mild arthrosclerotic calcification of the thoracic aortic arch.\nThere is a normal three-vessel takeoff from the arch.\nThere is calcified plaque at the carotid bifurcations bilaterally without\nstenosis.\nTiny irregularity in right V2 segment (se 2, im 191) -? Related to\natherosclerotic disease.\n\nThe distal right internal carotid artery measures 5.2 mm in diameter and the\ndistal left internal carotid artery measures 4.7 mm in diameter.\n\nCT neck:\n\nThe parotid and submandibular glands are unremarkable.\nTiny calcification in the left parotid gland.\nThe aerodigestive tract is unremarkable. There is no significant\nlymphadenopathy. There are mild emphysematous changes in the included lung\napices as well as mild biapical pleural parenchymal scarring. There are\ndegenerative changes throughout the cervical spine with right greater than\nleft facet and uncovertebral joint arthropathy resulting in varying degrees of\nright greater than left neural foraminal narrowing.\n\nMild to moderate ethmoidal and mild maxillary sinus mucosal thickening.\nSphenoid sinus septation inserts on the left carotid groove.\nThe mastoid air cells are grossly clear.\nPneumatization of the petrous apices.", + "output": "1. Patent major intra and extracranial arteries as described above without\nfocal flow-limiting stenosis, occlusion or aneurysm more than 3 mm.\nA tiny of 2.6 millimeter focal prominence at the right middle cerebral artery\none of the M2 branches - series 2, image 267, similar to the prior study of\n___-? Infundibulum or a tiny aneurysm.\nConsider nonemergent interventional neuroradiology consult, to decide on the\nsignificance and further management.\n\nAtherosclerotic calcifications in the aorta, common carotid bifurcations and\ncavernous carotid segments on both sides without flow-limiting stenosis.\n\n2. Multilevel, multifactorial degenerative changes in the cervical spine, with\nmild to moderate canal narrowing at C5-6 level and multilevel moderate to\nsevere foraminal narrowing.\n\nFinal approval on ___ as waiting for MIP reformations and report locked on\nVoice recognition system.\n\nNOTIFICATION: Entered in Radiology result communication dashboard by Dr. ___" + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Basilar cisterns are\npatent.\n\nIncluded paranasal sinuses and mastoids are clear. Multiple locules of\nintravenous air are noted in the extracranial soft tissues and cavernous\nsinuses. Skull and extracranial soft tissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass effect. \nThere is prominence of the ventricles and sulci suggestive of age advanced\ninvolutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality on noncontrast head CT, specifically no\nintracranial hemorrhage.\n2. No acute displaced calvarial fracture." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is re- demonstration of the intra sellar and suprasellar mass, which is\npartially calcified along the left lateral aspect, and extends into the third\nventricle. There is no evidence of no evidence of infarction, hemorrhage, or \nedema. The ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable. Retention cysts\nare seen in the bilateral maxillary sinuses. Periapical lucency is noted\nalong multiple left maxillary teeth.\n\nCTA HEAD: Atherosclerotic calcification in the cavernous internal carotid\nartery is seen. The infundibulum is noted at the origin of the right\nposterior communicating artery. Otherwise, the remainder of the vessels of\nthe circle of ___ and their principal intracranial branches appear normal\nwithout stenosis, occlusion or aneurysm formation. The dural venous sinuses\nare patent.\n\nCTA NECK: Minimal atherosclerotic calcification of the aortic arch is seen. \nOtherwise, the remainder of the carotid and vertebral arteries and their major\nbranches appear normal with no evidence of stenosis or occlusion. There is no\nevidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. There is a 0.8 cm left thyroid\nnodule, which requires no further follow-up by imaging according to the\n___ College of Radiology guidelines. Calcified pretracheal lymph nodes\nare seen, likely secondary to prior infection. Degenerative changes are noted\nthroughout the cervical spine.", + "output": "1. Re- demonstration of the partially calcified intra sellar and suprasellar\nmass, which is fully characterized on the subsequently performed MRI, and\nlikely represents a craniopharyngioma.\n2. No evidence acute intracranial hemorrhage.\n3. No evidence of aneurysm greater than 3 mm, dissection, vascular\nmalformation or significant luminal narrowing.\n4. Dental disease. Dental consultation is recommended." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is re- demonstration of the intra sellar/suprasellar mass, which is\npartially calcified along the left lateral aspect, and extends into the third\nventricle with cystic components. There is no evidence of no evidence of\ninfarction, hemorrhage, or edema. The ventricles and sulci are normal in size\nand configuration.\n\nThe visualized portion of the mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable. Retention cysts\nare seen in the bilateral maxillary sinuses.\n\nCTA HEAD: Atherosclerotic calcification in the cavernous internal carotid\nartery is seen. An infundibulum is noted at the origin of the right posterior\ncommunicating artery. The anterior and middle cerebral arteries are draped\nalong the anterior and lateral aspect of the lesions. Otherwise, the remainder\nof the vessels of the circle of ___ and their principal intracranial\nbranches appear normal without stenosis, occlusion or aneurysm formation. The\ndural venous sinuses are patent. There are questionable small feeding vessels\nto the lesion.\n\nOTHER:\nDegenerative changes are noted throughout the cervical spine.", + "output": "1. Re- demonstration of the partially calcified intra sellar/suprasellar mass,\nwhich is fully characterized on the recently performed MRI, and likely\nrepresents a craniopharyngioma. Questionable small feeding vessels are\npossibly noted around the periphery of the lesion.\n2. No evidence acute intracranial hemorrhage.\n3. No evidence of aneurysm greater than 3 mm, dissection, vascular\nmalformation or significant luminal narrowing." + }, + { + "input": "The patient is status post right frontal craniotomy with expected\npostoperative appearance with bifrontal pneumocephalus and a small amount of\nfluid in the right subdural space. This causes mass effect with effacement of\nthe adjacent sulci and effacement of the right lateral ventricle. There is no\nshift of normally midline structures. Hypodensity is seen along the anterior\nright temporal lobe extending to the suprasellar space compatible at the\nresection site. There is trace hyperdensity in this region likely reflecting\nminimal hemorrhage. There is some effacement of the right aspect of the\nsuprasellar cistern. The quadrigeminal plate cistern remains patent.\n\nMucous retention cysts are seen in the bilateral maxillary sinuses. \nHeterogeneous material seen within the right frontal sinus, likely related to\nsurgery. The remaining visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "Status post right frontal craniotomy with resection of the suprasellar mass. \nExpected postoperative appearance with pneumocephalus and a small amount of\nsubdural fluid on the right causing effacement of the adjacent sulci and the\nright lateral ventricle. Minimal blood products within the resection site." + }, + { + "input": "Compared with the prior study, there is increased hypodensity involving the\nright temporal lobe (___). Approximately 7 mm mixed density fluid\ncollection overlying the right frontal lobe at the craniotomy site, with\nminimal mass effect on the adjacent right frontal lobe is noted. Question\nhigh density components within this collection (02:14). The degree of\npneumocephalus has decreased. There is no shift of normally midline\nstructures. No new acute intracranial hemorrhage is detected. There is mild\nstable effacement of the suprasellar cistern right margin, with a patent\nquadrigeminal plate cistern.\n\nPatient is post right frontotemporal craniotomy. There has been interval\nincrease in size of overlying right subgaleal mixed density collection, now\nmeasuring up to 2.0 cm in width and extending along the right frontal\ncalvarium.\n\nBilateral maxillary sinus mucosal retention cysts are unchanged. Fluid\ntracking in the anterior ethmoidal air cells and right frontal sinus is noted.\nThe visualized portion of the mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. Evolving postsurgical changes related to patient's prior right\nfrontotemporal craniotomy and parasellar tumor section as described.\n2. New mixed density fluid collection overlying the right frontal craniotomy\nsite with interval extension along right temporal and parietal bones, as\ndescribed. While finding may represent collection of mixed density blood\nproducts, underlying CSF leak is not excluded on the basis of this\nexamination.\n3. Interval evolution of patient's previously noted right anterior temporal\nacute to subacute infarct, without definite evidence of hemorrhagic\ntransformation.\n4. Right frontal extra-axial fluid collection with hyperdense components\nmeasuring up to 7 mm. While findings may represent evolving postsurgical\nchanges, small acute on chronic subdural hemorrhage is not excluded on the\nbasis examination.\n5. Redemonstration of nonspecific stable frontal sinus opacification, as well\nas additional paranasal sinus disease as described.\n\nNOTIFICATION: The above findings of increasing subgaleal collection,\nincreasing left temporal low density region and redemonstration of\nhyperdensity overlying right frontal lobe were communicated via telephone by\nDr. ___ to Dr. ___ at 03:05 on ___, 3 min after discovery." + }, + { + "input": "Patient is status post remote right frontotemporal craniotomy for resection of\nright suprasellar craniopharyngioma, with subsequent CyberKnife therapy. Skin\nstaples overlie the right frontotemporal scalp. Again seen is a 2.1 x 2.1 cm\nhypodense lesion within the suprasellar cistern (3:13), better characterized\non prior MR, consistent with residual/recurrent craniopharyngioma. Area of\nlow-density within the white matter adjacent to the frontal horn of the right\nlateral ventricle (3:18) likely reflects postoperative changes. Stable\nencephalomalacia within the right anterior temporal lobe, consistent with\nprior infarct.\n\nThere is no acute large territorial infarction, hemorrhage, edema or mass. \nPeriventricular and subcortical white matter hypodensities are nonspecific,\nthough likely sequelae of chronic small vessel ischemic disease. Ventricles\nand sulci are prominent, unchanged from prior MRI on ___, but\nincreased in size from examination of ___.\n\nMultiple small mucous retention cysts are seen within the bilateral maxillary\nsinuses. The remaining visualized paranasal sinuses are clear, mastoid air\ncells and middle ear cavities are clear. Visualized portions of the orbits\nare unremarkable.", + "output": "1. No acute intracranial process. Specifically, stable mild ventricular\nprominence, as compared to prior MR on ___, without evidence of\nworsening ventriculomegaly. Of note, the ventricles are more prominent when\ncompared to examination of ___.\n2. Status post right frontotemporal craniotomy and CyberKnife therapy with\nexpected postoperative changes.\n3. Re-demonstrated 2.1 x 2.1 cm hypodense lesion within the suprasellar\ncistern, better characterized on prior MR, is consistent with\nresidual/recurrent craniopharyngioma.\n4. Stable encephalomalacia of the right anterior temporal lobe." + }, + { + "input": "There is no acute hemorrhage. White matter hypodensities within the right\nfrontal lobe are better characterized on recent MR dated ___,\nsequela of post treatment changes. Encephalomalacia within the right temporal\nlobe is additionally unchanged since prior MR. ___ is mild periventricular\nwhite matter hypodensity about the frontal horn of the left ventricle,\nnonspecific although probably reflective of chronic small vessel ischemia. A\ncystic suprasellar mass is identified, previously and better characterized by\nMR. ___ and sulci stable in configuration. There is no shift of\nnormally midline structures. Gray-white matter differentiation appears\npreserved. Basal cisterns are patent.\n\nPost right frontal craniotomy changes are noted. Imaged paranasal sinuses\ndemonstrate mucous retention cysts within the bilateral maxillary sinuses. \nThere are no air-fluid levels. Bilateral mastoid air cells and middle ear\ncavities are clear. Orbits are unremarkable. Carotid siphon vascular\ncalcifications are moderate.", + "output": "1. No acute hemorrhage.\n\n2. Re- demonstration of suprasellar cystic mass as well as white matter\nhypodensity within the right frontal lobe surrounding the frontal horn of the\nright lateral ventricle better characterized on prior MR dated ___.\n\n3. Stable right temporal horn encephalomalacia." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nacute large vascular territorial infarct. Gray-white differentiation is\npreserved. The ventricles and sulci are normal in size and configuration.\n\nNo acute fracture is seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "Loss of gray-white differentiation left temporal and parietal lobe is likely\nrelated to an infarct of indeterminate age, likely subacute to chronic. \nLinear hyperdensity layering along several of the parietal sulci is\nindeterminate, but could be related to cortical laminar necrosis versus blood\nproducts (for example 02:19). There is encephalomalacia of the right\noccipital lobe with ex vacuo dilatation of the posterior horn of the right\nlateral ventricle, likely related to a remote infarct. Additional prominence\nof the ventricles and sulci suggestive of involutional changes. \nPeriventricular and subcortical white matter hypodensities are nonspecific but\nlikely reflect sequelae of chronic small vessel ischemic disease.\n\nThere is no evidence of acute fracture. The maxillary maxillary sinuses,\nanterior ethmoid air cells, left sphenoid sinus, and frontal sinuses are\nnearly completely opacified. There is thickening of the sinus walls,\nsuggestive of chronic sinus disease. The visualized portion of the orbits are\nunremarkable with the exception of bilateral lens replacements.", + "output": "1. Hypodensity and loss of gray-white differentiation in the left temporal and\nparietal lobe is suggestive of subacute to chronic infarct. Dense material\ntracking along several of the primarily parietal sulci is indeterminate, but\ncould possibly reflect laminar necrosis. An MRI could be performed to\nestablish acuity of this pathology.\n2. Chronic, extensive paranasal sinus disease as described above.\n\nRECOMMENDATION(S): Brain MRI" + }, + { + "input": "There is no evidence of acute major infarction,hemorrhage,edema,or large mass.\nChronic encephalomalacia and cortical hypodensities in the left temporal,\nparietal and right occipital lobes as well as left cerebellar hemisphere\ncorresponding to chronic areas of infarction. Periventricular and subcortical\nwhite matter hypodensities correspond to chronic small vessel disease. Ex\nvacuo dilation of the occipital horn of the right lateral ventricle secondary\nto occipital encephalomalacia. Sulci are mildly prominent suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture. Ethmoidal mucosal thickening, aerosolized\nfluid and osseous cortical thickening in both maxillary sinus consistent with\nacute on chronic sinus disease. The visualized portion of the mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. No acute intracranial findings.\n2. Acute on chronic pansinus disease." + }, + { + "input": "Moderate patient motion, 2 sets of images were obtained.\n\nPunctate focus of artifact versus trace subarachnoid hemorrhage left vertex\nseries 2, image 21.\n\nNo evidence of large territorial infarction,edema,or mass. The ventricles and\nsulci are normal in size and configuration.\n\nThere is no evidence of fracture. Opacified paranasal sinuses mucosal\nthickening and fluid in the maxillary sinuses, suggestive of acute sinusitis.", + "output": "1. Motion degraded exam.\n2. Artifact versus punctate focus of subarachnoid hemorrhage left vertex..\n3. No calvarial fracture.\n4. Findings consistent with acute paranasal sinusitis." + }, + { + "input": "There remains mild motion artifact, at the base of skull, limiting assessment,\nthere remains diagnostic for evaluating the previous finding at the vertex. \nThe apparent punctate hyperdensity, within the left parietal lobe, is no\nlonger visualized, and was likely artifactual.\n\nThere remains no acute intracranial hemorrhage.\n\nThe intracranial arteries and veins, are slightly ___ relate to\ndehydration, or increased hematocrit.\n\nThere remain thickened secretions within the ethmoid and maxillary sinuses.", + "output": "No acute intracranial posttraumatic sequela. In particular, the spontaneously\ndense focus within the left parietal lobe on prior exam, likely artifactual." + }, + { + "input": "Evaluation for subarachnoid hemorrhage is limited in the absence of a\nprecontrast scan. There is no evidence for acute intracranial hemorrhage or\npathologic extra-axial collection. No abnormal parenchymal or meningeal\ncontrast enhancement is seen. There is no parenchymal edema, mass effect, or\nloss of gray/white matter differentiation. Ventricles, sulci, and basal\ncisterns are normal in size.\n\nNo suspicious bone lesion is seen. There is moderate opacification of\nbilateral ethmoid air cells with mucosal thickening plus/ minus fluid,\noccluding the frontoethmoidal recesses and extending into the inferior frontal\nsinuses. There is also 2 mm osteoma in the inferior left frontal sinus on\nimage 3:5. There is mild mucosal thickening in the partially visualized\nsphenoid sinuses. Maxillary sinuses are not imaged. Middle ear cavities,\npartially visualized mastoid air cells, and pneumatized petrous apices are\nwell-aerated.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. Moderate opacification of bilateral ethmoid air cells with mucosal\nthickening plus/ minus fluid, occluding the frontoethmoidal recesses and\nextending into the inferior frontal sinuses. Please correlate clinically\nwhether the patient has symptoms of acute sinusitis. Please note that the\nmaxillary sinuses are not imaged." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass.\n\nThe ventricles and sulci are age appropriate. There are periventricular\nhypodensities, nonspecific but suggestive of chronic microangiopathic changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere are atherosclerotic changes along both carotid siphons without\nhigh-grade stenosis. The vessels of the circle of ___ and their principal\nintracranial branches appear normal with no evidence of stenosis,\nocclusion,oraneurysm.\nThere is a patulous appearance of the basilar tip without discrete aneurysm\nformation.\nThe dural venous sinuses are patent.", + "output": "1. No acute intracranial abnormality. No evidence of acute infarction,\nhemorrhage or intracranial mass.\n2. Nonspecific periventricular hypodensities likely reflect sequela of chronic\nmicroangiopathic changes.\n3. Patent intracranial vasculature without evidence of stenosis, occlusion,\ndissection or aneurysm formation greater than 3 mm." + }, + { + "input": "Evaluation is significantly limited by motion and streak artifact. Within\nthis limitation, no acute intracranial hemorrhage is identified. There is\npossible subtle loss of gray-white matter differentiation in the left parietal\nregion, suggestive of an early infarction (4:1). There is prominence of the\nventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of grossly displaced fracture. The visualized portion of\nthe paranasal sinuses and mastoid air cells are grossly clear. Evaluation of\nthe orbits is limited by motion artifact.", + "output": "Evaluation is significantly limited by motion and streak artifact. Within this\nlimitation, no acute intracranial hemorrhage is identified. There is possible,\nsubtle loss of gray-white differentiation in the posterior aspect of the\ninsula, which may be suggestive of an early acute infarction (4:1)." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nWithin the region of the left parietal lobe, there is loss of gray-white\nmatter differentiation, concerning for infarction (series 2, image 20).\n\nThere is no evidence of hemorrhage,edema,ormass. The ventricles on sulci are\nmildly enlarged.\n\nMild mucosal thickening of the right maxillary sinus. Otherwise, the\nvisualized portion of the paranasal sinuses, mastoid air cells,and middle ear\ncavities are clear. The visualized portion of the orbits are remarkable for\nasymmetry of the bilateral orbital sizes, with the right orbit slightly\nsmaller the left and also lacking a lens. Recommend clinical correlation.\nThysis bulbi of right orbit.\n\nCT PERFUSION: CT perfusion demonstrates delayed transit time greater than 6 cm\nin the left parietal lobe measuring 64 mL and a corresponding decreased blood\nflow less than 30% of 42 mL. There is consequently a 22 mm mismatch\nindicating penumbra.\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThere is mild atherosclerotic plaque seen at the bilateral carotid\nbifurcations. Otherwise, the carotidandvertebral arteries and their major\nbranches appear normal with no evidence of stenosis or occlusion. There is no\nevidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the thyroid gland is demonstrates several calcified\nnodules within the left thyroid lobule (series 4, images 68 and 86) and a\nheterogeneous hypodensity within the right thyroid lobule (series 4, image\n91). An endotracheal tube in oral enteric tube are present.\n\nWithin the superior mediastinum and left lateral to the trachea, there is a\n1.2 x 3.0 cm rounded lesion, which may represent an enlarged and malignant\nlymph node (series 4, image 59). Additionally, there is a rounded soft tissue\nmass within the left supraclavicular mass measuring 4.0 x 2.8 cm (series 4,\nimage 81).\n\nThere is an 8 mm calcified granuloma within the right upper lobe (series 4,\nimage 16), as previously described on chest CT.\n\nMild pleural effusion within the right major fissure. There also several\nsubcentimeter lung parenchymal blebs scattered within the visualized lung\napices.", + "output": "1. Hypodensity in the left parietal lobe indicative of early infarct.\n2. 64 mL area of ischemia with 42 mL area of suspicious infarct core with a\nmismatch of 22 mL on CT perfusion.\n3. No large vessel occlusion or identified on CT angiography of the head neck.\nMild vascular calcifications are seen.\n4. Left supraclavicular neck mass with a enlarged necrotic lymph node in the\nsuperior mediastinum. Clinical correlation recommended.\n5. Several calcified nodules within the left thyroid lobe and heterogeneous\nregion in the right thyroid level." + }, + { + "input": "No hemorrhage or mass effect. More apparent left MCA distribution M2, M3, M5,\nand M6 zone infarcts. Approximately 50% of the insula is infarcted.\n\nThere is significant parietoccipital atrophy. Small chronic left occipital\nlobe infarct. Chronic small vessel ischemic changes. Oral tube in place,\nminimal mucosal thickening paranasal sinuses.\n Redemonstration of enophthalmos of a small right orbit. Again seen is\ncatheter coursing through the oropharynx.", + "output": "No hemorrhage.\nStable large left MCA distribution acute/early subacute infarct.\nChronic left occipital lobe infarct.\nRight enophthalmos, small right globe." + }, + { + "input": "Evolving large left MCA territory infarct is again noted without definite\nevidence of hemorrhagic transformation.\n\nVentricles and sulci are grossly stable in size and configuration. \nRedemonstration of chronic small vessel ischemic changes. There is no\ndefinite evidence of midline shift. Basilar cisterns are preserved.\n\n A nasoenteric tube is partially visualized. Soft tissue density is noted\nwithin the left external auditory canal, which may represent cerumen. \nNonspecific opacification of the ethmoid air cells is noted.", + "output": "1. No definite evidence of acute intracranial hemorrhage.\n2. Evolving large left MCA distribution subacute infarct, without definite\nevidence of hemorrhagic transformation." + }, + { + "input": "Continued evolution of the left MCA territory infarct without acute\nintracranial hemorrhage. There is slight decrease in edema and effacement of\nthe ventricles and sulci. Prominence of the ventricles and sulci suggest\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific but can suggest chronic small vessel ischemic\nchanges. Basal cisterns are patent. No midline shift.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Patient is\nstatus post left lens implant. Redemonstration of enophthalmos with small\nright orbit.", + "output": "1. No evidence of acute intracranial hemorrhage.\n2. Continued evolution of the left MCA territory infarct. Mild interval\ndecrease in effacement of the sulci and the left lateral ventricle." + }, + { + "input": "The study is limited by streak artifact. In comparison the previous\nexamination the patient is status post right craniectomy. There are expected\npostop surgical changes including pneumocephalus and a small subdural fluid\ncollection. There is no significant mass effect or midline shift. There is\nmesh in place over the craniectomy. There is re- demonstration of a bony\nlesion the left frontal bone.\nSubcortical and periventricular white matter hypodensities are consistent with\nchronic small vessel ischemic disease.\n\nThe basal cisterns appear patent and there is preservation of gray-white\nmatter differentiation.\n\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\n\nThe globes are unremarkable.", + "output": "1. Expected postop surgical changes all, including pneumocephalus and small\nright subdural fluid collection.\n\n2. There is re- demonstration of a bony lesion in the left frontal bone,\nbetter seen on MR." + }, + { + "input": "Expected postsurgical changes of a right craniectomy. The previously seen left\nfrontal lobe mass is not identified on this study. No abnormal foci of\nenhancement identified. There is no evidence of acute large vascular\nterritorial infarction, hemorrhage, edema, mass effect, midline shift, or\nmass. The ventricles and sulci are normal in size and configuration. Mucosal\nthickening in the left maxillary sinus is unchanged since ___. The\nmastoid air cells, and middle ear cavities are clear. .", + "output": "1. No acute intracranial process.\n2. Expected postsurgical changes of a right craniectomy." + }, + { + "input": "There is no evidence of acute large territory infarction,\nintracranialhemorrhage,edema,or discrete mass. The ventricles and sulci are\nnormal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. The\nvisualized portion of the orbits are unremarkable. Note is made of an ectopic\nmolar tooth in the left retro maxillary fat.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria however prominent lymphnodes are seen superior to the left\nsubmandibular gland, adjacent to the mandible may be reactive in etiology. The\nneck vessels are patent.\n\nThe imaged portion of the lung apices demonstrate mild bilateral scarring at\nthe apices. There are no osseous lesions.\n\nThe visualized bilateral mastoid air cells, middle ear cavities and partially\nvisualized paranasal sinuses are clear.\n\nThe visualized teeth appear fractured with multiple periapical lucencies. \nSoft tissue stranding overlying the mandible could be seen in the setting of\noverlying cellulitis.", + "output": "1. No retropharyngeal abscess. No drainable fluid collection.\n2. Visualized teeth appear fractured with multiple periapical lucencies,\nincompletely evaluated on this exam however could be seen in the setting of an\nodontogenic infection.\n3. Soft tissue stranding overlying the mandible could be seen in the setting\nof overlying cellulitis.\n\nRECOMMENDATION(S): Dental consult may be helpful for further evaluation for\nfurther evaluation of patient's poor dentition." + }, + { + "input": "Study is moderately degraded by motion. Within these confines:\n\nThere is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. There is mild prominence of the ventricles and sulci suggestive\nof involutional changes. There are periventricular and subcortical lucencies,\nwhich may represent small vessel ischemic changes. Atherosclerotic vascular\ncalcifications are noted of bilateral cavernous portions of internal carotid\narteries.\n\nThe left maxillary sinus is near completely opacified. There is mucosal\nthickening of bilateral sphenoid sinuses. The remaining imaged paranasal\nsinuses are clear. Mastoid air cells and middle ear cavities are well aerated.\nThe bony calvarium is intact.", + "output": "1. Study is moderately degraded by motion.\n2. Within limits of study, no acute intracranial abnormality. Please note MRI\nof the brain is more sensitive for the detection of acute infarct.\n3. Paranasal sinus disease , as described.\n4. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema,or midline shift. \nEncephalomalacia at the Left parietal lobe as sequelae from previous\ninfarction. The ventricles and sulci are within expected limits in size and\nconfiguration. Prominent right basal ganglia calcifications are\nre-identified.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of acute intracranial abnormality. No acute displaced\ncalvarial fracture.\n2. Left parietal lobe encephalomalacia from previous infarct.\n3. Prominent right basal ganglia calcifications are re-identified and\npotentially sequela prior trauma or infectious etiology." + }, + { + "input": "Overlying hardware streak artifact limits examination.\n\nThere is chronic bifrontal and left temporal encephalomalacia. There is\nassociated ex vacuo dilatation of the left lateral ventricle. There is no\nevidence of acute intracranial hemorrhage, acute large territorial infarct or\nmidline shift.\n\nThere is no evidence of fracture. The visualized portion of the mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable. Bilateral sphenoid, maxillary and frontal sinus and\nbilateral ethmoid air cell mucosal thickening is present.", + "output": "1. Overlying hardware streak artifact limits examination.\n2. Within limits of study, no definite evidence of acute intracranial\nhemorrhage or fracture.\n3. Chronic bifrontal and left temporal encephalomalacia.\n4. Paranasal sinus disease , as described." + }, + { + "input": "There is no evidence of fracture, infarction or edema. Within limits of this\ncontrast examination, there is no definite evidence of intracranial\nhemorrhage. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. There are periventricular and subcortical lucencies,\nwhich may represent small vessel ischemic changes. Atherosclerotic vascular\ncalcifications are noted of bilateral cavernous portions of internal carotid\narteries.\n\nThere is no abnormal enhancement. Grossly stable approximately 8 mm left\nparafalcine calcified structure arising from the falx is again noted (see\n04:22 on current study and 02:23 on prior exam).\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Grossly stable 8 mm left parafalcine heavily calcified structure, again\nsuggestive of meningioma versus dural calcification.\n3. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct and intracranial masses.\n4. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass effect, midline shift,\nor acute major vascular territorial infarct. Peripheral hypodensity in the\nright cerebellar hemisphere is compatible with prior infarct. CSF density\nmeasuring 1.6 x 2.5 cm in the left middle cranial fossa suggestive of an\narachnoid cyst. Rounded hyperdense partially calcified structure apparently\narising from the falx measuring 8 by 8 mm (601b:59) is likely a meningioma. \nScattered predominant subcortical white matter hypodensities are likely\nsequela of chronic small vessel disease. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Atherosclerotic\ncalcifications noted within the intracranial ICAs.\n\nThere is a large hematoma overlying the frontal bone on the left measuring 3.9\nx 1.9 cm. Subcutaneous stranding extends into the left supraorbital region. \nThere is no underlying fracture. Included paranasal sinuses and mastoids are\nessentially clear besides mild mucosal thickening in the maxillary sinuses and\nethmoid air cells. Skull and extracranial soft tissues are unremarkable.", + "output": "Left forehead hematoma without underlying fracture or acute intracranial\nhemorrhage.\nLeft middle cranial fossa probable arachnoid cyst and 8 mm hyperdense\nextra-axial lesion arising from the falx suggestive of a meningioma." + }, + { + "input": "There is a hypodensity in the right parietal lobe, likely sequela of prior\ninsult (03:20). There is no evidence of acute major vascular territory\ninfarction,intracranial hemorrhage,edema,or mass. There is minimal prominence\nof the ventricles and sulci suggestive of involutional changes. \nAtherosclerotic calcifications are seen in both carotid siphons.\n\nThere is no evidence of fracture. A mucous retention cyst is seen in the\nright maxillary sinus. Otherwise, the remaining visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. \nPatient is status post bilateral lens replacements.", + "output": "1. No acute intracranial abnormalities. Specifically, no evidence of\nintracranial hemorrhage.\n2. A hypodensity in the right parietal lobe likely represents sequela of\nremote infarct." + }, + { + "input": "Redemonstration of hypodensity in the right parietal lobe, unchanged compared\nto prior CT, likely sequela of a prior insult. No new large territory\ninfarction, hemorrhage, edema, or mass. Minimal prominence of ventricles and\nsulci, compatible with involutional changes.\n\nThere is no evidence of fracture. Right maxillary sinus mucosal retention\ncyst. Ethmoid mucosal thickening. Additionally, fluid within the bilateral\nmastoid air cells, more prominent on the left. Middle ear cavities are clear.\nThe visualized portion of the orbits are unremarkable.", + "output": "1. No acute large territory infarction or hemorrhage.\n2. Sinus and mastoid disease as described above." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, or loss of gray/\nwhite matter differentiation. The ventricles, sulci, and basal cisterns are\nnormal in size. The cerebellar tonsils are normally positioned. Sellar\ncontours are grossly unremarkable on noncontrast CT.\n\nNo suspicious bone lesion is seen. Partially visualized orbits appear\nunremarkable. There is a 2 mm osteoma in a right posterior ethmoid air cell. \nNo significant mucosal thickening or fluid is seen in the partially imaged\nparanasal sinuses. Middle ear cavities and mastoid air cells are clear.", + "output": "No evidence for acute intracranial abnormalities. Please note that MRI would\nbe significantly more sensitive for intracranial metastatic disease or other\nstructural sources of headaches, if clinically warranted." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "Study is moderately degraded due to motion artifact. Within limitations:\nThere is no evidence of acute large territorial infarction, intracranial\nhemorrhage, edema, or mass. There is prominence of the ventricles and sulci\nsuggestive of age-related cerebral volume loss. Periventricular and\nsubcortical white matter hypodensities are nonspecific, though likely sequelae\nof chronic small vessel ischemic disease. Atherosclerotic vascular\ncalcifications are noted of bilateral cavernous portions of internal carotid\narteries.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable. A left\nnasogastric tube is seen in situ.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "There is no evidence of acute large territorial infarction,intracranial\nhemorrhage,edema,or mass effect. There is prominence of the ventricles and\nsulci suggestive of involutional changes. Periventricular and subcortical\nwhite matter hypodensities are nonspecific, but likely reflective of chronic\nsmall vessel ischemic changes.\n\nThere is no evidence of fracture. Mild mucosal thickening of the ethmoid air\ncells. The visualized portion of the remaining paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. Status post bilateral lens\nreplacement. Mild atherosclerotic calcifications of the carotid siphons.", + "output": "No evidence of acute intracranial hemorrhage, large territorial infarct, or\nfractures." + }, + { + "input": "There is no evidence of acute major infarction,hemorrhage,edema,or discrete\nmass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mild mucosal wall thickening of\nthe right maxillary sinus. Otherwise the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are slightly prominent for the patient's age, suggesting mild\ncortical volume loss, however, this finding is nonspecific.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses and mastoid air cells are clear. Cerumen is present in the bilateral\nexternal auditory canals. There is a left eye prosthesis. Small right\noccipital scalp hematoma.", + "output": "1. No acute intracranial process.\n\n2. Slightly prominent ventricles and sulci for patient's age, suggesting\ncortical volume loss, this finding is nonspecific.\n\n3. Small right occipital scalp hematoma." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nlarge mass. Prominence of the ventricles and sulci is suggestive of\ninvolutional changes.\n\nNo fracture seen. There is mild mucosal thickening in the left anterior\nethmoid air cells. There is mild mucosal thickening in the anterior ethmoidal\nair cells and left frontal ethmoidal recess, otherwise, the paranasal sinuses,\nmastoid air cells, and middle ear cavities are otherwise clear. Left eye\nprosthesis is again seen and unchanged.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Prominence of\nthe ventricles and sulci is out of proportion to the patient's age and suggest\ninvolutional change.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. A left globe\nprosthesis is present. There is a small soft tissue hematoma overlying the\nleft posterior parietal bone. Again is noted left frontal scalp partially\ncalcified probable sebaceous cyst (see 2:60 and current study and 02:15 on\nprior exam). Soft tissue densities are noted within bilateral external\nauditory canals which may represent cerumen.", + "output": "1. No acute intracranial abnormality, with no evidence intracranial hemorrhage\nor fracture.\n2. Small left posterior parietal scalp soft tissue swelling.\n3. Left globe prosthesis.\n4. Grossly stable partially calcified left frontal scalp probable sebaceous\ncyst." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass effect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nSubtle stranding overlying the left occipital bone may reflect a small soft\ntissue contusion. Irregularity of the nasal bones is unchanged, reflecting\nprior fracture. No acute fracture. Subcutaneous punctate calcifications\noverlying the left frontal bone are unchanged. The visualized portion of the\nparanasal sinuses andmastoid air cells are clear. Debris in the bilateral\nexternal auditory canals likely reflects cerumen. A left globe prosthesis is\nagain noted.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nacute intracranial hemorrhage. No acute calvarial fracture.\n2. Global atrophy out of proportion to patient age is again noted.\n3. Subtle stranding overlying the left occipital bone may reflect a small soft\ntissue contusion." + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. There is no evidence of fracture. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. Left globe prosthesis is again noted. Debris in bilateral\nexternal auditory canals is present.", + "output": "1. No acute intracranial process.\n2. Global atrophy out of proportion to patient age is again noted." + }, + { + "input": "Study is limited due to artifact from dental amalgam, cervical fusion hardware\nand delayed image acquisition after contrast administration.\n\nCTA NECK:\nAtherosclerotic calcifications are noted at the aortic arch and proximal left\ncarotid subclavian artery without significant stenosis.\n\nThere is calcified plaque formation at the origin of the left common carotid\nartery without significant stenosis. There is mild atherosclerotic plaque\nformation at the left carotid bifurcation. There is mixed calcified and\nnoncalcified atherosclerotic plaque at the right carotid bifurcation. There\nis no evidence for internal carotid artery stenosis on either side by NASCET\ncriteria. There is no evidence of stenosis or dissection.\n\nThe bilateral vertebral artery origins are patent. Evaluation of the\nvertebral arteries is limited by suboptimal contrast bolus timing and motion\nartifact. Within these limitations, there is no evidence of high-grade\nstenosis or dissection within the vertebral arteries.\n\nOTHER:\nThe visualized portion of the lungs are clear. The thyroid gland appears\nsmall but otherwise unremarkable. There is no lymphadenopathy by CT size\ncriteria. A left chest implantable cardiac device is partially visualized.\n\nThe patient is status post anterior discectomy and cervical fusion of C3-C4\nwith fixation screw and plate hardware, which appears intact. There is\nmultilevel cervical spondylosis with osseous fusion of the vertebral bodies of\nC3 through C6.", + "output": "1. Limited study due to delayed image acquisition after contrast bolus. \nWithin these limitations:\n2. Atherosclerotic changes without evidence for vascular stenosis, dissection\nor aneurysm formation." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Age related involutional changes are noted. Ventriculomegaly is\nunchanged likely due to central involution. Mild small vessel disease noted. \nMastoid air cells and middle ear cavities are well aerated. Mild mucosal\nthickening within the ethmoidal air cells, otherwise the imaged paranasal\nsinuses are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are enlarged suggesting age related atrophy. \nPeriventricular and subcortical white matter hypodensities are nonspecific but\nlikely sequela of chronic small vessel disease.\n\nThere is mucosal thickening in the ethmoid air cells. The paranasal sinuses\nare otherwise clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. There is\nsymmetric calcification of the cavernous carotid arteries. The dural venous\nsinuses are patent. Note is made of a fetal type PCA on the left.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThere is biapical scarring. A 2 mm left apical micronodule (Series 5, image\n39), requires no specific followup. There are subcentimeter hypodense thyroid\nnodules on the left. There is no lymphadenopathy by CT size criteria.", + "output": "1. No acute intracranial process.\n2. Patent circle of ___ and cervical vessels.\n3. No narrowing of the internal carotid artery by NASCET criteria." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Prominent\nventricles and sulci is compatible with global atrophy. Periventricular and\nsubcortical white matter hypodensities are nonspecific, but likely reflect\nsequelae of chronic small vessel ischemic disease. The basal cisterns appear\npatent and there is preservation of gray-white matter differentiation.\n\nNo osseous abnormalities seen. A mucous retention cyst is seen within the\nleft ethmoid air cells. The remaining visualized paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. Heavy atherosclerotic\ncalcifications of the carotid siphons are noted. There has been no\nsignificant change.", + "output": "1. No evidence of acute intracranial process.\n\n2. Parenchymal atrophy and findings suggesting chronic small vessel ischemic\ndisease." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass.\nBilateral, symmetric prominence of the ventricles and sulci are overall\nsimilar the prior exam when accounting for differences in angulation and\nsuggest involutional changes. Prominence of the third ventricle and fourth\nventricle are also overall unchanged. No shift of normally midline\nstructures. The perimesencephalic cisterns are patent. Periventricular and\nsubcortical white matter hypodensities are nonspecific, likely reflecting\nsequelae of chronic small vessel ischemic disease in overall similar to the\nprior exam. Gray-white matter differentiation appears preserved. Dense\nvascular arteriosclerotic calcifications in the carotid siphons remain\nunchanged.\n\nNo evidence of fracture. Mucous retention cyst in the posterior left\nethmoidal air cell are overall unchanged. The remaining paranasal sinuses are\nclear. The mastoid air cells are clear. The external auditory canals are\nclear. The orbits are unremarkable.", + "output": "No acute intracranial process. No significant change from ___ head\nCT. Probable sequelae of chronic small vessel ischemic disease and age-related\natrophy. If high clinical concern of stroke, MRI is more sensitive for\ndetection of early stroke." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes, progressed compared to ___ prior exam. There are\nextensive periventricular and subcortical lucencies, which may represent small\nvessel ischemic changes. Atherosclerotic vascular calcifications are noted of\nbilateral vertebral and cavernous portions of internal carotid arteries.\n\nThere is no evidence of fracture. The visualized portion of the mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits demonstrate bilateral lens replacement postoperative changes. Left\nsphenoid sinus mucosal thickening is seen. Soft tissue densities are noted\nwithin bilateral external auditory canals which may represent cerumen.", + "output": "1. No acute intracranial abnormality. Please note MRI of the brain is more\nsensitive for the detection of acute infarct.\n2. Global cortical atrophy with extensive sequela of chronic microvascular\nischemic disease, progressed compared to ___ prior exam.\n3. Paranasal sinus disease , as described." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nlarge territorial infarction. The ventricles and sulci are normal in size and\nconfiguration. The basal cisterns appear patent and there is preservation of\ngray-white matter differentiation.\n\nThe visualized bony structures are grossly unremarkable. A large, left\nmaxillary mucous retention cyst is noted. The remainder of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are otherwise clear. Dense\natherosclerotic mural calcification of the bilateral vertebral and internal\ncarotid arteries is noted. A left globe prosthesis is noted. The right globe\nis unremarkable.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. Fetal origin\nof the right PCA is noted. A tiny 1 mm infundibulum is seen at the origin of\nleft posterior communicating artery. The dural venous sinuses are patent.\n\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nMild centrilobular and paraseptal emphysema is noted in bilateral lung apices.\nThe visualized portion of the thyroid gland is within normal limits. There is\nno lymphadenopathy.", + "output": "1. Major intracranial and cervical vessels are patent without stenosis." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The lateral\nventricles are slightly asymmetric. There is prominence of the ventricles and\nsulci suggestive of involutional changes. Periventricular white matter\nhypodensities are consistent with sequela of chronic small vessel ischemic\ndisease. An old right basal ganglia lacune is present.\n\nThere is no evidence of fracture. Mucosal thickening is noted in scattered\nanterior ethmoid air cells and fluid is seen in the right frontal sinus. The\nremaining visualized paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of hemorrhage\n2. No fracture" + }, + { + "input": "There is no acute hemorrhage, edema, mass effect, or loss gray/white matter\ndifferentiation. Ventricles, sulci, and basal cisterns are normal in size. \nThere is a left and midline parietal vertex subgaleal hematoma without\nevidence for a fracture. There is a small mucous retention cyst in the right\nsphenoid sinus. Other partially visualized paranasal sinuses and mastoid air\ncells are well aerated. Partially visualized orbits are unremarkable.", + "output": "No evidence for acute intracranial abnormalities." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction or midline shift.\nThere is no hydrocephalus. There is no edema. There is no fracture. The\npatient's previous trace parafalcine subdural hemorrhage has results.\n\nVisualized paranasal sinuses and mastoid air cells are clear.", + "output": "No evidence of acute intracranial process. Previous parafalcine subdural\nhematoma has resolved." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect. The\ngray-white matter interface is preserved without evidence of acute major\nvascular territorial infarct. The ventricles and sulci are normal in size for\nthe patient's age. The basal cisterns appear patent.\n\nNo concerning osseous lesions are seen. There are mucous retention cysts in\nthe bilateral maxillary sinuses. The remainder of the imaged paranasal\nsinuses, middle ear cavities and mastoid air cells are well aerated.", + "output": "No evidence of an acute intracranial abnormality." + }, + { + "input": "Small right frontal parafalcine subdural hematoma is again seen, unchanged\ncompared to the prior study. There is no parenchymal edema. Gray/ white\nmatter differentiation is preserved The ventricles are normal in size for age.\nThe basal cisterns appear patent.\n\nNo lytic or sclerotic bone lesions are seen. Opacification of the right Haller\ncell is again seen with associated osseous sclerosis, suggesting chronicity.\nThere are minimal secretions in the right sphenoid sinus, likely from\nprolonged supine positioning in the inpatient setting. Mastoid air cells are\nclear.", + "output": "1. Stable small right frontal parafalcine subdural hematoma.\n2. No evidence of mass effect or edema on noncontrast CT. MRI would be more\nsensitive for evaluation of lymphoma, if clinically indicated." + }, + { + "input": "There are several small nondisplaced fractures of the left occipital bone\n(3:6, 9, 13, 25), with a tiny 2 mm likely subdural hematoma adjacent to the\nleft cerebellar hemisphere (2:5). A small subgaleal hematoma overlying the\nleft occiput (3:44) is also present.\n\nThere is no evidence of large territorial infarction, edema, or mass. There\nis prominence of the ventricles and sulci suggestive of involutional changes.\nMild periventricular white matter hypodensities are nonspecific, but likely\nsequela of chronic small vessel ischemic disease.\nThere is\nbilateral maxillary mucosal thickening. The visualized portion of the\nremaining paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "Several small nondisplaced fractures of the left occipital bone, extending\nfrom the skull base superiorly. There is a tiny 2 mm likely subdural hematoma\nadjacent to the left cerebellar hemisphere (2:5). A small subgaleal hematoma\noverlies the left occiput, consistent with the clinical exam per report.\n\nNOTIFICATION: The above findings were communicated in person by Dr. ___\nto Dr. ___ surgery) at 09:45 on ___, 2 min after discovery.\n\nUpdated read regarding the 2 mm subdural hematoma was communicated via\ntelephone by Dr. ___ to Dr. ___ at 11:19 on ___, 2 min after\ndiscovery." + }, + { + "input": "The earlier described 2 mm likely subdural hematoma adjacent to the left\ncerebellar hemisphere is not as conspicuous on the current study. There is no\nevidence of new acute intracranial hemorrhage, large vascular territorial\ninfarction, edema, or mass. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. Mild periventricular white matter\nhypodensities are nonspecific, but likely sequela of chronic small vessel\nischemic disease.\n\nRe- demonstration of the previously described several small nondisplaced\nfractures of the left occipital bone, with a small overlying subgaleal\nhematoma (3:43). Bilateral maxillary sinus mucosal thickening is unchanged. \nThe visualized portion of the remaining paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. The previously described 2 mm likely subdural hematoma adjacent to the\nleft cerebellar hemisphere is not as conspicuous on the current head CT. \nTherefore, it has likely not enlarged.\n\n2. No evidence of new intracranial hemorrhage or other acute intracranial\nprocess since the earlier head CT.\n\n3. Re demonstration of the known left occipital fractures." + }, + { + "input": "Common origin of the brachiocephalic trunk and the left common carotid artery,\na developmental variant. The visualized aortic arch and origins of the great\nvessels are otherwise unremarkable.\n\nThe right common, internal and external carotid arteries are normal in\nappearance. There is no evidence of a significant stenosis by NASCET criteria\nor a dissection.\n\nThe left common, internal and external carotid arteries are normal in\nappearance. There is no evidence of a significant stenosis by NASCET criteria\nor a dissection.\nLeft distal cervical internal carotid artery is tortuous in course.\n\nThe cervical portions of the vertebral arteries demonstrate normal\nenhancement. The left vertebral artery is dominant. The right vertebral\nartery is very diminutive after the origin of the right posterior inferior\ncerebellar artery. There is no evidence of a stenosis or a dissection.\nThere is a left fetal equivalent posterior cerebral artery.\n\nCT neck: The thyroid gland is normal. The salivary glands are normal.\nA few small nodes are noted in both sides of the neck, some of which are\nmildly prominent left level 2 however not abnormally enlarged by size\ncriteria.\nNo significant lymphadenopathy is appreciated.\nLimited evaluation of the structures at the level of the mandible, due to\ndental artifacts.\n\nThere is mucosal thickening of the visualized paranasal sinuses.\nThe mastoid air cells and tympanic cavities are clear.\nThere are bilateral mandibular screws.\nThere is degenerative disc disease of the cervical spine with disc space\nnarrowing and osteophytosis at C5-6, C6-7, and C7-T1.\nThe visualized included upper lungs are clear; scattered emphysematous\nchanges.", + "output": "CTA NECK:\nPatent vasculature of the neck, without significant stenosis (by NASCET\ncriteria), dissection, or aneurysm.\nHead not completely included.\nMucosal thickening in the ethmoid, sphenoid, maxillary sinuses included.\nDegenerative changes in the cervical spine with mild to moderate canal and\nforaminal narrowing." + }, + { + "input": "The patient is status post left frontal craniotomy for tumor resection, with\nexpected postsurgical changes in the resection bed with pneumocephalus and\nsmall amount of surrounding hyperdensity, likely postoperative blood. \nHypodensity surrounding the surgical bed is indicative of edema, either from\nthe tumor or the post resection changes. There is no major territorial\ninfarct or other focus of intracranial hemorrhage.\nPost craniotomy changes are noted of the scalp and posterior aspect of the\nleft frontal bone.\n\nImaged paranasal sinuses are clear. The orbits are normal.", + "output": "Status post left frontal craniotomy for tumor resection with expected\npostoperative changes in the scalp as well as in the resection bed, containing\na small amount of pneumocephalus and blood." + }, + { + "input": "The patient is status post left occipital craniotomy and tumor resection with\nexpected postoperative changes, including pneumocephalus and fluid layering\nalong the resection cavity. The adjacent degree of white matter edema appear\nsimilar to the preoperative brain MRI dated ___.\n\nThere is no evidence for an intracranial hemorrhage, mass effect, or midline\nshift. The ventricles and sulci are normal in size and configuration. The\nbasal cisterns remain patent.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "Expected postoperative appearance status post left occipital craniotomy and\ntumor section, without evidence of intracranial hemorrhage." + }, + { + "input": "There are multiple hyperdense regions suggestive of hemorrhagic metastases:\n- left parietal lobe lesion (2:24) measures 1.7 cm\n- right parietal lesion (2:18) measures 1.8 cm\n- left thalamus lesion (2:14) measures 1.3 cm\n- right insular lesion (2:13) measures 1.3 cm\nThese are surrounded by confluent regions of hypodensity suggestive of\nvasogenic edema. There is no significant mass effect.\nAdditional enhancing lesions seen on prior MRI are not clearly delineated on\nthe CT, specifically in the left frontal lobe.\n There is no evidence of fracture. The ventricles and sulci are normal in\nsize and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "Multiple hyperdense lesions compatible with known hemorrhagic metastases. \nThese are overall similar in appearance in comparison to MR of the brain from\n___. No definite new lesion noting MRI would be more sensitive\nfor detection." + }, + { + "input": "Again seen are multiple hyperdense lesions that are suggestive of hemorrhagic\nmetastases, as detailed below. Additional smaller metastases seen on the\nrecent MRI are not appreciated on noncontrast CT.\n\nLeft parietal lesion (5; 23) measuring 1.6 cm in diameter, unchanged compared\nto prior.\nRight parietal lesion (5; 19) measuring 1.9 cm in diameter, unchanged compared\nto prior.\nLeft thalamus lesion (5; 14) measuring 1.4 cm in diameter, unchanged compared\nto prior.\nRight insular lesion (5; 15) measuring 1.3 cm in diameter, unchanged compared\nto prior.\n\nThe bilateral parietal and right insular lesions are associated with vasogenic\nedema, but there is no significant sulcal effacement, no shift of midline\nstructures, and no effacement of the ventricles. There is no significant\nedema associated with the left thalamic lesion. Basal cisterns are preserved.\n\nNo evidence for new intracranial hemorrhage or new mass effect.\n\nNo evidence for suspicious lytic or sclerotic bone lesions. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear\ncavitiesare well aerated. Unremarkable.", + "output": "1. Stable hemorrhagic metastases compared to the CT from ___,\nwith stable mild edema, but no shift of midline structures, and no ventricular\nsulcal effacement. Additional smaller metastases seen on the MRI from ___ are not appreciated on noncontrast CT.\n2. No evidence of new intracranial hemorrhage or new mass effect." + }, + { + "input": "Study is mildly degraded by motion. There is no evidence of infarction,\nhemorrhage, edema, or mass. The ventricles and sulci are normal in size and\nconfiguration.\nThere is no evidence of fracture. There is mucosal thickening in the ethmoid\nair cells, maxillary sinuses and sphenoid sinuses. The visualized mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. Study is mildly degraded by motion.\n2. Within limits of study, no intracranial hemorrhage.\n3. Paranasal sinus disease as described." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. Multiple small bilateral palatine tonsilliths. Mild mucosal\nthickening involving the inferior aspects of the maxillary sinuses the thyroid\ngland appears normal. There is no lymphadenopathy by CT criteria. The neck\nvessels are patent. Periapical lucency posterior most right mandibular molar,\nmay represent extension of periodontal disease or subclinical periapical\ninfection, there is surrounding sclerosing osteitis. Dental cavities.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules, but reference is made to CT chest done on the same\nday.There are no osseous lesions. Right Port-A-Cath in place.", + "output": "1. No adenopathy or metastatic disease.\n2. Periapical lucency right mandibular molar, may represent extension of\nperiodontal disease or periapical subclinical infection. Clinically\ncorrelate." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\n\nThere is trace acute subarachnoid hemorrhage within a sulcus of the medial\nsurface of the left superior frontal gyrus and within the left central sulcus\n(image 3:38), similar to the head CT acquired earlier the same date. No new\nhemorrhage.\n\nThere is chronic infarct within the left middle frontal gyrus, in the expected\nlocation of the left ACA-MCA border zone. The adjacent small acute to early\nsubacute infarct in the left centrum semiovale is faintly visualized, better\nseen on the prior MRI. There is also chronic lacunar infarct within the head\nof the right caudate nucleus. Ventricles and sulci are age-appropriate.\n\nThere is a small mucous retention cyst in the right maxillary sinus. Mastoid\nair cells are well aerated. The orbits are unremarkable.\n\nCTA NECK:\n\nThe carotid and vertebral arteries and their major branches appear widely\npatent with no evidence of flow-limiting stenosis. There is specifically no\nevidence of internal carotid stenosis by NASCET criteria.\n\nCTA HEAD:\n\nThere is minimal atherosclerotic plaque within the carotid siphons without\nstenosis. No other evidence for flow-limiting stenosis in the major\nintracranial arteries. There is fetal origin of the right posterior cerebral\nartery. No aneurysm is identified. Dural venous sinuses appear patent.\n\n\nOTHER:\n\nThere is a 2 cm air and debris filled outpouching anterolateral to the left\nside of the cervical esophagus just below the cricopharyngeus muscle. This is\nmost consistent with ___ diverticulum. The thyroid is grossly\nunremarkable. Evaluation of the included upper lungs is limited by\nrespiratory motion artifact, with some degree of associated air trapping. \nMild emphysema cannot be excluded. Degenerative changes are noted in the\ncervical spine.", + "output": "1. Stable mild left frontal and left central sulcus subarachnoid hemorrhage. \nNo new hemorrhage.\n2. Chronic left frontal and right caudate head infarcts. Small acute to early\nsubacute left frontal and superior parietal infarct are better seen on the\npreceding MRI.\n3. No flow-limiting stenosis in the major intracranial or cervical arteries.\n4. 2 ___ esophageal diverticulum." + }, + { + "input": "Evaluation of the soft tissue structures is limited in the absence of\nintravenous contrast.\n\nNasopharyngeal soft tissue contours are grossly unremarkable on noncontrast\nCT. Bilateral palatine tonsilliths are likely sequela of prior infections. \nMotion artifact limits evaluation of the epiglottis and vocal cord area, but\nno gross abnormalities seen. There is no narrowing of the cervical airway.\n\nSalivary glands appear grossly unremarkable on noncontrast CT.\n\nLarge heterogenous mass with calcifications , extending from the left thyroid\nlobe into the mediastinum, is again seen, as demonstrated on the recent ___ chest CT. The upper thoracic trachea is deviated to the right. \nThere is a stent in the upper thoracic trachea, new since ___,\nwhich terminates approximately 3 cm above the carina. There is mild\ncircumferential soft tissue density within the mid to distal portions of the\nstent, but tracheal compression the level of the stent has decreased compared\nto ___.\n\nCalcifications are present in the aortic arch and proximal visualized\ndescending aorta, as well as at the common carotid artery bifurcations and in\nthe carotid siphons.\n\nVisualized lung parenchyma is better assessed on the concurrent chest CT. \nSevere centrilobular emphysema is again seen in the included upper lobes.\n\nThis exam is not technically optimized for evaluation of the included brain\nparenchyma. No concerning abnormality is seen on limited assessment. \nPartially visualized orbits are unremarkable. Partially visualized paranasal\nsinuses are grossly well-aerated. Mild bilateral mucosal thickening in the\nmastoid air cells cannot be excluded, but evaluation is limited in the absence\nof dedicated bone algorithm images.\n\nThere are degenerative changes in the cervical spine.", + "output": "1. Evaluation of the cervical soft tissues is limited in the absence of\nintravenous contrast, as well as by motion artifact at the level of the\nepiglottis and vocal cords. No tracheal narrowing or other concerning\nabnormalities are seen in the neck.\n2. Large heterogenous mass with calcifications is again seen extending from\nthe left thyroid lobe into the mediastinum, with rightward tracheal\ndisplacement. The stent in the upper thoracic trachea terminates\napproximately 3 cm above the carina. There is mild circumferential soft\ntissue density within the mid to distal portions of the stent, but tracheal\ncompression of the level of the stent has decreased compared to ___." + }, + { + "input": "Patient remains intubated with the tip of the ETT seen approximately 1.6 cm\nabove the carina, for which retraction is required for optimal positioning. \nThe ETT remains patent without evidence of occlusion or stenosis. A small\namount of fluid is seen adjacent to the ETT and tracks along the course in the\nproximal to mid trachea. The soft tissues surrounding the ETT as well as the\nbase of the tongue appears edematous. There is no evidence of an enhancing\nloculated fluid collection concerning for abscess formation. An oral catheter\nis seen in the esophagus and continues out of view.\n\nPostsurgical changes following a left thyroidectomy on ___ are noted,\nincluding subcutaneous emphysema, surgical clips, and locules of air in the\npostsurgical resection bed. Postoperative fluid/seroma measuring\napproximately 3.0 x 3.3 x 8.2 cm (AP, TRV, SI ; series 2, image 64)) is noted\ntracking superiorly and inferiorly along the postsurgical bed along the left\naspect of the trachea, which can be expected in the postsurgical setting\nsetting (series 601b: Image 36). While this fluid collection exerts mild\nrightward mass effect on the airway, this is significantly improved from prior\nexamination.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding.A subcentimeter hypodensity is noted in the right thyroid lobe. \nThere is no lymphadenopathy by CT criteria. The neck vessels are patent. Mild\nmucosal thickening is noted in the left sphenoid sinus. The remaining\nvisualized paranasal sinuses and mastoid air cells appear clear.\n\nSignificant emphysematous changes are seen throughout the bilateral lung\napices. There are new left upper lobe pulmonary nodules, not seen on\nexamination of 2 days prior, presumably infectious or consolidative nature. \nThere is also a left-greater-than-right pleural effusion with associated\ncompressive atelectasis of the left lower lobe apex. Atherosclerotic\ncalcifications are seen in the aortic arch, the origin of the right vertebral\nartery, the bifurcations of the bilateral carotid arteries, and bilateral\ncarotid siphons. Mild-to-moderate degenerative changes are seen in the\ncervical spine.", + "output": "1. Postsurgical changes following a left thyroidectomy are noted with 3.0 x\n3.3 x 8.2 cm postoperative fluid/seroma seen tracking inferiorly and\nsuperiorly along the aspect of the trachea, not unexpected in the postsurgical\nsetting. There is improved but residual rightward mass effect on the airway.\n2. Patient remains intubated with the tip of the ETT seen approximately 1.6 cm\nabove the carina. A small amount of fluid is seen adjacent to the ETT which\ntracks along the course in the proximal to mid trachea.\n3. The soft tissues surrounding the ETT as well as a base of tongue appears\nedematous.\n4. There is left greater than right pleural effusion with associated\ncompressive atelectasis of the visualized left lower lobe apex. Correlation\nwith patient's symptoms is recommended. Please refer to concurrent CT chest\nfor additional details.\n\nRECOMMENDATION(S): Recommend retraction of the ETT for optimal positioning." + }, + { + "input": "Patient is status post partial left thyroidectomy, and compared with ___, the patient has undergone interval tracheostomy. There has\nbeen interval decrease in size of a postsurgical fluid collection in the left\nthyroid bed, measuring approximately 4.5 cm x 3.3 x 2.3 cm, compared with 6.7\ncm x 3.3 x 3.0 cm previously, with interval decrease in associated mass effect\non the airway (2:80), and decreased extent of air bubbles within fluid\ncollection.\nThere is symmetric mild mucosa thickening of base of the epiglottis,\naryepiglottic folds, extending into the true and false vocal cords, with\nresultant significant narrowing of the glottis series 2, image 65, making\nevaluation of vocal cord paralysis difficult. There is no definite asymmetry\nat the level of the true vocal cords. There is no definite medial dislocation\nof the arytenoid cartilage. There is stable heterogeneous appearance of the\nright thyroid lobe.\n\nThere is no lymphadenopathy by CT criteria.\n\nAn enteric tube is present in the esophagus, the distal tip of which is not\nvisualized. There are mild tracheal, mainstem bronchi secretions, and minimal\nmucous plugging in bilateral upper lobe distal bronchi. . There is moderate\ncentrilobular emphysema. Previously seen biapical lung nodules have improved.\nThere is extensive calcification of the aortic arch. There are multilevel\ndegenerative changes in the cervical spine. There are no suspicious osseous\nlesions.", + "output": "1. Interval decrease in size of a left thyroid bed postsurgical fluid\ncollection, with interval decrease in associated mass effect on the airway.\n2. There is laryngeal edema resulting in significant airway narrowing, no\ndefinite evidence of vocal cord paralysis.\n3. Improved upper lung nodules. Moderate centrilobular lung emphysema." + }, + { + "input": "There is no evidence of large territory infarction,hemorrhage,edema, or mass\neffect. The ventricles and sulci are age-appropriate.\n\nThere is no evidence of fracture. However, in the mid clivus is a sclerotic\nbony lesion that measures 0.7 x 0.7 cm that may represent a bone island, and\nappears nonaggressive. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "No acute intracranial process.\nNo hydrocephalus." + }, + { + "input": "There is no evidence of acute large territory infarction,\nintracranialhemorrhage,edema,or discrete mass. Right temporal\nencephalomalacia is unchanged compared to prior exam, likely representing\nsequela of prior infarction or trauma. There is prominence of the ventricles\nand sulci suggestive of involutional changes. Periventricular and subcortical\nhypodensities are nonspecific but compatible with chronic small vessel\ndisease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Patient is\nstatus post bilateral lens replacements.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Normal study." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,or\ndefinite mass. Age related involutional changes are noted though there is\ndisproportionate atrophy of the cerebellum.\n\nThere is no acute fracture. There is rightward deviation of the nasal septum.\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavitiesare well aerated. The visualized portion of the orbits are\nunremarkable. Skin staples are noted at the vertex with mild underlying soft\ntissue swelling.", + "output": "No acute intracranial abnormality." + }, + { + "input": "Motion artifact degrades image quality and limits evaluation. Within this\nlimitation, there is no evidence of large territorial infarction,acute\nintracranial hemorrhage,edema, or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Motion artifact degrades image quality and limits evaluation. Within this\nlimitation, no acute intracranial hemorrhage or other acute process\nidentified." + }, + { + "input": "There is small volume subarachnoid hemorrhage along the floor of the anterior\ncranial fossa medially, extending to the expected location of the A-comm. \nThere are moderate to severe chronic small vessel ischemic changes. Mild\ngeneralized brain parenchymal atrophy.\nThere is no evidence of acute infarction,edema,or mass. Arterial\ncalcifications.\nSmall area of soft tissue swelling and possible aeration left occipital\nscalp.. No fracture.\nMild mucosal thickening paranasal sinuses. Otherwise, the visualized portion\nof the paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.. Periodontal\ndisease.", + "output": "Small volume subarachnoid hemorrhage floor of the anterior cranial fossa\nextending to the level of A-comm. Findings are likely posttraumatic. \nConsider MRA brain without contrast if indicated - there is no reason to do\nvascular imaging of the neck in this case.\nModerate to severe chronic small vessel ischemic changes.\n\nNOTIFICATION: Changes to preliminary impression was discussed with with\n___, M.D. by ___, M.D. on the telephone on ___ at\n7:26 am, 5 minutes after discovery of the findings." + }, + { + "input": "A small amount of subarachnoid hemorrhage along the medial floor of the\nanterior cranial fossa appears less prominent. There is trace layering\nhemorrhage in the bilateral occipital horns of the lateral ventricles which\nappears new from prior (2:12, 2:13). There is no evidence of midline shift. \nNo hydrocephalus.\n\nThe ventricles and sulci are prominent compatible with involutional changes,\nbut stable in size and configuration from prior exam. Extensive\nperiventricular and subcortical white matter hypodensities appear overall\nunchanged from prior, nonspecific, but may reflect chronic small vessel\nischemic changes.\n\nSimilar appearance of radiodense staples overlying the left occiput with trace\nadjacent soft tissue edema. No acute fracture seen. The paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "1. Less prominent anterior cranial fossa subarachnoid hemorrhage.\n2. New trace bilateral interventricular hemorrhage, likely from\nredistribution.\n3. No evidence of hydrocephalus." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are mildly enlarged, compatible with age related atrophic\nchanges. Periventricular and subcortical white matter hypodensities are\nnoted, likely the sequelae of chronic small vessel ischemic disease. A right\ncerebellopontine angle arachnoid cyst is unchanged from the prior examination.\nThe basal cisterns remain patent. There is preservation of gray-white matter\ndifferentiation.\n\nNo fractures identified. Left temporomandibular joint degenerative changes\nare seen again. Dense material within the bilateral external artery canals\nlikely represent cerumen. Calcifications are seen within the bilateral\ncavernous carotid arteries and distal right vertebral artery. The paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable. A calcified sebaceous cyst is again noted within the left\nposterior scalp, near the vertex.", + "output": "No evidence for acute intracranial process." + }, + { + "input": "There is no acute intracranial hemorrhage, acute large vascular territorial\ninfarct, or brain edema. Gray-white differentiation is preserved. The basal\ncisterns are patent. There is no shift of normally midline structures. Mild\nprominence of the ventricles and sulci is compatible with age related\ninvolutional change. The visualized paranasal sinuses and mastoid air cells\nare clear. Atherosclerotic mural calcification is noted in the bilateral\nintracranial carotid arteries in the distal left intracranial vertebral\nartery. The globes and bony orbits are intact. There is no acute fracture.", + "output": "No acute intracranial process." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Prominence of the ventricles and sulci suggest involutional\nchanges. The imaged paranasal sinuses are clear. Mastoid air cells and\nmiddle ear cavities are well aerated. The bony calvarium is intact.", + "output": "There is no evidence of acute intracranial process or hemorrhage." + }, + { + "input": "There is a normal 3 vessel branching pattern of the aortic arch. The carotid\nand vertebral arteries and their major branches are patent with no evidence of\nstenoses. There is no evidence of dissection.\n\nThe lung apices are clear. The thyroid gland is normal. There is no\nlymphadenopathy in the neck.\n\nA periapical lucency, involving the socket of the right maxillary third molar,\nextends into the inferior maxillary sinus.", + "output": "1. No evidence of dissection. Normal CTA of the neck.\n2. Periapical cyst of the right maxillary third molar." + }, + { + "input": "There is marked prominence of the lingual and palatine tonsils notable for\nage. Additionally, there is abnormal fat stranding and some mild pharyngeal\nwall thickening along the right side extending between the right palatine and\nright lingual tonsils. There is a small fluid collection in the right\npharyngeal wall within the right lower palatine tonsil seen best on series 3,\nimage 84 measuring 1.1 x 1.5 x 1.4 cm concerning for small abscess. The\nairway remains open. There is minimal edema in the retropharyngeal space. No\nextension to the mediastinum. Multiple prominent right-sided cervical lymph\nnodes are seen including a right cervical level 2 a lymph node which measures\nup to 1.0 cm. Additional scattered cervical lymph nodes are somewhat\nprominent but not pathologically enlarged, likely reactive. The vocal folds\nlook mildly thickened, probably reactive.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding.There is a 1.1 cm hypoattenuating nodule in the right thyroid lobe.\nThe neck vessels are patent.\n\nThe imaged portion of the lung apices are clear without focal consolidation. \nThere are to 6 mm right upper lobe pulmonary nodules (series 3:209, 193).There\nare no suspicious osseous lesion. There is mild to moderate cervical\nspondylosis.", + "output": "1. Prominence of the palatine and lingual tonsils with abnormal thickening of\nthe right pharyngeal wall and small intra tonsillar abscess involving the\nright lower palatine tonsil with collection measuring 1.1 x 1.5 x 1.4 cm. \nOverall appearance could reflect tonsillitis with small abscess though given\nassociated prominent lymph nodes, a malignant process cannot be excluded. \nFollow-up to resolution is strongly advised.\n2. Two 6 mm pulmonary nodules. In the absence of known malignancy, please see\nrecommendation below.\n3. 1.1 cm right thyroid lobe nodule. No dedicated imaging follow-up is needed.\n\nRECOMMENDATION(S): Follow-up to resolution of the right parapharyngeal\nsuspected abscess, given that underlying mass is not entirely excluded.\n\nFor incidentally detected solid pulmonary nodules measuring 6 to 8 mm, a CT\nfollow-up in 6 to 12 months is recommended in a low-risk patient, optionally\nfollowed by a CT in ___ months. In a high-risk patient, a CT follow-up in 6\nto 12 months, and a CT in ___ months is recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___\n\n Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "Previously administered contrast limits evaluation for hemorrhage. Asymmetric\nhyperdensities along the sulci in the right frontoparietal and left\nparieto-occipital lobes may represent subarachnoid hemorrhage versus meningeal\nenhancement concerning for infection. Periventricular white matter\nhypodensities are nonspecific, but likely reflect sequelae of chronic small\nvessel ischemic disease. Prominence of the ventricles and sulci suggest\ninvolutional changes, in particular prominent sulci are noted at the vertex\nbilaterally. Hypodensity in the right occipital lobe likely represents\nchronic infarct (___). The imaged paranasal sinuses are clear. Mastoid air\ncells and middle ear cavities are well aerated. The bony calvarium is intact.", + "output": "Previously administered contrast limits evaluation for hemorrhage. Asymmetric\nhyperdensities along the sulci in the right frontoparietal and left\nparieto-occipital lobes may represent subarachnoid hemorrhage versus meningeal\nenhancement concerning for infection.\n\nRECOMMENDATION(S): MRI head with and without contrast.\n\nNOTIFICATION: The findings were discussed with ___, N.P. by\n___, M.D. on the telephone on ___ at 10:08 pm, 2 minutes\nafter discovery of the findings." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. There is 5 mm\ncerebellar tonsillar ectopia, with mild crowding at foramen magnum, findings\nmay represent carry 1 malformation versus developmental variant. Rounded,\nnormal tonsillar tip configuration.\n\nThere is no evidence of fracture. There is complete opacification of the\nright sphenoid sinus, mild mucosal thickening left sphenoid sinus. Right\nsphenoid sinus has central high density components, without calcification,\nwhich may be from inspissated secretions, allergic fungal sinusitis, or blood\nproducts. Otherwise, the remainder of suboptimally visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear on CT\nimages, although, scout radiograph has suggestion of right maxillary sinus\ndisease. The visualized portion of the orbits are unremarkable.", + "output": "1. 5 mm cerebellar tonsillar ectopia, developmental variant versus Chiari 1\nmalformation..\n2. Significant opacification of the sphenoid sinus, with central high density\ncomponents which may be from inspissated secretions, allergic fungal\nsinusitis, or blood products.\n\nRECOMMENDATION(S): Further evaluation of the paranasal sinuses, clinically or\nby CT paranasal sinuses.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 08:40 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThere is diffuse enlargement of the left parotid gland, particularly affecting\nthe parotid tail, with adjacent soft tissue stranding and small amount of\nfluid, compatible with acute parotitis. No obstructing stone or ductal\ndilation is identified. There is no rim enhancing fluid collection to suggest\nabscess formation, noting some limitation from dental amalgam at the level of\nmaximum inflammation. The other salivary glands are within normal limits. \nThere is some stranding seen superficial to the left-sided mandibular gland\ntracking inferiorly as well. The thyroid appears normal. There is no\nlymphadenopathy by CT criteria. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions. Minimal mucosal thickening\nof the right maxillary sinuses noted.", + "output": "Acute left parotitis without abscess formation." + }, + { + "input": "Approximately 3.9 x 2.8 cm parenchymal hemorrhage centered in the right\nthalamus appears stable in size with stable surrounding edema. \nIntraventricular extension of hemorrhage also does not appear significantly\nchanged, with a large amount of blood in the right lateral ventricle, moderate\nblood in the left lateral ventricle near the foramina of ___, small amount\nof blood in the left occipital horn, and large amount of blood filling the\nthird and fourth ventricles, with extension into the foramina of Magendie and\nforamina of Luschka. Dilatation of the occipital and temporal horns of the\nlateral ventricles, and of the atrium of left lateral ventricle, is stable in\nextent.\n\nBasal cisterns are not compressed. Cerebellar tonsils are normally positioned\nwithout effacement of CSF in the foramen magnum. Baseline size of cerebral\nsulci is not known, but they are not fully effaced. There is unchanged slight\nleftward displacement of the third ventricle, but no shift of the septum\npellucidum, falx cerebri, or other midline structures.\n\nThere is trace fluid in the left sphenoid sinus, which may be secondary to\nprolonged supine positioning in the inpatient setting. Mastoid air cells\nappear grossly well-aerated. There is evidence of bilateral cataract surgery.\nNo suspicious bone lesion is seen.", + "output": "-Stable parenchymal hematoma centered in the right thalamus with stable edema.\n-Stable large-volume intraventricular extension of hemorrhage.\n-Stable mild enlargement of the temporal and occipital horns of lateral\nventricles." + }, + { + "input": "Stable 3.6 x 2.2 cm parenchymal hemorrhage centered in the right thalamus with\nintraventricular extension. There is a slight redistribution of the\nhemorrhage, without change in the ventricular size. Blood is no longer seen\nin the aqueduct and the amount of blood in the fourth ventricle has slightly\ndecreased. Unchanged surrounding edema. There is dilation of the ventricles\nbilaterally as before, with unchanged prominence of the temporal dimple\nbilaterally. No enhancing lesion is identified.\nStable bilateral cerebellar hypodensities are again seen, likely representing\nold infarcts.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Stable right thalamus hemorrhage with slight redistribution of the blood.\n2. Stable dilation of the ventricles bilaterally.\n3. No enhancing lesion is identified." + }, + { + "input": "The right-sided thalamic hemorrhage has considerably evolved. Small amount of\nblood products and surrounding hypodensities due to edema seen. \nIntraventricular blood products have considerably decreased. Ventricles\nremain prominent including temporal horns but unchanged compared to the prior\nstudy. No new areas of hemorrhage are seen.", + "output": "1. Decrease in size and evolution of the blood products in the right thalamic\nregion. Evolution of blood products in the ventricles.\n2. Unchanged ventriculomegaly." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nNo significant change in the intraparenchymal hemorrhage centered at the right\nthalamus with significant intraventricular extension. Hyperdense blood\nproducts are present within the right greater than left lateral ventricles,\nthird ventricle and fourth ventricle. There is a small amount of vasogenic\nedema surrounding the right basal ganglia. There is associated mild\nenlargement of the ventricular system, which may in part relate to age-related\ninvolutional changes. Mild-to-moderate patchy periventricular white matter\nhypoattenuation is compatible with small vessel disease given the patient's\nage. There is no midline shift or large territorial infarct.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere are atherosclerotic calcifications of the carotid siphons. The right\nACA A1 segment is hypoplastic, likely congenital. The bilateral PCAs have\npersistent fetal origins. The remaining vessels of the circle of ___ and\ntheir principal intracranial branches appear normal without stenosis,\nocclusion, or aneurysm formation. The dural venous sinuses are patent. Focal\nstenosis in the V4 segment of the left vertebral artery is likely\natherosclerotic in etiology.\n\nCTA NECK:\nThere are atherosclerotic calcifications of the bilateral carotid bifurcations\n(left greater than right). There are atherosclerotic calcifications of the\norigins of the vertebral arteries with likely mild vessel narrowing on the\nright. The carotid and vertebral arteries and their major branches appear\notherwise normal with no evidence of stenosis or occlusion. There is no\nevidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThere is moderate paraseptal and centrilobular the emphysema. Patchy\nground-glass attenuation of the posterosuperior right upper lobe is\nnonspecific but may represent atelectasis versus areas of\ninfection/inflammation. A small amount of debris within the posterior trachea\nlikely represents aspirated material. The visualized portion of the thyroid\ngland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No significant change in the intraparenchymal hemorrhage centered at the\nright thalamus with significant intraventricular extension. Hemorrhage\netiology is likely hypertensive. No evidence for an arteriovenous\nmalformation.\n2. Mild associated enlargement of the ventricular system may in part relate to\nage-related involutional changes.\n3. Mild-to-moderate patchy periventricular white matter hypoattenuation is\ncompatible with small vessel disease given the patient's age.\n4. The patchy ground-glass attenuation of the posterosuperior right upper lobe\nis nonspecific and may represent atelectasis versus areas of\ninfection/inflammation." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nthere is a subgaleal hematoma at the right posterior vertex. No intra-axial\nor extra-axial hemorrhage, edema, shift of normally midline structures, or\nevidence of acute major vascular territorial infarction. There is diffuse\nperiventricular and subcortical white matter hypodensity which is concerning\nfor severe small vessel disease. Ventricles are normal in size. Age related\ninvolutional changes are noted. Imaged paranasal sinuses appear clear aside\nfrom mild mucosal thickening. The mastoid air cells and middle ear cavities\nare clear. The bony calvarium is intact.", + "output": "1. No intracranial hemorrhage.\n2. No fracture. Right posterior scalp vertex subgaleal hematoma.\n3. Significant microvascular ischemic disease." + }, + { + "input": "Left :\nPorous acusticus is mildly widened. Otherwise normal exam. Normal left EAC,\nmiddle ear, ossicles, semicircular canals, vestibule, cochlea, artery capsule.\nNo osseous erosions or hyperostosis adjacent to the tumor. Normal mastoid air\ncells.\n\nRight:\nNormal exam. Normal left EAC, middle ear, ossicles, semicircular canals,\nvestibule, cochlea, artery capsule. No osseous erosions. Normal mastoid air\ncells.\n\nOther:\nKnown left cerebellopontine angle mass is again seen, measures 2.1 x 1.9 cm\nwith local mass effect on middle cerebellar peduncle, cerebellum, brainstem,\nconsistent with vestibular schwannoma.. On prior MR, tumor was seen to extend\ninto the medial IAC, superiorly displaces cisternal segment fifth cranial\nnerve superiorly, and abutting superior, medial cisternal segments cranial\nnerve 9, 10. No osseous destruction at the jugular foramen pars vascularis or\nnervosa. The fourth ventricle is slightly effaced by the mass at its inferior\naspect.", + "output": "1. Findings consistent with left vestibular schwannoma. Local mass effect. \nOn comparison MR, there is displacement of cisternal segment CN 5, contact of\ncisternal segments CN 9, 10.\n2. No osseous involvement.\n3. Otherwise normal temporal bones." + }, + { + "input": "As seen previously, patient is status post left suboccipital craniectomy for\nprior resection of left CP angle cistern mass. Small amount of fluid seen\noverlying the craniectomy site in the overlying subcutaneous soft tissues,\nsimilar to prior.\n\nThe left transverse sinus appears higher in density than that of the right. \nThough size differences may account for some of this finding, the possibility\nof an underlying thrombosis is of concern as the density is higher in the left\ntransverse sinus when compared to the superior sagittal sinus.\n\nThere is no intra-axial or extra-axial hemorrhage, mass effect, midline shift,\nor acute major vascular territorial infarct. Gray-white matter differentiation\nis preserved. Ventricles and sulci are unremarkable. Basilar cisterns are\npatent.\n\nIncluded paranasal sinuses and mastoids are essentially clear besides mild\nmucosal thickening in the right maxillary sinus. Skull and extracranial soft\ntissues are otherwise unremarkable.", + "output": "Relative high density of the left transverse sinus concerning for dural venous\nsinus thrombosis though further evaluation with either CTV or MRI brain with\ncontrast is suggested to confirm.\n\nNOTIFICATION: The findings were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 10:13 am, 3 minutes after\ndiscovery of the findings." + }, + { + "input": "Redemonstration of dural venous sinus thrombosis of the left transverse sinus,\nnot significantly changed in attenuation and size since prior CT. There is no\nevidence of acute large territorial infarction,hemorrhage,edema,or unexpected\nmass effect. The ventricles and sulci are within expected limits in size and\nconfiguration.\n\nPostsurgical bony changes are again seen within the left occipital calvarium\nwith small amount of fluid within the overlying soft tissues.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Unchanged appearance of left transverse sinus to internal jugular vein\nthrombus within CT technique since prior exam.\n2. No evidence of acute large territory infarct or intracranial hemorrhage.\n3. Additional findings described above." + }, + { + "input": "Again seen is hyperdensity in the left transverse sinus extending into the\nleft internal jugular vein compatible with dural venous sinus thrombosis, not\nsignificantly changed.\n\nNo evidence of acute infarct or intracranial hemorrhage.\n\nThe ventricles and sulci are normal in size and configuration.\n\nAgain seen are postsurgical changes status post left suboccipital craniotomy. \nThere is no evidence of fracture. There is trace fluid in the right maxillary\nsinus. The visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Unchanged appearance of left transverse sinus and internal jugular vein\nthrombosis.\n2. No evidence of acute infarct or intracranial hemorrhage." + }, + { + "input": "There is asymmetric enlargement of the right master muscle particularly at the\nlevel of the mandible where there is also a 1.1 x 2.3 cm hypodense area within\nthe muscle with mild peripheral enhancement (2:111) suggestive of abscess. \ninflammatory changes of the subcutaneous fat surround the right master muscle\nextend nearly to the base of the neck. There is also asymmetric enlargement\nof the right submandibular gland relative to the left side. There is\nperiapical lucency surrounding a right mandibular molar with disruption of the\ncortex adjacent to the enlarged right mastoid air and right submandibular\ngland, raising concern for periodontal source of infection. There is also\nlucency within this tooth again raising concern for infection. There is mild\nmucosal thickening of the ethmoidal air cells. The visualized paranasal\nsinuses and mastoid air cells are otherwise clear.\nTheright vertebral artery is quite small and not completely visualized in its\ncourse through the cervical spine and. There may be a proximal stenosis or\nocclusion.", + "output": "1. Inflammatory changes surrounding an enlarged right master muscle containing\na 2.3 cm centrally hypodense area concerning for intramuscular abscess.\n2. Periapical lucency around an adjacent right mandibular molar with\ndisruption of the lateral cortex is suggestive of periodontal source of\ninfection.\n3. Enlargement of the adjacent right submandibular gland is also concerning\nfor infection." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is an 8 mm aneurysm arising from the supra clinoid segment of the right\ninternal carotid artery, distal to the origin of the ophthalmic artery. This\npoints superiorly. The neck is somewhat narrower than the dome, measuring\napproximately 4 mm in diameter.\nOtherwise, the vessels of the circle of ___ and their principal\nintracranial branches appear normal with no evidence of stenosis, occlusion,\nor other aneurysm. The dural venous sinuses are patent.", + "output": "1. 8 mm aneurysm arising from the supra clinoid segment of the right internal\ncarotid artery distal to the origin of the ophthalmic artery. Otherwise\nnormal study. ." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Right\nparaclinoid aneurysm pipeline redemonstrated. The ventricles and sulci are\nnormal in size and configuration. No acute fracture. 3 mm right sphenoid\nsinus osteoma. Mild to moderate mucosal thickening involving the left\nsphenoid sinus. The remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No evidence of intracranial hemorrhage, edema, or infarct.\n2. Left sphenoid paranasal sinus disease." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass effect, midline shift,\nor acute major vascular territorial infarct. Small high density focus, likely\ncalcific, in the left temporal lobe (2:16) was present on prior exam, though\nbetter visualized on the current head CT due to differences in technique. \nThis is nonspecific though could represent a cavernoma. Ventricles and sulci\nare unremarkable. Basilar cisterns are patent.\n\nPartial opacification noted of the bilateral ethmoids and mucosal thickening\nnoted in the maxillary sinuses with aerosolized debris layering in the right\nmaxillary sinus. Included paranasal sinuses and mastoids are otherwise clear.\nSkull and extracranial soft tissues are unremarkable.", + "output": "No acute intracranial process.\nHigh density likely calcific focus in the left temporal lobe was present on\nprior CT though is more conspicuous today likely due to differences in\ntechnique. This is nonspecific though could potentially represent an\nunderlying vascular malformation." + }, + { + "input": "There is no evidence of territorial infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "There is no evidence of territorial infarction, hemorrhage, edema, or mass." + }, + { + "input": "A tracheostomy is in place, and terminates about 4.4 cm above the carina. The\ntrachea is patent. The evaluation of the aerodigestive tract demonstrates no\nmass and no areas of focal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding.There is calcification in the left thyroid lobe and a hypodense\nnodule in the right thyroid measuring up to 2 cm.There is no lymphadenopathy\nby CT criteria. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no suspicious osseous l8esions. There are\nextensive degenerative changes of the cervical spine.\n\nThere is a fractured tooth, specifically ___ tooth number 31 which is also\nassociated with periapical lucency in adjacent sclerosis suggesting chronic\ninflammation.", + "output": "1. Tracheostomy is in place, terminating 4.4 cm above the carina. The trachea\nis patent. No soft tissue abnormality surrounding the tracheostomy.\n2. Hypodense right thyroid lobe nodule measuring 2 cm should be followed up\nwith nonemergent dedicated thyroid ultrasound.\n3. Fractured right second mandibular molar which is associated with periapical\nlucency and adjacent sclerosis of the mandible compatible with chronic\ninflammation." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema,or midline shift. The\nventricles and sulci are unremarkable.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No evidence of acute intracranial abnormality." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is a large right frontal extra-axial mass arising from the planum\nsphenoidal better characterized on the more recently performed MRI head study\nand likely representing a meningioma, measuring approximately 3.5 x 4.1 x 2.8\ncm. There is surrounding vasogenic edema and mass effect on the frontal horn\nof the right lateral ventricle. Midline shift of the anterior falx to the\nleft measures up to 7 mm.\n\nThere is no evidence of a large territorial infarction or hemorrhage. No\nhydrocephalus.\n\nThe visualized portion of the paranasal sinuses demonstrate mild mucosal\nthickening on the left maxillary sinus with small air-fluid level suggesting\nan ongoing inflammatory process, mastoid air cells, and middle ear cavities\nare clear. There is evidence of left pthisis bulbi.\n\nCTA HEAD:\nThere are atherosclerotic calcifications of the bilateral carotid siphons. \nThis results in areas of at least moderate narrowing of the paraclinoid\nsegment of the right ICA. There is a persistent fetal origin of the right\nPCA. The vessels of the circle of ___ and their principal intracranial\nbranches demonstrate mild bilateral segmental narrowing throughout the middle\ncerebral arteries and posterior cerebral arteries, suggesting changes due to\narteriosclerotic disease, no aneurysms are seen. The major dural venous\nsinuses are patent.\n\nCTA NECK:\nThere are mild calcified atheromatous changes of the origins of the ICAs. \nThere are mild atherosclerotic calcific occasions the origin of the right\nvertebral artery. There is not atherosclerotic plaque/irregularity of the\nright vertebral artery V3/V4 segments. The carotid and vertebral arteries and\ntheir major branches appear otherwise unremarkable. There is no evidence of\ninternal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. Multilevel degenerative changes throughout the cervical spine, more\nsignificant at C5-C6 level, consistent with anterior and posterior\nspondylosis.", + "output": "1. There is no evidence of large territorial infarct, intracranial hemorrhage\nor hydrocephalus. Small infarcts identified on a more recently performed MRI\nare not appreciated on this less sensitive CT noncontrast exam.\n2. Large right frontal extra-axial enhancing mass centered over the planum\nsphenoidale most compatible with a meningioma is better characterized on the\nmore recently performed MRI head study.\n3. There is associated mass effect on the frontal horn of the right lateral\nventricle and leftward shift of the anterior falx by approximately 7 mm.\n4. Atherosclerotic calcifications of the carotid siphons with areas of at\nleast moderate narrowing of the left paraclinoid ICA.\n5. No dissection, aneurysm or occlusion of the head neck. Mild\narteriosclerotic disease is identified in the intracranial vessels, more\nsignificant at the middle and posterior cerebral arteries. No significant ICA\nstenosis by NASCET criteria.\n6. Mild mucosal thickening is noted in the left maxillary sinus with air-fluid\nlevel, suggesting an ongoing inflammatory process." + }, + { + "input": "Again seen is a heterogeneous right inferior frontal lobe mass with a central\nhypodense necrotic area (2:7). There is extensive surrounding vasogenic edema\nwhich is similar to the MRI performed ___. It continues to a\nexert mass effect on the adjacent structures, including the right suprasellar\ncistern, the frontal horn of the right lateral ventricle and the right sylvian\ncistern. There is a persistent 5 mm leftward midline shift which is unchanged\nfrom yesterday. There is no evidence of intraparenchymal hemorrhage or acute\nlarge territorial infarction.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nethmoid air cells. The remainder of the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "1. Unchanged right frontal lobe mass with surrounding vasogenic edema and\npersistent 5 mm leftward shift, similar to ___ MR brain.\n2. Known left sided infarctions from the prior MRI of the brain are not well\nseen on the current exam." + }, + { + "input": "Again seen is a heterogeneous right inferior frontal mass with a central\nhypodense necrotic area (series 2; image 9), and which may slightly cross\nmidline. There is extensive surrounding vasogenic edema, which is similar to\nprior CT from ___. This edema continues to exert mass effect on\nadjacent structures, including right suprasellar cistern, right the frontal\nhorn of the right lateral ventricle, and the right sylvian cistern. There is\npersistent 4 mm of leftward midline shift, which is unchanged from ___. There is no evidence of intraparenchymal hemorrhage or acute large\nterritorial infarction. Previously seen left-sided infarctions from prior MRI\nand ___ are not well seen on this exam.\n\nThere is no evidence of acute fracture. There is unchanged minimal mucosal\nthickening of the anterior ethmoid air cells. The visualized portion of the\nremaining paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. Visualized orbits appear unchanged compared to prior.", + "output": "1. Unchanged right frontal lobe, which may extend slightly by beyond midline,\nwith surrounding vasogenic edema and persistent 4 mm of leftward shift,\nsimilar to ___ CT head.\n2. No notable acute change compared to prior." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nNo significant change in size of a right frontal extra-axial mass measuring\n3.5 x 3.3 cm in maximum axial ___, compatible with a meningioma. \nCentral hypoattenuation within the mass is compatible with necrosis. No\nsignificant change in degree of surrounding right frontal vasogenic edema. \nThere is resultant mild mass effect on the frontal horn of the right lateral\nventricle. Otherwise, there is mild prominence of the ventricles and sulci\nsuggestive involutional changes. unchanged minimal effacement of the right\nanterolateral aspect of the suprasellar cistern. No significant change in\nmild leftward shift of the anterior falx measuring up to 0.6 cm.\n\nHypodense focus within the right external capsule (02:18) may represent an\nage-indeterminate lacunar infarct versus small-vessel disease. There is no\nevidence of acute intracranial hemorrhage. Mild-to-moderate patchy\nperiventricular white matter hypoattenuation is compatible with small vessel\ndisease given the patient's age.\nBilateral maxillary sinus mucosal thickening is present the mastoid air cells\nand middle ear cavities are clear. Status post right lens replacement. Note\nis made of phthisis bulbi on the left.\n\nCTA HEAD:\nThe proximal left MCA M1 segment is not opacified. There is some\nreconstitution of the distal left MCA M1 segment and distal MCA branches. \nThere is multifocal mild-to-moderate narrowing of the right MCA M2 branches\n(3: 262, 264, 268). There is focal high-grade narrowing of the left PCA P2\nsegment (3:259). There is irregularity/narrowing of the right PCA P1 segment.\nNonocclusive irregularity of bilateral V4 segments of the basilar artery is\nnoted. The remaining vessels of the circle of ___ and their principal\nintracranial branches are grossly preserved. The dural venous sinuses are\npatent.\n\nCTA NECK:\nThere are mild atherosclerotic calcifications of the proximal aspects of the\nbilateral ICAs. There is evidence of diminished flow in the proximal left\ncervical ICA with non opacification of the distal left cervical ICA extending\nthroughout the intracranial left ICA consistent with occlusion. The left ACA\nA1 segment is also not opacified, possibly occluded versus congenitally\nabsent. Mild irregularity/narrowing of the intracranial vertebral arteries\nand basilar artery is likely on an atherosclerotic basis. Nonocclusive\nirregularity vs volume averaging artifact of the right vertebral artery is\nnoted (see series 454 and 3: 128-140). Nonocclusive stenosis of left P2\nsegment is noted. Otherwise, the remaining carotid and vertebral arteries and\ntheir major branches appear normal with no evidence of stenosis or occlusion.\nThere is no evidence of right internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Evidence of a small age-indeterminate right external capsule lacunar\ninfarct versus small vessel disease. Please note MRI of the brain is more\nsensitive for the detection of acute infarct.\n2. Grossly stable right frontal extra-axial mass measuring up to 3.5 cm better\ncharacterized on prior MRI imaging.\n3. Age indeterminate left cervical and petrous ICA high grade stenosis with\nocclusion of the left cavernous and supraclinoid intracranial ICA and proximal\nleft MCA M1 segment.\n4. Probable atherosclerotic narrowing of left proximal internal carotid artery\norigin as described.\n5. Nonvisualization of left ACA A1 segment. Differential considerations\ninclude occlusion vs congenitally absence.\n6. Multifocal narrowing of the right MCA M2 branches as described.\n7. High-grade focal narrowing of the left PCA P2 segment.\n8. Additional cervical and intracranial nonocclusive probable atherosclerotic\nchanges, as described.\n9. Probable white matter small vessel disease.\n10. Paranasal sinus disease , as described.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 1:30 am, 2 minutes\nafter discovery of the findings." + }, + { + "input": "There is a right frontal lobe mass measuring 3.5 x 3.3 cm in maximum axial\n___, similar compared to the prior CT, previously characterized as a\nmeningioma. There is extensive surrounding vasogenic edema. There is mass\neffect on the frontal horn of the right lateral ventricle. The extent of\nright to left midline shift is similar compared to prior. There is also mild\neffacement of the right aspect of the suprasellar cistern.\n\nNo evidence of acute territorial infarction or intracranial hemorrhage. There\nis prominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. Minimal mucosal thickening within the left\nmaxillary sinus. Otherwise, the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The patient is status\npost lens resection on the right. Note is made of the phthisis bulbi on the\nleft.", + "output": "1. No evidence of developing acute territorial infarction.\n2. Unchanged right frontal lobe mass measuring up to 3.5 cm with extensive\nsurrounding vasogenic edema, previously characterized as a meningioma. Mass\neffect on the right lateral ventricle and midline shift is unchanged." + }, + { + "input": "Study is mildly degraded by motion. Again seen, is an unchanged right frontal\nhypodensity, vasogenic edema and leftward midline shift, (02:16). \nRe-demonstrated is unchanged, mild effacement of the right lateral ventricle,\nand suprasellar cistern, (02:12).\n\nThere is grossly stable prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nAddition to areas of edema, there are confluent of hypodensities in the\nsubcortical and periventricular white matter, nonspecific but likely sequela\nof chronic microvascular disease.\n\n Again seen, are hypodensities distributed along the left cerebral hemisphere\nand left basal ganglia that are better demonstrated and was described on MR\nbrain.\n\nThere is no new hemorrhage, or large tentorial infarct.\n\nThere is no evidence of fracture. The mastoid air cells, and middle ear\ncavities are clear. Re-demonstrated, is a left phthisis bulbi, (02:10). Left\nmaxillary sinus, bilateral ethmoid air cell, and bilateral sphenoid sinus\nmucosal thickening is noted.", + "output": "1. Study is mildly degraded by motion.\n2. Grossly stable right frontal mass with vasogenic edema and stable leftward\nmidline shift.\n3. Within limits of study, no definite new hemorrhage or large territorial\ninfarct.\n4. Evolving left cerebral hemisphere and left basal ganglia infarcts, better\ndescribed on prior MR brain, without definite evidence of hemorrhagic\ntransformation." + }, + { + "input": "There has been evolution of left-sided middle cerebral artery infarct. \nHypodensity in the left middle cerebral territory indicates infarct with mild\nmass effect on the left lateral ventricle. There is no hemorrhagic conversion\nidentified. Edema in the right frontal lobe secondary to a extra-axial mass\nbetter demonstrated on previous MRI is unchanged. Phthisis bulbi is noted on\nthe left side.", + "output": "1. Evolving left middle cerebral artery infarct. No evidence of hemorrhage. \nMild mass effect.\n2. Unchanged edema in the right frontal lobe.\n3. No hydrocephalus." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nThere is no evidence of infarction, hemorrhage, edema, or mass. There is mild\nprominence of the ventricles and sulci suggestive of involutional changes.\nThere are periventricular and subcortical lucencies, which may represent small\nvessel ischemic changes. Atherosclerotic vascular calcifications are noted of\nbilateral cavernous portions of internal carotid arteries.\n\nThere is mucosal thickening in bilateral maxillary sinuses, left greater than\nright, left sphenoid sinus, bilateral inferior frontal sinuses, and bilateral\nethmoid air cells. Left maxillary sinus air-fluid level is seen. These\nfindings may be related to patient's intubation status.\n\nThere is no evidence of fracture. The visualized portion of the mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are preserved. Endotracheal tube and enteric tube are partially\nvisualized. Partially empty sella is noted", + "output": "1. Dental amalgam streak artifact limits study.\n2. No acute intracranial abnormality. Please note MRI of the brain is more\nsensitive for the detection of acute infarct.\n3. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described." + }, + { + "input": "Curvilinear hyperdensity outlining the sulci of the right parietal lobe is\nconsistent with reported subarachnoid hemorrhage (02:14). There is no acute\nlarge territorial infarction, edema or mass. There is prominence of the\nventricles and sulci suggestive of involutional changes. The deep\nperiventricular and subcortical white matter hypodensities are nonspecific and\nlikely represent sequela of chronic microvascular ischemic changes.\n\nThere is no evidence of fracture. Mucosal thickening of the ethmoid air\ncells. The remainder of the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. Small right parietal subarachnoid hemorrhage." + }, + { + "input": "No hemorrhage, edema, or mass effect is identified. Ventricles and sulci are\nprominent most compatible with age related involutional changes. There is no\nevidence of large acute territorial infarction. Periventricular, subcortical\nand deep white matter hypodensities are nonspecific though likely reflect\nsequela of chronic small vessel ischemic disease. Focal hypodensity within\nthe left thalamus may reflect prior lacunar infarct. There is no shift of\nnormally midline structures. Basal cisterns are patent.\n\nVisualized paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear aside from mucosal thickening in a right ethmoid air cell. . Carotid\nartery siphon vascular calcifications are moderate.", + "output": "No acute intracranial abnormality. Age related volume loss. Extensive\nperiventricular, deep and subcortical white matter hypodensities are\nnonspecific likely sequela of chronic small vessel ischemic disease." + }, + { + "input": "There is no evidence of hemorrhage, edema, or mass effect. Prominence of the\nventricles and sulci is stable, and compatible with unchanged global atrophy. \nDiffuse periventricular as well as deep and subcortical white matter\nhypodensity is unchanged, and nonspecific, however compatible with the\nsequelae of chronic small vessel ischemic change. Against this that I am it\nis not possible to detect the acute infarctions demonstrated on the MRI\nexamination. There is no shift of normally midline structures, and the basal\ncisterns are patent. There is preservation of gray-white matter\ndifferentiation. Carotid siphon calcifications are again seen. The\nvisualized paranasal sinuses and mastoid air cells are clear. The globes and\nbony orbits are intact.", + "output": "1. No evidence of hemorrhage. No change since the prior head CT. .\n2. Stable chronic findings including diffuse chronic small vessel white matter\nischemic change, vascular calcifications, and global atrophy. The small acute\ninfarctions seen on the MRI examination cannot be distinguished from the\nchronic white matter changes." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of hemorrhage, edema, or mass. Prominence\nof ventricles and sulci consistent with age-related involutional change. \nThere are bilateral chronic appearing lacunar infarctions in the globus\npallidus. There is no evidence of recent infarction. White matter\nhypodensities in the periventricular region consistent with chronic small\nvessel ischemic change. There is preservation of gray-white matter\ndifferentiation. Calcifications within the carotid siphon.\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD Neck:\nMild atherosclerotic calcifications of the bilateral internal carotid arteries\nnear the bifurcation and of the bilateral internal clinoid portions of the\ninternal carotid arteries. There is no evidence of internal carotid artery\nstenosis by NASCET criteria. There is no filling defect, thrombus, stenosis,\naneurysm, dissection. Mild calcifications in the left vertebral artery at the\ntakeoff of the left subclavian. Thyroid is unremarkable. There are diffuse\nground-glass opacities and bronchial wall thickening with small bilateral\npleural effusions at the dependent areas of the lung apices bilaterally.\n\n\nOTHER:\nThere are diffuse ground-glass opacities and bronchial wall thickening with\nsmall bilateral pleural effusions at the dependent areas of the lung apices\nbilaterally.The visualized portion of the thyroid gland is within normal\nlimits. There is no lymphadenopathy by CT size criteria.", + "output": "1. Mild atherosclerotic calficiations of the internal carotid arteries. No\nevidence of thrombus, stenosis, aneurysm, or dissection.\n2. Chronic small vessel ischemic change.\n3. Age-related involutional change" + }, + { + "input": "There multifocal hypodense areas in the right and left parietal lobes in the\nMCA territory corresponding to previously demonstrated regions of restricted\ndiffusion on MR from ___. There is also an area of hypodensity\nwithin the right frontal lobe with loss of gray-white matter differentiation\n(Series 2, image 16) which does not appear to correspond to areas of\nrestricted diffusion on prior MR, concerning for a new area of ischemia and\nevolving infarction. There is no evidence of hemorrhage. The basal cisterns\nare patent. There is no shift of midline structures. The ventricles and\nsulci are normal in caliber and configuration. The imaged paranasal sinuses\nand mastoid air cells are clear. The globes and bony orbits are intact and\nunremarkable.", + "output": "1. Hypodensity in the right frontal lobe with loss of gray-white matter\ndifferentiation appears to represent a new area of ischemia and evolving\ninfarction, not corresponding to foci of restricted diffusion on MRI from ___.\n2. Additional multiple bilateral areas of parenchymal hypodensity with loss of\ngray-white matter differentiation, consistent with evolving infarction,\ncorresponding to areas of restricted diffusion seen on recent MRI.\n3. No hemorrhage. No mass effect.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 5:19 AM, at the time of discovery" + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. The ventricles and sulci are normal in size and configuration.\n\nThere is partial opacification of the left mastoid air cells, and hyperdense\nmaterial in the left external auditory canal compatible with blood. A linear\nfracture is seen extending through the left temporal bone in into the external\nauditory canal (03:21). The otic capsule is grossly intact. The ossicles\nappear intact. No additional fractures are identified.\n\nThere is moderate mucosal thickening of the anterior ethmoid air cells,\notherwise the paranasal sinuses are clear. The imaged orbits are\nunremarkable.", + "output": "1. No acute intracranial hemorrhage.\n2. Linear fracture through the left temporal bone extending into the external\nauditory canal. There is associated partial opacification of the left mastoid\nair cells and fluid in the external auditory canal. The otic capsule and\nossicles appear intact." + }, + { + "input": "LEFT ICA:\nThere is a mixed fracture of the left temporal bone extending into the left\nmastoid air cells with moderate opacification of the left mastoid air cells\nand external auditory canal. The fracture line extends superiorly the level\nof the tegmen tympani (series 4, image 83). Additional fracture involving\nthe otic capsule extending the posterior semicircular canal (series 4, image\n121), which extends inferiorly to the jugular foramen. The fracture comes\ninto close proximity to the vestibular aqueduct (series 4, image 119). The\nfracture lucency also extends to the anterior wall of the external auditory\ncanal extending to the glenoid fossa.\n\nThere are scattered foci of air within the basal turn of the left cochlea and\nthe left vestibule (4:111), compatible with perilymphatic fistula secondary to\nthe fracture through the left posterior segment circular canal. There is no\nsuperior semicircular canal dehiscence.\nThere is partial opacification of the left mesotympanum and hypotympanum of\nthe middle ear cavity.\n\nThere is an asymmetric defect with slight widening of the medial margin of the\nleft incus/malleus articulation with a 1 mm rounded ossific density medially\n(4:109, 401:39), representing at least dislocation. It is difficult to\ndetermine if there is represents an ossicular fracture given the adjacent\nmiddle ear cavity opacification, although majority of the incus and malleus\nappear intact.\n\nThere is well-formed bony covering surrounding the intracranial internal\ncarotid artery without evidence of a fracture. There is apparent normal bone\nuncovering surround the facial nerve canal within the mesial tympanum,\nalthough optimal due to the degree of opacification within the middle ear. A\nfracture lucency does appear to extend to the level of the mastoid segment\n(series 4, image 123).\n\nProminent soft tissue and hematoma within the external auditory canal and with\npresumed packing material is also noted.\n\nRIGHT IAC:\nThere is no evidence of a fracture. The mastoid air cells and middle ear\ncavity appear clear. The right cochlear, semicircular canal, and facial nerve\nappear intact. There is no evidence of enlarged vestibular aqueduct.\n\nOTHER:\nThe visualized portions of the brain parenchyma appears unremarkable. There\nis interval healing of a previously seen fracture of the left tripod fracture", + "output": "1. Mixed fracture of the left temporal bone with opacification of the left\nmastoid air cells and external auditory canal, likely related to hemorrhage. \nThe fracture extends to the otic capsule, involving the posterior semicircular\ncanal and vestibular aqueduct. The fracture line also appears to extend to\nthe tegmen tympani.\n2. Air within the left cochlea and vestibule secondary to the otic capsule\nfracture is compatible with perilymphatic fistula.\n3. Asymmetric defect with slight widening of the medial margin of the left\nincus/malleus articulation with a 1 mm rounded ossific density medially, which\nmay represent an a secure fracture given the adjacent middle ear cavity\nopacification, although the majority of the incus and malleus appear intact.\nThe bony covering surrounding the left facial nerve within the middle ear and\nthe left internal carotid artery appear intact. However evaluation of the\nleft facial nerve canal is suboptimal due to the degree opacification of\nmiddle ear.\n4. A fracture lucency does appear to extend to the level of the facial canal\nat the level of the mastoid.\n5. Unremarkable right IAC. Additional findings as described above.\n\nNOTIFICATION: The findings were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 2:28 pm, 5 minutes after discovery\nof the findings." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Normal study." + }, + { + "input": "Beam hardening artifact limits examination. There is no intra-axial or\nextra-axial hemorrhage, edema, shift of normally midline structures, or\nevidence of acute major vascular territorial infarction. Ventricles and sulci\nare normal in overall size and configuration. The imaged paranasal sinuses are\nclear. Mastoid air cells and middle ear cavities are well aerated. The bony\ncalvarium is intact.", + "output": "1. Beam hardening artifact limits examination.\n2. No acute intracranial abnormality.\n3. Within limits of study, no evidence acute intracranial hemorrhage or\nfracture." + }, + { + "input": "Surgical changes of frontotemporal craniotomy are noted with aneurysm clip in\nplace. There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. The basal cisterns\nare patent and there is preservation of gray-white matter differentiation.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable. Incidental note\nmade of a Chiari type 1 malformation.", + "output": "1. No evidence of fracture,. Infarction or hemorrhage.\n2. Surgical changes of frontotemporal craniotomy with clip in place at site of\nprior right internal carotid artery bifurcation aneurysm." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, mass effect, or midline\nshift. The ventricles and basal cisterns appear normal. The orbits, skull\nbase, and paranasal sinuses are unremarkable.\n\nThere is atherosclerotic vascular disease involving the aortic arch. There is\nthe stenosis at the origins of the vertebral arteries. The left vertebral\nartery is dominant. There is atheromatous narrowing of the bilateral carotid\nbifurcations, with approximately 45% narrowing of the proximal right internal\ncarotid artery by NASCET criteria and approximately 35% narrowing of the left\nproximal internal carotid artery by NASCET criteria. There are postoperative\nchanges of prior left carotid endarterectomy.\n\nThe patient is edentulous. There are intracranial atheromatous calcifications\ninvolving the cavernous portion of the internal carotid arteries and the\ndistal portion of the left vertebral artery. There is no evidence of\nintracranial aneurysm formation or focal vessel cut off within the\nintracranial vasculature.", + "output": "1. Diffuse atherosclerotic vascular disease including stenosis at the origins\nof the bilateral vertebral arteries and atheromatous narrowing of the proximal\nbilateral internal carotid arteries measuring approximately 45% on the right\nand 35 % on the left, by NASCET criteria." + }, + { + "input": "Right frontal craniotomy is identified. No evidence of a nodular area of\nenhancement identified. No significant changes seen since the previous study.\nMild to moderate brain atrophy and small vessel disease identified.", + "output": "No signs of recurrent mass identified on head CT with contrast. Examination is\notherwise unchanged compared with ___. ." + }, + { + "input": "There is re-demonstration of a right frontal craniotomy site. There is no\nevidence of infarction, hemorrhage, edema,or recurrent mass within confines of\nCT technique. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific, but likely reflect sequelae of chronic small\nvessel ischemic disease. There is no abnormal enhancement on post contrast\nimages.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No new or recurrent intracranial masses identified within confines of CT\ntechnique.\n2. Chronic, age-related changes and sequelae of small vessel ischemic disease." + }, + { + "input": "Stable postsurgical changes after right frontal craniotomy for resection of a\nright frontal atypical meningioma and CyberKnife treatment to the resection\ncavity in ___. There is no evidence of tumor recurrence or new lesions.\n\nThere is no evidence of fracture, infarction, hemorrhage, edema, or mass.\nThere is no abnormal enhancement on postcontrast images.\n\nNonspecific periventricular hypodensities are again noted likely reflect\nsequela of chronic small vessel ischemic changes.\n\nThere is unchanged mild generalized parenchymal volume loss. Prominence of\nthe ventricular system and extra-axial CSF spaces is stable and consistent\nwith the previously mentioned parenchymal volume loss.\n\nAtherosclerotic changes along both intracranial vertebral arteries and carotid\nsiphons are again identified.\n\nThere is mild mucosal thickening along the ethmoid air cells and right\nanterior sphenoid sinus. The remainder of the paranasal sinuses appears\notherwise clear. There is partial opacification of the right posterior\nmastoid air cells. The left mastoid air cells appear clear. Soft tissue\ndensity in both external auditory canals most likely represents cerumen. The\norbits appear unremarkable.", + "output": "1. Stable postsurgical changes after right frontal craniotomy, resection and\nCyberKnife treatment of a right frontal atypical meningioma without evidence\nof recurrent or new intracranial masses.\n2. Stable nonspecific periventricular hypodensities, likely sequela of chronic\nsmall vessel ischemic changes.\n3. Otherwise no new intracranial abnormality. No evidence of acute infarction\nor hemorrhage." + }, + { + "input": "There is no evidence of acute major vascular territorial\ninfarction,hemorrhage,edema, or mass. Ventricles and sulci are\nage-appropriate.\n\nAtherosclerotic calcifications are noted in the cavernous internal carotid\narteries bilaterally.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial process identified." + }, + { + "input": "Head CT: There is no evidence of hemorrhage, edema, masses, mass effect, or\ninfarction. The ventricles and sulci are normal in caliber and configuration.\nNo fractures are identified. The orbits are unremarkable. There is mucosal\nthickening within the ethmoid air cells and bilateral maxillary sinuses. \nThere is a superimposed mucous retention cyst in the left maxillary sinus. \nThe mastoid air cells are clear.\n\nHead CTA: There are no intracranial vascular abnormalities. There is no\nevidence of aneurysm, stenosis or occlusion. There is a fetal type right\nposterior cerebral artery with a hypoplastic right P1 segment.\n\nNeck CTA: There is a normal three-vessel takeoff of the great vessels from\nthe aortic arch. The carotid and vertebral arteries and their major branches\nare patent with no evidence of stenoses. There is no evidence of internal\ncarotid stenosis by NASCET criteria. The distal left ICA measures 4.9 mm and\nthe distal right ICA measures 4.4 mm.\n\nThe salivary and thyroid glands image normally. There is mild pleural\nparenchymal scarring at the lung apices. The lungs are otherwise clear. No\nsuspicious osseous lesions are identified.", + "output": "1. Unremarkable unenhanced head CT without evidence of acute hemorrhage,\ninfarction, or mass lesion.\n\n2. Unremarkable CTA of the head and neck without evidence of aneurysm,\nstenosis, or occlusion." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass effect. 6 mm hypodensity in the left basal ganglia likely reflects a\ndilated perivascular space. The ventricles and sulci are normal in size and\nconfiguration.\n\nNo acute fractures are seen. There is mild mucosal thickening in the left\nsphenoid sinus. Otherwise, the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. The ventricles and sulci are normal in size and configuration. Mild\natherosclerotic calcification of the internal carotid arteries are noted.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable, allowing for left scleral buckle..", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nintracranial hemorrhage. No acute large territory infarct.\n2. Additional findings described above." + }, + { + "input": "There is no evidence of acute major vascular territory\ninfarction,hemorrhage,edema, or mass. The ventricles and sulci are\nage-appropriate.\n\nThere is no evidence of fracture. There is mild hyperostosis frontalis\ninterna. Mild mucosal thickening is seen in the maxillary sinuses, left\ngreater than right, left ethmoid air cells, and right sphenoid sinus. \nOtherwise, the remaining visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. No acute intracranial abnormalities.\n2. Mild paranasal sinus disease, as above." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThe patient is intubated and there is an enteric tube in place.\n\nThere is no evidence of no evidence of large territorial\ninfarction,hemorrhage,edema,ormass. There are moderate subcortical and\nperiventricular white matter hypodensities compatible with small vessel\ndisease. Prominence of the ventricles and cerebral sulci are compatible with\nage related involutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is mild narrowing of the distal right MCA M1 segment (4:265). The\nvessels of the circle of ___ and their principal intracranial branches\nappear otherwise normal with no evidence of stenosis, occlusion, or aneurysm. \nThe intracranial vertebrobasilar system is patent. The dural venous sinuses\nare patent.\n\nCTA NECK:\nThere are mild calcifications of the left carotid bulb. The carotid and\nvertebral arteries and their major branches appear otherwise normal with no\nevidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nCT PERFUSION:\nReported T-max > 6 sec volume of 179 mL within the right cerebral hemisphere;\nhowever, there are technical issues with the exam. Equivocal decreased CBF\nwithin the posterior right temporal lobe on the color map images. Recommend\nclinical correlation, with brain MRI without contrast if indicated.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No large acute territorial infarct or bleed.\n2. No evidence of dissection, aneurysm or occlusion of the head neck. No ICA\nstenosis by NASCET criteria.\n3. Mild-to-moderate focal narrowing of the right MCA M3 segment and mild focal\nnarrowing of the distal right MCA M1 segment.\n4. Reported T-max greater than 6 seconds volume of 179 mL within the right\ncerebral hemisphere. However, there are technical issues and this finding may\nbe artifactual as it is a relatively disproportionate to the punctate infarct\nidentified on the more recently performed MRI. A small area of decreased CBF\nin the posterior right temporal lobe is equivocal." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates nonspecific soft tissue\nfullness of the right piriform sinus (2:50). No evidence of peritonsillar\nabscess.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. The neck vessels are patent.\n\nThe imaged portion of the lung apices are demonstrate mild dependent\natelectasis and trace bilateral pleural effusions. There are no osseous\nlesions.", + "output": "1. Nonspecific soft tissue fullness of the right piriform sinus. Recommend\ncorrelation with direct visualization.\n2. No evidence of peritonsillar abscess." + }, + { + "input": "The right submandibular gland is enlarged relative to the left and there is\nmoderate hyperenhancement. There is loss of adjacent fat planes and a\nmoderate amount of swelling centered about the right submandibular gland. \nMultiple sublingual calcifications may represent sialoliths (image 46, series\n2 and image 51, series 2). There is no focal fluid collection. The thyroid\ngland appears normal. Slightly prominent lymph nodes noted at level 1B,\nhowever not enlarged by radiological criteria, and most likely reactive. The\nneck vessels are patent. The patient is edentulous.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.", + "output": "1. Sialoadenitis of the right submandibular gland, with probable obstructing\nsialolith. There is no focal fluid collection." + }, + { + "input": "There is no evidence of acute major infarction,hemorrhage,edema,or discrete\nmass. There is mild prominence of the ventricles and sulci suggestive of\ninvolutional changes. Subcortical and periventricular white matter\nhypodensities are nonspecific, however likely represent sequela of chronic\nsmall vessel ischemic disease.\n\nThere is no evidence of fracture. There is trace mucosal thickening in the\nethmoid air cells left sphenoid sinus. The visualized portion of the\nremainder of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of intracranial hemorrhage. There is no mass effect,\nhydrocephalus or shift of the normally midline structures. Gray-white matter\ndistinction appears preserved. Surrounding soft tissue structures are\nunremarkable. The visualized paranasal sinuses and mastoid air cells appear\nclear. Cavernous carotid arteries are calcified.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of hemorrhage, edema, mass effect, or acute infarction. \nThe ventricles are normal in size and configuration. The visualized portion\nof the paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nCalcifications are noted in the proximal supraclinoid internal carotid\narteries bilaterally without occlusion. Right fetal PCA configuration noted. \nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThere is a three vessel aortic arch with mild calcified atherosclerotic\nplaque. The origin of the common carotid and vertebral arteries are widely\npatent. Focal calcified atherosclerotic plaque along the V4 segment of the\nleft vertebral artery results in mild luminal narrowing but the vessel remains\npatent (5:213). Predominantly calcified plaque is in the carotid bulbs\nbilaterally however the internal carotid arteries are largely spared. There\nis no evidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The thyroid gland is within\nnormal limits. There is no lymphadenopathy by CT size criteria. Multilevel\ndegenerative changes are visualized throughout the cervical spine, consistent\nwith anterior and posterior spondylosis, more significant at C5/C6 and C6/C7\nlevels.", + "output": "1. No evidence of hemorrhage, edema, mass effect, or acute infarction.\n2. Unremarkable head and neck CTA." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema, or\nmass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nethmoid air cells. Mucosal thickening is also seen in the bilateral maxillary\nsinuses, more on the right. The remaining paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Mild mucosal thickening of the ethmoid air cells and bilateral maxillary\nsinuses." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema, or\nmass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "There is no evidence of acute intracranial process or hemorrhage." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territory infarct. Gray-white matter\ndifferentiation is preserved. Subtle mild periventricular white matter\nhypodensity is nonspecific, but most likely the sequela of chronic small\nvessel disease. The visualized paranasal sinuses demonstrate mild mucosal\nthickening of the bilateral ethmoid air cells.. The mastoid air cells are\nclear. No acute fracture is seen.", + "output": "No acute intracranial process." + }, + { + "input": "There is an enlarged heterogeneous thyroid gland with internal calcifications.\nThere is associated mass effect causing narrowing of the trachea with\n___ of 33 x 5 mm (AP x TV) at its narrowest point the there is no\nlymphadenopathy. The visualized lung apices are clear. Calcifications are\nnoted within the aortic arch. Multilevel degenerative changes are visualized\nthroughout the cervical spine, consistent with anterior posterior spondylosis,\nmoderate spinal canal stenosis from C3 through C7 levels, partially evaluated\nin this examination, correlation with MRI of the cervical spine is advised if\nclinically warranted, there is calcification of the ligamentum nuchae.", + "output": "1. Enlarged heterogeneous thyroid gland, causing mass effect and narrowing of\nthe trachea at described above.\n\n2. Multilevel degenerative changes throughout the cervical spine." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nA right frontal approach intraventricular catheter terminates in the area of\nthe third ventricle. There are stable postsurgical changes related to\nsuboccipital craniectomy and resection of enhancing cerebellar lesions. There\nis no evidence of new infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses,mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTV HEAD:\nNo gross abnormalities are detected in the vessels of the circle of ___ and\ntheir principal intracranial branches. The dural venous sinuses are patent,\nsimilar to prior MR. ___ is no definite abnormal enhancement on postcontrast\nimages.", + "output": "1. No evidence of dural venous sinus thrombosis.\n2. No acute intracranial abnormality.\n3. Postoperative changes related to suboccipital craniectomy.\n4. Stable right frontal approach ventriculostomy catheter with stable\nventricular size." + }, + { + "input": "Re-demonstrated is a left frontal approach ventriculostomy catheter with tip\nterminating at the foramen of ___. The ventricles are unchanged in size. \nPostsurgical changes are again noted at the right frontal as well as at the\nsuboccipital bone. Postsurgical encephalomalacia is noted in the cerebellum. \nThere is no evidence of acute vascular territorial infarction, hemorrhage,\nedema, or mass effect.\n\nNo acute fractures seen. The paranasal sinuses, mastoid air cells, and middle\near cavities are essentially clear. The orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Left frontal approach ventriculostomy catheter is in unchanged position.\n3. Status post suboccipital craniectomy with postsurgical change." + }, + { + "input": "Re-demonstrated is a right frontal approach ventriculostomy catheter with tip\nterminating at the foramen of ___. The ventricles are unchanged in size. \nPostsurgical changes are again noted in the right frontal bone as well as the\noccipital bone from prior suboccipital craniectomy. Encephalomalacia in the\ncerebellum is unchanged. There is no evidence of acute territorial\ninfarction, hemorrhage, edema, or mass effect.\n\nNo acute fractures are seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No acute intracranial process. Of note, MRI is more sensitive for\ndetection of intracranial masses.\n2. Right frontal approach ventriculostomy catheter is in unchanged position.\n3. Redemonstration of postsurgical changes related to suboccipital\ncraniectomy." + }, + { + "input": "Right frontal approach ventriculostomy catheter tip terminates in the foramen\nof ___. Hypodensity along the shunt catheter in the right frontal lobe is\nsimilar to prior, likely gliosis. Ventricular size is unchanged and not\ndilated. Patient is status post suboccipital craniectomy with similar\nencephalomalacia in the cerebellum. There is no evidence of acute territorial\ninfarction,hemorrhage,edema, or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Right frontal approach ventriculostomy catheter in unchanged position in\nthe foramen ___ with similar ventricular size compared to prior exams. \nNo hydrocephalus.\n3. Status post suboccipital craniectomy with similar appearance of\npostsurgical changes and encephalomalacia in the cerebellum." + }, + { + "input": "There are bilateral hyperdense inferior cerebellar masses, with the left\ncerebellar mass showing a necrotic center. Both masses measure approximately\n2.7 cm in diameter and demonstrate minimal peritumoral edema resulting in on\nmass effect with crowding of the foramen magnum and effacement of the fourth\nventricle. There is also a hyperdense 8 mm nodule in the left parietal lobe\n(series 2, image 22) also concerning for metastatic disease. There is no\nsignificant mass effect caused by this lesion. No other masses are identified.\n\nThere is no acute large territorial infarction. The ventricles and sulci are\nnormal in size and configuration with the exception of the already described\neffaced fourth ventricle. The orbits are within normal limits. The paranasal\nsinuses are clear. No acute fracture seen. Lucency in the right calvarium may\nrelate to venous lake, but metastatic focus is not excluded.", + "output": "1. At least 3 hyperdense neoplastic lesions, one in each inferior cerebellum\nand one in the left parietooccipital region are compatible with metastases.\n\n2. Mass effect from the cerebellar masses results in low lying cerebellar\ntonsils with crowding of the foramen magnum as well as effacement of the ___\nventricle. No hydrocephalus identified." + }, + { + "input": "There are postsurgical changes status post posterior fossa craniectomy and\nresection of multiple cerebellar lesions, including pneumocephalus and blood\nproducts within the surgical bed. There is stable bilateral cerebellar\nhemisphere edema.\n\nNo additional foci of intraparenchymal hemorrhage are identified, and there is\nno large extra-axial fluid collection seen. There is no appreciable midline\nshift or downward herniation. Redemonstrated is a stable, hyperdense, 6 mm\nlesion within the right pons (series 2, image 10).\n\nThe ventricles are stable in size and configuration. The paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "1. Postsurgical changes related to the patient's interval posterior craniotomy\nand multiple cerebellar tumor resection.\n2. Stable bilateral cerebellar edema." + }, + { + "input": "The patient is status post occipital craniotomy and resection of a posterior\nfossa tumor. There has been interval development of a right cerebellar\nhemisphere hemorrhage, which measures approximately 1.8 x 2.0 x 2.3 cm.\nAdditional blood is seen in the visualized spinal canal. There is mass effect\nand effacement of the quadrigeminal plate cistern. Cerebellar edema is\nunchanged. Bifrontal pneumocephalus, as well as free air on either side of the\ncraniotomy site, is decreased compared to the prior CT. A 4 mm focus of\nhyperdensity in the posterior left frontal lobe (2:19, 601b:71) is unchanged.\nA hyperdense focus within the right pons is also unchanged. There is no\nevidence of acute large territorial infarction. The ventricles are slightly\nincreased in size compared to the prior CT, suggestive of mild hydrocephalus.\n\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\nThe orbits are unremarkable.", + "output": "1. Interval development of a right cerebellar hemisphere hemorrhage, measuring\nup to 2.3 cm, with additional blood in the visualized spinal canal. This\nresults in mass effect and effacement of the quadrigeminal plate cistern and\nmild hydrocephalus.\n2. Unchanged hyperdense foci within the right pons and left posterior frontal\nlobe\n3. Status post occipital craniotomy, with decreased pneumocephalus.\n\nNOTIFICATION: These findings were discussed via telephone by Dr. ___\n___ with Dr. ___ at 1245 on ___, immediately upon\ndiscovery. The team was already aware of the findings, and had taken the\npatient to the OR that morning for placement of a drain." + }, + { + "input": "There has been interval placement of a right frontal approach extraventricular\ndrain, which terminates in the third ventricle. Expected postsurgical changes\nare present, consistent with pneumocephalus and residual subdural blood\nproducts along the right frontal region with no significant mass effect. The\nventricles are minimally decreased in size, measuring approximately 1.9 cm in\nwidth at the level of the basal ganglia (2:19, previously 2.2 cm). The\nquadrigeminal plate cistern, although still significantly diminutive, appears\nslightly more patent than on the prior exam. The remainder of the exam is\nlargely unchanged, with a right cerebellar intraparenchymal bleed and\npostoperative changes after occipital craniotomy with bifrontal pneumocephalus\nas well as free air along the surgical site. No new focus of hemorrhage is\nidentified. Hyperdense foci in the left subcortical white matter and right\npons remain unchanged. There is no evidence of acute large territorial\ninfarct. The paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The orbits are unremarkable.", + "output": "Status post interval placement of a right frontal approach extraventricular\ndrain, which terminates in the third ventricle, with minimally decreased size\nof the ventricles. The quadrigeminal plate cistern, although still diminutive,\nappears slightly more patent than on prior exam." + }, + { + "input": "The patient is status post occipital craniectomy with expected postsurgical\nchanges including pneumocephalus and a small degree of residual hyperdense\nmaterial at the craniectomy site. Redemonstrated is a right frontal approach\nEVD with its tip terminating in the left foramen of ___. A small degree of\nresidual right frontal extra-axial blood is again noted, minimally changed\nfrom prior examination. Pontine and left parietal white matter hyeprdense\nlesions are again seen, unchanged. The ventricular system has slightly\ndecreased in size, and remains patent. The suprasellar cistern is patent. The\nquadrigeminal plate cistern remains somewhat diminutive, although overall more\npatent as compared to the prior examination. There is no evidence of\ninfarction or new hemorrhage. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "Expected postoperative changes status post occipital craniectomy without\nevidence of new hemorrhage." + }, + { + "input": "Patient is status post suboccipital craniectomy. Pneumocephalus has decreased.\nScattered foci of hyperdense blood along the right cerebellar surgical bed are\nunchanged.\n\nAgain seen is the right frontal approach EVD catheter with its tip terminating\nin the region of the left foramen of ___, unchanged in position. The\nventricles overall are unchanged in size. The fourth ventricle is not\ncompressed, and the lateral and third ventricles are not dilated. Small amount\nof extra-axial blood anterior to the right frontal lobe is also unchanged.\n\nHyperdense lesions in the pons as well as the left parietal white matter are\nagain identified, previously characterized as metastatic disease and better\nevaluated on prior MRIs. The basal cisterns appear patent and there is\npreservation of gray-white matter differentiation.\n\nThe partially visualized paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear.", + "output": "1. Status post suboccipital craniectomy. Known intracranial metastases are not\nadequately reassessed on this noncontrast CT.\n2. No new hemorrhage or mass effect.\n3. Stable position of the right frontal approach EVD catheter. Stable\nventricular size without hydrocephalus." + }, + { + "input": "The patient is status post suboccipital craniectomy for resection of\nintracranial metastases, with no new hemorrhage in the posterior fossa.\nHyperdense lesion in the pons (02:11) is indicative of one of the intracranial\nmetastases which are not adequately evaluated via CT.\nRight frontal approach ventricular drain terminates near the interventricular\nforamen ___ and there is a small region of hyperdensity adjacent to the\ncatheter tip which may represent interval hemorrhage, which was less\nconspicuous on the prior CT. Ventricular size is stable. Small focus of\nextra-axial blood along the right frontal convexity is also stable.\n\nParanasal sinuses, mastoid air cells, and middle ears ear cavities are clear.\nThe occipital bone, C1 lamina and associated soft tissues of the craniectomy\nsite appear unremarkable.", + "output": "1. Interval development of focal hyperdensity adjacent catheter tip, near the\ninterventricular foramen of ___, concerning for a new focus of hemorrhage.\nNo interval change in ventricular size since ___.\n2. Stable appearance of the suboccipital craniectomy with no new posterior\nfossa hemorrhage.\n3. Please note that CT is suboptimal for evaluation of intracranial\nmetastases." + }, + { + "input": "As before, the patient is status post suboccipital craniotomy. Scattered foci\nof hyperdense blood along the right cerebellar surgical bed are stable to\nminimally decreased from the prior examination.\n\nA right frontal approach EVD catheter is seen with its tip terminating in the\nregion of the foramen of ___. The ventricles are overall unchanged in size.\nHyperdense blood is seen along the right frontal convexity as well along the\ncatheter tip (in the foramen ___ and third ventricle) is stable from the\nprior examination. As before, a hyperdense focus within the pons (series 3,\nimage 13) is consistent with an intracranial metastatic lesion, not well\nevaluated on CT. A rounded 5 x 6 mm hyperdense focus is more conspicuous on\nthe current examination involving the left parietal lobe (series 3, image 25)\nand corresponds with a metastatic focus on MRI from ___.\n\nParanasal sinuses, mastoid air cells and middle ear cavities are clear. The\noccipital bone, C1 lamina and associated soft tissues of the craniotomy state\nare unremarkable.", + "output": "Focus of extra-axial hemorrhage along the right frontal convexity and adjacent\nto the catheter tip are stable from the prior examination.\n\n6 mm hyperdense focus in the left parietal lobe corresponds with a focal\nmetastatic lesion on prior MRI, however is more conspicuous on the current\nexamination. Given the lesion appears increased in density from the prior\nexamination, this may represent a small, focal area of hemorrhage into the\nmetastatic lesion. Attention on followup exam.\n\nNOTIFICATION: These findings were communicated to ___ via\ntelephone at 18:39 on ___ immediately upon discovery by Dr. ___\n___." + }, + { + "input": "The patient is status post suboccipital craniotomy, unchanged in appearance\nfrom prior exam. The patient is status post right frontal approach EVD\ncatheter with the tip terminating in the region of the foramen of ___,\nunchanged from prior exam. Ventricles are stable in size and configuration\nwithout evidence of hydrocephalus.\n\nThe previously seen hyperdense blood along the right frontal convexity and the\ncatheter tip have resolved in interval. The previously seen 6 mm rounded\nhyperdense focus in the left parietal lobe is slightly less conspicuous on\nthis exam than on the prior exam, but is consistent with metastatic focus seen\non prior MR. ___ is no evidence of new hemorrhage, edema, mass effect, or\ninfarction. The basal cisterns appear patent and there is preservation of\ngray-white matter differentiation.\n\nNo fracture is identified. The visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The globes are unremarkable.", + "output": "1. Stable position of VP shunt with no evidence of hydrocephalus.\n\n2. Interval resolution of previously seen blood along the right frontal\nconvexity and catheter tip.\n\n3. Persistent 6 mm rounded hyperdense focus in the left parietal lobe,\nconsistent with metastatic focus seen on prior MR." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Prominent\nventricles and sulci suggest age related global atrophy. Periventricular and\nsubcortical white matter hypodensities are nonspecific, but likely reflect\nsequelae of chronic small vessel ischemic disease. The basal cisterns appear\npatent and there is preservation of gray-white matter differentiation.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. Bilateral lens surgery is are noted. \nAtherosclerotic calcifications of the carotid siphons are present bilaterally.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. There\nis prominence of the ventricles and sulci suggestive of involutional changes. \nMild bilateral periventricular subcortical white matter hypodensities are\nnoted, unchanged from prior and likely representative of chronic\nmicroangiopathy.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "1. No acute intracranial findings." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territory infarct. Prominence of the\nventricles and sulci is again consistent with global atrophy. Periventricular\nand subcortical white matter hypodensities are similar as compared to the\nprior study, likely due to sequela of chronic small vessel disease. Evidence\nof old lacuner infarcts in the left thalamus and possibly right cerebellum\nagain noted. Gray-white matter differentiation is preserved. The visualized\nparanasal sinuses are clear. The mastoid air cells are clear. No acute\nfracture is seen.", + "output": "No acute intracranial process. Chronic changes again seen." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect or\nlarge territorial infarction. There is no appreciable change since the next\nmost recent study. The ventricles and sulci remain prominent suggesting\nage-related atrophy. There is significant periventricular and subcortical\nwhite matter hypodensities which are nonspecific but may be seen in setting of\nchronic microvascular ischemic disease. There is evidence of chronic lacunar\ninfarcts in the left thalamus and right cerebellum. Gray-white matter\ndifferentiation is preserved. The basal cisterns are patent.\n\nThere is no acute fracture and the included paranasal sinuses, mastoid air\ncells and middle ear cavities are clear. There are atherosclerotic\ncalcifications of the cavernous internal carotid arteries.", + "output": "No acute intracranial abnormality. Chronic microvascular ischemic disease\nwith scattered lacunar infarcts." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territorial infarct. Prominence of the\nventricles and sulci is consistent with cortical volume loss. Periventricular\nand subcortical white matter hypodensities are likely sequelae of chronic\nsmall vessel disease. Chronic lacunar infarcts are re- demonstrated in the\nleft thalamus and right cerebellum. The visualized paranasal sinuses are\nclear. The mastoid air cells are clear. No acute fracture is seen.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage or large vascular\nterritorial infarction, edema, or mass effect. The ventricles and sulci are\nnormal in size and configuration.\n\nNo acute fracture is seen. The visualized portions of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "The patient is status post right parietal craniotomy for tumor resection. The\nhypodense resection bed measures 2.7 x 1.5 cm (2:20). In comparison to the\nMRI from ___, there has been interval increase in the surrounding\nedema with extension of the edema into the right temporal lobe. There is no\nsignificant mass effect.\n\nNo acute intracranial hemorrhage is seen. There is no evidence of new\nfracture. The ventricles and sulci are normal in size and configuration.\n\nThere is mucosal thickening of some ethmoid air cells. There is partial\nopacification of some inferior left mastoid air cells, seen on prior MRI. The\nright mastoid air cells are clear.", + "output": "1. In comparison to the MRI from ___, there is interval increase in\ndegree of surrounding edema at the surgical site in the right parietal lobe. \nNo evidence of significant mass effect. MRI would further assess.\n2. No evidence of acute intracranial hemorrhage.\n\nRECOMMENDATION(S): Recommend MRI for further characterization." + }, + { + "input": "Patient is status post right craniotomy. There is edema underlying the right\ncraniotomy site measuring up to 3.4 x 2.3 cm with locules of air. There is\nvasogenic edema tracking inferiorly. There is subcutaneous gas overlying the\nright scalp. There is a scalp hematoma measuring up to 5.1 x 1.6 cm on the\nright (series 601, image 79). No intracranial hemorrhage. It is difficult to\nrule out abscess given lack of contrast. There is minimal 2-3 mm leftward\nmidline shift.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. Status post right craniotomy with right parietal intraparenchymal edema\nmeasuring up to 3.4 cm with locules of gas. Scalp fluid collection overlying\nthe craniotomy site is identified. No evidence of acute intracranial\nhemorrhage. An abscess is difficult to rule out without contrast\nadministration.\n2. 2-3 mm leftward midline shift." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are normal in size and configuration.\n\nNote is made of enlarged lucency related to the roots of the first and second\nleft maxillary molars, with a small defect noted in the floor of the left\nmaxillary antrum, with adjacent mild mucosal thickening and a mucous retention\ncyst inferiorly in the left maxillary sinus. This may represent a periapical\ngranuloma, however dental infection is not excluded. The visualized portion of\nthe paranasal sinuses, mastoid air cells,and middle ear cavities are otherwise\nclear. The visualized portion of the orbits are normal.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. Note is made of fetal\norigin of the right posterior cerebral artery. The dural venous sinuses are\npatent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion.\n\n\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No acute intracranial abnormality or intracranial mass is identified.\n2. Note is made of enlarged lucency related to the roots of the first and\nsecond left maxillary molars, with a small defect noted in the floor of the\nleft maxillary antrum, with adjacent mild mucosal thickening and a mucous\nretention cyst inferiorly in the left maxillary sinus. This may represent a\nperiapical granuloma, however dental infection is not excluded.\n3. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n4. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection." + }, + { + "input": "No fractures are identified.\nSoft tissue swelling is noted overlying the right orbit and zygoma.\nThere is mild mucosal thickening in the left ethmoidal air cells and left\nfrontoethmoidal recess, causing narrowing of the left infundibulum (image 68,\nseries 601), there is mild mucosal thickening in the lateral recess of the\nleft sphenoid sinus and small mucous retention cyst in the left maxillary\nsinus, no air-fluid levels are seen. Mild nasal septum deviation towards the\nleft with small bone spur formation, better depicted in the coronal\nreformations.\nThere is no evidence of abnormal fluid collections.\nBilateral mastoids appear normal.\nThe globes, extraocular muscles, optic nerves, and retrobulbar fat appear\nnormal.\nThe visualized upper aerodigestive tract appears normal.\nThe mandible and temporomandibular joints appear normal.\nBorderline enlarged bilateral level IIa lymph nodes measuring 1.2 cm or less\nare likely reactive.", + "output": "1. No acute maxillofacial fractures are identified.\n2. Soft tissue swelling is identified overlying the right orbital zygoma.\n3. Borderline enlarged bilateral level IIa lymph nodes measuring up to 1.2 cm,\nprobably reactive in nature." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are within normal limits for patient's age.\n\nAside from mild changes of hyperostosis frontalis interna, no osseous\nabnormalities are noted. There is mucosal thickening of the frontal and\nsphenoid sinuses and ethmoid air cells. The patient is status post bilateral\nmaxillary sinus antrostomy. Sclerotic thickening of the maxillary sinus wall\nis consistent with sequelae of chronic sinusitis. There is partial bilateral\nmastoid air cell opacification. Carotid siphon calcifications are noted. The\nglobes and bony orbits are intact and unremarkable.", + "output": "1. No acute intracranial process.\n2. Pansinus mucosal thickening and postsurgical changes, as detailed above." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction, mass or midline\nshift. There is no hydrocephalus. There is a large arachnoid cyst in the left\ntemporo-parieto-frontal region measuring 7.7 x 4.5 cm. There is mild mucosal\nthickening and mucous retention cysts in the maxillary sinuses bilaterally,\notherwise the visualized paranasal sinuses and mastoid air cells are clear. \nThere is no fracture.", + "output": "No acute intracranial process. No fracture. Large arachnoid cyst in the left\ntemporo-frontal region" + }, + { + "input": "Head CT: Evolving subacute left temporoparietal infarct is identified,\npreviously demonstrated by MRI on ___, there is no evidence of\nhemorrhagic transformation or significant mass effect. The ventricles and\nsulci are slightly prominent for the patient's age, suggesting mild cortical\nvolume loss. The soft tissues and cranial bony structures are grossly\nunremarkable, the paranasal sinuses and the mastoid air cells are clear.\n\nHead and neck CTA: The carotid and vertebral arteries and their major branches\nare patent with no evidence of stenoses. The distal cervical internal carotid\narteries measure 5.5 mm in diameter on the left and 5.9 mm in diameter on the\nright. The right vertebral artery appears dominant, the basilar artery\nappears patent. There is no evidence of aneurysm formation or other vascular\nabnormality. Punctate arthrosclerotic calcifications are demonstrated in the\naortic arch. Mild multilevel degenerative changes are present throughout the\ncervical spine, consistent with posterior spondylosis, more significant at\nC5-C6, and C6/C7 levels. The lung apices are clear, and the cervical soft\ntissues are unremarkable.", + "output": "Evolving subacute left temporal parietal infarct, grossly unchanged in\ncomparison with the prior MRI dated ___ from an outside institution.\n\nThere is no evidence of intracranial hemorrhage or mass effect.\n\nCTA of the head and neck appears grossly unremarkable with no evidence of flow\nstenotic lesions or aneurysms." + }, + { + "input": "Hypodense region centered in the subcortical white matter of the left parietal\nlobe has not changed in appearance since ___ (2:20). There is no\nhemorrhage or shift of normally midline structures. The ventricles and sulci\nare mildly prominent, consistent with age related involutional changes. The\nbasal cisterns are patent. The visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear.", + "output": "Unchanged hypodense region in the left parietal lobe. Given its stability\nover 3 days and comparison with outside MRI, this is unlikely to represent an\ninfarction. A malignancy such as a glioma is far more likely.\n\nNOTIFICATION: Findings were discussed by Dr. ___ Dr. ___ with\nDr. ___ by phone at 12:19 on ___ (5 min after discovery)." + }, + { + "input": "Postoperative changes from a left parietal craniotomy and biopsy with a small\npneumocephalus and trace blood products layering within the biopsy bed. Re-\ndemonstration of the adjacent roughly 46 x 40 mm left parietal hypodense mass\nwith internal calcifications corresponding to lesion seen on prior MR. ___\nis no evidence of infarct. The ventricles and sulci are unchanged in size and\nconfiguration. .\nThere is no evidence of fracture apart from the craniotomy site. The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "Expected postoperative changes from left parietal craniotomy and biopsy, as\nabove" + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass. The ventricles and sulci are enlarged consistent with atrophy. Severe\nperiventricular, deep, and subcortical white matter hypodensities are\nnonspecific but likely reflect the sequela of chronic small vessel ischemic\ndisease. More focal hypodensities in the left thalamus and right corona\nradiata likely reflect chronic lacunes (02:23).\n\nNo acute osseous abnormalities seen. The paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The orbits are unremarkable apart from\nbilateral lens replacements. .", + "output": "Marked cerebral atrophy and chronic small vessel ischemic disease without\nevidence of acute intracranial hemorrhage. Please note that MRI is more\nsensitive for detection of acute infarction." + }, + { + "input": "A left subdural hematoma overlying the left cerebral convexity measures up to\n1.6 cm from the inner table is mixed in attenuation, predominantly hypodense\nto isodense in attenuation with several foci of hyperdensity consistent with\nat least a component of acute or subacute bleeding on a background of chronic\nhematoma. As the prior examination is not available at the time of dictation,\ncannot comment on a change in size. The adjacent sulci and left lateral\nventricle are effaced and there is 11 mm of rightward midline shift (series 2,\nimage 18). No loss of gray-white matter differentiation to suggest large\nterritorial infarction. No mass or edema. Basal cisterns are patent.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. There is mild\nrightward nasal septum deviation. The visualized portion of the orbits are\nunremarkable.", + "output": "Large left subdural hematoma overlying the left cerebral hemisphere with mass\neffect resulting in 11 mm of rightward midline shift, likely acute/subacute on\nchronic in age. The reported prior examination is not available at the time\nof dictation to assess for change in size/mass effect." + }, + { + "input": "There has been interval evacuation of the left convexity subdural hematoma\nwith expected postsurgical changes including pneumocephalus and placement of a\nleft subdural drain which tracks anterior to posterior and terminates in the\nsubdural space overlying the left frontal lobe. There has been decreased size\nof the left subdural fluid collection with residual fluid and high-density\nblood products adjacent to the left craniotomy site which measures 10 mm\nmaximally, previously 13 mm. Mass effect on the left lateral ventricle is\nslightly decreased. There is substantially decreased rightward midline shift\nnow measuring 7 mm, previously 11 mm. The basal cisterns remain patent. \nThere is no evidence of infarct or new hemorrhage.", + "output": "Interval left subdural hematoma evacuation with substantially decreased\nmidline shift now measuring 7 mm." + }, + { + "input": "Previously seen small left frontal subdural hematoma is isodense on today's\nscan and has evolved, and slightly decreased, measuring 0.5 cm, compared with\n0.5 cm on prior. Left parietal craniotomy.\n\nThere is no evidence of infarction,new hemorrhage,edema,or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Trace opacification left maxillary sinus. \nOtherwise, the visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "Decreased size and density of small subdural hematoma.\nNo new hemorrhage." + }, + { + "input": "Patient is status-post left frontal cranioplasty. Interval removal of a\nsubdural drainage catheter since 5 days prior. Interval decrease in\npneumocephalus. A left hemispheric subdural hematoma with mixed low and high\ndensity blood products is otherwise unchanged. Effacement of the adjacent\nsulci and approximately 7 mm of midline shift are unchanged. There is no\nevidence of new intracranial hemorrhage,infarction,edema,or mass. The\nventricles and sulci are normal in size and configuration.\n\nA surgical staple is located in the soft tissues overlying the left frontal\nbone (series 2, image 20). There is no evidence of acute fracture. The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "Interval removal of a left subdural drainage catheter with decreased\npneumocephalus. Otherwise, unchanged left hemispheric subdural hematoma with\napproximately 7 mm of rightward midline shift. No evidence of new\nintracranial hemorrhage." + }, + { + "input": "Patient is status post left frontoparietal craniotomy and evacuation of the\nmixed density subdural hematoma. There has been interval resolution of the\npneumocephalus. The pre-existing mixed density subdural hematoma has mostly\nresolved. However, there is a 7 mm extra-axial hyperdensity subjacent to the\ncraniotomy site. While this may represent dural thickening, the anterior\nextension is concerning for a new site of subdural hemorrhage. No midline\nshift is seen.\nThe mucosal thickening of the ethmoid air cells is mild. The visualized\nportion of the remaining paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear.", + "output": "7 mm left frontal extra-axial hyperdensity subjacent to the craniotomy site. \nWhile this may represent dural thickening, the degree of thickening and\nanterior extension is suspicious for new subdural hematoma. No midline shift.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 8:10 pm, 5 minutes after discovery of\nthe findings." + }, + { + "input": "There is no acute intracranial hemorrhage, edema, mass effect, or evidence of\nlarge acute vascular territorial infarction. There is an old left frontal\ninfarction with encephalomalacia and ex vacuo dilation of the frontal horn of\nthe left lateral ventricle. Otherwise, the ventricles and sulci are normal in\nsize and configuration. There is no fracture. The imaged paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear.", + "output": "No acute intracranial abnormality. Old left frontal infarction as above." + }, + { + "input": "CT HEAD:\nEmbolization material is noted within the left cerebellar hemisphere. Trace\namounts of residual hyperdensity surrounding this embolization material likely\nrepresents minimal residual hemorrhage. No evidence for new/acute\nintracranial hemorrhage.\n\nOtherwise, no evidence for vascular territorial infarction, mass effect, or\nmidline shift. The ventricles and sulci are normal in size and appearance.\n\n The paranasal sinuses, middle ear cavities, and mastoid air cells are clear.\nThe orbits are grossly unremarkable bilaterally.\n\n\nCTA HEAD AND NECK:\nWithin the left cerebellar hemisphere, there is again seen a tangle of vessels\nthat measures approximately 3.3 x 1.8 cm (14:3 and 32), demonstrating some\nareas of internal partial embolization. This compatible the patient's known\narteriovenous malformation, overall similar as compared to the prior CT\nexamination performed on ___.\n\nA three-vessel aortic arch is noted. The vertebral arteries are patent\nwithout high-grade stenosis or occlusion. The bilateral common carotid\narteries are patent. There is no evidence of internal carotid stenosis by\nNASCET criteria.\n\n The vessels of the circle of ___ and their principal intracranial branches\nare patent without high-grade stenosis, occlusion, or aneurysm formation. The\ndural venous sinuses are patent.\n\n\nOTHER:\nThe lung apices demonstrate mild centrilobular emphysematous changes\nbilaterally. No suspicious pulmonary nodule or consolidation. The thyroid\ngland is unremarkable in appearance. There is no cervical lymphadenopathy by\nCT size criteria.", + "output": "1. Stable appearance of a known, partially embolized arteriovenous\nmalformation within the left cerebellar hemisphere.\n2. Expected evolution with decreased conspicuity of minimal residual\nhemorrhage seen in the vicinity of the left cerebellar AVM.\n3. No evidence for new/acute intracranial hemorrhage. No vascular territorial\ninfarction.\n4. Patent intracranial and cervical vasculature without high-grade stenosis,\nocclusion, or dissection." + }, + { + "input": "The patient is status post left cerebellar AVM embolization. Embolization\nmaterial is seen within the left cerebellum, with extensive adjacent streak\nartifact. Allowing for artifact, no evidence for new blood products is seen,\nand hypodensity in the left cerebellum does not appear significantly changed. \nThe fourth ventricle is obscured by streak artifact. However, the third and\nlateral ventricles are stable in size.\n\nThe bones are grossly unremarkable. The visualized paranasal sinuses and\nmastoid air cells appear grossly well-aerated.", + "output": "1. Allowing for streak artifact from embolization material in the left\ncerebellum, there is no evidence for new hemorrhage. Hypodensity in the left\ncerebellar hemisphere appears grossly stable.\n2. Stable size of the third and lateral ventricles. The fourth ventricle is\nobscured by streak artifact." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is a 5 mm subgaleal hematoma overlying the right vertex, with no\nunderlying fracture (601:51). The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. 5 mm subgaleal hematoma overlying the right vertex, with no underlying\nfracture." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass or recent infarction. The\nventricles and sulci remain dilated in an atrophic pattern. There is unchanged\nleft posterior temporal and parietal tissue loss and dilatation of the\nadjacent atrium of the left lateral ventricle. These findings are likely a\nconsequence of old infarction. No osseous abnormalities seen. The paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "No evidence hemorrhage or recent infarction. Ventricular dilatation in an\natrophic pattern. Old left posterior temporal and parietal tissue loss likely\ndue to chronic infarction." + }, + { + "input": "HEAD CT:\n\nThere is no acute intracranial hemorrhage. No acute major vascular territorial\ninfarct is identified. There is left temporal/parietal encephalomalacia with\nex vacuo dilatation of the left lateral ventricle, consistent with a chronic\ninfarct within the left middle cerebral artery territory. The ventricles and\nsylvian fissures are large, consistent with parenchymal volume loss. Volume\nloss has progressed from the earliest available comparison CT date ___, but is similar to the most recent comparison from ___.\n\nNo suspicious calvarial lesions are identified. There is near-complete\nopacification of the ethmoid, sphenoid, and left greater than right maxillary\nsinuses, new from CT on ___. There is partial opacification of the\nfrontal sinuses, left greater than right. The mastoid air cells and tympanic\ncavities are clear. There has been prior bilateral lens surgery.\n\nNECK CTA:\n\nThere is 3 vessel aortic arch anatomy. There is moderate calcification of the\naortic arch.\n\nThere is mild calcification of the origin of the left subclavian artery\nwithout flow-limiting stenosis. The proximal left vertebral artery is\ntortuous. The left vertebral artery is widely patent.\n\nThere is mild calcification of the proximal right subclavian artery without\nflow-limiting stenosis. The cervical right vertebral artery widely patent; it\nenters the foramen transversarium at C4, a developmental variant.\n\nThe left common carotid artery is normal. There is calcification of the\nproximal left internal carotid artery but no stenosis by NASCET criteria. The\nleft external carotid artery is normal. The right common carotid artery has a\nmedialized course posterior to the right thyroid lobe. The right common\ncarotid artery is otherwise normal. There is mild calcification of the origins\nof the internal and external carotid arteries. There is no stenosis of the\nright internal carotid artery by NASCET criteria. Distal cervical internal\ncarotid arteries measure 3.9 mm on the right and 5.3 mm on the left.\n\nHEAD CTA:\n\nThere is calcification of the carotid siphons without flow-limiting stenosis.\n\nThere is a high-grade focal stenosis of the proximal inferior division of the\nleft middle cerebral artery (series 601b image 19). This stenosis appears to\nbeen present on contrast enhanced MPRAGE sequences from MRIs on ___\nand ___. The right middle cerebral artery is unremarkable.\n\nThere is irregularity of the proximal A2 segment of the left anterior cerebral\nartery with mild narrowing (series 601b image 17). This stenosis appears to\nbeen present on contrast enhanced MPRAGE sequences from MRIs on ___\nand ___. The right anterior cerebral artery is unremarkable. The\nanterior communicating artery complex is unremarkable.\n\nThe intracranial vertebral arteries and basilar arteries are unremarkable. The\nsuperior cerebellar arteries are remarkable. There is high-grade focal\nnarrowing of the proximal P2 segment of the right posterior cerebral artery\n(series 601b image 23). This stenosis appears to been present on contrast\nenhanced MPRAGE sequences from MRIs on ___ and ___. The\nleft posterior cerebral artery is unremarkable.\n\nThe major dural venous sinuses are patent.\n\n\nOTHER FINDINGS:\n\n\n\nThere is a 1.9 cm right level IIA lymph node (series 5, image 145). There is\nan enlarged 1.3 cm precarinal lymph node. There are several prominent 9 mm\nright paratracheal lymph nodes, not pathologically enlarged by CT criteria. \nThere is a 2.0 cm coarsely calcified nodule in the lower pole of the left\nthyroid lobe. Visualized upper lungs are clear.", + "output": "1. No evidence of acute intracranial abnormalities. MRI would be more\nsensitive for an acute infarction, if clinically warranted.\n2. Chronic left middle cerebral artery territory infarct involving the left\nparietal lobes, as seen on prior studies. Progression of global cerebral\nvolume loss since ___.\n3. Focal high-grade stenoses of the proximal inferior division of the left\nmiddle cerebral artery and proximal P2 segment of the right posterior cerebral\nartery. Irregularity and mild narrowing of the proximal A2 segment of the\nleft posterior cerebral artery. Allowing for differences in technique, these\nstenoses appear to have been present on contrast enhanced MPRAGE sequences\nfrom MRIs dated ___ and ___. Their chronicity is\nconsistent with sequela of atherosclerotic disease.\n4. New opacification of the paranasal sinuses compared to CT from ___. Please correlate with symptoms.\n5. Mildly enlarged 1.9 cm right level IIA lymph node. Mildly enlarged 1.3 cm\nprecarinal lymph node and several prominent 9 mm right paratracheal lymph\nnodes. Please correlate clinically.\n6. 2 cm calcified left thyroid nodule. While ultrasound will demonstrate\nextensive shadowing due to the calcification within this nodule, it it could\nbe attempted to evaluate for any potential noncalcified soft tissue\ncomponents." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or infarction. The\nventricles and sulci are normal in size and configuration. There is no\nfracture. Aside from minimal mucosal thickening in the ethmoid air cells, the\nimaged paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear.", + "output": "Minimal paranasal sinus mucosal thickening. Otherwise normal study." + }, + { + "input": "CT head: The gray-white matter differentiation is intact without acute\nterritorial infarct, hemorrhage, or mass effect. There is mineralization of\nthe left globus pallidus. There is linear hypodensity within the right corona\nradiata (02:20) the extra-axial spaces are unremarkable. The orbits, soft\ntissues, and calvarium are unremarkable. The paranasal sinuses, mastoid air\ncells, and middle ears are clear.\n\nCTV head: There is normal enhancement of the major cortical veins, deep\nveins, and dural venous sinuses, without evidence of thrombosis. The\nintracranial internal carotid arteries are patent. The anterior bilateral\nposterior communicating arteries are visualized. The arterial vasculature is\npatent, without occlusion, dissection, or aneurysm. .", + "output": "1. No acute intracranial abnormality.\n2. Patent intracranial vasculature, without evidence of venous sinus\nthrombosis.\n3. Linear hypodensity within the right corona radiata which is nonspecific and\nmay represent prominent perivascular spaces versus white matter disease. This\ncould be further characterized with a dedicated head MRI, if it would change\nclinical management." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. No evidence of acute intracranial hemorrhage or fracture." + }, + { + "input": "The large area of left frontoparietal encephalomalacia which extends\ninferiorly and appears to involve the anterior limb of the left external\ncapsule, as well as a smaller focus of encephalomalacia in the left occipital\nlobe, are compatible with sequelae of prior infarct, better assessed on MRI\nfrom ___. Otherwise, there is no evidence of hemorrhage, acute\ninfarction, mass, edema, or mass effect. Prominence of the ventricles and\nsulci is compatible with age-related global involutional change. \nPeriventricular and subcortical white matter hypodensities are consistent with\nsequelae of chronic small vessel ischemia. Bilateral basal ganglia\ncalcifications are identified.\n\nDiffuse pansinus mucosal thickening, with associated diffuse sclerotic\nthickening of the adjacent bones, is compatible with sequelae of chronic\nsinusitis. The mastoid air cells are clear. Bilateral carotid siphon\ncalcifications are noted. The globes and bony orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Foci of encephalomalacia in the left frontoparietal lobe and left occipital\nlobe, sequelae of prior infarct, better seen on MRI from ___.\n3. Chronic findings including white matter small vessel ischemic changes,\nage-related global involutional change, and changes related to chronic\nsinusitis." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass effect. Re-demonstration of encephalomalacia involving the left\nfrontal and occipital lobes, unchanged, compatible with chronic infarction. \nThere is prominence of the ventricles and sulci suggestive of age-related\nvolume loss. Periventricular and subcortical white-matter hypodensities are\nnonspecific, but likely represent sequela of chronic small vessel disease. \nModerate atherosclerotic calcifications of the cavernous carotid and distal\nleft vertebral arteries are noted.\n\nThere is no evidence of acute fracture. There is mild mucosal thickening in\nthe bilateral sphenoid sinuses and ethmoid air cells. Moderate mucosal\nthickening is seen in the bilateral maxillary sinuses with surrounding bony\nsclerosis likely reflective chronic sinusitis. The visualized portion of the \nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "No acute intracranial abnormality or acute fracture." + }, + { + "input": "There is encephalomalacia along the left frontoparietal region and left\noccipital lobe compatible with chronic infarction. There is also focal\nencephalomalacia of the right frontal lobe near the vertex (series 2: Image\n26) likely due to chronic infarction.\n\nThere is no evidence of hemorrhage, edema, shift of normally midline\nstructures, or infarction. Prominent ventricles and sulci compatible with\nage-related involutional changes. Periventricular subcortical white matter\nhypodensities likely represent chronic small vessel ischemic disease. There\nare mild atherosclerotic calcifications of the bilateral carotid siphons.\n\nThere is mucosal thickening in the bilateral ethmoid air cells and bilateral\nmaxillary and sphenoid sinuses. Frontal sinuses appear absent or\nunderpneumatized. Mastoid air cells and middle ear cavities are patent. \nThere is no evidence of fracture.", + "output": "1. No evidence of hemorrhage or recent infarction.\n2. Encephalomalacia in the left frontoparietal region, left occipital lobe,\nand right frontal lobe likely from chronic infarction." + }, + { + "input": "There is a subtle focus of increased density in the right sylvian fissure,\nseries 700b;image 50, likely secondary to artifact however a focus of\nsubarachnoid hemorrhage cannot be excluded. No other foci of hemorrhage are\nidentified. The ventricles and sulci are normal in size and configuration.\nThe basilar cisterns are patent and there is otherwise good preservation of\ngray-white matter differentiation.\n\nNo acute fractures identified. No soft tissue calcification or radiopaque\nforeign bodies seen. The visualized paranasal sinuses, mastoid air cells and\nmiddle ear cavities are clear.", + "output": "Subtle focus of increased density in the right sylvian fissure (700b;46-48),\nis likely secondary to artifact however a small focus of subarachnoid\nhemorrhage cannot be excluded. A repeat CT in 6 hrs is recommended to\nevaluate for interval change. No fractures identified." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. There are slightly age advanced involutional changes. Ventricles\nappear normal in size. Basal cisterns are patent. The imaged paranasal\nsinuses appear well aerated. The mastoid air cells and middle ear cavities\nare clear. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "The patient has undergone interval left frontal craniotomy and left MCA\nbifurcation aneurysm clipping. Expected postsurgical changes are noted\nincluding pneumocephalus and a small amount of extra-axial blood underlying\nthe craniotomy site. The postsurgical pneumocephalus exerts mild mass effect\non left frontal lobe. There is no significant midline shift. Postsurgical\nsoft tissue changes are noted overlying the craniotomy site. No evidence of\nacute infarct is seen. The visualized paranasal sinuses, mastoid air cells\nand middle ear cavities are clear. The orbits are unremarkable.", + "output": "Expected postsurgical changes following left frontal craniotomy and left MCA\naneurysm clipping including pneumocephalus and small amount of hemorrhage\nunderlying the craniotomy site." + }, + { + "input": "There is no evidence of intracranial hemorrhage, edema, or mass. Hypodensity\nin the central midbrain could represent an acute/subacute infarct versus\nartifact (3:12, 602:42). The ventricles and sulci are mildly prominent for\nage suggesting mild involutional change. Periventricular and subcortical\nwhite matter hypodensities are nonspecific but in a distribution that suggests\nchronic microangiopathy. No acute fracture. Sclerotic foci in the bilateral\nfrontal, temporal, and sphenoid bones, and zygomatic arches suggests bone\nislands, although nonspecific. Partially visualized right nasal tube. Fluid\nin the nasopharynx and ethmoid sinuses likely due to recent intubation. No\nosseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No intracranial hemorrhage\n2. Hypodensity in the central midbrain could represent an acute/subacute\ninfarct versus artifact. MRI could further assess.\n3. Fluid in the nasopharynx and ethmoid sinuses compatible with recent\nintubation.\n4. Few sclerotic osseous foci suggest bone islands, nonspecific." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThe area of mid brain hypodensity noted on the head CT of ___ is not\nseen on the current examination. If further evaluation of the possibility of\ninfarction is indicated, the brain MR examination may be helpful. There is no\nevidence of infarction, hemorrhage, edema, mass, or mass effect. The\nventricles and sulci are prominent, compatible with global parenchymal volume\nloss. Periventricular and bilateral ill-defined foci of deep white matter\nhypodensity are nonspecific but compatible with mild-to-moderate changes of\nchronic white matter microangiopathy. There is no displaced calvarial\nfracture.\n\nThere is trace ethmoid air cell mucosal thickening and mild sphenoid sinus\nmucosal thickening with layering fluid dependently. The remaining visualized\nparanasal sinuses, mastoids, middle ear cavities appear clear.\n\nThere is symmetric bilateral proptosis. Enteric and endotracheal tubes are\nseen in situ; notably, the nasoenteric tube is coiled within the oral cavity.\nCarotid siphon calcifications are noted bilaterally.\n\nCTA HEAD:\nWidely patent distal vertebral and basilar arteries. Conventional bilateral\nPCA anatomy. Widely patent posterior cerebral arteries with preserved distal\nrunoff bilaterally.\n\nThere is mild to moderate calcified plaque affecting the cavernous and\nparaclinoid intracranial ICAs bilaterally, causing areas of mild luminal\nnarrowing.\n\n Otherwise, the remaining portions of the bilateral intracranial internal\ncarotid arteries and the bilateral anterior and middle cerebral arteries are\npatent with normal distal runoff.\n\nNo large vessel occlusion. No aneurysm.\n\n Major dural venous sinuses are patent.\n\nCTA NECK:\nCalcified plaque at the right carotid bulb and proximal right extracranial ICA\ncauses approximately 20% luminal narrowing by NASCET criteria. There is mild\nnoncalcified plaque along the right anterolateral aspect of the mid and distal\nright common carotid artery, causing mild luminal narrowing. The remainder of\nthe right extracranial carotid artery is unremarkable.\n\nMild calcified plaque at the origin of the left common carotid artery causes\nmild luminal narrowing. Remainder of the left common carotid artery is\nunremarkable. There is mild calcified plaque at the left carotid bulb, not\ncausing left ICA luminal narrowing by NASCET criteria.\n\nCalcified plaque at the origin of the right vertebral artery causes severe\nluminal narrowing (see series ___. The remainder of the right\nextracranial vertebral artery is widely patent, unremarkable.\n\nThe extracranial left vertebral artery is normal.\n\nThere is mild calcified plaque at the aortic arch affecting the arch branch\nvessel origins, which are patent. There is calcified and noncalcified\natheromatous plaque moderately narrowing the lumen of the proximal left\nsubclavian artery (03:43).\n\nOTHER:\nSecretions surround endotracheal and enteric tubes in the aorta digestive\ntract. Multiple maxillary and mandibular periapical lucencies are noted. 2\nmm nodule, right lung apex (___). 2 mm nodule, left lung apex (___). \nThese of slight associated ground-glass haze, possibly infectious or\ninflammatory. There is linear atelectasis in the dependent right upper lobe. \nThere is no pathologic cervical adenopathy.", + "output": "1. No evidence of mass, hemorrhage or infarction. The hypodensity in the\nbrainstem seen on the head CT of ___ is not detected on the current\nexamination. If further evaluation is indicated, consider MR imaging.\n2. Mild-to-moderate calcified plaque, mild luminal narrowing, intracranial\nICAs bilaterally. Otherwise, widely patent and normal circle of ___. No\naneurysm or large vessel occlusion.\n3. Patent bilateral extracranial vertebral and carotid arteries. Calcified\nplaque causes 20% luminal narrowing of the right extracranial ICA by NASCET\ncriteria. Severe luminal narrowing of the right vertebral artery origin due\nto calcified plaque. Remainder of the vertebral and carotid arteries are\nwidely patent.\n4. Ill-defined hypodensity in the supratentorial white matter bilaterally most\nlikely represents moderate changes of chronic white matter microangiopathy,\nhowever if there is clinical concern for subacute ischemia, consider MRI for\nfurther evaluation.\n5. Note made of coiling of the nasoenteric tube in the oral cavity; correlate\nwith visual inspection and consider repositioning.\n6. Biapical sub-5 mm pulmonary nodules are likely infectious or inflammatory. \nOther incidental findings, as above.\n\nRECOMMENDATION(S): If there is clinical concern for acute or subacute\nischemia, MRI is more sensitive for detection of infarction." + }, + { + "input": "Both palatine tonsils are enlarged and hyperemic, contacting each other and\ncausing mild narrowing of the airway. However, the majority of the\naerodigestive tract remains patent. There is a 2.3 x 1.9 x 2.1 cm\nperitonsillar abscess on the left (02:35). There is also right palatine\ntonsillar edema with areas of lower attenuation consistent with inflammatory\nphlegmon/ developing abscess measuring up to 4 x 9 mm (02:33). There is\neffacement of the left piriform sinus secondary to edema as well as mucosal\nthickening and edema within the left lateral and posterior aspect of the\nhypopharynx.\n\nThe parotid, sublingual, and submandibular salivary glands enhance normally\nand are without mass or adjacent fat stranding.\n\nThe thyroid gland appears normal.\n\nThere are bilateral level II enlarged reactive lymph nodes, more so on the\nleft, measuring up to 15 mm in diameter (02:40).\n\nThe neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. Residual thymic tissue is noted in the anterior\nmediastinum.\n\nThere are no concerning focal osseous lesions.\n\nThere is complete opacification and atelectasis of the right maxillary sinus\nand sclerotic walls. A mucous retention cyst is identified in the left\nmaxillary sinus.", + "output": "Bilateral palatine tonsillitis with 2.3 x 1.9 x 2.1 cm peritonsillar abscess\non the left, with smaller 4 x 9 mm developing peritonsillar abscess on the\nright. No evidence of deep space infection. Reactive cervical\nlymphadenopathy." + }, + { + "input": "Trace bilateral maxillary and right sphenoid sinus mucosal thickening is\npresent. A mucous retention cyst versus polyp is noted within infundibulum of\nthe left maxillary sinus. The ostiomeatal units are patent. The cribriform\nplates are intact. There is no nasal septal defect. There is leftward nasal\nseptal deviation. The left anterior clinoid processes is pneumatized and the\nright is not. The lamina papyracea are intact. The sphenoid sinus septum is\nmidline with insertion upon thesellar floor.\n\nThe nasogastric tubes are partially imaged. Scout imaging demonstrates\npostsurgical changes related to patient's known bifrontal craniotomies.", + "output": "1. Minimal paranasal sinus disease including left maxillary sinus mucous\nretention cyst versus polyp as described.\n2. Leftward nasal septal deviation." + }, + { + "input": "Patient motion partially limits evaluation.\n\nThere is a large right frontal lobe parenchymal hemorrhage measuring\napproximately 5.9 x 5.4 cm (___). This hemorrhage causes mass effect with\npartial effacement of the body of the right lateral ventricle and\napproximately 0.7 cm of right to left midline shift. There is a smaller\nhemorrhage in the right parietal parietal lobe, measuring 2.7 x 3.7 cm. In\naddition, there is associated subarachnoid blood in the bilateral frontal and\nparietal lobes as well as the right temporal lobe. There is secondary\nasymmetry of the suprasellar cisterns with impending right uncal herniation.\n\nThe sulci and ventricles are prominent, consistent with moderate\nage-appropriate involutional changes. Right posterior temporal region of\nencephalomalacia suggest prior infarct.\n\nThere is no definite evidence of fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. \nStatus post bilateral lens replacements. Soft tissue swelling in the right\ntemporal and periorbital regions are noted.", + "output": "1. There is a large right frontal parenchymal hemorrhage, measuring\napproximately 5.9 x 5.4 cm (___) which causes mass effect with narrowing of\nthe body of the right lateral ventricle and approximately 0.7 cm of right to\nleft midline shift. Suprasellar cisterns are patent at this time but there is\nimpending right uncal herniation.\n2. There is a smaller hemorrhage in the right parietal lobe, measuring 2.7 x\n3.7 cm.\n3. Bilateral frontal, parietal, and right temporal lobe subarachnoid blood.\n4. No definite fracture." + }, + { + "input": "Compared to 10:54, interval increase in density of the previously seen large\nright frontal and right parietal parenchymal hemorrhages. There has been\ninterval blossoming of a left frontal lobe contusion (02:21). There is new\nblood layering in the body and occipital horn of the right lateral ventricle\nand left occipital horn. Drastic interval increase in subarachnoid blood with\nblood tracking throughout the basal cisterns and throughout the posterior\nfossa. No significant change in right to left midline shift, measuring 0.8\ncm. There may be slight interval enlargement of the left lateral ventricle\nand size of the third ventricle raising concern for developing hydrocephalus.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Compared to 10:54, dominant right frontal and right parietal parenchymal\nhemorrhages now appear more dense with similar degree of mass effect.\n2. Interval development of massive subarachnoid and intraventricular blood.\n3. No significant change in right to left midline shift, measuring 0.8 cm.\n4. Slight interval enlargement of the left lateral and third ventricles\nraising concern for developing hydrocephalus." + }, + { + "input": "Inthe right parieto-occipital lobe, there is a 2.2 x 6.1 cm hypodense area\nwith adjacent contiguous area of hyperdensity. . This appears to have subtle\nmass-effect with mild effacement of the atrium of the right lateral ventricle.\nThere is no shift of normally midline structures. Gray-white matter\ndifferentiation is preserved. Subcortical scattered white-matter hypodensities\nare seen, nonspecific though thought to reflect sequela of chronic small\nvessel ischemic disease. Basal cisterns are patent.\n\nNo fracture is identified. Visualized paranasal sinuses demonstrate mild\nethmoidal air cell mucosal thickening. Mastoid air cells and middle ear\ncavities are clear. Vascular calcifications of the carotid siphon are noted.", + "output": "Right parieto-occipital 2.2 x 6.1 cm predominantly hypodense lesion with\nadjacent contiguous area of hyperdensity. These findings are suggestive of\nsubacute hemorrhage. No significant mass effect.\n\nNOTE ON ATTENDING REVIEW:\n\nThe above findings represent acute-subacute infarct rather than primary\nhemorrhage.\nThe slightly dense focus represents part of the occipital lobe cortex rather\nthan hemorrhage.\n\nNOTIFICATION: Findings were communicated to Dr. ___ at 18:41 on ___ via telephone by Dr. ___ at the time study was reviewed." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nScattered paranasal sinus mucosal thickening, mucous retention cysts and\nopacification of bilateral mastoid air cells is consistent with prolonged\nsupination in the inpatient setting or intubation. Specifically, there is\nmoderate to large amount of mucosal thickening and mucous retention cysts in\nthe bilateral maxillary sinuses, right greater than left. Middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable. An\nendotracheal tube is incidentally noted.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. Nonspecific right sternocleidomastoid subcutaneous emphysema is\nnotes, which may be procedures related (see series 4, image 102).", + "output": "1. Dental amalgam streak artifact limits study.\n2. No evidence of acute intracranial abnormalities.\n3. No evidence of dissection, occlusion, aneurysm >3mm, or definite flow\nlimiting stenosis." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is an ill-defined hypodensity in the left corona radiata, new since the\nCT head from ___, without associated mass effect. No acute\nhemorrhage. Age-appropriate size of the ventricles and sulci. Basal cisterns\nare preserved.\n\nParanasal sinus disease is again demonstrated. Moderate polypoid mucosal\nthickening and mucous retention cyst in the maxillary sinuses are similar to ___. There is moderate mucosal thickening of the left anterior\nethmoid air cells, slightly improved compared to the ___. \nAerosolized secretions and moderate mucosal thickening in the left frontal\nsinus are seen, compared to prior fluid and moderate mucosal thickening. \nRight frontal sinus is hypoplastic. Aeration of the right anterior ethmoid\nair cells has improved with mild mucosal thickening. Complete opacification\nof bilateral posterior ethmoid air cells has worsened. There's moderate\nmucosal thickening with mucous retention cysts and aerosolized secretions in\nthe right sphenoid sinus, which has worsened. There's mild mucosal thickening\nin the left sphenoid sinus, which is unchanged.\n\nPartial bilateral mastoid air cell opacification is noted. There's presumed\ncerumen within bilateral external auditory canals.\n\nThe orbits appear unremarkable.\n\nCTA NECK:\nConventional branching of the aortic arch. Great vessel origins are widely\npatent. There is minimal calcified plaque at the right common carotid artery\nbifurcation. There is no right or left carotid stenosis by NASCET criteria. \nBilateral cervical vertebral arteries are widely patent.\n\nCTA HEAD:\nThere is minimal calcified plaque in the left carotid siphon without evidence\nfor flow-limiting stenosis. No flow-limiting stenosis is seen elsewhere in\nthe major intracranial arteries. No evidence for an aneurysm. The dural\nvenous sinuses are patent.\n\nOTHER:\nThe thyroid is unremarkable. No lymphadenopathy by CT criteria. There is\nmild emphysema in the visualized upper lungs. There is a 2 mm solid nodule in\nthe apical left upper lobe (3:52), in an area of motion artifact on the prior\nneck CTA. There are degenerative changes in the cervical spine.", + "output": "1. New ill-defined hypodensity in the left corona radiata, compatible with the\nreported subacute left corona radiata infarct on the recent outside MRI. No\nacute hemorrhage or mass effect.\n2. Extensive paranasal sinus disease is again demonstrated, with evidence of\nongoing inflammation, including aerosolized secretions in the left frontal\nsinus.\n3. Minimal calcified plaque at the right common carotid artery bifurcation\nwithout stenosis by NASCET criteria. Otherwise, normal neck CTA.\n4. No evidence for flow-limiting stenosis in the major intracranial arteries.\n5. Emphysema at the included lung apices. 2 mm micronodule in the apical left\nupper lobe, in an area obscured by motion artifact on the prior neck CT, but\nlikely related to small airways disease.\n\nRECOMMENDATION(S): For incidentally detected multiple solid pulmonary\nnodules smaller than 6 mm, no CT follow-up is recommended in a low-risk\npatient or a high-risk patient, though an optional noncontrast chest CT\nfollow-up in 12 months could be electively pursued in a high-risk patient, if\nclinically warranted (and assuming that there are no outside chest or neck CTs\nfor comparison). See the ___ ___ Society Guidelines for the\nManagement of Pulmonary Nodules Incidentally Detected on CT\" for comments and\nreference: ___.\n\nNOTIFICATION: Electronic preliminary report was provided by Dr. ___\non ___ at 9:33 ___." + }, + { + "input": "Left medial frontal lobe hypodensity is noted (series 2, image 11). An\nadditional left corona radiata hypodensity is noted (see 02:17). No priors\navailable for comparison. Nonspecific periventricular and subcortical white\nmatter hypodensities, likely reflecting chronic small vessel ischemic disease.\nThere is no evidence of new infarction,hemorrhage,edema, or mass effect. The\nventricles and sulci are prominent, suggesting involutional disease.\n\nThere is no evidence of new fracture. Mild mucosal thickening of the\nbilateral ethmoid air cells. The visualized portion of the mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No definite evidence of acute intracranial hemorrhage.\n2. Left frontal hypodensities compatible with provided history of 2 months\nprior infarct. Please note MRI of the brain is more sensitive for the\ndetection of acute infarct.\n3. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described.\n4. Paranasal sinus disease , as described." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nHypodensity in the medial left frontal lobe, consistent with history of prior\nleft ACA infarct. Additional periventricular and subcortical white matter\nhypodensities are nonspecific but likely sequelae of chronic small vessel\nischemic disease. No evidence of acute territorial infarction, hemorrhage, or\nmidline shift. There is mild mucosal thickening of the bilateral ethmoid air\ncells. Otherwise, the visualized portions of the paranasal sinuses are clear.\nThe orbits are unremarkable.\n\nCTA HEAD:\nBilateral ACAs arise the left MCA. The right A1 segment is hypoplastic. \nThere is early bifurcation of the distal right ACA. The vessels of the circle\n___ and their principal intracranial branches appear normal without\nstenosis, occlusion, or aneurysm formation greater than 3mm. The dural venous\nsinuses are patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are parent. There is a 3 mm\noutpouching of medial wall of the right ICA, consistent with pseudoaneurysm. \nOtherwise, no evidence of occlusion or acute dissection of the neck vessels. \nNo evidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThere is a large right pleural effusion and a small left pleural effusion. \nMultiple nodular opacities in the left visualized lung field measure up to 10\nmm (series 4, image 45). The visualized portion of the lungs are clear. The\nvisualized portion of the thyroid gland is within normal limits. There is no\nlymphadenopathy by CT size criteria.", + "output": "1. No acute infarction or hemorrhage.\n2. Focal 3 mm outpouching of one wall of the right ICA in the neck consistent\nwith pseudoaneurysm likely related to remote dissection.\n3. Bilateral pleural effusions, right greater than left, and bilateral\nairspace nodular opacities measuring up to 1.0 cm on the left. Further\nevaluation with dedicated chest CT is recommended.\n\nRECOMMENDATION(S): Chest CT." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are prominent, compatible with age related global\natrophy. Periventricular and subcortical white matter hypodensities likely\nreflect the sequelae of chronic small vessel ischemic disease. Dense\natherosclerotic calcifications are noted in the cavernous portions of the\ninternal carotid arteries.\n\nNo fractures are identified. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. The neck vessels are patent.\n\nImaged lung apices are clear. There are no concerning pulmonary nodules.\nThere are no osseous lesions. Incidental note is made of a prominent main\npulmonary artery measuring up to 3.3 cm in diameter.", + "output": "1. No evidence of submandibular abscess or other acute process in the neck.\n\n2. Prominent main pulmonary artery. Correlate for pulmonary hypertension." + }, + { + "input": "A small focus of subarachnoid hemorrhage in a right medial frontal sulcus on\nimage 3:35 is unchanged compared to 1 day earlier. No new intracranial\nhemorrhage or edema is seen.\n\nAgain seen are bilateral anterior frontal areas of encephalomalacia, which may\nbe post ischemic or posttraumatic, with gyriform mineralization suggesting\npseudolaminar necrosis. There is associated ex vacuo enlargement of the\nfrontal horns of the lateral ventricles. The remainder of the ventricles are\nmoderately prominent, and the sulci are mildly prominent, which most often\nindicates cerebral atrophy with central predominance, and less often may be\nrelated to communicating hydrocephalus. There are confluent periventricular\nareas of low density, which may be related to sequela of chronic small vessel\nischemic disease or chronic transependymal CSF migration. All of these\nfindings are unchanged compared to ___.\n\nThere is evidence of bilateral uncinectomies, middle turbinectomies, partial\nethmoidectomies, and surgical widening of frontoethmoidal recesses. Maxillary\nneo ostia are patent. Left lateral frontal sinus is opacified with polypoid\nsoft tissue density. Smaller polypoid soft tissue density is also seen in the\ninferior right frontal sinus. Right sphenoid sinus is not pneumatized. Mastoid\nair cells and pneumatized petrous apices are well aerated bilaterally. These\nfindings are similar to ___.", + "output": "1. Stable small focus of subarachnoid hemorrhage in a right medial frontal\nsulcus. No new intracranial hemorrhage.\n2. Bilateral anterior frontal areas of encephalomalacia are again noted.\n3. Unchanged disproportionate enlargement of the ventricles relative to mild\nenlargement of the sulci, which is most often related to cerebral atrophy with\ncentral predominance. However, please correlate clinically whether the patient\nhas any symptoms of communicating hydrocephalus.\n4. Postsurgical changes in the paranasal sinuses. Polypoid soft tissue\ndensities in the frontal sinuses, left larger than right, similar to ___." + }, + { + "input": "There is no evidence of fracture, acute major infarction,hemorrhage,edema,or\ndiscrete mass. Sequela of chronic small vessel disease is noted bilaterally. \nSmall left posterior fossa arachnoid cyst with mass effect on the transverse\ndural venous sinus. The ventricles and sulci are normal in size and\nconfiguration.\n\nMild mucosal thickening of the bilateral ethmoid air cells. The remainder of\nthe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No acute intracranial hemorrhage or fracture.\n2. Sequela of small vessel disease." + }, + { + "input": "There is no evidence of fracture, large territorial\ninfarction,hemorrhage,edema,or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. Periventricular and deep white\nmatter hypodensities are nonspecific, but likely sequela of chronic small\nvessel disease. Small left posterior fossa arachnoid cyst with mass effect on\nthe transverse dural venous sinus versus prominent CSF space, unchanged.\n\nThere is mild mucosal thickening of ethmoid air cells. The mastoid air cells\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality. No hydrocephalus. Stable appearance of\nthe ventricles." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nAgain identified are multiple left facial fractures, with nondisplaced\nmultiple fractures through the left zygomatic arch, comminuted fractures of\nthe anteromedial and lateral left maxillary sinus wall, with extension to the\norbital floor, left lateral orbital wall and left lamina papyracea, better\ncharacterized on the dedicated outside hospital facial CT examination. There\nis extensive surrounding soft tissue edema. There is associated hemorrhagic\nopacification of the left maxillary sinus. No other new fracture is\nidentified.\n\nThere is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nMinimal periventricular white matter hypodensities are in a configuration most\nsuggestive of chronic small vessel ischemic disease. There is a 4 x 3 mm\nhyperdense rounded focus at the level of the left ICA terminus (02:16),\ncorresponding to the area of concern on prior examination.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe 4 x 3 mm hyperdense focus at the level of the left ICA terminus\ncorresponds to the level of the A1/M1 bifurcation, and there is no discrete\naneurysm in this area. There are minimal atherosclerotic calcifications of\nthe bilateral intracranial internal carotid arteries without significant\nnarrowing. Presumed infundibular origin of a frontal pole arteries noted at\nthe anterior communicating artery (series 3, image 88-89). Incidental note is\nmade of a fenestrated basilar artery (series 459; image 1). The vessels of\nthe circle of ___ and their principal intracranial branches appear patent\nwith no evidence of significant stenosis, occlusion, or aneurysm. The dural\nvenous sinuses are patent.", + "output": "1. Comminuted fractures of the medial, anterior, and lateral left maxillary\nsinus wall though extension into the left orbital floor, left lateral orbital\nwall and left lamina papyracea with additional multipart fractures of the left\nzygomatic arch, better characterized on the outside hospital dedicated facial\nCT examination.\n2. 4 x 3 mm hyperdensity at the level of the left ICA terminus corresponding\nto area of concern corresponds to the left ICA bifurcation and no discrete\naneurysm in this area is seen.\n3. Presumed infundibular origin of a frontal polar artery noted at the\nanterior communicating artery (series 3, image 88-89).\n4. Patent intracranial vasculature without significant stenosis, occlusion, or\ndiscrete aneurysm formation." + }, + { + "input": "Left :\nThere is skin thickening and edema of the left external auditory canal,,\nentire left pinna and earlobe. There is no focal fluid collection. There is\na small amount of aerosolized secretions within the left external auditory\ncanal. No drainable fluid collection. No bone erosion. Mild stranding\nextends along the very posterior margin superficial left parotid, along\ninferior mastoid tip. No soft tissue infiltration posterior to the mandible,\nmandibular condyle or deep neck soft tissues.\n\nMild opacification left mastoids, less than 20%. Clear left middle ear oval,\nround window. A. Normal middle ear ossicles, seventh cranial nerve course.. \nNormal inner ear, IAC.\n\nRight:\nTrace opacification right mastoids. Clear middle ear cavity, oval, round\nwindow.. Normal middle ear ossicles, course of the seventh cranial nerve. If\nnormal inner ear, IAC.\n\nOther: Patent vasculature, including dural venous sinuses. Visualized brain\nis unremarkable.", + "output": "Findings consistent with left acute otitis externa involving EAC, pina.\nNo fluid collection.\nTrace fluid in the left mastoid air cells." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci and unremarkable. Basilar cisterns are\npatent.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Study is degraded by motion. There is no evidence of large territorial\ninfarction,hemorrhage,edema, or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. Periventricular and deep white\nmatter hypodensities are nonspecific, but most likely related to chronic small\nvessel ischemia. Atherosclerotic vascular calcifications are noted of\nbilateral vertebral and cavernous portions of internal carotid arteries.\n\nThere is no evidence of fracture or soft tissue abnormality. Patchy\naerosolized secretions are demonstrated in the ethmoid air cells. The\nvisualized portion of the mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are preserved.", + "output": "1. Study is degraded by motion.\n2. No acute intracranial abnormality. Please note MRI of the brain is more\nsensitive for the detection of acute infarct.\n3. Within limits of study, no definite evidence of acute intracranial\nhemorrhage or fracture." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are stable in size and configuration. Mild\nperiventricular and subcortical white matter hypodensities are not\nsubstantially changed.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial findings." + }, + { + "input": "There is no evidence of acute large territory infarction,intracranial\nhemorrhage,edema,or mass. The ventricles and sulci are normal in size and\nconfiguration. Mild periventricular and subcortical white matter\nhypodensities are not substantially changed, likely chronic sequela of small\nvessel ischemic disease. Vascular atherosclerotic calcifications are seen in\nthe carotid siphons and distal vertebral arteries bilaterally.\n\nThere is no evidence of fracture. Interval increase in partial opacification\nof the right mastoid air cells and right middle ear cavity. No apparent\nosseous erosion. Elsewhere, the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. No acute intracranial hemorrhage or other acute intracranial abnormality.\n2. Interval increase in nonspecific right middle ear effusion and right\nmastoid effusion." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are enlarged compatible with age related atrophy. \nPeriventricular white matter hypodensities are nonspecific the likely sequela\nof chronic small vessel disease. The basal cisterns are patent and there is\npreservation of gray-white matter differentiation.\n\nNo osseous abnormalities seen. There is mucosal thickening within the right\nmaxillary sinus and right frontal sinus. Aerosolized secretions are present\nwithin the right nasal cavity. Postsurgical changes from prior right\nuncinectomy and ethmoidectomy are present. The mastoid air cells are clear. \nThe right optic nerve and globe is retracted, the patient reportedly has a\nhistory of prior trauma with blindness of this eye.", + "output": "1. No acute intracranial process.\n2. Chronic changes of cerebral atrophy and small vessel disease.\n3. Chronic right orbital deformity with globe and optic nerve retraction." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is a 5 mm scalp hematoma overlying the right frontal bone (03:36). \nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No intracranial hemorrhage or fracture.\n2. 5 mm scalp hematoma overlying the right frontal bone." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is hypodensity in the ventromedial aspect of the left thalamus in\nkeeping with an acute infarct. There are several focal hypodense foci within\nthe head of the left caudate nucleus, the right frontal lobe, left cerebral\npeduncle, pons and bilateral cerebellar hemispheres, which may represent a\ncombination of old infarcts and dilated perivascular spaces. Note is made of\ncalcification of the basal ganglia bilaterally. There is no evidence\nhemorrhageormass. The ventricles and sulci are normal in size and\nconfiguration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is atheromatous calcification of the carotid siphons bilaterally, with\nmild atherosclerotic narrowing of the cavernous internal carotid arteries\nbilaterally. There is mild atherosclerotic calcification of the V4 segments\nof both vertebral arteries. The right vertebral artery is dominant, and the\nleft vertebral artery is diminutive. The vessels of the circle of ___ and\ntheir principal intracranial branches appear normal without stenosis,\nocclusion, or aneurysm. The dural venous sinuses are patent.\n\nCTA NECK:\nConventional branching of the aortic arch is demonstrated. Minimal\natherosclerotic calcification of the thoracic arch is present. There is a\ncombination of soft and calcified plaque material involving the origin and\nproximal segment of the left brachiocephalic trunk (series 602, image 32,\nimage 601, image 36). The bilateral common carotid arteries are widely\npatent. There is mixed calcified and noncalcified atherosclerotic plaque at\nthe origin of the right internal carotid artery with approximately 50%\nnarrowing by NASCET criteria. There is no evidence of left internal carotid\nstenosis by NASCET criteria. There is moderate narrowing at the origin of the\nthe left external carotid artery.\nThe vertebral arteries and their major branches appear otherwise normal with\nno evidence of stenosis or occlusion. The left vertebral artery is diminutive\nthroughout its length.\n\nAdditionally, there is moderate narrowing of the origin of the left subclavian\nartery with associated mixed calcified and noncalcified atherosclerotic\nplaque.\n\nCT PERFUSION: OLEA\nWith Tmax > 6s as threshold, there is punctate focal deficits within the right\ncerebellar and right temporal lobes, totaling 3.4 mL. However, these appear\nartifactual.\nWith CBF < 30 as threshold, there is no focal deficit to suggest core infarct.\nMismatch volume of 3.4 mL.\n\nOverall, no evidence of perfusion mismatch.\n\nOTHER:\nThere is mild emphysematous change at the lung apices bilaterally. The\nvisualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Hypodensity in the ventromedial aspect of the left thalamus in keeping with\nan acute infarct.\n2. Multiple bilateral infratentorial and supratentorial hypodensities, which\nlikely represent combination of old lacunar infarcts and dilated perivascular\nspaces.\n3. Mild atherosclerotic narrowing of the cavernous internal carotid arteries\nbilaterally. Otherwise patent circle of ___ without evidence of\nstenosis,occlusion,or aneurysm.\n4. 50% stenosis of the origin of the right internal carotid artery by NASCET\ncriteria. Otherwise patent bilateral cervical carotid and vertebral arteries\nwithout evidence of stenosis, occlusion, or dissection.\n5. Soft plaque and calcified plaque material is identified at the proximal\nsegment and origin of the left brachiocephalic trunk causing moderate\nstenosis.\n6. Additional findings as described above" + }, + { + "input": "Hypodensity within the left thalamus corresponds to acute infarction seen on\nMRI ___. No additional areas of infarction are identified.\n\nPreviously identified microbleeds were better characterized on the MRI ___. No acute intracranial hemorrhage identified on CT. Basal\nganglia calcifications are redemonstrated bilaterally.\n\nThe ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Hypodensity within the left thalamus corresponds to acute infarction seen on\nMRI ___. No additional areas of infarction are identified.\n\nPreviously identified microbleeds were better characterized on the MRI ___. No acute intracranial hemorrhage identified on CT. Basal\nganglia calcifications are redemonstrated bilaterally." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is hypodensity in the the left thalamus, head of the left caudate\nnucleus, the right frontal lobe, left cerebral peduncle, pons and bilateral\ncerebellar hemispheres, likely representing different stages ischemic changes.\nNote is made of calcification of the basal ganglia bilaterally. There is no\nevidence of acute intracranial hemorrhage or mass. The ventricles and sulci\nare normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.\n\nCTA HEAD:\nThere is severe atheromatous calcification of the carotid siphons bilaterally,\nwith moderate luminal narrowing and severe irregularities of the cavernous\ninternal carotid arteries bilaterally. There is mild calcified plaques of the\nV4 segments of both vertebral arteries with underlying mild multifocal luminal\nnarrowing and irregularity. The right vertebral artery is dominant, and the\nleft vertebral artery is diminutive.\n\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without severe stenosis, occlusion, or more than 3 mm aneurysm\nformation. The dural venous sinuses are patent.\n\nCTA NECK:\nConventional branching of the aortic arch is demonstrated. Minimal calcified\nplaques of the thoracic arch is present. There is a combination of soft and\ncalcified plaque material involving the origin and proximal segment of the\nleft brachiocephalic trunk (series 3, image 35)\n\nThe bilateral common carotid arteries are patent. There is calcified plaques\nwith pronounced luminal irregularities at the origin of both internal carotid\narteries more severe on the right side with approximately between ___\nnarrowing by NASCET criteria on the right right-side. There is no evidence of\nleft internal carotid stenosis by NASCET criteria.\n\nAlso there is, to a lesser extent, unusual involvement of the bilateral\nexternal carotid arteries with luminal irregularities; more pronounced on the\nleft side.\n\nThe right vertebral artery shows multifocal irregularities involving the\ncervical portion with superimposed calcified plaques as well as eccentric\nlinear hypodensities concerning for intimal flap with no underlying severe\nluminal narrowing. The left vertebral artery is diminutive; however\nunderlying dissection is a remote possibility.\n\nAdditionally, there is moderate narrowing of the origin of the left subclavian\nartery with associated mixed calcified and noncalcified plaques.\n\nOTHER:\nThere is mild emphysematous change at the lung apices bilaterally. The\nvisualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. There are bilateral supra and infratentorial intraparenchymal hypodensities\nlikely related to different stages ischemic insults affecting both anterior\nand posterior circulation could be embolic in source or related to underlying\nprimary/secondary vascular etiology.\n2. Background of moderate to severe atherosclerotic changes affecting both\ncavernous portion of internal carotid arteries; early for patient's age.\n3. There are multiple multifocal internal carotids and vertebral arteries\nirregularities with calcified plaques; more pronounced at the right vertebral\nartery.\n4. There is unusual pronounced involvement of the left subclavian artery,\nbrachiocephalic trunk as well as external carotid arteries with underlying\nmoderate stenosis.\n5. Considering patient's age and above-mentioned described findings;\nprimary/secondary vascular etiology is a consideration." + }, + { + "input": "Bilateral supra and infratentorial intraparenchymal hypodensities likely\nrelated to different stages of ischemic insults are re-demonstrated. There is\nno evidence of acute hemorrhage. Bilateral basal ganglia calcifications are\nre-demonstrated. There is prominence of the ventricles and sulci suggestive\nof involutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No evidence of acute hemorrhage. No evidence of mass-effect.\n2. When compared to the prior CT head ___, there is no\nsignificant change apparent on CT. Re-demonstrated bilateral supra and\ninfratentorial hypodensities are likely related to different stages of\nischemic insults." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nRedemonstration of the previously seen supra and infratentorial\nintraparenchymal hypodensities, which are likely related to prior ischemic\ninsults of varying age. There are no new areas of loss of gray-white matter\ndifferentiation.\nThere is no evidence of hemorrhage, edema, mass, or midline shift. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are normal.\n\nCTA HEAD:\nThere is no large vessel occlusion, or high-grade stenosis of the large\nvessels. The vessels of the circle of ___ and their principal intracranial\nbranches appear normal with no evidence of high-grade stenosis,\nocclusion,oraneurysm. The dural venous sinuses are patent. The left vertebral\nartery is noted to be hypoplastic and there is atherosclerotic disease of the\nV4 segments.", + "output": "1. No interval change in comparison to prior CTA dated ___.\n2. No large vessel occlusion or high-grade stenosis.\n3. Redemonstration of hypoplastic left vertebral artery with atherosclerotic\ndisease of both V4 segments noted." + }, + { + "input": "Although no contrast was administered for this exam, there is high density of\nthe blood pool compatible with recent intravenous contrast administration for\nprior imaging.\n\nThere is a 5.0 x 3.0 cm hypodense lesion adjacent to the cerebellum on the\nleft, most likely an arachnoid cyst. There is no evidence of large\nterritorial infarction,hemorrhage,edema, or mass. The ventricles and sulci\nare normal in size and configuration.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nethmoid air cells and left maxillary sinus. The remaining paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. No acute intracranial process. No fracture.\n2. A 5.0 x 3.0 cm hypodense lesion adjacent to the cerebellum on the left,\nmost likely an arachnoid cyst." + }, + { + "input": "Re- identified is a fracture of the right C6 facet extending to the pedicle,\nminimally displaced, with a small component involving the transverse foramen. \nThere is no evidence of underlying vascular injury. The carotid and vertebral\narteries and their major branches are patent with no evidence of stenoses. No\nevidence for dissection is seen.\n\nThere is no significant internal carotid artery stenosis by NASCET criteria.\n\nThe visualized lung apices are clear. There are scattered subcentimeter\nthyroid nodules measuring up to 6 mm in the left lobe.\n\nThere is moderate mucosal wall thickening in the visualized portion of the\nmaxillary sinuses.", + "output": "1. Minimally displaced right C6 facet fracture extending to the pedicle with\nminimal component involving the transverse foramen without underlying vascular\ninjury.\n2. Patent cervical vasculature without significant stenosis, occlusion, or\ndissection.\n3. Bilateral thyroid nodules measure up to 6 mm in the left lobe. The\n___ College of Radiology guidelines suggest that in the absence of risk\nfactors for thyroid cancer, no further evaluation is recommended." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal for age in size and configuration. There are\nmultiple scalp soft tissue nodules, some calcified. Perhaps a sebaceous cysts\nor granulomas.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Multiple scalp nodules, some calcified, perhaps sebaceous cysts or\ngranulomas. Otherwise normal study for age." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute hemorrhage, edema, mass effect, loss of\ngray/white matter differentiation, or extra-axial collection.\n\nThere is diffuse edema and fat stranding in the partially imaged subcutaneous\nfat of the left face, overlying the partially imaged left parotid gland, the\nmasticator muscles, and extending to the left periorbital region. There is no\nfluid collection. There is no intraorbital fat stranding or fluid\ninvolvement. No orbital subperiosteal abnormalities seen. There are several\nlymph nodes in the partially imaged left parotid gland measuring up to 7 mm,\nlikely reactive. Nonenlarged suboccipital lymph nodes are seen bilaterally, 7\nmm on the right and 6 mm on the left.\n\nThere is symmetric, mild, partial opacification of bilateral mastoid air\ncells, without osseous erosion, a nonspecific finding. Middle ear cavities\nare well aerated.\n\nThere is moderate opacification of the right anterior ethmoid air cells\nextending into the frontoethmoidal recess and hypoplastic right frontal sinus,\nnew compared to ___. There is mild mucosal thickening in the left\nanterior ethmoid air cells and left frontoethmoidal recess. Left frontal\nsinus is also hypoplastic. There is minimal mucosal thickening in the\nmaxillary sinuses and right sphenoid sinus.\n\nCTV HEAD:\nThere is no evidence of dural venous sinus thrombosis. Specifically, the\nsuperior sagittal, straight, transverse, and sigmoid sinuses are patent. \nInternal cerebral veins and the veins ___ are also patent. Major\nintracranial arteries are not fully assessed in the absence of dedicated 3D\nreformatted images. There is mild calcified plaque in the intracranial left\nvertebral artery without flow-limiting stenosis. There is also mild calcified\nplaque in the left greater than right carotid siphons without flow-limiting\nstenosis.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. Diffuse edema in the partially imaged subcutaneous fat of the left face,\ncompatible cellulitis. No evidence for fluid collection. No evidence for\nintraorbital extension.\n3. Symmetric, mild, partial opacification of the bilateral mastoid air cells\nwithout evidence for osseous erosion to indicate confluent mastoiditis, a\nnonspecific finding.\n4. Moderate opacification of the right anterior ethmoid air cells, new\ncompared to ___." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of large territorial infarction, hemorrhage, edema, or\nmass. There is mild-to-moderate prominence of the ventricles and sulci\nsuggestive of involutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nNo significant stenosis, occlusion, or aneurysm formation of the circle of\n___ and their principal intracranial branches. The right A1 ACA segment is\nmildly hypoplastic. There is a large right posterior communicating artery\npredominantly supplying the right superior cerebellar artery with tiny right\nP1 PCA contribution. The distal left cervical internal carotid artery\nexhibits mild narrowing due to tortuosity but is otherwise patent without\natheromatous plaque.\n\nA normal variant right transverse sinus is diminutive, but the dural venous\nsinuses are otherwise patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. Tortuous left cervical ICA. There is\nno evidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThere is a heterogeneously enhancing, partially calcified 1.4 cm exophytic\nnodule in the region of the inferior left lobe of the thyroid (3:80, 601:35)\nwhich may be thyroid or parathyroid in etiology. Degenerative changes\ncervical spine.", + "output": "1. No acute intracranial findings.\n2. Normal CTA head, neck.\n3. 1.4 cm exophytic nodule abutting inferior left lobe of the thyroid may be\nthyroid or parathyroid in origin.\n\nRECOMMENDATION(S): Ultrasound and PTH is recommended for further evaluation\nof exophytic nodule in the region of the left lobe of the thyroid." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The right\nA1 and A2 segments are hypoplastic. The right vertebral artery terminates as\nthe posterior inferior cerebellar artery, a normal anatomic variant. The\ndural venous sinuses are patent.\n\nCTA NECK:\nThere is a normal 3 vessel branching pattern of the aortic arch. The carotid\nand vertebral arteries and their major branches appear normal with no evidence\nof stenosis or occlusion. There is no evidence of internal carotid stenosis by\nNASCET criteria. The left vertebral artery is dominant.\n\nOTHER:\nThe visualized portion of the lungs are clear. Linear, tubular hypodensity in\nthe left thyroid lobe, measuring 8 mm, and a tubular hypodensity in the right\nthyroid lobe, measuring 7 mm, measure fat density and may represent\nadenomalipomas. Scattered subcentimeter nonspecific lymph nodes are noted\nthroughout the neck bilaterally. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Dental amalgam streak artifact limits study.\n2. No evidence of acute intracranial hemorrhage.\n3. No evidence ofaneurysm greater than 3 mm, dissection or significant\nluminal narrowing.\n4. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct." + }, + { + "input": "There is right frontal subarachnoid hemorrhage, similar in appearance to prior\nexam (series 3:image 12). No new intracranial hemorrhage is seen. There is\nno evidence of infarction, edema, or mass. The ventricles and sulci are normal\nin size and configuration for the patient's age.\n\nNo osseous abnormalities are seen. The paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The orbits are unremarkable. There is\ndecrease in size of the left parietal scalp hematoma.", + "output": "Stable right frontal subarachnoid hemorrhage. No new intracranial hemorrhage." + }, + { + "input": "No intra or extra-axial hemorrhage, mass effect, or shift of normally midline\nstructures. Mild low-attenuation of the periventricular and subcortical white\nmatter is nonspecific, but likely relates to chronic microangiopathic ischemia\ngiven the patient's age. Small chronic cortical infarct in the high left\nparietal region. No CT evidence for acute, major vascular territorial\ninfarction. Mild prominence of the ventricles, sulci, and cisterns appears\nproportional.\n\nSurrounding soft tissues and osseous structures are unremarkable. Visualized\nparanasal sinuses and mastoid air cells appear clear.", + "output": "1. No acute intracranial pathology.\n2. Interval resolution of subacute to chronic left parietal convexity subdural\nhematoma.\n3. Mild, chronic microangiopathic ischemic changes. Small, chronic left\nparietal infarct. Generalized volume loss." + }, + { + "input": "Compared to the prior head CT from ___, there has been interval\ndevelopment of a new left parietal convexity extra-axial fluid collection\nwhich is low in density aside from a small hyperdense component posteriorly\n(06:40), compatible with subdural hematoma which is subacute to chronic. This\ncollection measures up to 11 mm in greatest width. There is local sulcal\neffacement but no midline shift. Basal cisterns are patent. No evidence of\nacute major territorial infarct. Previously seen focus of right frontal\nsubarachnoid blood has improved, but still appears perceptible.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Low density left parietal convexity extra-axial fluid collection, new since\n___, however with only minimal hyperdense components, is likely a\nsubacute to chronic subdural hematoma. Local sulcal effacement but no midline\nshift.\n2. Near complete resolution of previously noted right frontal subarachnoid\nblood." + }, + { + "input": "Please note evaluation of the sella is limited secondary to streak artifact.\n\nThere is no definite evidence of infarction, hemorrhage, edema, or mass. The\nventricles sulci are normal in size and configuration. There is minimal\nasymmetry of the lateral ventricles, with the right lateral ventricle are to\nbe slightly larger than the left, without definite ventriculomegaly. Within\nthe limits of this examination, the sella is grossly unremarkable without\ndefinite evidence of macro hemorrhage.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. Evaluation of sella is limited secondary to streak artifact.\n2. Within limits of examination, no definite large hemorrhage identified\nwithin the sella and no definitive acute intracranial abnormality identified. \nRecommend clinical correlation. If clinically indicated, consider pituitary\nMRI for further evaluation." + }, + { + "input": "There is no evidence of intracranial hemorrhage, edema, or mass effect.\n\nThe ventricles and sulci are more prominent since prior exam, and reflect\nage-related cerebral atrophy.\n\nThere is subcortical white matter hypodensities, which are most likely sequela\nof chronic small vessel ischemic disease. The basal cisterns appear patent and\nthere is preservation of gray-white matter differentiation.\n\nThe visualized bony structures are grossly unremarkable. The paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "No evidence of intracranial hemorrhage or mass effect. MRI is recommended to\nevaluate subtle findings of infection." + }, + { + "input": "There is no acute intracranial hemorrhage, edema, mass effect, or loss of\ngray/ white matter differentiation. There are foci of low density in the\nsubcortical, deep, and periventricular white matter of the cerebral\nhemispheres, likely sequela of chronic small vessel ischemic disease in a\npatient of this age. There is moderate cerebral atrophy with associated\nprominence of the ventricles and sulci. No significant interval change is seen\nin the intracranial compartment compared to ___.\n\nRight mastoid has no pneumatized air cells, only a pneumatized antrum. There\nis an near-complete opacification of the right middle ear cavity and mastoid\nantrum, as well as fluid in the left mastoid antrum and left mastoid air\ncells, new compared to ___. There is also mild mucosal\nthickening in bilateral anterior ethmoid air cells and in bilateral sphenoid\nsinuses along the sphenoid septum, similar to prior.", + "output": "1. No acute intracranial hemorrhage and no evidence for other acute\nintracranial abnormalities.\n2. Near-complete opacification of the right middle ear cavity and mastoid\nantrum. Fluid in the left mastoid antrum and mastoid air cells. While there\nis no evidence for osseous destruction to suggest aggressive mastoiditis,\nplease correlate clinically with any infectious symptoms." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema,or mass.\nModerate predominantly periventricular white matter hypodensities are\nnonspecific, but likely represent the sequela of chronic microvascular\nischemia. There are multiple punctate calcifications throughout the right\nparietal and occipital lobes, most of which appear to be within the\nsubarachnoid space, and are likely due to prior infection. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Multiple punctate calcifications within the subarachnoid space throughout\nthe right parietal and occipital lobes, likely due to prior infection or due\nto vascular calcifications." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass effect. The ventricles and sulci are again prominent in size and\nconfiguration, consistent with age-related involutional change. \nPeriventricular and subcortical white matter hypodensities are nonspecific but\nlikely represent sequela of chronic ischemic microvascular disease. \nRe-demonstrated are stable punctate calcifications throughout the right\nparietal occipital lobes, most of which appear to be within the subarachnoid\nspace. These are unchanged compared to prior. Atherosclerotic calcifications\nare seen in the bilateral cavernous carotid arteries as well as the V4 segment\nof the left vertebral artery.\n\nNo acute fractures seen. A chronic left orbital floor fracture is noted. \nThere is minimal mucosal thickening of the right maxillary sinus, otherwise\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are\nessentially clear.", + "output": "1. No acute intracranial process.\n2. Unchanged appearance of multiple punctate calcifications within the\nsubarachnoid space throughout the right parietal and occipital lobes. No\nevidence of acute intracranial hemorrhage\n3. Re-demonstrated chronic left orbital floor fracture." + }, + { + "input": "CT HEAD:\nThere is no evidence for acute hemorrhage, acute vascular territorial\ninfarction, mass effect, or edema. The ventricles and sulci are mildly\nprominent, compatible with age related global cerebral volume loss.\n\nThere is mild mucosal thickening in left greater than right frontal sinuses\nwith a small polypoid component in the inferior right frontal sinus. There is\nmild mucosal thickening in the ethmoid air cells. There is minimal mucosal\nthickening along the floor of the left maxillary sinus. There is a periapical\nlucency ___ 4, which appears to be status post root canal, with associated\ndehiscence of the buccal cortex, image 3:193. Mastoid air cells are well\naerated. The orbits appear unremarkable.\n\nCTA NECK:\nThere is a 3 vessel aortic arch. There is mild calcified plaque in the\nproximal right internal carotid artery and mild noncalcified plaque in the\nproximal left internal carotid artery without stenosis by NASCET criteria. \nThere is minimal irregularity of the V3 segment of the left vertebral artery\nat the level of the left lateral mass of C1, just proximal to the C1\ntransverse foramen, images 3:202, 451:49, which may be secondary to\natherosclerosis versus mechanical effect from the left C1-C2 articulation\nosteophytes. Remaining courses of bilateral cervical vertebral arteries are\nwidely patent. No evidence for dissection.\n\nCTA HEAD:\nThere is calcified plaque within bilateral carotid siphons without evidence\nfor flow-limiting stenosis. Mild irregularity and minimal narrowing of the\ndistal basilar artery is likely secondary to atherosclerosis. No\nflow-limiting stenosis is seen elsewhere in the major intracranial arteries. \nNo evidence for an aneurysm. There appears to be a right ___ complex, a\nnormal variant. The dural venous sinuses are patent.\n\n\nOTHER:\nThere is mild dependent atelectasis in the included upper lungs. The thyroid\ngland is unremarkable in appearance. There is no cervical lymphadenopathy by\nCT size criteria. There are degenerative changes in the cervical spine, with\nan apparent calcified disc herniation plus/minus endplate osteophytes and\nligamentum flavum calcification at C4-C5 causing moderate to severe spinal\ncanal stenosis, not optimally assessed on this nondedicated exam. 8 mm\nsclerotic lesion in the inferior endplate of T1, images 3:78 and 602:32, is\nunchanged compared to prior chest CTs from ___ and ___,\nconsistent with a bone island.", + "output": "1. No evidence for acute intracranial abnormalities. MRI would be more\nsensitive for an acute infarction, if clinically warranted.\n2. Minimal irregularity of the V3 segment of the left vertebral artery\nadjacent to the lateral mass of C1, which may be secondary to mild\natherosclerosis versus mechanical effect from the left C1-C2 articulation\nosteophytes.\n3. Mild irregularity and minimal narrowing of the distal basilar artery,\nlikely atherosclerotic.\n4. Multilevel cervical degenerative disease with apparent moderate to severe\nspinal canal stenosis at C4-C5, not optimally assessed on this nondedicated\nexam.\n5. Periapical lucency ___ 4, which appears to be status post root canal,\nwith associated dehiscence of the buccal cortex. Please correlate clinically\nwhether this may represent an odontogenic source of paranasal sinus disease,\nwhich includes mucosal thickening along the floor of the right maxillary\nsinus.\n\nRECOMMENDATION(S): Consider cervical spine MRI for better assessment of\nspinal stenosis, particularly in the setting of paresthesias." + }, + { + "input": "There is no evidence of acute large territory infarction, hemorrhage, edema,\nor mass effect. The ventricles and sulci are normal in size and\nconfiguration.\n\nMild asymmetry is visualized in the left occipitomastoid suture which may be\ncongenital in nature rather than diastasis given lack of associated soft\ntissue hematoma or stranding. Otherwise, no evidence of acute fracture. The\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\norbits are unremarkable.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nlarge territory infarct or intracranial hemorrhage.\n2. There is asymmetry of the left occipitomastoid suture, felt likely be\ncongenital rather than traumatic diastasis given lack of associated soft\ntissue hematoma or stranding. Clinical correlation is recommended. \nOtherwise, no acute calvarial fractures identified.\n3. Additional findings as described above." + }, + { + "input": "No opacification of the mastoid air cells bilaterally.\n\nEvaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect. Nasoenteric tube is noted.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid appears normal. There is no lymphadenopathy by CT\ncriteria. The neck vessels are patent.\n\nThere is a moderate left nonhemorrhagic pleural effusion. Multiple nodules\nare noted measuring up to 6 mm in the right upper lobe. (2:99).There are no\nosseous lesions.", + "output": "1. No evidence of mastoid air cell opacification.\n2. Moderate left nonhemorrhagic pleural effusion.\n3. Multiple lung nodules measuring up to 6 mm. Follow-up CT in\n___ months is recommended, as described below.\n\nRECOMMENDATION(S): For incidentally detected multiple solid pulmonary\nnodules measuring 6 to 8mm, a CT follow-up in 3 to 6 months is recommended in\na low-risk patient, with an optional CT follow-up in 18 to 24 months. In a\nhigh-risk patient, both a CT follow-up in 3 to 6 months and in 18 to 24 months\nis recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is mild\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No evidence of mass, hemorrhage, or infarction.\nMild atrophy." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction, mass or midline\nshift. There is no hydrocephalus. Visualized paranasal sinuses and mastoid\nair cells are clear. There is no fracture.", + "output": "Status post left-sided extensive craniectomy with extensive encephalomalacic\nchanges in the left cerebral hemisphere predominantly left parietal, temporal\nand occipital lobes and part of left frontal lobe with ex vacuo dilation of\nthe left lateral ventricle, evolved since the prior study. There is resolution\nof the previously noted blood products in the left cerebral hemisphere and in\nthe left lateral ventricle.\nNo new acute intracranial hemorrhage or mass effect or new hypodense areas to\nsuggest obvious new major infarct.\nSella, pineal gland and the craniocervical junction regions are unremarkable.\n\nNo suspicious osseous lesions are noted.\nMild to moderate ethmoidal mucosal thickening.\n\nNOTIFICATION: Left-sided extensive craniectomy with extensive\nencephalomalacic changes in the left cerebral hemisphere, with some evolution\nsince the prior study of ___.\nStudy for surgical planning" + }, + { + "input": "Patient is status post left frontoparietal cranioplasty, new since ___.\nEncephalomalacia involving left parietal occipital lobe and left basal ganglia\nappears stable. Ex vacuo dilation of the left lateral ventricle is noted.\nThere is no evidence of acute intracranial hemorrhage, edema, or mass effect.\nThe basal cisterns appear patent. Postop pneumocephalus is noted adjacent to\nthe site of cranioplasty as expected.\nOpacification of left sphenoid sinus is noted. The remaining paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "Patient is status post left frontoparietal cranioplasty. Stable\nencephalomalacia of the left hemisphere. No evidence of acute hemorrhage or\nmass effect." + }, + { + "input": "There is a 5 x 5 x 2 mm hyperdensity along the right superior tentorium,\nimages 601b:79 and 602b:13, which may represent a dural calcification or a\nsmall calcified meningioma, and much less likely a small focus of subdural\nblood. There is no evidence for acute hemorrhage elsewhere. There is no edema,\nmass effect or evidence for an acute large vascular territorial infarction. \nMildly prominent ventricles and sulci are consistent with age-related\ninvolutional change. Foci of low density in the periventricular and\nsubcortical white matter of the cerebral hemispheres are nonspecific but\nlikely sequela of chronic small vessel ischemic disease in a patient of this\nage.\n\nNo fracture is identified. There is mild opacification of bilateral mastoid\nair cells. There is mild mucosal thickening in bilateral anterior ethmoid air\ncells. Other visualized paranasal sinuses are well aerated.", + "output": "5 x 5 x 2 mm hyperdensity along the right superior tentorium may represent a\ndural calcification or small calcified meningioma, and much less likely a\nsmall focus of subdural blood. Comparison with any outside prior studies would\nbe helpful to assess for chronicity. If no prior studies are available, follow\nup CT is recommended to assess stability.\n\nNOTIFICATION: Results and recommendations were discussed over the telephone\non ___ at 11:15 by Dr. ___ with Dr. ___." + }, + { + "input": "There is asymmetrical thickening of the right tentorium with a more focal area\nof hyperdensity measuring 5 x 2 mm (601b: 69), stable in appearance compared\nto the prior study performed 12 hours prior. This may represent pachymeningeal\nthickening with a small calcified meningioma, but in the trauma setting would\nbe suspicious for small subdural hematoma. No other areas concerning for acute\nhemorrhage are identified. There is no acute infarction, edema or mass. The\nventricles and sulci are normal in size and configuration. Periventricular and\nsubcortical white matter hypodensities are suggestive of chronic small vessel\nischemic disease.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. Asymmetrical thickening of right tentorium with a more focal area of\nhyperdensity measuring 5 x 2 mm (601b:69), which is stable compared to the\nprior study. While this may represent pachymeningeal thickening with a small\ncalcified meningioma, there is clinical suspicion for a small subdural\nhematoma in the recent trauma setting. No other areas concerning for acute\nhemorrhage. Longer term followup may help further delineate if clinically\nwarranted.\n2. Periventricular and subcortical white matter hypodensities, suggestive of\nchronic small vessel ischemic disease. No evidence of acute infarction or\nedema." + }, + { + "input": "There is no evidence of acute large territory infarction,hemorrhage,edema, or\nmass effect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular, deep white matter, and subcortical\nwhite matter hypodensities are nonspecific but likely chronic sequelae of\nsmall vessel ischemic disease. Previously identified asymmetric thickening of\nthe right tentorium is not seen on the current study.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. \nStatus post bilateral lens replacement.", + "output": "1. No acute intracranial process.\n2. Global involutional changes and likely sequelae of chronic small vessel\nischemic disease." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of age-related involutional\nchanges. Findings consistent with moderate chronic small vessel ischemic\nchanges.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. Patient is status post bilateral lens replacement. \nThe visualized portion of the orbits are otherwise unremarkable.\n\nCTA HEAD:\nThere is atherosclerotic calcification of the bilateral cavernous carotids\nwithout severe narrowing. The vessels of the circle of ___ and their\nprincipal intracranial branches appear normal without stenosis, occlusion, or\naneurysm formation. The left transverse sinus is hypoplastic. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThere is moderate calcification of the aortic arch..\n\nMild origin narrowing right vertebral artery by calcification. The remainder\nof the right vertebral artery is normal without significant stenosis or\nocclusion. There is mild narrowing at the takeoff of the left subclavian by\natherosclerotic plaque, as well as mild narrowing of the takeoff of the left\nvertebral artery. The remainder of the left vertebral artery is patent\nwithout significant stenosis.\n\nThere is atherosclerotic calcification at the left carotid bifurcation\nresulting in approximately a 30% narrowing of the left internal carotid artery\nby NASCET criteria. There is atherosclerotic calcification at the right\ncarotid bifurcation resulting in up to approximately 80 % stenosis of the\nproximal right internal carotid artery by NASCET criteria.\n\nOTHER:\nThere is mild bronchial wall thickening in the upper lobes. There are\nground-glass opacities and septal thickening at the lung apices. There is a\ncalcification in the right thyroid lobe. No suspicious thyroid nodules. \nPatient is status post extraction of a right maxillary premolar tooth. There\nis no lymphadenopathy by CT size criteria. Degenerative changes spine.", + "output": "1. No acute intracranial process.\n2. Brain parenchymal atrophy, moderate chronic small vessel ischemic changes..\n3. Unremarkable CTA of the brain.\n4. Atherosclerotic disease neck. 80% narrowing proximal right ICA..\n5. Mild bronchial wall thickening and ground-glass opacities upper lungs CT\nmay be due to chronic small airway disease, edema, or infection/ inflammation." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territorial infarct. Prominence of the\nventricles and sulci is consistent with involutional changes. Periventricular\nand subcortical white matter hypodensities are likely sequelae of chronic\nsmall vessel disease. The partially imaged paranasal sinuses are clear. The\nleft mastoid air cells and middle ear cavity are opacified, new since ___. No acute fracture is seen.", + "output": "1. No acute intracranial process.\n\n2. Essentially complete opacification of the left mastoid air cells and left\nmiddle ear cavity, new since ___, concerning for otomastoiditis." + }, + { + "input": "RIGHT: The external auditory canal is normal. There is mild thickening of the\ntympanic membrane with question of perforation, likely sequela of prior\ninfectious process. Clinical correlation is recommended. There is trace soft\ntissue density along Prussak's space (series 300, image 34) although the\nscutum appears sharp and there is no evidence of erosion. Otherwise, the\nremainder of the middle ear cavity is clear. The ossicles and tegmen are\nintact. There is no evidence for enlarged vestibular aqueduct or superior\nsemicircular canal dehiscence. The facial nerve follows a normal course\nthrough the middle ear. There is no evidence for inner ear dysplasia. Very\nminimal opacification of the right mastoid tip. There is no abnormal\nenhancement on post contrast imaging.\n\nLEFT: The external auditory canal is normal. The scutum may be mildly blunted\nalthough this could be secondary to postsurgical change. Fluid opacifies the\ntympanic cavity. The incus is not identified articulating with the head of\nthe malleus. There appears to be metallic and bony interposition grafts\n(series 4, image 134). The tegmen is intact.\n\nThere is no evidence for enlarged vestibular aqueduct or superior semicircular\ncanal dehiscence. The facial nerve follows a normal course through the middle\near. There is no evidence for inner ear dysplasia. The mastoids air cells are\nopacified; there is no dehiscence of the cortex. There is no abnormal\nenhancement on post contrast imaging.\n\nOther: Visualized brain and neck soft tissues are normal.", + "output": "1. There is complete opacification of the right tympanic cavity mastoid air\ncells without evidence osseous erosion through the septa or bony structures. \nThere is no evidence of surrounding soft tissue inflammatory stranding or\nabnormal enhancement. This likely represents uncomplicated otomastoiditis.\n2. The patient appears to be status post left ossicular chain reconstruction. \nThe inner ear structures appear grossly unremarkable. No evidence of otic\ncapsule lucency to suggest clinical history of otosclerosis on imaging.\n3. There is thickening of the right tympanic membrane with question of\nperforation. Correlation with clinical history is recommended.\n4. Minimal fluid opacification of the right mastoid tip. The remainder the\nmastoid air cells are clear.\n5. Trace soft tissue/fluid density along the right Prussak's space without\nevidence of ossicular erosion. The scutum appears sharp. The remainder of\nthe right tympanic cavity is clear.\n6. Additional findings as described above." + }, + { + "input": "Small left-sided temporal lobe conclusion and small subdural collection again\nidentified. No significant interval change is seen. A right inferomedial\nfrontal the encephalomalacia is again identified. There is no acute hemorrhage\nseen. There is no midline shift or hydrocephalus. Bilateral cerebellar\ncalcifications are seen.", + "output": "No significant change since the previous outside CT ___ in temporal\ncontusion and small left-sided subdural collection. No acute abnormalities\nseen." + }, + { + "input": "Since the prior head CT from ___, the density of the left\ncerebral subdural hematoma has decreased now similar to gray matter compatible\nwith subacute blood products. There is mild local mass effect with sulcal\neffacement and no shift of midline structures. Developing encephalomalacia in\nthe left temporal lobe at the site of prior hemorrhage is also noted. No new\nsite of hemorrhage. Previously noted right subdural hematoma is not\ndefinitively visualized. The basal cisterns are patent. There is no shift of\nnormally midline structures.\n\nInferior right frontal encephalomalacia is unchanged from prior exam.\nSenescent calcifications within the bilateral basal ganglia and bilateral\ncerebellar hemispheres are unchanged. Bilateral intracranial carotid artery\nand distal left vertebral artery calcifications are noted. Degenerative change\nof the left TMJ is unchanged. There is mucosal thickening of the partially\nimaged right maxillary sinus and ethmoid air cells. Otherwise, the frontal and\nsphenoid sinuses are clear. The bilateral mastoid air cells are clear. There\nis no fracture. The patient is status post right lens removal, otherwise, the\nglobes are unremarkable.", + "output": "Subacute left cerebral subdural hematoma, similar in size compared with prior\nexam with mild mass effect and no shift of midline structures. Developing\nencephalomalacia noted in the left temporal lobe at the site of recent\nhemorrhage. No acute hemorrhage." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect. Nasoenteric tube is partially visualized. Small amount of\naerosolized secretions are noted in the trachea.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal.\n\nProminent left jugulodigastric lymph nodes are similar to prior and do not\nmeet CT size criteria for lymphadenopathy, presumably reactive in nature. \nThere is no supraclavicular, axillary, or mediastinal lymphadenopathy by CT\ncriteria.\n\nThe patient is status post left carotid endarterectomy which appears similar\nin appearance when compared to outside hospital examination. The left\ninternal jugular vein is diminutive without occlusion (4; 39). The patient is\nstatus post closure of previously seen open incision along the left aspect of\nthe neck from incision and drainage of abscess with continued inflammatory\nstranding and enlargement of the left sternocleidomastoid muscle. Extensive\ninflammatory changes in the left parapharyngeal space are noted.\n\nDeep to the left anterior edge of the left sternocleidomastoid muscle is a 1.3\nx 0.6 cm peripherally enhancing collection (series 4, image 51) with a smaller\n5 x 5 mm pocket (series 4, image 50) anteriorly, which may represent\ndeveloping abscesses. The larger collection abuts the left internal jugular\nvein without disruption of the fascial planes.\n\nProminent atherosclerotic calcification of the right carotid bifurcation\nlikely results in at least 80-90% stenosis by NASCET criteria although the\nexamination is not optimized for such evaluation. The remainder of the\ncervical vessels are patent.\nThere are bilateral small pleural effusions with associated dependent\natelectasis.\n\nAir-fluid levels are seen in the sphenoid sinus. There is mild-to-moderate\nmucosal thickening of bilateral maxillary sinuses. Mild mucosal thickening of\nthe ethmoid sinuses are noted. There is partial opacification of bilateral\nmastoid air cells with clear middle ear cavities.\n\nThere are no osseous lesions. Mild degenerative changes with loss of disc\nheight and spondylosis at C5-C6. There are bilateral pleural effusions with\nmild associated compressive atelectasis. Interseptal thickening and\nground-glass opacities may represent pulmonary edema with infectious process\nnot entirely excluded.\n\nWhile this exam is not tailored to evaluation of intracranial structures, the\nvisualized portions are unremarkable.", + "output": "1. Interval closure of open incision along the left aspect of the neck with\npersistent inflammatory stranding and enlargement of the sternocleidomastoid\nmuscle. Persistent inflammatory stranding of the left parapharyngeal space.\n2. Deep to the anterior edge of the inferior sternocleidomastoid muscle are 2\nperipherally enhancing collections measuring 1.3 and 0.5 cm respectively,\nwhich abuts the left internal jugular vein. These may represent developing\nabscesses and close attention is recommended.\n3. There is asymmetric enlargement of the left jugulodigastric lymph nodes,\nnot pathologic by size criteria, presumably reactive.\n4. The patient is status post left carotid endarterectomy. The left internal\ncarotid artery appears patent. Extensive atherosclerotic calcification of the\nright internal carotid artery with severe stenosis is noted.\n5. Additional findings as described above.\n\nNOTIFICATION: The findings were discussed with ___, RN by ___\n___, M.D. on the telephone on ___ at 5:36 pm, 20 minutes after discovery\nof the findings." + }, + { + "input": "There is no evidence of fracture, infarction, hemorrhage, edema or mass. The\nventricles are enlarged, stable since the prior study from ___. This\nenlargement is greater involving the ventricles than the sulci with and an\n___ index of 0.38, raising the possibility of communicating hydrocephalus. \nThere is no abnormal enhancement on post contrast images.\n\nThe partially visualized upper left maxillary sinus is opacified (6:1). The\nbilateral mastoid air cells and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial pathology. Stable ventriculomegaly. Possible\ncommunicating hydrocephalus\n2. No pathologic postcontrast enhancement.\n3. Upper left maxillary sinus opacification." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are essentially clear besides a few scattered opacified\nmastoid air cells bilaterally. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "CTA NECK: There is no flow-limiting stenosis within the neck. The\nthree-vessel origin off the aortic arch is unremarkable.\n\nThe left internal carotid artery is slightly larger in caliber than the right,\nan anatomic variant, and there is no flow-limiting disease or significant\nnarrowing of the internal carotid arteries within the neck.\n\nCTA HEAD: The left A1 segment is markedly dominant giving rise to the\nanterior communicating artery and both A2 segments. There is mild, fusiform\ndilatation of the left cavernous carotid artery. Bilaterally, posterior\ncommunicating arteries are patent and provide dominant supply to the P2\nsegments. There is no other evidence of aneurysm, flow-limiting stenosis or\nlarge vessel occlusion. The major intracranial veins and dural venous sinuses\nare patent.\n\nThe visualized brain is grossly unremarkable on this examination limited by no\npre-contrast imaging.", + "output": "No evidence of flow-limiting stenosis, or large-vessel occlusion.\n\nFindings were discussed with Dr. ___, at 2:50 p.m. on ___.\nThree-dimensional reconstructions are pending at this time." + }, + { + "input": "There is a rounded, well defined midline heterogeneous hyperdensity, located\nbetween the frontal lobes, slightly anterior to the pars marginalis measuring\n1.0 (AP) x 8.3 (TV) x 1.1 (SI) mm . This may represent a focal mass lesion,\nsuch as meningioma. There is no evidence of acute infarction. The ventricles\nand sulci are normal in size and configuration. The basal cisterns are\npatent. There is no midline shift.\nThere is no evidence of fracture. Subcutaneous hematoma and laceration is\nseen overlying the right frontal bone. There is mild mucosal thickening of\nthe ethmoid air cells. The visualized portion of other the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. Rounded midline heterogeneous hyperdensity, measuring up to 1.1 cm between\nthe frontal lobes, most likely representing a meningioma. MRI may further\nassist in characterization. No mass effect. No acute infarction.\n2. Right frontal subcutaneous hematoma and laceration." + }, + { + "input": "There is no evidence of acute hemorrhage mass effect midline shift or\nhydrocephalus. Gray-white matter differentiation is maintained. At the site\nof abnormality seen on MRI, a subtle hyperdensity visualized on series 5,\nimage 21. No calcification is seen.\n\nThe visualized paranasal sinuses are clear. No skull fracture is seen.", + "output": "Previously seen small extra-axial mass on the MRI shows subtle hyperdensity\nwithout calcification. This may favor meningioma as the diagnosis." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. There is no intracranial hemorrhage. ." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territorial infarct. Mild prominence of the\nventricles and sulci is consistent with involutional changes. Mild\nperiventricular and subcortical white matter hypodensities are likely sequelae\nof chronic small vessel disease. The visualized paranasal sinuses are clear. \nThe mastoid air cells are clear. No acute fracture is seen.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute territory infarction, hemorrhage, edema,or mass.\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges, worse since ___. Mild periventricular and subcortical white\nmatter hypodensities are nonspecific but most likely represent sequela of\nchronic small vessel ischemic changes\n\nThere is no evidence of fracture. Areas of sclerosis involving the sphenoid\nbones bilaterally, more pronounced on the left, (3:9) appear unchanged and\nlikely nonaggressive. There is a 1.0 cm left frontal subgaleal hematoma. \nTrace fluid in the left sphenoid sinus. Otherwise, the remaining visualized\nparanasal sinuses, mastoid air cells, and middle ear cavitiesare essentially\nclear. Status post bilateral lens replacement. Otherwise orbits are\nunremarkable.", + "output": "1. 1.0 cm left frontal subgaleal hematoma. No calvarial fracture.\n2. No acute intracranial process." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. The\nventricles and sulci appropriate in size and configuration for age.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Bilateral lens\nreplacement. The visualized portion of the orbits are unremarkable.", + "output": "No acute intracranial findings." + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes, slightly prominent for patient's age. A deep scalp\nlaceration is seen at the vertex with radiodense material embedded in the\nscalp likely representing foreign bodies. There is a small associated\nsubgaleal hematoma without underlying fracture (601b:70 - 46) There is no\nevidence of fracture. Aside from minimal mucosal thickening of the anterior\nethmoidal air cells and bilateral maxillary sinuses, the visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nThe visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Vertex scalp laceration with associated foreign bodies, small subgaleal\nhematoma and no fracture." + }, + { + "input": "There is no evidence of infarction,hemorrhage,edema,or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes,\nadvanced for age.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nNo evidence for acute hemorrhage, edema, mass effect, or acute major vascular\nterritorial infarction. Scattered small foci of hypodensity within bifrontal\ndeep white matter are nonspecific, though most likely sequela of mild chronic\nsmall vessel ischemic changes in this age group. There are no white matter\nabnormalities specifically suggestive of PRES. There is mild age-related\nprominence of the ventricles and sulci.\n\nThere is mild opacification of bilateral anterior ethmoid air cells. Mastoid\nair cells are well aerated. The orbits are unremarkable.\n\nCTA NECK:\nThe left vertebral artery arises directly from the aortic arch, a normal\nvariant. There is mild calcified plaque within bilateral proximal internal\ncarotid arteries without stenosis by NASCET criteria. Bilateral vertebral\narteries are widely patent. The right vertebral artery is slightly dominant.\n\nCTA HEAD:\nThere is a short-segment, almost web-like moderate stenosis of the mid basilar\nartery, presumably atherosclerotic. No evidence for flow-limiting stenosis in\nthe major anterior circulation arteries. No evidence for a aneurysm. The\ndural venous sinuses appear grossly patent, though not optimally assessed in\nthe arterial phase of contrast enhanced.\n\nOTHER:\nThere is dependent atelectasis in the visualized upper lungs and mild biapical\npleural/parenchymal scarring. Endotracheal tube is well positioned. \nOrogastric tube is partially imaged. No lymphadenopathy by CT criteria. The\nthyroid is grossly unremarkable. Degenerative changes in the cervical spine. \nSubcentimeter sclerotic lesion in the left pedicle of T2 is nonspecific but\ncompatible with a bone island.", + "output": "1. No acute hemorrhage. No evidence for an acute major vascular territorial\ninfarction.\n2. Scattered nonspecific hypodensities within bifrontal white matter are most\nlikely sequela of mild chronic small vessel ischemic disease in this age\ngroup. No specific findings to suggest PRES. However, MRI would be more\nsensitive for further evaluation, if clinically warranted.\n3. Normal neck CTA. The left vertebral artery arises directly from the aortic\narch, a normal variant.\n4. Short-segment, almost web-like moderate stenosis of the mid basilar artery,\npresumably atherosclerotic." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nSubcortical white matter hypodensities are nonspecific and better seen on the\nprior MRI but could represent chronic demyelination or chronic small vessel\nischemic changes, as also noted on prior MRI.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "1. Subcortical white matter hypodensities are nonspecific and better seen on\nthe prior MRI but could represent chronic demyelination or chronic small\nvessel ischemic changes.\n2. No acute intracranial hemorrhage." + }, + { + "input": "There is no evidence of fracture, large territorial\ninfarction,hemorrhage,edema,or mass effect. Punctate calcification in the\nleft corona radiata is unchanged. Ventricles and sulci are mildly prominent,\nconsistent with age-related global parenchymal loss.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, or edema. \nProminence of the ventricles and sulci is suggestive of involutional changes,\nadvanced for age. Minor periventricular white matter hypodensities are\nsuggestive of chronic small vessel ischemic disease. Bilateral basal ganglia\ncalcifications are noted. Prominent extra-axial CSF spaces bilaterally within\nthe anterior middle cranial fossa are suggestive of symmetric arachnoid cysts\nor focal temporal lobe atrophy.\n\nNo osseous abnormalities seen. Bilateral nasal polyps are noted. There is\nminimal mucosal thickening of the left maxillary sinus. Bilateral mastoid air\ncells are hypoplastic and partially opacified. Otherwise, the remaining\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\norbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Global atrophy, advanced for age.\n3. Prominent extra-axial CSF density spaces within the anterior middle cranial\nfossa bilaterally suggestive of arachnoid cysts or focal temporal lobe\natrophy." + }, + { + "input": "There is prominence of the supraglottic posterior hypopharyngeal and\nretropharyngeal soft tissue at the C3-4 level with effacement of the piriform\nsinuses bilaterally (02:43, 602:30). There is no definite mass seen. There is\nno evidence of abscess. There digestive tract remains patent.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There is unchanged loss of height of C3 and C4 with similar\nirregularity of the C2-3 and C3-4 intervertebral levels. No evidence of acute\nfracture.", + "output": "Posterior hypopharyngeal and retropharyngeal soft tissue fullness at the C3-4\nlevel. No evidence of discrete mass or abscess. Further assessment with\nendoscopy is suggested given the history of dysphagia.\n\nRECOMMENDATION(S): Recommend further evaluation with endoscopy given history\nof dysphagia.\n\nNOTIFICATION: Updated recommendations were discussed with Dr. ___\nby Dr. ___ on the telephone at 16:00 on ___." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThe patient is status post right temporoparietal craniotomy for tumor\nresection. Tissue loss with calcifications within the resection bed are\nunchanged. There is ex vacuo dilatation of the temporal and occipital horn of\nthe right lateral ventricle, also unchanged.\n\nThere is no evidence of infarction,hemorrhage,edema,ormass. Prominence of the\nventricles and sulci suggest age-related involutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nNormal 3 vessel takeoff. Minimal atherosclerotic calcifications. Otherwise,\nthe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. Anterior fixation hardware with interbody vertebral spacing devices\nseen spanning C5 through C7.", + "output": "1. No acute abnormalities on a noncontrast head CT.\n2. Status post right temporoparietal craniotomy and tumor resection with\nsimilar posttreatment changes.\n3. Mild atherosclerosis, but otherwise normal CTA of the head and neck without\nevidence of high-grade stenosis or large vessel occlusion. No internal\ncarotid artery stenosis by NASCET criteria." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\n\nThe imaged paranasal sinuses are essentially clear. Mastoid air cells and\nmiddle ear cavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Unremarkable nonenhanced head CT, with no evidence of acute intracranial\nprocess or hemorrhage." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of acute infarction, hemorrhage, edema, or\nmass. With a hypodensity in the right basal ganglia consistent with a chronic\nlacunar infarct. There is prominence of the ventricles and sulci suggestive\nof involutional changes. Periventricular white matter hypodensities are\nnonspecific, but likely reflect sequelae of chronic small vessel ischemic\ndisease.\n\nThere is mild mucosal thickening of the bilateral maxillary sinuses. The\nremaining visualized portion of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. There is\nmoderate atherosclerotic calcification of the carotid siphons The dural venous\nsinuses are patent.\n\nCTA NECK:\nThe left vertebral artery appears occluded at its origin with intermittent\nflow seen within the vertebral artery and reconstitution at the level of C3\ndistally which could be from collaterals or retrograde flow. This is\nunchanged from MRI performed ___. There is calcified plaque at the\norigin of the right vertebral artery with less than 50% stenosis. A stent is\nseen within the left subclavian artery which appears widely patent. There is\nmixed calcified and noncalcified plaque in the distal left common carotid\nartery with calcified plaque at the bifurcation without significant stenosis. \nScattered calcifications are seen in the distal left internal carotid artery\nwithout significant stenosis. There is calcified plaque in the distal right\ncommon carotid artery with calcified plaque at the bifurcation without\nsignificant stenosis. Scattered calcifications are seen in the distal right\ninternal carotid artery without significant stenosis. There is no evidence of\ninternal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are notable for severe paraseptal and\ncentrilobular emphysema. There is a 4 mm left apical pulmonary nodule (5:98).\nThe visualized portion of the thyroid gland is within normal limits. There is\nno lymphadenopathy by CT size criteria.", + "output": "1. No evidence of hemorrhage or acute infarct.\n2. Occlusion of the left vertebral artery at its origin with intermittent\nopacification and ultimately reconstitution distally possibly from collaterals\nor retrograde flow.\n3. Scattered internal carotid artery calcifications bilaterally without\nevidence of stenosis by NASCET criteria.\n4. Severe emphysema.\n5. 4 mm left upper lobe pulmonary nodule.\n\nRECOMMENDATION(S): Given the pulmonary nodule, recommend complete evaluation\nof the chest with dedicated non emergent chest CT.\n\nNOTIFICATION: The updated impression # 5 and recommendation were discussed\nby Dr. ___ with Dr. ___ on the telephone on ___ at 11:35 AM, 5\nminutes after discovery of the findings." + }, + { + "input": "Head CT: There is no evidence of acute intracranial hemorrhage or mass\neffect. The ventricles and basal cisterns appear normal. Intracranial\natheromatous calcifications are noted. There is mild brain parenchymal volume\nloss. The orbits and skull base appear unremarkable. There is mild bilateral\nmaxillary sinus mucosal thickening.\n\nHead CTA: There is no evidence of aneurysm formation or other vascular\nabnormality.There is patency of the anterior and posterior circulation.\n\nThere are hypodense thyroid nodules, ultrasound could further evaluate, as\nclinically warranted. The aortic arch demonstrates conventional 3 vessel\nbranching configuration. The origins of the great vessels are patent. The\nvertebral arteries are codominant. There is minimal atheromatous narrowing of\nthe proximal bilateral internal carotid arteries without evidence of\nhemodynamic significant stenosis. There is no evidence of dissection. The\ndistal left internal carotid artery measures 4.5 mm in the distal right\ninternal carotid artery measures 4.9 mm.\n\nThere is no evidence of aneurysm, vascular malformation, or pathologic large\nvessel occlusion within the intracranial vasculature.\n\nThere is fibronodular scarring of the lung apices which appears unchanged when\ncompared to ___. There is multilevel cervical spondylosis.", + "output": "1. No evidence of acute intracranial hemorrhage or mass effect.\n2. No evidence of aneurysm, focal dissection, or pathologic large vessel\nocclusion within the vasculature of the head or neck.\n3. Hypodense thyroid nodules, ultrasound could further evaluate, as clinically\nwarranted." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no intra or extra-axial mass effect acute hemorrhage or large\nterritory infarct. The sulci, ventricles and cisterns are within expected\nlimits for the patient's age. Mild bilateral tonsillar inferior displacement\nis better evaluated on prior MRI head of ___, compatible with\ntonsillar ectopia/mild Chiari malformation. There are very small mucous\nretention cyst in the left maxillary sinus and right sphenoid sinus. The\nremainder of the visualized paranasal sinuses are essentially clear. The\norbits are unremarkable. The mastoid air cells and middle ears are well\npneumatized and clear.\n\nCTA HEAD:\nExamination is mildly degraded by contrast bolus timing. Within this confine:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear grossly normal with no evidence of stenosis, occlusion, or aneurysm.\nThe dural venous sinuses are patent.", + "output": "1. No acute intracranial abnormality on noncontrast CT head. Specifically no\nintracranial hemorrhage, acute infarct or mass effect.\n2. Better evaluated on prior examination is downward displacement of the\nbilateral cerebellar tonsils, compatible with Chiari 1 malformation/tonsillar\nectopia.\n3. CTA examination is suboptimal secondary to timing of the contrast bolus. \nWithin this confines: Grossly unremarkable CTA of the head. Please refer to\noutside hospital MRA head of ___ for additional detail." + }, + { + "input": "CT of the neck: There is a moderately displaced fracture of the posterior\nlateral arch of C1, additionally paravertebral soft tissue swelling is\nidentified, better depicted in the MRI of the cervical spine, extending from\nC1 through C4 level, the airway appears patent. Apparently the left C1\nfracture does not extend through the transverse foramen. No other fractures or\nnarrowing of the spinal canal is identified.\n\nCTA of the neck: In the area of the arch of C1 left side fracture, the\nadjacent left vertebral artery appears patent with no evidence of dissection\nor active extravasation. The origin of the common carotid arteries and right\nvertebral artery are normal with no evidence of flow stenotic lesions or\ndissection. The lung apices are clear, the thyroid gland appears unremarkable.", + "output": "1. Moderately displaced fracture through the left anterior and posterior\narches of C1 as described in detail above. The fracture apparently is not\nextending throughout the transverse foramen of C1. There is no evidence of\ndissection or active extravasation. There reminder neck vasculature appears\nnormal with no evidence of flow stenotic lesions.\n\n2. Soft tissue swelling identified and better depicted in the MRI of the\ncervical spine, extending from C1 through C4 level.\n\nNOTIFICATION: The preliminary wet read was provided by Dr. ___ on\n___ at 13:36. These findings were discussed with neurosurgery nurse\n___, at 14:00, ___, by Dr. ___\ntelephone." + }, + { + "input": "There is no evidence of infarction,intracranial hemorrhage,edema,or midline\nshift. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Punctate vascular atherosclerotic calcifications are\nseen in the carotid siphons bilaterally.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Patient is status post bilateral lens\nreplacement.", + "output": "1. There is no evidence of acute intracranial process or hemorrhage." + }, + { + "input": "Salivary glands:\nPlease note that this exam is limited secondary to metallic streak artifact\nrelated to dental amalgam. This especially limits evaluation of the right mid\nand distal aspects of Ste___'s duct. The visualized portions of the right\nStensen's duct appear dilated and fluid-filled, measuring up to 4 mm in\ndiameter (4:51). Findings may reflect occlusive sialolith within distal\nStensen's duct versus distal stricture. However, the right parotid gland\nappears grossly normal and not significantly changed in density in comparison\nto CT from ___, without surrounding inflammatory changes to\nsuggest acute parotitis.\n\nThe left parotid gland demonstrates diffuse fatty atrophy, new in comparison\nto CT from ___. Visualized portions of the left Stensen's duct\ndo not appear dilated, although its distal aspect is not well evaluated\nsecondary to metallic streak artifact.\n\nThere is been an increase in fatty atrophic changes of the right submandibular\ngland in comparison to the prior CT from ___, with increased\nmultifocal linear for calcifications along the course of ___ duct,\ncompatible with sialoliths with chronic upstream gland atrophy.\n\nThe left submandibular gland is not identified, unchanged since ___, which\nmay reflect congenital absence versus complete fatty atrophy. No\ncalcifications are noted in the expected region of the left ___ duct.\n\n\nAero digestive tract:\nNote is made of asymmetric fullness of the left palatine tonsil, incompletely\ncharacterized on the current exam secondary to extensive streak artifact from\nthe patient's dental amalgam.\n\nNeck lymph nodes:\nThere is no adenopathy involving bilateral levels ___. Scattered subcentimeter\nshort axis nonspecific lymph nodes are noted throughout the neck bilaterally,\nwithout suspicious features or definite enlargement by size criteria. There is\nno retropharyngeal adenopathy.\n\nExtra nodal tumor spread:\nThere are no findings suggestive of extra nodal extension.\n\nDeep neck muscles, masticator space:\nThere is no muscle invasion.\n\nBones, skull base:\nThere is no bone involvement.\nThere are no findings suggestive of perineural tumor extension.\nJugular foramen, carotid canal,pterygopalatine fossa,infraorbital\nforamen,other skull base foramina are not involved.\n\nVessels:\nThere is no vascular invasion.\n\nBrachial Plexus:\nThere is no brachial plexus contact or invasion.\n\nThyroid, salivary glands:\nThere is no mass.\n\nOther findings:\nThere are no lung nodules.\nThere are moderate multilevel degenerative changes within the visualized\nspine.", + "output": "Streak artifact from metallic dental hardware limits evaluation, particularly\nin the region of the distal bilateral Stensen's ducts. Within these confines:\n\n1. Fluid-filled dilatation of the right Stensen's duct up to 4 mm. Findings\nmay reflect occlusive sialolith within the distal aspect of Stensen's duct\nversus distal stricture. However, there is no surrounding inflammation to\nsuggest acute parotitis.\n2. Diffuse fatty atrophy of the left parotid gland, new since ___, without\ndefinite sialolith or dilatation of the left Stensen's duct.\n3. Increased fatty atrophy of the right submandibular gland since ___ with\nincreased linear calcifications along the course of ___ duct compatible\nwith sialoliths, suggesting chronic upstream gland atrophy.\n4. The left submandibular gland is not identified, similar to ___, which may\nreflect congenital absence versus complete fatty atrophy.\n5. Asymmetric fullness of the left palatine tonsil, incompletely characterized\non the current exam secondary to extensive streak artifact from the patient's\ndental amalgam. If there is further concern for oropharyngeal lesions, direct\nvisualization would be recommended." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or acute vascular\nterritorial infarction. A hypodensity in the left occipital lobe likely\nrelates to a chronic infarct (___). Periventricular white matter\nhypodensities are nonspecific but likely sequelae of mild chronic small vessel\nischemic change. The ventricles and sulci are mildly prominent in keeping with\nage related involutional changes. Basal cisterns are patent. Gray-white matter\ndifferentiation is preserved.\n\nPartially imaged paranasal sinuses are notable for mild opacification of the\nleft anterior ethmoid air cells. Mastoid air cells and middle ear cavities are\nclear. No fracture is identified. Cavernous carotid calcifications are noted.", + "output": "No evidence of acute intracranial abnormality. Focal prior left occipital\ninfarct." + }, + { + "input": "Somewhat limited by motion artifact. There is no acute intracranial\nhemorrhage, edema, mass effect, shift of normally midline structures or\nevidence of acute major vascular territorial infarction. Prominence of\nventricles and sulci is consistent with age related involutional changes.\nPeriventricular white matter hypodensities are likely a sequela of chronic\nsmall vessel ischemic disease. Note is made of an old infarct in the left\nposterior occipital lobe. The basal cisterns appear patent and there is\npreservation of gray-white matter differentiation. There is no fracture.\nEvaluation of the bones is somewhat limited by mild motion artifact. The\nvisualized paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear.", + "output": "No acute intracranial abnormality." + }, + { + "input": "CTA Head: There is calcification of the carotid siphons but no stenosis of\nthe intracranial internal carotid arteries. The anterior and middle cerebral\narteries are patent with normal contrast enhancement and branching pattern.\nThere is a normal anterior communicating artery complex.\n\nThe vertebral and basilar arteries demonstrate normal enhancement without\nstenosis or occlusion. The posterior cerebral arteries have a normal branching\npattern. The posterior communicating arteries are not visualized.\n\nThere is no evidence of stenosis, occlusion, aneurysm or arteriovenous\nmalformation.\n\nThe major dural venous sinuses and cerebral veins are patent.\n\nCTA Neck: There is marked calcification of the aortic arch with moderate\ncalcification of the origins of the major head and neck vessels.\n\nThere is 41% stenosis of the left internal carotid artery by NASCET criteria.\nThere is no stenosis of the right internal carotid artery by NASCET criteria.\n\nThe cervical portions of the vertebral arteries demonstrate normal\nenhancement. There is no evidence of a stenosis or a dissection.\n\nThere are calcified pleural plaques in the visualized right hemithorax. There\nare calcified nodules of both lung apices. There is a right IJ Port-A-Cath\nwith its tip in the SVC, the distal extent is not imaged.", + "output": "1. No stenosis, dissection, or aneurysm greater than 3 mm of the major\nintracranial arterial vasculature.\n2. Calcific atherosclerosis causing 41% stenosis of the left internal carotid\nartery by NASCET criteria. No right internal carotid artery stenosis by NASCET\ncriteria." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, mass, mass effect or\nshifting of the normally midline structures. The ventricles and sulci are\nslightly prominent, likely age related and involutional in nature, unchanged\nsince the prior head CT on ___. The soft tissues and bony\nstructures are unremarkable, the paranasal sinuses are notable for mucosal\nthickening in the ethmoidal air cells, and left maxillary sinus, apparently\nnew since the prior examination, the orbits are unremarkable. There is\nunchanged mild mucosal thickening in the mastoid air cells.", + "output": "1. There is no evidence of acute intracranial process, slightly prominent\nventricles and sulci, suggesting mild cortical volume loss, likely age\nrelated. No significant changes are demonstrated since the prior MRI and head\nCT examinations.\n\n2. New mucosal thickening identified on the left maxillary sinus, suggestive\nof an ongoing inflammatory process, mild mucosal thickening in the mastoid air\ncells appears unchanged." + }, + { + "input": "There is no acute intracranial hemorrhage, cerebral edema or evidence of major\nvascular territory infarction. A small chronic right occipital infarct is\nnoted. Prominent ventricles and sulci are likely due to age-related volume\nloss, overall unchanged since ___. Bilateral periventricular white\nmatter hypodensities are suggestive of chronic small vessel ischemic disease.\nThe basal cisterns are patent. Visualized paranasal sinuses, mastoid air cells\nand middle ear canals are clear. No fracture is identified. Bilateral orbits\nare unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Mild\nprominence of the ventricles and sulci is indicative of volume loss. Focal\nencephalomalacia in the right occipital lobe (02:14) is indicative of a remote\ninfarct.\n\nNo osseous abnormalities seen. There is minimal mucosal thickening of the\nethmoid air cells, otherwise the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of large acute territorial infarction, acute intracranial\nhemorrhage, edema, or mass effect. The ventricles and sulci are prominent,\nconsistent with age related volume loss. Focal encephalomalacia in the right\noccipital lobe is unchanged, and compatible with remote infarct (2:15).\n\nNo acute fracture identified. Mucosal thickening of the ethmoidal air cells\nis unchanged. The remaining paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial hemorrhage or infarction. Focal encephalomalacia due to\nprior right occipital lobe infarct is unchanged." + }, + { + "input": "There is predominantly hypodense mixed-density subdural hematoma along the\nbilateral cerebral convexities with associated sulcal effacement, consistent\nwith acute-on-chronic subdural hematoma, with a more acute component seen\nposteriorly bilaterally. Subdural blood measures up to 1.5 cm in the right\nand 1.6 cm on the left. There is no appreciable shift of normally midline\nstructures. Basal cisterns are patent. There is no evidence of\nhydrocephalus.\n\nThere is no acute large territorial infarction. Focal area of\nencephalomalacia in the right occipital lobe is unchanged and consistent with\nremote infarct. Mildly prominent ventricles and sulci suggest age-related\ninvolutional changes.\n\nNo acute calvarial fracture identified. Mild mucosal thickening of the\nethmoidal air cells. Otherwise, the remaining visualized paranasal sinuses,\nmastoid air cells and middle ear cavities are clear. Visualized portions of\nthe orbits are unremarkable.", + "output": "1. Predominantly hypodense mixed-density bilateral acute-on-chronic subdural\nhematomas with more acute component seen posteriorly bilaterally. No midline\nshift." + }, + { + "input": "There are bilateral mixed density, predominantly hypodense, subdural hematomas\nalong the lateral convexities. They are stable in size with the left subdural\nhematoma measuring 15 mm in width and the right subdural hematoma measures 14\nmm in width. No new hemorrhage, mass or infarct is noted. There is no shift\nof midline structures, and the basilar cisterns are patent.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The patient is\nstatus post bilateral lens replacement.", + "output": "Similar appearance of bilateral acute on chronic subdural hematomas. No new\nintracranial hemorrhage." + }, + { + "input": "The previously noted right subdural collection has almost completely resolved,\nwith minimal residual collection versus dural thickening at the right parietal\nvertex measuring 2 mm on images 602b:28, 601b:60. Right sulcal effacement has\nresolved.\n\nThe previously noted left subdural collection remains mixed intensity with\nhypodense and hyperdense components. It has decreased in size, now measuring\nup to 10 mm from the inner table on images 2:20, 2:23. Left sulcal effacement\nhas partially improved.\n\nBoth lateral ventricles have increased in size, suggesting re-expansion. \nConcordant prominence of the ventricles and sulci is congruent with\nage-related parenchymal volume loss. There is no shift of midline structures.\nWell-defined hypodensity is again seen in the right external capsule,\ncorresponding to prominent perivascular spaces on the ___ brain MRI.\nMore ill-defined hypodensities in the periventricular, deep, and subcortical\nwhite matter of the cerebral hemispheres are grossly stable, nonspecific but\nlikely sequela of chronic small vessel ischemic disease in this age group.\n\nThe bones are unremarkable. There is minimal mucosal thickening in the ethmoid\nair cells. Other visualized paranasal sinuses and mastoid air cells are well\naerated.", + "output": "1. Compared to ___, the right subdural collection has nearly\ncompletely resolved, with a 2 mm residual collection versus dural thickening\nremaining.\n2. The left subdural collection has decreased in size but remains mixed\nintensity, including hyperdense and hypodense components. Given persistence\nof hyperdense components, an element of interim the rebleeding cannot be\nexcluded entirely.\n3. Improved mass effect with resolution of right sulcal effacement and\nimprovement in left sulcal effacement." + }, + { + "input": "The previously noted right lateral convexity subdural collection continues to\ndecrease in size and has nearly completely resolved, with millimetric residual\nidentified representing either a minimal residual collection or dural\nthickening.\n\nMixed density left lateral convexity subdural collection has decreased in size\nmeasuring 6 mm in maximal thickness, previously 10 mm (601b:58). Minimal\nassociated mass effect has improved.\n\nThere is no evidence of infarction,new hemorrhage, edema, or mass. There is\nmild prominence of the ventricles and sulci suggestive of involutional\nchanges. Trace periventricular white matter hypodensities are in a\nconfiguration most suggestive of chronic small vessel ischemic change. There\nis a stable probable prominent perivascular space of the right external\ncapsule (02:11). Atherosclerotic vascular calcifications are noted of\nbilateral vertebral and cavernous portions of internal carotid arteries.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Interval decrease in size of a mixed density acute on chronic left lateral\nconvexity subdural collection, now measuring 6 mm.\n2. Interval decrease of a right lateral convexity subdural collection,\nsuggestive of trace residual hemorrhage versus or dural thickening.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 17:16 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." + }, + { + "input": "Compared with ___, a left subdural hematoma is decreased in size and\ndensity, currently measuring up to 2.5 mm, compared with 6 mm previously\n(2:18). A previously seen right lateral convexity subdural hematoma has\nnearly completely resolved, with millimetric residual either chronic hematoma\nor dural thickening, similar prior. There is no significant mass effect or\nmidline shift. There is no evidence of infarction,new intracranial\nhemorrhage,edema,or mass.\n\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Periventricular white matter hypodensities are nonspecific, however\nlikely represent sequela of chronic small vessel ischemic disease. Again seen\nis a probable prominent perivascular space in the right external capsule. \nThere are atherosclerotic calcifications in the bilateral cavernous carotids\nand vertebral arteries.\n\nThere is no evidence of fracture. There is mild mucosal thickening in the\nright maxillary sinus and ethmoid air cells. The visualized portion of the\nremainder of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. Patient is status post bilateral lens replacement. The visualized\nportion of the orbits are otherwise unremarkable.", + "output": "-Interval decrease in size and density of a chronic left subdural hematoma,\ncurrently measuring to 2.5 mm, compared with 6 mm previously. No significant\nmass effect.\n-Stable appearance of either trace residual right lateral convexity chronic\nsubdural hematoma or dural thickening.\n-No new intracranial hemorrhage.\n- Paranasal sinus disease as described." + }, + { + "input": "Previously seen left subdural hematoma has resolved in the interim. There is\nno intra-axial or extra-axial hemorrhage identified on today's exam. There is\nno edema, shift of normally midline structures, or evidence of acute major\nvascular territorial infarction. Ventricles and sulci are prominent\nconsistent with age related global atrophy. Periventricular, subcortical, and\ndeep white matter hypodensities are nonspecific, but likely represent sequela\nof chronic small vessel ischemic disease. There is unchanged likely prominent\nperivascular space in the right external capsule. There are arthrosclerotic\ncalcifications in the bilateral cavernous carotid and vertebral arteries. \nThere is mild mucosal thickening of the right maxillary sinus and anterior\nethmoid air cells. The remaining imaged paranasal sinuses are clear. Mastoid\nair cells and middle ear cavities are well aerated. The bony calvarium is\nintact.", + "output": "1. No acute intracranial process.\n2. Age-related global atrophy and sequela of chronic microvascular ischemic\ndisease.\n3. Sinus disease as described above." + }, + { + "input": "There is no evidence of acute large territorial infarction, intracranial\nhemorrhage, edema, or mass.\n\nThere is prominence of the ventricles and sulci suggestive of age-related\ncerebral volume loss. Periventricular and subcortical white matter\nhypodensities are nonspecific, though likely sequelae of chronic small vessel\nischemic disease. Atherosclerotic vascular calcifications are noted of\nbilateral vertebral and cavernous portions of internal carotid arteries.\n\nNo acute osseous abnormalities seen. The partially imaged paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The orbits demonstrate\nno acute abnormalities.", + "output": "No acute intracranial process. No evidence of intracranial hemorrhage." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of large territory infarction,hemorrhage,edema,ormass. \nChronic bilateral occipital lobe infarcts are similar in configuration to\nprior MRI from ___. Prominence of the ventricles and sulci is\nconsistent with age related volume loss.\n\nThere are mucous retention cyst in the right maxillary sinus and mild mucosal\nthickening of the ethmoidal air cells. Otherwise, the visualized portion of\nthe paranasal sinuses, mastoid air cells,and middle ear cavities are clear.\nThe visualized portion of the orbits demonstrate bilateral lens replacement.\n\nCTA HEAD:\nThere are extensive calcifications of the carotid siphons with probable\nmoderate narrowing. There is irregularity of the right A2 segment of the\nanterior cerebral artery and bilateral middle cerebral arteries, consistent\nwith atherosclerotic disease. Otherwise, the vessels of the circle of ___\nand their principal intracranial branches appear normal without high-grade\nstenosis, occlusion, or aneurysm formation greater than 3mm. The dural venous\nsinuses are patent.\n\nCTA NECK:\nThere is calcified atherosclerotic plaque at the origin of the right internal\ncarotid artery, with approximately 70% stenosis of the proximal right internal\ncarotid artery (series 3, image 132). There is calcified atherosclerotic\nplaque at the origin of the left internal carotid artery with approximately\n60% stenosis of the proximal left internal carotid artery. Irregularity of\nthe internal carotid arteries is suggestive of fibromuscular dysplasia. \nBilateral vertebral artery origins are patent.\n\nOTHER:\nBiapical scarring and multiple calcified nodules measuring up to 8 mm nodule\nare noted. The visualized portion of the thyroid gland demonstrates a 4 mm\nhypodense nodule in the left thyroid lobe. A right lower paratracheal lymph\nnode measures up to 0.7 cm which is not pathologically enlarged by CT size\ncriteria. (Series 3, image 33) There is no lymphadenopathy by CT size\ncriteria. Numerous sialoliths are noted in the right parotid gland. A second\nmillimetric calcific density is seen in the expected area of the left\n___ duct (series 3, image 173), without significant dilatation of the\nduct.", + "output": "1. No acute intracranial abnormality or evidence of large territorial infarct.\n2. Patent circle of ___ without definite evidence of occlusionor aneurysm. \nMultifocal vessel irregularity involving the left anterior cerebral artery and\nbilateral middle cerebral arteries is consistent with atherosclerotic disease.\n3. Patent bilateral cervical carotid and vertebral arteries without definite\nevidence of occlusionor dissection.\n4. Bilateral internal carotid artery atherosclerotic disease with 70% stenosis\nnear the origin the right internal carotid artery and 60% stenosis near the\norigin of the left internal carotid artery.\n5. Multifocal irregularity of the internal carotid arteries is suggestive of\nfibromuscular dysplasia.\n6. 4 mm left thyroid lobe nodule. Follow-up imaging is not warranted. See\nbelow.\n7. Multiple small intraparotid calcifications/calculi and possible left\nsubmandibular calculus.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or older.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nAgain noted is a hypodensity with loss of gray-white differentiation in the\nleft medial and inferior occipital lobe compatible with acute infarct. \nHypodensity with evidence of parenchymal volume loss in the right occipital\nlobe likely reflects chronic infarct. There is regional sulcal effacement in\nthe left occipital lobe, but no evidence of midline shift or intracranial\nhemorrhage. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere are mild ethmoid sinus mucosal inflammatory changes. A small mucous\nretention cyst is noted within the dependent right maxillary sinus. The\nmastoid air cells appear clear. The orbits and globes appear grossly\nunremarkable, noting bilateral lens replacements.\n\nCTA HEAD:\nThere are moderate calcifications of the bilateral carotid siphons, with\nprobable mild stenosis of the bilateral with supraclinoid ICAs.\n\nThere is focal high-grade stenosis versus occlusion of the left posterior\ncerebral artery P2 segment (3:238, 310:4). There is mild multifocal irregular\nluminal narrowing of the bilateral MCA M1 segments. There is moderate\nstenosis of the distal right ACA A1 segment. There is irregular luminal\nnarrowing of the bilateral proximal ACA A2 segments.\n\nThere is mild prominence of the anterior communicating artery complex without\nfrank aneurysm formation. There is no definite evidence of aneurysm\nformation.\n\nThe dural venous sinuses are patent, noting mild hypoplasia of the left\ntransverse sinus.\n\nCTA NECK:\nThere is moderate, predominantly calcified atherosclerotic plaque at the\naortic arch and at the origins of the great vessels.\n\nMixed calcified plaque at the origin of the left common carotid artery results\nin mild stenosis but distal reconstitution. There are atherosclerotic\ncalcifications at the origin of the right common carotid artery without\nsignificant stenosis. There are punctate atherosclerotic calcifications along\nthe right common carotid artery without stenosis.\n\nThere is prominent calcified atherosclerotic plaque at the bilateral carotid\nbifurcations and proximal internal carotid arteries resulting in approximately\n40% stenosis of the bilateral internal carotid arteries by NASCET criteria.\n\nThere are atherosclerotic calcifications at the bilateral vertebral artery\norigins with probable mild resultant stenosis. The remaining portions of the\nbilateral vertebral arteries appear patent, normal in course and caliber.\n\nThere is no evidence of carotid or vertebral artery dissection.\n\n\nOTHER:\nThe bilateral lung apices demonstrate linear foci of calcified pleural\nthickening/scarring and multiple large partially imaged right lung calcified\npleural plaques suggestive of prior asbestos exposure. Consider dedicated\nchest imaging for further evaluation. There is a 4 mm left thyroid lobe\nhypodense nodule, for which no specific follow up is recommended in a patient\nof this age, unless otherwise clinically indicated, as per ACR guidelines. \nThere is no cervical lymphadenopathy by CT size criteria.", + "output": "Head CT:\n\n1. Hypodensity in the left occipital lobe compatible with acute left PCA\ninfarct.\n2. No evidence of acute intracranial hemorrhage or significant mass effect.\n3. Chronic right PCA infarct.\n\n\nHead CTA:\n\n1. There is focal high-grade stenosis versus occlusion of the left posterior\ncerebral artery P2 segment (3:238, 310:4).\n2. Moderate calcifications of the bilateral carotid siphons, with probable\nmild stenosis of the bilateral with supraclinoid ICAs.\n3. Multifocal irregular luminal narrowing of the bilateral MCA M1 segments and\nproximal bilateral ACA A2 segments with moderate stenosis of the distal right\nACA A1 segment, likely reflecting atherosclerotic changes. Additional\nstenosis are seen involving the M2/proximal M3 segments of the right middle\ncerebral artery.\n4. There is no definite evidence of aneurysm formation, although there is mild\nprominence of the anterior communicating artery complex.\n\n\nNeck CTA:\n\n1. Calcified plaque at the left greater than right common carotid artery\norigins resulting in mild focal stenosis of the left common carotid origin.\n2. Prominent calcified plaque at the bilateral carotid bifurcations with\napproximately 40% stenosis of the bilateral internal carotid arteries by\nNASCET criteria.\n3. Atherosclerotic calcifications at the bilateral vertebral artery origins\nwith mild stenosis. The remaining portions of the vertebral arteries appear\nnormal.\n4. No evidence of carotid or vertebral artery dissection.\n5. The bilateral lung apices demonstrate linear biapical calcified pleural\nthickening/scarring as well as multiple large, partially imaged calcified\npleural plaques on the right, suggestive of prior asbestos exposure. Consider\ndedicated CT of the chest for further evaluation, if clinically indicated.\n\nNOTIFICATION: Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nAgain noted is a hypodensity with loss of gray-white differentiation in the\nbilateral occipital lobes likely; mildly progressed since previous examination\nspecially on the left side. There is regional sulcal effacement in the left\noccipital lobe, but no evidence of midline shift or brain herniation. Focal\nhypodensities in the subinsular white matter bilateral probably represent\nsequela of chronic infarctions, largely unchanged. Also similar are\nhypodensities in the left greater than right hippocampus. There are bilateral\nchronic cerebellar infarcts. Periventricular and subcortical white matter\nhypodensities, nonspecific but probably reflect sequela of chronic\nmicroangiopathy. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes with no evolving hydrocephalus. No acute intracranial\nhemorrhage.\n\nThere are mild ethmoid sinus mucosal inflammatory changes. A small mucous\nretention cyst is noted within the dependent right maxillary sinus. The\nmastoid air cells appear clear. The orbits and globes appear grossly\nunremarkable, noting bilateral lens replacements.\n\nCTA HEAD:\nThere are moderate calcifications of the bilateral carotid siphons, with\nprobable mild stenosis of the bilateral with supraclinoid ICAs.\n\nThere is focal high-grade stenosis versus occlusion of the left posterior\ncerebral artery P2 segment (series 4 image 235). There is mild multifocal\nirregular luminal narrowing of the bilateral MCA M1 segments. There is\nmoderate stenosis of the distal right ACA A1 segment. There is irregular\nluminal\nnarrowing of the bilateral proximal ACA A2 segments.\n\nThere is mild prominence of the anterior communicating artery complex without\nfrank aneurysm formation. There is no definite evidence of aneurysm\nformation.\n\nThe dural venous sinuses are patent, noting mild hypoplasia of the left\ntransverse sinus.\n\nCTA NECK:\nThere is moderate, predominantly calcified atherosclerotic plaque at the\naortic arch and at the origins of the great vessels.\n\nMixed calcified plaque at the origin of the left common carotid artery results\nin mild stenosis but distal reconstitution. There are atherosclerotic\ncalcifications at the origin of the right common carotid artery without\nsignificant stenosis. There are punctate atherosclerotic calcifications along\nthe right common carotid artery without stenosis.\n\nThere is prominent calcified atherosclerotic plaque at the bilateral carotid\nbifurcations and proximal internal carotid arteries resulting in approximately\n60% stenosis on the right side and 40% stenosis on the left side of the\nbilateral internal carotid arteries by NASCET criteria.\n\nThere are atherosclerotic calcifications at the bilateral vertebral artery\norigins with probable mild resultant stenosis. The remaining portions of the\nbilateral vertebral arteries appear patent, normal in course and caliber.\n\nThere is no evidence of carotid or vertebral artery dissection.\n\nOTHER:\nThe bilateral lung apices demonstrate linear foci of calcified pleural\nthickening/scarring and multiple large partially imaged right lung calcified\npleural plaques suggestive of prior asbestos exposure. Consider dedicated\nchest imaging for further evaluation. Thyroid show heterogenous enhancement.", + "output": "1. No acute intracranial hemorrhage.\n2. Redemonstration of bilateral occipital and bilateral temporal hypodensities\nof indeterminate age further characterization by MRI is advised.\n3. Background of moderate to severe form of chronic microangiopathy.\n4. Background of of moderate to severe atherosclerotic changes affecting of\nintracranial arterial vasculature with redemonstration of left posterior\ncerebral artery P2 segment occlusion/severe stenosis.\n5. Calcified and noncalcified atherosclerotic plaque affecting origin of great\nmediastinal vasculature as well as origin of internal carotid arteries.\n6. About 60% stenosis of the right and 40% stenosis of the left internal\ncarotid arteries at origin.\n7. Redemonstration of bilateral described parenchymal changes; consider\ndedicated CT of the chest for further evaluation, if clinically indicated." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or large mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process. Specifically, no intracranial hemorrhage or\nlarge mass." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is encephalomalacia of the right frontoparietal and temporal lobes,\nsecondary to a prior right MCA infarction. Asymmetric decrease in size of the\nright thalamus, cerebral peduncle and midbrain is seen, secondary to wallerian\ndegeneration. There is mild ex vacuo dilatation of the right lateral\nventricle.\n\nThere is no evidence of no evidence of acute infarction, hemorrhage, edema, or\nmass.\n\nThe visualized portion of the mastoid air cells, and middle ear cavities are\nclear. Bilateral cataract extractions are seen. There is mucosal thickening\nof the left maxillary and ethmoid sinuses.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK: The ascending thoracic aorta measures 4.2 cm. There is mild\natherosclerotic calcification of the aortic arch and branch vessels. Mild\natherosclerotic calcification of the carotid bulbs is also seen. Otherwise,\nthe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. Debris is noted in the bilateral external auditory canals with no\nassociated osseous erosions, likely representing cerumen. Degenerative\nchanges are noted throughout the visualized spine.", + "output": "1. No evidence of acute intracranial hemorrhage.\n2. No evidence of aneurysm greater than 3 mm, dissection or vascular\nmalformation, or significant luminal narrowing.\n3. Ascending aorta enlargement, measuring 4.2 cm." + }, + { + "input": "There is no evidence of large territorial infarction,acute intracranial\nhemorrhage,edema,or mass. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. Periventricular and deep white matter\nhypodensities are nonspecific, likely sequela of chronic small vessel ischemic\ndisease.\n\nThere is no calvarial fracture. There is moderate ethmoidal air cell\nthickening with mild bilateral maxillary and sphenoid sinus thickening. The\nvisualized portion of the remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "No evidence of acute intracranial hemorrhage." + }, + { + "input": "There is no acute intracranial hemorrhage, acute infarction, large mass or\nmidline shift. There is no hydrocephalus. The ventricles and sulci are normal\nin size and configuration. The basal cisterns are patent and there is\npreservation of gray-white matter differentiation. The orbits are\nunremarkable. The There is no fracture.\n\nThere is trace mucosal wall thickening in bilateral frontoethmoidal recesses\nas well as bilateral anterior ethmoid air cells. There is a moderate sized\nmucous retention cyst in the right maxillary sinus. There is trace mucosal\nwall thickening in bilateral sphenoid air cells. The sphenoid sinus minor\nseptation inserts on the right carotid groove. There is no bony sclerosis. The\ncribriform plate and lamina papyracea are intact. There is mild deviation of\nthe nasal septum to the right with a small bony spur. Ostiomeatal units are\npatent.", + "output": "1. No acute intracranial hemorrhage or mass effect. No obvious hyperdense cm\nto suggest infarction. However, CT can be limited for the assessment of acute\ninfarcts.\nCorrelate clinically and consider MRI of the head if not contraindicated.\n\n2. Trace chronic sinus changes as above." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of hemorrhage, edema, or mass effect. Prominent\nventricles and sulci likely reflect global atrophy. There is no shift of\nnormally midline structures. Cisterns are patent.\n\nThe orbits are unremarkable. Visualized paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion or aneurysm formation. The dural\nvenous sinuses are patent. Calcifications involve the carotid siphons\nbilaterally.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria. Moderate calcified and noncalcified atheromatous\nplaque involves the left carotid bulb (5:139) results in minimal narrowing. \nMinimal atherosclerotic calcifications involve the right internal carotid\nartery at its bifurcation. Focal calcifications involve the origin of the\nleft vertebral artery (5:8). Bilateral vertebral arteries are otherwise\nunremarkable and symmetric in caliber.\n\nOTHER:\nThe visualized portion of the lungs are clear. Airway thickening and\nnodularity is most pronounced within the right upper lobe. The thyroid gland\nappears heterogenous in attenuation with a 2.0 x 1.3 cm nodule within the left\nthyroid lobe noted. There is no cervical adenopathy. Multilevel degenerative\nchanges are most pronounced at the C3-C4 level with near complete loss of disc\nspace height.", + "output": "1. No flow limiting stenosis within the head and neck vessels. No evidence\nof aneurysm formation.\n2. No acute intracranial abnormality.\n3. Moderate partially calcified atheromatous plaque involves the left carotid\nartery at its origin resulting in minimal narrowing.\n4. Heterogenous thyroid gland with left thyroid nodule which measures up to 2\ncm for which correlation with ultrasound can be pursued on a non-emergent\nbasis if clinically warranted." + }, + { + "input": "There is no evidence of acute large territory infarction,hemorrhage,or edema. \nFew punctate and small hypodensities throughout the left basal ganglia could\nrepresent chronic lacunar infarcts or enlarged perivascular spaces. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nMild periventricular and deep white matter hypodensities are nonspecific but\nlikely chronic sequela of small-vessel ischemic disease.\n\nThere is no evidence of fracture. There is mild mucosal thickening throughout\nthe anterior ethmoid air cells. There is a small osteoma in the right\nfrontoethmoidal recess. The mastoid air cells, and middle ear cavities are\nclear.\n\nAlong the extraconal aspect of the right orbital roof, there is an ill-defined\n2.3 x 1.2 x 1.8 cm soft tissue lesion with intermediate density extending\nalong the region of the superior extraocular muscles which is nonspecific and\nincompletely evaluated on the CT.", + "output": "1. Ill-defined 2.3 x 1.2 x 1.8 cm intraorbital, extraconal soft tissue density\nalong the undersurface of the right superior orbital roof is nonspecific and\nincompletely evaluated. Findings may represent a hematoma in the setting of\ntrauma, however a soft tissue mass or metastatic disease cannot be excluded. \nNonurgent MR of the orbits may be obtained for further evaluation.\n2. No acute intracranial hemorrhage or calvarial fracture.\n3. Few small hypodensities throughout the left basal ganglia could represent\nchronic lacunar infarcts or enlarged perivascular spaces.\n\nNOTIFICATION: Updated findings discussed with ___, MD by ___\n___, MD via telephone at 5:52 pm on ___, 2 minutes after discovery of\nthe updated findings." + }, + { + "input": "There is a mixed density subdural collection along the left cerebral convexity\nwhich measures 9 mm (02:20) at the level of foramen of ___, unchanged in\nsize from comparison study. Although the majority of this collection is\nmostly low-density compatible with chronic blood, there are are high-density\nblood products within this subdural collection compatible with acute\nhemorrhage (02:25), unchanged from comparison study. There is mass effect and\n6 mm of right midline shift (02:21). There is no evidence of new or worsening\nintracranial hemorrhage. Basal cisterns are patent.\n\nThere is mucosal thickening of the bilateral ethmoid air cells, bilateral\nfrontal sinuses, and bilateral maxillary sinuses. Mastoid air cells and middle\near cavities are well aerated. The bony calvarium is intact.", + "output": "1. Mixed density left-sided subdural hematoma with some high-density blood\nproducts compatible with acute hemorrhage, unchanged from CT head ___ 06:56. No evidence of new or worsening intracranial hemorrhage.\n2. 6 mm of rightward midline shift, unchanged." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass. Focal\nencephalomalacia of the left inferior cerebellar hemisphere is old. The\nventricles and sulci are normal in size and configuration. The basilar\ncisterns appear patent. There is no evidence of herniation or shift of\nnormally midline structures.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process. Focal encephalomalacia of the left inferior\ncerebellar hemisphere." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\nThere is no evidence of fracture. Expansile ground-glass nature of the right\ngreater wing of the sphenoid and right sphenoid body is suggestive of fibrous\ndysplasia. The visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable. A small left frontal scalp hematoma is noted.", + "output": "1. No acute intracranial hemorrhage.\n2. Expansile ground-glass matrix of the sphenoid bone, suggestive of fibrous\ndysplasia." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or infarction. The\nventricles and sulci are normal in size and configuration. There is a 5 mm\nhyperdensity in the area of the foramen of ___, consistent with a colloid\ncyst. The basal cisterns appear patent and there is preservation of gray-white\nmatter differentiation.\n\nNo fracture is identified. The visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The globes are unremarkable.", + "output": "1. No acute intracranial process. MR is more sensitive for detection of acute\ninfarct.\n\n2. 5 mm colloid cyst." + }, + { + "input": "5 mm hyperdensity at the foramen ___ is unchanged from the prior\nexamination compatible with a colloid cyst. There is no acute intracranial\nhemorrhage,acute infarction, mass or midline shift. There is no hydrocephalus.\nThe ventricles and sulci are normal in size and configuration. The basal\ncisterns are patent and there is preservation of gray-white matter\ndifferentiation. Visualized paranasal sinuses and mastoid air cells are\nclear. The orbits are unremarkable. Dense atherosclerotic calcifications are\nnoted in bilateral carotid siphons. There is no fracture.", + "output": "1. No acute intracranial abnormality.\n2. Stable 5 mm colloid cyst." + }, + { + "input": "There is no evidence of acute large territory infarct, hemorrhage, edema, or\nmass effect. The ventricles and sulci are normal in size and configuration.\n\nUnchanged appearance of colloid cyst.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality on noncontrast head CT.\n2. Unchanged appearance of 4 mm colloid cyst." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass effect, midline shift,\nor acute major vascular territorial infarct. There is a 5 mm hyperdense focus\nat the foramina ___ compatible with a colloid cyst. Ventricles and sulci\nare age-appropriate. Gray-white matter differentiation is preserved. Basilar\ncisterns are patent.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable. Degenerative changes noted at the temporomandibular\njoints.", + "output": "No acute intracranial process.\nStable 5 mm colloid cyst. No hydrocephalus." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThe gray-white matter differentiation is intact without evidence acute large\nterritorial infarct, hemorrhage, mass, or mass effect. There is a right\nthalamic hypodensity, unchanged from outside hospital examination of ___, which may represent sequela of prior infarct, however acuity is\nuncertain. There is superimposed periventricular white matter hypodensity\nwhich is nonspecific but likely reflect sequela of chronic small vessel\ndisease. There is calcific atherosclerosis of the bilateral carotid siphons\nand right V4 segment vertebral artery. The extra-axial spaces are\nunremarkable.\n\nThe orbits, calvarium, and soft tissues are unremarkable. The paranasal\nsinuses and mastoid air cells are clear.\n\nCTA HEAD:\nThere is acute cut off at the right internal carotid artery terminus with\nabsent filling of the intracranial internal carotid artery. There is non\nfilling of the right ophthalmic artery. There is reconstitution of the right\nanterior and middle cerebral arteries across a visualized anterior and left\nposterior communicating arteries. There is mild calcific atherosclerosis and\nluminal irregularity of the left carotid siphon consistent with\natherosclerosis. There is mild calcific atherosclerosis of the right V4\nsegment vertebral artery. There is no evidence of significant stenosis or\naneurysm.\n\nThe dural venous sinuses are patent.\n\nCTA NECK:\nThere is a 3 vessel aortic arch. There is a progressive diminished contrast\nopacification of the right cervical segment internal carotid artery as it\napproaches the skullbase suggesting distal thrombus, likely at the ICA\nterminus given the aforementioned findings. There is normal contrast filling\nof the right external and common carotid arteries. There are codominant\nvertebral arteries. The left common, external, and internal carotid arteries\nare patent. There is no evidence of stenosis by NASCET criteria or aneurysm.\n\nThere is a 2 mm pulmonary nodule at the right upper lobe (05:29). There is 2\nmm anterior pleural-based nodule versus scar at the left upper lobe (05:40). \nThe thyroid and salivary glands are unremarkable. The pharynx, larynx, oral\ncavity, and nasal cavities are unremarkable. There is streak artifact\nsecondary to dental almalgam. There is no lymphadenopathy by CT criteria. \nThere are multilevel degenerative changes of the cervical spine without\nfracture or osseous lesion.", + "output": "1. Abrupt vascular cutoff at the right internal carotid artery terminus with\nabsent filling of the proximal intracranial internal carotid artery and\ndiminished filling of the cervical internal carotid artery suspicious for\nthrombus. There is reconstitution of the anterior circulation via the circle\nof ___.\n2. No CT evidence of acute infarct or hemorrhage.\n3. Sub 4 mm pulmonary nodules at the lung apices which do not require imaging\nfollow up in low risk patients per the ___ criteria guidelines." + }, + { + "input": "There is no evidence ofhemorrhage, edema, or mass. The ventricles and sulci\nare normal in size and configuration. Hypodensity in the right thalamus\nappears unchanged, and may relate to prior lacune. Periventricular and deep\nsubcortical white matter hypodensities are consistent with sequela of chronic\nsmall vessel ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Right thalamic hypodensity is unchanged from outside hospital examination\nof ___. This may represent prior lacunar infarct however acuity\nis uncertain.\n\n2. No evidence of large territorial infarction. Recommend correlation with\nMRI for further evaluation of acute infarct given findings of CTA." + }, + { + "input": "There are hypodense areas in the frontal lobe, insular cortex, posterior limb\nof the internal capsule, globus pallidus and thalamus on the right ,\ncorrelating with the previously seen decreased diffusion on the MR from ___. While these hypodensities were present on prior CT, it is more\nevident on today's exam. There are no areas of new infarction or hemorrhage. \nThere is no midline shift. The size and morphology of the ventricles are\notherwise similar to prior exam. The basal cisterns are patent.\n\nPeriventricular, subcortical and deep white matter hypodensities are\nconsistent with chronic small vessel ischemic disease.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare mostly clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Evolving appearance of previously seen right MCA territorial infarct. No\nsignificant mass effect. No evidence of hemorrhage or new infarction." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is continued evolution of known infarct of the right lentiform nucleus\nand deep watershed area, indicated by hypodensities in the right frontal lobe,\ninsular cortex, globus pallidus, and thalamus. There is no evidence of\nintracranial hemorrhage. There is no midline shift or significant mass\neffect. The ventricles are unchanged in size and configuration.\n\nThere is mild mucosal thickening in the left maxillary sinus (2:3). \nOtherwise, the visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable. A nasal feeding tube is in place.\n\nCTA HEAD:\nSince the prior study, there is now asymmetrically poor filling of the\nproximal right M1 segment of the middle cerebral artery, with intravascular\nfilling defect and complete occlusion of the distal M1 segment at the level of\nthe bifurcation (3:231, 228), extending into the M2 segment. There is distal\nreconstitution of several M2 and M3 branch vessels via collateral flow, but\nthese are overall attenuated compared to the contralateral normal left side.\n\nThere has been interval improvement in the degree of opacification of the\ndistal cervical and proximal intracranial right internal carotid artery, now\nfilling the petrous portion. There is also now thready opacification of the\ncavernous segment of the right internal carotid artery (3:222), extending into\nthe supraclinoid and communicating segments. The left internal carotid artery\nand branch vessels as well as the posterior circulation remains patent.\n\nCTA NECK:\nThe cervical portions of the carotid and vertebral arteries and their major\nbranches appear normal with no evidence of stenosis or occlusion. There is no\nevidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nSub 4 mm biapical pulmonary nodules are again noted. Otherwise, the\nvisualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Continued evolution of deep watershed infarction in the right basal\nganglia, thalamus and insula.\n2. New complete occlusion of the distal M1 segment of the right MCA to the\nlevel of the bifurcation, with distal collateralization but overall attenuated\nvascular supply in the right MCA distribution. These findings are likely due\nto arterio-arterial embolism, with interval distal migration of the previously\ndescribed thrombus at the right internal carotid artery terminus.\n3. Distal cervical and proximal intracranial portions of the right internal\ncarotid artery are now patent." + }, + { + "input": "Compared to prior CTs, there is no significant change. Again seen are several\nhypodensities within the territory of the right middle cerebral artery,\nconsistent with evolving right MCA territorial infarct. There is no\nsignificant change and size and morphology of the lateral ventricles. The\nbasal cisterns are patent. There is no mass effect or midline shift.\n\nThere is no evidence of acute hemorrhage, edema, or mass.\nNo fractures are identified. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are mostly clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Unchanged appearance of evolving right MCA territorial infarct. No\nsignificant mass effect or midline shift." + }, + { + "input": "Again seen is a focal area of left frontal white matter hypodensity, unchanged\nthe since ___. This this may reflect chronic infarction or a\nprominent perivascular space.\n\nThere is no evidence of hemorrhage, edema, mass or recent infarction. There\nis prominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No evidence of hemorrhage or recent infarction." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute intracranial hemorrhage. Subtle hypodensity is\nseen within the right parietal lobe as well as posterior margin of the right\ninsular cortex. A hypodensity within the left occipital lobe is seen which\nmay be secondary to a chronic infarction. Note is made of a subtle\nhypodensity within the left centrum semiovale, series 3, image 21. \nPeriventricular and deep subcortical white matter hypodensities are sequelae\nof chronic microangiopathy. Mild prominence of the ventricles and sulci is\nconsistent with chronic small vessel ischemic disease.\n\nMild mucosal sinus thickening is seen involving the ethmoid air cells. The\nremainder the visualized paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The globes are unremarkable.\n\nCTA HEAD:\nThe V4 segment of the left vertebral artery is dominant. The basilar artery\nis unremarkable. Note is made of a fetal type configuration of the right\nposterior cerebral artery. The left posterior cerebral artery is patent. The\nleft internal carotid artery and left MCA are unremarkable. The right\ninternal carotid artery, and right MCA are normal with appropriate flow. The\nanterior cerebral arteries are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. An enlarged right supraclavicular\nlymph node with short axis measurement up to 1.4 cm is noted (see series 5,\nimage 74). Additional scattered subcentimeter nonspecific lymph nodes are\nnoted throughout the neck bilaterally.", + "output": "1. Dental amalgam streak artifact limits study.\n2. Subtle hypodensities are seen within the right parietal lobe, left centrum\nsemiovale and posterior margin of the right insular cortex, which may be\nsecondary to an acute infarction. An MRI may be helpful for further\nevaluation.\n3. No acute intracranial hemorrhage.\n4. Hypodensity within the left occipital ___ be secondary to a chronic\ninfarction.\n5. Unremarkable CTA of the head without evidence of stenosis or aneurysm.\n6. Unremarkable CTA of the neck without significant internal carotid artery\nstenosis by NASCET criteria.\n7. Nonspecific enlarged right supraclavicular lymph node with short axis\nmeasurement up to approximately 1.4 cm, with additional subcentimeter\nnonspecific lymph nodes described. While finding may be reactive in nature,\ninfectious or neoplastic etiologies are not excluded on the basis examination.\n\nRECOMMENDATION(S): MRI is recommended for further evaluation.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 17:40 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is an unchanged subcentimeter focal hypodensity in the left frontal\ncentrum semiovale corresponding to unchanged lacunar infarct. There is subtle\nhypodensity and encephalomalacia in the right operculum and right posterior\nparietal subcortical white matter corresponding to evolution of prior known\ninfarct.\n\nThere is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass. Mild prominence of the ventricles and sulci suggestive of\ninvolutional change.\n\nThere is mild mucosal wall thickening in the floors of the maxillary sinuses. \nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are otherwise clear. The visualized portion of the orbits are\nunremarkable.\n\nCTA HEAD:\nThere is punctate atherosclerotic calcification of the cavernous segment of\nthe left internal carotid artery without narrowing. There is variant fetal\ntype origin of the right posterior cerebral artery. The vessels of the circle\n___ and their principal intracranial branches otherwise appear patent\nwithout stenosis, occlusion, or aneurysm formation. The dural venous sinuses\nare patent.\n\nCTA NECK:\nThere is a variant 2 vessel aortic arch. There is punctate atherosclerotic\ncalcification at the bilateral carotid bifurcations without narrowing. The\ncarotid and vertebral arteries and their major branches otherwise appear\npatent with no evidence of dissection, significant stenosis or occlusion.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. There are changes from median sternotomy. Mild-to-moderate\nmultilevel degenerate changes throughout the cervical spine, more significant\nat C5/C6 and C6/C7 levels", + "output": "1. Subtle areas of encephalomalacia/hypodensity in the right operculum and\nright posterior parietal subcortical white matter corresponding to evolution\nof known prior infarct. Unchanged left frontal centrum semiovale lacunar\ninfarct.\n2. No hemorrhage or acute large territorial infarct.\n3. Patent intracranial arterial vasculature without significant stenosis,\nocclusion, or aneurysm formation.\n4. Patent cervical arterial vasculature without significant stenosis,\nocclusion, or dissection." + }, + { + "input": "Patient is status post left fronto-temporal craniectomy and placement of a\nmetallic mesh. Artifact from the mesh limits assessment of the subjacent\nbrain.\n\nHigh-density adjacent to the mesh overlying the left frontal and temporal\nlobes with maximum thickness approximately 4.4 mm is noted (see 03:10). Left\nfrontal encephalomalacia is noted. A punctate hypodense focus is seen\nadjacent to the metallic mesh (4:22, 301:89).\n\nThere is no evidence of acute large territorial infarction, edema, or mass. \nVentricles and sulci are normal in size and configuration.\n\nNo acute fracture. The visualized paranasal sinuses, middle ear cavities, and\nmastoid air cells are clear. Orbits are unremarkable.", + "output": "1. Streak artifact from left frontoparietal craniectomy metallic mesh limits\nexamination.\n2. Nonspecific, approximately 4 mm hyperdense region adjacent to left frontal\nand left temporal lobe, which may be postsurgical change, however small\nsubdural is not excluded on the basis of this examination. Recommend\ncorrelation with neurological exam and prior outside studies as available.\n3. Punctate hypodense focus adjacent to metallic mesh may be a focus of gas\nversus metallic artifact. Recommend correlation with history of recent\nneuro-instrumentation, such as lumbar puncture.\n4. Left frontal encephalomalacia.\n\nRECOMMENDATION(S):\n1. A punctate hypodense focus adjacent to the metallic mesh may be a focus of\ngas versus metallic artifact. Recommend correlation with history of recent\nneuro-instrumentation, such as lumbar puncture.\n2. Nonspecific, approximately 4 mm hyperdense region adjacent to left frontal\nand left temporal lobe, which may be postsurgical change, however small\nsubdural is not excluded on the basis examination. Recommend correlation with\nneurological exam and prior outside studies as available.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\non the ___ ___ at 2:02 ___, 2 minutes after discovery of the\nfindings.\n\nFindings were also discussed by Dr. ___ with Dr. ___ the\ntelephone at 5:10PM on ___." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is redemonstration of a left cerebellar hemispheric intraparenchymal\nhemorrhage with the hyperdense component measuring approximately 2.2 cm in AP\ndimension. The hematoma is unchanged in size and appearance in comparison to\nthe study from 5 hours prior. There is mild interval worsening of the edema\nsurrounding the hemorrhage. No evidence of mass effect. There is no evidence\nof new infarction, or additional new hemorrhage. There is minimal effacement\nof the fourth ventricle. The ventricles and sulci are otherwise normal in\nsize and configuration.\n\nThere is no evidence of acute calvarial fracture. The visualized portion of\nthe paranasal sinuses demonstrate mild mucosal thickening in the ethmoidal air\ncells bilaterally, no air-fluid levels are seen, mastoid air cells, and middle\near cavities are clear.\n\nThe visualized portion of the orbits demonstrate prior lens surgery on the\nright but are otherwise unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. The dural venous\nsinuses are patent. No definite vascular malformation. Left dominant\nvertebral artery.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion.\n\nOTHER:\nThe visualized portion of the lungs are clear without focal consolidation.. \nThe visualized portion of the thyroid gland is normal. There is no\nlymphadenopathy by CT size criteria. Mild degenerative change of the cervical\nspine, please note that the patient is status post bilateral laminectomies and\nspinous process resection at C5 level.", + "output": "1. Redemonstration of left cerebellar hemisphere intraparenchymal hemorrhage\nmeasuring approximately 2.2 cm with mild progression of surrounding edema\nwithout evidence of mass effect.\n2. Patent circle of ___ without evidence of high-grade\nstenosis,occlusion,or aneurysm.\n3. Patent bilateral cervical carotid and vertebral arteries without evidence\nof high-grade stenosis, occlusion,or dissection." + }, + { + "input": "There is redemonstration of a left cerebellar hemispheric intraparenchymal\nhemorrhage measuring 2.3 cm in the AP dimension, not significantly changed in\ncomparison to the study from ___. There is mild surrounding\nedema. There is minimal effacement of the fourth ventricle.\n\nThere is no evidence of infarction, new or additional hemorrhage, or\nsuspicious mass. The ventricles and sulci are otherwise normal in size and\nconfiguration.\n\nThere is no evidence of acute calvarial fracture. The visualized portion of\nthe paranasal sinuses demonstrate mild mucosal thickening in the ethmoid air\ncells bilaterally, no air-fluid levels are seen. The, mastoid air cells, and\nmiddle ear cavities are clear.\n\nThe visualized portion of the orbits demonstrate prior lens surgery on the\nright and are otherwise unremarkable", + "output": "1. Redemonstration of left cerebellar hemispheric intraparenchymal hemorrhage\nmeasuring approximately 2.3 cm with mild surrounding edema. No evidence of\nmass effect. No significant interval change in comparison to the study from 1\nday prior." + }, + { + "input": "Compared with outside CT head in ___, there has been interval\nevolution of multiple foci of intraparenchymal hemorrhage in the right\nfrontal, occipital and temporal lobes, with hypodensities in the right frontal\nand temporal lobes at the site of prior hemorrhagic foci (3:5, 21). There is\nbeen interval resolution of intraventricular hemorrhage in the bilateral\nlateral ventricles. The lateral ventricles appear mildly increased in size\ngiven differences in head position. The third and fourth ventricles do not\nappear significantly changed. There is stable prominence of the sulci.\nPeriventricular subcortical and periventricular white matter hypodensities do\nnot appear significantly changed from prior.\n\nThere is a chronic left frontal infarct. No evidence of acute intracranial\nhemorrhage or acute large territorial infarction. There are atherosclerotic\ncalcifications in the bilateral cavernous carotids.\n\nA right temporal fracture is again noted, as seen on prior outside CT. No new\nfracture. The visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. Patient is status post bilateral lens\nreplacement. The visualized portion of the orbits are otherwise unremarkable.", + "output": "1. Interval evolution of multifocal foci of intraparenchymal hemorrhage in the\nright cerebral hemisphere and resolution of intraventricular hemorrhage in the\nbilateral lateral ventricles compared with ___.\n2. The bilateral lateral ventricles appear mildly increased in size compared\nwith prior, with no significant change in size of the third and fourth\nventricles.\n3. Subcortical and periventricular white matter hypodensities do not appear\nsignificantly changed from prior, likely due to chronic small vessel ischemic\ndisease.\n4. No definite evidence of new transependymal flow of CSF.\n5. No new infarct or acute intracranial hemorrhage." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass.\n\nSmall chronic infarct upper right cerebellum, stable dilated lateral, third,\nfourth ventricles, similar compared with ___. Ventricular system\nis mildly more dilated compared with ___, possibly related to\nacute changes seen on ___ scan, including cerebral edema, parenchymal\nhemorrhage, subarachnoid, ventricular hemorrhage. There is prominent left\nchoroidal fissure cyst, low-density abnormality about left temporal horn is\npartially explained by this finding.. Component of communicating\nhydrocephalus is difficult to exclude.\n\nSmall chronic cortical infarcts left parietal lobe, left anterior frontal\nlobe. Small areas of right superior frontal gyrus encephalomalacia, sequela\nof prior hemorrhagic contusions. Findings consistent with severe chronic\nsmall vessel ischemic changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.. Degenerative arthritis bilateral\ntemporomandibular joints.", + "output": "1. No intracranial hemorrhage.\n2. Dilated ventricular system, mildly out of proportion to degree of sulcal\natrophy, stable since ___, see above.\n3. Chronic infarcts.\n4. Findings consistent with severe chronic small vessel ischemic changes." + }, + { + "input": "Small right cerebellar and left frontal chronic infarcts are unchanged. \nSimilar periventricular and white matter hypodensities, likely sequela of\nsmall vessel disease.\nPersistent dilation of the lateral, third and fourth ventricles, unchanged\nsince ___ however increased since ___. Dilation\ncontinues to be disproportionate to the prominence of the sulci. There is no\nevidence of acute infarction,hemorrhage,edema, or mass.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Persistent disproportioned dilation of the lateral, third and fourth\nventricles, stable since ___, however increased since ___. With a history of intraparenchymal and interventricular hemorrhage,\ncommunicating hydrocephalus cannot be excluded.\n2. Severe chronic small vessel disease is unchanged." + }, + { + "input": "The lateral, third and fourth ventricle are again noted to be\ndisproportionately enlarged and are stable in size and configuration.\n\nOld infarcts are again noted in the left frontal lobe and right cerebellar\nhemisphere. There are unchanged bilateral supratentorial white matter\nhypodensities, consistent with moderate chronic small vessel ischemic disease.\n\nThere is no evidence of recent infarction, hemorrhage, edema, or mass.\n\nNote is made of atheromatous calcification of the intracranial internal\ncarotid arteries bilaterally.\n\nThere is no evidence of fracture. Note is made of moderate degenerative\nchange of the left temporomandibular joint, unchanged compared with the prior\nCT head. The visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Unchanged, persistent disproportionate enlargement of the lateral, third\nand fourth ventricles. This may be secondary to communicating hydrocephalus.\n2. Unchanged moderate chronic small vessel ischemic disease.\n3. Old infarcts in the left frontal lobe and right cerebellar hemisphere.\n4. Moderate degenerative change of the left temporomandibular joint." + }, + { + "input": "Atrophy of the cerebellum, pons, and medulla, grossly unchanged in size and\nappearance compared to MRI from ___, allowing for differences in\nmodalities. These findings are likely the sequela of prior encephalitis.\n\nThere is no evidence of fracture, acute large territorial\ninfarction,hemorrhage,edema,or mass. The ventricles and sulci within the\ncerebrum are normal in size and configuration.\n\nMucous retention cysts are noted in the bilateral maxillary sinuses. \nOtherwise, the visualized portion of the remaining paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are normal.", + "output": "1. No acute intracranial abnormality.\n2. Atrophy of the cerebellum, pons, and medulla, grossly similar in appearance\ncompared to MRI from ___, allowing for differences in modalities. \nThis finding is likely the sequela of prior encephalitis." + }, + { + "input": "There is no evidence of acute hemorrhage mass effect midline shift or\nhydrocephalus. Gray-white matter differentiation is maintained.\n\nThe visualized paranasal sinuses are clear. No skull fracture is seen.", + "output": "No acute intracranial abnormalities are identified." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is extensive diffuse subarachnoid hemorrhage in bilateral sulci,\nincluding the anterior interhemispheric fissure and bilateral sylvian\nfissures, and also involving the suprasellar cistern and bilateral basal\ncisterns. There is small amount of blood in the occipital horns of the\nlateral ventricles and in the third ventricle, as well as blood in the\ncerebral aqueduct and fourth ventricle. Third and lateral ventricles are\ndilated. Mild periventricular white matter hypodensities could represent\nsequela of chronic small vessel ischemic disease versus transependymal CSF\nflow. There is diffuse cerebral edema with sulcal effacement and partial\neffacement of the basal cisterns.\n\nThere is mild to moderate mucosal thickening and mucous retention cyst in the\nright maxillary sinus. Partial opacification of bilateral mastoid air cells\nmay be secondary to endotracheal and orogastric intubation. The orbits appear\nunremarkable.\n\nCTA NECK:\nThere is a 3 vessel aortic arch with abutting origins of the innominate and\nleft common carotid arteries. There is no right carotid stenosis by NASCET\ncriteria. There is mild irregular noncalcified plaque with a tiny focus of\nulceration in the left proximal internal carotid artery, images 306:9 and\n3:133, without stenosis by NASCET criteria. Bilateral vertebral arteries\nappear widely patent.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear widely patent without evidence for flow-limiting stenosis or aneurysm. \nThe preliminary report raises the question of a basilar tip aneurysm, but this\nis not supported on the 3D images or maximal intensity projection reformatted\nimages. Duplication/early branching of the right superior cerebellar artery,\nright ___ complex, and low origin of the left ___ at the junction of\nthe left V3/V4 segments, a normal variants. The dural venous sinuses are not\nwell assessed on this arterial phase exam.\n\nOTHER:\nThe thyroid is grossly unremarkable. No pathologically enlarged lymph nodes\nby CT criteria. Evaluation of the included upper lungs is limited by motion\nartifact; mild emphysema cannot be excluded.", + "output": "1. Extensive diffuse subarachnoid hemorrhage in bilateral sulci, anterior\ninterhemispheric fissure, sylvian fissures, and basal cisterns.\n2. Small amount of blood in the lateral, third, and fourth ventricles. Blood\nfilling the cerebral aqueduct.\n3. Obstructive hydrocephalus of the third and lateral ventricles. Possible\ntransependymal CSF flow versus sequela of chronic small vessel ischemic\ndisease in the periventricular white matter.\n4. Diffuse cerebral edema with sulcal effacement and partial effacement of\nbasal cisterns.\n5. Mild irregular noncalcified plaque in the proximal left internal carotid\nartery with a small focus of ulceration. No carotid stenosis by NASCET\ncriteria.\n6. No evidence for an intracranial aneurysm." + }, + { + "input": "Again seen is diffuse subarachnoid hemorrhage bilaterally within the sulci and\nbasal cisterns. There is a new focus of subarachnoid blood in the left\nlateral ventricle on image 2:23. There is unchanged blood in the fourth\nventricle and decreased blood in the third ventricle/cerebral aqueduct.\nDiffuse ventriculomegaly is not significantly changed. There is diffuse\nsulcal and basal cistern effacement, similar to prior.\n\nThere are mucous retention cysts and mild mucosal thickening in the right\nmaxillary sinus.", + "output": "1. Diffuse bilateral sulcal and cisternal subarachnoid hemorrhage is again\nseen.\n2. New focus of blood in the left lateral ventricle. Unchanged blood in the\nfourth ventricle. Decreased blood in the third ventricle/cerebral aqueduct.\n3. Unchanged diffuse ventriculomegaly." + }, + { + "input": "There has been interval placement of a right ventriculostomy drain which\nappears to terminate beyond the left lateral ventricle. There has been\ninterval decrease in the size of the lateral and third ventricles. Previously\nseen diffuse subarachnoid hemorrhage bilaterally is not well-visualized on\nthis study. There is no new hemorrhage. Minimal layering hemorrhage in the\noccipital horns of the lateral ventricles persists.\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated.", + "output": "1. Interval placement of a right ventriculostomy drain resulting in decrease\nin the size of the ventricles. The tip of the ventriculostomy appears to\nextend beyond the left lateral ventricle.\n2. Previously seen diffuse subarachnoid hemorrhage is not well-visualized on\nthe current study and there is no new hemorrhage.\n3. Minimal layering subacute hemorrhage in the occipital horns persists." + }, + { + "input": "There has been interval removal of a right frontal approach ventriculostomy\ncatheter with a tiny amount of hemorrhage along the catheter tract. \nVentricular size is grossly stable compared to prior exam, but decreased in\nsize compared to CT from ___. There is no evidence of acute large\nterritorial infarction or new hemorrhage. Previously seen diffuse\nsubarachnoid hemorrhage is not well appreciated on the current study apart\nfrom minimal hyperdense signal within the sulci in the left parietal lobe\n(02:19). There is minimal residual blood in the atrium of the left lateral\nventricle.\n\nNo acute fracture is seen.. Mild mucosal thickening of the right maxillary\nsinus stable. Otherwise, the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The orbits are unremarkable.", + "output": "1. Interval removal of right frontal approach ventriculostomy catheter with\ngrossly stable ventricular size. A tiny amount of blood is noted along the\ncatheter tract.\n2. Mild residual intraventricular hemorrhage without evidence of new\nhemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of age related involutional\nchanges. Confluent periventricular and subcortical white matter hypodensities\nare nonspecific, but likely the sequela of chronic small vessel ischemic\ndisease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Severe chronic small vessel ischemic changes.\n\nNOTIFICATION: The findings were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 11:44 AM, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "There is mild, asymmetric fat stranding of the left masticator space, which is\nnon-specific. There is no evidence of definite soft tissue density\nlesion/mass, or focal fluid collection within the limitations of non-contrast\ntechnique.\n\nThere are minimal aerosolized secretions with the left aspect of the sphenoid\nsinuses. Otherwise, the paranasal sinuses are normally aerated, with no\nmucosal thickening or air-fluid levels identified. The ostiomeatal units are\npatent. The cribriform plates are intact. There is no nasal septal defect. The\nnasal septum is slightly deviated to the left of midline. The anterior clinoid\nprocesses are not pneumatized. The lamina papyracea are intact. The sphenoid\nsinus septum is left of midline. The imaged portions of the maxillary\ndentition are normal without evidence periapical lucency or other evidence of\nodontogenic disease. Note, mandibular dentition is not visualized on this\nexamination.", + "output": "1. Minimal sphenoid sinus mucosal thickening. Otherwise, no sinus disease\nidentified.\n2. Non-specific left masticator space mild asymmetric fat stranding. See\nseparate CT neck report for further details.\n\nNOTIFICATION: The findings above were discussed with ___, M.D.\nby ___, M.D. on the telephone on ___ at 6:09 ___, 25\nminutes after discovery of the findings." + }, + { + "input": "There is ill-defined soft tissue density fullness of the left hypopharynx\nwithout a clearly definable lesion exerts mild left-to-right mass effect on\nthe adjacent airway, which nonetheless remains patent (see series 2 image 47).\nThis, in conjunction with minimal asymmetric stranding of the left masticator\nspace (for example see series 2, image 19). No definite of focal fluid\ncollection within limitation of noncontrast technique.\n\nThere is no prevertebral fluid. The salivary glands are normal within\nlimitation of noncontrast technique. The thyroid gland appears normal. There\nis no lymphadenopathy by CT criteria. There are no osseous lesions. There is\nmoderate multilevel cervical spine degenerative change. No concerning focal\nlytic or sclerotic osseous lesions seen. Please see separate report for\nintrathoracic findings from same-day CT chest.", + "output": "1. Soft tissue density fullness of the left hypopharynx exerts mild mass\neffect on the adjacent airway, which remains patent. Mild left masticator\nspace fat stranding. The findings overall nonspecific; although differential\nincludes infectious process, underlying mass is difficult to exclude and\nremains a consideration.\n2. Please see separate report for intrathoracic findings from same-day CT\nchest.\n\nRECOMMENDATION(S): Recommend clinical correlation with direct\ninspection/visualization, and short interval follow-up imaging with MRI in ___\nweeks if the patient's symptoms do not completely resolve with treatment.\n\nNOTIFICATION: The findings above were discussed with ___, M.D.\nby ___, M.D. on the telephone on ___ at 6:09 ___, 25\nminutes after discovery of the findings." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci in an atrophic pattern. Nonspecific\nperiventricular and deep subcortical white matter hypodensities most likely\nrepresent moderate chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of acute intracranial process.\n2. Lucent lesions within the calvarium in keeping with provided history of\nmultiple myeloma.\n3. Age related atrophy and nonspecific periventricular white matter\nhypodensities likely representing moderate chronic small vessel ischemic\ndisease.\n This preliminary report was reviewed with Dr. ___\nradiologist." + }, + { + "input": "There is no evidence of acute large territorial infarction,\nhemorrhage,edema,or mass effect. Encephalomalacia of the right pre central\ngyrus with widening of the right central sulcus is noted with a central\ncortical calcification which is likely dystrophic, findings which may reflect\nchronic infarct or prior traumatic insult. There is prominence of the\nventricles and sulci suggestive of involutional changes. Periventricular,\nsubcortical and deep white matter hypodensities are nonspecific, but likely\nreflect the sequela of chronic microvascular infarction. Mild atherosclerotic\ncalcifications of the cavernous carotid arteries are present.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Right frontal encephalomalacia may reflect chronic infarct or sequela of\nprior traumatic insult." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of hemorrhage, edema, or mass. The ventricles and sulci\nare normal in size and configuration. Moderate patchy white matter\nhypoattenuation is nonspecific but compatible with chronic small vessel\nischemic disease given the patient's age. No significant change in right\nposterior frontal encephalomalacia with associated linear cortical\ncalcification possibly representing sequela of an old infarct or prior\ntraumatic insult. There is no evidence of new infarction\n\nThere is moderate and trace fluid within the right and left mastoid air cells,\nrespectively. The visualized portion of the paranasal sinuses and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable. A\nsclerotic focus at the angle of the right mandible (series 3, image 146) is\nfavored to represent a bone island.\n\nCTA HEAD:\nThere are calcifications of the cavernous ICAs. There is a 3 mm left\nsupraclinoid ICA aneurysm near the expected origin of the ophthalmic artery,\nimages 223 and 224 of series 3 and image 33 of series 602. The vessels of the\ncircle of ___ and their principal intracranial branches appear otherwise\nnormal without stenosis, occlusion, or aneurysm formation. The dural venous\nsinuses are patent.\n\nCTA NECK:\nThere are mild calcifications at the origin of the left ICA. The carotid and\nvertebral arteries and their major branches appear normal with no evidence of\nstenosis or occlusion. There is no evidence of internal carotid stenosis by\nNASCET criteria.\n\nOTHER:\nThere is mild paraseptal emphysema at the left lung apex. The visualized\nportion of the thyroid gland is within normal limits. There is no\nlymphadenopathy by CT size criteria.", + "output": "1. No evidence of hemorrhage or recent infarction.\n2. A 3 mm left supraclinoid ICA aneurysm.\n3. No evidence of aneurysm, dissection or significant stenosis of the neck. \nNo internal carotid artery stenosis by NASCET criteria.\n4. Evidence of moderate white matter chronic small vessel ischemic disease.\n5. Unchanged right posterior frontal encephalomalacia with associated linear\ncortical calcification possibly representing sequela of an old infarct or\nprior traumatic insult.\n\nRECOMMENDATION(S): The impression and recommendation above was entered by\nDr. ___ on ___ at 14:27 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." + }, + { + "input": "There is re-demonstration of encephalomalacia with associated linear cortical\ncalcification which likely represents sequelae of old infarct, involving both\npre and postcentral gyri on the right. There is no evidence of acute large\nterritory infarction, hemorrhage, edema, or mass. The ventricles and sulci are\nnormal in size and configuration. Periventricular and subcortical white matter\nhypodensities are nonspecific, but likely reflect sequelae of chronic small\nvessel ischemic disease.\n\nNo osseous abnormalities seen. Right mastoids are partially opacified at the\ntip. Otherwise the paranasal sinuses, left mastoid air cells, and middle ear\ncavities are clear. The orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Unchanged right pre and post central gyrus encephalomalacia with associated\ncortical calcification likely representing sequelae of old infarct." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or infarction. The\nventricles and sulci are normal in size and configuration. The basal cisterns\nappear patent and there is preservation of gray-white matter differentiation.\n\nThe visualized bony structures are unremarkable.\n\nThere is moderate bilateral mucosal thickening involving the maxillary\nsinuses. There is minimal mucosal thickening of the ethmoid air cells. The\nleft ethmoid air cell osteoma is noted. The mastoid air cells are\nwell-aerated. The globes are unremarkable. Soft tissue swelling seen\noverlying the left periorbital region and in the premaxillary fat.", + "output": "No acute intracranial process. Left facial swelling, no acute fracture\nidentified. Bilateral maxillary sinus disease." + }, + { + "input": "There is no evidence of acute large territory infarct,hemorrhage,edema,or mass\neffect. There is mild prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture although no bone algorithm reformats were\navailable. There is opacification of a few ethmoid air cells. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. Patient is status post left globe metallic implant, with metal\nartifact obscuring the left orbit. The visualized portion of the right orbit\nis unremarkable.", + "output": "No acute intracranial abnormality on noncontrast head CT. Specifically no\nevidence of large territory infarct or intracranial hemorrhage, allowing for\nmetallic artifact." + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Mild periventricular white matter hypodensities are\nnoted, non-specific but likely related to chronic small vessel ischemic\ndisease. There is no evidence of fracture. A small subgaleal hematoma is\nnoted at the vertex. The visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "No acute intracranial process. Small scalp hematoma at the vertex." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "Artifact from dental amalgam limits evaluation of the adjacent structures. \nWithin this limitation, the aerodigestive tract demonstrates no mass and no\nareas of focal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding.The thyroid gland appears diffusely enlarged without focal\nnodularity.There is no lymphadenopathy by CT criteria. The neck vessels are\npatent.\n\nNonspecific, curvilinear calcifications are noted in the soft tissue\nimmediately subjacent to the bilateral external auditory canals. The EACs\nthemselves are widely patent bilaterally.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.", + "output": "1. No evidence for pathologic cervical lymphadenopathy by CT size criteria.\n2. Diffusely enlarged and homogeneous thyroid gland, compatible with the\nprovided history of goiter.\n3. Nonspecific curvilinear calcifications within the soft tissues subjacent\nto the bilateral external auditory canals. Findings may relate to recurrent\nexternal otitis, and correlation with relevant medical history is recommended." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema,or mass.\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Minimal periventricular and subcortical white matter hypodensities\nare nonspecific, but likely reflect the sequela of chronic microvascular\ninfarction.\n\nMinimally displaced fractures of the nasal bones bilaterally are noted with\noverlying soft tissue swelling and laceration. Tiny fracture of the anterior\nnasal spine is better assessed on same day facial bone CT. Partial\nopacification of the left anterior ethmoid air cell. The remaining visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are normal.", + "output": "1. Mildly displaced bilateral nasal bone fractures.\n2. Anterior nasal spine fracture is better visualized on same-day facial bone\nCT.\n3. No acute intracranial abnormality." + }, + { + "input": "Minimally displaced fractures of the nasal bones are noted bilaterally (2: 36,\n38) With overlying soft tissue swelling and laceration. Punctate radiopaque\ndensity overlying the midline tip of the nasal bones could reflect a tiny bony\nfragment though a small radiopaque foreign body is not excluded (2:33). \nAdditionally, there is a minimally displaced fracture of the anterior nasal\nspine (602:83).\n\nMinimal opacification of the left anterior ethmoid air cell. Visualized\nparanasal sinuses are otherwise well aerated.\nThere is no evidence of abnormal fluid collections.\nBilateral mastoids appear normal.\nThe globes, extraocular muscles, optic nerves, and retrobulbar fat appear\nnormal.\nThe visualized upper aerodigestive tract appears normal.\nThe mandible and temporomandibular joints appear normal.", + "output": "1. Minimally displaced fractures of the nasal bones bilaterally with overlying\nsoft tissue swelling and laceration.\n2. Minimally displaced fracture of the anterior nasal spine.\n3. Possible tiny bony fragment or radiopaque foreign body overlying the\nmidline tip of the nasal bones." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThe visualized portion of the mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable. A large\nretention cyst is seen in the left maxillary sinus.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal with no evidence of stenosis,occlusion or aneurysm. The dural\nvenous sinuses are patent.\n\nCTV HEAD: The proximal portion of the left transverse sinus is not well\nvisualized. There is suggestion of small adjacent vessels emptying into the\ndistal portion of the transverse sinus (8:89). No central filling defect\ndetected. This is unchanged in appearance compared to the prior outside\nMRI/MRA dated ___, and most likely congenital in nature. No\nsecondary signs on the prior MRI to suggest dural venous sinus thrombosis.\nVisualized portion of the distal transverse and sigmoid sinus are also noted\nto be hypoplastic. Otherwise, there is opacification of the right sigmoid\nsinus, superior sagittal sinus, inferior sagittal sinus and straight sinus. \nIncidental note is made of a left cerebellar DVA.", + "output": "1. No evidence of acute intracranial hemorrhage.\n2. No evidence of aneurysm greater than 3 mm, dissection or vascular\nmalformation, or significant luminal narrowing.\n3. Stable appearance of the proximal left transverse sinus with small adjacent\nvessels entering into the distal portion, stable in comparison to the prior\nstudies, and likely congenital in nature. No evidence for sinus venous\nthrombosis. The distal left transverse sinus and sigmoid sinuses are\ncongenitally hypoplastic." + }, + { + "input": "Diffuse cerebral edema with complete loss gray-white differentiation and\ndiffuse sulcal effacement. Lateral ventricles appears slit-like. Partial\neffacement of suprasellar cistern noted. There is no intra-axial or\nextra-axial hemorrhage. The bony calvarium is intact. An endotracheal tube\nis partially visualized. Mucosal thickening of the bilateral maxillary and\nethmoid sinuses is present.", + "output": "Diffuse cerebral edema with partial effacement of the suprasellar cistern. No\nhemorrhage.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. in person on ___ at 4:17 ___, at the time of discovery\nof the findings." + }, + { + "input": "Head CT: There is no evidence of hemorrhage, edema, masses, mass effect, or\ninfarction. The ventricles and sulci are normal in caliber and configuration.\nNo fractures are identified. The orbits are unremarkable. The paranasal\nsinuses and mastoid air cells are clear. There is mild calcification of the\nintracranial arterial vasculature noted.\n\nCTA Head: The intracranial internal carotid arteries demonstrate mild\natherosclerotic disease without hemodynamically significant stenosis or\nocclusion. The anterior and middle cerebral arteries are unremarkable. There\nis a stable 5.5 mm right MCA bifurcation aneurysm again noted. There is a\nstable tiny 1 mm outpouching seen arising than the left vertebral artery\nproximal to the origin of the posterior inferior cerebellar artery (series 6,\nimages ___ likely reflecting an additional tiny aneurysm. The left middle\ncerebral artery and anterior cerebral arteries are unremarkable. The right\nvertebral, basilar, and the posterior cerebral arteries demonstrate normal\nenhancement.", + "output": "1. No acute intracranial findings on unenhanced head CT\n\n2. Unchanged 5.5 mm right MCA bifurcation aneurysm.\n\n3. Unchanged tiny 1 mm outpouching arising from the left vertebral artery\nlikely reflecting an additional tiny aneurysm." + }, + { + "input": "There is no evidence of fracture, acute territorial\ninfarction,hemorrhage,edema,or mass. Basal ganglia calcifications are noted. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges.\n\nEndoscopic sinus surgery changes are noted. There is mild mucosal thickening\nof ethmoid air cells and maxillary sinuses. There is partial opacification\nthe inferior frontal sinuses. Otherwise, the visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are normal apart from bilateral lens\nreplacements. Mild to moderate atherosclerotic calcifications of the\ncavernous carotid arteries are noted.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of abnormal mass lesion or cortical erosion involving the\nmandible. The temporomandibular joints appear unremarkable bilaterally. \nExtensive maxillary dental caries is noted. No evidence of abnormal soft\ntissue swelling or inflammatory stranding. The bilateral parotid and right\nsubmandibular glands are unremarkable. The left submandibular gland is\ncompletely fatty replaced and demonstrates a associated 6 mm presume\nsialolith.\n\nOn axial images, there is mild asymmetric appearance along the course of the\nleft inferior alveolar canal with a gap along the buccal alveolar surface of\nthe left mandible (series 2, image 32), presumably secondary to a vascular\nchannel.\n\nTrace mucosal thickening of the maxillary sinuses is identified the\ninfundibulum of the ostiomeatal units are patent. There is minimal rightward\ndeviation of the nasal septum without perforation. The remainder the\nparanasal sinuses are essentially clear. The mastoid air cells middle ears\nare well pneumatized and clear. Skull-base foramina appear intact.\n\nThere is no cervical lymphadenopathy by size criteria. The visualized orbits\nare unremarkable, noting bilateral lens replacements. Although the\nexamination is not optimized for such evaluation, visualized brain parenchyma\nis grossly unremarkable, noting mild atherosclerotic calcifications of the\ninternal carotid arteries.\n\nProminent degenerative changes are noted in the craniocervical junction, with\na moderate-sized partially calcified degenerative pannus (compatible with CPPD\ndeposition). There is an associated degenerative 6 mm subcortical cyst at the\nbase of the dens (series 6, image 85), unchanged in appearance from prior MRIs\ndating back to ___. Posterior subluxation of C1 on C2, with mild widening of\nthe right atlantoaxial articulation is unchanged in appearance from prior\nMRIs, compatible with chronic degenerative subluxation. No suspicious blastic\nor lytic osseous lesions. Posterior calcified disc protrusions at C2-C3 and\nvisualized C3-C4 levels results in at least moderate spinal canal narrowing at\nC3-C4.", + "output": "1. No evidence of abnormal mass or osseous erosion to explain patient's\nsymptoms. No evidence of abnormal soft tissue swelling or collection.\n2. Diffuse maxillary dental caries as described above.\n3. Mild asymmetric appearance along the course of the left inferior alveolar\ncanal with a gap along the buccal alveolar ridge of the left mandible,\npresumably secondary to a vascular channel. However, if the patient's\nclinical symptoms occur along the mental nerve distribution, further\nevaluation with dedicated MRI may yield additional information.\n4. Findings of lytic lesion at the base of ends described in initial wet read\nis compatible with degenerative pannus and subcortical cystic change. \nAssociated widening of the right atlantodental articulation and retrolisthesis\nbilaterally of C1 on C2 is unchanged from prior examinations and is chronic.\n\nNOTIFICATION: The ammended findings of degenerative pannus and subcortical\ncystic change at C2 and chronic narrative C1-C2 subluxation was discussed with\nDr. ___, M.D. by ___, M.D. on the telephone on\n___ at 10:30 am, 30 minutes after discovery of the findings." + }, + { + "input": "Study is mildly degraded by motion.\nThere is no evidence of acute territorial infarction,hemorrhage,edema,or mass.\nConfluent periventricular and white matter white matter hypodensities are\nnonspecific, likely sequelae of chronic small vessel ischemic disease. There\nis prominence of the ventricles and sulci suggestive of involutional changes.\nAtherosclerotic vascular calcifications are noted of bilateral vertebral and\ncavernous portions of internal carotid arteries.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nbilateral maxillary sinuses and ethmoid air cells. The visualized portion of\nthe remaining paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits show bilateral lens\nreplacement.", + "output": "1. Study is mildly degraded by motion.\n2. No acute intracranial abnormality.\n3. No evidence acute intracranial hemorrhage or fracture.\n4. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described." + }, + { + "input": "Study is slightly limited due to motion. There is no evidence of acute large\nterritory infarction,hemorrhage,edema, or mass. There is prominence of the\nventricles and sulci suggestive of involutional changes, similar to prior. \nConfluent periventricular and subcortical white matter hypodensities are\nnonspecific, likely sequela of chronic small vessel ischemic disease, similar\nto prior. Atherosclerotic calcifications are again seen in the intracranial\nvertebral arteries and cavernous portions of the internal carotid arteries.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial hemorrhage, calvarial fracture, or other acute\nintracranial abnormality." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or large territorial\ninfarction. Prominent ventricles and sulci suggest age-related cortical\nvolume loss. Periventricular white matter hypodensities are nonspecific, but\nlikely sequelae from chronic small vessel ischemic disease. The basal cisterns\nappear patent and there is preservation of gray-white matter differentiation.\n\nNo fracture is identified. There is mild mucosal thickening of the ethmoid\nair cells. The remaining visualized paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The globes are unremarkable. There are\natherosclerotic calcifications of the cavernous portions of internal carotid\narteries bilaterally.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Prominent\nventricles and sulci are consistent with age-related involutional change.\nPeriventricular white matter hypodensities are consistent with chronic small\nvessel ischemic disease. The basal cisterns appear patent, and there is\npreservation of gray-white matter differentiation. Incidental note is made of\nbilateral basal ganglia calcifications, right greater than left.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "CT head: There is a 1.2 cm hyperdense parenchymal hemorrhage at the posterior\nlateral left thalamus, which is relatively unchanged (03:18). There is a\nsmall amount of new right sylvian fissure subarachnoid blood and layering\nblood within the left occipital horn lateral ventricle. There is nonspecific\nperiventricular white matter hypodensity likely reflecting sequela of chronic\nmicroangiopathy. There is prominence of the ventricles and cortical sulci\nconsistent with volume loss.\n\nThere facial bone fractures involving the right zygoma, superior, lateral, and\nanterior inferior right orbital wall, and anterior, anterior superior,\nanterior inferior, and right lateral walls of the right maxillary sinus. \nThese are more fully characterize and dedicated CT of the facial bones. There\nis right intraorbital air. There is no retro-orbital hematoma. The superior\nand lateral right orbital fractures have intracranial extension with a small\nfocus of pneumocephalus (5:248). There is mucosal thickening and partial\nfluid opacification of the paranasal sinuses. There is layering fluid within\nthe right greater than left ethmoid, maxillary, and sphenoid sinuses, likely\nrepresenting hemorrhage. The mastoid air cells and middle ears are clear. \nThere is soft tissue thickening and stranding and right periorbital and right\nfacial soft tissues. There is a right scalp hematoma.\n\nCTA head: There is calcific atherosclerosis of the bilateral intracranial\ninternal carotid arteries. There is a thrombosed calcified 4 mm superiorly\nprojecting left paraclinoid aneurysm (5:246; 6 02:36). The anterior\ncommunicating artery is visualized. The bilateral posterior communicating\narteries are not definitively seen. There are codominant vertebral arteries. \nThere is a the superior aspect of the basilar artery is patulous without\ndiscrete aneurysm. The anterior and posterior circulations are patent without\nocclusion, dissection, or significant stenosis. There is no evidence vascular\nmalformation.\n\nCTA neck: There is a 4 vessel aortic arch. There is calcific atherosclerosis\ninvolving aortic arch and great vessel origins without significant stenosis. \nThere is calcific atherosclerosis at the right carotid bifurcation and bulb\nwithout significant stenosis by NASCET criteria. There is dense calcific\natherosclerosis at the left carotid bifurcation and bulb with 60-70% stenosis\nof the left carotid bulb by NASCET criteria (5:142). There is a\nretropharyngeal course of the left internal carotid artery. The vertebral\narteries are patent and demonstrate codominant is. There is no evidence of\nocclusion, dissection, or aneurysm.\n\nThe pharynx, larynx, nasal cavity, and oral cavities are unremarkable. The\ndentition is intact. There is streak artifact secondary to dental almalgam\nwhich obscures adjacent structures. The masticator, parapharyngeal, and\ncarotid spaces are unremarkable. The thyroid and salivary glands are\nunremarkable. There is no lymphadenopathy by CT criteria. There is a large\nright glenohumeral joint effusion which extends into the subacromial space and\ndemonstrates heterogeneous internal hyperdensity and scattered calcifications\n(5:69). There are multilevel degenerative changes of the cervical spine. The\nlung apices are clear. There is a fracture of the right mid clavicle with\nadjacent stranding. There are comminuted fractures of the right lateral\nthird, fourth, and fifth ribs with adjacent stranding. There healing left rib\nfractures.", + "output": "1. Unchanged posterior-lateral left thalamic parenchymal hemorrhage without\nevidence of underlying vascular malformation.\n2. Small amount of new right sylvian fissure subarachnoid and layering\noccipital horn left lateral ventricular hemorrhage.\n3. Patent intracranial and neck vasculature without occlusion or dissection.\n4. 4 mm superiorly projecting thrombosed and calcified left supra clinoid\nsegment internal carotid artery aneurysm.\n5. 60-70% stenosis of the left carotid bulb by NASCET criteria.\n6. Fracture of the right orbit with intracranial extension and small foci of\npneumocephalus, as described. Additional fracture of the right zygoma and\nright maxillary sinus walls. The facial fractures are better characterized on\ndedicated CT of the face.\n7. Enlarging right scalp hematoma.\n8. Fractures involving the right mid clavicle, and the right lateral third,\nfourth, and fifth ribs, better characterized on dedicated CT of the chest.\n9. Partially visualized large right glenohumeral joint effusion extending into\nsubacromial space with internal heterogeneous hyperdensity and scattered\ncalcifications. Findings may be related to chronic degeneration versus an\nacute process. Recommend clinical correlation." + }, + { + "input": "There has been interval evolution in appearance of a small left posterior\ninferior thalamic hemorrhage. There is no evidence of new infarction,\nhemorrhage, edema, or mass. The ventricles and sulci are prominent,\nsuggestive of age-related involution. Multiple prominent perivascular spaces\nare again demonstrated as well as mild periventricular white matter\nhypodensities compatible with chronic small vessel ischemic changes. Small\nright cerebral convexity subdural hygroma appears relatively unchanged\ncompared to the previous MRI. Previously seen subarachnoid and\nintraventricular blood has resolved.\n\nSmall residual right frontal scalp hematoma has improved. Previously noted\nright lateral maxillary wall, right zygomatic process, right superior and\nlateral orbital wall fractures are either re- demonstrated or partially\nvisualized. Layering blood is again noted in the sphenoid air cells along\nwith a small amount of fluid partially visualized in the right maxillary sinus\nwith mild mucosal wall thickening in the bilateral ethmoid air cells. The\nmastoid air cells and middle ear cavities are clear.", + "output": "1. Interval evolution in appearance of a small left thalamic hemorrhage. No\nnew hemorrhage or territorial infarct.\n2. Partial visualization of right facial fractures with re- demonstration of\nright superior and lateral orbital wall fractures." + }, + { + "input": "Since ___, there has been interval evolution of the previously\ndescribed small left posterior inferior thalamic hemorrhage. Currently, no\nhyperdense blood products are identified in this region. There is no evidence\nof large territorial infarction, acute intracranial hemorrhage, edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Multiple prominent perivascular spaces are re-\ndemonstrated, along with periventricular white matter hypodensities compatible\nwith chronic small vessel ischemic disease.\n\nPreviously described fractures of the right zygomatic process and right\nsuperolateral orbital wall are again seen (3:5, 601b:20). No new fracture\ndetected. The visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Interval evolution/resolution of the previously described small left\nposterior inferior thalamic hemorrhage. No new acute intracranial hemorrhage.\n\n2. Previously described fractures of the right zygomatic process and right\nsuperolateral orbital wall are again seen. No new fracture detected." + }, + { + "input": "Dental hardware somewhat limits the evaluation of the oral cavity.\n\nThe paranasal sinuses are normally aerated, with no mucosal thickening or\nair-fluid levels identified. The ostiomeatal units are patent. The cribriform\nplates are intact. There is no nasal septal defect. The nasal septum is\nmidline. The anterior clinoid processes are not pneumatized. The lamina\npapyracea are intact. The sphenoid sinus septum is not midline with insertion\nupon the carotid canal.\n\nThe visualized parts of the thyroid gland are unremarkable.\n\nThe temporomandibular joints appear normal. No soft tissue abnormalities are\ndetected. There are multiple carious maxillary and mandibular molars with\nimplants in bilateral maxillary and mandibular molars and premolars. There is\na left maxillary unerupted tooth.", + "output": "1. No abnormality in the sinuses or temporomandibular joints.\n2. Dental disease as described above." + }, + { + "input": "There is no evidence of acute hemorrhage mass effect midline shift or\nhydrocephalus. Gray-white matter differentiation is maintained.\n\nThere is deformity of the nasal bone and soft tissue swelling in the nasal and\nfrontal region better evaluated on the facial bone CT of the same day.", + "output": "No acute intracranial abnormalities are identified. Please correlate with\nfacial bone CT report for details of the facial abnormalities." + }, + { + "input": "There is no evidence of acute territory infarction,hemorrhage,edema, or mass. \nThere is mild prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of acute fracture. Soft tissue density within the\nbilateral ear canals likely represents cerumen. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "No evidence of acute territorial infarction or acute intracranial hemorrhage." + }, + { + "input": "Unchanged hypodensities in the caudate heads, anterior limbs of the internal\ncapsule, and putamina bilaterally are consistent with chronic lacunar\ninfarcts. There is no evidence of new infarction or hemorrhage. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Mucosal thickening in the right sphenoid\nsinus. Otherwise, the visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. Thickening of the nasal mucosa\ncould reflect polyps. The visualized portion of the orbits are unremarkable.", + "output": "No new infarction or hemorrhage." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction, mass or midline\nshift. There is no hydrocephalus. Visualized paranasal sinuses and mastoid\nair cells are clear. There is no fracture.", + "output": "No acute intracranial process." + }, + { + "input": "There is no acute intracranial hemorrhage, acute infarction, edema or mass\neffect. The ventricles and sulci are normal in size and configuration for\npatient's age. The basal cisterns are clear. The gray white matter\ndifferentiation appears preserved.\n\nNo fracture is identified. The visualized paranasal sinuses, mastoid air\ncells and middle ear cavities are clear.", + "output": "No acute intracranial abnormality." + }, + { + "input": "A small, round, calcific density with surrounding increased density in the\nright parietal lobe (Series 3, Images ___ is largely unchanged from ___ (Series 5, Image 515; Series 302a, Image 49), but is new since ___\n(Series 3, Image 298). This new calcification appears vascular in origin on\nthe CTA from ___. While the hyperdensity in the right parietal lobe might\nstill represent a small amount of subarachnoid hemorrhage, this could also\nrepresent increased perfusion in the setting of ischemia from a calcified\nembolus. A small AVM would not occur in the short timeframe of 1 month.\n\nThere is no additional new focal hyperdensity to suggest new hemorrhage. \nThere is no evidence of acute infarction, edema, or mass. The ventricles and\nsulci are normal in size and configuration. The basal cisterns are patent.\nThere is no midline shift.\n\nNo osseous abnormalities are seen. The partially visualized paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "Small calcification with surrounding hyperdensity in the right parietal lobe\nis of unclear etiology but may represent a calcific embolus with luxury\nperfusion or small subarachnoid hemorrhage.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with ___\n___, from the referring neurosurgery team, on the telephone on ___ at\n12:46 ___, 15 minutes after discovery of the findings." + }, + { + "input": "The previously noted right parietal calcification is again seen on the current\nexamination (see series 2, image 113). A grossly stable 8 mm pineal cyst is\nagain noted, compared to the ___ prior CTA.\n\nThe vertebral arteries are normal; the vertebral arteries are codominant. The\nbasilar artery is small in caliber but otherwise unremarkable, unchanged from\nCTA on ___. The superior cerebellar arteries are normal. The left\nposterior cerebral artery is fetal type and the right posterior cerebral\nartery is fetal origin. Both posterior cerebral arteries demonstrate normal\npatency.\n\nThe internal carotid arteries are normal. The middle cerebral arteries are\nnormal. The anterior cerebral arteries and anterior communicating artery are\nnormal.\n\nThe dural venous sinuses are patent.\n\nThe osseous structures are normal. There is mild mucosal thickening of the\nleft maxillary sinus. The paranasal sinuses, mastoid air cells, and tympanic\ncavities are otherwise clear. The orbits are normal.", + "output": "1. No vascular abnormality in the high right parietal region at the site of\npreviously seen hyperdensity on noncontrast head CT.\n2. No evidence of stent occlusive disease, dissection, or aneurysm greater\nthan 3 mm.\n3. Stable, approximately 8 mm pineal cyst.\n4. Paranasal sinus disease as described." + }, + { + "input": "Ventricles, cisterns and sulci are unremarkable. There is no mass effect,\nhydrocephalus or shift of normally midline structures. Minimal white matter\ndisease along the anterior and occipital horns of the lateral ventricles is\nprobably due to slight chronic small vessel ischemic change in this age group.\nTiny subcortical white matter hypodensity in the right frontal lobe (02:24) is\nalso nonspecific and could be due to chronic small vessel ischemic change. \nUneven more punctate focus is noted along the anterior right frontal lobe\n(02:24), probably a try any prior lacunar infarct. Gray-white matter\ndistinction is preserved. No evidence of a cute intracranial hemorrhage. \nSurrounding soft tissue structures are unremarkable. Number of teeth are\nmissing but this is not fully characterized here. Paranasal sinuses and\nmastoid air cells appear clear. No evidence of fracture or bone destruction. \nBones are probably demineralized to some extent.", + "output": "No evidence of acute intracranial abnormality. Minimal white matter disease. \nThis is likely due to chronic small vessel ischemic change in this age group\nalthough not highly specific.\n\nThis study lack sensitivity to detect intracranial infections. Optimally, MR\nwith gadolinium should be performed for that purpose. If MR cannot be\nperformed then CT with contrast would increased sensitivity (this study was\nperformed without intravenous contrast).\n\nRECOMMENDATION(S): Consideration of contrast enhanced CT or much preferably\nMR with gadolinium if there is ongoing clinical concern regarding possibility\nof septic emboli to the brain." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Prominence of\nthe ventricles and sulci as indicative of involutional change. Mild\nperiventricular white matter hypodensities are likely a sequela of chronic\nsmall vessel ischemia.\n\nAside from minimal aerosolized secretion in the left sphenoid sinus, the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\norbits are unremarkable. Vascular arteriosclerotic calcifications are present\nin the carotid siphons bilaterally.\nAgain noted are extensive degenerative changes of the right temporomandibular\njoint,\nwith calcified pannus surrounding the joint, unchanged since ___.", + "output": "Sequela of involutional change and small vessel disease, but no hemorrhage or\ninfarct." + }, + { + "input": "CT HEAD WITHOUT CONTRAST: There is no evidence of acute intracranial\nhemorrhage, edema, mass effect or large territorial infarction. The\nventricles and sulci are prominent suggesting age-related involutional\nchanges. Periventricular and subcortical white matter hypodensities\nsuggestive of chronic microvascular ischemic disease. The basal cisterns are\npatent. Gray-white matter differentiation is maintained.\n\nThere is moderate mucosal thickening in the left sphenoid sinus. The mastoid\nair cells and middle ear cavities are clear\n\nCTA HEAD: The vessels of the circle of ___ and their principal intracranial\nbranches appear normal without stenosis, occlusion or aneurysm formation. \nThere is mild atherosclerotic calcification of the bilateral carotid siphons. \nThe dural venous sinuses are patent.\n\nCTA NECK: The carotid and vertebral arteries and their major branches appear\nnormal with no evidence of stenosis or occlusion. There is no evidence of\ninternal carotid stenosis by NASCET criteria.\n\nOTHER: There are numerous bilateral lung nodules measuring up to 3 mm in the\npartially imaged upper lobes. Bilateral thyroid nodules measure up to 1.5 x\n1.1 cm on the right (3:77).", + "output": "1. No acute intracranial abnormality.\n2. CT of the head and neck reveals no evidence of aneurysm, dissection or\nflow-limiting stenosis.\n3. Numerous bilateral pulmonary nodules in the included upper lobes measure up\nto 3 mm. These could be infectious but further evaluation with dedicated CT\nof the chest is recommended.\n4. Bilateral thyroid nodules measuring up to 1.5 x 1.1 cm marked nonurgent\nevaluation with thyroid ultrasound.\n\nRECOMMENDATION(S):\n1. Dedicated CT of the chest.\n2. Nonurgent thyroid ultrasound." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, ormass effect. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nPeriventricular white matter hypodensities suggest chronic small vessel\nischemic disease\nThere is no evidence of acute fracture. Mucosal thickening of the left\nsphenoid sinus is re- demonstrated.", + "output": "1. No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are prominent in keeping with generalized parenchymal volume loss. \nSubcortical and deep white matter hypodensities are nonspecific but likely\nreflect sequela of chronic microvascular ischemic change. Similarly, a focal\nhypodensity in the left pons may reflect sequela of a chronic infarct in\naddition to a wedge-shaped area of encephalomalacia in the left inferior\ncerebellum.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality. Changes compatible with chronic\nmicrovascular ischemic change and prior infarcts." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci appear normal for a patient of this age. The basal\ncisterns are patent and there is preservation of gray-white matter\ndifferentiation. Scattered calcifications within a cerebral hemispheres these\nare nonspecific but may be seen in infections such as cysticercosis.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No evidence of hemorrhage or mass.\n2. Scattered parenchymal calcifications as discussed above." + }, + { + "input": "A 1 x 0.4 cm (04:13) subtle hypodensity within the left globus pallidus is\nnoted. There is no additional evidence of infarction, hemorrhage, edema, or\nmass. Mild periventricular, subcortical and deep white matter hypodensities\nare likely sequelae of chronic small vessel ischemic disease. The ventricles\nand sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable. Calcification of\nbilateral cavernous portions of internal carotid arteries are present.", + "output": "1 cm hypodensity within the left globus pallidus is worrisome for a large\nsubacute lacunar infarct or edema surrounding a lesion. Recommend dedicated\nMR for further evaluation.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 11:30 ___, 5 minutes after discovery of the\nfindings." + }, + { + "input": "There is no evidence of acute major infarction,hemorrhage,edema,or discrete\nmass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. \nPatient is status post bilateral lens replacements. Otherwise, the visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormalities." + }, + { + "input": "For description of the intracranial parenchymal findings, please see the\nseparate dedicated noncontrast CT head examination performed earlier on the\nsame day.\n\nCTA HEAD AND NECK:\nThere is a normal 3 vessel aortic arch. However, the left vertebral artery\nappears to arise directly from the aorta itself. Mild calcifications are seen\nat the origin of the right V1 segment. The vertebral arteries are patent\nwithout high-grade stenosis or occlusion.\n\nMild partially calcified atherosclerotic disease is seen at the bilateral\ncarotid bulbs extending into the proximal internal carotid arteries. This\nresults in 30% stenosis of the right proximal ICA, with no significant\nstenosis of the left proximal ICA by NASCET criteria.\n\nThere is moderate calcification seen in the bilateral cavernous internal\ncarotid arteries. There is a fetal origin of the right posterior cerebral\nartery. The vessels of the circle of ___ and their principal intracranial\nbranches are patent without high-grade stenosis, occlusion, or aneurysm\nformation. The dural venous sinuses are patent.\n\nOTHER:\nThe lungs apices are clear bilaterally. Evaluation of the thyroid gland is\nlimited secondary to streak artifact from the adjacent osseous structures and\nintravenous bolus injection. Allowing for this, the parenchyma appears\nheterogeneous with several subcentimeter nodules. There is no cervical\nlymphadenopathy by CT size criteria.", + "output": "1. Multifocal atherosclerotic disease of the intracranial and cervical\nvasculature, as detailed above, without evidence for high-grade stenosis,\nvessel occlusion, dissection, or aneurysm greater than 3 mm.\n2. Suboptimal views of the thyroid demonstrate several probable subcentimeter\nhypodense nodules. Recommend nonurgent dedicated thyroid ultrasound for\nfurther evaluation.\n3. For description of the intracranial parenchymal findings, please see the\nseparate dedicated noncontrast CT head examination performed earlier on the\nsame day.\n4. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct.\n\nRECOMMENDATION(S): Suboptimal views of the thyroid demonstrate several\nprobable subcentimeter hypodense nodules. Recommend nonurgent dedicated\nthyroid ultrasound for further evaluation." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThere is left parietal scalp soft tissue swelling and hematoma, without\nunderlying fracture. The visualized paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality. Left parietal soft tissue swelling and \nhematoma without underlying fracture." + }, + { + "input": "CTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear patent without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThere is variant common origin of the brachiocephalic and left common carotid\narteries. There is trace atherosclerotic calcification the origin of the left\nsubclavian artery without significant stenosis. The carotid and vertebral\narteries and their major branches appear patent with no evidence of stenosis,\ndissection or occlusion. There is no evidence of internal carotid stenosis by\nNASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. There is heterogeneous\nappearance of the thyroid gland, with suggestion of multiple nodules measuring\nup to 12 mm in the right lobe. There is no lymphadenopathy by CT size\ncriteria. The paranasal sinuses, middle ear cavities and mastoid air cells\nare grossly clear. Re- identified is a left parietal scalp hematoma and\nlaceration with overlying skin staples. No underlying fracture is noted.", + "output": "1. Patent intracranial vasculature without significant stenosis, occlusion, or\naneurysm.\n2. Patent cervical vasculature without significant stenosis, occlusion, or\ndissection.\n3. Heterogeneous thyroid with multiple nodules measure up to 12 mm in the\nleft lobe. The ___ College of Radiology guidelines does not suggest \nthyroid ultrasound for further evaluation in a patient of this age unless\nthere are other concerning clinical history or features.\n4. Left parietal scalp hematoma and laceration." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Age related involutional changes are noted. Ventricles are\nnormal in size. The imaged paranasal sinuses are well aerated. Mild\nopacification of the left inferior mastoid air cells. Otherwise the mastoid\nair cells and middle ear cavities are well aerated. The nasal bones are\nintact. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nThere is preservation of gray-white matter differentiation. The basal\ncisterns remain patent.\n\nThere is no evidence of fracture. There is partial opacification of bilateral\nanterior and posterior ethmoid air cells. The remainder of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The patient is\nstatus post bilateral lens replacement. The visualized portion of the orbits\nare otherwise unremarkable.", + "output": "1. No evidence for acute intracranial process or hemorrhage.\n2. Moderate global cerebral trophic changes.\n3. Multifocal sinus disease predominantly involving the bilateral anterior and\nposterior ethmoid air cells." + }, + { + "input": "There is an acute left subdural hematoma predominately layering along the left\ntentorial leaflet. This subdural collection measures up to 7 mm in thickness.\nThere is no significant mass effect. No herniation or shift of midline\nstructures. There is no evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "Acute left cerebral subdural hematoma (~7mm) layering along the left tentorial\nleaflet." + }, + { + "input": "Left tentorial subdural hematoma is unchanged in size and appearance. No acute\nhemorrhage is seen. There is no mass effect, midline shift or hydrocephalus.", + "output": "Unchanged appearance of the left tentorial subdural hematoma. No acute\nabnormalities." + }, + { + "input": "Imaging was initially attempted with intravenous contrast material. However,\ndue to technical error, the contrast was not administered in the appropriate\namount or at the appropriate time of the study.\nThe study is limited in the absence of intravenous contrast. Dental amalgam\nartifact further limits evaluation of the oral cavity.\n\nAero digestive tract: 3.6 cm x 2.9 cm x 1.1 cm soft palate soft tissue\nfullness is better assessed on MRI ___.. No bone destruction. No\nother abnormalities. No evidence of perineural tumor.\n\nNeck lymph nodes: There are multiple bilateral scattered subcentimeter level\nI-VI cervical lymph nodes, not pathologically enlarged based on CT size\ncriteria. There is no retropharyngeal adenopathy.\n\nExtra nodal tumor spread: There are no findings suggestive of extra nodal\nextension.\n\nDeep neck muscles, masticator space: There is no muscle invasion.\n\nBones, skull base:\nThere is no bone involvement.\nThere are no findings suggestive of perineural tumor extension. Jugular\nforamen, carotid canal, pterygopalatine fossa, infraorbital foramen, other\nskull base foramina are not involved.\n\nVessels: There is no vascular invasion.\n\nBrachial Plexus: There is no brachial plexus contact or invasion.\n\nThyroid, salivary glands: There is no mass.\n\nOther findings: There are no lung nodules.", + "output": "1. Technical failure of IV contrast administration. Essentially noncontrast\nscan.\n2. Stable appearance of the hard/soft palate soft tissue abnormality.\n3. No definite adenopathy." + }, + { + "input": "There is an acute right frontal subdural hematoma measuring 4 mm in greatest\nthickness (601; 39) with adjacent mild mass effect, similar. No evidence of\nmidline shift. There is no evidence of infarction, edema,or mass. Mild to\nmoderate brain parenchymal atrophy. Mild chronic small vessel ischemic\nchanges. Stable chronic infarct right centrum semiovale.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits demonstrate left lens replacement. There is mild right\nlateral periorbital soft tissue swelling.", + "output": "1. Grossly stable right frontal subdural hematoma measuring 4 mm in greatest\nthickness. No midline shift. No new foci of hemorrhage." + }, + { + "input": "Since ___, there has been significant interval increase in size\nof right extra-axial subdural collection, now measuring up to 2 cm in width;\nthe subdural hematoma appears predominantly hypodense and chronic, however,\nthere are scattered small isodense to hyperdense areas suggesting acute on\nsubacute on chronic right subdural hematoma. There is now approximately of 9\nmm of associated leftward midline shift, as well as right-sided sulcal\neffacement and compression of the right lateral ventricle. Re-demonstrated\narea of hypodensity in the right centrum semiovale, measuring approximately\n1.1 cm, is similar to prior, most likely representing an old infarct.\n\nThe partially imaged paranasal sinuses demonstrate mild mucosal thickening in\nthe bilateral ethmoid air cells. The mastoid air cells and middle ear\ncavities are clear. No acute fracture seen..", + "output": "Significant interval increase in size of right subdural hematoma since ___, images from earlier today are not available for comparison to\nassess for interval change. The subdural hematoma appears predominantly\nhypodense and chronic, but there are scattered isodense to hyperdense areas\nsuggesting acute on subacute on chronic subdural hematoma.\n\n9 mm leftward midline shift/subfalcine herniation, with associated right-sided\nsulcal effacement and compression of the right lateral ventricle.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 8:20 pm." + }, + { + "input": "There has been no significant change in the size of a primarily hypodense\nright extra-axial subdural fluid collection measuring up to 2 cm with\nassociated sulcal effacement and effacement of the right lateral ventricle. \nThere is a small quantity of hyperdense blood products layering posteriorly\nand inferiorly, which is unchanged. The degree of leftward midline shift is\ngrossly unchanged, measuring about 8 mm. Hypodensity in the right centrum\nsemiovale all is unchanged in comparison with ___, probably\nrepresenting a remote infarct.\n\nThere is no new hemorrhage or evidence of acute infarct. Periventricular and\nsubcortical white matter hypodensities are nonspecific but likely reflect\nsequelae of chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. The\nvisualized portion of the orbits are unremarkable with the exception of prior\nleft lens removal.", + "output": "No significant interval change in the right primarily chronic subdural\nhematoma. Grossly unchanged 8 mm of leftward midline shift. No evidence of\nnew hemorrhage or infarction." + }, + { + "input": "There is expected interval evolution of the right convexity subacute subdural\nhematoma. There does remain small foci of hyperdense material at the vertex,\nmay represent more acute blood product. There is 4 mm right-to-left midline\nshift, decreased from 8 mm on the ___ head CT. The basilar\ncisterns are patent. No acute intracranial hemorrhage is identified.\n\nThere is mild narrowing of the right lateral ventricle and slight enlargement\nof the left lateral ventricle when compared to the ___ head CT. \nThere is mild generalized parenchymal volume loss. An area of low attenuation\nwithin the periventricular white matter adjacent to the posterior body of the\nright lateral ventricle is consistent with a old infarct. Areas of low\nattenuation within the subcortical periventricular white matter are\nnonspecific, but likely reflect the sequela of mild to moderate chronic small\nvessel disease. There is moderate atherosclerotic plaque within the carotid\nsiphons.\n\nThere is no depressed calvarial fracture. There is mild mucosal thickening\nwithin the bilateral ethmoidectomy beds status post functional endoscopic\nsinus surgery. There is a left lens implant. The orbits are otherwise\nunremarkable.", + "output": "Expected interval evolution of the subacute right cerebral convexity subdural\nhematoma, with 4 mm right to left midline shift, previously 8 mm on the ___ head CT. No acute intracranial hemorrhage, although there does\nappear to be small foci of relatively more hyperdense blood product near the\nvertex of the right subdural hematoma." + }, + { + "input": "There is no evidence of acute, large territorial\ninfarction,hemorrhage,edema,or mass. A focal hypodensity adjacent to the\nposterior aspect of the body of the right lateral ventricle is most compatible\nwith a chronic infarct. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. Periventricular white-matter\nhypodensities are nonspecific, likely sequela of chronic ischemic small vessel\ndisease.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. Aside from left lens replacement, the visualized\nportion of the orbits are normal. Prominent dental caries with loss of the\ncoronal aspect of the left maxillary second premolar and large dental ___\ninvolving the left maxillary first molar, along with periapical lucencies. \nDegenerative changes of the temporomandibular joints. Prominent\natherosclerotic vascular calcifications involving the intracranial segments of\nthe internal carotid arteries. There is soft tissue swelling in the right\nsuboccipital scalp.", + "output": "Right suboccipital soft tissue swelling with no underlying calvarial fracture\nor no acute intracranial hemorrhage." + }, + { + "input": "Evaluation of the skullbase is mildly limited by motion. There is no evidence\nof infarction, hemorrhage, edema, or mass. The ventricles and sulci are normal\nin size and configuration.\n\nA minimal right nasal bone deformity appears chronic. No acute fracture seen.\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\nThe orbits are unremarkable.", + "output": "No acute intracranial process on this mildly motion limited exam." + }, + { + "input": "There is minimal mucosal thickening (approximately 2 mm) of the left maxillary\nsinus. There is no evidence for periapical dental disease. The ostiomeatal\nunits are patent. The cribriform plates are intact. The nasal septum and a\nnasal spur is angled towards the right, contacting the middle nasal turbinate\n(601b:59). The right anterior clinoid processes is pneumatized. The lamina\npapyracea are intact. The sphenoid sinus septum is midline with insertion upon\nthe right carotid canal.", + "output": "1. Nasal septal spur contacting the right middle turbinate.\n2. Minimal mucosal thickening of the left maxillary sinus." + }, + { + "input": "There is a focal area of encephalomalacia in the right parietal lobe and a\nfocal hypodensity of the right caudate head compatible with prior areas of\nchronic infarct previously seen on MRI brain ___. Prominent\nventricles and sulci compatible with global age-appropriate atrophy. Mile\nsubcortical white matter hypodensities are likely sequela of chronic small\nvessel disease. There is no evidence of acute infarction, hemorrhage, edema,\nor mass.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No fracture or hemorrhage." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect or\nlarge territorial infarction. Ventricles and sulci are normal in size\nconfiguration. There are subcortical areas of white matter hypodensity which\nare somewhat focal and while nonspecific may reflect chronic microvascular\nischemic disease (2:18 and 2:13). The basal cisterns are patent. Gray-white\nmatter differentiation is preserved.\n\nThere is no fracture. The partially imaged paranasal sinuses, mastoid air\ncells and middle ear cavities are clear.", + "output": "1. No acute intracranial abnormality.\n2. Several subcortical areas of white matter hypodensity may reflect sequela\nof chronic microvascular disease. However, these appears somewhat focal and\nare more extensive than typical for a patient of this age. Further evaluation\nwith MRI is recommended non urgently.\n\nRECOMMENDATION(S): Nonurgent brain MR." + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass. The ventricles and sulci are normal in size and configuration.There is\nno evidence of fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Re-demonstrated subtle left frontal hyperdensity measures 1.7 x 1.1 cm on\nseries 2, image 16, possibly representing intraparenchymal contusion with\nsubtle mild adjacent edema. No midline shift is seen. No significant mass\neffect. The visualized paranasal sinuses demonstrate mucosal thickening of\nthe bilateral ethmoid air cells and minimal mucosal thickening of the\nbilateral maxillary and sphenoid sinuses.. The mastoid air cells are clear. \nNo acute fracture is seen. No scalp hematoma seen.", + "output": "Re-demonstrated subtle left frontal hyperdensity measures 1.7 x 1.1 cm,\nconcerning for subtle intraparenchymal contusion. No scalp hematoma seen,\nhowever. No midline shift." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is a 2.2 x 1.1 cm hyperdensity in the left frontal lobe suggestive of an\nintraparenchymal contusion with mild surrounding hypodensity suggesting edema,\nas seen on prior. No underlying vascular malformation. No enhancing mass. \nMild left frontal extracranial overlying soft tissue swelling. The ventricles\nand sulci are normal in size and configuration.\n\nMild mucosal thickening involving the paranasal sinuses. Under pneumatized\nmastoid bones are clear. The visualized portion of the orbits are\nunremarkable. Multiple dental caries with associated periapical lucencies and\ndental referral is advised.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nMild paraseptal emphysematous changes. Dependent ground glass centrilobular\nairspace opacification may represent aspiration or less likely atelectasis. \nThe visualized portion of the thyroid gland is within normal limits. There is\nno lymphadenopathy by CT size criteria. ET and feeding tubes in situ though. \nRetained secretions in the ___ and oropharynx.", + "output": "Findings most likely represent a left frontal intraparenchymal contusion\nhemorrhage. No underlying vascular malformation. No abnormal enhancing mass.\nSubtle hyperdensity in the left frontal convexity sulci and small hyperdensity\nin the interpeduncular cistern (02:13) may indicate small amount of\nsubarachnoid blood.\nFollow-up imaging advised to ensure resolution.\n\nNo intracranial arterial aneurysm or occlusion. No vascular malformation.\n\nNo ICA stenosis by NASCET criteria. The vertebral arteries are patent\nbilateral.\n\nMild paraseptal emphysematous changes. Dependent ground glass airspace\nopacification may represent aspiration or less likely atelectasis.\n\nMultiple dental caries with associated periapical lucencies and dental\nreferral is advised." + }, + { + "input": "A 2.6 x 1.8 cm left frontal hyperdensity and surrounding hypodensity is\nunchanged in size from MRI examination ___ and slightly more\nconspicuous when compared to CT examination ___.\n\nNo evidence of acute large territory infarct or new intracranial hemorrhage. \nThe sulci, ventricles and cisterns are within expected limits for the\npatient's age. No acute osseous abnormality. The orbits are unremarkable. \nModerate mucosal thickening of the ethmoid air cells. Mastoid air cells are\npartially opacified, greater on the right.", + "output": "1. 2.6 cm left frontal hyperdensity and surrounding edema pattern is overall\nunchanged in size from MRI examination of ___, but slightly more\nconspicuous when compared to CT examination of ___, potentially\nsecondary to differences in technique. Differential considerations include\nneoplasm such as oligodendroglioma, low-grade glioma or potentially cavernous\nmalformation.\n2. No new acute intracranial hemorrhage. No acute large territory infarct.\n3. Additional findings as described above." + }, + { + "input": "Left frontal linear hyperdensity, on series 2, image 23, coronal series 601,\nimage ___ represent subarachnoid hemorrhage versus artifact. No mass\neffect or midline shift is seen. There is no hydrocephalus. No evidence of\nacute large vascular territorial infarct.\n\nThe imaged paranasal sinuses demonstrate mucosal thickening of the bilateral\nethmoid air cells and minimal mucosal thickening of the bilateral maxillary\nand sphenoid sinuses.\n\nPartially imaged enteric and endotracheal tubes. Fluid secretions in the\nnasopharynx, likely relate to intubation. No acute fracture is seen.", + "output": "Left frontal linear hyperdensity, acute subarachnoid hemorrhage versus\nartifact. Recommend short-term follow-up CT to assess for interval change.\n\n\nNo midline shift or mass effect." + }, + { + "input": "Along the left parietal convexity and extending anteriorly along the left\nfrontal convexity, there is a subdural hemorrhage measuring 9 mm in maximum\nthickness, best seen on sequence 2 image 24. This results in mild effacement\nof adjacent sulci and a 4 mm rightward shift of normally midline structures.\nNo additional hemorrhage, mass, or large territorial infarction is identified.\nVentricles are prominent, likely reflective of age related involutional\nchanges. Basal cisterns are clear. There is preservation of gray-white matter\ndifferentiation.\n\nThere is a small subgaleal hematoma within the soft tissues along the left\nparietal bone best seen on sequence 3 image 38. No underlining bony\nabnormality is identified. There is no fracture. Visualized paranasal sinuses\ndemonstrates mild mucosal thickening within the right maxillary sinus. The\nmastoid air cells and middle ear cavities are clear.", + "output": "Subdural hemorrhage along the left parietal and frontal convexity with mild\neffacement of adjacent sulci and 4 mm shift of normally midline structures.\n\nLeft parietal small subgaleal hematoma. No fracture identified." + }, + { + "input": "Re- demonstration of a 9 mm subdural hematoma along the left parietal and\nextending anteriorly to the left frontal convexity. Secondary to patient\nmotion, evaluation for subtle new intraparenchymal or subdural collection is\nlimited. Allowing for this, no large hemorrhage is identified. A 4 mm\nrightward shift of normally midline structures persists, present on prior\nexamination and unchanged. Subtle effacement of adjacent sulci is additionally\nunchanged. Ventricles and sulci are prominent likely sequela of age-related\ninvolutional changes. Basal cisterns are patent.\n\nNo bony abnormality is detected. Prior left parietal subgaleal hematoma less\nconspicuous on today's examination. Visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear.", + "output": "Examination limited secondary to patient more motion despite multiple attempts\nat acquisition. Stable left convexity subdural hematoma with subtle effacement\nof adjacent sulci and 4 mm rightward shift of normally midline structures.\nAllowing for suboptimal images, no new large hemorrhage is identified.\nContinued follow up is recommended." + }, + { + "input": "Examination is extremely limited by motion artifact and patient's head\npositioning. There is again demonstration of a left subdural hematoma which\nmeasures up to 9 mm and appears to have redistributed, now occupying a greater\npart of the left parietal lobe. There is no evidence of new hemorrhage.\nEvaluation of normally midline structures is limited by motion artifact. The\nbasal cisterns appear grossly patent and there is preservation of gray-white\nmatter differentiation.\n\nThere is no fracture. The visualized paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear.", + "output": "Extremely limited examination due to motion artifact and patient's head\npositioning. Redemonstration of a 9 mm left subdural hematoma. No new\nhemorrhage identified." + }, + { + "input": "Evaluation is limited by patient positioning and motion artifact. A small left\nsubdural hematoma of the left parietal lobe is again seen, with a maximum\ndepth of 7 mm from the inner table, not increased in size since the prior\nstudy. Assessment of midline structures is limited, however there appears to\nbe no shift of normally midline structures. No new areas of hemorrhage are\nidentified. There is no fracture. The visualized paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear.", + "output": "Limited evaluation due to motion artifact and head positioning. Small left\nsubdural hematoma not increased in size. No new hemorrhage." + }, + { + "input": "There is no evidence of territorial infarction,hemorrhage,edema, or mass. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Pronounced and confluent subcortical, periventricular and deep white\nmatter hypodensities are nonspecific but likely represent sequela of chronic\nmicrovascular ischemic changes.\n\nThere is no evidence of fracture. There is near complete soft tissue\nopacification of the right sphenoid sinus (03:17) likely representing\ninspissated mucus. The visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. No evidence of fracture, hemorrhage or infarction.\n2. Near complete soft tissue opacification of the right sphenoid sinus likely\nrepresents inspissated mucus.\n3. Sequela of chronic microvascular ischemic changes." + }, + { + "input": "Large hypodensity in the left cerebellar hemisphere is new since ___ but\nappears chronic given the associated ex vacuo dilatation ofthe left fourth\nventricle and widening of the adjacent sulci compatible with encephalomalacia\nfrom probable prior infarct (series 2, image 12; series 601b, image 70). \nOther periventricular, subcortical, and deep white matter hypodensities are\nalso new since ___ and are nonspecific, but likely reflective of the sequelae\nof chronic small vessel ischemic disease. No intra or extra-axial hemorrhage.\nNo shift of normally midline structures. Bilateral, symmetric prominence of\nthe ventricles and sulci is mild and suggests a degree of cortical volume\nloss.\n\nNo fracture. The partially imaged right maxillary sinus is opacified with\nassociated hyperostosis of the maxillary sinus bones indicating a degree of\nchronicity. Intermediate attenuation material within the right maxillary\nsinus could be due to chronic inflammation or fungal colonization. Some of\nthe ethmoidal air cells are partially or completely opacified on the right. \nMucosal thickening of the left maxillary sinus is mild. The remaining\npartially imaged paranasal sinuses are clear. The mastoid air cells and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No intracranial hemorrhage or mass effect.\n2. Chronic left cerebellar hemispheric infarct, new since ___.\n3. Nonspecific white matter hypodensities, new since ___, likely sequelae of\nchronic small vessel ischemic disease.\n4. Predominantly right chronic paranasal sinus disease with hyperdense\ncontents which may be suggestive of fungal colonization." + }, + { + "input": "Numerous surgical clips are seen within the thyroid bed status post\nthyroidectomy. Streak artifact from the clavicles and shoulder girdles limit\nevaluation at this level. Soft tissue density at the surgical site and\neffacement of surrounding fat planes are compatible with postsurgical change. \nThere is no evidence for a rim enhancing fluid collection.\n\nThere is no evidence for an exophytic mucosal mass. Bilateral palatine\ntonsilliths matter below with sequela of prior infections. There is no\nevidence for retropharyngeal edema or fluid.\n\nThe salivary glands appear unremarkable.\n\nLevel 2A lymph nodes measure up to 1.6 cm bilaterally, minimally enlarged,\nimage 2:45. Bilateral level 1A, 1B, 2B, 3, and 4 lymph nodes are not\nenlarged.\n\nThe left vertebral artery arises directly from the aortic arch, a normal\nvariant. Carotid arteries are patent. Internal jugular veins are not\noptimally assessed due to the phase of contrast enhancement, but do not appear\ncompressed or occluded.\n\nIn the included portion of the mediastinum, prevascular lymph nodes measure up\nto 0.9 cm in short axis, not enlarged, and paratracheal lymph nodes measure up\nto 1.0 cm in short axis, top-normal. A partially visualized subcarinal lymph\nnode abutting the esophagus measures up to 0.9 cm, not fully evaluated. \nVisualized upper lungs are unremarkable allowing for suboptimal technique for\npulmonary evaluation.\n\nVisualized brain parenchyma is grossly unremarkable though this exam is not\ntechnically optimized for its evaluation. Deformity of the right zygomatic\narch is likely secondary to a prior healed fracture.\n\nThere is moderate opacification of visualized anterior ethmoid air cells and\nnear complete opacification of partially visualized posterior ethmoid air\ncells. There is mild mucosal thickening in the maxillary sinuses with a\nmucous retention cyst on the left. There is polypoid mucosal thickening in\nthe ostium of the left sphenoid sinus. There is mild mucosal thickening in\nthe right sphenoid sinus. Frontal sinuses are not imaged. Mastoid air cells\nand pneumatized petrous apices appear well aerated.\n\nThere are degenerative changes in the cervical spine.", + "output": "1. Postsurgical changes in the thyroidectomy bed with soft tissue density and\neffacement of fat planes. No evidence for a rim enhancing fluid collection,\nallowing for bone related streak artifact.\n2. Paranasal sinus disease. Please correlate with symptoms.\n3. Minimally enlarged bilateral level 2A lymph nodes, nonenlarged lymph nodes\nat levels 1, 2B, 3, and 4, and nonenlarged mediastinal lymph nodes are likely\nreactive." + }, + { + "input": "Limited examination due to patient motion. There is no evidence of\ninfarction, hemorrhage, edema, or mass. The ventricles and sulci are normal in\nsize and configuration.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of acute intracranial process." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci and unremarkable. Basilar cisterns are\npatent.\n\nMucous retention cyst is noted in the left maxillary sinus. Included\nparanasal sinuses and mastoids are otherwise clear. There is a fracture\nthrough the frontal process of the maxilla on the right. Skull and\nextracranial soft tissues are unremarkable.", + "output": "No acute intracranial process, no intracranial hemorrhage.\nFracture of the frontal process of the maxilla on the right to be correlated\nclinically regarding acuity." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThere is opacification of right sphenoid sinus and bilateral ethmoid air\ncells, unchanged compared to the prior study from ___. H the remaining e\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria. Incidentally seen is hypoplastic left vertebral\nartery.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Normal head and neck CTA.\n2. No acute intracranial abnormality.\n3. Paranasal sinus disease as described above." + }, + { + "input": "There is no evidence of fracture, territorial infarction,acute intracranial\nhemorrhage,edema,or mass. The ventricles and sulci are normal in size and\nconfiguration.\n\nTrace mucosal thickening of the ethmoid air cells. Otherwise, the visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are normal.", + "output": "There is no evidence of acute intracranial process or hemorrhage." + }, + { + "input": "There is no evidence of large territory infarction,hemorrhage,edema, or mass. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges.\n\nThere is no evidence of fracture. There is opacification of the bilateral\nfrontal and left maxillary sinuses and ethmoid air cells. There is mucosal\nthickening of the bilateral frontal, bilateral sphenoid, and left maxillary\nsinuses. Mastoid air cells middle ear cavities are clear. Partially imaged\nright maxilla demonstrates suggestion of possible periodontal disease in the\nregion of the right canine.", + "output": "1. No acute intracranial process.\n2. Paranasal sinuses as described in the body of the report.\n3. Partially imaged possible periodontal disease/apical lucency in the region\nof the right maxillary canine." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are normal in size and configuration.\n\nThere is congenital nonunion of the posterior arch of C1. There appears to be\nmild asymmetric soft tissue thickening in the left frontal region (601; 46),\nspecifically there is asymmetry of the temporalis muscle with enlargement on\nthe left with a 2.8 x 1.0 cm internal hypodensity.\n\nThere is no evidence of fracture. Moderate mucosal thickening of the ethmoid\nair cells are noted. The visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Asymmetry of the temporalis muscle with enlargement on the left with a 2.8\nx 1.0 cm internal hypodensity. This is nonspecific, to be correlated\nclinically." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect or\nlarge territorial infarction. The ventricles and sulci are prominent\nsuggesting age-related atrophy. Mild periventricular white matter\nhypodensities are nonspecific but may reflect chronic microvascular ischemic\ndisease. The basal cisterns are patent. Gray-white matter differentiation is\npreserved.\n\nThere is no acute fracture. There is minimal opacification of several left\nmastoid air cells. The partially imaged paranasal sinuses and middle ear\ncavities are clear. There are atherosclerotic calcifications of the cavernous\ninternal carotid arteries.", + "output": "No evidence of acute intracranial abnormality. Minimal opacification of\nseveral left mastoid air cells is nonspecific, potentially related to mild\ninflammation." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass, mass effect, or large\nvascular territory infarction. The ventricles and sulci are mildly prominent,\nlikely due to age related volume loss. Mild enlargement of the extra-axial\nspaces along the bilateral frontal convexities is not significantly changed\nfrom ___. The basal cisterns are patent. There is preservation of gray-white\nmatter differentiation. Minimal calcifications are noted in the intracranial\narteries.\n\nNo fracture is identified. The visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. A sebaceous cyst is noted along the\nleft posterior scalp. The soft tissues and orbits are otherwise unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. Bifrontal\nprominent CSF density in subarachnoid space is likely due to underlying volume\nloss.\n\nThere is no evidence of fracture. The scalp hematoma is seen overlying the\nfrontal bone. The visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. No acute intracranial abnormalities on noncontrast head CT.\n2. No acute fractures. Scalp hematoma overlying the frontal bone." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, loss of gray/\nwhite matter differentiation. Ventricles, basal cisterns, and sulci are\nnormal in size.\n\nMild soft tissue swelling appears present in the medial right periorbital\nregion extending to the bridge of the nose. There is no evidence of fracture.\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "No evidence for acute intracranial abnormalities. No evidence for a calvarial\nfracture." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions. There are moderate\ndegenerative changes in the lower C-spine, worst from C5-7.", + "output": "No acute findings." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular white matter hypodensities are\nnonspecific but suggestive of the sequela of chronic small vessel disease. \nPreviously demonstrated foci of signal abnormality on prior MR are not\nvisualized on this exam.\n\nThere is no evidence of fracture. Mild mucosal thickening is noted in the\nleft sphenoid sinus. Minimal opacification of the left inferior mastoid air\ncells are noted. The visualized portion of the orbits are unremarkable apart\nfrom bilateral lens resections.", + "output": "1. No acute intracranial process.\n2. Left third trigeminal nerve thickening and previously described areas of\ndiffusion abnormality on MRI are not well visualized on the current CT exam." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nMinimal aerosolized fluid is seen layering posteriorly in the left sphenoid\nsinus. Otherwise the imaged paranasal sinuses are well aerated as are the\nmastoid air cells and middle ear cavities. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Slightly\nprominent ventricles and sulci suggest mild age related global atrophy. The\nbasal cisterns appear patent and there is preservation of gray-white matter\ndifferentiation.\n\nNo osseous abnormalities seen. There is near complete opacification of the\nright maxillary sinus containing inspissated secretions as well as sclerosis\nof the maxillary wall compatible with chronic sinusitis. The remaining\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\norbits are unremarkable. A well-circumscribed hypodense lesion is seen at the\nright parietal soft tissues measuring 2.6 x 1.1 cm compatible with a sebaceous\ncyst.", + "output": "1. No acute intracranial process.\n2. Near complete opacification of the right maxillary sinus containing\ninspissated secretions with sclerosis of the maxillary wall compatible with\nchronic sinusitis." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are prominent consistent with mild atrophy.\n\nNo osseous abnormalities seen. There is complete opacification of the\nvisualized portion of the right maxillary sinus. The remainder of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\norbits are unremarkable. An ovoid lesion measuring 24 x 8 mm in the right\nparietal scalp overlying the vertex is unchanged from the prior study and may\nrepresent a sebaceous cyst.", + "output": "1. No acute intracranial process.\n2. Complete opacification of the right maxillary sinus.\n3. Unchanged right parietal scalp lesion, possibly a sebaceous cyst or other\nbenign etiology." + }, + { + "input": "A small amount of subarachnoid hemorrhage is seen in the right frontal lobe.\nNo other areas of hemorrhage are identified. There is no mass effect or shift\nof the normally midline structures.\n\nThere is no edema. The ventricles and sulci are of normal size and\nconfiguration for age. Scattered periventricular white matter hypodensities,\nwhile nonspecific, are presumably sequela from chronic small vessel ischemic\ndisease. There is no evidence for an acute infarction. The basal cisterns are\npatent. Hyperdensity of the basilar artery is likely physiologic.\n\nThe included paranasal sinuses and mastoid air cells are well-aerated. There\nis no acute fracture. A small subgaleal hematoma with skin staples is seen\nover the left parietal bone.", + "output": "Small amount of subarachnoid hemorrhage within the right frontal lobe. No\nmass effect." + }, + { + "input": "Small right frontal subarachnoid hemorrhage is stable in size with minimally\ndecreased density seen on coronal reformatted images. There is no new\nintracranial hemorrhage. There is no evidence for edema, mass effect, or loss\nof gray/ white matter differentiation in the brain parenchyma. Ventricles and\nsulci are mildly prominent due to age-related parenchymal atrophy, as before.\nA 7 mm coarse calcification is again seen along the caudal aspect of the left\ntentorium, image 602b:53 and image 601b:82, which may represent a dural plaque\nor calcified meningioma, without associated mass effect.\n\nThere is no fracture. Visualized paranasal sinuses and mastoid air cells are\nclear.", + "output": "Small right frontal subarachnoid hemorrhage is stable in size with slightly\ndecreased density. No new intracranial hemorrhage and no evidence for other\nnew intracranial abnormalities." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\nThere is no evidence of fracture. There is a mucous retention cyst in the\nright maxillary sinus and right sphenoid sinus. The remainder of the\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable. \nThere is a small amount of soft tissue swelling of the right frontal scalp.", + "output": "No acute intracranial process." + }, + { + "input": "There is a stable 0.8 x 0.7 cm (2:9) coarsely calcified lesion along the right\ntemporal lobe. Again seen is a subdural hematoma along the right frontal\nconvexity measuring 4 mm in maximal width, unchanged since prior examination. \nAlong the right frontal convexity small bilateral hygromas are noted.\n\nThere is no evidence of infarction or edema. The ventricles and sulci are\nnormal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Calcification of the cavernous\nportions of the internal carotid arteries are noted.", + "output": "1. Stable right frontal subdural hematoma measuring 4 mm in maximal with. No\nnew intraparenchymal hemorrhage.\n2. Stable 0.8 cm calcified lesion along right temporal lobe. Differential is\nbroad and includes cavernous malformation, AVM or potentially infectious\nprocess such as neurocysticercosis." + }, + { + "input": "Study is degraded by motion. Within these confines:\n\nThere is no evidence of fracture, infarction,hemorrhage,edema, or mass. There\nis mild prominence of the ventricles and sulci suggestive of involutional\nchanges. There are areas of periventricular and subcortical white matter\nhypoattenuation that are nonspecific but most likely represent chronic small\nvessel disease. Atherosclerotic vascular calcifications are noted.\n\nThe visualized portion of the mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are preserved. Limited imaging of\nthe parotid glands demonstrate bilateral subcentimeter nonspecific probable\nlymph nodes. Bilateral maxillary sinus mucosal thickening is present. \nMinimal right frontal sinus and bilateral ethmoid air cell mucosal thickening\nis present.", + "output": "1. Limited study as described.\n2. No acute intracranial abnormality. Please note MRI of the brain is more\nsensitive for the detection of acute infarct.\n3. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described." + }, + { + "input": "Significant artifact in the posterior fossa. Small linear hypodensity in the\ninferior left cerebellum may represent artifact or subacute infarct.\nHypodensities in the right basal ganglia (2:70) likely reflect prominent\nperivascular spaces, h or chronic lacunar infarcts. More diffuse subcortical\nwhite matter hypodensities are nonspecific, likely represent sequela of\nmoderate chronic ischemic microvascular disease. There is no evidence of\nacute territorial infarction, hemorrhage, cerebral edema or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. There is diffuse soft tissue edema, left\ngreater than right, likely due to fluid overload. Extensive opacification of\nthe paranasal sinuses with air-fluid levels, and moderate opacification of the\nright mastoids, likely secondary to intubation. Bilateral proptosis, no\nevidence of orbital mass or extraocular muscle enlargement.", + "output": "1. Small linear hypodensity in the inferior left cerebellum may represent\ndental streak artifact or subacute infarct, clinically correlate..\n2. Right basal ganglia prominent prevascular spaces versus chronic lacunar\ninfarcts.\n3. Evidence of moderate chronic ischemic disease.\n4. Diffuse soft tissue edema, left greater than right. Bilateral proptosis." + }, + { + "input": "NON-CONTRAST HEAD CT: There is no evidence of infarct, hemorrhage or mass. \nThe ventricles, cisterns and sulci are age-appropriate. The patient is status\npost left canal wall-down tympanomastoidectomy. The ossicles on the left are\nnot identified. There is fluid density material layering within the mastoid\nbowl, and within the middle ear.\n\nCTA HEAD: The right vertebral artery is slightly dominant. A prominent,\npatent right posterior communicating artery provides dominant supply to the\nright PCA. On the left, the P1 segment provides dominant supply, though the\nposterior communicating artery is patent.\n\nThe distal cervical and intracranial right internal carotid artery is larger\nin caliber than the left. In addition, the A1 segment of the right ACA gives\nrise to both A2 segments, with the A1 segment of the left ACA, aplastic, a\ncommon anatomic variant. There is no aneurysm larger than 2 mm, and no\nevidence of flow-limiting stenosis.", + "output": "1. No evidence of intracranial hemorrhage, mass, infarct or aneurysm larger\nthan 2mm.\n\n2. Incidental variant of the circle of ___ with both A2 segments arising\nfrom the A1 segment of the right ACA, and an essentially aplastic left A1\nsegment.\n\n3. Status post left canal wall-down tympanomastoidectomy, with the left\nossicular chain not identified; there is fluid density material within the\nmastoid bowl and the middle ear, which should be correlated clinically." + }, + { + "input": "Hyperdense material within the suprasellar cistern is consistent with acute\nsubarachnoid hemorrhage. Extension into the right sylvian fissures noted. \nFindings are highly concerning for ruptured aneurysm. There is no evidence of\nacute large territorial infarction, edema, or discrete mass.\n\nThe ventricles and sulci are normal in size and configuration. No\nhydrocephalus.\n\nNo acute osseous abnormalities seen. The partially imaged paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The orbits demonstrate\nno acute abnormalities.", + "output": "Acute subarachnoid hemorrhage centered in the suprasellar cistern extending\ninto the right sylvian fissure. Findings concerning for ruptured aneurysm and\nCTA strongly advised.\n\nRECOMMENDATION(S): CTA head and neck. Neurosurgical consultation." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nSubarachnoid hemorrhage is again identified extending along the\ninterhemispheric fissure and right anterior temporal lobe into the right\nsylvian fissure. There is no evidence of new hemorrhage. There is no\nintraventricular extension.\n\nThere is no evidence of infarction.\n\nThe ventricles and sulci are normal in size and configuration and unchanged\nfrom prior.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\nNote is made of osseous erosive changes along the right aspect of the maxilla\nwith probable residual right first bicuspid tooth root (series 3, image 201). \nThere is no evidence of active inflammatory changes suggestive of a more acute\nprocess.\n\nCTA HEAD:\nThere is an 6 x 3 mm (AP X TR) elongated anterior communicating artery\naneurysm which points to the right and is anteriorly and inferiorly directed. \nA slightly hyperdense 7 x 4 mm (AP X TR) collection posteriorly to the\naneurysm may represent recent subarachnoid blood (series 3, image 277).\n\nThe right A1 segment is small in caliber which is most likely congenital.\nThere are prominent bilateral posterior communicating arteries, normal\nanatomic variant.\nThe vessels of the circle of ___ and their principal intracranial branches\nappear unremarkable without high-grade stenosis, dissection or occlusion.\nThe dural venous sinuses are patent.\n\nCTA NECK:\nNormal 3 vessel aortic arch. The carotidandvertebral arteries and their major\nbranches appear normal with no evidence of stenosis or occlusion. There is no\nevidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nNo suspicious pulmonary nodules. The visualized portion of the thyroid gland\nis within normal limits. There is no lymphadenopathy by CT size criteria.", + "output": "1. Subarachnoid hemorrhage in the right suprasellar cistern with extension\ninto the interhemispheric fissure and along the anterior right temporal lobe\ninto the right sylvian fissure. No evidence of new hemorrhage.\n2. Elongated 6 x 3 mm anterior communicating artery aneurysm pointing to the\nright and anteriorly and inferiorly directed.\n3. Small caliber right A1 segment, most likely congenital." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nArtifact from the anterior communicating artery aneurysm coils limits\nevaluation the base of the brain. Within these confines:\n\nThe previously seen diffuse subarachnoid hemorrhage in the base of the brain\nis not seen. There is no evidence of infarction, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe patient is status post coiling of a ruptured anterior communicating artery\naneurysm. Evaluation for residual flow within the aneurysm is limited due to\nartifact. There is patent run-off of the anterior cerebral arteries.\n\nOtherwise, the vessels of the circle of ___ and their principal\nintracranial branches appear normal with no evidence of stenosis,\nocclusion,ornew aneurysm. The dural venous sinuses are patent.", + "output": "1. Status post coiling of a ruptured anterior communicating artery aneurysm. \nEvaluation for residual flow within the aneurysm is limited by artifact. \nHowever, patent distal run-off of the anterior cerebral arteries.\n2. Although artifact limits evaluation of the base of the brain, the\npreviously seen subarachnoid hemorrhage is not seen." + }, + { + "input": "There is no evidence of hemorrhage, edema, or mass. There is an old left\ncaudate head lacune, unchanged. There is no evidence recent infarction. The\nventricles and sulci are mildly prominent for the patient's age suggesting\nglobal atrophy. The basal cisterns are patent and there is preservation of\ngray-white matter differentiation.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable. There are\ncalcifications of the carotid siphons bilaterally.", + "output": "Old left caudate head infarction. No evidence of fracture, hemorrhage or\nrecent infarction.." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Chronic left caudate head lacunar\ninfarct is noted. Ventricles and sulci are unremarkable. Basilar cisterns\nare patent.\n\nPosterior parietal scalp hematoma is noted without underlying fracture. \nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are otherwise unremarkable.", + "output": "Posterior parietal scalp hematoma without underlying calvarial fracture or\nintracranial hemorrhage." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major infarction. Age related\ninvolutional changes are noted. Ventricles are stable in size. A chronic\nlacunar infarct is noted in the left caudate, unchanged. Imaged paranasal\nsinuses, mastoid air cells and middle ear cavities appear well aerated. \nVascular calcifications are present. No fracture. A subgaleal hematoma is\nnoted at the vertex.", + "output": "No acute hemorrhage or fracture. Chronic lacunar infarct in the left caudate.\nSubgaleal scalp hematoma at the vertex." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\n There is no evidence of acute large territorial infarction, intracranial\nhemorrhage, edema, or mass. There is a chronic appearing right cerebellar\ninfarct identified.\n\nThere is prominence of the ventricles and sulci suggestive of age-related\ncerebral volume loss. Periventricular and subcortical white matter\nhypodensities are nonspecific, though likely sequelae of chronic small vessel\nischemic disease.\n\nNo acute osseous abnormalities seen. The partially imaged paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The orbits demonstrate\nno acute abnormalities.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without flow limiting stenosis, occlusion, or aneurysm\nformation. The dural venous sinuses are patent.Atherosclerotic vascular\ncalcifications are noted of bilateral cavernous portions of internal carotid\narteries without significant stenosis.\n\nCTA NECK:\nThere is moderate calcification of the bilateral carotid bifurcations. The\ncarotid and vertebral arteries and their major branches appear normal with no\nevidence of stenosis or occlusion. By NASCET criteria, there is a 40 percent\nstenosis of the right ICA and a 40 percent stenosis of the left ICA.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No acute intracranial process.\nNo evidence of occlusion, flow-limiting stenosis, aneurysm, or dissection.\n2. 40% ICA stenosis bilaterally by NASCET criteria." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Minimal\nperiventricular and subcortical white matter hypodensities are nonspecific but\nlikely sequelae of chronic small vessel ischemic disease. The ventricles and\nsulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. A sclerotic focus within the clivus\nis unchanged since ___, likely a benign bone island.", + "output": "No evidence of intracranial hemorrhage or large territorial infarction." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass. The ventricles and sulci are enlarged suggesting age related\natrophy. Periventricular and white matter hypodensities are nonspecific but\nlikely sequela of chronic small vessel disease.\n\nThere is no evidence of fracture. There mucosal thickening in the bilateral\nmaxillary sinuses and ethmoid air cells. There is small amount of fluid in\nthe left sphenoid sinus. There are dense calcifications of the cavernous\ncarotid arteries bilaterally. The orbits are unremarkable.", + "output": "No acute intracranial abnormality on noncontrast head CT." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage, or\nmass. There is in region of hypodensity which does not appear to extend to\nthe cortex adjacent to the posterior horn of the right lateral ventricle\n(02:15). However, there does not appear to be any mass effect associated. \nThe sulci, ventricles and cisterns are within expected limits for the\npatient's age related global cerebral volume loss. Atherosclerotic vascular\ncalcifications are noted of bilateral vertebral and cavernous portions of\ninternal carotid arteries. Periventricular and subcortical white matter\nhypodensities are nonspecific, though likely sequelae of chronic small vessel\nischemic disease.\n\nThere is no evidence of acute fracture. There is opacification of the right\nposterior ethmoidal air cells and right sphenoid sinus without evidence of\nunderlying fracture. The visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear.", + "output": "1. No evidence of intracranial hemorrhage or fracture.\n2. Right parieto-occipital white matter hypodensity without mass effect, may\nrepresent white matter ischemic changes or other prior infarct, but underlying\nedema is not excluded. However, a mass with vasogenic edema cannot be\nexcluded and if clinical concern remains MRI may provide additional\ninformation.\n\nNOTIFICATION: Changes in initial preliminary read were discussed with ___,\nM.D. by ___, M.D. on the telephone on ___ at 6:39 pm, 5\nminutes after discovery of the findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass/mass effect. Punctate peripheral infarcts described on prior MRI are\nnot within the resolution of the current study. The ventricles and sulci are\nnormal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are essentially clear. The visualized portion of the orbits are\nunremarkable.\n\nCTA HEAD:\nThere is fetal origin of the right posterior cerebral artery. The left\nvertebral artery is dominant. The vessels of the circle of ___ and their\nprincipal intracranial branches appear normal without stenosis, occlusion, or\naneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe patient is status post T4 corpectomy with intervertebral spacer and\nposterior fusion with bilateral T3 and T5 lateral mass screws spanning the\nbilateral T3 and fusion rods. The left T5 lateral mass screw minimally skirts\nthe lateral edge of the spinal canal. The right T3 lateral mass screw\nterminates in the right paravertebral soft tissues (series 8, image 38). \nWithin the confines of CT examination, no evidence of hardware fracture. \nExpected postoperative changes are identified without evidence of large\nconfluent fluid collection in the prevertebral or paraspinal soft tissues.\n\nMultiple small lytic diffuse lesions throughout the visualized osseous\nstructures are compatible with given history of multiple myeloma. There is no\ncervical lymphadenopathy by size criteria. The visualized aerodigestive tract\nis unremarkable. The thyroid gland is unremarkable.\n\nMild posterior dependent atelectasis is identified in the visualized lung\napices. No concerning pulmonary nodules are identified.", + "output": "1. Allowing for common anatomic variations, unremarkable head and neck CTA.\n2. No acute intracranial abnormality on noncontrast head CT. Known punctate\nperipherally distributed infarcts described on prior MRI are too small to be\nvisualized on CT.\n3. Postsurgical changes from T4 with corpectomy and posterior fusion spanning\nT3 and T5 as described above." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of age-related involutional\nchanges.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "Normal study." + }, + { + "input": "There is no evidence of hemorrhage, infarction, edema,or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Mild mucosal thickening of the right\nmaxillary sinus. Partial opacification of the bilateral ethmoid air cells. \nSmall mucous retention cyst within the right sphenoid sinus. The visualized\nportion of the remaining paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Mild paranasal sinus inflammatory changes.\n2. Otherwise normal study." + }, + { + "input": "The patient is status post stent placement in the right cavernous and\nsupraclinoid internal carotid artery and in the left carotid canal and\ncavernous internal carotid artery. Again seen is enlargement of the left\ncavernous sinus. There is hyperdensity within the expanded cavernous sinus. \nAlthough difficult to compare across imaging modalities, the diameter of the\ncavernous aneurysm appears larger than on the study of ___.\n\n0.9 cm hypodensity in the left frontal lobe (02:16) may be sequela of old\ninfarct.\n\nThere is no evidence of other infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. 2.3 x 1.8 cm hyperdensity at the left cavernous sinus is consistent with\nknown left cavernous internal carotid artery aneurysm. Comparison is difficult\nbetween different modalities, however it measures slightly larger compared to\nprior MRI from ___ (previously 2.1 x 1.7 cm)." + }, + { + "input": "A stent in the right cavernous internal carotid artery extending into the\nsupraclinoid portion of the internal carotid artery is again demonstrated. \nAnother stent in the left petrous portion of the internal carotid artery\nextending through the cavernous left internal carotid artery is also\ndemonstrated. Expansion of the left cavernous internal carotid artery in\nprominence of the left ophthalmic vein is similar to the prior exam. The size\nof the aneurysm cannot be specifically measured on this exam. Hypodensity in\nthe right occipital and parietal lobe and left frontal lobe correspond to\nsubacute infarcts on the MRI from ___.\n\nNo evidence of other intracranial hemorrhage, mass-effect, or acute infarct.\n\nBilateral, mild symmetric prominence of the ventricles and sulci indicates\ncortical volume loss, unchanged.\n\nNo evidence of fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. Status post bilateral intracranial internal carotid arteries stents as\nabove with persistent and overall unchanged expansion of the left cavernous\nsinus from the known aneurysm, size incompletely evaluated on this\nnondedicated exam.\n2. No intracranial hemorrhage." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass effect. The ventricles and sulci are normal in size and configuration\nfor patient's age.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nright maxillary sinus. Otherwise, the remainder of the visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nThe visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormalities on noncontrast head CT.\n\n2. No acute calvarial fracture." + }, + { + "input": "There is minimal mucosal thickening of the right maxillary sinus and bilateral\nethmoid air cell. The paranasal sinuses are otherwise clear. There is an\naccessory left maxillary ostium. The ostiomeatal units are patent. There are\nbilateral concha bullosa with a right concha bullosa partial opacification\n(see 07:36). Bilateral Haller cells are seen. The cribriform plates are\nintact. The lamina papyracea are intact. There is sigmoid nasal septal\ndeviation.", + "output": "1. Paranasal sinus disease, as described.\n2. Bilateral concha bullosa.\n3. Bilateral Haller cells.\n4. Sigmoid nasal septal deviation." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nlarge territorial infarction. The ventricles and sulci are normal in size and\nconfiguration. The basal cisterns appear patent and there is preservation of\ngray-white matter differentiation.\n\nThe visualized bony structures are grossly unremarkable. The paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The globes are\nunremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute large territory infarct,hemorrhage,edema,ormass\neffect. The ventricles and sulci are within expected limits for the degree of\nmild senescent related global cerebral volume loss.\n\nDependent mucosal thickening in the bilateral maxillary sinuses and mild\nmucosal thickening of the ethmoid air cells is noted. The remainder the\nparanasal sinuses are essentially clear. The orbits are unremarkable. Trace\nopacification of the right mastoid tip. The remainder the mastoid air cells\nmiddle ears are clear. No suspicious osseous abnormality.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear unremarkable without stenosis, occlusion, or aneurysm, allowing for\ncommon normal anatomic variation such as fetal type origin of the right PCA. \nThe dural venous sinuses are patent.\n\nCTA NECK:\nMild atherosclerotic disease results in mild stenosis at the origins of the\nright brachiocephalic, bilateral subclavian and left vertebral artery, which\nare otherwise unremarkable to the level of the skull base. The bilateral\ncommon carotid and right vertebral arteries are unremarkable.\n\nThere is no evidence of internal carotid stenosis by NASCET criteria.\n\n\n\nOTHER:\nThe visualized portion of the lungs are clear allowing for respiratory motion\nartifact.. There is a 7 mm hypoattenuating left lobe nodule in a\nheterogeneous thyroid. There is no lymphadenopathy by CT size criteria. No\nsuspicious osseous lesions.", + "output": "1. No acute intracranial abnormality on noncontrast CT head. Specifically no\nacute large territory infarct or intracranial hemorrhage.\n2. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n3. Allowing for minimal atherosclerotic disease, patent bilateral cervical\ncarotid and vertebral arteries without evidence of stenosis, occlusion, or\ndissection.\n4. 7 mm hypoattenuating left lobe of the thyroid nodule. The thyroid is also\nslightly heterogeneous.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "NONCONTRAST HEAD CT:\nNo evidence of intracranial hemorrhage, acute large territorial infarction,\nedema, or mass. Mild mucosal thickening the bilateral maxillary sinuses and\nbilateral ethmoid air cells. The remainder of the paranasal sinuses are clear.\n\nCT BRAIN PERFUSION:\nThere is suspicion of decreased cerebral blood flow and volume in the left\noccipital region (1330:12 and 1329:12). However, given the inferior\nsensitivity of CT perfusion these findings are not as well seen as on the\nprevious ASL perfusion.", + "output": "Normal noncontrast head CT without acute abnormalities. Normal CT perfusion. \nWhile there is suspicion for decreased perfusion in the left occipital lobe\nthe findings are not as well seen as on the previous ASL. As suggested\npreviously a follow-up ASL examination is recommended in 1 week to see if\nthere is resolution." + }, + { + "input": "There is no evidence of acute large vascular territory infarction, hemorrhage,\nor edema. The ventricles and sulci are normal in size and configuration.\n\nLarge right frontotemporal subgaleal hematoma with overlying skin staples are\nidentified. No underlying fracture is seen. Otherwise, no evidence of acute\nfracture. The visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavitiesare essentially clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Large right frontotemporal subgaleal hematoma with overlying skin staples. \nNo evidence of an underlying fracture." + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass. The ventricles and sulci are normal in size and configuration.\n\nComminuted nasal bone fractures are noted bilaterally (3:7). Detailed facial\nbone assessment is better characterized on the concurrently obtained facial\nCT. Mucosal thickening is noted in the bilateral maxillary sinuses, ethmoid\nair cells, sphenoid sinuses. The frontal sinuses are underpneumatized. The\nmastoid air cells and middle ear cavities are grossly clear. The orbits are\nunremarkable.", + "output": "1. No acute intracranial pathology.\n2. Comminuted nasal bone fractures. Detailed assessment of the facial bones\nis provided in the concurrently obtained CT of the face." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. There\nis prominence of the ventricles and sulci suggestive of involutional changes.\nThere are areas of periventricular and subcortical white matter\nhypoattenuation that are nonspecific but most likely represent chronic small\nvessel disease. Calcifications are seen at the bilateral cavernous carotid\narteries.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "No evidence of acute intracranial hemorrhage, mass, or large territory\ninfarct." + }, + { + "input": "There is a new area of hypodensity in the right thalamus (2:15), measuring\napproximately 3 x 4 mm in transverse dimension, with no evidence of mass\neffect, probably consistent with lacunar ischemic change.\n\nUnchanged calcification in the left parietal lobe towards the convexity series\n2 image 21, could represent vascular calcification versus granuloma.\n\nUnchanged areas of hypodensity in the bilateral periventricular and\nsubcortical white, which are nonspecific and may reflect changes due to\nchronic small vessel disease.\n\nBilateral calcifications in the carotid siphons.\n\nThere is no evidence of fracture, hemorrhage, edema or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, middle ear\ncavities are clear. The visualized portion the orbits are normal", + "output": "1. New area hypoattenuation in the right thalamus, may represent area of small\nlacunar infarct, if there is any clinical concern related with acute or\nsubacute ischemic changes, correlation with MRI of the brain is advised.\n2. Unchanged punctate calcification in the left parietal lobe, probably\nconsistent with vascular calcification versus granuloma.\n3. Unchanged areas of low-density in subcortical and periventricular white\nmatter bilaterally which are nonspecific and may reflect changes due to\nchronic small vessel disease." + }, + { + "input": "CTA HEAD: There is luminal irregularity of the distal P1 and proximal P2\nsegments of the right posterior cerebral artery suggestive of nonocclusive\natheromatous plaque (series 2, images 210-212). There is no stenosis or\ncomplete occlusion in the remainder of the anterior and posterior circulation.\nThere is no evidence of aneurysm or vascular malformation. The dural venous\nsinuses are widely patent.\n\nCTA NECK: There is common origin of the left common carotid artery and\ninnominate artery. The common carotid arteries are widely patent. There is\ndiffuse atherosclerosis involving the intracranial internal carotid arteries,\nbut no stenosis by NASCET criteria. There is focal atherosclerosis of the V4\nsegment of the left vertebral artery, after which point there is mild\nshort-segment narrowing of this artery to its junction with the basilar\nartery. There is no significant stenosis in the vertebrobasilar system.\n\nOTHER: The left lobe of the thyroid gland is expanded by numerous mixed\ncystic/solid nodules which have previously been characterized on thyroid\nultrasound ___ and appear unchanged when accounting for\ndifferences between modalities. There are no pathologically enlarged,\nabnormally configured or necrotic lymph nodes. No mucosal abnormality is\nidentified in the neck. There is no soft tissue abnormality in the remainder\nof the neck.\n\nNo aggressive osseous lesion is identified. No suspicious nodules identified\non limited visualization of the lung apices.", + "output": "1. Likely nonocclusive atheromatous plaque involving the distal P1 and\nproximal P2 segments of the right posterior cerebral artery, but no\nsignificant arterial stenosis or complete occlusion in the head.\n2. No significant arterial stenosis in the neck.\n3. Stable appearance of multiple mixed cystic/solid nodules within the left\nlobe of the thyroid gland as compared to ultrasound ___." + }, + { + "input": "The exam is limited by patient motion. There is a hyperdense subdural\nhematoma along the right tentorial leaflet measuring 5 mm in greatest\nthickness, similar to prior (601:70). Hyperdense blood products are also\nagain noted along the posterior falx measuring up to 3 mm, unchanged from\nprior. There is no evidence of infarction. No midline shift. There is\nprominence of the ventricles and sulci compatible with age related\ninvolutional change.\n\nA 3.3 cm left frontal scalp hematoma is slightly smaller from prior when it\nmeasured 3.9 cm. There is no underlying fracture. There is fluid in the left\ngreater than right maxillary sinuses with minimal mucosal thickening in the\nethmoid air cells. There is partial opacification of the bilateral mastoid\nair cells. The middle ear cavities are clear. Visualized orbits are\nunremarkable.", + "output": "1. Limited exam due to motion.\n2. Right tentorial subdural hematoma. The overall size is stable from prior.\n3. Interval decrease in size of a right frontal scalp hematoma.\n4. Paranasal sinus inflammatory disease and partial mastoid air cell\nopacification." + }, + { + "input": "No evidence of acute major infarction or hemorrhage. Previously noted right\nsubdural hematoma has resolved. There is no edema or mass effect. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nMinimal residual forehead scalp hematoma noted. There is no underlying\nfracture. Opacification of mastoid cells and middle ears are again seen. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial findings. Interval resolution of previously detected\nright subdural hematoma.\n2. Small residual scalp hematoma at the forehead." + }, + { + "input": "A right frontal approach external ventricular drain there is re-demonstration\nof an interventricular hemorrhage involving the bilateral of ventricles (left\ngreater than right), third ventricle, cerebral aqueduct, and fourth ventricle\n(with some extension into the foraminal Luschka bilaterally). There is similar\ndegree of blood layering in the occipital horns of the lateral ventricles. \nThis is likely interventricular extension from a intraparenchymal hemorrhage\ncentered in the left internal capsule, demonstrating surrounding vasogenic\nedema. In addition, there is stable subarachnoid hemorrhage in the bilateral\nposterior sylvian fissures dependently (02:18, 602:70/24) there is no evidence\nof acute territorial infarction,new areas of hemorrhage,worsening edema,or\nmass. The sulci and basilar cisterns are patent and similar in configuration\nto prior.\n\nThere is slight decrease in right frontal pneumocephalus. There is increased\nsubcutaneous air and edema along the right frontoparietal scalp (02:23).\n\nThere is no evidence of fracture. Soft tissue densities in the bilateral ear\ncanals likely impacted cerumen. There is similar mucosal thickening of the\nparanasal sinuses. There is partial opacification of the bilateral mastoid\nair cells which can be seen in prolonged inpatient setting. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Similar volume left subcortical intraparenchymal hemorrhage with\nintraventricular and subarachnoid extension as detailed above. No new areas\nof hemorrhage or acute territorial infarcts.\n2. Decreased ventricular size.\n3. Slight interval decrease in right frontal pneumocephalus with interval\nincrease in right subcutaneous air/edema." + }, + { + "input": "Again seen is a right frontal approach external ventricular drain terminating\nnear right foramina ___. Right lateral ventricle is decompressed and\nnearly slit-like, more decompressed compared with ___ at 06:49.\nVolume of hemorrhage within left lateral ventricle third ventricle and fourth\nventricle is similar, no definite interval hemorrhage. Periventricular\nparenchymal bleed and mild edema is similar, without enlargement, involving\nupper and anterior left thalamus, extending to the level of the foramina\n___. Left lateral ventricle is more dilated today compared with ___ at 06:49, left temporal horn measures 8 mm today, compared with 6 mm on\nprior. There is 0.8 cm left-to-right midline shift at the level of the\nanterior septum pellucidum of the frontal horns, compared with 0.5 cm on\nprior.\nStable subarachnoid hemorrhage is similar. Decreased size of third ventricle.\nMild chronic bilateral perimesencephalic cisterns, no frank uncal herniation. \nMild effacement of prepontine cistern. Patent foramina magnum.\n\nThere is no evidence of new infarction,. There is unchanged mucosal thickening\nof the paranasal sinuses. There is partial opacification of the bilateral\nmastoid air cells. The visualized portions of the orbits are unremarkable. \nPostoperative changes, edema, fluid, the soft tissues scalp is more prominent.", + "output": "1. Interval more prominent dilatation of the left lateral ventricle, with\nworsened left to right midline shift measuring 0.8 cm at the level of the\nfrontal horns.\n2. Decompressed right lateral ventricle.\n3. Stable intraventricular, intracranial hemorrhage. No new hemorrhage.\n\nNOTIFICATION: The findings were discussed with ___, M.D.\nby ___, M.D. on the telephone on ___ at 11:24 am, 5\nminutes after discovery of the findings." + }, + { + "input": "New from prior is trace acute blood products adjacent to the right frontal\napproach ventriculostomy catheter (03:18). Again demonstrated is an\nintraparenchymal hemorrhage centered in the left basal ganglia with extension\ninto the left lateral ventricle. There is a similar amount of blood in the\nanterior and posterior horn of the left lateral, third and fourth ventricles. \nTrace subarachnoid hemorrhage is unchanged. A right frontal approach\nventriculostomy catheter terminates near the foramen ___ in unchanged\nposition. The right lateral ventricle is slightly increased in size from 2\ndays prior, but the left lateral ventricle is unchanged in size. There is no\nsignificant midline shift. Hypodensity in the right thalamus/posterior limb\nof the internal capsule has become progressively more apparent since ___, possibly reflecting a subacute lacunar infarct (for example 03:13).\n\nBurr-hole from right frontal approach ventriculostomy is noted. Appearance of\nthe paranasal sinuses is unchanged. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Trace intraparenchymal hemorrhage along the right frontal approach\nventriculostomy catheter is new from 2 days prior.\n2. Unchanged left basal ganglia intraparenchymal and intraventricular\nhemorrhage.\n3. Slight re-expansion of the right lateral ventricle with stable size of the\nleft lateral ventricle.\n4. Probable subacute right thalamus/internal capsule lacunar infarct given\nprogression in comparison with ___.\n\nNOTIFICATION: The findings were discussed with the ___ care NP by\n___, M.D. on the telephone on ___ at 5:38 pm, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "Again seen is a right frontal approach ventriculostomy catheter that\nterminates near the foramina ___ and is unchanged in position. There is\nno change in ventricular caliber.\nThere is no change in intraparenchymal and intraventricular hemorrhage. As\ncompared to the prior exam there is no evidence of new hemorrhage or\ninfarction. There is no significant midline shift. Re-demonstrated is a\nhypodensity in the region of the right posterior limb of the internal capsule\nwhich may reflect a subacute lacunar infarct.\n\nPostsurgical changes are noted within the right frontal calvarium. The\nvisualized portions of the paranasal sinuses are clear. The visualized\nportions of the orbits are unremarkable.", + "output": "1. No evidence of new hemorrhage or infarction.\n2. The size of the ventricles is unchanged as compared to the prior exam." + }, + { + "input": "Again seen is a right frontal approach ventriculostomy catheter, terminating\nat the foramen of ___. Interventricular hemorrhage is decreased from\nprior, now with residual hemorrhage only in the anterior lobe of the left\nlateral ventricle. Degree of rightward midline shift is decreased, now\nmeasuring 2 mm, most recently 3 mm. No evidence of new hemorrhage, edema or\nevidence of infarction. Ventricles are unchanged in size from prior. The\nimaged paranasal sinuses are essentially clear. Mastoid air cells and middle\near cavities are well aerated.", + "output": "Interval decrease in extent of left intraventricular hemorrhage, with\ndecreased rightward midline shift, and stable size of the ventricles." + }, + { + "input": "Re-demonstration of the known right frontal approach ventriculostomy catheter,\nwhich terminates at the foramen of ___, unchanged in position. \nIntraventricular hemorrhage is slightly decreased from the prior study, with\nresidual hemorrhage in the anterior horn of the left lateral ventricle. There\nis minimal, if any, rightward shift of normally midline structures, decreased\nfrom the prior study. No evidence of new hemorrhage, edema, or infarction. \nThe ventricles and sulci are stable in configuration compared with the prior\nstudy.\n\nThere is mild mucosal thickening in the right maxillary sinus. The visualized\nportion of the remaining paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Compared with the prior CT, slight interval decrease in the amount of\nresidual intraventricular hemorrhage in the anterior horn of the left lateral\nventricle.\n\n2. Minimal, if any, rightward shift of normally midline structures, also\ndecreased from the prior study.\n\n3. No evidence of new hemorrhage." + }, + { + "input": "Compared to ___, no change in the size of the ventricles.\n\nThere is an unchanged right frontal approach ventriculostomy catheter with tip\nin the right lateral ventricle, near the foramina of ___. There is\nunchanged hyperdense intraventricular hemorrhage in the anterior horn of the\nleft lateral ventricle. Minimal left subarachnoid hemorrhage is\nre-demonstrated. No evidence of midline shift. The basal cisterns are\npatent.\n\nThere is no evidence of acute large territorial infarction, edema, or mass. \nNo evidence of new hemorrhage.\n\nNo osseous abnormalities seen. Again seen is minimal mucosal thickening of\nthe right maxillary sinus. There is a partially visualized nasogastric tube. \nOtherwise, the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The orbits are unremarkable.", + "output": "1. Compared to ___, unchanged ventricular size.\n2. Unchanged intraventricular hemorrhage in the anterior horn of the left\nlateral ventricle. Minimal left subarachnoid hemorrhage, similar to previous.\n3. No evidence of midline shift." + }, + { + "input": "Since the prior study performed on ___, the right frontal\napproach ventriculostomy catheter has been removed in the interim. Trace\nblood products are seen adjacent to the catheter tract (series 2, images 22\nand 23).\n\nIntraventricular hemorrhage within the frontal horn of the left lateral\nventricle measures approximately 1.7 x 1.2 cm (02:18), similar to the prior\nstudy. There may be very trace residual hemorrhage layering within the\noccipital horn of the left lateral ventricle (02:15). Continued evolution of\ntrace left parieto-occipital subarachnoid hemorrhage (02:18). No new\nhemorrhage identified. No significant shift of midline structures.\n\nNo evidence of acute major vascular territorial infarction, edema, or defect. \nVentricles and sulci are unchanged in size and configuration. Other than the\nright frontal burr hole, there is no acute fracture. Mild mucosal thickening\nis noted in the right maxillary and left sphenoid sinuses. Remainder of the\nvisualized paranasal sinuses, mastoid air cells and middle ear cavities clear.\nUnchanged partial opacification of underpneumatized right mastoid air cells. \nPatchy nodular soft tissue densities in the right greater than left external\nauditory canals likely represent cerumen. The orbits are unremarkable in\nappearance. Partially imaged nasogastric tube.\n\nEvaluation of the soft tissues is notable for right frontal scalp edema and\nsubcutaneous emphysema adjacent to the prior catheter entry site.", + "output": "1. Interval removal of the right frontal approach ventriculostomy catheter,\nwith trace hemorrhage adjacent to the catheter tract. Unchanged ventricular\nconfiguration. No ventriculomegaly identified.\n2. No significant interval change in left intraventricular and subarachnoid\nhemorrhage. No new hemorrhage.\n3. Additional findings as described above." + }, + { + "input": "Compared to 12:40, no significant change. Again seen is intraventricular\nhemorrhage within the frontal horn of the left lateral ventricle, measuring\n1.5 x 1.1 cm (___). No evidence of midline shift. Basal cisterns are\npatent. Previously seen subarachnoid hemorrhage along the left parietal lobe\nis less conspicuous on this study. Again seen is a tract from prior right\nfrontal approach ventriculostomy catheter. There is associated subcutaneous\nedema and right frontal scalp edema\n\nThere is no evidence of acute large territorial infarction, edema, or mass. \nApart from the above, the ventricles and sulci are normal in size and\nconfiguration.\n\nNo osseous abnormalities seen. There is minimal mucosal thickening of some\nanterior ethmoidal air cells. Otherwise, the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. Cerumen is noted in the bilateral\nexternal auditory canals. The orbits are unremarkable.", + "output": "1. Compared to 12:40, no significant change. No new or enlarging hemorrhage. \nNo evidence of hydrocephalus.\n2. There is unchanged intraventricular hemorrhage within the frontal and of\nthe left lateral ventricle and continued evolution of previously seen\nsubarachnoid hemorrhage along the left parietal lobe." + }, + { + "input": "Re-demonstration of left intraventricular hemorrhage in the frontal horn\nmeasuring 1.5 x 1.0 cm similar to prior. However there is a new foci of air\nwithin the frontal horn of the left lateral ventricle. No new foci of\nhemorrhage is noted. No evidence of midline shift. Basal cisterns are again\npatent. There is again interval evolution of the subarachnoid hemorrhage seen\nalong the left parietal lobe which is not well seen on current study. The\ntract from prior right frontal approach ventriculostomy catheter is again\nnoted with skin staples. Associated subcutaneous and frontal scalp edema is\nsimilar to prior.\n\nNo evidence of large vascular territory infarction. The ventricles and sulci\nare unchanged in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. New foci of air is noted in the left frontal horn, unclear in etiology,\ncorrelate clinically.\n2. Re-demonstration of left intraventricular hemorrhage in the left frontal\nhorn. No new foci of hemorrhage. Interval evolution of subarachnoid\nhemorrhage along the left parietal lobe sulci." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is interval decompression of the ventricles status post ventriculostomy\ncatheter placement. The volume of intraventricular blood products and acute\nblood products within the medial nucleus of the left thalamus are not\nappreciably changed. There is some interval redistribution to the\nsubarachnoid spaces overlying the bilateral cerebral hemispheres.\n\nThere is no large acute infarct, midline shift, or herniation.\n\nFluid within the posterior nasal cavity, nasopharynx, and oropharynx is likely\nrelated to endotracheal intubation.\n\nThere is erosion of left mandibular second molar tooth and an associated\nperiapical lucency. There is mild mucosal thickening within the maxillary\nsinuses. There is trace fluid within the right mastoid air cells. The middle\near cavities and left mastoid air cells are clear.\n\nThere is no displaced calvarial or facial fracture.\n\nCTA HEAD:\nThere is diffuse narrowing of the intracranial internal carotid arteries from\nthe vertical petrous segment to the ICA terminus. The vessels of the circle\n___ major branches are also narrow, with some areas of more focal\nnarrowing, for example the proximal right M1 segment. The degree of narrowing\nis difficult to assess due to the diffusely small vessel caliber, however\nappears at least moderate in severity in some areas. The intracranial\nvertebral arteries and basilar artery also appear narrowed.\n\nNo large vessel occlusion. No aneurysm or high-flow vascular malformation is\nidentified on this exam.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Interval placement of a right frontal approach ventriculostomy catheter and\ndecompression of the ventricles. The volume of acute blood products within\nthe medial nucleus of the left thalamus and within the ventricular system is\nnot appreciably changed.\n2. No high-flow vascular malformation is identified. Please note that a\nvascular malformation could be compressed by the thalamic and intraventricular\nhemorrhage and therefore occult on this exam.\n3. Diffuse narrowing of the intracranial circulation, with some areas of at\nleast moderate focal narrowing, for example the proximal left M1 segment. \nThis is likely secondary to a small to medium size vascular process, possibly\nvasospasm secondary to subarachnoid hemorrhage and/or secondary to increased\nintracranial pressure or a small to medium size vessel vasculopathy or\nvasculitis.\n4. Dental disease. Recommend nonemergent dental consultation." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or infarction.\nProminent ventricles and sulci are consistent with age related involutional\nchanges. The basal cisterns appear patent and there is preservation of\ngray-white matter differentiation.\n\nNo fracture is identified. Mucosal thickening is seen in the ethmoid air\ncells. Otherwise the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The globes are unremarkable. Dense vascular\natherosclerotic calcifications are present in the carotid siphons bilaterally.", + "output": "No acute intracranial process. No significant changes since the prior head CT\ndated ___." + }, + { + "input": "There is no acute intracranial hemorrhage, edema, mass effect, or evidence of\nlarge vascular territorial infarction. The ventricles and sulci are\nprominent, suggesting age related involutional changes. Periventricular white\nmatter hypodensities are compatible with chronic small vessel ischemic\ndisease. There is preservation of grey-white matter differentiation and the\nbasal cisterns are patent.\n\nThere is no fracture. With the exception of a small mucous retention cyst in\nthe left maxillary sinus, the imaged paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territorial infarct. Prominence of the\nventricles and sulci is consistent with atrophy. Periventricular and\nsubcortical white matter hypodensities are likely sequelae of chronic small\nvessel disease. The visualized paranasal sinuses are clear. The mastoid air\ncells are clear. No acute fracture is seen. Staples are noted in the\nposterior scalp.", + "output": "No acute intracranial process." + }, + { + "input": "There is subtle increased attenuation of the cerebellum relative to the\ncerebral hemispheres. There is no intra-axial or extra-axial hemorrhage or\nshift of normally midline structures. Ventricles and sulci are normal in\noverall size and configuration. The imaged paranasal sinuses are clear.\nMastoid air cells and middle ear cavities are well aerated. The bony calvarium\nis intact.", + "output": "There is no evidence of acute intracranial hemorrhage. Subtle increased\nattenuation of the cerebellum relative to the cerebral hemispheres concerning\nfor edema/hypoxic brain injury.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 6:21 am, 1 minutes\nafter discovery of the findings." + }, + { + "input": "CTA HEAD:\nThere is no opacification of the circle of ___ and major intracranial\nbranches. Diffuse cerebral edema. Complete loss of gray-white matter\ndifferentiation over bilateral cerebral hemispheres, basal ganglia, thalami,\nconsistent with diffuse anoxic injury. There is some preservation of\ngray-white matter junction at the cerebellum. There is near complete\neffacement of the cerebral sulci, especially near the vertex. Partial\neffacement of the ambient and quadrigeminal cisterns. Dural venous sinuses\nare not opacified with contrast.\n\nCTA NECK:\nStandard 3 vessel aortic arch. There is opacification of the common carotid\nand internal carotid arteries to the level of C2 with transition to diminished\nopacification at the level of the skullbase.\n\nThere is opacification of the origins of the vertebral arteries with\nprogressive transition to diminished opacification throughout the cervical\nportions, worse on the right.\n\nOTHER:\nEndotracheal tube terminates in the midthoracic trachea. Aerosolized\nsecretions within the trachea. Enteric tube is partially visualized. \nEsophagus is patulous and contains debris.\n\nPatchy opacities superior segments of the lower lobes, likely due to\naspiration given debris in esophagus. Mild opacities bilateral lower lobes,\nappears centrilobular, consider infection, aspiration. No lymphadenopathy.", + "output": "1. Absence of intracranial flow. New diffuse cerebral edema, loss of\ncortical, deep nuclei gray-white matter differentiation. Findings consistent\nwith diffuse anoxic injury. Consider MRI brain or nuclear medicine study.\n2. Consider bilateral lower lobe aspiration or infection.\n3. Distended proximal cervical esophagus." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\n\nThe ventricles appear normal. There is no evidence for large acute\ninfarction. There is no acute intracranial hemorrhage or mass effect.\n\nThere are postoperative changes for left functional endoscopic sinus surgery. \nThere is minimal mucosal thickening within left frontal sinus and recess.\n\nCTA HEAD:\n\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\n\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\n\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No emergent large vessel occlusion. No acute intracranial hemorrhage or\nevidence for large acute infarction.\n2. Normal CTA head neck." + }, + { + "input": "Examination is mildly degraded by motion and streak artifact.\n\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. Mild prominence\nof the ventricles and sulci is suggestive of involutional changes. Multiple\nhypodensities in the subcortical and periventricular white matter are\nnonspecific but likely represent chronic small vessel ischemic disease.\n\nThere is mild opacification of the bilateral ethmoid sinuses. There is\ncomplete opacification of the right sphenoid sinus with irregular punctate\nhyperdensities. The mastoid air cells and middle ear are clear. The\nintraorbital contents are unremarkable.\n\nCT PERFUSION:\nThe CBF <30% volume is 0 mL. The T-max >6.0 seconds volume is 0 mL. There is\nno mismatch volume. The T-max >4.0 seconds is 25 mL corresponding to areas in\nthe bilateral parietal and occipital lobes. Otherwise, no perfusion\nabnormalities are identified to suggest acute ischemic changes.\n\nCTA HEAD:\nThere are mild atherosclerotic calcifications of the parasellar internal\ncarotid arteries. Otherwise, the vessels of the circle of ___ and their\nprincipal intracranial branches appear normal without stenosis, occlusion, or\naneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is standard 3 vessel aortic arch anatomy. There are mild\natherosclerotic calcifications of the right common carotid artery bifurcation\nand proximal right internal carotid artery with approximately 20% stenosis. \nOtherwise, the carotidandvertebral arteries and their major branches appear\nnormal with no evidence of stenosis or occlusion. There is no evidence of\ninternal carotid stenosis by NASCET criteria.\n\nOTHER:\nRespiratory motion limits evaluation of the lung parenchyma. Within\nlimitations, no suspicious pulmonary nodules are evident. The thyroid is\nunremarkable. There is no lymphadenopathy by CT size criteria.\n\nBone windows demonstrate multilevel degenerative changes of the cervical spine\nwith intervertebral disc height loss, hypertrophic in cystic endplate changes,\npredominately of the lower cervical spine.", + "output": "1. Examination is mildly degraded by motion and streak artifact.\n2. No evidence of infarction or hemorrhage.\n3. Mild atherosclerotic calcifications of the parasellar internal carotid\nthere is. Otherwise, patent circle of ___ with no stenosis or aneurysm\nformation.\n4. No areas of T-max greater than 6 seconds. 25 mL of bilateral occipital and\nposterior parietal lobe T-max greater than 4 seconds.\n5. Approximately 20% stenosis of the proximal right internal carotid artery. \nOtherwise, patent neck vasculature." + }, + { + "input": "There is a moderate-sized subgaleal hematoma overlying the right occipital\nbone. There is no evidence of underlying fracture.\n\nThere is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. Mild subcortical and deep white matter hypodensities are nonspecific,\nbut likely represent the sequela of chronic microvascular ischemia. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nMinimal mucosal thickening within the medial right maxillary sinus. \nOtherwise, the visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Moderate-sized severely hematoma overlying the right occipital bone without\nevidence of underlying fracture or intracranial hemorrhage.\n2. Prominent age-related involutional changes.\n3. Subtle thickening of the anterior falx (02:15 and 601:29) appears to be due\nto dural calcification." + }, + { + "input": "There is no evidence of infarction, intracranial hemorrhage hemorrhage, edema,\nor mass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Right-sided\nparietal subgaleal hematoma with scalp laceration and subcutaneous foci of air\nis demonstrated. The visualized portion of the orbits are unremarkable.", + "output": "1. No evidence of intracranial hemorrhage or fracture.\n\n2. Right parietal subgaleal hematoma.\n\nNOTIFICATION: The above findings were communicated in person by Dr. ___\nto Dr. ___ team) at 07:46 on ___, immediately after\ndiscovery." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Normal head and neck CTA." + }, + { + "input": "There is diffuse loss of sulcation and loss of gray-white matter\ndifferentiation, which is concerning for global anoxic brain injury. The\nbrain parenchyma appears hypodense throughout, consistent with diffuse brain\nedema. There is relative ___ of the falx, tentorium, circle ___,\nand subarachnoid spaces. Given this relative ___, subarachnoid\nhemorrhage cannot entirely be excluded, please note that there is residual\ncontrast from prior neck CT examination performed on ___. The\nventricles have decreased in size compared to the head CT dated ___. There is also a new effacement of the suprasellar and quadrigeminal\nplate cisterns.\n\nThere is no evidence of fracture. High-density material with mucosal\nthickening within the left maxillary sinus, likely due to chronic sinusitis\nand inspissated secretions given the sclerosis of the adjacent maxillary sinus\nwalls. Otherwise, the visualized portion of the paranasal sinuses, and middle\near cavities are clear. Partial opacification of the mastoid air cells\nbilaterally. The visualized portion of the orbits are unremarkable.", + "output": "Diffuse loss of sulcation, effacement of the CSF spaces, and loss of\ngray-white matter differentiation, new compared to the CT dated ___, compatible with global anoxic brain injury. Hypodense brain parenchyma,\ncompatible with diffuse brain edema. The extra-axial spaces appear relatively\nhyperdense, and a small amount of subarachnoid hemorrhage cannot entirely be\nexcluded, there is residual contrast from prior CT of the neck. MRI can be\nconsidered for confirmation.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 3:51 am, 5 minutes\nafter discovery of the findings." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is soft tissue swelling overlying the right frontal bone without\nevidence of underlying fracture. There is no evidence of acute fracture. Few\nmucous retention cysts are noted in the maxillary and sphenoid sinuses. There\nis mild mucosal thickening of the ethmoidal air cells. The visualized portion\nof the mastoid air cells and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of acute intracranial process.\n2. Soft tissue swelling over the right frontal bone without evidence of\nunderlying fracture.\n3. Findings consistent with sinus disease." + }, + { + "input": "Evaluation is mildly limited by motion. Mixed density right frontal subdural\nhematoma measures 5 mm maximally, previously 6 mm on examination earlier\ntoday. No new hemorrhage. No midline shift. The ventricles and sulci are\nprominent consistent with involutional changes, stable in size and\nconfiguration from prior. Periventricular white matter hypodensities are\nnonspecific and suggest chronic small vessel ischemic changes. No evidence of\nacute large territorial infarct.\n\nNo acute fracture is seen. Two right frontal calvarial burr holes are\nre-demonstrated. There is mild mucosal thickening of the ethmoid sinuses. \nThe remaining paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The orbits are unremarkable.", + "output": "1. Stable 5 mm right frontal subdural hematoma.\n2. No new hemorrhage. No midline shift." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is a metallic stent graft in the petrous segment of the left internal\ncarotid artery with contrast opacification of the lumen suggesting luminal\npatency. There is mild-to-moderate atherosclerosis involving bilateral\ncavernous carotid arteries. There is mild atherosclerosis involving the V4\nsegment of the left vertebral artery.\n\nThe vessels of the circle of ___ and their principal intracranial branches\nappear otherwise unremarkable without stenosis, occlusion or aneurysm\nformation. The dural venous sinuses are patent.\n\nIncidentally seen is heights are termination of the right vertebral artery\nwith dominant left vertebral artery.\n\nCTA NECK:\nThere is metallic stent graft in the left common carotid artery extending into\nthe left internal carotid artery with contrast opacification of the lumen\nsuggesting patency of the stent. The carotid and vertebral arteries and\ntheir major branches appear normal with no evidence of stenosis or occlusion.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Stent in the left common carotid artery extending into the left internal\ncarotid artery as well as a stent in the petrous segment of the left internal\ncarotid artery with contrast opacification of the lumen suggesting luminal\npatency.\n2. Otherwise, unremarkable CTA of the head and neck noting mild\natherosclerosis.\n3. No acute intracranial abnormality." + }, + { + "input": "CT head:\nThere is focal hypodensity at the left aspect of the splenium (02:18), which\nis unchanged comparison to prior study and corresponds to the site of\nsuspected subacute infarction. Otherwise the gray-white matter\ndifferentiation is intact without CT evidence of new acute territorial\ninfarct, hemorrhage, mass, or mass effect. There is a nonspecific\nperiventricular white matter hypodensity likely reflecting sequela of chronic\nmicroangiopathy. There is mild prominence of the ventricles and cortical\nsulci. The extra-axial spaces are unremarkable. The orbits, soft tissues,\nand calvarium are unremarkable. The paranasal sinuses and mastoid air cells\nare clear.\n\nCTA head: There is a stent within the left petrous segment internal carotid\nartery with kink at the genu causing mild luminal narrowing which is unchanged\ncomparison to prior study. There is calcific atherosclerosis of the bilateral\nintracranial internal carotid arteries. The anterior communicating artery is\nvisualized. The bilateral posterior communicating arteries are not\ndefinitively seen. There is a hypoplastic left A1 segment. There is a left\ndominant vertebral artery with the right vertebral artery terminating in the\nposterior inferior cerebellar artery. There is a 2 mm segmental severe\nstenosis at the left P4 segment posterior cerebral artery (601:20), with\ndistal filling of the parieto-occipital artery either across a stenosis or a\nvia distal collaterals. This is relatively unchanged comparison to prior\nstudy.\n\nThe remainder of the anterior posterior circulations are patent without\nocclusion, dissection, or aneurysm. There is no evidence of vascular\nmalformation. The dural venous sinuses are patent.\n\nCTA neck: There is a 3 vessel aortic arch. There is atherosclerosis of the\naortic arch without significant stenosis. The right carotid artery is patent\nwithout significant stenosis by NASCET criteria. There is a stent within the\nleft carotid artery extending from the superior common to the post bulbar\ninternal carotid artery. There is focal hypodensity at the mid posterior\naspect of the stent measuring approximately 1 mm causing approximately 33%\nstenosis (4:170). This is mildly more prominent comparison to prior study. \nThere is an additional focal hypodensity at the posterior aspect of the\ninferior stent measuring 1 mm or (4:173), which is relatively unchanged is not\ncausing significant stenosis. There is a subintimal ulcer at the posterior\nmedial aspect of the proximal left external carotid artery measuring 2 mm in\nwidth and depth (4:180), which is relatively unchanged comparison to prior\nstudy. The vertebral arteries are patent and demonstrate left dominance. \nThere is moderate to severe stenosis at the right vertebral artery origin\n(___).\n\nThe pharynx, larynx, nasal cavity, and oral cavities are unremarkable. There\nis streak artifact secondary to dental mg which obscures adjacent structures,\notherwise the dentition is intact. There is fat atrophy of the salivary\nglands. The thyroid gland is atrophic. There is a comminuted fragmented\nappearance of the medial right clavicle (4:86) which is unchanged comparison\n___. There is adjacent soft tissue stranding which may represent\npost radiation change versus hematoma. There is stranding throughout the neck\nsubcutaneous soft tissue, right greater than left, consistent with\npostradiation change.\nThere multilevel degenerative changes of the cervical spine. There is\npulmonary parenchymal scarring marginating the superior mediastinum which may\nrepresent postradiation changes.\n\nCT perfusion: There is geographic elevated mean transit time within the left\nparieto-occipital cortex without associated significant focal decrease in\ncerebral blood volume or flow to suggest an underlying core infarct.", + "output": "1. Short segment severe stenosis at the left P4 segment posterior cerebral\nartery with filling of the distal parieto-occipital artery either across a\nstenosis or via collaterals. There is associated geographic area of increased\nmean transit time within the parieto-occipital cortex consistent with slow\nflow to the cortex supplied by the parieto-occipital artery. No definitive\nunderlying core infarct on cerebral blood flow or blood volume. No associated\nhemorrhage.\n2. Unchanged focal hypodensity at the left splenium corpus callosum consistent\nwith site of subacute infarction.\n3. Patent left P2 segment internal carotid artery stent.\n4. Small focal filling defects within the common to bulb carotid stent which\nmay represent intimal thickening versus thrombus. The upper filling defect\nappears mildly enlarged in comparison to prior study.\n5. Unchanged ulceration at the proximal left external carotid artery.\n6. Comminuted right medial clavicle fragment with adjacent stranding which is\nunchanged comparison to ___ which may represent a subacute to\nchronic fracture possibly secondary to osteonecrosis given history of\nradiation.\n7. Radiation changes within the neck including fatty atrophy of the salivary\nglands, atrophic thyroid, and stranding throughout the subcutaneous soft\ntissues.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 8:55 AM, 15 minutes after discovery of\nthe findings." + }, + { + "input": "Again identified is a focal hypodensity within the left aspect of the splenium\n(3:17) corresponding to the known subacute infarction, stable in appearance. \nThere is no evidence of hemorrhage or mass effect. No loss of gray/ white\nmatter differentiation is seen. Mildly prominent ventricles and sulci\nsecondary to age related involutional changes are again seen. Mild\nperiventricular and subcortical white matter hypodensity is nonspecific though\nlikely sequela of chronic small vessel ischemia. Basal cisterns are patent.\n\nThe bones are unremarkable. Imaged paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear.", + "output": "Unchanged small hypodensity within the left aspect of the splenium corpus\ncallosum corresponding to the known subacute infarction. No acute hemorrhage.\nNo CT evidence for an acute major vascular territorial infarct." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of hemorrhage, edema, or mass. There is\nre- demonstration of the focal hypodensity in the left splenium of the corpus\ncallosum. There is a chronic lacunar infarction in the right basal ganglia. \nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is dense atherosclerotic calcification of the cavernous internal carotid\narteries. A stent is noted in the petrous portion of the left with flow seen\nthroughout its course. There is atherosclerotic calcification of the V4\nsegment of the left vertebral artery. The right vertebral artery is\ndiminutive and terminates in the right posterior inferior cerebellar artery. \nA diminutive left A1 segment is seen. Otherwise, the vessels of the circle of\n___ and their principal intracranial branches appear normal without\nstenosis, occlusion or aneurysm formation. The dural venous sinuses are\npatent.\n\nCTA NECK: There is mild atherosclerotic calcification of the aortic arch. \nAtherosclerotic calcification throughout the course of the bilateral\nsubclavian arteries is also seen. A stent is noted in the proximal left\ninternal carotid artery with flow noted throughout its course, however minimal\nnon calcified plaque versus intimal hyperplasia is seen in the posterior\nportion of the stent. There is a stable focal outpouching along medial aspect\nof the proximal left external carotid artery measuring 3 mm, consistent with\nan ulcer. There is a stable stenosis at the origin of the right vertebral\nartery. No stenosis in the internal carotid arteries by NASCET criteria is\nseen.\n\nCT perfusion: There is normal perfusion seen bilaterally with no discrepancy\nseen between the mean transit time, blood volume or blood flow.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. There is thickening of the epiglottis. Postradiation changes are\nnoted throughout the neck with stranding of the soft tissues and sagittal\nplanes. Stable deformity and destruction of the clavicular head is noted. \nPeriapical lucencies are noted along the remaining mandibular teeth on the\nleft.", + "output": "1. Evolving subacute infarction in the left splenium of the corpus callosum. \nNo intracranial hemorrhage.\n2. Stable appearance of the left proximal internal carotid artery and left\npetrous internal carotid artery stents with stable non calcified plaque versus\nintimal hyperplasia along the dependent aspect of the internal carotid artery\nstent.\n3. Stable ulceration of the proximal left external carotid artery.\n4. Normal CT perfusion.\n5. Post radiation changes to the neck, as described above.\n6. Dental disease. Dental consultation is recommended." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of acute infarction, hemorrhage, edema, or\nmass. Subcortical and periventricular white matter hypodensities are\nnonspecific, however likely represent sequela of chronic small vessel ischemic\ndisease. There is prominence of the ventricles and sulci suggestive\ninvolutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is severe stenosis of the petrous segment of the left internal carotid\nto less than 1 mm, however the vessel remains patent (7:234, ___, this\ncorresponds to a segment of narrowing seen on recent outside MRA. There is a\nlarge right A1 segment, with the bilateral A2 segments both arising from the\nright side. There are dense calcifications in the bilateral cavernous\ncarotids. The vessels of the circle of ___ and their principal\nintracranial branches otherwise appear normal without stenosis, occlusion or\naneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is a large amount of plaque at the origin of the left internal carotid\nartery, with some fatty density, indicating a lipid rich necrotic core (7:155,\n166). There is 77% stenosis of the left internal carotid artery by NASCET\ncriteria (12:48), this stenosis extends over a distance of approximately 15 mm\nand corresponds to a segment of narrowing seen on recent outside MRA\n(___). There is mild stenosis at the origin of the right vertebral\nartery (___).\n\nThe right carotid and left vertebral arteries and their major branches appear\nnormal with no evidence of stenosis or occlusion. There is no evidence of\nright internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Atrophy and probable small vessel ischemic disease.\n2. Severe stenosis of the petrous segment of the left internal carotid artery\nto less than 1mm, however the vessel remains patent, similar to recent MRA.\n3. Segment of narrowing of the at the origin of the left internal carotid\nartery extending over approximately 15 mm, similar to recent MRA. There is a\nlarge amount of plaque at the origin of the left internal carotid artery with\nlipid rich necrotic core, indicating high risk of plaque rupture, and causing\n77% stenosis by NASCET criteria.\n4. Large right A1 segment, with bilateral A2 segments originating from the the\nright side." + }, + { + "input": "Right occipital craniotomy, with cranioplasty., Mild encephalomalacia adjacent\ncerebellum.\nThere is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Periventricular and subcortical white matter hypodensities are\nnonspecific, but likely reflect sequelae of chronic small vessel ischemic\ndisease. Prominence of the ventricles and sulci suggest involutional changes.\nThere is mild mucosal thickening of bilateral maxillary sinuses. Left mastoid\nair cell ossification, from chronic inflammation. The remaining imaged\nparanasal sinuses are clear. Mastoid air cells and middle ear cavities are\nwell aerated. The bony calvarium is intact. Right periorbital soft tissue\nswelling, better evaluated on CT exam of the orbits performed same date,\nincluding right dacryocystitis, with preseptal, postseptal inflammatory\nchanges. Mass effect on the globe.", + "output": "No acute intracranial process.\nFindings of acute right dacryocystitis, with preseptal, postseptal\ninflammatory changes, mass effect on the globe, better seen on CT orbits.\n\nNOTIFICATION: The findings regarding head CT and orbital CT findings were\ndiscussed with ___, M.D. by ___, M.D. on the telephone\non ___ at 8:52 am, 5 minutes after discovery of the findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute large territory\ninfarction,hemorrhage,edema,ormass. The ventricles and sulci are normal in\nsize and configuration.\n\nA moderate to large-sized subgaleal hematoma overlies the right frontal bone\nmeasuring approximately 4.8 x 0.9 cm (02:26). There is minimal mucosal\nthickening of the right maxillary sinus and opacification of a few right\nethmoid air cells. There is opacification of a few inferior right mastoid air\ncells. The visualized portion of the remaining paranasal sinuses, andmiddle\near cavities are clear. The visualized portion of the orbits are normal.\n\nThe CTA exam is limited due to venous contamination secondary to poor bolus\ntiming. Within these confines:\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. The dural venous\nsinuses are patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No acute intracranial abnormality. No evidence of large vascular\ndistribution infarct, intracranial mass, or hemorrhage.\n2. Moderately sized subgaleal hematoma overlying the right frontal bone\nwithout underlying calvarial fracture.\n3. The CTA exam is limited due to venous contamination secondary to poor bolus\ntiming. Within these confines: Patent circle of ___ without evidence of\nstenosis,occlusion,or aneurysm. No dural sinus thrombosis.\n4. The CTA exam is limited due to venous contamination secondary to poor bolus\ntiming. Within these confines: Patent bilateral cervical carotid and vertebral\narteries without evidence of stenosis, occlusion, or dissection." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, or loss of\ngray/white matter differentiation. Ventricles, sulci, and basal cisterns are\nnormal in size.\n\nVisualized bones appear unremarkable. There is mild mucosal thickening in the\nfrontoethmoidal recesses. Visualized portions of the other paranasal sinuses\nand mastoid air cells are well aerated. The orbits are unremarkable.", + "output": "No evidence for acute intracranial abnormalities. MRI with high-resolution\nimages through the cranial nerves would be more sensitive for further\nevaluation if clinically warranted." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No fracture or acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. No\nhydrocephalus. Mild chronic small vessel ischemic changes. Moderate\ngeneralized cerebral, cerebellar atrophy.\n\nThere is no evidence of fracture. The visualized portion of the mastoid air\ncells, and middle ear cavities are clear. Moderate opacification of\nvisualized paranasal sinuses, with fluid in the maxillary, sphenoid sinuses,\nsuggest acute sinusitis L lysine there is a recent use of nasal tubes. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Moderate generalized brain atrophy.\nModerate paranasal sinus opacification, fluid, suggest acute sinusitis in the\nabsence of recent nasal tube use" + }, + { + "input": "There is no acute intracranial hemorrhage, acute infarction, edema or mass\neffect. The ventricles and sulci are normal in size and configuration for\npatient's age. The basal cisterns are clear. The gray white matter\ndifferentiation appears preserved.\n\nNo fracture is identified. Bilateral mastoid air cells and middle ear\ncavities are clear. Near complete opacification of the right sphenoid sinus as\nwell as right frontal sinus with moderate mucosal thickening and aeroslized\nsecretions are present.", + "output": "1. Extensive paranasal sinus disease as described concerning for acute\nsinusitis. Recommend clinical correlation.\n2. No acute intracranial abnormality." + }, + { + "input": "Again seen is extensive white matter hypodensities in the bilateral frontal\nlobes and left temporal lobe, with mild effacement of the sulci, not\nsignificantly changed from ___. Multiple punctate calcific densities\nin the bilateral frontal lobes, parietal occipital lobe, and right basal\nganglia are unchanged from prior exam, perhaps the sequela prior\nneurocysticercosis. Otherwise, there is no evidence of intracranial\nhemorrhage, new areas of edema, or mass lesion. No shift of midline\nstructures is demonstrated.. The ventricles and sulci are normal in size and\nconfiguration.\n\nThere is no evidence of acute fracture. There is mild mucosal thickening of\nthe visualized right maxillary sinus and ethmoid air cells. The visualized\nportion of the remaining paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "No significant interval change in the degree of extensive white matter\nhypodensities, worst in the frontal lobes with mild sulcal effacement compared\nto MRI from ___, allowing for differences in technique. Consider MRI\nif clinically indicated for improved assessment of interval change." + }, + { + "input": "Examination limited secondary to patient motion artifact.\n\nWithin these limitations, and upon repetition of the axial sequences, there is\nno evidence of infarction, hemorrhage, edema, or mass. The ventricles and\nsulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nethmoidal air cells. Small air-fluid levels are present within the sphenoid\nsinuses. Otherwise, the remaining visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Limited examination secondary to patient motion artifact. Within these\nconfines, no acute intracranial abnormality.\nATTENDING NOTE: Brain sulci are effaced. There is slight high-density the\ntentorium and choroid plexus which may suggest decreased density of the brain\nparenchyma. Although basal cisterns are patent, this appearance may suggest\nmild cerebral edema. Followup CTA or MRI can help for further assessment.\n\nRECOMMENDATION(S): Follow up head CT or MRI.\n\nNOTIFICATION: Revised findings of brain edema and follow up CT were discussed\nwith ___, M.D. by ___, M.D. on the telephone on\n___ at 9:37 AM, 10 minutes after discovery of the findings." + }, + { + "input": "Brain parenchymal volume is unusually large for patient's age. Diffuse sulcal\neffacement and low-density of brain parenchyma are persistent.\nThere is no evidence of hemorrhage.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No interval significant change. Persistent probable mild cerebral edema\nwithout brain herniation." + }, + { + "input": "Mild diffuse cerebral edema is unchanged. There is no evidence of large\nterritory infarction, hemorrhage, or mass. The ventricles and sulci are\nstable in size and configuration, without evidence of ventriculomegaly.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Unchanged mild cerebral edema without herniation." + }, + { + "input": "Head CT: There is no evidence of hemorrhage, edema, infarction, mass or\nmidline shift. The left medial temporal lobe enhancing lesion described on\nMRI from ___ is unable to be visualized, possibly due to\ndifferences in CT versus MRI technique. There is no hydrocephalus. Visualized\nparanasal sinuses and mastoid air cells are clear. There is no evidence of\nfracture.\n\nHead CTA: There is very slight irregularity of the A2 segments of the\nanterior cerebral arteries (right A2 series 6 image 52, left A2 series 6,\nimage 51). This corresponds to similar findings on MRA from ___.\nThis irregularity is also in the frontopolar branches of the anterior cerebral\narteries (3D series 754, image 9). Stenosis of the M2 segment of the right\nmiddle cerebral artery described on MRI from ___ is not appreciated\non CTA. No irregularity is identified elsewhere in the intracranial carotid\nand vertebrobasilar systems. There is no occlusion, aneurysm, or arteriovenous\nmalformation.\n\nThe major dural venous sinuses are patent. The left transverse sinus is\nhypoplastic.", + "output": "1. Slight irregularity of the A2 segments of the anterior cerebral arteries\n(series 6, images 51-52 and 3D series 754 image 9). No additional areas of\nvascular irregularity.\n2. Nonvisualization of the left medial temporal lobe enhancing lesion seen on\nMRI from ___, likely due to differences in technique." + }, + { + "input": "The right frontal approach ventriculostomy catheter ends in the frontal horn\nof the right lateral ventricle. The right lateral ventricle appears\ncollapsed, with similar configuration as compared to ___. The left\nlateral ventricle also appears to have similar size and configuration as seen\nin ___.\n\nThere is no evidence of hemorrhage, edema or infarction. The basal cisterns\nappear patent and there is preservation of gray-white matter differentiation.\n\nNo fracture is identified. The mastoid air cells, middle ear cavities, and\nvisualized paranasal sinuses are clear. The globes are unremarkable.", + "output": "Right frontal approach ventriculostomy catheter ends in the frontal horn of\nthe right lateral ventricle. The bilateral lateral ventricles have a similar\nsize and configuration as seen on CT of the head dated ___. No\nevidence of hydrocephalus on the current examination." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or large territorial\ninfarction. The ventricles and sulci are normal in size. Apparent asymmetry\nin the frontal horns of the lateral ventricles is likely congenital. The basal\ncisterns appear patent and there is preservation of gray-white matter\ndifferentiation. Incidental note is made of ___ cisterna magna.\n\nNo fracture is identified. The visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The globes are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no acute hemorrhage, edema, or mass effect. There is no CT evidence\nfor an acute major vascular territorial infarction. Large right inferior\nparietal/ occipital/ posterior temporal chronic infarct with encephalomalacia\nand foci of gyriform hyperdensity indicating pseudolaminar necrosis, and a\nsmall right corona radiata chronic infarct with encephalomalacia, are again\nnoted. Ventricles and sulci are enlarged due to global age-related\nparenchymal volume loss, with superimposed ex vacuo enlargement of the frontal\nhorn, atrium and temporal horn of the right lateral ventricle.\n\nNo osseous abnormalities seen. There is minimal mucosal thickening in the\nethmoid air cells. Mastoid air cells are well aerated. There is evidence of\nbilateral cataract surgery.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. Large chronic right inferior parietal parietal/ occipital/ posterior\ntemporal temporal infarct and small chronic right corona radiata infarcts are\nagain demonstrated.\n\nRECOMMENDATION(S): MRI would be more sensitive for an acute infarction or\nother posterior fossa pathology, if clinically warranted." + }, + { + "input": "There is no evidence of intracranial hemorrhage, acute infarction,edema,or\nmass. There is re-demonstration of a large area of hypodensity in the right\ntemporoparietal and occipital regions, as well as a separate area of\nhypodensity at the right corona radiata, which both appear unchanged from\nprior study and are compatible with chronic infarcts with encephalomalacia. \nThere is ex vacuo enlargement of the frontal horn of the right ventricle.\nThere is prominence of the ventricles and sulci compatible with age related\ninvolutional changes. Periventricular, subcortical and deep white matter\nhypodensities are nonspecific, but likely reflect the sequela of chronic\nmicrovascular infarction.\n\nThere is no evidence of fracture. There is a left posterior parietal\nsubgaleal hematoma measuring approximately 1.0 cm. There is mild thickening\nof the bilateral ethmoid air cells. The visualized portion of the remaining\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable apart from bilateral lens\nreplacements. Moderate atherosclerotic calcifications of the distal vertebral\nand cavernous carotid arteries are noted.", + "output": "1. Left posterior parietal subgaleal hematoma measuring 1.0 cm.\n2. No evidence of intracranial hemorrhage, acute infarction, or fracture.\n3. Re-demonstration of a large chronic right infarct with encephalomalacia in\nthe right temporoparietal/occipital region, and a small chronic infarct within\nthe right corona radiata, both unchanged from prior study." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nEncephalomalacia of the right temporoparietal lobe is unchanged, likely\nrelated to a remote infarct. No intracranial hemorrhage or evidence of acute\nlarge territorial infarct. Prominence of the ventricles and sulci is likely\nrelated to age related involutional changes. Periventricular and deep\nsubcortical white matter hypodensities are likely sequelae of chronic\nmicroangiopathy. The basilar cisterns are patent.\n\nNo acute fracture is identified. The visualized paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The patient is status post\nbilateral lens replacement surgery.\n\nCTA HEAD: The basilar artery is normal. The right posterior cerebral artery\nis normal. The left posterior cerebral artery is normal. The left internal\ncarotid artery demonstrates moderate atherosclerotic disease along the carotid\nsiphon. The left middle cerebral artery is normal with normal arborization of\nthe distal left MCA vessels. The right internal carotid artery demonstrates\nmild atherosclerotic disease along the carotid siphons. The right MCA is\nnormal. There is normal arborization of the distal right MCA vessels. The\nanterior cerebral arteries bilaterally are normal. The anterior communicating\nartery is normal.\n\n\nCTA NECK:\nThere is 50% stenosis of the right internal carotid artery by NASCET criteria.\nFlow is preserved throughout the course of the right internal carotid artery. \nMild atherosclerotic disease is seen at the left carotid bifurcation however\nthere is no evidence of internal carotid artery stenosis of the left internal\ncarotid artery by NASCET criteria. The left vertebral artery is unremarkable.\nThe right vertebral artery is normal. Moderate to severe atherosclerotic\ncalcifications are seen along the V4 segments of the vertebral arteries\nbilaterally.\n\nOTHER:\n2.3 cm left thyroid nodule demonstrated a similar appearance on ultrasound in\n___.\n\nThere are bilateral, right greater than left pleural effusions. Ground-glass\nopacity with interlobular septal thickening in the imaged upper lungs could\nreflect mild pulmonary edema.", + "output": "1. Stable encephalomalacia of the right temporal parietal lobe, likely\nsecondary to remote infarct. No new intracranial hemorrhage.\n2. 50% stenosis of the right internal carotid artery by NASCET criteria. No\nevidence of left internal carotid artery stenosis by NASCET criteria.\n3. Unremarkable circle of ___ without evidence of aneurysm or severe\nstenosis.\n4. Stable 2.3 cm left thyroid nodule.\n5. Bilateral moderate pleural effusions, right greater than left.\n6. Mild pulmonary edema." + }, + { + "input": "There is no evidence of acute large territory infarction, hemorrhage, edema,\nor mass.\n\nThere is re-demonstration large hypodense region extending from the\ntemporoparietal and occipital areas as well as the right corona radiata.\n\nThe ventricles and sulci are prominent compatible with age-related\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific, but likely reflect sequelae of chronic small\nvessel ischemic disease.\n\nNo acute calvarial fracture is identified. There is a large left frontal\nsubgaleal hematoma measuring up to 1.3 cm. The mastoid air cells, and middle\near cavities are clear. The orbits are notable for bilateral lens replacement.\nRight ethmoid air cell aerosolized mucosal thickening is noted. Bilateral\nethmoid air cell mucosal thickening is present.", + "output": "1. Large left frontal subgaleal hematoma measuring up to 1.3 cm without\nunderlying fracture.\n2. No acute intracranial hemorrhage or definite acute large territorial\ninfarction identified.\n3. Redemonstration of known early chronic right ACA and chronic right PCA\ndistribution infarcts.\n4. Paranasal sinus disease with findings suggestive of acute sinusitis, as\ndescribed." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nDense atherosclerotic calcifications noted within the intracranial ICAs.\n\nThere is no evidence of fracture. The mastoids are poorly pneumatized\nbilaterally and are opacified on the right. Right middle ears also opacified.\nThere is mucosal thickening in the maxillary sinuses which are small,\nparticularly on the left potentially due to sinus atelectasis. The visualized\nportion of the paranasal sinuses are otherwise clear. The visualized portion\nof the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere are calcifications of the carotid siphons. There is a persistent fetal\norigin of the left PCA. The vessels of the circle of ___ and their\nprincipal intracranial branches appear otherwise normal without stenosis,\nocclusion, or aneurysm formation. The dural venous sinuses are patent.\n\nCT PERFUSION:\nNo abnormal CBF, CBV or Tmax on dynamic perfusion CT images.\n\nCTA NECK:\nThere are calcifications of the carotid bifurcations. The carotid and\nvertebral arteries and their major branches appear otherwise normal with no\nevidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs demonstrate moderate paraseptal emphysema.\nThe visualized portion of the thyroid gland is within normal limits. There is\nno lymphadenopathy by CT size criteria. Chronic fracture left clavicle. \nAdvanced degenerative changes cervical spine.", + "output": "1. No acute intracranial abnormality.\n2. No evidence of abnormal CT perfusion.\n3. No stenosis, dissection, aneurysm or occlusion of the head, neck CTA.\n4. Paraseptal emphysema upper lungs." + }, + { + "input": "Again seen are nondisplaced fractures of the posterior arch of the C1\nvertebral body.\n\nThe right vertebral artery is hypoplastic but patent. There is minimal right\nV3 and V4 segment narrowing likely due to anatomic curvature of the vessel\nwithout occlusion, or dissection.\n\nThe left vertebral artery is patent throughout its entire visualized cervical\nand intracranial course, without evidence of dissection, occlusion, stenosis\nor aneurysm formation. Included images of the circle of ___ are grossly\npatent, without definite dissection, occlusion or aneurysm formation greater\nthan 2-3 mm. There is atherosclerotic calcification of the cavernous portions\nof the bilateral internal carotid arteries.\n\nNo definite vascular injury identified. No evidence for dissection is seen.\n\nThe carotid and vertebral arteries and their major branches are patent with no\nevidence of stenoses.\n\nBy NASCET criteria, no significant stenosis of bilateral internal carotid\narteries.\n\nOther: Moderate-sized right maxillary sinus retention cyst with mild mucosal\nthickening. Partial opacification of the right posterior ethmoidal air cell.\nOtherwise, the remaining visualized paranasal sinuses are clear.", + "output": "1. Nondisplaced fractures of the posterior arch of the C1 vertebral body are\nunchanged.\n2. No evidence of vascular injury.\n3. Minimal right vertebral V3 and V4 narrowing likely due to anatomic\ncurvature of the vessel.\n4. Moderate right maxillary sinus mucous retention cyst." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nThere are periventricular white matter hypodensities consistent with small\nvessel ischemic changes.\n\nNo evidence of acute fracture. The imaged paranasal sinuses are clear.\nMastoid air cells and middle ear cavities are well aerated.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute major vascular territorial\ninfarction,hemorrhage,edema,or mass effect. There is prominence of the\nventricles and sulci suggestive of involutional changes. Mild ill-defined\nsubcortical in and periventricular white matter hypodensities are nonspecific\nbut likely due to chronic small vessel ischemic disease. Atherosclerotic\ncalcifications are seen in the carotid siphons.\n\nThere is no evidence of fracture. Aerosolized secretions are noted in the\nright sphenoid sinus. There is mucosal thickening and partial opacification\nof the right ethmoid air cells. The remainder the visualized paranasal\nsinuses are clear. Soft tissue density within the bilateral external auditory\ncanals likely represent cerumen. There is opacification of the left much\ngreater than right mastoid tips no acute displaced calvarial fracture. The\norbits are unremarkable, noting bilateral lens replacements.", + "output": "1. No acute major intracranial abnormalities on noncontrast head CT. \nSpecifically no large territory infarct or intracranial hemorrhage.\n2. There is no acute displaced calvarial fracture.\n3. Age related global atrophy and chronic microangiopathy.\n4. Paranasal sinus disease, as above. Left much greater than right mastoid\ntip opacification.\n5. Soft tissue densities within the bilateral external auditory canals likely\nrepresents cerumen." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. Aside from moderate mucosal thickening of\nthe anterior ethmoidal air cells, the visualized portion of the paranasal\nsinuses, and middle ear cavities are clear. The left mastoid air cells are\nopacified, similar to the prior study. Nonspecific soft tissue density in the\nleft external auditory canal may represent cerumen. The visualized portion of\nthe orbits are unremarkable. The carotid siphons are heavily calcified.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "Left : There is complete opacification of the left external auditory canal,\nmastoid air cells, aditus, antrum, and middle ear cavity. Middle ear ossicles\nare intact. There is mild bony irregularity and lucency in this region, which\nmay reflect early reactive changes without definite dehiscence. There is no\nsuggestion of intracranial spread on this exam, although MRI head should be\nconsidered if intracranial spread is clinically suspected. There is no\nevidence for enlarged vestibular aqueduct or superior semicircular canal\ndehiscence. The facial nerve follows a normal course through the middle ear.\nThere is no evidence for inner ear dysplasia.\n\nRight: There is density within the external auditory canal, likely\nrepresenting cerumen. The middle ear cavity is clear. The ossicles and tegmen\nare intact. There is no evidence for enlarged vestibular aqueduct or superior\nsemicircular canal dehiscence. The facial nerve follows a normal course\nthrough the middle ear. There is no evidence for inner ear dysplasia. There is\npartial opacification of the right mastoid air cells.\n\nOther: Visualized brain and neck soft tissues are normal. Patient is status\npost bilateral lens resections. There are significant calcifications of the\nintracranial bilateral vertebral arteries as well as the distal cervical and\nintracranial bilateral internal carotid arteries.", + "output": "1. Complete opacification of the left external auditory canal, mastoid air\ncells, aditus, antrum, and middle ear cavity. Mild bony irregularity and\nlucency in this region may reflect early reactive changes without definite\ndehiscence. There is no suggestion of intracranial spread on this exam,\nalthough MRI head should be considered if intracranial spread is clinically\nsuspected.\n2. Density in the right external auditory canal likely represents cerumen. \nPartial opacification of the right mastoid air cells." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nCT HEAD:\nThere is no evidence for acute hemorrhage, vascular territorial infarction,\nmass effect, or edema. The ventricles and sulci are mildly prominent. \nPeriventricular and subcortical white matter FLAIR hyperintensities are noted,\na nonspecific finding that most likely represents the sequelae of chronic\nsmall vessel ischemic disease.\n\nMild mucosal thickening is seen within the maxillary sinuses and ethmoid air\ncells with partial opacification of several posterior right ethmoid air cells.\nThere is complete opacification of the left mastoid air cells and left middle\near cavity. Patient is status post bilateral lens replacement.\n\nCTA HEAD AND NECK:\nThere is a normal 3 vessel aortic arch. Calcifications are seen in the\nbilateral V4 segments. The vertebral arteries and basilar artery remain\npatent.\n\nThe bilateral common carotid arteries are patent. Partially calcified\natherosclerotic plaque is seen at the bilateral carotid bulbs extending to the\nproximal carotid arteries bilaterally. This results in less than 20% stenosis\nof the left and ___ stenosis of the right proximal internal carotid\narteries.\n\nDense calcifications are noted involving the bilateral cavernous carotid\narteries. Allowing for this, the intracranial vasculature is grossly patent\nwithout high-grade stenosis, occlusion, or aneurysm greater than 3 mm. There\nis a fetal type origin of the right posterior cerebral artery, a normal\nvariant. The dural venous sinuses are patent.\n\nOTHER:\nThere are moderate to large size bilateral pleural effusions with adjacent\natelectasis, partially imaged. Calcified mediastinal lymphadenopathy is\nnoted. There is no pathologic cervical lymphadenopathy. Thyroid gland is\ngrossly preserved. Soft tissue density is noted within the right external\nauditory canal, which may represent cerumen.", + "output": "1. Dental amalgam streak artifact limits study.\n2. No acute intracranial hemorrhage or vascular territorial infarction. \nPlease note MRI of the brain is more sensitive for the detection of acute\ninfarct.\n3. Global parenchymal volume loss and evidence of chronic small vessel\nischemic disease.\n4. Multifocal paranasal sinus disease and opacification of the left middle ear\ncavity and left mastoid air cells, unchanged.\n5. Multifocal atherosclerotic disease, as detailed above, with gross patency\nto the cranial and cervical vasculature. No high-grade stenosis, vessel\nocclusion, or aneurysm greater than 3 mm.\n6. Less than 20% left-sided and ___ right-sided stenosis of the proximal\ninternal carotid arteries by NASCET criteria.\n7. Moderate to large bilateral pleural effusions with adjacent atelectasis.\n8. Calcified mediastinal lymphadenopathy suggesting prior exposure to\ngranulomatous disease." + }, + { + "input": "Left :\nMild mucosal thickening of the left external auditory canal, improved since ___. On prior exam left EAC was completely opacified. Thickening of the\nleft periauricular soft tissues, thickening of the soft tissues of the left\npinna, consider otitis externa. Findings are more prominent compared with ___. Intact tegmen. Completely opacified round and oval window.\n\nComplete opacification left mastoid air cells, middle ear cavity, similar to\nprior. No interval osseous destruction of the outer cortex, sigmoid plate or\nosseous septations. Findings may represent chronic effusion, chronic\notomastoiditis. No definite evidence of cholesteatoma on CT.\n\nNo definite middle ear ossicular erosion. Intact scutum. No destruction of\nthe outer capsule. Normal vestibule, cochlear, semicircular canals, course of\nthe facial nerve.\n\nRight:\nMild opacification inferior right mastoid air cells, with areas of\nossification, consistent with contraction from chronic inflammation, similar\nto prior. Clear middle ear cavity, oval, round window. Intact ossicles. \nNormal cochlear, vestibule, semicircular canals, no dehiscence. Normal IAC. \nIntact tegmen.\n\nOther: Mild mucosal thickening paranasal sinuses.", + "output": "1. Left periauricular soft tissue thickening, edema of the left pinna, mild\nthickening left external auditory canal, consider otitis externa.\n2. Complete opacification left mastoid, middle ear cavity, similar to ___, may represent chronic effusion, chronic inflammation/infection, no\nevidence of destructive process to suggest progressive infection,\ncholesteatoma or underlying mass. No posterior nasopharynx mass.\n3. Right EAC cerumen. Mild chronic inflammation inferior right mastoids,\nstable.\n4. Pansinus disease is unchanged compared to recent CT sinus.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 1:21 pm, 10 minutes after discovery of\nthe findings." + }, + { + "input": "There is no hemorrhage mass effect midline shift or hydrocephalus. Mild brain\natrophy seen.\n\nBone images demonstrate opacification of the some of the mastoid air cells and\nepitympanum with overall decrease in opacification of the middle ear and\nmastoid air cells. There is no significant asymmetry of the soft tissues in\nthe mastoid region.", + "output": "1. No acute intracranial abnormalities are identified.\n2. Decreased soft tissues within the left mastoid air cells and middle ear\ncompared to the temporal bone CT of ___." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nSmall area of hypodensity in the high left frontal lobe extending to the\ncentrum semiovale (series 2, image ___ is compatible with region of chronic\nencephalomalacia. There is no evidence of acute hemorrhage or intracranial\nmass effect.\n\nThe ventricles and sulci are within expected limits in size and configuration.\n\nThere are atherosclerotic changes along both cavernous ICAs, the left V4\nsegment and proximal basilar artery.\n\nMild mucosal thickening of the right maxillary sinus. Otherwise, the\nremainder the visualized portion of the paranasal sinuses, mastoid air\ncells,and middle ear cavities are clear. Note is made of bilateral lens\nreplacement surgery. The visualized portion of the orbits are size\nunremarkable.\n\nCTA HEAD:\nThere are scattered calcifications along both cavernous ICAs without\nhigh-grade stenosis. The vessels of the circle of ___ and their principal\nintracranial branches appear otherwise normal without stenosis, occlusion, or\naneurysm formation.\nThe dural venous sinuses are patent.\n\nCTA NECK:\nNormal 3 vessel aortic arch. There are mixed atheromatous and atherosclerotic\nchanges extending in to the origin of the right innominate artery and\nresulting in mild stenosis.\n\nThere is swallowing artifact affecting the level of the bilateral carotid\nbifurcations, left greater than right. As previously seen on the carotid\nultrasound, a severe stenosis of the left ICA is noted, however, the\nevaluation residual lumen of the left internal carotid artery is severely\nmotion degraded and therefore, no accurate measurements are possible.\n\nAtherosclerotic changes are also visualized at the right carotid bifurcation\nwhich is also affected by the swallowing artifact but to a lesser degree. \nThere does not appear to be significant narrowing, however, no reliable\nmeasurements are possible.\n\nThe cervical segment of the vertebral arteries is unremarkable, noting mild\nstenosis at the origin of the left vertebral artery.\n\nOTHER:\nThere is bilateral gravity dependent atelectasis. No suspicious pulmonary\nnodules. A 5 mm oval shaped hypodense nodule in the inferior left thyroid\nlobe (series 3, image 92). The visualized portion of the thyroid gland is\notherwise within normal limits. There is no lymphadenopathy by CT size\ncriteria. No suspicious osseous lesions. 4 mm anterolisthesis of C4 on C5\nand severe narrowing of the left C4-C5 neural foramina is noted. No evidence\nof high-grade spinal canal narrowing.", + "output": "1. Small area of hypodensity in the high left frontal lobe extending to the\ncentrum semiovale compatible with chronic encephalomalacia.\n2. Swallow artifact precludes numeric evaluation of the left ICA stenosis. \nSevere narrowing is again noted however, the evaluation of residual vessel\nlumen severely motion degraded and therefore, no accurate measurements are\npossible.\n3. Mild stenosis at the right innominate artery origin.\n4. Oval-shaped 5 mm hypodense nodule in the left thyroid lobe.\n5. Additional findings described above." + }, + { + "input": "Dental amalgam streak and patient body habitus artifact limits study.\n\nCT HEAD WITHOUT CONTRAST:\nStable left frontal encephalomalacia is again seen. There is no evidence of\ninfarction,hemorrhage,edema,ormass. There is prominence of the ventricles and\nsulci suggestive of involutional changes. There are periventricular and\nsubcortical lucencies, which may represent small vessel ischemic changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits demonstrate\nbilateral lens replacement postoperative changes..\n\nCTA HEAD:\nNonocclusive atherosclerotic calcifications of the right supraclinoid internal\ncarotid artery are again noted. Otherwise, the vessels of the circle of\n___ and their principal intracranial branches appear preserved without\ndefinite stenosis, occlusion, or aneurysm formation. The dural venous sinuses\nare patent.\n\nCTA NECK:\nNonocclusive atherosclerotic calcifications are again noted at the aortic\narch, left subclavian artery origin, adjacent to the left vertebral artery\norigin, the right brachiocephalic origin and the right proximal subclavian\nartery. Otherwise, bilateral vertebral, common carotid, and subclavian artery\norigins are patent.\n\nThere as been interval placement of a stent within the proximal left common\ncarotid artery with extension along the left cervical internal carotid artery\nto approximately the level of C2-3. Contrast opacification of the stent is\nnoted along its entire course. Contrast opacification of the left external\ncarotid artery is also noted. Partially calcified plaque adjacent to the\nstent is noted.\n\nAllowing for difference in technique, grossly stable right carotid bifurcation\nand proximal internal carotid artery nonocclusive partially calcified\natherosclerotic plaque is noted, with approximately 15% narrowing by NASCET\ncriteria (see ___.\n\nOtherwise, the carotidandvertebral arteries and their major branches appear\npreserved with no definite evidence of stenosis or occlusion.\n\nOTHER:\nThe visualized portion of the lungs again demonstrate the right upper lobe\nprobable granuloma (see 3:5), biapical emphysematous changes, biapical\nscarring two 2 mm right upper lobe pulmonary nodule (03:54-55), and a 3 mm\nleft upper lobe pulmonary nodule (see 03:12).\n\nEvaluation of the thyroid gland is limited secondary to artifact, and within\nlimits of study, previously noted approximately 5 mm left thyroid lobe nodule\nis grossly unchanged (see 3:82 on current study and 3:92 on prior exam). An\napproximately 0.8 x 1.2 cm mediastinal lymph node is seen (see 3:4). \nScattered subcentimeter nonspecific lymph nodes are noted throughout the neck\nand mediastinum bilaterally, without definite enlargement by CT size criteria.\nLimited imaging of the cervical spine demonstrates multilevel spondylosis and\ndextroscoliosis.", + "output": "1. Dental amalgam streak and patient body habitus artifact limits study.\n2. Postsurgical changes related to patient's interval left internal carotid\nartery TCAR stent with patent lumen as described.\n3. Nonocclusive probable atherosclerotic changes of the cervical vasculature\nand circle of ___ as described.\n4. Approximately 15% narrowing of right internal carotid artery by NASCET\ncriteria.\n5. Otherwise patent circle of ___ without definite evidence of\nstenosis,occlusion,or aneurysm.\n6. Otherwise, patent bilateral cervical carotid and vertebral arteries without\ndefinite evidence of stenosis, occlusion, or dissection.\n7. Grossly stable left thyroid nodule as described.\n8. Nonspecific lymph nodes as described, which may be reactive.\n9. Multiple bilateral pulmonary nodules as described. Please see\nrecommendation section below.\n\nRECOMMENDATION(S): For incidentally detected multiple solid pulmonary nodules\nsmaller than 6mm, no CT follow-up is recommended in a low-risk patient, and an\noptional CT follow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nIn comparison to the prior CT from ___, there is a unchanged\nhypodensity in the left frontal lobe (2:26). There is no evidence of an acute\ninfarct, hemorrhage or mass. The ventricles and sulci are normal in size and\nconfiguration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are normal,\nhowever the patient is status post bilateral lens removal.\n\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. The dural venous\nsinuses are patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent. There is an area of\nhypodensity within the brachiocephalic trunk at its takeoff, which likely\nrepresents atherosclerotic disease/soft plaque (3:58). There is a stent in the\nleft common carotid and left internal carotid artery. There is a region of\nhypodensity extending from the common carotid to the internal carotid along\nthe posterior wall lateral wall of the stent, which likely represents interval\ndevelopment of a mural thrombus. There is severe narrowing of the left\ninternal carotid artery, approximately 75% narrowing by NASCET criteria. The\nstenosis is secondary to the stent itself combined with the additional\nnarrowing from thrombus formation. There is no right internal carotid artery\nstenosis by NASCET criteria\n\nThe vertebral arteries and their major branches appear normal with no evidence\nof stenosis or occlusion.\n\n\nOTHER:\nThere is linear atelectasis in the left lung, and dependent atelectasis in the\nright. Paraseptal emphysema is noted. The visualized portion of the thyroid\ngland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Interval development of left common and internal carotid artery mural\nthrombus along the posterolateral wall of the carotid stent. There is up to\n75% narrowing of the internal carotid artery, secondary to the stent and the\nthrombus.\n\n2. Patent circle of ___ without evidence of stenosis,occlusion,or\naneurysm.\n\n3. There is atherosclerotic disease/soft plaque within the brachiocephalic\ntrunk extending to the proximal right subclavian artery. The vertebral\narteries are without evidence of stenosis, occlusion, or dissection.\n\nRECOMMENDATION(S): If infarction continues to be of persistent clinical\nconcern, MRI brain would be a more sensitive exam.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 4:00 pm, 10 minutes after\ndiscovery of the findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is a unchanged hypodensity in the left middle frontal gyrus likely a\nsequelae of remote ischemic changes (series 2, image 22). There is\nredemonstration of multifocal periventricular and deep white matter\nhypodensities; nonspecific and could be related to chronic small vessel\ndisease. Background of involutional changes evidenced by prominent lateral\nventricles, and mild enlargement of extra-axial CSF spaces. There is no\nevidence of an acute infarct, hemorrhage or mass. The ventricles and sulci are\nstable in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are normal,\nhowever the patient is status post bilateral lens removal.\n\nCTA HEAD:\nThere is redemonstration of calcified atherosclerotic changes involving\nbilateral carotid siphons and left vertebral artery. The vessels of the\ncircle of ___ and their principal intracranial branches appear patent\nwithout high-grade stenosis, occlusion, or aneurysm. The dural venous sinuses\nare patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent. Atherosclerotic\ncalcification at left vertebral artery origin is noted. There is an area of\nhypodensity within the brachiocephalic trunk at its takeoff, which likely\nrepresents atherosclerotic disease/soft plaque (series 301 image 122)).\n\nThere is a stent in the left common carotid and initial segment of the left\ninternal carotid artery. There is redemonstration of intraluminal mural\nhypodensity extending from the common carotid to the internal carotid along\nthe posterior and lateral wall of the stent, not significantly changed\ncompared to previous examination. There is unchanged severe narrowing of the\nleft internal carotid artery, approximately 60% narrowing by NASCET criteria. \nThe stenosis is secondary to the stent itself combined with the additional\nnarrowing from thrombus formation.\n\nThere is no right internal carotid artery stenosis by NASCET criteria. There\nis redemonstration of calcified atherosclerotic plaques at origin of both\ninternal carotid arteries.\n\nThe vertebral arteries and their major branches appear patent with no evidence\nof high-grade stenosis or occlusion.\n\nOTHER:\nBilateral dependent atelectatic changes involving included lung parenchyma. \nNo suspicious lung nodules. No superior mediastinal or neck lymphadenopathy. \nThere is redemonstration of small left thyroid gland hypodense nodule\nmeasuring 8 x 4 mm. Multilevel degenerative changes throughout cervical\nspine, including mild anterolisthesis at C4-C5 level, anterior and posterior\nspondylosis, more significant from C4-C5 through C6-C7 levels.", + "output": "1. Redemonstration of left middle frontal gyrus hypodensity likely r" + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates mild thickening of the\naryepiglottic folds bilaterally (02:51). There is suggestion of right-sided\nvocal cord paralysis with medialization of the arytenoid cartilage and\ndilatation of the ipsilateral laryngeal ventricle (02:54). There is mild\neffacement of the piriform sinuses bilaterally, likely related to nonspecific\naryepiglottic fold thickening. The upper esophagus is patulous and\nfluid-filled. The epiglottis is normal and the subglottic airway appears\nnormal without narrowing.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland is surgically absent. A left supraclavicular\nlymph node is similar to the prior PET-CT, at which time it was FDG avid,\nmeasuring up to 1.1 cm in short axis (2:70).The neck vessels are patent.\n\nThe imaged portion of the lung apices is notable for right apical pleural and\nparenchymal scarring.\n\nThe visualized portions of the brain are notable for a rounded enhancing\nlesion in the right cerebellar hemisphere near the cerebellar peduncle\nmeasuring up to 1.1 x 0.9 cm for which nonemergent brain MRI is recommended\n(2:5).\n\nThere is a large lytic lesion involving the right aspect of the C3 vertebral\nbody measuring up to 1.6 x 1.3 cm in greatest axial ___ (02:37). \nAdditional lytic lesions are noted involving the right facets at the level of\nC3 (02:43), the left facets at the level of C4 (02:48), and heterogeneous\nsclerosis of C6, which may represent an additional metastatic deposit\n(602:30). Multiple additional osseous metastases are better evaluated on\nconcurrent chest. There is no critical spinal canal stenosis. No prevertebral\nsoft tissue swelling.\n\nAn accessed left pectoral Port-A-Cath catheter tip extends outside of the\nfield of view within the SVC. Proximal esophagus appears patulous.", + "output": "1. Nonspecific thickening of the aryepiglottic folds and mild effacement of\nthe piriform sinuses may suggest nonspecific supraglottic inflammation. No\nevidence of significant airway narrowing, subglottic airway inflammation, or\nepiglottitis.\n2. Findings suggestive of right-sided vocal cord paralysis.\n3. 1.1 cm rounded enhancing focus in the right cerebellar hemisphere,\npotentially a metastasis, for which nonemergent brain MRI is recommended.\n4. Cervical spine metastases, similar to the prior PET-CT.\n5. Patulous proximal esophagus which could suggest esophageal dysmotility." + }, + { + "input": "Again seen are postoperative changes with left frontal burr hole. Patient's\nknown left lateral ventricle ependymal lesion is not well assessed on CT\n(2:23). Surrounding vasogenic edema is not significantly changed compared\nwith prior MR. ___ described bilateral thalamic abnormalities are not\nwell assessed on the current exam.\nSubcortical, periventricular and deep white matter hypodensities again are\nnonspecific, most pronounced within the left external capsule, likely the\nsequela of chronic microvascular infarction. There is no evidence of acute\nlarge territorial infarction or hemorrhage. There is no midline shift. Basal\ncisterns are patent. Mild prominence of the ventricles and sulci is\ncompatible with age appropriate atrophy.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Probable sebaceous cyst in the left\nparietal scalp appears unchanged (02:31).", + "output": "1. No substantial interval change compared to the recent MRI allowing for\ndifferences in modalities. Known left lateral ventricle epididymal lesion\nbetter assessed on prior MRI with similar appearance of surrounding vasogenic\nedema within the left frontal lobe.\n2. Other known additional lesions within the thalami bilaterally are better\nvisualized on the prior contrast-enhanced MRI.\n3. No intracranial hemorrhage or new mass effect." + }, + { + "input": "The patient is status post left frontal burr hole craniotomy. The known left\nlateral ventricle ependymal lesion is better assessed on the recent MR ___\n2, image 20), but appears unchanged. White matter hypodensities adjacent to\nthe left lateral ventricle within the centrum semiovale and corona radiata,\nlikely due to posttreatment changes, as suggested on the recent MR. ___\nperiventricular ___ matter hypodensities are likely related to chronic\nmicrovascular ischemia.\n\nThere is no evidence of acute territorial infarction or hemorrhage. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. A 12 x 9 mm soft tissue nodule arising from\nthe subcutaneous tissues overlying the left parietal scalp is unchanged\n(series 3, image 59), likely a sebaceous cyst. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Known left lateral ventricle ependymal lesion with surrounding post\ntreatment changes are better evaluated on the recent MR.\n3. Unchanged left parietal subcutaneous soft tissue nodule, likely a sebaceous\ncyst." + }, + { + "input": "A left frontal approach ventriculoperitoneal shunt catheter is noted\nterminating at the foramen of ___. Expected pneumocephalus is identified. \nA known left lateral ependymal mass better evaluated by prior MR. ___,\nthere is no evidence of infarction, hemorrhage, edema, or new mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nSubcortical and periventricular white matter hypodensities are nonspecific and\nlikely secondary to chronic small vessel ischemic changes.\n\nThere is no evidence of fracture. Overlying the left parietal scalp, there is\nagain noted a 1.2 x 0.9 cm soft tissue nodule which likely represents a\nsebaceous cyst. The visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. Stable appearance of the ventricular system status post interval placement\nof a left frontal approach VP shunt catheter.\n2. Known left lateral ventricular ependymal mass is better evaluated on prior\nMR." + }, + { + "input": "Again seen is the left frontal ventriculoperitoneal shunt with catheter tip\nterminating in the foramen of ___. Pneumocephalus and air in the ventricle\nare consistent with recent shunt placement. Known thalamic mass is better\nevaluated by prior MR but otherwise similar to CT dated ___. \nThere is no evidence of infarction, hemorrhage,or new mass. The ventricles\nand sulci are similar to prior.\n\nThere is no evidence of fracture. Soft tissue swelling with tiny foci of air\naround the VP shunt are expected status post placement of shunt. The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Unchanged appearance of the ventricular system with the VP shunt in\nunchanged position.\n2. Thalamic mass is grossly unchanged but better evaluated on prior MR.\n\n___: The findings were discussed with ___ P.A. ___\n___, M.D. on the telephone on ___ at 1:45 pm, 20\nminutes after discovery of the findings." + }, + { + "input": "Again seen is the left frontal ventriculoperitoneal shunt with catheter tip\nterminating in the foramen of ___. The pneumocephalus has improved. The\nknown thalamic mass is again demonstrated without significant interval\nchanges, better evaluated by prior MR. ___ is no evidence of infarction,\nhemorrhage, or new mass. The ventricle size are slightly smaller in size as\nseen in the size of temporal horns.\n\n\nThere is no evidence of fracture. Mild subcutaneous air and soft tissue\nwithin have improved. There is mild mucosal thickening of the right frontal\nand moderate sinuses. The mastoid air cells,and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. Unchanged appearance of the VP shunt with slightly decreased ventricular\nsize.\n2. No evidence of hemorrhage or infarct.\n3. Thalamic mass is grossly unchanged but better evaluated on prior MR." + }, + { + "input": "Examination is severely motion degraded, despite attempts at repeat\nacquisition.\n\nA left frontal approach VP shunt catheter tip terminates in the third\nventricle, unchanged, with unchanged size of the ventricular system.\n\nA region of left frontal periventricular white matter hypodensity measuring 21\nx 12 mm is seen, corresponding to the enhancing lesion as seen on prior MR\n___: 21). Left-greater-than-right hemispheric white matter hypodensities\ncorrespond to signal abnormality as seen on prior MR.\n\n___ is no evidence of infarction,or hemorrhage given limitations of\nexamination.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare not well evaluated due\nto motion. The visualized portion of the orbits are unremarkable.", + "output": "1. Severely motion degraded examination demonstrating unchanged position of a\nleft frontal approach VP shunt catheter with no significant interval change in\nsize of the ventricular system.\n2. Region of left frontal periventricular white matter hypodensity,\ncorresponding to the enhancing lesion, better characterized on the prior MR\nexamination.\n3. Left-greater-than-right hemispheric white matter hypodensities, correspond\nsignal abnormality as seen on prior MR examination, representing either\nposttreatment change, or infiltrative disease. No definite correlate to the\npreviously identified thalamic signal abnormality." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nThere are multiple areas of encephalomalacia involving the right frontal lobe,\nright parietal lobe, and right occipital lobe with ex vacuo dilatation of the\nfrontal and occipital horns of the right lateral ventricle, indicating chronic\ninfarction. A hypodensity near the left basal ganglia may be a lacunar\ninfarct or prominent perivascular space. Hypodensities in the periventricular\nand subcortical white matter are consistent with chronic small vessel ischemic\ndisease.\nThere is no evidence of fracture. There is mild soft tissue stranding\noverlying the right occipital bone. There is mucosal thickening of the\nethmoid air cells and the sphenoid sinuses. There is a small mucous retention\ncyst in the left sphenoid sinus. There is a 6 mm osteoma in the left ethmoid\nsinus. The visualized portion of the other paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable. Dense atherosclerotic calcifications in the carotid\nsiphons are noted.", + "output": "1. No acute intracranial abnormalities.\n2. Chronic infarcts with encephalomalacia in the right frontal, parietal, and\noccipital lobes." + }, + { + "input": "CTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThere is occlusion of the right internal carotid artery from its origin to the\nlevel of the clinoid ICA. The right middle cerebral and anterior cerebral\narteries appear patent, via filling through the anterior communicating artery\nand a prominent right posterior communicating artery. The left carotid and\nbilateral vertebral arteries and their major branches appear normal with no\nevidence of stenosis or occlusion. There is no evidence of left internal\ncarotid stenosis by NASCET criteria. There is mild stenosis of the right\ncommon carotid artery at its origin.\n\nOTHER:\nOpacities of the right upper lobe of the lung may represent atelectasis versus\naspiration. The visualized portion of the thyroid gland is within normal\nlimits. There is no lymphadenopathy by CT size criteria.", + "output": "1. Occlusion of the right internal carotid artery from its origin to the level\nof the clinoid ICA with collateral filling the right middle and anterior\ncerebral arteries.\n2. Mild stenosis of the right common carotid artery at its origin.\n3. Opacities of the right upper lobe of the lung representing atelectasis\nversus aspiration\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:44 am, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "There is no evidence of acute infarctionhemorrhage,edema,or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere are several areas of encephalomalacia in the right frontal, right\noccipital, and right parietal lobes, stable from prior exam. Hypodensity in\nthe left basal ganglia is again seen and may also represent old lacunar\ninfarct.\n\nThere is no evidence of fracture. The left sphenoid sinus is opacified. The\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable. Atherosclerotic calcification of the carotid\nsiphons are noted.", + "output": "1. No evidence of hemorrhage or infarction." + }, + { + "input": "Right frontal, parietal, and occipital lobe areas of encephalomalacia are\nconsistent with old infarction. Left thalamic hypodensity is consistent with\nold lacunar infarction. More subtle focal hypodensity in the right thalamus\nsuggests prior lacunar infarct as well. There is no evidence of new large\nterritory infarction,hemorrhage,edema, or mass. There is prominence of the\nventricles and sulci suggestive of involutional changes, stable. Bilateral\nperiventricular white-matter hypodensities are nonspecific but most likely\nrepresent sequela of chronic small vessel ischemic changes.\n\nThere is no evidence of fracture. There is partial opacification of the left\nsphenoid and maxillary sinus. The remaining paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. No intracranial hemorrhage.\n2. Old right frontal, parietal, and occipital lobe infarctions. Old bilateral\nthalamic lacunar infarcts." + }, + { + "input": "Extensive right frontotemporal and parietal encephalomalacia is overall\nsimilar to prior head CT given differences in slice thickness. No\nintracranial hemorrhage or definite new hypodensity to suggest acute infarct. \nVentricles and sulci are overall unchanged in size and configuration with\npersistent ex vacuo dilatation of the occipital horn of the right lateral\nventricle. No midline shift.\n\nNo acute fracture. Likely congenital nonunion of the posterior arch of C1 is\npartially visualized. Nasoenteric tube is partially visualized. Fluid is\nseen within the left sphenoid sinus possibly due to prolonged supine\npositioning. The remaining paranasal sinuses and mastoid air cells are clear.\nThe orbits are unremarkable.", + "output": "1. No significant interval change.\n2. Overall stable appearance of extensive encephalomalacia involving the right\nfrontotemporal and parietal lobes." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable.\n\nIncluded paranasal sinuses and mastoids are essentially clear noting minimal\nmucosal thickening in the left maxillary sinus and a few scattered opacified\nright mastoid air cells. Postoperative changes of endoscopic sinus surgery is\nnoted. Skull and extracranial soft tissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass effect.\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No acute intracranial process." + }, + { + "input": "This patient, with end-stage renal disease, received intravenous contrast\nmaterial within the last 48 hr, which remains present within the intracranial\nvessels, and limits interpretation of this study.\n\nThere is no definite acute hemorrhage, edema, mass effect or acute large\nvascular territorial infarction. Prominent ventricles and sulci are consistent\nwith age-related involutional change. Periventricular white matter\nhypodensities are consistent with chronic small vessel ischemic disease.\nHypodensity in the right basal ganglia likely represents an old lacune. The\nbasal cisterns appear patent and there is preservation of gray-white matter\ndifferentiation.\n\nNo fracture is identified. Fluid is seen in the bilateral mastoid air cells,\nleft greater than right, as well as the left middle ear cavity. Fluid is also\nseen layering within the bilateral sphenoid sinuses, multiple ethmoid air\ncells, and the bilateral maxillary sinuses as well. The globes are\nunremarkable. Significant stranding in the subcutaneous tissues of the head is\nlikely related to third spacing.", + "output": "1. Persistent contrast material within the intracranial vessels limits\ninterpretation of this study. Allowing for this limitation, there is no\ndefinite acute hemorrhage, edema, mass effect, or acute large vascular\nterritorial infarction. If concern for acute intracranial process remains, MRI\ncould be performed for additional evaluation if there is no clinical\ncontraindication.\n\n2. Hypodensity in the right basal ganglia likely represents an old lacune.\n\n3. Fluid is seen in the bilateral mastoid air cells, left greater than right,\nas well as the left middle ear cavity. Fluid is also seen layering within the\nbilateral sphenoid sinuses, multiple ethmoid air cells, and the bilateral\nmaxillary sinuses as well. This may be related to prolonged intubation.\n\n4. Significant stranding in the subcutaneous tissues of the head is likely\nrelated to third spacing." + }, + { + "input": "There is no evidence of a large territorial infarction or hemorrhage. The\nventricles and sulci are normal in size and configuration.\n\nMotion artifact limits evaluation. There is no evidence of a grossly\ndisplaced fracture. The nasal septum has leftward deviation. There is left\nfrontal and maxillary sinus mucosal thickening with a left maxillary sinus\nmucous retention cyst.. There is mild mucosal thickening of the ethmoid air\ncells. The visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "Motion artifact limits evaluation. Within this limitation, there is no\nevidence of a large territorial infarction or hemorrhage." + }, + { + "input": "There is left greater than right maxillary sinus opacification. There is\nleftward deviation of the nasal septum. There is moderate mucosal thickening\nof the ethmoid air cells. The orbits are unremarkable. A nondisplaced left\nmandibular ramus extending into the coronoid process is demonstrated\n(602:132), just below the condyle. The temporomandibular joint is intact on\nthe right and on the left.. The entire mandible is not included on this exam.", + "output": "Nondisplaced left mandibular ramus fracture.\n\nNo orbital fracture is demonstrated." + }, + { + "input": "There is no evidence of large territorial infarction,acute intracranial\nhemorrhage, edema, or mass effect. There is prominence of the ventricles and\nsulci suggestive of involutional changes. Periventricular white matter\nhypodensities are nonspecific, but likely sequela of chronic small vessel\nischemic disease.\n\nThere is no evidence of acute fracture. There is mild to moderate mucosal\nthickening of the left maxillary sinus and partial opacification of the\ninferior most right mastoid air cells. The visualized portion of the\nremaining paranasal sinuses, left mastoid air cells, and middle ear cavities\nare clear.", + "output": "No acute intracranial hemorrhage." + }, + { + "input": "There is no evidence of acute hemorrhage mass effect midline shift or\nhydrocephalus. There is an area of encephalomalacia in the right frontal lobe\nunchanged from the previous MRI. Artifacts from previous port straight\ncommunicating artery coiling are seen in the right paraclinoid region. \nOtherwise the gray-white matter differentiation is maintained. The ventricles\nand sulci are normal in size.\n\nThe visualized paranasal sinuses are clear. No skull fracture is seen.", + "output": "No acute intracranial abnormalities are identified. Right frontal\nencephalomalacia and previous aneurysm coiling are noted." + }, + { + "input": "Streak artifact from previous right aneurysm coiling somewhat limits\nevaluation of the midbrain. However, within these limitations, there is no\nevidence of acute infarction, hemorrhage, edema, or mass. Focal\nencephalomalacia at the right frontal lobe is again present and stable. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormalities." + }, + { + "input": "There is no evidence of infarction,intracranial hemorrhage,edema,or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Mucous retention cyst is noted in the right\nmaxillary sinus, no air-fluid levels are seen. Anatomical variation of the\nparanasal sinuses consistent with pneumatization of the anterior clinoid\nprocesses bilaterally, otherwise, the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare unremarkable clear. \nThe visualized portion of the orbits are normal.", + "output": "No evidence of acute intracranial process or hemorrhage." + }, + { + "input": "Aero digestive tract:\n\nThere is no mass.\n\nNeck lymph nodes:\nThere is no adenopathy involving bilateral levels ___.\nThere is no retropharyngeal adenopathy.\n\nExtra nodal tumor spread:\nThere are no findings suggestive of extra nodal extension.\n\nDeep neck muscles, masticator space:\nUnremarkable.\n\nBones, skull base:\nUnremarkable.\n\nVessels:\nThe major vascular structures enhance normally.\n\nBrachial Plexus:\nThere is no brachial plexus contact or invasion.\n\nThyroid, salivary glands:\nThere is a 1.3 cm SI dimension nodule in the inferior aspect of the left\nthyroid lobe. CT appearance of the parotid submandibular glands is\nunremarkable.\n\nOther findings:\nPlease refer to the separate chest CT for thoracic findings including\npartially imaged upper mediastinal soft tissue mass.\nRight maxillary sinus mucous retention cyst.", + "output": "1. No cervical lymphadenopathy.\n2. 1.3 cm left thyroid nodule for which further assessment with ultrasound is\nrecommended.\n3. Please refer to the separate chest CT for description of thoracic findings,\nincluding a partially imaged upper mediastinal mass.\n\nRECOMMENDATION(S): Thyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or older, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or concerning mass. \nThere is a midline arachnoid cyst in the posterior fossa measuring 3.7 x 0.9\ncm. The ventricles and sulci are normal in size and configuration.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Incidentally noted posterior fossa arachnoid cyst." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute territorial infarction,hemorrhage,edema,ormass. \nThe ventricles and sulci are normal in size and configuration. There are\nperiventricular and subcortical lucencies suggestive of small vessel ischemic\nchanges.\n\nThere is partial opacification of the right mastoid air cells with suggestion\nof surrounding osseous sclerosis, which may be seen in the setting of chronic\nmastoiditis. The paranasal sinuses appear clear. The orbits and globes\nappear within normal limits.\n\nCTA HEAD:\nThere are trace atherosclerotic calcifications within the cavernous segments\nof the bilateral internal carotid arteries. There is a large patent left\nposterior communicating artery as well as patent P1 segment arising from the\nbasilar terminus. There is a small right posterior communicating artery. The\nvessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. The dural venous\nsinuses are patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent. There is a common\norigin of the right brachiocephalic artery and left common carotid artery, a\nnormal anatomical variant.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches demonstrate no\nevidence of stenosis or occlusion. Tiny peripheral apparent linear filling\ndefect within the left vertebral artery distal V2 segment (3:171) may reflect\nluminal infolding due to a turn in the vessel at this site. The left\nvertebral artery is dominant. The left internal carotid artery is tortuous.\n\n\nOTHER:\nThe visualized portion of the lungs are clear. The thyroid gland appears\nenlarged with multiple nodules bilaterally. Findings appear similar to those\nseen on thyroid ultrasound dated ___ and are compatible with\nmultinodular goiter. There is nodular extension of thyroid tissue inferiorly\nto the superior mediastinum (3:64), which appears similar to findings from MRI\ndated ___. There is no lymphadenopathy by CT size criteria.", + "output": "1. Head CT: No acute territorial infarct, hemorrhage or mass.\n2. CTA Head: Patent circle of ___ without evidence of stenosis,occlusion,or\naneurysm.\n3. CTA Neck: Patent bilateral cervical carotid and vertebral arteries without\nevidence of stenosis, occlusion, or acute dissection. Tiny peripheral\napparent linear filling defect within the left vertebral artery distal V2\nsegment which probably represents luminal infolding due to a tight vessel turn\nat this site.\n4. Other: Findings compatible with multinodular goiter which appears grossly\nsimilar to prior studies, as above." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Mild sulcal widening suggests mild global atrophy, advanced for\nage. Ventricles are normal in size and morphology.\n\nThere is minimal thickening of the subcutaneous tissues along the right\nfrontal region (601:19), nonspecific. There is partial opacification of the\nbilateral ethmoid air cells and mild mucosal thickening of the bilateral\nmaxillary and sphenoid sinuses. There is pneumatized secretions in the right\nmaxillary sinus. Mastoid air cells and middle ear cavities are well aerated.\nThe bony calvarium is intact.", + "output": "No acute intracranial abnormality. Mild global atrophy, advanced for age." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is artifact from the anterior communicating artery aneurysm coil. \nWithin these limitations, there is no evidence of a residual lumen or new\nsubarachnoid hemorrhage. The previously seen subarachnoid hemorrhage\ncontinues to evolve. The hyperdensity within the suprasellar cisterns and\nsylvian fissures is now less conspicuous. There is no evidence of infarction.\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nRe-identified coiled anterior communicating aneurysm. There is moderate\natheromatous calcification of the carotid siphons bilaterally. The vessels of\nthe circle of ___ and their principal intracranial branches appear normal\nwith no evidence of stenosis, occlusion,or new aneurysm. The dural venous\nsinuses are patent.", + "output": "1. Patient status post anterior communicating artery aneurysm coiling. No\nevidence of residual lumen, infarct or new hemorrhage.\n2. Previously seen subarachnoid hemorrhage has demonstrated interval\nimprovement.\n3. The vessels of the circle of ___ appear patent without evidence of\nstenosis, occlusion or new aneurysm." + }, + { + "input": "There is no evidence of acute infarction,intracranial hemorrhage,edema,or\nmass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "There is no evidence of acute intracranial process or hemorrhage." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. There is mild\nprominence of the ventricles and sulci which is likely due to age-related\ninvolutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nPerfusion\nT max >6.0 is 3 ml.\nCBF > 30% is 0 ml\nThe perfusion study demonstrates infinite mismatched ratio.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No evidence of acute infarction or intracranial hemorrhage.\n2. Normal head and neck CTA.\n3. Normal perfusion study. The perfusion images demonstrate a small area of\nhypoperfusion in the left temporal lobe which appears artifactual." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass.\n\nThe ventricles and sulci are normal in size and configuration.\n\nThere is mild mucosal thickening along the anterior ethmoid air cells. The\nremainder of the paranasal sinuses and mastoid air cells appears clear. The\norbits appear unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. Note is\nmade of a fetal right PCA, normal anatomic variant. The dural venous sinuses\nare patent.\n\nCTA NECK:\nThere is approximately 30% proximal left ICA narrowing by NASCET criteria, and\nno narrowing of the right ICA by NASCET criteria. The carotidandvertebral\narteries and their major branches appear otherwise unremarkable.\n\nOTHER:\nThere is gravity dependent atelectasis. No suspicious pulmonary nodules. \nThere is a 6 mm hyper dense nodule in the anterior right thyroid lobe (series\n10, image 83). There is no lymphadenopathy by CT size criteria.", + "output": "1. Normal intracranial contents.\n2. Approximately 30% narrowing of the left proximal ICA.\n3. Normal CTA head.\n4. Hyperdense 6 mm right thyroid lobe nodule.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or older.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are age-appropriate.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Small right frontal scalp hematoma is\nnoted.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute large territory infarction, hemorrhage, edema,\nor mass. The ventricles and sulci are normal in size and configuration.\nChronic lacunar infarct left putamen. Findings consistent with moderate\nchronic small vessel ischemic changes.\n\nNo osseous abnormalities seen. Submucosal retention cyst left maxillary\nsinus, mild mucosal thickening maxillary, ethmoid, sphenoid sinus. Minimal\nopacification inferior left mastoid air cells. Paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality. No hemorrhage.\nChronic lacunar infarct left putamen.\nParanasal sinus disease." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of large territorial infarction,acute intracranial\nhemorrhage, edema, or mass. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. Confluent periventricular and subcortical\nwhite matter hypodensities are nonspecific, but likely sequela of chronic\nsmall vessel ischemic disease.\n\nThere is no evidence of fracture. There is minimal right maxillary mucosal\nring. The visualized portion of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "-No evidence of acute intracranial hemorrhage." + }, + { + "input": "The patient is status post right thoracotomy and tracheobronchial plasty since\nexamination of ___. Endotracheal tube and enteric tubes are noted. \nThere is thickening mainstem bronchi, overall similar to prior examination. \nThe thickening of the mid to lower extrathoracic trachea as well as coronal is\nmuch more prominent when compared to prior examination, measuring up to 8 mm\nin greatest thickness circumferentially. The lumen does appear relatively\nmore narrow when compared to expiratory phase of the ___ study,\nhowever this could be secondary to diffuse thickening. Region of slight\nhypoenhancement along the posterolateral right aspect of the trachea (series\n2, image 79), appears to be most likely artifactual or surgical material,\nhowever devitalized tissue is not entirely excluded.\n\nNo evidence of extraluminal gas. Surgical clips along the right prevertebral\nspace at the T5 vertebral level is new from prior examination, compatible with\nsurgical approach.\n\nNo evidence of rim enhancing collection or loculated fluid collections. There\nis no cervical lymphadenopathy by size criteria. The major salivary glands\nare unremarkable. The thyroid is unremarkable. The cervical vessels are\npatent. Right-sided central catheter is identified.\n\n2 mm right upper lobe pulmonary nodule (series 301, image 199) is identified.\n\nIncidental note is made of a partial empty sella.\n\nPolypoid opacification of the visualized ethmoid air cells and mild mucosal\nthickening of the maxillary sinus alveolar recesses is noted. Mild to\nmoderate opacification of the left greater than right mastoid air cells. The\nmiddle ears are clear. No suspicious osseous lesions.", + "output": "1. There is diffuse circumferential thickening of the mid to lower trachea to\nthe level of the carina (including extra thoracic levels), not seen on\npreoperative examination of ___. This measures approximately 8 mm in\ngreatest thickness.\n2. There does appear to be a region of slight hypoenhancement along the\nposterolateral right aspect of the trachea, which could represent surgical\nmaterial versus artifact, however devitalized tissue is not entirely excluded\nalthough no prominent loculated fluid collections, surrounding\nphlegm/stranding or extraluminal gas is identified. Otherwise, no definite\nfindings to suggest necrotic or ischemic foci.\n3. Diffuse circumferential thickening may be postsurgical in nature versus\ndiffuse infectious tracheitis.\n4. The patient is intubated, which does result in suboptimal evaluation of the\naerodigestive tract.\n5. Additional findings as described above.\n6. 2 mm right upper lobe pulmonary nodule.\n\nRECOMMENDATION(S): For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommend in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No acute intracranial findings." + }, + { + "input": "Encephalomalacia centered in the right parietal lobe and right insula are\nsimilar to prior suggestive of prior infarct. There is no evidence of\ninfarction, hemorrhage, edema, or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. Periventricular white matter\nhypodensities consistent with small vessel ischemic changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Unfused posterior arch of C1 is\nnoted, congenital.", + "output": "1. No evidence of acute intracranial bleed, large territory infarct or midline\nshift.\n2. Encephalomalacia from old right MCA territory infarct." + }, + { + "input": "Redemonstration of encephalomalacia of the right parietal lobe and right\ninsula, unchanged since ___. No evidence of new acute infarction,\nhemorrhage, edema, or mass effect. There is prominence of the ventricles and\nsulci suggestive of involutional changes. Periventricular and subcortical\nwhite matter hypodensities are nonspecific but likely sequelae of chronic\nsmall vessel ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Redemonstration of congenital unfused\nposterior arch of C1.", + "output": "1. No evidence of hemorrhage or acute intracranial process.\n2. Redemonstration of unchanged encephalomalacia from prior right MCA\nterritory infarct." + }, + { + "input": "Chronic encephalomalacia in the right MCA territory is again noted.\nPeriventricular white matter hypodensities suggest chronic microvascular\nischemic disease. No evidence of hemorrhage, acute major infarction, edema or\ndiscrete mass. Age related involutional changes noted.\n\nThere is mucosal thickening of the bilateral maxillary sinuses. The mastoid\nair cells and middle ear cavities are clear. The visualized portion of the\norbits are normal.", + "output": "Chronic right MCA infarct. Small vessel disease. Mild sinus mucosal\nthickening." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of acute intracranial process.\n2. No edema or mass effect to suggest intracranial mass, although MRI is more\nsensitive in the detection of intracranial lesions." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nNo acute intracranial process.\n\nCTA HEAD:\nThere is occlusion, flow-limiting stenosis, or large aneurysm.\n\nCTA NECK:\nNo evidence of occlusion, dissection, or flow-limiting stenosis.\n\nOTHER:\nPartially visualized small left pleural effusion. Previously seen prominent\nparaesophageal lymph node is either only partially imaged or decreased in\nsize. Prominent bilateral level 1B cervical lymph nodes seen on the recent\nPET-CT scan appear slightly decreased in size (9:137, 9:140). Left thyroid\ngland contains numerous subcentimeter hypoenhancing nodules.", + "output": "No significant abnormalities on CT of the head without contrast. No\nsignificant abnormalities on CT angiography of the head and neck. Other\nfindings as described above." + }, + { + "input": "CT head shows no evidence of hemorrhage, or loss of gray-white matter\ndifferentiation. No midline shift or hydrocephalus seen.\n\nCT angiography of the neck shows normal appearance of the carotid and\nvertebral arteries without stenosis or occlusion or dissection. There is\nenlarged left lobe of thyroid with a small area of calcification. No\nhyperdensity seen.\n\nCT angiography of the head shows normal appearance of the arteries of the\nanterior and posterior circulation without stenosis or occlusion or aneurysm\ngreater than 3 mm in size. A small apparent protuberance at the right\nposterior communicating artery cisternal portion on the 3D reformatted\nintracranial images (860:13) appears to be due to partial volume averaging of\nthe adjacent dorsum sella.", + "output": "No significant abnormalities on CT of the head without contrast. No\nsignificant abnormalities on CT angiography of the head and neck. Slightly\nenlarged left lobe of thyroid with calcification." + }, + { + "input": "There is no evidence of fracture, infarction, hemorrhage, edema, or mass\neffect. There is no loss of gray-white matter differentiation, midline shift,\nor hydrocephalus. The ventricles and sulci are normal in size and\nconfiguration. There is no abnormal enhancement on post contrast images.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "No evidence of acute intracranial abnormality. No abnormal enhancement seen\non postcontrast images." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. \nPeriventricular and subcortical white matter hypodensity is nonspecific, but\nlikely reflects sequelae of chronic small vessel ischemic disease. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. Mild prominence\nof the ventricles and sulci is appropriate for age.\n\nThere is mild mucosal thickening of the maxillary sinuses. The mastoid air\ncells and middle ear cavities are clear. The visualized portion of the orbits\nare unremarkable. Soft tissue attenuation in the bilateral external auditory\ncanals likely relates to cerumen buildup.\n\nCTA HEAD:\nThere are mild atherosclerotic calcifications of the cavernous segments of the\nbilateral internal carotid arteries. Otherwise, the vessels of the circle of\n___ and their principal intracranial branches appear normal without\nstenosis, occlusion, or aneurysm formation. There is persistent fetal origin\nof the right posterior cerebral artery. The dural venous sinuses are patent.\n\nCTA NECK:\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nA right internal jugular port catheter is partially visualized extending into\nthe SVC.\n\nNo suspicious pulmonary nodules are evident. The left thyroid lobe is\nenlarged and heterogeneous and demonstrates coarse calcifications. A dominant\nnodule in the left thyroid lobe measures up to 3 cm. There is no\nlymphadenopathy by CT size criteria.\n\nBone windows demonstrate multiple periapical lucencies in the maxilla and\nmandible.", + "output": "1. No evidence of infarction or hemorrhage.\n2. Patent circle of ___ with no evidence stenosis or aneurysm formation.\n3. No evidence of internal carotid artery stenosis by NASCET criteria.\n4. Enlarged left thyroid lobe with a dominant nodule measuring up to 3 cm.\n\nRECOMMENDATION(S): Thyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or older, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass. The ventricles and sulci are prominent for age suggesting accelerated\natrophy. Tiny hypodensity in the left putamen likely represents a prominent\nVR space versus lacune. Mild carotid siphon and vertebral artery\ncalcifications are noted. No osseous abnormalities seen. Small mucous\nretention cyst in the left maxillary sinus. The remainder the visualized\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\norbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "Patient is status post partial left tonsil resection, bilateral neck\ndissection, submental flap and tracheotomy with associated substantial\npostsurgical changes demonstrated along the oropharynx. There is asymmetry of\nthe tongue consistent with left lingual release. Surgical material\ndemonstrated along the left oropharynx in the site of the previously\ndemonstrated tonsillar mass which is not visualized. Otherwise, the airway is\npatent. A tracheotomy is noted inferior to the thyroid cartilage. No\nsurrounding fluid collection identified.\n\n There is substantial subcutaneous edema with small volume fluid deep to the\nplatysma bilaterally along the surgical site overlying the cricoid cartilage,\nwhich measures high density (series 2, image 63). This fluid measures up to\n1.0 cm in thickness. Small foci of subcutaneous air are likely related to\nrecent surgery. There is additional non organized fluid seen along the\nperivascular space near the carotid canal (series 2, image 51). A fluid\ncollection without rim enhancement along the inferior and slightly buccal\naspect of the left mandible measures 2.2 x 1.6 cm with small foci of air\n(series 2, image 50).\n\nThe thyroid gland appears normal. The neck vessels are patent.\n\nThe skullbase, included portions of the orbits and external auditory canals\nare within normal limits. No acute osseous abnormalities are demonstrated.\n\nPlease see dedicated separate report for same-day CT chest for description of\nintrathoracic findings. There are no osseous lesions.", + "output": "1. Status post left tonsillar resection and bilateral neck dissection with\nsubmental flap.\n2. 2.2 x 1.6 cm fluid collection with foci of air along the inferior aspect of\nthe left mandible without rim enhancement. Additional nonenhancing fluid and\nedema tracking along the platysma bilaterally immediately inferior to the\nsurgical site measuring approximately 1.0 cm in thickness. Additional non\norganized fluid is seen along the perivascular space on the left. Findings\nmay reflect postoperative seromas and expected postsurgical change, although\ninfection of these collections cannot be excluded on the basis of this exam.\n3. No fluid collection about the tracheostomy." + }, + { + "input": "Scattered bilateral subarachnoid hemorrhage is seen, for example at the\nparietal vertex on series 2, image 21 and 22 bilaterally, small amount in the\nright frontal lobe and left frontal lobe on series 2 image 17 and 20, and\nsmall amount in the left sylvian fissure. In addition, there is a small acute\nright cerebral subdural hematoma measuring no more than 3 mm in maximal\nthickness without significant mass effect. At the right frontal vertex, there\nis a dural-based hyperdense mass measuring approximately 3.5 x 2.1 cm\nsuggestive of meningioma. Age related involutional changes are present. \nThere is left periorbital soft tissue contusion. There is no acute fracture. \nBilateral globes and orbital contents appear preserved.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The native lenses are surgically removed bilaterally.", + "output": "1. Acute right cerebral subdural hemorrhage along the right frontal vertex\nmeasuring up to 4 mm in thickness.\n2. Scattered bilateral subarachnoid hemorrhage.\n3. Hyperdense extra-axial mass in the right frontal vertex measuring 2.1 x 3.5\ncm likely represents a meningioma." + }, + { + "input": "Avidly enhancing extra-axial 3.6 x 1.9 x 1.8 cm (AP, TRV, SI; series 3, image\n26) lesion overlying the right superior frontal gyrus is compatible with a\nmeningioma. Minimal underlying mass effect without evidence of white matter\nedema pattern.\n\nNo other enhancing mass lesions is identified on contrast enhanced CT exam. \nThere is no evidence of acute large territory infarct. Subarachnoid\nhemorrhage involving the bilateral frontal and parietal lobes as well as\nwithin the left sylvian fissure is overall similar to prior examination. \nPreviously seen subtle 4 mm thick right convexity subdural hemorrhage is less\nconspicuous on the current examination, compatible with evolution. No new\nhemorrhage.\n\nThe sulci, ventricles and cisterns are otherwise within expected limits for\nthe patient's mild to moderate senescent related global cerebral volume loss. \nThe paranasal sinuses are essentially clear. The orbits are unremarkable\nnoting bilateral lens replacements. The mastoid air cells middle ears are\nclear. There is a 0.6 x 2.3 cm (SI, TRV) left parietal osseous heterogeneous\ninvolving the outer table, without aggressive features, presumably a\nfibro-osseous lesion. Attention on follow-up is recommended.", + "output": "1. Enhancing right frontal extra-axial lesion measuring up to 3.6 cm is\ncompatible with a meningioma. Minimal underlying mass effect without evidence\nof white matter edema pattern. No other enhancing lesions identified on\ncontrast enhanced CT exam.\n2. Known right convexity 4 mm thick subdural hematoma is less conspicuous. \nScattered subarachnoid hemorrhage is similar to prior exam.\n3. There is a left parietal calvarial lesion, presumably a benign\nfibro-osseous lesion given lack of aggressive features, however close\nattention on follow-up is recommended.\n4. Additional findings as described above." + }, + { + "input": "Patient's previously noted approximately 3.6 x 2 cm right frontal extra-axial\nmass is grossly unchanged compared to ___ prior exam. The mass\nagain exerts mass effect on the right frontal lobe.\n\nPreviously noted subarachnoid hemorrhage and right convexity subdural\nhemorrhage are not definitely seen on current examination.\n\nThere is no evidence of fracture, infarction,acute/subacute hemorrhage\noredema. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. There are periventricular and subcortical lucencies,\nwhich may represent small vessel ischemic changes. Atherosclerotic vascular\ncalcifications are noted.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits demonstrate\nbilateral lens replacement postoperative changes.", + "output": "1. Grossly stable approximately 3.6 x 2 cm right frontal extra-axial mass\ncompatible again suggestive of meningioma.\n2. Previously noted subarachnoid hemorrhage and right hemisphere subdural\ncollections not definitely seen on current study.\n3. Within limits of study, no definite evidence of new acute/subacute\nintracranial hemorrhage.\n4. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nCT HEAD WITHOUT CONTRAST:\nThere is redemonstration of a 3.6 x 2.2 x 1.7 cm enhancing, extra-axial mass\nalong the right frontal convexity with similar mild mass effect on the\nadjacent sulci of the right frontal lobe, not significantly changed since the\nprior study. There is no evidence of acute infarction, hemorrhage, edema, or\nnew mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. There are periventricular and subcortical white matter\nhypodensities, nonspecific but likely reflect small vessel ischemic changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits demonstrate\nbilateral lens replacement postoperative changes.\n\nCTA HEAD:\nThere is fetal type origin of the left posterior cerebral artery, a normal\nvariant. The basilar artery is diffusely small in caliber.\n Nonocclusive atherosclerotic narrowing of bilateral cavernous and\nsupraclinoid internal carotid artery and bilateral V4 segments of bilateral\nvertebral arteries are seen.\n\nOtherwise, the vessels of the circle of ___ and their principal\nintracranial branches otherwise appear patent with no evidence of stenosis,\nocclusion,oraneurysm. The dural venous sinuses are grossly patent.\n\nAt least one vessel terminating within the right frontal convexity extra-axial\nmass is suggested to arise from the right anterior cerebral artery (see 303:\n___.\n\nOTHER:\nOn limited imaging of the neck soft tissues, surgical clips are suggested\nanterior to the left mid internal cervical carotid artery at approximately\nlevel of the C1-2 junction. Limited imaging of the parotid glands demonstrate\nbilateral subcentimeter nonspecific probable lymph nodes.", + "output": "1. Allowing for difference technique, grossly stable enhancing, extra-axial\nright frontal mass measuring approximately 3.6 x 2.2 cm with unchanged mild\nmass effect on the adjacent cerebral sulci compatible with provided history of\nmeningioma. At least 1 vessel arising from the right anterior cerebral artery\nis suggested to terminate within this mass.\n2. No acute intracranial abnormality. Please note MRI of the brain is more\nsensitive for the detection of acute infarct.\n3. Nonocclusive atherosclerotic narrowing of circle ___ as described.\n4. Otherwise, grossly patent intracranial arteries without significant\nstenosis, aneurysm or occlusion.\n5. Additional findings as described above." + }, + { + "input": "There is no evidence of infarction, or hemorrhage. A 1.6 cm partially\ncalcified, hyperdense extra-axial lesion abutting the inferior margin of the\ntentorium to the right of midline in the posterior fossa is consistent with a\nmeningioma.\n\nThe ventricles and sulci are normal in size and configuration.\nThere is no evidence of fracture. There is mild amount of mucosal thickening\nin the ethmoid air cells and right frontal sinus. Otherwise, the visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No evidence of hemorrhage or infarction.\n2. A 1.6 cm calcified lesion in the posterior fossa is consistent with a\nmeningioma." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nHyperdense partially calcified extra-axial mass just inferior to the right\naspect of the tentorium measuring 1.4 x 1.4 cm is compatible with patient's\nknown meningioma.\n\nThere is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are essentially clear besides a fluid level in the left maxillary\nsinus and scattered opacification of the ethmoids. The visualized portion of\nthe orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal with no evidence of stenosis, occlusion or aneurysm. There is a\nfetal right PCA.\n\nCTV HEAD:\nThe dural venous sinuses are patent. The lesion is seen to abut the inferior\nmargin of the tentorium to the right of midline. Although it is in close\nproximity to the anterior margin of the right transverse sinus and the\ninferior margin of the posterior straight sinus, there is no apparent venous\ninvasion.", + "output": "Extra-axial lesion in the posterior fossa abutting the inferior margin of the\ntentorium compatible with meningioma. No evidence of venous invasion." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage, or edema. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. The previously characterized 1.4 cm right cerebellar hyperdense\nlesion compatible with a meningioma appears similar to prior.\n\nThere is no evidence of fracture. The left frontal sinus is nearly completely\nopacified, with higher density material centrally, which may be reflective of\nchronic inspissated secretions or fungal colonization. The left anterior\nethmoid air cells are also partially opacified. Otherwise, the visualized\nportion of the remaining paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute hemorrhage or calvarial fracture.\n2. Stable 1.4 cm right cerebellar meningioma.\n3. Near complete opacification of the left frontal sinus and partial\nopacification of the left ethmoid air cells, similar to prior, with hyperdense\ncontents which may be reflective of chronic inspissated secretions or fungal\ncolonization." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\n\nPatient is status post right frontal craniotomy with mesh noted overlying the\nright frontal bone. There is no evidence of infarction, hemorrhage, edema, or\nmass. The ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is relative paucity of flow noted in the M1 and M2 segments of the right\nmiddle cerebral artery, grossly unchanged from CTA head ___. \nThe left MCA, bilateral ICAs, and bilateral ACAs are patent without evidence\nof stenosis, occlusion, or aneurysm. The bilateral vertebral arteries,\nbasilar arteries, and bilateral posterior cerebral arteries are patent without\nevidence of occlusion, stenosis, aneurysm. The dural venous sinuses are\npatent.", + "output": "1. No evidence of abnormality involving the left middle cerebral artery or\nbilateral intracranial internal carotid arteries.\n2. Relative paucity of flow in the M1 and M2 segments of the right middle\ncerebral artery, grossly unchanged from CTA head ___." + }, + { + "input": "There is no evidence of acute major vascular territorial infarction,\nhemorrhage, edema, or large mass. There is marked prominence of the\nventricles and sulci, which likely reflects central atrophy. Moderate\nbilateral periventricular white matter hypodensities are nonspecific, but\nlikely represent a sequela of chronic small vessel disease. Cavum septum\npellucidum is incidentally noted.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Marked atrophy and probable small vessel disease.\nNo acute hemorrhage or evidence of acute territorial infarction." + }, + { + "input": "There is no evidence of hemorrhage, infarction, edema,or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No evidence of acute intracranial abnormality." + }, + { + "input": "Study is limited secondary to patient body habitus and limited bolus timing.\n\nCT HEAD WITHOUT CONTRAST:\nAgain seen is an area of ill-defined low attenuation in the distribution of\nright middle cerebral artery (see 04:20 -24) in keeping with acute infarct. \nThis is better evaluated on subsequent diffusion-weighted MRI of the brain\nperformed on ___.\n\nThere is no evidence of acute intracranial hemorrhage,or mass. The ventricles\nand sulci are normal in size and configuration. No osseous abnormalities seen.\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is abrupt cut off of the segment M1 of the right middle cerebral artery\nimmediately prior to the bifurcation (see 5:293) concerning for occlusion. \nThere is opacification of the M2 segment of right middle cerebral artery,\nlikely secondary to retrograde filling.\n\nThere is atherosclerotic calcification within the segments of the internal\ncarotid arteries without significant stenosis. No aneurysm greater than 3 mm\nin size or other vascular abnormality is seen. The dural venous sinuses are\npatent.\n\nCTA NECK:\nThe evaluation of neck vasculature is limited due to poor contrast\nopacification of the vasculature. Within the limits of this technique, the\nCarotid and vertebral arteries and their major branches are patent with no\nevidence of stenoses. There is no evidence of internal carotid stenosis by\nNASCET criteria.The carotid,vertebralandsubclavian artery origins are patent.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Study is limited secondary to patient body habitus and limited bolus\ntiming.\n2. Acute infarct in the right middle cerebral artery distribution as described\nabove.\n3. Right middle cerebral artery M1 segment occlusion.\n4. Within limits of study, grossly normal neck CTA" + }, + { + "input": "Patient is status post thrombectomy for right MCA syndrome. There is an\nevolving area of hypodensity within distribution of the right middle cerebral\nartery involving the right frontal, parietal and temporal lobes and right\nbasal ganglia which is more prominent compared to prior imaging with loss of\ngray-white differentiation and local sulcal effacement. There is increased\neffacement of the frontal horn and anterior body of the right lateral\nventricle, compared to prior imaging as well as minimal 2 mm leftward midline\nshift. There is no evidence of hydrocephalus. There is a 4 mm linear\nhyperdensity which appears to be within the right sylvian fissure (series 3,\nimage 11), likely representing a vessel however, hemorrhagic conversion is not\nentirely excluded and for which a follow-up imaging is recommended.\n\nNo evidence of a new large vascular territory infarction. There is no evidence\nof edema, mass or mass effect. The ventricles, apart from the above-noted\nchanges, and sulci are normal in caliber and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Status post thrombectomy for right MCA syndrome, significant interval\nenlargement of right basal ganglia, frontal, parietal and temporal lobe\nhypodensities compatible with expected evolution of infarcts.\n2. There is a linear hyperdensity which appears to be within the right sylvian\nfissure, most likely representing a vessel, although hemorrhagic\ntransformation is not entirely excluded. Close interval followup is\nrecommended.\n3. Increased effacement of the frontal horn and anterior body right lateral\nventricle without evidence of hydrocephalus. Interval development of minimal\n2 mm leftward midline shift.\n4. No new large vascular territory infarction.\n\nRECOMMENDATION(S): Recommend interval head CT to document stability of linear\n4 mm hyperdensity likely located within the right sylvian fissure. Although\nthis is most likely a vessel, hemorrhagic transformation should be excluded." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are diffusely prominent, suggestive of underlying cerebral atrophy. \nIs preservation of gray-white matter differentiation. Calcifications are noted\nwithin the cavernous carotid arteries.\n\nNo osseous abnormalities seen. A mucous retention cyst is noted within the\nleft maxillary sinus. The paranasal sinuses, mastoid air cells, and middle ear\ncavities are otherwise clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of intracranial hemorrhage, acute large territorial\ninfarction, edema,or discrete mass. There is prominence of the ventricles and\nsulci suggestive of involutional changes. Periventricular and subcortical\nhypodensities are nonspecific, though likely sequela of chronic small vessel\nmicroangiopathy.\n\nThere is no evidence of fracture. Complete opacification of the right\nmaxillary sinus, right sphenoid sinus, right ethmoid air cells, and right\nfrontal sinus, unchanged in appearance compared to prior study. Near complete\nopacification of the left sphenoid sinus and partial opacification of the left\nethmoid air cells, slightly increased from prior study. Partial opacification\nof the right mastoid air cells, unchanged. Mild osseous sclerosis of the\nethmoid air cells and maxillary sinuses areas of hyperdensity in the C9\nsinuses and ethmoid air cells, which may represent inspissated secretions\nthough fungal colonization cannot be excluded. The visualized portion of the\norbits are unremarkable.", + "output": "1. No evidence of acute intracranial abnormality.\n2. Unchanged paranasal sinus disease containing hyperdense material suggesting\ninspissated material, difficult to exclude fungal colonization." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. Ventricles and\nsulci are prominent, consistent with age-related global parenchymal loss.\nPeriventricular, subcortical, and deep white matter hypodensities are\nnonspecific, but may represent small vessel ischemic changes.\n\nThere is complete opacification of the right maxillary sinus right ethmoid air\ncells, right frontal sinus, and bilateral sphenoid sinuses. There is partial\nopacification of the left ethmoidal air cells and left frontal sinus. \nHyperdense material in the sinuses may reflect inspissated secretions and/or\nfungal colonization. There is a mucous retention cyst in the left maxillary\nsinus. The mastoid air cells,and middle ear cavities are clear. The\nvisualized portion of the orbits are normal.\n\nCTA HEAD:\nThere are atherosclerotic calcifications of bilateral V4 segments of vertebral\narteries and the proximal basilar artery. There are severe atherosclerotic\ncalcifications of bilateral carotid siphons. The vessels of the circle of\n___ and their principal intracranial branches appear normal without\nstenosis, occlusion, or aneurysm. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is mild atherosclerotic calcification at the right vertebral artery\norigin. Bilateral carotid and vertebral artery origins are patent. There are\nmild atherosclerotic calcifications of bilateral carotid bifurcations, causing\napproximately 20% stenosis of the right internal carotid artery by NASCET\ncriteria. There is no evidence of dissection.\n\nThere are mild atherosclerotic calcifications of the aortic arch.\n\nOTHER:\nThe visualized portion of the lungs are clear. There is a 1 cm enhancing\nlesion in the right parotid gland, which may represent a lymph node or primary\nparotid lesion. There is a 9 mm right thyroid nodule which does not warrant\nfollow-up according to ACR criteria. There is no lymphadenopathy by CT size\ncriteria. There are mild to moderate degenerative changes of the cervical\nspine.", + "output": "1. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described.\n2. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n3. Patent bilateral cervical carotid and vertebral arteries without evidence\nof occlusion or dissection. There is approximately 20% stenosis of the right\ninternal carotid artery caused by calcified atherosclerotic plaque.\n4. Sinus disease as above.\n5. 1 cm enhancing lesion in the right parotid gland, which may represent a\nlymph node or primary parotid lesion. Ultrasound could be considered non\nemergently for further characterization.." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of acute territorial infarction,\nhemorrhage, edema, or mass/mass-effect. The ventricles and sulci are normal\nin size and configuration.\n\nThere is mild mucosal thickening of the left maxillary sinus. The remaining\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "Unremarkable head and neck CTA. No evidence of vascular injury.\n\nNOTIFICATION: The findings were communicated via telephone by Dr. ___ to\nDr. ___ surgery) at 23:04 on ___, 2 min after discovery." + }, + { + "input": "There is no evidence of acute large territorial infarction, intracranial\nhemorrhage, edema, or discrete mass. Age advanced involutional changes may be\nclinically correlated. No acute osseous abnormalities seen. The partially\nimaged paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The orbits demonstrate no acute abnormalities.", + "output": "1. No acute intracranial process.\n2. Age advanced involutional changes." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There are\nprominent ventricles and sulci. Subcortical and periventricular white matter\nhypodensities are again seen.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are intact, and the right lens is\nnot seen.", + "output": "1. No signs of intracranial bleed.\n2. Involutional changes and probable chronic small vessel ischemic disease." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, mass effect or large\nterritorial infarction. Prominence of the ventricles and sulci is likely\nrelated to age related involutional changes. Periventricular, deep, and\nsubcortical white matter hypodensities are nonspecific but likely sequela of\nsmall vessel ischemic disease.\n\nNo acute fractures identified. There is mild 2 more mucosal thickening\ninvolving the partially visualized left maxillary sinus. Other visualized\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. \nThere is evidence of right lens replacement.", + "output": "No evidence for acute intracranial abnormalities." + }, + { + "input": "Extensive left intraparenchymal hematoma with surrounding edema has increased\nin size from the previous examination now measuring 10.5 x 5.4 x 5.9 cm,\npreviously 6.3 x 4.0 x 5.3 cm. Mass effect on the left lateral ventricle and\nrightward shift of midline structures now measuring 13 mm, previously 10 mm\nhave increased from prior examination. There is increased crowding of the\nabdominal cistern, concerning for early uncal herniation (2:12, 601b:50). \nInterventricular hemorrhage involving the right frontal and occipital horns\nand left occipital horns of the lateral ventricles and fourth ventricle are\nnew from previous examination.", + "output": "1. Worsening extensive left intraparenchymal hematoma and mass effect with 13\nmm of midline shift and concern for early uncal herniation.\n2. New intraventricular hemorrhage.\n\nRECOMMENDATION(S): Neurosurgical consultation.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 3:46 AM, 1 minute after\ndiscovery of the findings." + }, + { + "input": "Again seen is an extensive left frontal intraparenchymal hematoma with\nassociated surrounding edema, which measures 5.8 x 9.9 cm and appears\napproximately similar compared to the prior exam in ___. There is\npersistent mass effect on the left lateral ventricle with rightward midline\nshift measuring 13 mm (series 2: Image 17). There is interval increase in\nthe intraventricular hemorrhage component compared to prior exam, now seen in\nthe occipital horns of the lateral ventricles.\n\nThere is no definite evidence of new intracranial hemorrhage. The ventricles\nappear stable compared to the prior exam. Atherosclerotic vascular\ncalcifications are noted of bilateral vertebral and cavernous portions of\ninternal carotid arteries. There are periventricular and subcortical\nlucencies, which may represent small vessel ischemic changes.\n\nThere is no evidence of acute fracture. There is near complete opacification\nof the left maxillary sinus, right sphenoid sinus, partial opacification of\nbilateral ethmoid air cells and complete opacification of the right sphenoid\nsinus, which may be related intubation status. The mastoid air cells appear\nclear. Patient is status post right lens replacement.", + "output": "1. Grossly stable extensive left frontal intraparenchymal hematoma with\nsurrounding associated edema compared to prior exam in ___.\n2. Grossly stable 13 mm left to right midline shift, with continued concern\nfor uncal herniation.\n3. Interval increase intraventricular hemorrhage.\n4. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct." + }, + { + "input": "There is no acute intracranial hemorrhage, edema, mass effect or shift of\nnormally midline structures. The ventricles and sulci are prominent,\nconsistent with global atrophy. Subcortical and periventricular white matter\nhypodensities are in keeping with chronic small vessel ischemic disease. The\nbasal cisterns appear patent and gray-white matter differentiation is\npreserved. Lens replacement is noted in the right globe. There is mucosal\nthickening in the right posterior ethmoid air cells, similar to prior. The\nremaining imaged paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The calvaria appear intact.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is a large parenchymal hemorrhage likely arising from the left basal\nganglia with significant intraventricular extension as seen on prior exam. \nBlood is seen filling the third and fourth ventricles with possible mild\ninterval increase in size of the lateral ventricles which raises potential\nconcern for obstructive hydrocephalus. No new site of hemorrhage. \nPeriventricular white matter hypodensity is similar to prior. Basal cisterns\nremain patent. No signs of cerebral sulcal effacement.\n\nThe imaged paranasal sinuses are clear. Secretions are seen within the\nnasopharynx which may be secondary to intubation. Mastoid air cells and middle\near cavities are well aerated. The bony calvarium is intact.", + "output": "Acute left basal ganglia hemorrhage with significant intraventricular\nextension, likely causing early obstructive hydrocephalus given marginal\nincrease in lateral ventricular size compared to prior exam performed earlier\nsame day. Recommend clinical correlation for ventriculostomy placement." + }, + { + "input": "Left parenchymal caudothalamic hemorrhage is stable in size without\nsignificant adjacent edema. Large volume of hemorrhage in the lateral, third,\nand fourth ventricles is also stable. There has been interval placement of a\nright frontal approach extraventricular drain terminating near the right\nforamen of ___. There is a trace amount of superficial blood near the\nventriculostomy insertion site, which could be parenchymal or leptomeningeal\n(image 2:21). Diffuse hydrocephalus is unchanged. Periventricular white\nmatter hypodensity could be secondary to transependymal CSF flow superimposed\nupon chronic small vessel ischemic changes. Dolichoectasia of the basilar\nartery and bilateral carotid siphon calcifications are noted.\n\nNo concerning osseous abnormality is seen. There is mild mucosal thickening\nof the bilateral ethmoidal air cells. There are secretions in the\nnasopharynx, likely secondary to prolonged supine positioning in the inpatient\nsetting. Mastoid air cells are clear.", + "output": "1. Right frontal approach EVD terminates near the right foramen of ___. \nTrace super fish blood products along the ventriculostomy placement side.\n2. Unchanged large-volume intraventricular hemorrhage. Unchanged diffuse\nhydrocephalus.\n3. Stable left parenchymal caudothalamic hemorrhage." + }, + { + "input": "The left parenchymal caudothalamic hemorrhage is stable in size with expected\ninterim development of mild adjacent edema. Large volume of hemorrhage in the\nlateral, third, and fourth ventricles is unchanged. The right frontal\napproach ventriculostomy catheter terminates along the lateral wall of the\nbody of the right lateral ventricle. There is small amount of blood along the\nparenchymal course of the catheter, slightly increased since the prior CT. The\nleft lateral ventricle appears slightly larger, and enlargement of the other\nventricles is unchanged.\n\nThere is a left frontal corona radiata chronic infarct, as seen previously. \nNo acute large vascular territorial infarct is seen. Periventricular white\nmatter hypodensities could be due to transependymal flow superimposed upon\nchronic small vessel ischemic changes. Dolichoectasia of the basilar artery\nand bilateral carotid siphon calcifications are again noted.\n\nThere is no evidence of concerning bone lesions. Endotracheal and orogastric\ntubes are partially visualized. Previously noted secretions in the\nnasopharynx have resolved.", + "output": "1. Stable left parenchymal caudothalamic hemorrhage with expected interim\ndevelopment of mild adjacent edema.\n2. Unchanged large volume intraventricular hemorrhage. Slight interim\nenlargement of the left lateral ventricle and stable enlargement of the\nremaining ventricles.\n3. Right frontal approach ventriculostomy catheter terminates along the\nlateral wall of the right lateral ventricle. Slightly increased blood\nproducts along the right frontal course of the catheter." + }, + { + "input": "The known left parenchymal caudothalamic hemorrhage is stable in size with\nexpected surrounding edema compared to prior exam on ___. \nIntraventricular hemorrhage is again noted in the lateral, third, and fourth\nventricles, similar to prior exam. There is stable appearance of the size of\nthe left lateral ventricle, measuring 2.9 cm, previously 2.8 cm. Small amount\nof rightward midline shift persists, measuring 8 mm.\n\nA right frontal approach ventriculostomy catheter is seen terminating along\nthe body of the right lateral ventricle. A small amount of hemorrhage is seen\ntracking along the ventriculostomy course, similar to prior exam. No new\nintracranial hemorrhage is identified.\n\nA chronic left frontal corona radiata infarct is unchanged. Ill-defined\nperiventricular subcortical white matter hypodensities are likely due to\nsequela of chronic small vessel ischemic disease. The endotracheal tube and\nenteric tube are incidentally noted.\n\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "Stable appearance of known left parenchymal caudothalamic and intraventricular\nhemorrhage since the prior exam on ___. No new intracranial hemorrhage\nis identified." + }, + { + "input": "There has been interval placement of a new left frontal approach\nventriculostomy with the catheter tip traversing the left ventricle and\nterminating within the intraventricular clot. The position of the right\nfrontal approach ventriculostomy tip is unchanged. Unchanged volume of\nintraventricular hematoma, left caudothalamic intraparenchymal hematoma and\nadjacent edema. The size of the left ventricle is unchanged measuring\napproximately 2.8 cm. The size and configuration of the remaining ventricular\nsystem is unchanged. There is no evidence of new or enlarging hemorrhage.\n\nA chronic left frontal corona radiata infarct is unchanged. Ill-defined\nperiventricular subcortical white matter hypodensities are likely due to\nsequela of chronic small vessel ischemic disease. The endotracheal tube and\nenteric tube are incidentally noted.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Left ventriculostomy catheter traverses the left ventricle in terminates\nwithin the intraventricular clot. Unchanged position of right\nventriculostomy.\n2. Unchanged intraventricular and intraparenchymal hematomas. No new or\nenlarging hemorrhages.\n3. Unchanged hydrocephalus." + }, + { + "input": "The previously in bilateral ventricular catheters are again visualized. The\nleft-sided EVD appears to have been slightly withdrawn. The ventricular size\nis unchanged including aeration of the temporal horns with intraventricular\nblood as before. Hypodensity in the left periventricular region is again\nseen. No new hemorrhage.", + "output": "Slight change in position and the tip of the left EVD. Otherwise the\nexamination is unchanged." + }, + { + "input": "Interval decrease in size of the lateral ventricles. The position of the\nbilateral frontal approach ventriculostomies are unchanged. Unchanged volume\nof intraventricular hematoma, left caudothalamic intraparenchymal hematoma and\nadjacent edema. There is no evidence of new or enlarging hemorrhage.\n\nA chronic left frontal corona radiata infarct is unchanged. Ill-defined\nperiventricular subcortical white matter hypodensities are likely due to\nsequela of chronic small vessel ischemic disease. The endotracheal tube and\nenteric tube are incidentally noted.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Interval decrease of hydrocephalus.\n2. Unchanged intraventricular and intraparenchymal hematomas. No new or\nenlarging hemorrhages." + }, + { + "input": "Ventriculostomy catheter streak artifact limits examination.\n\nSlight interval decrease in size of the lateral ventricles is noted. The\nposition of the bilateral frontal approach ventriculostomies are unchanged. \nGrossly stable intraventricular hemorrhage, and left caudothalamic\nintraparenchymal hematoma and adjacent edema are note. There is no evidence\nof new or enlarging hemorrhage.\n\nA chronic left frontal subcortical infarct is unchanged. Ill-defined\nperiventricular and subcortical white matter hypodensities are likely due to\nsequela of chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Bifrontal ventriculostomy catheter streak artifact limits examination.\n2. Slight interval decrease of ventriculomegaly compared to most recent\nexamination.\n3. Stable intraventricular and intraparenchymal hematomas.\n4. Stable bifrontal ventriculostomy catheters, as described.\n5. No new or enlarging hemorrhages." + }, + { + "input": "Ventricles are smaller compared to 2 days ago. There has been interval\nremoval of right frontal approach ventriculostomy catheter. Small amount of\nblood is noted in the tract, slightly more prominent compared to pre removal\nstudy. Left frontal approach ventriculostomy catheter remains. \nIntraventricular hematoma, left caudal thalamic intraparenchymal hematoma and\nadjacent edema appear overall similar to before, except the hematoma spanning\nthe third ventricle and left lateral ventricle frontal horn appears slightly\nsmaller than before. There is no new hemorrhage.\n\nChronic left frontal corona radiata infarct is unchanged. Periventricular and\nsubcortical white matter hypodensities are consistent with chronic small\nvessel disease.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Decreased hydrocephalus compared to 2 days ago.\n2. Intraventricular and intraparenchymal hematoma is slightly smaller at third\nand left lateral ventricle frontal horn. No new hemorrhage is identified.\n3. Interval removal of a right trans frontal ventriculostomy catheter. \nHemorrhage product along the tract is slightly more prominent when compared to\npre-removal examination." + }, + { + "input": "Small right frontal superficial intraparenchymal hemorrhage at the site of\nprior right frontal approach ventriculostomy catheter, with a small depressed\nbone fragment, are unchanged, with stable mild surrounding edema.\n\nA left frontal ventriculostomy catheter is in unchanged position, terminating\nalong the lateral margin of the ventricular system near the foramen of ___. \nTrace blood products along the left frontal parenchymal course of the\ncatheter, image 2:22, stable to slightly decreased since the most recent CT. \nThe posterior components of the lateral ventricles have slightly decreased in\nsize since ___. There is unchanged blood filling and expanding\nthe third and fourth ventricles, as well as unchanged blood in the occipital\nhorns of the lateral ventricles.\n\nHemorrhage centered in a left thalamus appears slightly smaller compared to\nseveral days earlier, with mild associated edema.\n\nThe ___ CT demonstrated slightly asymmetric, though likely\nartifactual hypodensity projecting over the anterior right temporal lobe. No\nasymmetry is seen on the present exam.\n\nThere is mild mucosal thickening in the frontoethmoidal recesses and anterior\nethmoid air cells, and partial opacification of bilateral mastoid air cells,\nboth of which are unchanged since ___ 60 and could be secondary to\nprolonged supine positioning in the inpatient setting.", + "output": "1. Stable position of left frontal ventriculostomy catheter. Slightly\ndecreased size of the lateral ventricles. Stable hemorrhage expanding the\nthird lateral ventricles, and stable hemorrhage layering in the occipital\nhorns.\n2. Parenchymal hemorrhage centered in the left thalamus has slightly decreased\nin extent compared to several days earlier.\n3. Stable small right frontal superficial parenchymal hemorrhage at the site\nof prior right frontal ventriculostomy." + }, + { + "input": "There is a left transfrontal approach external ventricular drain which\nterminates in the body of the left lateral ventricle adjacent to the foramen\nof ___. There is minimal blood along the drain tract, decreased from the\nprior CT. Again seen is a small amount of blood along the prior right\ntransfrontal external ventricular drain tract. The size of the left thalamic\nhematoma is slightly decreased in size. The degree of intraventricular blood\nalong the third ventricle and body of the left lateral ventricle is\nessentially unchanged. The amount of blood in the occipital horns of the\nlateral ventricles bilaterally is decreased, left greater than right. The\nfourth ventricular blood is also unchanged. There is no new focus of\nhemorrhage. There is 5 mm rightward shift of the midline structures, which is\nnot significantly changed. No evidence of acute infarct.\n\nThe imaged paranasal sinuses are clear. Partial opacification of the mastoid\nair cells is again noted.", + "output": "1. No significant interval change in degree of third, left lateral, and fourth\nventricular hemorrhage.\n2. Minimal decrease in blood in the occipital horns of the lateral ventricles\nbilaterally as well as decreased size of the left thalamic hematoma.\n3. Stable position of the left transfrontal external ventricular drain." + }, + { + "input": "Left trans frontal ventriculostomy catheter terminating in the anterior body\nof the left lateral ventricle near the foramen ___ is stable. When\ncompared to prior examination, there appears to be interval increased size of\nthe lateral ventricles with prominence of the temporal horns, concerning for\nprogressing hydrocephalus.\n\n1.9 x 2.0 cm left subthalamic parenchymal hemorrhage with ventricular\nhemorrhage within the bilateral occipital horns and the fourth ventricle is\nsimilar to prior examination. Right frontal parenchymal hemorrhage along a\nventriculostomy tract is also similar to prior examination. There is no\nevidence for large acute territorial infarct or new hemorrhage.\n\nThe orbits are unremarkable. The visualized paranasal sinuses are essentially\nclear. There is opacification of the bilateral mastoid air cells. Allowing\nfor the left ventriculostomy catheter, no acute osseous abnormality.", + "output": "1. Interval increased size of the lateral ventricles with prominence of the\ntemporal horns concerning for progressing hydrocephalus.\n2. The position of the left trans frontal ventriculostomy catheter terminating\nin the left lateral ventricle is stable.\n3. No acute large territorial infarct. Unchanged appearance of left thalamic\nparenchymal hemorrhage with dependent hemorrhage within the occipital horns of\nthe lateral ventricles. Unchanged right frontal parenchymal hemorrhage along\na ventriculostomy tract.\n\nNOTIFICATION: The findings were discussed with ___, by\n___, M.D. on the telephone on ___ at 10:48 AM, 10 minutes\nafter discovery of the findings." + }, + { + "input": "The 1.9 x 2.0 cm left subthalamic intraparenchymal hemorrhage with ventricular\nextension in the fourth ventricle and layering dependently in the bilateral\noccipital horns is unchanged. Stable rightward midline shift. The right\nfrontal parenchymal hemorrhage along the previous ventriculostomy tract is\nalso unchanged. Left frontal approach ventriculostomy catheter terminating in\nthe anterior body of the left lateral ventricle is stable in position. There\nis no evidence of new infarct or new hemorrhage. Chronic left frontal corona\nradiata infarct is unchanged.\n\nThe ventricles are unchanged in size. The basilar cisterns are patent.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses and middle ear cavities are clear. There is unchanged opacification\nof the bilateral mastoid air cells most likely to prolonged supine position in\nthe inpatient setting or intubation. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Unchanged ventricular size.\n2. Stable positioning of left frontal ventriculostomy.\n3. Evolution of left subthalamic parenchymal hemorrhage with ventricular\nextension.\n4. Evolution of right frontal parenchymal hemorrhage along the previous right\nventriculostomy tract." + }, + { + "input": "Left frontal ventricular drain is identified extending to the ventricle. \nSmall hematoma in the left thalamus/lateral ventricle is again seen. There is\nno new hemorrhage identified. Small amount of blood is seen in the occipital\nhorns of the lateral ventricles. The ventricular size is unchanged.", + "output": "No acute intracranial abnormalities are identified. No change from previous\nstudy." + }, + { + "input": "The left frontal ventricular drain is unchanged in position, terminating in\nthe anterior body of the left lateral ventricle. The left thalamic hematoma\nwith ventricular extension into the fourth ventricle is stable in size since\nthe prior study, measuring 1.6 x 1.5 cm (3:25). There is persistent 3 mm\nrightward shift of normally midline structures. There is no evidence of new\ninfarction or new hemorrhage. Previously described chronic left frontal\ncorona radiata infarct is unchanged. The ventricles are unchanged in size. \nBasilar cisterns remain patent.\n\nThere is no evidence of fracture. There is persistent mild mucosal thickening\nof the right maxillary sinus. The visualized portion of the remaining\nparanasal sinuses and middle ear cavities are clear. Partial opacification\nof the bilateral mastoid air cells persists. The visualized portion of the\norbits are unremarkable.", + "output": "1. Compared with the study from ___, no change in the size of\nthe left thalamic hematoma. Stable intraventricular hemorrhage.\n\n2. Persistent 3 mm rightward shift of normally midline structures. No new\nhemorrhage or infarction detected." + }, + { + "input": "There is stable hemorrhage involving anterior left thalamus, with stable mild\nadjacent edema. There is stable intraventricular hemorrhage within bilateral\noccipital horns. Ventricular size is stable. Stable minimal midline shift at\nthe level of third ventricle. There is stable punctate focus of high\nattenuation in the right centrum semiovale. Right frontal burr hole in place,\nwith right frontal tract, tiny focus of residual tract hemorrhage, stable. . \nLeft frontal burr hole with intraventricular drain terminating in the left\nfrontal horn, stable. There is stable chronic infarcts involving anterior\nleft putamen. There is no evidence of acute infarction,no new hemorrhage,. \nThere are mild chronic small vessel ischemic changes.\n\nThere is no evidence of fracture. There is stable opacification of bilateral\nmastoid air cells. The visualized portion of the paranasal sinuses, ,\nbilateral middle ear cavities are clear. The visualized portion of the orbits\nare unremarkable. There is degenerative arthritis of the left\ntemporomandibular joint.", + "output": "1. There is stable left thalamus hemorrhage, small volume intraventricular\nhemorrhage. Ventricular size is stable. There is no new interval hemorrhage." + }, + { + "input": "Subcortical and periventricular white matter hypodensities appear overall\nsimilar to the prior MRI allowing for difference in technique consistent with\nareas of demyelination. Prominent ventricles and sulci likely related to\natrophy related to patient's multiple sclerosis and appear slightly progressed\nfrom the prior study. There is no evidence of hemorrhage, edema, mass effect\nor acute large vascular territory infarction. The basal cisterns appear\npatent and there is preservation of gray-white matter differentiation.\n\nNo fracture is identified. The visualized paranasal sinuses, mastoid air cells\nand middle ear cavities are clear. The globes are unremarkable.", + "output": "Extensive subcortical and periventricular white matter hypodensities\nconsistent with demyelination overall similar to the prior MRI allowing for\ndifferences in technique. No acute large vascular territory infarction\nidentified. In this patient with background abnormality, MRI would be more\nsensitive for detection of acute process." + }, + { + "input": "The study is limited due to motion artifact. There is no intra-axial or\nextra-axial hemorrhage, edema, shift of normally midline structures, or\nevidence of acute major vascular territorial infarction. Ventricles and sulci\nare significantly prominent, similar to slightly progressed compared with\nprior, and likely related to involutional changes associated with known\nmultiple sclerosis. Significant periventricular and subcortical white matter\nhypodensities have progressed from prior, given differences in patient\nposition. The imaged paranasal sinuses are clear. Mastoid air cells and\nmiddle ear cavities are well aerated. The bony calvarium is intact.", + "output": "1. No acute intracranial process.\n2. Similar to slightly progressed appearance of global involutional changes,\nwith progression of periventricular and subcortical white matter\nhypodensities.\n3. MRI is more sensitive for the detection of intracranial masses." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema. The ventricles and\nsulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. Prominence of\nthe ventricles and sulci suggest involutional changes. There is a small\ncalcification in a right frontal sulcus, presumably vascular.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is mild atherosclerotic calcified and noncalcified plaque focally within\nthe left V4 segment (3:239). The vessels of the circle of ___ and their\nprincipal intracranial branches demonstrate no high-grade stenosis, occlusion,\nor aneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is mild atherosclerotic calcification as well as larger noncalcified\nplaques at the origins of bilateral cervical ICAs. The carotid and vertebral\narteries and their major branches demonstrate no high-grade stenosis,\nocclusion, or dissection. There is no evidence of internal carotid stenosis\nby NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. The ascending aorta is aneurysmally dilated measuring up to 4.7 cm.\nThe main pulmonary artery is dilated measuring 3.6 cm.", + "output": "1. Focal left V4 segment atherosclerotic plaque without significant narrowing.\nNo evidence of high-grade stenosis, occlusion, or aneurysm of the carotid or\nvertebral arteries.\n2. Aneurysmally dilated ascending aorta measuring 4.7 cm. Further evaluation\nwith dedicated CTA of the chest is recommended if not previously worked up.\n3. Enlarged main pulmonary artery measuring 3.6 cm. Findings may be secondary\nto pulmonary arterial hypertension.\n\nRECOMMENDATION(S): Aneurysmally dilated ascending aorta measuring 4.7 cm.\nFurther evaluation with dedicated CTA of the chest is recommended if not\npreviously worked up." + }, + { + "input": "When compared to the prior outside CT, there has been interval decrease in\nsize of the right intraparenchymal hemorrhage in the cerebellar hemisphere,\nnow measuring 1.4 x 1.3 cm (AP X TR) from previously 1.7 x 1.6 cm. The amount\nof hyperdense blood centered within the bleed has also decreased in size well\nas the surrounding edema.\n\nNo new hemorrhages are identified. There is no evidence of acute intracranial\ninfarction.\nNo significant change of the nonspecific periventricular hypodensities, likely\nsequela of chronic small vessel ischemic changes.\n\nUnchanged mild generalized parenchymal volume loss, most likely age related. \nStable mild prominence of the ventricular system and extra-axial CSF spaces,\nconsistent with the previously mentioned parenchymal volume loss.\n\nThe paranasal sinuses and mastoid air cells appear clear. Postsurgical\nchanges after right scleral band placement and bilateral lens replacement\nsurgery are noted. The orbits are otherwise unremarkable.", + "output": "1. Decrease in size the right cerebellar intraparenchymal hemorrhage with\ndecreased amount of hyperdense blood and surrounding edema.\n2. Unchanged nonspecific periventricular hypodensities, likely sequela of\nchronic small vessel ischemic changes." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of acute fracture. Postsurgical changes along the right\nzygomatic arch include plate and screw fixation. There is postsurgical change\ndemonstrated at the right orbital floor which is incompletely assessed.\nThere is a linear ossific density in the inferior orbit with surrounding soft\ntissue thickening which slightly displaces the inferior rectus muscle mass\nmedially, chronicity is indeterminate due to lack of prior imaging, however\nthis may be sequela from prior trauma or surgical fixation. Right globe\nprosthesis is noted.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear.", + "output": "1. No acute intracranial hemorrhage.\n2. Postsurgical changes status post plate and screw fixation of the right\nzygomatic arch appear intact.\n3. There is a linear area of ossification within the inferior orbit with\nsurrounding soft tissue thickening which slightly displaces the inferior\nrectus muscle medially, chronicity is indeterminate due to lack of prior\nimaging, however this may be sequela from prior trauma or surgical fixation. \nRight globe prosthesis." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are normal in size and configuration.\n\nMild mucosal thickening of the ethmoid air cells is seen. The visualized\nportion of the mastoid air cells,and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\n Atherosclerotic changes of the carotid bifurcations are seen without\nnarrowing of the internal carotid arteries, by NASCET criteria. The vertebral\narteries and their major branches appear normal with no evidence of stenosis\nor occlusion.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Normal head and neck CTA.\n2. No acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or large mass. The\nventricles and sulci are normal in size and configuration. No osseous\nabnormalities seen. The paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Normal study." + }, + { + "input": "There is no evidence of large territorial infarction,acute intracranial\nhemorrhage,edema,or mass effect. There is mild prominence of the ventricles\nand sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Status post\nbilateral lens replacement.", + "output": "No evidence of acute intracranial hemorrhage or fractures." + }, + { + "input": "The previously described extra-axial right frontal hemorrhage has slightly\nenlarged, now measuring 9 x 7 mm, previously 6 x 4 mm (2:14, 400b:21). No new\nintracranial hemorrhage identified. No evidence of mass effect. Prominence\nof the ventricles and sulci suggest age related volume loss. Bilateral\nperiventricular subcortical white matter hypodensities are nonspecific and\nunchanged, likely sequela of chronic small vessel ischemic disease.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Previously described right frontal hemorrhage, likely subarachnoid, has\nslightly enlarged, now measuring 9 x 7 mm, previously 6 x 4 mm. No new\nintracranial hemorrhage identified." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territory infarct. Gray-white matter\ndifferentiation is preserved. There is no hydrocephalus. The visualized\nparanasal sinuses are clear. The mastoid air cells are clear. No acute\nfracture is seen.", + "output": "No acute intracranial process." + }, + { + "input": "Again seen is a large right MCA and PCA territory infarct. This is not\nsignificantly changed in appearance since the recent prior exam. Mild midline\nshift of 3 mm at the level of the third ventricle is stable. There is no acute\nintracranial hemorrhage or evidence of new infarct. Multiple discrete\nhypodensities in the left basal ganglia may represent prior lacunar infarcts\nor Virchow ___ spaces. The basal cisterns remain patent.\n\nThere is no fracture. The patient is status post left frontotemporal\ncraniotomy with aneurysm clipping. The visualized paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear.", + "output": "Stable appearance of large right MCA and PCA territory infarct. No\nhemorrhage." + }, + { + "input": "Head CT: There is a large infarct is in the right MCA and PCA territories,\nlargely unchanged from prior examination. There is associated cerebral edema\nwithin the right cerebral hemisphere with mild mass effect on the right\nlateral ventricle the ventricles are stable in size. Chronic infarcts or\nprominent perivascular spaces seen in the left subinsular region and left\nmidbrain. No fractures are identified. Postsurgical device is seen on series\n2, image 10.\n\nHead CTA: The intracranial carotid and vertebral arteries and their major\nbranches are patent with no evidence of stenoses, occlusions or aneurysm\nformation. There is a calcification within a distal branch of the right\nmiddle cerebral artery which may represent a small calcified embolus although\nthere is opacification of this vessel distal to the calcification. There are\natheromatous calcifications within the bilateral cavernous internal carotid\narteries. There is an aneurysm clip with associated streak artifact in the\nregion of the left MCA bifurcation. There is also a left-sided craniotomy. The\ndural venous sinuses appear patent. The right posterior cerebral artery is\nfetal in origin.\n\nNeck CTA: The aortic arch demonstrates conventional 3 vessel branching. The\norigins of the great vessels are patent. The vertebral arteries are\ncodominant. There is atheromatous calcification at the origin of the left\nproximal internal carotid artery without evidence of hemodynamically\nsignificant stenosis. There is atheromatous hard and soft plaque at the origin\nof the proximal right internal carotid artery with stenosis measuring\napproximately 70%. There is also a filling defect just proximal to the\nbifurcation, within the right common carotid artery. Distal to the stenosis,\nthe right internal carotid artery is patent and normal in caliber.\n\nThere is biapical pulmonary emphysema. There are postoperative changes of a\nprior median sternotomy. There is a hypodense right thyroid nodule which\nmeasures 1.0 cm. Ultrasound examination could further evaluate, as clinically\nwarranted. The submandibular glands and parotid glands appear normal.", + "output": "1. Large right MCA/PCA territorial infarct with associated right cerebral\nhemisphere edema and mild mass effect on the right lateral ventricle. The\nventricles are stable in size.\n2. Probable calcified embolus within a distal right MCA branch although this\nvessel is opacified distal to the calcification.\n3. Stenosis of the proximal right internal carotid artery which measures\napproximately 70% with additional filling defect within the right common\ncarotid artery, just proximal to the stenosis. The right internal carotid\nartery distal to this stenosis remains patent.\n4. Postoperative changes of prior left-sided craniotomy with clip in the\nregion of the left MCA bifurcation." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, midline shift, or acute\nmajor vascular territorial infarct. Incidentally noted is a 2.9 x 1.6 x 1.9\ncm right middle cranial fossa arachnoid cyst, with mild mass effect on the\nadjacent anterior right temporal lobe. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process, no hemorrhage.\nAn incidental 2.9 cm right middle cranial fossa arachnoid cyst." + }, + { + "input": "There is no acute hemorrhage, edema, shift of normally midline structures, or\nloss of gray/white matter differentiation. Ventricles, sulci, and basal\ncisterns are normal in size. All components of the right lateral ventricle,\nexcept the temporal horn, are larger than the left, indicating congenital or\ndevelopmental etiology for the asymmetry. The cerebellar tonsils are normally\npositioned.\n\nNo concerning osseous abnormality is seen. The orbits appear unremarkable. \nPartially visualized paranasal sinuses are well-aerated. Middle ear cavities\nand mastoid air cells are also well aerated.", + "output": "No evidence for acute intracranial abnormalities." + }, + { + "input": "Evaluation is limited by motion artifact on the CTA. Within these confines:\n\nCT HEAD WITHOUT CONTRAST:\nThere is right frontal parietal and temporal loss of gray-white\ndifferentiation, compatible with acute infarction. There is also hypodensity\nin the right caudate nucleus. There is punctate focus of hyperattenuation in\nthe right middle frontal gyrus, which may represent petechial hemorrhage (2,\n24).\n\nThere is no evidence of midline shift. The ventricles and sulci are normal in\nsize and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are normal.\n\nThere is remote fracture deformity of the right zygoma.\n\nCTA HEAD:\nThere is fetal type configuration of the right posterior cerebral artery.\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. The dural venous\nsinuses are patent.\n\nCTA NECK:\nThere is occulsion just distal to the origin of the left vertebral artery\nwithout distal reconstitution.\n\nThere is nonocclusive thrombus of the proximal cervical iright nternal carotid\nartery near the bifurcation.\n\nThere is no stenosis of the left internal carotid artery by NASCET criteria. \nThe right vertebral artery appears normal without evidence of stenosis or\nocclusion.\n\nOTHER:\nThere is a small branch vessel in the right upper lung which leads to a 7 mm\nnodule (3, 19) without internal cavitation. There is fraying surrounding\nground-glass opacity.\n\nThe visualized portion of the thyroid gland is within normal limits.\n\nThere is no lymphadenopathy by CT size criteria.", + "output": "1. Loss of gray-white differentiation in the right frontal, parietal and\ntemporal lobes as well as hypodensity in the right caudate nucleus. Findings\nare compatible with acute/subacute infarction. Possible petechial hemorrhage\nin the right middle frontal gyrus.\n2. Nonocclusive thrombus of the proximal cervical internal carotid artery near\nthe bifurcation.\n3. Occlusion of the left vertebral artery just distal to its origin.\n4. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n5. Non cavitary 7 mm right upper lung nodule, with a vessel leading to the\nnodule, highly suspicious for pulmonary septic emboli. Further evaluation\nwith CT chest is suggested.\n\nNOTIFICATION: At the time of this dictation, neurology team aware of above\nfindings as well as the subsequent MRI findings." + }, + { + "input": "There is a 6-7 mm aneurysm of the right ICA terminus (series 2, image 71) and\na 2-3 mm medially projecting outpouching of the right supra-clinoid ICA\n(series 2, image 61). There is a 2 mm medially projecting outpouching near\nthe genu of the left ICA (series 2, image 59), a 4 mm posteriorly projecting\nprojecting left ICA terminus outpouching (series 2, image 63) and an\nanteriorly projecting 3 mm outpouching of the very proximal left M1 segment\n((series 2, image 67). No additional aneurysms are identified. There is no\nocclusion or stenosis of the intracranial arterial circulation.\n\nThe paranasal sinuses are clear. The orbits are unremarkable. The mastoid air\ncells and middle ear cavities are well pneumatized and clear. Incidental note\nis made of a high riding right jugular bulb.", + "output": "1. 6-7 mm right ICA terminus/proximal M1 segment aneurysm.\n2. 2-3 mm medially projecting outpouching of the right supra-clinoid ICA and 2\nmm medially projecting outpouching of the left ICA genu potentially\nrepresenting infundibulum although aneurysms are not exclude.\n3. 4 mm posteriorly projecting left ICA terminus outpouching likely\nrepresenting aneurysm.\n4. 3 mm outpouching of the proximal left M1 segment, also likely representing\nan aneurysm." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, or loss of gray/\nwhite matter differentiation. The ventricles, sulci, and basal cisterns are\nnormal in size and configuration. There is faint hyperdensity in the region\nof the right ICA terminus aneurysm (image 3:14), which is better demonstrated\non the preceding CTA.\n\nNo osseous abnormalities seen. The included paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The included orbits are\nunremarkable.", + "output": "No acute hemorrhage. No evidence for other acute intracranial abnormalities." + }, + { + "input": "Postoperative changes with craniectomy identified in the left frontoparietal\nregion. There is a hypodensity in the left parietal lobe extending to the\nperiventricular region with several areas of high density due to metallic\nartifacts in the very tentorial region. There is no abnormal enhancement in\nthis region although evaluation somewhat limited due to streak artifacts. \nFindings indicate encephalomalacia. There are no other areas of abnormal\nenhancement seen. There is no midline shift or hydrocephalus. Bone images\ndemonstrate no lytic abnormalities.", + "output": "Left parietal encephalomalacia without definite area abnormal enhancement. No\nacute abnormalities. No abnormal enhancement seen in the other parts of the\nbrain." + }, + { + "input": "Surgical hardware streak artifact limits examination.\n\nRedemonstrated are stable postsurgical changes of left frontoparietal\ncraniotomy and cranioplasty. Encephalomalacia in this region with ex vacuo\ndilatation of the left lateral ventricle is unchanged. Within this region are\nmultiple small metallic elements with associated artifact, unchanged. Within\nthis limitation, there is no definite evidence of hemorrhage, edema, mass,\nmass effect, or acute vascular territorial infarction. There is no definite\nabnormal parenchymal or meningeal enhancement.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Surgical hardware streak artifact limits examination.\n2. Grossly stable postsurgical changes of left frontoparietal craniotomy and\ncranioplasty.\n3. Grossly stable frontoparietal encephalomalacia.\n4. Within limits of study, no definite evidence of hemorrhage, edema, mass\neffect, or acute large territorial infarction." + }, + { + "input": "Redemonstrated fractures of the right C6 inferior articulating facet, and C7\nlateral mass. There is also a tiny fracture fragment along the right\nanterolateral T1 vertebral body (2:112). While the C7 fracture does extend\nthrough the transverse foramen, no vascular injury is appreciated. Mild\nprevertebral edema is better evaluated on the concurrent cervical spine MRI.\n\nThe carotidandvertebral arteries and their major branches are patent with no\nevidence of stenoses. No evidence for dissection is seen.\n\nOther: The lung apices are clear. Thyroid gland is unremarkable. Cervical\nlymph nodes are not enlarged by CT size criteria.", + "output": "1. Patent carotid and vertebral arteries. No evidence of vascular injury.\n2. Redemonstrated fractures of the right C6 inferior articulating facet, C7\nlateral mass, and anterolateral T1 vertebral body." + }, + { + "input": "The patient is status post resection of a left cerebellar mass lesion. Air is\nscattered throughout the left cerebellar hemisphere, suprasellar region and\nthe frontal lobes bilaterally, consistent with recent surgery. A left\ninferior occipital craniotomy is noted. Tiny hypodensities in the deep white\nmatter are consistent with sequela of chronic small vessel ischemic disease.\n\nThe ventricles and sulci are normal size and configuration. The orbits are\nunremarkable. There is some degree of opacification of the mastoid air cells\nbilaterally. The paranasal sinuses are clear.", + "output": "1. The patient is status post resection of a left cerebellar mass. Air is\nscattered throughout the left cerebellar hemisphere, suprasellar region and\nthe frontal lobes bilaterally, consistent with recent surgery. No evidence of\nhemorrhage or large territorial infarction.\n\n2. Tiny hypodensities in the deep white matter are consistent with sequela of\nchronic small vessel ischemic disease." + }, + { + "input": "The patient is status post resection of a left cerebellar mass lesion with\nleft occipital craniotomy. A small focus of pneumocephalus is identified in\nthe surgical bed. High-density material is seen adjacent to the surgical bed\nis compatible with a combination of cranioplasty material and postoperative\nblood products, however no new area of infarction or intracranial hemorrhage\nis identified. There are very few scattered periventricular and subcortical\nwhite matter hypodensities, which are nonspecific, but compatible with chronic\nmicroangiopathy in a patient of this age. The ventricles and sulci are\nenlarged consistent with age related atrophy. The basal cisterns appear\npatent.\n\nThe paranasal sinuses are essentially. The mastoid air cells are opacified\nbilaterally. A high density fluid collection is seen in the subcutaneous\ntissues adjacent to the left occipital craniotomy consistent with a\npostsurgical collection, not significantly changed in size from the prior MRI.", + "output": "1. High-density material within the left occipital surgical bed is compatible\nwith a combination of cranioplasty material and postoperative blood products. \nNo evidence of acute intracranial hemorrhage or territorial infarction on the\ncurrent examination. If anti coagulation must be started, recommend short\ninterval follow-up head CT after the initiation of anti coagulation for\nfurther evaluation.\n2. 4.2 x 1.3 cm fluid collection in the subcutaneous tissues adjacent to the\nsurgical site, not significantly changed from the prior MRI on ___." + }, + { + "input": "The patient is status post left occipital craniectomy and resection of a left\ncerebellar mass with postoperative changes, including a stable subcutaneous\nfluid collection and a small focus of pneumocephalus. There is stable high\ndensity material within the surgical bed, which represents residual\npostoperative blood products. There is no evidence new hemorrhage or\ninfarction. There is prominence of the ventricles and sulci suggesting\nage-related atrophy. The subcortical and deep white matter hypodensities\nlikely represent chronic microvascular ischemic disease.\n\nThere is complete opacification of the mastoid air cells bilaterally,\npresumably due to prolonged supine positioning. The visualized portion of the\nparanasal sinuses and middle ear cavities are clear. The patient is status\npost bilateral cataract surgery. Otherwise, visualized portion of the orbits\nare unremarkable.", + "output": "1. Status post left occipital craniectomy and resection of a left cerebellar\nmass, with small amount of residual postoperative hemorrhage within the\nsurgical bed.\n2. No evidence of new hemorrhage." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass lesion. The\nventricles and sulci are normal in size. The visualized paranasal sinuses and\nmastoid air cells appear clear.\n\nCTA HEAD:\nThere is suggestion of a 2 mm medially and inferiorly projecting focal\noutpouching arising from the cavernous portion of the left internal carotid\nartery (3:60, 601b:24), which may represent a small aneurysm. Otherwise, the\nvessels of the circle of ___ and their principal intracranial branches\nappear normal with no evidence of stenosis, occlusion, or aneurysm. The dural\nvenous sinuses are patent.", + "output": "1. No infarction, hemorrhage, edema, or mass lesion.\n2. 2 mm focal outpouching arising from the cavernous portion of the left\ninternal carotid artery, which may represent a small aneurysm." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute infarction,hemorrhage,edema,ormass. \nPeriventricular and subcortical white matter hypodensity is nonspecific, but\nlikely reflect sequelae of chronic small vessel ischemic disease. Prominence\nof the ventricles and sulci are suggestive of involutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The orbits are unremarkable with the exception of\nbilateral lens implants.\n\nCTA HEAD:\nThere is a 2 mm probable infundibulum of the distal left P1 segment (3:235). \nThe vessels of the circle of ___ and their principal intracranial branches\nappear patent without stenosis, are occlusion. Atherosclerotic calcification\nof the cavernous and supraclinoid internal carotid arteries is noted without\nstenosis. The dural venous sinuses are patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent.\nCalcified and noncalcified plaque in tandem distribution along the right\ngreater than left common carotid artery results in about 10% stenosis. \nPredominantly calcified atherosclerotic plaque at the right carotid\nbifurcation results in up to 40% stenosis by NASCET criteria. Calcified and\nnoncalcified plaque at the left carotid bifurcation results in up to about 50%\nstenosis by NASCET criteria. The vertebral arteries are patent without\nevidence of stenosis, occlusion or dissection.\n\nOTHER:\nThe visualized portion of the lungs are clear. The thyroid gland is enlarged,\nwith a 1.3 cm calcified right sided nodule. There is no cervical\nlymphadenopathy by CT size criteria. Multilevel cervical spondylosis is\nnoted, more significant at C5-C6 level.", + "output": "1. No evidence of acute intracranial process or hemorrhage.\n2. 2 mm probable infundibulum of the distal left P1 segment.\n3. Patent circle of ___ without evidence of stenosis or occlusion.\n4. 40% right and 50% left internal carotid artery stenosis by NASCET criteria.\n5. Patent bilateral vertebral arteries.\n6. 1.3 cm calcified right thyroid nodule does not require follow-up unless\nclinically indicated.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "Small left parietal subarachnoid hemorrhage is stable. No new hemorrhage is\nseen. There is no parenchymal edema or mass effect. Ventricles and sulci are\nage-appropriate.\n\nNo concerning bone lesion is seen. Bilateral lens replacements are again\nnoted. Again seen is fluid and mucosal thickening in the maxillary sinuses,\ndependent secretions in left greater than right frontal sinuses, moderate to\nsevere opacification of anterior ethmoid air cells, mild mucosal thickening in\nposterior ethmoid air cells, and trace aerosolized secretions in bilateral\nsphenoid sinuses. Mastoid air cells are grossly well-aerated.", + "output": "1. Stable small left parietal subarachnoid hemorrhage. No new hemorrhage.\n2. Fluid and secretions in the paranasal sinuses may relate to prolonged\nsupine positioning in the inpatient setting or active sinus disease. Please\ncorrelate with symptoms." + }, + { + "input": "There is diffuse, symmetric loss of gray-white matter differentiation\ninvolving cerebral hemispheres, and deep gray matter nuclei including basal\nganglia, thalami supratentorially. Findings are most consistent with diffuse\ncerebral edema, most likely from diffuse anoxic injury, given clinical\nhistory. There are few tiny foci of parenchymal enhancement, including left\nvertex, which may represent some preserved brain parenchyma. There may be\nsome preservation of gray-white matter differentiation in the cerebellum,\nalthough, cerebellum appears abnormal as well. If clinically indicated, brain\nMRI would be helpful in further evaluation. There is residual intravascular\ncontrast from recently diminish third contrast for CT abdomen pelvis earlier\nthis morning. Visualized vessels appear patent. There is no evidence of\nhemorrhage or mass. There is generalized brain parenchymal atrophy at the\nvertex. There is symmetric linear increased enhancement of the tentorium\ncerebelli, which may be related to calcification and post-contrast images.\n\nThere is no evidence of fracture. There are secretions in the nasopharynx,\nlikely related to intubation. There is moderate opacification with fluid of\nthe sphenoid sinuses, mild opacification of ethmoid air cells, likely from\nintubation. Otherwise, the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "There is diffuse loss of gray-white matter differentiation, consistent with\ndiffuse edema, most likely from diffuse anoxic injury.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 4:39 pm, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "Since the previous MRI examination the patient has undergone frontal\ncraniotomy for resection of suprasellar mass. Blood products are seen in the\nsuprasellar region extending to the upper part of the sella. Expected\npostsurgical changes are seen with air in the subdural space. There is no\nhydrocephalus. Although evaluation is limited there is no large area of loss\nof gray-white matter differentiation seen.", + "output": "Expected postsurgical changes are seen." + }, + { + "input": "The patient is status post resection of craniopharyngioma with subsequent\nwound dehiscence at the surgical site along the right frontal convexity. When\ncompared to most recent CT dated ___, a right inferior frontal 12 mm\nheterogeneous collection is identified with decreased air collections. This\nappears slightly smaller than on the prior examination. There is stable mass\neffect with sulcal effacement of adjacent sulci is noted. There is no shift of\nmidline structures. Calcification in the sella is unchanged. Ventricles and\nsulci are within normal limits in size and configuration. No new hemorrhage or\nacute territorial infarction is identified. The gray-white matter\ndifferentiation is preserved. Basal cisterns are patent. Osseous structures\ndemonstrate postsurgical changes within the right frontal bone. Visualized\nmaxillary sinuses demonstrate mucosal thickening within the ethmoid air cells\nas well as the right maxillary sinus. The mastoid air cells and middle ear\ncavities are clear.", + "output": "Status post debridement of infection at right frontal craniotomy site for\nprior craniopharyngioma. This appears overall unchanged in size with subtle\neffacement of adjacent sulci. No new acute findings." + }, + { + "input": "Major glandular, vascular, and muscular structures throughout the neck are\nnormal in appearance. Scattered prominent cervical lymph nodes are noted\nthough none appear pathologically enlarged. The upper mediastinum is normal in\nappearance.\n\nLung apices appear unremarkable.\n\nNo pathologic osseous lesions are seen. Multilevel degenerative changes of the\ncervical spine are noted including multilevel degenerative disc disease.\n\nCircumferential right maxillary sinus mucosal thickening.", + "output": "1. No pathologic cervical lymphadenopathy.\n2. Paranasal sinus disease." + }, + { + "input": "The aerodigestive tract demonstrates no exophytic mucosal mass or focal areas\nof mass effect. The tonsils and salivary glands are unremarkable. The\nnasopharyngeal and oropharyngeal soft tissues are within normal limits. There\nis no effacement of the normal fat planes of the supra and infra hyoid neck\ncompartments. Scattered lymph nodes are not enlarged by CT size criteria nor\nhave they enlarged since prior. The larynx is within normal limits. The\nthyroid gland is unremarkable.\n\nThe cervical vessels enhance without evidence of high-grade stenosis or\nocclusion although this study is not as optimal as a dedicated CTA. Left\nvertebral artery arises directly from the aortic arch, a normal variant.\n\nThe imaged intracranial structures are unremarkable. Streak artifact from\ndental hardware limits evaluation for periodontal disease, though no obvious\nperiodontal or odontogenic abscess is identified. Mild mucosal thickening\nseen in the maxillary sinuses with significant interval improvement of mucosal\nthickening in the right maxillary sinus since prior. There is fusion of the\nvertebral bodies of C5 through C7. Minimal degenerative changes of the\ncervical spine are unchanged from prior.\n\nFor detailed description of the intrathoracic structures please refer to\nreport for concurrent chest CT.", + "output": "No cervical lymphadenopathy. No evidence of neck mass." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no exophytic mass, nor\nareas of focal mass effect. Evaluation of the cervical lymph chains\ndemonstrate no pathologic lymphadenopathy by imaging criteria. The visualized\nsalivary glands are unremarkable in appearance. No thyroid mass is seen. Neck\nvessels are patent. Upper lung fields are clear.\n\nAgain noted is fusion of the C5-C7 vertebral bodies. There is mild mucosal\nthickening of the maxillary sinuses. The visualized paranasal sinuses are\notherwise clear. The mastoid air cells and tympanic cavities are clear.", + "output": "No evidence of cervical lymphadenopathy. No neck mass." + }, + { + "input": "The thyroid gland, submandibular glands, and parotid glands appear normal.\nThere is no soft tissue mass or cervical lymphadenopathy. There are prominent\naxillary lymph nodes. Please see chest report for further details. The\nstructures of the aerodigestive tract appear normal.\n\nThere is a 4 mm right upper lobe pulmonary nodule which appears unchanged when\ncompared to ___. The lung apices are otherwise unremarkable.\n\nThe imaged intracranial contents are unremarkable. There is fusion of the C5\nthrough C7 vertebral bodies. There is multilevel cervical spondylosis.", + "output": "1. No cervical lymphadenopathy or soft tissue mass.\n2. Prominent axillary lymph nodes. Please see chest report for further\ndetails." + }, + { + "input": "There have been no significant changes since the prior study. Again seen, is\ninterbody fusion from C5 through C7. No other abnormalities are detected.\nEvaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.", + "output": "1. Normal neck CT. No evidence of masses or adenopathy." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by CT\ncriteria. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. Multilevel degenerative changes within the cervical spine\npersist unchanged. Patient is status post C5-C6 discectomy.\n\nThe orbits are unremarkable. Minimal mucosal thickening involves the anterior\nethmoidal air cells and bilateral maxillary sinuses with a small mucous\nretention cyst noted within the right maxillary sinus. Mastoid air cells are\nclear as are middle ear cavities. The right mastoid bone is under\npneumatized.", + "output": "Normal neck CT without evidence of adenopathy or masses." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There are several small left\naxillary nodes. None meet size criteria to suggest malignancy. There is no\nlymphadenopathy by CT criteria. The neck vessels are patent. Again seen, the\nthe patient is status post anterior fusion of the C5, 6 and 7 vertebral\nbodies.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.", + "output": "1. No adenopathy suggesting malignancy. Several small left axillary nodes are\nnoted. Status post cervical spine fusion. ." + }, + { + "input": "There is mucosal thickening noted within both maxillary sinuses as well as the\nethmoid air cells. No air-fluid levels are noted. The mastoid air cells are\nclear, as are the middle ear cavities. The ostiomeatal units are opacified\nbilaterally as well as the left frontoethmoidal recess. The cribriform plates\nare intact. The lamina papyracea are intact. Soft tissue debris within the\nright external auditory canal likely reflects cerumen.", + "output": "1. Sinus disease as described above. No air-fluid levels to suggest acute\nsinusitis." + }, + { + "input": "CT Head: There is no acute intracranial hemorrhage, mass effect, edema, or\nlarge territorial infarction. The ventricles and sulci are normal in size and\nconfiguration. The visualized bones are unremarkable in appearance.\n\nCTA Head and Neck: The cervical and intracranial carotid arteries and their\nmajor branches are patent. The left vertebral artery is patent without\nflow-limiting stenosis. There is gradual tapering of the right vertebral\nartery approximately 1.5 cm after its takeoff from the subclavian artery with\nocclusion and subtle areas of flow distally. The artery reconstitutes at the\nV4 segment with good intracranial flow (3:193). There is no evidence of\naneurysm >3 mm. The right internal carotid artery measures 9 mm approximately\nand 5 mm distally. The left internal carotid artery measures 9 mm and 4 mm\ndistally. A 9 mm thyroid nodule is noted in the isthmus (3:85). The lung\napices are clear.", + "output": "1. Gradual tapering of the right vertebral artery just after its takeoff from\nthe subclavian with occlusion and reconstitution of flow in the V4 segment,\nfindings are likely due to dissection.\n2. No flow-limiting stenosis in the intracranial internal carotid and\nvertebral arteries and their major branches.\n3. 9 mm thyroid nodule within the isthmus, a nonemergent thyroid ultrasound\ncan be obtained if clinically indicated." + }, + { + "input": "Head CT: There is no evidence of hemorrhage, edema, masses, mass effect, or\ninfarction. The ventricles and sulci are normal in caliber and configuration.\nNo fractures are identified. A stable probable arachnoid granulation is again\nnoted in the left frontal calvarium (series 8, image 457 on the current\nexamination and series 3, image 293 on the ___ head neck CTA). Mild\nbilateral maxillary sinus mucosal thickening is present.\n\nHead CTA: The intracranial carotid vertebral arteries and their major\nbranches are patent with no evidence of stenoses, occlusions or aneurysm\nformation. The left vertebral artery is dominant.\n\nNeck CTA: There is occlusion of the proximal right vertebral artery beginning\napproximately 1.5 cm after its takeoff from the subclavian artery. Compared to\nprior study, there has been interval improvement with reconstitution of flow\nwithin the vertebral artery, now all noted to start at the C5-C6 interspace,\npreviously having started at approximately the C1-2 level. The cervical\ncarotid arteries and left vertebral arteries are patent. There is no evidence\nof internal carotid artery stenosis by NASCET criteria. The distal right ICA\nmeasures 4.5 mm and the distal left ICA measures 4.5 mm.\n\nThere is a grossly stable 9 mm thyroid nodule again seen in the isthmus. The\nvisualized portion of the lung apices are clear. There are multilevel\ndegenerative changes in the spine.", + "output": "1. Continued occlusion of the origin of right vertebral artery, consistent\nwith patient's reported history of right vertebral artery dissection. Interval\nnew reconstitution of blood flow from C5-6 level, previously having been noted\nto reconstitute only at C1-2 level. Recommend clinical correlation and\nfollowup imaging as clinically indicated.\n\n2. Grossly stable 9 mm thyroid nodule in the isthmus.\n\n3. Mild bilateral maxillary sinus mucosal thickening." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. The basal cisterns appear\npatent, and there is preservation of gray-white matter differentiation.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.\n\nThere is a left frontal and temporal swelling and an apparent scalp laceration\nand hematoma. Bandage material is present over the left forehead.", + "output": "Left frontal and temporal scalp hematoma and likely laceration. Otherwise\nnormal study. ." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable with the exception of bilateral lens\nreplacements and a left scleral band.", + "output": "No acute intracranial abnormality. Please note that MRI is more sensitive in\nthe detection of acute infarct." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No CT findings of acute intracranial abnormality.\n\nNOTIFICATION: d" + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\nNo osseous abnormalities are seen. The paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The orbits are unremarkable.", + "output": "Unremarkable head CT." + }, + { + "input": "Head CT: Hypodensity in the right periventricular white matter into the\nputamen is likely an old infarct (2:25). Periventricular white matter\nhypodensities are consistent with chronic small vessel ischemic disease. There\nis no evidence of new hemorrhage, edema, masses, mass effect, or infarction.\nThe ventricles and sulci are prominent, consistent with age related volume\nloss. Mild mucosal thickening of the bilateral maxillary sinuses are noted. No\nfractures are identified.\n\nIncidental note is made of significant right pleural effusion, encompassing\nthe entire right lung apex, as well as pacemaker leads and atherosclerotic\ndisease of the aortic arch.\n\nHead CTA: There is one well-visualized anterior cerebral artery, suggesting\nazygos configuration of the ACA versus a hypoplastic anterior cerebral artery.\nThere is no evidence of aneurysm, stenosis or occlusion.\n\nNeck CTA: There is atherosclerotic calcifications at the origin of the left\nvertebral artery, which is mildly narrowed, but patent. The right carotid\nartery measures 5.1 mm proximally and 5.5 mm distally. The left carotid artery\ndemonstrates notable atherosclerotic calcifications and measures 3 mm\nproximally and 6.1 mm distally, consistent with a calculated 50% stenosis.", + "output": "1. No evidence of intra cerebral aneurysm, stenosis, or occlusion. The\npresence of one well-visualized anterior cerebral artery suggests azygos\nconfiguration of the ACA versus a hypoplastic anterior cerebral artery.\n\n2. Atherosclerotic calcifications noted at the origin the left vertebral\nartery and left carotid artery. The left carotid artery demonstrates 50%\nstenosis. The left vertebral artery is mildly narrowed but patent.\n\n3. Incidental note is made of a significant right pleural effusion, for which\ncorrelation on physical exam is advised." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass effect. The ventricles and sulci are prominent, consistent with\ninvolutional changes. There is periventricular and subcortical white matter\nhypodensity, which is nonspecific, but likely represents chronic microvascular\nischemic changes. There is calcification of the V4 segments of the bilateral\nvertebral arteries as well as calcification of bilateral carotid siphons.\n\nNo osseous abnormalities seen. There is mucosal thickening of some anterior\nethmoidal air cells and the left maxillary sinus. Incidentally noted right\nconcha bullosa. Otherwise, the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. Status post bilateral lens replacements.", + "output": "No acute intracranial abnormality." + }, + { + "input": "Head CT: There is a dense left MCA sign with loss of normal gray-white matter\ndistribution in the left MCA territory consistent with acute infarction. \nThere is no evidence of hemorrhagic transformation. There is no shift of\nmidline. A chronic left occipital infarct is again seen. There is\nperiventricular white matter low attenuation unchanged likely on the basis of\nchronic small vessel ischemic disease. The ventricles and sulci are normal in\ncaliber and configuration. No fractures are identified. The calvarium and\nskullbase are intact. Patient is status post bilateral lens replacement. \nThere is mucosal thickening within the maxillary sinuses with a superimposed\nright maxillary sinus mucous retention cyst. The remaining paranasal sinuses\nand mastoid air cells are clear.\n\nHead CTA: There is an abrupt termination of the left MCA consistent with of\nacute occlusion. The remaining intracranial vasculature is normal without\nevidence of aneurysm vascular malformation or further occlusion.\n\nNeck CTA: There is minimal calcification of the aortic arch. There is a\nnormal three-vessel takeoff. There is moderate calcified plaque at the right\ncarotid bifurcation with mild narrowing of the right proximal ICA. There is\nminimal calcification of the left carotid bifurcation without significant\nstenosis. The vertebral arteries and their major branches are patent with no\nevidence of stenoses. The distal right ICA measures 3.6 mm and the distal\nleft ICA measures 3.3 mm.\n\nThere is partially visualized enlargement of the right greater than left main\npulmonary arteries (series 8, image 4). The included lung fields are clear. \nThe visualized soft tissues of the neck are unremarkable. There are mild\ndegenerative changes in the spine.", + "output": "Occlusion of the left MCA proximal to the bifurcation with acute left MCA\nterritory infarction. No evidence of hemorrhagic transformation.\n\nRECOMMENDATION(S): There is partially visualized enlargement of the right\ngreater than left main pulmonary arteries. Clinical correlation is\nrecommended." + }, + { + "input": "There has been expected evolution of the large left MCA territory infarct,\nwith complete interval loss of gray-white matter differentiation, new\neffacement of the sulci, and new mild effacement of the frontal horn of the\nleft lateral ventricle. There is no shift of midline structures compared to\nbaseline, as the septum pellucidum was slightly deviated to the right on the\nprior CT when the infarction was barely visible. There is no herniation. No\nevidence of hemorrhagic transformation is seen.\n\nChronic left occipital infarct is again seen. The basal cisterns appear\npatent. Periventricular white matter hypodensities are consistent with\nchronic small vessel ischemic disease.\n\nNo osseous abnormalities seen. The partially included paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear.", + "output": "Expected evolution of the large left MCA territory infarct with new effacement\nof the sulci and new mild effacement of the frontal horn of the left lateral\nventricle. No evidence for acute hemorrhage.\n\nNOTIFICATION: These findings were discussed with Dr. ___ by Dr. ___\n___ telephone at 02:25 on ___, 5 minutes after discovery." + }, + { + "input": "No evidence of acute infarction,hemorrhage,edema, or mass effect. Hypodensity\nin the left temporal lobe inferiorly appears to be artifactual (series 2,\nimage 9). The ventricles and sulci are normal in size and configuration.\n\nNo evidence of fracture. Mucosal thickening of the ethmoidal air cells is\nvery mild. The visualized portion of the remaining paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable. 8 mm nodule in the left high scalp on series 2,\nimage 58 likely represents a sebaceous cyst.", + "output": "No hemorrhage or mass effect." + }, + { + "input": "Aero digestive tract: There is no mass.\n\n\nNeck lymph nodes: There are no cervical lymph nodes which are enlarged by CT\nsize criteria. There are subcentimeter slightly prominent left level 2 B\nlymph nodes on image 47 of series 2 corresponding to the hypermetabolic lymph\nnodes on PET-CT as well as a subcentimeter left level 3 lymph node\ncorresponding to the hyper body about lymph node on PET-CT. There is a mildly\nprominent right supraclavicular lymph node corresponding to the hypermetabolic\nnode on CT. There is also a prominent left supraclavicular lymph node on\nimage 69 of series 2. There are prominent axillary lymph nodes which are\npartially imaged as well as prominent upper mediastinal lymph nodes which are\npartially imaged.\n\nExtra nodal tumor spread: There are no findings suggestive of extra nodal\nextension.\n\nDeep neck muscles, masticator space: There is no muscle invasion.\n\nBones, skull base:\nThere are no acute osseous findings. There are degenerative changes of the\nspine.\n\nVessels: There is no vascular invasion. A right chest wall port is noted with\ninternal jugular approach catheter which extends into the superior vena cava,\nbelow field of view of the exam. There is mild vascular calcification at the\ncarotid bifurcations.\n\nBrachial Plexus: There is no brachial plexus contact or invasion.\n\nThyroid, salivary glands: There is no mass.\n\nOther findings: There are no lung nodules.", + "output": "1. Small lymph nodes on the left at level 2 and level 3 and in the\nsupraclavicular region bilaterally, corresponding to the avid lymph nodes seen\non the PET-CT. There also partially imaged prominent axillary and upper\nmediastinal lymph nodes which correspond to the FDG avid lymphadenopathy on\nCT." + }, + { + "input": "Aero digestive tract: There no mass.\n\nNeck lymph nodes:\n\nSimilar distribution of bilateral subcentimeter level 2 and 3 lymph nodes,\ncorresponding to a FDG avid nodes on recent PET-CT. Numerous bilateral level\n4 lymph nodes measuring up to 9 mm on the right are unchanged, and also\ncorrespond to FDG avid nodes on recent PET-CT (for example 2:61). Finally,\nbilateral level 7 lymph nodes measuring up to 8 mm are unchanged,\ncorresponding to FDG avid nodes on recent PET. Numerous partially imaged\nmediastinal and axillary lymph nodes are also similar, more completely\nevaluated on the concurrent CT chest.\n\nExtra nodal tumor spread: There are no findings suggestive of extra nodal\nextension.\n\nDeep neck muscles, masticator space: There is no muscle invasion.\n\nBones, skull base:\nThere is no bone involvement. Mild cervical spondylosis is redemonstrated.\nThere are no findings suggestive of perineural tumor extension. Jugular\nforamen, carotid canal, pterygopalatine fossa, infraorbital foramen, other\nskull base foramina are not involved.\n\nVessels: There is no vascular invasion. Trace calcification is again seen at\nboth carotid bifurcations. A right chest wall Port-A-Cath is redemonstrated.\n\nBrachial Plexus: There is no brachial plexus contact or invasion.\n\nThyroid, salivary glands: There is no mass.\n\nOther findings: There are no lung nodules.", + "output": "No significant interval change to multistation subcentimeter cervical lymph\nnodes corresponding to FDG avid node seen on PET-CT dated ___. \nPartially imaged prominent mediastinal and axillary lymph nodes are more\ncompletely assessed on the concurrent CT chest, and also correspond to FDG\navid nodes seen on PET-CT." + }, + { + "input": "There is no evidence of infarction, acute hemorrhage, or edema. There is a\nsmall focus of extra-axial density anterior to the left frontal lobe,\nmeasuring approximately 7 mm in transverse dimension (5:9). There is\nprominence of the ventricles and sulci suggestive ofmild age-related atrophy. \nSubcortical and periventricular white matter hypodensities are nonspecific,\nbut likely reflect the sequela of chronic small vessel ischemic disease.\n\nThere is no acute calvarial fracture. There is a small mucous retention cyst\nin the right mastoid air cells. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are otherwise clear.\n\nThe visualized portions of the orbits are normal.", + "output": "1. No definite acute intracranial abnormality.\n2. Small focus of intermediate density in the extra-axial left frontal lobe,\nwhich is nonspecific and likely artifactual. Recommend repeat CT imaging of\nthe head.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 2:51 pm." + }, + { + "input": "Aero digestive tract:\n\nThere no evidence for an exophytic mucosal mass.\n\nNeck lymph nodes:\nCompared to ___, multiple previously seen nonenlarged level 1\nthrough 4 lymph nodes have decreased in size.\nRight level 5 lymph node which was FDG avid on ___ now measures 4\nx 3 mm on image 3:23 compared to 6 x 4 mm on ___.\nLeft parotid tail lymph node which was FDG avid on ___ now\ndemonstrates a fatty hilus and measures 5 x 3 mm compared to 8 x 4 mm on ___.\nA right supraclavicular lymph node on image 3:16 measures 8 x 6 mm on image\n3:16 compared to 13 x 9 mm on ___.\nNo new enlarged lymph nodes.\n\nExtra nodal tumor spread:\nThere are no findings suggestive of extra nodal extension.\n\nDeep neck muscles, masticator space:\nUnremarkable.\n\nBones, skull base:\nNo evidence for suspicious lytic or sclerotic bone lesions. Degenerative\nchanges in the cervical spine.\n\nVessels:\nMild calcified plaque is again seen in the bilateral proximal internal carotid\narteries. Bilateral internal jugular veins appear patent.\n\nBrachial Plexus:\nThere is no brachial plexus contact or invasion.\n\nThyroid, salivary glands:\nNo evidence for focal lesions in the thyroid gland, bilateral submandibular\nglands, or right parotid gland. Left parotid tail lymph node has decreased in\nsize and demonstrates normal morphology, as stated above.\n\nOther findings:\nPlease refer to the separate report for the concurrent chest CT regarding the\nintrathoracic findings.\n\nThis exam is not technically optimized for evaluation of the included brain\nparenchyma; no concerning abnormalities are identified. A left posterior\nethmoid air cell is opacified, similar to ___.", + "output": "1. Compared to ___, multiple previously seen nonenlarged cervical,\nleft parotid tail, and right supraclavicular lymph nodes have decreased in\nsize. No new enlarged lymph nodes.\n2. Please refer to the separate report for the concurrent chest CT regarding\nthe intrathoracic findings." + }, + { + "input": "Aero digestive tract:\n\nThere is no mass.\nIf there is a mass, please insert field choice -->\n\nNeck lymph nodes:\nThere is no adenopathy involving bilateral levels ___.\nThere is no retropharyngeal adenopathy.\n\nExtra nodal tumor spread:\nThere are no findings suggestive of extra nodal extension.\n\nDeep neck muscles, masticator space:\nThere is no muscle invasion.\n\nBones, skull base:\nThere is no bone involvement.\nThere are no findings suggestive of perineural tumor extension.\nJugular foramen, carotid canal,pterygopalatine fossa,infraorbital\nforamen,other skull base foramina are not involved.\n\nVessels:\nThe cervical vessels are patent.\n\nBrachial Plexus:\nThere is no brachial plexus contact or invasion.\n\nThyroid, salivary glands:\nThe thyroid and major salivary glands are unremarkable.\n\nOther findings:\nThere are no lung nodules. Please refer to concurrent CT chest for additional\ndetails.", + "output": "1. There is no cervical lymphadenopathy by size criteria. No interval change\nfrom prior examination.\n2. Please refer to concurrent CT chest for additional details." + }, + { + "input": "Aero digestive tract:\nThere is no\n\nNeck lymph nodes:\nThere is no adenopathy involving bilateral levels ___.\nThere is no retropharyngeal adenopathy.\n\nExtra nodal tumor spread:\nThere are no findings suggestive of extra nodal extension.\n\nDeep neck muscles, masticator space:\nThere is no muscle invasion.\n\nBones, skull base:\nThere is no bone involvement.\nThere are no findings suggestive of perineural tumor extension.\nJugular foramen, carotid canal,pterygopalatine fossa,infraorbital\nforamen,other skull base foramina are not involved.\nDegenerative changes are noted involving joint right temporomandibular joint\ndegenerative changes in the spine.\n\nVessels:\nThere is no vascular invasion.\n\nBrachial Plexus:\nThere is no brachial plexus contact or invasion.\n\nThyroid, salivary glands:\nThere is no mass.\n\nOther findings:\nPlease refer to CT chest report done same day for intrathoracic findings.\n\nPartially included right Port a cath passing through SVC. Interval\ndevelopment of moderate opacification of bilateral maxillary, ethmoid sinuses\nand right sphenoid sinus with air-fluid levels and aerosolization. The nasal\ncavities essentially clear.", + "output": "1. No neck lymphadenopathy.\n2. Interval development of moderate opacification of paranasal sinuses with\nair-fluid levels and aerosolization which may suggest active sinus disease." + }, + { + "input": "Aero digestive tract:\nThere is no mass.\n\nNeck lymph nodes:\nThere is no adenopathy involving bilateral levels ___.\nThere is no retropharyngeal adenopathy.\n\nExtra nodal tumor spread:\nThere are no findings suggestive of extra nodal extension.\n\nDeep neck muscles, masticator space:\nThere is no muscle invasion.\n\nBones, skull base:\nThere is no bone involvement.\nThere are no findings suggestive of perineural tumor extension.\nJugular foramen, carotid canal,pterygopalatine fossa,infraorbital\nforamen,other skull base foramina are not involved.\nSpondylitic changes of the cervical spine more pronounced at cervical lower\nlevels.\n\nVessels:\nThere is no vascular invasion.\n\nBrachial Plexus:\nThere is no brachial plexus contact or invasion.\n\nThyroid, salivary glands:\nThere is no mass.\n\nOther findings:\nThere is refer to CT chest report done same day for intrathoracic findings. \nRedemonstration of moderate opacification of left maxillary sinus and right\nsphenoid sinus with air-fluid levels and aerosolized secretions. Mild mucosal\nthickening involving right maxillary and ethmoid air cells. Partially\nvisualized right Port a cath passing through right SVC.", + "output": "1. No neck lymphadenopathy.\n2. Redemonstration of paranasal sinus disease with imaging signs which may\nsuggest active component." + }, + { + "input": "There is a right internal jugular chemotherapy port.\n\nAero digestive tract:\nThere is no mass.\n\nNeck lymph nodes:\nThere is no adenopathy involving bilateral levels ___.\nThere is no retropharyngeal adenopathy.\n\nExtra nodal tumor spread:\nThere are no findings suggestive of extra nodal extension.\n\nDeep neck muscles, masticator space:\nThere is no muscle invasion.\n\nBones, skull base:\nThere is no bone involvement. There are mild unchanged degenerative changes\nof the cervical spine.\nThere are no findings suggestive of perineural tumor extension.\nJugular foramen, carotid canal,pterygopalatine fossa,infraorbital\nforamen,other skull base foramina are not involved.\n\nVessels:\nThere is no vascular invasion.\n\nBrachial Plexus:\nThere is no brachial plexus contact or invasion.\n\nThyroid, salivary glands:\nThe bilateral parotid and salivary glands are symmetric in size and\nenhancement pattern. There are no thyroid gland nodules.\n\nOther findings:\nThere are no lung nodules.\nThere is mucosal thickening of bilateral maxillary sinuses and the left\nposterior ethmoid air cells.", + "output": "1. No evidence of cervical lymphadenopathy.\n2. Unchanged paranasal sinus disease." + }, + { + "input": "There is a fluid collection abutting the left inferior margin of the hyoid\nbone of which crosses the midline inferior to the hyoid bone, extending over\nor bilateral thyroid cartilages. While it is difficult to measure this\ncollection due to its complex geometry, it does not appear significantly\nchanged in size, for example measuring approximately 2.9 x 1.8 cm in the left\nneck (02:49), previously 2.9 x 1.6 cm. The thickness of the hypodense fluid\nanterior to the cricoid cartilage measures up to 8 mm, previously 9 mm\n(02:54). There is partial rim enhancement along the left superior part of the\ncollection, similar to the prior study, with thinner and less avid rim\nenhancement of the lower bilateral portion of the collection. Thickening of\nleft greater than right strap muscles caudal to the collection has decreased\nsince the prior study. However, there is new trace fluid without rim\nenhancement tracking inferiorly in the midline to the level of the thyroid\nisthmus, image 602:27.\n\nThe collection appears to displace the left thyrohyoid membrane medially, with\nrightward shift of the airway. The patient is status post endotracheal\nintubation and orogastric tube placement, with associated secretions along the\npharyngeal courses of the tubes. Evaluation of the mucosal surfaces is\nlimited.\n\nThe salivary glands appear unremarkable.\n\nThere are multiple bilateral thyroid nodules measuring up to 1.6 cm on the\nleft, image 602:35.\n\nNo pathologically enlarged cervical or supraclavicular lymph nodes are seen.\n\nCervical carotid and vertebral arteries appear patent. Allowing for mixing\nartifact from the external circulation branches, internal jugular veins appear\npatent.\n\nThere is mild pleural/parenchymal scarring at the included lung apices.\n\nThere are no suspicious osseous lesions concerning for infection or\nmalignancy. Patient is status post instrumented fusion of C4-5 spinous\nprocesses with cerclage wires. There is partial fusion of C4 and C5 vertebral\nbodies and facet joints, possibly congenital. 3 mm anterolisthesis of C5 on\nC6 is unchanged.\n\nSome of the bilateral anterior ethmoid air cells are opacified. There is\ntrace fluid in the right sphenoid sinus, image 2:9, likely secondary to\nprolonged supine positioning and endotracheal intubation. Mastoid air cells\nappear clear. This exam is not technically optimized for evaluation of the\nincluded intracranial structures, but no concerning abnormalities are seen.", + "output": "1. No significant change in the fluid collection extending from the left\ninferior margin of the hyoid bone inferiorly over bilateral thyroid\ncartilages. Rim enhancement is most pronounced along the left superior\nportion of the collection, similar to the prior study, and less conspicuous\nthan on the prior study along the inferior bilateral portion of the\ncollection. This is overall compatible with an abscess\n2. Left greater than right strap muscle edema has improved. New trace fluid\nextending from the caudal portion of the above-described fluid collection in\nthe midline to the level of the thyroid isthmus, without rim enhancement.\n3. The above-described collection displaces the left thyrohyoid membrane\nmedially and displaces the airway to the right. The patient is intubated.\n4. Bilateral thyroid nodules measuring up to 1.6 cm.\n\nRECOMMENDATION(S): Outpatient thyroid ultrasound is recommended according to\nthe ACR guidelines for nodules exceeding 1.5 cm." + }, + { + "input": "Compared with prior CT head on ___, there is interval increase in\nsize of the ventricles, the lateral ventricles measuring approximately 3.0 cm\ncompared with 2.0 cm previously, and the third ventricle measuring 15 mm,\ncompared with 9 mm previously, with interval increase in extensive\nperiventricular hypodensity, likely representing transependymal flow of CSF\nsuperimposed on chronic small vessel ischemic changes. There is increased\neffacement of the sulci. Basal cisterns are patent. Previously seen\nintraventricular hemorrhage has resolved.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Interval increase in size of the ventricles and extensive periventricular\nhypodensity, likely representing transependymal flow of CSF superimposed on\nchronic small vessel ischemic changes, with increased effacement of the sulci,\nfindings likely represent developing hydrocephalus.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ on the telephoneon ___ at 1:43 ___, 20 minutes after\ndiscovery of the findings." + }, + { + "input": "In comparison ___ there is interval increase in size of the\nventricles with the right temporal horn measuring 2 cm, previously 1.7 cm and\nleft temporal horn measuring 1.6 cm, previously 1.5 cm. Persistent\nperiventricular hypodensity may represents transependymal flow of CSF\nsuperimposed on chronic small vessel ischemic disease. There is persistent\neffacement of the sulci. Basal cisterns are patent. No intraventricular\nhemorrhage or acute large territorial infarction. Interval progression of a\ncentrally hypodense, peripherally hyperdense 1.8 x 1.4 cm lesion along the\nright frontal lobe (602b:43; 2: 10) which is best assessed on sagittal\nimages.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Calcification of the internal carotid\narteries are noted.", + "output": "1. Decreased ventricular size since the previous CT of ___.\n2. Progression of 1.8 cm right frontal lobe lesion which is incompletely\ncharacterized. Although this may represent encephalomalacia MRI can help for\nassessment.\n\nRECOMMENDATION(S): Consider dedicated MR for further evaluation." + }, + { + "input": "Right cerebellar and left frontal encephalomalacia may reflect sequela of old\ninfarct.\nThere is no evidence of acute infarction, hemorrhage, edema, or mass. There\nis prominence of the ventricles and sulci suggestive of involutional changes. \nPeriventricular and subcortical white matter hypodensities are likely from\nchronic small vessel disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Right cerebellar and left frontal encephalomalacia may reflect sequela of\nold infarct." + }, + { + "input": "There is an ill-defined mass with faint rim enhancement and central\nnonenhancement in the left capitis muscle at C1-C2, images 3:23 and 6:48,\nwhich measures 0.8 x 1.0 x 1.1 cm, and corresponds to the area of increased\nFDG uptake on the ___ PET-CT. The mass abuts the left aspect of\nthe C2 spinous process and the left C2 lamina, without osseous erosion or\nremodeling.\n\nThe right levator scapulae muscle is diffusely thickened and asymmetrically\nenlarged in comparison to the left levator scapulae muscle with no discrete or\nenhancing mass. The right levator scapulae muscle previously demonstrated\ndiffusely increased FDG uptake.\n\nEvaluation of the aerodigestive tract demonstrates no evidence for an\nexophytic mucosal mass.\n\nThe salivary glands enhance normally without evidence for mass or adjacent fat\nstranding. The thyroid gland is unremarkable. There is no lymphadenopathy by\nCT criteria. The major neck vessels are patent.\n\nA sclerotic lesion in the T2 spinous process measures 1.0 cm. It was not FDG\navid on the recent PET-CT. There are multilevel degenerate changes of the\ncervical spine, most advanced at C5-C6.\n\nA loculated left pleural effusion is partially visualized. The visualized\nportion is similar to the ___ head CT, obtained with arms down. \nIt appears slightly larger than on the ___ chest CT obtained with\narms up, but this is likely due to differences in positioning. There is mild\nadjacent compressive atelectasis in the left lower lobe. Paramediastinal\nscarring in the visualized upper lungs bilaterally is again. A 7 x 4 mm\nnodule in the left lung apex, image 03:58, is unchanged. A 6 x 5 mm\nsubpleural nodule in the left upper lobe, image 3:69, has increased in size,\npreviously measuring 4 x 4 mm.\n\nA left-sided Port-A-Cath terminates in the superior vena cava.\n\nThis exam is not technically optimized for evaluation of the included\nintracranial contents ; no concerning abnormalities are seen on limited\nassessment. Partially visualized orbits are unremarkable. Partially\nvisualized paranasal sinuses are well aerated. Partial mastoid air cell\nopacification is present bilaterally. Bilateral middle ear cavities are\nclear.", + "output": "1. Ill-defined mass with faint rim enhancement in the left capitis muscle at\nC1-C2 corresponds to the increased FDG uptake on the ___ PET-CT,\nlikely representing metastases.\n2. Asymmetrically enlarged right levator scapulae muscle, as seen previously,\nwith increased FDG uptake on the prior PET-CT, without evidence for a discrete\nor enhancing mass. This may represent metastatic infiltration or muscular\nstrain.\n3. Partially visualized loculated left pleural effusion appears similar to ___.\n4. Interim enlargement of a 6 mm nodule in the left upper lobe and a stable 7\nmm nodule at the left lung apex.\n5. Unchanged sclerotic lesion in the T2 spinous process, without FDG uptake on\nthe recent PET-CT.\n6. No cervical lymphadenopathy." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Of note, an 8 mm rounded hyperdense lesion involving the right\nfrontal lobe is re- demonstrated and unchanged from the prior MRI in ___. A 5\nx 8 x 6 mm hyperdense focus along the left tentorium appears new from the\nprior MRI in ___ and may reflect a new leptomeningeal med or possibly a small\narea of hemorrhage. Ventricles and sulci are normal in overall size and\nconfiguration. The imaged paranasal sinuses are clear. The left mastoid air\ncells are opacified. The right mastoid air cells are clear. Note is made of\nTMJ arthritis. The bony calvarium is intact.", + "output": "1. 8 mm hyperdense focus along the left tentorium is new from the prior MRI\nand likely reflects a new leptomeningeal metastatic foci, possibly hemorrhagic\ngiven central high density. No peripheral edema.\n2. Right frontal lobe hyperdense lesion is unchanged in size from ___\nMRI.\n\nConsider brain MRI for further evaluation when clinically appropriate.\n\nNOTIFICATION: Updated findings were communicated to the ED QA nurses at 23:45\non ___ by Dr. ___." + }, + { + "input": "There is no evidence of hemorrhage,edema,or mass. Mild brain parenchymal\natrophy. Findings consistent with mild-to-moderate chronic small vessel\nischemic changes. Few small areas of low-attenuation are in the posterior\nright centrum ___ represent chronic or subacute infarcts.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Findings consistent with mild-to-moderate chronic small vessel ischemic\nchanges.\nPosterior right centrum ___, parietal lobe small low-attenuation areas,\nmay represent chronic or subacute infarct." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. The neck vessels are patent. Suboptimally seen prominent top of\naortic arch measuring 3.7 cm in diameter. Chest x-ray recommended.\n\n3 mm nodule right lung apex. Anterior fusion C5-C7 with plate, screws,\ninterbody grafts. Degenerative changes cervical spine.", + "output": "No mass, no adenopathy.\nMildly prominent partially seen aortic arch, chest PA and lateral recommended.\n\nRECOMMENDATION(S): Chest PA and lateral." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricularand subcorticalwhite matter hypodensities\nare nonspecific, but likely reflect the sequela of chronic microvascular\ninfarction.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territorial infarct. Prominence of the\nventricles and sulci is consistent with atrophy. Periventricular and\nsubcortical white matter hypodensities are likely sequelae of chronic small\nvessel disease. The visualized paranasal sinuses demonstrate mild mucosal\nthickening of the ethmoid air cells.. The mastoid air cells are clear. No\nacute fracture is seen.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema,or mass. There\nare deep subcortical and periventricular white matter hypodensities which are\nnonspecific but likely represent sequela of chronic microvascular ischemic\ndisease. Diffused bilateral ventriculomegaly out of proportion to the sulci\nprominence is again seen. When compared to ___ MRI, there is\nminimal increase ventricular size evidenced by 11 mm axial diameter of the\nthird ventricle, previously measuring 9 mm in ___ (2:17).\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. Minimal interval increase in diffuse ventriculomegaly when compared to the\n___ MRI. Ventriculomegaly out of proportion to sulci prominence\nmay represent central atrophy versus communicating hydrocephalus.\n2. Sequela of chronic small vessel ischemic disease." + }, + { + "input": "There is no evidence of acute major vascular territory\ninfarction,hemorrhage,edema, or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. Mild ill-defined\nperiventricular and subcortical white matter hypodensities are nonspecific but\nlikely due to chronic sequela of small-vessel disease. Vascular\ncalcifications are seen in both carotid siphons.\n\nThere is no evidence of fracture. Aerated secretions are seen in the right\nsphenoid sinus. Polypoid mucosal thickening is seen in the left sphenoid\nsinus, improved since exams dating to ___. Otherwise, the remaining\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormalities. Specifically, no evidence of\nintracranial hemorrhage.\n2. Mild interval improvement in paranasal sinus disease since ___." + }, + { + "input": "There is no evidence of fracture, large territorial\ninfarction,hemorrhage,edema,or mass. There is mild prominence of the\nventricles and sulci suggestive of involutional changes. There is mild\nhypodensity of the subcortical and periventricular white matter, nonspecific\nbut likely representing chronic microvascular ischemic disease.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal. \nEndotracheal and enteric tubes noted. Intracranial vascular calcifications\nnoted.", + "output": "1. No acute intracranial findings.\n2. Redemonstration of mild involutional changes and white matter disease." + }, + { + "input": "Exam is mildly motion limited. There is no evidence of infarction,\nhemorrhage, edema, or mass. The ventricles and sulci are normal in size and\nconfiguration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Exam is mildly motion limited. No acute intracranial process." + }, + { + "input": "The exam is limited by motion artifact. There is no evidence of gross acute\nlarge territorial infarction, hemorrhage, edema, or mass. The ventricles and\nsulci are normal in size and configuration. Mild atherosclerotic mural\ncalcification of the distal vertebral and internal carotid arteries is noted.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Motion limited exam. No gross acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. There is complete opacification of the\nbilateral mastoid air cells and middle ear cavities, new compared to ___. There is extensive paranasal sinus disease with mucous thickening of\nthe ethmoid air cells and complete opacification of the left sphenoid sinus. \nAir-fluid levels with aerosolized secretions are demonstrated within the\nbilateral maxillary sinuses and right sphenoid sinus. The visualized portions\nof the orbits are unremarkable.", + "output": "1. No intracranial process.\n2. Complete opacification of the bilateral mastoid air cells and middle ear\ncavities.\n3. Extensive paranasal sinus disease, as described above." + }, + { + "input": "There is aerosolized material in the nasopharynx which is a sequela of\nintubation. The frontal sinuses are not pneumatized. There is moderate\nmucosal thickening of the bilateral ethmoid, sphenoid and maxillary. \nAdditionally there is aerosolized fluid partially opacifying maxillary ethmoid\nair cells and right sphenoid sinus. The left sphenoid sinus is completely\nopacified. The mastoid air cells and middle air cavities are opacified. The\ncribriform plates are intact. The lamina papyracea are intact.", + "output": "1. Mucosal thickening and partial for complete opacification and aerosolized\nsecretions of the visualized sinuses is consistent with pansinusitis.\n2. Extensive soft tissue changes within the nasal passages could be due to\nmucosal thickening, or nasal packing.\n3. Opacification of the mastoid air cells and middle ear cavities may be a\nfunction of positioning, however infection cannot be excluded." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or mass\neffect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Mild periventricular white matter hypodensities are\nnonspecific, but likely represent sequela of chronic ischemic microvascular\ndisease. Vascular atherosclerotic calcifications are seen in the carotid\nsiphons bilaterally.\n\nThere is no evidence of fracture. There are air-fluid levels and aerosolized\nsecretions in the left maxillary sinus, bilateral sphenoid sinuses and ethmoid\nair cells, similar to prior. There is also persistent opacification of the\nbilateral mastoid air cells and middle ear cavities. The visualized portion\nof the orbits are unremarkable.", + "output": "1. No acute intracranial hemorrhage or large vascular territorial infarct.\n2. Redemonstration of extensive paranasal sinus disease, as above.\n3. Unchanged opacification of the bilateral mastoid air cells and middle ear\ncavities." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. ___ cisterna\nmagna is incidentally noted.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No fracture or acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nAside from mild mucosal thickening of the anterior ethmoidal air cells and\npartial opacification of the left mastoid air cells, the visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\nThe visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. There is a\nfetal type origin of the right PCA. The dural venous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No evidence of acute intracranial process.\n2. No stenosis, occlusion, dissection, or aneurysm greater than 3 mm in the\ngreat vessels of the head or neck." + }, + { + "input": "There is chronic encephalomalacia of the left frontal lobe causing mild ex\nvacuo dilatation of the left frontal ventricular horn. There is no evidence\nof acute infarction, intracranial hemorrhage,edema,or mass. The sulci are\nslightly prominent suggesting mild cortical volume loss, likely age related\nand involutional nature. Subtle subcortical and periventricular areas of low\nattenuation are nonspecific and may reflect changes due to small vessel\ndisease. Punctate arteriosclerotic calcifications are seen in the carotid\nsiphons bilaterally.\n\nThere is no evidence of fracture. There is mild soft tissue swelling\noverlying the right side of the occipital bone. There is complete\nopacification of the visualized portion of the left maxillary sinus, and\nmultiple bilateral ethmoid air cells with asymmetry and bone defect in the\nleft lamina papyracea, suggestive of chronic fracture, please correlate\nclinically (image 7, series 3). There is mild mucosal thickening of the right\nmaxillary sinus and bilateral sphenoid sinuses. There is underpneumatization\nof the frontal sinuses. The visualized portion of the mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. There is no evidence of acute intracranial process or hemorrhage.\n2. Encephalomalacia identified is left frontal lobe, causing mild ex vacuo\ndilatation of the left frontal ventricular horn as described above.\n3. Small occipital subgaleal hematoma. No underlying fracture.\n4. Paranasal sinus disease.\n5. Mild asymmetry of the left lamina papyracea suggest sequela of prior\nfracture, please correlate." + }, + { + "input": "There is a right subgaleal fluid collection which is larger than it was on ___. There is mass effect and leftward shift of normally midline\nstructures, however there is decreased effacement of the right lateral\nventricle. Additionally, there is a focus of hemorrhage in the right frontal\nlobe in the area of infarction as well as in the caudate head and the medial\ntemporal lobe. There is uncal herniation on the right. There is a gyriform\npattern of enhancement most consistent with evolving infarction. There is no\nevidence of edema surrounding the enhancing tissue, as would be expected for\ninfarction\n\nThe orbits are unremarkable.\n\nThe patient is status post right craniectomy. The paranasal sinuses, mastoid\nair cells, and middle ear cavities are unchanged in appearance.", + "output": "1. Large subgaleal fluid collection is larger in comparison to the prior study\nof ___. And\n2. Underlying parenchymal enhancement in the area of infarction is likely\nrelated to the prior infarction and less likely represents infection. There is\nimproved in mass effect and leftward shift of midline structures from the\nprior examination and no edema of adjacent brain tissue.\n3. Persistent right uncal herniation." + }, + { + "input": "Again right-sided craniectomy is identified. Encephalomalacia is seen in the\nright cerebellar hemisphere with ex vacuo dilatation of the right lateral\nventricle. There is depression seen at the craniectomy site as before. The\npreviously seen catheter has been removed. Acute abnormalities are seen. There\nis no hydrocephalus.", + "output": "Right frontoparietal craniectomy with depression at the craniectomy site and\nencephalomalacia no acute abnormalities." + }, + { + "input": "Compared with prior, there has been no significant interval change. Again seen\nis sequela of prior right MCA territory infarct. Post craniotomy changes are\nagain seen. There has been slight interval decrease in size of the frontal\nhorns of the lateral ventricles compared to prior. Leftward midline shift of\nthe anterior/frontal midline structures, anterior septum pellucidum is now 10\nmm, previously approximately 8 mm. Elsewhere, configuration of the ventricles\nis unchanged. Basilar cisterns are patent. Left cerebral hemisphere gray-white\nmatter differentiation is preserved. There is no intra or extra-axial\nhemorrhage. Included paranasal sinuses and mastoids are clear.", + "output": "Right MCA territorial infarct with overlying right-sided craniectomy. Mild\nintimal interval increase in degree of leftward midline shift anteriorly, now\n10 mm, previously 8 mm. No other change." + }, + { + "input": "Again seen are sequelae of prior right MCA and ACA infarcts with extensive\nencephalomalacia and ex vacuo dilatation of the right lateral ventricle.\nOverlying right-sided craniectomy changes are again noted. Elsewhere, the\ngray-white matter differentiation is preserved. Configuration of the\nventricles is stable noting 6 mm of midline shift at the level of the frontal\nhorns of the lateral ventricles. Brainstem and posterior fossa are grossly\nunremarkable. Included paranasal sinuses and mastoids are clear.", + "output": "Unchanged appearance of the brain with encephalomalacia and craniectomy\nchanges." + }, + { + "input": "Encephalomalacic changes in the right cerebral hemisphere, with ex vacuo\ndilation of the right lateral ventricle.\nHemicraniectomy defect on the right side, with deformity on the right cerebral\nhemisphere and mild leftward shift of the right lateral ventricle.\nNo acute intracranial hemorrhage, new mass effect or new hypodense area to\nsuggest new acute infarct.\nSella, pineal gland and the craniocervical junction regions are grossly\nunremarkable allowing for the distortion of the cranial structures.\nNo significant change compared to the most recent study.\nNo suspicious osseous lesions noted.\nNonunion of the posterior arch of the atlas, likely variant or remote trauma.\nThe included paranasal sinuses and the mastoid air cells are clear.", + "output": "No acute intracranial hemorrhage, new mass effect or new hypodense area to\nsuggest new acute infarct.\nRight hemi craniectomy defect, encephalomalacic changes in the right cerebral\nhemisphere as described above. Striker protocol planning study." + }, + { + "input": "Patient is status post right hemicraniectomy with deformity in the right\ncerebral hemisphere and mild leftward shift of the right lateral ventricle,\nwhich appears slightly improved since prior examination. Encephalomalacic\nchanges are again seen in the right cerebral hemisphere, with ex vacuo\ndilatation of the right lateral ventricle. There is no evidence of new\nhemorrhage or acute major vascular territorial infarction. The basal cisterns\nappear patent.\n\nThere is mild mucosal thickening of the maxillary sinuses bilaterally, left\nworse than right. Otherwise, the remaining visualized paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The globes are\nunremarkable.", + "output": "1. No evidence of hemorrhage, new mass effect or new hypodensity to suggest\nan acute area of infarct.\n\n2. Right hemicraniectomy defect and encephalomalacic changes in the right\ncerebral hemisphere." + }, + { + "input": "Since the previous study the patient has undergone cranioplasty. Postoperative\nchanges are seen with pneumocephalus\n. The ventricular size in the degree of midline shift remains unchanged. No\nacute hemorrhage is identified. Fluid level is seen in the extra-axial space\nfrom recent surgery.", + "output": "Post cranioplasty changes are identified. The midline shift and the\nventricular size is unchanged. No acute hemorrhage is identified." + }, + { + "input": "1 postoperative changes reflecting identified. Ex vacuo dilatation of the\nright lateral ventricle and right-sided encephalomalacia are seen. There is no\nevidence of acute hemorrhage. There is prominence of ventricles mild without\ndilatation of the left temporal horn which is most likely due to volume loss.\nMild periventricular edema seen. There is no evidence of large fluid\ncollection at the craniectomy site.", + "output": "Encephalomalacia of the right cerebral hemisphere and ex vacuo dilatation of\nventricles seen. No acute abnormalities." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is extensive subarachnoid hemorrhage noted in the bilateral sylvian and\ninterhemispheric fissure, and extending into the suprasellar, prepontine,\nambient cistern, and quadrigeminal cisterns. Small blood product is also\nnoted within the fourth ventricle. No intraparenchymal hemorrhage noted.\n\nThere is no evidence of infarction, edema,ormass. There is mild prominence of\nthe lateral ventricles, and the temporal horns.\n\nThere is mucosal thickening in the inferior maxillary sinuses, sphenoid sinus,\nand ethmoid air cells. The visualized portion of the mastoid air cellsand\nmiddle ear cavities are clear. The visualized portion of the orbits are\nnormal.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. The dural venous\nsinuses are patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion.\n\n\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Diffuse subarachnoid hemorrhage, predominantly in the basal cisterns,\ninterhemispheric and bilateral sylvian fissures. No evidence of large\nvascular distribution infarction.\n2. Mild prominence of the ventricular system. Early hydrocephalus is not\nexcluded.\n3. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n4. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nIn comparison with the prior examination there is interval improvement and\ndecreased pattern of subarachnoid hemorrhage, with redistribution of the blood\nproducts along bilateral parieto-occipital subarachnoid regions. There is\ncomplete resolution of previously identified small foci of intraventricular\nhemorrhage along the roof of the fourth ventricle with no hyperdense\nintraventricular hemorrhagic components. The ventricular system size is\ncomparable to the previous examination, there is no evidence of hydrocephalus.\n\nLimited assessment of the post subarachnoid hemorrhage ischemic changes;\nhowever there is no obvious newly developed intraparenchymal hypodensity with\npreserved gray-white matter differentiation.\n\nThere is minimal residual effacement of the perimesencephalic cisterns, there\nis no midline shift or cerebellar tonsillar herniation.\n\nThere is no evidence of acute calvarial fracture. There is mild mucosal\nthickening and fluid within the maxillary sinuses bilaterally. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare otherwise clear. The visualized portions of the orbits are normal.\n\nCTA HEAD:\nThere is diffuse narrowing of the anterior and middle cerebral arteries\nsuggestive mild vasospasm, no aneurysms larger than 3 mm in size are seen. \nThis assessment is significantly limited by the newly developed proximal\narterial intracranial circulation vasospasm.", + "output": "1. Interval improvement in the pattern of diffuse subarachnoid hemorrhage.\n2. No imaging signs to suggest evolving acute hydrocephalus.\n3. Interval development of proximal intracranial arterial vasculature\nvasospasm with no definite more than 3 mm aneurysm.\n4. Unexpected for perimesencephalic nonaneurysmal subarachnoid hemorrhage to\nextend to interhemispheric fissure and beyond superficial sylvian fissures; if\nclinically warranted further evaluation by conventional angiogram after\nvasospasms resolution is recommended." + }, + { + "input": "Comparison with the prior examination, there is interval improvement in the\npattern of subarachnoid hemorrhage. There is no evidence of infarction,\nedema, or mass. The ventricles and sulci are comparable in size and\nconfiguration compared to the prior study. There is no evidence of interval\ndevelopment of hydrocephalus.\n\nThere is no evidence of fracture. There is mild mucosal thickening and fluid\nwithin the maxillary sinuses bilaterally. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are otherwise\nclear. The visualized portions of the orbits are unremarkable.", + "output": "1. Interval improvement in the pattern of diffuse subarachnoid hemorrhage. No\nevidence of infarction or new hemorrhage.\n2." + }, + { + "input": "In comparison to the prior study there continues to be interval improvement\nand decreased pattern of subarachnoid hemorrhage with redistribution of the\nblood along the bilateral parieto-occipital regions. No new hemorrhage is\nidentified. There is no evidence of infarction, edema, or mass. There is\npreservation of gray-white matter differentiation. The ventricles and sulci\nare normal in size and configuration. There is no midline shift or cerebellar\ntonsillar herniation. There is no change in ventricular size or configuration\n\nThere is no fracture. Mild mucosal retention cyst in the right maxillary\nsinus. Mucosal thickening of the left maxillary sinus. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare otherwise clear. The visualized portions of the orbits are normal.", + "output": "1. Interval improvement in the pattern of diffuse subarachnoid hemorrhage. No\ninfarction or new hemorrhage.\n2. The ventricular system size is comparable to the previous examination." + }, + { + "input": "Compared to the most recent prior study, there is a similar degree of subtle\nsubarachnoid hemorrhage in the bilateral parietooccipital lobes, barely\nvisible and significantly improved from initial CT examinations dating back to\n___. There is no evidence of fracture, acute territorial\ninfarction, edema,or mass effect. The ventricles and sulci are unchanged in\nsize and configuration.\n\nAs before, there is a tiny mucous retention cyst in the right maxillary sinus.\nThere is trace mucosal thickening in the left maxillary sinus. Otherwise, the\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No significant change in pattern and extent of barely perceptible\nsubarachnoid hemorrhage in the bilateral parietooccipital lobes, however,\nsignificantly improved from examination of ___. No new infarct\nor hemorrhage.\n2. Ventricles and sulci are unchanged in size and configuration." + }, + { + "input": "There is mild prominence of the lateral ventricles most pronounced involving\nthe bodies is similar to prior studies. Temporal horns remain small. No\nevidence of hemorrhage, mass or infarction is evident.\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. Similar appearance of mild lateral ventriculomegaly.\n2. No evidence of acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute large vascular territory infarction,intracranial\nhemorrhage,edema,or mass effect. There is prominence of the ventricles and\nsulci suggestive of involutional changes. Nonspecific periventricular and\nsubcortical hypodensities, most notably around the frontal horns, could\nrepresent sequela of chronic small vessel disease. Additionally,\nhypodensities likely representing sequela of previous lacunar infarcts are\nseen in the basal ganglia bilaterally.\n\nThere is no evidence of acute fracture. There is partial opacification of 1\nleft ethmoid air cell. Otherwise, the remainder of the partially imaged\nparanasal sinuses are clear. There is opacification of a very few inferior\nright mastoid air cells, likely chronic. The remainder of the imaged mastoid\nair cells are clear. Calcification of the cavernous portions of the bilateral\ninternal carotid arteries is seen.", + "output": "No evidence of acute intracranial process. No acute intracranial hemorrhage." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are prominent compatible with global volume\nloss.\n\nIncluded paranasal sinuses and mastoids are clear. A 9 mm soft tissue density\nin the right occipital soft tissues is likely a sebaceous cyst. Skull and\nextracranial soft tissues are otherwise unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass effect. The ventricles and sulci are normal in size and configuration.\n\nNo acute fractures are seen. Aside from a mucous retention cyst in the right\nmaxillary sinus, the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The orbits are unremarkable.", + "output": "1. No acute intracranial process." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, shift of normally\nmidline structures or acute major vascular territorial infarction. Ventricles\nand sulci are normal in size and configuration. Subcortical and\nperiventricular white matter hypodensities are nonspecific but likely reflect\nthe sequela of chronic small vessel infarction. The basal cisterns appear\npatent and there is preservation of gray-white matter differentiation.\n\nThere is no fracture. The visualized paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear.", + "output": "No acute intracranial abnormality." + }, + { + "input": "HEAD CT: There is no evidence of intracranial hemorrhage, edema, mass effect\nor shift of normally midline structures. The gray-white matter interface is\npreserved without evidence of acute major vascular territorial infarct. The\nventricles and sulci are enlarged compatible with age related parenchymal\nvolume loss. Dense vascular calcifications are noted. The basal cisterns\nappear patent. The orbits and globes are unremarkable. Mild to moderate\nmucosal thickening and aerosolized secretions are present in the bilateral\nsphenoid sinuses. There are pooled secretions in the nasopharynx. The left\nmastoid and middle ear cavity are opacified. The remainder of the imaged\nparanasal sinuses, middle ear cavities and right mastoid air cells are clear.\nMaterial in the bilateral external auditory canal is compatible with impacted\ncerumen. The bony calvaria appear intact.", + "output": "1. No evidence of acute intracranial process.\n\n2. Opacification of the left mastoid and middle ear cavity with pooled\nsecretions in the nasopharynx are likely related to the patient's intubated\nstatus.\n\n3. Evidence of global atrophy." + }, + { + "input": "CT HEAD WITHOUT CONTRAST\nThere is no evidence of acute infarction, hemorrhage, edema, or mass effect. \nThe ventricles and sulci are normal in size and configuration. The visualized\nportions of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portions of the orbits are unremarkable.\n\nCTA NECK\nBilateral carotid and vertebral artery origins are patent. There is no\nevidence of internal carotid stenosis by NASCET criteria. The carotid and\nvertebral arteries and their major branches are without evidence of stenosis\nor occlusion.\nThere is a heterogeneous and enlarged left parotid gland with markedly\nincreased vascularity. There is no stone or abscess, no necrosis, and no\nsurrounding edema in or heterogeneity of the adjacent fat. Findings are\nconsistent with a vascular malformation.\n\nCTA HEAD\nThe vessels of the circle of ___ and their principal intracranial branches\nare without stenosis, occlusion, or aneurysm. The dural venous sinuses are\npatent.\n\nOTHER\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Heterogeneous enlarged left parotid gland with increased vascularity,\nnormal architecture and no edema, most suggestive of an arteriovenous or other\nvascular malformation.\n2. Bilateral carotid and vertebral arteries are patent with no evidence of\nstenosis, occlusion, or dissection.\n\nRECOMMENDATION(S): Recommend ENT consult." + }, + { + "input": "There is no significant change in right inferior temporal subarachnoid\nhemorrhage. Left frontal subarachnoid hemorrhage is no longer visible. Right\nparatentorial subdural hematoma is not significantly changed allowing for\nredistribution. There is no definite new hemorrhage. There is no edema, mass\neffect, or CT evidence for an acute major vascular territorial infarction. \nPeriventricular, deep, and subcortical white matter hypodensities are\nnonspecific but likely sequela of chronic small vessel ischemic disease in\nthis age group. Ventricles and sulci are prominent due to age-related\nparenchymal volume loss.\n\nThere is a nondisplaced right occipital bone fracture, unchanged from prior\n(3; 20). The visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits\nstatus post bilateral lens replacement.", + "output": "1. Unchanged right inferior temporal subarachnoid hemorrhage. Left frontal\nsubarachnoid hemorrhage is no longer visible.\n2. No significant change in right peritoneal subdural hematoma allowing for\ndistribution.\n3. No evidence for new hemorrhage.\n4. Unchanged nondisplaced right occipital bone fracture." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass effect. The ventricles and sulci are mildly prominent keeping with\nage-related involutional change. Mild periventricular and subcortical white\nmatter hypodensities are nonspecific, but likely represent sequela of chronic\nischemic microvascular disease.\n\nNo acute fractures are seen. Aside from mild mucosal thickening in the\nbilateral ethmoid air cells and right sphenoid sinus, the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "1. No acute intracranial process.\n2. Mild chronic small vessel disease." + }, + { + "input": "Artifact from dental hardware partially limits diagnostic evaluation.\n\nThere is partial opacification of all paranasal sinuses and the bilateral\nethmoid air cells. There are aerosolized secretions in the left maxillary\nsinus, left sphenoid sinus, and bilateral ethmoid air cells. The bilateral\nfrontoethmoidal recesses and infundibulum are completely opacified. The\ncribriform plates are intact. The lamina papyracea are intact. Minimal\nS-shaped curvature of the nasal septum without perforation.\n\nMastoid air cells and middle ear cavities are patent. There are mild\natherosclerotic calcifications within the clinoid portions of the bilateral\ninternal carotid arteries. Orbits are partially normal. Although not\noptimized for such evaluation, visualized brain parenchyma is grossly\nunremarkable.\n\nThere is mild malar subcutaneous stranding, which can be seen on prior MRI of\n___.", + "output": "-Partial opacification of all paranasal sinuses in the bilateral ethmoid air\ncells. Aerosolized mucus is noted in the left maxillary and sphenoid sinus.\n-There is opacification of the bilateral ostiomeatal units.\n-Additional findings described above." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. The ventricles and sulci are normal in size and configuration. \nThere are mild calcifications of the bilateral carotid siphons.\n\nThere is no evidence of fracture. There is moderate mucosal thickening in the\nleft maxillary sinus. There is mild mucosal thickening in some anterior\nethmoidal air cells. Otherwise, the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Prominent ventricles and sulci compatible with age related\ninvolutional change. Periventricular white matter hypodensities are likely\nsecondary to chronic small vessel ischemic change. There are marked vascular\ncalcifications at the cavernous portions of the bilateral internal carotid\narteries. The imaged paranasal sinuses are clear. Mastoid air cells and\nmiddle ear cavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "Study is mildly degraded by motion. No evidence of acute infarction,\nhemorrhage, edema,ormass. Bilateral, slightly worse on the right\nperiventricular, subcortical, and deep white matter hypodensities are\nnonspecific but similar to the prior exam and likely reflects sequelae of\nchronic small vessel disease and or old infarcts. Bilateral, symmetric\nprominence of the ventricles and sulci are also nonspecific but likely\nrepresent sequelae of age-related involutional change. Bilateral cavernous\ninternal carotid calcifications are present.\n\nNo evidence of fracture. Bilateral TMJ degenerative changes are noted. The\nvisualized portions of the paranasal sinuses are essentially clear. The\nmastoid air cells and middle ear cavities are clear. The visualized portion of\nthe orbits are unremarkable. Calcified pannus is noted at the C1-2 junction\nresulting in at least mild vertebral canal stenosis.", + "output": "1. Study is mildly degraded by motion.\n2. No evidence acute intracranial hemorrhage.\n3. No evidence of large territorial acute infarct. Note that MRI is more\nsensitive for the detection of acute infarct.\n4. Sequelae of chronic small vessel ischemic disease or old infarcts,\nunchanged." + }, + { + "input": "There is no evidence of territorial infarction, hemorrhage, edema, or large\nmass. The ventricles and sulci are prominent consistent with involutional\nchanges. Periventricular white matter hypodensities are nonspecific and may\nsuggest small vessel ischemic changes.\n\nA left parietal subgaleal hematoma near the vertex. No osseous abnormalities\nseen. The paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The orbits are unremarkable.", + "output": "1. Left parietal subgaleal hematoma without underlying fracture.\n2. No intracranial hemorrhage." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Periventricular and subcortical white matter hypodensities are\nnonspecific, but likely reflect sequelae of chronic small vessel ischemic\ndisease. Prominence of the ventricles and sulci suggest involutional changes.\n\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nMild periventricular and subcortical white matter hypodensities likely reflect\nsequela of chronic microangiopathy. There is a chronic lacunar infarct in the\nleft caudate head, unchanged from prior study.\n\nThere is no evidence of fracture. There is partial opacification of the right\nfrontal sinus and frontal ethmoidal recess with an air-fluid level. The\nvisualized portion of the remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. Status post bilateral lens replacement", + "output": "1. No intracranial hemorrhage. No large territorial infarction. No calvarial\nfractures.\n2. Air-fluid level and partial opacification of the right frontal sinus and\nfrontoethmoidal recess, which can be seen in the setting of acute sinusitis in\nthe appropriate clinical context." + }, + { + "input": "There is no evidence of fracture, acute territorial\ninfarction,hemorrhage,edema,or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. Periventricular, subcortical and\ndeep white matter hypodensities are nonspecific but likely sequelae of chronic\nsmall vessel ischemic disease.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. Patient is status post bilateral lens replacements. \nDense atherosclerotic calcifications of the cavernous carotid arteries are\nnoted.", + "output": "No acute intracranial abnormality." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\n There is no evidence of large vascular territory infarction, hemorrhage,\nedema, or mass. Ventricles and sulci are stably prominent, consistent with\nage-related global parenchymal loss. Subcortical, periventricular and deep\nwhite matter hypodensities are nonspecific, but likely reflect the sequela of\nchronic microangiopathic ischemic disease.\n\nThere is no fracture. The visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits demonstrate prior lens surgery and are otherwise normal.\n\nCTA HEAD:\nThere are atherosclerotic calcifications of the carotid siphons. The right A1\nis dominant. There is fetal configuration involving the bilateral PCAs,\nnormal variant. Otherwise, the vessels of the circle of ___ and their\nprincipal intracranial branches appear normal without stenosis, occlusion, or\naneurysm greater than 3 mm. The dural venous sinuses are patent.\n\nCTA NECK:\nThere are calcified and noncalcified atherosclerotic plaques throughout the\naortic arch. There is a 3 vessel aortic arch configuration. Bilateral\ncarotid and vertebral artery origins are patent.\nThere are calcifications of the bilateral common carotid artery bifurcations,\nbut there is no evidence of internal carotid stenosis by NASCET criteria.\nThe right vertebral artery is diminutive. Otherwise, the carotidandvertebral\narteries and their major branches appear normal with no evidence of stenosis\nor occlusion.\n\nThere are advanced multilevel degenerative changes of the cervical spine, more\npronounced from C3-C6, including intervertebral disc space narrowing, endplate\nsclerosis, subchondral cystic changes anterior and posterior osteophytosis. \nThere is no acute fracture. There is mild anterolisthesis of C5 over C6.\n\nCTP:\n\nCBF <30% volume = 0\nTmax >6.0s volume = 0\nMismatch volume = 0\nMismatch ratio = 0\n\nThere is a mild prolongation of T-max in the left frontal lobe without\ncorresponding MTT prolongation, decreased cerebral blood flow or volume, which\ncould be artifactual.\n\nOTHER:\nThe visualized portion of the lungs show biapical pleural scarring with\ndiffuse ground-glass opacities which may reflect chronic lung disease or\ninfectious/inflammatory processes. The visualized portion of the thyroid\ngland is atrophic. There is no lymphadenopathy by CT size criteria. There\nare multiple chronic compression deformities including at the T1, T3, T4, and\nT5 levels.", + "output": "1. There is no evidence of large vascular territory infarction, hemorrhage,\nedema, or mass.\n2. Grossly unchanged prominence of the ventricles and sulci consistent with\nage-related global parenchymal loss and white matter changes most consistent\nwith chronic microangiopathic ischemic disease.\n3. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n4. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion,or dissection.\n5. Advanced multilevel degenerative changes of the cervical spine, as above." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. There\nis prominence of the ventricles and sulci suggestive of involutional changes. \nPeriventricular and subcortical white matter hypodensities are nonspecific but\nlikely reflect the sequelae of chronic microvascular ischemic disease.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. There is a left-sided hearing aid. The visualized\nportion of the orbits are notable for bilateral lens replacements.", + "output": "1. No acute intracranial abnormality.\n2. Global age-related volume loss and white matter changes are most consistent\nwith chronic microangiopathic changes." + }, + { + "input": "There is polyp in the left LL cavity, measuring 3.8 cm in AP diameter,\nextending into the nasopharynx. Polyp probably extends into the left\nmaxillary sinus. There is adjacent presumed left middle meatal antrostomy\nversus accessory maxillary sinus ostium. Nearly completely opacified left\nmaxillary sinus. Left ostiomeatal unit appears intact, with intact uncinate\nprocess and completely opacified and mildly expanded base of the infundibulum.\nChronic periostitis left maxillary sinus. There is no retro antral, pre\nantral, orbital soft tissue early infiltration. No osseous destruction. \nDemineralized osseous architecture left inferior turbinate.\n\nThere is atelectasis of the right maxillary sinus which trace mucosal\nthickening, significantly narrowed infundibulum of right ostiomeatal unit and\naccessory ostium posteriorly.\n\nThere is trace mucosal thickening inferior left frontal sinus, with patent\nnasal drainage pathway and minimally narrowed infundibulum. Minimally\nthickening cause inferior right maxillary sinus, with mild narrowing of the\ninfundibulum of the frontal sinus drainage pathway.\n\nTrace mucosal thickening bilateral ethmoid air cells patent sphenoid sinus,\nsphenoid sinus ostia.\n\nNasal septal deviation to the right. Clear right nasal cavity.. Anterior\nclinoid processes are not aerated. Intact medial orbital walls. Intact\ncribriform plates. No air cells above anterior ethmoidal arteries. Carotid\ncanals are covered by bone. Optic nerve canals are covered by bone.", + "output": "1. Polypoid mass left nasal cavity, extending into the left maxillary sinus\nthrough surgical defect or accessory ostium. Near completely opacified left\nmaxillary sinus with mild chronic periostitis. Demineralized osseous\narchitecture left inferior turbinate." + }, + { + "input": "Postsurgical changes after endoscopic nasal approach for resection of a left\nnasal cavity/left maxillary sinus inverted papilloma are noted.\n\nThere is mild mucosal thickening along the floor of both frontal sinuses with\nextension into the frontoethmoidal junction but with a patent drainage\npathways. Mild mucosal thickening is noted along the ethmoid air cells.\nThe cribriform plates are intact. The lamina papyracea are intact.\n\nThe sphenoid sinuses are clear. There is minimal mucosal thickening in the\nright maxillary sinus. There is moderate mucosal thickening and a mucous\nretention cyst in the left maxillary sinus. A small amount of layering fluid\nis also present. The neo ostium is patent.\nMild mucosal thickening along the right ostiomeatal fibula is noted but\nwithout obstruction.\n\nThe nasal septum is intact with mild rightward deviation. The carotid canals\nand optic nerve canals are covered by bone.\n\nThe mastoid air cells are clear. The external auditory canals and visualized\nmiddle ear structures appear unremarkable.\n\nVisualized structures of the brain and soft tissues appear unremarkable. Note\nis made right lens replacement surgery. The orbits are otherwise\nunremarkable. No significant dental disease.", + "output": "1. Postsurgical changes after endoscopic nasal approach for resection of a\nleft nasal cavity/left maxillary sinus inverted papilloma with widely patent\nneo ostium.\n2. Mucous retention cyst and moderate mucosal thickening in the left maxillary\nsinus with also a small amount of layering fluid which can be seen with acute\nsinusitis in the appropriate clinical setting.\n3. Otherwise mild diffuse paranasal sinus disease with patent drainage\npathways." + }, + { + "input": "There is no evidence of acute infarction,intracranial hemorrhage,edema,or\nmass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "There is no evidence of acute intracranial process or hemorrhage." + }, + { + "input": "CTA HEAD:\nThe vertebral arteries are normal. The basilar artery is normal. The\nposterior cerebral arteries are normal. The left internal carotid artery is\nnormal. The left middle cerebral artery is normal. There is normal\narborization of the distal left MCA vessels. The right internal carotid\nartery is normal. The right middle cerebral artery is normal. There is\nnormal arborization of the distal right MCA vessels. The anterior cerebral\narteries are normal. The dural venous sinuses are patent. There is no\nevidence of aneurysm or severe stenosis.\n\nCTA NECK:\nThe right common and internal carotid artery are normal without evidence of\ninternal carotid artery stenosis by NASCET criteria. Mild atherosclerotic\ndisease is seen at the left common carotid bifurcation. The left common and\ninternal carotid artery are normal without evidence of stenosis by NASCET\ncriteria. The left vertebral artery is normal. The right vertebral artery is\nnormal.\n\nOTHER:\nThe visualized portion of the lungs are clear. The left thyroid lobe\ndemonstrates a 2 mm hypodensity. The thyroid is otherwise grossly\nunremarkable. There is no cervical lymphadenopathy. Mild degenerative\nchanges are visualized at C5/C6 level, consistent with anterior and posterior\nspondylosis and narrowing of intervertebral disc space.", + "output": "1. Unremarkable CTA of the head without evidence of aneurysm or stenosis.\n2. No evidence of internal carotid artery stenosis by NASCET criteria." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass effect. The ventricles and sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage or mass effect. The\nventricles and basilar cisterns appear normal. The orbits, skull base, and\nparanasal sinuses are unremarkable. There is no abnormality of cerebral blood\nflow or mean transit time seen on the perfusion images.\n\nThere is no evidence of aneurysm, hemodynamically significant stenosis, or\nvessel occlusion within the intracranial vasculature. There is minimal\natheromatous calcification of the cavernous portion of the right internal\ncarotid artery. The origins of the great vessels appear normal. The left\nvertebral artery is dominant. Right vertebral artery is hypoplastic and\nterminates in right ___. There is no evidence of pathologic large vessel\nocclusion or hemodynamically significant stenosis within the vasculature of\nthe neck.\n\nThe thyroid gland is mildly enlarged with multiple nodules, greater on the\nleft side, some of which appear calcified. Ultrasound examination could be\nperformed for further evaluation, as clinically indicated.", + "output": "1. No evidence of acute intracranial hemorrhage, mass effect, or acute\nischemia.\n2. No evidence of hemodynamically significant stenosis or pathologic large\nvessel occlusion within the vasculature of the head or neck." + }, + { + "input": "A focus of intraparenchymal hemorrhage is noted within the left occipital lobe\nmeasuring approximately 4.0 x 2.4 x 3.0 cm. There is surrounding vasogenic\nedema. There appears to be subtle extension into the left lateral ventricle\nwithout significant volume of intraventricular hemorrhage appreciated. No\ndiscrete underlying lesion is identified. There is mass-effect on the\nadjacent sulci without midline shift or herniation. No extra-axial collection\nis seen. No additional sites of hemorrhage. Ventricles appear normal in\nsize. Basal cisterns are patent. Imaged paranasal sinuses are well aerated. \nThe bony calvarium is intact. Mastoid air cells and middle ear cavities are\nwell aerated.", + "output": "Parenchymal hemorrhage in the left occipital lobe measuring 4.0 x 2.4 x 3.0 cm\nwith surrounding vasogenic edema. Subtle intraventricular extension of\nhemorrhage without hydrocephalus. Close followup advised." + }, + { + "input": "Centered in left occipital lobe is a 4.9 x 2.7 x 4.1 cm (AP by TV by CC) acute\nintraparenchymal hematoma with mild surrounding white matter hypodensity\n(series 2, image 13 and series 601, image 85). With the earlier same day\nstudy performed at 09:13, there is no appreciable interval change in the\nappearance of the hematoma or the surrounding brain parenchyma. There is\napparent extension of the hematoma inferiorly to the posterior left tentorium,\nwith suggestion of hyperdense thickening of the tentorium at this level,\nlikely extension of hemorrhage into the subdural space at this location,\nunchanged (series 601, image 83). Also again seen is extension of acute\nhemorrhage into the trigone and occipital horn of the left lateral ventricle\n(series 2, image 17).\n\nThere is suggestion of subtle hyperdensity within the right temporal sulci\n(for example see series 601, image 60). There is also similar although less\nconspicuous sulcal based hyperdensity seen in the left occipital region (for\nexample see series 601, image 75). Otherwise, no additional areas of acute\nhemorrhage are identified. There is no evidence of acute large vascular\nterritorial infarction. The basal cisterns are patent, and there is no shift\nof the normally midline structures. The ventricles and sulci are normal in\ncaliber and configuration.\n\nNo evidence of acute fracture. The visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are well pneumatized and clear. Carotid siphon\ncalcifications are noted bilaterally. The globes and bony orbits are intact\nand unremarkable.", + "output": "1. No appreciable interval change in the left occipital intraparenchymal\nhematoma with surrounding white matter vasogenic edema, with evidence of\nextension into the left lateral ventricle as well as likely into the subdural\nspace along the left tentorium, as above.\n2. Subtle sulcal-based linear hyperdensity in the right and left temporal and\noccipital lobes, respectively, raise the possibility of small foci of\nbilateral subarachnoid hemorrhage, although these areas demonstrate technical\nartifact on the current study. MR head could be utilized to further evaluate,\nif clinically indicated. In the absence of this, attention to these areas on\nfollow-up exam.\n\nRECOMMENDATION(S): If clinically indicated, MRI head could be performed for\nfurther evaluation of equivocal foci of small volume subarachnoid hemorrhage\nin the right temporal and left occipital lobes. Otherwise, attention to these\nareas on follow-up, as above." + }, + { + "input": "There is re-demonstration of a 4.9 x 2.6 cm left occipital lobe\nintraparenchymal hemorrhage with adjacent edema and left posterior tentorium\nsubdural hematoma, not significantly changed from most recent exam. \nAdditionally there is re-demonstration of intra-articular hemorrhage within\nthe occipital horn of the left lateral ventricle, not significant changed from\nprior study. Previously demonstrated subtle hyperdensity within the right\ntemporal sulci and left occipital sulci is not well visualized on this study. \nThe there is no evidence of acute large territory infarction or new\nintracranial bleed. The ventricles and sulci are normal in size and\nconfiguration.\n\nNo acute osseous abnormalities seen. The paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The orbits are unremarkable.", + "output": "1. Stable left occipital intraparenchymal hemorrhage with adjacent edema and\nintraventricular extension into the left lateral ventricle.\n2. Stable left posterior tentorial subdural hematoma.\n3. Previously demonstrated subtle hyperdensities in the right temporal sulci\nand left occipital sulci not well visualized on this study.\n4. No new intracranial hemorrhage identified." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nContinued evolution of the left occipital intraparenchymal hemorrhage\nmeasuring 2.8 x 5.1 cm, similar to prior. There is stable adjacent edema and\nmass effect with effacement of the occipital horn of the left lateral\nventricle. The intraventricular extension and subarachnoid hemorrhage noted on\nprior MR from ___ is not visualized on the current study. There is\nno midline shift.\n\nSize and configuration of the ventricles and sulci are unchanged compared to\nprior. No evidence of large vascular territory infarction. No new foci of\nhemorrhage.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nMild atherosclerotic calcifications are noted in bilateral cavernous carotid\narteries.\n\nCTA HEAD:\nNo vascular malformation is noted. There is a hypoplastic left A1 segment. \nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. There is a\ncongenitally hypoplastic left transverse sinus. The dural venous sinuses are\npatent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThere is a 5 mm pulmonary nodule noted in the left lung apex.\nThere is a 0.7 cm hypodense nodule in the right thyroid lobe is noted\nincidentally. There are prominent cervical and mediastinal lymph nodes\nmeasuring up to 0.9 cm in short axis, which is nonspecific and may be\nreactive.", + "output": "1. Continued evolution of left occipital intraparenchymal hemorrhage with\nstable mass effect and effacement of the left lateral ventricle. No new foci\nof hemorrhage.\n2. Normal head and neck CTA. No vascular malformation is noted.\n3. Prominent cervical and mediastinal lymph nodes are nonspecific and may be\nreactive.\n4. 5 mm pulmonary pulmonary nodule in the left lung apex.\n\nRECOMMENDATION(S): 6-month chest CT is recommended for follow up of lung\nnodules and lymphadenopathy." + }, + { + "input": "Encephalomalacia in the left occipital region is related to prior\nintraparenchymal hemorrhage. Curvilinear area of hyperdensity in this region\nof encephalomalacia is more likely reflective of an area of calcification\nrather than a small focus of hemorrhage (02:13, 400:52). No additional areas\nof intracranial hemorrhage are identified. There is no evidence of an acute\nlarge territorial infarct. Prominence of the ventricles and sulci suggestive\nof involutional changes. Periventricular and subcortical white matter\nhypodensity is nonspecific, but likely reflect sequelae of chronic small\nvessel ischemic disease. Dense atherosclerotic vascular calcification of the\ncavernous internal carotid arteries is noted.\n\nThere is no evidence of fracture. With the exception of mild anterior ethmoid\nair cell mucosal thickening, the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "Encephalomalacia in the left occipital region related to prior\nintraparenchymal hemorrhage. A curvilinear hyperdensity in the inferior left\noccipital lobe in this region of encephalomalacia is more likely reflective of\nan area of calcification rather than a focus of acute hemorrhage.\n\nNOTIFICATION: Update was paged to ___, M.D. by ___, M.D. on\nthe telephone on ___ at 5:37 pm, 2 minutes after discovery of the\nfindings." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nA soft tissue density within the left neck extends from approximately the\nlevel of the C2 vertebral body to the C7 vertebral body (05:38) (02:32). \nThere is no surrounding fat stranding or suggestion of abscess.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding.A hypodensity of the right thyroid measures approximately 1 cm\n(02:56).Multiple cervical and axillary lymph nodes are prominent (for example\n02:32).The neck vessels are patent.\n\nA right-sided Port-A-Cath is partially imaged. Approximately 4 mm left upper\nlobe pulmonary nodule (2:62). Otherwise, the imaged portion of the lung\napices are clear. Fracture of the right lamina of C5 (02:40), of uncertain\nchronicity.", + "output": "1. Extensive left cervical lymphadenopathy - may be reactive in etiology or\nsecondary to patient's neoplasm. Continue clinical follow up is recommended.\n2. Patent bilateral internal jugular veins.\n3. 1 cm hypodense right thyroid nodule.\n4. Fracture of the right lamina of C5, of uncertain chronicity.\n5. Approximately 4 mm left upper lobe pulmonary nodule." + }, + { + "input": "There is complete occlusion of the right internal jugular vein extending from\nangle of the mandible to the thoracic inlet. There is significant surrounding\nfat stranding in the carotid space, which may represent congestion in the\nsetting of venous thrombosis, however septic thrombophlebitis difficult to\nexclude. No drainable fluid collection.\n\nEvaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding.There is bilateral cervical lymphadenopathy, the largest lymph node\nmeasures 1.2 x 2.7 cm in level IIb, similar to prior.\n\nSmall pleural based nodules are again seen in the left upper lobe measuring up\nto 5 mm. An 8 mm hypodense right thyroid nodule is again noted. There are no\nosseous lesions. A right chest wall port is partially visualized in the SVC.", + "output": "1. Thrombosis of the right internal jugular vein extending from the angle of\nthe mandible to the thoracic inlet. Surrounding edema likely represents\ncongestion, however infection cannot be excluded. No drainable fluid\ncollection.\n2. Stable bilateral cervical lymphadenopathy which may be reactive or related\nto the patient's known neoplasm." + }, + { + "input": "In the left occipital lobe there is an area of encephalomalacia with a\ncurvilinear area of hyperdensity, similar to prior exam compatible with\ncalcification. There is no evidence of acute infarction,hemorrhage,edema, or\nmass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nethmoid air cells. There is partial opacification of a few inferior bilateral\nmastoid air cells, improved compared to prior. The visualized portion of the\nremaining paranasal sinuses, and middle ear cavities are clear. Tornwaldt\ncyst is noted in the nasopharynx. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial process. MRI is more sensitive for detection of\nintracranial metastasis.\n2. Stable area of encephalomalacia in the left occipital lobe and unchanged\nappearance of associated cortical calcification." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nAgain seen is extensive atrophy and ventricular dilatation. Unchanged is\nperiventricular white matter hypodensities suggesting chronic small vessel\nischemia. The lenses have been resected. There is calcification of the\ncavernous carotid arteries bilaterally.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is a tiny outpouching from the supraclinoid segment of the right\ninternal carotid artery. This may represent a 2 mm aneurysm or infundibulum. \nOtherwise, the vessels of the circle of ___ and their principal\nintracranial branches appear normal without stenosis, occlusion, or other\naneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nThe carotid and ertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria. The right vertebral artery is dominant. The\nsmall left vertebral artery arises directly from the arch.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Atrophy with no evidence of mass, hemorrhage or infarction.\n2. 2 mm infundibulum or aneurysm arising from the supraclinoid segment of the\nright internal carotid artery.\n3. Otherwise normal head and neck CTA." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nThere is mild mucosal thickening of the left maxillary sinus. The remaining\nimaged paranasal sinuses are clear. Mastoid air cells and middle ear cavities\nare well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There are numerous enhancing subcutaneous nodules. There is a 0.7 x 0.8 cm\nrim enhancing nodule just superficial to the skin surface with surrounding\nsubcutaneous fat stranding located just superior to the right trapezius muscle\n(02:42). A similar 0.7 x 0.6 cm subcutaneous nodules partially visualized\nsuperficial to the right pectoralis muscle in the anterior chest wall (02:69).\n2 additional similar appearing nodules are noted in the subcutaneous tissue of\nthe back at approximately the level of T1 (02:51, 02:49). These lesions are\nhighly suspicious for metastatic disease.\n\nThere are multiple enlarged, abnormal appearing lymph nodes. Two enlarged\nsupraclavicular lymph nodes, the larger of which measures 1.0 x 1.5 cm (02:51,\n02:49) with abnormal morphology, likely necrotic, and surrounding fat\nstranding. There is also a 1.0 x 0.9 cm right-sided level Ib lymph node\n(02:30). A prominent 0.7 cm lymph node is noted in the left supraclavicular\nregion. These are also compatible with metastatic disease.\n\nThere are no masses adjacent to the aerodigestive tract or evidence of focal\nmass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions. There is multilevel\ndegenerative disease of the spine with posterior osteophyte formation and\nsclerotic changes of the C4-C6 vertebral bodies.", + "output": "1. Numerous subcutaneous nodules in the anterior chest wall, posterior chest\nwall and right shoulder are highly suspicious for metastatic disease.\n2. Cervical and supraclavicular lymphadenopathy with necrotic changes.\n3. No mass effect on the aerodigestive tract.\n4. No osseous lesions.\n5. No pulmonary nodules in the visualized lung apices. Please refer to same\nday chest CT report for complete description of the intrathoracic findings.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 2:38 pm, 2 minutes after\ndiscovery of the findings." + }, + { + "input": "There are innumerable enhancing metastatic lesions within the cerebellum\nmeasuring up to 1.2 cm is in the region of the right cerebellopontine angle. \nSeveral of the lesions appear leptomeningeal in nature and are noted along the\naqueduct and fourth ventricle, as well as the tentorial leaflets bilaterally. \nThere does not appear to be any see enhancing supratentorial lesions. \nMultiple enhancing skin nodules are also noted measuring up to 2.1 cm in the\nright temporal scalp. There are no suspicious osseous lesions. No\nintracranial hemorrhage.\n\nThere is no prior head imaging for comparison however the ventricles appear\nprominent with mild surrounding hyperdense brain parenchyma concerning for\nhydrocephalus with mild transependymal flow of CSF. The cerebellar tonsils\nare somewhat low lying with crowding of the foramen magnum (4:2). There is no\nmidline shift.\n\nThere is a small amount of fluid in the right maxillary sinuses. Otherwise\nthe paranasal sinuses, mastoid air cells and middle ear cavities are clear. \nThe orbits are unremarkable.", + "output": "Extensive metastatic disease burden within the cerebellum involving the\nparenchyma and leptomeninges as described above. These lesions are likely\ncausing obstructive hydrocephalus with transependymal flow of CSF. \nAdditionally there is crowding at the foramen magnum concerning for increased\ncerebellar pressure and tonsillar herniation.\n\nMultiple enhancing subcutaneous nodules over the scalp.\n\nThe findings were discussed with ___, M.D. by ___, M.D. on\nthe telephone on ___ at 7:30 pm, 2 minutes after discovery of the\nfindings." + }, + { + "input": "The previously described numerous metastatic lesions within the cerebellum are\nbetter evaluated on the prior contrast enhanced CT. However, numerous\nhyperdensities are noted within the cerebellum likely corresponding to the\naforementioned lesions. There is no evidence of interval acute large\nterritorial infarction, although MRI would be more sensitive in its detection.\nThere is no intracranial hemorrhage.\n\nThe ventricular system again appears somewhat prominent, stable from prior. \nThere is nonspecific, CSF density fluid adjacent to the lateral ventricles and\nseptum pellucidum which may reflect mild transependymal flow of CSF. There is\nno midline shift. Cerebellar tonsils are low lying with crowding of the\nforamina magnum (2:1).\n\nThere is no evidence of fracture. The visualized paranasal sinuses, middle\near cavities and mastoid air cells are clear. The orbits are unremarkable.", + "output": "1. Metastatic disease within the cerebellum is better evaluated on the prior\ncontrast enhanced CT.\n2. Persistent, but stable obstructive hydrocephalus, with prominence of the\nventricular system, and transependymal migration of CSF.\n3. Persistent crowding of the cerebellar tonsils and fullness of the foramina\nmagnum. Continued close surveillance is recommended." + }, + { + "input": "There is a chronic left MCA infarction, evolved since the study of ___. \nA small right frontal hypodensity (02:14) stable compared to ___ and an area\nof hypodensity in the left parietal region (2: 20), new since ___ appear to\nrepresent chronic infarctions.\nNo hemorrhage is identified.\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of hemorrhage.\n\n2. Old left frontotemporal MCA infarct. Other smaller areas of hypodensity in\nthe right frontal and left parietal region are also likely areas of old\ninfarct." + }, + { + "input": "Focal 9 mm extra-axial hyperdensity at the right parietal vertex could\nrepresent focal acute subarachnoid hemorrhage versus non-calcified meningioma.\nNo mass effect or midline shift is seen. Extensive periventricular and\nsubcortical white matter hypodensities, nonspecific but probably reflect\nsequela of chronic microangiopathy There is prominence of the ventricles and\nsulci suggestive of involutional changes.\n\nMultiple fractures of the facial bones, including the anterior and lateral\nwalls of the left maxilla, and bilateral pterygoid processes, inferior orbital\nrims. These are better seen on the dedicated maxillofacial CT will be\ndescribed in further detail on this reported that CT. There is near complete\nopacification of the maxillary sinuses and ethmoid air cells with dense\nmaterial likely reflecting blood products in the setting of trauma.", + "output": "1. Focal 9 mm extra-axial hyperdensity at the right parietal vertex\nconcerning for acute subarachnoid hemorrhage versus non calcified meningioma. \nNo prior study available for comparison. Suggest short-term follow-up head CT\nto assess for interval change.\n2. Multiple facial fractures including left maxilla and bilateral pterygoid\nplates, inferior orbital rims, concerning for at least ___ type 2.\nWith near complete opacification of the maxillary sinuses and ethmoid air\ncells. These are better seen and described on the dedicated maxillofacial CT.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 7:35 pm, 2 minutes after\ndiscovery of the findings." + }, + { + "input": "There is no acute intracranial hemorrhage, edema, mass effect or acute\ninfarction. The ventricles and sulci are normal in size and configuration.\nThe visualized paranasal sinuses and mastoid air cells are clear. There is no\nacute fracture.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, or acute major\nvascular territorial infarction. Minimal white matter hypodensities are\nnoted, likely the sequela of chronic small vessel ischemic disease. There is\nprominence of the ventricles, sulci, and other extra-axial spaces, similar to\nprior, suggestive of involutional changes.\n\nThere is no evidence of fracture. There is mild mucosal thickening involving\nthe ethmoid air cells and a tiny mucous retention cyst in the left sphenoid\nsinus. The middle ear cavities and mastoid air cells are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No evidence for an acute intracranial abnormality." + }, + { + "input": "There is no evidence of large territory infarction,hemorrhage,edema, or mass. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. There is calcified atherosclerosis of the bilateral carotid siphons.\n\nThere is no evidence of fracture. A 4 mm hyperdense structure within the left\nfrontal sinus represents an osteoma. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Left lens\nextraction. The right orbit is unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of hemorrhage, edema, masses, mass effect or infarction. \nThere is enlargement of the ventricles and sulci within the range expected for\nage. The left lens has been resected. There is minimal mucosal thickening in\nthe ethmoid air cells. Otherwise, the paranasal sinuses and mastoid air cells\nappear normal.", + "output": "No evidence of mass, hemorrhage or infarction.\nMinimal paranasal sinus inflammatory changes." + }, + { + "input": "Re-demonstration of left greater than right bifrontal subarachnoid hyperdense\nmaterial consistent with subarachnoid hemorrhage. This appears slightly\nincreased in size measuring up to 1.3 cm in the left frontal lobe (02:15). A\n0.8 cm hyperdensity in the left anterior frontal lobe is more conspicuous on\ncurrent exam and may reflect an additional site of subarachnoid versus\nintraparenchymal hemorrhage (02:11). No evidence of acute territorial\ninfarction or edema. The ventricles and sulci are normal in size and\nconfiguration. No midline shift is present. Additional thickening along the\nfalx raises concern for subdural hemorrhage, unchanged compared to the prior\nexam.\n\nNondisplaced right parietal bone fracture is unchanged in appearance compared\nto the prior exam with associated extra-axial blood products. Right vertex\nsubgaleal hematoma is again demonstrated. there is mild mucosal thickening of\nthe bilateral sphenoid sinuses. Otherwise, the remaining visualized paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Re-demonstration of right greater than left bifrontal subarachnoid\nhyperdense material, consistent with hemorrhage. This appears slightly\nincreased in size measuring up to 1.3 cm in the left frontal lobe.\n2. 0.8 cm hyperdensity left anterior frontal lobe is more conspicuous on\ncurrent exam and may reflect an additional site of subarachnoid versus is\nintraparenchymal hemorrhage.\n3. No evidence of midline shift.\n4. Similar appearance of the transverse right parietal bone fracture with\nextra axial blood products.\n5. Subdural blood products along the falx is unchanged compared to the prior\nexam." + }, + { + "input": "There is loss of gray-white differentiation what appears to be the right\npostcentral gyrus (series 2, image 20) and right anterior insula (series 2,\nimage 11) with associated mild sulcal effacement and white matter hypodensity\nof the right corona radiata (series 2, image 16). Likely prominent\nperivascular space is noted in the left anterior external capsule. Otherwise,\nno evidence of acute intracranial hemorrhage or large territorial infarct.\n\nSuperimposed periventricular and subcortical T2 white matter hypodensities are\nnonspecific, but compatible with chronic microangiopathy in a patient of this\nage. The sulci, ventricles and cisterns are prominent, but within expected\nlimits for the degree of age related global cerebral volume loss.\n\nThere is no evidence of acute fracture. There is mild layering fluid in the\nmaxillary and sphenoid sinuses. There is polypoid opacification of the\nethmoid air cells. The mastoid air cells and middle ears are otherwise clear.\nThe visualized portion of the orbits are unremarkable. There is bilateral\ncarotid siphon and vertebral artery calcification.", + "output": "1. There is loss of gray-white differentiation of the apparent right post\ncentral gyrus and right anterior insula with associated mild sulcal effacement\nand white matter hypodensity of the right corona radiata, concerning for acute\ninfarcts given the clinical history. MRI would be more sensitive, if there\nare no contraindications, for more subtle findings.\n2. No acute intracranial hemorrhage. Additional findings as described above.\n\nNOTIFICATION: The change discussed in impression #1 from preliminary wet read\nwas discussed with Dr. ___, M.D. by ___, M.D. on the\ntelephone on ___ at 10:36 AM, 5 minutes after discovery of the\nfindings." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territorial infarct. Prominence of the\nventricles and sulci is consistent with cortical volume loss. Periventricular\nand subcortical white matter hypodensities are likely sequelae of chronic\nsmall vessel disease. Right basal gangliar lacune or infarct in the region of\nthe lentiform nucleus/external capsule is noted. The visualized paranasal\nsinuses are clear. The mastoid air cells are clear. No acute fracture is\nseen.", + "output": "No acute intracranial process." + }, + { + "input": "No acute fracture or dislocation is seen. The pterygoid plates are intact. \nThe mandible is intact. The bilateral temporomandibular joints are intact\nwithout significant degenerative change. The patient is edentulous. The\nparanasal sinuses, mastoid air cells, and middle air cavities are clear. The\nostiomeatal units are patent bilaterally.\nThere is mild left preseptal and periorbital soft tissue swelling. No\nretrobulbar involvement is seen. There is no retrobulbar or postseptal fat\nstranding or hematoma. The globes are intact. The orbits are intact.", + "output": "1. No acute fracture. Clear paranasal sinuses. Mild left preseptal and\nperiorbital soft tissue edema without retrobulbar or postseptal involvement." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe right brachiocephalic and left common carotid arteries share a common\norigin, a normal anatomic variant. The carotid and vertebral arteries and\ntheir major branches appear normal with no evidence of stenosis or occlusion.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Normal head and neck CTA.\n2. Normal head CT." + }, + { + "input": "Minimal right ethmoid air cell and bilateral maxillary sinus mucosal\nthickening is present. Otherwise, the paranasal sinuses are normally aerated,\nwith no mucosal thickening or air-fluid levels identified. The ostiomeatal\nunits are patent. The cribriform plates are intact. The lamina papyracea are\nintact.\n\nThere is leftward nasal septal deviation with bony spur. There is partial\npneumatization of bilateral anterior clinoid processes.\n\nQuestion extension of left maxillary first and second molar roots into left\nmaxillary sinus in region of noted mucosal thickening versus volume averaging\nartifact. A right-sided concha bullosa is present (see 06:41). Bilateral\nHaller cells are present.", + "output": "1. Minimal paranasal sinus disease as described.\n2. Question extension of left maxillary first and second molar roots into left\nmaxillary sinus with noted adjacent mucosal thickening, versus volume\naveraging artifact. Please noted odontogenic sinusitis is not excluded on the\nbasis of this examination.\n3. Leftward nasal septal deviation with bony spur.\n4. Right-sided concha bullosa.\n5. Bilateral Haller cells.\n6. Partial pneumatization of bilateral anterior clinoid processes." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe left vertebral artery is difficult to evaluate just distal to its origin\ndue to streak artifact. The carotid and vertebral arteries and their major\nbranches appear normal with no evidence of stenosis or occlusion. There is no\nevidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. Dental amalgam obscures the\noropharynx. Scattered nonenlarged lymph nodes are present throughout the\ncervical chain bilaterally. There is no lymphadenopathy by CT size criteria.", + "output": "1. No acute intracranial process on noncontrast head CT\n2. Unremarkable intracranial and neck vasculature." + }, + { + "input": "There is no CT evidence of large territorial infarct or intracranial\nhemorrhage. Compared to brain MRI on ___, there is interval\nplacement of an intraventricular catheter system, which is seen coursing\nthrough the right frontal bone and terminating at the septum pellucidum. \nThere is soft tissue swelling around the implanted subgaleal reservoir. \nNumerous intracranial metastatic lesions identified on prior MRI are not\napparent on the current study. No ventriculomegaly or overt interventricular\nhemorrhage. Mild prominence of the ventricles and sulci likely represents\nparenchymal volume loss due to age.\n\nThere is no evidence of fracture. The frontal sinuses are underpneumatized\nand demonstrate mild mucosal thickening. Otherwise, the visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nThe visualized portion of the orbits are unremarkable.", + "output": "Interval placement of a right-sided intraventricular catheter system with\ncatheter tip terminating near the third ventricle. No CT evidence of large\nterritorial infarct. No intracranial hemorrhage." + }, + { + "input": "Right frontal approach ventriculostomy catheter is seen terminating in the\nanterior third ventricle, similar to prior exam. The right lateral ventricle\nmeasures 7 mm, unchanged to slightly smaller compared to ___ where\nit measured 8 mm (02:13). The fourth ventricle is patent. There is no\nevidence of infarction or hemorrhage. No masses are detected on this\nnoncontrast CT scan. MR is far more sensitive for assessing progress of\nmetastatic disease.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. Bilateral lens replacements are noted.", + "output": "1. Right frontal approach ventriculostomy catheter terminates in the third\nventricle, similar to prior exam. No significant change in ventricular size\ncompared to ___.\n2. No evidence of mass, hemorrhage or infarction.\n3. MR is more sensitive for assessing the status of metastatic disease.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 12:10 am, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territorial infarct. The ventricles and sulci\nare normal in size and configuration.\n\nThere is no evidence of acute fracture. Small mucous retention cysts are\nnoted in the maxillary sinuses, bilaterally. Otherwise, the visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear.", + "output": "1. No acute intracranial abnormality. No acute fracture seen." + }, + { + "input": "Re-demonstration of extensive bilateral neck and facial edema. Enlarged\nbilateral level 1, 2 cervical lymph nodes, likely reactive. There is mild\nsymmetric mucosal wall thickening of the aryepiglottic folds bilaterally\nextending from the supraglottic larynx down toward the glottis, with moderate\nthickening involving true and false vocal cords, which appears new compared to\nprior CT neck performed ___. No evidence of thickening of the\nepiglottis. There is no evidence of retropharyngeal fluid collection or\nprevertebral edema. Platysmal thickening, subcutaneous stranding about\nanterior mandible, anterior neck and adjacent non organized fluid has\nimproved. Under venous fluid about bilateral mandibular glands has improved. \nSymmetric mild hyperemia involving both superficial lobes of the parotid\nglands is similar. No parotid fluid collection. Mild increase in fat\nstranding at the superior margin of the clavicles, appears slightly worse\ncompared to prior CT neck exam.\n\nSmall pockets of air with fluid surrounding the lateral margins of mandible\nwithout evidence of peripheral enhancement, likely represents postsurgical\nchanges or phlegmon, and appear improved on the right, and mildly worsened on\nleft side. Right-sided abnormality measures 0.8 cm x 0.4 cm, and on the left\n1.3 cm x 0.5 cm. Adjacent size of posterior bilateral mandibular and\nmaxillary molar extractions are seen.\n\nVisualized portion of the head demonstrates no gross abnormality. There is\nmild mucosal thickening of the left maxillary sinus. The remaining visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion the bilateral orbits are unremarkable. \nPatent neck vessels, including jugular veins.\n\nImaged portion of the lung apices demonstrates new consolidation, with nodular\ncomponents, in the right upper lobe, worrisome for pneumonia or aspiration. \nThis is better evaluated on contrast enhanced CT chest performed on the same\ndate. Probable mild subpleural atelectasis in partially seen left lung\nposteriorly there are small bilateral pleural effusions", + "output": "1. New symmetric thickening and edema of the glottis and supraglottic larynx\nextending into the aryepiglottic folds,, without epiglottic involvement, may\nbe reactive or inflammatory/infectious.\n2. Neck edema, stranding has overall mildly improved. Enhancement of the\nsuperficial lobes of the parotid glands is similar, may be reactive or from\nparotitis.\n3. There is mild increase in fat stranding at the superior margin of the\nclavicles, that appears slightly worse compared to prior CT neck.\n4. Small areas fluid and air adjacent to the lateral mandibles, may represent\npostoperative change or phlegmon, without definite evidence of well-defined\nabscess.\n5. New consolidation in the dependent portion right lower lobe, with nodular\ncomponents, partially seen, worrisome for pneumonia or aspiration. Small\npleural effusions. Refer to chest CT report." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. There\nis prominence of the ventricles and sulci suggestive of involutional changes. \nPeriventricular subcortical white matter hypodensities are nonspecific but\nsuggest chronic small vessel ischemic changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Normal study." + }, + { + "input": "HEAD CTA: There is calcified atherosclerotic disease of the carotid siphons,\nwithout evidence of significant stenosis. There is a triplex ACA,\nrepresenting variant anatomy. The anterior, and middle cerebral arteries are\notherwise unremarkable. The posterior communicating arteries are not\nidentified. I ncidentally noted is a \"patulous\" basilar summit, comprising\nconjoined origins of the right PCA and SCA on the right and infundibular\norigins of their left-sided counterparts.\n\nNECK CTA: There is a left-sided three-vessel aortic arch. There is mild\ncalcified atherosclerotic disease of the carotid bifurcations, bilaterally,\nwithout evidence of flow-limiting stenosis based on NASCET criteria. The\ncommon, internal and external carotid arteries are otherwise unremarkable. \nThe vertebral arteries are widely patent without evidence of significant\nstenosis.\n\nThere is a ill-defined heterogeneously dense nodule in the left thyroid lobe,\nmeasuring 2 x 2.9 cm. There is mild dependent atelectasis. There is\npanacinar emphysema with prominent subpleural bullae. There are mild cervical\nspine degenerative changes.", + "output": "Unremarkable head and neck CTA without evidence of steno-occlusive disease or\naneurysm larger than 2 mm.\n\n2 x 2.9 cm heterogeneously dense nodule in the left lobe of the thyroid gland\n. Recommend thyroid sonography, on an elective basis, for further evaluation." + }, + { + "input": "There is no evidence of hemorrhage, mass, or mass effect. Subtle\nhypodensities within the left frontoparietal region (___), appear more\nprominent compared to the prior exam. Periventricular and subcortical deep\nwhite matter hypodensities are likely related to small vessel ischemic\ndisease. There is no evidence of recent infarction. Mildly prominent\nventricles and sulci are likely related to age related involutional changes. \nThe basilar cisterns are patent.\n\nNo fractures identified. There is subtle mild mucosal sinus thickening\ninvolving the maxillary sinuses bilaterally. The ethmoid air cells, and\nsphenoid sinuses aside from mild mucosal thickening are clear. The frontal\nsinuses are clear. The mastoid air cells, and middle ear cavities are clear. \nThe globes are unremarkable.", + "output": "1. Subtle hypodensities within the left fronto-parietal region appear more\nprominent compared to the prior CT from ___. Suggesting a interval\nchronic changes related to small vessel ischemia. No evidence of hemorrhage\nor infarction. ." + }, + { + "input": "CT HEAD WITHOUT CONTRAST: No infarction, hemorrhage, edema or mass. Prominent\nventricles and sulci are consistent with age-related involutional changes. \nPeriventricular white matter hypodensities are are likely sequela of chronic\nsmall vessel ischemic disease.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion or aneurysm formation. Incidentally\nnoted is a trifurcation of the A2 segment of the anterior cerebral artery, a\nnormal variant.\n\nCTA NECK:\nAtheromatous changes at the internal carotid artery bifurcations are noted. \nNo occlusion, dissection or aneursym. There is no evidence of internal carotid\nartery stenosis by NASCET criteria.\n\nOTHER:\nBilateral emphysematous changes and ground-glass opacities at the pulmonary\napices, unchanged from prior imaging. The visualized portion of the thyroid\ngland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Atheromatous disease of the internal carotid artery bifurcations. No\nevidence of internal carotid artery stenosis by NASCET criteria.\n2. No occlusion, dissection or aneurysm.\n3. Unchanged bilateral emphysematous changes and ground-glass opacities of the\npulmonary apices." + }, + { + "input": "CT head: The gray-white matter differentiation is intact without acute\nterritorial infarct, hemorrhage, or mass effect. There is nonspecific\nperiventricular white matter hypodensity, likely reflecting sequela of chronic\nmicroangiopathy. There is mild prominence of the ventricles and cortical\nsulci consistent with volume loss. The extra-axial spaces are unremarkable.\n\nThe bilateral native lenses are absent, otherwise the orbits are unremarkable.\nThe calvarium and soft tissues are unremarkable. There is mild mucosal\nthickening within the bilateral maxillary sinuses. The mastoid air cells and\nmiddle ears are clear.\n\nCTA head: There is calcification the bilateral intracranial internal carotid\narteries, which are patent. The bilateral posterior communicating arteries\nare visualized. There are codominant vertebral arteries. There is no\nevidence of occlusion, dissection, significant stenosis, or aneurysm. There\nis no evidence of vascular malformation. There is normal enhancement of the\ndural venous sinuses.\n\nCTA neck: There is calcification of a 3 vessel aortic arch with mural\natheroma at the posterior wall of the descending thoracic aorta (05:22). \nThere is calcification of the great vessel origins without significant\nstenosis.\n\nThere is calcification at the right carotid bifurcation bulb, without stenosis\nby NASCET criteria. There is a tortuous course of the cervical segment. \nThere is a 2 mm posterior medially projecting outpouching from the cervical\nsegment internal carotid artery consistent with pseudoaneurysm with\nquestionable linear defect at the base likely representing a combination of\nvolume-averaging and streak artifact (05:201). There is a shallow wide-based\nulcer at the anterior aspect of the cervical segment right internal carotid\nartery measuring 1 mm in depth with a 3 mm in width (5:200). These findings\nare unchanged from CT examination ___.\n\nThere is calcification at the left carotid bifurcation bulb, without stenosis\nby NASCET criteria. There is a tortuous course of the cervical segment. The\nvertebral arteries are patent and demonstrate codominant.\n\nThere is asymmetric soft tissue prominence at the right tongue base (5:165),\npresumably the lingual tonsil. There is a heterogeneous appearance of the\nthyroid gland, without discrete nodule. The salivary glands are unremarkable.\nThe masticator and parapharyngeal spaces are unremarkable. There is streak\nartifact secondary to dental almalgam which obscures adjacent structures. \nThere is a periapical lucency at the left mandibular medial incisor. There is\ntorus mandibularis anatomy. There multilevel degenerate changes of the\ncervical spine without fracture or osseous lesion. There is centrilobular and\nparaseptal emphysema with large right apical bullae measuring up to 2.3 cm. \nThe mainstem pulmonary arteries are dilated measuring up to 3.4 cm in diameter\nwith prominence of the internal jugular veins, right greater than left.", + "output": "1. No acute intracranial abnormality on noncontrast head CT.\n2. Patent intracranial and neck vasculature without occlusion, significant\nstenosis, or aneurysm.\n3. 2 mm pseudoaneurysm and small broad-based ulcer at the mid right cervical\nsegment internal carotid artery, which is relatively unchanged comparison to\n___. Linear defect at the base of the pseudoaneurysm was present on\nprior study and likely represents streak artifact rather then a dissection\nflap.\n4. Small mural atheroma versus thrombus at the descending thoracic aorta.\n5. Unchanged asymmetric soft tissue prominence at the right tongue base which\nlikely represents lingual tonsil. Recommend correlation with direct\nvisualization if clinically indicated to exclude more worrisome lesion.\n6. Periapical lucency at the left mandibular medial incisor. Recommend\nfollow-up with dentistry.\n7. Centrilobular and paraseptal emphysema at the lung apices with large right\napical bullae.\n8. Dilated pulmonary arteries and prominent internal jugular veins which may\nbe seen with pulmonary arterial hypertension.\n\nRECOMMENDATION(S): Correlation with direct visualization as indicated for\nasymmetric soft tissue at the right tongue base.\n\nDentistry followup is recommended." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\n There is no evidence of infarction, hemorrhage, edema, or mass. Ventricles\nand sulci are prominent, consistent with mild age-related global parenchymal\nloss. Subcortical, periventricular and deep white matter hypodensities are\nnonspecific, but likely reflect the sequela of mild chronic microangiopathic\nischemic disease.\n\nThere is no fracture. Small scattered mucous retention cysts and mucosal\nthickening of the bilateral maxillary sinuses. Mild mucosal thickening of the\nanterior ethmoid air cells. The visualized portion of the remaining paranasal\nsinuses, mastoid air cells, and middle ear cavities are otherwise clear. The\nvisualized portion of the orbits demonstrate prior lens surgery and are\notherwise normal.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. There is\natherosclerosis of the bilateral intracranial arteries. The dural venous\nsinuses are patent.\n\nCTA NECK:\nAtherosclerosis of the aortic arch and proximal subclavian arteries is noted. \nBilateral carotid and vertebral artery origins are patent. There is calcified\natheromatous plaque at the origin of the right vertebral artery with mild\nstenosis. Mild atherosclerotic calcification of the carotid bifurcations\nbilaterally with approximately 40% stenosis of the right proximal internal\ncarotid artery by NASCET criteria. There is tortuosity and medialization of\nthe right cervical internal carotid artery. There is a 2 mm posteromedially\noriented outpouching of the cervical segment of the right internal carotid\nartery consistent with a pseudoaneurysm (3:189). The vertebral arteries and\ntheir major branches appear normal with no evidence of stenosis or occlusion.\n\nOTHER:\nThere is soft tissue thickening of the right upper lobe in close proximity to\nthe right hilum, measuring 4.2 x 4.6 cm (TRV by AP), increased in size\ncompared to the CT chest from ___. There is severe centrilobular\nand paraseptal emphysema in the visualized lung apices. There is a 1.4 cm\nhypoattenuating nodule in the left thyroid. There are multiple additional\nsubcentimeter nodules in the bilateral thyroid. There is mild ectasia of the\nleft main pulmonary artery. There is no lymphadenopathy by CT size criteria. \nModerate cervical spondylosis.", + "output": "1. No acute large territory infarction or hemorrhage. White matter changes\nconsistent with mild chronic microangiopathic ischemic disease.\n2. Patent circle of ___ without evidence of stenosis, occlusion, or\naneurysm.\n3. Unchanged 2 mm posteromedially oriented outpouching of the cervical segment\nof the right internal carotid artery consistent with a pseudoaneurysm.\n4. Atherosclerosis of the carotid bifurcations with approximately 40% stenosis\nof the right internal carotid artery by NASCET criteria.\n5. Patent bilateral cervical vertebral arteries without evidence of\nocclusionor dissection.\n6. Slight interval increase in the size of soft tissue thickening in the right\nupper lobe in close proximity to the right hilum. This can reflect post\nradiation change and/or tumor. Consider dedicated chest imaging.. Severe\ncentrilobular and paraseptal emphysema in the visualized lung apices.\n7. Stable 1.4 cm hypoattenuating nodule in the left thyroid lobe. Per ACR\nguidelines, no follow up recommended. See recommendations below.\n\nRECOMMENDATION(S): Absent suspicious imaging features, unless there is\nadditional clinical concern, ___ College of Radiology guidelines do not\nrecommend further evaluation for incidental thyroid nodules less than 1.0 cm\nin patients under age ___ or less than 1.5 cm in patients age ___ or older.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is subcortical periventricular and deep white matter hypodensity, most\nsuggestive of chronic small vessel ischemic disease. There is sulcal and\nventricular prominence, reflecting age related volume loss. There is no\nevidence of infarction,hemorrhage,edema,ormass.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are normal.\n\nCTA HEAD:\nThere is atherosclerosis of the bilateral cavernous and supraclinoid internal\ncarotid arteries with mild stenosis.\n\nThere is a trifurcation of the anterior communicating artery, consistent with\nanatomical vascular variation, otherwise the vessels of the circle of ___\nand their principal intracranial branches appear normal without stenosis,\nocclusion, or aneurysm.\n\nThe dural venous sinuses are patent.\n\nCTA NECK:\nThere is atherosclerotic calcifications of the aortic arch and the subclavian\narteries. Additionally, there is calcified atherosclerotic plaque at the\norigin of bilateral vertebral arteries resulting in mild stenosis. However the\norigins of the great vessels are patent.\n\nThere is calcified and noncalcified atherosclerotic disease of the bilateral\ncarotid bulbs and the proximal internal carotid arteries which results in\n___ stenosis of the right proximal internal carotid artery by NASCET\ncriteria. There is stable 2 mm medially oriented pseudoaneurysm of the right\ncervical internal carotid artery (3, 192).\n\nThe vertebral arteries and their major branches appear normal with no evidence\nof stenosis or occlusion.\n\nOTHER:\nThere is extensive biapical paraseptal and centrilobular emphysema. There is\nunchanged right hilar spiculated soft tissue thickening which is unchanged in\nappearance from prior exams.\n\nThere are bilateral thyroid gland nodules with the largest measuring\napproximately 1.3 cm and the left findings are similar in appearance to prior\nexam.\n\nThere are unchanged multilevel degenerative changes of the cervical spine,\nincluding mild anterolisthesis at C4-C5, and posterior spondylosis at C6-C7\nlevel.", + "output": "1. No acute large territory infarction or hemorrhage. Findings most\nsuggestive of moderate to advanced chronic small vessel ischemic disease on a\nbackground of age-related volume loss.\n2. Stable 2 mm pseudoaneurysm of the right cervical internal carotid artery.\n3. Unchanged ___ stenosis of the right proximal internal carotid artery by\nNASCET criteria.\n4. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm." + }, + { + "input": "There is no evidence of large territorial infarction, acute intracranial\nhemorrhage, edema, or mass. There is prominence of the ventricles and sulci\nsuggestive involutional changes. Periventricular and subcortical white matter\nhypodensities are again present. The basal cisterns are patent and there is\npreservation of gray-white matter differentiation. There is dense\natherosclerotic disease of the carotid siphons bilaterally. These findings\nare grossly stable compared to the ___ prior examination.\n\nNo osseous abnormalities seen. The paranasal sinuses, and middle ear cavities\nare clear. The orbits are unremarkable. There is small stable nonspecific\nright mastoid tip fluid (see series 3 on the current study and series 2, image\n4 on the ___ prior exam).", + "output": "1. No evidence of intracranial hemorrhage.\n2. Stable atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described.\n3. Ventricular prominence is again noted to be slightly more pronounced than\nsulcal prominence, unchanged compared to ___ prior examination. While finding\nis nonspecific, similar findings can be seen in the setting of normal pressure\nhydrocephalus. Recommend clinical correlation.\n4. Stable small nonspecific right mastoid tip fluid, unchanged compared to ___ prior exam." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. As before, the ventricles remain prominent, somewhat\nout proportion to the degree of sulcal atrophy. Periventricular, subcortical\nand deep white matter hypodensities are nonspecific, but likely reflect the\nsequela of chronic microvascular infarction. Moderate atherosclerotic\ncalcifications of the cavernous carotid arteries and mild atherosclerotic\ncalcification of the distal left vertebral artery are present.\n\nSmall amount of soft tissue swelling is noted overlying the posterior\ncalvarium toward the vertex. There is no evidence of fracture. Partial\nopacification of the right inferior mastoid air cells is unchanged. Mild\nmucosal thickening is seen involving the left maxillary sinus and scattered\nbilateral ethmoid air cells and right frontal ethmoidal recess. The\nvisualized portion of the remaining paranasal sinuses, left-sided mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable apart from bilateral lens resections..", + "output": "1. No acute intracranial hemorrhage or mass effect.\n2. Posterior calvarial soft tissue swelling towards the vertex without\nfracture.\n3. Prominence of the ventricles remains unchanged and somewhat\ndisproportionate to the degree of sulcal atrophy. Normal pressure\nhydrocephalus cannot be excluded, as suggested previously." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are mildly prominent consistent with mild involutional\nchanges.\n\nNo acute fracture is seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of fracture, infarction,intracranial hemorrhage,edema,or\nmass. The ventricles and sulci are enlarged suggestive of involutional\nchange. Periventricular and subcortical white matter hypodensities are\nnonspecific, and may reflect changes due to chronic small vessel ischemic\ndisease.\n\nThere is moderate mucosal thickening of the ethmoid air cells. Otherwise, the\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are normal.", + "output": "1. There is no evidence of acute intracranial process or hemorrhage." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, shift of normally\nmidline structures or acute major vascular territorial infarction. Prominence\nof ventricles and sulci is consistent with age-related involutional changes. \nChronic infarction in the right internal capsule is new compared to ___. Chronic infarction in the left internal capsule was previously present\non ___. Foci of hypodensity in the subcortical, deep, and\nperiventricular white matter of the cerebral hemispheres have progressed\ncompared to ___. They probably represent sequela of chronic small\nvessel ischemic disease, given the the patient's cardiovascular risk factors.\nProminence of the ventricles and sulci has increased since the prior exam and\nis unexpected for the patient's age.\n\nThere is no fracture. The visualized paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear.", + "output": "1. No evidence for an acute intracranial abnormality. No fracture.\n2. Progression of chronic small vessel ischemic disease compared to ___. New chronic infarction in the right external capsule.\n3. Progression of cerebral atrophy compared to ___, unexpected for\nthe patient's age." + }, + { + "input": "There is no acute infarct, mass effect, edema or hemorrhage.\nThere is re- demonstration of small chronic infarcts in the right internal\ncapsule as well these the left internal capsule. Prominent ventricles and\nsulci are suggestive of age-related involutional change. Areas of nonspecific\nperiventricular, subcortical and deep white matter hypodensity appear roughly\nsimilar to the prior examination and are suggestive of chronic small vessel\nischemic disease. The basal cisterns are patent and there is preservation of\ngray-white matter differentiation. The orbits are grossly unremarkable. \nThere is no fracture or suspicious lesion . The visualized paranasal sinuses,\nmastoid air cells and middle ear cavities are clear.", + "output": "1. No acute intracranial abnormality.\n2. Unchanged chronic infarcts in the right and left internal capsule.\nCorrelate clinically to decide on the need for further workup or followup." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nPeriventricular, subcortical, and deep white matter hypodensities are likely\nsequelae of chronic small vessel ischemic disease. Stable 0.6 cm lucency\nwithin the right basal ganglia is consistent with a chronic lacune or\nprominent Virchow ___ space. There is a chronic the left basal ganglia\ninfarct (02:17) which is new since ___\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Calcification the cavernous portions\nof the internal carotid arteries and vertebral arteries are noted.", + "output": "1. No acute intracranial process. Specifically, no intracranial hemorrhage.\n2. Chronic changes as described above." + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and deep white matter hypodensities are\nnonspecific but seen in chronic small vessel ischemic disease. Bilateral\nbasal ganglia lacunar infarcts are noted. There is no acute fracture. The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The patient is status post bilateral lens replacement. \nDense calcifications are noted along the bilateral carotid siphons.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no intra or extra-axial mass effect, acute hemorrhage or large\nterritory infarct. The sulci, ventricles and cisterns are within expected\nlimits for the patient's moderate to severe senescent related global cerebral\nvolume loss, overall similar to examination of ___. There are mild\nperiventricular and subcortical white matter hypodensities, nonspecific, but\ncompatible with chronic microangiopathy in a patient of this age.\nThe paranasal sinuses are essentially clear. The orbits are unremarkable\nnoting bilateral lens replacements. Bilateral surgical defects along the\nlateral walls of the mastoid air cells is unchanged from prior examination. \nThe mastoid air cells middle ears are well pneumatized and clear. No\nsuspicious osseous lesions.\n\nThere is a new 1.1 cm left parotid tail lesion (series 3, image 177), which\nmay represent an abnormal lymph node versus primary parotid neoplasm.\n\n\nCTA HEAD:\nMild-to-moderate atherosclerotic disease of the internal carotid arteries does\nnot result in high-grade stenosis. Otherwise, the vessels of the circle of\n___ and their principal intracranial branches appear normal without\nstenosis, occlusion, or aneurysm formation. The dural venous sinuses are\npatent.\n\nCTA NECK:\nMild atherosclerotic disease of the aortic arch, origins of the right\nprogressive folic, bilateral common carotid and subclavian arteries as well as\ncarotid bifurcation is identified. Otherwise, the carotidandvertebral\narteries and their major branches appear normal with no evidence of stenosis\nor occlusion. There is no evidence of internal carotid stenosis by NASCET\ncriteria.\n\nOTHER:\nAsymmetric fullness of the left fossa of ___ (series 3, image 183)\nwithout definitive underlying mass lesion. Clinical correlation is\nrecommended. The remainder the visualized aerodigestive tract is grossly\nunremarkable.\n\nReniform soft tissue measuring approximately 1.5 cm in long axis (series 3,\nimage 133) along the anterior aspect of the right submandibular gland (series\n3, image 133), felt to likely represent asymmetric portion of the right\nsubmandibular gland. Separate lymph node is not entirely excluded. The right\nparotid and left submandibular glands are otherwise unremarkable. There is no\ndefinitive cervical lymphadenopathy by size criteria.\n\nThe thyroid is unremarkable.\n\nBiapical pleuroparenchymal scarring and bronchiectasis is identified. No\nfocal suspicious pulmonary nodule.", + "output": "1. There is no acute intracranial abnormality on noncontrast CT head. \nSpecifically no acute large territory infarct or intracranial hemorrhage.\n2. Mild periventricular and subcortical white matter hypodensities,\nnonspecific, but compatible with chronic microangiopathy in a patient this\nage.\n3. Allowing for atherosclerotic disease, essentially unremarkable CTA of the\nhead and neck.\n4. 1.1 cm left parotid tail lesion which may represent an abnormal lymph node\nversus primary parotid neoplasm. Further evaluation with ultrasound is\nrecommended.\n5. Oval soft tissue asymmetry associated with the right submandibular gland,\nwhich may represent asymmetric size of the gland itself rather than\nsuperimposed abnormal lymph node. This could be further evaluated with\nultrasound at the same time as the left parotid lesion.\n6. Additional findings described above.\n\nNOTIFICATION: Further evaluation of 1.1 cm left parotid tail lesion with\nultrasound." + }, + { + "input": "There is no evidence of acute major vascular territory\ninfarction,hemorrhage,edema,or discrete mass. There is prominence of the\nventricles and sulci suggestive of involutional changes. Ill-defined\nperiventricular subcortical white matter hypodensities are nonspecific but\nlikely due to chronic sequela of small-vessel ischemic disease. A left\nthalamic hypodensity may represent old infarct (02:14). Atherosclerotic\ncalcifications are seen in both carotid siphons.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. There are\npost-mastoidectomy changes bilaterally. The visualized portion of the orbits\nare unremarkable.", + "output": "No acute intracranial abnormalities." + }, + { + "input": "There is no evidence of acute major infarction,hemorrhage,edema,or discrete\nmass. There is an unchanged tiny hypodensity in the left thalamus which\nlikely represents a old chronic lacunar infarct. There is prominence of the\nventricles and sulci suggestive of involutional changes. Subcortical and\nperiventricular white matter hypodensities are nonspecific, however similar to\nprior and likely represent sequela of chronic small vessel ischemic disease.\n\nThere is no acute fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The appearance of the\nbilateral mastoids is unchanged and may suggest prior partial mastoidectomies.\nPatient is status post bilateral lens replacement. The visualized portion of\nthe orbits are otherwise unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Postoperative changes suboccipital craniectomy, similar. No CT evidence of\nresidual tumor in the surgical bed. Stable intraosseous lobulations occipital\nbone compared to prior, likely postsurgical encephalomalacia of the\ncerebellum, likely surgical and treatment related. VP shunt in place via\nright frontal burr hole, tip is in the right frontal horn, no hydrocephalus. \nThere is no evidence of infarction, hemorrhage, edema, or mass. Left parietal\ncraniotomy.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Posttreatment changes. No residual tumor.\nVP shunt, no hydrocephalus." + }, + { + "input": "The carotid and vertebral arteries and their major branches are patent with no\nevidence of stenoses. Carotid bifurcations demonstrate calcifications. No\nevidence for dissection is seen. The neck vessels are patent.\nBy NASCET criteria, there is no stenosis of the right or left ICA.\n\nAgain seen is the fracture of C2 extending into the lateral masses and\ninvolving the right transverse foramen. There is no evidence of further\nnarrowing of the right vertebral artery in this region or evidence of\ndissection.\n\nThere is mucosal thickening of the left sphenoid sinus.\n\nEvaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect. The salivary glands enhance normally and are without mass\nor adjacent fat stranding. The thyroid gland appears normal. There is no\nlymphadenopathy by CT criteria. Multiple subcentimeter paraesophageal and\nright lower paratracheal lymph nodes are noted. Evaluation of the imaged\nportion of the lung apices is limited by respiratory motion however no gross\nabnormalities are noted.", + "output": "1. Carotid and vertebral arteries are patent with no evidence of dissection or\nstenosis.\n2. Known fracture of C2 extending into lateral masses and involving the right\ntransverse foramen.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 3:40 ___, 5 minutes\nafter discovery of the findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is loss of gray-white matter differentiation within the lateral left\nfrontal cortex and left posterior centrum semi ovale hypodensity consistent\nwith sites of subacute infarction better characterized on prior MR. ___ is\nno evidence of hemorrhage, mass, or mass effect. The ventricles and\nextra-axial spaces are unremarkable. The orbits, calvarium, and soft tissues\nare unremarkable. The paranasal sinuses and mastoid air cells are clear.\n\nCTA HEAD:\nThere is mild calcific atherosclerosis of the left carotid siphon without\nsignificant stenosis. The bilateral posterior communicating arteries are\nvisualized. There is normal flow in the intracranial vasculature without\nevidence of occlusion, dissection, or aneurysm. The dural venous sinuses are\npatent. There are focal short segment stenoses of the left V4 segment\nvertebral artery at its mid portion and at its anastomosis with the basilar\nartery.\n\nCTA NECK:\nThere is interval resolution of previously described left carotid bulb and\nnoncalcific atherosclerosis with patent lumen and no evidence of stenosis by\nNASCET criteria. There is subcutaneous emphysema marginating the left carotid\nsheath extending superficially to the lateral skin surface consistent with\npost endarterectomy surgical changes.\n\nThere is calcific and noncalcific atherosclerosis at the right carotid bulb\nwith approximately 29% stenosis by NASCET criteria.\n\nThere is calcific atherosclerosis at the right vertebral artery origin. There\nis calcific and noncalcific atherosclerosis with stenosis at the origin of the\nleft vertebral artery. There is no significant abnormality within the V2 or V3\nsegment bilateral vertebral arteries.\n\nThere is mild calcific atherosclerosis of the visualized aortic arch.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. There are multilevel degenerative changes of the cervical spine\nwithout acute fracture or osseous lesion. Soft tissue density is noted within\nthe right external auditory canal which may represent cerumen. There are\npostsurgical changes related to prior sternotomy noted.", + "output": "1. Expected post left endarterectomy changes with interval resolution of left\ncarotid bulb atheroma and stenosis. No evidence of complication.\n2. Infarct at the left frontal cortex and posterior left centrum semi ovale,\nbetter characterized on prior MR of the head. No new acute intracranial\nabnormality.\n3. Atherosclerosis and luminal stenosis at the right carotid bulb measuring\nless than 50 percent by NASCET criteria.\n4. Atherosclerosis with in the bilateral vertebral artery origins.\n5. Patent intracranial and neck vasculature without evidence of thrombosis or\ndissection." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no hemorrhage, mass. There is suggested loss of gray-white\ndifferentiation left superior frontal gyrus versus artifact. The ventricles\nand extra-axial spaces are normal. There is periventricular white matter\nhypodensity which is nonspecific but likely represents chronic microvascular\nwhite matter change. The orbits and calvarium are unremarkable. There is\nmild mucosal thickening and partial opacification of the bilateral ethmoid air\ncells. There remainder of the paranasal sinuses and mastoid air cells are\nclear.\n\nCTA HEAD:\nThere is mild calcific atherosclerosis of the left carotid siphon without\nsignificant stenosis. The bilateral posterior communicating arteries are\nvisualized. There is normal flow in the intracranial vasculature without\nevidence of occlusion, dissection, or aneurysm. The dural venous sinuses are\npatent. There are focal short segment stenoses of the left V4 segment\nvertebral artery at its mid portion and at its anastomosis with the basilar\nartery (see65___:5).\n\nCTA NECK:\nThere is calcific and non calcific atherosclerosis of the left carotid bulb\nwith maximal residual luminal patency measuring 2.2 mm at the maximum stenosis\n(see5:164) versus 3.8 mm any more cephalad internal carotid artery\n(see5:187)consistent with approximately 42% stenosis stenosis by NASCET\ncriteria.\n\nThere is calcific and noncalcific atherosclerosis at the right carotid bulb\nwith residual luminal patency measuring 3.5 mm at the maximum stenosis\n(see5:168) versus 4.6 mm at the more cephalad internal carotid artery\n(see5:191) consistent with approximately 24% stenosis by NASCET criteria.\n\nThere is calcific atherosclerosis with severe luminal stenosis at the right\nvertebral artery origin (see5:90). There is calcific and noncalcific\natherosclerosis with severe luminal stenosis at the origin of the left\nvertebral artery (see5:90). There is no significant abnormality within the V2\nor V3 segment bilateral vertebral arteries.\n\nThere is mild calcific atherosclerosis of the visualized aortic arch.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. There are multilevel degenerative changes of the cervical spine\nwithout acute fracture or osseous lesion. Soft tissue density is noted within\nthe right external auditory canal which may represent cerumen. Postsurgical\nchanges related to prior sternotomy noted.", + "output": "1. Patent intracranial and neck vasculature without evidence of dissection,\nocclusion, or aneurysm.\n2. Short segment mild stenoses of the left V4 segment vertebral artery which\nis nonspecific and may be seen with intracranial atherosclerosis.\n3. Atherosclerosis and luminal stenosis at of the bilateral carotid bulbs,\nleft greater than right as described, measuring less than 50% by NASCET\ncriteria.\n4. Atherosclerosis with severe luminal stenosis at the bilateral vertebral\nartery origins.\n5. Findings concerning for left frontal gyrus infarct versus artifact as\ndescribed. Recommend clinical correlation. If clinically indicated, MRI of\nthe brain may be obtained for further evaluation.\n6. Paranasal sinus disease as described.\n\nRECOMMENDATION(S): Findings concerning for left frontal gyrus infarct. \nRecommend clinical correlation. If clinically indicated, MRI of the brain may\nbe obtained for further evaluation." + }, + { + "input": "There is no CT evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. Atherosclerotic\nvascular calcifications are noted of bilateral vertebral and cavernous\nportions of internal carotid arteries.\n\nEthmoid sinus mucosal thickening is present. There is no evidence of\nfracture. The visualized portion of the mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.\nSoft tissue density is noted within the right external auditory canal which\nmay represent cerumen.", + "output": "1. No intracranial hemorrhage.\n2. Paranasal sinus disease as described." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. \nPeriventricular and subcortical white matter hypodensities are nonspecific but\nlikely sequelae of chronic small vessel ischemic disease. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. There is\nrightward nasal septum deviation anteriorly. Bilateral lens replacements are\nnoted. Carotid siphon calcifications are mild.", + "output": "No evidence of fracture, hemorrhage or infarction." + }, + { + "input": "There is no evidence of acute major vascular territorial\ninfarction,hemorrhage,edema, or mass. The ventricles and sulci are normal in\nsize and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute major intracranial abnormalities." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThe ventricles, sulci, and cisterns appear normal. There is no large infarct,\nintracranial hemorrhage, or mass effect.\n\nThere is opacification of a few bilateral ethmoid air cells and mild mucosal\nthickening within the maxillary sinuses. The orbits are unremarkable.\n\nCTA HEAD:\nThere is atherosclerotic plaque within the bilateral cavernous and\nsupraclinoid segments without significant stenosis.\n\nThe anterior cerebral arteries and middle cerebral arteries are patent without\nstenosis. An anterior communicating artery is not seen.\n\nThe posterior cerebral arteries are patent without stenosis. The posterior\ncommunicating arteries are not seen.\n\nThe vertebral arteries and basilar artery are patent without stenosis.\n\nNo aneurysm greater than 2 mm or arterial venous malformation is identified.\n\nCTA NECK:\nThere is mild atherosclerotic plaque within the aortic arch.\n\nThere is moderate atheromatous atherosclerotic plaque at the right carotid\nbulb with less than 50% stenosis by NASCET criteria. The right common carotid\nand internal carotid arteries are patent without stenosis.\n\nThere is mild atheromatous and atherosclerotic plaque at the left carotid bulb\nwith less than 50% stenosis by NASCET criteria. The left common carotid and\ninternal carotid arteries are patent without stenosis.\n\nThe vertebral arteries are patent without stenosis. There is slight\nremodeling of the right vertebral artery at the V1 V2 junction due to\nuncovertebral joint arthropathy at C6-C7.\n\nOTHER:\nMild diffuse peribronchiolar thickening and areas of mosaic perfusion is\nconsistent with small airways disease. No enlarged lymph nodes are\nidentified. The thyroid gland appears heterogeneous. The tonsillar pillars\nare prominent.", + "output": "1. Mild paranasal sinus disease. Otherwise unremarkable head CT.\n2. Mild intracranial and extracranial atherosclerosis, without significant\nstenosis." + }, + { + "input": "Ventricles, cisterns and sulci appear stable. There is no mass effect,\nhydrocephalus, or shift of normally midline structures. No intracranial\nhemorrhage is found. Gray-white matter distinction appears preserved. \nSurrounding soft tissue structures are unremarkable. There is mild mucosal\nthickening among ethmoid air cells, less than before. Mastoid air cells\nappear clear. There is no evidence of fracture or bone destruction.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "There is no acute intracranial hemorrhage, acute large infarction, mass effect\nor midline shift. There is no hydrocephalus. Visualized paranasal sinuses and\nmastoid air cells are clear. There is no fracture. Sclerotic calvarial\nmetastases are noted.", + "output": "No acute intracranial process. Calvarial metastasis." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration for patient's age.\nThere is a mucous retention cyst in the left sphenoid sinus and opacification\nof the posterior ethmoid sinuses bilaterally. The other visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nThe visualized portion of the orbits are unremarkable.", + "output": "1. No evidence of acute infarct or hemorrhage.\n2. Mucous retention cyst in the left sphenoid sinus and opacification of the\nposterior ethmoid sinuses bilaterally." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, or acute major\nvascular territorial infarction. The ventricles and sulci are mildly to\nmoderately prominent compatible with involutional changes. Periventricular\nand deep white matter hypodensities are nonspecific but likely sequela of\nchronic small vessel ischemic disease in this age group. Focal well-defined\nhypodensities in the bilateral anterior internal capsules and left putamen\ncorrespond to chronic infarctions on the prior MRI.\n\nThere is no evidence for a fracture. There is mild mucosal thickening in the\nethmoid air cells and frontoethmoidal recesses. Mastoid air cells are clear.", + "output": "No evidence for acute intracranial abnormalities." + }, + { + "input": "There is no intra or extra-axial mass effect acute hemorrhage or large\nterritory infarct. The sulci, ventricles and cisterns are within expected\nlimits for the degree of mild senescent related global cerebral volume loss. \nThere are periventricular and subcortical white matter hypodensities, which\nare unchanged from prior examination, nonspecific, but compatible with sequela\nof chronic microangiopathy in a patient of this age. There is no evidence for\nacute traumatic fracture. The paranasal sinuses are essentially clear. The\norbits are unremarkable. The mastoid air cells and middle ears are clear.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nlarge territory infarct or intracranial hemorrhage." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nThere is periapical lucency with thinning/dehiscence of the bone along the\nlateral aspect of the most posterior right maxillary molar without adjacent\nsoft tissue abnormality (series 5, image 31).\n\nCTA HEAD:\nThe approximately 4 mm medially directed left para ophthalmic internal carotid\nartery aneurysm is grossly unchanged compared to prior examination (series\n___, image 3. The vessels of the circle of ___ and their principal\nintracranial branches otherwise appear normal with no evidence of stenosis,\nocclusion, or new aneurysm. The dural venous sinuses are patent. The left\ntransverse and sigmoid sinuses are hypoplastic.", + "output": "1. Dental amalgam streak artifact limits study.\n2. Grossly stable 4 mm left paraophthalmic internal carotid artery aneurysm.\n3. Within limits of study, no definite new aneurysms identified.\n4. Right maxillary molar periodontal disease as described." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration for the degree of age related\nglobal cerebral volume loss. There are bilateral carotid siphon\ncalcifications.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Soft tissues seen in the right\nexternal auditory canal, potentially representing cerumen.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, mass effect, midline\nshift, or mass. The ventricles and sulci are normal in size and configuration.\nNo bony abnormalities seen. There are bilateral mucous retention cysts in the\nmaxillary sinuses. Otherwise, the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "Normal study. No fracture." + }, + { + "input": "There is trace mucosal wall thickening in the floor of the left maxillary\nsinus as well as in the roof (601:52). There is also trace mucosal thickening\nin the roof of the right maxillary sinus (601:53). Mucosal wall thickening\nminimally, though insignificantly narrows the proximal right infundibulum. \nThe paranasal sinuses are otherwise normally aerated and pneumatized, with no\nadditional areas of mucosal thickening or air-fluid levels identified. The\nostiomeatal units are otherwise patent. The cribriform plates are intact. The\nlamina papyracea are intact. The ethmoid roof is slightly higher on the\nright. The anterior clinoid processes are not pneumatized. The brain is\ngrossly unremarkable given low-dose technique. The nasal septum is mildly\ndeviated to the left with a moderate sized leftward osseous spur. There is\nmild polypoid contour of the inferior nasal turbinates. There is bilateral\nopacifications of the mastoid air cells. Periapical lucencies are noted in\nthe maxilla bilaterally, better depicted in the coronal reformations (image\n39, series 601) suggestive of periodontal disease.", + "output": "1. Trace mucosal wall thickening of the bilateral maxillary sinuses with mild\nnarrowing of the proximal right infundibulum.\n2. Mild polypoid contour of the inferior nasal turbinates suggestive of\npolyposis.\n3. Periodontal disease identified in the maxilla.\n4. Opacification of the mastoid air cells bilaterally." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass, mass effect, or acute\nvascular territorial infarction. The ventricles and sulci are normal in size\nand configuration.The basal cisterns appear patent and there is preservation\nof gray-white matter differentiation.\n\nThere is no pathologic parenchymal, leptomeningeal or dural focus of\nenhancement. The principal dural venous sinuses and the major vessels of the\ncircle of ___ enhance normally and symmetrically.\n\nNo fracture or suspicious osseous lesion is identified. The visualized\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nglobes are symmetric and unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. No mass or pathologic focus of enhancement." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no exophytic mucosal mass\nor focal areas of mass effect. The tonsils, submandibular glands and parotid\nglands are unremarkable without evidence of tonsillar, peritonsillar or\nretropharyngeal abscess. The submandibular soft tissues are unremarkable.\nThere is no subcutaneous stranding to suggest infection. The nasopharyngeal\nand oropharyngeal soft tissues are unremarkable.\n\nNo cervical lymphadenopathy is seen. The thyroid gland is unremarkable. The\ncervical vessels enhance without evidence of high-grade stenosis or occlusion\nalthough this study is not as optimal as a dedicated CTA.\n\nThe imaged intracranial structures are unremarkable.\n\nThe imaged lung apices are clear.\n\nThere is no osseous destructive lesion concerning for malignancy within the\ncervical spine.", + "output": "No evidence of tonsillar, peritonsillar or retropharyngeal abscess. No\nsubcutaneous stranding to suggest infection." + }, + { + "input": "There is a small acute right sided subdural hematoma overlying the right\nfrontal convexity measuring up to 4 mm (2:16). There is also a small acute\nleft subdural hematoma overlying the left frontal convexity measuring up to 4\nmm (2:18). No significant mass effect or midline shift. No evidence of acute\ninfarction. The ventricles and sulci are normal in size and configuration.\n\nThere is no fracture. There is mild mucosal thickening of the anterior\nethmoid air cells. The paranasal sinuses otherwise appear essentially clear. \nThe mastoid air cells and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "Bifrontal acute subdural hematomas, slightly more extensive on the right. No\nsignificant underlying mass effect or midline shift." + }, + { + "input": "Interval resolution of previously described bifrontal, hyperattenuating\nsubdural hematomas. There is no evidence of fracture,\ninfarction,hemorrhage,edema, midline shift or mass effect. The ventricles and\nsulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavitiesare well pneumatized. The visualized portion of the orbits are\nnormal.", + "output": "1. Interval resolution of previously described bifrontal acute subdural\nhematomas.\n2. No acute intracranial abnormality." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is loss of gray-white matter differentiation in the left temporoparietal\nlobe. There is no evidence of hemorrhage, edema, or mass. There are\nmultiple linear appearing hyperdensities in the left supratentorial\nsubarachnoid space. Prominent ventricles and sulci are compatible with\nage-related volume loss.Periventricular white matter hypodensities are\nconsistent with chronic small vessel ischemic disease. Atherosclerotic\nvascular calcifications are noted of bilateral vertebral and cavernous\nportions of internal carotid arteries.\n\nThe visualized portion of the mastoid air cells, and middle ear cavities are\nclear. Bilateral cataract extractions are seen. There is a 0.9 cm soft tissue\nlesion in the superior aspect of the right valleculae, series 5, image 149. \nAn air-fluid level is noted in the left maxillary sinus. There is mucosal\nthickening of the ethmoid sinus. There is a pedunculated bony mass in the\nright external auditory canal\n\nCTA HEAD: There is atherosclerotic calcification in the cavernous internal\ncarotid arteries. There are multiple occlusions in the distal left M3\nbranches of the middle cerebral artery, secondary to calcified atherosclerotic\nemboli, series 5, image 294 and 289. In addition, a nonocclusive calcified\nemboli is noted in the distal left ACA branch with normal opacification of the\ndistal vasculature, series 5 image 307. A nonocclusive calcified embolus is\nalso seen in the left proximal M2 MCA branch with diminutive but persistent\nflow distally, series 5, image 268. Atherosclerotic calcification of the V4\nvertebral arteries is seen. The dural venous sinuses are patent.\n\nCTA NECK: The ascending thoracic aorta measures 4 cm. There is\natherosclerotic calcification of the aortic arch and branch vessels. \nAtherosclerotic calcification of the carotid bulbs is also noted. There is\napproximately 30% stenosis of the origin of the left internal carotid artery\nby NASCET criteria. There is mild stenosis at the origin of the left\nvertebral artery. The remainder of the visualized carotid and vertebral\narteries appear normal with no evidence of stenosis or occlusion.\n\nOTHER:\nThere centrilobular emphysema. Biapical calcified pleural plaques are seen. \nThe visualized portion of the thyroid gland is within normal limits. There is\nno lymphadenopathy by CT size criteria.", + "output": "1. Loss of gray-white matter differentiation in the left MCA territory which\nrepresents a subacute infarction on the subsequently performed MRI. No\nevidence for hemorrhage or mass effect.\n2. Multiple occlusive and nonocclusive calcified thrombi in the left ACA and\nMCA distribution, as described above.\n3. Approximately 30% stenosis at the origin of the left internal carotid\nartery by NASCET criteria.\n4. Ascending thoracic aortic aneurysm measuring 4 cm.\n5. Bony exostoses in the right external auditory canal, consistent with an\nosteoma." + }, + { + "input": "Again there is a focal area of low attenuation in the left temporal lobe\nassociated with multiple vascular calcifications in the distribution of the\nleft middle cerebral artery, consistent with evolving acute/subacute\ninfarction, there is no evidence of hemorrhagic transformation mass effect or\nshifting of the normally midline structures. The ventricles and sulci are\nprominent, suggesting cortical volume loss, probably age related and\ninvolutional in nature. Confluent areas of low attenuation are again seen in\nthe subcortical and periventricular white matter, which are nonspecific and\nmay reflect changes due to small vessel disease. There is an unchanged\ncalcification in the tentorium and adjacent to the occipital lobe on the\nright, measuring approximately 6 x 5 mm in transverse dimension (image 10,\nseries 38). Vascular arteriosclerotic calcifications are present in the\ncarotid siphons and vertebral arteries bilaterally. The orbits are\nunremarkable, the paranasal sinuses and the mastoid air cells are clear.", + "output": "1. Unchanged evolving acute/subacute ischemic change in the vascular\nterritory of the left MCA, previously demonstrated by CTA of the head and neck\non ___ at 18:05 hr, please refer to this report for details.\n\n2. There is no evidence of hemorrhagic transformation, there are unchanged\nvascular arteriosclerotic calcifications in the vascular territory of the left\nmiddle cerebral artery.\n\n3. Areas of low attenuation in the subcortical white matter are nonspecific\nand may reflect changes due to small vessel disease." + }, + { + "input": "Hypodensity in the left frontal parietal temporal lobes associated with\nmultiple vascular calcifications consistent with known subacute left MCA\nvascular territory infarction is slightly more prominent when compared to\nprior exam compatible with expected evolution. There is no evidence of\nhemorrhagic transformation or mass effect. No new lesions of infarct\nidentified. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Superimposed periventricular and subcortical white\nmatter hypodensities are nonspecific, but likely reflect sequelae of chronic\nsmall vessel ischemic disease.\n\nAtherosclerotic calcification of the carotid siphons and vertebral arteries\nbilaterally are again noted.\n\nAgain seen is a calcification adjacent to the occipital lobe on the right,\nunchanged since prior study.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nvisualized portions of the maxillary sinuses and right sphenoid sinus. The\nvisualized portion of the remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. Bilateral lens replacement is noted.", + "output": "Re-identified are left frontoparietotemporal late acute infarctions without\nevidence of hemorrhagic transformation or worsening mass effect. No new\nregions of infarct identified." + }, + { + "input": "Severe mucosal thickening of the left maxillary sinus with near complete\nopacification with aerosolized central debris is identified. Aerosolized\ndebris is also seen in the inferior left frontal sinus with opacification of\nthe left frontal ethmoidal recess. The remainder of the paranasal sinuses are\nessentially clear. The right ostiomeatal unit is widely patent. The left\ninfundibulum of the ostiomeatal unit is opacified. ___ tooth number 14 root\nextends into the maxillary sinus. The maxillary teeth are not completely\nvisualized.\n\nThe cribriform plates are unremarkable. The lamina papyracea are intact. The\nsphenoid sinus septum bifurcates and inserts on the bilateral carotid grooves.\nThere is mild S shape of the nasal septum without perforation. The mastoid\nair cells and middle ear cavities are well pneumatized and clear.\n\nThe orbits are unremarkable. There is no abnormal postcontrast enhancement.\n\nEnlarged level 2A lymph nodes, measuring up to 1.2 cm in long axis are noted. \nProminence of the adenoids and palatine tonsils are noted.", + "output": "1. Near complete opacification of the left maxillary sinus with aerosolized\ndebris in the inferior left frontal sinus and opacification of left frontal\nethmoidal recess.\n2. ___ tooth 14 extends into the left maxillary sinus floor. Clinical\ncorrelation with odontogenic sinusitis is recommended.\n3. No peripherally enhancing fluid collections to suggest abscess formation.\n4. Enlarged level 2A lymph nodes as well as the adenoids and palatine tonsils\ncompatible with patient's given history of AML." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial process." + }, + { + "input": "There is no evidence of large vascular territory infarction,acute intracranial\nhemorrhage,edema,or mass effect. There is prominence of the ventricles and\nsulci suggestive of involutional changes. Periventricular and subcortical\nwhite matter hypodensities are nonspecific but suggest chronic small vessel\nischemic changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial process such as hemorrhage or large vascular\nterritory infarction.\n2. No evidence of fracture." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, mass, or mass effect. \nThe ventricles and sulci are normal in caliber and configuration. No\ndisplaced calvarial fracture. There is mucosal thickening and aerosolized\nsecretions in the left maxillary sinus. The remaining visualized paranasal\nsinuses, mastoids, middle ear cavities appear clear. Aside from bilateral\nlens extraction, the globes and orbits are within normal limits. Carotid\nsiphon calcifications are noted bilaterally.\n\nCTA HEAD:\nMinimal calcified plaque, distal left vertebral artery, no significant luminal\nnarrowing. Otherwise, the distal vertebral arteries are widely patent and\nunremarkable. Unremarkable basilar artery. Fetal type right PCA with a\nwidely patent right PCOM. Right P1 PCA not well seen, either diminutive or\nabsent. Conventional left PCA anatomy with a widely patent left P1 PCA. \nSmall but patent left PCOM. The P2 and more distal bilateral posterior\ncerebral arteries are widely patent with preserved distal runoff.\n\nThe right right A1 ACA is not well seen, either diminutive or absent.\n\nThere is mild calcified plaque affecting the distal cavernous and bilateral\nsupraclinoid intracranial ICAs causing up to mild to moderate luminal\nnarrowing bilaterally.\n\nThere is an inferiorly projecting 2-3 mm outpouching arising from the distal\nsupraclinoid/communicating left intracranial ICA, small infundibulum or tiny\naneurysm (series 4, image 188 ). Otherwise, the remaining portions of the\nbilateral intracranial internal carotid arteries and the bilateral anterior\nand middle cerebral arteries are patent with normal distal runoff.\n\nNo large vessel occlusion.\nMajor dural venous sinuses appear patent.\n\nCTA NECK:\nCalcified plaque at the carotid bulbs does not cause right ICA luminal\nnarrowing by NASCET criteria. The distal right extracranial ICA is tortuous\nbut otherwise unremarkable. Remaining components of the right cervical\ncarotid artery are unremarkable.\n\nCalcified plaque at the origin of the left common carotid artery at the aortic\narch causes mild luminal narrowing. Minimal left common carotid artery\ncalcified plaque, not causing luminal narrowing. Calcified plaque at the left\ncarotid bulb causing 33% luminal narrowing by NASCET criteria (___). \nDistal to this, left extracranial ICA is tortuous at the skullbase but\notherwise patent and unremarkable.\n\nCalcified plaque at the origin of the left vertebral artery causes moderate\nluminal narrowing. Otherwise the bilateral cervical vertebral arteries are\nwidely patent and unremarkable.\n\nThere is moderate calcified plaque at the aortic arch affecting the origins of\nthe arch branch vessels, which nonetheless remains patent throughout their\nvisualized course.\n\nOTHER:\nThere is atelectasis in the lung apices. No suspicious pulmonary nodule\nidentified. No cervical adenopathy. No aggressive focal osseous lesions. \nMultilevel degenerative changes are visualized throughout the cervical spine\nincluding mild anterolisthesis at C 2 on C3 and narrowing of the\nintervertebral disc spaces.", + "output": "1. No acute intracranial abnormality by unenhanced CT. No hemorrhage.\n2. Inferiorly projecting 2-3 mm aneurysm or infundibulum arising from the\ndistal left supraclinoid/communicating intracranial ICA.\n3. Mild calcified plaque bilateral intracranial ICAs, mild-to-moderate luminal\nnarrowing.\n4. Remaining circle of ___ vasculature is unremarkable.\n5. Calcified plaque at the carotid bulbs causes 33 % left ICA luminal\nnarrowing by NASCET criteria. No right ICA luminal narrowing. Moderate\nluminal narrowing, origin left vertebral artery. Otherwise, cervical\nvertebral and carotid arteries are widely patent.\n6. Mild sinus disease, left maxillary sinus." + }, + { + "input": "Study is degraded by motion. Within these confines:\n\nThere is no evidence of infarction, hemorrhage, edema, or mass. There is\npreservation of the gray-white matter differentiation of the insular cortices\nand basal ganglia bilaterally. Hypodensities in the right frontal lobe, left\nexternal capsule and right temporal lobe correspond to areas of T2 FLAIR\nsignal hyperintensity on the MRI from ___, consistent with chronic\ninfarcts. Ventricles and sulci are prominent, consistent with age-related\nglobal parenchymal loss. The basal cisterns are patent. Subcortical,\nperiventricular and deep white matter hypodensities are nonspecific, but\nlikely reflect the sequela of chronic microangiopathic ischemic disease. \nAtherosclerotic calcification of the carotid siphons is noted.\n\nThere is no fracture. There is mucosal thickening and aerosolized secretions\nin the left maxillary sinus. The secretions contain focal hyperdensities\nwhich can be seen in the setting of allergic fungal sinusitis. The visualized\nportion of the remaining paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. Dental implant bridges are noted in the bilateral\nmaxillary dental ridge. The visualized portion of the orbits demonstrate\nprior lens surgery and are otherwise normal.", + "output": "1. Study degraded by motion and dental artifact.\n2. Within limits of study, no definite evidence of acute intracranial\nhemorrhage or acute large territorial infarct. Please note MRI of the brain\nis more sensitive for the detection of acute infarct.\n3. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is pneumatization of the medial\naspect of the right greater wing of the sphenoid, which is in communication\nwith the right sphenoid sinus, seen on prior CT spine from ___. \nHowever, there is increased with mild mucosal thickening within (4:6). The\nremaining visualized portion of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass effect. The ventricles and sulci are normal in size and\nconfiguration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality on noncontrast head CT. Specifically no\nlarge territory infarct or intracranial hemorrhage." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass effect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific, but likely reflect sequelae of chronic small\nvessel ischemic disease.\n\nNasal bone fracture deformities are unchanged from prior exam. There is no\nevidence of acute fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nevidence of intracranial hemorrhage or acute large territory infarct.\n2. Additional findings described above." + }, + { + "input": "There been no significant changes since the prior study. There is no evidence\nof infarction, hemorrhage, edema, or mass. The ventricles and sulci are\nenlarged in an atrophic pattern.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Atrophy.\nNo significant changes since ___.\nNo evidence of hemorrhage." + }, + { + "input": "The study is degraded by incorrect bolus timing and motion artifact.\n\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of hemorrhage. Known, bilateral, punctate super and\ninfratentorial acute infarctions are better appreciated MRI head from ___ at 07:55. Generalized cerebral atrophy with ex vacuo dilatation of the\nventricular system.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nWithin the limits of the study there is no intracranial arterial aneurysm or\narterial occlusion.\n\nCTA NECK:\nWithin the limits of the study there is no carotid arterial occlusion or\naneurysm. No obvious ICA stenosis by NASCET criteria. Increased soft tissues\nsurrounding the junction of V3 and V4 of the right vertebral artery, poorly\ncharacterized, may be secondary to accompanying veins or may represent\ndissection, these cannot be differentiated due to poor contrast bolus timing\nand repeat CT or correlation with an MR study is advised. The left vertebral\nartery appears patent.\n\nOTHER:\nPatulous esophagus. Bilateral pleural effusions and interstitial thickening\nmost likely representing pulmonary edema. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. Evidence of prior CABG procedure", + "output": "The study is degraded by incorrect bolus timing and motion artifact.\n\nNo acute hemorrhage or large territorial infarct.\nKnown bilateral punctate supra and infratentorial acute infarctions are better\nappreciated on prior MRI head done ___. These infarcts are most likely\nembolic in nature.\n\nWithin the limits of the study there is no intracranial arterial aneurysm or\nocclusion. No ICA occlusion. No obvious ICA stenosis by NASCET criteria.\n\nIncreased soft tissues surrounding the junction of V3 and V4 segment of the\nright vertebral artery may be secondary to accompanying veins or may represent\ndissection, these cannot be differentiated due to poor contrast bolus timing\nand repeat CTA is advised.\n\nRECOMMENDATION(S): Increased soft tissues surrounding the junction of V3 and\nV4 segment of the right vertebral artery may be secondary to accompanying\nveins or may represent dissection, these cannot be differentiated due to poor\ncontrast bolus timing and repeat CTA or MR is advised if clinically indicated." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are prominent compatible with global volume\nloss. Minimal periventricular white matter hypodensities likely sequela of\nchronic small vessel disease.. Atherosclerotic calcifications noted within\nthe intracranial ICAs.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process. No evidence of intracranial metastases though\nMRI would be more sensitive for detection." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of hemorrhage, edema, mass effect, or acute infarction. \nThe ventricles are stable in size and configuration and prominence suggests\nage related atrophy. Periventricular and subcortical white matter\nhypodensities are nonspecific but likely sequelae of chronic microangiopathy. \nAdditional more focal hypodensities superimposed on periventricular\nhypodensities are unchanged compared to the prior MRI the likely represent\nlacunar infarcts or prominent perivascular spaces.\n\nThere is a small mucous retention cyst in the left maxillary sinus. The\nremaining paranasal sinuses, mastoid air cells, middle ear cavities are\nessentially clear. The orbits are unremarkable.\n\nCTA NECK:\nThere is moderate to severe atherosclerotic disease along the a three vessel\naortic arch. Mixed plaque at the origin of the left common carotid artery\nresults in mild luminal narrowing. The origin of the vertebral arteries and\nthe common carotid arteries are widely patent.\n\nPredominantly noncalcified plaque extends along the entire course of the left\ncommon carotid artery demonstrating mild-to-moderate luminal narrowing. There\nis mixed but predominantly noncalcified plaque in the left carotid bulb\nextending into the proximal left internal carotid artery with severe narrowing\nof a long segment of the cervical internal carotid artery. The left internal\ncarotid artery is severely attenuated in the petrous bone with heavy\natherosclerotic calcifications are seen along the distal petrous, lacerum,\ncavernous, supraclinoid left internal carotid artery demonstrating little if\nany flow distal to the petrous segment.\n\nThere is mild atherosclerotic plaque along the right common internal carotid\nartery without narrowing. There is no appreciable atherosclerotic disease\ninvolving the right carotid bulb and right cervical internal carotid artery. \nCalcified atherosclerotic plaque is present along the lacerum, cavernous, and\nsupraclinoid right internal carotid artery.\n\nThe vertebral arteries are within normal limits.\n\n\nCTA HEAD:\nThere are extensive atherosclerotic calcifications along the distal petrous,\ncavernous, and supraclinoid internal carotid arteries bilaterally, resulting\nin at least moderate narrowing of the supraclinoid right internal carotid\nartery, immediately distal to the takeoff of the ophthalmic artery (6:258). \nThe right internal carotid artery is patent. Small and irregular appearance\nof the right A1 and M1 segments is likely related to atherosclerotic disease.\nThere is fenestration of the distal A1 segment of the right anterior cerebral\nartery.\n\nThere is minimal flow in the intracranial left internal carotid artery. The\nleft carotid terminus and A1 and M1 segments are diminutive and irregular. \nThe A2 segment of the left anterior cerebral artery is supplied from the\ncontralateral side by the anterior communicating artery. The left M2 branches\nare small and there is paucity of more distal branches of the left middle\ncerebral artery as compared to the contralateral side.\n\nThere is no evidence of aneurysm.\n\nAsymmetric opacification of the left internal jugular and sigmoid sinuses is\nlikely related to contrast timing an anatomic variation.The dural venous\nsinuses are patent.\n\n\nOTHER:\nThe visualized portion of the lungs are notable for partially calcified\nbiapical pleuroparenchymal scarring/fibrosis. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No evidence of hemorrhage, edema, mass effect, or acute infarction.\n\n2. There is moderate predominantly noncalcified atherosclerotic disease in\nthe left common and internal carotid arteries resulting in severe long segment\nnarrowing of the cervical internal carotid artery and minimal flow in the\nintracranial portion of the left internal carotid artery which is heavy\ncalcified. The left carotid terminus and A1 and M1 branches are irregular and\nseverely diminutive. The left M2 branches are small and there is paucity of\nmore distal left middle cerebral artery branches. The A2 segment of the left\nanterior cerebral artery is supplied from the contralateral side by the\nanterior communicating artery.\n\n3. The right cervical internal carotid artery is patent and shows no stenosis\nby NASCET criteria. Confluent calcifications along the cavernous and\nsupraclinoid right internal carotid artery result in at least moderate focal\nnarrowing just distal to the take-off of the ophthalmic artery.\n\n4. The vertebral arteries are within normal limits." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is unchanged chronic right basal ganglia infarct. There is no evidence\nof acute large territorial infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is mild mucosal wall thickening in the bilateral maxillary sinuses. The\nremainder of the visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the orbits\nare unremarkable.\n\nCTA HEAD:\nAgain, there is moderate narrowing of the intracranial internal carotid\narteries, with occlusion at the level of the ICA terminus, with the diminutive\nleft MCA and ACA territory supplied likely from the left posterior and\nanterior communicating arteries. Atherosclerotic calcification of the right\nintracranial internal carotid artery mildly narrows the lumen. There is\nfenestration of the right A1 segment of the ACA. Diminutive left A1, left M1\nand left M2 segments are unchanged. The vessels of the circle of ___ and\ntheir principal intracranial branches otherwise appear patent without\nsignificant stenosis, other areas of occlusion, or aneurysm formation. The\ndural venous sinuses are patent.\n\nCTA NECK:\nThere are mild atherosclerotic calcifications of the aortic arch as well as\nthe origin of the left common carotid artery. There is some irregularity of\nthe distal left common carotid artery, likely reflecting calcified and\nnoncalcified atherosclerotic plaque come with similar area seen on the right. \nThere is post endarterectomy change of the left internal carotid artery, with\nsignificant improvement of the previously noted luminal stenosis. There is a\nlarge left-sided neck hematoma extending from the angle of the mandible\ninferiorly to the level of the thoracic inlet with a prominent surrounding\nsoft tissue edema with resultant rightward deviation of the cervical airway,\nand up to moderate narrowing of the supraglottic airway. Additional areas of\nsubcutaneous gas are seen within the areas of hematoma. The carotid and\nvertebral arteries and their major branches otherwise appear patent with no\nevidence of significant stenosis, dissection or occlusion. There is now no\nevidence of internal carotid stenosis by NASCET criteria. The hematoma exerts\ncompresses the left internal jugular vein, with scattered regions of thin\npostcontrast opacification noted.\n\nOTHER:\nThere is moderate right apical scarring with associated traction\nbronchiectasis. There is a mild degree of left apical scarring. The\nvisualized portion of the lungs are clear. The there is mild heterogeneity of\nthyroid gland with largest hypodense nodule measuring up to 8 mm in the right\nlobe (5:105). There is no lymphadenopathy by CT size criteria.", + "output": "1. No acute intracranial abnormality. Chronic right basal ganglia infarct.\n2. Changes from a left carotid endarterectomy with improvement of the caliber\nof the cervical portion of the left internal carotid artery, however with a\nlarge left-sided neck hematoma extending from the level of the angle of the\nmandible inferiorly to the thoracic inlet, with rightward displacement of the\ncervical airway, with up to moderate narrowing at the supraglottic level. No\nevidence of active extravasation. The hematoma compresses on the left\ninternal jugular vein, which demonstrates very minimal scattered segment of\nopacification.\n3. Occlusion of the left internal carotid artery terminus with the left ACA\nand MCA territories likely supplied by the anterior communicating and left\nposterior communicating arteries. Diminutive left A1, M1 and M2 segments are\nunchanged, likely secondary to atherosclerotic disease.\n4. Remainder of the intracranial vasculature is patent without additional\nareas of occlusion, or aneurysm.\n5. Patent cervical vasculature without significant stenosis, occlusion, or\ndissection.\n6. 8 mm right thyroid lobe nodule. The ___ College of Radiology\nguidelines suggest that in the absence of risk factors for thyroid cancer, no\nfurther evaluation is recommended.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with ___\nNP on the telephone on ___ at 6:07 AM, 5 minutes after discovery of the\nfindings." + }, + { + "input": "There is left periorbital and perimalar soft tissue hematoma.\n\nThere is a left orbital blowout fracture through the orbital floor, with a\ndefect measuring 1.4 cm AP x 1.3 cm transverse, and inferiorly and medially\ndisplaced fracture fragment, that may predispose to soft tissue \"trapdoor\n\"entrapment.\n\nThere is herniation of the extraconal fat and partial herniation of the\ninferior rectus muscle through the fracture defect (41:69), and into the left\nmaxillary sinus, with mild hemosinus. There is subtle stranding within the\nintraconal fat, but no definite subperiosteal/retrobulbar hematoma, or\nproptosis by CT measurements. The lamina papyracea, lateral orbital walls,\nand nasal bones are maintained.\n\nOn image 33, series 3, there is questionable lentiform density along the\ntemporal aspect of the posterior globe, could represent a small amount of\nvitreous or retinal hemorrhage.", + "output": "1. There is a left orbital blowout fracture, with inferiorly displaced\nfracture fragment that may predispose to entrapment of inferiorly herniated\nextraconal fat and the rectus inferior muscle into the maxillary sinus.\n2. A small amount of retinal/vitreous hemorrhage suspected.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 6:36 pm, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "Motion artifact and off axis images limit assessment.\n\nNo acute intracranial hemorrhage.\n\nNo depressed calvarial fracture.\n\nThere is extensive soft tissue edema and hematoma overlying the left orbit and\nperimalleolar region, with herniation of extraconal fat and the rectus\ninferior through a orbital blowout fracture and hemosinus described separately\non dedicated CT of the facial bones.", + "output": "1. No acute intracranial hemorrhage.\n2. Left orbital blow-out fracture reported separately on dedicated CT of the\nfacial bones." + }, + { + "input": "Left :\nThe external auditory canal is normal. The middle ear cavity is clear. The\nossicles and tegmen are intact. There is no evidence for enlarged vestibular\naqueduct or superior semicircular canal dehiscence. The facial nerve follows a\nnormal course through the middle ear. There is no evidence for inner ear\ndysplasia. Trace fluid is seen in the very dependent portion of the left\nmastoid air cells.\n\nRight:\nThere is a nondisplaced fracture involving right parietal bone extending\nthrough the parietal temporal suture to the mastoid segment temporal bone,\nwhich point the fracture is longitudinal to the petrous temporal bone (series\n3, image 115, 108, 80, and 52. Inner ear, membranous labyrinth is intact. No\nossicular displacement or fracture.\nThe external auditory canal is normal. There is partial opacification of the\nmiddle ear cavity mastoid air cells. Intact facial nerve canal. .\n\nOther: Intracranial hemorrhage was better seen on CT ___ from the\noutside institution, including subarachnoid hemorrhage and small areas of\nsuperficial hemorrhagic cortical contusions involving temporal lobe. Few\npunctate foci extra-axial air is seen on the comparison CT", + "output": "1. Right parietal, temporal bone fractures. Few foci of extra-axial air,\nlikely from violation of few mastoid air cells. Intracranial hemorrhage\nincluding subarachnoid hemorrhage, superficial hemorrhagic contusions right\ntemporal lobe better seen on prior.\n2. Moderately opacified right mastoid air cells, middle ear cavity." + }, + { + "input": "There is no evidence of herniation. The basal cisterns are preserved and\nunchanged from prior. The previously seen subarachnoid hemorrhage is nearly\nresolved. Small hemorrhagic parenchymal contusion right lateral temporal lobe\nand right medial orbital gyrus is stable compared with ___. No new\nhemorrhage. No evidence of acute infarct. No hydrocephalus. No midline\nshift.\n\nStable right parietal, mastoid segment temporal bone fracture. Mild\nopacification right mastoids, similar.", + "output": "Hemorrhagic parenchymal contusions right temporal, frontal lobe are stable. \nNo new hemorrhage. Nearly resolved previously seen subarachnoid hemorrhage. \nStable right parietal, temporal bone fracture." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nA broad hypodense area with loss of gray-white differentiation is seen\nencompassing the left MCA territory. The area matches the T-max on the\nperfusion scan and is worrisome for a left MCA infarct. Additionally, a\nhyperdense focus in left frontal lobe is concerning for intraparenchymal\nand/or subarachnoid hemorrhage.\n\nThe visualized paranasal sinuses are clear. The intraorbital contents are\nnormal. The mastoid air cells and middle ear cavities are clear.\n\n\nCTA HEAD:\nThere is complete occlusion of the left internal carotid artery from its\norigin up to the cavernous segment where there is reconstitution of blood\nflow.\n\nThere is abrupt cut off of contrast flow within the left middle cerebral\nartery at its origin. Severe attenuation of contrast flow is seen involving\nthe entirety of the left MCA territory, with the minimal flow seen likely\nbeing collateral. There is attenuation of contrast flow within the left\nanterior cerebral artery.\n\nThe right internal carotid artery demonstrates atherosclerotic change without\nsignificant stenosis. The right middle cerebral and anterior cerebral\narteries are patent.\n\nThe vertebrobasilar system is patent without significant stenosis.\n\nCTA NECK:\nAtherosclerotic changes of the aortic arch are seen. The common carotid\narteries are patent without significant stenosis. There is complete occlusion\nof the left internal carotid artery from its origin up to the cavernous\nsegment. Atherosclerotic changes of the right internal carotid artery are\nseen without significant stenosis, by NASCET criteria.\n\nA beaded appearance of the bilateral vertebral arteries is seen, involving\ntheir V3-V4 segments. No significant narrowing is seen.\n\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Broad hypodense area with loss of gray-white differentiation is seen\nencompassing the left MCA territory. The area matches the T-max on the\nperfusion scan and is worrisome for a left MCA infarct.\n2. Hyperdense focus in the high left frontal lobe is concerning for\nintraparenchymal and/or subarachnoid hemorrhage.\n3. Occlusion of the left MCA at its origin with severely diminished flow seen\nthroughout the left MCA territory with the minimal flow seen likely being\ncollateral.\n4. Complete occlusion of the left ICA from its origin to its cavernous\nsegment.\n5. Beaded appearance of the bilateral vertebral arteries involving the V3-V4\nsegments is likely due to atherosclerotic change; however, fibromuscular\ndysplasia or be in the differential.\n6. No significant narrowing of the right internal carotid artery, by NASCET\ncriteria." + }, + { + "input": "There is an evolving early subacute left MCA territory infarction involving\nthe frontal lobe, anterior parietal lobe, and insula. There is increased\ngyriform hemorrhage in the infarcted territory compared to approximately 24\nhours earlier. There is only minimal mass effect at this time with minimally\ndecreased size of the left lateral ventricle and third ventricle. There is\nnew minimal rightward shift of the third ventricle and septum pellucidum. \nThere is no mass effect on the basal cisterns.\n\nNo concerning osseous abnormalities are seen. Partially visualized paranasal\nsinuses and mastoid air cells appear grossly well-aerated allowing for absence\nof dedicated bone algorithm images.", + "output": "1. Evolving early subacute left MCA territory infarction, with left frontal,\nanterior parietal, and insular involvement.\n2. Increased gyriform hemorrhage compared to approximately 24 hours earlier.\n3. Minimally decreased size of the left lateral and third ventricles and new\nminimal rightward shift of midline structures compared to 24 hours earlier." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, loss of gray/\nwhite matter differentiation, or loss of density in the basal ganglia. \nEvaluation of the brain stem for subtle abnormalities is limited by bone\nrelated artifact. Ventricles, sulci, and basal cisterns are normal in size.\n\nNo osseous abnormalities seen. There is mild mucosal thickening in the\npartially visualized maxillary sinuses, in the sphenoid sinuses, and in\nscattered anterior ethmoid air cells. The mastoid air cells, and middle ear\ncavities are clear.", + "output": "No evidence for acute intracranial abnormalities.\n\nRECOMMENDATION(S): MRI would be more sensitive for an acute infarction or\nglobal hypoxic ischemic injury, if clinically warranted." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. The\nvisualized portion of the orbits are unremarkable.\n\nDystrophic calcification in the left cerebellum may be sequelae of prior\ninfarction/injury.", + "output": "No acute intracranial process. Dystrophic calcifications in the left\ncerebellum may be sequelae of prior infarction/injury.\n\nPlease note brain MRI is more sensitive for evaluation of metastatic disease." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal.There is left level 2 lymph node\nmeasuring 1.5 cm x 0.9 cm, compared with 1.2 cm x 0.8 cm on prior, some of the\nsize difference may be secondary to difference in techniques, it has normal\nenhancement and is morphologically normal in appearance.. There is 0.5 cm\nsubcutaneous nodule overlying posterior left neck musculature series 3, image\n30, not definitely seen on prior. Few additional small bilateral neck lymph\nnodes, within normal limits.\n\nThe neck vessels are patent. There is serpiginous focus of calcification\ninferolateral left cerebellum. Degenerative changes cervical spine. There are\nno osseous lesions.See chest CT report from today for lung findings.", + "output": "1. Left level 2 lymph node at the upper limits of normal.\n2. 0.5 cm posterior neck subcutaneous nodule." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. A 12 x 7 mm prominent left level 2 lymph node has decreased in\nsize, previously 15 x 9 mm (series 2, image 42). The neck vessels are patent.\nA 5 mm subcutaneous nodule posterior to the left neck musculature is stable\n(series 2, image 42).\n\nThe imaged portion of the lung apices are notable for nonspecific subpleural\nground-glass opacity at the left lung apex, more fully evaluated on dedicated\nchest CT same day. Lung apices are otherwise clear. There are no osseous\nlesions.\n\nMultilevel degenerative changes in the cervical spine are most severe at C4-5\nand C5-6 levels with posterior disc osteophytes resulting in mild narrowing of\nthe spinal canal and bilateral neural foramina.", + "output": "1. No enlarging soft tissue mass or cervical lymphadenopathy.\n2. 5 mm subcutaneous nodule posterior to the left neck musculature is stable." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass.\n\nThe ventricles and sulci are normal in size and configuration.\n\nThere is minimal mucosal thickening along the ethmoid air cells and a mucous\nretention cyst along the floor in the left maxillary sinus. The mastoid air\ncells appear clear. The orbits appear unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation.\nThe dural venous sinuses are patent.\n\nCTA NECK:\nNormal 3 vessel aortic arch. The carotidandvertebral arteries and their major\nbranches appear normal with no evidence of stenosis or occlusion. There is no\nevidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nNo suspicious pulmonary nodules. There is a heterogeneous 12 mm nodule in the\nright and a 5 mm hypodense nodule in the left thyroid gland. There is no\nlymphadenopathy by CT size criteria.", + "output": "1. No evidence of acute infarction, hemorrhage or intracranial mass.\n2. Patent intracranial and cervical vasculature without evidence of\ndissection, stenosis, occlusion or aneurysm formation greater than 3 mm.\n3. Heterogeneous 12 mm right thyroid lobe nodule.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or older.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or mass\neffect. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality identified. No acute fracture." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\n\nThere is mild mucosal thickening of the bilateral ethmoid air cells. \nRemaining paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nethmoid air cells bilaterally. Remainder the visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial process. No intra-axial hemorrhage." + }, + { + "input": "There is no intracranial hemorrhage, edema, shift of normally midline\nstructures, hydrocephalus, or evidence of infarction. Prominence of the\nventricles and sulci is compatible with age-related involutional change. Mild\ncalcifications are seen along the cavernous carotid arteries as well as the\nleft vertebral artery. There is minimal mucosal thickening within the left\nsphenoid sinus. The remainder the paranasal sinuses and mastoid air cells are\nwell aerated. No osseous lesions concerning for infection or malignancy.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular white matter hypodensities are\nnonspecific but likely a sequela of chronic small vessel ischemia.\n\nThere is no acute fracture. There is trace fluid in the right sphenoid sinus.\nOtherwise, the imaged paranasal sinuses are clear. Mastoid air cells and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "Age-related involutional changes, otherwise no acute intracranial abnormality." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is loss of the gray-white matter differentiation and hypoattenuation in\nthe left frontal, parietal, and temporal lobes, and in the insula. There is\nno acute hemorrhage. There is no significant mass effect, including no\neffacement of the ventricles and basal cisterns, and no shift of midline\nstructures.\n\nThere is a small air fluid level in the right maxillary sinus and mild mucosal\nthickening in the left maxillary sinus. There is partial right and near\ncomplete left mastoid air cell opacification. The left mastoid is also\nunderpneumatized compared to the right. Middle ear cavities appear\nwell-aerated bilaterally. The orbits are unremarkable.\n\nCTA NECK:\nThere is a normal 3 vessel branching pattern of the aortic arch. Bilateral\ncommon carotid arteries are widely patent. The left proximal internal carotid\nartery is occluded 2 cm distal to its origin. The right internal carotid\nartery is widely patent without evidence of stenosis by NASCET criteria. The\nvertebral arteries are patent throughout their course.\n\nCTA HEAD:\nThere is reconstitution of left distal petrous internal carotid artery. The\nleft distal petrous, cavernous and proximal supraclinoid internal carotid\nartery is smaller in caliber compared to the right. The right intracranial\ninternal carotid artery is patent. Anterior cerebral arteries are patent with\nsymmetric A2 segments. Bilateral middle cerebral arteries are patent, but the\nleft M1 segment is smaller in caliber and irregular compared to the right. \nThere is venous hyperemia in the left sylvian fissure.\n\nNo flow-limiting stenosis is seen in the posterior circulation. No aneurysms\nare identified. There appears to be a fenestration of the proximal basilar\nartery, a normal variant, versus abutting, \"kissing\" distal vertebral\narteries.\n\nThe major dural venous sinuses are patent.\n\nCT PERFUSION:\nThere is decreased cerebral blood flow and blood volume and increased mean\ntransit time corresponding with the areas of hypoattenuation and loss of\ngray-white matter differentiation in the left frontal, parietal, and temporal\nlobes, corresponding to an infarction. There are no areas of increased mean\ntransit time with normal or increased cerebral blood volume to suggest\nischemic penumbra.\n\nOTHER:\nEvaluation of the included upper lungs is limited by respiratory motion\nartifact. The thyroid gland is unremarkable allowing for artifacts from the\nshoulder girdles. There is no lymphadenopathy by CT size criteria.", + "output": "1. Acute infarction in the left frontal, parietal, and temporal lobes, as well\nas the insula, involving the MCA territory and possibly a portion of the ACA\nterritory. No acute hemorrhage.\n2. No evidence for ischemic penumbra on CT perfusion imaging.\n3. Occlusion of the left internal carotid artery 2 cm distal to its origin\nwith reconstitution in its left petrous segment. The reconstituted\nintracranial left internal carotid artery smaller in caliber than the right.\n4. Bilateral middle cerebral arteries are patent, but the left M1 segment is\nsmaller in caliber and irregular compared to the right.\n5. Venous hyperemia in the left sylvian fissure is likely secondary to the\nacute infarction." + }, + { + "input": "Worsening hypodensity and loss of gray-white differentiation of the left\nfrontal and temporal parietal measuring approximately 4.9 x 3.2 and 3.2 x 2.2\ncm (AP, TRV) respectively compared to prior CT examination where the\nhypodensity measured approximately 3.7 x 2.6 and 1.8 x 1.6 cm. These\ncorrespond to acute infarcts demonstrated on MRI of ___. There is\nnow near-complete effacement of the adjacent sulci of the left frontal lobe\nand increasing edema pattern and sulcal effacement involving the left\nprecentral gyrus. There may be minimal increased effacement of the frontal\nhorns of the lateral ventricles with mild 2 mm rightward midline shift. \nOtherwise, the remainder of the ventricles are unchanged in size and within\nexpected limits. There is no evidence of hemorrhagic transformation. There\nis no evidence of new large territorial infarct. The basal cisterns are\npatent.\nThere is no evidence of fracture. There is mucosal thickening in the right\nmaxillary sinus. The visualized portion of the other paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. There is expected interval evolution of known left MCA territory infarct\nwith worsening hypodensity of the left frontal and temporal parietal lobes.\n2. There is increasing sulcal effacement with interval development of 2 mm\nrightward midline shift. Close follow-up is recommended.\n3. No evidence of uncal herniation. The basilar cisterns remain patent and\nthe ventricles are essentially unchanged from prior exam.\n4. No evidence of hemorrhagic transformation. No new infarcts." + }, + { + "input": "Examination is minimally limited by streak artifact from metallic hair clips\noverlying the patient as well as streak artifact from left-sided venous\ncontrast infusion.\n\nCT HEAD WITHOUT CONTRAST:\nThere is encephalomalacia from large chronic infarcts in the left frontal and\nparietal lobes, both in the MCA territory. There is a tract of hypodensity\nleading to the atrophied left cerebral peduncle consistent with wallerian\ndegeneration. There is minimal ex vacuo dilatation of the left lateral\nventricle. There is no evidence of acute large territorial infarction,\nhemorrhage, edema, or mass. The ventricles and sulci are otherwise normal in\nsize and configuration.\n\nThere is minimal polypoid mucosal wall thickening in the inferior aspects of\nbilateral maxillary sinuses. The mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is variant fetal type origin of the right posterior cerebral artery. \nAnterior and posterior communicating arteries are demonstrated. The vessels\nof the circle of ___ and their principal intracranial branches are\notherwise patent without significant stenosis, occlusion, or aneurysm\nformation. There is reduced vascularity in the areas of left frontal and\nparietal infarct. The dural venous sinuses are patent.\n\nCTA NECK:\nPreviously seen occlusive thrombus in the distal left internal carotid artery\nhas improved, with areas of nonocclusive chronic appearing thrombus and web\nformation in the distal left internal carotid artery extending to the proximal\npetrous segment of the internal carotid artery (5:193- 214). This produces up\nto moderate narrowing of the lumen. The carotid and vertebral arteries and\ntheir major branches appear patent with additional areas of stenosis\n,occlusion, or dissection. There is no evidence of internal carotid stenosis\nby NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Examination is minimally limited by streak artifact from metallic hair\nclips overlying the patient as well as streak artifact from left-sided venous\ncontrast infusion.\n2. Interval evolution in appearance of now chronic large left frontal and\nparietal infarcts in the MCA territory with reduced vascularity in areas of\ninfarct. There is associated wallerian degeneration with atrophied left\ncerebral peduncle.\n3. No acute large territorial infarct or hemorrhage.\n4. Interval recannulization of a previously occluded left distal internal\ncarotid artery, with areas of nonocclusive partial thrombus with web-like\nappearance producing up to moderate narrowing in the left to distal internal\ncarotid artery continuing to the petrous left internal carotid artery. \nOtherwise patent cervical vasculature without occlusion or dissection.\n5. Reduced vascularity in the areas of left frontal and parietal infarct. \nOtherwise patent intracranial vasculature without significant stenosis,\nocclusion, or aneurysm." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Essentially normal noncontrast head CT. There is no evidence of acute\nintracranial process or hemorrhage." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. There is\npreservation of gray-white matter differentiation. There are periventricular\nand subcortical lucencies, which may represent small vessel ischemic changes.\n\nA mucous retention cyst is seen within the left maxillary sinus. Mild mucosal\nthickening is seen within the right maxillary and sphenoid sinuses and\nbilateral ethmoid air cells. The visualized portion mastoid air cells and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.\n\nCTA HEAD:\nCalcifications are noted in the bilateral cavernous carotid arteries without\nsignificant stenosis. Otherwise, the vessels of the circle of ___ and\ntheir principal intracranial branches appear normal without stenosis,\nocclusion, or aneurysm formation.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is demonstrates a 9 mm right thyroid nodule with central\ncalcification. There is no lymphadenopathy by CT size criteria.", + "output": "1. Dental amalgam streak artifact limits study.\n2. No evidence of acute intracranial hemorrhage or large vascular territorial\ninfarction.\nPlease note MRI of the brain is more sensitive for the detection of acute\ninfarct.\n3. Patent intracranial and neck vasculature without evidence of high-grade\nstenosis, dissection, or aneurysm greater than 3 mm.\n4. Paranasal sinus disease , as described.\n5. 9 mm right thyroid lobe nodule. The ___ College of Radiology\nguidelines suggest that in the absence of risk factors for thyroid cancer, no\nfurther evaluation is recommended." + }, + { + "input": "Some of the images were repeated due to motion on the initial scan. There is\nno evidence for acute intracranial hemorrhage, edema, mass effect, or acute\nmajor vascular territorial infarction. There is mild age-related prominence\nof the ventricles and sulci.\n\nRepeated images are submitted in soft tissue algorithm only, not bone\nalgorithm. Bone algorithm images are mildly limited by motion artifact. As\nvisualized, there is no evidence for a displaced fracture. There is\nsubcutaneous contusion in the midline forehead.\n\nThere is a small amount of fluid in the right sphenoid sinus. Right mastoid\nhas no pneumatized air cells. Bilateral mastoid antra, left mastoid air\ncells, and bilateral middle ear cavities are well aerated.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. Midline forehead contusion. No evidence for a fracture.\n3. Fluid in the right sphenoid sinus. Please correlate clinically with any\nassociated acute infectious or inflammatory symptoms." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass.\n\n There is prominence of the ventricles and sulci suggestive of involutional\nchanges. There are periventricular and subcortical lucencies, which may\nrepresent small vessel ischemic changes. Atherosclerotic vascular\ncalcifications are noted of bilateral cavernous portions of internal carotid\narteries.\n\nThere is no evidence of fracture. The visualized portion of the mastoid air\ncells, and middle ear cavities are clear. There is mucosal thickening of the\nethmoid sinuses. The visualized portion of the orbits are preserved. Frontal\ncalvarial probable hemangioma is noted (see 03:32).", + "output": "1. No evidence of acute intracranial hemorrhage or large territory infarct. \nPlease note MRI of the brain is more sensitive for the detection of acute\ninfarct.\n2. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described.\n3. Paranasal sinus disease , as described." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Mild mucosal thickening is seen within the\nethmoid air cells as well as within both sphenoid sinuses. The visualized\nportion of the remaining paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid is significantly enlarged and heterogeneous,\nconsistent with thyroid goiter.\n\nThere is no lymphadenopathy by CT criteria. Multiple mildly prominent lymph\nnodes bilaterally are noted. The carotid arteries are patent bilaterally.\n\nThere is a 5.9 x 5.6 x 4.6 cm mass centered at the right clavicular head which\nis focally eroded with a pathologic fracture. There is obliteration of the\nright internal jugular vein at this level and opacification of small\ncollateral vessels in the right anterior chest wall. The right common carotid\nartery is surrounded by the mass by at least 180 degrees and is narrowed as it\npasses by the mass but remains patent. Laterally the mass contacts the\nanterior portion of the a subclavian artery and encases the thyrocervical\ntrunk. The lesion is also seen to invade the sternocleidomastoid muscle as\nwell as the anterior scalene. Inferiorly, there is invasion of the pectoralis\nmajor. There is also extension to the skin superficially. This lesion is\nconcerning for malignancy. There is no fluid collection.\n\nSeveral areas of ___ opacities in the lung apices, especially on the\nleft, are concerning for small airways infection or inflammation. Biapical\nscarring is greater on the right.\n\nMucosal thickening seen the right maxillary sinus and ethmoid air cells.", + "output": "1. A 5.9 x 5.6 x 4.6 cm mass centered at the right clavicular head which is\neroded with a pathologic fracture. There is also obliteration of the right\ninternal jugular vein at this level and 180 degrees of encasement of the right\ncommon carotid artery which is narrowed but patent. Muscular invasion as\ndetailed above. Finding is most worrisome for neoplasm, likely metastatic\ndisease.\n2. Multinodular goiter of the thyroid.\n3. ___ opacities in the lung apices concerning for small airways\ninfection or inflammation.\n\nNOTIFICATION: Additions to wet read discussed by Dr. ___ with Dr.\n___." + }, + { + "input": "There is a 6.3 cm TR x 5.7 cm AP heterogeneously enhancing mass in the right\nsupraclavicular region with focal overlying skin thickening and an ulcerated\nskin defect. New central hypodensity is noted inferiorly along the mass. The\nmass invades the adjacent pectoralis muscle. The clavicle is pathologically\nfractured with osseous destruction as it courses through the mass. The soft\ntissue mass circumferentially encases the proximal right internal carotid\nartery, stable in comparison the prior CT. In addition, the mass encases the\nanterior aspect of the right subclavian artery. Opacification of the right\nsubclavian and internal jugular vein is not well visualized. There is a\nstable asymmetric increase in number of small lymph nodes in the\nsupraclavicular region. Multiple stable small lymph nodes are noted along the\nbilateral cervical chains. The right laryngeal ventricle is asymmetrically\nenlarged with asymmetric lack of medialization of the right true cords. A\nstable large 1.7 cm right paratracheal lymph node is seen. Multiple partially\nvisualized enlarged lymph nodes are noted in the bilateral subpectoral and\naxillary regions.\n\nEvaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. There is atherosclerotic calcification of the carotid bulbs and\nproximal internal carotid arteries. There is a multinodular enlarged thyroid\ngland, largest measuring 2.6 cm.\n\nRight apical scarring is seen. There is centrilobular emphysema. There is a\nheterogeneous appearance to the bone marrow with lytic lucencies seen in the\nC3, C4 and C5 vertebral bodies. There is a skin lesion overlying the left\ntemporal scalp, series 2, image 9. Low density is noted in the left\nvalleculae which may represent a vallecular cyst. There is partial\nopacification of the ethmoid sinus. A retention cyst is seen in the right\nmaxillary sinus.", + "output": "1. Re- demonstration of the heterogeneously enhancing 6.3 cm right\nsupraclavicular mass with interval increased superficial skin ulceration and\nhypodensity along the inferior aspect of the mass, consistent with to\nnecrosis, which may represent posttreatment changes. Stable invasion of the\nright pectoralis loss, vascular encasement, occlusion of the right\nsubclavian/internal jugular vein and bony involvement of the right clavicle\nwith an associated pathologic fracture. Enlarged thyroid gland is again\nidentified.\n2. Stable appearance of a 1.7 cm right paratracheal lymph node, which\ndemonstrated increased FDG activity.\n3. Numerous small, not pathologically enlarged lymph nodes, predominantly in\nthe right supraclavicular region, but also involving the bilateral cervical\nchains, subpectoral and axillary regions.\n4. Imaging findings of right vocal cord paralysis, likely secondary to\ninvolvement of the right recurrent laryngeal nerve by the supraclavicular\nmass.\n5. Stable enlarged multi nodular thyroid gland.\n6. Scattered lucent lesions throughout the cervical spine which may represent\nmetastatic disease. Recommend correlation with MRI of the spine or bone scan\nif clinically indicated." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding.The thyroid gland is enlarged and heterogeneous with multiple\nnodules, minimally changed from CT chest ___. There are scattered\ncervical chain lymph nodes none of which are pathologically enlarged by CT\nsize criteria, unchanged from ___.\n\nCentered in the right clavicular head is a heterogeneous mass with a skin\ndefect and internal foci of gas measuring 7.5 x 3.1 x 3.7 cm (AP by TV by CC,\n2:55, 601b:17), grossly unchanged in size as compared to chest CT ___. The amount of gas within this mass appears increased from ___.\nThere is obliteration of the right internal jugular vein and right subclavian\nvein, chronic and unchanged. There are prominent collateral veins in the\nanterior chest wall (2:77). The right common carotid artery is surrounded by\nthe mass by at least 180 degrees with mild narrowing as it passes through the\nmass. This mass encases the right subclavian artery and contacts the right\nthyrocervical trunk, unchanged. This mass appears to invade the right\nanterior scalene and right pectoralis major muscles. There is skin thickening\nalong the anterior chest wall, unchanged.\n\nLinear opacities in the right upper lobe are unchanged from ___ most\ncompatible with posttreatment changes. There are mild paraseptal and\ncentrilobular emphysematous changes in both lung apices. There is mild\ndependent atelectasis in the right upper lobe.", + "output": "1. Centered on the right clavicular head is a heterogeneous mass measuring 7.1\nx 3.1 x 3.7 cm which is grossly unchanged in size as compared to CT chest ___. There is a skin defect in the region of this mass with increased\nfoci of internal gas.\n2. Chronic occlusion of the right internal jugular and right subclavian veins\nat the level of the mass. 180 degrees of encasement of the right common\ncarotid artery, unchanged. Multiple venous collaterals in the anterior chest\nwall are again noted.\n3. Similar appearance of multinodular thyroid." + }, + { + "input": "The confluent right anterior chest wall and supraclavicular appears worse with\nareas of deeper ulceration. The right sternoclavicular joint is eroded. The\nmass extends to the level of the intercostal muscles and into the anterior\ncervical space at the lower margin of the thyroid gland (series 2 image 68). \nThe mass invades the right pectoralis muscles, right sternocleidomastoid,\nright omohyoid and right strap muscles. The mass is overall larger, most\nconspicuous within the inferior and middle thirds of the mass.\n\nThe right brachiocephalic trunk is preserved, however there is at least 180\ndegrees of encasement of the right common carotid and subclavian arteries. \nThe right subclavian and right internal jugular vein below the level of the\nthyroid remain occluded. There are numerous subcutaneous collateral veins\noverlying the right chest wall.\n\nThe mass likely traverses the middle layer of deep cervical fascia that\nenvelopes the visceral space. The is complete obliteration of the fat plane\nperipheral to the enlarged heterogeneous thyroid gland.\n\nThere are no lymph nodes greater than 1 cm in short axis dimension within the\nright suprahyoid neck or left neck.\n\nThere are a few low-density foci within the bilateral parotid glands, left\nmore than right, without interval change.\n\nSymmetric diffuse thickening of the pharyngeal mucosal surface within the\nnasopharynx, oropharynx, and hypopharynx and supraglottic larynx is likely\nrelate treatment related.\n\nPleural thickening and adjacent confluent past the, reticulation, and areas of\nground-glass opacity within the right upper lobe are likely related to prior\nradiation.\n\nThere is moderate atherosclerotic plaque within the aortic arch and the\nbilateral carotid bulbs. CTA neck is recommended for evaluation of luminal\nnarrowing at the carotid bulbs as clinically indicated.\n\nThere is diffuse periodontal disease and carious lesion of the abutment\nsurface of a left maxillary pre molar tooth. There is diffuse paranasal sinus\nmucosal thickening. The middle ear cavities and bilateral mastoid air cells\nare clear.", + "output": "Interval growth of the extensive right anterior chest wall and supraclavicular\nmass as detailed above. The mass is overall larger, most conspicuous within\nthe inferior and middle thirds of the mass. No enlarged lymph nodes within\nthe right suprahyoid neck or left neck." + }, + { + "input": "Head CT: There is a soft tissue mass opacifying the right frontal, ethmoid,\nand sphenoid sinuses. The mass erodes through the right lamina papyracea and\nextends into the right orbit and produces mass effect on the medial rectus and\nsuperior oblique muscles. There is also dehiscence of the right cribriform\nplate with associated intracranial extension and hyperdensity/ edema within\nthe right inferior frontal lobe. Diagnostic considerations include squamous\ncell carcinoma or less likely inverted papilloma. MRI of the sinuses is\nrecommended for further evaluation.\n\nThere is no evidence of acute intracranial hemorrhage. The ventricles are\nnormal in size. The brain parenchymal volume is within normal limits.\n\nThere is additional scattered paranasal sinus mucosal thickening.\n\nHead CTV: There is no evidence of dural venous sinus thrombosis. The\ncavernous sinuses appear symmetric; however, MRI would be better for further\nevaluation.", + "output": "Large soft tissue mass occupying the right frontal, ethmoid, and sphenoid\nsinuses with osseous dehiscence and extension into the right orbit and right\ninferior frontal lobe, as described in detail above. Diagnostic considerations\ninclude sinonasal squamous cell carcinoma or less likely inverted papilloma.\n\nRECOMMENDATION(S): MRI of the sinus is recommended for further evaluation." + }, + { + "input": "There is no evidence of acute large territorial infarction or hemorrhage. The\nventricles and sulci are normal in size and configuration. Hypodensity in the\nright inferior frontal lobe, consistent with edema, is unchanged compared to\n___.\n\nThe large soft tissue mass in the right orbit, ethmoid air cells, and sinuses\nis better evaluated on CT orbit/sinus from the same day.", + "output": "1. No evidence of acute large territorial infarct or hemorrhage, although MR\nis more sensitive in the detection of acute stroke. Edema in the right\ninferior frontal lobe is unchanged compared to ___.\n2. Mass effect on the right optic nerve and right medial rectus muscles, also\nseen on the prior MR study however, probably slightly increased compared to\nthe prior MRI study of ___. Correlate with opthalmologic examination.\n3. Please see the CT orbit/sinus from the same day for evaluation of the known\nlarge soft tissue mass in the right orbit, ethmoid air cells, and sinuses.\n\nRECOMMENDATION(S): Correlate with opthalmologic examination.\nFurther workup with MR if needed and no contra-indication.\n\nNOTIFICATION: D/w Dr. ___ by Dr. ___ phone 5 minutes after review\non ___ at 2.32pm." + }, + { + "input": "Since the previous CT examination, there has been considerable improvement. \nThe destructive changes within the medial wall of the right orbit and the\nright orbital mass have considerably decreased. Subtle soft tissue prominence\nremains medial to the right medial rectus muscle. The soft tissue changes\nwithin the frontal sinus and ethmoid air cells have considerably decreased. \nThere remains opacification of the right sphenoid sinus but the anterior\nmargin of the sphenoid sinus bony wall are much better defined on the current\nstudy. The remaining sinus changes which likely where reactive have also\nresolved. There remains some opacification of the left posterior ethmoid air\ncells. No new mass lesion is identified.", + "output": "1. Considerable improvement since the previous CT sinus with resolution of the\nsoft tissue mass in the orbit and improvement in bony destructive processes. \nImprovement in sinus soft tissue changes. Persistent opacification of the\nright sphenoid sinus." + }, + { + "input": "Overall no significant change from the prior exam yesterday. Again seen is a\nhypodensity in the left superior cerebellar hemisphere as well as right\ncerebellar hemisphere that are compatible with the history of prior infarct. \nThere is no evidence of hemorrhagic transformation. There is no evidence of\nnew hemorrhage or mass effect. There is no new focal hypodensity to suggest\nnew area of infarct. The appearance, size, and configuration of the\nventricles and sulci are unchanged. The cisterns and forth ventricle are\npatent and overall similar to the prior exam.\n\nNo osseous abnormalities are seen. The paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No significant interval change.\n2. Bilateral cerebral hemispheric infarcts are overall stable without evidence\nof hemorrhagic transformation.\n3. No new hemorrhage.\n4. Stable ventricle and cistern size." + }, + { + "input": "Again seen is a hypodensity in the left superior cerebellar hemisphere and a\nsmaller hypodensity in the peripheral right cerebellar hemisphere that are\ncompatible with a history of prior infarctions. There is no evidence of\nhemorrhagic transformation. These are unchanged since ___. There is\nno evidence of a new acute infarction, mass effect or intracranial hemorrhage.\nThe size and configuration of the ventricles is unchanged with patent basilar\ncisterns and fourth ventricle as seen previously.\n\nNo osseous abnormalities seen there is a small amount of fluid within the left\nmaxillary sinus. Remainder the paranasal sinuses, mastoid air cells and middle\near cavities are clear.", + "output": "No significant interval change in bilateral cerebellar hemispheric infarcts\nwithout evidence of hemorrhagic transformation. Stable ventricle and cistern\nsize." + }, + { + "input": "Head CT: A hypodensity in the superior left cerebellar is again noted (3:9).\nThere is no intracranial hemorrhage or mass effect. The ventricles and sulci\nare normal in size and configuration. No osseous abnormalities are noted.\n\nHead CTA: The left superior cerebellar artery is not well seen, which may be\ndue to small size or possible occlusion. There is no evidence of aneurysm,\nstenosis or dissection.\n\nNeck CTA: The carotid and vertebral arteries and their major branches are\npatent with no evidence of stenoses. There is no evidence of internal carotid\nstenosis by NASCET criteria. The ascending thoracic aorta is dilated,\nmeasuring 4.1 cm in diameter (5:4). The visualized lungs are clear, and the\nthyroid gland is normal.", + "output": "1. Hypodensity in the superior left cerebellum concerning for infarct.\n2. The left superior cerebellar artery is not well seen, which may be due to\nrelative small size or possible occlusion. No other intracranial vasculature\nabnormality.\n3. Dilation of the ascending thoracic aorta measuring 4.1 cm in diameter." + }, + { + "input": "There is a small left frontal scalp hematoma (series 3, image 41). There is\nno underlying fracture. There is no evidence of acute territorial\ninfarction,hemorrhage,edema, or mass. Predominantly periventricular white\nmatter hypodensities are nonspecific, but likely represent the sequela of\nchronic microvascular ischemic disease. The ventricles and sulci are normal\nin size and configuration.\n\nA 1.8 peripherally sclerotic lesion with an internal ground-glass matrix\nwithin the left parietal calvarium is unchanged since ___, likely a small\nfocus of fibrous dysplasia (series 3, image 54). There is a similar appearing\nlesion within the right frontal calvarium (series 601b, image 15), also\nunchanged. Mucosal thickening within the bilateral sphenoid sinuses, left\ngreater than right. Partial opacification of the left mastoid air cells. The\nvisualized portion of the middle ear cavities are clear. Senile scleral\ncalcifications are seen bilaterally. Otherwise, the visualized portion of the\norbits are unremarkable.", + "output": "Small left frontal scalp hematoma, but no evidence of underlying fracture or\nintracranial hemorrhage." + }, + { + "input": "There is no hemorrhage, edema, or mass effect. Prominent ventricles and sulci\nreflect age related volume loss. Periventricular and subcortical white matter\nhypodensity is nonspecific, likely sequela of chronic small vessel ischemia. \nThere is no shift of normally midline structures. The basal cisterns are\npatent. Gray-white matter differentiation is preserved.\n\nThe orbits are unremarkable. Imaged paranasal sinuses demonstrate mucosal\nthickening within the anterior ethmoidal air cells as well as nearly\ncompletely opacified left sphenoid sinus with sclerotic walls suggestive\nchronic inflammation, unchanged since ___. Mild mucosal\nthickening is noted within bilateral maxillary sinuses and right sphenoid\nsinus. Inferior-most left mastoid air cells are opacified, unchanged. \nBilateral middle ears cavities are clear. Carotid siphon vascular\ncalcifications are severe.\n\n1.7 x 1.4 cm sclerotic lesion within the left parietal calvarium (03:55) is\nunchanged.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, new mass\neffect or acute large vascular territorial infarct.. Moderate predominantly\nperiventricular white matter hypodensities are nonspecific, but likely\nrepresent the sequela of chronic microvascular ischemia. There is mild\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. Sclerotic lesion within the left parietal\ncalvarium is unchanged (series 3, image 53). Partial opacification within the\ninferior left mastoid air cells, unchanged. There is moderate mucosal\nthickening of the left sphenoid sinus. Minimal mucosal thickening affecting\nthe right sphenoid sinus. Sclerosis of the adjacent walls suggests chronic\nsinusitis. Senile scleral calcifications are seen bilaterally. Otherwise,\nthe visualized portion of the orbits are unremarkable.", + "output": "1. No evidence of fracture or traumatic malalignment.\n2. Unchanged sclerotic lesion within the left parietal calvarium." + }, + { + "input": "CT HEAD:\nThere is no evidence for acute hemorrhage, vascular territorial infarction,\nmass effect, or edema. The ventricles and sulci are normal in size and\nappearance. There is preservation of gray-white matter differentiation. The\nbasal cisterns remain patent.\n\nHyperostosis is seen throughout the inner table of the calvaria. Maxillary\nmucous retention cysts are seen involving the left maxillary sinus. The\nremainder of the paranasal sinuses, middle ear cavities, and mastoid air cells\nare clear. The orbits are grossly unremarkable bilaterally.\n\n\nCTA HEAD AND NECK:\nThere is a normal 3 vessel aortic arch. The vertebral arteries are patent\nwithout high-grade stenosis or occlusion.\n\nThe bilateral common carotid arteries are patent. There is no evidence of\ninternal carotid stenosis by NASCET criteria.\n\nThe left A1 segment is hypoplastic, a normal variant. There is a fetal origin\nof the left posterior cerebral artery, also a normal variant.\n\nThe intracranial vasculature is grossly patent without high-grade stenosis,\nocclusion, or aneurysm greater than 3 mm. The dural venous sinuses are patent.\n\n\nOTHER:\nThe lungs apices are clear bilaterally. The thyroid gland is unremarkable in\nappearance. There is no cervical lymphadenopathy by CT size criteria.", + "output": "1. No evidence for acute intracranial hemorrhage or vascular territorial\ninfarction.\n2. Patent intracranial and cervical vasculature without high-grade stenosis,\nlarge vessel occlusion, or aneurysm greater than 3 mm." + }, + { + "input": "There is no evidence of acute major infarction,hemorrhage,edema,or discrete\nmass. The ventricles and sulci are normal in size and configuration.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Status post\nbilateral lens replacement.", + "output": "No acute intracranial process." + }, + { + "input": "This exam is motion limited. No intra-axial or extra-axial hemorrhage, edema,\nshift of normally midline structures, or evidence of acute major vascular\nterritorial infarction. Ventricles and sulci are normal in configuration for\na patient of this age. Paranasal sinuses, mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No intracranial hemorrhage or fracture.\n\nNOTIFICATION: The findings, impression, and images were discussed with Dr.\n___. by ___, M.D. in person on ___ at 1835h, 1\nminutes after discovery of the findings." + }, + { + "input": "Small amount of layering hyperdense material is again seen within the right\noccipital horn of the lateral ventricle. No change in ventricular size. No\nnew site of intra or extra-axial hemorrhage. No evidence of acute major\nvascular territorial infarction. Imaged paranasal sinuses, mastoid air cells\nand middle ear cavities remain well aerated. The bony calvarium is intact.", + "output": "Small volume intraventricular hemorrhage, right-sided. No change in\nventricular size." + }, + { + "input": "Beam hardening artifact limits evaluation of bilateral frontal lobes and pons.\n\nQuestion minimal right lateral ventricle occipital horn dependent acute to\nintraventricular layering subacute blood products versus artifact (see 2:15). \nPreviously noted near complete opacification of right lateral ventricle\noccipital horn intraventricular hemorrhage is no longer visualized.\n\nThere is no evidence of fracture, infarction, edema,or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nThere are periventricular and subcortical lucencies, which may represent small\nvessel ischemic changes. Atherosclerotic vascular calcifications are noted. \nLeft basal ganglia chronic infarct is again seen.\n\nThe visualized portion of the mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits demonstrate bilateral lens\nreplacement postoperative changes. Minimal right maxillary sinus mucosal\nthickening is present.", + "output": "1. Limited study as described.\n2. Question punctate minimal right lateral ventricle occipital horn acute to\nsubacute intraventricular hemorrhage versus artifact.\n3. Previously noted near complete opacification of right lateral ventricle\noccipital horn by intraventricular hemorrhage is no longer seen.\n4. Atrophy, left basal ganglia chronic infarct, probable small vessel\nischemic changes, and atherosclerotic vascular disease as described.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 12:33 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is redemonstration of acute intraventricular hemorrhage layering\ndependently in both lateral ventricles, similar to slightly increased in the\nright lateral ventricle and more conspicuous on the left. There is\nredemonstration of hyperdense hemorrhage along the right temporal lobe,\npossibly subarachnoid with mild regional sulcal effacement, more conspicuous\non this exam. No acute infarction or midline shift. There is similar mild\nprominence of the ventricles compared with ___, likely related to\ninvolutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are normal, with\nthe exception of prior lens surgery.\n\nCTA HEAD:\nThere is extensive calcified atherosclerotic plaque in the cavernous and\nsupraclinoid internal carotid arteries resulting in mild luminal irregularity\nwithout high-grade stenosis. A 2 mm posteriorly projecting conical\noutpouching of the left carotid terminus (series 3, image 253) demonstrates\nsmall vessel arising from a compatible with an infundibulum. There is mild\nfocal narrowing at the origin of the left MCA. The vessels of the circle of\n___ and their principal intracranial branches otherwise appear patent\nwithout stenosis, occlusion, or aneurysm. The dural venous sinuses are\npatent.\n\nCTA NECK:\nThere are atherosclerotic calcifications along the aortic arch and origins of\nthe major vessels including the left common carotid and left subclavian\narteries resulting in mild to moderate right and mild left stenosis. There is\nmild atherosclerotic stenosis at the origin of the left vertebral artery and\nmoderate atherosclerotic stenosis at the origin of the right vertebral artery.\nBilateral carotid and vertebral artery origins are otherwise patent.\n\nThe patient is status post right carotid endarterectomy. There is luminal\nhyperplasia in the proximal right internal carotid artery results in\napproximately 55% stenosis by NASCET criteria. Predominantly calcified\natherosclerotic plaque in the proximal left internal carotid artery results in\napproximately 40% stenosis by NASCET criteria.\n\nBoth vertebral arteries are patent without evidence of occlusion or\ndissection. There is mild calcified and noncalcified plaque in the left\ngreater than right V4 vertebral artery segments that results in mild luminal\nirregularity without high-grade stenosis.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Similar extent of intraventricular hemorrhage layering dependently in the\nlateral ventricles, slightly more conspicuous in the left occipital horn since\nthe prior study and small amount of evolving subarachnoid hemorrhage in right\ntemporal sulci with mild regional edema. No significant mass effect, midline\nshift or large territory infarction.\n2. Stable ventricular size since the prior study from ___.\n3. Atherosclerotic plaque of the bilateral intracranial ICA resulting in mild\nleft and mild-to-moderate right ICA stenosis.\n4. Mild stenosis at the left MCA origin, likely related to atherosclerotic\ndisease.\n5. Otherwise patent circle of ___ without evidence of high-grade\nstenosis,occlusion,or aneurysm.\n6. Atherosclerotic narrowing results in 40% stenosis of the left ICA by NASCET\ncriteria. Intimal hyperplasia results in resulting in 55% stenosis of the\nright cervical internal carotid artery. The patient is status post right\ncarotid endarterectomy.\n7. Mild-to-moderate atherosclerotic narrowing of the bilateral vertebral\nartery origins and mild narrowing of the left subclavian artery origin.\n8. Otherwise patent cervical and vertebral arteries without evidence of\nocclusion, dissection or aneurysm.\n9. Additional findings described above." + }, + { + "input": "Study is mildly degraded by motion.\n\nCT HEAD WITHOUT CONTRAST:\nThere is a large amount of vasogenic edema centered in the left parietal and\ntemporal lobes likely secondary to previously characterized mass on MRI head ___. There is mass effect with partial effacement of the left lateral\nventricle and 6 mm of rightward midline shift, unchanged from outside hospital\nCT head ___.\n\nThere is mild mucosal thickening of the bilateral ethmoid air cells. Right\nminimally displaced nasal bone fracture without definite overlying soft tissue\nswelling or nasal cavity opacification is again noted (see 4:9 on current\nstudy and 2:1 on ___ prior outside head CT).\n\nCTA HEAD:\nThere is a large feeding vessel (4:73) into the area of the large mass which\noriginates from the P3 segment of the left posterior cerebral artery. There\nis moderate atherosclerotic calcification of the cavernous, clinoid, and\nsupraclinoid portions of the bilateral internal carotid arteries. The circle\n___ and its major branches demonstrate no occlusion, aneurysm, or\ndissection. The left A1 segment is hypoplastic, which can be a normal\nvariant.", + "output": "1. Study is mildly degraded by motion.\n2. Large feeding vessel into the area of the area of patient's previously\ncharacterized mass, seen on MRI head ___, which seems to originate from\nthe P3 segment of the left posterior cerebral artery.\n3. Vasogenic edema centered in the left parietal and temporal lobes likely\nsecondary to previously characterized mass.\n4. Grossly stable minimally displaced right nasal bone probable chronic\nfracture." + }, + { + "input": "Irregularly enhancing lesion with surrounding edema is seen in the left\ntemporal lobe with mass effect on the left lateral ventricle. There is no\nsignificant change in the mass effect compared to the prior study.", + "output": "Examination performed for surgical planning with STIR technique frame. \nIrregularly enhancing left temporal lobe lesion with surrounding edema is\nagain seen a CT of likely glioma." + }, + { + "input": "The patient is status post biopsy of left temporal mass. There is no\nhemorrhage identified. Unchanged mass effect and brain edema are seen. \nExpected post biopsy changes are identified.", + "output": "Expected post biopsy changes seen. No hemorrhage." + }, + { + "input": "Compared to prior exam, the left temporal lobe appears slightly\nheterogeneously hypodense with a persistent focus of hyperdensity measuring\n1.3 x 1.0 cm (2:8). Compared to prior exam on ___, there has been\ninterval decrease in the degree edema and the resulting mass effect. The\nbasement of the left lateral ventricle has near completely resolved. The\nventricles are overall symmetric in size and shape. The basal cisterns are\npatent. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific, however likely due to chronic small vessel\nischemic disease. Pneumocephalus has resolved. No new or enlarging\nintracranial hemorrhage or territorial infarction is seen.\n\nThere is no evidence of acute fracture. Mild mucosal thickening in the left\nsphenoid sinus has mildly decreased. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Patient is\nstatus post bilateral lens replacements. Otherwise, the visualized portion of\nthe orbits are unremarkable. Dense calcifications in the carotid siphons are\nnoted. Soft tissue densities in the external auditory canals are nonspecific,\nthough may represent cerumen.", + "output": "1. Interval development of left temporal lobe hypodensity in the area of known\ntemporal mass with decreased degree of mass effect. Please correlate with\ninterval treatment history. Persistent focus of hyperdensity measuring 1.3 x\n1.0 cm within the left temporal lobe.\n2. No new or enlarging intracranial hemorrhage or territorial infarct." + }, + { + "input": "There is no evidence of acute major vascular territorial infarction,\nhemorrhage, edema, or large mass. The ventricles and sulci are normal in size\nand configuration. No osseous abnormalities seen. The paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of large territory infarction,hemorrhage,edema,or\nmass-effect. There is mild prominence of the ventricles and sulci suggestive\nof involutional changes.\n\nThere is no evidence of fracture. Mild opacification of the paranasal sinuses\nwith mucosal thickening. Clear mastoids, middle ear cavities", + "output": "1. No acute findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of large territorial infarction,\nhemorrhage, edema, or mass effect. There is moderate scattered white matter\nhypoattenuation compatible with chronic small vessel ischemic disease given\nthe patient's age. Possible hypodensity is seen in the right parietal lobe,\nincompletely evaluated on this exam.\n\nThere is prominence of ventricles relative to the cerebral sulci. Prominence\nof the retrocerebellar space with evidence of mass-effect on an atrophy of the\ncerebellar vermis greater than the right and left cerebellar hemispheres.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere are calcifications of the carotid siphons. The vessels of the circle of\n___ and their principal intracranial branches appear otherwise normal\nwithout stenosis, occlusion, or aneurysm formation. The dural venous sinuses\nare patent.\n\nCTA NECK:\nCalcified atherosclerotic plaque results in narrowing of the origin of the\nright vertebral artery. There is a ___ mm infundibulum at the origin of the\nleft superior cerebellar artery. The carotid and vertebral arteries and their\nmajor branches appear otherwise normal with no evidence of stenosis or\nocclusion. There is no evidence of internal carotid stenosis by NASCET\ncriteria.\n\nOTHER:\nThere are bilateral calcified pleural plaques, which can be seen in the\nsetting of prior asbestos exposure. Additionally multiple bilateral pulmonary\ncalcified granulomas are present likely relating to a history of granulomatous\ninfection. Scarring is seen at the right lung apex. There is mild paraseptal\nand centrilobular emphysema. The visualized portion of the thyroid gland is\nwithin normal limits. There is no lymphadenopathy by CT size criteria. There\nare multilevel degenerative changes of the cervical spine.", + "output": "1. No large territorial infarction, intracranial hemorrhage, edema or mass\neffect. Possible hypodensity is seen in the right parietal lobe.\n2. No evidence of dissection, aneurysm or vessel occlusion within the head and\nneck. No significant ICA stenosis by NASCET criteria.\n3. Narrowing of the origin of the right vertebral artery secondary to\ncalcified atherosclerotic plaque.\n4. Moderate white matter chronic small vessel ischemic disease.\n5. Prominence of the ventricles relative the cerebral sulci can be seen with a\ncommunicating type hydrocephalus.\n6. Findings compatible with a large retrocerebellar arachnoid cyst causing\nmass effect on and atrophy of the cerebellar vermis greater than the\ncerebellar hemispheres.\n7. Chronic pulmonary findings as detailed above." + }, + { + "input": "RIGHT:\n\nThe external auditory canal is unremarkable. The middle ear cavity is clear.\nThe ossicles, scutum, and tegmen are intact. There is tiny dehiscence of the\nsuperior semi circular canal, images 7:61, 11:85. The facial nerve follows a\nnormal course through the middle ear. There is no evidence for inner ear\ndysplasia. There is no evidence for enlarged vestibular aqueduct. The mastoids\nare clear.\n\nLEFT :\n\nThe external auditory canal is unremarkable. The middle ear cavity is clear.\nThe ossicles, scutum, and tegmen are intact. There is dehiscence of the left\nsuperior semi circular canal, images 10b:49-52, 13:133-135. The facial nerve\nfollows a normal course through the middle ear. There is no evidence for inner\near dysplasia. There is no evidence for enlarged vestibular aqueduct. The\nmastoids are clear.\n\nOTHER:\n\nThere is mild atherosclerotic calcification of the cavernous internal carotid\narteries. This exam is not technically optimized for evaluation of the\nincluded brain parenchyma, but no concerning abnormalities are seen. \nPartially visualized paranasal sinuses are well aerated. There is evidence of\nright cataract surgery.", + "output": "Bilateral superior semicircular canal dehiscence, more extensive on the left\nthan right." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass effect. Bilateral\nbasal ganglial calcifications are present. The sulci are prominent consistent\nwith age-related involutional change. However, the ventricles appear\ndisproportionately enlarged relative to the sulci.\n\nThere is an air-fluid level in the right sphenoid sinus. Otherwise, the\nvisualized portion of the paranasal sinuses, mastoid air cells,and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere are minimal atherosclerotic calcifications in the left intracranial\ninternal carotid artery. Fetal origin of the right PCA is noted. The vessels\nof the circle of ___ and their principal intracranial branches otherwise\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nIncidentally noted are scattered calcified granulomas bilaterally. Otherwise,\nthe visualized portion of the lungs are clear. There is a partially\ncalcified, 6 mm hypoattenuating nodule in the right thyroid gland (3:106). \nThere is no lymphadenopathy by CT size criteria.", + "output": "1. Mild ventriculomegaly raises the possibility of communicating\nhydrocephalus. No evidence of infarction or intracranial hemorrhage.\n2. Mild paranasal sinus disease, as above.\n3. No evidence of occlusion, stenosis, dissection or aneurysm in the great\nvessels of the head and neck." + }, + { + "input": "There is no evidence of fracture, acute large territory infarction,\nhemorrhage, edema, or mass effect. The lateral ventricles, third, and fourth\nventricle are enlarged beyond what would be expected for degree of parenchymal\natrophy and sulcal prominence.\n\nThe imaged portions of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The imaged portions of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Ventricular enlargement beyond what would be expected for degree of\nparenchymal atrophy and sulcal prominence. Normal pressure hydrocephalus\ncould be a consideration in the proper clinical context." + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass. There is mild prominence of the ventricles and sulci suggestive of\ninvolutional changes. There is no evidence of fracture. There is minimal\nmucosal thickening of the bilateral ethmoid air cells. The visualized portion\nof the other paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Mild calcification of the internal\ncarotid arteries are noted.", + "output": "No acute intracranial process." + }, + { + "input": "Multiple areas of chronic infarction/encephalomalacia are noted within the\nleft frontal lobe extending into the corona radiata and anterior limb of the\nleft internal capsule, right anterior internal capsule/basal ganglia/corona\nradiata, right occipital lobe, and right cerebellar hemisphere/right\ncerebellar peduncle. There is no evidence of acute hemorrhage, edema, mass\neffect, or acute major vascular territorial infarction. There is prominence\nof the ventricles and sulci suggestive of age advanced involutional changes,\nwith superimposed ex vacuo enlargement of the frontal horn of the right\nlateral ventricle.\n\nThere is no evidence of fracture. There is a small amount of fluid in the\nright sphenoid and left maxillary sinuses, as well as mild mucosal thickening\nin the anterior ethmoid air cells. Mastoid air cells are well aerated. There\nis fluid in the nasopharynx.", + "output": "1. No evidence for acute intracranial abnormal.\n2. Multiple chronic infarcts within the left frontal lobe extending into the\ndeep white matter, right deep white matter/basal ganglia, and right cerebellar\nhemisphere/right cerebellar peduncle.\n3. Trace fluid in the right sphenoid and left maxillary sinuses may be\nrelated to inflammation in outpatient, but presence of fluid in the\nnasopharynx suggests prolonged supine positioning as a potential etiology. \nPlease correlate with any symptoms." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Ventricles\nand sulci are age-appropriate.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Focal hypodensity in the right cerebellar hemisphere\nsuggest prior infarct. Periventricular, subcortical and deep white matter\nhypodensities are nonspecific but most likely related to chronic small vessel\nischemia. Mild atherosclerotic calcifications of the cavernous carotid\narteries are demonstrated.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable apart from bilateral lens replacements.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. Periventricular, subcortical,\nand deep white matter hypodensities are likely sequelae of chronic small\nvessel ischemic disease. Hypodensity within the left putamin is most\nconsistent with streak artifact as only seen on axial view. Evidence of the\nprior right cerebellar stroke.\n\nNo osseous abnormalities seen. Mild mucosal thickening of the ethmoidal air\ncells with air-fluid level within the left maxillary sinus with aerosolized\nsecretions is present. The paranasal sinuses, mastoid air cells, and middle\near cavities are clear. Secretions are seen within the nasopharynx. The orbits\nare unremarkable. An endotracheal tube is seen partially visualized.\nCalcification of bilateral cavernous portions of internal carotid arteries as\nwell as the left vertebral artery is noted.", + "output": "Chronic changes as described above. No acute large territorial infarction or\nhemorrhage. Of note MR is more sensitive in detection of infarcts.\n\nATTENDING NOTE: Vague hypodensity seen in the right cerebellum which may\nindicate evolving infarct. No hemorrhage." + }, + { + "input": "There is no evidence of large vascular territory\ninfarction,hemorrhage,edema,or mass effect. There is prominence of the\nventricles and sulci suggestive of involutional changes. Periventricular and\nsubcortical white matter hypodensities are nonspecific but suggest chronic\nsmall vessel ischemic changes. Hypodensity in the right thalamus likely\nrepresents prior infarct. Mild atherosclerotic calcifications of bilateral\ncavernous carotid arteries are noted.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct and pontine lesions.\n3. Atrophy, probable chronic right thalamic lesion, probable small vessel\nischemic changes, and atherosclerotic vascular disease as described." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or mass\neffect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes, likely age-related. Periventricular, subcortical, and\ndeep white matter hypodensities are nonspecific, but likely the sequelae of\nchronic small vessel ischemic changes. Dilated perivascular spaces are again\nseen involving the basal ganglia bilaterally. Mild atherosclerotic\ncalcifications of the cavernous carotid arteries.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable apart from bilateral lens replacements.", + "output": "No acute intracranial process." + }, + { + "input": "The patient is status post right frontal approach ventricular drain, in a\nsimilar position as prior. Ventricular size appears slightly decreased from\nthe prior study. Subarachnoid blood within the suprasellar cistern, extending\ninto the foramen magnum, appears mildly decreased. Intraventricular blood\nwithin the occipital horns of the lateral ventricles and third and fourth\nventricles appears grossly stable. No evidence of new hemorrhage. \nHypodensities within the left cerebellum (3:6) and right occipital lobe\n(03:14) are compatible with known infarcts, as seen on prior MRI. An infarct\nof the medial left occipital lobe is better seen on the prior MRI.\n\nThere is no evidence of fracture. Mild mucosal thickening and partial\nopacification of the ethmoid air cells. Mild mucosal thickening of the right\nmaxillary sinus. Mucous retention cyst in the left maxillary sinus, with mild\nmucosal thickening. Otherwise, the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Status post right frontal approach ventricular drain, with mild interval\ndecrease in ventricular size.\n2. Interval mild decrease in aneurysmal pattern subarachnoid hemorrhage. No\nsignificant change in intraventricular hemorrhage. No evidence of new\nhemorrhage.\n3. Redemonstrated infarcts of the left cerebellum and right occipital lobe." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nA right transfrontal approach ventriculostomy catheter is seen terminating\nwithin the third ventricle. There is worsening ventriculomegaly of the\nlateral and third ventricles compared to the most recent CT of the head.\n\nSubarachnoid hemorrhage is re-demonstrated within the suprasellar cistern\nextending into the basal cisterns, improved from the prior exam.\n\nLayering intraventricular blood products are re-demonstrated in the bilateral\noccipital horns, unchanged.\n\nThere is overall slightly worse sulcal effacement of the bilateral cerebral\nhemispheres.\n\nOld infarcts are seen in the left cerebellar hemisphere and right occipital\nlobe.\n\nThere is mild mucosal thickening of the bilateral maxillary and ethmoid\nsinuses. The mastoid air cells,and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.\n\n\nCTA HEAD:\nThere is unchanged complete occlusion of the left V4 segment with faint\npartial opacification seen distally, likely from retrograde flow from a\ndiminutive right V4 segment. The basilar artery demonstrates heterogeneous\nflow with is areas of stenosis. There is fetal type configuration of the\nbilateral PCAs with diminutive distal flow. The left posterior inferior\ncerebellar artery is not visualized.\n\n Atherosclerotic changes of the supraclinoid segment of the left internal\ncarotid artery is seen without stenosis.\n\nOtherwise, the vessels of the circle of ___ and their principal\nintracranial branches appear normal with no evidence of stenosis,\nocclusion,oraneurysm. There is fetal origin of the right PCA. A hypoplastic\nright A1 segment is seen. The dural venous sinuses are patent.", + "output": "1. Right transfrontal approach ventriculostomy catheter terminating within the\nthird ventricle. Slightly worse ventriculomegaly of the lateral and third\nventricles compared to the most recent CT of the head.\n2. Slightly worse sulcal effacement of the bilateral cerebral hemispheres.\n3. Slight improvement in the degree of subarachnoid hemorrhage within the\nsuprasellar cistern and basal cisterns.\n4. Unchanged intraventricular hemorrhage within the occipital horns.\n5. Old left cerebellar and right occipital infarcts.\n6. Unchanged complete occlusion of the left V4 segment with no flow seen in\nthe left posterior inferior cerebellar artery." + }, + { + "input": "A right frontal approach ventriculostomy catheter is in unchanged position\nwith tip terminating in the left lateral ventricle in the region of the\nforamen of ___. The ventricles and sulci appear unchanged in size with\npersistent dilatation of the bilateral occipital and temporal horns of the\nlateral ventricles. A small amount of layering intraventricular blood within\nthe occipital horns, third ventricle and fourth ventricle appear unchanged. \nArtifact from the distal left vertebral artery embolization coil limits\nevaluation of the posterior fossa and suprasellar cistern, however, no new\nfoci of hemorrhage are identified. Hypodensity in the left cerebellum and\nright occipital lobe are unchanged and consistent with known infarcts. \nAdditional infarct in the medial left occipital lobe is better appreciated on\nthe prior MRI.\n\nThere is no evidence of fracture. Aside from a mucous retention cyst in the\nleft maxillary sinus and partial opacification of the bilateral ethmoid air\ncells, the visualized portion of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Patient is status post coiling of the distal left vertebral artery.\n2. No significant change appearance of the ventricles and sulci, with\npersistent dilatation of the bilateral occipital and temporal horns of the\nlateral ventricles.\n3. Unchanged layering intraventricular hemorrhage within the bilateral\noccipital horns, third and fourth ventricles. No new foci of intracranial\nhemorrhage are identified.\n4. Unchanged left cerebellar and right occipital infarcts." + }, + { + "input": "The patient is status post left vertebral coiling, with streak artifact\nlimiting evaluation of the posterior fossa. A right approach ventriculostomy\ncatheter terminates in the foramen of ___, unchanged. There is persistent\ndilation of the lateral and third ventricles, not substantially changed, with\nintraventricular hemorrhage layering in the bilateral posterior horns and\ntrace amount of residual hemorrhage in the third ventricle. Hypodensity in\nthe left cerebellum and right occipital lobe are unchanged, consistent with\nprior infarcts. There is no evidence of acute large territorial infarction.\n\nThere is no evidence of fracture. There is mucous retention cyst in the left\nmaxillary sinus and mild mucosal thickening of the right maxillary sinus. The\nvisualized portion of the remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavitiesare essentially clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. Status post left vertebral artery coiling. Unchanged position of right\nfrontal approach ventriculostomy catheter.\n2. Persistent dilation of the lateral and third ventricles, with layering\nintraventricular hemorrhage in the posterior horns and trace amount of\nhemorrhage in the third ventricle, similar to prior." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nSubacute left inferior cerebellar infarcts, similar.\nVP shunt in place. Mild hydrocephalus, stable. Small left and minimal right\ninterventricular hemorrhage in the occipital horns, decreased.\n\nPossible tiny subdural hemorrhage extends along the right posterior cerebral\nfalx and right tentorium, stable compared to ___.\n\nNo new areas of hemorrhage. Subtle right occipital and left cerebellar chronic\ninfarcts.\n\nMild mucosal thickening of the ethmoid and maxillary sinuses. Small mucous\nretention cyst in the left maxillary sinus. Clear mastoid air cells. \nUnremarkable intraorbital contents.\n\nCTA HEAD:\nPostprocedural changes of coil embolization of the left V4 fusiform aneurysm. \nThe left ___ is not visualized.\n\nSmall caliber distal basilar artery,, left PCA, right P1, PCOM segments.\nModerately narrowed right paraclinoid ICA, similar. Moderate narrowing right\nICA terminus, similar. Moderate narrowing left M1 segment, similar. Areas of\nmild-to-moderate narrowing bilateral M 2, M3 segments, similar. Moderate\nnarrowing left supraclinoid ICA, similar. Narrowed A1, A2 segments, similar.\n\nRight ICA terminus and left M1 narrowing is mildly worsened since ___, otherwise no change in the vessels.\n\nVascular narrowings are new since ___, findings consistent with\nvasospasm.\n\n\nCTA NECK:\nStandard 3 vessel aortic arch anatomy. There is diminished contrast\nopacification the left vertebral artery involving distal segment V2, V3 and\nleft V4, essentially no contrast opacification of the intradural left V4\nsegment. Coil embolization left V4 aneurysm.\n\n Artifact versus short-segment dissection very proximal left common carotid\nartery, series 3, image 43.\nNormal contrast opacification of the bilateral common carotid and internal\narteries. No evidence of internal carotid artery stenosis by NASCET criteria.\n\nOTHER:\nPICC line. Nodular centrilobular opacities posterior right upper lobe, likely\nrepresents aspiration or infection.\nNo lymphadenopathy by CT size criteria. No suspicious osteolytic or\nosteoblastic lesions.", + "output": "1. Moderate intracranial vasospasm anterior, posterior circulation, mildly\nworsened since ___, new since ___.\n2. Artifact versus short-segment dissection proximal left common carotid\nartery.\n3. Minimal residual intraventricular and subdural hemorrhage.\n4. Stable mild hydrocephalus.\n5. Small area right upper lobe nodular opacities, likely aspiration or\ninfection.\n6. Coil embolization left V4 segment aneurysm. Peripheral very distal left V2\nsegment, occluded V3 and V4 segments, ___.\n7. Stable subacute left cerebellar infarct.\n8. No definite new infarct or edema." + }, + { + "input": "A right frontal approach VP shunt terminates in the third ventricle, with\npostsurgical changes noted in the adjacent scalp. Small volume acute\nhemorrhage is seen in the right lateral ventricle (02:19). Dependent\nhemorrhage products are again seen in the bilateral occipital horns of the\nlateral ventricles. The ventricles are unchanged in size without evidence of\nhydrocephalus.\n\nThe hypodensities in the inferior left cerebellar hemisphere and right\noccipital lobe are unchanged and likely represent chronic infarcts. There is\nno evidence of large territorial infarction, edema,or mass-effect.\n\nOpacification of a few ethmoid air cells and a small right mucous retention\ncyst in the left maxillary sinus are unchanged. The visualized portion of the\nmastoid air cells and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.\n\nEmbolization coils are again noted in the left V4 vertebral artery segment.", + "output": "1. Right frontal approach VP shunt terminates in the third ventricle.\n2. New small volume acute hemorrhage in the right lateral ventricle. \nDependent hemorrhage products are again noted in the bilateral occipital horns\nof the lateral ventricles.\n3. No significant change in the size of the ventricles." + }, + { + "input": "Redemonstration of a right frontal approach VP shunt catheter with tip\nterminating in the third ventricle. Small volume of acute hemorrhage within\nthe right lateral ventricle remains similar in appearance to prior study\n(02:20). Blood products are again seen layering dependently within the\nbilateral occipital horns of the lateral ventricles. The ventricles remain\nunchanged in size without evidence of hydrocephalus. No evidence of acute\nlarge territorial infarction, edema, or mass. Hypodensities within the\ninferior left cerebellum and right occipital lobe are unchanged, likely\nconsistent with chronic infarcts.\n\nPostsurgical changes are again demonstrated within the right frontoparietal\nscalp. Small mucous retention cyst within the left maxillary sinus. Mild\nthickening of the bilateral ethmoid air cells. The visualized portion of the\nremaining paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable. Embolization\ncoils are again demonstrated in the left V4 vertebral artery segment.", + "output": "1. Re-demonstration of right frontal approach VP shunt catheter with tip\nterminating in the third ventricle, with similar appearance of small volume\nhemorrhage within the right lateral ventricle and layering blood products\nwithin the bilateral occipital horns of the lateral ventricles. Mild\nprominence of temporal horns is seen as before.\n2. No evidence of new intracranial hemorrhage or large territorial infarction." + }, + { + "input": "Right frontal approach VP catheter terminates in the third ventricle similar\nto prior. Interval improvement in layering intraventricular hemorrhage in the\nleft lateral ventricle. Interval evolution of right lateral ventricle\nhemorrhage, similar in extent to prior. No new foci of hemorrhage. The size\nand configuration of the ventricles are unchanged compared to prior. There is\nno evidence of acute large territorial infarction, midline shift, or mass\neffect.\n\nPatient is status post embolization coiling of the left V4 vertebral artery\nwith adjacent streak artifact.\n\nLeft cerebellum hypodensities are not as well visualized compared to prior\ngiven streak artifact from the aneurysm clip.\n\nThere is no evidence of fracture. Skin staples along the right frontoparietal\nscalp are again demonstrated. Small mucous retention cysts are seen in the\nleft maxillary sinus similar to prior. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Right frontal approach VP shunt catheter terminates in the third ventricle,\nsimilar to prior. Size and configuration of the ventricles are similar to\nprior. No new foci of hemorrhage." + }, + { + "input": "Posterior fossa aneurysm coiling. VP shunt via right frontal burr hole, tip\nin the anterosuperior third ventricle. Mildly prominent ventricular system,\ntemporal horns, similar to prior. Chronic small cerebellar infarct, stable. \nNo new hemorrhage, no infarct, no mass. Clear mastoids. Mucosal retention\ncyst left maxillary sinus. Normal bones, orbits.", + "output": "Mildly dilated ventricular system, stable." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere has been increase in the amount of subarachnoid hemorrhage centered in\nthe cervicomedullary junction with extension into the basal and suprasellar\ncisterns.\n\nThere is new intraventricular extension with a small amount of blood layering\nin the occipital horns of the bilateral ventricle and blood seen within the\nfourth ventricle, most likely due to redistribution. There has been interval\nincrease in size of the temporal horns and diameter of the third ventricle\nwhich now measures approximately 1.3 cm from previously 5 mm, indicative of\ndeveloping obstructive hydrocephalus.\n\nNew focus of hypodensity in the inferior left cerebellar hemisphere is\nconsistent with ___ infarction (series 2, image 4).\n\nThere is mucosal thickening throughout the paranasal sinuses. The mastoid air\ncells appear clear.\nThe patient is intubated.\n\nCTA HEAD:\nThe previously identified dissecting aneurysm at the left V4 junction is no\nlonger appreciated, suggestive of interval aneurysm thrombosis. There is new\nocclusion of the left vertebral artery and its proximal V4 segment. The\ndistal V4 segment is partially visualized, likely from retrograde flow. The\nleft ___ is faintly visualized.\n\nOtherwise, the right vertebral artery and vertebrobasilar junction appear\nunremarkable. Mild irregularity along the basilar artery and left PCA may\nrepresent vasospasm. The posterior circulation is otherwise unremarkable.\n\nThe anterior circulation is unremarkable without evidence of high-grade\nstenosis, occlusion or aneurysm formation greater than 3 mm. The dural venous\nsinuses are patent.", + "output": "1. Increased amount of subarachnoid hemorrhage centered in the\ncervicomedullary junction with extension into the basilar and suprasellar\ncisterns.\n2. New intraventricular extension of the bleed, likely due to redistribution\nwith interval increase in size of the temporal horns and diameter of the third\nventricle, indicative of developing obstructive hydrocephalus.\n3. New focus of hypodensity in the left inferior cerebellar hemisphere,\nconsistent with a left ___ infarction.\n4. Interval thrombosis of the previously identified dissecting aneurysm along\nthe left V4 segment with occlusion of the left vertebral artery.\n5. Mild irregularity along the basilar artery and left PCA may represent\nvasospasm." + }, + { + "input": "There has been interval placement of a right frontal approach ventricular\ndrain which appears to terminate in the floor of the left lateral ventricle. \nThere is no evidence of hemorrhage along the drain tract. The overall size\nand morphology of the ventricular system is stable from prior. There is a\nstable aneurysmal pattern of subarachnoid hemorrhage with extension into the\nsuperior cerebellar cistern, prepontine cistern and foramen magnum. Stable\nblood products are again seen layering within the occipital horns of the\nlateral ventricles within the third and fourth ventricle. No evidence of\nacute large territorial interval infarction.\n\nNo acute fracture. Extensive thickening is seen in the anterior ethmoidal air\ncells. Thickening and mucous retention cysts are seen in the left greater\nthan right maxillary sinuses. Mastoid air cells and middle ear cavities are\nclear. Orbits are unremarkable.", + "output": "1. Interval placement of a right frontal approach ventricular drain. Overall\nsize and morphology of the ventricular system is stable from prior. No\nevidence of hemorrhage along the drain tract.\n2. Stable aneurysmal pattern of subarachnoid blood within the superior\ncerebellar cistern, prepontine cistern and foramina magnum. There is\ninterventricular extension within the occipital horns of lateral ventricles,\nthird and fourth ventricles." + }, + { + "input": "Head CT:\n\nThere is no acute intracranial hemorrhage, mass effect, shift of normally\nmidline structures are hydrocephalus.\nNo obvious large hypodense focus is noted to suggest acute major territorial\ninfarct. However, assessment for subtle ischemic changes can be limited on\nnoncontrast CT.\nThe ventricles, and extra-axial CSF spaces on the sulci are unremarkable for\nthe age. Mild asymmetry in the size of the lateral ventricles, the right being\nslightly larger than the left can be developmental.\nNo suspicious osseous lesions are noted.\nThe imaged paranasal sinuses and the mastoid air cells are grossly clear.\nThe soft tissues of the scalp are unremarkable.\n\nHead and neck CTA:\n\nThe origin of the arch vessels are patent.\nCommon origin of the brachiocephalic trunk and the left common carotid artery.\nCalcifications are noted in the right common carotid bifurcation, extending\ninto the right proximal cervical internal carotid artery, with less than 50%\nnarrowing.\nMinimal calcifications are noted at the left common carotid bifurcation,\nextending into the left proximal cervical internal carotid artery.\nNo focal flow-limiting stenosis or occlusion or aneurysm noted.\nThe cervical internal carotid arteries are tortuous and medial in course\nindenting the lateral aspects of the oropharynx, right more than left.\n\nThe distal cervical internal carotid arteries measure 5 mm in diameter on the\nleft and 5 mm in diameter on the right.\n\nThe major intracranial arteries of the anterior and posterior circulation are\npatent, without focal flow-limiting stenosis, occlusion or obvious aneurysm.\nContour irregularity and calcifications noted in the cavernous carotid\nsegments related to atherosclerotic disease.\n\nCT NECK:\n\nA few small nodes are noted in both sides of the neck, not significantly\nenlarged by size criteria.\nMild fullness in the left piriform sinus.\nSphenoid sinus septations insert on the carotid groove on the right and medial\nto the left carotid groove.\nMild fullness in the left pyriform sinus and left fossa of Rosenmller.\nThyroid is unremarkable.\nParotid and submandibular glands are unremarkable.\nMultilevel, multifactorial degenerative changes are noted, with multilevel\nmild to moderate foraminal narrowing.\nImage lung apices are unremarkable.", + "output": "1. No acute intracranial hemorrhage or mass effect. No obvious major infarct\n2. Patent major intra and extracranial arteries as described above, without\nfocal flow-limiting stenosis, occlusion or aneurysm more than 3 mm.\nIf this is continued clinical concern for infarction or vascular abnormality,\nMRI can be considered if not contraindicated.\n3. Mild fullness in the left pyriform sinus and left fossa of Rosenmller.\nCorrelate with direct examn.\n4. Multilevel, multifactorial degenerative changes are noted, with multilevel\nmild to moderate foraminal narrowing." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of hemorrhage, edema, mass effect, or acute vascular\nterritorial infarction. The ventricles and sulci are age-appropriate.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is multifocal calcified atherosclerotic plaque along the cavernous and\nparaclinoid segments of the internal carotid arteries bilaterally without\nflow-limiting stenosis. The vessels of the circle of ___ and their\nprincipal intracranial branches otherwise appear normal without stenosis,\nocclusion, or aneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is a two vessel aortic arch with the left common carotid and innominate\narteries arising from a common trunk. Mixed calcified and soft plaque at the\nright carotid bifurcation extending into the proximal right internal carotid\nartery results in approximately 25% luminal narrowing by NASCET criteria. \nMild atherosclerotic plaque is also noted at the left carotid bifurcation\nwithout significant internal carotid artery stenosis NASCET criteria. The\nvertebral arteries are within normal limits.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. Scattered subcentimeter nonspecific\nlymph nodes are noted throughout the neck bilaterally, without definite\nenlargement by CT size criteria.", + "output": "1. Dental amalgam streak artifact limits study.\n2. No hemorrhage or acute infarction.\n3. Scattered atherosclerotic calcifications without definite occlusion of\ncircle of ___, as described.\n4. Mixed soft and calcified plaque at the right carotid bifurcation resulting\nin 25% narrowing of the proximal right internal carotid artery by NASCET\ncriteria. Atherosclerotic plaque at the left carotid bifurcation does not\nresult in significant narrowing of the internal carotid artery." + }, + { + "input": "There is no evidence of acute hemorrhage mass effect midline shift or\nhydrocephalus. Gray-white matter differentiation is maintained. Chronic left\noccipital infarct is noted.\n\nThere are retained secretions within the nasopharynx. No skull fracture is\nseen.", + "output": "No acute intracranial abnormalities are identified." + }, + { + "input": "There is no evidence of acute major vascular territory\ninfarction,hemorrhage,edema, or mass. The ventricles and sulci are stable in\nsize and configuration. Mild periventricular and subcortical white matter\nhypodensities are nonspecific but likely due to chronic sequela of\nsmall-vessel ischemic disease. Atherosclerotic vascular calcifications are\nnoted of bilateral vertebral and cavernous portions of internal carotid\narteries.\n\nThere is no evidence of fracture. The visualized portion of the mastoid air\ncells, and middle ear cavities are clear. Patient is status post lens\nreplacements. Soft tissue densities are noted within bilateral external\nauditory canals which may represent cerumen. Minimal bilateral ethmoid air\ncell mucosal thickening is present.", + "output": "1. No acute intracranial abnormalities.\n2. Trace paranasal sinus disease as described." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, or acute major\nvascular territorial infarction. Extensive periventricular, deep, and\nsubcortical white matter hypodensities are again noted, nonspecific but likely\nsequela of chronic small vessel ischemic disease in this age group. There is\nmild to moderate global parenchymal volume loss with associated prominence of\nthe ventricles and sulci, progressed since ___ but likely age-related.\n\nNo evidence for a fracture. Mild mucosal thickening in the ethmoid air cells.\nSmall mucous retention cyst versus polypoid mucosal thickening in the right\nsphenoid sinus along the anterior wall. Right mastoid air cells and partially\nvisualized left mastoid air cells appear well-aerated. The orbits appear\nunremarkable.", + "output": "No evidence for acute intracranial abnormalities." + }, + { + "input": "An ill-defined, calcified lesion is seen within the right skullbase at the\nlevel of the jugular foramen, causing mild expansion of the foramen (03:12). \nThere is sclerosis of the petrous apex and temporal bone surrounding the\njugular foramen. The lesion also appears to extend into the right hypoglossal\ncanal and right carotid space, encasing the right internal carotid artery. \nThere is no adjacent bone erosion or findings suggestive of an aggressive\nprocess. The right internal carotid artery appears grossly patent.\n\nThere is no evidence of acute, large territorial infarction, hemorrhage, or\nedema. A focal hypodensity within the right caudate is likely a chronic\ninfarct. The ventricles and sulci are mildly prominent, suggestive of\ninvolutional change. Atherosclerotic calcifications of the bilateral\ncavernous carotid arteries.\n\nMild mucosal thickening of the bilateral maxillary sinuses. Otherwise, the\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. Density within the left greater than right external\nauditory canals likely reflects cerumen. The visualized portion of the orbits\nare unremarkable.", + "output": "1. Ill-defined, calcified lesion of the right skullbase, at the level of the\njugular foramen, also involving the right hypoglossal canal and right upper\ncarotid space, without definite aggressive features, concerning for a mass,\nbetter assessed on the concurrent MRI. Differential considerations may\ninclude a paraganglioma or jugular foramen meningioma. Please refer to same\nday MR ___ for further details.\n2. No evidence of acute hemorrhage or large territorial infarction.\n3. Chronic infarct of the right caudate." + }, + { + "input": "Right:\nCentered in the right occipital bone, adjacent to the right occipital mastoid\nsuture, there is an expansile mixed lytic and sclerotic lesion which extends\nmedially to the lateral aspect of the clivus and inferiorly into the right\noccipital condyle. There is also hyperostosis surrounding the petrooccipital\nfissure and right hypoglossal canal resulting in mild narrowing. A small\namount of bone material is seen just superiorly to the entrance to the\noccipital canal with a small gap between the presumed normal petrous bone.\nAt the level of the jugular foramen, there is calcification which extends\nalong the expected path of the jugular vein. More areas of coarse\ncalcification are identified extending anteriorly and inferiorly into the soft\ntissues, up to the level of the internal carotid artery. The right internal\ncarotid artery is encased by the lesion. The luminal caliber of the vessel is\nhowever preserved.\nPosteriorly, the mass remains at first medially to the styloid process and\nthen continues laterally up to the level of the anterior arch and right\ntransverse process of the C1 vertebral body. There is no involvement of the\nC1 vertebral body. The mass extends further into the soft tissues which is\noutside of the field of view of the temporal bone exam.\n\nThe right transverse sinus and proximal portion of the sigmoid sinuses appear\npatent. The remainder of the right sigmoid sinus and right internal jugular\nvein is not well visualized and patency cannot be confirmed.\n\nThe middle ear cavity is clear. The ossicles and tegmen are intact. There is\nno evidence for enlarged vestibular aqueduct or superior semicircular canal\ndehiscence. The facial nerve follows a normal course through the middle ear.\nThere is no evidence for inner ear dysplasia.\nThere is a small amount of soft tissue density in the external auditory canal\nwhich most likely represents cerumen.\n\nLeft:\nThe middle ear cavity is clear. The ossicles and tegmen are intact. There is\nno evidence for enlarged vestibular aqueduct or superior semicircular canal\ndehiscence. The facial nerve follows a normal course through the middle ear.\nThere is no evidence for inner ear dysplasia. The mastoids are clear. There is\nno abnormal enhancement on post contrast imaging.\nThere is a small amount of soft tissue density in the external auditory canal\nwhich most likely represents cerumen.", + "output": "1. Mixed lytic and sclerotic lesion centered in the right occipital bone with\nmedial extension to the clivus and petrooccipital fissure as well as\ninvolvement of the right hypoglossal canal as detailed above and inferior\nextension into the right occipital condyle. Calcific material is seen in the\nright jugular foramen and along the expected path of the proximal right\ninternal jugular vein.\n2. A partially calcified soft tissue component of the mass extends anteriorly\nand inferiorly from the skull base at the level of the jugular foramen to\nright carotid artery with encasement of the vessel but preserved luminal\ncaliber. Posteriorly and laterally, the mass extends behind the right styloid\nprocess to the level of the right anterior arch and transverse process of the\nC1 vertebral body.\n3. The soft tissue component extends beyond the field of view and is\nincompletely evaluated with this CT. Differential considerations for this\nmass includes a jugular foramen meningioma or skullbase chondrosarcoma. MRI\nof the neck with and without contrast is recommended for further evaluation.\n4. Limited evaluation for patency of the right sigmoid sinus and internal\njugular vein. This can further be assessed on the contrast-enhanced MRI of\nthe neck.\n5. Otherwise, unremarkable CT of the right temporal bone with normal\nappearance of the middle ear cavity and internal auditory canal structures.\n6. Unremarkable CT of the left temporal bone.\n\nRECOMMENDATION(S): MRI of the neck with and without contrast is recommended\nfor further evaluation of the soft tissue component of the right skull base\nmass." + }, + { + "input": "Again seen is extensive calcified mass filling right jugular foramen,\nextending below skullbase along the right carotid sheath, pushing right ICA\nanteriorly. High right ICA is encased by approximately 180 degrees by the\nmass. No definite extension into the carotid canal. Right parapharyngeal\nspaces post anteriorly. No pterygoid involvement. No definite invasion of\nthe prevertebral musculature. Extensive areas of calcification extending fill\nboth partial ossicular send partial nervosa of the right jugular foramen,\nright hypoglossal canal. Areas of diffuse sclerosis involving right occipital\ncondyle, portion of the petrous segment right temporal bone, right lateral\nclivus, without destruction. Wide band of sclerosis at the jugular patent,\nwithout erosion or destruction. There is no destruction at the petroclival\nsynchondrosis or at the occipital mastoid synchondrosis.. The ride in bone\nextends to the level of the IAC and posterior to it, IAC's not obliterated. \nMass is situated medial, anterior and posterior to the styloid process,\nlateral to the is C1 lateral mass, extending to the mid C2 level. No osseous\ndestruction at the jugular foramen. No middle ear mass. No labyrinthine\ninvolvement. No vertebral artery involvement..\n\nOverall, mass measures 4.5 cm by 3.6 cm x 1.4 cm. The there is very little,\nif any enhancement, judging by noncontrast comparison head CT ___.\n\nDistal sigmoid sinus, jugular vein of the skullbase and upper neck are not\nopacified. Jugular vein in the low neck is opacified. There few vascular\ncollaterals near by, no definite arterial supply is visible to the mass. \nRight occipital artery is displaced laterally by the mass.\n\nDifferential considerations include heavily calcified meningioma, calcifying\npseudoneoplasm of the neuroaxis, less likely chondroblastoma. Degree of\ncalcification, very dark T2 signal on comparison MRI, very little enhancement\nand lack of bone destruction strongly argues against paraganglioma. Mass is\nnot centered at the synchondrosis, no bone destruction, very dark T2 signal\nargue against chondrosarcoma.\n\nOther findings:\nMild right paramedian position of the true vocal cord, enlarged right piriform\nsinus, consider vocal cord paresis.\nNo adenopathy.\n\nMild atherosclerotic calcifications at the common carotid artery bifurcations.\nOtherwise, the carotidandvertebral arteries and their major branches are\npatent. There is no evidence of internal carotid artery stenosis by NASCET\ncriteria. No evidence for dissection.\n\nMild left greater than right biapical scarring. No suspicious pulmonary\nnodules. Moderate to severe multilevel degenerative changes of the visualized\nspine, most pronounced at C5-C6 and C6-C7. There is mild mucosal thickening\nof the visualized maxillary sinuses. Small thyroid nodules, largest measures\n1.3 cm.", + "output": "Heavily calcified mass centered at right jugular foramen, extends into the\ncarotid space. Very little, if any, enhancement. Differential considerations\ninclude heavily calcified meningioma, calcifying pseudoneoplasm of the\nneuroaxis, unlikely chondroblastoma. Combined MR and CT appearance is not\nconsistent with paraganglioma, or chondrosarcoma.\nFollow-up imaging to ensure stability is recommended.\nConsider right vocal cord paresis.\nPatent vasculature.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or older.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. Prominence of\nthe ventricles and sulci, likely represent age related change. \nPeriventricular and deep white matter hypodensities are nonspecific but likely\nrepresent sequela of chronic small vessel ischemic disease. Tiny lacunar old\ninfarcts are noted in the left basal ganglia.\n\nThere is mild mucosal thickening in the left maxillary sinus. Otherwise, the\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is a 3 mm aneurysm arising from the posterior aspect of the distal right\ninternal carotid artery immediately inferior to the origin of the right MCA\n(series 3, image 242), apparently at the origin of the right posterior\ncommunicating artery. Vascular arteriosclerotic calcifications are present\nthe carotid siphons, with no evidence of flow stenotic lesions in the anterior\nand middle cerebral arteries, the posterior circulation demonstrates minimal\nirregular contour of the basilar artery suggesting arteriosclerotic disease\nwith no evidence of significant stenosis, both posterior cerebral arteries are\npatent.\n\nCTA NECK:\nThere is mild-to-moderate atherosclerotic stenosis at the origin of the left\nvertebral artery (series 3, image 80) and in the mid course of the V4 segment\n(series 3, image 212). There is multifocal mild to moderate <50% narrowing at\nthe origin of the left internal carotid artery by NASCET criteria (series 3,\nimage 148, 164), with a combination of soft plaque and calcified plaque\nmaterial. Punctate arteriosclerotic calcification is identified at the right\ncervical carotid bifurcation with no evidence of stenosis by NASCET criteria.\n\nOtherwise, the carotid and vertebral arteries and their major branches appear\nnormal with no evidence of stenosis or occlusion.\n\nOTHER:\nThere is mild segmental ground-glass opacity in the periphery of the lung\napices, bilaterally (series 3, image 35-13).\n\nMultiple nodules are noted in the left lobe of thyroid measuring up to 13 mm,\nsimilar to ___.\n\n Periapical lucencies involving a left anterior mandibular molar and two\nmaxillary incisors (series 3, image 162, 182).", + "output": "1. No acute intracranial abnormality. Tiny old lacunar infarcts are noted in\nthe left basal ganglia.\n2. Multifocal mild to moderate atherosclerotic narrowing involving the left\nvertebral artery and the left internal carotid artery, as detailed above. \nThere is a combination of soft plaque and calcific plaque at the left carotid\nsiphon. Punctate arteriosclerotic calcification at the right cervical\nbifurcation with no evidence of stenosis.\n3. 3 mm aneurysm arising from the posterior aspect of the distal right\ninternal carotid artery immediately inferior to the origin of the right MCA,\napparently at the origin of the right posterior communicating artery.\n4. Bilateral, mild segmental ground-glass opacities in the periphery the lung\napices, likely infectious or inflammatory.\n5. Thyroid nodules, grossly similar to ___. Consider thyroid\nultrasound if not been previously obtained.\n6. Maxillary and mandibular periapical lucencies. Clinical inspection is\nrecommended.\n\nNOTIFICATION: An e-mail was sent by ___ to the ED QA nurses on ___ at 11:45 approximately 5 minutes after the findings were\ndiscovered." + }, + { + "input": "HEAD CT:\n\nThere is no evidence of intra or extra-axial mass effect, acute hemorrhage or\ninfarct. Sulci, ventricles and cisterns are within expected limits. The\nparanasal sinuses are essentially clear. The mastoid air cells and middle ear\ncavities are well pneumatized and clear. Soft tissue density within the\nexternal auditory canals are noted, most likely representing cerumen. There is\nminimal asymmetric subcutaneous thickening of the right inferior medial aspect\nof the periorbital region, without evidence of surrounding inflammatory\nstranding or fluid collection. In addition, there is no evidence of postseptal\ninflammatory stranding. The globes are unremarkable.\n\nThere is ground-glass expansion of the skullbase extending up to the sphenoid\nwings and zygomatic arches, compatible with fibrous dysplasia.\n\nHEAD AND NECK CTA:\n\nThere is a normal 3 vessel arch. The carotid and vertebral arteries and their\nmajor branches are patent with no evidence of stenoses. The distal cervical\ninternal carotid arteries measure 4 mm in diameter on the left and 4 mm in\ndiameter on the right. The proximal cervical internal carotid arteries measure\n7 mm in diameter on the left and 8 mm in diameter on the right.\nThere is no significant stenosis of the extracranial internal carotid arteries\nby NASCET criteria.\nThe intracranial ICA, ACA, MCA and their major branches are unremarkable. The\nleft vertebral artery is dominant. Otherwise the posterior circulation is also\nunremarkable. There is no evidence of aneurysm. The dural venous sinuses are\npatent.\nSlightly prominent venous tributaries in the middle cranial fossae\nperipherally, right slightly more than left, question variant. (se 3, im\n282)\n\nCervical spine: Disc and vertebral body heights are maintained.\nNo evidence of acute fracture or subluxation.\n\nOther: The lung apices are clear. There is mild prominence of the adenoids,\nwithin expected limits for the patient's age. Calcifications in the palatine\ntonsils are noted, which may represent tonsilliths, potentially sequela of\nprior infection. There are prominent cervical lymph nodes, all nonpathologic\nby CT size criteria and demonstrating fatty hilum. The aerodigestive tract is\nunremarkable. The thyroid gland is also unremarkable.", + "output": "1. No evidence of flow-limiting stenosis, occlusion dissection or aneurysm\nmore than 3 mm in the neck or head.\n2. No fracture or acute subluxation of the cervical spine.\n3. Diffuse osseous ground-glass expansion of the skull base, extending to the\nsphenoid and zygomatic arches, compatible with fibrous dysplasia.\n4. No evidence of acute infarct or intracranial hemorrhage.\n5. Slightly prominent venous tributaries in the middle cranial fossae\nperipherally, right slightly more than left, question variant. However,\nconsider followup in a few months to assess for interval change" + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Scattered periventricular and\nsubcortical white matter hypodensities are likely sequela of chronic small\nvessel disease. Gray-white matter differentiation is preserved. Ventricles\nand sulci are prominent compatible with global volume loss. Basilar cisterns\nare patent.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarhemorrhage, edema, or mass. There are multiple\nchronic lacune is in the anterior limb and genu of the right internal capsule\nas well as the external capsule. There is mild hypodensity of the\nperiventricular white matter also suggesting chronic small vessel ischemia. \nThere is no evidence of recent infarction.\nDense cavernous carotid arterial calcification is noted bilaterally. The\nventricles and sulci are mildly enlarged in an atrophic pattern, well within\nthe range expected for age..\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Atrophy and chronic lacunes.\n2. No evidence of hemorrhage or recent infarction.." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nThere is an area of encephalomalacia in the left frontal lobe (2:16).\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Densities within the bilateral\nexternal auditory canals are likely cerumen.", + "output": "1. No acute intracranial hemorrhage.\n2. Nonspecific left frontal encephalomalacia. Finding may represent chronic\ninfarct. Recommend clinical correlation. If clinically indicated, consider\nbrain MRI for further evaluation.\n3. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema,or mass effect. There\nis prominence of the ventricles and sulci suggestive of involutional changes. \nPeriventricular and deep white matter hypodensities are nonspecific but likely\nrepresent sequela of chronic small vessel ischemic disease and appear\nunchanged from ___.\n\nThere is no evidence of fracture. There is mild mucosal thickening in the\nmaxillary sinuses, bilaterally otherwise, the visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. \nDeformity of the left globe is similar to prior.", + "output": "No acute intracranial abnormality.\n\nDeformity of the left globe is similar to prior." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular, subcortical and deep white matter\nhypodensities are nonspecific, but likely reflect the sequela of chronic\nmicrovascular infarction. Mild atherosclerotic calcifications of the\ncavernous carotid arteries are noted.\n\nThere is no evidence of fracture. Mild mucosal thickening is seen within the\nethmoid air cells bilaterally as well as the left maxillary sinus with mild\nleft periapical lucency about a left maxillary molar tooth. The visualized\nportion of the remaining paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable\napart from prior left lens resection.", + "output": "1. No acute intracranial abnormality. Please note that MRI would be more\nsensitive for detection of acute infarction.\n2. Chronic small vessel ischemic changes and moderate global atrophy." + }, + { + "input": "The carotidandvertebral arteries and their major branches are patent with no\nevidence of stenoses or dissection. There is no significant stenosis of\neither internal carotid artery by NASCET criteria. The left vertebral artery\noriginates directly from the aorta, a normal variant.\n\nA 5 mm hypodense nodule is noted within the right thyroid lobe, for which no\nspecific follow up is recommended in a patient of this age unless otherwise\nindicated (ACR guidelines provided below). There is a partially imaged 4 mm\ncalcified granuloma within the left upper lobe. Otherwise, the visualized\nlungs appear clear. There is no lymphadenopathy by CT criteria.\n\nThe cervical spine demonstrates mild to moderate multilevel degenerative\nchanges without evidence for acute fracture or subluxation.", + "output": "1. The carotidandvertebral arteries and their major branches are patent with\nno evidence of stenoses, dissection or aneurysm formation.\n2. Evaluation of the cervical spine demonstrates mild to moderate multilevel\ndegenerative changes without evidence of acute fracture or subluxation.\n\nNOTIFICATION: Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "An aneurysm clip is identified in the suprasellar region. There is no acute\nhemorrhage mass effect midline shift or hydrocephalus. Ventricles are normal\nin size. Bone images are unremarkable except for postoperative changes.\n\nThe visualized paranasal sinuses are clear. No skull fracture is seen.", + "output": "No acute abnormalities are identified. No hydrocephalus or hemorrhage. \nPostoperative changes identified." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD: A diminutive right A1 anterior cerebral artery is seen. There is a\n1 cm TR x 0.6 cm AP inferiorly oriented multi lobulated outpouching off of the\nanterior communicating artery with the left A2 anterior cerebral artery\narising from the lateral aspect of the aneurysm sac. In addition, there is a\n0.3 cm inferiorly oriented outpouching off of the terminal right M1 MCA, best\nseen on series 6, image 62 and series 750, image 25 . Otherwise, the vessels\nof the circle of ___ and their principal intracranial branches appear\nnormal with no evidence of stenosis or occlusion. The dural venous sinuses are\npatent.", + "output": "1. No intracranial hemorrhage.\n2. 1 cm multi lobulated inferiorly oriented aneurysm arising from the anterior\ncommunicating artery with the left A2 anterior cerebral artery arising from\nthe lateral aspect of the aneurysm sac.\n3. A 0.3 cm inferiorly oriented outpouching off of the terminal right M1 MCA\nwith the inferior M2 MCA brain most consistent with a small aneurysm." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nEncephalomalacia in the right thalamus with hypoattenuation of the right\nexternal capsule, right internal capsule, corona radiata, and centrum\nsemiovale are likely related to prior hemorrhage. There is no evidence of no\nevidence of acute infarction, hemorrhage, edema, or mass. Confluent\nhypoattenuation in the periventricular, subcortical, and deep white matter are\nnonspecific, but likely represent the sequela of chronic small vessel ischemic\ndisease. There is a dystrophic calcification in the right frontal\nperiventricular white matter. The ventricles and sulci are normal in size and\nconfiguration.\n\nThe right maxillary sinus contains a small mucous retention cyst. There is\nmild mucosal thickening in the left frontal ethmoidal recess. A right\nparietal burr hole is related to prior ventriculostomy catheter placement. \nThe visualized portion of the orbits are unremarkable. A 1.3 cm right\ntemporal scalp skin nevus is unchanged.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nare patent without stenosis, occlusion, or aneurysm formation. The bilateral\nA2, A3, M2, and M3 segments are limited by motion. There are mild\natherosclerotic calcifications of the bilateral cavernous and supra clinoid\ninternal carotid arteries.The dural venous sinuses are patent.\n\nCTA NECK:\nThere is a normal 3 vessel branching pattern of the aortic arch. The origins\nof the great vessels are patent. The bilateral common and external carotid\narteries are patent.\n\nThere is mild calcified and noncalcified plaque at the bilateral carotid\nbifurcations with no evidence of internal carotid artery stenosis by NASCET\ncriteria. Both vertebral arteries, including their origins, are patent.\n\nOTHER:\nThere is bibasilar atelectasis. A 3 mm hypodense nodule in the left thyroid\nlobe requires no further follow-up according to the ___ College of\nRadiology guidelines. There is no lymphadenopathy by CT size criteria. Mild\nto moderate multilevel degenerative changes are present throughout the\ncervical spine, consistent with spondylosis, more significant at C5/C6 and\nC6/C7 levels.", + "output": "1. Patent circle of ___.\n2. Patent vasculature in the neck with no evidence of internal carotid artery\nstenosis by NASCET criteria.\n3. No acute intracranial abnormality.\n4. Encephalomalacia in the right thalamus and hypoattenuation in the right\nexternal and internal capsules as well as in the right corona radiata and\ncentrum semiovale, likely related to prior, remote hemorrhage." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. Trace right pleural effusion. \nThe visualized portion of the thyroid gland is within normal limits. There is\nno lymphadenopathy by CT size criteria.", + "output": "Normal head and neck CTA.\nTrace right pleural effusion" + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. The\nventricles are normal in size, however notable for anatomical variation\nconsistent with septum cavum pellucidum et vergae, otherwise, the sulci are\nnormal in size and configuration for patient age.\n\nThere is a large scalp hematoma centered on the left frontal bone with\nextension over the superior orbit and involving the preseptal soft tissues. \nThere is no evidence of associated fracture. The nasal bones are intact. The\nsuperior orbital rim is intact. There is mild thickening in the anterior\nethmoidal air cells however the sphenoid sinuses and maxillary sinuses are\nclear. The mastoid air cells and middle ear cavities are clear. The orbits\nare normal in appearance without stranding in the retro orbital fat.", + "output": "1. Large scalp hematoma centered on the left frontal bone with extension over\nthe superior orbit and involving the preseptal soft tissues. No evidence of\nassociated fracture.\n2. No evidence acute intracranial process or hemorrhage." + }, + { + "input": "There is partial opacification of the right maxillary sinus layering fluid of\nintermediate attenuation. There is mild mucosal thickening of the bilateral\nanterior ethmoid air cells. The frontal and sphenoid sinuses are clear. \nOstiomeatal units appear patent.\n\nThere is no evidence of facial swelling. There is no evidence of abnormal\nfluid collections. Bilateral mastoids appear normal. Status post bilateral\nlens replacement; the globes, extraocular muscles, optic nerves, and\nretrobulbar fat otherwise appear normal. The visualized upper aerodigestive\ntract appears normal. The mandible and temporomandibular joints appear\nnormal.\n\nBilateral supraclinoid internal carotid artery vascular calcifications are\nnoted.", + "output": "Air-fluid level in the right maxillary sinus which is a finding that can\nreflect acute sinusitis in the appropriate setting. Intermediate attenuation\nfluid but lacking the type of high-density appearance that has somewhat more\nspecificity for fungal involvement. However fungal sinusitis is a\npossibility. Mild anterior ethmoid air cells mucosal thickening. No bone\ndestruction." + }, + { + "input": "The study is degraded by motion artifact. There is no evidence of acute\nmajor infarction, hemorrhage, edema, or large mass. The ventricles and sulci\nare normal in size and configuration. No osseous abnormalities seen. The\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\norbits are unremarkable.", + "output": "No acute intracranial process. CT with contrast or MRI would be more\nsensitive for assessment of intracranial mass lesions." + }, + { + "input": "Within the preseptal soft tissues of the left orbit, there is a 2.0 x 4.7 x\n2.5 cm low-density collection with rim enhancement, compatible with abscess. \nThere is fat stranding in the surrounding superficial soft tissues. The\ncollection appears intimately associated with the anterior margin of the left\nlobe. The globe maintains normal shape and appearance.\n\nThere is near complete opacification of the left maxillary sinus, left frontal\nsinus, and anterior left ethmoid air cells, with occlusion of the left\nostiomeatal unit. Material in the lateral left frontal sinus is hyperdense,\nand it erodes through the posterior wall of the left frontal sinus/anterior\norbital roof with minimal extension into the extraconal orbit, images 6:06,\n3:67.\n\nThe right orbit appears unremarkable.\n\nThere is mild mucosal thickening in the right frontoethmoidal recess. Right\nfrontal, ethmoid, and partially visualized right maxillary sinuses are\notherwise well aerated. Bilateral sphenoid sinuses are well-aerated. The\nright ostiomeatal unit is patent. The nasal septum is deviated to the left\nwith a large left-sided spur which abuts the medial wall of the left maxillary\nsinus.\n\nPartially visualized mastoid air cells and middle ear cavities are clear.\n\nThis exam is not technically optimized for evaluation of the included brain\nparenchyma. No concerning abnormalities are seen on limited evaluation. \nVisualized intracranial arteries are not evaluated in detail, but appear\ngrossly unremarkable.", + "output": "1. 2.0 x 4.7 x 2.5 cm rim enhancing collection, consistent with an abscess, in\nthe preseptal soft tissues of the left orbit, abutting the anterior margin of\nthe left globe.\n2. Near complete opacification of the left maxillary sinus, left frontal\nsinus, and anterior left ethmoid air cells, with occlusion of the left\nostiomeatal unit. Hyperdense material in the lateral left frontal sinus\nerodes the posterior wall of the left frontal sinus/anterior left orbital\nroof, with minimal extension into the extraconal left orbit. These findings\nsuggest that the left preseptal soft tissue abscess may be secondary to the\nsinus disease.\n3. Leftward nasal septal deviation with a large left osseous spur which abuts\nthe medial wall of the left maxillary sinus.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 6:15 ___, 2 minutes after\ndiscovery of the findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST: There is no acute intracranial hemorrhage, edema,\nmass effect, or evidence of large vascular territorial infarction. The\nventricles and sulci are normal in size and configuration. There is no\nfracture. The imaged paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear.\n\nCTA HEAD: The vessels of the circle of ___ and their principal intracranial\nbranches are patent, without high grade stenosis, occlusion, malformation, or\nlarge aneurysm greater than 3 mm in size. The dural venous sinuses are\npatent. Specifically, there is no evidence of a basilar tip aneurysm. There is\nprominence noted at the junction of the origins of the left posterior cerebral\nartery and left superior cerebellar artery which may correspond to the finding\nin question on prior study.", + "output": "Normal CTA of the head." + }, + { + "input": "No metallic density is seen in the region of previously described prominent\ngradient echo susceptibility blooming artifact on recent MRI performed on ___. No hyperdense material to suggest new hemorrhage product in the\nleft frontal lobe.\n\nNew hyperdensity within a right frontal vertex sulcus (series 4, image 27),\nnot seen on prior examinations is compatible with small focus subarachnoid\nhemorrhage.\n\nThere is no evidence of acute infarction, edema, or mass effect. Right\nfrontal lobe encephalomalacia is compatible with known chronic infarct. \nProminent ventricles and sulci are suggestive of age-related involutional\nchange. Hyperdensity compatible with pipeline embolization of a left\ncavernous ICA aneurysm is noted, without significant metallic streak artifact.\nA stent of the distal left cervical ICA is also noted.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No CT correlate to focus of prominent left frontal gradient echo\nsusceptibility artifact on prior MRI. Specifically no metallic foreign body\nis identified. No hyperdensity to suggest calcification or prior blood\nproduct in the left frontal lobe.\n2. New curvilinear hyperdensity interdigitating within in a right frontal\nvertex sulcus concerning for small region of subarachnoid hemorrhage.\n3. Hyperdensity compatible with pipeline embolization of a left cavernous ICA\naneurysm noted, without significant metallic streak artifact.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ on the telephoneon ___ at 2:34 ___, 10 minutes after\ndiscovery of the findings." + }, + { + "input": "Again demonstrated is a large intra-axial 5.4 cm x 3.6 cm hyperintensity with\nsurrounding vasogenic edema likely representing an acute intraparenchymal\nhemorrhage, which may be slightly increased in size from ___ (series\n3, image 22). It is effacing the right cerebral hemisphere gyri and sulci as\nwell as the right lateral ventricle and is causing approximately 5 mm of\nmidline shift, which is minimally increased from ___. The hemorrhage\nappears to be extending into the subarachnoid space, accumulating in the sulci\nof the posterior right frontal lobe near the vertex. There is no evidence of\nnew hemorrhage or infarct. A stent of the left distal cervical internal\ncarotid artery is partially visualized. A stent traversing the genu to\nsupra-clinoid portion of the left intracranial cervical internal carotid\nartery is also noted.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are essentially clear. \nThe visualized portion of the orbits are unremarkable.", + "output": "1. Mildly enlarged intra-axial hemorrhage, now measuring 5.4 cm x 3.6 cm, with\nextension into the subarachnoid space.\n2. 5 mm of midline shift, previously 4 mm.\n3. No evidence of new hemorrhage or infarct." + }, + { + "input": "The patient is status post right parietal craniotomy and evacuation of the\npreviously seen right frontoparietal intraparenchymal hemorrhage, with\nassociated postoperative changes including pneumocephalus. Since the prior\nstudy, a significant portion of the right frontoparietal intraparenchymal\nhemorrhage has been evacuated, with a residual component posteriorly measuring\napproximately 3.4 x 1.9 cm (03:23). Subarachnoid hemorrhage near the vertex\nsuperiorly as well as near the midline is stable (03:23, 27). Effacement of\nthe right frontal sulci is unchanged. Leftward shift of the midline\nstructures has improved, now measuring 2 mm, previously 6 mm. No new focus of\nhemorrhage is appreciated.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable. Left internal carotid artery stent is unchanged.", + "output": "1. Status post right parietal craniotomy and evacuation of right\nfrontoparietal intraparenchymal hemorrhage, with a moderate amount of residual\nintraparenchymal and subarachnoid hemorrhage.\n2. Decreased leftward midline shift, now 2 mm, previously 6 mm." + }, + { + "input": "The patient is status post right craniotomy with resultant pneumocephalus. \nComparison is made to examination performed 1 day prior. Blood products\nwithin the sulci of the right frontoparietal region and intraparenchymal\nhemorrhage persists, a unchanged in size relative to prior study. There is\nnote new focus of hemorrhage. Effacement of sulci within the right hemisphere\nis unchanged. Minimal 2 mm leftward shift of normally midline structures is\nunchanged. Basal cisterns remain patent. Postsurgical changes involving the\nright scalp remain.\n\nThe orbits are unremarkable. A left internal carotid artery stents are noted.\nImaged paranasal sinuses are clear. Mastoid air cells bilaterally and middle\near cavities are clear.", + "output": "Stable appearance of right frontoparietal intraparenchymal hemorrhage with\nstable mass effect and postsurgical right frontal craniotomy changes. No new\nhemorrhage." + }, + { + "input": "Right craniotomy is again seen. The previously noted right frontal hematoma\nhas resolved. There is persistent right frontal white matter hypodensity with\nmild sulcal effacement, indicating residual edema. Mass effect on the atrium\nof the right lateral ventricle has decreased. There is no significant shift\nof midline structures. Basal cisterns are not compressed. There is no new\nhemorrhage.\n\nThe imaged paranasal sinuses and mastoid air cells are grossly well-aerated.", + "output": "Right frontal hematoma has resolved, but sulcal effacement persists, and\nvasogenic edema has decreased but not resolved.\n\nRECOMMENDATION(S):\nRecommend follow up brain MRI with and without contrast.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 17:41 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." + }, + { + "input": "Study is mildly degraded by motion. Dental amalgam streak artifact limits\nstudy.\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nProminent ventricles and sulci compatible with age-related involutional\nchanges. Periventricular subcortical white matter hypodensities are\nnonspecific but likely represent sequelae of small vessel ischemic disease in\nthis age group.\n\nThere is mild mucosal thickening in the bilateral ethmoid air cells. \nRemaining paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are patent.\n\nCTA HEAD:\nThere is atherosclerotic calcification within the clinoid and supraclinoid\nportions of the bilateral internal carotid arteries. The vessels of the\ncircle of ___ and their principal intracranial branches appear normal\nwithout stenosis, occlusion, or aneurysm formation. The dural venous sinuses\nare patent.\n\nCTA NECK:\nThere is mild atherosclerotic calcification of the bilateral carotid siphons. \nThe carotid and vertebral arteries and their major branches appear patent with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nThere is mild atherosclerotic calcification of the aortic arch. There is\nminimal atelectasis in the bilateral lung apices. Motion degradation limits\nevaluation of lung parenchyma. Question patchy ground-glass opacities versus\nartifact. There is intervertebral disc space narrowing, anterior and\nposterior osteophyte formation, and endplate irregularity at multiple levels\nof the cervical spine, worse at C4-C5. Soft tissue densities are noted within\nbilateral external auditory canals which may represent cerumen. Grossly\nstable approximately 5 mm left temporal calvarium probable bone island is\nagain noted (see 3:239 on current study and 03:39 on prior exam).", + "output": "1. Dental amalgam streak artifact and mild motion limits examination.\n2. No evidence of dissection, aneurysm, or occlusion of the vessels in the\nhead and neck.\n3. No evidence of acute intracranial hemorrhage.\n4. Within limits of study, no evidence of acute large territorial infarct. \nPlease note MRI of the brain is more sensitive for the detection of acute\ninfarct.\n5. Age-related involutional changes and chronic small vessel ischemic disease.\n6. Motion degradation limits evaluation of lung parenchyma. Question\nbilateral patchy ground-glass opacities versus artifact. If clinically\nindicated, consider correlation with dedicated chest imaging." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are prominent compatible with global volume\nloss. Periventricular and subcortical white matter hypodensity is likely\nsequela of chronic small vessel disease. Dense atherosclerotic calcifications\nnoted within the intracranial ICAs.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process. Global volume loss and white matter\nhypodensities which are likely sequela of chronic small vessel disease." + }, + { + "input": "There is no evidence of acute hemorrhage. Subtle asymmetric hypodensity in\nthe left temporal lobe on image 2:8 could represent slightly asymmetric\ntemporal horn of the left lateral ventricle, but periventricular pathology\ncannot be excluded definitively. Elsewhere, there is no evidence for edema or\nloss of gray/white matter differentiation. Ventricles, sulci, and basal\ncisterns are normal in size for age. The cerebellar tonsils are normally\npositioned. Dural calcifications are incidentally noted near the vertex.\n\nThere is no evidence of fracture. There is a tiny mucous retention cyst in\nthe left middle ethmoid, image 3:2. Other visualized paranasal sinuses and\nmastoid air cells are well aerated. The orbits appear unremarkable.", + "output": "1. No acute intracranial hemorrhage.\n2. Subtle asymmetric hypodensity in the left temporal lobe represent slightly\nasymmetric temporal horn of the left lateral ventricle. However,\nperiventricular pathology cannot be excluded definitively.\n\nRECOMMENDATION(S): Brain MRI with and without contrast with dedicated coronal\nT2 weighted and postcontrast MP RAGE sequences through the temporal lobes.\n\nNOTIFICATION: Results and recommendations were transmitted in an electronic\nwet read by Dr. ___ on ___ at 05:32." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass effect. The ventricles and sulci are prominent keeping with age-related\ninvolutional change. Periventricular and subcortical white matter\nhypodensities are nonspecific, but likely represent sequela of chronic\nischemic microvascular disease. A chronic lacunar infarct is noted in the\nright globus pallidus. Bilateral globus pallidus calcifications are also\npresent. There are moderate bilateral atherosclerotic calcifications in the\ncarotid siphons.\n\nThere is a small subgaleal hematoma overlying the right parietal bone\nmeasuring up to 8 mm in thickness (03:48). A defect in the adjacent\nsuperficial skin most likely represents a small laceration.\n\nNo fractures are seen. The paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The orbits are unremarkable aside from bilateral lens\nreplacement.", + "output": "1. Small subgaleal hematoma with skin laceration overlying the right parietal\nbone. No evidence of fracture.\n2. No evidence of intracranial hemorrhage or infarction.\n3. Chronic small vessel disease and age-related parenchymal atrophy." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Basilar cisterns are\npatent.\n\nIncluded paranasal sinuses and mastoids are clear. Left posterior parietal\nscalp swelling note seen without underlying fracture.", + "output": "Left posterior parietal scalp swelling without underlying fracture or acute\nintracranial process." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect or\nlarge territorial infarction. The ventricles and sulci are prominent\ncompatible with age-related atrophy. There is mild periventricular white\nmatter hypodensity which is nonspecific but may reflect chronic microvascular\nischemic disease. The basal cisterns are patent. Gray-white matter\ndifferentiation is preserved.\n\nThere is no fracture. There is minimal mucosal thickening in the left\nmaxillary sinus. The remaining paranasal sinuses are clear. The mastoid air\ncells and middle ear cavities are clear. There are multiple soft tissue\nnodules in the scalp several of which are calcified. For example, centrally\ncalcified 1.2 cm nodule in the right parietal scalp, noncalcified 9 mm nodule\nat the vertex on the left.", + "output": "1. No evidence of acute intracranial abnormality.\n2. Multiple soft tissue nodules in the scalp several of which are calcified\nare of doubtful clinical significance." + }, + { + "input": "Of note, this is a limited scan for stereotactic localization/guidance for\nbrain biopsy. The previously noted left cerebellar lesion is not well seen on\ntoday's study, and is better assessed on the prior MRI exam from ___. A small amount of edema is seen in the left cerebellum with mass effect\non the fourth ventricle, presumably the region of known lesion from the MRI\nexam. There is no evidence of fracture, infarction or hemorrhage. The\nventricles and sulci are normal in size and configuration. There is no midline\nshift. No definite abnormal enhancement is seen on the post-contrast images.\n\nThere is partial opacification of the anterior ethmoidal air cells. A mucous\nretention cyst is noted in the left maxillary sinus. Mild mucosal thickening\nis seen in the maxillary sinuses. Otherwise, the remaining visualized portion\nof the paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. Of note, this is a limited scan for stereotactic localization/guidance of\nbrain biopsy. The previously seen left cerebellar lesion is better seen on\nthe prior MRI exam from ___ with a small amount of edema and mass\neffect seen in the left cerebellum on today's study, presumably the location\nof the known lesion." + }, + { + "input": "The patient is status post brain biopsy with a new left frontal burr hole\npresent. A small amount of left frontal pneumocephalus is noted. There is no\nhemorrhage or evidence of a large infarct. The ventricular size is unchanged\nand the basal cisterns are patent. Subtle hypodensity in the left-side\ncerebellum is again noted, related to the known cerebellar lesion.\nNo osseous abnormalities seen apart from the left frontal burr hole. The\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\norbits are unremarkable.", + "output": "Status post left frontal approach brain biopsy with a small amount of left\nfrontal pneumocephalus present. No hemorrhage." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is a subtle hypodensity in the medial left cerebellum abutting the\nfourth ventricle with mild effacement of the left lateral contour of the\nfourth ventricle. There is no hydrocephalus. There is no acute hemorrhage. \nThere is no evidence for edema or mass effect in the supratentorial\ncompartment.\n\nAerosolized secretions and mild mucosal thickening are noted in the right\nsphenoid sinus. Multiple anterior ethmoid air cells are opacified\nbilaterally, with opacification of the left frontoethmoidal recess suspected\nbut not well assessed with this technique. There is mild mucosal thickening\nin bilateral maxillary sinuses with a small mucous retention cyst on the left.\nMastoid air cells are well aerated. The orbits appear unremarkable.\n\nCTA NECK:\nThe carotid and vertebral arteries appear patent without flow-limiting\nstenosis or dissection. Specifically, there is no evidence of internal\ncarotid stenosis by NASCET criteria.\n\nCTA HEAD:\nThe major intracranial arteries demonstrate no evidence for flow-limiting\nstenosis or aneurysm. A1 segment of the left anterior cerebral artery, M1\nsegments of bilateral middle cerebral arteries, proximal branches of the right\nmiddle cerebral artery, and P2 segments of bilateral posterior cerebral\narteries appear mildly irregular on maximal intensity projection and 3D\nreformatted images. Right ___, right AICA, and left ___ complex are\nvisualized.\n\nThere is severe hypoplasia of the left transverse and sigmoid sinuses, as well\nas hypoplasia of the left internal jugular vein, suggesting congenital\netiology. Right transverse/sigmoid sinuses are dominant. Superior sagittal\nsinus, straight sinus, and major deep veins are patent.\n\nOTHER:\nThere may be mild diffuse bronchial wall thickening in the included upper\nlungs. No other pulmonary abnormality is seen allowing for respiratory motion\nartifact.\n\nThe thyroid gland is unremarkable.\n\nThere is a 10 x 11 mm hypodense lesion in the lower deep portion of the right\nparotid gland (series 5, image 194). This lesion is partially imaged on the\nsubsequent MRI demonstrating T2 hyperintense signal and lack of\ncontrast-enhancement, suggesting a cyst. Multiple tiny cysts are also seen in\nthe left parotid gland. There are multiple punctate calcifications in the\nleft and possibly also the right parotid glands, suggesting sialolith.\n\nThe adenoids are enlarged. Palatine tonsils are not enlarged. There are\nbilateral prominent cervical lymph nodes at multiple stations, some of which\nare mildly enlarged. There is bilateral supraclavicular lymphadenopathy. \nThere is a partially visualized, at least 24 x 52 mm homogeneous anterior\nmediastinal soft tissue mass that does not exert mass effect on the aorta main\npulmonary artery, but rather conforms to the mediastinal contours.", + "output": "1. Left cerebral lesion abutting and minimally effacing the fourth ventricle.\nAdditional intracranial abnormalities are better assessed on the subsequent\nbrain MRI, which is reported separately.\n2. No acute hemorrhage.\n3. Normal neck CTA.\n4. Questionable mild irregularity of the A1 segment of the left anterior\ncerebral artery, M1 segments of bilateral middle cerebral arteries, proximal\nbranches of the right middle cerebral artery, and P2 segments of bilateral\nposterior cerebral arteries on maximal intensity projection and 3D reformatted\nimages. This may be secondary to artifact, but vasculitis or spasm cannot be\nexcluded.\n4. Bilateral parotid lymphoepithelial cysts and punctate calcifications can\nbe seen in the setting of HIV, Sjogren disease, sarcoidosis, or prior\ninflammation.\n5. Prominent adenoids. Multiple bilateral cervical lymph nodes, some of\nwhich are mildly enlarged. Bilateral supraclavicular lymphadenopathy.\n6. Partially visualized homogeneous soft tissue mass in the anterior\nmediastinum, which may represent lymphoma or thymic neoplasm.\n\nRECOMMENDATION(S): CT chest." + }, + { + "input": "The patient is status post left translabyrinthine approach for surgical\nresection of a presumed vestibular schwannoma. Fat packing within the\nsurgical bed is noted. Pneumocephalus is associated with the surgical bed. \nThere is a small lenticular fluid collection and subcutaneous emphysema within\nthe superficial soft tissues overlying the surgical site.\n\nThere is no evidence for large intracranial hemorrhage or acute territory\ninfarct. The sulci, ventricles and cisterns are within expected limits.\n\nMild mucosal thickening is noted in the ethmoid air cells bilaterally. A tiny\nmucous retention cyst is noted in the left maxillary sinus. The right mastoid\nair cells are clear.", + "output": "1. No evidence of intracranial hemorrhage, mass effect or acute territorial\ninfarction on noncontrast head CT.\n2. Expected postsurgical findings from left translabyrinthine approach for\nvestibular schwannoma resection." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nLarge area of hypodensity in the left parietal, posterior temporal, and\noccipital lobes, including the left PCA and MCA territories, is larger than\nthe diffusion abnormalities in the same distribution on the ___ MRI,\nwith new effacement of the occipital horn of the left lateral ventricle and\nnew partial effacement of the atrium and posterior body of the left lateral\nventricle. Small hypodensity in the posterior inferior right frontal lobe on\nimage 3:14 is new compared to the ___ MRI. There is no shift of\nnormally midline structures. Prominence of the ventricles is again seen,\ncompatible with age-related parenchymal volume loss. Basal cisterns are not\ncompressed. There is no acute hemorrhage.\n\nThere is mild mucosal thickening in the ethmoid air cells and inferior frontal\nsinuses. Mastoid air cells and middle ear cavities are well aerated.\n\nCTA NECK:\nThere is a 3 vessel aortic arch. Common carotid arteries are widely patent. \nThere is mild calcified plaque at the left internal carotid artery origin\nwithout any stenosis by NASCET criteria. Right internal carotid artery is\nwidely patent without stenosis by NASCET criteria. Bilateral vertebral\narteries are widely patent.\n\nCTA HEAD:\nThere is mild atherosclerosis involving bilateral carotid siphons without\nflow-limiting stenosis. There is no flow-limiting stenosis or aneurysm\ninvolving the major intracranial arteries.\n\nThere is relatively paucity of the superficial blood vessels along the left\nparietal and occipital lobes. Major dural venous sinuses are patent.\n\nOTHER:\nThe visualized portion of the lungs are clear. The thyroid gland is grossly\nunremarkable. There is no cervical or upper mediastinal lymphadenopathy by CT\nsize criteria.\n\nDegenerative changes involving the visualized cervical spine are noted. A\npreliminary report raise the question of a lytic lesion in the right lateral\nmass of C1 on image 5:240, but this corresponds to a prominent vascular\nchannel in the right occipital condyle, which is similar to the ___ CT cervical spine.", + "output": "1. Large hypodensity in the left parietal, posterior temporal, and occipital\nlobes has progressed since ___, with mild mass effect on the left\nlateral ventricle and with relative paucity of superficial blood vessels along\nthe left parietal and occipital lobes. Small hypodensity in the posterior\ninferior right frontal lobe is new compared to ___. At the time\nof final interpretation, biopsy has been performed, and correlation with\nbiopsy results is recommended.\n2. No evidence for flow-limiting stenosis involving the major cervical or\nintracranial arteries.\n3. No evidence for intracranial aneurysm or arteriovenous malformation. \nPainted major dural venous sinuses." + }, + { + "input": "Extensive hypodensity involving the left parietal, temporal, and occipital\ncortex and white matter appears stable from the prior CT on ___. \nThere is no evidence of acute intracranial hemorrhage. There is unchanged\ncompression of the occipital horn of the left lateral ventricle, and unchanged\npartial effacement of the atrium and posterior body of the left lateral\nventricle. Temporal horns of the lateral ventricles remain symmetric without\nleft-sided dilatation. There is stable 3 mm of rightward shift of normally\nmidline structures.\n\nThe patient is status post left-sided craniotomy. The visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "Stable hypodensity involving the left parietal, temporal, and occipital cortex\nand white matter compared to ___, with stable mass effect left\nlateral ventricle and stable mild rightward shift of midline structures. No\nacute hemorrhage. Please correlate with biopsy results." + }, + { + "input": "The patient is status post left parietal craniotomy and brain biopsy. \nCompared to the head CT from ___, the white matter hypodensities in\nthe left parietal and temporal lobes are unchanged. There is no evidence of\nacute hemorrhage or acute infarct. Ventricular size is stable. Basal cisterns\nare patent.\n\nThe imaged paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. There is no abnormality of the orbits or globes.", + "output": "1. Postsurgical change related to patient's left parietal craniotomy and brain\nbiopsy.\n2. Grossly stable left parietal, occipital and temporal white matter probable\nedema compared to ___ pre-biopsy examination.\n3. No evidence of acute hemorrhage.\n4. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct." + }, + { + "input": "The patient has had prior left parietal craniotomy a brain biopsy that showed\ncerebral amyloidosis. Since the prior exam on ___, the confluent\nextensive white matter hypodensities in the left parietal, temporal, and\noccipital lobes are overall unchanged. Gray-white matter differentiation is\npreserved throughout. Tiny hypodensity in the right centrum semiovale is also\nunchanged. No evidence of acute hemorrhage. The overall size and\nconfiguration of the ventricles is unchanged with mild-to-moderate atrophy. \nThe basal cisterns remain patent. No mass effect.\n\nMucosal thickening of the left frontal sinus, incompletely imaged, is mild.\nThe visualized portion of the remaining paranasal sinuses, mastoid air cells,\nand middle ear cavities are essentially clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. No significant interval change in the confluent left parietal, occipital,\nand temporal white matter hypodensity that could reflect sequela of patient's\ninflammatory amyloid angiopathy.\n\n2. No evidence of acute hemorrhage.\n\n3. No mass effect." + }, + { + "input": "Redemonstrated are extensive hypodensities involving the left occipital,\nparietal, and temporal lobes. Hypodensities in the inferior left frontal lobe\nare more pronounced and corresponds evolving infarcts. Additional smaller\ninfarcts seen on MRI are not well appreciated on CT. There are no new\nabnormalities since the most recent MRI of ___. There is no\nevidence of hemorrhage. The ventricles are moderately prominent with a stable\nin size and configuration compared to the prior examinations. There is no\nshift of normally midline structures.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of hemorrhage or midline shift.\n\n2. Multiple evolving infarcts and chronic white matter changes are overall\nsimilar in distribution to the most recent MR examination." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\n\nRight frontoparietal subarachnoid hemorrhage is not significantly changed. No\nnew hemorrhage is seen. A small chronic infarct is again seen in the right\nposterior inferior cerebellar hemisphere. Confluent areas of low-density in\nthe periventricular, deep, and subcortical white matter of the cerebral\nhemispheres are nonspecific but likely sequela of chronic small vessel\nischemic disease in this age group. Prominence of the ventricles and sulci is\nagain seen, consistent with moderate global parenchymal volume loss.\n\nThere are mucous retention cysts along the floors of bilateral maxillary\nsinuses with adjacent periapical lucency of a right maxillary molar, image\n3:200. There is mild mucosal thickening in the anterior ethmoid air cells and\nfrontal sinuses.\n\nCTA NECK:\nThere is common origin of the innominate and left common carotid arteries, a\nnormal variant. There is mild calcified plaque at the left subclavian artery\norigin and in the proximal left subclavian artery without flow-limiting\nstenosis. Common carotid and internal carotid arteries are widely patent\nwithout stenosis by NASCET criteria. There is mild calcified plaque at the\nright vertebral artery origin with mild narrowing. Remaining right vertebral\nartery is widely patent. The left vertebral artery is widely patent.\n\nCTA HEAD:\nThere is calcified plaque in bilateral carotid siphons without evidence for\nflow-limiting stenosis. No flow-limiting stenosis is seen elsewhere in the\nanterior circulation. Vertebral, basilar, superior cerebellar, and posterior\ncerebral arteries are patent without evidence for flow-limiting stenosis, with\nnormal variant fetal type right posterior cerebral artery. Right ___ is not\nvisualized. There is a large left ___ with branches extending into the right\n___ territory. There are two foci of mild narrowing in the left ___,\nincluding to the right of midline, see images ___:41, ___:25.\n\nThe anterior communicating artery is hypoplastic. There is 2 mm medially\ndirected outpouching at the junction of the left anterior cerebral artery with\nthe anterior communicating artery, images 3:266, 456:9, 457:3, consistent with\nsmall aneurysm.\n\nThe dural venous sinuses are patent. The left transverse and sigmoid sinuses\nare hypoplastic.\n\nThere is no evidence for abnormal blood vessels in the region of the right\nsubarachnoid hemorrhage to suggest an arteriovenous fistula.\n\nOTHER:\nEvaluation of partially imaged upper lungs is limited by respiratory motion\nartifact. Within this limitation, there is no suspicious pulmonary nodule or\nconsolidation. Centrilobular emphysema is noted. There is an 8 mm exophytic\nnodule arising from the posterior right lobe of the thyroid gland (series 3,\nimage 94). There is no lymphadenopathy by CT size criteria. There are\ndegenerative changes in the cervical spine.", + "output": "1. Unchanged right frontal/parietal subarachnoid hemorrhage. No new\nhemorrhage.\n2. No evidence for an arteriovenous fistula in the region of the right\nsubarachnoid hemorrhage.\n3. 2 mm medially directed aneurysm at the junction of the left anterior\ncerebral artery with a hypoplastic anterior communicating artery.\n4. Nonvisualization of the right ___. Large left ___ with branches\nextending into the right ___ territory. Two foci of mild narrowing in the\nleft ___, including to the right of midline.\n5. Calcified plaque mildly narrowing the right vertebral artery origin.\n6. Emphysema in the included upper lungs.\n7. 8 mm right thyroid nodule. According to current ___ College of\nRadiology guidelines, no follow up is needed in the absence of specific\npersonal risk factors for thyroid malignancy.\n\nRECOMMENDATION(S): The 2 mm left anterior cerebral artery aneurysm is not\nrelated to the right frontal/parietal subarachnoid hemorrhage, and it should\nbe followed in the outpatient setting to assess stability.\n\nNOTIFICATION: Impression items 3 and 4, and the recommendation above, were\nemailed to the ED QA nurses list by Dr. ___ at 20:41 on ___, 2\nminutes after discovery." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nRe-identified is a left frontal, left parietal and left temporal lobe white\nmatter edema with cortical thickening and sulcal effacement. More subtle\nwhite matter edema of the bilateral occipital lobes is also identified. There\nare periventricular and subcortical white matter hypodensities, corresponding\nto FLAIR signal abnormalities on prior MRI. Known micro hemorrhages on MRI\ncannot be seen on CT examination. There is no evidence for acute territorial\ninfarct. There is no other intracranial hemorrhage.\n\nThe paranasal sinuses are clear. The mastoid air cells middle ear cavities\nare well pneumatized clear. The orbits are unremarkable.\n\nCTA HEAD:\nThe right A1 segment appears to be congenitally absent. Otherwise, the\nvessels of the circle of ___ and their principal intracranial branches\nappear normal with no evidence of stenosis,occlusion or aneurysm. The dural\nvenous sinuses are patent. No abnormal enhancement.\n\nOther: Dental caries and scattered periapical lucencies are noted.", + "output": "1. Unchanged configuration of left frontal, parietal, temporal and bilateral\noccipital lobe white matter edema.\n2. Known diffuse micro hemorrhages from likely amyloid angiopathy are not\nvisualized by CT examination. No acute territory infarct or other hemorrhage.\n3. Allowing for anatomic variation, essentially unremarkable CTA of the head. \nNo abnormal enhancement." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Periventricular white matter hypodensities are nonspecific, but\nlikely reflect sequelae of chronic small vessel ischemic disease. Prominence\nof the ventricles and sulci suggest involutional changes. There is mild\nmucosal thickening of the right maxillary sinus. The remaining imaged\nparanasal sinuses are clear. The right mastoid air cells are partially\nopacified with areas of sclerosis, sequela of chronic inflammation.. The left\nmastoid air cells and middle ear cavities are well aerated. The bony calvarium\nis intact.", + "output": "No acute intracranial process.\nPartial opacification right mastoid air cells, with evidence of chronic\ninflammation." + }, + { + "input": "Right frontal sinus, frontal sinus drainage pathway are patent. Left frontal\nsinus is clear, minimal mucosal thickening of the upper left frontal sinus\ndrainage pathway, lower left frontal sinus drainage pathway including\ninfundibulum are patent.\n\nThere is mild mucosal thickening of the bilateral maxillary sinus floors, with\nsmall submucosal retention cyst right maxillary sinus floor, mildly more\nprominent compared with ___. Patent infundibular of bilateral ostiomeatal\nunits.\n\nTrace mucosal thickening ethmoid sinus. Clear sphenoid sinus, sphenoid sinus\nostia.\n\nNasal septal deviation to the right. Small osseous spur projects into the\nright nasal cavity from the nasal septum. Nasal cavity is clear. Left concha\nbullosa. Minimal right concha bullosa. There is 2 mm discrepancy in the\ncribriform plates, right is more inferiorly positioned in the left. \nCribriform plates are intact. Intact medial orbital walls. Carotid canals\nare covered by bone. Right optic nerves covered by bone. Short segment of\nthe left optic canal along the inferomedial margin is very thin or does not\nhave bone. Anterior clinoid processes are not aerated. No evidence of air\nabove anterior ethmoid arteries. No periapical lucencies.\nNormal visualized soft tissues of the upper neck.", + "output": "1. Mild paranasal sinus disease." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, mass effect, midline\nshift . The ventricles and sulci are normal in size and configuration.\nNo bony abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial hemorhage or mass effect\nSoft tissue swelling anterior to the left orbit and left orbital fractures are\nbetter characterized on the dedicated CT of the facial bones.\n\nNOTE ON ATTENDING REVIEW:\n\n___ of posterior arch of atlas-? Congenital/ prior recent trauma; no\nsoft tissue swelling; partly included\nConsider CT C spine for better assessment" + }, + { + "input": "There is subarachnoid hemorrhage in the right frontal lobe (2:23), unchanged\nthe prior CT. Two additional foci of subarachnoid hemorrhage are noted within\nthe left temporal lobe; the focus located more anteriorly (2:10) appears\nslightly larger, but the one located more posteriorly at the level of the\nsylvian fissure (2:13) is smaller; some of the rest of the foci are stable. \nMinimal left frontal hemorrhage is stable.\nThere is no new hemorrhage. Prominence of ventricles and sulci in are normal\nfor patient's age. Basal cisterns are patent. Gray-white matter\ndifferentiation is preserved.\n\nThin lucent line in left occipital bone-? Related to suture or subtle\nfracture. (se 3, im 6)\nA small lucent focus in the right occipital bone along the inner table is\nstable compared to recent study; no remote priors.\nThere is mucosal thickening within the left maxillary sinus, not significantly\nchanged from prior. Remainder of the visualized paranasal sinuses are clear.\nMastoid air cells are clear. Bilateral orbits are unremarkable.", + "output": "1. Stable right frontal SAH.\n2. Interval mild increase in one of the foci of the left anterior temporal\nSAH (2:10).\n3. Left temporal SAH located more posteriorly at the level of the Sylvian\nfissure is smaller (2:13).\n4. No new hemorrhage.\n5. Thin lucent line in left occipital bone-? Related to suture or subtle\nfracture. (se 3, im 6)\n6. A small lucent focus in the right occipital bone along the inner table is\nstable compared to recent study; no remote priors.\n\nNOTIFICATION: Findings telephoned to Dr. ___ by ___ on\n___ at 3:09PM, time of read." + }, + { + "input": "There is no evidence of acute fracture, acute territorial\ninfarction,hemorrhage,edema,or mass. Subcortical and periventricular white\nmatter hypodensities are suggestive of chronic small vessel ischemic disease. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges.\n\nBurr hole defects are noted in the left frontal, right parietal, and right\nfrontal regions. The visualized portion of the mastoid air cells and middle\near cavities are clear. There is mild mucosal thickening of the bilateral\nfrontal sinuses as well as the ethmoid air cells and bilateral maxillary and\nsphenoid sinuses. Small mucous retention cysts are noted in bilateral\nmaxillary sinuses. Bilateral lens replacements are noted. Dense\natherosclerotic calcifications of the cavernous carotid and distal vertebral\narteries are present.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of no evidence of infarction, hemorrhage, edema, or\nmass. The ventricles and sulci are normal in size and configuration. There is\nsuggestion of bilateral superior frontal gyrus probable prominent perivascular\nspaces (see 2:25, 601b:66, 602b:56).\n\nThere is no evidence of fracture. Otherwise, the visualized portion of the \nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable. Minimal bilateral ethmoid and frontal sinus\nmucosal thickening is present.", + "output": "1. No acute intracranial abnormality.\n2. Paranasal sinus disease as described.\n3. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are normal in size and configuration.\n\nThere is mild mucosal thickening of the right maxillary sinus. The mastoid\nair cells,and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. There is\nhypoplasia of the left A1 segment.\n\nCTV HEAD:\nThe dural venous sinuses are patent.\n\nCTA NECK:\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No no evidence of mass, hemorrhage or infarction.\n2. No stenosis or occlusion of the circle ___ are cervical vessels.\n3. Patent dural venous sinuses." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nlarge mass. Periventricular and subcortical white matter hypodensities are\nnonspecific, but likely represent chronic small vessel ischemic disease. There\nis prominence of the ventricles and sulci suggestive of involutional changes,\nprogressed since ___.\n\nThere is no evidence of fracture. There are moderate aerosolized secretions\nin the right sphenoid sinus. There is mild layering fluid in the left\nsphenoid sinus. There is a small mucous retention cysts in the left posterior\nethmoid air cells. The visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are otherwise essentially clear. The\nvisualized portion of the orbits are unremarkable. There is bilateral carotid\nsiphon and right vertebral artery calcification.", + "output": "1. No acute intracranial process.\n2. Prominence of the ventricles is progressed since ___. Difficult to\nexclude NPH in the appropriate clinical setting." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal.The neck vessels are patent. \nNumerous bilateral cervical lymph nodes are prominent and measure up to 2.0 cm\nin the left level IIa station (series 2, image 47). Additional pathologically\nenlarged lymph nodes include the left level IIb station measuring 1.5 cm\n(series 2, image 42), right level IIa station measuring 1.3 cm (series 2,\nimage 40), and right level IIb station measuring 1.3 cm (series 2, image 43).\n\nThere is moderate maxillary sinus mucosal thickening and mild sphenoid sinus\nand ethmoid air cell mucosal thickening.\n\nHeterogeneity of multiple visualized vertebral bodies, the manubrium, and the\npartially visualized sternum suggest avascular necrosis in the setting of\nsickle cell disease.\n\nPlease refer to separate report for same-day CT chest for complete description\nof the thoracic findings.", + "output": "1. Cervical lymphadenopathy as described in the findings, possibly reactive. \nNo abscess formation.\n2. Moderate paranasal sinus disease.\n3. Manubrium, sternum, and vertebral body avascular necrosis in the setting of\nsickle cell disease.\n4. Please refer to separate report for same-day CT chest for complete\ndescription of the thoracic findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. A few scattered\nsubcortical and periventricular white matter hypodensities are likely sequela\nof chronic small vessel disease, some of which were acute infarct on recent\nprior MRI. The ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are essentially clear besides scattered mucosal thickening in the\nethmoids. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nAtherosclerotic calcifications noted in the cavernous ICAs bilaterally which\nare mildly narrowed, left greater than right. There is moderate narrowing of\nthe proximal M1 branch of the right MCA. There is occlusion of the superior\nM2 branch as noted previously. On the left, there is moderate narrowing of\nthe supraclinoid ICA.\n\nThere is severe narrowing at the proximal left ACA which is less well seen on\ntoday's exam. Bilateral A1 segments of the ACAs are diminutive on today's\nexam which were clearly demarcated on more remote exam from ___. Of\nnote, some of this may be due to technique/timing of the contrast bolus. \nThere is also less robust filling of the ACAs more distally compared to prior,\nparticularly the left A2 segment.\n\nThe left M1 segment of the MCA is not visualized though its distal branches\nare opacified, an appearance similar compared to prior.\n\nLeft vertebral artery is dominant and the major contributor to the basilar\nartery. Intradural right vertebral artery demonstrates regions of moderate to\nsevere narrowing. There is focal severe stenosis of the P2 segment of the\nright PCA which is similar compared to prior exams.\n\nCTA NECK: Patient is status post right carotid endarterectomy. \nAtherosclerotic calcifications noted at the aortic arch. Mild-to-moderate\nnarrowing seen at the origin of the left common carotid artery. Innominate\nartery and right common carotid artery are unremarkable. There is no stenosis\nby NASCET criteria in the carotid artery on the right. There is\nmild-to-moderate narrowing at the origin of the left common carotid artery as\nseen previously. Noncalcified atherosclerotic plaque seen at the origin of\nthe left internal carotid artery without narrowing by NASCET criteria. There\nis moderate stenosis of the left internal carotid artery at the skullbase at\nthe proximal petrous portion.\n\nThe right vertebral artery is not seen at its origin. It is irregular in\ncaliber and narrow throughout its course in the neck and intradural\ncomponents, similar compared to prior. There is mild narrowing at the origin\nof the left subclavian artery. The left vertebral artery is patent and\nuniform throughout its course in the neck.\n\n\nOTHER:\nThe visualized portion of the lungs are notable for an azygos fissure. The\nvisualized portion of the thyroid is within normal limits. There is no\nlymphadenopathy by CT size criteria. Small amount of fluid tracking along the\nsuperficial region of the right sternocleidomastoid muscle, likely related to\nprior surgery. Previously seen locules of air in the postoperative bed have\nresolved. Obscure a shin of the fat planes around the distal common carotid\nand proximal ICA and ECA are compatible with postoperative changes of\nendarterectomy.", + "output": "1. When compared to prior, the A1 segments of the ACAs are less clearly\ndelineated and perhaps more significantly stenotic on today's exam when\ncompared to prior exam from ___ when there was were more clearly\ndelineated. Less robust filling in the distal ACA branches, specifically the\nA2 segment of the left ACA.\n2. Other areas of moderate to severe narrowing and/or occlusion involving the\nsuperior branch of the right MCA, the M1 branch of the left MCA, right PCA P2\nbranch, and occlusion of the proximal right vertebral artery are unchanged. \nDetails as above.\n3. Postoperative changes of carotid endarterectomy. No residual stenosis of\nthe carotid arteries proximally. Moderate narrowing of the distal left\ncarotid artery at the skullbase, similar compared to priors.\n4. Sequela of prior infarcts and chronic small vessel disease." + }, + { + "input": "There is no evidence of acute territorial infarction, intracranial hemorrhage,\nor mass. Mild prominence of the ventricles and sulci is suggestive of\ninvolutional changes. No mass effect or midline shift.\n\nThere is a partially visualized air-fluid level in the left greater than right\nmaxillary sinuses. Mild mucosal thickening of the remaining paranasal\nsinuses. Mastoid air cells are clear. Intraorbital contents are preserved.", + "output": "1. No evidence of acute large territorial infarction or acute intracranial\nhemorrhage.\n2. Mild parenchymal volume loss.\n3. Paranasal sinus disease with findings concerning for acute sinusitis, as\ndescribed." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of hemorrhage,edema,mass or recent infarction. There is\na small chronic-appearing infarction in the left frontal white matter,\nunchanged since ___ mild prominence of the ventricles and sulci is\nsuggestive of age-related involutional change.\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is redemonstration of chronic occlusion of the superior division of the\nright middle cerebral artery at the MCA bifurcation (3:242, 302:23), \nunchanged. Focal stenosis involving the right M1 segment of the right MCA\n(3:242, 302:23), unchanged. There is a focal segment of narrowing involving\nthe petrous segment of the left internal carotid artery (3:204-212),\nunchanged. The left M1 segment of the left MCA again appears chronically\nseverely stenosed or occluded, with maintenance of distal flow, unchanged. \nThere are focal stenoses of the posterior cerebral arteries bilaterally in\ntheir P2 segments, severe on the right and unchanged. No evidence of new\nstenosis, occlusion, or aneurysm formation within the intracranial\nvasculature. The dural venous sinuses are patent.\n\nCTA NECK:\nRedemonstration of chronic occlusion involving the proximal V1 segment of the\nright vertebral artery, spanning from its origin to approximately the level of\nC5-C6, which appears to be fed by collateral vessels, unchanged in appearance\ncompared to prior CTA head/neck from ___. There is a hypoplastic\nright vertebral artery and dominant left vertebral artery. The\ncarotidandvertebral arteries and their major branches otherwise appear normal\nwith no evidence of stenosis or occlusion. There is no evidence of internal\ncarotid stenosis by NASCET criteria.\n\nOTHER:\nPostsurgical changes related to recent right carotid endarterectomy, including\nsubcutaneous emphysema and postoperative fluid within the right neck and chest\nwall. The visualized portion of the lungs are notable for mild biapical\nscarring and dependent bibasilar atelectasis. A prominent azygos vein with\nassociated azygos lobe is incidentally noted (03:36), a normal anatomic\nvariant. The thyroid appears normal. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No evidence of hemorrhage or infarction.\n2. No findings of new stenosis, occlusion, or aneurysm formation within the\nintracranial vasculature or great vessels of the neck.\n3. Unchanged appearance of multiple chronic arterial stenosis in the head and\nneck including chronic occlusion of the superior division of the right MCA at\nthe bifurcation bifurcation , focal stenosis of the right M1 segment, focal\nnarrowing of the petrous segment of the left ICA, chronic severe stenosis or\nocclusion of the left M1 segment, bilateral stenoses of the P2 segments of the\nposterior cerebral arteries and chronic occlusion of the proximal V1 segment\nof the right vertebral artery.\n4. Postsurgical changes related to recent right carotid endarterectomy,\nincluding subcutaneous emphysema within the right neck and chest wall." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of hemorrhage, edema, mass effect, or acute infarction. \nThe ventricles and sulci are age-appropriate.\n\nThe right frontal sinus is opacified. The right anterior ethmoidal cells are\nalso partially opacified. There is mucosal thickening in the right maxillary\nsinus without air-fluid levels. The mastoid air cells and middle ear cavities\nare clear. The orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe left vertebral artery is patent but hypoplastic, and the distal V4 segment\nbeyond the origin ___ is extremely diminutive, probably a normal variant. \nCarotidandvertebral arteries and their major branches appear normal with no\nevidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. There is a 6 x 10 mm hypodense\nright thyroid nodule (series 5, image 117), for which no follow-up is\nindicated according to current ___ College of Radiology guidelines. There\nis no lymphadenopathy by CT size criteria.", + "output": "1. No evidence of hemorrhage, edema, mass effect, or acute infarction.\n\n2. Unremarkable head and neck CTA aside from normal anatomic variation as\ndescribed." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration for age. Subtle\nscattered areas of subcortical white matter hypodensity are in a configuration\nmost suggestive of mild chronic small vessel ischemic disease. Vascular\ncalcifications are noted in the carotid siphons\n\nThere is no evidence of fracture. There is partial visualization of mucosal\nwall thickening in the left ethmoid air cells. The remainder of the\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "There is no in acute intracranial change.\nLeft ethmoid paranasal sinus disease, as described.\nMild chronic small vessel ischemic changes." + }, + { + "input": "There is no acute intracranial hemorrhage, edema, mass effect, or evidence of\nlarge vascular territorial infarction. Prominence of the ventricles and sulci\nis consistent with age-related involutional changes. There is particular\nenlargement of the frontal extra-axial spaces. There are non-specific\nperiventricular and subcortical white matter hypodensities which can be seen\nin patients with chronic small vessel ischemia. There is no fracture. There is\nopacification of several posterior ethmoid air cells. There are aerosolized\nsecretions in the right sphenoid sinus. The mastoid air cells and middle ear\ncavities are clear.", + "output": "No acute intracranial abnormality." + }, + { + "input": "No evidence of acute intracranial hemorrhage, midline shift, or mass effect. \nBilateral, periventricular, subcortical, and deep white matter hypodensities\nare nonspecific and could be sequelae of chronic small vessel ischemic disease\nor prior insult. In the absence of prior imaging, the age of these\nhypodensities, for example in the right basal ganglia and bilateral frontal\nparietal lobes is indeterminate (e.g., series 2, image 20, 19,). The\nventricles and sulci are normal in size and configuration for the patient's\nage.\n\nNo evidence of fracture. There is hyperostosis frontalis, a normal variant. \nThe right frontal sinus is hypoplastic. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are essentially\nclear. The visualized portion of the orbits are unremarkable other than\nbilateral lens replacements and 2 mm metallic density along the anterior right\nglobe (series 2, image 2).", + "output": "1. No acute intracranial hemorrhage or mass effect.\n2. Nonspecific bilateral periventricular, deep, and subcortical white matter\nhypodensities. This could be sequelae of chronic small vessel ischemic\ndisease; however, concurrent age-indeterminate infarcts cannot be excluded in\nthe appropriate clinical situation in the absence of prior exams for\ncomparison. MRI is more sensitive in detecting acute ischemia.\n3. No fracture.\n4. Sub-2-mm metallic density along anterior right globe, uncertain etiology. \nCorrelate with clinical assessment/history of prior intervention." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass. There\nis prominence of the ventricles and sulci suggestive of involutional changes. \nPeriventricular and subcortical white matter hypodensities are nonspecific,\nhowever likely reflect chronic small vessel ischemic disease.\n\nThere is no evidence of acute fracture. Air-fluid level within the left\nmaxillary sinus with hyperostosis of the maxillary wall is seen. The\nvisualized portion of the other paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial abnormalities." + }, + { + "input": "Images are limited by motion artifact. There is no evidence of large\nterritorial infarction, acute intracranial hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. Mild\nperiventricular white matter hypodensities are nonspecific, but likely sequela\nof chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. Mild mucosal thickening in the bilateral\nmaxillary sinuses. The visualized portion of the remaining paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "Images are limited by motion artifact. Within this limitation, no acute\nintracranial hemorrhage." + }, + { + "input": "There is no evidence of acute hemorrhage mass effect midline shift or\nhydrocephalus. Gray-white matter differentiation is maintained. Mild diffuse\nhypodensity of the white matter on the current study appears to be\ndifferences in technique. There are no focal abnormalities seen.\n\nThe visualized paranasal sinuses are clear. No skull fracture is seen.", + "output": "No acute intracranial abnormalities are identified." + }, + { + "input": "Trace mucosal thickening of the left maxillary alveolar recess with adjacent\nminiscule mucous retention cyst along the medial maxillary sinus wall is also\nseen. A small mucous retention cyst in the right maxillary alveolar recess is\nalso identified. The infundibulum of the ostiomeatal units are clear. There\nare bilateral Haller cells larger on the right which appear to minimally\nnarrow the infundibulum the frontal ethmoidal recesses are clear. The ethmoid\nair cells and frontal sinuses as well as sphenoid sinuses are clear. The\ncribriform plates and lamina papyracea are intact.\n\nLeftward deviation of the nasal septum without perforation is identified. \nThere is a leftward projecting spur which contacts the inferior turbinate on\nthe left.\n\nAlthough not optimized for such evaluation, visualized brain parenchyma is\ngrossly unremarkable. The orbits are unremarkable. The visualized mastoid\nair cells and middle ears are well pneumatized and clear. The patient is\nstatus post remote ORIF of the left orbital floor.", + "output": "1. Minimal mucosal thickening the left maxillary alveolar recess and a small\nmucous retention cyst in right maxillary alveolar recess. Otherwise, the\nremainder the paranasal sinuses are essentially clear. No findings to suggest\nfungal colonization or invasive fungal sinusitis.\n2. Bilateral Haller cells and leftward deviation of nasal septum with a\nleftward projecting spur. Additional findings as described above." + }, + { + "input": "Moderate bilateral maxillary, trace right sphenoid, mild bilateral inferior\nfrontal, and mild anterior ethmoid air cells mucosal thickening is mostly new\nsince the prior study. In ___ there was only mild bilateral\nmaxillary sinus mucosal thickening. No evidence of bone destruction is\nidentified. No intraorbital or masticator space fat stranding. Bilateral\nmaxillary infundibula and ostiomeatal unit are occluded. Bilateral Haller\ncells are again noted.\n\nSoft tissue fat stranding is identified at the right alarfacial groove\noverlying the medial portion of right maxillary sinus anterior wall.\n\nThe cribriform plates are intact. The lamina papyracea are intact. Bilateral\norbits are unremarkable.\nLeftward deviation of the nasal septum with leftward bone spur without is\nidentified.", + "output": "1. Paranasal sinus mucosal thickening, most prominent in the maxillary sinuses\nis mostly new compared to ___. Findings are consistent with\nparanasal sinusitis, infectious or inflammatory.\n2. Soft tissue edema at the right alarfacial groove may be infectious or\ninflammatory." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect. There is secretions in the posterior oropharynx at the\nlevel of the hyoid bone without mass effect on the airway.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules.\n\n There are no osseous lesions.\n\nThere is high-density moderate mucosal thickening in the bilateral maxillary\nsinuses likely reflects inspissated secretions or fungal colonization, with\nquestion osseous destruction of the posterolateral left maxillary wall\n(04:19).", + "output": "1. No evidence mass effect on the airway. No findings attributable to\ndysphagia.\n2. No evidence of facial cellulitis, drainable fluid collections or discrete\nabscess.\n3. Paranasal sinus disease as described above, better assessed on dedicated CT\nsinus from ___. The.\n4. Periodontal disease obscured by dental amalgam." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation\nis preserved. The ventricles and sulci are enlarged consistent with age\nrelated atrophy. Basilar cisterns are patent. Moderate calcifications on\nboth carotid siphons.\n\nThere is minimal mucosal thickening of the ethmoid air cells. The mastoid air\ncells are clear. Skull and extracranial soft tissues are unremarkable. The\npatient has had bilateral lens replacements.", + "output": "1. No acute intracranial process or significant change." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are prominent, compatible with mild atrophy\nwhich is age appropriate. Minimal periventricular white matter hypodensities\nare likely the sequelae of chronic small vessel ischemic change and were seen\non the previous MRI. The imaged paranasal sinuses are clear. Mastoid air\ncells and middle ear cavities are well aerated. The bony calvarium is intact. \nThere are mild atherosclerotic calcifications of the cavernous portions of the\nbilateral internal carotid arteries.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute large territory infarct,hemorrhage,edema, or\nmass effect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Mild periventricular white matter hypodensities likely\nreflect chronic small vessel disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality on noncontrast head CT. Specifically no\nlarge territory infarct or intracranial hemorrhage. No evidence of\nintracranial mass-effect." + }, + { + "input": "There is no evidence of acute major infarction,hemorrhage,edema,or discrete\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. There is stable mild periventricular and subcortical\nwhite matter hypodensities, which are nonspecific, though likely due to\nchronic small vessel ischemic disease. There is a prominent VR space inferior\nto the left basal ganglia. There is no evidence of acute fracture. Ethmoid\nair cell mucosal thickening is mild. The visualized portion of the remaining\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial abnormalities. Mild small vessel disease." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are prominent, suggestive of involutional\nchange. Stable mild to moderate periventricular and subcortical white matter\nhypodensities are nonspecific, but likely represent sequela of chronic small\nvessel ischemic disease. Re-demonstrated is a prominent VR space inferior to\nthe left basal ganglia. The imaged paranasal sinuses are clear aside from\nmild mucosal thickening in the bilateral ethmoid sinuses. Mastoid air cells\nand middle ear cavities are well aerated. The bony calvarium is intact. The\npatient is status post bilateral lens replacement.", + "output": "No acute intracranial hemorrhage or fracture. Mild to moderate small vessel\ndisease." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are within expected limits given the\npatient's mild senescent related global cerebral volume loss. There is\nperiventricular and subcortical white matter hypoattenuation which is\nnonspecific but could represent chronic small vessel ischemic disease. \nIncidental note is made of a partial empty sella, unchanged from prior exam.\n\nThere is mucosal thickening of the left anterior ethmoid air cells remaining\nparanasal sinuses are clear. Mastoid air cells and middle ear cavities are\nwell aerated. The bony calvarium is intact.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nintracranial hemorrhage or large territory infarct.\n2. Additional findings described above." + }, + { + "input": "There is no evidence of acute, large territorial infarction,hemorrhage,edema,\nor mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific, likely sequela of chronic ischemic small vessel\ndisease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Aside from\nbilateral lens replacements, the visualized portion of the orbits are\nunremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute large territory infarction,hemorrhage,edema,or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific, likely sequela of chronic small vessel ischemic\ndisease.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\npatient is status post bilateral lens replacement.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction,hemorrhage,edema,or mass. Periventricular\nand subcortical white matter may reflect treatment effect. There has been\nprogressive enlargement of the lateral ventricle compared to ___, greater\nthan the enlargement of the sulci. This may reflect treatment effect or a\ncomponent of communicating hydrocephalus.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No evidence of mass, hemorrhage or infarction.\nAtrophy.\nWhite matter hypodensity that may reflect treatment effect.\nProgressive ventricular enlargement may reflect treatment effect or a\ncomponent of communicating hydrocephalus." + }, + { + "input": "There is no evidence of acute large territorial infarction, acute intracranial\nhemorrhage, edema, or mass. The ventricles and sulci are normal in size and\nconfiguration. A 1 x 0.7 cm (2:9) hypodensity is seen within the left putamen\nand is most consistent with a prominent Virchow ___ space or chronic lacune.\n\nNo osseous abnormalities seen. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Calcification of the cavernous\nportions of bilateral internal carotid arteries are noted.", + "output": "1. No acute intracranial abnormality. No large intracranial mass. Of note MR\nis more sensitive in detection of subtle mass lesions.\n2. 1 cm hypodensity within the left putamen is most consistent with a\nprominent Virchow ___ space or chronic lacune." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nMild bilateral periventricular white matter hypodensities are nonspecific, but\nlikely a sequela of chronic small vessel disease. Atherosclerotic\ncalcifications are noted within the bilateral carotid siphons.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Scalp laceration with skin staples\nare noted along the right vertex.", + "output": "1. Scalp laceration with skin staples along the right vertex, without\nunderlying fracture or intracranial hemorrhage.\n2. Atrophy and probable chronic small vessel disease." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass-effect, midline shift,\nor acute major vascular territorial infarct. 8 mm pineal cyst is noted. \nGray-white matter differentiation is preserved. Ventricles and sulci and\nunremarkable. Basilar cisterns are patent.\n\nMucous retention cysts noted within the maxillary sinuses bilaterally. In\naddition, there is a oblong soft tissue density in the right nasal cavity with\nremodeling of the adjacent bone, of slightly high density which measuring 1.5\ncm cc by 0.9 cm TRV. This lesion is in the olfactory recess abutting the\nanterior skullbase without clear delineation of the cribriform plate. Other\nincluded paranasal sinuses are clear. There is poor pneumatization of the\nmastoids bilaterally.", + "output": "No acute intracranial process.\nFocal polypoid lesion in the right nasal cavity abutting the anterior cranial\nfossa. Cribriform plate is not clearly delineated. Differential for this\nfinding includes a nasal polyp although intranasal glioma (developmental\nabnormality) is also possible. Less likely encephalocele, but not entirely\nexcluded.\n\nNOTIFICATION: Consider MRI non urgently to further assess." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. An\n8 mm pineal cyst is unchanged (602b:42).\n\nThere is no evidence of acute fracture. A small subgaleal hematoma underlies\nthe right frontal scalp (3:44). The previously described oblong soft tissue\ndensity in the right nasal cavity with remottling of the adjacent bone,\nmeasuring 1.4 x 0.7 cm (601b:22), has not changed since the prior study. \nThere is mucosal thickening in the bilateral maxillary sinuses. The\nvisualized portion of the remaining paranasal sinuses and middle ear cavities\nare clear. There is underpneumatization of the bilateral mastoid air cells,\nas seen on the prior study. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial hemorrhage.\n\n2. Small right frontal subgaleal hematoma without underlying fracture.\n\n3. Small focal polypoid lesion in the right nasal cavity is unchanged since\n___." + }, + { + "input": "CT HEAD:\nThere is no evidence for acute hemorrhage, vascular territorial infarction,\nmass effect, or edema. The ventricles and sulci are normal in size and\nappearance.\n\nMucous retention cysts and mucosal thickening is seen involving the bilateral\nmaxillary sinuses. There is severe leftward nasal septal deviation with\nobstruction of the left-sided nasal passages at this level.\n\nThe remainder of the paranasal sinuses, middle ear cavities, and mastoid air\ncells are clear. The orbits are grossly unremarkable bilaterally.\n\n\nCTA HEAD AND NECK:\nThe left vertebral artery arises directly from the thoracic aortic arch.\nHypoplastic/diminshed caliber of the V4 segment of the right vertebral artery\nis unchanged compared to the MRI from ___. The vertebral arteries are patent\nwithout high-grade stenosis or occlusion.\n\nThe bilateral common carotid arteries are patent. Minimal calcifications are\nseen at the bilateral carotid bulbs. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nMild calcifications are noted in the bilateral cavernous internal carotid\narteries. Allowing for this, the intracranial vasculature is grossly patent\nwithout high-grade stenosis, occlusion, or aneurysm greater than 3 mm. There\nis a fetal origin of the right posterior cerebral artery. The dural venous\nsinuses are patent.\n\n\nOTHER:\nApical pleural scarring with bronchiectasis and mucous plugging is seen at the\nright lung apex. Mild air-trapping is seen bilaterally. The thyroid gland is\nunremarkable in appearance. There is no cervical lymphadenopathy by CT size\ncriteria. Severe multilevel degenerative changes of the cervical spine are\nagain seen, better assessed on subsequent MR cervical spine.", + "output": "1. No evidence for acute intracranial process.\n2. Multifocal atherosclerosis within the intracranial and cervical\nvasculature, as detailed above, without evidence of high-grade stenosis, large\nvessel occlusion, or aneurysm. Hypoplastic V4 segment of the right vertebral\nartery is unchanged compared to the prior exam.\n3. Paranasal sinus disease and severe leftward nasal septal deviation, as\nabove.\n4. Severe, multilevel degenerative changes of the cervical spine, better\nassessed on subsequent MR cervical spine examination." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Mild brain\nparenchymal atrophy. Findings consistent with mild chronic small vessel\nischemic changes.\n\nThere is no evidence of fracture. Mild paranasal sinus disease. Otherwise,\nthe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable. Degenerative changes spine. Additional nasal polyp the\nsuperior right nasal cavity.", + "output": "No acute findings." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. The basal cisterns appear\npatent, and there is preservation of gray-white matter differentiation.\n\nThere is prominent internal frontal hyperostosis, a normal variant. No\nosseous abnormalities seen. There is polypoid mucosal thickening within the\nright anterior ethmoid air cells and the bilateral maxillary sinuses. The\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\norbits are unremarkable.", + "output": "Mild paranasal sinus inflammatory changes. Otherwise normal study. ." + }, + { + "input": "Patient is status post left craniectomy with evacuation of extra-axial\nhemorrhage. There are expected postoperative changes with pneumocephalus and\nminimal residual extra-axial blood. Midline shift is improved now measuring 7\nmm, previously 10 mm. The suprasellar cistern is slightly better visualized\nsuggesting improvement in uncal herniation. The quadrigeminal plate cistern is\nalso better seen. There is persistent but improved effacement of the left\nlateral ventricle.\n\nSmall focus of extra-axial hemorrhage along the right inferior anterior\ntemporal lobe is minimally redistributed but similar in total size (3:15).\nSubcentimeter intraparenchymal contusions in the right frontal parietal lobe\nnear the vertex are unchanged. There is no evidence of large territorial\ninfarction.\n\nFacial, calvarial and skullbase fractures are redemonstrated but better\ncharacterized on recent maxillofacial CT. There is persistent opacification of\nthe sphenoid, posterior ethmoidal and right maxillary sinuses. The mastoid air\ncells and middle ear cavities are clear. A few foci of gas underlying the\nright temporalis muscle re- demonstrated.", + "output": "1. Decrease in midline shift and uncal herniation status post left craniectomy\nwith evacuation of extra-axial hemorrhage.\n2. Small right temporal extra-axial hemorrhage and several subcentimeter\nintraparenchymal contusions near the vertex are also stable.\n3. Facial, skull base and calvarial fractures are redemonstrated." + }, + { + "input": "NONCONTRAST CT HEAD: There is no pertinent change since the same day study at\n07:56. Patient status post left craniectomy. Minimal residual extra-axial\nhemorrhage along the left hemisphere and associated postoperative\npneumocephalus is re-demonstrated. 7 mm shift rightward shift of midline\nstable. Opacification of the sphenoid, posterior ethmoid and right maxillary\nsinuses are unchanged. The mastoid air cells and middle ear cavities are\nclear. Orogastric and endotracheal tubes are in place.\n\nCTA HEAD: Equivocal hypodense linear focus traversing the petrous portion of\nthe left internal carotid artery (3:267) adjacent to a fracture in the petrous\napex. While most likely artifactual, dissection cannot be completely\nexcluded and MRA of the head with axial T1 fat sat images is recommended.", + "output": "1. Patient status post left craniectomy. Minimal residual extra-axial\nhemorrhage along the left hemisphere and associated postoperative\npneumocephalus is re- demonstrated. 7 mm shift rightward shift of midline\nstable.\n\n2. Equivocal hypodense linear focus traversing the petrous portion of the left\ninternal carotid artery (3:267) adjacent to a fracture in the petrous apex. \nWhile most likely artifactual, dissection cannot be completely excluded and\nMRA of the head with axial T1 fat sat images is recommended." + }, + { + "input": "Patient is status post left frontoparietal cranioplasty. Subcutaneous gas,\nedema, and skin staples overlying that region are noted. A thin extra-axial\nhyperdense collection vs dural thickening is present along the craniotomy\n(3:15). There is no evidence of mass effect. The ventricles and sulci are\nnormal in size and configuration. The basal cisterns are patent. Gray-white\nmatter differentiation is preserved.\n\nPartially imaged paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. Globes are unremarkable.", + "output": "Status post left frontoparietal cranioplasty. A very thin extra-axial\nhemorrhage vs dural thickening is noted along the craniotomy." + }, + { + "input": "Since the most recent study, the skin staples in the right lateral frontal\nscalp have been removed, with resolution of soft tissue swelling. As before,\nthe patient is status post left frontoparietal craniotomy with cranioplasty,\nand expected post-surgical appearance. There has been interval resolution of\nthe thin residual subdural collection, layering over the left frontal\nconvexity\n\nThere is no intra - or extra-axial hemorrhage, the midline structures are in\nthe midline, and the ventricles and cisterns are normal in size and\nconfiguration. The gray-white matter differentiation is preserved with no\nevidence of cerebral edema or space-occupying lesion.The posterior fossa\nstructures are unremarkable.\n\nOtherwise, no fracture or suspicious osseous lesion is identified.The included\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear.The\nglobes and orbits are symmetric and unremarkable.", + "output": "1. Status post extensive left frontoparietal craniotomy with cranioplasty, and\nexpected post-surgical appearance.\n2. No acute intracranial abnormality." + }, + { + "input": "The study is slightly limited by patient motion.\n\nThere is no evidence of acute major vascular territorial\ninfarction,hemorrhage,edema, or mass. Specifically, there is no definite\nevidence of subdural hemorrhage layering along the left tentorium, as\nclinically queried. The ventricles and sulci are normal in size and\nconfiguration.\n\nThere is no evidence of fracture and the bony structures demonstrates mild\nhyperostosis frontalis interna. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality identified, within the limitations of this\nmildly motion degraded study. Specifically, no evidence of an acute tentorial\nsubdural hematoma." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. There is preservation gray-white matter\ndifferentiation. The basal cisterns remain patent.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial hemorrhage or large vascular territorial infarction." + }, + { + "input": "The study is mildly degraded by motion.\n\nThere is no evidence of acute major vascular territorial\ninfarction,hemorrhage,edema, or mass. The ventricles and sulci are normal in\nsize and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process identified, within the confines of this mildly\nmotion limited study." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands are grossly without mass or adjacent fat stranding. The\nthyroid gland appears enlarged, without discrete focal lesions.There are\nnumerous prominent bilateral cervical and supraclavicular lymph nodes which\nare not pathologic by CT size criteria. The adenoids are prominent without\nfocal lesion. No evidence of fluid collection in the neck or prevertebral\nedema.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions. There is posterior\nosteophytosis at C6 resulting in mild to moderate spinal canal narrowing at\nthis level. There appears to be moderate bilateral neural foraminal narrowing\nat this level.", + "output": "1. No drainable fluid collections. No evidence of soft tissue stranding or\nprevertebral edema.\n2. Posterior osteophytosis at C6, with mild to moderate spinal canal narrowing\nat this level. There is moderate bilateral neural foraminal narrowing at this\nlevel. Clinical correlation with patient neck pain is recommended. If there\nare no contraindications and clinically indicated, MRI of the cervical spine\nwithout contrast would better evaluate spinal canal and neural foraminal\nstenosis.\n3. The adenoids are prominent. The cervical lymph nodes are prominent, but\nnot pathologic by size criteria. These may be reactive. Of note, prominent\nadenoids can be partially visualized on CT head of ___.\n4. Enlarged thyroid, without definite discrete focal lesions." + }, + { + "input": "Redemonstrated is subtle cortical hyperdensity in the left frontal and\nparietal lobes, unchanged compared to the CT from ___, which\ndemonstrated corresponding FLAIR hyperintensity and contrast enhancement on\nthe MRI from ___. There is no associated volume loss to suggest\npseudolaminar necrosis related to a chronic infarct. There is no evidence for\nassociated siderosis on the MRI from ___. Therefore,\npostinflammatory etiology is favored.\n\nThere is no evidence for acute intracranial hemorrhage, edema, mass effect, or\nacute major vascular territorial infarction. Ventricles, sulci, and basal\ncisterns are normal in size. Scattered nonspecific dural calcifications along\nthe falx (2:26) and right superior tentorium (2:13) are again noted.\n\nThere is evidence of bilateral cataract surgery. No evidence for a fracture\nor suspicious bone lesion. Mastoid air cells and partially visualized\nparanasal sinuses are well-aerated.", + "output": "1. No evidence for acute intracranial abnormalities. MRI would be more\nsensitive for an acute infarction, if clinically warranted.\n2. Unchanged cell cortical hyperdensities in the left frontal and parietal\nlobes compared to the CT from ___, which demonstrate corresponding\nFLAIR hyperintensity and contrast enhancement on the MRI from ___. \nNo interim development of volume loss to suggest pseudolaminar necrosis\nrelated to a chronic infarct. No evidence for associated siderosis on the MRI\nfrom ___. Therefore, post inflammatory etiology is favored." + }, + { + "input": "There are multiple new small subarachnoid hemorrhages involving the left\nparietal (02:15, 601b:61) and left frontal lobes (02:11, 601b:29). There is\nno evidence of infarction, edema, or mass. The ventricles and sulci are\nnormal in size and configuration.\n\nNOTE ADDED AT ATTENDING REVIEW: The areas of high density noted appear to be\nwithin the cortex, rather than in the subarachnoid space. The significance is\nuncertain. These may be calcifications, rather than hemorrhage. Magnetic\nresonance imaging is recommended for further evaluation.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Multiple new, small left-sided parietal and frontal cortical hyper density is\nof uncertain etiology. These do not appear to represent subarachnoid\nhemorrhage come but may be calcifications. Magnetic resonance imaging is\nrecommended to further evaluate. No evidence of infarction or mass. .\n\nRECOMMENDATION(S): Magnetic resonance imaging of the brain is recommended to\nevaluate the cortical hyperdensities described above\n\nNOTIFICATION: The above findings were communicated via telephone by Dr.\n___ to Dr. ___ at 04:05 on ___, immediately after discovery.\n\nFindings and recommendation for brain MR were discussed with Dr. ___ by\ntelephone by Dr. ___ at 10:10 on ___, 10 minutes after\nreviewing the images." + }, + { + "input": "CTA HEAD:\nThere is atherosclerotic calcification involving intracranial carotid\narteries, especially the cavernous carotids. Also seen is tight stenosis of\nthe left M1 segment of the middle cerebral artery as seen on image 2:207. The\nremaining vessels of the circle of ___ and their principal intracranial\nbranches appear normal without stenosis, occlusion or aneurysm formation. The\ndural venous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nIncidentally seen is medial is retropharyngeal course of the left common\ncarotid artery.\n\nOTHER:\nThe left parietal and frontal convexity hyperdense lesions are better\nevaluated on the unenhanced CT. The presence of vascular enhancement somewhat\nobscures the underlying hyperdense lesions. There is no evidence of no\nevidence of infarction, hemorrhage, edema, or mass. The ventricles and sulci\nare normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Tight stenosis of left M1 segment and supraclinoid ICA.\n2. No acute intracranial abnormality. The previously known left parietal and\nfrontal hyperdense foci are better evaluated on the prior CT." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass effect. \nThe ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of acute fracture. There is near complete opacification\nof the left maxillary sinus. Mucosal thickening of the ethmoid air cells are\nmild. The visualized portion of the remaining paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. No acute intracranial abnormalities on the noncontrast head CT.\n2. Partially imaged sinus disease in the left maxillary sinus." + }, + { + "input": "Confluent hypodensity throughout the left frontotemporal region is compatible\nwith continued evolution of recent left MCA infarction. A pipeline catheter\nis present within the left middle cerebral artery and artifact from an\naneurysm clip in the region of the distal right anterior cerebral artery. \nThere is no evidence of hemorrhage or new area of infarction. Continued mass\neffect upon the left lateral ventricle is similar compared to the prior\noutside exam. There is no shift of the normally midline structures. Right\nfrontal craniotomy changes are again noted. A right cochlear implant device\ncauses significant streak artifact and obscures posterior fossa structures.", + "output": "1. Continued evolution of left MCA infarct.\n2. No evidence of hemorrhage." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. There is mild\nprominence of the ventricles and sulci, suggestive of age-related involutional\nchange.\n\nThere is mild mucosal wall thickening of the bilateral sphenoid sinuses, along\nwith a tiny mucous retention cyst in the right maxillary sinus and trace\nmucosal wall thickening in the left frontoethmoidal recess. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare otherwise clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is punctate atherosclerotic calcification of the cavernous right\ninternal carotid artery. The vessels of the circle of ___ and their\nprincipal intracranial branches appear patent without significant stenosis,\nocclusion, or aneurysm formation. The dural venous sinuses are patent.\n\nExpansion and somewhat irregular enhancement of the left cavernous sinus is\nbetter characterized on the concurrent MR examination.\n\nCTA NECK:\nThere is a 3 vessel aortic arch. The carotid and vertebral arteries and their\nmajor branches appear patent with no evidence of dissection, significant\nstenosis or occlusion. There is no evidence of internal carotid stenosis by\nNASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.\n\nDiffuse sclerotic osseous metastatic disease is noted. There is extensive\nsclerosis of the skullbase, slightly greater on the left, involving the\npterygoid plate. There is a large sclerotic lesion involving the left\nmandibular head and neck, and tiny lesions in the right mandibular head and\nneck. Extensive sclerotic lesions are noted throughout the visualized\nvertebral bodies, ribs, sternum and bilateral clavicles as well as involvement\nof the right hyoid bone. Additional sclerotic lesion is noted in the left\nmandibular base and right mandibular angle.", + "output": "1. No intracranial hemorrhage.\n2. Extensive sclerotic osseous metastatic disease, as described, with\ninvolvement of the skullbase.\n3. Irregular expansion and enhancement of the left cavernous sinus is better\ncharacterized on the concurrent MR examination.\n4. Patent intracranial arterial vasculature without significant stenosis,\nocclusion, or aneurysm.\n5. Patent cervical vasculature without significant stenosis, occlusion, or\ndissection." + }, + { + "input": "There is no evidence for acute intracranial hemorrhage, vascular territorial\ninfarction, mass, or edema. No midline shift or mass effect. There is\nprominence of the ventricles and sulci suggestive involutional changes. There\nare periventricular and subcortical lucencies, which may represent small\nvessel ischemic changes.\n\nExtensive sclerotic osseous metastatic disease is again noted involving the\nskullbase, clivus, bilateral petrous apices, left greater than right proximal\nmandibular bones, and left superolateral orbital rim. No definite evidence\nfor fracture. Bilateral sphenoid sinus mucosal thickening with areas of high\ndensity is present (see 4:5). Left frontal sinus probable osteoma is noted\n(4:7).", + "output": "1. No evidence for acute intracranial hemorrhage, vascular territorial\ninfarction, or mass within limitations of a noncontrast head CT. Please note\nMRI of the brain is more sensitive for the detection of acute infarct.\n2. Known extensive osseous metastatic disease is again noted, as detailed\nabove.\n3. Bilateral sphenoid sinus disease concerning for acute and chronic and/or\nfungal sinusitis, as described.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 00:09 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass effect, midline shift,\nor acute major vascular territorial infarct. Gray-white matter differentiation\nis preserved. Ventricles and sulci are unremarkable.\n\nIncluded paranasal sinuses and mastoids are clear. Diffuse sclerosis of the\nskullbase, particularly the clivus is compatible with metastatic prostate\ncancer. There is also involvement of the sphenoid on the left and the\nmandibular condyles, more extensive on the left.", + "output": "No acute intracranial process.\nOsseous metastatic disease." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is mild\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is a partially visualized left orbital floor fracture (series 3, image\n1). Subcutaneous air is seen tracking inferiorly and within the orbit. See\nmaxillofacial CT for full details.\n\nDiffuse osseous sclerosis at the skullbase is again demonstrated, including\nthe clivus, bilateral sphenoids, temporal bones, and left mandible consistent\nwith known metastatic prostate cancer. Bilateral mastoid air cells are well\nopacified.", + "output": "No acute intracranial process, no hemorrhage.\nSee concurrent CT maxillofacial for detailed description of facial fractures." + }, + { + "input": "CTA NECK:\nThere is moderate narrowing of the right V2 segment at the C5 vertebral level,\nin the region of the right C5 pedicle/transverse foramen fracture. No\ndissection flap is seen. The narrowing may be secondary to progressive\natherosclerotic disease as the caliber of the vertebral artery is similar to\nexamination ___ allowing for technical differences.\n\nBy NASCET criteria, there is no stenosis of the bilateral ICAs.\n\n\nOTHER:\nIntraorbital fat is seen herniating into the left maxillary sinus, secondary\nto the previously seen left orbital wall blowout fracture.\n\nThere is fatty replacement of the right hemi tongue, compatible with\ndenervation injury.\n\nDiffuse osteosclerosis is seen involving the skullbase and visualized spine,\nlikely secondary to the patient's known metastatic prostate cancer.\n\nLarge loculated right and moderate free left pleural effusions are seen, with\nassociated compressive atelectasis.. Mediastinal, supraclavicular and\ncervical lymphadenopathy is seen.\n\nPlease refer to concurrent CT chest and cervical spine for additional details.", + "output": "1. Moderate narrowing of the right V2 segment at the C5 vertebral level, in\nthe region of a right C5 pedicle/transverse foramen fracture may be secondary\nprogressive atherosclerotic disease as this appears similar to examination of\n___ allowing for technical differences. However, given the\ndifferences in modality, sequela of dissection is not entirely excluded and if\nthere is high clinical suspicion further evaluation with MRI of the neck\nutilizing axial fat saturated T1 sequences may be of benefit.\n2. Unremarkable left vertebral and bilateral internal carotid arteries.\n3. Additional findings as described above." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. There are few scattered bilateral\npunctate calcifications in the left frontal and bilateral parietal lobes,\npossibly sequela of prior neurocysticercosis. Gray-white matter\ndifferentiation is preserved. Ventricles and sulci and unremarkable. Basilar\ncisterns are patent.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Normal study." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage, oredema. A chronic left\nbasal ganglia infarct is noted. In the posterior fossa there is a 1.1 x 1.4\ncm oblong extra-axial mass with peripheral calcifications, which may represent\na meningioma. The ventricles and sulci are normal in size and configuration\nfor the patient's age.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nethmoid air cells. The visualized portion of the remaining paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits show bilateral lens replacement.", + "output": "1. No acute large territorial infarction or intracranial hemorrhage.\n2. A 1.4 cm posterior fossa extra-axial mass with peripheral calcifications,\nlikely a meningioma.\n\nRECOMMENDATION(S): A nonemergent brain MR with contrast is recommended for\nfurther characterization." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nextra-axial spaces, ventricles, and sulci are prominent, compatible with mild\nage-related involutional changes.\n\nNo osseous abnormalities seen. Aside from small mucous retention cyst in the\nright maxillary sinus, the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are prominent suggestive of age-related volume loss. Subcortical\nhypodensities in the frontal lobes potentially due to prominent perivascular\nspaces are unchanged. Dense atherosclerotic calcifications seen within the\nintracranial ICAs.\n\nNo fracture identified. The paranasal sinuses, mastoid air cells, and middle\near cavities are essentially clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no acute hemorrhage, edema, mass effect or acute large vascular\nterritorial infarction. The ventricles and sulci are normal in size and\nconfiguration. The basal cisterns appear patent and there is preservation of\ngray-white matter differentiation.\n\nNo fracture is identified. Mucosal thickening seen in the maxillary sinuses\nand ethmoid air cells. Mucosal thickening and aerosolized debris seen in the\nleft sphenoid sinus. The mastoid air cells, middle ear cavities, and\nvisualized paranasal sinuses are otherwise clear. The globes are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There has been no significant interval shunt catheter tip extending to the the\nleft lateral ventricle anterior horn. Small ventricles again identified. No\nhydrocephalus. No midline shift. The gray-white matter differentiation is\nmaintained. There is no evidence of acute hemorrhage.\n\nThe visualized paranasal sinuses are clear. No skull fracture is seen. The\npreviously described ethmoid sinus defect is not apparent on the current study\nin the absence of reformatted images.", + "output": "No significant interval change. No Hydrocephalus identified or acute\nhemorrhage seen." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nNo significant change in size of the large right parenchymal hemorrhage\ncentered in the parietal and occipital lobes, with involvement of the\nposterior frontal and temporal lobes, which measures approximately 9.4 x 5.3\ncm in maximal axial cross-section, though the measurements are affected by the\nangle of the scan and patient head position. Surrounding edema does not\nappear significantly changed. Superomedially, the hemorrhage extends to the\nmargin of the right lateral ventricle/caudothalamic groove region, with\nrelative ___ in this area on images 2: ___, similar to prior. The\nhemorrhage compresses the right lateral ventricle, limiting evaluation for\nintraventricular blood. The left lateral ventricle is severely effaced in\nshifted to the left. Left lateral ventricle is slightly dilated, indicating\nentrapment. There is trace blood in the occipital horn of left lateral\nventricle, more conspicuous than on the prior CT. Leftward shift of midline\nstructures measures up to 8 mm compared to 7 mm previously, which again may be\nsecondary to differences in patient head position and angle of the scan. \nRight uncal herniation is again noted.\n\nThere is a small amount of hyperdense blood layering dependently within the\noccipital horn of the left lateral ventricle. There is also small amount of\nsubarachnoid hemorrhage within the right parietal vertex.\n\nSwelling and sulcal effacement within the right frontal and right anterior\ntemporal lobes could be secondary to vasogenic edema, but cytotoxic edema\nsecondary to ischemia cannot be excluded.\n\nMild mucosal thickening in the ethmoid air cells. Minimal mucosal thickening\nin the maxillary sinuses. Mastoid air cells and pneumatized petrous apices\nare well-aerated. Status post bilateral cataract surgery.\n\nCTA NECK:\nThere is a 3 vessel aortic arch. There is calcified plaque at the great\nvessel origins without evidence for flow-limiting stenosis. There is mild,\npredominantly calcified plaque within bilateral proximal internal carotid\narteries without stenosis by NASCET criteria. Right vertebral artery is\nslightly dominant and appears widely patent. There is a focus of calcified\nplaque mildly to moderately narrowing the origin of the left vertebral artery.\n\nCTA HEAD:\nThere are mild calcifications of the carotid siphons (left greater than right)\nwithout evidence for flow-limiting stenosis. There is decreased caliber of\nthe right M2/M3 branches, which may be secondary to the mass effect from the\nintraparenchymal hemorrhage/edema. P2 segment of the right posterior cerebral\nartery is smaller than the left. There are asymmetrically prominent small\nblood vessels along the medial subependymal surface of the occipital horn of\nthe right lateral ventricle, image 3:305 which may be in contiguity with the\nP2 segment of the right posterior cerebral artery. These blood vessels extend\nsuperomedially towards the caudothalamic groove, coursing through the\n___ on the noncontrast portion of the scan.\n\nThere is hyperemia within the effaced sulci of the right frontal and anterior\ntemporal lobes.\n\nThere is no evidence for an aneurysm. The dural venous sinuses are patent.\n\nOTHER:\nThe patient is intubated and there is an enteric tube in place. The\nendotracheal tube terminates approximately 4.5 cm above the carina. Fluid in\nthe nasopharynx is likely secondary to endotracheal intubation. No\npathologically enlarged cervical lymph nodes. The thyroid is grossly\nunremarkable. Main pulmonary artery enlargement, 3.3 cm, may indicate mild\npulmonary arterial hypertension. Evaluation of the included upper lungs is\nlimited by respiratory motion artifact. Biapical pleural/parenchymal\nscarring, as well as paraseptal emphysema, are present. There also branching\nnodular ___ opacities in the apical left upper lobe, with the largest\nnodular area measuring 7 mm on image 3:09. Air in the left subclavian vein on\nimage 3:91 is likely secondary to intravenous catheter placement.", + "output": "1. Stable large right parenchymal hematoma centered in the parenchymal and\noccipital lobes, with posterior frontal and temporal lobe involvement. \nEssentially stable mass effect, with 8 mm leftward shift of midline\nstructures, right uncal herniation, effacement of the right lateral ventricle\nand near complete effacement of the third ventricle, and entrapment of the\nleft lateral ventricle. New trace blood in the left lateral ventricle.\n2. Small blood vessels along the medial ependymal surface of the occipital\nhorn of the right lateral ventricle, which may be contiguous with the right\nPCA P2 segment, with small blood vessels extending superomedially towards the\nright caudothalamic groove. Noncontrast scan demonstrates more concentrate\nhyperdense blood along these blood vessels, which may represent the source of\nhemorrhage, versus reactive hyperemia. However, there is no enlargement of\nthe right PCA to indicate an arteriovenous malformation.\n3. Slightly decreased caliber of the right MCA M2/M3 branches may relate to\nmass effect from the intraparenchymal hemorrhage/edema.\n4. Sulcal effacement with associated hyperemia involving the right anterior\nfrontal and anterior temporal lobes, which may be secondary to vasogenic\nedema, though cytotoxic edema secondary to ischemia cannot be excluded.\n5. Mild atherosclerosis of the proximal internal carotid arteries without\nstenosis by NASCET criteria.\n6. Mild enlargement of the main pulmonary artery, suggesting pulmonary\narterial hypertension. Please correlate clinically.\n7. Paraseptal emphysema and pleural/parenchymal scarring at the lung apices. \nBranching nodular ___ opacities in the apical left upper lobe appear\ninflammatory.\n\nRECOMMENDATION(S): There are no recommendations as, according to the ___\nmedical record, the patient expired on ___.\n\nNOTIFICATION: The intracranial and vascular findings were discussed with ___\n___, M.D. by ___, M.D. on the telephone on ___ at\n10:35 pm, 1 minutes after discovery of the findings." + }, + { + "input": "Images are motion degraded despite repeat attempts. Within this limitation\nthe following observations are made:\n\nThere is no intra-axial or extra-axial hemorrhage, mass effect, midline shift,\nor acute major vascular territorial infarct. Gray-white matter differentiation\nis preserved. Ventricles and sulci and unremarkable. Basilar cisterns are\npatent.\n\nIncluded paranasal sinuses and mastoids are grossly clear noting mucosal\nthickening in the ethmoid air cells. Left parietal scalp hematoma noted at\nthe vertex without underlying fracture.", + "output": "Moderately motion degraded exam without visualized acute intracranial process.\nLeft parietal scalp hematoma at the vertex." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial findings noncontrast CT head. Specifically no\nintracranial hemorrhage. No acute displaced calvarial fracture." + }, + { + "input": "Dense opacification of the right aspect of the sphenoid sinus, with a areas of\ncalcification (03:35), and adjacent reactive osseous thickening implies\nchronic inflammatory disease. Mild mucosal thickening of the ethmoid air\ncells is also noted. The frontal and bilateral maxillary sinuses are mostly\nclear, with a very thin layer of mucosal thickening in the left maxillary\nsinus (03:57). The middle ear cavities and mastoid air cells are clear\nbilaterally. The ostiomeatal units are patent. The cribriform plates are\nintact. There is no nasal septal defect. The nasal septum is midline. The\nanterior clinoid processes are not pneumatized. The lamina papyracea are\nintact. The sphenoid sinus septum is midline.\n\nA periapical lucency is noted about the left lateral maxillary incisor ___\n#10) (602 B:99). Dental caries are also noted in multiple mandibular teeth on\nthe left. Multiple prominent level IA, IB, and bilateral IIA lymph nodes are\nnoted, likely reactive. Level IIA nodes measure up to 0.9 x 1.5 cm on the\nright (3:87), and 1.5 x 1.6 cm on the left (3:85).", + "output": "1. Periapical lucency about the left lateral maxillary incisor, and multiple\ndental caries, for which dedicated dental examination is recommended.\n2. Chronic inflammatory changes of the sphenoid sinus on the right, the\npossibility of fungal colonization is a consideration.\n3. Prominent submental, submandibular, and cervical lymph nodes are likely\nreactive." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass.\n\nThe ventricles and sulci are age appropriate. Scattered patchy\nperiventricular hypodensities are nonspecific but suggestive of chronic\nmicroangiopathy.\n\nThere is near complete opacification of right sphenoid sinus with central\ncalcifications, consistent with fungal colonization. The visualized portion\nof the mastoid air cells,and middle ear cavities are clear. Mild soft tissue\ndensities in both external auditory canals most likely represents cerumen. \nThe visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere are mild atherosclerotic changes along both carotid siphons without\nhigh-grade stenosis. The vessels of the circle of ___ and their principal\nintracranial branches appear normal without stenosis, occlusion, or aneurysm\nformation. The dural venous sinuses are patent.\n\nCT HEAD Perfusion:\nPerfusion color maps demonstrate no definitive perfusion abnormality.\nDecreased CBF and increased T-max demonstrated on the RAPID summary appears\nmost likely artifactual.\n\nCBF <30% volume: 6 ml\nMismatch volume: 155 ml\nMismatch ratio: 26.8\nTmax>6.0 sec volume: 161 ml\n\n\nCTA NECK:\nNormal 3 vessel aortic arch. The carotidandvertebral arteries and their major\nbranches appear normal with no evidence of stenosis or occlusion. There is no\nevidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThere is gravity dependent atelectasis. No suspicious pulmonary nodules. \nThere is mild enlargement of a multinodular thyroid gland. There is no\nlymphadenopathy by CT size criteria.", + "output": "1. No evidence of acute infarction, hemorrhage or intracranial mass.\n2. Nonspecific mild patchy periventricular hypodensities likely sequela of\nchronic microangiopathy.\n3. Patent intracranial and cervical vasculature without evidence of\ndissection, high-grade stenosis, vessel occlusion or aneurysm formation\ngreater than 3 mm.\n4. No definitive perfusion abnormality on the perfusion color maps. Rapid\nsummary of decreased CBF and increased T-max is most likely artifactual.\nCBF <30% volume: 6 ml, mismatch volume: 155 ml, mismatch ratio: 26.8, Tmax>6.0\nsec volume: 161 ml" + }, + { + "input": "There is no evidence of fracture, infarction, hemorrhage,edema,or mass. The\nventricles and sulci are normal in size and configuration for patient's age.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "Normal study." + }, + { + "input": "The patient is status post left craniotomy for tumor resection, with expected\npostoperative changes including pneumocephalus, most significant overlying the\nfrontal lobes bilaterally and within the resection site in the left temporal\nlobe. There is a small hypodensity along the posterior aspect of the\nresection bed with adjacent hyperdensity likely representing blood products,\nas well as a small of subarachnoid blood, most consistent with postoperative\nchange. There is no evidence of infarction. No residual mass is seen,\nhowever, MRI is more sensitive for the detection of intracranial masses. The\nventricles and sulci are normal in size and configuration.\n\nPostoperative changes from recent left craniotomy. There is a mucous\nretention cyst in the right maxillary sinus, similar to prior. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear\ncavitiesare otherwise clear. The visualized portion of the orbits are\nunremarkable.", + "output": "Post-operative changes status post left craniotomy and resection of left\ntemporal tumor. Evaluation for residual tumor is limited and better evaluated\nwith MRI." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "No acute intracranial process." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction, mass or midline\nshift. There is no hydrocephalus. Visualized paranasal sinuses and mastoid air\ncells are clear. There is no fracture.", + "output": "Unremarkable unenhanced head CT." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nAllowing for differences in positioning, approximately 17 x 27 mm hyperintense\nright basal ganglia hemorrhage partially effacing frontal horn of the right\nlateral ventricle is grossly unchanged compared to the prior examination of ___. There is no shift of normally midline structures. There is no new\nhemorrhage.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal with no evidence of stenosis, occlusion, or aneurysm. The dural\nvenous sinuses are patent. There are no abnormal vessels in the region of the\nhematoma. No spot sign.", + "output": "1. Stable size of hyperdense right basal ganglia hemorrhage, partially\neffacing the anterior horn of the right lateral ventricle.\n2. Normal head CTA without evidence of aneurysm or abnormal vessels in the\nregion of the hematoma." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\nThere is no evidence of fracture. The visualized portion of the mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable. Minimal sphenoid sinus mucosal thickening is\npresent.", + "output": "1. No acute intracranial process.\n2. No definite subdural hygroma or subdural hemorrhage identified.\n3. Paranasal sinus disease as described." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding.The thyroid gland is not visualize. There is no lymphadenopathy by\nCT criteria.Mild atherosclerotic calcification of the right brachiocephalic,\nbilateral common carotid and vertebral artery origins is identified. The left\nvertebral artery arises from the aorta, a very common anatomic variant. \nOtherwise, the cervical vessels are unremarkable. A right-sided Port-A-Cath\nwith tip terminating out of the field of view in the superior SVC is\nidentified.\n\nThere is centrilobular emphysematous changes. No suspicious pulmonary nodules\nare identified in the visualized lung.There are no suspicious osseous lesions.\nA a C5-C6 disc protrusion results in mild spinal canal narrowing minimally\neffacing the ventral aspect of the thecal sac. Otherwise, no high-grade\nspinal canal or neural foraminal narrowing. There is mild mucosal thickening\nof the left maxillary sinus. The visualized orbits are unremarkable.", + "output": "1. No evidence of cervical lymphadenopathy. No abnormal enhancing masses\nwithin the neck.\n2. Additional findings described above.\n3. Please refer to dedicated CT chest and CT abdomen pelvis performed on the\nsame day for additional details." + }, + { + "input": "The parotid glands and submandibular glands are unremarkable. There is no\ncervical adenopathy. The thyroid is not visualized.\n\nThe aerodigestive tract appears normal. Aerosolized debris noted in the left\nmaxillary sinus which is smaller when compared to the right. Hyperostosis of\nthe walls is also seen suggesting chronic inflammation. Included paranasal\nsinuses and mastoids are otherwise clear.\n\nVascular structures in the neck are grossly unremarkable noting\natherosclerotic calcifications at the aortic arch and origins of the great\nvessels. The left vertebral artery is seen to arise directly from the arch, a\nnormal variant.\n\nIncluded intracranial structures appear normal.\n\nNo focal suspicious osseous lesion identified. Moderate to severe\ncentrilobular emphysema is noted.\n\nThere is a 1.1 x 1.2 cm cystic lesion in the subcutaneous tissues overlying\nthe right maxilla, previously 0.9 x 0.8 cm.", + "output": "No cervical adenopathy.\nInterval enlargement of a subcutaneous cystic lesion overlying the right\nmaxilla, potentially a sebaceous cyst but to be correlated clinically." + }, + { + "input": "Mildly prominent posterior nasopharyngeal soft tissues, similar to prior. \nEvaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding.Presumed thyroidectomy. 0.5 cm nodule in the right thyroid bed\nposteriorly is similar to prior. 0.5 cm short axis lymph node medial to the\nproximal left subclavian artery is stable..There is no lymphadenopathy by CT\ncriteria. The neck vessels are patent. There is moderate narrowing of the\nproximal left subclavian artery, similar to prior. Right Port-A-Cath in place\n\nPlease refer to separately dictated CT chest report for thoracic findings. \nThere is centrilobular emphysema\nThere is periapical lucency involving posterior most remaining right\nmandibular tooth, which is more prominent compared the ___,\nconsistent with extension of periodontal disease or periapical\ninflammation/infection. Mildly worsened surrounding sclerosis, likely\nrepresent sclerosing osteitis, without evidence of osseous destruction,\nperiosteal reaction to suggest osteomyelitis. There is mild adjacent buccal\nsurface soft tissue thickening coronal image 27, adjacent to the significant\ndental artifact, suggesting inflammation, without fluid collection to suggest\nabscess.\nBilateral torus mandibularis, developmental variant. There is moderate\nmucosal thickening of the left maxillary sinus, similar to prior, with chronic\nperiostitis, mild chronic volume loss from chronic inflammation, there is no\nretro antral or pre antral soft tissue infiltration. Clear mastoid air cells,\nremaining visualized paranasal sinuses. Incomplete fusion of the posterior C1\narch, stable. Stable focus of sclerosis right lateral mass of C1. \nDegenerative changes spine.", + "output": "1. No evidence of new adenopathy.\n2. Moderate mucosal thickening left maxillary sinus with chronic periostitis,\nstable since prior.\n3. Worsening of periapical lucency involving right posterior mandibular tooth,\nmay represent extension of periodontal disease, or periapical infection,\ndental consult recommended, surrounding mild inflammatory changes in the soft\ntissues on the buccal surface. No abscess. Mildly worsened surrounding\nmandibular sclerosis, likely represent sclerosing osteitis, without periosteal\nreaction or destruction to suggest osteomyelitis.\n\nRECOMMENDATION(S): Dental consult\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 16:47 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." + }, + { + "input": "Minimal prominence of the adenoids, unchanged from prior examination. \nOtherwise, the remainder of the aerodigestive tract demonstrates no mass and\nno areas of focal mass effect. The thyroid is not visualized. A 5 mm nodule\nin the right thyroid bed is unchanged from prior exam. There is no cervical\nlymphadenopathy by size criteria. No evident increase size of lymph nodes\nfrom prior examination.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. Mild atherosclerotic calcification of the aortic arch, with mild\nnarrowing at the origin of the left subclavian artery, unchanged. Mild\natherosclerotic calcification of the right carotid bifurcation is identified. \nThe neck vessels are patent.\n\nAllowing for respiratory motion artifact and atelectasis, the visualized lungs\nare clear. No suspicious osseous lesions.\nRight-sided Port-A-Cath is visualized. Mild mucosal thickening of the left\nmaxillary sinus has minimally increased from prior exam, with hyperostosis of\nthe maxillary sinus walls, unchanged. Minimal mucosal thickening of the\nfrontal ethmoidal recesses and ethmoid air cells also identified. The\nvisualized mastoid air cells and middle ears are clear.\n\n5 mm cutaneous cystic lesion overlying the right maxilla is unchanged, likely\na sebaceous cyst. There appears to be asymmetric thickening of the right\npalpebrae (series 301, image 9), of uncertain significance. Clinical\ncorrelation is recommended. Re-identified is periapical lucency ___ tooth\nnumber 29 with associated dental caries and mild stranding of the buccal\nalveolar ridge. Mild sclerosis of the associated mandible is unchanged. \nDental caries ___ tooth number 26 is also noted. This appears similar to\nprior exam.", + "output": "1. No evidence of new adenopathy.\n2. Mild increased left maxillary sinus mucosal thickening with unchanged\nhyperostosis of the maxillary sinus walls. Clinical correlation for acute on\nchronic sinusitis.\n3. Periodontal disease as described above, similar to prior exam.\n4. Minimally increased thickening of the right palpebrae, of uncertain\nclinical significance. Clinical correlation is recommended.\n5. Additional findings as described above." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass.\nSubcortical and periventricular white matter hypodensities are nonspecific,\nlikely the sequelae of chronic small vessel ischemic disease. 2\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nethmoid air cells and bilateral maxillary sinuses. The visualized portion of\nthe remaining paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits show right lens replacement.", + "output": "1. No acute intracranial process." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. There\nis prominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is mild mucosal thickening of the bilateral ethmoid air cells. \nOtherwise, the visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. Right nasal bone deformity is likely\nchronic. Left periorbital soft tissue swelling without underlying fracture. \nThe visualized portion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality. Left periorbital soft tissue swelling\nwithout underlying cortical" + }, + { + "input": "Streak artifact limits evaluation of pons.\n\nThere is no evidence of large acute large territorial infarction, acute\nintracranial hemorrhage, edema, or mass. The ventricles and sulci are\nprominent compatible with involutional changes.\n\nA right nasal bone deformity appears well corticated without adjacent soft\ntissue swelling, new compared to ___ prior exam. No definite acute fracture.\nLeft frontal supraorbital and left parietal scalp soft tissue swelling is\nnoted.\n\nBilateral maxillary sinus and ethmoid air cell mucosal thickening is noted. \nThe visualized mastoid air cells, and middle ear cavities are clear. The\norbits are preserved.", + "output": "1. Streak artifact limits evaluation of pons.\n2. No intracranial hemorrhage or definite acute fracture.\n3. Probable chronic right nasal bone deformity with no definite soft tissue\nswelling adjacent, as described.\n4. Left frontal supraorbital and left parietal scalp soft tissue swelling.\n5. Advanced global atrophy for age.\n6. Paranasal sinus disease , as described." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is mild\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No fracture or acute intracranial process." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Basilar cisterns are\npatent.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Basilar cisterns are\npatent.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is discontinuity of the posterior\nring of C1, likely congenital in nature. There is mucosal thickening and\nmucous retention cysts involving the within the right ethmoid air cells, as\nwell as the maxillary sinuses bilaterally. The visualized portion of the\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There are multiple enlarged lymph nodes on the left. For example, a left\nsubmental lymph node measures approximately 2.2 x 1.7 cm (series 2, image 43).\nAn additional left submandibular lymph node measures approximately 1.9 x 1.1\ncm (series 2, image 32). An additional lymph node along the left jugular\nchain measures 1.7 x 1.0 cm (series 2, image 44). There is a small amount of\nfat stranding overlying the body of the mandible on the left with thickening\nof the left platysma, but no focal fluid collections.\n\nThere is no evidence of dental disease, specifically no visualized periapical\nlucency. There is mucosal thickening within the left maxillary sinus, as well\nas mucous retention cysts within the maxillary sinuses bilaterally.\n\nEvaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid appears normal. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions. Incomplete fusion of the\nposterior ring of C1 is likely congenital.", + "output": "Multiple enlarged lymph nodes on the left measuring up to 2.2 cm, within the\nleft submental (in the region of the external marker) and submandibular\nregions, extending along the left jugular chain. The lymph nodes are likely\nreactive given adjacent stranding in the subcutaneous tissues. However, the\ndifferential includes neoplasm and lymphoproliferative disorders.\n\nRECOMMENDATION(S): Follow-up imaging suggested if these do not resolve\nclinically." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Normal study." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no acute hemorrhage. There is no evidence for edema or acute loss of\ngray/white matter differentiation. There are mild hypodensities in bilateral\nperiventricular white matter and in the subcortical white matter of right\ngreater than left occipital lobes, similar to the ___ brain MRI\nallowing for differences in modalities, which are nonspecific but likely\nsequela of chronic small vessel ischemic disease in this age group. \nVentricles and sulci are age-appropriate.\n\nThere is moderate mucosal thickening in the anterior ethmoid air cells,\nextending into the left frontoethmoidal recess, with mild mucosal thickening\nin the inferior portions of left greater than right frontal sinuses. There is\nalso minimal mucosal thickening in the maxillary sinuses and along the\nanterior wall of the left sphenoid sinus. Middle ear cavities, mastoid air\ncells, and pneumatized petrous apices are well-aerated.\n\nDysconjugate gaze is noted, seen on multiple prior exams dating back to ___.\n\nCTA NECK:\nThere is a 3 vessel aortic arch. The bilateral carotid and vertebral arteries\nappear patent without stenosis, occlusion, or dissection. There is no\nevidence of carotid stenosis per NASCET criteria.\n\nCTA HEAD:\nThere is a medially projecting 2 mm outpouching at the junction of the\nanterior communicating artery and the left anterior cerebral artery (2:271,\n350:21), which may represent a small aneurysm or infundibulum. There is no\nevidence for flow-limiting stenosis in the major intracranial arteries. The\ndural venous sinuses appear patent.\n\nOTHER:\nThere is minimal biapical pleural/parenchyma scarring. Evaluation of the\nincluded upper lungs is otherwise limited by respiratory motion artifact and\nmild atelectasis. The thyroid gland appears unremarkable. There is no\nlymphadenopathy per size criteria. Facet arthropathy in the cervical spine is\nmost prominent at C2-C3 on the left, at C6-C7 on the left, and at C7-T1 on the\nleft.", + "output": "1. No evidence of acute intracranial abnormalities. Hypodensities in the\nperiventricular white matter and right greater than left occipital subcortical\nwhite matter appear similar to the ___ MRI allowing for differences in\nmodalities, nonspecific but likely sequela of chronic small vessel ischemic\ndisease in this age group.\n2. 2 mm aneurysm versus infundibulum at the junction of the anterior\ncommunicating artery and the left anterior cerebral artery.\n3. No evidence for flow-limiting stenosis in the cervical or major\nintracranial arteries.\n\nRECOMMENDATION(S): MRI would be more sensitive for an acute infarction, if\nclinically warranted. Of note, MRI has already been obtained at the time of\nfinal interpretation." + }, + { + "input": "HEAD CT:\n\nMultiple chronic infarcts are again seen, including the right thalamus,\ncaudate, and left carina radiata/lentiform nucleus/external capsule, the\nlatter with associated ex vacuo enlargement of the anterior body of the left\nlateral ventricle. There also confluent areas of low density in the\nsubcortical, deep, and periventricular white matter of the cerebral\nhemispheres, nonspecific but the sequela of chronic microangiopathy. There is\nno acute intracranial hemorrhage and no evidence for an acute major vascular\nterritorial infarct. There is stable global cerebral volume loss with\nassociated prominence of the ventricles and sulci.\n\nNo suspicious blastic or lytic osseous lesions. Moderate mucosal thickening\nof the maxillary sinuses as well as partial opacification of the ethmoid air\ncells and milder mucosal thickening of the frontal and sphenoid sinuses are\nidentified. The mastoid air cells middle ear cavities are well pneumatized\nand clear.\n\nCT PERFUSION:\n\nNondiagnostic secondary to technical factors.\n\n\nNECK CTA:\n\nThere is common origin of the right brachiocephalic and left common carotid\narteries. The carotid and vertebral arteries and their major branches are\npatent with no evidence of stenoses. There is mild atherosclerotic\ncalcification of the bilateral carotid bifurcations without cervical internal\ncarotid stenosis by NASCET criteria. There is a retropharyngeal course of the\nleft common and cervical internal carotid arteries.\n\nHEAD CTA:\n\nAtherosclerotic calcification of the bilateral cavernous and supra clinoid\nICAs is noted without evidence for flow-limiting stenosis. Anterior and\nmiddle cerebral arteries are patent. The right vertebral artery is diminutive\ndistal to the ___ with a calcification at the mid V4 segment and\napparent chronic occlusion of the distal V4 segment. The left vertebral\nartery is dominant. There is no flow-limiting stenosis elsewhere in the\nposterior circulation. There is fetal origin of the right PCA. There is no\nevidence for an aneurysm.\n\nOTHER:\n\nThere is bronchiectasis and bronchial wall thickening in the visualized upper\nlungs bilaterally, with a bronchial thickening apparently new compared to\n___, which may be infectious or an fine. The upper lobe\ndemonstrates a calcified granuloma and there are multiple calcified\nmediastinal lymph nodes, compatible with prior granulomatous disease.\n\nPalatine and left lingual tonsilliths are identified. There is mass effect on\nthe posterior aspect of the left pharynx secondary to retropharyngeal course\nof the left common and internal carotid arteries. There is no evidence for an\nexophytic mucosal mass.\n\nSevere multilevel cervical spondylosis resulting in spinal canal narrowing and\nneural foraminal narrowing is identified, previously assessed by MRI on ___.", + "output": "1. No evidence for acute intracranial abnormalities on noncontrast head CT. \nNondiagnostic CT perfusion study due to technical factors.\n2. Multiple chronic infarcts are again seen in the right thalamus, left\ncaudate, and left lentiform nucleus/corona radiata/external capsule.\n3. No flow-limiting arterial stenosis in the neck.\n4. Unchanged atherosclerotic occlusion of the distal V4 segment of the non\ndominant right vertebral artery.\n5. Bronchiectasis in the visualized upper lungs with apparent new bronchial\nwall thickening compared to ___, which may represent superimposed\ninfectious/inflammatory process versus technical differences. Clinical\ncorrelation is recommended.\n6. Severe cervical spinal stenosis, previously assessed by MRI in ___.\n\nRECOMMENDATION(S): MRI would be more sensitive for an acute infarction, if\nclinically warranted." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Prominence of ventricles and sulci likely reflect age related\ninvolutional changes. Complete opacification of the bilateral maxillary\nsinuses which contain hyperdense material, possibly representing blood\nproducts, inspissated secretions, difficult to exclude fungal colonization. \nMild opacification of the right ethmoidal air cells and right frontal sinus. \nMastoid air cells are clear as are the middle ear cavities. The bony\ncalvarium is intact.", + "output": "1. No acute intracranial process.\n2. Complete opacification of the maxillary sinuses which contain hyperdense\nmaterial, differential includes blood products, inspissated material versus\nfungal colonization." + }, + { + "input": "Extensive streak artifact from metallic density in the suprasellar cistern, S\ncompatible with coil embolization. Within this limitation, there is no\nevidence of hemorrhage, edema, or mass effect. Gray- white matter\ndifferentiation is preserved. The ventricles and sulci are normal in size and\nconfiguration.\n\nThere is no evidence of fracture. There is a small mucous retention cyst\nalong the floor of the right maxillary sinus. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are otherwise\nclear. The visualized portion of the orbits are unremarkable. There is a 2\nmm thick right frontal subgaleal hematoma with associated subcutaneous\nemphysema and overlying skin laceration.", + "output": "1. No evidence of acute intracranial abnormality on noncontrast head CT. \nSpecifically no intracranial hemorrhage.\n2. No calvarial fracture is visualized.\n3. 2 mm thick right frontal subgaleal hematoma with associated subcutaneous\nemphysema and overlying skin laceration." + }, + { + "input": "There is no hemorrhage, edema, or mass effect. Prominent ventricles and sulci\nreflect age related volume loss. Periventricular and scattered deep white\nmatter hypodensities are nonspecific though likely reflect sequela of chronic\nsmall vessel ischemia, present on prior study and unchanged. More focal\nhypodensity within the left posterior external capsule likely reflect prior\nlacunar infarct versus prior hemorrhage, also unchanged. Chronic infarct of\nthe left frontal lobe (02:23 and 602b:63) is unchanged. There is no shift of\nnormally midline structures. Basal cisterns are patent.\n\nThe orbits are unremarkable. Imaged paranasal sinuses demonstrate moderate\nmucosal thickening and partial opacification of anterior ethmoidal air cells. \nMinimal mucosal thickening involves the sphenoid sinuses and bilateral\nmaxillary sinuses. Bilateral mastoid air cells and middle ear cavities are\nclear.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Linear hypodensity in the left external capsule is unchanged,\npotentially prior lacunar infarct or sequela of prior hemorrhage. There are\nalso chronic lacunar infarcts in the body of the caudate on the left. \nConfluent periventricular and scattered subcortical white matter hypodensities\nare likely sequela of chronic small vessel disease. Small focus of\nencephalomalacia in the left frontal lobe is unchanged since prior. \nProminence of the ventricles and sulci is compatible with global volume loss.\n\nMucosal thickening noted within the right ethmoids and left maxillary sinus. \nIncluded paranasal sinuses and mastoids are otherwise clear. Skull and\nextracranial soft tissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or mass\neffect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Bilateral periventricular subcortical white matter\nhypodensities are nonspecific but most likely represent sequela of chronic\nsmall vessel ischemic changes. Likely prior infarct involving the left\nexternal capsule. There is mild sclerotic calcifications in bilateral carotid\nsiphons.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nethmoid air cells and left maxillary sinus. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nintracranial hemorrhage or large territory infarct.\n2. Confluent bilateral periventricular and subcortical white matter\nhypodensities are nonspecific, but compatible with chronic microangiopathy in\na patient of this age. Likely chronic infarct involving the left external\ncapsule." + }, + { + "input": "There is no evidence of hemorrhage, mass, mass effect or infarction. Chronic\nlacune seen in the left caudate head and left putaminal are unchanged compared\nto the prior exam. Prominence of ventricles and sulci suggest age-related\ninvolutional changes. Periventricular and subcortical deep white matter\nhypodensities are consistent with chronic small vessel ischemic disease.\n\nMucosal thickening of the left maxillary sinus is seen. The ethmoid sinuses\nalso demonstrate mild mucosal thickening. The sphenoid sinuses are clear. \nMastoid air cells, and middle ear cavities are clear. The frontal sinuses are\nclear. The globes are unremarkable.", + "output": "1. Chronic findings as discussed above, unchanged since ___. No\nevidence of hemorrhage, fracture or infarction" + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are patent and prominent in keeping with age-related volume loss.\n\nThere are multiple scattered foci of hypodensity in the periventricular and\nsubcortical white matter, relatively unchanged compared to the prior study\nfrom ___, likely secondary to small vessel ischemic disease. There is\nintracranial atherosclerotic patient.\n\nThere is no evidence of fracture. There is a mucous retention cyst in the\nright maxillary sinus. The remaining visualized paranasal sinuses and mastoid\nair cells are clear. Bilateral middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Findings of global age-related involutional changes with small vessel\nischemic disease.\n2. No acute intracranial abnormality." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no fracture. Note is made of a os odontoideum, with the os located\nnear the foramen magnum in close proximity to the clivus with a mildly\ndysplastic odontoid process. There is associated enlargement of the C1 ring. \nMucous retention cysts are seen in bilateral maxillary sinuses. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare otherwise clear. The visualized portions of the orbits are normal.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. Focal 2 mm\noutpouching of the M1 segment of the right MCA likely represents infundibulum\nof the medial lenticulostriate vessels. The dural venous sinuses are patent.\n\nCTA NECK:\nNormal ranging of the aortic arch. Bilateral carotid and vertebral artery\norigins are patent.\nThere is no evidence of internal carotid stenosis by NASCET criteria. The\ncarotidandvertebral arteries and their major branches appear normal with no\nevidence of stenosis or occlusion.\n\nOTHER:\nA 5 mm calcified granuloma is noted in the right upper lobe (3:19). Dens are\notherwise clear without focal consolidation. Mild biapical pleural\nthickening. A single subpleural cyst-like lucency is seen in the right upper\nlobe. Multiple hypoattenuating nodules, too small to characterize, are seen\nin the bilateral thyroid lobes. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Normal head CT.\n2. Incidental note is made of a dystopic os odontoideum situated at the tip of\nthe odontoid with mild enlargement of the anterior arch of C1. The os is in\nclose proximity to the clivus and is mildly discontiguous with the dysplastic\nodontoid process. This finding is likely congenital. There is no surrounding\nedema or soft tissue inflammation, but this configuration does place the\npatient at risk for atlantoaxial instability.\n3. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n4. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage or mass effect. The\narea of ischemia seen on the prior MRI of the brain involving the left\ncerebellum and left pontine region are not clearly visualized in the current\nexam. Subtle areas of low attenuation in the subcortical white matter are are\nnonspecific and may represent changes due to small vessel disease. The\nventricles and sulci appear unchanged and are normal in size and configuration\nfor the patient's age. Dense vascular atherosclerotic calcifications are\npresent in the carotid siphons and vertebral arteries. Diffuse hyperostosis\nis again seen. The orbits are unremarkable, the paranasal sinuses and the\nmastoid air cells are clear.", + "output": "There is no evidence of acute intracranial hemorrhage. The area of ischemia\ndetected on the prior MRI of the brain involving the left cerebellar\nhemisphere, and left side of pons are not clearly seen in the current exam, if\nthere is concern for new acute or subacute ischemic changes, correlation with\nMRI of the brain is recommended if clinically warranted.\n\nNOTIFICATION: The findings were discovered and discussed with ___\nNP, by ___, MD. on the telephone on ___ at 12:35 ___, 2 minutes\nafter discovery of the findings.\n\nRECOMMENDATION(S): If there is persistent concern for new acute or subacute\nischemic changes, correlation with MRI/MRA of the head are recommended for\nfurther characterization." + }, + { + "input": "There is no evidence of territorial infarction, hemorrhage, edema, or mass\neffect. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There are small mucous retention cysts in\nthe right maxillary sinus. The remaining visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process. Of note MRI would be more sensitive for\ndetection of acute ischemia." + }, + { + "input": "Evaluation below the level of the third ventricle is limited by motion\nartifact, even though images were repeated twice. No definite hemorrhage is\nseen. There is no dense for edema or mass effect. Ventricular size is upper\nlimit of normal for age. Basal cisterns are not compressed.\n\nNo calvarial fracture is seen. Right facial fractures and the paranasal\nsinuses are better assessed on the concurrent facial bone CT. There is\nsubstantial, though incomplete opacification of the included upper right\nmaxillary sinus. There is right greater than left anterior ethmoid air cell\nmucosal thickening. There is a small mucous retention cyst in the left\nsphenoid sinus. Few left mastoid tip air cells are opacified, image 3c: 5.", + "output": "1. Motion limited exam without evidence for definite acute intracranial\nabnormalities.\n2. Right facial fractures and the paranasal sinuses are better assessed on the\nconcurrent facial bone CT." + }, + { + "input": "Right zygomaticomaxillary complex fracture is present. There is a comminuted\nfracture of the lateral wall of the right orbit (2:35) and right lateral\norbital rim (2:36) with a 2 mm step-off. There is minimal extraconal hematoma\nadjacent to the fracture. The right lateral rectus does not appear thickened\nor displaced. The globes are intact.\n\nThere is a comminuted fracture of the right zygomatic arch with medial\ndisplacement of a small free fragment and overriding of the main fracture\nfragments (02:53). There is a nondisplaced fracture of the anterior wall of\nthe right maxillary sinus, as well as a comminuted fracture of the\nlateral/posterior walls of the right maxillary sinus. (02:58, 2:71). The\nright maxillary sinus is almost completely opacified with blood in peripheral\nmucosal thickening, and the right ostiomeatal unit is occluded.\n\nMild irregularity of the right nasal bone on image 2:47 is unchanged compared\nto ___ and may be secondary to a chronic fracture. No acute nasal\nbone or nasal septum fracture is definitively identified. The nasal septum is\ndeviated to the left with a left osseous spur abutting the left inferior\nturbinate, unchanged.\n\nNo basal skull fracture is seen. The pterygoid plates are intact. The\ncribriform plates are intact.\n\nThe mandible is intact. The temporomandibular joints are well aligned in\nclosed mouth position.\n\nMaxillary teeth: There is a large periapical lucency surrounding ___ 4\nroot remnant. ___ 4 crown is absent. There is also ___ 12 root remnant,\nwithout periapical lucency. ___ 13 through 14 are absent. There is large\ncaries ___ 15.\nMandibular teeth: No dental fracture or periapical lucency seen.\n\nThere is mild mucosal thickening in the inferior frontal sinuses,\nfrontoethmoidal recesses, and anterior ethmoid air cells. There is also mild\nmucosal thickening in the left maxillary sinus. The left ostiomeatal unit is\npatent. There is a small mucous retention cyst in the left sphenoid sinus and\nminimal mucosal thickening in the right sphenoid sinus.\n\nFew left mastoid tip air cells are opacified, image 2:59. Concurrent head CT\nis reported separately.\n\nThere are incompletely evaluated degenerative changes in the partially\nincluded cervical spine at C5-C6.", + "output": "1. Right zygomaticomaxillary complex fracture, including fractures of the\nright lateral orbital wall and orbital rim, zygomatic arch, anterior and\nlateral/ posterior walls of the right maxillary sinus.\n2. Small extraconal hematoma in the lateral right orbit.\n3. Unchanged chronic mild deformity of the right nasal bone, likely a chronic\nfracture.\n4. No evidence for a skullbase fracture.\n5. No evidence for a mandibular fracture. The temporomandibular joints are\nwell aligned in closed mouth position.\n6. ___ 4 root remnant with large surrounding periapical lucency and ___ 12\nroot remnant are likely secondary to prior extractions. Otherwise, no dental\nfracture is seen. Large caries ___ 15 is noted.\n\nNOTIFICATION: An electronic wet read was provided to the emergency department\nby Dr. ___. Please refer to the WET READ section regarding the timing of\nthe wet read." + }, + { + "input": "There is no acute intracranial hemorrhage edema, mass effect, or loss of gray/\nwhite matter differentiation. The ventricles and sulci are normal in size and\nconfiguration for age. Small foci of low density in the subcortical, deep,\nand periventricular white matter of the cerebral hemispheres are nonspecific,\nbut likely sequela of mild chronic small vessel ischemic disease in a patient\nof this age. Atherosclerotic calcifications are noted in bilateral carotid\nsiphons.\n\nVisualized paranasal sinuses and mastoid air cells are clear. There is no\nfracture.", + "output": "No evidence for acute intracranial abnormalities." + }, + { + "input": "The parotid glands, submandibular glands, and thyroid are unremarkable. There\nis no cervical adenopathy. There is no focal abnormality underlying the\nmarker in the left submandibular region.\n\nThe aerodigestive tract appears normal. Included paranasal sinuses and\nmastoids are clear.\n\nVascular structures in the neck are grossly unremarkable.\n\nIncluded intracranial structures appear normal. Lung apices are clear.\n\nNo focal suspicious osseous lesion identified.", + "output": "Unremarkable CT of the neck, no findings to explain patient's symptoms. No\nfocal abnormality underlying the externally placed marker on the left\nsubmandibular region." + }, + { + "input": "Evaluation is limited by severe leftward tilt of the patient's head. There is\nno evidence for acute hemorrhage, edema, mass effect, or loss of gray/ white\nmatter differentiation. Ventricles, sulci, and basal cisterns are normal in\nsize for age.\n\nVisualized bones are unremarkable. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No evidence for acute intracranial abnormalities." + }, + { + "input": "Scout images were obtained of the neck and chest. The study was then aborted\nsince the patient vomited.", + "output": "Limited evaluation due to only scout images being obtained of the neck and\nchest." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect. The platysma is minimally thickened bilaterally, left\ngreater than right. There is subtle mild soft tissue swelling of the\nsubcutaneous fat of the left neck. No drainable collection identified. No\nretropharyngeal edema is seen.\n\nThe salivary glands enhance normally. The thyroid gland appears normal.Mildly\nprominent bilateral cervical lymph nodes are present. The neck vessels are\npatent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.", + "output": "Mildly thickened platysma bilaterally with subtle mild soft tissue swelling of\nthe subcutaneous fat of the left neck. No drainable abscess or phlegmon." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThere is mild mucosal thickening in the left maxillary sinus. The mastoid air\ncells are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nare patent without stenosis, occlusion or aneurysm formation. There is fetal\norigin of the right posterior cerebral artery and fetal type origin of the\nleft posterior cerebral artery. The basilar and the left intradural vertebral\narteries are diminutive in caliber. Mild narrowing and irregularity of the\nright distal M1 segment is likely related to atherosclerotic disease. The\ndural venous sinuses are patent.\n\nCTA NECK:\nThere is a normal, three-vessel branching pattern of the aortic arch. The\norigins of the great vessels are normal. The bilateral common, external, and\ninternal carotid arteries are patent with no evidence of stenosis by NASCET\ncriteria. There is a punctate focus of atherosclerotic calcification at the\nleft carotid bifurcation.\n\nThe origins of the vertebral arteries are patent. The right vertebral artery\nis dominant and patent throughout its course. The left V3 segment in the C1\ntransverse foramen is moderately narrowed by the expansile osteolytic lesion\nin the left anterior arch of C1, but remains patent.\n\nOTHER:\nA geographic, expansile, osteolytic lesion in the left anterior arch of C1,\ninvolving the transverse process and transverse foramen, measures 4.9 x 2.2 x\n1.9 cm. No other osteolytic or osteoblastic lesions are identified.\n\nThere is a small calcified granuloma in the right upper lobe. The visualized\nlungs are otherwise clear. The thyroid gland is normal. There is no\nlymphadenopathy by CT size criteria.", + "output": "1. Moderate narrowing of the left V3 segment in the C1 transverse foramen, due\nto compression from an expansile, osteolytic lesion in the left anterior arch\nand transverse process of C1, consistent with metastases.\n2. Patent circle of ___ with mild narrowing and irregularity of the right\nM1 segment, likely related to atherosclerotic disease.\n3. No evidence of internal carotid artery stenosis by NASCET criteria.\n4. No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass. The ventricles and sulci are normal in size and configuration.There is\nno evidence of fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable. There are atherosclerotic calcification of\nthe cavernous internal carotid arteries.", + "output": "No acute intracranial process." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci and unremarkable. Basilar cisterns are\npatent.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nlarge territorial infarction.\nProminent ventricles and sulci suggest age-related involutional changes or\natrophy. The basal cisterns appear patent and there is preservation of\ngray-white matter differentiation.\nThere is a right lamina papyracea deformity, compatible with an old fracture.\nThere is mild mucosal thickening of the ethmoid, sphenoid and maxillary\nsinuses compatible with ongoing inflammation. The mastoid air cells, and\nmiddle ear cavities are clear.\n\nAtherosclerotic mural calcification of the vertebral and cavernous carotid\narteries is noted.\nThe globes are unremarkable.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "There are chronic lacunes in the left thalamus and the right corona radiata.\nThere is no evidence of hemorrhage, recent infarction, large mass or midline\nshift. The ventricles and sulci are normal in size and configuration for age.\nThe basal cisterns are patent and there is preservation of gray-white matter\ndifferentiation. The orbits are unremarkable. Moderate mucosal wall thickening\nin the bilateral ethmoid air cells, bilateral sphenoid air cells. Small mucous\nretention cyst in the right maxillary sinus. Small layering aerosolized fluid\nin the left maxillary sinus. Postsurgical material in the anterior walls of\nbilateral maxillary sinuses. Middle ear cavities and mastoid air cells are\nclear. There is no fracture.", + "output": "1. No acute intracranial abnormality.\n2. Chronic lacunes in the left thalamus and right corona radiata.\n3. Small layering aerosolized fluid in the left maxillary sinus. Correlate\nclinically for signs of sinusitis." + }, + { + "input": "There is linear high density within a sulcus of the left occipital lobe\n(602:49) suspicious for subarachnoid hemorrhage. Otherwise, there is no\nintra-axial or extra-axial hemorrhage, mass, midline shift, or acute major\nvascular territorial infarct. Periventricular and subcortical white matter\nhypodensities may be sequela of chronic small vessel disease.. There is\nprominence of the ventricles and sulci though proportionally, the ventricles\nare enlarged. Basilar cisterns are patent.\n\nIncluded paranasal sinuses and mastoids are essentially clear. Skull and\nextracranial soft tissues are unremarkable.", + "output": "High density within the left occipital sulcus concerning for subarachnoid\nhemorrhage. No additional evidence of intracranial hemorrhage.\nVentricular enlargement, out of proportion to sulci raising the possibility of\nnormal pressure hydrocephalus." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no acute large territory infarct or intracranial hemorrhage. \nPeriventricular and subcortical white matter hypodensities are nonspecific,\nbut compatible with chronic microangiopathy in a patient this age. There is\nventriculomegaly, disproportionate for the degree of cerebral volume loss. In\naddition, there is disproportionate prominence of the sylvian fissures. The\nconstellation of findings would suggest normal pressure hydrocephalus in the\nappropriate clinical setting.\n\nThe paranasal sinuses are essentially clear. The orbits are unremarkable. \nThe mastoid air cells middle ears well pneumatized and clear. No suspicious\nosseous abnormality.\n\nCTA HEAD:\nThere is fetal type origins of the bilateral posterior cerebral arteries. The\nvessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThere is common origin of the right brachiocephalic and left common carotid\narteries. The bilateral common carotid, subclavian and left dominant\nvertebral arteries are unremarkable. There is no stenosis of the internal\ncarotid artery by NASCET criteria.\n\nOTHER:\nAllowing for respiratory motion artifact and biapical mild pleuroparenchymal\nscarring, the visualized lungs are clear. There is no cervical\nlymphadenopathy by size criteria. The visualized aerodigestive tract is\nunremarkable. The thyroid demonstrates a subcentimeter hypoattenuating nodule\nin the right lobe, unchanged. The patient is status post bilateral\nlaminectomies and fusion with right-sided plate and screws traversing C3\nthrough C7, unchanged from recent exam. Re-identified is a minimally\nenhancing for midline fluid collection measuring approximately 1.5 x 0.6 cm\n(TRV, AP) most compatible with a postoperative seroma however clinical\ncorrelation is recommended. Multilevel cervical spondylosis including 3 mm\nanterolisthesis of C7 on T1, severe loss of disc height with endplate\nsclerosis and subcortical cystic change spanning C3-C4 through C6-C7, severe\nright C4-C5 and severe left C5-C6 neural foraminal narrowing.", + "output": "1. Constellation of findings including a disproportionately prominent\nbilateral sylvian fissures, ventriculomegaly disproportionate to degree of\ncerebral volume loss, is suggestive of normal pressure hydrocephalus in the\nappropriate clinical setting. Clinical correlation is recommended.\n2. No acute intracranial abnormality on noncontrast head CT. Periventricular\nand subcortical deep white matter hypodensities are nonspecific, but\ncompatible with chronic microangiopathy in a patient of this age.\n3. Unremarkable CTA of the head neck.\n4. Cervical postsurgical findings as described above, unchanged from recent CT\nof ___. A postoperative fluid collection demonstrating mild\nperipheral enhancement in the surgical bed is unchanged, and is most\ncompatible with a postoperative seroma. Clinical correlation is recommended\nto exclude early infectious process.\n5. Additional findings described above." + }, + { + "input": "The patient is status post right frontal ventriculoperitoneal shunt placement\nwith a frontal burr hole, with small volume postprocedural pneumocephalus and\nthe tip of the catheter adjacent to the septum pellucidum. Compared to the\nmost recent prior study, the ventriculomegaly is unchanged. There is no\nevidence of acute infarction,hemorrhage,edema,or mass. Periventricular and\nsubcortical white matter hypodensities are nonspecific, but most likely\nsequela of chronic ischemic small vessel disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Interval placement of a right frontal VP shunt, with small volume\npostprocedural pneumocephalus and the tip of the catheter terminating adjacent\nto the septum pellucidum.\n2. Unchanged hydrocephalus. No evidence of hemorrhage." + }, + { + "input": "Previously seen mixed density right-sided subdural hematoma has minimally\nchanged. A shunt catheter extending from the right frontal region and\nprojected over the right left lateral ventricle with the tip near the septum\npellucidum also remains unchanged. There is mild dilatation of the left\nlateral ventricle and mass effect of the right lateral ventricle which is also\nunchanged.", + "output": "Right-sided subdural hematoma and the appearances are minimally changed since\nthe previous CT of ___." + }, + { + "input": "There is a right frontal burr hole with an EVD which terminates in the frontal\nhorn of the right lateral ventricle.\n\nThere is a re-demonstrated high-density extensive right subdural hematoma,\nwhich measures up to 1.5 cm in depth, unchanged. Blood products layering\nalong the tentorium are unchanged. 6 mm of rightward midline shift and\neffacement of the third and right lateral ventricle are both mildly improved. \nMild right uncal herniation appears unchanged.\n\nThere is a trace left subdural hematoma overlying the left parietal lobe\nmeasuring up to 3 mm in depth, unchanged allowing for scanning obliquity on\nthe prior study. Subdural hematoma layering along the clivus as well as the\nforamen magnum is unchanged.\n\nThe left ventricle appears stable morphology. No new focus of hemorrhage or\nlarge territorial infarction.\n\nTrace secretions are noted in the sphenoid sinus. The paranasal sinuses and\nthe mastoid air cells are otherwise clear. The orbits are unremarkable.", + "output": "1. Bilateral subdural hematomas, unchanged in size. Leftward midline shift\nand effacement of the right lateral and third ventricles appears mildly\nimproved. Mild right uncal herniation is unchanged. No new focus of\nhemorrhage or large territorial infarction.\n2. Additional findings described above." + }, + { + "input": "Leftward tilt of the patient's head limits evaluation comparison to the prior\nstudy.\n\nHigh-density right subdural hematoma is stable allowing for differences in\npatient head position. Trace hyperdense left subdural hematoma is probably\nalso stable allowing for differences in head position, image 2:19. Subdural\nhematoma overlying the bilateral tentorium also appears stable. Subdural\nhematoma along the clivus to the level of the foramen magnum is likewise\nstable.\n\nThere is persistent leftward midline shift of 5 mm and persistent minimal\nright uncal herniation without compression of the midbrain. Effacement of the\nright lateral and third ventricles is stable allowing for differences in\npatient head position. Dilatation of the left lateral ventricle is stable.\nThe right frontal approach VP shunt catheter terminates in the frontal horn of\nthe right lateral ventricle, unchanged.\n\nThere is no evidence of fracture. There is mild bilateral ethmoidal air cell\nmucosal thickening. Mastoid air cells appear well-aerated.", + "output": "1. Allowing for differences in patient head position, the right greater than\nleft convexity subdural hematomas, bilateral para tentorial subdural\nhematomas, and para clival subdural hematoma are stable. Associated mass\neffect is stable.\n2. Stable size of the ventricles. Stable position of the VP shunt catheter." + }, + { + "input": "No significant change in size of subacute right subdural hematoma overlying\nthe right frontal and temporal lobes measuring up to 14 mm in maximal\nthickness. Trace left subdural hematoma is barely perceptible on the current\nstudy, also not significantly changed. Subdural hematoma along the tentorium\nbilaterally and along the clivus is also not significantly changed. No new\nhemorrhage. Unchanged position of a right frontal approach ventriculostomy\ncatheter which terminates in the frontal horn of the left lateral ventricle. \nThe right lateral ventricle appears less effaced compared to prior. \nVentricular size all otherwise not significantly changed. Leftward midline\nshift measuring approximately 5 mm is not significantly changed.\n\nNo acute osseous abnormalities seen. The paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No significant change in size of the dominant subdural collection along the\nright convexity or smaller subdural collections along the left convexity, the\ntentorium bilaterally, or along the clivus.\n2. No significant change in associated mass effect with approximately 5 mm of\nleftward midline shift. Slight interval improvement in the effacement of the\nright lateral ventricle may reflect slightly improved mass effect or\ndeveloping hydrocephalus. Ventricular size is otherwise unchanged." + }, + { + "input": "There is been evolution of a right subdural hematoma, measuring up to 1.4 cm\nfrom the inner table of the calvarium. A more focal area of high density\nwithin the collection is not significantly changed in appearance from prior \nThere is no significant change in 5-6 mm of leftward midline shift. There is\nno evidence of acute large territorial infarction or mass. A right frontal\napproach ventriculostomy catheter terminates in the frontal horn of the right\nlateral ventricle. There is slight increase in effacement of the right\nlateral ventricle.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Evolution of right subdural hematoma, unchanged in size but the density\nhas slightly decreased. A more focal area of high density within the\ncollection is not significantly changed in appearance from prior.\n2. 5-6 mm of leftward midline shift, not significantly changed.\n3. Slight increase in effacement of the right lateral ventricle.\n4. A shunt catheter contacts the septum pellucidum and is unchanged." + }, + { + "input": "Right subdural hematoma measures up to 1.4 cm from the inner table of the\ncalvarium, unchanged when compared to most recent prior CT head dated ___, (series 2, image 16). Again seen, is a 2.4 x 1.4 cm, focal hyperdense\narea within the subdural collection, unchanged when compared to prior. There\nis an unchanged, 5-6 mm, leftward midline shift, (series 2, image 16). There\nis no evidence of an acute large territorial infarction. The right frontal\napproach ventriculostomy catheter terminates at the septum pellucidum. There\nis stable effacement of the right lateral ventricle.", + "output": "1. Stable right subdural hematoma with an unchanged hyperdensity within the\nsubdural collection.\n2. Stable left midline shift of 5-6 mm.\n3. Stable effacement of the right lateral ventricle.\n4. Unchanged position of the shunt catheter." + }, + { + "input": "A shunt catheter extending from the frontal horn of the right lateral\nventricle is in unchanged position.\n\nThere has been interval placement of a surgical drain within the mixed density\nright frontal subdural hematoma. Allowing for difference in positioning, the\nsize of the hematoma is unchanged with a diameter measuring up to 16 mm from\nthe inner table of the skull. 6 mm of leftward midline shift and moderate\neffacement of the right lateral and third ventricles is also unchanged. There\nis new expected pneumocephalus. The ventricles are essentially unchanged in\nmorphology. There is no large territorial infarction or new focus of\nhemorrhage. The basilar cisterns are patent.\n\nThe orbits are unremarkable. The paranasal sinuses and mastoid air cells are\nclear. A new burr hole is noted in the right frontal cranium at the site of\nsurgical drain placement.", + "output": "1. Interval right frontal drain placement. Unchanged, large right frontal\nmixed density subdural hematoma. Effacement of the right lateral and third\nventricles, as well as 6 mm of leftward midline shift is also unchanged. No\nevidence of worsening hydrocephalus. No large territorial infarction or new\nhemorrhage.\n2. Additional findings described above." + }, + { + "input": "Previously seen side right-sided subdural drain has been removed. Mixed\ndensity right-sided subdural hematoma along with air has not significantly\nchanged in size and extent compared to the prior study in still measures\napproximately 16-18 mm in maximum width. Mass effect on the right lateral\nventricle is again identified with midline shift. The anterior horn of the\nright lateral ventricle is not fully visualized on the current study which may\nsuggest slightly increased mass effect. The lateral ventricle on the left is\nstill mildly dilated as before. A right-sided frontal shunt projects or near\nthe septum pellucidum.", + "output": "The right-sided subdural drain has been removed. Although the subdural\nhematoma on the right may not have significantly changed in size slight\nincrease in mass effect is seen on the right lateral ventricle. Close\nfollow-up as clinically indicated." + }, + { + "input": "Compared to ___, again seen is a mixed density right-sided subdural\nhematoma with associated pneumocephalus. Overall thickness of collection\nmeasuring up to 1.4 cm in greatest dimension. There is associated sulcal\neffacement. Slight interval decrease in mass effect upon the right lateral\nventricle with a narrowed appearance of the frontal horn of the right lateral\nventricle (previously completely opacified). There has been mild increase in\nthe degree of right-to-left shift of the normally midline structures,\nmeasuring 0.8 cm, previously 0.6 cm (series 2/image 16). Again seen is mild\ndilatation of the left lateral ventricle. A right frontal approach\nventriculostomy catheter terminates at the septum pellucidum. There is no\nevidence of acute large territorial infarction.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Stable right hemispheric mixed density subdural collection. Minimally\nincreased in midline shift.. Stable dilatation left lateral ventricle." + }, + { + "input": "Patient is status post right frontal burr hole for subdural drain placement\nwith interval decrease in mixed density right-sided subdural hematoma which\nnow measures up to 0.9 cm at its greatest dimension, previously 1.4 cm. This\nresults in mild decrease in the left-sided midline shift which now measures 4\nmm, previously 6 mm. Pneumocephalus is re-demonstrated and slightly decreased\nfrom prior mild dilation of the left lateral ventricle persists. A right\nfrontal approach ventriculostomy catheter terminates at the septum pellucidum,\nunchanged. There is no evidence of acute large territorial infarction or new\nintracranial hemorrhage. The ventricles and sulci are otherwise stable in\nsize and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Status post right frontal burr hole and subdural drain placement with\ninterval decrease in subdural hematoma and mild decrease in leftward midline\nshift.\n2. Stable dilation of the left lateral ventricle.\n3. No new intracranial hemorrhage identified." + }, + { + "input": "Right-sided subdural hematoma is again identified with a subdural drain in\nposition. A right-sided ventricular drain tip is near the septum pellucidum. \nMild mass effect is seen on the right side sulci. No acute hemorrhage is\nseen.\n.", + "output": "No significant change since ___. No acute hemorrhage." + }, + { + "input": "Compared to ___, no significant change, again seen is a right-sided\nholohemispheric subdural hematoma, measuring up to 0.9 cm in greatest axial\ndimension with a subdural drain in place. There is also a right frontal\napproach ventriculostomy catheter with tip in the anterior horn of the right\nlateral ventricle adjacent to the septum pellucidum. As before, there is\nassociated mild sulcal effacement. There is approximately 0.5 cm unchanged\nright to left shift of the normally midline structures. Again seen is mild\ndilatation of the left lateral ventricle. There is periventricular and\nsubcortical white matter hypodensity, which is nonspecific, but likely\nrepresents chronic microvascular ischemic changes. There is no evidence of\nacute large territorial infarction or mass.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Compared to ___, no significant change. Stable right\nholohemispheric subdural hematoma. 5 mm leftward midline shift is unchanged\nfrom prior exam.\n2. Stable right subdural drain and right frontal approach ventriculostomy\ncatheter." + }, + { + "input": "VP shunt in place via right frontal burr hole terminates in the frontal horn\nnear septum pellucidum. Previously seen right hemispheric subdural collection\nhas nearly resolved, with 2 mm thick residual low-density fluid and/or dural\nthickening midline shift has resolved probably stable ventricular system,\nright ventricle has re-expanded secondary to decreased mass effect. Findings\nconsistent with moderate to severe chronic small vessel ischemic changes. No\nevidence of acute hemorrhage, infarct, midline shift. Right parietal burr\nhole.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Interval nearly resolved right hemispheric fluid collection. No acute\nhemorrhage.\nMildly prominent ventricular system, probably similar.\nFindings consistent with moderate to severe chronic small vessel ischemic\nchanges; component of periventricular edema cannot be excluded." + }, + { + "input": "VP shunt in place via right frontal burr hole, tip near septum pellucidum. \nVentricles have mildly decreased in size since ___. Trace residual\nright hemispheric dural thickening or chronic subdural fluid collection\nmeasuring 2 mm. Findings consistent with severe chronic small vessel ischemic\nchanges. No new hemorrhage.\n\nTrace mucosal thickening sphenoid sinus, right maxillary sinus. Clear\nmastoids. Clear paranasal sinuses, mastoids.", + "output": "No new hemorrhage.\nDecreased ventricular size." + }, + { + "input": "The patient is status post right frontal burr hole VP shunt placement, with\nthe tip near the septum pellucidum unchanged in appearance compared to the\nprior exam. The ventricular size is unchanged compared to the prior exam from\n___. There is no evidence of acute intracranial hemorrhage or\ninfarction. Periventricular and deep subcortical white matter hypodensities\nare likely sequelae of chronic microangiopathy. The basilar cisterns are\npatent, and there is otherwise good preservation of the gray-white matter\ndifferentiation.", + "output": "1. Stable position of the right frontal approach ventricular catheter. No\nsignificant interval change in the size of the ventricles compared to the exam\nfrom ___." + }, + { + "input": "VP shunt in place via right frontal approach, tip abuts septum pellucidum. \nStable ventricular size, with mildly prominent temporal horns. Ventricles are\nnot slit-like. No extra-axial fluid collections. Findings consistent with\nmoderate chronic small vessel ischemic changes, stable. No acute infarct,\nhemorrhage, midline shift.\n\nNo fracture. Right parietal burr hole. Clear mastoids. Mild mucosal\nthickening paranasal sinuses.", + "output": "VP shunt in place, stable ventricular size.\nNo evidence of over shunting.\nNo acute findings." + }, + { + "input": "Right frontal approach ventriculostomy seen with tip abutting the septum\npellucidum. Ventricles are smaller when compared to ___. For\nexample, the third ventricle measures 5 mm, previously 8 mm. Slightly\nprominent 2-3 mm low-density extra-axial fluid density seen overlying the\nbilateral frontal lobes, new since prior. No midline shift. There is no\nintra-axial or extra-axial hemorrhage. White matter hypodensities are again\nnoted.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "Stable right frontal approach ventriculostomy catheter.\nSlight interval decrease in size of the ventricles as above.\nThin, 2-3 mm low-density extra-axial fluid overlying the bilateral frontal\nlobes, potentially small subdural effusions." + }, + { + "input": "Again seen is a right frontal approach ventriculostomy catheter with distal\ntip abutting the anterior aspect of the septum pellucidum, unchanged in\ncomparison to the prior study. Linear hyperintensity (2; image 20) at the\nextra-axial space in the region of the catheter is likely postsurgical and\nsimilar to the prior study. There is no significant interval change in\nventricular size. Again seen are hypodense collections in the extra-axial\nspaces overlying the bilateral frontal lobes, measuring up to 4 mm on the\nright, unchanged in size or appearance in comparison to CT dated ___.\n\nThere is no evidence of acute territorial infarction,acute hemorrhage,edema,or\nmass. There is no midline shift or effacement of the basilar cisterns. \nPeriventricular and subcortical hypodensities are nonspecific but compatible\nwith sequela of chronic small vessel ischemia.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No significant interval change in comparison to head CT from ___.\n2. Specifically, the right frontal approach ventriculostomy catheter appears\nunchanged in position with stable appearance of the ventricles and unchanged\nextra-axial collections overlying the right greater than left frontal lobes\ncompatible with subdural hygromas versus chronic subdural hematomas." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nPatient is status post right frontal approach ventriculostomy, which is\nre-demonstrated in unchanged position. There is mild prominence of the\nventricles bilaterally, which are slightly smaller compared to prior. \nLow-density extra-axial fluid overlying the bilateral frontal lobes is\nslightly more prominent, and may represent enlarging hygromas. No evidence of\nherniation or midline shift. No large territory infarct, hemorrhage edema or\nmass.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs demonstrate mild biapical scarring. The\nvisualized portion of the thyroid gland is within normal limits. There is no\nlymphadenopathy by CT size criteria.", + "output": "1. No evidence of acute infarct, hemorrhage or mass. No large vessel\nocclusion, stenosis or dissection.\n2. Mild interval worsening of bilateral frontal hygromas." + }, + { + "input": "Bilateral acute on chronic subdural hematoma, right greater than left, which\nextension along the frontoparietal convexity bilaterally. These measure 1.3\ncm (02:17) on the right and 0.6 cm (02:16) on the left in maximal width. \nThere is 3 mm leftwards shift of normally midline structures. Mild effacement\nof the right sided sulci in comparison to the left is noted. No\nintraparenchymal hemorrhage. No subarachnoid hemorrhage. There is no\nevidence of infarction, edema or mass. Prominence of the ventricles and sulci\nare consistent with age-related cortical volume loss. Periventricular,\nsubcortical and deep white matter hypodensities are likely sequelae of chronic\nsmall vessel ischemic disease.\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. Calcification of bilateral cavernous portions\nof internal carotid arteries are noted. Soft tissue density within bilateral\nexternal auditory canals is most consistent with cerumen.", + "output": "1. Bilateral acute on chronic subdural hematomas, right greater than left,\nwith 3 mm leftwards shift of normally midline structures and mild effacement\nof the sulci, right greater than left.\n2. No intraparenchymal hemorrhage.\n3. Chronic changes as described above." + }, + { + "input": "Again seen are bilateral acute on chronic subdural hemorrhage, right greater\nthan left, not significantly changed from prior study from a day ago. 3 mm\nleftward shift of midline structures is stable. No new hemorrhage or\ninfarction are seen. The ventricles and sulci are unchanged in size and\nconfiguration.\n\nNo osseous abnormalities seen. Limited evaluation of the paranasal sinuses,\nmastoid air cells, and middle ear cavities appear clear. The orbits are\nunremarkable.", + "output": "Stable acute on chronic bilateral subdural hemorrhage. No new hemorrhage or\ninfarction." + }, + { + "input": "There is expected evolution of bilateral subacute on chronic subdural\nhematomas, right greater than left, measuring 8 mm on right (previously 11 mm)\nand 3 mm on left (previously 4 mm) with expected evolution of blood products. \nThere is stable 2 mm leftwards shift of normally midline structures. \n(previously 2 mm). There is no evidence of acute large territorial infarction,\nedema, or mass.\n\nThe ventricles are slightly larger since previous examinations dating back to\n___ most notable along the left atria which now measures 14 mm\n(previously 12 mm.) (04:15) and likely related to reducing mass effect.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable. Mild calcification\nof the vertebral arteries and cavernous portions of internal carotid arteries\nare noted.", + "output": "1. Minimal increase in size of lateral ventricles since ___ is most\nlikely related to reducing mass effect from subdural hematomas.\n2. Expected evolution of blood products within bilateral subacute on chronic\nsubdural hematomas which are stable in size causing 2 mm leftwards shift of\nnormally midline structures.\n3. No acute large territorial infarction. Of note MR is more sensitive in\ndetection of infarcts." + }, + { + "input": "Previously seen subdural hematoma has resolved. No acute hemorrhage is seen. \nMild to moderate brain atrophy identified. No midline shift or hydrocephalus.", + "output": "Resolution of previously seen subdural hematoma. No acute hemorrhage." + }, + { + "input": "The gray-white matter differentiation is intact without acute territorial\ninfarct, hemorrhage, mass, or mass effect. There is nonspecific\nperiventricular white matter hypodensity likely reflecting sequela of chronic\nmicroangiopathy. There is a prominence of ventricles mildly out of proportion\nto the degree of prominent cortical sulcation which is increased in comparison\nto prior study from ___, at which point the patient had bilateral\nsubdural hematomas, but similar in appearance to examination of ___. \nThe ___ index measuring 0.32 and the callosal angle at the posterior\ncommissure measures 118 degrees. The extra-axial spaces are unremarkable. \nThere is calcification of the bilateral intracranial internal carotid\narteries.\n\nThe bilateral lenses are absent. All the calvarium and soft tissues are\nunremarkable. There is motion artifact at the skullbase which limits spatial\nresolution of this level. There is mild soft tissue stranding at the\nposterior upper cervical neck (2:3)", + "output": "1. Increased prominence of the ventricles in comparison to ___ which\nmay represent re-expansion following resolution of the previously seen\nsubdural hemorrhages and similar in appearance to examination of ___.\nThe differential includes communicating hydrocephalus or normal pressure\nhydrocephalus. Recommend clinical correlation.\n2. No intracranial hemorrhage or acute territorial infarction.\n3. Mild soft tissue stranding and the posterior upper neck is unchanged from\nprior exam. Clinical correlation is recommended.\n\nRECOMMENDATION(S): The findings were discussed by Dr. ___ with Dr.\n___ on the ___ ___ at 4:36 ___, 10 minutes after discovery of\nthe findings." + }, + { + "input": "There is no evidence of acute vascular territorial infarction, hemorrhage,\nedema, or mass. The ventricles and sulci are prominent, compatible with\nglobal involutional change, and stable since the prior study from ___. Calcifications are again noted within the intracranial portions of the\nbilateral internal carotid arteries. Prior lens replacement surgery is\nevident bilaterally. Polypoid mucosal thickening is present in the anterior\nleft maxillary sinus. The remaining paranasal sinuses and mastoid air cells\nare grossly clear.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci in an atrophic pattern appropriate to\nage.\n\nThere is no evidence of fracture. There is a small mucous retention cyst in\nthe left maxillary sinus. There is mild mucosal thickening in the anterior\nethmoid air cells and frontoethmoidal recesses. The visualized portion of the\nmastoid air cells and middle ear cavities are clear. The orbits are\nunremarkable other than lens replacement. Bilateral carotid siphon\ncalcification is moderate.", + "output": "Chronic findings as noted above. No evidence of hemorrhage, fracture or\ninfarction." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nNo acute fracture is seen. Mucous retention cysts are seen within the left\nmaxillary sinus and a posterior right ethmoid air cell. Fluid and aerosolized\nsecretions are seen within the left sphenoid sinus. Remaining visualized\nparanasal sinuses, mastoid air cells, and middle ear cavities appear clear.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute large territory infarct,hemorrhage,edema, or\nmass effect. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mucosal thickening of the left\nmaxillary sinus with an air-fluid level and aerosolized secretions. There is\na deformity of the right lamina papyracea, likely a old fracture. There is\nmucosal thickening of the ethmoid air cells. Mastoid air cells are clear. \nThe visualized portion of the orbits are unremarkable. There is a small right\nfrontal soft tissue hematoma.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nlarge territory infarct or intracranial hemorrhage.\n2. Small right frontal soft tissue hematoma. No evidence of acute displaced\ncalvarial fracture.\n3. Air-fluid level in the left maxillary sinus, correlate with symptoms of\nacute sinusitis." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass effect. \nProminent ventricles and sulci are suggestive of age-related involutional\nchange. Periventricular white matter hypodensities, seen predominately\nadjacent to the occipital horns of the bilateral lateral ventricles, is\nconsistent with chronic small vessel ischemic disease. These chronic changes\nare progressed since ___.\n\nNo osseous abnormalities seen. Soft tissue swelling of the left frontal scalp\nnoted. The paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality. Mild left frontal scalp soft tissue\nswelling." + }, + { + "input": "There has been marked interval improvement in the vasospasm when compared to\n___ , with mild residual narrowing of the right M1 segment just distal to\nthe right anterior temporal artery origin. The right posterior communicating\nartery remains patent. The proximal portion of this vessel, and portions of\nthe right circle of ___, are largely obscured by streak artifact from the\nadjacent coil pack. There is no evidence of new aneurysm. Increased density\nin the cortex of portions of the right temporal and parietal lobes is\ncompatible with the evolution of the patient's known infarct, better evaluated\non the recent noncontrast head CT.", + "output": "1. Interval improvement in vasospasm with mild residual narrowing of the\nright M1 segment.\n\n2. Evolving right MCA infarct better demonstrated on recent noncontrast head\nCT." + }, + { + "input": "The previously described focus of hyperdensity in the left temporal lobe\nmeasuring approximately 6 mm is unchanged (601:48). There is no evidence of\nacute territorial infarction, edema, or mass effect. No other evidence of\nhemorrhage. The ventricles and sulci are normal in size and configuration.\n\nNo acute fractures are seen. Aside from a tiny mucous retention cyst in the\nsphenoid sinus and mild mucosal thickening in the left maxillary sinus, the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\norbits are unremarkable.", + "output": "A 6 mm hyperdensity in the left temporal lobe is unchanged. While\nnonspecific, this may represent a small parenchymal contusion or may represent\nanother hyperdense structure such as a cavernoma. Correlation with previous\nimaging could be of use if performed remotely at an outside institution\notherwise, longer term follow-up or MRI may help further delineate etiology." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass. The ventricles and sulci are mildly prominent, consistent with\ninvolutional changes.\n\nThere is a left parietal soft tissue swelling without underlying or other\nfracture. No osseous abnormalities seen. The frontal sinuses are aplastic. \nThe paranasal sinuses, mastoid air cells, and middle ear cavities are\notherwise clear. The orbits are unremarkable.", + "output": "Left parietal soft tissue swelling without underlying or other fracture. No\nacute intracranial abnormality." + }, + { + "input": "There is mild asymmetric fullness of the palatine tonsils, right greater than\nleft. There is with a vague area of slight hypodensity in the right\ntonsil(02:38), possibly early phlegmon formation, with no drainable fluid\ncollection identified. Extensive dental hardware artifact however limits full\nassessment particularly at the upper portions of the tonsils. Otherwise,\nevaluation of the aerodigestive tract demonstrates no exophytic mass, nor\nareas of focal mass effect.\n\nBilateral level II and III cervical lymphadenopathy is noted, measuring up to\n15 x 12 mm on the right, and 10 x 17 mm on the left (2:44, 46; 2:74). The\nvisualized salivary glands are unremarkable in appearance. A subcentimeter\nright thyroid nodule is incidentally noted (2:77). Neck vessels are patent.\nUpper lung fields are clear. No acute osseous abnormality is seen.", + "output": "1. Fullness of the palatine tonsils, right greater than left, with possible\nearly phlegmon formation on the right. No drainable abscess is identified.\nEvaluation of the superier aspect of the tonsils is limited due to extensive\ndental hardware artifact. No evidence of upper airway compromise.\n2. Bilateral cervical lymphadenopathy, likely reactive." + }, + { + "input": "Extensive dental hardware limits the full evaluation of the inferior border of\nthe tonsils. There is likely bilateral tonsillitis, more prominent on the\nleft with soft tissue edema and haziness of fat in the left lateral pharyngeal\nand jugulodigastric spaces. An asymmetric hypodensity adjacent to the left\npalatine tonsil measuring approximately 2.3 x 1.2 cm could represent early\nphlegmonous change. No drainable fluid collection is identified. There is no\nretropharyngeal edema.\n\nThere is persistent cervical and supraclavicular lymphadenopathy. For example,\na right cervical lymph node measures 14 x 9 mm (series 3:33). A large right\nsupraclavicular lymph node measures 1.6 x 1.3 cm (02:56). These are unchanged\nsince prior study. The visualized salivary glands are unremarkable in\nappearance. The neck vessels are patent. The visualized lung apices are clear.\nOsseous structures are grossly unremarkable.", + "output": "Bilateral tonsillitis, more prominent on the left. 2.3 x 1.2 cm hypodense area\nadjacent to the left palatine tonsil could represent early phlegmonous change.\nAssociated cervical edema noted. No drainable abscess identified. Bilateral\ncervical and supraclavicular lymphadenopathy is likely reactive." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect.\n\nEvaluation of the soft tissue structures is limited due to significant streak\nartifact from the dental amalgam. The salivary glands enhance normally and\nare without mass or adjacent fat stranding. The thyroid gland appears normal.\nThere is no lymphadenopathy by CT criteria. The neck vessels are patent, but\nthere are atherosclerotic calcifications of the bilateral carotid\nbifurcations.\n\nThere are no osseous lesions. Mild multilevel degenerative changes of the\ncervical spine are present.", + "output": "Evaluation is limited due to significant streak artifact from the dental\namalgam. Within this limitation, the aerodigestive tract demonstrates no\nevidence of mass or focal mass effect." + }, + { + "input": "Dental almalgam streak artifact limits study.\n\nNONCONTRAST HEAD CT:\n\nThe gray-white matter differentiation is intact without CT evidence of large\nterritorial infarct, hemorrhage, mass, or mass effect. There are\nperiventricular and subcortical lucencies, which may represent small vessel\nischemic changes. There is prominence of the ventricles and sulci suggestive\ninvolutional changes. There is calcification of the pineal gland. \nAtherosclerotic vascular calcifications are noted of bilateral vertebral and\ncavernous portions of internal carotid arteries.\n\nThere is mild thickening and calvarium with a mixed lytic and sclerotic\nappearance.\n\nThe soft tissues are unremarkable. There is a left maxillary sinus mucous\nretention cyst versus polyp. The mastoid air cells and middle ears are clear.\n\nHEAD CTA:\n\nThere is dense calcific atherosclerosis of the bilateral carotid siphons\nwithout significant luminal stenosis. The anterior communicating and right\ncommunicating arteries are visualized. There is a left fetal origin posterior\ncerebral artery. There are codominant vertebral arteries with focal calcific\natherosclerosis at the V3 V4 junction. The anterior and posterior circulations\nare patent without occlusion, dissection, significant stenosis, or aneurysm. \nThere is fenestration of the proximal basilar artery.\n\nNECK CTA:\n\nThere is a 3 vessel aortic arch. The subclavian arteries are patent. There\nis mild calcific atherosclerosis at the right carotid bifurcation and bulb\nwithout significant luminal stenosis by NASCET criteria. There is a tortuous,\nretropharyngeal course of the internal carotid artery.\nThere is mild calcific atherosclerosis at the left carotid bifurcation and\nbulb without significant luminal stenosis by NASCET criteria. There is a\ntortuous, retropharyngeal course\n\nThere patent, codominant vertebral arteries. There is no occlusion,\ndissection, aneurysm, or significant stenosis.\n\nOTHER:\nThe lung apices are clear. There is fatty replacement of the parotid glands. \nThe thyroid and submandibular glands are unremarkable. There is no CT\nevidence of lymphadenopathy. The pharynx, larynx, nasal cavity, and oral\ncavities are unremarkable. There is a subcutaneous right chest port with\ncatheter extending to the right internal jugular artery and superior vena\ncava. There degenerative changes of the cervical spine without fracture or\nosseous lesion. The masticator, parapharyngeal, and carotid spaces are\nunremarkable.", + "output": "1. Calcific atherosclerosis of bilateral carotid bifurcations and bulbs\nwithout significant stenosis by NASCET criteria.\n2. Bilateral carotid siphon dense atherosclerotic calcifications without\ndefinite occlusion.\n3. Patent intracranial and neck vasculature without occlusion, dissection,\nsignificant stenosis, or aneurysm.\n4. No acute intracranial abnormality.\n5. Mild calvarial thickening with mixed lytic and sclerotic appearance\nconsistent with Paget's disease as characterized on prior bone scan from ___." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territorial infarct. Prominence of the\nventricles and sulci is consistent with involutional changes. Periventricular\nand subcortical white matter hypodensities are likely sequelae of chronic\nsmall vessel disease. The visualized paranasal sinuses are clear. Frontal\nsinuses are not pneumatized. The mastoid air cells are clear. No acute\nfracture is seen.", + "output": "No acute intracranial process. Please note that MRI is more sensitive in\ndetecting acute ischemia." + }, + { + "input": "There is a large right mildly hyperdense extra-axial fluid collection with a\nbiconcave appearance measuring up to 2.7 cm within the left frontal region and\n1.9 cm within the left parietal region. The extra-axial collection\ndemonstrates subtle shading consistent with subacute hemorrhage. There is\nassociated effacement of the left lateral ventricle as well as 4 mm rightwards\nshift of midline structures. An additional 0.5 cm left frontoparietal subdural\nhematoma is acute. No acute large territorial infarction, edema, or mass.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable. Vascular\ncalcifications within cavernous portions of bilateral internal carotid\narteries is noted.", + "output": "1. Acute small left frontoparietal subdural hematoma measuring 0.5 cm in\nmaximal width.\n2. Large left frontoparietal subdural hematoma with evidence of subacute on\nchronic hemorrhage and 4 mm rightwards shift of midline structures.\n3. No fracture." + }, + { + "input": "Postsurgical changes from left frontal craniotomy and subdural hematoma\nevacuation. Along the left frontal convexity, there remains approximately 22\nmm of subdural fluid with some postoperative hemorrhage and pneumocephalus,\nprevious subdural hemorrhage measured roughly 25 mm in maximal thickness.\nThere remains a similar degree of localized mass effect with effacement of the\ninvolved sulci and some effacement of the left lateral ventricle. Movement in\nthe right to left midline shift, now measuring approximately 5 mm, previously\nmeasuring approximately 8 mm. High right frontal acute subdural hematoma\nappears unchanged, again measuring approximately 4 mm in maximal thickness,\nsuperimposed upon a more chronic appearing component. There is no evidence of\nlarge territory infarction, new intracranial hemorrhage, edema, or mass. The\nventricles and sulci are grossly stable in size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. Postsurgical changes related to patient's interval left frontal craniotomy\nand subdural hematoma evacuation, now with approximately 22 mm fluid\ncollection with small amount of blood and pneumocephalus.\n2. Mass effect has mildly improved with interval decrease of rightward midline\nshift compared to prior exam.\n3. Stable right frontal mixed density subdural hematoma.\n4. No new hemorrhage." + }, + { + "input": "Compared to the prior head CT from ___, there has been decrease in size\nof the left frontotemporal subdural hematoma with similar degree of hyperdense\ncomponents along the superior aspect. Maximal thickness is 15 mm, previously\n18 mm. There is no evidence of new hemorrhage or infarction. There is a\nmoderate mass effect upon the adjacent left frontal and temporal lobes, and 3\nmm of rightward shift of the midline structures, previously 5 mm. The basal\ncisterns are patent.\nCraniotomy changes in the left frontal bone and soft tissues are similar to\nthe prior exam. Motion artifact limits evaluation of the paranasal sinuses.", + "output": "1. Slightly decreased size of left frontotemporal subdural hematoma with\nsimilar degree of hyperdense components as on the prior CT, and no evidence of\nnew hemorrhage.\n2. Slight decrease in rightward shift of midline structures." + }, + { + "input": "Postoperative changes identified in the left frontoparietal region. There is a\npredominantly hypodense subdural with foci of hyperdensity peripherally in the\nleft frontoparietal region with a maximum width of 21 mm. This appears to be\nre- accumulation of previously seen postoperative subdural collection. There\nis mass effect on the left stable hemisphere and the left ventricle without\nmidline shift or hydrocephalus. Mild to moderate brain atrophy seen.\n\nThe visualized paranasal sinuses are clear.", + "output": "Slight increase in size of the left-sided frontoparietal subdural hematoma\nsince the previous postoperative CT examination. ." + }, + { + "input": "Postsurgical changes are from a prior left craniotomy. The left fronto\nparietal subdural hematoma has markedly decreased in size, currently measuring\nup to 5 mm in maximum depth and previously measuring up to 22 mm. The\nsubdural collection is primarily high density and also represent a component\nof postoperative material. The previously seen mass effect on the left\nlateral ventricle have completely resolved. The ventricles and sulci are\nslightly prominent consistent with age appropriate atrophy. There is no new\nhemorrhage, edema or mass effect. Right vertebral artery calcifications are\npresent.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Marked interval decrease in size of the left subdural hematoma with\nresidual 5 mm hyperintense material overlying the left frontal convexity.\n2. Resolution of previously seen mass effect on the right frontal parietal\nlobe.\n3. No new hemorrhages." + }, + { + "input": "NECT: There is no evidence of infarction, hemorrhage, mass, or edema. The\nventricles and sulci are normal in size and configuration.\n\nAerosolized secretions are demonstrated in the left maxillary sinus. \nOtherwise, the imaged paranasal sinuses, mastoid air cells and middle ear\ncavities are clear.\n\nCTA head:\n\nAs seen on the brain MRA from the day prior, a left MCA bifurcation saccular\naneurysm measures 4 mm (8:323).\n\nOtherwise, the vessels of the circle of ___ and their major branches are\npatent without evidence stenosis, occlusion or additional aneurysm. There is a\nprominent left posterior communicating artery. There may be a small right\nposterior communicating artery.\n\nThe dural venous sinuses appear patent.\n\nCTA neck:\n\nAgain demonstrated is a focal thin flap in the right carotid bulb (8:183,\n07:43). This is unchanged in appearance in comparison with the MRA from the\nday prior.\n\nThe left carotid artery is patent from its origin without evidence of\nstenosis, dissection or occlusion.\n\nThe vertebral arteries are patent from their origins without evidence of\nstenosis, occlusion or dissection.\n\nOther: There is a 9 mm hypoattenuating right thyroid nodule (8:102). The\nimaged lung apices are grossly clear with the exception of mild paraseptal\nemphysematous change. There is no cervical lymphadenopathy by CT size\ncriteria.", + "output": "1. No acute intracranial abnormality on unenhanced head CT.\n2. Paranasal sinus disease.\n3. 4 mm left MCA bifurcation saccular aneurysm.\n4. Focal a flap in the right carotid bulb either reflects a vascular web or\nulcerated plaque.\n5. 9 mm hypoattenuating right thyroid nodule. No specific follow-up is\nindicated based on nodule size.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nPostsurgical changes from the left frontal craniotomy demonstrating a\nfrontoparietal bone defect, left frontal pneumocephalus, and hyperdense\nmaterial on the inner table of the craniotomy site. There is left hemispheric\nsulci effacement with small left to right shift of normally midline structures\nmeasuring approximately 3 mm. There is subcutaneous edema and emphysema along\nthe left craniotomy site.\nStreak artifact from the metallic clip in the left MCA territory is noted.\nThere is no evidence of no evidence of large territorial infarction,\nhemorrhage, or mass.\n\nMucous retention cysts are noted in the bilateral maxillary sinuses. The\nremainder the paranasal sinuses are essentially clear. The orbits are\nunremarkable. The mastoid air cells and middle ears are well pneumatized and\nclear.\n\nCTA HEAD:\nStatus post clipping of the left MCA aneurysm without evidence of residual\naneurysm. The left distal M2 and M3 branches are patent. The other vessels\nof the circle of ___ and their principal intracranial branches appear\nnormal without stenosis, occlusion, or aneurysm formation. The dural venous\nsinuses are patent.\n\nCTA NECK:\nStable appearance of a focal intraluminal flap within the right carotid bulb,\neither representing a vascular web or ulcerated plaque. Otherwise, the\ncarotid and vertebral arteries and their major branches appear normal with no\nevidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs demonstrate bibasilar atelectasis. The\nvisualized portion of the thyroid gland is within normal limits. There is no\nlymphadenopathy by CT size criteria. Healing sternal fractures and bilateral\nanterior second and third rib fractures are also identified.", + "output": "1. Status post clipping of the left MCA aneurysm without definitive evidence\nof residual filling, with patent left distal M2 and M3 branches.\n2. Stable appearance of focal intraluminal flap within the right carotid bulb,\ncould represent a vascular web or ulcerated plaque.\n3. Postsurgical changes from left frontal craniotomy demonstrating left\npneumocephalus, sulci effacement, and mild left to right shift of normally\nmidline structures.\n4. No acute large territory infarct. However, MRI would be more sensitive for\nearly and subtle infarcts, if there are no contraindications." + }, + { + "input": "Patient is status post left frontal craniotomy and clipping of a left MCA\naneurysm with expected postoperative changes including pneumocephalus and\nhyperdense blood in the craniotomy site. There is no midline shift. \nEffacement of the ventricles is unchanged. However, diffuse sulci effacement\nhas worsened. There is no evidence of large territorial infarction,new\nhemorrhage, or mass.\n\nThere is no evidence of fracture. Subcutaneous edema and emphysema along the\nleft craniotomy site are again noted. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Status post left frontal craniotomy and clipping of a left MCA aneurysm\nwith expected postoperative pneumocephalus and for dense blood at the\ncraniotomy site. No new hemorrhage.\n2. Interval increased diffuse brain swelling compared to 6 hours prior.\n\nNOTIFICATION: The findings were discussed with ___, N.P. by\n___, M.D. on the telephone on ___ at 9:34 pm, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nlarge mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Right: The external auditory canal is normal. There is complete opacification\nof the mastoid air cells and extension of hypodense material to surround the\nossicles The underlyingossicles and tegmen are intact with no definite\nerosion. There is a filling defect in the distal right internal jugular vein\nat its junction with the sigmoid sinus at the level of the jugular foramen\nseen best in series 300b, image 130. There is additional attenuation of the\nadjacent right sigmoid sinus (series 300b, image 172).\n\nThere is no evidence for enlarged vestibular aqueduct or superior semicircular\ncanal dehiscence. The facial nerve follows a normal course through the middle\near. There is no evidence for inner ear dysplasia.\n\nLeft: The external auditory canal is normal. The middle ear cavity is clear.\nThe ossicles and tegmen are intact. There is no evidence for enlarged\nvestibular aqueduct or superior semicircular canal dehiscence. The facial\nnerve follows a normal course through the middle ear. There is no evidence for\ninner ear dysplasia. The mastoids are clear. There is no abnormal enhancement\non post contrast imaging.\n\nOther: Visualized brain and neck soft tissues are normal. No definite epidural\ncollection or abscess formation is identified. There is no evidence of\nabnormal enhancement on postcontrast imaging.", + "output": "1. Complete opacification of the right mastoid air cells with extension of\nhypodense material to surround the ossicles raises concern for otitis media.\n2. Filling defect involving the distal right internal jugular vein at its\njunction with the right sigmoid sinus as well as additional associated\nattenuation of the adjacent right sigmoid sinus are highly concerning for\nthrombosis.\n3. No definite epidural collection is identified on this examination.\n4. Unremarkable left temporal bone examination.\n\nNOTIFICATION: The findings were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 1:08 ___, 15 minutes after\ndiscovery of the findings." + }, + { + "input": "There is encephalomalacia within the bilateral frontal, parietal, temporal,\nand occipital cortices, right greater than left, corresponding to the middle\ncerebral artery territories, which is relatively unchanged. There is no CT\nevidence of acute infarct, hemorrhage, or mass effect. The extra-axial spaces\nare unremarkable. There is unchanged prominence of the ventricles with ex\nvacuo dilatation secondary to encephalomalacia. There is nonspecific\nperiventricular white matter hypodensity, likely reflecting sequela of chronic\nmicroangiopathy. There is calcification of the bilateral intracranial\ninternal carotid arteries and the V3/V4 segment vertebral arteries.\n\nThe bilateral native lenses are absent, otherwise the orbits are unremarkable.\nThe soft tissues and calvarium are unremarkable. There is an endotracheal\ntube in place. There is fluid layering within the visualized pharynx. The\nparanasal sinuses, mastoid air cells, and middle ears are clear.", + "output": "1. Unchanged extensive encephalomalacia within the bilateral cortices, as\ndescribed, without CT evidence of acute intracranial abnormality. Please note\nthat MRI provides greater sensitivity in evaluation of acute infarction.\n2. Fluid layering within the visualized pharynx, likely secondary to intubated\nstate.\n3. Interval resolution of previously noted right middle ear and mastoid air\ncell opacification." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Prominent\nventricles and sulci suggest age related global atrophy. Periventricular and\nsubcortical white matter hypodensities are nonspecific but likely reflects\nsequelae of chronic small vessel ischemic disease. The basal cisterns appear\npatent and there is preservation of gray-white matter differentiation.\n\nNo osseous abnormalities seen. There is mucosal thickening in the left\nsphenoid sinus. The remaining paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The orbits are unremarkable. Atherosclerotic\ncalcifications of the carotid siphons are noted.", + "output": "1. No evidence of acute intracranial process.\n2. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular calcifications as described." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage, edema, or\nmass effect. There is age-related cortical volume loss. Again seen are\nperiventricular and subcortical white matter hypodensities, likely the sequela\nof chronic small vessel ischemic disease. There is intracranial\natherosclerosis.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable, aside from a left lens replacement. \nIncidental note is made of a partial empty sella, unchanged from prior\nexamination.", + "output": "1. No acute intracranial abnormality noncontrast head CT." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or mass\neffect. Ventricles and sulci are prominent consistent with age-related global\nparenchymal loss. Bilateral lentiform hypodensities likely represent chronic\nlacunar infarcts, unchanged.\n\nThere is no evidence of fracture. There is mild mucosal thickening the\nbilateral anterior ethmoid air cells. The visualized portion of the remaining\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. \nPatient is status post bilateral lens resections.", + "output": "No acute intracranial abnormality, no hemorrhage." + }, + { + "input": "There is no evidence of acute major vascular territory\ninfarction,hemorrhage,edema, or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. Atherosclerotic calcifications\nare seen in both carotid siphons. Again seen are bilateral lentiform\nhypodensities, likely representing chronic lacunar infarcts.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. \nPatient is status post bilateral lens resections.", + "output": "1. No acute intracranial abnormalities.\n2. Unchanged bilateral lentiform hypodensity likely represent chronic lacunar\ninfarcts.\n3. Chronic microangiopathy and age related global atrophy." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. Small chronic bilateral putaminal lacunar infarcts. Periventricular\nand subcortical white matter hypodensities are nonspecific but likely sequelae\nof chronic small vessel ischemic disease. Incidental empty sella. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Bilateral lens\nreplacements. Severe carotid siphon and mild V4 segment atherosclerotic\ncalcifications.", + "output": "1. No evidence of an acute intracranial abnormality.\n2. Chronic small-vessel ischemic changes and age related global atrophy." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\n There is no evidence of acute large territorial infarction, intracranial\nhemorrhage, edema, or mass. There is prominence of the ventricles and sulci,\nas expected for age. Subcortical and periventricular white matter\nhypodensities are nonspecific, but likely reflect the sequela of chronic small\nvessel ischemic disease.\n\nNo acute osseous abnormalities seen. There is mild mucosal thickening of the\nethmoid and sphenoid sinuses. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are otherwise clear. The orbits demonstrate no acute\nabnormalities.\n\n\nCTA HEAD:\nThere is atherosclerotic plaque carotid siphons bilaterally causing mild\nstenosis in the supraclinoid segments. The vessels of the circle of ___\nand their principal intracranial branches appear normal without high-grade\nstenosis, occlusion, or aneurysm. The posterior communicating arteries are\npatent bilaterally. The posterior cerebral arteries middle cerebral arteries\nand anterior cerebral arteries are patent. The straight residual segment to\nthe right segment is noted, anatomic variant. The dural venous sinuses are\npatent.\n\nCTA NECK:\nThere is atherosclerotic plaque within the aortic arch, left subclavian artery\nand brachiocephalic trunk. There is atherosclerotic plaque in the origin of\nthe vertebral arteries bilaterally, with high-grade stenosis at the origin the\nleft vertebral artery. There is a mild-to-moderate grade stenosis of the left\nvertebral artery at the level the C7 vertebra. The bilateral carotid artery\norigins are patent.\n\nThere is atherosclerotic calcification the of the internal carotid arteries\nbilaterally at the level of the carotid bifurcation.\n\nThere is grade 1 anterolisthesis of C2 on C3, new since CT of the C-spine from\n___. There is grade 1 anterolisthesis C3 on C4, which appears\nslightly worse compared to prior. There is multilevel degenerative change of\nthe visualized cervical spine with anterior osteophytosis.\n\nOTHER:\nThe visualized portion of the lungs are clear without focal consolidation. \nThere is mild dependent atelectasis. The visualized portion of the thyroid\ngland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.\n\nOn scout images, loop recorder device is noted as well as degenerative changes\nof the shoulders and evidence of previous right shoulder surgery.", + "output": "1. No acute large territorial infarction or intracranial hemorrhage.\n2. Patent circle of ___ without evidence of high-grade stenosis, occlusion,\nor aneurysm.\n3. There is moderate stenosis of the left vertebral artery at its origin from\nthe subclavian artery. Mild-to-moderate grade stenosis of the left vertebral\nartery at the level of the C7 vertebra. Patent bilateral cervical carotid\narteries without evidence of high-grade stenosis, occlusion,or dissection.\n4. Grade 1 anterolisthesis of C2 on C3, new since the prior CT of the cervical\nspine from ___. Redemonstration of grade 1 anterolisthesis of C3 on\nC4, with multilevel degenerative changes." + }, + { + "input": "Soft tissue swelling is present about the left orbit there is a comminuted\nfracture of the left lateral orbital wall (02:47, 601:73). There is a small\namount of extraconal retrobulbar hematoma (For example 601:70) adjacent to a\ndiastatic/minimally displaced fracture at the left zygomaticofrontalsuture .\n\nMultiple additional facial fractures are seen including a left orbital floor\nfracture is also present, with up to 3 mm of depression (601:71). The left\ninferior rectus muscle abuts fracture line and is mildly edematous (601:69). \nThe left lamina papyracea appears grossly intact.\n\nThere are comminuted fractures of the anterior and lateral maxillary sinus\nwalls (2:59, 68).\n\nBlood products fill the left maxillary sinus and anterior ethmoid air cells.\n\nThere is partial opacification of the right mastoid air cells, although no\ndiscrete fracture is seen.\n\nThe visualized upper aerodigestive tract appears normal.\nThe mandible and temporomandibular joints appear normal.", + "output": "1. Multiple facial fractures are seen, including comminuted fracture of the\nleft lateral orbital wall with possible extra conal retrobulbar hematoma as\nwell as a diastatic/minimally displaced fracture at the left\nzygomaticofrontalsture.\n2. Comminuted left orbital floor fracture. The left inferior rectus muscle\nabuts the fracture line, and appears mildly edematous. Extraocular movement\nexam is required for evaluation for muscle entrapment.\n3. Comminuted fractures of the anterior and lateral maxillary sinus walls.\n4. Blood products fill the left maxillary sinus and anterior ethmoid air\ncells.\n5. Opacification of the right mastoid air cells without a discrete fracture. \nIn the setting of trauma, it is difficult to exclude a non displaced temporal\nbone fracture." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration for the patient's\nage\n\nThere is no evidence of acute fracture. Chronic healed facial fractures. The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is a small amount of soft tissue induration overlying the right\noccipital calvarium (series 3, image 19) there is no underlying fracture.\n\nThere is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is mild mucosal thickening within the right frontoethmoidal recess and\nmild mucosal thickening in a left ethmoid air cell. Otherwise, the visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable. \nCalcifications are noted of the cavernous carotid arteries bilaterally.", + "output": "Soft tissue induration overlying the right occipital calvarium, but no\nevidence of underlying fracture or intracranial hemorrhage." + }, + { + "input": "There is no evidence of acute large territory infarct, hemorrhage, edema, or\nmass effect. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality on noncontrast head CT." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute territorial infarction,hemorrhage,edema,ormass. \nThe ventricles and sulci are normal in size and configuration.\n\nThere is mucosal thickening involving the right frontal and anterior right\nethmoid air cells. Otherwise, the paranasal sinuses,mastoid air cells,and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nnormal.\n\nCTA HEAD:\nThere are moderate nonocclusive atherosclerotic calcifications at the\nbilateral carotid siphons.\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. The dural venous\nsinuses are patent.\n\nCTA NECK:\nThere is a common origin of the left common carotid artery and right\nsubclavian artery, a normal anatomical variant. The bilateral carotid and\nvertebral artery origins are patent.\n\nThere is no evidence of internal carotid stenosis on either side by NASCET\ncriteria.\n\nThe patient is left vertebral artery dominant, with an asymmetrically small\nright vertebral artery terminating as the right ___. There is calcified\natherosclerotic plaque at the left vertebral artery V3/V4 junction without\nsignificant stenosis. Otherwise, the carotidandvertebral arteries and their\nmajor branches appear normal with no evidence of stenosis or occlusion.\n\nOTHER:\nThe visualized portion of the lungs demonstrate no focal consolidation or\nsizable pleural effusion. The visualized portion of the thyroid gland is\nwithin normal limits. Scattered subcentimeter short axis bilateral cervical\nlymph nodes are noted, which may be reactive. Posterior spinal fusion\nhardware is noted from C2 through C5 with osseous fusion across these levels. \nThere are moderate degenerative changes of the visualized spine.", + "output": "1. Head CT: No acute intracranial pathology.\n2. Head CTA: Moderate nonocclusive atherosclerotic calcifications at the\nbilateral carotid siphons. Patent circle of ___ without evidence of\nstenosis,occlusion,or aneurysm.\n3. Neck CTA: Patent bilateral cervical carotid and vertebral arteries without\nevidence of stenosis, occlusion, or dissection." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration. There is moderate\ncalcification of the bilateral carotid siphons and vertebral arteries.\n\nThere is moderate opacification of the bilateral anterior ethmoid and left\ngreater than right maxillary and sphenoid sinuses. The visualized mastoid air\ncells and middle ear cavities are clear. The visualized portion of the orbits\nare normal.", + "output": "Paranasal sinus inflammatory changes.\nOtherwise normal study.." + }, + { + "input": "Allowing for mild motion artifact, there is no evidence for acute intracranial\nhemorrhage, edema, mass effect, or acute major vascular territorial\ninfarction. Ventricles, sulci, and basal cisterns are normal in size for the\npatient's age.\n\nFluid in the sphenoid sinuses and in the left maxillary sinus, as well as near\ncomplete opacification of the mastoid air cells, is likely secondary to\nprolonged supine positioning in the inpatient setting and endotracheal\nintubation. There is also mild mucosal thickening in the right maxillary\nsinus.", + "output": "Allowing for mild motion artifact, there is no evidence for acute intracranial\nabnormalities." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or acute vascular\nterritorial infarction. The ventricles and sulci are normal in size and\nconfiguration. The basal cisterns are patent. Gray-white matter\ndifferentiation is preserved.\n\nNo fracture is identified. Scalp soft tissue swelling noted in the right\ntemporal region series 3, image 42 with subgaleal hematoma.\nThere is mild mucosal thickening in bilateral maxillary and right frontal\nsinuses with moderate opacification of the ethmoid air cells.\nThe mastoid air cells and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "No acute intracranial hemorrhage or mass effect or acute fracture.\nScalp soft tissue swelling with subgaleal hematoma in the right temporal\nregion.\nParanasal sinus opacification in the ethmoid, frontal and maxillary sinuses.\nProminent adenoids." + }, + { + "input": "There is no hemorrhage, edema, or mass effect. Ventricles and sulci are age\nappropriate in size and configuration. There is no shift of normally midline\nstructures. Basal cisterns are patent. Gray-white matter differentiation is\npreserved.\n\nThe orbits are unremarkable bilaterally. Visualized paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. Moderate\natherosclerotic calcifications involve the carotid siphons bilaterally.", + "output": "No acute intracranial abnormality." + }, + { + "input": "Patient is status post left parietal burr hole placement with expected\npostoperative pneumocephalus and subgaleal fat stranding. There is minimal\nresidual extra-axial density along the left cerebral convexity to suggest\nresidual subdural blood. There is minimal high density material along the\ndrainage catheter (series 603; image 10), which is suggestive of a tiny\ncomponent of acute blood. Drainage catheter traverses to the level of the\ntentorium cerebelli. There has been interval decrease in right to left\nmidline shift, measuring 4 mm on today's exam, previously 8 mm. There is no\nsuggestion of large territorial infarction. Basal cisterns remain patent.\n\nThere is moderate mucosal thickening of the bilateral maxillary sinuses as\nwell as ethmoid air cells. There is mild mucosal thickening of the left\nsphenoid sinus. Minimal mucosal thickening is noted within the left mastoid\nair cells. Right mastoid air cells and middle ear cavities appear clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "Patient is status post left parietal burr hole with drainage catheter\nplacement with expected postoperative pneumocephalus and minimal high density\nmaterial adjacent to the drainage catheter suggestive of tiny component of\nacute blood. Interval decrease in right to left midline shift, measuring 4 mm\non today's exam, previously 8 mm. Basal cisterns remain patent." + }, + { + "input": "The patient is status post subdural drain removal, with mild decrease in\npostoperative pneumocephalus. Compared to the most recent prior study, small\nhypodense subdural blood along the left cerebral convexity appears similar. A\nlinear hyperdensity, which previously tracked along the course of the drainage\ncatheter (02:18), suggestive of acute blood, is unchanged. No evidence of new\nhemorrhage. Rightward shift of normally midline structures is unchanged. A\nfocal hypodensity adjacent to this blood is most compatible with an evolving\ncontusion. The basal cisterns are patent.\n\nModerate mucosal thickening of the bilateral maxillary sinuses and ethmoid air\ncells is unchanged. Otherwise, the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Interval removal of a left subdural drainage catheter, with persistent,\nunchanged mass effect from the left subdural hematoma. No evidence of new\nhemorrhage.\n2. Unchanged acute blood along the left frontal lobe, previously adjacent to\nthe drainage catheter, with an adjacent evolving parenchymal contusion." + }, + { + "input": "A left frontal burr hole is unchanged. There is a small mixed density left\nfrontal subdural hematoma measuring up to 5 mm in diameter. Midline shift is\nnearly resolved in comparison to the prior examination.\n\nNo additional focus of hemorrhage. The ventricles and sulci are normal in\nmorphology.\n\nThe orbits are unremarkable. There is mild opacification of the ethmoid air\ncells. The paranasal sinuses and mastoid air cells are otherwise clear.", + "output": "1. Small, mixed density left frontal subdural hematoma. Previously seen\nmidline shift is nearly resolved. No additional focus of hemorrhage." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are prominent compatible global volume loss.\n\nIncluded paranasal sinuses and mastoids are clear. Left frontal osteoma is\nincidentally noted. Skull and extracranial soft tissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nCT HEAD WITHOUT CONTRAST:\nAgain seen along the left tentorial leaflet at the level of the ambient\ncistern is a 9 x 5 mm hyperdense extra-axial mass (7:9), consistent with\ntentorial meningioma, not appreciably changed compared with prior study of\n___. The mass again is seen to narrow the left ambient cistern but not\ncontact the brainstem (07:10).\n\nOtherwise, there is no evidence of acute intracranial infarction, hemorrhage,\nedema, additional mass, or mass effect. There is prominence of the ventricles\nand sulci which is stable from prior and consistent with global involutional\nchange. Scattered bilateral periventricular and deep white matter hypodense\nfoci are nonspecific but compatible with at least moderate changes of chronic\nwhite matter microangiopathy.\n\nThere is no evidence of fracture. The visualized paranasal sinuses, mastoid\nair cells, and middle ear cavities are well pneumatized and clear. Carotid\nsiphon calcifications are noted bilaterally. Scleral calcifications are noted\non the right. Grossly stable nonspecific dysconjugate gaze is again noted.\n\nCTA HEAD:\nThere is prominent calcification of the cavernous segment of the left ICA\nwithout significant luminal narrowing. The A1 segment of the left MCA is not\nvisualized, which may be a normal variant.\n\nThere is nonocclusive calcification of bilateral internal carotid artery\ncavernous segments. There is mild focal luminal narrowing of the mid M1\nsegment of the right MCA (9:228). The remainder of the right MCA is widely\npatent.\n\nA focal 1-2 mm focus of hyperdensity along the posteromedial aspect of the\ndistal right (V4) vertebral artery is noted to represent a focus of\nmineralization/calcification, unchanged since at least ___ (9:95).\n\nOtherwise the remaining vessels of the circle of ___ and their principal\nintracranial branches appear normal without stenosis, occlusion, or aneurysm\nformation. The dural venous sinuses are grossly patent.\n\nCTA NECK:\nThere is approximately 30% left and 40% right and internal carotid origin\nnarrowing by NASCET criteria.\n\nOtherwise, the carotid and vertebral arteries and their major branches appear\npreserved with no evidence of stenosis, occlusion or dissection. Bilateral\ncommon carotid, vertebral and subclavian artery origins are patent.\n\nOTHER:\nNew since study of ___ is a superior endplate compression fracture\nof T1 with minimal anterior height loss, overall age indeterminate on this\nexam. There is minimal (approximately 2 mm) posterior bony\nprojection/retropulsion without significant spinal canal narrowing. There is\nno surrounding discernible hematoma.\n\nThere is fusiform dilation of the ascending thoracic aorta just proximal arch\nmeasuring up to 4.0 cm in diameter (9:1). There are no pathologically\nenlarged cervical common or visible mediastinal or supraclavicular lymph\nnodes. There is a 14 x 12 mm hypodense nodule in the right thyroid lobe\nprojecting inferiorly (09: 58). Lung apices are grossly clear. Vertebral\nbody hemangioma is partially seen in the left aspect of T5 (09:43). There is\ndiffuse osteopenia and there are multilevel at least moderate cervical spine\ndegenerative changes most pronounced at C5-6 and C6-7. Right maxillary tooth\nperiapical lucency is noted (see 9:164).", + "output": "1. Dental amalgam streak artifact limits study.\n2. No acute intracranial abnormality. Please note MRI of the brain is more\nsensitive for the detection of acute infarct.\n3. Age-indeterminate superior endplate compression fracture of T1 with mild\nloss of height and millimetric (approximately 2 mm) posterior bony projection\nwithout significant spinal canal narrowing with no hematoma. If concern for\nacute fracture, consider cervical spine MRI for further evaluation.\n4. Nonocclusive probable atherosclerotic changes of the circle of ___ as\ndescribed. Otherwise, patent circle of ___ vasculature without stenosis,\nocclusion, or aneurysm.\n5. Approximately 30% left and 40% right and internal carotid origin narrowing\nby NASCET criteria.\n6. Otherwise, patent bilateral vertebral and carotid arteries in the neck\nwithout definite evidence of stenosis, occlusion or dissection.\n7. Grossly stable 9 x 5 mm left tentorial leaflet probable meningioma.\n8. 4.0 cm fusiform dilation of the distal ascending thoracic aorta, not fully\nvisualized.\n9. Grossly stable nonspecific dysconjugate gaze.\n10. Right maxillary tooth periodontal disease.\n11. 1.4 x 1.2 cm right thyroid lobe nodule. Please see recommendation below.\n\nRECOMMENDATION(S):\n1. Age-indeterminate superior endplate compression fracture of T1 with mild\nloss of height and millimetric (approximately 2 mm) posterior bony projection\nwithout significant spinal canal narrowing with no hematoma. If concern for\nacute fracture, consider cervical spine MRI for further evaluation.\n\n2. Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or older.\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150.\n\nNOTIFICATION: The impression items ___ and recommendation 1 above was entered\nby Dr. ___ on ___ at 10:46 into the Department of\nRadiology critical communications system for direct communication to the\nreferring provider.\n\n The impression and recommendation above was entered by Dr. ___ on\n___ at 21:18 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema,or suspicious mass. \nA 5 mm hyperdense mass along the left tentorium is extra-axial and likely\nrepresents a meningioma, and is unchanged from prior. There is prominence of\nthe ventricles and sulci suggestive of moderate involutional changes. \nMultiple periventricular and subcortical white matter hypodensities are again\ndemonstrated, consistent with chronic microangiopathy, and not significantly\nchanged from prior study. Chronic bilateral cerebellar infarcts are again\nseen. There is also encephalomalacia in the right temporal lobe which is\nunchanged. Dense atherosclerotic calcifications noted within the intracranial\nICAs.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial findings.\n2. Age-related involutional changes as well as evidence of moderate chronic\nmicroangiopathy." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territorial infarct. Redemonstrated 8 mm\nhyperdense structure along the left tentorium is similar in appearance and\nmost likely represents a meningioma. Prominence of the ventricles and sulci\nis suggestive of involutional changes. Periventricular and subcortical white\nmatter hypodensities are likely sequelae of chronic small vessel disease. \nChronic infarcts are again seen in the bilateral cerebellar hemispheres. \nEncephalomalacia/old infarct in the right temporal lobe is also again seen. \nThe visualized paranasal sinuses are clear. The mastoid air cells are clear. \nNo acute fracture is seen. A 6 mm osteoma projects into the posterior left\nsphenoid sinus.", + "output": "1. No acute intracranial process.\n\n2. Again seen stable 8 mm hyperdense structure along the left tentorium, most\nlikely represents a meningioma." + }, + { + "input": "There is no evidence of acute intracranial infarction, hemorrhage, edema, or\nmass effect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific and are likely sequela of chronic small vessel\nischemic disease.\n\nThere is no evidence of fracture. There is opacification of the right mastoid\nair cells and middle ear cavity. There is minimal mucosal thickening of the\nmaxillary sinuses and anterior ethmoid air cells. The patient is status post\nbilateral lens replacements.", + "output": "1. No acute intracranial process." + }, + { + "input": "No evidence of acute large territorial infarct, hemorrhage, edema, or mass\neffect. Bilateral periventricular and subcortical white matter hypodensities\nare nonspecific and similar to the prior exam, likely sequelae of chronic\nsmall vessel ischemic disease. Bilateral, symmetric prominence of the\nventricles and sulci indicates cortical volume loss. Bilateral cavernous\ninternal carotid artery calcifications are moderate.\n\nThere is soft tissue ecchymosis and subgaleal hematoma with soft tissue gas\ncompatible with scalp laceration along the left vertex overlying the left\nparietal bone (series 2, image 27; series 602b, image 63). No evidence of\nassociated calvarial fracture. Left maxillary sinus demonstrates mild mucosal\nthickening with thick sclerotic walls suggestive of chronic inflammation. \nSome of the ethmoidal air cells are partially or completely opacified. The\nremaining paranasal sinuses are essentially clear. The orbits are\nunremarkable other than bilateral lens replacements. Opacification of the\nright mastoid air cells and right middle ear cavity is similar to the prior\nexam. On this nondedicated exam, the scutum appears within normal limits. No\nclear evidence of dehiscence. There is increased sclerosis of the mastoid on\nthe right. The left mastoid air cells and middle ear cavities are clear.", + "output": "1. No intracranial hemorrhage.\n2. Small left vertex scalp hematoma and laceration without fracture.\n3. Right mastoid air cells and middle ear cavity opacification, unchanged,\nlikely reflective of chronic inflammation.\n4. Cortical atrophy and sequelae of chronic small vessel ischemic disease.\n5. Paranasal sinus disease." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nDense atherosclerotic calcifications noted within the intracranial ICAs.\n\nThere is no evidence of fracture. Mild mucosal thickening is noted in the\nleft maxillary sinus, bilateral ethmoid air cells. There is chronic\nopacification of right middle ear and mastoid air cells. The visualized\nportion of the orbits are unremarkable. Small occipital subgaleal hematoma\nand overlying scalp laceration is noted.", + "output": "1. No acute intracranial process. Small occipital subgaleal hematoma and\noverlying scalp laceration without underlying fracture.\n2. Chronic opacification of right middle ear and mastoid air cells." + }, + { + "input": "There is no evidence of acute major infarction,hemorrhage,edema,or discrete\nmass. Age related involutional changes again noted. Ventricles are unchanged\nin overall size. Redemonstration of dense calcifications within the cavernous\ncarotid arteries.\n\nThere is no acute fracture. Chronic opacification of the right middle ear\ncavity and right mastoid air cells. Left-sided mastoid air cells and middle\near cavity appear well aerated. Minimal mucosal thickening is noted within\nthe ethmoidal air cells. Otherwise the imaged paranasal sinuses are clear. \nThe visualized portion of the orbits are unremarkable.", + "output": "No acute intracranial findings." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\nThere is no evidence of fracture. There is a small mucous retention cyst in\nthe right maxillary sinus. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are otherwise clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No evidence of intracranial hemorrhage or acute infarction.\n\n2. No fracture." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no intra or extra-axial mass effect, acute hemorrhage or large\nterritorial infarct. Left basal ganglia and bilateral corona radiata\nhypodensities are likely sequela of prior lacunar infarcts. There are\nsuperimposed periventricular and subcortical white matter hypodensities, which\nare nonspecific, but commonly seen in the setting of chronic microangiopathy\nin a patient of this age. Sulci, ventricles and cisterns are within expected\nlimits for the degree of mild presumably senescent related volume loss. Mild\nmucosal thickening of the right worse than left maxillary sinuses and of the\nethmoid air cells is identified. The remainder the paranasal sinuses are\nessentially clear. The orbits are unremarkable, noting bilateral lens\nreplacements. The mastoid air cells and middle ear cavities are well\npneumatized and clear.\n\nCTA HEAD:\nProminent atherosclerotic calcification of the bilateral internal carotid\narteries most prominent within the cavernous segments is identified without\nocclusion.\n\nThere is a 2 mm inferiorly oriented outpouching of the left supra clinoid ICA\n(series 3, image 218) which may represent an infundibulum although a small\naneurysm cannot be entirely excluded.\n\nThe remainder of the right ICA ACA, MCA and their major branches are\nunremarkable. Multifocal atherosclerotic calcification of the bilateral\nvertebral arteries is identified. Otherwise, the posterior circulation is\nunremarkable.\n\nCTA NECK:\nProminent atherosclerotic calcification of the aortic arch and origins of the\nright brachiocephalic, bilateral common carotid and subclavian arteries are\nnoted. There is at least moderate to severe stenosis of the proximal left\nsubclavian artery.\n\nAtherosclerotic calcification of the left carotid bifurcation results in 50%\nstenosis of the proximal cervical internal carotid artery by NASCET criteria. \nThere is no stenosis of the right proximal cervical internal carotid artery by\nNASCET criteria.\n\nThe left vertebral artery arises from the aorta. Moderate stenosis secondary\nto atherosclerotic calcification of the bilateral vertebral artery origins is\nnoted. The right vertebral artery is dominant. Multifocal atherosclerotic\ncalcification of the bilateral vertebral arteries does not result in severe\nstenosis or occlusion.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. The visualized aerodigestive tract is unremarkable, noting\nbilateral and palatine tonsilliths.", + "output": "1. Prominent atherosclerotic calcification of the bilateral cervical internal\ncarotid arteries is identified without occlusion or high-grade stenosis.\n2. 2 mm inferiorly oriented outpouching of the left supra clinoid ICA may\nrepresent an infundibulum although a small aneurysm is not entirely excluded. \nClose attention on followup is recommended.\n3. The remainder of the circle ___ and their major branches allowing for\natherosclerotic disease is grossly unremarkable.\n4. Atherosclerotic disease of the aortic arch and cervical vessels as\ndescribed above with 50% stenosis of the left proximal cervical internal\ncarotid artery by NASCET criteria.\n5. Sequela of prior lacunar infarcts of the left basal ganglia and bilateral\ncorona radiata. Nonspecific subcortical and periventricular white matter\nhypodensities likely represent chronic microangiopathy in a patient of this\nage. Otherwise, no acute intracranial abnormality on noncontrast head CT." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no acute large territory infarct, intra or extra-axial mass effect or\nacute hemorrhage. The sulci, ventricles and cisterns are within expected\nlimits for the patient's mild senescent related global cerebral volume loss. \nThere are mild-to-moderate periventricular and subcortical white matter\nhypodensities, nonspecific, but compatible with chronic microangiopathy in a\npatient this age.\n\nThere is mild mucosal thickening of the bilateral maxillary sinus alveolar\nrecesses. The remainder the paranasal sinuses are essentially clear. The\norbits are unremarkable, noting bilateral lens replacements. The mastoid air\ncells are clear. No suspicious osseous lesions.\n\nCTA HEAD:\nThe intracranial ICA demonstrates moderate atherosclerotic calcifications,\nslightly progressed from prior examination without evidence of high-grade\nstenosis. There is a subtle 1 mm inferiorly oriented outpouching of the left\nparaclinoid ICA, unchanged from prior examination, felt likely to represent an\ninfundibulum. Otherwise, the ACA, MCA and their major branches are\nunremarkable without evidence of high-grade stenosis, occlusion or aneurysm. \nMild multifocal narrowing of the bilateral P1 and P2 segments is compatible\nwith atherosclerotic disease. The dural venous sinuses are patent.\n\nCTA NECK:\nProminent atherosclerotic calcification of the aortic arch is noted. There is\nmoderate to severe stenosis of left common carotid and left subclavian artery\norigin. The left vertebral artery arises from the aortic arch, a normal\nvariant. No significant narrowing of the right brachiocephalic artery and\norigins of the right subclavian and common carotid arteries. Otherwise, the\nbilateral common carotid, subclavian and vertebral arteries are patent without\nevidence of high-grade stenosis elsewhere. Mild atherosclerotic calcification\nat the origins of the bilateral vertebral arteries noted. There is gradual\nslow flow within the right V2 vertebral artery segment with non opacification\nseen entering the cranium (series 3 image 141), which is new from ___,\nwithout evidence of intracranial reconstitution. Prominent atherosclerotic\ncalcification of the left V4 segment is identified.\n\nAtherosclerotic calcification at the right carotid bifurcation does not result\nin stenosis of the right cervical internal carotid artery by NASCET criteria. \nHowever there are multiple and foci of narrowing secondary to atherosclerosis\ndistally. Heavy atherosclerotic calcification of the left carotid bifurcation\nresults in nearly 50% stenosis of the left cervical internal carotid artery by\nNASCET criteria. Additional scattered atherosclerotic calcification of the\ndistal left cervical internal carotid artery is noted.\n\nOTHER:\nThe visualized lung apices are clear. The thyroid is unremarkable. There is\nno cervical lymphadenopathy by size criteria. The major salivary glands are\nunremarkable. The visualized aerodigestive track is within expected limits. \nNo suspicious osseous lesions. Incidental note is made of a LAD stent (series\n3, image 9) with unremarkable distal run-off.", + "output": "1. No evidence of acute large territory infarct or intracranial hemorrhage. \nThere are moderate periventricular and subcortical white matter hypodensities,\nnonspecific, but compatible with chronic microangiopathy in a patient of this\nage.\n2. There is gradual decreased opacification of the right V2 segment, with\napparent occlusion of the right vertebral artery to the basilar artery. This\nis felt to be likely chronic in nature but new from examination of ___. \nAcute dissection is not entirely excluded, however felt less likely.\n3. Atherosclerotic calcification of the carotid bifurcation results in\napproximately 50% stenosis of the left cervical internal carotid artery by\nNASCET criteria and no stenosis of the right cervical internal carotid artery.\nThere is moderate to severe stenosis of the left common carotid and subclavian\nartery origins with un remarkable distal flow. Allowing for additional foci\nof atherosclerotic disease, the remainder of the CTA neck is grossly\nunremarkable.\n4. There is occlusion of the right V4 segment, new from examination of ___. \n2 mm inferiorly oriented outpouching of the left para clinoid ICA likely\nrepresents an infundibulum, unchanged from ___. Atherosclerotic\ncalcification of the bilateral internal carotid arteries are similar. The\nremainder of the intracranial circulation is unremarkable allowing for\natherosclerotic disease.\n5. Recommend further evaluation with MRI head, if there are no\ncontraindications.\n6. Additional findings described above.\n\nRECOMMENDATION(S): Further evaluation with MRI head if there are no cough\ncontraindications." + }, + { + "input": "Patient is status post left frontal craniotomy for resection of left frontal\nmetastatic lesion with expected postsurgical changes visualized in the\nresection bed to include small subarachnoid hemorrhage (02:22),\npneumocephalus, and mild adjacent edema. Findings do not result in\nsignificant mass effect. There is no evidence of infarction. The ventricles\nand sulci are normal in size and configuration.\n\nSoft tissue swelling and subcutaneous air overlies left frontal craniotomy\nsite. The visualized portion of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "Status post left frontal craniotomy for resection of left frontal metastatic\nlesion with expected postsurgical changes. No significant mass effect is\nidentified." + }, + { + "input": "There is no evidence of intracranial hemorrhage. No mass effect,\nhydrocephalus or shift of normally midline structures. Ventricles, cisterns\nand sulci appear within normal limits. Gray-white matter distinction appears\npreserved in with. Surrounding soft tissue structures appear normal. There\nis no evidence of fracture or bone destruction. Visualized paranasal sinuses\nand mastoid air cells appear clear.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No intracranial hemorrhage. No large territorial infarction. No calvarial\nfractures." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass. The ventricles and sulci are enlarged in size and configuration\nconsistent with age-related atrophy. Similar remains enlarged in the patient\nis status post transsphenoidal resection of a pituitary adenoma. Previously\nnoted residual soft tissue in the left aspect of the sella is not clearly\nvisualized on this current noncontrast study.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable apart from right\nlens replacement. Moderate atherosclerotic calcifications of the cavernous\ncarotids are noted.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are stable in size and configuration. Gray-white matter\ndifferentiation is preserved.\n\nEnhancing soft tissue in the sella, too large to be a normal pituitary is\nsimilar compared to prior. There is also thickening of the infundibulum which\nis similar compared to previous exam.\n\nNo osseous abnormalities are seen. There is mucosal thickening and soft\ntissue opacity within the right maxillary sinus. The remaining paranasal\nsinuses and mastoid air cells are clear. The orbits are unremarkable. \nCalcification of the carotid siphons is incidentally noted.", + "output": "Enhancing soft tissue in the sella with thickening of the infundibulum similar\ncompared to exam from ___ given differences in technique. MRI may offer\nadditional detail in the absence contraindication." + }, + { + "input": "Again seen, the patient is status post endoscopic sinus surgery bilaterally. \nThere is now extensive opacification of the right maxillary sinus with wall\nsclerosis suggesting chronic inflammation. There is mild mucosal thickening\nin the remainder of the ethmoid air cells. There is minimal mucosal\nthickening inferiorly in the left maxillary sinus. Limited imaging of the\nsphenoid sinus appears normal. The frontal sinuses are not included in the\nstudy.\n\nThere is mild partial opacification of the mastoid air cells bilaterally.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. The neck vessels are patent.\n\nThe areas of ground-glass opacity in the superior segments of the lower lobes\nbilaterally (series 2 images 103 through 115) appear slightly more prominent\nsince the chest CT of ___. These are dependent and may reflect\natelectasis. However, continued follow-up is recommended. The tiny right\nnodule (Series 2, image 106) appears unchanged. There are no osseous lesions.\n\nThere is dense ossification of the posterior longitudinal ligament extending\nfrom mid C2 to the upper C5 with substantial narrowing of the spinal canal.", + "output": "1. Right maxillary sinus chronic inflammatory changes.\n2. No masses identified.\n3. Extensive os thick of the posterior longitudinal ligament with spinal canal\nencroachment\n4. Bilateral pulmonary findings including an unchanged right nodule and\nslightly increased dependent ground-glass opacities bilaterally.\n\nRECOMMENDATION(S): Continued follow-up CT for bilateral dependent\nground-glass opacities at ___ year." + }, + { + "input": "The sella is enlarged. While CT is a suboptimal modality for evaluation of\npituitary pathology, there is apparent soft tissue prominence at the left\naspect of the sella, measuring 9 mm AP x 10 mm TV x 10 mm SI. There is no\nevidence of an enhancing lesion. The infundibular is midline. There are\ncalcifications of the carotid siphons.\n\nThe visualized intracranial structures show no evidence of acute infarction,\nhemorrhage, edema, or mass. The ventricles and sulci are normal in size and\nconfiguration. There is no abnormal enhancement on post contrast images.\n\nThe patient is status post endoscopic sinus surgery bilaterally. There is\nmild-to-moderate mucosal thickening of the partially visualized right and\nminimal mucosal thickening of the left maxillary sinuses. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare otherwise clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Status post trans-sphenoidal surgery for pituitary adenoma resection.\n2. While CT is a suboptimal modality for evaluation of pituitary pathology,\nthere is apparent soft tissue prominence at the left aspect of the sella. \nFindings are nonspecific and may be postsurgical. While there is no definite\nevidence of an enhancing lesion, consider an MRI sella study for further\ncharacterization.\n3. Paranasal sinus inflammatory changes as detailed above.\n\nRECOMMENDATION(S): Consider MRI sella study for further characterization of\nnonspecific prominence at the left aspect of the sella." + }, + { + "input": "Residual mildly enhancing soft tissue in the left aspect of the sella\nmeasuring 9 x 9 mm in the coronal plane appears fairly similar compared to\nprior CT done ___. The pituitary stalk is slightly deviated to\nthe right, unchanged compared to prior. No suprasellar lesions.\n\nThe carotid siphons demonstrate mild atherosclerotic calcification but are\nwidely patent. The optic chiasm appears normal. No incidental brain lesions.\nThe orbits appear normal.\n\nMucosal thickening in the inferior aspect of the right maxillary sinus is\nagain noted (also present on prior CT brain done ___.", + "output": "1. No significant interval change.\n2. Residual mildly enhancing soft tissue in the left aspect of the sella\nappear similar compared to prior imaging done ___.\n3. Mucosal thickening in the inferior aspect of the right maxillary sinus\nagain noted (this was also present on prior CT brain done ___" + }, + { + "input": "Study is mildly degraded by motion.\n\nThere is no definite evidence of acute large territorial\ninfarction,hemorrhage,edema, or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. There are periventricular and\nsubcortical lucencies, which may represent small vessel ischemic changes. \nAtherosclerotic vascular calcifications are noted of bilateral vertebral and\ncavernous portions of internal carotid arteries.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits demonstrate bilateral lens replacement postoperative\nchanges .", + "output": "1. Study is mildly degraded by motion.\n2. No acute intracranial abnormality.\n3. Please note contrast brain MRI is more sensitive for the evaluation of\nintracranial metastatic disease and for acute infarct.\n4. Please see concurrently obtained neck CT for description of cervical\nstructures." + }, + { + "input": "Please note that evaluation for abscess is limited due to lack of\nadministration of intravenous contrast. Additionally, study is limited\nsecondary to dental streak artifact. Within these confines:\n\nContrast is noted within the visualized portion of the esophagus, at least\npartially demonstrated on patient's recent abdomen and pelvis oral contrast\nCT.\n\nEvaluation of the aerodigestive tract demonstrates no mass. Question minimal\nnonocclusive mass-effect on distal trachea by adjacent fluid-filled esophagus\nversus volume averaging artifact (see 2: 62-66).\n\nThe salivary glands are grossly preserved, without definite mass. There is\nmild bilateral submandibular fat stranding as well as the bilateral fascial\nplanes, consistent with history of sialoadenitis. No definite focal\ncalcifications are seen. The thyroid gland appears preserved.There is no\nlymphadenopathy by CT criteria. Within the limits of this noncontrast study,\nthe neck vessels are grossly patent.\n\nLimited imaging lungs demonstrate areas hazy opacity and small bilateral\npleural effusions.\n\nThere are no focal osseous lesions. A left-sided PICC line is seen up turned\ninto the internal jugular vein (06:28). Atherosclerotic vascular\ncalcifications are seen in bilateral carotid bifurcations. Minimal\nnonspecific edema is noted in the dural subclavicular soft tissues (see 3:\n118-130). Question right mastoid air cell osteoma (see 03:23).", + "output": "1. Please note that evaluation for abscess is limited due to lack of\nadministration of intravenous contrast. Additionally, study is limited\nsecondary to dental streak artifact.\n2. Within limits of study, no definite evidence of fluid collection within the\nneck.\n3. Mild bilateral submandibular fat stranding consistent with history of\nsialoadenitis.\n4. Question minimal nonocclusive mass-effect on distal trachea by adjacent\nfluid-filled esophagus versus volume averaging artifact. Otherwise, patent\nairway.\n5. Malposition left-sided PICC line as described. Patient's care team aware.\n6. Findings suggestive of air trapping and/or pulmonary opacities and\nbilateral pleural effusions, better demonstrated on same day chest, abdomen,\nand pelvis CT.\n7. Residual contrast within the midesophagus, concerning for aspiration risk.\n8. Please see concurrently obtained noncontrast head CT for description of\ncranial structures." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. TThere is\nprominence of the ventricles and sulci suggestive of involutional changes. \nThere calcifications in the bilateral cavernous carotids.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. There are\nbilateral lens replacements. The visualized portion of the orbits are\notherwise unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no acute large territorial infarction, hemorrhage, edema or mass. \nBasal cisterns are patent and there is preservation gray-white matter\ndifferentiation. Ventricles and sulci are normal in overall size and\nconfiguration.\n\nNo fracture identified. Extracranial soft tissues are unremarkable. Mild\nmucosal thickening within the right sphenoid sinus and mucosal small bilateral\nmaxillary mucous retention cysts are noted. There is minimal mucosal\nthickening within the left maxillary sinus as well. The remaining imaged\nparanasal sinuses, mastoid air cells and middle ear cavities are clear. \nOtherwise portions of the orbits are unremarkable.", + "output": "No acute intracranial abnormalities." + }, + { + "input": "There is no acute intracranial hemorrhage, edema, mass effect or shift of\nnormally midline structures. The ventricles and sulci are prominent,\nconsistent with global atrophy. Subcortical and periventricular white matter\nhypodensities are in keeping with chronic small vessel ischemic disease. . The\nbasal cisterns appear patent and gray-white matter differentiation is\npreserved. Bilateral lens replacements are noted. Mild mucosal thickening in\nthe right maxillary sinus and anterior ethmoid cells is noted. There is also\nevidence of chronic sinusitis in the right maxillary sinus. There is also a\nmucous retention cyst in the floor of the left maxillary sinus. The remaining\nimaged paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The anterior clinoid processes are pneumatized. The calvaria appear\nintact.", + "output": "1. No acute intracranial abnormality.\n2. Atrophy and sequela of chronic small vessel ischemic disease.\n3. Paranasal sinus inflammatory disease." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no radiopaque foreign body,\nmass,or edema. No pneumomediastinum or visualized pleural effusion.\n\nThe thyroid gland appears normal. There is no lymphadenopathy by CT criteria.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions. Degenerative changes in the\nspine are most prominent at C4-C5 through C6-C7 where intervertebral\nosteophytes results in mild to moderate spinal canal narrowing. Uncovertebral\nand facet arthropathy results in mild bilateral neural foraminal narrowing at\nC4-C5, severe right and mild left neural foraminal narrowing at C5-C6 and\nC6-C7.", + "output": "No radiopaque foreign body in the visualized esophagus. No pneumomediastinum\nor pleural effusion seen." + }, + { + "input": "There is an ill-defined area of soft tissue attenuation in the left\nsuboccipital/upper neck superficial soft tissues as delineated by radiopaque\nmarker. The area measures 2 cm TV x 0.7 cm AP (image 76 of series 4). There\nis associated skin thickening and minimal adjacent fat stranding. No focal\nfluid collections are identified.\n\nThere are a number of bilateral level 5 lymph nodes measuring up to 0.5 cm\nshort axis, but otherwise no lymphadenopathy by size criteria.\n\nEvaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe parotid glands enhance normally and are without mass or adjacent fat\nstranding. Submandibular glands are symmetric in size. The neck vessels are\npatent.\n\nThe visualized portions of the lung apices are limited due to respiratory\nmotion. No suspicious pulmonary nodules. Postsurgical changes of\nthyroidectomy.\n\nMild-to-moderate multilevel degenerative changes of the cervical spine, most\nsevere at C5-C6.", + "output": "1. Ill-defined nonspecific soft tissue lesion in the left suboccipital/upper\nneck superficial soft tissues as delineated by CT marker, with minimal\nunderlying soft tissue fat stranding, there is no evidence of underlying fluid\ncollection.\n2. No definite lymphadenopathy by size criteria." + }, + { + "input": "The patient has a right-sided frontal with ventriculoperitoneal shunt which\nextends to the right anterior horn. The ventricular size has not\nsignificantly changed since the MRI of ___. The lateral ventricles as\nwell as the third ventricular dilated with relatively normal size of the\ntemporal horns and fourth ventricle. There is no acute hemorrhage identified.\nNo periventricular edema is seen.", + "output": "Right frontal ventriculoperitoneal shunt tip is in the anterior horn of the\nright lateral ventricle. The ventricular size is unchanged compared to MRI of\n___. There is still moderate-to-severe ventriculomegaly without\ndilatation of the temporal horns." + }, + { + "input": "No fracture identified. Normal spinal alignment.\n\nThe carotidandvertebral arteries and their major branches are patent with no\nevidence of stenoses. No evidence for dissection is seen.\n\nThere is no internal carotid artery stenosis by NASCET criteria\n\nThere is left subpectoral gas extending superiorly along the left scalene and\nsternocleidomastoid muscles, tracking around the left vertebral artery at the\nC5 level. There is gas within the adjacent left epidural space. Gas is also\nseen tracking within the left posterior cervical neck muscles and left\ntrapezius muscle.\n\nThere is a shallow left apical pneumothorax. There is a small left\nhemothorax.", + "output": "-The carotidandvertebral arteries and their major branches are patent with no\nevidence of stenoses or dissection.\n- No fracture identified. Normal spinal alignment.\n-Shallow left apical pneumothorax.\n-Subcutaneous emphysema overlying the left lateral chest wall extending\nsuperiorly along the left scalene and sternocleidomastoid muscles. Gas is\nnoted around the left vertebral artery at the level of C5 and in the adjacent\nthe left epidural space." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territorial infarct. Prominence of the\nventricles and sulci is consistent with involutional change. Confluent\nperiventricular and subcortical white matter hypodensities are likely sequelae\nof chronic small vessel disease. The visualized paranasal sinuses demonstrate\nmucosal thickening in the anterior ethmoid air cells.. The mastoid air cells\nare clear. No acute fracture is seen.", + "output": "No acute intracranial process. Chronic changes. MRI is more sensitive in\ndetecting acute ischemia." + }, + { + "input": "The examination is partially limited due to patient motion, within this\nlimitation, grossly there is no evidence of acute territorial infarction,\nintracranial hemorrhage, edema, or mass effect. The ventricles and sulci are\nprominent keeping with age-related involutional change. Moderate\nperiventricular and subcortical white matter hypodensities are nonspecific,\nbut likely represent sequela of chronic ischemic microvascular disease.\n\nNo acute fractures are seen. Re-demonstrated is a small subgaleal hematoma\noverlying the left frontal bone measuring up to 7 mm in thickness (03:47). \nThere is new soft tissue swelling overlying the right frontal bone measuring\nup to 5 mm in thickness. A small amount of subcutaneous gas likely reflects\nknown laceration. Aside from mild mucosal thickening in the bilateral ethmoid\nair cells, the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The orbits are unremarkable.", + "output": "1. There is a new small subgaleal hematoma overlying the right frontal bone.\n2. Re-demonstrated is a small hematoma overlying the left frontal bone with\nan overlying laceration, and subcutaneous emphysema.\n3. No acute intracranial hemorrhage or fracture." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, shift of normally\nmidline structures or acute major vascular territorial infarction. Ventricles\nand sulci are normal in size and configuration. The basal cisterns appear\npatent and there is preservation of gray-white matter differentiation.\n\nThere is no fracture. The visualized paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The globes are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nNo acute fracture. The disc thickening of the posterior wall of the right\nmaxillary sinus and mild expansion of the calvarial diploic space are\ncompatible with the history sickle cell disease. Mucosal thickening of the\nright sphenoid and ethmoid sinuses. The remaining paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No evidence of hemorrhage or infarct.\n\n2. Osseous findings compatible the history of sickle cell disease." + }, + { + "input": "Stable left temporal cystic encephalomalacia from prior traumatic contusion.\nNew tiny lacune in the right insular white matter lacks features to suggest\nacuity (02:17). There is no acute intracranial hemorrhage, acute infarction,\nlarge mass or midline shift. There is no hydrocephalus. The ventricles and\nsulci are prominent suggestive of age related involution. The basal cisterns\nare patent and there is preservation of gray-white matter differentiation. The\norbits are unremarkable. Air-fluid level noted in the left maxillary sinus\n(simple fluid attenuation). The visualized paranasal sinuses, middle ear\ncavities and mastoid air cells are clear. There is no fracture.", + "output": "1. No acute intracranial abnormality.\n2. Simple air-fluid level in the left maxillary sinus. Correlate clinically\nfor symptoms of sinusitis.\n3. New tiny lacune in the right insular white matter without features to\nsuggest acuity.\n4. Stable left temporal cystic encephalomalacia from prior traumatic\ncontusion." + }, + { + "input": "There is no ievidence of hemorrhage, edema, mass effect, or infarction. \nPreviously seen left temporal cystic encephalomalacia from prior traumatic\ncontusion is again noted. The ventricles and sulci are mildly prominent for\nage. There is no shift of the normally midline structures.The basal cisterns\nappear patent and there is preservation of the gray-white matter\ndifferentiation.\n\nNo fracture or suspicious osseous lesion is identified.An air-fluid level with\naerosolized secretions is again noted in the left maxillary sinus. The\nremaining visualized paranasal sinuses, middle ear cavities, and mastoid air\ncells are clear.The orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Persistent air-fluid level with aerosolized secretions in the left\nmaxillary sinus, compatible with inflammatory disease.\n3. Stable left temporal cystic encephalomalacia." + }, + { + "input": "Re- demonstration of chronic encephalomalacia of the left temporal lobe from\nprior traumatic contusion. There is no evidence of infarction, hemorrhage,\nedema, or mass. The ventricles and sulci are normal in size and configuration.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Stable left temporal encephalomalacia from prior contusion." + }, + { + "input": "Since the outside hospital CT from the same day, the right thalamic hemorrhage\nis not significantly increased in volume, measuring 17 x 10 mm. Hypodensity in\nthe right frontal lobe is indicative of an evolving infarct. There is no\ninterventricular extension of the hemorrhage, or evidence of subarachnoid\nbleed. The ventricles and sulci are mildly prominent, compatible with volume\nloss. Periventricular white matter hypodensities are nonspecific but likely\nsequela of chronic small vessel ischemia. Hypodensity in the left aspect of\nthe pons is likely a prior infarct. Exuberant calcifications are noted of the\ncavernous carotids bilaterally. No bony or soft tissue abnormality. The\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "1. Stable right thalamic hemorrhage since the outside hospital CT from 18:25\non the same day.\n\n2. Right frontal infarct is likely subacute to chronic in age.\n\n3. Probably chronic left pontine infarct." + }, + { + "input": "There is significant increased in size of the previously noted right thalamic\nhemorrhage (measuring approximately 33 x 58 mm in transverse dimension) with\nassociated intraventricular hemorrhage and midbrain extension, causing\nsignificant mass effect and left ward midline shift ~12.2 mm of shift.\nAdditionally there is enlargement of the left lateral ventricles suggesting\ndeveloping hydrocephalus with narrowing of the sulci. The paranasal sinuses,\nmiddle ear cavities and mastoid air cells appear patent.", + "output": "1. Large interval increase in the right thalamic hemorrhage, causing\nsignificant mass effect such as dilation of left lateral ventricle and\nleftward midline shift, associated intraventricular hemorrhage and hemorrhagic\nchanges extending into the right midbrain.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 10:35 AM, 2 minute after discovery of the\nfindings." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Prominent retrocerebellar CSF space likely due to ___ cisterna\nmagna.\n\nSlightly angulated fracture through the left lamina papyracea is again noted. \nFracture involving the orbital roof/ floor of anterior cranial fossa was\nbetter seen on prior exam. This fracture does involve the posterior wall of\nthe frontal sinus with slight apparent displacement. Fracture involving the\nfrontal process of the maxilla on the left is again seen with extension to the\nlacrimal canal. Globes are grossly unremarkable. There is no retrobulbar\nhematoma. Fluid seen layering within the left maxillary sinus. Minimal\nopacification left frontal sinus is noted.", + "output": "No acute intracranial process.\nMultiple facial fractures involving the left lamina papyracea, orbital\nroof/floor of anterior cranial fossa/frontal sinus, and frontal process of the\nmaxilla on the left extending to the lacrimal canal are again noted. No\nretrobulbar hematoma." + }, + { + "input": "Hyperdense material is seen interdigitating between diffuse right greater than\nleft cerebral hemispheric sulci as well as occupying the right sylvian fissure\nand much of the right sided basilar cisterns including the suprasellar and\nquadrigeminal plate cisterns. Smaller foci of hyperdense intra sulcal\nmaterial is seen involving less hemispheric cerebral sulci (for example see\nseries 2, image 24). A small amount of hyperdense material seen layering in\nthe occipital horns of the bilateral lateral ventricles (series 2, image 15). \nFindings overall concerning for diffuse acute subarachnoid hemorrhage with\ninterventricular blood. The apparent increased density of the blood products\nlikely reflects the presence of residual contrast from prior same-day Neuro\nInterventional cerebral angiogram.\n\nThere is as a vague mass-effect. The ventricles and sulci are normal in\ncaliber and configuration. There is no shift of normally midline structures. \nLoss of gray-white matter differentiation involving the right insular cortex\nis unchanged from recent same-day unenhanced head CT. The right mastoid air\ncells are hypoplastic ; otherwise, the imaged paranasal sinuses and mastoid\nair cells are clear. Soft tissue swelling without underlying fracture seen\noverlying the left anterior zygomatic bone. The globes are intact are\nunremarkable.", + "output": "1. Diffuse right greater the left subarachnoid hemorrhage with bilateral\ninterventricular extension, as above.\n2. Loss of right insular cortex gray-white matter differentiation, unchanged\nfrom prior same-day unenhanced head CT, compatible with known right MCA\nterritory acute infarct.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 8:14 ___, 5 minutes after discovery of the\nfindings." + }, + { + "input": "Again seen is subarachnoid blood within the sulci of the right superior\nfrontal and parietal lobes, as well as the right temporal lobe and into the\nsylvian fissure. Tiny foci of subarachnoid blood along the left superior\nfrontal and parietal lobes is also seen. There is extension of blood into the\nright aspect of the suprasellar cistern and bilateral occipital horns of the\nlateral ventricles. This is all decreased compared to CT head from the day\nprior. No new focus of hemorrhage is identified. There is no evidence of no\nevidence of infarction, hemorrhage, edema, or mass. The ventricles and sulci\nare normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Decreased subarachnoid blood within the sulci of the right frontal, parietal,\nand temporal lobes, left frontal and parietal lobes, right aspect of the\nsuprasellar cistern, and bilateral occipital horns of the lateral ventricles,\nall decreased compared to CT head from the day prior. No new focus of\nhemorrhage identified." + }, + { + "input": "Again seen are multiple bilateral foci of subarachnoid hemorrhage in the\nsulci, right greater than left, as well as in the right lateral aspect of the\nsuprasellar cistern and the right sylvian fissure, not appreciably changed in\ncomparison to prior exam. Bilateral hyperdense blood within the occipital\nhorns of the lateral ventricles is also unchanged. There is no hydrocephalus.\nNo new hemorrhage is seen.\n\nThere is a large evolving acute right MCA territory infarct involving the\ntemporal lobe, posterior frontal lobe, portions of the parietal lobe, and\ninsula. There is another large evolving acute infarct in the left occipital\nlobe in the left PCA territory. A third small evolving acute infarct is seen\nin the and body of the left caudate nucleus and adjacent white matter. There\nis no evidence for hemorrhagic transformation in a left-sided infarcts. \nEvaluation for subtle hemorrhagic transformation of the right MCA infarct is\nlimited due to the sulcal subarachnoid hemorrhage. While there is associated\nsulcal effacement, no other significant mass effect is seen, including no\neffacement of the ventricles and no shift of midline structures. The basal\ncisterns remain patent.\n\nSoft tissue swelling overlying the left zygomatic process is again seen. \nThere is no evidence of a fracture. The visualized paranasal sinuses are\nclear. The right mastoid demonstrates no pneumatized air cells, and the right\nmastoid antrum is opacified. Right middle ear cavity is not well assessed. \nLeft middle ear cavity and mastoid air cells appear grossly clear.", + "output": "1. Large evolving acute infarcts in the right middle cerebral artery territory\nand left posterior cerebral artery territory, as well as a small evolving\nacute infarct involving the left caudate and adjacent white matter. No\nsignificant mass effect. No evidence for hemorrhagic transformation in the\nleft sided infarcts. Evaluation for the hemorrhagic transformation of the\nright MCA infarct is limited due to adjacent subarachnoid hemorrhage.\n2. Stable right greater than left subarachnoid hemorrhage.\n3. Stable intraventricular hemorrhage. No hydrocephalus." + }, + { + "input": "There is a small amount of residual subarachnoid hemorrhage noted within the\nright parietal sulci, significantly decreased from the prior examination. No\nnew foci of intraparenchymal or extra-axial hemorrhage is identified. \nRedemonstrated is a subacute left occipital infarction. Subtle, asymmetric\nloss of gray-white matter differentiation involving the right cerebral\nhemisphere, predominantly in the MCA/PCA territory, corresponds with the\npatient's prior infarction. No new large vascular territory infarction is\npresent. The basal cisterns remain patent.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Small, residual right parietal subarachnoid hemorrhage without evidence of\nmass effect or midline shift.\n2. Redemonstration of late subacute left occipital and right parietal\ninfarctions, without evidence for new, large vascular territorial infarction." + }, + { + "input": "There is a small amount of residual subarachnoid hemorrhage noted again within\nright parietal sulci with interval improvement since the prior exam in ___. There are areas of low hypodensity in the right MCA and right PCA\nterritories, which are again seen on prior studies.\n\nThere is a residual intraventricular hemorrhage of the left occipital horn of\nthe lateral ventricles. The ventricles are normal in size and the sulci are\nslightly prominent, although within normal limits for given age. There is no\nobvious soft tissue swelling. There is no evidence of fracture.\n\nRe-demonstrated are old infarcts in the left occipital lobe and right parietal\nlobe. No new acute infarcts are appreciated.\n\nThe left sphenoid sinus appears completely opacified there is mucosal\nthickening in the right sphenoid sinus. The bilateral ethmoid sinuses also\nhave mucosal thickening. The right mastoid air cell appears opacified with\nunderpneumatization of the left mastoid air cells.\n\nThe visualized portion of the orbits are unremarkable.", + "output": "1. Small amount of residual subarachnoid hemorrhage noted in the right\nparietal sulci with interval improvement since prior exam in ___.\n2. Stable residual intraventricular hemorrhage in the left occipital horn of\nthe lateral ventricles is unchanged since prior study.\n3. Areas of low hypodensities in the right MCA and PCA territories are again\nnoted.\n4. Re-demonstrated old infarcts in the left occipital lobe and right parietal\nlobe. No new infarcts are appreciated.\n5. Complete opacification of the left sphenoid sinus with mucosal thickening\nin the right sphenoid sinus and bilateral ethmoid sinuses are seen. \nAdditionally, the right mastoid air cells appear opacified with\nunderpneumatization of the left mastoid air cells." + }, + { + "input": "Redemonstrated is the known subarachnoid hemorrhage in the right parietal\nsulci with redistribution in a gyriform pattern but otherwise remaining\nunchanged from prior imaging in ___. Old infarcts present in the\nright parietal lobe and left occipital lobe are known from prior imaging and\nremain unchanged. Residual hemorrhage within the left occipital horn of the\nlateral ventricles is also unchanged from prior exam.\n\nThe ventricles and sulci are normal in size and configuration. There is no\nmidline shift or mass effect.\n\nThere is no evidence of fracture or new infarcts. The left sphenoid sinus\nremains opacified. There is right frontal and ethmoid sinus mucosal\nthickening. All other visualized portions of the paranasal sinuses appear\nclear. Mastoid air cells appear opacified bilaterally.\n\nThe visualized portion of the orbits are unremarkable.", + "output": "1. Essentially unchanged known subarachnoid hemorrhage in the right parietal\nsulci as well as the old infarcts present in the right parietal lobe and left\noccipital lobe.\n2. Stable residual intraventricular hemorrhage in the left occipital horn of\nthe lateral ventricles.\n3. No evidence of new fractures or infarcts.\n4. Complete opacification of the left sphenoid sinus with mucosal thickening\nin the right frontal and ethmoid sinuses are seen. Additionally, the\nbilateral mastoid air cells appear opacified." + }, + { + "input": "There is no evidence of intracranial hemorrhage, mass, mass effect or shifting\nof the normally midline structures. The ventricles and sulci are normal in\nsize and configuration for patient's age and unchanged since the prior study. \nNo focal or diffuse lesions are visualized throughout the brain parenchyma. \nThe soft tissues are notable for subcutaneous nodules in the frontal region an\nleft frontal area (image 26, series 4 and image 19, series 4), measuring less\nthan 1 cm in size, likely consistent with sebaceous cysts, unchanged since the\nprior exam. The orbits are unremarkable, the paranasal sinuses and the\nmastoid air cells are clear.", + "output": "Unremarkable noncontrast head CT, with no evidence of acute intracranial\nprocess or hemorrhage.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 12:40 ___, 2 minutes after\ndiscovery of the findings." + }, + { + "input": "The carotid and vertebral arteries and their major branches are patent with no\nevidence of stenoses. No evidence for dissection is seen.\n\nThere is no significant internal carotid artery stenosis by NASCET criteria.\n\nThere is multinodular enlargement of the left thyroid lobe, with the largest\nheterogeneous nodule measuring up to 21 x 15 mm (2:86). Punctate\ncalcifications are noted associated with these nodules. These have increased\nin size since the ___, and calcification is new.\n\nThe visualized paranasal sinuses are grossly clear. There is mild multilevel\ncervical spondylosis.", + "output": "1. Patent cervical vasculature without significant stenosis, occlusion, or\ndissection.\n2. Multinodular left thyroid lobe associated calcifications with largest\ndiscrete nodule measuring up to 21 x 15 mm, increased since ___. The\n___ College of Radiology guidelines suggest thyroid ultrasound for\nfurther evaluation.\n\nRECOMMENDATION(S): Thyroid ultrasound for evaluation of left thyroid nodule.\n\nNOTIFICATION: The recommendation of thyroid ultrasound for evaluation of the\nleft thyroid nodule was entered in the Radiology department non urgent\ncritical results notification system by Dr. ___ at 15:00 10 minutes after\nreviewing the images." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. \nPeriventricular and white matter hypodensities bilaterally indicate chronic\nsmall vessel angiopathy. The ventricles and sulci are prominent, indicating\ninvolutional changes. Mild atherosclerotic calcifications of the cavernous\ncarotid arteries are noted.\n\nSoft tissue swelling and loss is seen in the left frontal scalp with punctate\nradiopaque densities in the vicinity which may reflect tiny radiopaque foreign\nbodies or calcifications (3: 34, 36, 24). No acute osseous abnormalities\nseen. The paranasal sinuses, right mastoid air cells, and middle ear cavities\nare clear. Patient appears to be status post left mastoidectomy. The orbits\nare unremarkable.", + "output": "1. Left frontal soft tissue swelling and laceration with possible punctate\nradiopaque foreign bodies versus dermal calcifications. No acute fracture.\n2. No acute intracranial hemorrhage. Chronic small vessel disease." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territory infarct. Gray-white matter\ndifferentiation is preserved. There is no hydrocephalus. The visualized\nparanasal sinuses demonstrate near complete opacification of the left sphenoid\nsinus.. The mastoid air cells are clear. No acute fracture is seen.", + "output": "No acute intracranial process.\n\nNear complete opacification of the left sphenoid sinus." + }, + { + "input": "The carotid and vertebral arteries and their major branches are patent with no\nevidence of stenoses. No evidence for dissection is seen.\n\nBy NASCET criteria, no stenosis of the right ICA and no stenosis of the left\nICA.", + "output": "1. Normal CTA neck study." + }, + { + "input": "Beam hardening artifact limits evaluation of posterior fossa and brainstem. \nThere is no evidence of fracture, infarction, hemorrhage, edema, or mass. \nThe ventricles and sulci are normal in size and configuration. There is no\nabnormal enhancement on post contrast images.\n\nThe visualized portion of the mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are preserved. Left sphenoid\nsinus probable mucous retention cyst is noted. Minimal bilateral ethmoid air\ncell and maxillary sinus mucosal thickening is present. Minimal right mastoid\nair cell fluid is noted. Soft tissue density is noted within the right\nexternal auditory canal, which may represent cerumen.", + "output": "1. Within limits of study, no definite evidence of enhancing intracranial mass\non postcontrast imaging.\n2. Please note MRI of the brain is more sensitive for evaluation of\nintracranial metastatic disease.\n3. Paranasal sinus disease and nonspecific right mastoid fluid, as described." + }, + { + "input": "Please note the study is moderately degraded by motion, especially in the\nregion of lungs. Additionally, the study is limited secondary to patient body\nhabitus.\n\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. Anterior fusion hardware is seen at C4-C6 with interbody spacers at\nC4-C5 and C5-C6. There is disc space narrowing, endplate sclerosis and\nmarginal osteophyte formation at C3-C4.", + "output": "1. Please note the study is moderately degraded by motion, especially in the\nregion of lungs. Additionally, the study is limited secondary to patient body\nhabitus.\n2. Within limits of study, no definite abnormality of head and neck CTA\nidentified.\n3. Multilevel degenerative changes and postsurgical changes related to C4-C6\nACDF as described." + }, + { + "input": "The exam is limited by motion artifact despite a repeat scan. There is no\nevidence of infarction, hemorrhage, edema, or mass. The ventricles and sulci\nare normal in size and configuration.\nThere is no evidence of fracture. Aside from mild mucosal thickening in both\nmaxillary sinuses, the visualized portion of the remaining paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. Motion limited exam.\n2. No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute large territorial infarction hemorrhage, edema,\nor mass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Normal study." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. There are extensive deep, subcortical and\nperiventricular white matter hypodensities which are nonspecific but likely\nrepresent sequela of chronic microvascular ischemic disease.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nright sphenoid sinus, and partial opacification of the right mastoid air\ncells. The remainder of the visualized portion of the paranasal sinuses, left\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable apart from evidence of prior right lens\nreplacement. Dense atherosclerotic calcifications of the distal right\nvertebral and cavernous carotid arteries are noted bilaterally.", + "output": "1. No acute intra-axial hemorrhage.\n2. Sequela of chronic microvascular ischemic disease." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,or\ndiscrete mass. The ventricles and sulci are normal in size and configuration.\nThere are minimal subcortical and periventricular white matter hypodensities,\nnonspecific but compatible with sequelae of chronic small vessel ischemic\ndisease.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nright posterior ethmoid air cells. Otherwise, the visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute major vascular territorial\ninfarction,hemorrhage,edema,or mass effect. Periventricular white matter\nhypodensities are similar compared to FLAIR hyperintensities on prior MRI. \nThe ventricles and sulci are normal in size and configuration. The basilar\ncisterns appear patent.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No evidence of acute intracranial abnormalities. White matter changes similar\nin distribution to prior MRI." + }, + { + "input": "The carotidandvertebral arteries and their major branches are patent with no\nevidence of stenoses. No evidence for dissection is seen. No ICA narrowing\nby NASCET criteria.\n\nFracture of the lateral mass right C2, extending into the foramen\ntransversarium, and C1-C2 articulation, without depression at the articular\nsurface. Occiput C1, C1-C2 articulation is not distracted, no subluxation. \nNormal pre dentate interval. Normal spine alignment. No other fractures. No\nsignificant prevertebral edema.\n\nNormal right vertebral artery at the level of C2 foramen transversarium\nfracture, no evidence of dissection, intimal flap, caliber change or\npseudoaneurysm.\n\nMultiple recent dental extractions. Normal soft neck tissues, lungs.", + "output": "1. Fracture right lateral mass C 2, involves foramen transversarium, stable.\n2. Normal CTA. No dissection." + }, + { + "input": "Study is mildly limited due to motion artifact. A small hypodensity in the\nleft thalamus likely represents a chronic lacunar infarct. There is an\nadditional chronic lacune in the region of the left basal ganglia. There is no\nevidence of acute large territorial infarction, hemorrhage, edema, or mass\neffect. Mild prominence of ventricles and sulci is unchanged and consistent\nwith age-appropriate global atrophy. Periventricular and deep white matter\nhypodensity is nonspecific however compatible sequelae of chronic small vessel\nischemic changes.\n\nThere is a fracture of the nasal bone, age indeterminate (6, 34). No\nadditional fracture is seen. There is mild mucosal thickening affecting the\nethmoid air cells as well as the sphenoid and maxillary sinuses. The mastoid\nair cells and medullary cavities are well pneumatized and clear. Carotid\nsiphon calcifications are severe. Aside from bilateral lens removal, the\nglobes and bony orbits are intact and unremarkable.", + "output": "1. Mildly limited study due to motion artifact. Within limitation, no\nevidence acute intracranial abnormality on noncontrast head CT. No\nhemorrhage.\n2. Presumed chronic left thalamic and basal ganglia lacunar infarcts.\n3. Age indeterminate fracture of the nasal bone. Correlate with physical\nexam.\n4. Mild pansinus mucosal thickening.\n5. Chronic findings include age-appropriate global atrophy, vascular\ncalcifications, and mild-to-moderate changes of chronic white matter\nmicroangiopathy." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute infarction, hemorrhage, edema, or mass. \nPeriventricular and subcortical white matter hypodensity is nonspecific, but\nlikely reflect sequelae of chronic small vessel ischemic disease. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nFocus of low attenuation in the left precentral gyrus appears unchanged\n(series 6, image 25).\n\nUnchanged right sphenoid sinus mucous retention cyst. There is also mild\nmucosal thickening of the anterior air cells. The visualized portion of the\nmastoid air cells,and middle ear cavities are clear. The visualized portion of\nthe orbits are unremarkable.\n\nCTA HEAD:\nThere is significant atherosclerotic calcification of the cavernous and\nsupraclinoid internal carotid arteries bilaterally, resulting in moderate to\nsevere stenosis of the left greater than right supraclinoid segments (8:71). \nThis is similar in appearance to the MRA performed ___.\n\nThere is severe stenosis of the proximal right M1 segment, similar to the MRA\n(11:28, 10:26). The right MCA is patent distally. No other major\nintracranial stenoses are seen. No aneurysm or occlusion.", + "output": "1. No acute intracranial process.\n2. Moderate to severe bilateral supraclinoid internal carotid artery stenosis,\nsimilar to ___.\n3. Severe focal stenosis of the proximal right M1 segment, similar to ___." + }, + { + "input": "Head CT: Large, diffuse subarachnoid hemorrhage, with most of the blood in the\ncisterns, some in the ___ ventricle, and some in the right lateral ventricle.\nThere is some effacement of sulci, but no evidence of hydrocephalus. Sinuses\nand mastoids are clear. There is no evidence of masses or infarction. No\nfractures are identified.\nHead CTA: Approximately 7 x 5 mm anterior communicating artery aneurysm with\nirregular contour and an internal filling defect suggestive of turbulence.\nLeft posterior communicating artery aneurysm measures approximately 6 x 5 mm.\nThere is no evidence of stenosis or occlusion.\nNeck CTA: The carotid and vertebral arteries and their major branches are\npatent with no evidence of stenoses. There is no evidence of internal carotid\nstenosis by NASCET criteria. Bilateral atelectasis and small pleural effusion\non the left. ETT and orogastric tube are seen. Thyroid is unremarkable. Mild\nspondylosis and degenerative changes are seen in the C-spine.", + "output": "1. Ruptured anterior communicating artery aneurysm.\n2. Left posterior communicating artery aneurysm measures approximately 6 x 5\nmm.\n\nNOTIFICATION: The findings were discussed with NP ___ on the\ntelephone on ___ at 2:55 ___." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Minimal periventricular white matter hypodensities compatible\nwith small vessel disease. Ventricles and sulci are normal in overall size and\nconfiguration. The imaged paranasal sinuses are clear. Mastoid air cells and\nmiddle ear cavities are well aerated. The bony calvarium is intact. Partially\nvisualized right parotid masses better assessed on same-day C-spine CT.", + "output": "No acute intracranial process." + }, + { + "input": "Please note that this study is somewhat motion degraded.\n\nThere is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "Please note that this study is somewhat motion degraded.\n\nNo acute intracranial process." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "Fat stranding bilaterally with of the buccal and maxillary soft tissue with\nmild fascial thickening is of uncertain etiology.\n\nThere is diffuse periodontal disease with periapical lucencies surrounding\nmultiple maxillary and mandibular teeth. The visualized paranasal sinuses and\nmastoid air cells are clear. No drainable fluid collection.\n\nBilateral prominent level I and II cervical lymph nodes are likely reactive.\n\nEvaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. The neck vessels are patent.\n\nNo osseous lesions suspicious for malignancy or infection.\n\nRight port-A-cath is noted on the scout images. Please refer to the dedicated\nCT Chest report from the same day for a description of intrathoracic findings.", + "output": "1. No specific evidence to suggest lymphoma in the neck.\n\n2. Non-specific bilateral maxillary soft tissue fat stranding with bilateral\nprominence of cervical lymph nodes that are likely reactive. This could\nrepresent cellulitis in the appropriate clinical situation. Correlate with\nclinical exam and labs. No drainable fluid collection.\n\n3. Periodontal disease.\n\n4. Please refer to the dedicated CT Chest report from the same day for a\ndescription of intrathoracic findings." + }, + { + "input": "There is no acute hemorrhage, edema or shift of the normally midline\nstructures. Slight prominence of the ventricles and sulci is compatible with\nage related involutional changes. Confluent periventricular and subcortical\nwhite matter hypodensities, while nonspecific, are presumably sequela from\nchronic small vessel ischemic disease. Otherwise, the gray-white matter\ndifferentiation is preserved and there is no evidence for an acute vascular\nterritorial infarction. The basal cisterns are patent.\n\nThere is a small amount of fluid within the right mastoid tip. There are tiny\nmucous retention cysts within the left posterior ethmoidal air cell and right\nfrontal sinus. Otherwise, the included paranasal sinuses and mastoid air cells\nare well-aerated. The included lenses and globes are unremarkable. There is no\nfracture.", + "output": "No acute intracranial process." + }, + { + "input": "There is no acute hemorrhage, edema, mass effect, or CT evidence of an acute\nmajor vascular infarction. There is no pathologic extra-axial collection. \nThere is moderate ventricular enlargement and mild sulcal enlargement,\nunchanged. Periventricular, deep and subcortical white matter hypodensities\nare nonspecific, but grossly unchanged, likely the sequelae of chronic small\nvessel ischemic disease.\n\nThere is no evidence of fracture. There is opacification of several left\nmiddle ethmoid air cells. Other visualized partially visualized paranasal\nsinuses are well aerated. Middle ear cavities, mastoid air cells, and\npneumatized petrous apices are well-aerated. There is evidence of bilateral\ncataract surgery.", + "output": "No evidence for acute intracranial abnormalities." + }, + { + "input": "In the region of prior left inferior frontal lobe intraparenchymal hemorrhage,\nthere remains a hypodensity compatible with encephalomalacia. Within the right\nand left temporal lobes, in the region of prior intraparenchymal hemorrhage,\nthere additional foci of encephalomalacia are noted. Calcifications of\nbilateral basal ganglia are visualized. Previously seen extra-axial fluid\ncollection along the right frontal and parietal cerebral convexity no longer\nappreciated, most conspicuous on MR dated ___. The ventricles and\nsulci are prominent likely reflective of age related involutional changes.\nSubcortical confluent hypodensity is nonspecific but likely reflects chronic\nsmall vessel ischemic disease. There is no shift of normally midline\nstructures. The basal cisterns are patent. Visualized paranasal sinuses\ndemonstrates ethmoidal air cell mucosal thickening. Additional note is made of\nmild mucosal thickening within the visualized portions of bilateral sphenoid\nsinuses. The mastoid air cells as well as middle ear cavities are clear. No\nfracture is identified.", + "output": "In the regions of prior intraparenchymal hemorrhage within the left inferior\nfrontal lobe and bilateral temporal lobes, there now persists areas of\nencephalomalacia. No new hemorrhage is identified. Resolution of right\ncerebral convexity subdural hematoma." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "Normal study" + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema,or mass effect. The\nventricles and sulci are age-appropriate.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nright sphenoid and frontal sinuses. The visualized portion of the other\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "1. No acute intracranial process.\n2. No acute fractures." + }, + { + "input": "There is ___ evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are mildly prominent in size but otherwise normal in\nconfiguration.\n\nThere is ___ evidence of fracture. There is a mucous retention cyst in the\nleft sphenoid sinus, corresponding to the lesion seen on recent MR. ___ is\n___ surrounding osseous destruction. The remaining paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. ___ acute intracranial process.\n2. Mucous retention cyst in the left sphenoid sinus, corresponding to the\nlesion seen on recent MR. ___ osseous destruction.\n3. Findings suggestive mild atrophy, advanced for age." + }, + { + "input": "A small 2.1 cm posterior left sphenoid sinus mucous retention cyst is overall\nsimilar to prior examination allowing for mild differences in patient\npositioning. The right sphenoid ostium is patent. There is mild mucosal\nthickening and opacification of the left sphenoid ostium (series 3, image 24\nand 25) with adjacent miniscule mucous retention cyst along the anterior\naspect of the left sphenoid sinus. The frontal sinuses and frontal ethmoidal\nrecesses appear clear. The ethmoid air cells appear grossly clear.\n\nThere is mild there are bilateral Haller cells, which appear to narrow the\ninfundibulum of the ostiomeatal units. There is mucosal thickening along the\nleft infundibulum (series 601, image 55). The right infundibulum appears\ngrossly clear. A large left concha bullosa with pneumatization of the\nbilateral middle concha lamina is noted.\n\nThere is mild rightward deviation of the nasal septum with a small rightward\nprojecting spur which appears to contact a diminutive right middle turbinate. \nNo nasal septal perforation is identified.\nThe cribriform plates and lamina papyracea are intact. The orbits are\nunremarkable. The mastoid air cells middle ears are well pneumatized and\nclear. Although not optimized for such evaluation, visualized brain\nparenchyma is grossly unremarkable.", + "output": "1. Essentially unchanged appearance of a small posterior 2.1 cm left sphenoid\nsinus mucous retention cyst. There is mucosal thickening of the left sphenoid\nostium with adjacent miniscule mucous retention cyst along the anterior aspect\nof the left sphenoid sinus.\n2. Mild mucosal thickening of the left greater than right maxillary sinus\nalveolar recesses with mucosal thickening in the left infundibulum is noted.\n3. Bilateral Haller cells which appear to narrow the infundibulum of the\nostiomeatal units.\n4. Large left concha bullosa and additional anatomic findings as described\nabove." + }, + { + "input": "There is minimal right frontal scalp soft tissue swelling (see 2 a: 26,\n400b:51, 401b:13). Study is mildly degraded by motion. There is no evidence\nof infarction, hemorrhage, or edema. There is an approximately 22 (AP) x 16\n(TV) x 12 (SI) mm (see 2a:7, 400b:73, 401b:26). There is prominence of the\nventricles and sulci suggestive of involutional changes. Atherosclerotic\nvascular calcifications are noted of bilateral vertebral and cavernous\nportions of internal carotid arteries.\n\nThere is no evidence of fracture. The visualized portion of the middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.\nSoft tissue density is noted within the left external auditory canal which may\nrepresent cerumen. Minimal ethmoid sinus mucosal thickening is present. \nSmall nonspecific right mastoid fluid is present.", + "output": "1. Study is mildly degraded by motion.\n2. Minimal right frontal scalp soft tissue swelling.\n3. Within limits of study no evidence of acute intracranial hemorrhage or\nfracture.\n4. 2.3 cm right cerebellar hypodensity with question area central tissue\ndensity versus volume averaging artifact. Differential considerations include\nchronic infarct, however intracranial mass such as metastatic lesion is not\nexcluded. Recommend clinical correlation. If clinically indicated, consider\nMRI of the brain are further evaluation.\n5. Paranasal sinus disease as described.\n\nRECOMMENDATION(S): 2.3 cm right cerebellar hypodensity with question area\ncentral tissue density versus volume averaging artifact. Differential\nconsiderations include chronic infarct, however intracranial mass such as\nmetastatic lesion is not excluded. Recommend clinical correlation. If\nclinically indicated, consider MRI of the brain are further evaluation.\n\nNOTIFICATION: The updated wet read and differential diagnosis considerations\nwere communicated via telephone by Dr. ___ to Dr. ___ (neurology)\nat 06:45 on ___." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. There are deep\nwhite matter, brainstem low-attenuation changes, likely sequela of\nmild-to-moderate chronic small vessel ischemic change, periventricular chronic\ndemyelination could have similar appearance. Mildly hyperdense basilar\nartery, likely secondary to beam hardening attenuation from adjacent\nskullbase. If his concern from basilar artery thrombosis or brainstem process\nother than chronic small vessel ischemic change, MRI brain, MRA brain without\ncontrast would be helpful in further evaluation. Small benign arachnoid cyst\nleft middle cranial fossa anteriorly.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No bleed.\nProbable moderate chronic small vessel ischemic changes bilateral cerebral\nhemispheres, brainstem.\nMildly hyperdense basilar artery, likely secondary to beam hardening\nattenuation artifact from adjacent skullbase. If there is clinical concern\nfor basilar artery thrombosis or underlying brainstem abnormality, recommend\nMRA, MRI brain without contrast.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 4:20 pm, 5 minutes\nafter discovery of the findings." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction, mass or midline\nshift. There is no hydrocephalus. Visualized paranasal sinuses and mastoid\nair cells are clear. There is no fracture.", + "output": "No acute intracranial abnormalities identified." + }, + { + "input": "Status-post left frontotemporal craniotomy and temporal lobe mass resection. \nPostsurgical changes include surgical hardware, a subcutaneous surgical drain,\nsubcutaneous emphysema, pneumocephalus, and a small amount of extra-axial\nblood products. Few punctate foci of hyperattenuation in the left temporal\nlobe probably reflect blood products within the resection cavity. No\nsignificant mass-effect on the adjacent left lateral ventricle. Left\nfrontotemporal edema is essentially unchanged. No evidence of large\nterritorial infarction.\n\n The visualized portion of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "Expected postoperative changes status-post left frontotemporal craniotomy and\nleft temporal lobe mass resection. No large intracranial hemorrhage." + }, + { + "input": "There is extensive subcutaneous edema and fat stranding in the submandibular\nspace extending superiorly and symmetrically to the level of the parotid\nglands and surrounding the submandibular glands. There is thickening of the\nbilateral platysma muscles. There is no drainable fluid collection. The\nsublingual space is normal.\n\nEvaluation of the aerodigestive tract demonstrates no exophytic mass, nor\nareas of focal mass effect. There are multiple hyperenhancing non enlarged\nsubmandibular lymph nodes, likely reactive. The visualized salivary glands are\nunremarkable in appearance. No thyroid mass is seen. Neck vessels are patent. \nThere is mild paraseptal emphysema at the lung apices. No bony abnormality is\nseen. Mucosal thickening is seen within the maxillary sinuses bilaterally with\na mucous retention cyst in the left.", + "output": "Diffuse edema and stranding of the submandibular space extending superiorly to\nthe level of the parotid glands. No drainable fluid collection." + }, + { + "input": "Dental amalgam streak artifact limits study. The bilateral frontal, bilateral\nsphenoid, bilateral maxillary, and right ethmoid sinuses are clear. A single\nleft anterior ethmoid air cell contains a small amount of aerosolized\nsecretions with an air-fluid level. The ostiomeatal units are patent. The\ncribriform plates are intact. Minimal rightward nasal septal deviation is\npresent. The nasal septum is minimally deviated to the right. There are\nbilateral concha bullosa. The anterior clinoid processes are both\npneumatized. The lamina papyracea are intact. The sphenoid sinuses contain\nmultiple septa, with 1 inserting upon the right carotid groove and an\nincomplete septum inserting upon the left carotid groove.\n\nThe orbits and visualized brain are unremarkable. The mastoid air cells and\nmiddle ear cavities are clear.", + "output": "1. Dental amalgam streak artifact limits study.\n2. Minimal left anterior ethmoid sinus disease.\n3. Bilateral concha bullosa.\n4. Minimal rightward nasal septal deviation." + }, + { + "input": "Left : The external auditory canal is normal. The middle ear cavity is clear.\nThe ossicles and tegmen are intact. There is no evidence for enlarged\nvestibular aqueduct.Although the roof of the superior semicircular canal is\nthinned (series series 403b, image 84) there is no definitive dehiscence on\nStenver's view. The facial nerve follows a normal course through the middle\near. There is no evidence for inner ear dysplasia. The mastoids are clear.\n\nRight: The external auditory canal is normal. The middle ear cavity is clear.\nThe ossicles and tegmen are intact. There is no evidence for enlarged\nvestibular aqueduct or superior semicircular canal dehiscence. The facial\nnerve follows a normal course through the middle ear. There is no evidence for\ninner ear dysplasia. The mastoids are clear.\n\nOther: Although not optimized for such evaluation, visualized brain is\ngrossly unremarkable.", + "output": "1. The roof of the left superior semicircular canal is thinned without\nevidence of definitive dehiscence (series 403b, image 84).\n2. Unremarkable CT of the temporal bones." + }, + { + "input": "CT head shows no evidence of hemorrhage, or loss of gray-white matter\ndifferentiation. No midline shift or hydrocephalus seen.\n\nCT angiography of the neck shows normal appearance of the carotid and\nvertebral arteries without stenosis or occlusion or dissection. The ascending\naorta is minimally dilated measuring up to 3.8 cm.\n\nCT angiography of the head shows normal appearance of the arteries of the\nanterior and posterior circulation without stenosis or occlusion or aneurysm\ngreater than 3 mm in size.", + "output": "No significant abnormalities on CT of the head without contrast. No\nsignificant abnormalities on CT angiography of the head and neck. Slightly\nprominent ascending aorta partially visualized." + }, + { + "input": "There are multiple large hyperdense lesions in the right frontal lobe, left\nfrontal lobe, and bilateral cerebellum, which are concerning for metastatic\nlesions, hemorrhagic. The largest lesion in the left frontal lobe measures\napproximately 3.5 x 4.6 cm (series 2: Image 17). The largest lesion in the\nleft cerebellum appears confluent measuring approximately 2.9 x 3.8 cm (series\n2: Image 8) and has a central region of hypodensity which may represent\nnecrosis. There is mild mass-effect and edema surrounding the lesions,\nparticularly the left cerebellar lesion with slight mass effect on the ___\nventricle. No hydrocephalus is seen. There is no evidence of acute major\nvascular territory infarction. No evidence of significant midline shift. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Mild mucosal thickening is seen in the\nbilateral ethmoid air cells. Otherwise, the remaining visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "1. Multiple large supratentorial and infratentorial hyperdense lesions with\nmild mass effect, concerning for hemorrhagic metastatic lesions. Mass effect\non the fourth ventricle without hydrocephalus seen.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 6:35 ___, 2 minutes after discovery of\nthe findings." + }, + { + "input": "The patient has had interval left suboccipital craniotomy with expected post\nsurgical changes in the overlying soft tissue and underlying extra-axial\nspace. There is a mild pneumocephalus in the posterior fossa and region of\nthe basal cisterns. Small amount of hyperdense material along the resection\nbed could be residual blood products and/or residual hemorrhage and tumor. In\nthe left cerebellar hemisphere a circumscribed 1.6 x 1.4 cm hyperdense lesion\nis probably residual hemorrhagic tumor or hematoma (series 3, image 9). A 6\nmm hyperdense lesion in left temporal lobe is consistent with metastasis. A 6\nmm hyperdense lesion in the right cerebellar hemisphere is unchanged and\ncorresponds to a metastasis. A 4 mm hyperdense metastasis in the left frontal\nlobe is unchanged. The large hemorrhagic metastasis in the right frontal lobe\nis unchanged, measuring 4.4 x 3.5 cm.\n\nNo shift of normally midline supratentorial structures. There is stable\neffacement of the fourth ventricle, with mild shift of midline cerebral\nstructures to the right, stable. Superior cerebellar cistern is completely\neffaced, stable. Pre pontine cistern is effaced. Foramen magnum is patent. \nThe overall size and configuration of the lateral ventricles is unchanged.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Expected post left suboccipital craniotomy changes to resect a left\ncerebellar metastasis as above. There is small residual hematoma or\nhemorrhagic metastasis along the upper margin of the surgical cavity, similar.\n2. Other hemorrhagic metastases are unchanged as above.\n3. Similar mass effect in the posterior fossa with stable partial effacement\nof the fourth ventricle, rightward shift of midline cerebellar structures,\neffacement of superior cerebellar and pre pontine cisterns, and patent foramen\nmagnum.\nThere is no hydrocephalus." + }, + { + "input": "Patient is status post interval left frontal craniotomy with expected\npostsurgical changes including pneumocephalus and trace hyperdense blood\nproducts within the resection cavity. There is no significant midline shift\nor large subdural collection. Changes related to recent suboccipital left\ncraniotomy for resection of cerebellar metastasis are also similar with a\nhyperdense metastatic focus along the superior margin of the resection cavity,\nunchanged. Numerous additional scattered small hemorrhagic metastases within\nboth cerebral and cerebellar hemispheres are similar in distribution and\nextent. Mild effacement of the fourth ventricle and suprasellar cistern are\nunchanged.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Expected postoperative appearance following interval right frontal\ncraniotomy and resection of a large right frontal lobe metastatic lesion.\n2. Unchanged appearance of the left suboccipital craniotomy resection cavity.\n3. Unchanged scattered small hemorrhagic metastases." + }, + { + "input": "Patient is status post right frontal craniotomy with resection changes seen in\nthe right frontal lobe. Suboccipital left craniotomy changes are also\nunchanged.\n\nThere is redemonstration of numerous scattered hemorrhagic metastatic lesions\nwithin the cerebral and cerebellar hemispheres. The largest lesion measures\napproximately 1.7 x 2.1 cm in the left cerebellum, which appears mildly\nenlarged compared to the prior study. There is again vasogenic surrounding\nedema causing mass-effect in the posterior fossa and fourth ventricle. \nAdditionally, there is new vasogenic edema surrounding a 1.5 cm metastatic\nlesion in the left parieto-occipital lobe, adjacent to the occipital horn of\nthe left lateral ventricle, not seen on the prior study from ___\n(series 2: Image 13). Multiple other metastatic lesions also appear enlarged.\n\nThere is no evidence of acute major vascular territory infarction or new\nhemorrhage. The ventricles and sulci are stable in size and configuration. \nThere is no midline shift.\n\nMild mucosal thickening is seen in the ethmoid air cells. Otherwise, the\nremaining visualized portion of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear.", + "output": "1. There is interval increase in size of multiple scattered\nhemorrhagic/hyperdense metastatic lesions since ___. For example,\nthe largest left cerebellar lesion is slightly enlarged with vasogenic edema\ncausing mass-effect in the posterior fossa and fourth ventricle. No evidence\nof acute major vascular territory infarction or new hemorrhage.\n2. The patient is status post right frontal craniotomy and suboccipital left\ncraniotomy with resection changes in the right frontal lobe." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial process." + }, + { + "input": "There is no evidence of intracranial hemorrhage, acute large territorial\ninfarction, edema,or mass. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. Periventricular and subcortical\nhypodensities are nonspecific, though likely sequela of chronic small vessel\nischemic disease. Bilateral basal ganglia calcifications are noted. \nExtensive atherosclerotic calcifications involving the carotid siphons and\nbilateral V4 segments of the vertebral arteries.\n\nThere is no evidence of fracture. Mild mucosal thickening of the bilateral\nethmoid air cells and visualized bilateral maxillary sinuses. The visualized\nportion of the remaining paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "No evidence of acute intracranial abnormality." + }, + { + "input": "There is no evidence of fracture, large territorial\ninfarction,hemorrhage,edema,or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. Periventricular and subcortical\nwhite matter hypodensities are nonspecific but likely sequelae of chronic\nsmall vessel ischemic disease. There are extensive calcifications of the\ncarotid siphons and bilateral V4 segments of the vertebral arteries as well as\npunctate calcifications in the distribution of the external carotid arteries.\n\nThere is mucosal thickening of the bilateral maxillary sinuses. Otherwise,\nthe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. Patient is status post bilateral lens replacements.", + "output": "There is no evidence of acute intracranial process or hemorrhage." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\n\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass effect. Chronic lacunar infarcts vs prominent perivascular spaces are\nagain seen in the bilateral basal ganglia. The ventricles and sulci are\nnormal in size and configuration.\n\nNo osseous abnormalities seen. There are mucous retention cysts in the\nbilateral maxillary sinuses as well as the mild mucosal thickening in the\nbilateral ethmoid air cells. Otherwise, the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute vascular territorial infarction, hemorrhage,\nedema, or mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process identified." + }, + { + "input": "SOFT TISSUES: There is no stranding, fluid collection, hematoma, or other\nsoft tissue abnormality.\n\nMAXILLOFACIAL BONES: The maxillofacial bones are intact, without fracture.\nThe zygomatico-maxillary complex is intact. The lateral pterygoid plates are\nintact.\n\nMANDIBLE: The mandible is without fracture or temporomandibular joint\ndislocation. The temporomandibular joints are symmetric, without significant\ndegenerative change.\n\nDENTITION: There are no dental fractures.\n\nSINUSES: The paranasal sinuses are intact and clear. The ostiomeatal units\nare patent. The mastoid air cells and middle ear cavities are clear.\n\nNOSE: There is a tiny 1 mm ossific fragment in the region of the left nasal\nbone (02:48), suspicious for fracture. The chronicity is indeterminate, as\nthere is no significant surrounding soft tissue stranding or edema.\nNasopharyngeal soft tissues are unremarkable. There is no nasal septal\nhematoma.\n\nORBITS: The orbits, including the laminae papyracea, are intact. The globes\nare intact with non-displaced lenses and no intraocular hematoma. There is no\npreseptal soft tissue edema. There is no retrobulbar hematoma or fat\nstranding.\n\nHead CT dictated separately.", + "output": "1. Probable left nasal bone fracture, age indeterminate. This may be chronic\nas there is no significant surrounding edema.\n2. There is otherwise no facial fracture.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 1:06 ___, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Prominent\nventricles and sulci suggest age-related involutional changes or atrophy. \nSubcortical and periventricular white matter hypodensities are consistent with\nchronic small vessel ischemic disease.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nethmoid air cells. Remainder of the paranasal sinuses are clear. Of note,\nthe frontal sinus is not pneumatized. The mastoid air cells and middle ear\ncavities are clear. The patient is status post bilateral lens replacement.", + "output": "No acute intracranial process." + }, + { + "input": "There is no acute intracranial hemorrhage, edema, mass effect or shift of\nnormally midline structures. The ventricles and sulci are normal in size and\nconfiguration for the patient's age. The basal cisterns appear patent and\ngray-white matter differentiation is preserved. Tiny periventricular\nhypodensity near the head of the left caudate likely represents chronic small\nvessel ischemic disease. The orbits and globes are unremarkable. The imaged\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nbony calvaria appear intact.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no acute hemorrhage, edema, mass effect or acute large vascular\nterritorial infarction. The ventricles and sulci are normal in size and\nconfiguration. Periventricular white matter hypodensities are consistent with\nchronic small vessel ischemic disease. The basal cisterns appear patent and\nthere is preservation of gray-white matter differentiation.\n\nNo fracture is identified. The mastoid air cells and middle ear cavities are\nclear. There is mucosal thickening in the right maxillary sinus. The globes\nare unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nlarge territorial infarction. Prominent ventricles and sulci suggest\nage-related involutional changes or atrophy. Subcortical and periventricular\nwhite matter hypodensities are consistent with chronic small vessel ischemic\ndisease. The basal cisterns appear patent and there is preservation of\ngray-white matter differentiation.\n\nThe visualized bony structures are grossly unremarkable. There is mucosal\nthickening seen within the bilateral frontal sinuses, bilateral ethmoid air\ncells, and right maxillary sinus. The bilateral mastoid air cells and middle\near cavities are clear. Atherosclerotic mural calcification of the bilateral\ninternal carotid arteries is noted. The globes are unremarkable.", + "output": "1. No evidence of acute intracranial hemorrhage or large vascular territory\ninfarction.\n2. Moderate cerebral atrophy and sequelae of chronic small vessel ischemic\ndisease.\nCorrelate clinically to decide on the need for further workup or followup.\n3. Multifocal paranasal sinus disease, as above." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass-effect. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The frontal sinuses are underdeveloped. \nOtherwise, the visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial abnormality.\n2. No evidence of acute intracranial hemorrhage" + }, + { + "input": "Subarachnoid hemorrhage within the left parietal sulci (series 2, image 23)\nand within the right frontal, parietal sulci and within the right inferior\nfrontal lobe are unchanged since the prior study. A small amount of\nsubarachnoid hemorrhage within the left temporal lobe is also unchanged\n(series 2, image 14). There are no and newly area of hemorrhage, edema, mass\neffect or acute territorial infarction. The ventricles and sulci are normal\nin size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "Stable subarachnoid hemorrhage as described above without significant mass\neffect. No new intracranial hemorrhage." + }, + { + "input": "HEAD CT: There is a hypodensity within the posterior limb of the right\ninternal capsule with extension into the medial right temporal lobe and right\ncerebral peduncle. Findings are grossly unchanged when compared to recent MRI.\nThere is no hemorrhage, vascular territorial infarct or mass effect. The\nventricles, and sulci are normal.\n\nThe orbits, mastoid air cells and visualized soft tissues are unremarkable.\nThere is a retention cyst within the right side of the sphenoid sinus.\n\nHEAD CTA: there is a hypoplastic left A1 segment. The anterior and posterior\ncirculations are otherwise unremarkable. There is no significant stenosis,\nvessel occlusion or aneurysm greater than 2 mm. There are no definite imaging\nfindings of vasculitis.\n\nNECK CTA: Incidentally noted is a left vertebral artery arising from the\naortic arch. The vertebral arteries are otherwise unremarkable.\n\nThe common carotid, internal carotid and external carotid arteries are widely\npatent without evidence of significant stenosis based on NASCET criteria.\nThere is no evidence of arterial dissection.", + "output": "There is a hypodensity corresponding to the MRI signal abnormalities within\nthe posterior limb of the right internal capsule with extension into the\nmedial right temporal lobe and cerebral peduncle. There is no hemorrhage.\n\nUnremarkable head and neck CTA without evidence of significant stenosis,\naneurysm or dissection.\n\nCASE REVIEWED WITH ___. ___." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema,or\ndiscrete mass. The ventricles and sulci are age-appropriate. There is no\nevidence of fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "Venous contrast poolinganddental amalgam streak artifactandpatient body\nhabitus limits study. Within these confines:\n\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nThere are periventricular and subcortical lucencies, which may represent small\nvessel ischemic changes.\n\nThe visualized portion of the mastoid air cells,and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\n Nonocclusive atherosclerotic narrowing of the cavernous and supraclinoid\nsegments of the bilateral internal carotid arteries are seen. Otherwise, the\nvessels of the circle of ___ and their principal intracranial branches\nappear preserved without stenosis, occlusion, or aneurysm formation greater\nthan 3 mm. The dural venous sinuses are grossly patent.\n\nCTA NECK:\nNonocclusive atherosclerotic calcifications are noted and the aortic arch. \nNonocclusive atherosclerotic narrowing of bilateral subclavian artery origins\nis noted. Nonocclusive atherosclerotic calcifications noted at the origin of\nthe right common carotid and vertebral arteries. Left vertebral and common\ncarotid artery origins are otherwise patent. Nonocclusive atherosclerotic\nnarrowing of the mid left common carotid artery is noted. Artifact limits\nevaluation of right vertebral artery proximal V3 segment. Approximately 30%\nnarrowing of the left internal carotid artery origin by atherosclerotic plaque\nis noted (see 454:40). There is no evidence of moderate or high-grade internal\ncarotid stenosis by NASCET criteria.\nOtherwise, the carotidandvertebral arteries and their major branches appear\npreserved with no definite evidence of stenosis or occlusion.\n\nOTHER:\nThe visualized portion of the lungs demonstrate biapical scarring and\nnonspecific approximately 1.1 cm right upper lobe opacity (see 3:60).. Mildly\nenlarged heterogenous thyroid gland with no discrete focal lesion. Scattered\nsubcentimeter nonspecific lymph nodes are noted throughout the mediastinum and\nneck bilaterally, without definite enlargement by CT size criteria. Bilateral\nethmoid air cell mucosal thickening is present. Nonspecific patchy induration\nof bilateral pre malar are and right pre mandibular soft tissues are noted.", + "output": "1. Limited study as described.\n2. No acute intracranial abnormality. Please note MRI of the brain is more\nsensitive for the detection of acute infarct.\n3. Nonocclusive probable atherosclerotic narrowing of circle ___ as\ndescribed.\n4. Otherwise, grossly patent circle of ___ without definite evidence of\nstenosis,occlusion,or aneurysm greater than 3 mm.\n5. Multifocal cervical atherosclerotic nonocclusive narrowing as described.\n6. Artifact limits evaluation of right vertebral artery proximal V3 segment.\n7. Otherwise, grossly patent bilateral cervical carotid and vertebral arteries\nwithout definite evidence of stenosis, occlusion, or dissection.\n8. Paranasal sinus disease , as described.\n9. Limited imaging of the lungs demonstrate biapical scarring and\napproximately 1.1 cm nonspecific right upper lobe pulmonary opacity. \nRecommend correlation with dedicated chest imaging.\n10. Additional findings as described above.\n\nRECOMMENDATION(S): Limited imaging of the lungs demonstrate biapical scarring\nand approximately 1.1 cm nonspecific right upper lobe pulmonary opacity.\nRecommend correlation with dedicated chest imaging." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, shift of normally\nmidline structures or acute major vascular territorial infarction. Ventricles\nand sulci are normal in size and configuration. The basal cisterns appear\npatent and there is preservation of gray-white matter differentiation.\n\nThere is no fracture. The visualized paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The globes are unremarkable.", + "output": "No acute intracranial abnormality.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 7:14 ___, 10 minutes after discovery of\nthe findings." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nPeriventricular and subcortical white matter hypodensities are nonspecific but\nlikely reflect sequelae of chronic small vessel ischemic disease. Mild\natherosclerotic vascular calcifications of the cavernous carotid arteries are\nnoted. Dolichoectasia of the vertebrobasilar system is noted.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nanterior ethmoid air cells, otherwise the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable with the exception of bilateral lens\nreplacements.", + "output": "No acute intracranial abnormality." + }, + { + "input": "Limited examination due to patient motion. Within this limitation, grossly\nthere is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\n\nThere is mucosal thickening of bilateral ethmoid air cells a bilaterals\nsphenoid and maxillary sinuses. Mastoid air cells and middle ear cavities are\nwell aerated. The bony calvarium is intact.", + "output": "Limited examination due to patient motion, within this limitation, grossly\nthere is no evidence of acute intracranial process or hemorrhage." + }, + { + "input": "There is no acute intracranial hemorrhage, edema, or evidence of large\nvascular territorial infarction. Perimesencephalic cistern remains effaced\nbilaterally due to bilateral uncal herniation, with associated midbrain\ndeformity. Other basal cisterns are not compressed. Cerebellar tonsils are\nnormally positioned. The sulci remain smaller than the ventricles. There is no\nhydrocephalus. Evidence of left frontal craniotomy for left dural biopsy is\nagain seen.\n\nThere is mild mucosal thickening of bilateral ethmoid air cells. Other imaged\nparanasal sinuses are clear. Mastoid air cells are well aerated bilaterally.", + "output": "Unchanged effacement of the perimesencephalic cistern due to bilateral uncal\nherniation, with associated midbrain deformity. No evidence for acute\nabnormalities." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. There is effacement of the bilateral perimesencephalic cisterns\ncompatible with bilateral uncal herniation and ill-defined hypoattenuation\ninvolving the midbrain, unchanged as compared to MRI head ___. \nLow lying cerebellar tonsils are unchanged in position dating back to ___.\n\nThere is mucosal thickening of the bilateral ethmoid air cells. The imaged\nparanasal sinuses are clear. Mastoid air cells and middle ear cavities are\nwell aerated.Patient is status post left frontal craniotomy. The bony\ncalvarium is otherwise intact. Bilateral frontalis internus is noted.", + "output": "1. No intracranial hemorrhage or acute intracranial abnormality.\n2. Bilateral uncal herniation with low lying cerebellar tonsils appears\ngrossly unchanged as compared to MRI head ___ and CT head ___. These findings again may be suggestive intracranial\nhypotension." + }, + { + "input": "HEAD CT: Allowing for differences in imaging modality, the overall appearance\nof the brain is unchanged from ___. Note is again made of asymmetry\nof the brain with the left lateral ventricle appearing smaller than the right.\nThe right cerebral sulci are effaced. The suprasellar and ambient cisterns are\neffaced with bilateral uncal herniation as seen on the preceding MRI. Minimal\nleft to right midline shift is also unchanged. There is no evidence of\nhemorrhage. The small extra axial fluid collections seen on the MR study are\nnot detected on this CT examination. There is no evidence of generalized\nedema. The gray-white matter interface is preserved without evidence of\ninfarciont. The orbits and globes are unremarkable. The imaged paranasal\nsinuses, middle ear cavities and mastoid air cells are clear bilaterally. The\nbony calvaria appear intact. Significant hyperostosis frontalis interna is\nnoted.", + "output": "No significant interval change in appearance of the brain from ___\nallowing for differences in imaging modality. Unchanged effacement of the\nright cerebral sulci and the suprasellar and ambient cisterns with uncal\nherniation bilaterally possibly related to metabolic encephalopathy given lack\nof mass effect or cerebral edema." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is an evolving intraparenchymal hematoma in the posterior right\ntemporal/occipital lobe measuring 3 x 2.1 cm with surrounding edema and mild\nmass effect including partial effacement of the temporal horn of the right\nlateral ventricle, not significantly changed since the prior exam. There is\nno significant midline shift or tonsillar herniation. There are no new areas\nof hemorrhage. The ventricles and the sulci are age-appropriate. No acute\nfracture is visualized.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are normal.\n\nCTA HEAD:\nMild atherosclerotic calcification involving the bilateral cavernous and the\nsupraclinoid ICA of without significant stenosis. The bilateral MCAs and\ntheir distal branches are patent. The left ACA arises from the right side, a\nnormal anatomic variant. The basilar artery and the bilateral PCAs are widely\npatent. There is mild atherosclerotic calcification involving the right V4\nsegment, without significant stenosis. The right vertebral artery is\ndominant. The vessels of the circle of ___ and their principal\nintracranial branches otherwise appear patent without stenosis, occlusion, or\naneurysm. The dural venous sinuses are patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Evolving intraparenchymal hemorrhage in the right temporal/occipital region\nmild regional edema and mass effect including partial effacement of the\ntemporal horn, not significantly changed since the prior study. No midline\nshift or new hemorrhage.\n2. Patent circle of ___ without evidence of\nstenosis,occlusion,arteriovenous malformation or aneurysm.\n3. Unremarkable CT of the neck without evidence of stenosis, occlusion, or\ndissection." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nNasal bone fractures are probably chronic. Mild mucosal thickening is noted\nin bilateral ethmoid and maxillary sinuses. Aerosolized fluid is noted in the\nnasopharynx. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Nasal bone fractures are probably chronic, be correlated clinically." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "A large skin laceration/defect is seen overlying the left frontal lobe. There\nis no evidence of underlying fracture.\n\nThere are small foci of linear high density within the sulci overlying the\ncerebellum bilaterally (series 2, image 6), which may be secondary to a small\namount of subarachnoid hemorrhage, mineralization, or less likely streak\nartifact. There is no evidence of acute territorial\ninfarction,hemorrhage,edema, or mass. Minimal periventricular white matter\nhypodensities are nonspecific, but likely represent the sequela of chronic\nmicrovascular ischemia. There is mild prominence of the ventricles and sulci\nsuggestive of involutional changes.\n\nMinimal mucosal thickening within the inferior right frontal sinus. \nOtherwise, the visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "Large skin laceration/defect overlying the left frontal lobe without evidence\nof underlying fracture. Small foci of linear high density overlying the\ncerebellum bilaterally, likely small volume subarachnoid hemorrhage, less\nlikely streak artifact. Alternatively, this may represent mineralization,\nalthough no susceptibility artifact is seen on the MR dated ___.\n\nRECOMMENDATION(S): This finding can be followed up with a repeat head CT in\n12 hours or an MRI for further evaluation.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 2:51 pm, 10 minutes\nafter discovery of the findings." + }, + { + "input": "The imaged paranasal sinuses demonstrate mild mucosal thickening in the\nbilateral maxillary sinuses and partial opacification of bilateral ethmoid air\ncells. The patient is reportedly status post recent tooth extraction along\nthe right posterior mandible. A small focus of air adjacent the site of\nextraction is noted (02:33), not unexpected. There is minimal stranding along\nthe buccal surface of the mandible (601b:32 and 02:42). There is no abscess.\n\nThere is a 0.9 x 0.8 cm hyperdense focus at the base of the tongue chest above\nthe hyoid bone (02:42). Evaluation of the aerodigestive tract is otherwise\nunremarkable. The salivary glands enhance normally and are without mass or\nadjacent fat stranding. The thyroid itself appears normal. There is no\nlymphadenopathy by CT criteria. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.", + "output": "Status post right mandibular tooth extraction. Minimal stranding adjacent to\nthe buccal surface of the mandible without discrete fluid collection.\nIncidentally noted ectopic thyroid tissue at the base of the tongue. Normal\nposition thyroid gland is identified as well." + }, + { + "input": "There is no evidence of fracture, acute large territory\ninfarction,hemorrhage,edema,or mass. The ventricles and sulci are normal in\nsize and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "No acute intracranial abnormality." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nAn ill-defined intraparenchymal hematoma in the superficial anterior left\nfrontal lobe measures 1.3 x 0.8 cm. There is a small amount of adjacent\nsubarachnoid hemorrhage. There is minimal associated edema. There is no\nshift of midline structures. Ventricles and basal cisterns are normal in\nsize.\n\nThe right sphenoid sinus contains 2 small mucous retention cyst. There is a\npartially visualized small mucous retention cyst in the included portion of\nright maxillary sinus and a small focus of mucosal thickening in the partially\nvisual left maxillary sinus. The mastoid air cells and middle ear cavities\nare clear. The orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear patent without evidence for flow-limiting stenosis or aneurysm. There\nis no evidence of an arteriovenous malformation.\n\nCTV HEAD:\nThe superior sagittal sinus, transverse sinuses, sigmoid sinuses, proximal\ninternal jugular veins, straight sinus, and inferior sagittal sinus are\npatent. There is no evidence of dural venous sinus thrombosis.", + "output": "1. 1.3 cm superficial anterior left frontal intraparenchymal hematoma with a\nsmall amount of adjacent subarachnoid hemorrhage and mild surrounding edema.\n2. No evidence of an arteriovenous malformation or aneurysm.\n3. No evidence for dural venous sinus thrombosis." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nMild mucosal thickening of bilateral maxillary sinuses and moderate thickening\nof the bilateral anterior ethmoid air cells. The remaining imaged paranasal\nsinuses are clear. Mastoid air cells and middle ear cavities are well aerated.\nThe bony calvarium is intact.", + "output": "-No acute intracranial abnormality on noncontrast head CT. Specifically no\nintracranial hemorrhage or large territory infarct.\n-Moderate mucosal thickening of the anterior ethmoid air cells and mild\nmucosal thickening of the maxillary sinuses." + }, + { + "input": "There is a similar overall pattern of intracranial hemorrhage with layering\nintraventricular hemorrhage in the occipital horns of the lateral ventricles\nas well as left perimesencephalic hemorrhagic focus, within the subarachnoid\nspace, best seen on series 2, image 9 measuring 18 x 13 mm stable. No change\nin ventricular size or evidence of obstructive hydrocephalus. Subtle\nsubarachnoid hemorrhage is noted in the right sylvian fissure. Exam is\nslightly motion limited. Chronic right MCA territory infarct noted. No signs\nof downward or subfalcine herniation. No acute bony abnormality.", + "output": "1. Stable overall pattern of hemorrhage with intraventricular and\nsubarachnoid hemorrhage as stated.\n2. Chronic right MCA infarct." + }, + { + "input": "Study is moderately degraded secondary to motion artifact. However within\nthese limitations, there is stable appearance of a left perimesencephalic\nhemorrhagic focus within the subarachnoid space measuring 1.7 x 1.3 cm\n(06:11), compared to previous measurement of 1.8 x 1.3 cm. Layering\nintraventricular hemorrhage within the occipital horns of the lateral\nventricles, similar to prior study. Subtle subarachnoid hemorrhage within the\nbilateral sylvian fissures, also unchanged from prior study. No evidence of\nnew hemorrhage or acute large territorial infarction. Encephalomalacia within\nthe right MCA territory is compatible with chronic infarction. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nPeriventricular and subcortical hypodensities are nonspecific, though likely\nsequela of chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Overall stable appearance of subarachnoid and intraventricular hemorrhage\nas described above, most notably including a hemorrhagic focus within the\nsubarachnoid space in the left perimesencephalic region measuring 1.7 x 1.3\ncm.\n2. Chronic right MCA territory infarct.\n3. Additional findings described above." + }, + { + "input": "Left perimesencephalic subarachnoid hemorrhage measuring 1.1 x 1.6 cm not\nsignificantly changed allowing for differences in slice selection patient head\nposition, 1.3 x 1.7 cm on ___. There is stable mass effect on the\nleft pons and stable posterior/inferior extension along the pons.\n\nSubarachnoid hemorrhage in the sylvian fissures and adjacent sulci is not\nsignificantly changed.\n\nLayering hemorrhage within the occipital horns of bilateral lateral ventricles\nis stable. Ventriculomegaly is stable.\n\nChronic right MCA infarct is again seen. Periventricular and subcortical\nwhite matter hypodensities are also again seen, nonspecific but likely sequela\nof chronic small vessel ischemic disease in this age group.\n\nNo evidence for concerning osseous lesions. Unchanged trace fluid versus\ndependent mucosal thickening in the left sphenoid sinus, and unchanged\naerosolized secretions in the anterolateral aspect of the left sphenoid sinus.\nUnchanged minimal mucosal thickening in the ethmoid air cells. Evidence of\nbilateral cataract surgery is again seen.", + "output": "Stable appearance of subarachnoid and intraventricular hemorrhage. Stable\nventriculomegaly." + }, + { + "input": "The patient is status post endovascular graft placement of the thoracic aorta\njust distal to the origin of the left common carotid artery extending to the\ndescending aorta with an aorto-right brachiocephalic and aorto-left common\ncarotid artery bypass. There is occlusion of the proximal left subclavian\nartery. A by-pass graft extending from the left common carotid artery to the\nleft subclavian artery is noted (series 18b, image 189-194) with decrease\nconstitution of the left subclavian artery at the level of the anastomosis.\n\nOtherwise, the common carotid, cervical internal carotid and vertebral\narteries are unremarkable and patent. There is no significant stenosis of the\ncervical internal carotid arteries by NASCET criteria. Visualized segments of\nthe circle ___, noting mild atherosclerotic calcification of the carotid\nsiphons are also unremarkable.\n\nOther: Median sternotomy wires are noted and appear intact. There is right\napical scarring, unchanged appearance from prior exam of ___. The remainder\nof the lung apices are clear. There is no mediastinal or cervical\nlymphadenopathy by CT size criteria. There is a left palatine tonsilith\nunchanged in appearance from prior exam presumably sequela of prior infection.\nThere is adherent soft tissue density along the right lateral aspect of the\ntrachea extending from the level of the glottis to the level of the carina,\nlikely mucus debris as there has changed configuration from prior examination.\nOtherwise the aerodigestive tract is unremarkable. The submandibular and\nparotid glands are unremarkable. The thyroid gland is unremarkable.\n\nPolypoid mucosal thickening of the left greater than right maxillary sinuses\nis noted, similar in appearance to prior examination of ___ to slightly\nimproved. Opacification of the ethmoid air cells are also seen, slightly\nprogressed from prior exam. The sphenoid sinus is essentially clear. The\norbits are unremarkable. The mastoid air cells and middle ear cavities are\nwell pneumatized and clear.\n\nExtensive osteoarthritic degenerative changes with near-complete loss of joint\nspace is noted in the right shoulder. There is multilevel cervical spondylosis\nwithout evidence of suspicious blastic or lytic osseous lesions.", + "output": "1. The patient is status post an aorto-right brachiocephalic, aorto-left\ncommon carotid artery bypass and left common carotid to left subclavian \nbypass.\n2. There is occlusion at the origin of the left subclavian artery with\nreconstitution at the level of the bypass anastomosis.\n3. Otherwise, the cervical vessels are widely patent. There is no significant\ncervical internal carotid artery stenosis by NASCET criteria.\n4. Please refer to dedicated CTA of the chest for full evaluation of the\nbypass.\n5. Additional chronic findings as described above." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. No osseous abnormalities seen.\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\nThe orbits are unremarkable. Vascular calcifications are prominent in keeping\nwith history of renal disease.", + "output": "No of hemorrhage or infarction. Please note, MRI would be significantly more\nsensitive." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\n\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration. Periventricular\nwhite matter hypodensities are suggestive of small vessel ischemic disease.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria. Atherosclerotic calcifications of the right\ncarotid bulb are seen without evidence of stenosis.\n\nOTHER:\nThere is minimal dependent atelectasis in the lungs bilaterally. There is\npleural scarring in the right upper lobe of the lung. There is a 0.9 cm nodule\nin the right lobe of the thyroid with peripheral calcifications and slightly\nheterogeneous for which further evaluation with ultrasound is recommended.\nThere is no lymphadenopathy by CT size criteria. Mild multilevel degenerative\nchanges are visualized throughout the cervical spine.", + "output": "1. Normal head and neck CTA.\n2. 9 mm peripherally calcified nodule in the right lobe of the thyroid.\n\nRECOMMENDATION(S): Impression 2. Correlation with thyroid ultrasound is\nrecommended." + }, + { + "input": "At the base of the tongue to the right of the midline and extending into the\nright vallecula, there is a 1.2 x 0.7 cm centrally hypodense peripherally\nhyperdense focus with rim calcification seen. This appears well circumscribed\nand without local extension. Degree of enhancement is difficult to assess in\nthe absence of a non contrast study.\n\nThe aerodigestive tract is otherwise unremarkable. Airways are patent.\nEvaluation of the cervical lymph chains demonstrate no pathologic\nlymphadenopathy by imaging criteria. The visualized submandibular and parotid\nglands are unremarkable in appearance. The thyroid gland appears enlarged\nthough no nodule was seen. Neck vessels are patent. Moderate calcifications\nare identified within the aortic arch and origins of the left subclavian\nartery. Additional calcifications within the right carotid artery at the\ncarotid bulb is additionally noted. Bilateral trace pleural effusions are\nnoted. Dependent atelectasis is additionally seen. No bony abnormality is\nseen.", + "output": "1. 1.2 x 0.7 cm tongue base mass with peripheral calcification. Differential\nwould include a malignant lesion of the oral cavity, though lack of local\nextension or adenopathy is noted suggesting alternative diagnosis. Minor\nsalivary gland tumors such as adenoid cystic lesion should additionally be\nconsidered as well as mucoepidermoid carcinoma or adenocarcinoma.\n2. Enlarged thyroid gland without a focal nodule identified. Correlation with\nthyroid function tests recommended." + }, + { + "input": "Multiple foci of metastatic disease, including a 2.1 x 1.6 cm left frontal\nhyperdensity with surrounding edema, and a 1.7 x 1.7 cm right occipital\nhyperdensity with surrounding edema, are mostly cortically based. Some of\nthese seem to reach the surface of the brain, and may reflect leptomeningeal\ninvolvement. The ventricles and sulci are normal in size and configuration for\nage.\nRight parietal calvarial lucency, partially seen on prior CT neck, could be a\nfocus of metastatic disease. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. Multiple foci of metastatic disease as described above. Some of these seem\nto reach the surface of the brain, and may reflect leptomeningeal involvement.\n2. Right parietal calvarial lucency, partially seen on prior CT neck, could be\na focus of metastatic disease." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no exophytic mass, nor\nareas of focal mass effect. Cervical lymph nodes are prominent, right greater\nthan left, but not pathologically enlarged by CT size criteria. The\nvisualized salivary glands are unremarkable in appearance. The thyroid gland\nis surgically absent. The neck vessels are patent, with calcified\natherosclerotic plaque noted at the bilateral carotid bulbs. There is no focal\nlytic or sclerotic lesion within the osseous structures. Mild mucosal\nthickening of the left maxillary sinus is seen.\nPlease see the dedicated CT chest from the same day for detailed evaluation of\nthe thorax.", + "output": "Status post thyroidectomy with the expected postsurgical changes. No\nlymphadenopathy or soft tissue mass identified." + }, + { + "input": "There are postoperative changes of prior thyroidectomy. The submandibular\nglands and parotid glands appear normal. There is a calcified right\nparatracheal lymph node which measures 1.1 cm and is unchanged when compared\nto prior exam. Additional smaller calcified lymph nodes along the left\nparatracheal region are unchanged. There are scattered prominent bilateral\ncervical lymph nodes, all of which appear unchanged when compared to prior\nexam. There is no new lymphadenopathy, mass, or abnormal fluid collection.\n\nThe masticator and parapharyngeal spaces appear normal. The oropharynx,\nnasopharynx, and structures of the aerodigestive tract are unremarkable.\n\nThere is extensive paranasal sinus opacification, predominantly involving the\nmaxillary sinuses, increased from prior exam. The imaged intracranial\ncontents, orbits, and mastoid air cells are unremarkable.\n\nAtherosclerotic vascular disease is present within the aortic arch. There are\ncalcifications within the bilateral proximal internal carotid arteries. The\nlung apices are unremarkable.\n\nThere is a sclerotic foci within the lateral aspect of the third ribs\nbilaterally which are unchanged and likely represents a bone island.", + "output": "1. Postoperative change of prior thyroidectomy with scattered prominent in\ncalcified cervical lymph nodes, unchanged from prior exam.\n2. Increased paranasal sinus disease." + }, + { + "input": "CT HEAD:\nThere is no evidence of hemorrhage, infarction, mass effect, or edema. The\nventricles and sulci are age appropriate and symmetric. There is a densely\ncalcified dural plaque adjacent to the inner table in the left middle cranial\nfossa.\n\nThe basal cisterns remain patent. There is preservation of gray-white matter\ndifferentiation.\n\nMucosal thickening is seen involving the bilateral maxillary sinuses and\nscattered ethmoid air cells. The remainder of the paranasal sinuses, middle\near cavities, and mastoid air cells are clear. The orbits are grossly\nunremarkable bilaterally.\n\n\nCTA HEAD AND NECK:\nThere is a normal 3 vessel aortic arch. The vertebral basilar system is\nright-sided dominant. Within the distal right V4 segment, immediately prior\nto the junction with the left V4 segment to form the basilar artery, there is\na subtle linear intraluminal filling defect (3:260, 601:44), which is\nnon-anatomic in configuration and likely artifactual. The bilateral vertebral\narteries are otherwise grossly unremarkable.\n\nThe common carotid and their major branches appear patent without high-grade\nstenosis or occlusion. There is no evidence of internal carotid stenosis by\nNASCET criteria.\n\nMild, partially calcified atherosclerotic disease is seen within the bilateral\ncarotid bulbs. There are large posterior communicating arteries seen\nbilaterally, with hypoplastic P1 segments, more notable on the left. The\nvessels of the circle of ___ and their principal intracranial branches are\npatent without evidence of stenosis, occlusion, or aneurysm formation. The\ndural venous sinuses are patent.\n\n\nOTHER:\nA calcified granuloma is noted within the right upper lobe. The lungs are\notherwise grossly unremarkable. The thyroid gland is unremarkable in\nappearance. There is no cervical lymphadenopathy by CT size criteria.", + "output": "1. No evidence of hemorrhage or infarction.\n2. Patent intracranial and cervical neck vasculature without high-grade\nstenosis, convincing evidence for dissection, or aneurysm greater than 3 mm.\n\nNOTIFICATION: Findings were conveyed by Dr. ___ to Dr. ___ text\n___ at 08:30 on ___, 2 minutes after interpretation." + }, + { + "input": "There is no evidence of fracture, infarction, hemorrhage within the confines\nof a contrast-enhanced examination, edema or mass. The ventricles and sulci\nappear normal for age. There is no abnormal enhancement on post contrast\nimages.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "Normal study." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Mild mucosal thickening right maxillary\nsinus floor. There is mild opacification of the right mastoid air cells. \nOtherwise, the visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is a tiny right parietal subgaleal hematoma (601b:67). There is no\nevidence of fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable. Cavernous carotid atherosclerotic\ncalcifications are noted.", + "output": "Tiny right parietal subgaleal hematoma. No fracture, intracranial hemorrhage,\nor large territorial infarction." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no intracranial hemorrhage, edema, or midline shift. The ventricles\nare normal in size.\n\nThere is lucency within the left parietal bone (05:312), which may represent a\nburr hole; correlate clinically. There are moderate bilateral ethmoid and\nmaxillary sinus mucosal opacifications within left maxillary sinus mucosal\nretention cyst. The remaining paranasal sinuses and bilateral mastoid air\ncells appear clear.\n\nCTA HEAD:\nThere is hypoplastic left A1 segment of the anterior cerebral artery, likely a\ncongenital variant. There are mild vascular calcifications of the bilateral\ncavernous internal carotid arteries. There is a hypoplastic right vertebral\nartery. Otherwise, the visualized principal arterial branches, including the\ncircle of ___ appear patent without stenosis, occlusion, or aneurysm\nformation.\n\nCTA NECK:\nThe bilateral common and internal carotid arteries appear patent without\nstenosis per NASCET criteria. The bilateral vertebral arteries appear patent.\nThere is no evidence of stenosis, occlusion or dissection.\n\nOTHER:\nThe visualized lung apices appear unremarkable. The mild vascular\ncalcifications of the aortic arch. There is no lymphadenopathy per size\ncriteria. The thyroid gland appears unremarkable. The multilevel degenerate\nchanges of the cervical spine.", + "output": "1. No hemorrhage or hypodensities or other significant abnormalities. \nHowever, dedicated MRI would be helpful to further assess.\n2. No evidence of stenosis, occlusion, or aneurysm formation of the\nintracranial vasculature.\n3. Unremarkable CT neck without stenosis, occlusion, or dissection.\n\nRECOMMENDATION(S): Head MRI to evaluate for acute infarction." + }, + { + "input": "CT head: The gray-white matter differentiation is intact without CT evidence\nof acute territorial infarct, hemorrhage, or mass effect. The ventricles and\ncortical sulci are normal in caliber and configuration. The extra-axial\nspaces are unremarkable.\n\nThe orbits, soft tissues, and calvarium are unremarkable. The paranasal\nsinuses, mastoid air cells, and middle ears are clear.\n\nCTA head: The bilateral intracranial internal carotid arteries are patent. \nThe anterior and right posterior communicating arteries are visualized. The\nleft posterior communicating artery is not definitively seen. There are\ncodominant vertebral arteries. The arterial circulation is patent without\nocclusion, stenosis, aneurysm, or dissection. There is no evidence of\nvascular malformation. There is normal dural venous sinus enhancement.\n\nCTA neck: There is a 3 vessel aortic arch with patent subclavian arteries. \nThe carotid arteries are patent without stenosis by NASCET criteria. There is\na short segment mild beaded appearance of the right cervical segment internal\ncarotid artery (60___:33). The vertebral arteries are patent and demonstrate\ncodominant is.\n\nThe masticator and parapharyngeal spaces are unremarkable. There is a 4 x 6\nmm calculus within the right submandibular gland (5:119), without associated\ngland lipoatrophy or ductal dilatation. Remainder of the salivary glands are\nunremarkable. There is a 1.1 cm right thyroid lobe nodule (05:50). There is\na 0.7 cm left thyroid lobe nodule (5:60). There is streak artifact secondary\nto dental hardware and almalgam which obscures adjacent structures. There is\nno fracture or osseous lesion. The lung apices are clear. There are no\nsuspicious lymph nodes by size or morphology. There scattered tonsilliths\nwithin the bilateral palatine tonsils, right greater than left. The nasal and\noral cavities are unremarkable. The larynx is unremarkable.", + "output": "1. No CT evidence of acute intracranial abnormality. Please note that MRI\nprovides greater sensitivity in evaluation of acute infarction.\n2. Patent intracranial and neck vasculature, without carotid stenosis by\nNASCET criteria.\n3. Short segment mild beaded appearance of the right cervical segment internal\ncarotid artery. This is unlikely to represent atherosclerosis given the\nabsence of atherosclerosis within the remaining vasculature. Differential\nconsiderations include an incidental tortuous course versus fibromuscular\ndysplasia. Recommend clinical correlation.\n4. 1.1 and 0.7 cm thyroid nodules, as described.\n5. 4 x 6 mm sialolith within the central aspect of the right submandibular\ngland without associated glandular atrophy or ductal dilatation.\n\nRECOMMENDATION(S):\n1. Recommend clinical correlation for signs and symptoms of fibromuscular\ndysplasia given these short segment mild beaded appearance of the right\ncervical segment internal carotid artery.\n2. Per the ___ College of Radiology recommendations, thyroid nodules\nmeasuring less than 1.5 cm in patient's greater than ___ years of age do not\nnecessitate follow-up imaging, in the absence of clinical risk factors. If\npatient has clinical risk factors, then recommend dedicated thyroid\nultrasound." + }, + { + "input": "There is evidence of prior sinus surgery with right middle meatal antrostomy,\nethmoidectomy, sphenoid sinus osteotomy. No retained ethmoid partitions. \nChronic periostitis about ethmoid sinus. Partial bilateral middle\nturbinectomy.\n\nRight maxillary sinus antrostomy is widely patent. There is trace mucosal\nthickening right maxillary sinus.\n\nMild atelectasis left maxillary sinus secondary to chronic inflammation. \nUncinate process, infundibulum are retracted medially and infundibulum is\nobstructed. There is accessory ostium in the left maxillary sinus.\n\nSmall benign osteoma inferior right frontal sinus and trace mucosal\nthickening. Otherwise, frontal sinuses including drainage pathways,\ninfundibula are patent.\n\nMild mucosal thickening ethmoid septa. Trace mucosal thickening right\nsphenoid sinus, sphenoid sinuses bilaterally otherwise patent.\n\nThe cribriform plates are intact. The lamina papyracea are intact. The orbits\nare unremarkable. Limited evaluation of the brain parenchyma demonstrates no\ngross abnormality. Mild nodular thickening of the mucosal surface nasal\nseptum. Nasal septal deviation to the right anteriorly, and to the left\nposteriorly. Clear nasal cavity no periapical lucencies at the maxilla. \nThere are no air cells above bilateral anterior ethmoidal artery. Optic nerve\ncanals are covered by bone. Chronic nasal bone fracture. Anterior clinoid\nare not aerated.", + "output": "1. Postsurgical changes..\n2. Mild mucosal thickening left maxillary sinus, maxillary sinus atelectasis,\nobstructed infundibulum, and accessory ostium." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere are mild periventricular and subcortical white matter hypodensities,\nnonspecific but likely sequelae of chronic small vessel disease. There is no\nevidence of infarction,hemorrhage,edema,ormass. The ventricles and sulci are\nnormal in size and configuration.\n\nThe patient is edentulous. The visualized portion of the paranasal sinuses,\nmastoid air cells,and middle ear cavities are clear. The visualized portion of\nthe orbits are normal.\n\nCTA HEAD:\nAtherosclerotic calcifications of the bilateral intracranial ICA are noted\nwith resulting mild left greater than right stenosis. The right A1 segment is\nhypoplastic the vessels of the circle of ___ and their principal\nintracranial branches appear normal without stenosis, occlusion, or aneurysm. \nThe dural venous sinuses are patent.\n\nCTA NECK:\nMild atherosclerotic calcifications are noted along the aortic arch. There is\nmild noncalcified atherosclerotic plaque at the origins of the bilateral\nvertebral arteries resulting in mild stenosis. Bilateral carotid and vertebral\nartery origins are otherwise patent. Calcified atherosclerotic plaque is noted\nat the bilateral common carotid artery bifurcations and proximal left internal\ncarotid artery resulting in mild stenosis, proximally 10% by NASCET criteria. \nThere is no evidence of right internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches otherwise appear\npatent with no evidence of stenosis or occlusion.\n\n\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No acute intracranial process or mass.\n2. Mild bilateral atherosclerotic stenosis of the intracranial ICA, more\npronounced on the left.\n3. Otherwise patent circle of ___ without evidence of stenosis,occlusion,or\naneurysm.\n4. Mild atherosclerotic stenosis of the bilateral vertebral artery origins and\nproximal left internal carotid artery.\n5. Otherwise patent bilateral cervical carotid and vertebral arteries without\nevidence of stenosis, occlusion, or dissection.\n6. Mild periventricular and subcortical white matter hypodensities,\nnonspecific but likely sequelae of chronic small vessel disease." + }, + { + "input": "No aerodigestive tract mass. Normal salivary glands, no evidence of\ninflammation, fluid collection or stones. No evidence of stones within ducts.\nNo submandibular or submental area inflammatory changes, mass or fluid. \nNormal floor mouth, no fullness. No periapical lucencies.\n\nNormal thyroid gland.No adenopathy.The neck vessels are patent.\n\nDefined predominant centrilobular ground-glass nodular opacities in the upper\nlungs, differential considerations include inflammatory and infectious\netiology. No consolidation.", + "output": "1. No evidence of mass or inflammatory changes in the neck.\n2. Centrilobular lung ground-glass opacities, likely inflammatory or\ninfectious.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 15:18 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Incidental cavum septum pellucidum is noted. There are\nbilateral confluent subcortical and periventricular matter hypodensities,\nwhich are nonspecific but may represent chronic microangiopathy.\n\nMild soft tissue swelling is seen overlying the left posterior parietal\nregion. Mildly displaced fracture of the left nasal bone of indeterminate age\n(series 2, image 10). Rightward nasal septal deviation appears congenital\nwithout a additional fractures appreciated. There is calcification along the\nleft cerebral convexity with some low-density attenuation in the epidural\nspace (series 601, image 42). This is likely a chronic process. Mild mucosal\nthickening is seen in the left maxillary sinus. The visualized portion of the\nremaining paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The left globe is absent with a dense round opaque structure in the\nleft orbit which may represent a prosthesis.", + "output": "1. Mild left posterior parietal scalp soft tissue swelling. No calvarial\nfracture.\n2. Mildly displaced left nasal bone fracture of indeterminate chronicity.\n3. No acute intracranial hemorrhage or large territorial infarction.\n4. Evidence of chronic small vessel disease.\n5. Absent left globe with likely an intra orbital prosthesis." + }, + { + "input": "CT HEAD:\nMultiple hypodensities throughout the right corona radiata and centrum\nsemiovale, and a solitary punctate focus of hypodensity in the left centrum\nsemiovale (02:26) correlate with areas of late acute to early subacute\ninfarction as characterized on the subsequent MRI examination.\n\nThere is no evidence for acute intracranial hemorrhage, mass effect, or\nmidline shift. The ventricles and sulci are prominent, age advanced given the\npatient's stated age.\n\nMild mucosal thickening is seen involving the distal anterior ethmoid air\ncells and bilateral frontoethmoidal recesses. A mucous retention cyst is\nnoted in the right maxillary sinus. The remainder of the paranasal sinuses,\nmiddle ear cavities, and mastoid air cells are clear. The orbits are grossly\nunremarkable bilaterally.\n\nCTA HEAD AND NECK:\nThere is a normal 3 vessel aortic arch identified. The vertebral arteries are\npatent without high-grade stenosis or occlusion.\n\nThe bilateral common carotid arteries are patent. Mild to moderate partially\ncalcified atherosclerotic plaque seen at the bilateral carotid bulbs. There\nis subsequent complete occlusion of the entire right internal carotid artery,\nbeginning just after its bifurcation. There is reconstitution at the level of\nthe supraclinoid right ICA though the vessel in this region is less robust\ncompared to the left. Possible peripheral filling is seen within the distal\npetrous portion of the left internal carotid artery.\n\nModerate calcifications are seen in the left cavernous internal artery. Mild\nnarrowing is seen in the midportion of the right M1 segment (3:275, 276),\nlikely secondary to atherosclerotic disease. Allowing for this, the\nintracranial vasculature remains grossly patent without high-grade stenosis,\nocclusion, or aneurysm.\n\nOTHER:\nThe lungs apices are clear bilaterally. The thyroid gland is unremarkable in\nappearance. Multiple prominent cervical lymph nodes are seen bilaterally, none\nof which are pathologically by CT size criteria.", + "output": "1. Numerous areas of hypodensity involving the right greater than left centrum\nsemiovale in a watershed distribution, compatible with late acute to early\nsubacute infarcts as subsequently characterized by MRI.\n2. No evidence for acute intracranial hemorrhage.\n3. Age advanced prominence to the ventricles and sulci.\n4. Complete occlusion of the right internal carotid artery extending from just\nbeyond the bifurcation with reconstitution at the supraclinoid right ICA.\n5. Filling defect versus contrast mixing within the left petrous internal\ncarotid artery, which otherwise appears patent both proximal and distal to\nthis level.\n6. Multiple additional sites of atherosclerotic disease throughout the\nintracranial and cervical vasculature, without additional sites of high-grade\nstenosis or aneurysm within 3 mm." + }, + { + "input": "There are multiple extra-axial mass lesions within thin hyperdense rims\nscattered throughout the bilateral frontal, parietal, occipital, and temporal\nregions. Although many lesions are homogeneously hyperdense, consistent with\nhemorrhage, many demonstrate layering fluid-fluid levels with the more\nhyperdense blood in the dependent regions and the hypodense fluid layering\nabove it. The largest lesion, in the left temporal region, measures 4.8 cm in\nmaximum diameter. These mass lesions are localized to the supratentorial\nregion and none are visualized in the posterior fossa. There is diffuse\neffacement of the cerebral sulci and left temporal horn of the lateral\nventricle is. There is a slight 2 mm leftward shift of normally midline\nstructures. There is no downward transtentorial herniation. There is no\nintraventricular blood.\n\nThere is hyperdense subdural blood along the left falx posteriorly measuring\nup to 7 mm wide and layering along the right and left tentorium.\n\nMild atherosclerotic calcifications are demonstrated of the cavernous carotid\narteries. There is no evidence of fracture or focal osseous lesions\nsuspicious for metastasis. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. Multiple extra-axial hemorrhagic supratentorial masses, the largest, in the\nleft temporal region, measures 4.8 cm, with diffuse sulcal effacement and mild\nleftward shift of normally midline structures. Findings are concerning for\nmultiple dural-based hemorrhagic metastases. MRI with contrast is suggested\nfor further assessment.\n2. Acute subdural blood along the posterior falx as well as along the right\nand left tentorium.\n\nRECOMMENDATION(S): MRI of the brain with contrast.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 12:45 pm, 1 minute\nafter discovery of the findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal for age in size and configuration. Again seen\nis periventricular white matter hypodensity similar to that present in ___. \nAlthough nonspecific, this is often attributed to chronic small vessel\nischemia. Also again seen and unchanged is a chronic left putamen lacune.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The A1\nsegment of the right anterior cerebral artery is hypoplastic, a normal\nvariant. The dural venous sinuses are patent.\n\nCTA NECK:\nThere are calcified plaques at the origins the internal carotid arteries\nbilaterally without stenosis on the left by NASCET criteria. The plaque\nproduces an approximately 20% stenosis of the right internal carotid artery by\nNASCET criteria. Otherwise, the carotid and vertebral arteries and their\nmajor branches appear normal with no evidence of stenosis or occlusion.\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No evidence of mass, hemorrhage or recent infarction.\n2. Chronic left putamen lacune and extensive white matter hypodensity\nsuggesting chronic small vessel ischemia.\n3. Normal head CTA.\n4. Calcified plaque at the origins of the internal carotid arteries\nbilaterally. On the right, this results in approximately 20% stenosis" + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. ___ cisterna magna is re-demonstrated. Confluency\nperiventricular, subcortical, and deepwhite matter hypodensities are\nnonspecific, but likely reflect the sequela of chronic microvascular\ninfarction.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality. Please note that MRI would be more\nsensitive for the detection of acute infarction." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Evidence of prior lacunar infarct of the left basal\nganglia. Periventricular, subcortical, and deep white matter hypodensities\nare nonspecific, but likely reflect the sequela of chronic microvascular\ninfarction.\n\nThere is no evidence of fracture. There is minimal mucosal thickening of the\nethmoid sinuses. Otherwise, the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass effect. The ventricles and sulci are normal in size and\nconfiguration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormalities identified on noncontrast head CT.\n2. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct if there is further clinical concern." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nNo evidence of acute intracranial hemorrhage. This is communicated to the\nprimary neurology team.\n\nThere is an area of mild hypodensity in the medial aspect of the right\noccipital lobe. However, there is no frank loss of gray-white differentiation\nor edema. here is no mass or subsequent mass-effect.\n\nBased on the RAPID algorithm, there is a focal small area of increased mean\ntransit time in the right MCA distribution (right operculum) but there is no\ndecreased cerebral blood flow. Questionable small area of ischemia in the\nright MCA distribution without infarcted core.\n\nThere is a small mucous retention cyst in the right maxillary sinus. Mild\nmucosal thickening of the ethmoid air cells is identified. The remainder the\nparanasal sinuses are essentially clear. The orbits are unremarkable, noting\nbilateral lens replacements. The mastoid air cells middle ears are clear.\n\nCTA HEAD:\nThe vertebral basilar arterial system is unremarkable. The circle of ___\nand its major branches are patent without high-grade stenosis or aneurysm\ngreater than 3 mm.\n\nCTA NECK:\nMild calcified atherosclerotic disease of the aortic arch. There is a 35%\nstenosis of the right internal carotid, just distal to the bifurcation,\nsecondary to a noncalcified plaque (series ___, image 23; series 4, image\n136) by NASCET criteria. There is no stenosis of the left cervical internal\ncarotid artery by NASCET criteria. Otherwise, the remaining carotid and\nvertebral arterial systems appear unremarkable.\n\nOTHER:\nThe visualized portion of the lungs are clear. The thyroid demonstrates\nhypoattenuating nodules measuring up to 8 mm. The visualized aerodigestive\ntract is within expected limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Questionable small area of ischemia in the right MCA distribution (right\noperculum) without infarcted core. Recommend further evaluation with MRI head\nwithout contrast.\n2. Unremarkable CTA of the head.\n3. 35% stenosis of the right internal carotid artery secondary to non\ncalcified atherosclerotic plaque by NASCET criteria.\n4. Additional findings as described above." + }, + { + "input": "There is no acute intracranial hemorrhage, acute infarction, edema or mass\neffect. Prominent ventricles and sulci is compatible with global atrophy. The\nbasal cisterns are clear. The gray white matter differentiation appears\npreserved.\n\nAs previously identified on CT dated ___, bilateral nasal bone\nfractures are again noted. Partial opacification of posterior right ethmoidal\nair cells as well aerosolized secretions within the left maxillary sinus and\nleft sphenoid sinus noted. Relative to prior examination, this appears to have\nmildly decreased in extent. Bilateral mastoid air cells and middle ear\ncavities are clear.", + "output": "1. No acute intracranial abnormality.\n2. Old bilateral nasal bone fractures again noted, as identified on prior CT\ndated ___.\n3. Sinus disease as described above." + }, + { + "input": "CT head: No evidence of acute intracranial hemorrhage. The ventricles and\nbasilar cisterns are normal in appearance.\n\nLarge, partially calcified left cerebellopontine angle mass without apparent\nintracranial extension is most compatible with the appearance of a meningioma.\n\nCTA head/neck: There is no evidence of focal vessel cut off, aneurysm, or\nvascular malformation within the intracranial circulation. There is maintained\nflow within the left transverse sinus and sigmoid sinuses. There are no\nenlarged arterial structures associated with the left cerebellopontine angle\nmass. The mass may be partially attached to the dura of the left transverse\nsinus.\n\nMajor glandular muscular structures throughout the neck appear unremarkable.", + "output": "1. Partially calcified left cerebellopontine angle mass most compatible with a\nappearance of a meningioma.\n2. The mass appears to abut the dura of the left transverse sinus though flow\nis maintained within transverse and sigmoid sinuses." + }, + { + "input": "Patient is status post left posterior fossa craniotomy with resection of left\ncerebellopontine angle meningioma. Expected pneumocephalus and air within the\nsubcutaneous tissue about the surgical site is seen. There is no evidence of\nhemorrhage, infarction, edema, or mass effect. Ventricles and sulci are stable\nin size and configuration. The basal cisterns are patent. There is no shift of\nnormally midline structures. Gray-white matter differentiation is preserved.\n\nMinimal ethmoidal cell mucosal thickening is identified. Bilateral mastoid air\ncells, middle ear cavities and the remainder of the visualized paranasal\nsinuses are clear. Minimal atherosclerotic calcifications of the carotid\nsiphon are noted.", + "output": "Status post left posterior fossa craniotomy with resection of left\ncerebellopontine angle meningioma. Expected pneumocephalus and postoperative\nchanges within the surrounding soft tissues is seen. No hemorrhage is\nidentified within the surgical bed." + }, + { + "input": "Patient is status post left suboccipital craniotomy for resection of a\nmeningioma. Post-operative changes including superficial soft tissue swelling\nadjacent to the craniotomy site, edema and pneumocephalus, are\nre-demonstrated. However, in comparison to the prior study on ___,\ncerebellar tonsils appear to be extending below the margins of the foramen\nmagnum (401b:42), possibly due to mass effect from adjacent edema.\nNo significant interval change in mass effect on the ___ ventricle, though\ndifficult to assess given patient rotation. No shift of midline structures.\nBasal cisterns are patent.\nThere is no acute hemorrhage or major vascular territory infarction.\n\nOther than the post craniotomy defect in the left occipital lobe, no fractures\nare identified. There is minimal mucosal thickening of the left maxillary\nsinus. Otherwise, remainder visualized paranasal sinuses are clear.\nSlight opacification of the left mastoid air cells. Right mastoid air cells\nare clear.\nMinimal cerumen is noted in the bilateral middle ureter canals.", + "output": "1. No acute hemorrhage or major vascular territory infarction.\n2. Low-lying cerebellar tonsils, likely due to mass effect from post-surgical\nedema.\n3. No significant interval change in mass effect on the ___ ventricle. Close\nf/u as needed.\n\nNOTIFICATION: Findings telephoned to ___, NP, by ___ on\n___ at 2:24PM, approximately 5 minutes after discovery." + }, + { + "input": "Venous contrast poolinganddental amalgam streak artifactandpatient body\nhabitus limits study. Additionally streak artifact limits evaluation of pons.\n\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of large vascular territory\ninfarction,hemorrhage,edema,ormass. The ventricles and sulci are preserved in\nsize and configuration.\n\nThe visualized portion of the mastoid air cells,and middle ear cavities are\nclear. The visualized portion of the orbits are preserved. Minimal bilateral\nmaxillary sinus mucosal thickening is present.\n\nCTA HEAD:\nThe right posterior cerebral artery demonstrates a fetal origin. The vessels\nof the circle of ___ and their principal intracranial branches appear\npreserved without stenosis, occlusion, or aneurysm formation greater than 3mm.\nThe dural venous sinuses are grossly patent.\n\nCTA NECK:\nVenous contrast artifact limits evaluation of left vertebral artery origin. \nOtherwise, bilateral carotid and right vertebral artery origins are patent.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear preserved,\nwith no evidence of stenosis or occlusion.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. An approximately 1.1 cm right level\nIIa enlarged lymph node is seen (see 3:169). Additional scattered\nsubcentimeter nonspecific lymph nodes are noted throughout the neck\nbilaterally, without definite enlargement by CT size criteria. Limited\nimaging of cervical spine demonstrates multilevel degenerative changes without\ndefinite evidence of moderate or severe vertebral canal narrowing.", + "output": "1. Venous contrast poolinganddental amalgam streak artifactandpatient body\nhabitus limits study. Additionally streak artifact limits evaluation of pons.\n2. No acute intracranial abnormality, no definite evidence of acute\nintracranial hemorrhage or acute large territorial infarct. Please note MRI of\nthe brain is more sensitive for the detection of acute infarct.\n3. Left vertebral artery origin not able to be visualized secondary to\nartifact.\n4. Otherwise, patent circle of ___ without definite evidence of\nstenosis,occlusion,or aneurysm.\nPatent bilateral cervical carotid and vertebral arteries without definite\nevidence of stenosis, occlusion, or dissection.\n5. Approximately 1.1 cm right level IIa enlarged lymph node with additional\nscattered subcentimeter nonspecific lymph nodes as described.\n6. Paranasal sinus disease , as described." + }, + { + "input": "The parotid glands, submandibular glands, and thyroid are unremarkable. The\nright-sided cervical lymph nodes are hyperenhancing. A level three node on\nthe right (2:65) is enlarged measuring 1.4 cm long axis. Right level five\nnode also enlarged, measures 1.3 cm. No additional adenopathy identified.\n\nThere is a thin sliver of fluid tracking along the scalp on the right,\noverlying the posterior aspect of the temporalis muscle stranding in the\noverlying soft tissues (2:5). There is edema tracking within the right\nposterior paraspinal musculature. Additionally posterior aspect of the right\nsternocleidomastoid muscle is enlarged with surrounding edema, potentially\nfrom myositis.\n\nMastoids are entirely clear bilaterally as are the middle ears. Visualized\nparanasal sinuses are notable for mucous retention cysts in the right\nmaxillary sinus.\n\nLung apices are clear.\n\nAir digestive tract demonstrates no focal mass lesion or mass effect.\n\nVascular structures in the neck are unremarkable.\n\nIntracranial structures are unremarkable on this nondedicated examination.\nNo focal suspicious osseous lesions.", + "output": "Sliver of fluid and overlying edema overlying the right temporalis posteriorly\nwith subcutaneous edema and thickening of the soft tissues of the scalp in the\nright parieto-occipital region. Edema tracking within the right posterior\nparaspinal musculature, as well as the right sternocleidomastoid muscle which\nis enlarged potentially from myositis.\nHyperenhancing right-sided cervical lymph nodes some of which are slightly\nenlarged, likely reactive.\nMastoid air cells are clear bilaterally, no mastoiditis." + }, + { + "input": "There is no evidence of acute large territory infarction,hemorrhage,edema, or\nmass. Chronic infarct left thalamus, internal capsule, probably globus\npallidus, stable since ___, has evolved since MR ___. \nChanges. Atherosclerotic calcifications are noted in the bilateral carotid\nsiphons.. Findings consistent with moderate chronic small vessel ischemic\nchanges.\n\nThere is no evidence of fracture. Mild mucosal thickening is noted in the\nbilateral frontal sinuses, bilateral frontal ethmoid junctions, and bilateral\nmaxillary sinuses. The remaining visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. No acute findings.\n2. Chronic infarct left thalamus, basal ganglia, internal capsule, similar." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nCT HEAD WITHOUT CONTRAST:\nFocal hypodensity in the posterior limb of the left internal capsule raises\nconcern for acute infarction. There is no evidence of hemorrhage, edema, or\nmass. There is mild prominence of the ventricles and sulci suggestive of\ninvolutional changes. Mild periventricular white matter hypodensities are\nlikely the sequela of chronic small vessel ischemic disease.\n\nThere is mucosal thickening of the anterior ethmoidal air cells and left\nsphenoid sinus with aerated mucosal thickening and air-fluid level in left\nsphenoid sinus. Two tiny mucous retention cysts are present in the left\nmaxillary sinus. The remaining visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.\n\nCTA HEAD:\nThere are densely calcified carotid siphons. Irregular narrowing without\ndefinite occlusion is noted of bilateral V4 segments (see 650 06:13). . The\nvessels of the circle of ___ and their principal intracranial branches\nappear normal without occlusion, or aneurysm formation. The dural venous\nsinuses are patent with a hypoplastic appearance to the left transverse and\nsigmoid sinuses. In the region of the right thalamus vascular blush is noted,\nsuggestive of a capillary telangiectasia.\n\nCTA NECK:\nThere is moderate amount of atherosclerotic plaque at the left carotid\nbifurcation. There is no evidence of right internal carotid stenosis by\nNASCET criteria. There is 33% stenosis of the left internal carotid artery by\nNASCET criteria (series ___, image 46).\n\nThevertebral arteries and their major branches appear normal with no evidence\nof stenosis or occlusion. There is a small focus of calcified plaque at the\ntakeoff of the left ___ (series 5, image 211). The origin of each vertebral\nartery is normal.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland appears mildly enlarged with no definite discrete nodule\nidentified. Small scattered bilateral level IB and IIB lymph nodes are not\npathologically enlarged. There is no cervical lymphadenopathy by CT size\ncriteria. Bilateral mandibular periodontal disease is noted (see 5:182).", + "output": "1. Dental amalgam streak artifact limits study.\n2. Focal hypodensity in the posterior limb of the left internal capsule\nconcerning for acute infarction. Please note MRI of the brain is more\nsensitive for the detection of acute infarct.\n3. No intracranial hemorrhage.\n4. Nonocclusive narrowing of bilateral V4 segments.\n5. Patent intracranial vasculature with no evidence of aneurysm formation or\ndissection.\n6. Patent cervical vasculature with 33% stenosis of the left internal carotid\nartery by NASCET criteria.\n7. Paranasal sinus disease as described.\n8. Periodontal disease as described.\n9. Right thalamic probable capillary telangiectasia.\n\nNOTIFICATION: Final report, specifically findings #2, #4, #6, #8 and #9 were\ndiscussed with Dr. ___. by ___, on the telephone on\n___ at 9:04 AM, 30 minutes after discovery of the findings." + }, + { + "input": "There is a 1.2 x 0.9 cm hypodensity in the posterior limb left internal\ncapsule (02:14), consistent with an infarction. This is unchanged in\nappearance compared to the prior CTA performed several hours earlier. No\nother findings concerning for acute major vascular territorial infarction. No\nhemorrhage, edema or large mass. Ventricles and sulci are normal in size and\nconfiguration.\n\nThere is no evidence of fracture. Mild secretions in the left sphenoid. \nRemainder of the visualized paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute hemorrhage.\n2. Re- demonstration of hypodensity within the left internal capsule remains\nconcerning for acute infarction." + }, + { + "input": "There is no evidence of intracranial hemorrhage. There is no mass effect,\nhydrocephalus or shift of the normally midline structures. Gray-white matter\ndifferentiation appears preserved. Surrounding soft tissue structures are\nunremarkable. There is new bilateral maxillary mucosal thickening and fluid\nas well as moderate new bilateral ethmoid mucosal thickening which is moderate\nin degree. Aerosolized secretions are present in the sphenoid. All of these\nfindings are new since ___.", + "output": "A new moderately striking inflammatory changes including fluid in maxillary\nsinuses which could be seen with acute sinusitis in the appropriate clinical\nsetting. No evidence of intracranial process or injury, however." + }, + { + "input": "There is minimal proptosis on the right. There are bilateral senile calcific\nscleral plaques of the globes. The orbits are otherwise unremarkable with no\nevidence of intra or extraconal lesions.\n\nThere is mild mucosal thickening of the ethmoid air cells. The paranasal\nsinuses are otherwise normally aerated. The ostiomeatal units are patent. The\ncribriform plates are intact. The lamina papyracea are intact. Dense vascular\narteriosclerotic calcifications are present in the distal vertebral arteries\nand bilateral carotid siphons.\n\nThere is a grossly unchanged chronic right hemispheric subdural hematoma,\npartially evaluated this exam and better depicted in the concurrent head CT. \nLimited portions of the brain demonstrate a CSF density space occupying lesion\n(3.0 cm AP x 4.1 cm TV) in the left anterior middle cranial fossa causing mass\neffect on the anterior left temporal lobe likely representing an arachnoid\ncyst. The visualized aspect of the ventricles and sulci are prominent\nsuggesting cortical volume loss, likely age related and involutional in\nnature. Status post right temporal craniotomy.", + "output": "1. Minimal proptosis on the right.\n2. Stable evidence of a left anterior middle cranial fossa arachnoid cyst.\n3. Grossly unchanged chronic right hemispheric subdural hematoma partially\nseen in this exam, and better depicted in the concurrent head CT." + }, + { + "input": "New small area of right frontal extra-axial hyperdensity measuring 0.5 cm in\nthickness (4 1; 21) is concerning for acute or subacute on chronic subdural\nhematoma. Right frontal convexity prominent extra-axial low-density CSF\nattenuation measuring 1.2 cm in greatest thickness may represent component of\nchronic subdural hematoma or subdural hygroma on a background of brain\nparenchymal atrophic changes similar to prior. Patient is status post right\nfrontoparietal craniotomy for prior subdural evacuation.\n\nChronic lacunar infarcts posterior limb right internal capsule, right caudate\nnucleus, stable since prior. Severe generalized brain parenchymal atrophy,\nsimilar. Mild-to-moderate chronic small vessel ischemic changes, similar.\nThere is no evidence of infarction,edema,or mass effect. Benign arachnoid\ncyst left middle cranial fossa.\n\nDense atherosclerotic calcifications are noted in the bilateral cavernous\ncarotid arteries.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. New small right frontal subdural acute to early subacute hemorrhage. \nRemainder as above." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is only partial visualization of the brain from the foramen magnum\nthrough of the orbits. There is no evidence of acute major vascular\nterritorial infarction. Hypodensities in the subcortical, periventricular,\ndeep white matter nonspecific but are likely related to chronic microvascular\ndisease in a patient of this age.\n\nThe ventricles and sulci are prominent, suggesting involutional changes. \nProminent extra-exial space overlying the right frontotemporal lobe may be\nsecondary to volume loss or represent a collection such as a chronic subdural\nhematoma or hygroma. As seen on the subsequent CTA examination, there is a 5\nmm thick acute on chronic subdural hematoma noted along the right frontal\nconvexity (3:306).\n\nThere are dense calcifications of bilateral V4 segments of the vertebral\narteries. There is evidence of right frontoparietal craniotomy.\n\n\nCTA HEAD:\nModerate calcifications are seen in the bilateral cavernous and supraclinoid\ninternal carotid arteries, in addition to the bilateral V4 segments and\nproximal basilar artery. There is mild irregularity and narrowing of the\nbilateral P1 segments and the right M1 segment, without high-grade stenosis or\nocclusion.\n\nThe remaining vessels of the circle of ___ and their principal intracranial\nbranches appear normal without stenosis, occlusion, or aneurysm formation. \nThe right transverse sinus is hypoplastic, likely a congenital finding.\n\n\nCTA NECK:\nDense atherosclerotic calcifications are seen at the aorta and the origins of\nthe great vessels, without definite high-grade stenosis. There is a normal 3\nvessel aortic arch.\n\nAtherosclerotic calcifications at the bilateral vertebral origins result in\nmoderate narrowing of the right V1 segment, and mild-to-moderate narrowing of\nthe left V1 segment.\n\nCalcifications are also noted at the bilateral carotid bulbs. There is\nprominent fibrofatty plaque with a rim of calcification at the left carotid\nbifurcation measuring up to 3.3 mm.\n\nThere is 38% stenosis of the left internal carotid artery by NASCET criteria. \nThere is narrowing of the right internal carotid artery with 33% stenosis by\nNASCET criteria.\n\n\nOTHER:\nThere are bilateral pleural effusions, right greater than left. There is\nevidence of interlobular thickening and ground-glass opacifications in both\nlungs more prominent on the right, suggestive of pulmonary edema. The\nthyroid is unremarkable in appearance. There are no pathologically enlarged\ncervical lymph nodes identified.", + "output": "1. No convincing evidence for acute territorial infarction.\n2. Stable appearance of a 5 mm thick acute on chronic right frontal subdural\nhematoma.\n3. Multifocal atherosclerotic disease throughout the cervical vasculature, as\ndetailed above. Findings result in 33% stenosis of the proximal right and 38%\nstenosis of the proximal left internal carotid arteries by NASCET criteria.\n4. Multifocal atherosclerotic disease within the intracranial vasculature,\nalso detailed above, without high-grade stenosis, occlusion, or aneurysm.\n5. Bilateral pleural effusions and slightly asymmetric right greater than left\npulmonary edema, better evaluated on recent CT chest examination." + }, + { + "input": "There is re-demonstration of the right frontal extra-axial hyperdensity\nmeasuring 0.6 cm in greatest thickness consistent with an acute or subacute on\nchronic subdural hematoma similar to prior. Right frontal convexity prominent\nextra-axial low-density CSF attenuation which likely represents chronic\nsubdural hematoma or subdural hygroma with background of age related atrophy\nagain is similar to prior. No new foci of hemorrhage. There is no evidence\nof infarction, edema,or midline should. There is prominence of the ventricles\nand sulci suggestive of involutional changes. Periventricular and subcortical\nwhite matter hypodensities are nonspecific but suggest chronic small vessel\nischemic changes. Re-demonstration of chronic lacunar infarcts in the\nposterior limb of the right internal capsule and right caudate nucleus. \nUnchanged arachnoid cyst in the left middle cranial fossa.\n\nPatient is status post right frontoparietal craniotomy for prior subdural\nevacuation. The visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. No significant interval change in acute to subacute on chronic subdural\nhematoma/effusion over the right frontal region. No new foci of hemorrhage." + }, + { + "input": "There is advanced generalized brain parenchymal atrophy, similar to prior. \nChronic lacunar infarct posterior right putamen, right globus pallidus,\nsimilar to prior. Mild-to-moderate chronic small vessel ischemic changes are\nstable. If there is stable arachnoid cyst in the anterior left middle cranial\nfossa. If there is 2.2 cm x 0.5 cm extra-axial high-density abnormality of\nlying anterior right basal frontal lobe, similar in appearance and size\ncompared with ___, minimally decreased since ___,\nconsistent with subacute hematoma. No other areas of interval acute\nhemorrhage within right hemispheric chronic subdural hematoma, which measures\n1.2 cm in maximum thickness overlying right frontal operculum, stable. Right\nparietal craniotomy.\n\nThere is no evidence of acute infarction,new hemorrhage,edema,or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No interval hemorrhage. Stable subacute on chronic right hemispheric\nsubdural hematoma.\n2. Generalized brain parenchymal atrophy, small chronic lacunar infarcts." + }, + { + "input": "The salivary glands enhance normally. There is a 2.0 x 1.1 x 2.5 cm hypodense\nmass posterior to the left external auditory canal adjacent to the mastoid air\ncells with peripheral rim enhancement. There is mild adjacent fat stranding. \nThe external auditory canal is unremarkable. There is no erosion seen of the\nadjacent mastoid bone. The left middle ear cavity is unremarkable. There are\nmultiple prominent left level 2 and level 3 cervical lymph nodes measuring up\nto 1.4 x 0.8 cm, likely reactive.\n\nThe thyroid gland appears normal. The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions. There are mild degenerative\nchanges at C5-6.", + "output": "1. 2.0 x 1.1 x 2.5 cm hypodense mass posterior to left external auditory\ncanal with peripheral enhancement and adjacent fat stranding. Differential\ndiagnosis includes abscess vs necrotic lymph node vs neoplasm; underlying\nneoplasm not excluded. MRI could provide further assessment. Although no\nprior images are available for comparison, per the ___ report on ___, this is larger in size.\n2. Multiple prominent left level 2 and 3 cervical lymph nodes are likely\nreactive.\n\nRECOMMENDATION(S): MRI of the parotid gland may be obtained for further\nevaluation if clinically indicated.\n\nNOTIFICATION: The findings were discussed with ___, M.D.\nby ___, M.D. on the telephone on ___ at 6:45 pm, 2 minutes\nafter discovery of the findings." + }, + { + "input": "There is no acute hemorrhage, edema or shift of the normally midline\nstructures. The ventricles and sulci are of normal size and configuration. The\ngray-white matter differentiation is preserved and there is no evidence for an\nacute infarction. The basal cisterns are patent.\n\nThere is no acute fracture. There is mild mucosal thickening within the\nethmoid air cells, otherwise, the included paranasal sinuses and mastoid air\ncells are well-aerated. The imaged lenses and globes are normal.", + "output": "No acute intracranial process." + }, + { + "input": "When compared with recent prior exam from 2 weeks ago, there has been no\nsignificant interval change. Again seen, it is hypodensity centered in the\nleft temporoparietal region adjacent to the left lateral ventricle consistent\nwith known astrocytoma. Please refer to recent prior MRI for further\ncharacterization. Areas of punctate calcification again noted within this\nregion. No hemorrhagic complication.\nDegree of mass effect is stable. No shift of midline structures or evidence of\nherniation. Old bilateral cerebellar infarcts again noted. White matter\nhypodensity may reflect chronic microvascular ischemic disease possibly with a\ncomponent of radiation related white matter disease. The imaged paranasal\nsinuses are clear. Mastoid air cells and middle ear cavities are well aerated.\nThe bony calvarium is intact.", + "output": "No hemorrhage. Grossly stable appearance of left temporal parietal\nperiventricular mass." + }, + { + "input": "There is new hyperdensity along the left inferior temporal lobe sulci\nconsistent with subarachnoid hemorrhage. Again seen is an ill-defined\nhypodensity within the left temporoparietal region adjacent to the left\nlateral ventricle consistent with known astrocytoma with adjacent vasogenic\nedema. Areas of punctate calcification are again seen within this region. No\nsignificant change in mass effect. No shift of midline structures. Old\nbilateral cerebellar infarcts are stable in appearance.\n\nPeriventricular, subcortical, and deep white matter hypodensities are likely\nsequela of chronic small vessel ischemic disease. Mild prominence of the\nventricles and sulci are consistent with age-related cortical volume loss and\nare similar in size and appearance to previous examination.\n\nA 2.6 x 1.3 cm soft tissue hematoma is seen along the right zygomatic arch\nwith fat stranding. Hyperdense material is seen within the right maxillary\nsinus.\n\nLeft occipital burr hole noted. No additional osseous abnormalities seen. \nMild mucosal thickening of the ethmoidal air cells is noted. The additional\nvisualized paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. A 3.5 x 1.3 cm right periorbital hematoma is present. The orbits are\notherwise unremarkable. No retrobulbar hematoma. Lens are intact.", + "output": "1. Small amount of subarachnoid hemorrhage along the inferior left temporal\nregion.\n2. No significant change in left temporoparietal hypodensity consistent with\nknown astrocytoma and vasogenic edema. No evidence of herniation.\n3. Stable bilateral chronic cerebellar infarcts.\n4. Hematoma and stranding within the right periorbital and pre-maxillary\nregions.\n5. Hyperdense material within the right maxillary sinus may represent chronic\ninspissated secretions or fungal colonization with hemorrhage considered\nunlikely given the lack of an associated fracture." + }, + { + "input": "Compared to the prior examination performed 7 hr earlier, there has been no\nsignificant interval change. Redemonstrated is a small degree of subarachnoid\nhemorrhage layering along the left inferior temporal lobe sulci. Within the\nleft parietotemporal lobe, there is a periventricular hypodensity with\nsurrounding vasogenic edema, compatible with the patient's known astrocytoma.\nThere is no appreciable midline shift or increased mass effect identified.\nSmall, chronic, bilateral cerebellar infarcts are again noted.\n\nMild prominence of the ventricles and sulci is suggestive of age related\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are likely secondary to chronic small vessel ischemic disease.\n\nRedemonstrated is a left occipital burr hole. Adjacent to the right zygomatic\narch is a 2.7 x 2.2 cm soft tissue hematoma (2:14), slightly increased in size\ncompared to the prior examination. Also redemonstrated is a stable right\nperiorbital hematoma. The right maxillary sinus remains abdominal AA opacified\nin contains hyperdense material. The remainder of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear.", + "output": "1. Stable appearance of subarachnoid hemorrhage layering along the left\ntemporal sulci.\n2. No significant change in the appearance of a left parietotemporal\nhyperdensity compatible with known astrocytoma. No evidence of downward\nherniation or increased mass effect.\n3. Large right periorbital and ___ soft tissue hematoma formation,\nminimally increased from the prior examination.\n4. Chronic bilateral cerebellar infarcts.\n5. Unchanged appearance of right maxillary sinus opacification with multiple\nfoci of intrinsic hyperdense material." + }, + { + "input": "There is no significant change in the appearance of the head compared to 1 day\nprior. There is redemonstration of small subarachnoid hemorrhage layering\nalong the left inferior temporal lobe sulci (series 4 images 18, 13). Left\nperiventricular hypodensity and surrounding vasogenic edema is unchanged\ncompatible with patient's known astrocytoma. There is no new hemorrhage\nidentified. There is no appreciable shift of midline structures. The\nventricles and sulci are unchanged in size and configuration. The basal\ncisterns are patent. Periventricular white matter hypodensities are likely\nsequela of small vessel disease.\n\nPostsurgical changes from left occipital burr hole are again seen. Soft tissue\nhematoma adjacent to the right zygoma has not significantly changed. Right\nperiorbital hematoma is also stable. The right maxillary sinus is opacified\nwith hyperdense material. The remainder of the paranasal sinuses are clear.\nThere is no acute fracture identified.", + "output": "1. Stable small subarachnoid hemorrhage layering along left temporal sulci.\n2. No significant change in the appearance of left parietal temporal\nhypodensity and surrounding vasogenic edema, consistent with known\nastrocytoma.\n3. Grossly stable paranasal sinus disease as described.\n4. Stable right prezygomatic soft tissue swelling." + }, + { + "input": "No acute intracranial infarction or hemorrhages are seen. Hypodensity\ncompatible the known mass in seen in the periventricular left temporoparietal\nregion. Associated calcifications associated with the mass are more\nconspicuous on the current exam and and calcification is also seen at the body\nof the corpus callosum on the left. Degree of surrounding white matter\nhypodensity in the left cerebral hemisphere is grossly unchanged when compared\nto prior FLAIR sequences and is likely in part post treatment related. \nAdditional bilateral periventricular and subcortical white matter\nhypodensities may be some combination of post treatment versus related to\nchronic small vessel disease.\n\nAgain seen are chronic cerebellar infarcts, unchanged from prior. The basal\ncisterns are patent. The size and morphology of the ventricles appears\nsimilar to prior exam.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nleft anterior ethmoid air cells. The visualized portion of the other\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormalities.\n2. Similar appearance of known underlying left frontotemporal mass with\nassociated post treatment changes. MRI would be more sensitive for detection\nof subtle change." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, or edema. \nHypodensity within the left temporoparietal region extending into the\nsubcortical white matter and along the left lateral ventricle with associated\ncoarse calcifications is unchanged from the prior study and compatible with\nthe patient's known brain mass. Surrounding hyperdensity suggesting cytotoxic\nedema is unchanged from the prior study. Chronic bilateral cerebellar\ninfarctions are also stable. There is mild ex vacuo dilatation of the\ninferior horn of the left lateral ventricle. The ventricles are otherwise\nunremarkable. Mild periventricular hypodensities around the right lateral\nventricle suggests chronic small vessel ischemic change. There is no midline\nshift and the basal cisterns are patent.\n\nThere is no evidence of fracture. Left parietal burr hole is stable. Mild\nmucosal thickening is seen within the left maxillary sinus. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare otherwise clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nacute intracranial hemorrhage. No definitive new lesions.\n2. Grossly stable appearance of known left frontotemporal mass with associated\ncoarse calcifications likely related to treatment changes. Degree of\nassociated edema is stable.\n3. Stable hypodensities within the cerebellum." + }, + { + "input": "White matter hypodensity in the left cerebral hemisphere at the confluence of\nthe frontal, temporal and parietal lobes is essentially unchanged and likely\nreflects edema in the setting of known mass. Foci of calcification in this\nregion likely reflect treatment related changes and appear stable. There is a\nstable configuration of the ventricles, likely with mild ex vacuo dilatation\nof the left lateral ventricle. The basal cisterns are patent. There is no\nevidence of acute hemorrhage or acute large vascular territorial infarction.\nSubcentimeter hypodensities in the left cerebellar hemisphere are unchanged. \nThere is no shift of normally midline structures. A burr hole defect is noted\nin the left parietal bone. The imaged paranasal sinuses and mastoid air cells\nare clear. The globes and bony orbits are intact and unremarkable.", + "output": "1. No acute intracranial process. No hemorrhage.\n2. Grossly stable appearance of known left cerebral mass with associated\ncalcification and surrounding edema.\n3. Stable left cerebellar hypodensities, likely chronic infarcts." + }, + { + "input": "White matter hypodensity in the left cerebral hemisphere at the confluence of\nthe frontal, temporal, and parietal lobes in the region of the known left\ntemporal astrocytoma is essentially unchanged in extent. Calcifications\nthroughout this region likely reflect post-treatment changes and appear\ngrossly stable. The configuration of the ventricles is stable with mild ex\nvacuo dilatation of the left lateral ventricle. Stable periventricular\nwhite-matter hypodensities are nonspecific, but likely reflect chronic\nmicrovascular ischemic disease. Basal cisterns are patent. No evidence of\nacute intracranial hemorrhage or acute, large vascular territorial infarction.\nUnchanged, subcentimeter hypodensities in the bilateral cerebellar\nhemispheres, left greater than right, are consistent with prior infarcts.\n\nThere is a burr hole defect in the left parietal bone. There is no evidence of\nfracture. The visualized portions of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portions of the\norbits are unremarkable. Soft tissue density within the right external\nauditory canal likely reflects cerumen.", + "output": "1. No acute intracranial hemorrhage.\n2. Grossly stable appearance of the known left cerebral mass with associated\ncalcification and white matter hypodensity.\n3. Stable, chronic, bilateral cerebellar infarcts." + }, + { + "input": "The patient is status post left parietal craniectomy. The partially calcified\nleft periatrial cerebral confluent white matter hypodensities are unchanged\ncompared to the CT dated ___, reflecting treated anaplastic astrocytoma. \nThere is moderate ex vacuo dilatation of the left lateral ventricle, also\nunchanged. There is no evidence of intracranial hemorrhage.\n\nChronic left cerebellar infarcts are re- demonstrated. The periventricular\nwhite matter hypodensities are nonspecific, but likely reflect chronic\nmicrovascular ischemic disease. There is no evidence of new large territorial\ninfarction.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "1. No evidence of intracranial hemorrhage.\n2. Unchanged partially calcified confluent left white matter hypodensities\nwith ex vacuo dilatation of the left lateral ventricle reflecting treated\nanaplastic astrocytoma.\n3. Chronic left cerebellar infarcts." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nNo calvarial fractures are identified. There is a large left frontal\nsubgaleal hematoma. Maxillofacial findings is separately reported on same day\nmaxillofacial CT.", + "output": "1. No acute intracranial abnormality.\n2. Large left frontal subgaleal hematoma. No calvarial fractures are\nidentified.\n3. Maxillofacial findings will be separately reported on the concurrently\nperformed maxillofacial CT." + }, + { + "input": "There is a mildly comminuted fracture of the left lamina papyracea (02:38). \nThis is associated with a mildly comminuted left orbital floor fracture with\nextensive soft tissue stranding and air (401:53). There is no definite\nevidence of muscle entrapment. There is mild soft tissue stranding about the\nmedial and inferior rectus muscles, which otherwise appears intact. There is\na minimally displaced left nasal bone and nasal spine fracture (02:41). No\nother fractures are identified.\n\nThere is high attenuating material demonstrated in the ethmoid air cells and\nleft maxillary sinus is hypoplasticcompatible with hemorrhagic blood products.\n\nThe right maxillary sinus is clear. There is trace mucosal thickening of the\nbilateral sphenoid sinuses. Bilateral mastoid air cells and middle ear\ncavities are clear.\n\nThere is mild proptosis of the left globe with respect to the right with\nextensive overlying soft tissue swelling. There is mild soft tissue stranding\nof the left retrobulbar fat. The right globe appears within normal limits.\n\nThere is partial evaluation of an enteric and endotracheal tube.\n\nThe mandible and temporomandibular joints appear normal.", + "output": "1. Comminuted fractures involving the medial and inferior walls of the left\norbit. No definite evidence of muscle entrapment.\n2. Mild left-sided proptosis with mild soft tissue stranding about the medial\nand inferior rectus muscles.\n3. Minimally displaced left nasal bone and nasal spine fracture.\n4. High-density material within the ethmoid air cells and left maxillary sinus\nare compatible with hemorrhagic blood products." + }, + { + "input": "There is no evidence of infarction, hemorrhage, or edema. There is a centrally\ncalcified hyperdense extra-axial mass arising from the right anterior cerebral\nfalx measuring 1.4 x 1.3 cm (2:13) x 2.1 cm cc with minimal local mass effect.\nThere is no shift of normally midline structures. The ventricles and sulci are\nprominent, compatible with age related parenchymal volume loss.\n\nThere is opacification of the right inferior mastoid air cells with adjacent\nsclerosis suggesting chronic inflammation. Patient is status post endoscopic\nsinus surgery. No fracture is detected. The orbits are unremarkable.", + "output": "1. No acute intracranial hemorrhage.\n2. Opacification of the right inferior mastoid air cells with findings\nsuggesting chronic inflammation. No fracture detected.\n3. Incidental dural based extra-axial mass arising from the right cerebral\nfalx most compatible with a meningioma." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. There\nis prominence of the ventricles and sulci suggestive of involutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "No acute intracranial abnormality." + }, + { + "input": "CTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. There is prominence\nof the left posterior cerebral artery origin likely reflecting infundibulum in\ncombination with a conjoined common origin of the left posterior cerebellar\nartery. There is a fenestration of the anterior communicating artery. The\nleft-sided A 2 segment is low the predominant supply to the distal anterior\ncerebral artery segments. The dural venous sinuses are patent.\n\nCTA NECK:\nMinimal atherosclerotic calcifications noted in the aortic arch.\nBilateral carotid and vertebral artery origins are patent.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion.\n\n\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Normal head CT.\n2. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n3. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection.\n4. There is irregularity of the bilateral distal internal carotid arteries\nwhich could be due to underlying noncalcified atherosclerotic plaque in this\nage group, but fibromuscular dysplasia is also a consideration in the relative\nabsence of significant atherosclerotic disease elsewhere in the imaged\ncirculation." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Basilar cisterns are\npatent.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema,or mass\neffect. The ventricles and sulci appear age appropriate. Dural venous system\nis mildly hyperdense, may be from dehydration, dural venous thrombosis is less\nlikely. If clinically suspected, consider MR venogram if indicated.\n\nThere is no evidence of fracture. There is suggestion of secretions s in the\nleft maxillary and right sphenoid sinuses, which can be seen in acute\nsinusitis. There is chronic periostitis involving right maxillary sinus. \nThere is mild mucosal thickening of the anterior ethmoid air cells. \nOtherwise, the visualized portion of the remaining paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. Entire dural venous system is mildly hyperdense, likely from dehydration,\ndural venous thrombosis is less likely. If dural sinus thrombosis is\nclinically suspected, consider MR venogram if indicated.\n2. Otherwise normal intracranial contents.\n3. Paranasal sinus disease, suggestion of mild acute paranasal sinusitis.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 10:49 am, 5 minutes\nafter discovery of the findings." + }, + { + "input": "There is no acute intracranial hemorrhage, edema, mass effect, or evidence of\nlarge vascular territorial infarction. The ventricles and sulci are normal in\nsize and configuration. There are atherosclerotic calcifications of the\nbilateral cavernous carotid arteries. There is no fracture. There is mucosal\nthickening in the right posterior ethmoid air cells and sphenoid sinus, the\nlatter with bony wall thickening suggesting long chronicity to inflammation. \nThere is a mucous retention cysts in the left maxillary sinus. Bilateral\nocular staphylomas are again incidentally noted.", + "output": "No evidence of acute intracranial abnormality. Chronic inflammatory disease\nof paranasal sinuses." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, or loss of gray/\nwhite matter differentiation. There is no pathologic extra-axial collection. \nThe ventricles and sulci are normal in size for age. There is a stable small\nhypodensity in the anterior limb of the right internal capsule and in the\ninferior left putamen, which correspond to prominent Virchow ___ spaces on\nthe prior MRI. No abnormality is identified in the left external capsule.\n\nThere is no evidence of fracture. There is mild mucosal thickening in\nscattered anterior ethmoid air cells.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. Unchanged small hypodensities in the anterior limb of the right internal\ncapsule and in the left inferior putaminal, which correspond to prominent\nVirchow ___ spaces on the brain MRI from ___." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Generalized\nbrain parenchymal atrophy. No hydrocephalus.\n\nThere is no evidence of fracture. There few well-defined lucent abnormalities\ninvolving calvarium, stable since ___, most likely benign given stability,\nmay represent arachnoid granulations, venous lakes.\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Brain parenchymal atrophy." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "1. No acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are mildly enlarged in an atrophic pattern, unchanged. \nThere is a small calcification adjacent to the optic chiasm and, unchanged\nright optic nerve\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The lenses\nhave been resected. Otherwise, the visualized portion of the orbits are\nunremarkable.", + "output": "No evidence of fracture, mass, hemorrhage or infarction." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Mild periventricular and subcortical white matter\nhypodensities are nonspecific, but likely reflect chronic small vessel\nischemic changes, as seen previously.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable apart from prior bilateral lens\nreplacements. Mild atherosclerotic calcifications of the cavernous carotid\narteries are noted.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific, but likely reflect sequelae of chronic small\nvessel ischemic disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Patient is\nstatus post lens replacements bilaterally. Atherosclerotic calcifications of\nthe carotid siphons are noted.", + "output": "1. No acute intracranial abnormality on noncontrast head CT.\n2. Parenchymal atrophy and chronic small vessel ischemic disease." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or mass\neffect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Mild periventricular and subcortical white matter\nhypodensities are nonspecific but likely suggest chronic small vessel ischemic\nchanges.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits demonstrate bilateral lens replacement. Mild\natherosclerotic calcifications of the cavernous carotid arteries are noted.", + "output": "No acute intracranial process." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Basilar cisterns are\npatent.\n\nIncluded paranasal sinuses and right mastoids are clear. Minimal\nopacification of left mastoid tip is noted without erosive changes. Skull and\nextracranial soft tissues are unremarkable. Degenerative changes noted at the\ntemporomandibular joints.", + "output": "No acute intracranial process.\nNo evidence of collection or other sequela of otitis externa." + }, + { + "input": "Head CT: There is no evidence of hemorrhage, edema, masses, mass effect, or\ninfarction. There is confluent subcortical cyst white matter hypodensity\nwhich is presumably on the basis of chronic small vessel ischemic disease.\nThere is diffuse brain parenchymal volume loss and. No fractures are\nidentified. Incidental note is made of cavum septum pellucidum et vergae.\n\nHead/neck CTA: The aorta demonstrates a conventional three-vessel branch\nconfiguration. There is atherosclerotic vascular disease within the aortic\narch although the origins of the great vessels are patent. There is\natherosclerotic narrowing at the origin of the right subclavian artery. There\nis atheromatous narrowing at the origin of the bilateral proximal internal\ncarotid arteries without evidence of hemodynamically significant stenosis or\npathologic large vessel occlusion. There is mild fusiform dilatation of the\ndistal right vertebral artery which is unchanged. There is no evidence of\naneurysm, vascular malformation, or pathologic large vessel occlusion within\nthe intracranial vasculature. There are atheromatous calcifications within the\ncavernous internal carotid arteries. The dural venous sinuses appear patent.\n\nThere are postoperative changes of the cervical spine. There is multilevel\ndegenerative spondylosis. The parotid glands, submandibular glands, and\nthyroid gland appear unremarkable. The upper mediastinum is normal. There are\nfew patchy opacities within the lung apices which may represent atelectasis\nand/ or scarring.", + "output": "1. No evidence of intracranial hemorrhage or mass effect.\n2. Scattered atheromatous vascular disease without evidence of aneurysm,\nhemodynamically significant stenosis, or pathologic large vessel occlusion\nwithin the vasculature of the head or neck.\n3. This report is provided without 3D and curved reformats. When these\nimages are available, and if additional information is obtained, then an\naddendum may be given to this report." + }, + { + "input": "There is no evidence of new hemorrhage, edema, ormass effect . There is\nmoderate to marked could dilation of the lateral and the third ventricles\nincluding the temporal horns, similar to the prior study and greater than the\nprominence of the cerebral sulci, indicating preferential central parenchymal\nvolume loss with or without superimposed communicating hydrocephalus.\nThe bifrontal diameter of the lateral ventricles superiorly, measures\napproximately 48 mm, compared to the prior of 42 mm, with mild increase\ncompared to the prior study of ___.\n Periventricular, deep and subcortical white matter hypodensities are\nnonspecific but suggests chronic small vessel ischemic changes. The basilar\ncisterns are patent. The cerebellar tonsils are slightly low, at or just\nbelow the margins of foramina magnum, similar to the prior study.\n\nThere is no evidence of fracture. Complete opacification of the left frontal\nsinus, frontal ethmoidal recess and left anterior ethmoid air cells is noted,\nunchanged from prior exam. The other visualized paranasal sinuses,right\nmastoid air cells, and middle ear cavities are clear. Left mastoid is not\nwell pneumatized. Sphenoid sinus septations insert on the left carotid\ngroove. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial hemorrhage or mass effect or acute fracture.\n\n2. Moderate dilation of the lateral and the third ventricles, increased since\nthe prior study of ___. This can relate to preferential central\nparenchymal volume loss with or without superimposed communicating\nhydrocephalus.\nCorrelate clinically to decide on the need for further workup or followup.\n3. Moderate opacification of the left frontal sinus and retention cyst in the\nright maxillary sinus.\nOther details as above." + }, + { + "input": "No intra-axial or extra-axial hemorrhage, edema, shift of normally midline\nstructures, or evidence of acute major infarction. The ventricles and sulci\nare normal in size and configuration.\n\nThere is no evidence of fracture. Mucosal thickening of the ethmoid air\ncells. The visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "No acute intracranial process" + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute large territory infarct,hemorrhage,edema,or mass\neffect. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture.\n\nMild thickening of the anterior ethmoid air cell walls. There is bilateral\nmucosal thickening of the maxillary sinuses, with almost complete\nopacification of the right maxillary sinus as well as a polypoid lesion\nextending through a posterior right accessory ostia into the nasopharynx. The\nnasal portion of the polypoid lesion measures approximately 3.7 x 1.2 cm (AP,\nTRV), new from examination of ___. Redemonstration of a well\ncorticated small bony defect along the lateral wall of the right maxillary\nsinus appears unchanged from prior scan. The remaining visualized portion of\nthe mastoid air cells and middle ear cavities are clear.\n\nThe visualized portion of the orbits are unremarkable.\n\nThere is mild atherosclerotic calcifications of the left vertebral artery.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nlarge territory infarct or intracranial hemorrhage.\n2. There is no evidence of acute calvarial fracture.\n3. Complete opacification of the right maxillary sinus with a polypoid lesion\nextending through the middle meatus to the nasopharynx, increased in size from\nexamination ___, compatible with an antrochoanal polyp. \nDifferential considerations include inverted papilloma (with concurrent\nsinonasal carcinoma not excluded), but felt less likely given imaging\nappearance from CT sinus of ___.\n4. Right maxillary alveolar ridge periapical lucencies demonstrated on\nexamination of ___ is not within the field of view on the current\nexamination, however clinical correlation for odontogenic sinusitis is\nrecommended." + }, + { + "input": "2.1 x 1.5 cm area of hypodensity in the left frontal region with sulcal\neffacement is compatible with cytotoxic edema and reflective of a subacute\ninfarct. There is no acute intracranial hemorrhage, mass, or shift of\nnormally midline structures. The ventricles and sulci are normal in size and\nconfiguration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. 2.1 x 1.5 cm area of hypoattenuation in the left frontal lobe compatible\nwith a subacute infarct. Consider MRI/MRA for further assessment.\n2. No intracranial hemorrhage or mass.\n\nRECOMMENDATION(S): Consider MRI/MRA for further assessment." + }, + { + "input": "CT HEAD:\nA hypodensity within the left frontal lobe corresponds with an area of late\nacute to early subacute infarct as seen on subsequent MRI. The additional\nsite of infarct within the medial left occipital lobe is less well seen on CT.\n\nThere is no evidence of hemorrhage. No mass, mass effect, edema, or midline\nshift. The ventricles and sulci are normal in size and morphology.\n\n The paranasal sinuses, middle ear cavities, and mastoid air cells are clear.\nThe orbits are grossly unremarkable bilaterally.\n\n\nCTA HEAD AND NECK:\nThere is a normal 3 vessel aortic arch. The vertebral arteries are patent\nwithout high-grade stenosis or occlusion.\n\nThe bilateral common carotid arteries are patent. Mild atherosclerotic disease\nis seen at the bilateral carotid bulbs. There is no evidence of internal\ncarotid stenosis by NASCET criteria.\n\nMild to moderate cavernous carotid artery calcifications are noted. Allowing\nfor this, the intracranial vasculature is grossly patent without high-grade\nstenosis, occlusion, or aneurysm greater than 3 mm. The dural venous sinuses\nare patent.\n\n\nOTHER:\nThe lungs apices are clear bilaterally. The thyroid gland is unremarkable in\nappearance. There is no cervical lymphadenopathy by CT size criteria.", + "output": "1. Hypodensity within the left frontal lobe corresponds with an area of late\nacute versus early subacute infarct as seen on subsequent MRI.\n2. Additional left occipital lobe infarct seen on subsequent MRI is not well\nappreciated by CT.\n3. No evidence of hemorrhage.\n4. Grossly patent intracranial cervical vasculature withoutstenosis,\nocclusion, or aneurysm." + }, + { + "input": "No acute intracranial hemorrhage is seen. There is diffuse enlargement of the\nventricles out of proportion to the sulci, not significantly changed from\nprior study. There is no periventricular hypodensity to suggest\ntransependymal flow of CSF. The in inferior cerebellar hemispheres are\nhypoplastic, unchanged. There is a unchanged CSF density retrocerebellar\ncollection in the posterior fossa, likely an arachnoid cyst(s) versus ___\ncisterna magna.\n\nThere is no evidence of acute fracture. There is opacification of a few\nbilateral ethmoid air cells. The mastoid air cells are clear.", + "output": "1. No significant interval change since prior outside hospital MRI from ___.\n2. No significant change in degree of diffuse ventriculomegaly/hydrocephalus. \nNo evidence of transependymal flow of CSF.\n3. Unchanged retrocerebellar CSF-density region, likely an arachnoid cyst(s)\nversus ___ cisterna magna." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nA 1.5 x 1.5 cm round primarily low density lesion, which appears intra-axial,\nis seen in the left parietal subcortical white matter adjacent to the falx\n(02:21). This is grossly unchanged in comparison with ___. There is no\nmidline shift. The ventricles and sulci are normal in size and caliber. There\nis no evidence of hemorrhage or infarction.\n\nThere is a mucous retention cyst in the left maxillary sinus, otherwise the\nparanasal sinuses, mastoid air cells and middle ear cavities are clear. The\nimaged portions of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their major branches are patent\nwithout evidence of stenosis, occlusion or aneurysm formation. There are no\nvessels entering the left parietal parafalcine lesion, and it displaces the\nsurrounding vessels (3:335).\n\nThe dural venous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. 1.5 x 1.5 cm round, proximally intra-axial left parafalcine lesion is\nunchanged in comparison with MRI from ___.\n2. The mass is hypovascular and displaces adjacent vessels.\n3. Patent intracranial and neck vessels." + }, + { + "input": "The patient is status post left craniotomy with the expected postsurgical\nchanges, including pneumocephalus along the left frontal lobe, posterior\nparietal lobe, along the left aspect of the posterior falx, and in the\nsurgical bed. There is mass effect upon the underlying brain parenchyma, with\n5 mm of rightward shift of normally midline structures. There is no evidence\nof blood in the surgical bed. There is no evidence of infarction. There is\nmild mass effect upon the frontal horn of the right lateral ventricle. The\nventricles are otherwise normal in size and configuration. The basal cisterns\nare patent.\n\nThere are post craniotomy changes on the left. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Status post left craniotomy with expected postsurgical changes including\npneumocephalus along the left frontal lobe, posterior parietal lobe, along the\nleft aspect of the posterior falx, and in the surgical bed.\n2. Mass effect on the underlying brain parenchyma with 5 mm of rightward shift\nof normally midline structures. Mild mass effect on the frontal horn of the\nright lateral ventricle.\n3. No evidence of hemorrhage or infarction." + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass. The ventricles and sulci are normal in size and configuration. No\nosseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process" + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of acute large territorial infarction,\nhemorrhage, edema, or mass effect. Prominent ventricles and sulci are\ncompatible with age-related volume loss. Periventricular white matter\nhypodensities are consistent with chronic small vessel ischemic disease.\nAtherosclerotic vascular calcifications are noted of bilateral vertebral and\ncavernous portions of internal carotid arteries.\n\nThe visualized portion of the mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable. There is\npartial opacification of the ethmoid sinus with near complete opacification of\nthe left maxillary sinus.\n\nCTA HEAD: There is atherosclerotic calcification of the cavernous internal\ncarotid arteries. A diminutive right A1 segment of the anterior cerebral\nartery is seen. Punctate atherosclerotic calcification is noted in the left\nA1 anterior cerebral artery with normal opacification distally. Otherwise,\nthe remainder of vessels of the circle of ___ and their principal\nintracranial branches appear normal without stenosis, occlusion, or aneurysm\nformation. The dural venous sinuses are patent.\n\nCTA NECK: A common origin between the brachiocephalic and left carotid artery\nis seen. There is atherosclerotic calcification of the aortic arch and branch\nvessels. Atherosclerotic calcification of the right carotid bulb is seen. \nThere is significant soft and calcified atherosclerotic plaque in the proximal\nleft internal carotid artery resulting in approximately 70% stenosis by NASCET\ncriteria. There is mild ulceration of the plaque proximal to the stenosis,\nbest seen on series 5, image 178. There is segmental atherosclerotic\ncalcification of the left vertebral artery. There is stenosis at the origin\nof the left vertebral artery.\n\nOTHER:\nThe visualized portion of the lungs are clear. Debris is noted in the\ntrachea, extending into the right mainstem bronchus. A 0.4 cm left thyroid\nnodule is seen, which requires no further imaging follow-up per the ___\nCollege of Radiology guidelines. There is no lymphadenopathy by CT size\ncriteria. Degenerative changes are noted throughout the cervical spine. \nThere is anterior fusion at C3-4.", + "output": "1. No acute intracranial hemorrhage or large territory infarct.\n2. Paranasal sinus disease.\n3. Approximately 70% stenosis of the proximal left internal carotid artery by\nNASCET criteria. Mild ulceration of the plaque, proximal to the stenosis.\n4. Stenosis of the origin of the left vertebral artery.\n5. No evidence for vascular abnormality, occlusion or aneurysm formation." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is redemonstration of an evolving intraparenchymal hemorrhage in the\nright occipital lobe measuring approximate 2.2 x 1.9 cm, stable since the\nprior study obtained 5 hours earlier. There is mild regional edema and mass\neffect including partial effacement of the regional cerebral sulci and\noccipital horn of the right lateral ventricle. No significant midline shift\nis present. There is no new hemorrhage or definite intraventricular\nextension. There is no evidence of acute large territory infarction,. Focal\nhypodensities in the anterior limb of the right internal capsule and bilateral\nbasal ganglia are noted, likely related to chronic lacunar infarcts. There is\nprominence of the cerebral sulci and ventricles suggestive of involutional\nchanges in this age group.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nModerate calcified atherosclerotic plaque in the bilateral carotid siphons\nwithout high-grade stenosis. There is fetal origin of the left posterior\ncerebral artery, a normal variant. The vessels of the circle of ___ and\ntheir principal intracranial branches otherwise appear normal without\nstenosis, occlusion, arteriovenous malformation or aneurysm formation greater\nthe right posterior communicating artery is not visualized and may be\nhypoplastic or congenitally absent. Than 3mm. The dural venous sinuses are\npatent.\n\nCTA NECK:\nMild calcified atherosclerotic plaque of the aortic arch and origins of the\nright innominate, left common carotid and left subclavian is present.\nBilateral carotid and vertebral artery origins are patent.\nMild calcified atherosclerotic plaque at the bilateral common carotid\nbifurcations without high-grade stenosis. There is no evidence of internal\ncarotid stenosis by NASCET criteria.\nMild calcified atherosclerotic plaque the V4 segment of the left vertebral\nartery without high-grade stenosis. The carotidandvertebral arteries and\ntheir major branches are otherwise normal with no evidence of stenosis or\nocclusion.\n\n\n\nOTHER:\nThe visualized portion of the lungs demonstrate left apical scarring. The\nvisualized portion of the thyroid gland is within normal limits. There is no\nlymphadenopathy by CT size criteria.", + "output": "1. Evolving intraparenchymal hemorrhage in the right occipital lobe, overall\nsimilar in size when compared with the prior study obtained 5 hours earlier. \nSimilar mild regional edema and mass effect. No significant midline shift.\n2. No new intracranial hemorrhage or acute large vessel infarct.\n3. Patent circle of ___ without definite evidence of arteriovenous\nmalformation, aneurysm, high-grade stenosis or occlusion.\n4. Patent bilateral cervical carotid and vertebral arteries without definite\nevidence of stenosis, occlusion, or dissection.\n5. Chronic lacunar infarcts in the anterior limb of the right internal capsule\nbilateral basal ganglia." + }, + { + "input": "There is redemonstration of intraparenchymal hemorrhage within the right\noccipital lobe measuring approximately 2.2 x 1.8 cm, previously measuring 2.2\nx 1.9 cm on study from 12 hours prior (02:13). Mild adjacent edema is\nunchanged. There is no significant midline shift or mass-effect. There is no\nnew intracranial hemorrhage.\nPeriventricular and subcortical white matter hypo densities are likely sequela\nof chronic small vessel disease. There is prominence of the ventricles and\nsulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No substantial interval change in the right occipital lobe intraparenchymal\nhemorrhage compared to study from 12 hours prior. There is no significant\nmass effect or midline shift. No new intracranial hemorrhage." + }, + { + "input": "Trace mucosal thickening along the right greater than left superior aspect of\nthe ostiomeatal infundibulum (series 601, image 55), otherwise, the paranasal\nsinuses are clear. A small left partially opacified Haller cell is\nidentified. The cribriform plates and lamina papyracea are intact. Prominent\nrightward deviation of the nasal septum, with a small rightward projecting\nspur is identified. Left-sided concha bullosa. Paradoxical turn of the left\nmiddle turbinate is re-identified. The orbits are unremarkable, noting right\nlens replacement. Asymmetric enlargement of the left foramina rotundum\n(series 601, image 85) is unchanged since ___. Otherwise, the skull-base\nforamina appear intact.\n\nAlthough not optimized for such evaluation, visualized brain parenchyma is\ngrossly unremarkable. The visualized mastoid air cells middle ears are well\npneumatized and clear.", + "output": "1. Trace mucosal thickening along the right greater than left superior aspect\nof the ostiomeatal infundibulum. Otherwise, the ostiomeatal units are clear.\n2. The remainder the paranasal sinuses are clear. A small partially opacified\nleft Haller cell is re-identified.\n3. Asymmetric enlargement of the left foramina rotundum is unchanged since\n___.\n4. Additional findings described above." + }, + { + "input": "There is no evidence of acute large territory infarction,\nintracranialhemorrhage,edema,or discrete mass. The ventricles and sulci are\nnormal in size and configuration.\n\nThere is no evidence of fracture. Mild ethmoid and maxillary sinus thickening\nand mucous retention cysts seen within the maxillary sinuses bilaterally. \nOtherwise, the visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavitiesare essentially clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Sinus disease as above." + }, + { + "input": "There has been interval development of extensive edema extending along the\nright frontoparietal lobe secondary to the known left frontal lobe infarction.\nThere is mild effacement of the right lateral ventricle without midline shift,\nslightly increased in prominence compared to prior MRI of ___. No\nevidence of hemorrhage or new area of infarction is noted. Prominence of the\nventricles and sulci suggest involutional changes. Periventricular and\nsubcortical white matter hypodensities are nonspecific, but likely reflect\nsequelae of chronic small vessel ischemic disease. There is moderate fluid in\nthe left sphenoid sinus. The remaining imaged paranasal sinuses are clear.\nMastoid air cells and middle ear cavities are well aerated. The bony calvarium\nis intact.", + "output": "Extensive edema along the right frontoparietal lobes secondary to known left\nfrontal lobe infarction, increased from prior examinations with minimally\nprogressed right lateral ventricle effacement without midline shift or\nventriculomegaly. No evidence of hemorrhage or new area of infarction." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nMild mucosal thickening is seen within the ethmoid air cells. Mastoid air\ncells and middle ear cavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute infarction,intracranial hemorrhage, edema, or\nmass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No evidence of acute intracranial process. No evidence of acute fracture or\nintracranial hemorrhage." + }, + { + "input": "A stereotactic core biopsy device is in place. Patient is status post left\nfrontal craniotomy. There is a 3.0 x 2.6.0 cm peripherally enhancing\nhypodense lesion in the left frontal lobe adjacent to the frontal horn of the\nleft lateral ventricle with surrounding edema, not significantly changed\ncompared with MRI ___ allowing for differences in modality. Minimal\neffacement of the frontal horn of the left lateral ventricle is similar to\nprior. Cystic encephalomalacia in the anterior left frontal lobe is not\nsignificantly changed. No new enhancing lesions.\n\nThere is no evidence of fracture. There is a small mucosal retention cysts in\nthe left maxillary sinus. The visualized portion of the remainder of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "Re-demonstration of a peripherally enhancing left frontal lobe mass with\nsurrounding edema, not significantly changed compared with MRI ___." + }, + { + "input": "The patient is status post brain biopsy via left frontal burr hole. The\npreviously reported peripherally enhancing mass in the left frontal lobe is\nnot well seen on this noncontrast exam, but the extent and distribution of\nedema in the left frontal lobe is similar to CT from earlier today. No acute\nhemorrhage or midline shift. Encephalomalacia in the anterior left frontal\nlobe is also similar to prior. The ventricles and sulci are otherwise normal\nin size and configuration.\n\nThere is no evidence of fracture. The patient is status post left frontal\ncraniotomy. The visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The orbits are unremarkable.", + "output": "No significant change since CT earlier today status post brain biopsy via a\nleft frontal burr hole. No acute hemorrhage or midline shift." + }, + { + "input": "Multiple foci of acute hemorrhage, most likely subarachnoid are seen\nthroughout both cerebral hemispheres. These are more conspicuous than on the\nprior imaging and/or noted to involve the vertex, rectus gyri, temporal lobes\nand right occipital lobe. Additionally there is hyperdense blood product\nnoted along the falx in keeping with an element of subdural blood. There is\nno evidence of intraventricular extension of hemorrhage or hydrocephalus. \nThere is no midline shift, significant mass effect or herniation. The basal\ncisterns are patent.\n\nThere is no acute fracture identified. The sinuses, mastoid air cells and\nmiddle ear cavities are clear. The orbits are unremarkable. No significant\nsoft tissue swelling.", + "output": "Scattered supratentorial foci of subarachnoid hemorrhage as well as a probable\nsubdural bleed along the posterior falx are more conspicuous than on the\nimaging performed several hours prior. No midline shift or evidence of\nherniation." + }, + { + "input": "Small amount of hemorrhage along the posterior falx, likely subdural is\nunchanged from prior. Multiple scattered foci of subarachnoid hemorrhage\nbilaterally at the vertex are stable to slightly conspicuous compared to prior\nin keeping with expected evolution of blood products. Small amount of\nprobably intraparenchymal hemorrhage in the left occipital lobe, right\ntemporal lobe, and left frontal lobe at the rectus gyrus is also unchanged. \nNo new hemorrhage identified. The there is no evidence of infarction. The\nventricles and sulci are unchanged and normal in size and configuration.\n\nThere is no evidence of fracture. Small mucous retention cyst is seen in the\nright maxillary sinus. Otherwise, the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Expected evolution of multiple foci of subarachnoid, intraparenchymal, and\nsubdural hemorrhage as described above. No evidence of new hemorrhage.\n2. Stable size and configuration of the ventricles." + }, + { + "input": "There is no evidence of large territorial infarction,acute intracranial\nhemorrhage,edema,or mass. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. Periventricular and subcortical white\nmatter hypodensities are nonspecific, likely sequela of chronic small vessel\nischemic disease. Atherosclerotic vascular calcifications in the imaged\nbilateral vertebral and cavernous carotid arteries are again noted.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable, noting bilateral lens replacements. \nThe endotracheal and nasogastric tubes are partially imaged.", + "output": "No evidence of acute intracranial hemorrhage. No change since the head CT of\n___." + }, + { + "input": "Dental amalgam streak artifact and motion limits examination.\n\nThere is no evidence of infarction, hemorrhage, edema, or mass. Subcortical\nand periventricular white matter hypodensities are nonspecific, likely\nsequelae of chronic small vessel ischemic disease. There is prominence of the\nventricles and sulci suggestive of involutional changes. Atherosclerotic\ncalcifications are seen along bilateral carotid siphons and the left V4.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nethmoid air cells. The visualized portion of the remaining paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits show bilateral lens replacement. Soft tissue densities are noted\nwithin bilateral external auditory canals which may represent cerumen.", + "output": "1. Dental amalgam streak artifact and motion limits examination.\n2. No evidence of intracranial hemorrhage or large territorial infarction.\nPlease note MRI of the brain is more sensitive for the detection of acute\ninfarct.\n3. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass. There is prominence of the ventricles and sulci suggestive of\nage-related cerebral volume loss. Periventricular and subcortical white matter\nhypodensities are nonspecific, though likely sequelae of chronic small vessel\nischemic disease. Atherosclerotic vascular calcifications are noted of\nbilateral vertebral and cavernous portions of internal carotid arteries.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Prominent\nventricles and sulci are suggestive of age-related involutional change.\nPeriventricular white matter hypodensities are consistent with severe chronic\nsmall vessel ischemic disease. No osseous abnormalities seen. There is mild\nmucosal thickening in the right maxillary sinus. The other visualized\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\norbits are unremarkable.", + "output": "1. No acute infarct, hemorrhage, or fracture.\n2. Age-related involutional changes and sequela of chronic small vessel\nischemic disease." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. \nProminence of ventricles and sulci is consistent with age related involutional\nchanges. Periventricular white matter hypodensities are likely the sequela of\nsevere chronic small vessel ischemic disease.\n\nNo osseous abnormalities seen. There is mild mucosal thickening of the\nanterior ethmoidal air cells and right maxillary sinus. The remaining\nvisualized paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The orbits are unremarkable. Dense atherosclerotic calcifications noted\na the carotid siphons bilaterally.", + "output": "No acute intracranial hemorrhage or mass effect.\nOther details as above.\nCorrelate clinically the to decide on the need for further workup or followup." + }, + { + "input": "Large area of hypodensity involving the right parietal/temporal/occipital\nlobes, likely representing a chronic infarction involving the PCA territory or\nencephalomalacia due to prior traumatic injury. Smaller focal left frontal\nlobe hypodensity (4:66), likely representing chronic infarction. Nonspecific\nperiventricular and subcortical white matter hypodensities, likely reflecting\nchronic small vessel ischemic disease. There is no evidence of new acute\ninfarction,hemorrhage,edema,or mass effect. The ventricles and sulci are\nprominent, suggestive of involutional disease.\n\nThere is no evidence of acute calvarial fracture. Mild mucosal thickening of\nthe ethmoid air cells. The mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. No evidence of acute intracranial abnormalities. Specifically, no evidence\nof acute infarction or hemorrhage.\n2. Large area of hypodensity involving the right parietal/temporal/occipital\nlobes, likely representing chronic infarction involving the PCA territory or\nencephalomalacia due to prior traumatic injury.\n3. Small focal left frontal lobe hypodensity (4:66), likely representing\nchronic infarction.\n\nRECOMMENDATION(S): If there is persistent clinical concern related with\nacute/subacute ischemic changes, correlation with MRI is advised." + }, + { + "input": "5 mm calcified focus arising from the right parasagittal parietal inner table\n(series 3, image 47) corresponds to a focus gradient echo susceptibility\nartifact seen on prior MRI, likely representing a calcified meningioma. There\nis no intra or extra-axial mass effect, acute hemorrhage or large territory\ninfarct. Ventricles and sulci are within expected limits for the patient's\nage. The imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial abnormality on noncontrast head CT." + }, + { + "input": "Dental amalgam streak artifact limits study.\n\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nMild paraseptal emphysema involves the lung apices bilaterally and\nsymmetrically. A right chest port traverses the right chest wall and into the\nright internal jugular vein, its tip incompletely imaged. A 1.1 x 0.9 cm soft\ntissue oval density within the left parotid gland (5:151) may reflect a lymph\nnode although remains incompletely characterized. The visualized portion of\nthe thyroid gland is within normal limits. There is no lymphadenopathy by CT\nsize criteria.", + "output": "1. Dental amalgam streak artifact limits study.\n2. No evidence of acute intracranial hemorrhage.\n3. No evidence ofaneurysm greater than 3 mm, dissection or significant\nluminal narrowing.\n4. Left parotid gland oval soft tissue nodule may reflect a lymph node but\nremains incompletely characterized. Ultrasound or MRI can be obtained on a\nnonemergent basis for further evaluation." + }, + { + "input": "There is no evidence of acute large territorial infarction or hemorrhage. \nHyperdense lesions are seen in the left periventricular area (___) and\nsplenium of the corpus callosum with surrounding hypodensity that may\nrepresent vasogenic edema. The surrounding hypodensities appear to be\nprogressed and increased in size from prior MR study from ___. \nThere is prominence of the ventricles and sulci suggestive of volume loss.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of intracranial hemorrhage or acute large territorial\ninfarction.\n2. Hyperdense lesions in the left periventricular area and corpus callosum\nwith surrounding hypodensity that may represent vasogenic edema. The\nsurrounding hypodensity appears to have increased in size from prior MR study\nfrom ___. Please refer to nearly concurrent MRI brain study for\nmore detailed characterization." + }, + { + "input": "There is no evidence of hemorrhage or infarction. Vague hyperdense areas\naround the atrium of the left lateral ventricle with surrounding edema is\nagain seen. Edema is also seen in the splenium of the corpus callosum. \nCorresponding to the enhancing infiltrating lesion, presumably lymphoma, seen\non the brain MR areas edema appear stable to slightly improved compared to\nprior CT. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of hemorrhage or infarction.\n2. The changes of parenchymal lymphoma are far better seen on the MR exam of ___. However, allowing for the difference in technique, there appears to\nbe no progression. Surrounding edema is stable to slightly improved." + }, + { + "input": "There is no evidence of hemorrhage. Again seen, is vasogenic edema\nsurrounding vague areas of hyperdensity in white matter adjacent to the atrium\nof the left lateral ventricle and in the splenium of the corpus callosum. \nCompared to prior CT scan from ___, there is significant increase in\nvasogenic edema, most pronounced superiorly (series 2, image 21). There is a\n7 mm hyperdense nodule adjacent to the atrium of the left lateral ventricle,\nwhich appears more conspicuous on the current examination with associated\nenhancement on recent MRI, consistent with lymphoma thus change (series 2,\nimage 17). Compared to recent MRI there is no appreciable interval change\nhowever. The basal cisterns appear patent however there is mass effect on the\nuncus.\n\nThere is no fracture. The paranasal sinuses and mastoid air cells are clear. \nThe orbits are unremarkable.", + "output": "1. No evidence of intracranial hemorrhage.\n2. Changes of parenchymal lymphoma are better evaluated on MRI examination\nfrom ___. Allowing for differences in technique, there appears to be no\nprogression over this short time interval. However, in comparison to the\nprior head CT from ___, there is significant increase in associated\nvasogenic edema." + }, + { + "input": "No evidence of intracranial hemorrhage. There is edema within the left\nparietal, temporal, white matter, and swelling within the bilateral splenium\nof the corpus callosum, similar to the recent CT and MRI. Some of the\nenhancing areas on the ___ MRI, corresponding to the known lymphoma,\nare mildly hyperdense on the present CT, for example in the right splenium of\nthe corpus callosum on image 4:18, and in the left periatrial white matter on\nimage 4:17. There persistent effacement of the occipital horn of the left\nlateral ventricle. There is no shift of midline structures.\nNo suspicious bone lesion is seen. Paranasal sinuses and mastoid air cells\nappear grossly well-aerated.", + "output": "No acute hemorrhage. The extent of edema in bilateral splenium of the corpus\ncallosum and left cerebral hemisphere is similar to the ___ CT." + }, + { + "input": "Extensive edema within the left parietal and temporal lobes with extension\nacross the midline within the splenium of the corpus callosum is unchanged\nfrom brain MRI dated ___ and similar slightly improved from the head\nCT of ___. There is no midline shift. Associated sulcal effacement\nis similar. There is no intracranial hemorrhage and the ventricles appear\nnormal in configuration and caliber.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Unchanged left temporoparietal edema with extension across the midline\nwithin the splenium of the corpus callosum and mild associated sulcal\neffacement.\n2. No worsening mass effect or intracranial hemorrhage.\n3. Please note MRI of the brain is more sensitive for the evaluation of\nintracranial tumors." + }, + { + "input": "Chronic right basal ganglia lacunar infarct is seen (03:16). There is no\nevidence of acute major infarction,hemorrhage,edema,or discrete mass. There\nis prominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavitiesare essentially\nclear. The visualized portion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute major vascular territorial infarction or acute\nintracranial hemorrhage. There is persistent mildly hyperdense cortical\nthickening and sulcal effacement along the left parietal lobe (3:25) that is\nunchanged from prior studies. Again seen is extensive left cerebral white\nmatter edema that is unchanged from the recent MRI dated ___. No new\nloss of gray-white matter differentiation. Prominent ventricles and sulci are\nlikely due to age-related volume loss.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "Overall no significant interval change in extensive left cerebral white matter\nedema and cortical thickening/sulcal effacement along the left parietal lobe\nbetter characterized on MRI ___. No evidence of acute infarct or\nhemorrhage." + }, + { + "input": "Again seen is a subacute subdural hematoma at the left vertex, effacing the\nleft superior frontal and parietal sulci. The degree of associated mass effect\nis unchanged. There is no shift of midline structures or ventricular\neffacement. There is no acute hemorrhage. Unaffected sulci and the ventricles\nare prominent due to age-related parenchymal atrophy. Basal cisterns are not\ncompressed. Areas of low density in the subcortical, deep, and periventricular\nwhite matter of the cerebral hemispheres are again seen, nonspecific but\nlikely sequela of chronic small vessel ischemic disease in a patient of this\nage.\n\nNo suspicious osseous abnormalities are seen. Paranasal sinuses are well\naerated. Mastoid air cells are underpneumatized but few pneumatized mastoid\nair cells on each side are well-aerated.", + "output": "Stable appearance of subacute subdural hematoma at the left vertex, with\nstable effacement of the left superior frontal and parietal sulci. No new\nabnormalities are seen.\n\nRECOMMENDATION(S):\nIf clinically warranted, MRI would be more sensitive for an acute infarction." + }, + { + "input": "There is no evidence of intracranial infarction, edema or mass. Specifically,\nthe previous area of concern in the left anterior cranial fossae is\nunremarkable. However, there is a tiny frontal subarachnoid hemorrhage\n(602:45, 601:18). The ventricles and sulci are normal in size and\nconfiguration. Chronic small vessel ischemic changes noted.\n\nStable subgaleal hematoma in the left frontoparietal regions. There is a\nnondisplaced left superior orbital rim fracture (601:25) with adjacent\npunctate focus of gas. The paranasal sinuses, mastoid air cells, and middle\near cavities are clear. Status post right lens replacement.", + "output": "1. Tiny focal left frontal subarachnoid hemorrhage. The previous area of\nconcern in the left anterior cranial fossae is unremarkable.\n2. Nondisplaced left superior orbital rim fracture.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:36 am, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "Subtle flattening of the nasal bone, subtle irregularity tip of the frontal\nprocess right maxilla, consistent with fractures, of indeterminate age. \nSubtle mid, minimally displaced fractures bilateral superior orbital walls, on\nthe right side coronal image 87, and fracture extends into the orbital apex,\nwithout involvement of the optic canal on the left side coronal image 64. \nTiny air bubble along the left superior orbital wall fracture, likely related\nto near by fracture of the superior ethmoid roof. Hairline fractures probably\ninvolve adjacent ethmoid roofs on the left, and possibly on right. If there\nis rhinorrhea, CSF leak should be excluded.. No definite fracture of the\ncribriform plate or lateral lamella.\n\nNo orbital hematoma. Left forehead, periorbital soft tissue swelling. Normal\nglobes bilaterally. Intact medial, inferior orbital walls.\n\nMild opacification of the ethmoid air cells, with probably some fluid. No\nfluid in the sphenoid, maxillary sinuses. Mild opacification inferior left\nfrontal sinus and frontal drainage pathway.", + "output": "1. Fractures bilateral superior orbital walls, involving orbital apex on the\nright. Probable fractures of the adjacent ethmoid roofs.\n2. Tiny air bubble along the left orbital roof fracture, likely extra-axial\nfrom communication with the ethmoid sinuses, clinical follow-up recommended to\nexclude development of infection.\n3. Fluid ethmoid air cells bilaterally. If there is rhinorrhea, CSF leak\nshould be excluded.\n4. No orbital hematoma.\n5. Subtle nasal bone fracture, indeterminate age.\n6. Left forehead, periorbital soft tissue swelling." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. Basal cisterns are\npatent. Significant artifact anterior skullbase from motion and beam\nhardening attenuation. Artifact versus trace hemorrhage base left anterior\ncranial fossa series 2, image 14. Chronic small vessel ischemic change.\n\nSubgaleal hematomas are noted in the left frontal and parietal regions. There\nis no evidence of fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. Moderate artifact.\n2. Artifact versus trace hemorrhage left anterior cranial fossa.\n3. Scalp soft tissue edema..\n\nRECOMMENDATION(S): Repeat head CT scan.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 8:02 am, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "CT HEAD:\nEvaluation is limited secondary to extensive artifact from dental amalgam. \nAllowing for this:\n\nThere is a large hypodensity seen within the medial right occipital lobe,\ncorrelating to an area of known infarction as seen on prior MRI. Additional\nsmall right parietal and occipital lobe infarction seen on prior MRI are not\nwell visualized on CT.\n\nPeriventricular and subcortical white matter hypodensities are noted, likely\nthe sequelae of chronic small vessel ischemic disease. There is no evidence\nfor acute hemorrhage, mass effect, or edema. The ventricles and sulci are\nmildly prominent for the patient's given age.\n\nAn air-fluid level and aerosolized secretions are seen in the right maxillary\nsinus. The remainder of the paranasal sinuses, middle ear cavities, and\nmastoid air cells are clear. The orbits are grossly unremarkable bilaterally.\n\n\nCTA HEAD AND NECK:\nThere is a normal 3 vessel aortic arch with moderate calcifications at the\norigin of the brachiocephalic artery and at the origin of the left subclavian\nartery.\n\nMild-to-moderate calcifications are seen within the left V1 segment, with\nsevere calcifications in the proximal left V4 segment. Moderate to severe\ncalcifications are noted at the origin of the right V1 segment, with mild to\nmoderate calcifications in the distal right V3 and proximal right V4 segment. \nThere is mild luminal narrowing of the distal right V4 segment (5:246). The\nbasilar artery is widely patent.\n\nPartially calcified atherosclerotic plaque is noted in the bilateral carotid\nbulbs. There is extension of atherosclerotic disease into the proximal right\ninternal carotid artery resulting in approximately 50% stenosis by NASCET\ncriteria. Atherosclerotic disease within the proximal left internal carotid\nartery results in less than 30% stenosis by NASCET criteria.\n\nModerate calcifications are seen in the bilateral cavernous internal carotid\narteries. There is a hypoplastic left A1 segment. There is a hypoplastic but\npatent right posterior communicating artery. There is a fetal origin of the\nleft posterior cerebral artery. Otherwise, the vessels of the circle of\n___ and their principal intracranial branches are patent without high-grade\nstenosis, occlusion, or aneurysm formation.\n\nOTHER:\nNasogastric and orogastric tubes are incompletely imaged. An endotracheal\ntube is in place, with the tip terminating in the mid thoracic trachea. \nSecretions are seen within the distal thoracic trachea lying dependently.\n\nThe patient is status post CABG, with expected postsurgical changes. The\nthyroid gland is unremarkable in appearance. There is no cervical\nlymphadenopathy by CT size criteria.", + "output": "1. Known right medial occipital lobe infarct, now late acute/early subacute. \nAdditional small infarcts as seen on prior MRI are not well documented by CT.\n2. No evidence of hemorrhage.\n3. Atherosclerotic disease within the bilateral carotid bulbs and proximal\ninternal carotid arteries, with approximately 50% stenosis of the proximal\nright ICA and less than 30% stenosis of the proximal left ICA by NASCET\ncriteria.\n4. Multifocal atherosclerotic disease within the bilateral vertebral arteries,\nas above. Findings are most significant within the proximal left V4 segment\nwhere there is severe calcifications, with gross patency of the artery itself.\n5. Mild-to-moderate calcifications of the proximal right V4 segment with mild\ncaliber change distal to this. No evidence of intraluminal filling defect or\ndissection flap." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Head CT: The old left frontal infarct and associated encephalomalacia are\nunchanged. There is no hemorrhage, major vascular territorial infarction,\nmass, or shift of the normally midline structures. The ventricles and sulci\nare moderately enlarged. Basal cisterns are patent. The differentiation of\ngrey and white matter is preserved. Visualized paranasal sinuses and mastoid\nair cells are clear. There is no fracture.\n\nCTA Neck: There is minimal calcified plaque at the proximal right internal\ncarotid artery. There is no substantial right internal carotid artery stenosis\nby NASCET criteria.\n\nThere is a partially calcified plaque in the mid left common carotid artery\n(___). A focal narrowing leads to approximately 50% stenosis. There is\nminimal calcified plaque at the origin of the left internal carotid artery.\nThere is no substantial stenosis of the left internal carotid artery by NASCET\ncriteria.\n\nThe thyroid gland is markedly heterogeneous with multiple hypointense nodules.\nThere are small mucous retention cysts in the left maxillary sinus. The\naerodigestive tract is patent.\n\nCTA head: The intracranial circulation is patent without stenosis, occlusion,\nor aneurysm. There is moderate calcification of the cavernous internal\ncarotid arteries bilaterally.", + "output": "1. Approximately 50% left common carotid artery stenosis. Otherwise patent\ncervical and intracranial vasculature.\n2. No CT correlate to multiple known punctate MCA ACA watershed infarcts.\n3. Old left frontal infarct.\n4. Heterogeneous thyroid gland. Consider nonemergent correlation with\nultrasound if clinically indicated." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nNo intracranial hemorrhage. Vague hypodense changes in the high right\nsuperior frontal gyrus in the distribution of the right ACA which may\nrepresent an acute infarct. Correlation with MRI imaging is advised. Cystic\nencephalomalacia in the left parietal area in the distribution of left MCA in\nkeeping with a chronic infarct.\nMild mucosal thickening involving the paranasal sinuses. The mastoid air\ncells are clear. Multiple dental caries with periapical lucencies are noted. \nThe visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nare patent without marked stenosis, occlusion, or aneurysm formation. \nModerate narrowing in the mid to distal right A2 segment (series 602, image\n35). Fetal type origin of the right PCA. The dural venous sinuses are\npatent.\n\nCTA NECK:\nModerate short-segment stenosis of the distal left CCA by predominantly soft\ntissue plaque. Mild atherosclerotic changes of the proximal ICAs bilateral,\nbut no stenosis by NASCET criteria. Mild moderate calcific atherosclerotic\nchanges of the carotid siphons bilateral, but no marked stenosis. The\nvertebral arteries are patent bilateral.\n\nOTHER:\nNo suspicious pulmonary nodules or masses. Multiple thyroid nodules ranging\nup to 14 mm the right lobe of thyroid. There is no lymphadenopathy by CT size\ncriteria. Patulous appearance of the esophagus. Degenerative changes of\ncervical spine.", + "output": "Vague hypodense changes in the right superior frontal gyrus for which\ncorrelation with MRI with diffusion-weighted imaging is advised.\n\nNo intracranial hemorrhage. No intracranial mass.\n\nChronic infarct in the left parietal area in the distribution of the left MCA.\n\nNo intracranial arterial occlusion or aneurysm. Mild narrowing in the mid to\ndistal right A2 segment.\n\nModerate short-segment stenosis of the distal left CCA by predominantly soft\ntissue plaque.\n\nMild atherosclerotic changes of the proximal ICAs bilateral, but no stenosis\nby NASCET criteria.\n\nNOTIFICATION: ED URGENT ATTENTION\n\n The findings were discussed by Dr. ___ with Dr. ___ on the ___\n___ at 1:50 pm, 2 minutes after discovery of the findings." + }, + { + "input": "There are confluent areas of white matter hypodensity in the bilateral frontal\nlobes without significant mass effect on the adjacent ventricles, is\nsuggestive of extensive microangiopathic changes/gliosis and less likely\nvasogenic edema. No definite underlying mass identified. Hyperdense foci are\nnoted in the posterior aspects of the parietal lobes bilaterally, suspicious\nfor small foci of hemorrhage (2:17). There is no definite evidence of acute\nlarge territorial infarction.\n\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Atherosclerotic vascular calcifications are noted. There are\nperiventricular and subcortical lucencies, which may represent small vessel\nischemic changes.\n\nThere is no evidence of fracture. There is moderate mucosal thickening of the\nbilateral maxillary and sphenoid sinuses. Partial opacification of the right\nmiddle ear cavity is noted. The patient is status post bilateral lens\nreplacement surgery.", + "output": "1. Biparietal intraparenchymal versus subarachnoid hemorrhages.\n2. Bifrontal diffuse white matter hypodensities as described. While findings\nmay represent extensive microangiopathic changes or chronic infarcts,\nvasogenic edema related to metastatic disease cannot be excluded on the basis\nexamination. If concern for intracranial metastatic disease, consider\ncontrast brain MRI for further evaluation.\n3. Hyperdense foci in the bilateral parietal lobes are suspicious for small\nfoci of intraparenchymal hemorrhage.\n4. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described.\n5. Paranasal sinus disease and nonspecific partial opacification of right\nmiddle ear cavity, as described." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. Severe predominantly periventricular white matter hypodensities are\nnonspecific, but likely represent the sequela of chronic microvascular\nischemia. Chronic lacunar infarct within the left basal ganglia and insula. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Small amount\nof soft tissue within the left ear canal, likely cerumen. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormalities.\n2. Severe chronic microvascular ischemic and age-related involutional changes." + }, + { + "input": "There is a hypodensity of the right occipital-parietal lobe, concerning for\nsubacute infarction. The wedge shape of the hypodensity and its involvement\nof the cortex without surrounding edema is consistent with a sterile infarct. \nBy CT, suspicion for infection is low given the lack of surrounding edema. \nHowever, MR would be more sensitive for detecting edema or enhancement\nassociated with aseptic infarction. MR may also be helpful for detecting a\npossible mycotic aneurysm, although the optimal timing of such in examination\nis unclear.\n\nThere is an additional area of tissue loss in the right frontal lobe, which is\nconsistent with evolution of a chronic infarct.\n\nThere are calcifications in the right sylvian fissure suspicious for vessel\nwall calcification versus calcified emboli; however, these are not proximal to\nthe infarcted brain.\n\nThe ventricles and sulci are within normal limits for age.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Right occipital parietal subacute infarction without edema.\n2. MR may be helpful for further characterization to investigate the\npossibility of infection as well as any evidence for mycotic aneurysm.\n3. Evidence of chronic infarct in the right frontal lobe.\n\nRECOMMENDATION(S): By CT, suspicion for infection history low. If clinical\nsuspicion is high for infection, would recommend obtaining MR/MRA to further\nclarify the presence infection. Additionally, an MR/MRA may help to determine\nthe presence of possible mycotic aneurysm. MR/MRA would also help to further\ncharacterize the infarcts." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci and unremarkable. Basilar cisterns are\npatent.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of hemorrhage, mass effect, or recent infarction. Again\nseen are post treatment changes in the left frontal lobe as well as basal\nganglia with encephalomalacia and ex vacuo dilatation of the left lateral\nventricle. Periventricular and subcortical white matter hypodensities are\nnonspecific, but likely reflect sequelae of chronic small vessel ischemic\ndisease. Prominent ventricles and sulci suggest age related global atrophy.\nThe basal cisterns appear patent and there is preservation of gray-white\nmatter differentiation.\n\nNo acute osseous abnormalities seen. Patient is status post left frontal\ncraniectomy with overlying chronic soft tissue deformity. There is mucosal\nthickening in the ethmoid air cells. The remaining paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No evidence of acute intracranial process.\n\n2. Post treatment changes in the left frontal lobe and basal ganglia with\nencephalomalacia, not significantly changed since MRI from ___.." + }, + { + "input": "Prominence of the ventricles and left frontal lobe encephalomalacia with ex\nvacuo dilatation of the left lateral ventricle is similar compared the prior\nstudy. Confluent bilateral periventricular and subcortical white matter\nhypodensity, a similar in distribution to T2 hyperintensity seen on FLAIR\nimages on the prior study. Re-demonstrated left basal ganglia\nencephalomalacia. Prominence of the sulci is again seen. No acute\nintracranial hemorrhage is seen. There is no midline shift. MRI would be\nmore sensitive in assessing for acute ischemia. Patient is status post left\nfrontal craniotomy. The paranasal sinuses and mastoid air cells are clear. \nSubtle mottled appearance of the calvarium could relate to underlying\nlymphoproliferative disease, or renal insufficiency", + "output": "No acute intracranial hemorrhage. Chronic changes including prominence of the\nventricular system, ex vacuo dilatation of the left frontal horn with left\nfrontal lobe encephalomalacia, and confluent bilateral periventricular and\nsubcortical white matter hypodensity, similar in distribution compared to\nprior MRI. If concern for acute ischemia, MRI would be more sensitive.\n\nNo midline shift." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. Hypodensity in the right\nputamen may represent a prominent perivascular space or remote infarction\n(02:12). Periventricular and deep subcortical white matter hypodensities are\ncompatible with moderate chronic small vessel ischemic changes.\n\nThere is no evidence of fracture. Mild mucosal thickening and mucous\nretention cysts are seen in bilateral maxillary sinuses, the ethmoidal air\ncells, and the frontoethmoidal recess on the right. Inspissated secretions\nare noted within the right aspect of the sphenoid sinus. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare otherwise clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Paranasal sinus disease as described above.\n3. Moderate chronic small vessel ischemic changes." + }, + { + "input": "Study is moderately degraded by motion. Within these confines:\n\nThere is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction.\n\nVentricles and sulci are prominent, suggestive of volume loss. \nAtherosclerotic vascular calcifications are noted of bilateral vertebral and\ncavernous portions of internal carotid arteries. There are periventricular\nand subcortical lucencies, which may represent small vessel ischemic changes.\n\nThere is mucosal thickening of the right maxillary sinus and bilateral ethmoid\nair cells. Mastoid air cells and middle ear cavities are well aerated. The\nbony calvarium is intact.", + "output": "1. Study is moderately degraded by motion.\n2. Within limits of study, no definite evidence of acute intracranial\nhemorrhage.\n3. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct.\n4. Paranasal sinus disease, as described.\n5. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is mild global parenchymal volume loss. Confluent areas of low\nattenuation within the subcortical and periventricular white matter likely\nreflect chronic small vessel disease. There is no large infarct, acute\nintracranial hemorrhage, or mass effect.\n\nThe orbits are grossly unremarkable. There is mild mucosal thickening within\nthe maxillary sinuses. There is partial opacification of the right posterior\nethmoid air cells. The paranasal sinuses otherwise clear. The middle ear\ncavities and mastoid air cells are clear. Torus ___, mandibularis, and\nmaxillaris are noted.\nCTA HEAD:\nThere is mild atherosclerotic plaque within the cavernous segments of the\nbilateral internal carotid arteries, without stenosis. The anterior and\nmiddle cerebral arteries are patent, without stenosis.\n\nThe posterior cerebral arteries are patent, without stenosis. A left posterior\ncommunicating artery is not seen. The right posterior communicating artery is\npatent.\n\nThere is mild atherosclerotic plaque within the V4 segments of the vertebral\narteries, without stenosis. The basilar artery is patent, without stenosis.\n\nNo aneurysm or high-flow vascular malformation is identified.\n\nCT PERFUSION HEAD:\nNo abnormality on CT perfusion images to suggest a large area of ischemia or\ninfarction.\n\nCTA NECK:\nThere is a 2 vessel aortic arch with the left common carotid derived from the\nbrachiocephalic trunk.\n\nThere is minimal atherosclerotic plaque at the right carotid bulb, without\nstenosis by NASCET criteria. The right common carotid internal carotid\narteries otherwise appear normal.\n\nThere is minimal atherosclerotic plaque at the left carotid bulb, without\nstenosis by NASCET criteria. The left common carotid internal carotid arteries\notherwise appear normal.\n\nThe vertebral arteries are patent, without stenosis.\n\nOTHER:\nAreas of ground-glass opacity and reticulation within the bilateral lower\nlobes likely reflects atelectasis. No enlarged cervical lymph nodes are\nidentified.", + "output": "1. No large acute infarct or area of ischemia on CT perfusion images.\n2. Mild intracranial atherosclerosis, without stenosis or occlusion.\n3. Mild extracranial atherosclerosis, without stenosis by NASCET criteria.\n4. Probable chronic small vessel disease." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nRe-demonstrated are confluent periventricular and subcortical hypodensities,\nwhich may represent small vessel ischemic changes.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nbilateral maxillary sinuses. The visualized portion of the remaining\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "CT head: There is loss of the gray-white matter differentiation at the right\ninsular cortex and the anterior right frontal cortex at both the ganglionic\nand supra ganglionic levels consistent with acute infarct. There is no\nevidence of hemorrhagic conversion. The remainder of the parenchyma\ndemonstrates normal attenuation. The ventricles and cortical sulci are normal\nin caliber configuration. The extra-axial spaces are unremarkable.\n\nThe orbits, calvarium, soft tissues are unremarkable. There is a left\nmaxillary sinus mucous retention cyst. There is mild mucosal thickening\nwithin the bilateral maxillary sinuses. The mastoid air cells middle ears are\nclear.\n\nCTA head: There is absent filling of the right internal carotid artery\nextending from the carotid bulb to the anterior cavernous segment. There is\ndistal retrograde filling across patent anterior and right posterior\ncommunicating arteries. There is abrupt vascular cutoff at the anterior\ndivision post bifurcation M1/M2 middle cerebral artery (5:273). There are\nasymmetrically diminished collaterals within the more distal frontal and\ninsular parotid. There is a likely fenestration at the left anterior\ncommunicating artery (5:274). The bilateral posterior communicating arteries\nare visualized. There is a left dominant vertebral artery. There is no\nevidence of aneurysm or vascular malformation. The dural venous sinuses are\npatent.\n\nCTA neck: There is 3 vessel aortic arch. There is a flame shaped cut off at\nthe right carotid bulb with absent filling distally to the cavernous segment\ninternal carotid artery, with morphology suggesting a dissection (5:161). The\nleft carotid arteries patent without significant stenosis by NASCET criteria. \nThere is a left dominant vertebral artery. There is abrupt decrease in\ncaliber of the right V3 segment vertebral artery as it enters the right C1\ntransverse foramen (5:200), which may represent congenital hypoplastic variant\nversus dissection.\n\nThe pharynx, larynx, nasal cavity, and oral cavities are unremarkable. The\nmasticator and parapharyngeal spaces are unremarkable. There is streak\nartifact secondary to dental amalgam which obscures adjacent structures,\notherwise the dentition is intact. The thyroid and salivary glands are\nunremarkable. There are no suspicious lymph nodes by size or morphology. \nThere is no fracture or osseous lesion. The lung apices are clear.", + "output": "1. Flame shaped cut off at the right carotid bulb with absent filling to the\ncavernous segment internal carotid artery. This morphology suggests a\ndissection. Distal retrograde filling across a patent anterior and right\nposterior communicating artery.\n2. Abrupt vascular cut off at the anterior division post bifurcation M1/M2\nmiddle cerebral artery consistent with embolism. Associated loss of\ngray-white matter differentiation within the right insular cortex and anterior\nright frontal cortex at the ganglionic and super ganglionic levels, consistent\nwith infarction. No associated hemorrhagic conversion. Asymmetrically\ndecreased collaterals in the affected parenchyma. Dense right MCA near\nbifurcation due to thrombus.\n3. Abrupt decrease in caliber at the right V3 segment vertebral artery which\nmay represent congenital variant ." + }, + { + "input": "Mild loss of gray-white matter differentiation in the right frontal lobe is\nunchanged. There is no evidence of hemorrhagic transformation. There is no\nmass effect. The ventricles and sulci are normal in size and configuration.\nA new right ICA stent is incompletely imaged. Other than mucous retention\ncyst within the left maxillary sinus, the visualized paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "Unchanged mild loss of gray-white matter differentiation in the right frontal\nlobe, without evidence of new hemorrhage." + }, + { + "input": "Linear, curve shaped area of increased attenuation in between bilateral\ninternal cerebral veins, curves behind splenium corpus callosum, it is along\nthe anterior margin of the vein ___ and probably external anterior to it,\nno extension into the inferior sagittal sinus. Findings are most likely\nextravascular, may represent calcified pericallosal lipoma. MR brain without\nand with gadolinium including MP rage images would be helpful to assess venous\nanatomy, to exclude small likelihood of intravenous thrombosis. Internal\ncerebral veins themselves, remainder of vein of ___, and straight sinus,\nother dural venous sinuses are normal.\n\nThere is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is opacification of a single left\nethmoid air cell. The visualized portion of the remainder of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Curvilinear abnormality about splenium corpus callosum, may represent\ncalcified pericallosal lipoma. MR brain with gadolinium, MP rage images\nrecommended to assess venous anatomy, to exclude small likelihood of venous\nthrombosis.\nNo fracture, or hemorrhage.\n\nNOTIFICATION: The findings were communicated with ED QA nurses by ___\n___, M.D. By e-mail ___ at 9:57 am, 5 minutes after discovery of\nthe findings." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, or mass effect. Prominent\nventricles and sulci likely reflect age related volume loss. Subcortical,\ndeep and periventricular white matter hypodensities are nonspecific though\nlikely sequela of chronic small vessel ischemic disease. More discrete\nhypodensity adjacent to the frontal horn of the right lateral ventricle\n(02:17) in the region of the right caudate nucleus appears to have been\npresent on prior study and consistent with lacunar infarct. Additional\nhypodensity within the region of the left lentiform nucleus (02:14) is\nnonspecific, potentially prior lacunar infarct or enlarged perivascular space.\nThere is no evidence of acute large territorial infarction. Basal cisterns\nare patent.\n\nMinimal mucosal thickening involves the ethmoidal air cells. Remaining imaged\nparanasal sinuses are essentially clear. Mastoid air cells and middle ear\ncavities bilaterally are clear. The orbits are unremarkable. The bony\ncalvarium appears intact.", + "output": "No acute intracranial abnormality on noncontrast head CT. Overall stable\nappearance of the brain with unchanged chronic right caudate nucleus lacunar\ninfarct." + }, + { + "input": "A right, frontal approach ventriculostomy catheter terminates within the right\nlateral ventricle, in the vicinity of the foramen of ___. Diffuse\nsubarachnoid hemorrhage is noted filling the cerebral sulci, bilaterally. \nAdditionally, there is extensive intraventricular hemorrhage with apparent\nintraparenchymal extension into the right frontal lobe (2a:11). Multifocal\ncerebral edema is most notable in the right frontal lobe adjacent to this\nhemorrhage.\n\nNOTE ADDED AT ATTENDING REVIEW: There is extensive hypodensity in the cortex\nand underlying white matter in the right frontal lobe and scattered areas of\ncortical hypodensity in the parasagittal left frontal lobe. These findings\nsuggest early infarction in the distribution of the anterior cerebral\narteries.\n\nThe ventricles and sulci are grossly normal in size and configuration. The\nbasal cisterns appear crowded, but grossly patent. There is no evidence of\nimpending downward herniation.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Extensive subarachnoid, intraventricular, and right frontal\nintraparenchymal hemorrhage, compatible with the given history of anterior\ncerebral aneurysm rupture.\n2. Status post right frontal approach ventriculostomy catheter placement.\n3. Mild associated cerebral edema, most notable within the right frontal\nlobe, with crowding of the basal cisterns but no evidence of impending\ndownward herniation.\n4. Findings suggesting early anterior cerebral artery distribution\ninfarction, greater on the right than left." + }, + { + "input": "There is been no significant interval change compared to the prior CT\nperformed earlier on the same date. Again noted are ill-defined white matter\nhypodensities in the bilateral ACA territories, suggestive of early\ninfarction. This has not significantly evolved compared to the prior study. \nDiffuse subarachnoid, intraparenchymal and intraventricular hemorrhage is\nlittle changed. No new hemorrhage. Ventriculostomy catheter terminates in\nthe frontal horn of the right lateral ventricle. Ventricles remain enlarged,\nbut not significantly changed. No shift of midline structures.\n\nThere is no evidence of fracture. There is mild mucosal thickening within the\nbilateral ethmoid air cells and sphenoid sinuses. Frontal and maxillary\nsinuses are clear. Mastoid air cells and middle ear cavities are clear. \nOrbits are unremarkable.", + "output": "1. Little change compared to prior study performed earlier on the same date.\n2. Stable subarachnoid, intraparenchymal and intraventricular hemorrhage. No\nnew hemorrhage.\n3. Stable ventriculomegaly.\n4. No significant evolution in findings suggestive of ACA territory\ninfarction." + }, + { + "input": "A right frontal approach ventriculostomy catheter terminates in the body of\nthe right lateral ventricle, as on prior. There is stable hypodensity along\nthe catheter tract. There has been expected interval evolution of diffuse\nsubarachnoid hemorrhage, as well as unchanged intraventricular hemorrhage,\nwith blood seen layering dependently in the temporal horns of the lateral\nventricles. There is no evidence of new interval hemorrhage. Mass-effect\nappears mildly increased, with more pronounced diffuse cerebral hemispheric\nsulcal effacement. Areas of hypodensity in the bilateral ACA territories are\npersistent, consistent with a evolving ACA territory infarcts. More apparent\non the current examination in comparison to priors as subtle hypodensity of\ndiffuse cortical gray matter areas, most pronounced in the right parietal\nregion (series 3, image 26); while this may be technical in nature, this\nappearance is concerning for early diffuse areas of cortical infarction in the\nsetting of cerebral edema.\n\nThe quadrigeminal plate and perimesencephalic cisterns are patent. There is no\nevidence of cerebellar tonsillar herniation. The suprasellar cistern is\nobscured by hardware artifact. The visualized paranasal sinuses and mastoid\nair cells are clear. The globes are intact and unremarkable.", + "output": "1. More pronounced is diffuse cerebral hemispheric sulcal effacement. In this\nsetting, subtle new areas of cortical gray matter hypodensity are concerning\nfor possible diffuse areas of evolving cortical infarction due to cerebral\nedema.\n2. Evolving bilateral ACA territory infarcts.\n3. Evolving subarachnoid and intraventricular hemorrhage. No new interval\nhemorrhage.\n4. Patent basal cisterns." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nBilateral ACA territorial infarctions continued to evolve. \nMulti-compartmental intracranial hemorrhage includes subarachnoid,\nintraparenchymal, and intraventricular spaces, and is not significantly\nchanged since the prior CT from approximately 12 hr ago. There is no shift of\nthe normally midline structures. Right frontal approach ventriculostomy\ncatheter is unchanged in position, terminating near the foramen of ___. \nVentricular size and configuration is stable since the prior study. Beam\nhardening artifact related to embolization coil pack in the anterior\ncommunicating artery.\n\nMucosal thickening is noted in the ethmoid air cells. Otherwise, the imaged\nparanasal sinuses, mastoid air cells, and middle ear cavities are grossly\nclear. The orbits are unremarkable.\n\nCTA HEAD:\nThere is essentially no opacification of intracranial arteries due to\nsuboptimal bolus timing, rendering the CTA portion of this examination\nnondiagnostic.", + "output": "1. Evolving bilateral ACA territorial infarctions, as described above.\n2. Multicompartmental intracranial hemorrhages are similar compared to prior\nCT from approximately 12 hr ago.\n3. ACA aneurysm coil pack and right frontal ventriculostomy catheter are\nunchanged.\n4. CTA portion of the examination is nondiagnostic secondary to suboptimal\nbolus timing.\n\nNOTIFICATION: The above findings and limitations of this study were\ncommunicated by Dr. ___ to Dr. ___ telephone on ___ at 06:00." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nA right frontal approach ventriculostomy catheter terminates in the frontal\nhorn of the right lateral ventricle. Hemorrhagic products and small locules\nof gas follow the ventriculostomy catheter tract (03:20, 17). The overall\nsize and configuration of the ventricles and sulci is unchanged. Continued\nevolution of bifrontal ACA territorial infarctions is again noted, with\nassociated right lobar hematoma. Layering blood products in the occipital\nhorns of the lateral ventricles is again noted bilaterally, without\nsubstantial change since the prior study. Likewise, the degree of\nsubarachnoid hemorrhage effacing the bifrontal sulci is not significantly\nchanged. The basal cisterns remain patent.\nStreak artifact related to aneurysm coil pack in the previously treated\nanterior communicating arterial aneurysm limits assessment of surrounding\nstructures, but appears grossly unchanged. The paranasal sinuses, mastoid air\ncells, and middle ear cavities are grossly clear.\n\n\nCTA HEAD:\nQuestion mild asymmetric diminution of the right supraclinoid ICA in\ncomparison to the left is noted. Evaluation of the bilateral A1 segments is\ndifficult due to aneurysm coil-associated hardware artifact. The bilateral A2\nsegments are symmetric; there is no appreciable interval change in comparison\nto angiographic images from ___, although inter-modality comparison\nlimits sensitivity for the detection of small changes. The bilateral PCAs are\npatent and unremarkable. The basilar tip is somewhat patulous, due to\nconjoined origin of the superior cerebellar and posterior cerebral arteries,\nunchanged. Major dural venous sinuses are patent.", + "output": "1. Streak artifact related to aneurysm coil pack in the recently treated ACA\nlimits assessment of surrounding structures.\n2. Question mild asymmetric diminution of supraclinoid right ICA, concerning\nfor possible vasospasm. Recommend clinical correlation.\n3. Stable subarachnoid and intraventricular hemorrhages.\n4. Stable ventricular size and configuration.\n5. Stable Right frontal approach ventriculostomy catheter." + }, + { + "input": "Evaluation is somewhat limited by streak artifact from coiling of an ACA\naneurysm. Again noted is diffuse subarachnoid hemorrhage. Intraventricular\nhemorrhage is also noted layering in the occipital horns of the bilateral\nlateral ventricles, similar or slightly decreased in extent. Right frontal\nlobar hemorrhage appears similar to prior exam.\n\nBilateral ACA territorial infarcts are again noted, and infarction of the\ncorpus callosum is also noted. There is also a hypodense appearance of the\nleft temporal lobe concerning for infarction.\n\nThere is a right frontal ventriculostomy catheter terminating in the frontal\nhorn of the right lateral ventricle, and the ventricles appear slightly\ndecreased in size. A small amount of hemorrhage and pneumocephalus are noted\nalong the ventriculostomy catheter tract. Diffuse cerebral edema is seen. \nThe visualized paranasal sinuses are grossly clear. The left mastoid air\ncavity and middle ear cavity are clear. An endotracheal tube is noted. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. Similar appearance of multicompartment intracranial hemorrhage including\nsubarachnoid hemorrhage, intraventricular hemorrhage and right lobar\nhemorrhage.\n2. Bilateral ACA territorial and corpus callosum infarcts.\n3. Hypodense appearance of the left temporal lobe concerning for possible\ninfarction.\n4. Stable position of a right frontal ventriculostomy catheter with slight\ndecrease in size of the ventricles." + }, + { + "input": "Evaluation is somewhat limited by streak artifact from ACA aneurysm coil. \nRight frontal approach ventriculostomy catheter terminates in the frontal horn\nof the right lateral ventricle. There remains a small amount of hemorrhage\nalong the catheter tract. Ventricular size and configuration is unchanged. \nAgain seen, is diffuse subarachnoid hemorrhage and intraventricular hemorrhage\nlayering in the occipital horns of the bilateral lateral ventricles. Right\nfrontal lobar hemorrhage not significantly changed. Bilateral anterior\ncommunicating artery territorial infarcts are also again seen and not\nsignificantly changed. Hypodensity in the left temporal lobe described\npreviously not well appreciated on the current study. No new hemorrhage is\nidentified. There is diffuse cerebral edema. There is no acute fracture. \nThere is fluid within the left maxillary and sphenoid sinuses. There is\nmucosal thickening of the ethmoid air cells and frontal sinuses. The mastoid\nair cells are clear. The orbits are unremarkable.", + "output": "1. Similar appearance of multicompartmental intracranial hemorrhage including\nsubarachnoid, intraventricular, and right lobar hemorrhage.\n2. Bilateral anterior communicating artery territorial infarctions.\n3. Stable appearance of right frontal approach ventriculostomy catheter. \nUnchanged ventricular size." + }, + { + "input": "The right frontal ventriculostomy catheter is in similar position, terminating\nnear the foramen ___ of the right lateral ventricle. The ventricles\nappear slightly decreased in size from the earlier exam at 05:44. Small\namount of hemorrhage is noted along the catheter tract.\n\nThe patient is status post ACA aneurysm coiling with streak artifact limiting\nevaluation. Extensive multi-compartment intracranial hemorrhage is again\nnoted including intraventricular hemorrhage, subarachnoid hemorrhage and right\nfrontal lobar hemorrhage. Hypodense appearance of the bilateral parafalcine\nfrontal lobes reflect infarcts, similar to prior exam. No new large infarct\nor hemorrhage is seen.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. Similar position of a right frontal ventriculostomy catheter with slight\ninterval decrease in ventricle size.\n2. Similar appearance of extensive multicompartment intracranial hemorrhage\nand bilateral ACA infarcts." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nExtensive multi-compartment hemorrhage including intraventricular, right lobar\nand subarachnoid hemorrhage is noted. The right frontal ventriculostomy\ncatheter is in stable position, and the ventricles appear similar in size. \nEvolution of bilateral ACA vascular territorial infarctions is noted. Mild\nparanasal sinus disease of the ethmoid air cells and sphenoid sinus is seen. \nThe visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe patient is status post aneurysm coiling, and streak artifact from the coil\nmaterial limits evaluation. There is improvement in luminal narrowing of the\nbasilar artery and right middle cerebral artery reflective improvement in\nvasospasm. No vascular occlusion is seen, and evaluation of the aneurysm is\nlimited.", + "output": "1. Similar extensive multi-compartment hemorrhage including intraventricular,\nright lobar and subarachnoid hemorrhage.\n2. Interval evolution of the bilateral ACA vascular territorial infarctions.\n3. Improvement in vasospasm following pharmacological treatment." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is hyperdense caudal packing at the anterior communicating artery\nconsistent with treated aneurysm. There is associated marked streak artifact\nwhich obscures adjacent structures. There is right orbital frontal hyperdense\nedema and a small amount of parenchymal hemorrhage. There is sulcal\neffacement of the right frontal cortex consistent mass effect without\nsignificant midline shift or downward herniation.\n\nThere is geographic hypodensity with loss of gray-white matter differentiation\nwithin the bilateral parasagittal frontal cortices corresponding to the\nanterior cerebral artery territories, consistent with infarction. There is\nsulcal hyperdensity within the left frontal on and right insular cortices\nconsistent with subarachnoid hemorrhage, which is unchanged. There is a right\nfrontal approach ventriculostomy catheter with tip terminating at the right\nforamen of ___. There is a hypodense edema and a small amount of hyperdense\nblood along the ventriculostomy catheter course. There is a small amount of\nblood layering within the right occipital horn lateral ventricle.\n\nThere is a right frontal burr hole. The orbits are unremarkable. There is an\nendotracheal and oral enteric tube in place. There is fluid layering within\nthe nasopharynx. There is partial fluid opacification the ethmoid sinuses\nmastoid air cells.\n\nCTA HEAD:\nThe visualized cervical internal carotid arteries are patent. There is\natherosclerosis the bilateral carotid siphons. The right A1 segment internal\ncarotid artery is hypoplastic. There is dense sequela packing the anterior\ncommunicating artery consistent with treated aneurysm which causes marked\nstreak artifact obscuring adjacent structures. Within the limitations of the\nstreak artifact there is no visualized luminal filling of the aneurysm. The\nbilateral anterior communicating arteries distal sequela packing, and middle\ncerebral arteries are patent without significant stenosis. The posterior\ncommunicating arteries are not visualized. The vertebral arteries are\ncodominant. The posterior circulation is patent.\n\nDural venous sinuses are patent.", + "output": "1. Coiled anterior communicating artery aneurysm causing streak artifact\nobscuring adjacent structures.\n2. Grossly patent intracranial vasculature with caliber similar to prior study\nfrom ___ and improved in comparison to ___, with no\ndefinite evidence of vasospasm.\n3. Evolving bilateral anterior communicating artery territory infarctions\nwithout hemorrhagic conversion.\n4. Within limits of study, no definite filling of anterior communicating\nartery aneurysm.\n5. Stable subarachnoid, intraventricular, and right frontal parenchyma\nhemorrhages\n6. Right frontal approach ventriculostomy catheter with edema and hemorrhage\nalong the catheter course.\n7. Interval decreased amount of intraventricular blood products without\nsignificant ventricular dilatation." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction, mass or midline\nshift. There is no hydrocephalus. Prominent ventricles and sulci are\nsuggestive of age-related involutional change. The basal cisterns are patent\nand there is preservation of gray-white matter differentiation. Dense\natherosclerotic calcifications are noted in the vertebral arteries and carotid\nsiphons. Visualized paranasal sinuses and mastoid air cells are clear. There\nis no fracture.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. The basal cisterns appear\npatent and there is preservation of gray-white matter differentiation.\n\nNo osseous abnormalities seen. There is mucosal thickening in the left\nmaxillary sinus. The remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration. The basal cisterns are patent\nand there is preservation of gray-white matter differentiation.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, mass, or mass\neffect. The basal cisterns are patent, and there is no shift of normally\nmidline structures. Hypodensities involving the right external capsule and\nthe anterior limb of the left internal capsule may represent sequelae of\nprior/old lacunar infarcts. Mild prominence of the ventricles and sulci is\ncompatible with age related involutional change. Periventricular white matter\nhypodensity is compatible with the sequelae of chronic small vessel ischemia.\n\nMultiple facial fractures are seen. In particular, there is a comminuted\nfracture of the nasal bone anteriorly, (series 3, image 4), as well as a more\nposterior displaced/angulated fracture of the nasal septum (series 3, image\n1). Although not clearly seen on this exam, there may be of fractures through\nthe inferomedial wall of the right orbit (series 3, image 9) simple this is\nbetter evaluated on same-day CT facial bones. Hyperdense fluid and small foci\nof air fills the right maxillary sinus, compatible with acute blood products. \nA smaller amount of layering hyperdense material is seen in the left maxillary\nsinus as well as filling the paranasal sinuses and partially opacifying the\nfrontal sinuses and ethmoid air cells. There is partial left mastoid air cell\nopacification, but no fracture is seen. The right mastoid air cells are\nclear. There is no evidence of calvarial fracture. Bilateral carotid siphon\ncalcifications are noted. The globes appear intact.", + "output": "1. No evidence of intracranial hemorrhage or acute infarction.\n2. Multiple facial bone fractures, at least including the nasal bone, the\nnasal septum, and likely the inferomedial wall of the right bony orbit/lamina\npapyracea. These are better evaluated on same-day CT facial bones.\n3. Chronic findings including white matter small vessel ischemic changes and\nvolume loss." + }, + { + "input": "There is no hemorrhage, infarction, edema, mass, or mass effect. Mild\nprominence of the ventricles and sulci is compatible with age appropriate\nglobal atrophy. There is no shift of midline structures. Periventricular and\nsubcortical white matter hypodensity is mild and nonspecific, however may\nrepresent sequelae of chronic small vessel ischemic change.\n\nThere is mild right maxillary sinus and ethmoid air cell mucosal thickening. \nThe mastoid air cells are clear. The globes and bony orbits are intact and\nunremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no acute hemorrhage, edema, or mass effect. Prominent ventricles and\nsulci likely reflect global atrophy. There is no shift of normally midline\nstructures. Basal cisterns are patent. Periventricular and white matter\nhypodensities are nonspecific though likely sequela of chronic small vessel\nischemic disease. Orbits are unremarkable. Visualized paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. Carotid siphon vascular\ncalcifications are moderate. Nasal bone fracture is better characterized on\nsame day dedicated CT sinus examination. Several small lucent bone lesions\nare compatible with known myeloma.", + "output": "No acute intracranial abnormality. Global atrophy and sequela of chronic\nsmall vessel ischemic disease." + }, + { + "input": "There is no evidence of acute large territorial infarction, intracranial\nhemorrhage, edema, or mass.\n\nThere is prominence of the ventricles and sulci suggestive of age-related\ncerebral volume loss. Periventricular and subcortical white matter\nhypodensities are nonspecific, though likely sequelae of chronic small vessel\nischemic disease. Atherosclerotic vascular calcifications are noted of\nbilateral vertebral and cavernous portions of internal carotid arteries.\n\nThere is evidence of a right occipital craniotomy. Otherwise, no acute\nosseous abnormalities seen. The partially imaged paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The orbits demonstrate no acute\nabnormalities.", + "output": "No acute intracranial process. No evidence of acute intracranial hemorrhage\nor fracture." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is a hypodensity in the region of the left basal ganglia and anterior\nlimb internal capsule measuring approximately 12 x 24 mm (series 2, image 19),\nconsistent with a late acute infarct seen on subsequent MRI. Subtle\nhypodensities in the left parietal temporal region also present acute\ninfarcts, the entire extent of which is better appreciated on the subsequent\nMRI. There is no hemorrhage. There is no mass effect or shift of normally\nmidline structures. The ventricles and sulci are age-appropriate.\n\nThere is no fracture. The paranasal sinuses, mastoid air cells, middle ear\ncavities are clear. The orbits are unremarkable.\n\nCTA HEAD:\nThere is tapering with moderate short segment narrowing of the mid M1 segment\nof the left middle cerebral artery with preserved flow more distally (series\n3, image 235). Vessels of the circle of ___ and their principal\nintracranial branches otherwise appear normal without stenosis, occlusion, or\naneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria. There is mild calcified atherosclerotic plaque\nat the left carotid bifurcation.\n\nOTHER:\nPartially imaged upper lungs is notable for a 4 mm solid pulmonary nodule\nalong the periphery of the left upper lobe (series 3, image 31). There is no\nconsolidation . There are 2 hypodense nodules in the thyroid gland measuring\nup to 4 mm, for which according to current ___ College of Radiology\nguidelines, no follow-up is indicated. There are a multiple prominent\nsymmetric cervical and mediastinal lymph nodes, none meeting criteria for\npathologic enlargement, but potentially reactive.", + "output": "1. Acute left MCA territory infarcts with the largest focus involving the left\nbasal ganglia as described above are better appreciated on the subsequent MRI.\nNo hemorrhage.\n2. Tapering and moderate short segment narrowing of the mid M1 segment of the\nleft middle cerebral artery with preserved flow more distally. The circle of\n___ is otherwise unremarkable.\n3. Unremarkable neck CTA aside from mild atherosclerotic plaque at the right\ncarotid bifurcation. No internal carotid artery stenosis by NASCET criteria.\n4. 4 mm pulmonary nodule along the periphery of the left upper lobe.\n\nRECOMMENDATION(S):\nFor incidentally detected single solid pulmonary nodule smaller than 6 mm, no\nCT follow-up is recommended in a low-risk patient, and an optional CT in 12\nmonths is recommend in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute hemorrhage, edema, mass effect, or acute major\nvascular territorial infarction. Ventricles, sulci, and basal cisterns are\nnormal in size. There is 1 mm ectopia of the right cerebellar tonsil, images\n2:2 and 602b:29.\n\nThere is mild mucosal thickening along the floors of the bilateral maxillary\nsinuses with a mucous retention cyst on the right, and mild mucosal thickening\nin the anterior ethmoid air cells. There are periapical lucencies ___ 2\nand 3. The orbits appear unremarkable.\n\nCTA NECK:\nThere are mild atherosclerotic calcifications along a 3 vessel aortic arch. \nThere are trace atherosclerotic calcifications at the bilateral carotid\nbifurcations without stenosis by NASCET criteria. Vertebral arteries appear\nwidely patent. The left vertebral artery is dominant.\n\nCTA HEAD:\nThere is no evidence for flow-limiting arterial stenosis or aneurysm. Right\n___ is low-lying and appears extradural, a normal variant. There is a\nsmall infundibulum at the right ___. There is a small fenestration of\nthe right aspect of the anterior communicating artery, image 459:21. The\ndural venous sinuses are patent.\n\nOTHER:\nThere is mild dependent atelectasis in the included left upper lung. There is\na paramediastinal paraseptal bulla in the left upper lung at the mediastinal\nthe thyroid gland is grossly unremarkable. Insertion of the left major\nfissure, image 3:11. Numerous small calcifications are noted throughout the\nbilateral parotid glands, with bilateral partial fatty replacement of the\nparotid glands. There are degenerative changes in the cervical spine.", + "output": "1. No evidence for an acute intracranial abnormality.\n2. Minimal atherosclerosis of bilateral common carotid bifurcations without\nstenosis by NASCET criteria.\n3. No evidence for flow-limiting stenosis or aneurysm in the major\nintracranial arteries.\n4. Small fenestration of the right aspect of the anterior communicating\nartery.\n5. Numerous small bilateral parotid calcifications, which may be seen in the\nsetting of chronic parotitis or Sjogren syndrome.\n6. Periapical lucencies ___ 2 and 3 with inflammatory changes along the\nfloors of right greater than left maxillary sinuses. Please correlate\nclinically whether active dental inflammation may be present.\n\nRECOMMENDATION(S): MRI would be more sensitive for posterior fossa pathology,\nif clinically warranted." + }, + { + "input": "The patient is status post remote left ethmoidectomy, middle and inferior\nturbinectomy and left maxillary antrostomy. Metallic focus along left medial\norbital wall is stable. There is stable hyperostosis of the residual left\nmaxillary sinus walls, sphenoid sinus, ___ and left\nmaxillary sinus walls. There is moderate mucosal thickening of the left\nsphenoid sinus with mild aerosolized debris, improved from examination of ___. Similar mild mucosal thickening of the inferior left frontal\nsinus, frontal ethmoidal recess and residual left anterior ethmoid air cells\nis also mildly improved from prior exam. Mild mucosal thickening with\ndependent aerosolized debris of the left maxillary sinus is noted. Interval\nresolution of previously described left dacrocystitis.\n\nThe right maxillary, sphenoid, frontal sinuses as well as ethmoid air cells\nand frontal ethmoidal recess are clear. The infundibulum of the right\nostiomeatal unit is widely patent and clear. There is mild rightward\ndeviation of the nasal septum with a small rightward projecting spur. There\nis no nasal septal perforation. The sphenoid sinus septum inserts on the\nright carotid canal. The anterior clinoid processes are not pneumatized. The\ncribriform plates and right lamina papyracea are intact.\n\nThe mastoid air cells and middle ear cavities are well pneumatized and clear. \nVisualized brain and aerodigestive tract are unremarkable. Multiple\nperiapical lucencies of the visualize remaining maxillary teeth are unchanged\nfrom prior exam.", + "output": "1. Interval resolution of previously described left dacrocystitis.\n2. Interval improvement in degree of left sphenoid sinus, left frontal sinus\nand left anterior ethmoid air cell mucosal thickening.\n3. Unchanged postoperative findings as described above.\n4. The right sided paranasal sinuses are clear." + }, + { + "input": "The patient is status post left ethmoidectomy, middle and inferior\nturbinectomies, and maxillary antrostomy, with the expected postsurgical\nchanges. Metallic material along the left orbital wall is unchanged. There\nis again mild mucosal thickening of the remaining left maxillary sinus, as\nwell as the left sphenoid and frontal sinuses. This is decreased compared to\n___. The right ostiomeatal unit is patent.. The cribriform plates\nare intact. There is no nasal septal defect. There is mild rightward curvature\nof the nasal septum, with a right-sided spur in the midportion. The anterior\nclinoid processes are not pneumatized. The right lamina papyracea is intact.\nThe sphenoid sinus septum is not midline with insertion upon the right carotid\ncanal. The right sphenoid sinus is again noted to be hypoplastic compared to\nthe left.\n\nUnchanged periapical lucencies of the remaining maxillary teeth. The\nvisualized mastoid air cells middle ear cavity is well pneumatized and clear. \nVisualized brain is unremarkable allowing for technique.", + "output": "1. Unchanged postsurgical appearance of the left maxillary sinus.\n2. Mild mucosal thickening of the remaining left maxillary sinus and left\nsphenoid and frontal sinuses, slightly improved from prior exam." + }, + { + "input": "There are postsurgical changes left turbinectomies, ethmoidectomies, and\nuncinectomies. There is unchanged demineralization versus osseous dehiscence\nat the inferior medial left orbit, at the posterior lateral and anterior\nmedial maxillary walls, and at the left hard palate. There is circumferential\nsoft tissue thickening marginating the left maxillary neo ostium and inferior\nleft maxillary antrum, which are relatively unchanged. There is mild mucosal\nthickening within the left frontal sinus. There is opacification of residual\nanterior left ethmoid air cells and the frontal ethmoid drainage, which is\nincreased in comparison to prior study.\n\nThere is osseous thickening and chronic medial bowing of the left lamina\npapyracea. There are metallic foci within the superior medial left extraconal\norbit (03:27). There is moderate mucosal thickening within the left sphenoid\nsinus with a patent sphenoid ethmoidal recess. The right frontal, maxillary,\nethmoid, and sphenoid sinuses are relatively clear. There is osseous\nnarrowing of the right maxillary infundibulum.\n\nThe fovea ethmoidalis, cribriform plates, and right lamina papyracea are\nintact. The nasal septum is intact with right deviation and a right osseous\nspur which contacts the right middle terminate (601:63). There is a\nperiapical lucency involving the root at the left maxillary molar (601:63),\nwhich is unchanged. There is unchanged periapical lucency at the left\nmaxillary canine (601:36).\n\nThe intracranial structures are unremarkable. The mastoid air cells and\nmiddle ears are clear. The soft tissues are unremarkable.", + "output": "1. Postsurgical and post treatment changes of the left paranasal sinuses and\nnasal cavity, as described.\n2. Unchanged circumferential soft tissue at the left maxillary neo ostium and\ninferior maxillary antrum which may represent residual disease or\nposttreatment change. No new sites of disease.\n3. Unchanged demineralization versus osseous dehiscence at the inferior medial\nleft orbit, posterior-lateral and anterior medial left maxillary wall, and\nleft hard palate.\n4. Increased opacification of the left frontoethmoidal drainage pathway and\nresidual anterior left ethmoid air cells as compared to prior study. Mucosal\nthickening within the left maxillary and left sphenoid sinuses are relatively\nunchanged.\n5. Unchanged periapical lucency of the left maxillary canine.\n6. Unchanged periapical lucency at the left maxillary molar involves the tooth\nroot and likely communicates with the maxillary antrum." + }, + { + "input": "There is no evidence of acute large territory infarction,hemorrhage,edema,or\ndiscrete mass. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is opacification of a single right\nethmoid air cell. The remainder of the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intra-axial hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Partially imaged right periorbital\nsoft tissue swelling is not well evaluated on this study.", + "output": "1. No acute intracranial abnormality." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction.\n\nThere is a large right sided subgaleal hematoma extending from the right\nfrontal region into the right periorbital region. There is a right-sided\nsuperior retrobulbar extraconal hematoma with internal foci of air (2:13).\nPlease see dedicated maxillofacial CT for additional details including\nmultiple facial fractures.", + "output": "1. No intracranial hemorrhage.\n2. Large right-sided subgaleal hematoma extending from the right frontal\nregion to the right periorbital region.\n3. Multiple facial fractures, fully outlined on concurrent maxillofacial CT." + }, + { + "input": "There is no evidence of large territorial infarction, intracranial\nhemorrhage,edema,or mass. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. Bilateral periventricular and subcortical\nhypodensities are nonspecific but most likely represent sequela chronic small\nvessel ischemic changes. Atherosclerotic calcifications are seen in the\nbilateral carotid siphons.\n\nThere is no evidence of fracture. There is near complete opacification of the\nleft sphenoid sinus. There is mild mucosal thickening of the ethmoid air\ncells. Otherwise, the remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. Status post left lens replacement. Otherwise,\nthe visualized portion of the orbits are unremarkable.", + "output": "1. There is no evidence of acute intracranial process or hemorrhage.\n\n2. Opacification of the sphenoid sinus on the left as described above." + }, + { + "input": "CTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. Right fetal\nPCA is noted. The dural venous sinuses are patent.\n\nCTA NECK:\nAberrant right subclavian artery arises after the left subclavian artery and\ncourses posterior to the esophagus. Punctate calcification is noted at the\norigin of the left V1 segment (02:50). Vertebral artery is dominant. The\ncarotid and vertebral arteries and their major branches appear otherwise\nnormal with no evidence of stenosis or occlusion. There is no evidence of\ninternal carotid stenosis by NASCET criteria.\n\nOTHER:\n Near complete opacification of the left sphenoid sinus is noted. Pharyngeal\ntonsilliths bilaterally are incidentally noted. The partially visualized\nesophagus is patulous filled with air and fluid (02:38) just below the level\nof the aberrant right subclavian artery. A calcified granuloma is noted in\nthe right upper lobe. The visualized portion of the lungs are otherwise\nclear. The visualized portion of the thyroid gland is within normal limits.\nThere is no lymphadenopathy by CT size criteria.", + "output": "Patent intracranial and cervical vasculature without aneurysm, dissection,\nstenosis or occlusion." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. There are scattered hypodensities within the\nperiventricular and subcortical white matter, nonspecific, but likely the\nsequela of chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. There is partial opacification of the left\nsphenoid sinus and minimal mucosal thickening of the bilateral ethmoid\nsinuses. The visualized portion of the other paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. Orbits are unremarkable with\nexception of a prior left lens replacement.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of fracture, acute large territory infarction,\nintracranialhemorrhage,edema,or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. Periventricular and subcortical\nwhite matter hypodensities are nonspecific but compatible with chronic small\nvessel ischemia.\n\nThere is partial opacification of the left sphenoid sinus with slightly\nthickened and sclerotic sinus wall suggesting chronic sinusitis. The\nvisualized portion of the remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. Patient is status post left lens replacement.", + "output": "1. No acute intracranial abnormality.\n2. Involutional and chronic small vessel disease changes." + }, + { + "input": "Punctate, 1 mm density in medial left basal ganglia at midline (02:12, 602:42\n601b:48) measures between 70 and 80 ___. There is no evidence of acute\nterritorial infarction, edema, or large mass. The ventricles and sulci are\nnormal in size and configuration. Atherosclerotic vascular calcifications are\nnoted of bilateral cavernous portions of internal carotid arteries.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. Punctate medial left basal ganglia punctate hyperdensity. While finding\nmay represent a punctate parenchymal calcification or volume averaging of\ncalcified choroid within adjacent third ventricle, differential consideration\nof punctate hemorrhage is not excluded on the basis of this examination. \nRecommend clinical correlation. If available, consider comparison with prior\nimaging. If clinically indicated, consider short-term follow-up imaging\nfurther evaluation.\n2. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct.\n\nRECOMMENDATION(S): Recommend clinical correlation. If available, consider\ncomparison with prior imaging. If clinically indicated, consider short-term\nfollow-up imaging further evaluation.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 2:25 AM." + }, + { + "input": "Linear hypodensity in the right cerebellum (02:10) is new from the prior study\nof ___ and likely represent age indeterminate stroke, possibly subacute to\nchronic. There is no evidence of hemorrhage,edema,or mass. Punctate midline\nhyperdensity in the region of the foramina ___ is nonspecific but\nunchanged. No evidence of obstructing hydrocephalus. The ventricles and\nsulci are normal in size and configuration. Calcifications are again seen in\nthe cavernous portions of the bilateral internal carotid arteries.\n\nBilateral hyperostosis frontalis interna is again seen. There is no evidence\nof fracture. The visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. New right cerebellar hypodensity likely represents age-indeterminate\nstroke, possibly subacute to chronic. MR is recommended for further\nevaluation.\n2. No acute intracranial hemorrhage.\n\nNOTIFICATION: Updated findings discussed with ___, MD by ___\n___, MD via telephone at 20:08 on ___, 2 minutes after discovery of the\nfindings." + }, + { + "input": "Head CT: There is loss of normal gray-white matter differentiation in the\nleft occipital lobe compatible with acute infarction. There is no evidence of\nhemorrhage. There is evidence of prior infarction in the inferior left frontal\nlobe with associated ex vacuo dilatation of the left lateral ventricle. The\nventricles and sulci are otherwise normal in caliber and configuration for\npatient age. There is no extra-axial fluid collection. No fractures are\nidentified. The paranasal sinuses and mastoid air cells are clear.\n\nHead CTA: There is decreased vascularity in the left occipital lobe compared\nto the right. Additionally, there is a segment of significant stenosis of the\njunction of the left petrous portion of the internal carotid artery with the\nleft cavernous segment (series 5 images 247- 250 and series ___, image 12).\nThe right internal carotid artery, middle cerebral arteries, anterior cerebral\narteries, basilar artery, and vertebral arteries are unremarkable. There is no\naneurysm.\n\nNeck CTA: There is normal three-vessel takeoff from the aortic arch. There is\ncalcification of the carotid bifurcations bilaterally without evidence of\ninternal carotid stenosis by NASCET criteria. There is arthrosclerotic\nirregularity of the cervical left vertebral artery. The right vertebral\nartery is unremarkable. The distal left internal carotid artery measures 3.4\nmm and the distal right measures 3.7 mm.\n\nThe soft tissues of the neck are unremarkable. The lung apices are clear.\nThere are mild degenerative changes in the spine.", + "output": "1. Loss of gray-white matter differentiation in the left occipital lobe\ncompatible with acute infarct. No evidence of hemorrhagic transformation.\n\n2. Chronic left frontal lobe infarction.\n\n2. Decreased vascularity in the left occipital lobe compared to the right.\n\n3. Short segment of severe stenosis of the left internal carotid artery at the\njunction of the petrous and cavernous portion" + }, + { + "input": "There is no acute hemorrhage, edema, or mass effect. Mildly prominent\nventricles may reflect age related volume loss. Gray-white matter\ndifferentiation is preserved. Basal cisterns are patent.\n\nThe orbits are unremarkable. Imaged paranasal sinuses, bilateral mastoid air\ncells, and middle ear cavities are clear. Carotid siphon arterial\natherosclerotic calcifications are moderate. Bony calvarium appears intact.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is re-demonstration of the subdural hematoma over the left frontal\nconvexity measuring 7 mm in greatest thickness as well as over the left\ntentorium. There is also left parafalcine subdural blood. There is mass\neffect with effacement of the right frontal lobe sulci as well as the left\nlateral ventricle.. There is minimal leftward midline shift measuring 4 mm,\nsimilar to prior. Trace subarachnoid blood is seen in bilateral frontal\nconvexities, similar to prior. The size and configuration of bilateral\nventricles and sulci are unchanged.\n\nNo new foci of hemorrhage, and no large vascular territory infarction.\n\nThere is a small left occipital scalp hematoma with soft tissue gas and skin\nstaples. There is no evidence of fracture. There is a right concha bullosa. \nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Re-demonstration of left frontal , left tentorial and left parafalcine\nsubdural hematoma, similar to prior. Local mass effect and minimal leftward\nmidline shift measuring 4 mm is also similar to prior.\n2. Trace subarachnoid blood is seen in bilateral frontal convexities, similar\nto prior." + }, + { + "input": "3 mm punctate hyperdense focus in the left frontal lobe could reflect a tiny\nfocus of intraparenchymal or subarachnoid hemorrhage (601:16). There is no\nevidence of acute large territorial infarction,edema or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nExtensive periventricular and subcortical white matter hypodensity is\nnonspecific, but likely reflect sequelae of chronic small vessel ischemic\ndisease. This is particularly prominent in the left frontal subcortical white\nmatter, possibly suggestive of a prior infarct. Vascular calcifications of\nthe cavernous internal carotid arteries are noted.\n\nThere is a deep laceration overlying the right frontal bone and extending\nposteriorly along the parietal bone, which appears to extend to the calvarium\n(03:56). Subcutaneous gas and subgaleal hematoma overlies the right frontal\nand parietal bone (for example 601:33). There is no evidence of fracture. \nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. 3 mm hyperdense focus in the left frontal lobe may be calcification, but a\npunctate intraparenchymal hemorrhage, less likely subarachnoid hemorrhage\ncannot be excluded.\n2. Deep laceration overlying the right frontal bone and extending posteriorly\nalong the parietal bone, portions of this appear to extend to the surface of\nthe calvarium. There is also subgaleal hematoma overlying the right parietal\nbone. No fracture is identified.\n\nNOTIFICATION: Update was discussed with ___, M.D. by ___, M.D.\non the telephone on ___ at 8:57 pm, 2 minutes after discovery of the\nfindings." + }, + { + "input": "There is no acute hemorrhage, edema or shift of the normally midline\nstructures. Chronic appearing infarctions are again seen in the left\nhemispheric deep white matter and left basal ganglia. There has been expected\nevolution of the left frontal lobe infarction. There is no evidence for new,\nacute infarction. The ventricles and sulci are of normal size and\nconfiguration for age. The basal ganglia are patent.\n\nMucous retention cysts are seen within the right maxillary sinus. Otherwise,\nthe included paranasal sinuses are well-aerated. The mastoid air cells are\nunder-pneumatized. The lenses and globes are unremarkable. There is no\nfracture.", + "output": "No acute intracranial process." + }, + { + "input": "There is a new area of cortical hypodensity in the right parieto-occipital\nregion, with loss of gray-white matter differentiation, consistent with an\nacute infarct. No acute hemorrhage is seen. Hypodensity is again noted in the\nleft parietal lobe, consistent with prior infarct. Hypodensities likely\nrepresenting lacunar infarcts are noted adjacent to the frontal horn of the\nright lateral ventricle on the frontal horn of the left lateral ventricle.\nMildly prominent ventricles and sulci suggest age related involutional\nchanges. Periventricular white matter hypodensities are consistent with small\nvessel ischemic disease. The basal cisterns appear patent and there is\npreservation of gray-white matter differentiation.\n\nNo fracture is identified. The visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The globes are unremarkable.", + "output": "Acute infarct in the right parieto-occipital region without acute hemorrhage. \nOld left parietal infarct.\n\nNOTIFICATION: The findings were communicated to Dr. ___ at 9:06 p.m. on\n___ by phone." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nSmall amount of soft tissue swelling overlies the right supraorbital region. \nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Minimal soft tissue swelling overlying the right supraorbital region. No\nacute fracture.\n2. No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nencephalomalacia in the left frontal lobe involving the straight and orbital\ngyrus. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. There are periventricular and subcortical hypodensities,\nwhich may represent small vessel ischemic changes.\n\nThere is no evidence of acute fracture. An old frontal skull fracture is\nre-demonstrated. The visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. No evidence of acute intracranial process or hemorrhage.\n\n2. Sequela of prior hemorrhagic contusion causing encephalomalacia in the\nleft frontal lobe, involving the straight and left orbital gyrus." + }, + { + "input": "There is no evidence of acute fracture, acute large territorial\ninfarction,hemorrhage,edema,or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. Unchanged area of\nencephalomalacia is seen in the left frontal lobe. Periventricular and\nsubcortical white matter hypodensities are nonspecific, but likely reflect the\nsequela of chronic microvascular infarction.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No acute intracranial abnormality.\n2. Redemonstration of left frontal lobe encephalomalacia compatible with\nsequela of prior hemorrhagic contusion." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or infarction.\n\nThe ventricles and sulci are enlarged consistent with age related atrophy.\nPeriventricular white matter hypodensities are suggestive of chronic small\nvessel ischemic disease.\n\nThe basal cisterns appear patent and there is preservation of gray-white\nmatter differentiation.\n\nAgain seen is a 1.5 x 1.0 cm dural-based meningioma at the vertex, previously\ncharacterized on MR, and is unchanged in appearance. There is no evidence of\nfracture.\n\nThere is very minimal mucosal thickening of the ethmoid air cells. The\nremainder of the paranasal sinuses are clear. The mastoid air cells are\nwell-aerated.\n\nThe globes are intact.", + "output": "No evidence of acute intracranial process." + }, + { + "input": "The bilateral parafalcine subdural hematomas are minimally changed since\n___, with maximum thickness measuring 5 mm. There is no evidence of new\nintracranial hemorrhage or infarction. The ventricles and sulci are normal in\nsize and configuration. The basal cisterns appear patent and there is\npreservation of gray-white matter differentiation.\n\nNo fracture is identified. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear.\nThe globes are unremarkable.", + "output": "Thin bilateral parafalcine subdural hemorrhage, stable since ___. No\nnew intracranial hemorrhage." + }, + { + "input": "The previously seen subdural hematoma along the falx has resolved. No new\nhemorrhage is seen. There is no mass shift or hydrocephalus.\n\nThe visualized paranasal sinuses are clear. No skull fracture is seen.", + "output": "Resolution of previously seen subdural hematoma along the falx. No acute\nhemorrhage identified." + }, + { + "input": "There is a mixed density right frontotemporal convexity subdural hematoma with\nhyperdense components anteriorly and intermediate to slightly hyperdense\ncomponents posteriorly. Compared to the outside hospital head CT, the overall\namount of blood has decreased, likely secondary to redistribution, measuring\nup to 13 mm wide, previously 19 mm wide. There is mass effect upon the\nadjacent right frontal lobe, and shift of midline structures by 3 mm, not\nsignificantly changed from the outside hospital head CT. As seen previously,\nsmall amount of blood layers along the right tentorium and right falx. There\nis no evidence of acute infarct or hydrocephalus. Basal cisterns are patent. \nMinimal periventricular white matter hypodensities likely reflect the sequela\nof chronic microvascular infarction.\n\nThere is no fracture. Paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The orbits remarkable for lens replacement bilaterally. \nExtensive atherosclerotic calcifications are noted involving the cavernous\ncarotid and distal left vertebral artery is.", + "output": "Compared to the outside hospital head CT from earlier today, mixed density\nright frontotemporal convexity subdural hematoma appears slightly smaller with\noverall redistribution of blood products. No evidence of new hemorrhage or\nacute infarct. Unchanged 3 mm of leftward shift of normally midline\nstructures." + }, + { + "input": "This examination is markedly limited due to patient motion. Within these\nconfines:\nA mixed density right fronto temporal convexity subdural hematoma with\nhyperdense components anteriorly is grossly unchanged to slightly increased in\nsize from the prior examination, although hematoma layering along the falx and\ntentorium is more prominent.\n\nThere is new hypodensity of the right precentral gyrus (series 3, image 32),\nnot seen on prior examination, which may represent sequela acute infarct\nversus seizure activity. There also appears to be minimally increased sulcal\neffacement of the right frontal and parietal convexity from examination ___.\n\nMass effect upon the right lateral ventricle is largely stable. 3 mm of\nleftward shift of normally midline structures is stable. There is no evidence\nof large territorial infarction. No additional foci of hemorrhage are\nidentified. The basal cisterns appear patent.\n\n\nThere is no evidence of fracture. The mastoid air cells are not well\nevaluated. The paranasal sinuses are clear. The visualized portion of the\norbits are unremarkable, noting bilateral lens replacements.", + "output": "1. Markedly limited exam due to patient motion. Given that, the mixed density\nright fronto temporal convexity subdural hematoma is similar to minimally\nincreased in size from the prior examination on ___. 3 mm of\nleftward shift of normally midline structures is stable. There does appear to\nbe minimally increased is right frontal and parietal convexity sulcal\neffacement.\n2. Not seen on prior examination of ___ is hypodensity of the\nposterior right frontal lobe, which may represent sequela of acute infarct\nversus seizure activity. Further evaluation with MRI, if there no\ncontraindications is recommended.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ on the telephoneon ___ at 8:42 AM, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "There is an mixed density right cerebral subdural hematoma measuring up to 8\nmm in maximal thickness and causing right cerebral sulcal effacement and\nminimal shift of midline structures to the left, approximately 4 mm. The\nmajority of this right cerebral subdural hematoma contains intermediate\ndensity material likely subacute hemorrhage with a small hyperdense acute\ncomponent (02:20). There is a subacute infarct in the right frontal cortex,\nwith mild interval evolution. Ventricular size is unchanged and there is no\nintraparenchymal or intraventricular hemorrhage.\n\nThere is no fracture or scalp hematoma. The paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear.", + "output": "1. Right cerebral subdural hematoma containing acute and subacute hemorrhagic\ncomponents, measures up to 8 mm an causes 4 mm of leftward shift of midline\nstructures. Minimal change from prior.\n2. Expected evolution of the subacute infarct in the right frontal cortex." + }, + { + "input": "Images are degraded by motion artifact.\n\nThere is a subdural fluid collection on the right, which is unchanged in size\ncompared to the prior examination. The right subdural fluid collection\ncontains mixed density, likely representing evolution of the acute hemorrhage\nvisualized on the prior exams. There is effacement of the sulci and of the\nright lateral ventricle, which is unchanged compared to prior. There is\nminimal right-to-left midline shift, also unchanged. There is an evolving\ninfarction involving the right frontal lobe, better visualized on the MRI\ndated ___. No evidence of new hemorrhage.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The patient is\nstatus post bilateral cataract surgery. Otherwise, the visualized portion of\nthe orbits are unremarkable.", + "output": "1. Evolution of the subdural fluid collection on the right, without evidence\nof new hemorrhage.\n2. Minimal right-to-left midline shift with effacement of the sulci and right\nlateral ventricle, unchanged from prior.\n3. Evolving infarct involving the right frontal lobe, better visualized on the\nprior MRI." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nAgain visualized is the mixed density right subdural collection, which is\nunchanged in size compared to the prior CT. There is small focus of\nhyperdense blood within this collection anteriorly, which appear slightly\ndenser than on the prior CT on images 2:21, 2:22, but this is most likely\nartifactual given the lack of enlargement. Stable hypodensity within the right\nfrontal lobe represents evolving subacute infarction. No evidence of new\nhemorrhage or large vascular territorial infarction. The ventricles and sulci\nare stable in size and configuration. Minimal leftward shift of the septum\npellucidum is stable.\n\nThe patient is status post bilateral cataract surgery.\n\nCTA HEAD:\nThere is calcified plaque within bilateral carotid siphons without evidence\nfor flow-limiting stenosis. There is calcified plaque causing short-segment\nmild stenosis of the proximal V4 segment of the left vertebral artery. No\nflow-limiting stenosis is seen elsewhere in the intracranial circulation. \nThere is no evidence for an aneurysm. The major dural venous sinuses are\npatent.\n\nCTA NECK:\nThere is atherosclerotic calcification of the aortic arch and the great vessel\norigins. There is at least mild narrowing of the proximal left subclavian\nartery. There is mild plaque in the proximal right subclavian artery without\nassociated stenosis.\n\nThere is a tortuous right common carotid artery with medialization of its\ndistal portion, indenting the posterior pharyngeal wall. There is no internal\ncarotid atherosclerosis or stenosis by NASCET criteria. There is a high-grade\nstenosis at the origin of the left vertebral artery. The right vertebral\nartery appears widely patent.\n\nOTHER:\nThere is dependent atelectasis with the lungs bilaterally. There is fluid\nwithin the superior pericardial recesses. The thyroid gland is grossly\nunremarkable. There is no cervical lymphadenopathy by CT size criteria. There\nare degenerative changes within the cervical spine.", + "output": "1. The mixed density right subdural hematoma is stable in size. The small\nfocus of hyperdense blood within the anterior aspect of the collection appears\nslightly denser than on the prior CT, but this is most likely artifactual\ngiven the lack of enlargement. This may be reassessed on follow-up\nnoncontrast CT.\n2. Stable appearance of evolving subacute infarction in the right frontal\nlobe.\n3. High-grade stenosis at origin of the left vertebral artery\n4. Mild short-segment stenosis of the proximal V4 segment of the left\nvertebral artery.\n5. At least mild narrowing of the proximal left subclavian artery.\n6. No evidence for carotid stenosis." + }, + { + "input": "There has been evolution of blood products in the right-sided subdural\nhematoma extending from frontal to the occipital region with a maximum width\nof approximately 15 mm which is unchanged from the prior study. Associated\nobliteration of the sulci is also unchanged. There is no significant midline\nshift or herniation. Mild prominence of sulci and ventricles again seen. \nThere is no evidence of acute hemorrhage.", + "output": "Evolution of blood products in the right-sided subdural hematoma without\nsignificant change in size or extent. No acute hemorrhage." + }, + { + "input": "There is no hemorrhage, edema, mass effect, midline shift, or mass. Prominence\nof ventricles and sulci as indicative of age-advanced involutional change.\nPeriventricular and subcortical white matter hypodensities are nonspecific but\nmost likely due to chronic small vessel ischemia. Focal hypodensity in the\nleft thalamus likely represents a prior lacunar infarct. Encephalomalacia\nadjacent to the occipital horns bilaterally are indicative of chronic\ninfarcts. The basal cisterns are patent and there is normal gray-white matter\ndifferentiation.\nNo bony abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "Sequela of chronic small vessel ischemic disease and evidence of prior\ninfarcts, but no evidence of subdural fluid collection." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass. Hypodensities in the basal ganglia bilaterally are unchanged\ncompared to ___, and likely related to prior infarct. Prominent\nventricles and sulci are suggestive of age-related involutional change.\nPeriventricular white matter hypodensities are consistent with chronic small\nvessel ischemic disease. Right thalamic and bilateral basal ganglia lacunar\ninfarcts are again seen. Atherosclerotic vascular calcifications are noted of\nbilateral vertebral and cavernous portions of internal carotid arteries.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits again demonstrate change related to\nbilateral orbital surgery.", + "output": "1. No evidence of acute large territorial infarct or hemorrhage. Please note,\nhowever, that MR is more sensitive in the detection of acute stroke.\n2. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Normal study." + }, + { + "input": "There is no evidence of acute large territorial infarct, hemorrhage, edema, or\nmass effect. Prominent ventricles and sulci are suggestive of age-related\ninvolutional changes. Extensive periventricular and subcortical matter\nhypodensities likely reflect the sequela of chronic small vessel ischemic\ndisease, although no prior exam is available for comparison. Atherosclerotic\ncalcifications noted within the intracranial ICAs bilaterally.\n\nNo osseous abnormalities seen. There is mild mucosal thickening in the right\nmaxillary sinus. The other visualized paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. There are bilateral lens replacements.", + "output": "1. No acute intracranial abnormality.\n2. Age-related involutional changes and and white matter hypodensities likely\nreflecting sequela of chronic small vessel ischemic disease." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is no\nmidline shift or mass effect.\n\nThere is prominence of the ventricles and sulci suggestive involutional\nchanges.\n\nThere is no evidence of fracture. There is mild mucosal thickening on the\nright ethmoid sinus. The other visualized portions of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. No evidence of hemorrhage, infarctions, or fractures." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nNo acute fracture is seen. Right frontal sinus is under pneumatized. The\nimaged paranasal sinuses are clear. Mastoid air cells and middle ear cavities\nare well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute, large territorial infarction,\nfracture,hemorrhage,edema,or mass. There is prominence of the ventricles and\nsulci suggestive of involutional changes. Periventricular and subcortical\nwhite matter hypodensities are nonspecific, likely sequela of chronic ischemic\nsmall vessel disease.\n\nFocal cutaneous soft tissue within the right frontal scalp. The frontal\nsinuses are opacified. There is opacification and moderate mucosal thickening\nof the left ethmoid air cells and sphenoid sinus. The right maxillary sinus\nis clear. The left maxillary sinus is nearly completely opacified, against a\nbackground of mucosal thickening, and contains hyperdense material. The left\nmaxillary sinus walls are thickened and sclerotic. The visualized portion of\nthe mastoid air cells and middle ear cavities are clear. Aside from bilateral\nlens replacements and scleral calcifications, the visualized portion of the\norbits is unremarkable.", + "output": "1. No acute intracranial hemorrhage or mass effect on noncontrast CT head. No\nsuspicious parenchymal edema pattern. However, MRI is more sensitive for\ndetection of intracranial masses if there are no contraindications.\n2. Opacified, predominantly left-sided paranasal sinuses, against a background\nof mucosal thickening, with hyperdense material within the left maxillary\nsinus and associated thickened and sclerotic left maxillary sinus walls. \nThese findings likely reflect paranasal sinus disease and chronic\ninflammation, with possible fungal colonization." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The native lenses removed bilaterally.", + "output": "No acute intracranial abnormalities." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci and unremarkable. Basilar cisterns are\npatent.\n\nIncluded paranasal sinuses and mastoids are essentially clear. Skull and\nextracranial soft tissues are unremarkable.", + "output": "Normal head CT." + }, + { + "input": "Area of hypodensity in the left parietal region is more hypodense compared to\n1 day ago, likely reflecting interval evolution of recent infarct. Hypodensity\nin the left cerebellar hemisphere is unchanged and likely reflect sequela of\nold infarct. There is no evidence of new infarction,hemorrhage,edema, or\nmass. The ventricles and sulci are stable in size and configuration.\n\n2 burr holes are noted in left frontal and parietal regions. Mucosal\nthickening is mild in bilateral maxillary sinuses. The visualized portion of\nthe orbits are unremarkable.", + "output": "1. Interval evolution of recent left parietal infarct.\n2. No intracranial hemorrhage is identified." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nArea of hypodensity is identified in the left parietal region with loss of\ngray-white differentiation.\nEncephalomalacia is noted in the right cerebellar hemisphere. There is no\nacute intracranial hemorrhage.\nProminence of ventricles and sulci likely reflect involutional changes.\n\n2 burr holes are noted in the left frontal and parietal regions. Mucosal\nthickening is mild in the left maxillary sinus. The visualized portion of the\norbits are unremarkable.\n\nCTA HEAD:\nLeft internal carotid artery is completely occluded at the petrous segment.\nSupraclinoid segment is stenotic.\nFocal 5 mm heavy calcification at right vertebral artery V4 segment limits\nevaluation of the vessel patency at the location.\nLeft vertebral artery V4 segment ends in posterior inferior cerebellar artery.\n\nThere is a lack of distal MCA branches in the left parietal region.\nOtherwise, the vessels of the circle of ___ and their principal\nintracranial branches appear patent without stenosis, occlusion, or aneurysm\nformation.\nThe dural venous sinuses are patent.\n\nCTA NECK:\nSevere stenosis (70-99%) is identified at the bilateral internal carotid\nartery origins. Left cervical internal carotid artery is diminutive with a\ndiameter measuring 1-2 mm. The left internal carotid artery becomes\ncompletely occluded at the petrous segment. Left lacerum internal carotid\nartery and more distal segments are diminutive but patent.\n\nRight vertebral artery is completely occluded from the origin to the right C7\ntransverse foramen.\nRight vertebral artery V3 segment is completely occluded below the right C1\ntransverse foramen and patent above.\n\n\nCT PERFUSION:\nArea of increased mean transit time is identified in the left\nparieto-occipital region, involving estimated volume of 212 mL. Smaller area\nof decreased cerebral blood flow is identified in the left parietal region,\ninvolving estimated volume of 39 mL.\nFindings are consistent with acute infarct with estimated ischemic penumbra\nvolume of 173 mL.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy.", + "output": "1. Findings consistent with acute left parietal infarct with surrounding\nischemic penumbra in the left parieto-occipital region.\n2. Severe stenosis (70-99%) is identified at bilateral internal carotid artery\norigins.\n3. Left internal carotid artery is diminutive and is completely occluded at\nthe petrous segment.\n4. Right vertebral artery is completely occluded from the origin to C7 level. \nSecond site of occlusion is at V3 segment, below C1 transverse foramen. Focal\ncalcification in V4 segment limits evaluation of vessel patency at that\nlocation.\n5. Left vertebral artery ends in posterior inferior cerebellar artery.\n6. There is a lack of distal MCA branches in the left parietal region.\nOtherwise, the vessels of the circle of ___ and their principal\nintracranial branches appear patent.\n7. Right cerebellar encephalomalacia is likely an old infarct.\n\nNOTIFICATION: The findings were discussed with a neurosurgery resident\nworking with Dr. ___ by ___, M.D. on the telephone on ___ at\n5:10 pm, 10 minutes after discovery of the findings. Patient was already at\nthe angio suite for arteriogram. The resident had to cut the conversation\nshort before giving her name for documentation." + }, + { + "input": "A region of hypodensity with decreased gray-white differentiation is seen\nwithin the left parietal lobe, unchanged compared to prior, compatible with\nevolving infarct. Effacement of the adjacent sulci, but no significant mass\neffect. There is no evidence of hemorrhagic transformation.\n\nChronic encephalomalacia is seen within the right cerebellum. There is no\nevidence of mass. Mild white matter hypodensities are nonspecific, but likely\nrepresent the sequela of chronic microvascular ischemia. There is prominence\nof the ventricles and sulci suggestive of involutional changes.\n\nPatient is status post left parietal craniotomy. There is no evidence of\nfracture. Soft tissue within the left ear canal likely represents cerumen. \nMild mucosal thickening within the left frontal and bilateral maxillary\nsinuses. Otherwise, the visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "Evolving infarct within the left parietal lobe without evidence of hemorrhagic\ntransformation. No significant mass effect." + }, + { + "input": "There is no evidence of acute hemorrhage mass effect midline shift or\nhydrocephalus. Gray-white matter differentiation is maintained. Mild brain\natrophy is identified. The\n\nThere is opacification of the right frontal maxillary sinuses with thickening\nof the bony wall of the right maxillary sinus indicative of chronic sinusitis.\nBone images demonstrate no evidence of skull fracture.", + "output": "No acute intracranial abnormalities are identified. Chronic sinusitis\ninvolving right maxillary and frontal sinuses." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nEvaluation of the V1 and V2 left vertebral artery is limited. Otherwise, the\ncarotid and vertebral arteries and their major branches appear normal with no\nevidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. The visualized esophagus is patulous.", + "output": "1. No acute intracranial abnormality. No high-grade stenosis, dissection or\naneurysm greater than 3 mm.\n2. The partially visualized upper thoracic esophagus is somewhat patulous and\ncould be fluid filled. If there are clinically relevant symptoms chest CT or\nupper GI study can be performed." + }, + { + "input": "The patient is status post interval suboccipital craniectomy and C1\nlaminectomy, with expected postsurgical changes noted in the posterior fossa. \nTrace blood product within the resection cavity is noted. Notably, there is\nan occipital bony defect, with adjacent pneumocephalus, as well as smaller\nfoci of pneumocephalus seen more superiorly within the suprasellar and\nquadrigeminal plate cisterns, as well as along the right greater left\nbifrontal cerebral convexities, not unexpected. Posterior occiput\nsubcutaneous emphysema and soft tissue edema is also expected. There is no\nevidence of acute territorial, edema, or mass effect. Basal cisterns are\npatent. There is no shift of normally midline structures. The ventricles and\nsulci are normal in caliber and configuration.\n\nThe visualized paranasal sinuses and mastoid air cells are clear. The globes\nare intact and unremarkable.", + "output": "Expected postoperative sequelae following suboccipital craniectomy and C1\nlaminectomy. No evidence of acute territorial infarction." + }, + { + "input": "Postoperative changes suboccipital craniectomy, posterior C1 arch resection. \nForamina magnum is decompressed.. Findings consistent with mild-to-moderate\nchronic small vessel ischemic changes. No acute infarct, hemorrhage,\nhydrocephalus.. Posterior left occipital benign subgaleal lipoma, stable,\nmeasures 2.5 cm x 0.7 cm.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Foramen magnum decompression. No acute findings." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nA mucous retention cyst is seen in the right maxillary sinus with mucosal\nthickening of the bilateral maxillary sinuses as well as the sphenoid sinus. \nThere is opacification of the bilateral ethmoid air cells. The visualized\nportion of the remaining paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear.", + "output": "1. No acute intracranial abnormality.\n2. Sinus disease as detailed above." + }, + { + "input": "There is no evidence of acute major infarction,hemorrhage,edema,or discrete\nmass. Relative prominence of the bifrontal CSF space could reflect\ndisproportionate frontal atrophy versus CSF hygromas. There is no subdural\nhematoma. The ventricles and sulci are otherwise normal in size and\nconfiguration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No intracranial hemorrhage.\n2. No subdural hematoma. Mild prominence of bifrontal CSF space is\nnonspecific." + }, + { + "input": "CT head:\nThere is no evidence of acute intracranial hemorrhage, edema,or mass. The\nventricles and sulci are normal in size and configuration.\nThere is opacification of the bilateral ethmoid air cells and mucosal\nthickening of the bilateral sphenoid sinuses and right maxillary sinus. \nMastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.\n\nCT cervical spine: There is expansion and widening with soft tissue density in\nthe right neural foramina at C3-C4. There is no evidence of acute cervical\nspine fracture or malalignment. There is no suspicious osseous lesion. There\nis no spinal canal or neural foraminal stenosis. There is no prevertebral\nedema.", + "output": "1. There is no evidence of acute intracranial process or hemorrhage.\n2. Expansion and widening with soft tissue density in the right neural foramen\nat C3-C4. This is nonspecific in etiology and could represent underlying\nmass, a nonurgent MRI can be considered for further characterization.\n\nRECOMMENDATION(S): Expansion and widening of the right neural foramen at\nC3-C4 level as described detail above suggest underlying mass lesion,\ncorrelation with MRI of the cervical spine with and without contrast is\nrecommended for further characterization." + }, + { + "input": "CT HEAD WITHOUT CONTRAST: There is no intra or extra-axial mass effect, acute\nhemorrhage or infarct. Sulci, ventricles cisterns are within expected limits.\nThe gray-white differentiation is preserved. The paranasal sinuses are clear.\nThe orbits are unremarkable. The mastoid air cells and middle ear cavities or\narising clear. No suspicious blastic or lytic osseous lesions.\n\nCTV HEAD: The dural venous sinuses are patent. The internal cerebral veins are\nalso patent. Incidental note is made of a 3 mm arachnoid granulation in the\nright transverse sinus. The left transverse sinus is congenitally hypoplastic.", + "output": "1. No evidence of a dural venous sinus thrombosis.\n2. Incidental note is made of a 3 mm arachnoid granulation in the right\ntransverse sinus. The left transverse sinus is congenitally hypoplastic." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no exophytic mass, nor\nareas of focal mass effect.\n\nThe parotid, sublingual, and submandibular salivary glands enhance normally\nand are without mass or adjacent fat stranding.\n\nThe thyroid gland appears normal.\n\nThere is mild enlargement of the submental and upper cervical lymph nodes,\nlikely reactive in the setting of infection or inflammation. There are mucous\nretention cysts in the bilateral maxillary sinuses.\n\nThe neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules.\n\nThere are no concerning focal osseous lesions.", + "output": "Essentially normal CT of the neck with reactive lymph nodes from\ninfectious/inflammatory process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nMild mucosal thickening of the paranasal sinuses. The mastoid air cellsand\nmiddle ear cavities are clear. Dysconjugate gaze. Otherwise unremarkable\nintraorbital contents.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No acute intracranial abnormalities.\n2. Patent head and neck vasculature with no evidence of occlusion.\n3. No evidence of internal carotid artery stenosis by NASCET criteria." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, or shift of normally\nmidline structures. Prominent ventricles and sulci compatible with\nage-related involutional changes. Periventricular subcortical white matter\nhypodensities are nonspecific but likely represent chronic small vessel\nischemic disease. Atherosclerotic vascular calcifications are noted of\nbilateral vertebral and cavernous portions of internal carotid arteries.\n\nThere is partial opacification of the bilateral ethmoid air cells and\nbilateral maxillary sinuses. An osteoma is noted in the right frontal sinus. \nMastoid air cells and middle ear cavities are well aerated. The bony calvarium\nis intact. Right frontal sinus osteoma is noted (see 2:8). 1.5 cm left\nparietal scalp vertex probable sebaceous cyst is noted (see 3:64).", + "output": "1. No intracranial hemorrhage.\n2. No evidence of acute large territorial infarct. Please note MRI of the\nbrain is more sensitive for the detection of acute infarct.\n3. Paranasal sinus disease , as described.\n4. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described.\n5. Left parietal scalp vertex probable sebaceous cyst." + }, + { + "input": "CTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nThere is mosaic attenuation in the visualized lungs, likely secondary to small\nairway disease. The visualized portion of the thyroid gland is within normal\nlimits. There is no lymphadenopathy by CT size criteria. Prominent\ncalcifications are seen the bilateral palatine tonsils, presumed secondary to\nprior infectious process.", + "output": "1. Normal head and neck CTA.\n2. Mosaic attenuation in the visualized upper lung fields, likely secondary to\nsmall airway disease. Further evaluation with dedicated chest CT can be\nperformed as clinically indicated.\n\nRECOMMENDATION(S): Mosaic attenuation in the visualized upper lung fields,\nlikely secondary to small airway disease. Further evaluation with dedicated\nchest CT can be performed as clinically indicated." + }, + { + "input": "There is no evidence of large acute territorial infarction, hemorrhage, edema,\nor mass. The ventricles and sulci are normal in size and configuration. There\nis no shift of normally midline structures. Basal cisterns are patent. The\ngray-white matter differentiation is preserved.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality.\n\nRECOMMENDATION(S): MRI is more sensitive for the detection of acute\ninfarction." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "The examination is significant limited by motion artifact. Allowing for this,\nno gross abnormalities are seen. The calcified left temporal meningioma\nmeasuring 1.2 cm (05:13), is unchanged from ___. Basal cisterns are\npatent. No evidence of fracture. Paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear aside from minimal mucous and a right anterior\nethmoid air cell.", + "output": "1. Stable left temporal meningioma from ___.\n2. Limited exam due to excessive motion artifact without gross abnormality. \nIf there is continued concern, repeat study when patient is able to lay still." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nAs before, the patient is status post right frontotemporal craniotomy.\n\nCompared to 11:48, no significant change in extensive subarachnoid hemorrhage\noverlying the bilateral, right greater than left, frontal lobes and right\nparietal and occipital lobes as well as tracking along the falx with layering\nblood in the occipital horns of bilateral lateral ventricles and right aspect\nof the fourth ventricle. Subarachnoid blood also extends throughout the\nbasilar cisterns. There is no evidence of acute large territorial infarction\nor mass. Again seen is diffuse loss of gray-white differentiation along the\nright MCA distribution, consistent with chronic infarct. The ventricles and\nsulci are enlarged, consistent with involutional changes.\n\nThere is a mucous retention cyst in the left maxillary sinus. Otherwise, the\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.\n\n\nCTA HEAD:\nThere is a 0.7 x 0.6 cm aneurysm arising from the proximal A2 segment of the\nleft anterior cerebral artery (series 3/image 232). There is an outpouching\narising from the C4 segment of the left internal carotid artery, likely\nrepresenting an infundibulum of the meningohypophyseal trunk. There is\natherosclerotic calcification of the cavernous segments of bilateral internal\ncarotid arteries without significant stenosis. Otherwise, the vessels of the\ncircle of ___ and their principal intracranial branches appear normal\nwithout stenosis or occlusion. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is atherosclerotic calcification of the left carotid bifurcation without\nsignificant stenosis. There is atherosclerotic calcification of the V4 segment\nof the left vertebral artery without significant stenosis. Otherwise, the\ncarotid and vertebral arteries and their major branches appear normal with no\nevidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is prominent without evidence of focal lesion. There is no\nlymphadenopathy by CT size criteria.", + "output": "1. Compared to 1148, no significant change in extensive subarachnoid\nhemorrhage and moderate intraventricular hemorrhage. No evidence of new or\nenlarging hemorrhage.\n2. 0.7 x 0.6 cm aneurysm arising from the proximal A 2 segment of the left\nanterior cerebral artery, for which neurosurgery consult is recommended.\n\nRECOMMENDATION(S): Neurosurgery consult.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 2:59 pm, 5 minutes\nafter discovery of the findings." + }, + { + "input": "Compared to approximately 17 hours prior, there is no appreciable change in\nextensive subarachnoid hemorrhage overlying the bilateral cerebral hemispheres\nand nearly filling the suprasellar cistern. Small amount of intraventricular\nhemorrhage layering dependently in the occipital horns of the lateral\nventricles is unchanged. Ventriculomegaly is unchanged with a third ventricle\ndiameter of 1.1 cm. Chronic right MCA territory infarcts with associated ex\nvacuo dilation of the right lateral ventricle is unchanged. No evidence of\nnew, acute, large territorial infarction or new intracranial hemorrhage. No\nsignificant midline shift.\n\nStatus-post right frontotemporal craniotomy. A mucous retention cyst in the\nleft maxillary sinus is unchanged. There is mild rightward nasal septum\ndeviation. The visualized portion of the remaining paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable. Mild carotid siphon and left V4 segment\ncalcifications are noted.", + "output": "Unchanged appearance of subarachnoid hemorrhage, intraventricular hemorrhage,\nand mild ventriculomegaly. No evidence of new infarction or intracranial\nhemorrhage." + }, + { + "input": "Interval placement of a right frontal approach ventriculostomy catheter\nterminating near the anterior, superior aspect of the third ventricle. Mild\nventriculomegaly is unchanged, with a third ventricle diameter of 1.1 cm. \nSubarachnoid and intraventricular hemorrhage previously described are\nunchanged. No significant midline shift. Right frontal encephalomalacia\nassociated with ex vacuo dilation of the right lateral ventricle is unchanged.\nNo evidence of new or enlarging intracranial hemorrhage or acute territorial\ninfarction.\n\nStatus-post right frontotemporal craniotomy. Increased posterior ethmoid air\ncell and left maxillary sinus fluid with air-fluid levels noted, probably\nrelated to interval nasoenteric and endotracheal tube placement. The\nremaining paranasal sinuses are clear. The mastoid air cells and middle ear\ncavities are clear. Mild carotid siphon and left V4 segment calcifications\nare again noted. The orbits appear unremarkable.", + "output": "1. Unchanged mild ventriculomegaly status-post right frontal approach\nventriculostomy catheter placement terminating near the anterior, superior\naspect of the third ventricle.\n2. Unchanged subarachnoid and intraventricular hemorrhage.\n3. No evidence of new infarction or intracranial hemorrhage." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThe patient is status post right frontal craniotomy. A ventriculostomy\ncatheter terminates in the region of the foramina ___. Chronic right MCA\ninfarct. Small area of hemorrhagic blood products in the right temporal lobe\nis similar. A 4 mm focus of intraparenchymal hemorrhagic in the right frontal\nlobe is mildly increased since prior.\n\nEmbolization coils in the anterior suprasellar region are new from the prior\nexamination.\n\nModerate improvement in subarachnoid hemorrhage since ___. Mild\nincrease in intraventricular hemorrhage within left occipital horn, stable\nright occipital horn hemorrhage, likely from redistribution. Small area of\nsubarachnoid hemorrhage overlies occipital lobes, likely from redistribution. \nStable ventricular size.\n\nSubacute infarct left caudate nucleus, anterior limb left oral capsule,\nanterior putamen,, new since ___.\n\nThe left maxillary and sphenoid sinuses contain mucous retention cysts. \nOtherwise, the paranasal sinuses and mastoid air cells are clear. The orbits\nare unremarkable.\n\nCTA HEAD:\nThere is interval caliber decrease in the right A1, A2, A3 segment, inferior\nleft M 2 segment. Left A1 segment is difficult to evaluate given streak\nartifact.\n\nThere is mild caliber decrease right MCA M1, and probably M2 and distal\nbranches.\n\nInterval mild caliber decrease of the right P1, P2 segments. Possible caliber\ndecreased left P1 segment, there is significant streak artifact this level\n\nOtherwise, the vessels of the circle of ___ and their principal\nintracranial branches appear normal without stenosis, occlusion, or aneurysm\nformation. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is mild atherosclerotic disease at the origin of the left internal\ncarotid artery without significant narrowing. Mild atherosclerotic narrowing\nat the V4 segment of the left vertebral artery is noted. Otherwise, the\ncarotid and vertebral arteries and their major branches appear normal with no\nevidence of stenosis or occlusion. No evidence of internal carotid stenosis\nby NASCET criteria.\n\nPerfusion:\nAreas of increased Tmax and MTT in the distribution of the right MCA infarct\nwith smaller areas of decreased rBV is noted.\n\nOTHER:\nEvaluation the lungs is limited by respiratory motion. An enteric tube within\nthe esophagus is noted. There is borderline enlargement of the ascending\naorta measuring up to 4.1 cm. 5 mm hypodensity in the right lobe of the\nthyroid is noted.", + "output": "1. Compared with ___ there has been decrease in subarachnoid\nhemorrhage. Mild intraventricular hemorrhage, slightly increased, likely from\ndistribution. Stable ventricular dilatation. Chronic right MCA distribution\ninfarct.\n2. 2 areas of parenchymal hemorrhage, stable in the right temporal lobe,\nmildly increased in the right frontal lobe.\n3. Early subacute left basal ganglia infarct.\n4. Mild-to-moderate vasospasm.\n5. Areas of increased Tmax and MTT in the right MCA territory with smaller\nareas of decreased rBV is noted, consistent with mismatch." + }, + { + "input": "Motion artifact limits evaluation.\n\nThe patient is status post right frontal craniotomy. A right ventriculostomy\ncatheter is in unchanged position. Embolization coils are again noted in the\nanterior suprasellar region.\n\nHemorrhage in the dependent portion of the right lateral ventricle is\nunchanged. There is less hemorrhage in the dependent portion of the left\nlateral ventricle. The ventricles are stable in morphology.\n\nSubdural and subarachnoid hemorrhage in the right occipital and anterior\nparafalcine regions is less conspicuous in comparison to the prior\nexamination, compatible with evolution. A small amount of left occipital\nsubarachnoid hemorrhage is unchanged.\n\nConfluent right frontotemporal MCA infarct is unchanged from the prior\nexamination, however an 8 mm punctate focus of intraparenchymal hemorrhage\n(series 3, image 23) appears mildly increased in size (previously 4 mm),\ncompatible with hemorrhagic transformation. Additional intraparenchymal\nhemorrhage in the periventricular right temporal lobe, appears mildly less\nconspicuous in comparison to prior examinations, compatible with evolution.\n\nA 12 mm subacute infarct in the anterior limb of the internal capsule on the\nleft is unchanged.\n\nThe orbits are unremarkable. There is a small mucous retention cyst in the\nleft maxillary sinus.", + "output": "1. A right frontal 8 mm intraparenchymal focus of hemorrhage, compatible with\nhemorrhagic transformation may have minimally increased a may be more\nconspicuous due to slice selection. Extensive right MCA distribution infarct\nappears otherwise unchanged. No worsening mass effect or midline shift.\n2. Additional foci of bilateral occipital, right temporal and parafalcine\nintraparenchymal and subarachnoid hemorrhage appear unchanged or less\nconspicuous, compatible with evolution.\n3. Unchanged, subacute infarct in the anterior limb of the internal capsule on\nthe left.\n\nNOTIFICATION: The findings were discussed with ___, N.P. by ___,\nM.D. on the telephone on ___ at 12:11 pm, 5 minutes after discovery of\nthe findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nVascular coils in relation to the known left ACA aneurysm results in beam\nhardening artifact obscuring the tissues in this area.\n\nRight frontal approach external ventricular drain terminating in the midline\nat the foramina ___ is unchanged compared to prior. Ventricular profile\nappear similar compared to prior imaging. Subarachnoid and intraventricular\nblood is again noted and appears slightly decreased compared to prior imaging.\nHemorrhage in relation to the right insular cortex appears fairly similar\ncompared to prior. Right frontal hemorrhagic area (series 2, image 21) is\nslightly more conspicuous compared to prior imaging. Multiple known left\nbasal ganglia and left internal watershed infarcts are again noted but was\nbetter appreciated on most recent MRI. Right periventricular and deep white\nmatter hypodense changes are similar compared to prior. Chronic right basal\nganglia infarct is unchanged.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is persistent decrease in the caliber of the right ACA (A1 through A3\nsegment) and right MCA (M1, M 2 and M3 segments) vessels with the right ACA\nnarrowing appearing fairly similar and right MCA narrowing appearing similar\nto slightly improved compared to prior imaging. There is also left A1 segment\nnarrowing, overall similar to prior exam.\n\nShort-segment narrowing of the proximal PCAs appear similar compared to prior\nimaging.\n\nThe rest of the vessels of the circle of ___ are patent. The dural the\nsinuses are suboptimally assessed.", + "output": "1. There is persistent narrowing (suspected vasospasm) of the right ACA and\nMCA vessels as well as left A1 segment as described above. Narrowing of the\nright ACA appear similar compared to most recent prior imaging, with the MCA\nvessel narrowing appearing similar to slightly improved compared to prior.\n2. Mild narrowing involving the proximal PCAs bilateral are also unchanged.\n3. Known right insular and right frontal lobe hemorrhages as described above. \nThe right frontal hemorrhage demonstrates mild interval increase in size\n(could still be in the spectrum of normal expected evolution).\n4. Multiple known infarcts demonstrate normal expected evolution, with the\nacute infarct in the left basal ganglia and centrum semiovale (internal\nwatershed) better characterized on prior MRI.\n5. Right external ventricular drain in situ with persistent prominence of the\nventricular system which is unchanged." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nA right frontal ventriculostomy catheter entering via right frontal burr hole,\nterminates in the region of the foramen of ___. The ventricular morphology\nis unchanged. A right MCA distribution infarct with right temporal and right\nfrontal foci of hemorrhagic transformation is unchanged. Mild layering\nhemorrhage in the occipital horns of the lateral ventricles is unchanged.\n\nA left caudate head infarct is again noted. Trace subarachnoid hemorrhage in\nthe anterior interhemispheric and bilateral occipital regions is unchanged.\n\nEmbolization coils are again noted in the region of the anterior suprasellar\ncistern.\n\nMultiple left centrum semiovale infarcts are better appreciated on the MR from\n___. Additional nonspecific periventricular and deep white matter\nhypodensities likely represent sequela of chronic small vessel ischemic\ndisease.\n\nThe patient status post right frontotemporal craniotomy. The paranasal\nsinuses and mastoid air cells are clear. The orbits are unremarkable.\n\nCTA HEAD:\nVascular coil artifact obscures portions of the circle of ___. There is\nunchanged mild decrease vascular caliber throughout the right ACA, worse in\nthe A1 segment. Mild caliber narrowing is noted throughout the M1, M2 and M3\nbranches of the right MCA, unchanged. Short-segment narrowing of the proximal\nPCAs is unchanged from prior examination. The dural venous sinuses are\npatent.\n\nCTA NECK:\nThere is mild atherosclerotic disease at the origin of the internal carotid\narteries, bilaterally without stenosis by NASCET criteria. The carotid\nsiphons are mildly calcified. Otherwise, the carotid and vertebral arteries\nand their major branches appear normal with no evidence of stenosis or\nocclusion.\n\nOTHER:\nNo suspicious pulmonary nodules. The thyroid contains hypodense nodules\nmeasuring up to 6 mm. Multilevel degenerative changes throughout the cervical\nspine, more significant at C5-C6 level consistent with anterior and posterior\nspondylosis.", + "output": "1. Persistent mild decreased caliber of the right ACA and right MCA vessels,\nsuggestive of vasospasm.\n2. Mild caliber decrease of the bilateral proximal PCAs are also unchanged.\n3. Unchanged large right MCA distribution infarct with hemorrhagic\ntransformation. Foci of subarachnoid and intraventricular hemorrhage are\nunchanged from the prior examination, but decreased in conspicuity from\nmultiple priors.\n4. Unchanged, left basal ganglia and centrum semiovale infarcts, better\nappreciated on recent MR." + }, + { + "input": "Right frontal shunt catheter tip is in the region of right lateral ventricle\nunchanged from the previous study. Prior embolization in the region of\nanterior communicating artery is visualized. Small amount of blood products\nin the right temporal region again seen. No significant change in the\nventricular size noted. No new hemorrhage is seen.", + "output": "Unchanged study without acute abnormalities or change in ventricular size\ncompared with ___." + }, + { + "input": "Right VP shunt in place via frontal burr hole, tip in the right frontal horn,\nstable. Extensive stable low-attenuation change right cerebral hemisphere\ninvolving frontal, parietal, temporal lobes. Small volume intraventricular\nhemorrhage, improved since prior. Small area of parenchymal hemorrhage right\nfrontal, temporal lobes, similar. Suggestion of low-density extra-axial fluid\ncollection overlying left upper cerebellum, stable suprasellar aneurysm\nembolization coils. Chronic encephalomalacia, likely from infarct right MCA\ndistribution, extending into the sub insula, right thalamus, stable. Small\nsubacute left basal ganglia, centrum semiovale infarcts were better seen on MR\n___. Findings consistent with severe chronic small vessel ischemic\nchanges. Prominent ventricular system, stable. Minimal pneumocephalus,\nimproved. Clear mastoids, paranasal sinuses.", + "output": "Essentially stable exam. Stable small volume intracranial hemorrhage. Stable\nprominent ventricular system. Stable right hemispheric low-attenuation\nchanges. Stable subacute and chronic ischemic changes." + }, + { + "input": "Streak artifact from the left ACA aneurysm coil limits evaluation.\n\nRe-demonstrated is right frontal craniotomy and right frontal approach VP\nshunt with tip terminating in the frontal horn of the right lateral ventricle,\nunchanged in position compared to the prior study. Minimal pneumocephalus in\nthe right frontal lobe is again noted unchanged compared to the prior study.\n\nChronic right encephalomalacia with ex vacuo dilation of the right lateral\nventricle is noted. The ventricles and sulci grossly stable in size and\nconfiguration.\n\nA small amount of intraparenchymal hemorrhage along the right frontotemporal\nlobes is similar in appearance compared to the prior study.\n\n Periventricular and subcortical white matter hypodensities are nonspecific,\nbut likely reflect sequelae of chronic small vessel ischemic disease. \nProminence of the ventricles and sulci suggest involutional changes.\nParanasal sinuses are clear. Mastoid air cells and middle ear cavities are\nwell aerated.", + "output": "1. Streak artifact from left ACA aneurysm coil limits evaluation.\n2. Grossly stable minimal right frontotemporal intraparenchymal hemorrhage.\n3. Grossly stable right frontal approach VP shunt catheter, with stable\nventricular size." + }, + { + "input": "There is a presumed aneurysm coil pack in the anterior suprasellar cistern,\nwith streak artifact limiting evaluation at adjacent levels. The patient is\nstatus post right frontal craniotomy and frontal approach VP shunt catheter\nplacement with tip terminating slightly proximal to the foramen of ___. \nThere is stable diffuse ventriculomegaly with stable superimposed ex vacuo\nenlargement of the right lateral ventricle secondary to the right\nfrontal/anterior parietal/temporal encephalomalacia. There is no evidence of\nacute hemorrhage. There remains trace amount of pneumocephalus.\n\nThere is mild mucosal thickening in the ethmoid air cells and maxillary\nsinuses, with a small mucous retention cyst in the left maxillary sinus. \nMastoid air cells are well aerated. Enteric tube is partially imaged in the\noropharynx.", + "output": "1. Stable position of the VP shunt catheter. Stable size and configuration of\nthe ventricles.\n2. No evidence of acute hemorrhage." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass, and no areas of\nfocal mass effect.\n\nThe right submandibular gland is absent. The salivary glands enhance normally\nand are without mass or adjacent fat stranding. The thyroid gland appears\nnormal. There are a number of reactive, prominent cervical lymph nodes,\nmeasuring a maximum of 2 cm in greatest dimension (03:27). There is tonsillar\nenlargement without peritonsillar collection. Tonsilloliths are seen within\nthe palatine tonsils. Surgical clips are noted in the left neck. The neck\nvessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.", + "output": "1. Tonsillar enlargement without peritonsillar abscess.\n2. Prominent likely reactive cervical lymph nodes." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. Findings\nconsistent with moderate chronic small vessel ischemic changes, worsened since\n___.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Perforated nasal septum, defect\nmeasures 3 cm, stable.", + "output": "No acute findings.\nNasal septal perforation.\nModerate chronic small vessel ischemic changes." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. In\nthe left globe, there is layering hyperdensity. On in the right globe, there\nis irregularly, ovoid shaped hyperdensity measuring 2.1 x 1.2 cm. The intra\nand extraconal fat are unremarkable bilaterally.", + "output": "1. No acute intracranial abnormalities.\n2. Layering hyperdensity within the left globe, concerning for hemorrhage,\nquestion history of retinal detachment. No definite intra or extraconal fat\nstranding.\n3. Irregular ovoid hyperdensity in the right globe. ___ represent\npostprocedural changes, such as injection, retinal hemorrhage or procedure\nrelated. Correlation with prior surgical and trauma history is recommended.\n\nNOTIFICATION: The findings were discussed with ___. by ___\n___, M.D. on the telephone on ___ at 4:54 pm, 10 minutes after discovery\nof the findings." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect. Given the limitation of a noncontrast study, no fluid\ncollection is seen in the neck.\n\nThe salivary glands are grossly without mass or adjacent fat stranding.The\npatient is status post left hemithyroidectomy with multiple surgical\nclips.There is no lymphadenopathy by CT criteria.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions. No acute fracture or\nmalalignment of the cervical spine. Mild degenerative changes of the cervical\nspine are most consistent at C5-6.", + "output": "Given the limitation of a noncontrast study, no evidence of fluid collection\nor deep space infection in the neck." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, mass effect, midline\nshift, or mass. Asymmetric frontal horns of the lateral ventricles is likely\ncongenital. The ventricles and sulci are normal in size. No bony abnormalities\nseen. There is minor mucosal thickening in the paranasal sinuses. The mastoid\nair cells, and middle ear cavities are clear. The orbits are intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of territorial infarction,hemorrhage,edema, or mass. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nethmoid air cells. The visualized portion of the remaining paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "No evidence of acute intracranial process or injury." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no dense for an exophytic\nmucosal mass, and no areas of focal mass effect. The the linear hyperdense\npresumed radiopaque foreign body in the left oropharyngeal submucosal space\nextending to the right greater cornu of the hyoid bone is no longer\nvisualized. 2 mm left tonsillar region calcification is unchanged. (series\n2, image 34; series 601b, image 33). No pneumomediastinum or subcutaneous\nemphysema. No evidence for fluid collection on noncontrast CT.\n\nThe salivary glands and the thyroid appear unremarkable on noncontrast CT. No\nenlarged cervical lymph nodes are seen.\n\nIn the posterior segment of the upper lobe of the left lung, there is a\npartially visualized subsegmental peribronchial ___ opacity, not\nincluded in the field of view of the preceding CT.\n\nDegenerative changes of the cervical spine are again noted.\n\nThis exam is not technically optimized for evaluation of the included brain\nparenchyma. No concerning abnormalities seen on limited assessment. There is\nmild mucosal thickening in the left maxillary sinus.", + "output": "1. The linear radiopaque presumed foreign body in the left oropharynx is no\nlonger identified. 2-mm calcification in the left tonsillar region is\nunchanged, compatible with tonsillith or a broken retained fragment of the\nprior foreign body.\n\n2. No evidence of pneumomediastinum or subcutaneous emphysema. No evidence\nof the fluid collection on noncontrast CT.\n\n3. Partially visualized subsegmental peribronchial ___ pulmonary\nopacity in the posterior segment of the left upper lobe, not included in the\nfield of view of the preceding neck CT, is compatible with pneumonia or\ninflammatory small airways disease.\n\nNOTIFICATION: The impression items 1 and 2 were discussed with ENT on call by\n___, M.D. in person on ___ at 6:31 AM, 1 minutes after\nrevision of the findings regarding possible retained/broken foreign body as\nabove.\n\nImpression item 3 was emailed to the ED QA nurses list by Dr. ___ at 17:47\non ___." + }, + { + "input": "There is re-demonstration of the mixed density acute on chronic subdural\nhematoma overlying the right cerebral convexity, and measuring approximately\n2.9 cm in maximal thickness, unchanged from the earlier MRI (2:23). There is\npersistent effacement of the right lateral ventricle frontal and occipital\nhorns, with unchanged 7 mm leftward shift of normally midline structures\n(02:17). Right-sided sulcal effacement is again seen. No new intracranial\nhemorrhage detected.\n\nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. Periventricular white matter hypodensities are nonspecific, likely\nsequela of chronic small vessel ischemic disease. Incidental note is made of\nheavy atherosclerotic calcifications involving the left vertebral artery.\n\nComminuted, depressed left nasal bone fracture is of indeterminate age. \nModerate mucosal thickening is identified in the bilateral maxillary sinuses\nand ethmoidal air cells. The visualized portion of the remaining paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable, noting bilateral lens replacements.", + "output": "Compared with the earlier MRI, given differences in modality, no significant\ninterval change of the mixed density acute on chronic subdural hematoma\noverlying the right cerebral convexity. Unchanged 7 mm leftward shift of\nnormally midline structures with effacement of the frontal and occipital horns\nof the right lateral ventricle. No new hemorrhage detected.\n\nComminuted, depressed left nasal bone fracture, of indeterminate age. No\nsignificant overlying soft tissue swelling seen." + }, + { + "input": "Patient is post interval right burr hole evacuation of the previous subdural\nhemorrhage overlying the right cerebral convexity. A right parietal approach\ndrain has been left in place over the right cerebral convexity. Expected\npostoperative changes include small foci of air and hyperdense blood products\nin the surgical bed, as well as soft tissue swelling and postsurgical skin\nstaples overlying the right calvarium. There is decreased leftward shift of\nnormally midline structures, now measuring 3 mm compared with 7 mm on ___ (2:25). There is persistent mild mass effect upon the right frontal and\noccipital horns of the lateral ventricle, but this has also improved. No\nevidence of large territorial infarction. Right-sided sulcal effacement has\nimproved. No new intracranial hemorrhage detected.\n\n The visualized portion of the re-demonstration of a comminuted, partially\ndepressed left nasal bone fracture, of indeterminate age. Moderate mucosal\nthickening again noted in the maxillary sinuses and ethmoidal air cells. The\nvisualized portions of the remaining paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable, noting bilateral lens replacements. Again noted is a heavily\ncalcified 1.1 cm left vertebral artery aneurysm.", + "output": "1. Status post interval hole evacuation of the previous right subdural\nhemorrhage, with expected postsurgical changes. A drain has been left in\nplace overlying the right cerebral convexity.\n\n2. Decreased leftward shift of normally midline structures, now measuring 3\nmm compared with 7 mm previously. Right-sided sulcal effacement has also\nimproved.\n\n3. No new intracranial hemorrhage or large territorial infarction detected." + }, + { + "input": "There is re-demonstration of right convexity subdural hemorrhage, with\nlayering blood products status post right burr hole evacuation, and right\nparietal approach drain placement with postoperative changes, and mild\nassociated pneumocephalus, that is similar in appearance to most recent prior\nstudy. There is re-demonstration of minimal shift of normally midline\nstructures that measures 3 mm, unchanged from prior. The basal cisterns are\npatent. The ventricles and sulci are stable in size and configuration. No\nacute large territory infarction is demonstrated\n\nThere is re-demonstration of a comminuted partially depressed left nasal bone\nfracture with no acute fracture identified. There is re-demonstration of\nbilateral mild-to-moderate mucosal thickening of the maxillary sinuses and\nethmoid air cells otherwise the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The patient is status post bilateral lens\nreplacement, otherwise the visualized portion of the orbits are unremarkable.", + "output": "1. Stable right convexity subdural hemorrhage status post right burr hole and\nright parietal approach drain placement with stable postoperative changes and\nunchanged 3 mm midline shift.\n2. No new intracranial hemorrhage or acute large territory infarction\nidentified.\n\nNOTIFICATION: The findings were discussed with ___, P.A. by ___\n___, M.D. on the telephone on ___ at 10:41 am." + }, + { + "input": "Again seen is the right convexity subdural hematoma demonstrating layering of\nblood products. The right parietal approach catheter within this collection\nis unchanged in position. Postprocedure pneumocephalus is again noted. The\nsubdural collection continues to measure 11 mm in maximum thickness. There is\na stable 3 mm leftward midline shift. The basal cisterns remain patent\nwithout evidence of downward herniation. There is no evidence of an acute\nlarge territorial infarction or progression of intra-axial hemorrhage. There\nis prominence of the ventricles and sulci suggestive of involutional changes.\n\nUnchanged comminuted and partially depressed in left nasal bone fracture\nwithout visualization of acute fracture. There is mild mucosal thickening of\nthe ethmoid air cells and bilateral maxillary sinus. The remainder of the\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. Patient is status post bilateral lens replacements, the\nvisualized portion of the orbits are unremarkable.\n\nThe heavily calcified left vertebral artery aneurysm is again seen.", + "output": "1. No interval change in the size and appearance of the right convexity\nsubdural hematoma since yesterday status post right burr hole and drain\nplacement .\n2. Stable 3 mm leftward midline shift.\n3. No new areas of intra-axial hemorrhage." + }, + { + "input": "The patient is status post right frontal parietal burr holes, for evacuation\nof right subdural hematoma. There remains a right convexity extra-axial mixed\ndensity subdural hematoma measuring up to 7 mm in greatest thickness, overall\nimproved from prior examination of ___. A previously seen subdural\ndrain has been removed. Interval resolution of leftward midline shift.\n\nThere is no acute large territorial infarct or new intracranial hemorrhage. \nThe sulci, ventricles cisterns are within expected limits for the degree of\nmild senescent related global cerebral volume loss. Periventricular and\nsubcortical white matter hypodensities are nonspecific, but compatible with\nchronic microangiopathy in a patient of this age.\n\nDolichoectasia of the vertebral and basilar arteries is unchanged from prior\nexam. Partially calcified 1.2 cm left vertebral artery aneurysm is also\nunchanged.\n\nNo acute osseous abnormality. Fracture deformity of the nasal bones are\nunchanged. Mild mucosal thickening of the maxillary sinuses and ethmoid air\ncells, unchanged. The orbits are unremarkable noting bilateral lens\nreplacements. Chronic opacification and sclerosis of the right mastoid air\ncells.", + "output": "1. There remains a mixed density subacute subdural hematoma measuring\napproximately 7 mm in greatest thickness, overall improved from examination of\n___. No evidence of new intracranial hemorrhage.\n2. Interval resolution of leftward midline shift.\n3. No acute large territory infarct.\n4. The dolichoectasia of the vertebral and basilar arteries as well as 1.2 cm\nleft vertebral artery calcified aneurysm unchanged.\n5. Additional findings described above." + }, + { + "input": "Comparison with the prior head CT scan reveals apparent complete regression of\nthe right cerebral convexity mixed density subdural hematoma. There is no\nevidence for an acute intracranial hemorrhage, new mass effect or shift of\nnormally midline structures, change in ventricular or sulcal size. \nLow-density within the periatrial white matter bilaterally, more evident on\nthe left side is again seen, and given the patient's advanced age and absence\nof mass effect, probably represents chronic small vessel infarction. The\npreviously suspected left vertebral artery calcified aneurysm ache is again\nseen. The two burr holes within the right side of the calvarium are again\nnoted.", + "output": "Complete regression of previously noted mixed density right cerebral convexity\nsubdural hemorrhage. Please see above report for details." + }, + { + "input": "No fractures are identified. There is no evidence of facial swelling. \nVisualized paranasal sinuses are well aerated. There is no evidence of\nabnormal fluid collections. Bilateral mastoids appear normal. The globes,\nextraocular muscles, optic nerves, and retrobulbar fat appear normal. The\nvisualized upper aerodigestive tract appears normal. The mandible and\ntemporomandibular joints appear normal.", + "output": "No evidence of abscess." + }, + { + "input": "There is no evidence of fracture, infarction, hemorrhage, edema, or mass. \nThe ventricles and sulci are normal in size and configuration. There is no\nabnormal enhancement on post contrast images.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No evidence of acute hemorrhage or mass.\n2. The paranasal sinuses are clear, but better assessed on the concurrent\nsinus CT." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Normal study. No evidence of fracture or intracranial hemorrhage." + }, + { + "input": "There is no evidence of large vascular territory infarction,hemorrhage,edema,\nor mass effect. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific but suggest chronic small vessel ischemic\nchanges. Hypodensity in the right body of the caudate suggests chronic\nlacunar infarct.\n\nThere is no evidence of fracture. Aerosolized secretions seen within the\nfrontal sinus, ethmoid sinuses, sphenoid sinuses and right maxillary sinus\nsuggesting acute sinus disease. Otherwise, the left maxillary sinus, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. No evidence of acute intracranial abnormality on noncontrast head CT. \nSpecifically no large territory infarct or intracranial hemorrhage.\n2. There is mild to moderate global cerebral senescent related volume loss\nwithout lobar predominance or disproportionate mesial temporal volume loss.\n3. Aerosolized secretions seen within the paranasal sinuses may represent\nacute sinus disease. Clinical correlation is recommended." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable.\n\nIncluded paranasal sinuses and mastoids are clear besides mucous retention\ncyst in the left maxillary sinus. Skull and extracranial soft tissues are\nunremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is a scalp hematoma and laceration overlying the frontal bone on the\nright. There is no underlying fracture.\n\nThere is no evidence of acute territorial infarctionhemorrhage,edema,or mass. \nExtensive confluent subcortical, deep, and periventricular white matter\nhypodensities likely represent the sequela of chronic microvascular ischemic\ndisease. Unchanged region of encephalomalacia within the inferior left\ntemporal lobe and inferior left frontal lobe as well as chronic bilateral\ncerebellar infarcts. There is prominence of the ventricles and sulci\nsuggestive of involutional changes.\nThere is no fracture. There is near complete opacification of the right\nmaxillary sinus. There is also partial opacification of the left sphenoid\nsinus with an air-fluid level. Soft tissue density within the right external\nauditory canal likely represents cerumen. Visualized portion of the mastoid\nair cells and middle ear cavities are clear. Patient is status post bilateral\nlens resections. Bilateral senile scleral calcifications are visualized. \nAgain, there is a periapical lucency surrounding the right maxillary second\nmolar.", + "output": "1. Scalp hematoma and laceration overlying the frontal bone, but no evidence\nof underlying fracture or intracranial hemorrhage.\n2. Sequela of extensive chronic microangiopathy with an unchanged regions of\nencephalomalacia within the left frontal and temporal lobes as well as the\nbilateral cerebellar hemispheres.\n3. Paranasal sinus disease with an air-fluid level, slightly improved compared\nto prior. Please correlate with any clinical signs of acute sinusitis." + }, + { + "input": "There is no evidence of acute major vascular territorial\ninfarction,hemorrhage,edema, or mass. The ventricles and sulci are normal in\nsize and configuration. Calcific density at the left frontal convexity region\n(02:27) likely due to a inner table osteoma is unchanged.\n\nThere is no evidence of fracture. Mild mucosal thickening is seen in the\nright maxillary sinus. Otherwise, the remaining visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality." + }, + { + "input": "Subcutaneous edema and stranding is seen along the bilateral lips with mild\nsubcutaneous inflammatory changes seen along the right cheek. A small mildly\ndisplaced fracture seen along the right anterior maxillary wall (Series 1:\nImage 63). A locule of subcutaneous gas is seen adjacent to the fracture site\n(series 1: Image 67). Mild mucosal thickening is seen adjacent to the\nfracture site in the right maxillary sinus.\n\nThe remaining visualized paranasal sinuses, mastoid air cells, and middle ear\ncavities appear grossly clear. The ostiomeatal units are not opacified. \nThere is mild leftward septal deviation. There is no evidence of abnormal\nfluid collections.\n\nThe globes, extraocular muscles, optic nerves, and retrobulbar fat appear\nnormal. The visualized upper aerodigestive tract appears normal. The\nmandible and temporomandibular joints appear normal.", + "output": "1. A small mildly displaced fracture seen along the right anterior maxillary\nwall. There is increased soft tissue swelling and edema seen along the right\ncheek and bilateral lips, likely reactive." + }, + { + "input": "There has been interval development of intraparenchymal hemorrhage with a\nhematocrit level in the left posterior parietal lobe, most consistent with\ninterval hemorrhage of a metastatic lesion (series 2, image 23). This hematoma\nmeasures 2.6 x 2.0 cm. There is surrounding edema with local mass effect but\nno shift of midline structures. Multiple additional known supratentorial\nmetastatic lesions are again seen, including with the left parafalcine region\n(series 2, image 26), right frontal lobe (series 2, image 26), and right\noccipital lobe(series 2, image 13). No new masses are otherwise clearly\nevident on this current exam. The ventricles and sulci are normal in size and\nconfiguration for age. The white matter hypodensities likely reflect the\nsequela of chronic small vessel infarction.\n\nNo osseous abnormalities seen. Extensive carotid siphon calcifications and\ncalcifications of the distal vertebral arteries and basilar artery are noted.\nOpacification of the left frontal sinus extending into the left anterior\nethmoid air cells is again noted. Additionally, a small air-fluid level in\nthe left sphenoid sinus is present. The orbits are unremarkable.", + "output": "1. Interval hemorrhage of a left posterior parietal metastatic lesion without\nmidline shift.\n2. Redemonstration of additional known metastatic lesions. No new metastatic\nlesions are definitely visualized, but MR would be more sensitive for\nassessment of known and new metastases." + }, + { + "input": "In comparison to ___ there appears to be new hemorrhage within the\nleft posterior parietal lobe metastatic lesion (02:26) measuring 2.9 x 1.8 cm\n(previously 2.6 x 2 cm). An adjacent 1.4 x 1.1 cm (02:25) hemorrhagic\nmetastatic lesion is seen along the left parafalcine region. There is\nsurrounding edema with local mass effect but no shift of midline structures.\nMultiple additional known supra tentorial metastatic lesions are again seen\nincluding right frontal lobe (02:30) measuring 1.1 cm, left frontal lobe\nmeasuring 0.7 cm (02:20), and right temporal lobe measuring 1 cm (02:13).\nThere is no evidence of infarction. Prominence of the ventricles and sulci\nare consistent with age-related cortical volume loss. Periventricular,\nsubcortical, and deep white matter hypodensities are likely sequela chronic\nsmall vessel ischemic disease. Calcification of bilateral cavernous portions\nof internal carotid arteries, basilar artery, and vertebral arteries is noted.\n\nNo osseous abnormalities seen. Near-complete opacification of the left\nfrontal sinus with aerosolized secretions as well as air-fluid level with the\nleft sphenoid sinus is noted. The additional visualize paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "1. New hemorrhage since CT of ___ within left posterior parietal lobe\nmetastatic lesion and left parafalcine metastatic lesion which are similar in\nsize to MRI of ___, and better characterized on previous MR.\n2. Multiple intracranial metastatic lesion as described above. No signs of\nherniation.\n3. Acute on chronic sinus disease." + }, + { + "input": "New punctate hyperdense foci in the superficial left parietal lobe (4:22)\nsuggest new hemorrhage of unclear etiology, as no underlying metastatic\nlesions were seen on the recent MRI.\n\nAllowing for differences in positioning, the 2 x 1.6 cm left parafalcine\nhemorrhagic metastasis and 3.1 x 1.6 cm left anterior parietal hemorrhagic\nmetastasis (04:29) are not significantly changed. Surrounding edema is\nunchanged.\n\nThe left frontal operculum hemorrhagic metastasis (04:21) is grossly\nunchanged, without edema.\n\nPreviously seen hyperdense metastasis in the medial right occipital lobe\n(04:17) has decreased central density and appears stable in size, without\nassociated edema.\n\nAdditional metastases demonstrated on the recent contrast enhanced MRI are not\nadequately reassessed on the present noncontrast CT. Multiple additional areas\nof vasogenic edema within the cerebral hemispheres are unchanged, most\nextensive in the right frontal and left parietal lobes. Compression of the\nposterior body and atrium of the left lateral ventricle is unchanged. The\nremainder the ventricular system is stable in size as well. There is no\nevidence for edema in the posterior fossa.\n\nNo suspicious lytic or sclerotic osseous lesions are seen. Fluid within the\nleft sphenoid sinus and opacification of the left frontal sinus could be due\nto prolonged supine positioning in the inpatient setting.", + "output": "1. New punctate hemorrhages in the superficial left parietal lobe (4:22) are\nof unclear etiology, as no underlying metastatic lesions were seen on the\nrecent brain MRI.\n2. The small hemorrhagic metastasis in the medial right occipital lobe (04:17)\nis stable in size with slightly decreased density of blood products.\n3. Hemorrhagic metastases in the left parafalcine, left anterior parietal, and\nleft frontal operculum regions are unchanged. Additional metastases\ndemonstrated on the recent MRI are not adequately assessed on the present\nnoncontrast CT.\n4. Multi focal edema in the cerebral hemispheres is unchanged. No edema is\nseen in the posterior fossa." + }, + { + "input": "There is expected evolution of the left parietal intraparenchymal hemorrhages\nwith stable amount of surrounding vasogenic edema in the region of the known\nmetastases better seen on prior MR. ___ metastases are vaguely\nidentified, specifically involving the medial left occipital and left frontal\nopercular lesion are less clearly seen on today's exam. The gray-white matter\ndifferentiation is maintained throughout. No new focus of hemorrhage. No shift\nof normally midline structures. Bilateral symmetric prominence of the\nventricles and sulci suggest cortical volume loss if are overall unchanged.\nThe perimesencephalic cisterns are patent.\n\nNo fracture. Opacification of the left frontal sinus persists. Mucosal\nthickening in the left sphenoid sinus is also overall unchanged. Otherwise,\nthe remaining paranasal sinuses, mastoid air cells, middle ear cavities are\nclear. The orbits are unremarkable.", + "output": "1. Expected evolution of left intraparenchymal hemorrhage with stable\nvasogenic edema.\n\n2. Known metastases are better seen on MRI.\n\n3. No new focus of hemorrhage." + }, + { + "input": "Redemonstrated are multiple bilateral parenchymal metastases, a left frontal\nhyperdense lesion measures 1.4 cm, minimally increased from prior examination.\nAdjacent left hypodense parieto-occipital lesions measure 1.5 cm and 2.3 cm,\nrespectively, not significantly changed from prior examination. Within the\nright parietotemporal lobe, there is a 3.5 cm hypodense lesion with a\nhyperdense rim and surrounding vasogenic edema, previously measuring 1.7 cm on\n___.\n\nThe ventricles and sulci are prominent, compatible with age related atrophic\nchanges. Periventricular and subcortical white matter hypodensities are\nnoted, likely the sequelae of chronic small vessel ischemic disease. The\nbasal cisterns are patent and gray-white matter differentiation is preserved. \nThere is no evidence of impending downward hemorrhage.\n\nNo osseous abnormalities seen. Calcifications are seen within the bilateral\ncavernous carotid and vertebral arteries. The paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The orbits are unremarkable.", + "output": "1. Interval increase in size of a now 3.5 cm centrally hypodense right\nparietotemporal lesion with associated vasogenic edema, previously measuring\n1.7 cm. Although this lesion causes mild associated mass effect, there is no\nappreciable midline shift or evidence of impending downward herniation.\n2. Multiple additional bilateral parenchymal lesions are largely similar as\ncompared to the prior examination dated ___." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. There is\nleft temporoparietal encephalomalacia. Sequela of prior left sided\nparenchymal hemorrhage centered in the insula is noted. The ventricles and\nsulci are normal in size and configuration for patient's age. There are dense\natherosclerotic calcifications of bilateral carotid siphons.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nethmoid air cells. The visualized portion of the remaining paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits show bilateral lens replacement.", + "output": "No acute intracranial process." + }, + { + "input": "VP shunt is in place via a right frontal burr hole, with tip near foramen of\n___, stable in position since prior exam. The lateral, third ventricles are\nslit-like and nearly completely collapsed, they have decreased compared with\nthe prior exam, correlate clinically for over shunting. There are no\nextra-axial fluid collections. There is no evidence of infarction,\nhemorrhage, edema, or mass.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. There is VP shunt in place. Ventricles are slit-like, please clinically\ncorrelate for over shunting." + }, + { + "input": "NECT:\nNo intracranial hemorrhage. Loss of gray-white differentiation is identified\nin the medial left occipital region, suspicious for acute/subacute infarct.\n\nEncephalomalacia in the left precentral gyrus likely a sequela of old infarct.\nA punctate hyperdensity in the left cerebellar hemisphere is unchanged\n(02:12), and may represent a chronic punctate microhemorrhage or potentially a\ncavernoma.\n\nThe ventricles and sulci are mildly prominent. Periventricular and\nsubcortical white matter hypodensities are noted, a nonspecific finding that\nmost likely represents the sequelae of chronic small vessel ischemic disease.\n\nThe mastoid air cells and paranasal sinuses are clear. The orbits are\nunremarkable bilaterally.\n\n\nCTA HEAD AND NECK:\nIncidentally noted is an aberrant right subclavian artery which demonstrates a\nretropharyngeal course. The vertebrobasilar system is left-sided dominant, a\nnormal variant. Calcifications are seen within the left V4 segment. The\ndiminutive right vertebral artery terminates in the posterior inferior\ncerebellar artery.\n\nThe common carotid arteries are patent bilaterally. Minimal calcifications\nare seen at the carotid bulbs. There is no evidence for internal carotid\nartery stenosis by NASCET criteria.\n\nMild calcifications are seen involving the bilateral cavernous internal\ncarotid arteries. The distal left posterior cerebral artery is difficult to\ntrace as it travels posteriorly at the margin of area of hypodensity in the\nleft occipital region, with apparent focal stenosis (3:309).\n\nMultiple prominent vessels are identified in the posterior fossa. A focally\ndilated venous structure measures 7 mm near the cerebellar vermis (3:289).\n\nThe remainder of the intracranial arterial vasculature appears grossly patent\nwithout additional sites of high-grade stenosis, occlusion, or aneurysm. The\nright posterior cerebral artery demonstrates a fetal origin, a normal variant.\nThe dural venous sinuses are grossly patent.\n\n\nOTHER:\nThe visualized lung apices are clear. The thyroid gland is unremarkable. No\nevidence for pathologically enlarged cervical lymph nodes.", + "output": "1. Loss of gray-white matter differentiation along the left paramedian\noccipital lobe with associated focal occlusion of the distal left posterior\ncerebral artery. Taken together, these findings are concerning for evolving\nacute infarction.\n2. No evidence for acute intracranial hemorrhage.\n3. Otherwise patent intracranial and cervical vasculature without additional\nsite of high-grade stenosis, occlusion, or aneurysm.\n4. Subcentimeter focal hyperdensity in the left cerebral hemisphere,\ncorrelating with areas of susceptibility artifact on previous MRI examination.\nThis finding taken together with a tangle of abnormal vessels adjacent the\nleft cerebellar vermis suggests a cavernoma with associated developmental\nvenous anomaly. Additional considerations include avascular malformation\nwhich could be further assessed by MRA if clinically indicated.\n5. Additional findings, as above.\n\nNOTIFICATION: Findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 4:41 pm, 5 minutes after discovery of\nthe findings." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Chronic infarct involving the right basal ganglia is\npresent with associated ex vacuo dilatation of the right lateral ventricle. \nChronic lacune in the right thalamus is also detected. Confluent\nperiventricular , subcortical, and deepwhite matter hypodensities are\nnonspecific, but likely reflect the sequela of chronic microvascular\ninfarction. Punctate focus of hyperdensity within the right frontal white\nmatter (02:22) may reflect an area of mineralization.\n\nThere is no evidence of acute fracture. Mild mucosal thickening is seen\nwithin the left sphenoid sinus. The visualized portion of the remaining\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable apart from bilateral lens\nreplacements. Extensive atherosclerotic calcifications of the cavernous\ncarotid and distal left vertebral arteries are noted.", + "output": "1. No acute intracranial hemorrhage or mass effect.\n2. Remote right basal ganglia infarct. Chronic small right thalamic lacunar\ninfarct.\n3. Chronic microvascular infarction and moderate global atrophy." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of age-related involutional\nchanges.\n\nThere is no evidence of acute fracture. Lucency extending along bilateral\ncoronoid processes are unchanged from ___ (3A: 25). The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are notable for bilateral\nocular surgery.", + "output": "1. No acute intracranial process. Specifically no intracranial hemorrhage.\n2. Chronic age related changes as described above." + }, + { + "input": "The palatine tonsils are enlarged, right more than left. Within the right\npalatine tonsil, there is a 1.6 x 0.9 x 1.6 cm hypoenhancing collection,\ndenser than expected for fluid, and without rim enhancement. This likely\nrepresents a phlegmon without a fully formed abscess. Calcifications in the\nleft tonsil are likely sequela of prior infections. There is no associated\nnarrowing of the airway. Bilateral level 2A lymph nodes are top-normal in\nsize, 1.5 cm in long axis diameter, likely reactive. Salivary glands and\nthyroid gland appear unremarkable. The imaged upper lungs are clear. The major\nvascular structures of the neck appear patent. In the cervical spine at C5-6,\nthere is a disc osteophyte complex mildly indenting the ventral thecal sac.", + "output": "Tonsillitis. 1.6 x 0.9 x 1.6 cm collection in the right tonsil, denser than\nfluid and without rim enhancement, likely represents a phlegmon with a\npossible developing, but not fully formed abscess.\n\nNOTIFICATION: Results were discussed with Dr. ___ with Dr. ___ on ___ at 16:10 by telephone." + }, + { + "input": "There is no evidence of acute hemorrhage mass effect midline shift or\nhydrocephalus. Gray-white matter differentiation is maintained.\n\nThe visualized paranasal sinuses are clear. No skull fracture is seen.", + "output": "No acute intracranial abnormalities are identified." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. There are 2 discrete subependymal nodules along the left lateral\nventricle which can be seen on series 2, image 18, measuring approximately 9 x\n10 mm and 10 x 13 mm. These lesions have a similar density to gray matter and\ncould represent areas of gray matter heterotopia versus hamartomas. There is\nmild periventricular white matter hypodensity which could reflect chronic\nmicrovascular ischemic disease. An extra-axial calcified lesion is seen at\nthe left frontal vertex measuring 10 x 8 mm likely a small meningioma. Age\nappropriate involutional changes in the ventricles are normal in size.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. Densities within the left external ear canal probably\nrepresents cerumen. The visualized portion of the orbits are normal.", + "output": "1. No acute hemorrhage.\n2. Subependymal nodules along the left lateral ventricle which could\nrepresent hamartomas versus heterotopic gray matter, consider MRI to further\nassess.\n3. Probable small calcified meningioma at the left frontal vertex.\n4. Mild small vessel disease.\n\nRECOMMENDATION(S): Nonemergent MRI of the brain with contrast." + }, + { + "input": "Several masses in the left basal ganglia and along the posterior horn of the\nleft lateral ventricle (2:16) measuring up to 2.7 cm are all markedly bigger,\npreviously up to 1.6 cm. Central hypodensity seen within the posterior mass\nmay represent edema or internal necrosis. There is no significant vasogenic\nedema surrounding these masses. There are local mass effects on the left\nlateral ventricle. There is no CT evidence of hydrocephalus. No midline\nshift.\n\nA calcified meningioma at the left skull vertex is unchanged.\n\nThere is no evidence of fracture, infarction,or hemorrhage.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. Several left brain masses measuring up to 2.7 cm are markedly bigger from\n___, highly suspicious for metastatic disease given history of lung\ncancer. Local mass effect on the left lateral ventricle.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 8:25 pm, 2 minutes after discovery\nof the findings." + }, + { + "input": "No evidence of acute infarction. Multiple slightly hyperdense metastases are\nredemonstrated in the left basal ganglia, adjacent to the caudate head with\nextension into the lateral ventricle, along the left centrum semiovale, and\nabutting the left splenium of the corpus callosum. The masses along the\ncaudate head and left centrum semiovale are decreased in size. Given that the\nmasses are intrinsically hyperdense, it is impossible to exclude hemorrhage\nwithin the masses. Vasogenic edema and mass effect is not appear increased.\n\nVentricular size is slightly increased. Calcified round mass arising from the\ninner table of the left parietal bone most likely reflects a meningioma,\nunchanged.\n\nThere is mild mucosal thickening of the anterior ethmoid air cells. The\nvisualized portion of the mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are normal.", + "output": "1. No acute infarction.\n2. Slight interval increase in the diameter of the lateral and third\nventricles, suspicious for developing hydrocephalus.\n3. Multiple hyperdense masses are redemonstrated, better evaluated on the MRI\nperformed ___. Impossible to exclude hemorrhage within the masses,\ngiven intrinsic hyperdensity. There is decrease in the size of the metastases\nis abutting the left lateral ventricle. These are better evaluated on MRI." + }, + { + "input": "NON-CONTRAST HEAD CT: There is no evidence of hemorrhage. Chronic appearing\nleft medial occipital encephalomalacia is compatible with a chronic infarct. \nThere is prominence of the ventricles, cisterns and sulci related to volume\nloss and dense calcific arteriosclerosis of the intracranial arteries. In\naddition, hypodense appearance to the periventricular and cerebral white\nmatter is compatible with underlying microvascular ischemic change. There is\nno large territorial infarct apparent on the precontrast portion of the study.\nThe patient is status post bilateral lens surgery.\n\nCTA NECK: There are regions of moderate motion artifact.\n\nThere is three-vessel aortic arch with mild calcific arteriosclerosis but no\nevidence of flow-limiting disease. The left vertebral artery is markedly\ndominant. The right terminates as the ___. The distal left vertebral artery\nbecomes mildly dolichoectatic. There are regions of mild calcific\narteriosclerosis but no flow-limiting disease. The common carotid arteries\nare tortuous, coursing medially in the lower cervical region. The carotid\nbifurcations have moderate calcific arteriosclerosis without flow-limiting\ndisease. A wispy linear filling defect within the left internal carotid\nartery origin, tapering through the proximal cervical left internal carotid\nartery may represent a focal dissection or complex atheromatous plaque.\n\nCTA HEAD: The markedly dominant left vertebral artery is densely calcified\nbut shows no flow-limiting stenosis.\n\nThe carotid siphons are densely calcified with at least moderate narrowing in\nthe supraclinoid regions. In addition, there is a moderate-to-severe\natherosclerotic irregularity of the M1 segments of the middle cerebral\narteries bilaterally, as well as of the posterior greater than anterior\ncerebral arteries. The left A1 segment is slightly hypoplastic. No posterior\ncommunicating arteries are identified. There is no evidence of large vessel\nocclusion. There is no evidence of aneurysm.\n\nDegenerative osseous changes are noted. A 1-cm density within the right body\nof the mandible may represent a tooth remnant. There is no destructive\nosseous lesion. There are numerous thyroid nodules.\n\nCT PERFUSION: The CT perfusion maps demonstrate increased mean transit time\nwithin the right posterior frontal/anterior parietal lobes with similar defect\non the cerebral blood volume and cerebral blood flow maps.", + "output": "1. Matched MTT/CBV/CBF defect of the right frontal/pareital region compatible\nwith MCA territory infarct. No infarct is appreciated on the noncontrast\nportion of the study, likely because the infarct is acute.\n2. No evidence of intracranial hemorrhage.\n3. Extensive calcific arteriosclerosis, particularly intracranially, with\nregions of moderate-to-severe narrowing but no evidence of large vessel\nocclusion and no aneurysm.\n4. No flow-limiting disease within the neck. A thin linear filling defect\nwithin the left internal carotid artery origin, may represent a focal\ndissection or complex atheromatous plaque.\n5. Multinodular thyroid. Consider followup ultrasound if not already\nevaluated elsewhere." + }, + { + "input": "The fat planes of the supra and infra hyoid neck compartments are preserved.\nThe aerodigestive tract demonstrates no exophytic mucosal mass or focal areas\nof mass effect. The tonsils and salivary glands are unremarkable. The\nsubmandibular soft tissues are within normal limits. There is no subcutaneous\nstranding to suggest infection. The nasopharyngeal and oropharyngeal soft\ntissues are unremarkable.\n\nNo cervical lymphadenopathy is seen. Multiple cervical lymph nodes are not\nenlarged by CT size criteria. The thyroid gland is enlarged with a\nheterogeneous attenuation and at least 2 discrete nodules in the right lobe. \nMeasurements are limited by overlying artifact, however the largest nodule\nappears to measure approximately 14 mm in diameter. The cervical vessels\nenhance without evidence of high-grade stenosis or occlusion although this\nstudy is not as optimal as a dedicated CTA.\n\nThe imaged intracranial structures are unremarkable. There is a periapical\nlucency about the root ___ tooth 9 suggestive of periodontal disease. There\nis no evidence of phlegmon or cellulitis in the adjacent soft tissues. Torus\npalatinum is incidentally noted.\n\nSevere emphysematous changes are seen in both lung apices.\n\nMultilevel, multifactorial degenerative changes are seen throughout the\nvisualized cervical spine. There is no osseous destructive lesion concerning\nfor malignancy within the cervical spine.", + "output": "1. No cervical lymphadenopathy.\n\n2. Enlarged and heterogeneous appearing thyroid may be further evaluated with\nultrasound on a nonemergent basis.\n\n3. Periapical lucency about the root ___ tooth 9 compatible with\nperiodontal disease.\n\n4. Severe emphysematous changes of both lung apices." + }, + { + "input": "There is no evidence of territorial infarction, intracranial hemorrhage,\nedema, or mass. The ventricles and sulci are prominent consistent with\ninvolutional changes. Periventricular white matter hypodensities are\nnonspecific but suggest chronic ischemic small vessel changes.\n\nNo osseous abnormalities seen. There is opacification of the left mastoid air\ncells and middle ear, suggesting an ongoing inflammatory process. The orbits\nare unremarkable.", + "output": "1. No evidence of acute intracranial process or hemorrhage.\n\n2. Opacification of the left mastoid air cells and middle ear, suggesting an\nongoing inflammatory process, please correlate." + }, + { + "input": "There is no evidence of acute vascular territorial infarction, hemorrhage,\nedema, or mass effect. The ventricles and sulci are again prominent distant\nwith age-related involutional change. Periventricular and subcortical white\nmatter hypodensities are nonspecific, but likely represent sequela of chronic\nmicrovascular disease.\n\nNo acute fractures seen. There is minimal opacification of the left mastoid\nair cells, improved compared to prior. There is new minimal mucosal\nthickening in the right mastoid air cells. Otherwise, the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no acute hemorrhage mass effect midline shift or hydrocephalus. \nThere is prominence of sulci indicating brain atrophy. Sulcal prominence\nappears more pronounced on the current study which is likely secondary to\ndifferences in angulation and slice selection. The ventricular size is\nunchanged. Mild changes of small vessel disease are seen. No new areas of\nhypodensity are identified otherwise.", + "output": "No acute abnormalities or significant change since the previous CT of ___." + }, + { + "input": "There is interval expected evolution of the subarachnoid hemorrhage seen on ___. There is no new hemorrhage. There is interval improvement in\nappearance of the right posterior scalp hematoma. There is no edema, shift of\nnormally midline structures, or CT evidence of acute major vascular\nterritorial infarction. Ventricles and sulci are normal in overall size and\nconfiguration.\n\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact. There is a metallic\nclip lateral to the orbital rim of unknown etiology but external to the\npatient, possibly a ring.", + "output": "1. Expected evolution of the subarachnoid hemorrhage seen on ___ and\ninterval improvement in the right posterior scalp hematoma without evidence of\nnew hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nExtensive right-sided facial bone fractures including comminuted fractures\nthrough all walls of the maxillary sinus, the zygomatic arch, and lateral and\ninferior orbital walls, coronoid process of the mandible, will be detailed on\ndedicated maxillofacial bones CT. There is extensive air surrounding the\nright orbit and extending into the extraconal fat. Right globe appears\nintact. There is a soft tissue hematoma inferior to the right zygoma.", + "output": "1. No intracranial hemorrhage.\n2. Right-sided facial bone fractures, including of the lateral and inferior\norbital wall, zygomatic arch, and all walls of the maxillary sinus will be\ndetailed on dedicated maxillofacial bones CT." + }, + { + "input": "There are multiple prominent lymph nodes noted bilaterally at several cervical\nlymph node stations, none of which are pathologically enlarged by CT size\ncriteria. A dominant lymph node is noted at the left level II a station,\nmeasuring up to 8 mm in short axis (02:27).\n\nEvaluation of the aerodigestive tract demonstrates no focal enhancing mass. \nHowever, there is asymmetry to the true vocal cords (02:40). Asymmetry is\nalso noted within the inferior left piriform sinus (02:35).\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding.Multiple thyroid nodules measure up to 1.2 cm (02:58) within the\nright thyroid lobe, demonstrating mixed solid and cystic components with a\nperipheral calcification. The neck vessels are patent.\n\nLimited evaluation of the intracranial contents is grossly unremarkable. \nMultilevel spondylosis of the cervical spine is noted without critical canal\nstenosis.\n\nFor description of the intrathoracic findings, please see the separate\ndedicated CT chest examination performed on the same day.", + "output": "1. Multiple bilateral cervical lymph nodes measuring up to 8 mm in short axis\nat the left level IIa station. None of which are pathologically enlarged by\nCT size criteria.\n2. Asymmetry to the true vocal cords and inferior left piriform sinus. If\nthere is ongoing clinical concern, recommend correlation with direct\nvisualization.\n3. Multiple thyroid nodules measuring up to 1.2 cm on the right demonstrating\nperipheral calcification.\n4. For description of the intrathoracic findings, please see the separately\ndictated CT chest examination.\n\nRECOMMENDATION(S): Thyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or older, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding.Again seen are stable right 2 thyroid nodules, larger measures 1.3\ncm..There is no lymphadenopathy by CT criteria.Previously seen bilateral neck\nsubcentimeter lymph nodes have decreased in size, largest measures 0.7 cm\nshort axis, normal by morphologic and size criteria. The neck vessels are\npatent.\n\nPlease refer to chest CT report from today for thoracic findings. There is\nirregular lobular nodular opacity along the posterior margin of the left upper\nlobe. There is residual oral contrast in the hypopharynx, may be residua from\ningested oral contrast, versus reflux. There are trace secretions at the\nlevel of the glottis, and subglottis, clinically correlate to exclude\naspiration. Mild medial deviation of the left false vocal cords, with near\ncomplete obliteration of the level of the glottis providing adequate\nevaluation, probably normal anatomic orientation of the true vocal cords.\n\nThere are no osseous lesions. Port-A-Cath in place. Mild paranasal sinus\ndisease, with mucosal thickening", + "output": "1. No adenopathy.\n2. Indeterminate left lung nodule, better seen on chest CT from today.\n3. Small volume subglottic secretions, consider aspiration.\n4. Stable thyroid nodules." + }, + { + "input": "Aero digestive tract: There no evidence for an exophytic mucosal mass. \nAdenoids and tonsils are not enlarged.\n\nNeck lymph nodes: There is bilateral supraclavicular lymphadenopathy. The\nlargest nodes measure 1.6 x 1.2 cm on image 3:15 on the right, 1.5 x 1.1 cm on\nimage 3:17 on the right, 1.6 x 1.4 cm on image 3:18 on the left. 0.6 cm right\nlevel IIIb lymph node on images 3:25, 6:34 is not enlarged by CT criteria, but\nslightly asymmetric.\n\nExtra nodal tumor spread: There is mild fat stranding surrounding a 0.9 x 0.65\ncm right supraclavicular lymph node on image 3:20, of uncertain clinical\nsignificance.\n\nDeep neck muscles, masticator space: No concerning findings.\n\nBones, skull base:\nNo evidence for suspicious bone lesions. Extensive facet arthropathy in the\ncervical spine.\n\nVessels: Right Port-A-Cath is partially imaged. Calcified plaque is seen at\nbilateral internal carotid artery origin; this exam is not technically\noptimized for calculating carotid stenosis. Mixed atherosclerotic plaque is\nalso seen within proximal left common carotid and bilateral subclavian\narteries. Internal jugular veins are patent.\n\nThyroid, salivary glands: The thyroid is unremarkable. No evidence for\nintraparotid lymphadenopathy or mass. Submandibular glands are unremarkable.\n\nOther findings: Concurrent chest CT is reported separately. Included brain\nparenchyma was better assessed on the brain MRI from 1 day prior. Mastoid air\ncells and partially included paranasal sinuses appear grossly well-aerated.", + "output": "1. Bilateral, right greater than left supraclavicular lymphadenopathy,\nmeasuring up to 1.6 cm bilateral, with FDG avidity on the concurrent PET-CT,\nconsistent with lymphomatous involving. Mild fat stranding surrounding a 0.9\ncm right supraclavicular lymph node is of uncertain significance with regard\nto possible extranodal spread.\n2. 0.6 cm right level IIIb lymph node is not enlarged by CT criteria but\nslightly asymmetric." + }, + { + "input": "Aero digestive tract: There is no mass.\n\nNeck lymph nodes: In comparison to the study of ___, there are\npersistent, slightly smaller, bilateral supraclavicular lymphadenopathy, the\nlargest measuring 1.2 x 1.3 cm (4:140) on the right and 1 x 0.65 cm on the\nleft (4:147), previously 1.5 x 1.1 cm and 1.4 x 1.6 cm, respectively. \nAdditionally, there is a 1.1 x 0.7 cm right supraclavicular lymph node,\npreviously measuring 1.2 x 1.6 cm (4:152). No new lymphadenopathy.\n\nExtra nodal tumor spread: There are no findings suggestive of extra nodal\nextension.\n\nDeep neck muscles, masticator space: There is no muscle invasion.\n\nBones, skull base:\nMild degenerative changes of the visualized spine. Stable grade 1\nanterolisthesis of C3 on C4, C4 on C5, C5 on C6. Unchanged facet arthropathy\nnoted in the cervical spine.\n\nVessels: There is no vascular invasion. Patent dural venous sinuses. \nPartially visualized right porta catheter traversing through subclavian\nvessel. Atherosclerotic vascular calcifications are noted at the carotid\nsiphons and bilateral internal carotid arteries (03: 33, 37).\n\nBrachial Plexus: There is no brachial plexus contact or invasion.\n\nThyroid, salivary glands: There is no mass.\n\nOther findings: There are no lung nodules. Patient status post bilateral lens\nreplacements. Partially visualized paranasal sinuses, mastoid air cells and\nmiddle ear cavities are unremarkable.", + "output": "1. Bilateral, slightly smaller, supraclavicular lymphadenopathy compared to\nprior. No new lymphadenopathy.\n2. Please refer to the same day dedicated CT chest, abdomen and pelvis report\nfor further findings." + }, + { + "input": "Aero digestive tract: There is no mass.\n\nNeck lymph nodes: Small bilateral supraclavicular lymph nodes are again\ndemonstrated. The largest on the right now measures 11 x 8 mm on image 121 of\nseries 30, previously 11 x 7 mm. The second larger 13 x 12 mm lymph node\ndescribed on the previous examination is not seen with certainty today. The\nlargest on the left measures approximately 10 x 8 mm compared to 10 x 7 mm\npreviously. No new lymphadenopathy is seen elsewhere.\n\nExtra nodal tumor spread: There are no findings suggestive of extra nodal\nextension.\n\nDeep neck muscles, masticator space: There is no muscle invasion.\n\nBones, skull base:\nThere is no bone involvement.\nThere are no findings suggestive of perineural tumor extension. Jugular\nforamen, carotid canal, pterygopalatine fossa, infraorbital foramen, other\nskull base foramina are not involved.\nMild degenerative changes are again seen in the cervical spine as well as\nanterolisthesis C3 on C4, C4 on C5, and C5 on C6. Multilevel facet\narthropathy. Minimal mucosal thickening in the inferior maxillary sinuses. \nDebris in the external auditory canals, probably cerumen.\n\nVessels: There is no vascular invasion. The right chest wall port is noted.\n\nBrachial Plexus: There is no brachial plexus contact or invasion.\n\nThyroid, salivary glands: There is no mass.\n\nOther findings: Please refer to the separate chest CT for thoracic findings.", + "output": "1. Small supraclavicular lymph nodes are again demonstrated. The largest on\nthe right is noted an essentially stable 11 x 8 mm lymph node, with the\nprevious 12 x 13 mm lymph node on the right not convincingly demonstrated on\nthe current exam. There is no new lymphadenopathy." + }, + { + "input": "Aero digestive tract:\n\nThere no mass.\n\nNeck lymph nodes:\nA left supraclavicular lymph node measures approximately 10 x 8 mm, previously\n12 x 9 mm (3:18). On the right, a supraclavicular lymph node measures\napproximately 9 x 12 mm, previously 7 x 11 mm (3:122). A pretracheal lymph\nnode measures 8 x 8 mm, unchanged (3:137). No additional abnormal lymph nodes\nare seen in the neck.\n\nThere is no retropharyngeal adenopathy.\n\nExtra nodal tumor spread:\nThere are no findings suggestive of extra nodal extension.\n\nDeep neck muscles, masticator space:\nThere is no muscle invasion.\n\nBones, skull base:\nThere is no bone involvement.\nThere are no findings suggestive of perineural tumor extension.\nJugular foramen, carotid canal,pterygopalatine fossa,infraorbital\nforamen,other skull base foramina are not involved.\n\nVessels:\nThere is no vascular invasion. Predominantly calcified plaque, without\nsignificant is redemonstrated at both carotid bifurcations stenosis.\n\nBrachial Plexus:\nThere is no brachial plexus contact or invasion.\n\nThyroid, salivary glands:\nThere is no mass.\n\nOther findings:\nMild paranasal sinus disease is partially imaged, including a mucous retention\ncyst in the right maxillary sinus. Partially imaged orbits are notable for\nchanges from bilateral lens surgery.\n\nPlease refer to the separately dictated CT chest report performed concurrently\nfor a complete description of thoracic findings including a small left pleural\neffusion.", + "output": "1. No significant change 2 bilateral supraclavicular lymph nodes and a\npretracheal lymph node as described above.\n2. Please refer to the separately dictated CT chest report performed\nconcurrently for description of thoracic findings." + }, + { + "input": "Aero digestive tract:\n\nThere is no mass.\n\nNeck lymph nodes:\nA left supraclavicular lymph node abnormal rounded morphology now measures\napproximately 8 x 8 mm, previously 10 x 8 mm.\n\nA right supraclavicular lymph node with rounded morphology now measures\napproximately 10 x 8 mm, previously 9 x 12 mm.\n\nA pretracheal lymph node measures approximately 6 x 8 mm, minimally decreased\nin size.\n\nNo new lymphadenopathy is seen in the neck\n\nExtra nodal tumor spread:\nThere are no findings suggestive of extra nodal extension.\n\nDeep neck muscles, masticator space:\nThere is no muscle invasion.\n\nBones, skull base:\nThere is no bone involvement.\nThere are no findings suggestive of perineural tumor extension.\nJugular foramen, carotid canal,pterygopalatine fossa,infraorbital\nforamen,other skull base foramina are not involved.\n\nVessels:\nThere is no vascular invasion. Atherosclerotic plaque is noted at both\ncarotid bifurcations. There is a right chest wall port with catheter entering\nvia an IJ approach.\n\nBrachial Plexus:\nThere is no brachial plexus contact or invasion.\n\nThyroid, salivary glands:\nThere is no mass.\n\nOther findings:\nPlease refer to the separate chest CT for thoracic findings. There is mild\nparanasal sinus disease with mucosal thickening in the maxillary sinuses and a\nsmall right maxillary sinus mucous retention cyst.", + "output": "1. Decreased size of bilateral supraclavicular lymph nodes and slight decrease\nin size of a pretracheal lymph node as described above.\n2. Please refer to separate chest CT for thoracic findings." + }, + { + "input": "Aero digestive tract:\n\nThere no mass.\n\nNeck lymph nodes:\nUnchanged bilateral supraclavicular small rounded lymph nodes measuring 10 x 8\nmm on the right side and 8 x 8 mm on the left side on maximum axial dimension.\nAlso; unchanged superior mediastinal small rounded lymph node measuring 7 x 6\nmm maximal axial dimension.\nThere is no new adenopathy involving bilateral levels ___.\nThere is no retropharyngeal adenopathy.\n\nExtra nodal tumor spread:\nThere are no findings suggestive of extra nodal extension.\n\nDeep neck muscles, masticator space:\nThere is no muscle invasion.\n\nBones, skull base:\nThere is no bone involvement.\nThere are no findings suggestive of perineural tumor extension.\nJugular foramen, carotid canal,pterygopalatine fossa,infraorbital\nforamen,other skull base foramina are not involved.\n\nVessels:\nThere is no vascular invasion. Atherosclerotic vascular calcifications are\nnoted in the carotid arteries.\n\nBrachial Plexus:\nThere is no brachial plexus contact or invasion.\n\nThyroid, salivary glands:\nThere is no mass.\n\nOther findings:\nThere is redemonstration of right Port a cath passing through right subclavian\nvein and superior vena cava and its tip is not included. Please refer to CT\nchest done same day for intrathoracic findings. Small mucous retention cyst\nat right maxillary sinus.\nDegenerative changes of the spine", + "output": "1. Stable bilateral supraclavicular small lymph nodes.\n2. No new enlarging neck lymphadenopathy." + }, + { + "input": "There is a incompletely visualized right internal jugular tunneled catheter.\n\nAero digestive tract:\nThe airway and digestive tract are unremarkable in appearance. No enhancing\nlesion is identified along the mucosa.\n\nNeck lymph nodes:\nThere is a mildly prominent midline superior mediastinal lymph node measuring\n8 x 16 x 11 mm (AP by transverse by SI) (series 3, image 65). Appearance is\nnot significantly changed from ___ examination.\nThere is a mildly prominent left supraclavicular measuring 7 x 7 x 5 mm (AP by\ntransverse by SI) (series 3, image 59), unchanged.\nThere is a stable mildly prominent right supraclavicular lymph node (series 3,\nimage 62), measuring 6 x 8 by 5 mm (AP by transverse by SI), unchanged.\nThere is no retropharyngeal adenopathy.\n\nDeep neck muscles, masticator space:\nUnremarkable\n\nBones, skull base:\nThere is mild degenerative change of the cervical spine with bilateral facet\narthropathy. There is degenerative change of the left temporomandibular\njoint. There is a stable lucent focus in the left occipital calvarium (series\n4, image 69) consistent with arachnoid granulation, as are 2 additional\nsimilar appearing foci on image 61 and 58 of series 4.\n\nVessels:\nThere is calcified atherosclerotic disease of the bilateral carotid bulbs and\ncavernous internal carotid arteries.\n\nBrachial Plexus:\nUnremarkable\n\nThyroid, salivary glands:\nThe thyroid gland and submandibular glands are unremarkable in appearance.\n\nOther findings:\nThere is ill-defined ground-glass opacity in the anterior left lung apex. The\npatient has had bilateral cataract surgeries. There is incidental note of a\ntorus palatini. Small right maxillary sinus mucous retention cyst. Right IJ\ncatheter from chest wall port.", + "output": "1. Stable appearing prominent lymph nodes involving the bilateral\nsupraclavicular and suprasternal regions. No new adenopathy identified." + }, + { + "input": "The parotid glands, submandibular glands, and thyroid are unremarkable. There\nis no cervical adenopathy. Subcentimeter bilateral supraclavicular lymph\nnodes are unchanged.\n\nThe aerodigestive tract appears normal. Included paranasal sinuses and\nmastoids are clear.\n\nVascular structures in the neck are notable for atherosclerotic calcifications\nat the carotid bulbs. Right chest wall port catheter is partially visualized.\n\nIncluded intracranial structures appear normal.\n\nNo focal suspicious osseous lesion identified. Degenerative changes in the\nspine most notable for multilevel facet joint hypertrophy is seen previously. \nGround-glass opacity in the anterior left lung apex is unchanged.", + "output": "No cervical adenopathy. No change since prior." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nAgain seen are postsurgical changes related to prior resection of known right\nplanum sphenoidale meningioma, including craniotomy and cranioplasty. No\nevidence for acute infarction, edema, acute hemorrhage, or mass effect. \nNormal size of the ventricles, sulci, and basal cisterns.\n\nThere is a small mucous retention cyst along the floor of the right maxillary\nsinus. Other paranasal sinuses are well-aerated. Mastoid air cells appear\ngrossly well-aerated. The orbits appear unremarkable.\n\nCTA NECK:\nThere is common origin of the innominate and left common carotid arteries, a\nnormal variant. There artifacts through the proximal great vessels. Apparent\nlinear hypodensity at the origin of the right common carotid artery, deep to\nthe right clavicle, most likely represents an artifact, less likely a web\n___, 3:61).\n\nThere is minimal noncalcified plaque at the left carotid bulb without stenosis\nby NASCET criteria. There is no right carotid stenosis by NASCET criteria.\n\nStreak artifact from concentrated contrast in the adjacent veins limits\nevaluation of the V1 and proximal V2 segment of the left vertebral artery. \nCervical vertebral arteries otherwise appear widely patent.\n\nCTA HEAD:\nNo evidence for flow-limiting stenosis in the major intracranial arteries. \nRight A1 segment is mildly hypoplastic, as seen on multiple prior MRIs. There\nis are two small adjacent clusters of prominent blood vessels along the right\npericallosal artery, images 3:286 and 3:291. A small aneurysm or\narteriovenous malformation in this area is difficult to exclude. The dural\nvenous sinuses are patent.\n\nOTHER:\nThe visualized portion of the lungs demonstrate dependent atelectasis but\notherwise appear clear. Unchanged approximately 2.5 cm dominant right thyroid\nnodule. Please refer to report from thyroid ultrasound dated ___. \nThere is no lymphadenopathy by CT size criteria. There are multilevel\ndegenerative changes in the cervical spine.", + "output": "1. No evidence for acute intracranial abnormalities. Postsurgical changes\nrelated to prior resection of known right planum sphenoidale meningioma.\n2. Apparent linear hypodensity at the origin of the right common carotid\nartery, deep to the right clavicle, in area of artifacts, most likely\nrepresents an artifact. Otherwise, unremarkable CTA of the neck.\n3. Two small adjacent clusters of prominent blood vessels along the right\npericallosal artery, images 3:286 and 3:291. A small aneurysm or arteriovenous\nmalformation in this area is difficult to exclude. This may be better\nassessed by a conventional cerebral angiogram.\n4. Approximately 2.5 cm right thyroid nodule, last assessed by ultrasound on\n___.\n\nRECOMMENDATION(S): Recommend vascular neurosurgery consultation for determine\nwhether a cerebral angiogram is warranted.\n\nNOTIFICATION: Dr. ___ the ___ QA nurses list at 6:08 p.m. on ___ regarding the impression item 3 and the recommendations above." + }, + { + "input": "The frontal sinuses and frontoethmoidal recesses are clear. There is trace\nmucosal thickening of the anterior ethmoid air cells. The sphenoid sinuses\nand sphenoethmoidal recesses are clear. There is mild bilateral maxillary\nsinus mucosal thickening, with mucous retention cyst in the right maxillary\nsinus. The ostiomeatal units are patent. There is a prominent Haller cell on\nthe left. The nasal septum is mildly deviated to the left.\n\nThe cribriform plates are intact. The lamina papyracea are intact. The\nanterior clinoid processes are not pneumatized. The right carotid canal\nindents mildly into the right sphenoid sinus, and the underlying bone appears\nvery thin.\n\nPostsurgical changes from right craniotomy and cranioplasty are noted. The\nimaged soft tissues are unremarkable. Limited evaluation of the intracranial\ncontents is grossly unremarkable.", + "output": "Mild paranasal sinus disease involving the maxillary sinuses and anterior\nethmoid air cells. Patent ostiomeatal units." + }, + { + "input": "-Soft tissue nodule is noted in the right thyroid lobe, measuring 25 x 24 x 34\nmm (AP,TV,SI directions; respectively) (303: 107). This appears hypodense on\nthe noncontrast images avidly enhancing on the arterial phase, with partial\nwashout on the delayed phase. Taking into account the appearance on the\nultrasound, this is consistent with a primary thyroid nodule which also took\nup the sestamibi on the nuclear medicine scan. In addition, there may be 1 or\n2 small adjacent lymph nodes centrally and posteromedially adjacent to the\nesophagus.\n-There are 2 extrathyroidal nodules on the right side, 1 posteromedial to the\nupper pole, almost in a retroesophageal location, small it certainly\ncompatible with the normal right upper pole parathyroid gland, all minimally\nenlarged.\n-A similar finding is also noted at the right lower pole, medial in on the\ntracheal surface. And consistent with a a normal to minimally enlarged right\nlower pole parathyroid gland.\n-Soft tissue nodule with cystic changes is noted posteromedial to mid pole\nleft thyroid lobe at left tracheoesophageal groove inferior to level of\ncricoid cartilage, measuring 8 x 11 x 16 mm (AP,TV,SI directions;\nrespectively) (303:102). This appears hypodense on the noncontrast images,\navidly enhancing on the arterial phase, with partial washout on the delayed\nphase; consistent with a parathyroid adenoma.\n\n-Small soft tissue nodule is noted posterior to inferior left thyroid lobe\nlateral to the trachea measuring about 4 x 2 x 2 mm (303: 147). This is\nsuggestive of a slightly enlarged right lower pole parathyroid gland. In\naddition, posterior to the mid to upper pole of the left thyroid lobe is a\nmulti lobular nodule projecting posteriorly, partially cystic which\ndemonstrated hypervascularity on ultrasound and shows partial enhancement and\nwashout. Although this could possibly represent an exophytic thyroid nodule,\nis more likely to represent an unusual lobular, partially cystic parathyroid\nadenoma. There is a possibility this could be intrathyroidal.\n\nThyroid gland show heterogenous enhancement, better evaluated on previous\nultrasound thyroid examination.\n\nThere is no evidence of a mucosal lesion. There is no cervical\nlymphadenopathy.\n\nBones: There is generalized decreased bone density with no new focal, lytic or\nsclerotic lesions. There are multilevel degenerative changes more pronounced\nat lower cervical spine as well as reversed cervical lordosis.\n\nNo suspicious lung nodules. Bilateral dependent atelectatic changes.", + "output": "1. Very large right-sided thyroid nodule which took up the sestamibi on the\nnuclear medicine scan, is solid on a ultrasound with a peripheral\ncalcification and hypervascular both on ultrasound and 4DCT. This is almost\ncertainly a primary thyroid nodule and as suggested on ultrasound, FNA of this\nlesion is warranted. The possibility of small central nodes cannot be\nexcluded.\n2. 2 small extrathyroidal enhancing nodules on the right 1 posterior to the\nupper pole far medial in an almost retroesophageal location, the other at the\nright lower pole, both representing either normal to slightly enlarged\nparathyroid glands.\n3. Enhancing nodule at the lower pol" + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. Normal study." + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass effect. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No evidence of intracranial hemorrhage or acute territorial infarction." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territory infarct. Gray-white matter\ndifferentiation is preserved. There is no hydrocephalus. The partially\nimaged paranasal sinuses demonstrate opacification of a right ethmoid air cell\nand minimal mucosal thickening of the right frontal sinus. The mastoid air\ncells are clear. No acute fracture seen.", + "output": "No acute intracranial process. Please note that MRI is more sensitive in\ndetecting small intracranial lesions." + }, + { + "input": "There is redemonstration of a left-sided extra-axial collection measuring up\nto 14 mm (02:23), largely hypodense with layering increased density hematocrit\nlevel, compatible with chronic subdural hematoma. Minimal rightward shift of\nmidline structures measures 2 mm, unchanged. Very small right frontal\nsubdural hematoma is also unchanged. No evidence of new hemorrhage, acute\nlarge territorial infarction, edema,or mass. There is prominence of the\nventricles and sulci suggestive of involutional changes. There is no evidence\nof fracture. The visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the\norbits are unremarkable.", + "output": "1. Stable appearance of a 1.4 cm chronic subdural hematoma within the left\nfrontoparietal convexity. This again shows a layering effect which suggested\ncoagulopathy. Very small unchanged right frontal subdural hematoma.\n2. Minimal rightward shift of midline structures measures 2 mm, unchanged.\n3. No evidence of new intracranial hemorrhage or acute large territorial\ninfarction." + }, + { + "input": "There is a left convexity subacute on chronic subdural hematoma, which is\nslightly increased in maximal depth compared with the most recent CT head (13\nmm, previously 10 mm). There is now slight midline shift to the right, of 3\nmm. There is new hyperdensity, inferiorly within the left subdural hematoma,\nadjacent to the left temporal lobe, in keeping with acute/subacute subdural\nhemorrhage. Few septations. The previously noted shallow subdural hematoma\noverlying the right frontal lobe anteriorly has now resolved.\n\nThere is no evidence of infarction, edema, or mass. The ventricles are normal\nin size and configuration. Mild-to-moderate chronic small vessel ischemic\nchange.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Left acute/subacute on chronic subdural hematoma, slightly increased in\nsize, with interval hemorrhage since prior.\n2. Mild midline shift to the left, more prominent.\n3. The shallow subdural hematoma overlying the right frontal lobe anteriorly\nhas now resolved.\n\nRECOMMENDATION(S): .\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 12:27 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." + }, + { + "input": "There is redemonstration of a mixed density subdural fluid collection\noverlying the left cerebral convexity with layering hyperdense components\nmeasuring up to 1.1 cm in thickness compatible with different aged components,\ndecreased in size since the prior MRI from ___ given differences\nin technique. There is mild regional mass effect on the underlying cerebral\nsulci without significant midline shift.\nThere is evolution of left parietal white matter hypodensity reflecting\nevolution of the previously noted infarction.\nThere is no evidence of new infarction,or mass. The ventricles and sulci are\nnormal and unchanged in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. Postsurgical changes related to the right ocular\nglobe and left infratemporal fossa are noted.", + "output": "1. Possible slightly decreased size of the subdural hematoma overlying the\nleft cerebral convexity given differences in technique with components of\ndifferent ages, possibly subacute on chronic with an acute component not\nexcluded.\n2. Areas of possible small cortical infarctions or subarachnoid hemorrhage\nseen on prior MRI are not well visualized on this study. If clinically\nindicated, repeat MRI may be helpful for further evaluation.\n3. Similar regional mass effect without significant midline shift.\n4. Mild interval progression of predominantly subcortical white matter\ninfarction.\n\nRECOMMENDATION(S): The areas of possible small cortical infarctions are\nsubarachnoid hemorrhage seen on prior MRI are not well visualized on this\nstudy. If clinically indicated, repeat MRI may be helpful for further\nevaluation." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nAgain seen is a large to mixed chronic and recent subdural hematoma over the\nleft convexity. This appears unchanged since the head CT of ___.\nThere is unchanged mild local mass effect with effacement of sulci. There is\nno midline shift.\nUnchanged are areas of white matter hypodensity in the left hemisphere that\nmay reflect chronic ischemia as well as potential lacune in the left putamen. \nThere is no evidence of new infarction. No intraparenchymal hemorrhage is\nidentified. The ventricles and sulci are enlarged in an atrophic pattern.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\nEmbolic material is seen along the course of the left middle meningeal artery\nin the middle cranial fossa.\n\nCT PERFUSION:\nThere are 20 mL of brain demonstrating T-max greater than 6 seconds. This is\nlocated in the territory of the inferior division of the left middle cerebral\nartery.\nThere are 23 mL of brain with cerebral blood flow less than 30%. These\ncorrespond to the left-sided subdural hematoma and not to the left middle\ncerebral artery brain parenchymal abnormality identified based on T-max\ncriteria.\nThus, the images suggest ischemia without core infarction.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. The dural venous\nsinuses are patent. There is a fetal left posterior cerebral artery, a common\nvariant. The intracranial left vertebral artery is small, perhaps related to\nproximal occlusion.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent.\nThere is atherosclerotic plaque at the right common carotid artery bifurcation\nwith approximately 50% stenosis of the origin of the right internal carotid\nartery by NASCET criteria. The plaque is largely calcified.\nThere is largely noncalcified plaque involving the distal left common carotid\nartery and proximal left internal carotid artery. There is a focal\noutpouching of the proximal left ICA, suggesting an ulcer. There is no left\ninternal carotid artery stenosis by NASCET criteria.\n\nThere is a stenosis at the origin of the right vertebral artery.\nThere are mixed calcified and noncalcified plaques involving the the left\nsubclavian artery. The left vertebral artery is not identified in the neck.\n\n\n\nOTHER:\nThere are bilateral large pleural effusions. There is septal thickening\nbilaterally, greater on the left. The visualized portion of the thyroid gland\nis within normal limits. There is no lymphadenopathy by CT size criteria.\nEnlargement of the right piriform sinus and adduction of the right vocal cord\nsuggest vocal cord paresis or paralysis.", + "output": "1. Unchanged left subdural hematoma.\n2. Multiple white matter hypodensities suggesting chronic ischemia.\n3. No evidence of intraparenchymal hemorrhage or recent infarction.\n4. Approximately 50% stenosis of the origin of the right internal carotid\nartery.\n5. Stenosis at the origin of the right vertebral artery.\n6. Atherosclerotic changes throughout the left subclavian artery with stenoses\nand apparent occlusion of the left vertebral artery.\n7. Reconstitution of the intracranial left vertebral artery from the basilar.\n8. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm." + }, + { + "input": "The patient is status post left middle meningeal artery embolization. When\ncompared to the prior examination, near complete resolution of previously\ndescribed left convexity subdural hematoma, with residual 3 mm thick left\nfrontal collection (series 2, image 14). Otherwise, the sulci, ventricles and\ncisterns are within expected limits for the degree of mild senescent related\nglobal cerebral volume loss. Moderate periventricular and subcortical white\nmatter hypodensities, most prominent in the left temporoparietal lobe, are\nnonspecific, but compatible with chronic microangiopathy in a patient of this\nage.\n\nThe visualized paranasal sinuses are clear. The orbits are unremarkable,\nnoting bilateral globe prostheses. The mastoid air cells and middle ears well\npneumatized and clear. No suspicious osseous lesion.", + "output": "1. Near complete resolution of left convexity subdural hematoma with trace\nresidual 3 mm thick left frontal collection.\n2. No acute infarct or intracranial hemorrhage. No intracranial mass effect.\n3. The patient is status post left middle meningeal artery embolization.\n4. Additional findings as described above." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction, mass or midline\nshift. There is no hydrocephalus. There is no fracture. No abnormal\nenhancement is seen. Postoperative changes are seen in maxillary sinuses\nwhich are partially visualized. Minimal mucosal thickening is seen in the\nethmoid air cells.", + "output": "No significant abnormalities are seen on CT of the head with contrast. No\nenhancing brain lesions are seen." + }, + { + "input": "In the left frontal lobe, there is a 1.2 x 1.2 cm round peripherally\nhyperdense lesion (02:16) with surrounding vasogenic edema at the gray-white\nmatter junction. There is no significant sulcal effacement. In the right\nfrontal lobe at the gray-white matter junction, there is a 1.6 x 1.3 cm round\nperipherally hyperdense lesion with surrounding vasogenic edema (02:21). In\nthe left centrum semiovale, there is a 7 x 5 mm hyperdense lesion with mild\nsurrounding vasogenic edema (02:22). In the left parietal lobe at the\ngray-white matter junction, there is a 7 x 6 mm hyperdense lesion and a 11 x\n11 peripherally hyperdense round mass (02:15), both with surrounding vasogenic\nedema (02:19). In the right frontal periventricular white matter, there is a\n9 x 7 mm hyperdense lesion (02:11). Heterogenic edema is also seen within the\ncerebellar hemisphere though no discrete mass is identified. There is no\nshift of the midline structures and no evidence of hemorrhage. No evidence of\nacute infarct.\n\nThere is no acute fracture or scalp hematoma. There is scattered mucosal\nthickening of the maxillary, posterior ethmoid, and sphenoid sinuses. Mastoid\nair cells and middle ear cavities are clear. Visualized aspects of the orbits\nare unremarkable.", + "output": "1. Multiple hyperdense lesions in the right and left cerebral hemispheres,\nmany at the gray-white matter junction, with surrounding vasogenic edema,\ncompatible with metastatic disease.\n2. Vasogenic edema in the left cerebellar hemisphere is also suspicious for\nan underlying mass lesion, though none is discretely identified. No evidence\nof intracranial hemorrhage or acute infarct.\n3. Please note that MRI is more sensitive for detection of smaller\nmetastases." + }, + { + "input": "Maxillofacial:\nA drain is in place adjacent to the right maxilla, with surrounding fat\nstranding and without discrete fluid collection. Diffuse, right\nperiorbital/preseptal soft tissue swelling and fat stranding has not\nsubstantially changed. There is diffuse right malar soft tissue swelling and\nfat stranding, with new, interval small locules of air with adjacent stranding\nspanning approximately 2.3 x 0.9 cm (2:36). Diffuse fat stranding extends\ninferiorly into the right submandibular space and posteriorly into the\nmasticator and parotid spaces. No drainable fluid collection.\n\nThere is no facial bone fracture. Pterygoid plates are intact. There is no\nmandibular fracture and the temporomandibular joints are anatomically aligned.\nThe orbits are intact. Aside from the aforementioned findings, the globes and\nextra-ocular muscles are unremarkable.\n\nIncluded paranasal sinuses are clear.\n\nNeck:\nEvaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nFocal calcifications are seen within the inferior aspect of the right parotid\ngland (2:50), which most likely represents sialoliths. The other salivary\nglands are grossly without mass or adjacent fat stranding. Multiple prominent\nto enlarged right-sided cervical nodes measure up to 1.1 cm (2:52).\n\nMild mosaic attenuation of the lung apices is nonspecific. A hypodense right\nthyroid nodule measures 1.5 cm. No worrisome osseous lesions or acute\nfracture.", + "output": "1. Diffuse right malar soft tissue swelling and fat stranding following\ndrainage of a right maxillary abscess, with a drain in situ. Small locules of\nair within the right malar soft tissues may reflect postprocedural changes. No\nevidence of drainable fluid collection.\n2. No substantial change in diffuse right periorbital/preseptal soft tissue\nswelling.\n3. Right-sided cervical lymphadenopathy, likely reactive.\n4. Hypodense right thyroid nodule, measuring up to 1.5 cm. Further evaluation\nis recommended with thyroid ultrasound as an outpatient, if this has not been\npreviously worked up." + }, + { + "input": "There is no evidence of infarction, fracture, hemorrhage, or mass. The\nventricles and sulci are normal in size and configuration.\n\nRight facial edema and fat stranding is partially visualized. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are normal.", + "output": "1. There is partial visualization of known right facial infection.\n2. Otherwise normal head CT." + }, + { + "input": "Right malar soft tissue swelling and fat stranding appears similar in extent\nto the study performed 7 days prior, extending to the right\nperiorbital/preseptal soft tissues and the right parotid gland. Including the\nsurrounding inflammatory changes, confluent fluid within the region of prior\nabscess is similar in size measuring 2.8 x 1.3 cm (3:9), previously 2.7 x 1.3\ncm. Evaluation for abscess, however, is limited in the absence of intravenous\ncontrast administration. Poor dentition is again seen, with essentially all\nmaxillary teeth missing. The cortex of the superficial alveolar ridge in the\nregion of the second and third teeth is interrupted, possibly related to\nrecent tooth extraction although source for facial abscess cannot be excluded,\nespecially given continuity between the confluent right facial fluid. Few\nfoci of gas (3:8) within an abscess cavity or between the maxilla and buccal\nmucosa.\n\nNo fractures are identified.\nOther than mild mucosal thickening in the right maxillary sinus, visualized\nparanasal sinuses are well aerated.\nBilateral mastoids appear normal.\nThe globes, extraocular muscles, optic nerves, and retrobulbar fat appear\nnormal.\nThe visualized upper aerodigestive tract appears normal.\nThe mandible and temporomandibular joints appear normal.", + "output": "Evaluation for organized fluid/abscess is limited without intravenous contrast\nhowever there is no definite evidence of a drainable collection.. The right\nfacial soft tissue infection appears similar, including confluent fluid in the\nregion of known abscess measuring 2.8 x 1.3 cm. There is soft tissue\nthickening and stranding which is continuous from this confluent fluid to a\ncortical defect in the superficial alveolar process of the right maxilla which\nmay be related to recent tooth extraction or suggest periapical abscess." + }, + { + "input": "Re demonstrated right malar soft tissue swelling and fat stranding appears\nslightly improved to the study performed 3 days ago, and extends to the right\ninfraorbital pre maxillary area. The extent of periorbital and preseptal soft\ntissue thickening appears improved compared to the prior exam. Within the\nregion of surrounding inflammation, there is a 2.4 x 1.1 cm soft tissue\nstructure, previously measuring 2.8 x 1.3 cm (4; 6). There is no evidence of\ndrainable fluid collection.\n\nThe patient is edentulous in the upper maxilla, status post likely dental\nextractions. There is irregularity and erosion involving the cortex of the\nsuperficial alveolar ridge and region of the second and third right molars. \nGas in the region of the soft tissues overlying part of the maxilla has\ncoalesced into a single focus of gas measuring 5 mm (4; 4).\n\nThe paranasal sinuses are normally aerated, with no mucosal thickening or\nair-fluid levels identified. The ostiomeatal units are patent.\n\nThe cribriform plates are intact. The lamina papyracea are intact.", + "output": "1. Interval improvement of right malar soft tissue swelling and fat stranding,\nwith no evidence of drainable fluid collection.\n2. Redemonstrated irregularity and erosion in the second and third right molar\nregions. Gas in the region of the soft tissues overlying the area has\ncoalesced." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nChronic bilateral basal gangliar lacunar infarcts are noted. No large\nvascular territory infarction, hemorrhage, edema, or mass. Hypodensities in\nthe right cerebellar hemisphere may reflect chronic infarctions. Prominence\nof the ventricles and sulci is most indicative of age-related involutional\nchange. There is a small area of hyperdensity in the left sylvian fissure\n(02:12) indicating dense middle cerebral artery.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are essentially clear. Bilateral lens replacements are noted.\n\nCTA HEAD: There is complete occlusion beyond the left M2 portion of the middle\ncerebral artery (4:246). Otherwise, the remainder of the visualized vessels\nof the circle of ___ in the principal intracranial branches appear normal\nwithout evidence of stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK: There is complete occlusion of the left common carotid artery\nsecondary to calcific and noncalcific plaque just distal to its takeoff at the\nthoracic inlet. There is reconstitution of flow within the supraclinoid\nportion of the left internal carotid artery (4:240). The left external\ncarotid artery is supplied by collateral vessels. There is approximately 40%\nstenosis of the right internal carotid artery. The vertebral arteries appear\nnormal with no evidence of stenosis or occlusion.\n\n CT perfusion: Mismatch in the left MCA territory\nCBF<30% volume: 0 mL\nT-max > 6.0s volume: 52 mL\nMismatch volume: 52 mL\nMismatch ratio: Infinite\n\nOTHER: There is moderate right apical pleuroparenchymal scarring. Ill-defined\nleft thyroid hypodensity measures 1.6 cm (4:109). There is no lymphadenopathy\nby CT size criteria.", + "output": "1. Complete occlusion of the left carotid artery just distal to its takeoff at\nthe thoracic inlet with reconstitution at the supraclinoid portion of the left\ninternal carotid artery.\n2. Occlusion beyond the M2 portion of the left middle cerebral artery, with\nassociated mismatch defect in the left MCA territory on CT perfusion, as\ndetailed above.\n3. 40 per % stenosis of the right internal carotid artery by NASCET criteria.\n4. 1.6 cm left thyroid nodule. Further evaluation with dedicated thyroid\nultrasound is recommended.\n\nRECOMMENDATION(S): Thyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or ___, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "Motion artifact limits evaluation of the paranasal sinuses, temporal lobes,\nand posterior fossa\n\nThere is increased hypodensity centered in the left parietal lobe and left\ninsula in the MCA territory consistent with an evolving acute infarction. A\ndense MCA sign is again seen in the sylvian fissure. A chronic infarct is\nagain seen in the cerebellum on the right. Hypodensities in the basal ganglia\nmay be prior lacunar infarcts versus prominent perivascular spaces. There is\nno evidence ofhemorrhageor mass. There is prominence of the ventricles and\nsulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare essentially clear. The\nvisualized portion of the orbits show bilateral lens replacement.", + "output": "Increased hypodensity in the left parietal lobe and left insula, consistent\nwith evolution of the acute left MCA stroke. Redemonstration of a dense MCA\nsign in the sylvian fissure. No evidence of hemorrhagic transformation." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are prominent compatible with global volume\nloss. Atherosclerotic calcifications noted within the intracranial ICAs.\n\nIncluded paranasal sinuses and mastoids are essentially clear besides mild\nmucosal thickening in the left maxillary sinus and ethmoid air cells. Skull\nand extracranial soft tissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "This exam is slightly degraded by motion. Within this limitation, there is no\nevidence of acute territorial infarction,hemorrhage,edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nMild periventricular and subcorticalwhite matter hypodensities are\nnonspecific, but likely reflect the sequela of chronic microvascular\ninfarction.\n\nThere is no evidence of fracture. Mild mucosal thickening is seen involving\nthe left maxillary sinus. The visualized portion of the remaining paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable apart from prior left lens replacement.", + "output": "Slightly motion degraded exam. Within this limitation, no acute intracranial\nabnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mucosal thickening in the\nbilateral maxillary sinuses, frontal sinuses and ethmoid air cells. The\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable. There is no periorbital stranding.", + "output": "1. No orbital cellulitis or acute intracranial process.\n2. Mucosal thickening in the bilateral maxillary sinuses, frontal sinuses and\nethmoid air cells. Correlate clinically for sinusitis." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass efect. The ventricles and sulci are normal in size and configuration.\n\nWhen compared to immediate prior examinations of ___, there is\ninterval increased left periorbital inflammatory is thickening and stranding,\ncompatible with cellulitis.\n\nThere is no evidence of fracture. There is stable moderate mucosal thickening\nof the bilateral ethmoid sinuses and mild mucosal thickening of the bilateral\nfrontal and maxillary sinuses, as described in ___ study.", + "output": "1. There is no evidence of acute large territorial infarction, hemorrhage,\nedema nor mass effect.\n2. Interval increased left periorbital inflammatory stranding compatible with\ncellulitis. Please refer to dedicated concurrent CT orbits for further\ndetails.\n3. Stable paranasal sinuses disease as described above." + }, + { + "input": "There is edema and swelling of the left preseptal periorbital soft tissue. \nPostseptal fat stranding and edema/phlegmon is also noted along the orbital\nroof. The inflammation appears to be mostly localized to the\nsuperior-medial-lateral extraconal regions with mass effect on the underlying\nextraocular muscles. The left superior oblique muscle is displaced 4 mm\ninferiorly when compared to the right superior oblique muscle on coronal view.\nThere is also a mild inflammatory stranding and thickening with lateral mass\neffect along the medial orbital wall (is series 3, image 24). There is no\ndefinitive evidence of inflammation or thickening of the left extraocular\nmuscles; however, faint fat stranding is seen within the intraconal region\nsuggesting intraconal extension of the inflammation. There is no evidence of\ninflammation within the left globe.\n\nOf note there is also a moderate to severe mucosal thickening of the adjacent\nethmoid sinus (left greater than right) that appears to have worsened when\ncompared to the ___ head CT. Although there is no obvious evidence of\nsinus wall bony defect visible on the this CT, extension of sinusitis to the\nleft orbit cannot be excluded.\nThere is also mild mucosal thickening of the bilateral frontal, bilateral\nsphenoid and bilateral maxillary sinuses.\n\nThe patient is status post right uncinectomy and partial ethmoidectomies. The\nneo ostia is patent on the right. There is mucosal thickening and\nopacification of the ostiomeatal units. There is no abnormal osseous\nexpansion or destruction of the infraorbital canal or supraorbital foramina. \nThe visualized skull-base foramina appear intact.", + "output": "1. Left preseptal and postseptal orbital cellulitis, not seen on prior\nexamination. The postseptal orbital inflammation/phlegmon is predominantly\nlocalized to the superior-medial-lateral extraconal regions with mass effect\nand inferior displacement of the underlying extraocular muscles, with\nextension to the medial orbital wall. However, there is faint stranding seen\nwithin the left intraconal region that is concerning for intraconal spread. \nThere is no evidence of left globe involvement.\n2. No definite confluent collection to suggest abscess. These findings could\nbe better evaluated with dedicated MRI of the orbits.\n3. There is moderate to severe sinus mucosal thickening most prominent in the\nleft ethmoid sinus that appears to have worsened when compared to the ___ study. Although there is no obvious evidence of sinus wall bony defect\nvisible on the this CT, extension of sinusitis to the left orbit cannot be\nexcluded. In the the appropriate clinical setting, may consider the\npossibility of paranasal sinusitis as a potential source of infection and\norbital cellulitis." + }, + { + "input": "Frontal sinus mucosal thickening with air-fluid levels is slightly increased\nfrom ___. Opacification of the left ethmoid sinus and diffuse ethmoid\nsinus mucosal thickening is slightly increased from ___ without definite\nevidence of bony dehiscence although the adjacent lamina propecia is very\nthin.\n\nBilateral maxillary sinus mucosal thickening is slightly increased from ___. The left ostiomeatal unit is occluded in the right ostiomeatal unit is\npatent. Nasal septum is midline without spur. The sphenoid sinus septum is\nmidline with insertion upon the sellar floor.\n\nLeft orbial proptosis with retrobulbar fat stranding and adjacent soft tissue\npreseptal edema and stranding increased from ___. No retrobulbar or\nsubperiosteal abscess is identified. Mass effect on and enhancement of the\nsuperior and lateral rectus muscles appears overall unchanged.\n\nMeningeal enhancement seen on MRI brain is not visualized on this examination\nand there is no evidence of emphysema or intracranial abscess.", + "output": "1. Increased prominence of the left ethmoid, frontal, and maxillary sinus\nsinusitis without definite bony dehiscence identified. This likely represents\nan infectious source.\n2. Persistent left orbital cellulitis with increased retrobulbar, preseptal,\nand left facial inflammation, stable mass effect on the superior and lateral\nrectus muscles, and no evidence of retrobulbar or periosteal abscess.\n3. Meningeal enhancement seen on previous MRI is not well demonstrated on this\nstudy. There is no evidence of intracranial abscess or empyema.\n4. Left superior ophthalmic vein is normal in size and there is symmetric\nappearance of cavernous sinuses." + }, + { + "input": "1 cm extra-axial hyperdense focus over the right fronto parietal convexity\n(601b:55; se 2, im 26 and 27) may reflect hemorrhage or artifact. The\nventricles and sulci are normal in size configuration. The basal cisterns are\npatent. Gray-white matter differentiation is preserved.\n\nThere is no fracture. The included paranasal sinuses, mastoid air cells and\nmiddle ear cavities are clear. The orogastric tube loops up into the\nnasopharynx and then continues into the esophagus. Patient is intubated.", + "output": "1. 1 cm focus of extra-axial hyperdensity over the right fronto parietal\nconvexity (601b:55; 2: 26) may reflect hemorrhage or artifact. Followup CT in\n___ hr is recommended for further evaluation.\n2. The nasogastric tube is partially looped up into the nasopharynx but then\ncontinues normally into the esophagus." + }, + { + "input": "There is no acute intracranial hemorrhage, cerebral edema or loss of gray/\nwhite matter differentiation. Specifically, the previously noted small\nextra-axial hyperdensity at the right frontal vertex is no longer seen. Basal\ncisterns, ventricles, and sulci are normal for age.\n\nNo fracture is identified. There is new fluid and mucosal thickening within\nthe left frontal sinus, minimal mucosal thickening within the right sphenoid\nsinus, and trace fluid within bilateral mastoid air cells, probably due to\nprolonged supine positioning in the inpatient setting.", + "output": "No evidence for acute intracranial abnormalities. Previously visualized small\nhyperdense extra focus at the right frontal vertex is no longer seen." + }, + { + "input": "There is no hemorrhage, acute large vascular territorial infarct, or brain\nedema. There is preservation of gray-white matter differentiation. There is\nno shift of normally midline structures. The basal cisterns are patent.\nProminence the ventricles and sulci is compatible with age related\ninvolutional change. Periventricular and subcortical white matter confluent\nhypodensities are likely the sequelae of chronic small vessel ischemia. \nBilateral intracranial carotid artery calcifications are noted. The visualized\nparanasal sinuses and mastoid air cells are clear. The patient is status post\nbilateral lens removal. Otherwise, the globes and bony orbits are intact.\nThere is no fracture.", + "output": "No acute intracranial process. Of note, MRI is more sensitive for the\ndetection of small intracranial lesions." + }, + { + "input": "A tiny extra-axial hyperdense lesion which could represent subdural hematoma\nlayering along the right frontal falx measuring approximately 3 mm has not\nsignificantly changed (series 601b, image 43). There are no new areas of\nhemorrhage identified. The ventricles and sulci are mildly enlarged for the\npatient's age suggesting cerebral volume loss. Periventricular white matter\nhypodensities are nonspecific but likely sequela of chronic small vessel\ndisease. The basal cisterns are patent and there is preservation of\ngray-white matter differentiation. There is a 12 x 11 mm hyperdense\nsellar/suprasellar mass.\n\nThere is no acute fracture. The paranasal sinuses and mastoid air cells are\nclear. There dense calcifications within the carotid siphons bilaterally.", + "output": "1. Unchanged tiny 3 mm extra-axial hyperdense lesion which could be subdural\nhematoma layering along the right anterior falx versus meningioma. No new\nintracranial hemorrhage.\n2. 12 x 11 mm hyperdense suprasellar mass concerning for a a pituitary\nmacroadenoma, further evaluation with dedicated MRI is recommended on a\nnonemergent basis.\n\nNOTIFICATION: Uppdated findings were discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 7:34 ___, 5 minutes after discovery of the\nfindings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nExtensive diffuse bilateral subarachnoid and intraventricular hemorrhage is\nseen within the bilateral sylvian fissures, anterior interhemispheric fissure,\nbasilar cisterns, third ventricle, fourth ventricle and bilateral lateral\nventricles. There is no evidence of acute intracranial infarction. \nHydrocephalus is present with prominent temporal horns..\n\nNo acute fracture is identified. The visualized paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The globes are unremarkable.\n\nCTA HEAD:\nThe vertebral arteries are normal. The basilar artery is normal. The\nposterior cerebral arteries are normal. The cavernous segment of the left\ninternal carotid artery demonstrates mild calcifications, which is otherwise\nunremarkable. The left middle cerebral artery is normal. There is normal\narborization of the distal left MCA vessels. The cavernous segment of the\nright internal carotid artery demonstrates mild calcifications. The right MCA\nis normal. There is normal arborization of the distal right MCA vessels.\n\nThere is A-comm aneurysm measuring 0.6 cm in transverse diameter, 0.5 cm from\nbase to apex, projecting anterior inferiorly, it has 0.2 cm neck. The\nanterior cerebral arteries are otherwise unremarkable. There is no evidence\nof significant stenosis. No evidence of vasospasm. The dural venous sinuses\nare patent.\n\nCTA NECK:\nThere is approximately 20% right ICA origin narrowing by NASCET criteria. \nOtherwise, the carotid and vertebral arteries and their major branches appear\nnormal with no evidence of stenosis or occlusion. There is no evidence of left\ninternal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. Multiple hypodense lesions are\nseen within the thyroid lobes bilaterally measuring up to 0.7 cm, no further\nfollow-up is indicated. There is no cervical lymphadenopathy. There is mild\ndegenerative changes in the cervical spine.", + "output": "1. Significant subarachnoid, intraventricular hemorrhage with hydrocephalus.\n2. There is 0.6 cm x 0.5 cm A-comm aneurysm with a 0.2 cm neck. Otherwise,\nposterior and anterior circulation appears to be patent.\n3. There is approximately 20% right ICA origin narrowing." + }, + { + "input": "There is been interval placement of a right transfrontal ventricular drain,\nterminating at the interventricular foramen of ___. Ventricular size is\nunchanged from the prior study. Diffuse subarachnoid, basilar cistern, and\nintraventricular hemorrhage is similar, however the volume of the\nintraventricular component has slightly increased.\nPostprocedural pneumocephalus is noted along the right frontal convexity. No\nother relevant change.", + "output": "1. Right transfrontal ventricular drain terminating at the foramen of ___.\n2. Re-demonstrated diffuse subarachnoid and intraventricular hemorrhage.\n3. Unchanged ventricular size." + }, + { + "input": "The patient is status post coiling of an A-comm aneurysm. Artifact from the\ncoils somewhat limits the evaluation of the surrounding brain parenchyma. \nUnchanged right transfrontal ventricular drain terminating in the region of\nthe foramina of ___. The size of the ventricles is grossly unchanged given\ndifferences in technique.\n\nDiffuse subarachnoid hemorrhage is re-identified with extension into the basal\ncisterns and ventricular system. There has been interval increase in amount\nof intraventricular blood, particularly within the occipital horns of the\nlateral ventricles. A small amount of pneumocephalus is noted in the right\nfrontal lobe, unchanged.\n\nNo other significant interval change.", + "output": "Interval coiling of an A-comm aneurysm as described above.\n\nRe-demonstration of diffuse subarachnoid and intraventricular hemorrhage." + }, + { + "input": "Streak artifact from the anterior communicating artery coil pack partially\nobscures evaluation of the mid brain.\nIn comparison to the prior head CT, there has been significant reduction in\nventricular size, now normal, and unchanged position of the right transfrontal\napproach ventricular drain, terminating at the foramina of ___. The amount\nof blood in the lateral ventricles appears to have increased, however this may\nbe due to the significant decrease in size of the ventricles overall. \nBifrontal extra-axial fluid collections are small. The amount of subarachnoid\nblood in the intrahemispheric fissure has decreased as well as in the sylvian\nfissures and basal cisterns. Trace residual pneumocephalus in the ventricles\nnoted.\nNo evidence of acute infarct. Minimal increased hypodensity of the medial\nfrontal lobes adjacent to the interhemispheric subarachnoid hemorrhage is\nidentified, presumably reactive edema. There is partial opacification of the\nleft sphenoid sinus and mastoid air cells bilaterally. The middle ear\ncavities are clear.", + "output": "1. Significant interval decrease in ventricular size compared to ___.\n2. While there is still a considerable amount of subarachnoid blood in the\ninterhemispheric fissure, basal cisterns, and lateral ventricles, the overall\nvolume is decreased compared to the prior study.\n3. New hypodense bifrontal extra-axial fluid collections, small." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nIn comparison with the prior noncontrast head CT of ___, previously\nnoted extensive subarachnoid hemorrhage has substantially decreased, with\nmoderate subarachnoid blood remaining in the anterior interhemispheric fissure\nand bilateral medial frontal sulci, small amount of subarachnoid blood\nremaining in the left-convexity sulci and left greater than right sylvian\nfissures. There is also residual subarachnoid blood in the suprasellar\ncistern, partially obscured by streak artifact from the anterior communicating\nartery aneurysm coil pack. Intraventricular blood has decreased in extent,\nwith only a small amount of blood remaining in the occipital horns of lateral\nventricles. Allowing for the decreased hemorrhage, ventricular size is not\nsignificantly changed. Right frontal approach EVD catheter terminates in the\nregion of the foramina of ___, unchanged. There is no shift of midline\nstructures. Allowing for the streak artifact from the anterior communicating\nartery coil pack, there is no CT evidence for an acute major vascular\nterritorial infarction.\n\nFluid within the bilateral mastoid air cells and middle ear cavities as well\nas fluid in the left sphenoid sinus, increased compared to the prior CTA of ___, is likely secondary to prolonged supine positioning in the\ninpatient setting.\n\n\nCTA HEAD:\nIn comparison to the prior head CTA from ___, there is interval\ndevelopment of moderate to severe narrowing and irregularity of the A1\nsegments of bilateral anterior cerebral arteries and moderate narrowing and\nmultifocal irregularity of the A2 segments of bilateral anterior cerebral\narteries. There is also interval development of mild narrowing of the M1\nsegment of the left middle cerebral artery. This is consistent with\nvasospasm. Detailed evaluation of the proximal portion of the anterior\ncerebral arteries is limited by extensive streak artifact from the coil pack. \nEvaluation for any residual filling of the coiled anterior communicating\nartery aneurysm is also limited by streak artifact.", + "output": "1. Decreased subarachnoid and intraventricular hemorrhage compared to ___. No new hemorrhage.\n2. Stable ventricular size. Stable position of the right frontal approach\nEVD.\n3. Interval development of vasospasm compared to ___, moderate to\nsevere in bilateral A1 segments, moderate in bilateral A2 segments, and mild\nin the left M1 segment." + }, + { + "input": "In comparison to the noncontrast CT head from ___ and ___,\nthere is continued interval redistribution of the subarachnoid hemorrhage\nwhich is again seen in the anterior interhemispheric fissure and bilateral\nmedial frontal sulci and less apparent in the sylvian fissures. Again, there\nis subarachnoid blood noted in the suprasellar cistern, with streak artifact\nfrom the anterior communicating artery aneurysm coil. There is persistent\nlayering of blood products in the occipital horns of bilateral lateral\nventricles. Interval decreased prominence of by frontal extra-axial fluid\ncollections. Right frontal approach EVD catheter is again seen terminating\nnear the foramen of ___. There is no shift in normally midline structures. \nAgain, within limitations of streak artifact from the aneurysm coil, there is\nno large vascular territorial infarction. The ventricles appear more\nprominent bilaterally in comparison to the most recent CT head.\n\nThere is no evidence of fracture. There is opacification of bilateral mastoid\nair cells and bilateral middle ear cavities with decreased fluid in the\nsphenoid sinus compared to prior. Otherwise, the visualized portion of the\nremaining paranasal sinuses are clear. The visualized portion of the orbits\nare unremarkable.", + "output": "1. Continued redistribution in interval evolution of the subarachnoid\nhemorrhage, again most prominently seen in the anterior interhemispheric\nfissure.\n2. The ventricles appear overall slightly more prominent in comparison to the\nmost recent head CT, potentially secondary decreased size of bifrontal\nextra-axial collections, although developing hydrocephalus is not entirely\nexcluded. Close attention on follow-up." + }, + { + "input": "A right frontal approach ventriculostomy catheter is in stable position\nterminating at the right foramen of ___. The ventricles are stable in size\nand configuration from prior exam. A small amount of subarachnoid hemorrhage\nis noted along the left frontal lobe as well as along the anterior\ninterhemispheric fissure. (Series 2:image 21, 15). There is a moderate\namount of intraventricular hemorrhage layering dependently in the occipital\nhorns bilaterally, similar in amount to ___.\n\nNo new intracranial hemorrhage, edema or mass is seen. There is no evidence\nof acute vascular territorial infarction. Patient is status post coiling of\nan A-comm aneurysm. There is preservation of normal gray-white matter\ndifferentiation. The basilar cisterns are patent.\n\nThere is no evidence of fracture. Opacification of the bilateral mastoid air\ncells and middle cavities may be due to supine positioning. The visualized\nportion of the other paranasal sinuses are clear. The visualized portion of\nthe orbits are unremarkable.", + "output": "1. Stable of position of the right frontal ventriculostomy catheter and\nventricle size. Stable amount of intraventricular blood.\n2. Small amount of subarachnoid hemorrhage again noted. No new intracranial\nhemorrhage." + }, + { + "input": "Anterior interhemispheric fissure and corpus callosum hematoma evolution\ncontinues with no evidence of new hemorrhage. Compared to prior exam, there\nis slightly increased amount of hyperdensity along the tentorium and the\nposterior falx, which may be due to small amounts of subdural hemorrhage. \nDiffuse subarachnoid hemorrhage in the anterior interhemispheric fissure and\nin the left sylvian fissure left appear unchanged.\nPatient is status post removal of the right frontal approach ventriculostomy\ntube. There is no evidence of hydrocephalus.. Layering hyperdensity in the\nbilateral occipital horns are stable. The basal cisterns remain patent. \nartifacts from the coiling material somewhat limits the evaluation for\ninfarcts. Subtle hypodensities in the right temporal lobe and left frontal\nlobe gray matter likely represent volume averaging from slice selection,\nrather than acute infarct.\nThere is mucosal retention cysts in the right maxillary sinus. There is\npartial opacification of the bilateral mastoid air cells. The visualized\nportion of the remaining paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "-Small subdural hematoma along the posterior falx and tentorium.\n-No evidence of new subarachnoid hemorrhage.\n-Status post removal of the right frontal approach ventriculostomy tube with\nno hydrocephalus." + }, + { + "input": "NONCONTRAST HEAD CT:\n\nStreak artifact from the coil pack in the treated anterior communicating\nartery aneurysm limits evaluation at adjacent levels. There is continued\nexpected evolution of anterior interhemispheric fissure and cerebral sulci,\nand of the corpus callosum hematoma. Blood in the occipital horn of the right\nlateral ventricle is unchanged, and blood in the occipital horn of the left\nlateral ventricle appears slightly decreased in density. There is minimal\nresidual subdural hemorrhage along the posterior falx. No evidence of new\nhemorrhage. Ventricular size is unchanged.\n\nNo CT evidence for a new major vascular territorial infarct. Periventricular,\ndeep, and subcortical white matter hypodensities are nonspecific, though\nlikely reflect sequelae of chronic small vessel ischemic disease in this age\ngroup.\n\nThere is moderate mucosal thickening in the right maxillary and anterior\nethmoid sinuses, including a mucous retention cyst in the right maxillary\nsinus. Partial opacification of the bilateral mastoid air cells is unchanged.\n\nCTA HEAD:\n\nModerate-to-severe narrowing and irregularity of the bilateral A1 segments of\nthe anterior cerebral arteries and moderate narrowing and irregularity of the\nbilateral A2 segments of the anterior cerebral arteries, as well as mild\nnarrowing of the M1 segment of the left middle cerebral artery, are similar to\nprior exam and consistent with vasospasm. Mild irregularity of the P2 segment\nof the right posterior cerebral artery appears more pronounced with decreased\ncaliber compared to ___, but it is not clear whether there is any\nchange compared to ___. Evaluation for residual filling of the\ncoiled anterior communicating artery aneurysm is limited by streak artifact. \nDural venous sinuses are patent.", + "output": "1. Grossly unchanged resolving subarachnoid hemorrhage compared to ___. Hemorrhage in the occipital horns of lateral ventricles is stable on\nthe right and decreased in density on the left. Minimal residual subdural\nhematoma along the posterior falx is stable.\n2. Stable ventricular size.\n3. No CT evidence for an acute major vascular territorial infarction.\n4. Persistent moderate-to-severe bilateral A1, moderate bilateral A2, mild\nleft M1, and mild right P2 segment vasospasm." + }, + { + "input": "The patient is status post coiling of an anterior communicating artery\naneurysm, and artifact from the aneurysm coils somewhat limits evaluation. \nThere has been interval resolution of subarachnoid hemorrhage seen previously\nin the intrahemispheric fissure, with trace of residual blood products. There\nis persistent edema in the intraventricular septum anteriorly. There has been\ninterval resolution of intraventricular blood. There is stable size of the\nventricles. Periventricular white matter hypodensities are nonspecific but\nsuggestive of chronic small vessel ischemic disease. There is no evidence of\ninfarction or new hemorrhage.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses and middle ear cavities are clear. There is opacification of most of\nthe mastoid air cells bilaterally, increased from prior exam. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Interval resolution of previously seen subarachnoid hemorrhage, with\npersistent edema of the anterior intraventricular septum. No evidence of new\nhemorrhage.\n2. Increased opacification of bilateral mastoid air cells." + }, + { + "input": "There is no acute large vascular territorial infarction, hemorrhage, edema or\ndefinite mass. Basal cisterns are patent, and there is preservation of\ngray-white matter differentiation. Encephalomalacia in the left temporal lobe\n(2:8) is consistent with prior infarct. Prominent ventricles and sulci\nreflect age-appropriate involutional changes.\n\nNo fracture identified. The imaged paranasal sinuses are clear. Mastoid air\ncells and middle ear cavities are well aerated. Visualized portions of the\norbits are unremarkable. Mild atherosclerotic calcification of the bilateral\ncarotid siphons.", + "output": "1. No acute intracranial process. Specifically, no acute large vascular\nterritory infarction. No intra-axial or extra-axial hemorrhage.\n2. Prominence of the bilateral ventricles, predominantly the lateral\nventricles, most likely represents age-related involutional changes, though is\nslightly more pronounced than would be expected. This may reflect a central\nprocess, for which clinical correlation is advised.\n2. Left temporal lobe encephalomalacia, consistent with prior infarct." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nMild atherosclerotic changes along both carotid siphons without high-grade\nstenosis. There is a 4 mm left pericallosal artery aneurysm. The vessels of\nthe circle of ___ and their principal intracranial branches appear\notherwise unremarkable without stenosis or occlusion.\nThe dural venous sinuses are patent.\n\nCTA NECK:\nNormal 3 vessel aortic arch the carotidandvertebral arteries and their major\nbranches appear normal with no evidence of stenosis or occlusion. There is no\nevidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No evidence of infarction, hemorrhage or intracranial mass.\n2. 4 mm left pericallosal artery aneurysm.\n3. Otherwise patent cervical intracranial vasculature without evidence of\ndissection, stenosis or vessel occlusion." + }, + { + "input": "There is no evidence of intracranial hemorrhage,acute large territorial\ninfarction,edema,or mass. There is mild prominence of the ventricles and\nsulci suggestive of involutional changes. Periventricular and subcortical\nhypodensities are nonspecific, though likely sequela of chronic small vessel\nischemic disease.\n\nThere is an air-fluid level with inspissated secretions within the right\nmaxillary sinus, findings likely compatible with sinusitis. The visualized\nportion of the remaining paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No evidence of acute intracranial abnormality.\n2. Small air-fluid level with inspissated secretions within the right\nmaxillary sinus, findings likely compatible with sinusitis." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. Minimal\nsubcortical and periventricular white matter hypodensities are nonspecific,\nlikely sequelae of chronic small vessel ischemic disease. There is prominence\nof the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. Subgaleal hematomas are seen overlying the\nposterior right parietal bone, the posterior left parietal bone, and the\noccipital bone. Subcutaneous emphysema is noted within the left parietal soft\ntissues (see 02:20). The visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are preserved. Bilateral temporomandibular joint degenerative changes\nare noted.", + "output": "1. No acute intracranial abnormality.\n2. No evidence acute intracranial hemorrhage or fracture.\n3. Bilateral posterior parietal and occipital subgaleal hematomas with left\nparietal probable laceration." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles are normal in size. Sulcal prominence reflect age\nrelated involutional changes. Relative cerebellar atrophy is noted. The\nimaged paranasal sinuses are clear. Mastoid air cells and middle ear cavities\nare well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. Mild\nperiventricular and subcortical white matter hypodensities are nonspecific but\nlikely sequelae of chronic small vessel ischemic disease, better characterized\non prior MRI. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No evidence of an acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, or loss of\ngray/white matter differentiation. Hypodense foci in the anterior limb of the\nright internal capsule (2:15, 601:40) and subcortical white matter of the\ninferior right frontal lobe (2:12, 601:36) may represent small chronic\ninfarctions. More ill-defined foci of hypodensity in the periventricular,\ndeep and subcortical white matter of the cerebral hemispheres are nonspecific\nbut most likely sequela of chronic small vessel ischemic disease in this age\ngroup. Ventricles and sulci are age-appropriate.\n\nThere is no evidence of a displaced calvarial fracture. Minimal mucosal\nthickening is seen in the ethmoid air cells. Bilateral mastoid tip air cells\nare opacified. The orbits are unremarkable.", + "output": "No evidence for acute intracranial abnormalities or displaced calvarial\nfracture." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass effect.\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No evidence of acute intracranial abnormality. Specifically, no evidence\nof fracture or intracranial hemorrhage.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 12:40 pm, 3 minutes after discovery\nof the findings." + }, + { + "input": "There is no evidence of infarction,hemorrhage,edema,or mass effect. Ventricles\nand sulci are age-appropriate.\n\nThere is no evidence of fracture. There is mucous retention cyst in the lower\nright maxillary sinus. There is mild mucosal thickening the bilateral\nanterior ethmoid air cells. Otherwise, visualized paranasal sinuses, middle\near cavities, and mastoid air cells are clear. Patient is status post\nbilateral lens resections.", + "output": "Normal study" + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass. The ventricles and sulci are normal in size and configuration.\nThere is no evidence of fracture. There is mild mucosal thickening in the\nleft maxillary sinus. There is mild mucosal thickening of the anterior\nethmoid air cells bilaterally. Otherwise, the visualized portions of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portions of the orbits are unremarkable.", + "output": "No acute intracranial hemorrhage or fracture." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Aside from mild thickening of the ethmoid\nair cells bilaterally, the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. No acute intracranial hemorrhage or fracture." + }, + { + "input": "A mixed density left-sided subdural collection with both hyperdense and\nisodense components overlying the left frontoparietal convexity measures up to\n2.1 cm at its largest diameter. There is 7 cm of rightward shift of normally\nmidline structures. There is no evidence of intraparenchymal hemorrhage. The\nbasal cisterns are patent. No definite ventriculomegaly is noted. Bilateral\nbasal ganglia probable prominent perivascular spaces are noted.\n\nThere is no evidence of acute territorial infarction.\n\nNo osseous abnormalities seen. The paranasal sinuses are clear. There is\nminimal fluid in the left mastoid air cells. The right mastoid air cells are\nwithin normal limits.", + "output": "1. Please note no prior exam was submitted for direct comparison.\n2. Acute on chronic left subdural hematoma measures up to 2.1 cm at its\nlargest diameter.\n3. There is 7 mm of rightward shift of normally midline structures.\n4. Nonspecific left mastoid fluid.\n5. Probable bilateral basal ganglia prominent perivascular spaces. If\nclinically indicated, consider correlation with patient's reported recent\noutside brain MRI." + }, + { + "input": "There has been interval evacuation of the left convexity extra-axial fluid\ncollection with expected postsurgical changes, pneumocephalus, and drain\nterminating the left frontal subdural space. Mixed density extra-axial fluid\ncollection has substantially decreased in size, now measuring maximally 17 mm,\npreviously 31 mm. Previously demonstrated midline shift has essentially\nresolved. No new hemorrhage is identified. No areas of hypodensity to\nsuggest infarct are seen. Mass-effect on the frontal horns of ventricles has\ndecreased, although a small amount remains. The basal cisterns are patent.", + "output": "1. Interval evacuation of the left subdural hematoma and drain placement with\nsubstantial decreased size of the extra-axial fluid collection (although some\nremains) and resolution of midline shift and decreased mass effect on the\nlateral ventricles.\n2. No new hemorrhage or CT evidence of infarct." + }, + { + "input": "Patient is status-post left frontal craniotomy with associated postsurgical\nchanges including trace underlying pneumocephalus, subcutaneous emphysema,\ncutaneous staples, and subcutaneous fat stranding. An extra-axial drain has\nbeen removed. The mixed density subdural fluid collection appears unchanged\nin size, now measuring 1.7 cm from the inner table at the craniotomy site\n(series 2, image 24). Approximately 1 mm of midline shift is unchanged. \nEffacement of the adjacent sulci is unchanged. The basilar cisterns are\npatent. No evidence of new intracranial hemorrhage. No evidence of large\nterritorial infarction, edema, or mass. Hypo densities in the bilateral basal\nganglia are unchanged.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "A mixed density subdural hematoma is unchanged in size since 2 days prior, now\nstatus-post extra-axial drain removal. No evidence of new hemorrhage. The\nventricles are stable in size and configuration." + }, + { + "input": "Postoperative changes left parietal craniotomy. Mixed density subdural\ncollection overlying the left parietal and frontal lobes is predominantly\nintermediate and low density, there is been some mixing of the blood products\nsince prior. No definite acute blood products. Fluid collection measures 1.0\ncm in maximum thickness just below the level of the roof of the lateral\nventricles, compared to 1.2 cm on prior. There are benign prevascular spaces\nin inferior bilateral basal ganglia. There is 0.1 cm left to right midline\nshift, minimally decreased since prior. There is no evidence of\ninfarction,new hemorrhage,edema,or mass. The ventricles and sulci are normal\nin size and configuration.\n\nThere is no evidence of fracture. Trace fluid in left mastoid air cells. \nOtherwise, the visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable. Degenerative arthritis left temporomandibular joint.", + "output": "Interval evolution of blood products within mixed density left hemispheric\nsubdural hematoma, no new hemorrhage since prior." + }, + { + "input": "There left parietal craniotomy changes with minimal soft tissue/fluid\nthickening underlying the craniotomy flap that could reflect residual dural\nthickening and/or a minimal amount of subdural fluid. The ventricles, sulci,\nand cisterns are age appropriate. There is no large infarct, acute\nintracranial hemorrhage, or mass effect. There is mild atherosclerotic plaque\nwithin the cavernous segments of bilateral internal carotid arteries.\n\nThe imaged paranasal sinuses are clear. The middle ear cavities and mastoid\nair cells are clear. Debris within the external auditory canals likely\nreflects cerumen.", + "output": "Near complete resolution of the left cerebral convexity subdural hematoma,\nwith only minimal fluid or residual dural thickening underlying the craniotomy\nflap. No acute intracranial hemorrhage." + }, + { + "input": "There is no evidence of acute large territory infarction,intracranial\nhemorrhageedema,or mass. There is prominence of the ventricles and sulci\nsuggestive of involutional changes. Confluent hypodensity in the right\nparietal lobe represents encephalomalacia from prior hemorrhage.\n\nThere is no evidence of fracture. Mild mucosal thickening of the left\nsphenoid sinus. Otherwise, the visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavitiesare essentially clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Sinus disease and chronic changes as above." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. There is\nredemonstration of right parietooccipital lobe encephalomalacia from remote\nintracranial hemorrhage. The previously described 4 mm left cerebellar\nenhancing mass is suboptimally evaluated on a noncontrast CT. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process. Specifically, no evidence of acute infarction\nor intracranial hemorrhage." + }, + { + "input": "There is no acute intracranial hemorrhage, loss of gray /white matter\ndifferentiation, edema or mass effect. The ventricles and sulci are mildly\nprominent, as before, indicating mild cerebral atrophy. Small foci of low\ndensity seen are again seen in the subcortical, deep and periventricular white\nmatter of the cerebral hemispheres, likely sequela of chronic small vessel\nischemic disease in a patient of this age.\n\nThere is a right periorbital hematoma without evidence for intraorbital\nextension. No fracture is identified. Minimal mucosal thickening within\nethmoid air cells is noted. The remainder of the visualized paranasal sinuses,\nmastoid air cells and middle ear cavities are clear.", + "output": "No evidence for an acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass effect. A chronic left caudate head lacunar infarct is noted. \nProminent ventricles and sulci are suggestive of age-related involutional\nchange. Mild periventricular white matter hypodensities are consistent with\nchronic small vessel ischemic disease. Dense atherosclerotic calcifications\nare seen within the cavernous carotid arteries as well as distal left\nvertebral artery.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. There is soft\ntissue swelling and hematoma in the extracranial soft tissues overlying the\nleft orbit. Both globes are intact without retrobulbar hematoma.", + "output": "1. No acute intracranial abnormality. Soft tissue swelling and hematoma in\nthe extracranial soft tissues about the left orbit. Globes intact.\n2. Age-related involutional changes and mild sequela of chronic small vessel\nischemic disease." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are mildly enlarged for the patient's age suggesting cerebral\natrophy.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. There are dense calcifications of the\ncarotid siphons bilaterally.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nMild periventricular and subcortical white matter hypodensities are likely\nsequelae of chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. Mild mucosal thickening of the ethmoidal\nair cells are noted. The additional visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Internal carotid artery and left\nvertebral artery calcifications are noted.", + "output": "1. No acute intracranial process. Specifically no hemorrhage or fracture.\n2. Chronic changes as described above." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, mass, mass effect or\nshifting of the normally midline structures. The ventricles and sulci are\nprominent suggesting cortical volume loss for the patient's age. Confluent\nareas of low attenuation are demonstrated in the subcortical and\nperiventricular white matter, which are nonspecific and may reflect areas of\nsmall vessel disease, which is also unusual in this age group, please\ncorrelate. Dense vascular arteriosclerotic calcifications are present the\ncarotid siphons bilaterally as well as the left vertebral artery. No\nfractures are identified. The soft tissues and bony structures are\nunremarkable, the mastoid air cells are clear.", + "output": "There is no evidence of acute intracranial process, however the ventricles and\nsulci are prominent for the patient's age. Areas of low attenuation in the\nsubcortical and periventricular white matter are nonspecific and may reflect\nchanges due to small vessel disease, which is also unusual in this age group,\nplease correlate." + }, + { + "input": "Head CT: There is extensive, diffuse subarachnoid hemorrhage centered within\nthe suprasellar cistern with intraventricular extension, layering in the\noccipital horns of the bilateral lateral ventricles as well as the third and\nfourth ventricle. When compared to prior exam, the intraventricular component\nis increased. The ventricular size appears similar to prior exam. Sulcal\neffacement within the bilateral cerebral hemispheres likely represents edema\nin relation to subarachnoid hemorrhage. The orbits, skull base, and paranasal\nsinuses are unremarkable. The patient is edentulous.\n\nHEAD CTA:\nThere is a 4 mm loculated aneurysm of the right MCA bifurcation.\nThere is an additional tiny 1-2 mm outpouching at the origin of the left\nposterior communicating artery which may represent an infundibulum and on the\nright at cavernous carotid segment (se 5, im 220).\nThere is a 3 mm vascular outpouching of the basilar tip, projecting superiorly\nand to the left, which is compatible with a small aneurysm.\nThe anterior communicating artery appears prominent, particularly at the\njunction of the A1 and A2 segments on the right, the appearance of which is\nlikely related to confluence of vessels rather than discrete aneurysm, a small\naneurysm can be difficult to assess.\nThere is no evidence of focal flow-limiting stenosis or vascular occlusion\nwithin the intracranial vasculature.\n\nNECK CTA:\n\nThe brachiocephalic artery and left common carotid artery share a common\norigin. There is atherosclerotic vascular disease within the aortic arch and\narch vessels with calcified and non-calcified plaques and tortuosity. The\norigin of the brachiocephalic artery is not imaged although appears patent in\nits proximal aspect. The origin of the left subclavian artery is patent.\nThere is mild stenosis at the origin of the right vertebral artery. The right\nvertebral artery is dominant. There is atherosclerotic vascular disease at\nthe origins of the proximal bilateral internal carotid arteries without\nevidence of stenosis by NASCET criteria.\nMild calcifications are noted in the common carotid arteries along with mildly\nprominent bifurcations left more than right.\nThe left proximal cervical internal carotid artery is tortuous in course, with\na focal prominence series 5, image 139 likely related to atherosclerotic\ndisease.\nThere is a focal outpouching of the distal right cervical internal carotid\nartery which may be on the basis of atherosclerotic vascular irregularity. \nSeries 5, image 175\n\nMISCELLANEOUS:\nThere is biapical pulmonary scarring and bilateral upper lobe bronchiectasis,\nright greater than left. Pleural plaques are noted within the right lung apex,\ncan be seen with prior asbestos exposure. An endotracheal tube and enteric\ntube are in place. There is fluid within the nasopharynx, likely related to\nintubation. The thyroid gland, submandibular glands, and parotid glands are\nunremarkable. No osseous lesions are seen. There is multilevel cervical\nspondylosis.", + "output": "1. Diffuse subarachnoid hemorrhage, centered within the suprasellar cistern,\nwith increased intraventricular extension when compared to prior exam.\n2. 4 mm lobulated aneurysm of the right MCA bifurcation.\n3. Additional 3 mm aneurysm of the basilar tip.\n4. Probable infundibulum at the origin of the left posterior communicating\nartery and on the right ; mild prominence of the anterior communicating artery\ncomplex-? Related to confluence of vessels or small aneurysm.\n5. Additional focal outpouching of the distal right cervical internal carotid\nartery which may be on the basis of atherosclerotic vascular irregularity.\n6. Atherosclerotic disease involving the cervical and intracranial arteries as\ndescribed above.\nOther details as above\n\nNOTIFICATION: Initial findings were discussed with ___ by Dr. ___\nin person immediately following initial review on 2:40 ___ ___." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, mass effect, midline\nshift, or mass. The ventricles and sulci are prominent consistent with\nage-related atrophy. There are calcifications in the basilar artery and\ncavernous portion of the internal carotid arteries. No bony abnormalities\nseen. There is mucous retention cyst in the left maxillary sinus and mucosal\nthickening in the ethmoid air cells; otherwise, the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The orbits are unremarkable. \nThere is a large right posterior scalp hematoma.", + "output": "1. Large right posterior scalp hematoma.\n\n2. No acute intracranial process." + }, + { + "input": "There is no evidence of no evidence of infarction, hemorrhage, edema, or\nmass. Prominent ventricles and sulci are preserved. Atherosclerotic vascular\ncalcifications are noted of bilateral cavernous portions of internal carotid\narteries.\n\nThere is no evidence of fracture. The visualized portion of the mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the orbits\nare unremarkable. Again is noted nonspecific suboccipital soft tissue\ninduration of fat at the midline (see ___. Minimal left maxillary sinus\nmucosal thickening is present.", + "output": "1. No acute intracranial process.\n2. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct.\n3. Nonspecific induration of suboccipital soft tissues may represent\npostoperative changes. However other etiologies are not excluded the basis\nexamination. Recommend clinical correlation and correlation with direct\nexamination.\n\nNOTIFICATION: Findings were communicated to Dr. ___ at 1:56 a.m. on ___ in person." + }, + { + "input": "CT noncontrast head:\n\nThere is no acute intracranial hemorrhage, infarction, mass, mass effect, or\nmidline shift. The ventricles and sulci are normal in size and configuration.\n\nCTA head:\nThe vessels of the circle of ___ and their principal intracranial branches\nare patent without stenosis, occlusion or aneurysm formation. The right A1\nsegment is absent or hypoplastic. Irregularity and narrowing of the right\nophthalmic segment of the internal carotid arteries are related to\natherosclerotic calcifications. The dural venous sinuses are patent.\n\nCTA NECK:\nThere is a short segment of near occlusion of the right proximal internal\ncarotid artery at the carotid bifurcation on 5:149 related to soft and\ncalcified plaque. A lumen of the right proximal internal carotid artery\nmeasures less than 0.5 mm. The remainder of the distal right internal carotid\nartery measures 5 mm. The remainder of the cervical and intracranial segments\nof the right internal carotid artery are diminutive in caliber relative to the\nleft internal carotid artery. There is no evidence of stenosis or occlusion of\nthe left internal carotid artery by NASCET criteria. There are atherosclerotic\ncalcifications at the origins of the vertebral artery, which remain patent.\n\nOTHER:\nSubsegmental atelectasis is noted in the left upper lobe. A 3 mm solid nodule\nin the right upper lobe is noted on 05:53. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. Short-segment, near occlusion with greater than 90% estimated stenosis of\nthe right proximal internal carotid artery by NASCET criteria.\n2. Patent circle of ___.\n3. No evidence of left internal carotid artery stenosis by NASCET criteria.\n4. There is a 3 mm right upper lobe nodule. If the patient is at low risk for\nmalignancy, no further follow-up is necessary. If the patient is at high risk\nfor malignancy, CT follow-up is recommended in 12 months. These guidelines\nare based on ___ criteria.\n\nRECOMMENDATION(S):\nThree mm right upper lobe nodule. If the patient is at low risk for\nmalignancy, no further follow-up is necessary. If the patient is at high risk\nfor malignancy, CT follow-up is recommended in 12 months. These guidelines\nare based on ___ criteria." + }, + { + "input": "There is no evidence of acute large territorial infarct,hemorrhage, edema, or\nmass effect. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mucosal thickening of anterior and\nposterior ethmoid air cells bilaterally. The other visualized paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No evidence of acute large territorial infarct or hemorrhage." + }, + { + "input": "CTA HEAD:\nThere is mild narrowing of the mid basilar artery which could be secondary to\natherosclerotic disease. Otherwise, The vessels of the circle of ___ and\ntheir principal intracranial branches appear normal without stenosis,\nocclusion or aneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThere are calcified granulomas in the lung apices. The visualized portion of\nthe thyroid gland is within normal limits. There is no lymphadenopathy by CT\nsize criteria.", + "output": "1. Mild atherosclerotic disease and narrowing of the mid basilar artery,\notherwise, patent circle of ___.\n2. No evidence of internal carotid artery stenosis by NASCET criteria." + }, + { + "input": "Postsurgical changes consistent with right frontal burr hole. There is no\nevidence of acute intracranial hemorrhage, mass, mass effect or shifting of\nthe normally midline structures. The ventricles and sulci are slightly\nprominent suggesting involutional changes. Subtle areas of low density are\ndemonstrated in the subcortical and periventricular white matter, which are\nnonspecific and may reflect changes due to chronic small vessel disease. \nVascular atherosclerotic calcifications are seen in the carotid siphons\nbilaterally\n\nThe orbits are unremarkable, the paranasal sinuses, demonstrate mild mucosal\nthickening in the sphenoid sinus on the left, the middle ear cavities and\nmastoid air cells are clear.\n\nThe soft tissues are unremarkable, no fractures are identified.", + "output": "1. There is no evidence of acute intracranial process or hemorrhage.\n\n2. Subtle areas of low attenuation in the subcortical white matter are\nnonspecific and may reflect changes due to small vessel disease.\n\n3. Postsurgical changes consistent with right frontal burr hole.\n\n4. Mild mucosal thickening identified in the sphenoid sinus on the left." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or mass. Patchy areas\nof hypoattenuation in the white matter noted which are nonspecific but may\nreflect chronic microvascular disease. There are atherosclerotic\ncalcifications of the bilateral carotid siphons. There is prominence of the\nventricles and sulci suggestive of involutional changes.\n\nA right frontal burr hole is noted. There is mucosal thickening in the\nsphenoid sinus on the left. The visualized portion of the paranasal sinuses,\nmastoid air cells,and middle ear cavities are otherwise clear. The visualized\nportion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal with no evidence of stenosis, occlusion,oraneurysm. The A1\nsegment of the right anterior cerebral artery is smaller than the left an\nanatomic variant. The dural venous sinuses are patent.", + "output": "1. No aneurysm or vascular malformation is demonstrated.\n2. Subtle areas of low attenuation in the white matter may reflect chronic\nmicrovascular disease in this age group." + }, + { + "input": "Aero digestive tract:\nAgain seen is a circumscribed fluid density focus along the right base of\ntongue laterally, just above the level of the glossotonsillar sulcus, likely a\nsubmucosal retention cyst, unchanged since prior study (9:34, 3:21). There is\nenlarged but otherwise identical lesion along the slightly more inferior,\nmedial base of tongue, protruding posteriorly into the oro pharyngeal lumen,\nmore clearly seen on this study than on prior due to improved patency of the\noropharyngeal lumen on this study, also suggestive of submucosal retention\ncyst (03:26, 09:38). These are not appreciably changed compared with studies\ndating to at least ___.\n\nOtherwise, there is no evidence of aerodigestive tract mucosal mass or mass\neffect.\n\nNeck lymph nodes:\nThere is no adenopathy involving bilateral levels ___. There is no\nretropharyngeal adenopathy.\n\nExtra nodal tumor spread:\nThere are no findings suggestive of extra nodal extension.\n\nDeep neck muscles, masticator space:\nThere is no muscle invasion.\n\nBones, skull base:\nThere is no bone involvement.\nNo aggressive focal osseous lesions.\nThere are no findings suggestive of perineural tumor extension. Jugular\nforamen, carotid canal, pterygopalatine fossa, infraorbital foramen, other\nskull base foramina are not involved.\n\nVessels:\nThere is no vascular invasion.\nThe inferior half of the right internal jugular vein is collapsed, either\nchronically occluded or diminutive, with most venous flow draining via the\nright external jugular vein, unchanged from prior exams. The previously\npatent right-sided veins including the superior right IJ and the right EJ,\nremain patent. Remainder of the neck vessels are grossly patent bilaterally,\nwith at least moderate bilateral, left worse than right, carotid bulb and\nproximal extracranial ICA calcified plaque.\n\nThere is a right chest Port-A-Cath with distal catheter tip seen to the level\nof the mid SVC.\n\nBrachial Plexus:\nThere is no evidence of brachial plexus contact or invasion.\n\nThyroid, salivary glands:\nThere is no mass.\n\nOther findings:\nImaged base of the brain is unremarkable.", + "output": "1. No cervical adenopathy. No evidence of lymphoma recurrence.\n2. Small probable submucosal retention cysts are seen in the oropharynx, along\nthe base of tongue, as above, measuring up to 11 mm, stable since at least\n___. Attention to these on follow-up.\n3. Please see separate report for intrathoracic findings from same-day CT\nchest." + }, + { + "input": "Aero digestive tract: There is no mass. Benign submucosal retention cyst base\nof tongue, similar.\n\nNeck lymph nodes: There is no adenopathy involving bilateral levels ___. \nThere is no retropharyngeal adenopathy.\n\nExtra nodal tumor spread: There are no findings suggestive of extra nodal\nextension.\n\nDeep neck muscles, masticator space: There is no muscle invasion.\n\nBones, skull base:\nThere is no bone involvement.\nThere are no findings suggestive of perineural tumor extension. Jugular\nforamen, carotid canal, pterygopalatine fossa, infraorbital foramen, other\nskull base foramina are not involved. Benign bone island C7, stable since\n___.\n\nVessels: There is no vascular invasion.\n\nBrachial Plexus: There is no brachial plexus contact or invasion.\n\nThyroid, salivary glands: There is no mass.\n\nOther findings: There are no lung nodules. Port-A-Cath in place.", + "output": "1. No mass. No adenopathy." + }, + { + "input": "Aero digestive tract: There is no mass.\nAgain seen is a small fluid collection at the right base of tongue, most\nsuggestive of a mucous retention cyst. This appears slightly larger than on\nthe prior studies.\n\nNeck lymph nodes: There is no adenopathy involving bilateral levels ___. \nThere is no retropharyngeal adenopathy.\n\nExtra nodal tumor spread: There are no findings suggestive of extra nodal\nextension.\n\nDeep neck muscles, masticator space: There is no muscle invasion.\n\nBones, skull base:\nThere is no bone involvement.\nThere are no findings suggestive of perineural tumor extension. Jugular\nforamen, carotid canal, pterygopalatine fossa, infraorbital foramen, other\nskull base foramina are not involved.\n\nVessels: There is no vascular invasion.\n\nBrachial Plexus: There is no brachial plexus contact or invasion.\n\nThyroid, salivary glands: There is no mass.\n\nOther findings: There are no lung nodules. A right internal jugular vein\ncatheter remains in place.", + "output": "1. No adenopathy detected.\n2. fluid collection at the right base of tongue, perhaps a mucosal retention\ncyst, has has gradually and slightly enlarged since ___." + }, + { + "input": "Some of the images have been degraded by streak artifact from dental amalgam.\n\nAero digestive tract: There no mass. Note is again made of a small fluid\ncollection at the right base of tongue, most likely a mucous retention cyst,\nthis is unchanged in size compared to prior.\n\n\nNeck lymph nodes: There is no adenopathy involving bilateral levels ___. \nThere is no retropharyngeal adenopathy.\n\nExtra nodal tumor spread: There are no findings suggestive of extra nodal\nextension.\n\nDeep neck muscles, masticator space: There is no muscle invasion.\n\nBones, skull base:\nThere is no bone involvement.\nThere are no findings suggestive of perineural tumor extension. Jugular\nforamen, carotid canal, pterygopalatine fossa, infraorbital foramen, other\nskull base foramina are not involved.\n\nVessels: There is no vascular invasion. Note is made of the right sided\ncentral venous catheter. There is atheromatous calcification of the\nbifurcation of both common carotid arteries. There is atheromatous\ncalcification of the carotid siphons bilaterally.\n\nBrachial Plexus: There is no brachial plexus contact or invasion.\n\nThyroid, salivary glands: There is no mass.\n\nOther findings: There are no lung nodules.", + "output": "-No lymphadenopathy identified.\n-Stable appearance of the small fluid collection at the right base of tongue,\nwhich likely represents a mucous retention cyst." + }, + { + "input": "There is extensive bulky cervical lymphadenopathy affecting all cervical\nstations. There is also diffuse cysts bilateral supraclavicular, bilateral\naxillary, mediastinal, and bilateral hilar lymphadenopathy. There is also\nenlargement of the intra parotid lymph nodes. The largest cervical lymph node\nis located in right level II a measuring up to measuring up to 31 x 19 mm\n(03:29). The largest supraclavicular lymph node is on the left measuring up\nto 31 x 17 mm (03:55). The largest visualized left axillary lymph node\nmeasures 23 x 21 mm (3:64). The largest visualized right axillary lymph node\nmeasures 27 x 24 mm (3:65). The largest visualized mediastinal lymph node\nmeasures up to 23 x 18 mm in the precarinal station (3:83). The largest\nvisualized right hilar lymph node is partially visualized, measuring up to 26\nx 22 mm (3:88). The largest visualized left hilar lymph node measures up to\n18 x 15 mm (3:85).\n\nThere is prominent lymphoid tissue enlargement in ___'s ring\nsignificantly narrows the airway (03:26). Evaluation of the remainder of the\naerodigestive tract demonstrates no mass and no areas of focal mass effect.\n\nThe submandibular glands are unremarkable.The thyroid gland appears normal. \nThe neck vessels are patent.\n\nA right upper lobe pulmonary nodule measures 6 mm (3:76). A possible left\nupper lobe pulmonary nodule measures approximately 3 mm (series 3, image\n83).There are no osseous lesions.\n\nThe visualized brain is grossly unremarkable. The visualized paranasal\nsinuses, mastoid air cells and middle ear cavities are grossly clear.", + "output": "1. Diffuse, extensive bulky intra parotid, cervical, supraclavicular,\naxillary, mediastinal and hilar lymphadenopathy, as described, concerning for\nlymphoma.\n2. Prominent enlargement of lymphoid tissue in Waldeyer's ring, prominently\nnarrowing the airway down to a minimal diameter of 4 mm.\n3. 6 mm right upper lobe pulmonary nodule and possible 3 mm left pulmonary\nnodule, better characterized on the concurrent dedicated chest CT.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 5:04 pm, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "Significant interval decrease size diffuse cervical and axillary\nlymphadenopathy when compared to examination of ___. There\nremains enlarged bilateral level 2 lymph nodes measure up to 2.2 cm on the\nright and 1.6 cm on the left in long axis. ___'s ring has significantly\ndecreased in size. There is no evidence of mucosal mass or lesion within the\nvisualized aerodigestive track. The thyroid is unremarkable. There is mild\nmucosal thickening of the visualized paranasal sinuses. The visualized\nmastoid air cells middle ears well pneumatized and clear. The visualized\norbits are unremarkable. No suspicious osseous lesions. Although not\noptimized for such evaluation, visualized brain parenchyma is grossly\nunremarkable. The lymph nodes and ___'s ring appear grossly unchanged\nfrom most recent PET-CT ___ allowing for technical differences.\n\nThere appears to be overall interval enlargement of a right parotid tail lymph\nnode measuring approximately 1.9 cm in long axis. Additional smaller right\nparotid lymph nodes have decreased in size. The left parotid gland is\nunremarkable. The submandibular glands appear grossly unremarkable.\n\nMultiple pulmonary nodules have decreased in size from prior examination. For\nexample a dominant right upper lobe 6 mm pulmonary nodule now measures\napproximately 2 mm (series 3, image 162). No definite new pulmonary nodules. \nNo suspicious osseous lesions. Right-sided Port-A-Cath is identified. The\ncervical vessels are patent. Mild atherosclerotic calcification of the aortic\narch and carotid bifurcations are again noted.", + "output": "1. Significant interval decrease size of diffuse cervical and axillary lymph\nnodes when compared to examination of ___, with dominant lymph\nnodes in the bilateral level 2A measuring up to 2.2 cm in long axis on the\nright. Waldeyer's ring has also significantly decreased in size from\nexamination of ___. The above findings are overall similar to prior PET-CT\nof ___ allowing for technical differences.\n2. There is a enlarged 1.9 cm right parotid tail lymph node, increased in size\nfrom examination of ___ although previously described enlarged right\nparotid lymph nodes have decreased in size.\n3. Please refer to concurrent CT chest for additional details. However,\nvisualized pulmonary nodules in the lung apices have also decreased in size\nfrom examination of ___.\n4. Additional findings described above." + }, + { + "input": "The parotid glands, submandibular glands, and thyroid are unremarkable.\n\nThere is no cervical adenopathy. Previously seen enlarged lymph nodes have\ndemonstrated interval decrease in size. For example right level-IIa lymph\nnode (03:22) measures 1.4 cm in long axis, previously 2.2 cm. Right level ___\nlymph node (03:42) currently measures 0.5 cm, previously 1.4 cm. Rounded soft\ntissue density in the right parotid tail on prior is no longer visualized.\n\nThe aerodigestive tract appears normal. Included paranasal sinuses and\nmastoids are clear.\n\nVascular structures in the neck are grossly unremarkable noting partially\ncalcified atherosclerotic plaque at the carotid bulbs bilaterally, worse on\nthe left.\n\nIncluded intracranial structures appear normal.\n\nNo focal suspicious osseous lesion identified. A C7 vertebral body bone\nisland is unchanged.\n\nPlease see concurrent CT chest for detailed description of the pulmonary\nfindings.\n\nRight chest wall port is partially visualized.", + "output": "No cervical adenopathy. Previously seen enlarged lymph nodes have\ndemonstrated interval decrease in size." + }, + { + "input": "Nonenhancing hypodensities within the bilateral lingual tonsils are unchanged\nfrom prior examination, likely representing mucous retention cysts. No\nevidence of recurrence of diffuse enlargement of Waldeyer's ring as seen on\nexamination of ___. The remainder of the aerodigestive track is\nunremarkable. The parotid and submandibular glands are unremarkable. There\nis no cervical lymphadenopathy by size criteria. The thyroid is unremarkable.\n\nAtherosclerotic calcification of the bilateral carotid bifurcations is\nunchanged. Otherwise, cervical vessels are patent. The visualized orbits are\nunremarkable. No suspicious osseous lesions. Although not optimized for such\nevaluation, visualized brain parenchyma is unremarkable. Visualized orbits\nare unremarkable. There is mild mucosal thickening of the visualized ethmoid\nair cells. The mastoid air cells and middle ears are clear. No suspicious\nosseous lesions. A C7 bone island is unchanged. Mild interval progression of\nC6 superior endplate degenerative changes.\n\nScattered small pulmonary nodules measuring less than 1-2 mm is identified. \nRight Port-A-Cath is noted. Please refer to concurrent CT chest for\nadditional details.", + "output": "1. No cervical lymphadenopathy by size criteria. The appearance of the lymph\nnodes are overall unchanged from examination of ___.\n2. Nonenhancing hypodensities in the bilateral lingual tonsils are unchanged\nfrom prior exam and compatible with mucous retention cysts. Otherwise, the\naerodigestive tract is grossly unremarkable.\n3. Additional findings as described above." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect. Few mucosal retention cysts oropharynx.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria.Narrowed proximal left ICA by atheromatous plaque. Chronically\noccluded right internal jugular vein in the low neck, with prominent venous\ncollaterals.\n\nRefer to chest CT report from today for thoracic findings, including lung\nnodule..There are no osseous lesions. Port-A-Cath in place. Paranasal sinus\ndisease, moderate opacification right maxillary, ethmoid sinus, mild mucosal\nthickening ulcer, worsened since prior. Air-fluid level right maxillary\nsinus, consider acute sinusitis. Degenerative changes spine.", + "output": "1. No adenopathy or mass.\n2. Moderate paranasal sinus disease, suggestive of acute sinusitis." + }, + { + "input": "In comparison with most recent CT from ___, several prominent\nsupraclavicular lymph nodes are present. The largest lymph node on the right\nmeasures up to 1 cm on axial imaging, located medial to the right external\njugular vein and lateral to another prominent lymph node measuring 0.7 cm\n(series 3, image 52). The largest supraclavicular lymph node on the left\nmeasures up to 0.8 cm located posterior to the left internal jugular vein\nanterior to another lymph node also measuring up to 0.8 cm (series 3, images\n50 and 51). These lymph nodes demonstrate no enhancement. No other prominent\nlymph nodes are identified.\nEvaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal.The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.", + "output": "1. Prominent bilateral nonenhancing supraclavicular lymph nodes measuring up\nto 1 cm on the right, concordant with recent PET-CT findings.\n2. No cervical mass or lymphadenopathy." + }, + { + "input": "Streak artifact from dental hardware limits evaluation.\n\nThere are a number of subcentimeter bilateral level 2, level 3, and level 4\nlymph nodes, majority of which are decreased in size compared to prior exam. \nFor example, a right level 4 lymph node currently measures up to 0.5 cm (image\n66 of series 2), previously 1 cm. A left level 4 lymph node currently\nmeasures 0.5 x 0.5 cm (image 67 of series 2), previously 0.9 cm.\n\nEvaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding.\n\nThe thyroid is preserved.\n\nThe neck vessels are patent. There are atherosclerotic calcifications of the\nleft greater than right carotid artery bifurcations. Atherosclerotic vascular\ncalcifications are noted of bilateral cavernous portions of internal carotid\narteries.\n\nThere is mild mucosal thickening of the ethmoid and left maxillary sinuses.\n\nOn the scout images, there is a right internal jugular port catheter with tip\nprojecting over the right atrium.\n\nThe lung windows show minimal biapical scarring.\n\nBone windows demonstrate multilevel degenerative changes of the cervical\nspine, most pronounced at C5-C6 with intervertebral disc height loss. C7\nvertebral body probable bone island is again seen.", + "output": "1. Streak artifact from dental hardware limits evaluation.\n2. Multiple cervical chain lymph nodes decreased in size compared to prior\nexam.\n3. No enlarged lymph nodes by CT size criteria.\n4. Paranasal sinus disease , as described." + }, + { + "input": "Right-sided Port-A-Cath is partially visualized.\n\nThere is no cervical lymphadenopathy by size criteria. Cervical lymph nodes\nare unchanged in size from prior examination. The visualized aerodigestive\ntract and Waldeyer's ring are unremarkable.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding.The thyroid appears unremarkable.The neck vessels are patent.\n\nThe visualized paranasal sinuses are essentially clear. The mastoid air cells\nmiddle ears well pneumatized and clear. Visualized orbits are unremarkable. \nAlthough not optimized for such evaluation, visualized brain parenchyma is\ngrossly unremarkable.\n\nThere are scattered 1-2 mm pulmonary nodules in the visualized lung apices,\nbetter evaluated on concurrent CT chest.There are no suspicious osseous\nlesions.", + "output": "1. There is no cervical lymphadenopathy by size criteria. Unchanged\nconfiguration and size of the cervical lymph nodes from prior examination.\n2. Additional findings described above." + }, + { + "input": "Mild soft tissue stranding is seen along bilateral margins of the frontal\nbone. There is no evidence of fracture, infarction,hemorrhage,edema, or mass.\nSubcortical and periventricular white matter hypodensities are nonspecific,\nlikely the sequelae of chronic small vessel ischemic disease. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nA mucous retention cyst is seen in the right posterior ethmoid air cell. An\nair-fluid level seen in a left posterior ethmoid air cell. The visualized\nportion of the remaining paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits show evidence of\nbilateral lens implants.", + "output": "1. No acute intracranial process no acute intracranial hemorrhage..\n2. Mild soft tissue swelling along bilateral lateral margins of the frontal\nbone may represent sites of soft tissue injury. There is no underlying\nfracture. Recommend correlation with clinical exam." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mild mucosal thickening in the\nethmoid air cells. The visualized portion of the remainder of paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No fracture or acute intracranial process." + }, + { + "input": "Chronic encephalomalacia is noted in the left frontotemporal region. No\nintra-axial or extra-axial hemorrhage, edema, shift of normally midline\nstructures, or evidence of acute major vascular territorial infarction. The\nventricles are within normal limits of size. Age related involutional changes\nare present. There is mild cerebellar atrophy. Basilar cisterns are patent. \nParanasal sinuses are mostly clear. The imaged mastoid air cells and middle\near cavities are well aerated. The bony calvarium is intact.", + "output": "1. No acute intracranial process.\n2. Chronic encephalomalacia in the left frontotemporal region." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nlarge territorial infarction. Prominent ventricles and sulci may be related\nto HIV. The basal cisterns appear patent and there is preservation of\ngray-white matter differentiation. The visualized bony structures are grossly\nunremarkable. There is mild mucosal thickening of bilateral ethmoid air cells\nand maxillary sinuses. The remaining paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear.\nThe globes are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of no evidence of acute major infarction, hemorrhage,\nedema, or large mass. Prominent ventricles and sulci suggest age related\ninvolutional changes. There is no evidence of fracture. Mucous retention\ncyst is seen in the bilateral maxillary sinuses. Mucosal thickening is seen\nin the ethmoid air cells. Otherwise, the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Prominence of the ventricles and sulci are compatible with age\nrelated global atrophy. Ill-defined periventricular and subcortical white\nmatter hypodensities are nonspecific but likely due to sequela of chronic\nischemic small vessel changes.\n\nThere are mucous retention cysts in the bilateral maxillary sinuses. Mucosal\nthickening is noted in the bilateral ethmoid sinuses. An air fluid level seen\nin the left maxillary sinus and fluid is noted within the posterior\nnasopharynx, findings which may be related to recent intubation. Mastoid air\ncells and middle ear cavities are well aerated. The bony calvarium is intact. \nPeriapical lucencies and dental caries within the maxillary teeth are\nconsistent with periodontal disease. Patient is intubated.", + "output": "No acute intracranial process." + }, + { + "input": "Right-sided subdural hematoma is stable in thickness, measuring 4 mm. Blood\nproducts have redistributed posteriorly into the right parietal region. There\nis no shift of normally midline structures or evidence of central herniation.\nThere is no new hemorrhage. The ventricles and sulci are normal in size and\nconfiguration for the patient's age. The basal cisterns appear patent and\ngray-white matter differentiation is preserved. The orbits and globes are\nunremarkable. The imaged paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The bony calvaria appear intact.", + "output": "Stable right parietal subdural hematoma. No new hemorrhage or mass effect." + }, + { + "input": "Streak artifact from dental amalgam limits evaluation of the posterior fossa\nand lower occipital lobes.\n\nOtherwise, no evidence for acute intracranial hemorrhage, edema, mass effect,\nor acute major vascular territorial infarction. Extensive, partially\nconfluent periventricular, deep, and subcortical white matter hypodensities,\nare nonspecific, though most likely sequela of chronic small vessel ischemic\ndisease given the patient's age and known vascular disease mild global\nparenchymal volume loss for the patient's age with prominent ventricles and\nsulci.\n\nEndotracheal and orogastric tubes are partially imaged. No concerning osseous\nabnormalities are seen. There is a large amount of fluid and mild mucosal\nthickening in the right maxillary sinus, which may be secondary to intubation.\nThere is partial right and trace left mastoid air cell opacification. A right\nmaxillary periapical lucency involving either ___ 7 or 8 cannot be excluded,\nthough this may be an artifact of volume averaging, image 2:14.", + "output": "1. Technically limited exam.\n2. No evidence for acute hemorrhage or acute major vascular territorial\ninfarction.\n3. Extensive 5 supratentorial white matter hypodensities are nonspecific,\nthough statistically likely sequela of chronic small vessel ischemic disease\ngiven the patient's age and known vascular disease.\n4. Fluid in the right maxillary sinus may be secondary to endotracheal\nintubation. However, please correlate with any signs of acute sinusitis,\ngiven the patient's recent sepsis.\n5. Possible right maxillary periapical lucency involving either ___ 7 or 8,\nversus volume averaging artifact." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere are moderate periventricular and subcortical white matter hypodensities\nwhich are nonspecific may reflect chronic ischemic ischemic gliotic changes. \nPreviously noted multifocal small supra and infratentorial regions of\nrestricted diffusion suggestive of cardioembolic infarcts on the previous MRI\ndated ___ are not well differentiated from the chronic changes on\nnoncontrast CT. No evidence of acute large vascular territorial infarct. No\nacute intracranial hemorrhage. Again seen is prominence of the ventricles and\nsulci is compatible with moderate atrophic changes.\n\nA small amount of fluid is noted layering within the dependent right maxillary\nsinus, which may related to intubation. There is near complete opacification\nof the right mastoid air cells and complete opacification of the right middle\near cavity, progressed compared to ___, which may also be secondary\nto endotracheal intubation. The left middle ear cavity and left mastoid air\ncells appear clear. There is a large periapical lucency in the maxilla\ninvolving ___ 7 and 8, and a separate periapical lucency involving ___ 9. \nStatus post lens replacement bilaterally.\n\nCTA NECK:\nThere is calcified plaque at the great vessel origins left flow-limiting\nstenosis, as well as mixed plaque in the proximal left subclavian carotid\nartery with minimal luminal narrowing. The left vertebral artery arises\ndirectly from the aortic arch, a normal variant.\n\nCalcified plaque causes up to 70% stenosis of the proximal left ICA by NASCET\ncriteria (series 302, image 42).\n\nCalcified plaque causes approximately 50% stenosis of the proximal right ICA\nby NASCET criteria (series 304, image 13).\n\nThere is calcified plaque at the origin of the dominant right vertebral artery\nwith moderate luminal narrowing. There is also calcified plaque within the\nright V4 segment without flow-limiting luminal narrowing.\n\nThe left vertebral artery arises directly from the aortic arch, a normal\nvariant. There is minimal calcified plaque in the V1 segment without\nflow-limiting stenosis. V1 through V3 segments. There is calcified plaque\nmoderately narrowing the mid left V4 segment proximal to the left ___,\nwith associated narrowing of the left ___.\n\nCTA HEAD:\nAtherosclerotic calcifications are noted within the right greater than left\npetrous through supraclinoid portions of the bilateral internal carotid\narteries, without significant luminal stenosis. There is calcified plaque\nmoderately narrowing the mid left V4 segment proximal to the left ___,\nwith associated narrowing of the left ___. Mild calcified plaque in\nthe right V4 segment without flow-limiting stenosis.\n\nNo evidence for an aneurysm. Please note that CTA has limited sensitivity for\nsmall peripheral mycotic aneurysms.\n\nNormal variants include early branching of the right superior cerebellar\nartery and early branching of the right A2 segment.\n\nDural venous sinuses are patent. Right transverse and sigmoid sinuses are\ndominant.\n\nOTHER:\nEndotracheal and enteric tubes are identified. There is small volume\ninspissated material along the dependent tracheal wall compatible with\nsecretions. A left IJ central venous catheter terminates in the left\nbrachycephalic vein near its junction with the SVC.\n\nPneumomediastinum, diffuse anterior chest wall subcutaneous gas and a\nmediastinal drain are seen, compatible with recent cardiac surgery. There are\npartially imaged bilateral pleural effusions and findings compatible with\npulmonary edema, as well as dependent atelectasis. Multiple prominent\nnonenlarged mediastinal lymph nodes are likely reactive. This is incompletely\nevaluated on this nondedicated exam.\n\nThe visualized thyroid is unremarkable. There is no cervical lymphadenopathy\nby CT size criteria.", + "output": "1. No acute hemorrhage or evidence for an acute major vascular territorial\ninfarct. Multiple small subacute infarcts seen on the ___ MRI are\nnot well differentiated from chronic small vessel ischemic changes on the\npresent CT.\n2. No evidence for an aneurysm. Please note that CTA has limited sensitivity\nfor small peripheral mycotic aneurysms.\n3. Up to 70% stenosis of the proximal left ICA by NASCET criteria and\napproximately 50% stenosis of the proximal right ICA by NASCET criteria.\n4. Calcified plaque moderately narrowing the dominant right vertebral artery\norigin.\n5. Non dominant left vertebral artery arises directly from the aortic arch, a\nnormal variant. Calcified plaque causes moderate narrowing of the mid left V4\nsegment proximal to the left ___, as well as a probable narrowing of\nthe left ___.\n6. Postsurgical changes in the included upper thorax. Partially imaged\npleural effusions and pulmonary edema.\n7. Increased, complete opacification of the right middle ear cavity and near\ncomplete opacification of the right mastoid air cells, as well as fluid in the\nright maxillary sinus, likely secondary to endotracheal intubation and\nprolonged supine positioning in the inpatient setting. However, please\ncorrelate clinically whether there is any concern for superimposed infection." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, midline shift, mass\neffect, or acute large vascular territory infarct. Mild periventricular white\nmatter hypodensity is nonspecific, but most likely sequela of chronic small\nvessel disease. Right caudate lacunar infarct is re-demonstrated. The\nvisualized paranasal sinuses are clear. Subtle mild opacification of inferior\nright mastoid air cells is likely chronic. The remainder of the mastoid air\ncells are clear. No acute fracture is seen.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass.\n\nThe ventricles and sulci are normal in size and configuration.\n\nPostsurgical changes after endoscopic sinus surgery are noted. There is\nsevere mucosal thickening involving the frontoethmoidal junctions and ethmoid\nair cells. There is complete obliteration of the sphenoid sinuses. It small\namount of layering fluid is seen in the bilateral maxillary sinuses. The\nmucus is partially hyperattenuating (series 3, image 235), likely reflecting\ninspissated secretions or allergic fungal sinusitis. The lamina papyracea are\ndehiscent, better evaluated on the sinus CT from ___. No evidence of\nintraorbital inflammation.\n\nCTA HEAD:\nThere are mild atherosclerotic changes along both cavernous ICAs without\nhigh-grade stenosis. The vessels of the circle of ___ and their principal\nintracranial branches appear normal without stenosis, occlusion, or aneurysm\nformation. A prominent left posterior communicating artery is present, normal\nanatomic variant.\nThe dural venous sinuses are patent.\n\nCTA NECK:\nNormal 3 vessel aortic arch. The carotidandvertebral arteries and their major\nbranches appear normal with no evidence of stenosis or occlusion. There is no\nevidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nNo suspicious pulmonary nodules. There is a 9 mm hypodense nodule in the left\nthyroid lobe. The remainder of the thyroid gland appears unremarkable. There\nis no lymphadenopathy by CT size criteria.", + "output": "1. No significant intracranial abnormality. No evidence of acute infarction,\nhemorrhage or intracranial mass.\n2. Patent intracranial and cervical vasculature without evidence of\ndissection, stenosis, occlusion or aneurysm formation greater than 3 mm.\n3. Postsurgical changes after endoscopic sinus surgery with overall severe\nparanasal sinus disease.\n4. Partially hyperattenuating mucous likely reflects inspissated secretions or\nallergic fungal sinusitis.\n5. Unchanged dehiscence of the lamina papyracea bilaterally." + }, + { + "input": "There is no evidence of acute fracture, infarction, hemorrhage or edema. \nRedemonstrated hypodensity in the right basal ganglia is likely an old lacunar\ninfarct. Slightly increased attenuation of the cerebellar tonsils on either\nside, can relate to artifacts from the adjacent bone. No mass effect or\neffacement of the adjacent CSF space noted.\n\n\nThe ventricles and sulci are normal in size and configuration. Ill-defined\nperiventricular hypodensities are seen bilaterally, most likely representing\nchronic small vessel ischemic disease. There is no midline shift or mass\neffect.\n\nThere is no abnormal enhancement on post contrast images.\n\nThe visualized portions of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are grossly clear. Mild ethmoidal mucosal thickening.\nThe sphenoid sinus septation inserts on the left carotid groove. Patient has\nhad prior bilateral lens replacements.\nSmall scattered foci of sclerosis are noted in the left frontal (series 301,\nimage 66), right parietal (series 301, image 41), and right anterior skull\nbase (series 301, image 106) which are consistent with bone islands and remain\nstable compared to prior imaging from ___.", + "output": "1. No evidence of acute intracranial abnormalities.\n\nRECOMMENDATION(S): Further workup cervical spine with MRI if not\ncontraindicated, given the radiating symptoms and history of lymphoma or\nFollow up is recommended as clinically indicated.\n\nNOTIFICATION: Prelim findings of CT Discussed with Dr. ___ by Dr. ___ on\nthe day of the study" + }, + { + "input": "There is no evidence of large territorial infarction, hemorrhage, edema, or\nmass effect. Again seen is a right basal ganglia hypodensity, which may\nrepresent prior lacunar infarct. Periventricular and subcortical white matter\nhypodensities are noted, consistent with small vessel ischemic disease. The\nventricles are unchanged since prior examination in unremarkable. The basilar\ncisterns are patent.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nPeriventricular and subcortical white matter hypodensities are consistent with\nchronic small vessel disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Right frontal subgaleal hematoma is\nnoted.", + "output": "1. No acute intracranial process. Right frontal soft tissue swelling." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular, subcortical and deep white matter\nhypodensities are nonspecific, but likely reflect the sequela of chronic\nmicrovascular infarction.\n\nThere is no evidence of fracture. Mild mucosal thickening is seen involving\nthe right maxillary sinus. The visualized portion of the remaining paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable apart from bilateral lens replacement. \nDense atherosclerotic calcifications are seen involving the V4 segment of the\nleft vertebral artery and both cavernous carotid arteries.", + "output": "No acute intracranial abnormality including no hemorrhage or mass effect." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass effect. The ventricles and sulci are normal in size and configuration.\nPunctate area of hypodensity in the right basal ganglia likely represents a\nchronic lacunar infarct. Periventricular and subcortical white matter\nhypodensities are nonspecific, but likely represent sequela of chronic\nischemic microvascular disease. Bilateral basal ganglia calcifications are\nalso noted.\n\nNo acute fractures are seen. There is mucosal thickening in the right\nmaxillary sinus and minimal mucosal thickening in the bilateral ethmoid air\ncells. The mastoid air cells are clear.", + "output": "No acute intracranial process." + }, + { + "input": "Postsurgical changes related to interval left frontal parafalcine meningioma\nresection via left frontal craniotomy are noted. Hyperdense material similar\nto mass remains. Postsurgical changes including pneumocephalus, edema, and\nfluid are present in the subdural space and resection bed. Hyperdense\nmaterial is noted within the resection cavity. There is mild mass effect on\nthe anterior horns of the lateral ventricles which appears slightly smaller\nthan on ___ prior exam. No midline shift. The basal cisterns are\npatent. The paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The orbits are preserved.", + "output": "1. Post left frontal meningioma resection with expected postsurgical changes\nand hemorrhage in the resection bed.\n2. Please note that residual tumor is not excluded on the basis of this\nexamination.\n\nNOTIFICATION: The findings were discussed with ___, N.P. by ___\n___, M.D. on the telephone on ___ at 7:52 am, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "Re-demonstration of postsurgical changes status post left frontal parafalcine\nmeningioma resection and left frontal craniotomy. Postsurgical changes again\nincluding pneumocephalus decreased from prior, edema, and fluid in the\nsubdural space and resection bed. Subcutaneous air is again noted. There is\nre-demonstration of hyperdense material within the resection cavity and mild\nmass effect on the anterior horns of the lateral ventricles, similar to prior.\nNo midline shift. There is a small amount of low-density left frontal\nsubdural fluid with ___ of 20.\n\nNo large vascular territory infarction or acute intracranial hemorrhage is\nnoted.\n\n The visualized portion of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Postsurgical changes are again noted status post left craniotomy. Small\namount of low-density frontal subdural fluid without evidence of acute\nhemorrhage." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration for age.\n\nThere is mild mucosal wall thickening in the left frontoethmoidal recess and\nleft ethmoid air cells. There is a small mucous retention cyst with mild\nsurrounding mucosal wall thickening in the inferior aspect of the right\nmaxillary sinus. The remainder of the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is mild atherosclerotic calcification in the cavernous and supra clinoid\nsegment of the left internal carotid artery without significant narrowing. \nThere is variant partial fetal type origin of the left posterior cerebral\nartery. Anterior communicating artery is demonstrated. Right posterior\ncommunicating artery is demonstrated. The vessels of the circle of ___ and\ntheir principal intracranial branches appear normal without stenosis,\nocclusion, or aneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nExamination is mildly limited by streak artifact. There is common origin of\nthe brachiocephalic and left common carotid artery. There is variant direct\norigin of the left vertebral artery from the aortic arch. There is mild\nnarrowing at the origin of the right vertebral artery secondary to\natherosclerotic calcification. There is mild atherosclerotic calcification at\nthe carotid bifurcations bilaterally without significant stenosis. The\ncarotid and vertebral arteries and their major branches appear patent with no\nevidence of significant stenosis or occlusion or dissection. There is no\nevidence of internal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. There is an 8 mm hypodense\nnodule in the left lobe of the thyroid gland. There is no lymphadenopathy by\nCT size criteria.", + "output": "1. No acute intracranial abnormality.\n2. Patent intracranial vasculature without significant stenosis, occlusion or\naneurysm.\n3. Mild narrowing at the origin of the right vertebral artery secondary to\natherosclerotic calcification. Otherwise patent cervical vasculature without\nocclusion, or dissection.\n4. 8 mm left thyroid lobe nodule. The ___ College of Radiology\nguidelines suggest that in the absence of risk factors for thyroid cancer, no\nfurther evaluation is recommended." + }, + { + "input": "There is no evidence of fracture, infarction, hemorrhage, edema, or mass. \nThere is generalized brain parenchymal atrophy, most prominent at the\ntemporal, parietal lobes, with left greater than right anteromedial temporal\nlobe atrophy. There is no abnormal enhancement on post contrast images. \nThere are mild chronic small vessel ischemic changes. Visualized dural venous\nsinuses are patent.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\nThere arterial calcifications of the cavernous segments carotid arteries.", + "output": "1. There is no mass." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, , mass effect or large\nterritorial infarction. Prominence of the ventricles and sulci is likely\nrelated to age related involutional changes. Periventricular and deep white\nmatter subcortical hypodensities are likely related to small vessel ischemic\ndisease. The basilar cisterns are patent, and there is otherwise good\npreservation of gray-white matter differentiation.\n\nA nondisplaced fracture is seen along the right lateral maxillary wall, series\n3, image 6. Hyperdense air-fluid levels are seen within the right maxillary\nsinus, concerning for blood products. The sphenoid sinuses are clear. The\nleft maxillary sinus is clear. The ethmoid air cells are clear. The frontal\nsinuses are clear.\n\nA subtle lucency is seen within the right zygomatic arch, series 3, image 8\nconcerning for a nondisplaced fracture. There is extensive ___ and\ninfraorbital soft tissue swelling.\n\nThe mastoid air cells, and middle ear cavities are clear. The globes are\nunremarkable.", + "output": "1. No acute intracranial abnormalities identified.\n2. Subtle nondisplaced fracture seen along the right lateral maxillary wall,\nwith hyperdense air-fluid levels seen within the right maxillary sinus\nconcerning for blood products.\n3. Subtle lucency seen within the right zygomatic arch, is also concerning for\na nondisplaced fracture. There is extensive overlying soft tissue swelling." + }, + { + "input": "There are mucous retention cyst within the inferior aspect of the left\nmaxillary sinus. There is opacification at the left infundibulum occluding\nthe ostiomeatal complex. The right maxillary sinus is clear with a patent\nostiomeatal complex. The bilateral frontal sinuses and ethmoid air cells are\nclear. There is a small mucous retention cyst within the right lateral\nsphenoid sinus. The frontal ethmoidal and sphenoid ethmoidal complexes are\npatent. The nasal septum is intact. There is rightward deviation of the bony\nnasal septum which contacts the right inferior turbinate (601:63). The fovea\nethmoidalis and cribriform plate are intact. The olfactory grooves measure up\nto 5 mm in depth. The anterior clinoid processes are not pneumatized. The\nsphenoid osseous septum is midline. The lamina papyracea are intact.\n\nThere is a periapical lucency at the right maxillary second molar (601:64) and\nthe left maxillary second molar (601:66). The visualized intracranial\nstructures are unremarkable. The orbits and soft tissues are unremarkable.", + "output": "1. Paranasal sinus disease as described.\n2. Rightward nasal septal deviation with bony spur which contacts the right\ninferior turbinate.\n3. Bilateral periapical lucencies involving the maxillary second molars. \nRecommend clinical correlation and correlation with dental examination.\n\nRECOMMENDATION(S): Bilateral periapical lucencies involving the maxillary\nsecond molars. Recommend clinical correlation and correlation with dental\nexamination." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, hemorrhage, edema, or parenchyma mass. \nBrain parenchymal atrophy. Findings consistent with mild chronic small vessel\nischemic changes. Probable small chronic infarct right centrum semiovale. \n1.1 cm calcified dural-based mass anterior left middle cranial fossa,\nconsistent with meningioma.\n\nThere is mild mucosal thickening within the right sphenoid sinus. The\nremaining visualized portion of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. Left lens replacement is noted. Right orbit\nis unremarkable.\n\nCTA HEAD:\nAtherosclerotic plaque, mild narrowing left V4 segment vertebral artery.\nAtherosclerotic calcifications bilateral cavernous, supraclinoid segments,\nwith mild narrowing.\nThe remaining vessels of the circle of ___ and their principal intracranial\nbranches appear normal without stenosis, occlusion, or aneurysm formation.\nThe dural venous sinuses are patent.\n\nCTA NECK:\nThere is moderate atherosclerotic calcification of the aortic arch. Mild\natherosclerotic disease bilateral carotid bifurcations. Otherwise, the\ncarotid and vertebral arteries and their major branches appear normal with no\nevidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. Distended proximal esophagus. Proximal esophageal wall thickening,\nmay be reactive, inflammatory or neoplastic.. Degenerative changes spine.", + "output": "1. No evidence of acute intracranial process.\n2. Probable chronic small infarct right centrum semiovale.\n3. Small left middle cranial fossa meningioma.\n4. Atherosclerotic disease, mild intracranial narrowing.\n5. No vascular narrowing in the neck.\n6. Indeterminate circumferential wall thickening of the proximal thoracic\nesophagus, may be inflammatory, neoplastic." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "1. No acute intracranial process." + }, + { + "input": "Surgical changes after right frontotemporal craniotomy noted. There is an\naneurysm clip noted in the right suprasellar cistern. There is no evidence of\nintracranial hemorrhage. The ventricles and sulci are normal in size and\nconfiguration. There is no evidence of edema or mass effect. The basal\ncisterns are patent and there is preservation of gray-white matter\ndifferentiation.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "S/P aneurysm clipping. Otherwise normal. No evidence of hemorrhage or\ninfarction." + }, + { + "input": "Head CTA: There is a aneurysm clip noted in the region of the right A-comm.\nStreak artifact from aneurysm clip partially limits evaluation. However, no\ndefinite residual aneurysm is seen. There are no intracranial vascular\nabnormalities. There is no evidence of aneurysm, stenosis or occlusion.\n\nNeck CTA: There is an a normal 3 vessel takeoff from the aortic arch. The\ncarotid and vertebral arteries and their major branches are patent with no\nevidence of stenoses. There is no evidence of internal carotid stenosis by\nNASCET criteria. There is mild irregularity of the cervical vasculature likely\nreflecting early arthrosclerotic changes.\n\nPatient is status post right frontal cranioplasty. The orbits are\nunremarkable. There is mucosal thickening in the left maxillary sinus. The\nremaining paranasal sinuses and mastoid air cells are clear.\n\nThe visualized lungs are clear. The soft tissues of the neck are unremarkable.\nThe thyroid gland is unremarkable. There are degenerative changes throughout\nthe spine.", + "output": "1. Aneurysm clip in the region of the right A-comm. Evaluation is limited by\nstreak artifact. However, there is no definite evidence of residual aneurysm\nor new aneurysm formation.\n\n2. No significant internal carotid artery stenosis by NASCET criteria." + }, + { + "input": "Aneurysm clip in the right anterior suprasellar cistern is again noted, with\nassociated streak artifact. There is no evidence of acute intracranial\nhemorrhage, edema, mass effect, or acute major vascular territorial\ninfarction. Scattered periventricular and subcortical white matter\nhypodensities are again seen, for example in the right frontal subcortical\nwhite matter on image 2:19, nonspecific but likely sequela of mild chronic\nsmall vessel ischemic disease in this age group. Mild global parenchymal\nvolume loss is again noted, likely age-related. No hydrocephalus.\n\nPostsurgical changes related to right craniotomy are again noted. No\nconcerning bone lesions. Minimal mucosal thickening in the ethmoid air cells\nand partially imaged maxillary sinuses. Mastoid air cells are well aerated. \nStatus post bilateral cataract surgery.", + "output": "No evidence for acute intracranial abnormalities. Postsurgical changes\nrelated to right craniotomy and aneurysm clipping are again noted." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Basilar cisterns are\npatent.\n\nIncluded paranasal sinuses and mastoids are clear besides minimal mucosal\nthickening in the left anterior ethmoids. Skull and extracranial soft tissues\nare unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration the patient's age. \nSubtle areas of low density in the subcortical white matter are nonspecific\nand may reflect changes due to small vessel disease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No hemorrhage or evidence of acute infarct. Please note that MR is more\nsensitive for the detection of early stroke." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass effect. The predominantly periventricular white matter hypodensities are\nnonspecific, but likely represent the sequela of chronic microvascular\nischemic disease. There is prominence of the ventricles and sulci suggestive\nof involutional changes.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "No evidence of acute fracture or intracranial hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\ngeneralized brain parenchymal atrophy, with prominent atrophy of anteromedial\ntemporal lobes, more prominent on the left, overall unchanged since priors. \nThere are moderate chronic small vessel ischemic changes. There is no\nevidence of new infarct or mass\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Stable exam.\nThere is no new temporal lobe infarct or mass.\nThere is generalized parenchymal atrophy, most evident at anteromedial\ntemporal lobes, more prominent on the left. Moderate chronic small vessel\nischemic changes." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of new, acute major vascular territorial\ninfarction. Ventricles and sulci are enlarged consistent with involutional\nchanges. There are unchanged, moderate chronic small vessel ischemic changes.\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are prominent likely age related with a\nsimilar extent of ventricular prominence. Periventricular white matter\nhypodensities consistent with chronic microvascular ischemic disease appears\nmildly progressed from the prior exam. Tiny right caudate lacunar infarct is\nnoted. Imaged paranasal sinuses, mastoid air cells middle ear cavities are\nwell aerated. The bony calvarium is intact.", + "output": "No acute intracranial process. Chronic microvascular ischemic disease,\npossibly mildly progressed. Tiny right caudate lacunar infarct. Stable\nventricular prominence." + }, + { + "input": "There is no evidence of acute major infarction,hemorrhage,edema,or discrete\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.Mild periventricular and subcortical white matter\nhypodensities are nonspecific, but likely reflect the sequela of chronic\nmicrovascular infarction.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process. Chronic microvascular ischemic disease." + }, + { + "input": "There is no evidence of fracture, acute large territory\ninfarction,hemorrhage,edema,or mass. Bilateral periventricular, subcortical,\ndeep white matter hypodensities are nonspecific and likely represent sequela\nof chronic microvascular ischemic disease. There is prominence of the\nventricles and sulci suggestive of involutional changes.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No acute intracranial process.\n2. Sequela of chronic microvascular ischemic disease." + }, + { + "input": "Study is mildly degraded by motion.\n\nEvaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nMucosal thickening of the left maxillary sinus is seen.\n\nDiffuse superficial skin thickening extends from the region of the mandible\nsuperiorly to the periorbital area. There is diffuse hazy stranding\nunderlying the skin. Secretions are seen in the nasopharynx. The oropharynx\nis thickened with prominent adenoids and palatine tonsils, all of which are\ncontributing to the mild narrowing of the oropharynx.\n\nMildly prominent left cervical lymph nodes, the largest measuring 9 mm (2;\n42), are likely reactive.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. There is a 13 mm exophytic thyroid nodule on the right lobe. \nRecommend ultrasound for further characterization.\n\nThere is an apparent filling defect seen in the right internal jugular vein\nwhich is likely an artifact.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.", + "output": "1. Diffuse superficial skin thickening with hazy stranding underlying the\nskin. Mildly narrowed oropharynx due to thickened oropharynx and prominent\nadenoid and palatine tonsils. These findings suggest a possible diffuse\nallergic reaction, cellulitis, or other inflammatory reaction.\n2. Prominent left cervical lymph nodes are likely reactive.\n3. 13 mm exophytic right thyroid nodule. Recommend ultrasound for further\ncharacterization.\n\nRECOMMENDATION(S): Recommend thyroid ultrasound for further characterization\nof right thyroid nodule.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 12:37 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. A few scattered periventricular and\nsubcortical white matter hypodensities are likely sequela of chronic small\nvessel disease. Ventricles and sulci are age-appropriate.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, intracranial hemorrhage, edema, mass, or\nmass effect. The ventricles and sulci are mildly prominent, compatible with\nglobal parenchymal volume loss.\n\nThe visualized paranasal sinuses and mastoids appear clear. The globes and\norbits are unremarkable. Enteric tube is seen in situ. Trace fluid in the\nnasopharynx.\n\nCTA HEAD:\nMildly limited study due to suboptimal opacification completely related to\ntiming of image acquisition following the contrast bolus. Within these\nconfines:\n\nPatent distal vertebral and basilar arteries. Left dominant vertebral artery,\na normal variant. Conventional bilateral PCA anatomy. Posterior\ncommunicating artery is not well seen. P2 and more distal posterior cerebral\narteries are grossly patent with normal-appearing distal runoff. Distal\nbranches not well seen.\n\nSlight irregularity and calcification of the cavernous intracranial ICAs\nbilaterally likely reflects mild luminal narrowing due to underlying\natheromatous plaque. Otherwise, the remaining portions of the bilateral\nintracranial internal carotid arteries and the bilateral anterior and middle\ncerebral arteries are patent with normal appearing distal runoff, although\nnote the distal branches are not well seen due to technical limitations above.\n\nThe major dural venous sinuses are not well opacified or evaluated on this\nexam.\n\nCTA NECK:\nDue to a combination of streak-artifact likely related to dental amalgam, in\nconjunction with the suboptimal arterial opacification (as above), portions of\nthe bilateral cervical carotid and vertebral arteries are mildly obscured at\nthe level C2-3, limiting assessment in these locations. Within these\nconfines:\n\nThere is mild calcification at the left carotid bulb. No resultant ICA\nnarrowing by NASCET criteria. The remainder of the bilateral cervical carotid\narteries are widely patent. No right ICA luminal by NASCET criteria. Widely\npatent bilateral cervical vertebral arteries.\n\nImaged portions of the arch and arch branch vessel origins are patent and\nunremarkable.\n\nOTHER:\nMultifocal bilateral biapical pulmonary consolidative and ground-glass\nopacities as well as diffuse lobular septal thickening. Large right and small\nto medium left layering nonhemorrhagic pleural effusions. Left major fissural\nfluid. Secretions surround endotracheal tube in the proximal airway; ETT seen\nto the level of the distal thoracic esophagus, terminating just above the\ncarina. Enteric tube is seen in situ.\n\nThere is diffuse subcutaneous edema throughout the imaged neck and chest wall.\nThere is a right IJ central venous catheter with tip seen to the level of the\nlow SVC. No cervical adenopathy. No visible upper mediastinal, axillary, or\nsupraclavicular adenopathy. Moderate cervical spine degenerative changes,\nslightly more pronounced at C5-C6 and C6-C7 levels. Periapical lucency,\nlikely left ___ mandibular tooth 19 (3:180 and 28:1). Otherwise no aggressive\nfocal osseous lesions.", + "output": "Mildly limited study due to suboptimal opacification, likely related to timing\nof image acquisition following the contrast bolus. Within these confines:\n\n1. Mild atheromatous disease affecting the cavernous intracranial ICAs\nbilaterally causing mild luminal irregularity and mild narrowing. Otherwise,\nwithin technical limitations described above, widely patent circle ___\nvasculature. No additional stenosis, occlusion, or aneurysm. No mycotic\naneurysm identified.\n2. Although vessels are suboptimally opacified and somewhat obscured at the\nlevel of C2-3 due to dental amalgam-related artifact, within these confines,\nwidely patent bilateral cervical vertebral and carotid arteries.\n3. Multifocal biapical mixed consolidative and ground-glass pulmonary\nopacities are not well evaluated on this study however raise concern for\nmultifocal pneumonia and/or superimposed pulmonary edema. Consider CT chest\nfor further evaluation.\n4. Large right and small to medium left layering nonhemorrhagic pleural\neffusions.\n5. Periapical lucency, likely left mandibular ___ tooth 19, periapical cyst or\ngranuloma, cannot exclude abscess. Correlate with dental examination.\n6. Diffuse subcutaneous edema, likely due to generalized edematous state. \nOther incidental findings, as above.\n\nRECOMMENDATION(S):\n-Consider CT chest for further evaluation of multifocal biapical pulmonary\nground-glass and consolidative opacities, possibly multifocal pneumonia.\n-Dental evaluation for further evaluation of left mandibular likely ___ tooth\n19 periapical lucency." + }, + { + "input": "There is no acute hemorrhage, edema, mass effect or acute large vascular\nterritorial infarction. There is a subtle hyperdensityin the cortex of the\nright frontal lobe near the vertex (2:23, which in the setting of lung cancer\nmay represent a subtle focus of metastatic disease.\n\nThe ventricles and sulci are normal in size and configuration. Periventricular\nwhite matter hypodensities are consistent with chronic small vessel ischemic\ndisease. The basal cisterns appear patent and there is preservation of\ngray-white matter differentiation.\n\nNo fracture is identified. The mastoid air cells and middle ear cavities are\nclear. There is fluid within the bilateral sphenoid sinuses. The globes are\nunremarkable.", + "output": "There is a subtle hyperdensity in the right frontal lobe near the vertex,\nwhich in the setting of lung cancer may represent a subtle focus of metastatic\ndisease. Recommend MRI of the head for additional evaluation of metastatic\ndisease.\n\nNOTIFICATION: These findings were discussed with Dr. ___ by Dr. ___\ntelephone at 11:28pm on ___, 5 minutes after discovery." + }, + { + "input": "There is a small focal hypodensity at the junction of the right thalamus and\nright internal capsule, not seen on recent prior. There is no acute\nintra-axial or extra-axial hemorrhage,edema,or discrete mass. There is\nprominence of the ventricles and sulci likely reflecting involutional changes.\n\nThere is no evidence of fracture. There is moderate mucosal thickening of the\nbilateral ethmoid sinuses and left maxillary sinus. The left maxillary sinus\nand posterior ethmoid air cells are partially opacified with aerosolized\nmaterial suggesting sinus disease. The visualized portion of the other\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable. There is a left frontal\nscalp and left periorbital contusion. No evidence of underlying calvarial\nfracture.", + "output": "1. New small hypodensity in the region of the right thalamus could represent\nan acute lacunar infarct. Please correlate clinically, consider MRI to\nfurther assess if clinically warranted.\n2. Left frontal scalp and left periorbital contusion without underlying\nfracture.\n\nRECOMMENDATION(S): A follow-up MRI brain is more specific to further\ncharacterize possible infarction.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 8:36 pm, 15 minutes after\ndiscovery of the findings." + }, + { + "input": "CTA HEAD:\nThere is occlusion of the right posterior cerebral artery at its P2 segment\n(2:255).\n\n Atherosclerotic changes of the cavernous and supraclinoid segments of the\nbilateral internal carotid arteries are seen without stenosis.\n\nOtherwise, the vessels of the circle of ___ and their principal\nintracranial branches appear normal without stenosis, occlusion, or aneurysm\nformation. A hypoplastic right A1 segment is noted. The dural venous sinuses\nare patent.\n\nA displaced left orbital floor fracture is re-demonstrated with fat\nherniation. No muscle herniation or entrapment are seen. There is moderate\nmucosal thickening of the left maxillary sinus with hyperdense material,\nlikely representing blood products.\n\nThere is subcutaneous edema involving the left mandibular region and extending\ninto the left preorbital region. A large left frontal scalp hematoma is seen.\n\n\nCTA NECK:\n Atherosclerotic changes of the carotid bifurcations are seen without\nnarrowing of the internal carotid arteries, by NASCET criteria. The vertebral\narteries appear normal with no evidence of stenosis or occlusion.\n\n\nOTHER:\nA collapsed left lower lobe is partially visualized. Diffuse ground-glass\nairspace opacifications and bronchial wall thickening are seen.\n\nAn endotracheal tube is seen terminating proximal to the carina. An\noro-enteric tube is partially visualized.\n\nMediastinal lymphadenopathy is seen, with the largest pretracheal lymph node\nmeasuring 1.8 cm x 1.5 cm. Multiple subcentimeter nodules are seen in the\nthyroid lobe.", + "output": "1. Occlusion of the right posterior cerebral artery at its P2 segment.\n2. Left orbital floor blow-out fracture with fat herniation but without muscle\nherniation or entrapment. Probable blood products in the left maxillary\nsinus.\n3. Large left frontal scalp hematoma. Subcutaneous edema involving the left\nmandibular region and extending into the left periorbital region, likely\nposttraumatic.\n4. No stenosis or occlusion of the cervical arteries.\n5. Partially visualized collapse left lower lobe.\n6. Diffuse ground-glass airspace opacifications and bronchial wall thickening,\nsuggestive of small airways disease.\n7. Mediastinal lymphadenopathy.\n\nRECOMMENDATION(S): Thyroid nodules. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." + }, + { + "input": "Compared to the prior CT a right posterior cerebral artery infarction is now\napparent on CT imaging as a region of mild swelling and hyperdensity, in\naddition to effacement of the gray-white matter distinction. The distribution\nof the infarction is essentially the same as the more recent MR. ___ the right\nthalamus, which had already shown hypoattenuating infarct on the prior study\nCT, the appearance is vaguely hyperdense without well-defined hematoma,\nalthough there is mild swelling. Some degree of hemorrhagic transformation\nwas already present on the more recent MR, however, so this is probably\nunchanged since the recent MR. ___ is no substantial midline shift or\nhydrocephalus. There is no evidence of extra-axial collection. Left frontal\nsuperficial hemorrhage appears unchanged. Opacification of the left maxillary\nsinus is very similar. There is new patchy density in the ethmoid sinuses,\nthe right maxillary sinus and in the left frontal. This is probably not\nsignificant in the setting of endotracheal intubation. Mastoid air cells\nappear clear. No evidence of fracture or bone destruction.", + "output": "Evolving right posterior cerebral artery territory infarction including some\nhemorrhagic transformation of the right thalamic component, probably unchanged\nsince the very recent prior MR." + }, + { + "input": "Progressive evolution of a right posterior cerebral artery territory\ninfarction. Subtle hyperdensity centered within the right thalamus is\ncompatible with hemorrhagic blood products, and is decreased in extent\ncompared to ___. No new areas of hemorrhage are identified. There\nis persistent local mass effect and sulcal effacement. There is no evidence\nof midline shift of structures. There is prominence of the ventricles and\nsulci suggestive of involutional changes, similar to prior exam.\n\nLeft frontal subgaleal hematoma appears decreased in size. Soft tissue\nthickening and edema overlying the left temple appears similar to ___. No calvarial fractures are identified. There is slight interval\nincrease in opacification of the bilateral mastoid air cells and middle ear\ncavities as compared to most recent prior head CT. Extensive paranasal sinus\ndisease involving the bilateral maxillary, sphenoid, and frontal sinuses\nappears progressed including worsening blood products in the sphenoid,\nethmoid, and left maxillary sinuses. There has been interval increased\nopacification of the ethmoid air cells. The visualized portion of the orbits\nis notable for a right-sided lens replacement.", + "output": "1. Continued evolution of a right PCA territory infarct. Right thalamic blood\nproducts appear decreased in extent compared to ___. No new areas\nof intracranial hemorrhage are identified.\n2. Worsening acute blood products are seen in the sphenoid and ethmoid sinuses\nas well as left maxillary sinus. Recommend correlation with platelet\ndysfunction.\n3. Left frontal subgaleal hematoma appears decreased in size.\n4. Slight interval increase in opacification of the bilateral mastoid air\ncells and middle ear cavities.\n5. Redemonstrated is the left orbital floor blow-out fracture, better seen on\nthe prior CT's.\n6. Worsening paranasal sinus disease, as described above.\n\nNOTIFICATION: The findings were discussed with Dr. ___., M.D. by ___\n___, M.D. on the telephone on ___ at 3:13 pm, 10 minutes after\ndiscovery of the findings." + }, + { + "input": "There is a comminuted fracture of the left inferior orbital wall with inferior\ndisplacement of fracture fragments into the left maxillary sinus. There is\nadjacent infraorbital, extraconal hematoma abutting the left inferior rectus\nmuscle and along the fracture fragments without evidence of herniation of\nintraorbital contents. Left globe is intact. There is left periorbital and\nleft pre maxillary soft tissue swelling.\nThere is mild mucosal thickening of the maxillary sinuses bilaterally as well\nas scattered ethmoid air cells bilaterally. Minimal mucosal thickening is\nseen within the left frontal sinus. Otherwise visualized paranasal sinuses\nare clear.\nThere is left periorbital soft tissue swelling and hematoma.\nThere is no evidence of abnormal fluid collections.\nBilateral mastoids appear normal.\nThe right globe, extraocular muscles, optic nerves, and retrobulbar fat appear\nnormal.\nThe visualized upper aerodigestive tract appears normal.\nThe mandible and temporomandibular joints appear normal.", + "output": "1. Left inferior orbital wall comminuted fracture with mild inferior\ndisplacement of fracture fragments into the left maxillary sinus and\nassociated intraorbital, extraconal hematoma. No evidence herniation of\nintraorbital contents. Left globe is intact.\n2. Left periorbital and pre maxillary soft tissue swelling and hematoma." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are mildly enlarged, compatible with age related atrophic\nchanges. Periventricular white matter hypodensities are noted, likely the\nsequelae of chronic small vessel ischemic disease. Basal cisterns remain\npatent. There is preservation of gray-white matter differentiation.\n\nNo osseous abnormalities seen. Calcifications are seen within the bilateral\ncavernous internal carotid and right vertebral arteries. The paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "1. No evidence for acute intracranial process.\n2. Mild age-related cerebral atrophy and chronic small vessel ischemic\ndisease." + }, + { + "input": "There is no evidence of acute hemorrhage or infarction. Age related cerebral\nvolume loss is noted. There are periventricular white matter hypodensities,\nconsistent with small vessel ischemic changes.\n\nNo osseous abnormalities are seen. The paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormalities." + }, + { + "input": "There is no evidence of acute infarct,hemorrhage, edema, or mass effect.\nProminent ventricles and sulci are suggestive of age-related involutional\nchange. Periventricular, subcortical, and deep white matter hypodensity is\nconsistent with chronic small vessel ischemic disease, similar to ___.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality. Specifically, no acute hemorrhage. \nPlease note that MR is more sensitive in the detection of acute infarct.\n2. Age-related involutional change and sequela of small vessel disease." + }, + { + "input": "There is no evidence of acute large territory infarction,intracranial\nhemorrhage,edema,or mass. The ventricles and sulci are normal in size and\nconfiguration.\nSubtle areas of low attenuation in the periventricular white matter are\nnonspecific and may reflect changes due to small vessel disease.\n\nThere is no evidence of fracture. Slightly irregular lucent area in the\noccipital bone is consistent with arachnoid granulation. The visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. There is no evidence of acute intracranial process or hemorrhage.\n\n2. Within the limitation of this examination without contrast, there is no\nevidence of metastatic disease\n\nRECOMMENDATION(S): MRI of the head with and without contrast is a more\nspecific examination to rule out intracranial metastatic disease." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nlarge territorial infarction.\n\nThe ventricles and sulci are moderately prominent but not significantly\nchanged since prior study and are most likely due to age-related cerebral\natrophy. The basal cisterns appear patent.\n\nPeriventricular white matter hypodensities are most likely sequela of chronic\nsmall vessel ischemic disease. There is preservation of gray-white matter\ndifferentiation.\n\nThere is mild soft tissue swelling in the right infraorbital and premaxillary\nregion. No acute fracture. The orbits and globes are normal.\n\nThere is mild mucosal thickening in the ethmoid air cells. The mastoid air\ncells and middle ear cavities are clear.\n\nAtherosclerotic mural calcification of the bilateral cavernous carotid\narteries is noted.", + "output": "1. Mild soft tissue swelling in the right infra-orbital/premaxillary region.\nNo acute calvarial fracture.\n2. No acute intracranial hemorrhage." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific, but likely reflect sequelae of chronic small\nvessel ischemic disease.\n\nThe superior ophthalmic veins are dilated and prominent bilaterally (series 2,\nimage 8) and there is increase proptosis of the bilateral globes when compared\nto prior examination. The finding is nonspecific and may represent increased\nvenous pressure or intracranial pressure secondary to the patient's congestive\nheart failure were hypertension. Clinical correlation is read.\n\nThere is no evidence of fracture. There is near complete opacification of the\nright maxillary sinus, mild opacification of bilateral ethmoid air cells, and\nminimally in the left sphenoid sinus. The remaining visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. \nPatient is status post bilateral lens replacements. Dense atherosclerotic\nmural calcifications in the carotid siphons and vertebral arteries are noted\nbilaterally.", + "output": "1. There is no evidence for acute territory infarct or intracranial\nhemorrhage.\n2. The bilateral ophthalmic veins are dilated and torturous with increased\nproptosis of the globes. This is nonspecific and could simply represent\nincreased venous pressure or intracranial pressure from Valsalva or patient's\ncongestive heart failure. Clinical correlation is recommended as this could\nbe seen in setting of more concerning cavernous sinus thrombosis or CC\nfistula, both which are less likely given the patient's clinical history. \nClose attention on followup exam could be performed to document resolution.\n3. Paranasal sinus disease as described above, new from examination of ___. Correlation with patient's symptoms is recommended.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\non the ___ ___ at 10:00 AM, 15 minutes after discovery of the\nfindings." + }, + { + "input": "Left frontal convexity encephalomalacia is likely related to remote prior\ninfarction, unchanged from ___. There is no evidence of acute\ninfarction, hemorrhage, edema, or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. Periventricular and deep\nsubcortical white matter hypodensities are compatible with moderate chronic\nsmall vessel ischemic changes. Extensive arterial calcifications are noted.\n\nThere is no evidence of fracture. Complete opacification of the maxillary\nsinus and partial opacification of the right anterior ethmoidal air cells has\nworsened compared with the prior study. The visualized portion of the \nmastoid air cells and middle ear cavities are clear. The visualized portion\nof the orbits are notable for bilateral cataract surgery.", + "output": "1. No acute intracranial process.\n2. Unchanged left frontal encephalomalacia, age related involutional changes,\nand sequelae of chronic small vessel ischemic disease.\n3. Of note, MRI is more sensitive for the detection of intracranial masses." + }, + { + "input": "There is no acute hemorrhage mass effect or midline shift. Left frontal\nencephalomalacia again seen. Mild to moderate brain atrophy and small vessel\ndisease noted. Extensive soft tissue vascular calcifications are seen.", + "output": "No acute intracranial abnormalities are identified or change since the\nexamination obtained 10 hr earlier. ." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass. The ventricles and sulci are prominent compatible with involutional\nchanges, stable from prior examinations. Periventricular and subcortical\nwhite matter hypodensities are nonspecific and may suggest chronic small\nvessel ischemic changes. A right cerebellar hypodensity is also present in\n___ suggestive of a chronic infarct (2:9).\n\nNo acute fracture seen. Mucous retention cyst is noted in the sphenoid sinus.\nThe remaining paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The orbits are unremarkable.", + "output": "No intracranial hemorrhage or CT evidence of acute infarct. MRI would be more\nsensitive." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. Similar dilatation of the ventricles is seen, slightly more\npronounced than the degree of sulcal atrophy, which could reflect central\natrophy though normal pressure hydrocephalus is not excluded. Ill-defined\nperiventricular and subcortical white matter hypodensities are nonspecific but\nlikely due to sequela of chronic small-vessel ischemic disease. A right\ncerebellar hypodensity is unchanged, suggestive of a chronic infarct (02:13). \nAtherosclerotic calcifications are seen along the carotid siphons. Vertebral\nartery remains ectatic.\n\nThere is no evidence of fracture. A mucous retention cyst is seen in the left\nsphenoid sinus. Otherwise, the remaining visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial hemorrhage or mass effect.\n2. Similar dilatation of the ventricles which appears slightly more pronounced\nthen the degree of sulcal atrophy, which could reflect preferential central\natrophy, however normal pressure hydrocephalus is not completely excluded and\nclinical correlation is needed.\n3. Chronic microangiopathy and global atrophy." + }, + { + "input": "Study is degraded by motion. Dental amalgam streak artifact limits study.\n\nCT HEAD WITHOUT CONTRAST:\nPossible focus of encephalomalacia, right cerebellar hemisphere (02:12),\nunchanged. There is no evidence of acute intracranial hemorrhage, edema,\nmass, or mass effect. The ventricles sulci are prominent; as seen previously,\nthere is suggestion of ventricular enlargement which is slightly out of\nproportion to sulcal enlargement. Periventricular and in areas confluent\nareas of deep white matter hypodensity bilaterally are nonspecific however\ncompatible with moderate changes of chronic white matter microangiopathy.\n\nThere is no calvarial fracture. There is trace sphenoid sinus mucosal\nthickening; otherwise, the visualized paranasal sinuses, mastoid air cells,\nand middle ear cavities are well pneumatized and clear. Globes and orbits are\npreserved.\n\nCTA HEAD:\nThere is a tortuous vertebrobasilar system, however patent without evidence of\nstenosis, occlusion, or aneurysm. Patent bilateral posterior cerebral\narteries with normal distal runoff.\n\nMild motion degradation somewhat limits assessment of the petrous portions of\nthe intracranial ICAs bilaterally. There is mild calcification of the\ncavernous and supraclinoid intracranial internal carotid arteries bilaterally,\ncausing minimal/mild luminal narrowing. Otherwise, the remaining components\nof the intracranial ICAs and their principal intracranial branches including\nthe bilateral anterior and middle cerebral arteries, are patent with normal\ndistal runoff.\n\nNo additional area of stenosis, occlusion, or aneurysm formation identified. \nThe major dural venous sinuses are grossly patent. No arteriovenous\nmalformation identified\n\nCTA NECK:\nNote that there medialized distal common carotid arteries bilaterally (3:143).\nThere is minimal calcified plaque at the origin of the left ICA (03:57), not\ncausing moderate or severe luminal stenosis by NASCET criteria. There may be\nmild focal luminal narrowing at the origin of the left vertebral artery due to\nnoncalcified plaque, however this appearance may relate to tortuosity of the\nvessel (series 3, image 98).\n\nOtherwise, widely patent bilateral cervical vertebral and carotid arteries. \nNo right ICA stenosis by NASCET criteria.\n\nOTHER:\nAortic arch branch vessel origins and proximal components are tortuous but\npatent without high-grade luminal narrowing other focal abnormality. There is\nsuggestion of prominent pulmonary arteries, partially visualized bilaterally,\noverall not well evaluated on this study. Within limitation of respiratory\nmotion artifact, the lung apices are grossly clear. No focal thyroid\nabnormality. There are no pathologically enlarged cervical lymph nodes. No\nvisible supraclavicular, axillary, or mediastinal lymphadenopathy. Moderate\nto severe multilevel cervical spine degenerative changes are noted. 3 mm\nright supraorbital frontal scalp soft tissue lesion is noted (see 3:250).", + "output": "1. Dental amalgam streak artifact and motion limits study.\n2. No acute intracranial abnormality by unenhanced head CT, with no definite\nevidence of acute intracranial hemorrhage. Please note MRI of the brain is\nmore sensitive for the detection of acute infarct.\n3. Grossly stable global volume loss with question disproportionate\nventriculomegaly again noted. While nonspecific, similar findings may be seen\nin the setting of normal pressure hydrocephalus.\n4. Nonocclusive probable atherosclerotic disease of circle of ___ as\ndescribed.\n5. Otherwise, patent circle ___ vasculature without definite evidence of\nstenosis, occlusion, or aneurysm formation.\n6. Minimal nonocclusive left internal carotid artery origin probable\natherosclerotic changes without definite moderate or severe stenosis by NASCET\ncriteria as described.\n7. Otherwise, patent bilateral cervical carotid and vertebral arteries without\ndefinite evidence of stenosis, occlusion, or dissection.\n8. Right frontal supraorbital scalp 3 mm dermal lesion. While finding may\nrepresent scar or sebaceous cyst, melanoma is not excluded on the basis of\nthis examination." + }, + { + "input": "There is no evidence of large territory infarction, hemorrhage, or edema. The\nventricles and sulci are prominent, as seen previously, likely consistent with\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific but likely secondary to moderate chronic\nmicrovascular ischemic disease. Unchanged encephalomalacia in the right\ncerebellum.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "No evidence of acute large territorial infarction, acute intracranial\nhemorrhage, edema, or mass effect. The ventricles and sulci are prominent,\nlikely secondary to age related involutional changes. Periventricular and\nsubcortical hypodensities are nonspecific, but likely reflect chronic small\nvessel ischemic changes.\n\nNo acute osseous abnormalities. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of fracture, acute large territory\ninfarction,hemorrhage,edema,or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. Moderate hypoattenuation of the\nperiventricular and subcortical white matter is nonspecific but may reflect\nchronic microvascular ischemic disease. Focal hypodensity in the left basal\nganglia likely reflects a chronic lacunar infarct.\n\nMild mucosal thickening in the left sphenoid sinus. The visualized portion of\nthe remaining paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are normal.", + "output": "1. No acute intracranial abnormality" + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major infarction. Evaluation is\nslightly limited given motion artifact. A chronic lacunar infarct is noted\nagain in the region of the left basal ganglia. Age related involutional\nchanges are similar to prior with stable prominence of the ventricles. \nPeriventricular and subcortical white matter hypodensities suggest chronic\nmicrovascular ischemic disease.", + "output": "No acute intracranial process. Similar pattern of involutional changes and\nsmall vessel disease." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass. Ventricles and sulci are prominent, consistent with age-related\nglobal parenchymal loss. Subcortical, periventricular and deep white matter\nhypodensities are nonspecific, but likely reflect the sequela of chronic\nmicroangiopathic ischemic disease. Redemonstration of chronic lacunar\ninfarcts within the left basal ganglia, as well as the internal capsules\nbilaterally.\n\nThere is no fracture. The visualized portion of the paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear aside from a mucous retention\ncyst within the left sphenoid sinus. The visualized portions of the orbits\nare normal. Mild atherosclerotic calcifications are seen in the cavernous\ncarotid arteries.", + "output": "1. No acute intracranial abnormality." + }, + { + "input": "Redemonstration of lacunar infarcts within the left basal ganglia and\nbilateral internal capsules. There is also chronic right cerebellar infarct. \nNo evidence of acute large territorial infarction, acute intracranial\nhemorrhage, edema, or mass effect. The ventricles and sulci are prominent,\nlikely reflective of age-related volume loss. Periventricular and subcortical\nhypodensities are nonspecific, but likely reflect chronic small vessel\nischemic changes.\n\nNo acute osseous abnormalities. There is trace amount of layering fluid within\nthe left sphenoid spinous. The remaining paranasal sinuses are clear. The\nmastoid air cells and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. The ventricles and sulci are age appropriate in size and configuration.\nThere is a punctate 5 mm hyperdensity in the left inferior frontal gyrus\n(series 2, image 18).\n\nThere is no evidence of acute fracture. There are mucous retention cysts of\nthe left maxillary sinus and mucosal thickening the bilateral ethmoid sinuses.\nThere is mild underpneumatization of the bilateral mastoid air cells. The\nvisualized portion of the remaining paranasal sinuses and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality. Specifically, no evidence of acute\nterritorial infarction or hemorrhage.\n2. Punctate hyperdense focus in the left inferior frontal gyrus appears\nunchanged compared to CT head performed approximately 7 hours earlier, and may\nrepresent a calcified vascular anomaly. Nonurgent outpatient MRI could be\nconsidered for further evaluation." + }, + { + "input": "Dental amalgam streak artifact and cervical spinal fusion hardware limits\nstudy.\n\nCT HEAD WITHOUT CONTRAST:\nFocal encephalomalacia is seen in the inferomedial left cerebellar hemisphere.\nThere is no evidence of acute intracranial infarction, hemorrhage, edema,\nmass, or mass effect. The ventricles and sulci are normal in caliber and\nconfiguration.\n\nThe visualized paranasal sinuses, mastoid air cells, and middle ear cavities\nare well pneumatized and clear. The globes and orbits are unremarkable.\n\nCTA HEAD:\nThere is a left dominant vertebral artery. There is a persistent right\ntrigeminal artery, a normal anatomic variant (see series 602, image 32, as\nwell as see series 3, images 272 and 268). An approximately 2 mm right\nsupraclinoid internal carotid artery infundibulum versus aneurysm is noted\n(see 602:33; 459:8). The circle of ___ vasculature and principal\nintracranial branches are patent without stenosis, occlusion, or aneurysm. \nThe major dural venous sinuses are grossly patent.\n\nCTA NECK:\nThe right vertebral artery is diminutive, not unexpected in the setting of a\npersistent ipsilateral trigeminal artery. Otherwise, patent bilateral\nvertebral and carotid arteries in the neck. No ICA stenosis by NASCET\ncriteria.\n\nOTHER:\nThyroid is preserved. There are no pathologically enlarged cervical lymph\nnodes by CT size criteria. Imaged lung apices are grossly clear. The patient\nis status post laminectomies at C4, C5, and C6, with placement of bilateral\nrods and transpedicular screws posteriorly. Within limits of study, no\ndefinite evidence of diffuse for fracture or perihardware lucency.", + "output": "1. Dental amalgam streak artifact and cervical spinal fusion hardware limits\nstudy.\n2. No acute intracranial abnormality.\n3. 2 mm supraclinoid right internal carotid artery infundibulum versus\naneurysm.\n4. Otherwise, patent circle of ___ without definite evidence of stenosis,\nocclusion, or aneurysm.\n5. Patent bilateral cervical vertebral and carotid arteries with no definite\nevidence of stenosis, occlusion, or dissection.\n6. Persistent right trigeminal artery, a normal vascular anatomic variant.\n7. Left cerebellar encephalomalacia likely relates to chronic infarct.\n8. Postsurgical changes related to C4 through C6 laminectomies and posterior\nfusion." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass effect. The ventricles and sulci are prominent in keeping with\nage-related involutional change.\n\nNo acute fractures are seen. Aside from near complete opacification of the\nleft maxillary sinus, mild mucosal thickening in the bilateral ethmoid air\ncells and a small amount of aerosolized secretions in the right sphenoid\nsinus, the paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. A small osteoma is noted within the left frontal sinus. The orbits\nare unremarkable.", + "output": "1. No acute intracranial process.\n2. Aerosolized secretions within the right sphenoid sinus may suggest a\ncomponent of acute on chronic sinusitis." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No evidence of acute intracranial abnormality. No fracture." + }, + { + "input": "CT HEAD: There is subarachnoid hemorrhage within the suprasellar and\nprepontine cisterns, unchanged. There is a small amount of left-sided\nintraventricular hemorrhage, not clearly identified on prior study.\n\nThere is no major vascular infarction, mass or midline shift. Gray-white\nmatter differentiation is preserved. Ventricles and sulci are unchanged in\nsize and configuration.\n\nThere is complete opacification of the right maxillary sinus with widening of\nthe accessory maxillary ostium. There is also maxillary wall thickening\nindicative of osteitis. There is periapical lucency involving the anterior\nbuccal root peg of the ___ #3 tooth. There is also a increased sclerosis\naround this tooth which suggests that these findings are likely chronic.\n\nCTA HEAD: There is a bulbous anterior communicating complex with a\nhypoplastic A1 segment. There is an early bifurcation of the left MCA with a 4\nmm lobulated aneurysm at the origin of its inferior division. The right MCA is\nunremarkable.\n\nThere is a 2 mm triangular out pouching at the origin of the right posterior\ncommunicating artery, likely representing an infundibulum. There is a\nconjoined left PCA and SCA origin. The origin of the left SCA is also bulbous.\n\nCTA NECK: There is a normal 3 vessel left-sided aortic arch. The common\ncarotid, internal carotid and external carotid arteries are unremarkable\nwithout evidence of significant stenosis based on NASCET criteria. The\nvertebral arteries are widely patent. There is no evidence of arterial\ndissection.\n\nAt C3-C4, there are uncovertebral and facet osteophytes resulting in mild\nright neural foraminal narrowing. There is no significant spinal canal or\nneural foraminal narrowing at the other levels.", + "output": "Subarachnoid blood within the basilar and prepontine cisterns, not\nsignificantly changed from prior study; a small amount a left-sided\nintraventricular hemorrhage is not clearly identified on prior examination. \nOverall, this is a non-aneurysmal pattern of subarachnoid hemorrhage.\n\nEarly bifurcation of the left MCA with a 4 mm lobulated aneurysm at the origin\nof the inferior division; this appears incidental, and likely unrelated to the\nsubarachnoid blood, above, given its distribution.\n\nComplete opacification of the right maxillary sinus, likely secondary to\nodontogenic disease, given the periapical lucency involving the buccal root of\n___ tooth #3. Recommend correlation with history and detailed dental\nexamination.\n\nNOTIFICATION: Case discussed with Dr. ___ by Dr. ___ by telephone, at\n0030h on ___, immediately after the findings were made." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of territorial infarction, intracranial\nhemorrhage, edema, or mass. The ventricles and sulci are normal in size and\nconfiguration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere is a 2-3 mm aneurysm arising from the medial aspect of the right\nsupraclinoid ICA (series ___, image 31, series 3, image 257). The left ACA\nA1 segment is hypoplastic, likely congenital. The vessels of the circle of\n___ and their principal intracranial branches appear otherwise normal\nwithout stenosis, occlusion, or aneurysm formation. The dural venous sinuses\nare patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No evidence of acute intracranial process or hemorrhage.\n2. A 2-3 mm aneurysm arising from the medial aspect of the right supraclinoid\nICA.\n3. No evidence of dissection or significant stenosis of the head and neck. No\nevidence of significant cervical ICA stenosis by NASCET criteria.\n\nRECOMMENDATION(S): The impression and recommendation above was entered by Dr.\n___ on ___ at 15:38 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect or acute\nterritorial infarction. An area of encephalomalacia and white matter\nhypodensity involving the left frontal lobe is stable and reflects\npostsurgical and post radiation changes in that area. No mass lesion is\nidentified. The ventricles and sulci are in large consistent with age related\natrophy. The basal cisterns are patent.\n\nA mucous retention cyst is seen within the right maxillary sinus. The\nremainder of the paranasal sinuses are clear. The mastoid air cells are well\naerated. The globes are unremarkable. Nasal bones are deviated to the right.", + "output": "Postsurgical and post radiation changes seen within the left frontal lobe\nincluding areas of encephalomalacia and subcortical white matter hypodensity. \nNo evidence of acute hemorrhage or territorial infarction. Of note, MRI is\nmore today for the detection of metastatic disease or acute infarction." + }, + { + "input": "Status post left frontal craniotomy with underlying encephalomalacia, stable\nsince ___. Subcortical encephalomalacia within the right precentral\ngyrus is also unchanged since ___ (series 2, image 20).\n\nThere is no evidence of acute territorial infarction, hemorrhage, edema, or\nnew mass. Confluent subcortical, periventricular, and white matter\nhypodensities are re- demonstrated, likely reflective of post radiation\nchanges and sequela of chronic microvascular infarction. There is prominence\nof the ventricles and sulci suggestive of involutional changes.\n\nChronic bilateral nasal bone fractures are visualized. No acute fractures. A\nlarge mucous retention cyst is seen within the right maxillary sinus. \nOtherwise, the visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. Patient is status post bilateral lens\nresections.", + "output": "1. No acute intracranial process.\n2. Status post left frontal craniotomy with unchanged underlying postsurgical\nand postradiation changes." + }, + { + "input": "NONCONTRAST HEAD CT:\nStatus post left frontal craniotomy with stable left frontoparietal\nencephalomalacia. Subcortical encephalomalacia within the right precentral\ngyrus is unchanged since at least ___ (2:21).\n\nThere is no evidence of acute large vascular territory infarction, hemorrhage,\nedema or mass. Confluent periventricular, subcortical and deep white matter\nhypodensities are nonspecific, likely sequelae of chronic small vessel\nischemic disease. Prominent ventricles and sulci suggest age-related\ninvolutional changes.\n\nChronic bilateral nasal bone fractures are re-demonstrated. No acute fractures\nidentified. Large right maxillary sinus mucous retention cyst. Remaining\nvisualized paranasal sinuses, mastoid air cells and middle ear cavities are\nclear. Patient is status post bilateral lens surgery.\n\nCTA HEAD: There is a 4 x 3 mm right PCOM aneurysm (3:250). The left PCOM is\nunremarkable. Otherwise, the remaining branches of the circle of ___ and\nprincipal intracranial branches are grossly patent without additional\naneurysm, stenosis, dissection or occlusion. Dural venous sinuses are grossly\npatent.\n\nCTA NECK: Dominant left vertebral system. The V3 and V4 segments of the right\nvertebral artery are diminutive, though do not demonstrate focal abrupt\ncaliber change. Overall, there is no evidence of stenosis, dissection, or\nocclusion within the bilateral carotid or vertebral arteries. There is\nmoderate calcification of the V4 segment of the left vertebral artery. There\nis atherosclerotic disease at the right carotid bifurcation without\nsignificant internal carotid artery stenosis per NASCET criteria.\n\nOther: Severe centrilobular emphysema. Postoperative changes within the right\nposterior chest wall, with likely surgical mesh in place. Thyroid gland is\nunremarkable without discrete nodule. No cervical lymphadenopathy by CT size\ncriteria. A 9 mm left level 6 lymph node is unchanged since examination of\n___. There is moderate cervical spondylosis, worse at C4-C5 level.", + "output": "1. No evidence of acute infarction, hemorrhage, or edema. Status post left\nfrontal craniotomy with stable left frontoparietal and right precentral\nencephalomalacia.\n2. Right posterior communicating artery aneurysm measuring 4 x 3 mm.\n3. Otherwise, patency of the intracranial vasculature without stenosis or\nocclusion.\n4. Mild atherosclerotic disease at the right carotid bifurcation without\ninternal carotid artery stenosis per NASCET criteria.\n5. Severe centrilobular emphysema." + }, + { + "input": "Limited by motion degradation.\n\nThere is a focus of subarachnoid hemorrhage within the left postcentral sulcus\nnear the vertex (series 2:25). Again noted is left frontal encephalomalacia\nand subcortical hypodensity within the right precentral gyrus, unchanged from\nCTA head and neck ___. There is no edema or shift of normally\nmidline structures. Prominent ventricles and sulci compatible with\nage-related involutional changes. Confluent areas of periventricular and\nsubcortical white matter hypoattenuation likely represent chronic small vessel\nischemic disease.\n\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. Left frontal craniotomy changes are noted. There\nis no acute fracture. Nasal bone deformities appear chronic.", + "output": "1. Focus of acute subarachnoid hemorrhage along the left postcentral sulcus\nnear the vertex (series 2:25)\n2. Stable left frontoparietal and right precentral gyrus encephalomalacia." + }, + { + "input": "Patient is status post left frontal craniotomy for resection of metastatic\nlesion. Encephalomalacia noted in the left frontal lobe is unchanged from\nprior, reflective of postsurgical changes. There is decrease in density in\nthe 8 mm hyperdense foci in the left postcentral sulcus consistent with\ninterval evolution of previously noted subarachnoid hemorrhage (2; 26). No\nnew foci of hemorrhage. No large vascular territory infarction. No evidence\nof mass effect. The ventricles and sulci are prominent in size and\nconfiguration consistent with age related atrophy. Nonspecific subcortical\nand periventricular white matter hypodensities suggest small vessel ischemic\ndisease.\n\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\nThe orbits are unremarkable.", + "output": "Interval evolution of 8mm left subarachnoid hemorrhage along the left post\ncentral sulcus with decrease in density. No large vascular territory\ninfarction." + }, + { + "input": "The patient is status post left frontal craniotomy with stable left frontal\nencephalomalacia related to post treatment change. There is no evidence of\nhemorrhage, edema, mass effect or acute large vascular territory infarction.\nProminent ventricles and sulci suggest age related atrophy. Periventricular\nwhite matter hypodensities are nonspecific but likely represent sequela of\nchronic small vessel ischemic disease. The basal cisterns appear patent and\nthere is preservation of gray-white matter differentiation.\n\n No acute fracture is identified. Old fractures of the bilateral nasal bones\nare unchanged. A mucous retention cyst in the right maxillary sinus is\nunchanged. The visualized paranasal sinuses, mastoid air cells and middle ear\ncavities are otherwise clear. The globes are unremarkable.", + "output": "No evidence of acute intracranial process. MRI would be more sensitive for\ndetection of metastases." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis or occlusion. There is an approximately 3 mm\naneurysm of the left posterior communicating artery (603b:36). The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThere are bilateral carotid bulb soft plaques mildly narrowing in the internal\ncarotid lumen, right greater than left. However, there is no evidence of\ndissection, occlusion, or flow limiting stenosis. By NASCET criteria, there\nis approximately 20% stenosis of the left internal carotid artery and no\nstenosis of the right internal carotid artery. The vertebral arteries and\ntheir major branches appear normal with no evidence of stenosis or occlusion.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No evidence of vascular dissection or occlusion.\n2. 3 mm aneurysm of the left posterior communicating artery\n3. Bilateral carotid bulb soft plaques causing mild narrowing of the bilateral\ninternal carotid arteries, right greater than left.\n4. By NASCET criteria, there is approximately 20% stenosis of the left\ninternal carotid artery and no stenosis of the right internal carotid artery." + }, + { + "input": "There is no evidence of territorial infarction, intracranial hemorrhage,\nedema, mass effect, midline shift, or mass. The ventricles and sulci are\nnormal in size and configuration.\nNo bony abnormalities seen. There is minimal fluid in the left maxillary\nsinus suggestive of ongoing inflammation. Otherwise, the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable. There is a left frontal scalp hematoma.", + "output": "No acute intracranial process. Left frontal scalp hematoma." + }, + { + "input": "No evidence of infarction, hemorrhage, edema, or mass. Periventricular white\nmatter hypodensities are nonspecific and likely reflects sequela of chronic\nsmall vessel ischemic disease. Bilateral, symmetric prominence of the\nventricles and sulci likely age-related involutional change.\nNo evidence of fracture. The visualized portion of the paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable other than lens replacement.", + "output": "1. No evidence of hemorrhage.\n\n2. Age-related involutional change.\n\n3. Sequelae of chronic small vessel ischemic disease." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is a 2.5 x 2.9 cm heterogeneous rounded enhancing lesion in the right\nfrontal lobe with extensive surrounding vasogenic edema. There is\napproximately 5 mm of leftward midline shift and effacement of the right\nfrontal lobe sulci, as well as partial effacement of the right lateral\nventricle. There is no evidence of acute large territorial infarction or\nhemorrhage.\n\nThere is high-density material within an atelectatic right maxillary sinus. \nThe visualized portion of the remaining paranasal sinuses,mastoid air\ncells,and middle ear cavities are essentially clear. The visualized portion\nof the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent. At the site of the previously described right\nfrontal lobe mass, there is associated enhancement and torturous vessels\nsuggestive of neovascularity.\n\nCTA NECK:\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear aside from mild bilateral\ndependent atelectasis. The visualized portion of the thyroid gland is notable\nfor left hemithyroidectomy and atrophic right lobe. There is no\nlymphadenopathy by CT size criteria.", + "output": "1. There is a 2.5 x 2.9 cm a rounded heterogeneous enhancing lesion in the\nright frontal lobe, with extensive surrounding vasogenic edema, the pattern of\nenhancement suggest neovascularity on CTA, and is concerning for malignancy.\nThere is associated mass effect, with effacement of the sulci and partial\neffacement of the right lateral ventricle, as well as 5 mm of leftward midline\nshift. Contrast enhanced MRI is recommended.\n2. Patent head and neck vessels, with no evidence of stenosis, occlusion or\naneurysm.\n3. There is high density material within an atelectatic right maxillary sinus.\n\nRECOMMENDATION(S): Correlation with MRI of the head with and without contrast\nis recommended for further characterization.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 12:23 pm, at time\nof discovery of the findings." + }, + { + "input": "The patient is status post right frontal craniotomy and resection of a right\nfrontal lesion. There is bifrontal pneumocephalus and fluid within the\nsurgical bed which is likely secondary to postsurgical changes. There is\nunchanged vasogenic edema involving the right frontal and parietal regions. \nThere is a 3 mm leftward midline shift, unchanged. There is no large\nterritory infarction or unexpected intracranial hemorrhage. There is\nunchanged partial effacement of the right lateral and third ventricles.\n\nThe visualized portion of the orbits, paranasal sinuses, mastoid air cells,\nand middle ear cavities are stable in appearance.", + "output": "1. The patient is status post right frontal craniotomy and resection of the\nright frontal lesion with pneumocephalus and fluid within the surgical bed\nwhich is likely secondary to postsurgical changes.\n2. Unchanged vasogenic edema involving the right frontal and parietal regions.\n3. Unchanged 3 mm left midline shift.\n4. No large territory infarction or unexpected intracranial hemorrhage." + }, + { + "input": "Patient is status post right frontal craniotomy for resection of right frontal\nlesion. Redemonstration of expected postsurgical changes, including bifrontal\npneumocephalus and fluid within the surgical bed. Vasogenic edema within the\nright frontal and parietal regions is similar to the prior study. There is 3\nmm leftward shift of midline structures, unchanged. No evidence of new\nhemorrhage or of infarction. Unchanged partial effacement of the right\nlateral ventricle and third ventricle.\n\n The visualized portion of the paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. Status post right frontal craniotomy for resection right frontal lesion,\nwith overall similar appearance of expected postsurgical changes.\n2. Unchanged vasogenic edema involving the right frontal and parietal regions.\n3. Unchanged 3 mm leftward midline shift." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThe patient is status post right frontal craniotomy for resection of right\nfrontal and temporal lobe tumor. There is extensive vasogenic edema in the\nright frontal and temporal lobes, overall similar in configuration to FLAIR\nhyperintensity seen on MRI from ___. There is no evidence of\ninfarction.\n\nA thin line of hyperdense material at the surgical bed is consistent with\nresidual blood products, not significantly changed from prior. There is no new\nhemorrhage. There is approximately 4 mm of leftward midline shift due to the\nextensive right cerebral edema, unchanged. The ventricles and sulci are\nnormal in size and configuration.\n\nThe right maxillary sinus is opacified, unchanged. Otherwise, the visualized\nportion of the paranasal sinuses, mastoid air cells,and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent. There is thick rind of enhancement at the right\nsurgical bed measuring approximately 3.1 x 4.9 cm with associated large\nfeeding vessels, concerning for tumor progression.\n\nCTA NECK:\nThere is a kink in the right common carotid artery approximately 1.7 cm distal\nfrom the origin, with at least a moderate narrowing at this level (series 4,\nimage 56 and series 602, image 39). Otherwise, the carotidandvertebral\narteries and their major branches appear normal with no evidence of high-grade\nstenosis or occlusion. There is no evidence of internal carotid artery\nstenosis by NASCET criteria.\n\nCT Perfusion:\nNo evidence of acute infarct.\nCBF less than 30% volume: 0 mL\nT-max greater than 6.0 seconds volume: 0 mL\n\nNote is made of an area of decreased cerebral blood volume posterior to the\nresection bed. There is increased mean transit time in the area of the right\nfrontal tumor.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No evidence of infarction.\n2. Status post right frontal craniotomy and resection of right frontal and\ntemporal lesion. A thick rind of enhancement enhancement with large feeding\nvessels to an area measuring 3.1 x 4.9 cm is concerning for tumor progression.\n3. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion,or dissection.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 4:08 pm, 5 minutes after\ndiscovery of the findings.\n\nThe findings and recommendations for MRI were discussed with ___,\nM.D. by ___, M.D. on the telephone on ___ at 4:46 pm." + }, + { + "input": "Patient is status post right frontal craniotomy for resection of the\nintracranial lesion. Extensive vasogenic edema is seen in the surgical bed,\noverall similar in configuration to prior CTA on ___. An oval\nhypodensity measuring 3.6 x 2.5 cm within the surgical bed is again seen,\nsimilar in size from ___. There is a 2 mm leftward midline shift,\npreviously 4 mm.\n\nOf note, the extensive vasogenic edema makes it difficult to exclude a\nsuperimposed ischemia. Redemonstration of a thin line of hyperdense material\non the lateral aspect, not significant changed from prior. This likely\nrepresents surgical material or calcification.\n\nThere is no evidence of acute intracranial hemorrhage. The ventricles and\nsulci are otherwise normal in size and configuration.\n\nOpacification of the right maxillary sinus, unchanged. The paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "1. 3.6 x 2.5 cm oval hypodensity with surrounding vasogenic edema within the\nright front surgical bed is similar to ___.\n2. Interval decrease of now 2 mm leftward midline shift, previously 4 mm.\n3. The extensive vasogenic edema makes it difficult to exclude a superimposed\nischemia.\n4. No evidence of acute intracranial hemorrhage." + }, + { + "input": "Patient is status post right frontal craniotomy. There is redemonstration of\na 3.3 x 2.5 cm right frontal hypodense mass (series 6, image 17) with\nextensive surrounding vasogenic edema, better characterized on recent MRI\ndated ___. Subsequently, there is persistent mass-effect on the\nright lateral ventricle and 4 mm leftward midline shift. There is no acute\nlarge territory infarction or intracranial hemorrhage.\n\n Unchanged opacification of the right maxillary sinus.", + "output": "1. No new acute intracranial abnormality.\n2. Grossly stable 3.3 cm right frontal mass with extensive surrounding\nvasogenic edema causing 4 mm leftward midline shift and mass-effect on the\nright lateral ventricle, better characterized on MRI brain dated ___.\n3. Persistent opacification of the right maxillary sinus.\n4. No definite evidence of acute intracranial hemorrhage." + }, + { + "input": "Re-demonstrated are postsurgical changes from right frontal craniotomy and\ntumor resection. The known right frontal lobe mass is better defined by\nprevious MRI, but is noted on image 15 of series 5 where measures\napproximately 4.5 x 3.1 cm. There is a thin extra-axial collection\nimmediately subjacent to the craniotomy site on image 13 of series 5 which\nappears similar to previous examination. There is no significant change in\nthe degrees of effacement of the right lateral ventricle for leftward midline\nshift measuring approximately 4 mm.\n\nThere is continued opacification of the right maxillary sinus with remodeling\nchanges of the maxillary sinus walls, partially imaged, and similar to the\nprevious exam. The visualized portions of the paranasal sinuses and mastoid\nair cells are otherwise clear.", + "output": "No new intracranial abnormality is demonstrated.\n\nKnown right frontal lobe mass with extensive surrounding edema, mass effect on\nthe right lateral ventricle, and 4 mm leftward midline shift, which was better\ncharacterized by previous MRI. Particularly in the setting of the mass and\nits associated surrounding hypoattenuation, MRI would offer greater\nsensitivity for acute superimposed processes, as needed clinically." + }, + { + "input": "Again demonstrated are postoperative changes of right frontal craniotomy and a\nlarge heterogeneously hypodense irregular area in the right frontal lobe at\nthe location of the partially resected mass and surrounding edema which is\nbetter delineated and characterized on prior head MR. ___ is a new focal\nintraparenchymal hyperdensity in the inferior right frontal lobe worrisome for\nacute intracranial/intraparenchymal hemorrhage (___). There is\nassociated mass effect with an increased 9 mm leftward shift of normally\nmidline structures with right subfalcine herniation, previously 4 mm. There is\nextensive effacement of the right lateral ventricle. The basal cisterns are\npatent.\n\nNo acute hemorrhage or suspected acute territorial infarction is noted.\n\nPartially imaged paranasal sinuses demonstrate persistent opacification of the\nright maxillary sinus with wall remodeling. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are normal.", + "output": "1. Postoperative changes of right frontal craniotomy with partial resection of\nright frontal mass with increased mass effect resulting in a 9 mm leftward\nshift of midline structures, previously 4 mm, with subfalcine herniation.\n2. Focal intraparenchymal hyperdensity in the inferior right frontal lobe\nconcerning for acute intracranial hemorrhage, new since prior study." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,or edema. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nPeriventricular white matter hypodensities consistent with chronic small\nvessel ischemic changes. There is a possible small chronic infarct in the\nsuperolateral left cerebellar hemisphere, image 9 series 2, image 78 series\n601, image 62 series 602.. Atherosclerotic calcifications noted involving the\nintracranial segments of the internal carotid and vertebral arteries.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No evidence of fracture or intracranial hemorrhage.\n2. Possible small chronic infarct in the superolateral left cerebellar\nhemisphere." + }, + { + "input": "There is no evidence of fracture, infarction, hemorrhage, edema,or mass. The\nventricles and sulci are normal in caliber and can. There is no abnormal\nenhancement on post contrast images.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "1. Normal study. No evidence of mass, edema or infarction." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema or\nmass. There is preservation of gray-white matter differentiation. Basal\ncisterns are patent. Ventricles and sulci are normal in size and morphology.\n\nNo fracture identified. The imaged paranasal sinuses are clear. Mastoid air\ncells and middle ear cavities are well aerated. Visualized portions of the\norbits are unremarkable.", + "output": "No acute intracranial abnormalities." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nare patent without stenosis, occlusion or aneurysm formation. Minimal\natherosclerotic calcifications involve the bilateral cavernous internal\ncarotid arteries. There is fetal origin of the left posterior cerebral\nartery. The left intradural vertebral artery terminates as the left posterior\ninferior cerebellar artery. The dural venous sinuses are patent.\n\nCTA NECK:\nThere are minimal atheromatous changes at the carotid bifurcations\nbilaterally. Otherwise, carotid and vertebral arteries and their major\nbranches appear normal with no evidence of stenosis or occlusion. The right\nvertebral artery is dominant. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The left thyroid gland is\nslightly enlarged and heterogeneous. The round, 0.7 cm hypodense nodule in\nthe left upper thyroid lobe is unchanged. There is no lymphadenopathy by CT\nsize criteria.", + "output": "1. Patent circle ___.\n2. No evidence of internal carotid artery stenosis by NASCET criteria.\n3. No evidence of infarction or hemorrhage." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\n\nA small area of scalp stranding consistent with known forehead abrasion\nwithout underlying fracture. The imaged paranasal sinuses are clear. Mastoid\nair cells and middle ear cavities are well aerated. The patient is status post\nsurgical fixation of prior left facial bone fractures.", + "output": "1. Small area of scalp stranding consistent with known forehead abrasion.\n2. No hemorrhage or large territorial infarction identified." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration. There is area of\nlow-attenuation, likely representing encephalomalacia at the left MCA and ACA,\nPCA watershed distribution, may be sequela of prior watershed distribution\ninfarct or PRES, stable since prior. There is mild asymmetric decrease left\ncerebral hemisphere secondary to decreased anterior cranial fossa, without\nassociated hypo pneumatization of the frontal sinus or thickening of the\nbones. There is no asymmetric brain parenchymal atrophy.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Right lacrimal gland is enlarged. \nLeft lacrimal gland is borderline sized to mildly enlarged. Findings can be\nseen with inflammatory conditions, including inflammatory pseudotumor,\nsarcoid, Sjogren's, lymphoproliferative disorder or primary salivary gland\nneoplasm. There is no flattening of the globe. If right lacrimal gland was\nprobably enlarged in ___, arguing for benign process, clinically correlate.", + "output": "Areas of cortical and subcortical decreased attenuation involving the left\ncerebral watershed distribution, may represent sequela of prior watershed\ndistribution infarct or PRES, stable since prior." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Mild periventricular, subcortical, and deep white\nmatter hypodensities are nonspecific, but likely reflect the sequela of\nchronic microvascular infarction. Moderate atherosclerotic calcifications of\nthe cavernous carotid arteries are noted.\n\nThere is a subgaleal hematoma overlying the right parietal bone measuring 5 mm\nfrom the calvarium There is no acute fracture. There is an air-fluid level\nseen in the right maxillary sinus. The other paranasal sinuses are clear. \nThe mastoid air cells are clear bilaterally. The visualized portion of the\norbits are unremarkable.", + "output": "1. No acute intracranial hemorrhage. No large territorial infarction.\n2. 5 mm subgaleal hematoma overlying the right parietal bone. No calvarial\nfracture.\n3. Air-fluid level in the right maxillary sinus may represent acute sinusitis\nand clinical correlation is needed." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass.\n\nThere is mild generalized parenchymal volume loss, unchanged and most likely\nage related. The ventricles and sulci are age appropriate.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are essentially clear. There is a right lens replacement. The\nvisualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThere are atherosclerotic changes along both carotid siphons but without\nhigh-grade stenosis. Note is made of a right fetal type posterior cerebral\nartery, a normal anatomic variant. A small left posterior communicating\nartery is also present.\nThe right A1 segment appears hypoplastic.\n\nthe vessels of the circle of ___ and their principal intracranial branches\nappear otherwise unremarkable without stenosis, occlusion, or aneurysm\nformation. The dural venous sinuses are patent.\n\nCTA NECK:\nNormal three vessel aortic arch. There are scattered atherosclerotic changes\nalong the great vessels without high-grade stenosis. Note is made of a short\nsegment beaded appearance of the midportion of the right ICA, consistent with\nfibromuscular dysplasia. Slight kinking in may be some irregularity is also\nseen along the distal left ICA which may also be related to fibromuscular\ndysplasia.\n\nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThere is mild dependent atelectasis. No suspicious pulmonary nodules. Note\nis made of mild biapical pulmonary scarring. There is a small subcentimeter\nhypodense nodule in the right thyroid lobe for which no follow-up is\nrecommended according to current guidelines. The visualized portion of the\nthyroid gland is otherwise within normal limits. There is no lymphadenopathy\nby CT size criteria.\nIncidental note is made of fatty atrophy of the left parotid gland. There is\na 4 x 4 x 4 mm soft tissue nodule along the cervical-a of the left parotid\ngland which appears grossly unchanged from ___.", + "output": "1. No significant intracranial abnormality. No evidence of acute infarction,\nhemorrhage or intracranial mass.\n2. Short-segment beaded appearance of the bilateral cervical ICAs, right more\nthan left, consistent with fibromuscular dysplasia.\n3. Mild atherosclerotic changes of the cervical vasculature but without\nsignificant stenosis.\n4. Otherwise patent cervical and intracranial vasculature without evidence of\nsignificant stenosis, occlusion, dissection or aneurysm formation greater than\n3 mm." + }, + { + "input": "There is no evidence of infarction,hemorrhage,edema,or mass-effect. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. Aerosolized secretions are seen in the\nright maxillary sinus. There is small mucous in the left maxillary sinus. \nThe visualized portion of the other paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "Paranasal sinus inflammatory changes. Otherwise normal study." + }, + { + "input": "There is no acute hemorrhage, edema or shift of the normally midline\nstructures. Slight prominence of the ventricles is compatible with age\nrelated, centrally predominant involutional changes. The gray-white matter\ndifferentiation is preserved and there is no evidence for an acute territorial\nvascular infarction.\n\nThe included paranasal sinuses and mastoid air cells are well-aerated. The\nimaged lenses and globes are normal. Dense calcifications are seen within the\ncarotid siphons. There is no skull fracture.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or large territorial\ninfarction. Prominent ventricles and sulci are compatible with age-related\nvolume loss. The basal cisterns appear patent and there is preservation of\ngray-white matter differentiation. Atherosclerotic vascular calcifications are\nnoted of bilateral cavernous portions of internal carotid arteries.\n\nNo fracture is identified. The patient is intubated with partial\nopacification of ethmoid air cells. The visualized paranasal sinuses, mastoid\nair cells, and middle ear cavities are otherwise clear. Soft tissue density\nis noted within the left external auditory canals which may represent cerumen.", + "output": "1. No intracranial hemorrhage or evidence of acute territorial infarction.\n2. Please note MRI of the brain is more sensitive for the detection of acute\ninfarct.\n3. Question left external auditory canal cerumen. Recommend correlation with\ndirect examination." + }, + { + "input": "The patient is status post right trans frontal ventriculostomy with tip\nterminating in the anterior horn of the right lateral ventricle, overall\nunchanged in position from examination of ___.\n\nSince the prior examination of ___, the patient is status post\ntrans-sphenoidal resection of a posterior fossa mass arising from the clivus,\nhistologically diagnosed as a chordoma.\n\nAllowing for postsurgical changes, no evidence of significant interval change\nin degree of clival and sphenoid osseous erosion since preoperative\nexamination of ___.\n\nResolution of mass effect on the pons. There is no hydrocephalus. The pons\ndoes demonstrate volume loss at the pontomedullary junction, which may in part\nrepresent posttreatment change. There is mild soft tissue enhancement in the\nprepontine cistern, which abuts the basilar artery (series 303, image 41;\nseries 6, image 31), which may represent residual tumor versus scar tissue. \nThe suprasellar cistern appears unremarkable. Pituitary gland is visualized\nthe infundibulum appears roughly midline.\n\nThere is no evidence of acute large territory infarct or intracranial\nhemorrhage. The sulci, ventricles and cisterns are otherwise within expected\nlimits for the patient's age. No other osseous abnormality. Moderate mucosal\nthickening of the ethmoid air cells. The orbits are unremarkable. Mastoid\nair cells and middle ears are clear.", + "output": "1. No prior postoperative examinations are available for comparison.\n2. The patient is status post trans-sphenoidal resection of a clival mass seen\non examination of ___, with resolution of mass effect on the pons. There\nremains mild enhancing soft tissue in the prepontine cistern abutting the\nbasilar artery, which may represent residual lesion versus granulation/scar\ntissue. Comparison with prior examination is recommended.\n3. There is no evidence of acute intracranial abnormality. No acute large\nterritory infarct or intracranial hemorrhage. Other abnormal enhancement is\nidentified.\n4. Osseous erosion of the clivus and sphenoid is grossly unchanged since\npreoperative examination.\n5. Additional findings as described above." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are enlarged, due to age related global atrophy.\nScattered subcortical and periventricular white matter hypodensities reflect\nthe sequelae of chronic small vessel ischemic disease. A right basal ganglia\nlacunar infarct is again noted.\nNo fractures are seen. There is persisting complete opacification of the left\nmaxillary sinus, with underlying bony sclerosis. The remaining paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "No acute intracranial process. Chronic small vessel ischemic changes and left\nmaxillary sinus opacification." + }, + { + "input": "There is no evidence of acute large territory infarction, hemorrhage, edema,\nor mass. The ventricles and sulci are prominent consistent with age-related\natrophy. Confluent periventricular and subcortical white matter hypodensities\nlikely represent the sequela of chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. A few ethmoid air cells are opacified and\nthe left maxillary sinus is completely opacified, unchanged compared to the\nprior CT head examination. There is sclerosis of the walls of the left\nmaxillary sinus which suggests chronicity. The cavernous portion of the\ninternal carotid arteries and distal right vertebral artery demonstrate\natherosclerotic calcifications. The mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.", + "output": "No acute intracranial process. Chronic findings as described above." + }, + { + "input": "CTA HEAD:\nSevere atherosclerotic calcifications involve the cavernous and supra clinoid\nsegments of the bilateral internal carotid arteries with severe narrowing of\nthe lumen of the bilateral supra clinoid segments of the internal carotid\narteries. The cavernous segments of the internal carotid arteries are\nirregular with multifocal segments of moderate to severe stenosis. The\npetrous segments of the internal carotid arteries are patent. The anterior,\nmiddle, and posterior cerebral arteries are patent with no evidence of\nstenosis or occlusion. There is an equivocal outpouching formation at the\nbifurcation M1/ M2 segment on the right middle cerebral artery, measuring\napproximately 2.6 mm in transverse dimension (image 18, series 602b and image\n278, series 2) a small aneurysm cannot be completely rule out. The left\nintradural vertebral artery is mildly narrowed and irregular, likely related\nto atherosclerotic disease. The right intradural vertebral artery is patent\nand contains a punctate atherosclerotic calcification. The basilar artery is\npatent. A 2 mm focal outpouching at the origin of the right superior\ncerebellar artery is noted.\n\nCTA NECK:\nThere is a normal 3 vessel branching pattern of the aortic arch. \nAtherosclerotic calcifications involve the aortic arch. The origins of the\ngreat vessels are patent. The common carotid and external carotid arteries\nare patent. A 0.8 cm length segment of focal narrowing of the left proximal\ninternal carotid artery, 0.8 cm distal to the carotid bifurcation, has an\napproximate stenosis of 70% by NASCET criteria secondary to calcified and\nnoncalcified plaque. Calcified and noncalcified plaque narrows the right\nproximal internal carotid artery, just distal to its bifurcation with an\napproximate stenosis of 60% by NASCET criteria.\n\nThere are atherosclerotic calcifications at the origins of both vertebral\narteries, which remain patent. The right vertebral artery is dominant. \nEvaluation of the left V1 segment, distal to its origin, is limited due to\nextensive streak artifact from dense contrast in an adjacent vein. Both\nvertebral arteries are patent throughout their course.\n\nOTHER:\nA left pleural effusion with adjacent atelectasis is partially visualized. \nThe right thyroid gland lobe is enlarged relative to the left thyroid lobe. \nThe thyroid gland enhances homogeneously. There is no lymphadenopathy by CT\nsize criteria. A rounded, sclerotic focus in the T1 vertebral body likely\nrepresents a bone island. There are multilevel degenerative changes of the\ncervical spine.", + "output": "1. No evidence of dissection.\n2. Approximately 70% stenosis of the left proximal internal carotid artery and\n60% stenosis of the right proximal internal carotid artery by NASCET criteria.\n3. Extensive atherosclerotic calcifications of the cavernous and supra clinoid\nsegments of the internal carotid arteries, resulting in severe, multifocal\nstenoses. Patent anterior, middle, and posterior cerebral arteries.\n4. Two mm outpouching at the origin of the right superior cerebellar artery,\nlikely representing an infundibulum. A small aneurysm cannot be excluded. \nPossible aneurysm identified at the bifurcation of the right middle cerebral\nartery as described above, measuring approximately 2.6 mm in transverse\ndimension." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular, subcortical, and deep white matter\nhypodensities are compatible with the sequela of chronic small vessel ischemic\ndisease. Additionally, a chronic lacune is seen within the right basal\nganglia. Extensive atherosclerotic calcifications are noted within the\ncavernous carotid arteries and mild atherosclerotic calcifications are noted\nwithin the distal vertebral arteries.\nThere is no evidence of fracture. Severe opacification of the maxillary\nsinuses are noted bilaterally with thickening and sclerosis of the left\nmaxillary sinus walls indicative of chronic inflammation. Mild mucosal\nthickening is also noted within the ethmoid air cells. The visualized portion\nof the remaining paranasal sinuses mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Extensive chronic small vessel ischemic disease.\n3. Bilateral maxillary sinus disease, a component of which is chronic on the\nleft." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor mass. There is moderate prominence of the ventricles and sulci suggestive\nof involutional change. Confluent areas of periventricular, subcortical and\ndeep white matter hypodensities are in a configuration most suggestive of\nchronic small vessel ischemic disease. There is a small lacune or prominent\nperivascular space in the region of the posterior putamen. Vascular\ncalcifications identified in the carotid siphons and right vertebral artery.\n\nThere is no evidence of fracture. There is mild mucosal wall thickening and\nsmall layering fluid in the left maxillary sinus. The visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear. \nThe visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Moderate atrophy and areas of white matter hypodensity in a configuration\nmost suggestive of chronic small vessel ischemic disease.\n3. Small amount of layering fluid in the left maxillary sinus which can be\nseen in the setting of acute sinusitis in the appropriate clinical context." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass. Prominence of ventricles and sulci consistent with age related\ninvolutional changes. Nonspecific periventricular and subcortical white\nmatter hypodensities are suggestive of chronic small vessel ischemic disease.\n\nMild soft tissue swelling is seen over the left frontal and supraorbital area.\nNo acute osseous abnormalities seen. Partial opacification of inferior\nright-sided mastoid air cells suggests mild inflammation. Otherwise, the\nparanasal sinuses, left mastoid air cells, and middle ear cavities are clear.\nThe orbits are unremarkable apart from bilateral lens replacements noted. \nMild atherosclerotic calcifications of the cavernous carotid arteries are\nnoted.", + "output": "Mild left frontal and supraorbital soft tissue swelling without acute\nfracture. No acute intracranial process otherwise identified." + }, + { + "input": "There is no evidence of acute territorial infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular, subcortical and deep white matter\nhypodensities are nonspecific, but likely reflect the sequela of chronic\nmicrovascular infarction.\n\nComminuted and mildly displaced fractures of both nasal bones are present with\noverlying soft tissue swelling. There is chronic partial opacification of the\ninferior right mastoid air cells. A mucous retention cyst in the right\nmaxillary sinus is incompletely imaged. The visualized portion of the\nparanasal sinuses, left mastoid air cells, and middle ear cavities are clear. \nThe visualized portion of the orbits are unremarkable apart from bilateral\nlens replacements. Mild atherosclerotic calcifications are noted involving\nthe cavernous carotid arteries.", + "output": "1. Comminuted and mildly displaced bilateral nasal bone fractures with\noverlying soft tissue swelling.\n2. No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass.\nSubcortical and periventricular white matter hypodensities are nonspecific,\nlikely the sequelae of chronic small vessel ischemic disease. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nAgain seen are comminuted and mildly displaced fractures of bilateral nasal\nbones with interval improvement in overlying soft tissue swelling. A mucous\nretention cyst is seen in the right maxillary sinus. There is opacification\nof a few inferior right mastoid air cells, similar to prior. The visualized\nportion of the remaining paranasal sinuses, left mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits show bilateral\nlens replacement.", + "output": "No acute intracranial process." + }, + { + "input": "The underpneumatized right frontal sinus, frontal recess, and anterior ethmoid\nair cells are clear. There is mild mucosal thickening within the right\nmaxillary sinus. Osseous septations within the right maxillary sinus anterior\nand superomedial aspect.. The maxillary infundibulum is patent. There is\nmild mucosal thickening within the right posterior ethmoid air cells and\nsphenoid sinus. The sphenoethmoidal recess is patent.\n\nThere is moderate mucosal thickening within floor of the left frontal sinus,\nleft frontal sinus upper drainage pathway is probably obstructed at narrow\npoint, lower drainage pathway, infundibulum is patent. The left anterior\nethmoid air cells are clear. There is mild mucosal thickening within the left\nmaxillary sinus. Osseous septations within the left maxillary sinus are\nnoted, with and enclosed left infraorbital air cell. The maxillary\ninfundibulum is clear. There is mild mucosal thickening within the posterior\nethmoid air cells and sphenoid sinus. Sphenoethmoidal recess is clear.\n\nThere is mucosal thickening adjacent to the medial wall of the maxillary\nsinuses within the middle meatus, right more advanced than left. There is\nleftward nasal septal deviation and a left septal spur that remodels the left\ninferior turbinate. There is a paradoxical curvature of the right middle\nturbinate.\n\nThe right fovea ethmoidalis is lower than the left. The cribriform plate\nappears intact. The medial orbital walls are covered by bone. The carotid\ncanals are thinned though probably covered by bone.\n\nThe middle ear cavities and mastoid air cells are clear. Debris within the\nright external auditory canal likely reflects cerumen.\n\nThere is mild atlantoaxial osteoarthritis.", + "output": "1. Mild paranasal sinus disease as detailed above.\n2. Leftward nasal septal deviation with a prominent septal spur." + }, + { + "input": "There is no evidence of large vascular territorial infarction, hemorrhage,\nedema, or mass. Moderate ventriculomegaly is unchanged from ___.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No evidence of acute intracranial hemorrhage or large vascular territorial\ninfarction." + }, + { + "input": "LEFT :\nThere is non-mineralized material in the left external auditory canal. The\ncontours the left external auditory canal remain intact. No osseous erosion\nis seen.\n\nThe middle ear cavity is clear. The ossicles and tegmen are intact. There is\nno evidence for enlarged vestibular aqueduct or superior semicircular canal\ndehiscence. The facial nerve follows a normal course through the middle ear.\nThere is no evidence for inner ear dysplasia. The mastoids are clear.\n\nRIGHT:\nThere is non-mineralized material in the right external auditory canal. The\ncontours the left external auditory canal remain intact. No osseous erosion is\nseen.\n\nThe middle ear cavity is clear. The ossicles and tegmen are intact. There is\nno evidence for enlarged vestibular aqueduct or superior semicircular canal\ndehiscence. The facial nerve follows a normal course through the middle ear.\nThere is no evidence for inner ear dysplasia. Trace opacification of a few\nright mastoid air cells (6:108) is nonspecific.\n\nOther: Redemonstration of known ventriculomegaly, which is partially imaged.", + "output": "1. No evidence malignant otitis externa or otitis media.\n2. Non mineralized material in the bilateral external auditory canals is\nnonspecific and may represent cerumen or debris related to otitis externa.\n3. Trace opacification of a few right mastoid air cells is nonspecific." + }, + { + "input": "There is no evidence of fracture, large territorial\ninfarction,hemorrhage,edema,or mass. Moderate ventriculomegaly is unchanged\nfrom multiple priors.\n\nOpacification of a single left ethmoid air cell is noted. The visualized\nportion of the remaining paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable\napart from bilateral lens replacements.", + "output": "1. No evidence of acute intracranial abnormality.\n2. Moderate ventriculomegaly is unchanged from multiple priors." + }, + { + "input": "There is no evidence of an acute fracture, infarction,hemorrhage,edema, or\nmass. Moderate ventriculomegaly is unchanged from prior.\n\nThere is mild mucosal thickening of the left anterior ethmoid air cells;\notherwise, the visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. Status post bilateral lens replacement;\notherwise, the visualized portion of the orbits are normal.", + "output": "1. No acute intracranial hemorrhage or infarct. Mild chronic microangiopathy.\nPlease note that MRI would be more sensitive if there is further clinical\nconcern for infarction.\n2. Stable moderate ventriculomegaly." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. Moderate\nventriculomegaly is unchanged from multiple priors.\n\nPartial opacification of the left ethmoid air cells. Otherwise, the\nvisualized portion of the paranasal sinuses, mastoid air cells,and middle ear\ncavities are clear. Status post bilateral lens replacement; otherwise, the\nvisualized portion of the orbits are normal.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear patent without stenosis, occlusion, or aneurysm. Mild atherosclerotic\ncalcification of the internal carotid arteries without stenosis fenestrated\nanterior communicating artery complex. The dural venous sinuses are patent.\n\nCTA NECK:\nBilateral carotid and vertebral artery origins are patent.\nThere is no evidence of internal carotid stenosis by NASCET criteria.\nTortuosity of the bilateral distal cervical internal carotid arteries is\nnoted. Otherwise, the carotidandvertebral arteries and their major branches\nappear normal with no evidence of stenosis or occlusion.\n\n\n\nOTHER:\nThe visualized portion of the lungs are clear. There is a 4 mm left thyroid\nlobe nodule. There is no lymphadenopathy by CT size criteria.", + "output": "1. No acute intracranial abnormality.\n2. Unchanged ventriculomegaly.\n3. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n4. Patent bilateral cervical carotid and vertebral arteries without evidence\nof stenosis, occlusion, or dissection." + }, + { + "input": "There is no evidence of acute hemorrhage, edema, mass effect, or acute major\nvascular territorial infarction. There is moderate global parenchymal volume\nloss with associated prominence of the ventricles and sulci. Mild\nsubcortical, deep, and periventricular white matter hypodensities are\nnonspecific but likely the sequela of chronic microvascular ischemic disease\nin this age group.\n\nThere is no evidence of a displaced fracture. There is a small mucous\nretention cyst in the right maxillary sinus adjacent to a secondary osteoma in\nits medial wall. Middle ear cavities, mastoid air cells (which only partially\nvisualized on the right), and pneumatized petrous apices are well-aerated.", + "output": "No evidence for acute intracranial abnormalities." + }, + { + "input": "There is a new left frontal burr hole. There is pneumocephalus and small\namount of hyperdense blood along the biopsy track in the left frontal lobe. A\npunctate focus of hyperdensity within the left frontal lobe, likely represents\na small focus of post surgical hemorrhage (series 3, image 21).\n\nAgain seen is a large heterogeneous mass involving the medial frontal lobes\nand anterior corpus callosum, larger on the left than right, with extensive\nvasogenic edema, also larger on the left than right. There is unchanged degree\nof mass effect causing effacement of the lateral ventricles, left greater than\nright, and left to right subfalcine herniation. Basal cisterns are not\ncompressed.\n\nThe paranasal sinuses, mastoid air cells, and middle ear cavities are grossly\nwell aerated.", + "output": "1. S/p left frontal approach biopsy with pneumocephalus and small amount of\nblood along the biopsy tract.\n2. Large mass involving the medial frontal lobes and anterior corpus callosum,\nlarger on the left than right, with extensive left greater than right\nvasogenic edema, is again demonstrated with stable mass effect." + }, + { + "input": "Re-demonstrated are several intraparenchymal hemorrhagic contusions of the\nright inferior frontal and temporal lobes with surrounding edema (series 2,\nimages 7, 8, 10). The largest measures 2.1 x 0.8 cm. Additionally, small\namount of extra-axial blood is seen overlying the right frontal lobe (02:23),\nlikely subarachnoid hemorrhage, as well as a small right parafalcine subdural\nhematoma measuring up to 2 mm (02:24). These hemorrhages are grossly\nunchanged when compared to the prior study. No evidence of new mass effect,\nmidline shift, or hydrocephalus. There is no evidence of acute territorial\ninfarction. The ventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Grossly unchanged appearance of multiple intraparenchymal hemorrhagic\ncontusions with surrounding edema of the right inferior frontal and temporal\nlobes, the largest measuring 2.1 x 0.8 cm.\n2. Small focus of extra-axial blood, likely subarachnoid hemorrhage, overlying\nthe right frontal lobe as well as a tiny right parafalcine subdural hematoma\nare also unchanged.\n3. No new intracranial hemorrhage, evidence of acute territorial infarction,\nmass effect, midline shift, or hydrocephalus." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe parotid and submandibular appear normal. The thyroid gland appears\nnormal. There is no lymphadenopathy by CT criteria. The neck vessels are\npatent. Periapical lucency adjacent to the lateral left maxillary incisor may\nreflect loosening and clinical correlation is advised. Numerous dental caries\nare present.\n\nThere are no osseous lesions. Bronchial wall thickening in the imaged upper\nlungs suggest small airways disease. The patient status post right\ncraniotomy. Chronic appearing defect of the left lamina papyracea suggests\nprior trauma.", + "output": "1. No submandibular mass or findings to explain the patient's dysphagia.\n2. Findings concerning for loosening of the lateral left maxillary incisor.\n3. Small airways disease." + }, + { + "input": "There is no evidence of no evidence of acute major infarction, hemorrhage,\nedema, or large mass. Prominent ventricles and sulci suggest age related\ninvolutional changes. There is no evidence of fracture. The visualized portion\nof the paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles are normal in size and configuration. Basal cisterns\nare patent. There is a fracture involving the left anterior maxillary wall\nextending to the left orbital floor. Adjacent gas within the left pre\nmaxillary soft tissues along with an air-fluid level likely blood within the\nleft maxillary sinus. There is no evidence of left retrobulbar hematoma or\nleft globe disruption. No significant displacement of fracture fragments\nalong the left orbital floor or convincing signs of entrapment. The calvarium\nis intact. Nasal bones appear intact.", + "output": "1. No acute intracranial process.\n2. Acute fracture involving the left maxillary sinus along the anterior wall\nextending to the left orbital floor." + }, + { + "input": "There are multiple fractures of the anterior maxillary sinus wall with\nextension to the inferior orbital rim, with foci of air seen along the\ninferior orbital wall (602b:99, 601b:42). There is no evidence of herniation\nof orbital fat or entrapment of extraocular muscles. Pterygoid plates are\nintact. There is no mandibular fracture and the temporomandibular joints are\nanatomically aligned. The orbits are intact. The globes and extra-ocular\nmuscles are unremarkable. There is no orbital hematoma.\n\nThere is subcutaneous emphysema in the premaxillary soft tissues. There is\nhigh density material in the left maxillary sinus and ethmoid air cells,\nconsistent with blood. Included extracranial soft tissues are unremarkable.", + "output": "1. Comminuted fractures of the anterior left maxillary sinus wall, with\nextension to the left orbital inferior rim. No herniation of orbital contents\nor entrapment of extraocular muscles.\n\n1. No additional facial fracture visualized." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Normal study." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, mass, mass effect or\nlarge territorial infarction. Mildly prominent ventricles and sulci is likely\nrelated to age related involutional changes. The basilar cisterns are patent,\nand there is otherwise good preservation of the gray-white matter\ndifferentiation.\n\nNo acute fractures identified. The visualized paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The globes are unremarkable. Mild\nsoft tissue swelling is seen overlying the anterior left orbit, but there is\nno underlying fracture.", + "output": "No acute intracranial abnormalities identified." + }, + { + "input": "Previously seen tiny focus of hemorrhage in the right vertex is no longer\npresent. There is no evidence of infarction,new hemorrhage,edema,or mass. \nThere is mild generalized brain parenchymal atrophy.\n\nThere is no evidence of acute fracture. Small linear calcification lateral\nmargin of the forehead is similar to prior, may be sequela of prior trauma or\nenthesophyte.. Mild opacification of the posterior left ethmoid air cells\nsimilar to prior. Partially seen is submucosal retention cyst in the right\nmaxillary sinus, which was also present on prior. Otherwise, the visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "Previously seen hemorrhage is resolved. No new hemorrhage." + }, + { + "input": "There is no evidence of large territorial infarctionhemorrhage,edema,or mass. \nThere is prominence of the ventricles and sulci suggestive of involutional\nchanges. There are periventricular and subcortical lucencies, which may\nrepresent small vessel ischemic changes. Atherosclerotic calcifications are\nseen in the bilateral carotid siphons. Bilateral anterior middle cranial\nfossa probable arachnoid cyst is noted.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nethmoid air cells and right maxillary sinus. Small amount of fluid is seen in\nthe right sphenoid sinus. Otherwise, the remaining paranasal sinuses, mastoid\nair cells, and middle ear cavities are clear. The visualized portion of the\norbits are preserved.", + "output": "1. No acute intracranial process.\n2. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described.\n3. Bilateral middle cranial fossa probable arachnoid cysts.\n4. Paranasal sinus disease , as described." + }, + { + "input": "There is no hemorrhage, infarction, edema, or mass effect. The basal cisterns\nare patent, and there is no shift of normally midline structures. The\nventricles and sulci are mildly prominent, compatible with age-appropriate\nglobal atrophy. The visualized paranasal sinuses and mastoid air cells are\nclear. The globes and bony orbits are intact and unremarkable. Carotid siphon\ncalcifications are noted.", + "output": "1. No acute intracranial process. Note, MR is more sensitive for the detection\nof small lesions related to either embolic disease or metastasis.\n2. Chronic findings including age-appropriate global atrophy and vascular\ncalcifications." + }, + { + "input": "There is no acute intracranial hemorrhage, edema, mass, mass effect, or\nevidence of large vascular territorial infarction. The ventricles and sulci\nare normal in size and configuration. There is no fracture.\n\nThere is mucosal thickening and a mucus-retention cyst in the right sphenoid\nsinus. Otherwise, the imaged paranasal sinuses, mastoid air cells, and middle\near cavities are clear.", + "output": "No acute intracranial abnormality.\nBifrontal cortical atrophy, unexpected in a patient of this age, likely\nrelated to the above history.\nCircumferential mucosal thickening in the right sphenoid air cell, which may\nrelate to protracted intubation." + }, + { + "input": "There is no acute intracranial hemorrhage,acute infarction, mass or midline\nshift. The ventricles are normal in size and configuration for age.\nIncidental note is made of variant cavum septum pellucidum et vergae. There is\nre- demonstration of bifrontal cortical atrophy. There is no hydrocephalus. \nThere is mild mucosal wall thickening in the right sphenoid air cell. \nVisualized paranasal sinuses and mastoid air cells are otherwise clear. There\nis no fracture.", + "output": "No acute intracranial abnormality. Redemonstration of bifrontal cortical\natrophy.\n\nCOMMENT ON ATTENDING REVIEW:\nThere is prominence of the right frontal extra-axial space with an apparent\nsubdural collection which is new since ___ but relatively stable\ncompared to ___. This could represent a subacute subdural hematoma.\nConsider further evaluation with MRI. Findings discussed with Dr. ___\nTransplant surgery at 10:35 on ___ via telephone." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or acute infarction.\nProminence of the right frontal extra-axial space from a probable subacute\nsubdural hematoma is unchanged. Ventricles and sulci are stable in size and\nconfiguration. The basal cisterns are patent. Gray-white matter\ndifferentiation is preserved.\n\nPartially imaged paranasal sinuses are notable for persistent mucosal\nthickening of the ethmoid air cells on the right sphenoid sinus. There is\nhowever interval increased opacification of bilateral mastoid air cells.", + "output": "1. Stable appearance of prominent right frontal extra-axial space probably\nrelated to a subacute subdural hematoma. Correlation with MRI of the head is\nadvised.\n\n2. Interval increased opacification of bilateral mastoid air cells may relate\nto immediate postop status, but should be clinically correlated." + }, + { + "input": "Within bilateral globus pallidi, note is made of calcifications, present on\nprior examinations and unchanged. There is no hemorrhage, infarction, edema\nor mass effect. The ventricles and sulci are normal in size and configuration\nfor patient's age. There is no shift of normally midline structures. The basal\ncisterns are clear. The gray white matter differentiation appears preserved.\n\nNo fracture is identified. Visualized paranasal sinuses are clear. Note is\nmade of partial opacification of bilateral mastoid air cells, right greater\nthan left. Middle ear cavities are clear bilaterally.", + "output": "Partial opacification of the mastoid air cells. Otherwise normal study" + }, + { + "input": "There is no evidence of acute large territorial infarctionhemorrhage, edema,\nor mass. Mild prominence of the sulci and ventricles is compatible with age\nrelated atrophy. Differentiation of the gray and white matter is preserved. \nMinimal periventricular white matter hypodensity likely reflects chronic small\nvessel ischemic change. The basal cisterns are patent.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is a right frontoparietal scalp small subgaleal hematoma (02:26) without\nunderlying fracture. There is no evidence of infarction, hemorrhage, edema,\nor mass. The ventricles and sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. Right frontal parietal scalp subgaleal hematoma without underlying\nfracture.\n2. No acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. There is mild-to-moderate mucosal thickening\nof the frontal sinuses and ethmoidal air cells. The visualized paranasal\nsinuses, mastoid air cells, and middle ear cavities are otherwise clear. The\norbits are preserved.", + "output": "1. No acute intracranial abnormality, with no definite evidence of acute\nintracranial hemorrhage or mass. Please note MRI of the brain is more\nsensitive for the evaluation of intracranial masses.\n2. Paranasal sinus disease, as described." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Normal study." + }, + { + "input": "Upon second read, the previously seen focus hyperattenuation likely just\nrepresents prominent right transverse sinus without evidence hemorrhage or\nvenous sinus thrombosis. There is no edema, shift of normally midline\nstructures, or infarction. Ventricles and sulci are normal in overall size and\nconfiguration. The imaged paranasal sinuses are clear. Mastoid air cells and\nmiddle ear cavities are well aerated. The bony calvarium is intact.", + "output": "Upon second read, the previously seen focus hyperattenuation likely just\nrepresents prominent right transverse sinus without evidence hemorrhage or\nvenous sinus thrombosis. Normal study.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 4:40 am, 1 minutes\nafter discovery of the findings.\n\n The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 9:50 am, 1 minutes after discovery of\nthe findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of acute major vascular territorial\ninfarction, hemorrhage, edema, or mass effect. There is prominence of the\nventricles and sulci suggestive of involutional changes. Mild periventricular\nand subcortical white matter hypodensities are nonspecific but likely sequela\nof chronic small-vessel ischemic disease. The basilar cisterns are patent.\n\nAerosolized secretions are noted in the right maxillary sinus. Otherwise\nother paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\nPatient is status post bilateral lens replacement.\n\nCTA NECK:\nThere is a 3 vessel aortic arch. There is predominantly calcified plaque\ninvolving the right distal common carotid and internal carotid arteries with\napproximately 60% stenosis by NASCET criteria. There is mixed plaque\ninvolving the left distal common and proximal internal carotid arteries with\napproximately 30% stenosis by NASCET criteria. There is a small focus of\ncalcified plaque in the V1 segment of the right vertebral artery at the level\nof C7, without flow-limiting stenosis . There is a focus of calcified plaque\nat the left vertebral artery origin, causing mild stenosis.\n\nCTA HEAD:\nThere is a short-segment moderate stenosis of the proximal M1 segment of the\nleft middle cerebral artery, images 661:22 and 660 03:23. There is mild\nnarrowing of the proximal inferior division of the right middle cerebral\nartery, image 602b:22. There is also irregularity of the basilar artery with\nmild short-segment stenosis in its midportion, image 664:25. There is\nirregularity and mild narrowing of P1 and proximal P2 segments of the left\nposterior cerebral artery, images 664:23, ___:27. The above findings are\npresumably atherosclerotic.\n\nThere is no evidence for an aneurysm. The dural venous sinuses are patent.\n\nOTHER:\nMultiple thyroid nodules measure up to 0.9 cm in the left lobe.\nBilateral pleural effusions are partially visualized with adjacent dependent\natelectasis.\nThere are degenerative changes of the cervical spine.", + "output": "1. No evidence for acute intracranial abnormalities.\n2. Aerosolized secretions in the right maxillary sinus. Please correlate\nclinically whether the patient may have symptoms of acute sinusitis. \nApproximately 60% stenosis of the proximal right internal carotid artery and\napproximately 30% stenosis of the proximal left internal carotid artery by\nNASCET criteria.\n3. Mild stenosis of the left vertebral artery origin.\n4. Short-segment moderate stenosis of the proximal M1 segment of the left MCA,\nmild narrowing of the proximal inferior division of the right MCA,\nirregularity of the basilar artery with mild short-segment stenosis in its\nmidportion, and irregularity and mild narrowing of P1 and proximal P2 segments\nof the left posterior cerebral artery, which are most likely atherosclerotic.\n5. Multiple thyroid nodules measuring up to 0.9 cm. The ___ College of\nRadiology guidelines suggest that in the absence of risk factors for thyroid\ncancer, no further evaluation is recommended.\n6. Partially visualized bilateral pleural effusions with associated\natelectasis. Concurrent chest radiograph is reported separately.\n\nRECOMMENDATION(S): MRI would be more sensitive for an acute infarction, if\nclinically warranted." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\nThere is no evidence of fracture. The visualized portion of the mastoid air\ncells, and middle ear cavities are clear. Mild mucosal thickening of the\nright maxillary sinus is noted. The visualized portion of the orbits are\nunremarkable. Mild irregularity of the right nasal bone may indicate a\nfracture.", + "output": "1. No acute intracranial process.\n2. Mild irregularity of the right nasal bones may indicate a fracture." + }, + { + "input": "SOFT TISSUES: There is no stranding, fluid collection, hematoma, or other\nsoft tissue abnormality.\n\nMAXILLOFACIAL BONES: The maxillofacial bones are intact, without fracture.\nThe zygomatico-maxillary complex is intact. The lateral pterygoid plates are\nintact.\n\nMANDIBLE: A mildly displaced left mandibular fracture is present. The\nmandible is without temporomandibular joint dislocation. The\ntemporomandibular joints are symmetric, without significant degenerative\nchange.\n\nDENTITION: There are no dental fractures.Periapical lucencies of bilateral\nmandibular premolar and molar teeth.\n\nSINUSES: Mucosal thickening of bilateral maxillary sinuses is noted, more on\nthe right. The paranasal sinuses are intact and clear. The right ostiomeatal\nunit is patent. The left ostiomeatal unit is not patent. The mastoid air\ncells and middle ear cavities are clear.\n\nNOSE: Mild irregularity of the right nasal bone may indicate a fracture. \nNasopharyngeal soft tissues are unremarkable. There is no nasal septal\nhematoma.\n\nORBITS: The orbits, including the laminae papyracea, are intact. The globes\nare intact with non-displaced lenses and no intraocular hematoma. There is no\npreseptal soft tissue edema. There is no retrobulbar hematoma or fat\nstranding.", + "output": "1. Mildly displaced left mandibular fracture.\n2. Mild irregularity of the right nasal bone may indicate a fracture.\n3. Multiple dental caries. Periapical lucencies right mandibular third molar." + }, + { + "input": "Head CT: There is no evidence of acute hemorrhage, edema, masses, or mass\neffect. A small acute left basal ganglionic infarct is again noted.\nCalcifications are again noted within the globus pallidus, thalamus, pons and\ncentrum semiovale unchanged. The ventricles are again noted to be mildly\ndilated. There is periventricular low attenuation which is most likely\nsecondary to chronic small vessel ischemic change. No fractures are\nidentified. There is mild mucosal thickening within the ethmoid and left\nmaxillary sinus. There is opacification of the right sphenoid sinus. There is\na right mastoid effusion. Left mastoid air cells are clear. The orbits are\nunremarkable appear\n\nHead CTA: There is mild irregularity of the inferior division of the left\nmiddle cerebral artery consistent with early atherosclerotic disease.\nIntracranial vasculature is otherwise unremarkable. There are no lesions of\ntotal occlusion or aneurysms detected.\n\nNeck CTA: Imaging of the neck reveals no evidence of arterial stenosis or\nocclusion. There is no evidence of internal carotid artery stenosis by NASCET\ncriteria.\n\nA 2.0 mm nodule is noted in the left upper lobe. (Series 3, image 68).", + "output": "1. Small left basal ganglia infarct, unchanged.\n2. Mild irregularity of the inferior division of the left middle cerebral\nartery consistent with early atherosclerotic disease. Otherwise unremarkable\nCTA of the head and neck\n3. 2 mm pulmonary nodule noted in the left upper lobe of the lung. Per\n___ society guidelines, if the patient has no risk factors for\nmalignancy, no followup is required. If patient has risk factors, followup is\nrecommended in ___ year." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavitiesare grossly clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "Normal study" + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are prominent, suggestive of volume loss. \nThere are periventricular and subcortical hypodensities, which may represent\nsmall vessel ischemic changes. The imaged paranasal sinuses are clear. There\nis opacification of left mastoid air cells, with sclerosis of the adjacent\nbone, suggesting that findings may be chronic. There is slight partial\ncalcification of right mastoid air cells. The middle ear cavities are well\naerated. The bony calvarium is intact.", + "output": "No acute intracranial process.\n\nOpacification left mastoid air cells with sclerosis of the adjacent bone,\nsuggesting that findings may be chronic. Mild partial opacification of right\nmastoid air cells. Correlate with history of mastoiditis." + }, + { + "input": "Unenhanced head CT is not sensitive for the detection of intracranial\nmetastases. If ongoing clinical concern for intracranial metastasis exists,\nrecommend MRI head if not CI. Within these limitations, there is no evidence\nof intracranial mass effect, nor evidence of hemorrhage, major infarct, or\nshift of normally midline structures. There is a subtle focus of hypodensity\nin the left frontal lobe near the vertex, which may represent normal white\nmatter or vasogenic edema, as slightly more hypodense (series 3 image 28).\nAdjacent to this in the same image, there is a subtle hyperdense focus\nadjacent to the falx, of uncertain significance.\n\nThe basal cisterns are patent. The cerebellar tonsils are normally positioned.\nThere is no ventriculomegaly. There is no evidence of blastic or lytic bone\nlesion. The visualized paranasal sinuses and mastoid air cells are clear.", + "output": "1. Subtle hypodensity in the left frontal lobe near the vertex, with an\nadjacent small hyperdense focus along the falx; cannot exclude vasogenic edema\nor focal lesion. Unenhanced head CT is not sensitive for detection of\nintracranial metastases; if continued clinical concern exists, recommend MRI\nhead.\n2. No evidence of hemorrhage, major infarct, or mass-effect.\nPl. See subsequent MR reports" + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, edema, mass effect, or\nlarge territorial infarction. There is preservation of gray-white matter\ndifferentiation. The ventricles and sulci are normal. The basal cisterns\nappear patent. The small intracranial lesions previously seen on MRI study\nare better seen on MRI.\n\nThe visualized bony structures are grossly unremarkable without evidence of\nacute fracture. The paranasal sinuses are better characterized in the CT\norbit study from the same day, but appear grossly clear in this exam. The\nmastoid air cells and middle ear cavities are clear.", + "output": "No acute intracranial abnormality." + }, + { + "input": "The patient is status post C5 corpectomy with C4 through 6 anterior spinal\nfusion. Hardware position is unchanged from prior. Postoperative air in the\nsubcutaneous soft tissues has resolved. There is no drainable collection\nidentified within the soft tissues. There remains minimal fluid within the\nretropharyngeal space which has overall decreased from ___.\n\nThe parotid glands, submandibular glands, and thyroid are unremarkable. There\nis no cervical adenopathy.The aerodigestive tract appears normal. Included\nparanasal sinuses and mastoids are clear.\n\nIncluded intracranial structures appear normal.\n\nNo focal suspicious osseous lesion identified. Multilevel degenerative\nchanges are again noted.\n\nAgain seen, are metallic densities in the right cervical internal carotid\narteries. The patient is status post right A-comm aneurysm clipping.", + "output": "Status post C5 corpectomy and C4 through 6 anterior spinal fusion without\nevidence of postoperative fluid collection. No evidence of hardware\ncomplication." + }, + { + "input": "Right parietal craniotomy, posttreatment changes posterior right temporal,\noccipital lobe. Stable 5.1 cm x 3.7 cm subacute parenchymal hematoma\ninvolving posterior right temporal and occipital lobe, similar to prior. Mass\neffect on the atrium of the right lateral ventricle, with mildly prominent\nright temporal horn, similar to prior. Remainder of the ventricular system is\nnormal. No new hemorrhage. No evidence of acute infarct. No midline shift.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Stable subacute parenchymal hematoma, surrounding posttreatment changes. Mass\neffect on the atrium right lateral ventricle, mild prominence of the right\ntemporal horn, similar.\nNo new hemorrhage." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is polypoid right maxillary sinus\nmucosal thickening. There is left maxillary sinus and ethmoid air cell\nmucosal thickening. Sphenoid and frontal sinuses are clear. The mastoid air\ncells are clear. The globes and bony orbits are intact and unremarkable. \nThere is no evidence of fracture.", + "output": "No acute intracranial process." + }, + { + "input": "Exam is mildly degraded by motion, 2 acquisitions were done.\n\nThere is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mild mucosal thickening in the\nright maxillary sinus and ethmoid air cells. The visualized portion of the\nremainder of paranasal sinuses, mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "No acute findings." + }, + { + "input": "There is no hemorrhage, edema, or mass effect. Ventricles and sulci are\nnormal in size and configuration. Gray-white matter differentiation is\npreserved. There is no shift of normally midline structures. Basal cisterns\nare patent.\n\nImaged paranasal sinuses, bilateral mastoid air cells, and middle ear cavities\nare clear. The orbits are unremarkable. Bony calvarium is intact.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration. No parenchymal\ncalcifications.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Normal study." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass effect.\nThe ventricles and sulci are mildly enlarged, well within the range expected\nfor age\n\nDense calcifications are seen in bilateral V4 segments of the vertebral\narteries in the cavernous portions of the internal carotid arteries. Several\ntiny calcifications are present superficially, likely in the subarachnoid\nspace, in the right occipital lobe. These are probably vascular.\n\nThe right ophthalmic artery can not be evaluated without contrast. The lenses\nhave been resected. Otherwise, the orbits appear normal.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits demonstrate\nbilateral lens replacement.", + "output": "No evidence of mass, hemorrhage or infarction.\nNoncontrast CT can not evaluate the ophthalmic arteries.\n\nNOTIFICATION: The limitations of a noncontrast head CT were discussed with\n___, N.P. by ___, M.D. on the telephone on ___ at\n4:20 am and CT head without contrast was performed to rule out acute\nintracranial abnormalities." + }, + { + "input": "Extensive parenchymal hemorrhage is noted in the right frontal, temporal,\nparietal, and occipital lobes with dominant component of the bleed measuring\napproximately 8.6 cm AP by 4.4 cm TRV by approximately 5.6 cm cc with\nassociated surrounding vasogenic edema. Additional components of subarachnoid\nhemorrhage in the parieto-occipital region. Subdural hematoma overlying the\nfrontal lobe measures up to 8 mm in thickness with small thin component along\nthe right aspect of the tentorium as well.\n\nThere is resultant complete effacement of the right-sided sulci and the right\nlateral ventricle with approximately 19 mm of midline shift to the left. In\naddition, the basilar cisterns are effaced, with evidence of right-sided uncal\nherniation, resulting in mass effect upon the brainstem.\n\nNo osseous abnormalities seen. An endotracheal tube is partially visualized. \nThe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\nThe orbits are unremarkable.", + "output": "Extensive right frontal, parietal, temporal, and occipital parenchymal\nhemorrhage with significant mass-effect including 19 mm of leftward midline\nshift and right uncal herniation. Additional components of left-sided\nsubarachnoid and subdural hemorrhage.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\non the ___ ___ at 10:45am, 1 minute after discovery of the\nfindings." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are prominent compatible with global volume\nloss. Atherosclerotic calcifications noted within the intracranial ICAs.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No focal abnormality or acute intracranial process.Global volume loss." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,or\ndiscrete mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and subcortical white matter\nhypodensities are nonspecific but likely reflect sequelae of chronic small\nvessel ischemic disease. Dense atherosclerotic vascular calcifications of the\nbilateral cavernous internal carotid arteries is noted.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable with the exception of bilateral lens\nreplacements.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. Ventricles and sulci are normal in overall size and configuration.\nThere is moderate mucosal thickening within the right maxillary sinus. The\nremaining imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. There is mild subcortical white matter hypodensity, likely the\nsequelae of chronic microvascular ischemic disease. Basal cisterns are\npatent. Ventricles are normal in size. Mucosal thickening is noted within\nthe ethmoid and maxillary sinuses, mild. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "No acute intracranial process. Mild small vessel disease." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThe examination is mildly motion degraded. Within this confines: No evidence\nof acute large territory infarct or intracranial hemorrhage. There is\nsuggestion o asymmetric hyperdensity in the expected location of a left M2\ndivision, suggesting thrombus. The sulci, ventricles and cisterns are within\nexpected limits for the patient's age.\n\nThere is mild mucosal thickening of the ethmoid air cells with small mucous\nretention cysts in the right maxillary sinus. Small mucous retention cyst in\nthe right sphenoid sinus is also noted. The orbits are unremarkable. The\nmastoid air cells and middle ears are well pneumatized and clear.\n\nCTA HEAD:\nMinimal atherosclerotic calcification of the internal carotid arteries is\nidentified. There is abrupt termination of the distal left M2 superior\ndivision branch (series 4, image 279; series 557, image 4). In addition,\nthere is overall paucity of vessels in the left inferior division, suggesting\nan additional site of occlusion, not definitively visualized. The right MCA,\nbilateral ACA and their major branches are unremarkable. There is fetal type\norigin of the left posterior cerebral artery. An apparent linear filling\ndefect in the mid right vertebral artery (series 4, image 218) is felt to\nlikely be artifactual otherwise, the remainder of the posterior circulation is\nunremarkable. No evidence of aneurysm. The dural venous sinuses are patent.\n\nCTA NECK:\nThe right left common carotid artery arises from the right brachiocephalic, a\nnormal anatomic variant. The bilateral common carotid arteries are\nunremarkable. The subclavian arteries are unremarkable. The right vertebral\nartery is dominant otherwise, the vertebral arteries are unremarkable. There\nis no stenosis of the cervical internal carotid arteries by NASCET criteria. \nVery minimal atherosclerotic disease is noted at the carotid bifurcations.\n\nCT PERFUSION: Automated CT profusion software demonstrates large region of\nelevated T-max, predominantly involving the left posterior frontal and\nparietal lobes with total volume of 145 mL. No evidence of CBF less than 30%.\nGiven lack of CT findings of acute infarct, this would suggest a large\npenumbra.\n\nOTHER: The visualized lungs are clear allowing for respiratory motion\nartifact. No acute osseous abnormality. Multiple periapical lucencies with\ndehiscence of the buccal alveolar ridge and dental caries, predominantly\ninvolving ___ teeth number 2 through 4 is noted. The thyroid is unremarkable.\nThere is no cervical lymphadenopathy by size criteria. The visualized\naerodigestive tract is unremarkable. The major salivary glands are within\nexpected limits.", + "output": "1. Findings compatible with occlusion of the left distal M2 superior division.\nThere is also overall paucity of enhancement in the inferior division\nterritory, although site of occlusions not definitively visualized.\n2. No evidence of acute large territory infarct or intracranial hemorrhage on\nnoncontrast head CT.\n3. Allowing for left MCA findings, the remainder of the CTA head is\nunremarkable without aneurysm or other sites of large vessel occlusion. \nUnremarkable CTA neck.\n4. CT perfusion suggest large ischemic penumbra involving the left posterior\nfrontal and parietal lobes with total volume of 145ml.\n5. Additional findings as described above including scattered dental caries\nand periapical lucencies. Dental exam when feasible is recommended." + }, + { + "input": "The patient is status post conventional cerebral angiogram and thrombectomy.\n\nThere is suggestion of subtle loss of gray-white differentiation of the left\ninferior parietal lobule, corresponding to region of increased mean transit\ntime on prior CT perfusion. No other regions of acute large territory infarct\nis identified. No evidence of hemorrhagic transformation. There is increased\ndensity of a proximal left superior M 2 division (series 2, image 21), felt\nlikely to represent residual thrombus. The sulci, ventricles and cisterns are\notherwise within expected limits for the patient's age. No acute osseous\nabnormality. Mild mucosal thickening of the right maxillary sinus is noted. \nThe orbits are unremarkable. The mastoid air cells middle ears are well\npneumatized and clear.", + "output": "1. Suggestion of subtle loss of gray-white differentiation of the left\ninferior parietal lobule corresponding to region of increased mean transit\ntime on prior CT perfusion.\n2. No evidence of hemorrhagic transformation.\n3. Hyperdensity of the left MCA bifurcation of a superior M2 division is\ncompatible with residual thrombus.\n4. Additional findings as described above." + }, + { + "input": "There is a large geographic hypodense area within the left cerebral hemisphere\nconsistent with the known left MCA infarct. There is associated sulcal\neffacement and effacement of the left lateral ventricle. There is 4 mm of\nrightward midline shift. Mild uncal herniation is however noted with\nmass-effect on the left side of the suprasellar cistern. There is no evidence\nof hemorrhagic transformation..\n\nNo osseous abnormalities seen. Several right maxillary periapical lucencies\nare noted and consistent with periodontal disease. There is mild mucosal\nthickening in the right maxillary sinus. Otherwise the remain paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "Evolving large left MCA territory infarct without hemorrhagic transformation. \nThere is increased mass effect as described above including new mild uncal\nherniation.\n\nNOTIFICATION: The findings were discussed with the ___ care NP by\n___, M.D. on the telephone on ___ at 10:22 pm, 2 minutes\nafter discovery of the findings." + }, + { + "input": "Large subacute left MCA distribution infarct is stable compared with ___. Additional small infarcts seen in the left caudate head, and\nleft ACA distribution, stable.\n\nRightward midline shift by 11 mm is increased from 4 mm on ___. Mild\ncrowding at foramen magnum. Left uncal herniation is worsened, partial\neffacement of the superior cerebellar cistern is worsened, effacement of the\nperimesencephalic cisterns and mass effect on the upper midbrain is worsened. \nCompletely effaced suprasellar cistern, completely effaced prepontine cistern,\nworsened.\nIation. There is no evidence of hemorrhage. Worsened dilatation of the right\nlateral ventricle, consistent with developing hydrocephalus and right\nventricular trapping.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. Small amount\nof fluid is noted in the right maxillary sinus.", + "output": "Stable distribution of extensive left MCA distribution infarct. Smaller\nstable infarcts left caudate nucleus, left ACA distribution.\nIncreased rightward midline shift, completely efface suprasellar, pre pontine\ncisterns, worsened uncal herniation, mild right lateral ventricular trapping,\nand mild crowding of the cerebellar tonsils at foramen magnum.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:30 am, 2 minutes after discovery\nof the findings." + }, + { + "input": "Compared with ___, patient has undergone interval left craniectomy\nfor decompression with a small amount of expected pneumocephalus, and a\nleft-sided surgical drain in place. Again seen is a large infarct in the left\nMCA distribution, now with herniation through the craniectomy defect. There is\na new small focus of hyperdense hemorrhage along the inferior aspect of the\ninfarct territory measuring up to 17 mm (601:71). There is improved mass\neffect, with decreased effacement of the left lateral ventricle, and rightward\nmidline shift currently measuring up to 4 mm, compared with 11 mm previously. \nEffacement of the basal cisterns is improved. Entrapment of the right lateral\nventricle is improved. Additional small infarcts in the distribution of the\nleft ACA and in the left caudate head are unchanged.\n\nSurgical staples overlie the left craniectomy site. There is no evidence of\nfracture. There is mucosal thickening in the right maxillary sinus, bilateral\nsphenoid sinuses, and ethmoid air cells. The visualized portion of the\nremainder of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable. An\nendotracheal tube is partially visualized.", + "output": "1. Status post interval left craniectomy for decompression, with interval\nimprovement in mass effect, with decreased effacement of the left lateral\nventricle and basal cisterns, and rightward midline shift currently measuring\nup to 4 mm, compared with 11 mm previously.\n2. New small focus of acute hemorrhage along the inferior aspect of the\ninfarct territory measures up to 17 mm.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with ___\n___ on the telephone on ___ at 4:40 am, 1 minutes after discovery\nof the findings." + }, + { + "input": "Patient is status post left frontoparietal decompression craniectomy. \nHerniation of left parietal and temporal lobes through the craniectomy defect\nappears similar to 2 days ago. Small amount of subdural hematoma is noted at\nthe surgical bed. Large area of hypodensity associated with vasogenic edema\nin the left parietal temporal lobe is consistent with history of recent left\nMCA infarct. Ventricles and sulci appear similar in configuration as before,\nincluding effacement of left lateral ventricle. Small areas of hyperdensity\nwithin the area of infarct (02:18, 17) correspond to areas of hemorrhagic\ntransformation, better seen on prior MRI. Mild rightward midline shift by 3\nmm is similar to before.\nMucosal thickening is noted in the right maxillary, bilateral ethmoid, and\nsphenoid sinuses. The visualized portion of the orbits are unremarkable.", + "output": "1. Patient is status post left frontoparietal decompression craniectomy for\nlarge territory left MCA infarct. Mass effect and small subdural hematoma at\nthe surgical bed appear similar to before. Small areas hemorrhagic\ntransformation were better evaluated on prior MRI and appear grossly similar." + }, + { + "input": "Again noted is left frontoparietal decompression craniectomy with herniation\nof the left parietal and temporal lobes through the defect. The subdural\ncollection is increased since the prior study measuring up to 2.2 cm in\ngreatest axial thickness. Extensive vasogenic edema predominantly in the left\nparietal and temporal lobes compatible with history of recent left MCA infarct\ndecreased since the prior study from ___. Small areas of\nhemorrhagic transformation within the evolving infarct are less well\nvisualized, likely reflecting evolving blood products. There is no\nsignificant midline shift. Mild effacement of the left lateral ventricle is\nimproved. Mild right maxillary sinus mucosal thickening is noted. The\nremaining imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated.", + "output": "1. No evidence of acute hemorrhage.\n2. Extensive vasogenic edema in the evolving left MCA infarct is decreased\nsince the prior study.\n3. Post craniectomy changes as detailed above." + }, + { + "input": "The patient is status post frontoparietal decompression craniectomy. Again\nseen is evolution of left middle cerebral artery infarction (2: 18). There is\nno new hemorrhage or midline shift. There is no interval change in the \nextra-axial collection that extends into the craniectomy site. Slight\ninterval increase in compression of the anterior horn of the lateral\nventricles.\n\nThe left mastoid air cells are partially opacified. Otherwise the right\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. Patient is status post frontoparietal decompression craniectomy.\n2. Large evolving subacute infarct extending along the left parietal and\ntemporal lobes with decreasing vasogenic edema.\n3. Slight interval increase of compression on the anterior horn of the\nlateral ventricles.\n4. There is no new hemorrhage or midline shift." + }, + { + "input": "The patient is status post left frontal parietal craniectomy, with unchanged\nherniation of the left cerebral hemisphere through the craniectomy defect. \nEvolving sequela of left middle cerebral artery subacute infarct is identified\nwithout evidence of interval new hemorrhage. Mild gyriform hyperdensity\nwithin the infarct is compatible with petechial hemorrhage, unchanged. No\nevidence of new acute large territorial infarct. Minimal 2 mm rightward\nmidline shift is unchanged. There remains mild mass effect on the right\nlateral ventricle. The visualized paranasal sinuses are essentially clear. \nThe orbits are unremarkable fluid in the left mastoid air cells is overall\nsimilar to prior exam. The right mastoid air cells are clear.", + "output": "1. Unchanged appearance of frontoparietal decompressive craniectomy.\n2. Evolving sequela of left MCA subacute infarct, also unchanged from prior\nexam. Unchanged appearance of the lateral ventricles from prior exam.\n3. No interval change from prior exam." + }, + { + "input": "The patient is status left frontal parietal craniectomy with no interval\nchange of left cerebral herniation through craniectomy site, (302:29). \nRe-demonstrated, is a large evolving left parietal hypodensity due to recent\nleft MCA infarct, (302: 24). There is no new hemorrhage. There is no new\ninfarct. Interval decrease of subgaleal fluid collection at the left,\n(302:34).\n\nRe-demonstrated, partial opacification of the left mastoid air cells,\n(302:14). Otherwise, the maxillary, frontal, sphenoid and ethmoid sinuses are\nwell aerated. The right mastoid air cells and middle ear canals are clear.", + "output": "1. Again seen is a large evolving left parietal subacute infarct.\n2. No interval change in leftward midline shift.\n3. No interval change of left cerebral herniation through the craniectomy\nsite.\n4. Interval decrease of subgaleal fluid collection." + }, + { + "input": "Postsurgical changes are again seen following left frontoparietal craniectomy.\nThere is persistent cerebral herniation through the craniectomy site. There\nis redemonstration of an evolving left frontoparietal infarct. As previously\nmentioned, mild gyriform hyperintensity within the known infarct likely\nrepresents petechial hemorrhage. No new intracranial hemorrhage or large acute\ninfarct. There is no midline shift.\n\nThere is interval placement of a right frontal approach ventriculostomy\ncatheter which terminates near the left foramen of ___. Small amount\npneumocephalus is seen in the right frontal convexity (02:19). The ventricles\nand sulci are stable compared to the same-day prior study. There is interval\nincrease in a subgaleal collection measuring up to 1.5 cm in maximal thickness\n(02:17) since the earlier same day study.\n\nThere is no new osseous abnormality. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Interval increase in a left-sided subgaleal collection measuring up to 1.5\ncm in maximal thickness as compared to the earlier same-day study.\n2. Interval placement of a right frontal approach ventriculostomy catheter\nwhich terminates near the left foramen of ___.\n3. Again seen is an evolving left frontoparietal infarct. No new large acute\ninfarct or intracranial hemorrhage.\n4. Stable postsurgical changes following left frontoparietal craniectomy." + }, + { + "input": "Status post left craniectomy with unchanged extent of parenchymal herniation\nis present through the craniectomy site. Extra-axial fluid collection in the\ncraniectomy site has substantially decreased, with new small foci of air\nwithin this collection. Subacute left MCA territory infarct is again seen. \nNo acute hemorrhage. No evidence for new parenchymal edema.\n\nA right frontal approach ventriculostomy catheter terminates near the left\nforamen ___ in unchanged position. Mild hypodensity along the right\nfrontal path of the catheter has increased compared to ___. Frontal\nhorns and bodies of the lateral ventricles have slightly decreased in size. \nAsymmetric enlargement of the atrium and temporal horn of the left lateral\nventricle persist. The third ventricle has slightly decreased in size. The\nfourth ventricle is stable. Basal cisterns are stable in size.\n\nThe left mastoid is underpneumatized and partially opacified, similar to\nprior. Small mucous retention cyst in the right posterior ethmoid. Mild\nmucosal thickening and mild aerosolized secretions in the partially visualized\nright maxillary sinus.", + "output": "1. The right frontal approach ventriculostomy catheter terminate near the left\nforamina of ___, unchanged. Slightly decreased horns of the frontal horns\nand bodies of the lateral ventricles, and of the third ventricle, compared to\n___.\n2. Subacute left MCA infarct is again demonstrated.\n3. Status post left craniectomy with stable herniation of the brain parenchyma\nthrough the defect. Decreased in the size of the left extra-axial collection.\nUnchanged herniation of the brain parenchyma through the defect." + }, + { + "input": "Brain ectomy is identified in the left cerebral hemisphere. A large\nhypodensity seen in the region of left parietal lobe. The overall protrusion\nof brain parenchyma through the craniectomy site has slightly decreased. A\nventricular drain is seen neck tearing from the right frontal region with the\ntip in the left anterior horn. No acute hemorrhage is identified.", + "output": "Left-sided craniectomy is identified with hypodensity in the left parietal\nlobe with decreasing mass effect compared to the previous CT of ___. No acute hemorrhage. Unchanged ventricular size. No hydrocephalus." + }, + { + "input": "The patient is status post decompressive left hemicraniectomy. Extensive\ncystic encephalomalacia in the distribution of the distal left MCA demonstrate\nin keeping with normal expected evolution of the infarct. There is still\nherniation through the left hemi craniectomy defect. Ex vacuo dilatation of\nthe atrium, occipital and temporal horns of the left lateral ventricle. Right\nfrontal approach EVD in situ with its tip terminating in the frontal horn of\nthe left lateral ventricle. Minimal hypodense changes surrounding the EVD. \nThere is no new intracranial hemorrhage or acute large territorial infarct. \nThe midline structures are central.\n\nThe paranasal sinuses and mastoid air cells are clear. The orbits appear\nnormal.", + "output": "The patient is status post decompressive left hemicraniectomy.\n\nCystic encephalomalacia in the distal distribution of the left MCA\ndemonstrates expected evolution. Persistent herniation through the\ncraniectomy defect.\n\nPosition of the right EVD drain with its tip in the left lateral ventricle\nfrontal horn is unchanged.\n\nNo evidence of new hemorrhage or recent infarction." + }, + { + "input": "Patient is status post left hemi-craniectomy for decompression, now status\npost cranioplasty. Hematoma, soft tissue swelling and subcutaneous air are\nnoted overlying the surgical site, representing expected postoperative\nchanges.\n\nThere is hypodense fluid at the surgical site measuring up to 8 mm from the\ninner table with mild pneumocephalus, consistent with expected postoperative\nchanges.\n\nInfarct and encephalomalacia is re-demonstrated in the distribution of the\ndistal left MCA, overall similar in size to prior.\n\nStable right frontal EVD terminates within the frontal horn of the left\nlateral ventricle, with grossly stable ventricular size. No evidence of new\ninfarct or hemorrhage. No midline shift is demonstrated.\n\nThe visualized portion of the mastoid air cells, and middle ear cavities are\nclear. The visualized portion of the orbits are preserved. Right maxillary\nsinus aerosolized mucosal thickening is present. Minimal bilateral ethmoid\nair cell mucosal thickening is seen.", + "output": "1. Status post cranioplasty with expected postoperative changes.\n2. No midline shift, no acute large territorial infarct or intracranial\nhemorrhage.\n3. Stable right frontal ventriculostomy catheter terminating in the frontal\nhorn of the left lateral ventricle, with no definite evidence\nventriculomegaly.\n4. Grossly stable left MCA distribution chronic infarct." + }, + { + "input": "The patient is status post left hemi craniectomy for decompression, now status\npost cranioplasty and duraplasty. The overlying left extracranial fluid\ncollection measures 15 mm in diameter, appears slightly decreased in size\ncompared to prior (20 mm) with a better defined rim/capsule. There is\nassociated increased air locules in the superior aspect of the collection and\nsecondary infection should be excluded. There appears to be a left\npre-auricular fistulous tract draining from the collection to the skin. \nSurrounding subcentimeter lymph nodes.\nThe left subdural collection measures 10 mm diameter and also appear similar\ncompared to prior with a couple of air locules which appear similar to\nslightly decreased compared to prior. The subdural collection present\ncommunicated the extracranial collection. Cystic encephalomalacia is again\nnoted in the left temporoparietal area in keeping with prior left MCA infarct.\nEx vacuo dilatation of the adjacent trigone of the left lateral ventricle with\nno clear ependyma lining/brain seen between the ventricle and the cystic\nencephalomalacia making continuation between the ventricular system and the\ncystic encephalomalacia possible (porencephalic cyst). Right frontal approach\nEVD in situ with the tip in the frontal horn of the left lateral ventricle is\nunchanged. No new intracranial hemorrhage, mass or large acute territorial\ninfarct.\n\nMild mucosal thickening involving the right maxillary sinus is again noted. \nNo acute fractures.", + "output": "1. The patient is status post left hemicraniectomy for decompression, now\nstatus post duraplasty and cranioplasty.\n\n2. The overlying left extracranial fluid collection is slightly decreased in\nsize, with a better defined rim/capsule, however there is associated mild\nincrease in air locules in the superior aspect of the collection and secondary\ninfection should be excluded. There appears to be a left pre-auricular\nfistulous tract from the collection draining to the skin.\n\n3. The left subdural collection is essentially unchanged compared to prior. \nAssociated air locules appear similar to slightly decreased compared to prior.\n\n4. No new intracranial pathology/insult. External ventricular drain and\nventricular profile unchanged." + }, + { + "input": "The parotid glands, submandibular glands, and thyroid are unremarkable. There\nis no cervical adenopathy.\n\nThe aerodigestive tract appears normal.\n\nIncluded paranasal sinuses and mastoids are essentially clear. Multiple\ndental caries are noted.\n\nVascular structures in the neck are grossly unremarkable. Atherosclerotic\ncalcifications are noted at the aortic arch.\n\nIncluded intracranial structures appear normal.\n\nNo focal suspicious osseous lesion identified. Degenerative changes are\nnoted.\n\nLung apices are clear.", + "output": "No focal abnormality of the aerodigestive tract, no evidence of abscess\nformation." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThere are small mucous retention cyst in the inferior aspects of the maxillary\nsinuses as well as minimal mucosal thickening in the left sphenoid air cell. \nThe remainder of the visualized portion of the paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The visualized portion of the orbits\nare unremarkable.\n\nCTA HEAD:\nThere is minimal posterior conical posterior projection at the expected origin\nof the left posterior communicating artery, likely infundibulum. The vessels\nof the circle of ___ and their principal intracranial branches otherwise\nappear patent without stenosis, occlusion, or discrete aneurysm formation. \nThe dural venous sinuses are patent.\n\nCTA NECK:\nThere is mild atherosclerotic calcification in the thoracic aortic arch. \nThere is mild atherosclerotic calcification at the origin of the right\nsubclavian artery. There is punctate atherosclerotic calcification in the\nproximal right internal carotid artery. The carotid and vertebral arteries\nand their major branches appear normal with no evidence of stenosis or\nocclusion or dissection. There is no evidence of internal carotid stenosis by\nNASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.", + "output": "1. No acute intracranial abnormality.\n2. Patent intracranial vasculature without significant stenosis, occlusion, or\ndiscrete aneurysm formation.\n3. Patent cervical vasculature without significant stenosis, occlusion or\ndissection." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are normal in size and configuration. No osseous\nabnormalities seen. There is a mild amount of fluid in the left sphenoid. \nThe remaining paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormalities." + }, + { + "input": "Enlargement of the lateral ventricles has slightly increased compared to ___. Sylvian fissures and cerebral sulci remain enlarged without\nsignificant change. The degree of ventricular enlargement is not significantly\ndisproportionate from the degree of sulcal enlargement. Again seen are\nextensive areas of low density in the subcortical, deep, and periventricular\nwhite matter of the cerebral hemispheres. The hypodensity appears to be more\nextensive in the inferior right frontal lobe on image 2:7 compared to ___, but there is no mass effect. There is no acute hemorrhage and no\nevidence for parenchymal edema. Basal cisterns appear age-appropriate.\n\nPreviously noted lobulated soft tissue lesion in the right parietal scalp at\nthe vertex, with low-density but denser than on the prior CT and denser than\nexpected for simple fluid, is not significantly changed in size, allowing for\nits complex geometry. No focal osseous abnormality is seen. Some of the left\nanterior ethmoid air cells are opacified, and there is mild mucosal thickening\nin the inferior left frontal sinus and in the anterior right ethmoid air\ncells. Mastoid air cells are well aerated.", + "output": "1. Enlargement of the lateral ventricles has slightly increased compared to ___, but is not significantly disproportionate compared to the degree\nof sulcal enlargement. This suggests progression of cerebral atrophy with\nslight central predominance.\n2. Extensive areas of low density are again seen in the supratentorial white\nmatter with apparent slight progression in the inferior right frontal lobe.\nThese are nonspecific, though most likely related to sequela of chronic small\nvessel ischemic disease in a patient of this age.\n3. Large lobulated lesion in the right parietal scalp at the vertex\ndemonstrates slightly increased density compared to ___, without a\nclear change in size. Please correlate with physical exam." + }, + { + "input": "There is a hyperdense approximately 2.6 x 3.4 x 1.5 cm (AP, TRV, SI ; series\n302 B, image 47 and series 3, image 14) rounded lesion likely extra-axial\noverlying the cribriform plate and planum sphenoidale, likely representing an\nolfactory groove meningioma. This did appears to exert mass effect on the\nrectus gyri and orbital frontal lobes, with associated bilateral frontal lobe\nedema pattern, slightly more prominent when compared to examination of ___.\n\nSuperimposed periventricular and subcortical white matter hypodensities are\nunchanged, nonspecific, but likely representing sequela chronic\nmicroangiopathy in a patient of this age.\n\nThere is no acute intracranial hemorrhage or territorial infarct. A 2 mm\nthick right parietal occipital skull subgaleal hematoma is not associated\nwith underlying skull fracture. Previously described lobulated right parietal\nskull soft tissue lesion at the vertex is similar in appearance to prior\nexamination. Clinical correlation is recommend. Polypoid mucosal thickening\nof the left maxillary sinus with extension of soft tissue through the\ninfundibulum into the right middle meatus is noted. There is opacification of\nthe left anterior ethmoid air cells. The mastoid air cells appear clear.", + "output": "1. No evidence for acute intracranial hemorrhage or territorial infarct on\nnoncontrast head CT.\n2. There is a hyperdense approximately 2.6 cm rounded likely extra-axial\nlesion overlying the cribriform plate, exerting mass effect on the bilateral\nrectus gyri and orbital frontal lobes. There is interval increased white\nmatter edema pattern of the orbital frontal lobes. The finding likely\nrepresents olfactory groove meningioma. Further evaluation with MRI is\nrecommended.\n3. Small right parietal occipital skull scalp hematoma without underlying\nskull fracture.\n4. Re-identified is a lobulated right parietal skull soft tissue lesion at the\nvertex similar appearance to prior exam. If not already performed, physical\nexamination and clinical correlation is recommended.\n5. Polypoid left maxillary sinus disease as described above improved from\nexamination of ___." + }, + { + "input": "There is no evidence of infarction or hemorrhage. There is redemonstration of\na hypodense extra-axial mass in the floor of the anterior cranial fossa with\nmild associated vasogenic edema measuring 3.7 x 3.2 cm, previously measuring\n3.7 x 3.2 cm on prior study dated ___. There are bilateral\nperiventricular and subcortical white matter hypodensities, nonspecific but\ncompatible with sequelae of chronic small vessel ischemic disease. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nleft ethmoid air cells. Otherwise, the visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Stable olfactory groove meningioma, unchanged in size from prior study\ndated ___." + }, + { + "input": "There is no evidence of fracture, acute large territory\ninfarction,hemorrhage,edema. Redemonstration of a hypodense extra-axial mass\nalong the floor of the anterior cranial fossa with adjacent mild vasogenic\nedema measuring 3.6 x 3.2 cm, previously 3.7 x 3.2 cm stable since ___. The aforementioned findings are consistent with a stable all factory\ngroove meningioma. There is prominence of the ventricles and sulci suggestive\nof involutional changes.Moderate to severe hypoattenuation of the\nperiventricular and subcortical white matter is nonspecific but may represent\nsequela of microvascular ischemic changes. Mild to moderate calcification of\nthe bilateral carotid siphons\n\nModerate mucosal thickening of the bilateral ethmoid air cells and mild\nmucosal thickening of the bilateral maxillary sinuses. The visualized portion\nof the other paranasal sinuses, mastoid air cells, and middle ear cavities\nwell pneumatized. Along the right posterior parietal scalp is a intermediate\ndensity soft tissue lesion which measures 2.0 x 1.0 cm in the sagittal\ndimension, unchanged since ___. Differential considerations\ninclude sebaceous cyst versus granuloma.", + "output": "1. No acute intracranial process.\n2. Stable appearance of olfactory groove meningioma since MRI head dated\n___.\n3. Stable appearance of a intermediate density soft tissue lesion along the\nright posterior parietal scalp since ___. Differential\nconsiderations include sebaceous cyst versus granuloma." + }, + { + "input": "There is no evidence of fracture, acute large territory infarction, or\nintracranial hemorrhage. Redemonstration of a 3.7 x 3.3 cm extra-axial mass\ncentered along the floor of the anterior cranial fossa with several foci of\ninternal calcification (3:25), consistent with known olfactory groove\nmeningioma. Again, there is mild adjacent vasogenic edema. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nPeriventricular and subcortical white matter hypodensities are nonspecific but\nlikely sequelae of chronic small vessel ischemic disease.\n\nMild mucosal thickening is noted involving the ethmoid air cells. The\nremainder of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are normal. Redemonstration\nof a 1.4 cm ovoid intermediate density structure within the right posterior\nparietal scalp (3:33), likely a sebaceous cyst.", + "output": "1. No evidence of acute large territory infarction or intracranial hemorrhage.\n2. Stable appearance of a 3.7 cm olfactory groove meningioma along the floor\nof the anterior cranial fossa." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage or extra-axial fluid\ncollection. No definite evidence of acute large territorial infarct. \nRedemonstrated 3.7 x 3.3 8 0 mass lesion centered along the floor of the\nanterior cranial fossa with the foci of calcification, consistent with known\nolfactory groove hemangioma.\n\nThere are bilateral periventricular and subcortical white matter\nhypodensities, nonspecific likely sequela of chronic small vessel ischemic\ndisease.\n\nThe visualized portions of the orbits are unremarkable.\n\nModerate mucosal thickening of the bilateral left greater than right ethmoid\nair cells. The remainder of the paranasal air cells, mastoid air cells and\nmiddle ear cavities are clear. Redemonstration of right posterior scalp\nintermediate density lesion lesion, consistent with known sebaceous cyst\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No evidence of acute intracranial hemorrhage or large territorial\ninfarction.\n2. Stable appearance of olfactory groove meningioma." + }, + { + "input": "Study is mildly degraded by motion.\n\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of no evidence of infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration.\n\nThere are scattered hypodensities in the subcortical and periventricular white\nmatter, nonspecific, likely secondary to small vessel ischemic disease.\n\nThe orbits appear unremarkable. There is an air-fluid level in the right\nmaxillary sinus, complete opacification of bilateral anterior ethmoid air\ncells with partial opacification of right frontal sinus and mucosal thickening\nin bilateral maxillary sinuses. Bilateral mastoid air cells are clear.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nImaging of the lungs is limited secondary to breathing motion artifact. There\nis suggestion of mild emphysematous changes. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria.\n\nThere is an heterogeneous enhancing mass in the nasopharynx with central areas\nof necrosis as seen on series 7 images 221-229 extending into the right nasal\ncavity with a erosion of the right inferior turbinate. The mass extends\nlaterally into the right parapharyngeal space on image 7:213. The mass abuts\nthe medial aspect of the right internal carotid artery on image 7:219 without\ndefinite invasion.", + "output": "1. Study is mildly degraded by motion.\n2. Normal head and neck CTA.\n3. No acute intracranial abnormality .\n4. Heterogeneously enhancing nasopharyngeal mass extending into right\nparapharyngeal space abutting the right internal carotid artery without\ndefinite encasement. The mass extends anteriorly into the right nasal cavity\neroding the inferior turbinate. Associated paranasal sinus disease as\ndescribed above. This is most likely in keeping with nasopharyngeal\ncarcinoma. Consider contrast nasopharynx MRI for further evaluation." + }, + { + "input": "A catheter with fluid-filled balloons are noted entering the right nostril and\nterminating at the posterior wall of the nasopharynx. The known soft tissue\nlesion in the posterior nasopharynx previously seen on MRI is not well\nvisualized in this exam. An embolization coil in the right maxillary artery\nis again seen. There is mucosal thickening of bilateral maxillary sinus with\naerosolized air-fluid levels. There is near complete opacification of\nbilateral ethmoid air cells and sphenoid sinuses. Frontal sinus is partially\nopacified. Middle ear cavities are clear. Right mastoid air cells are\npartially opacified. The cribriform plates are intact. Nasal septum is\ndeviated to the left. The lamina papyracea are intact.", + "output": "1. Sinus disease as described above.\n\n2. Known soft tissue lesion in the posterior nasopharynx previously seen on\nMRI is not well visualized in this exam." + }, + { + "input": "There is no evidence of acute large territorial infarction, hemorrhage, edema,\nor mass effect. The ventricles and sulci are normal in size and\nconfiguration.\n\nThere is no evidence of fracture. There is mild mucosal thickening in the\nright maxillary sinus. The remaining visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nintracranial hemorrhage.\n2. No acute calvarial fracture." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,\nor discrete mass. The ventricles and sulci are age-appropriate.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, and middle ear cavities are clear. There is partial opacification of\nthe left mastoid air cell tip. The right mastoid air cells are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of fracture, large territorial\ninfarction,hemorrhage,edema,or mass effect. There is prominence of the\nventricles and sulci suggestive of involutional changes. Mild periventricular\nand subcortical white matter hypodensities are nonspecific, but likely\nrepresent sequela of chronic ischemic microvascular disease. There are mild\natherosclerotic calcifications in the bilateral intracranial internal carotid\narteries. Incidental note is made of a partial empty sella. Hyperostosis\nfrontalis interna is also noted.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal aside\nfrom bilateral lens replacement.", + "output": "1. No acute intracranial abnormality on noncontrast CT head. Specifically, no\nintracranial hemorrhage.\n2. No acute displaced calvarial fracture." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are normal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Normal study." + }, + { + "input": "Previously seen small right-sided subdural hematoma has evolved and decreased\nin size. Subtle isodense subdural is remaining in the right convexity. No\nacute hemorrhage is identified. Brain atrophy and small vessel disease are\nagain seen. Calcific density in the left centrum semiovale likely due to\nprior infection is unchanged.", + "output": "Evolution and decrease in size of previously seen subdural hematoma with\nsubtle subdural collection remaining. No acute abnormalities." + }, + { + "input": "There is no evidence of acute large territory infarction, hemorrhage, edema,\nor mass effect. The ventricles and sulci are normal in size and\nconfiguration.\n\nNo fractures. There is mucosal thickening in the anterior ethmoidal air cells\nas well as the left maxillary sinus. A right molar tooth is unerupted in the\nright maxillary sinus. Otherwise, the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The orbits are unremarkable.", + "output": "1. No acute intracranial abnormality noncontrast head CT. Specifically no\nlarge territory infarct or intracranial hemorrhage.\n2. No acute displaced calvarial fracture." + }, + { + "input": "An intra-axial mass is noted within the left posterior temporal lobe measuring\n3.2 x 3.4 x 2.9 cm. There is surrounding vasogenic edema which result in\neffacement of the regional sulci. There is no midline shift or downward\nherniation. No intralesional, intra-axial or extra-axial hemorrhage.\nVentricles are normal in size. The basal cisterns are patent. Right\npreseptal and periorbital soft tissue swelling is noted with trace amounts of\nsoft tissue gas suggesting a laceration. There is a depressed fracture\ninvolving the right lamina papyracea with hemosinus involving the right\nethmoidal air cells and small amount of extraconal hematoma along the medial\naspect of the right orbit. Mild thickening of the right medial rectus muscle\nlikely reflects adjacent blood products. No definite signs of muscular\nentrapment. A small amount of fluid within the right maxillary sinus layering\nposteriorly may represent blood products. The mastoid air cells are\nunderpneumatized. The middle ear cavities appear well aerated bilaterally. \nThere is no calvarial fracture.", + "output": "1. Left posterior temporal lobe mass measures up to 3.4 cm with surrounding\nvasogenic edema, no herniation at this time. This lesion could represent\nprimary or metastatic cancer.\n2. Mildly depressed fracture involving the right lamina propria show with\nassociated right ethmoidal hemosinus and small medial extraconal hematoma in\nthe right retrobulbar space. No evidence of muscular entrapment." + }, + { + "input": "The patient is status post left parietal craniotomy with resection of a left\nparietal lesion. Post surgical changes including pneumocephalus and blood\nproducts is visualized within the surgical bed. Edema within the left\ntemporoparietal lobes is similar to the prior MRIs. There is no midline shift\nor mass effect. The basal cisterns are patent. A known 4 mm right frontal\nlesion was better evaluated with MRI.\n\nNo osseous abnormalities seen apart from the postsurgical changes in the left\nparietal bone. The paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The orbits are unremarkable.", + "output": "Postsurgical changes in the left cerebral hemisphere as described above\nfollowing a left parietal craniotomy and resection of a left parietal lesion." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThe patient is status post left parietal craniotomy.\n\nThe degree of vasogenic edema in the left temporal and occipital lobes has\nsignificantly increased compared to the prior MRI dated ___. \nEnhancing mass surrounding surgical cavity has worsened, abnormality measures\n4.2 cm x 3.4 cm in diameter. The previously seen postoperative subdural\ncollection is resolved. This mass has increased cerebral blood volume on\nperfusion images and is most consistent with tumor, unlikely postradiation\nchange.\n\nNew 1.4 cm enhancing mass in the anteromedial left middle cranial ___\nbe dural based.\n\nDural-based 7 mm enhancing lesion along the anterior margin of the right\nmiddle cranial ___ is similar compared with ___.\nThe previously seen right frontal lobe lesion is not seen on the current CT,\nlikely due to its size.\n\nThe ventricles and sulci are normal in size and configuration. A\nsubcentimeter low-attenuation lesion is seen along the left anterior\ncommissure, likely representing a prominent perivascular space.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The patient is status post bilateral cataract\nsurgery.\n\nCT Perfusion:\nCBF <30% volume: 0 mL\nTmax >6 sec: 0 mL\nMismatch ration: 0 mL\n\nIncreased cerebral blood volume surrounding surgical cavity in the region of\nperipheral enhancing mass.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. There is\nfetal origin of the left PCA. The dural venous sinuses are patent.\n\nCTA NECK:\nThe carotid and vertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria. The minimal atheromatous calcification bilateral\ncarotid bifurcations.\n\nOTHER:\nCentrilobular emphysematous changes are seen.. Indeterminate 4 mm left lung\nnodule. Multiple bilateral thyroid nodules, consistent with multinodular\ngoiter. There is no lymphadenopathy by CT size criteria. Compression fracture\nT4 vertebral body, similar to PET scan..", + "output": "1. Worsening mass at surgical cavity, with increased CBV, consistent with\ntumor progression. Worsening moderate surrounding edema.\n2. New mass left middle cranial ___, consistent with metastasis.\n3. Stable 7 mm dural-based lesion right middle cranial ___ represent\nmeningioma.\n4. 4 mm left lung nodule.\n5. Multiple thyroid nodules, likely multinodular goiter.\n6. No significant arterial narrowing in the head, neck..\n7. Compression fracture T4 vertebral body, vertebral body sclerosis, similar\nto PET scan ___." + }, + { + "input": "Dental almalgam streak artifact limits study.\n\nBilateral maxillary, right frontal and right sphenoid sinus mucosal thickening\nis noted, decreased compared to ___ prior exam. Mucous retention cyst versus\npolyps are noted within bilateral maxillary and left sphenoid sinuses. The\nostiomeatal units are patent. The cribriform plates are intact. There is no\nnasal septal defect. There is rightward nasal septal deviation. The anterior\nclinoid processes are not pneumatized. The lamina papyracea are intact. The\nsphenoid sinus septum is multipartite with insertion upon the sellar floor.\n\nThe patient is partially edentulous. A right mandibular lateral incisor\ncavity is noted (see 3:25, 7:80). Additionally, a right maxillary canine\ncavity with absent crown is noted (see 7:66, 03:34). Similarly, a left\nmandibular second premolar cavity with absent crown is also noted.", + "output": "1. Dental almalgam streak artifact limits study.\n2. Paranasal sinus disease as described, decreased compared to ___ prior\nexam.\n3. Multiple dental caries, with some absent dental crowns, as described.\n4. Rightward nasal septal deviation." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass effect. The\nventricles and sulci are normal in size and configuration. A hyperdense focus\nin the anterior left internal capsule appears minimally increased in size from\n___ and likely represents a tiny focus of mineralization (series 2, image\n16).\n\nThere is no evidence of fracture. There is moderate mucosal thickening and\nlayering fluid in the right maxillary sinus. Otherwise, the visualized\nportion of the paranasal sinuses, mastoid air cells, and middle ear cavities\nare clear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality on noncontrast head CT. Specifically no\nintracranial hemorrhage. No acute displaced calvarial fracture." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is no lymphadenopathy by\nCT criteria. The neck vessels are patent, however there is severe\natherosclerotic plaque at the origin of the right ICA.\n\nA 2 mm nodule is noted at the right lung apex (3:190). Moderate multilevel\ndegenerative changes are worse at C6-7.", + "output": "1. No abnormal enhancement in the neck.\n2. Severe atherosclerotic plaque at the origin of the right ICA.\n3. 2 mm lung nodule at the right lung apex. For incidentally detected nodules\nsmaller than 6mm in the setting of an incomplete chest CT, no CT follow-up is\nrecommended.\n\nRECOMMENDATION(S): For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction, intracranial hemorrhage, edema, mass, or\nmass effect. The ventricles and sulci are normal in caliber and configuration.\n\n The visualized paranasal sinuses and mastoids appear clear. The globes and\norbits are unremarkable.\n\nCT PERFUSION:\nRapid CT perfusion algorithm demonstrates areas of elevated mean transit time\nabove 6 seconds with a volume of 55 mL, primarily confined to the left\ntemporal lobe. No volume of reduced cerebral blood volume less than 30%. \nSubjective review of cerebral blood volume, cerebral blood flow, and MT\nT/T-max maps again demonstrates areas of mildly elevated mean transit time in\nthe left temporal lobe. No convincing evidence of infarct core.\n\nCTA HEAD:\nWidely patent vertebrobasilar system. Patent bilateral posterior cerebral\narteries with normal distal runoff.\n\nMinimal calcified plaque along the left cavernous intracranial ICA causing\nmild luminal narrowing. Otherwise, the remaining portions of the bilateral\nintracranial internal carotid arteries and the bilateral anterior and middle\ncerebral arteries are patent with normal distal runoff.\n\nNo aneurysm, additional stenosis, or occlusion.\n\nThe left transverse sinus is diminutive and not well assessed. The remaining\nvisualized major dural venous sinuses are patent.\n\nCTA NECK:\nMild motion degradation at the arch, somewhat limiting assessment. Dense\ncalcified plaque at the carotid bulb and proximal right ICA, causing mild\nnarrowing at the origin of the ECA, and approximately 18% proximal ICA luminal\nnarrowing by NASCET criteria (___). The cervical ICA distal to this is\nwidely patent.\n\nCalcified plaque along the midportion of the left CCA causes mild luminal\nnarrowing (4:119). There is moderate calcified plaque at the left carotid\nbulb and proximal left cervical ICA, not causing left ICA narrowing by NASCET\ncriteria, however causing mild narrowing of the origin of the left ECA.\n\nMild calcified plaque at the origin of the right cervical vertebral artery\ndoes not cause significant luminal narrowing. Otherwise, widely patent and\nunremarkable bilateral cervical vertebral arteries.\n\nMild arch calcifications noted. Arch branch vessel origins are mildly\ncalcified including the origin of the left subclavian artery causing mild\nluminal narrowing, otherwise widely patent.\n\nOTHER:\nThyroid unremarkable. Normal submandibular, parotid glands. No cervical\nadenopathy. No visible upper mediastinal, axillary, or supraclavicular\nadenopathy. Faint ground-glass opacity is seen in the superior segment of the\nleft lower lobe (4:3), partially visualized better evaluated on same-day CTA\nchest. There is a focal 2.7 x 1.8 cm lytic lesion in the lateral right\nclavicle (4:166). Additional lytic lesions seen in the right humeral head\nmeasuring 2 cm (4: 127). These are unchanged from recent FDG PET-CT. Mild\nmultilevel degenerative changes throughout the cervical spine.", + "output": "1. No acute intracranial abnormality by unenhanced head CT. No hemorrhage.\n2. No large vessel occlusion. Minimal narrowing, left cavernous ICA. \nOtherwise, unremarkable circle of ___.\n3. 55 mL volume of elevated MTT, primarily left temporal lobe. No evidence of\nabnormal cerebral blood flow or cerebral blood volume. No evidence of infarct\ncore.\n4. Calcified atherosclerotic plaque causes 18% proximal right ICA luminal\nnarrowing by NASCET criteria. Mild narrowing, bilateral ECA origins. \nOtherwise, widely patent cervical vertebral and carotid arteries. No left ICA\nnarrowing.\n5. Lytic lesions in the right clavicle and humerus, unchanged in size,\npreviously FDG avid on PET-CT from ___, better evaluated on that\nstudy.\n6. Ground-glass opacity in the superior segment, left lower lobe, better\nevaluated on same-day CTA chest." + }, + { + "input": "There is no evidence of large territorial infarction,hemorrhage,edema, or\nmass. The ventricles and sulci are normal in size and configuration. There\nare bilateral periventricular subcortical hypodensities that are non specific\nmost likely related to chronic small vessel ischemia.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. Bilateral periventricular and subcortical hypodensities that are most\nlikely related to chronic small vessel ischemia." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nPeriventricular and subcortical white matter hypodensities are likely\nsecondary to chronic microvascular ischemic disease. Atherosclerotic vascular\ncalcifications are noted of bilateral cavernous portions of internal carotid\narteries.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality. Please note MRI of the brain is more\nsensitive for the detection of acute infarct.\n2. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. Periventricular\nand subcortical white matter hypodensities are nonspecific but likely sequelae\nof chronic small vessel ischemic disease. The ventricles and sulci are\nslightly prominent, indicative of chronic involutional change.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm formation. The left\ntransverse sinus is hypoplastic. The dural venous sinuses are patent.\n\nCTA NECK:\nThe carotidandvertebral arteries and their major branches appear without\nevidence of significant stenosis or occlusion. There is moderate carotid\nbifurcation calcification. There is no evidence of internal carotid stenosis\nby NASCET criteria.\n\nOTHER:\nThere is an air-fluid level in the oropharynx in the setting of intubation. \nThe endotracheal tube terminates 4.1 cm proximal to the carina. A left lower\nlobe superior segment consolidation is partially imaged, new since ___ chest CTA, unchanged and probably reflecting left lower lobe collapse\ngiven the immediately preceding chest radiograph. The visualized portion of\nthe thyroid gland is within normal limits. There is no lymphadenopathy by CT\nsize criteria.", + "output": "1. No evidence of mass, hemorrhage or infarction.\n2. The major arteries the head and neck are patent.\n3. Partially imaged left lower lobe collapse. Difficult to exclude pneumonia\nin the appropriate clinical setting. Please see report for subsequent chest\nradiograph dated ___." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nMild periventricular and subcorticalwhite matter hypodensities are\nnonspecific, but likely reflect the sequela of chronic microvascular\ninfarction.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality. No fracture." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema,or discrete mass. There\nis prominence of the ventricles and sulci suggestive of involutional changes.\nMinimal periventricular and subcortical white matter hypodensities are\nnonspecific, but likely reflect sequelae of chronic small vessel ischemic\ndisease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process. No fracture." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. There\nis prominence of the ventricles and sulci suggestive of involutional changes.\nAtherosclerotic vascular calcifications are noted.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are preserved. \nRight frontal calvarium sclerotic lesion is grossly unchanged compared to ___ prior exam (see 8:43 on current study and 3:15 on prior CT\nstudy), and again may represent bone island.", + "output": "1. No acute intracranial abnormality.\n2. No evidence acute intracranial hemorrhage or fracture." + }, + { + "input": "There is no evidence of fracture, infarction,hemorrhage,edema, or mass. There\nis prominence of the ventricles and sulci suggestive of involutional changes.\n\nPreviously seen right frontal calvarial sclerotic focus is unchanged. The\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The visualized portion of the orbits are normal.", + "output": "1. No acute intracranial process." + }, + { + "input": "There is no evidence of fracture, acute large territory infarction,\nintracranial hemorrhage, edema, or mass effect. There is prominence of the\nventricles and sulci suggestive of involutional changes.\n\nThe imaged portions of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no evidence of acute major vascular territory\ninfarction,hemorrhage,edema,or mass-effect. The ventricles and sulci are\nnormal in size and configuration.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Multiple subcutaneous calcified\nlesions are seen scattered throughout the scalp, possibly representing\ncalcified sebaceous cysts.", + "output": "1. No acute intracranial abnormalities." + }, + { + "input": "There is no evidence of acute major vascular territorial\ninfarction,hemorrhage,edema, or mass. The ventricles and sulci are normal in\nsize and configuration.\n\nThere is no evidence of fracture. A mucous retention cyst is noted in the\nright maxillary sinus. There is mild mucosal thickening in the maxillary\nsinuses. Otherwise, the remaining visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Multiple subcutaneous calcified\nlesions are seen scattered throughout the scalp, possibly representing\ncalcified sebaceous cysts.", + "output": "1. No acute intracranial abnormalities\n2. Paranasal sinus disease, as above." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nAgain seen is stable linear sulcal hyperdensity overlying the right frontal\nlobe and within the right central sulcus in keeping with subarachnoid\nhemorrhage as seen on image 4: ___\n\nThere is no evidence of no evidence of infarction, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is minimal hypodensity in the periventricular, subcortical and deep\nwhite matter, nonspecific, likely secondary to small vessel ischemic disease.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\nDefects in the lamina papyracea bilaterally appear chronic and may be from\nprior trauma.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion or aneurysm formation. The dural\nvenous sinuses are patent.\n\nCTA NECK:\nThere is atherosclerotic calcification involving bilateral carotid\nbifurcations causing approximately 30% stenosis by NACSET criteria on the left\nwithout significant narrowing on the right. The carotid and vertebral\narteries and their major branches appear otherwise unremarkable with no\nevidence ofocclusion.\n\nOTHER:\nThere is a focal airspace opacity in the right middle lobe, partially\nvisualized on image 5:1. There is focal bronchiectasis leading up to the\nairspace opacity. Also seen is a 3 mm nodule in the right upper lobe on image\n5:63. There is ground-glass nodule measuring approximately 3 mm in the left\nupper lobe on image 5:63. Further evaluation with dedicated CT of the chest\ncan be performed as clinically indicated.\n\nDegenerative changes involving the visualized spine. The thyroid gland is\nunremarkable. There is atherosclerosis involving the aortic arch and its\nmajor branches.", + "output": "1. Stable subarachnoid hemorrhage in the right frontal lobe and central\nsulcus.\n2. Unremarkable CTA of the head without any aneurysm seen.\n3. Atherosclerotic calcification involving bilateral carotid bifurcations\ncausing approximately 30% stenosis by NASCET criteria on the left without\nsignificant narrowing on the right.\n4. Airspace opacity in the right middle lobe with focal bronchiectasis only\npartially visualized. Also seen are multiple lung nodules, the largest\nmeasuring 3 mm in the right upper lobe. Further evaluation with dedicated CT\nof the chest can be performed as clinically indicated, especially in light of\nhistory of lung cancer." + }, + { + "input": "The parotid glands, submandibular glands, and thyroid are unremarkable. There\nis cervical adenopathy, on the left measuring 2.0 cm long axis at level two. \nBorderline enlarged right level two lymph nodes measure up to 1.6 cm long\naxis. These are likely reactive.\n\nThere is hyperenhancement of the palatine tonsils bilaterally with slight\nenlargement on the left. There is fat stranding in the left parapharyngeal\nspace. No abscess identified.\n\nAerodigestive tract is otherwise unremarkable. Included paranasal sinuses and\nmastoids are essentially clear besides mild right maxillary sinus mucosal\nthickening.\n\nVascular structures in the neck are grossly unremarkable.\n\nIncluded intracranial structures appear normal.\n\nNo focal suspicious osseous lesion identified. Lung apices are unremarkable.", + "output": "Hyperenhancing palatine tonsils with enlargement on the left with surrounding\nstranding though no abscess. Likely reactive cervical adenopathy, left more\nso than right." + }, + { + "input": "There is a right-sided frontoparietal subdural hemorrhage, with some\nhyperdense contents suggesting an acute component. The hemorrhage is up to 8\nmm of thickness (series 2, image 21) and results in minimal effacement of the\nadjacent sulci but no significant shift of midline structures or mass effect.\nThere is no fracture of the underlying bone. No subarachnoid hemorrhage is\nidentified.\n\nThere is no evidence of large vascular territory infarction. The ventricles\nand sulci are prominent, suggesting age related involutional changes. There is\npreservation of grey-white matter differentiation and the basal cisterns are\npatent.\n\nThere is no fracture. The imaged paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear.", + "output": "Right-sided subdural hemorrhage with some hyperdense contents suggesting an\nacute component. No significant mass effect or fracture of the underlying\nbone.\n\nNOTIFICATION: The findings were communicated to the emergency department via\nthe communicator dashboard system by Dr. ___, on ___\nat 0:28 hrs, 2 minutes after discovery of the findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of acute territorial infarction,intracranial\nhemorrhage,edema,ormass. Mild subcortical, deep, and periventricular white\nmatter hypodensities are nonspecific, but likely represent the sequela of\nchronic microvascular ischemia. The ventricles and sulci are normal in size\nand configuration.\n\nMinimal mucosal thickening within the inferior maxillary sinuses. Otherwise,\nthe visualized portion of the paranasal sinuses, mastoid air cells,and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nCTA HEAD:\nMild atherosclerotic calcifications of the cavernous carotid arteries\nbilaterally. The vessels of the circle of ___ and their principal\nintracranial branches appear normal without stenosis, occlusion, or aneurysm\nformation. The dural venous sinuses are patent.\n\nCT PERFUSION: Nondiagnostic due to poor bolus timing.\n\nCTA NECK:\nMild atherosclerotic calcifications at the carotid bifurcations bilaterally. \nThe carotidandvertebral arteries and their major branches appear normal with\nno evidence of stenosis or occlusion. There is no evidence of internal carotid\nstenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is within normal limits. There is no lymphadenopathy by CT size\ncriteria. Sternotomy wires appear intact. Mild multilevel degenerative\nchanges are visualized throughout the cervical spine, slightly more pronounced\nat C5-C6 level.", + "output": "1. No evidence of acute territorial infarction or intracranial hemorrhage.\n2. CT perfusion is nondiagnostic due to poor bolus timing.\n3. No evidence of large vessel occlusion, stenosis, aneurysm, or dissection." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are prominent, consistent global cerebral volume loss.\n\nThere is mild mucosal thickening of the maxillary sinuses. Multiple maxillary\nmandibular periapical cysts are seen. The mastoid air cells,and middle ear\ncavities are clear. The visualized portion of the orbits are unremarkable.\n\n\nCTA HEAD:\n Atherosclerotic changes of the cavernous and supraclinoid segments of the\nbilateral internal carotid arteries are seen without stenosis.\n\nOtherwise, the vessels of the circle of ___ and their principal\nintracranial branches appear normal without stenosis, occlusion, or aneurysm\nformation. The dural venous sinuses are patent.\n\n\nCTA NECK:\n Atherosclerotic changes of the carotid bifurcations are seen without\nnarrowing of the internal carotid arteries, by NASCET criteria. The vertebral\narteries appear normal with no evidence of stenosis or occlusion.\n\n\nOTHER:\nSternotomy wires are seen. The visualized portion of the lungs are clear. \nThe visualized portion of the thyroid gland is within normal limits. There is\nno lymphadenopathy by CT size criteria.", + "output": "1. Normal head CTA.\n2. Calcified atheromatous plaque at the proximal internal carotid arteries\nbilaterally without stenosis by NASCET criteria.\n3. Otherwise normal neck CTA." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, edema, shift of normally\nmidline structures, or evidence of acute major vascular territorial\ninfarction. There is a persistent cavum septum pellucidum et vergae. \nOtherwise, ventricles appear unremarkable. Basal cisterns are patent. A\nsmall fluid level is noted within the left maxillary sinus. Minimal\nopacification of the left ethmoidal air cells. Mastoid air cells middle ear\ncavities are well aerated. Bony calvarium is intact. The orbits appear\nunremarkable. The imaged portions of the globes and retrobulbar space is\nnormal. Superior ophthalmic veins appear symmetric and normal.", + "output": "No acute intracranial process." + }, + { + "input": "There is mild mucosal thickening within the alveolar recess of left maxillary\nsinus with mild mucosal thickening near the left infundibulum which remains\npatent. The drainage pathways of sinuses are patent without fluid levels or\naerosolized secretions. The nasal passage is patent.\n\nEvaluation of the soft tissues in the anterior neck demonstrate the absence of\nleft submandibular gland with STIR adjacent soft tissue distortion which\nappears to be due to prior surgery and is unchanged from the previous MRI. \nThere is no evidence of bony erosion near the skullbase or mass in the\nparapharyngeal region. Evaluation of the cavernous sinus region is incomplete\nwithout contrast administration. Both lung apices are symmetric without mass\nlesion. No intraorbital mass lesion is identified. Both inferior orbital\nnerve canals are symmetric.", + "output": "1. Absent left submandibular gland with distortion in the area due to fibrosis\nunchanged from previous MRI. No soft tissue mass is seen in the\nparapharyngeal region or asymmetry of the nasopharyngeal soft tissues seen. \nNo bony erosion of the skullbase.\n2. Mild mucosal thickening left maxillary sinus. Drainage pathways are\npatent.\n3. Cavernous sinuses are not fully evaluated. For better evaluation of the\ntrigeminal nerve MRI using trigeminal protocol can help for further\nassessment.\n\nRECOMMENDATION(S): Cavernous sinuses are not fully evaluated. For better\nevaluation of the trigeminal nerve, MRI using trigeminal protocol can help for\nfurther assessment." + }, + { + "input": "There is no evidence of acute large territorial infarction,hemorrhage,edema,or\nlarge mass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes. Periventricular and subcortical white matter\nhypodensity is nonspecific but may be related to sequelae of chronic small\nvessel ischemic disease. Atherosclerotic calcification of the cavernous\ncarotid arteries is noted.\n\nThere is left periorbital soft tissue swelling.there is no evidence of\nfracture. There is mild anterior ethmoid air cell mucosal thickening,\notherwise the visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial process.\n2. Left periorbital soft tissue swelling." + }, + { + "input": "There is no evidence of acute large territorial infarction, intracranial\nhemorrhage, edema, or mass.\n\nThe ventricles and sulci are normal in size and configuration.\n\nNo acute osseous abnormalities seen. There is trace mucosal thickening of the\nethmoidal air cells bilaterally. Right frontal sinus mucosal thickening is\npresent. Otherwise, the partially imaged paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The orbits demonstrate no acute\nabnormalities. Minimal right frontal supraorbital scalp soft tissue swelling\nis noted.", + "output": "1. No acute intracranial abnormality.\n2. No evidence acute intracranial hemorrhage or fracture.\n3. Minimal right frontal supraorbital scalp soft tissue swelling.\n4. No evidence of masses within the limitations of noncontrast study.\n5. Please note, that MRI is more sensitive for the detection of seizure foci\nin intracranial masses.\n6. Paranasal sinus disease , as described." + }, + { + "input": "Study is degraded by motion. Dental amalgam streak artifact limits study. \nOverlying surgical hardware streak artifact limits examination.\n\nCT HEAD WITHOUT CONTRAST:\nIll-defined hyperdensity along the sulci of the right parietal lobe (series 2,\nimage 20), concerning for intraparenchymal or subarachnoid hemorrhage,\nunchanged in size or extent compared to the prior study. There is no mass\neffect. No additional foci of hemorrhage are identified. No large territorial\ninfarction.\n\nMild parenchymal volume loss consistent with age related atrophy. There is\nbilateral mild subcortical and periventricular white matter hypodensities,\nwhich are nonspecific but likely represent sequela from chronic small vessel\ndisease.\n Bilateral orbits demonstrate postoperative changes.\n\nCTA HEAD:\nNonocclusive probable atherosclerotic calcifications of bilateral internal\nsegments. Minimal nonocclusive irregularity of the right A1 segment is noted.\nOtherwise, the vessels of the circle of ___ and their principal\nintracranial branches appear grossly preserved without stenosis, occlusion, or\naneurysm formation. The dural venous sinuses are grossly patent.\n\nNo definite vascular malformation underlying the site of suspected hemorrhage\nis identified.\n\nCTA NECK:\nMinimal nonocclusive atherosclerotic plaque bilateral proximal cervical\ninternal carotid arteries without definite severe stenosis by NASCET criteria\nis noted. Otherwise, the carotidandvertebral arteries and their major\nbranches appear grossly preserved with no evidence of stenosis or occlusion.\n\nOTHER:\nThe esophagus is patulous. There is bilateral airway thickening centrally.\n\nLimited imaging of lungs suggest biapical patchy opacities versus artifact.\n\nCalcified bilateral thyroid nodules measure up to 0.8 cm.\n\nScattered subcentimeter nonspecific lymph nodes are noted throughout the neck\nbilaterally, without definite enlargement by CT size criteria.\n\nLimited imaging of the teeth demonstrate left maxillary tooth with absent\ncrown and periapical lucency (see 4:120).", + "output": "1. Study graded by dental and overlying surgical hardware streak artifact and\nmotion.\n2. Right parietal ill-defined hyperdensity, concerning for intraparenchymal or\nsubarachnoid hemorrhage, grossly stable compared to prior. Please note that\nunderlying mass is not excluded on the basis examination. If concern for\nintracranial mass, consider contrast brain MRI for further evaluation.\nRecommend follow-up imaging to resolution.\n3. Nonocclusive probable atherosclerotic narrowing of circle of ___ as\ndescribed.\n4. Otherwise, patent circle of ___ without definite evidence of\nstenosis,occlusion,or aneurysm.\n5. Grossly patent bilateral cervical carotid and vertebral arteries without\ndefinite evidence of stenosis, occlusion, or dissection.\n6. Limited imaging of lungs suggest biapical patchy opacities versus artifact,\nand central airway thickening. If clinically indicated, consider correlation\nwith dedicated chest imaging.\n7. Calcified bilateral thyroid nodules measuring up to 0.8 cm.\n8. Nonspecific subcentimeter cervical lymph nodes as described, which may be\nreactive.\n9. Left maxillary molar tooth dental disease as described.\n\nRECOMMENDATION(S): Right parietal ill-defined hyperdensity, concerning for\nintraparenchymal or subarachnoid hemorrhage, grossly stable compared to prior.\nPlease note that underlying mass is not excluded on the basis examination. If\nconcern for intracranial mass, consider contrast brain MRI for further\nevaluation. Recommend follow-up imaging to resolution." + }, + { + "input": "There is redemonstration of an ill-defined hyperdensity along the sulci of the\nright parietal lobe (series 4, image 20), which appears similar compared to\nprior CT dated ___. No new areas of intracranial hemorrhage. No\nacute large territory infarction, edema,or mass. There is prominence of the\nventricles and sulci suggestive of involutional changes. Periventricular\nhypodensities are nonspecific but compatible with chronic small vessel\ndisease.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Left occipital scalp hematoma is\nidentified.", + "output": "1. Redemonstration of a similar-appearing right parietal likely subarachnoid\nhemorrhage.\n2. No new intracranial hemorrhage noted.\n3. Left scalp occipital hematoma without underlying displaced calvarial\nfracture." + }, + { + "input": "There is no evidence of new infarction, hemorrhage, edema, or mass.\nHyperdensity in the right parietal lobe is again seen likely corresponding to\nevolving subarachnoid blood. The ventricles and sulci are enlarged in keeping\nwith generalized parenchymal volume loss. Subcortical and deep white matter\nhypodensities are nonspecific but likely reflect chronic microvascular\nischemic change.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable. Bilateral lens\nreplacements are noted.", + "output": "No acute intracranial abnormality since prior. Evolving subarachnoid\nhemorrhage in the right parietal lobe." + }, + { + "input": "There is hypoattenuation and encephalomalacia in the left parietal lobe\ncompatible with chronic infarct. There is no intra-axial or extra-axial\nhemorrhage, edema, shift of normally midline structures, or evidence of acute\nmajor vascular territorial infarction. Prominent ventricles sulci compatible\nwith age-related involutional changes. Periventricular and subcortical\nconfluent hypoattenuation is nonspecific but likely represent sequelae of\nsmall vessel ischemic disease in this age group. There are moderate\natherosclerotic calcifications in the carotid siphons and intracranial\nportions of the vertebral arteries bilaterally.\n\nImaged paranasal sinuses are clear. Mastoid air cells and middle ear cavities\nare well aerated. The bony calvarium is intact.", + "output": "1. Hypoattenuation and encephalomalacia in the left parietal lobe likely\nrepresents a chronic infarct.\n2. No acute intracranial abnormality.\n3. Age-related involutional changes and chronic small vessel ischemic disease." + }, + { + "input": "CT HEAD:\nThere is an evolving late subacute infarction again seen within the left\nparieto-occipital lobe, containing internal areas of hyperdensity which are\ncompatible with hemorrhagic conversion. Additional areas of hypodensity\ncompatible with subacute infarcts are seen within the posterior left parietal\nlobe, better delineated on the patient's recent MRI examination.\n\nThere is no evidence of new infarct. No extra-axial fluid collection. No\nmass effect or midline shift.\n\nThe ventricles and sulci are normal in size and appearance. The basal cisterns\nremain patent.\n\nMucosal thickening is seen within the bilateral maxillary sinuses and\nscattered ethmoid air cells. Fluid is seen within the bilateral mastoid air\ncells, left greater than right. The remainder of the paranasal sinuses and\nmiddle ear cavities are clear. The orbits are grossly unremarkable\nbilaterally.\n\nCTA HEAD AND NECK:\nThere is a 3 vessel aortic arch. Calcifications are seen within the left V4\nsegment (3:230). Left V4 terminates as a ___. A dominant right-sided\nvertebral basilar system is present. Calcifications are noted within the\ndistal right V4 segment (3:239).\n\nThe proximal right internal carotid artery demonstrates mild luminal\nirregularity with probable noncalcified atherosclerotic disease resulting in\nless than 30% stenosis by NASCET criteria. The left internal carotid artery\ndemonstrates more extensive luminal irregularity, with a slightly beaded\nappearance. Findings may represent fibromuscular dysplasia versus\nnoncalcified atherosclerotic plaque, resulting in up to approximately 50%\nstenosis by NASCET criteria (___).\n\nCalcifications of the cavernous internal carotid arteries are moderate on the\nright and mild on the left. The left A1 segment is hypoplastic but grossly\npatent. The distal A2 segments are widely patent.\n\nOtherwise, the vessels of the circle of ___ and their principal\nintracranial branches are patent without high-grade stenosis, occlusion, or\naneurysm formation.\n\nOTHER:\nAn endotracheal tube is noted, terminating in the lower thoracic trachea and\npointing towards the proximal right mainstem bronchus. There are extensive\nbackground paraseptal emphysematous changes. Small left and moderate right\npleural effusions are noted with adjacent atelectasis. An orogastric tube is\npartially imaged.\n\nThe thyroid gland is preserved. Scattered subcentimeter nonspecific lymph\nnodes are noted throughout the neck bilaterally, without definite enlargement\nby CT size criteria.", + "output": "1. Known, subacute infarcts within left parietal and occipital lobes. The\nextent of these are better characterized on the patient's recent MRI\nexamination.\n2. Hyperdensity within the dominant left occipital lobe infarct is compatible\nwith hemorrhagic conversion, correlating with findings on gradient echo\nsequences on recent MRI examination.\n3. Luminal irregularity involving the left greater than right proximal\ninternal carotid arteries, demonstrating a mildly beaded appearance on the\nleft with up to approximately 50% stenosis by NASCET criteria. Findings may\nreflect noncalcified atherosclerotic disease versus fibromuscular dysplasia.\n4. Multifocal calcified atherosclerotic disease within the bilateral V4\nsegments and cavernous internal carotid arteries. No high-grade stenosis,\nocclusion, dissection, or aneurysm greater than 3 mm.\n5. ETT terminating in the lower thoracic trachea near the level of the carina\nand directed into the proximal right mainstem bronchus.\n6. Moderate right pleural effusion and small left pleural effusion, with\nbilateral emphysematous changes and dependent atelectasis. If clinically\nindicated, consider correlation with dedicated chest imaging." + }, + { + "input": "There is some streak artifact through the midportion of the head, possibly\nrelated to patient motion. Given this, there is no evidence of acute\nintracranial hemorrhage, midline shift, mass effect, or acute large vascular\nterritory infarct. Gray-white matter differentiation is preserved. The\nvisualized paranasal sinuses demonstrate minimal mucosal thickening in the\npartially imaged left maxillary sinus.. The mastoid air cells are clear. No\nacute fracture is seen.", + "output": "Some streak artifact through the midportion of the head, possibly related to\npatient motion. Given this, no acute intracranial process seen." + }, + { + "input": "There is a circumferential mass there is supraglottic, glottic and subglottic\nof consistent with known laryngeal cancer. There are no prior images for\ncomparison. The esophagus looks normal there is no evidence of rupture. There\nis no evidence of malignant adenopathy. The tumor erodes the hyoid bone.\nThere is bilateral pulmonary atelectasis which may be due to aspiration.\nThere is pleural thickening versus fluid collection on the left.", + "output": "Supraglottic glottic and subglottic circumferential mass consistent with known\nlaryngeal cancer." + }, + { + "input": "A tracheostomy device is present. There is increased size of the\ncircumferential laryngeal mass with associated erosion of the thyroid\ncartilage, now extending more anteriorly into the fat plane. Several small\nvessels appear to be the right superior aspect of the mass, arising from the\nright external carotid artery. There is increased effacement of the superior\naspect of the trachea in association with the increased size of the mass. The\nmass approaches the carotid space, right greater than left, though this is not\nappear to invade the carotid arteries.\n\nThere is scattered atherosclerotic vascular disease within the aortic arch and\nbilateral carotid bifurcations though without evidence of hemodynamically\nsignificant stenosis or pathologic large vessel occlusion within the neck. The\ncarotid and vertebral arteries and their major branches are patent with no\nevidence of stenoses. The distal cervical internal carotid arteries measure\n4.4 mm in diameter on the left and 4.6 mm in diameter on the right.\n\nThere are multiple enlarged paratracheal and upper mediastinal lymph nodes,\nsimilar to prior exam.\n\nThe intracranial contents are unremarkable. There is a small left maxillary\nsinus mucosal retention cyst.", + "output": "1. Increased size of circumferential laryngeal mass with increased erosion of\nthe thyroid cartilage.\n2. The mass approaches the carotid spaces, right greater than left, although\nthough does not appear to invade the carotid arteries and there is no evidence\nof active arterial contrast extravasation.\n3. Several enlarged upper mediastinal and paratracheal lymph nodes, similar to\nprior exam." + }, + { + "input": "There is no evidence of fracture, acute territorial\ninfarction,hemorrhage,edema,or mass. There are bilateral basal ganglia\ncalcifications. There is a focal hypodensity in the right basal gangliar\nconsistent with an age indeterminate lacunar infarct. There is also\nhypodensity in the left sub insular region consistent with age indeterminate\nlacunar infarct. There is prominence of the ventricles and sulci suggestive\nof involutional changes. There is mild left parietal scalp soft tissue\nswelling.\n\nThe visualized portion of the mastoid air cellsand middle ear cavities are\nclear. The visualized portion of the orbits are normal. There is a mucous\nretention cyst in the left maxillary sinus. There is mild mucosal thickening\ninvolving bilateral ethmoid air cells and right frontal sinus. Dense\natherosclerotic calcifications of the cavernous carotid arteries.", + "output": "1. No acute intracranial hemorrhage.\n2. Left parietal scalp soft tissue swelling.\n3. Focal hypodensities in the right basal ganglia and left subinsular region\nconsistent with age indeterminate lacunar infarcts. Please correlate\nclinically.\n4. Mild paranasal disease." + }, + { + "input": "There is no acute intracranial hemorrhage, cerebral edema, mass effect, or\nloss of gray/ white matter differentiation. Ventricles, sulci, and basal\ncisterns are normal in size. Postcontrast images demonstrate no evidence for\nan enhancing mass, and no other pathologic contrast enhancement.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. No suspicious lytic or sclerotic bone lesions are\nseen.", + "output": "No evidence for intracranial abnormalities.\n\nRECOMMENDATION(S): If clinically warranted, MRI brain with/without contrast,\nwith MRV if appropriate, would be significantly more sensitive for\nintracranial infection or vascular thrombosis." + }, + { + "input": "Evaluation of the aerodigestive tract demonstrates no mass and no areas of\nfocal mass effect.\n\nWithin the left ___ duct, adjacent to the mandibular symphysis are 2\nobstructing stones measuring 0.9 x 0.5 cm each with resultant ductal\ndilatation measuring up to 3 mm and mucosal hyperemia. Additionally, the left\nsubmandibular gland is asymmetrically enlarged and moderately hyperenhancing\nwhen compared to the right with subtle adjacent fat stranding concerning for\nacute sialadenitis. No adjacent fluid collection is demonstrated. Adjacent\nto the left submandibular gland are conspicuous lymph nodes measure up to 9\nmm, (series 2, image 52) which do not demonstrate pathologic features and are\nlikely reactive.\n\nThe other salivary glands enhance normally and are without mass or adjacent\nfat stranding. The thyroid gland appears normal. The neck vessels are\npatent.\n\nIncidental note is made of mucous retention cysts within the left maxillary\nsinus. Additionally there is layering fluid within the right maxillary sinus\nis nonspecific which may represent sinusitis in the appropriate clinical\nsetting. There is mild mucosal thickening of the right ethmoid cells which is\nnonspecific.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.\n\nIncidental note is made of multiple calcified left supraclavicular and\nprevascular mediastinal lymph nodes, (series 2 image 82) which are likely\nsecondary to prior granulomatous disease.", + "output": "1. Acute sialoadenitis of the left submandibular gland due to two obstructing\nstones within the left ___ duct measuring up to 0.9 x 0.5 cm.\n2. Prominent reactive submandibular lymph nodes.\n3. Layering fluid within the right maxillary sinus is nonspecific but may\nrepresent acute sinusitis in the appropriate clinical setting." + }, + { + "input": "CT HEAD:\nCraniotomy changes are seen along the right temporoparietal cortex. There is\nan acute 1.2 cm intraparenchymal hemorrhage in the left medial temporal lobe\nwith surrounding vasogenic edema (02:13). Additionally, there is\nintraventricular decompression with blood seen layering in the occipital horns\nof the lateral ventricles, left greater than right (02:15). There is no\nmidline shift. Grossly stable left basal ganglia probable calcification is\nagain noted (see 02:13 on current study and 02:12 on prior exam).\n\nThere is mild prominence of the ventricles and sulci, grossly unchanged\ncompared to ___ prior exam. Chronic hypodensities noted along the right\nfrontal lobe white matter in the vicinity of a prior external ventricular\ndrain placement. There is no evidence for large vascular territorial\ninfarction.\n\nThe paranasal sinuses, middle ear cavities, and mastoid air cells are clear.\nThe orbits are grossly unremarkable bilaterally.\n\nCTA HEAD:\nThe patient is status post a superior temporal-middle cerebral artery bypass\non the right, better assessed on recent cerebral angiogram.\n\nThere is narrowing of the petrous, supraclinoid, and paraclinoid portions of\nthe right internal carotid artery. The terminal portion of the right ICA is\nnot discretely visualized.\n\nThere is extensive narrowing of multiple vessels involving the circle of\n___ including bilateral M1 segments, A1 segments, and right PCOM arteries. \nThe left PCOM artery remains patent. Multiple collateral lenticulostriate\nvessels are noted, with a \"puff of smoke\" appearance, all of which are\ncompatible with the patient's known diagnosis of moyamoya. The posterior\ncirculation appears patent and, overall, less affected. Bilateral visualized\nportion of V3 segments are patent. Bilateral V4 segments are patent. The\nbasilar artery is patent. Bilateral SCA is are visualized. Bilateral P1\nsegments are visualized. Infundibulum is noted at the right P1-P2 junction. \nFocal nonocclusive narrowing of the right distal P2 segment is noted. \nBilateral P2 and P3 segments are otherwise grossly patent.", + "output": "1. Postsurgical changes following prior right temporoparietal craniotomy with\nright STA-MCA bypass.\n2. Grossly stable acute, intraparenchymal hemorrhage within the left medial\ntemporal lobe with associated intraventricular decompression and mild local\nvasogenic edema, without definite midline shift.\n3. Intraventricular hemorrhage as described. Allowing for difference\ntechnique, slightly increased compared to recent prior outside exam.\n4. No additional site of hemorrhage.\n5. No evidence for vascular territorial infarction. Please note MRI of the\nbrain is more sensitive for the detection of acute infarct.\n6. Diffusely irregular and narrowed intra cerebral vasculature, as detailed\nabove, most prominently affecting the bilateral M1 and A1 segments with\nassociated lenticulostriate collateral formation, compatible with patient's\nprovided history of moyamoya.\n7. Moderate narrowing of the right petrous, paraclinoid, and supraclinoid ICA,\nwith near complete occlusion of the terminal right ICA.\n8. Right distal P2 segment nonocclusive stenosis." + }, + { + "input": "The patient is status post right temporoparietal craniotomy. A 9 mm focus of\nintraparenchymal hemorrhage is seen with in the left temporal lobe, slightly\ndecreased in size compared to prior, with mild surrounding edema. A small\namount of hemorrhage is seen layering within the left occipital horn of the\nlateral ventricle, decreased compared to prior study. No significant midline\nshift. A chronic infarct is seen in the right frontal lobe. There is no\nevidence of acute infarctionor mass. The ventricles are stable in size\nwithout evidence of hydrocephalus.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nethmoid air cells. The visualized portion of the remaining paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The visualized portion\nof the orbits are unremarkable.", + "output": "1. Interval decrease in left intraparenchymal hemorrhage with mild\nsurrounding edema and interventricular extension. No definite midline shift. \nInterval decrease in interventricular hemorrhage.\n2. Chronic right frontal lobe infarct." + }, + { + "input": "There is no evidence of territorial infarction, hemorrhage, edema, or mass.\nThe ventricles and sulci are normal in size and configuration. Extensive\natherosclerotic calcification of the bilateral internal carotid arteries and\nvertebral arteries are noted.\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. There is a\nleft-sided scleral buckle. The patient is status post left lens replacement. \nThe right globe is unremarkable.", + "output": "1. No acute intracranial process, specifically, no hemorrhage.\n\nNOTIFICATION: Wet read was discussed with Dr. ___ by Dr. ___\ntelephone at 22:29 on ___, 2 min after discovery." + }, + { + "input": "There is no evidence of acute territorial infarction, hemorrhage, edema, or\nmass effect. There is mild asymmetry in the lateral ventricles, with the left\nlateral ventricle appearing slightly bigger than the right, but this is likely\nlongstanding. Otherwise, the ventricles and sulci are normal in size and\nconfiguration.\n\nNo acute fractures are seen. There is mild mucosal thickening in the right\nfrontal sinus is and bilateral ethmoid air cells. Otherwise, the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear.", + "output": "No acute intracranial process. Of note, MRI is more sensitive for detection\nof intracranial masses." + }, + { + "input": "There is no evidence of acute infarction,hemorrhage,edema, or mass. The\nventricles and sulci are normal in size and configuration. Nonspecific\nperiventricular and deep subcortical white matter hypodensities most likely\nrepresent mild chronic small vessel ischemic disease. A rounded hypodensity\nin the left pons may represent a small lacunar infarction (02:11).\n\nThere is no evidence of fracture. There is a large subgaleal hematoma with\nassociated edema overlying the right parieto-occipital region with associated\nskin staples. Aside from diffuse mild to moderate mucosal thickening of the\nanterior ethmoidal air cells, maxillary sinuses, and sphenoid sinuses, the\nvisualized portion of the paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. A small osteoma is noted in the upper right anterior\nethmoidal air cells (301:29). The visualized portion of the orbits are\nunremarkable.", + "output": "1. No evidence of acute intracranial process.\n2. Subgaleal hematoma and edema overlying the right occipitoparietal region\nwithout underlying fracture.\n3. Possible small lacunar infarction in the pons.\n4. Nonspecific white matter hypodensities likely representing the sequelae of\nmoderate chronic small vessel ischemic disease." + }, + { + "input": "Dental amalgam and patient body habitus streak artifact and motion limits\nstudy.\n\nCT HEAD WITHOUT CONTRAST:\nThere is no evidence of infarction,hemorrhage,edema,ormass. The ventricles\nand sulci are preserved in size and configuration.\n\nThe visualized portion of the mastoid air cells,and middle ear cavities are\nclear. Deformation of the right lamina papyracea with clear adjacent ethmoid\nair cells is noted, grossly similar compared to ___ prior outside\ncontrast brain MRI. The visualized portion of the orbits are preserved. \nBilateral maxillary sinus and ethmoid air cell mucosal thickening is present.\n\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear grossly preserved without definite evidence of stenosis, occlusion, or\naneurysm formation. The dural venous sinuses are patent.\n\nCTA NECK:\nArtifact limits evaluation of right vertebral artery origin. Within limits of\nstudy, right vertebral artery origin is grossly patent. Otherwise, the\ncarotidandvertebral arteries and their major branches appear grossly preserved\nwith no evidence of stenosis or occlusion. There is no definite evidence of\ninternal carotid stenosis by NASCET criteria.\n\nOTHER:\nThe visualized portion of the lungs are clear. The visualized portion of the\nthyroid gland is grossly preserved. Scattered subcentimeter nonspecific lymph\nnodes are noted throughout the neck bilaterally and mediastinum, without\ndefinite enlargement by CT size criteria. Limited imaging of cervical spine\ndemonstrates multilevel degenerative changes, with at least mild vertebral\ncanal narrowing at C6-7 secondary disc osteophyte complex.", + "output": "1. Dental amalgam and patient body habitus streak artifact and motion limits\nstudy.\n2. No acute intracranial abnormality.\n3. Grossly patent circle of ___ without definite evidence of\nstenosis,occlusion,or aneurysm.\n4. Grossly patent bilateral cervical carotid and vertebral arteries without\ndefinite evidence of stenosis, occlusion, or dissection.\n5. Probable chronic right lamina papyracea defect, as described.\n6. Please see ___ contrast sella MRI for description sella\nfindings.\n7. Nonspecific subcentimeter cervical and mediastinal lymph nodes as\ndescribed, which may be reactive.\n8. Paranasal sinus disease, as described.\n9. Multilevel cervical spondylosis as described, with least mild vertebral\ncanal narrowing at C6-7." + }, + { + "input": "There is no evidence of acute major vascular territorial infarction,\nhemorrhage, edema, or large mass. The ventricles and sulci are normal in size\nand configuration. The basal cisterns appear patent and there is preservation\nof gray-white matter differentiation.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process. Please note that MRI would be more sensitive\nfor subtle intracranial lesions." + }, + { + "input": "Head CT: There is no evidence of hemorrhage, edema, masses, mass effect, or\ninfarction. The ventricles and sulci are normal in caliber and configuration.\nNo fractures are identified. There is mucosal thickening within the right\nmaxillary sinus and a small mucous retention cyst within the left maxillary\nsinus. The remainder of the paranasal sinuses are clear. The mastoid air cells\nare clear.\n\nHead CTA: There is a severe stenosis of the superior division of the left MCA\njust distal to the bifurcation. The remainder of the vessels are patent\nwithout evidence of stenosis or occlusion. No aneurysms are detected. A right\nfetal type PCA is noted.\n\nNeck CTA: Imaging of the neck reveals no evidence of arterial stenosis or\nocclusion. There is no evidence of internal carotid artery stenosis by NASCET\ncriteria. The distal right internal carotid artery measures 4.8 mm in\ndiameter. The distal left internal carotid artery measures 4.8 mm in diameter.", + "output": "1. Unremarkable noncontrast CT scan of the head.\n\n2. Severe stenosis of the superior division of the left MCA\n\n3. Unremarkable CTA of the neck" + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is mild\nprominence of the ventricles and sulci as expected for age.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No evidence of mass, hemorrhage or infarction. Normal study" + }, + { + "input": "Dental amalgam and overlying hardware streak artifact limits study.\nAdditionally, streak artifact limits evaluation of pons and midbrain.\n\nThere is no evidence of acute large territorial infarction,hemorrhage,or mass.\nVentricles and sulci are grossly preserved without definite evidence of\nventriculomegaly. Atherosclerotic vascular calcifications are noted. The\nbasilar cisterns are preserved.\n\n\nThere is no evidence of fracture. Mild mucosal thickening of the bilateral\nmaxillary sinuses and the ethmoid air cells, consistent with intubation\nstatus. The visualized portion of the mastoid air cells and middle ear\ncavities are clear. The visualized portion of the orbits are preserved.", + "output": "1. Dental amalgam streak artifact limits study.\n2. No evidence of hemorrhage, acute large territorial infarction, herniation,\nor midline shift. Please note MRI of the brain is more sensitive for the\ndetection of acute infarct." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of acute fracture. A 1.1 cm osteoma is demonstrated\narising from the mid occiput. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No evidence of acute intracranial abnormality. No evidence of acute\nfracture." + }, + { + "input": "There is no evidence of acute large territorial infarction, acute intracranial\nhemorrhage, edema, or mass. The ventricles and sulci are normal in size and\nconfiguration. An empty sella is incidentally noted.\n\nNo acute osseous abnormalities seen. Mild mucosal thickening of the left\nposterior ethmoidal air cells is noted. The remaining visualized portion of\nthe paranasal sinuses, mastoid air cells, and middle ear cavities are clear.\nThe visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality. Specifically no intracranial\nhemorrhage.\n2. Incidental note of an empty sella." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\nHypodense lesion in the pineal gland is again seen and unchanged from ___, presumed to represent a pineal cyst.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable. Polypoid soft tissue density within\nthe posterior nasopharyngeal tissues may reflect a Tornwaldt cyst and appears\nunchanged from the previous CT and can be correlated with direct visual\ninspection.", + "output": "No acute intracranial process." + }, + { + "input": "SOFT TISSUES: Mild soft tissue fat stranding is identified overlying the left\nzygoma.\n\nMAXILLOFACIAL BONES: The maxillofacial bones are intact, without fracture.\nThe zygomatico-maxillary complex is intact. The lateral pterygoid plates are\nintact.\n\nMANDIBLE: The mandible is without fracture or temporomandibular joint\ndislocation. The temporomandibular joints are symmetric, without significant\ndegenerative change.\n\nDENTITION: Dental amalgam creates streak artifact and limits evaluation. \nFocal defect is identified in the medial aspect of the left maxillary central\nincisor. There is no remarkable periodontal disease, periapical lucency, or\nodontogenic abscess.\n\nSINUSES: The paranasal sinuses are intact and clear. The ostiomeatal units\nare patent. The mastoid air cells and middle ear cavities are clear.\n\nNOSE: There is no nasal bone fracture. Nasopharyngeal soft tissues are\nunremarkable. There is no nasal septal hematoma. There is a nasal septal\nperforation (series 2, images 64). A leftward projecting spur is identified\ncontacting the left inferior turbinate.\n\nORBITS: The orbits, including the laminae papyracea, are intact. The globes\nare intact with non-displaced lenses and no intraocular hematoma. There is no\npreseptal soft tissue edema. There is no retrobulbar hematoma or fat\nstranding.\n\nAllowing for imaging technique optimized for the face, the limited included\nportion of the brain is grossly unremarkable.", + "output": "1. No facial bone fracture is identified. No maxillary fractures are noted.\n2. Focal defect in the left maxillary central incisor may reflect dental\nfracture or dental caries.\n3. Mild soft tissue swelling is noted overlying the left zygoma.\n4. Anterior nasal septal perforation." + }, + { + "input": "There is no evidence of acute intracranial hemorrhage, abnormal extra-axial\nfluid collection, midline shift, or acute territorial infarction, or mass\neffect. There is mild prominence of the ventricles and sulci consistent with\natrophy. There are periventricular and subcortical lucencies suggestive of\nsmall vessel ischemic changes.\n\nNo osseous abnormalities seen. The mastoid air cells, and middle ear cavities\nare clear. The orbits are unremarkable. There is a left ethmoid air cell\nmucous retention cyst versus polyp.", + "output": "1. No acute intracranial abnormality.\n2. Findings suggestive of atrophy and small-vessel ischemic changes.\n3. Left anterior ethmoid air cell mucous retention cyst versus polyp.\n4. Please note that MRI of the brain is more sensitive for the evaluation of\nstroke." + }, + { + "input": "There is no evidence of focal fluid collection or suspicious soft tissue\nlesion within the oropharynx. Evaluation of the aerodigestive tract\ndemonstrates no mass and no areas of focal mass effect. There is prominence\nof the palatine tonsils. No peritonsillar abscess. There are bilateral\nenlarged cervical lymph nodes, specifically at level two measuring up to 2.6\ncm long axis on the left and up to 2.4 cm long axis on the right. These are\nlikely reactive.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid appears normal.There are scattered subcentimeter\ncervical lymph nodes measuring up to 5 mm, not pathologically enlarged based\non CT size criteria (3:87).The neck vessels are patent.\n\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.\n\nThere is near complete opacification of the left maxillary sinus, compatible\nwith acute sinusitis.", + "output": "Prominence of the palatine tonsils without evidence of peritonsillar abscess. \nBilateral cervical adenopathy, likely reactive." + }, + { + "input": "Significant encephalomalacia in the left inferior frontal and temporal lobes\nis compatible with a prior infarct. There is no evidence of intracranial\nhemorrhage, edema, or acute infarction. Prominence of the ventricles and sulci\nas indicative of volume loss. Basal cisterns are patent and gray-white matter\ndifferentiation is maintained. Calcified extra-axial lesion at the inner table\nof the right temporal bone measuring 11 x 7 mm (2a:12) is compatible with a\nmeningioma. Bony defects in surgical hardware from prior resection is noted.\nNo fracture or soft tissue abnormality is seen. Imaged paranasal sinuses are\nclear.", + "output": "1. No acute intracranial abnormality.\n2. 11 x 7 mm calcified focus at the inner table of the right temporal bone is\ncompatible with a meningioma.\n3. Evidence of chronic left inferior frontal and temporal lobe infarction." + }, + { + "input": "In the left cerebellar hemisphere, there is a 2.4 x 2.8 cm intraparenchymal\nhemorrhage with surrounding edema. Mild mass effect is noted with effacement\nof the fourth ventricle. Note should be made that patient received\nintravenous contrast for a CTA chest on the same day approximately 2 hr\npreviously accounting for enhanced vasculature. No additional hemorrhage is\nidentified. There is no shift of normally midline structures. Ventricles and\nsulci are normal in size and configuration for patient's age. Basal cisterns\nare patent. Gray-white matter differentiation is preserved.\n\nBilateral mucous retention cysts are noted in the maxillary sinuses. Partial\nopacification and mucosal thickening within the anterior ethmoidal cells as\nwell as left frontal sinus is additionally seen. Extensive atherosclerotic\ncalcifications are noted in the carotid siphon. Bilateral mastoid air cells\nand middle ear cavities are clear. No acute fracture is identified.", + "output": "2.4 x 2.8 cm left cerebellar acute intraparenchymal hemorrhage with mild mass\neffect and effacement of the fourth ventricle.\nCorrelate clinically for etiology and further workup.\n\nNOTIFICATION: Findings communicated immediately to the ordering physician ___.\n___ by Dr. ___ telephone at 2:21 am on ___." + }, + { + "input": "The left cerebellar hematoma measures 2.5 x 2.0 cm (AP x TV), previously 2.4 x\n2.8 cm on ___. The surrounding edema and mass effect on the left side of\nthe ___ ventricle and rightward shift are not significantly changed from the\nprior study.\nThere are no new foci of hemorrhage formation. No evidence of midline shift.\nThe lateral ventricles and sulci are within normal limits. Basal cisterns are\npatent. Gray-white matter differentiation is preserved. No fracture is\nidentified. The paranasal sinuses, mastoid air cells and middle ear cavities\nclear. Bilateral orbits are unremarkable.", + "output": "Stable left cerebellar hematoma with mass effect on the left side of the ___\nventricle; slightly increased mass effect on ___ ventricle.\nLimited assessment of position of cerebellar tonsils, due to dental artifacts\nand lack of sagittal and coronal reformations is performed as a portable\nstudy.\nConsider standard CT head study as needed and feasible." + }, + { + "input": "There are right sphenoid sinus and left frontal sinus mucous retention cysts. \nTrace right maxillary sinus mucosal thickening is present. The remaining\nparanasal sinuses are well aerated without air-fluid levels. The ostiomeatal\nunits are patent. The cribriform plates are intact. There is a mild leftward\nnasal septal deviation with small septal spur (4:18). The anterior clinoid\nprocesses are not pneumatized. The lamina papyracea are intact. The sphenoid\nsinus septum is not midline with insertion upon the sellar floor. Visualized\nportion of the mastoid air cells internal auditory canal are clear.", + "output": "1. Paranasal sinus disease as described.\n2. Leftward nasal septal deviation with small bony spur." + }, + { + "input": "Head CT:\n\nThere has been no significant interval change in left cerebellar hemorrhage.\nIntraventricular extension of hemorrhage and hydrocephalus is again noted and\nalso not significantly changed. No new intracranial abnormalities are seen.\n\nThere is mucosal thickening of the ethmoid sinuses and opacification of the\nright frontal, maxillary, and sphenoid sinuses. There is sclerosis of the wall\nof the sphenoid sinus and right maxillary sinus compatible with chronic\ninflammation. There is hyperdense material within the sinuses consistent with\ninspissated secretions versus fungal colonization. There are secretions noted\nwithin the nasopharynx. No fractures are identified.\n\nHead CTA:\n\nThe intracranial carotid and vertebral arteries and their major branches are\npatent with no evidence of stenoses, occlusions or aneurysm formation. A\ncommon origin of the right posterior cerebral artery and superior cerebellar\nartery is noted.\n\nNeck CTA:\n\nThere is a 3 vessel aortic arch. There is no evidence of internal carotid\nartery stenosis by NASCET criteria. The distal right ICA measures 3.3 mm and\nthe distal left ICA measures 3.6 mm. The right vertebral artery is within\nnormal limits. There is irregularity of the V3 portion of the left vertebral\nartery which may be secondary to diminutive size, but is also suspicious for\npossible intramural hematoma/dissection.\n\nOther findings:\n\nThere is borderline pulmonary hypertension with pulmonary artery measuring 3.0\ncm. There are partially visualized bilateral pleural effusions and\natelectasis. The endotracheal tube is well positioned. There are degenerative\nchanges in the cervical spine and instrument anterior fusion of C5-C7.", + "output": "1. Irregularity of the V3 portion of the nondominant left vertebral artery,\nwhich may be secondary to diminutive size, but is also suspicious for\nintramural hematoma/dissection. Further evaluation by MRA weighted axial T1\nfat saturated images would be helpful.\n2. Unremarkable MRA of the head.\n3. No significant interval change in left cerebellar hemorrhage with\nintraventricular extension and severe hydrocephalus.\n4. Borderline pulmonary hypertension. Partially visualized bilateral pleural\neffusions.\n\nNOTIFICATION: Findings and recommendations in impression item 1 were\ndiscussed with Dr. ___ by Dr ___ on ___ at 3:50 pm over\nthe telephone, ten minutes after the findings were discovered." + }, + { + "input": "The right frontal approach EVD is unchanged in position, entering the frontal\nhorn of the right lateral ventricle, and terminating at the foramen of ___. \nIn the 14 hr interval since the prior study, however, a new 3.1 x 4.1 x 3.0 cm\n(TV x AP x CC) parenchymal hemorrhage has developed in the right frontal lobe\nsurrounding the EVD.\n\nVentricular size has decreased from the prior study. The layering\nintraventricular blood in the occipital horns of the lateral ventricles has\ndecreased in density. There is new hyperdense blood within the third ventricle\n(2:16). Subarachnoid blood in the left frontal lobe is unchanged. There has\nbeen minimal increase in the amount of hyperdense acute blood in the\ncerebellum.\n\nThe basal cisterns are patent. Gray-white matter differentiation is preserved.\n\n There is no fracture. Extensive opacification of the paranasal sinuses is\nunchanged. Appearance of the mastoids is unchanged.", + "output": "1. Relatively large new parenchymal hemorrhage in the right frontal lobe,\nsurrounding the EVD.\n2. EVD, unchanged in position and ventricular size is decreased from\nyesterday's study.\n3. Overall decrease in density of blood within the lateral ventricles, with\nnew hyperdense blood in the third ventricle.\n4. Minimal interval increase in hyperdense blood in the left cerebellar\nhemisphere and vermis.\n5. Stable left frontal subarachnoid hemorrhage.\n\nNOTIFICATION: Preliminary findings were communicated to Ms. ___,\nNP (Neurosurgery service) by Dr. ___ telephone on ___ at 7:11 AM,\n1 minute(s) after discovery." + }, + { + "input": "Replaced right frontal approach extraventricular drain terminates in the\nfrontal horn of the right lateral ventricle. Hemorrhage along the course of\nthe drain is stable in size and distribution. There is increased hemorrhage\nlayering posteriorly in the lateral ventricles. Blood in the third and fourth\nventricles remains.\n\nPatient is status post suboccipital craniotomy with evacuation of the\nposterior fossa hemorrhage. Residual blood in the surgical site is mildly\nincreased. Subarachnoid hemorrhage in the parietal and occipital lobes\nbilaterally is unchanged. Small right parietal subdural hemorrhage is also\nstable.\n\nMinimal pneumocephalus along the bilateral frontal convexities is slightly\ndecreased. Size and configuration the lateral ventricles is stable. There is\nno evidence of large territorial infarction.", + "output": "1. Increased hemorrhage in the cerebellum at the site of evacuation.\n2. Mild increase of hemorrhage in the lateral ventricles.\n3. The right frontal approach extraventricular drain terminates in the frontal\nhorn of the right lateral ventricle. The ventricles are stable in size and\nconfiguration.\n\nNOTIFICATION: The findings were telephoned to ___ by ___ at\n19:48, ___, 10 min after discovery." + }, + { + "input": "The right frontal EVD was previously located at the foramen ___ as seen\non the study from ___ at 11:20. However, on the most recent\ncomparison from 18:32 and on the current study, the catheter has been\nwithdrawn so that its tip barely enters the frontal ___ of the right lateral\nventricle (2:15). There is a small amount of blood products at the tip.\n\nThe right frontal acute parenchymal hemorrhage around the EVD has enlarged\nfrom the prior study performed approximately 14 hr ago, from 2.3 x 2.5 cm to\n3.1 x 3.0 cm when measured in the axial plane (2:20).\n\nThere is acute, hyperdense blood in the frontal ___ of the right lateral\nventricle, the third and fourth ventricles, and in the occipital horns of the\nlateral ventricles bilaterally. Although this is unchanged from the prior\nstudy, ventricular size has diffusely increased.\n\nDiffuse subarachnoid hemorrhage, left greater than right, is unchanged.\n\nThe patient is status post suboccipital craniectomy. There is minimally\nincreased acute blood in the resection cavity, most notable in a rounded, 1.0\nx 1.1 cm focus of blood in the left cerebellar hemisphere (2:8).\n\nThere is hyperdensity along the inner table of the left occipital bone, which\nmay represent a subdural hematoma, but dural venous sinus thrombosis cannot be\nexcluded. This was present on the study from ___ conducted at\n18:32, but was not present at 11:20.\n\nOpacification of the paranasal sinuses and mastoid air cells bilaterally is\nunchanged. Partial opacification of the middle ears bilaterally is also\nunchanged.", + "output": "1. Right frontal parenchymal hemorrhage around the EVD has increased in size.\n2. Beginning with the study conducted yesterday at 18:32, the EVD has been\npulled out such that the tip is barely enters the frontal ___ of the right\nlateral ventricle.\n3. Ventricular size is increased. Coupled with the blood products seen at the\ntip of the catheter, this may represent EVD malfunction secondary to thrombus.\n4. Hyperdensity along the inner table of the left occipital bone may represent\nsubdural hematoma, but dural venous sinus thrombosis would appear similarly. \nThis entity is new since yesterday at 18:32.\n5. Blood in the posterior fossa resection site has increased.\n6. Unchanged diffuse subarachnoid and intraventricular hemorrhage.\n\nNOTIFICATION: Preliminary findings were communicated to Dr. ___ By Dr.\n___ phone on ___ at 7:40 AM, 3 minute(s) after discovery." + }, + { + "input": "The right frontal approach ventriculostomy catheter has been repositioned\nentering the right frontal horn and with the tip terminating in the\nsuprasellar cistern. Overall configuration of the ventricles and sulci is\nunchanged from 5 hours prior with re- demonstration of ventriculomegaly and a\nlarge amount of blood within the occipital horns of the lateral ventricles as\nwell as the third and fourth ventricles.\n\nThe right frontal parenchymal hemorrhage surrounding the ventriculostomy\ncatheter is unchanged in size measuring roughly 3.1 x 3.0 cm with surrounding\nedema. Diffuse subarachnoid blood is unchanged. Trace pneumocephalus is\nunchanged.\n\nPatient is status post suboccipital craniectomy with a similar amount of blood\nin the resection cavity and a similar appearance of the cerebellar hemorrhage.\nThere is no new focus of hemorrhage. Linear hyperdensity along the left\noccipital bone is re- demonstrated.\n\nThe paranasal sinuses remain prominently opacified along with opacification of\nthe bilateral mastoid air cells. The middle ear cavities are clear. Orbits\nare unremarkable.", + "output": "1. Right frontal horn ventriculostomy catheter with the tip terminating in the\nsuprasellar cistern.\n2. Stable ventriculomegaly with large amount of blood products.\n3. Stable right frontal parenchymal hemorrhage and cerebellar hemorrhage\ncompared to 5 hours prior. No new focus of hemorrhage.\n4. Re- demonstration of hyperdensity along the inner table of the left\noccipital bone which could represent postoperative blood but dural venous\nsinus thrombosis is difficult to exclude.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with ___\n___, NP on the telephone on ___ at 11:38 AM, 5 minutes after\ndiscovery of the findings." + }, + { + "input": "The right frontal approach ventriculostomy catheter ends in the foramen of\n___ in appropriate position. The ventricles are significantly decreased in\nsize compared to prior study. Blood in the occipital horns is decreased. The\nright frontal parenchymal hemorrhage surrounding the ventriculostomy catheter\nis unchanged measuring 3.2 x 2.8 cm. Diffuse subarachnoid blood is unchanged.\nBlood is again seen in the fourth ventricle. The cerebellar hemorrhage is\nsimilar in appearance in size measuring 5.0 x 4.7 cm. There is no new focus of\nhemorrhage. Linear hyperdensity along the left occipital bone is again seen. \nThis appears to be within the transverse sinus and suggests the sinus\nthrombosis. Paranasal sinuses and mastoid air cells are prominently opacified\nand unchanged.", + "output": "Right frontal ventriculostomy catheter in appropriate position, with\nsignificant decrease in size of ventricles compared to prior study. Decrease\nblood within the occipital horns.\n\nStable right frontal parenchymal hemorrhage and cerebellar hemorrhage and\ndiffuse subarachnoid hemorrhage. No new areas of hemorrhage." + }, + { + "input": "Again seen is a right frontal approach ventriculostomy catheter ending at the\nforamen ___ in appropriate position. The ventricles have once again\ndecreased in size compared to prior study. Blood is again seen in the\noccipital horns, slightly decreased in amount. The right frontal parenchymal\nhemorrhage is minimally decreased in size measuring 3.0 x 2.8 cm. Diffuse\nsubarachnoid blood is slightly decreased in density consistent with evolution\nof the blood products. The cerebellar hemorrhage is unchanged in size\nmeasuring 4.9 x 4.5 cm. No new foci of hemorrhage. Linear hyperdensity along\nthe left occipital bone is again seen and unchanged, and may represent sinus\nthrombosis.", + "output": "Right frontal ventriculostomy catheter in appropriate position with continued\ndecrease in size of ventricles. Decrease of blood within the occipital horns.\n\nMinimal decrease in size of right frontal parenchymal hemorrhage. Cerebellar\nhemorrhage and diffuse subarachnoid hemorrhage are unchanged. No new\nhemorrhage.\n\nLinear hyperdensity along the left occipital bone is again seen and unchanged,\nand may represent sinus thrombosis." + }, + { + "input": "Hemorrhage centered in the left cerebellar hemisphere is again seen extending\nto the fourth ventricle, unchanged compared to prior study. Patient is status\npost suboccipital craniectomy. There is small amount of extra-axial blood in\nthe left posterior fossa, as before.\n\nRight frontal ventriculostomy catheter is again seen, with more blood and\nincreased edema along the path of the catheter through the right frontal lobe.\nThere is new associated mild leftward shift of the anterior falx.\n\nThere is increased blood in the frontal horn of the right lateral ventricle\nand bilateral foramina of ___. The lateral ventricles and third ventricle\nhave increased in size. These findings suggest that the ventriculostomy\ncatheter may be occluded. Blood within the occipital horns of the lateral\nventricles is unchanged. Blood is present in the third ventricle, but the\namount is difficult to compared to the prior exam due to interim enlargement\nof the third ventricle.\n\nLeft greater than right subarachnoid hemorrhage is unchanged.\n\nFluid within bilateral mastoid air cells and paranasal sinuses is likely\nrelated to prolonged supine positioning in inpatient setting. There is also\nunderlying chronic sinusitis with hyperdense material in the paranasal sinuses\ncompatible with inspissated secretions or fungal colonization. Evidence of\nbilateral internal maxillary artery embolization is again noted.", + "output": "1. New blood in bilateral foramina ___ and frontal horn of the right\nlateral ventricle, and interim enlargement of the lateral and third\nventricles, suggesting that the right frontal ventriculostomy catheter is\noccluded.\n2. Increased blood and edema along the right frontal past of the\nventriculostomy catheter,, with new mild leftward shift of the anterior falx.\n3. Stable left cerebellar hemorrhage extending into the fourth ventricle.\nStable small extra-axial hematoma in the left posterior fossa. Stable left\ngreater than right subarachnoid hemorrhage.\n\nNOTIFICATION: Results communicated to ___ by Dr. ___ telephone\nat 10:00 on ___ 5 min after discovery of the results." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass. A left\nsub insular hypodensity likely represents an old lacune. Mild periventricular\nwhite matter hypodensities are compatible with sequela of chronic\nmicrovascular ischemic disease. The ventricles and sulci are enlarged\ncompatible with age related parenchymal volume loss. The basilar cisterns are\npatent. There is no evidence of herniation or shift of normally midline\nstructures.\n\nNo osseous abnormalities seen. There is mild mucosal thickening of the right\nmaxillary sinus. The remainder of the imaged paranasal sinuses, mastoid air\ncells, and middle ear cavities are clear. The orbits are unremarkable. The\nbilateral lenses have been replaced.", + "output": "No acute intracranial process. Evidence of global atrophy and chronic\nmicrovascular ischemic disease." + }, + { + "input": "There is no evidence of hemorrhage, large acute infarction, edema, or mass\neffect. The ventricles and sulci are normal in caliber and configuration. A\nhypodensity in the left insular subcortical white matter is relatively\nunchanged in comparison to prior head CT, likely sequela of chronic small\nvessel ischemic disease (series 2, image 14). The basal cisterns are not\ncompressed.\n\nThere is no evidence for a fracture. There is mild bilateral maxillary sinus\nand ethmoid air cell mucosal thickening with small mucous retention cysts in\nthe maxillary sinuses. Mastoid air cells are well aerated.", + "output": "No evidence of acute intracranial injury." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. 2 small areas of right frontal\nencephalomalacia are noted as on prior MR (___). Gray-white matter\ndifferentiation is otherwise preserved. Ventricles and sulci are age\nappropriate.\n\nIncluded paranasal sinuses and mastoids are essentially clear besides\npartially visualized right maxillary sinus mucosal thickening. Skull and\nextracranial soft tissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Patent and unremarkable bilateral vertebral and carotid arteries. No evidence\nof injury or dissection, including to the right vertebral artery at the site\nof the known C3 comminuted fracture involving the right transverse foramen. \nNo ICA stenosis by NASCET criteria. The imaged portions of the intracranial\nICAs, and very distal vertebral and proximal basilar arteries are\nunremarkable.\n\nImaged base of brain is without acute focal abnormality on limited evaluation.\nThe visualized portions of the paranasal sinuses, aside from mild bilateral\nmaxillary sinus mucosal thickening, well pneumatized and clear. Middle ear\ncavities are partially visualized but grossly clear.\n\nThyroid is unremarkable. Scattered bilateral multilevel cervical lymph nodes\nare not pathologically enlarged. There are secretions seen within the\nproximal trachea at the level of the thoracic inlet (02:55). There is mild\nright apical paraseptal emphysema. Lung apices are otherwise grossly clear.\n\nRe-demonstrated is the comminuted fracture through the right aspect of the C3\nvertebral body including involving the inferior articular facet, which is\nmildly posteriorly displaced (12:1 and 2:190). Additionally, fracture line is\nseen to extend through the right transverse foramen. There is unchanged C2-3\nanterolisthesis.", + "output": "1. Patent bilateral vertebral and carotid arteries. No evidence of dissection\nor injury including to the right vertebral artery at the site of the known C3\nfracture through the right transverse foramen. No ICA stenosis by NASCET\ncriteria.\n2. Redemonstration of comminuted fracture through the right aspect of the C3\nvertebral body , better evaluated on earlier dedicated CT cervical spine from\n___.\n3. Secretions noted in the proximal tracheal lumen at the level of thoracic\ninlet. Correlate with any symptoms/signs of aspiration." + }, + { + "input": "Abutting the superolateral left cerebellar hemisphere and the tentorium, there\nis a 3.2 x 2.6 x 2.8 cm dense lesion with adjacent vasogenic edema with\nresultant mass effect on the quadrigeminal plate cistern and fourth ventricle.\nNo evidence of herniation currently.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "A dense mass abutting the tentorium and left cerebellar hemisphere with\nadjacent vasogenic edema and mass effect effacing the fourth ventricle and\nquadrigeminal plate cistern, most likely represents meningioma. No current\nherniation. Recommend MRI with intravenous contrast for further evaluation,\nif no contraindication.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 9:45 pm, approximately 10\nminutes after discovery of the findings." + }, + { + "input": "Again seen is hyperdensity measuring 2.7 x 2.8 cm adjacent to the left\ncerebellum, abutting the tentorium, and causing mass effect and vasogenic\nedema in the cerebellar white matter, better seen on the MRI from ___. Overall, the mass appears grossly unchanged from ___ allowing\nfor differences in technique. Mass effect on the fourth ventricle is\npersistent. Mild narrowing of the quadrigeminal cistern is stable. \nOtherwise, the basal cisterns remain overall patent. There is no evidence of\nacute infarction or hemorrhage. The ventricles and sulci are unchanged in\nsize and configuration.\n\nThere is no evidence of acute fracture. The visualized portion of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "1. No acute hemorrhage or territorial infarction.\n2. Stable appearance of left extra-axial mass abutting the tentorium and left\ncerebellar hemisphere, most consistent with a meningioma. Stable associated\nvasogenic edema and mass effect on the fourth ventricle and quadrigeminal\ncistern." + }, + { + "input": "Again seen is a 3.1 x 2.9 cm predominantly hyperattenuating extra-axial mass\nabutting the tentorium and left cerebellar hemisphere previously characterized\non MR as meningioma. The meningioma is not significantly changed in size\nsince prior MR from ___, however\nThere is an increased hypodense component along the posterior aspect of the\nmeningioma which could be secondary to worsening necrosis/subacute hemorrhage.\nThere is increased vasogenic edema and mass effect resulting in moderate\nsulcal effacement and partial effacement of the fourth ventricle, and mass\neffect upon the midbrain/pons increased since the prior study from ___. \nMillimetric increase in size of the third ventricle is seen compared to the\nprior exam from ___.\nThere is no evidence of acute large vascular territory infarction.\nThe imaged paranasal sinuses are clear. Mastoid air cells and middle ear\ncavities are well aerated. The bony calvarium is intact.", + "output": "1. 3.1 cm posterior fossa meningioma not significantly changed in size since\nthe prior study from ___, however there is increased hypodense component\nalong the posterior aspect of the meningioma concerning for worsening necrotic\ncomponent vs new subacute hemorrhage within the lesion.\n2. There is increased vasogenic edema resulting in increased mass effect with\nworsening moderate sulcal effacement, mass effect upon the midbrain/pons and\npartial effacement of the fourth ventricle, increased since the prior study.\n3. Millimetric increase in size of ventricles raises concern for possible\nworsening mild hydrocephalus.\nRECOMMENDATIONS: MRI is recommended for further evaluation.\n\nNOTIFICATION: Updated findings and recommendations were discussed with ___\n___, M.D. by ___, M.D. on the telephone on ___ at 9:15 am,\n10 minutes after discovery of the findings." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\n\nRe-demonstration of the 3.1 x 2.8 cm hyperdense, likely dural-based mass\nabutting to the left tentorium and left sigmoid sinus, likely a meningioma. \nAs before there is a hypodense component along the posterior aspect of the\nmeningioma, which may reflect a component of necrosis and/or subacute\nhemorrhage. Associated vasogenic edema and mass effect results in left\ncerebellar sulcal effacement and partial effacement of the fourth ventricle,\nas well as mass effect upon the midbrain and pons.\n\nThere is no evidence of infarction or hemorrhage.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are unremarkable.\n\nThe contrast images are limited by poor vascular opacification, likely due to\ntiming of the injection.\nCTA HEAD:\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal with no evidence of stenosis, occlusion, or aneurysm.\n\nCTV HEAD:\nContrast bolus timing was suboptimal for complete evaluation of the dural\nvenous sinuses. There appears to be poor or no filling of the left sigmoid\nsinus, adjacent to the hyperdense mass, suggesting that the tumor likely\ninvades the sinus and perhaps occludes it. The left transverse sinus appears\nattenuated, but patent at the confluence. The other major dural venous\nsinuses appear patent, within the limitations of the suboptimal contrast\nbolus.", + "output": "1. 3.1 x 2.8 cm hyperdense, likely dural based, mass likely a meningioma. \nThere is associated vasogenic edema and mass effect causing left cerebellar\nsulcal effacement and partial effacement of the fourth ventricle.\n\n2. Contrast bolus timing was suboptimal for complete evaluation of the dural\nvenous sinuses. However, there appears to be poor or no filling of the left\nsigmoid sinus adjacent to the mass, suggesting tumoral invasion and possible\nocclusion.\n\n3. The left transverse sinus appears patent at the confluence." + }, + { + "input": "The patient is status post left suboccipital craniectomy for resection of a\nleft cerebellar lesion. There are expected postoperative changes, including a\nsmall volume of pneumocephalus and a tiny extra-axial fluid collection. There\nis expected hypodensity at the site of the prior mass. There is associated\nedema in the left cerebellum. There is a small volume of subcutaneous gas. \nThere is no evidence of acute large territorial infarction or mass. The\nventricles and sulci are normal in size and configuration.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits are unremarkable.", + "output": "1. Expected postoperative appearance status post left suboccipital craniectomy\nfor resection of a left cerebellar lesion with a small volume of\npneumocephalus and a tiny extra-axial fluid collection.\n2. No evidence of large volume hemorrhage or acute large territorial infarct." + }, + { + "input": "Please note that the exam is limited due to motion artifact. Within these\nlimitations, there is no evidence of acute major vascular territory\ninfarction,hemorrhage,edema,or discrete mass. Within the left posterior\nfossa, there is no postsurgical complications seen. The ventricles and sulci\nare normal in size and configuration.\n\nThere is no evidence of fracture. Note is made of prior left occipital\ncraniotomy changes with cranioplasty.The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. Please note that the exam is limited due to motion artifact. Within these\nlimitations, no acute intracranial abnormalities.\n2. Status post left occipital craniotomy with cranioplasty." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Basilar cisterns are\npatent.\n\nIncluded paranasal sinuses and mastoids are clear. Skull and extracranial soft\ntissues are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Again seen is a left frontal lobe developmental venous anomaly, unchanged\nsince the MR examination of ___.\n\nImages through the mandible and adjacent neck demonstrate no abnormalities. \nThe parotid and submandibular glands appear normal. There is no evidence of\nedema or tissue induration. There are scattered mildly prominent lymph nodes,\nnone reaching size criteria for malignancy. Evaluation of the aerodigestive\ntract demonstrates no mass, and no areas of focal mass effect.\n\nThere is a mixed calcified and noncalcified atherosclerotic plaque involving\nthe proximal left internal carotid artery. This appears to produce\napproximately 20% stenosis of the ICA by NASCET criteria.\n\nThe salivary glands enhance normally and are without mass or adjacent fat\nstranding. The thyroid gland appears normal. There is a mucous retention\ncyst in the right maxillary sinus.\nThe imaged portion of the lung apices are clear and there are no concerning\npulmonary nodules. There are no osseous lesions.", + "output": "1. No abnormalities noted in the region of the left mandible.\n2. Mild atherosclerotic narrowing of the left internal carotid artery.\n3. Left frontal lobe developmental venous anomaly, unchanged since the prior\nbrain MR.\n\n___:\nPreliminary findings discussed with Dr. ___ the telephone by ___\n___ on ___ at 10:15, 5 minutes after they were made." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is a mucus retention cyst in the\nright maxillary sinus. Otherwise, the remaining visualized portions of the\nparanasal sinuses, mastoid air cells, and middle ear cavities are clear. The\nvisualized portion of the orbits are unremarkable.", + "output": "No acute intracranial abnormality. No evidence acute intracranial hemorrhage\nor fracture." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. There is\nprominence of the ventricles and sulci suggestive of involutional changes.\n\nThere is no evidence of fracture. Small mucous retention cyst is noted in the\nright anterior ethmoid sinus. The visualized portion of the orbits are\nunremarkable.", + "output": "1. No acute intracranial process." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, shift of normally\nmidline structures or acute major vascular territorial infarction. Ventricles\nand sulci are normal in size and configuration. The basal cisterns appear\npatent and there is preservation of gray-white matter differentiation.\n\nThere is no fracture. The visualized paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The globes are unremarkable.", + "output": "No acute intracranial abnormality." + }, + { + "input": "There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or\nacute major vascular territorial infarct. Gray-white matter differentiation is\npreserved. Ventricles and sulci are unremarkable. Basilar cisterns are\npatent.\n\nIncluded paranasal sinuses and mastoids are essentially clear. Skull and\nextracranial soft tissues are unremarkable.", + "output": "No acute intracranial process. No hemorrhage." + }, + { + "input": "There is no evidence of acute major vascular territorial infarction,\nhemorrhage, edema, or mass. Bilateral periventricular and subcortical white\nmatter hypodensities are nonspecific but may be the sequela of chronic small\nvessel ischemic changes. Prominence of the ventricles and sulci are\ncompatible with age related involutional changes. Atherosclerotic\ncalcifications are noted within the bilateral carotid siphons.\n\nNo osseous abnormalities seen. There is mild mucosal thickening within the\nbilateral maxillary and ethmoid sinuses. Sphenoid sinuses are clear. Mastoid\nair cells and middle ear canals are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "Head CTA: There is arthrosclerotic irregularity and narrowing of the distal\nleft vertebral artery. There is a severe stenosis and near occlusion of\nbasilar artery. There is narrowing of the distal left internal carotid artery\nextending into the proximal anterior and middle cerebral arteries. There is\nno evidence of aneurysm or malformation. There is a fetal type left PCA.\n\nNeck CTA: Patient is status post right carotid endarterectomy with expected\nsurgical changes. These include swelling at the surgical site as well as a\npatulous vessel and small areas of apparent dissection at the proximal and\ndistal anastomoses. There is moderate atherosclerotic calcification of the\naortic arch within normal three-vessel takeoff. The vertebral arteries are\npatent without evidence of significant stenosis. The left vertebral artery is\nnoted to be dominant. There is calcified plaque involving the left carotid\nbifurcation with proximal left ICA narrowing of approximately 35-40%. The\nthere is no evidence of stenosis of the right internal carotid artery by\nNASCET criteria.\n\nThere is interlobular septal thickening and mosaic attenuation in the included\nlungs which is a nonspecific finding but may be seen with pulmonary edema. \nThe pulmonary artery is enlarged suggestive of pulmonary arterial\nhypertension. Mildly enlarged mediastinal and hilar lymph nodes are noted\nwhich may be reactive. The thyroid gland is atrophic but normal. The\nsalivary glands image normally. There are degenerative changes in the spine.", + "output": "1. No evidence of aneurysm or vascular malformation\n\n2. Atherosclerotic irregularity and narrowing of the left distal intracranial\nvertebral artery and basilar artery.\n\n3. Patient is status post right carotid endarterectomy with expected\npostsurgical changes including a patulous vessel and small dissections at the\nproximal and distal anastomoses.\n\n4. Calcification of the left carotid bifurcation with resulting 35-40%\nnarrowing of the proximal left internal carotid artery.\n\n5. Enlarged pulmonary artery compatible with pulmonary arterial hypertension.\n\nRECOMMENDATION(S): Interlobular septal thickening, mosaic attenuation, and\nmildly enlarged mediastinal and hilar lymph nodes are noted in the included\nlung fields which could be seen in the setting of pulmonary edema. Clinical\ncorrelation is recommended." + }, + { + "input": "There is no evidence of acute infarction, hemorrhage, edema, or mass. \nProminent ventricles and sulci are likely related to involutional changes. \nPeriventricular and deep white matter hypodensities are likely sequela of\nchronic small vessel ischemic disease. Chronic right cerebellar infarcts are\nagain noted.\n\nNo fracture is seen. Mild mucosal thickening of the bilateral maxillary\nsinuses and ethmoid air cells is again noted. The other paranasal sinuses,\nmastoid air cells, and middle ear cavities are clear. The orbits are\nunremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of intracranial hemorrhage, acute large territorial\ninfarction, edema,or mass. Extensive encephalomalacia within the posterior\nright parietal lobe is consistent with prior infarct. Chronic infarction is\nalso noted of the adjacent to the right caudate nucleus. There is prominence\nof the ventricles and sulci suggestive of involutional changes. \nPeriventricular and subcortical hypodensities are nonspecific, though likely\nsequela of chronic small vessel ischemic disease.\n\nThere is no evidence of fracture. Partial opacification of the bilateral\nethmoid air cells. Mild mucosal thickening of the bilateral sphenoid sinuses\nand maxillary sinuses with small amount of layering fluid. Complete\nopacification of the bilateral mastoid air cells. The middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. No evidence of acute intracranial abnormality or hemorrhage.\n2. Chronic right caudate nucleus infarct, and chronic posterior right parietal\nlobe infarct as described above.\n3. Moderate paranasal sinus disease with complete opacification of the\nbilateral mastoid air cells and layering fluid within the bilateral sphenoid\nsinuses and maxillary sinuses, possibly sequela of intubation." + }, + { + "input": "There is no evidence of fracture, acute major infarction,hemorrhage,edema,or\ndiscrete mass. There are diffuse involutional changes, advanced for patient's\nage, and most notable in the cerebellum.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are normal.", + "output": "Age advanced involutional changes, most notable in the cerebellum. Clinical\ncorrelation is advised. Otherwise unremarkable." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are normal in size and configuration.\n\nThere is no evidence of fracture. There is mild mucosal thickening of the\nbilateral ethmoid air cells. The visualized portion of the other paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "Normal study." + }, + { + "input": "No evidence of acute large territorial infarction,hemorrhage,edema,or mass\neffect. Bilateral moderate periventricular, subcortical, white hypodensities\nnonspecific but can be seen as sequelae of chronic small vessel ischemic\ndisease a patient of this age. Bilateral, symmetric prominence of ventricles\nand sulci indicates cortical volume loss.\n\nAtherosclerotic calcifications of the bilateral cavernous and supraclinoid\nportions of the internal carotid arteries is mild-to-moderate. \nAtherosclerotic calcifications in the bilateral V4 segments of basilar artery\ntip are mild.\n\nNo evidence of fracture. Polypoid mucosal thickening and/or mucous retention\ncyst in the right sphenoid sinus is small. Bilateral posterior ethmoidal air\ncells are opacified. Polypoid mucosal thickening of the right maxillary sinus\nis mild. The remaining partially imaged paranasal sinuses are clear. The\nright mastoid air cells are under pneumatized but clear. The left mastoid air\ncells are clear. The middle ear cavities are clear bilaterally. The orbits\nare unremarkable.", + "output": "1. No intracranial hemorrhage. No acute intracranial abnormality on\nnoncontrast head CT.\n2. Probable sequelae of chronic small vessel ischemic disease.\n3. Cortical atrophy.\n4. Paranasal sinus disease." + }, + { + "input": "There is no evidence of acute major infarction,hemorrhage,edema,or discrete\nmass. Periventricular, subcortical white matter hypodensities are\nnonspecific, likely represent sequela of chronic small vessel ischemic\ndisease. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no acute fracture. The paranasal sinuses demonstrate retention cysts\nin the right maxillary and sphenoid sinuses. Mild mucosal thickening within\nthe ethmoidal air cells. The mastoid air cells and middle ear cavities are\nclear. The visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial process.\n2. Paranasal sinus retention cysts, similar to previous study." + }, + { + "input": "There is no hemorrhage, edema, mass effect, midline shift, or mass. Prominence\nof ventricles and sulci is out of proportion to patient's age. The basal\ncisterns are patent and there is normal gray-white matter differentiation.\n\nNo acute bony abnormalities seen. Congenital lack of fusion of the posterior\narch of C1 is incidentally noted. Patient is status post left-sided endoscopic\nsinus surgery. The paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear besides mild mucosal thickening in the left maxillary sinus\nwith hyperostosis of the wall suggesting a component of chronic inflammation.\nThe orbits are remarkable for lens replacement bilaterally.", + "output": "No significant intracranial abnormality. Volume loss out of proportion to\npatient age." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The\nventricles and sulci are prominent consistent with age appropriate atrophy.\nThere is periventricular white matter hypodensity consistent with chronic\nsmall vessel ischemic disease.\n\nNo osseous abnormalities seen. Patient is status post left maxillary sinus\nsurgery. There is hyperostosis of the left maxillary sinus likely due to prior\nchronic sinus disease. There is partial opacification of the mastoid air cells\nbilaterally but unchanged from the prior study.", + "output": "No acute intracranial process. Atrophy and chronic small vessel ischemic\ndisease." + }, + { + "input": "There is no evidence of hemorrhage, edema, mass effect, or infarction. The\nventricles and sulci are normal in size and configuration. A hypodensity\nlikely reflecting an old lacunar infarct or prominent perivascular space is\nseen in the left parietal white matter (2:17). The basal cisterns appear\npatent and there is preservation of gray-white matter differentiation.\n\nSmall amount of subcutaneous gas and soft tissue stranding seen in the region\nof the right forehead without underlying fracture. The visualized paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The globes are\nunremarkable.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute large territory infarction,hemorrhage,edema, or\nmass. There is prominence of the ventricles and sulci suggestive of\ninvolutional changes.\n\nThere is no evidence of fracture. A 1.8 x 0.8 cm soft tissue density about\nthe high right parietal scalp (02:23) is nonspecific but could represent a\nposttraumatic scalp hematoma. The nasal cavity is extensively opacified,\nlikely related to intubation. There is extensive opacification throughout the\nanterior ethmoid air cells. There is mild mucosal thickening throughout the\nmaxillary sinuses. Mastoid air cells and and middle ear cavities are clear. \nThere appears to be increased prominence of the intraconal vessels without\ndefinitive evidence for stranding, of uncertain clinical significance. \nOtherwise, the visualized portion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality on noncontrast CT head. Specifically, no\nacute large territory infarct or intracranial hemorrhage.\n2. 1.8 cm subcutaneous soft tissue density about the right parietal scalp\ncould represent a scalp hematoma in the posttraumatic setting. Direct\ninspection recommended.\n3. Extensive paranasal sinus disease.\n4. Nasal cavity opacification is likely related to intubation.\n5. Increased prominence of intracranial vessels without definitive evidence\nfor inflammatory stranding of uncertain clinical significance. The superior\nophthalmic veins do not appear significantly enlarged nor do the extraocular\neye muscles to suggest cavernous sinus thrombosis or fistula." + }, + { + "input": "Extensive patient motion limits examination. Allowing for this, there is no\nacute intracranial hemorrhage, acute infarction, edema or mass effect.\nProminent ventricles and sulci likely reflect age related involutional\nchanges. Subcortical and periventricular white matter hypodensity is\nnonspecific though is most compatible with chronic small vessel ischemic\ndisease. The basal cisterns are clear. The gray white matter differentiation\nappears preserved.\n\nNo fracture is identified. The visualized paranasal sinuses, mastoid air\ncells and middle ear cavities are clear.", + "output": "No evidence of acute intracranial abnormality." + }, + { + "input": "There is no evidence of infarction, hemorrhage, edema, or mass. The ventricles\nand sulci are prominent in size and configuration, consistent with age related\ninvolutional changes. Nonspecific periventricular and subcortical\nhypodensities suggest chronic small vessel ischemic changes. Scattered\npunctate calcifications suggest sequelae of prior infection.\n\nNo osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and\nmiddle ear cavities are clear. The orbits demonstrate bilateral lens\nreplacement.", + "output": "No acute intracranial process." + }, + { + "input": "There is no evidence of acute major vascular territorial\ninfarction,hemorrhage,edema, or mass. Hypodensity in the left occipital lobe\n(02:17) is unchanged from ___, although new from ___, and\nlikely represents a chronic infarction. Confluent bilateral periventricular\nand deep white matter hypodensities are nonspecific, but likely reflect a\nsequela of chronic small vessel ischemic disease. There is prominence of the\nventricles and sulci suggestive of involutional changes. Scattered punctate\ncalcifications predominantly located throughout the subarachnoid space (series\n2, images 12, 15, 16, 19), suggests sequela of prior infection.\n\nHeavy atherosclerotic calcifications are noted in the cavernous internal\ncarotid arteries bilaterally.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute intracranial abnormality.\n2. No evidence acute intracranial hemorrhage or fracture.\n3. Chronic left occipital infarction.\n4. Atrophy, probable small vessel ischemic changes, and atherosclerotic\nvascular disease as described." + }, + { + "input": "There is no evidence of acute major vascular territory\ninfarction,hemorrhage,edema, or mass. There is prominence of the ventricles\nand sulci suggestive of involutional changes. There is stable appearance of a\nchronic infarct in the left occipital lobe. Ill-defined periventricular\nsubcortical white matter hypodensities are nonspecific but likely due to\nchronic sequela of small-vessel ischemic disease. Atherosclerotic\ncalcifications are seen in the carotid siphons bilaterally.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "1. No acute major intracranial process. Stable appearance of a chronic\ninfarct in the left occipital lobe.\n2. Chronic microangiopathy and age related global atrophy." + }, + { + "input": "There is no evidence of intracranial hemorrhage. There is no evidence of\nacute large territorial infarction. In comparison to the prior head CT dated\n___ there is a stable appearance of a left occipital lobe chronic\ninfarct. There is no evidence of edema or mass lesion. There is prominence of\nthe ventricles and sulci suggestive of involutional changes. Periventricular\nand subcortical white matter hypodensities are nonspecific and likely reflect\nsequelae of chronic small vessel ischemic disease. Calcifications are seen\nwithin the carotid siphons bilaterally.\n\nThere is no evidence of fracture. The visualized portion of the paranasal\nsinuses, mastoid air cells, and middle ear cavities are clear. The visualized\nportion of the orbits are unremarkable.", + "output": "No acute intracranial process. Please note MRI of the brain is more sensitive\nfor the detection of acute infarct." + }, + { + "input": "There is no evidence of large territory infarction,intracranial\nhemorrhage,edema,or midline shift. No evidence of acute fracture. There is\nprominence of the ventricles and sulci suggestive of involutional changes. \nExtensive periventricular white matter hypodensities consistent with small\nvessel ischemic changes including sequelae from previous occipital infarct.\n\nThe visualized portion of the paranasal sinuses, mastoid air cells, and middle\near cavities are clear. The visualized portion of the orbits are\nunremarkable.", + "output": "No evidence of acute fracture or intracranial hemorrhage." + }, + { + "input": "CT HEAD WITHOUT CONTRAST:\nMultiple punctate acute infarcts within the bilateral cerebral and cerebellar\nhemispheres, as seen on the subsequent MRI, are not well identified on this\nCT. Coarse punctate calcifications in the right cerebral hemisphere appear\nunchanged, likely the sequela of prior infection/inflammation. Confluent\nperiventricular hypodensities appear unchanged, compatible with chronic small\nvessel ischemic changes. A chronic infarct of the left occipital lobe appears\nunchanged. There is no acute intracranial hemorrhage, edema, significant mass\neffect or midline shift. There is prominence of the ventricles and sulci\nsuggestive of involutional changes.\n\nThere are mild ethmoid and bilateral maxillary sinus mucosal inflammatory\nchanges. The mastoid air cells are clear. The orbits and globes appear\nunremarkable, noting bilateral lens replacements.\n\nCTA HEAD:\nThere are moderate atherosclerotic calcifications of the bilateral carotid\nsiphons without stenosis.\nThe vessels of the circle of ___ and their principal intracranial branches\nappear normal without stenosis, occlusion, or aneurysm. The dural venous\nsinuses are patent.\n\nCTA NECK:\nThere are moderate atherosclerotic calcifications involving the aortic arch. \nThere are atherosclerotic calcifications at the origins of the bilateral\ncommon carotid arteries without stenosis. There is minimal calcified plaque\nformation at the bilateral carotid bifurcations without stenosis of either\ninternal carotid artery by NASCET criteria. The left vertebral artery origin\nappears within normal limits. The right vertebral artery origin demonstrates\natherosclerotic calcifications without significant stenosis. The remaining\nportions of the bilateral vertebral arteries appear patent and symmetric in\ncourse and calibre, with the exception of mild irregular luminal narrowing of\nthe right vertebral artery V4 segment (7:189) suggestive of atherosclerotic\nchanges. No evidence of carotid or vertebral artery dissection.\n\nOTHER:\nThe visualized portion of the lungs appear clear. The visualized portion of\nthe thyroid gland is within normal limits. There is no lymphadenopathy by CT\nsize criteria. There are multilevel degenerative changes within the\nvisualized spine.", + "output": "HEAD CT:\n\n1. Multiple punctate acute infarcts within the bilateral cerebral and\ncerebellar hemispheres, as seen on the subsequent MRI, are not well identified\non this CT.\n2. No acute large territorial infarct, intracranial hemorrhage or significant\nmass effect. Redemonstrated chronic infarct of the left occipital lobe.\n3. Diffuse involutional changes and moderate periventricular white matter\nhypodensities compatible with chronic small vessel ischemic changes.\n\nCTA HEAD:\n\n1. Moderate atherosclerotic calcifications of the bilateral carotid siphons\nwithout stenosis.\n2. Patent circle of ___ without evidence of stenosis,occlusion,or aneurysm.\n\nCTA NECK:\n\n1. Moderate atherosclerotic calcifications involving the aortic arch and the\norigins of the great vessels without significant stenosis.\n2. Calcifications at the bilateral carotid bifurcations without stenosis of\neither internal carotid artery by NASCET criteria.\n3. The left vertebral artery appears within normal limits.\n4. The right vertebral artery demonstrates nonstenotic calcifications at its\norigin and irregular luminal narrowing within the V4 segment suggestive of\natherosclerotic changes." + }, + { + "input": "Head CT: There is no intra or extra-axial mass effect, acute hemorrhage or\ninfarct. Sulci, ventricles and cisterns are within expected limits. The\ngray-white differentiation is preserved. The paranasal sinuses are clear. The\norbits are unremarkable. The mastoid air cells and middle ear cavities are\nwell pneumatized and clear.\n\nCTA of the head and neck is suboptimal secondary to timing postcontrast.\n\nHead CTA: The intracranial ICA, ACA, MCA and their major branches are\nunremarkable. There is fetal origin of the bilateral posterior cerebral\narteries. Otherwise, the posterior circulation is also unremarkable. No\naneurysms larger than 3 mm.\n\nNeck CTA: There is a 2 vessel arch, a very common anatomic variant. Otherwise,\nthe brachiocephalic, common carotid and vertebral arteries are unremarkable. \nMinimal atherosclerotic calcification of the left carotid bifurcation. There\nis no significant stenosis of the right or left cervical internal carotid\narteries by NASCET criteria.\n\nOther: Lung apices are clear. The thyroid gland is unremarkable. There are\nprominent level IIa lymph nodes, not pathologic by CT size criteria, measuring\nup to 1.5 cm. Punctate calcification in the adenoids is noted, likely\nrepresenting sequela of prior infection. Otherwise, the remainder of the\naerodigestive tract is unremarkable. The submandibular, and parotid glands are\nunremarkable. Multilevel cervical spondylosis without suspicious blastic or\nlytic osseous lesions.", + "output": "1. No intracranial hemorrhage or CT evidence of infarct.\n2. Allowing for normal anatomic variations and technical limitations,\nessentially unremarkable CTA of the head and neck." + }, + { + "input": "There is no evidence of acute major infarction, hemorrhage, edema, or large\nmass. Sulcal prominence is noted consistent with age related atrophy with\nprominence of the bifrontal CSF space. The basal cisterns are patent and\nthere is preservation of gray-white matter differentiation. No osseous\nabnormalities seen. The paranasal sinuses, mastoid air cells, and middle ear\ncavities are clear. The orbits are unremarkable.", + "output": "No acute intracranial process." + } + ] +} \ No newline at end of file